Induced membrane technique for malignant bone tumours of the humerus.

PURPOSE: The aim of this study was to report on mid- to long-term results following large humeral tumoral resection and reconstruction with the induced-membrane technique in skeletally immature patients suffering from primary malignant bone tumours. METHODS: A retrospective analysis identified all children who underwent the two stages of a humeral reconstruction using the induced-membrane technique for primary malignant humerus tumours between 2002 and 2020. Functional assessment was conducted by an independent observer using the Musculoskeletal Tumor Society (MSTS) scoring system for the upper limb. Radiological assessment was performed by two independent observers and the healing index was calculated (i.e., months/cm). RESULTS: Eight adolescents (5 osteosarcomas and 3 Ewing sarcoma), with a mean age of 14.2 years (SD = 2.7), were included. The mean length of the bone resection was 17.4 cm (SD = 3.8), and the mean delay of the resection and reconstruction stages was 9.4 months (SD = 4). The mean follow-up was 6.6 years (SD = 4.3). The mean MSTS score was 77.4% and the global average healing index was 1.04 months/cm (SD = 2.2). Four complications (i.e., prominence device, fracture, aseptic pseudarthrosis, radial palsy) and one local recurrence were observed in four patients, requiring four unplanned surgical procedures in three patients. One patient died fourteen years after the initial treatment due to a lung recurrence. CONCLUSION: The induced-membrane technique is an effective and safe alternative for reconstructing large humeral bone defects after tumour resection in adolescents. Although this is a two-stage technique, it gives good functional results comparable to other strategies found in the literature. LEVEL OF EVIDENCE: IV.

Microfractures, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and autologous chondrocyte implantation for knee chondral defects: a systematic review and network meta-analysis of randomized controlled trials.

Purpose: Despite the publication of several randomized controlled trials (RCTs), it is not clear which technique for the treatment of focal chondral and osteochondral defects of the knee grants the best clinical outcome. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of microfractures (MF), autologous chondrocyte implantation (ACI), autologous matrix-induced chondrogenesis (AMIC), osteochondral autograft transplantation (OCT) at short (< 1 year), intermediate (1-5 years) and long-term (> 5 years). Methods: We carried out an NMA with Bayesian random-effect model, according to PRISMA guidelines. The search was performed in MEDLINE, EMBASE, Web of Science, CENTRAL, CINAHL, SPORTDiscus, clinicaltrials.gov, WHO ICTRP, from inception to November 2022. The eligibilities were randomized controlled trials on patients with knee chondral and osteochondral defects, undergoing microfractures, OCT, AMIC, ACI, without restrictions for prior or concomitant surgery on ligaments, menisci or limb alignment, prior surgery for fixation or ablation of osteochondritis dissecans fragments, and prior cartilage procedures as microfractures, drilling, abrasion, or debridement. Results: Nineteen RCTs were included. No difference among treatments was shown in the pooled comparison of patient reported outcome measures (PROMs) at any timepoint. Safety data were not available for all trials due to the heterogeneity of reporting, but chondrospheres seemed to have lower failure and reoperation rates. Conclusion: This NMA showed no difference for PROMs with any technique. The lower failure and reoperation rates with chondrospheres must be interpreted with caution since adverse event data was heterogenous among trials. The standardization of the efficacy and safety outcome measures for future trials on knee cartilage repair and regeneration is necessary.

The use of a tibial stem in primary total knee arthroplasty for patients with a frontal deformity of more than ten degrees reduces the rate of postoperative pain.

BACKGROUND: The use of a tibial stem for large deformities (> 10°) would reduce the incidence of pain. The aim of this study was to compare the effect of tibial stem on postoperative pain and aseptic loosening at the tibia in patients with a preoperative deformity > 10° in the frontal plane at 2 years follow-up. METHODS: This was a retrospective single-center case-control study. Ninety-eight patients with deformities greater than 10° in the frontal plane and a BMI > 30 kg/m2 who had undergone posterior-stabilized (PS) total knee arthroplasty (TKA) with a tibial stem were matched using a propensity score to 98 patients who had undergone PS TKA without a tibial stem. The primary endpoint was the pain rate at 2 years. The secondary endpoints were the rate of aseptic loosening of the tibia at 2 years post-operatively. RESULTS: A significant difference was found in the rate of postoperative pain at 2 years. It was higher in the group without tibial stem compared with the group with tibial stem (41.8% vs 17.3%, p = 0.0003). In the group without tibial stem, 24.4% of pain was mild, 61% moderate and no severe pain. In the tibial stem group, 47.1% of pain was mild, 41.2% moderate and no severe pain. A radiolucent line (RLL) was present at 2 years in 26.5% of prostheses in the without tibial stem group and in 9.2% of prostheses in the tibial stem group (p = 0.002). There was no difference between the two groups in terms of aseptic loosening. CONCLUSION: The use of a tibial stem in primary TKA in patients with frontal deformities greater than 10° reduces postoperative pain and the presence of radiolucent lines.

