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Introduction: Osteoarticular infections (OAI) after prosthetic surgery have serious functional and economic consequences. Rapid tests for alpha-defensin (TAD) and leukocyte esterase (TLE) are two intra-articular markers involved in the diagnosis of OAIs. TLE cannot be applied in the presence of blood unless centrifugation is used, but the rate of "non-application" of the test for this reason is unknown in complex microbiological situations (discordant or negative puncture, ongoing antibiotic treatment). We therefore conducted a prospective study to determine: 1) the performance of the TAD and TLE rapid tests in diagnosing complex OAI, 2) the rate of non-application of the TLE due to hemarthrosis, and 3) the concordance between the two tests., Assumption: These two diagnostic tests had a negative predictive value (NPV) ≥ 90% for the diagnosis of complex OAI., Materials and Methods: A total of 79 suspected OAI patients with complex microbiological diagnoses were included between 2018 and 2023. They were 52 men (66%) for 27 women (34%), with a mean age of 66 ± 13.5 years. The hip (n = 41, 52%) and knee (n = 36, 46%) were the most represented, followed by the elbow (n = 1, 1%) and shoulder (n = 1, 1%). These patients were suspected of having an OAI that required joint puncture, but with a complex microbiological diagnosis due to discordant punctures (n = 21, 27%) or sterile punctures despite strong suspicion of infection (n = 50, 63%), or in case of ongoing antibiotic treatment (n = 8, 10%). All patients underwent joint fluid puncture followed by TAD (Synovasure™, Zimmer, Warsaw, IN, USA) and, when the macroscopic appearance of the sample allowed (clear fluid group), TLE (Multistix 8SG, Siemens Healthcare GmbH, Erlangen, Germany). The results of both tests were compared with Musculoskeletal Infection Society (MSIS) criteria., Results: Of the 79 patients included, 27 (34%) were considered infected according to the MSIS. In 30% of cases (n = 24), TLE was not feasible due to the presence of blood in the joint fluid. In the "clear fluid" group, the NPV was equal to 90% for both TAD (sensitivity 87%, specificity 88%) and TLE (sensitivity 87%, specificity 81%). The two parameters showed almost perfect agreement (κ = 0.927)., Conclusion: TAD and TLE are two rapid, reliable tests with near-perfect concordance and high NPV, even in situations of complex microbiological diagnosis. They are particularly useful for deciding on a therapeutic strategy for patients with complex OAI. The TLE cannot be used in 30% of cases due to hemarthrosis, but centrifugation can correct this defect., Level of Evidence: III; Prospective comparative diagnostic accuracy study., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: The GeneXpert® MRSA/SA SSTI test allows early detection of methicillin-resistant staphylococci in intraoperative samples of prosthetic joint infections (PJI) in order to stop early broad-spectrum antibiotics., Questions/purpose: (1) What is the rate of false-negative GeneXpert® MRSA/SA SSTI test results? (2) Does a false-negative GeneXpert® MRSA/SA SSTI test result increase the risk of treatment failure for the patient with a PJI? (3) What are the risk factors of a false-negative result?, Method: A retrospective study was carried out to compare all GeneXpert® assays to conventional cultures in prosthetic joint infections from April 1 st , 2012 to October 1 st , 2016. False-negative (FN) results (absence of methicillin-resistant staphylococci (MRS) with GeneXpert® test, but presence in the culture) were identified. We compared the rate of treatment failure between FN results and other test results and we established the risk factors of having a FN result., Results: Among the 612 GeneXpert® results, the rate of FN results was 3.6 % (22/612). We found a significant increase in treatment failures for prosthetic joint infection with a FN result with 14 treatment failures (14/22) compared to 198 treatment failures (198/590) in the other test results (OR, 2.1; 95 % CI, 1.3-3.4, p = 0.0019). Not considering suppressive antibiotics as a treatment failure, we found no significant difference in the rate of treatment failures between the false-negative tests and the other tests (OR, 1.36; 95 % CI, 0.66-2.81, p = 0.41). Tobacco use (OR, 3.8; 95 % CI, 1.4-10.3, p = 0.004), ASA classification (OR, 2,4; 95 % CI, 0.9-6.9, p = 0.064), history of infection in the joint (OR, 3.2; 95 % CI, 1.2-9.6, p = 0.007), chronic infections (OR, 3.2; 95 % CI, 0.8-17.5, p = 0.01) and polymicrobial infections (OR, 3.2; 95 % CI, 1.1-9.2, p < 0.0001) were risk factors for a FN result., Conclusion: GeneXpert® tests in prosthetic joint infections showed a low rate of FN results. An increased risk of treatment failures was observed in FN results only when long-term use of suppressive antibiotics was considered as treatment failure., Level of Evidence: III; Diagnostic retrospective case control study., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: The GeneXpert® MRSA/SA SSTI (Methicillin Resistant Staphylococcus aureus/S. aureus skin and soft tissue infection) PCR test allows early detection of methicillin resistance in staphylococci. This test was developed for skin infections and has been evaluated for prosthetic joint infections but, to our knowledge, has not been evaluated for hardware infections outside of arthroplasties. Furthermore, we conducted a retrospective study in patients with non-prosthetic osteosynthesis hardware aiming: (1) to identify the diagnostic values of the PCR test compared to conventional cultures and the resulting rate of appropriate antibiotic therapy; (2) to identify the rate of false negative (FN) results; (3) to identify and compare the rates of failure of infectious treatment (FN versus others); (4) to search for risk factors for FN of the PCR test., Hypothesis: The PCR test allowed early and appropriate targeting of antibiotic therapy., Material and Methods: The results of PCR tests and conventional cultures for osteoarticular infections of non-prosthetic hardware over four years (2012-2016) were compared to identify the diagnostic values of using the results of conventional culture as a reference and the rate of appropriate antibiotic therapies. Infectious management failures between the results of the FN group and the others were compared, and variables associated with a FN of the PCR test were identified., Results: The analysis of 419 PCR tests allowed us to establish a sensitivity of 42.86%, a specificity of 96.82%, a positive predictive value of 60% and a negative predictive value of 93.83%. Using the results of the PCR test for the targeting of postoperative antibiotic therapy, it was suitable for staphylococcal coverage in 90.94% (381/419). The rates of patients for whom infectious treatment failed were not significantly different between the FN group and the other patients (20.8% versus 17.7%, respectively; Hazard Ratio=1.12 (95%CI 0.47-2.69, p=0.79)). A skin opening during the initial trauma (p=0.005) and a polymicrobial infection were significantly associated with a risk of FN from the PCR test (p<0.001)., Conclusion: The PCR test makes it possible to reduce the duration of empirical broad-spectrum antibiotic therapy during the treatment of an infection of osteosynthesis hardware but causes a lack of antibiotic coverage in 9.06% of cases., Level of Evidence: III; diagnostic case control study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Several surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate., Hypothesis: Our hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases., Patients and Methods: Fifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications., Results: At a mean follow-up of 3 years (2-10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment., Conclusion: Due to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang., Level of Evidence: IV., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: In 2015, we described a capsule-thickening technique via an anterior approach for iliopsoas cup impingement. To our knowledge, medium-term results have not been reported. We therefore retrospectively analyzed all cases in the initial series and those since 2015, to assess this original technique over a longer follow-up: (1) to analyze complications, and (2) to assess functional outcome., Hypothesis: The study hypothesis was that this surgical solution has a success rate sufficient for it to be included in the therapeutic armamentarium for iliopsoas impingement., Material and Method: Fourteen patients were included. Nine plasties were in first line, 3 after tenotomy, and 2 after cup exchange. The anterior Hueter approach was used, visualizing anterior cup overhang, sometimes associated with penetration of the anterior capsule, and enabling capsule-thickening by a folded Vicryl™ mesh. Functional results were analyzed., Results: At a median 4years' follow-up (IQR: 2-5; range: 1-9), change over baseline in Oxford score was 7 points (p=0.004), median Medical Research Council thigh flexion strength score was 5 (IQR: 5-5), and 50% of patients (7/14) were satisfied or very satisfied. The major complications rate was 7% (1/14), for 1 irrigation of infected hematoma, cured without recurrence; there was also 1 minor case of injury to the lateral cutaneous nerve of the thigh. Forty-three percent of patients (6/14) exhibited a minimal clinically important difference (MCID) and 64% (9/14) a patient-acceptable symptom state (PASS). Median anatomic overhang on anatomic CT transverse slice was 7mm (IQR: 3-8; range: 0-13). Four patients underwent secondary acetabular component exchange; their median overhang was 7.5mm (IQR: 7-8) compared to 5mm (IQR: 2-8) for the other patients (p-value non-calculable)., Conclusion: This surgical option seems interesting when acetabular overhang is not too great, especially as it does not affect flexion strength., Level of Evidence: IV., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Susceptibility of delafloxacin on 199 osteoarticular levofloxacin-resistant staphylococci strains was reported in 49% and 1% using SSTI S. aureus breakpoint (0.25 mg/L) and general S. aureus breakpoint (0.016 mg/L) respectively. Fifty percents levofloxacin-resistant staphylococci showed resistance to delafloxacin using CA-SFM/EUCAST recommendations. Microbiological societies should define new breakpoints especially for CoNS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The threshold of a Leg Length Discrepancy (LLD) by clinical examination on a sheet or centimeter paper (CP) is not known precisely whether or not it concerns limbs equipped with a hip prosthesis. We therefore conducted a prospective in silico study in order to: (1) determine the reproducibility