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Biomedical subjects

M Lequesne

Publications and source records attributed to M Lequesne.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Post-traumatic coxarthrosis. Medicolegal conditions of the likelihood of fractures, luxations or contusions].

Trauma is the cause of 5 to 10% of all cases of osteoarthritis of the hip. One third of patients with a dislocation or fracture-dislocation of the hip or an acetabular fracture develop osteoarthritis of the hip within one to 20 years. Symptoms may be minor or absent during the interval. In addition to severe injuries, simple contusions resulting for instance from a blow to the greater trochanter or knee or from forced abduction of the hip (e.g., splits) can also result in osteoarthritis of the hip. We developed a set of five imputability criteria, of which three are essential: 1) documentation of the exact nature of the trauma; 2) absence of osteoarthritis in the uninjured hip; 3) consistency between the estimated duration of osteoarthritis and the date of the injury. Causality assessment problems which arise when a trauma worsens or accelerates preexisting osteoarthritis are discussed on the basis of clinical and roentgenographic findings. Mechanical and biochemical factors involved in the pathophysiology of contusion-related osteoarthritis of the hip are briefly reviewed.

Adolescent↗
PubMed1993

[Quality of life and functional indices in osteoarthritis].

The main Indices of Quality of Life used in rheumatology and their aims and applications are surveyed. Their use in osteoarthritis implies a few issues that are addressed in a critical manner. Indices of Quality of Life are useful to measure deficiency resulting from osteoarthritis by comparison with other rheumatic diseases, as rheumatoid arthritis, connective tissue diseases, fibromyalgia... They are sensitive enough for apraising the domains improved by a radical treatment such as joint replacement. However, their scores are only slightly changing in most of the drug trials, in which the more simple functional indices seem demonstrative enough. Last but no least, they are notably time consuming for both the patient and the physician.

Activities of Daily Living↗
PubMed1993

[Unusual secondary coxarthrosis and posterior coxarthrosis].

Certain atypical forms of osteoarthritis of the hip are misleading: forms with very severe pain, forms with pain predominantly in the sitting position, forms with disproportionate pain. These atypical features can sometimes be explained by certain anatomical arrangements: superomedial narrowing over an aggressive double line, posterior osteoarthritis of the hip which can only be demonstrated on a false lateral view in the form of posteroinferior narrowing with its corollaries: anterosuperior diastasis and marked osteophytes of the posterior horn appearing to advanced underneath the femoral head on the lateral view. These atypical forms frequently only last several months or years. Posterior osteoarthritis of the hip has a less severe and slower course than the usual forms with superior narrowing.

Adolescent↗
PubMed1993

[Rapidly progressing destructive diseases of the hip].

Rapidly destructive hip disease includes rapid forms of infectious and inflammatory arthritis, tabetic hip degeneration, arthropathies associated with articular chondrocalcinosis, ochronosis, haemochromatosis and haemodialysis, and rapidly destructive osteoarthritis of the hip, first described in France in 1970. It is defined by progressive narrowing of the joint space by at least 2 mm per year (0.80 to 2 mm for the semirapid form), while common osteoarthritis only loses 0 to 0.80 mm per year (mean: 0.22 mm/year). Chrondrolysis leads to an erosion abrading subchondral bone. Painful disability is generally more severe than in common osteoarthritis. Passive range of movement is fairly well conserved for a long time. Risk factors are advanced age, excess weight, and excessive locomotor activity (about 50% of cases). Treatment consists of total hip replacement.

Arthritis, Infectious↗
PubMed1993

[Isolated or predominant bone cysts of the femoral head].

By definition, the signs of osteoarthritis in this context are absent or minor. Isolated or predominant bone situated anywhere in the femoral head, are more or less well demarcated and occasionally multiple or multilocular. They affect men three times more frequently than women with a mean age of 34 years. Painful disability is generally moderate and intermittent for many years. Limitation of movement is minor or absent. The clinical course is very slow and rarely required surgical treatment. Aetiology: in the 23 cases observed over a period of 20 years, two thirds involved a dysmorphic femoral head: coxa plana, polyepiphyseal dysplasia, osteochondritis dissecans, occasionally associated; three cases were due to excessive pressure (dysplasia or subluxation without signs of osteoarthritis). The other possible causes were juxta-articular bone cyst, chondroblastoma, giant cell tumour and clear cell chondrosarcoma.

Adult↗
PubMed1993

[Capsular retraction of the hip].

