Transsupraspinatus arthrotomy through an enlarged transacromial approach for total shoulder replacement.

The authors describe a step-by-step technique for anatomic total shoulder arthroplasty using transsupraspinatus arthrotomy via the enlarged transacromial approach. This technique seems ideal to ensure adequate postoperative tensional balance of the infraspinatus and the subscapularis, which is critical for the rotator cuffs to function properly and to achieve optimal arthroplasty stability. Reviewing these different steps helps understanding each rotator cuff individual component's contribution to achieve optimal arthroplasty stability.

[The role of surgery in bone metastases of renal cell carcinoma: 13 case reports]. / La place de la chirurgie des métastases osseuses dans le cancer du rein: à propos de 13 cas.

INTRODUCTION: Surgery for osseous metastases seems to improve the patients with renal cell carcinoma. The goal of this study is to evaluate the efficacy and safety of surgery for osseous metastases from renal cell carcinoma. MATERIALS: We performed 21 surgery for osseous metastases in 13 patients who have been treated for metastatic renal cell carcinoma at one institution between 2001 and 2007. The surgical procedure included curetage with cementing and or internal fixation, in bloc resection or surgical decompressive procedure. Disease-free and overall survival was calculated using Kaplan-Meïer analysis. RESULTS: The overall patient survival rate at one year was 84%. The overall median survival time was 23months (IC95%; 16,9-78,1%). The disease-free survival was 19 months (IC95%: 26,7%-80,9%) after surgery. Positive margins were observed in 9 patients (R2) and negative margins in 8 patients (R0). R0 and R2 resections have no impact on local relapse. Minor complications occurred in two patients. There was no intra- or postoperative hemorrhage. CONCLUSION: Surgery of osseous metastases is safe and effective and seems to improve outcomes of metastatic renal cell carcinoma.

[What is the interest of early mobilization after total hip arthroplasty? Development of French guidelines for clinical practice]. / Intérêt d'une mobilisation très précoce après la pose d'une prothèse totale de hanche ? Elaboration de recommandations françaises pour la pratique clinique.

AIMS: To develop clinical practice guidelines for early mobilisation after total hip replacement (THR). METHOD: We used the French Society of Physical and Rehabilitation Medicine (Sofmer) methodology, which associates a systematic review of the literature, the collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. RESULTS: Recommending early mobilisation after THR is not established by a review of the literature. A survey of French clinical practice allows for recommending early mobilisation in the context of complex hip issues. Trials with good methodology must be developed to evaluate the interest of early functional mobilisation corresponding to when patients first stand and take their first steps after surgery. These trials should focus mainly on the final pain, functional status, and reduction of handicap.

Hemarthrosis: an unusual complication of type 1 neurofibromatosis.

Type 1 neurofibromatosis is one of the most common autosomal-dominant disorders and often includes orthopedic manifestations. We report the case of a 48-year-old woman with hemarthrosis caused by a popliteal cyst infiltrated by a diffuse neurofibroma associated with angiodysplasia. Surgical resection of this tumor was followed by postoperative hemorrhagic complications.

Poor eight-year survival of cemented zirconia-polyethylene total hip replacements.

Between January 1988 and January 1991 we performed 100 consecutive cemented total hip replacements using a zirconia head, a titanium alloy stem and a polyethylene cup. We reviewed 78 of these hips in 61 patients in detail at a mean of 5.8 years (1 to 9). Aseptic loosening was seen in 11 hips (14%). Eight needed revision. In total, 37 cups (47.5%) showed radiolucent lines, all at the cement-bone interface, with 18 (23%) involving all the interface. Of the 78 femoral implants, 17 (21.7%) showed radiolucent lines, and two, which had a complete line of more than 1 mm thick, definite endocortical osteolyses. There was also an abnormally high incidence of osteolysis of more than 2 mm at the calcar. Survivorship analysis showed that only 63% were in situ at eight years. These worrying results led us to abandon the use of zirconia heads, since at the same hospital, using the same femoral stem, cement and polyethylene cup, but with alumina femoral heads, the survival rate was 93% at nine years. We discuss the possible reasons for the poor performance of zirconia ceramic.

[10-year actuarial analysis of a cohort of 156 total hip prostheses of a cemented polished aluminum/polyethylene alloy]. / Analyse actuarielle à 10 ans d'une cohorte de 156 prothèses totales de hanche cimentées à couple de frottement alumine/polyethylène.

PURPOSE OF THE STUDY: From 1983 to 1986, 156 alumina/polyethylene combination hip arthroplasties (131 patients) were performed at the Henri Mondor Hospital. Before 1983, the stainless-steel/polyethylene combination was performed. In this follow-up study, the outcome of the first 156 consecutive alumine-polyethylene combination hip arthroplasties were analyzed with clinical and radiological features. The comparison of the two combinations was analyzed. A survival analysis was performed over a ten years interval. MATERIAL AND METHODS: The femoral component of the prosthesis was made of Titanium alloy (TiA16V4). The femoral head was made of dense alumina (A1203). The head diameter was 32 mm. The socket was made of ultra-high-molecular-weight polyethylene (UHMWPE). Fixation of head to stem was obtained through conical sleeving. We used a posterolateral approach, and a cemented THA without pressurization. At last follow-up evaluation, 90 patients were reviewed, 9 patients were interviewed by phone. Three patients were dead and 20 patients were lost for follow-up evaluation, in the first year. Nine failures were reoperated. The major cause of failure was septic complication of the THA (8). The average age of patients at arthroplasty was 58.1 year. The clinical evaluation was performed with the Merle d'Aubigné, Postel scoring system. The radiographs of 117 hips out of the 156 were available for this evaluation. Radiolucents, failures and wear were analyzed. RESULTS: There was a 5 per cent rate (8 hips) of deep infection due for two hips to the underlying pathology. Ten (6.5 per cent) of the 156 hips had had an episode of dislocation at last follow-up. Eighty-nine per cent of the hips were rated excellent, very good, and good; 9.3 per cent were rated fair: and 1.7 per cent were rated poor. The radiographs of the socket revealed 54 per cent of bone-cement radiolucent and three failures at last follow-up. The radiographs of the stem revealed 29 per cent of bone-cement radiolucent and one failure at last follow-up. There was no revision of the femoral stem. Survival analysis (aseptic failures) depicted 93.45 per cent durability of the arthroplasty at 10 years. The survival analysis for the socket alone, using the same criteria for failure, demonstrated 94.53 per cent survival success at 10 years, and 98.91 per cent for the stem component. The comparison of the two combinations gave us a survival analysis for the socket alone, using aseptic failure as criteria, 79.84 per cent for stainless-steel/polyethylene combination at 8 years, and 97.63 per cent for alumina/polyethylene at the same time. CONCLUSION: The alumina/polyethylene combination with a 32 mm head diameter gave better results than the stainless-steel/polyethylene combinations. The improvement was noted on the acetabular component.

The importance of systematic histological examination after loosening of an implant.

A 65-year-old man presented with a painful hip five years after a cemented replacement. Histological examination of a biopsy taken from tissue surrounding the femoral implant showed infiltration of a squamous-cell carcinoma. Further investigation revealed a primary growth in the left lung. This rare example of a metastasis in relation to a joint replacement illustrates the necessity for histological examination of the tissue adjacent to a loose prosthesis.