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Narahashi É, Guimarães JB, Filho AGO, Nico MAC, Silva FD. Measurement of tibial slope using biplanar stereoradiography (EOS®). Skeletal Radiol 2024; 53:1091-1101. [PMID: 38051424 DOI: 10.1007/s00256-023-04528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard. METHODS This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson's correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings. RESULTS The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738-0.883 and 0.870-0.975). CONCLUSIONS Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT.
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Affiliation(s)
- Érica Narahashi
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Flávio Duarte Silva
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
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Charre D, An JS, Khakha R, Kley K, Şahbat Y, Ollivier M. 'One millimetre equals one degree' is a major source of inaccuracy in planning osteotomies around the knee for metaphyseal deformities compared to the digital planning. Knee Surg Sports Traumatol Arthrosc 2024; 32:987-999. [PMID: 38431800 DOI: 10.1002/ksa.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The objective of this study was to compare the accuracy of virtually performed osteotomies around the knee. The comparison was made between the Miniaci method (method 1), considered the gold standard planning, with the widely held dogma that one degree of correction required equates to one millimetre of opening/closing (method 2). METHODS This retrospective cross-sectional study was conducted between December 2018 and September 2022 in patients aged at least 15 years with metaphyseal knee deformity. Osteotomy planning was performed in methods 1 and 2 utilising calibrated long-leg alignment X-rays in the frontal plane. In both methods, the desired correction was defined by the Fujisawa point. The error % in measurement (ratio method 1/method 2) and the difference in millimetres (method 1 - method 2) between the two methods were analysed. RESULTS A total of 107 osteotomies with 27 (25.2%) distal femoral osteotomies, 54 (50.5%) proximal tibial osteotomies and 26 (24.3%) double-level osteotomies were performed virtually with a mean hip-knee-ankle angle of 176.4 ± 6.6. In distal femur osteotomy, the mean error % between methods 1 and 2 was 38.9 ± 16.7% and 22.4 ± 16.8% for the opening and closing groups, respectively. In proximal tibial osteotomies, the mean error % was 22.7 ± 15.6% and 9 ± 10.8% for the opening and closing groups, respectively. In double-level osteotomy, the mean error % of femur-based corrections was 34.9 ± 19% and 19.5 ± 21% for the opening and closing groups, respectively, and the mean error of the tibial-based corrections was 26.4 ± 12.1% for the opening group and 10.8 ± 10% for the closing group, respectively. CONCLUSION Planning one millimeter per degree of desired correction for osteotomies around the knee in metaphyseal deformities is a major source of error when compared with digital planning using the Miniaci method. This was seen most frequently with osteotomies of the distal femur and all opening wedge osteotomies. LEVEL OF EVIDENCE Level Ⅲ, retrospective cross-sectional study.
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Affiliation(s)
- Dimitri Charre
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | - Jae-Sung An
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kristian Kley
- Harley Street Specialist Hospital, London, UK
- Orthopädie Maximilium, Donauwörth, Germany
| | - Yavuz Şahbat
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
- Erzurum Regional Training and Research Hospital, Orthopaedic Surgery and Traumatology, Erzurum, Turkey
| | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
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Wang J, Wang X, Sun B, Yuan L, Zhang K, Yang B. 3D-printed patient-specific instrumentation decreases the variability of patellar height in total knee arthroplasty. Front Surg 2023; 9:954517. [PMID: 36704513 PMCID: PMC9871753 DOI: 10.3389/fsurg.2022.954517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Three-dimensionally (3D) printed patient-specific instrumentation (PSI) might help in this regard with individual design and more accurate osteotomy, but whether the utility of such instrumentations minimizes the variability of patellar height in total knee arthroplasty (TKA) and the reasons for this effect are unknown. Our aim is to compare and analyze the variability of patellar height with PSI and conventional instrumentation (CI) in TKA. Methods Between March 2018 and November 2021, 215 patients with severe knee osteoarthritis who were treated with primary unilateral TKA were identified for this observational study. The patients were divided into the CI-TKA group and PSI-TKA group according to the osteotomy tools used in TKA. Preoperative and postoperative radiographic parameters including hip-knee-ankle angle (HKA), posterior tibial slope (PTS), Insall-Salvati ratio, modified Caton-Deschamps (mCD) ratio, anterior condylar offset (ACO), and posterior condylar offset (PCO) were evaluated. Results The groups were similar in patients' demographic data, clinical scores, and radiographic parameters preoperatively. Overall, according to the results of the Insall-Salvati ratio, postoperative patellar height reduction was noted in 140 patients (65.1%). Interestingly, the variability of patellar height was smaller in the PSI-TKA group. Radiographic evaluation revealed that the Insall-Salvati ratio after TKA had a minor change in the PSI-TKA group (p = 0.005). Similarly, the mCD ratio after TKA also had a minor change in the PSI-TKA group (p < 0.001). Compared to those in the CI-TKA group, the ACO (p < 0.001) and PCO (p = 0.011) after TKA had a minor change in the PSI-TKA group, but no minor PTS change (p = 0.951) was achieved in the PSI-TKA group after TKA. However, even with 3D-printed patient-specific instrumentation, there were still significant reductions in patellar height, ACO, PCO, and PTS after TKA (p < 0.001). Conclusion The variability of patellar height was sufficiently minimized with more accurate anterior and posterior femoral condyle osteotomy when 3D printed PSI was used. Furthermore, there was a trend in over-resection of the femoral anterior and posterior condyle and a marked reduction in PTS during TKA, which could lead to a change in patellar height and might result in more patellofemoral complications following TKA. Level of evidence Level II.
