[Sinistrality in orthopedic surgery: state of the art and perspectives].
Explore the source record for details and available documents.
Compensation and Redress↗
Biomedical subjects
C Delaunay
Publications and source records attributed to C Delaunay.
[Can metal-on-metal bearings improve the longevity of total hip prostheses?].
PURPOSE OF THE STUDY: In total hip arthroplasty (THA), inter-series comparative clinical results cannot be considered worthy before at least 10 years of average follow-up, as shown in the Swedish Arthroplasty Register experience (1978-1993). Last generation metal-on-metal bearings were introduced in France only nine years ago (1995). To date, using mid term information, data from the literature, and our experience, one could assume that this bearing material has the capacity to improve THA longevity. Three types of information were analyzed: 1) comparative radiographic and EBRA studies published on early migration (<2 years) of acetabular implants; 2) preliminary comparative data on wear and osteolysis at the 8-year maximum follow-up; 3) clinical data on dislocation frequency and in vitro and in vivo observations of bearing separation and sliding. Study no 1: primary stability of these metal-on-metal acetabular cups was better than for polyethylene (PE) cups or alumina liners; study no 2: no detectable wear and less osteolysis were observed to date with metal-on-metal bearings versus their alumina-on-PE counterparts. Study no 3: less dislocation and less head sliding were measured with the metal-on-metal versus alumina-on-PR bearings possibly due to the interfacial forces provided by lubricating fluid (suction fit). CONCLUSION: According to current knowledge, this metal-on-metal bearing still represent, with alumina-on-alumina and highly crosslinked PE, a competitive and comprehensive option to improve THA longevity. The real pending problem concerns the frequency and above all the intensity of metal delayed hypersensitivity reaction and their potential effect on implant loosening.
Aluminum↗
Mesenchymal stem cells rescue CD34+ cells from radiation-induced apoptosis and sustain hematopoietic reconstitution after coculture and cografting in lethally irradiated baboons: is autologous stem cell therapy in nuclear accident settings hype or reality?
Autologous stem cell therapy (ACT) has been proposed to prevent irradiated victims from bone marrow (BM) aplasia by grafting hematopoietic stem and progenitor cells (HSPCs) collected early after damage, provided that a functional graft of sufficient size could be produced ex vivo. To address this issue, we set up a baboon model of cell therapy in which autologous peripheral blood HSPCs collected before lethal total body irradiation were irradiated in vitro (2.5 Gy, D0 1 Gy) to mimic the cell damage, cultured in small numbers for a week in a serum-free medium in the presence of antiapoptotic cytokines and mesenchymal stem cells (MSCs) and then cografted. Our study shows that baboons cografted with expanded cells issued from 0.75 and 1 x 10(6)/kg irradiated CD34+ cells and MSCs (n=2) exhibited a stable long-term multilineage engraftment. Hematopoietic recovery became uncertain when reducing the CD34+ cell input (0.4 x 10(6)/kg CD34+ cells; n=3). However, platelet recovery was accelerated in all surviving cografted animals, when compared with baboons transplanted with unirradiated, unmanipulated CD34+ cells (0.5-1 x 10(6)/kg, n=4). Baboons grafted with MSCs alone (n=3) did not recover. In all cases, the nonhematopoietic toxicity remained huge. This baboon study suggests that ACT feasibility is limited.
Animals↗
Second generation anti-cyclic citrullinated peptide (anti-CCP2) antibodies can replace other anti-filaggrin antibodies and improve rheumatoid arthritis diagnosis.
We compared the diagnostic performance of anti-cyclic citrullinated peptide antibodies detected with second-generation enzyme immunoassay (anti-CCP2) with that of IgM-rheumatoid factor (RF), anti-perinuclear factor (APF), and anti-keratin antibodies (AKA). The sensitivity of anti-CCP2 was better than that of APF and AKA: they were detected in 25% rheumatoid arthritis (RA) patients without detectable APF or AKA. Their specificity, evaluated in other inflammatory rheumatic disease, was similar to that of APF and AKA. Despite the lower specificity, IgM-RF in combination with anti-CCP2 is interesting, as they do not completely overlap. Anti-CCP2 antibody detection seems to be a good alternative to other anti-filaggrin antibodies in the diagnosis of RA.
