Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104004
Sena Boukhelifa, Marie Protais, Clélia Thouement, Elhadi Sariali
<div><h3>Introduction</h3><div>Spinal deformities can lead to specific complications after total hip arthroplasty (THA), such as functional leg length discrepancy due to a fixed pelvic obliquity, as well as an increased risk of prosthetic instability due to a lack of adaptive pelvic mobility, but these issues were not investigated in large comparative series. Therefore a retrospective case-control study was done aiming: 1) to analyze the impact of a preoperative scoliotic deformity on the functional outcomes of patients who underwent THA with a minimum 1-year follow-up, 2) to measure the prevalence of scoliosis in both the case and control groups 3) to screen other factors that may be correlated with poorer clinical outcomes in patients who underwent THA, including age, gender, Body Mass index (BMI), American Society of Anesthesiologists (ASA) score, primary THA etiology and postoperative complication occurrence.</div></div><div><h3>Hypothesis</h3><div>The presence of scoliosis would have a negative impact on THA outcomes as assessed by PROMs.</div></div><div><h3>Materials and methods</h3><div>A case-control study was conducted using prospectively collected data including 268 patients who underwent THA between January 2009 and December 2021 through a direct anterior approach by the same senior surgeon. Cases were identified based on a 1-year follow-up modified Harris Hip score (mHHS) lower than 81 while controls were defined as patients with an excellent 1-year follow-up mHHS score (equal to or higher than 81). Three controls were randomly matched with each case based on the surgery period. To assess the impact of a concurrent scoliosis on clinical outcomes, a mathematical univariate and multivariate logistic model was used, including other confounding factors (age, gender, ASA score, BMI, Complication occurrence, etiology), to calculate the adjusted odds-ratio.</div></div><div><h3>Results</h3><div>In the multivariate analysis, scoliosis was found to be a significant risk factor, with a three-fold higher adjusted odds-ratio of lower mHHS score (adjOR = 3.1; 95 CI:1.4–7, [p < 0.01]). The mean mHHS score was significantly lower in the scoliosis group compared to the non-scoliosis group (77 vs. 84 [p = 0.01]) as well as the mean Oxford Hip Score (36 vs. 43 [p < 0.001]). Among the other assessed risk factors, only the occurence of a postoperative complication was associated with an increased odds ratio of poorer mHHS scores (adjOR = 7.1; 95 CI: 2.78–18.24, [p < 0.001]). The prevalence of scoliosis in our practice was 19%.</div></div><div><h3>Discussion</h3><div>: Given the prevalence of 19% found in our study, we recommend screening for scoliosis in all patients scheduled for THA. Our results indicate that patients who had scoliosis experienced lower PROMs scores compared to those who had not. Surgeons should consider delivering this information to patients who have scoliosis undergoing THA to mitigate patient dissatisfaction.</div></div><di
{"title":"Poorer clinical outcomes after THA in patients with a spinal scoliotic deformity: a case-control study of 268 patients assessed with PROMS","authors":"Sena Boukhelifa, Marie Protais, Clélia Thouement, Elhadi Sariali","doi":"10.1016/j.otsr.2024.104004","DOIUrl":"10.1016/j.otsr.2024.104004","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal deformities can lead to specific complications after total hip arthroplasty (THA), such as functional leg length discrepancy due to a fixed pelvic obliquity, as well as an increased risk of prosthetic instability due to a lack of adaptive pelvic mobility, but these issues were not investigated in large comparative series. Therefore a retrospective case-control study was done aiming: 1) to analyze the impact of a preoperative scoliotic deformity on the functional outcomes of patients who underwent THA with a minimum 1-year follow-up, 2) to measure the prevalence of scoliosis in both the case and control groups 3) to screen other factors that may be correlated with poorer clinical outcomes in patients who underwent THA, including age, gender, Body Mass index (BMI), American Society of Anesthesiologists (ASA) score, primary THA etiology and postoperative complication occurrence.</div></div><div><h3>Hypothesis</h3><div>The presence of scoliosis would have a negative impact on THA outcomes as assessed by PROMs.