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Introduction: The scarf osteotomy is a reliable surgical technique for treating hallux valgus. The aim of our study was to analyze the occurrence of transfer metatarsalgia after surgery on the first ray using a screwless Scarf osteotomy technique that we have been using in our department since 1995, which consists of stabilization by axial impaction without internal fixation. We hypothesized that the alleged shortening of the first metatarsal produced by this technique may be at the origin of postoperative metatarsalgia., Patients and Methods: This was a case series of first ray metatarsal screwless Scarf osteotomies reviewed in the medium term. We did a clinical and radiological review of all patients operated using this technique between 2012 and 2017 who did not meet the following exclusion criteria: procedure on the other lateral metatarsals, concurrent hindfoot pathology, incomplete medical records., Results: Of 114 feet, 96 were included in the study and 18 were excluded. The mean follow-up was 1 year and 8 months [1-4years]. The mean AOFAS score was 90.3 and 96% of patients were either satisfied or very satisfied with the outcome. All the parameters improved significantly: shoe wearing, pain, function, alignment. Fourteen feet had transfer metatarsalgia, which appeared during the first year postoperative (AOFAS 75/100). Ten other complications occurred: two Morton's neuromas, three cases of complex regional pain syndrome, one superficial infection, one paresthesia, two recurrences with surgical revision, one nonunion. No general complications were found. Based on radiographs, the mean M1 shortening was 3.3mm (6.3mm in metatarsalgia group versus 3.0 mm in the non-metatarsalgia group, P=0.2) and the mean angular correction was 16.2° (±6°)., Discussion: The overall results of screwless Scarf osteotomy are comparable and satisfactory, allowing large deformities to be corrected (28°±8° preoperatively in our cohort). M1 shortening and the transfer metatarsalgia rate appear to be higher than with other techniques., Conclusion: Screwless scarf osteotomy of M1 yields good functional and radiological outcomes in the medium term. However, it appears to cause more shortening and transfer metatarsalgia., Level of Evidence: IV Retrospective, non-interventional in current practice (Recommendation grade C, low level of scientific proof)., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Severe lower-limb trauma is a major event in a patient's life, and treatment is a challenge that has not been sufficiently studied. The main objective of the present study was to assess the difference in disability between amputees and patients who kept their leg after severe open lower-limb fracture., Hypothesis: The study hypothesis was that amputation allows better functional recovery and quality of life, in the same time-frame., Materials and Methods: All male and female patients aged over 18 years admitted to one of the trauma centers of Marseille (France) for major lower-limb trauma with Gustilo IIIb or IIIc fracture were included. Minimum follow-up was 2 years. Two groups were distinguished according to primary treatment: lower-limb salvage, or amputation. Rates of infection and of surgical revision, hospital stay, functional parameters (walking distance, standing, use of canes, running, jumping, driving, and physical and occupational activity) and quality of life (MOS SF-36 score) were compared between groups., Results: The conservative treatment group comprised 27 patients, and the amputation group 24. Rates of infection and of surgical revision and hospital stay were significantly lower in the amputation group (P<0.02). All functional parameters (except return to work) and overall quality of life were significantly better in the amputation group. There was no significant inter-group difference in MOS mental score., Conclusion: In severe lower-limb trauma, amputation seems to give better functional and quality-of-life results. It did not, however, improve return to work, and was not better accepted psychologically than long and complex conservative management., Level of Evidence: IV, retrospective study., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: Giant cell tumors (GCTs) make up 15 to 20% of bone-related tumors in adults. They are often found around the knee in the metaphysis and epiphysis area, contacting the joint cartilage. The aims of our study were to evaluate the presence of early knee osteoarthritis (OA) in patients with GCTs in the knee area treated by curettage-cement packing, and to evaluate whether replacing subchondral bone with acrylic cement has an effect on the functional outcomes and quality of life., Material and Methods: This was a retrospective study of all patients operated between 2000 and 2010 by the same specialized surgical team. Functional outcomes and quality of life were evaluated in each patient using the Knee Injury and Osteoarthritis Outcome (KOOS), the Musculoskeletal Tumor Society Score (MSTS) and the Short Form-36 (SF-36). The presence of OA was evaluated in a full radiological work-up comparing the operated knee with the healthy contralateral knee. Knee OA was defined as grade 3 or grade 4 radiographic findings based on the Kellgren and Lawrence classification, and a significant difference between the operated and contralateral knee., Results: Nineteen patients were included in this study. The average follow-up was 120 months (range 60-180). Four patients (21%) had radiographic KL-3 and one patient (5%) had KL-4. Eight patients (42%) had recurrence of the GCT. The distance between the tumor and cartilage, and the area of the subchondral bone invaded by the tumor appeared to contribute to OA progression., Discussion: Resection of GCTs around the knee by curettage-cement packing did not have an effect on development of OA. In the four patients who developed knee OA, the tumor was located less than 3mm from the joint cartilage and took up more than 90% of the epiphysis. Based on these observations, there seems to be a strong correlation between the development of knee OA and the small quantity of subchondral bone left after curettage. The functional outcomes and quality of life were similar no matter the knee OA grade in patients. Replacing subchondral bone by cement had no effect on quality of life in this study., Level of Evidence: IV (retrospective study)., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Myxoid liposarcomas (MLS) are the second most common type of liposarcoma. Although some MRI findings are distinctively characteristics of MLS, the diagnosis can be tricky in tumors with a large portion of round cells (RC). Known predictors of an unfavorable outcome include