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Place: Germany; International audience; PURPOSE: Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years. METHODS: A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student's t test was used to estimate evolution of functional outcomes. RESULTS: The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied. CONCLUSION: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.

Background:Inadequate deformity analysis and planning before high tibial osteotomy (HTO) may result in correction errors with unsatisfactory clinical results.Indications:The purpose of this article is to describe the deformity analysis and preoperative planning before HTO. This surgery is effective for young patients with compartmental mild knee osteoarthritis. A partial deformity analysis without considering the femoral or intra-articular deformity may lead to overcorrection or excessive joint line obliquity. Preoperative planning using the Miniaci method with manual or semiautomated digital measures may help to prevent these types of errors.Technique Description:Landmarks are used at the proximal femoral side, distal condyles, proximal tibial plateau, and talus borders to define angles automatically on PeekMed software. Fujisawa point is determined to be 50% of the length of the proximal tibia, and Miniaci method is performed after defining the weightbearing line. The method can be performed manually or semiautomatically with the software. In this last case, the optimal procedure to be done to correct the malalignment is proposed by the software which automatically does the opening of the osteotomy to match the desired weightbearing axis and displays the size of the wedge in millimeters.Results:The intraobserver and interobserver reproducibility were performed by 2 different analyses and 2 different observers. The precision of the measures was confirmed based on computed tomographic (CT) scan 3-dimensional measures defined as the gold standard. All the intraobserver and interobserver reproducibility correlation coefficients and precision were satisfactory compared with the gold standard. Hip-knee-ankle angle may vary because of weightbearing situations between CT and long-axis x-rays.Discussion/Conclusion:The interest of semiautomated software for angular value measurements is now well recognized, and the inclusion of anatomical landmarks allows accurate and reproducible angular value measurements. Automatic knee osteotomy planning analyzes the metaphyseal deformity of both the tibia and the femur, and the software suggests the optimal procedure with the degree of openness to obtain the desired mechanical axis without creating excessive joint line obliquity

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.

Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature. Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics. Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.

Six to eight months after total hip arthroplasty, patients only attain 80% of the functional level of control groups. Understanding which functional tasks are most affected could help reduce this deficit by guiding rehabilitation towards them. The timed up-and-go test bundles multiple tasks together in one test and is a good indicator of a patient’s overall level of function. Previously, biomechanical analysis of its phases was used to identify specific functional deficits in pathological populations. To the best of our knowledge, this analysis has never been performed in patients who have undergone total hip arthroplasty. Seventy-one total hip arthroplasty patients performed an instrumented timed up-and-go test in a gait laboratory before and six months after surgery; fifty-two controls performed it only once. Biomechanical features were selected to analyse the test’s four phases (sit-to-stand, walking, turning, turn-to-sit) and mean differences between groups were evaluated for each phase. On average, six months after surgery, patients’ overall test time rose to 80% of the mean of the control group. The walking phase was revealed as the main deficiency before and after surgery (-41 ± 47% and -22 ± 32% slower, respectively). High standard deviations indicated that variability between patients was high. On average, patients showed improved results in every phase of the timed up-and-go test six months after surgery, but residual deficits in function differed between those phases. This simple test could be appropriate for quantifying patient-specific deficits in function and hence guiding and monitoring post-operative rehabilitation in clinical settings.

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.

Introduction: Knee osteoarthritis is the main indication for primary total knee arthroplasty (TKA). It is now accepted that cementless implantation of the femoral component provides equivalent results to cemented one, however, the optimal fixation method of the tibial component remains controversial. The purpose of this study was to compare the survivorship of cemented versus cementless tibial baseplate in primary total knee arthroplasty.Materials and methods: We carried out a retrospective, monocentric study, including 109 TKA (Zimmer®Natural Knee II ultra-congruent mobile-bearing) implanted between 2004 and 2010 for primary osteoarthritis, comparing 2 groups depending on tibial component fixation method, one cemented (n = 68) and one cementless (n = 41). Clinical (Knee Society Rating System (KSS), Hospital for Special Surgery (HSS) scores, range of motion) and radiodiological outcomes were assessed at last follow-up with a minimal follow-up of 5 years.Results: Mean follow-up were 8.14 [5.31–12.7] and 8.06 [5.22–12.02] years, respectively, in cemented and cementless groups. The tibial component survival rate was 100% [95CI: 91.4–100] in the cementless group and 97.1% [95CI: 89.78–99.42] in the cemented group (2 aseptic loosenings) (p = 0.27). Radiolucent lines were present in 31.7% (n = 13) of the cementless and 44.1% (n = 30) of the cemented baseplates (p = 0.2). The postoperative KSS knee score was higher in the cementless group (99 ± 3 vs. 97 ± 7.5;p = 0.02), but there was no significant difference in KSS function, global KSS and HSS scores. Mean range of flexion was 120 ± 10° in the cementless group and 122.5 ± 15° in the cemented group (p = 0.37). No significant differences were found on the radiographic data or on complications.Conclusion: In this study, the survival rate of the tibial component is not influenced by its fixation method at a mean follow-up of 8 years in osteoarthritis, which confirms the reliability of cementless fixation in primary TKA.