</div></div><div><h3>Materials and methods</h3><div>A case-control study was conducted using prospectively collected data including 268 patients who underwent THA between January 2009 and December 2021 through a direct anterior approach by the same senior surgeon. Cases were identified based on a 1-year follow-up modified Harris Hip score (mHHS) lower than 81 while controls were defined as patients with an excellent 1-year follow-up mHHS score (equal to or higher than 81). Three controls were randomly matched with each case based on the surgery period. To assess the impact of a concurrent scoliosis on clinical outcomes, a mathematical univariate and multivariate logistic model was used, including other confounding factors (age, gender, ASA score, BMI, Complication occurrence, etiology), to calculate the adjusted odds-ratio.</div></div><div><h3>Results</h3><div>In the multivariate analysis, scoliosis was found to be a significant risk factor, with a three-fold higher adjusted odds-ratio of lower mHHS score (adjOR = 3.1; 95 CI:1.4–7, [p < 0.01]). The mean mHHS score was significantly lower in the scoliosis group compared to the non-scoliosis group (77 vs. 84 [p = 0.01]) as well as the mean Oxford Hip Score (36 vs. 43 [p < 0.001]). Among the other assessed risk factors, only the occurence of a postoperative complication was associated with an increased odds ratio of poorer mHHS scores (adjOR = 7.1; 95 CI: 2.78–18.24, [p < 0.001]). The prevalence of scoliosis in our practice was 19%.</div></div><div><h3>Discussion</h3><div>: Given the prevalence of 19% found in our study, we recommend screening for scoliosis in all patients scheduled for THA. Our results indicate that patients who had scoliosis experienced lower PROMs scores compared to those who had not. Surgeons should consider delivering this information to patients who have scoliosis undergoing THA to mitigate patient dissatisfaction.</div></div><di","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104004"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104073
Philippe Gicquel
Knee ligament and meniscus injuries in children and teenagers are becoming more numerous because of increased sports participation but also better diagnosis. Meniscus injuries occur either in a normal meniscus or due to a congenital anomaly. The diagnosis is made clinically and confirmed by MRI. Treatment depends on the findings: meniscoplasty for discoid meniscus and primary repair of meniscus tears. Meniscus preservation is the rule.
Injuries to the central pivot of the knee typically involve either the anterior cruciate ligament (ACL) or the tibial spine. Age, anatomy and the mechanism of injury determine the specific nature of the injury. The treatment of tibial spine fractures is highly standardized and typically surgical, with the aim of limiting residual laxity. ACL tears can be treated either by primary repair or non-surgically with guided rehabilitation. ACL reconstruction in skeletally immature patients is feasible as long as the growth plates are protected. The rate of residual laxity or retear is lower when anterolateral reconstruction is performed simultaneously.
{"title":"Knee ligament and meniscus injuries in children and teenagers","authors":"Philippe Gicquel","doi":"10.1016/j.otsr.2024.104073","DOIUrl":"10.1016/j.otsr.2024.104073","url":null,"abstract":"<div><div>Knee ligament and meniscus injuries in children and teenagers are becoming more numerous because of increased sports participation but also better diagnosis. Meniscus injuries occur either in a normal meniscus or due to a congenital anomaly. The diagnosis is made clinically and confirmed by MRI. Treatment depends on the findings: meniscoplasty for discoid meniscus and primary repair of meniscus tears. Meniscus preservation is the rule.</div><div>Injuries to the central pivot of the knee typically involve either the anterior cruciate ligament (ACL) or the tibial spine. Age, anatomy and the mechanism of injury determine the specific nature of the injury. The treatment of tibial spine fractures is highly standardized and typically surgical, with the aim of limiting residual laxity. ACL tears can be treated either by primary repair or non-surgically with guided rehabilitation. ACL reconstruction in skeletally immature patients is feasible as long as the growth plates are protected. The rate of residual laxity or retear is lower when anterolateral reconstruction is performed simultaneously.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104073"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103913
Jules Levasseur , Pierre Bordure , Yvon Moui , Guillaume David , Louis Rony
Introduction
Intramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10–20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking.
Hypothesis
Nailing with double distal locking decreases non-union rates compared to single or no locking.
Material and methods
This single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs).
Results
There were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (p = 0.32). Constant score at 6 months was significantly different between the 3 groups (p = 0.01). Group 2 used more NSAIDs than the other groups (39.1% vs. 20.0% in group 1 and 33.3% in group 3; p = 0.37).
