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Resume Introduction Les implants type UniSpacer™ ont fait partie de l’arsenal therapeutique de l’arthrose femoro-tibiale mediale avant l’arret de leur commercialisation. Cet implant d’interposition mobile, auto-stable, en forme de menisque, ne necessite ni resection osseuse, ni fixation. Cette note correspond au suivi a 10 ans de recul d’une serie de patients etudies dans une precedente etude publiee en 2011. Elle permet de reevaluer la survie de l’implant, 5 ans apres une premiere analyse, ainsi que la satisfaction des patients et leur resultat fonctionnel. Hypothese La survie de l’UniSpacer™ reste stable a 5 ans avec des resultats fonctionnels satisfaisants. Materiel et methodes Cette etude a inclus les memes patients operes de 2003 a 2009, soit 17 implants UniSpacer™ chez 16 patients. Ils ont tous beneficie de la meme technique operatoire. Les patients ont ete evalues cliniquement (score IKS, revision, implant oublie) et radiologiquement au dernier recul lors d’une consultation dediee. Resultats Le suivi moyen de cette etude retrospective sur base de donnees prospective est de 118 ± 25 mois. Sur 17 implants, la survie au dernier recul est de 53 %, soit 9 implants (8 patients). Six patients (37,5 %) ont eu une arthroplastie de revision precoce (entre 6 mois et 4 ans). Un patient a ete perdu de vue et un autre est decede. Le score global moyen IKS genou est de 76 ± 15, l’IKS fonction est de 80 ± 25. Le score global IKS au dernier recul etait de 157 ± 39. La flexion moyenne est de 119 ± 20°. Sur les 8 patients (9 implants) porteurs de leur implant au dernier recul, 5 patients rapportaient des implants oublies (56 %). Entre 4 ans et 10 ans de recul, aucune revision n’a ete realisee. Discussion La survie a 10 ans est limitee : 53 %, les patients encore porteurs de leur implant ont des resultats cliniques qui demeurent satisfaisants. Son faible cout et sa simplicite de mise en œuvre pourraient constituer une alternative pour une population contre indiquee pour une approche chirurgicale plus lourde. Niveau de preuve IV.

Resume Introduction Les protheses totales de genou (PTG) charnieres constituent une option frequente en cas de reprise chirurgicale ou de chirurgie primaire mais leurs complications sont moins bien connues depuis l’essor des protheses a glissement. La litterature reste heterogene sur le sujet, avec des etudes aux effectifs souvent limites, au recul variable et avec des indications tres differentes. Aussi nous avons mene une large etude multicentrique au recul minimal de 5 ans afin d’evaluer les complications apres PTG charniere hors tumeur en fonction de l’indication sur genou natif, en cas de reprise chirurgicale aseptique ou dans un contexte traumatique. Hypothese L’hypothese etait que les PTG charnieres avaient un taux de complications eleve quel que soit l’indication. Materiel et methode Deux-cent quatre-vingt-dix patients (290 genoux) ont ete inclus de facon retrospective, de janvier 2006 a decembre 2011 dans 17 centres, avec un recul minimal de 5 ans. Les patients ont ete separes en trois groupes : chirurgie primaire (111 patients), chirurgie de reprise aseptique (127 patients) et chirurgie dans un contexte traumatologie recent ( Resultats Le recul moyen de l’etude est de 71 ± 39 mois [0 a 188]. Sur les 290 patients de l’etude, 108 patients (37,2 %) ont presente au moins une complication et 55 patients (19 %) ont necessite une reprise chirurgicale dont 16 dans la serie PTG primaire (16/111, 14,4 % des PTG primaires), 28 dans le cas de chirurgie de reprise (28/127, 22 % des PTG de reprise) et 11 dans le cadre de la traumatologie (11/52, 21 % des PTG traumatiques). Les complications sur PTG charnieres etaient par ordre de frequence pour la totalite des patients : raideur (41/290, 14,1 %), douleur chronique postoperatoire (37/290, 12,8 %), infection (32/290, 11,0 %), descellement aseptique (23/290, 7,9 %), complications generales (20/290, 6,9 %), complications de l’appareil extenseur (19/290, 6,6 %), fracture peri-prothetique (9/290, 3,1 %), faillite mecanique (2/290, 0,7 %). Pour le groupe PTG primaire, la complication principale ayant donne lieu a re intervention etait l’infection (12/111, 10,8 %), alors que c’etait le descellement pour le groupe PTG revision (15/127, 11,8 %) et l’infection (8/52, 15,4 %) pour les PTG traumatiques. Discussion Le taux de complications des implants a charnieres est eleve avec 37,2 % et 19 % ayant donne lieu a une re-intervention. La frequence des complications etait differente selon la situation : primaire, reprise ou traumatique. Les complications impliquant une revision chirurgicale etaient les complications mecaniques empechant le maintien de l’autonomie (infection, descellement douloureux, fracture, faillite de l’implant). La raideur et les douleurs chroniques, complications les plus frequemment retrouvees qui n’etaient que rarement reprises. Niveau de preuve IV ; etude de cohorte retrospective.

