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Biomedical subjects

J M Aubaniac

Publications and source records attributed to J M Aubaniac.

At least 19 recordsLinked to original sources
PubMed2006

[Custom cementless stem for osteoarthritis following developmental hip dysplasia].

PURPOSE OF THE STUDY: Arthroplasty in developmental dysplasia of the hip joint raises technical problems related to the anatomy and age of the young patient. The purpose of this work was to report results obtained with a custom-designed cementless stem. MATERIAL AND METHODS: This study included 257 hips reviewed at mean 82 months (range 43-162 months). Mean patient age was 55 years (17-78), mean weight 67 kg (42-118), and mean height 164 cm (147-190). A standard imaging protocol was performed for all patients: AP pelvis in reclining position, AP and lateral views of healthy and pathological hip, AP view of entire lower limb in standing position, computed tomography of lower limb. La position of the greater trochanter and the lengthening necessary was determined from the preoperative films. Stem integration and migration as well as osteolysis were studied postoperatively. Femoral anteversion and the anteroposterior diameter of the paleoacetabulum were measured on the superposed computed tomographic images. Surgery was performed via a Watson-Jones approach to insert a noncemented cup hooked in the obturator foramen and implanted in the paleoacetabulum. The femur endomedullary cavity was prepared with a ream having the form of the definitive stem and the prosthetic neck was custom fit to match the desired lever arm and anteversion. RESULTS: The series included 174 cases of dysplasia and 83 dislocations, 39% stage 1, 30% stage 2, 14% stage 3 and 17% stage 4. Mean lengthening was 39 mm. The mean helitorsion was 28 +/- 16 degrees and the mean anteroposterior diameter of the acetabulum was 51 mm. On average, the alpha correction in the prosthetic neck was -13.4 degrees (-71 degrees to +37 degrees). The Postel-Merle-d'Aubigné score improved from 10.4 points preoperatively to 16.7 points at last follow-up. Postoperative x-rays showed signs of osteointegration in 88% of cases, osteolysis in 5% and one case of stem impaction. Ten hips (3.9%) required revision for replacement (7 for an aseptic problem and 3 for sepsis). Survival was 94.7% at 13 years. DISCUSSION: This study confirmed the anatomic modifications observed in patients with developmental hip dysplasia and the surgical problems they cause. There was no correlation between the degree of dislocation and the degree of helitorsion which is difficult to assess without a preoperative computed tomography. The survival rate at 13 years is encouraging in this population. The intramedullary portion of the cementless stem must be adapted to the dimensions of the femoral canal which decrease with increasing dislocation.

Adolescent↗
PubMed2004

[Hip and knee replacement and sport].

INTRODUCTION: Knee or hip arthroplasty in the sportsman raise many problems including the possibility or to come back to sports activities, and the implants longevity. Unicompartimental prosthesis of the knee is a relatively preserving surgery whose results in the long run in particular for the sporting subject can be for some authors sometimes disappointing. Total knee arthroplasty remains more invasive but with functional results always compatible with some sports activities. The functional result depends much on the postoperative, plurifactorial flexion. Concerning the hip, the sportsman, more active and younger than the average population suffering from osteoarthritis suffer statically more of osteoarthritis. The contribution of the total hip prostheses without cement, anatomical even custom, and of the new couples of friction seems to allow a better longevity. In addition, the contribution of the mini-invasive techniques and the computer-assisted surgery seem techniques with a promising future. METHODS: We present our experience with the unicompartimental arthroplasty, the postoperative flexion in the total knee prostheses and in the hip arthroplasty for the younger patient and the relations between these interventions and sports. RESULTS: Many authors studied the possibilities of sporting recovery (standard of sport and level of practice). The majority of the activities can be taken again, by excluding the sports of team, of ball and the jogging. The contribution of the mini-invasive techniques seems to allow a faster recovery and the uncemented hip prostheses give good long-term results in the young and active patient.

Adult↗
PubMed2000

Total knee arthroplasty in femorotibial instability.

