Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus?

High tibial osteotomy (HTO) is commonly used for genu varum deformity in young and active patients. Corrective valgus osteotomy may however lead to an oblique joint line in cases of associated femur varum or absence of tibia vara. The over-correction, needed to obtain good long-term clinical results, may increase the obliquity even more. To avoid this drawback, the authors suggest use of an accurate and reproducible radiological protocol including at least a standing AP long-leg X-ray to measure not only the hip-knee-ankle (HKA) angle but also the medial distal femoral mechanical angle (MDFMA) and the medial proximal tibial mechanical angle (MPTMA). These measures will guide the surgeon to choose the best indication, including HTO, double level osteotomy (DLO) and distal femoral osteotomy (DFO). Computer-navigation of the osteotomies is the best choice to achieve the preoperative goal. This paper will present the pre- and perioperative protocols of HTO and DLO and the rationale behind this way of thinking.

Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results.

The purpose of this study was twofold: to evaluate the radiological and clinical results of 33 total knee arthroplasties (TKA) implanted between January 1993 and March 2005, to replace failed medial unicompartmental knee arthroplasty (UKA), and to develop a strategy to deal with bone defects in the tibial plateau. Failure was due to: tibial loosening (15 cases), femoral loosening (five cases), femoral and tibial loosening (two cases), polyethylene wear (five cases), lateral compartment osteoarthritis (two cases), patellofemoral osteoarthritis (two cases), laxity and PE dislocation (one case), and sepsis in one case. In 12 cases the tibial bone defect was filled with a metallic wedge, in seven we used an allograft (femoral head), and in one we used both. We report the results of 27 cases (five patients died and one was lost to follow-up). The mean follow-up was 73+/-41.7 months (range, 8-153) and the global IKS score was 166.72+/-21.3 points (range, 128-200). X-rays of the eight allografts showed osteointegration in all cases and no radiolucency was noted.

Open Latarjet Procedures Produce Better Outcomes in Competitive Athletes Compared With Recreational Athletes: A Clinical Comparative Study of 106 Athletes Aged Under 30 Years.

BACKGROUND: In cases of shoulder stabilization for anterior instability, the main goals of the surgery are a rapid and efficient return to sports and excellent long-term outcomes without recurrence of dislocation, particularly in young and competitive athletes. PURPOSE: To determine whether outcomes of open Latarjet procedure (OLPs) depend on the level of sports practiced by patients and to report clinical scores and complication rates for OLP at a minimum follow-up of 2 years. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective comparative study was conducted for all patients who underwent OLP by the senior author (J.B.) between July 2007 and December 2012. The indication for OLP at the authors' institution was a minimum of 2 episodes of dislocation and/or subluxation, a positive apprehension test result in the cocking position, an Instability Severity Index Score more than 2, and evidence of anterior instability lesions on computed tomography arthrograms. The 106 included patients (110 shoulders) with a mean follow-up of 46 months were compared in 2 groups depending on sport activities: 57 (54%) competitive athletes and 49 (46%) recreational athletes. The principal outcome measure was evidence of recurrent instability. The secondary outcome measures were clinical scores related to anterior instability and related to sport practice: Rowe score, Oxford Shoulder Instability Score (OSIS), Western Ontario Shoulder Instability Index, and level of satisfaction. RESULTS: Of the 106 patients, 3 reported recurrence of shoulder dislocation: 2 competitive athletes (3.5%; 95% CI, 0.9%-11.2%) and 1 recreational athlete (2%; 95% CI, 0.4%-10.7%) ( P = .684). The persistent apprehension test result was positive in 7 competitive athletes (11.5%) and in 5 recreational athletes (10%) ( P = .566). The Rowe scores improved from 56.3 ± 13.2 (range, 30-80) preoperatively to 84.2 ± 16.4 (range, 30-100) postoperatively in competitive athletes and from 55.0 ± 11.0 (range, 35-80) to 69.5 ± 22.0 (range, 15-100) in recreational athletes ( P < .001). The net improvement in Rowe scores was significantly greater in competitive athletes (27.9 ± 21.7) compared with recreational athletes (14.5 ± 24.4) ( P = .006). The scores unrelated to sport activity (Oxford Shoulder Instability Score and Simple Shoulder Test) were similar for the 2 groups. All 57 (100%) competitive athletes and 34 (69.4%) recreational athletes resumed their previous sports practice, at the same level or higher than before their injury (respectively, 78.9% and 42.9%; P = .004). CONCLUSION: The OLP could be considered for primary shoulder stabilization, particularly in competitive athletes, who have high functional demands and great risks of redislocation.

