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Amouyel T, Szymanski C, Rodrigues V, Saab M, Maynou C. Poor clinical outcomes and high rates of dislocation after modular reverse shoulder arthroplasty for proximal humeral oncologic resection. Int Orthop 2024; 48:1331-1339. [PMID: 38403733 DOI: 10.1007/s00264-024-06122-7] [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: 11/27/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The shoulder is the most common site for upper extremity tumors. The aim of the study was to analyze the outcomes and the complications of modular reverse shoulder arthroplasty (RSA) after proximal humerus resection. METHODS We retrospectively included 15 consecutive patients who underwent a modular MUTARS™ RSA reconstruction after proximal humerus tumour resection between 2017 and 2020. The mean age was 52 years. Their clinical outcomes were assessed using the Constant-Murley score and the MSTS shoulder. Radiological outcomes were assessed based on the presence of loosening, osteolysis, and scapular notching. Complications such as dislocation, oncological recurrence, and infection were assessed. Mean follow-up time was 32.9 months (24 to 45). RESULTS The mean adjusted Constant score was 50.7% (min 22, max 81), and the mean MSTS score was 15.6 (min 4, max 26). We had no loosening, osteolysis, or scapular notching on the radiographs at last follow-up. We had a high complication rate of 53%: one infection, one oncological recurrence, and six dislocations (40%), of which five were re-operated. CONCLUSION In our experience, the MUTARS™ Implantcast™ modular RSA has poor functional results and a high rate of dislocation in the case of large proximal humerus resections below the distal insertion of the deltoid.
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Affiliation(s)
- Thomas Amouyel
- UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Univ. Lille, CHU Lille, Service d'orthopédie 1, 59000, Lille, France.
| | - Christophe Szymanski
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
| | - Valentin Rodrigues
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
| | - Marc Saab
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
| | - Carlos Maynou
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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Raj C, Amouyel T, Maynou C, Chantelot C, Saab M. Limb schwannoma: Factors for postoperative neurologic deficit and poor functional results. Orthop Traumatol Surg Res 2024:103839. [PMID: 38355010 DOI: 10.1016/j.otsr.2024.103839] [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: 01/15/2022] [Revised: 10/29/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Neurologic complications after limb schwannoma resection are not unusual, but there is no consensus on risk factors for neurologic deficit or poor functional results. We therefore conducted a retrospective study, to screen for factors predicting, firstly, postoperative neurologic deficit and, secondly, poor functional results. HYPOTHESIS Certain pre- and intraoperative features predict risk of failure, poor results or aggravation. PATIENTS AND METHODS A single-center retrospective study was conducted in the University Hospital of Lille, France, for the period January 2004 to March 2020, including 71 patients. Preoperative variables (gender, age, symptoms, progression, tumor location and size) and operative data (type of surgery) were collected as possible risk factors for postoperative sensory deficit (Weber) and/or motor deficit [Medical Research Council (MRC)] and poor functional result [Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH); Lower Extremity Functional Scale (LEFS) and douleur neuropathique (neuropathic pain) 4 (DN4)]. RESULTS Results were assessed a mean 69.4±38.5 months' follow-up (range, 6-180 months). In total, 21 patients (29.6%) had deficits (21 sensory, 1 motor) preoperatively and 25 patients (35.2%) postoperatively (20 sensory, 9 motor) (p=0.689). Fourteen patients (19.7%) showed functional aggravation. Fascicular resection was associated with risk of postoperative deficit [OR = 4.65 (95% CI: 1.485-15.543); p=0.004] and functional deterioration [OR = 3.9 (95% CI: 1.143-13.311); p=0.042]. Thirteen patients (18.3%) showed no improvement on DN4. Preoperative pain was a factor for improvement on DN4 [OR = 3.667 (95% CI: 1.055-12.738); p=0.0409]. DISCUSSION The study identified fascicular resection as a risk factor for postoperative deficit and functional deterioration after limb schwannoma resection. Patients with preoperative neuropathic pain showed alleviation. Resection should be precise, under magnification, avoiding fascicular resection. Preoperative patient information is essential. LEVEL OF EVIDENCE IV; retrospective series.
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Affiliation(s)
- Corentin Raj
- Service d'orthopédie-traumatologie, CHU of Lille, 59000 Lille, France
| | - Thomas Amouyel
- Service d'orthopédie-traumatologie, CHU of Lille, 59000 Lille, France
| | - Carlos Maynou
- Service d'orthopédie-traumatologie, CHU of Lille, 59000 Lille, France
| | | | - Marc Saab
- Service d'orthopédie-traumatologie, CHU of Lille, 59000 Lille, France.
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Martin T, Martinot P, Leclerc JT, Titécat M, Loïez C, Dartus J, Duhamel A, Migaud H, Chantelot C, Desmurs BL, Amouyel T, Senneville E. Accuracy of the GeneXpert® MRSA/SA SSTI test to diagnose methicillin-resistant Staphylococcus spp. infection in bone fixation and fusion and management of infected non-unions. Orthop Traumatol Surg Res 2024:103820. [PMID: 38266672 DOI: 10.1016/j.otsr.2024.103820] [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: 01/18/2023] [Revised: 07/22/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The GeneXpert® MRSA/SA SSTI (Methicillin Resistant Staphylococcus aureus / S. aureus skin and soft tissue infection) PCR test allows early detection of methicillin resistance in staphylococci. This test was developed for skin infections and has been evaluated for prosthetic joint infections but, to our knowledge, has not been evaluated for hardware infections outside of arthroplasties. Furthermore, we conducted a retrospective study in patients with non-prosthetic osteosynthesis hardware aiming: 1) to identify the diagnostic values of the PCR test compared to conventional cultures and the resulting rate of appropriate antibiotic therapy. 2) to identify the rate of false negative (FN) results, 3) to identify and compare the rates of failure of infectious treatment (FN versus others) 4) to search for risk factors for FN of the PCR test. HYPOTHESIS The PCR test allowed early and appropriate targeting of antibiotic therapy. MATERIAL AND METHODS The results of PCR tests and conventional cultures for osteoarticular infections of non-prosthetic hardware over four years (2012-2016) were compared to identify the diagnostic values of using the results of conventional culture as a reference and the rate of appropriate antibiotic therapies. Infectious management failures between the results of the FN group and the others were compared, and variables associated with a FN of the PCR test were identified. RESULTS The analysis of 419 PCR tests allowed us to establish a sensitivity of 42.86%, a specificity of 96.82%, a positive predictive value of 60% and a negative predictive value of 93.83%. Using the results of the PCR test for the targeting of postoperative antibiotic therapy, it was suitable for staphylococcal coverage in 90.94% (381/419). The rates of patients for whom infectious treatment failed were not significantly different between the FN group and the other patients (20.8% versus 17.7%, respectively; Hazard Ratio = 1.12 (95%CI 0.47-2.69, p = 0.79)). A skin opening during the initial trauma (p = 0.005) and a polymicrobial infection were significantly associated with a risk of FN from the PCR test (p < 0.001). CONCLUSION The PCR test makes it possible to reduce the duration of empirical broad-spectrum antibiotic therapy during the treatment of an infection of osteosynthesis hardware but causes a lack of antibiotic coverage in 9.06% of cases. LEVEL OF EVIDENCE III; Diagnostic case control study.
