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INTRODUCTION: Infections following orthopedic surgery are rare but difficult to treat. Among the prevention measures reviewed during the Musculoskeletal Infection Society's (MSIS) 2023 international consensus meeting, the only strategy to obtain 100% agreement was the control of traffic in and out of the operating room (OR). Although this recommendation makes good sense, to our knowledge, it has not been previously investigated in a comparative study. We, therefore, conducted a prospective, observational, before-and-after study of the implementation of an informational sign designed to limit traffic in and out of the OR to (1) determine its impact on door openings and the number of people present during orthopedic surgery and (2) assess the risk of surgical site infection after the institution of this sign. HYPOTHESIS: This type of sign reduces the number of door openings. MATERIALS AND METHODS: This prospective, observational study included all patients operated on in one of our ORs over a 6-week period. The number of entrances and exits from the OR and how long the doors were kept open were recorded during the entire study period. After 3 weeks, an informational sign was posted on the OR doors warning people that unnecessary traffic in and out of the OR increases the risk of infection. During this period, we also recorded the type of procedure, operative time, the number of people in the OR at the time of the incision, and the number of entrances and exits. Patients underwent a follow-up at 2 years to check for postoperative infection. The primary endpoint was the number of OR door openings, and the secondary endpoint was the number of infections at 2 years postoperatively. RESULTS: The 2 groups (before and after the implementation of the sign) were homogeneous. The average total number of door openings for all ORs was 28.9±19.6 [2-90]. In the no sign group, it was 33.3±20.9 [3-90], and in the sign group, it was 21.0±14.7 [2-50] (p=0.011). The maximum number of people in the OR at one time was 8.32±1.84 [4-12] in the no sign group and 8.44±1.98 [5-12] in the sign group (p=0.8). There were 3 postoperative infections at the 2-year follow-up, all occurring in the no sign group. The infection rate was 6.4% (3/47) in the no sign group versus 0% (0/25) in the sign group (p=0.197). DISCUSSION: Our prospective study demonstrated a simple strategy to reduce the number of entrances and exits, the number of people in the OR, and potentially the risk of surgery-related infection. Another larger-scale study is needed to assess the exact impact of this type of sign, particularly on the risk of infection. LEVEL OF EVIDENCE: III; prospective non-randomized comparative study.
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Quirófanos , Procedimientos Ortopédicos , Infección de la Herida Quirúrgica , Humanos , Estudios Prospectivos , Infección de la Herida Quirúrgica/prevención & control , Masculino , FemeninoRESUMEN
Introduction: Femoral neck fractures (FNF) in the geriatric population are commonly treated with hip replacement procedures, such as total hip arthroplasty, unipolar hip hemiarthroplasty (UHA), and bipolar hip hemiarthroplasty (BHA). The optimal treatment remains controversial, considering outcomes and cost-effectiveness, with UHA often being cheaper. This prospective observational study aims to evaluate UHA's clinical and radiological outcomes, safety, and survivorship compared to existing literature. Methods: We followed 90 elderly patients who underwent UHA following FNF. We assessed patients using the Parker score before and after surgery, as well as Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) scores postoperatively. All complications, acetabular erosions and heterotopic ossifications (HO), were documented. Results: One year post-surgery, 26.7% of patients had passed away, mostly due to declining general health status. Systemic complications occurred in 14.4% of cases, with a 1.1% rate of deep surgical site infections. A single dislocation resulted from excessive stem anteversion. UHA implant survival rate was 97.8% after 4 years. The Parker score remained stable, and HHS at 6 and 12 months was 71.5 ± 12.9 and 70.9 ± 11.8, respectively, while PMA score was 14.3 ± 2.4 and 14.5 ± 2.1, respectively. Five hips showed Baker I acetabular wear. HO were noted as Brooker I in 12 patients, II in 4 patients, and IV in 1 patient. Discussion: UHA exhibited comparable systemic complication rates, implant survivorship, and dislocation rates to those in the literature for both UHA and BHA. The deep surgical site infection rate was lower than reported for BHA. Patients' functional and mental abilities did not decline based on clinical scores. Acetabular wear in UHA was similar to its bipolar counterpart, while HO were only minor findings with no clinical implications. Conclusion: In elderly patients, UHA demonstrated clinical and radiological outcomes similar to BHA in existing literature. UHA may represent a cost-effective alternative for patients with limited life expectancy.
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CONTEXT: The distributions and projections of trauma, treated according to the anatomical region, have not been studied in France. The objectives of this study were to obtain French epidemiological data specific to trauma procedures in orthopedic surgery, as well as to establish a statistical trend on the evolution of medical and surgical procedures resulting from this, since 2013 and over the years to come. Our hypothesis was that an increasing trend in trauma procedures since 2013 exists, with an epidemiological forecast of a continuing increase over 50 years, mainly in the context of the management of osteoporotic fractures related to the ageing French population. MATERIAL AND METHODS: We conducted a retrospective study using national data to obtain completion of procedures between the start of 2013 and the end of 2021. RESULTS: From 2013 to 2021, we noted a total of 5,216,567 procedures related to orthopedic traumatology for an average of 579,618 procedures per year. We noted an overall increase in all procedures, continuing from 2013 to 2019, with an average annual increase of 1.125%. The most commonly performed procedure was osteosynthesis, with an average of 276,989 procedures per year. This was followed by wound sutures with an average of 185,023 procedures, orthopedic reductions of fractures and/or dislocations at an average of 62,960, then arthroplasties with 25,425 procedures per year, musculotendinous ruptures were 19,755 procedures per year, surgical reductions of fractures and/or dislocations represented 6920 procedures per year, and fasciotomies with 2848 procedures. From 2013 to 2021, there was an annual average of 276,989 osteosynthesis procedures. Open osteosynthesis, with an average of 146,547 procedures per year, represented 55% of osteosynthesis procedures. Fractures of the proximal end of the femur represented 79,549 procedures on average per year, including 46,621 (58%) involving the trochanter, while 32,852 (41%) were of the femoral neck. Wrist fractures accounted for an annual average of 55,300. Hand fractures represented an annual average of 38,444, of which 52.2% were closed (17,778). On average, 1000 fractures per year involved the carpus without scaphoid involvement, and 2177 scaphoid fractures. Ankle fractures represented 37,951 procedures on average per year, including 74% of the malleolar complex (28,199). Leg fractures represented 17,613 procedures per year, 58% tibial diaphysis (10,091), 41% tibial plateau (6,857). The strengths of this study are the exhaustiveness of the data, presenting all the Common Classification of Medical Procedures (CCAM) chosen during the defined period. CONCLUSION: This study allowed us to establish, to our knowledge, the first epidemiological database of French orthopedic traumatology. LEVEL OF EVIDENCE: IV; epidemiological descriptive study.
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Fracturas de Tobillo , Traumatismos de la Mano , Ortopedia , Fracturas Osteoporóticas , Traumatismos de la Muñeca , Humanos , Estudios Retrospectivos , Fijación Interna de Fracturas/métodosRESUMEN
INTRODUCTION: Shoulder arthroplasty is increasingly frequent, and the associated literature is abundant. Citation rate is often considered a good means of assessing impact and scientific value. However, analysis of methodological quality is also essential in evidence-based medicine. OBJECTIVES: (1) To identify the 50 most cited articles on shoulder arthroplasty, and (2) to assess the correlation between citation rate and methodological quality. The study hypothesis was that there is no correlation between citation rate and methodological quality. METHOD: Articles were retrieved from PubMed and Google Scholar, identifying the 50 most cited articles on shoulder arthroplasty via the keywords "shoulder joint replacement", "shoulder arthroplasty", "anatomic shoulder prothesis", "reverse shoulder prothesis", and "glenohumeral arthritis". Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS) were calculated. RESULTS: Mean citation rate for the 50 articles was 312.4±169.5 (range, 151-841.5), with a mean citation density of 18.8±10.6 (range, 4.7-46.7). 56% of the studies (28/50) were retrospective case series with level of evidence IV. There was no correlation between citation rate and methodological quality. DISCUSSION: The 50 most cited articles on shoulder arthroplasty mostly showed low levels of methodological quality. There was no correlation between citation rate and methodological quality: the literature needs to be read with a critical eye. LEVEL OF EVIDENCE: IV.
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Artroplastía de Reemplazo de Hombro , Bibliometría , Humanos , Estudios Retrospectivos , Artroplastia , HombroRESUMEN
BACKGROUND: In children, the incidence of anterior cruciate ligament (ACL) ruptures and reconstructions has significantly risen. Unfortunately, re-rupture rates following surgery are substantially higher in children than adults. Previous research suggests that smaller graft diameters are predictive of re-rupture. OBJECTIVE: This study aimed to investigate the growth progression of the ACL bone graft, specifically in terms of width and length, within the intra-articular portion and tunnels, using successive magnetic resonance imaging (MRI) scans. The hypothesis was that the ACL grafts would undergo thinning during growth. MATERIALS AND METHODS: The cohort comprised 100 patients who underwent ACL reconstruction. Among them, 37 patients with significant residual growth were selected for analysis. Of these, 4 patients experienced graft rupture, 5 had "over-the-top" techniques, 12 had missing MRI scans and 5 were lost to follow-up. Each included patient underwent two MRI scans; the analyses of which were conducted in a double-masked manner. RESULTS: A total of 13 knees (and patients) were analyzed, with a mean ± SD (range) delay of residual growth between the two MRI scans of 3.3 + / - 1.4 (1.2-5.2) years. The graft exhibited elongation, thinning and eventual integration with the surrounding bone in the tunnels. Within the intra-articular portion, the mean [95% CI] increase in graft size between the two MRI scans was 30.8% in length and 14.8% in width. The width/length ratio in the intra-articular part was 20.4% on the first MRI and 20.8% on the second MRI. Since this difference in the ratio (+ 0.4%) was not statistically significant (P=0.425), our results indicate that the grafts remained stable in terms of proportions without thinning or thickening. Therefore, the initial hypothesis was validated for the tunnel portion but not the intra-articular portion of the grafts. CONCLUSION: In children with open physes, ACL grafts demonstrate smooth growth progression in all dimensions. However, this finding does not fully explain the high rate of re-rupture observed in children. Further research is needed to elucidate the underlying factors contributing to re-rupture in this population.
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Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Adulto , Humanos , Niño , Ligamento Cruzado Anterior/diagnóstico por imagen , Ligamento Cruzado Anterior/cirugía , Ligamento Cruzado Anterior/patología , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Lesiones del Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética/métodos , Rodilla , Rotura/patologíaRESUMEN
BACKGROUND: Single-use (SU) ancillaries for cup preparation in total hip arthroplasty (THR) aim to reduce the costs of hip replacement surgery. These devices have been recently introduced, but their safety and feasibility have not been studied. Therefore, we performed a prospective randomized study aiming to assess the impact in our department of using these SU ancillaries versus standard reusable ancillaries for dual mobility THR regarding 1) the cost, 2) operative time, 3) quality of primary fixation. HYPOTHESIS: We hypothesized that the use of SU ancillaries for acetabular preparation would reduce maintenance costs, and so optimise the operating procedure, reduce the overall cost of surgery, save time, while maintaining the same quality of prosthesis fitting. METHOD: We conducted a randomised, controlled, open-label, two-arm, single-centre, prospective therapeutic trial with a medico-economic objective. Inclusions were made prospectively from patients hospitalised and surgically managed in our department for arthrosis over 18 years old treated with dual mobility THR. RESULTS: In the current study, 18/20 (90%) of the cases required the use of one SU reamer when using SU ancillaries. Only two cases (10%) required a second SU reamer (without SU failure regarding the acetabular implant) because there was too much subchondral bone left and not enough cancellous bone allowing correct cup fitting. We also found that the test implant supplied in the SU kit had a less secure press-fit than the reusable metal test implants. There was one of primary press-fit failure in the SU group requiring a different cup with additional screws. The estimated cost to the supplier per procedure was 20,105 euros using single-use reamers versus 26,666 euros using conventional ancillary kits, a saving of 6561 euros (p<0.001). For the healthcare institution, the median price per intervention on the differentiating points was 2648 euros versus 2580 euros, with no significant difference (p=0.297). The results show an average societal cost of 52,199 euros using single-use and 53,572 euros using reusable ancillary equipment, with a significant difference between the two groups (p<0.003). The average cost of Healthcare Risk Waste (HCRW) disposal in the SU group was 5.2 euros per intervention against 5.1 euros in the RU group, without significant difference (p=0.910). We found a similar result for the cost of disposal of non-HCRW waste per procedure: 0.37 euros in the SU group versus 0.34 in the RU group, without significant difference (p=0.345). CONCLUSION: SU ancillaries significantly reduce the table set up time and have the potential to facilitate time and cost savings but further research is needed in this direction. Our study shows that the daily workload, operating times, and the number of boxes of instruments to be sterilised are decreased. The associated environmental gain is significant. Nevertheless, the economic promise of these SU ancillaries is only partially supported in this trial owing to the small number of patients. Further work will be needed to obtain a more powerful medico-economic assessment of this promising ancillary product. LEVEL OF EVIDENCE: II; prospective randomized study.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Humanos , Adolescente , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Factibilidad , Acetábulo/cirugía , Análisis Costo-BeneficioRESUMEN
BACKGROUND: Early surgery seeks to decrease peri-operative complication rates and mean hospital stay lengths while also improving patient satisfaction. Few data exist on optimising care before orthopaedic and trauma surgery (OTS), notably regarding delays to surgery after admission. The objective of this study was to identify reasons for OTS delays at a university-hospital OTS centre in France. Surgery was defined as delayed if performed more than 48h after admission. HYPOTHESIS: Some reasons for OTS delays are amenable to modification by measures aimed at decreasing the adverse impact of long wait times. MATERIAL AND METHOD: We conducted a retrospective single-centre observational study. Of 18 495 who underwent surgery at the OTS centre of the Clermont-Ferrand university hospital in 2015-2019, 1946 had a post-admission wait time longer than 48h. After exclusion of repeat surgical procedures and dressing changes, 1175 patients remained for the analysis. The records of each patient were reviewed to identify the reason for the surgical delay. RESULTS: A delay longer than 48h was noted for 6.3% of OTS procedures. The most common reasons were limited resource availability (e.g., of operating theatres, nurses, or anaesthesia teams) (21.3%) and patient treatment by anticoagulants (20.9%). CONCLUSION: Most delays were due to reasons independent from the patients operating-theatre logistics, delays in obtaining investigations) that could be targeted by those involved with operating-theatre management to diminish both surgical delays and hospital stay lengths. LEVEL OF EVIDENCE: IV, retrospective observational cohort study.