Discussion
Non-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation.
Level of evidence
III; retrospective comparative study.
简介髓内钉是治疗肱骨轴骨折的手术方法之一。不愈合是一种常见的并发症，发生率为 10-20%。本研究旨在比较采用双远端锁定、单远端锁定或无锁定髓内钉治疗的肱骨轴骨折的不愈合情况：材料和方法：这是一项单中心回顾性比较研究：这项单中心回顾性对比研究纳入了87例接受前行髓内钉治疗的无神经功能缺损的闭合性肱骨干骨折患者：第一组（双锁定）15例骨折；第二组（单锁定）2例骨折：15例骨折；第2组（单锁）：63例骨折；第3组（无锁定）：3例骨折：63处骨折；第3组（无锁定）：9处骨折：9处骨折。未愈合的定义为 6 个月后影像学上无胼胝，且无临床疼痛。主要终点是每组的非愈合率。次要终点是6个月时的Constant评分和术后非甾体抗炎药（NSAIDs）的使用情况：非愈合率无明显差异：第一组为 20.0%，第二组为 20.3%，第三组为 0%（P = 0.32）。三组在 6 个月时的恒定评分有明显差异（P = 0.01）。第二组比其他组使用更多的非甾体抗炎药（39.1% vs 20.0% in group 1 and 33.3% in group 3; p = 0.37）：讨论：髓内钉治疗无神经功能缺损的闭合性肱骨干骨折时，无论远端锁定与否，非愈合率都相似。尽管如此，双锁定组患者在6个月后的Constant评分更高，这可能与固定的稳定性更高有关，从而使康复更有效率：证据等级：III；回顾性比较研究。
{"title":"Does double distal locking reduce non-union rates in intramedullary nailing for humeral shaft fracture?","authors":"Jules Levasseur , Pierre Bordure , Yvon Moui , Guillaume David , Louis Rony","doi":"10.1016/j.otsr.2024.103913","DOIUrl":"10.1016/j.otsr.2024.103913","url":null,"abstract":"<div><h3>Introduction</h3><div>Intramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10–20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking.</div></div><div><h3>Hypothesis</h3><div>Nailing with double distal locking decreases non-union rates compared to single or no locking.</div></div><div><h3>Material and methods</h3><div>This single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs).</div></div><div><h3>Results</h3><div>There were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (<em>p</em> <!-->=<!--> <!-->0.32). Constant score at 6 months was significantly different between the 3 groups (<em>p</em> <!-->=<!--> <!-->0.01). Group 2 used more NSAIDs than the other groups (39.1% vs. 20.0% in group 1 and 33.3% in group 3; <em>p</em> <!-->=<!--> <!-->0.37).</div></div><div><h3>Discussion</h3><div>Non-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation.</div></div><div><h3>Level of evidence</h3><div>III; retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103913"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104062
Hassan Al Khoury Salem , Elie Haddad , Bruno Dohin , Franck Accadbled
Patellar instability can be defined as dislocation or subluxation of the patella relative to the femoral trochlea. It is a common reason for consulting a pediatric orthopedic surgeon. Its etiology is multifactorial. Because of the work of Hughston, Merchant, Ficat, Insall and Dejour, the overall care of this pathology has changed greatly. Surgical stabilization of the patella in children is being performed more often due to better understanding of the pathology and widespread adoption of reconstruction techniques for the medial patellofemoral ligament. However, some surgical techniques should not be used in children. Determining the type of instability is the first step to selecting the appropriate technique and to avoiding the biggest pitfall — recurrence.
