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Biomedical subjects

D Goutallier

Publications and source records attributed to D Goutallier.

At least 19 recordsLinked to original sources
PubMed2005

[Histological lesions of supraspinatus tendons in full thickness tears of the rotator cuff].

PURPOSE OF THE STUDY: Iterative tears after simple tendon bone suture of transfixiant ruptures of the rotator cuff are frequent. The frequency of iterative ruptures had seemed to be correlated to the importance of the preoperative fatty degenerations of the cuff muscles. But fatty degeneration cannot account for iterative ruptures occurring with no or little preoperative muscle fatty degeneration. The authors have tried to know if iterative ruptures could also be accounted for by the presence on repaired tendinous stumps of histological lesions which are known to lower their mechanical quality, and if such was the case, they have tried to know what could be the impact of these lesions on the repairing technique by suturing cuff ruptures. MATERIAL AND METHOD: Thirty-two distal stumps of ruptured supraspinatus, resected on more than 1 cm to eliminate macroscopic tendinous lesions (thin, lacerated, cleaved, hardened or whitish tendons) and to reach a new stump, slightly bleeding and thick enough to hold the stitches correctly, have been studied on longitudinal histological slides. RESULTS: All the tendinous resected stumps had histological anomalies: dilacerations lesions of the conjunctive tissue, fatty infiltrations, necrosis, scar lesions and micro calcifications were found. The histological lesions were often associated. The histological lesions were an average 4 mm shorter than those of the tendinous resection. In 18 cases however the whole of the resected tendon was histologically abnormal. DISCUSSION: Tendinous histological lesions found on the whole or almost the whole length of the macroscopically abnormal tendinous stumps diminish the mechanical quality of the tendons. Insufficient resection of the tendinous stumps leaving macroscopical lesions and therefore histological lesions could account for iterative ruptures in the first post operative year. Yet complete resection of the macroscopically abnormal tendinous stump does not entail that the neo tendinous stump to be repaired is histologically normal. This encourages to put the stitches well within the zone of the tendinous resection and to bury the tendinous stumps into a highly vascular bony trough. But tendinous resection although logical from the histological and mechanical point of view widens the rupture of the cuff to be repaired. It can make sutures under tension, which can entail iterative ruptures. Musculo-tendinoplasty appears then necessary to perform sutures without tension. CONCLUSION: Histological lesions of tendinous stumps of cuff ruptures correspond roughly to tendinous macroscopic lesions. They could be at the origin of iterative ruptures that take place after simple tendon-bone sutures of ruptured cuffs which are not accounted for by muscular fatty degeneration. They could also partly account for iterative ruptures taking place when pre operative fatty degeneration is evident. It seems logical to resect macroscopically abnormal tendinous stumps before performing a suture. But the tendon-bone suture without tension is then often possible only with musculo-tendinoplasties.

Aged↗
PubMed2004

[Long-term results of alumina-on-alumina total hip arthroplasty].

PURPOSE OF THE STUDY: Mechanical failure in total hip arthroplasty is usually related to aseptic loosening itself related to wear particles as seen with polyethylene bearings. Alumina has bee proposed to avoid wear problems. In vitro and mid-term clinical studies have shown tribological advantages but early acetabular fixation remains an issue. Since alumina-on-alumina bearings are currently used with new fixation techniques, updated evaluations of older series are informative regarding the long-term tolerance of alumina in vivo. MATERIAL AND METHODS: We investigated 104 consecutive alumin-on-alumina cemented total hip arthroplasties (Cervaer-Osteal, Roissy, France) implanted 20 years ago in 81 patients (from 1979 to 1983). A32-mm alumina femoral head was used. The alumina acetabular socket and the titanium femoral stem were cemented. The Postel-Merle-d'Aubigne score was used for clinical evaluation. Radiological wear and development of osteolysis or loosening were noted for establishing actuarial curves. When accessible, histological samples from revision procedures were analyze. RESULTS: Six infected cases were not taken into account for data analysis. The average follow-up was 11 years, reaching 18 years in 38 cases. Twenty-three hips were revised for changing 23 acetabular sockets, 12 femoral heads, and one femoral stem. We noted one femoral head fracture, 24 definite acetabular loosenings, 12 probable acetabular loosenings, and 3 definite femoral loosenings. Radiological acetabular osteolysis was present in 4 cases, always limited to De Lee zone 1, and associated with loosening. Radiological wear was below eye detection. Periprosthetic tissue showed non-specific histological reactions to cement particles. Survival rate at 20 years was 62.8% [49.3-76.2%], in terms of revision 57.1% [42.5-71.7%] and 95.2% [89.9-100%] in terms of definite acetabular and femoral loosening. DISCUSSION: Besides the high rate of cemented fixation failure of the socket, loosened and non-loosened cases showed an excellent long-term tolerance of the alumina-on-alumina bearing with normal wear and osteolysis. This may also have protected the femoral component from complications. This study confirms in vivo the long-term tribological benefit of the alumina-on-alumina bearing in total hip arthroplasty and suggests that acetabular fixation should be improved to achieve full benefit.

