Impact on facial skin aging signs of a 1-year standardized photoprotection over a classical skin care routine in skin phototypes II-VI individuals: A prospective randomized trial.

BACKGROUND: Data reflecting the impact of photoprotection on cutaneous aging are scarce and mostly limited to fair skin. OBJECTIVE: To assess the effectiveness of a photoprotective product in counteracting the photoaging process in different skin phototypes over 1 year compared against a classical routine. MATERIALS AND METHODS: Two hundred and ninety Brazilian women aged 30-65 years, with skin phototype II-VI were equally randomized in two groups. Group 1 kept on their routine whereas Group 2 applied, twice daily, a photoprotective product (SPF 60, PPD = 24.1) replacing the one they routinely used. Volunteers reported the duration of their daily sun-exposure. Standardized photographs taken at D0 and D365 were analysed by 15 dermatologists to assess eight wrinkles and pigmentation signs. RESULTS: A global increase in severity was reported which was significant for Group 1. This increase was lower in Group 2 where only half the signs showed significant worsening. In Group 2 versus Group 1, the increase in forehead wrinkles, marionette lines, wrinkles created by ptosis and size of dark spot was significantly (p < 0.05) decreased by 30%-50%. CONCLUSION: Daily application of a high photoprotective product significantly decreases the progression of skin aging signs after 1 year in skin phototypes II-VI.

Artificial Intelligence analysis of over half a million European and Chinese women reveals striking differences in the facial skin ageing process.

BACKGROUND: Artificial Intelligence (A.I) and deep learning-based algorithms are increasingly being used in dermatology following the emergence of powerful smartphones with high-resolution cameras. OBJECTIVES: To use an A.I-based algorithm, validated by dermatologists, to compare the evolution of the skin ageing process among Chinese and European women. METHODS: Selfie images were taken by 465 587 European and 79 016 Chinese women ranging from 18 to 85 and 18 to 69 years old, respectively, without facial skin diseases and who had access to a smartphone with a high-resolution camera (≥4 Megapixels). The selfies were analysed by facial skin diagnostic using a smartphone application to grade the severity of 9 facial signs (including wrinkles, sagging, vascular, pigmentation signs, pores). RESULTS: Wrinkles/texture, ptosis and sagging increased linearly with age in European women compared to lower scores and more gradual increase in the younger age-classes in Chinese women. In Chinese women, pigmentation signs increased regularly between 18 and 40 years, plateaued between 40 and 60 years, then increased in the over 60s compared to lower scores and a slower more regular increase with age in European women. Vascularization signs increased steadily with age in European women compared to no significant change in Chinese women. CONCLUSIONS: Marked differences were observed in the skin ageing process between European and Chinese populations, both in the prevalence of each facial ageing sign and their kinetics. Automatic grading performed on selfies and analysed by A.I is a fast and confidential method for quantifying signs of facial ageing and identifying the main issues for each population and age-class, which is of practical interest, as it will allow the development of tailored prevention and therapeutic measures.

Clinical impacts of sun exposures on the faces and hands of Japanese women of different ages.

OBJECTIVE: To assess the impacts of sun exposures on some skin signs on the faces and hands of differently aged Japanese women, according to their distinct behaviours towards vis à vis sun exposure. METHODS: Two comparable cohorts of Japanese women (aged 18-83 years) were created according to their usual behaviour towards sun exposure i.e. non-sun-phobic (N = 495) and sun-phobic (N = 516) and through their regular use(s) of a photo-protective product. Standard photographs (full-face and 45° lateral) allowed to focus on 18 facial signs that were graded by 15 experts, using a referential skin ageing Atlas. From these two cohorts, two sub-cohorts (114 and 122 women) were created with regard to the similar clinical aspects of the dorsal side of their hands (Left vs. Right) that were further graded. Absolute differences in the scores of each sign were used (non-sun-phobic minus sun-phobic), by age-ranges, to better ascertain the impact of sun exposures and photo-protection. RESULTS: Facial signs related to skin wrinkles/texture and pigmentary spots were found significantly more accentuated among non-sun-phobic women and show an early onset (20-30 years). Facial sagging and crow's feet wrinkles appear delayed (30-40 years). The severity of vascular disorders was found to be similar in the two cohorts. The absolute differences in the grading's of almost all signs were unsurprisingly found increased with advancing ages, illustrating the combination of chronological and photo-ageing processes. With regard to hands, differences in skin texture and pigmentary disorders are of a late onset (40-50 years) and were found much increased at older ages. The cutaneous signs of the hands of Japanese women can hardly be taken as reliable markers of their photo-ageing status. CONCLUSION: The present work illustrates, for the first time, some specificities of the impact of sun exposures on the facial skin of Japanese women, pinpointing the fact that some facial signs are of an early onset. Results significantly confirm the importance of both sun avoidance coupled with photo-protective measures.

