[A pedicled deep inferior epigastric flap to cover a hip arthroplasty infection]. / Couverture d'une prothèse de hanche infectée par un lambeau perforant épigastique inférieur profond pédiculé.

The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62years old woman with a BMI at 42kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon.

Treatment of aseptic osteonecrosis of the femoral head: Historical aspects.

The treatment of aseptic osteonecrosis (ON) of the femoral head has been the subject of numerous therapeutic and surgical proposals due to the absence of medical treatment with proven efficacy. For many years, the goal of surgical treatment was to avoid total hip replacement (THR) with uncertain survival in patients considered too young (30-50 years) for this procedure. Numerous conservative treatments were thus proposed: core decompression with numerous variants, non-vascularized and vascularized bone grafts, intertrochanteric and rotational transtrochanteric osteotomies, cementing. The lack of a common classification and a lack of knowledge of natural history complicated the interpretation of the results for a long time. Nevertheless, it appeared that these treatments were effective only in the very early stages and among these in the limited ONs, medial rather than central and especially lateral, with discrepancies according to etiologies apart from sickle cell disease recognized by all as being pejorative. For the same reason, partial arthroplasties have been attempted and abandoned in turn: femoral head total and partial resurfacing and femoral prosthesis. The most recent advances are stem-cell-enhanced core decompression and progress in total arthroplasty, whose reliability has made it possible to extend the indications to increasingly younger patients seeking treatment with guaranteed or near-guaranteed efficacy. Most of the other interventions have disappeared or almost disappeared because of their lack of effectiveness especially in extensive and post-fracture ONs, sometimes because of their complexity and the length of their post-operative management, and also because they complicate and penalize a future total arthroplasty. This argues for early detection of ON at an early stage where the "head can be saved" by stem cell augmented core decompression, a minimally invasive treatment that leaves the chances of success of a THR intact.

Global radiological score for femoral cementless revision stem.

PURPOSE: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) revision with cementless stems using a numeric global radiological score (GRxS) that summarizes two previously validated scores: secondary bone stock (SBS) and osseointegration-secondary stability (O-SS). METHOD: One hundred fifty cases of THA were evaluated at a mean follow-up of 6.5 ± 3.7 years. The GRxS combines the SBS, which evaluated cortical bone thickness, bone density and bone defects in each Gruen zone and the O-SS, which evaluated the location and extent of a single radiolucent line. To calculate the GRxS, the SBS and O-SS were each expressed on a 10-point scale and given equal weighing. The final result was a number out of 20. The GRxS was used to assign a radiological grade to each THA case: very good (20), good (18-15), average (13-12), or poor (≤ 10). The numerical mean (Nm) was calculated for each grade. The inter- and intra-observer reproducibility was evaluated. RESULTS: The inter-observer reproducibility was good (0.8) and the intra-observer reproducibility was very good (0.9). The GRxS was considered very good in 46 cases (Nm 20), good in 57 cases (Nm 16.6), average in 25 cases and poor in 22 cases. There was a significant relationship between the GRxS and the Harris Hip and Postel Merle d'Aubigné scores (p < 0.0001), and the initial bone stock (p = 0.0001). CONCLUSIONS: The GRxS is reliable and reproducible. This information can be used by surgeons to adapt the surgical technique to bone characteristics (especially during revision cases) and to compare the outcomes of different implant designs.

Wear products of total hip arthroplasty: The case of polyethylene.