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Affiliation(s)
- Théo Martin
- Service d'orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France.
| | - Pierre Martinot
- Département de chirurgie orthopédique, Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Lomme, France
| | - Jean-Thomas Leclerc
- Service d'orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; Département de chirurgie orthopédique, CHU de Québec-Université Laval, QC, Canada
| | - Marie Titécat
- CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; Microbiologie, Centre de Biologie Pathologie Pierre-Marie Degand, CHU Lille, Boulevard du Pr Jules Leclercq, F-59000, Lille, France
| | - Caroline Loïez
- CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; Microbiologie, Centre de Biologie Pathologie Pierre-Marie Degand, CHU Lille, Boulevard du Pr Jules Leclercq, F-59000, Lille, France
| | - Julien Dartus
- Service d'orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France
| | - Alain Duhamel
- CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre d'étude et de recherche en informatique médicale, Maison de la recherche clinique hospitalière et universitaire, CHU Lille, 6 Rue du Professeur Laguesse, F-59000, Lille, France
| | - Henri Migaud
- Service d'orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France
| | - Christophe Chantelot
- CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; Service de Traumatologie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France
| | - Barthélémy Lafon Desmurs
- CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; Service Universitaire des Maladies Infectieuses, CH Dron, 155 Rue du Président Coty, F-59200, Tourcoing, France
| | - Thomas Amouyel
- Service d'orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France
| | - Eric Senneville
- CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France; Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO), Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France; Service Universitaire des Maladies Infectieuses, CH Dron, 155 Rue du Président Coty, F-59200, Tourcoing, France
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Lopes R, Amouyel T, Benoist J, De L'Escalopier N, Cordier G, Freychet B, Baudrier N, Dubois Ferrière V, Leiber Wackenheim F, Mainard D, Padiolleau G, Barbier O. Return to sport after surgery for osteochondral lesions of the talar dome. Results of a multicenter prospective study on 58 patients. Orthop Traumatol Surg Res 2023; 109:103675. [PMID: 37683912 DOI: 10.1016/j.otsr.2023.103675] [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: 07/03/2022] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Osteochondral lesions of the talar dome (OLTD) are most often found in patients for whom the return to sports activities is the main issue. Two types of surgery have been distinguished at present, bone marrow stimulation techniques and mosaicplasty techniques. The size of the lesion indicating the need for bone marrow stimulation as the required surgical procedure has recently been decreased (<1cm). The main objective of this study was therefore to evaluate the return to sport after OLTD surgery. Our hypothesis is that surgery of osteochondral lesions of the talar dome allows the resumption of sports activities in the majority of cases. MATERIAL AND METHODS This multicenter prospective study was conducted across 10 French centers specializing in foot and ankle surgery. All patients aged 18 to 65 with symptomatic OLTD resistant to thorough medical treatment for at least 6 months, justifying surgery, were included from June 2018 to September 2019. In addition to the usual demographic data, the practice of sport and level (professional, competitive, leisure) were systematically investigated preoperatively. A common protocol for surgical management and postoperative follow-up had previously been established according to the arthrographic stage of the lesion. The most recent recommendations based on size, but also depth, were taken into account. The primary endpoint was return to sport. RESULTS A final functional evaluation with the AOFAS (American Orthopedic Foot & Ankle Society) score was performed at a minimum of 12 months. Of 58 sports patients, 70.6% returned to sport (41/58) with an average delay of 4.3 months. A high AOFAS functional score (p=0.02) and a stage 1 lesion (p=0.006) were the only preoperative criteria significantly associated with a return to sport. No other factor was predictive of a return to sport. CONCLUSION Our prospective study shows that 70.6% of sports patients returned to sport after OLTD surgery according to a surgical protocol and standardized follow-up. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ronny Lopes
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69000 Lyon, France.
| | - Thomas Amouyel
- Service de chirurgie orthopédique, CHRU Lille, hôpital Salengro, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Nicolas De L'Escalopier
- Service de chirurgie orthopédique, traumatologique et réparatrice des membres, HIA Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Guillaume Cordier
- Centre de chirurgie orthopédique et sportive, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Benjamin Freychet
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Nicolas Baudrier
- Centre ASSAL de médecine et de chirurgie du pied, avenue de Beau-Séjour, 6, 1206 Genève, Suisse
| | | | | | - Didier Mainard
- Santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Giovanny Padiolleau
- Service de chirurgie orthopédique, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
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Rodrigues V, Szymanski C, Saab M, Maynou C, Tiffreau V, Wieczorek V, Dartus J, Amouyel T. Recovery of leg strength based on isokinetic testing after tumor resection and reconstruction with a modular rotating hinge knee system: Prospective cross-sectional study with a minimum follow-up of 24 months. Orthop Traumatol Surg Res 2023; 109:103631. [PMID: 37119875 DOI: 10.1016/j.otsr.2023.103631] [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: 11/22/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND While modular reconstruction implants can be used to replace the bone lost after bone tumor resection, tumor excision from the neighboring soft tissues can lead to loss of strength and joint range of motion (ROM), which results in worse knee function. Functional recovery after total knee arthroplasty for osteoarthritis has been extensively documented. But few studies have evaluated the recovery after total knee reconstruction following tumor excision despite the fact that most of these patients are young and have high functional demands. We did a prospective cross-sectional study to: 1) compare muscle strength recovery around the knee with an isokinetic dynamometer after tumor excision and reconstruction with a modular implant to the healthy contralateral knee; 2) determine if the differences in peak torque (PT) in the knee extensors and flexors had a clinical impact. HYPOTHESIS Resection of soft tissues during tumor excision around the knee causes strength loss that cannot be fully recovered. METHODS The 36 patients who underwent extra- or intra-articular resection of a primary or secondary bone tumor in the knee area followed by reconstruction with a rotating hinge knee system between 2009 and 2021 were eligible for this study. The primary outcome was the ability to actively lock the operated knee. The secondary outcomes were the concentric PT during isokinetic testing at slow (90°/sec) and fast (180°/sec) speeds, flexion-extension ROM, Musculoskeletal Tumor Society (MSTS) score, the IKS, Oxford Knee Score (OKS) and KOOS. RESULTS Nine patients agreed to participate in the study, all of whom had regained the ability to lock their knee postoperatively. PT in flexion and extension on the operated knee was less than the healthy knee. The PT ratio for the operated/healthy knee at 60°/sec and 180°/sec in flexion was 56.3%±16.2 [23.2-80.1] and 57.8%±12.3 [37.7-77.4], respectively, which corresponded to a slow-speed strength deficit of 43.7% in the knee flexors. The PT ratio for the operated/healthy knee at 60°/sec and 180°/sec in extension was 34.3%±24.6 [8.6-76.5] and 43%±27.2 [13.1-93.4], respectively, which corresponded to a slow-speed strength deficit of 65.7% in the knee extensors. The mean MSTS was 70%±20 [63-86]. The OKS was 29.9/48±11 [15-45], the mean IKS knee was 149.6±36 [80-178] and the mean KOOS was 67.43±18.5 [35-88.7]. DISCUSSION Despite all patients having the ability to lock out their knee, there was an imbalance in the strength between opposite muscle groups: 43.7% strength deficit at slow-speed and 42.2% at fast speed for the hamstring muscles, and 65.7% at slow-speed and 57% at fast speed for the quadriceps muscles. This difference is considered pathological with an increased risk of knee injury. Despite this strength deficit, this joint replacement technique, which is free of complications, can preserve good knee function with acceptable knee joint ROM and satisfactory quality of life. LEVEL OF EVIDENCE III; prospective cross-sectional case-control study.
