172 results on '"Christophe Trojani"'
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2. Hallucination Rates and Reference Accuracy of ChatGPT and Bard for Systematic Reviews: Comparative Analysis
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Mikaël Chelli, Jules Descamps, Vincent Lavoué, Christophe Trojani, Michel Azar, Marcel Deckert, Jean-Luc Raynier, Gilles Clowez, Pascal Boileau, and Caroline Ruetsch-Chelli
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundLarge language models (LLMs) have raised both interest and concern in the academic community. They offer the potential for automating literature search and synthesis for systematic reviews but raise concerns regarding their reliability, as the tendency to generate unsupported (hallucinated) content persist. ObjectiveThe aim of the study is to assess the performance of LLMs such as ChatGPT and Bard (subsequently rebranded Gemini) to produce references in the context of scientific writing. MethodsThe performance of ChatGPT and Bard in replicating the results of human-conducted systematic reviews was assessed. Using systematic reviews pertaining to shoulder rotator cuff pathology, these LLMs were tested by providing the same inclusion criteria and comparing the results with original systematic review references, serving as gold standards. The study used 3 key performance metrics: recall, precision, and F1-score, alongside the hallucination rate. Papers were considered “hallucinated” if any 2 of the following information were wrong: title, first author, or year of publication. ResultsIn total, 11 systematic reviews across 4 fields yielded 33 prompts to LLMs (3 LLMs×11 reviews), with 471 references analyzed. Precision rates for GPT-3.5, GPT-4, and Bard were 9.4% (13/139), 13.4% (16/119), and 0% (0/104) respectively (P
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- 2024
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3. The reliability of the Neer classification for proximal humerus fractures: a survey of orthopedic shoulder surgeons
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Mikaël Chelli, MD, MSc, Gregory Gasbarro, MD, Vincent Lavoué, MD, Marc-Olivier Gauci, MD, PhD, Jean-Luc Raynier, MD, MSc, Christophe Trojani, MD, PhD, and Pascal Boileau, MD, PhD
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Proximal humerus fracture ,Neer classification ,Traumatology ,Survey ,Interobserver agreement ,Reliability ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: The Neer classification is among the most widely used systems to describe proximal humerus fractures (PHF) despite the poor interobserver agreement. The purpose of this study was to verify whether or not blinded shoulder surgeons and trainees agree with the authors of articles published in the highest impact-factor orthopedic journals. Methods: All articles regarding PHF published between 2017 and 2019 in the top 10 orthopedic journals as rated by impact factor were searched. Articles were included if the authors used the Neer classification to describe at least 1 PHF in the figures. Figures were extracted without the legend, and X-rays ± computed tomography scan images were included when available. An international survey was conducted among 138 shoulder surgeons who were asked to record the Neer classification for each de-identified radiograph in the publications. The type of fracture mentioned in the legend of the published figure was considered as the gold standard. Results: Survey participants agreed with the published article authors in 55% of cases overall (range 6%-96%, n = 35). The most common response disagreed with the article authors in 13 cases (37%), underestimating the number of parts in 11 of 13 cases. The interobserver agreement between the 138 responders was fair (k = 0.296). There was an association between the percentage of concordant answers and greater experience (number of years of shoulder surgery practice) of the responders (P = .0023). The number of parts, the number or type of available imaging modalities, and the geographic origin of participants did not influence the agreement between responders and authors. Discussion: In more than one-third of cases, specialized shoulder surgeons disagree with article authors when interpreting the Neer classification of de-identified images of PHF in published manuscripts. Morphologic classification of PHF as the sole basis for treatment algorithms and surgical success should be scrutinized.
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- 2022
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4. Sciatic nerve block or not for outpatient total knee arthroplasty? Study protocol for a randomized controlled trial
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Laurie Tran, Melissa Barthelemy, Pascal Boileau, Marc Raucoules-Aime, Michel Carles, and Christophe Trojani
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Total knee arthroplasty ,Outpatient procedure ,Sciatic nerve block ,Randomized controlled study ,Medicine (General) ,R5-920 - Abstract
Abstract Background The number of patients operated on for total knee arthroplasty (TKA) is growing worldwide. Outpatient surgery is defined by a length of stay (LOS) in the hospital of less than 12 h. This can be limited for TKA, with the efficient management of pain and perioperative complications, such as blood loss, affecting a safe hospital discharge. Outpatient TKA with a suitable protocol, including multimodal measures, could improve the success rate of this procedure. Among the main measures, single-shot sciatic nerve block in association with continuous femoral nerve block for pain control needs to be evaluated in outpatient TKA. Furthermore, to promote the safety of the postoperative period and to accelerate rehabilitation, patients who undergo ambulatory TKA could be discharged to a rehabilitation center on the day of surgery to screen adverse events and to optimize the rehabilitation process. This study is designed to assess the benefits of sciatic nerve block in postoperative pain relief for outpatient TKA. Methods/design This randomized prospective controlled study will be conducted in the knee unit of the teaching hospital of the Nice university and will include 40 patients undergoing primary unilateral outpatient TKA, discharged the day of surgery to a private rehabilitation center for enhanced recovery after surgery, after a hospital stay of less than 12 h. Before surgery, all patients will receive a continuous femoral nerve block with 2 mg/ml ropivacaine 20 ml, and then patients will be randomly assigned to receive or not receive a single-shot sciatic nerve block with 2 mg/ml ropivacaine, 20 ml. The primary outcome measure is the success rate of outpatient TKA. This rate is defined by patients discharged from the hospital to a rehabilitation center the day of surgery with no re-hospitalization due to insufficient pain control before the fifth postoperative day. Secondary outcomes include the incidence of major and minor adverse events during the first five postoperative days and measurement of the quality of recovery using the Knee injury and Osteoarthritis Outcome Score and the new International Knee Society scores plus the Quality of Recovery-40 questionnaire. Discussion The assessment of anesthesia and rehabilitation protocols enabling major orthopedic surgery, such as TKA, is necessary. This randomized controlled study will address the hypothesis that a suitable multimodal protocol including sciatic nerve block could improve pain control and thus improve the success rate of outpatient TKA. Trial registration EudraCT, 2016-000226-19. Registered on 15 April 2016.
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- 2019
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5. Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss
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David Saliken, M.D., F.R.C.S.C., Vincent Lavoué, M.D., Christophe Trojani, M.D., Ph.D., Jean-François Gonzalez, M.D., Ph.D., and Pascal Boileau, M.D.
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Orthopedic surgery ,RD701-811 - Abstract
Patients presenting with recurrent shoulder instability and bipolar glenohumeral bone loss are at risk of failed standard soft-tissue repair techniques. Even isolated bony-stabilization procedures such as the Latarjet or remplissage technique may not provide sufficient stability in the face of combined bone loss. We use a combined all-arthroscopic remplissage, Latarjet, and Bankart repair for patients with significant combined glenohumeral bone loss and/or in the revision setting. This allows reconstruction of both the Hill-Sachs and glenoid bone defects and repair of the capsulolabral complex in a minimally invasive manner. Furthermore, the use of cortical-button fixation of the coracoid bone graft may reduce the risk of hardware-related complications while still achieving excellent bone union.
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- 2017
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6. The Arthroscopic Trillat Procedure Is a Valuable and Durable Treatment Option for Recurrent Anterior Instability Associated With Massive Irreparable Cuff Tears
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Pascal Boileau, Gilles Clowez, Soufyane Bouacida, Gilles Walch, Daniel G. Schwartz, and Christophe Trojani
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Orthopedics and Sports Medicine - Abstract
The purpose of the present study is to report the mid- and long-term clinical and radiological outcomes of the arthroscopic Trillat for the treatment of recurrent anterior instability in patients with chronic massive irreparable rotator cuff tears (MIRCT) and maintained active shoulder motion. where RSA is not indicated.Twenty-one consecutive patients (mean age 61 years) identified and retrospectively reviewed. All patients had recurrent anterior dislocations and conserved active forward elevation (AFE) and active external rotation (ARE). The MIRCTs included a retracted (stage 3) supraspinatus tear in 14%, a supra- and infraspinatus tear in 76.5%, and a 3-tendon tear in 14%. A closed wedge osteotomy of the coracoid was performed, and the coracoid was fixed above the subscapularis with a cannulated screw (10 cases) or suture-buttons (11 cases). We followed patients with x-rays, CT scan at 6 months, Subjective Shoulder Value, VAS, Walch, Constant, and Rowe scores. The mean clinical and radiographic follow up was 58 months (24-145 months).Overall, 96% (20/21) of the patients had a stable and functional shoulder and were satisfied with the procedure; no patient lost active shoulder motion. The Subjective Shoulder Value increased from 44% (10-75) to 94% (80-100), p0.001. The Constant and Rowe scores improved from 60 (25-81) to 81 (66-96) and from 54 (35 to 65) to 92 (70-100), respectively (p0.001).Among the 13 patients practicing sports before surgery, 10 (77 %) went back to sports. At last follow-up, only one patient was revised to RSA.The arthroscopic Trillat procedure is a valuable and durable option for the treatment of recurrent anterior dislocations in older patients with chronic MIRCTs and conserved active shoulder motion.Level IV, therapeutic case series.