and sensitivity of the clinical measurement of the LLD in different ideal and "degraded" clinical situations, (2) determine the threshold from which the human eye is capable of detecting a length inequality in clinic, (3) to determine whether the use of a graduated support (centimeter paper) improves the clinical measurement threshold., Hypothesis: Our hypothesis was that clinical measurement on a centimeter support would improve clinical measurement accuracy., Material and Methods: This was an in silico study, the experiment was conducted on a mannequin. Different inequalities were created on a mannequin and photographed with a total of 30 inequalities from -22 to +22 mm on sheet or centimeter paper (CP). This was a multicenter study, with 40 different readers. We asked the readers to make a second measurement one month later. We evaluated the inter- and intra-observer reproducibility. The error rate at the threshold of 3 mm and 5 mm were calculated versus the gold standard. Finally, we determined at which thresholds respectively 75% and 95% of the measurements were correct., Results: A total of 4140 measurements were performed and compared to the gold standard. With a threshold of 75% accurate measurement, the LLD detection threshold was 2.8 mm on centimeter paper and 4.5 mm on sheet. With a threshold of 95% accurate measurement, the LLD detection threshold was 3.4 mm on centimeter paper and 5.2 mm on sheet. Interobserver agreement (assessed overall on the 40 observers by Krippendorff's generalized Kappa) was 0.86 (95% confidence interval (CI95%) = 0.79 to 0.92) on CP and 0.71 (CI95% = 0.63 to 0.79) on sheet. Intra-observer agreement assessed by the intraclass correlation coefficient among observers who made 2 measurements had a median value (IQR) of 0.96 (0.94 to 0.99) on CP and 0.90 (0.83 to 0.94) on sheet., Discussion: The clinical detection threshold on sheet at the patient's bed appears close to 5 mm. A more precise measurement is possible with graduated centimeter paper. A study in daily practice on patients in real situations would confirm our results., Level of Evidence: III; prospective diagnostic comparative in Silico study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: In revision total hip arthroplasty (THA), the advent of porous custom-made triflange acetabular implants with 3D scan planning offers a new perspective to improve implantation accuracy and anatomical restoration of the center of rotation (COR). This issue was investigated using CT-scan as the measurement tool, but in limited series (±10 cases) and without investigating the factors that may influence errors in positioning. Therefore we performed a retrospective study aiming to: (1) assess the placement accuracy of such implants with respect to the preoperative planning, (2) examine whether the volume of bone to be resected in order to apply the implant had an impact on this accuracy, (3) assess if errors in position at surgery had any influence on function, complications and survival., Hypothesis: Preoperative planning could be accurately reproduced when implanting porous custom-made acetabular implants, and that accuracy would decrease in proportion to the volume of bone to be resected METHOD: Twenty patients undergoing THA revision with porous custom-made acetabular implants were included in this single-center retrospective study. Mean follow-up was 17.9 months ± 9.4 [2-45.1]. Preoperative planning was performed using 3D scanographic modeling. A post-operative CT scan was performed to assess implantation accuracy in terms of orientation and COR restitution. Demographic data, Oxford scores, complications and survival were recorded., Results: Mean deviation from the preoperative planning in inclination, anteversion and rotation were 4.3 ° ± 2.5, 6.1 ° ± 4.7, and 7 ° ± 4.6, respectively. Restoration of the COR showed a mean deviation of 2.1 ± 1.3 mm anteroposteriorly, 2.5 ± 2 mm mediolaterally and 2.2 ± 1.3 mm proximodistally. In total, 45% (9/20) of implants were positioned with perfect restoration of orientation (±10 °) and COR (±5 mm). The mean planned bone resection was 8.1 ± 4.9 cm 3 , with placement accuracy and COR restitution decreasing significantly when the volume of bone to be resected exceeded 2.7 cm 3 . One dislocation was found (5%, 1/20). Survival at last follow-up was 100%, the mean Oxford score at follow-up was 31.7 ± 7.9 [16-52], without being influenced by errors in position or COR restitution., Conclusion: In total 45% of the implants restored an orientation and a COR as planned, particularly when the volume of bone to be resected is less than 2.7 cm3. Although these are complex cases with large amounts of bone loss, 3D manufacturing could give us hope of greater precision. The link between better precision and low bone resection volume could be an area to develop with the manufacturer in order to improve results., Level of Evidence: III; diagnostic using CT in transversal retrospective study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Context: To assess the effect of a surgical procedure on a patient, it is conventional to use clinical scores before and after the procedure, but it is increasingly common and recommended to weight the results of these scores with the notion of minimal clinically important difference ("MCID"). This MCID should be determined using either the data distribution method based on score variation, or the anchor method, which uses an external question to categorize the results. MCIDs vary from one population to another, and to our knowledge there has been no investigation in France for total knee arthroplasties (TKAs). We therefore conducted a prospective study on a population of TKAs in order to: 1) Define MCID in France on a population of TKAs for the Oxford score, KOOS (Knee injury and Osteoarthritis Outcome Score) and its derivatives, 2) Determine whether MCID for these scores in France is comparable to results in the literature., Hypothesis: Is the MCID for total knee arthroplasty in France comparable to other results in the literature?, Material and Method: This was a prospective observational study in which 218 patients (85 men, 133 women) with a mean age of 72 years [27-90] who had undergone a primary TKA out of 300 initially included responded, before and after surgery, to the Oxford-12, KOOS and Forgotten Joint Score (FJS) questions (mean follow-up 24 months). MCID was calculated using the distribution method as well as the anchor method ("improvement 1 to 5" and "improvement yes or no")., Results: At a mean follow-up of 24 months [18-36], the Oxford-12 score increased from 16 ± 8 [0-41] to 34 ± 11 [6-48] (p < 0.001), all components of the KOOS score were improved and the FJS at follow-up was 47 ± 32 [0-100]. For the anchor "improvement 1 to 5", there were 14 unimproved patients, 23 patients in identical condition and 179 patients improved by surgery. For the anchor "are you improved yes/no", there were 8 unimproved patients, 22 in identical condition and 187 surgically-improved patients. The mean MCID for all methods (anchor method and distribution) was 10 [7-13] for Oxford-12, 12 [12-12] for KOOS Symptom, 14 [12-17] for KOOS Pain, 12 [11-14] for KOOS Function, 14 [12-16] for KOOS Sport, 15 [15-16] for KOOS Quality of Life (QOL), 11 [10-12] for KOOS 12, 15 [12-18] for KOOS 12 Pa in. 12 [12-13] for KOOS 12 Function, 15 [15-15] for KOOS 12 QOL, 14 [13-14] for KOOS Physical Function Short-form (PS) and 14 [13-16] for KOOS Joint Replacement (JR)., Discussion: The MCID for the Oxford-12, KOOS and its derivatives scores in a French population is comparable to that observed in other populations in the literature., Level of Evidence: IV; prospective study without control group., (Copyright © 2024. Published by Elsevier Masson SAS.)

Implant-related infections may need suppressive antibiotic therapy (SAT). We describe a SAT strategy using dalbavancin with therapeutic drug monitoring (TDM). This is a retrospective bicentric study of patients with implant-related infection who received dalbavancin SAT between January 2021 and September 2023. Fifteen patients were included. Median number of injections was 4 (IQR: 2-7). Median time between two reinjections was 57 days (IQR 28-82). Dalbavancin plasma concentrations were above 4 mg/L for 97.9% of dosages (93/95) and above 8 mg/L for 85% (81/95). These results support the use of dalbavancin SAT for implant-related infections., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The use of a sliding prosthesis in total knee arthroplasty (TKA) with increased stress is an intermediate solution in primary surgery, between posteriorly stabilized prostheses and hinged prostheses, in cases of ligamentous laxity and/or loss of bone substance. Favorable results have been reported in the medium term but to our knowledge, this type of prosthesis has not been evaluated in Europe beyond 10 years of follow-up. We therefore conducted a retrospective study in order to carry out: 1) the study of the survival of the Legacy Constrained Condylar Knee (LCCK™) prosthesis in primary surgery, 2) the analysis of complications, functional scores and radiographic data, 3) the analysis of the link between the diaphyseal filling rate and prosthetic loosening., Hypothesis: The LCCK™ sliding prosthesis with increased constraint has equivalent long-term survival and clinical results to standard posteriorly stabilized TKA and superior to hinged TKA., Material and Method: A retrospective series of 141 LCCK™ implanted in 134 patients between 1997 and 2010 was analyzed. Survival was assessed with censoring through an evaluation of partial or total revision of the implants. The functional results were evaluated using the IKS and Oxford 12 scores. Data regarding the Canal Fill Ratio (CFR) and the presence of pathological periprosthetic lines were also collected., Results: The average follow-up was 11.3±5.3years with a maximum follow-up of 22.7years. Survival at 20years was 90.8% [95% CI: 83.7-95.7]. The rate of early complications was 13.5% (19/141), predominantly comprised of venous thrombosis (6/141), hematomas (3/141 including two requiring surgical drainage), stiffness (3/141) and early infections (3/141). The rate of late complications was 17% (24/141), led by stiffness (4.4%; 6/141), infections (2.9%; 4/141) and hardware failure (2. 