Regarding the reasons for failure of conventional knee arthroplasty a lot of work has be done on loosening and polyethylene wear, often leading to recurrent deformation and osteolysis. But there are only few reports concerning femorotibial instability. This instability is related to failure of the collateral ligaments which can often be found in cases of important frontal deformity both in the varus and valgus knee or in rheumatoid arthritis. Femorotibial instability has been reported in the literature as reason of failure of knee replacement in 10 to 30% of all cases. This complication may be avoided by a precise preoperative analysis including unipodal standing view and stress X-Rays. Encouraged by the good long-term results published by the Endo-Klinik we started to use the ENDO-Model rotational knee system in patients with suspected femorotibial instability in order to resolve the problems of resurfacing the patella restoring mobility correcting the deformity stabilising the knee In fact, the rotating or hinge prosthesis is actually transforming the anatomical joint in a mechanical joint in which the pivot is acting as a ligament should act.

Adult↗
PubMed1997

Psoriasis is a risk factor for hip-prosthesis infection.

Risk factors for hip and knee prosthesis infection have been described, but not psoriasis. Eighty five infected patients from different centers and 202 non infected patients were included in a case-control study. Fifteen of 85 infected patients (17.6%), and 2 of 202 (1%) non infected patients had psoriasis. Odds ratio for infection in patients with psoriasis is 21.4 (4.7-195.5), and 39.7 (5.3-1718.8) in patients with hip prosthesis and psoriasis. No significant difference was found in patients with knee prosthesis. These data indicate that psoriasis is a risk factor for hip prostheses infection.

Case-Control Studies↗
PubMed1997

[Modularity of prostheses].

Modularity allows a large choice of implants, like the use of cementless acetabular cups inducing bone ingrowth. The length and direction of the neck may also be adapted to be new joint. Risks of modularity are: implant dissociation, restriction of joint mobility, and especially augmentation of metal debris as a potential source of polyethylene wear. It is then critical to play attention to implant design, material choice and planning of the arthroplasty.

Hip Prosthesis↗
PubMed1996

[Transfusion strategy in programmed hemorrhagic orthopedic surgery].

OBJECTIVES: Prospectively assess autologous blood transfusion for programmed orthopedic procedures. METHODS: From January 1 to December 31 1993, 307 patients underwent programmed orthopedic procedures: total hip replacement (n = 191), total knee replacement (n = 83) and osteotomy (n = 33). General (94%) or spinal anesthesia (6%) was used. The anesthesist explained transfusion techniques and patients gave informed consent for inclusion in an autologous transfusion protocol including differed autologous transfusion, intentional normovolemic hemodilution and intraoperative transfusion of shed blood. RESULTS: A total of 269 autologous transfusion were performed among the 307 patients (87.6%). This was sufficient in 242 cases (78.8%) and in 65 (21.2%) homologous transfusion was required. Among the 269 patients given autologous transfusion, differed transfusion was used in 145 (53.9%), intentional normovolemic hemodilution in 124 (46%) and intraoperative transfusion of shed blood in 222 (82.5%). Among the patients given a differed autologous transfusion, 9 (6.2%) required a homologous transfusion and among the 40 patients in which all 3 techniques were used, only 2 (5%) received homologous blood, both due to secondary complications. CONCLUSION: These findings show that when differed autologous transfusion is included in the transfusion strategy, less than 10% of the patients require homologous blood. In addition, when the 3 autologous transfusion techniques are used, the rate of homologous blood transfusion approaches zero.

Adolescent↗
PubMed1996

Cell surface expression of surrogate light chain (psi L) in the absence of mu on human pro-B cell lines and normal pro-B cells.

Surrogate light chains (psi L) encoded by lambda-like (lambda 5) and VpreB genes play a critical role in controlling the early steps of B cell differentiation. We prepared new anti-VpreB monoclonal antibodies (mAb) (3C7/6F6) which preferentially recognize the VpreB epitope at the cell surface of human cell lines that do not express the mu chain. These mAb provide the first characterization of human pro-B cell lines expressing surface psi L. We demonstrate that surface psi L expression is considerably enhanced upon interleukin-7 stimulation and that the psi L complex is formed independently of the Ig alpha/Ig beta heterodimer. Finally, using these antibodies, we confirm the existence of a normal pro-B cell population in human adult bone marrow. These cells are CD34+ CD38+ psi L+, do or do not express CD19, CD10, or both epitopes, and may represent the earliest cell population committed to B cell differentiation.

