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Bricard R, Pelletier Y, Allia J, Raffaelli A, Gonzalez JF, de Dompsure R, Bronsard N. Minimally invasive sacroiliac joint fusion secondary to lumbosacral fusion: clinical and functional results at 2 years of follow-up. Orthop Traumatol Surg Res 2024:103892. [PMID: 38648887 DOI: 10.1016/j.otsr.2024.103892] [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: 03/28/2023] [Revised: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2 years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion. MATERIALS AND METHODS We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2 years' follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59 years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion. RESULTS The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2 years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2 years, which was a 33% improvement (p < 0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery. DISCUSSION After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included. CONCLUSION Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Renaud Bricard
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France.
| | - Yann Pelletier
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France
| | - Jeremy Allia
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France
| | - Antoine Raffaelli
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France
| | - Régis de Dompsure
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Service de Chirurgie Orthopédique - Traumatologique & Chirurgie vertébrale, Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
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de Geofroy B, Ghabi A, Attas J, Micicoi L, Lopez M, Bernard de Dompsure R, Gonzalez JF, Micicoi G. Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores. Orthop Traumatol Surg Res 2024; 110:103746. [PMID: 37923174 DOI: 10.1016/j.otsr.2023.103746] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION The Harris Hip Score (HHS) and the Merle D'Aubigné Postel (MDP) score both provide an objective and subjective evaluation of hip function. These scores are collected during the follow-up of patients who have a hip disease. The objectives of this prospective study were (1) to analyze the differences between the two new French self-report versions of the HHS and MDP, and the traditional surgeon-assessed HHS and MDP; (2) to analyze the correlation between the self-report HHS and MDP and the surgeon-assessed HHS and MDP; (3) to analyze the floor and ceiling effects of the two self-report scores and the reliability of these self-report scores in operated and non-operated patients. HYPOTHESIS The French self-report HHS and MDP are sufficiently reliable to accurately estimate the patient's objective and subjective outcomes compared to the clinical examination done by a surgeon. METHODS A prospective multicenter study was done with patients who had a hip disease. Two self-report questionnaires were completed by the patient, independently of the clinical examination done by the surgeon. The questionnaires were in French and consisted solely of checkboxes, with sample photos that corresponded to the various range of motion items in the HHS and MDP. The agreement between the self-report scores and the surgeon-assessed scores were evaluated using the intraclass correlation coefficient (ICC). Differences in the mean values were evaluated with a paired t test. RESULTS The analysis involved 89 patients. The self-report HHS was 2.7±3.7 points (/100) lower than the surgeon-assessed HHS, but this difference was not statistically significant (p=0.34). The self-report MDP was significantly less by 1.2±2.9 points (/18) than the surgeon-assessed MDP (p=0.01). The agreement between the self-report HSS and the surgeon-assessed HSS was excellent (ICC=0.86) as was the one between the self-report MDP and the surgeon-assessed MDP (ICC=0.75). There was a strong positive correlation between the surgeon-assessed and self-report HHS in operated patients (ICC= 0.84; R=0.75; p<0.001) and in non-operated patients (ICC=0.96; R=0.89; p<0.001). This positive correlation was also found between the surgeon-assessed and self-report MDP for operated patients (ICC=0.73; R=0.62; p<0.001) and non-operated patients (ICC=0.79; R=0.64; p<0.001). A ceiling effect (maximum of 100 points) was found in 22% of patients (20/89) for the self-report HHS and in 34% of patients (30/89) for the self-report MDP (maximum of 18 points). No floor effect was observed for either questionnaire. CONCLUSION The French version of the HHS self-report questionnaire is an excellent overall estimator of the HHS score for patients with hip osteoarthritis or fracture, whether operated or not. The addition of the MDP, whose self-report version is less accurate, is also a reliable tool. These self-report questionnaires, when validated on a larger scale, will be useful for the long-term follow-up of patients undergoing hip arthroplasty. LEVEL OF EVIDENCE III; prospective diagnostic study.
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Affiliation(s)
- Bernard de Geofroy
- Department of Orthopedic Surgery and Traumatology, Laveran Military Teaching Hospital, 34, boulevard Laveran, 13384 Marseille, France
| | - Ammar Ghabi
- Department of Orthopedic Surgery and Traumatology, Laveran Military Teaching Hospital, 34, boulevard Laveran, 13384 Marseille, France
| | - Joseph Attas
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, 30, avenue Voie Romaine, 06001 Nice, France
| | - Lolita Micicoi
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, 30, avenue Voie Romaine, 06001 Nice, France
| | - Michael Lopez
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, 30, avenue Voie Romaine, 06001 Nice, France
| | - Régis Bernard de Dompsure
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, 30, avenue Voie Romaine, 06001 Nice, France
| | - Jean-François Gonzalez
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, 30, avenue Voie Romaine, 06001 Nice, France
| | - Grégoire Micicoi
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, 30, avenue Voie Romaine, 06001 Nice, France.
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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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Micicoi L, Gonzalez JF, Gauci MO, Chabrand P, Machado A, Bronsard N, Micicoi G. Acute compartment syndrome of the lower limbs: Fasciotomy or dermofasciotomy? A cadaver study of compartment pressures. Orthop Traumatol Surg Res 2024; 110:103736. [PMID: 37890523 DOI: 10.1016/j.otsr.2023.103736] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments. HYPOTHESIS Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value. MATERIAL AND METHODS A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP15), >30mmHg (ICP30), and >50mmHg (ICP50). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy. RESULTS Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05). CONCLUSION Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal. LEVEL OF EVIDENCE IV, experimental study.
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Affiliation(s)
- Lolita Micicoi
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Jean-François Gonzalez
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Marc-Olivier Gauci
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | | | - Axel Machado
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Nicolas Bronsard
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France
| | - Grégoire Micicoi
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France.
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de Geofroy B, Micicoi G, Olmos M, Boileau P, Bronsard N, Gonzalez JF, Gauci MO. Early morbidity and mortality after one-stage bilateral shoulder arthroplasty. Int Orthop 2024; 48:505-511. [PMID: 37853140 DOI: 10.1007/s00264-023-06003-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high. METHODS A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders. RESULTS There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction. CONCLUSIONS One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation.