2%; 3/141). Ten of the 141 patients (7.1%) had LCCK failure, including 3 (2.1%) for stiffness, 3 (2.1%) for hardware failure, 2 (1.4%) for infection, 1 (0.7%) for laxity and 1 (0.7%) for a periprosthetic fracture. No aseptic loosening was found. The total IKS score went from 65 [0-116] to 143 [79-200] at follow-up, the IKS knee score went from 30 [0-66] to 85 [44-100], and the IKS function score went from 35 [0-70] to 57 [0-100]. The Oxford score went from 14 [2-25] to 34 [15-48] at follow-up. Only two patients (1.4%) presented with a partial periprosthetic line. The tibial CFR was 0.81 and the femoral CFR was 0.76. The influence of the CFR could not be analyzed due to the absence of loosening., Discussion: The LCCK™ prosthesis in primary surgery has good medium-term survival, a significant improvement in functional scores and a complication rate comparable to posteriorly stabilized prostheses. The complication rate is lower than that of hinged prostheses., Level of Evidence: IV; single-center retrospective study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Aims: Mechanical impingement of the iliopsoas (IP) tendon accounts for 2% to 6% of persistent postoperative pain after total hip arthroplasty (THA). The most common initiator is anterior acetabular component protrusion, where the anterior margin is not covered by anterior acetabular wall. A CT scan can be used to identify and measure this overhang; however, no threshold exists for determining symptomatic anterior IP impingement due to overhang. A case-control study was conducted in which CT scan measurements were used to define a threshold that differentiates patients with IP impingement from asymptomatic patients after THA., Methods: We analyzed the CT scans of 622 patients (758 THAs) between May 2011 and May 2020. From this population, we identified 136 patients with symptoms suggestive of IP impingement. Among them, six were subsequently excluded: three because the diagnosis was refuted intraoperatively, and three because they had another obvious cause of impingement, leaving 130 hips (130 patients) in the study (impingement) group. They were matched to a control group of 138 asymptomatic hips (138 patients) after THA. The anterior acetabular component overhang was measured on an axial CT slice based on anatomical landmarks (orthogonal to the pelvic axis)., Results: The impingement group had a median overhang of 8 mm (interquartile range (IQR) 5 to 11) versus 0 mm (IQR 0 to 4) for the control group (p < 0.001). Using receiver operating characteristic curves, an overhang threshold of 4 mm was best correlated with a diagnosis of impingement (sensitivity 79%, specificity 85%; positive predictive value 75%, negative predictive value 85%)., Conclusion: Pain after THA related to IP impingement can be reasonably linked to acetabular overhang if it exceeds 4 mm on a CT scan. Below this threshold, it seems logical to look for another cause of IP irritation or another reason for the pain after THA before concluding that impingement is present., Competing Interests: J. Girard reports consulting fees from Smith & Nephew, Corin, and Medacta, unrelated to this study. H. Migaud reports consulting fees from Zimmer Biomet, Corin, MSD, and SERF, and is the chief editor of Orthopaedics & Traumatology: Surgery & Research, unrelated to this study., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Background: Knowledge of the antibiotic susceptibility profiles of the bacteria responsible for osteoarticular infections is crucial for choosing the appropriate empirical antibiotic regimen. Wide use of broad spectrum antibiotics in these infections may have lead to selection of resistant bacteria. The aim of our study was to answer to these questions: (1) Did the bacterial pathogens isolated from osteoarticular infections (OAIs) and their antibiotic susceptibility profile change over the 10-year period in our University Hospital, particularly for Staphylococcus aureus and Coagulase negative staphylococci? (2) Are the antibiotics used for post-operative antibiotic therapy still effective against staphylococci involved in OAIs? (3) Are the antibiotics used for documented therapy still effective against staphylococci involved in OAIs?, Hypothesis: We hypothetise that bacterial epidemiology and antibiotic resistance rates have changed little thanks to a reasoned prescription of antibiotics in our Center., Materials and Methods: We performed a retrospective study describing the antibiotic susceptibility profile of bacteria isolated from osteoarticular infections over 10years in our University Hospital, with a focus on the Staphylococcus genus., Results: A total of 3474 staphylococci were included (2373 coagulase negative staphylococci and 1101 S. aureus), 34.8% (1207/3469) of which were resistant to methicillin. Antibiotic susceptibility profiles remained quite stable between 2010 and 2019, except for rifampicin (14.1% (45/318) versus 5.7% (23/401), p=0.0001) and fluoroquinolones (35.3% (109/309) versus 20.3% (81/399), p=0.000008) for which resistance rates significantly decreased even among methicillin-resistant strains., Discussion: In spite of wide use of antibiotics in orthopaedic units, overall resistance rates did not increase over the last 10years. The prescription of these molecules in combination regimens guided by the antibiotic susceptibility patterns performed on reliable samples and on the basis of multidisciplinary discussions may explain these results., Level of Evidence: IV, retrospective study., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: The use of artificial intelligence (AI) is soaring, and the launch of ChatGPT in November 2022 has accelerated this trend. This "chatbot" can generate complete scientific articles, with risk of plagiarism by mining existing data or downright fraud by fabricating studies with no real data at all. There are tools that detect AI in publications, but to our knowledge they have not been systematically assessed for publication in scientific journals. We therefore conducted a retrospective study on articles published in Orthopaedics & Traumatology: Surgery & Research (OTSR): firstly, to screen for AI-generated content before and after the publicized launch of ChatGPT; secondly, to assess whether AI was more often used in some countries than others to generate content; thirdly, to determine whether plagiarism rate correlated with AI-generation, and lastly, to determine whether elements other than text generation, and notably the translation procedure, could raise suspicion of AI use., Hypothesis: The rate of AI use increased after the publicized launch of ChatGPT v3.5 in November 2022., Material and Methods: In all, 425 articles published between February 2022 and September 2023 (221 before and 204 after November 1, 2022) underwent ZeroGPT assessment of the level of AI generation in the final English-language version (abstract and body of the article). Two scores were obtained: probability of AI generation, in six grades from Human to AI; and percentage AI generation. Plagiarism was assessed on the Ithenticate application at submission. Articles in French were assessed in their English-language version as translated by a human translator, with comparison to automatic translation by Google Translate and DeepL., Results: AI-generated text was detected mainly in Abstracts, with a 10.1% rate of AI or considerable AI generation, compared to only 1.9% for the body of the article and 5.6% for the total body+abstract. Analysis for before and after November 2022 found an increase in AI generation in body+abstract, from 10.30±15.95% (range, 0-100%) to 15.64±19.8% (range, 0-99.93) (p < 0.04; NS for abstracts alone). AI scores differed between types of article: 14.9% for original articles and 9.8% for reviews (p<0.01). The highest rates of probable AI generation were in articles from Japan, China, South America and English-speaking countries (p<0.0001). Plagiarism rates did not increase between the two study periods, and were unrelated to AI rates. On the other hand, when articles were classified as "suspected" of AI generation (plagiarism rate ≥ 20%) or "non-suspected" (rate<20%), the "similarity" score was higher in suspect articles: 25.7±13.23% (range, 10-69%) versus 16.28±10% (range, 0-79%) (p < 0.001). In the body of the article, use of translation software was associated with higher AI rates than with a human translator: 3.5±5% for human translators, versus 18±10% and 21.9±11% respectively for Google Translate and DeepL (p < 0.001)., Discussion: The present study revealed an increasing rate of AI use in articles published in OTSR. AI grades differed according to type of article and country of origin. Use of translation software increased the AI grade. In the long run, use of ChatGPT incurs a risk of plagiarism and scientific misconduct, and needs to be detected and signaled by a digital tag on any robot-generated text., Level of Evidence: III; case-control study., (Copyright © 2023. Published by Elsevier Masson SAS.)

Introduction: Unicompartmental knee arthroplasty (UKA) and valgus high tibial osteotomy (HTO) are two options for isolated medial femorotibial osteoarthritis in genu varum. In the absence of registries for osteotomies and for arthroplasty in the knee, epidemiological data are hard to obtain in France. We therefore performed a retrospective study, with the aims of: 1) estimating UKA and HTO survival without revision by total knee arthroplasty (TKA), and 2) assessing risk factors for revision according to treatment group., Hypothesis: Medium-term survival is better with HTO than UKA in under-70-year-olds., Materials and Method: All elderly patients undergoing HTO or UKA in the French National Hospitals Database for the period 2011-2020 were included: i.e., 108,007 patients; 43,537 HTO (29,330 male, 14,207 female; mean age 49.7 years, 95% CI 49.6-49.8) and 64,470 UKA (31,181 male, 33,289 female; mean age 60.5 years, 95% CI 60.5-60.6)., Results: Survival free of revision by TKA was 75.8% (95% CI=75.2-76.4) for UKA and 80.6% (95% CI=80.0-81.3) for HTO (p<0.00001). In UKA, revision risk factors comprised: low annual center volume (<17 UKAs per year) (HR=1.50; 95% CI=1.41-1.59), obesity (HR=1.25; 95% CI=1.18-1.32), and age <60years, with maximum risk for 50-59years (HR=2.41; 95% CI=1.83-3.16 in 50-59 year-olds). In HTO, revision risk factors comprised: obesity (HR=1.42; 95% CI=1.31-1.53), rheumatoid arthritis (HR=2.75; 95% CI=1.37-5.51), joint chondrocalcinosis (HR=2.01; 95% CI=1.18-3.39), and age >60years (HR=8.81; 95% CI=7.23-19.73 in 60-69-year-olds). Male gender was a protective factor against revision in both groups: UKA, HR=0.75 (95% CI=0.72-0.79); HTO, HR=0.73 (95% CI=0.69-0.77). The number of UKAs increased over the years, matching the increase in arthroplasty in France, with a decrease in HTOs until 2019., Conclusion: HTO showed better medium-term survival than UKA in under-70-year-olds in France. Even so, indications decreased in favor of UKA, although the respective risk factors differ. These findings suggest that conservative surgery still has a role, depending on osteoarthritis stage., Level of Evidence: III; retrospective comparative study., (Copyright © 2023. Published by Elsevier Masson SAS.)

