PubMed Health⌕ Search

Biomedical subjects

B Augereau

Publications and source records attributed to B Augereau.

At least 19 recordsLinked to original sources
PubMed2006

[Metal-metal-backed polyethylene cemented hip arthroplasty: mid-term results].

PURPOSE OF THE STUDY: Metal-on-metal bearings in total hip arthroplasty may, in theory, provide an effective answer to osteolysis in active patients. The purpose of this retrospective study was to evaluate the results of a consecutive series of Metasul total hip arthroplasties with a cemented socket. MATERIAL AND METHODS: The series was composed of 28 total hip arthroplasties in 23 patients (13 women and 10 men). The mean age at operation was 44 +/- 8.3 years (range 22-59 years). The initial diagnosis was osteoarthritis (14 hips), osteonecrosis of the femoral head (11 hips) and rheumatoid arthritis (3 hips). Cemented cups with a metal articulation surface molded into the polyethylene were used. The cup was articulated with a 28-mm metallic head. Cemented stems were used in 27 hips, whereas a hydroxyapatite coated stem was implanted in one hip. RESULTS: One hip required revision for deep infection five months postoperatively. One patient (one hip) was lost to follow-up. Twenty-six hips were evaluated at an average 31-month follow-up (range 12-47 months). All hips were rated excellent or very good. Radiographically, seven hips (27%) had a progressive acetabular radiolucent line, including three complete radiolucent lines. The latter always were located at the bone-cement interface. No implant migration was noted. In these cases, the mean socket diameter was lower than for the rest of the cohort (p < 0.001). DISCUSSION AND CONCLUSION: Progression of acetabular radiolucent lines remains of concern in this series of Metasul artificial hips. It is hypothesized that the diminution of polyethylene thickness has led to an increased rigidity of the socket, resulting in a higher rate of constraints at the bone-cement interface. Special attention must be given to these hips.

Adult↗
PubMed2004

Brown tumor of the spine and progressive paraplegia in a hemodialysis patient.

STUDY DESIGN: Case report. OBJECTIVE: To describe the radiographic features and management of spinal brown tumor and to document tumor mineralization after parathyroidectomy. SUMMARY OF BACKGROUND DATA: Brown tumors are classic skeletal manifestations of hyperparathyroidism usually seen in severe forms. They are increasingly rare because hyperparathyroidism is now diagnosed and treated at an early stage. METHODS: A case of brown tumor of the spine in a 37-year-old woman on chronic hemodialysis is described. The imaging findings before and after parathyroidectomy are discussed. RESULTS: In a woman on chronic hemodialysis, a brown tumor of T8 caused acute spinal cord compression with paraplegia. Magnetic resonance imaging provided an accurate evaluation of the lesion, and needle biopsy confirmed the diagnosis. Emergent surgery was needed to relieve the spinal compression and stabilize the spine. The vertebral lesion underwent remineralization after parathyroidectomy. CONCLUSION: Brown tumor is a benign tumor that resolves after parathyroidectomy. When brown tumor arises in the spine, surgery may be needed to preserve neurologic function.

Adult↗
PubMed2002

[Bipolar arthroplasty in rotator cuff arthropathy: 13 cases].

