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The purpose of this study was to assess the outcomes of a new arthroscopic Trillat technique at a 2-year follow-up. Our current hypothesis was that this technique could be used for the effective treatment of chronic post-traumatic unidirectional anterior shoulder instability, and that the recurrence and complication rates, external rotation, and functional outcomes would be as good as those of the reference technique.Between April 2012 and August 2016, all patients older than 16 years who underwent the arthroscopic Trillat technique for unidirectional chronic post-traumatic anterior shoulder instability at the Dijon University Hospital (France), after the failure of well-conducted medical and rehabilitation treatment with at least 24 months of follow-up, were included. Criteria for noninclusion were association with posterior and/or inferior instabilities, voluntary instabilities, and glenoid bone loss greater than 20%. Patients attended follow-up with their surgeon before the intervention, in the immediate postoperative period, at 6 weeks, 3 and 6 months, and then by an independent observer for the last evaluation. Patients were then examined clinically with scores such as Constant, Rowe and Walch-Duplay scores, and subjective shoulder value, for shoulder range of motion, and radiographically (anteroposterior and Lamy's lateral x-rays of the operated shoulder).Forty-nine patients and 52 shoulders were included, with a mean follow-up of 40 months (range, 24-71 months). The recurrence rate of instability was 3.8% (2 of 52). No conversion to arthrotomy was necessary. No intraoperative complications, postoperative neurological lesions, or sepsis were observed. The mean Constant score was 92.1 (77.5-100) points, Walch-Duplay 82.9 (40-100), Rowe 81.73 (5-100), and subjective shoulder value 86.1 (50-100) at the last follow-up. The arm at side external rotation limitation averaged 8.4° (-25° to 40°) and the external rotation with 90° arm abduction limitation 0.34° (-5° to 15°). Forty-one patients (79%) resumed their sports activity at the same level. Fifty patients (96%) were satisfied to very satisfied. One patient developed nonunion of the coracoid process and subsequently underwent a Latarjet procedure with a good outcome.The arthroscopic Trillat procedure offers good outcomes as a first-line treatment for chronic anterior post-traumatic glenohumeral instability. It should be excluded in cases of glenoid loss greater than 20%.

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

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

Summary Objective This pragmatic, multicenter, open-label, randomized controlled trial (RCT) aimed to compare the effectiveness, safety, and cost–utility of a custom-made knee brace versus usual care over 1 year in medial knee osteoarthritis (OA). Design 120 patients with medial knee OA (VAS pain at rest >40/100), classified as Kellgren–Lawrence grade II-IV, were randomized into two groups: ODRA plus usual care (ODRA group) and usual care alone (UCA group). The primary effectiveness outcome was the change in VAS pain between M0 and M12. Secondary outcomes included changes over 1 year in KOOS (function) and OAKHQOL (quality of life) scores. Drug consumption, compliance, safety of the knee brace, and cost–utility over 1 year were also assessed. Results The ODRA group was associated with a higher improvement in: VAS pain (adjusted mean difference of −11.8; 95% CI: −21.1 to −2.5); all KOOS subscales (pain: +8.8; 95% CI: 1.4–16.2); other symptoms (+10.4; 95% CI: 2.7–18); function in activities of daily living (+9.2; 95% CI: 1.1–17.2); function in sports and leisure (+12.3; 95% CI: 4.3–20.3); quality of life (+9.9; 95% CI: 0.9–15.9), OAKHQOL subscales (pain: +14.8; 95% CI: 5.0–24.6); and physical activities (+8.2; 95% CI: 0.6–15.8), and with a significant decrease in analgesics consumption at M12 compared with the UCA group. Despite localized side-effects, observance was good at M12 (median: 5.3 h/day). The ODRA group had a more than 85% chance of being cost-effective for a willingness-to-pay threshold of €45 000 per QALY. Conclusions The ERGONOMIE RCT demonstrated significant clinical benefits of an unloader custom-made knee brace in terms of improvements in pain, function, and some aspects of quality of life over 1 year in medial knee OA, as well as its potential cost–utility from a societal perspective.

Hip dysplasia and femoroacetabular impingement are pathologies whose impact on the function and survival of the hip joint is no longer debated. Labral tears may be present and impact the prognosis of the causal pathology. Labral tear management lacks consensus and still raises several questions, thus we conducted a systematic analysis to clarify: 1) What is its prevalence in hip dysplasia and femoroacetabular impingement? 2) Does it modify the symptomatology of the causal pathology? 3) Is its repair better than resection or abstention?A systematic literature review was carried out following the PRISMA guidelines, using the Medline and Embase databases and including all articles in French or English, written until June 2022 referring to labral tears in hip dysplasia and femoroacetabular impingement. The articles were analyzed by 2 surgeons in order to select them according to a predefined algorithm. 1) Articles were selected by title from the search results. 2) A selection based on the abstract was then made. 3) A final selection was made upon complete reading. 4) In the event of a discrepancy during the selection, a third co-author was contacted for a final decision. 5) Data extraction was then carried out by the two readers using a preformatted sheet.Of the 1177 articles identified, 43 articles were kept for the final analysis. The prevalence of labral tears was on average 78.80±4.7% [17 to 100%] in dysplasia and 93.8±16.8% [33% to 100%] in impingement. The review did not reveal any symptomatology specific to the labral tear. In dysplasia, 5 comparative studies were analyzed. A single study on shelf arthroplasties demonstrated the negative impact of a labral tear in the event of resection on survival compared to no tear (83% versus 15.2% (p = 0.048)). Regarding impingements, 8 comparative studies were analyzed. At 7 years of follow-up, only one study found a significant and clinically relevant functional gain in terms of MCID (minimal clinically important difference) for labral repair compared to debridement on the mHHS score (p = 0.008), SF-12 score (p = 0.012), and pain scale (p = 0.002). One study showed superiority of repair over labral debridement in terms of 10-year survival (78% 95% CI [64-92%] vs 46% 95% CI [26-66%] (p = 0.009)).The literature analysis was heterogeneous with a few comparative studies and predominantly short periods of follow-up. Understanding labral pathology and its impact requires differentiating between the different tear categories and proposing treatment to restore or preserve the biomechanical properties of the joint.IV, Systematic Review of Level 1-4 Evidence.

