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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 532 - 532
1 Nov 2011
Galois L Cournil-Henrionnet C Huselstein C Mainard D Bensoussan D Stoltz J Netter P Gillet P Watrin-Pinzano A
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Purpose of the study: Monolayer cultures of chondrocytes multiply and rapidly lose their chondrocyte phenotype, limiting their potential for tissue engineering. Mesenchymatous stem cells can preserve their phenotypic characteristics after several monolayer passages, offering a promising alternative for cartilage repair. The purpose of this work was to study the influence of transforming growth factor beta-1 (TGF-beta1) and bone morphogenic protein-2 (BMP2) and/or culture supplements (hyaluronic acid) on matrix synthesis and chondrocyte differentiation of human mesenchymatous stem cells (MSC) cultured on collagen sponges.

Material and methods: MSC were isolated from bone marrow harvested during hip arthroplsty. At the third passage in monolayer culture, the MSC were reseeded on collagen sponges and cultured in vitro for 28 days under seven differ conditions: insulin transferrin selenium (ITS), foetal calf serum (FCS), ITS+TGFbeta1, ITS+ hyaluronate, ITS+TGFbeta1+hyaluronate, ITS+TGFbeta1+BMP2, ITS +TGFbeta1+BMP2+hyaluronate. The phenotypic evolution was followed using the expression of different genes of interest with PCRq (collagen2, collagen1, collagen3, collagen10, agrecanne, versicanne, COMP, Sox9). Synthesis of matrix material was assessed histologically and immunohistochemically.

Results: Used alone, hyaluronic acid did not trigger chondrocyte differentiation of MSC. For the additives FCS, ITS, or hyaluronate, the synthesis of matrix material in the sponge was weak and poor in major constituents of cartilage. Conversely, the other conditions in presence of TGFbeta1±BMP2 induced important expression of collagen2, agrecanne and COMP as well as increased matrix synthesis with a strong content in proteoglycans and collagen.

Discussion: The usefulness of MSC is growing due to their pluripotent characteristics. The conditions leading to their differentiation into the chondrocyte phenotype remains a subject of discussion. Our results show the particular importance of TGFbeta1 in the process of differentiation.

Conclusion: Chondrogenic differentiation of MSC cultured in collagen sponges as well as the synthesis of the cartilaginous matrix requires the presence of TGFbeta1 in the culture medium and to a lesser extent BMP2. These results suggest the perspective of using MSC for guided cell therapy targeting cartilage.


Non union of long bone remains a dreadful complication.

The introduction of new strategies for orthopaedic surgeons to control and modulate bone healing using growth factors such as bone morphogenetic proteins (BMP) have been shown to induce bone formation and union in long bone defects and non unions.

A recombinant form of BMP (BMP-2) is FDA approved to promote fracture healing in tibial non unions.

The study aim was the assessment of the safety and efficacy of a single dose of recombinant human bone morphogenetic protein-2 (INDUCTOS®) combined with bank bone on the rate of bone formation and union in long bone defects and non unions.

Since October 2005, 44 patients (28 men, 16 women) with a median age of 41.81 (range: 14–78) received a single dose of BMP-2 (INDUCTOS®) in an extensive segmental long bone defects (mean score: 31.7 cc +/− 63.2; range: 5–261) in combination with bone bank graft (chips or cancellous bone blocs), without any adjunct of autologous bone or bone marrow. The series included 12 femur, 24 tibia, 5 radius/ulna, 3 humerus. All fractures were stabilised using external or internal fixation (mostly Ilizarov). All cases are available for complete follow-up.

Assessment of fusion was performed using digital radiographs at postoperative time, at 10 to 15 days and 1, 2, 3 month and every month till healing. Outcomes of the defects were evaluated using the Imagika® software.

Clinical stabilisation of the diaphyseal non unions, restoration of the limb length and axis, solid bone fusion were observed in all but two patients within a median time of 6.1 +/− 3.0 months (range: 2.5–15.0).

We observed that BMP-2 induced bone formation across the defect; radiographs showed rapid ossification, with bone graft densification and margin’s shadings.

With no need for donor sites, BMP restored the continuity and stability of critical-size defects faster than what we had observed in our former practice using large amounts of autograft combined with bank bone when necessary. We believe that this procedure provide faster healing, give more comfort and less sequel to patients.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 515 - 516
1 Oct 2010
Georis P Gillet P
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Cross-linked PE theoretically allows the use of thinner inserts and larger diameter heads than UHMWPE. This participates in reducing the risk of dislocation. Durasul® liners have demonstrated improved wear performance over UHMWPE in laboratory testing. This may also result in lower migration and loosening rates of the implants.

Our first aim was the assessment of linear wear of Durasul® inserts associated with Protasul® 36 mm CoCr prosthetic heads. We compared the results with our data on 28 mm CoCr and Biolox heads.

The first hypothesis was that Durasul® inserts combined with a 36 mm CoCr head would not produce more wear than would Durasul® inserts in association with a 28 mm CoCr prosthetic head.