Resume La luxation traumatique isolee de tete radiale est une lesion exceptionnelle chez l’adulte, majoritairement diagnostiquee en urgence et reduite par manœuvres externes. Si elle passe inapercue initialement, cette reduction devient impossible. Pour le traitement de ces formes chroniques, la litterature rapporte differentes alternatives comme l’abstention therapeutique, la resection de tete radiale ou la plastie annulaire eventuellement associee a une osteotomie de l’ulna. En cas de symptomatologie invalidante, il est licite de proposer une chirurgie. La technique decrite ici est celle de PM Grammont associant une plastie ligamentaire et une osteotomie oblique plane de l’ulna. Nous l’avons appliquee chez un patient de 31 ans presentant une luxation anterieure isolee de tete radiale datant de 3 mois. A un an de suivi, la recuperation des amplitudes articulaires etait complete avec une reprise professionnelle a 5 mois. Cette technique nous semble indiquee dans ce type de lesion avec des resultats radio-cliniques prometteurs. Niveau de preuve IV.

Hinged total knee arthroplasty (TKA) implants are a commonly used option during revision or even primary surgery, but their complications are not as well known, due to the rapid adoption of gliding implants. The literature is inconsistent on this topic, with studies having a small sample size, varied follow-up duration and very different indications. This led us to carry out a large multicentre study with a minimum follow-up of 5 years to evaluate the complications after hinged TKA in a non-tumoral context based on the indications of primary arthroplasty, aseptic surgical revision or fracture treatment around the knee.Hinged TKA was associated with a high complication rate, no matter the indication.Two hundred and ninety patients (290 knees) were included retrospectively between January 2006 and December 2011 at 17 sites, with a minimum follow-up of 5 years. The patients were separated into three groups: primary surgery (111 patients), aseptic revision surgery (127 patients) and surgery following a recent (3 months) fracture (52 patients: 13 around the TKA and 39 around the knee treated by hinged TKA). Patients who had an active infection the knee of interest were excluded. All the patients were reviewed based on a standardised computer questionnaire validated by the SOFCOT.The mean follow-up was 71±39 months [range, 0 to 188]. Of the 290 patients included in the study, 108 patients (37%) suffered at least one complication and 55 patients (19%) had to undergo revision surgery: 16 in the primary TKA group (16/111, 14% of primary TKA), 28 in the revision surgery group (28/127, 22% of revision TKA) and 11 in the fracture treatment group (11/52, 21% of fracture TKA). The complications due to the hinged TKA for the entire cohort from most to least common were stiffness (41/290, 14%), chronic postoperative pain (37/290, 13%), infection (32/290, 11%), aseptic loosening (23/290, 8%), general complications (20/290, 7%), extensor mechanism complications (19/290, 6%), periprosthetic fracture (9/290, 3%), mechanical failure (2/290, 0.7%). In the primary TKA group, the main complication leading to re-operation was infection (12/111, 11%), while it was loosening for the revision TKA group (15/127, 12%) and infection (8/52, 15%) for the fracture TKA group.The 37% complication rate for hinged TKA implants is high, with 19% of them requiring re-operation. The frequency of complications differed depending on the context in which the hinged implant was used (primary, revision, fracture). The complications requiring revision surgery were major ones that prevented patients from preserving their autonomy (infection, symptomatic loosening, fracture, implant failure). The most found complications - stiffness and chronic pain - rarely led to revision.IV; retrospective cohort study.