Isokinetic Strength and Balance Analyses for Predicting Return to Sports After the Latarjet Procedure: A Prospective Cross-sectional Study.

BACKGROUND: Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint. PURPOSE: To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability-Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed. RESULTS: A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s (P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST (P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities (r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s (r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s (r = 0.30-0.38; P < .05). CONCLUSION: Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.

Comparison of survival between cemented vs cementless unicompartimental knee arthroplasty: a case control study with propensity score matching.

INTRODUCTION: The first results of cementless prosthesis were rather disappointing. However recent progress in methods of cementless fixation of prosthesis should lead to better results in terms of survival of these prostheses. The main objective is to compare the survival rate at last follow-up of UKA with cemented tibial or cementless. HYPOTHESIS: We hypothesize that UKAs with uncemented tibial implants have better survival compared to UKAs with cemented tibial implants. MATERIAL AND METHODS: This single center case-control study included 94 medial UKA with a cemented tibial component that were paired by propensity score matching to 94 medial UKA with a uncemented tibial component. The main evaluation criterion was the comparison of the survivorship of the UKA between a cemented tibial implant and those with a cementless tibial implant in terms of all-cause revision surgery at last follow-up. The secondary endpoints were the analysis of the causes of failure. RESULTS: The mean final follow-up was 6.1years (2.3). The overall survival rate in our serie of medial UKA was 92.4% [88.7%-96.3%] at five years. The overall survival rate in cemented group was and 91.5% [86.0%-97.3%] at five years and at 93.2% [88.1%-98.7%] at five years, in the uncemented group. No differences significant were observed in the two groups (p.value = 0.6). Only the tibial preoperative deformity was a risk factor of failure (HR: 1.11 [1.02, 1.20], value = 0.02). DISCUSSION: The use of a cemented or a cementless tibial component in a medial UKA did not influence the survival rate. LEVEL OF EVIDENCE: III; case control study.

Validation of mediCAD® software for fully digital preoperative planning of total hip arthroplasty: a retrospective study.

INTRODUCTION: The planning step that precedes a total hip arthroplasty (THA) procedure is crucial. Digital planning software programs are being increasingly used, although few studies have reported on the reliability of such tools. Furthermore, no studies have been conducted on the mediCAD® software, despite it being widely used in France. This led us to conduct a retrospective study to: (1) assess the accuracy of this planning software, (2) determine the intra- and inter-rater reliability, (3) determine how obesity affects the accuracy of planning. HYPOTHESIS: THA planning is accurate and reliable when using the mediCAD® software. PATIENTS AND METHODS: This was a single center, retrospective study. One hundred one consecutive cases performed by a single experienced surgeon were planned retrospectively by two blinded surgeons on two separate occasions. The acetabular cup was cemented in 90 hips (89%), cementless in 11 hips (11%). A dual mobility cup was used in 21 hips (21%). The femoral stem was cemented in 60 hips (59%). The endpoint was the number of exact plans, defined as the same size as the actual implants. An acceptable match was defined as a difference of one size. The match was unacceptable if the planned and implanted size differed by more than 2 for the acetabular cup or by more than 1 size for the femoral stem. The intra-rater and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI). RESULTS: Exact agreement was found by the first rater for 15 planned acetabular cups (15%) and for 45 planned femoral stems (45%) relative to the implants used. The second rater reached exact agreement for 20 planned acetabular cups (20%) and 50 planned femoral stems (50%). The intra-rater reliability for the acetabular cup was average (ICC = 0.57; 95%CI [0.43-0.69]) and poor (ICC = 0.38 95%CI [0.20-054]) for the 1st and 2nd rater, respectively. The intra-rater reliability for the femoral stem was poor for the 1st rater (ICC = 0.47 95%CI [0.30-0.61]) and the 2nd rater (ICC = 0.45 95%CI [0.29-0.60]). The interobserver reliability was low for the planned acetabular cup (ICC = 0.39 95%CI [0.21-0.54]) and the planned femoral stem (ICC = 0.42 95%CI [0.24-0.57]). Overall, when combining the two raters, exact prediction of the acetabular cup was achieved in 31 hips (19%) in non-obese patients and in 7 hips (21%) in obese patients (p = 0.62). DISCUSSION: This study found acceptable reliability of the mediCAD® software. Experience level, radiograph magnification affected the planning outcome in this study, but obesity did not. We currently do not have the ability to incorporate a reliable radiological scale for two-dimensional templating. Some surgeons prefer using a CT scan, but this costs more than conventional radiographs and exposes the patient to more radiation. This study shows that the mediCAD® software can provide satisfactory output for the preoperative planning of THA. LEVEL OF EVIDENCE: III; retrospective, diagnostic, comparative study.

Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion.

INTRODUCTION: Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection. TECHNIQUE: We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease. CONCLUSIONS: Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.

Reasons for malpractice claims after primary total hip arthroplasty in France: Insurance data from 240 claims from 2014 to 2017.

INTRODUCTION: Total hip arthroplasty (THA) is one of the most frequent orthopedic surgery procedures, and orthopedic surgeons are among the most frequently accused of malpractice by their patients. Identifying the main reasons for malpractice claims after THA is a prior condition to reducing their frequency. The quality of the preoperative risk information given to the patient by the surgeon is crucial for these purposes. Data specific to THA are sparse in France, and we therefore conducted a retrospective study (1) to determine whether the outcome of medico-legal expert appraisal correlated with the quality and traceability of preoperative information, and (2) to identify the most frequent grounds for complaint after primary THA. HYPOTHESIS: The quality of patient information partly determines expert appraisal. MATERIAL AND METHOD: A retrospective study was conducted based on data from the Branchet medical professional insurance agency for malpractice claims following THA over the period 2014-2017, with 240 complete files, for 125 women and 115 men. Data comprised: type of procedure, main grounds of complaint (complications), positive or negative expert appraisal, quality of preoperative patient information, amounts of compensation accorded and fees paid, and the practitioner's liability. We assessed correlations between information quality and liability. RESULTS: Surgical site infection and neurologic deficit were the two main grounds for malpractice claims. In the 240 files, cases for 106 operations (44.2%) were submitted to arbitration, 95 (39.6%) were brought to court, and 39 (16.2%) were settled out of court. The practitioner was held at least partly liable in 40 files (16.7%). Information to the patient was deemed imperfect or poor for 119 files (49.6%) and good in 121 (50.4%). Mean compensation was €30,940 (range, €0 to €198,100). In 27 of the 40 cases of liability (67.5%), the information to the patient was deemed imperfect or poor. Twenty-six of the 40 cases (65%) were settled out of court. In case of poor information, there was a significant risk for the practitioner to be held liable: 7.5 vs. 25% (p=0.003). DISCUSSION: The present study listed the main complications underlying malpractice claims after THA: infection, neurologic complications, and limb-length discrepancy. This should enable practitioners to improve patient information so as to reduce the rate of malpractice claims or at least decrease the practitioner's liability, as the study found a correlation between information quality and expert appraisal. LEVEL OF EVIDENCE: IV; retrospective study.

The arthroscopic Latarjet procedure with a posterior guided system and suture-button fixation enables more precise bone block positioning in the axial plane versus anterior screws fixation.

PURPOSE: Adequate position of the bone block during arthroscopic Latarjet procedure is critical for an optimal functional outcome. However, this procedure is complex with a long learning curve. Our aim was to compare the bone block position between a dedicated glenoid posterior instrumentation and suture button fixation versus an anterior screw fixation, on a postoperative computed tomography (CT) scan. METHOD: Seventy-nine consecutive patients operated on for an anterior shoulder instability were included in this retrospective study. The same surgeon performed arthroscopically the Latarjet procedure either with an anterior drilling and screw fixation (Group A), or with a specific posterior glenoid guide pin, a posterior drilling, and a suture cortical button fixation (Group B). Evaluations were made by two independent observers. The position was evaluated by CT scan in the axial and sagittal planes. Learning curves with operative time, complications and clinical outcomes were assessed at a minimum of 2 years of follow-up. RESULTS: Thirty-five patients were included in Group A and 44 in Group B. In Group A, 27 bone blocks were flush (87.1%) and 38 in Group B (92.7%) (p < 0.01). In Group A, 72% of the bone block height was below the equator and 76%, in Group B (ns). The mean operating time was 123 ± 32.5 min in Group A and 95 ± 34.1 min in Group B (p < 0.0001). At the final follow-up, the mean aggregate Rowe score was respectively 94.6 ± 10.4 and 93.1 ± 9.8 points in Groups A and B. The mean aggregate Walch-Duplay score was respectively 94.2 ± 11.6 and 93.4 ± 10.6 points in Groups A and B. There were 11 complications (31.4%) in Group A and five complications (11.3%) in Group B (ns). CONCLUSION: The arthroscopic Latarjet procedure with a posterior drilling guided system and suture-button fixation allows more precise positioning in the axial plane than with anterior drilling and screw fixation. This posterior-guided procedure could reduce intraoperative and short-term complications. LEVEL OF EVIDENCE: Level IV.

