Jean-Claude Bové

Publications (5) View all

• Article: Computer-assisted total knee arthroplasty: Does the tibial component remain at malposition risk?

  J-C Bové
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  ABSTRACT: The development of computer-assisted surgery in total knee arthroplasty continues its search for better accuracy in the spatial positioning of prosthetic components and in achieving the best ideal ligament balance. Many studies have underscored the value of computer-assisted navigation in obtaining precise bone cuts in terms of both orientation and location, which would optimize bone resection and thereby fulfill ligament balancing requirements. Yet improving bone cut accuracy can be undermined by positioning errors of the component at the final stage of implantation. The objective of this prospective study was to assess this possible loss of accuracy and to suggest possible solutions to minimize this risk. A consecutive series of 50 total knee arthroplasties was studied using an imageless computer navigation system. This study compared the spatial orientation of the prosthesis components determined using software (frontal positioning for the femoral component, frontal and sagittal positioning for the tibial component) with the recorded orientation of the corresponding bone cuts, which allowed us to quantify the loss of accuracy of these predefined positions after cutting. Trial and final implant orientation was taken into account. Moreover, the mechanical axes of the lower limb, the trial and then the final prosthesis in place were compared. Two procedures were abandoned in the study and two patient files were incomplete, which left a series of 46 cases (29 females and 17 males; mean age at surgery, 67 years; mean BMI, 31.27). Bone cut orientation was consistently found to be satisfactory. Frontal orientation of the final femoral component (0.2° valgus) did not differ statistically significantly from the distal femoral cut (0.3° valgus) and from the orientation of the trial femoral component, as was true of the slope of the tibial component (4.8°) versus the tibial cut (6.3°) and the mechanical axis of the lower limb with the trial prosthesis and the final implant. The frontal plane orientation of the tibial component (0.6° varus) differed statistically significantly from the bone cut (0.1° valgus). Several studies have demonstrated the value of computer-assisted surgery, notably in the accuracy of the bone cuts, confirming the work reported herein. The loss of accuracy observed between the bone cut and the final implantation can only be explained by soft tissues between the prosthesis and the bone cut, unequal cement thickness, an orientation error in the impaction handle when placing the final implant, or a conflict between the prosthetic keel and cortical bone. Better exposure of the tibial plateaus, discontinuation of cement use, and navigated impaction ancillary tools could reduce these errors. Level IV. Prospective study.
  Orthopaedics & Traumatology Surgery & Research 09/2010; 96(5):536-42. · 0.94 Impact Factor
• Article: [Computer-assisted total-knee arthroplasty. Comparison of two successive systems. Learning curve].

  J-C Bové
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  ABSTRACT: The increasing popularity of total-knee arthroplasty has led to many technical improvements both in the field of prosthesis design and implanted material and instrumentation. The recent advent of computer-assisted techniques is the fruit of a search for more precision for the bone cuts and better ligament balance. The purpose of the present study was to demonstrate how easy it is to use navigation systems by examining the difficulties encountered by one operator with navigation experience when the material was changed. The first 30 total-knee arthroplasties implanted with a new navigation system were investigated. Elements specifically related to navigation difficulties were studied. The series was composed of 16 women and 14 men, mean age 65.9 years at the time of surgery (range, 43 to 84). Mean BMI was 30.66 (range, 23.05 to 39.54). All patients were reviewed by the operator using a standard X-ray protocol. Mean follow-up was six months. The 30 arthroplasties were consecutive, with no exclusions excepting revision procedures. Primary or post-traumatic degeneration was the main reason for surgery. This series was compared with two prior series of 30 prostheses each, implanted with a different navigation system. The first 30 and last 30 implantations using the previous navigation system were thus compared in terms of operative time and precision (comparison of postoperative alignment and implant position). The study focused on difficulties encountered when using the new system, on intra- and postoperative complications and on assessment of implant position. All procedures were totally performed with the navigation system, no interruptions. Operative time was lengthened by an average of 18 min (range, 0 to 45 min). There were no complications specifically related to the navigation system. The position of the implants was assessed in the frontal and sagittal plane on the plain X-rays and with a goniometer. Computed tomography was used to assess femoral component rotation. The overall alignment of the lower limb was within the "ideal" range of +/-3 degrees in 97% (average 0.1 degrees varus). The position of the femoral implant and the tibial plate was correct in the frontal and sagittal planes and no internal rotation of the femoral piece was noted on the 27 ct scan studies (mean 1.9 degrees external rotation). Implant accuracy was equivalent to that observed in the series of the last 30 implants using the prior navigation system. The learning curve was shorter. This small series demonstrated the absence of major problems with the new navigation system. The length of the learning curve was acceptable. This study demonstrated that prior experience with navigation is beneficial because the learning curve with the new system was shorter and the accuracy of implantation was equivalent to that achieved with the prior system. Widespread use of computer-assisted surgery should enable continued improvement in ancillary systems in the upcoming years, particularly concerning rotatory position of the femoral implants, which is still a problem. Cost containment will also be a necessary goal.
  Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2008; 94(3):252-60. · 0.37 Impact Factor
• Article: [Utilization of a porous alumina ceramic spacer in tibial valgus open-wedge osteotomy: fifty cases at 16 months mean follow-up].

