Search

Background: Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.Methods: Forty knees (32 patients) were included prospectively. All patients had patellofe-moral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.Results: Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 +/- 1.1 degrees for tibial torsion (axial plane), 0.8 +/- 0.7 degrees for MPTA (coro-nal plane) and 0.8 +/- 0.6 degrees for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 +/- 1.4 degrees for femoral anteversion (axial plane), 0.9 +/- 0.9 degrees for LDFA (coronal plane) and 0.9 +/- 0.9 degrees for PDFA (sagittal plane). The IKSG was improved from 58.0 +/- 13.2 degrees to 71.4 +/- 10.9 (p = 0.04) and the IKSF from 50.2 +/- 14.3 to 87.0 +/- 6.9 (p < 0.001).Conclusions: Using the PSCG for derotational osteotomy allows excellent correction accu-racy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability.Level of clinical evidence II, prospective cohort study.(c) 2022 Elsevier B.V. All rights reserved.

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%.

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

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 Introduction Les protheses totales de genou (PTG) charnieres constituent une option frequente en cas de reprise chirurgicale ou de chirurgie primaire mais leurs complications sont moins bien connues depuis l’essor des protheses a glissement. La litterature reste heterogene sur le sujet, avec des etudes aux effectifs souvent limites, au recul variable et avec des indications tres differentes. Aussi nous avons mene une large etude multicentrique au recul minimal de 5 ans afin d’evaluer les complications apres PTG charniere hors tumeur en fonction de l’indication sur genou natif, en cas de reprise chirurgicale aseptique ou dans un contexte traumatique. Hypothese L’hypothese etait que les PTG charnieres avaient un taux de complications eleve quel que soit l’indication. Materiel et methode Deux-cent quatre-vingt-dix patients (290 genoux) ont ete inclus de facon retrospective, de janvier 2006 a decembre 2011 dans 17 centres, avec un recul minimal de 5 ans. Les patients ont ete separes en trois groupes : chirurgie primaire (111 patients), chirurgie de reprise aseptique (127 patients) et chirurgie dans un contexte traumatologie recent ( Resultats Le recul moyen de l’etude est de 71 ± 39 mois [0 a 188]. Sur les 290 patients de l’etude, 108 patients (37,2 %) ont presente au moins une complication et 55 patients (19 %) ont necessite une reprise chirurgicale dont 16 dans la serie PTG primaire (16/111, 14,4 % des PTG primaires), 28 dans le cas de chirurgie de reprise (28/127, 22 % des PTG de reprise) et 11 dans le cadre de la traumatologie (11/52, 21 % des PTG traumatiques). Les complications sur PTG charnieres etaient par ordre de frequence pour la totalite des patients : raideur (41/290, 14,1 %), douleur chronique postoperatoire (37/290, 12,8 %), infection (32/290, 11,0 %), descellement aseptique (23/290, 7,9 %), complications generales (20/290, 6,9 %), complications de l’appareil extenseur (19/290, 6,6 %), fracture peri-prothetique (9/290, 3,1 %), faillite mecanique (2/290, 0,7 %). Pour le groupe PTG primaire, la complication principale ayant donne lieu a re intervention etait l’infection (12/111, 10,8 %), alors que c’etait le descellement pour le groupe PTG revision (15/127, 11,8 %) et l’infection (8/52, 15,4 %) pour les PTG traumatiques. Discussion Le taux de complications des implants a charnieres est eleve avec 37,2 % et 19 % ayant donne lieu a une re-intervention. La frequence des complications etait differente selon la situation : primaire, reprise ou traumatique. Les complications impliquant une revision chirurgicale etaient les complications mecaniques empechant le maintien de l’autonomie (infection, descellement douloureux, fracture, faillite de l’implant). La raideur et les douleurs chroniques, complications les plus frequemment retrouvees qui n’etaient que rarement reprises. Niveau de preuve IV ; etude de cohorte retrospective.

Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient's age, BMI, excessive preoperative PTS, or degree of correction achieved (p0.05).Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.IV; retrospective cohort study.

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.

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.