Several studies have investigated the influence of body mass index (BMI) on functional gain after total hip replacement (THR) or total knee replacement (TKR) in osteoarthritis, with contradictory results. This systematic literature review was conducted to ascertain whether obesity affects functional recovery after THR or TKR in the short (1 year), medium (3 years) and long term (3 years).The study was registered with PROSPERO and conducted according to the PRISMA guidelines. A systematic literature search was conducted across Medline and EMBASE databases for articles published between 1980 and 2020 that investigated patient-reported measures of functional recovery after THR and TKR in participants with osteoarthritis and obesity (defined as BMI ≥30 kg/mTwenty-six articles reporting on 68,840 persons (34,955 for THR and 33,885 for TKR) were included in the final analysis: 5 case-control studies, 21 cohort studies (9 for THR only, 10 for TKR only and 2 for both). The average minimum follow-up was 36.4 months, ranging from 6 weeks to 10 years. Most studies found significantly lower pre-operative patient-reported functional scores for participants with obesity. After THR, there was a small difference in functional recovery in favor of those without obesity in the short term (6 months), but the difference remained below the minimal clinically important difference (MCID) threshold and disappeared in the medium and long term. After TKR, functional recovery was better for those with obesity than those without in the first year, similar until the third year, and then decreased thereafter.Although there is a paucity of high-quality evidence, our findings show substantial functional gains in people with obesity after total joint replacement. Functional recovery after THR or TKR does not significantly differ, or only slightly differs, between those with and without obesity, and the difference in functional gain is not clinically important.CRD42018112919.

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

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

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

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

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

Total hip arthroplasty (THA) in patients with acetabular bone defects is associated with a high risk of dislocation and aseptic loosening. No studies to date have examined the use of uncemented and augmented dual mobility cups (DMC) in patients with acetabular defects. We hypothesized that the use of augmented DMC under these conditions would reduce the dislocation rate and lead to satisfactory bone integration in the medium term despite acetabular bone defects.This continuous multicenter study included all cases of augmented DMC performed between 2010 and 2017 in patients with acetabular bone loss (Paprosky 2A: 46%, 2B: 32%, 2C: 15% and 3A: 6%). The indications for implantation were revisions for cup aseptic loosening (AL) (n=45), femoral stem AL (n=3), bipolar AL (n=11), septic loosening (n=10), periprosthetic fracture (n=5), chronic dislocation (n=4), intraprosthetic dislocation (n=2), cup impingement (n=1), primary posttraumatic arthroplasty (n=8), and acetabular dysplasia (n=4). The clinical assessment consisted of the Harris hip score (HHS) and Merle d'Aubigné Postel score (MDP), along with preoperative and final follow-up radiographs. The primary endpoint was surgical revision for aseptic acetabular loosening or the occurrence of dislocation.Overall, 93 patients were reviewed at a mean follow-up of 5.3 ± 2.3 years [0, 10]. As of the last follow-up, the acetabular cup had been changed in five cases: 3 AL (3.2%) and 2 infections (2.1%). Thus the overall survivorship of the cup was 94.6% and the survivorship for AL was 96.8%. Three patients (3%) suffered a dislocation. At the last follow-up visit, the mean MDP and HHS scores were 14.75 and 72.15, respectively, which reflected significant improvements relative to the preoperative scores (p0.05).Use of an uncemented and augmented DMC in cases of acetabular bone defect leads to satisfactory medium-term results with low dislocation and loosening rates. We recommend its use in these cases.

Outcome in hip fracture patients tends to be poor, with an associated death rate of 20 to 33%. The primary aim of our monocentric retrospective study was to compare mortality rates one year after surgery in patients with extracapsular fracture versus patients with intracapsular fracture of the proximal femur. Our secondary aims were the evaluation of functional independence and the rate of institutionalization one year after surgery.We compared two groups of 100 patients. The first group had an average age of 83.2 years, and the patients underwent total hip replacement for intracapsular fracture. Patients in the second group, who underwent osteosynthesis for extracapsular fracture, were aged 83.6 years on average.One year post-surgery, there was not a significant difference in mortality between the two groups (23% for extracapsular fracture vs 22% for intracapsular fracture). The rate of independent walking was significantly better in the intracapsular fracture group (42.3% vs 27.3%, p=0.047), and the rate of institutionalization was significantly higher in the extracapsular fracture group (35.8% vs 17.3%, p=0.043).Elderly patients with hip fracture are prone to poor outcomes. When compared with osteosynthesis, total hip replacement does not lead to higher mortality rates though it is a more complex surgery. Our findings raise questions regarding of treatment for extracapsular fracture and the choice between osteosynthesis or total hip replacement with a reconstruction of the proximal femur.