Arthritis, Rheumatoid↗
Osteopenia in patients infected by the human immunodeficiency virus. A case control study.
Summary - In the last few years, the use of highly active antiretroviral therapy has radically modified the prognosis of human immunodeficiency virus (HIV) infection. Osteonecrosis and osteoporosis are among the bone complications recently described in HIV-infected patients. We report a preliminary study comparing 47 HIV-infected patients (31 men and 16 women) to 47 age- and sex-matched controls. Bone mineral density was lower in patients than in controls: in men, 0.919 +/- 0.120 g/cm2 vs. 1.010 +/- 0.139 g/cm2 (P = 0.01) at the total hip and 0.948 +/- 0.100 g/cm2 vs. 1.043 +/- 0.117 g/cm2 (P = 0.0008) at the lumbar spine; in women, 0.912 +/- 0.149 g/cm2 vs. 0.968 +/- 0.090 g/cm2 at the total hip (P = 0.17) and 0.989 +/- 0.152 g/cm2 vs. 1.080 +/- 0.097 g/cm2 (P = 0.01) at the lumbar spine. HIV-infected males were more likely to have osteopenia and osteoporosis, as compared to the male controls (19 vs. 14 and 4 vs. 1, respectively, P = 0.02). None of the women had osteoporosis; nine HIV-infected women and one female control had osteopenia (P = 0.003). No fractures were recorded. In this preliminary study, no evidence supporting a relationship between bone loss and protease inhibitor treatment was found.
Absorptiometry, Photon↗
Incidence of hematological malignancies in Martinique, French West Indies, overrepresentation of multiple myeloma and adult T cell leukemia/lymphoma.
A registry of hematological malignancies is held in the unit of cytology of the University Hospital of Martinique. Human T cell lymphotropic virus type-1 (HTLV1) is endemic in this island. We determined the incidence and epidemiological features of hematological malignancies from the 715 new cases diagnosed between 1990 and 1998 among the adult population. Incidence rates per year were steady during this period. The most frequent hematological malignancies were multiple myeloma (MM) (34%), followed by non-Hodgkin's lymphoma (NHL) (23%). Among the cases of NHL with an immunohistological study, 57% had a T cell phenotype. Among these 61% were adult T cell leukemia/lymphoma. Epidemiological data on hematological malignancies in the West Indies has not been previously reported. There are two striking differences with other population-based registries: a high incidence of MM (5/100000) and a high proportion of T cell NHL among NHL (57%). The high proportion of T cell NHL is probably due to the high incidence of ATL. A low incidence of B cell NHL might also contribute to this effect. The increased incidence of MM in West Indies had not been previously reported. A similar high incidence of MM has been reported among Afro-Americans in the USA.
Adult↗
Grit-blasted titanium femoral stem in cementless primary total hip arthroplasty: a 5- to 10-year multicenter study.
A total of 133 cementless primary total hip arthroplasties using the Zweymuller-Alloclassic grit-blasted titanium tapered stem were performed in 3 institutions. The patient cohort was divided into 2 subgroups, nonselected and selected, on the basis of excellent bone stock and age (<65 years old at surgery). Acetabular components were all cementless, and bearing surfaces were all alumina-ceramic on polyethylene. After a 7.3-year average follow-up period (range, 5-10 years), 118 primary femoral replacements in 109 patients could be reviewed fully. Mean age at surgery was 55.7 years (range, 27-84 years). According to the Merle d'Aubigne and Charnley rating system, clinical results were graded excellent and good in 89% of hips and fair in 11%. Radiologically, early subsidence >2 mm could be detected in 4 hips (3.4%). Calcar atrophy and spot welds were noted in 77% and 82% of hips. Femoral osteolysis granuloma was noted in 4 hips (3.4%). There has been no stem fracture and no ceramic head breakage. The survivorship at 10 years with definite femoral aseptic loosening (radiographic failure) as the endpoint was 100% (95% Wilson confidence interval, 78.4%-100%; worst scenario, 95.4%). A significant difference between the nonselected and selected patient subgroups was observed only for early reoperation (P =.03) and proximal stress shielding (P =.01). Press-fitting but not filling the femoral canal with a rough titanium, straight, tapered femoral component represents, at intermediate follow-up, a promising cementless option in primary total hip arthroplasty.
Adult↗
Survival analysis of cementless grit-blasted titanium total hip arthroplasties.