OBJECTIF: D'évaluer les impacts de l'exposition solaire sur plusieurs signes du visage et des mains de femmes Japonaises d'âge différents, selon leurs différents comportements vis-à-vis de l'exposition solaire. MÉTHODES: Deux cohortes comparables de femmes Japonaises (âgées de 18 à 83 ans) ont été créées selon leur comportement habituel vis à vis de l'exposition solaire, phobique (N = 516) ou non (N = 495) et selon leur utilisation(s) régulière(s) de produits photo-protecteurs. Des photographies standardisées du visage de face et latérales (45°) ont permis de se focaliser sur 18 signes cliniques du visage dont la sévérité a été quantifiée par 15 experts, utilisant un Atlas de référence du vieillissement cutané. De ces deux cohortes, deux sous-cohortes ont été extraites (114 et 122 femmes) par les aspects cliniques similaires de la face dorsale de leurs mains (Gauche vs. Droite) pour être ensuite quantifiées. Les différences absolues de chaque signe (non-phobiques moins phobiques), par tranches d'âges, ont été utilisées pour mieux déterminer l'impact des expositions solaires et des routines de photo-protection. RÉSULTATS: Les signes du visage liés à la texture cutanée/rides et aux taches pigmentaires ont été trouvés significativement aggravés chez les femmes non-phobiques de l'exposition solaire et d'apparition précoce (20-30 ans) tandis que la ptose du visage ou les rides de la patte d'oie apparaissent plus tardivement (30-40 ans). La sévérité des désordres vasculaires du visage a été trouvée similaire dans les deux cohortes. Les différences absolues dans la sévérité de la plupart des signes ont été logiquement trouvées accrues avec l'âge, illustrant la combinaison du vieillissement chronologique et de celui photo-induit. Concernant les mains, les différences dans la texture cutanée et les désordres pigmentaires apparaissent significativement tardives (40-50 ans) et augmentent à des âges plus avancés. Les signes cutanés des mains des femmes Japonaises ne semblent donc pas être des marqueurs fiables du vieillissement photo-induit. CONCLUSION: La présente étude illustre, pour la première fois, quelques spécificités des impacts de l'exposition solaire sur les signes faciaux de femmes Japonaises, pointant le fait que certains sont d'apparition précoce. Les résultats confirment de manière significative l'importance d'éviter les expositions solaires et de recourir à des mesures photo-protectrices.

A new bunya-like virus associated with mass mortality of white-clawed crayfish in the wild.

We report the discovery of a new enveloped, spherical virus belonging to the Phenuiviridae family of negative ssRNA viruses associated with a massive outbreak in a French population of the endangered white-clawed crayfish Austropotamobius pallipes. We call this virus Bunya-like Brown Spot Virus (BBSV) and characterize it using transmission electronic microscopy, genome sequencing and clinical signs. Infected specimens show discolored brown spots on the cuticle. Using RNA-seq data we assembled a partial sequence for the L, M and S genome segments of BBSV. Phylogenetic analyses using all three segments show this virus is closely related to the Wenling crustacean virus 7 (China) and to a bunya-like virus found in feces of the European otter. Our survey of the mass mortality event indicates the virus is less virulent than the crayfish plague caused by Aphanomyces astaci. Overall, the discovery of BBSV provides a new important asset to monitor A. pallipes populations.

Concomitant association of giant cell arteritis and malignancy: a multicenter retrospective case-control study.