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

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

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

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

Introduction Le Trillat arthroscopique est une technique aux resultats preliminaires interessants. Notre objectif etait d’evaluer son efficacite en traitement de premiere intention dans l’instabilite chronique anterieure d’epaule. Materiels et methode Nous avons inclus dans cette etude monocentrique retrospective continue les patients operes en premiere intention pour instabilite gleno-humerale anterieure chronique d’avril 2012 a aout 2016, avec deux ans de recul minimum. Le critere principal de jugement etait la survenue d’un nouvel accident d’instabilite. Les criteres secondaires etaient la recuperation fonctionnelle (scores cliniques, reprise sportive, amplitudes articulaires), la satisfaction du patient, l’evolution de la trophicite du muscle sub-scapularis, la position de la vis et de la coracoide. Resultats Quarante-neuf patients pour 52 epaules ont ete inclus. L’âge moyen etait de 25,4 an s (16–63). Le recul moyen etait de 40 mois (24–83). Le taux de recidive etait de 3,8 % (2/52). Le score global moyen selon Walch-Duplay etait de 82,9 (40–100) et le score SSV etait de 86,17 (50–100). Le delai moyen de reprise sportive etait de 4,3 mois (2–12) chez les patients exercant une activite de categorie 2 ou plus dans la classification de Duplay. 79 % des patients ont repris a un niveau identique. Aucune degenerescence significative n’a ete trouvee pour le sub-scapularis. Un total de 77 % des patients etaient tres satisfaits et 19 % satisfaits. La position de la vis et de la coracoide a l’aide du viseur etait satisfaisante. La duree operatoire moyenne etait de 51 minutes. Discussion Les resultats obtenus sont comparables a ceux trouves dans la litterature avec d’autres techniques, notamment la butee de Lartajet, arthroscopique ou a ciel ouvert, qui demeure la technique de reference. La technique de Trillat arthroscopique presente des avantages objectifs en termes de duree operatoire, de courbe d’apprentissage, et de complications septiques et neurologiques. Le passage d’une vis transfixiante au travers du muscle sub-scapularis et du defile omo-coracoidien n’a pas de consequence fonctionnelle ou trophique sur les fibres musculaires. Conclusion Le Trillat arthroscopique se montre une technique fiable, reproductible, transmissible et efficace dans le traitement de premiere intention de l’instabilite anterieure chronique d’epaule. Nos resultats sur l’instabilite sont comparables aux techniques de references, avec un taux plus faible de complications, une courbe d’apprentissage et une duree operatoire plus courte. Des ameliorations sur la vis d’osteosynthese et l’ancillaire sont en cours d’elaboration.

Resume Le traitement des fractures de l’acetabulum est complexe et necessite des voies d’abord adaptees et souvent extensives. Nous decrivons ici une voie d’abord ilio-femorale modifiee, innovante par l’osteotomie de la crete iliaque pediculisee sur les muscles larges de l’abdomen pour permettre, tout en respectant la musculature abdominale, un controle direct de la reduction et ainsi creer un espace de travail au plus proche de la fracture, sans aborder ni le canal inguinal, ni le paquet vasculonerveux femoral. Sur les 15 cas de fractures complexes ou nous l’avons appliquee, nous avons obtenu selon les criteres de Matta 13 reductions excellentes ou bonnes, et 13 bons ou excellents resultats. Cette voie d’abord peut etre combinee a d’autres voies, telle que la voie posterieure, et ainsi constituer une alternative a la voie ilio-inguinale dans le traitement des fractures complexes de l’acetabulum.

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

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

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

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

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

In this article, we report the case of a patient with a symptomatic accessory soleus muscle with an atypical clinical presentation. As the existence of this accessory muscle went unrecognized for a long time, various diagnoses of the patient's condition were made. Initially, the patient was treated for muscle strain and compartment syndrome, but the second MRI revealed the accessory muscle and led to appropriate diagnosis and surgical treatment.

SummaryOsteoid osteoma is a common benign bone tumor affecting the young adult with typical clinical and radiographic presentation in its most common locations. However, when arising in unusual intra-articular locations, diagnosis may appear confusing and lead to delayed management. We present the case of a 24-year-old man with intra-articular osteoid osteoma of the hip involving the posteroinferior quarter of the femoral head. This unusual location was at the origin of unexplained pain and delayed diagnosis made 18months after the onset of symptoms since the initial magnetic resonance imaging (MRI) examination could not identify the lesion whereas it was detected on bone scintigraphy and thin slice CT imaging. Due to the complex location providing difficult access for radioguided techniques, an open surgical management was suggested and performed through a limited posterolateral approach with no hip dislocation, after identification of the circumflex pedicle. Following complete surgical excision of the tumor, the diagnosis could be confirmed after histopathologic analysis. No recurrence was observed.

Resume L’osteome osteoide est une tumeur benigne touchant l’adulte jeune. Classiquement, son tableau clinique et radiologique est typique dans ses localisations habituelles mais dans certaines formes intra-articulaires exceptionnelles, le diagnostic peut s’averer difficile, causant de longs retards de prise en charge. Nous presentons le cas d’un homme de 24 ans porteur d’un osteome osteoide intra-articulaire de la hanche localise dans le quadrant postero-inferieur de la tete femorale. Cette localisation atypique a ete a l’origine de douleurs inexpliquees et d’un retard diagnostique de 18 mois, d’autant que l’IRM initiale n’a pas permis d’identifier la lesion, au contraire de la scintigraphie et de la tomodensitometrie en coupes millimetriques. Devant cette localisation particuliere d’acces difficile notamment pour les techniques radioguidees, une chirurgie a ciel ouvert a ete proposee, par une voie posterolaterale reduite sans luxation de hanche, apres reperage du pedicule circonflexe. La resection de la lesion etait complete avec confirmation histologique du diagnostic. Il n’y a pas eu de recidive.