Although about 200000 cementless Zweymüller-Alloclassic total hip arthroplasties (THAs) were carried out worldwide in the last decade, the survival analysis of these prostheses was not available in the 2000 report of the Swedish national hip arthroplasty registry. We report a prospective survivorship analysis of 200 consecutive grit-blasted cementless Alloclassic primary THAs carried out since 1988. Using surgical, clinical and radiological endpoints for the stem and the threaded cup the ten-year survivorship was 91.5% for reoperation for any cause, 96.4% for hip pain (Merle d'Aubigné score < 5 points, clinical failure), 99.4% for definite aseptic loosening (radiological failure) and 99.3% for revision for aseptic loosening. Using the Swedish registry criteria of primary osteoarthritis and revision for aseptic loosening as the endpoint, the survival rate of 99.1% at ten years for the subgroup of 157 Alloclassic THAs in osteoarthritis compares favourably with that of the best modern cemented hip replacements reported in the Swedish arthroplasty registry.
Adult↗
[Straight femoral taper in cementless primary total hip replacement in less than 65 year-old patients: multicenter study of 115 consecutive implantations at mean 8,2 year follow-up].
PURPOSE OF THE STUDY: The Swedish Arthroplasty Registry experience with cemented primary total hip arthroplasty (THA) has pointed out age below 65 and high activity level as 2 major factors impairing THA long-term outcome. The aim of this study was to provide intermediate results of cementless femoral replacement in primary THA with use of the Alloclassic-SL grit-blasted titanium stem in "high risk" groups of patients. MATERIAL AND METHODS: From June, 1988 to June, 1992, 127 cementless primary THA's were consecutively performed in<65 year old patients in 2 institutions. Acetabular components were all cementless (threaded cup in 74%) and bearing surfaces were all alumina-ceramic 28mm heads on polyethylene (PE). Five patients (6 hips) died and 6 other hips were lost to follow-up before the 5-year minimum follow-up. Thus, 115 hips in 106 patients could be fully reviewed after a 8.2 year average follow-up period (range, 5 to 12 years). Mean age at surgery of the 62 male and 44 female patients was 52 years (range, 27 to 65 years). RESULTS: Of the index group (127 hips), intra-operative fracture of the greater trochanter and early dislocation were noted in 4.7% and 3.2% of hips, respectively. Of the study group (115 hips), clinical results according to the Merle d'Aubigné and Charnley rating system were graded excellent and good in 94% of hips and fair in 6% (7 hips), with no poor result. Radiologically, early subsidence of more than 2mm could be detected in 8 hips (7%). Calcar atrophy and spot welds were noted in 81% and 89% of hips, respectively. Proximal reactive and lucent lines and mild proximal stress shielding were observed in 10.5% and 4.3% of hips, respectively. Ten-year survivorship with stem revision for any reason as the end point was 99.2% (92.4-99.9) (1 stem exchanged and reoriented for immediate dislocation). One revision is pending for extensive femoral osteolysis due to polyethylene (PE) wear. There was no stem fracture and no ceramic head breakage thus far. Overall PE-wear rate ranging 1-2 mm was detected in 13 hips (9.6%) and femoral osteolysis in 4 hips (3.5%). DISCUSSION: Mid-term results of this cementless straight taper at 10 year are at least equal to those of well performing cemented components, even in "high risk" groups of patients. Conversely, 28mm alumina-ceramic heads can reduce but not prevent the occurrence of PE-wear in such a healthy and active population. CONCLUSION: Press-fitting but not filling the femoral canal with rough titanium straight tapers like the Alloclassic-SL femoral component represent a promising alternative to modern femoral cementing technique in primary THA. Improvement is expected through the use of more wear resistant bearing surfaces.
Adult↗
[Arthroscopic assessment and clinical correlation of femoro-patellar tracking. Apropos of 116 knees in 115 patients under 40].