Aged↗
PubMed2002

[Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results].

PURPOSE OF THE STUDY: Patients with painful patella syndrome without objective instability are often treated by section of the lateral retinacular of the patella or advancement osteotomy of the tibial tuberosity with less than satisfactory mid-term results. One explanation of the persistent pain could be hyperpression within the femoro-patellar joint due to excessive protrusion of the trochleae (>=7 mm). We propose retro-trochlear wedge resection to achieve reduction trochleoplasty. The wedge is cut with a superior base so the trochlear angle remains unchanged. We describe here the operative technique and report early results at more than two years follow-up. MATERIAL AND METHOD: We reviewed retrospectively 12 knees treated with trochleoplasty for painful patella syndrome. Eleven of these knees had had previous operations for objective (n=9) or potential (n=2) patellar instability. Mean follow-up was 4 years (range 2-6). A complete pre- and postoperative radiological work-up was obtained for all knees including 30 degrees flexion femoropatellar views and computed tomography measurements of TA-GT value at 30 degrees flexion. Functional outcome was studied with the Arpege scale. Trochleoplasty was performed via an anterolateral approach and was associated with frontal translation of the tibial tuberosity if the preoperative TA-GT was not in accord with the trochlear angle. RESULTS: Functional outcome improved during the first two postoperative years then stabilized. Improvement in pain and instability was statistically significant. Functional outcome was scored good or very good for nine knees. The two failures occurred in the oldest patients whose knees had had several operations. Mean trochlear protrusion was 8 mm preoperatively and 3 mm postoperatively. All trochleoplasties healed; there was no trochlear necrosis. DISCUSSION: The described trochleoplasty has an advantage over classical reduction trochleoplasty because it does not modify the trochlear angle. In addition, it is quantifiable. It is biomechanically more logical than advancement of the tibial tuberosity. In our patients, the trochlear protuberance was reduced to 3 mm. Associated with correction of mechanical femoro-patellar anomalies in the frontal plane, this trochleoplasty can provide good relief even in patients with persistent pain in previously operated knees treated for objective or potential patellar instability or for simple patellar pain.

Adult↗
PubMed2001

Macroscopic and histological assessments of the cruciate ligaments in arthrosis of the knee.

We examined the macroscopic appearance of both cruciate ligaments in 52 knees during knee replacement. It was classsified as normal, abnormal or ruptured. The ligaments were also evaluated histologically: stage 0 (normal), stage I (degeneration of < 1/3 of the collagen fibers), stage 2 (degeneration of 1/3-2/3) and stage 3 (> 2/3). 17 anterior cruciate ligaments (ACL) were normal, 14 were abnormal and 21 ruptured. All the posterior cruciate ligaments (PCL) were normal. 14 ACL were stage 0, 6 stage 1, 8 stage 2 and 24 were stage 3. 22 PCL were stage 0, 14 stage 1, 13 stage 2 and 3 were stage 3. When the ACL was abnormal or ruptured, the PCL was stage 0 only in one fourth of the cases. The long-term results of TKR retaining the PCL should be better if the ligament is strong. The intraoperative assessment of the macroscopic appearance of the ACL reflects the histological state of the PCL.

Aged↗
PubMed2001

[Degenerative lumbar spondylolisthesis treated with isolated intersomatic arthrodesis: results of 30 cases with an average 4-year follow up].

