Vincent Souillac

Association between psoas abscess and prosthetic hip infection: a case-control study

Background and purpose The relationship between prosthetic hip infection and a psoas abscess is poorly documented. We determined the frequency of prosthetic hip infections associated with psoas abscesses and identified their determinants. Methods We conducted a 2-year observational study. Data from patients with psoas abscesses that were associated with prosthetic hip infections were examined in a case-control study. Results Of 106 patients admitted to the Infectious Diseases Department with prosthetic hip infection, 13 also had a psoas abscess (12%; 95% CI: 6–19). By conditional logistic regression analysis, psoas abscesses were observed more frequently in cases of hematogenous prosthetic infections (OR = 93, p = 0.06) and in patients with a history of neoplasm (OR = 20, p = 0.03). Interpretation Our results suggest that the presence of psoas abscesses is a frequent but under-diagnosed complication of prosthetic hip infection. We recommend that an abdominal CT scan be performed on patients with hematogenous prosthetic hip infection or with a history of neoplasm.

Tolérance et efficacité d’une entretoise articulée dans les reprises en deux temps de prothèses de genou infectées

PURPOSE OF THE STUDY Two-stage reimplantation remains the most popular solution for infected total knee arthroplasty. We have used articulated spacers since their introduction in 2000. We evaluated tolerance, joint motion under general anesthesia before reimplantation and also the infectious and functional long-term outcome. MATERIAL AND METHODS Between June 2000 and April 2003, we implanted an articulated spacer in 28 patients who required revision of their total knee arthroplasty. Postoperatively, contact weight bearing was allowed with unlimited knee motion depending on pain control. Mean time between implant removal and reimplantation was eight weeks (range 6-16 weeks). RESULTS There was one dislocation due to excessive play between the two components. Passive joint motion before reimplantation was 53 degrees (range 5-80 degrees ). At last follow-up, 24 patients were free of overt infection and all antibiotic regimens had been discontinued for at least 20 months (20-48 months). Two patients required a second two stage revision. One had an arthrodesis and in one only suppressive antibiotic therapy was possible. DISCUSSION Spacer removal appears easy at reimplantation. Good knee flexion (greater than 40 degrees in ten patients and greater than 60 degrees in eight) facilitated exposure, avoiding the need for tilting of the tibial tuberosity in seven patients. Functional and infectious outcomes were similar to those reported in the literature. CONCLUSION The spacer appears to improve patient comfort between the two operations. It also facilitates the reimplantation procedure because of the easier exposure and greater knee flexion compared with a mono-bloc spacer or an external fixator. There must however be enough bone stock to hold the articulated spacer in place.Resume Dans la prise en charge en deux temps des protheses totales de genoux infectees, l’intervalle entre les deux chirurgies est une periode importante ou la conservation de l’espace articulaire est primordiale. Nous avons voulu evaluer dans ce travail, les resultats obtenus avec l’emploi d’espaceurs articules. Entre juin 2000 et avril 2003, 28 espaceurs articules ont ete mis en place apres ablation de protheses totales de genou a glissement de premiere intention. Les deposes iteratives et de protheses a charniere ont ete exclues, et ont, elles, beneficie de la mise en place d’espaceurs monoblocs. Nous avons etudie la tolerance de tels espaceurs, les amplitudes articulaires a la repose et les resultats sur le versant infectieux et fonctionnel, au dernier recul. Le delai de repose etait en moyenne de 8 semaines (6 a 16). La tolerance des espaceurs a ete bonne et nous n’avons constate qu’un seul cas de subluxation de l’espaceur, sans reprise chirurgicale prematuree. Les amplitudes articulaires etaient en moyenne de 53° (5 a 80°) avant repose; ce qui nous a facilite l’exposition, avec necessite de basculement de la tuberosite tibiale que dans 7 cas (3 avaient deja beneficie de cette bascule lors de la depose). Au dernier recul, 24 patients ne presentaient pas de reveil infectieux patent et toute antibiotherapie avait ete arretee depuis au moins 20 mois (de 20 a 48 mois). Deux patients ont necessite une nouvelle depose puis repose. Un patient a ete arthrodese et, chez un patient, a ete mis en route une antibiotherapie suppressive.

