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Biomedical subjects

D Goutallier

Publications and source records attributed to D Goutallier.

At least 109 records · Page 6Linked to original sources
PubMed1988

[Treatment of lax arthrotic genu valgum using Debeyre's unicondylar osteotomy. A radioclinical study of 55 knees operated on more than 5 years ago].

Seventy-five cases of degenerative arthritis of the knee with laxity (Ahlback grade III, IV and V) were treated by unicondylar osteotomies of the femur performed between 1967 and 1980. 64 have been reviewed after more than five year follow-up. Among them, nine had been re-operated on because of early complications when this technique was set up. The fifty-five remaining knees were reviewed after a nine year average follow-up. Despite the severity of the joint involvement forty-four were still improved by the osteotomy. The tightening of the collateral ligaments had suppressed the joint laxity. The subluxation of the lateral femoro-tibial joint was reduced and the joint space was enlarged. Eleven knees had deteriorated after five years, seven times in the lateral compartment, four times in the medial one. Five had to be re-operated on, due to functional worsening. Good results were observed when the obtained angle was situated between 3 degrees valgus and 10 degrees varus. A persisting valgus more than 4 degrees may lead to a recurrence. Hypercorrection led to a worsening of the medial femoro-tibial joint in two cases. The unicondylar femoral osteotomy is worth-while even in severe degenerative arthritis. The technique must be precise to avoid failures. It is indicated in cases of joint laxity, extra articular osteotomies being indicated when the laxity is absent. It should not be proposed over the age of 70 years to avoid a risk of stiffness.

Follow-Up Studies↗
PubMed1988

GUEPAR unicompartmental Lotus prosthesis for single-compartment femorotibial arthrosis. A five- to nine-year follow-up study.

The results of 52 Groupe d'utilisation et d'expérimentation des prosthèses articulaires (GUEPAR) unicompartmental Lotus knee prostheses implanted for osteoarthritis of the knee are analyzed with a follow-up time exceeding five years (five to nine years). Thirty-five knees had no weight-bearing pain, six knees had slight pain, three knees had moderate pain, and eight knees had revisions. Except for one complication from infection, all the poor results (eight revisions and three knees with moderate pain) in terms of pain can be explained by mechanical causes, i.e., femorotibial subluxation, loosening of the tibial component, or narrowing of the nonprosthetic femorotibial space. Because the cause of these poor results appears to be due to malposition of the prosthesis component, or to components that are too thick with an inadequate mechanical axis, the precision of the surgical procedure is important.

Aged↗
PubMed1987

[Experimental study on osteosarcoma of local chemotherapy diffusing from surgical acrylic cement and plaster].

An experimental study has been made to explore the possibility of using plaster or surgical cement as a vehicle for the diffusion of local chemotherapeutic agents in osteosarcoma. In vitro, leeching out of methotrexate from plaster or acrylic cement occurred with a peak during the first few hours followed by a decreasing curve lasting for an average of two weeks. In dogs suffering from a spontaneous osteosarcoma, the loss of substance produced by excision was filled with cement to which methotrexate had been added extemporaneously. This method of administration produced a general diffusion of methotrexate whose blood levels were measured for three to five days. In laboratory rats into which osteosarcomata had been grafted, tablets of plaster containing antimitotic drug were implanted into the tumour, which was left in situ. This made it possible to show that the local chemotherapy was having a true effect, particularly when the antimitotic used was cisplatinum. In patients who had acrylic cement containing methotrexate inserted during operation, local diffusion resulted in very high concentrations, evidenced by the concentration found in fluid obtained from suction drains during the early days after operation.

Animals↗
PubMed1987

[Outcome of the femoropatellar joint in osteoarthritic genu varum after tibial wedge osteotomy for angulation. 10 to 13 year regression].