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Affiliation(s)
- Valentin Rodrigues
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France.
| | - Christophe Szymanski
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Marc Saab
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Carlos Maynou
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Vincent Tiffreau
- Service de rééducation et réadaptation, hôpital Swynghedauw, 1, rue André Verhaeghe, 59800 Lille, France
| | - Valerie Wieczorek
- Centre hospitalier universitaire de Lille (CHU), CHU Lille - Eurasport, 413, avenue Eugène Avinée, 59120 Loos, France
| | - Julien Dartus
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Thomas Amouyel
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
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Delamarre M, Saab M, Chantelot C, Amouyel T. Evaluation clinique et radiologique des arthrodèses des trois os du carpe dans les SLAC et SNAC wrists avec un recul moyen de 6 ans: À propos de 14 cas. Hand Surgery and Rehabilitation 2022. [DOI: 10.1016/j.hansur.2022.09.080] [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: 11/29/2022]
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Lopes R, Geffroy L, Padiolleau G, Ngbilo C, Baudrier N, Mainard D, Benoist J, Leiber Wackenheim F, Cordier G, Dubois Ferriere V, Freychet B, Barbier O, Amouyel T. Reply to the letter of Berhan Pirimoglu. Orthop Traumatol Surg Res 2022; 108:103304. [PMID: 35470115 DOI: 10.1016/j.otsr.2022.103304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/22/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Ronny Lopes
- Pied Cheville Nantes Atlantique, santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
| | - Loic Geffroy
- Pied Cheville Nantes Atlantique, santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Giovany Padiolleau
- Pied Cheville Nantes Atlantique, santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Cedric Ngbilo
- Centre orthopédique SANTY, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Nicolas Baudrier
- CHU Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Didier Mainard
- CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Jonathan Benoist
- CH Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | | | - Guillaume Cordier
- Clinique du sport, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Victor Dubois Ferriere
- Hopitaux universitaires de Genève, rue Gabrielle-Perret-Gentil, 41205 Genève, Switzerland
| | - Benjamin Freychet
- Centre orthopédique SANTY, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Olivier Barbier
- Hopital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Thomas Amouyel
- Service d'orthopédie 1, hôpital Roger Salengro, place de Verdun, CHRU, 59037 Lille, France
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Amouyel T, Barbier O, De L'Escalopier N, Cordier G, Baudrier N, Benoist J, Ferrière VD, Wackenheim FL, Mainard D, Padiolleau G, Lopes R. Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-06876-w. [PMID: 35094097 DOI: 10.1007/s00167-022-06876-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Osteochondral lesions of the talus (OLT) are a frequent cause of pain in young patients and a new CT arthrographic classification system of OLT was recently proposed to help guide the choices of and standardize the indications for surgical treatment. The primary hypothesis was that this algorithm would result in a postoperative AOFAS score of ≥ 80/100. The secondary hypothesis was to identify the preoperative factors of successful surgery. METHODS This was a prospective observational multicenter study. Eighty-six patients who underwent surgery for OLT after at least 6 months of unsuccessful conservative management were included for a mean follow-up of 15 months (12-36). Forty-nine patients with stage 1 OLT underwent microperforation, 2 patients with stage 2 OLT underwent a lift, drill, fill, and fix graft procedure with screw fixation, and 35 patients with stage 3 OLT were treated with mosaicplasty. RESULTS After a follow-up of at least 1 year, 56 patients (65%) had an AOFAS score > 80 and the mean AOFAS score was 82 (16-100). A lower BMI (p = 0.038), a higher preoperative range of motion in the ankle (p = 0.033), higher preoperative AOFAS and FAOS scores (p = 0.001 and p = 0.011), and the presence of a preoperative bone bruise on MRI (p = 0.020) were good prognostic factors on univariate analysis. The presence of grade 1 osteoarthritis on the Van Dijk classification was predictive of a poor prognosis (p = 0.044). Multivariate analysis showed that a good preoperative range of motion (OR = 1.080 [1.020-1.150] p = 0.01) was predictive of a positive outcome, while grade 1 osteoarthritis was predictive of a poor outcome (OR = 0.147 [0.036-0.603] p = 0.008). The postoperative AOFAS decreased in six patients and 17 patients had at least one complication: six dysthesias of the superficial fibular nerve, two of the sural nerve, and nine stage 1 complex regional pain syndromes. CONCLUSION The new algorithm for OLT resulted in a postoperative AOFAS score of ≥ 80/100 in 65% of cases. The positive predictive factors of a successful postoperative outcome were the presence of a good preoperative range of motion and the absence of preoperative osteoarthritis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- T Amouyel
- Service de Chirurgie Orthopédique, CHU Lille Hopital Salengro, 2 Avenue Oscar Lambret, 59000, Lille, France
| | - O Barbier
- Service de Chirurgie Orthopédique, HIA Sainte Anne, 2 Boulevard Sainte Anne, 83000, Toulon, France
| | - N De L'Escalopier
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice des Membres, HIA Percy, 101, Avenue Henri-Barbusse, 92140, Clamart, France
| | - G Cordier
- Centre de Chirurgie Orthopédique et Sportive, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - N Baudrier
- Service de Chirurgie Orthopédique, Hopital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - J Benoist
- CHP Saint Grégoire, 7 Bd de la Boutière, 35760, Saint-Grégoire, France
| | - V Dubois Ferrière
- Centre Assal de Médecine et de Chirurgie du Pied, Avenue de Beau-Séjour 6, 1206, Genève, France
| | - F Leiber Wackenheim
- Clinique de l'Orangerie, 29 Allée de la Robertsau, 67000, Strasbourg, France
| | - D Mainard
- Hopital Central, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - G Padiolleau
- Centre PCNA, Avenue Claude Bernard, 44800, Saint-Herblain, France
| | - R Lopes
- Centre PCNA, Avenue Claude Bernard, 44800, Saint-Herblain, France.
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de l'Escalopier N, Amouyel T, Mainard D, Lopes R, Cordier G, Baudrier N, Benoist J, Ferrière VD, Leiber F, Morvan A, Maynou C, Padiolleau G, Barbier O. Long-term outcome for repair of osteochondral lesions of the talus by osteochondral autograft: A series of 56 Mosaicplasties®. Orthop Traumatol Surg Res 2021; 107:103075. [PMID: 34563735 DOI: 10.1016/j.otsr.2021.103075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The present study analyzed results in 56 osteochondral Mosaicplasty® autografts for osteochondral lesion of the talus (OLT) at more than 5 years' follow-up. HYPOTHESIS Mosaicplasty® shows long-term efficacy and low morbidity in the treatment of OLT. PATIENTS AND METHODS A multicenter retrospective study included patients treated by Mosaicplasty® with more than 5 years' follow-up. Preoperative data were collected from medical files, and all patients were reassessed. AOFAS scores and FAOS were calculated at last follow-up. Imaging comprised standard radiographs and MRI or CT arthrography of the ankle. RESULTS Fifty-six patients were included, with a mean age of 34 years (range, 18-60 years). Seventeen involved work accidents. Mean follow-up was 8.5 years (range, 5-20 years). Mean AOFAS score at follow-up was 80.6±19.4 and mean FAOS 77.8±21.5. Work accident, preoperative osteoarthritis and untreated laxity correlated significantly with poorer results. At last follow-up, 22 patients (39%) showed signs of osteoarthritis. There was no morbidity implicating the malleolar osteotomy. There were 11 cases (20%) of persistent patellar syndrome at the donor site. DISCUSSION The present results were comparable to those reported elsewhere, showing that functional results of Mosaicplasty® autograft for OLT do not deteriorate over the long term. Work accidents correlated significantly with poorer functional outcome. Any associated instability must always be treated. Malleolar osteotomy provides good exposure without additional morbidity. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Nicolas de l'Escalopier
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice des Membres, HIA Percy, 101, avenue Henri Barbusse, 92140 Clamart, France.