Usefulness of PKH fluorescent labelling to study leukemic cell proliferation with various cytostatic drugs or acetyl tetrapeptide--AcSDKP.

BACKGROUND: PKH67 labelling was compared for classical proliferation assessment (using S phase evaluation) to analyse the cell proliferation of 29 AML patients treated or not with various drugs. Among these drugs, the effect of tetrapeptide AcSDKP or AcSDKP-NH2 on AML cells, stimulated or not by cytokines, was also evaluated in order to determine (i) if AcSDKP was able to inhibit blast cell proliferation as it inhibits haematopoietic progenitors (ii) if AcSDKP-NH2 was more stable than AcSDKP with FBS. METHODS: For PKH labeling, cells were suspended in Diluent C, and rapidly admixed with PKH67 solution at 20 microM PKH67. Staining was stopped by addition of FBS. RESULTS: A good correlation between PKH67 labelling and bromodeoxyuridine incorporation was obtained first with 6/9 patients for control cells, then for 11/17 AML patients treated with classical antileukemic drugs (among whom 4 were also treated with AcSDKP). The effect of AcSDKP was also studied on 7 patients. The discrepancy between both methods was essentially due to an accumulation of cells into different cycle phases measured by BrdUrd incorporation secondary to drug action and PKH67 labelling which measured the dynamic proliferation. This last method allows identifying resistant cells which still proliferate. AcSDKP or AcSDKP-NH2 induced a decrease of leukemic cell proliferation in 5/7 patients when cytokines were added (in order to stimulate proliferation) one day after tetrapeptide AcSDKP or AcSDKP-NH2. No effect on proliferation was noted when cytokines were added to AcSDKP-NH2. CONCLUSION: PKH67 labelling method is a powerful tool for cell proliferation assessment in patients with AML, even in cells treated by various drugs.

Alveolar neutrophilia is a predictor for the bronchiolitis obliterans syndrome, and increases with degree of severity.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is a common complication of lung transplantation (LT), associated with a tremendous mortality and morbidity. Recent innovative research has focused on bronchoalveolar lavage (BAL) analysis, assuming that neutrophilia might be a marker of chronic rejection. PATIENTS AND METHODS: To address this issue, we retrospectively analyzed 258 sequential BAL from 44 lung transplant recipients, having survived for more than 3 months after surgery. RESULTS: At the end of the follow-up, 22, 7, 7 and 8 patients had BOS stage 0, 1, 2 and 3, respectively. The total cell count and neutrophilia increased with BOS severity (P < 0.01). BOS occuring before and after the 12th month of LT were associated with early and more delayed increases of BAL neutrophils, respectively. Finally, the various kinetic profiles of neutrophil progression were identified, allowing for an earlier identification of BOS stages 2 and 3, by 3 and 6 months, respectively. Conversely, neutrophilia associated to BOS stage 1 remained low, and could not be distinguished from that of stage 0. CONCLUSIONS: These results support the possible role of neutrophils in BOS pathogenesis, and may be of interest for an earlier detection and management of chronic rejection.

Computer-assisted double level osteotomy for severe genu varum.

High tibial osteotomy is commonly used for genu varum deformity in young and active patients. Corrective valgus osteotomy may however lead to an oblique joint line in case of associated femur varum or absence of tibia vara. The correction, needed to obtain long-term good clinical results, may increase the obliquity even more. To avoid this drawback, the authors have performed computer-assisted double osteotomy since 2001. They developed this new technique because combining distal valgus femoral osteotomy and proximal high tibial valgus osteotomy is a demanding technique. The purpose of this article is to present a technical procedure of computer-assisted double level osteotomy and to discuss its rationale and indications.