PURPOSE OF THE STUDY: A series of 13 patients with an excentered osteoarthritis of the glenoid who underwent bipolar shoulder arthroplasty is reported. MATERIAL AND METHODS: The series included 13 patients treated in two centers between 1995 and 1998. Mean age was 70 years (58-88). Constant's absolute score and Swanson's score were used for clinical assessment. The Hamada and Fukuda classification was used for the radiographic assessment. The follow-up radiography series included an AP view in the three rotation positions, an AP view in maximum abduction to assess intraprosthetic mobility, a lateral view (Lamy) and measurements of both humeri. Several measurements were made to assess humerus lateralization and glenoid wear: deltoid lever arm, lateral humeral displacement, distance between the lateral border of the coracoid and the center of the glenoid and the subacromial space. Mean preoperative Constant score was 23 points: pain 3 pts, activity 5 pts, motion 13 pts, force 2 pts. Mean preoperative Swanson score was 11. Active anteflexion was 78 degrees, active abduction 68 degrees and passive external rotation 17 degrees. The Hamada and Fukuda classification was 9 grade 4 and 4 grade 5. All patients had a full thickness unrepairable rotator cuff tear: three with 2 tendon tears, and 10 with 3 tendon tears. All patients were reviewed clinically and had a complete radiography series at last follow-up (mean 28 months, range 7 - 56 months). RESULTS: At last follow-up, the mean absolute Constant score was 37 points: pain 10 pts, activity 9 pts, motion 14 pts, force 4 pts. Mean Swanson score at last follow-up was 19 points. Mean active anteflexion was 69 degrees, active abduction was 63 degrees and passive external rotation was 29 degrees. A satisfactory deltoid lever arm had been achieved compensating the glenoid wear by a greater lateral displacement of the humerus. At last follow-up, there were no cases of humeral loosening but three cases with important glenoid wear were observed after two years. Comparing the results obtained using small cups (40 and 44) with arthroplasties using large cups (48 and 52) showed a trend favoring small cups: Constant score 43 vs 32 points, Swanson score 21 versus 17 points, anteflexion 72 degrees versus 66 degrees and passive external rotation 34 degrees versus 26 degrees. DISCUSSION: Our results confirmed the efficacy of bipolar arthroplasty for pain relief, but the mobility outcome was less than satisfactory, excepting passive external rotation. It would appear to be preferable to use small cups. Comparing our results with data in the literature, particularly the better results for mobility using simple humeral prostheses, suggests that the principles of shoulder and hip arthroplasty concern different mechanisms: a sufficient deltoid lever arm must be achieved, but without overstretching the periarticular soft tissue (capsule, subcapsule, teres minor), and using a cup size close to the size of the healthy humeral head. Glenoid reaming should not be reserved only for asymmetrical glenoid wear in the horizontal plane. CONCLUSION: Our results suggest that bipolar arthroplasty for excentered osteoarthritis of the glenoid cavity is indicated for: stiffness in external rotation, major concentric wear in patients under 65 years of age, or asymmetric glenoid wear.

Aged↗
PubMed2002

[The superolateral approach for shoulder prosthesis].

We describe a superolateral approach to the shoulder for implantation of total shoulder prostheses or humeral prostheses. The advantages of this approach include preservation of the supraspinatus tendon and an excellent exposure of the posterior part of the glenoid cavity. We illustrate this approach with three clinical examples: total shoulder arthroplasty with reconstruction of the posterior part of the glenoid using a screwed autograft for central degeneration with posterior wear of the glenoid, intermediate arthroplasty for excentric degeneration with irreparable rotator cuff tears, and simple humeral arthroplasty with bone suture of the tuberosities for cephalotuberosity fracture.

Arthroplasty, Replacement↗
PubMed2001

[Infection of a total knee prosthesis revealed by an abscess of the posterior leg compartment. A case report].

We report a case of infection of a non-cemented total knee prosthesis that led to abscess formation in the posterior compartment of the leg. This case illustrates the deleterious effect of screws used to fix the non-cemented articular surface of the tibia. Infection, like osteolysis due to polyethylene granuloma, can develop along the screw tract and reach the posterior compartment, especially when the screw protrudes through the posterior cortical of the tibia. Diffusion of an intra-articular event into the posterior compartment should be suspected in patients with a total knee prosthesis who experience calf pain.

Abscess↗
PubMed2001

[GUEPAR total elbow prosthesis in rheumatoid arthritis. A multicentric retrospective study of 38 cases with an average 4-year follow-up].

PURPOSE OF THE STUDY: We conducted a multicentric retrospective analysis of outcome after implantation of 38 GUEPAR elbow prostheses in 36 patients with rheumatoid polyarthritis. MATERIAL AND METHODS: The GUEPAR elbow prosthesis is an anatomic prosthesis developed in 1985 by the Groupe pour l'Utilisation et l'Etude des Prothèses Articulaires (GUEPAR). The recommended surgical technique is described. Patients included in this series had moderate to severe persistent elbow pain. Preoperative motion was 113 degrees flexion with a mean 41 degrees extension deficit. The mean global Mayo Clinic score was 32/100; clinically, the overall assessment was poor in 8 and mediocre in 30. Radiographically there were 16 grade III, 16 grade IV and 4 grade V elbows in the Larsen classification. Two cases were arthroplasty revisions. RESULTS: All patients were seen at a mean 47.6 months follow-up (12 to 97 months). There were two early failures (1 infection and 1 instability) leading to ablation of the prosthesis. Results were analyzed for the 36 remaining arthroplasties. Total pain relief was achieved in 18 cases with only occasional pain in 17 others. Postoperative motion was 132 degrees flexion with a 30 degrees extension deficit, giving a mean 30 degrees gain. The global Mayo Clinic score was 85/100 with 32 excellent, 3 good and 1 mediocre results. Radiography revealed 2 cases of loosening of the humeral component and 1 bipolar loosening that had not required revision at last follow-up. Prosthetic instability was the most frequent among the early and late complications. DISCUSSION: Total elbow arthroplasty is a useful therapeutic option among the treatments proposed (including chemical or isotopic synoviothesis, synovectomy, arthroplastic resection) for rheumatoid elbows. It is indicated for Larsen grades III, IV and V and provides good functional outcome and nearly constant pain relief with an amplitude greater than the 100 degrees, generally accepted as functionally useful. In light of our experience we propose certain modifications of the current GUEPAR implant: adjunction of a condylar extension to the humeral component in order to reduce rotation stress and thus avoid humeral loosening and a radial head element to limit the risk of instability.