Background: There is a paucity of data in the literature regarding negative articles concerning surgery in orthopedics and trauma. Knowledge pertaining to treatments or techniques which confer a beneficial effect remains important, as does knowledge regarding those which have a null or pejorative effect. Thus, this study was carried out on negative articles in order to: (1) determine their proportion in the ten predominant journals concerning orthopedic and trauma surgery; (2) assess variability in their publication rate depending on the journal and the year, and compare their citation rate to that of positive articles; (3) specify whether a positive article was more likely to be cited compared to a negative article; (4) carry out the same bibliometric analysis with the "Orthopedics & Traumatology: Surgery & Research (OTSR)" journal, and detect possible selection bias for negative articles during the review., Hypothesis: There are fewer negative articles than positive articles in the literature relating to orthopedic and trauma surgery., Material and Method: The study was carried out using the ten orthopedic and trauma surgery journals with the highest impact factors for the year 2021. Two periods were compared, 2009-2010 and 2019-2020. Among the 17,812 publications obtained, 11,962 publications were retained to carry out the analysis (technical notes, meta-analyses, editorials and letters to the editor were all excluded). An analysis using the same method was carried out on the 3,727 articles submitted to OTSR from 2015 to 2021, which made it possible to compare the rejected articles to the accepted articles., Results: Negative articles represented 11% (1,342/12,023) of the literature relating to orthopedic and trauma surgery. There were differences in the rate of publication of negative articles depending on the journals (from 4.04% to 17.14%) (p<0.0001). The negative article publication rate did not change between the two periods studied: 534/4963 articles (10.76%) in 2009-2010 versus 802/6999 (11.46%) in 2019-2020 (p=0.23). Positive articles were not cited more often than negative ones: no significant difference between the Category Normalized Citation Impact (CNCI) classes (respectively for classes 0;1[/[1;2[/≥ 2 with 45.66% 28.22% and 26.12% for negative articles versus 44.90% 27.46% and 27.64% for positive articles [p=0.4]) and the Top10% (with 18.86% for negative articles versus 20.10% for positive ones [p=0.28]). The OTSR journal had a rate of negative articles of 9.46% which was within the average range of the journals studied. A selection bias (p<0.02) for negative articles during the review of the OTSR journal was identified with fewer negative articles accepted (115/1216 [9.46%]) than positive articles (164/1330 [12.33%])., Discussion: The publication of negative articles varies according to the journals and although it is modest, at only 11%, it is essential because it allows us not to repeat errors but also not to bias the carrying out of meta-analyses, and among other things to avoid useless studies., Level of Evidence: III; case control study from the literature., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: A considerable number of patients are not satisfied after total knee replacement (TKR) because of persistent pain. This pain can also be neuropathic in origin. Both types of pain have a large impact on function and quality of life. Furthermore, the trajectory of anxiety and depressive symptoms and pain catastrophizing has rarely been studied after TKR surgery. The primary objective of this study was to define the trajectory of knee pain after primary TKR. The secondary objectives were to evaluate how neuropathic pain, anxiety and depressive symptoms and pain catastrophizing change over time., Methods: This prospective, single-center study included patients who underwent primary TKR for primary osteoarthritis between July 2011 and December 2012. Personal data (age, sex, body mass index, knee history, operated side, surgical approach, type of implant, operative time, and rehabilitation course) and the responses to seven questionnaires (Numerical pain rating scale, DN4-interview for neuropathic pain, Oxford Knee Scale, Hospital and Anxiety Depression Scale, Beck Depression Inventory, Patient Catastrophizing Scale and Brief Pain Inventory) were determined preoperatively, at 6 months postoperative and at a mean follow-up of 7.5 years., Results: Preoperatively, 129 patients (35 men, 94 women) filled out all the questionnaires. Subsequently, 32 patients were excluded because of incomplete responses at 6 months postoperative, 6 were excluded because they had undergone revision surgery, 11 patients were lost to follow-up and 5 patients had died. In the end, 65 patients were available for analysis (50% of the initial cohort) who were 74 years old on average at inclusion. Between the preoperative period and 6 months postoperative, pain (p<0.001), function (p<0.001), anxiety symptoms (p<0.001) and catastrophizing (p<0.001) had improved. Depressive symptoms did not change (p=0.63). Between 6 months postoperative and the latest follow-up, none of the parameters changed further (p>0.05). Of the 65 patients analyzed, 21% had chronic pain of undefined origin at 6 months postoperative and 26% had chronic pain at the end of follow-up, with 50% also having neuropathic pain. Preoperatively, 40% of the 65 patients had neuropathic pain, 30% at 6 months (p=0.27) and 18% at 7.5 years after TKR (p=0.01)., Conclusion: The number of patients who have chronic pain after TKR is considerable, especially since knee pain stabilized at 6 months postoperative. Early detection is vital to prevent the pain from becoming chronic, which makes it more difficult to treat. Half the patients with persistent pain also had neuropathic pain, which should be detected before surgery so the patients can be referred to a specialized pain management center. The presence of anxiety and depressive symptoms and pain catastrophizing is not a contraindication to TKR, but these patients should be referred to specialists for treatment before surgery., Level of Evidence: IV, prospective cohort study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: The relationship between the occurrence of a periprosthetic hip or knee joint infection, a post-surgical hematoma and the time to surgical revision, along with the need to take samples for microbiology analysis has not been clearly defined. This led us to perform a retrospective study to: 1) define the rate of infected hematoma and subsequent infection after surgical revision for hematoma and 2) analyze in which time frame the hematoma was likely to be infected., Hypothesis: The more time elapsed before the postoperative hematoma is drained surgically after hip or knee replacement, the higher the hematoma infection rate and the late infection rate., Patients and Methods: Between 2013 and 2021, 78 patients (48 hip and 30 knee replacements) who had a postoperative hematoma without signs of infection upon draining were included in the study. Surgeons decided whether samples for microbiology were collected (33/78 patients (42%)). The data compiled consisted of the patient's demographics, the risk factors for infection, number of infected hematomas, number of subsequent infections at a minimum follow-up of 2 years, and the time to revision surgery (lavage)., Results: Of the 27 samples collected from the hematoma during the first lavage, 12/27 (44%) were infected. Of the 51 that did not have samples collected initially, 6/51 (12%) had them collected during the second lavage; 5 were infected and 1 was sterile. Overall, 17/78 (22%) of the hematomas were infected. Conversely, there were no late infections at a mean follow-up of 3.8 years (min 2, max 8) after the hematoma was drained in any of the 78 patients. The median time to revision was 4 days (Q1=2, Q3=14) for non-infected hematomas that were drained surgically versus 15 days (Q1=9, Q3=20) for hematomas that were found to be infected (p=0.005). No hematoma was infected when it was drained surgically within 72hours post-arthroplasty (0/19 (0%)). The infection rate went up to 2/16 (12.5%) when it was drained 3 to 5 days later and 15/43 (35%) when it was drained after more than 5 days (p=0.005). We believe this justifies collecting microbiology samples immediately when the hematoma is drained more than 72hours after the joint replacement procedure. Diabetes was more prevalent in patients who had an infected hematoma (8/17 [47%] versus 7/61 [11.5%], p=0.005). The infection was due to a single bacterium in 65% of cases (11/17); S. epidermidis was found in 59% (10/17) of infections., Conclusion: The occurrence of a hematoma after hip or knee replacement that requires surgical revision is associated with increased risk of infection, since the hematoma infection rate was 22%. Since hematomas drained within 72hours are less likely to be infected, samples do not need to be collected for microbiology at that time. Conversely, any hematomas being drained surgically beyond this time point should be considered as infected, thus microbiology samples should be collected, and empirical postoperative antibiotic therapy initiated. Early revision may prevent the occurrence of late infections. The standard treatment of infected hematomas appears to resolve the infection at a minimum follow-up of 2 years., Level of Evidence: Level IV Retrospective study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

In 2005 and 2011, we reported results for a comparative study of two types of 28-mm bearing (metal-on-metal (MoM) and ceramic-on-polyethylene (CoP) in active patients with respectively 5 and 12 years' follow-up. The present report is an update at a mean 20 years' follow-up, addressing 2 issues: (1) implant survival at a mean 20 years; and (2) long-term complications with the metal-on-metal bearing. Twenty-eight millimeters MoM bearings show good survival at 20 years in young active subjects. Two groups of cementless hip prostheses were compared: Metasul™ 28mm MoM versus 28mm CoP. The MoM group comprised 30 patients (39 hips), with a mean age of 40±6.7 years [range, 22.6-49 years], and the CoP group comprised 32 patients (39 hips), with a mean age of 40.5±8.7 years [range, 15-50 years]. The groups were matched in 2005 for age, activity level and preoperative Harris score. At a mean 20±5.3 years' follow-up [range, 5-23 years], in the MoM group 2 hips (5%) showed limited non-progressive acetabular osteolysis, not requiring revision surgery; in the CoP group, there were 21 revision procedures (54%), including 15 for polyethylene wear. In the MoM group, the median total blood cobalt concentration was 1.03g/L [range, 0.3-3.5] and the median chromium concentration was 1.07g/L [range, 0.3-3.2]. Twenty-year all-cause survival was 100% in the MoM group, and 46% (95% CI, 37-59%) in the CoP group (p<0.0001). At long-term follow-up, MoM implants showed better survival than CoP implants in a young active population. Level of evidence: III, matched case series., (Copyright © 2022. Published by Elsevier Masson SAS.)

Introduction: The ceramic-on-ceramic couple in total hip arthroplasties (THA) has the advantage of excellent wear resistance and the bioinert nature of its debris. Noise occurring from this friction torque is a common complication, the contributing factors of which are debated. The noise is caused by a lack of lubrication, due in most part to the positioning of the acetabular cup. The study of metal-on-metal couples identified that the calculation of the Contact Patch to Rim (CPR) distance provides information on lubrication defects and also that it is correlated with the wear of metal-on-metal implants. This CPR distance is not recognized to be correlated with the occurrence of noise for the ceramic-on-ceramic couple at a caliber ≤ 36mm. We therefore conducted a retrospective case-control study to assess: 1) The influence of the CPR distance on noise occurrence; 2) Whether other factors associated to noise occurrence exist?, Hypothesis: Our hypothesis was that a low CPR distance was correlated with noise occurrence., Method: This was a case-control study with 3 controls for each case, analyzing 21 THAs (21 patients) with noise compared to 63 THAs without noise (63 patients) matched for age, sex and body mass index. These patients were taken from a continuous retrospective series of 96 patients for 104 total hip arthroplasties (THA) with a single operator and 4 th generation Biolox Delta ceramic-on-ceramic single implant, performed between 2007 and 2012. The calculation of the CPR distance was then performed for both groups using measurements of inclination angles, anteversion angles, and implant data regarding the head/insert contact angle, head/insert diameter and clearance., Results: At the mean follow-up of 7.1 years±1.2 [5 to 9.6], the mean CPR distance was lower in the noise group 10mm±3.3 [3.8 to 16.4] than in the control group 14.8mm±4.3 [7.3 to 24.4] (p=0.0007). The mean inclination angle was higher in the noise group 45.1°±7.8 [31 to 62] than in the control group 41.2°±7.2 [26 to 56] (p=0.04). The occurrence of noise was independent of anteversion, head caliber, cup diameter, neck length and stem size, and stem type (standard or lateralized)., Conclusion: A low CPR distance was correlated with the occurrence of noises, similarly a steep inclination was correlated with the occurrence of noises., Level of Evidence: III; Retrospective case-control study., (Copyright © 2022. Published by Elsevier Masson SAS.)

Introduction: Total hip resurfacing arthroplasty (THRA) is an alternative to conventional total hip replacement (THR) in young patients with osteonecrosis of the femoral head. Series have been small, without criteria regarding extent of necrosis, thus vitiating results. We therefore conducted a retrospective assessment of THRA for small necrosis, to determine (1) implant survival, (2) functional scores, and (3) systemic chromium, cobalt and titanium ion concentrations., Hypothesis: The study hypothesis was that the revision rate is low, meeting the National Institute for Health and Care Excellence (NICE) criterion of<0.5% revision per year., Material and Method: A single-center single-surgeon retrospective study included 62 patients, for 73 RTHAs, with a mean age of 45.6years (range: 23-68years) presenting Ficat stage 3 or 4 osteonecrosis of the femoral head with<330° total Kerboul angle (frontal+lateral angles) on simple preoperative X-ray. Study data comprised implant survival and preoperative and last follow-up functional scores (Postel-Merle-d'Aubigné, Oxford-12, Harris, and Devane) and titanium, chromium and cobalt blood concentrations. Necrosis size was assessed on preoperative Kerboul angle., Results: At a median 8years' follow-up (IQR: 5.9-9.3years), implant survival was 98.6% (95% CI: 97.22-99.98%). Only 1 implant was exchanged, for femoral loosening. Three other patients underwent revision surgery: 2 cases of lavage for infection, and 1 muscle hernia repair. Postel-Merle-d'Aubigné, Oxford-12 and Harris functional scores and Devane activity scores were significantly improved at follow-up, by a median +5 (IQR: 5 to 7), -26 (IQR: -29 to -23), +55 (IQR: 49 to 61) and +1 (IQR: 1 to 2), respectively (all p<0.001). Ion concentrations at last follow-up for titanium, chromium and cobalt were respectively 4.0μg/L (range: 3.6-4.1), 1.1μg/L (range: 0.8-1.9) and 1.1μg/L (range: 0.6-1.8)., Conclusion: THRA is a useful option in the long-term for young patients with osteonecrosis with Kerboul angle<330°., Level of Evidence: IV, retrospective study., (Copyright © 2022. Published by Elsevier Masson SAS.)

