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Dauny V, Thietart S, Cohen-Bittan J, Riou B, Khiami F, Meziere A, Verny M, Boddaert J, Zerah L, Villain C. Association between Vitamin D Deficiency and Prognosis after Hip Fracture Surgery in Older Patients in a Dedicated Orthogeriatric Care Pathway. J Nutr Health Aging 2022; 26:324-331. [PMID: 35450987 DOI: 10.1007/s12603-022-1762-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Vitamin D deficiency is common in patients undergoing hip fracture surgery (HFS) and has been found to be associated with poor post-operative outcome in other settings. This study aimed to analyze the association between vitamin D status and prognosis after HFS. DESIGN Observational, prospective, single-center study. SETTING AND PARTICIPANTS All patients admitted in a peri-operative geriatric unit between 2009 and 2020 for HFS were included. MEASUREMENTS A moderate vitamin D deficiency was defined by a vitamin D level between 25 and 75 nmol/l and a severe deficiency by a vitamin D level <25 nmol/l. Primary endpoint was mortality 6 months after surgery. Secondary endpoints were bacterial infections and delirium during hospitalization. Odds ratio (OR) and 95% confidence interval (95%CI) were computed using logistic regression models with adjustment for confounders. RESULTS 1197 patients were included (median age 87 years, IQR [82-91]). Median vitamin D level was 55 nmol/l (IQR [30-75 nmol/l]). Moderate and severe vitamin D deficiencies were reported in 53% and 21% of patients, respectively. There was no significant association between moderate or severe vitamin D deficiencies and 6-month mortality (OR 0.91, 95%CI [0.59-1.39], and OR 1.31, 95%CI [0.77-2.22], respectively), bacterial infection (OR 0.89, 95%CI [0.60-1.31] and OR 1.55, 95%CI [0.99-2.41], respectively), nor delirium (OR 1.03, 95%CI [0.75-1.40], and OR 1.05, 95%CI [0.70-1.57], respectively). CONCLUSION Vitamin D deficiency was not associated with mortality, bacterial infection or delirium after HFS. Our results suggest that comorbidities, functional status and post-operative complications are the main determinants of post-operative outcome after HFS.
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Affiliation(s)
- V Dauny
- Cédric Villain, MD, PhD, Department of Geriatrics, CHU Caen Normandie, Caen, France, Avenue de la Côte de Nacre, 14000 Caen, France, E-mail:
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Chassaing V, Courilleau N, Blin JL, Khiami F, Zeitoun JM, Decrette E, Vendeuvre T, Brèque C. The torsion of tibial tuberosity, a new factor of patellar instability. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714215] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- V. Chassaing
- ABS Lab Université de Poitiers
- Antony Private Hospital
| | | | | | | | | | | | - T. Vendeuvre
- ABS Lab Université de Poitiers
- Institut PPrime UPR 3346 Futuroscope
| | - C. Brèque
- ABS Lab Université de Poitiers
- Institut PPrime UPR 3346 Futuroscope
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Boddaert J, Na N, Le Manach Y, Raux M, Cohen-Bittan J, Vallet H, Meziere A, Khiami F, Riou B. Prediction of postoperative mortality in elderly patients with hip fracture: are specific and geriatric scores better than general scores? Br J Anaesth 2018; 118:952-954. [PMID: 28575342 DOI: 10.1093/bja/aex148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kajetanek C, Benoît O, Granger B, Menegaux F, Chereau N, Pascal-Mousselard H, Khiami F. Athletic pubalgia: Return to play after targeted surgery. Orthop Traumatol Surg Res 2018; 104:469-472. [PMID: 29549038 DOI: 10.1016/j.otsr.2018.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgery for athletic pubalgia usually consists in abdominal wall repair combined with routine bilateral adductor tenotomy. We currently confine the surgical procedure to the injured structure(s) (abdominal wall only, adductor tendon only, or both) to limit morbidity and expedite recovery. Outcomes of this à la carte approach are unclear. The objectives of this retrospective study were to determine the return to play (RTP) time, evaluate the potential influence of injury location, and assess the frequency of recurrence or contralateral involvement. HYPOTHESIS À la carte surgery for athletic pubalgia is associated with similar RTP times as the conventional procedure and is not followed by recurrence. MATERIAL AND METHODS Consecutive adults younger than 40 years of age who underwent surgery for athletic pubalgia with injury to the abdominal wall and/or adductor attachment sites between 2009 and 2015 were included. Patients with intra-articular hip disorders, isolated pubic symphysis involvement, or herniation were not eligible. The diagnosis was established clinically then confirmed by at least one imaging technique (ultrasonography plus either a radiograph of the pelvis or magnetic resonance imaging of the pelvis). The criterion for performing surgery was failure of appropriate conservative therapy followed for at least 3 months. RESULTS Of the 27 included patients, eight had abdominal wall involvement only, seven adductor tendon involvement only, and 12 both. Overall, 25 (92.6%) patients returned to play at their previous level, after a mean of 112±38 days (range, 53-223 days), and experienced no recurrence during the 1-year follow-up. Mean RTP time was significantly shorter in the group with abdominal wall injury only (91.1±21.0 days) compared to the groups with adductor tendon injury only (101.7±42.0 days) or combined injuries (132.5±39.0) (p=0.02). DISCUSSION In patients with athletic pubalgia, à la carte surgery confined to the injured structure(s) produces excellent RTP outcomes. RTP time is shortest in patients with isolated lower abdominal wall injuries. LEVEL OF EVIDENCE IV, retrospective study with no control group.
