Johan Bellemans

Publications (86)165.07 Total impact

• Article: Chronic posttraumatic bursitis of the medial collateral ligament: surgical treatment in 2 high-level professional athletes.

  Kristoff Corten, Hilde Vandenneucker, Johan Van Lauwe, Johan Bellemans
  The American journal of sports medicine 02/2009; 37(3):610-3. · 3.61 Impact Factor
• Article: Cementing the femoral component in total knee arthroplasty: which technique is the best?

  Michaël Vaninbroukx, Luc Labey, Bernardo Innocenti, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: Although several techniques exist for cementing the femoral component in TKA, no data are available on which is the best one to use. We therefore compared four cementing techniques in an anatomical open pore sawbone model (n=20), in order to investigate the influence of cementation technique on overall cement penetration as well as length of the cement mantle over the different cuts. The technique which included cement application onto the anterior and distal bone surfaces, as well as the posterior flanges of the prosthesis, was statistically superior to the other techniques. We therefore advocate this technique as the standard for cementing the femoral component.
  The Knee 02/2009; 16(4):265-8. · 1.74 Impact Factor
• Article: A pyogenic, ruptured Baker's cyst induced by arthroscopic pressure pump irrigation.

  Kristoff Corten, Hilde Vandenneucker, Peter Reynders, Stefaan Nijs, Theo Pittevils, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: Post-steroid septic arthritis can be treated with irrigation pump assisted arthroscopic synovectomy. The high-intra-articular fluid pressures can force the pyogenic fluid into a pre-existing Baker's cyst. The cyst can rupture and with the pre-existing steroid induced immune-suppression, the calf abscess will be hard to control. Therefore, thorough investigation with an ultrasound-guided aspiration followed by an early drainage of the collection is warranted and mandatory. Close monitoring for the development of a deep thrombosis of the popliteal vein is required.
  Knee Surgery Sports Traumatology Arthroscopy 01/2009; 17(3):266-9. · 2.21 Impact Factor
• Article: Double-bundle anterior cruciate ligament reconstruction: a cadaveric study on the posterolateral tunnel position and safety of the lateral structures.

  Enrico Neven, Pieter D'Hooghe, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: The aim of this study was to identify the anatomic relation between the posterolateral drill hole and the lateral structures of the knee. The length of the posterolateral tunnel and the feasibility of the EndoButton CL (Smith & Nephew, Andover, MA) as posterolateral graft fixation device was also evaluated. An anatomic descriptive study was performed on 24 cadaveric knees. The double-bundle anterior cruciate ligament (ACL) was reconstructed using standard arthroscopic techniques and the EndoButton CL fixation system. The study protocol was as follows: first, an arthroscopy with posterolateral pin placement and drilling of the posterolateral tunnel was performed. Subsequently, the lateral structures were dissected and the distance between the pin and the different anatomic structures was measured. From outside in, the length of the posterolateral tunnel was also measured. This study shows that there is no increased risk of injuring the lateral collateral ligament during posterolateral tunnel placement in double-bundle ACL reconstruction, when performed through a low anteromedial portal in high flexion. Furthermore, a safe margin was noted between the posterolateral tunnel and the adjacent lateral gastrocnemius and popliteus tendons. The length of the posterolateral tunnel was between 32 and 44 mm (mean, 36.92 mm). We conclude that the posterolateral tunnel can be created safely in double-bundle ACL reconstruction without additional risk to the surrounding structures. A 15-mm EndoButton CL fixation device is routinely advised as posterolateral graft fixation in order to avoid the risk of over-advancing the device or overdrilling. This study has shown that there is no risk of iatrogenic lesion to the lateral collateral ligament, lateral gastrocnemius tendon, or popliteus tendon with a posterolateral tunnel drilled through a low anteromedial portal in high flexion.
  Arthroscopy The Journal of Arthroscopic and Related Surgery 05/2008; 24(4):436-40. · 3.02 Impact Factor
• Source

  Available from: actaorthopaedica.be

  Article: Metastasis from renal cell carcinoma presenting as osteolysis in total hip arthroplasty: a case report.

