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Erivan R, Matthieu PA, Boyer B, Reina N, Rhame M, Rouchy RC, Moreau S, Sanchez T, Roche O, Caton J, Rouvillain JL, Missenard G, Ramdane N, Mulliez A, Descamps S, Boisgard S. Use of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years' average follow-up. Orthop Traumatol Surg Res 2019; 105:957-966. [PMID: 31147251 DOI: 10.1016/j.otsr.2019.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/16/2018] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors. HYPOTHESIS Acetabular reconstruction can be performed equally well with frozen or processed morselized allografts. MATERIALS AND METHODS This retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years±1.89 [5-12.32]) than that of the processed grafts (8.22 years±1.77 [5.05-15.48]) (p=0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years±14.2 [17-80]) than in the processed group (57.5 years±13.0 [12-94]) (p<0.001) and were also younger at the time of THA revision (67.8 years±12.2 [36.9-89.3] versus 70 years±11.7 [25-94.5]) (p=0.041). RESULTS There were more complications overall in the frozen allograft group (46/242=19.0%) than the processed allograft group (35/256=13.2%) (p=0.044) with more instances of loosening in the frozen group (20/242 [8.2%]) than in the processed group (6/266 [3.3%])(p=0.001). Conversely, the dislocation rate (16/242=6.6% vs. 17/266=6.4%) (p=0.844) and infection rate (18/242=7.4% vs. 15/266=5.7%) (p=0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p=0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p=0.006) and a relative risk of 1.95 (95% CI: 1.26-2.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23-4.70) (p=0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52-6.51) (p=0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26-8.26) (p=0.022). DISCUSSION Our hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabular bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior. LEVEL OF EVIDENCE III, comparative retrospective study.
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Affiliation(s)
- Roger Erivan
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Pierre-Alain Matthieu
- Département d'orthopédie-traumatologie, CHU Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Bertrand Boyer
- Inserm, U1059, 42270 Saint-Étienne, France; Université Saint-Étienne, 42270 Saint-Étienne, France; Service d'orthopédie, hôpital La Charité, hôpital Nord, CHU Saint-Étienne, 44, rue Pointe Cadet, 42055 Saint-Étienne, France
| | - Nicolas Reina
- Hôpital Pierre-Paul-Riquet, Institut Locomoteur, CHU de Toulouse, Allée Jean Dausset, 31059 Toulouse, France
| | - Michel Rhame
- Department of orthopaedic surgery and traumatology, Hautepierre hospital, Strasbourg university hospitals group, 1, avenue Molière, 67098 Strasbourg, France
| | - René-Christopher Rouchy
- Service de chirurgie orthopédique et de traumatologie du sport, urgences, hôpital Sud, CHU de Grenoble, 19, avenue de Kimberley, 38130 Échirolles, France
| | - Sébastien Moreau
- Hôpital Raymond Poincaré, CHU Paris Garches, 104, boulevard Raymond Poincaré, 92380 Garches, France
| | - Thomas Sanchez
- Chirurgie orthopédique et traumatologie du membre inférieur, CHU Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34000 Montpellier, France
| | - Olivier Roche
- Centre Chirurgical Emile Gallé, CHRU Nancy, 49, rue Hermite, 54000 Nancy, France
| | - Jacques Caton
- Institut de chirurgie orthopédique Lyon, 103, rue Coste, 69300 Caluire-et-Cuire, France
| | - Jean-Louis Rouvillain
- Service de chirurgie orthopédique et traumatologique, CHU La Meynard CS90632, 97261 Fort-de-France, Martinique, France
| | - Gilles Missenard
- Orthopaedic department, tumor and spine unit, Bicêtre university hospital, AP-HP, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; JE 2494 université Paris-Sud Orsay, 01405 Orsay, France
| | - Nassima Ramdane
- Unité de méthodologie - biostatistique et Data Management, CHRU de Lille, 59037 Lille, France
| | - Aurélien Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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- 56, rue Boissonnade, 75014 Paris, France
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Cuenca C, Mention PJ, Vergnenegre G, Matthieu PA, Charissoux JL, Marcheix PS. Are orthopedic surgeons exposed to excessive eye irradiation? A prospective study of lens irradiation in orthopedics and traumatology. Orthop Traumatol Surg Res 2019; 105:569-572. [PMID: 30898557 DOI: 10.1016/j.otsr.2019.01.013] [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: 07/08/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Numerous studies in recent years highlighted an increased risk of pathologies related to ionizing radiation in caregivers. A new French decree was adopted on June 4, 2018, dividing by 7.5 the radiation dose authorized in the lens for exposed workers. HYPOTHESIS The hypothesis of the present study was that ocular irradiation in orthopedic surgeons was below the new legal threshold. METHOD The equivalent dose (mSv) received by the lens was prospectively assessed in 10 orthopedic surgeons (5 senior, 5 residents), using 3 passive dosimeters placed at the forehead and either temple. Each intervention of each operator was recorded, with dose per area in the operating room at each use of the fluoroscope. RESULTS All equivalent doses to the lens at the end of the 4 month study period were well below threshold. Doses were not significantly different between forehead and either temple (p=0.7, p=0.6 for the 2 temples). There was no difference according to side of the head (p=0.3). The dose received in the lens correlated with the dose delivered in the room (p=0.004). There were no significant differences in irradiation according to the surgeon's experience (p=0.2) or trauma activity rate (p=0.4). DISCUSSION No studies have reported equivalent doses to the lens exceeding the authorized limit. But none previously measured equivalent dose to the lens according to the axis of irradiation in the eyes. The present study showed that orthopedic surgeons received as much eye radiation laterally as frontally. Ocular radiation protection needs therefore to be as effective laterally as frontally. The surgeon's experience did not emerge as a protective factor against ocular irradiation.
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Affiliation(s)
- Céline Cuenca
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - Pierre-Jean Mention
- Service de médecine nucléaire, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Guillaume Vergnenegre
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Alain Matthieu
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Jean-Louis Charissoux
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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