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Ortopedia , Humanos , Estudios Retrospectivos , Quirófanos , Infección de la Herida Quirúrgica , Centros TraumatológicosRESUMEN
Allograft bone tissue has a long history of use. There are two main ways of preserving allografts: by cold (freezing), or at room temperature after an additional cleaning treatment using chemicals. These chemicals are considered potentially harmful to humans. The aim of the study was (i) to assess the presence of chemical residues on processed bone allografts and (ii) to compare the in vitro biocompatibility of such allografts with that of frozen allografts. The presence of chemical residues on industrially chemically treated bone was assessed by high performance liquid chromatography (HPLC) after extraction. Biocompatibility analysis was performed on primary osteoblast cultures from Wistar rats grown on bone disks, either frozen (F-bone group) or treated with supercritical carbon dioxide with no added chemical (scCO2-bone group) or industrially treated with chemicals (CT-bone group). Cell viability (XTT) was measured after one week of culture. Osteoblastic differentiation was assessed after 1, 7 and 14 days of culture by measuring alkaline phosphatase (ALP) activity directly on the bone discs and indirectly on the cell mat in the vicinity of the bone discs. Residues of all the chemicals used were found in the CT-bone group. There was no significant difference in cell viability between the three bone groups. Direct and indirect ALP activities were significantly lower (-40% to -80%) in the CT-bone group after 7 and 14 days of culture (p < 0.05). Residues of chemical substances used in the cleaning of bone allografts cause an in vitro decrease in their biocompatibility. Tissue cleaning processes must be developed that limit or replace these chemicals to favor biocompatibility.
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Trasplante Óseo , Osteoblastos , Inactivación de Virus , Fosfatasa Alcalina , Aloinjertos , Animales , Dióxido de Carbono , Osteoblastos/efectos de los fármacos , Ratas , Ratas WistarRESUMEN
BACKGROUND: No studies have evaluated, to our knowledge, potential differences in practices in France according to type of healthcare institution, i.e., university public hospital, community public hospital, or private hospital with or without participation in the public healthcare system. The objectives of this study of the exhaustive information collected in the French hospital-admission database were to: (1) describe the numbers of the main procedures performed in France by orthopaedic and trauma surgeons in each type of institution and each subspecialty; and (2) to determine whether the pattern of procedures differed according to the type of healthcare institution. HYPOTHESIS: Differences in surgical practice patterns exist across healthcare institution types and according to the nature of the procedures. PATIENTS AND METHODS: A retrospective observational nationwide study was performed using the exhaustive French hospital database. All surgical procedures done in 2019 for orthopaedic and trauma indications were collected. We then classified the procedures according to the most common diagnoses by distinguishing procedures on the hip, knee, shoulder, hand, spine, ankle, and foot, as well as paediatric and traumatology procedures. RESULTS: Procedures performed more often in private institutions included those on the hip (93,225 [64.3%] of 144,919), knee (223,542 [75.5%] of 296,255), shoulder (103,923 [76.6%] of 300,577), hand (408,035 [77.6%] of 525,534), spine (for degenerative disease, 27,001 [71.2%] of 37,915), and ankle and foot (75,392 [77.1%] of 105,720). In contrast, of the 19,157 (80.3%) of the 23,848 paediatric procedures and 203,090 (67.7%) of the 300,065 traumatology procedures were done in public institutions. For all eight comparisons, the difference between public and private institutions was statistically significant. The overall trend was towards public university hospitals performing more paediatric and trauma procedures and more complex surgeries such as those required by multiple traumatic injuries. DISCUSSION: Our study provides accurate numbers of surgical procedures done in public and private healthcare institutions in France in 2019. We found major differences not only across categories and specialties but also within specialties depending on the type of procedure. Orthopaedic surgical activity shows a marked imbalance in France between public and private institutions. Further research would be needed to identify the causes. LEVEL OF EVIDENCE: IV, retrospective observational epidemiological study.
