Publications by authors named "Julien Dartus"

21 Publications

  • Page 1 of 1

Above-the-knee amputation versus knee arthrodesis for revision of infected total knee arthroplasty: recurrent infection rates and functional outcomes of 43 patients at a mean follow-up of 6.7 years.

Orthop Traumatol Surg Res 2021 Mar 31:102914. Epub 2021 Mar 31.

Univ Lille, Hauts de France, F-59000 Lille, France; Service d'orthopédie, Hôpital Salengro, Place de Verdun, CHU Lille, F-59000 Lille, France; CRIOAC, Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes Lille-Tourcoing, rue Emile Laine, F-59000 Lille, France.

Introduction: In cases of repeated treatment failure of periprosthetic joint infections (PJI) of the knee, above-the-knee amputation (AKA) or knee arthrodesis can be proposed to reduce the risk of recurrent infection, especially in cases with major bone defects or irreparable damage to the extensor mechanism of the knee. Since AKA versus knee arthrodesis results have been rarely assessed for these indications, we conducted a retrospective case-control study to compare both the rates of recurrent infection and functional outcomes.

Hypothesis: Patients who underwent AKA had fewer recurrent infections than those who had arthrodesis.

Materials And Methods: Twenty patients who underwent AKA and 23 patients who had knee arthrodesis, between 2003 and 2019, were retrospectively included in this study. These two groups were comparable in age (73.8 versus 77.7 years (P = .31)) and sex (10 women and 10 men versus 16 women and seven men (P = .19)). Each group was analyzed individually and then compared in terms of survival (recurrent infection) and functional outcomes using clinical assessment scores (visual analog scale (VAS), French neuropathic pain questionnaire (DN4), Parker and Palmer mobility score and the 36-item short-form survey (SF-36)).

Results: The rate of recurrent infection was 10% (two out of 20 patients) for the AKA group and 21.75% (five out of 23 patients) for the arthrodesis group (P = .69). The mean follow-up for the AKA group was 4.18 years (1.2-11.8) and 9.7 years (1.1-14.33) for the arthrodesis group (P = .002). The number of previous revisions (three (1.5-4) for AKA and two (2-3) for arthrodesis) and the time between the primary arthroplasty and surgical procedure were significantly greater in the AKA group (48.0 (12.0-102.0) months) than the arthrodesis group (48.0 (24.0-87.0) months) (P <.001). The AKA group had significantly better clinical results for VAS (2.7 ± 2.2 vs. 3.1 ± 3.3), DN4 (1.5 ± 2.1 vs. 2.6 ± 2.9), Parker and Palmer (5.2 ± 1.7 vs. 4.6 ± 1.4), and SF-36 (30.9 ± 15.6 vs. 26.9 ± 17.0) (P <.001).

Conclusion: Above-the-knee amputation and knee arthrodesis showed no differences in the rate of recurrent sepsis. However, the comparison of the two groups demonstrated that patients who underwent an AKA had less pain, were more autonomous and had a better quality of life.

Level Of Evidence: III; retrospective case-control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2021.102914DOI Listing
March 2021

Diagnostic accuracy of the BJI InoPlex™ (Diaxonhit) immunoassay on blood samples for periprosthetic joint infection in complex microbiological situations. Preliminary results of 24 cases in a French Reference Center for Complex Bone and Joint Infection (CRIOAC).

Orthop Traumatol Surg Res 2021 Mar 28:102909. Epub 2021 Mar 28.

University Lille, CHU de Lille, ULR 4490, département universitaire de chirurgie orthopédique et traumatologique, 59000 Lille, France; CRIOAC, centre de référence pour le traitement des infections ostéo-articulaires complexes Lille-Tourcoing, rue Emile-Laine, 59037 Lille, France; CHU de Lille, service de bactériologie-hygiène, centre de biologie-pathologie, 59000 Lille, France.

Background: While joint aspiration is the benchmark for diagnosing periprosthetic joint infections (PJI), the results can be flawed because certain bacteria are difficult to culture, the patient is on concurrent antibiotic therapy or in some cases, repeated joint aspirations confer conflicting results. The BJI InoPlex™ (Diaxonhit) is a multiplex ELISA (Enzyme Linked Immunosorbent Assay) that measures the immune response (presence of specific IgG) to certain bacterial species from three families: Staphylococcus (8 antigens) epidermidis, aureus and lugdunensis, Streptococcus B (4 antigens) and Cutibacterium acnes (4 antigens). This assay is done with peripherally collected blood. However, there are few published studies about this assay, especially if the microbiological diagnosis is in doubt in cases of suspected chronic PJI. This led us to conduct a retrospective study in a French tertiary care center to determine 1) the sensitivity and specificity of the BJI InoPlex™, 2) its positive (PPV) and negative predictive value (NPV) and 3) what causes diagnostic errors.

Hypothesis: The BJI InoPlex has a sensitivity/specificity and PPV/NPV above 75%.

Materials And Methods: The BJI InoPlex was used 24 times on 24 patients between January 2016 and January 2017 in scenarios where the microbiological diagnosis was difficult: 1 with on-going antibiotic therapy, 13 conflicting repeat joint aspirations, 10 negative cultures with history of infection and/or clinical evidence of a PJI. The series consisted of 11 hip arthroplasty and 13 knee arthroplasty cases. The results of the BJI InoPlex test were compared to the MusculoSkeletal Infection Society (MSIS) the criteria for a joint infection.