INTRODUCTION: Some studies suggest that there is an increased risk of malignancies in giant cell arteritis (GCA). We aimed to describe the clinical characteristics and outcomes of GCA patients with concomitant malignancy and compare them to a GCA control group. METHOD: Patients with a diagnosis of GCA and malignancy and with a maximal delay of 12 months between both diagnoses were retrospectively included in this study and compared to a control group of age-matched (3:1) patients from a multicenter cohort of GCA patients. RESULTS: Forty-nine observations were collected (median age 76 years). Malignancies comprised 33 (67%) solid neoplasms and 16 (33%) clonal hematologic disorders. No over-representation of a particular type of malignancy was observed. Diagnosis of GCA and malignancy was synchronous in 7 (14%) patients, while malignancy succeeded GCA in 29 (59%) patients. Malignancy was fortuitously diagnosed based on abnormalities observed in laboratory tests in 26 patients, based on imaging in 14 patients, and based on symptoms or clinical examination in the nine remaining patients. Two patients had a concomitant relapse of both conditions. When compared to the control group, patients with concomitant GCA and malignancy were more frequently male (p < 0.001), with an altered general state (p < 0.001), and polymyalgia rheumatica (p < 0.01). CONCLUSIONS: This study does not indicate an over-representation of any particular type of malignancy in GCA patients. Initial follow-up dictated by vasculitis may have led to an early identification of malignancy. Nevertheless, GCA male patients with an altered general state and polymyalgia rheumatica might more frequently show concomitant malignancies.

Schnitzler syndrome: validation and applicability of diagnostic criteria in real-life patients.

BACKGROUND: Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, and clinical, histological, and biological signs of neutrophil-mediated inflammation. The aim of this study was to assess the applicability and validity of the existing diagnostic criteria in real-life patients. METHODS: This multicentric study was conducted between 2009 and 2014 in 14 hospitals in which patients with Schnitzler syndrome or controls with related disorders were followed up. We compared the sensitivities and specificities and calculated the positive and negative predictive values of the Lipsker and of the Strasbourg criteria for the patients with Schnitzler syndrome and for the controls. We included 42 patients with Schnitzler syndrome, 12 with adult-onset Still's disease, 7 with cryopyrin-associated periodic disease, 9 with Waldenström disease, and 10 with chronic spontaneous urticaria. RESULTS: All patients with Schnitzler syndrome met the Lipsker criteria. According to the Strasbourg criteria, 34 patients had definite Schnitzler syndrome, five had probable Schnitzler syndrome, and three did not meet the criteria. One control met the Lipsker criteria and had probable Schnitzler syndrome according to the Strasbourg criteria. Sensitivity and specificity of the Lipsker criteria were 100% and 97%, respectively. For the Strasbourg criteria, sensitivity for definite and probable diagnosis was 81% and 93%, respectively, with a corresponding specificity of 100% and 97%. CONCLUSION: Diagnostic criteria currently in use to diagnose Schnitzler syndrome are reliable. More investigations must be done to attest their efficiency in patients with recent-onset manifestations.

Can the presence of an infection be predicted before a revision total hip arthroplasty? Preliminary study to establish an infection score.

INTRODUCTION: The diagnosis of periprosthetic joint infection can be challenging, in part because there is no universal diagnostic test. Current recommendations include several diagnostic criteria, and are mainly based on the results of deep microbiological samples; however, these only provide a diagnosis after surgery. A predictive infection score would improve the management of revision arthroplasty cases. The purpose of this study was to define a composite infection score using standard clinical, radiological and laboratory data that can be used to predict whether an infection is present before a total hip arthroplasty (THA) revision procedure. HYPOTHESIS: The infection score will make it possible to differentiate correctly between infected and non-infected patients in 75% of cases. MATERIAL AND METHODS: One hundred and four records from patients who underwent THA revision for any reason were analysed retrospectively: 43 with infection and 61 without infection. There were 54 men and 50 women with an average age of 70±12 years (range 30-90). A univariate analysis was performed to look for individual discriminating factors between the data in the medical records of infected and non-infected patients. A multivariate analysis subsequently integrated these factors together. A composite score was defined and its diagnostic effectiveness was evaluated as the percentage of correctly classified records, along with its sensitivity and specificity. RESULTS: The score consisted of the following individually weighed factors: body mass index, presence of diabetes, mechanical complication, wound healing disturbance and fever. This composite infection score was able to distinguish correctly between the infected patients (positive score) and non-infected patients (negative score) in 78% of cases; the sensitivity was 57% and the specificity 93%. DISCUSSION: Once this score is evaluated prospectively, it could be an important tool for defining the medical - surgical strategy during THA revision, no matter the reason for revision. LEVEL OF EVIDENCE: Level IV - retrospective study.

Registries in orthopaedics.