The second hypothesis was that Durasul® inserts combined with a 36 mm head could even produce less wear than a UHMWPE liner in association with a Biolox® 28 mm prosthetic head.

The second aim was to correlate cup migration with polyethylene wear rate.

111 patients (37 men, 74 women) with a median age of 74 years (range: 54–90) received Durasul® liners in an Allofit Ti cup and Protasul® 36 mm heads. They were followed for minimum 5 years.

16 patients with a Durasul® liner received a 28 mm Protasul® head (control A) and 40 received a UHMWPE liner combined with a Biolox® 28 mm head (control B).

Patient outcome was assessed with the HHS. PE wear assessment was performed using a specific analysis model created in the Imagika® software. Cup migration was evaluated using the EBRA-CUP® software.

The preoperative and last follow-up HHS were 50.4+/−10.5 and 97.5+/−5.5 respectively.

The bedding-in penetration of the prosthetic head were 0.054+/−0.009 mm (Durasul®, 36 mm CoCr head), 0.056+/−0.008 mm (Durasul®, 28 mm CoCr head) and 0.057+/−0.010 mm (UHMWPE, Biolox® 28 mm head). There were no significant differences between the different groups.

The annual linear wear rates were 0.029+/−0.003 mm (Durasul®, 36 mm CoCr head), 0.032+/−0.014 mm (Durasul®, 28 mm CoCr head) and 0.087+/−0.056 mm (UHMWPE, Biolox® 28 mm head). There were no significant differences between Durasul® groups, but a P value of 0.00027 was observed between the study group and the control B group.

We didn’t observed cup migration in our patients (0.09 mm medially and 0.13 mm cranially).

Patient satisfaction was high with improvement of quality of life.

Combined with the Durasul® inserts used in this series, 36 mm CoCr prosthetic heads had no unfavourable influence on the wear assessment compared with the use of 28 mm prosthetic heads. The annual linear wear rate of Durasul® liners was 37.84% of that seen with the UHMWPE liner. The absence of cup migration at last follow-up may indicate very low PE wear rates.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 146 - 146
1 Mar 2009
GEORIS P THIRION T PETERS S LEMAIRE R GILLET P
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Radiographic evidence of migration of the femoral stem component after THA is the most important diagnostic sign of femoral implant loosening. Early detection of stem subsidence may help in deciding to perform revision surgery before severe bone destruction has occurred, at a moment when standard clinical and radiological follow-up may still be reassuring.

The aim of this study was to identify the most appropriate bone and prosthetic landmarks to study subsidence and to determine the accuracy of the Imagika® method as compared to the ‘gold standard’ EBRA-FCA® software.

256 THA in 242 patients (102 men, 140 women) with a median age of 63.8 years (range: 36–85) received 4 different cementless or cemented prosthetic stem designs. They were followed for 10.6 years (range: 6–16). CLS® stems were used in 56 patients, MS-30® in 76, Elite® in 50 and Osteal® in 74.

4 specific analysis models were created in the Imagika® software in order to evaluate several possible landmarks on the proximal femur and on the stem, and to evaluate the possibility of using a correction factor to improve the comparability of successive x-rays taken under non standardised conditions. The most accurate prosthetic landmarks were the prosthesis shoulder in CLS® and MS-30® stems and the lateral aspect of the collar in Elite® and Osteal® stems. The best bone landmark was the top of the greater trochanter in all cases.

For the whole series, the annual linear subsidence rates were 0.049+/−0.014 mm with EBRA-FCA® and 0.052+/−0.012 mm with Imagika® respectively (P = 9E-7). Migration values in the 4 different groups were respectively 0.06 +/− 0.01 mm/yr and 0.05 +/− 0.01 mm/yr in the CLS® group (P = 4.6E-6), 0.02 +/− 0.002 mm/yr and 0.06 +/− 0.09 mm/yr in the MS-30® group (P = 6.8E-4), 0.06 +/− 0.002 mm/yr and 0.04 +/− 0.003 mm/yr in the Elite® group (P = 4.2E-5), and 0.05 +/− 0.005 mm/yr and 0.06 +/− 0.004 mm/yr in the Osteal® group (P = 7.4E-7). The different prosthetic designs did not show significant differences concerning migration values when studied according both methods.

Thanks to a correction factor, the Imagika® method uses all the radiographs when EBRA-FCA® rejects incomparable radiographs.

The Imagika® method is more users friendly and provides excellent reliability thanks to an automatic edge detection device.

Since no significant difference was observed between EBRA-FCA® and Imagika® methods whatever the prosthetic stem design studied, our results authorise us to apply these analysis models within the Imagika® software to all THAs to follow their radiographic evolution and to possibly predict the clinical evolution.


The New Jersey Low Contact Stress prosthesis was introduced in 1977. LCS mobile bearing prostheses have been implanted in patients in the United States since 1985. The PCL-sacrificing rotating platform design of the LCS® prosthesis was designed to minimally constrain knee kinematics while minimising bone-cement-prosthesis interface stresses and polyethylene wear.

