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M H Fessy

Publications and source records attributed to M H Fessy.

At least 19 recordsLinked to original sources
PubMed2006

[Survival of cementless dual mobility sockets: ten-year follow-up].

PURPOSE OF THE STUDY: We report a retrospective series of 106 total hip prosthesis with ten years follow-up. The purpose of this study was to analyze survival of cementless dual mobility sockets. MATERIAL AND METHODS: The series included 90 consecutive patients with 106 first-intention total hip prosthesis, all with cementless dual mobility sockets. All prosthesis (Novae-1 socket and Profil-1 stem, Serf) were implanted within a 6-month period. The stainless steal socket was coated with alumina and had two short anchorage studs and a superior mooring screw and a polyethylene retentive liner. The stem had a 22.2 mm chromium cobalt head. The main indication for arthroplasty was degenerative joint disease. Mean age at implantation was 56 years (range 23-87). All patients were seen for physical examination and x-rays every two or three years. We noted cup survival at ten years (actuarial method), defining surgical revision for cup replacement due to an aseptic cause as the endpoint. RESULTS: Twelve patients died during the 10-year follow-up and one was lost to follow-up. The Postel-Merle d'Aubligné score improved from 7.1 preoperatively to 15.8 at ten years. There were two isolated acetabular loosenings, two intra-prosthetic dislocations due to advanced wear of the polyethylene insert. The overall survival rate of the socket was 94.6% at ten years. There were no episodes of prosthetic instability in this series. DISCUSSION: This study demonstrates the good ten-year survival of the dual mobility socket, comparable to that of conventional prostheses. The absence of any case of prosthetic instability in this series confirms the good short-term and long-term stability of the dual mobility socket. Intraprosthetic dislocation, due to loss of the polyethylene retaining ring is the main limitation of this method. The incidence was however low (2% at ten years) and treatment was not a problem. We recommend using the dual-mobility socket as the first-intention implant for patients with a high risk of post-operative instability, but also recommend it for all patients aged over 70 years since instability is the leading cause of surgical revision after this age.

Adult↗
PubMed2006

[Iliopsoas bursal distension revealing complication of total hip arthroplasty: five cases].

The iliopsoas bursa is situated immediately anterior to the hip joint. Communication can develop between a hip prosthesis and the iliopsoas bursa leading to distension and formation of an inguinal mass revealing complication of total hip arthroplasty. We report five clinical cases. The five patients with a total hip arthroplasty developed a mass in the Scarpa triangle which correlated with defective prosthesis function. We chose not to dissect the cystic mass but to treat the intra-articular cause. Symptoms resolved after the intervention in all cases. This rare condition should be envisioned if an inguinal mass develops or has a functional impact, particularly on the lymphovenous circulation. Anatomic relations can be distinguished with computed tomography. Prosthetic complications include infection, loosening or wear. The work-up should include search for infection and standard x-rays of the hip joint. Before surgery, duplex Doppler should be performed systematically to search for a thromboembolic complication.

Aged↗
PubMed2003

[Value of percutaneous core needle biopsy in the investigation of a suspected bone tumor].

PURPOSE: To Determine the value of percutaneous core needle biopsy in the investigation of a suspected bone neoplasm. MATERIAL AND METHODS: We performed a retrospective study of 91 core needle biopsies performed between May 1995 and October 2001. Patients were excluded if they had a known primary carcinoma or if an infection was suspected by clinical, physical or laboratory findings. The results were correlated to the analysis of the surgical piece or, for the 28 patients who did not undergo surgery, to the clinical evolution over more than 12 months. RESULTS: The final diagnosis was metastasis in 29 cases, primary bone tumor in 36 cases and benign lesions in 25 cases. Sensitivity was 92.3% and specificity was 97.4%. For primary malignant bone tumors, results respected histology features and grade in 79.2%. In cases of mistake, because of the correlation of these results to the clinical and radiological context, the treatment of the bony malignant lesions were adapted in 95.8% of cases. Only one major complication was reported in these 91 biopsies. CONCLUSION: First intention core needle biopsy, confronted with radio-clinical context seems to have a place in the evaluation of bone lesions when a tumor is suspected. This technique, less expensive than an open biopsy and with fewer complications, is best performed as part of a multidisciplinary approach with the surgeon's collaboration.

