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T Judet

Publications and source records attributed to T Judet.

At least 19 recordsLinked to original sources
PubMed2006

[Outpatient parenteral antimicrobial therapy (OPAT) in bone and joint infections].

The medical treatment of many bone and joint infections (including chronic osteomyelitis, prosthetic joint infection, and septic arthritis) requires prolonged intravenous antimicrobial therapy. For some patients, this treatment could be administered outside the hospital in a program that offers outpatient parenteral antimicrobial therapy (OPAT). In France, we have no registry of patients receiving OPAT. Initiation of this program requires specific criteria based on a patient evaluation and selection, and an interdisciplinary team of professionals committed to high-quality patient care. Various vascular access devices and infusion pump therapy are used to administer OPAT. The most common parenteral agents for OPAT are beta-lactams and glycopeptids (specifically vancomycin). Antimicrobial courses are stopped prematurely in 3 to 10% of the cases because of an adverse reaction or vascular access complications. Several published studies demonstrate the effectiveness of OPAT and higher patient satisfaction than hospital care. In addition, OPAT is clearly more cost-effective than intravenous therapy provided in the hospital setting. Some diagnoses, such as cellulites, community-acquired pneumonia, and endocarditis may be managed with OPAT.

Anti-Bacterial Agents↗
PubMed2006

Mobile versus fixed-bearing total knee arthroplasty: mid-term comparative clinical results of 216 prostheses.

Since the late 1970s, mobile-bearing total knee designs have been advocated as having theoretical advantages over fixed-bearing total knee replacements. At present there is no consensus as to whether there are any differences in clinical results between the two designs. We present the results of two consecutive cohorts each of over 100 prosthesis. The first cohort underwent a fixed-bearing prosthesis, whilst the second cohort received the mobile bearing variant of the same prosthesis. Both groups were assessed pre- and post-operatively using the American Knee Society knee and function scores as well as range of movement and the presence or absence of anterior knee pain. No difference was found statistically significant between the groups, either for the knee score (P=0.068), the function score (P=0.26), the range of movement (P=0.11) or the proportions of anterior knee pain (P=0.06). It is our opinion that mobile bearing knee prosthesis have still to prove their theoretical advantages in clinical practice.

Aged↗
PubMed2006

[Femoral revision using cemented stem and compacted bone graft: femoral migration analysis].

PURPOSE OF THE STUDY: If the bone loss is significant, revision total hip arthroplasty can be most difficult. We present a series of 30 patients with major loss of bone stock treated with the X-change (Exeter) technique for revision total hip arthroplasty. MATERIAL AND METHODS: This prospective consecutive series included 30 reconstructions performed between 1996 and 2001. Compacted grafts with cryopreserved bone were used. Mean follow-up was 42 months (range 24-80). According to the SOFCOT classification, bone loss was stage II in one patient, stage III in 14 and stage IV in 15. The technique described by Gie, Linder and Ling was rigorously applied: smooth stem, no force on the Merckel, cement in the impacted allograft, filling of femoral bone defects. Reinforcement with plates, mesh, or wire was used as necessary to bridge cortical defects. The Postel-Merle-d'Aubigné (PMA) score was used to assess clinical outcome. Digital x-rays were obtained before and after surgery and at last follow-up to assess implant position (vertical migration and frontal deviation), changes in bone stock, and the Pierchon classification. Thirty patients were seen at two years follow-up. Two patients were lost to follow-up after two years. Material had to be removed in two patients because of mechanical intolerance. There was one postoperative fracture at six months. One patient died more than two years after implantation. The PMA score improved from 11 to 17 at last follow-up. Radiographic results showed mean 7.3 mm stem migration and mean 2 degrees frontal deviation which were not correlated with clinical presentation. The Pierchon classification revealed 20 situations of corticalization and eight of trabeculation. Factors affecting migration were modalities of graft preparation and time to first weight bearing. Migration was unchanged after twelve months. DISCUSSION AND CONCLUSION: The functional and radiographic results remained satisfactory in light of the initial bone loss. Implant migration did not affect outcome. We have modified the surgical technique in line with these results, particularly concerning preparation of the impacted bone graft. This technique has the advantage of filling bone defects and avoiding therapeutic escalation.

Adult↗
PubMed2006

[Every two year follow-up of arthroplasties: myth or reality?].