Introduction L’influence de l’IMC sur les parametres de marche apres prothese totale de hanche (PTH) est meconnue. Aucune etude n’a analyse l’influence de l’IMC sur la recuperation des amplitudes de flexion de hanche a la marche (AFH) ou sur la vitesse de marche apres PTH. Notre objectif etait d’evaluer cet impact en preoperatoire et a 6 mois postoperatoires. Materiel et methodes Soixante-seize patients operes d’une PTH pour coxarthrose beneficiaient d’une analyse quantifiee de la marche en preoperatoire et a 6 mois postoperatoires avec un groupe de temoins sains. La vitesse de la marche, l’AFH a la marche, le Hip Osteoarthrtitis Outcomes Score (HOOS), la douleur (EVA) et la qualite de vie etaient evalues, pour tous les parametres le gain etait calcule. Les patients etaient repartis en 2 groupes patients non-obeses (g1) IMC Student et de Kruskall-Wallis etaient utilises pour evaluer les differences pre- et postoperatoires entre g1 et g2, puis les differences de gain entre g1 et g2. Enfin, un test de Spearman recherchait des correlations entre l’IMC, la vitesse de la marche et l’AFH. Resultats En preoperatoire, la vitesse de la marche et l’AFH etaient significativement plus bas chez les obeses (vitesse g1- 0,81 ± 0,22 m/s vs. g2- 0,65 ± 0,23 m/s, p = 0,004 et AFG g1- 26,2 ± 7,3 vs. g2- 21,4 ± 6,6, p = 0,005). A 6 mois postoperatoire, la vitesse de la marche et l’AFH etaient significativement plus bas pour tous les patients operes d’une PTH comparativement au groupe temoin. En preoperatoire, les obeses etaient plus symptomatiques (HOOS h1- 36,7 ± 12,9 vs. g2- 28,1 ± 15,7, p p = 0,04). Aucune correlation significative n’etait retrouvee entre la vitesse de la marche l’AFH et l’IMC. Discussion L’IMC n’a pas d’effet deletere sur la recuperation des parametres de marche. En effet, malgre une symptomatologie preoperatoire plus forte les patients obeses presentent une amelioration comparable en terme de gain aux patients non-obeses. Cependant, les parametres de la marche 6 mois apres une PTH demeurent significativement plus bas que ceux des temoins, quel que soit l’IMC des patients operes, sans recuperation ad integrum clinique ou biomecanique.

Introduction Cette etude a pour but d’apprecier la situation respective de l’axe de la tete humerale et de sa retroversion avec le centre de la gouttiere bicipitale, par rapport a la palette humerale. L’etude morphologique de l’humerus montre que la position de la gouttiere bicipitale est variable selon les individus ainsi que la retroversion de la tete humerale. Ces deux parametres en fonction des auteurs, varient de maniere independante ou associee. Nous avons donc decide d’etudier cette relation avec la plus grosse serie jamais publiee. Materiel et methodes Soixante-dix humerus secs ont ete scannes afin de permettre de recuperer des reconstructions 3D. Sur des vues aeriennes permettant d’avoir sur une meme image la palette humerale, la gouttiere bicipitale et la tete humerale, une methode de mesure originale nous a permis d’obtenir l’angle de retroversion humerale et l’angle de lateralisation de la gouttiere bicipitale par rapport a la ligne bicondylaire. La correlation entre ces deux angles a ensuite ete etudiee par le test Pearson. Resultat Un test de Pearson a ete effectue sur les variables des 70 humerus secs entre l’angle de la gouttiere et l’angle de retroversion humerale. Il a permis de mettre en evidence une correlation lineaire suivant une courbe de tendance de maniere significative. La p - value = 7,510–7, avec un coefficient de correlation egal a –0,5515, intervalle de confiance a 95 % (−0,6962 + 0,3636). Le p Discussion Nous avons etudie la repartition des valeurs de lateralisation bicipitale dans la serie d’humerus sec. En tracant un histogramme nous avons pu constater que les valeurs suivaient une repartition Gaussienne. Afin d’etre utilisable en pratique clinique, nous avons calcule le degre d’erreur pour chacune des 70 mesures. Nous avons donc pu determiner un intervalle ou l’angle de lateralisation permet d’obtenir la torsion humerale de maniere fiable. Conclusion Nous avons donc demontre une relation lineaire entre la retroversion humerale et la lateralisation du long biceps et ceci avec une puissance jamais retrouvee dans la litterature. Cette relation pourra etre utilisee en pratique clinique pour l’etude de la retroversion sans avoir besoin de scanners d’humerus entier dans notre intervalle de fiabilite entre 115 et 150° de lateralisation bicipitale.

Introduction Le but de notre etude prospective etait d’evaluer les resultats de la prothese d’epaule inversee dans les fractures complexes de l’extremite superieure de l’humerus, chez les personnes âgees. Nous avons recherche s’il existait une relation entre les scores SF-36 et DASH preoperatoires et le score de Constant final. Une attention specifique a ete portee a l’attitude a adopter vis-a-vis des tuberosites. Patients et methode Entre novembre 2011 et juin 2012, 30 epaules chez 30 patients (80 % de femmes) ont ete operees par prothese d’epaule inversee pour fracture trois ou quatre fragments, sur deux sites hospitaliers. C’est une serie homogene, utilisant le meme implant avec la meme voie d’abord supero-externe. Le recul moyen est de 24 mois. L’âge moyen de la population etait de 78,8 ans. Un patient est decede, non revu. Resultats En preoperatoire – score Short-Form (SF) 36 mental moyen – 68 physique – 67,9 + DASH moyen – 33,27. A 6 mois – score de Constant moyen 52,6 (item douleur a 14,3/15) + a 12 mois 57,9 (item douleur a 14,6/15) et a 24 mois 58,2 (item douleur a 14,8/15). A un an, score SF-36 mental moyen – 64,4, physique – 59,4 et DASH moyen – 39,3. A deux ans, DASH moyen – 39,7. Amplitudes moyennes observees – antepulsion 100,8°, abduction 86°, une rotation interne niveau L3, une rotation externe main-vertex-coude en avant. L’absence de fixation anatomique des tuberosites n’a pas eu d’impact pejoratif sur les resultats. Radiologiquement – pas de migration d’implant, pas d’osteolyse periprothetique, 11 eperons inferieurs et pas d’encoche. Dix-sept pour cent de complication – 4 luxations aigues ( Conclusion Dans les fractures complexes de l’extremite superieure de l’humerus chez les patients âges, la prothese inversee d’epaule est une option permettant d’obtenir de bons resultats cliniques tout en autorisant une reeducation precoce. Les caracteristiques mecaniques de la prothese d’epaule inversee facilitent cette reeducation precoce, pour laquelle l’utilisation d’un implant retentif systematique en absence de fixation des tuberosites limitera le risque d’instabilite. Concernant les facteurs patients, on constate la relation directe mais non exclusive entre les scores preoperatoire SF-36, DASH et le resultat clinique. Pour comparer les series entres-elles, il est donc utile de realiser en preoperatoire des scores de qualite de vie.

The increased use of the reverse prosthesis over the last 10 years is due to a large series of publications using the reverse prosthesis developed by Paul Grammont. However, there is no article reporting the story of the concepts developed by Grammont. The purposes of this review are to describe the principles developed by Grammont, the chronology of development, and the biomechanical concepts and studies that led to the current design of the reverse prosthesis. We selectively reviewed literature and provide personal observations. From phylogenetic observations, Grammont developed the principle of functional surgery applied to the rotator cuff tears. To increase the deltoid lever arm, he imagined two possibilities: the lateralization of the acromion, which facilitates the action of the rotator cuff, and the medialization of the center of rotation, which has been developed to respond to situations of rotator cuff deficiency. Grammont proposed the use of an acromiohumeral prosthesis, which was quickly abandoned due to problems of acromial loosening. Finally, Grammont used the principle of reverse prosthesis developed in the 1970s, but made a major change by medializing the center of rotation in a nonanatomic location. In 1985, Grammont validated the concept by an experimental study and the first model using a cemented sphere was implanted. The development of the modern reverse prosthesis is the result of the intellectual and experimental work conducted by Grammont and his team for 20 years. Knowledge of this history is essential to envision future developments.

Introduction Une large exposition est necessaire pour la prise en charge des infections periprothetiques du genou. Lorsque l’eversion de la patella ou la depose de l’implant tibial le necessite, une osteotomie de la tuberosite anterieure du tibia (TTO) doit etre realisee. Cette etude rapporte les resultats cliniques, radiologiques et les complications des osteotomies tibiales proximales dans la prise en charge des infections sur prothese de genou. Materiel et methode De janvier 2008 a decembre 2013, 40 TTO chez 26 patients ont ete incluses et analysees retrospectivement dont 22 changements de protheses en deux temps et 5 arthrodeses par clou femoro-tibial. Les TTO etaient subdivisees en 2 groupes – 22 TTO en milieu septique lors des deposes et 18 TTO lors de la repose d’une prothese en milieu considere comme non septique. Le critere principal etait la consolidation de la TTA et les criteres secondaires le nombre de complications et la guerison du sepsis. Les patients ont ete revus a 45 jours, 3 mois, 6 mois et 1 ans. Le delai moyen de suivi etait de 11 mois. L’osteosynthese etait realisee par au minimum deux cerclages metaphysaires du tibia par fil metallique. Resultats La consolidation de la TTA etait obtenue a 3 mois dans 31,8 % des cas en milieu septique et 31,3 % en milieu non septique. A 6 mois, 71,4 % des TTO septiques etaient consolidees et 72,2 % des TTO non septiques. Au dernier recul, la consolidation de la TTA est obtenue dans 100 % dans les arthrodeses et dans 88 % (15 17) des reposes de protheses. Sur les 40 osteotomies ont a deplore 4 desunions de cicatrice dont une necessitant une exerese de la TTA et 1 deplacement secondaire responsable d’une insuffisance quadricipitale. La guerison du sepsis etait obtenue dans les reposes et les arthrodeses pour 19 patients sur 23 des patients (83 %). La longueur de l’osteotomie de la TTA etait en moyenne de 94 mm lors des deposes 93 mm lors des reposes et de 146 mm lors des arthrodeses. Dans les cas de repose de prothese, la tuberosite avait ete prealablement osteotomisee en moyenne 5 fois. Discussion La bonne consolidation des osteotomies repetees de la TTA en non milieu septique est retrouvee dans la litterature (Chalidis et al.) mais seul Choi l’a etudie en milieu septique avec egalement un bon resultat. Conclusion L’osteosynthese par cerclage metallique nous parait fiable dans ce contexte. L’osteotomie de la TTA repetee ou en milieu septique ne doit pas etre redoutee dans la prise en charge des revisions prothetiques de genou.