| | - Thomas Amouyel
- Hôpital Salengro, Service de Chirurgie Orthopédique, 2, avenue Oscar Lambret, 59000 Lille, France
| | - Didier Mainard
- Hôpital Central, 29, avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Ronny Lopes
- Centre PCNA, avenue Claude Bernard, 44800 Saint-Herblain, France
| | - Guillaume Cordier
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Nicolas Baudrier
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Jonathan Benoist
- Institut Locomoteur de l'Ouest, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Victor Dubois Ferrière
- Centre Assal de Médecine et de Chirurgie du Pied, avenue de Beau-Séjour 6, 1206 Geneva, Switzeraland
| | - Fréderic Leiber
- Clinique de l'Orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Antoine Morvan
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Carlos Maynou
- Hôpital Salengro, Service de Chirurgie Orthopédique, 2, avenue Oscar Lambret, 59000 Lille, France
| | | | - Olivier Barbier
- Service de Chirurgie Orthopédique et Traumatologique, HIA Sainte Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Padiolleau G, Amouyel T, Barbier O, De L'Escalopier N, Cordier G, Baudrier N, Benoist J, Dubois-Ferrière V, Leiber F, Morvan A, Mainard D, Maynou C, Lopes R. Safety of malleolar osteotomies in surgery for osteochondral lesions of the talus. Orthop Traumatol Surg Res 2021; 107:103070. [PMID: 34547541 DOI: 10.1016/j.otsr.2021.103070] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The talus is a central bone in the hindfoot that is difficult to access surgically. Performing a medial or lateral malleolar osteotomy in the management of an osteochondral lesion of the talus (OLT) is a feared procedure amongst surgeons and their patients. The objective of this study was to assess the complications inherent to malleolar osteotomies in the treatment of OLTs. HYPOTHESIS The use of a standardized protocol concerning the technical performance and osteosynthesis of malleolar osteotomies results in fewer postoperative complications than a non-standardized protocol. MATERIALS AND METHOD This is a comparative study comprising a prospective multicenter non-randomized series with a standardized protocol for performing malleolar osteotomies, and a multicenter retrospective series without a standardized protocol. We included all patients aged 16 to 65 years with symptomatic OLTs, resistant to more than 6-months of well-conducted medical treatment, for whom surgery was considered. The minimum follow-up was 1 year for the prospective study, and 5 years for the retrospective study. A total of 86 and 97 patients were included in the prospective and retrospective studies, respectively. Of these 183 patients, 86 patients (33 prospective and 53 retrospective) underwent medial or lateral malleolar osteotomies as part of their surgery for OLT. Complications specific to the osteotomy procedures such as scar tissue, surgical site infection, non-union, articular malunion, neurological lesions or surgical revision, were investigated. RESULTS No specific complication was found to be associated to the malleolar osteotomy. No surgical revision was directly linked to the osteotomy procedure. No significant difference was found between the two series. DISCUSSION There was no evidence of morbidity related specifically to medial or lateral malleolar osteotomies. A standardized protocol, subject to rigorous technical implementation, does not improve results after malleolar osteotomy. The fear associated with this malleolar osteotomy procedure seems unfounded. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Thomas Amouyel
- Hôpital Salengro, Service de chirurgie orthopédique, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Olivier Barbier
- Hôpital d'Instruction des Armées Sainte Anne, Service de chirurgie orthopédique, 2, boulevard Sainte Anne, 83000 Toulon, France
| | - Nicolas De L'Escalopier
- Hôpital d'Instruction des Armées Percy, service de Chirurgie Orthopédique, Traumatologique et Réparatrice des membres, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Guillaume Cordier
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Nicolas Baudrier
- Hôpital Ambroise Paré, Service de chirurgie orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Jonathan Benoist
- Institut locomoteur de l'ouest, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Victor Dubois-Ferrière
- Centre Assal de Médecine et de Chirurgie du pied, avenue de Beau-Séjour 6, 1206 Genova, Switzerland
| | - Frédéric Leiber
- Clinique de l'Orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Antoine Morvan
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Didier Mainard
- Hôpital Central, 29, avenue du maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Carlos Maynou
- Hôpital Salengro, Service de chirurgie orthopédique, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Ronny Lopes
- Centre PCNA, avenue Claude-Bernard, 44800 Saint-Herblain, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Leroy HA, Portella T, Amouyel T, Bougeard R, Assaker R, Mourier KL. Management of symptomatic postoperative epidural hematoma in spine surgery: Medicolegal implications. Orthop Traumatol Surg Res 2021; 107:103024. [PMID: 34329762 DOI: 10.1016/j.otsr.2021.103024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/10/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Spine surgery is one of the specialties with the highest medicolegal risk, with a legal action initiated every 17 months per practitioner. One of the most dreaded complications is an epidural hematoma with postoperative deficit. The treatment of this complication is still being debated. We therefore conducted a retrospective study of the database of a medical liability insurer to assess perioperative factors determining the liability of the surgeon or paramedical team during an expert review in the event of a postoperative symptomatic epidural hematoma. HYPOTHESIS To identify the factors determining the liability of the medical team in the event of a postoperative symptomatic epidural hematoma. MATERIALS AND METHODS We retrospectively analyzed the largest French register of medicolegal expert reviews between 2011 and 2018. We identified 68 cases by entering the following keywords in this database: "spine surgery," "complications," and "epidural hematoma." After a thorough review of each case, only 14 were deemed to be truly relevant to our study. We collected for each patient the perioperative data, complications (including neurologic deficits) and their clinical course. RESULTS Only one surgeon was accused and found liable for failing to perform a surgical revision within a reasonable timeframe (time to revision of 11 days). In 2 cases, the liability of a nurse working in the surgical department was called into question for failing to contact the surgeon upon the onset of symptoms. In the other cases (11 patients, 79%), the occurrence of a symptomatic epidural hematoma was considered a no-fault medical accident that was not caused by the surgeon. The presence of a drain did not have any medicolegal impact in the cases reviewed. CONCLUSION The key element in medicolegal decisions is the reaction time of the healthcare teams, in particular the time between the onset of symptoms and surgical revision. According to these expert reviews, the placement of a drain was not taken into consideration during the medicolegal assessment of a postoperative symptomatic epidural hematoma. LEVEL OF EVIDENCE II; retrospective prognostic study, investigation of patient characteristics and their impact on functional outcome.
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Affiliation(s)
- Henri-Arthur Leroy
- University Lille, CHU Lille, Département de Neurochirurgie, 1, rue Émile Laine, 59000 Lille, France.