In this article, we propose a simple calculation to project quantitatively the number of consultations implied by a systematic follow-up protocol for arthroplasty surgery. In France, this surveillance schedule has become mandatory and will have a pertinent impact on health care expenditures. The longevity of implanted prostheses as well as patient life expectancies can be used to estimate the number of consultations necessary for a regular follow-up. For example, a surgeon who performs 200 arthroplasty procedures per year will have to see 17 patients per week 20 years later.

Age Factors↗
PubMed2006

Polymorphism of the cell wall-anchoring domain of the autolysin-adhesin AtlE and its relationship to sequence type, as revealed by multilocus sequence typing of invasive and commensal Staphylococcus epidermidis strains.

We sequenced the adhesin-cell wall-anchoring domain of the atlE gene of 49 invasive and commensal Staphylococcus epidermidis strains. We identified 22 alleles, which could be separated into two main groups: group 1 (alleles 1 and 6 to 16, 32/49 strains) and group 2 (alleles 2 to 5 and 17 to 22, 17/49 strains). Allele 1 (the type strain sequence) was by far the most prevalent (21 of 49 strains). Multilocus sequence typing showed a clear relationship between the atlE allele and the sequence type (ST), with the "nosocomial" ST27 clone and closely related STs expressing group 1 alleles.

Adhesins, Bacterial↗
PubMed2006

Spinal and pelvic parameters in Marfan's syndrome and their relevance to surgical planning.

Spinal deformities are a common feature of Marfan's syndrome and can be a significant cause of morbidity. The morphology of the scoliosis associated with this condition was previously described by Sponseller, but no correlation with the pelvic parameters has been seen. We performed a retrospective radiological study of 58 patients with scoliosis, secondary to Marfan's syndrome and related the findings in the thoracolumbar spine to the pelvic parameters, including pelvic version (tilt), pelvic incidence and sacral slope. Our results showed marked abnormalities in the pelvic values compared with those found in the unaffected population, with increased retroversion of the pelvis in particular. In addition we found a close correlation between the different patterns of pelvic parameters and scoliosis morphology. We found that pelvic abnormalities may partially dictate the spinal disorders seen in Marfan's syndrome. Our results supplement the well-established Sponseller classification, as well as stressing the importance of considering the orientation of the pelvis when planning surgery.

Adolescent↗
PubMed2005

[Tibia nonunion after intramedullar nailing for fracture: decortication and osteosynthesis by medial plating].

PURPOSE OF THE STUDY: Intramedullar nailing is now widely used for fractures of the tibia. Extension of nailing indications to proximal, distal, and comminuted fractures has led to a significant rate of complications. The purpose of this study was to analyze decortication and medial plating for the treatment of tibial nonunion after intramedullary nailing. MATERIAL AND METHODS: Eighteen cases of aseptic tibial nonunion after nailing for fracture were treated in three women and fifteen men, mean age 39 years (19-57). The initial classification was open (n = 8), segmental (n = 3), single-focus (n = 15). The fracture site was inferior (n = 6), middle (n = 7), and superior (n = 2). Primary nailing used reaming in 15 cases (83%), unreamed in 3 (17%) static in 13 and dynamic in 5. Four plaster cabts were also applied. Complications were: infection (n = 1), compartmental syndrome (n = 2), tibial nerve palsy (n = 1), dysesthesia (n = 2), and protrusion of the nail into the knee (n = 1). Dynamization was performed in 11 patients, one with additional bone graft and fibulectomy. Repeated reamed nailing was performed in one patient. Seven nonunions were atrophic and 11 were hypertrophic. There were 13 malpositionings associated with the nonunion. Treatment of the nonunion was performed 300 days on average (90-900) after nailing: cancellous bone graft was associated with decortication in four cases because of bone loss (n = 3) or atrophic nonunion (n = 1). RESULTS: Union rate was 94%. Mean time for union was 108 days (80-180) with no significant difference (Student t-test) between atrophic (119 days) and hypertrophic (103 days) nonunion. Correction of the malposition was incomplete in seven patients, with angular malunion of less than 6 degrees in five patients and greater than 10 degrees in two. One late infection occurred and finally healed after external fixation and antibiotic therapy. No skin necrosis occurred. Five patients had pain on the hardware. Removal was performed in one time and pain resolved. Improvement of knee and ankle stiffness was achieved in all patients. DISCUSSION: This technique has been used in our department since 1967. Different studies have found a union rate ranging from 94% to 100% with this procedure. Intramedullary nailing, sometimes associated with bone graft or decortication, is also used for tibial nonunion with a good rate of union. The main problem of intramedulary nailing for nonunion, as for fracture, is the difficulty in avoiding malunion. Plating a nonunion, as a fracture, enables better reduction. Skin problems can occur with the medial plate if the soft tissues are damaged. This situation is very uncommon in secondary surgery. CONCLUSION: Decortication and medial plating was a safe and efficient treatment for tibia nonunion after failure of intramedullary nailing and allows better reduction and repeated nailing.

