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Trojani MC, Clavé A, Bereder I, Camuzard O, Bernard De Dompsure R, Gonzalez JF, Trojani C, Santucci-Darmanin S, Carle GF, Breuil V, Pierrefite-Carle V. Autophagy markers are decreased in bone of osteoporotic patients: a monocentric comparative study. Eur J Endocrinol 2024; 190:K27-K31. [PMID: 38430550 DOI: 10.1093/ejendo/lvae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/04/2024]
Abstract
BACKGROUND Osteoporosis (OP) is a pathology characterized by bone fragility affecting 30% of postmenopausal women, mainly due to estrogen deprivation and increased oxidative stress. An autophagy involvement is suspected in OP pathogenesis but a definitive proof in humans remains to be obtained. METHODS Postmenopausal women hospitalized for femoral neck fracture (OP group) or total hip replacement (Control group) were enrolled using very strict exclusion criteria. Western blot was used to analyze autophagy level. RESULTS The protein expression level of the autophagosome marker LC3-II was significantly decreased in bone of OP patients relative to the control group. In addition, the protein expression of the hormonally upregulated neu-associated kinase (HUNK), which is upregulated by female hormones and promotes autophagy, was also significantly reduced in bone of the OP group. CONCLUSIONS These results demonstrate for the first time that postmenopausal OP patients have a deficit in bone autophagy level and suggest that HUNK could be the factor linking estrogen loss and autophagy decline. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03175874, 2/6/2017.
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Affiliation(s)
- Marie-Charlotte Trojani
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- Service de Rhumatologie, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur II, 06000 Nice, France
| | - Arnaud Clavé
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- Service de Chirurgie Orthopédique, Clinique Saint Georges, 06105 Nice, France
| | - Isabelle Bereder
- Service de Gériatrie, Centre Hospitalier Universitaire de Nice, Hôpital de Cimiez, 06000 Nice, France
| | - Olivier Camuzard
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- Service de Chirurgie Réparatrice, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur II, 06000 Nice, France
| | - Régis Bernard De Dompsure
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur II, 06000 Nice, France
| | - Jean-François Gonzalez
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur II, 06000 Nice, France
| | | | - Sabine Santucci-Darmanin
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- CNRS, 75005 Paris, France
| | - Georges F Carle
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- CNRS, 75005 Paris, France
| | - Véronique Breuil
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- Service de Rhumatologie, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur II, 06000 Nice, France
| | - Valérie Pierrefite-Carle
- Université Côte d'Azur, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), UMR E4320 TIRO-MATOs, 06107 Nice, France
- INSERM, 75013 Paris, France
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Trojani C. Regarding "Anterior Slope Correction-Flexion Osteotomy in Traumatic Genu Recurvatum". Arthroscopy 2023; 39:2257-2258. [PMID: 37866859 DOI: 10.1016/j.arthro.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
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Boileau P, Clowez G, Bouacida S, Walch G, Schwartz DG, Trojani C. The Arthroscopic Trillat Procedure Is a Valuable and Durable Treatment Option for Recurrent Anterior Instability Associated With Massive Irreparable Cuff Tears. Arthroscopy 2023; 39:935-945. [PMID: 36370919 DOI: 10.1016/j.arthro.2022.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of the present study is to report the mid- and long-term clinical and radiologic outcomes of the arthroscopic Trillat for the treatment of recurrent anterior instability in patients with chronic massive irreparable rotator cuff tears (MIRCTs) and maintained active shoulder motion where reverse shoulder arthroplasty (RSA) is not indicated. METHODS Twenty-one consecutive patients (mean age 61 years) were identified and retrospectively reviewed. All patients had recurrent anterior dislocations and conserved active forward elevation and active external rotation. The MIRCTs included a retracted (stage 3) supraspinatus tear in 14%, a supra- and infraspinatus tear in 76.5%, and a 3-tendon tear in 14%. A closed-wedge osteotomy of the coracoid was performed, and the coracoid was fixed above the subscapularis with a cannulated screw (10 cases) or suture buttons (11 cases). We followed patients with x-rays and computed tomography scan at 6 months, along with Subjective Shoulder Value, visual analog scale, Walch, Constant, and Rowe scores. The mean clinical and radiographic follow-up was 58 months (24-145 months). RESULTS Overall, 96% (20/21) of the patients had a stable and functional shoulder and were satisfied with the procedure; no patient lost active shoulder motion. The Subjective Shoulder Value increased from 44% (10%-75%) to 94% (80%-100%), P < .001. The Constant and Rowe scores improved from 60 (25-81) to 81 (66-96) and from 54 (35 to 65) to 92 (70-100), respectively (P < .001). Among the 13 patients practicing sports before surgery, 10 (77%) went back to sports. At last follow-up, only 1 patient was revised to RSA. CONCLUSIONS The arthroscopic Trillat procedure is a valuable and durable option for the treatment of recurrent anterior dislocations in older patients with chronic MIRCTs and conserved active shoulder motion. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice-Locomoteur & Sports, Nice, France.
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Boileau P, Clowez G, Bouacida S, Walch G, Trojani C, Schwartz DG. The Arthroscopic Trillat Procedure Is a Valuable Treatment Option for Recurrent Anterior Instability in Young Athletes With Shoulder Hyperlaxity. Arthroscopy 2023; 39:948-958. [PMID: 36368519 DOI: 10.1016/j.arthro.2022.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study is to report the outcomes of the all-arthroscopic Trillat procedure, combined with capsular plication, for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity (external rotation >90°). METHODS We performed a retrospective evaluation of patients with recurrent anterior instability and shoulder hyperlaxity who underwent an arthroscopic Trillat between 2009 and 2019. Patients with concomitant rotator cuff lesions or voluntary or multidirectional instability were excluded. The osteotomized coracoid was fixed above the subscapularis with a cannulated screw or a suture button; a capsular plication was systematically associated. We followed patients with x-rays, computed tomography scans, and Subjective Shoulder Value, visual analog scale, Walch, Constant, and Rowe scores. Mean follow-up was 56 months (24-145). RESULTS Twenty-eight consecutive patients (30 shoulders) with a mean age of 25 years were identified, and all met criteria. The main finding under arthroscopy was a "loose shoulder" with anteroinferior capsular redundancy and no or few (10%) labrum tears, glenoid erosion (13%), or Hill-Sachs lesions (10%). At last follow-up, 90% of the shoulders (27/30) were stable, and 79% (19/24) of the patients practicing sports returned to their preinjury activity level. The Walch-Duplay and Rowe scores improved from 54 (38-68) to 81 (4-100) and 55 (30-71) to 84 (45-100), respectively, P < .001. CONCLUSIONS The arthroscopic Trillat is an effective procedure for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity but no substantial humeral or glenoid bone loss, allowing return to overhead/contact sports. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice-Locomoteur & Sports, Nice, France.
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Micicoi G, Bernard de Dompsure R, Boileau P, Trojani C. Comparative study of bilateral total hip arthroplasty in one or two stages. Orthop Traumatol Surg Res 2022; 108:103359. [PMID: 35781050 DOI: 10.1016/j.otsr.2022.103359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA). MATERIALS AND METHODS This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed. RESULTS Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results. CONCLUSION Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Grégoire Micicoi
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30, avenue Voie Romaine, 06000 Nice, France
| | - Régis Bernard de Dompsure
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30, avenue Voie Romaine, 06000 Nice, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice Locomoteur et du Sport (ICR), Clinique Kantys Centre, Groupe Kantys, 7, avenue Durante, 06000 Nice, France
| | - Christophe Trojani
- Institut de Chirurgie Réparatrice Locomoteur et du Sport (ICR), Clinique Kantys Centre, Groupe Kantys, 7, avenue Durante, 06000 Nice, France.
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Trojani C, Tran L. Comments on: "Negative influence of femoral nerve block on quadriceps strength recovery following total knee replacement: A prospective randomized trial" by M Angers, E Belzile, J Vachon, P Bauchamp-Chalifour, S Pelet published in Orthop Traumatol Surg Res 2019;105:633-37. Orthop Traumatol Surg Res 2022; 108:103324. [PMID: 35577275 DOI: 10.1016/j.otsr.2022.103324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Christophe Trojani
- Institut de Chirurgie Réparatrice Locomoteur et du Sport (ICR), Clinique St Antoine, Groupe Kantys, 7 Avenue Durante, 06000 Nice, France.
| | - Laurie Tran
- Pôle d'Anesthésie-Réanimation, Institut Arnault Tzanck, 06700 Saint-Laurent du Var, France
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Boileau P, Gendre P, Saliken DJ, Thélu CÉ, Trojani C. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation. J Shoulder Elbow Surg 2022; 31:1451-1462. [PMID: 35172210 DOI: 10.1016/j.jse.2022.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is growing interest in using suture buttons for coracoid fixation to avoid the complications associated with screws during the Latarjet procedure. However, achieving bone block healing is critical for successful shoulder stabilization and return to sport. The purpose of this study was to assess and compare the healing rates and positioning of the coracoid bone block fixed with cortical suture buttons that were either manually tensioned (using a knot pusher) or mechanically tensioned (using a tensioning device) during arthroscopic Latarjet procedures. METHODS This prospective, nonrandomized, comparative study enrolled 69 consecutive patients (mean age, 27 years) who underwent an arthroscopic guided Latarjet procedure with suture-button fixation. Hand tensioning was performed in the first 34 shoulders, whereas the next 35 shoulders underwent mechanical tensioning. Twelve patients (17%) had a history of failed Bankart stabilization. The characteristics of the patients in each group in terms of age, sex, type of sport, bone loss, number of previous failed surgical procedures, smoking, and length of follow-up were comparable. Intraoperatively, the tensioning device was set at 100 N successively 3 times until complete immobilization of the bone block was confirmed, as assessed with a probe. The primary outcome measure was coracoid bone block union and position on computed tomography scan images at 6 months' follow-up. Secondary outcome measures included functional outcome scores, shoulder stability, return to sports, and complications at last follow-up. RESULTS Overall, the rate of bone block healing was 74% (25 of 34 patients) in the hand-tensioning group and 94% (33 of 35 patients) in the mechanical tensioning group (P = .043). Smoking was an independent risk factor associated with nonunion (P < .001) in each group. Patient age, size of the preoperative glenoid bone defect (<20% or >20%), and a history of surgery were not found to have any influence. The tensioning modality did not affect the bone block position, which was subequatorial in 92% of the cases and flush with the glenoid rim in 92%. At a mean of 34 months of follow-up (range, 24-62 months), 96% of the patients (65 of 69) had a stable shoulder and 87% returned to sports. At final follow-up, no significant difference in clinical scores was noted between the groups; no neurologic or hardware complications were observed. CONCLUSION Mechanical tensioning achieves significantly higher healing rates than hand tensioning during the arthroscopic Latarjet procedure with suture-button fixation. The use of a suture-tensioning device is a key step to the suture-button fixation technique during arthroscopic Latarjet procedures. By making the suture-button construct rigid, the tensioning device transforms the initially flexible suture into a "rigid fixation", similar to a bolt (or a rivet).
