Medium-term osteolysis with the Wallaby I® deep-dished total knee prosthesis.

Background: Highly congruent total knee prostheses were introduced in the 1990s in the hope of decreasing polyethylene wear, thereby minimising loosening and particle-induced peri-prosthetic osteolysis. Despite promising long-term outcomes, substantial rates of aseptic loosening were reported with conventional gamma-irradiated polyethylene inserts, suggesting that highly reticulated polyethylene should be used instead. We assessed medium-term outcomes of the Wallaby I® total knee prosthesis with a deep-dished tibial insert made of conventional gamma-irradiated polyethylene.

Removal of infected cemented hinge knee prostheses using extended femoral and tibial osteotomies: six cases.

Extended femoral and tibial osteotomies were performed to remove infected cemented hinged knee prostheses in five patients (six knees) with a mean age of 72 years (44-85) and a history of multiple knee surgeries. A tibial osteotomy was used to mobilise the distal quadriceps insertion and to release the tibial extension. The femoral component was extracted by downward traction and its cement mantle was cleared through an anterior osteotomy (n=4) or via the distal approach (n=2).

Does fibrin sealant use in total knee replacement reduce transfusion rates? A non-randomised comparative study.

Background: Studies assessing fibrin sealants use during total knee replacement (TKR) have produced inconsistent results. We evaluated fibrin sealant therapy in TKR procedures performed without tourniquet and without postoperative drains.

Hypothesis: Use of a fibrin sealant during TKR decreases calculated total blood loss, thereby diminishing blood transfusion requirements and costs.

Is alumina-on-alumina ceramic bearings total hip replacement the right choice in patients younger than 50 years of age? A 7- to 15-year follow-up study.

Introduction: The alumina-on-alumina bearing couple in total hip replacement seems to be well adapted for young and active patients because of the absence of wear and the rarity of osteolysis. Over the long term, doubts persist as to the cementless cup fixation and on the functioning of this bearing system because of possible acoustic emissions during use.

Hypothesis: In young subjects, the ceramic-on-ceramic bearing system limits wear and osteolysis occurrences, without exposing patients to serious side effects.

Methicillin-resistant coagulase-negative staphylococci in the community: high homology of SCCmec IVa between Staphylococcus epidermidis and major clones of methicillin-resistant Staphylococcus aureus.

Background: Data on community spread of methicillin-resistant coagulase-negative staphylococci (MR-CoNS) are scarce. We assessed their potential role as a reservoir of staphylococcal cassette chromosome mec (SCCmec) IVa, the leading SCCmec subtype in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).

Methods: Nasal carriage of MR-CoNS was prospectively investigated in 291 adults at hospital admission.

Navigated revision knee arthroplasty using a system designed for primary surgery.

While navigation is now recognized as an efficient tool for improving femoro-tibial alignment of primary knee prostheses, its use in revision surgery has not yet been fully evaluated. We describe a procedure based on a bone morphing acquisition performed on the surface of the original implants, followed by a dependant bone cut sequence (tibia first). Using the current system, a preoperative CT-scan measurement of the original femoral component was required.

The composite meniscal-capsular-fat pad flap in a lateral approach to the fixed valgus knee: an anatomical study.

We present an anatomical study on the vascular supply to the patellar fat pad. Forty knees from fresh cadavers were dissected after injecting the femoral artery with colored latex. In all cases, the vascular supply to the fat pad depended essentially on the lateral inferior genicular artery, which enters this structure at its posterolateral extent.

Survival of total knee replacement with a megaprosthesis after bone tumor resection.

Background: The use of a megaprosthesis has become the method of choice for reconstruction after bone tumor resection at the knee. However, the long-term survival of megaprostheses is poor. In this study, we sought to identify factors that were associated with implant failure and amenable to interventions designed to improve implant survival.

Partial anterior trochanteric osteotomy in total hip arthroplasty: surgical technique and preliminary results of 127 cases.