Introduction: The management of prosthetic joint infection (PJI) has been widely studied in the context of total hip arthroplasty (THA). However, the outcomes of debridement, antibiotics and implant retention (DAIR) for PJI have never been compared between hip resurfacing arthroplasty (HRA) and THA. This led us to carry out a retrospective case-control study comparing the surgical treatment of post-operative infections between HRA and THA to determine the infection remission rate and the medium-term functional outcomes., Methods: This single-centre case-control study analysed 3056 HRA cases of which 13 patients had a PJI treated by DAIR. These patients were age-matched with 15 infected THA hips treated by DAIR and modular component exchange (controls). Their survival (no recurrence of the infection) was compared and factors that could affect the success of the DAIR were explored: sex, body mass index, age at surgery, presence of haematoma, type of bacteria present and antibiotic therapy., Results: At a mean follow-up of five years (2-7), the infection control rate was significantly higher in the HRA group (100% [13/13]) than in the THA group (67% [10/15]) (p = 0.044). More patients in the THA group had undergone early DAIR (< 30 days) (73% [11/15]) than in the HRA group (54% [7/13]). There was no significant difference between the two groups in the ASA score, presence of comorbidities, body mass index and duration of the initial arthroplasty procedure. At the review, the Oxford-12 score of 17/60 (12-28) was better in the HRA group than the score of 25/60 (12-40) in the THA group (p = 0.004)., Conclusion: DAIR, no matter the time frame, is a viable therapeutic option for infection control after HRA., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Background: Tibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off., Hypothesis: Postoperative lift-off is a rare event that is predictive of laxity., Methods: We carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014., Results: The frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12-49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes., Discussion: Immediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years' follow-up; however, a long-term assessment is required to verify this finding., Level of Evidence: III - case-control study., (Copyright © 2022. Published by Elsevier Masson SAS.)

Introduction: Total hip arthroplasty (THA) in young adults, especially in those with hip dysplasia, is affected by wear and acetabular fixation problems. Shelf acetabuloplasty is performed to delay THA in patients with acetabular dysplasia. Thus, we conducted a retrospective, continuous case-control study at a single healthcare facility to analyze (1) the influence of prior shelf acetabuloplasty on the survival of a subsequent THA and (2) the functional outcomes., Materials and Methods: We evaluated 105 patients (124 THA) who underwent THA due to hip dysplasia: 54 patients (61 THA) were included in the THA post-shelf acetabuloplasty group (case group) and 51 patients (63 THA) in the THA for dysplasia group (control group)., Results: At 15 years' follow-up, 89% of patients (95% CI: 84-91%) in the shelf group and 83% (95% CI: 81-90%) in the dysplasia group had not undergone surgical revision. This difference between groups was not statistically significant (p = 0.566). The functional outcomes were satisfactory in both groups; however, they were significantly better in the dysplasia group than in the shelf group based on the Merle d'Aubigne and Postel score (16.9 vs 16.0 min-max: 14-18 vs 3-18) (p = 0.01), Harris Hip score (90.0 vs 84.7, min-max: 62-100 vs 22-100) (p = 0.017), and the Oxford-12 (18/60 vs 21/60, min-max: 45-12 vs 51-12) (p = 0.04)., Conclusion: Shelf acetabuloplasty before THA does not negatively affect THA survivorship. The functional outcomes appear to be better in the hips that did not undergo shelf acetabuloplasty, although the results were good in both groups., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Introduction: Osteoarticular infections (OAIs) of native joints lead to cartilage damage which may require subsequent arthroplasty. There is no consensus on systematic intraoperative microbiological sampling when performing an arthroplasty on a native joint with a history of OAI. We carried out a retrospective study to: (1) identify the frequency of the persistence of the microorganism(s) involved during the initial, presumed cured OAI, when performing an arthroplasty for sequelae of osteoarthritis, (2) to find an association between the length of time between the OAI and arthroplasty, and the recurrence of bacterial infection, (3) to assess the influence of the presence of hardware on the risk of infectious recurrence., Hypothesis: Systematic sampling is justified during a subsequent arthroplasty after an OAI, even after a prolonged period., Material and Method: This single-center, retrospective descriptive study included all patients whose indication for arthroplasty resulted from osteoarthritis, osteitis or bacterial osteomyelitis of a native joint, or in the aftermath of an infection post osteosynthesis. All patients were considered to have recovered from the initial infection at the time of the arthroplasty. Between 2008 and 2019, 92 patients were included in the study, with an average age of 56.5years (range: 21-97years). OAI occurred at a mean age of 35years (range: 1-84years). The average time from OAI to implantation was 15years (range: 1-65years). The bacteria most frequently found in the initial OAI was Staphylococcus aureus, involved in 35.8% of cases (n=33/92)., Results: The intraoperative samples came back positive in 17% of cases (n=16/92), including 9 positive for the same bacteria as the OAI (56%, n=9/16). For these 16 cases, the time between the OAI and the arthroplasty was 1year for 5 patients, between 1 and 15years for 5 patients and greater than 15years for 6 patients. For 3 positive patients, the information on the initial microorganism was not known and 4 patients were positive for a bacterium different from the initial one. The time from the initial OAI to the arthroplasty was not associated with positive results (p=0.38). There was no significant difference between a positive culture at the time of arthroplasty and the initial type of OAI [native joint versus presence of hardware and/or open fracture (p=0.41)]., Conclusion: The results of this work suggest there is value in microbiological sampling when performing an arthroplasty on a previously infected joint, regardless of the duration of the infection., Level of Evidence: IV; retrospective study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Trochleoplasty is an effective patellar stabilization procedure; however, it is associated with a risk of complications that cannot be ignored. Prior systematic reviews on this topic did not include more recent studies reporting important outcomes, particularly the long-term results of lateral elevation trochleoplasty. This led us to carry out a new meta-analysis of the various trochleoplasty procedures to specify: (1) the recurrence rate of patellofemoral dislocation; (2) the complication rates and; (3) the clinical outcomes., Patients and Methods: Studies reporting complications and clinical outcomes of trochleoplasty, whether or not it was combined with other procedures for patellofemoral instability, were identified in the MEDLINE, Embase, Scopus, Cochrane Library, Web of Science databases and by searching the grey literature. The primary endpoint was the recurrence of patellofemoral dislocation while the secondary endpoints were objective patellofemoral instability without dislocation, stiffness, patellofemoral osteoarthritis, subsequent surgeries and various clinical outcome scores. The results were combined in a random-effects model (weighing factor: inverse variance) when the heterogeneity was less than 80%., Results: Twenty-eight studies were included: 5 featured lateral elevation trochleoplasty, 10 about the Dejour deepening trochleoplasty, 12 about the Bereiter deepening trochleoplasty and 1 about the recession wedge trochleoplasty. A total of 1000 trochleoplasty procedures were done in 890 patients who had a follow-up of 1 to 25 years. There were 24 cases of recurrent dislocation (24/994 [2.4%]; this outcome was not reported for 6 trochleoplasties). The Dejour deepening trochleoplasty was the most effective with only 1 recurrence in 349 knees (0.28%). For the other complications, residual patellar instability without dislocation occurred in 82 of 754 knees (8% [95% CI: 3-14%]), patellofemoral osteoarthritis in 117 of 431 knees (27%), stiffness in 59 of 642 knees (7% [95% CI: 3-12%]) and the need for subsequent surgery in 151 of 904 knees (17%)., Discussion: This study found a low recurrence rate for patellofemoral dislocation and residual instability. The incidence of stiffness, patellofemoral osteoarthritis and subsequent surgery remains high but differs greatly between studies. This meta-analysis showed a very large disparity between studies for most complications, which justifies the need for randomized and comparative studies to establish the role of trochleoplasty procedures in the treatment algorithm for patellar instability., Level of Evidence: IV; systematic review and meta-analysis., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: The optimal length of the intravenous antibiotic treatment of periprosthetic joint infections (PJIs) generally ranges from one to six weeks and is a matter of debate. Most antibiotics active against Gram-positive cocci (GPC) exhibit both high oral bioavailability and bone diffusion. Thus, early oral therapy may be a reasonable option in GPC-related PJIs., Methods: A 2 year before and after monocentric study that aimed to compare two antibiotic strategies. Empirical intravenous postoperative antibiotic treatment was followed by 7 to 10 days of intravenous targeted therapy ('before' group) or by full orally targeted antibiotic treatment ('after' group). The primary outcome was a treatment failure during follow-up., Results: A total of 93 patients were analysed, 43 and 50 in the before and the after groups, respectively. Both groups were comparable in terms of surgical procedures, comorbidities, microbiological documentation and infection site. Antibiotics prescribed to our patients had high oral bioavailability and bone diffusion with rifampicin/fluoroquinolone combinations being the most frequent antibiotic regimens. Both hospital stay and intravenous antibiotic treatment mean durations were shorter in the before group than in the after group [15.0 versus 11.0 days; (P < 0.01) and 13.0 versus 7.0 days; P < 0.001, respectively]. The remission rate assessed after at least a year of follow-up was comparable in the before and the after groups (hazard ratio = 0.70; 95% CI 0.30-1.58)., Conclusions: Full oral targeted antibiotic therapy using a drug regimen with high oral bioavailability and good bone diffusion is an option for the treatment of patients with GPC-related PJIs., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Patient-reported outcome measures such as the Oxford-12 Hip Score and Hip Disability and Osteoarthritis Outcome Score (HOOS) are used in daily orthopaedic practice to evaluate patients. Because different studies use different scores, it would be important to build conversion tables between scores (crosswalk) to compare the results of one study with those of another study. Various mapping methods can be used to develop crosswalk tables that convert Oxford-12 scores to the HOOS (and its derivatives, including the HOOS physical function short form, HOOS joint replacement, and HOOS-12) and vice versa. Although prior studies have investigated this issue, they are limited to short forms of the HOOS