  Jean-Pierre Simon, Johan Bellemans, Ignace Samson
  [show abstract] [hide abstract]
  ABSTRACT: We report a case of a pelvic metastasis from a renal carcinoma in association with a total hip arthroplasty. Mistakenly diagnosing such lesion as a granulomatous osteolytic foreign body reaction due to polyethylene debris may lead to devastating and uncontrollable haemorrhage during revision arthroplasty.
  Acta orthopaedica Belgica 03/2008; 74(1):122-4. · 0.40 Impact Factor
• Article: Tibial cyst and intra-articular granuloma formation after anterior cruciate ligament reconstruction using polylactide carbonate osteoconductive interference screws.

  Jan Dujardin, Hilde Vandenneucker, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: We report a case of sterile tibial cyst and intra-articular granuloma formation of the knee 6 months after a double-bundle anterior cruciate ligament reconstruction with bioabsorbable polylactide carbonate osteoconductive interference screws. The patient presented with increasing pain and swelling of the knee. Surgical exploration was performed, and 2 pretibial cavities were encountered, filled with remnants of the biodegradable screws and fibrinous material. Both sites underwent curettage, and the cavities were filled with allogeneic bone grafts. Arthroscopic evaluation of the knee showed an intact anterior cruciate ligament and a large granuloma formation anterior to the intercondylar notch in conjunction with the anteromedial tibial tunnel. Arthroscopic resection of the granuloma together with synovectomy was performed. To our knowledge, this is the first case report of this complication with polylactide carbonate screws.
  Arthroscopy The Journal of Arthroscopic and Related Surgery 03/2008; 24(2):238-42. · 3.02 Impact Factor
• Article: Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture.

  Daniel B F Saris, Johan Vanlauwe, Jan Victor, Miroslav Haspl, Michael Bohnsack, Yves Fortems, Bruno Vandekerckhove, K Frederik Almqvist, Toon Claes, Frank Handelberg, Koen Lagae, Jan van der Bauwhede, Hilde Vandenneucker, K Gie Auw Yang, Mislav Jelic, Rene Verdonk, Nancy Veulemans, Johan Bellemans, Frank P Luyten
  [show abstract] [hide abstract]
  ABSTRACT: As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative medicine. Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo. To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture. Randomized controlled trial; Level of evidence, 1. Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken at 1 year using (1) computerized histomorphometry and (2) evaluation of overall histological components of structural repair. Clinical outcome was measured using the self administered Knee injury and Osteoarthritis Outcome Score. Adverse events were recorded throughout the study. Characterized chondrocyte implantation resulted in better structural repair, as assessed by histomorphometry (P = .003) and overall histologic evaluation (P = .012). Aspects of structural repair relating to chondrocyte phenotype and tissue structure were superior with characterized chondrocyte implantation. Clinical outcome as measured by the Knee injury and Osteoarthritis Outcome Score at 12 to 18 months after characterized chondrocyte implantation was comparable with microfracture at this stage. Both treatment groups had a similar mean baseline overall Knee injury and Osteoarthritis Outcome Score (56.30 +/- 13.61 and 59.53 +/- 14.95 for microfracture and characterized chondrocyte implantation, respectively), which increased in both groups to 70.56 +/- 12.39 and 72.63 +/- 15.55 at 6 months, 73.26 +/- 14.66 and 73.10 +/- 16.01 at 12 months, and 74.73 +/- 17.01 and 75.04 +/- 14.50 at 18 months, respectively. Both techniques were generally well tolerated; the incidence of adverse events after characterized chondrocyte implantation was not markedly increased compared with that for microfracture. One year after treatment, characterized chondrocyte implantation was associated with a tissue regenerate that was superior to that after microfracture. Short-term clinical outcome was similar for both treatments. The superior structural outcome may result in improved long-term clinical benefit with characterized chondrocyte implantation. Long-term follow-up is needed to confirm these findings.
  The American journal of sports medicine 03/2008; 36(2):235-46. · 3.61 Impact Factor
• Article: Cartilage damage determines intermediate outcome in the late multiple ligament and posterolateral corner-reconstructed knee: a 5- to 10-year follow-up study.