Results: For the bacterial species covered by the test, the sensitivity of the BJI InoPlex for diagnosing a chronic PJI based on the 2018 MSIS criteria was 50%, the specificity was 56%, the PPV was 36% and the NPV was 69%.

Discussion: While innovative, minimally invasive, and rapid (results in a few hours), the BJI InoPlex does not provide an effective diagnosis of chronic PJI in complex microbiological situations. In this study, we used the test in the most difficult situations possible and on a small number of patients, which may explain why the results were not as good as in other studies. Its current performance and cost mean there is no role for it in our algorithm for treating patients with a suspected PJI, contrary to other biomarkers. Its spectrum must include other bacterial strains involved in chronic PJI. Knowledge of the specific infectious agent increases its diagnostic value, it could be used to monitor the outcome of a PJI, although other studies would be needed to support this use.

Level Of Evidence: IV-Retrospective diagnostic study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2021.102909DOI Listing
March 2021

The advantages of cone-beam computerised tomography (CT) in pain management following total knee arthroplasty, in comparison with conventional multi-detector CT.

Orthop Traumatol Surg Res 2021 Feb 26:102874. Epub 2021 Feb 26.

Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France.

Background: Revision of total knee arthroplasty (TKA) requires preoperative assessment to identify the causes of failure. Multidetector computerised tomography (MDCT) is a commonly used imaging technique, but is sensitive to certain artifacts, such as metal implants, limiting its use. Cone-beam CT (CBCT) is a new technique dedicated to musculoskeletal imaging that is less sensitive to artifacts and could be utilised in knee implantation surgery. CBCT has not yet been validated for this indication, and we therefore undertook a retrospective assessment of MDCT versus CBCT, comparing: 1) image quality; 2) reproducibility of angle measurements; 3) effectiveness in screening for periprosthetic radiolucency and implant loosening; and 4) radiation dose.

Hypothesis: This study hypothesised that CBCT provides better image quality, angle measurement reproducibility, and screening for radiolucency and implant loosening at lower doses of radiation than MDCT.

Patients And Method: Between October 2017 and March 2018, 28 patients, with a mean age of 61±11.6 years [range, 45-85 years] underwent both MDCT and CBCT for pain following TKA. Two radiologists performed angle measurements on both devices: patellofemoral tilt (PFT), rotation angle of the femoral component (RAFC) and rotation angle of the tibial component (RATC). They also screened for pathological radiolucency and/or implant loosening, and assessed image quality at the various bone/implant interfaces. The mean CT dose index per examination was recorded.

Results: Intraclass correlation coefficients for angles and radiolucency screening on MDCT and on CBCT were respectively good (0.73) and excellent (0.82) for PFT, borderline (0.28) and moderate (0.44) for RAFC, excellent (0.82) and excellent (0.96) for RATC, and moderate (0.45) and excellent (0.84) for radiolucency screening. The inter-observer kappa correlation coefficients for diagnosis of implant loosening and image quality assessment for MDCT and CBCT were respectively moderate (0.45) and excellent (0.93) for tibial loosening and low (0.19) and borderline (0.38) for femoral loosening. The mean image quality at the various interfaces for MDCT and CBCT was respectively 2.2/3 and 2.75/3 at the tibia/tibial implant interface, 1/3 and 2.3/3 at the trochlear region/femoral implant interface, 0.9/3 and 2/3 at the femoral condyle/femoral implant interface, and 1.25/3 and 2.1/3 at the patella/patellar medallion interface. The mean CT dose index was significantly lower, by a factor of 1.24, on CBCT (4.138 mGy) than MDCT (5.125 mGy) (p<00396).

Conclusion: The results of the present study revealed added value for CBCT in the etiological work-up for pain following a TKA. It was reliable and reproducible for the rotation measurement and diagnosis of implant loosening, due to enhanced image quality despite a lower radiation dose than conventional MDCT.

Level Of Evidence: III; retrospective comparative study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2021.102874DOI Listing
February 2021

Impact of introducing extremity cone-beam CT in an emergency radiology department: A population-based study.

Orthop Traumatol Surg Res 2021 Apr 29;107(2):102834. Epub 2021 Jan 29.

Department of Musculoskeletal Radiology, Lille University Hospital, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Emile Laine, 59037 Lille cedex, France; Lille University School of Medicine, Faculté de Médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France.

Background: Musculoskeletal cone-beam CT (CBCT) recently appeared on the market, with image quality comparable to that of high-resolution CT. It was previously implemented mainly in craniofacial surgery and in orthopedic limb surgery for weight-bearing imaging, but without large-scale assessment in emergency settings. We therefore conducted a retrospective comparative study in an emergency radiology department: 1) to assess whether introduction of CBCT dedicated to extremity traumatology reduced radiation dose delivered to the patient undergoing cross-sectional imaging, 2) to assess whether it increased turnover, and 3) to study the feasibility and practical consequences. Study hypothesis Introducing CBCT dedicated to traumatology in an emergency radiology department reduces radiation dose related to cross-sectional imaging in extremity trauma.