The diagnosis of capsular retraction of the hip is based on measurement of the capacity of the joint cavity on arthrography: it is reduced by at least 25% (normally 15 ml +/- 2 ml). The opaque area is only visible reduced in the more severe forms with a capacity of 5 ml or less. The arthrographic image is therefore not the key to the diagnosis. The major clinical sign is restriction of joint movement, especially in abduction and rotation. Secondary, "surgical" capsular retraction of the hip is the most common form. It is associated with synovial chondromatosis in more than one half of cases. The mean capacity is 6.8 ml (range: 0 to 12 ml). Irreducible flexion deformity and limitation of movement are of variable severity. Capsulectomy must be combined with joint debridement (systematically including the depth of the socket). "Medical" capsular retraction of the hip is the rarest form. It may be either idiopathic or secondary to diabetes or chronic barbiturate abuse. It is subacute and resolves within several months to two years. Fluoroscopic intra-articular injection of corticosteroids, repeated as required by pain, constitutes the best treatment.

Acetabulum↗
PubMed1992

Longitudinal radiologic evaluation of osteoarthritis of the knee.

Radiologic assessment appears to be an objective standard for longterm evaluation of osteoarthritis (OA) and it is inexpensive, quick, simple and noninvasive. We conducted a one year followup study of patients with OA of the knee to evaluate the reproducibility and validity of this evaluation. The intra and interobserver reproducibility of the radiologic variables were evaluated on 275 and 539 patients, respectively, and found to be satisfactory (intraclass coefficient of correlation above 0.70 for the evaluation of the space narrowing of the joint). During the one year followup study, there was a slight but statistically significant deterioration of the joint space narrowing, evaluated on a 6 grade scale on 360 patients (p less than 0.001). The changes in the joint space narrowing were more closely correlated with treatments received by the patients for OA (nonsteroidal antiinflammatory drug (NSAID) intake, synovial fluid aspiration) than with changes in the recorded clinical variables (pain on a visual analog scale, Lequesne algofunctional index). Moreover, some factors such as obesity, generalized OA and flares of OA appeared to be correlated with the deterioration of joint space narrowing. Further studies are necessary to confirm and/or explain the relationship between the deterioration of the joint space narrowing and such factors (i.e., NSAID intake, obesity, flares of OA, generalized OA), which were detected in this study.

Aged↗
PubMed1991

[Tendinitis of the hip region].

Tendinitis and bursitis are less common around the hip than around the shoulder. Nevertheless, they must be recognized to avoid unnecessary and costly diagnostic errors. Their various clinical forms are studied in detail. Tendino-bursitis of the gluteus medius muscle is the most frequent in its subacute form, but it is rare in its acute, pseudo-gouty form. Calcification of the reflected tendon of the rectus femoris muscle often closely resembles arthritis of the hip. Synovial cysts of the psoas bursa and rupture of the gluteus medius tendon are rare but must be known. Local injections of corticosteroids play an important part in the treatment of these diseases.

Hip Joint↗
PubMed1991

Indices of severity and disease activity for osteoarthritis.

Several indices have recently been constructed by rheumatologists for the assessment of clinical status in osteoarthritis of the extremities. These include the algofunctional indices for the hip and knee (Lequesne), the Western Ontario and McMasters Universities (WOMAC) index (Bellamy), patients and investigator's overall opinion (results of drug trials), global evaluation of change in handicap (self-assessment), and articular index of physical examination in nature (Doyle et al). Each of the above indices have been validated by their respective authors. Presently, we propose to further validate the disease-activity indices.

Humans↗
PubMed1991

[Conflict between psoas and total hip prosthesis].

This conflict leads to a chronic irritation of the psoas by the antero-medial part of the cup, but it has been poorly described in the past. A study of six patients suffering from this trauma, and who were re-operated revealed that the muscle was worn thin in front of the prominent cup. In the case of 4 of the 6 patients pain had started to occur shortly after total hip replacement. The following symptoms were noted among all 6 patients: pain was suffered during flexion--extension movements--walking up stairs--arising from a chair. Pressure on the medial part of the groin was painful, especially during active elevation of the lower limb. Passive mobility was normal and painless. Psoas bursitis was observed in three cases. The main cause of this conflict is the protrusion of the cup beyond the antero-medial edge of the acetabulum; this protrusion may be either due to a bone graft or a bit of cement, but most often an acetabular insufficiency (congenital dysplasia) favors the formation of this anterior overhang. The spiral cup screwed into the bone can be especially aggressive when it protrudes. Treatment includes the resection of the overhang, but post-operative results will be uncertain unless the resection is really complete. In the case of 4 patients the results of such an intervention were only mild to poor. This problem can be avoided by proper care and preventive measures in the original replacement avoiding all projections beyond the anterior edge of the acetabulum--cup, bone graft, cement, especially if dysplasic.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[How to evaluate the long-term course of osteoarthritis. Tests for trials of fundamental treatments (spine excluded)].