score. Consequently, they cannot be applied to hip preservation surgery and do not include quality-of-life items, whereas the Oxford-12 Hip Score is used for all hip evaluations., Questions/purposes: We prospectively studied the Oxford-12 and HOOS and its derivatives to (1) determine which version of the HOOS has the best mapping with the Oxford-12, (2) define the most-appropriate mapping method using selected indicators, and (3) generate crosswalk tables between these two patient-reported outcome measures., Methods: The study enrolled 500 adult patients before primary THA (59% men [294 of 500 patients]) with hip osteoarthritis or avascular necrosis of the femoral head who completed the HOOS and Oxford-12. Patients were recruited from January 2018 to September 2019 in a tertiary-care university hospital, and we included all primary THAs in patients older than 18 years with a BMI lower than 35 kg/m2 and greater than 18 kg/m2. After a minimum of 6 months of follow-up, 39% (195 of 500) of the patients were assessed using the same tools. To determine which version of the HOOS mapped best to the Oxford-12 and what the most-appropriate mapping method was, we used preoperative data from all 500 patients. Because there is no consensus on the method to establish crosswalk, various mapping methods (linear regression, tobit regression, and quantile regression) and equating methods (linear equating and equipercentile method) were applied along with cross-validation to determine which method was the most suitable and which form of the HOOS provided the best result according to different criteria (mean absolute error, r2, and Kolmogorov-Smirnov distance).To generate crosswalk tables, we created a conversion table (between the Oxford-12 and the HOOS form that was chosen after answering our first research question and the method chosen after answering our second question) using preoperative and postoperative data (n = 695). This table was meant to be simple to use and allows easy conversions from one scoring system to another., Results: The Oxford-12 and HOOS were strongly correlated (Pearson correlation coefficient range 0.586-0.842) for the HOOS subcategories and HOOS physical function, HOOS joint replacement, and HOOS-12. The correlation between the HOOS-12 and Oxford-12 was the strongest (r = 0.825). According to the three different criteria and five methods, the HOOS-12 was the best suited for mapping. The goal was to minimize the mean absolute error (perfect model = 0), have a Kolmogorov-Smirnov distance as close as possible to 0, and have the r2 as close as possible to 1. Regarding the most-suitable method for the crosswalk mapping (research question 2), the five methods generated similar results for the r2 (range 0.63-0.67) and mean absolute error (range 6-6.2). For the Kolmogorov-Smirnov distance, the equipercentile method was the best (Kolmogorov-Smirnov distance 0.04), with distance reduced by 43% relative to the regression methods (Kolmogorov-Smirnov distance 0.07). A graphical comparison of the predicted and observed scores showed that the equipercentile method provided perfect superposition of predicted and observed values after mapping. Finally, crosswalk tables were produced between the HOOS-12 and Oxford-12., Conclusion: The HOOS-12 is the most complete and suitable form of the HOOS for mapping with the Oxford-12, while the equipercentile method is the most suitable for predicting values after mapping. This study provides clinicians with a reliable tool to crosswalk between these scores not only for joint arthroplasty but also for all types of hip surgeries while also assessing quality of life. Our findings should be confirmed in additional studies., Clinical Relevance: The resulting crosswalk tables can be used in meta-analyses, systematic reviews, or clinical practice to compare clinical studies that did not include both outcome scores. In addition, with these tools, the clinician can collect only one score while still being able to compare his or her results with those obtained in other databases and registries, and to add his or her results to other databases and joint registries., Competing Interests: Each author certifies that neither he nor she, nor any members of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)

Introduction: In cases of repeated treatment failure of periprosthetic joint infections (PJI) of the knee, above-the-knee amputation (AKA) or knee arthrodesis can be proposed to reduce the risk of recurrent infection, especially in cases with major bone defects or irreparable damage to the extensor mechanism of the knee. Since AKA versus knee arthrodesis results have been rarely assessed for these indications, we conducted a retrospective case-control study to compare both the rates of recurrent infection and functional outcomes. Hypothesis Patients who underwent AKA had fewer recurrent infections than those who had arthrodesis., Materials and Methods: Twenty patients who underwent AKA and 23 patients who had knee arthrodesis, between 2003 and 2019, were retrospectively included in this study. These two groups were comparable in age (73.8 versus 77.7 years (p=.31)) and sex (10 women and 10 men versus 16 women and seven men (p=.19)). Each group was analyzed individually and then compared in terms of survival (recurrent infection) and functional outcomes using clinical assessment scores (visual analog scale (VAS), French neuropathic pain questionnaire (DN4), Parker and Palmer mobility score and the 36-item short-form survey (SF-36))., Results: The rate of recurrent infection was 10% (two out of 20 patients) for the AKA group and 21.75% (five out of 23 patients) for the arthrodesis group (p=.69). The mean follow-up for the AKA group was 4.18 years (1.2-11.8) and 9.7 years (1.1-14.33) for the arthrodesis group (p=.002). The number of previous revisions (three (1.5-4) for AKA and two (2-3) for arthrodesis) and the time between the primary arthroplasty and surgical procedure were significantly greater in the AKA group (48.0 (12.0-102.0) months) than the arthrodesis group (48.0 (24.0-87.0) months) (p<001). The AKA group had significantly better clinical results for VAS (2.7±2.2 vs. 3.1±3.3), DN4 (1.5±2.1 vs. 2.6±2.9), Parker and Palmer (5.2±1.7 vs. 4.6±1.4), and SF-36 (30.9±15.6 vs. 26.9±17.0) (p<001)., Conclusion: Above-the-knee amputation and knee arthrodesis showed no differences in the rate of recurrent sepsis. However, the comparison of the two groups demonstrated that patients who underwent an AKA had less pain, were more autonomous and had a better quality of life., Level of Evidence: III; retrospective case-control., (Copyright © 2021. Published by Elsevier Masson SAS.)

Background: Diagnosis of periprosthetic infection (PPI) is crucial for management of bone and joint infection. The preoperative gold-standard is joint aspiration, providing results after 2-14 days' culture, with non-negligible false negative rates due to the fragility of certain micro-organisms and/or prior antibiotic treatment. The Synovasure™ alpha-defensin lateral flow test (Zimmer, Warsaw, IN, USA) contributes within minutes to joint fluid diagnosis of almost all infectious agents, including in case of concomitant antibiotic therapy. Validity remains controversial, notably in complex microbiological situations: multi-operated patients, diagnostic doubt despite iterative sterile culture, long-course antibiotic therapy. We extended a prospective study reported in 2018, to determine whether the test maintained diagnostic value in a larger population, assessing 1) negative (NPV) and positive (PPV) predictive value, and 2) sensitivity and specificity., Hypothesis: Synovasure™ maintains NPV above 95% in a broader population of microbiologically complex suspected PPI., Material and Methods: Synovasure™'s performance was assessed between October 2015 and October 2019 in 106 patients (112 tests) in complex diagnostic situations: 37 discordant cultures (discordant findings between 2 samples), 65 cases with clinically or biologically suspected infection but iterative sterile culture, 10 emergencies (requiring surgery, precluding antibiotic window, or mechanical failure in suspected infection), including 5 with ongoing antibiotic therapy for infection in another organ. Six tests were repeated in the same patient and same joint at >6 months' interval for strong clinical suspicion of infection. The main endpoint was the MSIS score (MusculoSkeletal Infection Society, 2018)., Results: NPV was 98.8%, PPV 72.4%, sensitivity 95.5% and specificity 91%. Prevalence of infection was 19.6%. Only 1 of the 22 infected patients had negative Synovasure™ tests, compared to 81 of the 84 non-infected patients., Conclusion: Synovasure™ is a reliable novel diagnostic test, contributing mainly to ruling out infection thanks to its strong NPV. The cost imposes sparing use, but medico-economic assessment would be worthwhile., Level of Evidence: III; prospective of diagnostic performance., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: While joint aspiration is the benchmark for diagnosing periprosthetic joint infections (PJI), the results can be flawed because certain bacteria are difficult to culture, the patient is on concurrent antibiotic therapy or in some cases, repeated joint aspirations confer conflicting results. The BJI InoPlex™ (Diaxonhit) is a multiplex ELISA (Enzyme Linked Immunosorbent Assay) that measures the immune response (presence of specific IgG) to certain bacterial species from three families: Staphylococcus (8 antigens) epidermidis, aureus and lugdunensis, Streptococcus B (4 antigens) and Cutibacterium acnes (4 antigens). This assay is done with peripherally collected blood. However, there are few published studies about this assay, especially if the microbiological diagnosis is in doubt in cases of suspected chronic PJI. This led us to conduct a retrospective study in a French tertiary care center to determine 1) the sensitivity and specificity of the BJI InoPlex™, 2) its positive (PPV) and negative predictive value (NPV) and 3) what causes diagnostic errors., Hypothesis: The BJI InoPlex has a sensitivity/specificity and PPV/NPV above 75%., Materials and Methods: The BJI InoPlex was used 24 times on 24 patients between January 2016 and January 2017 in scenarios where the microbiological diagnosis was difficult: 1 with on-going antibiotic therapy, 13 conflicting repeat joint aspirations, 10 negative cultures with history of infection and/or clinical evidence of a PJI. The series consisted of 11 hip arthroplasty and 13 knee arthroplasty cases. The results of the BJI InoPlex test were compared to the MusculoSkeletal Infection Society (MSIS) the criteria for a joint infection., Results: For the bacterial species covered by the test, the sensitivity of the BJI InoPlex for diagnosing a chronic PJI based on the 2018 MSIS criteria was 50%, the specificity was 56%, the PPV was 36% and the NPV was 69%., Discussion: While innovative, minimally invasive, and rapid (results in a few hours), the BJI InoPlex does not provide an effective diagnosis of chronic PJI in complex microbiological situations. In this study, we used the test in the most difficult situations possible and on a small number of patients, which may explain why the results were not as good as in other studies. Its current performance and cost mean there is no role for it in our algorithm for treating patients with a suspected PJI, contrary to other biomarkers. Its spectrum must include other bacterial strains involved in chronic PJI. Knowledge of the specific infectious agent increases its diagnostic value, it could be used to monitor the outcome of a PJI, although other studies would be needed to support this use., Level of Evidence: IV-Retrospective diagnostic study., (Copyright © 2021. Published by Elsevier Masson SAS.)