| | - Thibault Portella
- CHU Dijon, Département de Neurochirurgie, 14, rue Paul Gaffarel, 21000 Dijon, France
| | - Thomas Amouyel
- University Lille, CHU Lille, Département de Chirurgie orthopédique, 1, rue Émile Laine, 59000 Lille, France
| | - Renaud Bougeard
- Clinique du Val D'Ouest, Département de Neurochirurgie, 39, chemin de la Vernique, 69130 Écully, France
| | - Richard Assaker
- University Lille, CHU Lille, Département de Neurochirurgie, 1, rue Émile Laine, 59000 Lille, France
| | - Klaus-Luc Mourier
- CHU Dijon, Département de Neurochirurgie, 14, rue Paul Gaffarel, 21000 Dijon, France
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Lopes R, Geffroy L, Padiolleau G, Ngbilo C, Baudrier N, Mainard D, Benoist J, Leiber Wackenheim F, Cordier G, Dubois Ferriere V, Freychet B, Barbier O, Amouyel T. Proposal of a new CT arthrographic classification system of osteochondral lesions of the talus. Orthop Traumatol Surg Res 2021; 107:102890. [PMID: 33713874 DOI: 10.1016/j.otsr.2021.102890] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/22/2020] [Revised: 08/19/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment of osteochondral lesions of the talus (OLT) is warranted if medical treatments fail, achieving good results in around 85% of cases. Numerous classification systems, based on all possible imaging modalities (radiography, MRI, CT scan, scintigraphy, and CT arthrography), have been proposed to guide surgical treatments, but none has proven to be superior. A recent study demonstrated the prognostic value of CT arthrography by accurately describing the subchondral bone plate. A systematic review of the literature has brought new criteria to predict good outcome following bone marrow stimulation surgical techniques: lesions should measure less than 1 centimeter in size and 5 millimeters in depth. Based on these data, we are proposing a new simple, 3-stage CT arthrographic classification system of OLT. MATERIALS AND METHODS After a brief overview of the classification, 60 CT-arthrographies of ankles with OLT were organized according to this new CT arthrographic classification system by four surgeons (two juniors and two seniors). Two imaging assessments were performed one month apart. Statistical analysis was performed using the Fleiss' kappa coefficient to determine the inter- and intraobserver agreement. RESULTS An excellent inter- and intraobserver agreement was found with overall Fleiss' kappa coefficients of 0.897 and 0.847, respectively. CONCLUSION The results of our study showed an excellent inter- and intraobserver agreement for this new CT arthrographic classification system of OLT. The principal advantage of this new classification system, based on the latest data in the literature, is its ability to easily distinguish lesions that are more amenable to bone marrow stimulation techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ronny Lopes
- Santé Atlantique, avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Loïc Geffroy
- Santé Atlantique, avenue Claude Bernard, 44800 Saint-Herblain, France
| | | | - Cédric Ngbilo
- Centre Orthopédique SANTY, 24, avenue Paul Santy, 69008 Lyon, France
| | - Nicolas Baudrier
- CHU Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Didier Mainard
- CHU Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Jonathan Benoist
- CH Saint Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | | | - Guillaume Cordier
- Clinique du sport, 4, rue Georges Negrevergne, 33700 Mérignac, France
| | | | - Benjamin Freychet
- Centre Orthopédique SANTY, 24, avenue Paul Santy, 69008 Lyon, France
| | - Olivier Barbier
- Hôpital d'instruction des Armées Sainte Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Thomas Amouyel
- Service d'orthopédie 1, hôpital Roger Salengro, CHRU, place de Verdun, 59037 France
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14
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d'Almeida MA, Sturbois-Nachef N, Amouyel T, Chantelot C, Saab M. Four-corner fusion: Clinical and radiological outcome after fixation by headless compression screws or dorsal locking plate at minimum 5 years' follow-up. Orthop Traumatol Surg Res 2021; 107:102886. [PMID: 33711508 DOI: 10.1016/j.otsr.2021.102886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Among the various procedures for degenerative carpal lesions, four-corner fusion relieves pain while conserving motion and strength. There are various fixation options, not presently standardised. HYPOTHESIS Internal fixation by screws or dorsal locking plate provides good 5-year clinical results in four-corner fusion. MATERIAL AND METHOD A single-centre retrospective study included 18 four-corner fusions at a minimum 5 years' follow-up: 8 plate and 10 screw fixations. Endpoints comprised pain, wrist range of motion, grip strength, QuickDASH and PRWE scores, and immobilisation time. Radiographic analysis was performed and complications inventoried. RESULTS Pain VAS score fell to 1/10 in both groups. Flexion-extension was 56° with screws and 55° with plates. QuickDASH was 20.5 and 4.6 respectively, and PRWE 11 and 9. Grip strength was 16kg in both groups. The consolidation rate was 85.7% with screws and 57.1% with plates. Eighty percent of patients with screw fixation progressed toward radiolunate osteoarthritis. Four patients required revision surgery: 3 in the screw group and 1 in the plate group. DISCUSSION There was clear clinical and functional improvement in both groups at a minimum 5 years. Consolidation was better with screw fixation, but with risk of radiolunate osteoarthritis. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
| | | | - Thomas Amouyel
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
| | - Christophe Chantelot
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
| | - Marc Saab
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
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15
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Lebot G, Amouyel T, Hardy A, Chantelot C, Saab M. Perilunate fracture-dislocations: Clinical and functional outcomes at a mean follow-up of 3.3 years. Orthop Traumatol Surg Res 2021; 107:102973. [PMID: 34052510 DOI: 10.1016/j.otsr.2021.102973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/22/2020] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Perilunate lesions in the carpus are severe injuries whose functional consequences can limit patients' ability to regain their pre-injury activity levels. The aim of this study was to evaluate the outcomes of a series of patients who suffered a perilunate fracture-dislocation and to assess their ability to resume their social and professional activities. HYPOTHESIS After surgical management of this injury, the medium-term functional outcomes will allow patients to return to their pre-injury social and professional activities. MATERIALS AND METHODS This was a single center, retrospective study. Included patients were adults who had suffered a perilunate fracture-dislocation that was treated emergently. The clinical and functional assessment consisted of comparing the mobility and grip strength between the injured and contralateral wrists, determining the functional outcome scores and the resumption of social and professional activities. A radiological assessment was done to look for instability of the proximal row of the carpus, nonunion or necrosis of the carpal bones, loss of carpal height, and presence of carpal osteoarthritis. RESULTS Ten patients were included with a mean follow-up of 39.4 months. The mean flexion/extension arc decreased significantly to 88° (20°-150) which was 55% of the healthy contralateral side (p=0.0026) while the grip strength decreased but not significantly (40.6 Kg vs. healthy side 62.4 Kg, p=0.063). The mean MWS was 58.75 (40-100), the mean PRWE was 32.9 (4-67.5) and the mean QuickDASH was 30.2 (0-77). Six of the ten patients (60%) were able to return to work, although three required occupational reclassifications. Four patients had signs of proximal row instability. There were seven instances of radiocarpal osteoarthritis, two of which were combined with mid-carpal osteoarthritis. DISCUSSION This study found shorter range of motion and worse patient-reported outcomes than other published studies, which may be due to the severity of the perilunate fracture-dislocation injuries and the inclusion of polytrauma patients. Nevertheless, the subjective scores were comparable. These injuries have serious consequences on social and professional activities of manual workers. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Gaspard Lebot
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France
| | - Thomas Amouyel
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France
| | - Alexandre Hardy
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France
| | | | - Marc Saab
- CHU Lille, Service d'Orthopédie-Traumatologie 1, 59000 Lille, France.
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Abdallah Z, Saab M, Amouyel T, Guerre E, Chantelot C, Sturbois-Nachef N. Reply to the letter by D. Estoppey, O. Nicod, A. Durand, T. Jager, G. Pomares. Orthop Traumatol Surg Res 2021; 107:102844. [PMID: 33548561 DOI: 10.1016/j.otsr.2021.102844] [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: 08/26/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Ziad Abdallah
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, Place de Verdun, 59037 Lille cedex, France.