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Affiliation(s)
- C Kajetanek
- Service d'orthopédie et de traumatologie du sport, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - O Benoît
- Service chirurgie digestive, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - B Granger
- Service d'orthopédie et de traumatologie du sport, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - F Menegaux
- Service chirurgie digestive, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - N Chereau
- Service chirurgie digestive, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - H Pascal-Mousselard
- Service d'orthopédie et de traumatologie du sport, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - F Khiami
- Service d'orthopédie et de traumatologie du sport, Sorbonne University, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
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Haillotte G, Hardy A, Granger B, Noailles T, Khiami F. Early strength recovery after anterior cruciate ligament reconstruction using the fascia lata. Orthop Traumatol Surg Res 2017; 103:1021-1025. [PMID: 28899822 DOI: 10.1016/j.otsr.2017.07.013] [Citation(s) in RCA: 7] [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: 03/26/2017] [Revised: 07/13/2017] [Accepted: 07/21/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION After undergoing anterior cruciate ligament (ACL) reconstruction, patients must recover at least 80% of their hamstring and quadriceps strength to be able to return to sports without risk to the graft. Harvesting of the patellar tendon leads to large deficits in quadriceps strength, while harvesting the hamstring tendons leads to large deficits in hamstring strength. However, there are no published studies on the strength deficit after ACL reconstruction with the fascia lata. The objective of this study was to evaluate the results of isokinetic testing in patients who underwent ACL reconstruction with a fascia lata graft and to analyze the individual factors affecting these results. The hypothesis was that preserving the quadriceps and hamstrings would lead to satisfactory isokinetic testing results by preserving the physiological balance between the flexor and extensor mechanisms in the leg. MATERIALS AND METHODS In this retrospective, single-center study, 53 patients had their quadriceps and hamstring strength recovery evaluated 6 months and 1 year post-ACL reconstruction by concentric isometric testing at a slow (90°/s) and fast velocity (240°/s). These results were analyzed as a function of individual characteristics such as age, sex, preinjury level and type of sports activity, and IKDC and Lysholm scores. RESULTS The quadriceps strength deficit at the slow and fast velocities was 27.5% and 22.5% at 6 months and 15.5% and 11% at 1 year, respectively. The hamstring strength deficit at the slow and fast velocities was 12.1% and 7% at 6 months and 8% and 6.4% at 1 year, respectively. The quadriceps to hamstring ratio at the slow and fast velocities was 66.7±16.5 and 71.3±15.5 at 6 months, and 61.1±14.9 and 67.6±12.5 at 1 year. Being less than 25 years of age, having a subjective IKDC grade or Lysholm score above 90, and being a professional athlete were significant predictors of better muscle strength recovery. DISCUSSION Isokinetic testing at 6 months and 1 year after ACL reconstruction surgery using the fascia lata showed that the quadriceps to hamstring ratio is close to physiological standards. LEVEL OF EVIDENCE IV retrospective study.
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Affiliation(s)
- G Haillotte
- Service de chirurgie orthopédique, hôpital Pitié-Salpêtrière, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - A Hardy
- Service de chirurgie orthopédique, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - B Granger
- Service de biostatistique, hôpital Pitié-Salpêtrière, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - T Noailles
- Service de chirurgie orthopédique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - F Khiami
- Service de chirurgie orthopédique, hôpital Pitié-Salpêtrière, 91, boulevard de l'Hôpital, 75013 Paris, France
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Zerah L, Cohen-Bittan J, Raux M, Meziere A, Verny M, Khiami F, Boddaert J. COGNITIVE STATUS AND OUTCOME IN ELDERLY PATIENTS WITH HIP FRACTURE IN AN ORTHOGERIATRIC CARE PATHWAY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4463] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L. Zerah
- Department of Geriatrics, Unit of Peri-Operative Geriatric care, Pitie salpetrière hospital, Paris, France,
- Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France,
| | - J. Cohen-Bittan
- Department of Geriatrics, Unit of Peri-Operative Geriatric care, Pitie salpetrière hospital, Paris, France,
| | - M. Raux
- Departments of Anesthesiology and Critical Care, GH Pitié-Salpêtrière, Paris, France,
| | - A. Meziere
- Department of Rehabilitation, GH Charles Foix, Ivry sur Seine, France,
| | - M. Verny
- Department of Geriatrics, Unit of Peri-Operative Geriatric care, Pitie salpetrière hospital, Paris, France,
- Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France,
- Centre National de la Recherche Scientifique (CNRS), UMR 8256, Paris, France,
| | - F. Khiami
- Departments of Orthopedic Surgery and Trauma, GH Pitié-Salpêtrière, Paris, France
| | - J. Boddaert
- Department of Geriatrics, Unit of Peri-Operative Geriatric care, Pitie salpetrière hospital, Paris, France,
- Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France,
- Centre National de la Recherche Scientifique (CNRS), UMR 8256, Paris, France,
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Choufani C, Rousseau R, Massein A, Pascal-Moussellard H, Khiami F. Functional and ultrasonographic outcomes after surgical fibular tendon stabilisation by isolated re-tensioning of the superior fibular retinaculum. Orthop Traumatol Surg Res 2017; 103:393-397. [PMID: 28038992 DOI: 10.1016/j.otsr.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 11/13/2016] [Accepted: 12/05/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fibular tendon dislocation is a rare and usually sports-related injury. We report the functional and ultrasonographic outcomes of a simple technique for re-tensioning the superior fibular retinaculum. HYPOTHESIS Our retinaculum re-tensioning technique is not followed by recurrent fibular tendon dislocation, as demonstrated by ultrasonography. MATERIAL AND METHOD This single-centre single-surgeon retrospective study included 17 patients who underwent surgery to treat fibular tendon dislocation between January 2008 and December 2013. The functional outcome at last follow-up was assessed based on the AOFAS score. Subjective patient satisfaction and return to sports were recorded. Dynamic comparative ultrasonography was performed at last follow-up and the results used to separate the patients into four categories: normal, recurrent dislocation, subluxation, and residual tendinopathy. RESULTS The 17 patients had a mean age of 32.6±9.7 years (range, 18-52 years) and a mean pre-operative AOFAS score of 59.9±11.3 (range, 34-71). Mean follow-up was 36.9±16.9 months (range, 12-60 months). The mean AOFAS score at last follow-up was 89±9.0 (range, 68-100). Of the 17 patients, 7 (41%) returned to the same level of sports. The remaining 10 patients returned to a lower level or did not return to sports, usually (70%) for personal or work-related reasons. Follow-up ultrasonography was normal in 12 (71%) patients. Of the remaining 5 patients, 2 had clinically silent recurrent dislocation and 3 had residual tendinopathy, including 1 who was only moderately satisfied due to persistent pain. Of the 4 patients who reported pain due to the knots in the non-absorbable sutures used to tighten the retinaculum, 1 required removal of the sutures. No other complications were recorded. Finally, 16 (94%) patients were satisfied or very satisfied. DISCUSSION Retinaculum re-tensioning is effective in stabilising the fibular tendons, with no true recurrences. Ultrasonography can detect clinically silent subluxation. This simple and reproducible technique is associated with a very low complication rate and with excellent functional and anatomical outcomes. LEVEL OF EVIDENCE Retrospective, level IV.
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Affiliation(s)
- C Choufani
- Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - R Rousseau
- Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - A Massein
- Service de radiologie ostéoarticulaire, Hôpital de la Pitié Salpêtrière, Paris, France
| | - H Pascal-Moussellard
- Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - F Khiami
- Service de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, Paris, France
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Perrin C, Khiami F, Beguin L, Calmels P, Gresta G, Edouard P. Translation and validation of the French version of the Western Ontario Shoulder Instability Index (WOSI): WOSI-Fr. Orthop Traumatol Surg Res 2017; 103:141-149. [PMID: 28069409 DOI: 10.1016/j.otsr.2016.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Western Ontario Shoulder Instability Index (WOSI) is a specific self-administered questionnaire measuring the functional impact on patients with chronic glenohumeral instability. In its English version, it is valid, reliable, and sensitive to change. The objective of the present study was to provide a linguistic and cross-cultural adaptation of the original version of the WOSI to French and to assess the metrologic properties of this version in patients with chronic shoulder instability. MATERIAL AND METHODS The WOSI was translated and adapted both linguistically and culturally to French (WOSI-Fr) according to current guidelines. The metrologic properties of the WOSI-Fr were analyzed in the following groups - unoperated patients with chronic shoulder instability (UOG), operated patients with chronic shoulder instability (OG), patients with instability (TotG=UOG+OG), and control patients (ContG) - through analysis of the construct validity by comparing the WOSI-Fr with the Rowe, Walch-Duplay, QuickDASH, and VAS pain scores, and through analysis of reliability through the reproducibility of internal consistency. RESULTS The WOSI-Fr version was established and then accepted by an expert group (n=7). There was a statistically significant correlation between the WOSI and the different pain and function scores for TotG, OG, and UOG (except with the VAS pain score and the QuickDASH for UOG). Reproducibility (n=27) was good: the ICC value for the total score was 0.88 (95% CI, 0.47-0.98), varying from 0.80 to 0.94 according to the four domains of the WOSI-Fr, and from 0.70 to 0.94 for the different items separately. For TotG, Cronbach's alpha was 0.953, the SEM and the MDC were 120.2 (5.7%) and 333 (15.9%), respectively. CONCLUSION The French version of the WOSI (WOSI-Fr) is available, adapted linguistically and culturally, valid, and reliable. We recommend using it in following up patients with shoulder instability. LEVEL OF EVIDENCE Prospective, level 2.
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Affiliation(s)
- C Perrin
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM EA 7424), Université Jean-Monnet, Université de Lyon, F-42055 Saint-Etienne, France; Unité de Médecine du Sport, Service de Physiologie Clinique et de l'Exercice, Hôpital Nord, IRMIS Campus Santé Innovations, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France; Service de Médecine Physique et de Réadaptation, Hôpital de Bellevue, CHU de Saint-Etienne, boulevard Pasteur, 42055 Saint-Etienne cedex 2, France.
| | - F Khiami
- Service de Chirurgie Orthopédique et Traumatologie du sport, Hôpital de La Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, 75013 Paris, France
| | - L Beguin
- Centre Orthéo, 42100 Saint Etienne, France
| | - P Calmels
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM EA 7424), Université Jean-Monnet, Université de Lyon, F-42055 Saint-Etienne, France; Service de Médecine Physique et de Réadaptation, Hôpital de Bellevue, CHU de Saint-Etienne, boulevard Pasteur, 42055 Saint-Etienne cedex 2, France
| | - G Gresta
- Service de Chirurgie Orthopédie, Hôpital Nord, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France
| | - P Edouard
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM EA 7424), Université Jean-Monnet, Université de Lyon, F-42055 Saint-Etienne, France; Unité de Médecine du Sport, Service de Physiologie Clinique et de l'Exercice, Hôpital Nord, IRMIS Campus Santé Innovations, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France
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Bouget P, Breque C, Beranger JS, Faure JP, Khiami F, Vendeuvre T. Biomechanical cadaveric comparison of patellar ligament suture protected by a steel cable versus a synthetic cable. J Exp Orthop 2017; 4:9. [PMID: 28332149 PMCID: PMC5362567 DOI: 10.1186/s40634-017-0084-6] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background Purpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. The gold standard is the steel cable, but its rigidity and the necessity of a surgical re-intervention for its removal render it unsatisfactory. The objective of this paper is to quantify the mechanical protection provided by the terylene® in comparison with steel. Methods Twenty-four knees of 12 fresh frozen cadaveric subjects were divided into 2 homogeneous groups (terylene and steel) of 12 knees (mean age = 69.3 years). Proximal ligament repair was performed according to a three-tunnel transosseous reinsertion technique. Mechanical tests were performed in flexion to simulate movement of the knee. The interligament gap and the amplitude angulation of the knee were measured by a system of extensometer and optical goniometer. Mechanical analysis permitted calculation of flexion amplitude for a ligament gap of 1 and 2 mm taking as initial angle the adjusting angle of pretension of the protection frame. Study of deformations of frames was performed. Statistical analysis was performed with a Wilcoxon Mann Whitney test. Results There is no significant difference in protection of the ligament suture between the “terylene” and “steel” groups. Mean flexion amplitudes (mΔF) show no significant differences between the 2 groups for a distension of the suture of 1 mm (m ΔF terylene1 = 4.74 °; mΔF steel1 = 5.91°; p = 0.198) and 2 mm (mΔF terylene2 = 8.71°; mΔF steel2 = 10.41°; p = 0.114). Elastic deformation of terylene was significantly greater than that of steel (p = 0.0004). Conclusion Suture protection of the patellar ligament by a terylene wire is not significantly different from that provided by steel frame. The elastic properties of terylene and absence of a need for re intervention to secure its removal lead us towards its use in acute ruptures of the patellar ligament. The main limits involve the properties of the chain extenders with no contraction/muscle shortening and partial dehydration of tendons and ligaments and the mean age of 69.3 years. Level 5. Electronic supplementary material The online version of this article (doi:10.1186/s40634-017-0084-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Bouget
- Department of Orthopedics and Traumatology, University Hospital Center of Poitiers, Poitiers, France.