Lateral opening wedge distal femoral osteotomy (LOWDFO) is indicated for isolated lateral osteoarthritis in the valgus morphotype. Medial hinge fracture is a factor for poor prognosis. The present study had two aims: 1) to assess the impact of a temporary K-wire on hinge fracture risk; and 2) to assess the impact of LOWDFO opening speed.The main study hypothesis was that a temporary hinge K-wire reduces hinge fracture risk. The second hypothesis was that faster opening speed increases fracture risk.Twenty femurs were produced by 3D printing from a CT database, reproducing LOWDFO anatomy. The ABS® polymer showed the same breaking-point behavior as human bone. Ten specimens were included in the "K-wire" group (KW+) and 10 in the "No K-wire" group (KW-). To determine high and low speed, a motion-capture glove was used by 2 operators, providing 3D modeling of the surgeon's hand. High speed was defined as 152mm/min and low speed as 38mm/min. The KW+ and KW- groups were subdivided into high- and low-speed subgroups (HS, LS) of 5 each. Compression tests were conducted using an Instron® mechanical test machine up to hinge fracture. The main endpoint was maximum breaking-point force (N); the secondary endpoints were maximum displacement (mm) and maximum speed (min) at breaking point.The K-wire significantly increased maximum breaking-point force (LS, 143.08N vs. 93.71N, p0.01; and HS, 186.98N vs. 95.22N, p0.01), but not maximum displacement (LS, 26.17mm vs 24.11mm, p= 0.31; and HS 26.18mm vs. 23.66mm, p=0.14) or maximum time (LS, 27.07sec vs. 24.94sec, p=0.31; and HS, 5.24sec vs. 4.73sec, p=0.14). Speed did not affect maximum force (KW+, 143.08N vs. 186.98N, p= 0.06; and KW-, 93.71N vs. 95.22N, p=0.42) or maximum displacement (KW+, 26.17mm vs. 26.18mm, p=1; and KW-, 24.11mm vs. 23.66mm, p=0.69). Only maximum time was greater at low speed (KW+, 27.07sec vs. 5.24sec, p0.01; and KW-, 24.94sec vs. 4.73sec, p0.01), which is obvious for constant distance.The first study hypothesis was confirmed, with significantly lower hinge fracture risk with the K-wire, independently of opening speed. The second hypothesis was not confirmed. The study was performed under strict experimental conditions, unprecedented to our knowledge in the literature. However, complementary clinical studies are needed to confirm the present findings.IV, experimental study.

Valgus-producing medial opening-wedge proximal tibial osteotomies (V-MOW-PTO) are used to treat isolated medial-compartment knee osteoarthritis in patients with varus malalignment. A fracture of the lateral cortical hinge is a risk factor for poor outcomes. Implantation of a protective K-wire has been suggested to prevent this complication. The primary objective of this bench study was to assess the ability of a protective K-wire to prevent lateral cortical fractures. The secondary objective was to evaluate the influence of the opening speed on fracture risk during the osteotomy.The primary hypothesis was that a protective K-wire decreased the risk of hinge fracture. The secondary hypothesis was that this risk was greater when the opening speed was high.We performed an experimental study of 20 simulated thermoplastic-polymer (ABS) tibias obtained by 3D printing to assess the effects of wedge-opening speed (high vs. low) and presence of a protective K-wire (yes vs. no). The opening rates were determined in a preliminary study of Sawbone® specimens opened using a distractor. The opening rate was measured using an accelerometer via a motion-capture glove. After assessing several high and low opening speeds, we selected 38mm/min and 152mm/min for the study. We divided the 20 ABS specimens into four groups of five each: high speed and K-wire, low speed and K-wire, high speed and no K-wire, and low speed and no K-wire. The force was applied using an Instron™ testing machine until construct failure. The primary outcome measure was the load at failure (N) and the secondary outcome measures were the displacement (mm) and maximum time to failure (s).At both speeds, values were significantly higher with vs. without a K-wire for load to failure (low: 253.3N vs. 175.5N, p0.01; high: 262.2N vs. 154.1N, p0.01), displacement (low: 11.1mm vs. 8.7mm, p0.01; high: 11mm vs. 8.9mm; p=0.012), and maximal time to failure (low: 11.4 s vs. 8.9 s; p=0.012; high: 2.2 s vs. 1.8 s; p=0.011). Thus, the osteotomy opening speed seemed to have no influence on the risk of lateral cortex fracture.Our main hypothesis was confirmed but our secondary hypothesis was refuted: a protective K-wire significantly decreased the risk of hinge fracture, whereas the osteotomy opening speed had no influence. To our knowledge, this is the first published study assessing the potential influence of opening speed on risk of lateral cortex fracture. Our findings were obtained in the laboratory and should be evaluated in clinical practice.IV, experimental study.