| | - Marc Saab
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, Place de Verdun, 59037 Lille cedex, France
| | - Thomas Amouyel
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, Place de Verdun, 59037 Lille cedex, France
| | - Elvire Guerre
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, Place de Verdun, 59037 Lille cedex, France
| | - Christophe Chantelot
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service de Traumatologie, Hôpital Salengro, CHU de Lille, Place de Verdun, 59037 Lille cedex, France
| | - Nadine Sturbois-Nachef
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, Place de Verdun, 59037 Lille cedex, France
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17
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Pougès C, Hardy A, Vervoort T, Amouyel T, Duriez P, Lalanne C, Szymanski C, Deken V, Chantelot C, Upex P, Maynou C. Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial. Am J Sports Med 2021; 49:1166-1174. [PMID: 33705240 DOI: 10.1177/0363546521996381] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients. PURPOSE/HYPOTHESIS The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment for shoulder dislocation in patients younger than 25 years, with a minimum of 2 years of follow-up. The hypothesis was that surgery would decrease the risk of recurrence. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS We included patients aged between 18 and 25 years after a first episode of anterior shoulder dislocation and divided them into 2 groups. The first group was treated surgically with an arthroscopic Bankart repair within 2 weeks after the dislocation; the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Standard radiography and computed tomography were performed immediately after reduction of the dislocation, and follow-up was performed at 3, 6, 12, and 24 months. The primary outcome measure was instability recurrence, defined as another anterior shoulder dislocation requiring closed reduction by another person (the patient was unable to reduce the dislocated joint themselves), a subluxation, or a positive apprehension test. Secondary outcome measures included range of motion, return to sport, and functional scores such as the short version of the Disabilities of the Arm, Shoulder and Hand score the Walch-Duplay score, and the Western Ontario Shoulder Instability Index (WOSI). RESULTS A total of 20 patients were included in each group. The mean ± SD age was 21 ± 1.8 years, and there were 33 men (82.5%) and 7 women (17.5%) in the total sample. Recurrence of instability was significantly decreased in the surgical treatment group compared with the nonoperative group (2 [10%] vs 14 [70%], respectively; P = .0001). Fewer patients in the surgical treatment group versus the nonoperative group had another episode of dislocation (0 vs 6 [30%], respectively), subluxation (2 [10%] vs 13 [65%], respectively; P = .003), or a positive apprehension test (1 [5%] vs 11 [58%], respectively; P = .0005). The Walch-Duplay score (88.4 vs 70.3 points; P = .046) and WOSI (11.5 vs 17.7 points; P = .035) were significantly better in the surgical group versus the nonoperative group after a 2-year follow-up. Level of sport was the same or better in 89% of the surgical treatment group vs 53% of the nonoperative treatment group (P = .012). No surgical complication was recorded. We did not find any significant difference in range of motion. CONCLUSION In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up. Surgical treatment after a first episode of shoulder dislocation could be offered as a primary treatment option in a younger population if these results are confirmed by larger studies with a longer follow-up. REGISTRATION NCT03315819 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Cécile Pougès
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Alexandre Hardy
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Thomas Vervoort
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France.,Arcachon Clinic, La Teste-de-Buch, France
| | - Thomas Amouyel
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Pauline Duriez
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Clément Lalanne
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Christophe Szymanski
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Valérie Deken
- Lille-Hauts de France University, Lille, France.,Methodology Unit-Biostatistics and Data Management, Lille University, France
| | - Christophe Chantelot
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Peter Upex
- Orthopedic Department, Saint Joseph Hospital, Paris, France
| | - Carlos Maynou
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
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18
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Vernois J, Redfern D, Amouyel T. Percutaneous basal closing wedge osteotomy for hallux valgus deformity. Oper Orthop Traumatol 2021; 33:358-363. [PMID: 33439268 DOI: 10.1007/s00064-020-00691-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This article describes the percutaneous technique of a minimally invasive basal closing wedge osteotomy for correction of hallux valgus. INDICATIONS This procedure allows correction of severe deformity with a minimally invasive approach. CONTRAINDICATIONS No specific contraindication; a fusion would be preferred for an arthritic tarsometatarsal or metatarsophalangeal joint. SURGICAL TECHNIQUE The surgical technique is based on the use of burrs specifically adapted for foot surgery. A basal closing wedge osteotomy is performed and fixed percutaneously. Each step is controlled under fluoroscopy. POSTOPERATIVE MANAGEMENT A postoperative heel shoe is prescribed for 6 weeks with crutches. The foot is elevated during the first 2 weeks. Impact is forbidden for 3 months. RESULTS The authors report good and excellent results with an average correction of the hallux valgus angle of 26° and an intermetatarsal angle of 8.2°.
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Affiliation(s)
- Joel Vernois
- Sussex Orthopaedic Treatment Centre (SOTC), Haywards Heath, UK. .,Institut de Chirurgie du Pied (ICP), Clinique Blomet, 136 rue Blomet, 75015, Paris, France.
| | - David Redfern
- London Foot & Ankle Centre, Hospital St John & St Elizabeth, 60 Grove End Road, NW8 9NH, London, UK
| | - Thomas Amouyel
- Centre Hospitalier Universitaire de Lille (CHU Lille), Cite Hospitaliere, 2 Avenue Oscar Lambret (HOP SALENGRO-HOPITAL B CHR LILLE), 59000, Lille, France
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19
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Cornu A, Amouyel T, Chantelot C, Saab M. Clinical, functional and prognostic results after repair of peripheral lesions of the triangular fibrocartilage complex: a retrospective study of 21 patients. Eur J Orthop Surg Traumatol 2020; 31:557-562. [PMID: 33048247 DOI: 10.1007/s00590-020-02805-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main objective of this study was to assess the clinical and functional outcomes of arthroscopic TFCC repair in patients with an isolated Atzei type 1, 2 or 3 lesion or after a distal radius fracture. The secondary objective was to identify which factors could contribute to poor functional outcome. METHODS A retrospective study was conducted from November 2017 to May 2019. The inclusion criteria were patients with an Atzei type 1, 2 or 3 TFCC lesion who underwent arthroscopic repair and with a minimum of 6-month follow-up. Wrist motion, grip and pronation-supination strength were noted. QuickDASH, MMWS and PRWE scores were performed. An analysis was conducted to search for poor outcomes predictive factors (MMWS < 80). RESULTS Twenty-one patients were included with a mean follow-up of 26 months. Seventeen patients (80%) had an Atzei 1 lesion, one (4.8%) had an Atzei 2, and 3 (14%) had an Atzei 3. Wrist motion significantly decreased compared to contralateral. Only pronation and supination were not significant. Grip strength was 73.4% compared to the contralateral (p = 0.002). Mean PRWE was 29.14 (1.5-70.5), QuickDASH was 30.72 (2.3-70.5), and MMWS was 79.3 (35-100). In all patients with a MMWS ≥ 80, none had lunotriquetral lesions when it was the case for 5 of 9 patients with a MMWS < 80 (p = 0.006). Except a story of workplace injury, no other prognosis factor was significant. CONCLUSION Patients with Atzei 1, 2 or 3 TFCC who underwent arthroscopic repair seem to have good outcomes. However, an associated lunotriquetral lesion appears to worsen the functional prognosis.
