Survivorship and complications of cementless compared to cemented posterior-stabilized total knee arthroplasties: A systematic review and meta-analysis.

PURPOSE: Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries. METHODS: Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis. RESULTS: When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development. CONCLUSION: We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period.

Arthroscopy with partial meniscectomy for degenerative tear does not increase the risk of total knee arthroplasty at five year follow up; however, this population undergoes total knee arthroplasty with a lower threshold of osteoarthritis.

PURPOSE: Degenerative meniscus tears can cause discomfort in some patients, and when medical treatments fail to provide relief, arthroscopy may be considered before resorting to knee prosthesis. However, the benefits of arthroscopy over nonsurgical treatments in patients over 60 years old are limited, and the evidence regarding its overall efficiency and drawbacks remains scarce. Furthermore, there has been no investigation into whether those patients treated with partial meniscectomy, undergo the knee operation at an earlier stage of osteoarthritis. METHODS: This study focused on data from a single Belgian hospital, involving patients over 60 years old with internal meniscal tears. The participants were categorized into two groups based on the treatment they received: arthroscopic partial meniscectomy (APM) or conservative management. The primary outcome assessed was the occurrence of knee arthroplasty within a five year period. Secondary outcomes included evaluating the ICRS cartilage grade and the time taken until total knee arthroplasty (TKA). RESULTS: A total of 194 patients with internal meniscal tears were included in the study. At the 5-year mark, the overall rate of knee arthroplasty was found to be 16.5%, with 11.9% of cases occurring within two years. After the 5-year follow-up, it was observed that 19.2% (24 patients) of the APM group and 11.6% (8 patients) of the conservative management group underwent knee arthroplasty. Notably, patients over 70 years old who underwent APM had a higher risk of eventually requiring TKA compared to those who received conservative management. Additionally, patients who underwent meniscectomy and later underwent TKA showed less wear in the internal compartment of the knee compared to patients in the conservative treatment group who underwent TKA. CONCLUSION: The study suggests that patients who underwent arthroscopy faced a similar risk of knee arthroplasty compared to those who underwent conservative management, excepted for patients over 70 years old. Despite this similar risk of arthroplasty for the whole population, they exhibited lower osteoarthritis severity when compared to the conservative group.

Hip fractures re-operation compared with death at two year in elderly patients: lowest risk of revision with dual mobility total hip arthroplasty than with bipolar hemiarthroplasty or internal fixation of Garden I and II.

PURPOSE: This study determined at two year follow-up the lifetime risk of re-operation for elderly patients with hip fractures undergoing internal fixation, dual mobility total hip arthroplasty, or bipolar hemiarthroplasty, using death of the patient as a competing risk. MATERIALS AND METHODS: With the hypothesis that arthroplasties may have less complications without increasing mortality even for Garden I and Garden II fractures, we retrospectively reviewed 317 hips with femoral neck fractures operated between January 2015 and August 2019. The mean age at time of surgical intervention was 82.4 years (range 65 to 105). Sixty patients presented a nondisplaced hip fracture (Garden I or II) treated by internal fixtion (I-F), and 257 were treated by hip arthroplasty: 118 dual mobility total hip arthroplasty (DM-THA) and 139 with a bipolar hemiarthroplaty (B-H). Demographics, surgical and complications data, and mortality were collected and compared for each group. RESULTS: The overall mortality rate was 22.4% at two years, and similar (p = 0.98) in all groups, respectively 22%, 22%, and 23% for DM-THA, B-H, and I-F groups. With dual mobility THA, the cumulative incidence of re-operations for any reason was (lower (9%) than with internal fixation (22%) or bipolar hemiarthroplasties (19%). CONCLUSION: Using a double mobility total prosthesis does not increase the post-operative mortality of the patients, nor does it increase their survival. But, reducing the risk of complications certainly improves their quality of life during the little time they have left .

Endoscopic fascia lata release for treatment of gluteal tendinopathy: a prospective study with a follow-up of 6 months to 1 year.