{"title":"Techniques for surgical stabilization of the patella in children","authors":"Hassan Al Khoury Salem , Elie Haddad , Bruno Dohin , Franck Accadbled","doi":"10.1016/j.otsr.2024.104062","DOIUrl":"10.1016/j.otsr.2024.104062","url":null,"abstract":"<div><div>Patellar instability can be defined as dislocation or subluxation of the patella relative to the femoral trochlea. It is a common reason for consulting a pediatric orthopedic surgeon. Its etiology is multifactorial. Because of the work of Hughston, Merchant, Ficat, Insall and Dejour, the overall care of this pathology has changed greatly. Surgical stabilization of the patella in children is being performed more often due to better understanding of the pathology and widespread adoption of reconstruction techniques for the medial patellofemoral ligament. However, some surgical techniques should not be used in children. Determining the type of instability is the first step to selecting the appropriate technique and to avoiding the biggest pitfall — recurrence.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104062"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104074
Cécile Batailler , Nicolas Cance , Sébastien Lustig
In two-stage revision of infected implants, the first stage involves removing the implant and implanting a joint spacer, and the second stage involves implanting a new prosthesis at least 6 weeks later. Spacers have two main functions: local administration of high-dose antibiotics, and preservation of the joint space by reducing soft tissue retraction and improving patient comfort until reimplantation. The present review aims to detail the necessary characteristics of antibiotics added to cement to achieve good joint diffusion, to describe the steps of two-stage revision, and to present the types of spacer available according to the joint and complications.
The antibiotic used in the spacer must be heat-resistant, water-soluble and chemically stable in the cement. Gentamicin and vancomycin are generally preferred. We recommend at least 3 months’ systematic antibiotic therapy for periprosthetic joint infection. Reimplantation is performed either at 6 weeks without antibiotic washout or 3 months after 2 weeks’ washout
Spacers may be static (non-articulating) or dynamic (articulating). Static spacers are mainly used in the knee or hip in cases of severe bone defect or risk of soft-tissue lesions. An articulating spacer enables some joint functions to be preserved in the knee, hip or shoulder.
The most frequent complications are the dislocation of dynamic spacers and the breakage of static or dynamic spacers. To optimize efficacy and minimize complications, the biomechanical and bacteriological characteristics of spacers must be considered.
{"title":"Spacers in two-stage strategy for periprosthetic infection","authors":"Cécile Batailler , Nicolas Cance , Sébastien Lustig","doi":"10.1016/j.otsr.2024.104074","DOIUrl":"10.1016/j.otsr.2024.104074","url":null,"abstract":"<div><div>In two-stage revision of infected implants, the first stage involves removing the implant and implanting a joint spacer, and the second stage involves implanting a new prosthesis at least 6 weeks later. Spacers have two main functions: local administration of high-dose antibiotics, and preservation of the joint space by reducing soft tissue retraction and improving patient comfort until reimplantation. The present review aims to detail the necessary characteristics of antibiotics added to cement to achieve good joint diffusion, to describe the steps of two-stage revision, and to present the types of spacer available according to the joint and complications.</div><div>The antibiotic used in the spacer must be heat-resistant, water-soluble and chemically stable in the cement. Gentamicin and vancomycin are generally preferred. We recommend at least 3 months’ systematic antibiotic therapy for periprosthetic joint infection. Reimplantation is performed either at 6 weeks without antibiotic washout or 3 months after 2 weeks’ washout</div><div>Spacers may be static (non-articulating) or dynamic (articulating). Static spacers are mainly used in the knee or hip in cases of severe bone defect or risk of soft-tissue lesions. An articulating spacer enables some joint functions to be preserved in the knee, hip or shoulder.</div><div>The most frequent complications are the dislocation of dynamic spacers and the breakage of static or dynamic spacers. To optimize efficacy and minimize complications, the biomechanical and bacteriological characteristics of spacers must be considered.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104074"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103977
Matthieu Ollivier , Youngji Kim , Kristian Kley , Muneaki Ishijima , Shintaro Onishi , Hiroshi Nakayama , Raghbir Khakha
Chiba osteotomy is an effective technique for advanced knee osteoarthritis (KOA). The principle of the osteotomy is to correct both varus deformity and intra-articular joint congruity through an L-shaped osteotomy from the medial tibial condyle to the lateral intercondylar eminence. Previous studies have demonstrated that Chiba osteotomy is an effective method for alignment correction surgery for severe knee osteoarthritis. However, these reports slightly differ from the original concept of Chiba osteotomy. This report describes the pre-operative planning and surgical technique of Chiba osteotomy for patients with large tibial varus deformity, focusing on the management of early knee osteoarthritis following conditions such as post-traumatic Blount disease and “Pagoda” like proximal tibia varus deformities, as originally described.
