Acetabular reconstruction with a bipolar prosthesis. Five year results of the Dautry technique.

We report the results of acetabular reconstruction using a bipolar prosthesis bearing on cancellous bone graft in 37 patients after a minimum of five years. There was a satisfactory clinical outcome in 58% when assessed by pain, range of movement and stability, with greater improvement in the pain score than of the other parameters. Radiological migration of the prosthesis was a frequent finding although this did not always correlate with symptoms. Better results were obtained in cases of primary or secondary protrusio acetabuli than after the revision of previous total arthroplasties.

[Limitations of replacing the semilunar with a Swanson's implant]. / Les limites du remplacement du semi-lunaire par l'implant de Swanson.

Nineteen patients have had an arthroplasty of the semilunar by Swanson's prosthesis at stage III of Kienbock's disease. They have been reviewed after an average period of 4 years. The clinical evaluation finds 14 good and excellent results, two fair and 3 poor ones. Its analysis shows a persistence of a non limiting pain 15 times; a fair muscular strength which reaches 65 per cent of the strength of the healthy side and articular amplitudes reduced by 36 per cent of the normal amplitude. Radiologically, the study of the wrist as a whole shows that the prosthetic implantation avoids the aggravation of the collapse of the wrist, whereas its cubital sliding increases by about 15 per cent. The analysis of the evolutive mode of the wrist shows a subluxation of the scaphoid which leads 15 times to a scaphoradial arthrosis; 17 times were observed lytic signs which in 4 cases have evoked a synovitis. It seems therefore that the clinical results are favourable more than 3 times out of 4, but radiological signs of osteoarticular degeneration show the necessity to stabilize the external column of the wrist, in order to avoid the deterioration of the Swanson's implants.

[Prevention of abscess of the abdominal wall by continuous antisepsis, combined with antibiotherapy. 4751 cases]. / Prévention des abcès de paroi par l'antisepsie continue, associée à l'antibiothérapie. 4751 observations.

The reduced incidence of wall abscesses following routine general surgery was studied in 4751 cases over the period from 1973 to 1987. The therapeutical evolution spanned over three consecutive treatment periods, each one falling into one patient group. The reference period (Group I) extended from 1973 to 1978. Starting from 1978 and up till 1984 (Group 2), systematic repeated lavage of the operative field with an iodized polyvinylpyrrolidone solution were carried out, providing thus for true continuous antisepsis (CA). Starting from 1985 (Group 3), the method of continuous antisepsis was associated with systematic prophylactic antibiotherapy (SPAB). Groups 1, 2 and 3 included 2051, 1955 and 745 cases, respectively, and presented progressively decreasing rates of abscess formation (4%, 2.5%, 1.7%, respectively). In order to better assess these results, an in-depth analysis was carried out on two types of surgical operations, i.e., appendicitis and gynecological surgery, based on Altemeier's classification. The rate of abscess formation was lowered. This result is particularly interesting from the point of view of gynecological surgery, inasmuch as a relative increase in the frequency of the more esthetic horizontal incisions is being concurrently noted.

Orientation of the articular processes at L4, L5, and S1. Possible role in pathology of the intervertebral disc.

In the synergistic complex formed by the intervertebral disc and posterior articular processes, the latter play a significant role to protect the disc and block forward movement of the spine. This role is of special importance at the level of the lumbosacral interface whose inclination contributes to increase shearing forces acting on the disc. The orientation of the lumbosacral articular processes modifies the distribution of the mechanical stress acting at their level. The relationship between the orientation of the articular processes and the stress transmitted to the disc was studied by computerized tomography (31 subjects without disc prolapse, 35 subjects with disc prolapse, 110 operative reports). Sagittal orientation of the facet joints, which is consistently more pronounced on the right side, seems to promote the occurrence of disc prolapse at the lumbosacral level.