Introduction Nous presentons une adaptation arthroscopique de la technique de stabilisation anterieure de l’epaule selon Trillat dans le traitement des instabilites anterieures chroniques d’epaule. Materiel Le principe original de cette technique consiste a obtenir un renforcement de la sangle anterieure musculaire active stabilisant l’epaule par le coraco-biceps lors de l’arme par osteotomie de flexion – medialisation de la coracoide. Nous proposons une solution arthroscopique utilisant un viseur dedie permettant de mobiliser et fixer la coracoide. Cette etude preliminaire comprend 15 hommes d’âge moyen 24 ans, au recul moyen de 18 mois. Methodes Une etude scannographique sur sujets anatomiques a permis de definir la morphologie du col de l’omoplate et les rapports coracoide – glene. Puis nous avons imagine un viseur original repondant au cahier des charges. Apres osteoclasie de la coracoide par un mini-open delto-pectoral, le viseur est positionne dans l’intervalle des rotateurs sous controle arthroscopique. Le viseur prend appui sur la glene, permet le positionnement precis d’une broche guide de la coracoide au col de l’omoplate. Une vis canulee fixe ensuite la coracoide dans la position recherchee. Apres validation experimentale de la faisabilite de la technique sur piece anatomique, nous avons procede aux premiers essais cliniques. Resultats Quinze patients ont ete operes avec cette instrumentation arthroscopique. Le positionnement souhaite de la coracoide et de la vis a ete juge conforme dans 13 cas sur 15, approximatif dans 1 cas et mauvais dans 1 cas aboutissant dans ce dernier cas a une recidive de luxation au quatrieme mois. Les 14 autres patients sur 15 sont satisfaits (score moyen de Rowe 85 %). Discussion Les techniques de stabilisation arthroscopique de l’epaule sont en plein essor. Si l’intervention de o Bankart arthroscopique O voit ses indications diminuer du fait d’un taux d’echecs importants chez des patients souvent insuffisamment selectionnes, le o Latarjet arthroscopique Oreste faiblement diffuse du fait de sa complexite et de sa courbe d’apprentissage. La recherche d’une simplification technique nous a conduit a proposer un o Trillat arthroscopique O afin de se soustraire a l’arthrotomie, au passage de la coracoide a travers le sous scapulaire et aux difficultes de positionnement de la butee. Un ancillaire specifique permet un positionnement par rapport a l’interligne, offrant une solution techniquement plus simple et reproductible. Conclusions Le debut de notre experience confirme la faisabilite, la reproductibilite de l’intervention de o Trillat arthroscopique O avec des preliminaires encourageants nous incitant a poursuivre cette etude.

Introduction Differentes etudes rapportent une majoration du risque de fracture peroperatoire lors de l’utilisation d’implants non scelles dans le traitement des fractures de l’extremite superieure du femur. Il existe cependant tres peu d’etudes evaluant le retentissement clinique a cours et moyen termes de ces fractures. Nous avons cherche a evaluer l’incidence de cette complication et ses implications fonctionnelles. Patients et methode Il s’agit d’une etude retrospective, continue, monocentrique portant sur tous les patients operes d’une prothese totale de hanche (PTH) pour fracture deplacee du col femoral entre 2011 et 2013. Le critere de jugement principal etait le taux de fractures peri-prothetiques per- ou postoperatoires immediates. Les criteres secondaires sont le taux de luxation et le resultat fonctionnel (scores de Harris et PMA). Resultats Deux cent soixante-trois patients d’âge moyen de 81 ans ont ete inclus durant cette periode avec un suivi a un an de 76,8 %. On deplore 39 deces (19,3 %) au terme de notre etude. Vingt-trois patients d’âge moyen de 86 ans ont presente une fracture periprothetique per- ou postoperatoire immediate (8,7 %), avec 5 fractures du calcar et 18 du grand trochanter dont seulement 4 ont necessite un report d’appui. La duree moyenne de sejour ne presentait pas de difference significative (9,75 vs 11 jours) pour les patients fractures ou non. On ne deplore aucun deces peroperatoire et 5 luxations antero-superieures precoces dont aucune n’a necessite de reprise chirurgicale ou n’a presente d’instabilite persistante. Les scores de Harris et PMA a 6 mois et 1 ans ne presentaient pas de difference significative pour les patients fractures ou non. Discussion La litterature rapporte plus de fractures pour les implants sans ciment (3,5 a 15 %) mais moins de complications d’ordre medical et de deces peroperatoires avec une survie des implants superieure. Notre taux de complications mecaniques semble inferieur a ces chiffres et la survenue d’une fracture n’a entraine ni reprise chirurgicale, ni allongement de la duree de sejour, ni diminution du resultat fonctionnel. L’arthroplastie non cimentee presente en outre l’avantage d’une duree operatoire moyenne reputee plus courte. Conclusion L’arthroplastie de hanche sans ciment dans le traitement des fractures cervicales deplacees du femur semble etre une solution adaptee meme pour les sujets âges. Son taux de fracture peroperatoire reste modere et ne represente pas un facteur de mauvais pronostic pour la suite de la convalescence.

In some carcinomas such as digestive tract carcinomas, bone marrow infiltration by tumor cells is a frequent event but usually remains a micrometastatic disease and rarely induces overt bone lesions. The mechanisms responsible for the control of these metastases in the bone marrow remain poorly known. We show that freshly isolated bone marrow cells from human, murine and rat origin rapidly kill a wide range of syngeneic or xenogeneic carcinoma cell lines in culture. Further analysis of this cytotoxic process in the rat indicated that neither resident bone marrow macrophages nor NK cells were responsible for this cytotoxic effect that was restricted to a subpopulation of bone marrow cells expressing CD90 (Thy-1), a marker of hemopoietic precursors. The tumoricidal activity of these cells did not require long-term culture nor addition of exogenous cytokines or growth factors. A subset of CD90+ cells that rapidly differentiates into CD163(ED2)-expressing macrophages was observed to be responsible for tumor cell killing. These macrophages induced a non-apoptotic death of tumor cells, a process that required both a direct interaction with the tumor cell and nitric oxide (NO) production through the activation of inducible nitric oxide-synthase (iNOS). This ability of pluripotent hemopoietic stem cells to rapidly differentiate into macrophages capable of killing invasive tumor cells may account for the limited expansion of micrometastases of some carcinomas in the bone marrow. © 2003 Wiley-Liss, Inc.