| | - C Breque
- ABS Lab, University School of Medicine of Poitiers, Poitiers, France
| | - J S Beranger
- Department of Orthopedics and Traumatology, André Mignot Hospital, Hospital Center of Versailles, Versailles, France
| | - J P Faure
- ABS Lab, University School of Medicine of Poitiers, Poitiers, France.,Department of Visceral Surgery, University Hospital Center of Poitiers, Poitiers, France
| | - F Khiami
- Department of Orthopedics and Traumatology, La Pitié Salpêtrière Hospital, Public Hospital of Paris, Paris, France
| | - T Vendeuvre
- Department of Orthopedics and Traumatology, University Hospital Center of Poitiers, Poitiers, France
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Mirouse G, Rousseau R, Casabianca L, Ettori MA, Granger B, Pascal-Moussellard H, Khiami F. Return to sports and functional results after revision anterior cruciate ligament reconstruction by fascia lata autograft. Orthop Traumatol Surg Res 2016; 102:863-866. [PMID: 27720633 DOI: 10.1016/j.otsr.2016.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/09/2016] [Revised: 06/11/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The surgical revision rate following anterior cruciate ligament (ACL) surgery is 3% at 2 years and 4% at 5 years. Revision ACL surgery raises the question of the type of graft to be used. The present study assessed return to sports and functional results after revision ACL reconstruction by fascia lata graft. The hypothesis was that fascia lata provides a reliable graft in revision ACL surgery. MATERIAL AND METHODS A single-center retrospective continuous study included 30 sports players with a mean age of 26.8±8 years undergoing surgical revision for iterative ACL tear between 2004 and 2013. Multi-ligament lesions were excluded. Type and level of sports activity were assessed preoperatively, after primary surgery and at end of follow-up. Clinical assessment used subjective IKDC, Lysholm and KOOS scores. RESULTS At a mean 4.6±1.6 years' follow-up, all patients had resumed sport activity, but only 12 with the same sport at the same level. Median subjective IKDC score increased from 57 [54.3; 58.5] preoperatively to 82 [68.3; 90] at last follow-up, and Lysholm score from 46 [42.3; 51] to 90.5 [80.8; 96.8]; KOOS score at last follow-up was 94.7 [83; 100]. CONCLUSION Functional results in revision ACL reconstruction by fascia lata graft were satisfactory, with similar return-to-sports rates as with other techniques. Fascia lata provides a reliable graft in revision ACL surgery. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- G Mirouse
- Département de Chirurgie Orthopédique et Traumatologie du Sport, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - R Rousseau
- Département de Chirurgie Orthopédique et Traumatologie du Sport, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - L Casabianca
- Département de Chirurgie Orthopédique et Traumatologie du Sport, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - M A Ettori
- Département de Chirurgie Orthopédique et Traumatologie du Sport, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - B Granger
- Département de Biostatistiques, de Santé Publique et d'Information Médicale, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - H Pascal-Moussellard
- Département de Chirurgie Orthopédique et Traumatologie du Sport, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - F Khiami
- Département de Chirurgie Orthopédique et Traumatologie du Sport, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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Ankri M, Khiami F, Rochcongar G, Joubert T, Pillet H, Thoreux P, Rouch P. Isometric point of lateral femoral condyle analysis with in vitro kinematic study in order to position the extra-articular part of an ACL reconstruction. Comput Methods Biomech Biomed Engin 2015; 18:1872-1873. [DOI: 10.1080/10255842.2015.1069548] [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] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- M. Ankri
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers ParisTech, Paris, France
| | - F. Khiami
- Pitié-Salpetrière Hospital-Université Paris 6, Paris, France
| | - G. Rochcongar
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers ParisTech, Paris, France
- Caen Hospital, Caen, France
| | - T. Joubert
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers ParisTech, Paris, France
| | - H. Pillet
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers ParisTech, Paris, France
| | - P. Thoreux
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers ParisTech, Paris, France
- Avicenne Hospital-Université Paris 13-Sorbonne Paris Cité, Bobigny, France
| | - P. Rouch
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers ParisTech, Paris, France
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Hirsch C, Breque C, Ragot S, Pascal-Mousselard H, Richer JP, Scepi M, Khiami F. Biomechanical study of dynamic changes in L4-L5 foramen surface area in flexion and extension after implantation of four interspinous process devices. Orthop Traumatol Surg Res 2015; 101:215-9. [PMID: 25736197 DOI: 10.1016/j.otsr.2014.11.016] [Citation(s) in RCA: 9] [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: 10/30/2012] [Revised: 03/31/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lumbar spinal stenosis is a major public health issue. Interspinous devices implanted using minimally invasive techniques may constitute an alternative to the reference standard of bony decompression with or without intervertebral fusion. However, their indications remain unclear, due to a paucity of clinical and biomechanical data. Our objective was to evaluate the effects of four interspinous process devices implanted at L4-L5 on the intervertebral foramen surface areas at the treated and adjacent levels, in flexion and in extension. MATERIALS AND METHOD Six fresh frozen human cadaver lumbar spines (L2-sacrum) were tested on a dedicated spinal loading frame, in flexion