Patients And Methods: Two periods were distinguished: in May-November 2016, the only cross-sectional imaging available in our emergency radiology department was multi-detector CT (MDCT); in May-November 2017, both MDCT and CBCT were available. Thus, the population in period 1 (n=165) had undergone only MDCT extremity imaging, while patients in period 2 underwent either CBCT (n=139) or MDCT (n=85). Study parameters notably included dose-length product (DLP) and length of patient stay in the radiology department (turnover).

Results: Mean DLP was significantly reduced with the introduction of CBCT: 210.3±133.6 mGy.cm (range, 20-595) in period 1, versus 138.4±92.7 mGy.cm (range, 32-623) in period 2 (p<0.0001). Taking both periods together, mean DLP was 50.7% lower with CBCT (n=139) than MDCT (n=249): respectively, 101.6±14.9 mGy.cm (range, 50.6-126.9) versus 206.5±131.8 mGy.cm (range, 20-623) (p<0.0001). Turnover accelerated with the introduction of CBCT, with mean stay of 84.9minutes in period 1 versus 72.1minutes in period 2 (p=0.011). In period 2, turnover was 23.6% faster with CBCT than MDCT: respectively, 64.9minutes versus 85.0minutes (p=0.0004).

Discussion: Introducing CBCT dedicated to the extremities in an emergency radiology department was feasible. It reduced overall radiation dose and accelerated turnover.

Level Of Evidence: III; comparative case-control study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2021.102834DOI Listing
April 2021

Can the minimal clinically important difference be determined in a French-speaking population with primary hip replacement using one PROM item and the Anchor strategy?

Orthop Traumatol Surg Res 2021 Jan 29:102830. Epub 2021 Jan 29.

Université de Lille, 59000 Lille, France; University of Lille, CHU of Lille, ULR2694-METRICS: évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Department of biostatistics, CHU Lille, 59000 Lille, France.

Background: The impact of surgery on the patient is classically assessed on pre- and post-treatment scores. However, it is increasingly recommended to rank these results according to the minimal clinically important difference (MCID), using either the data distribution method or the anchor method, latter consisting in an extra question specifically targeting the patient's improvement. MCIDs vary between populations and, to the best of our knowledge; there have been no investigations in France regarding this in the context of total hip replacement (THR). Therefore, we conducted a prospective study in a population with THR to determine: 1) whether MCID scores in France were comparable to those reported in the data from the international literature; 2) whether a general item taken from a different score could serve as an anchor; and 3) whether an item from the actual questionnaire itself could serve as an anchor.

Hypothesis: When pre- and post-treatment scores are available, an item from the questionnaire itself can serve as an anchor for MCID.

Material And Methods: In a prospective observational study, 123 primary THR patients (69 male, 54 female), out of 150 initially included, completed the 5 domains of the HOOS hip disability and osteoarthritis outcome score and the Oxford-12 questionnaire, preoperatively and at 6-12 months. The MCID was calculated via the distribution-based and the anchor-based methods. Two Oxford items (questions 1 and 2) and 2 HOOS items (questions S1 and Q4) were used as anchors, as well as a supplementary question on improvement and the Forgotten Joint Score (FJS).

Results: At a mean 10.12±1.2 months' follow-up [range, 6.5-11.9 months], the Oxford-12 score increased from 19±8 [3-35] to 40±10 [8-48] (p<0.001), all HOOS components demonstrated improvement, and the FJS at the final follow-up was 71±29 [0-100]. The general items (Oxford question 1 and HOOS question Q4) were more discriminating than the joint-specific items (Oxford question 2 and HOOS question S1). Based on results from the 3 anchors (improvement rated 1 to 5, Oxford question 1 and HOOS question Q4), 3 to 5 patients showed deterioration, 5 to 6 were unchanged, 30 to 40 were slightly improved, and 73 to 80 were improved by THR. The mean MCID on both distribution and anchor methods was 9 [5.5-12] for Oxford-12, 20 [12-27] for HOOS symptoms, 26 [10-36] for HOOS pain, 22 [11.5-28] for HOOS function, 26 [13-34] for HOOS sport and 22 [14-28] for HOOS quality of life.

Discussion: The MCID for the Oxford-12 and HOOS scores in a French population was comparable to data from the past literature. Using a score item as an anchor to define improvement is possible, but only if a general item is used.

Level Of Evidence: IV; prospective study without control group.

Clinical Trials Registration: NCT04057651.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2021.102830DOI Listing
January 2021

Hip arthroscopy in France: An epidemiological study of postoperative care and outcomes involving 3699 patients.

Orthop Traumatol Surg Res 2021 Feb 29;107(1):102767. Epub 2020 Dec 29.

University Lille, ULR 2694 Metrics, CERIM, 59000 Lille, France; CHU Lille, Pôle de santé publique, 59000 Lille, France.

Background: Hip arthroscopy is a surgical procedure that is becoming more and more prevalent in France. Even though indications are now well-established little is still known about patient outcomes. Therefore, the purpose of our retrospective study was to: (1) describe the circumstances in which hip arthroscopies are being performed; (2) study arthroscopy and arthroplasty reoperation rates; (3) assess the incidence of readmissions for complications.

Hypothesis: Hip arthroscopy in France produced similar results to those observed in other countries.

Materials And Methods: We conducted a cohort study from January 2008 to December 2014 in the French population using the national hospital discharge database called "Programme de médicalisation des systèmes d'information (PMSI)." We included all admissions that had a hip arthroscopy code and analyzed readmissions for conversion to hip arthroplasty, revision hip arthroscopy and complications (without being able to provide detailed descriptions). Risk factors associated with conversion, revision and readmission for complications were studied after performing a population analysis.