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- 2023
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7. The Arthroscopic Trillat Procedure Is a Valuable Treatment Option for Recurrent Anterior Instability in Young Athletes With Shoulder Hyperlaxity
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Pascal Boileau, Gilles Clowez, Soufyane Bouacida, Gilles Walch, Christophe Trojani, and Daniel G. Schwartz
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Orthopedics and Sports Medicine - Abstract
The purpose of this study is to report the outcomes of the all-arthroscopic Trillat procedure, combined with capsular plication, for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity (ER90°).We performed a retrospective evaluation of patients with recurrent anterior instability and shoulder hyperlaxity who underwent an arthroscopic Trillat between 2009 and 2019. Patients with concomitant rotator cuff lesions, voluntary or multidirectional instability were excluded. The osteotomized coracoid was fixed above the subscapularis with a cannulated screw or a suture button; a capsular plication was systematically associated. We followed patients with X-rays, CT-scans, Subjective Shoulder Value, VAS, Walch, Constant, and Rowe scores. Mean follow-up was 56 months (24-145).Twenty-eight consecutive patients, 30 shoulders (mean age 25 years) were identified and all met criteria. The main finding under arthroscopy was a "loose shoulder" with anteroinferior capsular redundancy and no or few (10%) labrum tears, glenoid erosion (13%) or Hill-Sachs lesions (10%). At last follow-up, 90% of the shoulders (27/30) were stable, and 79% (19/24) of the patients practicing sports returned to their preinjury activity level. The Walch-Duplay and Rowe scores improved from 54 (38-68) to 81 (4-100) and 55 (30-71) to 84 (45-100) respectively, p0.001.The arthroscopic Trillat is an effective procedure for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity, but no substantial humeral or glenoid bone loss, allowing return to overhead/contact sports.Level IV, retrospective study.
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- 2023
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8. Incidence du confinement sur l’activité de chirurgie orthopédique et traumatologique
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Jeremy Allia, Gaya Ait Saada, Nicolas Bronsard, Jean-François Gonzalez, Pascal Boileau, and Christophe Trojani
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Orthopedics and Sports Medicine ,Surgery - Published
- 2023
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9. PTG Bilatérales en une session opératoire versus PTG Unilatérales : analyse comparative
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Antoine Raffaelli, Yoann Lévy, Pascal Boileau, and Christophe Trojani
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Orthopedics and Sports Medicine ,Surgery - Published
- 2022
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10. Prothèse totale de hanche bilatérale en une ou deux sessions opératoires ? Étude comparative
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Grégoire Micicoi, Régis Bernard de Dompsure, Pascal Boileau, and Christophe Trojani
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Orthopedics and Sports Medicine ,Surgery - Published
- 2022
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11. Arthroscopic Lateral Patellar Facetectomy and Lateral Release Can Be Recommended for Isolated Patellofemoral Osteoarthritis
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Joseph W. Galvin, Pascal Boileau, Vincent Lavoué, Adil Douiri, and Christophe Trojani
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Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Knee Joint ,medicine.medical_treatment ,Total knee replacement ,Osteoarthritis ,Patellofemoral Joint ,Patellofemoral osteoarthritis ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Lateral release ,business.industry ,Minimal clinically important difference ,Mean age ,Patella ,Middle Aged ,Osteoarthritis, Knee ,medicine.disease ,Surgery ,Treatment Outcome ,Facetectomy ,Female ,business ,Follow-Up Studies - Abstract
Purpose To analyze the clinical outcomes and survival curve of arthroscopic lateral patellar facetectomy and lateral release for isolated patellofemoral osteoarthritis (PFOA). Methods All patients undergoing arthroscopic lateral patellar facetectomy and lateral release between January 2008 and January 2018 were evaluated retrospectively. The inclusion criteria were 1) diagnosis of isolated symptomatic lateral PFOA, 2) PFOA with kissing lesions (defined as a lesion on both the patella and trochlea, which were in direct contact, 3) arthroscopic lateral patellar facetectomy and lateral release, and 4) two-year minimum follow-up. Evaluation included preoperative and postoperative subjective International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) scores, and visual analogue pain scale (VAS). The primary end point determining the survival curve was revision of lateral facetectomy. Results A retrospective analysis was conducted of 61 consecutive arthroscopic lateral patellar facetectomy and lateral release procedures, performed in 55 patients for a diagnosis of isolated PFOA. Five patients were lost to follow-up, leaving 56 knees (50 patients) available at a mean follow up of 7.5 years (range: 2-10). The cohort included 37 women and 13 men with a mean age of 59 years (range: 34-87). Nine patients (18%) underwent revision surgery: six total knee replacements (TKR), two high tibial osteotomies, and one revision arthroscopic lateral patellar facetectomy. The mean time from arthroscopic facetectomy to TKR was 51 months (range: 10-114). The survival curve rate was 86% at 7.5 years. Both KOOS and IKDC scores improved significantly. These results are confirmed by an analysis of MCID. The mean VAS decreased from 6.98 ± 1.2 preoperatively to 2.06 ± 1.6 at the last follow-up (ΔCI95% = [−5.6; −4.4]; P = .0001). Conclusion Arthroscopic lateral patellar facetectomy and lateral release for isolated PFOA demonstrates sustained significant improvement in knee clinical outcome scores and pain with a low rate of complications and revision surgery at mid-term follow-up. This operation can be recommended in cases of symptomatic isolated PFOA. Level of Evidence IV, case series
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- 2022
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12. The Arthroscopic Trillat Procedure: A Reliable Treatment Option For Patients With Recurrent Anterior Instability And Massive Irreparable Cuff Tears
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Pascal Boileau, Gilles Clowez, Soufyane Bouacida, Daniel G. Schwartz, and Christophe Trojani
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Orthopedics and Sports Medicine ,Surgery ,General Medicine - Published
- 2023
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13. Ostéotomie tibiale de flexion pour genu recurvatum ligamentaire pathologique
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Pascal Boileau, Christophe Trojani, and Grégoire Micicoi
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Orthopedics and Sports Medicine ,Surgery - Abstract
Resume Introduction Le genu recurvatum ligamentaire pathologique (GRLP) se caracterise par une hyperextension asymetrique du genou associee a des douleurs et une sensation d’instabilite survenant au cours de la marche. L’origine ligamentaire du recurvatum est liee a une entorse en hyperextension responsable d’une rupture des coques posterieures pouvant etre associee a une rupture du pivot central. Hypothese L’Osteotomie tibiale de flexion (OTF) permet de controler un GRLP sans rupture du pivot central secondaire a une entorse en hyperextension. Materiel et methodes Dix patients (12 genoux) dont 8 femmes, âges de 30,8 ans en moyenne (16–52) presentant un GRLP asymetrique secondaire a une entorse en hyperextension sans rupture du pivot central ont ete operes par OTF. Une osteotomie de la tuberosite tibiale anterieure (TTA) etait realisee associee a une osteotomie trans-tuberositaire d’ouverture anterieure du tibia proximal dans le plan sagittal. La TTA etait fixee par deux vis en compression avec un effet d’abaissement de la rotule correspondant a l’ouverture anterieure. L’angle de recurvatum du genou (RG), la pente tibiale (angle RT) et la hauteur rotulienne selon d’index de Caton–Deschamps (ICD) etaient determines. Tous les patients ont ete evalues a l’aide des scores IKDC et de Lecuire (scores anatomique et fonctionnel). Resultats Le recul moyen etait de 4,2 ans (12–106 mois). L’angle RG etait de 7,3 ± 3,2°, contre 22,7 ± 4,1° en preoperatoire (p Conclusion L’Osteotomie tibiale de flexion trans-tuberositaire est une strategie efficace en cas de genu recurvatum ligamentaire pathologique sans rupture du pivot central secondaire a une entorse en hyperextension sur un terrain d’hyperlaxite. Cette intervention permet une amelioration clinique significative et une correction de la deformation en recurvatum a moyen terme. Niveau de preuve IV, etude descriptive retrospective.
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- 2021
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14. Prothèses d’épaule en ambulatoire : faisabilité, acceptation et sécurité
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Caroline Cointat, Michel Azar, Laurie Tran, Marc Olivier Gauci, Christophe Trojani, and Pascal Boileau
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030229 sport sciences - Abstract
Resume Introduction La chirurgie ambulatoire en France est definie par l’HAS comme une chirurgie programmee permettant la sortie du patient le jour-meme de son intervention, sans risque majore. Avec l’avenement de la readaptation acceleree apres chirurgie, l’ambulatoire est devenue courante en arthroplastie du membre inferieur. En France, seulement 1,1 % des protheses de genou, ont ete realisees en ambulatoire en 2017. Objectifs (1) Evaluer la morbi-mortalite precoce apres prothese d’epaule en ambulatoire pour valider les criteres d’eligibilite et de securite, et (2) evaluer l’acceptation de l’ambulatoire par les patients. Methodes Etude monocentrique avec criteres d’inclusion suivants : arthroplastie d’epaule primaire, score ASA 9/10 et le score EVA Resultats Entre fevrier 2016 et fevrier 2018, 36 patients se sont vu proposer une arthroplastie d’epaule en ambulatoire : 12 (33 %) ont refuse l’ambulatoire sans raison et 24 patients l’ont acceptee (7 HA, 9 TSA, 8 RSA). L’âge moyen des patients a la chirurgie etait de 70 ans (55–82) ; l’IMC moyen de 26 (21–32) et 14 patients etaient ASA 2 (66 %). En postoperatoire, malgre un score PADSS > 9/10 et un controle de la douleur, 3 patients (12 %) ont refuse de sortir. Deux patients (8 %) ne sont pas rentres a domicile le jour meme pour des raisons medicales (1 douleur et 1 HTA). Sur les 19 arthroplasties realisees en ambulatoire, aucune readmission ou complication n’ont ete notees. Aucun patient ambulatoire n’a utilise d’opiaces. Tous les patients etaient satisfaits du resultat fonctionnel ; 84 % satisfaits de l’ambulatoire ; 17 % regrettaient l’hospitalisation conventionnelle, se sentant pas assez encadres. Conclusions (1) L’arthroplasties d’epaule en ambulatoire peut etre proposee en toute securite, chez des patients selectionnes avec de faibles comorbidites, quel que soient l’âge et le type d’implant choisi. (2) Chez nos patients, le taux d’acceptation de l’ambulatoire pour une prothese d’epaule reste faible. Ces resultats doivent nous inciter a mieux eduquer les patients a l’ambulatoire. Niveau de preuves IV ; etude retrospective.
