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Background: Several cutting guides including conventional, navigation, patient specific instrumentation (PSI) and robotic are currently used in unicompartmental knee arthroplasty (UKA). A network meta-analysis was conducted to compare the most widely used cutting guides regarding the improvement of radiological, functional outcomes and the rate of complications., Methods: Randomised controlled trials (RCTs) comparing UKA cutting guides were searched in electronic databases, major orthopaedics journals, and oral communications in major orthopaedics meetings, until May 1st, 2022. The primary outcomes were the rate of outliers for the tibial and femoral components in the frontal plane, KSS score and the complication rate., Results: Eighteen RCTs involving 1562 patients with 1564 UKA were included Regarding the prosthetic components' positions, we found a significant increase of the outliers rate using PSI for the femoral component, compared to robotic surgery (risk ratio 0.00 [95% CI 0.00 to 0.55]) and navigated surgery (risk ratio 305.1 [95% CI 1.50 to 1,27e + 07]). We didn't emphasize any difference regarding the tibial component's position, the KSS value at 24 months postoperatively, and the complication rate. Regarding secondary outcomes, robotics provided a better precision in bone cuts in the sagittal plane for the tibial component and the lower limb alignment. No other differences were observed., Conclusion: In the light of these results, the robot seems to be the most precise cutting instrument to perform UKA. However, this did not demonstrate any difference in functional or clinical outcome. The cost of this technology can be a major economic brake, especially in surgical centers that do not have an exclusive prosthetic activity. Further outcome and survivorship data is needed to recommend one cutting instrument over the other., 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 © 2023 Elsevier B.V. All rights reserved.)

Radiation-induced sarcoma is a long-term complication of radiation therapy. The most common secondary neoplasia is the undifferentiated pleomorphic sarcoma, which is usually described in the deep soft tissue of the trunk or extremities. Radiation-induced sarcomas have a poor prognosis. An early diagnosis and management are needed to improve the survival rate of such patients. We presently report a case of a radiation-induced undifferentiated pleomorphic sarcoma of the left gluteus maximus muscle, which developed 25 years after an initial diagnosis of aggressive fibromatosis and 21 years after a tumour recurrence. This case study illustrates the risk of developing a sarcoma in a radiation field and the need for long-term follow-up after radiation therapy. Unnecessary radiation therapy, in particular in the case of benign conditions in young patients, should be avoided., (Copyright © 2015 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Background: Patients receiving anti-platelet agents for secondary cardiovascular prevention frequently require non-cardiac surgery. A substantial proportion of these patients have their anti-platelet drug discontinued before operation; however, there is uncertainty about the impact of this practice. The aim of this study was to compare the effect of maintenance or interruption of aspirin before surgery, in terms of major thrombotic and bleeding events., Methods: Patients treated with anti-platelet agents for secondary prevention and undergoing intermediate- or high-risk non-cardiac surgery were included in this multicentre, randomized, placebo-controlled, trial. We substituted non-aspirin anti-platelets with aspirin (75 mg daily) or placebo starting 10 days before surgery. The primary outcome was a composite score evaluating both major thrombotic and bleeding adverse events occurring within the first 30 postoperative days weighted by their severity (weights were established a priori using a Delphi consensus process). Analyses followed the intention-to-treat principle., Results: We randomized 291 patients (n=145, aspirin group, and n=146, placebo group). The most frequent surgical procedures were orthopaedic surgery (52.2%), abdominal surgery (20.6%), and urologic surgery (15.5%). No significant difference was observed neither in the primary outcome score [mean values (SD)=0.67 (2.05) in the aspirin group vs 0.65 (2.04) in the placebo group, P=0.94] nor at day 30 in the number of major complications between groups., Conclusions: In these at-risk patients undergoing elective non-cardiac surgery, we did not find any difference in terms of occurrence of major thrombotic or bleeding events between preoperative maintenance or interruption of aspirin.