  Kristoff Corten, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: Patients with chronic ruptures of 1 or both cruciate ligaments in combination with posterolateral rotatory instability of the knee often have some degree of cartilage damage at the time of surgery. Chondrosis at the time of reconstruction does not influence early and intermediate functional outcome of the multiple ligament reconstructed knee. Case series; Level of evidence, 4. Twenty-one patients were available from an original 27 treated between 1995 and 2000. All patients were assessed preoperatively and postoperatively by physical examination and by applying 4 different knee rating scores. All patients were assessed at a mean follow-up of 39 months (range, 14-75 months) and 87 months (range, 62-123 months). At the first follow-up, all knee rating scores had improved significantly (P < .0003) compared with preoperatively; 84% of the reconstructed knees had normal to nearly normal laxities according to the International Knee Documentation Committee 2000 score. At the second follow-up, the functional scores remained significantly (P < .0089) better than preoperatively. Patients with chondrosis at the time of surgery did not have significantly different knee rating scores at the first follow-up compared with patients without cartilage damage. Four years later, the results in the chondrosis group were significantly worse (P < .05) for all knee rating scores compared with the patients without chondrosis. The results in 3 of 4 knee rating scores declined significantly in the chondrosis group over the 48-month interval between follow-up sessions. In the Tegner and Lysholm score, the results deteriorated to the preoperative level. Patients with different cruciate ligament reconstructions did not have significantly different knee rating scores. The posterolateral sling procedure is a stable and reliable technique for posterolateral corner reconstruction. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up.
  The American journal of sports medicine 02/2008; 36(2):267-75. · 3.61 Impact Factor
• Article: Robot-assisted total knee arthroplasty.

  Johan Bellemans, Hilde Vandenneucker, Johan Vanlauwe
  [show abstract] [hide abstract]
  ABSTRACT: Increasing evidence suggests performing total knee arthroplasty using computer navigation can lead to more accurate surgical positioning of the components and knee alignment compared to a conventional operating technique without computer assistance. The use of robotic technology could theoretically take this accuracy one level further because it uses navigation in combination with ultimate mechanical precision, which could eliminate or reduce the inevitable margin of error during mechanical preparation of the bony cuts of total knee arthroplasty by the surgeon. We prospectively followed 25 consecutive cases using an active surgical robot. The minimum followup was 5.1 years (mean, 5.5 years; range, 5.1-5.8 years). Our results demonstrate excellent implant positioning and alignment was achieved within the 1 degree error of neutral alignment in all three planes in all cases. Despite this technical precision, the excessive operating time required for the robotic implantation, the technical complexity of the system, and the extremely high operational costs have led us to abandon this procedure and direct our interest more toward smart semiactive robotic systems. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
  Clinical Orthopaedics and Related Research 12/2007; 464:111-6. · 2.53 Impact Factor
• Source

  Available from: actaorthopaedica.be

  Article: Intraoperative arterial occlusion in total hip arthroplasty. A report of two cases.

  Jean-Pierre Simon, Antoon Van Raebroeckx, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: Limb threatening arterial occlusion during total hip or knee arthroplasty is an uncommon complication. The authors present two cases of thrombosis of the common femoral artery that occurred following and during total hip arthroplasty respectively. Acute thrombectomy was performed in both patients within 3-4 hours after the diagnosis. Both patients permanently kept some numbness over the foot and slight weakness in the extensors. With a delayed diagnosis such lesion may have lead to the loss of their limb. This underlines the absolute need for regular control of the arterial supply, sensory and motor conditions following joint arthroplasty during the first 24 hours following surgery.
  Acta orthopaedica Belgica 09/2007; 73(4):533-5. · 0.40 Impact Factor
• Article: Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome.

  Alexander Van Tongel, Jos Stuyck, Johan Bellemans, Hilde Vandenneucker
  [show abstract] [hide abstract]
  ABSTRACT: Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare complication. In the literature, several different managements are proposed. The graft can be retained during treatment of a septic arthritis after anterior cruciate ligament reconstruction. Case series; Level of evidence, 4. A retrospective analysis of knee joint infections occurring after arthroscopically assisted anterior cruciate ligament reconstructions was conducted. Fifteen patients were treated for postoperative septic arthritis of the knee after anterior cruciate ligament reconstruction between 1996 and 2005. All patients underwent an urgent extensive arthroscopic debridement (wash-out and synovectomy) and parenteral antibiotics and oral antibiotics subsequently. Repetitive wash-outs were performed if necessary. The average time at follow-up for our series was 58 months (range, 9-99 months). Only 1 graft was removed during debridement because it was nonfunctional. All other patients retained their anterior cruciate ligament reconstruction. There was no reinfection. There were 2 traumatic reruptures. We evaluated 11 patients: in 6 patients the Lachman test showed a translation of more than 3 mm, but all patients had a firm endpoint and there was no subjective instability. Early signs of radiological degeneration were seen in 3 patients. The value for the Lysholm knee scoring scale was 83, on average, ranging from 57 to 100. Regarding the International Knee Documentation Committee score, 2 patients had a final evaluation of normal, 7 patients nearly normal, and 2 patients abnormal. The graft can be retained during treatment of septic arthritis after anterior cruciate ligament reconstruction.
  The American Journal of Sports Medicine 08/2007; 35(7):1059-63. · 3.79 Impact Factor
• Source

  Available from: Johan Vanlauwe

  Article: Repair of symptomatic cartilage lesions of the knee: the place of autologous chondrocyte implantation.

