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ABSTRACT: We report on seven traumatic lesions of the tibialis anterior tendon (one subcutaneous rupture and six open tears) in seven injured patients of mean age 45 years [17-79] all managed by direct suture and immobilization either using a cast boot (four cases) or a lower leg external fixator (three cases). After a mean follow-up of 31 months (6-50), external fixation achieved favourable clinical results with no specific complication. External fixation improves the conditions for suture efficiency, provides full immobilization and facilitates wound care in patients at a high risk of developing cutaneous complications. In accordance with data published in the literature, immobilization by means of a windowed cast boot achieved satisfactory results in patients with no risk factors. This method compatible with early mobilization avoids placement of a posterior splint which could induce slackening and weakening of tendon repair. LEVEL OF EVIDENCE: Retrospective study (Level IV).
Orthopaedics & Traumatology Surgery & Research 01/2011; 97(2):211-6. · 0.94 Impact Factor
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ABSTRACT: Atrophic scaphoid non-union and lunate necrosis can be treated with vascularized bone grafting; through a posterior approach as described by Zaidemberg, based on a supraretinacular artery, or through an anterior approach, based on the volar carpal artery, according to Kuhlmann's procedure. The aim of our study was to determine the area covered by each of these two grafts and their respective future applications. Fifteen hands from eight adult human cadavers, free of any scar, were dissected after injection of colored fluid latex, through dorso-radial approach for Zaidemberg's graft and through volar approach for Kuhlmann's. We observed the morphological parameters of the pedicles and the arc of rotation of each flap. The volar vascularized graft had a constant origin and it could be transferred to the scaphoid, the lunate and the scapholunate joint. The posterior graft of Zaidemberg was technically more difficult to harvest because of the anatomical variations. It made it possible to reach the scaphoid, the trapezium and the scaphotrapeziotrapezoid joint line. Both these two vascularized bone grafts represent interesting procedures for treatment of scaphoid non-union or lunate necrosis, or intracarpal bones arthrodesis. They bring various possibilities of bone covering, related to specific area of mobilization and are not opposite procedures, but have different targeted indications. One must better define the respective places of the vascularized bone grafts, compared with the traditional free (non-vascularized) graft.
Surgical and Radiologic Anatomy 03/2007; 29(1):15-20. · 1.06 Impact Factor
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Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 07/2006; 92(4 Suppl):109-10. · 0.37 Impact Factor
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Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 07/2006; 92(4 Suppl):113. · 0.37 Impact Factor
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ABSTRACT: We present a case report of severe localized infection after continuous popliteal sciatic nerve block. The report highlights the importance of meticulous asepsis and possibly limiting the duration of catheter use.
BJA British Journal of Anaesthesia 09/2005; 95(2):255-6. · 4.24 Impact Factor
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ABSTRACT: After orthopaedic surgery, continuous nerve block analgesia provides effective postoperative pain relief. The practical use of these techniques may present problems. The purpose of this study was to assess the development of continuous block procedure for postoperative pain based on quality standard management and the effectiveness of initial training as an adjunct for introduction of these techniques.
A staff committee of anaesthesiologists established a specific practical working protocol. The medical and paramedical teaching sessions were immediately evaluated using a questionnaire.
214 consecutive patients were included. The incidence of side effects and complications were higher in the beginning of protocol. Constant improvement of these results was observed throughout the study. The rate patients with pain were 10%. The analysis of medical evaluation should permit to determine an acceptable level of quality. Most patients were satisfied with their management.
Pain management quality assurance program provided an improvement in efficacy of postoperative pain management in our protocol. Further, evaluation may be required to assess the complete benefits of this new protocol as regards postoperative pain.