The purpose of the current study was to assess the in vivo rotating platform PE wear of the LCS-RP® and to check if the PE tray mobility is preserved over time.

We investigated 120 total knee replacements in 108 patients (38 men, 70 women) treated by the LCS-RP® prosthesis for osteoarthritis or rheumatoid arthritis. Average age of the patients was 70.4 years (range: 36–81). Average follow-up was 15.3 years (range: 10–18).

PE wear assessment was performed using a specific analysis model created in the Imagika® software on AP radiographs.

Rotating platform mobility was assessed thanks to another analysis model. We used prosthetic landmarks (tip of the prosthetic stem, tibial tray and tantalum markers embedded into the PE) visible on lateral radiographs.

Linear wear rates were 0.012+/−0.007 mm (tibial plate/ PE interface), 0.026+/−0.034 mm (PE/internal condyle interface) and 0.017+/−0.041 mm (PE/external condyle interface). There were no significant differences between wear values of both internal and external sides of the upper surface of the PE insert (P = 0.000054) and of tibial plate PE/external condyle PE interfaces (P = 0.0012), but a P value of 0.063 was observed between the tibial plate PE interface and the internal condyle PE interface.

The PE range of motion was 5.3 +/− 1.2° (range: −2.5 (external) to +3.2 (internal)) at last follow-up as compared to the first radiograph (3 months after operation). All trays preserved there mobility in rotation.

Annual PE wear rates were extremely low as well as at the lower and the upper surfaces of the mobile bearing. Our results suggest that the long term mobility conservation contributed to low PE wear rates despite a high anatomic congruency due to the prosthetic design.


Spondylolysis can be associated with severe back or leg pain requiring surgical management.

Fusion is the most often performed procedure since disk degeneration is frequently present. In a limited number of cases, when there is no disk disease or only limited dehydration, isthmic reconstruction may be considered, saving mobility and avoiding adjacent level stress.

We review 30 patients submitted to L4 or L5 posterior arch reconstruction and 60 patients submitted to a one level (L4L5 or L5S1) posterior or interbody fusion.

Through Prolo scores, SF36 and Oswestry questionnaires, the every day, professional and sports functional and satisfaction rates are evaluated.

Present data fail to show better functional results in the isthmic reconstruction group. However, even longer follow up will be necessary in these groups of young adults with a great life expectancy to show potentially less degenerative deterioration in adjacent levels. Meanwhile, isthmic reconstruction proved to be an effective technique, comparable to fusion in patients with no associated disk disease, with no need for further surgery and minimal complications.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_I | Pages 32 - 32
1 Jan 2004
Galois L Etienne S Grossin L Cournil C Netter P Minard D Gillet P
Full Access

Purpose: Section of the anterior cruciate ligament (ACL) is classically used to induce experimental joint degeneration in animal models (dog, rabbit, rat…), but the contribution of physical activity to the course of the cartilage damage observed in this model remains unknown. We studied the influence of moderate physical activity on the course of experimental knee joint degeneration induced by section of the ACL in the rat.

Material and methods: The right knee ACL was sectioned with and arthrotome in 60 male Wistar rats (180 g) under general anaesthesia. Full section of the ACL, performed with a fine lancet, was verified clinically by demonstrating anterior drawer. The non-operated knee served as a control. The rats were separated at random into two groups, with or without exercise. Exercise was calibrated on a treadmill running at constant speed (30 cm/s for 30 min, i.e. 15 km for 28 days). Rats were sacrificed on days 7, 14 and 28. Macroscopic inspection, histological analysis and immunohistochemistry tests (Caspase 3) were performed on each knee segment. NO was also assayed in the synovial fluid.

Results: No cartilage damage was observed in the non-operated knees after running 15 km. Marked synovitis was observed in the knees with a sectioned ACL starting on day 7, associated with fibrillary surface formations. The severity of the cartilage damage increased from day 14 to day 28, predominantly on the medial tibial plateau and to a lesser extent on the adjacent femoral condyle, in the weight-bearing zone. Damage was minimal on the patella. Chondrocyte apoptotic phenomena were also observed, reaching maximum on day 7 and sustained thereafter. Physical activity had a significant effect on these parameters showing an improvement in the macroscopic and histological lesions from day 14 to day 28, and improvement in chondrocyte apoptosis from day 7 to day 14 and to day 28.

Discussion: This novel work confirms the beneficial effect of moderate physical activity in an experimental joint degeneration rat model. Elsewhere, it has been well established experimentally that intense joint activity has a deleterious effect on chondral lesions after meniscectomy and/or section of the ACL. This unfavourable effect of intense physical activity has also been observed clinically in high-level athletes. Our experimental data suggest that moderate physical activity does not increase the risk of joint degeneration and could, under certain conditions, have a beneficial effect, as has been suggested by certain recent clinical data.