PURPOSE OF THE STUDY: The dynamic study of the patello-femoral joint is of outstanding interest in unexplained anterior knee pain syndrome. Accuracy of information provided by video-arthroscopy is of concern due to its technical conditions. Serum inflow favors the natural patellar tendency to shift laterally (mean value, 7 degrees ). Absence of active quadriceps muscle contraction under anesthesia and use of a tourniquet act conversely. The aim of this study conducted in less than 40 year-old patients, was to correlate retrospectively arthroscopic evaluation of patello-femoral tracking and trochlear centralization measured during conventional "inflow" procedure, with patella related pain syndrome and its outcome. MATERIAL AND METHODS: The study group included 116 knees in 66 male and 49 female patients (1 bilateral). Mean age at arthroscopy was 26 years (range, 12 to 40 years). According to pre-arthroscopic clinical data, knees were broken down into 3 study groups: Gr-T (Test, painless patella), 50 knees with meniscal and/or ligament injury: Gr-PRP (Patella Related Pain but no dislocation), 55 knees: Gr-DLC (patella DisLoCation), 11 knees. Arthroscopic technique was the following: general anesthesia, high-proximal pneumatic tourniquet (40mmHg), single antero-lateral portal and serum inflow by simple gravity (2m). The minimum flexion angle that was necessary to obtain de visu a perfect centralization of the patella dome into the trochlear groove was systematically measured before any arthroscopic procedure was performed. RESULTS: Average value of the Flexion Angle providing perfect Centralization (FAC) in the "serum inflow" arthroscopic situation was 39 degrees in Gr-T and 52 degrees in Gr-PRP; this difference was highly significant (p <.0001). Patella centralization could not be achieved despite maximum possible flexion in 5 of the 55 PRP-knees and in 9 of the 11 DLC-knees. FAC value > 65 degrees correlated significantly (chi2, p=0.0001) with patella related clinical symptoms (pain and instability, groups PRP + DLC) and indicated patellar maltracking. In the PRP-group, an "FAC value > 65 degrees" showed a low sensitivity (0.34), but high specificity and positive predictive value of 0.98 and 0.95, respectively. DISCUSSION AND CONCLUSION: Arthroscopic examination for patello-femoral tracking can provide measurable information on the FAC angle, that is reproducible under precise technical conditions. Its diagnostic value in unexplained anterior knee pain versus information provided by conventional imaging, and their respective effectiveness-risk and -cost relations could be the purpose of future prospective studies.
Adolescent↗
[Second-generation metal bearings in cementless primary total hip arthroplasty: rationale, French homologation and preliminary results].
PURPOSE OF THE STUDY: Long-term outcome of Charnley low-friction arthroplasty in young active patients is impaired worldwide due to wear of the polyethylene (PE) component and osteolysis. In the late eighties, reports of possible low wear with some former metal on metal total hip arthroplasties led to the reintroduction of metallic bearings. The aims of this work were to examine the rationale for using metal on metal bearings in primary total hip arthroplasty (THA) and report preliminary results obtained with cementless Metasul -Alloclassic hips. MATERIALS AND METHODS: From January 1994 to March 1997, 64 cementless primary Alloclassic-THA (grit-blasted titanium SL stems and CSF treaded cups) with 28 mm Metasul bearings were performed. Mean age at surgery was 60 years (range, 36-73). Diagnoses were usual, mainly primary osteoarthrosis in 70 p. 100 of the hips. Two bearing surfaces were exchanged for late dislocation at 2.6 and 2.9 years. Thus, 62 hips in 58 active patients (4 bilateral) were reviewed after a minimum 2-year follow-up (mean 3.2 years, range 24-66 months). RESULTS: Clinical results according to the Merle d'Aubigne and Charnley rating system were graded excellent or good in all 62 hips. Radiologically, calcar, atrophy and spot welds were noted in 93 p. 100 and 82 p. 100 of hips respectively. Proximal reactive and lucent lines and mild proximal stress shielding were observed in 8 p. 100 and 4.8 p. 100 of hips respectively. No osteolysis granuloma has thus far been observed in the vicinity of any component. Cobalt blood level remained normal, except in 6 cases due to occupational exposure (n=1), possible impingement (n=1) or an unknown cause (n=4). All elevated cobalt levels (range 7 to 25 microg/l) were nevertheless far below the toxic limit. DISCUSSION: Dislocation may be due either to the posterolateral surgical approach and/or early impingement with the first Metasul bearing design (head sleeve). Metasul acetabular component fixation is not restricted to only cementless metal-backing, unlike alumina-ceramic cups. The concern about the toxicity of metallic wear debris dissemination and the hematocarcinogenic risk must be taken into consideration as for any metallic THA. Follow-up is too short for the new polys for significant comparisons. CONCLUSION: Metal on metal tribology is well known in vitro and Metasul bearings have functioned in vivo for 12 years (120 000 Metasul hips worldwide) as was expected from laboratory tests. Obviously, this friction couple is not the unique answer to PE-wear and THA longevity, but, in light of current data, appears as a trustworthy solution available today.