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Affiliation(s)
- Bernard de Geofroy
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Grégoire Micicoi
- Department of Orthopaedic Surgery and Sport Surgery, University Institute of Locomotion and Sport, University Hospital of Nice, 30 Av Voie Romaine, 06000 Cedex 1, Nice, CS, France
| | - Manuel Olmos
- Department of Orthopaedic Surgery and Sport Surgery, University Institute of Locomotion and Sport, University Hospital of Nice, 30 Av Voie Romaine, 06000 Cedex 1, Nice, CS, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Groupe Kantys, Locomoteur & Sport, Clinique St Antoine7 Av Durante, 06000, Nice, France
| | - Nicolas Bronsard
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Jean-François Gonzalez
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Marc Olivier Gauci
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France.
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Gauci MO, Glevarec L, Bronsard N, Cointat C, Pelletier Y, Boileau P, Gonzalez JF. Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00051-X. [PMID: 38281677 DOI: 10.1016/j.jse.2023.11.031] [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: 08/23/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant. METHODS Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants. RESULTS No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants' position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P < .01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P < .001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P < .001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P = .01, and 23° ± 3°, P < .001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P = .02, and 22° ± 2°, P < .001). CONCLUSIONS This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France.
| | - Laure Glevarec
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France
| | - Caroline Cointat
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Yann Pelletier
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France
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Gauci MO, Ceccarelli R, Lavoue V, Chelli M, van der Meijden OAJ, Gonzalez JF, Boileau P. Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum? J Shoulder Elbow Surg 2024:S1058-2746(23)00894-7. [PMID: 38182028 DOI: 10.1016/j.jse.2023.11.010] [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: 06/15/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively. MATERIAL We performed a retrospective, single-center study including 62 TSA patients with a preoperative PHS of the glenohumeral joint (31 men, 31 women, 70 ± 9 years) between January 2000 and January 2014. Glenoids were classified as B2 (32 cases), B3 (13 cases), or C (17 cases). Glenoid retroversion was corrected by anterior asymmetric reaming. Patients were reviewed for clinical and CT scan assessment with a mean follow-up of 8.3 years (minimum 5 years). At final follow-up, the CT images were reconstructed in the scapular plane. A PHS index >65% defined persistence. RESULTS The revision-free rate was estimated at 93%. Correlation between PHS and retroversion was moderate preoperatively (ρ = 0.58) and strong at final follow-up (ρ = 0.73). Postoperative CT scans on average showed a surgical correction of PHS compared to preoperatively (79% vs. 65% respectively, P < .05) and retroversion (20° vs. 10° respectively, P < .05). At final follow-up, 25 of 62 patients had a persistence in the 2-dimensional (2D) model and 41 of 62 in the corrected 2D model. Persistence of PHS had no influence on clinical outcomes but did demonstrate a significantly higher glenoid loosening rate (20% vs. 59%, P < .05). CONCLUSION Correlation between PHS and retroversion was moderate preoperatively and strengthened at long-term follow-up. Anterior asymmetric reaming allowed for a surgical improvement of both PHS and retroversion, but it was not sufficient to maintain a correction over time. Glenoid loosening was more frequent in case of PHS persistence but seemingly without clinical relevance.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
| | - Romain Ceccarelli
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Vincent Lavoue
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Mikael Chelli
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | | | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
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Micicoi L, Machado A, Ernat J, Schippers P, Bernard de Dompsure R, Bronsard N, Gonzalez JF, Micicoi G. Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5171-5179. [PMID: 37758904 DOI: 10.1007/s00167-023-07588-5] [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: 07/06/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes. METHODS This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coefficient. RESULTS During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients. CONCLUSION Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Lolita Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Axel Machado
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Justin Ernat
- University of Utah Health, Salt Lake City, Utah, USA
| | - Philipp Schippers
- Départment of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Régis Bernard de Dompsure
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France.
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
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Chau Y, Roux C, Gonzalez JF, Breuil V, Bernard de Dompsure R, Fontas E, Rudel A, Sédat J. Effectiveness of Geniculate Artery Embolization for Chronic Pain after Total Knee Replacement-A Pilot Study. J Vasc Interv Radiol 2023; 34:1725-1733. [PMID: 37391071 DOI: 10.1016/j.jvir.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA). MATERIALS AND METHODS Twelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points. RESULTS A mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week. CONCLUSION GAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months.
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Affiliation(s)
- Yves Chau
- Neurointerventionnal and Interventional Vascular Unit, CHU de Nice, Pasteur 2 Hospital, Nice, France.
| | - Christian Roux
- Department of Rheumatology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | | | - Véronique Breuil
- Department of Rheumatology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | | | - Eric Fontas
- Department of Clinical Research and Innovation, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | - Alexandre Rudel
- Department of Osteo-Articular Radiology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | - Jacques Sédat
- Neurointerventionnal and Interventional Vascular Unit, CHU de Nice, Pasteur 2 Hospital, Nice, France
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Machado A, Micicoi L, Ernat J, Schippers P, Bernard de Dompsure R, Bronsard N, Gonzalez JF, Micicoi G. Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4276-4284. [PMID: 37326635 DOI: 10.1007/s00167-023-07465-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO. METHODS This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed. RESULTS The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = - 0.15, p = 0.04) and function IKS (R = - 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°. CONCLUSION Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Axel Machado
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Lolita Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Justin Ernat
- University of Utah Health, Salt Lake City, Utah, USA
| | - Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Régis Bernard de Dompsure
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France.
