Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"In proximal tibial anterior closing wedge (slope changing) osteotomy lower starting points imply larger bone resection.","authors":"Youngji Kim, Shintaro Onishi, Mitsuaki Kubota, Raghbir Khakha, Muneaki Ishijima, Matthieu Ollivier","doi":"10.1016/j.otsr.2024.103979","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103979","url":null,"abstract":"<p><strong>Background: </strong>Anterior closing wedge osteotomy (ACWO) for tibial slope correction is a validated procedure in revision anterior cruciate ligament reconstruction (ACLR). This study aims to determine how different starting points of the osteotomy affect the amount of bone resection in ACWO.</p><p><strong>Hypothesis: </strong>We hypothesized that the lower osteotomy starting points in ACWO imply larger bone resection.</p><p><strong>Patients and methods: </strong>A total 52 patients who underwent ACWO using infra-tuberosity technique in our institution were included in this study. Each of patients was simulated using additional two separate methods (based on osteotomy level: supra- and trans-tuberosity) based on lateral calibrated pre-operative X-rays of the whole tibia according to the post-operative correction angle. The resection height of the closing wedge, which corresponded to the base of the osteotomy, was measured and compared among the three groups.</p><p><strong>Results: </strong>The mean actual pre-operative proximal posterior tibial angle (PPTA) was 75.8 ± 2.0°. Post-operatively, PPTA was 84.0 ± 0.6°, and correction angle was 8.2 ± 2.2°. The mean resection height in the supra-tuberosity group was 7.5 ± 0.2 mm, 8.0 ± 2.1 mm in the trans-tuberosity group, and 9.2 ± 2.1 mm in the infra-tuberosity group. There were significant differences between each approach (p ≦ 0.0001). Resection height was moderate positively correlated with the starting point of osteotomy (r = 0.33, 95%CI: 0.18-0.46, p < 0.0001).</p><p><strong>Conclusion: </strong>This study suggests that selecting a distal starting point for the osteotomy in ACWO is directly proportional to the observed increase in bone resection, providing valuable insights for pre-operative planning. These findings are clinically relevant and will aid in preoperatively deciding approach in ACWO.</p><p><strong>Level of evidence: </strong>IV; retrospective case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094221","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":"Mid to long-term survivorship of hip arthroplasty in patients 40 years and younger.","authors":"Camille Vorimore, Andrew Adamczyk, Pierre Laboudie, Marc Antoine Ricard, Paul E Beaule, George Grammatopoulos","doi":"10.1016/j.otsr.2024.103978","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103978","url":null,"abstract":"<p><strong>Background: </strong>Etiology of hip osteoarthritis (OA) and survival of hip arthroplasty in the young (below 40-years-old) remains poorly described. Furthermore, joint survivorship mid to long-term and PROMs according to the etiology are unclear. The study aims were to 1) identify the indications for arthroplasty in the below 40-years-old cohort; 2) define hip arthroplasty outcomes in the young and 3) test whether patients with sequelae of pediatrics hip disease have inferior outcome compared to other patients.</p><p><strong>Hypothesis: </strong>Our hypothesis was that hip arthroplasty is a viable option for managing hip disease in patients under 40, with excellent survival rates and outcomes.</p><p><strong>Material and methods: </strong>This is an IRB approved, retrospective, consecutive, multi-surgeon, cohort study from a single academic center. Indication for hip arthroplasty of 346 patients (410 hips) below 40-years-old were studied; 239 underwent THA (58%) and 171 hip resurfacing (42%). Patient, surgical and implant factors were tested for association with implant survivorship and functional outcome for hip arthroplasty performed with a follow-up of more than two years. Pediatric hip sequelae patients were compared for survival and PROMs with the rest of the cohort.</p><p><strong>Results: </strong>The most common etiology of OA was FAI (47%), followed by pediatric hip sequelae (18%). The 10-year survivorship was 97.2% ± 1.2, mean OHS was 45.1 ± 6.3 and mean HHS was 93.4 ± 12.6. The pediatric hip sequelae subgroup demonstrated no differences in 10-year survivorship and better PROMs compared to rest (OHS: 46.6 ± 3.8; HHS: 96.0 ± 8.5).</p><p><strong>Discussion: </strong>The most common aetiologies amongst the young with hip OA is FAI and pediatric hip sequelae. Hip arthroplasty in the young presents excellent 10-year survivorship and PROMs. Excellent survival and PROMs in the young with pediatric hip sequelae provide important information for decision-making in this challenging population.</p><p><strong>Level of evidence: </strong>III; retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094158","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":"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":"<p><p>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. LEVEL OF EVIDENCE: IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","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}