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Affiliation(s)
- Alexandre Cornu
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France. .,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France.
| | - Thomas Amouyel
- Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
| | - Christophe Chantelot
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France.,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
| | - Marc Saab
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France.,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
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20
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Abdallah Z, Saab M, Amouyel T, Guerre E, Chantelot C, Sturbois-Nachef N. Total trapeziectomy for osteoarthritis of the trapeziometacarpal joint: Clinical and radiological outcomes in 21 cases with minimum 10-year follow-up. Orthop Traumatol Surg Res 2020; 106:775-779. [PMID: 32362426 DOI: 10.1016/j.otsr.2020.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/06/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Trapeziectomy is a technique of choice for osteoarthritis of the trapeziometacarpal joint, but few studies have assessed long-term radiological and clinical outcome in total trapeziectomy, mean follow-up being rather between 2 and 6 years in most cases. The main aim of the present study was to assess loss of trapezial space height at a minimum 10 years' follow-up. Secondary endpoints comprised functional outcome at the same follow-up. HYPOTHESIS There is systematic loss of trapezial space height, with discrepancy between radiological and clinical results, beyond 10 years' follow-up. MATERIAL AND METHODS Sixteen patients were retrospectively reassessed at a mean 13.8 years' follow-up (range, 10-17.8 years), for 21 total trapeziectomies. Criteria for the main endpoint comprised trapezial space height (TSH) and trapezial space ratio (TSR=TSH/thumb P1 phalanx length). Secondary endpoint criteria comprised pain, Kapandji opposition and retropulsion scores, active abduction, dynamometric parameters (key-pinch, tip-pinch and grip strength compared to the contralateral side), QuickDASH and satisfaction. RESULTS Mean TSH and TSR were respectively 3.7mm (range, 0.5-6.1) and 0.14 (0.02-0.25) at last follow-up. Ranges of motion were conserved, with mean Kapandji score of 9.3 (6-10), Kapandji retropulsion score of 2.8 (1-4) and active abduction of 43° (30-45°). Strength measurements were comparable to contralateral values except for key-pinch, which was significantly weaker on the operated side (4.8kg (1.5-8.5kg) versus 5.5kg (1.5-8kg); p=0.041). Mean QuickDASH was 23.5 (0-68.2), and overall satisfaction on VAS was 9.5/10 (6-10). Statistical testing confirmed the absence of correlation between radiological and clinical criteria. DISCUSSION Despite systematic trapezial space height loss, functional results were satisfactory and stable at a mean follow-up of 13.8 years. There was no correlation between radiological and clinical criteria in the long term. LEVEL OF EVIDENCE IV, single-center retrospective study.
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Affiliation(s)
- Ziad Abdallah
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, place de Verdun, 59037 Lille cedex, France.
| | - Marc Saab
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Thomas Amouyel
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie A, Hôpital Salengro, CHU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Elvire Guerre
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Christophe Chantelot
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service de Traumatologie, Hôpital Salengro, CHU de Lille, place de Verdun, 59037 Lille cedex, France
| | - Nadine Sturbois-Nachef
- CHU Lille, Université Lille-Nord-de-France, 59000 Lille, France; Service d'Orthopédie B, Hôpital Salengro, CHU de Lille, place de Verdun, 59037 Lille cedex, France
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21
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Gaeremynck P, Amouyel T, Saab M, Gadisseux B, Soudy K, Szymanski C, Maynou C. Clinical and radiological outcomes of 17 reverse shoulder arthroplasty cases performed after failed humeral head resurfacing. Orthop Traumatol Surg Res 2019; 105:1495-1501. [PMID: 31548154 DOI: 10.1016/j.otsr.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/01/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite the good outcomes with shoulder resurfacing procedures reported by some authors, our team has documented several failures caused by glenoid erosion and rotator cuff rupture, likely due to implant overstuffing. The aim of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) performed after failed humeral head resurfacing (HHR). MATERIAL AND METHODS This was a retrospective, single-center study of 17 patients who underwent RSA after failed HHR between January 2011 and February 2016. The mean patient age was 69.4 years and the mean time between HHR and surgical revision was 41 months (14.7-73.5±18.8). Preoperative ultrasonography and CT were used to evaluate the condition of the rotator cuff, extent of glenoid erosion and to look for signs of humeral cup loosening. The clinical outcomes were evaluated pre- and postoperatively using the simple shoulder test (SST), DASH (Disabilities of the Arm, Shoulder and Hand) and the Constant-Murley score. Pain was estimated using a visual analog scale (VAS). The range of motion (ROM) was determined pre- and postoperatively. All patients had standard AP and lateral X-ray views of the shoulder taken as part of their postoperative follow-up protocol to look for implant loosening. RESULTS The mean follow-up was 35.9 months (24-59±10.7). There were no intraoperative or postoperative complications. All the functional scores were improved after RSA. The median weighted Constant score preoperatively was 46% (36; 62) while it was 92% postoperatively (78; 100) (p<0.0001). The active ROM improved by 65° in forward flexion (p=0.0003) and by 30° in external rotation (p=0.002). On X-rays, we identified one patient with Sirveaux stage 4 glenoid notching and one patient with a humeral periprosthetic radiolucent line less than 2mm thick in zone 6, with no clinical consequences. CONCLUSION The excellent outcomes after RSA for failed HHR in our study are similar to the ones reported when RSA is performed for cuff tear arthropathy.
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Affiliation(s)
- Pierre Gaeremynck
- Orthopédie A, CHRU de Lille, 2, avenue Emile-Laine, 59000 Lille, France.
| | - Thomas Amouyel
- Orthopédie A, CHRU de Lille, 2, avenue Emile-Laine, 59000 Lille, France
| | - Marc Saab
- Orthopédie A, CHRU de Lille, 2, avenue Emile-Laine, 59000 Lille, France
| | | | - Kevin Soudy
- Orthopédie A, CHRU de Lille, 2, avenue Emile-Laine, 59000 Lille, France
| | | | - Carlos Maynou
- Orthopédie A, CHRU de Lille, 2, avenue Emile-Laine, 59000 Lille, France
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Amouyel T, Benazech B, Saab M, Sturbois-Nachef N, Maynou C, Mertl P. An unexpected complication of nonoperative treatment for tibial posterior -malleolus fracture: bony entrapment of tibialis posterior tendon - a case report. Acta Orthop 2019; 90:624-625. [PMID: 31402729 PMCID: PMC6844445 DOI: 10.1080/17453674.2019.1652972] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Thomas Amouyel
- Université de Lille Nord de France, Service d’orthopédie 1, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, France; ,Correspondence:
| | - Baptiste Benazech
- Service orthopédie, Centre Hospitalo-Universitaire Amiens Picardie, 80480 Amiens, France
| | - Marc Saab
- Université de Lille Nord de France, Service d’orthopédie 1, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, France;
| | - Nadine Sturbois-Nachef
- Université de Lille Nord de France, Service d’orthopédie 1, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, France;
| | - Carlos Maynou
- Université de Lille Nord de France, Service d’orthopédie 1, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, France;
| | - Patrice Mertl
- Service orthopédie, Centre Hospitalo-Universitaire Amiens Picardie, 80480 Amiens, France
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Cornu A, Sturbois-Nachef N, Baudoux M, Amouyel T, Saab M, Chantelot C. Radiocarpal dislocation: A retrospective study of 14 patients. Orthop Traumatol Surg Res 2019; 105:1611-1616. [PMID: 31676274 DOI: 10.1016/j.otsr.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/03/2018] [Revised: 05/20/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Radiocarpal dislocation (RCD) is defined as total loss of contact between the carpal and radial joint surfaces. The condition is rare, with few published series. The aim of the present study was to assess functional results of RCD surgery, notably without ligament reconstruction. HYPOTHESIS Functional outcome of RCD surgery is satisfactory for everyday use of the wrist. MATERIALS AND METHODS A retrospective study was performed for the period January 2012 to July 2017. Inclusion criteria comprised: RCD on preoperative X-ray, in adult patients, with a minimum 6months' follow-up; exclusion criteria comprised: unclosed growth plate, and distal radial epiphyseal fracture with large displacement. RCD type was assessed on Dumontier's classification. Functional results were assessed as postoperative range of wrist motion, grip strength (Jamar®), and QuickDASH and Green-O'Brien (modified by Cooney) functional scores. RESULTS Fourteen patients were followed up at a mean 31months (range, 7-60months). Three showed type I RCD and 11 type II. All were treated surgically; no ligament sutures were performed. Mean flexion was 63° (range, 20-90°), extension 51° (25-90°), pronation 79° (60-90), supination 80° (50-90), and grip strength 27.9kg (8-40). Mean QuickDASH and modified Green-O'Brien scores were respectively 25.6 (4.54-40.9) and 74 (35-100). DISCUSSION The present functional results were satisfactory and comparable to those of the literature, despite no use of radiocarpal ligament suture in type-1 RCD. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexandre Cornu
- Service de traumatologie, CHRU Lille Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France.