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Affiliation(s)
- Pascal Boileau
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France.
| | | | | | | | - Christophe Trojani
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
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Douiri A, Lavoué V, Galvin J, Boileau P, Trojani C. Arthroscopic Lateral Patellar Facetectomy and Lateral Release Can Be Recommended for Isolated Patellofemoral Osteoarthritis. Arthroscopy 2022; 38:892-899. [PMID: 34256109 DOI: 10.1016/j.arthro.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/29/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the clinical outcomes and survival curve of arthroscopic lateral patellar facetectomy and lateral release for isolated patellofemoral osteoarthritis (PFOA). METHODS All patients undergoing arthroscopic lateral patellar facetectomy and lateral release between January 2008 and January 2018 were evaluated retrospectively. The inclusion criteria were 1) diagnosis of isolated symptomatic lateral PFOA, 2) PFOA with kissing lesions (defined as a lesion on both the patella and trochlea, which were in direct contact, 3) arthroscopic lateral patellar facetectomy and lateral release, and 4) two-year minimum follow-up. Evaluation included preoperative and postoperative subjective International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) scores, and visual analogue pain scale (VAS). The primary end point determining the survival curve was revision of lateral facetectomy. RESULTS A retrospective analysis was conducted of 61 consecutive arthroscopic lateral patellar facetectomy and lateral release procedures, performed in 55 patients for a diagnosis of isolated PFOA. Five patients were lost to follow-up, leaving 56 knees (50 patients) available at a mean follow up of 7.5 years (range: 2-10). The cohort included 37 women and 13 men with a mean age of 59 years (range: 34-87). Nine patients (18%) underwent revision surgery: six total knee replacements (TKR), two high tibial osteotomies, and one revision arthroscopic lateral patellar facetectomy. The mean time from arthroscopic facetectomy to TKR was 51 months (range: 10-114). The survival curve rate was 86% at 7.5 years. Both KOOS and IKDC scores improved significantly. These results are confirmed by an analysis of MCID. The mean VAS decreased from 6.98 ± 1.2 preoperatively to 2.06 ± 1.6 at the last follow-up (ΔCI95% = [-5.6; -4.4]; P = .0001). CONCLUSION Arthroscopic lateral patellar facetectomy and lateral release for isolated PFOA demonstrates sustained significant improvement in knee clinical outcome scores and pain with a low rate of complications and revision surgery at mid-term follow-up. This operation can be recommended in cases of symptomatic isolated PFOA. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Adil Douiri
- University Institute for Locomotion and Sports, Hospital Pasteur 2, University Côte d'Azur, Nice, France
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Chelli M, Gasbarro G, Lavoué V, Gauci MO, Raynier JL, Trojani C, Boileau P. The reliability of the Neer classification for proximal humerus fractures: A survey of orthopedic shoulder surgeons. JSES Int 2022; 6:331-337. [PMID: 35572425 PMCID: PMC9091924 DOI: 10.1016/j.jseint.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The Neer classification is among the most widely used systems to describe proximal humerus fractures (PHF) despite the poor interobserver agreement. The purpose of this study was to verify whether or not blinded shoulder surgeons and trainees agree with the authors of articles published in the highest impact-factor orthopedic journals. Methods All articles regarding PHF published between 2017 and 2019 in the top 10 orthopedic journals as rated by impact factor were searched. Articles were included if the authors used the Neer classification to describe at least 1 PHF in the figures. Figures were extracted without the legend, and X-rays ± computed tomography scan images were included when available. An international survey was conducted among 138 shoulder surgeons who were asked to record the Neer classification for each de-identified radiograph in the publications. The type of fracture mentioned in the legend of the published figure was considered as the gold standard. Results Survey participants agreed with the published article authors in 55% of cases overall (range 6%-96%, n = 35). The most common response disagreed with the article authors in 13 cases (37%), underestimating the number of parts in 11 of 13 cases. The interobserver agreement between the 138 responders was fair (k = 0.296). There was an association between the percentage of concordant answers and greater experience (number of years of shoulder surgery practice) of the responders (P = .0023). The number of parts, the number or type of available imaging modalities, and the geographic origin of participants did not influence the agreement between responders and authors. Discussion In more than one-third of cases, specialized shoulder surgeons disagree with article authors when interpreting the Neer classification of de-identified images of PHF in published manuscripts. Morphologic classification of PHF as the sole basis for treatment algorithms and surgical success should be scrutinized.
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Affiliation(s)
- Mikaël Chelli
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
- Université Côte d'Azur, Inria, Epione Research Team, Nice, Provence-Alpes-Côte d'Azur, France
- Corresponding author: Mikaël Chelli, MD, MSc, ICR - 7 avenue Durante, 06000 Nice, Provence-Alpes-Côte d'Azur, France.
| | - Gregory Gasbarro
- Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
| | - Vincent Lavoué
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
| | - Marc-Olivier Gauci
- University Institute for Locomotion and Sports (iULS), University Côte d'Azur, Nice, Provence-Alpes-Côte d'Azur, France
| | - Jean-Luc Raynier
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
| | - Christophe Trojani
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
| | - Pascal Boileau
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
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Trojani C, Micicoi G, Boileau P. High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum. Orthop Traumatol Surg Res 2021; 107:103025. [PMID: 34329759 DOI: 10.1016/j.otsr.2021.103025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments. HYPOTHESIS Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension. MATERIAL AND METHODS Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores). RESULTS The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved. CONCLUSION Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term. LEVEL OF EVIDENCE IV, retrospective descriptive study.
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Affiliation(s)
- Christophe Trojani
- Institut de chirurgie réparatrice, locomoteur & sport, 7, avenue Durante, 06000 Nice, France.
| | - Grégoire Micicoi
- Service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (IULS) - hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Pascal Boileau
- Institut de chirurgie réparatrice, locomoteur & sport, 7, avenue Durante, 06000 Nice, France
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Trojani C. Regarding "The Top 50 Most-Cited Shoulder Arthroscopy Studies". Arthroscopy 2021; 37:2728-2729. [PMID: 34481613 DOI: 10.1016/j.arthro.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/06/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Christophe Trojani
- Institut de Chirurgie Réparatrice Locomoteur et du Sport, Groupe Kantys, Nice, France
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Cointat C, Gauci MO, Azar M, Tran L, Trojani C, Boileau P. Outpatient shoulder prostheses: Feasibility, acceptance and safety. Orthop Traumatol Surg Res 2021; 107:102913. [PMID: 33798792 DOI: 10.1016/j.otsr.2021.102913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Outpatient surgery in France is defined by the national authority for health (HAS) as a scheduled surgery enabling same-day discharge without any increased risk to the patient. With the advent of enhanced recovery after surgery, outpatient lower limb arthroplasty has become a common procedure. However, only 1.1% of knee arthroplasties in France were performed on an outpatient basis in 2017. OBJECTIVES 1) assess early morbidity and mortality after outpatient shoulder arthroplasties to validate eligibility and safety criteria; and 2) assess patient acceptance of outpatient surgery. METHODS A single-center study with the following inclusion criteria: primary shoulder arthroplasty, American Society of Anesthesiology (ASA) score I or II, no cognitive impairment, and no coronary artery or thromboembolic diseases. Analgesia was provided by bupivacaine via a peripheral nerve catheter in the first 72 hours followed by oral analgesics. Patients were discharged if the post-anesthetic discharge scoring system (PADSS) was>9/10 and the visual analog scale (VAS) was<5/10. Postoperative telephone interviews were carried out on D1, D2 and D3 to assess pain with the numerical rating scale and to collect data on their analgesic consumption. All patients were seen by an independent observer at one and six months for a clinical and radiologic follow-up and at 90 days during a consultation with the senior surgeon. The primary endpoint was the 90-day morbidity and mortality rate (readmissions, rehospitalizations, and minor and major complications). A satisfaction questionnaire was collected at one and six months. RESULTS Thirty-six patients were offered an outpatient shoulder arthroplasty between February 2016 and February 2018: 12 (33%) refused with no valid reasons and 24 patients agreed to the procedure (seven hemiarthroplasties, nine anatomic shoulder arthroplasties and eight reverse shoulder arthroplasties). The mean age at surgery was 70 years (55-82), mean body mass index (BMI) was 26 (21-32) and 14 patients were ASA II (66%). Three patients (12%) refused same-day discharge despite a PADSS score>9/10 and adequate pain management. Two patients (8%) were not discharged home on the same day as the surgery for medical reasons (one for pain and one for high blood pressure). No readmissions or complications were reported for the 19 outpatient arthroplasties. None of the outpatients used opioids. All patients were satisfied with their functional outcome, 84% were satisfied with the outpatient management and 17% felt they were insufficiently monitored and regretted that they were not hospitalized. CONCLUSIONS 1) outpatient shoulder arthroplasty can be safely proposed to selected patients with low comorbidities, regardless of their age and type of implant; 2) the acceptance rate for outpatient shoulder arthroplasty remained low among our patient population. These results should incite us to better educate patients about outpatient surgery. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Caroline Cointat
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Marc Olivier Gauci
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Michel Azar
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Laurie Tran
- Service d'anesthésie-réanimation, institut Arnault-Tzanck, 171, rue du Commandant Gaston-Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Christophe Trojani
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France; Groupe Kantys, institut de chirurgie réparatrice locomoteur et du sport (ICR), 7, avenue Durante, 06000 Nice, France
| | - Pascal Boileau
- Unité de recherche clinique Côte d'Azur (UR2CA), service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (iULS), CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France.
