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D Goutallier

Publications and source records attributed to D Goutallier.

174 records · Page 10Linked to original sources
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[The patello-femoral joint in osteoarthritis of the knee with gene varum (author's transl)].

The authors have treated 63 knees with osteoarthritis associated with varus deformity by valgus osteotomies. The clinical and radiological state of the patello-femoral joints has been studied before and after correction of varus deformity. No correlation was found between the severity of tibio-femoral osteoarthritis and patello-femoral osteoarthritis. Medical patello-femoral discordance was found in 12 p. 100 of the cases. Clinical evidence of pain arising from the patello-femoral joint was more often found than evidence of radiological abnormality. It is concluded that pain arising from the medial compartment may be confused with patello-femoral pain. A five-year follow-up showed that the patello-femoral joint was not influenced radiologically by the valgus osteotomy but patellar pain was improved in most of the cases. Procedures to re-align the patella should not normally be associated with valgus osteotomy in cases in which patellar pain exists in association with osteoarthritis of the knee with varus deformity.

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[The patello-femoral joint in osteoarthritis of the knee with genu varum (author's transl)].

The authors have treated 63 knees with osteoarthritis associated with varus deformity by valgus osteotomies. The clinical and radiological state of the patello-femoral joints has been studied before and after correction of varus deformity. No correlation was found between the severity of tibio-femoral osteoarthritis and patello-femoral osteoarthritis. Medial patello-femoral discordance was found in 12 p. 100 of the cases. Clinical evidence of pain arising from the patello-femoral joint was more often found than evidence of radiological abnormality. It is concluded that pain arising from the medial compartment may be confused with patellofemoral pain. A five-year follow-up showed that the patello-femoral joint was not influenced radiologically by the valgus osteotomy but patellar pain was improved in most of the cases. Procedures to re-align the patella should not normally be associated with valgus osteotomy in cases in which patellar pain exists in association with osteoarthritis of the knee with varus deformity.

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[Long-term results of the treatment of medial femoro-tibial gonarthrosis by tibial valgisation osteotomy. Outcome of 93 osteotomies after more than 10 years].

Amongst the 250 tibial valgisation osteotomies performed for medial femoro-tibial osteoarthrosis of the knee between 1970 and 1973, only 93 in 66 patients could be followed up for 10 years or more (10-13 years). The long term outcome of the operation is dominated by frontal angular correction. The radiological and clinical result was regularly satisfactory after ten years only when the valgus was between 3 and 6 degrees. With more than 6 degrees valgus, there was deterioration of the lateral femoro-tibial compartment in all cases. Clinical and radiological results were variable with more than 3 degrees varus and were all the worse when there was considerable persistent varus. However functional impairment of those knees in which correction was inadequate occurred only after a mean latent period of 7 years. It remained slow and moderate, offering the possibility of a new osteotomy in case of failure. This would confirm that tibial osteotomy has at least two actions: a trophic action which disappears at about 7 years and a mechanical action, the importance of which appears in the long term. It is therefore felt that tibial valgisation osteotomy is a sufficiently reliable operation to be proposed in all cases of symptomatic and progressive osteoarthrosis with genu varum. Correction and results are all the more satisfactory when the operation is carried out before flexion deformity or laxity interfere with the accuracy of the correction. A preference for the insertion of a prosthesis may be preferred only in the elderly (the authors preferring the medial unicompartmental type), the principal advantage being to decrease the relatively long period of postoperative immobilisation following osteotomy.

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[Unicompartmental femorotibial arthroplasty and lateral gonarthrosis. Outcome of 52 prostheses implanted for more than 5 years].

The results of 52 Lotus unicompartmental knee implants with a follow up time exceeding 5 years are analysed. Forty-one prostheses with a mean follow-up of 6.5 years have given very good or good relief of pain. In almost all cases, flexion range exceeds 90 degrees and the preoperative motion has been most often clearly improved. Except for those due to prosthesis infection, all the poor and fair results in terms of pain, are explained by mechanical causes i.e. persistence of a frontal instability, loosening of the tibial component (2 cases) or narrowing of the nonprosthetic femorotibial space (11 cases). The latter is not related to the presence of any radiological chondrocalcinosis. These poor anatomical and clinical results appear to be preventable by a correct operative technique. In particular, the complete correction, by the prosthesis, or the angular deformity which has caused the lateral knee OA must be avoided. This is in contrast to what must be done in osteotomies. Unicompartmental prostheses thus have to stay in stress so that their long term future is uncertain. In the surgical management of lateral knee OA, these prostheses are not to be preferred to correction of frontal angular deformity by osteotomy, except in the elderly, when deformity cannot be completely corrected. Unicompartmental prostheses are particularly indicated in unstable knees in which osteotomies are known to be difficult to perform correctly.

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