Adult↗
PubMed2001

[Unstable pelvic ring fracture: osteosynthesis of the posterior lesion by percutaneous sacroiliac fixation].

PURPOSE OF THE STUDY: We report our experience with percutaneous sacroiliac screwing for unstable pelvic ring fracture. MATERIAL AND METHODS: Twenty unstable pelvic ring fractures with sacroiliac disjunction (9 cases), trans-sacral fracture (9 cases), or bilateral posterior fractures (5 cases) were managed with percutaneous sacroiliac fixation using 1 or 2 screws. There was also pubic disjunction in 7 cases, managed by osteosynthesis in 5 cases. No fixation of fractures of one or both of the obturator rings, present in 13 cases, was attempted. The posterior screwing was performed under fluoroscopic guidance in 15 cases and computed tomographic guidance in 5. RESULTS: There were no infectious or neurological complications. Radiographically, anatomic reduction of the posterior fracture was achieved in 10 cases. A vertical ascension persisted in 4 patients and a rotation in 6. Radiographic results were correlated with delay to surgery: correction of the vertical displacement was achieved in 80% of the patients operated before five days and in 55% of the others. Two patients experienced a secondary displacement. There was no cases of nonunion of either the anterior or posterior fracture. Follow-up was available for 14 patients (2 patients died and follow-up was too short for 4). The mean Majeed score was 92/100 and none of the patients experienced anterior pain. Three patients had moderate pain in the sacroiliac area. DISCUSSION: The ventral position appears to be best adapted for percutaneous sacroiliac screwing but can be contraindicated by concomitant lesions. We prefer fluoroscopic guidance for these emergency procedures. Two views, ascending and descending, appear sufficient. The better stability provided by two screws can be achieved under computed tomographic guidance without risk of neurovascular damage. CONCLUSION: Percutaneous sacroiliac screwing is a good management strategy for unstable pelvic ring fractures with little risk of morbidity.

Activities of Daily Living↗
PubMed2001

[Vascular risk and total hip arthroplasty].

PURPOSE OF THE STUDY: Though exceptional, there is a real risk of vascular complications during total hip arthroplasty procedures. The gravity of these iatrogenic accidents results from their high mortality (7%) and possible functional sequelae (19%). MATERIAL AND METHOD: We report a retrospective multicenter study of 14 vascular complications, six of which occurred during revision surgery for total hip arthroplasty. We assessed risk factors and identified situations of major risk related to acetabular revision: intrapelvic dislocation, protrusion with no bony barrier, and presence of intrapelvic foreign bodies. We advocate the retroperitoneal approach for acetabular revision in case of intrapelvic dislocation or anomalous vessel size or trajectory on the preoperative arteriography. This approach allows ablation of the implants under visual control of the iliac vessels. RESULTS AND DISCUSSION: A careful preoperative work-up is essential to avoid arterial or venous injury. A perfect knowledge of the vessel trajectories and their projection on the acetabulum is crucial. Indeed, such vascular complications are never expected and transform a well-programmed functional procedure into an emergency procedure with the inherent risks. We recall that such accidents may be expressed well after closing and the importance of careful surveillance before, during and after the surgical procedure.

Aged↗
PubMed2001

[Surgical treatment of acetabular fractures: outcome in a series of 60 consecutive cases].

