Replacement Arthroplasty: Biau D

Postel JM, Thoumie P, Missaoui B, Biau D, Ribinik P, Revel M, Rannou F, Anonymous00070. · Clinique Arago, 95, boulevard Arago, 75014 Paris, France. · Ann Readapt Med Phys. · Pubmed #17412445 No free full text.

Abstract: OBJECTIVE: To develop clinical practice guidelines concerning the use of continuous passive motion (CPM) compared with intermittent mobilization after total knee arthroplasty (TKA). METHOD: We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review and collection of everyday clinical practice concerning postoperative rehabilitation techniques and external review by a multidisciplinary expert panel, to develop the guidelines. RESULTS: The literature contains no evidence of the advantages of CPM over other techniques of mobilization, although CPM could be adjuvant therapy used to accelerate short-term recovery. However, in France, CPM remains widely used after TKA, both in orthopedic surgery units and in physical medicine and rehabilitation services. CONCLUSION: Good methodological quality studies are needed to assess different CPM modalities and compare them to alternative intermittent mobilization techniques, particularly those with therapy starting from a flexed position.

Paysant J, Jardin C, Biau D, Coudeyre E, Revel M, Rannou F. · Institut régional de médecine physique et de réadaptation, 75, boulevard Lobau, 54042 Nancy cedex, France. · Ann Readapt Med Phys. · Pubmed #18221816 No free full text.

Abstract: AIMS: To develop clinical practice guidelines for early mobilisation after total knee replacement (TKR). METHOD: We used the French Society of Physical and Rehabilitation Medicine (SOFMER) methodology, which associates a systematic review of the literature, collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. RESULTS: A review of the literature and French clinical practice allow for recommending early mobilisation, at day 0, after TKR. This practice, with continuous passive motion, does not seem to increase the frequency of complications and seems to help with rapid recovery of the joint range of motion. Trials with good methodology must be developed to define the criteria for prescribing early mobilisation after TKR. These trials should focus mainly on joint range of motion but also on economical criteria (duration of hospitalisation, rehabilitation, physiotherapy, use of painkillers) and the satisfaction of the patient.

Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D, Sedel L. · Lariboisière Hospital, Paris, France. · Clin Orthop Relat Res. · Pubmed #15738822 No free full text.

Abstract: From individual randomized studies it is unclear whether the patella should be replaced during total knee replacement. We did a meta-analysis to provide quantitative data to compare patellar resurfacing with nonresurfacing during total knee arthroplasty. Only randomized, controlled trials reported between January 1966 and August 2003 comparing patellar replacement with patella retention were included for a total of 12 studies. Two reviewers assessed trial quality and extracted data from papers. The outcomes identified were reoperations for patellar problems, anterior knee pain, knee scores, stair climbing, and patient satisfaction. The resurfaced patella performed better, and we found an increased relative risk (defined by the ratio of the risk of the event in the resurfaced group on the risk of the event in the nonresurfaced group) for reoperation, for significant anterior knee pain, and for significant pain during stair climbing when the patella was left unresurfaced. No differences were observed between the two groups for International Knee Society function score, Hospital for Special Surgery score, and for patient satisfaction. Despite these general findings, forming a definitive conclusion is difficult because many confounding factors, such as component design, surgeon experience, and technical aspects of the surgery, might influence the result in a patient.

Piriou P, Biau D, Judet T. · Service de Chirurgie Orthopédique, Hôpital Raymond-Poincaré, Garches. · Rev Chir Orthop Reparatrice Appar Mot. · Pubmed #16910614 No free full text.

Abstract: 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.

Biau D, Mullins MM, Judet T, Piriou P. · Hôpital Raymond Poincaré, Service de Chirurgie Orthopédique et Traumatologique, Garches, France. · Clin Orthop Relat Res. · Pubmed #16826114 No free full text.

Abstract: The decision on whether to perform a total knee replacement in extremely elderly patients is controversial. To assess the influence of age as an independent factor for early postoperative morbidity and mortality, we did a case-control study comparing a group of 22 patients 85 years or older that was matched for known predictive factors of nonsurgical postoperative complications with a younger control group. Both groups received the same perioperative and postoperative management. We then compared the number of postoperative complications. Standardized mortality ratios were performed to assess the influence of knee replacement on mortality. The 11 patients (50%) in the elderly group had one or more medical complications, which was similar to those of the five patients (23%) in the control group. Mortality in the elderly group who had knee replacements was almost (1/2) that of the general population (standardized mortality ratio, 0.53). We think age should not be a limitation for total knee replacements in elderly patients, although they should be given consideration for special care while in the hospital. LEVEL OF EVIDENCE: Therapeutic study, Level III (Case control study). See the Guidelines for Authors for a complete description of levels of evidence.

Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. · Cochin Teaching Hospital, Assistance publique-Hôpitaux de Paris, Service de chirurgie orthopédique et traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75679 Paris CEDEX 14, France. · J Bone Joint Surg Am. · Pubmed #16757762 No free full text.

Abstract: BACKGROUND: The use of a megaprosthesis has become the method of choice for reconstruction after bone tumor resection at the knee. However, the long-term survival of megaprostheses is poor. In this study, we sought to identify factors that were associated with implant failure and amenable to interventions designed to improve implant survival. METHODS: A retrospective review of the charts of ninety-one patients who had undergone resection of a tumor of the knee followed by reconstruction with a custom-made megaprosthesis was performed. The distal part of the femur was resected in fifty-six patients and the proximal part of the tibia, in thirty-five patients. The reconstruction was performed with an allograft-prosthesis composite in thirty-three patients and with metal or plastic sleeves in fifty-eight patients. Reconstruction of the extensor mechanism was necessary in all thirty-five patients with a tibial tumor. RESULTS: The median duration of follow-up was sixty-two months. The extensor mechanism was significantly less likely to rupture when partial continuity had been preserved at the time of the resection. Intra-axial laxity (an arc of motion of >5 degrees in the frontal plane) was significantly more common when the prosthesis had an antirotation pin than when it did not have an antirotation pin (p = 0.0023). There was mechanical failure of ten allograft-prosthesis composites and ten sleeve reconstructions. Thirty-six patients had removal of at least one component of the prosthesis. When revision due to local tumor recurrence was excluded, the median duration of prosthetic survival was 130 months following the distal femoral resections and 117 months following the proximal tibial resections. The median duration of survival was 117 months for the allograft-prosthesis composites and 138 months for the sleeve reconstructions. Body weight and activity level were independent predictors of early revision. CONCLUSIONS: The long-term survival of the knee megaprostheses in this study was poor. Mechanical failure was multifactorial and the leading cause of revision. Use of allograft-prosthesis composites and use of bushings or an antirotation pin appeared to have no mechanical benefits. We recommend that weight control programs and advice about adapting their activity level be offered to patients preoperatively.

Biau D, Mullins MM, Judet T, Piriou P. · Service de Chirurgie Orthopedique et Traumatologique, Hopital Raymond Poincare, 104, Boulevard Raymond Poincaré, 92380 Garches, France. · Knee Surg Sports Traumatol Arthrosc. · Pubmed #16565879 No free full text.

Abstract: 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.