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Boileau P, Seeto BL, Clowez G, Gauci MO, Trojani C, Walch G, Chelli M. SECEC Grammont Award 2017: the prejudicial effect of greater tuberosity osteotomy or excision in reverse shoulder arthroplasty for fracture sequelae. J Shoulder Elbow Surg 2020; 29:2446-2458. [PMID: 33190752 DOI: 10.1016/j.jse.2020.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim was to evaluate risk factors for complications, revision, and mid- to long-term outcomes after reverse shoulder arthroplasty (RSA) implanted for proximal humeral fracture sequelae (PHFS). METHODS The radiographs of 98 patients (mean age, 68 years) who underwent RSA for the treatment of PHFS were reviewed at a minimum 5-year follow-up. PHFS were divided into 4 types according to the Boileau classification: type 1 (46 cases), type 2 (6 cases), type 3 (12 cases), and type 4 (34 cases). The tuberosities underwent osteotomy in 28 cases and excision in 12 (all type 3 or 4 PHFS). The mean follow-up period was 8.4 years (range, 5-14 years). RESULTS The functional results and rate of RSA survival without revision (85% vs. 100% at 10 years, P = .007) were significantly lower for types 3 and 4 vs. types 1 and 2. Overall, our findings showed that RSA for PHFS is not the panacea that surgeons once believed: At a mean follow-up of 8.5 years (range, 5-14 years), 59% of the patients in our series had fair or poor results. Patients who underwent tuberosity osteotomy or excision had lower functional results (adjusted Constant score, 69% vs. 88%; P < .001), more postoperative complications (32% vs. 9%, P = .003), and a higher revision rate (15% vs. 2%, P = .017). Patients who underwent tuberosity osteotomy or excision at the time of RSA were at risk of postoperative prosthetic instability and humeral stem loosening. The absence of the greater tuberosity at last radiographic follow-up was predictive of higher rates of complications and revisions, as well as a poorer final outcome. Previous fracture fixation was associated with a higher rate of complete tuberosity resorption (56% vs. 33%, P = .026) and with higher rates of postoperative complications (27% vs. 13%, P = .099) and reinterventions (17% vs. 2%, P = .018). CONCLUSION The functional results and rates of complications and revision depend on the type of fracture sequelae and tuberosity management. Patients with more severe (type 3 and 4) fracture sequelae who undergo tuberosity osteotomy or excision are at risk of having a poorer functional result and higher rates of complications and revision with lower survival. Previous fracture fixation is also a prejudicial factor.
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Affiliation(s)
- Pascal Boileau
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France.
| | - Brian L Seeto
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | - Gilles Clowez
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | - Marc-Olivier Gauci
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | - Christophe Trojani
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
| | | | - Mikaël Chelli
- iULS-University Institute for Locomotion & Sport, Pasteur 2 Hospital, Nice, France
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Bronsard N, Pelletier Y, Darmante H, Andréani O, de Peretti F, Trojani C. Sacroiliac joint syndrome after lumbosacral fusion. Orthop Traumatol Surg Res 2020; 106:1233-1238. [PMID: 32900669 DOI: 10.1016/j.otsr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION One-third of low back pain cases are due to the sacroiliac (SI) joint. The incidence increases after lumbosacral fusion. A positive Fortin Finger Test points to the SI joint being the origin of the pain; however, clinical examination and imaging are not specific and minimally contributory. The gold standard is a test injection of local anesthetic. More than 70% reduction in pain after this injection confirms the SI joint is the cause of the pain. The aim of this study was to evaluate the decrease in pain on a Numerical Rating Scale (NRS) after intra-articular injection into the SI joint. We hypothesised that intra-articular SI injection will significantly reduce SI pain after lumbosacral fusion. METHODS All patients with pain (NRS>7/10) suspected of being caused by SI joint syndrome 1 year after lumbosacral fusion with positive Fortin test were included. Patients with lumbar or hip pathologies or inflammatory disease of the SI joint were excluded. Each patient underwent a 2D-guided injection of local anesthetic into the SI joint. If this failed, a second 2D-guided injection was done; if this also failed, a third 3D-guided injection was done. Reduction of pain on the NRS by>70% in the first 2 days after the injection confirmed the diagnosis. Whether the injection was intra-articular or not, it was recorded. Ninety-four patients with a mean age of 57 years were included, of which 70% were women. RESULTS Of the 94 patients, 85 had less pain (90%) after one of the three injections. The mean NRS was 8.6/10 (7-10) before the injection and 1.7/10 after the injection (0-3) (p=0.0001). Of the 146 2D-guided injections, 41% were effective and 61% were intra-articular. Of the 34 3D-guided injections, 73% were effective and 100% were intra-articular. DISCUSSION This study found a significant decrease in SI joint-related pain after intra-articular injection into the SI joint in patients who still had pain after lumbosacral fusion. If this injection is non-contributive when CT-guided under local anesthesia, it can be repeated under general anesthesia with 3D O-arm guidance. This diagnostic strategy allowed us to confirm that pain originates in the SI joint after lumbosacral fusion in 9 of 10 patients. CONCLUSION If the first two CT-guided SI joint injections fail, 3D surgical navigation is an alternative means of doing the injection that helps to significantly reduce SI joint-related pain after lumbosacral fusion. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Nicolas Bronsard
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France.
| | - Yann Pelletier
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Hugo Darmante
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Olivier Andréani
- Radiology Unit, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Fernand de Peretti
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Christophe Trojani
- Orthopedic, Traumatology and Spine Unit, Institut Universitaire Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
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Manuello R, Ruimy R, Boileau P, Trojani C, Courjon J. Re: 'Pathogenesis and management of fracture-related infection' by Depypere et al. Clin Microbiol Infect 2020; 26:650-651. [PMID: 31605744 DOI: 10.1016/j.cmi.2019.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 01/17/2023]
Affiliation(s)
- R Manuello
- Infectiologie, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France
| | - R Ruimy
- Laboratoire de Bactériologie, Hôpital Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France; Université Côte d'Azur, CHU, INSERM, C3M, France
| | - P Boileau
- Service de Chirurgie Orthopédique et Chirurgie Du Sport, Institut Universitaire Locomoteur et Du Sport (IULS), Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France; Université Côte d'Azur, France
| | - C Trojani
- Service de Chirurgie Orthopédique et Chirurgie Du Sport, Institut Universitaire Locomoteur et Du Sport (IULS), Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France; Université Côte d'Azur, France
| | - J Courjon
- Université Côte d'Azur, CHU, INSERM, C3M, France; Service de Chirurgie Orthopédique et Chirurgie Du Sport, Institut Universitaire Locomoteur et Du Sport (IULS), Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France.
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Boileau P, Pison A, Wilson A, van der Meijden O, Sacconi S, Trojani C, Gauci MO. Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences. J Shoulder Elbow Surg 2020; 29:931-940. [PMID: 31982337 DOI: 10.1016/j.jse.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulothoracic arthrodesis (STA) has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy (FSHD). However, the rate of osseous fusion is variable, and there is a theoretical risk of reduced respiratory function after bilateral STA. METHODS This was a retrospective study of 10 STAs, performed sequentially, in 5 FSHD patients. The surgical technique involved use of a semitubular plate and wire construct with autograft (iliac crest) interposed between the scapula and rib cage. Osseous fusion, respiratory function, and shoulder function were evaluated. The mean follow-up period was 141 ± 67 months (range, 24-225 months). RESULTS Early complications included 1 pneumothorax and 1 pleural effusion. No late complications occurred, and no patients underwent reoperation. On postoperative computed tomography images, complete bony union of the scapula to the ribs was observed in 90% of shoulders (9 of 10). Comparison of preoperative and postoperative pulmonary function test results showed no significant difference in vital capacity (from 87% ± 14% to 85% ± 12%) and forced vital capacity (from 86% ± 16% to 77% ± 15%). Patients gained on average 40° of active forward elevation (from 62° ± 20° to 102° ± 4°) and 22° of abduction (from 58° ± 21° to 89° ± 7°) (P < .001). The mean Subjective Shoulder Value increased from 25% ± 8% to 72% ± 18% (P < .001). All patients were pleased with the results and would recommend the procedure to other persons. CONCLUSION In patients with FSHD, bilateral STA provides satisfactory shoulder function with a high rate of scapulothoracic fusion and few or no significant respiratory repercussions.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France.
| | | | - Adam Wilson
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Olivier van der Meijden
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Sabrina Sacconi
- Department of Neuroscience, Pasteur 2 Hospital, Nice, France
| | - Christophe Trojani
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Marc-Olivier Gauci
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
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Micicoi G, de Dompsure RB, Micicoi L, Tran L, Carles M, Boileau P, Trojani C. One-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study. Orthop Traumatol Surg Res 2020; 106:577-581. [PMID: 32265170 DOI: 10.1016/j.otsr.2020.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates. HYPOTHESIS In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA. MATERIAL AND METHOD Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction. RESULTS Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08). DISCUSSION One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip. LEVEL OF EVIDENCE III, matched case-control study.
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Affiliation(s)
- Grégoire Micicoi
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Régis Bernard de Dompsure
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Lolita Micicoi
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Laurie Tran
- Service d'anesthésie-réanimation, institut Arnault Tzanck, 171, rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Michel Carles
- Service d'anesthésie-réanimation, CHU de la Guadeloupe, route Chauvel, 97110 Pointe-à-Pitre, France
| | - Pascal Boileau
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Christophe Trojani
- Service de chirurgie orthopédique et chirurgie du sport, Institut universitaire locomoteur et du sport (IULS), hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
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Bronsard N, Pelletier Y, Andréani O, de Peretti F, Trojani C. O-arm-guided sacroiliac joint injection: New techniques with reflux test. Orthop Traumatol Surg Res 2020; 106:281-283. [PMID: 31787556 DOI: 10.1016/j.otsr.2019.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 02/03/2023]
Abstract
Diagnosis of degenerative sacroiliac pain syndrome is difficult. Sacroiliac injection confirms diagnosis by relieving pain. The present study aimed to describe a sacroiliac injection technique under O-arm guidance. Fifty-four patients, with a mean age of 58 years, presenting resistant sacroiliac pain syndrome after two 2D CT-guided injections received O-arm guided sacroiliac injection. Anesthetic reflux on joint lavage validated the technique. Clinical efficacy was assessed as pain relief on a simple numeric scale (positive if>70%). Reflux was observed in 92% of cases. Pain was relieved in 81%, with mean score reduced to 3.1 from 8.5. O-arm guided sacroiliac injection was reproducible and relieved sacroiliac pain after failure of 2D-guided injection, thus confirming the clinical diagnosis.
