Publications by authors named "Guillaume Villatte"

41 Publications

No Detectable Alteration of Inorganic Allogeneic Bone Matrix Colonizing Mesenchymal Cells: A Step Towards Personalized Bone Grafts.

J Bone Metab 2021 May 31;28(2):161-169. Epub 2021 May 31.

Université Clermont Auvergne, CHU Clermont-Ferrand, GECOM, CRB Auvergne, Clermont-Ferrand, France.

Background: During major bone substance loss, secured allogeneic bone matrix (ABM) is normally utilized for bone repair. Here, we propose a method to colonize ABM using autologous mesenchymal cells (MCs) to improve their integration. Moreover, in this study, the consequences of in vitro colonization on MCs have been evaluated.

Methods: After in vitro propagation of MCs, their proliferation kinetics on ABM pre-coated with gelatin, fibronectin, collagen IV and human serum (HS) was monitored, and they were compared with cells cultured without ABM for 8 weeks. The effect of ABM on cell phenotype was also assessed. Lastly, the ability of ABM-colonizing MCs to perform hematopoiesis, a function normally preserved in selected culture conditions, and their differentiation towards osteoblastic lineage were evaluated.

Results: MC and colony-forming unit-fibroblast proliferated 930- and 590-fold, respectively. The proliferation rate of the expanded MCs was higher, forming a 3-dimensional structure in all ABMs. Pre-coating with HS was the most efficient treatment of ABMs to increase the initial adherence of MCs, and it partly explains the reason for the higher propagation of MCs. Flow cytometry analyses revealed subtle alterations in ABM-colonizing cells; however, the ability of MCs to maintain long-term culture initiating cells proliferation and differentiate into osteoblastic lineage was preserved.

Conclusions: In this study, the in vitro biocompatibility of bone marrow (BM) MCs with ABMs, the role of HS in scaffold coating, and the possibility of initially using a small BM sample for this approach were demonstrated.
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http://dx.doi.org/10.11005/jbm.2021.28.2.161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206612PMC
May 2021

Place of residence before and place of discharge after femoral neck fracture surgery are associated with mortality: A study of 1238 patients with at least three years' follow-up.

Orthop Traumatol Surg Res 2021 05 27;107(3):102876. Epub 2021 Feb 27.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.

Background: Femoral neck fractures constitute a major public health challenge. The risk of death after surgery depends chiefly on the patient's general health and comorbidities. No studies assessing place of residence are available. The objectives of this study were to determine whether mortality differed according to the patient's previous place of residence and to the place of discharge, and to describe the complications occurring after femoral neck fracture surgery.

Hypothesis: After femoral neck fracture surgery, the place of discharge is associated with the risk of death, and the complication rate is high.

Methods: This single-centre retrospective study included 1241 adults who sustained a true femoral neck fracture between 2006 and 2016 and were followed up for at least 3 years. The following data were collected: age at the time of the fracture, sex, hospital stay length, place of residence before and after the fracture, characteristics of the fracture, type of treatment, time from the fracture to surgery, and whether anticoagulant therapy was given. We then recorded data on mortality and complications.

Results: The 3-year mortality rate was 36.0±1.4% (95%CI, 33.3-38.7). Place of residence before the fracture was strongly associated with mortality: the risk of death was higher in patients who lived in care homes (hazard ratio [HR], 2.18) or were hospitalised (HR, 1.78) and lower in patients who lived at home (HR, 0.46). The risk of death was also higher in patients discharged to care homes (HR, 1.82) or to hospitals (HR, 1.90) and lower in patients discharged home (HR, 0.30). All these differences were statistically significant (p<0.0001).

Conclusion: Place of residence and likely place of discharge should be evaluated as soon as the patient is admitted to the emergency department, in order to provide the best information possible to the patient and family and to establish the most appropriate treatment strategy. Patient self-sufficiency is a major parameter that should be preserved to the extent possible.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.otsr.2021.102876DOI Listing
May 2021

Bibliometric analysis of case report citations and their effect on the impact factor: How does publishing case reports impact journals?

Orthop Traumatol Surg Res 2020 Dec 23;106(8):1463-1467. Epub 2020 Oct 23.

Université Clermont-Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.

Introduction: Given their low citation rate, case reports may reduce a journal's impact factor (IF), making a journal less likely to accept them for publication. However, this concept has never been proven in a bibliometric study. This led us to carry out a bibliometric analysis to evaluate (1) the exact number of case reports published in orthopedics over a 2-year period, (2) their citation rate, (3) what the journals' IF would be if they had not published these case reports.

Hypothesis: Publishing case reports reduces a journal's IF, bringing into question whether they should be published.

Materials And Methods: This was a retrospective bibliometric study. We focused on all the articles influencing the year 2017. We looked at all the journals in the "Orthopedics" discipline that had published at least one article in the years n-2 (=2015) or n-1 (=2016).

Results: There were 1925 case reports among the 28,903 articles published in all orthopedics journals in 2015-2016, a 6.7% share of publications. Individually, each case report in 2015-2016 was cited an average of 0.86 times±1.4 [0-13] in 2017. Of all the case reports published in 2015-2016, 571 (30%) had not been cited in 2017. When comparing the individual number of each case report citation to the journal's IF, we found 413 instances (21.5%) where the case report was cited more than expected and 1512 (78.5%) where it was cited less than expected based on the journal's IF. The mean IF was 2.013. If the journals had not published any case reports, the mean IF would have been 2.072 (p<0.0001). For all the SIGAPS categories, the mean IF would have been higher if no case reports had been published. On average, the IF was lower by 0.059 points±0.121 [-0.165-0.537], with the difference being statistically significantly only for SIGAPS C and D journals. In 69 instances, the IF would be higher if the journal had not published any case reports. Conversely, the IF improved in 8 instances by publishing case reports: 3 were tier D journals and 5 were tier E journals.

Discussion: Our study brings into question whether case reports should be published. Indeed, the publication of case reports lowers the IF of scientific journals. However, we should not completely stop publishing case reports since they can be useful to clinicians caring for patients with rare diseases or medical conditions.

