Modular megaprosthesis for proximal femoral tumors.

Fifteen patients with proximal femoral tumors had resection and limb salvage with an uncemented Kotz (HMRS) megaprosthesis. There were five osteosarcomas, four chondrosarcomas, one hemangioendothelioma, three fibrosarcomas, and two Ewing's sarcomas. The mean follow-up was 6.7 (range 3-10) years. Two patients died of causes not related to the prosthesis. The postoperative Musculoskeletal Tumor Society score (MSTS) score was 19 (range 12-26) for the remaining 13 patients. There were one aseptic loosening, two infections, and one local recurrence. The most frequent complication was hip dislocation at 20%. Reconstruction of proximal femoral tumors with a modular megaprosthesis is a good procedure, but hip instability remains a major problem.

Modular megaprosthesis for distal femoral tumors.

We treated 48 patients with distal femoral tumors by resection and limb salvage with an uncemented megaprosthesis (Howmedica Modular Replacement System). Diagnoses included: 32 osteosarcomas, five chondrosarcomas, six giant cell tumors of the bone, three fibrosarcomas, and two Ewing's sarcomas. The mean follow-up was 5.6 years (2-10 years). The overall complication rate was 39%. Seven patients died of their disease, but none from complications related to the surgery. Five patients were revised to arthrodesis, and one required amputation because of complications. The mean postoperative Musculoskeletal Tumor Society score (MSTS) score was 21 (6-28) for the remaining 35 patients. The most frequent complications were infection (14.6%) and aseptic loosening (4.8%). Ten-year survival of the prosthesis was 65%.

Limb salvage surgery in bone tumour with modular endoprosthesis.

Thirty-three patients with bone tumours were treated by resection of the growth and reconstruction with a Kotz modular endoprosthesis. The average follow-up was for 50 months, ranging from 14 to 79 months. At the last review, 12 patients (36%) had died due to the tumour and 9 others (27%) had metastases. All 4 patients with proximal tibial reconstruction had poor functional results, due to an extension lag or to knee stiffness. Four of the six tumours of the proximal femur were complicated by local recurrence or dislocation of the hip, and had poor or fair functional results. Of the patients with distal femoral reconstruction, 17 out of 22 had excellent or good functional results. Reconstruction with a modular prosthesis after resection of a tumour gives excellent or good functional results in more than three-fourths of the cases of distal femur reconstruction, but it should be used with caution in the proximal tibia and proximal femur.

Reimplantation of autoclaved tumour bone in limb salvage surgery.

This is a prospective clinical study of 7 patients with malignant bone tumours who were treated by resection of the tumour, followed with reconstruction by reimplantation of the resected autoclaved tumour bone. There were 3 male and 4 female patients between 10 and 36 years of age. All the tumours were Stage IIB. Five of the 7 were in the region of the knee joint. Histologically, 5 were osteosarcomas, 1 a recurrent chondrosarcoma and 1 a recurrent Ewing's sarcoma. All the patients were treated by en bloc resection of the tumour with wide margins. The resected length ranged from 13 cm to 28 cm. After removal of soft tissue and cartilage, the resected bone segment was autoclaved for 5 min at 132 degrees C and 29 pounds per square inch pressure (0.2 mega Pascal). This autoclaved segment of bone was then reimplanted and fixed with an appropriate implant. The average follow-up was 20 months with a range of 14 to 27 months. None of the tumours recurred and, at the most recent follow-up, all the patients were alive, 6 with no evidence of disease and one with a lung metastasis. Six of the 7 patients were available for radiological assessment. Solid bone union was seen in 4 patients, delayed union in 1 and nonunion in 1. This method of reconstruction using an autoclaved tumour bone graft is useful in countries where facilities for allograft or tumour prostheses are not available owing to financial, technical or sociocultural reasons.

Bipolar hip replacement in sickle cell disease.

A retrospective study is presented of 26 uncemented bipolar hip replacements for avascular necrosis of the femoral head due to sickle cell disease which were carried out between 1987 and 1992. All patients were treated according to a protocol. The average follow up was 4.6 years (range 2.1 to 7 years). After operation, the average Harris hip score improved from 36 to 88. Bone culture was positive for bacterial growth in 4 hips (coagulase negative staphylococcus in 3). There was progressive wear of acetabular articular cartilage in 2 cases, but no clinical or radiological evidence of loosening of the femoral stem. Seventeen complications occurred in 9 of the 21 patients (5 in one patient). A longitudinal split of the femur was the commonest operative complication and occurred in 5 hips. Femoral medullary sclerosis was seen in 8 cases. Patients with sickle cell disease have a high risk of complications, but this type of hip replacement should be considered in carefully selected patients who have avascular necrosis of the femoral head.

Solitary infantile myofibromatosis of axis. A case report.

Lytic lesions of the cervical spine are rare and may be caused by infection or tumors. The authors report a rare case of solitary infantile myofibromatosis presenting as a lytic lesion of the second cervical vertebral body (C2) and odontoid, causing atlanto-axial instability.

9 Knee arthroplasties for sickle cell disease.

Sickle cell disease sometimes presents with knee arthropathy secondary to osteonecrosis. We report our experience with 9 total knee arthroplasties in 5 patients. The joint fluid, synovium, capsule, and excised bones were sent for culture. Tissue cultures from 5 knees grew organisms. The outcome was: 6 excellent, 1 good, 1 satisfactory, and 1 poor. Infection in 1 case led to removal of the prosthesis and subsequent arthrodesis. 1 patient had persistent peroneal nerve palsy. There were no hematological complications. We suggest that osteonecrosis in sickle cell disease should be considered septic.

[Corneal complications caused by indomethacin eyedrop]. / Complications cornéennes par usage de collyre indométacine.

During ocular treatments by drops of INDOCID are observed 4 superficial punctuate keratitis disappearing when INDOCID is discontinued, and 2 diffuse corneal oedemas. Some possible explanations for such a corneal involvement are suggested.

[Syndrome of acute choriocapillaris ischemia in leukemia. Thoughts apropos of a case]. / Syndrome d'ischémie aiguë choriocapillaire au cours d'une leucose. Réflexion à propos d'une observation.

Choriocapillaris occlusion is rare in leukemia. After Zimmerman in 1964 our case is the tenth published. A 20-year-old maghrebin male with documented acute lymphoblastic leukemia in relapse from two years was evaluated for sudden loss of vision Examination of the both fundus revealed a serous central retinal detachment. Our material consists in four fluorescein angiographies realized at 72 hours, 8th, 25th and 65th days. Initial aspect was numerous hyperfluorescent spots at the level of the pigment epithelium and following a bleb of serous detachment fullfiled of dye. The deep leakages were blown out after a week, when patient received anti-neoplasic drugs and corticoids. On the 25th Elschnig's spots appeared but a recurrence happened after two months. Unfortunately the eyes were not documented. Choroid is the most frequent ocular structure infiltrated in leukemia. On the other hand parallel may be done with Stern and Ernest experimentation (microspheres occlusion). Thus we considered that occurs infraction of choriocapillaris units by lymphoblasts or coagulopathy. Succed focal acute changes in Bruch's membrane and pigment epithelium.