Among the bearing surfaces involved in a total hip arthroplasty, ultra-high molecular weight polyethylene (UHMWPE) is the weak link. It is submitted to the friction of a harder bearing, producing wear particles, which, in turn, initiate an inflammatory reaction ultimately leading to osteolysis. This kind of bone deterioration sometimes turns out to an aggressive granuloma and may provoke implant loosening. Wear resistance of UHMWPE depends on its molecular weight and crystallinity. Some steps of the manufacturing process were improved to optimize its tribological properties and to slow down degradation resulting from mechanical (abrasion) and chemical (oxidation) phenomena. Its preparation and conservation must be performed in an inert atmosphere, i.e. without ambient oxygen. Its resistance to abrasion depends on its cross-linking degree. Its cross-linking rate was observed to increase proportionally to the irradiation doses, improving its wear resistance. However, its mechanical properties are impaired and moreover, it becomes oxidation sensitive. It is therefore necessary to submit it to a thermal treatment to eliminate free radicals that were produced during irradiation. More recently impregnation by vitamin E, a powerful anti-oxidant product, was proposed to preserve the polymer from in vivo oxidation while maintaining its mechanical properties. We raised the hypothesis that last-generation UHMWPE could offer the same wear resistance as the most performing bearings (ceramic-on-ceramic). Recent clinical results confirm the tribological performance of highly crosslinked UHMWPE in vivo. However, it remains to be seen whether this excellent wear resistance would persist under eccentric load such as edge loading, and if, in the long run, this kind of bearing proves capable of reducing the risk of osteolysis in young and active patients.

Proximal interphalangeal joint prosthetic arthroplasty.

Surgical treatment of the painful proximal interphalangeal (PIP) joint has evolved considerably over the past century. If arthrodesis has long been the gold standard and remains so for some, prosthesis would meet patient demand: mobility and indolence. Faced with a demanding patient, the surgeon must decide the indication, the type of prosthesis, the approach, the post-operative follow-up, etc. The history of the development of PIP prostheses demonstrates the complexity of the treatment of the destroyed PIP: appearance of prostheses, evolution and sometimes disappearance from the market for commercial reasons or related to complications. The main objective of this conference is to identify the main indications for prosthetic arthroplasties and to describe the various prostheses available on the market.

Radiological positioning of a proximal interphalangeal joint resurfacing implant: Reliability and functional outcomes correlation.

OBJECTIVES: The aims of this study were to define radiological measurements for quantifying the position of a surface replacing implant (CapFlex-PIP) in the proximal interphalangeal (PIP) joint, to test the reliability of these measurements, and to explore whether implant position influences patient-reported and clinical outcomes one year after surgery. MATERIAL AND METHODS: We developed 7 radiographic measurements to quantify the position of the proximal and distal implant components. Two independent surgeons analyzed the 1-year postoperative radiographs of 63 fingers documented in our registry. Inter-rater reliability of these measurements was calculated with the intraclass correlation coefficient (ICC). Correlations between the radiographic measurements and PIP range of motion (ROM), the brief Michigan Hand Outcomes Questionnaire (MHQ), and pain were determined using Spearman's correlation coefficient. Radiographic measurements of patients with the worst and best postoperative ROM were compared using the Mann-Whitney-U test. RESULTS: Inter-rater reliability was only good for 1 measurement (ICC = 0.89), but poor to moderate for the other measurements (ICC ranging from 0.34 to 0.69). These measurements neither correlated with ROM, brief MHQ nor pain based on correlation coefficients ranging from 0.00 to 0.31. There were no relevant differences in the radiographic measurements between patients with the worst and best ROM. CONCLUSION: The position of the CapFlex-PIP implant could not be reliably quantified on plain radiographs. The lack of correlations between implant position and postoperative outcomes can be attributed either to the unreliable measurements or the actual lack of influence of the implant position on pain and function.

3D-planned corrective osteotomy of metacarpal arch disruption after Motec® wrist prosthesis.

We report two cases of metacarpal arch disruption after Motec® total wrist arthroplasty, with hyperextension of the third metacarpal and dorsal protrusion of the head. Correction osteotomies of the adjacent metacarpals using preoperative 3D surgical planning were successful. This report seeks to shed light on the origin of this deformation and to recommend some operative precautions. It is important that surgeons should be aware of the existence of this complication, as disruption of the transverse metacarpal arch affects both grasp and hand esthetics. LEVEL OF EVIDENCE: IV.

[Anatomical and functional results of total hip prosthesesat Kati University Hospital]. / Résultats anatomiques et Fonctionnels des prothèses totales de hanche au CHU de Kati.

