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INTRAPROSTHETIC DISLOCATION: A RARE COMPLICATION IN DUAL MOBILITY CUPS M.H. Fessy

MO n°152 March 2006

The main problem with dual mobility cups in the medium term is intraprosthetic dislocation. The head comes out of the polyethylene through wear of the retentive rim. The head then lodges itself in the metalback shell which can be seen by a characteristic view on x.ray. (figure 1). Alas this type of incident is reported in all the literature on series of dual mobility cups, which is an indicator of this sad reality. Figure 1 bilateral intraprosthetic dislocation We were able to conduct an exhaustive retrospective analysis of all the cases of intraprosthetic dislocation in our departments care between 1991 and 2002. 63 cases were analysed. For each of these 63 cases we had complete medical, surgical and radiological files. Average age at implantation was 51 years. In 30 cases the stem implanted opposite was a PF. This was a screw in stem ... M.H. Fessy

TRIBUTE - GILLES BOUSQUET, Surgeon and technician A. Rambert

MO n°152 March 2006

In 1969 I was running an applied mechanics laboratory at the Ecole Catholique des Arts at Métiers – ECAM - in Lyon. A phone call from one of my suppliers in scientific materials, informed me that one of his cousins, Head of Clinic in Orthopaedics at the Hospices Civils de Lyon, was looking for an engineer to work on an innovative project; making a knee prosthesis. Naturally I hesitated before meeting this surgeon given my lack of knowledge in anatomy, but accepted to meet with him for a first contact a few days later. The surgeon was Gilles Bousquet, he was Head of Clinic in Professor Albert Trillats department, and had just presented a thesis on knee laxities. Professor Albert Trillat had an international reputation and combined with his exceptional surgical qualities a particular liking for mechanics and mathematics. When ... A. Rambert

DUAL MOBILITY: A Stéphanois Concept (St Etienne area, France) M.H. Fessy

MO n°152 March 2006

It was Gilles Bousquet who has the merit of having first defined the original concept of dual mobility. The prosthetic head is mobile within a retentive polyethylene which is free to move within a metalback cup (figure 1). Figure 1 : The principle of dual mobility The first drafts of the project began in the early 1970s. The first implantations started in 1975. The finalisation of the project was due to the meeting of three men. - Gilles Bousquet, Professor in Orthopaedics at the University Hospital of St Etienne - Jean Rieu, Professor of teaching at the Ecole des Mines in St Etienne, and director of the biomaterials department - André Rambert, engineer and Professor in mechanical engineering at the ECAM school in Lyon Gilles Bousquet proposed the concept, Jean Rieu brought his knowledge in biomaterials and especially in surface finishing ... M.H. Fessy

SURGICAL TREATMENT FOR ACHILLES TENDINOPATHY IN ATHLETES E. Rolland, G. Lorton, G. Saillant

MO n°138 November 2004

Operative management of Achilles tendinopathy is still considered in the orthopaedic world as minor and poorly coded surgery, due to the wide variety of anatomopathological forms and lack of accuracy of the techniques available. However, as any surgical repair, it requires careful assessment of the lesions and the use of an appropriate surgical technique to ensure a successful outcome. Surgical treatment for Achilles tendinopathy began to develop in the 1980s, after Jenkins' experiments in sheep using carbon fiber and the experimental work done on horses by the veterinary team from Chantilly. The early techniques advocated by Kvist involved isolated synovectomy. After that, other techniques were introduced which included longitudinal tenotomy and use of carbon fibres (Lemaire), and variants using autografts. Kouvalchouk, in 1987 (Cahiers ... E. Rolland, G. Lorton, G. Saillant

ARTHROSCOPIC ROTATOR CUFF REPAIR USING A TENSION BAND SUTURE TECHNIQUE P. Boileau, N. Brassard, C. Trojani, F. Balg

MO n°137 October 2004

INTRODUCTIONArthroscopic rotator cuff repair is a recently developed technique that is gaining increased popularity. To make arthroscopic rotator cuff repair a straightforward, standardized procedure, we have designed a special technique based on the tension band principle, using between 2 and 5 inverted horizontal mattress sutures placed through the tendon and anchors placed in the lateral cortex of the greater tuberosity (Fig. 1). Figure 1 : Tension band principle : AP and lateral PATIENT POSITIONING - ENTRY PORTALSSurgery can be performed with the patient in a beach chair position or a lateral decubitus position. The patient's arm rests on a draped U-shaped support (Trillat support). We personally are not using traction ; this ensures the freedom of motion of open surgery, performing rotation/abduction or lift-off of the patient's ... P. Boileau, N. Brassard, C. Trojani, F. Balg