Peri-prosthetic fractures (PPFs) are steadily rising in number due to population ageing and increased performance of joint replacement procedures. Although PPFs without implant loosening are usually managed by internal fixation, no consensus exists regarding the optimal construct. The primary objective of this study was to compare five constructs, and the secondary objective was to compare sub-groups of mono-cortical screw constructs, with the goal of identifying the method most appropriate for diaphyseal fracture fixation when prosthetic material is present within the intra-medullary canal.The primary hypothesis was that fixation using bi-cortical screws, i.e., the current reference standard, was superior over other fixation methods. The secondary hypothesis was that adding double cerclage to mono-cortical screw fixation provided the greatest mechanical strength.Synthetic osteoporotic bone was used to compare five methods for locking-screw fixation of a femoral diaphyseal plate. One method involved bi-cortical screws and four methods mono-cortical screws, with no cerclage wire, a single cerclage wire on either side positioned near or at a distance from the fracture, and two cerclage wires on both sides of the fracture. A complex fracture was simulated by creating a 2-cm diaphyseal gap. Load-to-failure was determined by applying compression loading along the anatomical axis of the femur.Bi-cortical screw fixation provided greater mechanical strength than did three of the four mono-cortical screw constructs. The exception was the mono-cortical-screw and double-cerclage construct, for which no significant difference was found compared to bi-cortical screw fixation. Thus, mono-cortical screw fixation with double cerclage may be the best alternative when presence of an implant in the intra-medullary canal precludes bi-cortical screw fixation.The findings from this study have clear implications for clinical practice. The study hypotheses were partly confirmed. The absence of a significant difference between the reference-standard bi-cortical screw fixation method and mono-cortical screw fixation with double cerclage, combined with the results regarding the secondary objective, suggest that mono-cortical screws plus double cerclage deserve preference in patients with an intra-medullary implant. Clinical studies are needed to assess the results of this bench study.IV, bench study.

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

A valgus osteotomy around the knee is a conservative procedure performed to unload the medial tibiofemoral compartment. However, the optimal postoperative alignment target remains controversial. Many studies have applied a "Fujisawa point" at 62.5%. The results of recent studies suggest decreasing the range of the mechanical axis target correction to 50-55%. The primary purpose of this study was to define the mean position of the lateral tibial spine in healthy patients from a reproducible 3-dimensional (3D) analysis. The study hypothesis was that the apex of the lateral tibial spine was a reliable and reproducible landmark for planning valgus osteotomies and preventing overcorrections.The study included 1140 patients: 560 women and 580 men, with a mean age of 61.7±16.5 years (18-98) and a mean body mass index (BMI) of 24.9±4.9kg/mThe mean tibial plateau width was 72.9±5.7mm (59.1-91.1). The mean position of the lateral tibial spine was 53.6±1.1% (48.9-57.2). The mean position of the medial tibial spine was 48.4±2.5% (43.6-56.1) while the center of the tibial spines was 51.0±1.5% (46.4-56.1). Africans had a significantly more lateral mean tibial spine position than Asians (54.7% vs. 53.3%, p=0.001), Caucasians (54.7% vs. 53.7%, p=0.002) and Middle Easterners (54.7% vs. 53.6%, p=0.034).The lateral tibial spine is a simple and reproducible bony landmark. This landmark can be used when planning valgus osteotomies aiming for a "Fujisawa point" at 54%.IV.

