Biomedical subjects

Laurent Sedel

Publications and source records attributed to Laurent Sedel.

8 recordsLinked to original sources

PubMed2004

Use of the Cusum technique for evaluation of a CT-based navigation system for total knee replacement.

Most of the early failures of total knee replacements are related to technical flaws. Conventional ancillary devices achieve good alignment in the frontal plane in only an average of 75% of total knee replacements. Computer-assisted surgery may improve the technical quality of implantation surgery. The aim of our study was to evaluate the use of computer-assisted surgery using a quality control process. Seventy-eight total knee arthroplasties were done with a CT-based computer-assisted surgery system. The outcomes studied were alignment of the lower limb, implant positioning, and operative time. The target for alignment was 180 degrees +/- 3 degrees. Cusum analysis showed that the three outcomes were controlled during the study. The cusum test identified any existing outliers. Because few data were available at the beginning of this study regarding computer-assisted surgery for total knee replacement, a randomized study was not relevant. However, a control of the procedure was mandatory. The cusum technique allowed continuous evaluation of the performance of the new procedure, and is a useful tool in assessing new technology. The results of this study showed that it is possible to do a randomized study to determine if computer-assisted surgery can improve the technical result of total knee replacement.

Adult↗

PubMed2003

Fractures of ceramic bearings: history and present status.

During a period of 25 years (1977 to 2001), 13 fractures of an alumina component were recorded retrospectively. During the same period, approximately 5500 alumina components were implanted (3300 with all-alumina bearings and 1200 with alumina-on-polyethylene). These events occurred in seven women and six men, with a mean age of 59 years and a mean weight of 71 kg. There were eight fractures of the femoral head and five fractures of the socket component. Three fractures clearly were related to trauma (two fractures of the socket and one fracture of the head) and two were related to an abnormal design (one 22-mm head and one extra-long neck). Five fractures occurred without any rational explanation, but two fractures that occurred in the early phase could have been caused by a weaker alumina material. Finally three recent fractures of the liner were related to a change in the design of the material. This has been corrected and no additional fractures were observed. Although this dramatic event is of concern, it is infrequent and easy to solve by a limited revision procedure if done emergently. This rare complication should be balanced with the other complications of THR, including mechanical failures and osteolysis, often described with metal-on-polyethylene prostheses.

Adult↗

PubMed2003

Long-term results of alumina-on-alumina hip arthroplasty for osteonecrosis.

Alumina-on-alumina bearings in THR may, in theory, provide an effective answer to osteolysis in young patients with ON of the femoral head. The purpose of this retrospective study was to report the long-term results of a series of 52 consecutive alumina THAs (41 patients) done for ON. The mean age of the patients at surgery was 41 years (range, 22-79 years). Cemented femoral stems with a 32-mm alumina head were used. Plain alumina cups were used and were either cemented (39 hips) or press-fit (13 hips). No patients were lost to followup. Sixteen hips have been revised. Aseptic loosening of the socket was the main cause of failure. At an average 16-year followup (range, 11-23.65 years), 26 hips were rated excellent and one hip was rated good. No osteolysis was observed and wear was undetectable. If revision for aseptic loosening was the end point, the rate of survival was 88.5% at 10 years for the socket and 100% at 10 years for the stem. With the alumina-on-alumina hip replacement done for ON, absence of osteolysis can be expected for as many as 24 years after the operation. New methods of socket fixation now are being explored.

Adult↗

PubMed2003

In vitro acoustic waves propagation in human and bovine cancellous bone.

UNLABELLED: The acoustic behavior of cancellous bone with regard to its complex poroelastic nature has been investigated. The existence of two longitudinal modes of propagation is demonstrated in both bovine and human cancellous bone. Failure to take into account the presence of these two waves may result in inaccurate material characterization. INTRODUCTION: Acoustic wave propagation is now a commonly used nondestructive method for cancellous bone characterization. However, wave propagation in this material may be affected by fluid-solid interactions inherent to its poroelastic nature, resulting in two different longitudinal waves. This phenomenon has been demonstrated in previous studies and is in agreement with Biot's theory. The purpose of this paper is to extend these findings to human trabecular bone and to thoroughly investigate these two waves. MATERIALS AND METHODS: Sixty human and 14 bovine cancellous bone cubic specimens were tested in vitro in three different directions using an immersion acoustic transmission method. Original procedures were developed to quantify both velocity and attenuation characteristics of each wave. In term of attenuation, a modified broadband ultrasound attenuation (BUA), describing the rate of change of the frequency-dependent attenuation, was defined for each wave (FDUA). RESULTS: Both waves were identified in most of the specimens. The fast wave velocities demonstrated a negative linear correlation with porosity (1500-2300 m/s, R2 = 0.44, p < 10(-3)), whereas the slow wave velocities exhibited two different behaviors: (1) a first set of data clearly dependent on porosity showing a positive linear correlation (1150-1450 m/s, R2 = 0.26, p < 10(-3)) and (2) a second group independent on porosity. The fast wave FDUA (20-140 dB/cmMHz) showed a parabolic behavior and reached a maximum for 75% porosity (second degree relationship R2 = 0.41,p < 10(-3)), whereas a positive linear behavior was observed for the slow wave FDUA (15-40 dB/cmMHz; R2 = 0.15, p < 10(-2)). CONCLUSIONS: Existence of two wave propagation modes were demonstrated in human cancellous bone. Our data suggest that, in some cases, the amplitude of the slow wave is much larger than the amplitude of the fast wave. For this reason, care should be taken when using measurement systems that incorporate simple threshold detection because the fast wave could remain undetected. Moreover, failure to consider the presence of these two waves could result in an inaccurate quantification of cancellous bone physical properties.