The authors describe a new approach to the hip joint arthroplasty performed in 127 cases of total hip arthroplasty without major complication. A small anterior fragment of greater trochanter, maintaining the insertions of the gluteus minimus and vastus lateralis muscles, is detached. The whole insertion of the gluteus medius is preserved intact, providing good prosthetic stability and rapid recovery of abductor power and gait.

Mycetoma of the foot caused by Fusarium solani: identification of the etiologic agent by DNA sequencing.

We report a case of Fusarium solani mycetoma of the foot that could not be diagnosed by culture, but was correctly identified after amplification and sequence analysis of fungal internal transcribed spacers 1 and 2 and 5.8S ribosomal DNA regions.

[Epidural aspergillosis secondary to lung aspergilloma despite long-term itraconazole treatment].

A 58-year-old man developed spinal cord compression at the T2-T3 level due to an Aspergillus epidural abscess. This presumably immunocompetent patient had been treated for two years by oral itraconazole (200 mg/day) for a lung aspergilloma that occurred seven years after removal of a lung adenocarcinoma. Surgical debridement was performed via a wide posterior approach associated with high-dose amphotericin B.

Complications and functional evaluation of 17 saddle prostheses for resection of periacetabular tumors.

Seventeen saddle prostheses were inserted between 1988 and 1997 after resection of periacetabular tumors. The tumors involved the zones II and III of Enneking classification in 13 patients, the zones I and II in 2 patients, and the zone II in 2 patients. The tumors included 11 chondrosarcomas, 3 Ewing sarcomas, 2 giant cells tumors, and 1 metastasis of renal carcinoma.

Knee reconstruction with prosthesis and muscle flap after total arthrectomy.

A massive prosthesis and medial gastrocnemius muscle transfer were used to reconstruct the knee after extracapsular en bloc excision for bone sarcoma. Magnetic resonance images showed intraarticular involvement. This technique was used in nine patients, six men and three women aged 18 to 51 years, with primary malignant bone tumors of the knee.

[Sacral chordoma: retrospective review of 11 surgically treated cases].

Purpose Of The Study: Chordoma is a malignant neoplasm believed to arise from notochord remnants. It accounts for approximately 3 to 4 p. 100 of primary bone tumors and is localized along the axial skeleton, 50 p.

[Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite. A comparative study of functional results, complications and longevity in 41 cases].

Purpose Of The Study: To compare femoral reconstruction using megaprosthesis versus allograft prosthesis composite.

Material And Methods: Forty-one consecutive proximal femoral reconstructions with an allograft-prosthesis composite (21 cases) or a megaprosthesis (20 cases) after tumor resection were reviewed in a retrospective study. The following criteria were considered: functional outcome; long term survival; complications.

Arthroscopic treatment of bilateral humeral head osteonecrosis.

A 37-year-old woman with a renal transplant was treated by arthroscopic debridement for bilateral steroid-induced humeral head osteonecrosis. Radiologically, the right shoulder had been categorized as stage III and the left as stage IV according to Arlet and Ficat. Relief of pain and improved range of motion were obtained especially on the right shoulder.

[Primary leiomyosarcoma of bone. Report of 5 anatomo-clinical cases and review of the literature].

Introduction: Leiomyosarcoma is a malignant smooth muscle tumor occurring most frequently in uterus or soft tissues and more rarely in bone.

Materials And Methods: We report the clinicopathologic, immunohistochemical and ultrastructural findings of five cases of primary leiomyosarcoma of bone treated in our Department between 1991 and 1994. The pertinent medical literature is discussed.

Massive pelvic and femoral pseudotumoral osteolysis secondary to an uncemented total hip arthroplasty.

A 51 year-old man developed an extensive osteolytic response to wear debris in an uncemented porous-coated total hip arthroplasty, with metal/polyethylene interface, which had been implanted eighteen years previously. This reaction, which involved the upper femur and the ilium, produced a mass which compressed the pelvic viscera.