Is tibial cut navigation alone sufficient in medial unicompartmental knee arthroplasty? Continuous series of fifty nine procedures

Purpose

Our purpose was to assess medial unicompartmental knee arthroplasty with navigation alone for the tibial cut and limb alignment. We hypothesised that this technique could be used routinely in practice.

Methods

Outcome measures were tibial cut orientation and residual varus. Six-month post-operative radiographs of 59 knees were assessed.

Results

Tibial cut orientation was within 2° of planned in 70.2 and 76.3 % of knees in the coronal and sagittal planes, respectively (49.1 % in both), within 4° in 91.2 and 91.5 %, respectively (82.5 % in both). All coronal-plane errors were in varus. Excessive planed tibial slope was at risk of excessive varus of the tibial cut. The hip-knee-ankle angle was ≤179° in 81.4 % and the mechanical axis through Kennedy Zone 2 in 59.3 % of knees. Risk factors for inadequate varus were pre-operative hip-knee-ankle angle >176° and strictly articular varus.

Conclusions

Our results are not as good as previously reported with this technique, but taking into account the factors of failure identified, we could enhance the results.

     

Lumboradiculopathy due to epidural varices: two case reports and a review of the literature

Lumbar radicular pain caused by epidural varices is rare. Its incidence is evaluated at 4.5% of operations for disc herniation. We report 2 cases which were only diagnosed during surgery for a herniated disk as is usually observed in the literature. The mechanism behind radicular pain is not fully understood. It may be compression by the varix itself but it may also be secondary to diffculty in venous return. Several anatomical types are described: thrombosed varix (type 1), non thrombosed varix (type 2), localized hematoma (type 3). Our 2 cases corresponded to type 2. The diagnosis can established by MRI at the pre-operative stage. The images vary according to the anatomical type and the age of the lesions. Treatment is by surgery.     

Traumatic obturator foramen hip dislocation: a case report and review of the literature

We report a case of traumatic anteroinferior (obturator foramen) hip dislocation in an adult. Femoral neck fracture occurred during reduction of the dislocation. Cephalic necrosis required total hip arthroplasty. We call attention to the difficult reduction of traumatic obturator formaen dislocation. We reviewed the literature concerning prognostic factors and propose a therapeutic attitude.     

The use of standardized assessment procedures in the evaluation of patients with multiple injuries.

The accuracy of diagnosis in multiple trauma can be greatly improved by the use of standardized assessment routines and standard documentation. In the two groups of patients reviewed the diagnostic error rate fell from 23% in the period 1979-1980 to 8% for the period 1981-1982.     

Prosthetic joint infection: when can prosthesis salvage be considered?

Management of prosthetic joint infection (PJI) remains a therapeutic challenge. We retrospectively studied 69 infected total hip or knee arthroplasties managed between 1980 and 1996 in our institution. Treatment failure, defined as relapse of PJI in the first year following the last antimicrobial treatment, occurred for 14 patients (20.3%). None of the potentially contributive parameters analyzed was significantly predictive of treatment failure. Of the subgroup of 34 patients with PJI who initially underwent debridement with retention of the prosthesis, the 13 (38.2%) who did not require further surgical treatment had symptoms for a significantly shorter duration before debridement (4.85 vs. 54.24 days; P < .0001). Because debridement with retention of the prosthesis rarely enables control of PJI, this therapeutic approach should be considered only when the duration of symptoms is very short.     

Morbidity of laparoscopic fundoplication for gastroesophageal reflux: a retrospective study about 1470 patients

BACKGROUND/AIMS: The aim of this retrospective study was to report and quantify the immediate and 3-year complications after laparoscopic anti-reflux surgery in order to understand the mechanism. METHODOLOGY: From 1992 to 1996, 1470 laparoscopic fundoplications were performed for symptomatic gastroesophageal reflux disease. Preoperative checkup included upper gastrointestinal tract endoscopy in 1437 patients (97.7%), esophageal manometry in 934 patients (63.5%), and 24-hour pHmetry in 799 patients (54.3%). Three procedures were performed: Nissen (n = 655), Nissen-Rossetti (n = 423), and Toupet (n = 392). The results were estimated at 1 and 3 months; thereafter they were evaluated at 3 years. Patients unable to return to the hospital center were contacted by telephone. RESULTS: Mean length of hospital stay was 4.6 days (range: 2-48 days). The preoperative complication rate was 2.1% (n = 31). The postoperative morbidity and mortality rates were 2.9% (43 patients) and 0.07% (1 patient), respectively. Conversion rate to laparotomy was 6.5% (96 patients). At 3 months, 87 patients (5.9%) had invalid dysphagia but there was no difference between the 3 procedures. Twelve patients have been reoperated (0.8%). At 3 years, 78 patients (5.6%) presented a clinical recurrence. The rate of dysphagia was 0.35%, and 38 patients were reoperated. CONCLUSIONS: Laparoscopic fundoplication is safe and effective with a low morbidity and mortality rate if junior surgeons commenced this procedure under the direct supervision of an experienced surgeon. Despite the advantage of this technique, we believe that indications for surgical management remain unchanged in the laparoscopic era.     

Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients

OBJECTIVE: To evaluate the usefulness of bronchoalveolar lavage in establishing the diagnosis of the fat embolism syndrome in trauma patients with long-bone fractures. DESIGN: Case series. SETTING: Referral hospital. PATIENTS: Eighteen trauma patients with long-bone fractures, including 5 with definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 8 with no clinical evidence of the syndrome. Control groups included 9 patients without previous trauma who developed the adult respiratory distress syndrome for various reasons and 15 normal volunteers. MEASUREMENTS AND MAIN RESULTS: Each patient had fiber-optic bronchoscopy with bronchoalveolar lavage, and the percentage of lavage cells containing intracellular fat droplets stained with oil red 0 were determined. In the five patients with definite fat embolism syndrome, light microscopic study of bronchoalveolar cells stained with oil red 0 showed many large intracellular fat droplets (mean percentage of cells containing fat droplets, 63%; range, 31% to 82%), whereas less than 2% of cells recovered by lavage from trauma patients with no clinical evidence of the syndrome, from patients with the adult respiratory distress syndrome, or from normal volunteers contained such inclusions. Use of the same technique in the five patients with possible fat embolism syndrome permitted the immediate identification of three patients in whom this diagnosis was later confirmed by subsequent autopsy or clinical follow-up. CONCLUSIONS: The identification of fat droplets within cells recovered by bronchoalveolar lavage in trauma patients may be a rapid and specific method for establishing the diagnosis of the fat embolism syndrome.