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Place: France; International audience; INTRODUCTION: Femoroacetabular impingement (FAI) is a frequent cause of inguinal pain. Treatment failure rates range between 2.9% and 13.2%. The aim of the present study was to assess the impact of preoperative bone deformities (BD), labral lesions (LL) and cartilage lesions (CL) on clinical results of arthroscopic treatment of FAI. MATERIAL AND METHOD: A prospective operational study included patients undergoing hip arthroscopy for FAI. All patients had full radiographic work-up and clinical assessment on Non-Arthritic Hip Score (NAHS), preoperatively and at 1year. Hips with Tönnis grade\textgreater1, coxa profunda [VCE (vertical center edge angle)\textgreater35°] or borderline dysplasia (VCE\textless25°) were excluded. The Czerny classification was used for the labrum and the Beck classification for the cartilage. The aim of the study was to assess the impact of preoperative BD, LL and CL on clinical results of arthroscopic treatment of FAI. The study hypothesis was that type of lesion does not influence early functional results at 1year, whatever the technique used for the labrum. RESULTS: One hundred and ninety-seven patients were included. Mean preoperative NAHS was 59.1±17.5. There were 145 patients with labral suture (73.6%), 42 with labral debridement (21.3%) and 10 with conservative treatment (5.1%). At 1year, mean NAHS was 88.1±15.3: i.e., a significant improvement (p\textless2.2×10(-16)). Improvement was also significant in the debridement, non-operative and suture subgroups. BD showed significant correction in the overall population (alpha angle 48.2° postoperatively versus 66.7° preoperatively; crossing sign in 14.5% versus 62.9% of cases). There were no significant differences in functional scores according to extension or type of labral or cartilage lesion. At follow-up, 3 patients (1.5%) required repeat arthroscopy. CONCLUSION: The present study showed that early functional results of arthroscopic treatment of FAI were unaffected by the severity of bone deformity (alpha and VCE angles), or extension or type of labral or cartilage lesion. Regardless of BD, LL and CL, 1-year clinical progression was satisfactory when all bone deformities were treated by the arthroscopic procedure. LEVEL OF EVIDENCE: IV; prospective non-comparative study.

The placement of prostheses for a total hip arthroplasty (THA) is essential to limit complications and optimize functional results. In a recent study of more than 100 THA placed through a direct anterior approach using a traction table, we found that the mean anteversion of the cup was greater (30°) than recommended (20°). To explain this phenomenon, we considered that the anterior pelvic plane (APP), defined by the plane passing through the anterior-superior iliac spines and the pubic symphysis, which serves as a landmark for the placement and calculation of the anteversion of the cup, was not horizontal when the patient was lying on the traction table. This concept has not been evaluated so we conducted a prospective study to: 1) measure the position of the pelvis on a traction table; 2) compare to the standing position, 3) assess its impact on the anteversion of the cup.The standing pelvic version is identical to the supine pelvic version on the traction table.A prospective 3-month monocentric study was conducted. All patients operated on for a THA by a direct anterior approach, on a traction table, were included. The position of the pelvis was assessed by measuring the tilt of the APP on lateral pelvic X-rays, while on the traction table and while standing. The impact of the position of the pelvis on the positioning of the cup, as well as the anteversion, were measured using the EOS imaging system. The anatomic anteversion of the cup was measured in relation to the APP.Fifty-eight patients were included (32 women, 26 men) with an average age of 67 years. The tilt of the supine APP was 6°±8.3 [range of -10.5 to 31.0] (indicating a retroverted pelvis on the traction table). The difference between the tilt of the standing and lying APP (within 90°) was not significant (standing was on average 4.5° [range of -11.0 to 27.0] versus lying on the table, was on average 6° [range of -10.5 to 31.0] (p=0.75). A strong correlation was observed between the tilt of the supine APP and the anatomic anteversion of the cup (p0.001). Thus, the more retroverted the pelvis was on the traction table, the lower the anatomic anteversion of the acetabular cup.The supine pelvis on the traction table is not always horizontal and its position on the traction table is similar to its standing position, within 90 degrees. The analysis of the positioning of the preoperative pelvis appears to be essential in the planning of a THA through direct anterior approach using a traction table.IV; Prospective Cohort Study.