Aged↗
[Extrapulmonary tuberculosis in the central western region. Retrospective study of 217 cases (Gericco 1991-1993)].
OBJECTIVES: To analyze the epidemiological, clinical and diagnostic characteristics of extrapulmonary tuberculosis in western France observed from 1991 to 1993 in different patients populations (HIV+ infected patients, immunosuppressed non-HIV infected patients, non-immunosuppressed patients) and according to various localizations (lymph nodes, bone and joints, genital organs, nervous system and meninges, miliary disease). METHODS: This retrospective study included 217 cases of extrapulmonary tuberculosis diagnosed from 1991 to 1993 in western France by GERICCO (Groupe d'Epidémiologie et de Recherche en Infectiologie Clinique du Centre-Ouest). Demographic, clinical, biological, microbiological and radiographic characteristics as well as clinical course on specific therapy were assessed. RESULTS: Extrapulmonary tuberculosis generally occurred most often in immunosuppressed patients but 34% of cases were observed in people without any underlying disease or risk factors. Delay to diagnosis was especially long in the non-immunosuppressed patients (mean = 96 days) but shorter in the HIV-infected patients (mean = 59 days). It was shorter in case of nervous system involvement (mean = 52 days) or military disease (mean = 80 days) than in bone and joints (mean = 120 days) and lymph nodes (mean = 102 days). Microbiologically proven tuberculosis represented only 75% of cases despite numerous investigations. Overall prognosis was good except in nervous system and meninges localizations. Failures were mainly due to death in immunosuppressed patients. CONCLUSION: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. In 50% of cases, confirmation of diagnosis takes more than one month. In case of doubt, clinicians should not wait for laboratory results before implementing empirical specific therapy.
AIDS-Related Opportunistic Infections↗
Cementless primary total hip replacement. Four to eight year results with the Zweymüller-Alloclassic prosthesis.
One hundred and twenty-nine consecutive cementless primary total hip arthroplasties with Zweymüller-Alloclassic grit-blasted titanium components were evaluated prospectively at an average follow-up of 5.9 years. The clinical results were graded as excellent or good in 116 hips (90%), fair in 12, and poor in one due to a fracture of the femoral shaft at operation leading to early stem loosening and delayed ring loosening. Failure was defined as definite aseptic loosening, and the final survivorship at 8 years was 99.3% for the SL-stem, and 99.1% for the CSF-threaded cup. These early results compare favourably with those of total hip arthroplasties using new cementing techniques.
Adult↗
Glucose-insulin kinetics of a bioartificial pancreas made of an AN69 hydrogel hollow fiber containing porcine islets and implanted in diabetic mice.
The goal of this study was to determine whether porcine islets encapsulated in hollow fibers made of AN69 copolymer can correct hyperglycemia in diabetic mice and provide normal tolerance to a glucose challenge. In vitro perifusion of hollow fibers demonstrated the rapid kinetics of insulin release in response to glucose. Two fibers containing islets were transplanted into the peritoneal cavity of each of 17 streptozotocin induced diabetic mice. In 11 mice, diabetes was reversed within 3 days with plasma glucose levels decreasing from 19.7 +/- 0.9 (mean +/- SEM) before implantation to 10.9 +/- 0.8 mmol/L. Intraperitoneal glucose tolerance tests were performed in transplanted (n = 7), nondiabetic (n = 15), and diabetic mice (n = 6). A normal glucose pattern was observed in the transplanted diabetic mice. This was achieved in the presence of plasma insulin levels lower than those observed in control nondiabetic mice, suggesting the presence of a state of hypersensitivity to insulin, which was demonstrated in this model by exogenous insulin tolerance tests. In conclusion, encapsulation of islets suspended in ultraculture medium in biocompatible membranes of AN69 can provide xenograft survival, and complete normalization of glucose tolerance can be achieved.
Acrylic Resins↗
[Multifocal tuberculosis. Apropos of 49 cases in the midwest region. GERICCO (Group for Epidemiology and Research in Clinical Infections of the Central West of France), 1991-1993].