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Affiliation(s)
- Nicolas Bronsard
- Service de chirurgie orthopédique - traumatologique et chirurgie vertébrale, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
| | - Yann Pelletier
- Service de chirurgie orthopédique - traumatologique et chirurgie vertébrale, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Olivier Andréani
- Service de radiologie ostéo-articulaire, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Fernand de Peretti
- Service de chirurgie orthopédique - traumatologique et chirurgie vertébrale, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Christophe Trojani
- Service de chirurgie orthopédique - traumatologique et chirurgie vertébrale, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
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Chau Y, Roux C, Breuil V, Trojani C, Gonzalez JF, Amoretti N, Sédat J. Endovascular Occlusion of Neovascularization as a Treatment for Persistent Pain After Total Knee Arthroplasty. Cardiovasc Intervent Radiol 2020; 43:787-790. [PMID: 32144433 DOI: 10.1007/s00270-020-02449-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
Approximately 20% of patients have persistent unexplained pain after total knee arthroplasty (TKA). Currently available treatments are unsatisfactory. The present report describes four patients in whom transcatheter arterial embolization had a remarkable effect on pain after TKA. Abnormal neovessels were identified in all patients. For 48 h, one patient experienced remarkable postprocedural pain at the inner side of the knee that was subsided by level 1 analgesics and another patient development of a spontaneous skin ulceration resolving within 8 days. The mean Knee injury and Osteoarthritis Outcome Score pain subtotal had increased from 39 to 82 one month after treatment. Endovascular occlusion of neovascularization, decreasing chronic inflammation and the growth of unmyelinated sensory nerves may be treatment options for persistent unexplained pain following TKA.Level of Evidence IV, Case report.
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Affiliation(s)
- Yves Chau
- Neurointerventional and Interventional Vascular Unit, Université Côte d'Azur (UCA), Hôpital Pasteur 2, CHU Nice, 30 Voie Romaine, Nice, France.
| | - Christian Roux
- Department of Rheumatology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Véronique Breuil
- Department of Rheumatology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Christophe Trojani
- Department of Orthopedic Surgery, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Jean-François Gonzalez
- Department of Orthopedic Surgery, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Nicolas Amoretti
- Department of Osteointerventional Radiology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Jacques Sédat
- Neurointerventional and Interventional Vascular Unit, Université Côte d'Azur (UCA), Hôpital Pasteur 2, CHU Nice, 30 Voie Romaine, Nice, France
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Boileau P, Gastaud O, Wilson A, Trojani C, Bronsard N. All-Arthroscopic Reconstruction of Severe Chronic Acromioclavicular Joint Dislocations. Arthroscopy 2019; 35:1324-1335. [PMID: 31054712 DOI: 10.1016/j.arthro.2018.11.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6 weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations. METHODS We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n = 11), type IV (n = 19), and type V (n = 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39 months (range, 6 months to 17 years). The mean age at surgery was 42 years (range, 19-71 years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36 months (range, 12-72 months). RESULTS Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied. CONCLUSIONS All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Pascal Boileau
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France.
| | - Olivier Gastaud
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Adam Wilson
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Christophe Trojani
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
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Tran L, Barthelemy M, Boileau P, Raucoules-Aime M, Carles M, Trojani C. Sciatic nerve block or not for outpatient total knee arthroplasty? Study protocol for a randomized controlled trial. Trials 2019; 20:30. [PMID: 30621742 PMCID: PMC6325783 DOI: 10.1186/s13063-018-3142-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 12/17/2018] [Indexed: 01/05/2023] Open
Abstract
Background The number of patients operated on for total knee arthroplasty (TKA) is growing worldwide. Outpatient surgery is defined by a length of stay (LOS) in the hospital of less than 12 h. This can be limited for TKA, with the efficient management of pain and perioperative complications, such as blood loss, affecting a safe hospital discharge. Outpatient TKA with a suitable protocol, including multimodal measures, could improve the success rate of this procedure. Among the main measures, single-shot sciatic nerve block in association with continuous femoral nerve block for pain control needs to be evaluated in outpatient TKA. Furthermore, to promote the safety of the postoperative period and to accelerate rehabilitation, patients who undergo ambulatory TKA could be discharged to a rehabilitation center on the day of surgery to screen adverse events and to optimize the rehabilitation process. This study is designed to assess the benefits of sciatic nerve block in postoperative pain relief for outpatient TKA. Methods/design This randomized prospective controlled study will be conducted in the knee unit of the teaching hospital of the Nice university and will include 40 patients undergoing primary unilateral outpatient TKA, discharged the day of surgery to a private rehabilitation center for enhanced recovery after surgery, after a hospital stay of less than 12 h. Before surgery, all patients will receive a continuous femoral nerve block with 2 mg/ml ropivacaine 20 ml, and then patients will be randomly assigned to receive or not receive a single-shot sciatic nerve block with 2 mg/ml ropivacaine, 20 ml. The primary outcome measure is the success rate of outpatient TKA. This rate is defined by patients discharged from the hospital to a rehabilitation center the day of surgery with no re-hospitalization due to insufficient pain control before the fifth postoperative day. Secondary outcomes include the incidence of major and minor adverse events during the first five postoperative days and measurement of the quality of recovery using the Knee injury and Osteoarthritis Outcome Score and the new International Knee Society scores plus the Quality of Recovery-40 questionnaire. Discussion The assessment of anesthesia and rehabilitation protocols enabling major orthopedic surgery, such as TKA, is necessary. This randomized controlled study will address the hypothesis that a suitable multimodal protocol including sciatic nerve block could improve pain control and thus improve the success rate of outpatient TKA. Trial registration EudraCT, 2016-000226-19. Registered on 15 April 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-3142-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laurie Tran
- Department of Anesthesiology, Intensive care and Emergency Medicine, Pasteur 2 Hospital, 30, Voie Romaine, CS 51069, 06001, Nice, Cedex 1, France.
| | - Melissa Barthelemy
- Department of Anesthesiology, Intensive care and Emergency Medicine, Pasteur 2 Hospital, 30, Voie Romaine, CS 51069, 06001, Nice, Cedex 1, France
| | - Pascal Boileau
- Department of Orthopedics & Sports, iULS - University Institute of Locomotion & Sports, Pasteur 2 Hospital, 30, Voie Romaine, CS 51069, 06001, Nice, Cedex 1, France
| | - Marc Raucoules-Aime
- Department of Anesthesiology, Intensive care and Emergency Medicine, Pasteur 2 Hospital, 30, Voie Romaine, CS 51069, 06001, Nice, Cedex 1, France
| | - Michel Carles
- Department of Anesthesiology, Intensive care and Emergency Medicine, Pasteur 2 Hospital, 30, Voie Romaine, CS 51069, 06001, Nice, Cedex 1, France
| | - Christophe Trojani
- Department of Orthopedics & Sports, iULS - University Institute of Locomotion & Sports, Pasteur 2 Hospital, 30, Voie Romaine, CS 51069, 06001, Nice, Cedex 1, France
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Trojani C. Comments on: "Hip resurfacing before 50 years of age: A prospective study of 979 hips with a mean follow-up of 5.1 years" by Girard J, Lons A, Ramdane N, Putman S. published in Orthop Traumatol Surg Res. 2018;104(3):295-299. Orthop Traumatol Surg Res 2018; 104:1297-1298. [PMID: 30077658 DOI: 10.1016/j.otsr.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Christophe Trojani
- Institut universitaire locomoteur et du sport (iULS), unité de chirurgie de la hanche et du genou, hôpital Pasteur 2, 30, avenue Voie-Romaine, 06000 Nice, France.
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Balaguer T, Fellah BH, Boukhechba F, Traverson M, Mouska X, Ambrosetti D, Dadone B, Michiels JF, Amri EZ, Trojani C, Bouler JM, Gauthier O, Rochet N. Combination of blood and biphasic calcium phosphate microparticles for the reconstruction of large bone defects in dog: A pilot study. J Biomed Mater Res A 2018; 106:1842-1850. [DOI: 10.1002/jbm.a.36384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/03/2018] [Accepted: 02/27/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Thierry Balaguer
- Université Côte d'Azur, CNRS, Inserm, iBV; France
- Centre Hospitalier Universitaire, Pôle de Chirurgie Réparatrice et Ostéo Articulaire; Nice France
| | - Borhane H. Fellah
- CRIP, Centre de Recherche et d'Investigation Précliniques, ONIRIS; Nantes France
| | | | - Marine Traverson
- CRIP, Centre de Recherche et d'Investigation Précliniques, ONIRIS; Nantes France
| | | | - Damien Ambrosetti
- Centre Hospitalier Universitaire, Laboratoire central d'anatomopathologie; Nice France
| | - Bérengère Dadone
- Centre Hospitalier Universitaire, Laboratoire central d'anatomopathologie; Nice France
| | | | | | - Christophe Trojani
- Université Côte d'Azur, CNRS, Inserm, iBV; France
- Centre Hospitalier Universitaire, Pôle de Chirurgie Réparatrice et Ostéo Articulaire; Nice France
| | | | - Olivier Gauthier
- CRIP, Centre de Recherche et d'Investigation Précliniques, ONIRIS; Nantes France
- Université de Nantes, Inserm UMRS 791, LIOAD; Nantes France
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Boileau P, Baba M, McClelland WB, Thélu CÉ, Trojani C, Bronsard N. Isolated loss of active external rotation: a distinct entity and results of L'Episcopo tendon transfer. J Shoulder Elbow Surg 2018; 27:499-509. [PMID: 29290606 DOI: 10.1016/j.jse.2017.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to characterize a subgroup of cuff-deficient patients with isolated loss of active external rotation (ILER) but preserved active elevation and to evaluate the outcomes of the L'Episcopo procedure to restore horizontal muscle balance. METHODS During a 10-year period, 26 patients (14 men, 12 women) were identified with ILER in the setting of massive irreparable posterosuperior cuff tears. A modified L'Episcopo tendon transfer was performed to restore active external rotation and to improve shoulder function. The mean age at surgery was 64.5 years (29-83 years). Patients were evaluated with a mean follow-up of 52 months (range, 24-104 months). RESULTS Preoperatively, despite maintained active elevation (average of 161°), ILER patients complained about loss of spatial control of the arm and difficulties with activities of daily living. On computed tomography scan or magnetic resonance imaging, there was severe fatty infiltration of infraspinatus and absent or atrophic teres minor. After L'Episcopo transfer, 84% of patients were satisfied. The gain in active external rotation was +26° in arm at the side and +18.5° in 90° abduction. Adjusted Constant score and Simple Shoulder Value increased from 63.6% to 86.9% and from 36.9% to 70.8%, respectively (P < .001). The ADLER score increased from 10 to 24.5 points (P < .002). Two patients with advanced cuff tear arthropathy (Hamada stage 3 and 4) required conversion to a reverse shoulder arthroplasty (RSA) 7 and 9 years after the index surgery. CONCLUSIONS ILER is a distinct entity that is a cause of severe handicap because of loss of spatial control of the upper limb. This symptom is related to absent or atrophied infraspinatus and teres minor. In properly selected cases (Hamada stage 1 or 2), the modified L'Episcopo transfer is effective at restoring anterior-posterior rotator cuff force balance. In more advanced cuff tear arthropathy (Hamada stage ≥3), the tendon transfer should be performed with an RSA because of possible secondary degeneration of the glenohumeral joint.