Adult↗
PubMed2000

[Transfer of the clavicular portion of the pectoralis major muscle in the treatment of irreparable tears of the subscapularis muscle].

PURPOSE OF THE STUDY: Old tears of the subscapular muscle situated in the glenoid area are not accessible to direct repair and require locoregional muscle plasty. The clavicular portion of the pectoralis major can be used for reconstruction. The purpose of this study was to describe the operative technique and examine short-term outcome. MATERIAL AND METHODS: Five patients, mean age 54 years (45-71 years) with an irreparable tear of the subscapularis in the glenoid area with fatty degeneration greater than grade two in the Goutallier classification were treated. Four had had previous surgery for acromioplasty associated with rotator cuff repair in two or implantation of a humeral prosthesis in one. The preoperative Constant score was 27.5 (mean, range=8.5-54) due to invalidating pain, limited active mobility and reduced muscle force. Gerber's lift-off test was positive for those patients for whom it could be performed. Plain x-rays evidenced anterior subdislocation of the humeral head in one case. Subscapular reconstruction was achieved using the entire clavicular portion of the pectoralis major which was dissected and sectioned at its distal insertion on the humerus then reinserted by transosseous suture onto the lesser tuberosity. The rehabilitation program started with active and passive mobility against gravity within a few days of surgery using biofeedback contraction of the muscle flap then active contractions two months postoperatively. Patients were reviewed at a mean 19 months (6-42 months) for clinical and radiological assessment. RESULTS: Four patients had a painless shoulder with a negative lift-off test. The gain in active mobility was predominantly achieved with anterior elevation and abduction. Muscle force was weak leading to a low overall Constant score at revision (mean=50, range=30-63). Radiographically, the humeral head was centered exactly as on the preoperative films. There were no cases with a new anterior subdislocation nor an aggravation of a former subdislocation. Functional outcome was better in cases with a unique tear of the subscapularis. DISCUSSION AND CONCLUSION: Open surgery is used for primary repair of recent tears of the subscapularis. This technique gives 80 p. 100 good and very good results. In case of symptomatic acromioclavicular osteoarthtisis, better long-term results can be obtained by using a tendodesis of the long biceps and resecting the lateral centimeter of the clavicle. In case of irreparable tears in the glenoid area, reconstruction by transfer of the clavicular portion of the pectoralis major can produce a stable painless shoulder with improved active moblity and normal clinical tests. This method provides anterior stability of the glenohumeral articulation and prevents any anterior subdislocation of the humeral head, thus protecting the joint from secondary degeneration.

Activities of Daily Living↗
PubMed1999

[Cadaver study of acetabular cup mobility in the healthy hip and prosthesis by monopodal pressure simulation ].