Level Of Evidence: IV, systematic retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2020.05.016DOI Listing
December 2020

Do bibliometric findings differ between Medline, Google Scholar and Web of Science? Bibliometry of publications after oral presentation to the 2013 and 2014 French Society of Arthroscopy (SFA) Congresses.

Orthop Traumatol Surg Res 2020 Dec 3;106(8):1469-1473. Epub 2020 Nov 3.

CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France.

Introduction: Bibliometrics consists in quantitative and qualitative analysis of an individual's or group's communication (volume, visibility), and impacts research funding. There are a number of bibliometric data sources, functioning in different ways and liable to give rise to differing statistics. This point has not been investigated in relation to publication following presentation to a French congress. We therefore conducted a study comparing the main bibliometric instruments, aiming to assess: (1) publication rates following oral presentation to the 2013 and 2014 French Society of Arthroscopy (SFA) Congresses according to the database used, and (2) citation rates for these publications according to database.

Hypothesis: Publication and citation rates differ according to database. Material and method All 199 Abstracts of oral presentations to the 2013 and 2014 SFA Congresses were included. Based on author names and key-words, manual search was conducted in the Medline, Web of Science and Google Scholar databases. Publication characteristics (citation rate) were studied using the 3 databases and the French SIGAPS (Système d'Interrogation, de Gestion et d'Analyse des Publications Scientifiques: Scientific Publication Search, Management and Analysis System) website.

Results: Publication rates according to Medline and Google Scholar were the same (48.2%: 96 articles for 199 presentations), but significantly lower on Web of Science (44.7%: 89/199; p=0.002). Citation rates differed significantly (p<0.001) between sources, with Google Scholar listing a mean 1.5-3.4-fold more citations per article than the other 2 databases. Citation rates between the 3 databases correlated strongly (r=0.93).

Discussion: The example presented in this study illustrates the differences in bibliometrics found between different databases. There was a 4% difference (7/199 articles) in publication rates following oral presentation to an SFA Congress, and even greater differences in citation rates per article, with 1.5-3.4-fold more citations according to Google Scholar. Bibliometric studies need to acknowledge the database(s) being used, which should be as many as possible to enhance exhaustiveness.

Level Of Evidence: IV; descriptive epidemiologic study.
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http://dx.doi.org/10.1016/j.otsr.2020.09.005DOI Listing
December 2020

Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years' follow-up.

Orthop Traumatol Surg Res 2020 Nov 10;106(7):1425-1431. Epub 2020 Oct 10.

CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France.

Introduction: Failure rates for screw fixation in femoral neck fracture in young patients are often high, with risk of aseptic femoral head osteonecrosis and non-consolidation. The present study sought to identify factors for success or failure of internal fixation according to: 1) initial treatment; 2) initial reduction quality; and 3) population characteristics.

Hypothesis: The study hypothesis was that population, fracture type, initial treatment and reduction quality can predict survival.

Material And Methods: A retrospective study included all cases of femoral neck fracture in under 65-years-old treated by screwing in our center: i.e., 112 patients. Patient characteristics, time to surgery were collated; surviving patients were followed up at a minimum 24 months. Reduction quality was assessed on X-rays in 3 dimensions and cervico-diaphyseal angle.

Results: Mean follow-up was 5.3±3.0 years [range, 2.0-13.6 years]. At 2 years, 23 of the 112 patients (20.5%) had developed complications: 10 osteonecroses (8.9%) and 13 non-unions (11.6%). Known hip osteonecrosis risk factors showed no significant association with survival. Failure rates were significantly higher in unstable (Garden≥3) than stable (Garden≤2) fracture: HR=2.77 [95%CI: 1.09-7.02]; p=0.025. There was no significant association with time to treatment (≤6 hours): HR=1.08 [95%CI: 0.46-2.54]; p=0.86. On 2-year radiographs, mean shortening on the z-axis was 12.3±4.8mm [-0.7 to 26.2], 8.5±5.0mm [-6.8 to 23.9] on the x-axis, and 6.4±6.1mm [-6.3 to 25.3] on the y-axis. There was a significant negative correlation between z shortening and HOOS pain component (r=-0.38; p=0.005), a non-significant negative correlation with quality of life (r=-0.20; p=0.16), and a significant negative correlation with sports activity (r=-0.28; p=0.039).

Conclusion: The present series showed lower rates of complications and of arthroplasty than in the literature. Internal fixation seemed to be indicated even at an interval of 6 hours or more.

Level Of Evidence: IV, retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2020.06.011DOI Listing
November 2020

Medium term clinical outcomes of tibial cones in revision knee arthroplasty.

Arch Orthop Trauma Surg 2021 Jan 10;141(1):113-118. Epub 2020 Oct 10.

Rush University, Chicago, IL, USA.

Introduction: Trabecular metal cones are a relatively new option for reconstruction of major bone defects during revision total knee arthroplasty (TKA). The purpose of the present study was to retrospectively assess medium-term results for tibial cones in revision TKA with a severe proximal tibial bone defect. We hypothesized that revision TKA patients with bone defects treated with trabecular metal cones have excellent medium-term clinical and radiological results.

Patients And Methods: A single-center retrospective review included all consecutive cases of tibial revision using trabecular metal cones. All patients with a minimum 2-year follow-up were included in the study. There were no exclusion criteria. The primary endpoint was tibial cone survivorship. The secondary endpoints were revision TKA all-cause survivorship, patient-reported outcome measures with a Knee injury and Osteoarthritis Outcome Score (KOOS), SF 12, and radiographic analysis.

Results: Five of the 57 patients alive at last follow-up (8.77%) had undergone revision (4 for infection and 1 for instability). Complications comprised four cases (7.02%) of infection, 2 cases (3.51%) of tibial and femoral implant aseptic loosening that did not require revision surgery, 1 of which (1.75%) with associated patellar loosening, and 1 case (1.75%) of instability. Kaplan-Meier estimates showed 100% 5-year survivorship with tibial cone revision for aseptic loosening and 93.44% (95% CI 83.47-97.49%) for all-cause revision.