Results: A total of 3,699 patients were included over a period of seven years. The mean age was 40 years, with women being significantly older (mean age of 43 years) than men (38 years) (p<0.05). The number of procedures increased from 240 in 2008 to 702 in 2014. Synovectomies (67.9%; 2514/3699) and surgical bone procedures (acetabuloplasty or femoroplasty) (47.3%; 1751/3699) were the main procedures performed during the primary arthroscopy. In total, 410 patients underwent a conversion to arthroplasty, 231 patients had a revision arthroscopy, and 126 patients suffered a complication. Five years after the index procedure, the conversion rate was 16.3%, revision rate was 8.2%, and readmission rate for a postoperative complication was 5%. The main risk factor associated with conversions was [Hazard ratio (HR) and 95% Confidence Index (CI)] an age between 40 and 79 years during the first arthroscopy [3.04 (2.40; 3.87) compared with the reference class of 25-39 years]. Patients between ages 16 to 24 years during the first arthroscopy (0.35 [0.20; 0.61] compared with the reference class of 25-39 years) had a decreased risk of conversion (HR and 95% CI). The main risk factors associated with revisions were: synovectomies [1.90 (1.34; 2.70)] and surgical bone procedures on the femoral neck and/or the acetabulum [1.82 (1.36; 2.4)]. The risk factor associated with complication-related readmissions was an age greater than 40 years [2.23 (1.43; 3.49)].

Conclusion: Unlike the international literature, our study population was largely male. The rates of revision (8.2% after five years) and conversion to arthroplasty (16.3% after five years) were relatively low and comparable to the different international studies. This procedure, which is not widely performed, is growing in popularity, has low morbidity and remains an interesting approach given the revision and conversion rates after five years. The implementation of specific coding for arthroscopic hip procedures and the pathologies to be treated seems warranted.

Level Of Evidence: IV; descriptive epidemiological study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.102767DOI Listing
February 2021

Salvage reconstruction of hip ligaments using absorbable material to treat recurrent instability of revision THA without abductor mechanism.

Orthop Traumatol Surg Res 2021 Feb 13;107(1):102783. Epub 2020 Dec 13.

Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France.

Dual-mobility and constrained cups can stabilise most recurrent dislocations of total hip arthroplasty (THA), but may fail in case of hip abductor mechanism loss. For such complex situations, we developed an original artificial iliofemoral and ischiofemoral ligament reconstruction technique using a polyglactin 910 mesh (Vicryl ™) associated to repositioning of a Lefèvre constrained liner adapted to hip range of motion to prevent cam effects. The technique was implemented in 2 patients showing recurrent dislocation after THA, associating total femur replacement and cemented constrained liner in a metal reinforcement ring. In one of the 2 cases, the abductor mechanism had been entirely sacrificed. This simple and accessible salvage technique prevented recurrence of dislocation at 12 months' follow-up in these complex cases, previously subject to several episodes per year.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.102783DOI Listing
February 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.05.016DOI Listing
December 2020

Return to work after hip resurfacing.

Orthop Traumatol Surg Res 2020 Dec 12;106(8):1507-1510. Epub 2020 Nov 12.

Service d'orthopédie C, Hôpital Salengro, CHRU de Lille, Lille, France; University of Lille, University of Artois, University Littoral Côte d'Opale, EA 7369-URePSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France. Electronic address:

Introduction: Hip arthroplasty is being performed in ever-younger patients, for whom return to work is a major issue. Type of job, type of implant and comorbidities all affect outcome. Heavy manual work is harder to resume after hip replacement, and reclassification or cessation of activity may ensue. This, however, is little dealt with in the literature, although its consequences are both psychologically and financially critical. The aim of the present study was to perform a retrospective analysis of return to work after hip resurfacing (HR).

Material: A retrospective study included patients undergoing Birmingham Hip Resurfacing with at least 6 months' follow-up. Occupational status was assessed, preoperatively and at follow up, as not working, in work or retired, type of work as sedentary, manual, or strenuous, and time to return to work was noted. Clinical assessment, preoperatively and at follow-up, used Postel Merle d'Aubigné, Harris, Devane, UCLA and Oxford scores.

Results: One hundred and seventeen patients were included (114 male, 3 female) for 121 HRs. Mean age was 52.9 years (range, 29-66 years). Mean follow-up was 14.3 months (range, 6-20 months), with no loss to follow-up. Crutches were abandoned in week 3 on average (range, 1-7 weeks). Four patients had no occupation; analysis focused on the other 113. At follow-up, only one patient had not resumed work, and was reclassified. The other 112 (99.1% of those in work) returned to their previous job at a mean 9.4 weeks (range, 1-22 weeks). Nine patients required therapeutic part-time work for a mean 5.3 weeks (range, 3-8 weeks). Time to return to work was significantly shorter for "sedentary" workers than "physical" (manual/strenuous) workers: 6.4 weeks (range, 1-9 weeks) versus 13.5 weeks (range, 2-22 weeks).

Discussion&conclusion: Return to work was feasible for almost all these young patients after HR. Sedentary work was resumed very quickly (<7 weeks), while strenuous work required 3 months' sick leave.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.07.009DOI Listing
December 2020

Treatment of femoroacetabular impingement by arthroscopy versus anterior mini-open approach: Case-control study of a continuous series of 91 cases at a mean 4.6 years' follow-up.