  Johan Vanlauwe, Frederik Almqvist, Johan Bellemans, Jean-Pierre Huskin, René Verdonk, Jan Victor
  [show abstract] [hide abstract]
  ABSTRACT: An increasing number of patients with cartilage defects of the knee are being treated with autologous chondrocyte implantation (ACI). To date, no clear guidelines exist for the use and indications of this technique. The BVOT and SOBCOT have established a working group to review the clinical results and the cost-effectiveness of the various treatment modalities and particularly of ACI. This group has formulated recommendations and presents a treatment algorithm based on an in-depth review of recent European and American literature, on peer-reviewed opinions of leading investigators in the field and on a comparative analysis of the clinical results and health-economic aspects of current cartilage repair techniques.
  Acta orthopaedica Belgica 05/2007; 73(2):145-58. · 0.40 Impact Factor
• Article: Cementless total knee arthroplasty with Profix: a 8- to 10-year follow-up study.

  François Hardeman, Hilde Vandenneucker, Johan Van Lauwe, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: A consecutive series of 115 cementless Profix (Smith and Nephew, Memphis, USA) Total Knee Arthroplasties performed in 113 patients were followed in order to determine the functional results and survivorship at 8 to 10 years. All patients were included in a prospective database and were reviewed annually until final follow-up. Patients overall satisfaction was excellent or good in 91.3% of cases. The mean Knee Society's knee and function scores increased respectively from 49.3 and 36.7 preoperatively to 93.1 and 82.2 postoperatively. The Kaplan-Meier estimate of implant survival at 10 years was 97.1%. Two patients underwent revision and were considered as failures. One patient had a fracture of the medial condyle at 4 days post-surgery, and the other was revised for aseptic loosening of the tibial component at 6 years post-surgery. On the basis of this long-term follow-up study, we can conclude that the Profix Total Knee System is effective and safe.
  The Knee 01/2007; 13(6):419-21. · 1.74 Impact Factor
• Article: Physiologic kinematics as a concept for better flexion in TKA.

  Jan Victor, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: Functional outcome after total knee arthroplasty is determined by strength, stability and range of motion. Flexion in the replaced knee is suboptimal for many patients and kinematics after total knee arthroplasty is abnormal. The relation between kinematics of the replaced knee and postoperative flexion is analyzed and compared to normal knee kinematics. Specific characteristics that relate to better flexion are defined: posterior condylar offset, femoral roll-back and femoral external rotation. The rationale for a guided motion knee arthroplasty is developed and positioned within the current state of the art knowledge on total knee arthroplasty.
  Clinical Orthopaedics and Related Research 12/2006; 452:53-8. · 2.53 Impact Factor
• Article: Flexion contracture in total knee arthroplasty.

  Johan Bellemans, Hilde Vandenneucker, Jan Victor, Johan Vanlauwe
  [show abstract] [hide abstract]
  ABSTRACT: We retrospectively evaluated a surgical algorithm for treating flexion contracture in total knee arthroplasty using a prospectively collected database of 2898 knees. We asked how many steps were required to obtain correction with increasing severity of the flexion contracture. We further wanted to know whether correction was maintained at two years after surgery, and which complications occurred in relation to the algorithm. Our algorithm consisted of four steps executed until full extension was achieved: (1) mediolateral ligament balancing with resection of all osteophytes and overresection of the distal femur by 2 mm; (2) progressive posterior capsular release and gastrocnemius release; (3) additional resection of the distal femur up to a maximum of 4 mm; (4) hamstring tenotomy. A flexion contracture between 5 degrees and 15 degrees occurred in 794 cases, between 15 degrees and 30 degrees in 95 cases, and greater than 30 degrees in 35 cases. The data suggest 98.6% of the cases with flexion contracture less than 30 degrees could be corrected with Steps 1 and 2. Even in the 35 flexion contractures greater than 30 degrees, additional resection of the distal femur and hamstring tenotomy was performed in only 28.6% and 22.9% of cases, respectively.
  Clinical Orthopaedics and Related Research 12/2006; 452:78-82. · 2.53 Impact Factor
• Article: Soft tissue balance in total knee arthroplasty: does stress relaxation occur perioperatively?