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
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Gauci MO, Olmos M, Cointat C, Chammas PE, Urvoy M, Murienne A, Bronsard N, Gonzalez JF. Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence. Int Orthop 2023; 47:299-307. [PMID: 36574021 DOI: 10.1007/s00264-022-05675-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Clinical evaluation of the shoulder range of motion (RoM) may vary significantly depending on the surgeon. We aim to validate an automatic shoulder RoM measurement system associating image acquisition by an RGB-D (red/green/blue-depth) video camera to an artificial intelligence (AI) algorithm. METHODS Thirty healthy volunteers were included. A 3D RGB-D sensor that simultaneously generated a colour image and a depth map was used. Then, an open-access convolutional neural network algorithm that was programmed for shoulder recognition provided a 3D motion measure. Each volunteer adopted a randomized position successively. For each position, two observers made a visual (EyeREF) and goniometric measurement (GonioREF), blind to the automated software which was implemented by an orthopaedic surgeon. We evaluated the inter-tester intra-class correlation (ICC) between observers and the concordance correlation coefficient (CCC) between the three methods. RESULTS For manual evaluations EyeREF and GonioREF, ICC remained constantly excellent for the widest motions in the vertical plane (i.e., abduction and flexion). It was very good for ER1 and IR2 and fairly good for adduction, extension, and ER2. Differences between the measurements' means of EyeREF and shoulder RoM was significant for all motions. Compared to GonioREF, shoulder RoM provided similar results for abduction, adduction, and flexion and EyeREF provided similar results for adduction, ER1, and ER2. The three methods showed an overall good to excellent CCC. The mean bias between the three methods remained under 10° and clinically acceptable. CONCLUSION RGB-D/AI combination is reliable in measuring shoulder RoM in consultation, compared to classic goniometry and visual observation.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
| | - Manuel Olmos
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Caroline Cointat
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Pierre-Emmanuel Chammas
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | | | - Albert Murienne
- B-Com, Institut de Recherche Technologique, Cesson-Sévigné, Bretagne, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
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Olmos MI, Johnston TR, Gonzalez JF, Camuzard O, Gauci MO. Glomus tumor of the scapular neck with axillary nerve compression at the shoulder. A case report. Shoulder Elbow 2023; 15:61-64. [PMID: 36895604 PMCID: PMC9990104 DOI: 10.1177/17585732211040160] [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: 03/28/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022]
Abstract
Background Glomus tumors, also known as benign acral tumors are extremely rare. Previous glomus tumors from other regions of the body have been linked to neurological compression symptoms, however axillary compression at the scapular neck has never been described. Case presentation Here, we report a case of axillary nerve compression in a 47-year-old man, secondary to a glomus tumor of the neck of the right scapula, initially misdiagnosed with biceps tenodesis performed and no pain improvement. The magnetic resonance imaging demonstrated a well-contoured, 12 mm tumefaction at the inferior pole of the scapular neck T2-hyperintense and T1-isointense and interpreted as a neuroma. An axillary approach allowed the dissection of the axillary nerve, and the tumor was completely removed. The pathological anatomical analysis resulted in a nodular red lesion measuring 14 × 10 mm, delimited and encapsulated with a definitive diagnostic of glomus tumor. The neurologic symptoms and pain disappeared 3 weeks after surgery and the patient reported satisfaction with the surgical procedure. After 3 months, the results remain stable with a complete resolution of the symptoms. Conclusions In cases of unexplained and atypical pain in the axillary area, and to avoid potential misdiagnoses and inappropriate treatments, an in-depth exploration for a compressive tumor should be performed as a differential diagnosis.
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Affiliation(s)
- Manuel Ignacio Olmos
- Institut Universitaire Locomoteur et du Sport (IULS), Unité de Recherche
Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur (UCA), Nice,
France
| | - Tyler Robert Johnston
- Institut Universitaire Locomoteur et du Sport (IULS), Unité de Recherche
Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur (UCA), Nice,
France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport (IULS), Unité de Recherche
Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur (UCA), Nice,
France
| | - Olivier Camuzard
- Institut Universitaire Locomoteur et du Sport (IULS), Unité de Recherche
Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur (UCA), Nice,
France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), Unité de Recherche
Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur (UCA), Nice,
France
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Azar M, Van der Meijden O, Pireau N, Chelli M, Gonzalez JF, Boileau P. Arthroscopic revision cuff repair: do tendons have a second chance to heal? J Shoulder Elbow Surg 2022; 31:2521-2531. [PMID: 35671929 DOI: 10.1016/j.jse.2022.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/29/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have investigated postoperative tendon integrity after reoperation for failed rotator cuff repair. The purpose of this study was to evaluate the anatomic and clinical outcomes of arthroscopic revision rotator cuff repair (AR-RCR) and identify the risk factors related to re-retear. METHODS Sixty-nine consecutive patients (mean age, 55 years) with primary failed open (38%) or arthroscopic (62%) cuff repairs underwent AR-RCR and were reviewed regarding clinical examination findings and imaging studies. Patients with massive cuff tears and upward humeral migration (acromiohumeral distance < 6 mm) or glenohumeral osteoarthritis were excluded. Revision repair was performed by a single, experienced shoulder surgeon. Complete footprint coverage was achieved in all cases using a single-row (70%), double-row (19%), or side-to-side (11%) technique. The primary outcome measure was tendon healing assessed with magnetic resonance imaging (57 cases) or computed tomography arthrogram (12 cases) performed at minimum 1-year follow-up. Secondary outcome measures included functional outcome scores, subjective results, and complications. The mean follow-up period was 43 months (range, 12-136 months). RESULTS The cuff tendons did not heal to the tuberosity in 36% of the shoulders (25 of 69) following revision cuff surgery. Absence of tendon healing was associated with poorer shoulder function (average Constant score, 69 ± 20 vs. 54 ± 18; P = .003) and a decreased Subjective Shoulder Value (72% vs. 54%, P = .002). Factors that were negatively associated with tendon healing were age ≥ 55 years (odds ratio [OR], 4.5 [95% confidence interval, 1.6-12.5]; P = .02), tendon retraction of stage 2 or higher (OR, 4.4 [95% confidence interval, 1.4-14.3]; P = .01), and fatty infiltration index > 2 (OR, 10.2; P < .0001). No differences in retear rates were found between single-row and double-row cases. In 36 shoulders, tissue samples were harvested and submitted for bacteriologic culture analysis; 13 (36%) showed positive findings for infection (Cutibacterium acnes in 12 of 13) and associated antibiotic treatment was given. Overall, 25% of patients had unsatisfactory clinical results and 22% were disappointed or dissatisfied. At last follow-up, 4 patients (5.7%) underwent reoperations, with a second AR-RCR in 1 and conversion to reverse shoulder arthroplasty in 3. CONCLUSION Despite careful patient selection and intraoperative complete footprint coverage, in this study the tendons did not heal to bone in 36% of cases after revision cuff surgery. The absence of tendon healing is associated with poorer clinical and subjective results. Patients aged ≥ 55 years and patients with larger tears (stage 2 or higher) and/or muscle fatty infiltration (fatty infiltration index > 2) have significantly lower rates of healing. Surgeons should be aware that structurally failed cuff repair may also be associated with low-grade infection.
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Affiliation(s)
- Michel Azar
- Institut de Chirurgie Réparatrice (ICR) Nice, Groupe Kantys, Nice, France
| | | | | | - Mikaël Chelli
- Institut de Chirurgie Réparatrice (ICR) Nice, Groupe Kantys, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice (ICR) Nice, Groupe Kantys, Nice, France.