Greater trochanteric pain syndrome (GTPS) is clinically defined as greater trochanter pain with mechanical characteristics. The most common diagnosis is gluteal tendinopathy. Most cases of gluteal tendinopathy resolve with conservative management. In case of refractory pain endoscopic surgical treatment can resolved symptoms. This article presents a prospective study of endoscopic proximal fascia lata release associated to trochanteric bursectomy for recalcitrant trochanteric pain syndrome. 33 patients (35 hips) with refractory pain during more than six months were included. All patients were treated by endoscopic iliotibial band release and bursectomy according to Ilizaliturri. Outcomes were assessed by using Harris hip score and Womac hip score. Patients were follow-up until one year after surgery. The mean age was 53.7 years old, there was 9 men and 24 women. There were two bilateral cases in the female group. The average duration of conservative treatment was 20 months (CI95 9 to 31 months). 68% of patients were satisfied of the surgery with disappearance of pain after surgery. WOMAC and Harris hip score significantly improved after surgery until 6 months (respectively from 67 to 29 and from 40 to 76 - p<0.05). No complication was reported. Age, body mass index and duration of conservative treatment did not influence surgical results. This study showed that the endoscopic ilio tibial band (ITB) release and trochanteric bursectomy is simple, safe and easily reproductible but future prospective studies with a larger number of patients are required.

Vitamin C prevention of complex regional pain syndrome after foot and ankle surgery: a prospective randomized study of three hundred and twenty nine patients.

PURPOSE: Complex regional pain syndrome (CRPS) after foot and ankle surgery has a significant impact on the ability to walk. As the symptomatic treatment of this disaster complication is poor and has low efficacy, a preventive treatment would be beneficial. Vitamin C has been reported to be efficient in preventing CRPS in elective scheduled surgery. Few authors explored this efficiency in foot and ankle surgery. We, therefore, evaluated the efficacy of vitamin C in preventing this complication after foot and ankle surgeries for both trauma and elective surgery. MATERIAL AND METHODS: Between January 2018 and December 2019, 329 patients were included in the study. We conducted a prospective randomized study on the efficiency of vitamin C (one group with and one without vitamin C) to prevent CRPS risk in patients operated in our institution on foot or ankle surgery. The incidence of CRPS after foot and ankle surgery was evaluated in both groups; the diagnostic of CRPS was made using the Budapest criteria associated with three-phase bone scintigraphy. RESULTS: Among the 329 patients included in the study (232 women and 97 men), 121 patients were included in the vitamin C group and 208 in the control group (without vitamin C). Vitamin C was statistically linked with a decreased risk of CRPS (OR 0.19; CI 95% from 0.05 to 0.8; p = 0.021). Alcoholism and cast immobilization were increased risks factors of CRPS (respectively p = 0.001 and p = 0.034). CONCLUSION: Taking 1 g per day of vitamin C during 40 days after a foot or ankle surgery reduces the risk of CRPS.

Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations.

PURPOSE: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, fractures still need to be treated, as some patients with non-deferrable pathologies. The aim of this paper is to report the early experience of an integrated team of orthopaedic surgeons during this period. MATERIAL AND METHODS: This is a mono-geographic, observational, retrospective, descriptive study. We collected data from the beginning of the epidemic (1 March 2020), during the pandemic lockdown period (declared in the country on March 16, 2020) until the end of our study period on April 15, 2020. All the 140 patients presented to the Emergency Department of the hospital during this period with a diagnosis of fracture, or trauma (sprains, dislocations, wounds) were included in the cohort. In addition, 12 patients needing hospitalization for planning a non-deferrable elective surgical treatment were included. A group of patients from the two same hospitals and treated during the same period (1st March 2018 to April 15, 2018) but previously was used as control. RESULTS: Of these 152 patients (mean age 45.5 years; range 1 to 103), 100 underwent a surgical procedure and 52 were managed non-operatively. Twenty-eight were children and 124 were adults. The COVID-19 diagnosis was confirmed for four patients. The frequency of patients with confirmed COVID-19 diagnosis among this population treated in emergency was ten fold higher (2.6%; 4 among 152) than in the general population (0.30%) of the country. The mortality rate for patients with surgery was 2% (2 of 100 patients) and 50% (2 of 4) for those older than 60 years with COVID-19; it was null for patients who were managed non-operatively. As compared to the year 2018, the number of patients seen with trauma had decreased of 32% during the epidemic. CONCLUSION: Staying home during the COVID-19 pandemic decreased trauma frequency of 32%. The structural organization in our hospital allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available to treat all the patients who needed orthopedic care during this period.