Isolated traumatic radial head dislocation is exceedingly rare in adults, usually diagnosed on an emergency basis, and reduced by external manoeuvres. If the diagnosis is not made immediately, external reduction is no longer feasible. Various options have been described for treating these chronic forms, including therapeutic abstention, radial head resection and annular ligamentoplasty combined, if appropriate, with osteotomy of the ulna. In patients with incapacitating symptoms, proposing a surgical option makes sense. Here, we describe the technique developed by PM Grammont, which combines ligamentoplasty and an oblique flat osteotomy of the ulna. We used this technique in a 31-year-old male with isolated anterior dislocation of the radial head of 3 months’ duration. One year after surgery, he had fully recovered range of motion in all planes. He returned to work 5 months after surgery. The promising clinical and radiological outcomes in our patient support the use of this technique in adults with chronic isolated radial head dislocation. Level of evidence IV.

Resume La technique de Trillat a ciel ouvert a demontre son efficacite dans le traitement de l’instabilite anterieure d’epaule, tant pour prevenir la recidive que pour permettre une bonne recuperation des amplitudes articulaires. Nous decrivons ici une adaptation arthroscopique de cette technique et nos premiers resultats cliniques. Pour les 18 patients que nous avons operes entre 2011 et 2014, au suivi moyen de 2 ans (24,7 ± 9,8 mois), les resultats cliniques etaient tres satisfaisants avec un score de Walch–Duplay a 81,5 ± 18, un score de Rowe de 83,6 ± 16 et 94 % de patients satisfaits ou tres satisfaits avec une duree operatoire de 55 ± 13 min. Nous ne notons aucune recidive. Ainsi, par sa facilite de realisation et ses bons resultats cliniques, cette adaptation arthroscopique constitue une alternative simple et reproductible aux butees arthroscopiques, qui restent actuellement reservees a des equipes expertes.

International audience; PURPOSE: The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results.METHODS: One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n=74) or in group DI (with distal interlocking screw, n=47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6months of follow-up. Pain, operating time, and radiation time were also analyzed.RESULTS: The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p=0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09±21.30min vs DI 87.96±30.11min, p

The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA).Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI30 kg/mAt baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P.001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011).These findings show that all patients improved biomechanically and clinically, regardless of their BMI.

Complications following arthroscopy of the elbow for the treatment of lateral epicondylitis are essentially related to the anterior arthroscopic approach. The principal aims of this study were to describe and evaluate the mixed arthroscopic and endoscopic surgical technique using posterolateral approaches exclusively. This was a retrospective study of consecutive patients operated on between 2005 and 2014 for lateral epicondylitis following more than 6 months of ineffective medical treatment. The exploration was arthroscopic via a distal posterolateral portal. The extensor carpi radialis brevis was disinserted via a proximal extra-articular posterolateral endoscopic portal. The postoperative clinical follow-up included subjective (visual analog scale, Nirschl) and objective (Mayo Clinic Elbow Performance Score) evaluations of pain, the time to return to work, the level of satisfaction, complications, and failures. Thirty-seven patients underwent the procedure, including 3 lost to follow-up. Mean±SD follow-up was 32.8±24.7 months. Mean±SD visual analog scale scores were 0.8±0.8 at rest, 2.4±1.3 during everyday activities, and 3.1±1.5 during effort. Mean±SD Mayo Clinic Elbow Evaluation Score was 10.1±1.0 of 12 and mean±SD Mayo Clinic Elbow Performance Score was 91.9±12.5 of 100. Mean±SD Nirschl score was 67.5±9.6 of 80. Mean±SD time to return to work was 2.0±2.6 months. The level of satisfaction was 94.1%. The failure rate was 2.9%, with no neurological lesions. With equivalent or even better results than those already published, this surgical procedure enables the treatment of lateral epicondylitis via posterolateral portals alone, thus avoiding the complications inherent to anterior and medial arthroscopic approaches. [ Orthopedics . 2019; 42(6):e521–e527.]

