Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Vancouver B2 Periprosthetic femoral fractures around cemented polished taper-slip stems - how should we treat these? A systematic scoping review and algorithm for management.","authors":"Benjamin Schapira, Suroosh Madanipour, Padmanabhan Subramanian","doi":"10.1016/j.otsr.2024.104110","DOIUrl":"10.1016/j.otsr.2024.104110","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic femoral fractures (PFF) are a challenging complication of hip arthroplasty surgery, posing a high risk of morbidity, mortality and reoperation. The Vancouver Classification describes a B2 PFF around a loose stem with sufficient bone stock. In recent years, the number of B2 PFFs and cementation of femoral stems have increased substantially.</p><p><strong>Hypothesis: </strong>This systematic scoping review aimed to review the options available to surgeons in managing Vancouver B2 PFFs around cemented polished taper-slip (PTS) stems and establish an algorithm of management to treat varying fracture presentations.</p><p><strong>Patients and methods: </strong>This study reviewed articles reporting on Vancouver B2 PFFs around cemented femoral stems between 2012 and 2022. Data extracted included: patient demographics, index prosthesis, surgical intervention and decision for treatment, operation time, transfusion requirement, length of hospital stay, post-operative rehabilitation protocol, mobility outcomes, radiological outcomes, complications, reoperations, mortality rates and follow-up.</p><p><strong>Results: </strong>In total, fourteen studies met all inclusion criteria including 552 cases. Mean patient age was 76.8 years with a male:female ratio 1:1.83 and median follow-up 49.2 months. Treatment options included open reduction and internal fixation (ORIF), revision arthroplasty using cementless modular and monoblock long-stems ± distal locking, cement-in-cement revision and cemented long-stem revision ± impaction bone grafting.</p><p><strong>Conclusions: </strong>Management of B2 PFFs around cemented PTS stems is complex and aims to obtain stable fracture and stem fixation. Options include ORIF, cement-in-cement and cementless revision. The optimal choice depends on a combination of patient, fracture and surgeon factors. This review has proposed an algorithm to aid in decision making.</p><p><strong>Level of evidence: </strong>III; systematic scoping review.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104110"},"PeriodicalIF":2.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830888","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}

{"title":"Extension patellar engagement index: a new measurement of patellar height.","authors":"Vincent Chassaing, Marie-Dominique Chancelier, Jean-Louis Blin, Jonathan Curado, Jean-Marc Zeitoun","doi":"10.1016/j.otsr.2024.104086","DOIUrl":"10.1016/j.otsr.2024.104086","url":null,"abstract":"<p><strong>Introduction: </strong>Patellar instability is a multifactorial pathology requiring precise evaluation of its contributing factors, particularly patella alta. Patellotibial height measurement indexes, such as the Caton-Deschamps index, have the disadvantage of being referenced to the tibia. Patellotrochlear indexes are more appropriate but fail to account for variable knee flexion during magnetic resonance imaging (MRI).</p><p><strong>Objective: </strong>This study aims to validate a new MRI-based patellotrochlear measurement, the extension patellar engagement (EPE) index, which is reproducible and measures patellar height relative to the trochlea independently of knee flexion during MRI.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on 77 MRIs (37 unstable patients with a history of patellar dislocation, 40 controls with meniscal injury). The EPE index is the ratio between the patellar engagement length on the cartilaginous trochlea and the patellar cartilage length, measured on a knee virtually extended. Four measurements on multiple sagittal slices were used to calculate the EPE index.</p><p><strong>Results: </strong>The inteobserver intraclass correlation coefficient (ICC) was excellent (0.79). The mean EPE index's value for all knees was 0.22. It was significantly higher (p = 0.034) in the instability group (0.26) compared to the control group (0.19). The average knee flexion during MRI was 11 ° (range: -8 ° to 25 °).</p><p><strong>Discussion: </strong>The EPE index is reproducible. It is an anatomical index to classify patella alta when the patella does not reach the trochlea in knee extension (EPE index ≤0). It is also a functional index, with a mean value of 0.19 in the control group.</p><p><strong>Conclusion: </strong>The EPE index measures the patellar engagement on the trochlea taking into account the knee flexion during MRI. It may guide surgical decision-making for patellar distalization and quantify the required correction.</p><p><strong>Level of evidence: </strong>III; retrospective comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104086"},"PeriodicalIF":2.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822898","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}