INTRODUCTION: Hip prosthetic surgery is a commonly performed procedure in orthopedic trauma. It has changed the prognosis of traumatic, degenerative and inflammatory hip diseases. OBJECTIVE: The aim of this work was to evaluate the functional and anatomical results of a series of total hip replacements in our department in the short and medium term and to compare them with the literature. PATIENTS AND METHODS: This was a retrospective descriptive and analytical study of a series of 96 total hip replacements performed at the University Hospital of Kati, from January 2019 to December 2021. Functional discomfort was assessed in all patients before and after surgery. The prostheses used were of the Aston, AK, Surgival, Evolutus and Sharma types. The anatomical results were assessed by radiological criteria and the functional results by Postel Merle d'Aubigné criteria. RESULTS: In our study, 96 hips were operated on by total prosthesis in 91 patients, including five bilateral cases. The patients were 49 men and 42 women. The average age was 46.9 years. Coxarthrosis associated with necrosis of the femoral head was the most frequent indication for arthroplasty (n=51), followed by femoral neck fracture (n=26). The inclination of the cup was anatomical in 73.3% of cases. The mean femoral offset was 44.1 mm with extremes of 26 and 59 mm. Cup anteversion was normal in 79.4% of cases. The mean preoperative PMA score increased from 5.2 (0 and 15) to 16.9 (4 and 18) late postoperatively. Our results were satisfactory in 89% of cases. CONCLUSION: Total hip arthroplasty allows, in the vast majority of cases, to recover indolence and perfect functionality of the hip.

INTRODUCTION: La chirurgie prothétique de hanche est une intervention couramment pratiquée en orthopédie traumatologie. Elle a changé le pronostic des pathologies traumatiques, dégénératives et inflammatoires de la hanche. OBJECTIF: Le but de ce travail était d'évaluer à court et moyen terme les résultats fonctionnels et anatomiques d'une série de prothèses totales de hanche dans notre service et de les comparer avec la littérature. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective descriptive et analytique d'une série de 96 prothèses totales de hanche réalisées au CHU de Kati, allant de janvier 2019 à décembre 2021. Les gênes fonctionnelles ont été appréciées chez tous les patients avant et après l'intervention. Les prothèses utilisées étaient de type Aston, AK, Surgival, Evolutus et Sharma. Les résultats anatomiques ont été appréciés par les critères radiologiques et les résultats fonctionnels par les critères de Postel Merle d'Aubigné. RÉSULTATS: Au cours de notre étude 96 hanches ont été opérées par prothèse totale chez 91 patients dont cinq cas bilatéraux. Il s'agit de 49 hommes et 42 femmes. L'âge moyen était 46,9 ans. La coxarthrose associée à la nécrose de la tête fémorale était l'indication de l'arthroplastie la plus fréquente (n=51) suivie de la fracture du col fémoral (n=26). L'inclinaison de la cupule était anatomique dans 73,3% des cas. L'offset fémoral moyen était 44,1 mm avec des extrêmes de 26 et 59 mm. L'antéversion de la cupule était normale dans 79,4% des cas. Le score moyen du PMA préopératoire était passé de 5,2 (0 et 15) à 16,9 (4 et 18) en postopératoire tardive. Nos résultats étaient satisfaisants dans 89% des cas. CONCLUSION: L'arthroplastietotaledehanchepermet,danslatrèsgrandemajoritédescas,deretrouve runeindolenceet une fonctionnalitéparfaite de la hanche.

Time to return to work after total trapeziometacarpal prosthesis.

OBJECTIVES: This study assessed return to work and prosthesis survival after trapeziometacarpal prosthesis surgery. MATERIAL AND METHODS: A multicenter retrospective study was carried out on patients operated on between 2002 and 2020. All working patients who had undergone trapeziometacarpal prosthesis surgery were included. Return to work was defined as resuming the same full-time position. Postoperative events and their specific treatment and failure to return to work were reported. RESULTS: 240 prostheses in 211 patients were included. The complications rate was 7.5%, with 97% prosthesis survival. 94.3% of patients returned to work, at a mean 48 days (range, 29-210 days; SD, 22.7 days), with no significant difference according to age. Twelve patients did not return to work, half of whom because of prosthetic complications. CONCLUSION: Trapeziometacarpal arthroplasty enables most patients to return to work within 6 weeks. In this series, the prosthetic survival rate was 97%.