Orthop Traumatol Surg Res 2020 Dec 11;106(8):1575-1580. Epub 2020 Nov 11.

Hauts de France, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.

Introduction: Femoroacetabular impingement is a frequent cause of hip pain, and can be managed by conservative surgery. Many studies assessed postoperative course, but none compared operative techniques within a given population. We therefore conducted a retrospective case-control study comparing the minimally invasive anterior Hueter approach versus arthroscopy, assessing difference in 1) functional gain and 2) complications and 3) analyzing the impact of labral or cartilage lesions on functional scores.

Hypothesis: Clinical results do not differ between the mini-open and arthroscopic approach.

Material And Method: Between 2007 and 2018, 91 hips in 84 patients were treated for femoroacetabular impingement: 69/91 (75.8%) cam effect, 6/91 pincer effect (6.6%) and 16/91 mixed (17.6%). Fifty-five were treated by arthroscopy and 36 by the Hueter mini-open approach. There were 20 female and 71 male hips. Mean age at surgery was 32 years (range, 17-55 years). Potential predictive factors comprised Nötzli alpha angle, labral/cartilage lesion and type of surgery.

Results: Mean follow-up was 4.6 years (range, 1-16 years), with no loss to follow-up. The arthroscopy and Hueter groups showed no differences in functional improvement on Oxford-12 score (gain, -6.7±5.9 versus -6.2±8.1 (p=0.73), Postel Merle d'Aubigné (PMA) score (gain, 1.3±1 versus 1.1±0.9; p=0.41), operative time (75 versus 67min; p=0.16), or alpha angle correction (-10.9±12.9 versus -9.8±7.1; p=0.22). Complications did not differ: 1/55 severe complications after arthroscopy (1 definitive femoral nerve palsy) versus 4/36 non-severe complications after Hueter (3 cases of dysesthesia in the lateral cutaneous nerve of the thigh, 1 rectus femoris enthesopathy) (p=0.15). Labral lesions (37/91) did not affect clinical outcome: gain, 1.2±1 versus 1.3±0.9 on PMA (p=0.514) and -7.3±6 versus -6±7.3 on Oxford-12 (p=0.366). Cartilage lesions (27/91) were associated with poorer outcome on PMA (gain, 1±1.1 versus 1.3±0.9; p=002) but not on Oxford-12 (gain, -6.1±7.3 versus -6.7±6.6; p=0.288).

Conclusion: Impingement correction by the minimally invasive anterior Hueter approach gave clinical results comparable to those of hip arthroscopy in terms of Oxford and PMA scores, alpha angle correction, operative time and complications. Cartilage lesions were associated with poorer clinical results.

Level Of Evidence: III; retrospective case-control study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.07.006DOI Listing
December 2020

Rate of publication in predatory journals by orthopedic surgeons members of the French orthopedic and traumatology society (SOFCOT): A follow-up note.

Orthop Traumatol Surg Res 2020 Dec 31;106(8):1457-1461. Epub 2020 Oct 31.

Service d'orthopédie, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France; University of Lille, CHU of Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France.

Background: France ranks 9th worldwide for scientific publication in orthopedics and the increase in both the quantity and the quality of its scientific production has been described in detail. On the other hand, publishing by French orthopedic surgeons in predatory journals is more obscure. The journals in question are difficult to identify but are based on an open-access model with article processing charges (APC), except in rare cases that are difficult to specify, as they are not stated at the time of submission. The increase in the number of predatory journals over the last 10 years led us to attempt to assess the rate at which French orthopedic surgeons publish in them, as revealed by investigation of the SIGAPS bibliometric database.

Hypothesis: Over the period 2008-2017, the rate of publications by French orthopedic surgeons in predatory journals was less than 5%.

Material And Method: The SIGAPS database contains the detail of publications by French orthopedic surgeons members of the French Society of Orthopedic Surgery and Traumatology (SoFCOT) and was used to analyse all such articles (journal article, review or editorial) so as to isolate articles with PubMed-Not-MEDLINE status falling in the SIGAPS non-classified (NC) category and to determine the predatory status of the journal using established lists, such as Beall's list or that drawn up by StopPredatoryJournals. In case of difficulty in determining predatory status, we applied the criteria defined by Beall and the Committee on Publication Ethics (COPE).

Results: Out of 6056 articles in the SIGAPS database published by French orthopedic surgeons between 2008 and 2017, 323 could be suspected of being published in a predatory journal, but only 33 were so confirmed: i.e., 0.55% of French orthopedic scientific output over the study period. Eleven appeared in journals whose publishers were listed as predatory by Beall, 21 appeared in journals whose publishers had been listed as predatory on Beall's list in 2012 with the dubious editorial practices defined by Beall, and one article appeared in a journal found to be predatory on analysis of its editorial board. More than half of these articles (58%) were subject to APCs averaging $400.

Discussion: Despite a strong increase in the number of predatory journals over the last decade, very few French orthopedic surgeons resort to them to publish their work. Difficulty of identification and authors' lack of knowledge about this type of journals may account for some of these submissions. Scientific teams need to check certain criteria before submitting to a journal: short time to publication and low APC should be taken as warning signs, and any demand for payment after acceptance certainly raises the question of the journal's predatory nature.

