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M Postel

Publications and source records attributed to M Postel.

At least 37 records · Page 2Linked to original sources
PubMed1986

[Mycobacterial infection of the hip following total prosthesis. Study of 6 cases].

The authors present 6 cases of mycobacterial infection of the hip after total hip replacement: 5 cases of tuberculosis and 1 case of Mycobacterium fortuitum infection. They emphasise the clinical, radiological, bacteriological and histological signs which are generally very characteristic and unequivocal. A review of the literature reveals the rarity of these infections, but stresses the need for a complete bacteriological survey to avoid missing the diagnosis. A routine medicosurgical therapeutic approach is proposed.

Adult↗
PubMed1986

[Replacement of a failed total hip prosthesis].

At the present time, apart from infectious complication, failed total hip prosthesis essentially consist of detached prosthesis. On the basis of their experience of eight thousand arthroplasties, including more than 6,000 Charnley prosthesis, performed over a period of 18 years, the authors propose three basic principles designed to ensure a long term satisfactory result: steel on polyethylene prosthesis, diameter 22 and fixation with acrylic cement. They consider that this approach can offer a second chance to patients with a detached prosthesis, especially when the technique of the first arthroplasty was faulty or if a poor quality prosthesis was used. The authors' experience has confirmed that the second operation should aim to restore an arthroplasty as close as possible to normal anatomy. The authors have satisfactorily achieved this aim by the wide use of homografts.

Hip Prosthesis↗
PubMed1986

[Reconstruction prosthesis of the upper part of the femur. Intermediate results in 20 resections for tumor. Current trends].

Twenty total hip prostheses inserted after massive resection of the upper part of the femur for tumour have been reviewed after a 3 year mean follow-up. Fifteen cases were of primary malignant tumour. The mean resection of the femur measured 175 mm in length and was reconstructed using Cochin prostheses. From the oncological standpoint, the results were comparable with those obtained after disarticulation of the hip, but the functional results were, of course, much better. Five patients were able to resume their previous professional work; 13 were able to have a normal type of life and only 2 were severely crippled. Nineteen hips were painless. Nine patients could walk without a stick, 9 used one stick for walking outside and 2 used sticks permanently. Two cases were complicated by dislocation. Despite an extensive resection of the greater trochanter, one third of the hips were stable on standing on one leg, thanks to the design of the prostheses. No prostheses broke. Two loosenings of the acetabular cup had to be revised. No loosening of the femoral stem was found, despite the frequency of osteolysis of the diaphysis to 4-5 cms below the level of resection. The authors intend now to improve the design of the prostheses and to aid the reinsertion of the muscles, which can be improved by using homografts surrounding the femoral prostheses.

Femoral Neoplasms↗
PubMed1986

[Repair of the acetabulum using a bone homograft preserved at the time of revision of total hip prostheses].

Between 1973 and 1982 the authors have used the preserved femoral head to allograft the affected acetabulum in 80 patients with loose total hip arthroplasties. The problems of reconstruction were various and several techniques were used. 65 cases have been reviewed with more than one year follow-up. No complication relating to the graft was found. All patients but 6 had dramatic relief of pain. Four new loosenings were encountered. The quality of the functional result was related to the pre-operative condition of the hip and the adequacy of the repair.

Acetabulum↗
PubMed1986

[Use of an aiming device and nail-plate osteosynthesis in rotation osteotomies of the femur neck].

During the past four years, the authors have performed 16 anterior rotation osteotomies of the femoral neck in cases idiopathic necrosis of the head of the femur, using the Sugioka technique. There were a number of difficulties in obtaining the planned displacement, satisfactory apposition of the bone ends and sound fixation. An original design of aiming device was made to allow greater accuracy during the operation. Fixation was obtained by a one-piece nail-plate. The surgical technique is described fully. The results have been improved, thanks to this new technique.

Bone Nails↗
PubMed1985

[Hip surgery: local tissue reactions].

Present extent of total hip prostheses, protracted course of first operations lead to pathological studies on local tissue reactions, sign of the failure or of the damaging of the artificial hip. Another pathology, often as intricate, is observed after more conservative surgery: high femoral osteotomies, cup arthroplasties, femoral metallic prostheses. Failure of an high femoral osteotomy shows a running of osteoarthritic lesions the topography of which is always modified by the new orientation of the articular bearing segment. Osteosclerosis, osteoarthritic cysts may develop on a preexisting osteophytosis. Osteonecrosis or bone resorption are sometimes found. Anatomical results in case of a successful osteotomy are scarce. Fibrous layer eventually quoted as a guide to the development of fibrocartilage is more often associated with osteoclast mediated bone loss. Efficient bone remodelling is assumed only, today, by radiological proof. Failures of cup arthroplasties induce femoral bone or acetabular cartilage lesions which are different according to the surgical technic. Some are marked by cartilage destruction of the acetabula or by a cup dislodgement. Bone structure in those cases shows under the cup a good remodelling with a fibrous or fibrocartilaginous mantle originating from the bone marrow spaces and the capsular attachment. In other cases, the femoral head presents areas of superficial or total osteonecrosis, signs of intense osteoclastic activity, cleaving of the fibrous surface and eventually metallic debris or cement induced histiocytic granuloma. A fibrous layer may develop between the cup and the acetabula. Femoral metallic prostheses may damage in some years cartilage of the acetabula. Osteoarthritic bone remodelling is sometimes observed in close contact with the metallic collar. Lesions of capsular tissues are eventually represented by metallic debris or an histiocytic granuloma due to cement anchorage. Material received at the time of surgical revision on total hip arthroplasties concerns chiefly the newly formed capsular and synovial tissues. Their appearance is quite similar to the tissular layers found between prosthetic material and bone or cement. For the pathologist, main inquiries are the rule out of an infection, the extent and course of the macrophage or giant cell response, the nature of wear debris or of the products of corrosion and the histological factors contributing to the loosening of the prosthetic components. It should be stressed that any physiopathological schedule of an artificial hip failure is a topographical and dynamic problem only partly resolved by studying autopsy material.