PURPOSE OF THIS STUDY: The purpose of this study was to quantify relative displacement of anterior and posterior horn of the acetabulum lunate surface using Omega strain gauges while increasing loads were applied to the hip joint. Measurement were performed on fresh cadaver bones in unipodal stance using experimental method before and after socket's implantation. MATERIAL AND METHODS: [corrected] Nine skeletons, from fresh non-embalmed cadavers, including pelvis, the three last lumbar vertebrae and both femurs were maintained in unipodal equilibrium using metallic cables for muscle passive simulation. Loads were applied up to 700 N. Specific extensometric Omega strain gauges were created and tested, with 5 mu of sensibility. Measurement of displacement between horns were studied on two sides of each pelvic before and after implantation of conventional and prototype cemented or press fit implants. RESULTS: Among 81 loads on 18 acetabulum healthy and implanted, displacement was significant in 58 cases with a spacing of horn of 7 to 140 mu with average 31.1 mu and non significant in 25 cases. On healthy acetabulum, spacing was variable from 12 to 140 mu (average 43.2 mu) in 18 of 26 loads. On implanted acetabulum by different sockets, spacing was variable from 7 to 100 mu (average 27.4 mu) in 40 of 55 loads. Displacement was function of rotation hip, smaller in internal rotation and larger in external rotation. Spacing of horns was reduced in oversize sockets. DISCUSSION: The data obtains by omega strain gauge suggest acetabular displacement is not univocal under load. There were a widening of the acetabular notch on load. This can be explained by the modification of primary incongruity of the two components of the hip joint because of acetabular deformation. Such results are in agreement with recently published data obtained about length of the transverse acetabular ligament.

Acetabulum↗
PubMed1997

[Acetabulum deformations after implantation of a cemented cup with or without metal-back component. An in vitro comparative study of monopodal load].

PURPOSE OF THE STUDY: The purpose of this study was to find a biomechanical explanation for a clinical failure of metal backed acetabular components. Periacetabular deformations were measured on fresh cadaver bones equipped with strain-gauge rosettes. MATERIAL AND METHODS: Two skeletons, including pelvic bone, the two last lumbar vertebrae, and both femurs were maintained in unipodal equilibrium using metallic cables for muscle simulation. Loads were applied up to 700 N the approximating average body weight. A comparative study of periacetabular deformations was performed: right sides of each pelvic bone were implanted with conventional cemented implants, and left sides with metal backed cemented implants of same diameter and size. RESULTS: Significant differences were noted: whereas no modification was brought by implantation of conventional cemented sockets, periacetabular deformations were reduced and smoothed after implantation of cemented metal backed implants. Such results are in agreement with recently published data obtained, using the finite element analysis method. DISCUSSION: A study of pelvic ring and acetabular walls displacement was performed, but the authors couldn't find any clinical relevance to this biomechanical study.

Acetabulum↗
PubMed1997

[Bad clinical results of cemented caps with metal-backed acetabular components. 124 cases with 21 months follow-up].

PURPOSE OF THE STUDY: The authors reviewed with short term follow-up 124 total hip arthroplasties using a cemented metal-backed acetabular component. The purpose of the study was to evaluate clinical and radiological results because of early periacetabular radiolucent lines reported by Ritter. MATERIAL AND METHODS: Surgical procedures were performed in 1988 and 1989 with Saint-Antoine prosthesis (PSA) including cemented titanium metal-backed socket. Functional results were appreciated with Postel-Merle d'Aubigne's score. Radiological results were appreciated using De Lee and Charnley's criterias for radiolucent lines and Yoder's criterias for socket's migrations. We studied correlation between radiolucent line and age, weight, hip disease, associated bone graft, socket size and technical errors. RESULTS: With short term follow-up (21 months), we found 60.4 per cent hips with a maximal PMA score (18) with an average score of 17.5 per cent. We observed 26.4 per cent of complete periacetabular radiolucent lines with 3 sockets loosening with migration. No significant correlation were found between radiolucent lines and age, weight, hip disease, associated bone graft, socket size, and technical errors. DISCUSSION: This periacetabular radiolucent line rate was comparable to the results of the series using such a cemented metal-backed socket. This rate was clearly higher than the results of others series using cemented polyethylene sockets. These bad results were not correlated to those of finite elements analysis. We think that this is due to metal-backed socket excessive rigidity. CONCLUSION: Because of this high periacetabular radiolucent line rate, despite of finite elements analysis results, we no more use cemented metal-backed acetabular socket since 1991.

Adult↗
PubMed1996

Experimental study of periacetabular deformations before and after implantation of hip prostheses.