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Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years' follow-up in a case-control study. Orthop Traumatol Surg Res 2022; 108:103444. [PMID: 36252927 DOI: 10.1016/j.otsr.2022.103444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off. HYPOTHESIS Postoperative lift-off is a rare event that is predictive of laxity. METHODS We carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014. RESULTS The frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12-49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes. DISCUSSION Immediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years' follow-up; however, a long-term assessment is required to verify this finding. LEVEL OF EVIDENCE III - case-control study.
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Nguyen HC, van Egmond N, de Visser HM, Weinans H, Sakkers RJ, Custers RJ. Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable. Cartilage 2022; 13:59-65. [PMID: 36305650 PMCID: PMC9924985 DOI: 10.1177/19476035221113952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. DESIGN This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman's rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. RESULTS Spearman's rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 (P < 0.01). Women had an increased odds ratio of 3.7 (P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 (P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. CONCLUSIONS Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. LEVEL OF EVIDENCE Diagnostic level II.
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Affiliation(s)
- H. Chien Nguyen
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke van Egmond
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Huub M. de Visser
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph J.B. Sakkers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands,Roel J.H. Custers, Department of
Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX
Utrecht, The Netherlands.
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Rassat R, Micicoi G, Jacquet C, Guy S, Fayard JM, Martz P, Ollivier M. Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊. Orthop Traumatol Surg Res 2022; 109:103466. [PMID: 36377059 DOI: 10.1016/j.otsr.2022.103466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture. MATERIALS AND METHODS This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed. RESULTS The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient's age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05). CONCLUSION Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Robin Rassat
- Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Grégoire Micicoi
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, UR2CA, University Côte d'Azur, Nice, France
| | - Christophe Jacquet
- Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Sylvain Guy
- Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, 24, Avenue Paul Santy, 69008 Lyon, France
| | - Pierre Martz
- Service de chirurgie orthopédique et traumatologique adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - Matthieu Ollivier
- Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
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Sappey-Marinier E, Meynard P, Shatrov J, Schmidt A, Cheze L, Batailler C, Servien E, Lustig S. Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs. Knee Surg Sports Traumatol Arthrosc 2022; 30:2915-2921. [PMID: 35013747 DOI: 10.1007/s00167-021-06832-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements. METHODS This is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing. RESULTS The mean FMA was 91.3 ± 2.2° (range 82°-97°), the mean TMA was 85.7 ± 2.5° (range 75°-98°), the mean aHKA was 177.0 ± 3.0° (range 164°-185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°-192°). No significant difference was observed between aHKA and vcHKA (p = 0.06). A significant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001). CONCLUSION This study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre-arthritic coronal alignment of the knee for the extension gap. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France.
| | - P Meynard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France
| | - J Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - A Schmidt
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France
| | - L Cheze
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - C Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - E Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - S Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Barbotte F, Delord M, Pujol N. Coronal knee alignment measurements differ on long-standing radiographs vs. by navigation. Orthop Traumatol Surg Res 2022; 108:103112. [PMID: 34648999 DOI: 10.1016/j.otsr.2021.103112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The long-standing radiograph (LSR) is the reference tool for assessing knee alignment after total knee arthroplasty (TKA). However, its value is debatable, as many factors can influence measurement accuracy. Computer-assisted surgery (CAS) provides accurate measurements. Few studies have compared LSR and computer-assisted measurements of knee alignment. The objective of this study was to compare hip-knee-ankle (HKA) angle values obtained before and after TKA on LSRs to those obtained during CAS. HYPOTHESIS The HKA angle values measured on LSRs before and after surgery are identical to those measured during CAS. MATERIAL AND METHODS The HKA angles of 126 knees were measured on bipedal full-weight-bearing LSRs obtained before and 3 months after TKA. The results were compared to the values obtained during CAS. RESULTS Before surgery, the standard deviation was 2.672, with limits of agreement of {-5.391; + 5.082}. The intra-class coefficients were good for the overall measurements (0.9), good for detecting>10° varus (0.89), fair for<10° varus and valgus (0.66 and 0.71, respectively), poor for>10° valgus (0.43) and poor for normal alignment (0). Post-operatively, the standard deviation was 3.113, with limits of agreement of {-6.426; +5.776}. The intra-class coefficient was poor for the overall measurements (0.20), negative for normal alignment (-0.05) and<10° valgus (-0.05), and positive for<10° varus (0.017) and for>10° varus and valgus (0.33). CONCLUSION Before TKA, the LSR overestimates the deformity compared to CAS. After surgery, the two methods are not comparable. These findings underline the relevance of routinely obtaining LSRs and for using LSR results to estimate costs for healthcare insurance reimbursement purposes. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
| | - Marc Delord
- Centre hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Pujol
- Centre hospitalier de Versailles, Le Chesnay, France.
