Ten-year outcomes of the Arpe prosthesis for the treatment of osteoarthritis of the trapeziometacarpal joint.

Outcomes of 66 Arpe prostheses in 50 patients treated for osteoarthritis of the trapeziometacarpal joint were investigated with a mean follow-up of ten years. Ten-year survival was 87% when failure was defined as implant removal followed by trapeziectomy and tendon interposition. Ten-year survival was 82% when revision of the cup was also considered as failure and it was 80% when replacement of the neck alone was also chosen as an endpoint. Of the 52 prostheses that were not revised mean DASH score was 11, mean pain score 1.2 and mean score for satisfaction 9.5. It can be concluded that the majority of patients who did not underwent revision surgery were satisfied and had little or no pain. However, long-term survival of the Arpe prosthesis was moderate and patients should be warned that after ten years the risk for reoperation might be up to 20%.

[How to choose the ideal graft for anterior cruciate ligament reconstruction]. / Comment choisir le type de greffe pour la reconstruction du ligament croisé antérieur ?

Indication for anterior cruciate ligament reconstruction is a debated subject and needs to be discussed on an individual basis, depending on the patient's age and physical demands. Graft selection is a crucial step for successful outcome and needs to be adapted to the patient, to the concomitant lesions, preoperative knee and lower limb injuries, but also to the surgeon's experience and preference. The present article summarizes current concepts, the pros and cons of the most used autografts and allografts, and highlights the importance to adapt postoperative rehabilitation in function of the graft.

L'indication à la reconstruction du ligament croisé antérieur est sujet à débat et nécessite d'être discutée au cas par cas, selon l'âge du patient et sa demande fonctionnelle. Le choix de la greffe est crucial pour un résultat satisfaisant et repose sur les souhaits du patient, la présence de lésions associées, de douleurs ou comorbidités du membre inférieur ainsi que sur l'habitude et l'expérience du chirurgien. Cet article résume les concepts chirurgicaux, les avantages et inconvénients des types d'autogreffe et d'allogreffe, et indique l'importance de l'adaptation de la rééducation en fonction de la greffe choisie.

Enhancing rotational placement of reconstruction prostheses of the distal femur after sarcoma resection.

INTRODUCTION: Currently there are no accepted international guidelines for the correct placement of reconstruction prostheses in the axial plane of the femur after en bloc resection. The most accepted method is based on the linea aspera as an intraoperative landmark, indicating posterior. This study was conducted to address the reliability of the linea aspera as a landmark for rotational alignment. MATERIAL AND METHODS: 50 CT angiographies of the right limb were used for this purpose. These 2D images were reconstructed into 3D models using proprietary software (materialize NV, Leuven, Belgium). The posterior condylar line was used as a reference axis. The orientation of the linea aspera was described as the angle between the perpendicular line to the PCL, through the center of the diaphysis, and the lateral (α) and medial labium (ß). RESULTS: The linear mixed model shows that the α- and ß-angles are significantly associated with the distance from the joint line (p<0.001) and vary significantly between subjects (p<0.001). The α-angle has the lowest variance and approximates more closely true posterior, while the median ß-angle never overlaps true posterior. DISCUSSION: When a surgeon would blindly rely on the linea aspera as a posterior landmark roughly 78% of the femoral implants would exceed the accepted ±3° deviation around the surgical transepicondylar axis (sTEA) as defined in total knee replacement. The linea aspera is not a reliable landmark for axial rotation of femoral implants. The position is highly dependent on the osteotomy height and in addition differs between individual patients. Preoperative assessment of the linea aspera is advocated in order to reduce the risk of malrotation. As the height of the osteotomy cannot always be determined correctly preoperatively, a table was designed as a guideline for how much a deviation from the planned resection height will affect the rotation of the implant.