Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs.

PURPOSE: The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements. METHODS: This is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing. RESULTS: The mean FMA was 91.3 ± 2.2° (range 82°-97°), the mean TMA was 85.7 ± 2.5° (range 75°-98°), the mean aHKA was 177.0 ± 3.0° (range 164°-185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°-192°). No significant difference was observed between aHKA and vcHKA (p = 0.06). A significant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001). CONCLUSION: This study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre-arthritic coronal alignment of the knee for the extension gap. LEVEL OF EVIDENCE: IV.

No significant clinical and radiological differences between fixed versus mobile bearing total knee replacement using the same semi-constrained implant type: a randomized controlled trial with mean 10 years follow-up.

PURPOSE: The aim of this study was to compare the long-term clinical and radiological results between fixed (FB) and mobile bearing (MB) implants with identical design from the same manufacturer. METHODS: From March 2007 to May 2009, we recruited 160 patients in a prospective, single centered, randomized controlled trial. The authors compared 81 FB total knee arthroplasty (TKA) versus 79 MB with medial compartment osteoarthritis. The same posterior stabilized HLS Noetos knee prosthesis (CORIN) was used in all patients. The two groups only differed by the tibial insert (fixed or mobile). The authors compared the postoperative Knee Society Score (KSS), the passive clinical and active radiological knee flexion, the implant survivorship, the complications, and the presence of radiolucent lines. RESULTS: At mean 10.5 years' follow-up (range 8-12.1 years) no significant differences were found in clinical scores (KSS (p = 0.54), pain score (p = 0.77), stair climbing (p = 0.44), passive maximum flexion (p = 0.5)) or for radiological analyses (maximum active radiological flexion (p = 0.06), presence of progressive radiolucent lines (5 (MB group) versus 6 (FB group); p = 0.75)) between groups. No significant difference was found in overall implant survivorship (82% (MB group) versus 78% (FB group) p = 0.58) or complication rate (p = 0.32) at the last follow-up. CONCLUSION: No significant clinical and radiological differences were found between fixed and mobile bearing TKA using the same semi-constrained implant type with comparable overall survivorship. The choice between a fixed or mobile bearing implant should be based on surgeon preference and experience with the selected implant. LEVEL OF EVIDENCE: Prospective randomized controlled trial, Level II.

Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months.

PURPOSE: The aim of the study was to compare clinical and radiological outcomes between primary and aseptic revision TKAs using the same posterior-stabilised (PS) prosthesis. The authors hypothesised similar outcomes between both groups for selected patients. METHODS: This retrospective, case-control study assessed 36 patients who underwent aseptic revision TKA compared to a match group of 72 primary TKA. Both groups had the same PS design implant (ANATOMIC®, Amplitude, Valence, France). The International Knee Society (IKS) score, radiological outcomes (postoperative alignment, patellar tilt and radiolucent lines), re-intervention and revision rate were compared between the two groups with a minimum follow-up of 3 years. RESULTS: The final study cohort included 29 patients and 63 patients respectively in the revision and primary group, with a mean follow-up of 49.1 months (range 36.1-69). Postoperatively, there was no significant difference in IKS scores between the two groups [169.8 for the revision group and 179.6 for the primary group (p = 0.09)]. No statistical difference was observed for post-operative satisfaction 86.2% versus 92.1% (p = 0.46). Between the two groups, there was no difference in mean radiological assessment, including radiolucent lines (p = 0.7). There was no significant difference for overall implant survivorship 96.5% versus 100% (p = 0.13) at 36 months. CONCLUSION: Similar clinical, radiological and survivorship outcomes were found between rTKA and primary TKA groups using the same PS level of constraint in patients undergoing revision surgery for aseptic indications at 3-year follow-up. Use of PS implants in rTKA for the correct indication suggests this to be a safe approach at least in the medium term. LEVEL OF EVIDENCE: IV, retrospective case-control study.

Increased valgus laxity in flexion with greater tibial resection depth following total knee arthroplasty.