Adult↗
PubMed1995

Is there a place for patellofemoral arthroplasty?

Indications for patellofemoral arthroplasty were studied based on a 2- to 10-year followup review. Of 183 patellofemoral prostheses implanted between 1980 and 1990, 104 were associated with unicompartmental arthroplasty, and 79 were implanted alone. Thirteen patients were lost to followup. The results of 66 patellofemoral arthroplasties are reported at an average followup of 66 months. The mean age of the patients at surgery was 57 years. Underlying causes of the osteoarthritis included patellar dislocation or dysplasia (22), patellar fracture (20), and primary osteoarthritis (24). A metallic femoral groove was associated with a polyethylene patella with no metal backing. Two (9%) prostheses were revised in the dysplasia group, 1 (5%) in the posttraumatic group, and 7 (29%) in the primary osteoarthritis group. In this latter group, the indications of patellofemoral arthroplasty must be restricted to lesions of the patellofemoral joint in a knee in neutral axis evaluated preoperatively on full standing and stress radiographs. The best results of patellofemoral arthroplasty were obtained in osteoarthritis after patellar dislocation or patellar fracture.

Activities of Daily Living↗
PubMed1992

The morphology of the proximal femur. A three-dimensional radiographic analysis.

Biological fixation of cementless femoral implants requires primary stability by optimal fit in the proximal femur. The anatomy of the bone must then be known precisely. We analysed in vitro the accuracy of bone measurements of 32 femurs and compared the dimensions obtained from radiographs and CT scans with the true anatomical dimensions. Standard radiographs gave only a rough approximation of femoral geometry (mean difference: 2.4 +/- 1.4 mm) insufficiently accurate to allow selection of the best fitting prosthesis from a range of sizes and altogether inadequate to design a custom-made prosthesis. CT scans give greater accuracy (mean difference: 0.8 +/- 0.7 mm) in our experimental conditions, but in clinical practice additional sources of error exist.

Aged↗
PubMed1991

[Value of the technique of cellular lysis by thermic shock in the isolation of bacteria causing osteoarticular infections].

The purpose of this work is to compare, a conventional technique, for bacterial isolation, with a lysis-centrifugation method using a rapid freezing in liquid nitrogen, followed by decongelation at 37 degrees C for bone and joint samples. The bone and joint specimens were biopsies and punctions (35 cases) or fistula (10 cases). The residual antibiotic activity of the sample was determined using a susceptible strain of Micrococcus luteus and of Staphylococcus epidermidis. Among the 45 samples, 20 were sterile with both methods among which 8 exhibited a residual antibiotic activity which may have contributed to isolation failure. In 12 cases, bacterial isolates were obtained with both methods. Cultures were obtained from 13 samples with the lysis centrifugation method alone. The isolates were 4 Staphylococcus aureus, 8 coagulase-negative Staphylococcus and 1 Acinetobacter sp. These results suggest that the intracellular location of bacteria may be responsible for the negative cultures from bone or joint specimens.

Aged↗
PubMed1990

[Arthroplasty of the hip after bone fusion. Report of 13 cases].

The authors have realized this surgical procedure upon 68 patients from 1978 to 1987. The fusion was badly tolerated or initiated a decompensation in the lumbar spine, in the knees, or in the opposite hip. This type of arthroplasty is difficult because the usual anatomical marks are changed and a pre-operative schedule is necessary to restore a satisfactory abductor strength. Special implants are needed to fit the frequent femoral dystrophies. 57 patients (62 hips) have been reviewed four to five years after operation. The functional improvement was important in the lumbar spine, not as much in the knees and in the opposite hip. The result upon the operated hip was satisfying for the mobility (average flexion: 78 degrees) and for the pain which disappeared apart from scarce complications. But, the stability was not as good with 20 per cent insufficiencies of the gluteus medius, implying for these patients the use of a walking-stick, the impossibility of standing on one leg, and the Trendelenburg sign. The state of the gluteus medius is the condition of a successful operation. The electromyogram performed before the operation may show a denervation; in this case, a choice must be done between an osteotomy of femoral correction and an arthroplasty implying a risk of instability which would be said to the patient.