Comparison of the retear rate 2years after ACL reconstruction with the Tape Locking Screw short graft system and the STG technique: A case control study with propensity score matching.

PURPOSE: Theoretically, short semitendinosus grafts result in less pain and morbidity while providing greater knee flexion strength and sparing the gracilis tendon. They often require the use of blind bone tunnels as well as fixation at both ends of the graft with suspensory cortical buttons. The "Tape Locking Screw" (TLS) system is another option. There are few studies comparing ACL reconstruction with a short graft using the 4-strand semitendinosus graft (ST4-TLS) technique with that of the semitendinosus-gracilis (STG) procedure. This study was designed: (1) to compare the retear rate following these two technics after 2years of follow-up, (2) to compare the clinical scores, complications and return to sport times between the two procedures Q1, Q2. HYPOTHESIS: Our hypothesis was that there would be no differences in retear rates between the two techniques. METHODS: This single center case control study included 290 patients who underwent STG reconstruction that were paired by propensity score matching to 299 patients who underwent ST4-TLS reconstruction. The main evaluation criterion was the retear rate 2years after surgery. Secondary criteria were the two-year postoperative complication rate, the time to return to sport, to pivot sports and to running, as well as the complication rates and clinical scores 6months, 1year and 2years after surgery. RESULTS: At the final follow-up, the overall retear rate in our series of ACL ligament reconstruction was 6.0% (36/596). There was no difference in retear rates between the groups 2years after ligament reconstruction [ST4-TLS: 6.7% (20/299) vs. STG: 5.4% (16/297); p=0.47]. The postoperative KOOS symptom score and the Tegner score were found to be better in the STG group at 1year (81 vs. 78, p=0.008) and 2years (5.64 vs. 5.10, p=0.016), respectively, representing the minimally clinically important difference (MCID) for the latter. No difference was found in the other clinical scores 6months, 1year or 2years after surgery. There was no significant difference in the return to sport [TLS: 93.0% (164/299) vs. STG: 93.0% (158/297) p=0.99] or the complication rate [TLS: 8.7% (26/299) vs. STG: 7.4% (22/297) p=0.89] between the groups. DISCUSSION: The ST4-TLS ACL ligament reconstruction technique was found to be as reliable as the standard STG procedure 2years after surgery for the retear rate and the return to sport, although the results of certain postoperative clinical scores seem to be lower. LEVEL OF EVIDENCE: III; case control study.

Nonliving versus Living Animal Models for Microvascular Surgery Training: A Randomized Comparative Study.

BACKGROUND: Ethical and financial considerations have encouraged the use of nonliving models for simulation-based training in microsurgery, such as commercially available chicken thighs. The purpose of this study was to compare the nonliving chicken thigh model to the one currently considered as the standard-namely, the living rat model-in the setting of an initiation microsurgery course. METHODS: Applicants to the 3-day basic microsurgery course of the Paris School of Surgery were assigned randomly to either one group that received the regular training of the school (RT group), including four hands-on sessions using only living rat models, or one group that received a modified curriculum in which a nonliving chicken thigh model was used for the first hands-on session (CT group). During the following session, all trainees were evaluated on living rat models, using a global rating scale and two task-specific scales (knot-tying and anastomosis); rates of anastomosis patency, animal survival, and technique completion were recorded. RESULTS: Ninety-three residents were enrolled. Global rating scale, knot-tying, and anastomosis task-specific scale scores were significantly higher in the CT group ( n = 51) than in the RT group, with mean differences of 2.6 points ( P = 0.0001), 1.3 points ( P < 0.0001), and 1.4 points ( P < 0.0001), respectively. Patency and survival rates were significantly higher in the CT group than in the RT group, with mean differences of 22% ( P = 0.0020) and 27% ( P < 0.0001), respectively; completion rates were not statistically different. CONCLUSION: Subject to the use of validated models, such as the chicken thigh, nonliving animal models are a suitable alternative to the living rat model in microsurgery initial training. CLINICAL RELEVANCE STATEMENT: The use of validated non-living models, such as the chicken thigh, is a suitable alternative to the living rat model in microsurgery initial training.