Level Of Evidence: IV; retrospective study without control group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.03.042DOI Listing
December 2020

Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? Case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years' follow-up.

Orthop Traumatol Surg Res 2020 12 26;106(8):1561-1568. Epub 2020 Oct 26.

SOFCOT, 56, rue Boissonade, 75014 Paris, France.

Introduction: Avascular necrosis of the femoral head often progresses to femoral head collapse if not treated. Conservative treatment yields highly variable results and is not standardised, mainly because it is typically evaluated in small patient populations. This led us to conduct a large retrospective comparative study with the goals of 1) analysing survival and functional outcomes, 2) looking for differences in survival between core decompression techniques (standard versus augmented), and 3) studying the risk factors for femoral head collapse and revision by arthroplasty.

Hypothesis: Core decompression limits the number of patients who suffer femoral head collapse requiring arthroplasty at 2 years' follow-up.

Methods: This multicentre, comparative, retrospective study analysed 330 patient records (1975-2016) where at least 2 years' follow-up was available. Sixty-two patients were excluded from the analysis: 5 had a stage III with collapse, 5 were lost to follow-up, 2 died within 24 months of the procedure and 50 had incomplete data. The study included 263 patients with a mean age of 42 years (15.7-70). In the Ficat classification, there were 51 cases of stage I necrosis, 186 cases of stage II and 22 cases of stage II with crescent sign (transition stage). The Kerboull angle on radiographs was between 5° and 20° in 40 patients, between 20° and 40° in 107 patients, between 40° and 60° in 52 patients and more than 60° in 29 patients. A standard core decompression was done in 79 patients and an augmented one in 184 patients. The more severe AVN cases (stage II) were more likely to be treated by augmented CD (160/184 patients, 87%) than by standard CD (48/79 patients, 61%) (p<0.001).

Results: In the 263 patients, the overall survival (no arthroplasty at 2 years) was 73% (196/263). At 2 years, the survival rate (without arthroplasty) was 71% (56/79) in the standard CD group versus 76% (140/184) in the augmented CD group. This difference was significant when adjusted for Ficat stage and Kerboull angle [HR=0.457, 95% CI (0.247-0.844) (p=0.012)]. When the survival data was adjusted to the Ficat stage, augmented CD was better than standard CD with 10-year survival of 58.1% vs. 57.9% (p=0.0082). More than 30% necrosis volume increased the risk of failure [HR=3.291 95%CI (1.494-7.248) (p=0.0031)]. Also, a Kerboull angle above 60° increased the risk of failure [HR=3.148 95%CI (1.346-7.5) (p=0.0083)].

Conclusion: After 2 years, CD for non-collapsed femoral head AVN prevents collapse and revision to arthroplasty in 73% of cases (196/268). Augmented CD improves the 2-year survival and the long-term survival after adjusting for preoperative characteristics (Kerboullangle and Ficat stage). The risk of collapse and need for arthroplasty is greater in patients with 30% necrosis volume on MRI and Kerboull angle above 60°.

Level Of Evidence: III; retrospective case-control study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.03.040DOI Listing
December 2020

Publication rate of studies presented at the French Arthroscopic Society Meeting in 2014.

Orthop Traumatol Surg Res 2020 Dec 2;106(8S):S189-S194. Epub 2020 Sep 2.

French Arthroscopic Society, 15, rue Ampère, 92500 Rueil-Malmaison, France.

Introduction: Publication rates for studies reported at French Arthroscopic Society (Société francophone d'arthroscopie, SFA) meetings are not known. A comprehensive search of podium presentations to the 2014 SFA meeting was performed, assessing: (1) publication rate for meeting abstracts, and (2) bibliometric parameters including journal Impact Factor.

Hypothesis: The full-text publication rate for abstracts accepted for the 2014 French Arthroscopic Society (SFA) meeting was around 47.1%: i.e., the rate reported for the 2013 meeting of the French Society of Orthopedic Surgery and Traumatology (SoFCOT).

Material And Methods: Bibliometric analysis of all abstracts accepted for the 2014 SFA annual meeting was undertaken by the Junior French Arthroscopic Society (SFA Junior), who collated the podium presentations. Reported studies were retrospective in 43 cases (54%) and prospective in 36 (46%). They consisted in clinical studies in 52/79 cases (66%), experimental studies in 4 (5%), cadaver or animal studies in 13 (16.5%), epidemiological studies in 8 (10%), a case report in 1 (1.2%) and a literature review in 1 (1.2%). Thirty-two (40.5%) concerned the shoulder and 31 (39%) the knee. Publication was checked on systematic PubMed-Medline search of authors' names. Articles found on PubMed-Medline were downloaded into the SIGAPS scientific publication search, management and analysis system database. Journal impact factor and SIGAPS category (A to E) were obtained, as were number of citations and h-index. This was a descriptive study, assessing numbers; results were reported as number and percentage.

Results: Overall publication rate was 31/79 (39.2%): 20/31 clinical studies (64.5%), 6 cadaver studies (19.4%), 3 epidemiology studies (9.7%), 1 experimental study (3.2%) and 1 literature review (3.2%). Mean 2014 SFA meeting-to-publication time was 18.7 months [range, -2 to 60 months]. Journal SIGAPS categories were A for 4 articles (13.3%), B for 13 (43.3%), C for 3 (10%), D for 9 (30%), with no E category articles but 1 article (3.3%) without SIGAPS category.