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Le Maréchal M, Cavalli Z, Batailler C, Gonzalez JF, Ferreira A, Lustig S, Ferry T, Courjon J. Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization. BMC Infect Dis 2021; 21:401. [PMID: 33933020 PMCID: PMC8088082 DOI: 10.1186/s12879-021-06075-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. RESULTS Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90-92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. CONCLUSIONS Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.
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Affiliation(s)
- Marion Le Maréchal
- Centre Hospitalier de Grenoble, Grenoble, France
- Université de Grenoble-Alpes, Grenoble, France
| | - Zoé Cavalli
- Hôpital de Mercy, Centre Hospitalier Régional de Metz-Thionville, Ars-Laquenexy, France
| | | | - Jean-François Gonzalez
- Université Côte d'Azur, Nice, France
- Université Côte d'Azur, CHU, INSERM, C3M, Nice, France
| | - André Ferreira
- Société Française de chirurgie de la hanche et du genou, Paris, France
| | | | - Tristan Ferry
- Claude Bernard University Lyon 1, Villeurbanne, France
- CRIOAc Lyon, Lyon, France
| | - Johan Courjon
- Université Côte d'Azur, CHU, INSERM, C3M, Nice, France.
- Infectiologie, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France.
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Boileau P, Galvin JW, Pangaud C, Gonzalez JF, Gauci MO. Response to Letter to the Editor regarding: "Fracture of pyrocarbon humeral head resurfacing implant: a case report". J Shoulder Elbow Surg 2021; 30:e134-e135. [PMID: 33359906 DOI: 10.1016/j.jse.2020.11.005] [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: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Pascal Boileau
- Institut de Chirurgie Réparatrice - ICR - Institute for Reconstructive Bone and Joint Surgery & Sport Surgery, 7 av Durante, Nice, France.
| | - Joseph W Galvin
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France
| | - Corentin Pangaud
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France.
| | - Jean-François Gonzalez
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France
| | - Marc-Olivier Gauci
- University Institute for Locomotion and Sports (iULS), Hospital Pasteur 2, University Côte d'Azur, Nice, France
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Boileau P, Raynier JL, Chelli M, Gonzalez JF, Galvin JW. Reverse shoulder-allograft prosthesis composite, with or without tendon transfer, for the treatment of severe proximal humeral bone loss. J Shoulder Elbow Surg 2020; 29:e401-e415. [PMID: 32713667 DOI: 10.1016/j.jse.2020.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/31/2019] [Revised: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of severe proximal humeral bone loss (PHBL) secondary to tumor resection or failed arthroplasty is challenging. We evaluated the outcomes and complications of reconstruction with reverse shoulder-allograft prosthesis composite (RS-APC), performed with or without tendon transfer. METHODS An RS-APC procedure was performed in 25 consecutive patients with severe PHBL (>4 cm): 12 after failed reverse shoulder arthroplasty, 5 after failed hemiarthroplasty for fracture, 6 after failed mega-tumor prosthesis placement, and 2 after tumor resection. The median length of humeral bone loss or resection was 8 cm (range, 5-23 cm). Humeral bone graft fixation was obtained with a long monobloc reverse stem and a "mirror step-cut osteotomy," without plate fixation. Nine infected shoulders underwent a 2-stage operation with a temporary cement spacer. In addition, 9 patients (36%) underwent an associated L'Episcopo procedure. The median follow-up duration was 4 years (range, 2-11 years). RESULTS Overall, 76% of patients (19 of 25) were satisfied. In 8 patients (32%), a reoperation was needed. At last follow-up, we observed incorporation at the allograft-host junction in 96% of the cases (24/25); partial graft resorption occurred in 3 cases and severe in 1. The median adjusted Constant score was 53% (range 18-105); Subjective Shoulder Value, 50% (range 10%-95%). Additional tendon transfers significantly improved active external rotation (20° vs. 0°, P < .001) and forward elevation (140° vs. 90°, P = .045). CONCLUSIONS (1) Shoulder reconstruction with RS-APC provides acceptable shoulder function and high rates of graft survival and healing. (2) Additional L'Episcopo tendon transfer (when technically possible) improves active shoulder motion. (3) The use of a long monobloc (cemented or uncemented) humeral reverse stem with mirror step-cut osteotomy provides a high rate of graft-host healing, as well as a limited rate of graft resorption, and precludes the need for additional plate fixation. (4) Although rewarding, this reconstructive surgery is complex with a high risk of complications and reoperations. The main advantages of using an allograft with a reverse shoulder arthroplasty (compared with other reconstruction options) are that this type of reconstruction (1) allows restoration of the bone stock, thus improving prosthesis fixation and stability, and (2) gives the possibility to perform a tendon transfer by fixing the tendons on the bone graft to improve shoulder motion.
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Affiliation(s)
- Pascal Boileau
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France.
| | - Jean-Luc Raynier
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France
| | - Mikaël Chelli
- University Institute for Locomotion and Sports (iULS), Pasteur 2 Hospital, Nice, France
| | | | - Joseph W Galvin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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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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Gauci MO, Cavalier M, Gonzalez JF, Holzer N, Baring T, Walch G, Boileau P. Revision of failed shoulder arthroplasty: epidemiology, etiology, and surgical options. J Shoulder Elbow Surg 2020; 29:541-549. [PMID: 31594726 DOI: 10.1016/j.jse.2019.07.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 04/18/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our aim was to analyze the epidemiology, etiologies, and revision options for failed shoulder arthroplasty from 2 tertiary centers. METHODS From 1993 to 2013, 542 failed arthroplasties were revised in 540 patients (65% women): 224 hemiarthroplasties (HAs, 41%), 237 anatomic total shoulder arthroplasties (TSAs, 44%) and 81 reverse total arthroplasties (RSAs, 15%). Data about patients, pathology, and reintervention procedures, as well as intraoperative data, were analyzed from our 2 local registries that prospectively captured all the revision procedures. Patients had an average follow-up period of 8.7 years. RESULTS The revision rate was 12.7% for HAs, 6.7% for TSAs, and 3.9% for RSAs. HAs were revised earlier (33 ± 40 months) than RSAs (47 ± 150 months) and TSAs (69 ± 61 months). Glenoid failure was a major cause of reintervention: erosion in HAs (29%) or loosening in TSAs (37%) and RSAs (24%). Instability was another major cause of reintervention: 32% in RSAs, 20% in TSAs, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs, 6% of HAs, and 6% of TSAs. Multiple reinterventions were required in 21% of patients, mainly for instability (26%) and/or infection (25%). The final implant was an RSA in 48%, especially when associated with cuff insufficiency, instability, and/or bone loss. Final reimplantation was possible in 90% of cases, with the remaining 10% treated with a resection or spacer. CONCLUSION Glenoid failure and instability are the most common causes of revision. Soft-tissue insufficiency and/or infection results in multiple revisions. Surgeons must recognize all complications so that they can be addressed at the first revision operation and avoid further reinterventions. RSA was the most common final revision implant.