Adult↗
PubMed2005

[Excision of heterotopic new bone around the elbow in patients with head injury: 51 cases].

PURPOSE OF THE STUDY: Neurogenic paraosteoarthropathy of the elbow is a frequent complication in head injury patients. The functional impairment may be severe. The purpose of this work was to evaluate the efficacy of our medico-surgical approach and to determine indications for surgery. MATERIAL AND METHODS: We analyzed retrospectively a continuous series of 44 patients (51 elbows) with neurogenic heterotopic new bone of the elbow joint managed from 1993 to 2000. The heterotopic bone had developed on a central deficit limb in 70% of the patients. Flexion-extension was limited in all patients, and pronation-supination in nine. The ulnar nerve was compressed by the heterotopic bone in half of the patients. A 3D reconstruction CT-scan with contrast injection was obtained in all patients. We consider did not the classical criteria for bone maturation to assess operability. Using an adapted approach, we removed the heterotopic new bone to enable complete elbow motion. Associated procedures were performed in fifteen patients due to persistent intraoperative joint stiffness related to muscle-tendon retraction. We did not prescribe diphosphonates or radiotherapy postoperatively. RESULTS: At 45 months follow-up, one patient had been lost. Relative gain was considered very good in 34 elbows, good in 13 and fair in 3. There were no cases of lost motion. There were no recurrences causing joint limitation, but two of nine cases of radioulnar synostosis recurred. DISCUSSION: Neurogenic paraosteopathy of the elbow impairs joint function and may lead to ulnar nerve compression. The goal of surgery is to improve function. The analysis of our results show that early surgery yields good results without complementary treatment, irrespective of the patient's overall functional deficit or cognitive status and irrespective of the localization of the hetertopic bone. The essential prognostic factor for the quality results is the neurological status of the limb, particularly the degree of spasticity and muscle-tendon retraction.

Adult↗
PubMed2005

Use of genotypic identification by sodA sequencing in a prospective study to examine the distribution of coagulase-negative Staphylococcus species among strains recovered during septic orthopedic surgery and evaluate their significance.

A total of 212 coagulase-negative Staphylococcus strains recovered prospectively during 119 surgeries for proven or suspected bone and joint infection (BJI) were identified by sodA sequencing. These strains were identified as 151 Staphylococcus epidermidis isolates, 15 S. warneri isolates, 14 S. capitis isolates, 9 S. hominis isolates, 6 S. lugdunensis isolates, 5 S. haemolyticus isolates, 4 S. caprae isolates, 4 S. pasteuri isolates, 3 S. simulans isolates, and 1 S. cohnii isolate. Only S. epidermidis, S. lugdunensis, S. capitis, and S. caprae were found to be infecting organisms and were involved, respectively, in 35 (81.4%), 3 (7.0%), 3 (7.0%), and 2 (4.6%) cases of BJI.

Adult↗
PubMed2005

Ankylosing neurogenic myositis ossificans of the hip. An enhanced volumetric CT study.

Neurogenic myositis ossificans is a disabling condition affecting the large joints of patients with severe post-traumatic impairment of the central nervous system. It can result in ankylosis of the joint and vascular or neural compression. Surgery may be hazardous with potential haemorrhage, neurovascular injury, iatrogenic fracture and osteochondral injury. We undertook pre-operative volumetric CT assessment of 45 ankylosed hips with neurogenic myositis ossificans which required surgery. Helical CT with intravenous contrast, combined with two- and three-dimensional surface reconstructions, was the only pre-operative imaging procedure. This gave good differentiation of the heterotopic bone from the adjacent vessels. We established that early surgery, within 24 months of injury, was neither complicated by peri-operative fracture nor by the early recurrence of neurogenic myositis ossificans. Surgical delay was associated with a loss of joint space and a greater degree of bone demineralisation. Enhanced volumetric CT is an excellent method for the pre-operative assessment of neurogenic myositis ossificans and correlates well with the operative findings.

Adult↗
PubMed2004

Midterm results of the Salto Total Ankle Prosthesis.

