Search

The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO).This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point.At the time of HTO, mean age was 55 years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3 years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3 years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate.At mean follow-up of 13 years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA.Retrospective case series, IV.

The aim of the study was to compare clinical and radiological outcomes between primary and aseptic revision TKAs using the same posterior-stabilised (PS) prosthesis. The authors hypothesised similar outcomes between both groups for selected patients.This retrospective, case-control study assessed 36 patients who underwent aseptic revision TKA compared to a match group of 72 primary TKA. Both groups had the same PS design implant (ANATOMIC®, Amplitude, Valence, France). The International Knee Society (IKS) score, radiological outcomes (postoperative alignment, patellar tilt and radiolucent lines), re-intervention and revision rate were compared between the two groups with a minimum follow-up of 3 years.The final study cohort included 29 patients and 63 patients respectively in the revision and primary group, with a mean follow-up of 49.1 months (range 36.1-69). Postoperatively, there was no significant difference in IKS scores between the two groups [169.8 for the revision group and 179.6 for the primary group (p = 0.09)]. No statistical difference was observed for post-operative satisfaction 86.2% versus 92.1% (p = 0.46). Between the two groups, there was no difference in mean radiological assessment, including radiolucent lines (p = 0.7). There was no significant difference for overall implant survivorship 96.5% versus 100% (p = 0.13) at 36 months.Similar clinical, radiological and survivorship outcomes were found between rTKA and primary TKA groups using the same PS level of constraint in patients undergoing revision surgery for aseptic indications at 3-year follow-up. Use of PS implants in rTKA for the correct indication suggests this to be a safe approach at least in the medium term.IV, retrospective case-control study.

Patellar dislocation represents a rare but invalidating trauma. Indeed, 94 to 100% of patients suffer from medial patellofemoral ligament (MPFL) rupture just after the first patellar dislocation, and approximately half of these patients develop recurrent dislocations. MPFL reconstruction is a commonly performed surgery for patellofemoral instability. Anatomic reconstruction of the MPFL restores patellar stability in patients with recurrent patellar instability with neutral lower limb alignment. We describe a technique, which creates an anatomic reconstruction using trans-osseous suture loop. Conclusion: Compared to similar techniques, the described procedure has the following advantages: smaller tunnels, less donor side morbidity, reduced risk of graft failure, minimal invasiveness, more appealing cosmetic results and easily reproducible. Complications and outcomes of this technique, including the risk for patellar fracture, must be further evaluated in a larger patient cohort with longer follow-up.

The aim of this study was to compare the long-term clinical and radiological results between fixed (FB) and mobile bearing (MB) implants with identical design from the same manufacturer.From March 2007 to May 2009, we recruited 160 patients in a prospective, single centered, randomized controlled trial. The authors compared 81 FB total knee arthroplasty (TKA) versus 79 MB with medial compartment osteoarthritis. The same posterior stabilized HLS Noetos knee prosthesis (CORIN) was used in all patients. The two groups only differed by the tibial insert (fixed or mobile). The authors compared the postoperative Knee Society Score (KSS), the passive clinical and active radiological knee flexion, the implant survivorship, the complications, and the presence of radiolucent lines.At mean 10.5 years' follow-up (range 8-12.1 years) no significant differences were found in clinical scores (KSS (p = 0.54), pain score (p = 0.77), stair climbing (p = 0.44), passive maximum flexion (p = 0.5)) or for radiological analyses (maximum active radiological flexion (p = 0.06), presence of progressive radiolucent lines (5 (MB group) versus 6 (FB group); p = 0.75)) between groups. No significant difference was found in overall implant survivorship (82% (MB group) versus 78% (FB group) p = 0.58) or complication rate (p = 0.32) at the last follow-up.No significant clinical and radiological differences were found between fixed and mobile bearing TKA using the same semi-constrained implant type with comparable overall survivorship. The choice between a fixed or mobile bearing implant should be based on surgeon preference and experience with the selected implant.Prospective randomized controlled trial, Level II.