PURPOSE OF THE STUDY: The aim of this study was to analyze clinical and radiographic results after surgical treatment of acetabular fractures. MATERIAL AND METHODS: We reviewed 60 consecutive fractures of the acetabulum with loss of joint congruency at mean 5-years follow-up after treatment. There were 49 men and 11 women, mean age 41 years. According to the R.O. grading, the fractures were: 22 class A (33.3%) including 17 type A1, 23 class B (38%) including 10 type B1a2, 14 class C (23.3%) and 1 unclassifiable. Eight of the patients had associated pelvic injury, 40 had hip dislocations and 9 had sciatic nerve injury. Ten femoral head fractures were discovered during the surgical procedure. Three surgical approaches were used: 1) Kocher Langenbeck approach (28 cases), 2) Mears and Rubash triradiate approach (8 cases), 3) extended iliofemoral approach (22 cases), 4) other approaches (2 cases). Anteroposterior and 45 degrees oblique view of the pelvis were obtained for all patients following admission. Computerized tomography scans were performed in all cases. Fracture displacement and congruency of the femoral head with the roof were documented according to the SOFCOT radiographic criteria. The quality of reduction was assessed using the Matta criteria and the Duquennoy and Senegas criteria. Clinical outcome was assessed at follow-up using the Postel-Merle-d'Aubigné score. RESULTS: Anatomic reduction was achieved in 62% of the cases (1 mm or less displacement on all views) and congruency of the femoral head with the roof was excellent in 73% of the cases. Clinical outcome was satisfactory in 80% (excellent or good). Operative complications included significant ectopic bone in 21, and in 2 others sciatic nerve palsy that had resolved at 1 year follow-up. Three patients developed avascular necrosis of the femoral head. DISCUSSION: Clinical outcome depends on the quality of the reduction. Class C and class B fractures with roof injury should thus be treated by large surgical exposure. The triradiate approach increases the incidence of ectopic bone. The higher incidence of ectopic bone in patients treated by osteotomy of the trochanter compared with patients without osteotomy of the trochanter was significant (p<0.05). Avascular necrosis of the femoral head was associated with delayed reduction (66% of the cases). CONCLUSION: Our good clinical results are encouraging; we are pursuing the use of surgical treatment for displaced acetabular fractures. Clinical outcome depends on the use of the appropriate surgical approach.

Acetabulum↗
PubMed2001

[Iliopsoas impingement in 12 patients with a total hip arthroplasty].

PURPOSE OF THE STUDY: We report 12 cases of iliopsoas impingement, an under-recognized cause of hip pain in total hip arthroplasty patients. MATERIAL AND METHODS: Between January 1998 and October 2000, we diagnosed 12 cases of iliopsoas impingement among 280 total hip arthroplasty patients with hip pain (4.3%). Our population was composed of 9 women and 3 men aged 62 to 80 years (mean 72 years). Nine patients had a first intention arthroplasty and 3 had a revision prosthesis. Delay from implantation to diagnosis of impingement ranged from 6 months to 5 years. Common cases of pain after hip arthroplasty, infection, loosening, were ruled out in all cases. A standard x-ray series including an AP view of the pelvis, an AP view of the hip and a surgical false-lateral view of the hip as well as a CT scan were obtained when iliopsoas impingement was suspected. The CT series extended from the lower part of the acetabulum through the fixation screws. RESULTS: Pain had been observed immediately after implantation in 10 cases (83%) and in 2 cases (17%) 3 to 5 years later. These patients did not have to use crutches when pain started to develop. Pain projected anteriorly and was always exaggerated when moving from the sitting position to the upright position and when going up stairs. In one patient, palpation revealed a mass in the groin that corresponded to a massive iliopsoas bursitis. Two non-pathognomonic physical signs were found in all cases: groin pain induced by active flexion against force in the lateral reclining position and at hip extension, and pain in the dorsal reclining position at deflexion of the hip, starting at 45 degrees. The standard AP views showed evidence of defective anteversion of 4 press fit cups, 1 off-centered screwed cup and 3 oversized cups. The CT scan demonstrated that the impingement involved the anterior border of the cup applied against the iliopsoas tendon in 8 cases either due to anterior uncovering in a dysplasic hip or anterior cup overhang. In 4 cases the cup fixation screws protruded anteriorly in front of the ilion and came in contact with the posterior aspect of the iliopsoas muscle. A bursitis had developed in 50% of the cases. DISCUSSION: When infection and loosening have been ruled out, hip pain after total hip arthroplasty would suggest a possible impingement of the acetebular component on the iliopsoas muscle due to defective anteversion or centering, the use of oversized cups, and/or the use of fixation screws. We emphasize the importance of a correct position for the cup to avoid an overhanging anterior border and discuss the use of screwed cups for primary total hip arthroplasty and of oversized cups for revision procedures.