This study presents systematic chemical (U, Pb, Ca, Si, Fe) mapping coupled with in situ analyses of major, minor and trace elements, U/Pb, 207Pb/206Pb, and O isotopic compositions of natural uraninites (UO2) from two samples of the high-grade uranium ore from the Cigar Lake unconformity-related uranium deposit (Athabasca Basin, Saskatchewan, Canada). The studied uraninites are characterized by major chemical and isotopic heterogeneities expressed at small scale (µm to tens of µm), from almost pristine zones to strongly altered material. The 206Pb/238U and 207Pb/235U ratios of the different areas are widely spread and depict two similar and well-defined Discordia, providing an upper intercept age of crystallization at ca. 1300 Ma (1299 ± 4 and 1308 ± 14 Ma, respectively) and lower intercepts at 38 ± 13 and 72 ± 22 Ma, respectively. The freshest areas are characterized by sub-concordant 206Pb/238U and 207Pb/235U ratios, identical chemical compositions and similar very low δ18O values (−39.3 to −31.4‰). These data indicate that the two uraninites both crystallized at ca. 1300 Ma, from the same fluid and under identical physico-chemical conditions. Alteration is characterized by (i) the progressive incorporation of Ca, Si, and Fe, reaching several wt.%, which substitute to the radiogenic Pb and cause a progressive decrease in the Pb/U isotopic ratios. The radiogenic Pb is also substituted by water during the alteration, (ii) concomitant variations in trace element contents (As, Mn, V, LREEs, Sr, Th, B, Ba, Nb, for example) and (iii) heavier δ18O signatures (−22.5 to −8.91‰), typical of meteoric waters, in the altered zones. This combined approach demonstrates that fluid-driven post-crystallization exchanges affected each uraninite during recent fluid flow events (ca. 40 Ma and 70 Ma respectively). The relatively high dispersion of the Pb/U ratios in relation to the Discordia for both samples is considered as linked to a local (nm to µm-scale) differential mobility between lead and uranium within the uranium oxides. The chemical changes affecting elements previously considered as immobile in uraninite, such as REEs, indicate that these elements are not preserved during the post-crystallization alteration process studied here. Alteration processes may therefore have a major impact on the classical geochemical tracers, such as REE patterns or LREE/HREE ratios, currently used in nuclear forensic studies. The isotopic and chemical tracers currently used to track back the origin, age and history of natural uraninites should therefore be considered with a high degree of caution to avoid misleading and erroneous conclusions. Moreover, the comparison of calculated U-Th-Pb chemical, 207Pb/206Pb, and Pb/U isotopic ages shows that the use of age clustering for determining U-Th-Pb chemical ages and 206Pb/207Pb ages is not appropriate for constraining crystallization stage(s) of altered uraninites and for deciphering the different fluid events that potentially altered or recrystallized the uraninites over time. This study also indicates that estimation of the crystallization age of uraninite from substitution trends of Pb to Ca is not applicable to unconformity-related U deposits and results in overestimated ages because of an initial integration of calcium in the uraninite lattice at the time of crystallization.

Lower limb alignment is a major determinant of long-term outcomes after osteotomy or total knee replacement. The aim of this paper is to define the mean values of coronal and sagittal lower limb alignment for Caucasians as a function of sex using 3D reconstructions from CT-scans.The analysis involved 586 Caucasian patients (269 males and 317 females) who had their hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior proximal tibial angle (PPTA), lateral and medial proximal posterior tibial angles (LPPTA/MPPTA), posterior distal femoral angle (PDFA), and non-weightbearing joint convergence angle (nwJLCA) measured. This analysis was performed using a CT-scan-based modelling system (SOMA). Differences between sexes and morphotypes (neutral, varus and valgus) were analyzed statistically.The mean HKA was 180±2.57°, LDFA 86.1±1.87°, MPTA 86.1±2.15°, PPTA 84.6±2.58°, LPPTA 84.9±3.17°, MPPTA 85.1±3.21°, PDFA 85.3±1.50° and nwJLCA 0.82±1.32°. There was a significant difference between sexes for the HKA (180.3±2.46° and 179.0±2.52°), LDFA (85.6±1.90° and 86.8±1.61°), MPPTA (84.7±3.06° and 85. 6±3.31°). The neutral morphotype was more frequent in women than men (78% vs. 73%), the varus morphotype was more frequent in men than women (20% vs. 7.6%) and the valgus morphotype was more frequent in women than men (15% vs. 6.7%).Normal parameters for lower limb alignment in Caucasian patients were described in the coronal and sagittal planes. There was a significant influence of sex in the coronal plane, which was not found in the sagittal plane.IV; retrospective cohort study.

