Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · May 2007
Comparative Study[Total hip arthroplasty in patients with chronic renal failure transplant or dialysis].
Total hip arthroplasty (THA) is generally proposed for renal transplant patients with invalidating hip disease. For patients on chronic dialysis, the few published series report a higher rate of complications. These patients are considered more vulnerable. We report the results of a retrospective mid-term analysis of 28 renal failure patients (37 hips) with THA comparing renal transplant recipients with chronic dialysis patients. ⋯ In renal transplant recipients, total hip arthroplasty is a reliable treatment for hip disease, providing good mid-term results and a morbidity close to that observed in the general population. Conversely, dialysis patients have a greater perioperative morbidity. Use of non-cemented implants is not associated with a higher rate of loosening than with cemented implants. It can be recalled that this type of surgery must be performed within the framework of careful pluridisciplinary patient management.
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Rev Chir Orthop Reparatrice Appar Mot · May 2007
[Acetabular revision for aseptic loosening in total hip arthroplasty using cementless cup and impacted morselized allograft].
Impaction grafting can be used in cementless fixation with morsellized bone, bone graft, and hemispherical cup. The first goal of impaction grafting in revision of total hip arthroplasty is to transform segmental defects into cavitary defects and obtain a full compaction of the graft in order to restore the bone stock. The second goal is to achieve primary stability of the cup. The third goal is to restore the hip center of rotation with a cup anatomically located in the acetabulum. The aim of our study was to evaluate the results of a surgical technique with impacted morsellized bone graft and a cementless press-fit cup for the revision with defect type III according to the AAOS classification. ⋯ Restoration of bone stock is one of the main goals during hip reconstruction after aseptic loosening. Clinical experience in our series has shown the reliability of the impacted morsellized bone graft allowing relocation of the center of rotation and good cup stability. Biological fixation of the cup and graft integration seems good at mid-term follow-up. The cup that we used in our series combined the advantages of a press-fit cup and those of a reinforcement ring. The combination of this type of cup with morsellized bone graft seems to be a reliable solution for restoring bone stock, relocating the hip center, and stabilizing the cup in revision total hip arthroplasty with type III acetabular defect according to the AAOS classification.
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Rev Chir Orthop Reparatrice Appar Mot · May 2007
Comparative Study[Biomechanical evaluation of posterior instrumentation for lumbar burst fracture: comparison of two internal devices].
Burst fractures generally occur due to trauma to the thoracolumbar spine. Surgery is indicated for unstable fractures. Posterior instrumentation with pedicular screws is generally proposed. In certain circumstances, hooks may be preferred due to excessive risk of insertion of the pedicular screw. The purpose of this study was to compare two posterior instrumentations, one using pedicular screws on either side of the fracture each protected by hoods and a second composed of the same pedicular screws inserted under the fracture hooks above. ⋯ This mode simulating burst fractures of the spine appears to be reproducible and more realistic than corporectomy. Attention should be taken concerning the limits of this type of study since fractures can occur for forces as small as 10.6 Nm. Thus we observed that pedicle screw configurations and also fractures produced mean ranges of motion greater than intact segments irrespective of the type of lesion simulated. However, the net increase in motion was observed during rotation movements when hooks were used, even when they were placed only below the fracture. Putting pressure on the hooks does not prevent them from slipping along the lamina. But neither of these two configurations controls the fracture gap. A vertebral reinforcement might be necessary.
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Rev Chir Orthop Reparatrice Appar Mot · May 2007
Comparative Study[Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement].
There have been few prospective studies comparing minimally invasive approaches for total hip replacement. We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the standard posterolateral approach in terms of early outcome. ⋯ The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation. A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding. It enables satisfactory reproducible implant positioning. Conversion to an open posterolateral approach is possible if needed. The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation. Early clinical outcome is better but beyond six weeks, the functional results are comparable for the two approaches. The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve.