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Resume Introduction Le remplacement prothetique bilateral de hanche offre l’avantage d’une seule anesthesie, d’un sejour hospitalier unique et d’une seule reeducation. L’ecueil theorique de cette strategie est une majoration du risque operatoire. Il existe peu de series francaises et aucune n’est comparative avec des arthroplasties unilaterales. Aussi, nous avons mene une etude comparative cas temoin de protheses bilaterales une seule seance (PTH Bi) versus unilaterales (PTH Uni) avec pour objectifs de : 1) comparer la morbi-mortalite, 2) la survie, 3) les scores fonctionnels et le taux de hanche oubliee. Hypothese Sur une population selectionnee ASA 1 ou 2 les PTH Bi ne modifiaient ni le le taux de complications ni la survie par rapport aux PTH unilaterales. Materiel et methode Entre 2004 et 2018, 327 patients ont ete inclus comportant 109 operes par PTH Bi et 218 operes par PTH Uni. Un patient opere par PTH bilaterale etait apparie a deux patients operes par PTH unilaterale selon l’âge, le sexe, le diagnostic, le score ASA 1 ou 2 et la voie d’abord anterieure ou posterieure. Le recul minimum etait de 12 mois et le recueil des complications dans les deux groupes a ete realise pour tous les patients. La morbi-mortalite precoce (≤ 90 jours) ou tardive (> 90 jours) etait renseignee ainsi que la survie prothetique des deux groupes. Les criteres secondaires concernaient la strategie d’epargne et les pertes sanguines, les scores fonctionnels et de satisfaction des patients. Resultats La mortalite etait nulle dans les deux groupes. Aucune difference significative concernant le taux de complications globales n’etait observee entre les groupes PTH Bi (38,5 %) versus PTH Uni (40,8 %) (p = 0,69) que les complications soient precoces (PTH Bi = 8,3 % [9/109] ; PTH Uni = 7,8 % [17/218] [p = 0,89]) ou tardives (PTH Bi = 30,3 % [33/109] ; PTH Uni = 33,0 % [72/218] [p = 0,61]). Le taux d’inegalite de longueur des membres inferieurs etait significativement inferieur dans le groupe PTH Bi (PTH Uni = (29/218) 13,3 % ; PTH Bi = [6/109] 5,5 % [p = 0,03]). Le taux de hanche oubliee etait significativement plus important dans le groupe PTH Bi (94/109 [86 %]) que dans le groupe PTH Uni (152/218 70 %) (p = 0,01). La survie de l’implant a 5 ans selon l’analyse de Kaplan-Meier etait de 97,2 % (IC 95 % = [91,9–99,1]) dans le groupe PTH Bi et de 96,6 % (IC 95 % = [93,0–98,4]) dans le groupe PTH Uni (p = 0,08). Discussion Cette etude montre que le remplacement prothetique bilateral en une session operatoire est une strategie recevable et non prejudiciable pour les patients presentant une coxarthrose bilaterale invalidante a faible risque operatoire (ASA 1 et 2). En effet sans modifier la mortalite, les complications ou la survie, la procedure bilaterale en une seance permet un meilleur controle des longueurs de membre et un taux de hanche oubliee plus important. Niveau de preuve III, etude cas temoin appariee.

Background One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates. Hypothesis In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA. Material and method Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤ 90 days) or late (> 90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction. Results Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p = 0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p = 0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p = 0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p = 0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p = 0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9–99.1]) in 1B-THA and 96.6% (95% CI [93.0–98.4]) in U-THA (p = 0.08). Discussion One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip. Level of evidence III, matched case-control study.

Advantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss.1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used.A single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA.We included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108-255minutes) in the PA group (p0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5-11 days) in the AA group, and 8.2 days (range, 3-13 days) in the PA group (p0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58).In selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used.III, comparative study of consecutive patients.

The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.

Background . The purpose of this study is to analyze morbidity and mortality and to determine the relative contribution of each of these potential prognosis variables for predicting morbidity and mortality in patients after pleurodesis by thoracotomy or thoracoscopy. Methods . Between March 1, 1996, and January 31, 2001, a total of 70 patients underwent pleurodesis for recurrent malignant pleural effusion. Thoracoscopy was performed in 54 patients (77%); pleurodesis was achieved by pleural abrasion (n = 15), pleurectomy (n = 5), and talc insufflation (n = 34). Thoracotomy was performed in 16 patients (23%) who also needed pleurectomy and decortication for a trapped lung. Results . Postoperative complications occurred in 24 patients (34%). Factors adversely affecting morbidity with univariate analysis included: three or four metastatic sites ( p = 0.003), and thoracotomy ( p = 0.009). Factors adversely affecting morbidity with multivariate analysis included: thoracotomy ( p = 0.0005) and number of metastatic sites ( p = 0.007). Six patient deaths (8.6%) occurred during hospitalization. Factors adversely affecting in-hospital mortality with univariate analysis included: Eastern Cooperative Oncology Group Performance Status 2 to 3 ( p = 0.001), lower preoperative serum hemoglobin ( p = 0.001), lower preoperative serum albumin ( p = 0.0001), and thoracotomy ( p = 0.03). Factors adversely affecting in-hospital mortality with multivariate analysis included: preoperative serum albumin less than 60 g/L ( p = 0.007) and ECOG Performance Status 2 to 3 ( p = 0.008). Twelve patients (17%) died within 90 days after surgery. Factors adversely affecting 3-month mortality with univariate analysis included: ECOG Performance Status 2 to 3 ( p = 0.001), lower preoperative serum hemoglobin ( p = 0.03), higher preoperative white cells ( p = 0.03), lower preoperative serum albumin ( p = 0.03), and preoperative thoracentesis more than once per month ( p = 0.03). Factors adversely affecting 3-month mortality with multivariate analysis included: ECOG Performance Status 2 to 3 ( p = 0.01), preoperative thoracentesis more than once per month ( p = 0.03), three or four metastatic sites ( p = 0.02), and preoperative white blood cell count ≥ 12,000/mm 3 ( p = 0.03). Conclusions . Thoracotomy is not indicated in patients with a malignant effusion because of poor survival, a high frequency of complications, and prolonged hospital stay. Pleurodesis thoracoscopy is indicated in patients with good performance status coupled with good nutrition.