Discussion: The present study of cones used for tibial revision supports shows excellent results; however, longer and larger follow-up is needed to better assess results in revision TKA.

Level Of Evidence: 4, retrospective study.
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http://dx.doi.org/10.1007/s00402-020-03532-1DOI Listing
January 2021

Progression and projection for shoulder surgery in France, 2012-2070: Epidemiologic study with trend and projection analysis.

Orthop Traumatol Surg Res 2020 Oct 27;106(6):1067-1077. Epub 2020 Aug 27.

Université Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, Service d'orthopédie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.

Introduction: Shoulder surgery has been rapidly expanding over the past 20 years and now makes up a large share of orthopedic surgery practice. Data on how this activity has changed is not available in France due to a lack of registries. The study objectives were to: (1) quantify the number of shoulder surgeries in France, (2) predict how this activity will change over the next 50 years based on extreme scenarios.

Methods: This study involved an analysis of shoulder surgery data taken from the French hospital discharge database (PMSI). Two mathematical scenarios were applied to define the change over time: the first only considered the evolution in the population and changes in the age brackets over time; the second extrapolated the trends observed over the past few years (2012 to 2018).

Results: In 2018, there were 234,612 procedures coded as primary shoulder surgery procedures in France. This activity increased 24.5% between 2012 and 2018 and is projected to increase 18% to 161% from now to 2050, depending on the scenario (p<0.0001). Rotator cuff surgery procedures were done 173,799 times - of which 61,055 were tendon repair - representing 74% of all shoulder procedures. The scenarios point to an increase of 13.6% to more than 300% (p<0.0001). Primary shoulder arthroplasty corresponded to 17,043 procedures in 2018 (7.3% of all procedures), with a 47% increase between 2012 and 2018. Between 2018 and 2050, the number of total shoulder arthroplasty procedures is expected to increase 31% to 322% (p<0.0001). The total number of revision arthroplasty procedures was 1508, increasing by 39% from 2012 to 2018. There were 14,229 procedures done for anterior or posterior instability in 2018 (6% of total). Bone block procedures made up 53% of these cases. This increased 17% between 2012 and 2018, with a projected increase of 5% to 82% up to 2050 (p<0.01).

Discussion: Shoulder surgery is the third largest activity in the orthopedic realm after hip and knee surgery, although it has seen the largest increases in recent years. This growth in shoulder procedures should continue over the next decades.

Level Of Evidence: IV, descriptive epidemiology study.
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http://dx.doi.org/10.1016/j.otsr.2020.04.019DOI Listing
October 2020

Survival at 11 to 21 years for 779 Metasul® metal-on-metal total hip arthroplasties.

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(2):2309499020926265

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France.

Background: Total hip arthroplasties (THAs) bearing is one of the most important factors for hip replacement because THA survival depends on it. Metal-on-metal (MoM) bearing has lower wear than metal-on-polyethylene but lot of aseptic loosening decrease utilization. We analyze the survival rate of 28 mm Metasul® bearings after a mean follow-up of 12.9 years.

Methods: The main objective of this study was to evaluate the survival of the MoM. We evaluate 779 consecutive THAs performed between January 1995 and December 2005 for primary osteoarthritis, congenital dysplasia classified Crowe I, or rheumatoid arthritis. Survival rate was calculated by the Kaplan-Meir method. The association between survival and age, gender, body mass index (BMI), and surface coating was investigated with a proportional odds model. The clinical assessment included Oxford score.

Results: Six hundred fifty-two THAs were reviewed. Sixty-two revisions (9.5%) were performed including 34 aseptic loosening and 11 deep infections. The survival for prosthesis with any reason at 20 years was 87% (confidence interval (CI) 83-90.2) for aseptic loosening at 20 years was 90.1% (CI 87-93.8). There was no association with age, BMI, and surface coating. Gender was significant with lower aseptic loosening for men, hazard ratio = 0.45, value = 0.035. Oxford score was 57 ± 6.7 (19-60).

Conclusion: The survival rate of Metasul was well and seems to be like our clinical finding. However, radiographic aseptic loosening without surgery is not included in the survival rate. The Oxford score was very good with a lot of patients with asymptomatic hip.

Level Of Evidence: Level IV/Retrospective study.
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http://dx.doi.org/10.1177/2309499020926265DOI Listing
February 2021

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

Arch Orthop Trauma Surg 2020 Oct 10;140(10):1475-1485. Epub 2020 Jun 10.

Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, BP 69, 63003, Clermont-Ferrand Cedex 01, France.

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.
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http://dx.doi.org/10.1007/s00402-020-03511-6DOI Listing
October 2020

Knee surgery trends and projections in France from 2008 to 2070.

Orthop Traumatol Surg Res 2020 Sep 4;106(5):893-902. Epub 2020 Jun 4.

Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.

Introduction: Knee surgery makes up a large share of the orthopedic surgery practice. Data on how this activity has changed over time is not available in France, thus we wanted to do a study to determine 1) how many knee surgeries were performed in France in 2018, 2) how this changed between 2012 and 2018, and 3) how it is projected to change by 2070. The hypothesis is that the number of knee surgeries will increase over the next 50 years.

Methods: This was an epidemiology study analysing coding data for surgical procedures in France between 2012 and 2018. Two scenarios were defined to assess the change over time: the first only considered population growth and how the age distribution changes over time, and the second extrapolated the trends observed over the past few years.

Results: In 2018, 321,179 procedures were coded as a main knee surgery procedure. The three most frequent were primary knee arthroplasty with 113,600 procedures (31.2% of procedures) then meniscus surgery (110,510 procedures or 30.3%) and then ligament surgery (57,053 procedures or 15.7%). The number of primary knee arthroplasty procedures increased by 32.2% between 2012 and 2018. Between 2018 and 2050, the different scenarios suggested an increase of 30.8% to 152.8%. The number of ligament surgery procedures increased by 17.3% between 2012 and 2018. Between 2018 and 2050, an increase of 1.2% to 49.2% is expected. The number of meniscus procedures decreased by 14.2% between 2012 and 2018. Between 2018 and 2050, scenario 1 projects a 5.6% increase and scenario 2 a 73.6% reduction.