  Johan Bellemans, Pieter D'Hooghe, Hilde Vandenneucker, Geert Van Damme, Jan Victor
  [show abstract] [hide abstract]
  ABSTRACT: The restoration of correct soft tissue tension is key to achieving a successful total knee arthroplasty. However, it remains unclear whether the status achieved immediately after the operation will persist over time. Some surgeons believe soft tissue stress relaxation occurs and therefore the knee loosens somewhat after the procedure. It was the aim of this study to investigate this hypothesis. We analyzed 25 in vivo total knee implantations using contemporary computer navigation technology to assess and quantify perioperative soft tissue relaxation. Mediolateral joint laxity and maximal passive extension were analyzed immediately intraoperatively and 30 minutes later under the same conditions. Stress relaxation occurred in all cases, leading to increased mediolateral laxity by an average of 1 mm on the medial and lateral sides. Maximal passive extension increased by an average of 3 degrees. This data confirms the hypothesis the knee becomes looser in the early phase after total knee arthroplasty.
  Clinical Orthopaedics and Related Research 12/2006; 452:49-52. · 2.53 Impact Factor
• Source

  Available from: actaorthopaedica.be

  Article: Ankylosis due to heterotopic ossification following primary total knee arthroplasty.

  Emmanuel Thienpont, Thomas Schmalzried, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: We present a case of ankylosis of the knee after knee arthroplasty due to heterotopic ossification in the ligaments. Treatment with resection of the collateral ligaments, reconstruction with a hinged implant and radiotherapy was successful.
  Acta orthopaedica Belgica 09/2006; 72(4):502-6. · 0.40 Impact Factor
• Source

  Available from: actaorthopaedicabelgica.be

  Article: Periprosthetic fracture of the tibial plateau after unicompartmental knee arthroplasty.

  Pieter Van Loon, Bart de Munnynck, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: The authors report three cases of unicompartmental knee arthroplasty (UKA), complicated with peri-operative periprosthetic fracture of the tibial plateau. The surgical technique was held responsible in all cases. The initial treatment was different in every case; all patients ultimately underwent revision total knee arthroplasty with a good functional outcome. The authors emphasise the importance of careful preparation of the tibial plateau during UKA, adequate sizing of the tibial component and caution when using a hammer during implantation of the tibial component. When a tibial plateau fracture occurs, the treatment of choice should be immediate revision total knee arthroplasty.
  Acta orthopaedica Belgica 07/2006; 72(3):369-74. · 0.40 Impact Factor
• Source

  Available from: actaorthopaedicabelgica.be

  Article: Development of a clinical pathway for total knee arthroplasty and the effect on length of stay and in-hospital functional outcome.

  Kris Vanhaecht, Walter Sermeus, Gerd Tuerlinckx, Ine Witters, Hilde Vandenneucker, Johan Bellemans
  [show abstract] [hide abstract]
  ABSTRACT: The goal of reducing the length of a patient's hospital stay after orthopaedic surgery has recently gained much interest from surgeons and hospital administrators. The influence of hospital stay reduction on qualitative outcome is not always documented. The purpose of this study was to investigate this relationship in more detail. We report our experience with patients undergoing total knee arthroplasty. In 2000, an in-hospital clinical pathway for patients undergoing total knee arthroplasty was instituted at the University Hospitals Pellenberg, Belgium. We evaluated this pathway in 103 patients by using a pre-experimental, interrupted, time-series design. This pathway significantly decreased length of stay by 33% without negatively affecting functional outcomes during hospitalisation. In further research also the long-term effects have to be studied.
  Acta orthopaedica Belgica 09/2005; 71(4):439-44. · 0.40 Impact Factor
• Article: What should the surgeon aim for when performing computer-assisted total knee arthroplasty?

  Geert Van Damme, Koen Defoort, Yves Ducoulombier, Francis Van Glabbeek, Johan Bellemans, Jan Victor
  The Journal of Bone and Joint Surgery 02/2005; 87 Suppl 2:52-8. · 3.27 Impact Factor