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Biomedical subjects

J N Argenson

Publications and source records attributed to J N Argenson.

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↗
PubMed2004

[CT evaluation of total HIP prosthesis infection].

PURPOSE: To evaluate the ability of CT imaging to detect infectious lesions in total hip prosthesis. PATIENTS AND METHODS: CT was performed in 17 cases of suspected total hip prosthesis infection. Images were reviewed to evaluate for the presence of soft tissue abscess, hip joint effusion or fistula and peri-prosthetic lucency or erosion at bone window setting. The feasibility of CT imaging is assessed with regards to metallic artifacts. RESULTS: Infection was confirmed in 10 hips. A soft tissue abscess was present in 8 of these cases, in association to a joint effusion, presumably septic, in 7 cases. A fistula was identified in 8 cases. A peri-prosthetic lucency was present in 10 cases, 7 of which with infection, and erosions were noted in 4 patients, 2 of which with infection. Metallic artifacts reduced image quality but did not prevent detection of soft tissue abscesses. CONCLUSION: CT is useful for detection of soft tissue abscesses in patients with infected hip prosthesis. CT is useful for surgical planning or follow-up of patients treated conservatively.

Aged↗
PubMed2001

Molecular identification of a Dietzia maris hip prosthesis infection isolate.

Dietzia maris, an environmental actinomycete, has been implicated only once in human disease. We herein report the first D. maris isolate from a bone biopsy specimen in a patient hospitalized for a total hip prosthesis replacement. Cell wall fatty acid analysis and 16S ribosomal DNA gene sequencing were utilized to achieve its definite identification. This case report illustrates the usefulness of such methods for the accurate identification of actinomycetes.

Actinomycetales↗
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↗
PubMed1998

Ambulatory treatment of multidrug-resistant Staphylococcus-infected orthopedic implants with high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole).

We examined the effectiveness and safety of high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole) for the treatment of orthopedic implants infected with multidrug-resistant Staphylococcus species. The prospective study was conducted between 1989 and 1997 in a university medical center with ambulatory-care services. Patients eligible for the study consisted of those from whom multidrug-resistant Staphylococcus spp. organisms susceptible only to glycopeptides and co-trimoxazole were isolated from their orthopedic implants and for whom there was no contraindication to the treatment. All patients were treated orally with high-dose co-trimoxazole (trimethoprim, 20 mg/kg of body weight/day; sulfamethoxazole, 100 mg/kg/day). Patients with prosthetic hip infections were treated for 6 months, with removal of any unstable prosthesis after 5 months of treatment; patients with prosthetic knee infections were treated for 9 months, with removal of any unstable prosthesis after 6 months of treatment; and patients with infected osteosynthetic devices were treated for 6 months, with removal of the device after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment, and follow-up examinations were conducted regularly for up to 6 years. The overall treatment success rate was 66.7% (26 of 39 patients), with success rates of 62.5% for patients with prosthetic knee infections, 50% for those with prosthetic hip infections, and 78.9% for those with other device infections. Seventeen of the 28 (60.7%) patients who did not have any orthopedic material removed were cured. Eight patients stopped the treatment because of side effects, and one patient was not compliant. In three patients treatment failed because of the appearance of a resistant bacterium. Long-term oral ambulatory treatment with co-trimoxazole appears to be an effective alternative to the conventional medicosurgical treatment of chronic multidrug-resistant Staphylococcus-infected orthopedic implants which includes long-term intravenous antibiotic therapy combined with surgical debridement and removal of foreign material or its subsequent one- or two-stage replacement.

Administration, Oral↗
PubMed1997

Three-dimensional morphology of the proximal femur.

In the field of uncemented hip arthroplasties, secondary biologic fixation of femoral implants depends directly on the quality of the primary stability. Metaphyseal filling and a good fit between the implant and the proximal femur improve initial stabilization and optimize the transmission of forces to the bone. Precise knowledge of the three-dimensional femoral shape is essential to the design and selection of adapted implants. Three hundred ten femurs in 300 patients suffering from primary hip osteoarthritis were analyzed by computed tomography scanning. After three-dimensional reconstruction, several measurements were extracted, and the parameters essential to the characterization of the diverse femoral morphologies encountered were identified. A new classification of the proximal femur is proposed. The consequences on the design and the preoperative selection of femoral implants are discussed.

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

Oral treatment of Staphylococcus spp. infected orthopaedic implants with fusidic acid or ofloxacin in combination with rifampicin.

Oral therapy of staphylococcal infection of orthopaedic implants with 900 mg/day rifampicin combined with either 1.5 g/day fusidic acid for 5 days followed by 1 g/day thereafter, or 600 mg/day ofloxacin was compared. Patients with an infected hip were treated for 6 months, with removal of any unstable prosthesis after 5 months' treatment and those with an infected knee prosthesis were treated for 9 months, with removal of the prosthesis after 6 months of treatment. Patients with infections of other type of bone implants were treated for 6 months with removal of the implant after 3 months of treatment, if necessary. Cure was defined as the absence of clinical, microbiological and radiological evidence of infection 12 months after completion of treatment. The treatment of 46 of the 52 included in the study was evaluated for safety and that of 42 was assessed for efficacy. Overall treatment was successful for 11 (55%) of 20 patients treated with rifampicin and fusidic acid group and for 11 (50%) of the 22 treated with rifampicin and ofloxacin. Treatment failed in four cases in each treatment group because of persistent infection. One patient given rifampicin and fusidic acid and three patients given rifampicin and ofloxacin failed treatment because of relapse. Superinfection led to failure in the remainder and was due to staphylococci in all but one case in which Acinetobacter calcoaceticus var. anitratus was isolated. There were no side effects related to study treatment. Oral treatment with rifampicin combined with fusidic acid may be a suitable alternative to the combination of rifampicin and ofloxacin for treating implant infections due to Staphylococcus spp. either when the patient is intolerant to quinolones or when the infecting organism is resistant to these drugs.

Administration, Oral↗
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↗