The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established registries, with varying degrees of success. Managing a registry requires time and money. Factors that contribute to successful registry management include the use of a single identifier for each patient to ensure full traceability of all procedures related to a given implant; a long-term funding source; a contemporary, rapid, Internet-based data collection method; and the collection of exhaustive data, at least for innovative implants. The effects of registries on practice patterns should be evaluated. The high cost of registries raises issues of independence and content ownership. Scandinavian countries have been maintaining orthopaedic registries for nearly four decades (since 1975). The first English-language orthopaedic registry was not created until 1998 (in New Zealand), and both the US and many European countries are still struggling to establish orthopaedic registries. To date, there are 11 registered nationwide registries on total knee and total hip replacement. The data they contain are often consistent, although contradictions occur in some cases due to major variations in cultural and market factors. The future of registries will depend on the willingness of health authorities and healthcare professionals to support the creation and maintenance of these tools. Surgeons feel that registries should serve merely to compare implants. Health authorities, in contrast, have a strong interest in practice patterns and healthcare institution performances. Striking a balance between these objectives should allow advances in registry development in the near future.

Effect of hydroxyapatite coating on the radio-clinical results of a grit-blasted titanium alloy femoral taper. A case-control study of 198 cementless primary total hip arthroplasty with the Alloclassic™ system.

BACKGROUND: The effect of hydroxyapatite (HA) coating on the fixation of a cementless femoral stem is discussed, in particular in cases of primary fixation with geometrically stable components. Therefore, we performed a comparative retrospective study of a series of Alloclassic-SL™ stems to: 1) present the long-term results and 2) evaluate the contribution, if any, of proximal HA coating. HYPOTHESES: Long-term cementless press-fit ("flat wedge-shaped") fixation is reliable and HA coating only improves the radiological results of the proximal bone-prosthesis interface. MATERIALS AND METHODS: One hundred and ninety-eight Alloclassic total hip arthroplasties were performed in 179 patients, mean age 66 years old (22-85), including 105 with proximal HA coating and 93 with the original grit-blast coating. One hundred and ninety-three hips were analyzed after a mean follow-up of 9.8 years (1-24 years). RESULTS: Results were excellent or good in 184 hips (95%) with no significant difference between the 2 groups (Merle d'Aubigné≥16 for 89/92 (98%) without HA compared to 95/101 (94%) with HA P=0.59). Radiographic signs of stable osseointegration were observed in 173 hips (90% of the cases). HA coating significantly improved the radiographic results of the proximal bone-implant interface: (42/92 (46%) of the stems without HA had proximal radiolucencies in zones 1 and 7 compared to 4/101 (4%) with HA (P=0.0001)). Polyethylene wear>0.1 mm/year was observed in 6 hips (3%) including 1/101 (1%) in the group with HA versus 5/92 (5.4%) without HA (P=0.17). One intra-operative femoral fracture occurred and there were 9 dislocations in the first 3 postoperative months (4.5%). The main cause of revision surgery was recurrent dislocation (11/17 cases). The "revision per-100 observed-femoral component years" was 0.10 in both groups and survival for aseptic loosening of the stem was 100% (95% CI=73.2% to 100%) at 20 years. CONCLUSION: This study shows that secondary fixation by osseointegration of a straight standard grit-blasted titanium alloy non-anatomical implant is reliable. Possible proximal fibrous encapsulation, which is reduced by HA coating, but especially conventional polyethylene wear, were the main limitations of this system. LEVEL OF EVIDENCE: III retrospective case-control study.

Revision of primary total hip arthroplasty for peri-prosthetic fracture: A prospective epidemiological study of 249 consecutive cases in France.

BACKGROUND: Revision total hip arthroplasty (reTHA) for peri-prosthetic fracture (PPF) is increasingly performed but still ranks fourth among reasons for reTHA in registries. In France, no specific registry is available and the frequency of PPF among reasons for THA revision is therefore unknown. Here, our objectives were to determine the relative frequency of PPF as a reason for reTHA, to identify patient-related and primary-THA-related factors associated with reTHA for PPF, to describe reTHA modalities for PPF, and to determine the morbidity and mortality associated with reTHA for PPF. HYPOTHESIS: PPF is the second most common reason for reTHA, after loosening. METHODS: Consecutive reTHA procedures performed in 30 French centres over a 2-year period were collected prospectively. Repeat revisions and revisions of hemi-arthroplasties were excluded. The epidemiological, clinical, and surgical data needed to answer the questions of the study were collected. RESULTS: PPF was the second leading reason for reTHA (249/2107, 11.8%). Vancouver type B2 fractures were the most common (n=127 [51.5%]). Compared to patients who underwent reTHA for reasons other than PPF, those with reTHA for PPF were older at primary THA (67.9 years versus 57.7 years) and more often had intra-operative complications (16.9% versus 11.6%); furthermore, the primary THA was more often cementless (62.7% versus 42.7%) with a dual-mobility cup (20.6% versus 11.1%). At reTHA, the patients with PPF were older (77.6 years versus 69.2 years), had worst medical condition (mean ASA score, 2.4 versus 2.1) and less physically active (mean Devane score, 2.1 versus 2.4). The patients with reTHA for PPF had a shorter time to revision (9.8 years versus 11.4 years), a longer operative time (144 minutes versus 128 minutes), and more frequent use of the posterior approach (77% versus 67%) with a cementless dual-mobility cup (78% versus 60%) and a cementless revision femoral stem (72% versus 50%). Morbidity and mortality rates were high (5.9% operative complication rate and 12% of surgical complications with 4.8% mortality within the first 3 months) however, these results were similar to those in the rest of the cohort. DISCUSSION AND CONCLUSION: PPF is the second most common reason for reTHA, a result that is at variance with data in national registries. LEVEL OF EVIDENCE: Level IV, prospective observational cohort study.

