Growth progression of anterior cruciate ligament bone grafts in a pediatric population: magnetic resonance imaging analysis.

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.

Clinical practice recommendations for nurse-administered intramuscular injections in mental health: A modified Delphi study.

AIM: To develop clinical practice recommendations for nurse-administered intramuscular injections in mental health. BACKGROUND: Intramuscular injection is the main route of long-acting injectable antipsychotics' administration that appear to improve the long-term prognosis of mental illness. Specific guidelines related to the nurse administration of intramuscular injections need to be updated and to explore not only the technical aspects of this procedure. DESIGN: A modified RAND/University of California Los Angeles (UCLA) appropriateness method Delphi study was conducted between October 2019 and September 2020. METHODS: A multidisciplinary steering committee conducted a literature review and developed a list of 96 recommendations. These recommendations were submitted in a two-round Delphi electronic survey to a panel of 49 experienced practicing nurses from five mental health hospitals in France. Each recommendation was rated for its appropriateness and applicability in clinical practice on a 9-point Likert scale. Consensus among nurses was evaluated. The steering committee discussed the results after each round and approved the final set of recommendations. RESULTS: A final set of 79 specific recommendations were accepted for their appropriateness and applicability in clinical practice. Recommendations were classified in five domains: legal and quality assurance aspects, nurse-patient relationship, hygiene, pharmacology, and injection technique. CONCLUSION: The established recommendations placed patients at the heart of the decisions concerning the intramuscular injection and underlined the need for specific training programs. Future research should focus on the integration of these recommendations in clinical practice, by both before-and-after studies and regular assessments of professional practices with relevant indicators. IMPACT: The recommendations developed for good nursing practices explored not only the technical aspects but integrated the nurse-patient relationship. These recommendations may impact usual practices of administration of long-acting injectable antipsychotics and most of them could be applied in many countries. NO PATIENT OR PUBLIC CONTRIBUTION: Due to the study design.

Intercalary allograft reconstruction following femoral tumour resection: mid- and long-term results and benefits of adding a vascularised fibula autograft.

PURPOSE: Bone healing in femoral reconstructions using intercalary allografts can be compromised in a tumour context. There is also a high revision rate for non-union, infection, and fractures in this context. The advantages and disadvantages of an associated vascularised fibula graft (VFG) are still a matter of debate. METHODS: In a multicentre study, we retrospectively analysed 46 allograft reconstructions, operated on between 1984 and 2017, of which 18 were associated with a VFG (VFG+) and 28 without (VFG-), with a minimum follow-up of 2 years. We determined the cumulative probability of bone union as well as the mid- and long-term revision risks for both categories by Kaplan-Meier survival analysis and a multivariate Cox model. We also compared the MSTS scores. RESULTS: Significant differences in favour of VFG+ reconstruction were observed in the survival analyses for the probability of bone union (log-rank, p = 0.017) and in mid- and long-term revisions (log-rank, p = 0.032). No significant difference was observed for the MSTS, with a mean MSTS of 27.6 in our overall cohort (p = 0.060). The multivariate Cox model confirmed that VFG+ was the main positive factor for bone union, and it identified irradiated allografts as a major risk factor for the occurrence of mid- and long-term revisions. CONCLUSION: Bone union was achieved earlier in both survival and Cox model analyses for the VFG+ group. It also reduced the mid- and long-term revision risk, except when an irradiated allograft was used. In case of a tumour, we thus recommend using VFG+ from a fresh-frozen allograft, as it appears to be a more reliable long-term option.

Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis.

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.

Ultrasound Evaluation of Anterior Acromioclavicular Relationship in the Horizontal Plane on 40 Healthy Subjects. A New Possibility for Differential Diagnosis of Acromioclavicular Disjunctions Rockwood Stage 3 and 4? A Pilot Study.