Discussion: The number of knee surgery procedures per year has increased over the past few years in France and should continue to increase.

Level Of Evidence: IV, descriptive epidemiology study.
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http://dx.doi.org/10.1016/j.otsr.2020.02.018DOI Listing
September 2020

A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading.

J Shoulder Elbow Surg 2020 Oct 1;29(10):1967-1973. Epub 2020 Jun 1.

Department of Orthopaedic Surgery and Traumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France.

Background: The critical shoulder angle (CSA) has been shown to be correlated with shoulder disease states. The biomechanical hypothesis to explain this correlation is that the CSA changes the shear and compressive forces on the shoulder. The objective of this study is to test this hypothesis by use of a validated computational shoulder model. Specifically, this study assesses the impact on glenohumeral biomechanics of modifying the CSA.

Methods: An inverse dynamics 3-dimensional musculoskeletal model of the shoulder was used to quantify muscle forces and glenohumeral joint forces. The CSA was changed by altering the attachment point of the middle deltoid into a normal CSA (33°), a reduced CSA of 28°, and an increased CSA of 38°. Subject-specific kinematics of slow and fast speed abduction in the scapular plane and slow and fast forward flexion measured by a 3-dimensional motion capture system were used to quantify joint reaction shear and compressive forces.

Results: Increasing the CSA results in increased superior-inferior forces (shearing forces; integrated over the range of motion; P < .05). Reducing CSA results in increased lateromedial (compressive) forces for both the maximum and integrated sum of the forces over the whole motion (P < .01).

Discussion/conclusion: Changes in the CSA modify glenohumeral joint biomechanics with increasing CSA producing higher shear forces that could contribute to rotator cuff overuse, whereas reducing the CSA results in higher compressive forces that contribute to joint wear.
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http://dx.doi.org/10.1016/j.jse.2020.03.002DOI Listing
October 2020

Epidemiology of painful knee after total knee arthroplasty in a tertiary care center: Assessment by decision tree.

Knee 2020 Jun 15;27(3):1049-1056. Epub 2020 Apr 15.

Rush University, Chicago, IL, USA; Central DuPage Hospital, Northwestern University, Winfield, IL, USA.

Background: Painful knee after arthroplasty concerns up to 21% of patients at six months. We aimed to evaluate: the application of a decision tree to explain painful knee after total knee arthroplasty (TKA), the rate of unexplained pain after complete algorithmic screening. The aim of the study was to evaluate the causes of painful TKA. Our hypothesis was that it is possible to find the cause of the pain in more than 90% of cases.

Methods: A single-center retrospective study analyzed all 1130 consultations between 1 April 2017 and 31 July 2018. We included all patients consulting for unexplained chronic painful knee arthroplasty.

Results: We included 112 knees in 105 patients as unexplained painful knee arthroplasty. Final diagnostic status was no diagnosis in seven (6.3%) cases; infection in five (4.5%); instability without real dislocation in three (2.7%); placement error in two (1.8%), due to rotational problems; loosening in 25 (22.3%): 24 (21.4%) tibial and two (1.8%) femoral; polyethylene wear in nine (8.0%); periarticular pain in 37 (33.9%): 20 with quadriceps deficiency, four with iliotibial tendinitis, four with pes bursitis, six with stiffness, and three with prepatellar bursitis); zero material problems; projected pain in 21 (18.8%); and complex regional pain syndrome in three (2.7%) cases, improved by gentle physiotherapy.

Conclusions: The present study was original and presents the problem in the context of everyday practice, from the clinician's point of view, with an easy-to-use decision tree that can be implemented to assess painful knee in consultation.
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http://dx.doi.org/10.1016/j.knee.2020.03.010DOI Listing
June 2020

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

Eur J Orthop Surg Traumatol 2020 Jul 27;30(5):845-850. Epub 2020 Feb 27.

CNRS, SIGMA Clermont, ICCF, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.

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.
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http://dx.doi.org/10.1007/s00590-020-02644-zDOI Listing
July 2020

Hip preserving surgery for avascular hip necrosis: does terminating exposure to known risk factors improve survival?

Phys Sportsmed 2020 09 18;48(3):335-341. Epub 2020 Jan 18.

CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Université Clermont Auvergne , Clermont-Ferrand, France.

: Avascular necrosis of the hip is rarely detected in early pre-radiographic stages (Arlet-Ficat stages I and II) where conservative treatment would still be possible. Studies of risk factors were often merely descriptive. The aim of the present study was to make a retrospective assessment of treatment survival rate for conservative management of avascular hip necrosis according to whether exposure to avoidable risk factors is eliminated or not. The study hypothesis was that eliminating avoidable risk factors is effective and reduces the risk of failure, and hence of hip replacement. : A single-center retrospective study was performed for conservatively managed avascular hip necrosis. Thirty-seven consecutive hips in 34 patients underwent decompression drilling, with a minimum 3-year follow-up. Known risk factors for osteonecrosis were classified as avoidable or non-avoidable. Results were analyzed according to the elimination of avoidable risk factors. The main endpoint was survival, with failure defined as femoral head collapse and/or recourse to total hip replacement. Avoidable risk factors (corticosteroids, smoking, alcohol consumption, blood pressure elevation, hypercholesterolemia) persisted for 17 hips (45.9%) and were prevented for 15 (40.5%). Five patients (5 hips: 13.5%) did not show preoperatively identified risk factors. Groups were demographically comparable. : Mean follow-up was 7.5 ± 3.7 years (range, 3.1-16.0 years). At last follow-up, there was a significant difference in survival at cumulative 9-year follow-up between patients with no risk factors (100%), with risk factors eliminated (59.3%; 95% CI, 0.273-0.012), and with persisting risk factors (23.5%; 95% CI, 0.013-0.458) (p = 0.001). : No studies were found in the literature assessing the survival of hip preserving surgery according to persistence or elimination of known risk factors for osteonecrosis. Eliminating risk factors significantly improved the survival rate for conservative treatment of femoral head necrosis.
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http://dx.doi.org/10.1080/00913847.2020.1711827DOI Listing
September 2020

Poor results of functional treatment of Garden-1 femoral neck fracture in dependent patients.