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Affiliation(s)
- Marc-Olivier Gauci
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Maxime Cavalier
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | | | - Toby Baring
- Homerton University Hospital Foundation Trust, London, UK
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Pascal Boileau
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
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Chelli M, Bronsard N, Gonzalez JF, Blasco L, Gauci MO, Boileau P. The distal-medial pilot hole: A simple way to ease volar plate positioning in extra-articular distal radius fractures. Injury 2020; 51:779-782. [PMID: 32014260 DOI: 10.1016/j.injury.2020.01.038] [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: 08/11/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 02/02/2023]
Abstract
Volar plating is one of the most used surgical treatments for dorsally displaced extra-articular distal radius fractures. However, the reduction of the dorsal tilt can be difficult. It usually requires a flexion maneuver of the wrist while maintaining and screwing the plate, which is cumbersome. Plate positioning also is a crucial step and is sometimes difficult because of the large size of the plate relative to the width of the distal radius. We use an epiphysis-first technique. We place all the epiphyseal screws before reduction, and then we take advantage of the anatomical shape of a locking plate to automatically reduce the dorsal tilt by fixing the proximal radius to the plate with cortical compression screws. To ensure easy and accurate positioning of the plate, we drill a distal medial pilot hole in a free-hand fashion 10 mm proximal to the watershed line and 10 mm lateral to the medial rim of the radius, without positioning the plate. This allows a clear view of the location of this first hole. The locking plate is then applied to the distal radius with help of a monocortical non-locking screw, and it is controlled under fluoroscopy. When this medial pilot hole is properly positioned and the plate correctly tilted on the anteroposterior view, the remaining epiphyseal holes are filled with locking screws. Then the plate is fixed on the proximal radius with bicortical compression screws, allowing an automatic reduction of the epiphyseal dorsal tilt. We believe this technique is a safe and reproducible way to position volar plates and to reduce anatomically the dorsal tilt in extra-articular posteriorly displaced distal radius fractures (AO A2 and A3). Furthermore, the automatic fracture reduction provided by this technique decreases operation time and radiation.
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Affiliation(s)
- Mikaël Chelli
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice.
| | - Nicolas Bronsard
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Jean-François Gonzalez
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Laurent Blasco
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Marc-Olivier Gauci
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Pascal Boileau
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
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20
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Gauci MO, Cavalier M, Gonzalez JF, Holzer N, Baring T, Walch G, Boileau P. Revision of Failed Shoulder Arthroplasty: Epidemiology, Etiology and Surgical Options. JSES Open Access 2019. [DOI: 10.1016/j.jses.2019.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Ode Q, Gonzalez JF, Paihle R, Dejour D, Ollivier M, Panisset JC, Lustig S. Influence of operative technique on anterior cruciate ligament reconstruction in patients older than 50 years. Orthop Traumatol Surg Res 2019; 105:S253-S258. [PMID: 31551194 DOI: 10.1016/j.otsr.2019.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A consequence of the steady growth in the worldwide population of elderly individuals who remain in good health and continue to engage in sports is an increase in the incidence of anterior cruciate ligament (ACL) rupture occurring after 50 years of age. ACL reconstruction was formerly reserved for young athletes but now seems to produce good outcomes in over 50s. The type of graft and graft fixation method were selected empirically until now, given the absence of investigations into potential relationships of these two parameters with the outcomes. The objective of this study was to assess associations linking the type of graft and the method of femoral graft fixation to outcomes in patients older than 50 years at ACL reconstruction. HYPOTHESIS The operative technique is not associated with the clinical outcomes or differential laxity. MATERIAL AND METHODS A multicentre retrospective cohort of 398 patients operated between 1 January 2011 and 31 December 2015 and a multicentre prospective cohort of 228 patients operated between 1 January 2016 and 30 June 2017 were conducted. Mean follow-up was 42.7 months in the retrospective cohort and 14.2 months in the prospective cohort. The primary evaluation criterion was the clinical outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Score (TAS). Differential laxity was the secondary evaluation criterion. The Wilcoxon rank sum test and Kruskal-Wallis test were used to compare groups, and p-values<0.05 were considered significant. RESULTS In the retrospective and prospective cohorts, hamstring tendons were used in 269 (67.6%) and 197 (86.4%) patients and extensor apparatus tendons in 124 (31.2%) and 31 (13.6%) patients. Femoral fixation in the retrospective cohort was cortical in 81 (20.4%) cases, by press-fit in 112 (28.1%) cases, and by interference screw in 205 (51.5%) cases; corresponding figures in the prospective cohort were 135 (59.2%), 17 (7.5%), and 76 (33.3%). The multivariate analysis of the retrospective data identified no significant associations of graft type or femoral fixation type with the KOOS, TAS, or differential laxity values. In the prospective cohort, hamstring grafts were associated with 0.6mm of additional laxity (p=0.007); compared to cortical fixation, press-fit fixation of patellar tendon grafts was associated with 0.3mm of additional laxity (p=0.029) and a 0.5-point lower TAS value (p=0.033), with no difference in KOOS values. None of these differences were clinically significant. DISCUSSION The various ACL reconstruction techniques used in patients older than 50 years produce similar outcomes. The technique can be chosen based on surgeon preference without regard for patient age. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Quentin Ode
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - Jean-François Gonzalez
- Institut universitaire locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Régis Paihle
- Orthopaedics, hôpital Sud, CHU de Grenoble, avenue Kimberley-Echirolles, 38000 Grenoble, France
| | - David Dejour
- Clinique de la Sauvegarde, 8, avenue David-Ben-Gourion, 69009 Lyon, France
| | - Matthieu Ollivier
- Institute of movement and locomotion, orthopedic surgery, boulevard Sainte-Marguerite, 13900 Marseille, France
| | - Jean-Claude Panisset
- Chirurgie orthopédique, clinique des Cèdres, 51, rue Albert-Londres, 38230 Échirolles, France
| | - Sébastien Lustig
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Université Claude-Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France.