OBJECTIVE: To evaluate the repeatability and reproducibility of an ultrasound examination of the acromioclavicular joint (ACJ) performed by an orthopaedic surgeon to analyze anterior ACJ relationship in the horizontal plane. DESIGN: Prospective observational study on healthy subjects. SETTING: The study was conducted in 2017 in a university department of orthopaedic surgery and traumatology. LEVEL OF EVIDENCE: III. PATIENTS (OR PARTICIPANTS): Forty consecutive volunteers aged 18 to 40 years were involved. INTERVENTIONS (OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES):: The ultrasound examination was performed by 2 orthopaedic surgeons with a SonoSite M-Turbo portable ultrasound machine (Fujifilm, Japan). Distance measurement between the anterior edge of the clavicle (AECL) and the anterior edge of the acromion (AEAC) was done on the right side, then on the left one and repeated by the same examiner. MAIN OUTCOME MEASURES: The intra- and interexaminer reproducibility of measurements was analyzed as primary outcome. Concordance of distance measurements between the right and left sides on the same subject was evaluated, as well as the "typical morphology" of the ACJ in the horizontal plane. RESULTS: The intra- and interexaminer reproducibility for AECL-AEAC distance measurements was, respectively, 0.95 (0.93-0.97) and 0.87 (0.84-0.90). The correlation between the right and left sides was significant (P < 0.001), with a reproducibility of 0.86 (0.83-0.89). Twenty-seven (67.5%) volunteers were considered to have a "perfect alignment" of the AECL and AEAC. CONCLUSIONS: This study confirms that it is possible to evaluate with good reproducibility the anterior AC relationship in the horizontal plane and that both sides are similar on the same subject.

Short stems reproduce femoral offset better than standard stems in total hip arthroplasty: a case-control study.

INTRODUCTION: In total hip arthroplasty (THA), altering the original offset can lead to poor outcome or even complications or revision when the changes are too great. The aim of the present study was to compare femoral offset between short and standard stems. The hypothesis was that the short stems studied provide better control of post-operative femoral offset. PATIENTS AND METHODS: We retrospectively reviewed 100 consecutive THAs using uncemented optimys™ short stems (Mathys, Bettlach, Switzerland), matched to 100 standard stem THAs performed during the same period. The primary endpoint was femoral offset; secondary endpoints were the limb length and cervico-diaphyseal angle. RESULTS: The mean femoral offset increased by 6.0 ± 7.2 mm overall (p < 0.0001), 4.7 ± 6.7 mm in the short-stem group (p < 0.0001), and 7.2 ± 7.5 mm in the standard stem group (p < 0.0001), with a significant inter-group difference (p = 0.0152). Limb length showed no significant inter-group difference (p = 0.8425). Cervico-diaphyseal angle was increased by surgery overall, and more by standard than by short stems (p < 0.05). CONCLUSION: Measurement of femoral offset revealed significant lateralization. It is critical that offset should be maintained in THA. The technique we use increases femoral offset, but the present study showed less increase using short than standard stems. These findings must be borne in mind to achieve good clinical outcome.

Which type of bone releases the most vancomycin? Comparison of spongious bone, cortical powder and cortico-spongious bone.

Bone infections can be challenging to treat and can lead to several surgeries and relapses. When a graft is needed, cavitary bone loss can be grafted with cancellous or cortical bone. Both can be used for grafting. However, the antibiotic releasing capacity of these grafts has not been compared. Which type of bone is best at releasing the most antibiotic has not been well established. The aim of this study was to determine which type of bone is best for antibiotic release when the bone is suffused with antibiotics by the surgeon. The hypothesis is that there would be a difference between the type of bone tested due to different release capacities of cortical and cancellous bone. This was an experimental study. Cortical spongy bone in chips, Spongy bone in chips and demineralized cortical bone powder were compared. For each type of bone, 5 samples were tested. Processed and decontaminated grafts were freeze-dried to be kept at room temperature. The primary endpoint was the amount of vancomycin released by the graft as it affects the concentration of antibiotic around the graft in clinical practice. The procedure for the study consisted of full graft immersion in a vancomycin solution. Then, the liquid was removed with aspiration. In order to measure the quantity of antibiotic released, the bone was put into distilled water in agitation in a heated rocker at 37 °C. After 30 min of soaking, 1 mL of the liquid was removed. The same extraction process was also carried out after 60 min soaking, 2 h, 3 h, 24 h, and 48 h. No differences were found between each type of bone relative to the concentration of vancomycin released at each time of the assessment. There was a significant difference in the weight of the bone with a higher weight for the cortical powder (1.793 g) versus cortical spongy bone and spongy bone (1.154 g and 1.013 g) with a p value < 0.0001. A significant difference was seen in the weight of the bone with vancomycin after the aspiration of the liquid with 3.026 g for cortical powder, 2.140 g and 2.049 g for the cortical spongy bone and the spongy bone with a p value < 0.0001. In daily clinical practice, one can use cancellous bone, cortico-cancellous bone or cortical powder in order to add vancomycin to a bone graft. Our results show the release kinetics of the soaked allografts. With a maximum of 14 mg/mL in the first minutes and a rapid decrease it shows a pattern comparable to antibiotic loaded bone cement. The method used appears favourable for prophylactic use, protecting the graft against contamination at implantation, but is not sufficient for treating chronic bone infection. LEVEL OF EVIDENCE: V.

Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review.

INTRODUCTION: Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. MATERIAL AND METHODS: Medline, Cochrane, Embase databases were searched for studies reporting on bone allograft reconstruction in anterior glenohumeral instability with glenoid defect. We conducted a systematic review of studies with all levels of evidence reporting on clinical or radiological outcomes or both. LEVEL OF EVIDENCE: IV. RESULTS: Ten studies met the inclusion criteria for the review; 283 shoulders were included with a mean age of 26 years (17-63) and mean follow-up of 34 months (4-168). Glenoid reconstruction was performed using bone from different source: femoral head (1 study), distal tibia allograft (5 studies), and iliac crest (4 studies). Allografts were fresh in 4 studies, demineralized in 2 studies, and freeze-dried after sterilization in 1 study. All scores performed in the different studies increased between pre-operative and post-operative evaluations (mean + 36.8 points for the ASES). Global rate of recurrence was 3.9% (11 patients) (0-11%), comprising 6 cases of dislocation (2.1%) and 5 subluxations (1.8%). Allograft healing occurred in 93.5% of cases. CONCLUSIONS: This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results.

Primary total hip replacement in Ficat-Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year follow-up.

INTRODUCTION: Results of total hip replacement (THR) for aseptic osteonecrosis are controversial and conflicting according to implant type and generation. The present study consisted in a retrospective assessment of implant survival in primary THR for aseptic osteonecrosis, using a cemented stem, standard polyethylene press-fit acetabular component, and metal-metal bearing. The study hypothesis was that THR results are equivalent between aseptic osteonecrosis and osteoarthritis of the hip. MATERIAL AND METHOD: A single-center retrospective study included 54 patients with metal-on-metal THR for femoral head osteonecrosis. The main endpoint was revision surgery for all causes, whether implant related or procedure related; secondary endpoints were complications and progression in clinical scores. RESULTS: Mean follow-up was 13.9 ± 1.6 years (range 12.0-17.1 years). Eighteen of the 54 patients (33.3%) died. Implant survival at last follow-up was 93.8% (95% CI, 87.1-100). There were 12 complications (22.2%): 1 intraoperative, 5 (9.3%) immediate postoperative, and 6 (11.1%) long term. Clinical assessment found a significant 43.1 point improvement in mean Harris score (p = 8.4E-33) and a 5.6 point improvement in mean PMA score (p = 2.9E-22). CONCLUSION: Survival in primary THR for aseptic osteonecrosis was good. Follow-up needs to be rigorous to screen for onset of complications. Primary THR is thus justified in Ficat-Arlet stage 3 and 4 aseptic osteonecrosis of the hip. LEVEL OF EVIDENCE: IV.

Tibiofemoral dislocation after primary total knee arthroplasty: a systematic review.

INTRODUCTION: Tibiofemoral dislocation is the most serious form of instability following total knee arthroplasty (TKA). It is little reported in the literature, despite severity comparable to that in the native knee. The present systematic review and meta-analysis aimed to identify risk factors and treatment strategies. METHODS: The Cochrane, Medline (via PubMed), Google, and PROSPERO data-bases were searched in January 2018 following the PRISMA meta-analysis guidelines. All articles referring to tibiofemoral dislocation following primary TKA were included for analysis and extraction of individual data. Study data comprised age, gender, comorbidities, primary and revision implant design, aetiology, and treatment strategy. RESULTS: Individual data for 57 patients (23 studies) were analyzed. A total of 62.0% of primary implants were posterior-stabilized (49 patients) and 30.4% posterior-cruciate-retaining (24 patients). Obesity was the most frequent comorbidity (39.2%; 31 patients), followed by severe pre-operative deformity (31.6%; 25 patients). Aetiologies of dislocation were mainly related to comorbidity (15 studies; 65.2%) or intra-operative iatrogenic destabilization (14 studies; 60.9%). Non-operative treatment (splint) after dislocation was associated with high rates of recurrence (39.1%) but significantly fewer complications (p = 0.033). Implant revision surgery (45 patients; 80.4%) usually involved higher-constraint models (31 patients; 70.8%). CONCLUSIONS: Improved implant design has reduced the rate of tibiofemoral dislocation, although this complication remains serious in both the short and the long term. The present review identified patient- and surgeon-related risk factors. Awareness of the former, which are identifiable pre-operatively, and of the most frequent technical errors is critical.