Annales Françaises d Anesthésie et de Réanimation 08/2005; 24(7):795-801. · 0.84 Impact Factor
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Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 01/2004; 89(8):747-52. · 0.37 Impact Factor
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ABSTRACT: . This study aimed at finding a relationship between functional results obtained after a total hip arthroplasty and gait analysis. One hundred primary Charnley prosthesis (66 patients) were reviewed, with a mean follow-up of 4.5 (1-22) years with good or very good functional results according to the MDA scale. Hip kinematic parameters were studied with the VICON system, and results were compared with those of a control group of 55 subjects matched for sex, age and height. Cadence did not seem to be related to functional results. Speed, step length and hip flexion-extension amplitude were related to the functional score. Patients with the best functional results appeared to be close to the control group for these criteria. A relationship was also observed between rotation amplitude and functional results but was greater in patients with the best results than in control subjects. Because of these relationships between functional results and kinematic parameters, kinematic studies could be useful for objective comparisons between the results of various surgical techniques. Such comparisons would be more objective than those based on functional scores, including subjective items. It remains to be demonstrated whether the measure of these kinematic parameters would provide greater sensitivity than the simple use of a functional scale. Resume. Le but de cette étude était de rechercher un lien entre le résultat fonctionnel obtenu après arthroplastie totale de hanche et la cinématique articulaire au cours de la marche. Cent prothèses totales de hanche mises en place chez 66 patients ont été incluses en sélectionnant des patients strictement indemnes d'autres affections ou antécédents susceptibles de perturber la marche. Il s'agissait de prothèses type Charnley de première intention, revues avec recul moyen de 4,5 ans (extrêmes de 1 à 22 ans) et présentant un bon ou très bon résultat fonctionnel selon la cotation de Merle d'Aubigné. La cinématique de la hanche a été étudiée avec le système VICON et les résultats ont été comparés à un groupe témoin de 55 sujets, appariés en terme de sexe, d'âge et de taille. La cadence de marche n'est pas apparue dépendre statistiquement du résultat fonctionnel, ni différente des valeurs observées dans le groupe témoin. La vitesse, la longueur du pas et l'amplitude de flexion-extension de hanche sont apparues liés au score fonctionnel. Les patients ayant atteint les meilleurs résultats fonctionnels présentaient pour ces 3 paramètres, un intervalle de fluctuation totalement inclus dans celui observé au sein du groupe témoin. L'amplitude de rotation est également apparue liée au résultat fonctionnel mais d'une amplitude supérieure à celle des sujets témoins pour les patients présentant le meilleur résultat. Ces relations entre le résultat fonctionnel et les paramètres cinématiques permettent d'envisager l'utilisation des études cinématiques lors de comparaisons objectives entre les résultats de différentes techniques chirurgicales. Une telle comparaison aurait l'avantage d'être plus objective qu'une comparaison reposant sur l'utilisation de scores fonctionnels qui comportent une part subjective. Il reste cependant à démontrer que la mesure de ces paramètres cinématiques apporterait réellement une sensibilité plus grande que l'utilisation simple d'une échelle fonctionnelle.
European Journal of Orthopaedic Surgery & Traumatology 02/2002; 12(1):30-35. · 0.10 Impact Factor
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ABSTRACT: The purpose of this experimental work was to obtain a radiographical assessment of the effect of the compression achieved with the Herbert screw due to its different thread diameters by comparing the real and expected reduction of interfragment gap (IFG) on cadaver bones. To better understand and define the limits of this "self-compressing" effect and to study the usefulness of screw sizes smaller than the scaphoid, we measured the maximal and mean reduction of IFG without using the instrumentation.
Twelve scaphoids were obtained from fresh cadavers. The scaphoid holes were drilled and tapped in the largest axis of the scaphoid, in a central position parallel to an anti-rotation wire. A transverse osteotomy was made in the mid third of the scaphoid to simulate a Schernberg grade III fracture. The real IFG reduction was defined as the difference between the gap measured before and after screwing. The expected IFG reduction was defined by multiplying the number of screw turns by the pitch height per turn.
On the reduction average, a Herbert screw produced a 1.1 mm IFG reduction. The maximal reduction IFG measured was 1.5 mm. For 7 cases, the real IFG reduction was larger than expected, for 4 cases it was smaller than expected and for 1 case the difference was considered negligible. The Fisher test did not demonstrate any significant statistical difference between the real and expected IFG reduction for all scaphoids. The operator perceived a subjective sensation of compression after one screw turn that continued up through the last turn.