Orthop Traumatol Surg Res 2020 Jun 18;106(4):601-605. Epub 2019 Dec 18.

Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.

Introduction: Variable results are reported after functional treatment for Garden-1 femoral neck fracture, with no definite factors for failure, particularly in the absence of selection for risk. It seems well indicated in frail and/or dependent patients with comorbidities, but this has not been specifically assessed, and failure is frequent in this target population. We therefore performed a retrospective study to: (1) assess results of functional treatment for Garden-1 impacted femoral neck fracture in dependent patients, and (2) analyze survival in terms of complications and death, and related factors.

Hypothesis: Functional treatment for Garden-1 fracture in dependent patients gives poor results, with a high rate of surgical revision.

Material And Methods: A retrospective analysis was made of Garden-1 femoral neck fracture in dependent patients (Parker score≤5), with a minimum 2 years' follow-up. One hundred and forty-six patients were included: mean age, 81.3±8.7 years (range, 55.7-99.6 years). The endpoint was survival in terms of complications requiring surgery, secondary displacement requiring surgery, excessive pain requiring surgery, non-union or femoral head osteonecrosis. Secondary endpoints were overall mortality and mortality related to complications.

Results: Mean follow-up was 4.2±2.6 years (range, 2.0-10.3 years). Ninety-one of the 146 patients (62.3%) required secondary surgery: 79 (54.1%) early (<3 months post-fracture), with 77 (52.7%) secondary displacements and 2 cases (1.4%) of excessive pain; and 12 (8.2%) late (162.2±132.3 days; range, 90-454 days), with 8 (5.4%) non-unions and 4 (2.7%) osteonecroses. Mean time to onset of secondary displacement was 13.6±11.8 days (range, 0-67.0 days). Two-year survival in terms of revision surgery was 34.1% [95% CI: 26.0-42.4]. At last follow-up, 91 patients (62.3%) had died; 2-year survival in terms of death was 69.9% [95% CI: 62.4-77.3]. Survival analysis in terms of complications revealed greater mortality in absence of complications: 42 of the 55 patients (76.3%) without complications requiring surgery died, versus 49 of the 91 (53.8%) with complications requiring surgery (p=0.012); relative risk of death in absence of complications requiring surgery was 1.42 [95% CI: 1.33-5.77].

Discussion: Functional treatment for Garden-1 fracture in dependent patients gave poor short- and medium-term results. Surgery is therefore recommended in this specific population; the present findings should improve survival.

Level Of Evidence: IV, retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2019.09.027DOI Listing
June 2020

Full-text publication rate of studies reported as 2013 SoFCOT meeting abstracts.

Orthop Traumatol Surg Res 2019 Nov 10:1447-1452. Epub 2019 Nov 10.

EA 2694 - Santé publique : épidémiologie et qualité des soins, université de Lille, CHU de Lille, 59000 Lille, France.

Background: Publication of scientific work, although mandatory to ensure dissemination of novel research findings and obtain further funding, can require considerably more time and effort compared to conference presentations. Several national or scientific societies have determined the publication rate of studies reported at their meetings. The French Society for Orthopaedic and Trauma Surgery (Société française de chirurgie orthopédique et traumatologique, SoFCOT) has not yet measured this parameter. The objective of this study was to (i) evaluate the full-text publication rate of studies accepted in abstract form for podium presentations or posters at the 2013 SoFCOT meeting and (ii) identify characteristics of abstracts associated with subsequent full-text publication.

Hypothesis: The full-text publication rate of abstracts accepted for the 2013 SoFCOT meeting was equal to or greater than the mean reported by national societies, i.e., 44.5%.

Material And Methods: Publication rates of the 503 studies reported as abstracts at the 2013 SoFCOT meeting were studied. The time horizon was thus at least 5years. The topic was orthopaedic surgery for 315 (62.6%) abstracts, trauma surgery for 153 (30.4%) abstracts, and fractures in elderly patients - the cross-field theme for that year - for 35 (7.0%) abstracts. Reporting was as a podium presentation for 275 (54.7%) abstracts, an e-poster for 205 (40.8%) abstracts, an instructional course lecture for 20 (4.0%) abstracts, a symposium for 2 (0.4%) abstracts, and a round table for 1 (0.2%) abstract.

Results: The full-text publication rate was 35.6% overall and 47.1% (139 publications) for podium presentations. Mean time from podium or poster presentation at the SoFCOT meeting to full-text publication was 1.2±1.5years (range: -2.5 to 6.1years). The full-text publications had 0.8±2.3 (range: -6 to 11) more authors compared to the abstract. They appeared in 54 journals with a mean impact factor of 1.9±1.3 (range: 0.25 to 13.77; median: 1.41; interquartile range: 1.26 to 2.47). Subgroup comparisons showed that full-text publication was more common for prospective than retrospective studies (50.0% versus 30.5%, p<0.0001) and for studies showing a significant difference (48.6% versus 33.0%, p<0.0001). Systematic reviews were more often published in full than were anecdotal case-reports. The full-text publication rate was also higher for studies reported as podium presentations than as e-posters (47.1% versus 17.6%, p<0.0001). Finally, studies of orthopaedic surgery were more often published in full than were studies of trauma surgery (39.7% versus 28.2%, p=0.033).

Discussion: The 5-year full-text publication rate of studies reported as abstracts at the 2013 SoFCOT meeting was consistent with previously reported data. The impact factors of the journals in which the studies were published are evidence of the high quality of the information shared at SoFCOT meetings.