Diffuse or multifocal tuberculosis (TB) accounts for 9% to 10% of cases of extrapulmonary TB and carries a poor prognosis with a mortality rate of 16% to 25%. Forty-nine cases of multifocal TB defined as involvement of two extrapulmonary sites with or without pulmonary TB were reviewed. Mean patient age (+/- SD) was 50 +/- 18 years. Twenty-three per cent of patients were immigrants. A history of TB and contact with a TB patient were found in 23% and 18% of cases, respectively. Of the 52% of immunocompromised patients, 38% were HIV-positive. The skin tuberculin test was positive in 67% of cases. Mean time from symptom onset to admission was 80 +/- 77 days (median, 58 days). The 49 patients had a total of 128 TB foci. Six patients had positive blood cultures. The tubercle bacillus was recovered from the extrapulmonary sites in 88% of cases. Mean treatment duration was nine months. Recovery from the TB was achieved in 64% of cases. The overall mortality rate was 47%, and 33% of patients died as the direct result of TB. Most deaths occurred in immunocompromised patients. A high index of suspicion for multifocal TB should be maintained in immunocompromised patients, even those who test negative for the HIV.
AIDS-Related Opportunistic Infections↗
[Effect of arthroscopic fluid inflow on the femoro-patellar tracking. Comparative study of the dry and fluid filled knee].
INTRODUCTION: The dynamic study of the patello-femoral joint is of outstanding interest in unexplained anterior knee pain syndrome. Nevertheless, the accuracy of information regarding this particular point by means of video-arthroscopy is of concern, due to the surgical conditions of the procedure. The aim of this study was to appreciate the effect of serum inflow on the visual evaluation of the patello-femoral tracking during conventional knee arthroscopy. MATERIAL AND METHODS: The study group included 100 knees in 68 male and 32 female patients. Mean age at surgery was 36 years (range, 13 to 69 years). Indication for knee arthroscopy was: meniscal and/or ligament injury in 77 knees (group I), patello-femoral pain in 13 knees (group II), tibial tuberosity screw removal in 7 knees (group III) and "mysterious" painful knee in 3 patients (group IV). Arthroscopic technique was conventional; general anaesthesia, pneumatic tourniquet, single antero-lateral portal and serum inflow by simple gravity. We measured the minimum flexion angle that was necessary to obtain de visu a perfect centralization of the patella dome into the trochlear groove in two situations: before inflating the knee ("dry" angle) and after serum inflow ("serum" angle). RESULTS: The average value of the flexion angle providing perfect centralization (FAC) in the "dry" situation and in the "serum" situation was 31 degrees (range, 10 to 75 degrees) and 38 degrees (range, 20 to 85 degrees), respectively. Of the 100 studied knees, the average difference between the "serum" and the "dry" FAC was about 7 degrees (6 degrees 45', standard deviation: 3 degrees 56') and was superior to 10 degrees in only one occasion; this difference is significative (T-test; p < 0.0001). Conversely, there was no significant difference between the average differential FAC figure noted in each group of patients (ANOVA; p = 0.28). DISCUSSION: The role, if any, of the tourniquet inflated around the proximal thigh is more or less constrictive, thus restricting the natural patellar tendency to shift laterally. Moreover, the absence of active quadriceps muscle contraction under general anaesthesia acts also in the same way. CONCLUSION: By comparison with the more natural "dry" situation, in nearly all occasions serum inflow by simple gravity induced less than 10 degrees of knee flexion overcourse until the obtention of a perfect patello-trochlear centralization. This data must be taken to consideration during arthroscopic examination of the patello-femoral tracking in the diagnosis of anterior knee pain that would remain unexplained after conventional imaging procedures.
Adolescent↗
[10-year survival of Zweymüller total prostheses in primary uncemented arthroplasty of the hip].