PURPOSE: Soft tissue balancing is of central importance to outcome following total knee arthroplasty (TKA). However, there are lack of data analysing the effect of tibial bone cut thickness on valgus laxity. A cadaveric study was undertaken to assess the biomechanical consequences of tibial resection depth on through range knee joint valgus stability. We aimed to establish a maximum tibial resection depth, beyond which medial collateral ligament balancing becomes challenging, and a constrained implant should be considered. METHODS: Eleven cadaveric specimens were included for analysis. The biomechanical effects of increasing tibial resection were studied, with bone cuts made at 6, 10, 14, 18 and 24 mm from the lateral tibial articular surface. A computer navigation system was used to perform the tibial resection and to measure the valgus laxity resulting from a torque of 10 Nm. Measurements were taken in four knee positions: 0° or extension, 30°, 60° and 90° of flexion. Intra-observer reliability was assessed. A minimum sample size of eight cadavers was necessary. Statistical analysis was performed using a nonparametric Spearman's ranking correlation matrix at the different stages: in extension, at 30°, 60° and 90° of knee flexion. Significance was set at p < 0.05. RESULTS: There was no macroscopic injury to the dMCL or sMCL in any of the specimens during tibial resection. There was no significant correlation found between the degree of valgus laxity and the thickness of the tibial cut with the knee in extension. There was a statistically significant correlation between valgus laxity and the thickness of the tibial cut in all other knee flexion positions: 30° (p < 0.0001), 60° (p < 0.001) and 90° (p < 0.0001). We identified greater than 5° of valgus laxity, at 90° of knee flexion, after a tibial resection of 14 mm. CONCLUSION: Increased tibial resection depth is associated with significantly greater valgus laxity when tested in positions from 30° to 90° of flexion, despite stability in extension. Greater than 5° of laxity was identified with a tibial resection of 14 mm. When a tibial bone cut of 14 mm or greater is necessary, as may occur with severe preoperative coronal plane deformity, it is recommended to consider the use of a constrained knee prosthesis.

[Eating behaviors and emotional symptoms in childhood obesity: a cross-sectional exploratory study using self-report questionnaires in 63 children and adolescents]. / Conduites alimentaires et symptômes émotionnels dans l'obésité infantile : étude exploratoire transversale à partir d'autoquestionnaires chez 63 enfants et adolescents.

OBJECTIVES: The main objective was to assess emotional symptoms (anxiety and depression) and to describe eating behaviours in a population of children and adolescents consulting for obesity. The second objective was to examine the interactions between these parameters. METHOD: A cross-sectional exploratory study in obese children and adolescents was conducted using self-report questionnaires for depression (Child Depression Inventory), anxiety (State-Trait Anxiety Inventory for Children), binge eating (Binge Eating Scale adapted for children), emotional, external, and restrained eating (Dutch Eating Behaviour Questionnaire adapted for children) in obese children and adolescents, from both sexes, aged 7-15 years old. RESULTS: Fourty-one children and 22 adolescents were assessed, two-third were female, the mean age was 11 years ± 2.3 and the mean BMI z-score was 4.2 ± 0.9. Nearly half had significant anxiety, nearly one-third had depressive symptoms, and 15% had severe binge eating symptoms. Girls reported more anxiety than boys. Emotional and external eating, binge eating, and emotional symptoms were strongly associated. Binge eating was independently associated with emotional eating, depression, and anxiety (r=0.86, P<0.001). DISCUSSION: Emotional eating and emotional symptoms were strongly associated in the child and adolescent overweight population in these out-patient pediatric departments. CONCLUSION: Emotional symptoms and eating behavior assessments are needed in overweight children and adolescents in order to implement multidisciplinary treatment.

Body composition determined with MR in patients with Duchenne muscular dystrophy, spinal muscular atrophy, and normal subjects.