{"title":"Development and validity evidence of an interactive 3D model for thoracic and lumbar spinal fractures pedagogy: a first step of validity study.","authors":"Léonard Swann Chatelain, Emmanuelle Ferrero, Pierre Guigui, Christian Garreau de Loubresse, Dan Benhamou, Antonia Blanié","doi":"10.1016/j.otsr.2024.104084","DOIUrl":"10.1016/j.otsr.2024.104084","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thoracic and lumbar spinal fractures are common in trauma care, requiring accurate classification to guide appropriate treatment. While traditional teaching methods use static 2D images, there is a growing need for interactive tools to improve understanding. This study addresses the lack of interactive three-dimensional (3D) models for teaching the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine classification for thoracic and lumbar fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;A free and open-access interactive 3D model of thoracic and lumbar spinal fractures was developed. The study aimed to provide preliminary validity evidence. We hypothesized that this model would be a valid educational tool for teaching the AO Spine classification, receiving high scores from senior spine surgeons on a validation questionnaire regarding anatomical realism and pedagogical value. The primary endpoint was the percentage of surgeons rating the model ≥8/10 on the Likert scale for content validation. We hypothesized that the 3D model would be validated by at least 75% of participating senior spine surgeons (rating ≥8/10) for anatomical realism and pedagogical value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The 3D model was created using the Blender® software, incorporating CT-scan images of a lumbar spine. AO Spine classification was used to recreate spinal fractures animations. The model could be used on any computer or smartphone, directly online. A total of 24 senior spine surgeons (5 professors, 6 fellows, 8 hospital practitioners, and 5 private practitioners) evaluated the 3D model using a structured questionnaire with seven Likert-scale items, assessing anatomical realism, fracture representation, adherence to the AO Spine classification, pedagogical value, and ease of use. A score of ≥8/10 was considered a positive validation. Group comparisons were made based on hospital activity and age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 3D model was positively validated by 92% of surgeons for anatomical realism, 88% for fracture representation, and 92% for adherence to the AO Spine classification. The model's educational value for junior residents was rated positively by 100% of participants. Six out of 24 surgeons (25%) rated the ease of navigation &lt;8/10. Group comparisons revealed that university-affiliated surgeons rated the model higher overall (mean score 9.25/10) compared to private practitioners, who gave the lowest ratings (mean score 8.6/10). No significant correlation was found between age and ease of navigation (p = 0.948).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The developed 3D model of thoracic and lumbar spine fractures is the first of its kind. It provides an innovative, open-access and freely online accessible tool for teaching the AO Spine classification. The findings demonstrate that it is a valid pedagogical tool for teaching the AO Spine classification, with strong support for its anatomical accuracy and pedagogical effect","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104084"},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803520","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}

{"title":"Variation in lumbar regional kyphosis between supine and standing positions. Implications for spinal fracture management.","authors":"Marc Khalifé, Emmanuelle Ferrero, Wafa Skalli, Pierre Guigui, Claudio Vergari, Laura Marie-Hardy","doi":"10.1016/j.otsr.2024.104085","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.104085","url":null,"abstract":"<p><strong>Purpose: </strong>The variation of lumbar lordosis between standing and supine position is poorly explored in literature. This study sought to analyze variation of lumbar regional angulations (RA) in healthy volunteers between standing and supine positions, according to pelvic incidence (PI).</p><p><strong>Methods: </strong>This study included 171 patients who had an abdominal CT-scan in supine position and 879 healthy volunteers with full-body stereoradiographs. The two populations were matched using a propensity score including age, PI, and sex. PI and RAs for all vertebrae from T12 to L5 (measured between the overlying vertebra's upper endplate of and the underlying vertebra's lower endplate) were assessed. Studied parameters were compared between Supine and Standing groups in the whole cohort and in every PI group. Multivariate analysis was performed to ascertain the effect of position change.</p><p><strong>Results: </strong>The analysis was performed on 314 subjects (157 matched in each group). In the overall cohort, all RAs from L1 to L4 were more lordotic in the Standing group, ranging from 3 to 8° difference (all p < 0.001), while T12 and L5 RAs were comparable in both groups (p = 0.55 and 0.49, respectively). Multivariate analysis confirmed the significant associations between subject's position and all RAs except for L5 and T12. RA variation between positions occurred at more vertebral levels and tended to be greater in higher PI groups.</p><p><strong>Conclusion: </strong>RA values in the lumbar spine are more lordotic in standing position than supine, except for T12 and L5. These results help estimate RA in Standing position in patients with lumbar fractures.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104085"},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814669","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}