Aged↗
PubMed1999

Locating the center of rotation of the hip.

In prosthetic surgery of the hip joint it is essential to recenter the hip to recreate the leverage of the gluteus medius muscle. Determination of the center of rotation of the hip is difficult if both hip joints have been destroyed. On the basis of 70 frontal radiographs of the hip in the standing position, the authors measured the position of the center of the femoral head in relation to Köhler's line and the TD line joining the two radiological Us ("tear-drops"). On the same radiograph they defined the horizontal and vertical indices. The descriptive analysis of these parameters stresses the influence of sex on the coordinates of the center of rotation of the hip. The authors demonstrated the statistical correlations between the coordinates of this center of rotation of the joint and certain horizontal and vertical indices. It emerged that knowledge of these indices suffices to define the theoretic position of the center of rotation. The method is compared with other principles set out in the literature. The procedure has a clinical application in the context of preoperative planning of prosthetic reconstruction of the acetabulum, whenever it is destroyed bilaterally (after trauma, in congenital dislocation or acetabular loosening, etc).

Adult↗
PubMed1999

[Total hip arthroplasty. Risk factors and prevention of iatrogenic vascular complications].

Vascular injuries during orthopaedic hip surgery are rare. However, they must always be feared because they threaten life and limb. We present 11 vascular injuries observed over a 12-year period. Seven women and 4 men, treated by elective surgery, presented 14 vascular injuries (6 arterial, 5 venous and 3 prosthetic vascular graft). Four injuries occurred during revision procedures. They were all operated as an emergency for ischaemic syndrome (6 cases) and/or haemorrhage (7 cases). Four patients (37%) died and 4 developed sequelae, various directly attributable to the vascular injury. In the light of these cases, we tried to determine the various mechanisms of the injury and the orthopedic and vascular risk factors. Preoperative detection and well defined therapeutic rules are very important for the prevention of these severe vascular accidents.

Adult↗
PubMed1999

[An unusual anomaly : cervical spondylolysis in an adult].

A case of spondylolysis with exceptional involvement of the cervical spine is reported. The lesion turned out to be a defect in the pars interarticularis of a cervical vertebra. Such cases generally involve the sixth vertebra. Spondylolysis is asymptomatic more often than not. Positive diagnosis is supported by an analysis of the anatomic structures on radiographs and CT-scans. Differential diagnoses include congenital lesion (articular dysplasia) is always found, there is no argument allowing the assertion that cervical spondylolysis is a congenital condition rather than secondary to stress fractures.

Adult↗
PubMed1997

Acetabular anatomy and the relationship with pelvic vascular structures. Implications in hip surgery.

Most direct vascular trauma occurring during hip surgery results from injury to pelvic vascular structures which are not visible during the procedures of reaming, drilling holes or the fixation of screws. In this study, 5 pelves of fresh cadavers were injected with a radiopaque mixture and were visualised with a scanner according to 5 predetermined sections. Bone depth of the acetabulum was measured in each section. A calculation was made describing the minimal distance separating the inner cortex from the principal pelvic vessels. After an anatomic dissection of each pelvis, the relationship between the vessels and screws of the fixation cup, implanted identically on the quadranted acetabulum, was observed. The screws placed in the anterior and inferior quadrants and the center of the acetabulum endangered the external iliac v. and a. and the obturator pedicle. The depth of the periacetabular bone was greater in the superior and posterior quadrants. The inferior gluteal, pudendal and superior gluteal aa. were more than ten mm from the posterior wall. Conversely, the external iliac and obturator pedicles came in contact with the osseous surface on which they lay. A projection of the vessels on the acetabulum was made, and the reproducible character of the acetabular-quadrant system was verified. The superior quadrant offers all the characteristics of a vascular safe zone. A knowledge of these anatomic relationships explain vascular trauma in pelvic fractures and helps to prevent vascular injury in hip surgery.