and extension, from 0 to 10 N·m, after preparation and marking of the L3-L4, L4-L5, and L5-S1 foramina. Stereoscopic 3D images were acquired at baseline then after implantation at L4-L5 of each of the four devices (Inspace(®), Synthes; X-Stop(®), Medtronic; Wallis(®), Zimmer; and Diam(®), Medtronic). The surface areas of the three foramina of interest were computed. RESULTS All four devices significantly opened the L4-L5 foramen in extension. The effects in flexion separated the devices into two categories. With the two devices characterized by fixation in the spinous processes (Wallis(®) and Diam(®)), the L4-L5 foramen opened only in extension; whereas with the other two devices (X-Stop(®) and Inspace(®)), the L4-L5 foramen opened not only in extension, but also in flexion and in the neutral position. None of the devices implanted at L4-L5 modified the size of the L3-L4 foramen. X-Stop(®) and Diam(®) closed the L5-S1 foramen in extension, whereas the other two devices had no effect at this level. CONCLUSION Our results demonstrate that interspinous process devices modify the surface area of the interspinous foramina in vitro. Clinical studies are needed to clarify patient selection criteria for interspinous process device implantation. LEVEL OF EVIDENCE Level IV. Investigating an orthopaedic device.
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Affiliation(s)
- C Hirsch
- Department of Orthopaedic Surgery, hôpital de la Pitié-Salpêtrière, AP-HP, UPMC University, 75013 Paris, France.
| | - C Breque
- Laboratoire d'anatomie, Université de Poitiers, 15 rue de l'Hôtel Dieu, TSA 71117, 86073 Poitiers Cedex 9, France
| | - S Ragot
- Clinical Investigation Centre, Poitiers University, Poitiers, France
| | - H Pascal-Mousselard
- Department of Orthopaedic Surgery, hôpital de la Pitié-Salpêtrière, AP-HP, UPMC University, 75013 Paris, France
| | - J-P Richer
- Anatomy Department, Poitiers University, Poitiers, France
| | - M Scepi
- Anatomy Department, Poitiers University, Poitiers, France
| | - F Khiami
- Department of Orthopaedic Surgery, hôpital de la Pitié-Salpêtrière, AP-HP, UPMC University, 75013 Paris, France
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Boddaert J, Raux M, Khiami F, Riou B. Épidémiologie et facteurs de risque des fractures de l’extrémité supérieure du fémur. Ann Fr Med Urgence 2015. [DOI: 10.1007/s13341-015-0525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khiami F, Di Schino M, Sariali E, Cao D, Rolland E, Catonné Y. Treatment of chronic Achilles tendon rupture by shortening suture and free sural triceps aponeurosis graft. Orthop Traumatol Surg Res 2013; 99:585-91. [PMID: 23845278 DOI: 10.1016/j.otsr.2013.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 01/14/2013] [Accepted: 03/07/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Bosworth technique is old but still widely used. It involves problems of precisely determining the length of the Achilles tendon and of a volume effect in the turndown area. HYPOTHESIS A new reconstruction technique is assessed, based on free sural triceps aponeurosis transfer without turndown, associated to tendon shortening suture. MATERIALS AND METHODS Twenty-three patients were assessed by AOFAS score and clinical examination (plus MRI in 14 cases) at a mean 24.5 months' follow-up. Mean age was 52.1 years. Mean pre-operative AOFAS score was 63.6/100. RESULTS Mean postoperative AOFAS score was 96.1. Mean graft length was 7.5 cm. Surgical revision was required for one case of postoperative infection. Twelve patients resumed leisure sports at their previous level by a mean 9.4 ± 2 months; three competitive sportsmen resumed sport at their previous level by a mean 7.6 months. None were dissatisfied or disappointed with their operation. MRI performed at 1 year found increased tendon volume without abnormality in 57% of cases; 43% showed abnormal images. DISCUSSION Functional results were comparable to literature reports. It can be difficult to determine Achilles length for the Bosworth technique: this is made easier by conserving a fibrous support of a length determined with reference to the healthy side. The technique avoids aponeurosis turndown, and thus avoids the problem of plasty volume effect. The two cases of cutaneous complication occurred in the two most elderly patients, raising the question of the indications for reconstructive surgery in the elderly. The abnormalities found on MRI concerned scar tissue remodeling in patients with good or excellent clinical results. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- F Khiami
- Service de chirurgie orthopédique et traumatologie, Hôpital de Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Khiami F, Wajsfisz A, Meyer A, Rolland E, Catonné Y, Sariali E. Anterior cruciate ligament reconstruction with fascia lata using a minimally invasive arthroscopic harvesting technique. Orthop Traumatol Surg Res 2013; 99:99-105. [PMID: 23270723 DOI: 10.1016/j.otsr.2012.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 09/04/2012] [Accepted: 09/07/2012] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction using the fascia lata has undergone a number of technical modifications since the work of Hey-Groves, MacIntosh, and Jaeger. Arthroscopy has simplified this technique, notably in the positioning of the tunnels. Minimally invasive harvesting through two lateral proximal and distal approaches considerably reduces cosmetic problems. The femoral tunnel is made from the outside to the inside using a specific targeting device, and the transplant harvest site is closed using the Jaeger procedure so as not to weaken lateral knee stabilizing structures. This procedure consists in opening the lateral intermuscular septum 1cm from the femur to let it shift laterally and allow the transplant harvesting area to be closed. This technique uses a fascia lata transplant, the harvesting of which has shown few iatrogenous complications but requires rigorous adherence to certain rules.