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- 2021
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15. Arthro-Latarjet With A Guided Technique And Cortical Button Fixation: Long-Term (Minimum 10-Year FU) Outcomes
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Jules Decamps, Valentina Greco, Mikaël Chelli, Christophe Trojani, and Pascal Boileau
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Orthopedics and Sports Medicine ,Surgery ,General Medicine - Published
- 2023
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16. Morbi-mortalité précoce des fractures de l’odontoïde après 70 ans
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Fernand de Peretti, Laurent Barresi, Jeremy Allia, Christophe Trojani, Nicolas Bronsard, and Hugo Darmanté
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030217 neurology & neurosurgery - Abstract
Resume Introduction Les fractures de l’odontoide sont tres frequentes chez les personnes âgees et leur mortalite est elevee. Le but de cette etude est d’evaluer le traitement conservateur des fractures de l’odontoide non deplacees et le traitement chirurgical des fractures deplacees chez les patients âges de plus de 70 ans. L’hypothese est que la mortalite precoce des fractures deplacees est superieure a celle des fractures non deplacees. Materiels et methodes Il s’agit d’une etude observationnelle monocentrique retrospective incluant les fractures de l’odontoide (type II de la classification d’Anderson et d’Alonzo), chez les patients de plus de 70 ans, entre 2014 et 2017. Un traitement orthopedique avec une immobilisation rigide pendant 3 mois etait propose en cas de deplacement 2 mm (fracture deplacee). Le critere de jugement principal etait le taux de mortalite a 3 mois. Nous avons inclus 79 patients (46 femmes) avec un âge moyen de 85 ans (70–105). Resultats La mortalite globale a 3 mois de la cohorte etait de 27 et de 30 % evaluee a 1 an. Trente-six patients presentaient une fracture non deplacee et beneficiaient d’un traitement orthopedique. Dans ce groupe, on observait 11 % de deces a 3 mois. Quarante-trois patients presentaient une fracture deplacee : 17 patients etaient operes par vissage anterieur ; 20 etaient contre-indiques a la chirurgie et 6 decedaient dans les 24 premieres heures. Dans ce groupe, on observait 40 % de deces a 3 mois : trois patients sur les 17 operes par complication respiratoire postoperatoire ; huit patients sur les 20 contre-indiques en plus des six deces immediats. Discussion Cette etude confirme la morbi-mortalite precoce elevee des fractures de l’odontoide. Cette etude montre un taux de mortalite significativement plus eleve en cas de fracture deplacee, confirmant ainsi l’hypothese des auteurs. Le taux de mortalite est particulierement eleve si les patients sont contre-indiques pour la chirurgie. Cette etude montre enfin un taux eleve de complications respiratoires apres osteosynthese par voie anterieure. Conclusion A la lumiere des resultats de cette etude, il apparait necessaire de comparer, pour les fractures deplacees, le traitement orthopedique au traitement chirurgical, et au sein du groupe de patients operes, la voie anterieure a la voie posterieure. Niveau de preuve IV.
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- 2020
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17. Early mortality and morbidity of odontoid fractures after 70 years of age
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Nicolas Bronsard, Jeremy Allia, Fernand de Peretti, Hugo Darmanté, Laurent Barresi, and Christophe Trojani
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medicine.medical_specialty ,Bone Screws ,Fracture group ,Fracture Fixation, Internal ,03 medical and health sciences ,0302 clinical medicine ,Odontoid Process ,medicine ,Clinical endpoint ,Humans ,Orthopedics and Sports Medicine ,In patient ,Aged ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Mortality rate ,Retrospective cohort study ,030229 sport sciences ,Surgery ,Conservative treatment ,Treatment Outcome ,Cohort ,Spinal Fractures ,Female ,Anterior approach ,Morbidity ,business - Abstract
Introduction Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures. Material and methods This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months. Results The study included 79 patients (46 women) who had a mean age of 85 years (70–105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24 hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred. Discussion This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures. Conclusion Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases. Level of evidence IV.
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- 2020
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18. Syndrome douloureux sacro-iliaque après arthrodèse lombo-sacrée
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Nicolas Bronsard, Olivier Andreani, Christophe Trojani, Fernand de Peretti, Hugo Darmanté, and Yann Pelletier
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03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Orthopedics and Sports Medicine ,Surgery ,030217 neurology & neurosurgery - Abstract
Resume Introduction Un tiers des lombalgies basses serait imputable a l’articulation sacro-iliaque (ASI). Cette prevalence augmente apres arthrodese lombo-sacree. Un « Fortin Finger test » positif fait suspecter l’origine SI des douleurs mais l’examen clinique et l’imagerie sont non specifiques et peu contributifs. Le gold standard reste l’infiltration-test aux anesthesiques locaux. Une amelioration de la douleur de plus de 70 % apres l’injection valide le diagnostic de syndrome douloureux d’origine SI. L’objectif principal de cette etude est d’evaluer la diminution de la douleur apres infiltration test intra-articulaire SI sur une echelle numerique simple (ENS). L’hypothese est qu’une infiltration sacro-iliaque intra-articulaire permet de diminuer significativement les douleurs sacro-iliaques apres arthrodese lombo-sacree. Materiels et methodes Tous les patients presentant des douleurs (ENS > 7/10) suspectes de SDSI, un an apres une arthrodese lombo-sacree avec signe de Fortin positif etaient inclus. Les pathologies lombaires, de hanche ou inflammatoires de l’ASI etaient exclues. Chaque patient beneficiait d’une infiltration-test aux anesthesiques locaux de l’ASI sous guidage 2D. En cas d’echec, une seconde infiltration 2D etait realisee puis une derniere sous guidage 3D en cas d’echec iteratif. Une amelioration de la douleur sur l’ENS > 70 % dans les 2 premiers jours suivant l’infiltration validait le diagnostic. Le caractere intra-articulaire ou non de l’infiltration etait note. Quatre-vingt-quatorze patients d’âge moyen 57 ans ont ete inclus dont 70 % de femmes. Resultats Quatre-vingt-cinq patients sur 94 (90 %) ont ete ameliores par une des trois d’infiltrations. L’ENS moyen des patients etait de 8,6/10 (7–10) avant infiltration et de 1,7/10 apres infiltration (0–3) (p = 0,0001). Sur 146 infiltrations sous guidage 2D, on retrouvait 41 % d’efficacite et 61 % d’injections intra-articulaire. Sur 34 infiltrations avec guidage 3D on notait 73 % d’efficacite et 100 % d’injections intra-articulaires. Discussion Cette etude montre une diminution significative des douleurs d’origine sacro-iliaque apres infiltration sacro-iliaque intra-articulaire chez des patients restants douloureux apres arthrodese lombo-sacree. Cette infiltration si elle est non contributive sous anesthesie locale et TDM 2D peut etre repetee sous anesthesie generale et OARM 3D. Cette strategie diagnostique a permis de confirmer l’origine sacro-iliaque des douleurs apres arthrodese lombo-sacree chez 9 patients sur 10. Conclusion Apres echec de deux infiltrations sacro-iliaques sous controle TDM 2D, l’infiltration sous guidage 3D est une alternative permettant de diminuer significativement les douleurs d’origine sacro-iliaque apres arthrodese lombo-sacree. Niveau de preuve IV, etude retrospective.
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- 2020
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19. Prothèse totale de genou bilatérale en une session opératoire : complications tardives et courbe de survie
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Michel Carles, Yoann Lévy, Pascal Boileau, Antoine Raffaelli, Laurie Tran, Michel Azar, and Christophe Trojani
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine - Abstract
Resume Introduction La morbi-mortalite precoce du remplacement prothetique bilateral de genou (PTG Bi) en une session operatoire est un sujet d’interet dans la litterature medicale. L’evolution clinique a long terme de cette strategie est quant a elle bien moins etudiee. L’objectif de cette etude etait de rapporter les complications tardives (> 90 jours), les resultats cliniques, KOOS et new IKS, ainsi que la survie prothetique des PTG Bi en une session operatoire. L’hypothese etait qu’une strategie de PTG Bi en une session operatoire entrainait peu de complications tardives et une survie prothetique compatible avec les criteres du National Institute of health and Clinical Excellence (NICE). Methode Cette etude retrospective monocentrique a analyse sur une periode de 8 ans, entre 2009 et 2016, une cohorte de patients ASA 1 et 2 operes par PTG bilaterales en une session operatoire. La population se composait de 116 patients, en majorite des femmes (65,5 % femmes vs 34,5 % d’hommes) avec un âge moyen a l’inclusion de 69 ans (32–85 ans) ; 22,4 % des patients etaient ASA 1 et 77,6 % ASA 2. Les complications tardives prothetiques, mecaniques ou infectieuses survenues apres les 90 premiers jours postoperatoires, les resultats cliniques (scores KOOS, new IKS) et radiographiques, ainsi que la courbe de survie, ont ete enregistres lors des consultations de controle systematiques a 3 mois, 6 mois et 1 an postoperatoire et lors du suivi a long terme ou lors d’un evenement intercurrent. Resultats Aucun patient n’etait perdu de vue. Quinze complications etaient recensees (6,5 %) : 4 infections, 4 problemes rotuliens (3 « clunck syndrome » et un syndrome douloureux rotulien), 4 raideurs, 2 douleurs inexpliquees et une fracture periprothetique femorale. Huit patients ont ete readmis (6,9 %) ; il y a eu 7 re-operations (3 %) et 2 revisions prothetiques (0,9 %). Les scores fonctionnels (KOOS et new IKS) etaient ameliores de maniere significative et 87 % des patients se disaient satisfaits ou tres satisfaits par cette intervention. A 5 ans de recul moyen, l’estimation de la survie prothetique par la methode de Kaplan-Meier etait de 98,4 % (IC 95 % = 0,933–0,996) Conclusion La realisation de PTG Bi en une session operatoire est une strategie fiable car elle engendre un faible taux de complications tardives, d’excellents resultats a moyen terme ainsi qu’une courbe de survie compatible avec les criteres du NICE, permettant ainsi de verifier l’hypothese de cette etude. Niveau de preuve IV, etude retrospective.
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- 2020
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20. PTH bilatérales en une session opératoire versus PTH unilatérales : analyse comparative rétrospective
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Christophe Trojani, Michel Carles, Grégoire Micicoi, Lolita Micicoi, Pascal Boileau, Régis Bernard de Dompsure, and Laurie Tran
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Gynecology ,030222 orthopedics ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine ,business - Abstract
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.
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- 2020
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21. One-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study
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Lolita Micicoi, Michel Carles, Laurie Tran, Pascal Boileau, Régis Bernard de Dompsure, Christophe Trojani, and Grégoire Micicoi
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musculoskeletal diseases ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Population ,Osteoarthritis ,Hip replacement (animal) ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Patient satisfaction ,medicine ,Humans ,Orthopedics and Sports Medicine ,education ,Retrospective Studies ,030222 orthopedics ,education.field_of_study ,Rehabilitation ,business.industry ,030229 sport sciences ,medicine.disease ,Arthroplasty ,Surgery ,Treatment Outcome ,Case-Control Studies ,Implant ,business ,Total hip arthroplasty - Abstract
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.
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- 2020
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22. Infiltration sacro-iliaque naviguée sous OARM : nouvelle technique avec test de reflux
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Fernand de Peretti, Nicolas Bronsard, Yann Pelletier, Olivier Andreani, and Christophe Trojani
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030217 neurology & neurosurgery - Abstract
Resume Le syndrome douloureux sacro-iliaque (SDSI) degeneratif est de diagnostic difficile. L’infiltration sacro-iliaque, si elle soulage la douleur, confirme le diagnostic. L’objectif est de decrire une methode d’infiltration sacro-iliaque guidee par la navigation OARM. Cinquante-quatre patients d’âge moyen 58 ans presentant un SDSI non soulage apres 2 infiltrations avec guidage TDM 2D ont beneficie d’une infiltration sacro-iliaque avec navigation OARM. Un reflux du produit anesthesique lors du lavage articulaire validait la technique. L’efficacite clinique etait mesuree par la diminution de la douleur (ENS) apres l’infiltration (positif si > 70 %). Un reflux etait observe dans 92 % des cas. La douleur etait amelioree dans 81 % des cas : L’ENS passait de 8,5 a 3,1 en moyenne. L’infiltration sacro-iliaque sous navigation OARM est reproductible et ameliore les patients atteints de SDSI apres echec des infiltrations avec guidage 2D, confirmant le diagnostic clinique.
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- 2020
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23. Endovascular Occlusion of Neovascularization as a Treatment for Persistent Pain After Total Knee Arthroplasty
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Jean-François Gonzalez, Christophe Trojani, Jacques Sedat, Véronique Breuil, Yves Chau, Christian Roux, and Nicolas Amoretti
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Knee Joint ,medicine.medical_treatment ,Total knee arthroplasty ,Osteoarthritis ,Endovascular occlusion ,030218 nuclear medicine & medical imaging ,Neovascularization ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Unexplained pain ,Radiology, Nuclear Medicine and imaging ,Embolization ,Arthroplasty, Replacement, Knee ,Aged ,Aged, 80 and over ,Neovascularization, Pathologic ,business.industry ,Persistent pain ,Arterial Embolization ,Endovascular Procedures ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Female ,Chronic Pain ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Approximately 20% of patients have persistent unexplained pain after total knee arthroplasty (TKA). Currently available treatments are unsatisfactory. The present report describes four patients in whom transcatheter arterial embolization had a remarkable effect on pain after TKA. Abnormal neovessels were identified in all patients. For 48 h, one patient experienced remarkable postprocedural pain at the inner side of the knee that was subsided by level 1 analgesics and another patient development of a spontaneous skin ulceration resolving within 8 days. The mean Knee injury and Osteoarthritis Outcome Score pain subtotal had increased from 39 to 82 one month after treatment. Endovascular occlusion of neovascularization, decreasing chronic inflammation and the growth of unmyelinated sensory nerves may be treatment options for persistent unexplained pain following TKA. Level of Evidence IV, Case report.
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- 2020
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24. The impact of confinement on orthopaedic and trauma surgical activity
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Christophe Trojani, Pascal Boileau, Nicolas Bronsard, Gaya Ait Saada, Jean-François Gonzalez, and Jeremy Allia
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,business.industry ,Incidence (epidemiology) ,Surgery ,Secondary outcome ,Primary outcome ,Emergency medicine ,Cohort ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Observational study ,business ,Trauma surgery - Abstract
On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p0.001).This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.Confinement had a significant impact on orthopaedic and trauma surgical activity.III; comparative and retrospective.
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- 2023
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25. Latarjet arthroscopique avec une technique guidée et une fixation par double-bouton : résultats à long terme (minimum 10 ans de recul)
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Jules Descamps, Valentina Greco, Jean-Luc Raynier, Mikaël Chelli, Christophe Trojani, and Pascal Boileau
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Orthopedics and Sports Medicine ,Surgery - Published
- 2022
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26. Comparative study of bilateral total hip arthroplasty in one or two stages
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Grégoire, Micicoi, Régis, Bernard de Dompsure, Pascal, Boileau, and Christophe, Trojani
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Postoperative Complications ,Treatment Outcome ,Arthroplasty, Replacement, Hip ,Case-Control Studies ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Osteoarthritis, Hip ,Retrospective Studies - Abstract
Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA).This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed.Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results.Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis.III, retrospective comparative study.
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- 2022
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27. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation
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Pascal Boileau, Patrick Gendre, David J. Saliken, Charles-Édouard Thélu, and Christophe Trojani
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Adult ,Joint Instability ,Arthroscopy ,Sutures ,Shoulder Joint ,Shoulder Dislocation ,Suture Techniques ,Humans ,Orthopedics and Sports Medicine ,Surgery ,General Medicine ,Prospective Studies - Abstract
There is growing interest in using suture buttons for coracoid fixation to avoid the complications associated with screws during the Latarjet procedure. However, achieving bone block healing is critical for successful shoulder stabilization and return to sport. The purpose of this study was to assess and compare the healing rates and positioning of the coracoid bone block fixed with cortical suture buttons that were either manually tensioned (using a knot pusher) or mechanically tensioned (using a tensioning device) during arthroscopic Latarjet procedures.This prospective, nonrandomized, comparative study enrolled 69 consecutive patients (mean age, 27 years) who underwent an arthroscopic guided Latarjet procedure with suture-button fixation. Hand tensioning was performed in the first 34 shoulders, whereas the next 35 shoulders underwent mechanical tensioning. Twelve patients (17%) had a history of failed Bankart stabilization. The characteristics of the patients in each group in terms of age, sex, type of sport, bone loss, number of previous failed surgical procedures, smoking, and length of follow-up were comparable. Intraoperatively, the tensioning device was set at 100 N successively 3 times until complete immobilization of the bone block was confirmed, as assessed with a probe. The primary outcome measure was coracoid bone block union and position on computed tomography scan images at 6 months' follow-up. Secondary outcome measures included functional outcome scores, shoulder stability, return to sports, and complications at last follow-up.Overall, the rate of bone block healing was 74% (25 of 34 patients) in the hand-tensioning group and 94% (33 of 35 patients) in the mechanical tensioning group (P = .043). Smoking was an independent risk factor associated with nonunion (P .001) in each group. Patient age, size of the preoperative glenoid bone defect (20% or20%), and a history of surgery were not found to have any influence. The tensioning modality did not affect the bone block position, which was subequatorial in 92% of the cases and flush with the glenoid rim in 92%. At a mean of 34 months of follow-up (range, 24-62 months), 96% of the patients (65 of 69) had a stable shoulder and 87% returned to sports. At final follow-up, no significant difference in clinical scores was noted between the groups; no neurologic or hardware complications were observed.Mechanical tensioning achieves significantly higher healing rates than hand tensioning during the arthroscopic Latarjet procedure with suture-button fixation. The use of a suture-tensioning device is a key step to the suture-button fixation technique during arthroscopic Latarjet procedures. By making the suture-button construct rigid, the tensioning device transforms the initially flexible suture into a "rigid fixation", similar to a bolt (or a rivet).
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- 2021
28. Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
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Grégoire Micicoi, Michel Carles, Nicolas Bronsard, Laurie Tran, Régis Bernard de Dompsure, Christophe Trojani, and Pascal Boileau
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Adult ,Male ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Deep vein ,medicine.medical_treatment ,Operative Time ,Posterior approach ,Piriformis syndrome ,Fractures, Bone ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Venous Thrombosis ,030222 orthopedics ,Rehabilitation ,business.industry ,Mortality rate ,Retrospective cohort study ,030229 sport sciences ,Length of Stay ,Middle Aged ,medicine.disease ,Survival Analysis ,Thrombosis ,Surgery ,medicine.anatomical_structure ,Female ,France ,business ,Complication - Abstract
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.
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- 2019
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29. Morbi-mortalité précoce après prothèse totale de hanche bilatérale en une session opératoire : voie antérieure versus voie postérieure
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Grégoire Micicoi, Michel Carles, Pascal Boileau, Nicolas Bronsard, Laurie Tran, Régis Bernard de Dompsure, and Christophe Trojani
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine - Abstract
Resume Introduction Le remplacement prothetique de hanche bilateral en une session operatoire offre les avantages d’un seul sejour hospitalier, d’une seule anesthesie et d’une reeducation raccourcie. Des controverses existent concernant les risques perioperatoires, et en particulier la morbi-mortalite. Surtout, peu d’etudes comparent les voies d’abord anterieure directe (VA) et posterieure (VP) dans cette indication. Aussi, nous avons realise une etude retrospective comparative afin de comparer entre VA et VP : 1) la mortalite, 2) les complications precoces et le taux de readmission jusqu’a 90 jours, 3) la duree d’hospitalisation. Hypothese La mortalite precoce apres PTH bilaterale en une session operatoire est nulle et la morbidite precoce faible quelle que soit la voie d’abord realisee. Methode Cette etude retrospective monocentrique comparait la morbi-mortalite precoce dans les 90 premiers jours postoperatoires apres PTH bilaterale en une session operatoire entre deux groupes : VA (n = 55 patients) et VP (n = 82 patients). Tous les patients avaient un score ASA ≤ 2 et un âge ≤ 80 ans, ont ete operes de maniere continue entre 2004 et 2018. Les deux groupes etaient comparables concernant le sexe, l’âge, le score ASA, l’hemoglobine preoperatoire et l’indication de la prothese. Resultats Le taux de deces precoce etait nul dans les deux groupes. Trois complications precoces sont survenues dans le groupes VA et six dans le groupe VP (p = 0,74). Aucune difference n’etait observee pour chaque type de complications, trois complications majeures ont ete observees apres VA (p = 0,06) (deux accidents vasculaires cerebraux et une fracture peri-prothetique) et six complications mineures apres VP (une luxation, une irritation de l’ilio-psoas, un syndrome du piriforme, une escarre sacree et une thrombose veineuse profonde) (p = 0,08). La duree operatoire pour l’intervention bilaterale par VA etait de 144 minutes [110–195 min] contre 171 minutes [108–255] pour la VP (p Discussion La mortalite perioperatoire, apres PTH bilaterale en une session etait nulle dans cette population selectionnee de patients (ASA 1 et 2 Niveau de preuve III, etude comparative en serie continue.
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- 2019
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30. Attentat du 14 juillet 2016 à Nice : expérience des chirurgiens orthopédistes
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Pascal Boileau, Fernand de Peretti, Jonathan Thomas, Michel Carles, Jean-Luc Raynier, Lauryl Decroocq, Jean-François Gonzalez, and Christophe Trojani
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03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine ,030217 neurology & neurosurgery - Abstract
Resume Introduction Le 14 juillet 2016 un terroriste utilisant un camion a percute la foule sur la Promenade des Anglais a Nice. Le bilan final sera de 87 morts et de 458 blesses. L’objectif de cette etude etait d’evaluer la strategie de prise en charge des blesses osteo-articulaires lors de cet attentat. L’hypothese etait que cette strategie avait permis de respecter un delai de prise en charge inferieur a 6 heures pour les fractures ouvertes. Materiel et methode Il s’agit d’une etude retrospective monocentrique du 14 au 31 juillet 2016, incluant tous les patients victimes de l’attentat presentant une lesion osteo-articulaire et hospitalises a l’hopital Pasteur 2. Les criteres d’evaluation pour chaque patient etaient : l’âge, le sexe, le type de lesion, l’Injury Severity Score (ISS), le traitement par « Damage Controle Orthopedique » (DCO) ou par « Tout En Un Temps » (TEUT), son delai, la duree operatoire, les reprises. Le critere de jugement principal etait le delai de prise en charge des differentes lesions. Resultats Parmi les 182 patients admis aux urgences, 32 presentant des lesions osteo-articulaires ont necessite une hospitalisation. Dix-huit etaient traumatises severes (ISS > 15) et 11 polyfractures. Ils presentaient des lesions de traumatologie routiere avec 45 % de fractures des membres inferieurs dont 25 % etaient ouvertes. Quatorze patients ont ete operes la premiere nuit et 19 au total. Un DCO a ete utilise 12 fois et une strategie TEUT 7 fois. Tous les patients ont ete pris en charge dans des delais recommandes, en particulier les 21 fractures ouvertes et les 2 fractures fermees de diaphyse femorale. Discussion Tous les patients presentant des lesions osteo-articulaires ont ete pris en charge dans des delais recommandes. Pour 25 % d’entre eux, une chirurgie en un temps aurait ete possible dans ce contexte d’afflux massif non saturant. Type d’etude IV, etude retrospective.
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- 2019
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31. All-Arthroscopic Reconstruction of Severe Chronic Acromioclavicular Joint Dislocations
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Pascal Boileau, Nicolas Bronsard, Adam Wilson, Christophe Trojani, and Olivier Gastaud
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Adult ,Joint Instability ,Male ,Shoulder ,medicine.medical_specialty ,Shoulder surgery ,Radiography ,medicine.medical_treatment ,Joint Dislocations ,Biceps ,Coracoid ,Arthroscopy ,Rotator Cuff ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Acromioclavicular joint ,Orthopedics and Sports Medicine ,Rotator cuff ,Prospective Studies ,Aged ,Subluxation ,030222 orthopedics ,business.industry ,Shoulder Dislocation ,Suture Techniques ,030229 sport sciences ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Clavicle ,Surgery ,medicine.anatomical_structure ,Acromioclavicular Joint ,Ligaments, Articular ,Ligament ,Female ,business ,Follow-Up Studies - Abstract
PURPOSE To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6 weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations. METHODS We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n = 11), type IV (n = 19), and type V (n = 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39 months (range, 6 months to 17 years). The mean age at surgery was 42 years (range, 19-71 years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36 months (range, 12-72 months). RESULTS Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied. CONCLUSIONS All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability. LEVEL OF EVIDENCE Level IV, case series.
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- 2019
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32. Comments on: 'Negative influence of femoral nerve block on quadriceps strength recovery following total knee replacement: A prospective randomized trial' by M Angers, E Belzile, J Vachon, P Bauchamp-Chalifour, S Pelet published in Orthop Traumatol Surg Res 2019;105:633-37
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Christophe, Trojani and Laurie, Tran
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Humans ,Orthopedics and Sports Medicine ,Surgery ,Prospective Studies ,Anger ,Arthroplasty, Replacement, Knee ,Femoral Nerve ,Quadriceps Muscle - Published
- 2022
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33. Regarding 'The Top 50 Most-Cited Shoulder Arthroscopy Studies'
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Christophe Trojani
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Shoulder arthroscopy ,medicine.medical_specialty ,Shoulder ,medicine.diagnostic_test ,business.industry ,Shoulder Joint ,General surgery ,Arthroscopy ,MEDLINE ,Bibliometrics ,medicine ,Humans ,Orthopedics and Sports Medicine ,business - Published
- 2021
34. Liste des auteurs
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Gaëtan Aüllo-rasser, Nadia Bahlouli, S. Bahroun, Stijn Bartholomeeusen, Cécile Batailler, Philippe Boisrenoult, François Bonnomet, Nicolas Bouguennec, Yves Catonné, Étienne Cavaignac, Simone Cerciello, M. Cermolacce, Dimitri Charre, Steven Claes, Philippe Colombet, Harold Common, Julien Dartus, Bernard de Geofroy, David Dejour, Guillaume Demey, Stéphane Descamps, Émile Dobelle, Mathias Donnez, Adil Douiri, Matthieu Ehlinger, Roger Erivan, Jean-Charles Escudier, Maxime Fabre-aubrespy, Henri Favreau, Jean-Marie Fayard, Xavier Flecher, C. Foissey, Thomas Gicquel, Nicolas Graveleau, François-Xavier Gunepin, Lukas Hanak, J. Hernigou, Philippe Hernigou, C. Horteur, Christophe Hulet, Marie-Ève Isner, Christophe Jacquet, Nicolas Jan, Jean-Yves Jenny, E. Joseph, Raghbir S. Khakha, Kristian Kley, Hideyuki Koga, Sébastien Lustig, Pascal Maman, Chloé Masson, Marcelle Mercier, G. Mergenthaler, T. Mesnier, Grégoire Micicoi, Xavier Nicolau, Matthieu Ollivier, Régis Pailhé, Sébastien Parratte, Gilles Pasquier, Charles Pioger, César Praz, Nicolas Pujol, Sophie Putman, Goulven Rochcongar, Anouk Rozinthe, E. Sappey-marinier, Dominique Saragaglia, Pierre Sautet, Magali Schultz, Romain Seil, Elvire Servien, Renaud Siboni, Bertrand Sonnery-cottet, Robert Teitge, Matthieu Thaunat, Christophe Trojani, A. Urbain, Ronald J. van Heerwaarden, Anthony Viste, Franck Wein, and Adrian J. Wilson
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- 2021
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35. Feasibility, Acceptance and Safety of Ambulatory Shoulder Arthroplasty: A Pilot Study
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Pascal Boileau, Marc-Olivier Gauci, Tyler R. Johnston, Caroline Cointat, and Christophe Trojani
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Ambulatory ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,General Medicine ,business ,Arthroplasty - Published
- 2021
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36. A Population Pharmacokinetic Analysis of Continuous Infusion of Cloxacillin during Staphylococcus aureus Bone and Joint Infections
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François Jehl, Christophe Trojani, David Chirio, Jean-Luc Raynier, Mikaël Chelli, Johan Courjon, Sylvain Goutelle, Pierre-Marie Roger, Thibaud Lavrut, Elisa Demonchy, Antoine Grillon, Raymond Ruimy, Laura Cabane, Margaux Garzaro, Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë, and Université de Strasbourg (UNISTRA)
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Pharmacology ,0303 health sciences ,education.field_of_study ,030306 microbiology ,business.industry ,Population ,Liter ,[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences ,030226 pharmacology & pharmacy ,Crossover study ,3. Good health ,Penicillin ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Cloxacillin ,Pharmacokinetics ,Pharmacodynamics ,Anesthesia ,medicine ,Pharmacology (medical) ,Dosing ,education ,business ,medicine.drug - Abstract
Intravenous administration of antibiotics is recommended during the early phase of methicillin-susceptible S. aureus (MSSA) bone and joint infection (BJI). We sought to compare the plasma concentrations of cloxacillin administered alternately by continuous and intermittent infusion (CI and ItI) in patients with MSSA BJI. In this prospective crossover trial, patients were randomly assigned to receive either 3 days of CI (two 75-mg/kg 12-h cloxacillin infusions per day) and then 3 days of ItI (four 37.5-mg/kg 1-h cloxacillin infusions per day) or vice versa. The drug concentration measurement was performed on day 3 of each type of administration at 1, 6, and 11 h and at 1, 2, 3, 4, and 6 h after the beginning of CI and ItI, respectively. We used the nonparametric algorithm NPAG to estimate population pharmacokinetic (PK) parameters. The final model was used to perform pharmacokinetic/pharmacodynamic (PK/PD) simulations and calculate the probabilities of target attainment (PTA) for several ItI and CI dosing regimens. We considered two PK/PD targets of time spent above the MIC for free cloxacillin concentrations (fT>MIC): 50 and 100%. Eighty-four concentrations from 11 patients were analyzed. A two-compartment model adequately described the data. ItI with q6h regimens and short 1-h infusions of 2,000 or 3,000 mg were associated with low PTA, even for the low target (50% fT>MIC) while 3-h infusions and continuous infusions (6 to 12 g/day) were associated with a PTA of >90% for an MIC up to 0.5 mg/liter. These results support the use of prolonged or continuous infusion of cloxacillin in patients with BJI.