Introduction: Knee arthrodesis utilizes an arthrodesis nail as a salvage technique for infected total knee arthroplasty (TKA), especially when the extensor mechanism is damaged, or the skin is compromised. This implant helps to minimize or prevent leg length discrepancy, while allowing immediate weight bearing without requiring bone fusion. However, there is a risk of infection. Surgical revisions were required in 19% of patients at 50 months' follow-up in our team's initial 31-patient case series. Since there is little long-term outcome data, we reviewed this same group of patients after a mean of 13 years to determine: (1) the implant's long-term survival, (2) the functional outcomes, (3) the microbiological changes in revision cases., Hypothesis: The long-term survival of knee arthrodesis using an arthrodesis nail for failed infected TKA is acceptable., Material and Methods: Thirty-one patients operated on between January 2005 and December 2008 were retrospectively included in the initial study. The functional outcomes consisted of pain on a visual analog scale (VAS), neuropathic pain (DN4) and the Oxford Knee Score. All surgical revisions were documented with repeat microbiology samples., Results: The median follow-up time was 13.1 years [11.5-13.5]. No mechanical failure (implant failure or aseptic loosening) was observed. Eight patients were re-operated on due to new infections. The nail had to be removed in five of these patients. None of the patients required an amputation. Among the eight patients who were re-operated on, only two (25%) had been re-operated on since the initial study and underwent a two-stage arthrodesis revision. At 10 years, the cumulative incidence of surgical revision at the knee was 26% [95% CI: 12%-43%] and 16% [95% CI: 5.7%-31%] for an implant change. Six (75%) of the re-operated patients had their revision within the first 72 months of the initial TKA, while 4 (50%) had it within the first 26 months. Among the 15 patients who were still alive, the median Oxford Knee Score was 17/48 [12-28]. At the final assessment, the median pain level was 0 [0-5], although 4 of the 10 analyzable patients (of the 15 living patients, 3 had a cognitive impairment and 2 refused to participate) had neuropathic pain and pain on VAS of 3/10. The microbiologic findings were the same during the surgical revision in five of the eight re-operated patients (62%); however, one patient who had a Staphylococcus aureus infection had acquired a resistance to methicillin. In one patient, only one of the two bacteria identified initially was still present (methicillin-susceptible Coagulase-negative staphylococci [CNS]) and while in two patients, the infectious agent changed completely (shift from Gram-negative bacilli to methicillin-susceptible CNS, and the opposite for the other patient)., Discussion: Knee arthrodesis with a custom modular intramedullary nail is a viable limb salvage option in failed infected TKA cases with long-term survival, and it is comparable to other arthrodesis techniques. In most cases, recurrence of the infection occurred in the short term (<72 months). Later recurrences of the infection (>72 months) were rarer and were found in only two of our patients (6%). There were no mechanical failures., Level of Evidence: IV; Retrospective cohort study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The genus Staphylococcus is the main causative agent of bone and joint infections (BJI) in which outcomes are impacted by both effective surgical and appropriate antimicrobial management. In this context, methicillin resistance (MR) detection is a microbiological challenge to optimize the anti-staphylococcal drug coverage and to secure the surgical procedure. During the last decade, molecular tools have been developed to rapidly detect bacterial-resistant strains in clinical samples. The GeneXpert MRSA/SA SSTI ® assay (Cepheid, Sunnyvale, CA, USA) is a real-time PCR method aimed at detecting methicillin-resistant Staphylococcus aureus (MRSA) in skin and soft tissues infections. In the literature, this test has been reported to be diverted from its original purpose to be evaluated in surgical samples. Within the current review, we update the GeneXpert MRSA/SA SSTI ® assay performance in staphylococcal species determination (i.e., S. aureus vs. coagulase-negative species) together with MR genotype detection, when performed in osteoarticular infections., Competing Interests: ES declares personal honoraria from Cepheid for speaker activity. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Titécat, Loïez, Demaeght, Leclerc, Martin, Dezèque, Migaud and Senneville.)

Background: The impact of surgery on the patient is classically assessed on pre- and post-treatment scores. However, it is increasingly recommended to rank these results according to the minimal clinically important difference (MCID), using either the data distribution method or the anchor method, latter consisting in an extra question specifically targeting the patient's improvement. MCIDs vary between populations and, to the best of our knowledge; there have been no investigations in France regarding this in the context of total hip replacement (THR). Therefore, we conducted a prospective study in a population with THR to determine: 1) whether MCID scores in France were comparable to those reported in the data from the international literature; 2) whether a general item taken from a different score could serve as an anchor; and 3) whether an item from the actual questionnaire itself could serve as an anchor., Hypothesis: When pre- and post-treatment scores are available, an item from the questionnaire itself can serve as an anchor for MCID., Material and Methods: In a prospective observational study, 123 primary THR patients (69 male, 54 female), out of 150 initially included, completed the 5 domains of the HOOS hip disability and osteoarthritis outcome score and the Oxford-12 questionnaire, preoperatively and at 6-12 months. The MCID was calculated via the distribution-based and the anchor-based methods. Two Oxford items (questions 1 and 2) and 2 HOOS items (questions S1 and Q4) were used as anchors, as well as a supplementary question on improvement and the Forgotten Joint Score (FJS)., Results: At a mean 10.12±1.2 months' follow-up [range, 6.5-11.9 months], the Oxford-12 score increased from 19±8 [3-35] to 40±10 [8-48] (p<0.001), all HOOS components demonstrated improvement, and the FJS at the final follow-up was 71±29 [0-100]. The general items (Oxford question 1 and HOOS question Q4) were more discriminating than the joint-specific items (Oxford question 2 and HOOS question S1). Based on results from the 3 anchors (improvement rated 1 to 5, Oxford question 1 and HOOS question Q4), 3 to 5 patients showed deterioration, 5 to 6 were unchanged, 30 to 40 were slightly improved, and 73 to 80 were improved by THR. The mean MCID on both distribution and anchor methods was 9 [5.5-12] for Oxford-12, 20 [12-27] for HOOS symptoms, 26 [10-36] for HOOS pain, 22 [11.5-28] for HOOS function, 26 [13-34] for HOOS sport and 22 [14-28] for HOOS quality of life., Discussion: The MCID for the Oxford-12 and HOOS scores in a French population was comparable to data from the past literature. Using a score item as an anchor to define improvement is possible, but only if a general item is used., Level of Evidence: IV; prospective study without control group., Clinical Trials Registration: NCT04057651., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: The HOOS and KOOS scoring questionnaires comprise respectively 40 and 42 items; a shorter 12-item version was recently developed, but remains to be validated in a French-speaking population. We therefore conducted a prospective study: 1) to determine whether the new 12-item versions in French are equivalent to the longer HOOS and KOOS versions, and 2) to validate the French-language HOOS-12 and KOOS-12 patient-reported outcome measures in a population of primary total hip and knee arthroplasty: validity, reliability, and responsiveness., Hypothesis: The change in language in a score already validated in its long version does not alter its properties in the short version., Material and Methods: One hundred patients (59 males, 41 females) undergoing primary total hip arthroplasty and 100 patients (43 males, 57 females) undergoing primary total knee arthroplasty were prospectively included. They filled out the original HOOS or KOOS questionnaires, their simplified versions (PS: Physical function Short form; JR: Joint Replacement) and the short HOOS-12 and KOOS-12 versions, and also the Oxford-12 score assessing the affected joint, preoperatively, then at 6-12 months., Results: The 100% response rate confirmed ease of use. There were no redundant items. There were strong correlations between the 12-item and longer versions (>0.9). The HOOS-12 and KOOS-12 scores were reliable and valid: 1) there were no ceiling or floor effects for pre- or postoperative KOOS-12 scores, although a ceiling effect was found for HOOS-12 postoperatively (20% of patients having maximum scores of 100); 2) internal consistency was confirmed, with Cronbach alpha>0.8; 3) external consistency between Oxford-12 and HOOS-12/KOOS-12 was excellent, with Pearson correlation coefficient>0.8. Sensitivity to pre-/postoperative change was confirmed, with effect size>0.8., Discussion: The present study confirmed the usefulness of this new 12-item form for HOOS and KOOS. Properties were identical between the French- and English-language versions, authorising everyday use of these simpler versions., Level of Evidence: IV; prospective study without control group., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Revision of total knee arthroplasty (TKA) requires preoperative assessment to identify the causes of failure. Multidetector computerised tomography (MDCT) is a commonly used imaging technique, but is sensitive to certain artifacts, such as metal implants, limiting its use. Cone-beam CT (CBCT) is a new technique dedicated to musculoskeletal imaging that is less sensitive to artifacts and could be utilised in knee implantation surgery. CBCT has not yet been validated for this indication, and we therefore undertook a retrospective assessment of MDCT versus CBCT, comparing: 1) image quality; 2) reproducibility of angle measurements; 3) effectiveness in screening for periprosthetic radiolucency and implant loosening; and 4) radiation dose., Hypothesis: This study hypothesised that CBCT provides better image quality, angle measurement reproducibility, and screening for radiolucency and implant loosening at lower doses of radiation than MDCT., Patients and Method: Between October 2017 and March 2018, 28 patients, with a mean age of 61±11.6 years [range, 45-85 years] underwent both MDCT and CBCT for pain following TKA. Two radiologists performed angle measurements on both devices: patellofemoral tilt (PFT), rotation angle of the femoral component (RAFC) and rotation angle of the tibial component (RATC). They also screened for pathological radiolucency and/or implant loosening, and assessed image quality at the various bone/implant interfaces. The mean CT dose index per examination was recorded., Results: Intraclass correlation coefficients for angles and radiolucency screening on MDCT and on CBCT were respectively good (0.73) and excellent (0.82) for PFT, borderline (0.28) and moderate (0.44) for RAFC, excellent (0.82) and excellent (0.96) for RATC, and moderate (0.45) and excellent (0.84) for radiolucency screening. The inter-observer kappa correlation coefficients for diagnosis of implant loosening and image quality assessment for MDCT and CBCT were respectively moderate (0.45) and excellent (0.93) for tibial loosening and low (0.19) and borderline (0.38) for femoral loosening. The mean image quality at the various interfaces for MDCT and CBCT was respectively 2.2/3 and 2.75/3 at the tibia/tibial implant interface, 1/3 and 2.3/3 at the trochlear region/femoral implant interface, 0.9/3 and 2/3 at the femoral condyle/femoral implant interface, and 