Prospective observational analysis of intraoperative radiation exposure with a mini C-arm intensifier in percutaneous forefoot surgery.

INTRODUCTION: Percutaneous forefoot surgery has been associated with higher radiation exposure than the conventional approach. However, there is little data on forefoot surgery using a mini C-arm intensifier. We, therefore, conducted a prospective study to (1) evaluate the intraoperative radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm; (2) compare the radiation received by the surgeon with the guidelines for occupational exposure issued by the International Commission on Radiological Protection (ICRP) (20 millisieverts per year [mSv/year] for the whole body, 500mSv/year for the hands, and 20mSv/year for the lens of the eye); and (3) compare the radiation received during percutaneous forefoot surgery with that of the open approach, which has already been reported in the literature. HYPOTHESIS: The radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm is lower than the ICRP guidelines, and the findings reported in the literature. MATERIALS AND METHODS: This prospective single-center study was conducted from September 2020 to May 2021. A total of 639 feet (i.e., 435 patients) were included. Of these 639 feet, 336 (52%) were hallux valgus repairs, 49 (8%) were stand-alone procedures of the lateral rays, and 124 (19%) were a combination of both. The radiation dose data was retrieved from the mini C-arm daily: dose-area product (DAP) in centigray per square centimeter (cGy/cm2) and radiation exposure duration in seconds. The doses received by the surgeon were collected every month by 4 passive dosimeters (hand, eye lens, and chest [on and under the lead apron]) and 2 active dosimeters (on and under the lead apron). RESULTS: The DAP emitted by the mini C-arm during an operating day was 0.10±0.01cGy/cm2 (range, 0.0-3.9), and the mean daily radiation duration was 34.7±19.3seconds (range, 0.7-226.8). There was a mean of 8±8 (range, 1-18) elective procedures per operating day. The daily reading on the active dosimeter worn on the lead apron was 0.002±0 microSv (range, 0-0.04), while the one worn under the apron was 0.001±0 microSv (range, 0-0.03). The equivalent doses over the 7-month study period for the hand, eye lens, and chest (over and under the apron) were 0.14mSv, 0mSv, 0.22mSv, and 0mSv, respectively. DISCUSSION/CONCLUSION: The radiation exposure in percutaneous forefoot surgery with a mini C-arm intensifier observed in our study was lower than the ICRP recommendations and literature findings during open surgery. LEVEL OF EVIDENCE: IV; prospective study without a control group.

Description of the Simple Ankle Value: A Simplified Patient-Reported Outcome Measure for the Assessment of Ankle and Hindfoot Function.

Background: The Simple Ankle Value (SAV) is a patient-reported outcome measure (PROM) in which patients grade their ankle function as a percentage of that of their contralateral uninjured ankle. Purpose/Hypothesis: The primary aims of this study were to validate the SAV and evaluate its correlation with other PROMs. It was hypothesized that the SAV would be seen as a valid score that provides results comparable with those of the Foot and Ankle Ability Measure (FAAM) and the European Foot & Ankle Society (EFAS) score. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Patients seen for an ankle or hindfoot tissue were divided into those treated operatively and nonoperatively. A control group of patients treated for issues outside of the foot and ankle was also created. All patients completed the SAV followed by the FAAM and the EFAS scores. Patients treated operatively completed the questionnaires before surgery and 3 months after surgery. Patients treated nonoperatively completed the questionnaires twice 15 days apart. The correlation between the SAV score, the FAAM score, and the EFAS score was estimated with the Spearman correlation coefficient. Results: A total of 209 patients (79 in the operative group, 103 in the nonoperative group, and 27 in the control group) were asked to complete the questionnaire, and all were included. The test-retest reliability of the SAV was excellent (intraclass correlation coefficient, 0.92; 95% CI, 0.88-0.94). No ceiling or floor effect was reported. Strong correlation was found between the SAV and the FAAM and EFAS scores. The SAV was able to discriminate patients from controls (54.18 ± 21.22 and 93.52 ± 9.589; P < .0001); however, SAV was not able to detect change from preoperative to 3 months postoperative (from 54.18 ± 21.22 to 62.53 ± 20.83; P = .44). Conclusion: Our study suggests that the SAV is correlated with existing accepted ankle PROMs. Further work with this PROM is needed to validate the questionnaire.