Introduction Le tedizolide est un antibiotique de la famille des oxazolidinones, semblant presenter un meilleur profil de securite hematologique et neurologique a long terme que le linezolide, et restant actif contre les bacteries multiresistantes (BMR) a Gram-positif. Par consequent, il pourrait representer une option comme traitement antimicrobien suppressif (TAS) chez les patients souffrant d’une infection osteo-articulaire (IOA) complexe sur implant a BMR a Gram-positif. Materiels et methodes Nous avons realise une etude de cohorte entre 2017 et 2020 afin d’evaluer la securite a long terme du tedizolide en tant que TAS chez les patients presentant une IOA associee a un implant. Dans tous les cas, l’utilisation du tedizolide a ete validee comme derniere option therapeutique orale lors de reunions multidisciplinaires dans un CRIOAc. Les evenements indesirables graves, les raisons de l’arret du traitement et les donnees biologiques habituelles (hemogramme, ionogramme, bilan hepatique realises au minimum tous les mois) ont ete collectes de maniere prospective. Resultats Dix-sept patients (13 (76 %) hommes; âge median de 73 ans ; IMC moyen de 28,1 ± 5,1 kg/m2) ont recu du tedizolide en tant que TAS pour des infections de prothese (n = 16, dont 10 (59 %) protheses de genou, 5 (29 %) de hanche et une (6 %) d’epaule) ou une infection d’osteosynthese (n = 1). La duree mediane du traitement par tedizolide etait de 6 mois (range 1-31). Les pathogenes impliques etaient principalement des staphylocoques a coagulase negative multi-resistants (n = 16, 80 %), suivis de Corynebacterium striatum (n = 2) et d’Enterococcus faecium resistant a la vancomycine (n = 1). Des co-infections a bacteries a Gram-negatif (Pseudomonas aeruginosa, Serratia marcescens et Proteus mirabilis) ont ete observees chez 3 patients. La seule raison de l’arret du traitement a ete l’echec de la strategie conservatrice, avec une rechute observee chez 4 patients (23,5 %). Aucun patient n’a developpe d’evenement indesirable grave clinique ou biologique ou n’a vu son traitement par tedizolide interrompu en raison d’un evenement indesirable. Aucun evenement indesirable neurologique n’a par ailleurs ete observe durant le suivi de meme qu’aucune interaction medicamenteuse malgre la co-administration de traitement serotoninergique (anti-depresseur tricyclique (n = 2) et tramadol (n = 4)). Conclusion Le tedizolide semble etre une option sure en tant que TAS chez les patients presentant une IOA complexe associee a un implant due a des bacteries a Gram-positif BMR.

International audience; The evaluation of the wear of hip prostheses is regulated by international standards, however, the results of in vitro tests do not allow to predict the effective lifetime once the implants are in place. Our study aims to develop a new method of in vitro testing of implants, more representative of their wear in physiological conditions. We also want to develop a questionnaire that can detect the particular sensitivities of each patient to the constituent materials of the prostheses and thus guide the choice of one's implant to limit the risk of aseptic loosening.

La osteocondritis disecante de los condilos femorales es una patologia infrecuente. Afecta principalmente a ninos varones y a adultos jovenes. Su etiologia es multifactorial y es probable que los factores mecanicos microtraumaticos esten en un primer plano. Se trata de una patologia artrogena cuando no se logra la cicatrizacion. Existe una forma juvenil con capacidad de cicatrizacion, que puede requerir un tratamiento conservador, asi como una forma del adulto, que precisa cirugia en la mayoria de los casos. La cirugia tiene como finalidad lograr la cicatrizacion de la lesion osteocondral mediante una estimulacion medular o por injerto oseo y osteosintesis si el fragmento es inestable. Cuando el fragmento se desprende y existe una perdida de sustancia osteocartilaginosa, la dificultad reside en reconstruir el defecto. Se pueden utilizar muchas tecnicas: autoinjertos en «mosaico», aloinjertos, injertos de condrocitos, impulsadas por el auge de los biomateriales, pero con las que aun no se dispone de una experiencia suficiente.