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Ortopedia , Traumatología , Niño , Humanos , Atención a la Salud , Francia , Hospitales Privados , Estudios RetrospectivosRESUMEN
Primary bone cancers commonly involve surgery to remove the malignant tumor, complemented with a postoperative treatment to prevent cancer resurgence. Studies on magnetic hyperthermia, used as a single treatment or in synergy with chemo- or radiotherapy, have shown remarkable success in the past few decades. Multifunctional biomaterials with bone healing ability coupled with hyperthermia property could thus be of great interest to repair critical bone defects resulting from tumor resection. For this purpose, we designed superparamagnetic and bioactive nanoparticles (NPs) based on iron oxide cores (γ-Fe2O3) encapsulated in a bioactive glass (SiO2-CaO) shell. Nanometric heterostructures (122 ± 12 nm) were obtained through a two-step process: co-precipitation of 16 nm sized iron oxide NPs, followed by the growth of a bioactive glass shell via a modified Stöber method. Their bioactivity was confirmed by hydroxyapatite growth in simulated body fluid, and cytotoxicity assays showed they induced no significant death of human mesenchymal stem cells after 7 days. Calorimetric measurements were carried out under a wide range of alternating magnetic field amplitudes and frequencies, considering clinically relevant parameters, and some were made in viscous medium (agar) to mimic the implantation conditions. The experimental specific loss power was predictable with respect to the Linear Response Theory, and showed a maximal value of 767 ± 77 W gFe-1 (769 kHz, 23.9 kA m-1 in water). An interesting value of 166 ± 24 W gFe-1 was obtained under clinically relevant conditions (157 kHz, 23.9 kA m-1) for the heterostructures immobilized in agar. The good biocompatibility, bioactivity and heating ability suggest that these γ-Fe2O3@SiO2-CaO NPs are a promising biomaterial to be used as it is or included in a scaffold to heal bone defects resulting from bone tumor resection.
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Neoplasias Óseas , Hipertermia Inducida , Osteosarcoma , Agar , Materiales Biocompatibles/química , Materiales Biocompatibles/farmacología , Neoplasias Óseas/terapia , Vidrio/química , Humanos , Fenómenos Magnéticos , Dióxido de SilicioRESUMEN
INTRODUCTION: Revision for loosening of femoral stems requires an extensive analysis of bone defects to determine the most appropriate course of action. The drawbacks of using modular stems are that they can break or corrode at their junction. They have rarely been evaluated based on the extent of bone loss and particularly in patients with less severe bone loss. This led us to carry out a retrospective study to analyze modular femoral stems as a function of the initial bone defect (stage IIIB versus less severe in the Paprosky classification): 1) implant survivorship, 2) osteointegration and subsidence of the stem, and 3) breakage of implant. HYPOTHESIS: Modular femoral stems can be used for all types of bone defects (not only IIIB) as the complication rate is identical. PATIENTS AND METHODS: Between January 1, 1996, and December 31, 2016, 163 patients were included who had received a modular femoral revision stem. The minimum follow-up was 4 years; the mean was 6.7 years±3.3 [4-21]. One patient was lost to follow-up, 88 had died before the analysis date and 74 were still alive; however, 10 of them had the stem removed less than 4 years after implantation. Thus 64 patients were available for the clinical evaluation. There were 44% (72 patients) with Paprosky stage IIIB femoral bone loss and 56% (91 patients) with stage I, II or IIIA bone loss. The stem's bone integration was evaluated using the Engh and Massin score. All complications were documented. RESULTS: The survivorship of the femoral stem was 93.75% (95% CI: 83.33-96.70) at 5 years with removal for any reason as the end point. There was no significant difference (p=0.0877) in survivorship relative to the severity of the initial bone loss: 89.84% (95% CI: 78.73-95.31) for stage IIIB; 95.23% (95% CI: 82.24-98.79) for stage IIIA; 97.06% (95% CI: 80.90-99.58) for stage II. Bone integration was considered as being achieved in 76% of stems based on available radiographs (119 of 156 patients) with the severity of bone loss having no effect. We found 18 instances of stem subsidence out of 156 stems with available data (11.5%). The mean subsidence was 14.7 mm ± 12.3 [5-40]. Among the 18 stems with postoperative subsidence, 13 had been implanted for stage IIIB defects, while 5 were for less severe defects (p=0.751). Two stem fractures occurred in patients with stage IIIB bone loss, thus 2/66 for stage IIIB and 0/86 in the less severe bone loss cases (p=0.188). CONCLUSION: Modularity provides similar results no matter the severity of initial bone loss, without the risk of additional complications. LEVEL OF EVIDENCE: IV, Retrospective study.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios RetrospectivosRESUMEN
PURPOSE: Currently, autografts and allografts are largely used to treat large or massive rotator cuff tear (RCT), without any evidence in favour of one graft or the other. The purpose of this study was to determine the rate of retear of autograft and allograft in the treatment of large or massive posterosuperior RCT. METHOD: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating clinical and radiological results of surgical treatment with autograft or allograft for large or massive RCT since 2008. The main criterion was the retear rate of the graft assessed on MRI or US scan at 1-year minimum follow-up. Partial tear were classified as "tear". RESULTS: The overall retear rate was 23.6% (15.5-32.7) at a mean follow-up of 18.4 ± 7.8 (12-36) months. There was no significant difference between the two kinds of graft, with a retear rate of 27.0% (15.4-40.2) and 20.9% (9.9-34.2) with autograft and allograft respectively (n.s.). Similar improvements of functional scores (+ 28.8 to 38.4 points for the Constant score, + 33.6 to 38.4 points for the ASES, and - 4.0 to - 4.1 points for pain-VAS) were reported in the two groups after at 27.2 ± 11.1 (12-48) months. The rate of complications except retear was 1.8% (0.2, 3.7) with autograft and 0.5% (0.8, 1.8) with allograft (n.s.). CONCLUSION: The use of autograft and allograft for the treatment of large or massive RCT leads to similar retear rate and clinical outcomes at short to medium terms. LEVEL OF EVIDENCE: Level IV.
