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Biomedical subjects

P Bizot

Publications and source records attributed to P Bizot.

At least 19 recordsLinked to original sources
PubMed2006

[Femoral reconstruction with impacted macroporous calcium phosphate ceramic in revision hip arthroplasty].

PURPOSE OF THE STUDY: Management of bone stock loss remains one of the most challenging problems for revision hip surgery. The aim of this retrospective study was to report the preliminary results of peri-prosthetic femoral defect reconstruction with impacted granules of calcium phosphate ceramic. MATERIAL AND METHODS: Fourteen hips in 13 patients (3 men and 10 women) were evaluated. Age at surgery ranged from 30 to 79 years (mean 66.1 years). All revised devices had been cemented. Femoral revision was indicated for loosening in eleven hips (including six septic cases), femoral osteolysis (one hip), persistent pain (one hip), and recurrent dislocation (one hip). On the preoperative radiological evaluation, bone defects were assessed as SOFCOT grade II in seven case, and grade III in fourteen. None was rated grade IV. Once the loose prosthesis had been removed, bone graft or ceramic granules (14 cases) were firmly impacted in the femoral canal. The stem was standard and always cemented using modern cementing technique. RESULTS: At a mean follow-up of 34 +/- 15 months (range 14-76 months), eleven of fourteen hips were rated good or very good according to the Postel-Merle-d'Aubigné score. One diaphyseal femoral fracture occurred and later united. Two hips required re-revision (one aseptic femoral loosening, one septic recurrence). Direct bonding between synthetic graft and bone was observed on standard radiographs in eleven cases. Stem subsidence occurred in two cases and was limited (mean 4.5 mm). DISCUSSION: Femoral bone reconstruction using impacted calcium phosphate ceramic in revision hip arthroplasty provided encouraging results in the short to mid term. Femoral stock restoration was achieved in the great majority. No adverse effect related to the use of a synthetic graft was noted. Further long-term evaluation is required before wider application.

Adult↗
PubMed2005

A meta-analysis of patellar replacement in total knee arthroplasty.

From individual randomized studies it is unclear whether the patella should be replaced during total knee replacement. We did a meta-analysis to provide quantitative data to compare patellar resurfacing with nonresurfacing during total knee arthroplasty. Only randomized, controlled trials reported between January 1966 and August 2003 comparing patellar replacement with patella retention were included for a total of 12 studies. Two reviewers assessed trial quality and extracted data from papers. The outcomes identified were reoperations for patellar problems, anterior knee pain, knee scores, stair climbing, and patient satisfaction. The resurfaced patella performed better, and we found an increased relative risk (defined by the ratio of the risk of the event in the resurfaced group on the risk of the event in the nonresurfaced group) for reoperation, for significant anterior knee pain, and for significant pain during stair climbing when the patella was left unresurfaced. No differences were observed between the two groups for International Knee Society function score, Hospital for Special Surgery score, and for patient satisfaction. Despite these general findings, forming a definitive conclusion is difficult because many confounding factors, such as component design, surgeon experience, and technical aspects of the surgery, might influence the result in a patient.

Activities of Daily Living↗
PubMed2005

Surgical management of trapezius palsy.