Introduction: The current craze for minimally invasive approaches is leading to a renewed interest in total hip arthroplasty, but to our knowledge there is no evidence of the superiority of an operative technique in terms of quality of walking recovery. This review aims to analyze the restoration of the spatio-temporal parameters of gait in first-line total hip arthroplasty suites on hip osteoarthritis and perform a comparison of recovery according to the surgical technique. Materials and Method: 15 studies were analyzed according to the main criteria of walking speed, unipodal support time, step length and preoperative loading and in the short, medium- and long-term postoperative period. Results: Although most of the results obtained in the studies analyzed show an improvement in these criteria post-operatively, they remain lower than those obtained in a healthy population. Conclusion: This work does not highlight the superiority of recovery of the operation of a surgical technique.

Total hip arthroplasty (THA) performed as day-surgery is an emerging and growing practice. The main aim of the present study was to assess the feasibility and safety of primary THA in an outpatient setting. The study hypothesis was that, within a specifically dedicated structure, such surgery is feasible and safe.A prospective observational study was performed in two centers, one private hospital and one university hospital, including all patients operated on by two senior surgeons between 2014 and 2017 for primary THA and eligible for day-surgery. The clinical pathway was governed by a pre-established protocol. Preoperatively, all patients took part in an information workshop, with their spouses and the surgeon. Postoperative phone interviews were held on D1 and D3, then out-patient consultations were conducted at 1 and 6 weeks. The main study endpoint was successful outpatient management, failure being defined as crossover or readmission within 1 week of discharge. Secondary endpoints comprised complications rate and satisfaction as assessed by patient and spouse at 6 weeks.During the study period, 1,303 patients received primary THA. 338 (25.9%) were eligible for day-surgery, but 17 (5%) declined; the day-surgery series thus comprised 321 patients (24.6%): 166 men, 155 women; mean age, 61.2±9.7 years. Same-day discharge was not possible for 14 patients (4.5%): 9 due to persistent faintness, 2 to intraoperative femoral fracture, 1 to organizational issues, 1 to an uncomplicated fall, and 1 to hemoglobinemia11g/100ml in a coronary patient. There were no readmissions during week 1. At 6 weeks' follow-up, there had been 3 adverse events: 2 dislocations, and 1 periprosthetic fracture. 312 patients (97.2%) were satisfied.The present prospective study found no major adverse events in patients undergoing day-surgery for primary THA. However, patients should be selected, consenting, prepared and managed on a standardized clinical pathway.IV; non-comparative prospective study.

To assess the ability of 2 independent surgical techniques, an inside-out technique and an outside-in technique, using bony landmarks on the femoral wall, to place the anterior cruciate ligament graft anatomically.A retrospective single-center study was conducted in 2012 and included patients who underwent anterior cruciate ligament reconstruction. Two techniques were used: The lateral condylar wall was visualized from the anterolateral portal and tunnels were drilled "outside-in" in one group, whereas viewing was performed from the anteromedial portal and retrograde drilling ("inside-out") was performed in the other group. The primary outcome measure was the placement of the tunnel center point on postoperative computed tomography scans with 3-dimensional reconstruction, according to the radiographic quadrant method of Bernard and Hertel. The measurements were compared with optimal placements according to Bird et al. Their reliability was assessed with Spearman (rho) and intraclass correlation coefficients.Forty patients were included, with 20 in each group; the mean age was 29.8 ± 9.6 years, and there were 33 men and 7 women. The interobserver reliability and intraobserver reliability of measurements were good, with a Spearman ρ between 0.46 (P = .002) and 0.93 (P.001) and an intraclass correlation coefficient between 0.44 (P = .001) and 0.86 (P.001). The femoral tunnel positions of both techniques were close to the previously published anatomic placements, but there was a significant difference between our results and the theoretical position in proximal-distal measurements (P = .01). There was no difference in the anteroposterior measurements. There was no statistical difference in the accuracy of placement of the femoral tunnel center point between these 2 independent techniques.The direct arthroscopic visualization of bony landmarks seems sufficient for accurate positioning of the femoral tunnel whatever the drilling technique. This finding is clinically relevant because the routine use of direct measurement techniques or intraoperative radiographs may not be necessary to obtain anatomic tunnel placement.Level IV, case series.