{"title":"Benefits of a spine team for the surgical management of paediatric scoliosis.","authors":"Florence Julien-Marsollier, Pierre Pardessus, Kelly Brouns, Adèle Happiette, Souhayl Dahmani, Brice Ilharreborde","doi":"10.1016/j.otsr.2024.103976","DOIUrl":"10.1016/j.otsr.2024.103976","url":null,"abstract":"<p><strong>Background: </strong>For many years, blood-saving techniques and the enhanced recovery after surgery approach have been used to optimise the quality of care and shorten hospital stays. The creation of dedicated spine teams combining surgeons and anaesthesiologists specialised in spine surgery has been proven beneficial in adults. The objective of this study was to determine whether involving a spine team in the management of paediatric patients with scoliosis treated by posterior spinal fusion was associated with shorter hospital stays.</p><p><strong>Hypothesis: </strong>The hospital stay would be shorter in patients managed by a spine team.</p><p><strong>Materials and methods: </strong>This single-centre, non-randomised, comparative study was initiated after approval by the local ethics committee. One group of patients was managed by a spine team composed of an anaesthesiologist and a surgeon with over 10 years of experience and the control group by an anaesthesiologist and a surgeon with less than 5 years of experience. The primary outcome was hospital stay length (median [interquartile range]).</p><p><strong>Results: </strong>The study included 157 paediatric patients who underwent spinal fusion in 2021 for adolescent idiopathic scoliosis (AIS, n = 106) or secondary scoliosis (n = 51). The spinal team was involved for 48 (45%) AIS procedures and 38 (74.5%) secondary-scoliosis procedures. Both operative time and anaesthesia time were significantly shorter in the spinal-team group, by 10% and 15% (p < 0.001 for both comparisons), respectively, for SIA and by 20% (p = 0.002) and 25% (p < 0.001), respectively, for secondary scoliosis. The spinal-team group had a shorter median hospital stay, the difference being significant for AIS (in days, 5 [4-7] versus 7.1 [5-10], p = 0.03) and nearly significant for secondary scoliosis (6.9 [5-10] versus 9 [6-23], p = 0.07). Fewer patients required blood transfusion in the spine-team group than in the control group (AIS: 0% versus 8.8%, p = 0.05; and secondary scoliosis, 28% versus 58%, p<0.01).</p><p><strong>Conclusion: </strong>Involvement of a spine team optimises the peri-operative management of patients with AIS, thus shortening the hospital stay. Further work is needed to assess the potential associations of spine team involvement with complication rates.</p><p><strong>Level of evidence: </strong>III; non-randomised comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057244","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":"Opportunistic CT screening demonstrates increased risk for peri-articular fractures in osteoporotic patients.","authors":"Jared Reid, Matthew McCrosson, Jacqueline Tobin, Gabriella Rivas, Stacey Rothwell, Langdon Hartsock, Kristoff Reid","doi":"10.1016/j.otsr.2024.103935","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103935","url":null,"abstract":"<p><strong>Background: </strong>Underdiagnosis or undertreatment of osteoporosis consequently impacts individual morbidity and mortality, as well as on healthcare systems and communities as a whole. Dual-energy x-ray absorptiometry (DXA) is the gold standard method for identifying osteoporosis, however, opportunistic CT screening is capable of precisely estimating bone mineral density (BMD) in abdominopelvic imaging with no additional cost, radiation exposure or inconvenience to patients. This study uses opportunistic CT screening to determine the prevalence of osteoporosis and anatomic distribution patterns in patients presenting with lower extremity fractures at our institution.</p><p><strong>Hypothesis: </strong>Trauma patients with low bone mineral density (BMD) are more likely to present with peri-articular versus shaft fractures.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of 721 patients presenting as trauma activations to the emergency department (ED) of a Level 1 Trauma Center with lower extremity fractures. Patients were excluded if under the age of 18 or lacking a CT scan upon arrival in the ED. Hounsfield Units (HU) were measured at the L1 vertebral level on CT scans to determine bone mineral density. Values of ≤100 HU were consistent with osteoporosis, whereas 101-150 HU were consistent with osteopenia.