MémoireTolérance et efficacité d’une entretoise articulée dans les reprises en deux temps de prothèses de genou infectées: Série rétrospective de 28 prothèsesEvaluation of an articulated spacer for two-stage reimplantation for infected total knee arthroplasty: 28 cases

PURPOSE OF THE STUDY Two-stage reimplantation remains the most popular solution for infected total knee arthroplasty. We have used articulated spacers since their introduction in 2000. We evaluated tolerance, joint motion under general anesthesia before reimplantation and also the infectious and functional long-term outcome. MATERIAL AND METHODS Between June 2000 and April 2003, we implanted an articulated spacer in 28 patients who required revision of their total knee arthroplasty. Postoperatively, contact weight bearing was allowed with unlimited knee motion depending on pain control. Mean time between implant removal and reimplantation was eight weeks (range 6-16 weeks). RESULTS There was one dislocation due to excessive play between the two components. Passive joint motion before reimplantation was 53 degrees (range 5-80 degrees ). At last follow-up, 24 patients were free of overt infection and all antibiotic regimens had been discontinued for at least 20 months (20-48 months). Two patients required a second two stage revision. One had an arthrodesis and in one only suppressive antibiotic therapy was possible. DISCUSSION Spacer removal appears easy at reimplantation. Good knee flexion (greater than 40 degrees in ten patients and greater than 60 degrees in eight) facilitated exposure, avoiding the need for tilting of the tibial tuberosity in seven patients. Functional and infectious outcomes were similar to those reported in the literature. CONCLUSION The spacer appears to improve patient comfort between the two operations. It also facilitates the reimplantation procedure because of the easier exposure and greater knee flexion compared with a mono-bloc spacer or an external fixator. There must however be enough bone stock to hold the articulated spacer in place.Resume Dans la prise en charge en deux temps des protheses totales de genoux infectees, l’intervalle entre les deux chirurgies est une periode importante ou la conservation de l’espace articulaire est primordiale. Nous avons voulu evaluer dans ce travail, les resultats obtenus avec l’emploi d’espaceurs articules. Entre juin 2000 et avril 2003, 28 espaceurs articules ont ete mis en place apres ablation de protheses totales de genou a glissement de premiere intention. Les deposes iteratives et de protheses a charniere ont ete exclues, et ont, elles, beneficie de la mise en place d’espaceurs monoblocs. Nous avons etudie la tolerance de tels espaceurs, les amplitudes articulaires a la repose et les resultats sur le versant infectieux et fonctionnel, au dernier recul. Le delai de repose etait en moyenne de 8 semaines (6 a 16). La tolerance des espaceurs a ete bonne et nous n’avons constate qu’un seul cas de subluxation de l’espaceur, sans reprise chirurgicale prematuree. Les amplitudes articulaires etaient en moyenne de 53° (5 a 80°) avant repose; ce qui nous a facilite l’exposition, avec necessite de basculement de la tuberosite tibiale que dans 7 cas (3 avaient deja beneficie de cette bascule lors de la depose). Au dernier recul, 24 patients ne presentaient pas de reveil infectieux patent et toute antibiotherapie avait ete arretee depuis au moins 20 mois (de 20 a 48 mois). Deux patients ont necessite une nouvelle depose puis repose. Un patient a ete arthrodese et, chez un patient, a ete mis en route une antibiotherapie suppressive.

Tolérance et efficacité d'une entretoise articulée dans les reprises en deux temps de prothèses de genou infectées : Série rétrospective de 28 prothèses