The Herbert screw develops maximal compression force when all the screw threads are totally anchored in the bone. The interfragment gap closes linearly, bringing the two bone fragments together. However, failure can result if the gap is too wide (>2 mm), the screw is poorly positioned, or there is an inappropriate correspondence between screw length and diameter and scaphoid size. Unlike spongy bone screws, the Herbert screw has a round non-conical tip thread and a shallow thread that do not bring the bone fragments together. The perception of compression corresponds to the passage of the screw through the spongy bone and not to real narrowing of the gap between the fragments. In clinical practice, because of the use of instrumentation for open surgery in carpal scaphoid fracture, it is not necessary to rely on these data, but they can be useful for percutaneous screw insertion without a guidewire and without prior compression or for another localization. Peroperative radiographs should be obtained to assess the quality of the screw position and check reduction and the reality of the compression.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 01/2002; 87(8):796-801. · 0.37 Impact Factor
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ABSTRACT: An osteoid osteoma was discovered at the site of fusion of a mid-third femoral shaft fracture in an 18-year-old girl. This unusual localization was revealed by persistent pain after ablation of the material after fracture healing. Postoperatively, a discharge from the skin wound that persisted for a few days, raised the differential diagnosis between low-grade bone infection and an osteoid osteoma suggested by the patient's age and the clinical presentation. Computed tomography and leukocyte-labeled bone scintigraphy provided the diagnosis of osteoid osteoma that was confirmed at pathology examination after resection. Isotopic mapping of this very small intraosseous lesion that exhibited strong isotope uptake was particularly contributive.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/2001; 87(5):503-5. · 0.37 Impact Factor
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ABSTRACT: This study aimed at comparing the results obtained with a sliding screw plate and an experimental device including a small-diameter nail that can be placed with a mini-invasive approach and provides a stable fixation.
Randomized prospective study.
University hospital.
The study included two groups with thirty fractures of the trochanteric area.
In both groups, the surgical procedure was carried out on patients placed on a traction table in a supine position, under an x-ray amplifier. Sliding screw plates (THS) were set in place according to the usual open technique. Nails were placed through a twenty-millimeter supratrochanteric cutaneous incision. This experimental system comprised a locked intramedullary nail with two nonparallel seven-millimeter cervicocephalic screws.
The comparison between the two groups was based on the surgical procedure (time, duration of x-ray irradiation, and total blood loss); the initial postoperative period (complications, duration of hospital stay, and the time before returning home); the time before full weight bearing became effective; the functional and social recovery; mortality; and the quality of immediate and final anatomic restitution and healing.
Operating time (p < 0.001) and blood loss (p < 0.001) were lower in the nail group, and no blood transfusion was required. Postoperative pain (p < 0.01), time necessary to support full weight bearing (p < 0.02), and time before returning home (p < 0.05) were reduced in the nail group. All fractures healed in the same amount of time, with good anatomic results in the nail group, whereas ten impactions beyond ten millimeters occurred in the plate group. No difference was found between the two groups in walking ability and autonomy recovery, but hip function (p < 0.05) was better in the nail group.
This preliminary clinical study has shown the advantages of this mini-invasive technique. It could not evaluate all the possible disadvantages inherent in the method. These points will be evaluated in a multicenter study justified by these preliminary results.
Journal of Orthopaedic Trauma 09/2001; 15(6):401-6. · 2.13 Impact Factor
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ABSTRACT: Authors describe a transgluteal approach of the hip which is not based on the somewhat unsure common insertion of gluteus medius and vastus lateralis. Anatomical basis and technical particularities of division of anterior part of gluteus medius, of gluteus minimus and capsule are given which allow preservation of gluteal nerve, stability of the joint, and solid reparation of abductor muscles.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/1999; 85(5):520-5. · 0.37 Impact Factor
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ABSTRACT: A fluctuant, painful, subcutaneous, and intermuscular tumor developed in a 38-year-old man with severe acquired immunodeficiency syndrome (AIDS) in which immunodeficiency was severe. Surgery revealed lesions that formed a multilocular pouch embedded in deep tissues in the forearm filled with tapiocalike material containing a viscous fluid, granules, and cysticercilike small vesicles. Pathologic and parasitologic evaluation showed cysticerci embedded in a fibrocollagen reaction with inflammatory granulomatous reaction. Each cysticercus contained an invaginated scolex with two rows of small (i.e., 80 microm) and large (i.e., 114 microm) rostellar hooks, identical to larva of Taenia crassiceps. All clinical, parasitologic, and pathologic features of these cysticerci were very different from those of all other larval cestode (i.e., Taenia solium cysticercosis, coenurosis, sparganosis, cysticercosis due to Taenia saginata [Cysticercus bovis], primary and secondary hydatidosis [Echinococcus species]). T crassiceps cysticerci usually develop in subcutis and pleuroperitoneal cavities of rodents, whereas the adult tapeworm is commonly found in the digestive tract of foxes. Biologic properties of T crassiceps cysticerci and epidemiologic characteristics of pandemic human immunodeficiency virus (HIV) could eventually indicate new potential cases of T crassiceps cysticercosis in humans.