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.

Objectives: Arthroscopic adaptation of the Trillat procedure has become a part of the armamentarium for anterior shoulder instability. As the first team to have described a surgical technique, we present the results of our first 100 patients. Methods: This is a cohort study on a prospective database, descriptive of patients who had undergone surgery for chronic anterior shoulder instability between March 2011 the date our technique was developed, and October 2019. Patients were clinically and radiologically evaluated preoperatively (standard radiographs, CT scan) and postoperatively (standard radiographs) at 1, 3, 6 and 12 months and by CT scan 6 months postoperatively to evaluate the consolidation of the coracoid fracture and subscapularis muscle trophicity. Functional results were evaluated by Constant, SSV, Walch/Duplay and Rowe scores and recurrences of accidents due to instability and complications were collated. Results: 100 patients, mean follow-up of 25 months (6-96), mean age, 29 years (15-73), 71% sportspeople, mean age at first episode, 20 years (7-59), 20% hyperlaxity. 67% notches, 22% bony Bankart, 15% glenoid wear and 2% rotator cuff tear. The surgical technique was identical, there were 3 operators, average operating time was 50 min (26-145), 70% were ambulatory, there were 13 fractures and no conversion to an open technique. At the last follow-up there were 3 recurrences of luxation and 4 recurrences of subluxation and in 4 cases failure to recover muscle tone was noted. 95% of the sportspersons resumed their activity, 81% at the previous level. One year postoperatively, the Walsh-Duplay score was 88 (40-100) and the Rowe score was 92 (40-100). There were 4 cases of pseudoarthrosis, 3 of which were due to a technical defect, 2 coracoid fractures, 1 case of resolving sepsis and no neurological complications. There was no damage to the subscapularis. 97% of the patients were satisfied or very satisfied. Conclusion: This is the largest available series on the arthroscopic Trillat procedure. The results are identical to those in the preliminary series and as good as those for the reference techniques. Failures and complications were few and often the result of technical errors. The recovery of muscle tone in the limb on which surgery was performed seemed to influence the effectiveness of stabilization.

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; Treatment of acetabular fracture is complex, requiring adapted and often extensive surgical approaches. We describe a modified iliofemoral approach, with the particularity of including iliac crest osteotomy sparing abdominal muscles to allow direct control of reduction while respecting the abdominal muscles, creating a workspace as close to the fracture as possible, without involving the inguinal canal or femoral vascular-neural bundle. In 15 complex fractures, the technique provided 13 excellent or good reductions and 13 excellent or good results according to the Matta criteria. This approach can be combined with others, such as a posterior approach, thus providing an alternative to the ilioinguinal approach in the treatment of complex acetabular fracture.

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.

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

Introduction Little is known concerning the influence of body mass index (BMI) on patient recovery after total knee arthroplasty (TKA), in terms of gait performance. Indeed, no studies have documented its influence on the recovery of range of motion (ROM) of the knee during gait and of gait velocity. Therefore, the objective of this study was to investigate the influence of BMI on these parameters before and 1 year after surgery. Materials and methods Seventy-nine patients were evaluated before and one year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and one year post-TKA), the Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life and patient satisfaction were assessed. Non-obese (BMI Results At baseline, gait velocity and knee ROM were significantly lower in obese compared to non-obese patients (0.99 ± 0.27 m/s vs. 1.11 ± 0.18 m/s, effect size, 0.53; P = 0.021. ROM: 41.33 ± 9.6 vs. 46.05 ± 8.39, effect size, 0.52; P = 0.022). 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 non-obese (WOMAC pain: 36.1 ± 14.0 vs. 50.4 ± 16.9, effect size, 0.9; P Conclusions These findings show that all patients improved biomechanically and clinically regardless of their BMI.