[A comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty]. / Comparaison entre embase tibiale métallique et plateau tout polyéthylène dans la prothèse totale de genou.

PURPOSE OF THE STUDY: The purpose of our study was to compare the clinical, functional and radiological results of two types of tibial components for the same total knee prosthesis (posterior stabilized HLS), all-polyethylene (group A) and metal-backed (group B), in order to answer the following question: does use of an all-polyethylene piece affect mid-term outcome of total knee arthroplasty (TKA)? MATERIAL AND METHODS: This was a retrospective comparative analysis of a single-center non-randomized consecutive series of 169 patients with an all-polyethylene posterior stabilized cemented gliding TKA. This series was matched with another retrospective series of 169 posterior stabilized cemented TKA with a metal-backed tibial piece. Matching factors were age, gender, etiology, and follow-up. The two series were extracted from our database which included all patients who underwent surgery for a TKA in the same institution (Lyon Civil Hospices) performed by one of the authors (PN) or under his responsibility between 1987 and 1996 for group A (all-poly) and between 1987 and 1997 for group B (metal-backed). Mean follow-up was 66 months. The IKS scores and radiological findings were recorded. RESULTS: In group A, 96% of patients were satisfied, 93% in group B. The IKS knee score for group A was 89 +/- 10.8 and 88.3 +/- 11.9 for group B. The function score was 68 +/- 23.7 in group A and 71 +/- 24 in group B. Mean flexion was 113 degrees for both groups. Non-progressive lucent lines were noted in 27 cases in group A and 23 in group B. Revision TKA was performed for 18 knees in group A, including six with implant replacement (three of them for infection). In group B, there were ten revisions, seven with implant replacement including one with infection and three without implant replacement. The 10-year survival was 94.5% in group A and 93.64% in group B. There was no significant difference in the function and knee scores, the presence of lucent lines, and the number of implant replacements between group A and group B (p>0.05). DISCUSSION: This study was unable to demonstrate any superiority in clinical and radiological results for TKA between the all-polyethylene and metal-backed options at five years follow-up.

[Study of the plantar arch: correlations between podometrical and radiological parameters. results of a prospective study of 79 cases]. / Etude de la voûte plantaire: corrélations entre des paramètres podométriques et radiologiques. Résultats d'une etude prospective de 79 cas.

The authors present a prospective study on the potential correlations between eight footprint parameters and three radiological parameters in the study of the plantar arch. Seventy nine patients were evaluated in 2001. The eight footprint parameters were as fellows : the arch angle, the Chippaux-Smirak's index, the Quamra's contact index 2,3 and 4, the Schwartz's footprint angle, the Staheli's arch index and the arch length index. The three radiological parameters were as fellows : the Djian-Annonier's angle, the Méary's angle and the calcaneal inclination. This prospective study confirms the best correlation, found in others studies, obtained between the Djian-Annonier's angle and the Chippaux-Smirak. The use of the Méary's angle and the calcaneal inclination is not justified because they have bad correlations with footprint parameters.

[Morbidity and reliability of total hip implants positioning using the posterior minimally invasive approach: a consecutive series of 100 cases]. / Morbidité et fiabilité de la mise en place d'une prothèse totale de hanche par voie d'abord postérieure réduite: à propos d'une série prospective de 100 cas.

PURPOSE OF THE STUDY: We wanted to determine whether the minimally invasive posterior approach for total hip arthroplasty leads to defective implant positioning or specific complications. MATERIAL AND METHODS: One hundred total hip arthroplasties were performed in 98 patients via the posterior minimally invasive approach using a specific instrumentation between June 2003 and January 2004. All operations were performed by the same surgeon. The series included 59 men. Mean patient age was 61 years (range 25-83) and the mean body mass index as 26.1 kg/cm2 (14.1-40.7). RESULTS: Mean length of the incision was 65 mm (range 45-80 mm). Mean operative blood loss was 393 ml. The VAS decreased from 2.6 on day 1 to 1.0 on day 5. The Harris score rose from 54.5 preoperatively to 85.6 six weeks postop. Mean cup abduction was 43.6 degrees and mean anteversion 16.4 degrees . The center of the hip was restituted within 5 mm in 91% of hips. Stem alignment was 0.8 degrees varus. The femoral offset and the overall hip offset were restituted within 10 mm in 88% of hips. There were no leg length discrepancies greater than 15 mm. Two patients required in addition cup fixation intraoperatively due to acetabular fracture and cup instability. There was one vertical fissuration at the lower end of the stem on one postoperative x-ray. There were no infections nor vascular or neurological lesions. Early dislocation occurred in one 78-year-old patient. There were no revisions for complications. DISCUSSION: Total hip prosthesis implanted via the minimally invasive posterior approach is a difficult operation. Despite the use of specific instruments adapted to this limited approach, the method appear to be safe and to provide reliable results. If the incision has to be widened in a given patient, use of a familiar approach would be advisable. Experience and use of specific instruments enables proposing this technique for the majority of first intention total hip arthroplasties.