PURPOSE OF THE STUDY Two-stage reimplantation remains the most popular solution for infected total knee arthroplasty. We have used articulated spacers since their introduction in 2000. We evaluated tolerance, joint motion under general anesthesia before reimplantation and also the infectious and functional long-term outcome. MATERIAL AND METHODS Between June 2000 and April 2003, we implanted an articulated spacer in 28 patients who required revision of their total knee arthroplasty. Postoperatively, contact weight bearing was allowed with unlimited knee motion depending on pain control. Mean time between implant removal and reimplantation was eight weeks (range 6-16 weeks). RESULTS There was one dislocation due to excessive play between the two components. Passive joint motion before reimplantation was 53 degrees (range 5-80 degrees ). At last follow-up, 24 patients were free of overt infection and all antibiotic regimens had been discontinued for at least 20 months (20-48 months). Two patients required a second two stage revision. One had an arthrodesis and in one only suppressive antibiotic therapy was possible. DISCUSSION Spacer removal appears easy at reimplantation. Good knee flexion (greater than 40 degrees in ten patients and greater than 60 degrees in eight) facilitated exposure, avoiding the need for tilting of the tibial tuberosity in seven patients. Functional and infectious outcomes were similar to those reported in the literature. CONCLUSION The spacer appears to improve patient comfort between the two operations. It also facilitates the reimplantation procedure because of the easier exposure and greater knee flexion compared with a mono-bloc spacer or an external fixator. There must however be enough bone stock to hold the articulated spacer in place.Resume Dans la prise en charge en deux temps des protheses totales de genoux infectees, l’intervalle entre les deux chirurgies est une periode importante ou la conservation de l’espace articulaire est primordiale. Nous avons voulu evaluer dans ce travail, les resultats obtenus avec l’emploi d’espaceurs articules. Entre juin 2000 et avril 2003, 28 espaceurs articules ont ete mis en place apres ablation de protheses totales de genou a glissement de premiere intention. Les deposes iteratives et de protheses a charniere ont ete exclues, et ont, elles, beneficie de la mise en place d’espaceurs monoblocs. Nous avons etudie la tolerance de tels espaceurs, les amplitudes articulaires a la repose et les resultats sur le versant infectieux et fonctionnel, au dernier recul. Le delai de repose etait en moyenne de 8 semaines (6 a 16). La tolerance des espaceurs a ete bonne et nous n’avons constate qu’un seul cas de subluxation de l’espaceur, sans reprise chirurgicale prematuree. Les amplitudes articulaires etaient en moyenne de 53° (5 a 80°) avant repose; ce qui nous a facilite l’exposition, avec necessite de basculement de la tuberosite tibiale que dans 7 cas (3 avaient deja beneficie de cette bascule lors de la depose). Au dernier recul, 24 patients ne presentaient pas de reveil infectieux patent et toute antibiotherapie avait ete arretee depuis au moins 20 mois (de 20 a 48 mois). Deux patients ont necessite une nouvelle depose puis repose. Un patient a ete arthrodese et, chez un patient, a ete mis en route une antibiotherapie suppressive.

Complicanze tardive delle fratture del piatto tibiale

Riassunto Anche se la scelta e la condotta terapeutica sono adeguate, le fratture del piatto tibiale sono sempre esposte all’insorgenza di complicanze secondarie con importanti ripercussioni funzionali. La rigidita articolare e l’artrosi femoro-tibiale sono le piu temute e le piu frequenti. Negli ultimi 15 anni lo sviluppo della chirurgia protesica del ginocchio ha rappresentato un importante progresso nella gestione di questi pazienti, anche se il trattamento conservativo trova ancora una sua indicazione.

In Vitro and In Vivo Behavior of Coral Treated by Hydrogen Peroxide, Supercritical Ethanol, or Heat

In this study we focus on the use of coral Porites Lutea and the various treatments used to remove proteins while assessing the impact of the various removal methods on the in vitro and in vivo coral behavior. No significant differences were observed in vitro among all materials. In vivo, no histological differences were observed between BiocoralÒ and samples treated by either hydrogen peroxide or a thermal procedure. The implants made from supercritical fluid treated coral were more resistant to resorption (50% more resistant after one month).

Complicaciones tardías de las fracturas de los platillos tibiales

Resumen Las fracturas de los platillos tibiales, incluso despues de una decision y una conducta terapeutica adaptadas, siempre estan expuestas a la aparicion de complicaciones secundarias con gran repercusion funcional. Las manifestaciones mas temibles y frecuentes siguen siendo la rigidez articular y la artrosis femorotibial. El desarrollo en los ultimos quince anos de la cirugia protesica de la rodilla representa un progreso importante en el tratamiento de estos pacientes. Si bien la cirugia no debe sustituir a los tratamientos conservadores, representa un avance notable en las opciones terapeuticas para tratar estas complicaciones.