Background and Objective: To develop a checklist of items measuring the quality of reports of randomized clinical trials (RCTs) assessing nonpharmacological treatments (NPTs)., Study Design and Setting: The Delphi consensus method was used to select and reduce the number of items in the checklist. A total of 154 individuals were invited to participate: epidemiologists and statisticians involved in the field of methodology of RCTs (n = 55), members of the Cochrane Collaboration (n = 41), and clinicians involved in planning NPT clinical trials (n = 58). Participants ranked on a 10-point Likert scale whether an item should be included in the checklist., Results: Fifty-five experts (36%) participated in the survey. They were experienced in systematic reviews (68% were involved in the Cochrane Collaboration) and in planning RCTs (76%). Three rounds of the Delphi method were conducted to achieve consensus. The final checklist contains 10 items and 5 subitems, with items related to the standardization of the intervention, care provider influence, and additional measures to minimize the potential bias from lack of blinding of participants, care providers, and outcome assessors., Conclusions: This tool can be used to critically appraise the medical literature, design NPT studies, and assess the quality of trial reports included in systematic reviews.

Alumina-on-alumina total hip arthroplasty has been used for 30 years, mainly in Europe. The theoretical advantages of this combination are represented by its remarkable sliding characteristics, its very low wear debris generation, and its sufficient fracture toughness. These advantages are achieved if the material is properly controlled with high density, high purity, and small grains. The authors summarize the results obtained with ceramic/ceramic total hip arthroplasty. Information is provided about in vivo behavior regarding wear debris characterization and quantification, and histological tissue examinations for inflammatory reactions, which were not encountered except when alumina debris was mixed with metal or cement. Modification of socket fixation resulted in improved clinical outcomes. With a press-fit metal shell and an alumina liner utilized for 10 years, the results are excellent especially in a young and active population. Alumina-on-alumina seems at the moment to be one of the best choices when a total hip arthroplasty has to be performed in young and active patients.

We report a retrospective study of 14 Peptostreptococcus magnus bone and joint infections, following orthopaedic prostheses or implantation of fixation devices, diagnosed in two Paris hospitals between 1992 and 1996. Five patients experienced a knee joint infection after anterior cruciate ligament reconstruction with 4 artificial grafts, and 9 caught joint or wound infections, after limb traumatic injuries or bone neoplastic ruptures involving femur, tibia, calcaneum and humerus, treated by arthroplasty or osteosynthesis with implantation of biomaterials. Septic arthritis was experienced one week to one year after reconstructive surgery, and had evolved for several months to years before etiologic diagnosis in 5 cases. Specimens of pus, tissues or removed implants produced numerous slow growing small colonies of Gram positive cocci arranged in clumps on culture media incubated in anaerobic atmosphere only. In 10 patients, the same organism was disclosed in several separate specimens. The identification of P. magnus was assessed by the enzyme profile (rapid ID 32A API strips), gaz liquid chromatography, catalase and coagulase production, resistance to novobiocin and Na polyanethol sulphonate. Antibiotic sensitivity testing performed by disc method was constant to penicillin G, amoxicillin, cefuroxime, cefoxitin, imipenem and pristinamycin with penicillin G MICs < 0.125 mg/l and metronidazole MICs < 1 mg/l. Erythromycin, clindamycin, rifampicin, tetracycline and fosfomycin were active against more than 70% of P. magnus. All patients were cured after a prolonged course of various antibiotics and surgical removal of the foreign material whenever possible. We studied in vitro binding of P. magnus with extracellular matrix proteins adsorbed onto biomaterials, by particle agglutination assays of latex beads coated with proteins. Eighty one% of strains bound to collagen, 69% to fibrinogen and 46% to fibronectin. Comparison of orthopaedic strains with strains of other infections and from skin showed a correlation between P. magnus from bone and joint infections and their fibrinogen binding ability (69% against 20%, p < 0.05).