BACKGROUND: Injury to the spinal accessory nerve in the posterior cervical triangle leads to paralysis of the trapezius muscle. The aim of this study was to determine the indications for nerve repair or reconstructive surgery according to the etiology, the duration of the preoperative delay, and specific patient characteristics. METHODS: Of twenty-seven patients with a trapezius palsy, twenty were treated with neurolysis or surgical repair (direct or with a graft) of the spinal accessory nerve and seven were treated with the Eden-Lange muscle transfer procedure. Lymph node biopsy was the main cause of the nerve injury. The nerve repairs were performed at an average of seven months after the injury, and the reconstructive procedures were done at an average of twenty-eight months. Nerve repair was performed for iatrogenic injuries of the spinal accessory nerve, within twenty months after the onset of symptoms, and in one patient with spontaneous palsy. Reconstructive surgery was performed for cases of trapezius palsy secondary to radical neck dissection, for spontaneous palsies, and after failure of nerve repair or neurolysis. The mean follow-up period was thirty-five months. The functional outcome was assessed clinically on the basis of active shoulder abduction, pain, strength of the trapezius on manual muscle-testing, and level of subjective patient satisfaction. RESULTS: The results were good or excellent in sixteen of the twenty patients treated with nerve repair and in four of the seven patients treated with the Eden-Lange procedure. Poor results were seen in older patients and in patients with a previous radical neck dissection. CONCLUSIONS: Good results can be expected from a repair of the spinal accessory nerve if it is performed within twenty months after the injury, as the nerve is basically a purely motor nerve and the distance from the injury to the motor end plates is short. Muscle transfer should be performed in patients with spontaneous trapezius palsy, when previous nerve surgery has failed, or when the time from the injury to treatment is over twenty months. Treatment is less likely to succeed when the patient is older than fifty years of age or the palsy was due to a radical neck dissection, penetrating injury, or spontaneous palsy.

Accessory Nerve↗
PubMed2004

Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years. A six- to 11-year evaluation.

Between 1990 and 1992, we implanted 71 hybrid alumina-on-alumina hip arthroplasties in 62 consecutive patients under the age of 55 years, with a mean age of 46 years at surgery. There were 56 primary and 15 secondary procedures. The prostheses involved a cemented titanium alloy stem, a 32 mm alumina head, and a press-fit metal-backed socket with an alumina insert. Three patients (four hips) died from unrelated causes. Four hips had revision surgery for either deep infection, unexplained persistent pain, fracture of the alumina head, or aseptic loosening of the socket. The nine-year survival rate was 93.7% with revision for any cause as the end-point and 98.4% with revision for aseptic loosening as the end-point. The outcome in the surviving patients (50 patients, 57 hips) with a minimum five-year follow-up (mean eight years) was excellent in 47 hips (82.5%), very good in eight (14%), good in one and fair in one. A thin, partial, lucent line, mainly in zone III was present in 38% of the sockets and one socket had a complete lucency less than 1 mm thick. One stem had isolated femoral osteolysis. There was no detectable component migration nor acetabular osteolysis. This hybrid arthroplasty gave satisfactory medium-term results in active patients. The press-fit metal-backed socket appeared to have reliable fixation in alumina-on-alumina hip arthroplasty. The excellent results using cemented fixation of the stem may be related to the low production of wear debris.

Adult↗
PubMed2004

Surgical management of trapezius palsy.

BACKGROUND: Injury to the spinal accessory nerve in the posterior cervical triangle leads to paralysis of the trapezius muscle. The aim of this study was to determine the indications for nerve repair or reconstructive surgery according to the etiology, the duration of the preoperative delay, and specific patient characteristics. METHODS: Of twenty-seven patients with a trapezius palsy, twenty were treated with neurolysis or surgical repair (direct or with a graft) of the spinal accessory nerve and seven were treated with the Eden-Lange muscle transfer procedure. Lymph node biopsy was the main cause of the nerve injury. The nerve repairs were performed at an average of seven months after the injury, and the reconstructive procedures were done at an average of twenty-eight months. Nerve repair was performed for iatrogenic injuries of the spinal accessory nerve, within twenty months after the onset of symptoms, and in one patient with spontaneous palsy. Reconstructive surgery was performed for cases of trapezius palsy secondary to radical neck dissection, for spontaneous palsies, and after failure of nerve repair or neurolysis. The mean follow-up period was thirty-five months. The functional outcome was assessed clinically on the basis of active shoulder abduction, pain, strength of the trapezius on manual muscle-testing, and level of subjective patient satisfaction. RESULTS: The results were good or excellent in sixteen of the twenty patients treated with nerve repair and in four of the seven patients treated with the Eden-Lange procedure. Poor results were seen in older patients and in patients with a previous radical neck dissection. CONCLUSIONS: Good results can be expected from a repair of the spinal accessory nerve if it is performed within twenty months after the injury, as the nerve is basically a purely motor nerve and the distance from the injury to the motor end plates is short. Muscle transfer should be performed in patients with spontaneous trapezius palsy, when previous nerve surgery has failed, or when the time from the injury to treatment is over twenty months. Treatment is less likely to succeed when the patient is older than fifty years of age or the palsy was due to a radical neck dissection, penetrating injury, or spontaneous palsy.