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Mechanical alignment for primary TKA may change both knee phenotype and joint line obliquity without influencing clinical outcomes: a study comparing restored and unrestored joint line obliquity. Knee Surg Sports Traumatol Arthrosc 2022; 30:2806-2814. [PMID: 34291311 DOI: 10.1007/s00167-021-06674-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In total knee arthroplasty (TKA), knee phenotypes including joint line obliquity are of interest regarding surgical realignment strategies. The hypothesis of this study is that better clinical results, including decreased postoperative knee pain, will be observed for patients with a restored knee phenotype. METHODS A retrospective analysis was performed on prospective data, including 1078 primary osteoarthritic knees in 936 patients. The male:female ratio was 780:298, mean age at surgery was 71.3 years ± 8.0. International Knee Society Scores and standardized long-leg radiographs (LLR) were collected preoperatively and at 2 years follow-up after TKA. Patients were categorized using the Coronal Plane Alignment of the Knee (CPAK) classification including the lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) measured on LLR by a single observer, allowing knee phenotypes to be categorized considering the arithmetic hip-knee-ankle (aHKA) angle (MPTA-LDFA) as measure of constitutional alignment, and joint line obliquity (JLO) (MPTA + LDFA). Clinical results were compared between patients with surgically restored preoperative constitutional knee phenotype to patients without restored constitutional knee phenotypes. Descriptive data analysis such as means, standard deviations and ranges were performed. T tests for independent samples were performed to compare group differences. Comparisons of categorical data were performed using the χ2 test. Significance was set at p < 0.05. RESULTS A third of patients (33.4%) had constitutional knee varus with apex distal JLO. 63.5% of patients had preoperative apex distal JLO. Postoperatively, 57.8% of patients had a neutral HKA (- 2° to 2°) and a neutral JLO (- 3° and 3°), with only 18% of patients with restored constitutional knee phenotype. Of these patients, statistically less postoperative pain was observed in patients where apex distal JLO was restored compared to non-restored apex distal JLO (pain score 46.7 vs. 44.6; p = 0.02) without clinical relevance. Other categories of restored JLO or arithmetic HKA angle were not associated with improved outcomes. CONCLUSION This study showed that performing mechanical alignment for primary TKA resulted in most cases in a change of the preoperative knee phenotype. These results emphasize the relevance of considering joint line obliquity to better understand preoperative knee deformity and better restore knee phenotypes with a more personalized realignment strategy to potentially improve TKA postoperative results. LEVEL OF EVIDENCE III.
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Nicolau X, Jenny JY, Bonnomet F, Ollivier M, Favreau H, Ehlinger M. Accuracy of the correction achieved after a valgus high tibial osteotomy: Comparison of the Hernigou table and navigation. Orthop Traumatol Surg Res 2022; 108:103241. [PMID: 35151890 DOI: 10.1016/j.otsr.2022.103241] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The outcome of a medial opening wedge valgus high tibial osteotomy indicated for the treatment of isolated medial tibiofemoral osteoarthritis depends mainly on the accuracy of the correction of the hip-knee-ankle angle (HKAA) and the mechanical medial proximal tibial angle (mMPTA). Most authors aim for a desired correction target between 2° and 4° of valgus. Several planning and surgical techniques have been described to achieve this target value that is specific to each surgeon. OBJECTIVE The purpose of this study was to compare the accuracy of the correction achieved using either the Hernigou table (HT) planning method or a computer-assisted navigation system (CAS). It was hypothesized that no difference would be found between these 2 techniques. MATERIALS AND METHODS This retrospective single-center study involved 43 knees: 21 in the HT group and 22 in the CAS group. Two surgeons (ME, JYJ), who were experts in 1 of the 2 planning methods performed these procedures, with a single surgeon assigned to each group. The correction was noted in the operative report and was considered to be the desired correction target. The surgical correction was calculated by comparing preoperative and immediate postoperative mMPTA measurements. The surgical accuracy, where a value close to 0 represented optimal accuracy, was defined as the absolute value of the difference between the correction target set by the surgeon and the surgical correction achieved. The median accuracy between the 2 groups was compared by a Mann-Whitney U test (significance level at 5%). The number of patients deviating from the target by>3° was analyzed with a Fisher exact test (significance level at 5%). Pre- and postoperative comparisons of the HKAA measurements could not be used because the measurement was not performed postoperatively for the CAS group. RESULTS The median surgical accuracy on the mMPTA was 1.4° (0-4.1) for the HT group versus 1.9° (0.2-6.7) for the CAS group (p=0.85). Sixteen procedures (76%) were performed with an accuracy of<3° in the HT group versus 15 in the CAS group (68%) (p=0.73). DISCUSSION-CONCLUSION The working hypothesis was confirmed: no differences were found between the HT and CAS groups regarding the surgical accuracy in achieving the corrections set in this series. We therefore demonstrated that HT was a highly accessible, simple and reliable technique for achieving the planned target. It can be used widely. LEVEL OF EVIDENCE III; comparative retrospective series.