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Chelli M, Lo Cunsolo L, Gauci MO, Gonzalez JF, Domos P, Bronsard N, Boileau P. Reverse shoulder arthroplasty in patients aged 65 years or younger: a systematic review of the literature. JSES Open Access 2019; 3:162-167. [PMID: 31709356 PMCID: PMC6835024 DOI: 10.1016/j.jses.2019.06.003] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Reverse shoulder arthroplasty (RSA) is offered to young patients with a failed previous arthroplasty or a cuff-deficient shoulder, but the overall results are still uncertain. We conducted a systematic review of the literature to report the midterm outcomes and complications of RSA in patients younger than 65 years. Methods A search of the MEDLINE and Cochrane electronic databases identified clinical studies reporting the results, at a minimum 2-year follow-up, of patients younger than 65 years treated with an RSA. The methodologic quality was assessed with the Methodological Index for Non-Randomized Studies score by 2 independent reviewers. Complications, reoperations, range of motion, functional scores, and radiologic outcomes were analyzed. Results Eight articles were included, with a total of 417 patients. The mean age at surgery was 56 years (range, 21-65 years). RSA was used as a primary arthroplasty in 79% of cases and revision of a failed arthroplasty in 21%. In primary cases, the indications were cuff tear arthropathy and/or massive irreparable cuff tear in 72% of cases. The overall complication rate was 17% (range, 7%-38%), with the most common complications being instability (5%) and infection (4%). The reintervention rate was 10% at 4 years, with implant revision in 7% of cases. The mean weighted American Shoulder and Elbow Surgeons score, active forward elevation, and external rotation were 64 points, 121°, and 29°, respectively. Conclusions RSA provides reliable clinical improvements in patients younger than 65 years with a cuff-deficient shoulder or failed arthroplasty. The complication and revision rates are comparable to those in older patients.
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Affiliation(s)
- Mikaël Chelli
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Lucas Lo Cunsolo
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Peter Domos
- Royal Free London NHS Foundation Trust, London, UK
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, Nice, France
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Zamora-Mendoza BN, Espinosa-Tanguma R, Ramírez-Elías MG, Cabrera-Alonso R, Montero-Moran G, Portales-Pérez D, Rosales-Romo JA, Gonzalez JF, Gonzalez C. Surface-enhanced raman spectroscopy: A non invasive alternative procedure for early detection in childhood asthma biomarkers in saliva. Photodiagnosis Photodyn Ther 2019; 27:85-91. [PMID: 31082526 DOI: 10.1016/j.pdpdt.2019.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/28/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022]
Abstract
The early detection of bronchial inflammation in asthma, through a non-invasive, simple method and under a subclinical state, could lead to a more effective control of this condition. The aim of this study was to identify biomarkers of bronchial inflammation in the saliva of children with asthma through immunoassay and Surface Enhanced Raman Spectroscopy (SERS). We conducted an analytical cross-sectional study in 44 children ages 6-12; the diagnosis of asthma was made according to Global Initiative for Asthma (GINA) standards. The children's saliva was analyzed by immunoassay for the quantification of 37 cytokines, as well as SERS analysis in a confocal Raman microscope at 785 nm. We found a significant association between bronchial obstruction and IL-8 (p = 0.004), IL-10 (p = 0.008) and sCD163 (p = 0.003). The Raman spectra showed significant amplification in the region of 760 to 1750 cm-1. The Principal Component Analysis and Linear Discriminant Analysis (PCA-LDA) method has a sensitivity of 85%, specificity of 82% and an accuracy of 84% for the diagnosis of asthma. These results demonstrate the presence of a subclinical inflammatory state, suggestive of bronchial remodeling in the population studied. The SERS method is a potential tool for identifying bronchial inflammation and its endotype, allowing for a highly sensitive and specific diagnosis.
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Affiliation(s)
- B N Zamora-Mendoza
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico
| | - R Espinosa-Tanguma
- Universidad Autonoma de San Luis Potosi, Facultad de Medicina, Av. Venustiano Carranza #2405, San Luis Potosí, 78210, Mexico
| | - M G Ramírez-Elías
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias, Av. Chapultepec #1570Privadas del Pedregal, San Luis Potosí, 78290, Mexico
| | - R Cabrera-Alonso
- Universidad Autonoma de San Luis Potosi, Coordinación para la Innovacion y Aplicacion de la Ciencia y la Tecnologia (CIACyT), Av. Sierra Leona #550, San Luis Potosi, 78210, Mexico
| | - G Montero-Moran
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico
| | - D Portales-Pérez
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico
| | - J A Rosales-Romo
- Servicios de Salud de San Luis Potosi, Hospital General de Soledad de Graciano Sánchez, Prolongación Valentín Amador #1112, Colonia Genovevo Rivas Guillen, Soledad de Graciano Sánchez, San Luis Potosí, 78432, Mexico
| | - J F Gonzalez
- Universidad Autonoma de San Luis Potosi, Coordinación para la Innovacion y Aplicacion de la Ciencia y la Tecnologia (CIACyT), Av. Sierra Leona #550, San Luis Potosi, 78210, Mexico
| | - C Gonzalez
- Universidad Autonoma de San Luis Potosi, Facultad de Ciencias Quimicas, Av. Dr. Manuel Nava #6, San Luis Potosí, 78210, Mexico.