PURPOSE OF THE STUDY: Degenerative spondylolisthesis of the osteoarthritic spine can lead to severe invalidating back pain, decompensating a clinical situation previously well controlled with drugs. Hypothesizing that such invalidating spinal pain might be related to the unstable olisthy, we treated our patients with isolated intersomatic arthrodesis without reducing the displacement. We present here our results in a retrospective analysis of 39 patients who underwent surgery between 1981 and 1992. MATERIAL AND METHODS: Mean age of the 39 patients, 11 men and 28 women, was 62 years (mean, range 37-89). Lumbar spine pain had been well controlled for a mean 10 years. The development of important lumbalgia despite adequate drug treatment led to the indication for surgery in all cases. Thirty-four patients experienced radicular claudication which was severe in 16 cases with a walking distance of less than 100 m. Invalidating radiculalgia occurred in a territory compatible with the olisthy: 33 L4-L5, 2 L5-S1, 4 L2-L3. Twelve patients had a neurological deficit in the L5 territory. Myelography, performed in 26 patients, demonstrated complete interruption of the opaque column in 10 facing the superior surface of the oisthy and radicular amputation in 13; compression over several levels was observed in 13 cases. Anterior intersomatic arthrodesis was done with an iliac tricortical corticospongious graft, associated with en bloc cement insertion in 3 cases. A strut plate screwed on the adjacent vertebral bodies was adapted to the vertebral displacement that was not modified. The upright position was authorized on day 20-45 with a corset worn until day 90. No procedure was attempted on adjacent levels. Postoperative myelography or MRI was obtained for 30 patients. RESULTS: Mean follow-up was 4 years (range 1-10 years). Transient postoperative paresis (L5) occurred after L4-L5 arthrodesis in 2 patients and phlebitis in 3 patients (one complicated with pulmonary embolism without sequelae). Fusion of the arthrodesis was achieved in all cases. The degree of displacement and the height of the "intersomatic space" was modified little compared with the preoperative situation. Radicular claudication regressed totally in 29 cases (85%) and partially in 5 (15%). Radiculalgia regressed totally in 29 (74%) and partially but substantially in 7 (18%). Lumbalgia regressed totally in 20 cases (54%) and partially in 15 (40%). Function, as assessed wth the Beaujon scale, improved from 8 to 17/20 points. There was one case of secondary degradation with development of radiculalgia related to the level above the arthrodesis in one case. No cause could be identified to explain the failure to relieve preoperative radiculalgia in 8% of the patients. CONCLUSION: Strut plates screwed onto the vertebral bodies enabled intersomatic fusion in all cases. Stabilization of the olisthy alone, without correction of the displacement nor release of the canal, successfully relieved pain in all cases of severe radiculalgia due to osteoarthritic spondylolisthesis and even provided improvement of lumbar pain in patients with various levels of discopathy. Unstable olisthy would thus be the major cause of invalidating pain, particularly radiculalgia in these patients.

Adult↗
PubMed2000

[Hand on composite prosthesis after resection of peri-acetabular sarcoma].

PURPOSE OF THE STUDY: To improve function after pelvic resection involving theacetabulum we have used an anatomic composite implant built with screws and cement. MATERIAL AND METHOD: Since 1990, 27 patients with peri-acetabular bone sarcoma have been treated by extensive resection followed by "hand on innominate prosthesis with constrained total hip prosthesis. The hand on innominate prosthesis was made of a titanium cup, a set of long titanium screws and 2 or 3 packs of gentamycin loaded ciment. RESULTS: Many postoperative complications were observed; deep infection (15 p. 100), hip prosthesis dislocation (33 p. 100) and local recurrence (17 p. 100). Nine patients (33 p. 100) had to be reoperated. Nevertheless at last follow up 24 patients still had their composite prosthesis. The mean functional result, rated according to a modified Enneking's staging system, was 83 p. 100 with unlimited walking without support, average hip flexion 100 degrees, length discrepancy less than 1 centimeters. DISCUSSION: These results were similar to those described in the literature for custom made innominate prosthesis and much better than those of alternative reconstructive procedures. Hand on composite prosthesis is cheaper, easier, more adaptable and enables better anchorage than custom-made prosthesis. Such a procedure can be used even after total iliac wing resection. CONCLUSIONS: The advantages of such procedure pleads for using it extensively after acetabular resection. But long term follow up is necessary to validate indications.