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Lesiones del Manguito de los Rotadores , Aloinjertos , Artroscopía/métodos , Autoinjertos , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/cirugía , Rotura , Resultado del TratamientoRESUMEN
INTRODUCTION: In total hip replacement (THR), a short stem theoretically provides more physiological force transfer to the proximal femur, conserves bone stock and facilitates minimally invasive surgery. On the other hand, such implants involve a learning curve and incur risk of malpositioning or fracture and of secondary mobilization. There are several types of short stem, and classification is needed. Classifications exist, but are based more on implant length than on anchorage zone, and most have not been tested for reproducibility. The French Hip & Knee Society (SFHG) developed a short-stem classification based on anchorage zone inside the femur. The objectives of the present study were: (1) to present the classification, (2) to apply it to the short-stem models available in France and those widely used worldwide, and (3) to assess reproducibility. HYPOTHESIS: The SFHG short-stem classification enables reproducible comparison. MATERIAL AND METHOD: A short-stem classification according to anchorage zone was drawn up by an expert group. The stems and the classification were presented to 12 surgeons performing THR, who classified the stems according to the classification; a retest was performed 2 months later. RESULTS: The classification is based on femoral stem anchorage site, in 5 types: type 1, cephalic; type 2, isolated cervical; type 3, Calcar femorale; type 4, metaphyseal; and type 5, conventional metaphyseal-diaphyseal, with shortened stems. Inter-observer reproducibility was 92.7% [95%CI: 91.7%-93.6%], with kappa 0.785 [95%CI: 0.755-0.814], and Lin test-rest concordance correlation coefficient 0.852 [95%CI: 0.836-0.869]. Intra-observer reproducibility was 94.0% [95%CI: 91.9%-96.1%], with kappa 0.820 [95%CI: 0.759-0.882], and Lin test-retest concordance correlation coefficient 0.820 [95%CI: 0.792-0.849]. DISCUSSION: This new classification enables femoral implants to be reproducibly compared according to anchorage zone. LEVEL OF EVIDENCE: IV; retrospective study without control group.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Fémur/cirugía , Humanos , Diseño de Prótesis , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
To determine the survival of slotted acetabular augmentation in adult dysplasia, we reviewed all cases operated on between 2002 and 2020 with clinical and radiological assessment and a 2.63 year minimum of follow-up. Twenty-three patients were included, with 91% of Crowe 1 hip dysplasia. Seven patients underwent THA at a mean 6.0 ± 3.5 years; 15 retained SAA without THA at a mean 9.5 years' follow-up; 1 was lost to follow-up. There was a significant improvement in PMA and HHS scores, with decreased pain. WOMAC and SF12 quality-of-life scores were moderate due to frequent pain. The patients with preoperative osteoarthritis showed little progression at seven years 'follow-up. We concluded SAA is a corrective treatment for residual hip dysplasia. Its goal is to normalize joint loading by increasing the contact area and improving the lever arm of the hip. Its postponed onset of osteoarthritis and reduced pain, thereby allowing to postpone THA.
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INTRODUCTION: Authors are responsible for their own Disclosure of Interests in submitting to Orthopaedics & Traumatology: Surgery & Research (OTSR). Disclosure may be incomplete or false, by deliberate or unintended omission. Omission may impact the analysis of results or at least the reader's perception of it. The rate of validity of disclosure in OTSR is not known, and we therefore conducted a bibliometric study on articles published in 2017, in order to: 1) determine the proportion of articles in which authors disclose interests; and 2), when interests are disclosed, to assess their validity by comparison against the Transparence.gov.fr database. HYPOTHESIS: Disclosure rates exceed 75%. MATERIAL AND METHOD: We analyzed all articles published in OTSR in 2017, and extracted those with at least one French author. We also analyzed data from the Transparence.gouv.fr corporate declaration database, for comparison with the authors' own disclosures in each article. Significant interest was defined by a 1000 threshold, although higher thresholds (>5000, >10,000 and >100,000) were also investigated. RESULTS: In 2017, 337 articles were published in OTSR, 210 of which had at least 1 French author. Of these, 201 (95.7%) had at least 1 author with significant interest (>1000) according to the Transparence data. In 189 of these 201 articles (94%), authors had failed to disclose at least 1 direct or indirect conflict of interest. This omission rate fell to 22/45 (48.9%) for more substantial interests, which were more faithfully disclosed. At the 1000 threshold, in only 8/201 articles (4%) did authors disclose all their interests with perfect validity, but this rate increased up to 25/45 (55.5%) at higher thresholds. At the 1000 threshold, 66 of the 201 articles cited the trade-name of interest, resulting in 54/66 (82%) correct disclosure of direct interest; this rate increased up to 25/26 (96%) at higher thresholds. DISCUSSION: At a threshold of 1000, the rate of complete and valid disclosure was 4% and the rate of omission 94%. At higher thresholds, rates were better, with just 48.9% omission and, above all, 55.5% validity, even if these rates were lower than hypothesized (75%). Authors and editors need to take greater care. Disclosures were often made, but incompletely, and authors need reminding that they must disclose not only interests related to the article in question but also all interests that might directly or indirectly influence their interpretation of the results reported, allowing readers to make up their own minds. LEVEL OF EVIDENCE: IV; systematic retrospective study.