Characteristics and costs of carbapenemase-producing enterobacteria carriers (2012/2013).

OBJECTIVES: We had for aim to determine the characteristics of carbapenemase-producing enterobacteria (CPE) carriers and to assess the economic impact of isolation measures leading to loss of activity (closed beds, prolonged hospital stays) and additional personnel hours. PATIENTS AND METHODS: We conducted a retrospective study for 2years (2012/2013), in a French general hospital, focusing on CPE carriers with clinical case description. The costs were estimated by comparing the activity of concerned units (excluding the ICU) during periods with CPE carriers or contacts, during the same periods of the year (n-1), plus additional hours and rectal swabs. RESULTS: Sixteen EPC carriers were identified: 10 men and 6 women, 65±10years of age. Seven patients acquired EPC in hospital during 2 outbreaks in 2012. Four patients presented with an infection (peritonitis, catheter infection, and 2 cases of obstructive pyelonephritis) with a favorable outcome. The median length of stay was 21days [4,150]. Six patients died, 1 death was indirectly due to CPE because of inappropriate empiric antibiotic therapy. A decrease in activity was observed compared to the previous year with an estimated 547,303€ loss. The 1779 additional hours cost 63,870€, and 716 screening samples cost 30,931€. The total additional cost was estimated at 642,104€ for the institution. CONCLUSIONS: Specialized teams for CPE carriers and isolation of contact patients, required to avoid/control epidemics, have an important additional cost. An appreciation of their support is needed, as well as participation of rehabilitation units.

[Infectious events during the course of systemic necrotizing vasculitis: a retrospective study of 82 cases]. / Événements infectieux au cours des vascularites nécrosantes systémiques: étude rétrospective de 82 cas.

PURPOSE: The aim of this study was to assess the infections occurring in a series of 82 patients followed for a systemic necrotizing vasculitis and to determine potential risk factors. METHODS: We studied retrospectively the medical files of 23 Churg and Strauss syndrome, 18 periarteritis nodosa, 14 microscopic polyangiitis, and 27 granulomatosis with polyangiitis, over a 15-year period. Infection delay corresponded to the period from treatment to first infection or between two infections. RESULTS: A total of 61 patients developed 147 infections. Causal agent was identified in 70 cases, 42 were bacterial, 20 viral and 8 fungal. Bronchopneumonia was the most frequent infection (43 %). Sixty-two percent of infections occurred within 2 years after vasculitis diagnosis. Seven infections were major, requiring intensive care, with one infection-death related. Pneumocystis prophylaxis concerned 75 % of patients on cyclophosphamide. Significant factors reducing infection delay were initial hypergammaglobulinemia, hypoalbuminemia, lymphopenia, as well as cyclophosphamide and methotrexate treatment. Large quantities of corticosteroids, cyclophosphamide or azathioprine increased infection delay. This result underlines the early occurrence of infectious complications during vasculitis course. CONCLUSION: Infectious events occurring in systemic necrotizing vasculitis are frequent and occurs early in disease course, and could be prevented with simple prophylactic measures. Vasculitis relapse and infection share similarities and this require permanent clinical vigilance.

Primary total hip arthroplasty revision due to dislocation: prospective French multicenter study.