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Affiliation(s)
- F Khiami
- Department of Orthopaedics and trauma Surgery, La Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Khiami F, Sariali H, Rosenheim M, Hardy P. The WOSI correlates with the Walch-Duplay score in the assessment of arthroscopic treatment of anterior shoulder instability. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sariali E, Mauprivez R, Khiami F, Pascal-Mousselard H, Catonné Y. Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating. Orthop Traumatol Surg Res 2012; 98:151-8. [PMID: 22381566 DOI: 10.1016/j.otsr.2011.09.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/05/2011] [Accepted: 09/30/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A high accuracy was recently reported for the three-dimensional (3D) computerised planning of total hip arthroplasty (THA), comparing well with navigation regarding leg length and femoral offset. However, there is no randomised study comparing 3D preoperative planning with conventional 2D templating in terms of accuracy and clinical relevance. HYPOTHESIS The 3D preoperative planning has a higher accuracy than the conventional 2D preoperative templating regarding the implants size and their positioning. PATIENTS AND METHODS A prospective comparative randomised study was carried out from 2008 to 2009, including two groups of 30 patients who underwent THA for primary osteoarthritis. One surgeon performed all the surgical procedures using a minimally invasive direct anterior approach. In one group, the planning was made on calibrated X-rays using 2D templates. In the other group, a CT-scan based 3D computerised planning was performed with dedicated software. The reconstructed hip final anatomy was compared postoperatively to the preoperative planning and the accuracy was expressed as the mean difference (±SD) between the planned positioning and the final positioning of the implants. RESULTS The prediction rate for the stem and the cup sizes were respectively of 100% and 96% in the 3D group versus 43% for both components in the 2D group. When combining both components, the prediction rate was 96% in the 3D group versus 16% in the 2D group. In the 3D group, a high accuracy was achieved for the planning of the leg length (-1.8±3.6 mm ranging from -8 to+4mm) and the femoral offset (-0.07±2.7 mm ranging from -5 to+4mm) versus 1.37±6.4mm ranging from -9 to 13 mm and 0.33±5.7 mm (-16 to 11 mm) in the 2D templating group (P<0.0001). DISCUSSION The 3D planning gives a higher accuracy than conventional 2D templating in forecasting the size of cup and the stem. This contributes to the prediction for leg length and offset that is more reliable with the 3D technique. This study suggests that 3D planning CT-scan data is an attractive alternative to navigation to restore these parameters. The high accuracy achieved by a low-experience surgeon suggests that 3D planning may help shorten the learning curve when using the minimally invasive direct anterior approach. LEVEL OF EVIDENCE Level III low-powered prospective randomized trial.
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Affiliation(s)
- E Sariali
- Department of Orthopaedic Surgery and Traumatology, la Pitié-Salpétrière Hospital, 47-83 boulevard de l'Hôpital, 154, rue de Picpus, 75012 Paris, France.
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Khiami F, Sariali E, Rosenheim M, Hardy P. Anterior shoulder instability arthroscopic treatment outcomes measures: the WOSI correlates with the Walch-Duplay score. Orthop Traumatol Surg Res 2012; 98:48-53. [PMID: 22204794 DOI: 10.1016/j.otsr.2011.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 08/23/2011] [Accepted: 09/13/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE New techniques and instrumentation for arthroscopic management of shoulder instability require accurate measurement tools to investigate possible clinical improvements. The aim of the study was to assess the self-administrated Western Ontario Shoulder Instability Index (WOSI), which is a subjective quality of life measurement tool specific to shoulder instability, and also to validate this score by comparison with the Walch-Duplay score, which is the gold standard score used in Europe. These two scores had never been compared. METHODS Forty-eight patients, who underwent arthroscopic surgery for anterior shoulder instability, were evaluated using the WOSI and the Walch-Duplay score at 42.7 months' follow-up. The correlation between these two scores was investigated. RESULTS The WOSI significantly correlated with the Walch-Duplay score (global score, and specific items of pain, stability, return to activity). The standard correlation coefficient was 0.8 and the Lin correlation coefficient was 0.65. The WOSI did not correlate with the mobility item of the Walch-Duplay score. DISCUSSION The WOSI was found to correlate with the Walch-Duplay score. However, the WOSI was more sensitive than the Walch-Duplay score for the assessment of patient satisfaction. It is likely that both self-administrated questionnaires and physical examinations are complementary for an accurate investigation of the functional objective and subjective outcome after shoulder stabilization surgery. TYPE OF STUDY Retrospective. Level IV.
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Affiliation(s)
- F Khiami
- Department of Orthopaedic Surgery, La Pitié-Salpétrière Hospital, Paris, France.