{"title":"Chiba osteotomy (Tibial condylar valgus osteotomy) for a large tibial varus deformity: Technical note","authors":"Matthieu Ollivier , Youngji Kim , Kristian Kley , Muneaki Ishijima , Shintaro Onishi , Hiroshi Nakayama , Raghbir Khakha","doi":"10.1016/j.otsr.2024.103977","DOIUrl":"10.1016/j.otsr.2024.103977","url":null,"abstract":"<div><div>Chiba osteotomy is an effective technique for advanced knee osteoarthritis (KOA). The principle of the osteotomy is to correct both varus deformity and intra-articular joint congruity through an L-shaped osteotomy from the medial tibial condyle to the lateral intercondylar eminence. Previous studies have demonstrated that Chiba osteotomy is an effective method for alignment correction surgery for severe knee osteoarthritis. However, these reports slightly differ from the original concept of Chiba osteotomy. This report describes the pre-operative planning and surgical technique of Chiba osteotomy for patients with large tibial varus deformity, focusing on the management of early knee osteoarthritis following conditions such as post-traumatic Blount disease and “Pagoda” like proximal tibia varus deformities, as originally described.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103977"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103984
François Laudet , Alice Gay , Hervé Dutronc , Thierry Fabre , Pierre Meynard , Stéphane Costes
Background
Infection is one of the main complications of hip and knee arthroplasties. Topical application vancomycin to prevent postoperative infections is efficient in spine surgery, and is spreading in prosthetic surgery. However, its clinical relevance and safety are still under debate. Thus, we conducted the present study to (1) assess whether topical vancomycin reduces peri-prosthetic infection rate, and (2) investigate its influence on surgical wound complications.
Hypothesis
Our hypothesis was that topical administration of diluted vancomycin during arthroplasty would reduce infection rate within the first postoperative year.
Material and methods
In total, 1900 hip and knee arthroplasties were performed between 2014 and 2021 in a single hospital. From July 2018 and December 2021, 910 prostheses were implanted with intra-articular instillation of vancomycin and tranexamic acid. From November 2014 to June 2018, 990 prostheses were set up without vancomycin. During a follow-up of minimum 12 months, we reported periprosthetic infections occurring during the first postoperative year, as well as vancomycin-induced general or cutaneous complications.
Results
We observed periprosthetic infections in 9/990 cases (0.91%) of the control group and 10/910 cases (1.1%) of the vancomycin group (p = 0.82). In parallel, we observed wound complications (erythema, seroma, hematoma, dehiscence and delay in wound healing) in 19/990 (1.9%) and 10/910 cases (1.1%) of the control and vancomycin group, respectively (p = 0.19). There were no general complications resulting from the application of vancomycin.
Discussion
Topical diluted vancomycin does not reduce periprosthetic infection risk, and has no effect on the occurrence of surgery wound complications. Considering the present findings, the use of vancomycin cannot be recommended in current practice to prevent infections following hip and knee arthroplasties. Finally, its use does not induce any specific complications, whether local (cicatrisation) or general (related to ototoxicity or nephrotoxicity).
{"title":"Does the use of topical vancomycin during primary hip or knee arthroplasty protect from infections?","authors":"François Laudet , Alice Gay , Hervé Dutronc , Thierry Fabre , Pierre Meynard , Stéphane Costes","doi":"10.1016/j.otsr.2024.103984","DOIUrl":"10.1016/j.otsr.2024.103984","url":null,"abstract":"<div><h3>Background</h3><div>Infection is one of the main complications of hip and knee arthroplasties. Topical application vancomycin to prevent postoperative infections is efficient in spine surgery, and is spreading in prosthetic surgery. However, its clinical relevance and safety are still under debate. Thus, we conducted the present study to (1) assess whether topical vancomycin reduces peri-prosthetic infection rate, and (2) investigate its influence on surgical wound complications.</div></div><div><h3>Hypothesis</h3><div>Our hypothesis was that topical administration of diluted vancomycin during arthroplasty would reduce infection rate within the first postoperative year.