age, tumor size, high RC content and positive resection margins. The goal of this retrospective study was to define prognostic factors for recurrence, with special emphasis on the percentage of RCs and medical care provided in a non-specialized center., Patients and Methods: Twenty patients (11 women, 9 men) with a mean age of 44.3 years (18-73) were reviewed after a mean of 55.9 months. Six of these patients had been operated at a non-specialized center. The diagnostic MRI was read by a specialized radiologist and the resection procedures performed by two specialized surgeons. Tumors were labeled as either "pure myxoid liposarcoma" or "myxoid/round-cell liposarcoma". The local recurrence-free survival rate and mortality rate were calculated., Results: Fifteen patients had undergone an MRI during the initial assessment. The typical MRI findings of MLS were present in four of them. The MRI suggested a non-specific lesion in the other 11 patients. After correlation with pathology findings, these tumors contained more than 5% round cells. The fourteen patients treated at our facility had undergone a biopsy, while none of the ones treated outside did. Five patients had R0 resection margins and 15 had R1 margins. Prognostic factors for recurrence consisted of age, tumor size >10 cm, R1 resection margins, FNCLCC grade 2+R1 margins, medical care at a non-specialized center, and >5% round cells. There were eight local recurrences and three metastases (15%). Two patients died (90% overall survival rate)., Discussion: The risk of local recurrence was 3.86 times greater in this study when the tumor contained more than 5% RCs, which is consistent with published data. The MLS diagnosis was made only four times based on the initial MRI because misleading nature of high RC tumors. R1 resection margins are a risk factor for local recurrence. However, cases with R1 margins have a recurrence rate that is similar to R0 cases when the surgery is performed at a specialized cancer center. Treatment of MLS in a non-specialized center is a key negative prognostic factor. The reported rate of metastasis varies. Atypical extrapulmonary localizations are common, and often multifocal. MRI has been shown to be superior at detecting secondary lesions and some have suggested that a full-body MRI should be performed., Conclusion: Prognostic factors for the recurrence of myxoid liposarcomas have been identified. MRI analysis is not definitive and must be supplemented by a biopsy., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Management of extensive proximal femur bone loss secondary to tumor resection or major osteolysis remains controversial. The possible options include a composite allograft/stem prosthesis, a modular type megaprosthesis or a custom-made megaprosthesis. Modularity allows versatility at reconstruction and avoids the delay required manufacturing a custom-made implant. Hypothesis and type of study: A retrospective radiological and clinical study investigated whether a special reconstruction modular stem design (JVC IX) would provide medium term success in the treatment of severe proximal femur bone loss., Material and Methods: Between 1995 and 2005, 23 JVC IX hip replacements were performed for severe segmental proximal femur bone loss. Etiology was: 13 cases of tumor resection, eight of extensive osteolysis secondary to femoral implant loosening, and two traumatic situations. Follow-up was annual. Functional assessment used the Musculo-Skeletal Tumor Score (MSTS), and implant survival rates underwent Kaplan-Meier analysis, with surgical revision (to replace or remove the implant) as the end point., Results: All 23 patients (23 hips) were followed up for a mean 5.4 years (+/-3.7 yrs). Mean MSTS was 16.2 (max.=30). All stems demonstrated good fixation at radiological assessment, except for one case of probable loosening in contact with a metastatic osteolysis. Four implants had to be revised: two for non-controlled infection, one for tumor extension, and one for stem fatigue fracture. At 10 years' follow-up, implant survivorship was 81.5% (range: 62% to 100%)., Discussion: Severe proximal femur bone loss is a difficult situation to deal with, offering no ideal treatment option. Modular megaprostheses are salvage procedures. Their results at a mean 5.4 years' follow-up are encouraging, and appear comparable to the ones obtained with alternative solutions (composite allograft/stem prostheses)., Type of Study: Level IV retrospective, therapeutic study., (2009 Published by Elsevier Masson SAS.)

Background: Postoperative dislocation is the commonest complication following revision total hip arthroplasty (THA). HYPOTHESIS AND TYPE OF STUDY: Dual mobility cups are supposed to reduce the risk of THA instability. The present retrospective study tested this hypothesis on revision THAs and also, assessed this design contribution to acetabular fixation longevity., Materials and Methods: The series was homogeneous and continuous, comprising a total of 163 revision THAs: 110 of them were bipolar revisions and 53 were restricted to the acetabular component exchange. Mean patient age was 68.7 years (range: 34-92 years). Novae (SERF, Décines) dual mobility cups were used in all cases: 110 cementless cups were used and 53 cups were cemented in a Kerboull reinforcement ring due to severe acetabular bone loss., Results: Mean patients' follow-up (FU) was 60.4 + or - 17.6 months. There were six early dislocations (which were reduced without additional surgery and remained recurrence-free) and two cases of acetabular loosening. The total postoperative dislocation rate at the end of follow-up was 3.7% and the 7-year cup survivorship rate was 96.1% (95% CI: 92.8-99.2%). In revision for aseptic loosening, the instability rate was 2.9%; in the higher instability risk groups (i.e., revision for infection and or recurrent instability) the dislocation rate was respectively 9% and 0%., Discussion: Dual mobility cups provided a dislocation rate of only 3.7% in revision THA, comparable to the one reported with standard implants for primary THA. This kind of cup design is especially suited to deal with high instability risk revision cases, where constrained components are generally recommended. It can also be indicated in cases of aseptic loosening, where it resulted in a 2.9% dislocation rate and only two impending failures of fixation. In terms of mechanical failure rate, these numbers compare well to the ones pertaining to tripolar and constrained implants. These later alternatives remain possible options but are not fully efficient in terms of long-term stability and fixation longevity. LEVEL OF STUDY: Level IV, retrospective or records-based., (2009 Elsevier Masson SAS. All rights reserved.)