Managing early complications in total hip arthroplasty: the safety of immediate revision.

PURPOSE: Immediate revision refers to a reoperation that involves resetting, draping, and exchanging the implant, after wound closure in total hip arthroplasty. The purpose of this study is to investigate the impact of immediate revision after total hip arthroplasty on subsequent infection and complication rates. METHODS: A total of 14,076 primary total hip arthroplasties performed between 2010 and 2020 were identified in our institutional database, of which 42 underwent immediate revision. Infection rates were determined 2 years after the index arthroplasty. The cause and type of revision, duration of primary and revision surgeries, National Nosocomial Infections Surveillance score, implant type, changes in implants, complications, and preoperative and intraoperative antibiotic prophylaxis were all determined. RESULTS: No infections were observed within 2 years after the index arthroplasty. Leg length discrepancy (88%, n = 37) and dislocation (7.1%, n = 3) were the main causes of immediate revision. In most cases of discrepancy, the limb was clinically and radiologically longer before the immediate revision. The mean operative time was 48 ± 14 min for the primary procedure and 23.6 ± 9 min for the revision. The time between the first incision and last skin closure ranged from 1 to 3 h. None of the patients were extubated between the two procedures. Two patients had a National Nosocomial Infections Surveillance score of 2, 13 had a score of 1, and 27 had a score of 0. CONCLUSION: Immediate revision is safe for correcting clinical and radiological abnormalities, and may not be associated with increased complication or infection rates. STUDY DESIGN: Retrospective cohort study; level of evidence, 3.

Clinical evaluation of a resurfacing device implant for femoral osteochondral defects greater than 1 cm2 with a minimal follow-up of 4 years: a prospective cohort study.

PURPOSE: Osteochondral defects have a limited capacity to heal and can evolve to an early osteoarthritis. A surgical possibility is the replacement of the affected cartilaginous area with a resurfacing device BioPoly™ RS Partial Resurfacing Knee Implant. The aim of this study was to report the clinical and survival outcomes of the BioPoly™ after a minimum follow-up of 4 years. METHODS: This study included all patients who had a BioPoly™ for femoral osteochondral defects greater than 1 cm2 and at least ICRS grade 2. The main outcome was to observe the KOOS and the Tegner activity score were used to assess outcomes preoperatively and at the last follow-up. The secondary outcomes were the VAS for pain, the complications rate post-surgery and survival rate of BioPoly™ at the last FU. RESULTS: Eighteen patients with 44.4% (8/18) of women were included with a mean age of 46.6 years (11.4), a mean body mass index (BMI) of 21.5 (kg/m2) (2.3). The mean follow-up was 6.3 years (1.3). We found a significant difference comparing pre-operative KOOS score and at last follow-up [respectively, 66.56(14.37) vs 84.17(7.656), p < 0.01]. At last follow-up, the Tegner score was different [respectively, 3.05(1.3) vs 3.6(1.3), p < 0.01]. At 5 years, the survival rate was of 94.7%. CONCLUSIONS: BioPoly™ is a real alternative for femoral osteochondral defects greater than 1 cm2 and at least ICRS grade 2. It will be interesting to compare this implant to mosaicplasty technic and/or microfracture at 5 years postoperatively regarding clinical outcomes and survival rate. LEVEL OF EVIDENCE: Therapeutic level III. Prospective cohort study.

Short term results of anatomic stemless shoulder replacement with peripheral neck fixation.