Acetabulum↗
PubMed1999

Poor eight-year survival of cemented zirconia-polyethylene total hip replacements.

Between January 1988 and January 1991 we performed 100 consecutive cemented total hip replacements using a zirconia head, a titanium alloy stem and a polyethylene cup. We reviewed 78 of these hips in 61 patients in detail at a mean of 5.8 years (1 to 9). Aseptic loosening was seen in 11 hips (14%). Eight needed revision. In total, 37 cups (47.5%) showed radiolucent lines, all at the cement-bone interface, with 18 (23%) involving all the interface. Of the 78 femoral implants, 17 (21.7%) showed radiolucent lines, and two, which had a complete line of more than 1 mm thick, definite endocortical osteolyses. There was also an abnormally high incidence of osteolysis of more than 2 mm at the calcar. Survivorship analysis showed that only 63% were in situ at eight years. These worrying results led us to abandon the use of zirconia heads, since at the same hospital, using the same femoral stem, cement and polyethylene cup, but with alumina femoral heads, the survival rate was 93% at nine years. We discuss the possible reasons for the poor performance of zirconia ceramic.

Adult↗
PubMed1999

Trans-styloid fixation of fractures of the distal radius. A prospective randomized comparison between 6- and 1-week postoperative immobilization in 60 fractures.

We performed a prospective randomized study on 60 patients with dorsally displaced extra-articular or noncomminuted intraarticular fractures of the distal radius. All 60 fractures were treated by closed reduction and Kirchner wire trans-styloid fixation. 30 patients had 1 weeks' postoperative immobilization and 30 patients had 6 weeks' immobilization. All patients had a clinical and radiographic review at 6 weeks and at 1 year after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, frontal radial deviation, ulnar variance, and radial shortening were assessed radiographically. Rates of complications were the same in both groups. At follow-up, pain was similar in both groups and range of motion and grip strength were somewhat better after early mobilization--in comparison with the opposite wrist--but this was statistically significant only for ulnar deviation. The postoperative radiographic reductions were similar in both groups, with no differences in loss of reduction after bone healing. Therefore, in Colles' fractures, trans-styloid fixation with two K-wires seems to give a stable osteosynthesis, which does not need additional immobilization with a plaster cast.

Adolescent↗
PubMed1999

[Impact of fatty degeneration of the suparspinatus and infraspinatus msucles on the prognosis of surgical repair of the rotator cuff].

PURPOSE OF THE STUDY: Rupture of the cuff tendons can induce a fatty degeneration of cuff muscles. In 1989 the authors proposed a grading in 5 stages of this degeneration based on CT scan. The purpose of this study was to determine whether this degeneration had an influence on anatomical and clinical results after surgical repair of the cuff. MATERIAL AND METHODS: Seventy-four patients operated for a ruptured cuff had prospectively a pre-operative CT scan grading of muscular degeneration, and a post-operative anatomical control by opaque arthrography at about 10.5 months follow-up. Forty-four patients were males and 30 were females. The mean age at operation was 58.7 (40 to 75). Fifty-two ruptures were large involving the supraspinatus and infraspinatus in 17 cases, the supraspinatus and the subscapularis in 20 cases and all three tendons in 15 patients. Twenty-two ruptures were smaller and involved only the supraspinatus. To repair the cuff, it was necessary to advance the supraspinatus muscle in 28 cases and both supra and infraspinatus in 24 cases. No patient was lost for follow-up, and 51 of the 56 having more than one year of follow-up (mean 3 years, maximum 7.5 years) were evaluated according to Constant and Murley score. Two reoperated patients were excluded from the final analysis. RESULTS: Complete supraspinatus tears after repair recurred in 16 cases (22 p.cent). No infraspinatus rupture occurred after 32 infraspinatus repairs. Re-tears were observed only when a muscular advancement had been performed. Except in one case, re-tears occurred only when supraspinatus and/or infraspinatus were degenerated. The mean Constant score at revision for 49 patients was 66.6 points. According to this scoring system, 67.3 p.cent had a satisfactory result, 24.5 p.cent a fair result, and 8.2 p.cent a bad result. The mean score of the 39 patients having a continent cuff was 67.4 points, and was not significatively better than that of the patients with a re-tear (63.7 points). The best results were noted for the postero-superior tears (74.6 points). The type of repair had no significative influence on the final Constant score. The best improvements in external rotation were observed when a double advancement was performed. The stage of fatty degeneration, particularly of the infraspinatus, had an influence on the final range of motion, particularly in external rotation, and on the final strength. DISCUSSION: The fatty degeneration of supra and infraspinatus is an important prognostic factor of the anatomical and functional results after surgical repair of the cuff. More-over, when it is present, the surgeon may have some difficulties to close the tear during surgery. This study confirms that it is probably better to operate rotator cuff tears before the appearance of irreversible muscular damage, particularly when the lesions extend posteriorly to the supraspinatus.