The Salto Total Ankle Prosthesis is noncemented with mobile bearings and is characterized by an anatomic design and a dual Ti-HA coating. Between 1997 and 2000, 98 consecutive Salto prostheses were implanted. At last followup, two patients were deceased, one patient was lost to followup, and two prostheses were removed in two patients. Ninety-three implants in 91 patients were available with a mean followup of 35 months (range, 24-68 months). Survivorship at 68 months, with the end point implant removal, then was 98% (favorable scenario) to 94.9% (unfavorable scenario). The American Orthopaedic Foot and Ankle Society score was 32.3 points preoperatively and 83.1 points at followup. Seventy-two patients are pain-free, 54 patients walk unlimited distances, and 25 patients have limitation but walk more than 1 km. Sixty-seven patients have no limp but seven need walking aids. Fifty-eight patients can walk on tiptoes, 49 patients can walk on uneven ground, 14 patients can run, 76 patients ascend stairs normally, and 63 patients descend stairs normally. Range of motion as measured on stress radiographs improved from 15.2 degrees preoperatively to 28.3 degrees at followup. Preliminary results of the Salto prosthesis are encouraging and validate the concept of anatomic replacement.

Adult↗
PubMed2003

[Surgical treatment of orthopedic deformities due to spasticity in the lower limb].

Orthopedic deformities in the lower limb concern all joints (hip, knee, ankle, foot) with a wide range of clinical forms. Spasticity, contracture, stiffness, laxity, neurological deficit are assessed to establish the surgical procedure. Surgical techniques are adapted to the goals that are detailed with the patient and his family: standing, transferring, walking, hygiene, devices (shoes, orthosis, canes, wheelchair). Surgical procedures can associate: lengthening of contractured muscles (tenotomy with or without sutures, fractional lengthening at the musculo-tendinous junction or desinsertion), strengthening of antagonists (passive or active tendon transfer) and correction of joint deformity (arthrolysis, arthrodesis, arthroplasty). In adults, the most common deformities are the equinus or equinovarus foot, toe curling, hip adductum, knee flessum. Talus or knee recurvatum are less frequently observed. The association of various deformities raises questions concerning the hierarchy of surgical procedure, from an anatomical point of view (do we start with proximal or distal joint first?) as from chronological concerns (shall we do one or more procedures?). Pluridisciplinary assessment using neurological anesthetic blocs and dynamic EMG or gait analysis is necessary to detail the aims of surgery and choose the surgical procedures.

Foot Deformities, Congenital↗
PubMed2003

[Use of combined gallium-technetium scintigraphy to determine the interval before second-stage prosthetic reimplantation in hip arthroplasty infection: a consecutive series of 30 cases].

PURPOSE OF THE STUDY: We report a series of 30 consecutive patients with chronically infected total hip replacement in a prospective treatment protocol that included two-stage revision surgery and scintigraphic monitoring. The serial bone scans were used to evaluate the course of infection, but not for diagnosis. Negative scintigraphic results were required before the second-stage prosthesis reinsertion after laboratory, clinical, and radiographic normalization were achieved. MATERIAL AND METHODS: Between 1987 and 1997, we prospectively followed thirty patients, who had a chronically infected hip arthroplasty treated by the conventional two-stage revision procedure using scintigraphic verification. For the present series, negative bone scan results were achieved in the resected hip before reinsertion of the prosthesis in all patients except one. The labels used were in every case gallium-67 and technetium-99m MDP with early and late (after 30 hours) scans. A scintigraphic result was considered positive if more gallium than technetium was fixed at a site. Our conventional medical and surgical protocol consisted of an initial complete excision of all foreign bodies with systematic parenteral administration of two antibiotics after having searched for the causative organism. A spacer was never used. Tibial pin traction was always applied during the duration of drainage of the wound. The antimicrobial regimen was administered to all of these patients for 3 months. The prosthesis was reinserted when C-reactive protein (CRP) levels returned to normal and negative scintigraphic results were obtained after a period with no antibiotic therapy. Reimplantation of the prosthesis was always performed with preventive antibiotic therapy selected according to the susceptibility of the initial organisms and begun after collecting new intraoperative bacteriological culture specimens. This antibiotic therapy was pursued only for the duration of the postoperative drainage. RESULTS: This follow-up based on combined technetium-gallium bone scans demonstrated two major advantages. First, no recurrence of infection was observed except in the single patient for whom the protocol was not observed. The second advantage was to permit nonarbitrary determination of the moment of reimplantation of the prosthesis, as there is no clear consensus regarding the interval before reinsertion in the literature. The patients underwent the second-stage of hip reconstruction after a mean interval of 9 months. The mean delay before negative scintigraphic results was 7 months. DISCUSSION: This method, which determines the optimum delay before reimplantation reducing the risk of reinfection to a minimum, gave promising results in this prospective study of 30 patients.