Hinged total knee arthroplasty (TKA) implants are a commonly used option during revision or even primary surgery, but their complications are not as well known, due to the rapid adoption of gliding implants. The literature is inconsistent on this topic, with studies having a small sample size, varied follow-up duration and very different indications. This led us to carry out a large multicentre study with a minimum follow-up of 5 years to evaluate the complications after hinged TKA in a non-tumoral context based on the indications of primary arthroplasty, aseptic surgical revision or fracture treatment around the knee.Hinged TKA was associated with a high complication rate, no matter the indication.Two hundred and ninety patients (290 knees) were included retrospectively between January 2006 and December 2011 at 17 sites, with a minimum follow-up of 5 years. The patients were separated into three groups: primary surgery (111 patients), aseptic revision surgery (127 patients) and surgery following a recent (3 months) fracture (52 patients: 13 around the TKA and 39 around the knee treated by hinged TKA). Patients who had an active infection the knee of interest were excluded. All the patients were reviewed based on a standardised computer questionnaire validated by the SOFCOT.The mean follow-up was 71±39 months [range, 0 to 188]. Of the 290 patients included in the study, 108 patients (37%) suffered at least one complication and 55 patients (19%) had to undergo revision surgery: 16 in the primary TKA group (16/111, 14% of primary TKA), 28 in the revision surgery group (28/127, 22% of revision TKA) and 11 in the fracture treatment group (11/52, 21% of fracture TKA). The complications due to the hinged TKA for the entire cohort from most to least common were stiffness (41/290, 14%), chronic postoperative pain (37/290, 13%), infection (32/290, 11%), aseptic loosening (23/290, 8%), general complications (20/290, 7%), extensor mechanism complications (19/290, 6%), periprosthetic fracture (9/290, 3%), mechanical failure (2/290, 0.7%). In the primary TKA group, the main complication leading to re-operation was infection (12/111, 11%), while it was loosening for the revision TKA group (15/127, 12%) and infection (8/52, 15%) for the fracture TKA group.The 37% complication rate for hinged TKA implants is high, with 19% of them requiring re-operation. The frequency of complications differed depending on the context in which the hinged implant was used (primary, revision, fracture). The complications requiring revision surgery were major ones that prevented patients from preserving their autonomy (infection, symptomatic loosening, fracture, implant failure). The most found complications - stiffness and chronic pain - rarely led to revision.IV; retrospective cohort study.

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

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

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

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

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

International audience; Hydrogen (H2)-rich fluids are observed in a wide variety of geologic settings including gas seeps in serpentinized ultramafic rocks, sub-seafloor hydrothermal vents, fracture networks in crystalline rocks from continental and oceanic crust, and volcanic gases. Natural hydrogen sources can sustain deep microbial ecosystems, induce abiotic hydrocarbons synthesis and trigger the formation of prebiotic organic compounds. However, due to its extreme mobility and small size, hydrogen is not easily trapped in the crust. If not rapidly consumed by redox reactions mediated by bacteria or suitable mineral catalysts it diffuses through the rocks and migrates toward the surface. Therefore, H2is not supposed to accumulate in the crust. We challenge this view by demonstrating that significant amount of H2may be adsorbed by clay minerals and remain trapped beneath the surface. Here, we report for the first time H2content in clay-rich rocks, mainly composed of illite, chlorite, and kaolinite from the Cigar Lake uranium ore deposit (northern Saskatchewan, Canada). Thermal desorption measurements reveal that H2is enriched up to 500 ppm (i.e. 0.25molkg−1of rock) in these water-saturated rocks having a very low total organic content (

The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA).Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI30 kg/mAt baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P.001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011).These findings show that all patients improved biomechanically and clinically, regardless of their BMI.