INTRODUCTION: Dislocation following total hip arthroplasty (THA) may require surgical revision, and is one of the most frequent causes for revision in national registers. The goals of this study were to determine the characteristics of revision THA for dislocation and identify the typical features of hips revised due to dislocation. MATERIALS AND METHODS: A prospective multicenter study (30 centers) was performed in first revision THA performed between January 1, 2010 and December 31, 2011 (multiple revisions were excluded). RESULTS: Two hundred nineteen (10.4%) of all first revisions (2153 cases in 2107 patients) were for dislocation, which was the fifth cause of revision. There were 135 men and 84 women, mean age 65.9 years old (24.3-92.4) at primary THA and 72.9 years old (31.9-98.8) at revision. Revision surgery was performed a mean 7.1 years (± 7.1) after primary THA. The predictive risk factors for dislocation were: a 22.2mm diameter femoral head (risk × 2.4), a posterolateral approach (risk × 1.7), older age (risk × 1.1), an elevated rim liner for primary THA (risk × 6.6). The use of a dual mobility cup did not influence the rate of revision for dislocation (8.8%) compared to the use of a flat rim liner (9.1%). DISCUSSION: The 10.4% rate of revision of THA for dislocation seems markedly lower than the results in the literature both for frequency and ranking. The use of elevated rim or constrained liners designed to decrease the risk of dislocation does not improve results compared to standard liners. LEVEL OF EVIDENCE: Level IV, prospective prognostic study without a control group.

Infection as a cause of primary total hip arthroplasty revision and its predictive factors.

INTRODUCTION: Infection is a serious complication of total hip arthroplasty (THA) and is one of the most frequent causes of failure. The goal of this study was to evaluate the importance of infection among the different causes of revision THA and identify any risk factors specifically associated with this cause of revision. MATERIALS AND METHODS: All patients who underwent a first revision of THA were included in a prospective multicenter study. Postoperative clinical and radiological evaluation and follow-up of morbidity and mortality were performed at 3 months. RESULTS: Two hundred forty out of 2107 revisions (11.4%) were performed for infected THA, which was the third cause after aseptic loosening (42.3%) and peri-prosthetic fractures (11.8%). These patients had a higher BMI associated with co-morbidities and lower clinical scores than patients with other causes of revision. One-stage revision was performed in most cases (66%) with replacement of the complete implant in 86% of cases, resulting in longer surgery compared to that for other causes. Male gender (OR 2.3), avascular necrosis (OR 2.4), arthroplasties with dual mobility cups (OR 2.5) and a Rottinger anterolateral approach (OR 3.4) were all associated with an increased risk of infection. DISCUSSION: Some of these risk factors are not or have rarely been reported in the literature. They should be taken into consideration to help in the prevention and continuing battle against THA infection. LEVEL OF EVIDENCE: Level IV, prospective cohort study.

Quality and reproducibility of French publications on total hip arthroplasty.

INTRODUCTION: The goal of the Quality of Literature in Arthroplasty (QoLA) project launched in 2009 was to compare the implant results from clinical studies published in indexed scientific journals with those found in reference national registers. The potential biases in the chosen articles (country of origin, inventor involved in study, methodological quality) were systematically analyzed and the revisions per 100 observed component years (Revp100OCY) index was calculated. For a given implant, a differential factor greater than 3 between the Revp100OCY index for published series and the one from registers was considered as indicative of a potential selection (inventor) or publication (conflict of interest) bias. Although initially performed on English publications, this methodology was subsequently applied to French publications in the field of total hip arthroplasty (THA). MATERIAL AND METHODS: French publications indexed in Medline (Rev Chir Orthop and Orthop Trauma Surg Res since 2009) were analyzed. These studies involved implants designed in France (ABG, Corail stem, Cerafit/Osteal, Bousquet) or that were used worldwide (Omnifit stem, Alloclassic and Charnley-type or Müller-type implants). The articles or abstracts selected had to contain sufficient information (number of revisions, number of cases and/or revisions, average follow-up) to allow the Revp100OCY index to be calculated. RESULTS: Overall, the average Revp100OCY index for THA series published in French was 0.76, which is consistent with the worldwide average of 1.29. For the ABG System, the Revp100OCY index was 1.5, which was higher than register data (0.77). Cemented Charnley-type stems had a Revp100OCY index of 1.68 (register 0.64) and low friction arthroplasty type THA had a Revp100OCY index of 0.59 (register 0.33). The Revp100OCY index was slightly lower relative to register data for the Müller THA (0.22 versus 0.33), Corail stem (0.1 versus 0.24), Omnifit (0.26 versus 0.37) and Alloclassic (0.21 versus 0.49). Other implants without comparable register data had a relatively high Revp100OCY index: 1.2 for the Bousquet dual mobility cup and 1.35 for the Osteal/Cerafit hybrid system. CONCLUSIONS: The few studies published in French include only a limited number of cases, but their follow-up is long and the revision rate consistent with register data. There is no indication of any type of bias in French scientific publications relative to the reproducibility of THA results.