Bioabsorbable poly-L/D-lactide (96/4) scaffold arthroplasty as a salvage procedure in the metacarpophalangeal joint.

We report the case of a 69-year-old female patient, who developed an impressive foreign body reaction around broken metacarpophalangeal silicone implants, including serious axillary lymphadenopathy 3 years after surgery. Possible revision arthroplasties were evaluated but, due to poor bone stock, no regular implants could be used. Instead, a double RegJoint™ (Scaffdex Oy, Finland), a bioabsorbable poly-L/D-lactide implant, was used for each of the 4 metacarpophalangeal joints. At follow-up, we observed no recurrence of synovitis, lymphadenopathy, or any other adverse events. The patient was highly satisfied with the results of the surgery, and painless functional joint movement could be achieved. The restorable RegJoint™ implant seems to be a valid revision option in case of failed silicone arthroplasty.

ISIS trapeziometacarpal arthroplasty: What are the outcomes in male patients?

Trapeziometacarpal arthroplasty is a well-known treatment of thumb basal joint arthritis. However, only a few studies have been done on its use specifically in men, with one of the most recent showing a high implant failure rate. Our study was a retrospective analysis of the ISIS prosthesis exclusively in men. Our hypothesis was that it is a viable therapeutic solution. Between 2010 and 2020, 23 ISIS prostheses were implanted in 19 patients. A radiological and functional analysis was done, combined with a self-evaluation by multiple validated outcome scores (visual analog scale for pain, QuickDASH, PRWE, SF36, and Kapandji scores). The median follow-up was 76 months (13-134) with a median age of 69 years. The mean pain level was 1/10, the QuickDASH was 22.7, the PRWE was 14.2, the SF-36 was 61.1 and the Kapandji score was 8.9. One dislocation occurred in one patient; two patients had to be reoperated for periprosthetic ossifications. Radiolucency was found around the cup in one patient and around the metacarpal shaft in one patient. There was no implant failure and only one case of asymptomatic loosening, with a survival rate of 94% at 111 months. In the medium-term, clinical, and functional outcomes were satisfactory with pain relief similar to that of published studies, with a low rate of complications. ISIS arthroplasty appears to be a suitable treatment for thumb basal joint arthritis in men, although a non-negligible rate of periprosthetic ossifications required revision surgery in half of the cases.

Proximal interphalangeal joint arthroplasty with the Tactys® prosthesis: Clinical and radiological outcomes at a mean 3.1 years' follow-up.

Preliminary results with the Tactys® modular gliding prosthesis for proximal interphalangeal joint (PIPJ) replacement were encouraging, with notable improvement in clinical and functional scores at 1 and 2 years' follow-up. However, a recent study found a trend for deterioration over time. We wanted to check this by analyzing medium-term outcomes. Sixty-four arthroplasties were performed in 48 patients in single facility between January 2015 and January 2020. Clinical, functional, and radiographic outcomes were analyzed at short- and medium-term follow-up for 15 of these arthroplasties. Mean follow-up of the 48 patients was 3.1 years. Pain significantly decreased on the numeric rating scale (p < 0.01) and the functional QuickDASH score improved from 67.3 to 55.9 (p < 0.01). Grip and pinch strengths were lower in the operated than in the contralateral hand (p = 0.04 and p = 0.6, respectively). PIPJ active range of motion (ROM) in flexion/extension improved from 44° to 49.4° (p = 0.17). 70% of the 48 patients were satisfied. Fifteen arthroplasties were analyzed at 17 and 61 months' follow-up. Pain relief continued. ROM decreased from 57° to 46° (p < 0.05) and the functional QuickDASH score deteriorated from 25.8 to 54.7 (p < 0.01). Both grip and pinch strength increased, with a significant difference in pinch (p = 0.003). The main complication was swan-neck deformity (46%), with a mean 11 months' onset. Our results confirmed the deterioration trend observed over time in the functional results of the Tactys® prosthesis despite, good patient satisfaction. LEVEL OF EVIDENCE: 4.

The INCA® implant to treat isolated scaphotrapeziotrapezoid osteoarthritis: Preliminary results at a minimum 2 years' follow-up.