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Affiliation(s)
- Pascal Boileau
- Institut Universitaire Locomoteur et Sport (iULS), Hôpital Pasteur 2, University of Nice Sophia Antipolis (UNSA), Nice, France.
| | - Mohammed Baba
- Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | | | | | - Christophe Trojani
- Institut Universitaire Locomoteur et Sport (iULS), Hôpital Pasteur 2, University of Nice Sophia Antipolis (UNSA), Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et Sport (iULS), Hôpital Pasteur 2, University of Nice Sophia Antipolis (UNSA), Nice, France
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Saliken D, Lavoué V, Trojani C, Gonzalez JF, Boileau P. Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss. Arthrosc Tech 2017; 6:e2031-e2037. [PMID: 29399470 PMCID: PMC5795097 DOI: 10.1016/j.eats.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/04/2017] [Indexed: 02/03/2023] Open
Abstract
Patients presenting with recurrent shoulder instability and bipolar glenohumeral bone loss are at risk of failed standard soft-tissue repair techniques. Even isolated bony-stabilization procedures such as the Latarjet or remplissage technique may not provide sufficient stability in the face of combined bone loss. We use a combined all-arthroscopic remplissage, Latarjet, and Bankart repair for patients with significant combined glenohumeral bone loss and/or in the revision setting. This allows reconstruction of both the Hill-Sachs and glenoid bone defects and repair of the capsulolabral complex in a minimally invasive manner. Furthermore, the use of cortical-button fixation of the coracoid bone graft may reduce the risk of hardware-related complications while still achieving excellent bone union.
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Affiliation(s)
| | | | | | | | - Pascal Boileau
- Address correspondence to Pascal Boileau, M.D., Department of Orthopaedic Surgery and Sports Traumatology, iULS (Institut Universitaire Locomoteur & Sport), Hôpital Pasteur 2, University of Nice Sophia-Antipolis, 30, Avenue de la Voie Romaine, Nice, France 06001 Cedex 1.Department of Orthopaedic Surgery and Sports TraumatologyiULS (Institut Universitaire Locomoteur & Sport)Hôpital Pasteur 2University of Nice Sophia-Antipolis30, Avenue de la Voie RomaineNice06001 Cedex 1France
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26
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Abstract
The authors describe a novel suture fixation technique that combines a doubled suture with a sliding knot. The knot can be tied in both open and arthroscopic surgery to fix torn tendons/ligaments and fractured/osteotomized bones. The advantages of the doubled-suture Nice knot include strength, adjustability, simplicity, and versatility. This technique, which has proven useful in the authors' practice for the past 10 years, has replaced metallic wires and cables for bone fixation. The doubled-suture Nice knot can also be tied over a double-button and has been used for ankle syndesmosis, acromioclavicular joint separation repair, and coracoid bone block fixation. [Orthopedics. 2017; 40(2):e382-e386.].
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Gendre P, Thélu CE, d'Ollonne T, Trojani C, Gonzalez JF, Boileau P. Coracoid bone block fixation with cortical buttons: An alternative to screw fixation? Orthop Traumatol Surg Res 2016; 102:983-987. [PMID: 27720375 DOI: 10.1016/j.otsr.2016.06.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 06/22/2016] [Accepted: 06/30/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation. MATERIALS AND METHODS Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively. RESULTS The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method. CONCLUSIONS (1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- P Gendre
- Institut Universitaire Locomoteur et Sport, hôpital Pasteur 2, 30 Voie Romaine - CS 51069, 06001 Nice Cedex 1, France
| | - C-E Thélu
- Clinique du Sport et de Chirurgie Orthopédique, 199 rue de la Rianderie, 59706 Marcq-en-Baroeul, France
| | - T d'Ollonne
- Institut Universitaire Locomoteur et Sport, hôpital Pasteur 2, 30 Voie Romaine - CS 51069, 06001 Nice Cedex 1, France
| | - C Trojani
- Institut Universitaire Locomoteur et Sport, hôpital Pasteur 2, 30 Voie Romaine - CS 51069, 06001 Nice Cedex 1, France
| | - J-F Gonzalez
- Institut Universitaire Locomoteur et Sport, hôpital Pasteur 2, 30 Voie Romaine - CS 51069, 06001 Nice Cedex 1, France
| | - P Boileau
- Institut Universitaire Locomoteur et Sport, hôpital Pasteur 2, 30 Voie Romaine - CS 51069, 06001 Nice Cedex 1, France.
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Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, Wright RW, Kaeding CC. Erratum to: Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 2016; 24:3694-3695. [PMID: 26537594 DOI: 10.1007/s00167-015-3835-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert A Magnussen
- Department of Orthopaedics, Sports Health and Performance Institute, The Ohio State University, Columbus, OH, 43221, USA.
| | - Christophe Trojani
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice-Sophia Antipolis, Nice, France
| | - Lars-Petter Granan
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Philippe Neyret
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rouse, Lyon, France
| | | | - Lars Engebretsen
- Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Rick W Wright
- Department of Orthopaedic Surgery, Washington University, Chesterfield, MO, USA
| | - Christopher C Kaeding
- Department of Orthopaedics, Sports Health and Performance Institute, The Ohio State University, Columbus, OH, 43221, USA
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Boileau P, Gendre P, Baba M, Thélu CÉ, Baring T, Gonzalez JF, Trojani C. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg 2016; 25:78-89. [PMID: 26256014 DOI: 10.1016/j.jse.2015.06.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/08/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications. MATERIALS AND METHODS Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit. RESULTS At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%). CONCLUSIONS A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France.
| | - Patrick Gendre
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France
| | - Mohammed Baba
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France
| | - Charles-Édouard Thélu
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France
| | - Toby Baring
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France
| | - Jean-François Gonzalez
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France
| | - Christophe Trojani
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, Medical University of Nice-Sophia-Antipolis, Nice, France
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Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, Wright RW, Kaeding CC. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 2015; 23:2339-2348. [PMID: 24850239 PMCID: PMC4241181 DOI: 10.1007/s00167-014-3060-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 05/02/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE The goal of this paper is to compare patient factors, intra-operative findings, and surgical techniques between patients followed in large cohorts in France, Norway, and North America. METHODS Data collected on 2,286 patients undergoing revision anterior cruciate ligament reconstruction (ACLR) were obtained. These data included 1,216 patients enrolled in the Multicenter ACL Revision Study (MARS) in North America, 793 patients undergoing revision ACLR and recorded in the Norwegian Knee Ligament Registry (NKLR), and 277 patients recorded in the revision ACL database of the Société Française d'Arthroscopie (SFA) in France. Data collected from each database included patient demographics (age, sex, height, and weight), graft choice and reason for failure of the primary ACLR, time from primary to revision ACLR, pre-revision patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score, subjective International Knee Documentation Committee), associated intra-articular findings and treatments at revision, and graft choice for revision reconstruction. RESULTS Patient demographics in the three databases were relatively similar. Graft choice for primary and revision ACLR varied significantly, with more allografts used in the MARS cohort. Hamstring autograft was favoured in the NKRL, while bone-patellar tendon-bone autograft was most common in the SFA cohort. Reasons for failure of the primary ACLR were comparable, with recurrent trauma noted in 46-56 % of patients in each of the three cohorts. Technical error was cited in 44-51 % of patients in the MARS and SFA cohorts, but was not clearly elucidated in the NKLR cohort. Biologic failure of the primary graft was more common in the MARS cohort. Differences in associated intra-articular findings were noted at the time of revision ACLR, with significantly more high-grade cartilage lesions noted in the MARS group. CONCLUSIONS Significant differences exist between patient populations followed in revision ACL cohorts throughout the world that should be considered when applying findings from such cohorts to different patient populations. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Robert A. Magnussen
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA,Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA
| | - Christophe Trojani
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, Nice, France
| | - Lars-Petter Granan
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | | | - Philippe Neyret
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rouse, Lyon, France
| | | | - Lars Engebretsen
- Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University, Chesterfield, MO, USA
| | - Christopher C. Kaeding
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA,Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA
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Sonnery-Cottet B, Bazille C, Hulet C, Colombet P, Cucurulo T, Panisset JC, Potel JF, Servien E, Trojani C, Djian P, Graveleau N, Pujol N. Histological features of the ACL remnant in partial tears. Knee 2014; 21:1009-13. [PMID: 25112212 DOI: 10.1016/j.knee.2014.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/01/2014] [Accepted: 07/15/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to investigate the histological features of the remaining fibers bridging the femur and tibia in partial ACL tears. METHODS Twenty-six ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cells positive for α-smooth actin and for mechanoreceptor detection. RESULTS In these samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54% of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41% of the specimens. The cellularity was correlated to the time between injury to surgery (p=0.001). CONCLUSION Competent histological structures including a well-vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered. CLINICAL RELEVANCE Descriptive laboratory study.