Accessory Nerve Injuries↗
PubMed2003

[Surgical treatment of a femoral agenesis: a case report].

We report a case of severe femoral agenesia in an adult and propose a new surgical approach facilitating prosthesis fitting. The procedure involves insertion of a total hip arthroplasty, arthrodesis of the knee and amputation of the foot. The final prosthesis fits on the crural area with weight bearing on the ischiatic region, the lesser pelvis, and the articulated knee. Outcome was satisfactory at one year in our patient. Other surgical alternatives are presented.

Adult↗
PubMed2001

Prevention of wear and osteolysis: alumina-on-alumina bearing.

Alumina-on-alumina bearings in total hip replacement have been used for 30 years. Excellent tribologic properties and extra low debris generation could, in theory, provide an answer to osteolysis. A review of the authors' experience with alumina-on-alumina bearings showed that, except in a few bearings that had been loose for a long time, osteolysis was not a problem. Although the cemented titanium stem and the alumina-on-alumina couple were not a problem, fixation of the socket had to be improved. To improve the socket fixation system and to avoid the use of a cemented titanium stem that may have created problems in the long-term, a new design was introduced in 1997. The current authors present the preliminary results of the first 96 hips with cementless fully-coated hydroxyapatite titanium alloy stems and sockets, 32-mm alumina femoral head, and alumina liner, both held with a Morse taper. Ninety-six consecutive hips in 89 patients (57 males, 32 females) with a median age of 46 years (range, 14-72 years) were analyzed. One socket was revised at 4 months because of poor primary stability in a patient with a severe acetabular fracture. One patient experienced a traumatic fracture of the implanted femur 3 weeks after surgery. The mean followup was 16 months (range, 4-38 months). One patient died from rupture of an aneurysm. Ninety-three hips in 86 patients were assessed regarding the clinical and radiologic ratings. Two patients (two hips) were interviewed by telephone. The Merle d'Aubigné rating system was 18 in 65 hips (59 patients), 17 in 25 hips (25 patients), and 16 in three hips (three patients) mainly related to a previous disability including limp, sciatic palsy, or stiffness. Examination of 93 available radiographs revealed no ostelolysis, no radiolucent lines at the last examination, and no subsidence. The level of excellent results, even in this young population, and lack of osteolysis and wear are encouraging, even if the followup is too short to allow any conclusions to be made.

Adolescent↗
PubMed2000

Ceramic/ceramic total hip arthroplasty.

Alumina-on-alumina total hip arthroplasty has been used for 30 years, mainly in Europe. The theoretical advantages of this combination are represented by its remarkable sliding characteristics, its very low wear debris generation, and its sufficient fracture toughness. These advantages are achieved if the material is properly controlled with high density, high purity, and small grains. The authors summarize the results obtained with ceramic/ceramic total hip arthroplasty. Information is provided about in vivo behavior regarding wear debris characterization and quantification, and histological tissue examinations for inflammatory reactions, which were not encountered except when alumina debris was mixed with metal or cement. Modification of socket fixation resulted in improved clinical outcomes. With a press-fit metal shell and an alumina liner utilized for 10 years, the results are excellent especially in a young and active population. Alumina-on-alumina seems at the moment to be one of the best choices when a total hip arthroplasty has to be performed in young and active patients.

Aluminum Oxide↗
PubMed2000

Alumina-on-alumina total hip prostheses in patients 40 years of age or younger.