Background: Most of the current stemless implants are using a central neck fixation design. Easytech Stemless replacements (FX Solutions®, Viriat, France) were developed promoting the idea of peripheral fixation of the stemless implant. The aim of this study was to analyze clinical and radiological results of this stemless TSA implanted for osteoarthritis (OA). Methods: A retrospective study of patients who received TSA with the Easytech® Anatomical Shoulder System (FX Solutions®, Viriat, France) for OA was completed at five clinical sites. Preoperative and minimum 2 year follow-up Constant Scores and X-rays were evaluated. Two independent orthopedic surgeons analyzed X-rays to assess anatomy reconstruction and component migration. Revisions and serious adverse effects were reviewed. Results: 129 patients were analyzed with an average follow-up of 37.47 months (24-54). Seven patients had a revision surgery and one of these resulted in the removal of the Anchor Base. The postoperative Constant Scores showed significant improvement with a mean raw Constant Score of 73.78 (38.0-100.0, mean increase 40.96, P < .0001) and mean adjusted Constant Score of 99.14 (42.20-133.30, mean increase 55.68, P < .0001). Radiographic review demonstrated that no modification of the center of rotation (COR) at minimum 24 months was greater than 3 mm and in comparison to preoperative radiographs, restoration of COR was lateralized in 25% of the cases, medialized in 61.5% and 13.5% had no change in COR. The mean value of the cervico-diaphyseal angle was 130.2° (114; 149) at 3 weeks and 129.9° (113.5; 144.0) at 2 years, demonstrating no significant difference (P = .16). 36 patients (35%) had calcar remodeling. Univariate and multivariate logistic regression found no significant factor, which was associated with the variation of the cervico-diaphyseal angle over time, center of rotation, calcar remodeling, or final Constant Score. The Walch B2 and C glenoid subset of patients (n = 13) had overall survival rate of 90.9% [95% CI 75.4-100.0] vs. 98.0% [95% CI 95.3-100.0] in other glenoid types (P < .01). Walch B2/C patients were 4.44 [95% CI 1.13, 17.6] times more likely to have a Constant Score <85 (P = .03). Conclusions: The peripheral fixation of the Easytech® Anatomical Shoulder System for OA provides excellent clinical results and imaging stability at minimum two year follow-up. Elderly age, gender and BMI do not affect the stability.

Are self-reported anthropometric data reliable enough to meet antibiotic prophylaxis guidelines in orthopedic surgery?

BACKGROUND: Surgical site infection is a serious complication in orthopedic surgery. The use of antibiotic prophylaxis (AP) combined with other prevention strategies has been shown to reduce this risk to 1% for hip arthroplasty and 2% for knee arthroplasty. The French Society of Anesthesia and Intensive Care Medicine (SFAR) recommends doubling the dose when the patient's weight is greater than or equal to 100 kg, and the body mass index (BMI) is greater than or equal to 35 kg/m2. Similarly, patients with a BMIgreater than40 kg/m2 orlesser than18 kg/m2 are ineligible for surgery in our hospital. Self-reported anthropometric measurements are commonly used in clinical practice to calculate BMI, but their validity has not been assessed in the orthopedic literature. Therefore, we conducted a study comparing self-reported with systematically measured values and observed the impact these differences may have on perioperative AP regimens and contra-indications to surgery. HYPOTHESIS: The hypothesis of our study was that self-reported anthropometric values differed from those measured during preoperative orthopedic consultations. MATERIALS AND METHODS: This single-center retrospective study with prospective data collection was conducted between October and November 2018. The patient-reported anthropometric data were first collected and then directly measured by an orthopedic nurse. Weight was measured with a precision of 500 g and height was measured with a precision of 1 cm. RESULTS: A total of 370 patients (259 women and 111 men) with a median age of 67 years (17-90) were enrolled. The data analysis found significant differences between the self-reported and measured height [166 cm (147-191) vs. 164 cm (141-191) (p<0.0001)], weight [72.9 kg (38-149) vs. 73.1 kg (36-140) (p<0.0005)] and BMI [26.3 (16.2-46.4) vs. 27 (16-48.2) (p<0.0001)]. Of these patients, 119 (32%) reported an accurate height, 137 (37%) an accurate weight, and 54 (15%) an accurate BMI. None of the patients had two accurate measurements. The maximum underestimation was 18 kg for weight, 9 cm for height, and 6.15 kg/m2 for BMI. The maximum overestimation was 28 kg for weight, 10 cm for height, and 7.2 kg/m2 for BMI. The verification of the anthropometric measurements identified another 17 patients who had contra-indications to surgery (12 with a BMI>40 kg/m2 and 5 with a BMI<18 kg/m2) and who would not have been detected based on the self-reported values. CONCLUSIONS: Although patients underestimated their weight and overestimated their height in our study, these had no impact on the perioperative AP regimens. However, this misreporting failed to detect potential contraindications to surgery. LEVEL OF EVIDENCE: IV; retrospective study with prospective data collection and no control group.

