Late results of Harrington's operation. Long-term evolution of the lumbar spine below the fused segments.

Between 1963 and 1971, Harrington's technique was used by the senior author to operate on 493 scoliotic patients, of which 364 were idiopathic. A total of 276 patients were reexamined, of which 209 were idiopathic cases. All met the following criteria: a follow-up period of at least 10 years; the operation was performed by the same surgeon; and the review was undertaken by one person. The average follow-up period was 13 years, 10 months. A total of 95 patients had a follow-up period of more than 15 years, of these 75 patients were idiopathic. The surgical technique was similar in all cases: a distraction rod in the concavity, arthrodesis by decortication, and a corticospongious graft obtained from one or both iliac crests. Postoperative immobilization was assured by a plaster corset for 6 months, followed by a "plexidur corset lyonnais." The review of the patients examined was based on rigorous clinical and radiological analyses. Anteroposterior and lateral radiographs were obtained, complemented by a lateral radiograph of the lumbosacral segment. The angular results were disappointing, decreasing from 66.2 degrees to 38 degrees immediately postoperatively but increasing to an average final curve of 51.4 degrees. Clinical results were good: Only 21.3% of patients actually had back pain. The patients were satisfied with their appearance and their professional, social, and marital status. This study indicates the outcome of the lumbar spine below the graft. The vertebral bodies were modified morphologically; they became elongated and more trapezoidal leading to a quite normal average lordosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term course of lumbar curvature following Harrington instrumentation for thoracic or double major idiopathic scoliosis]. / Evolution à long terme de la courbure lombaire après instrumentation de Harrington pour scoliose thoracique ou double majeure idiopathique.

A long-term follow-up study has been made of 276 patients with thoracic or double major idiopathic curves treated by Harrington rodding between 1963 and 1971. 82 patients were able to be followed up to the present date, including 24 double major idiopathic curves and 58 thoracic or thoracolumbar curves. The average follow-up was 15 years with a maximum of 20 years. There were 71 female and 11 male patients. It was concluded that the lumbar curve associated with a thoracic or thoraco-lumbar curve lost about 9.9 degrees when the lower point of insertion of the rod was higher than L3. When it was at L3 or L4 loss of correction was only 3.6 degrees. During the same period the loss of correction of the main grafted curve was 13.6 degrees. In double major curves, the best results were obtained when the lumbar curve was completely or almost completely fused, with an average correction of 17.2 degrees. The results were good when the fixation extended to the apex of the lumbar curve, with an average correction of 11.6 degrees and was moderate when it extended to a higher level with an average correction of 10.9 degrees. It is concluded that in almost all cases, instrumentation needs to be extended to a low level at L3 or L4 to provide greater stability. A study on all 276 cases showed that the morphological adaptation beneath the grafts was satisfactory and long lasting. When the instrumentation stopped at the level of T12, L1 or L2 there was a danger of the development of secondary lumbar kyphosis. Low back pain was not made worse in any cases of low lumbar fixation.

[Reoperation after failure of unicompartmental knee prosthesis. Therapeutic strategy and results based on 40 cases]. / Reprises pour échecs de prothèses unicompartimentales du genou. Stratégie thérapeutique et résultats à propos de 40 cas.

Forty revisions for failure of unicompartmental knee prostheses were assessed. Twenty-eight women and twelve men (mean age: 67 years) were reoperated. Failure of an medial single-compartment prosthesis was involved in 35 cases, of a lateral prosthesis in 5 cases. The initial prostheses had been cemented in 19 cases and uncemented in 21 cases. Preoperative functional conditions were assessed by Hungerford's functional score and a 200-points score. The radiological study before revision showed 35 cases of varus distortion; in 12 of these, the varus distortion exceeded 10 degrees. Rather than studying the causes for failure of the single-compartment prosthesis, it seemed more useful to try to define the adequate reoperation procedure strategy and analyze its results. Our procedure aimed at solving the following difficulties: surgical approach: the same incision as in the initial operation was performed, the primary prosthesis was removed and a two-stage treatment was justified in cases of infection, metallosis involved complete removal of debris, the problem of bone-recutting and, chiefly, the problem of residual bone defect requiring bone-graft. Bone-recutting was performed with the tibial and femoral elements of the primary prosthesis still in place and using the ancillary equipment of the new prosthesis. Bone defects involved the femur as often (14 cases) as the tibia (12 cases); tibial bone defects occurred more frequently with cemented prostheses (9 cases) than with uncemented prostheses (3 cases). Femoral graft being relatively easier to perform one of the two major difficulties in our strategy was the achievement of a tibial graft.(ABSTRACT TRUNCATED AT 250 WORDS)

[Stress fractures of the tibia: uncommon mechanical complication of osteoarthritis of the knee. Report of 3 cases]. / Fractures de contrainte du tibia: complication mécanique inhabituelle de la gonarthrose. A propos de trois cas.

Three cases are reported of spontaneous fracture of the tibia complicating osteoarthritis of the knee with genu varum. These fractures, which are very rare, with only eight cases published in the literature, seem to be associated with severe osteoarthritis in small, obese women. They usually progress to union with simple relief from weight-bearing but non-union may develop which makes the treatment of the causative osteoarthritis more difficult. A review of the published cases helped the indications for treatment to be defined.

Safety and efficacy of three arthroscopic procedures using Holmium: Yag laser in two high-responder haemophiliacs.

We report here on the efficacy and safety of three arthroscopic procedures using a Holmium: Yag laser in two high-responder haemophiliacs. The two patients were treated with an activated prothrombin complex concentrate (FEIBA; Immuno, Vienna, Austria). Treatment was started just before surgery and continued for 4-8 days. On one occasion antifibrinolytics were concomitantly used without thromboembolic complication. Post-operative blood loss was slight, joint mobility was rapidly acceptable and full weight bearing without pain was possible on day 4. Such a procedure would appear to be superior to conventional arthroscopic synovectomy utilizing mechanical devices in haemophiliacs, because it might improve the quality of local haemostasis and the rapidity of post-operative recovery. In addition, it is also the technical procedure of choice in haemophilic patients with inhibitors who need synovectomy.