Acoustics↗

PubMed2002

[Hip replacement].

Total hip replacement is widely in use all over the world. It is an extremely beneficial procedure. But some requirements must be fulfilled: an excellent indication, a good technique and a special choice of the material in use. For elderly patients less demanding, regular metal on polyethylene cemented implants are still in use. For younger patients, more sophisticated materials like ceramic on ceramic, or metal on metal seem to be more appropriate. The way the prosthesis is stabilized, using or not cement, is also of marked importance. Many other details are relevant: the approach, the surgical technique, the way the patients are followed, the survivorship analysis which can predict partially the outcome in the future for a given prosthesis.

Adult↗

PubMed2002

Interaction of specifically chemically modified dextrans with transforming growth factor beta1: potentiation of its biological activity.

Transforming growth factor beta (TGFbeta), a potent multifunctional cytokine, is well known to demonstrate heparin binding ability. This study investigated the binding capacity of heparin-like family of chemically modified dextrans to TGFbeta1. Dextran derivatives with various substitution contents in carboxymethyl, benzylamide and sulfate groups were evaluated using a gel mobility shift assay. This structure-function study indicated that a synergistic role of benzylamide and sulfate substituents resulted in an optimal interaction with the growth factor. The effect of these polymers on the biological response of TGFbeta1 was assessed using mink lung epithelial cells transfected with a plasminogen activator inhibitor-1 promoter-luciferase construct (PAI/Luc). When the growth factor was mixed with 250 microg/mL of carboxymethyl-benzylamide-dextran (DCMB) or carboxymethyl-benzylamide-sulfate-dextran (DCMBSu), the luciferase gene expression was enhanced. Only polymers exhibiting TGFbeta1 binding demonstrated a biological potentiating effect. However, this effect was strongly amplified as the cell plating time increased (35-fold increase with a 2 days plating time versus 1.1-fold increase with a 4 hr plating time at a 0.25 ng/mL concentration of TGFbeta1). TGFbeta1 induced the PAI/Luc construct in a dose-dependent fashion but its effect diminished when added to cells previously cultured for 24 and 48 hr. The results indicated that the potentiating effect required a complex formation between TGFbeta1 and polymers, the action of which seeming to locally maintain TGFbeta1 in an active form. TGFbeta isoforms playing a key role in the process of bone repair, specifically designed functionalized dextrans could potentiate the in vivo TGFbeta1 biological effect and be used in the field of wound healing applications.

Animals↗

PubMed2002

Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study.

BACKGROUND: The purpose of this retrospective study was to report the results, after a minimum of 18.5 years of follow-up, in a consecutive series of total hip arthroplasties performed with an alumina-on-alumina combination. METHODS: One hundred and eighteen consecutive total hip arthroplasties were performed in 106 patients between 1979 and 1980. The prostheses combined a 32-mm alumina head and an all-alumina socket. Both components were cemented in eighty-five hips, both components were implanted without cement in twenty-nine, and only the stem was cemented in four. The mean age of the patients at the time of the index arthroplasty was 62.2 years (range, thirty-two to eighty-nine years). RESULTS: At the 18.5 to 20.5-year follow-up evaluation, forty-five patients (fifty-one hips) were alive and had not had a revision, twenty-five patients (twenty-five hips) had undergone revision of one or both components, twenty-seven patients (thirty hips) had died, and nine patients (twelve hips) had been lost to follow-up. The mean Merle d'Aubigné hip score (and standard deviation) was 16.2 +/- 1.8 points at the latest follow-up evaluation. The rate of survival at twenty years, with revision for any reason as the end-point, was 85.6% for the cementless cups compared with 61.2% for the cemented cups and 84.9% for the cementless stems compared with 87.3% for the cemented stems. Wear of the prosthetic components was undetectable on plain radiographs. Periprosthetic cystic or scalloped lesions requiring the use of allograft bone during revision were present in three of the twenty-five revised hips. In addition, seven hips had moderate acetabular osteolysis treated with a 4-mm-larger cup. No fracture of the alumina socket or head was recorded. The mean acetabular wear rate in this series was <0.025 mm/yr. CONCLUSION: With the alumina-on-alumina total hip arthroplasty, minimal wear rates and limited osteolysis can be expected up to twenty years after the operation, provided that sound acetabular component fixation is obtained.

Adult↗

PubMedDate not supplied

Scapulothoracic fusion for serratus anterior paralysis.

Paralysis of the serratus anterior may lead to severe disability. Many surgical options are available, from soft-tissue procedures to scapulothoracic fusion. We report the results of 10 consecutive scapulothoracic fusions in 10 patients (7 men and 3 women) treated between 1980 and 1997. The mean age at surgery was 39 years (range, 22-57 years). Paralysis of the serratus anterior was isolated in five patients. One patient was lost to follow-up, and one patient died from an unrelated cause. Fusion was not achieved in three patients, two of whom had successful revision within 1 year postoperatively. One patient with an excellent result had a traumatic arthrodesis fracture and underwent successful revision. Results were assessed in 8 patients, including 3 who had reoperation. At a mean follow-up of 6.2 years (range, 1-15 years), 6 patients had a very good or good result and returned to manual labor. The mean active mobility was limited to 93 degrees in abduction and 101 degrees in forward elevation but was well tolerated. Two patients had a poor result because of nonunion and frozen shoulder, respectively. Scapulothoracic fusion may not be recommended as a primary procedure in the treatment of winging of the scapula due to serratus anterior paralysis. However, with the use of a careful technique, this method may be an alternative to muscle transfer, especially in patients in whom a previous soft-tissue procedure has failed or in patients with strenuous activities or combined muscular lesions.

Adult↗