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Affiliation(s)
- Xavier Nicolau
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Jean-Yves Jenny
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Matthieu Ollivier
- Aix Marseille Univ, AP-HM, CNRS, ISM, Sainte-Marguerite Hôpital, Institut du Mouvement, Département d'Orthopédie et de Traumatologie, Marseille, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
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11
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Sappey-Marinier E, Batailler C, Swan J, Malatray M, Cheze L, Servien E, Lustig S. Primary osteoarthritic knees have more varus coronal alignment of the femur compared to young non-arthritic knees in a large cohort study. Knee Surg Sports Traumatol Arthrosc 2022; 30:428-436. [PMID: 32488367 DOI: 10.1007/s00167-020-06083-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Many surgeons are performing total knee arthroplasty (TKA) with an aim to reproducing native anatomical coronal alignment. Yet, it remains unclear if primary osteoarthritic and non-osteoarthritic populations have similar knee coronal alignment. This study aims to describe and compare the distribution of femoral and tibial coronal alignment in a large primary osteoarthritic cohort and a young non-osteoarthritic cohort. METHODS This is a retrospective analysis of a monocentric prospectively gathered data, from 1990 to 2019, of 2859 consecutive primary osteoarthritic knees in 2279 patients. Patients underwent standardized long-leg radiographs. Femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were digitally measured using software. Femoral, tibial and knee phenotypes were analyzed, and descriptive data were reported. Data were compared to a young non-osteoarthritic population previously described. RESULTS In osteoarthritic knees, the mean FMA was 91° ± 2.9° (range 86°-100°) and the mean TMA was 87° ± 3.1° (range 80°-94°). No significant difference was observed for FMA and TMA between genders. The most common femoral and tibial phenotypes were varus (38.7%) and neutral (37.1%). The most frequent knee phenotype was a varus femoral phenotype with a neutral tibial phenotype (15.5%), which is different to the non-osteoarthritic population. CONCLUSION This study showed the wide distribution of knee phenotypes in a large osteoarthritic cohort. There was more varus distribution of the femoral coronal alignment compared to a non-osteoarthritic population, suggesting consideration and potential adaptation of the realignment strategy of the femoral component during TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elliot Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France.
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France
| | - John Swan
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France
| | - Matthieu Malatray
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France
| | - Laurence Cheze
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR LBMC UMR-T9406, 69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR LBMC UMR-T9406, 69622, Lyon, France
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Jahn R, Cooper JD, Juhan T, Kang HP, Bolia IK, Gamradt SC, Hatch GF, Weber AE. Reliability of Plain Radiographs Versus Magnetic Resonance Imaging to Measure Tibial Slope in Sports Medicine Patients: Can They Be Used Interchangeably? Orthop J Sports Med 2021; 9:23259671211033882. [PMID: 34646895 PMCID: PMC8504693 DOI: 10.1177/23259671211033882] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 01/13/2023] Open
Abstract
Background: The slope of the tibial plateau has been proposed as a reason for failure of anterior cruciate ligament reconstruction. Purpose: To evaluate the interobserver reliability of measurements of tibial slope on radiographs versus magnetic resonance imaging (MRI) scans and to assess whether the modalities can be used interchangeably for this purpose. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: This retrospective study included 81 patients aged 18 to 30 years who were evaluated in a sports medicine setting for knee pain and who had lateral knee radiographs as well as knee MRI scans on file. Medial and lateral tibial plateau slope measurements were made by 3 blinded reviewers from the radiographs and MRI scans using graphic overlay software. The paired t test was used to compare measurements of the medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) from radiographs and MRI scans. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver reliability of measurements within each imaging modality, and Pearson correlation coefficients were calculated to determine the relationship between measurements on radiographs versus MRI scans. Results: Imaging from 81 patients were included. The average MTPS was significantly larger on radiographs compared with MRI scans (8.7° ± 3.6° vs 3.7° ± 3.4°; P < .001), and the average LTPS was also significantly larger on radiographs compared with MRI scans (7.9° ± 3.4° vs 5.7° ± 3.7°; P < .001). ICC values indicated good to excellent intraobserver agreement for all imaging modalities (ICC, 0.81-0.97; P ≤ .009). The ICCs for interobserver reliability of MTPS and LTPS measurements were 0.92 and 0.85 for radiographs, 0.87 and 0.83 for MRI based off the subchondral bone, and 0.86 and 0.71 for MRI based off the cartilage, respectively (P < .001). Medium correlation was noted between radiographic and MRI measurements; Pearson correlation coefficients for radiographic versus subchondral MRI measurements were 0.30 and 0.37 for MTPS and LTPS, respectively. Conclusion: The average MTPS and LTPS were significantly larger on radiographs compared with MRI scans. Although tibial slope measurements using radiography and those using MRI are reliable between individuals, the measurements from radiographs and MRI scans cannot be used interchangeably, and caution should be used when interpreting and comparing studies using measurements of the tibial slope.