Level Of Evidence: IV, systematic retrospective analysis.
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http://dx.doi.org/10.1016/j.otsr.2019.09.022DOI Listing
November 2019

Progression and projection for hip surgery in France, 2008-2070: Epidemiologic study with trend and projection analysis.

Orthop Traumatol Surg Res 2019 11 9;105(7):1227-1235. Epub 2019 Oct 9.

Università Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.

Introduction: Hip replacement was declared "operation of the century" in tribute to the functional improvement it provides. Frequency is increasing, but it is difficult to estimate the actual number of procedures performed and the expected progression, because of changes in indications and lengthening life-expectancy, and also, in France, because there is no registry. As data are lacking in France, we conducted an investigation 1) to update the number of hip surgeries in France, and 2) to forecast progression over the coming decades, considering extreme scenarios.

Hypothesis: The number of hip procedures can be expected to increase considerably over the coming 50 years.

Material And Method: A study was conducted to analyze national coding data for the number of hip surgeries performed in France. Two scenarios were defined: one taking account of population progression and age structure, the other also extrapolating trends observed over recent years. Current hip surgery activity in France was measured, and progression estimated according to population changes.

Results: In 2018 in France, 183,139 procedures were coded as principally concerning the hip. There was a clear predominance of reconstruction procedures, with 148,965 primary hip replacements, 124,251 of which were total. There were 19,304 hip replacement revision procedures. There were strong regional differences in revision according to the type of center performing surgery (p<0.0001). Between 2018 and 2050, primary hip replacement could be expected to increase by 41.9% or 114.3% and hip surgery overall by 42.0% or 98.3%, depending on the scenario.

Discussion: The present results are subject to future technological breakthroughs and medical discoveries, but forecast a major increase in hip surgery requirements. These results extend the present state of medical knowledge.

Level Of Evidence: IV, descriptive epidemiological study.
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http://dx.doi.org/10.1016/j.otsr.2019.07.021DOI Listing
November 2019

Long-term survival of hybrid total hip arthroplasty with the uncemented CLS cup, cemented Müller cobalt-chromium stem, and 28-mm Metasul™ bearings: Retrospective review of 115 hips after a minimum of 17.8 years.

Orthop Traumatol Surg Res 2019 11 13;105(7):1289-1295. Epub 2019 Sep 13.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France.

Background: Hard-on-hard bearings require a meticulous implantation technique but may be associated with lower wear rates in young active patients. Among them, metal-on-metal (MoM) bearings have been blamed for specific complications including adverse reactions to metal debris and metal hypersensitivity. These complications have been chiefly reported with large-head MoM implants (except when used for hip resurfacing). Most of the published data on small-head MoM implants were obtained using uncemented stems. To our knowledge, no information on outcomes beyond 15 years is available for small-head MoM implants with cemented cobalt-nickel-chromium (Co-Ni-Cr) stems, which might increase the risk of complications. The objective of this study was to collect long-term follow-up data on patients who underwent hybrid total hip arthroplasty (THA) with 28-mm MoM Metasul™ bearings in order to assess: (1) long-term survival (based on the revision rate), (2) and the occurrence of adverse reactions to metal debris documented during revision.

Hypothesis: Survival of 28-mm Metasul™ bearings used with hybrid THA is acceptable.

Patients And Methods: A single-centre retrospective study was conducted in consecutive patients managed using 28-mm Metasul™ bearings in a press-fit cup, with a cemented Co-Ni-Cr stem. Follow-up was at least 17 years. The clinical and radiographic data were analysed. Mean age at surgery was 57.3±7.9 years (range, 29.6-75.3 years).

Results: The study included 115 hips with a mean follow-up of 20.3±0.8 years (range, 17.8-21.6 years). Survival to revision for any reason was 86.10% (95% CI, 79.8-92.4%) and survival to revision for aseptic loosening was 92.6% (95% CI, 87.7-97.6). Half the specimens obtained during revision showed a macrophage reaction and a non-specific inflammatory infiltrate. No patient experienced complications specifically related to the use of Metasul™ bearings with a cemented Co-Ni-Cr stem.

Discussion: Long-term survival of 28-mm MoM Metasu™ bearings was close to that of metal-on-polyethylene bearings and lower than that of ceramic-on-ceramic or small-head MoM bearings in other studies. No complications specifically related to the use of small-head MoM bearings with a cemented Co-Ni-Cr stem were recorded.

Level Of Evidence: IV, retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2019.06.019DOI Listing
November 2019

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

Eur J Orthop Surg Traumatol 2019 Dec 6;29(8):1709-1717. Epub 2019 Jul 6.

CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.

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.
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http://dx.doi.org/10.1007/s00590-019-02491-7DOI Listing
December 2019

Response to Letter to the Editor on "Unexplained Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results".

J Arthroplasty 2019 09 11;34(9):2196. Epub 2019 Jun 11.

Midwest Orthopaedics at Rush, Central Dupage Hospital, Chicago, IL.

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http://dx.doi.org/10.1016/j.arth.2019.06.001DOI Listing
September 2019

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

Int Orthop 2020 01 28;44(1):45-51. Epub 2019 Jun 28.

CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France.

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.
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http://dx.doi.org/10.1007/s00264-019-04355-5DOI Listing
January 2020

[Interest of enhanced recovery programs in the elderly during total hip arthroplasty A systematic review].

Geriatr Psychol Neuropsychiatr Vieil 2019 09;17(3):234-242

GRACE Groupe francophone de RAC, Service de chirurgie, Hôpital d'Etaing, CHU Clermont-Ferrand, France.

Enhanced recovery after surgery (ERAS) is an evident advance in the management of patients. Its feasibility and its effectiveness have been little analyzed in elderly's orthopedics. The aim of this systematic review of the literature was to analyze the feasibility (realization of classic ERAS items) and the efficiency (length of stay, morbidity and mortality) of ERAS in the elderly during total arthroplasty hip.

Materials And Methods: A bibliographic search was performed with PubMed, Medline, CINAHL, Cochrane and Embase, using keywords "total hip arthroplasty", "orthopedics surgery", "fast track", "enhanced recovery after surgery", and" elderly ". Seventy-two articles were listed and 47 fully analyzed by 2 independent authors.