We aimed to evaluate the performance of the Khorana score in predicting venous thromboembolic events in ambulatory cancer patients. Embase and MEDLINE were searched from January 2008 to June 2018 for studies which evaluated the Khorana score. Two authors independently screened studies for eligibility, extracted data, and assessed risk of bias. Additional data on the 6-month incidence of venous thromboembolism were sought by contacting corresponding authors. The incidence in each Khorana score risk group was estimated with random effects meta-analysis. A total of 45 articles and eight abstracts were included, comprising 55 cohorts enrolling 34,555 ambulatory cancer patients. For 27,849 patients (81%), 6-month follow-up data were obtained. Overall, 19% of patients had a Khorana score of 0 points, 64% a score of 1 or 2 points, and 17% a score of 3 or more points. The incidence of venous thromboembolism in the first six months was 5.0% (95% CI: 3.9-6.5) in patients with a low-risk Khorana score (0 points), 6.6% (95% CI: 5.6-7.7) in those with an intermediate-risk Khorana score (1 or 2 points), and 11.0% (95% CI: 8.8-13.8) in those with a high-risk Khorana score (3 points or higher). Of the patients with venous thromboembolism in the first six months, 23.4% (95% CI: 18.4-29.4) had been classified as high risk according to the Khorana score. In conclusion, the Khorana score can be used to select ambulatory cancer patients at high risk of venous thromboembolism for thromboprophylaxis; however, most events occur outside this high-risk group.

International audience; To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan–Meier method was 76.2 [95% CI 68–83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69–0.88]; p 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI.

Local injection of a bacteriophages mix during debridement, antibiotics and implant retention (“DAIR”) was performed to treat a relapsing Staphylococcus aureus chronic prosthetic joint infection (PJI). This salvage treatment was safe and associated with a clinical success. Scientific evaluation of the potential clinical benefit of bacteriophages as antibiofilm treatment in PJI is now feasible and required.

Total joint replacement is the standard treatment of advancedosteoarthritis. Metal-on-Metal (MoM) hip resurfacing and hiparthroplasty are associated with long durability and low rates ofdislocations and used to be the standard surgical treatments.Complications due to MoM prostheses have however beenwidely reported. Adverse reactions to metal debris (ARMD)such as metallosis result from the progressive degradation of themetal surface and from metal ions deposition in the surroundingtissues. The formation of 'pseudotumors' leading to prosthe-sis malfunction has been reported after MoM resurfacing. Totalarthroplasty can also lead to the infection of the prosthesis asa consequence of contamination during surgery or bacteremicinfection not related to the prosthesis. Infections remain quitecommon (1-3% of surgical procedures) but reports of associ-ated ARMD are limited. We report the case of three patientspresenting with metallosis-associated infection on joint pros-thesis.

International audience; OBJECTIVES: The high microbiologic diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in cases of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum β-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to describe the microbiologic epidemiology of PJI according to the chronology of infection. METHODS: This prospective cohort study (2011-2016) evaluated the microbiologic aetiology of 567 PJI according to time of occurrence from prosthesis implantation-early (\textless3~months), delayed (3-12~months) and late (\textgreater12~months)-as well as mechanism of acquisition. RESULTS: Initial microbiologic documentation (n~=~511; 90.1%) disclosed 164 (28.9%) Staphylococcus aureus (including 26 (16.1%) methicillin-resistant S.~aureus), 162 (28.6%) coagulase-negative staphylococci (including 81 (59.1%) methicillin-resistant coagulase-negative staphylococci), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) streptococci and 60 (10.6%) Cutibacterium acnes. Considering nonhaematogenous late PJI (n~=~182), Enterobacteriaceae (n~=~7; 3.8%) were less represented than in the first year after implantation (n~=~56; 17.2%; p \textless0.001), without difference regarding nonfermenting GNB (4.6% and 2.7%, respectively). The prevalence of anaerobes (n~=~40; 21.9%; including 32 (80.0%) C.~acnes) was higher in late PJI (p \textless0.001). Consequently, a broad-spectrum β-lactam might be useful in 12 patients (6.6%) with late PJI only compared to 66 patients (20.3%) with early/delayed PJI (p \textless0.001). CONCLUSIONS: Considering the minority amount of GNB in late postoperative PJI, the empirical use of a broad-spectrum β-lactam should be reconsidered, especially when a two-stage exchange is planned.

SFA 2017 - Congrès annuel de la Société Francophone d'Arthroscopie, MARSEILLE, FRANCE, 06-/12/2017 - 09/12/2017; Lors de la ligamentoplastie du LCA, l'adjonction d'une plastie antérolatérale (PAL) a pour but d'améliorer le contrôle de la stabilité en rotation du genou. L'efficacité de cette technique et ses conséquences sur les risques de re-rupture et d'atteinte dégénérative secondaire sont discutées.