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Khiami F, Bendahou M, Scepi M, Riou B. Luxation rétrosternale de la clavicule. Ann Fr Med Urgence 2011. [DOI: 10.1007/s13341-011-0050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lustig S, Khiami F, Boyer P, Catonne Y, Deschamps G, Massin P. Post-traumatic knee osteoarthritis treated by osteotomy only. Orthop Traumatol Surg Res 2010; 96:856-60. [PMID: 21115418 DOI: 10.1016/j.otsr.2010.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/23/2010] [Accepted: 06/03/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteotomies to address lower extremity post-traumatic deformities are more complex than standard osteotomies performed for congenital deformities, standard osteotomies and their outcomes are not well known. We performed a multicentric retrospective study of these cases. We hypothesized that osteotomy without total knee replacement to correct fracture malunion deformities can provide long-term relief from athritic pain. PATIENTS AND METHODS Twenty-eight patients, mean age 46.4 years old, underwent, between 2000 and 2008, osteotomy for post traumatic osteoarthritis which had resulted in intraarticular malunion in six patients and extraarticular malunion in 22 cases. The initial trauma had occurred a mean 17.3 years before. There were 11 valgus and 17 varus deformities. Two osteotomies were performed in the callus to correct intraarticular malunion. The other osteotomies were performed outside the callus: in 25 cases to correct coronal plane deformities (nine tibial, 11 femoral and five tibial and femoral), including nine cases with associated derotation. Osteotomies were performed on the distal femoral metaphysis and the proximal tibia. There was also one case of supramalleolar derotation osteotomy of the tibia. All 28 patients were contacted again for a consultation. There was a postoperative clinical and radiographic follow-up of at least 2years for all patients despite four lost to follow-up patients. There were 18 patients with Ahlback grade 2 arthritis, nine grade 3 and one grade 4. RESULTS Two patients with an intraarticular malunion finally underwent revision surgery to receive total knee replacement because of persistent pain. These patients had grade 3 and 4 arthritis respectively and undercorrection persisted in the coronal plane. Four patients underwent repeated surgery for stiffness, early infection treated with debridement and antibiotics as well as femoral pseudarthrosis (two cases). After a mean follow-up of 3.8 years, the pain score had improved significantly with more marked improvement in extraarticular malunions (P=0.03). Functional improvement was moderate (equivalent in patients with Ahlback grades 2 and 3 arthritis) and articular range of motion did not change. Osteotomy corrected valgus and varus deformities with a mean realignment effect of 9° and 10° respectively. DISCUSSION Osteotomy should correct the three components of the traumatic deformity at the distal femoral metaphysic level to allow mechanical axis and rotation anomalies correction, and at the proximal tibia level for realignment purposes. Supramalleolar tibial osteotomy should be performed for tibial derotation. Pain relief with osteotomy had better outcomes when dealing with extraarticular malunions. In unicompartmental grade 2 and 3 arthritis, the indications can be fairly broad in young patients. Besides providing temporary relief, osteotomy facilitates future total knee replacement surgery in these cases. LEVEL OF EVIDENCE Level 4; non controlled, retrospective study.
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Affiliation(s)
- S Lustig
- Albert-Trillat Surgical Center, North Lyon Teaching Hospital Center, Lyon 1 Claude-Bernard University, 8, rue des Margnolles, 69300 Caluire-et-Cuire, France
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Deschamps G, Khiami F, Catonné Y, Chol C, Bussière C, Massin P. Total knee arthroplasty for osteoarthritis secondary to extra-articular malunions. Orthop Traumatol Surg Res 2010; 96:849-55. [PMID: 21035414 DOI: 10.1016/j.otsr.2010.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/23/2010] [Accepted: 06/08/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Post-traumatic total knee arthroplasty for extra-articular malunion requires correction of the deformity, either through asymmetrical bone resection (possibly inducing ligaments imbalance) or osteotomy at the time of arthroplasty. We report the results of a continuous multicenter, retrospective series of 78 patients (18 implants with osteotomy) with a mean 4 years of follow-up. The hypothesis is that the selected procedure requires to be based on the deformity's location and severity. PATIENTS With a mean age of 63 years (younger in the osteotomy group), 38 patients had femoral malunion, 36 had tibial malunion, and four had a combined malunion. There were 70 frontal deformities (48 varus and 22 valgus) and 10 rotational deformities, often diaphyseal, four of which more than 20°. Twelve patients had a history of infection; eight had frontal laxity greater than 10°, and 15 a limited range of motion in flexion. In 70 cases, semi- or nonconstrained implants were used, and in eight cases more constrained implants, including four hinge prostheses. RESULTS We observed two deep infections, one case of avulsion of the extensor mechanism, and two cases of aseptic loosening with femoral malunion and varus deformity. Two osteotomies resulted in nonunion, one with internal fixation devices mobilization requiring revision using extension rods. The function and pain scores were significantly improved. The mobility improvements were moderate but did not compromise the surgical procedure main objective. The preoperative hip-knee angle was corrected with both techniques. Only the function score gain was greater for the isolated arthroplasty procedures. DISCUSSION AND CONCLUSION The indications for arthroplasty alone were extended to 20° varus and 15° valgus, with no major residual laxity. Beyond 10°, hinge prosthesis should be available. Associated osteotomy can correct rotational deformities that cannot be compensated with bone cuts. In deformities that are close to the joint, osteotomy facilitates implantation of moderately constrained prosthesis. This indication is based on CAT scan rotational deformities measurements because rotational deformities require an osteotomy, and/or the presence of extraligamentous deformity that cannot be reduced with collateral ligaments surgical release. LEVEL OF EVIDENCE Level 4. Non-controlled retrospective study.
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Affiliation(s)
- G Deschamps
- Medico-Surgical Hospital Center, 2, rue du Pressoir, 71640 Dracy-le-Fort, France
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Nodarian T, Sariali E, Khiami F, Pascal-Mousselard H, Catonné Y. Iliac crest bone graft harvesting complications: A case of liver herniation. Orthop Traumatol Surg Res 2010; 96:593-6. [PMID: 20638921 DOI: 10.1016/j.otsr.2010.03.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 03/07/2010] [Accepted: 03/16/2010] [Indexed: 02/02/2023]
Abstract
The iliac crest is an easily accessible donor site offering a relatively large and safe supply of bone. There are however possible complications; residual pain frequently, and more rarely herniation. This latter's true incidence is unknown in a literature review, which found 15 articles. We report a case of liver herniation in a 64-year-old overweight lady after harvesting bone from her iliac crest. The clinical diagnosis was confirmed by CT scan. Despite an appropriate surgical repair, the hernia recurred. This serious complication of bone harvesting from the iliac crest, and possible other undesirable events described, prompted reconsideration of our harvesting techniques, and the use in our unit of bone substitutes or cell therapy to fill bone defects.
