Varus stem positioning does not affect long-term functional outcome in cementless anatomical total hip arthroplasty.

INTRODUCTION: Varus positioning is the most common femoral malposition in total hip arthroplasty (THA). We compared the long-term outcomes of an anatomical cementless femoral stem positioned in varus versus neutral alignment. MATERIALS AND METHODS: Data were retrospectively reviewed for all patients receiving a cementless anatomical femoral stem in THA for osteoarthritis between 1998 and 2008. Exclusion criteria were complex cases, incomplete data or follow-up < 1 year. Primary outcome was survival rate with complications and secondary outcomes were clinical scores, thigh pain, radiological score, cortical hypertrophy and filling rate. RESULTS: Of the 283 included patients, 127 stems were classified as varus and 156 neutral. Mean follow-up was 10 years. Femoral stem size was smaller in the varus group (4.1 vs. 4.4, p = 0.047). A stem-filling rate < 80% was more frequent in the varus group (p < 0.001). The long-term survival rate without any revision procedure was 94.8% ± 2.3% (95%CI 88.4-98.7) in the varus group and 94.1% ± 2.0% (95%CI 91.3-99.1) in the neutral group (p = 0.55). There was no difference in clinical scores, thigh pain or complication occurrence between groups. The Engh-Massin score was lower in the varus group (p < 0.01) and cortical hypertrophy was higher (p < 0.001). CONCLUSIONS: A varus alignment of a cementless anatomic femoral stem does not affect survivorship, clinical outcomes or complication rate on an average follow-up of 10 years, despite increasing stress-shielding rates.

Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties.

INTRODUCTION: Despite the optimization of implant positioning, the clinical benefit of the use of robotic assistance during THA remains uncertain. In this case-control study (robotic versus manual technique) we made a retrospective short-term comparison of: (1) the functional results, (2) the complications, (3) and the influence of radiological symmetrization of the hips on the functional result. HYPOTHESIS: The use of a robotic arm improved the functional results of a THA. MATERIALS AND METHOD: A retrospective case-control study was performed, including patients with unilateral hip osteoarthritis who underwent a robotic arm-assisted THA (THA-R). The controls (THA-C) were matched according to age, sex, body mass index and surgical approach. The Harris (HHS), Oxford (OHS) and Forgotten Joint (FJS) scores were collected preoperatively and 1 year postoperatively. At each review, complications were categorized into minor events, revision surgery with and without implant change. Radiographic analysis was performed on weight-bearing images of the pelvis 3 months postoperatively. The objective of the surgery was symmetrization of the THA in the contralateral healthy hip. For each measured parameter of the hip joint center of rotation (COR), global offset (GO) and articular leg length discrepancy (aLLD), the difference between the two sides corresponding to the delta symmetrization was compared. RESULTS: Ninety-eight patients were included in the THA-R group and matched to 98 controls in the THA-C group. At 1 year postoperatively, the FJS and OHS scores were statistically higher in the THA-R group, respectively 82.1±22.3 [8.3; 100] and 40.8±8.8 [6; 48] vs. 71.2±27.8 [0; 100] and 38.1±9.7 [12; 48] in the THA-C group (p=0.004 and p=0.043). There was no difference in HHS (THA-R: 85.9±15.8 [31; 100] vs. THA-C: 85.8±13.3 [49-100] (p=0.962)). The implant revision rate at 1 year was significantly higher in the THA-C group (0% vs. 5.1% (p=0.025)). There was no difference in the reoperation without component exchange despite 3 dislocations (3.1%) in the THA-R group (5 (5.1%) vs. 9 (9.2%) (p=0.273)). The rate of abarticular pathologies (ilio-psoas irritation and greater trochanteric bursitis) was higher in the THA-C group (10 (10.8%) vs. 2 (2%) (p=0.016). Robotic acetabular assistance allowed a significantly better restitution of the horizontal position (THA-R: 1mm±4.8 [-11.7; 12.6] vs. THA-C: 4.1mm±7 [-29.6; 28] (p=0.0005)) and vertical COR (THA-R: 0.5mm±3.1 [-6; 8.3] vs. THA-C: 2mm±4.1 [-6; 14.6] (p=0.0068)). Navigated assistance of the femur did not significantly optimize the restitution of the Global Offset (THA-R: +2mm±6.4 [-16.4; 27.6] vs. THA-C: +0.5mm±7 .7 [-34; 30.2] (p=0.145)), or lower limb length (THA-R: +1.1mm±5 [-8.2; 13.5] vs. THA-C: +0.3mm±6 [-14.1; 22.5] (p=0.344). The FJS was statistically correlated with the restoration of the symmetry of the COR and the aLLD. A post-hoc power analysis confirmed sufficient potency (1-ß=0.85). CONCLUSION: Robotic acetabular assistance combined with femoral navigation improves clinical outcomes of THAs with fewer short-term complications. The precision of the positioning of the implants, optimized by the computer-assisted surgery system, is correlated with the missed joint score. LEVEL OF EVIDENCE: III, retrospective case-control study.