American Journal of Surgical Pathology 04/1998; 22(4):488-92. · 4.35 Impact Factor
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ABSTRACT: Polymerase chain reaction (PCR) amplification, which is a useful method for detecting infectious agents in joints, has potential utility in the molecular diagnosis of venereal-associated arthritis. Among pathogens detected by this technique, Ureaplasma urealyticum, which is primarily associated with reactive arthritis (ReA), is also implicated in septic arthritis in immunocompromised patients. We report here a case of destructive polyarthritis, initially suggestive of septic arthritis, in an immunocompetent patient whose PCR positivity for U. urealyticum DNA in one joint, in conjunction with the disease outcome and histologic findings, led to the diagnosis of destructive ReA.
Arthritis & Rheumatism 12/1997; 40(11):2084-9. · 7.87 Impact Factor
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ABSTRACT: This study aimed to evaluate a method for the treatment of upper tibial metaphyseal fractures using an external epiphysodiaphyseal fixation with the double-frame Hoffmann device.
The study included 48 patients (37 men and 11 women) aged 16 to 82 years. The tibial fracture was simple in 15 cases, included a metaphyseal comminution, partial in 3 cases and total in 30. In 13 patients, there was also a simple articular fracture. The fracture was opened in 24 cases (type I in 10, type II in 7 and type III in 7 cases).
The gap and displacement evaluation between the fragments after reduction was made on postsurgical roentgenograms; its was considered as complete when all fragments were in contact with each other, without frontal or anteroposterior translation above 5 mm. Healing was defined as a complete bone continuity providing a painless load bearing. The patients were clinically and radiologically reexamined with a mean follow-up of 15.45 months (5 to 62 months).
After healing, there were 2 cases of angular deformities in patients whose autonomy was otherwise already reduced. Twenty-three patients had a minor pin tract infection. There was 3 cases of secondary osteitis after a type-III open fractures and 3 other deep septic complications without functional consequences. Forty-one fractures healed without bone graft in a mean time of 18 +/- 7.6 weeks. Healing did not seem to statistically depend on the opening nor on the type of fracture, but rather on the association with a peroneal fracture and the loss of cohesion between the fragments. The duration of professional invalidity evaluated in 20 cases, varied between 4 to 21 months (means: 11.3 months), and none of the patients had to modify his activity because of the tibial fracture. At follow-up, no patient complained of invalidating pain. Thirty-two patients recovered a satisfactory knee joint mobility and among the 16 others, in only 3 no particular reason was found to explain the deficit.
While good anatomic and functional results lead us to keep the principle of external fixation, it seems however necessary to modify the modalities of the treatment in order to improve healing conditions, especially by improving the cohesion of the fragments through secondary minimal internal fixation. The use of dynamic axial fixation devices could therefore bring a theoretical advantage, but it must be proven that they produce in this site a primary stabilization which is a good as that obtained with Hoffmann's device.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1996; 82(6):490-9. · 0.37 Impact Factor
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ABSTRACT: The major problem in external fixation of upper metaphyseal tibial fractures with a double-frame Hoffmann device is poor healing. With a dynamic fixation, it would be possible, with no change in technique, to compress the fracture site in a second phase, and therefore to facilitate the healing process. However, a new fixation device should not compromise the primary stability of the fixation. The aim of this experimental study on cadavers was to compare, in conditions very close to a clinical situation, the initial stabilization capability of five types of external fixation.
Five types of external fixators were tested on cadavers specimens: 1. a standard double-frame Hoffmann device; 2. a double-frame Hoffmann's device sagittaly reinforced with two additional anterior-posterior half-pins; 3. a type-1 axial dynamic fixation device using 6-mm conical pins; 4.a type-2 dynamic axial fixation device with 5-mm cylindrical pins; and 5. a mixed device including an lizarov-type epiphyseal fixation and a monoplane diaphyseal fixation.
The metaphyseal fracture was simulated by a transversal resection of a 20-mm segment. Specimens received by increments a load of up to 310 N, with which it was possible to determine stiffness components in valgus/varus, flexion/extension, rotation around the vertical axis and axial vertical displacement. The bone mineral content of the specimens was measured by Di Energy X-ray Absorptiometry.