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Affiliation(s)
| | | | | | | | - Thomas Cucurulo
- Centre Borely Mermoz, 118 rue Jean Mermoz, Marseille 13008, France
| | | | | | - Elvire Servien
- CHU de la Croix Rousse, 103 Grande Rue de la Croix-Rousse, Lyon 69004, France
| | - Christophe Trojani
- Service de Chirurgie Orthopédique, Hôpital de l'Archet 2, 151 route St A. de Ginestière, Nice 06200, France
| | | | | | - Nicolas Pujol
- Hôpital André Mignot, 177 rue de Versailles, Le Chesnay 78150, France.
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Bessière C, Trojani C, Carles M, Mehta SS, Boileau P. The open latarjet procedure is more reliable in terms of shoulder stability than arthroscopic bankart repair. Clin Orthop Relat Res 2014; 472:2345-51. [PMID: 24615422 PMCID: PMC4079884 DOI: 10.1007/s11999-014-3550-9] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. QUESTIONS/PURPOSES We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. METHODS In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. RESULTS At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation > 85° in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018). CONCLUSIONS Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles Bessière
- Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202 Nice, France
| | - Christophe Trojani
- Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202 Nice, France
| | - Michel Carles
- Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202 Nice, France
| | - Saurabh S. Mehta
- Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202 Nice, France
| | - Pascal Boileau
- Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202 Nice, France
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Boileau P, Thélu CÉ, Mercier N, Ohl X, Houghton-Clemmey R, Carles M, Trojani C. Arthroscopic Bristow-Latarjet combined with bankart repair restores shoulder stability in patients with glenoid bone loss. Clin Orthop Relat Res 2014; 472:2413-24. [PMID: 24942959 PMCID: PMC4079880 DOI: 10.1007/s11999-014-3691-x] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic Bankart repair alone cannot restore shoulder stability in patients with glenoid bone loss involving more than 20% of the glenoid surface. Coracoid transposition to prevent recurrent shoulder dislocation according to Bristow-Latarjet is an efficient but controversial procedure. QUESTIONS/PURPOSES We determined whether an arthroscopic Bristow-Latarjet procedure with concomitant Bankart repair (1) restored shoulder stability in this selected subgroup of patients, (2) without decreasing mobility, and (3) allowed patients to return to sports at preinjury level. We also evaluated (4) bone block positioning, healing, and arthritis and (5) risk factors for nonunion and coracoid screw pullout. METHODS Between July 2007 and August 2010, 79 patients with recurrent anterior instability and bone loss of more than 20% of the glenoid underwent arthroscopic Bristow-Latarjet-Bankart repair; nine patients (11%) were either lost before 2-year followup or had incomplete data, leaving 70 patients available at a mean of 35 months. Postoperative radiographs and CT scans were evaluated for bone block positioning, healing, and arthritis. Any postoperative dislocation or any subjective complaint of occasional to frequent subluxation was considered a failure. Physical examination included ROM in both shoulders to enable comparison and instability signs (apprehension and relocation tests). Rowe and Walch-Duplay scores were obtained at each review. Patients were asked whether they were able to return to sports at the same level and practice forced overhead sports. Potential risk factors for nonhealing were assessed. RESULTS At latest followup, 69 of 70 (98%) patients had a stable shoulder, external rotation with arm at the side was 9° less than the nonoperated side, and 58 (83%) returned to sports at preinjury level. On latest radiographs, 64 (91%) had no osteoarthritis, and bone block positioning was accurate, with 63 (90%) being below the equator and 65 (93%) flush to the glenoid surface. The coracoid graft healed in 51 (73%), it failed to unite in 14 (20%), and graft osteolysis was seen in five (7%). Bone block nonunion/migration did not compromise shoulder stability but was associated with persistent apprehension and less return to sports. Use of screws that were too short or overangulated, smoking, and age higher than 35 years were risk factors for nonunion. CONCLUSIONS The arthroscopic Bristow-Latarjet procedure combined with Bankart repair for anterior instability with severe glenoid bone loss restored shoulder stability, maintained ROM, allowed return to sports at preinjury level, and had a low likelihood of arthritis. Adequate healing of the transferred coracoid process to the glenoid neck is an important factor for avoiding persistent anterior apprehension. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet 2, University of Nice Sophia-Antipolis, 151 route de St Antoine de Ginestière, 06202, Nice, France,
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Kumar G, Roger PM, Ticchioni M, Trojani C, Bernard de Dompsur R, Bronsard N, Carles M, Bernard E. T cells from chronic bone infection show reduced proliferation and a high proportion of CD28⁻ CD4 T cells. Clin Exp Immunol 2014; 176:49-57. [PMID: 24298980 DOI: 10.1111/cei.12245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 12/16/2022] Open
Abstract
Chronic bone infection is associated with bone resorption. From animal studies, CD3/CD28-activated T cells are known to enhance osteoclastogenesis and bone resorption. Because CD28 is expressed constitutively on T cells and its expression is down-regulated by chronic exposure to the inflammatory environment, we characterized co-stimulatory molecule expression on T cells from chronically infected patients. We used cytofluorometric techniques to phenotypically characterize T cells, its co-stimulatory molecules and perforin secretion from infected and non-infected human bones. Chronic bone infection was defined as infection lasting for more than a month. We show a higher T cell activation [human leucocyte antigen D-related (HLA-DR⁺)] in infected compared to non-infected bones: median being 16 versus 7%, P = 0·009 for CD4 T cells, and 33 versus 15%, P = 0·038 for CD8 T cells, respectively. However, T cell proliferation (Ki67⁺) was lower for CD8 T cells in infected bones: 26 versus 34%, P = 0·045. In contrast, we detected no difference in apoptosis and regulatory T cells. In infected bone, we found higher CD28-negative CD4⁺ T cells compared to non-infected bone: 20 versus 8%, respectively (P = 0·005); this T cell subset had higher CD11b expression and perforin secretion. Chronically infected human bones are characterized by an increase of CD28-negative CD4⁺ T cells, indicating long-term activated cells with cytotoxic ability. Therefore, this alteration of co-stimulatory molecules may modify interactions with osteoclasts and impact bone resorption.
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Affiliation(s)
- G Kumar
- Unité 576, Institut National de la Santé et de la Recherche Médicale, Hopital L'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Nice, France
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Trojani C, Elhor H, Carles M, Boileau P. Anterior cruciate ligament reconstruction combined with valgus high tibial osteotomy allows return to sports. Orthop Traumatol Surg Res 2014; 100:209-12. [PMID: 24529851 DOI: 10.1016/j.otsr.2013.11.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/17/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study reports a series of patients operated on by anterior cruciate ligament (ACL) reconstruction combined with valgus high tibial osteotomy (HTO) for chronic anterior knee instability associated with medial tibiofemoral osteoarthritis. It was hypothesized that the combined surgery would enable return to sport, stabilize the knee and relieve medial pain. PATIENTS AND METHODS A retrospective study enrolled a continuous series of 29 patients (20 males, nine females; mean age, 43 years (range, 25-56 yrs), at a mean 14 years (range, 2-29 yrs) after the initial injury. ACL autograft used a bone-patellar tendon-bone transplant in 12 patients and hamstring tendon transplant in 17. Medial opening wedge HTO used an asymmetric wedge plate. Results were assessed on subjective and objective IKDC scores, monopodal weight-bearing and full-leg radiographs, telemetry and Merchant view at a mean 6 years follow-up (range, 25 months to 12 years). RESULTS At follow-up, 23 patients had resumed sports activities, with 45% in competitive sports; 28 were free of instability and 21 free of pain. Mean subjective IKDC score was 77 (34-97) and 70% had A or B global objective IKDC scores. The knee axis was in 2.5° valgus. DISCUSSION Combined ACL graft and valgus HTO relieved pain in 70% of cases, and restored knee stability enabling return to sport in 80%. LEVEL OF EVIDENCE Level IV. Retrospective therapeutic study.
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Affiliation(s)
- C Trojani
- Service de chirurgie orthopédique et traumatologie du sport, hôpital de l'Archet 2, 151, route de St-Antoine-de-Ginestière, 06200 Nice, France.
| | - H Elhor
- Service de chirurgie orthopédique et traumatologie du sport, hôpital de l'Archet 2, 151, route de St-Antoine-de-Ginestière, 06200 Nice, France
| | - M Carles
- Service d'anesthésie-réanimation, hôpital de l'Archet 2, 151, route de St-Antoine-de-Ginestière, 06200 Nice, France
| | - P Boileau
- Service de chirurgie orthopédique et traumatologie du sport, hôpital de l'Archet 2, 151, route de St-Antoine-de-Ginestière, 06200 Nice, France
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Piriou P, Bugyan H, Casalonga D, Lizée E, Trojani C, Versier G. Can hip anatomy be reconstructed with femoral components having only one neck morphology? A study on 466 hips. J Arthroplasty 2013; 28:1185-91. [PMID: 23245588 DOI: 10.1016/j.arth.2012.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 08/03/2012] [Accepted: 08/17/2012] [Indexed: 02/01/2023] Open
Abstract
This extensive radiographic study asks if there is a statistical relationship between the size of the stem that will best fit the femur and the vertical and lateral offsets of the reconstructed acetabular center, what is the distribution of vertical and lateral offsets in this large and if there is a statistical difference among surgeons in the planned location of the reconstructed acetabular center. On 466 radiographs, five surgeons separately templated stem size and acetabular cup location. The vertical and horizontal coordinates of the reconstructed acetabulum center were measured relative to the planned position of the stem. We found a strong correlation between the stem size and the average lateral and vertical offsets. Acetabular reaming associated with the anatomic variability of native femoral necks, leads to a span of 36 mm in lateral offset, and a span of 39 mm in vertical offset. Statistically significant differences were also found in the way surgeons plan acetabular reaming.