European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing.

INTRODUCTION: There is an ongoing debate about the optimal use of metal-on-metal (MoM) bearings in total hip replacement, since there are uncertainties about local and systemic adverse effects due to wear and corrosion of these bearings. Despite various national recommendations, efforts to achieve international harmonization of specific evidence-based recommendations for best practice are still lacking. HYPOTHESIS: An international consensus study group should be able to develop recommendations on the use and monitoring of MoM bearings, preferably at the European level, through a multidisciplinary approach, by integrating the perspectives of various stakeholders. MATERIALS AND METHODS: Twenty-one experts representing three stakeholder groups and eight countries participated in this European consensus study, which consisted of a consensus meeting, subsequent structured discussion, and consensus voting. RESULTS: The current statement defines first of all benefits, local and systemic risks, as well as uncertain issues related to MoM bearings. Safety assessment after implantation of MoM comprises all patients. A closer follow-up is recommended for large head MoM (≥36mm) and resurfacing. In these implants basic follow-up should consist of x-rays and metal ion measurement of cobalt in whole blood, performed with GF-AAS or ICP-MS. Clinical and/or radiographic abnormality as well as elevated ion levels needs additional imaging (ultrasound, CT-scan and/or MARS-MRI). Cobalt values less than 2 µg/L are probably devoid of clinical concern, the threshold value for clinical concern is expected to be within the range of 2-7 µg/L. DISCUSSION: This is the first multinational, interdisciplinary, and multiprofessional approach for developing a recommendation for the use and monitoring of MoM bearings in total hip replacement. The current recommendations are in partial agreement with previous statements regarding the extent of follow-up and imaging techniques. They however differ from previous communications regarding measurement of metal ions and especially the investigated medium, technique, and eventual threshold levels. LEVEL OF EVIDENCE: Level V, expert opinion/agreement conference.

[Suitability of red blood cell transfusion: a multicenter study]. / Évaluation multicentrique de la pertinence des prescriptions de concentrés de globules rouges.

The purpose of this retrospective observational multicenter study was to assess appropriateness of red blood cell (RBC) transfusion, according to the French national guidelines (Agence française de sécurité sanitaire des produits de santé) published in 2002. Six hundred and thirty-nine RBC transfusions from nine institutions have been randomly selected and analysed. The data collected are issued from different specialities. Patients' characteristics, occurrences of transfusion, admission, pre-transfusion, post-transfusion and discharge haemoglobin concentrations have been collected. Two physicians (who are in charge) must evaluate the appropriateness of pre-transfusion, discharged haemoglobin concentrations, quantity and quality of transfused RBC. The mean pre-transfusion haemoglobin concentration was 7.89 ± 1.24, the median number of transfused RBC was two (extremes: 1-16), the mean discharge haemoglobin concentration was 10.14 ± 1.30 (-5 days after the end of transfusion). The pre-transfusion and discharge haemoglobin concentrations were higher if the patient presented a co-morbidity factor. Ninety-three percent of pre-transfusion and 79% of discharge haemoglobin concentrations are in accordance with the guidelines. According to the physicians, the RBC transfusions are too "precocious" when pre-transfusion haemoglobin concentration is above nine and the anaemia is asymptomatic. 50% of RBC transfusion with discharge haemoglobin concentration above 10 is not excessive. In case of acute anaemia, the pre-transfusion and discharge haemoglobin concentrations are higher and RBC transfusion excessive. In this study, the trigger haemoglobin concentration is "restrictive", but the target haemoglobin concentration is "liberal" with a high-discharge haemoglobin concentration. Inappropriate RBC transfusions are mainly due to over-transfusion.

Survival analysis of an asymmetric primary total knee replacement: a European multicenter prospective study.