Background UniSpacer™ type implants were part of the therapeutic armamentarium for medial tibio-femoral osteoarthritis before they were taken off the market in 2011. UniSpacer™ is a mobile interpositional self-centring implant that replicates the shape of the meniscus. It requires no bone cuts or component fixation. The objective of this follow-up note is to provide data on the 10-year outcomes in a cohort investigated previously in a study published in 2011. This study provides a re-evaluation of implant survival 5 years after the first analysis, as well as information on patient satisfaction and functional outcomes. Hypothesis UniSpacer™ survival remains stable after 5 additional years and provides satisfactory functional outcomes. Material and methods We included the same patients operated on from 2003 to 2009, namely, with 17 UniSpacer™ implants in 16 patients. The operative technique was the same in all patients. At last follow-up, the patients attended a visit designed specifically to allow a clinical evaluation (IKS score, revision, forgotten implant) and new radiographic imaging of the treated knee. Results Mean follow-up of this retrospective study of a prospective database was 118 ± 25 months. Of the 17 implants, 9 (53%), in 8 patients, were still in place. Six (37.5%) patients underwent early revision arthroplasty (between 6 months and 4 years). One patient was lost to follow-up and another had died. The mean global IKS knee score was 76 ± 15 and the mean IKS function score was 80 ± 25. The global IKS score at last follow-up was 157 ± 39. Mean range of flexion was 119 ± 20°. Of the 8 patients (9 implants) who still had their implants at last follow-up, 5 (56%) reported forgetting their implant. No revisions were performed between 4 and 10 years of follow-up. Discussion The ten-year survival was limited (53%). Clinical outcomes were satisfactory in the patients who still had their implants. The low cost and simplicity of insertion may make this implant a reasonable alternative for patients with contraindications to very major surgery. Level of evidence IV.

The objective was to evaluate clinical and radiological outcomes, survival rate and complications of primary contemporary rotating hinged total knee arthroplasty (CRH-TKA). Through a national multicenter retrospective study (14 centers), 112 primary CRH-TKA performed between 2006 and 2011 were included. Indications were: severe frontal plane deformity (55%), inflammatory, constitutional, congenital or post-trauma arthritis (26%), ligament laxity (10%), primary osteoarthritis (9%). Population was elderly (68 ± 13), sedentary (37.5% with a Devane score ≥ 3) and with important comorbidities (87% with ASA score ≥ 2). A clinical (KSS, Oxford scores) and radiological evaluation (implant loosening), as well as survival and reoperation rates assessment, were performed. At last follow-up (7 ± 3 years), KSS and Oxford scores were 64 ± 43 and 33 ± 10 each with a significant improvement of both scores overtime (respectively, p = 0.047 and p

International audience; The Trillat procedure performed as open surgery to treat anterior shoulder instability has been proven effective in preventing recurrences and restoring range of motion. An arthroscopically assisted variant of the Trillat procedure is described here, together with the preliminary clinical results in 18 patients treated between 2011 and 2014. After a mean follow-up of 24.7±9.8 months, the clinical outcomes were very satisfactory, with a Walch-Duplay score of 81.5±18.0, a Rowe score of 83.6±16.0, and 94% of satisfied or very satisfied patients. Mean operative time was 55±13min. No recurrences were recorded. As an easily performed procedure that provides good clinical outcomes, the arthroscopically assisted Trillat procedure is a simple and reproducible alternative to arthroscopic Latarjet procedure, which is still reserved for highly experienced surgical teams.

International audience; PURPOSE:In practice, obesity leads to poor functional outcomes after total hip arthroplasty (THA). However, in clinical research, the influence of body mass index (BMI) on the gait recovery and kinematics for THA is not well documented. The purpose of this study was to assess the influence of BMI on gait parameters pre-operatively and six months after THA for hip osteoarthritis (OA) patients.METHODS:We included 76 THA for hip OA: non-obese group (G1): 49 (BMI

International audience; Introduction Morphological studies of the humerus have shown that the position of the bicipital groove varies with the individual and the retroversion of the humeral head. Depending on the authors, these two parameters are independent or associated. This study evaluated the relationship between the humeral head axis and its retroversion and the bicipital groove relative to the humeral biepicondylar line.Materials and methods Seventy cadaveric humeri were scanned to obtain 3D reconstructions. Views of the 3D reconstruction from above showed the bicondylar line, the bicipital groove and the humeral head on a single image. After measuring the humeral retroversion angle and the bicipital groove angle relative to the bicondylar line, we assessed the relationship between these two angles with Pearson's correlation coefficient.Results Pearson's correlation coefficient indicated a significant linear correlation between the angle of the groove and the angle of humeral retroversion based on the 70 cadaveric humeral bones (the p-value was 7.5(10) (7), the correlation coefficient was -0.5515, and the 95% confidence interval was (-0.6962; -0.3636)). Our study thus demonstrates that the less lateralized the bicipital groove is, the greater the humeral retroversion will be.Conclusion We demonstrated a linear relationship between humeral head retroversion and bicipital groove lateralization. Within our reliability interval, this relationship can be used in clinical practice to evaluate retroversion without resorting to CT of the entire humerus.