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- 2020
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37. Same-day bilateral total knee replacement versus unilateral total knee replacement: A comparative study
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Antoine Raffaelli, Yoann Lévy, Pascal Boileau, and Christophe Trojani
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Aged, 80 and over ,Treatment Outcome ,Knee Joint ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Blood Transfusion ,Osteoarthritis, Knee ,Arthroplasty, Replacement, Knee ,Retrospective Studies - Abstract
Bilateral total knee arthroplasty (TKA) in a single session is rarely done in France, mainly due to the increased risk of perioperative and late complications. The primary objective of this study was to compare the complication rates of same-day bilateral TKA (TKA bilat) with that of unilateral TKA (TKA unilat). The hypothesis was bilateral TKA increases the rate of early and late complications in a group of selected patients (ASA 1 or 2, less than 80 years of age).Retrospective comparative study of 91 bilat TKA and 182 unilat TKA cases operated on between 2009 and 2016 (1 bilat TKA paired with 2 controls). The patients were matched based on age, sex, indication and ASA score. The minimum follow-up was 2 years. Mortality along with early and late complications were documented. The secondary endpoints were implant survival, functional outcomes, and patient satisfaction.The early mortality rate was zero in both groups. The early complication rate was lower in the bilat TKA group (9%) than in the unilat TKA group (22%) (p0.001). The late complications did not differ between groups. Implant survival at 5 years was 99% (95% CI=[95.6-99.7]) in the bilat TKA group and 97% (95% CI=[92.8-98.8]) in the unilat TKA group. The autologous blood transfusion rate was 33% in the bilat TKA group and 2.2% in the unilat TKA group (p0.001). There was no difference between groups in the satisfaction rate or the KOOS and New IKS scores. A larger share of patients in the unilat TKA group (54%) said they had forgotten about their knee than in the bilat TKA group (43%) (p=0.036).There were few early complications in the bilat TKA group. There was no significant difference in the number of late complications, survival, functional scores, or patient satisfaction between the two groups. The transfusion rate was higher in the bilat TKA group, while the forgotten knee rate was higher in the unilat TKA group.Our hypothesis was not confirmed: in the context of this study, in patients who are ASA 1 or 2, and less than 80 years old, same-day bilateral TKA does not increase the complication rate relative to unilateral TKA.III, comparative study of continuous paired cases.
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- 2020
38. A Population Pharmacokinetic Analysis of Continuous Infusion of Cloxacillin during
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Johan, Courjon, Margaux, Garzaro, Pierre-Marie, Roger, Raymond, Ruimy, Thibaud, Lavrut, Mikaël, Chelli, Jean-Luc, Raynier, David, Chirio, Elisa, Demonchy, Laura, Cabane, François, Jehl, Christophe, Trojani, Antoine, Grillon, and Sylvain, Goutelle
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Staphylococcus aureus ,Humans ,Microbial Sensitivity Tests ,Prospective Studies ,Clinical Therapeutics ,Infusions, Intravenous ,Cloxacillin ,Anti-Bacterial Agents - Abstract
Intravenous administration of antibiotics is recommended during the early phase of methicillin-susceptible S. aureus (MSSA) bone and joint infection (BJI). We sought to compare the plasma concentrations of cloxacillin administered alternately by continuous and intermittent infusion (CI and ItI) in patients with MSSA BJI. In this prospective crossover trial, patients were randomly assigned to receive either 3 days of CI (two 75-mg/kg 12-h cloxacillin infusions per day) and then 3 days of ItI (four 37.5-mg/kg 1-h cloxacillin infusions per day) or vice versa. The drug concentration measurement was performed on day 3 of each type of administration at 1, 6, and 11 h and at 1, 2, 3, 4, and 6 h after the beginning of CI and ItI, respectively. We used the nonparametric algorithm NPAG to estimate population pharmacokinetic (PK) parameters. The final model was used to perform pharmacokinetic/pharmacodynamic (PK/PD) simulations and calculate the probabilities of target attainment (PTA) for several ItI and CI dosing regimens. We considered two PK/PD targets of time spent above the MIC for free cloxacillin concentrations (fT(>MIC)): 50 and 100%. Eighty-four concentrations from 11 patients were analyzed. A two-compartment model adequately described the data. ItI with q6h regimens and short 1-h infusions of 2,000 or 3,000 mg were associated with low PTA, even for the low target (50% fT(>MIC)) while 3-h infusions and continuous infusions (6 to 12 g/day) were associated with a PTA of >90% for an MIC up to 0.5 mg/liter. These results support the use of prolonged or continuous infusion of cloxacillin in patients with BJI.
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- 2020
39. Outpatient shoulder prostheses: Feasibility, acceptance and safety
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Marc Olivier Gauci, Pascal Boileau, Christophe Trojani, Caroline Cointat, Michel Azar, and Laurie Tran
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medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Outpatient surgery ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,Outpatients ,medicine ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies ,Bupivacaine ,030222 orthopedics ,business.industry ,Shoulder Joint ,Shoulder Prosthesis ,Retrospective cohort study ,030229 sport sciences ,Arthroplasty ,Surgery ,Catheter ,Treatment Outcome ,Arthroplasty, Replacement, Shoulder ,Feasibility Studies ,France ,business ,medicine.drug - Abstract
Outpatient surgery in France is defined by the national authority for health (HAS) as a scheduled surgery enabling same-day discharge without any increased risk to the patient. With the advent of enhanced recovery after surgery, outpatient lower limb arthroplasty has become a common procedure. However, only 1.1% of knee arthroplasties in France were performed on an outpatient basis in 2017.1) assess early morbidity and mortality after outpatient shoulder arthroplasties to validate eligibility and safety criteria; and 2) assess patient acceptance of outpatient surgery.A single-center study with the following inclusion criteria: primary shoulder arthroplasty, American Society of Anesthesiology (ASA) score I or II, no cognitive impairment, and no coronary artery or thromboembolic diseases. Analgesia was provided by bupivacaine via a peripheral nerve catheter in the first 72 hours followed by oral analgesics. Patients were discharged if the post-anesthetic discharge scoring system (PADSS) was9/10 and the visual analog scale (VAS) was5/10. Postoperative telephone interviews were carried out on D1, D2 and D3 to assess pain with the numerical rating scale and to collect data on their analgesic consumption. All patients were seen by an independent observer at one and six months for a clinical and radiologic follow-up and at 90 days during a consultation with the senior surgeon. The primary endpoint was the 90-day morbidity and mortality rate (readmissions, rehospitalizations, and minor and major complications). A satisfaction questionnaire was collected at one and six months.Thirty-six patients were offered an outpatient shoulder arthroplasty between February 2016 and February 2018: 12 (33%) refused with no valid reasons and 24 patients agreed to the procedure (seven hemiarthroplasties, nine anatomic shoulder arthroplasties and eight reverse shoulder arthroplasties). The mean age at surgery was 70 years (55-82), mean body mass index (BMI) was 26 (21-32) and 14 patients were ASA II (66%). Three patients (12%) refused same-day discharge despite a PADSS score9/10 and adequate pain management. Two patients (8%) were not discharged home on the same day as the surgery for medical reasons (one for pain and one for high blood pressure). No readmissions or complications were reported for the 19 outpatient arthroplasties. None of the outpatients used opioids. All patients were satisfied with their functional outcome, 84% were satisfied with the outpatient management and 17% felt they were insufficiently monitored and regretted that they were not hospitalized.1) outpatient shoulder arthroplasty can be safely proposed to selected patients with low comorbidities, regardless of their age and type of implant; 2) the acceptance rate for outpatient shoulder arthroplasty remained low among our patient population. These results should incite us to better educate patients about outpatient surgery.IV; retrospective study.