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Moineau G, McClelland WB, Trojani C, Rumian A, Walch G, Boileau P. Prognostic factors and limitations of anatomic shoulder arthroplasty for the treatment of posttraumatic cephalic collapse or necrosis (type-1 proximal humeral fracture sequelae). J Bone Joint Surg Am 2012; 94:2186-94. [PMID: 23224389 DOI: 10.2106/jbjs.j.00412] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the prognostic factors and limitations of anatomic unconstrained shoulder arthroplasty, performed without tuberosity osteotomy, for the treatment of secondary glenohumeral arthritis following posttraumatic cephalic collapse or necrosis of the humeral head, defined as type-1 fracture sequelae. METHODS Fifty-five patients with type-1 fracture sequelae treated with anatomic shoulder arthroplasty were included in this retrospective single-center cohort study. All anatomic humeral prostheses were implanted without performing a greater tuberosity osteotomy. Glenoid resurfacing was performed in forty-four patients (80%). Clinical and radiographic analysis was performed at a mean of fifty-two months (range, twenty-four to 180 months) postoperatively. RESULTS Four reoperations (7%) were performed, including two revisions in patients who required glenoid resurfacing because of glenoid erosion after hemiarthroplasty. At the time of the latest follow-up, 93% of patients were satisfied or very satisfied, and the mean Subjective Shoulder Value (SSV) was 81%. There were significant improvements in the mean Constant score (from 32 to 69 points), active anterior elevation (from 88° to 141°), external rotation (from 6° to 34°), and internal rotation (from the buttock to L3). Significantly poorer results were associated with proximal humeral deformity in varus and with fatty infiltration of the rotator cuff muscles. Patients with proximal humeral deformity, specifically varus or valgus malunion of the greater tuberosity, had a mean Constant score that was 10 points lower and active elevation that was almost 20° less than patients with no such deformity. The poorest results were observed in patients with varus malunion. CONCLUSIONS Our study confirmed that the outcomes of anatomic shoulder arthroplasty for the treatment of type-1 fracture sequelae are good and predictable when deformation of the proximal humerus is acceptable(i.e., when no greater tuberosity osteotomy is necessary). The results were negatively affected by proximal humeral varus deformity and by fatty infiltration of the rotator cuff on imaging studies. In such cases, reverse shoulder arthroplasty may be more appropriate, especially in elderly patients.
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Affiliation(s)
- Grégory Moineau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice-Sophia Antipolis, 151 Route de St. Antoine de Ginestière, 06202 Nice, France
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Pujol N, Colombet P, Potel JF, Cucurulo T, Graveleau N, Hulet C, Panisset JC, Servien E, Sonnery-Cottet B, Trojani C, Djian P. Anterior cruciate ligament reconstruction in partial tear: selective anteromedial bundle reconstruction conserving the posterolateral remnant versus single-bundle anatomic ACL reconstruction: preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res 2012; 98:S171-7. [PMID: 23142049 DOI: 10.1016/j.otsr.2012.09.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Partial tears of the anterior cruciate ligament (ACL) are frequent. Conserving ACL remnants is central to the concept of anatomic, biomechanical and biological reconstruction. The interest of such conservation remains theoretical. The present hypothesis was that selective anteromedial (AM) bundle reconstruction is preferable to the standard single-bundle reconstruction in partial ACL tear. MATERIALS AND METHODS A multicenter prospective randomized study recruited 54 partial ACL tears operated on either by selective AM bundle reconstruction (Group 1, n=29) or by standard anatomic single-bundle reconstruction (Group 2, n=25). All patients were clinically assessed on subjective and objective IKDC, Lysholm and KOOS scores, with a minimum 12 months' follow-up. Comparative pre- to postoperative anterior laxity was measured on the Rolimeter(®) device, with statistical analysis of results. RESULTS There were no significant preoperative differences between the two groups. All patients were followed-up at 6 months and 1 year. Mean subjective IKDC scores for groups 1 and 2 respectively were 55.8 and 56.8 preoperatively versus 86.2 and 85.7 at 1 year; Lysholm scores were 69.9 and 71.1 versus 90.9 and 91.8. These inter-group differences were non-significant. Differential laxity for groups 1 and 2 respectively was 5.0mm (range, 2-10) and 5.1mm (2-12) preoperatively (P=0.73), versus 1.2mm and 1.9 mm postoperatively (P=0.03). DISCUSSION AND CONCLUSION In partial ACL tear, selective AM bundle reconstruction conserving the posterolateral bundle remnant provides clinical results comparable to the standard single-bundle technique, with better control of anterior laxity. Longer follow-up, however, will be needed to compare evolution in anterior and rotational laxity and in subjective results over time.
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Affiliation(s)
- N Pujol
- Versailles Hospital Center, Versailles-Saint-Quentin University, 177, rue de Versailles, 78157 Le Chesnay, France.
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Sonnery-Cottet B, Panisset JC, Colombet P, Cucurulo T, Graveleau N, Hulet C, Potel JF, Servien E, Trojani C, Djian P, Pujol N. Partial ACL reconstruction with preservation of the posterolateral bundle. Orthop Traumatol Surg Res 2012; 98:S165-70. [PMID: 23142050 DOI: 10.1016/j.otsr.2012.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/09/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved considerably. Based on this knowledge, ACL reconstruction techniques have changed and selective reconstruction procedures have been developed for partial tears. Our hypothesis was that stability and function can be restored to the knee with selective bundle reconstruction of partial ACL tears and preservation of the residual fibers. MATERIALS AND METHODS This was a multicenter retrospective study of 168 partial reconstructions of the anteromedial (AM) bundle of the ACL with preservation of the posterolateral (PL) bundle. All patients underwent a clinical evaluation based on the objective and subjective IKDC scores and the Lysholm score after a mean follow-up of 26 months (12-59 months). Preoperative and postoperative instrumental measurement of knee laxity was performed by arthrometer and/or by (Telos(®)) stress radiography. Statistical analysis and comparison was performed between pre- and postoperative results. RESULTS The preoperative and postoperative subjective IKDC scores were 63.7 and 90.5 at the final follow-up respectively (P<0.001). The preoperative and postoperative Lysholm scores were 80 and 95.5 respectively (P<0.001). Preoperatively, most patients were classified C on the objective IKDC score. At the final follow-up 92% of the patients were classified A or B (P<0.001). Differential preoperative laxity was 5.5mm (range: 0-14 mm) and 1.1mm (range: 0-4mm) at the final follow-up (P<0.00001). DISCUSSION AND CONCLUSION Our study confirms that selective reconstruction of the AM bundle of the ACL with preservation of the PL bundle restores stability and function to the knee. Special attention should be paid to the size of the graft used to avoid excess tissue in the intercondylar notch.
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Affiliation(s)
- B Sonnery-Cottet
- Centre orthopédique Paul-Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
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Trojani C, Bugnas B, Blay M, Carles M, Boileau P. Bilateral total knee arthroplasty in a one-stage surgical procedure. Orthop Traumatol Surg Res 2012; 98:857-62. [PMID: 23146285 DOI: 10.1016/j.otsr.2012.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 08/02/2012] [Accepted: 08/30/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bilateral total knee arthroplasty (TKA) in a one-stage surgical procedure has the advantage of a single hospital stay, shorter rehabilitation, and reduced patient management costs. However, until now the use of this strategy has been limited by the fear of a higher rate of perioperative complications. The hypothesis of this study was that in selected patients, this management strategy would not result in any serious complications. MATERIALS AND METHODS This prospective 24-month pilot study was performed in a continuous series of patients without a control group. Inclusion criteria were bilateral non-infectious gonarthropathy, in patients classified as American Society of Anesthesiology (ASA) 1 or 2 and presenting with a preoperative hemoglobin level of at least 13g/dL. All patients underwent a pre- and postoperative evaluation using the International Knee Society (IKS) and Knee Injury and Osteoarthritis Score (KOOS) scores. RESULTS Thirty patients were included in the study (25 women, mean age 70.3years old [32 to 88years]; five ASA 1 and 25 ASA 2). All patients were followed-up and evaluated for a mean 18months (6 to 30months). Three deep vein thromboses, one cardiopulmonary accident and three confusional states were reported, but there were no perioperative deaths, pulmonary embolisms, nosocomial infections or revision procedures. At 18months follow-up the IKS score had improved from 98 (33-139) preoperatively to 169 (62-200) postoperatively. The five items of the KOOS score improved significantly. DISCUSSION This preliminary series confirms that bilateral total knee replacement in a one-stage surgical procedure is a reliable alternative to a two-stage procedure in ASA 1 and 2 patients. Because of the savings in health costs with this strategy, public healthcare authorities should provide support by creating and sponsoring a specific group for further study. LEVEL OF EVIDENCE 4, prospective, no control group.
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Affiliation(s)
- C Trojani
- Department of Orthopaedic surgery and sport traumatology, hôpital de l'Archet II, 151 route de Saint-Antoine-de-Ginestière, Nice, France.
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Pujol N, Colombet P, Cucurulo T, Graveleau N, Hulet C, Panisset JC, Potel JF, Servien E, Sonnery-Cottet B, Trojani C, Djian P. Natural history of partial anterior cruciate ligament tears: a systematic literature review. Orthop Traumatol Surg Res 2012; 98:S160-4. [PMID: 23153663 DOI: 10.1016/j.otsr.2012.09.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be raised by a diagnostic aspect associating slight laxity with no clear pivot-shift. Unlike that of complete ACL tear, the natural history of partial tear remains controversial. MATERIAL AND METHOD A systematic literature review searched for referenced publications on the natural history of partial ACL tear. Twelve specific articles were retrieved. Initial diagnosis was systematically confirmed on arthroscopy, without ACL surgery. The following criteria were analyzed: firstly, preoperative: confirmation of inclusion criteria, preoperative clinical data, follow-up, arthroscopic lesion assessment, Lachman test, Pivot shift test, hemarthrosis, associated lesions and secondly, follow-up: Lachman test, Pivot shift test, revision surgery, functional clinical scores, pain, sport and return to sport, meniscal events. RESULTS Preoperatively, Lachman tests were positive (soft or delayed) in a mean 49.7% of cases (range, 0-100%); pivot shift test was systematically negative. At a mean 5.2 years' follow-up, Lachman test was "positive" in 47.6% of cases (range, 38-59%), with positive pivot shift test in 26.3% (range, 5-51%). 54.3% patients reported pain (range, 36-64%), and mean Lysholm score was 88.4 (17-100%). Fifty-two percent (21-60%) of patients resumed sport at their previous level. DISCUSSION/CONCLUSION The natural history of non-operated partial ACL tear is good over the medium term, especially if patients limit their sports activities. The greater the functional instability, the more frequent is residual pain. Laxity, although not quantified, seems to progress with time, with a positive pivot shift test emerging in a quarter of cases. Functional management may be recommended in non-athletic patients without meniscal lesion, but surgical treatment may be recommended in other patients. Indications for ACL reconstruction are thus the same in partial as in complete tear.
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Affiliation(s)
- N Pujol
- Versailles Hospital Center, Orthopedics Department, Versailles-Saint-Quentin University, 177, Rue de Versailles, 78157 Le Chesnay, France.