Results: Thirty-two articles were selected. All the articles demonstrated ERAS feasibility in the elderly. The most frequently performed items were: preoperative information, spinal anesthesia and local or regional anesthetic infiltrations, multimodal analgesia with opioids sparing. Early stand-up is desirable but more difficult to achieve than in younger. Compared with traditional management, ERAS decreases the average length of stay without increasing complications, re-admissions and mortality rates. Medico-economic analyzes would be in favor of a reduction in the overall cost. The elderly's adherence to ERAS program depends on information's quality provided at the time of the consultation.

Conclusion: The application of ERAS program in total hip arthroplasty in the elderly is feasible and efficient to reduce hospital stay and morbidity without increasing the complication rates. Protocols must be adapted to the particularities of this population.
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http://dx.doi.org/10.1684/pnv.2019.0796DOI Listing
September 2019

Knee arthroscopy prospective observational study of patient information.

Eur J Orthop Surg Traumatol 2019 Oct 23;29(7):1495-1500. Epub 2019 May 23.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France.

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.
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http://dx.doi.org/10.1007/s00590-019-02447-xDOI Listing
October 2019

Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results.

J Arthroplasty 2019 Aug 13;34(8):1802-1807. Epub 2019 Apr 13.

Midwest Orthopaedics at Rush, Central Dupage Hospital, Chicago, IL.

Introduction: Identifying the source of pain is paramount for determining appropriate treatment and ensuring successful outcome in terms of management and relief of pain. The difficulty is that each surgeon has his or her own way of seeing the problem, and there is no consensus for the evaluation of these patients. The study hypothesis was that it is possible to find the cause of the pain in most cases.

Patients And Methods: All patients consulting for unexplained painful hip arthroplasty were included and followed a decision tree to assess the cause of the pain. The primary endpoint was the final diagnosis. Secondary endpoints were subgroup comparison between main causes and assessment of risk factors.

Results: Two hundred one hips of 194 patients were included as unexplained painful hip arthroplasty 6 months postoperatively. Final diagnoses comprised periarticular pain in 53 cases (26.4%): 40 cases of trochanteric bursitis, 5 of iliopsoas tendinitis, 5 of abductor deficiency, 1 of ischial tuberosity tendinitis, and 2 of heterotopic ossification; projected pain in 49 (24.4%): 45 cases of back pain with or without neuropathy, 3 of knee osteoarthritis, and 1 of metabolic neuropathy; wear in 40 (19.9%), in the polyethylene liner; loosening in 20 (10.0%): loosening of the femoral component in 8 and that of the cup in 12; material problems in 17 (8.5%): trunnionosis in 13 and metallosis in metal-on-metal implants in 4; no diagnosis in 7 hips (3.5%); infection in 6 (3.0%), all chronic; instability without real dislocation in 3 (1.5%); misplacement in 3 (1.5%), all for leg-length discrepancy; fracture in 2 (1.0%): 1 of greater trochanter and 1 of ilio-ischiopubic ramus; complex regional pain syndrome in 1 (0.5%).

Discussion: To our knowledge, this is the first study on the causes of painful hip arthroplasty in clinical practice, whether leading to revision or not. A systematic approach, including physical examination, radiographic assessment and laboratory studies, is needed to find the cause of the pain. It is important to understand the pain so that it can be treated appropriately. Revision surgery can sometimes help-but the worst thing is to make the patient worse.

Level Of Evidence: level 4, retrospective study.
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http://dx.doi.org/10.1016/j.arth.2019.04.014DOI Listing
August 2019

Bilateral simultaneous chronic exertional compartment syndrome of the lateral forefoot: A case report (compartment syndrome of the forefoot).

J Orthop Surg (Hong Kong) 2019 May-Aug;27(2):2309499019839647

1 Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand BP 69, Clermont Ferrand, France.

A 20-year-old patient came to the sport medicine clinic for bilateral forefoot pain during sport activities (running) progressing for the last 3 months. Thanks to a positive measurement of the compartment pressure during a running test reproducing the symptomatology and exclusion of classical differential diagnosis, a bilateral chronic compartment syndrome of the lateral forefoot was confirmed. Three months after a surgical fasciotomy, the patient fully recovered. No previous study described this specific compartment of the forefoot. Level of evidence: IV.
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http://dx.doi.org/10.1177/2309499019839647DOI Listing
March 2020

The top 100 most-cited Orthopaedics & Traumatology: Surgery & Research articles.

Orthop Traumatol Surg Res 2019 12 14;105(8):1459-1462. Epub 2019 Mar 14.

CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.

Background: The French peer-reviewed journal Revue d'Orthopédie founded on 1st January 1890 extended its scope in 2009 by creating the English-language, online-only, indexed journal Orthopaedics & Traumatology: Surgery & Research (OTSR). Bibliometric data help authors and readers assess the citation potential of articles published in a given journal. We found no bibliometrics for the first 10years of OTSR. The objectives of this bibliometric study were to identify (i) the 100 most-cited OTSR articles and (ii) the specialties or article types most often involved in citations.

Methods: The Scopus database was used to determine the citation rates of the 2158 articles published in OTSR during the journal's first 10years. A bibliometric analysis was performed on the 100 most-cited articles.

Results: Mean time since publication of the 100 most-cited articles was 6.60±1.66years (range: 2-10years) and mean number of citations per article was 49.59±24.16 (range: 30-169). Mean number of citations per year was 7.75±3.26 (range: 4-18.78) and mean number per author was 5.52±3.14 (range: 1-21). The first author was French in 89/100 cases. Of the 100 articles, 56 were based on a multi-centre study and 21 on an international study. Finally, 22/100 articles reported studies sponsored by a scientific society.

Discussion: The 100 articles identified in this study deserve to be viewed as influential. The number of citations will continue to rise, thereby amplifying the impact of OTSR on worldwide research in orthopaedic surgery.