{"title":"Unicompartmental knee arthroplasty implant survival in patients with borderline indications.","authors":"Grégoire Vaz, Florian Collignon, Elodie Jeanbert, Laurent Galois, François Sirveaux, Olivier Roche, Andrea Fernandez","doi":"10.1016/j.otsr.2024.104083","DOIUrl":"10.1016/j.otsr.2024.104083","url":null,"abstract":"<p><strong>Introduction: </strong>In the literature, 80%-92% of patients are satisfied with their medial femorotibial unicompartmental knee arthroplasties (UKAs). These results are associated with a 10-year implant survival rates ranging from 94% to 98% in various studies. Such outcomes are generally reported after excluding patients with obesity, chronic anterior instability, frontal deformities, or preoperative knee flexion deformities exceeding 10 °. These contraindications remain controversial in the literature. The primary objective of this study was to compare the survival rates of implants used for medial femorotibial UKA performed under borderline indications with those of procedures performed under conventional indications and to identify the prognostic factors for revision surgery.</p><p><strong>Hypothesis: </strong>We hypothesized that the survival of medial femorotibial UKAs is not impacted by these contraindications.</p><p><strong>Materials and methods: </strong>This was a retrospective, single-center, observational, epidemiological study. All consenting patients who underwent medial femorotibial UKA between 2009 and 2015 were included. Patients who underwent other types of arthroplasties concurrently were excluded. The primary evaluation criterion was implant survival, which was characterized by no need for revision surgery. The borderline indications were defined as follows: obesity (Body Mass index BMI > 30), anterior cruciate ligament (ACL) deficiency, preoperative lower limb frontal deviation ≥10 °, or preoperative flexion deformity ≥10 °.</p><p><strong>Results: </strong>A total of 468 patients were included, and the average follow-up duration was 8.5 years [7.1; 10.3]. Among them, 270 (57.7%) underwent UKA under at least one borderline indication, whereas 198 (42.3%) underwent UKA under conventional indications. Forty revision surgeries were recorded, and the average time to revision surgery was 26 months. No statistically significant difference in survival was observed between patients with borderline indications and those with conventional indications. Multivariate analysis revealed that obesity (HR = 3.0 [1.5-5.7]) and ACL deficiency (HR = 3.5 [1.4-8.8]) significantly increased the risk of revision surgery.</p><p><strong>Discussion: </strong>This study revealed no significant difference in survival between UKAs performed under borderline versus conventional indications. Larger studies are needed to confirm these findings.</p><p><strong>Level of evidence: </strong>IV; retrospective observational study. Mots clés: genou, arthroplastie, obésité, ostéoarthrite, survie.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104083"},"PeriodicalIF":2.3,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803521","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}

{"title":"Effectiveness of adductor canal block combined with posterior capsular infiltration on pain and return to walking after total knee arthroplasty: comparative analysis with femoral and popliteal sciatic nerves blocks.","authors":"Siam Knecht, Lyna Tamine, Nicolas Faure, Pierre Tran, Jean-Christophe Orban, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi","doi":"10.1016/j.otsr.2024.104082","DOIUrl":"10.1016/j.otsr.2024.104082","url":null,"abstract":"<p><strong>Introduction: </strong>Perioperative analgesia after total knee arthroplasty (TKA) reduces morphine consumption and speeds up rehabilitation. The primary objective of this study was to compare the pain experienced by patients with an adductor canal and posterior capsule block with those with a continuous femoral nerve block combined with a popliteal sciatic nerve block. The secondary objectives were to analyze the time to recovery from early walking, length of hospital stay, and block-related complications between the two groups.</p><p><strong>Hypothesis: </strong>Patients with an adductor canal block and posterior capsular infiltration had less pain 24 h after TKA.</p><p><strong>Material and methods: </strong>This single-center retrospective study included 774 TKA between January 2020 and March 2023. Two types of locoregional blocks were evaluated: patients who had a continuous femoral nerve block with a single-shot popliteal sciatic nerve block (FN-PSN group) operated on before March 2022 and those who had a single-shot adductor canal block combined with posterior capsular infiltration (ACB-PI group) operated on after March 2022. One patient in the ACB-PI group was matched to two patients in the NF-BS group according to sex, age, and BMI. A total of 725 TKA were included: 500 in the FN-PSN group and 225 in the ACB-PI group. The primary endpoint was pain assessed using the numerical pain rating scale (NPRS) and opioid consumption at 24 h after TKA. Resumption of walking, defined as getting up for the first time and walking ten steps until discharge from the hospital, and complications between the two groups were also assessed. The study population consisted of 471 women (64.9%) with a mean age of 72.2 ± 8.2 years and a mean BMI of 28.2 ± 4.6.</p><p><strong>Results: </strong>Patients in the FN-PSN group had less pain at NPRS (1.3 versus 1.9; p < 0.001), and fewer patients required morphine titration (13.8% versus 6.8%, p = 0.02) within the first 8 h of surgery with no difference at 24 h, 48 h and 72 h. The mean doses of morphine administered were similar between the groups. Resumption of walking was significantly longer in the FN-PSN group (1.5 versus 2.0 days, p = 0.003), and hospitalization times and complications were similar between the groups.</p><p><strong>Conclusion: </strong>Adductor canal block combined with posterior capsular infiltration did not reduce postoperative pain compared with femoral and popliteal sciatic block at 24 h after TKA. Opioid consumption and pain were similar between the groups, with more patients requiring morphine in the first eight hours in the ACB-PI group but with a faster return to walking.</p><p><strong>Level of evidence: </strong>III; comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104082"},"PeriodicalIF":2.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792861","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}

