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Resume Fondement Le benefice apporte par les protheses totales de hanche (PTH) dans le traitement de l’arthrose des sujets de plus de 80 ans est certain mais cette population a la reputation d’etre exposee a une surmorbidite. Hypothese, objectifs Evaluer si cette population, operee par voie anterieure reduite et beneficiant des protocoles modernes d’anesthesie, est effectivement exposee a une morbidite plus elevee et determiner les facteurs de risque de morbidite. Materiel et methodes Soixante-douze patients, operes entre octobre 2003 et decembre 2006, ont ete analyses retrospectivement. Les interventions, menees par voie d’abord anterieure sur table orthopedique, ont utilise une prothese totale cimentee avec une piece acetabulaire cimentee retentive. Resultats Au recul moyen de 31 mois (min cinq mois, max 54 mois), aucun patient n’a ete perdu de vue et aucune prothese n’a ete revisee. Dix-neuf patients ont presente 27 complications dont la survenue n’a ete influencee ni par le score de l’American Society of Anaesthesiolgy (ASA) (p > 0,1) ou la presence de comorbidites (p > 0,5). Nous ne deplorons ni deces perioperatoire ni infection. Vingt-huit patients ont ete transfuses. Le score ASA (p 0,5), l’existence d’une pathologie orthopedique associee (p Discussion L’implantation d’une PTH pour coxarthrose chez des patients âges de plus de 80 ans exposait a un taux de complication de 27 %, aucun facteur de risque specifique n’a ete identifie. Les autres atteintes neuro-orthopediques entravaient la qualite du resultat fonctionnel. L’usage d’une cupule retentive n’a pas evite la survenue de deux luxations (2,6 %). Niveau IV : retrospectif ou serie historique.

The life expectancy increased significantly during last four decades and is associated with an increasing quality of life. The purpose of this study was to determine morbidity and mortality of degenerative lumbar spine surgery in patients 80 years of age or older. A consecutive retrospective review evaluated 121 consecutive patients, who had undergone posterior decompression associated or not with lumbar instrumentation. The average age at the time of surgery was 83.2 ± 2.4 years. The study analyzed the comorbidities, the operative procedure and postoperative morbidity and mortality. Blood loss increased significantly with instrumentation (538 vs. 280 mL, p

Resume Le pyoderma gangrenosum est une dermatose de type neutrophilique grave qui peut compliquer toute chirurgie. Il a surtout ete decrit dans les suites de la chirurgie du sein, mais peut aussi compliquer la chirurgie orthopedique. Sa meconnaissance peut etre a l’origine de sequelles graves, du fait d’une prise en charge inadaptee ou trop tardive. En effet, contrairement aux infections qu’il simule, le traitement du pyoderma gangrenosum necessite l’institution d’une corticotherapie et surtout d’eviter les gestes de debridement. Ceux-ci provoquent le developpement des lesions dermatologiques sur les zones traumatisees ce qui aggrave et accelere le processus. L’apport de l’anatomopathologie etant frequemment decevant, il est fondamental de penser au diagnostic devant l’apparition precoce d’une lesion pustuleuse superficielle s’etendant rapidement malgre l’institution d’une antibiotherapie. Nous presentons un cas survenu apres chirurgie prothetique de la hanche et rappelons les principaux elements permettant le diagnostic ainsi que les modalites du traitement.

This study evaluates a pragmatic approach using duplex ultrasonography (US) for detecting venous thromhosis (VT) after total hip arthroplasty (THA).Venous B-mode and colour duplex US examination of both legs including a systematic evaluation of calf veins was performed twice during hospitalisation in 286 consecutive patients. VT was diagnosed in 31 patients (12%). Thrombosis was asymptomatic in 28 patients (90%), and was bilateral or concerned the non-operated leg in 6 patients (19,4%). No clinical pulmonary embolism occurred during hospitalisation. Prior phlebitis and age over 70 were identified as statistically significant risk-factors (pVenous US performed twice after THA detected VT in 31 patients, 90% of these were asymptomatic. This approach might explain the absence of pulmonary embolism (PE) in our series, and support a systematic evaluation of the vein of the lower limb with ultrasonography after THA.

SummaryBackgroundIn osteoarthritic patients aged 80 years or older, total hip arthroplasty (THA) offers well-established benefits; however this selective group of population is known to carry a high morbidity rate.HypothesisThe higher morbidity rate carried by this group does benefit more from identification of risk factors than from improved surgical and anesthesia techniques.Materials and methodsSeventy-two patients, operated between October 2003 and December 2006, were retrospectively analyzed. The interventions performed on the traction table, through an anterior approach, involved implantation of a cemented total prosthesis combined to a retentive, cemented acetabular component.ResultsAt an average delay of 31 months (minimum 5 months, maximum 54 months), no patient was lost to follow-up and no prosthesis had to be revised. In total, 19 patients presented 27 complications, which were not influenced by their American Society of Anesthesiology (ASA) score (p>0.1) nor by the presence of co-morbidities (p>0.5). No perioperative deaths or infection occurred. Twenty-eight patients required blood products transfusion. ASA score (p0.5), the occurrence of an associated orthopaedic condition (p

The purpose of this study was to evaluate a pragmatic approach using duplex ultrasonography (US) for detecting deep vein thrombosis (DVT) after total hip (THA) and total knee (TKA) replacement.Venous B-mode and color duplex US examination of both legs including a systematic evaluation of calf veins was performed twice during hospital stay (Between day 1 and day 4 for the first exam and between day 7 and day 11 for the second) in 400 consecutive patients.Deep vein thrombosis was diagnosed in 53 patients (13.5%) including 7 patients with proximal DVT. Thrombosis was asymptomatic in 46 patients (85%), and was bilateral or concerned the non-operated leg in 8 patients (14.5%). No clinical pulmonary embolism (PE) occurred during hospital stay (mean hospital stay: 12.3). Prior phlebitis and age over 70 were identified as a statistically significant risk-factor for post-operative DVT (p = 0.001 and p0.01 respectively) concerning the whole series and the THA series (p0.02 and p0.04 respectively). No statistically significant risk factor was founded for the TKA series (p0.2 and p0.2 respectively). All patients were seen at three months. Four patients (1.16%) developed DVT between hospital discharge and the 3-month follow-up visit. One patient with coronary disease died suddenly on post-operative day 24, without clinical signs or symptoms of PE or DVT.Venous US performed twice after total hip replacement detected asymptomatic DVT in 85% of patients. This approach might explain the absence of PE in our series and thus justify systematic ultrasonographic evaluation of lower limb veins after prosthetic replacement.

SummaryPyoderma gangrenosum is a severe neutrophilic dermatosis that may occur as a complication following any kind of surgery. Although mainly reported secondary to breast surgery, it may also arise in orthopedic surgery. Misdiagnosis risks serious sequelae, due to inappropriate or delayed treatment. Unlike the infections, which it mimics, it is to be managed by corticosteroids, and debridement is absolutely contraindicated, as it will cause dermatologic lesions in the traumatized areas, worsening and accelerating the pathologic process. As anatomopathology tends to shed little light, it is essential to bear the diagnosis in mind in case of any early superficial pustular lesion showing rapid extension despite correctly administered antibiotherapy. We report a case of pyoderma gangrenosum secondary to hip replacement surgery, and detail diagnostic factors and means of treatment.