This work is based upon an experimental simulation of one-legged stance, under loads close to the average body weight. Skeletons, harvested from fresh non-embalmed cadavers, included pelvis, two lumbar vertebrae, and both femurs. Periacetabular deformations were studied using tridirectional strain gauges before and after implantation of different types of acetabular prostheses in eight pelves: conventional polyethylene-cemented sockets, polyethylene sockets cemented into a metallic device, metal-backed cemented sockets, and hemispherical cementless press-fit cups with porous or hydroxyapatite coating. Strain measurements showed the persistence of important bone deformations at implant periphery. Mean values of normal periacetabular deformations were significantly reduced in two out of five acetabula implanted with cemented implants. In contrast, mean values of normal and circumferential deformations increased when polyethylene sockets were cemented into acetabular reinforcement devices, but this augmentation was significant in only one out of two cases. After implantation of cementless hemispherical metal-backed cups, periacetabular bone deformations also increased, but modifications were significant in a single case. Results are discussed according to the type of fixation (cemented or cementless), and to the difference in rigidity between implant and bone. There was no clear relation between implant stiffness and the magnitude of bone deformations.

Acetabulum↗
PubMed1996

[Four part valgus impacted fractures of the upper extremity of humerus: ilium graft reconstruction. Apropos of 8 cases].

PURPOSE OF THE STUDY: We present the results of an original technique for reconstruction of valgus-impacted humeral head using autologous iliac bone. MATERIAL AND METHODS: Between 1992 and 1993, 8 patients (average age 66 years, range 43 to 79 years) with four-part valgus impacted proximal humeral fractures were operated with the aim of preserving the humeral head. All fractures were treated with open reduction and were stabilized only with autologous bone. This procedure provided fixation without osteosynthesis. Using a deltopectoral approach the impacted segment of the humeral head was raised, the void was filled with autologous three-cortical iliac bone graft, and the tuberosities were relocated with the goal of anatomic reconstruction. The assessment included clinical examination including Constant's score, radiographic examination and MRI examination. Only one patient was not available for the review at follow-up evaluation (minimum 12 months, average 16 months). RESULTS: According to Constant's criteria, two results were excellent, two very good, one good, one fair and one patient were considered failure. Average Constant's score was 62; average score in comparison with the healthy side was 76 per cent. Radiographic findings showed in all cases healing and incorporation of the graft. MRI results showed only one asymptomatic partial avascular necrosis (14 per cent). DISCUSSION: This specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment without lateral displacement has a rate of avascular necrosis lower than that of other displaced four-part fractures. Blood supply of the articular segment is maintained via the periosteum extending to the medial part of the anatomic humeral neck. These data authorized the authors to propose a new conservative treatment for four-part valgus impacted proximal humeral fractures.

Adult↗
PubMed1996

[Instability of the elbow after supracondylar humeral non-union in cubitus varus rotation. Apropos of 2 cases observed in adults].

The authors describe 2 originals cases with a painful snap or "recurrent" elbow instability in adults after displaced supracondylar fractures in childhood, with a malunion in varus and internal rotation. Varus and internal rotation of the distal humeral epiphysis were responsible for instability because of elbow kinematic modification. Extra-articular osteotomy fixed with a plate allowed pain relief, stability, and range of motion improvement.

Adult↗
PubMed1994

[The Guepar total elbow arthroplasty].

The Guepar total elbow replacement is a low friction, minimally constrained gliding prosthesis. The humeral and ulnar components are of metal with intramedullary stems, which are cemented. There is a sigmoid shaped, high density polyethylene interposition bearing. The authors have used the prosthesis in 33 patients with rheumatoid arthritis, 4 with post-traumatic problems, one with chondrocalcinosis and another with degenerative changes of uncertain aetiology. In the patients with rheumatoid arthritis, one sustained a posterior dislocation and two suffered deep infection. In the remaining 30, the overall results were good at an average review of 32 months. The mean range of movement had increased by 31 degrees and pain was absent in 28 elbows. In the management of rheumatoid arthritis total elbow arthroplasty must be part of an overall plan of treatment. Severe involvement of the wrist and shoulder must be dealt with before elbow replacement is considered.

Adult↗
PubMed1993

[Management of a suspected lesion of a cruciate ligament].

After classifying and describing the epidemiology of various traumatic ligament lesions of the knee: "isolated rupture", "triads" and "pentads", the author describes their mechanism and clinical presentation. Plain x-rays and stress x-rays, possibly under anaesthesia, are necessary to establish the diagnosis of the lesions. In 1991, in the absence of triads, pentads or radiological bone avulsion, they are followed by diagnostic arthroscopy to determine the partial or complete nature of the cruciate ligament rupture; stress films and arthroscopy under anaesthesia can be advantageously replaced by high performance MRI in the months to come.

Anterior Cruciate Ligament↗