Publications by authors named "Roger Erivan"

45 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

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.
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http://dx.doi.org/10.1016/j.otsr.2020.03.042DOI 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

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

Disrupting research in orthopedics: Reasons for facing the challenge of change.

Orthop Traumatol Surg Res 2020 Apr 18;106(2):213-215. Epub 2020 Jan 18.

Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Pôle Locomax, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.

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http://dx.doi.org/10.1016/j.otsr.2019.12.004DOI Listing
April 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

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

Cell Tissue Bank 2020 Mar 21;21(1):131-137. Epub 2019 Dec 21.

Barcelona Tissue Bank, Banc de Sang I Teixits, Barcelona, Spain.

Bone infections can be challenging to treat and can lead to several surgeries and relapses. When a graft is needed, cavitary bone loss can be grafted with cancellous or cortical bone. Both can be used for grafting. However, the antibiotic releasing capacity of these grafts has not been compared. Which type of bone is best at releasing the most antibiotic has not been well established. The aim of this study was to determine which type of bone is best for antibiotic release when the bone is suffused with antibiotics by the surgeon. The hypothesis is that there would be a difference between the type of bone tested due to different release capacities of cortical and cancellous bone. This was an experimental study. Cortical spongy bone in chips, Spongy bone in chips and demineralized cortical bone powder were compared. For each type of bone, 5 samples were tested. Processed and decontaminated grafts were freeze-dried to be kept at room temperature. The primary endpoint was the amount of vancomycin released by the graft as it affects the concentration of antibiotic around the graft in clinical practice. The procedure for the study consisted of full graft immersion in a vancomycin solution. Then, the liquid was removed with aspiration. In order to measure the quantity of antibiotic released, the bone was put into distilled water in agitation in a heated rocker at 37 °C. After 30 min of soaking, 1 mL of the liquid was removed. The same extraction process was also carried out after 60 min soaking, 2 h, 3 h, 24 h, and 48 h. No differences were found between each type of bone relative to the concentration of vancomycin released at each time of the assessment. There was a significant difference in the weight of the bone with a higher weight for the cortical powder (1.793 g) versus cortical spongy bone and spongy bone (1.154 g and 1.013 g) with a p value < 0.0001. A significant difference was seen in the weight of the bone with vancomycin after the aspiration of the liquid with 3.026 g for cortical powder, 2.140 g and 2.049 g for the cortical spongy bone and the spongy bone with a p value < 0.0001. In daily clinical practice, one can use cancellous bone, cortico-cancellous bone or cortical powder in order to add vancomycin to a bone graft. Our results show the release kinetics of the soaked allografts. With a maximum of 14 mg/mL in the first minutes and a rapid decrease it shows a pattern comparable to antibiotic loaded bone cement. The method used appears favourable for prophylactic use, protecting the graft against contamination at implantation, but is not sufficient for treating chronic bone infection. LEVEL OF EVIDENCE: V.
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http://dx.doi.org/10.1007/s10561-019-09806-2DOI Listing
March 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

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.
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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.
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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.
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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.
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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

Use of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years' average follow-up.

Orthop Traumatol Surg Res 2019 09 27;105(5):957-966. Epub 2019 May 27.

56, rue Boissonnade, 75014 Paris, France.

Background: In the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors.

Hypothesis: Acetabular reconstruction can be performed equally well with frozen or processed morselized allografts.

Materials And Methods: This retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years±1.89 [5-12.32]) than that of the processed grafts (8.22 years±1.77 [5.05-15.48]) (p=0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years±14.2 [17-80]) than in the processed group (57.5 years±13.0 [12-94]) (p<0.001) and were also younger at the time of THA revision (67.8 years±12.2 [36.9-89.3] versus 70 years±11.7 [25-94.5]) (p=0.041).

Results: There were more complications overall in the frozen allograft group (46/242=19.0%) than the processed allograft group (35/256=13.2%) (p=0.044) with more instances of loosening in the frozen group (20/242 [8.2%]) than in the processed group (6/266 [3.3%])(p=0.001). Conversely, the dislocation rate (16/242=6.6% vs. 17/266=6.4%) (p=0.844) and infection rate (18/242=7.4% vs. 15/266=5.7%) (p=0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p=0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p=0.006) and a relative risk of 1.95 (95% CI: 1.26-2.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23-4.70) (p=0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52-6.51) (p=0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26-8.26) (p=0.022).

Discussion: Our hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabular bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior.

Level Of Evidence: III, comparative retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2019.02.025DOI 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

Preservation Methods Influence the Biomechanical Properties of Human Lateral Menisci: An Ex Vivo Comparative Study of 3 Methods.

Orthop J Sports Med 2019 Apr 29;7(4):2325967119841622. Epub 2019 Apr 29.

Aix-Marseille University, Marseille, France.

Background: Three main meniscal preservation methods have been used over the past decade: cryopreservation, freezing, and freezing with gamma irradiation.

Hypothesis: All 3 preservation methods will result in similar biomechanical properties as defined by tensile and compression testing.

Study Design: Controlled laboratory study.

Methods: A total of 24 human lateral menisci were collected from patients who underwent total knee arthroplasty. Inclusion criteria were patients younger than 70 years with primary unilateral (medial) femorotibial knee osteoarthritis. Each meniscus was divided into 2 specimens cross-sectionally. One specimen was systematically cryopreserved and constituted the control (Cy; -140°C), and the other specimen was used for either the simple frozen group (Fr; -80°C) or the frozen+irradiated group (FrI; -80°C + 25-kGy irradiation). Compression and tensile tests were performed to analyze the elasticity modulus (Young modulus) in compression, the elasticity modulus in tension, the tensile force at failure, and the rupture profile of the tensile stress-strain curve.

Results: A significant difference in the mean compression elasticity modulus was observed between the Cy and Fr groups (28.86 ± 0.77 vs 37.26 ± 1.08 MPa, respectively; < .001) and between the Cy and FrI groups (28.86 ± 0.77 vs 45.92 ± 1.09 MPa, respectively; < .001). A significant difference in the mean tensile elasticity modulus was also observed between the Cy and Fr groups (11.66 ± 0.97 vs 19.97 ± 1.37 MPa, respectively; = .008) and between the Cy and FrI groups (11.66 ± 0.97 vs 45.25 ± 1.39 MPa, respectively; < .001). There were no significant differences between the control and study groups in tensile force at failure. The analysis of the stress-strain curve revealed a slow-slope curve with a nonabrupt rupture (ductile material) for the Cy samples versus a clear rupture of the curve for the Fr and FrI samples (more fragile material).

Conclusion: Cryopreservation allows for more elastic and less fragile tissue compared with simple freezing or freezing plus irradiation.

Clinical Relevance: The study results exhibit the detrimental effect of simple freezing and freezing plus irradiation on human meniscal mechanical properties. If these effects occur in menisci prepared for allograft procedures, important differences could appear in the graft's mechanical behavior and thus patient outcomes.
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http://dx.doi.org/10.1177/2325967119841622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488788PMC
April 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