Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Feb 2003
Comparative Study[Management of stiffness after total knee arthroplasty: indication for different mobility management in 62 cases].
Stiffness of the knee is a common reason for revision of total knee arthroplasty. Three methods are currently used to mobilize the knee: manipulation under general anesthesia, arthroscopic release, open surgical release. The purpose of the present work was to determine the respective indications of these three procedures in a large single-center study. ⋯ We recommend treatment of stiff total knee prosthesis by manipulation under general anesthesis if the procedure is performed less than eight weeks after implantation; a delay of six weeks is even better because intraoperative complications were observed for patients treated between six and eight weeks. Between eight weeks and six months, arthroscopic release should be advised, surgical release thereafter. Whatever the delay, this protocol is appropriate for stiff knee prostheses without infection and without component malposition. Whatever procedure is applied, the definite range of motion is reached six months after the intervention.
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Rev Chir Orthop Reparatrice Appar Mot · Feb 2003
[Chronic anterior shoulder dislocation treated by open reduction sparing the humeral head].
Treatment options for unreduced anterior dislocation of the shoulder have varied from nonoperative treatment to different surgical options. Little has been written in the literature on the management of unreduced anterior dislocation or on the results of the different procedures. We report our experience and present the outcome after an open reduction joint-saving procedure used in five patients. ⋯ Unreduced anterior shoulder dislocation should be treated with an open reduction and reconstruction of the specific lesions, unless the patient is old or debilitated. This operation can however be difficult and requires extensive soft tissue release, and occasionally use of a bone graft to reconstruct the anterior defect of the glenoid. The long-term results remain modest. When the humeral head cannot be saved because of extensive osteochondral lesions, shoulder arthroplasty must be the treatment of choice.
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Rev Chir Orthop Reparatrice Appar Mot · Feb 2003
[Shoulder arthroplasty for non-operated anterior shoulder instability with secondary osteoarthritis].
The purpose of this study was to analyze the natural history of osteoarthritis of the shoulder joint secondary to non-operated anterior instability, to evaluate the clinical and radiological outcome after arthroplasty for this indication, and to compare results with data reported in the literature. ⋯ The forty-year age cutoff allowed us to distinguish two populations. The first population of patients whose first dislocation had occurred before the age of 40 years was predominantly male, with a long history of constructive osteoarthritis without rotator cuff tears. Most of these patients were treated with total shoulder arthroplasty which gave results similar to those obtained with arthroplasty for primary centered osteoarthritis. The second sub-group of patients aged over 40 years at the time of the first dislocation were predominantly female with a short history of minimally constructive osteoarthritis and frequent rotator cuff tears. Humeral implants were used for most of these patients and gave less favorable results than in the former sub-group, probably due to the high rate of rotator cuff tears.