[Surgical treatment for distal rupture of the biceps tendon]. / Les ruptures du tendon bicipital distal et leur traitement chirurgical.

PURPOSE OF THE STUDY: Avulsion of the distal biceps brachii tendon at the elbow is uncommon. We analyzed cases operated in our department in order to define etiological factors and surgical treatment outcome. MATERIAL AND METHODS: We reviewed retrospectively eleven patients, ten male patients, average age 43 years (range 37-59) with distal biceps tendon ruptures repaired anatomically with a double-incision technique and one other male patient whose tendon was attached to the brachialis anterior. Nine patients were seen for clinical assessment at least two years after operation. RESULTS: Average follow-up was 7 years (range 1-10). Patient satisfaction was good and all stated they would opt for surgical treatment again. The most common mechanism of injury was heavy weight lifting with the elbow at 90 degrees flexion or excentric loading on a flexed elbow. The dominant limb was injured in all patients. Eight patients had sustained injury during domestic activities and three during sports activities. Clinical diagnosis was the rule. MRI was useful in patients seen late after injury. We found nine cases of avulsion located at the bicipital tuberosity. All subjective results were good. Strength testing of the injured limbs revealed a loss of 30% supination strength and 40% supination endurance for the anatomic reinsertions. For the non-anatomic reinsertion, there was a 50% decrease in strength and 60% decrease in endurance. Clinical follow-up after seven years showed no nerve damage or heterotopic bone formation. DISCUSSION: Anatomic repair of distal biceps tendon rupture provides consistently good results. Attachment of the brachial tendon to the brachial anterior muscle cannot restore supination force. The two-incision technique with the extensor mass-splitting approach described by Boyd and Anderson lessens the risk of radial nerve plasty. CONCLUSION: Early anatomic reconstruction can restore more strength and endurance for supination. Attachment of the brachialis muscle must be considered in the event of late reconstruction. Subjective satisfaction with functional outcome has been excellent for all patients.

[Surgical indications and techniques in Basedow's disease, multinodular goiter and thyroid cancers]. / Indications et techniques chirurgicales dans la maladie de Basedow, le goitre multinodulaire et les cancers thyroïdiens.

This is a retrospective study of 47 near total and 30 total thyroidectomies for multinodular goiter, Graves' disease and thyroid cancer. Complications are rare: one permanent recurrent nerve palsy out of 154 nerves at risk, one definitive hypoparathyroidism. For a benign pathology, the former bilateral sub-total thyroidectomy should be replaced by a near-total thyroidectomy which leaves one unilateral thyroid remnant the size of a cherry. Using this technique, we did not observe any recurrence. Among 42 patients controlled after more than one year 1/3 have a normal thyroid function. Systematic substitution is not indicated. Thyroxine should be used only if hypothyroidism develops after the operation or if an increase of the thyroid remnant is demonstrated. Thyroid cancer should be treated by total thyroidectomy, except for noninvasive papillary cancer without node metastasis for which a total lobectomy is sufficient.

[Thyroid nodules. Surgical aspects]. / Nodules thyroïdiens. Aspect chirurgical.

This is a restrospective study of 176 thyroid nodules operated between 1977 and 1990, excluding bilateral goiters. 145 were benign with 111 cold and 34 hot nodules; 31 were cancers. Fine needle biopsy (FNB) is useless in hot nodules. For the cold ones, even in recent series, FNB can give false positive or negative results. This means that the answer of FNB should be closely related to the clinical and US findings. The surgical treatment of thyroid nodules must be a total lobectomy including the isthmus. The recurrent laryngeal nerve must be followed entirely. There was no permanent nerve palsy among the 122 total lobectomies. The risk of developing another controlateral nodule later is low (2/110 cases). It is very difficult to distinguish a follicular cancer from an adenoma on frozen section. For this reason, the patient should be warned that a second operation might be necessary some days later if the definitive diagnosis is a follicular cancer. For a non-invasive and non-metastatic papillary cancer, total lobectomy is sufficient. More advanced papillary and all other thyroid cancers should be treated by a total thyroidectomy.