To avoid the consequences of polyethylene wear in a high-risk population, 128 alumina-on-alumina total hip arthroplasties have been done in 104 consecutive patients. The maximum age of patients was 40 years. The main preoperative diagnoses were osteonecrosis and sequellae of congenital hip dislocation (71% of the hips). The same titanium alloy cemented stem was implanted in all of the hips. Four types of alumina acetabular component fixations were used: a cemented plain alumina socket (41 hips), a screw-in ring with an alumina insert (22 hips), a press-fit plain alumina socket (32 hips), and a press-fit titanium metal back with an alumina insert (33 hips). Eight patients (11 hips) died during the followup period. Sixteen revisions have been documented, 12 for acetabular aseptic loosening, three for bipolar loosening (two of which were septic), and one for unexplained pain. Eighty-eight hips in 74 patients have been followed up radiologically for 2 to 22 years. Wear was unmeasurable. Four additional sockets showed definite migration. The respective survival rates after 7 years were 94.1% for the cemented cup, 88.8% for the screw-in ring, 95.1% for cementless press-fit plain alumina socket and 94.3% for the metal-back press-fit component. The 10-year survival rate was 90.4% for the cemented socket and 88.8% for the screw-in ring. The 15-year survival rate was 78.9% for the cemented socket. Grafting was the only prognostic factor, with a survival rate of 62.6% after 10 years for the hips with a bone graft and of 90.1% for hips without a graft. The alumina-on-alumina bearing surfaces seem to be a valuable alternative to the standard metal-on-polyethylene system for young patients. However, an improvement in socket fixation is required to lengthen the life span of the prosthesis to match the life expectancy of this demanding population.

Adolescent↗
PubMed2000

Press-fit metal-backed alumina sockets: a minimum 5-year followup study.

Two hundred thirty-four consecutive alumina-on-alumina hip replacements using a press-fit metal-backed socket, performed on 214 patients (98 women, 116 men) have been reviewed. These included 201 primary procedures and 33 revision procedures. The median age of the patients at the time of surgery was 62 years (range, 21-83 years). Fourteen patients (16 hips) died from unrelated causes. Eleven patients (11 hips) underwent a total hip arthroplasty revision for recurrent dislocation (one hip), deep infection (two hips), fracture of alumina femoral head (one hip), persistent hip pain (one hip) and aseptic loosening (six hips). The survival rate after 9 years was 93.4% when revision of the prosthesis was considered the end point, and 97.4% if revision of the prosthesis for aseptic loosening was considered the end point. Results were assessed in the surviving patients with a minimal 5-year followup (170 patients, 184 hips). At the median followup of 7.8 years, the average Merle d'Aubigné and Postel score had improved from 11.9- to 17.7. Results were graded as excellent in 148 hips (80.5%), very good in 31 hips (17%), good in two hips (1%), and fair in three hips (1.5%). Radiologic data were documented for 134 patients (143 hips). Three sockets (2%) had a complete and nonprogressive radiolucent line less than 1-mm thick, one stem (0.7%) had lucencies involving five zones, and two stems (1.4%) had isolated femoral osteolysis. Neither component migration nor acetabular osteolysis were detected. A press-fit metal-backed socket may offer a good solution for alumina socket fixation when combined with a careful surgical technique of implantation.

Adult↗
PubMed2000

[Role of osteosynthesis in the consolidation of posterolateral arthrodesis: a comparative study in patients operated for lumbar stenosis].

PURPOSE OF THE STUDY: The main objective of this work was to determine the impact of osteosynthesis for posterolateral arthodesis on bone consolidation. We also tried to isolate factors predictive of nonunion and the effect of nonunion on the final outcome. MATERIAL AND METHODS: We recaIIed for assessment patients who had undergone surgery for stenosis of the lumbar spine and who had a posterolateral lumbar or lumbosacral arthodesis in addition to the spinal decompression. Among a total of 98 operated patients, 31 had arthrodesis without instrumentation. These 31 patients were matched for age, sex, smoking habits, and extent of the fusion with 31 other patients who had an instrumented arthrodesis. Radiological and clinical assessment obtained preoperatively and at 6, 12, and 24 months postoperatively were available for all 62 patients. RESULTS: Our two groups of patients were similar for comorbidity, number of arthodesis levels, fusion zone, extent and site of associated radicular release, lumbar lordosis, slope of the sacrum, global spinal mobility, and angular anteroposterior intersegmentary mobility of the different levels of the fusion zone, and interertebral sliding (site, degree, type, ante- or retrolisthesis). At last follow-up, rate of malunion was the same in the two groups (35 p. 100). Statistical analysis demonstrated three factors significantly associated with malunion: anteroposterior intersegmentary mobility, and especially angular mobility and disk height. Disk height was not however significant if it was associated with intersegmentary hypermobility. Other parameters studied, and notably use of ostheosynthesis material or not, preoperative comorbility, presence or not of preoperative intervertebral displacement, and level of the arthrodesis, had no effect. DISCUSSION: Considering the type of arthrodesis studied (short fusion on a globally minimally mobile spine) the series demonstrated that the use of osteosynthesis material does not significantly increase the rate of fusion of posterolateral arthrodesis and that the mobility of the spinal segment involved is probably a more important predictive factor for the quality of the fusion.