Adipose Tissue↗
PubMed1998

Expanding prostheses in conservative surgery for lower limb sarcoma.

Conservative resection of bone sarcoma in the lower limbs in children is very likely to be followed by a progressive problem of leg length inequality resulting from removal of the growth cartilage. To overcome this we have been using an expanding prosthesis and we report our experiences during the period 1985-1996. The prostheses are made of titanium and comprise 3 parts: an articular component, an expanding mechanism, and tibial and femoral stems. The degree of possible lengthening of the prostheses is virtually unlimited, and they can be inserted in children of 5 or more years of age. We report the use of 28 prostheses in patients aged from 5 to 18 years, of which 4 were tibial, 5 total femur, and 16 distal femur. There were 6 Ewing's sarcoma, 21 osteosarcoma, and 1 synovial sarcoma. The average follow-up was for 5 years. Five patients died from their disease, and 21 benefited from an average lengthening of 2.6 cm (range: 2 mm-120 mm). Using the Société Européenne des Tumeurs Osseouses (EMSOS) criteria, the functional results were excellent or very good in 16, fair in 7 and bad in 5. Five patients developed an infection; one required amputation and the others received a new expanding prosthesis. We conclude that an expanding prosthesis is an excellent alternative to amputation in young children. However, the risk of infection associated with repeat surgery has led us to develop a prosthesis which can be lengthened externally, without the need for reopening the wound.

Adolescent↗
PubMed1998

The importance of systematic histological examination after loosening of an implant.

A 65-year-old man presented with a painful hip five years after a cemented replacement. Histological examination of a biopsy taken from tissue surrounding the femoral implant showed infiltration of a squamous-cell carcinoma. Further investigation revealed a primary growth in the left lung. This rare example of a metastasis in relation to a joint replacement illustrates the necessity for histological examination of the tissue adjacent to a loose prosthesis.

Aged↗
PubMed1998

Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder.

We performed ninety-five consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1969 and 1983. In 1993, we retrospectively reviewed the clinical and radiographic results that were available for fifty-six patients (fifty-eight shoulders) who had been followed for an average of 143 years (range, ten to twenty-three years). The purpose of the study was to determine the prevalence of glenohumeral osteoarthrosis and the factors related to its development after the Latarjet procedure. The procedure was performed for the treatment of recurrent anterior dislocation in fifty shoulders and painful recurrent anterior subluxation in eight. All patients had a radiographic evaluation (three anteroposterior radiographs, with the humerus in external, neutral, and internal rotation, and one lateral radiograph) before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation, six patients had apprehension with regard to possible dislocation, and one had occasional subluxation. According to the system of Rowe et al., fifty-one (88 per cent) of the fifty-eight shoulders had an excellent or good result; five (9 per cent), a fair result; and two (3 per cent), a poor result. Twenty-two shoulders had no glenohumeral osteoarthrosis. Thirty-four shoulders had centered glenohumeral osteoarthrosis (the humeral head remained in front of the center of the glenoid cavity), which was grade 1 in twenty-five shoulders, grade 2 in four, grade 3 in three, and grade 4 in two, and two shoulders had grade-4 eccentric glenohumeral osteoarthrosis (the humeral head was more proximal than normal in relation to the center of the glenoid cavity). Postoperative grade-1 glenohumeral osteoarthrosis, unlike the higher grades, had no effect on the function of the shoulder.