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

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.

The evolution of basinal brines through percolation into basement rocks is studied in the Paleo- to Mesoproterozoic Athabasca Basin and its underlying basement. This specific geological context includes the evolution of a NaCl-rich basinal brine to a U-mineralizing CaCl2-rich brine that is of particular importance for the understanding of the formation of giant U deposits. The objective of this study is to determine the physico-chemical parameters (P-T-X) of the basinal brines and their changes both within the Athabasca Group sandstones and the underlying basement lithologies, on the scale of several km around the world class unconformity-related Cigar Lake U deposit. Particularly, this study focuses on the basement-hosted fault systems that are considered to be the main fluid flow pathways. A comprehensive study including microthermometry, Raman spectroscopy, and LA-ICP-MS analyses was carried out on fluid inclusions, as was a semi-quantitative estimation of the microfracture paleoporosity based on the surface density of fluid inclusion planes. Initial NaCl-rich brines were trapped during early diagenesis (c.a. 1.7–1.65 Ga) in dickite-rich sandstones, under a three to seven kilometers thick sedimentary cover at around 90 to 150 °C under hydrostatic pressure, or at 120–210 °C assuming lithostatic conditions. At the time of U deposits formation (ca. 1.46–1.29 Ga), these brines percolated through the entire basement, but preferentially within the damage zones of some graphite-rich faults, formed during the ca. 1.8 Ga Trans-Hudson Orogeny and active during the subsequent retrograde metamorphism and exhumation (ca. 1.8–1.72 Ga). The circulation of the basinal brines into these structures was enhanced and structurally-controlled by the microfracture network inherited from earlier brittle reactivation during basement uplift. The resulting high microfracture paleoporosity in the vicinity of some, but not all, of these structures favored intense interaction between the brines and basement rocks that induced the formation of illite-sudoite alteration haloes. In the basement, the percolating brines scavenged Mn, K, Ba, Sr, and especially U, and evolved from the original NaCl-dominant composition toward a higher salinity CaCl2-rich composition. The resulting U-bearing brine mixed with the unmodified diagenetic NaCl-rich brine in, above, and all along the reactivated faults, either during thermal convection in isobaric settings and higher temperatures (110–200 °C) or through episodic tectonic reactivation in isothermal settings through episodic pressure fluctuation. In direct vicinity of the U deposits, the interactions between the brines and the basement rocks were the strongest, which is marked by the highest intensity of alteration of the host rocks. Thus, the formation of ore-forming fluids resulted from the interaction between NaCl-rich basinal brines and highly-microfractured basement rocks. This study reinforces the hypothesis that interaction with basement rocks enhanced by strong fluid flow in cataclastic zones, can significantly modify the physico-chemical characteristics of basin-derived brines, leading to the formation of mineralizing fluids and the genesis of giant ore deposits, such as the unconformity-related U deposits.

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

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

The objective was to evaluate clinical and radiological outcomes, survival rate and complications of primary contemporary rotating hinged total knee arthroplasty (CRH-TKA). Through a national multicenter retrospective study (14 centers), 112 primary CRH-TKA performed between 2006 and 2011 were included. Indications were: severe frontal plane deformity (55%), inflammatory, constitutional, congenital or post-trauma arthritis (26%), ligament laxity (10%), primary osteoarthritis (9%). Population was elderly (68 ± 13), sedentary (37.5% with a Devane score ≥ 3) and with important comorbidities (87% with ASA score ≥ 2). A clinical (KSS, Oxford scores) and radiological evaluation (implant loosening), as well as survival and reoperation rates assessment, were performed. At last follow-up (7 ± 3 years), KSS and Oxford scores were 64 ± 43 and 33 ± 10 each with a significant improvement of both scores overtime (respectively, p = 0.047 and p

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

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

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.