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- 2020
40. SECEC Grammont Award 2017: the prejudicial effect of greater tuberosity osteotomy or excision in reverse shoulder arthroplasty for fracture sequelae
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Gilles Clowez, Pascal Boileau, Gilles Walch, Brian L. Seeto, Mikaël Chelli, Christophe Trojani, and Marc-Olivier Gauci
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Radiography ,medicine.medical_treatment ,Awards and Prizes ,Reverse shoulder ,Osteotomy ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Fracture fixation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Societies, Medical ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Shoulder Joint ,030229 sport sciences ,General Medicine ,Recovery of Function ,Humerus ,Middle Aged ,Arthroplasty ,Surgery ,Prosthesis Failure ,Europe ,Humeral fracture ,Orthopedics ,Treatment Outcome ,Arthroplasty, Replacement, Shoulder ,Shoulder Fractures ,Constant score ,Female ,business ,Greater Tuberosity ,Follow-Up Studies - Abstract
The aim was to evaluate risk factors for complications, revision, and mid- to long-term outcomes after reverse shoulder arthroplasty (RSA) implanted for proximal humeral fracture sequelae (PHFS).The radiographs of 98 patients (mean age, 68 years) who underwent RSA for the treatment of PHFS were reviewed at a minimum 5-year follow-up. PHFS were divided into 4 types according to the Boileau classification: type 1 (46 cases), type 2 (6 cases), type 3 (12 cases), and type 4 (34 cases). The tuberosities underwent osteotomy in 28 cases and excision in 12 (all type 3 or 4 PHFS). The mean follow-up period was 8.4 years (range, 5-14 years).The functional results and rate of RSA survival without revision (85% vs. 100% at 10 years, P = .007) were significantly lower for types 3 and 4 vs. types 1 and 2. Overall, our findings showed that RSA for PHFS is not the panacea that surgeons once believed: At a mean follow-up of 8.5 years (range, 5-14 years), 59% of the patients in our series had fair or poor results. Patients who underwent tuberosity osteotomy or excision had lower functional results (adjusted Constant score, 69% vs. 88%; P.001), more postoperative complications (32% vs. 9%, P = .003), and a higher revision rate (15% vs. 2%, P = .017). Patients who underwent tuberosity osteotomy or excision at the time of RSA were at risk of postoperative prosthetic instability and humeral stem loosening. The absence of the greater tuberosity at last radiographic follow-up was predictive of higher rates of complications and revisions, as well as a poorer final outcome. Previous fracture fixation was associated with a higher rate of complete tuberosity resorption (56% vs. 33%, P = .026) and with higher rates of postoperative complications (27% vs. 13%, P = .099) and reinterventions (17% vs. 2%, P = .018).The functional results and rates of complications and revision depend on the type of fracture sequelae and tuberosity management. Patients with more severe (type 3 and 4) fracture sequelae who undergo tuberosity osteotomy or excision are at risk of having a poorer functional result and higher rates of complications and revision with lower survival. Previous fracture fixation is also a prejudicial factor.
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- 2020
41. Reverse Shoulder Arthroplasty Beats Anatomical Arthroplasty For Severe Malunion Of Proximal Humerus Fractures In Patients Younger Than 60 Years
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Mikaël Chelli, Christophe Trojani, Jean-Luc Raynier, Jean-François Gonzalez, Marc-Olivier Gauci, Laurent Blasco, and Pascal Boileau
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Orthopedics and Sports Medicine ,Surgery ,General Medicine - Published
- 2022
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42. Morbi-mortalité précoce après prothèses totales de genou bilatérales en une session opératoire
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Yoann Lévy, Pascal Boileau, Laurie Tran, Nicolas Bronsard, Michel Azar, and Christophe Trojani
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine - Abstract
Resume Introduction Le remplacement prothetique de genou bilateral en une session operatoire offre les avantages d’un seul sejour hospitalier, d’une seule anesthesie, d’une reeducation raccourcie et d’une diminution du cout de prise en charge par patient. Cependant, des controverses existent, notamment du fait du risque perioperatoire. L’hypothese de cette etude etait que cette strategie n’engendre pas de mortalite perioperatoire precoce, ainsi qu’un taux de readmission et une morbidite precoces faibles dans une population de patients selectionnes par le score ASA. Methode Cette etude retrospective monocentrique a analyse, sur une periode de 8 ans entre 2009 et 2016, une cohorte de patients ASA 1 et 2 operes par PTG bilaterales en une session operatoire. La population etudiee se composait de cent seize patients, en majorite des femmes avec un âge moyen a l’inclusion de 69 ans ; 22,4 % des patients etaient ASA 1 et 77,6 % ASA 2. Les deces, les complications precoces, dans les 90 premiers jours postoperatoires, le taux de readmission precoce et la strategie d’epargne sanguine ont ete analyses, a partir des donnees cliniques et paracliniques relevees lors de l’hospitalisation, lors du sejour systematique en centre de convalescence, et lors des consultations de controle systematiques a 6 semaines et 3 mois postoperatoire. L’analyse a ete completee a l’aide du logiciel intra-hospitalier Clinicom, qui permet une tracabilite de tous les evenements et de tous les episodes pour chaque patient. Resultats Le taux de deces precoce etait nul. Cinq complications majeures (4,3 %) et treize complications mineures (11 %) ont ete observees. Le taux de readmission precoce etait de 5,2 %. La transfusion homologue postoperatoire concernait 36 % des patients et a ete diminuee par l’acide tranexamique a 24,3 % versus 44 % pour les patients sans acide tranexamique, (p = 0,06). Conclusion La mortalite perioperatoire, dans cette population selectionnee est nulle et la morbidite precoce acceptable. Le taux de readmission precoce est faible. Proposer une PTG bilaterale en une session operatoire a un patient repondant aux criteres definis dans cette etude est donc une strategie recevable. Niveau de preuve IV, etude retrospective.
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- 2018
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43. Combination of blood and biphasic calcium phosphate microparticles for the reconstruction of large bone defects in dog: A pilot study
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Ez-Zoubir Amri, Christophe Trojani, Damien Ambrosetti, Thierry Balaguer, Olivier Gauthier, Jean-Michel Bouler, Marine Traverson, Xavier Mouska, Florian Boukhechba, Bérengère Dadone, Nathalie Rochet, Borhane H. Fellah, and Jean-François Michiels
- Subjects
Materials science ,Mature Bone ,0206 medical engineering ,Autologous blood ,Ulna ,Metals and Alloys ,Biomedical Engineering ,Biomaterial ,FEMORAL CONDYLE ,02 engineering and technology ,021001 nanoscience & nanotechnology ,Biphasic calcium phosphate ,Autologous bone ,020601 biomedical engineering ,Ectopic bone formation ,Biomaterials ,medicine.anatomical_structure ,Ceramics and Composites ,medicine ,sense organs ,0210 nano-technology ,Biomedical engineering - Abstract
We previously reported that biphasic calcium phosphate (BCP) microparticles embedded in a blood clot induces ectopic bone formation in mice and repairs a critical femoral defect in rat. The present pilot study aimed to evaluate in dog and in two models of large defects the efficacy of this composite named "blood for reconstruction of bone" (BRB). We show here that BRB is a cohesive biomaterial easy to prepare from dog autologous blood and to mold to fill large bone defects. First in a model of cylindrical femoral condyle defect, the BRB was compared with BCP particles alone. After 8 weeks, this revealed that the amount of mature bone was slightly and significantly higher with BRB than with BCP particles. Second, in a model consisting in a 2 cm-long critical interruptive defect of the ulna, the BRB was compared with autologous bone. After 6 months, we observed that implantation of BRB can induce the complete reconstruction of the defect and that newly formed bone exhibits high regenerative potential. Comparison with the results obtained with autologous bone grafting strongly suggests that the BRB might be an efficient biomaterial to repair large bone defects, as an alternative or in addition to autologous bone. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1842-1850, 2018.
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- 2018
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44. À propos de : « Effet négatif du bloc fémoral sur la force de récupération du quadriceps après prothèse totale du genou : un essai prospectif randomisé » par M Angers, E Belzile, J Vachon, P Bauchamp-Chalifour, S Pelet. Publié dans Rev Chir Othop Traumatol 2019 ; Juin 105(4) : 428-32
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Laurie Tran and Christophe Trojani
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business.industry ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,business - Published
- 2021
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45. High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
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Pascal Boileau, Christophe Trojani, and Grégoire Micicoi
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Adult ,Genu recurvatum ,medicine.medical_specialty ,Knee Joint ,medicine.medical_treatment ,Hyperextension ,Tibial tuberosity ,Osteotomy ,Deformity ,medicine ,Humans ,Orthopedics and Sports Medicine ,Tibia ,Retrospective Studies ,business.industry ,Patella ,musculoskeletal system ,medicine.disease ,Sagittal plane ,Surgery ,medicine.anatomical_structure ,Ligaments, Articular ,Female ,medicine.symptom ,business ,human activities - Abstract
Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments.Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension.Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores).The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p0.01). The IKDC and Lecuire scores improved.Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term.IV, retrospective descriptive study.
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- 2021
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46. Sacroiliac joint syndrome after lumbosacral fusion
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Fernand de Peretti, Olivier Andreani, Christophe Trojani, Yann Pelletier, Hugo Darmanté, and Nicolas Bronsard
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.drug_class ,Physical examination ,Injections, Intra-Articular ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Imaging, Three-Dimensional ,Lumbosacral fusion ,medicine ,Humans ,Orthopedics and Sports Medicine ,Local anesthesia ,Retrospective Studies ,Sacroiliac joint ,030222 orthopedics ,medicine.diagnostic_test ,Local anesthetic ,business.industry ,Retrospective cohort study ,Sacroiliac Joint ,030229 sport sciences ,Middle Aged ,Low back pain ,Surgery ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,Female ,medicine.symptom ,business ,Tomography, X-Ray Computed - Abstract
Introduction One-third of low back pain cases are due to the sacroiliac (SI) joint. The incidence increases after lumbosacral fusion. A positive Fortin Finger Test points to the SI joint being the origin of the pain; however, clinical examination and imaging are not specific and minimally contributory. The gold standard is a test injection of local anesthetic. More than 70% reduction in pain after this injection confirms the SI joint is the cause of the pain. The aim of this study was to evaluate the decrease in pain on a Numerical Rating Scale (NRS) after intra-articular injection into the SI joint. We hypothesised that intra-articular SI injection will significantly reduce SI pain after lumbosacral fusion. Methods All patients with pain (NRS > 7/10) suspected of being caused by SI joint syndrome 1 year after lumbosacral fusion with positive Fortin test were included. Patients with lumbar or hip pathologies or inflammatory disease of the SI joint were excluded. Each patient underwent a 2D-guided injection of local anesthetic into the SI joint. If this failed, a second 2D-guided injection was done; if this also failed, a third 3D-guided injection was done. Reduction of pain on the NRS by > 70% in the first 2 days after the injection confirmed the diagnosis. Whether the injection was intra-articular or not, it was recorded. Ninety-four patients with a mean age of 57 years were included, of which 70% were women. Results Of the 94 patients, 85 had less pain (90%) after one of the three injections. The mean NRS was 8.6/10 (7–10) before the injection and 1.7/10 after the injection (0–3) (p = 0.0001). Of the 146 2D-guided injections, 41% were effective and 61% were intra-articular. Of the 34 3D-guided injections, 73% were effective and 100% were intra-articular. Discussion This study found a significant decrease in SI joint-related pain after intra-articular injection into the SI joint in patients who still had pain after lumbosacral fusion. If this injection is non-contributive when CT-guided under local anesthesia, it can be repeated under general anesthesia with 3D O-arm guidance. This diagnostic strategy allowed us to confirm that pain originates in the SI joint after lumbosacral fusion in 9 of 10 patients. Conclusion If the first two CT-guided SI joint injections fail, 3D surgical navigation is an alternative means of doing the injection that helps to significantly reduce SI joint-related pain after lumbosacral fusion. Level of evidence IV, retrospective study.