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Ortopedia , Traumatología , Conflicto de Intereses , Revelación , Humanos , Estudios RetrospectivosRESUMEN
The aging of our population is accompanied by an increased prevalence of chronic diseases. Among those, liver, joint and adipose tissue-related pathologies have a major socio-economic impact. They share common origins as they result from a dysregulation of the inflammatory and metabolic status. Plant-derived nutrients and especially polyphenols, exert a large range of beneficial effects in the prevention of chronic diseases but require clinically validated approaches for optimized care management. In this study, we designed an innovative clinical approach considering the metabolites produced by the digestive tract following the ingestion of an artichoke leaf extract. Human serum, enriched with metabolites deriving from the extract, was collected and incubated with human hepatocytes, human primary chondrocytes and adipocytes to determine the biological activity of the extract. Changes in cellular behavior demonstrated that the artichoke leaf extract protects hepatocytes from lipotoxic stress, prevents adipocytes differentiation and hyperplasia, and exerts chondroprotective properties in an inflammatory context. These data validate the beneficial health properties of an artichoke leaf extract at the clinical level and provide both insights and further evidence that plant-derived nutrients and especially polyphenols from artichoke may represent a relevant alternative for nutritional strategies addressing chronic disease issues.
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Antiinflamatorios/uso terapéutico , Cynara scolymus/química , Extractos Vegetales/uso terapéutico , Hojas de la Planta/química , Sustancias Protectoras/uso terapéutico , Adipocitos , Adulto , Proliferación Celular , Colesterol/análisis , Condrocitos , Células Hep G2 , Hepatocitos/efectos de los fármacos , Humanos , Hígado , Enfermedades Metabólicas/tratamiento farmacológico , Polifenoles , Triglicéridos/análisisRESUMEN
BACKGROUND: During major bone substance loss, secured allogeneic bone matrix (ABM) is normally utilized for bone repair. Here, we propose a method to colonize ABM using autologous mesenchymal cells (MCs) to improve their integration. Moreover, in this study, the consequences of in vitro colonization on MCs have been evaluated. METHODS: After in vitro propagation of MCs, their proliferation kinetics on ABM pre-coated with gelatin, fibronectin, collagen IV and human serum (HS) was monitored, and they were compared with cells cultured without ABM for 8 weeks. The effect of ABM on cell phenotype was also assessed. Lastly, the ability of ABM-colonizing MCs to perform hematopoiesis, a function normally preserved in selected culture conditions, and their differentiation towards osteoblastic lineage were evaluated. RESULTS: MC and colony-forming unit-fibroblast proliferated 930- and 590-fold, respectively. The proliferation rate of the expanded MCs was higher, forming a 3-dimensional structure in all ABMs. Pre-coating with HS was the most efficient treatment of ABMs to increase the initial adherence of MCs, and it partly explains the reason for the higher propagation of MCs. Flow cytometry analyses revealed subtle alterations in ABM-colonizing cells; however, the ability of MCs to maintain long-term culture initiating cells proliferation and differentiate into osteoblastic lineage was preserved. CONCLUSIONS: In this study, the in vitro biocompatibility of bone marrow (BM) MCs with ABMs, the role of HS in scaffold coating, and the possibility of initially using a small BM sample for this approach were demonstrated.