Introduction Le but de ce travail etait de rechercher s’il existe des facteurs predictifs morphologiques osseux scapulaires coracoidiens vis a vis du risque de recidive de luxation antero-interne d’epaule et de permettre d’en deduire l’influence de la position coracoidienne sur la stabilite anterieure, ainsi que ses applications chirurgicales. Patients et methodes Soixante et un patients ayant beneficie d’un scanner de l’epaule au CHU de Dijon entre janvier 2012 et avril 2013 ont ete repartis en 2 groupes : population de reference et population luxee. Une nouvelle methode de mesure radiologique, precise et reproductible, a ete definie pour caracteriser la position coracoidienne. Les images tomodensitometriques pour l’etude morphologique apres reduction ont ete obtenues par un scanner de l’epaule en contraste spontane. Une acquisition helicoidale a ete realisee en coupes fines en filtre dur avec reconstruction multiplanaire. Des mesures precises, anatomique de la hauteur, lateralisation et avance coracoidienne ont pu etre obtenues grâce a la reconstruction MPR en post-traitement des images. Resultats Pour la hauteur coracoidienne (p = 0,047, IC : [−0,0192 ; −0,012], moyenne luxee : 0,059, moyenne reference : 0,049) la coracoide est donc plus haute et ceci de maniere significative chez les patients de la population luxee. Les tests statistiques sur les autres criteres : l’avancee (p = 0,95) et la lateralisation (p = 0,043) n’ont pas montre de significativite. La reproductibilite inter- et intra-observateur des mesures a ete verifiee par deux operateurs independants. Conclusion Des morphotypes osseux d’instabilite d’epaule ont pu etre identifies. En ce qui concerne les morphotypes coracoidiens seul la hauteur coracoidienne a un role sur la stabilite (une coracoide haute est une facteur d’instabilitee). Et des applications cliniques et chirurgicales sur les interventions arthroscopiques de stabilisation de l’epaule ont pu etre definies. Nous confortant dans le developpements de notre techniques d’osteoclasie de type Trillat arthroscopique.

Introduction Il est admis que la reconstruction du ligament croise anterieur aux ischio-jambiers entraine des suites simples mais au detriment d’un deficit musculaire de 20 % sur les flechisseurs. Nous presentons les resultats d’une technique n’utilisant que le semi-tendinosus, la preservation du gracilis devant permettre une optimisation musculaire des flechisseurs. L’objectif principal de cette etude etait d’evaluer le deficit musculaire des extenseurs et des flechisseurs du genou opere, au sixieme mois postoperatoire, par un test isocinetique puis nous avons etudie les resultats cliniques et laximetrique de la ligamentoplastie. Materiel et methode Nous avons effectue une etude prospective de tous les patients operes d’une ligamentoplastie en all-inside, par DT4 entre 2011 et 2013. La fixation au femur et au tibia etait assuree par un bouton ACL TightRope® (Arthrex). Un bilan isocinetique a eu lieu au sixieme mois postoperatoire. Une evaluation clinique et laximetrique a ete realisee au huitieme mois. Resultats Nous avons inclus cent dix patients. Le bilan isocinetique a retrouve un deficit musculaire moyen du quadriceps de 16,78 % en concentrique rapide et 25,27 % en concentrique lent. Le deficit musculaire moyen des ischio-jambiers etait de 14,66 % en concentrique rapide, de 9,09 % en concentrique lent et de 7,77 % en excentrique. Le rapport agonistes/antagonistes moyen de 1,05 mettait en evidence un desequilibre au detriment de l’action des muscles extenseurs par rapport a celle des muscles flechisseurs au niveau du genou opere. Au recul, le score IKDC subjectif moyen etait de 85,35/100, le score de Lysholm moyen etait de 90,27/100 et le score IKDC objectif classait 96 patients sur 110 dans le groupe normal ou presque normal. La laxite residuelle etait de 1,38 mm. Discussion Le deficit musculaire est modere sur le quadriceps mais superieur a 20 % ce qui influence la stabilite du genou. Le deficit musculaire des ischio-jambiers est negligeable en concentrique rapide et en excentrique. Le deficit musculaire persistant sur ces deux muscles est retrouve dans la litterature au-dela du sixieme mois postoperatoire mais il semble moins important sur les ischio-jambiers dans notre serie. Conclusion La reconstruction du ligament croise anterieur en all-inside par le semi-tendinosus a quatre brins avec une double fixation corticale suspendue donne de bons resultats cliniques et isocinetiques avec un controle satisfaisant de la laxite anterieure du genou. Les resultats a plus long terme vont etre evalues.