Activities of Daily Living↗
PubMed1998

[10-year actuarial analysis of a cohort of 156 total hip prostheses of a cemented polished aluminum/polyethylene alloy].

PURPOSE OF THE STUDY: From 1983 to 1986, 156 alumina/polyethylene combination hip arthroplasties (131 patients) were performed at the Henri Mondor Hospital. Before 1983, the stainless-steel/polyethylene combination was performed. In this follow-up study, the outcome of the first 156 consecutive alumine-polyethylene combination hip arthroplasties were analyzed with clinical and radiological features. The comparison of the two combinations was analyzed. A survival analysis was performed over a ten years interval. MATERIAL AND METHODS: The femoral component of the prosthesis was made of Titanium alloy (TiA16V4). The femoral head was made of dense alumina (A1203). The head diameter was 32 mm. The socket was made of ultra-high-molecular-weight polyethylene (UHMWPE). Fixation of head to stem was obtained through conical sleeving. We used a posterolateral approach, and a cemented THA without pressurization. At last follow-up evaluation, 90 patients were reviewed, 9 patients were interviewed by phone. Three patients were dead and 20 patients were lost for follow-up evaluation, in the first year. Nine failures were reoperated. The major cause of failure was septic complication of the THA (8). The average age of patients at arthroplasty was 58.1 year. The clinical evaluation was performed with the Merle d'Aubigné, Postel scoring system. The radiographs of 117 hips out of the 156 were available for this evaluation. Radiolucents, failures and wear were analyzed. RESULTS: There was a 5 per cent rate (8 hips) of deep infection due for two hips to the underlying pathology. Ten (6.5 per cent) of the 156 hips had had an episode of dislocation at last follow-up. Eighty-nine per cent of the hips were rated excellent, very good, and good; 9.3 per cent were rated fair: and 1.7 per cent were rated poor. The radiographs of the socket revealed 54 per cent of bone-cement radiolucent and three failures at last follow-up. The radiographs of the stem revealed 29 per cent of bone-cement radiolucent and one failure at last follow-up. There was no revision of the femoral stem. Survival analysis (aseptic failures) depicted 93.45 per cent durability of the arthroplasty at 10 years. The survival analysis for the socket alone, using the same criteria for failure, demonstrated 94.53 per cent survival success at 10 years, and 98.91 per cent for the stem component. The comparison of the two combinations gave us a survival analysis for the socket alone, using aseptic failure as criteria, 79.84 per cent for stainless-steel/polyethylene combination at 8 years, and 97.63 per cent for alumina/polyethylene at the same time. CONCLUSION: The alumina/polyethylene combination with a 32 mm head diameter gave better results than the stainless-steel/polyethylene combinations. The improvement was noted on the acetabular component.

Actuarial Analysis↗
PubMed1998

[Suture of the anterior cruciate ligament reinforced with carbon fibers. Anatomic results and articular degradation after 8-year follow-up].

PURPOSE OF THE STUDY: Osteoarthritis in anterior cruciate ligament (A.C.L.) deficient knees is reported by numerous authors, especially when conservatively treated. The aim of this study was to analyze at a longterm follow-up the outcome of these knees after surgical repair of an A.C.L. rupture augmented with carbon fibers. MATERIAL AND METHODS: Forty seven A.C.L. ruptures in 26 men and 21 women, whom mean sport level was low, had a surgical suture augmented with carbon fibers. The clinical and radiological results were analyzed at a mean follow-up of 8 years (6.2 to 10.8 years). RESULTS: At maximum follow-up, 64 per cent of patients had moderate pain in their operated knee and 11 per cent had major pain. The Lysholm score was 86.5. The "ARPEGE" functional cotation showed only 51 per cent excellent and good results. The mean anterior laxity was 12.8 mm. Sixty eight per cent of operated knees had no pivot shift. Eighteen knees (38 per cent) had femorotibial osteoarthritis and 23 (49 per cent) had femoropatellar osteoarthritis. The frequency and the level of osteoarthritis were correlated with the range of residual anterior laxity. CONCLUSION: Low sport level patients with A.C.L. deficient knee may have knee osteoarthritis. An effective correction of the anterior laxity, by any form of surgical treatment, seems indicated in these patients in order to prevent this articular degradation.

Adolescent↗