</p><p><strong>Results: </strong>The final cohort included 416 patients, with mean age of 49 ± 21 years. Average bone density was 203.9 ± 73.4 HU. 15.9% of patients were diagnosed as osteopenic and 9.9% as osteoporotic. 64.2% of fractures were peri-articular, 25.7% were shaft, and 10.1% were a combination. Peri-articular fractures were significantly more likely to have lower average BMD than shaft fractures (189 ± 74.7 HU vs. 230.6 ± 66.1 HU, p < 0.001).</p><p><strong>Discussion: </strong>Our study demonstrates a significant relationship between low bone mineral density and lower extremity fracture pattern, however, likely influenced by other factors such as sex. Opportunistic CT screening for osteoporosis in trauma settings provides ample opportunity for early detection of low BMD and implementation of highly effective lifestyle modification and pharmacotherapy intervention. Reduction in the overall incidence of peri-articular fracture with widespread adoption of opportunistic CT screening may lessen the morbidity, mortality, and total cost currently afflicting patients, healthcare systems, and communities.</p><p><strong>Level of evidence: </strong>III, therapeutic.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001332","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":"Microsurgery and vasospasms: Spasms' predictive factors during harvesting.","authors":"Germain Pomares, Amandine Ledoux, Thomas Jager, Christophe Duysens, Alban Fouasson-Chailloux","doi":"10.1016/j.otsr.2024.103966","DOIUrl":"10.1016/j.otsr.2024.103966","url":null,"abstract":"<p><strong>Background: </strong>Vasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited.</p><p><strong>Hypothesis: </strong>Our objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses.</p><p><strong>Patients and methods: </strong>Primary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer.</p><p><strong>Results: </strong>In this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert's classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009).</p><p><strong>Discussion: </strong>The occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894896","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":"Analysis of risk factors for modification of femoral offset after internal fixation of Garden I and II femoral neck fractures.","authors":"Thomas Druart, Nicolas Fréger, Pierre Pries, Alexandre Losson, Pierre Bouget, Tanguy Vendeuvre, Mathieu Severyns","doi":"10.1016/j.otsr.2024.103967","DOIUrl":"10.1016/j.otsr.2024.103967","url":null,"abstract":"<p><strong>Background: </strong>The concept of restoring the femoral offset is well established during hip replacement surgery, but is less well known when treating Garden I or II femoral neck fractures by internal fixation. And yet, the therapeutic aim for these fractures is to restore this native parameter as best possible. The aim of this study was to identify the risk factors for reduction of femoral offset after union of a Garden I or II femoral neck fracture treated by internal fixation.</p><p><strong>Hypothesis: </strong>After internal fixation of a femoral neck fracture, certain factors may contribute to reducing the femoral offset, which itself has been identified as being responsible for altering the patients' quality of life and functional outcomes.</p><p><strong>Materials and methods: </strong>This multicenter study included 193 patients who had a Garden I or II femoral neck fracture treated by cannulated screws or a sliding compression screw-plate. The difference between the femoral offset in the operated hip and that of the contralateral hip was measured in weightbearing patients after the fracture had healed. This difference was the primary outcome measure. Univariate and multivariate analyses were done to look for risk factors contributing to femoral neck shortening.</p><p><strong>Results: </strong>Based on the univariate analysis, being more than 85 years of age, having a Garden I fracture, and cannulated screw fixation were associated with a significantly greater reduction in the femoral offset. In the multivariate analysis, only Garden I fractures were associated with a greater reduction in femoral offset.</p><p><strong>Discussion: </strong>Garden I fractures were associated with a greater reduction in the offset, although there was no evidence that this change was related to early weightbearing. By identifying this risk factor, surgeons can optimize the indications given that the treatment of these fractures is still widely debated and there is still no consensus as to the best method.