The stabilization characteristics of type-1 axial dynamic fixation were identical to those of the standard Hofmann's device in flexion/extension and in rotation as well as axially, but a greater mobility in valgus/varus was observed. The sagittal reinforcement of Hoffmann's device increased its rigidity in flexion/extension. The mixed lizarov fixation was stiffer than the standard Hoffmann's device in rotation; it was equivalent in valgus/varus and flexion/extension and less stiff in axial vertical displacement. In this study it was showed that the individual variability of bone mineral content is a negligible parameter.
The experimental behaviour of the mixed Ilizarov device gives to assume that it may facilitate the healing process without endangering the primary stability of the fixation. However, this theoretical advantage should be validated in a randomized prospective clinical study.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1996; 82(6):500-7. · 0.37 Impact Factor
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ABSTRACT: We have carried out a retrospective study of 100 fractures of the distal radius which were classified according to 3 principal factors, namely the amount of displacement (D), the involvement of the epiphysis (E), and the degree of metaphyseal comminution (M). Each of these 3 groups was further divided into 4 levels of increasing instability. The fractures were assessed 3 months after injury. Most occurred in old patients with low grades in the DEM scale, often in association with osteoporosis and following a simple fall. Metaphyseal comminution and the degree of displacement did not correlate with the degree of osteoporosis. The highest grades of epiphyseal lesions occurred in young patients, and intact epiphyses were seen in the more osteoporotic population. The Kapandji technique, using 3 Kirschner wires, was used in 58 cases, mostly with low grades of DEM, and gave satisfactory results, but in 14% anterior carpal translation was noted. This may lead to anterior instability. External fixation was employed in 32 patients with higher grade fractures. A good anatomical result was usually obtained but the wrists were more stiff. In 7 of these patients fixation of articular fragments by wires was also needed. Reduction and immobilisation in a cast was undertaken in 7 cases with variable results. Double cortical pinning was used in 3 patients and was useful in the highest grades of displacement. We outline a scheme for treatment based on our classification.
International Orthopaedics 02/1996; 20(1):15-22. · 2.03 Impact Factor
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ABSTRACT: Cent dossiers de fractures de l’extrémité inférieure du radius déplacées (FEIR) ont été revus retrospectivement à la lumière
d’une classification originale privilégiant 3 éléments d’analyse: le déplacement (D), l’atteinte épiphysaire (E), et l’éclatement
cortical métaphysaire (M), chaque fois subdivisé en 4 grades d’instabilité potentielle supposée croissante. Les résultats
radiologiques au 3° mois ont été rapportés au type de la fracture et à son traitement, et validés par une étude statistique.
La majorité des FEIR sont de faibles grades D/E/M chez des patients agés souvent ostéoporotiques, qui se fracturent après
une simple chute de leur hauteur. Les types d’atteintes métaphysaires et de déplacement ne sont corrélés ni à l’age ni à l’ostéoporose;
les atteintes épiphysaires les plus graves ont concerné des patients significativement plus jeunes, et le respect de l’épiphyse
des patients significativement plus souvent ostéoporotiques. Le triple embrochage intra-focal (58 cas) s’est adresséà des
fractures de faibles grades D/E/M, avec des résultats cliniques et morphologiques satisfaisants sauf dans 14% des cas où on
déplore une translation antérieure du carpe en rapport avec des types d’atteinte métaphysaire ou de déplacement comportant
une instabilité antérieure potentielle, non controlée par la méthode. La fixation externe (32 cas) s’est attaquée à un lot
de fractures significativement plus graves, avec des mobilités finales en flexion extension significativement inférieures
à la technique précédente. Les résultats morphologiques voient leur limite dans les formes articulaires déplacées où l’indication
d’embrochages associés, efficaces 7 fois sur 8, mérite d’être étendue. Bien que faiblement représentés: le traitement orthopédique
(7 cas) est apparu décevant, et l’embrochage bicortical (3 cas) efficace, même dans les formes les plus graves de déplacement.
Finalement une orientation thérapeutique est proposée à partir des éléments de notre classification.