PURPOSE OF THE STUDY: This multicenter prospective study objective is to provide midterm results and 10-year survival analysis of the original Natural Knee-I System™ as experienced by a group of surgeons performing, within various settings, primary total knee replacement (TKR) in the general population. HYPOTHESIS: The midterm experience with this TKR system in the hands of independent surgical teams can duplicate the satisfaction level that was already published by the designer's group itself. MATERIAL AND METHOD: Two hundred and sixty-three primary TKR were performed by seven surgical teams (37 surgeons) and prospectively evaluated in four European countries. Mean age of the 263 patients (sex ratio, 2.7 females/1 male) was 69 years (range, 35-92) and diagnosis was primary osteoarthritis in 85%. For the 247 TKR with complete operative data, the approach was subvastus in 59%, posterior cruciate ligament was spared in 78%, patella was resurfaced in 56%, and 79% of reconstructions were totally cement-free. Fixation mode was only depending on the surgeon's choice. RESULTS: At 76 months average follow-up (range 24-190 months), modified Hospital for Special Surgery knee mean score improved from 48 points preoperatively to 83 points. Four reoperations and five revision procedures were required for eight knees. Over the 14-year survey period, the overall revision rate burden was 2% and revision rate per 100 observed component/year, 0.32. At 10 years, survivorship (with revision for aseptic loosening as its end-point [two fully cementless knees]) was 98.6%. DISCUSSION: Both this multicenter study and data drawn from national registers provided outcomes with equivalent level of satisfaction at equivalent follow-up to those reported by the NK-I prosthesis designer. There was no significant difference between revision rates of cemented, hybrid or cementless reconstructions. CONCLUSION: In non-designer orthopaedists' hands, the Natural Knee-I System™, either with cemented or cementless fixation, provided satisfying midterm results as normally expected in primary TKR with such a modern modular prosthesis. LEVEL OF EVIDENCE: Level IV. Prospective study.

Near-miss event assessment in orthopedic surgery: Antimicrobial prophylaxis noncompliance.

INTRODUCTION: Antimicrobial prophylaxis is one of the main safety measures to be enforced when implanting any medical device; surveys of practice, however, have found poor compliance. MATERIAL AND METHODS: This study is based on analysis of 153 dedicated in-depth analysis forms sent to orthopedic surgeons who had reported an antimicrobial prophylaxis-related near-miss event (NME) during the year 2008 as part of their certification report to the official organization, Orthorisq (orthopaedic Patient safety risk management agency). RESULTS: Antimicrobial prophylaxis guidelines exist in 95% of French centers, but in 14% are not available in the right place. 88% of orthopedic surgeons consider them well-adapted to their practice. Most declarations follow fortuitous discovery by the surgeon of an immediate peri-operative malfunction. Human causes were found in 92% of declarations, general organizational causes in 50% and material causes in 28%. Regarding corrective action, 65% of respondents reported implementing a second-order procedure, and only 20% were able to resume truly regular antimicrobial prophylaxis. CONCLUSION: The main reason for poor or non-performance of antimicrobial prophylaxis was "omission by negligence or oversight", reported in 56% of declarations. Proposals for improvement were: revised antimicrobial prophylaxis guidelines specifying "who does what"; guideline awareness checks on new, temporary and locum-tenens staff; patient involvement in personal data collection; and implementation of a check-list in line with WHO and French Health Authority recommendations. These improvement proposals were taken on board in the antimicrobial prophylaxis consensus update currently being drawn up by the French Society for Anesthesia and Intensive Care. LEVEL OF EVIDENCE: Level IV, Decision Analyses Study.

Metal-on-metal bearings total hip arthroplasty: the cobalt and chromium ions release concern.

With certain concerns recently reported on metal-on-metal bearing couples in total hip arthroplasty, this study's objective is to review the current knowledge concerning release of metal ions and its potential consequences. Each metal-on-metal implant presents different tribological properties. The analytical techniques for metals are accurate and the Co ion rates seem acceptable up to 2 µg/L. A delayed type IV hypersensitivity reaction (atypical lymphocytic vasculitis-associated lesion [ALVAL]) may be the source of arthroplasty failure. Idiosyncratic, it remains unpredictable even using cutaneous tests and apparently is rare (0.3%). Today, there are no scientific or epidemiologic data supporting a risk of carcinogenesis or teratogenesis related to the use of a metal-on-metal bearings couple. Solid pseudotumors nearly exclusively are observed with resurfacing procedures, carrying a high annual revision rate in women under 40 years of age, occurring particularly in cases of acetabular malposition and with use of cast molded Cr-Co alloys. Osteolysis manifests through complete and progressive radiolucent lines or through cavitary lesions stemming from ALVAL-type alterations or impingement problems or implant incompatibility. The formation of wear debris exceeding the biological tolerance is possible with implant malposition, subluxation, and jamming of the femoral head in cases of cup deformity. Moreover, each implant presents different metal ion production; assessment of their performance and safety is required before their clinical use. With the knowledge available today, metal-on-metal bearing couples are contraindicated in cases of metal allergies or end stage renal dysfunction and small size resurfacing should cautiously be used.