TREATMENT OPTIONS FOR GIANT-CELL TUMOR B. Tomeno

MO n°136 August 2004

Why write an article specifically on GCT (giant-cell tumor) ?This decision has been carefully thought through : as a giant-cell tumor (GCT) can be benign or malignant, an in-depth study of GCT provides the essence of what one needs to know about tumors and their variants, as well as the technical tricks regarding curettage & bone-grafting which is the classical treatment for all benign intraosseous tumors. An overview of the malignant forms of GCT gives an idea of the resection-reconstruction techniques and associated therapies (radiation therapy and chemotherapy). GCT is an ideal "model" for educational purposes. Giant cell tumor (GCT) is a frequent occurrence. It accounts for 15 to 20% of all bone tumors. However, its histogenesis remains unclear (it is thought to originate from connective tissue precursor cells). GCT is mostly found in ... B. Tomeno

TREATISE ON FRACTURES AND DISLOCATIONS: Plate XXX : DISLOCATION OF THE BONES OF THE FOOT J.-F. Malgaigne

MO n°133 April 2004

Fig. 1 -- Recent medial dislocation of the tibia. This specimen was retrieved from a man who had died several days after the accident. The compound dislocation is associated with a comminuted fracture of the distal fibula and with a transverse fracture of the medial malleolus. The remainder of the malleolus projects a considerable distance, both medially and posteriorly, with the tip of the foot turned very markedly outward. Plantar alignment is still largely correct; and despite the projection of the malleolus, tibiotalar contact has not been entirely lost. Fig. 2 -- Old medial dislocation of the tibia (Dupuytren Museum, Exhibit No. 705). The dislocation had remained unreduced. The fibula has healed in malunion, forming an inward angle called a “hatchet blow deformity” by Dupuytren. The tibia, the fibula, and the talus have fused. ... J.-F. Malgaigne

A new movement: surgical Art C. Raux

MO n°126 August 2003

We all know nautical art – those tiny little ships in bottles, made by sailors whiling away the long winter months; and peasant art – those carved wooden tools that are the pride of folk museums everywhere. Are we now seeing the advent of a new art form – surgical art? PMMA, an acrylic cement, was introduced into dentistry in 1933; today, 150,000 kits are used annually in France. This development has gone hand in hand with the evolution of a new art form that has been confined to operating theatres: polymethylmethacrylate sculpture – with or without added antibiotics. Antibiotics – at least the aminoglycosides gentamicin or tobramycin – have something to do with fungi. So, if we have fungi in the sculptors’ raw material, would that be like the eggs used by early Italian fresco painters for mixing ... C. Raux

Arthroscopy, shelf, and core decompression: minimal-access conservative hip surgery Ph. Chiron

MO n°123 April 2003

The technique of enlarging the acetabulum by means of an extra-articular bony extension goes back to Koenig , and was first described in the literature by Marcel Lance [1], in 1925. The shelf consists of a corticocancellous autograft that is fitted on the anterosuperior aspect of the joint capsule in order to provide a larger weightbearing surface and, thus, to reduce the pressure on the cartilage. In the 60s of the last century, a number of authors (among them Castaing, Salmon, Judet, Roy-Camille, Rieunau, Chiari, and Spitzy [2]) devised modifications of the original technique, in order to improve graft placement and graft fixation. In these modified techniques, the surgical approach initially suggested by Lance – an incision similar to the Smith-Petersen approach – was retained. This route involves wide exposure of the iliac ... Ph. Chiron

ARTHROSCOPY OF THE WRIST: Use and technical possibilities Ch. Dumontier

MO n°119 December 2002

The wrist is a frequent source of pain, the clinical and radiographic investigation of which remains difficult (See Maîtrise Orthopédique n°49). Accordingly, arthroscopic diagnosis is still indicated in some cases. However, as in other joints, wrist arthroscopy is, above all, a therapeutic act. Although its use is not yet widespread in France, probably because of the material cost, wrist arthroscopy is an ever-growing part of the therapeutic arsenal of hand surgeons. In certain indications, the results of arthroscopic treatment are now superior to those of open techniques. At present, the number of patients in published series and follow-up are sufficiently extensive for arthroscopy of the wrist to warrant more widespread attention. Even if you have few indications in your practice, this short article is designed to illustrate what one sees ... Ch. Dumontier