PURPOSE OF THE STUDY: To provide clinical and survival results of a consecutive series of primary total hip arthroplasties (THA) performed with the Zweymüller grit-blasted titanium total hip prostheses of the 2 last designs (Hg and Alloclassic-SL), and to compare the 10-year survivorship with those of other prostheses either cemented or cementless. MATERIAL AND METHODS: Of 238 index THAs, 213 hips have been prospectively studied with a 2 year minimum follow-up (average, 6.5 years; range, 25 to 146 months). Mean age was 63 years. Hip arthrosis was the main diagnosis (88 per cent). RESULTS: Intra-operative fracture rate (n = 238 primary THAs) was 6.3 per cent, 2.9 per cent and 1.3 per cent, for the greater trochanter, the upper femur, and the acetabulum, respectively. Early dislocation rate was 4.6 per cent. Average Postel-Merle d'Aubigné-Charnley Hip Score raised from 11.3 points pre-operatively, to 16.7 points at last follow-up. Clinical results were graded excellent and good in 93 per cent of hips, fair in 5.1 per cent, and poor in 1.9 per cent. At least 19.5 per cent of stems subsided 2-10mm within the first 2 years. Reactive and lucent lines have been noted in 33 hips (15.5 per cent) in complete Gruen zones 1 and 7, and in 4 hips (1.9 per cent) extending in zones 2 and 6. 1 Hg and 1 SL components definitively failed to stabilize, and have been revised, at 5.6 and 2.4 years, respectively. Proximal mild stress shielding and Brooker III and IV heterotopic bone formation were noted in 11.7 per cent and 12.7 per cent of hips, respectively. Beside one immediate revision, 4 threaded components failed to achieve initial stability. Two migrated within the first 2 years, then stabilized with good clinical results at 8.5 and 5.2 years. The 2 others failed their osseointegration, with only 1 revision thus far. Most immediate post-surgery bone-implant acetabular gaps in 57.8 per cent of hips, have nearly disappeared at last control, with residual lucencies around 7 per cent of rings. Annual linear wear rate superior to 0.2 mm per year could be detected in only 1 ceramic-PE bearing surfaces, but femoral osteolysis was seen in 3 cases. There has been no ceramic head breakage thus far. At 10 years, survivorship of the 238 index THAs with "pain graded < 5" and "revision for clinical failure" (dislocation excluded) as end point was 95.8 per cent and 98 per cent, respectively. With "definite loosening" (radiographic failure) as end point, 10 year survivorship was 99.1 per cent for the stems and 98.6 per cent for the threaded cups. DISCUSSION: Once osseointegration apparently occurred, the authors have never observed any secondary migration indicating failure of the bone-implant anchorage. The femoral implantation technique was critical and improved following an unavoidable learning curve. Liner disassociation, evolutive acetabular lucencies, worrisome wear and osteolysis were not of great concern thus far. Results of these grit-blasted threaded cups are much better than those of former smooth screw rings. CONCLUSION: Ten year survivorships of the Zweymüller cementless prostheses in primary THA are better than those of former cemented or cementless prostheses, and are within the range of the best results published at equivalent follow-up with hybrid reconstructions with use of stems cemented with up to date technique and hemispheric cementless press-fit cups with screw fixation.
Adult↗
Bioartificial pancreas containing porcine islets of Langerhans implanted in low-dose streptozotocin-induced diabetic mice: effect of encapsulation medium.
Two encapsulation culture media without animal serum were compared for development of a bioartificial pancreas. Porcine islets were suspended in Hams F10 medium supplemented with 2% Ultroser (US) or in Ultraculture medium (UC) and encapsulated in hollow fibres composed of AN69 copolymer. The function of encapsulated islets was assessed by intraperitoneal transplantation of two fibres in streptozotocin-induced diabetic mice. In both groups of transplanted mice (US, n = 26; UC, n = 18), a significant decrease in plasma glucose concentration was observed three days after fibre implantation (from 21.9 +/- to 14.4 +/- 0.8 mmol/l for US fibres and from 22.7 +/- 0.8 to 13.3 +/- 1.3 mmol/l for US fibres and from 22.7 +/- 0.8 to 13.3 +/- 1.3 mmol/l for UC fibres). Graft survival 17 days after implantation was 61% for mice with UC fibres and 35% for those with US fibres (P = 0.0001). Intramuscular glucose tolerance tests were performed in these animals (US, n = 5; UC, n = 10), and a normal glucose pattern was observed in both groups of transplanted mice. The results show that a complete normalisation of blood glucose and glucose tolerance can be achieved by implantation of a bioartificial pancreas. Moreover, UC appears to be a more suitable encapsulation culture medium for porcine islets in vivo.
Acrylic Resins↗