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Affiliation(s)
- Ryan Jahn
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Joseph D Cooper
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Tristan Juhan
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
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13
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Gao H, Liu Z, Wang G, Wang B. A New Accurate, Simple and Less Radiation Exposure Device for Distal Locking of Femoral Intramedullary Nails. Int J Gen Med 2021; 14:4145-4153. [PMID: 34377014 PMCID: PMC8349542 DOI: 10.2147/ijgm.s321005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Due to the metal elasticity of intramedullary nails (IMs) and irregularities of the long bone marrow cavity and other reasons, one of the greatest challenges for surgeons is to position the distal locking screw. Therefore, a novel laser guiding navigation device was designed for the distal locking of femoral IMs. The purpose of this study was to compare the effectiveness of the novel device and freehand technique for distal locking of IMs in the femoral model. Methods The laser guiding navigation device (laser group) and freehand technique (freehand group) were used in the distal locking of the IMs in the femoral model. All operations were performed by surgeons of the same level. The differences between the two groups were compared in terms of operative time, radiation exposure time, first success rate, deviation angle between ideal trajectory and actual trajectory, and learning curve. Results The distal locking of the IMs in the femoral model was performed 40 times in each group. The results showed that the laser group was better than the freehand group in terms of operative time (345±165 VS 212±105 seconds, t=4.27, P<0.001), radiation exposure time (164±57 VS 41±15 seconds, t=13.15, P<0.001) and first successrate (χ 2=21.36, P<0.001). Compared with the freehand group, the actual trajectory of the laser group was closer to the ideal trajectory in coronal and horizontal planes. Furthermore, the learning curve time of the laser group was shorter. Conclusion Compared with traditional freehand technique, the novel laser guiding navigation device can shorten the operative time and reduce radiation exposure invitro. In addition, it is easy to master with more accuracy and a higher first success rate in vitro.
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Affiliation(s)
- Hua Gao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhenyu Liu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Gang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Baojun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
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14
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Moerenhout K, Allami B, Gkagkalis G, Guyen O, Jolles BM. Advantages of patient-specific cutting guides with disposable instrumentation in total knee arthroplasty: a case control study. J Orthop Surg Res 2021; 16:188. [PMID: 33722256 PMCID: PMC7958711 DOI: 10.1186/s13018-021-02310-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 03/13/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is most frequently planned using conventional two-dimensional weight-bearing lower limb radiographs and is performed with conventional femoral and tibial cutting guides. Questions have been raised about the accuracy of conventional TKA instrumentation and planning for an anatomically standard or complex joint. Use of computed tomography (CT)-based three-dimensional (3D) templating and patient-specific cutting guides printed in 3D has shown improved postoperative lower limb alignment parameters. This case-control study compared costs and operative times of using CT-based, patient-specific, single-use instruments versus conventional metal instruments for TKA. Methods In this case-control, retrospective chart review, all TKAs were performed by one senior surgeon, using the F.I.R.S.T. posterior-stabilised knee prosthesis (Symbios, CH), with a similar protocol and identical operating room setup. Group A included 51 TKAs performed with patient-specific cutting guides and conventional metal instruments. Group B included 49 TKAs performed with patient-specific cutting guides and patient-specific, single-use instrumentation. Operation duration, number of instrumentation trays and sterilisation costs were evaluated. Results The groups were similar for age, body mass index, hip-knee-ankle angle and operation duration. The mean number of instrumentation trays was 8.0 ± 0.8 for group A (controls) and 5.1 ± 0.9 for group B (p<0.001). The mean sterilisation costs were 380 ± 47 Swiss Francs (CHF) for group A and 243 ± 55 CHF for group B (p<0.001), for a mean cost reduction of 130.50 CHF per intervention in group B. The time interval between two consecutive surgeries was 24 min for group A and 18 min for group B. There were no adverse events or complications, instrument-related or otherwise. Conclusion Compared to conventional instrumentation, use of patient-specific, single-use instruments for TKA reduced the number of instrumentation trays by more than one-third and saved 36% in sterilisation costs. If fabrication costs of single-use instruments are included by the company, the total cost is significantly diminished. There was no operative time advantage for single-use instrumentation.