Adult↗
PubMed1989

[Treatment of osteo-articular infections with ofloxacin. Preliminary study].

Twenty-three patients with osteoarthritis were treated by ofloxacin. Antibiotic association was used for 22 patients. Five patients have had osteomyelitis without foreign material. Four of them recovered. Seventeen patients carried foreign material. Evaluation are in progress for 5 of them. In the 12 remaining patients, 8 recovered at a mean duration follow-up of 6 months. One patient have had arthralgia that may be attributable to the treatment. The mean duration of treatment was 6 months for the foreign material group of patient, and 3 for the other.

Adolescent↗
PubMed1989

[Bilateral genu flessum in a patient with Cooley's disease].

An original case of bilateral knee flexion of sixty degrees is reported in a twenty-four year old mean, with a beta-thalassemia diagnosed at three years old. The defect of straightening is the result of premature epiphysis fusion, only posterior in this case, and affecting preferentially the tibia. That is the reason why the flexion has been corrected by a bilateral tibial soustraction osteotomy, under the tibial tuberosity. The consolidation of the osteotomies has been obtained without any complications, with a complete extension and normal walk in a man moving only with a wheelchair before surgery. No similar case seems to be described in this kind of pathology.

Adult↗
PubMed1988

[Treatment of chronic hip dislocation in adults by recentered total prosthesis. Apropos of 43 cases].

Forty-three total hip prostheses were inserted in 33 adults suffering from a chronic high dislocation of the hip. Ten patients had a bilateral arthroplasty. The authors decided to keep in this series only hips presenting with a very considerable upward displacement of the femoral head of type IV in Crowe, Maini and Ranawat's classification. All the hips were treated in the same way with pre-operative planning using template tracings to anticipate problems of length and choice of implant. The acetabular cup was placed in the old acetabulum with downward displacement of the femur. The results were studied in 39 prostheses with a mean follow-up of five-and-a-half years (two years to nine-and-a-half years). The mean age of the patients was 48 and-a-half years (28 to 76 years). A satisfactory result was obtained in 79.5 per cent of cases. The mean downward displacement of the femur was 4.8 cm. Complications included one death from pulmonary embolus, two phlebitides, two fractures of the femoral shaft and four dislocations. There were nos cases of sepsis or neurological complications. The authors advise the use of custom-made implants, consider the tactical problems relative to the opposite hip. It is concluded that the value of the method often lies in the transformation of the life of these young patients by a "functional miracle", but the operative indications need to be considered carefully, since the procedures are sometimes extensive, often difficult and always require technical skill.

Adult↗
PubMed1984

[Intertrochanteric flexion osteotomy in aseptic osteonecrosis of the femoral head in adults. Apropos of 52 cases].

Fifty-two intertrochanteric osteotomies were performed in 42 cases of idiopathic avascular necrosis of the femoral head of which 10 were bilateral. By flexion at the osteotomy site, the operation aims to place the superior pole of the femoral head during weight bearing towards the superior part of the acetabulum. The use of a specially angled nail-plate makes the procedure safe and simple. The results were analysed with an average follow-up of 46 months and a minimum follow-up for 2 years. The overall results were good in 72 p. 100 of cases, with better results for pain and mobility than for stability and gait. The results were better when the necrosis did not reach the centre of the head and when there was true relief from weight-bearing pressure. The indication were the best in grade II necrosis in patients less than 55 years old.

Adult↗
PubMed1978

[Solitary secreting plasmocytoma in a femoral localization in a young man (author's transl)].

A pathological fracture in 20-year-old man led to the discovery of a right femoral plasmocytoma. Immunoelectrophoresis revealed the existence of a monoclonal Kappa IgG. After tumour reduction by radiotherapy and chemotherapy, surgical excision was possible with the insertion of a reconstructive prosthesus. Functional recovery was complete. The dysglobulinaemia completely disappeared and, with a two year follow-up, no dissemination of the plasmocytoma has been found.

Adult↗