The success of shoulder stabilization with the Latarjet procedure depends on the correct positioning of the coracoid graft at the glenoid. The aim of this study was to assess intra-observer reproducibility and inter-observer reproducibility of a new standardized CT scan analysis for coracoid graft positioning in the axial plane after the Latarjet procedure and to assess the positioning in the study group. A consecutive series of 27 patients (22 men, 5 woman, 26.1 ± 6.4 years—13 right, 14 left shoulders) were followed up with CT scans between 2010 and 2012. The analysis of the CT scans (2.4 ± 0.7 months postoperatively) was performed with Osirix™ software. The assessment included two criteria in the axial plane: relation of the graft to the articular surface of the glenoid and impingement of the graft with the maximal humeral head circumference. Grafts were judged to be lateral, congruent, flush or medial. The strength of intra-observer agreement and inter-observer agreement was measured by the Kappa coefficient. The Kappa coefficient for intra-observer agreement was “substantial” (K = 0.64 ± 0.14, z = 4.6) to “almost perfect” (K = 0.81 ± 0.14, z = 5.7). The Kappa coefficient for inter-observer variability was “substantial” (K = 0.59 ± 0.14, z = 4.3) to “almost perfect” (K = 0.89 ± 0.14, z = 6.0). In our study, in the axial plane, 3 (11 %) transplants were lateral; 6 (22 %) transplants were congruent; 16 (60 %) flush and 2 (7 %) medial. This standardized CT scan analysis after Latarjet procedure has shown to accurately describe graft positioning in the axial plane with both good intra-observer reproducibility and inter-observer reproducibility. Case series, treatment study, Level IV.

Background Heterotopic ossification (HO) of the shoulder after central nervous system damage has seldom been studied. Materials and methods We performed a single-center retrospective study from 1993 to 2009 including patients who underwent surgery for troublesome shoulder HO. Demographic data, HO location, surgical approach, preoperative and postoperative shoulder range of motion, etiologies, and postoperative complications were collected from patients' files. Results We found 19 shoulder HOs in 16 patients (traumatic brain injury in 11, spinal cord injury in 2, stroke in 1, and cerebral anoxia in 2). The data in 2 files were incomplete and were therefore not used. HO locations around the joint were anteroinferomedial in 4 (21.1%), posteroinferomedial in 5 (26.3%), encircling in 3 (15.8%), superior in 1 (5.3%), and mixed (2 associated HOs that are not encircling) in 6 (31.6%). The surgical approaches were as follows: deltopectoral, 5 (26.3%); Neer, 3 (15.8%); posterior, 5 (26.3%); axillary, 1 (5.3%); Martini, 2 (10.5%); posterior associated with deltopectoral, 2 (10.5%); and Neer (superolateral) associated with deltopectoral, 1 (5.3%). The mean range of motion increased significantly (gain at follow-up of 69°, 60°, and 13° in forward elevation, abduction, and lateral rotation, respectively). Regarding postoperative complications, there was 1 case of capsulitis and 1 reoperation for insufficient excision (because of hemorrhage during surgery). There were no other side effects. Conclusion Anatomic relations with nerves and vessels, as well as limited range of motion, require a case-by-case surgical approach, a preoperative scan (looking for a gutter), and sometimes, electromyography. Surgical indications depend on the degree of loss of function or hygiene, control of comorbid factors, and discussion with the patient and his or her family.