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894895","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":"Do the porous custom implants have a position consistent with the planning and allow anatomical reconstruction of hip center of rotation in complex acetabular revisions Paprosky III?","authors":"Constant Foissey, Sophie Putman, Adrien Zampieri, Henri Migaud, Julien Dartus","doi":"10.1016/j.otsr.2024.103936","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103936","url":null,"abstract":"<p><strong>Introduction: </strong>In revision total hip arthroplasty (THA), the advent of porous custom-made triflange acetabular implants with 3D scan planning offers a new perspective to improve implantation accuracy and anatomical restoration of the center of rotation (COR). This issue was investigated using CT-scan as the measurement tool, but in limited series (±10 cases) and without investigating the factors that may influence errors in positioning. Therefore we performed a retrospective study aiming to: (1) assess the placement accuracy of such implants with respect to the preoperative planning, (2) examine whether the volume of bone to be resected in order to apply the implant had an impact on this accuracy, (3) assess if errors in position at surgery had any influence on function, complications and survival.</p><p><strong>Hypothesis: </strong>Preoperative planning could be accurately reproduced when implanting porous custom-made acetabular implants, and that accuracy would decrease in proportion to the volume of bone to be resected METHOD: Twenty patients undergoing THA revision with porous custom-made acetabular implants were included in this single-center retrospective study. Mean follow-up was 17.9 months ± 9.4 [2-45.1]. Preoperative planning was performed using 3D scanographic modeling. A post-operative CT scan was performed to assess implantation accuracy in terms of orientation and COR restitution. Demographic data, Oxford scores, complications and survival were recorded.</p><p><strong>Results: </strong>Mean deviation from the preoperative planning in inclination, anteversion and rotation were 4.3 ° ± 2.5, 6.1 ° ± 4.7, and 7 ° ± 4.6, respectively. Restoration of the COR showed a mean deviation of 2.1 ± 1.3 mm anteroposteriorly, 2.5 ± 2 mm mediolaterally and 2.2 ± 1.3 mm proximodistally. In total, 45% (9/20) of implants were positioned with perfect restoration of orientation (±10 °) and COR (±5 mm). The mean planned bone resection was 8.1 ± 4.9 cm³, with placement accuracy and COR restitution decreasing significantly when the volume of bone to be resected exceeded 2.7 cm³. One dislocation was found (5%, 1/20). Survival at last follow-up was 100%, the mean Oxford score at follow-up was 31.7 ± 7.9 [16-52], without being influenced by errors in position or COR restitution.</p><p><strong>Conclusion: </strong>In total 45% of the implants restored an orientation and a COR as planned, particularly when the volume of bone to be resected is less than 2.7 cm3. Although these are complex cases with large amounts of bone loss, 3D manufacturing could give us hope of greater precision. The link between better precision and low bone resection volume could be an area to develop with the manufacturer in order to improve results.</p><p><strong>Level of evidence: </strong>III; diagnostic using CT in transversal retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879816","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 the minimal clinically important difference (MCID) for the Oxford score, KOOS and its derivatives be identified in a French sample of total knee arthroplasties?","authors":"Tom Roussel, Julien Dartus, Gilles Pasquier, Alain Duhamel, Cristian Preda, Henri Migaud, Sophie Putman","doi":"10.1016/j.otsr.2024.103965","DOIUrl":"10.1016/j.otsr.2024.103965","url":null,"abstract":"<p><strong>Context: </strong>To assess the effect of a surgical procedure on a patient, it is conventional to use clinical scores before and after the procedure, but it is increasingly common and recommended to weight the results of these scores with the notion of minimal clinically important difference (\"MCID\"). This MCID should be determined using either the data distribution method based on score variation, or the anchor method, which uses an external question to categorize the results. MCIDs vary from one population to another, and to our knowledge there has been no investigation in France for total knee arthroplasties (TKAs). We therefore conducted a prospective study on a population of TKAs in order to: 1) Define MCID in France on a population of TKAs for the Oxford score, KOOS (Knee injury and Osteoarthritis Outcome Score) and its derivatives, 2) Determine whether MCID for these scores in France is comparable to results in the literature.