Fifteen-year survival of the Cedior™ total knee prosthesis.

Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis of the knee. No large and long-term follow-up study has been done about Cedior® prosthesis. The study hypothesis was that 15-year survival for the Cedior™ prosthesis is at least as good as rates reported for other models. A continuous retrospective single-center study included patients managed by Cedior™ TKA with at least 15-year follow-up. The main endpoint was prosthesis survival; secondary objectives were to identify factors for implant revision and to assess functional scores at 15 years. In the present series, 15-year all-cause survival for the Cedior® knee prosthesis was 93.03%; comparable to rates in the literature, posterior-stabilized implants showed higher revision rates. No other factors for revision emerged. These findings are comparable with those of the literature.

Knee arthroscopy prospective observational study of patient information.

INTRODUCTION: Arthroscopy is especially well suited to outpatient implementation, as procedures are less heavy for the patient. Few studies, however, have focused on patient information and understanding in arthroscopic and outpatient surgery. The aim of the present study was to perform a prospective assessment of the information received by the patient concerning outpatient arthroscopic surgery. The study hypothesis was that there is room for improvement in information. MATERIALS AND METHODS: A prospective descriptive observational cohort study was made of the means of information available to patients, their understanding of arthroscopic surgery and their satisfaction with the information delivered. Inclusion criteria consisted in scheduled outpatient arthroscopic surgery in whatever joint. RESULTS: Fifty consecutive patients responded to the study questionnaire. Forty-eight (96%) considered that the surgeon had provided sufficient oral information. Twenty-nine (58%) considered that they had received sufficient written information. Forty-four (88%) reported searching on the Internet. Twelve (24%) had sought testimony and advice from someone who had undergone similar surgery. Eighteen (36%) had sought information from their community physician. Four (8%) had called back or taken a new appointment with the surgeon to get more information. Five (10%) attributed lack of information to lack of time in the preoperative consultation. Three (6%) considered the information to have been too technical for good understanding of the procedure. DISCUSSION: The present study showed that this cohort, which was relatively young compared to patients undergoing implantation, was notably autonomous in their search for information. They mainly sought information in general-public medical information websites, rather than from their community physician or specialist. CONCLUSION: It is important to improve patient information, and specific tools should be implemented ahead of outpatient arthroscopic surgery. LEVEL OF EVIDENCE: Four observational studies.

Rehydration improves the ductility of dry bone allografts.

Processing of bone allografts improves infectious safety and allows storing bone substitutes at room temperature. The aim of this study was to compare mechanical properties of the processed Osteopure™ bone with fresh frozen bone. All the samples were pieces from femoral heads retrieved during hip arthroplasty operations. The processing includes chemical decellularization, drying and irradiation with 25 kGy. Three types of samples were tested: 1. fresh frozen thawed wet, 2. dry non-rehydrated graft 3. dry rehydrated graft. In the 3-point bending test Young's modulus and stress at break yielded no significant difference among the 3 different sample groups. Rehydrating of the dry graft showed increased ductility in strain at break test compared with the other 2 groups (p = 0.003). In compression tests dry grafts had significantly higher maximum effective stress and apparent maximum deformation compared with the grafts of other groups (p < 0.05). Processed bone has almost similar mechanical properties compared with fresh frozen bone. However, rehydration of processed dry graft increases its ductility. These grafts may tolerate bending forces better before breakage.

The Müller self-locking cemented total hip prosthesis with polyethylene liner: After twenty years, what did they become?

BACKGROUND: The M.E. Müller (MEM) prosthesis is a self-locking straight stem. Although this prosthesis is widely used, few outcomes have been published thus far. METHODS: We examined long-term outcomes with the MEM cemented self-locking total hip arthroplasty (THA) with a polyethylene liner and 28-mm head. Between 1993 and 1994, 167 patients (173 hips) underwent primary THA implantation and were invited for clinical and radiological review a mean of 20.6 (20.1 - 21.7) years later; 111 patients had a metal and 62 a ceramic head. Hip function was assessed using the Postel Merle d'Aubigné Score. RESULTS: Overall, 121 patients died and six were lost to follow-up. Forty patients (41 hips) were reviewed. Five patients required revision, of whom two were due to acetabular loosening, one to premature haematoma, one to recurrent dislocation and one to femoral fracture. Wear levels were significantly lower with ceramic than metal heads. The majority of radiological or clinical failures were acetabular (7.3 % versus 2.4 % femoral). At the femoral level, osteolysis was observed in seven patients (17 %). Twenty-year survival was 88.67 ± 6.61 % using an endpoint of all-cause revision and 97.9 ± 2.1 % using femoral failure as the endpoint. CONCLUSION: Our retrospective analysis confirms the good results seen with the MEM stem in the literature and support the "French paradox" concept. Failures of these prostheses with a cemented polyethylene cup are largely on the acetabular side and, as such, the cup is the weak link. Improvements in survival will require optimisation of cup fixation and the use of a ceramic head to reduce wear in patients with a long life expectancy.