Conclusion: The publication rate for abstracts accepted for report to the 2014 SFA annual meeting was lower than for the 2013 SoFCOT meeting. The high level of the journals in question testified to the quality of the studies reported at the SFA meeting.

Level Of Evidence: IV, retrospective study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.08.003DOI Listing
December 2020

[Reaction during dalbavancin infusion: About one case].

Therapie 2020 Jul 8. Epub 2020 Jul 8.

Département de maladies infectieuses, CH Gustave Dron, 59200 Tourcoing, France; Université Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, 59000 Lille, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.therap.2020.06.015DOI Listing
July 2020

A profile on the Synovasure alpha defensin test for the detection of periprosthetic infections.

Expert Rev Mol Diagn 2020 09 12;20(9):895-904. Epub 2020 Oct 12.

Rererent Center for Complex Bone and Joint Infections, Roger Salengro Hospital , Lille, France.

Introduction: Clinicians have waited a long time for a 'universal' marker that may help them distinguish infected from non-infected total joint arthroplasties when doubts persist after using classical clinical and biological signs of infection. In recent years, synovial fluid biomarkers including leukocyte esterase, alpha-defensins, and CRP have shown promising results for the diagnosis of periprosthetic joint infections (PJIs).

Areas Covered: This review provides an overview of the rational and the use of the Synovasure® alpha-defensin tests in patients with a suspicion of PJI. Using a systematic investigation by keywords, we looked for all citations (and the citations to these citations) of the selected papers.

Expert Opinion: The Synovasure® alpha-defensin tests demonstrate high potential for the diagnosis of PJIs. However, the data currently available also show that the universal marker of infection in the settings of PJIs is still to be discovered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14737159.2020.1792780DOI Listing
September 2020

Is the economic and social cost of one-stage bilateral hip resurfacing lower than two-stage procedures? Retrospective case-control study of 260 hips.

Orthop Traumatol Surg Res 2020 May 4;106(3):535-542. Epub 2020 Apr 4.

Université Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université Lille 2, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.

Background: Studies on the economic impact of medical practices and estimates of intra- and extra-hospital costs have an important role in controlling healthcare spending. But few studies of this nature have been done for bilateral surgery in a single operative session. This led us to carry out a health economics study to determine whether (1) bilateral hip resurfacing arthroplasty (HRA) performed in one stage instead of two stages will reduce the health care expenditures (costs of hospitalization, medical leave, rehabilitation), (2) it is equally safe for the patient. Hypothesis One-stage bilateral HRA is less costly for the health care system than two-stage bilateral resurfacing.

Methods: This was a single-center, single-surgeon retrospective cohort study comparing patients who underwent bilateral HRA in one stage (53 cases) or in two stages (77 cases). We determined the intra-hospital costs based on the French National Cost Scales and the extra-hospital costs (medical leave and rehabilitation), perioperative data (blood loss, operation time, duration of narcotic analgesic use, medical and surgical complications) and the outcomes with a mean follow-up of 4.8 years [1.7-10.1].

Results: The total costs for the one-stage group (€16,840.94±7042.7) were significantly less than those of the two-stage group (€19,335.0±7296.9) (p=0.0101). The two groups were comparable except for the one-stage group having more primary hip osteoarthritis indications (72% (38/53)) than the two-stage group (49% (38/77)) (p=0.0111). The main differences between groups was the cost and duration of hospitalization, with cost of €10,546.06±2049.47 and average length of stay (ALS) of 9.83±2.19 days in the one-stage group and €13,569.49±2186.30, ALS=15.04±3.15 days in the two-stage group (p<0.0001). There was no significant difference in the length of medical leave: 67.15±50.36 (0-180) days for the one-stage group and 97.89±108.39 (0-730) days for the two-stage group (p=0.1933).

Conclusion: Performing bilateral HRA during a single hospital stay results in lower health care expenditures than performing it during two separate hospital stays. Similar studies on other surgical procedures could help to promote the simultaneous nature of bilateral procedures and reset the current pricing, which is currently too low in the French health care system.

Level Of Evidence: III, Retrospective case-control study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2020.01.011DOI Listing
May 2020

Bibliometric evaluation of orthopaedics and traumatology publications from France: 20-year trends (1998-2017) and international positioning.

Orthop Traumatol Surg Res 2019 12 13;105(8):1425-1437. Epub 2019 Nov 13.

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

Background: Little is known about the scientific publication output for individual countries and medical specialties. The contribution of French authors to the currently expanding volume of publications on orthopaedics and traumatology (OT) is unclear. Orthopaedics & Traumatology: Surgery & Research (OTSR) is an English-language version of a preexisting French journal that was launched in 2009 to increase the dissemination of research done in France. The objective of this study was to use Web of Science (WoS) data from 1998 to 2017 to determine (i) the contribution of OT publications to the total worldwide volume of scientific publications, (ii) the contribution of OT publications from France to the total worldwide volume of OT publications, and (iii) changes over time in the proportion of OT publications from France with special attention to potential effects of the creation of OTSR.

Hypothesis: The proportion of OT publications from France increased after 2010-2012, indicating a positive effect of OTSR.