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- 2019
47. One-session bilateral total knee replacement: Late complications and survivorship
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Pascal Boileau, Yoann Lévy, Antoine Raffaelli, Laurie Tran, Michel Azar, Michel Carles, and Christophe Trojani
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Male ,Reoperation ,medicine.medical_specialty ,Periprosthetic ,Nice ,Survivorship ,03 medical and health sciences ,0302 clinical medicine ,Survivorship curve ,medicine ,Humans ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,Survival analysis ,computer.programming_language ,Retrospective Studies ,030222 orthopedics ,business.industry ,Retrospective cohort study ,030229 sport sciences ,Surgery ,Treatment Outcome ,Radiological weapon ,Cohort ,Female ,Implant ,business ,Knee Prosthesis ,computer ,Follow-Up Studies - Abstract
Introduction The early morbidity and mortality of one-session bilateral total knee arthroplasty (1-session BTKA) has been reported in the medical literature. However, there is less information about the long-term clinical impact of this strategy. The aim of this study was to report on the late complications (> 90 days), clinical outcomes (KOOS and new KSS) along with the survivorship of 1-session BTKA. We hypothesised that 1-session BTKA will cause few late complications and that the implant survival will meet the criteria of the National Institute for Health and Clinical Excellence (NICE). Methods This single-centre retrospective study analysed a cohort of ASA-1 and ASA-2 patients who underwent 1-session BTKR over an 8-year period (2009 to 2016). The cohort consisted of 116 patients (66% women, 34% men) with mean age at inclusion of 69 years (32–85 years); 22% of patients were ASA-1 and 78% were ASA-2. The implant-related, infection-related or mechanical complications that occurred more than 90 days after the operation, the clinical outcomes (KOOS and New KSS) and radiological outcomes, along with the survivorship were determined during the scheduled follow-up visits at 3 months, 6 months and 1 year postoperative and during the long-term follow-up or during an intercurrent event. Results No patients were lost to follow-up. Fifteen complications occurred (6.5%): four infections, four patellar problems (three cases of clunk syndrome and one of patellofemoral pain), four cases of stiffness, two of unexplained pain and one femoral periprosthetic fracture. Eight patients were readmitted to the hospital (7%); seven were reoperated (3%) and two implants were revised (1%). The functional outcomes (KOOS and New KSS) were significantly improved and 87% of patients were satisfied or very satisfied with this procedure. At a mean follow-up of 5 years, the survivorship estimated using the Kaplan–Meier method was 98.4% (95% CI: 0.933–0.996). Conclusion Performing 1-session BTKA is a reliable strategy as it produces a low rate of late complications, excellent medium-term functional outcomes and survivorship that meets NICE criteria, thus confirming our hypothesis. Level of evidence IV, retrospective case series.
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- 2019
48. O-arm-guided sacroiliac joint injection: New techniques with reflux test
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Nicolas Bronsard, Olivier Andreani, Yann Pelletier, Fernand de Peretti, and Christophe Trojani
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musculoskeletal diseases ,medicine.medical_specialty ,Sacroiliac joint injection ,Pain relief ,Injections, Intra-Articular ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Clinical efficacy ,030222 orthopedics ,business.industry ,Reflux ,Mean age ,Sacroiliac Joint ,030229 sport sciences ,Middle Aged ,musculoskeletal system ,Surgery ,Surgery, Computer-Assisted ,SACROILIAC PAIN ,Clinical diagnosis ,business ,Tomography, X-Ray Computed ,Low Back Pain - Abstract
Diagnosis of degenerative sacroiliac pain syndrome is difficult. Sacroiliac injection confirms diagnosis by relieving pain. The present study aimed to describe a sacroiliac injection technique under O-arm guidance. Fifty-four patients, with a mean age of 58 years, presenting resistant sacroiliac pain syndrome after two 2D CT-guided injections received O-arm guided sacroiliac injection. Anesthetic reflux on joint lavage validated the technique. Clinical efficacy was assessed as pain relief on a simple numeric scale (positive if>70%). Reflux was observed in 92% of cases. Pain was relieved in 81%, with mean score reduced to 3.1 from 8.5. O-arm guided sacroiliac injection was reproducible and relieved sacroiliac pain after failure of 2D-guided injection, thus confirming the clinical diagnosis.
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- 2019
49. La fixation des butées coracoïdiennes par boutons corticaux : une alternative à la fixation par vis ?
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Thomas D’ollonne, C E Thelu, Pascal Boileau, Christophe Trojani, Jean-François Gonzalez, and Patrick Gendre
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030222 orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics and Sports Medicine ,Surgery ,030229 sport sciences - Abstract
Resume Introduction L’objectif de cette etude etait d’evaluer la consolidation osseuse des butees coracoidiennes fixees par suture et boutons corticaux. L’hypothese etait que (1) la fixation des butees coracoidiennes par suture et boutons corticaux pourrait etre une alternative a la fixation par vis, permettant d’obtenir la consolidation osseuse et (2) reduirait le taux de complications traditionnellement rapporte avec les vis. Materiel et methode Etude retrospective de 70 patients (âge moyen 27 ans) presentant une instabilite anterieure recidivante de l’epaule, operes par butee coracoidienne sous arthroscopie. Les patients ont ete inclus dans 2 groupes en fonction du positionnement de la butee sur la face anterieure du col de la glene : groupe A (35 patients) butee en position debout (technique Bristow) et groupe B (35 patients) butee en position couchee (technique Latarjet). La fixation de la butee etait assuree par deux boutons corticaux relies par des fils de suture. Un scanner postoperatoire etait realise a 2 semaines pour controler le positionnement et a 6 mois minimum pour controler la consolidation osseuse de la butee. Resultats La butee etait sous-equatoriale dans 93 % des cas et affleurante au bord anterieur de la glene dans 94 % des cas. La consolidation osseuse globale etait de 83 % (58/70), avec 74 et 91 % respectivement dans les groupes A et B. Il n’a pas ete constate de migration de la butee ni de bris de materiel. Conclusions (1) La fixation de la butee coracoidienne par suture et boutons corticaux est une alternative a la fixation par vis permettant d’obtenir la consolidation osseuse. (2) La consolidation osseuse a ete obtenue de facon plus reproductible en position couchee et (3) les complications signalees classiquement avec les vis n’ont pas ete retrouvees. Niveau de preuve Niveau IV.
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- 2016
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50. The 14 July 2016 terrorist attack in Nice: The experience of orthopaedic surgeons
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Michel Carles, Jean-François Gonzalez, Jean-Luc Raynier, Jonathan Thomas, Pascal Boileau, Christophe Trojani, Fernand de Peretti, and Lauryl Decroocq
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Nice ,Time-to-Treatment ,03 medical and health sciences ,Fractures, Bone ,Fractures, Open ,Young Adult ,0302 clinical medicine ,Injury Severity Score ,Medicine ,Humans ,Mass Casualty Incidents ,Orthopedics and Sports Medicine ,Damage control orthopaedics ,Multiple fractures ,computer.programming_language ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Multiple Trauma ,General surgery ,Retrospective cohort study ,030229 sport sciences ,Emergency department ,Evidence-based medicine ,Middle Aged ,Surgery ,Motor Vehicles ,Operative time ,Female ,Joints ,Diaphyses ,France ,business ,computer - Abstract
Background On 14 July 2016, a terrorist drove a truck through the crowd on the Promenade des Anglais in Nice, France, killing 87 people and injuring 458. The objective of this study was to evaluate the management strategy used to handle the osteo-articular injuries caused by this attack. Hypothesis The management strategy used ensured that open fractures were treated within 6 hours. Material and method This single-centre retrospective study included all victims of the attack admitted to the Pasteur 2 Hospital in Nice, France, for osteo-articular injuries, and treated between 14 and 31 July 2016. The following data were collected for each patient: age, sex, type of injury, Injury Severity Score (ISS), whether the damage control orthopaedics (DCO) or early total care (ETC) approach was followed, time from injurytotreatment, operative time, and surgical revisions. The primary outcome measure was the injury to treatment time for each lesion. Results Of the 182 patients admitted to the emergency department, 32 required admission for osteo-articular injuries, including 18 with severe injuries (ISS > 15) and 11 with multiple fractures. Their injuries were of the type seen in traffic accidents. Of the 87 fractures, 45% involved the lower limbs and 25% were open fractures. Surgery was performed in 14 patients on the first night (14 to 15 July) and in 19 patients overall. The approach was DCO in 12 and ETC in 7 of these 19 patients. All lesions were managed within recommended time intervals, including the 21 open fractures and 2 closed femoral shaft fractures. Discussion Injury-to-surgery time complied with recommendations in all cases. In 25% of cases, ETC would have been feasible during the mass influx of patients without hospital capacity saturation. Level of evidence IV, retrospective observational study.
- Published
- 2018
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