We have carried out a retrospective study of 100 fractures of the distal radius which were classified according to 3 principal
factors, namely the amount of displacement (D), the involvement of the epiphysis (E), and the degree of metaphyseal comminution
(M). Each of these 3 groups was further divided into 4 levels of increasing instability. The fractures were assessed 3 months
after injury. Most occurred in old patients with low grades in the DEM scale, often in association with osteoporosis and following
a simple fall. Metaphyseal comminution and the degree of displacement did not correlate with the degree of osteoporosis. The
highest grades of epiphyseal lesions occurred in young patients, and intact epiphyses were seen in the more osteoporotic population.
The Kapandji technique, using 3 Kirschner wires, was used in 58 cases, mostly with low grades of DEM, and gave satisfactory
results, but in 14% anterior carpal translation was noted. This may lead to anterior instability. External fixation was employed
in 32 patients with higher grade fractures. A good anatomical result was usually obtained but the wrists were more stiff.
In 7 of these patients fixation of articular fragments by wires was also needed. Reduction and immobilisation in a cast was
undertaken in 7 cases with variable results. Double cortical pinning was used in 3 patients and was useful in the highest
grades of displacement. We outline a scheme for treatment based on our classification.
International Orthopaedics 01/1996; 20(1):15-22. · 2.03 Impact Factor
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ABSTRACT: A particularly short traumatic amputated forearm finally led to a simplified under-elbow prosthesis after a long surgical program including: 1) A progressive 8 cm ulnar lengthening with a Wagner device; 2) and a secondary groin flap resurfacing the distal stump. Complications essentially concerned the ulnar lengthening particularly because of a weak osseous callus. Final aesthetic and functional results are satisfying with a 6 years follow-up.
Annales de Chirurgie de la Main et du Membre Supérieur 02/1995; 14(1):28-32.
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ABSTRACT: In cases of severe hip osteoarthritis in young patients, the intertrochanteric osteotomy can delay total hip arthroplasty. The main advantage of the osteotomy is to preserve the bone stock. The main disadvantages are the lasting postoperative invalidity and the varying longterm success rate. Our aim was to quantify these disadvantages using survivorship analysis.
The study included 64 patients (65 osteotomies) ranging from 16 to 68 years. The osteotomies were performed between 1975 and 1987. The osteoarthritis was stage III or IV, with a joint space less than 50 per cent. Osteoarthritis was primitive in 25 cases and secondary in the others. The osteotomy always included a medial displacement of the shaft according to the principle of Mac Murray's procedure, but also 22 cases (33.8 per cent) had a varus angulation and 19 (29.2 per cent) a valgus angulation. The preoperative pain score according to the Merle d'Aubigné (MDA) grading was 2.6 (1 to 4) and the global functional score was 11.1 (5 to 15). The patients were reviewed in 1991 and examined clinically and radiographically.
The results of the 65 cases were distributed into 3 groups: -29 cases having reached the follow-up without difficulty, -7 patients were lost for follow-up examination, 6 of these latter than 9 years, -29 patients taking osteotomy failure as a pain lesser than the 3 MDA score. The postoperative delay to obtain the best functional result was 6 to 24 months (mean: 13.65). This result ranged from 5 to 17 MDA score (mean: 15) with pain ranging from 2 to 6 (mean: 5). The survivorship analysis curve showed 67.5 +/- 19.5 per cent survival for all osteotomies to the interval of 9-10 years. There were 3 types of results: -3 early failures (4.6 per cent) one because of a deep infection, -in 7 cases, after a short initial functional improvement, there was a progressive degradation leading to failure in 3.7 years (2 to 6 years), -55 cases with a lasting period of functional improvement, 26 osteotomies leading to failure in 3.5 to 15 postoperative years and, 29 cases having reached the follow-up (7 to 16 years mean 10 years). There was radiographic improvement of the osteoarthritis increasing the joint space in 59 cases (90.7 per cent). There was no radiographic improvement in the 6 other cases, including the 2 functional failures. The functional degradation appeared parallel to the radiographic degradation leading to a decrease of joint space to 90 per cent. We tested differences between various groups using Log Rank test. We found no difference in survival between the 3 different types of osteotomy.
The results of this study can help to choose between intertrochanteric osteotomy and THA in the case of severe osteoarthritis. The best functional result of the osteotomy is in one postoperative year, with a mean MDA score of 15 and a mean pain score of 5. It appears that we do not predict the duration of functional improvement, the patient has 2/3 chances that this improvement reaches 10 years.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1994; 80(6):485-92. · 0.37 Impact Factor