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Cytotoxicity and antibacterial properties associated with the dopant release of Cu-doped Biphasic Calcium Phosphate (BCP) powders, mainly composed of hydroxyapatite mixed with ß-tricalcium phosphate powders, were investigated. Twelve BCP ceramics were synthesized at three different sintering temperatures (600 °C, 900 °C and 1200 °C) and four copper doping rates (x = 0.0, 0.05, 0.10 and 0.20, corresponding to the stoichiometric amount of copper in Ca10Cux(PO4)6(OH)2-2xO2x). Cytotoxicity assessments of Cu-doped BCP powders, using MTT assay with human-Mesenchymal Stem Cells (h-MSCs), indicated no cytotoxicity and the release of less than 12 ppm of copper into the biological medium. The antibacterial activity of the powders was determined against both Gram-positive (methicillin-sensitive (MS) and methicillin resistant (MR) Staphylococcus aureus) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria. The Cu-doped biomaterials exhibited a strong antibacterial activity against MSSA, MRSA and E. coli, releasing approximatively 2.5 ppm after 24 h, whereas 10 ppm were required to induce an antibacterial effect against P. aeruginosa. This study also demonstrated that the culture medium used during experiments can directly impact the antibacterial effect observed; only 4 ppm of Cu2+ were effective for killing all the bacteria in a 1:500 diluted TS medium, whereas 20 ppm were necessary to achieve the same result in a rich, non-diluted standard marrow cell culture medium.
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BACKGROUND: Femoral neck fractures constitute a major public health challenge. The risk of death after surgery depends chiefly on the patient's general health and comorbidities. No studies assessing place of residence are available. The objectives of this study were to determine whether mortality differed according to the patient's previous place of residence and to the place of discharge, and to describe the complications occurring after femoral neck fracture surgery. HYPOTHESIS: After femoral neck fracture surgery, the place of discharge is associated with the risk of death, and the complication rate is high. METHODS: This single-centre retrospective study included 1241 adults who sustained a true femoral neck fracture between 2006 and 2016 and were followed up for at least 3 years. The following data were collected: age at the time of the fracture, sex, hospital stay length, place of residence before and after the fracture, characteristics of the fracture, type of treatment, time from the fracture to surgery, and whether anticoagulant therapy was given. We then recorded data on mortality and complications. RESULTS: The 3-year mortality rate was 36.0±1.4% (95%CI, 33.3-38.7). Place of residence before the fracture was strongly associated with mortality: the risk of death was higher in patients who lived in care homes (hazard ratio [HR], 2.18) or were hospitalised (HR, 1.78) and lower in patients who lived at home (HR, 0.46). The risk of death was also higher in patients discharged to care homes (HR, 1.82) or to hospitals (HR, 1.90) and lower in patients discharged home (HR, 0.30). All these differences were statistically significant (p<0.0001). CONCLUSION: Place of residence and likely place of discharge should be evaluated as soon as the patient is admitted to the emergency department, in order to provide the best information possible to the patient and family and to establish the most appropriate treatment strategy. Patient self-sufficiency is a major parameter that should be preserved to the extent possible. LEVEL OF EVIDENCE: IV.
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Fracturas del Cuello Femoral , Adulto , Fracturas del Cuello Femoral/cirugía , Estudios de Seguimiento , Humanos , Alta del Paciente , Estudios Retrospectivos , Factores de RiesgoRESUMEN
INTRODUCTION: Given their low citation rate, case reports may reduce a journal's impact factor (IF), making a journal less likely to accept them for publication. However, this concept has never been proven in a bibliometric study. This led us to carry out a bibliometric analysis to evaluate (1) the exact number of case reports published in orthopedics over a 2-year period, (2) their citation rate, (3) what the journals' IF would be if they had not published these case reports. HYPOTHESIS: Publishing case reports reduces a journal's IF, bringing into question whether they should be published. MATERIALS AND METHODS: This was a retrospective bibliometric study. We focused on all the articles influencing the year 2017. We looked at all the journals in the "Orthopedics" discipline that had published at least one article in the years n-2 (=2015) or n-1 (=2016). RESULTS: There were 1925 case reports among the 28,903 articles published in all orthopedics journals in 2015-2016, a 6.7% share of publications. Individually, each case report in 2015-2016 was cited an average of 0.86 times±1.4 [0-13] in 2017. Of all the case reports published in 2015-2016, 571 (30%) had not been cited in 2017. When comparing the individual number of each case report citation to the journal's IF, we found 413 instances (21.5%) where the case report was cited more than expected and 1512 (78.5%) where it was cited less than expected based on the journal's IF. The mean IF was 2.013. If the journals had not published any case reports, the mean IF would have been 2.072 (p<0.0001). For all the SIGAPS categories, the mean IF would have been higher if no case reports had been published. On average, the IF was lower by 0.059 points±0.121 [-0.165-0.537], with the difference being statistically significantly only for SIGAPS C and D journals. In 69 instances, the IF would be higher if the journal had not published any case reports. Conversely, the IF improved in 8 instances by publishing case reports: 3 were tier D journals and 5 were tier E journals. DISCUSSION: Our study brings into question whether case reports should be published. Indeed, the publication of case reports lowers the IF of scientific journals. However, we should not completely stop publishing case reports since they can be useful to clinicians caring for patients with rare diseases or medical conditions. LEVEL OF EVIDENCE: IV, systematic retrospective study.