International audience; Osteonecrosis of the femoral head affects mainly young patients with high functional needs this increases the risk of dislocation. Dual mobility cups known for low rate of dislocation and high mobility range seems indicated. We evaluate functional efficiency, survival and dislocation rate of dual mobility cup for total hip arthroplasty for osteonecrosis in young patients. Monocentric retrospective clinical study, from 2000 to 2008. With a clinical analysis in pre-operative and over ten years of follow-up of one cohort of patients under 55 years old with an indication of THA for ONFH. The judgement criteria was: clinical scores at the maximal follow-up, the dislocation rate, and the cumulate survival rate over ten years follow-up. Forty THA in 31 patients, nine bilateral cases, 23 males and eight females with average age of 44 (+/- 4) years old. In pre-operative: PMA 11 (+/- 3.3), HHS 50,8 (+/- 15.5). At the final follow-up of 129.8 (+/- 33.8) months: PMA (17.4 +/- 1.12), HHS (95.7 +/- 6.9), no dislocation. We had 11 deaths on average at 95.2 +/- 47.3 months. The cumulate survival rate over ten years follow-up is 100% without revisions or long-term dislocation. Analysis concludes to very significant functional improvement without any dislocation despite the young population with high level of activity. Thus, dual mobility cups is a reliable choice preventing dislocation with a very good survival rate without premature wear, preserving mobility and activity.

International audience; Purpose In the literature, there are several techniques for measuring the glenoidal version of the scapula. The superiority of the scannographic measurement over the standard radiologic measures seems evident. The main problems are the evaluation and the reproducibility of these methods, which are dependent on the quality of the CT scan and the orientation of its sections. We pinpoint a simple method of the "scapular triangle", the reliability of which deserves special consideration. The aim of this study is to report a simple and reproducible computed tomography method to measure the glenoidal version.Methods Thrity-one shoulder CT scans, performed on patients attending the emergency department of the University Hospital of Dijon between January 2012 and April 2013 for shoulder trauma, were evaluated retrospectively. The CT scan must include the entire body of scapula to allow measurements to be made with both methods: the conventional method of Friedman and our new method of the "scapular triangle". Two independent operators performed inter-observer and intra-observer reproducibility. We compared both techniques with Pearson's test.Result Pearson's test showed a trend line according to a linear correlation between the two methods with a p value of 7.791(-10) and a correlation coefficient of 0.85 with the 95 % confidence interval (0.7213; 0.929).Conclusion The method of the "scapular triangle" is easily applicable on most sections of the CT scan of scapula whether or not it takes the whole body. It is more reliable and reproducible and could be used by any radiologist.

International audience; PURPOSE: We assumed that the combination of dual-mobility total hip arthroplasty (THA) using the minimally-invasive Röttinger anterolateral approach could guarantee hip stability with faster functional recovery. We objectively analyzed functional improvement after dual-mobility THA by quantitative gait analysis.METHODS: We compared the results achieved following two different surgical approaches: Röttinger's versus Moore's approach (posterolateral approach). We included 70 patients in an open prospective single-centre study: 38 by Rottinger's approach (age = 67yo) and 32 by Moores's approach (age = 68yo). Clinical and biomechanical analysis (kinematic and kinetic parameters of the hip) were conducted at the pre-operative period and at six months post-op RESULTS: We found a significant improvement in all clinical scores and all biomechanical parameters but no difference was found between the two approaches. However, the study showed marked clinical, biomechanical and functional improvements for patients treated with dual-mobility THA for osteoarthritis without complete hip recovery compared with a control group.CONCLUSIONS: The combination of the Röttinger approach with a dual-mobility cup remains a valid choice for primary THA without functional advantage at midterm.