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Chelli M, Levy Y, Lavoué V, Clowez G, Gonzalez JF, Boileau P. The "Auto-Constant": Can we estimate the Constant-Murley score with a self-administered questionnaire? A pilot study. Orthop Traumatol Surg Res 2019; 105:251-256. [PMID: 30876713 DOI: 10.1016/j.otsr.2018.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 01/29/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Constant score, allows an objective and subjective assessment of the shoulder function. It has been proven to have a poor interobserver reliability for some of its aspects and is not usable as a remote assessment tool. HYPOTHESIS The Constant-Murley functional shoulder score can be assessed with a self-administered questionnaire. METHODS We conducted a prospective continuous study in a shoulder-specialized service. For each patient seen in consultation or hospitalized for a shoulder pathology, a self-administered questionnaire was delivered, and a clinical examination was performed by a surgeon. The questionnaire, in French language, was composed of checkboxes only, with pictures preferred over text for most items. Correlations with surgeon examination were assessed with the intraclass correlation coefficients, differences with the paired t-test. RESULTS One hundred consecutive patients were analyzed. Correlation between the two scores was excellent (0.87), as were the range of motion and the pain subscores (0.85 and 0.78), good for the activity (0.69) and fair for the strength (0.57). The mean total score was 3 points lower for the self-administered questionnaire (CI95 [-5; -1]; p<0.01). Activity and pain were not significantly different (-0.4/20 and -0.3/40; p>0.05) but pain and force were slightly different (+0.8/15; -3.0/25; p<0.01). CONCLUSION The Auto-Constant questionnaire in French is an excellent estimator of the Constant score, and of its pain and mobility sub-scores. It is less accurate for the evaluation of the strength, but differences between sub-scores compensate and allow its use in daily practice. LEVEL OF PROOF II, Prospective continuous clinical series.
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Affiliation(s)
- Mikaël Chelli
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France.
| | - Yohann Levy
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Vincent Lavoué
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Gilles Clowez
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
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Boileau P, Saliken D, Gendre P, Seeto BL, d'Ollonne T, Gonzalez JF, Bronsard N. Arthroscopic Latarjet: Suture-Button Fixation Is a Safe and Reliable Alternative to Screw Fixation. Arthroscopy 2019; 35:1050-1061. [PMID: 30857907 DOI: 10.1016/j.arthro.2018.11.012] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [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: 01/07/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate mid-term clinical outcomes, complications, bone-block healing, and positioning using suture-button fixation for an arthroscopic Latarjet procedure. METHODS Patients with traumatic recurrent anterior instability and glenoid bone loss underwent guided arthroscopic Latarjet with suture-button fixation. We included patients with anterior shoulder instability, glenoid bone loss >20%, and radiographic and clinical follow-up minimum of 24 months. Patients with glenoid bone loss <20% or those that refused computed tomography imaging were excluded. Bone-block fixation was accomplished with 2 cortical buttons connected with a looped suture (4 strands). The looped suture was tied posteriorly with a sliding-locking knot. After transfer of the bone block on the anterior neck of the scapula, compression (100 N) was obtained with the help of a tensioning device. Clinical assessment was performed at 2 weeks, 3 months, 6 months, and then yearly with computed tomography completed at 2 weeks and 6 months to confirm bony union. RESULTS A consecutive series of 136 patients underwent arthroscopic Latarjet with 121 patients (89%; mean age 27 years) available at final follow-up (mean follow-up, 26 months; range, 24-47 months). No neurologic complications or hardware failures were observed; no patients had secondary surgery for implant removal. The transferred coracoid process healed to the scapular neck in 95% of the cases (115/121). The bone block did not heal in 4 patients; it was fractured in 1 and lysed in another. Smoking was a risk factor associated with nonunion (P < .001). The coracoid graft was positioned flush to the glenoid face in 95% (115/121) and below the equator in 92.5% (112/121). At final follow-up, 93% had returned to sports, whereas 4 patients (3%) had a recurrence of shoulder instability. The subjective shoulder value for sports was 94 ± 3.7%. Mean Rowe and Walch-Duplay scores were 90 (range, 40-100) and 91 (range, 55-100), respectively. CONCLUSIONS Suture-button fixation is an alternative to screw fixation for the Latarjet procedure, obtaining predictable healing with excellent graft positioning, and avoiding hardware-related complications. There was no need for hardware removal after suture-button fixation. The systematic identification of the axillary and musculocutaneous nerves reduced risk of neurologic injury. A low instability recurrence rate and excellent return to pre-injury activity level was found. Suture-button fixation is simple, safe, and may be used for both open and arthroscopic Latarjet procedure. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Pascal Boileau
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France.
| | - David Saliken
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Patrick Gendre
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Brian L Seeto
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Thomas d'Ollonne
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
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Abstract
Inferring the surface charge distribution from experimental Kelvin probe microscopy measurements is usually a hard task. Although several approximations have been proposed in order to estimate the effect of these charges, the real inverse problem has not been addressed so far. In this paper, we propose a fast and intuitive method based on Fast Fourier Transform algorithms that allows the surface charge distribution to be obtained directly from the experimental Kelvin voltage measurements. With this method, quantitative physical information such as the total charge and charge position is accessible even in complex charge distributions such as highly insulating polymer surfaces. Moreover, one of the strongest points is that sub-tip resolution is achieved, and therefore the usually unknown charge size can be estimated.
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Affiliation(s)
- J F Gonzalez
- Biomedical Science, Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden
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27
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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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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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Esnault P, Prunet B, Cungi PJ, Caubere A, Lacroix G, Bordes J, David JS, Gonzalez JF, Kaiser E. [Thromboelastometric profile of unwashed shed blood after primary knee arthroplasty]. Transfus Clin Biol 2015; 22:30-6. [PMID: 25595822 DOI: 10.1016/j.tracli.2014.12.001] [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] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retransfusion of unwashed salvaged blood. Some studies question the quality of this blood and in particular its ability to clot. These studies use "static" coagulation tests reflecting only partially the reality, unlike viscoelastic methods. The main objective of this study was to evaluate the salvaged blood thromboelastometric profile using ROTEM® system and to compare these results with patient venous blood. MATERIALS AND METHODS We performed an observational, prospective, single-center study conducted over 3 months in 2013. Agreement of local ethical committee and patient consent were obtained beforehand. All adult patients who underwent a primary total knee arthroplasty were included. A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same time on patient venous blood and on unwashed salvaged blood in the PACU. RESULTS Twenty patients were included. The median duration of surgery was 93 minutes. Thirteen patients (65%) received tranexamic acid during procedure. The median volume of shed blood was 225 mL. Two patients (10%) received a reinfusion. Analysis of shed blood showed a major deficiency of clotting factor in standard biology (PT<10%) and an absence of clot formation in thromboelastometric test (In-tem®, Ex-tem®, Fib-tem® or Ap-tem®). Compared to venous blood, shed blood had significantly lower hemoglobin levels: 8.8 vs 13.5 g/dL (P<0.0001). Allogenic transfusion concerned 5% of patients. DISCUSSION In this work, we confirmed that shed blood was naturally uncoagulable probably due to a multifactorial mechanism involving a major clot factor deficiency and an activation of fibrinolysis.