</div></div><div><h3>Material and methods</h3><div>In total, 1900 hip and knee arthroplasties were performed between 2014 and 2021 in a single hospital. From July 2018 and December 2021, 910 prostheses were implanted with intra-articular instillation of vancomycin and tranexamic acid. From November 2014 to June 2018, 990 prostheses were set up without vancomycin. During a follow-up of minimum 12 months, we reported periprosthetic infections occurring during the first postoperative year, as well as vancomycin-induced general or cutaneous complications.</div></div><div><h3>Results</h3><div>We observed periprosthetic infections in 9/990 cases (0.91%) of the control group and 10/910 cases (1.1%) of the vancomycin group (p = 0.82). In parallel, we observed wound complications (erythema, seroma, hematoma, dehiscence and delay in wound healing) in 19/990 (1.9%) and 10/910 cases (1.1%) of the control and vancomycin group, respectively (p = 0.19). There were no general complications resulting from the application of vancomycin.</div></div><div><h3>Discussion</h3><div>Topical diluted vancomycin does not reduce periprosthetic infection risk, and has no effect on the occurrence of surgery wound complications. Considering the present findings, the use of vancomycin cannot be recommended in current practice to prevent infections following hip and knee arthroplasties. Finally, its use does not induce any specific complications, whether local (cicatrisation) or general (related to ototoxicity or nephrotoxicity).</div></div><div><h3>Level of evidence</h3><div>III; case control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103984"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Length variations of the lower limbs after total knee arthroplasty (TKA) constitute a poorly evaluated parameter and can be associated with worse functional outcomes. The objectives of this study were to: (1) describe the variations in the lower limb length after TKA according to the digital accuracy of the computerized navigation system used for prosthesis implantation, (2) describe patient sensation of limb length modification at 3 months postoperatively and to identify its risk factors, (3) identify factors affecting lower limb length modification and to analyze the predictive value causing in the patient the sensation of lower limb discrepancy.
Hypothesis
We hypothesize that there may be a lower limb length discrepancy after TKA, which may cause some distress to the patient.
Patients and methods
This prospective study included 100 TKAs implanted with navigation gap-balanced adjusted mechanical alignment. Were compared the length of the lower limb before and after implantation and the patient’s changes in leg length perception at 3 months postoperatively. A subgroup analysis was performed according to preoperative knee deformities: varus knee was an HKA < 177 °, normal knee was an HKA between 117° and 183 ° and valgus was an HKA >183 °.
Results
Ninety-seven out of 100 patients experienced lengthening compared to the preoperative ipsilateral length, and twenty-three experienced lengthening greater than 10 mm. The mean lengthening was 7.3 mm (maximum 24.8 mm). Lengthening was significantly greater in valgus knees 9.9 mm [range, 2.0–24.8] than in varus 7.2 mm [range, 1.46–19.4] and normal knees 4.11 mm [range, 0.4–11.4] (p < 0.05). The correction of frontal and sagittal deformation were risk factors for limb length modification (OR = 0.595; 95% CI [0.544−0.816] [p = 0.001], OR = 0.396; 95% CI [0.351−0.653] [p = 0.001]).
Twenty-two patients reported a sensation of limb length change: 11 (50%) reported equalization, whereas the remainder reported lengthening with a leg length difference. The preoperative sensation of lower limb length inequality was the unique factor affecting the patient’s perception post-surgery (OR = 37.50; 95% CI [9.730–144.526] [p = 0.0001]). A threshold value of 6.6 mm was identified for the sensation of limb length modification.
Conclusion
Navigation is a tool for describing ipsilateral leg length variations after TKA. These variations are significant and perhaps explain some patient dissatisfaction. A partial correction of the frontal deformity according to the knee phenotype could limit the risk of modification of the native length.