</p><p><strong>Hypothesis: </strong>Is the MCID for total knee arthroplasty in France comparable to other results in the literature?</p><p><strong>Material and method: </strong>This was a prospective observational study in which 218 patients (85 men, 133 women) with a mean age of 72 years [27-90] who had undergone a primary TKA out of 300 initially included responded, before and after surgery, to the Oxford-12, KOOS and Forgotten Joint Score (FJS) questions (mean follow-up 24 months). MCID was calculated using the distribution method as well as the anchor method (\"improvement 1 to 5\" and \"improvement yes or no\").</p><p><strong>Results: </strong>At a mean follow-up of 24 months [18-36], the Oxford-12 score increased from 16 ± 8 [0-41] to 34 ± 11 [6-48] (p < 0.001), all components of the KOOS score were improved and the FJS at follow-up was 47 ± 32 [0-100]. For the anchor \"improvement 1 to 5\", there were 14 unimproved patients, 23 patients in identical condition and 179 patients improved by surgery. For the anchor \"are you improved yes/no\", there were 8 unimproved patients, 22 in identical condition and 187 surgically-improved patients. The mean MCID for all methods (anchor method and distribution) was 10 [7-13] for Oxford-12, 12 [12-12] for KOOS Symptom, 14 [12-17] for KOOS Pain, 12 [11-14] for KOOS Function, 14 [12-16] for KOOS Sport, 15 [15-16] for KOOS Quality of Life (QOL), 11 [10-12] for KOOS 12, 15 [12-18] for KOOS 12 Pa in. 12 [12-13] for KOOS 12 Function, 15 [15-15] for KOOS 12 QOL, 14 [13-14] for KOOS Physical Function Short-form (PS) and 14 [13-16] for KOOS Joint Replacement (JR).</p><p><strong>Discussion: </strong>The MCID for the Oxford-12, KOOS and its derivatives scores in a French population is comparable to that observed in other populations in the literature.</p><p><strong>Level of evidence: </strong>IV; prospective study without control group.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876748","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":"Anterior-approach total hip arthroplasty in patients with poliomyelitis: Long-term outcomes","authors":"Grégoire Rougereau ,&nbsp;Bernard Hollier-Larousse ,&nbsp;Thomas Bauer ,&nbsp;François Genêt ,&nbsp;Marjorie Salga ,&nbsp;Fabien Cale","doi":"10.1016/j.otsr.2024.103964","DOIUrl":"10.1016/j.otsr.2024.103964","url":null,"abstract":"<div><h3>Objective</h3><p>In patients with residual poliomyelitis-related impairments, total hip arthroplasty (THA) is challenging due to the high frequency of risk factors such as hip dysplasia, dislocation, muscle weakness, and fracture. The objective of this study was to assess the long-term functional and radiographic outcomes of anterior-approach THA with a ceramic-ceramic, dual-mobility, or constrained implant in patients with poliomyelitis sequelae.</p></div><div><h3>Hypothesis</h3><p>THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable technique that is not associated with excess risks of instability or aseptic loosening.</p></div><div><h3>Material and methods</h3><p>This single-centre retrospective study included consecutive patients with poliomyelitis sequelae who underwent THA between January 1998 and September 2019 via the anterior approach, with implantation of a ceramic-ceramic, dual-mobility, or constrained implant. The Harris Hip Score (HHS), implant position, and complications (e.g., infection and loosening) were collected during the most recent in-person visit.</p></div><div><h3>Results</h3><p>The study included 19 patients (23 hips). Mean follow-up was 5.2 ± 4.2 years (range, 2.0–10.6 years). Only six of the 23 procedures were done on the side with greater muscle weakness. The mean HHS at last follow-up was 80.4 ± 10.4. A single procedure (1/23, 4%) was followed by a complication, consisting in intra-prosthetic dislocation 2 years after implantation of a dual-mobility cup. At last follow-up, the HHS was not associated with psoas and gluteus muscle strength (r_s = 0.35, <em>p</em> = 0.11 and r_s = 0.37, <em>p</em> = 0.09, respectively) and was not significantly different between the weaker vs. stronger side (82.7 ± 8.0 vs. 79.5 ± 11.3, respectively; <em>p</em> = 0.53). Cup position was more horizontal, thereby optimising function, when the procedure was done on the weaker vs. the stronger side (39.9° ± 4.3 vs. 45.0° ± 6.8, respectively; <em>p</em> = 0.02).</p></div><div><h3>Conclusion</h3><p>THA is a good option for improving function in patients with poliomyelitis sequelae. THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable method that is not associated with an excess risk of instability or loosening.</p></div><div><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794109","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}