We report results with the INCA® distal scaphoid pole resurfacing implant anchored within the scaphoid for isolated scaphotrapeziotrapezoid osteoarthritis. Thirty-five implants in 27 patients (mean age, 69 years) were retrospectively included with a minimum follow-up of 2 years. Outcome criteria were pain (VAS), PROMs (QuickDASH, PRWE and MMWS), wrist motion, pinch and grip strength, and radiographic assessment. The average follow-up was 4.6 years. There was a significant improvement in pain, PROMs, grip and pinch strength. Radial deviation and wrist extension showed slight but significant postoperative decrease (-4° for both). Dorsal intercalated segment instability (DISI) was significantly improved postoperatively (7 cases versus 21 preoperatively). There were 2 cases of implant loosening (6%) within the first 10 months: 1 keel malpositioning and 1 insufficient postoperative immobilization. These findings suggest that the INCA® implant is an effective and reliable medium-term solution for isolated scaphotrapeziotrapezoid osteoarthritis. By restoring scaphoid length and gliding on the trapeziotrapezoid surface, the implant contributes to restoring normal bone alignment of the wrist.

[Anatomical and Junctional results of total hip prosthesesat Kati University Hospital]. / Résultats anatomiques et Fonctionnels des prothèses totales de hanche au CHU de Kati.

INTRODUCTION: Hip prosthetic surgery is a commonly performed procedure in orthopedic trauma. It has changed the prognosis of traumatic, degenerative and inflammatory hip diseases. OBJECTIVE: The aim of this work was to evaluate the functional and anatomical results of a series of total hip replacements in our department in the short and medium term and to compare them with the literature. PATIENTS AND METHODS: This was a retrospective descriptive and analytical study of a series of 96 total hip replacements performed at the University Hospital of Kati, from January 2019 to December 2021. Functional discomfort was assessed in all patients before and after surgery. The prostheses used were of the Aston, AK, Surgival, Evolutus and Sharma types. The anatomical results were assessed by radiological criteria and the functional results by Postel Merle d'Aubigné criteria. RESULTS: In our study, 96 hips were operated on by total prosthesis in 91 patients, including five bilateral cases. The patients were 49 men and 42 women. The average age was 46.9 years. Coxarthrosis associated with necrosis of the femoral head was the most frequent indication for arthroplasty (n=51), followed by femoral neck fracture (n=26). The inclination of the cup was anatomical in 73.3% of cases. The mean femoral offset was 44.1 mm with extremes of 26 and 59 mm. Cup anteversion was normal in 79.4% of cases. The mean preoperative PMA score increased from 5.2 (0 and 15) to 16.9 (4 and 18) late postoperatively. Our results were satisfactory in 89% of cases. CONCLUSION: Total hip arthroplasty allows, in the vast majority of cases, to recover indolence and perfect functionality of the hip.

INTRODUCTION: La chirurgie prothétique de hanche est une intervention couramment pratiquée en orthopédie traumatologie. Elle a changé le pronostic des pathologies traumatiques, dégénératives et inflammatoires de la hanche. OBJECTIF: Le but de ce travail était d'évaluer à court et moyen terme les résultats fonctionnels et anatomiques d'une série de prothèses totales de hanche dans notre service et de les comparer avec la littérature. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective descriptive et analytique d'une série de 96 prothèses totales de hanche réalisées au CHU de Kati, allant de janvier 2019 à décembre 2021. Les gênes fonctionnelles ont été appréciées chez tous les patients avant et après l'intervention. Les prothèses utilisées étaient de type Aston, AK, Surgival, Evolutus et Sharma. Les résultats anatomiques ont été appréciés par les critères radiologiques et les résultats fonctionnels par les critères de Postel Merle d'Aubigné. RÉSULTATS: Au cours de notre étude 96 hanches ont été opérées par prothèse totale chez 91 patients dont cinq cas bilatéraux. Il s'agit de 49 hommes et 42 femmes. L'âge moyen était 46,9 ans. La coxarthrose associée à la nécrose de la tête fémorale était l'indication de l'arthroplastie la plus fréquente (n=51) suivie de la fracture du col fémoral (n=26). L'inclinaison de la cupule était anatomique dans 73,3% des cas. L'offset fémoral moyen était 44,1 mm avec des extrêmes de 26 et 59 mm. L'antéversion de la cupule était normale dans 79,4% des cas. Le score moyen du PMA préopératoire était passé de 5,2 (0 et 15) à 16,9 (4 et 18) en postopératoire tardive. Nos résultats étaient satisfaisants dans 89% des cas. CONCLUSION: L'arthroplastietotaledehanchepermet,danslatrèsgrandemajoritédescas,deretrouve runeindolenceet une fonctionnalitéparfaite de la hanche.

Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit.

Semiconstrained arthroplasty of the distal radioulnar joint (DRUJ) (Scheker prosthesis, Aptis Medical, Glenview, KY, USA) is a treatment option in case of irreparable destruction of the DRUJ. In our unit, a Scheker endoprosthesis was implanted in 5 wrists in 4 patients. 3/5 wrists (60%) in 3/4 patients (75%) underwent revision surgery. Reasons for revision surgery were implant loosening, periprosthetic fracture of the radius and suspicion of periprosthetic infection. Asymptomatic loosening of the screw of the radial head cover was detected in one wrist. Scheker arthroplasty is technically demanding. The prosthesis is prone to failure over the long term. Before implantation, all patients should be informed of the high risk of revision surgery.

Arthroplasty for destroyed proximal interphalangeal joint in hand trauma surgery: Silicone hinged NeuFlex® or gliding Tactys®?

The treatment of proximal interphalangeal joints (PIP) after a traumatic injury has produced disappointing outcomes. The objective of this study was to evaluate the functional results of emergency hinged or gliding arthroplasty for destroyed PIP joints. A two-center retrospective study was carried out in 24 patients with open and closed trauma of the PIP joint of the fingers from 2007 to 2019. Fifteen hinged silicone implants (NeuFlex®) and nine gliding implants (Tactys®) were used. Pain on a visual analog scale (VAS), stability and total active motion (TAM), grip and pinch strength (Jamar®), QuickDASH and PRWE and satisfaction were assessed, and X-rays were performed. With a mean follow-up of 48 months, 24 patients aged 58 years on average were reviewed. Pain on VAS was 0.2/10, the TAM was 72% of the contralateral side, the QuickDASH was 15.6/100 and the PRWE was 24.5/100. PIP flexion was ≥50% of the contralateral side in 75% of patients. PIP and DIP extensor lag of 9° was significantly larger with the Tactys® than with the NeuFlex®, with no significant difference in the TAM. Three clinodactylies in fingers with the NeuFlex® and three reducible swanneck deformities in fingers with the Tactys® were noted. Three-quarters of patients were very satisfied or satisfied with the outcome. Emergency PIP arthroplasty with Tactys® seems to provide functional results that are as good as with NeuFlex®. Clinodactyly was found with NeuFlex® use. A significant PIP and IPD extensor lag of 9° and swan-neck deformities were found with Tactys® without significant functional impairment.

The concept of first metacarpal M1-M2 arch. New interest in trapeziometacarpal prostheses.

Analysis of the M1-M2 arch, otherwise known as the M1-M2 metacarpal hanger, objectively helps all surgeons treating basal thumb osteoarthritis to fit a trapeziometacarpal prosthesis that respects the physiological length of the thumb column and thus the physiological tensions of the APL, EPL, and EPB tendons as well as the interossei and thenar muscles. Kapandji X-ray views are a gold-standard in the radiological study of basal thumb osteoarthritis, to classify progression, measure trapezium height, and assess the deformity. Ledoux's M1/M2 ratio is the only method for assessing the normal length of the thumb column but cannot be easily used during surgery. We describe the first metacarpal arch, obtained by a radiological anteroposterior X-ray of the hand and wrist with the thumb in 45° abduction. It may be broken or conserved, depending on the form of osteoarthritis. It can objectively predict whether a prosthesis must be placed iso-long or so as to lengthen the thumb column. This overcomes the subjectivity of the notion of "intraoperative piston" and avoids excessive tensioning of the prosthesis, which would increase stress on the prosthetic components and thus the risk of wear and complications. We applied this technical principle to 148 dual mobility prostheses fitted between January 2019 and May 2021. By respecting the arch, the right trade-off is found between intraoperative stability and mobility while protecting the long-term performance of the prosthesis.