Long-term functional and radiological outcomes of allograft hip prosthesis composite. A fourteen -year follow-up study.

PURPOSE: Allograft hip composite prosthesis (APC) is a type of reconstruction after resection of the proximal femur. This study aimed to assess long-term outcomes after an APC reconstruction. MATERIALS AND METHODS: Forty-six patients were retrospectively included (14 revision total hip replacements, 30 primary malignant bone tumors, two metastasis). RESULTS: The mean length of femoral bone resection was 16.4 cm (7 to 27). With a mean follow-up of 14.7 years (6.3 to 32.6), Postel-Merle d'Aubigné score was 15.7 (8 to 21), Musculoskeletal Tumor Society score at 23.1 or 77% (15 to 29), and abductor strength at 3.4 (2 to 5). Allograft resorption was minor for 20 patients (44.4%), moderate for 13 patients (28.9%), and severe for 12 patients (26.7%). Host-allograft shaft bone fusion was achieved in 37 cases (84.1%). Trochanteric fracture occurred in 26 cases (59.1%). Length of femoral resection, allograft bone resorption, and trochanteric fracture did not have an effect on functional outcomes. At ten years follow-up, overall revision-free and femoral stem survivals were 54.1 ± 0.8% and 81.4 ± 0.6% respectively. No parameter evaluated influenced the survivorship. CONCLUSION: APC is a reliable reconstruction adapted for huge proximal femoral bone resections. Trochanteric fracture and allograft bone resorption do not seem to influence functional results. LEVEL OF EVIDENCE: Level IV.

Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study.

PURPOSE: Total hip arthroplasty (THA) is considered a painful procedure with significant blood loss. The aim of the this study was to determine whether local infiltration analgaesia (LIA) (with long-acting local anaesthetics and epinephrine) during THA could reduce acute postoperative pain, improve early recovery and reduce per- and postoperative bleeding. METHODS: One hundred and fifty patients scheduled for primary THA were randomised into two groups. The treatment group received LIA (ropivacaine with epinephrine), whereas the control group had no infiltration. Pain intensity was measured with a visual analogue scale (VAS) for the duration of hospital stay and analgaesic consumption. Length of hospital stay, time to get out of bed alone and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index at 3, 6 and 12 months were recorded to evaluate recovery. Per- and postoperative bleeding were evaluated using direct and indirect criteria (operative blood loss, haemoglobin, estimation of uncompensated blood loss and red blood cell transfusion). RESULTS: Patients with LIA had significantly less pain during the first 24 h (p = 0.04). No significant differences were found in terms of analgaesic consumption (p = 0.57), early and delayed recovery or bleeding between groups. CONCLUSIONS: Operative wound infiltration of LIA reduced acute pain after primary THA but did not improve recovery or influence per- and postoperative bleeding.

Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment.

BACKGROUND: Between 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA). METHODS: Before THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed. RESULTS: Preoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient's expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient -0.55 [-0.88; -0.21], p = 0.002), good physical function (-0.96 [-1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (-2.10 [-2.79; -1.42], p <0.001) and pain relief (-14.83 [-22.38; -7.29], p < 0.001). CONCLUSION: To improve patient satisfaction after THA, patients' expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons' expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons' and patients' expectations.

Epidemiology of limb trauma interventions in France: Current state and future projections.

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.

Unipolar Hip Hemiarthroplasty in Geriatric Patients: A Prospective Study and Analysis of Clinical and Radiological Outcomes.

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.

Does a sign restricting operating room access reduce staff traffic in the surgical department?

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 ±â€…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 ±â€…14.7 [2-50] (p = 0.011). The maximum number of people in the OR at one time was 8.32 ±â€…1.84 [4-12] in the no sign group and 8.44 ±â€…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.