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Purpose of the Study: Management of bone stock loss remains one of the most challenging problems for revision hip surgery. The aim of this retrospective study was to report the preliminary results of peri-prosthetic femoral defect reconstruction with impacted granules of calcium phosphate ceramic., Material and Methods: Fourteen hips in 13 patients (3 men and 10 women) were evaluated. Age at surgery ranged from 30 to 79 years (mean 66.1 years). All revised devices had been cemented. Femoral revision was indicated for loosening in eleven hips (including six septic cases), femoral osteolysis (one hip), persistent pain (one hip), and recurrent dislocation (one hip). On the preoperative radiological evaluation, bone defects were assessed as SOFCOT grade II in seven case, and grade III in fourteen. None was rated grade IV. Once the loose prosthesis had been removed, bone graft or ceramic granules (14 cases) were firmly impacted in the femoral canal. The stem was standard and always cemented using modern cementing technique., Results: At a mean follow-up of 34 +/- 15 months (range 14-76 months), eleven of fourteen hips were rated good or very good according to the Postel-Merle-d'Aubigné score. One diaphyseal femoral fracture occurred and later united. Two hips required re-revision (one aseptic femoral loosening, one septic recurrence). Direct bonding between synthetic graft and bone was observed on standard radiographs in eleven cases. Stem subsidence occurred in two cases and was limited (mean 4.5 mm)., Discussion: Femoral bone reconstruction using impacted calcium phosphate ceramic in revision hip arthroplasty provided encouraging results in the short to mid term. Femoral stock restoration was achieved in the great majority. No adverse effect related to the use of a synthetic graft was noted. Further long-term evaluation is required before wider application.

Two black patients from Africa presented idiopathic tumoral calcinosis. This rare disease, defined by the presence of calcified deposits in peri-articular tissues remains poorly elucidated. Pathogenesis is still hypothetical. The diagnosis can be established with careful physical examination and appropriate complementary exams, allowing early complete surgical resection without biopsy. Pathology examination is required for formal differential diagnosis. The present tumors were particularly large, but did not produce signs of compression. In the first patient, the tumor developed after pregnancy in the zone of antibiotic injections. The second patient presented multiple bilateral symmetrical localizations with bone invasion. Histology confirmed the nature of the lesions and revealed bony metaplasie in the first patient, an element rarely described. Prognosis is excellent with early treatment. Recurrence is the rule in the event of incomplete resection. We discuss the appropriate diagnostic and therapeutic management.

Purpose of the Study: We report our experience with eleven patients treated for disabling genu valgum from 1979 to 1994., Material and Methods: Genu valgum resulted from femoral deformation in all patients. Ten had a congenital condition and one a post-traumatic knee. IKS scores were used for the clinical evaluation. The lateral femorotibial joint space and the lateral femoral angle (LFA) were measured on plain films. Goniometry was used to measure the axis of the loaded lower limb. All patients underwent osteotomy of the distal femur for varisation and plate fixation. One patient required revision for a unicompartment lateral prosthesis subsequent to fracture of the homolateral lateral tibial plateau. Mean follow-up was 10.5 years (3.5-21.5)., Results: There were no cases of nonunion. Four patients had a good or excellent knee score. Eight patients had a good or excellent function score. Osteoarthritis worsened in two patients. The mean LFA increased from 72.5 degrees preoperatively to 83.5 degrees postoperatively and a last follow-up. Mean genu valgum was 13 degrees preoperatively and 2 degrees at last follow-up. All patients except one were satisfied or very satisfied. Insufficient correction appeared to be the main complaint., Discussion: These results and results reported in the literature demonstrate that distal femoral osteotomy for disabling genu valgum is an effective treatment if the correction is complete and osteosynthesis effective, providing long lasting results when femoral deformation is involved and osteoarthritis limited.

We report a case of severe femoral agenesia in an adult and propose a new surgical approach facilitating prosthesis fitting. The procedure involves insertion of a total hip arthroplasty, arthrodesis of the knee and amputation of the foot. The final prosthesis fits on the crural area with weight bearing on the ischiatic region, the lesser pelvis, and the articulated knee. Outcome was satisfactory at one year in our patient. Other surgical alternatives are presented.