Summary Morse tapers are frequently used in total hip replacement to achieve precise adjustment of lengths and femoral offset. Mechanically, they do not raise any specific problems so long as strict positioning requirements are observed and elements from different manufacturers are not mixed together. We report a case in which the implant induced unexplained pain at 2 years, in relation to a defective fit between the metallic head and the Morse taper. Asymmetric partial fit of the head onto the taper was detected on control X-ray and was implicated as causing metallosis due to excessive release of metal debris from the Morse taper. Revision required femoral stem exchange because of the damage to the Morse taper as well as replacing the cup with new metal-metal bearings. Evolution was favorable at 3 years’ follow-up. Most hip replacements include a Morse taper; the present clinical case is a reminder that strict positioning rules are to be respected, without which corrosion and wear may lead to mechanical failure.

Objective To describe original surgical treatment in patients with ischemic mitral valve regurgitation due to tenting phenomenon. Background The optimal surgical treatment of ischemic mitral regurgitation (MR) in patients with coronary artery disease is controversial. The standard treatment is revascularization and reduction annuloplasty. We describe the first clinical application of an original technique to treat MR, through aortotomy. The chordal cutting technique was described first in experimental studies by Messas et al. Methods The procedure consisted in cutting the 2 strut chordae of the anterior mitral valve through a small aortotomy, using a brief conventional cardiopulmonary bypass. All the cases were controlled at the end of the procedure by transesophageal echocardiography (TEE). Results Five patients were treated using this technique; the procedure was brief, effective and safe in all the patients. TEE showed no mitral regurgitation. No preoperative morbidity or mortality occurred and post-operative course was uneventful. Conclusion Chordal cutting technique through aortotomy is a safe and effective technique that should be considered to treat severe ischemic mitral regurgitation due to tenting phenomenon.

Cup design has been incriminated as the source of groin pain after hip resurfacing but has not been well described; thus, it was assessed in a prospective study looking at three implant types.A group-match was done between three groups of hip resurfacing devices according to age, sex, body mass index, activity level, osteoarthritis aetiology and pre-operative scores.The global groin pain rate was 5.7 % at six months and 2.7 % at last follow-up. Groin pain rate was significantly different between the three groups (p = 0.004) and had a strong influence on the subjective results (p = 0.04). No groin pain emerged between six months and last follow-up. No clinical differences were noted in Harris hip score and Merle d'Aubigné-Postel score at last follow-up. However, the Oxford hip score and Devane activity score were significantly lower for cups with macrostructures.The low groin pain rate in this prospective cohort was probably secondary to the specific surgical technique used and seems to be correlated with cup design. Macrostructures on the external part of the cup could be significantly harmful.

Background One of the identified risk factors for anterior shoulder instability is bone loss on the anterior-inferior glenoid rim. The aim of our study was to assess intraobserver and interobserver reproducibility of the Bernageau view to estimate glenoid bone loss and validate this radiographic method with computed tomography (CT) scan. The second objective was to find correlation between Bernageau and arthroscopic bone loss measurements. Materials and methods Twenty patients were included retrospectively. Two independent observers evaluated glenoid bone loss with the ratio between glenoid joint surface diameters of the pathologic and healthy shoulders on Bernageau views. Results were compared with CT (gold standard) and arthroscopic measurements. Validity and reliability of Bernageau measurement were assessed with Spearman correlation coefficients ( r ) and intraclass correlation coefficients (ρ). Results The interobserver and intraobserver reliability and the validity of Bernageau measurement compared with the reference test, the CT scan, were all excellent, with a Spearman ρ between 0.56 ( P = .0002) and 0.95 ( P P = .0007) and 0.97 ( P −5 ). There was no correlation with arthroscopic evaluation. Conclusion The glenoid bone defect measurement on the Bernageau profile view is a valid and reliable method. Furthermore, it is easy to use in current clinical practice. Surgeons can therefore consider it as a tool for preoperative planning, and its use could decrease CT scan indications.