Female↗
PubMed2000

[Long-term influence of associated arthrodesis on adjacent segments in the treatment of lumbar stenosis: a series of 127 cases with 9-year follow-up].

PURPOSE OF THE STUDY: Little is known about the impact of posterolateral arthrodesis on adjacent levels. In order to examine this question, we analyzed the radiological evolution of the lumbar spine in patients treated for lumbar stenosis, comparing cases where posterolateral arthrodesis was used with the other cases. Our aim was to determine whether the long-term radiographical modifications were affected by the arthrodesis. MATERIAL AND METHODS: Among our series of patients presenting with lumbar stenosis between 1984 and 1992, we retained two groups: patients in group 1 (n=46) who underwent single-level decompressions at L4-L5 or L4-L5 and L5-S1 level; and patients in group II (n=81) who underwent decompressions on the same levels associated with posterolateral arthrodesis extending from L4 to the sacrum with or without instrumentation. We compared the course of the two levels above the decompression (L2-L3 and L3-L4) between the two groups. We compared three radiological parameters: disc height, intervertebral slipping, and intersegmental mobility. We also examined the correlations between radiological modifications and functional outcome. Mean follow-up for these 127 patients was 9 years. RESULTS: The two groups were comparable for age, gender, follow-up, and presurgical functional score, disc height and intervertebral slipping at equivalent levels. At last follow-up, disc narrowing was observed at L2-L3 and L3-L4; it was significantly greater in the group with complementary arthrodesis. At L3-L4, intervertebral slipping also worsened more in the arthrodesis patients. Use of osteosynthesis significantly increased the risk of developing such radiological lesions. These lesions were associated, solely in the arthrodesis group, with poorer functional outcome. CONCLUSION: Our findings allow the conclusion that, despite the effect of physiological aging, the observed long-term degenerative lesions in patients undergoing treatment of lumbar stenosis are related to the associated arthrodesis which increases their frequency and severity, deteriorating the functional outcome.

Aged↗
PubMed1999

Cementless bulk alumina socket: preliminary results at 6 years.

To avoid polyethylene wear observed in total hip replacement, an alumina-alumina combination has been used since 1977. The aim of this study is to report the results of a hybrid alumina-alumina total hip arthroplasty with a cementless press-fit bulk alumina socket and a cemented titanium alloy stem in 55 patients (62 hips) operated on between 1982 and 1990. The bearing surfaces were a 32-mm alumina head articulating within the alumina socket. Four failures occurred: 3 aseptic loosenings of the socket and 1 femoral head fracture. Considering aseptic loosening as the endpoint, the survival rate was 93.2% after 6 years. At a mean of 72.1 months' follow-up, 92.4% of the surviving hips were graded as very good or good using the Merle d'Aubigné-Postel hip score. Radiolucent lines were observed on the acetabular side in 68.1 of the hips. The future of this interface, which is probably fibrous, remains questionable. With the exception of 1 femoral head fracture, all revisions were related to failure of the bony fixation of the socket, and no problem was encountered related to the alumina-alumina friction coupling. Alumina sockets with other types of cementless fixation have therefore been designed and are presently under clinical investigation.

Adult↗