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Affiliation(s)
- T Nodarian
- Department of Orthopaedic Surgery and Traumatology, Pitié-Salpétrière Teaching Hospital Center, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Mabit C, Tourné Y, Besse JL, Bonnel F, Toullec E, Giraud F, Proust J, Khiami F, Chaussard C, Genty C. Chronic lateral ankle instability surgical repairs: the long term prospective. Orthop Traumatol Surg Res 2010; 96:417-23. [PMID: 20493799 DOI: 10.1016/j.otsr.2010.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 03/15/2010] [Indexed: 02/02/2023]
Abstract
UNLABELLED The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction. MATERIAL AND METHODS A multicenter retrospective review was performed on 310 lateral ankle ligament reconstructions, with a mean 13-year-follow-up (minimum FU: 5 years). Male subjects (53%) and sports trauma (78%) predominated. Mean duration of instability was 92 months; mean age at surgery was 28 years. Twenty-eight percent of cases showed subtalar joint involvement. Four classes of surgical technique were distinguished: C1, direct capsular ligamentous complex reattachment; C2, augmented repair; C3, ligamentoplasty using part of the peroneus brevis tendon and C4, ligamentoplasty using the whole peroneus brevis tendon. Clinical and functional assessment used Karlsson and Good-Jones-Livingstone scores; radiologic assessment combined centered AP and lateral views, hindfoot weight-bearing Méary views and dynamic views (manual technique, Telos or self-imposed varus). RESULTS The majority of results (92%) were satisfactory. The mean Karlsson score of 90 [19-100] (i.e., 87% good and very good results) correlated with the subjective assessment, and did not evolve over time. Postoperative complications (20%), particularly when neurologic, were associated with poorer results. Control X-ray confirmed the very minor progression in degenerative changes, with improved stability; there was, however, no correlation between functional result and residual laxity on X-ray. Unstable and painful ankles showed poorer clinical results and more secondary osteoarthritis. Analysis by class of technique found poorer results in C4-type plasties and poorer control of laxity on X-ray in C1-type tension restoration. DISCUSSION The present results confirm the interest of lateral ankle ligamentoplasty in the management of instability and protection against secondary osteoarthritis, and of precise lesion assessment (CT-scan/MRI) to adapt surgery to the ligamentary and associated lesions. LEVEL OF EVIDENCE Level IV. Retrospective therapeutic study.
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Affiliation(s)
- C Mabit
- Orthopedic and Traumatologic Surgery Department, Dupuytren Teaching Hospital, Limoges, France.
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Khiami F, Rampal V, Seringe R, Wicart P. Congenital pseudarthrosis of the tibia: an atypical proximal location. Orthop Traumatol Surg Res 2010; 96:70-4. [PMID: 20170861 DOI: 10.1016/j.rcot.2009.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 11/12/2009] [Indexed: 02/02/2023]
Abstract
UNLABELLED Proximal location of congenital pseudarthrosis of the tibia (CPT) is uncommon, and its management challenging, risking to end in amputation. We here report a case of proximal CPT managed in a limb-sparing perspective and followed up until the end of growth. A 17-year-old girl presented with type-1 neurofibromatosis and proximal CPT. Initial X-ray showed severe pseudarthrosis of the tibia with bone atrophy, 12-cm shortening and femorotibial and femoropatellar dislocation. Inter-tibiofibular graft and fibular tibialization were performed. At end of follow-up (age 33 years), fusion had been obtained. For orthoprosthetic and cosmetic reasons, a Boyd amputation of the tarsus was performed when the patient was 22 years of age. The functional result was very good, with 0-100 degrees knee mobility. CPT, when proximal, completely disorganizes the knee joint, which is otherwise usually unaffected by this pathology. To achieve a good result, a limb-sparing treatment should combine correction of the tibial axis and of the dislocation of the knee, fibula osteosynthesis and bone graft. LEVEL OF EVIDENCE Level IV retrospective
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Affiliation(s)
- F Khiami
- Service d'orthopédie traumatologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Bohu Y, Khiami F, Rolland E, Saillant G, Catonné Y. [Early failure of anterior bone block in multidirectional shoulder instability: a case report]. Rev Chir Orthop Reparatrice Appar Mot 2008; 94:407-412. [PMID: 18555869 DOI: 10.1016/j.rco.2008.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2008] [Indexed: 05/26/2023]
Abstract
We report the case of a 47-year-old female patient who developed predominantly anterior multidirectional glenohumeral instability. After rehabilitation, this patient was treated surgically with an anterior coracoid bone block using the Latarjet technique. The second postoperative day, the control scan revealed posterior glenohumeral dislocation. The patient underwent a second operation for a posterior iliac block. At last clinical follow-up (six years), the patient had normal shoulder motion; shoulder function was considered excellent using the clinical scores. We recall the pathogenic hypotheses explaining multidirectional shoulder instability and discuss the proposed treatments. This case illustrates the difficult diagnosis and therapeutic management of multidirectional instability. Under general anesthesia, examination showed that posterior laxity predominated while paradoxically, the patient presented predominantly anteromedial dislocations. This case is also exceptional by the development of posterior dislocation, an unusual postoperative complication after an anterior bone block; we describe the therapeutic options. In the event of multidirectional instability with bone injuries, we recommend a block in the direction of the instability. Preoperative examination under general anesthesia can be helpful in understanding the mechanism of residual postoperative instability, which would require complementary surgical stabilization.
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Affiliation(s)
- Y Bohu
- Service de Chirurgie Orthopédique et Traumatologique du Sport, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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