The progressive radiological changes in the patello-femoral joint after upper tibial osteotomy performed for arthrosis of the knee were studied more than 10 years after the surgical procedure. The changes were found to be minimal. In cases where the patello femoral joint space was normal before the osteotomy, it was still so 10 years later. In half of the cases where the patello-femoral joint space was abnormal before the osteotomy, it had deteriorated 10 years later, the lesions being more severe on the medial facet of the patella. This change occurred in 11 cases. It was not affected by the extent of the valgus osteotomy, changes in the tibio femoral joint space or the technique of the osteotomy. The functional results could only be correlated with the changes in the tibio femoral joint space and not with those in the patello-femoral joint space. However, excellent results as regards the tibio femoral joint space could still be associated with pain in the patello-femoral joint when it was arthrotic before the osteotomy. Nevertheless, the authors conclude that an associated transposition of the tibial tubercle in association with upper tibial osteotomy is not worthwhile, since no failure in their series could be attributed to impairment of the patello-femoral joint.

Follow-Up Studies↗
PubMed1987

Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.

The results in ninety-three knees that had been treated by proximal tibial opening-wedge osteotomy for varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of 11.5 years (range, ten to thirteen years). After ten years, only forty-two (45 per cent) of the ninety-three knees had an excellent or good result, and in fifty-one knees there was recurrent pain for which seventeen had another operation. At five years, on the other hand, 90 per cent of the knees had a good result. Deterioration occurred at an average of seven years after the osteotomy and was always associated with recurrence of pain. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the twenty knees that had a hip-knee-ankle angle of 183 to 186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the five knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the sixty-eight undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow (average, seven years), and it was not associated with lateral laxity and deterioration of the lateral compartment, which are the changes that characterize the natural course of gonarthrosis as described by Hernborg and Nilsson. Therefore, proximal tibial osteotomy is a very suitable operation for patients who have gonarthrosis of the medial compartment, but a rigidly standardized and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb, because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy.

Activities of Daily Living↗
PubMed1986

[Biopsy in sarcoma of the limbs. 135 cases].

Between 1979 and 1984, 135 patients with primary bone and soft tissue sarcoma of the limbs and girdles were treated conservatively, using a variety of methods. In 54 patients the biopsy was adapted to the requirements of one-block extratumoral resection; all remained with a functional limb and only suffered minima complications, viz. skin necrosis in 3 cases, resolved infection in 1 case and local recurrence in 2 cases, one of which was cured by a second conservative excision. Fifty-one patients were biopsied with a technique that was not adapted to a conservative anticancer treatment. In these patients the biopsy was most probably responsible for 4 therapeutic failures, 4 immediate amputations, 5 local recurrences, 6 out of 7 cases of skin necrosis and 2 out of 3 cases of deep infection consecutive to conservative surgery. The biopsy technique therefore is a determinant factor of local prognosis, more important than the size or location of the tumour or the presence of a fracture. Used routinely, without prior CT examination and disregarding precise rules, it is fraught with serious consequences and responsibilities.

Adolescent↗
PubMed1986

[Massive allografts cold-preserved and radiation-sterilized].

Thirty massive bone allografts measuring between 7 and 30 centimeters and banked after freezing at -30 degrees centigrade and sterilization by Beta irradiation (2.5 to 3.5 megarads) were implanted. Ninety eight grafts were for reconstructions after a tumour resection and two were used for the treatment of femoral non-union and for reconstruction after removal of a prosthesis. In fifteen instances the only goal was to restore bone stability--six arthrodeses, seven replacements of diaphyseal or metaphyseal section and two iliac bone lesions. In fifteen other cases the aim was to preserve mobility (10 knees, 2 hips and 3 shoulders). Among these cases, a prosthesis was added in 9 knees and 2 hips and the graft was used alone in three shoulders and one knee. The average follow-up is too short to assess the incidence of recurrence, but it is long enough to note that there has been no case of post-operative infection. The authors considered that this is thanks to the use of sterilization by irradiation. Bone union was seen in 26 out of 30 cases at the diaphyseal--graft junction and in eight cases out of nine at the epiphyseal--graft junction. Three cases are pure diaphyseal replacements, did not unite. Two recurrent fractures of the graft at the third and fourth month united later. Scintigraphy showed that revascularization may take place after three months, thanks to the peripheral muscle which reattach to the graft spontaneously. This could be demonstrated by biopsy made during a second surgical procedure. A search for anti-HLA anti-bodies in the serum was positive on three occasions.