{"title":"Change in lower limb length following total knee arthroplasty","authors":"Simon Marmor , Younes Kerroumi , Guillaume Rigoulot , Pierre-Alban Bouché","doi":"10.1016/j.otsr.2024.104005","DOIUrl":"10.1016/j.otsr.2024.104005","url":null,"abstract":"<div><h3>Background</h3><div>Length variations of the lower limbs after total knee arthroplasty (TKA) constitute a poorly evaluated parameter and can be associated with worse functional outcomes. The objectives of this study were to: (1) describe the variations in the lower limb length after TKA according to the digital accuracy of the computerized navigation system used for prosthesis implantation, (2) describe patient sensation of limb length modification at 3 months postoperatively and to identify its risk factors, (3) identify factors affecting lower limb length modification and to analyze the predictive value causing in the patient the sensation of lower limb discrepancy.</div></div><div><h3>Hypothesis</h3><div>We hypothesize that there may be a lower limb length discrepancy after TKA, which may cause some distress to the patient.</div></div><div><h3>Patients and methods</h3><div>This prospective study included 100 TKAs implanted with navigation gap-balanced adjusted mechanical alignment. Were compared the length of the lower limb before and after implantation and the patient’s changes in leg length perception at 3 months postoperatively. A subgroup analysis was performed according to preoperative knee deformities: varus knee was an HKA < 177 °, normal knee was an HKA between 117° and 183 ° and valgus was an HKA >183 °.</div></div><div><h3>Results</h3><div>Ninety-seven out of 100 patients experienced lengthening compared to the preoperative ipsilateral length, and twenty-three experienced lengthening greater than 10 mm. The mean lengthening was 7.3 mm (maximum 24.8 mm). Lengthening was significantly greater in valgus knees 9.9 mm [range, 2.0–24.8] than in varus 7.2 mm [range, 1.46–19.4] and normal knees 4.11 mm [range, 0.4–11.4] (p < 0.05). The correction of frontal and sagittal deformation were risk factors for limb length modification (OR = 0.595; 95% CI [0.544−0.816] [p = 0.001], OR = 0.396; 95% CI [0.351−0.653] [p = 0.001]).</div><div>Twenty-two patients reported a sensation of limb length change: 11 (50%) reported equalization, whereas the remainder reported lengthening with a leg length difference. The preoperative sensation of lower limb length inequality was the unique factor affecting the patient’s perception post-surgery (OR = 37.50; 95% CI [9.730–144.526] [p = 0.0001]). A threshold value of 6.6 mm was identified for the sensation of limb length modification.</div></div><div><h3>Conclusion</h3><div>Navigation is a tool for describing ipsilateral leg length variations after TKA. These variations are significant and perhaps explain some patient dissatisfaction. A partial correction of the frontal deformity according to the knee phenotype could limit the risk of modification of the native length.</div></div><div><h3>Level of evidence</h3><div>IV; Descriptive therapeutic prospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104005"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104071
Julie Mathieu , Mathilde Gatti , Louis Dagneaux
Supramalleolar osteotomy (SMO) aims to correct extra-articular deformities of the distal lower leg. There are several indications, the most common being varus osteoarthritis of the ankle. The rationale in this indication is to modify talocrural stress and pressure distribution by reorienting the limb axis. Preoperative planning is essential to optimize functional outcome, limiting the risk of under- or over-correction. Several SMO procedures have been described, and are preferably performed at the deformity site or center of rotation and angulation (CORA). They aim to restore talocrural joint-line anatomy and correct talar tilt while conserving physiological hindfoot valgus. Techniques use K-wires as cut guides. 3D imaging and patient-specific instrumentation now play key roles in this surgery, which is difficult both to plan and to execute. The present study addresses the following questions: What are the indications and contraindications? What are the technical principles? What preoperative work-up is required for planning and execution? What are the technical particularities? And what contribution can new technologies make?
{"title":"Supramalleolar osteotomy: technical note","authors":"Julie Mathieu , Mathilde Gatti , Louis Dagneaux","doi":"10.1016/j.otsr.2024.104071","DOIUrl":"10.1016/j.otsr.2024.104071","url":null,"abstract":"<div><div>Supramalleolar osteotomy (SMO) aims to correct extra-articular deformities of the distal lower leg. There are several indications, the most common being varus osteoarthritis of the ankle. The rationale in this indication is to modify talocrural stress and pressure distribution by reorienting the limb axis. Preoperative planning is essential to optimize functional outcome, limiting the risk of under- or over-correction. Several SMO procedures have been described, and are preferably performed at the deformity site or center of rotation and angulation (CORA). They aim to restore talocrural joint-line anatomy and correct talar tilt while conserving physiological hindfoot valgus. Techniques use K-wires as cut guides. 3D imaging and patient-specific instrumentation now play key roles in this surgery, which is difficult both to plan and to execute. The present study addresses the following questions: What are the indications and contraindications? What are the technical principles? What preoperative work-up is required for planning and execution? What are the technical particularities? And what contribution can new technologies make?</div></div><div><h3>Level of evidence</h3><div>V.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104071"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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