Acetabulum↗
PubMed1997

Anatomical basis for the choice of the femoral implant in the total hip arthroplasty.

There is within the population a considerable variation in the endosteal canal anatomy of the proximal extremity of the femur. This anatomical variation might jeopardize the result of the total hip arthroplasty when the surgeon uses a cementless femoral shaft. Indeed, if the secondary fixation of an implant stays under the dependency of many parameters, one has to obtain before anything else a very good primary stability, obtained by the morphological appropriateness of the bone-implant. The authors propose to define the cementless indications, as regards total hip arthroplasty, defining two radio-anatomical parameters: the Cortico-Medullary Index and the Femoral Flare Index.

Adolescent↗
PubMed1997

Morphometry of the talocrural joint.

Based on two orthogonal radiologic views, the authors present a morphometric study of the talocrural joint. In 50 normal subjects, 10 parameters were measured and divided into 3 groups: the distal tibial joint surface parameters, the malleolar parameters and the talar parameters. These parameters were treated in both a descriptive and a correlative analysis. If the talocrural joint is a hinge joint whose talar articular surface can be simplified and classed as a cylinder segment, it is possible to calculate its curve radius. Then the correlative analysis allows to define the talar parameters and the corresponding parameters of the distal tibial joint surface. The malleolar parameters are independent factors. This study is the first morphologic analysis to serve as a basis for an ankle arthroplasty.

Adult↗
PubMed1995

The upper end of the femur: dimensions of the endosteal canal.

Based on a prospective study of 30 right or left femurs removed in a continuous series in the anatomy department, a study was made of the dimensions of the endosteal canal of the upper end of the femur. The femora were analysed by means of 12 CT scans below the lesser trochanter. The sections were numbered and the dimensional parameters calculated by computer, using an original plan. The results were subjected to descriptive and correlative analysis. From these dimensional findings it appeared that the anatomy of the upper end of the femur is not random; morphotypic models exist and the laws of a normal model are regulated by a mathematical equation.

Cadaver↗
PubMed1995

[Analysis of restraint of the femur head. Experimental study of allograft of cold bone and autoclaved bone to kill the HIV virus].

The retrovirus S.I.A.D. grown in marrow bone and iatrogenic infections may be possible after bone graft in following total hip arthroplasties. Previous investigators proposed several methods to kill the virus, but without bacteriological safety. They found 20 to 55% of loss on mechanical properties. The present study reports the response of autoclaved femoral heads compression testing on material machine Model 1026 Instron. The stress response of marrow bone to stains showed a classic peak and with linear regression study we saw a relationship between autoclaved bone and cold bone. The cortical bone resists to strains highly 12% of load.

Aged↗
PubMed1995

[Preliminary and multidisciplinary study of three Coptic mummies of the Testut-Latarjet museum at Lyon].

In 1901 Albert Gayet raked up from Antinoe three mummies exhibited to day at the Anatomy Museum of Lyon. The study of the three mummies was made in detail as to their dress, anthropometric and scannographic findings. The clothes were characteristic of coptic civilization. The radiographic date gave a life span of around 40 years. The X-ray imagery shows the remains of cerebral and visceral organs. The sexual criteria are thought to be those of two women and undetermined for the child. Later, several investigations like endoscopic autopsy, tooth microscopy and chromosomic map will be necessary.

Anthropometry↗