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Affiliation(s)
- Kevin Moerenhout
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Behrang Allami
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Georgios Gkagkalis
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Olivier Guyen
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Brigitte M Jolles
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Muskuloskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland.,Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
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15
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Long-term radiological changes and functional outcomes after proximal row carpectomy: Retrospective study with 3 years' minimum follow-up. Orthop Traumatol Surg Res 2020; 106:1589-1595. [PMID: 33289656 DOI: 10.1016/j.otsr.2020.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the radiological changes and determine the clinical and functional outcomes of proximal row carpectomy (PRC) over the long term. HYPOTHESIS Radiological changes after PRC occur in every patient while the clinical and functional outcomes remain stable over time. METHODS This was a retrospective single-center study of patients who underwent PRC between January 2004 and December 2014. A clinical assessment (range of motion, grip strength), functional assessment (Mayo Wrist score and QuickDASH) and radiographic assessment (radiocapitate osteoarthritis, radiocapitate congruency) was done in every patient at the longest follow-up. RESULTS Thirty-one patients were reviewed with a mean follow-up of 97.9 months. The indications for PRC were SLAC (n=10), SNAC (n=5), Kienböck disease (n=9) and other conditions (n=7). The radiocapitate index, which is the radius of curvature of the tip of the capitate divided by the mean radius of curvature of the lunate fossa, went from 0.68 immediately postoperative to 0.74 at the final assessment (p=0.035). The mean flexion/extension arc was 93°. The mean grip strength was 25 kg. The mean QuickDASH was 29 and the mean Mayo Wrist score was 69. Fifteen patients had radiocapitate osteoarthritis. Seven patients (22%) required revision surgery for wrist fusion after a mean of 18.6 months. CONCLUSION Radiological adaptation in the radiocapitate joint after PRC was found in this study. PRC is a reliable solution and yields stable outcomes over time for treating radiocarpal osteoarthritis, except in young adults and manual laborers who had a notable early revision rate. LEVEL OF EVIDENCE IV - retrospective study.
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Accuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical method. INTERNATIONAL ORTHOPAEDICS 2020; 44:2613-2619. [PMID: 32820360 DOI: 10.1007/s00264-020-04777-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Medial valgus-producing tibial osteotomy (MVTO) is classically used to treat early medial femorotibial osteoarthritis. Long-term results depend on the mechanical femorotibial angle (HKA) obtained at the end of the procedure. A correction goal between 3 and 6° valgus is commonly accepted. Several planning methods are described to achieve this goal, but none is superior to the other. OBJECTIVE The main objective was to compare the accuracy of the correction obtained using either the Hernigou table (HT) or a so-called conventional method (CM) for which 1° of correction corresponds to 1° of osteotomy opening. The secondary objective was to analyze the variations observed in the sagittal plane on the tibial slope and on the patellar height. The working hypothesis was that the HT allowed a more accurate correction and that the tibial slope and patellar height were modified in both groups. MATERIAL AND METHOD In this monocentric and retrospective study, two senior surgeons operated on 39 knees (18 in the CM group, 21 in the HT group) between January 1, 2009 and December 31, 2014. The operator was unique for each group and expert in the technique used. The correction objective chosen for each patient, and written in the operative report, was considered as the one to be achieved. The surgical correction was the difference between the pre-operative and immediate post-operative data (< 5 J) for the mechanical tibial angle (MTA) and the hip-knee-ankle (HKA) angle. Surgical accuracy, where a value close to 0 is optimal, was the absolute value of the difference between the surgical correction performed and the goal set by the surgeon. RESULTS The median surgical accuracy on the MTA was 3.5° [0.2-7.4] versus 1.4° [0-4.1] in the CM and HT groups, respectively (p = 0.006). In multivariate analysis, with the same objective, the CM had a significantly lower accuracy of 1.9° ± 0.8 (p = 0.02). For HKA, the median accuracy was 3.1° [0.3-7.3] versus 0.8° [0-5] in the CM and HT groups, respectively (p = 0.006). Five (5/18, 28%) and 16 (16/21, 76%) knees were within 3° of the target in the CM and HT groups, respectively (p = 0.004). The median tibial slope increased in both groups. This increase was significantly greater in the CM group compared with the HT group, with 5.5° [- 0.3-13] versus 0.5 [- 5.2-5.6], respectively (p < 0.001). The median Caton-Deschamps index decreased (patella lowered) in both groups after surgery, by - 0.21 [- 1.03; - 0.05] and - 0.14 [- 0.4-0.16], but without significant difference (p = 0.19). In univariate analysis, changes in tibial slope and patellar height were not significantly related to frontal surgical correction performed according to ΔMTA (R2 = 0.07; p = 0.055) and (R2 = - 0.02; p = 0.54) respectively. DISCUSSION The correction set by the surgeons was achieved with greater accuracy and more frequently in the HT group, confirming the working hypothesis. The HT is therefore recommended as a simple way of achieving the set objective; the tibial slope and patellar height were modified unaffected by the frontal correction performed.