Magnetic resonance imaging was used to determine total fat mass of patients with neuromuscular disorders, accounting for intramuscular fat. Nineteen boys aged 9 to 12 (eight with Duchenne muscular dystrophy, three with type II spinal muscular atrophy and eight control subjects) underwent whole-body magnetic resonance imaging examination and anthropometric measurements. Whole-body fat mass was deduced from automated analysis of images normalized by a reference signal. Intramuscular and subcutaneous fat masses were deduced from manual analysis of twelve reference slices. Affected children significantly differed from control subjects for higher total fat mass, mostly related to intramuscular fat mass. Shorter protocols validated from whole-body data were shown to be more accurate than fat mass estimation derived from anthropometric measurements.

Blood levels of water-soluble vitamins in pediatric patients on total parenteral nutrition using a multiple vitamin preparation.

Although guidelines for the parenteral use of vitamin preparations in pediatric patients have been published, there are very limited data on the efficiency of these preparations and on the exact needs of infants and children on total parenteral nutrition (TPN). We report here an open, prospective, study of the blood levels of water-soluble vitamins in infants and children on TPN before and during supplementation with a new water-soluble multivitamin formula containing per vial unit: B1, 3 mg; B2, 3.6 mg; B6, 4 mg; niacin, 40 mg; pantothenate, 15 mg; ascorbate, 100 mg; biotin, 60 micrograms; folic acid, 400 micrograms; B12, 5 micrograms. Thirteen children, 9 months to 15 yr old, on home TPN for 1.5 months to 7 yr, and 17 hospitalized infants and children, 1 week to 15 yr old, receiving TPN were studied for 2 weeks to 4 months. Daily doses were given according to age: 1/2 vial if less than 18 months; 1 vial if greater than 18 months and less than 10 years; 1.5 vials if greater than 10 years. Assays for B1, B2, biotin, niacin, plasma and red blood cell (RBC) folates were performed by microbiologic methods, B12 was measured by radioimmunoassay. During the study, B1 levels were consistently above the upper limit of the normal range, B2 and B12 remained in the normal range although there was a slight decrease in B12 values. Almost half of the patients had initially low levels of biotin, niacin, and folates. Biotin, after a significant sharp rise during the first month of supplementation returned to normal range. Niacin levels were initially low in infants and rose toward normal values during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Contribution of the shunt pathway of mevalonate metabolism to the regulation of cholesterol synthesis in rat liver.

The modulation of the shunt pathway of mevalonate metabolism (Edmond, J., and Popják, G. (1974) J. Biol. Chem. 249, 66-71) has been studied in livers from fed, starved, and diabetic rats perfused with a physiological concentration (300 nM) of [5-14C] + [5-3H]mevalonate. Shunt activity was measured by (i) production of 14CO2 (corrected for loss of label by exchange reactions) and (ii) production of 3H2O. Contribution of exogenous mevalonate to total mevalonate production (0.06-0.11%) was assessed in parallel experiments by the incorporation of 3H2O into sterols. Inhibition of non-saponifiable lipid synthesis by starvation and diabetes is not associated with an inhibition of mevalonate production but with a major increase in shunting (7-34%) of sterol-bound mevalonate. The shunt pathway of mevalonate metabolism appears to participate in the regulation of cholesterol synthesis.

[Effects of loperamide on the fecal flora in children in severe diarrheas]. / Effets de la lopéramide sur la flore fécale de l'enfant au cours des diarrhées graves sévéres.

Loperamide has been recently indicated in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide on fecal flora in severe protracted diarrheas. 19 children aged 1 to 36 months, with severe protracted diarrhea were studied: 14 received loperamide (0.5 mg/kg/d) and 5 were without loperamide treatment. Criteria analysed were: clinical tolerance (vomiting and abdominal distention); efficacy (number of stools, transit time and Na+/K+ in stools) and effect on fecal flora, with differential qualitative and quantitative analysis method (complete identification and counts of aerobic and strict anaerobic bacteria in fresh fecal samples before and 4 to 8 days after the beginning of loperamide). Parenteral and/or oral alimentation remain constant during the study. Results show a rapid (24 h) efficacy in 9/14. Although important changes in specific fecal flora counts was noticed for streptococcus D and Proteus as compared to five controls, no bacterial overgrowth appeared or was increased during loperamide treatment.