| | - Nadine Sturbois-Nachef
- Service d'orthopédie B, CHRU Lille Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Matthieu Baudoux
- Service d'orthopédie pédiatrique, CHRU Lille Jeanne-de-Flandre, avenue Eugène-Avinée, 59037 Lille, France
| | - Thomas Amouyel
- Service d'orthopédie A, CHRU Lille Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Marc Saab
- Service d'orthopédie B, CHRU Lille Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Christophe Chantelot
- Service de traumatologie, CHRU Lille Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France
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Amouyel T, Le Moulec YP, Tarissi N, Saffarini M, Courage O. Arthroscopic Biceps Tenodesis Using Interference Screw Fixation in the Bicipital Groove. Arthrosc Tech 2017; 6:e1953-e1957. [PMID: 29430396 PMCID: PMC5798995 DOI: 10.1016/j.eats.2017.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/12/2017] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic repair of the long head of the biceps (LHB) is performed to treat various biceps pathologies yet the choice between tenotomy or tenodesis remains controversial. Although tenotomy is simpler and quicker, tenodesis results in fewer complications, and there are several techniques available using various fixation devices and sites. This Technical Note describes an all-arthroscopic, suprapectoral tenodesis technique using a bioresorbable interference screw, without motorized devices to create the humeral tunnel in the bicipital groove. The LHB tendon is detached from its glenoid insertion using an arthroscopic cutting instrument or electrocautery. Two portals are created 50 mm distal to the acromioclavicular joint and at 15 mm on either side of the bicipital groove. The arthroscope is introduced through the distal lateral portal till it makes contact with the humerus. The LHB is fastened within its groove using a grasper, reinforced, and then fixed in the humeral tunnel using an interference screw. The present technique is safe, simple, and reproducible. It requires 2 portals in addition to the standard posterior portal and the intra-articular working portal. It minimizes iatrogenic intra-articular damage and thereby limits possible complications. It also limits the intra-articular operative time compared with SLAP repairs.
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Affiliation(s)
- Thomas Amouyel
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France,Address correspondence to Thomas Amouyel, M.D., Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), 505 rue Irène Juliot-Curie, Le Havre 76620, France.Department of Orthopaedic SurgeryHopital Privé de l’Estuaire (HASS)505 rue Irène Juliot-CurieLe Havre76620France
| | - Yves-Pierre Le Moulec
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France
| | - Nicolas Tarissi
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France
| | | | - Olivier Courage
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France
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Amouyel T, Brunschweiler B, Freychet B, Lautridou C, Rosset P, Massin P. No improvement in the post-TKA infection prognosis when the implant is not reimplanted: Retrospective multicentre study of 72 cases. Orthop Traumatol Surg Res 2015; 101:S251-5. [PMID: 26296308 DOI: 10.1016/j.otsr.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/02/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION For the surgeon and patient, permanent removal of an infected knee prosthesis is an unwelcome decision taken out of necessity because unfavourable local or general conditions may increase the likelihood of mechanical or infectious failure upon prosthesis reimplantation. The purpose of this study was to determine if permanent removal of an infected total knee arthroplasty (TKA) implant controls the infection and prevents above-the-knee amputation when reimplantation turns out to be too risky. It was hypothesized that removal without reimplantation contributes to eradicating the infection and helps to avoid amputation. PATIENTS AND METHODS Seventy-two consecutive patients who underwent TKA removal between 2000 and 2010 at 14 hospitals were reviewed. The TKA removal was followed by knee fusion in 29 cases or implantation of a permanent cement spacer in 43 cases. RESULTS If failure is defined as clinically obvious recurrence of the infection, the survival rate was 65 ± 5% at 2 years; 44% of patients had a recurrence of the infection, 8% had undergone amputation and 19% presented with nonunion at the last follow-up. The male gender and the presence of multiple co-morbidities were predisposing factors for failure. DISCUSSION Control of the infection is not guaranteed upon TKA implant removal; the success rate is lower than in cases of two-stage reimplantation. The outcomes in this study are worse than those of other published studies. This is likely due to the heterogeneity in the patient population and treatments, along with the presence of co-morbidities. This treatment option should be the last recourse before amputation.
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Affiliation(s)
- T Amouyel
- Service de chirurgie orthopédique et traumatologique, CHU Amiens, 1, place Victor-Pauchet, 80054 Amiens, France
| | - B Brunschweiler
- Service de chirurgie orthopédique et traumatologique, CHU Amiens, 1, place Victor-Pauchet, 80054 Amiens, France
| | - B Freychet
- Service d'orthopédie 2, hôpital Trousseau, CHU, 37044 Tours cedex 1, France
| | - C Lautridou
- Service d'Orthopédie, Hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - P Rosset
- Service d'orthopédie 2, hôpital Trousseau, CHU, 37044 Tours cedex 1, France
| | - P Massin
- Service de Chirurgie Orthopédique, Hôpitaux Universitaires Paris Nord Val de Seine, Site Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; EA REMES, Université Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France.
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Valenti P, Boughebri O, Moraiti C, Dib C, Maqdes A, Amouyel T, Ciais G, Kany J. Transfer of the clavicular or sternocostal portion of the pectoralis major muscle for irreparable tears of the subscapularis. Technique and clinical results. International Orthopaedics (SICOT) 2014; 39:477-83. [DOI: 10.1007/s00264-014-2566-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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Amouyel T, Deroussen F, Plancq MC, Collet LM, Gouron R. Successful treatment of humeral giant aneurysmal bone cyst: value of the induced membrane reconstruction technique. J Shoulder Elbow Surg 2014; 23:e212-6. [PMID: 25127911 DOI: 10.1016/j.jse.2014.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/24/2014] [Revised: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas Amouyel
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - François Deroussen
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Marie-Christine Plancq
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Louis-Michel Collet
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Richard Gouron
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.
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Mencière ML, Amouyel T, Taviaux J, Bayle M, Laterza C, Mertl P. Fracture of the cobalt-chromium modular femoral neck component in total hip arthroplasty. Orthop Traumatol Surg Res 2014; 100:565-8. [PMID: 25104423 DOI: 10.1016/j.otsr.2014.03.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 10/04/2013] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 02/02/2023]
Abstract
Total hip prostheses using cervico-metaphyseal modularity were designed to better replicate the geometry of the native extra-medullary femur. However, they are associated with numerous complications including corrosion, disassembly, pseudotumours and, most notably, fractures of the modular neck. All reported cases of modular neck fractures occurred with titanium components (Ti-6Al-4V). To prevent this weakness, manufacturers developed modular necks made of cobalt-chromium (Co-Cr). We report a fracture of a long, 8° varus, Co-Cr modular neck connected to a 36-mm short (-3.5mm) femoral head. The fracture occurred 22 months post-implantation in a woman who had a low level of physical activity and a body mass index of 28.7 kg/m(2). To our knowledge, this case is the first reported instance of Co-Cr modular neck fracture. It may challenge the wisdom of further developing this modularity design, as our patient had none of the known risk factors for modular neck fracture. In addition, cases of pseudotumour have been reported with Co-Cr modular necks subjected to fretting corrosion, which contributed to the fracture in our patient.
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Affiliation(s)
- M-L Mencière
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France.
| | - T Amouyel
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
| | - J Taviaux
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
| | - M Bayle
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
| | - C Laterza
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
| | - P Mertl
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
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