1.25/3 and 2.1/3 at the patella/patellar medallion interface. The mean CT dose index was significantly lower, by a factor of 1.24, on CBCT (4.138 mGy) than MDCT (5.125 mGy) (p<00396)., Conclusion: The results of the present study revealed added value for CBCT in the etiological work-up for pain following a TKA. It was reliable and reproducible for the rotation measurement and diagnosis of implant loosening, due to enhanced image quality despite a lower radiation dose than conventional MDCT., Level of Evidence: III; retrospective comparative study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Hip arthroscopy is a surgical procedure that is becoming more and more prevalent in France. Even though indications are now well-established little is still known about patient outcomes. Therefore, the purpose of our retrospective study was to: (1) describe the circumstances in which hip arthroscopies are being performed; (2) study arthroscopy and arthroplasty reoperation rates; (3) assess the incidence of readmissions for complications., Hypothesis: Hip arthroscopy in France produced similar results to those observed in other countries., Materials and Methods: We conducted a cohort study from January 2008 to December 2014 in the French population using the national hospital discharge database called "Programme de médicalisation des systèmes d'information (PMSI)." We included all admissions that had a hip arthroscopy code and analyzed readmissions for conversion to hip arthroplasty, revision hip arthroscopy and complications (without being able to provide detailed descriptions). Risk factors associated with conversion, revision and readmission for complications were studied after performing a population analysis., Results: A total of 3,699 patients were included over a period of seven years. The mean age was 40 years, with women being significantly older (mean age of 43 years) than men (38 years) (p<0.05). The number of procedures increased from 240 in 2008 to 702 in 2014. Synovectomies (67.9%; 2514/3699) and surgical bone procedures (acetabuloplasty or femoroplasty) (47.3%; 1751/3699) were the main procedures performed during the primary arthroscopy. In total, 410 patients underwent a conversion to arthroplasty, 231 patients had a revision arthroscopy, and 126 patients suffered a complication. Five years after the index procedure, the conversion rate was 16.3%, revision rate was 8.2%, and readmission rate for a postoperative complication was 5%. The main risk factor associated with conversions was [Hazard ratio (HR) and 95% Confidence Index (CI)] an age between 40 and 79 years during the first arthroscopy [3.04 (2.40; 3.87) compared with the reference class of 25-39 years]. Patients between ages 16 to 24 years during the first arthroscopy (0.35 [0.20; 0.61] compared with the reference class of 25-39 years) had a decreased risk of conversion (HR and 95% CI). The main risk factors associated with revisions were: synovectomies [1.90 (1.34; 2.70)] and surgical bone procedures on the femoral neck and/or the acetabulum [1.82 (1.36; 2.4)]. The risk factor associated with complication-related readmissions was an age greater than 40 years [2.23 (1.43; 3.49)]., Conclusion: Unlike the international literature, our study population was largely male. The rates of revision (8.2% after five years) and conversion to arthroplasty (16.3% after five years) were relatively low and comparable to the different international studies. This procedure, which is not widely performed, is growing in popularity, has low morbidity and remains an interesting approach given the revision and conversion rates after five years. The implementation of specific coding for arthroscopic hip procedures and the pathologies to be treated seems warranted., Level of Evidence: IV; descriptive epidemiological study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Dual-mobility and constrained cups can stabilise most recurrent dislocations of total hip arthroplasty (THA), but may fail in case of hip abductor mechanism loss. For such complex situations, we developed an original artificial iliofemoral and ischiofemoral ligament reconstruction technique using a polyglactin 910 mesh (Vicryl ™) associated to repositioning of a Lefèvre constrained liner adapted to hip range of motion to prevent cam effects. The technique was implemented in 2 patients showing recurrent dislocation after THA, associating total femur replacement and cemented constrained liner in a metal reinforcement ring. In one of the 2 cases, the abductor mechanism had been entirely sacrificed. This simple and accessible salvage technique prevented recurrence of dislocation at 12 months' follow-up in these complex cases, previously subject to several episodes per year., (Copyright © 2020. Published by Elsevier Masson SAS.)

Background: We aimed to compare the long-term clinical outcomes, complications, and survival of 2 revision stems with different geometries, extents of coating, and distal-locking mechanisms., Methods: We retrospectively compared outcomes at a minimum of 7 years following revision THA using 2 proximally coated distal-locking stems: 98 Ultime first-generation (G1) and 116 Linea second-generation (G2) stems. Ten-year Kaplan-Meier survival was assessed considering stem re-revision for any reason and for aseptic reasons. At final follow-up, Harris Hip Score and Oxford Hip Score were collected, and any thigh pain or complications were noted., Results: Considering re-revision for any reason, survival was 69% for G1 stems and 91% for G2 stems. Considering re-revision for aseptic reasons, survival was 77% for G1 stems and 92% for G2 stems. Re-revisions were due to fracture of 6 G1 stems but no G2 stems. Complications that required reoperation without stem or cup removal occurred in 3 of the G1 stems and 1 of the G2 stems. Compared to the G1 stems, the G2 stems resulted in better Harris Hip Score (83 vs 71, P = .001), Oxford Hip Score (22 vs 27, P = .019), less thigh pain (4% vs 39%, P < .001), and fewer nonoperated complications (9% vs 15%)., Conclusion: The second-generation stem had significantly better survival and clinical outcomes than the first-generation stem. The differences in survival and clinical outcomes could be attributed to the larger coated surface of the G2 stem and to the fact that the G1 stem was originally intended as a temporary implant to be followed by de-escalation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and Hypothesis: The ability to participate in sports after hip arthroplasty is increasingly being requested by patients. The possibilities of participating in sports such as judo after hip arthroplasty have not been explored sufficiently even though these sports are associated with a high risk of loosening, dislocation or revision. The aim of this study was to evaluate the return to judo after hip resurfacing arthroplasty (HRA) in terms of time and level of practice in an expert population and to determine the surgical complication rate., Materials and Methods: This was a retrospective observational study of all licensed judo practitioners at an expert level (≥black belt 3rd Dan) who underwent HRA. Patients filled out a sport-specific questionnaire that captured their level of judo practice (international, national, regional, recreational), type of practice (teaching, technical recreational, competitive recreational), dan grade, weekly volume of practice and time elapsed after surgery before resuming judo. The features of the return to judo were analyzed (technical, ground, combat)., Results: Sixty-seven HRA were implanted in 60 patients: 11 were international judokas, 3 were national, 8 were regional and 38 were recreational. The case series consisted of 18 patients who were 3rd Dan, 18 were 4th Dan, 7 were 5th Dan, 5 were 6th Dan and 12 were 7th Dan. The average follow-up was 65.3 months (range 9.9-11.9). All the clinical scores pointed to clinically and statistically significant improvement. Of the 60 patients, 53 had resumed judo at the final assessment (90%) after a mean of 4 months (2-7) for technical judo, 6 months (3-10) for ground judo and 7 months (3-12) for combat judo. Of those who did not resume their judo practice, 3 patients voluntarily changed sports, 2 had psychological apprehension and 2 had residual groin pain. The weekly volume of practice preoperatively was 0.9hours (0-5) and postoperatively it reached 5hours (2-18) (P<0.001)., Conclusion: HRA in a population of high-level judokas allows for return to sport practice without short-term complications such as fracture, dislocation or loosening., Level of Evidence: III., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Femoroacetabular impingement is a frequent cause of hip pain, and can be managed by conservative surgery. Many studies assessed postoperative course, but none compared operative techniques within a given population. We therefore conducted a retrospective case-control study comparing the minimally invasive anterior Hueter approach versus arthroscopy, assessing difference in 1) functional gain and 2) complications and 3) analyzing the impact of labral or cartilage lesions on functional scores., Hypothesis: Clinical results do not differ between the mini-open and arthroscopic approach., Material and Method: Between 2007 and 2018, 91 hips in 84 patients were treated for femoroacetabular impingement: 69/91 (75.8%) cam effect, 6/91 pincer effect (6.6%) and 16/91 mixed (17.6%). Fifty-five were treated by arthroscopy and 36 by the Hueter mini-open approach. There were 20 female and 71 male hips. Mean age at surgery was 32 years (range, 17-55 years). Potential predictive factors comprised Nötzli alpha angle, labral/cartilage lesion and type of surgery., Results: Mean follow-up was 4.6 years (range, 1-16 years), with no loss to follow-up. The arthroscopy and Hueter groups showed no differences in functional improvement on Oxford-12 score (gain, -6.7±5.9 versus -6.2±8.1 (p=0.73), Postel Merle d'Aubigné (PMA) score (gain, 1.3±1 versus 1.1±0.9; p=0.41), operative time (75 versus 67min; p=0.16), or alpha angle correction (-10.9±12.9 versus -9.8±7.1; p=0.22). Complications did not differ: 1/55 severe complications after arthroscopy (1 definitive femoral nerve palsy) versus 4/36 non-severe complications after Hueter (3 cases of dysesthesia in the lateral cutaneous nerve of the thigh, 1 rectus femoris enthesopathy) (p=0.15). Labral lesions (37/91) did not affect clinical outcome: gain, 1.2±1 versus 1.3±0.9 on PMA (p=0.514) and -7.3±6 versus -6±7.3 on Oxford-12 (p=0.366). Cartilage lesions (27/91) were associated with poorer outcome on PMA (gain, 1±1.1 versus 1.3±0.9; p=002) but not on Oxford-12 (gain, -6.1±7.3 versus -6.7±6.6; p=0.288)., Conclusion: Impingement correction by the minimally invasive anterior Hueter approach gave clinical results comparable to those of hip arthroscopy in terms of Oxford and PMA scores, alpha angle correction, operative time and complications. Cartilage lesions were associated with poorer clinical results., Level of Evidence: III; retrospective case-control study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Clinicians have waited a long time for a 'universal' marker that may help them distinguish infected from non-infected total joint arthroplasties when doubts persist after using classical clinical and biological signs of infection. In recent years, synovial fluid biomarkers including leukocyte esterase, alpha-defensins, and CRP have shown promising results for the diagnosis of periprosthetic joint infections (PJIs)., Areas Covered: This review provides an overview of the rational and the use of the Synovasure® alpha-defensin tests in patients with a suspicion of PJI. Using a systematic investigation by keywords, we looked for all citations (and the citations to these citations) of the selected papers., Expert Opinion: The Synovasure® alpha-defensin tests demonstrate high potential for the diagnosis of PJIs. However, the data currently available also show that the universal marker of infection in the settings of PJIs is still to be discovered.