Adult↗
PubMed2002

[Value of MRI to evaluate extra-abdominal desmoid fibromatosis].

PURPOSE: To describe the MR appearance of extra-abdominal desmoid fibromatosis, especially using sequences such as MR angiography, STIR and FAT SAT. Materials and methods. We reviewed retrospectively the MRI studies of 8 patients (4 men and 4 women) with histologically proved desmoid fibromatosis. In five patients the lesion corresponded to recurrent disease. Eleven MRI examinations were available (Siemens, Vision, 1.5T) including the following sequences: pre- and postcontrast T1 weighted (11 cases), STIR (9 cases), and MRA (3 cases). All lesions were imaged in at least two orthogonal planes. CT was available for 5 patients. RESULTS: The lesions were localized to the girdles in 8 cases and to the upper extremity in 3 cases. Most lesions (10/11) were isointense to muscle on noncontrast T1W images and showed intense enhancement on postcontrast T1W images. All lesions (9/9) were hyperintense on STIR images. CONCLUSION: A STIR sequence is useful as a first sequence to identify smaller lesions (usually recurrences) and to better adapt the FOV of following sequences, especially before administration of intravenous contrast. MR angiography may be valuable for surgical planning.

Adult↗
PubMed2001

Cranial nerve palsy revealing an occipitovertebral metastasis from carcinoma of the uterine cervix.

A 37-year-old woman had a histologically documented occipitovertebral metastasis from an invasive epidermoid carcinoma of the uterine cervix. The metastasis was found 3 months after the primary and was treated by local radiation therapy followed by systemic chemotherapy. Radiation therapy was highly effective in relieving the pain but was not associated with changes in magnetic resonance imaging findings. Lymph node involvement and local extension occurred. The patient died 1 year after the diagnosis of the metastasis. Involvement of the occipitovertebral junction by uterine cervix carcinoma metastasis is exceedingly rare. The relevant literature is reviewed.

Adult↗
PubMed2001

Partial resurfacing arthroplasty of the femoral head in avascular necrosis. Methods, indications, and results.

The current study reports results using a partial surface replacement for osteonecrosis of the femoral head. The surgical technique, implant design, and instrumentation cause minor soft tissue disruption and require little bony resection. Thirty-seven prostheses were placed in 33 patients during the past 7 years. The mean age of the patients was 43 years (range, 24-59 years), and the preoperative Ficat classification was Stage III in 26 hips, Stage IV in 10, and Stage II in one hip. For the surviving prostheses, the mean followup was 49 months (range, 24-89 months). Of the 28 surviving implants, 24 continue to function well and the patients have excellent or good hip scores according to the Merle d'Aubigne system. There were nine failures, mainly attributable to the extension of the osteonecrosis. In comparison with alternative techniques, the operative surgery for partial surface replacement is straightforward, requiring little preoperative planning and immediate weightbearing postoperatively. Should failure occur, little bone stock loss is incurred and revision to a total hip replacement is as simple as primary hip arthroplasty.

Adult↗
PubMed2001

[Original valgus tibial osteotomy by internal opening and without loss of bone contact. Technique and incidence of consolidation speed: a preliminary series of 33 cases].

PURPOSE OF THE STUDY: We propose an original open wedge medial osteotomy of the upper tibia. This new technique, unlike conventional open wedge osteotomies, allows a large bone contact surface without requiring graft filling. MATERIAL AND METHOD: The new technique is based on two anterior and posterior hemi-osteotomies instead of the single osteotomy with the classical technique. The two hemi-osteotomies join laterally but start medially at very different heights on the tibia. The two hemi-osteotomies open a wedge but nevertheless lead to a very large bone contact due to the slippage in a frontal connecting frontal osteotomy. The technique uses a cutting guide to allow perfect orientation meeting the requirements of the operative plan. We studied prospectively the first 33 patients who underwent this new procedure in two centers (Jouvenet Clinic and Tenon Hospital, Paris). We report here the effect on healing time. RESULTS: There was one failure (retarded healing and partial loss of correction) due to incomprehension of the postoperative instructions. The other 32 cases consolidated in 45 days. No graft filling was needed.

Adult↗