Outcomes of Isolated Biceps Tenodesis/Tenotomy or Partial Rotator Cuff Repair Associated with Biceps Tenodesis/Tenotomy for Massive Irreparable Tears: A Systematic Review.

Irreparable large to massive rotator cuff tears (MIRCTs) are a prevalent cause of shoulder pain and dysfunction, and nonoperative treatment may not always be effective. Various surgical options exist, with isolated biceps tenotomy/tenodesis (BT) or arthroscopic partial repair with associated biceps tenotomy/tenodesis (PCR-BT) being the most common. The aim of this study was to systematically review the available data on the clinical and functional outcomes of BT and PCR-BT in patients with MIRCTs. METHODS: MEDLINE, Embase, and CENTRAL databases were searched for studies on the treatment of MIRCT. We included studies with BT or PCR-BT with a minimum follow-up of 24 months. The MINORS (Methodological Index for Nonrandomized Studies) score was used to assess study quality. Outcomes included were the visual analog scale for pain, functional scores such as Constant-Murley and American Shoulder and Elbow Surgeons, range of motion, radiological measurements, and complications. RESULTS: A total of 1101 patients (506 had a BT and 595 had a PCR-BT) from 22 studies were included (cases series = 13, case-control = 7, randomized control trial = 1, prospective cohort study = 1). The mean MINORS score was 13.2 ± 3.2. The mean age and follow-up were 67 ± 6.8 years and 4.58 ± 1.1 years (range, 2, 12), respectively. The VAS improvement showed at the last follow-up for PCR-BT (range, 1.97, 5.8) and BT (range, 4, 6.1). CMS was improved at the final follow-up for PCR-BT (range, 13, 47.6) and BT (range, 10.8, 28). Regarding the ASES, it has demonstrated significant improvements for PCR-BT (range, 31.81, 44.8) and BT (range, 30,45.8). For forward flexion, PCR-BT showed improvement (range, -14°, 59.4°), as well as the BT group (range, 2°, 27.9°). CONCLUSIONS: This systematic review demonstrated that both BT and PCR-BT improve functional outcomes and reduce pain at midterm follow-up for MIRCT. Since we know that a failed cuff repair would worsen the shoulder, it might be beneficial in terms of the risk-benefit ratio to not repair in certain patients with MIRCT.

Age Influence Upon Glenohumeral Remodeling After Shoulder Axial Rebalancing Surgery in Brachial Plexus Birth Injury.

BACKGROUND: Shoulder rebalancing procedures have been proven to provide satisfactory functional improvements in patients with shoulder external rotation (ER) deficit due to brachial plexus birth injury (BPBI). However, the influence of age at the time of surgery on osteoarticular remodeling remains uncertain. The purposes of this retrospective case series were (1) to assess the age impact on glenohumeral remodeling and (2) to determine an age limit after which significant changes can no longer be expected. METHODS: We reviewed preoperative and postoperative magnetic resonance imaging data of 49 children with BPBI who underwent a tendon transfer to reanimate active shoulder ER, with (n=41) or without (n=8) concomitant anterior shoulder release to restore passive shoulder ER, at a mean age of 72 ± 40 months (19;172). Mean radiographic follow-up was 35 ± 20 months (12;95). Univariate linear regressions were used to assess the influence of age at the time of surgery upon changes of glenoid version, glenoid shape, percentage of the humeral head anterior to the glenoid midline, and glenohumeral deformity. Beta coefficients with 95% CI were calculated. RESULTS: Improvements of glenoid version, glenoid shape, percentage of the humeral head anterior and glenohumeral deformity significantly decreased by 0.19 degrees [CI=(-0.31; -0.06), P =0.0046], 0.02 grade [CI=(-0.04; -0.01), P =0.002], 0.12% [CI=(-0.21; -0.04), P =0.0076], and 0.01 grade [CI=(-0.02; -0.01), P =0.0078] per additional month of age at the time of surgery, respectively. The threshold of 5 years was identified as the age at the time of surgery after which significant remodeling no longer occurred. No significant postoperative changes were observed in patients without glenohumeral dysplasia on preoperative magnetic resonance imaging. CONCLUSION: In the setting of BPBI-related glenohumeral dysplasia, the younger the surgical axial rebalancing of the shoulder, the greater the glenohumeral remodeling seems to be. Such procedure seems to be safe in patients without significant joint deformity on preoperative imaging. LEVEL OF EVIDENCE: Therapeutic-Level IV.