Material And Methods: WoS data were used to identify original studies and review articles written by at least one French author, published between 1998 and 2017, and dealing with OT (defined as orthopaedics and/or traumatology in adult and/or paediatric patients). The worldwide volumes of publications in OT and other specialties were compared. Within worldwide OT publications, the proportion from France was determined. Indicators of impact were evaluated during successive 5-year periods. Finally, the position of OT in worldwide research was assessed and OT journals were analysed.

Results: Among worldwide scientific medical publications, the proportion dealing with OT increased year on year from 1.93% in 1998 to 2.65% in 2017. Among annual publications from France, the proportion dealing with OT rose similarly, from 1.32% to 2.40%. Over the 20-year study period, France moved from the sixth to the ninth position, chiefly due to a large increase in publications from Asia. However, France remained in third position among European countries and increased its OT production 3-fold between 1998 and 2017. The proportion of OT articles from France that ranked among the top 1% most cited articles increased by 65% from 2008-2012 (20 articles) to 2013-2017 (33 articles), and the proportion in the top 10% increased by 31.8% (211 in 2008-2012 and 278 in 2013-2017). This rate of progression was faster than in any of the other western countries. Between 1998-2011 and 2012-2017, the contribution of French OT to publication output showed a 1.56-fold greater increase than did the contribution of OT to the worldwide volume of scientific medical publications.

Discussion: OT publications from France have kept pace with the steady increase seen worldwide over the last 20years. Although the US and UK remain in the lead, and despite the considerable growth in the output of Asian countries, France occupies a prominent position on the international OT scene. The creation of OTSR has elevated the international profile of French OT centres.

Level Of Evidence: IV, retrospective study with no control group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2019.07.025DOI Listing
December 2019

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2019.09.022DOI Listing
November 2019

Publication output of French orthopedic and trauma surgeons: Quantitative and qualitative bibliometric analysis of their scientific production in orthopedics and other medical fields.

Orthop Traumatol Surg Res 2019 12 18;105(8):1439-1446. Epub 2019 Oct 18.

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

Introduction: Bibliometric analysis is being used more and more in orthopedics and traumatology. However, the quantity and quality of publications authored by French orthopedic and trauma surgeons outside their discipline have never been analyzed, nor has the change in the quality of orthopedics publications. This led us to carry out a bibliometric analysis to answer the following questions: 1) How has the quantity of scientific production by French orthopedists changed over the past 10 years? 2) How has the quality of the overall scientific production by French orthopedists changed over the past 10 years?

Hypothesis: From 2008 to 2017, the production of French orthopedists has increased in quantity and quality in orthopedics and other medical fields.

Material And Methods: The analysis was performed by cross-referencing the list of SOFCOT (French Society for Orthopaedic Surgery and Traumatology) members with the French SIGAPS database and the InCites platform. Out of 3979 SOFCOT members, 972 (24%) had authored publications during this period and were included in the analysis. Several indicators were analyzed: number of publications; SIGAPS score (production quality) for the various Web of Science (WoS) categories; number and percentage of publications in the top 1% and top 10% (most highly cited articles worldwide).

Results: The "Orthopedics" discipline was still the most prevalent with 68% of all publications identified. The "Surgery" discipline was stable, and the share of publications had increased in five other disciplines: Sports Sciences, Clinical Neurology, Emergency Medicine, Engineering-Biomedical and Material Science-Biomaterials. Of the 727 journals indexed in PubMed in which at least one author is a French orthopedic or trauma surgeon, 79 journals (11%) had at least 10 articles authored by a French orthopedists, making up 4680/6056 published articles (77%) during the study period. The highest SIGAPS score was in the "Orthopedics" discipline followed by "Surgery", and then by "Sport Sciences" with a large number of publications in the SIGAPS B category. Publications in "Orthopedics" category A and B journals increased 14% during this period. When all disciplines are pooled, the share of publications in SIGAPS A, B and C categories increased by 10% from 2008 to 2017. The largest increase in publications for categories A and B and the top 1% and 10% was in "Sports Sciences".

Discussion: Over the past 10 years, French orthopedists have continued to increase their scientific production in the orthopedics field and in related fields such as Sport Sciences, Clinical Neurology and Biomedical Engineering. The quality of the scientific production of French orthopedists in their discipline and outside of it has greatly improved, as evidenced by the shift toward SIGAPS A and B journals.

Level Of Evidence: IV, retrospective study without control group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2019.09.018DOI Listing
December 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otsr.2019.07.021DOI Listing
November 2019

Joint Effusion and Bone Outlines of the Knee: Radiographic/MR Imaging Correlation.

Magn Reson Imaging Clin N Am 2019 Nov 19;27(4):685-699. Epub 2019 Jul 19.

Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France; Lille University School of Medicine, Faculté de Médecine Henri Warembourg, F-59045 Lille CEDEX, France; Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), Rue du Professeur, Emile Laine, 59037 Lille CEDEX, France.

Knee radiographs are widely used in clinical practice. Many features can be depicted when a systematic analysis of the different views is performed. This article focuses on different types of joint effusion and on the analysis of the bone outlines of the knee, particularly on the lateral view. Systematic analysis of these bone outlines and knowledge of several key points are particularly useful for the depiction of abnormal bone morphology or positioning, and of several conditions, such as trochlear dysplasia, patellar dislocation, impaction fractures, or ligament injuries and avulsion fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mric.2019.06.001DOI Listing
November 2019