Purpose of the Study: In order to avoid polyethylene wear observed in total hip replacement, an alumina-alumina combination has been used since 1977. The aim of this prospective study was to assess the results of an alumina-alumina total hip arthroplasty with a cementless press-fit plain alumina socket and a cemented titanium alloy stem with special attention for socket fixation because of previously encountered problems., Materials and Methods: Fifty-five patients (62 hips) were operated on between 1982 and 1990. The main parameter for inclusion was a high level activity demand. The bearing surfaces were a 32 mm alumina head articulating within the alumina socket. Mean follow-up was 6 years., Results: Four revisions occurred in this series: 3 for aseptic loosenings of the socket and 1 for femoral head fracture. Considering acetabular revision for aseptic loosening as the end point, the survival rate was 93.2 % at six years and 78.8 % at six years when considering acetabular loosening as the end point. At a mean of 72.1 month-follow-up, 92.4 % of the remaining hips were graded as very good or good while 44.6 % showed radiolucent lines around the socket and 4 had migrated with no radio-clinical correlation. On the femoral side, there was no radiolucent line nor loosening, and the value of the colar calcar resorption was low (mean 0.4 mm). In all four revisions, the stem was left in place, and there was no bone loss, which allowed simple revisions., Discussion: Thin radiolucent lines around bulk alumina press-fit sockets can be understood as a normal bone reaction to material as the Young's modulus is much higher. They do not necessarily signify mechanical failure of the fixation. However when considering the rate of acetabular loosening, an improvement of the alumina/bone interface is still required.

Introduction: Alumina on alumina friction couple has proven its reliability in the field of total hip arthroplasty. However, loosening of the alumina socket has been responsible for most of the failures. An improvement of the bone/alumina interface could be achieved with the use of an osteconductive material as a coating on alumina. The aim of this study was to evaluate the osteconductive properties of two types of bioactive glasses as a coating on alumina substrates., Materials and Methods: Two types of coated implants (silicate glass coated alumina - AVSi, and phosphate glass coated alumina - AVP) were evaluated in a rabbit cancellous bone model. Pure alumina implants (A) were used as negative controls and bulk glasses (silicate - VSi and original 45S5, and phosphate glasses -VP) as negative controls. Sacrifices were performed at 3, 12 and 24 weeks. The interface evaluation included histomorphometry using an image analyzer., Results: Silicate glasses demonstrated high osteoconductive properties. However, non mineralized osteoid tissue was the main tissue in contact with both coated implants and bulk phosphate glasses. This tissue covered over 70 p. 100 after 24 weeks of implantation, while it was never observed around pure alumina implants after 3 weeks., Discussion: Amongst the hypotheses that could explain this mineralization inhibitory process, the one involving an Al(3+) glasses contamination from Al(2) O(3) is the likeliest. The high temperature coating procedure could be responsible for alumina transformation into a more soluble phase.

Twenty-three shoulder arthrodeses after brachial plexus injuries have been performed. Average time between injury and arthrodesis was 3.4 years. 18 patients had palliative procedures or direct approach of the brachial plexus to improve shoulder and hand function. Average follow-up was 5 years and 11 months. An analysis based on pain, function, and fusion occurrence gave 15 good, 2 fair and 4 poor results. The authors conclude that the shoulder arthrodesis is indicated when elbow and hand functions are sufficient and deafferentation pain has not occurred.

This work deals with the results obtained by four French orthopaedic departments using the electromagnetic field stimulation for non union treatment. This is the method established by A. Bassett. 37 cases are studied, the results are known for 35 of them with 6 failures and 29 successes. The failures can be explained for four of them by a bad application of the device. Concerning the 29 successful cases, the role of the stimulation is discussed. Discarding those who have been treated a short time after a surgical procedure, those who have been immobilized more than 6 months and those where the non union could have been a delayed union, it remains 14 successful cases apparently undisputable. For them the role of the electromagnetic field stimulation seems real.

The results of a series of 86 cases with a follow-up of 2 to 23 years are presented. Treatment was surgical in all cases except in spine and pelvis. 24 cases were treated by curetage, 51 by resection in some cases after curetage. Block resection nearly suppresses the recurrences and, when used as the first treatment, may avoid secondary malignant degeneration.

The authors have observed 103 cases of brachial plexus paralysis due to trauma. There were 65 total and 38 partial paralysis. The follow-up was for more than 5 years in half of the cases. Twenty-one of the 65 total paralysis showed no recovery. Total or partial recovery occurred in other cases. Recovery was more complete when it began earlier, within a few days or weeks, but, in a number of cases, isolated muscles such as biceps recovered after two, three or even four years. The authors analyse the results of peripheral surgery. Amputation did not improve patient function. Arthrodesis of the shoulder, tendon transfers for the restoration of finger extension and Stenidler procedures at the elbow gave good results. Tendon transfers at the shoulder (Clark procedure), operations for restoration of opposition of the thumb and transfers of triceps to biceps were beneficial. Poor results were obtained after arthrodesis of the wrist, complex tendon transfers in the hand and transfers of latissimus dorsi and teres major. A direct surgical approach to the lesion is indicated when there is no recovery after two months.

Twelve sheep were used in an experimental study on bone healing. The first metatarsal was fractured and fixed either by plating without compression or by intramedullary nailing. Three months later, the animals were sacrificed, the fractured bone removed and the mechanical properties of the callus were assessed by resistance to rupture, tangential strain measurement, the energy required for rupture, module of elasticity and the moment of inertia. It was concluded that callus was superior quantitatively as well as qualitatively after nailing. The mechanical properties of the callus wwere related to its degree of mineralisation.