Level Of Evidence: IV, systematic retrospective analysis.
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http://dx.doi.org/10.1016/j.otsr.2019.01.016DOI Listing
December 2019

French translation and cultural adaptation of a questionnaire for patients with hip or knee prosthesis.

Orthop Traumatol Surg Res 2019 05 8;105(3):435-440. Epub 2019 Mar 8.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.

Introduction: The Kingsbury questionnaire offers the possibility of follow-up by means of an X-ray and a simple questionnaire sent to the home address of the patient, who will not need to come in consultation if there are no problems. The questionnaire detects any anomaly in follow-up. In case of anomaly in the questionnaire or radiograph, the patient is contacted and/or seen again, as appropriate. The Kingsbury questionnaire has had no transcultural validation, and we therefore conducted a prospective study in order to 1) translate into French the questionnaire, previously validated in English; 2) adapt it for good understanding according to cultural habits; and 3) assess the translated version on a test-retest procedure.

Hypothesis: The study hypothesis was that the translated questionnaire would show good test-retest reproducibility.

Material And Methods: The exact English version of the questionnaire was obtained directly from the authors of the index publication. A methodology of translation, back-translation and test-retest enabled assessment of the translation and of the reproducibility of the French version. The reference method of cultural adaptation of self-administered questionnaires and patient information documents was used. The questionnaire was tested prospectively.

Results: One hundred patients were contacted, providing 73 clinical tests with radiographic validation and 48 complete test-retests in a representative population of total hip and total knee arthroplasty (THA, TKA). Internal coherence showed a KR-20 coefficient of 0.71 and Cronbach alpha of 0.76: e.g., good internal coherence. Item difficulty, requiring renewed contact, was low for all questions. Mean variance was low on the first 7 questions: 0.08 (range, 0.02-0.16). Correlation was close to 0.5 for each question. Analysis of reproducibility found excellent agreement (>90%) for the first 7 questions, which were binary; for question 8, agreement was good (83.3%) considering that there were 5 possible responses. For 19 of the 73 respondents, the questionnaire results indicated a need for further contact. After analysis of their radiographs, 4 needed to be seen in consultation again. The other 15 had unfavorable responses but without deterioration since the last classical consultation or any radiologic abnormality consultation, and were not called back for consultation.

Conclusion: The French version of the Kingsbury questionnaire provided reproducible assessment, avoiding the need to call the patient back for consultation unnecessarily. The questionnaire needs validating in a larger sample before being widely used: the present study was just a first step.

Level Of Evidence: IV, Prospective without control group.
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http://dx.doi.org/10.1016/j.otsr.2019.01.011DOI Listing
May 2019

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

Int Orthop 2019 07 23;43(7):1599-1609. Epub 2019 Jan 23.

Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand BP 69, 63003, Clermont Ferrand Cedex 01, France.

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.
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http://dx.doi.org/10.1007/s00264-019-04287-0DOI Listing
July 2019

7-year results of primary total hip arthroplasty with the uncemented Avenir stem.

Hip Int 2019 Jul 11;29(4):418-423. Epub 2018 Nov 11.

1 Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France.

Aims: The aim of the present study was to evaluate the 7-year functional outcome and radiographic results of primary total hip arthroplasties (THAs) performed with the uncemented Avenir stem.

Patients And Methods: Between January 2006 and October 2008, 100 consecutive primary hips in 92 patients were enrolled at 2 centres. The mean age at operation was 58.5 years (27-87 years). Mini-incision (50%) and standard approaches (50%) were used to implant 22 standard and 78 lateralised stems.

Results: The 7-year Kaplan-Meier survival rate was 98.9% (95% CI, 92.9-99.8) with stem revision for any reason as endpoint. No stem related complications occurred. 1 stem revision was due to deep infection at 51 months post-op. We had 4 acetabular revisions. The mean Harris Hip Score (HHS) at 7 years follow-up was 93.1 points (60-100). Radiographic analysis showed 2 patients had non-progressive radiolucent lines and no patient had any signs of stem subsidence or loosening.

Conclusion: The 7-year implant survival and the functional outcomes for THA performed with the study device are excellent and were in line with those documented for comparable contemporary uncemented fully HA-coated stems. Longer term follow-up of this consecutive series needs to be performed.
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http://dx.doi.org/10.1177/1120700018810211DOI Listing
July 2019

Irradiation at 11 kGy conserves the biomechanical properties of fascia lata better than irradiation at 25 kGy.

Clin Biomech (Bristol, Avon) 2018 12 12;60:100-107. Epub 2018 Oct 12.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France.

The objective of this study was to determine the biomechanical properties of the fascia lata and the effects of three preservation methods: freezing, cryopreservation with dimethylsulfoxide solution and lyophilization; and to compare the effects of low-dose (11 kGy) and normal-dose (25 kGy) gamma-ray sterilization versus no irradiation. 248 samples from 14 fasciae latae were collected. Freezing samples were frozen at -80 °C. Cryopreservation with dimethylsulfoxide solution samples were frozen with 10 cl dimethylsulfoxide solution at -80 °C. Lyophilization samples were frozen at -22 °C and lyophilized. Each preservation group were then randomly divided into 3 irradiation groups. The cryopreservation with dimethylsulfoxide solution samples had significantly worse results in all 3 irradiation conditions. Young's modulus was lower for the freezing samples (p < 0.001) and lyophilization samples groups (p < 0.001). Tear deformation was lower for the freezing samples (p = 0.001) and lyophilization samples groups (p = 0.003), as was stress at break (p < 0.001 and p < 0.001). Taking all preservation methods together, samples irradiated at 25 kGy had worse results than the 0 kGy and 11 kGy groups in terms of Young's modulus (p = 0.007 and p = 0.13) and of stress at break (p = 0.006 and p = 0.06). The biomechanical properties of fascia lata allografts were significantly worse under dimethylsulfoxide cryopreservation. The deleterious effects of irradiation were dose-dependent.
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http://dx.doi.org/10.1016/j.clinbiomech.2018.10.016DOI Listing
December 2018