[Effect of loperamide on fecal flora of children with severe prolonged diarrhea]. / Effet de la lopéramide sur la flore fécale d'enfants atteints de diarrhées graves prolongées.

Loperamide has recently been proposed in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide (0.5 mg/kg/d) on fecal flora in 19 cases of severe protracted diarrhea. Criteria analysed were: clinical tolerance (vomiting and abdominal distension) and efficacy (number of stools, transit time and Na/k in stools); complete identification and counts of aerobic and strict anaerobic bacteria in fresh stools before and 4 to 8 days after the beginning of loperamide. Parental and/or oral alimentation remained unchanged during the entire study. Clinical resolution of diarrhea was rapid (less than 24 h) in 9 of 14 patients. In 2 cases ileus was observed and resolved when loperamide was discontinued. Although important changes in specific fecal flora counts was noticed for streptococcus D and proteus as compared to 5 controls, no bacterial overgrowth appeared or was worsened during loperamide treatment.

Lack of perinatal transmission of hepatitis B virus infection in Senegal, West Africa.

Between 1977 and 1980, 1442 pregnant women in Thies, Senegal, were tested for serologic markers of hepatitis B virus (HBV) infection. Of these, 9.8% were HBsAg(+), 59.9% were anti-HBs(+), and 15.6% had anti-HBc alone. Of 116 HBsAg(+) pregnant women, only 19.8% were HBeAg(+), a much lower proportion of infectious carriers than seen in Asian populations. Cord blood from 1353 babies was HBsAg(-), implying that the babies were not infected prior to birth. Four hundred sixty-two babies, including 88 born to HBsAg(+) mothers, were observed for 2 weeks to 38 months after birth. In contrast to observations in Asia, none of the babies became HBsAg(+) before 5 months of age, and only three of the 16 born to HBeAg(+) mothers became HBsAg(+) within the first year of life; all three developed chronic infections (i.e., HBsAg(+) for greater than or equal to 6 months. In the second year of life, six of 34 babies born to HBsAg(+), HBeAg(-)/anti-HBe(-) mothers became infected with HBV, and four of the six developed chronic infections. During the first 3 years of life, infections occurred at a higher rate in infants born to HBsAg(+) (17%) than to HBsAg(-) (4%) women. The latter group of infants included 4.0% of those born to anti-HBs(+) mothers, 4.6% born to anti-HBcAg(+), and 3.2% born to uninfected women. These observations indicate that HBV infections in Senegal usually do not occur perinatally, but do occur at high incidence later in infancy and childhood. Such infections can be prevented by the use of hepatitis B vaccine alone; administration of hepatitis B immune globulin should not be needed.

The shunt pathway of mevalonate metabolism in the isolated perfused rat liver.

The shunt pathway of mevalonate metabolism (Edmond, J., and Popják, G. (1974) J. Biol. Chem. 249, 66-71) has been studied in isolated livers from fed rats perfused with physiological concentrations of variously labeled [14C]mevalonates. The measured rates of 14CO2 production were converted to rates of mitochondrial acetyl-CoA production from mevalonate by methods which take into account underestimations of metabolic rates derived from 14CO2 production. Our data confirm that the shunt pathway leads to mitochondrial acetyl-CoA. The apparent negligible rate of mevalonate shunting in liver, previously reported by others, stems from the very low contribution (congruent to 0.1%) of plasma mevalonate to total mevalonate metabolism in the liver. This contribution was assessed from the relative incorporations of 3H2O and [5-14C]mevalonate into sterols. In livers from fed rats, the shunt diverts about 5% of the production of mevalonate. The total rate of mevalonate shunting in the liver is about 200 times greater than in two kidneys. The liver is therefore the main site of mevalonate shunting in the rat.