{"title":"Triangular pelvic fixation in the management of adult spinal deformities: technical note and preliminary results.","authors":"Solène Prost, Sébastien Pesenti, Stéphane Bourret, Romain Ambrosino, Stéphane Fuentes, Jean-Charles Le Huec, Benjamin Blondel","doi":"10.1016/j.otsr.2024.104081","DOIUrl":"10.1016/j.otsr.2024.104081","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Optimal choice of the lower instrumented vertebra in the management of adult spinal deformity that include lumbosacral junction is still unclear. It is therefore possible to stop fixation in S1 but also lower (S2AI or iliac screws) in order to reduce the risk of implants pullout. In such situations, mechanical solicitations can lead to secondary degradation of sacro-iliac joints.</p><p><strong>Technique and results: </strong>Based on triangular pelvic fixation described for pelvic trauma, a posterior only fixation that combine S1 screws, iliac screws and sacro-iliac implants can be performed.</p><p><strong>Discussion: </strong>We are describing here the operative technique of this « bedrock » fixation under fluoroscopic guidance and its preliminary results about 15 patients.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104081"},"PeriodicalIF":2.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792863","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}

{"title":"Comparing performances of french orthopaedic surgery residents with the artificial intelligence ChatGPT-4/4o in the French diploma exams of orthopaedic and trauma surgery.","authors":"Nabih Maraqa, Ramy Samargandi, Antoine Poichotte, Julien Berhouet, Rayane Benhenneda","doi":"10.1016/j.otsr.2024.104080","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.104080","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates the performance of ChatGPT, particularly its versions 4 and 4o, in answering questions from the French orthopedic and trauma surgery exam (Diplôme d'Études Spécialisées, DES), compared to the results of French orthopedic surgery residents. Previous research has examined ChatGPT's capabilities across various medical specialties and exams, with mixed results, especially in the interpretation of complex radiological images.</p><p><strong>Hypothesis: </strong>ChatGPT version 4o was capable of achieving a score equal to or higher (not lower) than that of residents for the DES exam.</p><p><strong>Methods: </strong>The response capabilities of the ChatGPT model, versions 4 and 4o, were evaluated and compared to the results of residents for 250 questions taken from the DES exams from 2020 to 2024. A secondary analysis focused on the differences in the AI's performance based on the type of data being analyzed (text or images) and the topic of the questions.</p><p><strong>Results: </strong>The score achieved by ChatGPT-4o was equivalent to that of residents over the past five years: 74.8% for ChatGPT-4o vs. 70.8% for residents (p = 0.32). The accuracy rate of ChatGPT was significantly higher in its latest version 4o compared to version 4 (58.8%, p = 0.0001). Secondary subgroup analysis revealed a performance deficiency of the AI in analyzing graphical images (success rates of 48% and 65% for ChatGPT-4 and 4o, respectively). ChatGPT-4o showed superior performance to version 4 when the topics involved the spine, pediatrics, and lower limb.</p><p><strong>Conclusion: </strong>The performance of ChatGPT-4o is equivalent to that of French students in answering questions from the DES in orthopedic and trauma surgery. Significant progress has been observed between versions 4 and 4o. The analysis of questions involving iconography remains a notable challenge for the current versions of ChatGPT, with a tendency for the AI to perform less effectively compared to questions requiring only text analysis.</p><p><strong>Level of evidence: </strong>IV; Retrospective Observational Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104080"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792860","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}