Surgical repair of a tibialis anterior tendon rupture : a case report.

A 61-year-old man who stretched in the morning presented a rupture of the tibialis anterior tendon treated by extensor hallucis longus transfer. Rupture of the tibialis anterior tendon is rare. Surgical treatment seems to be more efficient in improving the function.

Knee size chart nomogram for evaluation of tibial tuberosity-trochlear groove distance in knees with or without history of patellofemoral instability.

PURPOSE: Lateralized tibial tubercle is a cause of patellar instability. Before proceeding with reduction of the tibial tubercle-trochlear groove (TT-TG) distance, surgeons prefer to know whether this distance is pathologic. However, the pathological value remains discussed and may vary with the size of the knee. METHODS: We sought to determine variability in the traditional TT-TG distance versus the anthropometric knee size, using dimensions of the distal part of the femur and proximal part of the tibia of 85 CT scans of the knees in two groups of knees, one normal group without history of patellofemoral instability and one pathologic group with history of instability. RESULTS: The average TT-TG distance measured 13 mm in normal knees and 16.4 mm in pathologic knees. The variability in measurements between normal and pathologic knees varied respectively between ± 5 and ± 15 mm, with as consequence absence of threshold value between normal and pathologic knees. These measurements were supplemented by an analysis of a size ratio coefficient. In the normal group without history of instability, linear regression analysis showed that patients with larger knees tended to have higher TT-TG distances and that the values are associated with the mean ML femoro-tibial width (p = 0.014; Pearson coefficient = 0.4). The knees with history of instability also keep proportional increase of TT-TG with the size of the knee as the knees without history of instability. We developed a nomogram to more appropriately represent the normal values for a given size of the knee. Application of the nomographic model on the CT scan TT-TG data of the patients who have knee instability allows the orthopaedic surgeon to associate the TT-TG distance with the knee size and to evaluate the medial transfer corresponding to the knee size. CONCLUSIONS: The average TT-TG distances in normal and pathologic knees were not identical for each size of the knees.

Risk of vascular injury when screw drilling for tibial tuberosity transfer.

PURPOSE: During tibial tubercle transfer, popliteal vessels are at risk from drills and screws. The risk is around 0.11%, as described in the literature. We reviewed knee injected CT scan for analysis of the location of arteries, identified landmarks allowing minimizing risks, and defined a safe zone. MATERIAL AND METHOD: Distances between the posterior cortex and arteries were measured on CT scans from 30 adults (60 knees) at three levels (proximal part of the tibial tuberosity, 20 mm and 40 mm distally). Data were used to create a "risk map" with different angular sectors where the frequency of the presence of arteries was analyzed in each area. We also analyzed the position of 68 screws of 47 patients who underwent a medial tibial tuberosity transfer. RESULTS: The nearest distance between artery and the posterior tibial cortex was found at the level corresponding to the top of the tuberosity with less than 1 mm, while the largest distance was found at the distal level. We were able to define a safe zone for drilling through the posterior tibial cortex which allows a safe fixation for the screws. This zone corresponds to the medial third of the posterior cortex. When the safe zone is not respected, screws that overtake the posterior cortex may be close to arteries as observed for 37 of the 68 screws analyzed. CONCLUSION: We described new landmarks and recommendations to avoid this complication during tibial tuberosity transfer.

Management of greater trochanteric pain syndrome : a systematic review.

Greater trochanteric pain syndrome is characterized by pain at or around the greater trochanter. Numerous management modalities have been proposed, with varying success. Cochrane and Pubmed database have been searched from 1990 for studies focusing on the management of this syndrome. We only selected studies with a validated outcome measure. 11 studies met our inclusion criteria. Evidence points towards a pain reduction in the first months after a corticosteroid injection, but this effect does not persist with time. Low energy shock wave therapy also has a positive effect in the short term, the longer term results being more controversial. Although surgery is poorly documented, authors agree to reserve this option only for greater trochanteric pain syndrome failing to respond to conservative measures. The complication and re-intervention rate should not be underestimated.