The best assessment tests for long term trials on osteoarthritis (OA) of the hip and knee are the following, in order of relevance value (consensus of french experts): 1) the loss of joint space thickness on successive radiographies; 2, 3) the indices of the severity for OA of the hip and knee; the investigator's overall opinion; 4) the patient's overall opinion (visual analogue scale of handicap); 5, 6, 7) the pain level (visual analogue scale); the time for going up and down a standard flight of stairs and the time of pain in this distance; the limitation of two articular movements; 8) the increase of either analgesics or NSAIDs consumption; 9) concerning OA of fingers, the number of joints newly involved on successive radiographies. At present, only the radiological tests 1 and 9 are validated. The clinical tests 2 to 8, valuable for short term trials, have yet to be validated for long term follow-up. Recommended duration of trials is three years. A rigorous organisation is necessary to avoid erroneous inclusions: all data recorded in the pre-inclusion visit have to be checked by the principal investigator. Since we have not yet a validated chondroprotective agent as a reference drug, the trial must be randomised, double blind, placebo controlled, parallel group study.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

[Pain-function indices for the follow-up of osteoarthritis of the hip and the knee].

Algo-functional or severity index for hip diseases (AFIH), proposed in 1980 and validated in 1981, and algo-functional or severity index for knee diseases (AFIK), validated in 1985-1987, were applied to osteo-arthritis of the hip and of the knee. With strictly standardized interviews and well-trained investigators (20 to 30 patients), these indices are reliable: the interobserver reproducibility is good (mean discrepancy: 1/2 point) and the score usually decreases 3 points (mean) under active drug treatment. Each index was individually validated. The severity index for hip is more discriminant than that for knee diseases. The place of each index among the other assessment tests was appraised according to their discriminant capacity. These indices are useful: 1) for drug trials (analgesics and NSAIDs); 2) for the long term follow-up and the so-called chondroprotective agents trials; 3) for a rational decision concerning hip or knee prosthesis (score reaching 8 to 12 points). These AFIH and AFIK are well suited to daily practice and are not time-consuming: 3 to 4 minutes for each.

Cross-Sectional Studies↗
PubMed1990

Methodology issues in the evaluation of NSAID in inflammatory rheumatic diseases.

The characteristics required of tests used in trials of nonsteroidal antiinflammatory drugs in patients with inflammatory rheumatic diseases in order for such tests to provide meaningful results are reviewed. Those tests most widely used in trials of patients with rheumatoid arthritis or ankylosing spondylitis are assessed, and the ability of such tests to discriminate among the treatment effects of different agents is considered. Finally, several statistical and procedural issues important to clinical trial methodology are discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

The osteoporosis of heparinotherapy and systemic mastocytosis.

Heparinotherapy and systemic mastocytosis are two unusual aetiologies of diffuse osteopenia, possibly linked by common pathophysiological factors. Osteoporosis related to heparinotherapy has only been observed in patients treated with doses higher than 10,000 units per day and for more than 4 months. Even in these, it is a rare disorder which has only been reported approximately 15 times in the world literature. Bone histomorphometry has demonstrated the occurrence of marked hyperresorption. In vitro, heparin appears to have resorptive and collagenolytic effects which could play a pathophysiological part in the disorder. Diagnosis of the osteopenic form of systemic mastocytosis may be difficult. Urticaria pigmentosa is a very important clue but may be misdiagnosed or even missing. Hepato or splenomegaly are inconstant. X-rays may show the coexistence of osteosclerotic lesions. Standard biochemical tests are of little help. The urinary excretions of the histamine metabolites methyl histamine and methyl imidazolacetic acid have been found increased when measured. Finally, the diagnosis is made by bone histology which must be performed without decalcification and read by a pathologist informed of the potential diagnosis. Toluidine blue stain shows that mastocytes are numerous in the bone marrow where they are grouped in foci. Histomorphometry demonstrates a high bone turnover with excessive resorption, which could be mediated by heparin or PG E 2 contained in mastocyte granules. Treatment is difficult and may involve cytostatic drugs and/or inhibitors of bone resorption: Clodronate has recently been reported to be at least transiently effective.

Female↗
PubMed1989

Informational indices. Validation of criteria and tests.

The informational indices comprise sensitivity, specificity and predictive value, and they give information on the probability of rheumatic disease being present or not. It is interesting that in clinical situations where the probability of the disease is appraised by the physician before the test, the probabilities may be strongly modified after the test. For example, if one estimates the pre-test probability of ankylosing spondylitis at 50% in a given patient, the HLA B27 antigen test will modify the probability of the disease as follows: B27 positive: probability 90% B27 negative: probability 7% The second part of the study discusses modern methods for the validation of diagnostic criteria and assessment tests. Validation of the latter includes inter- and intra-observer reproducibility, coefficient of variation, discriminating power of each assessment test in a double-blind "reverse" trial, in which the difference between placebo and active drug is the known base, the value of the tests being the unknown.

Arthritis, Rheumatoid↗