Arthroplasty↗
PubMed1985

Chondrocalcinosis and rapid destruction of the hip.

The frequency and significance of articular chondrocalcinosis was studied in 86 cases of osteoarthritis (OA) with rapid destruction of the hip that underwent total arthroplasty. The occurrence of articular chondrocalcinosis was 3 times more frequent than in a matched control population without rheumatic complaints (32.5% vs 10.5%). In a matched group of control patients operated on for common OA of the hip, the frequency of articular chondrocalcinosis (18.6%) was higher than in the control patients but significantly lower than in the patients with rapid destruction of the hip. Fifty-five patients in each of the 3 groups were aged 70 years or more, and the frequency of articular chondrocalcinosis in those patients with rapid destruction of the hip rose to 45.4% compared to 13.7% for the control group (p less than 0.01) and 27.2% for the group with common OA of the hip (p less than 0.05).

Aged↗
PubMed1985

[Carpo-metacarpal dislocation of the 5th digit with fracture of the hamate bone. Apropos of a recent case].

The authors report one case of recent fracture of the hamate with dorsal dislocation of the fifth metacarpal. This type of lesion is infrequent and may be misdiagnosed unless appropriate radiographs are taken with oblique views. The lesion was not stable after closed reduction and required fixation with a pin through the hamate fracture. The functional result was satisfactory.

Adult↗
PubMed1983

[Indications for arthrodesis of the hip in the adult].

The indications for and results of operations for arthrodesis of the hip undertaken between 1975 and 1980 have been compared with a similar series published from the same department in 1964. The development and reliability of total replacement of the hip has reduced the need for arthrodesis of the joint, with its attendant problems of long term overload of the back and knee. However arthrodesis is still a valuable salvage procedure after immobilisation of the muscles which move the joint, often as a result of multiple operations, or in the presence of troublesome infection.

Adolescent↗
PubMed1983

[Luxations of the Charnley type and Kerboull-modified Charnley-type total prostheses].

The authors have observed 82 dislocations in a series of 4833 total hip prostheses of the Charnley or modified Charnley type. This represents 1.7 p. 100 of the cases. In 26 instances, the hip dislocated only once. In other instances, the dislocation became recurrent. Several factors favoured the incidence of dislocation and could be corrected - malposition of the prosthetic components as shown in radiographs, leverage due to ossification or hypertrophic synovium, and non-union after division of the greater trochanter. In 17 instances, no reason could be found except muscle atrophy. This type of case was difficult to treat and continued to dislocate later.

Hip Prosthesis↗
PubMed1981

[Total replacement of ankylosed hips (author's transl)].

31 patients were operated on using total hip replacement. Most of them had suffered an ankylosis of the hip in malposition, resulting in pain in the lumbar spine and knee. The average post-operative mobility was of 75 degrees of flexion. Stability returned to normal one year after operation. The pain in the lumbar spine was consistently improved, and could be completely relieved in cases without spinal arthrosis if it was of short duration. Pain in the knee was completely relieved in cases where the procedure restored a satisfactory bio-mechanical state. 29 patients were reviewed, of which 25 were satisfactory.

Adult↗
PubMed1981

[Acute chondrolysis following slipped capital femoral epiphysis. A study of 41 cases (author's transl)].

The authors have seen 41 instances of chondrolysis following slipped capital femoral epiphyses. Most of the cases were followed-up for more than five years. The main clinical features are reviewed. There is joint stiffness and generalised narrowing of the joint space during the year following the initial lesion. The evolution of the lesion is unpredictable. A number of possible radiological changes may develop including renewal of the joint space, modifications in the femoral head with a tendency towards protrusio, and osteophyte formation at the lateral margins of the acetabulum. In five cases a biopsy was performed which showed a non-specific dystrophy of the acetabular and femoral cartilage, with sub-chondral bony change different from that found in epiphyseal necrosis. The synovium did not show inflammatory change. The treatment should not be surgical at an early stage but the effectiveness of traction was uncertain. Later, corrective osteotomies may be indicated. Definitive surgical procedures such as arthrodesis or arthroplasty should not be made early because late clinical recovery has been noted. Cup arthroplasties gave deceptive results. The etiology of this disease is discussed.

Adolescent↗
PubMed1979

Clear-cell chondrosarcoma: a report of five cases including ultrastructural study.

Five cases of clear-cell variant of chondrosarcoma (Unni et al.) are reported. The tumors occurred in the epiphyseal region of long bones; three in the femoral head. Roentgenographically, the lesion was usually a well-defined and benign appearing one, either purely lytic (3 cases) or with central radiodensity (2 cases). Histologically, all five cases had areas of conventional chondrosarcoma; however, the greater portion of the tumor was made up of sheets of clear-cells intermixed with nonneoplastic bone trabeculae but devoid of chondroid matrix. Electron microscopic studies showed that these clear-cells possess cytoplasmic microvilli, abundant glycogen particles and prominent golgi complexes, like normal or tumorous chondroid cells usually have. In our experience, the best treatment seemed to be en bloc resection with joint replacement; indeed, despite the fact that they are true chondrosarcomas, these tumors usually have a very slow rate of growth.

Adolescent↗