Results with a cementless alumina-coated cup with dual mobility. A twelve-year follow-up study.

Between April 1980 and December 1981, 135 alumina-coated hemispherical cups were inserted without cement in patients with degenerative lesions. The cups were anchored by press fit and secured with a tripod attachment. The follow up was for over ten years. A bipolar polyethylene insert was used. Only one patient was lost to follow up in less than 2 years. Forty-four implants worked perfectly up to the time of death of the patients. Four cups were replaced, two after the patients sustained violent trauma, and there was an isolated instance of replacement of the insert only. The cumulative survival rate was 95.4% at 10 and 12 years follow up. The 78 surviving patients (85 cups) were examined, and radiographs were taken in 62 of them. Three patients showed clinical signs of deterioration and radiological signs of loosening, 2 others showed radiological signs of cup displacement without clinical symptoms. There was no evidence of osteolysis at the bone-cup interface in well functioning implants. These results confirm that cementless hemispherical cups survive well and demonstrate the value of a cup without holes for screws which can allow migration of polyethylene particles which might induce osteolysis of the adjacent ilum.

[Surgical treatment of ruptures of the Achilles tendon. Apropos of 42 cases treated by Bosworth's technique]. / Traitement chirurgical des ruptures du tendon d'Achille. A propos de 42 cas traités selon la technique de Bosworth.

PURPOSE OF THE STUDY: There is no consensus on the treatment of acute ruptures of the Achilles tendon. We have chosen surgical technique with early muscle stimulation. This study analyses possibilities of functional recovery and complications in Athletes. MATERIALS AND METHODS: Between 1983 and 1994, we treated surgically 42 Athletes who had Achilles tendon ruptures with early musculo-tendinous stimulation. The 39 male and 4 female patients had a mean age of 41 years (range, 15 to 70). We have always used Bosworth's technique with gastrocnemius flap procedure. Immediately after surgery, weightbearing with below-the-knee cast was initiated for 6 weeks followed by rehabilitation. RESULTS: There was no local major complication, deep vein thrombosis or pulmonary embolism. Only one patient suffered from a traumatic rerupture one month after surgery. Mean value of the calf atrophy was less than 1 cm. 93 per cent of patients returned to previous activity levels and 78.5 per cent of patients returned to their usual sport activity. DISCUSSION: Like this study recent results confirm the low complication and recurrence rate of the surgical treatment. Percutaneous technique and conservative treatments seem to be worse for rerupture and sportive functional recovery. Early muscle stimulation decrease morbidity and calf atrophy. Our protocol with weightbearing in ankle neutral position reduces calf atrophy. CONCLUSION: A rigid and stable reconstruction, allowing early weightbearing without equinus position seems to be a rational treatment for Achilles tendon rupture in athletes.

[Azygo-portal disconnection by the abdominal route]. / Déconnexion azygo-portale par voie abdominale.

Azygo-portal disconnection by the abdominal route consists of devascularization of the lower oesophagus, cardiac orifice and greater gastric tuberosity by ligation of the varices and section of the oesophagus, combined in every case with truncular vagotomy and gastric bypass. In emergencies the abdominal approach enables the bleeding points to be accurately localized. In the treatment of haemorrhages due to portal hypertension, this technique offers an alternative to porto-caval bypasses when these cannot be performed (thrombosis or portal cavernoma) or when the risk of encephalitis is too high. However, contrary to liver transplantation, it is a palliative technique for cirrhotic patients.