{"title":"Can we trust the accuracy of the automatic calibration of the EOS system to measure lower limb length inequality after total hip arthroplasty? Comparison of EOS versus manual measurement on 110 calibrated radiographs.","authors":"Pierre Klein, Mehdi Hormi-Ménard, Roger Erivan, François Bonnomet, Pablo Lamotte-Paulet, Alain Duhamel, Henri Migaud","doi":"10.1016/j.otsr.2024.104079","DOIUrl":"10.1016/j.otsr.2024.104079","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Traditionally, to determine a length on a limb radiograph after total hip arthroplasty (THA), calibration is performed manually with the diameter of a ball or the femoral head. More recently, the development of EOS with automatic calibration has called into question the usefulness of manual calibration to highlight lower limb length inequality (LLLI). However, the validation of EOS with automatic calibration without landmarks to measure length inequalities on large images has not been verified against manual measurements on calibrated radiographs (conventional method), which motivated the present work.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;EOS is more accurate and reproducible from one reader to another in highlighting LLLI after THA than the classic method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;One hundred and ten patients included underwent primary THA surgery in 2 centers, with postoperative EOS performed. This EOS was extracted in 2 formats: a DICOM file with automatic calibration and an uncalibrated JPEG file (220 radiographic files in total). Two readers, without knowledge of the clinical data, each analyzed all of these images using 2 methods: by measuring the distance between the center of the femoral head and the center of the mortise on the operated side and the non-operated side on the DICOM file, therefore via the software integrated into the EOS image (method 1), or by measuring these same distances on the JPEG file by calibrating the measurement to the diameter of the prosthetic head (method 2). The reproducibility of the measurements from one reader to another (inter-observer reproducibility) and the agreement of the measurements between the 2 methods (inter-method agreement) were evaluated using the intraclass correlation coefficient (ICC) and the Bland- Altman graphic method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Inter-method agreement was satisfactory regardless of the reader but with a significantly higher agreement for reader 1 (inter-method agreement for reader 1: CL1 = 0.95 and for reader 2: CL2 = 0.90 (p = 0.008)) and this result was also confirmed by the Bland-Altman plot with no bias tendency for each reader and less than 5% of measurements that were outside the agreement band. Inter-observer reproducibility for method 1 was better than that for method 2 to highlight an LLLI after THA according to the CCI. Inter-observer reproducibility for method 1 (RM1) was 0.96 and 0.92 for method 2 (RM2) (p = 0.009). This result was confirmed by the Bland-Altman plot with a mean difference of less than 1 mm for each of the methods (-0.2 (standard deviation = 2.23) and 0.81 (3.03) for method 1 and method 2 respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Our hypothesis has therefore been partially verified. The use of the calibrated software integrated into the EOS system and manual calibration are two valid methods for searching for an LLLI. The measurements remain more reproducible from one reader to ","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104079"},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792859","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}

{"title":"Is pre-operative block-test with lidocaine injection efficient in predicting the functional result of revision total hip arthroplasty?","authors":"Maxime Wolf, Philippe-Alexandre Faure, Julien Dartus, Thomas Amouyel, Hélène Behal, Julien Girard, Henri Migaud, Pierre Martinot","doi":"10.1016/j.otsr.2024.104075","DOIUrl":"10.1016/j.otsr.2024.104075","url":null,"abstract":"<p><strong>Background: </strong>While performing a hip joint aspiration for culture, a lidocaine diagnostic injection called block test can be performed during the investigation of painful total hip arthroplasties (THA). This test was formerly applied to limited series in pre-operative and without assessing the predictive value on the results of THA revision. Therefore we investigated a consecutive series of THA revisions who underwent pre-operative aspiration-block test to determine if patients with pre-operative positive block test (disappearance of symptoms) have a better clinical improvement after revision.</p><p><strong>Hypothesis: </strong>The positive pre-operative block test has a positive predictive value greater than 80% in predicting the favourable result of THA revisions.</p><p><strong>Materials and methods: </strong>We reviewed 152 patients who had a hip aspiration associated with a block test before their THA revision. The patients were evaluated according to the Oxford hip score (OHS). The primary outcome was considered positive if the patient presented an improvement in the OHS greater than the Minimal Clinically Important Difference (MCID; 9 points) and/or if the postoperative OHS was higher than the Patient Acceptable Symptom State (PASS, defined as 39/48).</p><p><strong>Results: </strong>Block tests were positive for 61.2% (93/152) of patients. The median improvement in the OHS was 23.0 [IQR 16.0; 30.0] if the block test was positive versus 16.0 [IQR 4.0; 17.0] if negative (p = 0.002). The primary outcome after revision was strongly associated with block test positivity (p < 0.0001). The positive block test had a 67.7% sensitivity, 73.3% specificity, 91.4% Positive Predictive Value and 37.3% Negative Predictive Value for significant improvement after revision surgery.</p><p><strong>Conclusion: </strong>Hip joint aspiration for culture with concomitant block test seems to be an interesting tool in predicting outcomes of revision surgery for painful THA.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104075"},"PeriodicalIF":2.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755765","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}