Introduction Les protheses totales de hanche (PTH) a double mobilite sont en progression dans le traitement de la coxarthrose mais rares sont les etudes avec analyse quantifiee de la marche + une telle analyse biomecanique permet une evaluation plus precise et objective de la recuperation fonctionnelle. Nous pratiquons 2 voies d’abord differentes – une voie postero-laterale de Moore (VM) et une voie antero-laterale mini-invasive de Rottinger (VR). Notre objectif etait d’analyser les resultats cliniques et biomecaniques de patients coxarthrosiques traites par PTH a double mobilite puis de les comparer selon ces 2 voies d’abord. Materiel d’etude Etude clinique prospective ouverte monocentrique avec 2 groupes de sujets coxarthrosiques repartis selon le chirurgien en VM vs. VR. Methodes Analyse a moyen terme (j180), d’une part de la cohorte, puis comparative entre les groupes. Les criteres de jugement etaient – analyse subjective – questionnaires Hip disabilty and Osteoarthritis Outcome Score (HOOS), Harris (HHS) et Postel Merle D’Aubigne (PMA) + analyse objective – parametres biomecaniques de la marche (vitesse, longueur du pas, temps d’appui) Resultats Quarante-six patients inclus – 22 dans le groupe VM (âge = 66,66A9,86 + IMC = 28,8A4,1 kg/m 2 ), 24 dans le groupe VR (âge = 65,1A10 + IMC = 27,8A5,63 kg/m 2 ). A l’inclusion le groupe VR etait significativement plus symptomatique, cliniquement et biomecaniquement (HOOS – 41 vs 28, p = 0,001, vitesse du pas 0,68 m/s vs 0,83 m/s p = 0,015) L’analyse de cohorte trouve une amelioration significative de tous les scores cliniques et de tous les parametres biomecaniques. Pour le HOOS, la VR montre une amelioration plus importante ( p = 0,005). Aucune autre difference n’a ete trouvee entre les groupes. Discussion L’analyse biomecanique de la cohorte apporte des elements objectifs complementaires de ceux fournis par la clinique et confirme les bons resultats fonctionnels des PTH a double mobilite. Le HOOS semble plus discriminant par rapport aux hetero-questionnaires et a l’analyse quantifiee de la marche. La VR permettrait une amelioration plus importante des capacites fonctionnelles a 6 mois que la VM, les groupes etant toutefois non comparables a l’inclusion. Conclusion Les PTH a double mobilite permettent donc d’importantes ameliorations fonctionnelles cliniques mais egalement biomecaniques sur une cohorte de patients coxarthrosiques. La capacite discriminante du HOOS est superieure a celle de l’analyse quantifiee de la marche pour comparer les resultats de deux voies d’abord. L’analyse quantifiee de la marche apporte une vision plus precise de la recuperation fonctionnelle, pouvant permettre l’exploration de cas cliniquement particuliers.

We provide a link to the original description of the “delta” reverse shoulder arthroplasty published in 1993 by Paul Grammont and Emmanuel Baulot. While many surgeons view “anatomic reconstruction” as essential for virtually all operations, Grammont recognized that not all reconstructions needed to be anatomic and in fact some problems with so-called anatomic reconstructions could be solved by developing nonanatomic approaches. Through careful reasoning and intuition, Grammont and Baulot suggested placing the ball of the shoulder on the glenoid and the concave matching surface on the humerus in patients with an absent rotator cuff (essentially rendering any anatomic reconstruction “nonanatomic” when the cuff function could not be normally restored). They argued the deltoid muscle could compensate for an absent rotator cuff if four conditions were present: (1) a lever arm effective from the start of movement; (2) a fixed center of rotation; (3) inherent stability; (4) maintenance of adequate external rotation. The result of their reasoning was the Delta Shoulder Prosthesis, the prototype of all other modern reverse shoulder arthroplasty designs. They briefly reported 14 patients with 2-year followup, finding acceptably restored function in 13. (Editor’s Note: The original article had no Abstract; this Abstract was therefore written to provide readers a summary.) The Classic article is © 1993 and is reprinted from Grammont PM, Baulot E. Delta Shoulder Prosthesis for Rotator Cuff Rupture. Orthopedics. 1993;16:65–68 available at http://www.orthosupersite.com/view.aspx?rid=84164. An accompanying biographical sketch of Paul Grammont is available at DOI 10.1007/s11999-011-1959-y.

Introduction La prothese totale inversee est un des traitements propose dans l’omarthrose excentree. Son indication reste prudente a ce jour du fait de l’apparition quasi systematique d’une encoche, en quelques mois, au bord inferieur de la glene, responsable d’une rupture de la courbe de survie de l’implant vers la 7 e annee. Gerber a montre que le positionnement bas de l’implant glenoidien permet de limiter la survenue de l’encoche. Cette fixation basse est limitee par le faible stock osseux a cet endroit. Materiel et Methodes Depuis Mars 2003, nous avons realise 122 protheses totales inversees d’epaule. L’âge moyen est de 70 ans, le recul moyen est de 18 mois. La voie d’abord a ete 59 fois antero-superieure, et 63 fois deltopectorale. Resultats Nous constatons une seule encoche (0,01 %). Celle-ci est survenue sur une prothese inversee vers le 3 e mois, est evolutive, avec une degradation clinique sur 12 mois. Aucun descellement n’est manifeste, cette encoche concerne le 1/3 inferieur de la glene et n’est pas associee a un eperon osseux. Par contre, nous constatons un eperon osseux, de volume variable, dans 71 cas. Dans les 50 autres cas, aucune image d’addition ou de soustraction osseuse n’est visible. Cet eperon n’est pas specifique des protheses inversees, puisqu’on le retrouve egalement 1 fois sur 2 dans les protheses totales anatomiques. Discussion Nous expliquons mal notre seul cas d’encoche evolutive. Peut-etre s’agit-il d’un sepsis latent. Les eperons surviennent tres tot, vers le 3 e mois, puis se stabilisent. Ils n’ont pas ete responsables de complications. Conclusion Le dessin de l’implant glenoidien et humeral semble tout aussi important que son positionnement bas pour eviter la survenue de l’encoche.