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Morphometric study of gender difference in osteoarthritis posterior tibial slope using three-dimensional magnetic resonance imaging. Surg Radiol Anat 2020; 42:667-672. [PMID: 32086624 DOI: 10.1007/s00276-020-02429-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
Posterior tibial slope (PTS) is an important parameter of sagittal alignment associated with postoperative stability and kinematics after total knee arthroplasty (TKA). However, data are limited regarding the innate gender differences in PTS in Koreans. The current study separately measured the PTS of the medial and lateral tibial plateau on magnetic resonance images of 511 patients with knee joint osteoarthritis who had Kellgren and Lawrence grade 3 and 4 (430 women, 81 men) and compared the measurements between and within the genders. The tibia was then rotated to the tibial plateau with the tibial centroid axis and the PTS was evaluated from best-fit planes on the surface of the proximal tibia and individually for the medial, lateral, and overall plateaus. The average overall PTS was 10.0° ± 3.5°. The average overall PTS of the female and male patients was 10.2° ± 3.4° and 8.8° ± 4.0°, respectively. The average medial PTS was 10.4° ± 4.0°, significantly greater than the mean lateral PTS of 8.7° ± 3.9° (P < 0.05). The average medial and lateral tibial slopes for female patients were 10.7° ± 3.8° and 8.8° ± 3.8°, respectively, while the average medial and lateral tibial slopes for male patients were 8.9° ± 4.8° and 7.9° ± 4.7°, respectively. The medial and overall PTS were significantly greater in female patients than in male patients (P < 0.05). The results showed a gender difference in PTS and that medial PTS was greater than lateral PTS. These findings have clinical relevance in knee reconstructive surgery for determining ideal placement of the posterior slope tibial component. Surgeons should be aware of variability and gender differences in the tibial slope of patients undergoing TKA.
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Rivière C, Vigdorchik JM, Vendittoli PA. Mechanical alignment: The end of an era! Orthop Traumatol Surg Res 2019; 105:1223-1226. [PMID: 31378698 DOI: 10.1016/j.otsr.2019.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/26/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Charles Rivière
- Adult Reconstruction and Joint Replacement, MSK-Lab-Imperial College London, Charing Cross Campus, Laboratory Block, London W6 8RP, Great Britain.
| | - Jonathan M Vigdorchik
- Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, 535, East 70th Street, New York, NY 10021, United States.
| | - Pascal-André Vendittoli
- Montreal University, Department of surgery Montreal University, Maisonneuve-Rosemont Hospital, 5415, boulevard L'Assomption, Montreal, H1 T 2M4, Québec, Canada.
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Marmor S, Renault E, Valluy J, Saffarini M. Over-voluming predicted by pre-operative planning in 24% of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1544-1551. [PMID: 29860600 DOI: 10.1007/s00167-018-4998-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/30/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Numerous studies demonstrated that prosthetic overhang and over-sizing cause pain and stiffness following total knee arthroplasty (TKA), but none considered volume changes within the joint capsule. This study was designed to investigate differences in volumes of resected bone compared to implanted components in TKA, and to determine the incidence and factors related to 'over-voluming'. METHODS Three-dimensional reconstructions were created from 100 magnetic resonance imaging scans taken to design patient-specific instruments for TKA. The preoperative simulations were used to calculate the volume ratio (VR) by dividing volume of planned components by that of planned bone resections. Uni- and multi-variable linear regressions were performed to determine associations between 'over-voluming' (VR > 1.0) and gender, implant size and version (standard versus narrow), osteophytes, resection levels, external rotation of the femoral component, hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA). RESULTS The overall implant/bone volume ratio was 0.91 ± 0.11 (range 0.63-1.16) with 'over-voluming' observed in 24 knees. Multi-variable regression confirmed over-voluming to be associated with lower mLDFA (OR 0.66; CI 0.45-0.93; p = 0.026) and extensive osteophytes (OR 0.14; CI 0.03-0.61; p = 0.014), but not HKA angle (OR 0.98; CI 0.76-1.26; p = n.s.). CONCLUSIONS Over-voluming was observed in 24% of knees, in which the implant volume exceeded the resected volume by up to 16%. Over-voluming was associated with intra-articular femoral valgus (low mLDFA), but not directly associated with tibial deformity (mMPTA) or HKA angle. Over-voluming could be associated with prosthetic overhang or excessive tensions within the joint capsule, and, therefore, contribute to unexplained pain and stiffness following TKA. LEVEL OF EVIDENCE IV, Retrospective cohort study.
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Affiliation(s)
- Simon Marmor
- Department of Orthopaedic Surgery, Croix-Saint-Simon Teaching Hospital, Paris, France
| | - Eric Renault
- Department of Research and Development, Corin-Tornier, Montbonnot, France
| | - Jeremy Valluy
- ReSurg SA, ch. de la Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, ch. de la Vuarpilliere 35, 1260, Nyon, Switzerland.