Rehabilitation after proximal interphalangeal joint replacement: A structured review of the literature.

Proximal interphalangeal (PIP) joint arthroplasty is an unsolved biomechanical challenge despite advances in materials and new implant designs. This leads to a high rate of complications. Moreover, there is heterogeneity in postoperative management according to the literature. The present structured review examined the therapeutic strategies utilized by physiotherapists to restore a functional finger chain and prevent postoperative complications following PIP joint replacement. Patients undergoing primary total PIP joint arthroplasty of the index, ring, middle or little finger were included. Articles published from 2008 onwards, in French or English, and reporting on PIP joint replacement and postoperative management, were included. Therapeutic strategies were organized according to the surgical approach. Details of splint strategies, mobilization and muscle strengthening and management of postoperative complications were collected. Forty-eight studies, 3 of which provided a description of surgical techniques, were included. In relation to hand function, most authors advocated joint mobilization (n = 45) and some recommended muscle strengthening (n = 4). Static (n = 43) and dynamic splints (n = 14) and buddy taping (n = 12) were frequently recommended to prevent and manage postoperative complications. Few studies (n = 13) reported wound assessment or control of postoperative edema. Precise recommendations concerning therapeutic strategies following PIP joint arthroplasty cannot be made based on available evidence. Specific protocols for rehabilitation following PIP joint replacement need to be clarified in future research.

Wide resection for giant-cell tumor of the distal radius: which reconstruction? A systematic review of the literature and pooled analysis of 176 cases.

Giant-cell tumor (GCT) is often more aggressive when located in the distal radius, and wide resection is then the gold-standard. No single reconstruction protocol is recommended, and the technique depends upon the surgeon's preferences. The aim of the present review was to determine the recurrence rate of GTC of the distal radius after intralesional treatment, to assess the results, advantages and complications of the various surgical techniques, and to draw up a decision-tree for surgical indications. The review of literature was performed in the main healthcare databases, searching for studies that reported results of wide resection and reconstruction of distal radius GCT. Local recurrence rates, metastasis rates, reconstruction techniques and respective results and complications were evaluated and analyzed. Sixteen studies were selected, for a total population of 226 patients; 6.0% and 0.9% experienced local recurrence and lung metastasis, respectively. Arthroplasty with non-vascularized or vascularized ipsilateral fibula were the most common techniques and were associated with the highest satisfaction rates: 86.4% and 88.0%, respectively. Arthroplasty with allograft presented a MusculoSkeletal Tumor Society (MSTS) score of 79.2% and arthroplasty with custom-made prosthesis presented an MSTS score of 81.8%. Arthrodesis was performed in 46 cases, with an MSTS score of 82.7%. Arthroplasty techniques are the most common in literature; they are used in patients who wish to conserve joint motion. Reconstruction with non-vascularized fibula seems to provide the best results, with lower morbidity. Arthrodesis is usually reserved for heavy manual workers or in case of arthroplasty failure.

Results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist at a mean 5 years' follow-up.

Management of severe joint involvement in rheumatoid wrist is controversial. The gold-standard is total wrist fusion, but total wrist replacement offers a motion-conserving alternative. The purpose of this study was to present the results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist. We performed a retrospective review of 28 arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. Mean follow-up was 64 months. We measured range of motion, grip strength, and pain (on VAS). Function was evaluated preoperatively and at last follow-up with the DASH and PRWE scores. Mean range of motion in flexion-extension was maintained while mean inclination and rotational range of motion showed significant improvement. Mean grip strength increased from 10 kg to 17 kg. Mean pain score decreased from 6/10 to 2/10. Mean PRWE and QuickDASH scores decreased from 62/100 to 25/100 and from 62/100 to 36/100, respectively. Three patients underwent early reoperation to reposition a dislocated implant. No implants had to be removed. Amandys® pyrocarbon arthroplasty is a reliable alternative to total fusion or total replacement in rheumatoid wrist. Indications must be limited to well-aligned wrists with competent capsule-ligament structures.