Arthroscopic reduction and internal fixation (ARIF) for talar body fractures: systematic review.

PURPOSE: This study aimed to systematically assess the available literature on the technique and results of arthroscopic reduction - internal fixation for displaced fractures of the talar body. METHODS: A systematic review was made of the available literature on MEDLINE, EMBASE, and the Cochrane Library database, including studies from January 1985 to July 2021. The literature search, data extraction, and quality assessment were conducted by two independent reviewers. Surgical technique, perioperative management, clinical outcome scores, radiographic outcomes, and complication rates were evaluated. RESULTS: Out of 37 articles reviewed, 12 studies met the inclusion criteria. The studies included reported on the results of 22 patients. No complications were observed in any of the patients treated. CONCLUSIONS: The included studies had too many weaknesses to allow the pooling of data or meta-analysis. However, percutaneous arthroscopic talar internal fixation appears to be a good option for uncomplicated displaced intra-articular talar fractures. Appropriately powered randomized controlled trials with long-term follow-ups are required to confirm the effectiveness of this technique. LEVEL OF EVIDENCE: Level IV, a systematic review of Level IV studies.

Using Ultrasonography During the Fixation of Distal Radius and Finger Fractures.

Ultrasonography (US) is a noninvasive examination modality that is devoid of risk, both for the patient and the surgeon, compared with fluoroscopy. The principle is the same for distal radius and finger fractures: replace the fluoroscopy checks with US checks to reduce the patient's, surgeon's, and surgical team's exposure to radiation. In this article, the authors report their experience of the effectiveness of ultrasound imaging during the fixation of a distal radius and long finger fracture. They also describe equipment needed and surgical procedure.

Is there a persistent capital femoral epiphysis growth after screw fixation for slipped capital femoral epiphysis?

Femoral neck screwing during child development is controversial. The objective of this study was to evaluate the residual growth of the capital femoral physis after screw fixation. This retrospective study included children aged younger than 12 years treated for slipped capital femoral epiphysis (SCFE) with a single percutaneous partially threaded cannulated screw. The children were followed up for at least 1 year. Some patients also underwent prophylactic contralateral screwing. Preoperative, immediate postoperative and final follow-up X-rays were evaluated to determine the degree of slippage, pin-joint ratio (PJR), neck-pin ratio (NPR), number of threads crossing the physis, neck-shaft angle (NSA), screw-physis angle and screw position in the physis. We included 17 patients (29 hips: 18 SCFE and 11 prophylactic) with a mean age of 10.1 years (range: 7.1-11.9 years) at the time of surgery. Significant evolution of radiological growth parameters of the proximal femoral physis was noted during a mean follow-up of 2.4 years (range: 1-4.3 years). The mean PJR significantly decreased from 7.3 to 6.0, the mean NPR significantly decreased from 106 to 96 and the mean number of threads beyond the physis decreased from 3.3 to 1.8. The mean NSA decreased by 6.5°, from 139° to 132.5°. Persistent capital femoral epiphysis growth occurs after screw fixation. The NSA significantly decreases over time but remains within the physiological limits. Level of evidence: IV (case series).