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Jenny JY, Dillmann G, Gisonni V, Favreau H. Noninvasive navigated assessment of the lower limb axis prior to knee arthroplasty: a feasibility study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:855-860. [PMID: 30631945 DOI: 10.1007/s00590-019-02380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
The purpose of the study was to assess accuracy and repeatability of a noninvasive navigated (NIN) measurement of the lower limb axes by comparison with the conventional, invasive navigated (IN) technique. The tested hypothesis was that NIN measure will significantly differ from IN measure when performed on a supine patient under general anesthesia just prior to knee arthroplasty. The accuracy study involved 20 cases. The following measures were performed with both systems: maximal extension angle, coronal mechanical femoro-tibial angle at the previously assessed maximal extension angle, coronal mechanical femoro-tibial angle at 30° of knee flexion. NIN and IN measures were compared with the appropriate statistical tests. The repeatability study involved 14 cases. The same measures were performed with the NIN system twice by two independent observers. The intra- and inter-observer variability was assessed by the calculation of the intra-class correlation coefficient. After correction for the systematic biases, the differences between the two systems were not significant. A good correlation, a good coherence and an excellent agreement between NIN and IN measures of maximal extension angle and coronal femoro-tibial mechanical angle at maximal extension. But measures at 30° of flexion were inconsistent. The NIN system can be considered as an accurate and precise tool for the assessment of the knee extension angle and the coronal deformation at maximal extension prior to knee arthroplasty. But this system is less accurate and less repeatable when measuring coronal femoro-tibial mechanical angle at 30° of flexion and should not be used for this purpose.
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Affiliation(s)
- Jean-Yves Jenny
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France. .,Université de Strasbourg, Strasbourg, France.
| | - Gauthier Dillmann
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
| | - Vincent Gisonni
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
| | - Henri Favreau
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
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21
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Ho JPY, Merican AM, Hashim MS, Abbas AA, Chan CK, Mohamad JA. Three-Dimensional Computed Tomography Analysis of the Posterior Tibial Slope in 100 Knees. J Arthroplasty 2017; 32:3176-3183. [PMID: 28579444 DOI: 10.1016/j.arth.2017.04.060] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/23/2017] [Accepted: 04/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The posterior tibial slope (PTS) is an important consideration in knee arthroplasty. However, there is still no consensus for the optimal slope. The objectives of this study were (1) to reliably determine the native PTS in this population using 3-dimensional computed tomography scans and (2) to determine the normal reference range for PTS in this population. METHODS One hundred computed tomography scans of disease-free knees were analyzed. A 3-dimensional reconstructed image of the tibia was generated and aligned to its anatomic axis in the coronal and sagittal planes. The tibia was then rotationally aligned to the tibial plateau (tibial centroid axis) and PTS was measured from best-fit planes on the surface of the proximal tibia and individually for the medial and lateral plateaus. This was then repeated with the tibia rotationally aligned to the ankle (transmalleolar axis). RESULTS When rotationally aligned to the tibial plateau, the mean PTS, medial PTS, and lateral PTS were 11.2° ± 3.0 (range, 4.7°-17.7°), 11.3° ± 3.2 (range, 2.7°-19.7°), and 10.9° ± 3.7 (range, 3.5°-19.4°), respectively. When rotationally aligned to the ankle, the mean PTS, medial PTS, and lateral PTS were 11.4° ± 3.0 (range, 5.3°-19.3°), 13.9° ± 3.7 (range, 3.1°-24.4°), and 9.7° ± 3.6 (range, 0.8°-17.7°), respectively. CONCLUSION The PTS in the normal Asian knee is on average 11° (mean) with a reference range of 5°-17° (mean ± 2 standard deviation). This has implications to surgery and implant design.
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Affiliation(s)
- Jade Pei Yuik Ho
- Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azhar M Merican
- Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Sufian Hashim
- Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlina A Abbas
- Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Ken Chan
- Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jamal A Mohamad
- KPJ Selangor Specialist Hospital, Shah Alam, Selangor, Malaysia
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Sabour S, Ghassemi F. Comments on "Reproducibility of digital measurements of lower-limb deformity on plain radiographs and agreement with CT measurements" by Sorin G, Pasquier G, Drumez E, Arnould A, Migaud H, Putman S published in Orthop Traumatol Surg Res 2016;102:423-28. Common mistake and methodological issue to avoid mismanagement. Orthop Traumatol Surg Res 2016; 102:827-8. [PMID: 27527250 DOI: 10.1016/j.otsr.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/08/2016] [Indexed: 02/02/2023]
Affiliation(s)
- S Sabour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of Clinical Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - F Ghassemi
- Department of retina & ocular oncology, School of medicine, Farabi Eye hospital, Tehran University of Medical sciences, Tehran, Islamic Republic of Iran
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Drumez E, Putman S, Sorin G, Pasquier G, Arnould A, Migaud H, Duhamel A. Reply to the Letter by Siamak Sabour, Fariba Ghassemi. Orthop Traumatol Surg Res 2016; 102:829. [PMID: 27499116 DOI: 10.1016/j.otsr.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/11/2016] [Indexed: 02/02/2023]
Affiliation(s)
- E Drumez
- Unité de biostatistiques, university Lille, CHU de Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, 59000 Lille, France; Université Lille, 59000 Lille, France
| | - S Putman
- Université Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - G Sorin
- Département d'orthopédie, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France
| | - G Pasquier
- Université Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - A Arnould
- Université Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - H Migaud
- Université Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
| | - A Duhamel
- Unité de biostatistiques, university Lille, CHU de Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, 59000 Lille, France; Université Lille, 59000 Lille, France
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