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Trojani C, d'Ollonne T, Saragaglia D, Vielpeau C, Carles M, Prudhon JL. One-stage bilateral total hip arthroplasty: functional outcomes and complications in 112 patients. Orthop Traumatol Surg Res 2012; 98:S120-3. [PMID: 22939864 DOI: 10.1016/j.otsr.2012.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 06/29/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advantages of one-stage bilateral total hip arthroplasty (THA) include a single hospital stay, a shorter rehabilitation time, and decreased management costs per patient. However, concern about a possible increase in the perioperative complication rate has limited the use of this strategy. Here, our objectives were to evaluate morbidity and mortality, as well as functional outcomes, in patients managed with one-stage bilateral THA. HYPOTHESIS The complication rate after one-stage bilateral THA is not significantly different from that after unilateral THA. MATERIALS AND METHODS Four French surgical centres participated in a retrospective observational study of patients managed with one-stage bilateral THA. The 112 included patients (55 women) had a mean age of 59 years (range, 22-84) and a mean follow-up of 30 months (6-103). RESULTS Mean hospital stay length was 10.8 days (6-27), mean operative time was 162 minutes (95-270), and mean haemoglobin levels were 14.3g/dL preoperatively and 10.1g/dL postoperatively. No perioperative deaths were recorded. Deep vein thrombosis occurred in eight (7.1%) patients and pulmonary embolism in six (5.4%). The Merle d'Aubigné score improved from 9.25 ± 2.9 (3-16) preoperatively to 17.5 ± 1 (14-18) at last follow-up. All but three patients (109/112, 97%) said they would choose the same operation again and 102/112 (91%) said they would recommend it to a family member. DISCUSSION The results of this multicentre retrospective study indicate that one-stage bilateral THA is a valid alternative to two-stage bilateral THA in ASA 1 and 2 patients with a preoperative haemoglobin level of about 14 g/L. The major complication rate was 7.1%, which was slightly higher than after unilateral THA, and the main complications were deep vein thrombosis and pulmonary embolism.
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Affiliation(s)
- C Trojani
- Department of Orthopaedics and Sports Trauma, De l'Archet Hospital, Nice Teaching Medical Center, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
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Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, Boileau P, de Peretti F. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 2012; 98:715-9. [PMID: 23000039 DOI: 10.1016/j.otsr.2012.05.013] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 03/15/2012] [Accepted: 05/21/2012] [Indexed: 02/02/2023]
Abstract
Proximal humerus fractures (PHF) are osteoporotic fractures that affect women over 70 years of age. Like fractures of the femoral neck they have become a public health concern. As the population ages there is an increase in the number of people in poor general condition with an increased risk of falls on fragile bones. The incidence of these fractures has increased by 15% per year. All patients managed for PHF in our center in the past year were included in this prospective study (prospective cohort study; level 2). Three hundred and twenty-five patients were included with 329 fractures. There was a ratio of two women to one man. At the final follow-up 50 patients had died (15%) and 25 patients were lost to follow-up. The mean age was 70 years old. There were two types of risk factors. The first was fragile bones, and the second was patient specific risk of falls. The severity of the fracture increased with the age of the population. In the study by Charles S. Neer in 1970, 85% of PHF were not or were only slightly displaced, while this category percentage was only 42% in our study. Hospitalization was necessary in 43% of the cases in our study. Surgical management was necessary in 21%. This lack of relationship between the percentage of displaced fractures (58%) and the percentage of surgically treated fractures is a sign of the difficulties of managing this population, which is usually in poor general condition.
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Affiliation(s)
- A Roux
- Department of Trauma and Orthopaedic Surgery, Saint-Roch Hospital, Nice Teaching Hospital Center, 15, rue Pierre-Devoluy, 06000 Nice, France.
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Frigenza M, Delotte J, Baque P, Trojani C, Mialon O, Chassang M, Carles M, Bongain A. [A recurrent cutaneous fistula secondary to the migration of a clip: report of a complication of tubal sterilization]. Gynecol Obstet Fertil 2012; 40:379-381. [PMID: 22306366 DOI: 10.1016/j.gyobfe.2011.07.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/31/2011] [Indexed: 05/31/2023]
Abstract
The tubal sterilization is a safe and recognized sterilization method. The complications of this intervention are rare and mainly concern failure of surgical procedure or clip migrations. We report the first case of spontaneous migration of a clip behind the psoas followed by a chronic osteitis.
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Affiliation(s)
- M Frigenza
- Service de gynécologie-obstétrique-reproduction et de médecine fœtale, université de Nice-Sophia Antipolis, hôpital de l'Archet 2, CHU de Nice, route Saint-Antoine-de-Ginestière, 06200 Nice, France.
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Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, Bussière C, Ehkirch FP, Burdin G, Dubrana F, Beaufils P, Franceschi JP, Chassaing V, Colombet P, Neyret P. Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 2011; 19:196-201. [PMID: 20644911 DOI: 10.1007/s00167-010-1201-6] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 06/14/2010] [Indexed: 11/26/2022]
Abstract
The purpose of this multicenter retrospective study was to analyze the causes for failure of ACL reconstruction and the influence of meniscectomies after revision. This study was conducted over a 12-year period, from 1994 to 2005 with ten French orthopaedic centers participating. Assessment included the objective International Knee Documenting Committee (IKDC) 2000 scoring system evaluation. Two hundred and ninety-three patients were available for statistics. Untreated laxity, femoral and tibial tunnel malposition, impingement, failure of fixation were assessed, new traumatism and infection were recorded. Meniscus surgery was evaluated before, during or after primary ACL reconstruction, and then during or after revision ACL surgery. The main cause for failure of ACL reconstruction was femoral tunnel malposition in 36% of the cases. Forty-four percent of the patients with an anterior femoral tunnel as a cause for failure of the primary surgery were IKDC A after revision versus 24% if the cause of failure was not the femoral tunnel (P = 0.05). A 70% meniscectomy rate was found in revision ACL reconstruction. Comparison between patients with a total meniscectomy (n = 56) and patients with preserved menisci (n = 65) revealed a better functional result and knee stability in the non-meniscectomized group (P = 0.04). This study shows that the anterior femoral tunnel malposition is the main cause for failure in ACL reconstruction. This reason for failure should be considered as a predictive factor of good result of revision ACL reconstruction. Total meniscectomy jeopardizes functional result and knee stability at follow-up.
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Affiliation(s)
- Christophe Trojani
- Service de Chirurgie Orthopédique, Hôpital de l'Archet 2, 151 rte St A. de Ginestière, 06200 Nice, France.
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Balaguer T, Boukhechba F, Clavé A, Bouvet-Gerbettaz S, Trojani C, Michiels JF, Laugier JP, Bouler JM, Carle GF, Scimeca JC, Rochet N. Biphasic Calcium Phosphate Microparticles for Bone Formation: Benefits of Combination with Blood Clot. Tissue Eng Part A 2010; 16:3495-505. [DOI: 10.1089/ten.tea.2010.0227] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Thierry Balaguer
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
- Service de Chirurgie Plastique, Réparatrice et Esthétique, Chirurgie de la Main, Centre Hospitalier Universitaire de Nice, Hôpital St. Roch, Nice, France
| | - Florian Boukhechba
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
| | - Arnaud Clavé
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
| | | | - Christophe Trojani
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
- Service de Chirurgie Orthopédique, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jean-François Michiels
- Service d'Anatomopathologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jean-Pierre Laugier
- Centre Commun de Microscopie Appliquée, Université de Nice-Sophia Antipolis, UFR Sciences, Nice, France
| | - Jean-Michel Bouler
- LIOAD, Université de Nantes, INSERM UMR 791, UFR d'Odontologie de Nantes, Nantes, France
| | - Georges F. Carle
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
| | - Jean-Claude Scimeca
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
| | - Nathalie Rochet
- GEPITOS, Université Nice Sophia-Antipolis, CNRS, UFR de Médecine, Nice, France
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Farhad R, Roger PM, Albert C, Pélligri C, Touati C, Dellamonica P, Trojani C, Boileau P. Six weeks antibiotic therapy for all bone infections: results of a cohort study. Eur J Clin Microbiol Infect Dis 2009; 29:217-22. [DOI: 10.1007/s10096-009-0842-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 11/14/2009] [Indexed: 11/27/2022]
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Boisgard S, Versier G, Descamps S, Lustig S, Trojani C, Rosset P, Saragaglia D, Neyret P. Mécanismes et classifications des luxations et des lésions ligamentaires bicroisées du genou. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.rcot.2009.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Saada E, Thariat J, Follana P, Birtwisle-Peyrottes I, Haudebourg J, Trojani C, Bacque P, Thyss A. Primitive neuroectodermal tumor of the pelvis in an elderly patient. ACTA ACUST UNITED AC 2009; 32:499-502. [PMID: 19745594 DOI: 10.1159/000226585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral primitive neuroectodermal tumors (PNET) belong to the rare family of primary bone neoplasms. Recent clinicopathological studies have revealed that Ewing's sarcoma and PNET have overlapping features and they are now included in the same classification, the Ewing's sarcoma family of tumors (EFTs). PNET have a marked predilection for the extremities and are very rare in the pelvis. These tumors can occur at any age with a peak of incidence in the second and third decades but are very rare in patients over 40 years. CASE REPORT We report the case of a 69-year-old man with PNET sarcoma. Outcome was favorable after combined modality treatment including chemotherapy based on the Memphis protocol - adapted from that used for Ewing's sarcoma in children - and surgery. CONCLUSION Our case is uncommon because of the age at diagnosis, the fortuitous way of revelation, and the choice of dose-intense chemotherapy adapted from the Memphis protocol (cyclophosphamide- and doxorubicin-based) for children, which was efficient and safe. It supports the fact that an adult, and even an old patient, with good physical status, may be treated safely and radically even with dose-adapted aggressive chemotherapy.
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Affiliation(s)
- Esma Saada
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
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Farhad R, Roger PM, Trojani C, Girard-Pipau F, Albert C, De Peretti F, Boileau P. COL7-04 Bi-antibiothérapie de 6 semaines pour toutes les infections ostéo-articulaires (IOA) : les 100 premiers patients. Med Mal Infect 2009. [DOI: 10.1016/s0399-077x(09)74294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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