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Affiliation(s)
- P Esnault
- Département d'anesthésie réanimation, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France.
| | - B Prunet
- Département d'anesthésie réanimation, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
| | - P J Cungi
- Département d'anesthésie réanimation, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
| | - A Caubere
- Service de chirurgie orthopédique et traumatologique, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
| | - G Lacroix
- Département d'anesthésie réanimation, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
| | - J Bordes
- Département d'anesthésie réanimation, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
| | - J-S David
- Département d'anesthésie réanimation, hospices civils de Lyon, CHU de Lyon Sud, 69310 Lyon, France
| | - J F Gonzalez
- Service de chirurgie orthopédique et traumatologique, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
| | - E Kaiser
- Département d'anesthésie réanimation, hôpital d'instruction des armées Sainte-Anne, 83000 Toulon, France
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Gonzalez JF, Alami GB, Baque F, Walch G, Boileau P. Complications of unconstrained shoulder prostheses. J Shoulder Elbow Surg 2011; 20:666-82. [PMID: 21419661 DOI: 10.1016/j.jse.2010.11.017] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [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: 04/06/2010] [Revised: 11/12/2010] [Accepted: 11/17/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Jean-François Gonzalez
- Department of Orthopedic Surgery and Traumatology, Hôpital d'Instruction des Armées Legouest, Metz Armées, France
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Boileau P, Gonzalez JF, Chuinard C, Bicknell R, Walch G. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg 2009; 18:600-6. [PMID: 19481959 DOI: 10.1016/j.jse.2009.03.011] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [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: 11/05/2008] [Revised: 03/17/2009] [Accepted: 03/21/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose is to report the results of reverse shoulder arthroplasty (RSA) after previous failed rotator cuff surgery. MATERIALS AND METHODS A retrospective multicenter study of 42 RSA in 40 patients (mean age, 71 years) with a mean follow-up of 50 months. Thirty shoulders presented with a pseudoparalytic shoulder and 12 with a painful shoulder with maintained active anterior elevation (AAE >or= 90 degrees). RESULTS Five complications (12%) occurred and 2 patients (5%) underwent re-operation. In pseudoparalytic shoulders, AAE increased from 56 degrees to 123 degrees and 7% were disappointed or dissatisfied. In painful shoulders, AAE decreased from 146 degrees to 122 degrees and 27% were disappointed or dissatisfied. DISCUSSION RSA can improve function in patients with cuff deficient shoulders after failure of previous cuff surgery. However, results are inferior to primary RSA. RSA when the patient maintains greater than 90 degrees of preoperative AAE risks loss of AAE and lower patient satisfaction.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France
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Peycru T, Gonzalez JF, Kraemer P, Calvet P, Tramond B, Martin F. Actinomycétome abdominal avec atteinte viscérale. Presse Med 2005; 34:1039. [PMID: 16225260 DOI: 10.1016/s0755-4982(05)84107-7] [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] [Indexed: 11/21/2022] Open
Affiliation(s)
- Thierry Peycru
- Service de chirurgie, Centre hospitalier des Armées Bouffard, Djibouti.
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Sanderson M, Gonzalez JF. 1988 National Maternal and Infant Health Survey: methods and response characteristics. Vital Health Stat 2 1998:1-39. [PMID: 9623337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The 1988 National Maternal and Infant Health Survey (NMIHS) was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications. METHODS The NMIHS is a nationally representative sample of 11,000 women who had live births, 4,000 who had late fetal deaths, and 6,000 who had infant deaths in 1988. Questionnaires were mailed to mothers based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States. RESULTS The response rates in all three components of the NMIHS differed according to the mothers' characteristics. Mothers were more likely to respond if they were 20-39 years of age, were white, were married, had fewer than four children, entered prenatal care early, had more prenatal visits, had more years of education, or resided in the Midwest Region. The percent of respondents was lower for teenage mothers, mothers of races other than white, and mothers with four or more children, little prenatal care, or fewer years of education. Mothers whose infants weighed less than 2,500 grams were less likely to respond in the live-birth and infant-death components than mothers whose infants weighed 2,500 grams or more. CONCLUSIONS The NMIHS will provide an invaluable tool for researchers and practitioners seeking solutions to perinatal and obstetric problems.
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Weissleder R, Elizondo G, Stark DD, Hahn PF, Marfil J, Gonzalez JF, Saini S, Todd LE, Ferrucci JT. The diagnosis of splenic lymphoma by MR imaging: value of superparamagnetic iron oxide. AJR Am J Roentgenol 1989; 152:175-80. [PMID: 2783273 DOI: 10.2214/ajr.152.1.175] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study was designed to evaluate superparamagnetic iron oxide (AMI-25) as a contrast agent for MR to distinguish normal spleens from those diffusely infiltrated by lymphoma. As diffuse splenic involvement lacks visible tumor-tissue boundaries, signal-intensity measurements of spleens were used as a diagnostic criterion in 33 patients (lymphoma, n = 8; benign splenomegaly, n = 5; normal subjects, n = 20). Unenhanced MR images were insensitive (four of eight patients) and nonspecific (20 of 25 patients) in the diagnosis of lymphoma. After injection of superparamagnetic iron oxide (40 mumol Fe/kg), lymphomatous spleens showed a significantly higher signal intensity (p less than .05) than did normal spleens or spleens enlarged by benign disease (hepatic cirrhosis, n = 4; spherocytosis, n = 1). Changes in splenic MR signal intensity unambiguously identified eight of eight lymphomatous spleens and 25 of 25 normal or enlarged spleens that did not contain lymphoma. Phagocytosis of superparamagnetic iron oxide in lymphomatous spleens is reduced because of diffuse displacement of splenic macrophages by lymphoma cells and/or by immunologic suppression of macrophage activity. Our results suggest that superparamagnetic iron oxide (AMI-25) can improve the accuracy of MR imaging in the diagnosis of splenic lymphoma. With further development, this noninvasive technique may reduce the need for diagnostic splenectomy in lymphoma patients.
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Affiliation(s)
- R Weissleder
- Department of Radiology, Massachusetts General Hospital, Boston
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35
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Gonzalez JF. [Characteristics of the vitamin and mineral composition of the diets of weightlifters in Cuba]. Vopr Pitan 1986:34-7. [PMID: 3765535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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