  J C Bové
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  ABSTRACT: The aim of this work was to study the behavior of an inert porous alumina ceramic spacer used with a plate fixation for open-wedge tibial valgus osteotomy in patients with osteoarthritis of the knee and genu varum. The population included 50 patients who underwent surgery between October 1994 and December 2000. There were 31 women and 19 men, mean age 55 years at surgery (26 right knees and 24 left knees). Patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, and one year, then every 2 years. Clinical and radiological data were available for all patients. Mean follow-up was 16 months. Two patients were lost to follow-up at 5 and 6 months. The results of the open-wedge tibial osteotomy were in agreement with the usual outcome reported in the literature concerning pain relief, functional recovery, joint motion, angle correction, and good preservation of the clinical and radiological result. Three fracture lines were observed on the lateral tibial plateau but did not affect final outcome or angle correction. There was however one case with loss of correction due to fracture of the screws. Radiographically, at 6 months, there were 9 thin lucent lines around the spacer (24%) which did not affect final outcome. Bone healing was achieved at 3 months on the average in all cases except 2 (4%) where healing was achieved at 8 and 13 months. The porous alumine spacer is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. There were no specific complications related to use of the spacer.
  Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/2002; 88(5):480-5. · 0.37 Impact Factor
• Article: [Idiopathic osteonecrosis of the medial femoral condyle. Treatment with tibial osteotomy or unicompartmental arthroplasty].

  P Hernigou, J C Bove, D Goutallier
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  ABSTRACT: Thirty-three patients, with a mean age of 72 years, were treated for idiopathic osteonecrosis of the medial femoral condyle by a valgus upper tibial osteotomy in 18 cases and by a unicompartmental arthroplasty in 15 cases. The site of the osteonecrosis was in the medial femoral condyle alone in 27 knees and in the medial femoral condyle and the medial tibial plateau in six knees. Pre-operatively, the two groups were comparable with involvement localised to the medial compartment and with no changes in the lateral compartment or the patello-femoral joint. The mean age of the unicompartmental arthroplasties was higher. At follow-up at the present time, which was nine years for the osteotomies and five years for the prostheses, no knee has had to have a further operation. All the knees were improved by the operation. The functional results were the same in both groups. The necrotic nature of the medial femoral condyle did not affect the cementing of the femoral component in the arthroplasties and no loosening occurred. After osteotomy, no further depression of the osteochondral fragment developed. When the knee did not show osteoarthritic change before operation, the valgus tibial osteotomy was not able to prevent narrowing of the medial compartment in this series unless the correction obtained exceeded two degrees of valgus.
  Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1988; 74(3):232-7. · 0.37 Impact Factor
• Source

  Available from: InTech

  Chapter: Computer Assisted Total Knee Arthroplasty � The Learning Curve

  Jean-Claude Bov�
  01/2012; , ISBN: 978-953-307-841-0