Adolescent↗
PubMed1986

[Outcome at more than 10 years of 93 tibial osteotomies for internal arthritis in genu varum (or the predominant influence of the frontal angular correction)].

Ninety three high tibial valgus osteotomies have been performed by the authors for degenerative arthritis and reviewed more than 10 years later. The mean age of the 66 patients was 70 years. The results were somewhat disappointing. Seventeen knees had to be operated on before the tenth post-operative year and only 42 knees were painless at the time of review. Radiological improvement in the medial tibio-femoral joint was rarely seen. Fortunately, deterioration in the lateral tibio femoral joint was exceptional and joint laxity was rarely troublesome. The authors conclude that the amount of correction at the time of the osteotomy is of extreme importance. The results were satisfactory only in cases where valgus ranging between 3 and 6 degrees had been obtained. When an osteotomy produced a greater amount of valgus, deterioration of the lateral tibio-femoral joint was seen. When the osteotomy produced less than 3 degrees of valgus, recurrence of the varus deformity developed. In these cases, functional deterioration was noted after seven years. Thus, the osteotomy appeared to have slowed down the natural evolution of the disease. The results of valgus osteotomy were satisfactory in most of the cases, but they were excellent only in cases in which a valgus ranging from 3 to 6 degrees had been produced. The importance of a precise radiological measurement is stressed, the accuracy of measurement being doubtful in cases with associated flexion deformity or joint laxity. The precision of the surgical procedure is also very important.

Aged↗
PubMed1985

Carbon-PGLA prostheses for ligament reconstruction. Experimental basis and short-term results in man.

The efficiency of a pure carbon prosthesis to reconstruct intra-articular ligamentous loss of substance was evaluated on 14 sheep with an 18-month follow-up study of recent and old ACL experimental injuries. Functional results showed a correlation between a tightened implant, the stability of the knee, and the absence of severe arthritis. The rupture strength of the newly formed ligament amounts to about 300 Newtons (N). That of the normal ACL amounts to 250-550 N. The structure gives a viscoelastic behavior to the prosthesis. This tissue was made of collagen fibers surrounding the carbon fibers and running generally in the direction of the ligament. In the osseous tunnels, the newly formed lamellar bone invaded and surrounded the implant. Carbon fiber fragmentation occurred, and fibers were found in the synovia and in the homolateral, inguinal, and paraaortic lymph nodes. No degeneration, necrosis of tissue, or cellular toxicity was found. On these bases, the carbon prosthesis was modified by adding a resorbable copolymer of polyglycollic (PGA) and polylactic acid (PLA) around the fibers and a resorbable sheath of the same polymer. This carbon-PGA/PLA prosthesis was used in 23 patients with a three- to 12-month follow-up period. Patients were evaluated by clinical tests and by functional control of the ligament. The indications for prosthetic replacement were: recent mop-end tears of the ACL, cruciate ligament reconstruction in chronic knee instability, and wide rotator cuff loss of substance. Five complications occurred because of hematomas and/or sepsis and prosthesis breakage. Eighteen of 23 patients had good clinical results with good function in five. The conclusions are that PGA/PLA produces a clean and flexible ligament, thus eliminating carbon fiber articular deposits and allowing a normal function. Inflammatory postoperative reactions seem to be more frequent than with other procedures and call for operative and clinical care in order to eliminate hematoma and sepsis. The efficiency of a rehabitable carbon-PGA/PLA prosthesis in intra-articular ligamentous defects in man will be confirmed only by controlled long-term clinical observations.

Adult↗