Cost-effectiveness of a bone substitute delivering gentamicin in the treatment of chronic osteomyelitis of long bones: Protocol for the CONVICTION randomized multicenter study

IntroductionChronic osteomyelitis is a serious osteoarticular infection that most often occurs in the long bones, responsible for significant morbidity with the risk of fracture and amputation. Despite advances in both antibiotics and surgical treatment, the probability of recurrence of infection remains at around 20%. Cerament-G (BONESUPPORT AB, Sweden) is a synthetic bone substitute that fills the bone void left by surgery, prevents infection and promotes bone regeneration within this space. Cerament-G also provides the local delivery of high doses of gentamicin over several weeks. Two prospective observational studies described a number of infectious recurrences of 4 and 5% after the use of Cerament-G. Although available in France, Cerament-G is currently not reimbursed and its high cost constitutes a barrier to its use. We hypothesize that the use of Cerament-G will lead to fewer costs to the collectivity while improving patient utility and, as an innovative strategy, will be superior to standard of care on recurrence of infection.Methods and analysisThe Conviction Study is a prospective, multicenter, randomized, single blind study conducted in 14 French Reference Centers for Complex Osteoarticular infections. The main objective is to evaluate the cost-effectiveness of using Cerament-G in the treatment of chronic long bone osteomyelitis by comparing this innovative strategy to standard of care. A cost-utility analysis from the collective perspective will be conducted over a 24-month time horizon after the initial surgery. The outcome for the main medico-economic evaluation will be Quality Adjusted Life Years (QALYs).DiscussionThe study is being conducted throughout the CRIOAc network in France, in referral centers for the management of complex infections which will facilitate patient recruitment. This study has several limitations: the investigators have to be trained to handle the device, and it was impossible to blind the surgeon.ConclusionIf the use of Cerament-G is demonstrated to be superior to leaving the dead space empty during surgery for patients with stage III chronic long bone osteomyelitis, its use will be recommended to improve the prognosis of such patients, and this device may eventually qualify for reimbursement through the French Health Insurance scheme.Ethics and disseminationThis protocol received authorization from the Ethics Committee CPP Sud Méditerranée V on April 27, 2021 (21.03.10.77652) and the French National Agency for Medicines and Health Products on May 6, 2021 (2020-A02299-30). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals

New measurement technique for restoration of the trochlear offset after image-based robotic-assisted total knee arthroplasty: a reliability study

Introduction: The new concepts in total knee arthroplasty (TKA) tend to improve the alignment and ligament balancing after TKA. Nevertheless, the assessment of the anterior compartment is difficult. The purpose of this study was to describe a new measurement technique of trochlear offset restoration on CT-scan after primary robotic-assisted TKA and assess its reliability and repeatability. Method: This monocentric study assessed the trochlear offset restoration on a CT scan after 20 robotic-assisted TKA. To evaluate the trochlear offset restoration, we measured the depth difference between the native and the prosthetic trochlea. Four sequential positions were assessed on the trochlea: at full extension, at 30°, 70°, and 90° flexion. For each of these positions, we compared the highest point of the lateral native condyle and the lateral prosthetic condyle, the highest point of the medial native condyle and the medial prosthetic condyle, the deepest point of the native trochlear groove and the prosthetic trochlea. Two independent reviewers performed the measurements to assess their reliability. To determine intraobserver variability, the first observer performed the measurements twice. Results: The mean age was 67.3 years old ± 8.3. Mean values of the trochlear offset restoration for the medial condyle, trochlear groove and lateral condyle were respectively: 1.0 mm ± 1.6, 1.1 mm ± 1.5, −2.7 mm ± 2.3 in full extension; −3.5 mm ± 1.7, −1.5 mm ± 1.7, −3.9 mm ± 3.9 at 30° flexion; −5.1 mm ± 1.8, 2.1 mm ± 2.7, −3.8 mm ± 1.8 at 70° flexion; 2.0 mm ± 1.4 and 3.1 mm ± 1.5 for the medial and lateral condyles at 90° flexion. The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements with mean kappa values of 0.92 and 0.74. Conclusion: We present a novel measurement technique on CT scan for evaluating the restoration of the trochlear offset after TKA, demonstrating excellent inter and intra-observer reliability

Time to benefit of heart rate reduction with ivabradine in patients with heart failure and reduced ejection fraction

Aims In the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial, ISRCTN70429960) study, ivabradine reduced cardiovascular death or heart failure (HF) hospitalizations in patients with HF and reduced ejection fraction (HFrEF) in sinus rhythm and with a heart rate (HR) ≥70 bpm. In this study, we sought to determine the clinical significance of the time durations of HR reduction and the significant treatment effect on outcomes among patients with HFrEF. Methods and results The time to statistically significant reduction of the primary outcome (HF hospitalization and cardiovascular death) and its components, all-cause death, and HF death, were assessed in a post-hoc analysis of the SHIFT trial in the overall population (HR ≥70 bpm) and at HR ≥75 bpm, representing the approved label in many countries. Compared to placebo, the primary outcome and HF hospitalizations were significantly reduced at 102 days, while there was no effect on cardiovascular death, all-cause death, and HF death at HR ≥70 bpm. In the population with a baseline HR ≥75 bpm, a reduction of the primary outcome occurred after 67 days, HF hospitalization after 78 days, cardiovascular death after 169 days, death from HF after 157 days and all-cause death after 169 days. Conclusion Treatment with ivabradine should not be deferred in patients in sinus rhythm with a HR of ≥70 bpm to reduce the primary outcome and HF hospitalizations, in particular in patients with HR ≥75 bpm. At HR ≥75 bpm, the time to risk reduction was shorter for reduction of hospitalization and mortality outcomes in patients with HFrEF after initiation of guideline-directed medication, including beta-blockers at maximally tolerated doses

Efficacy of ivabradine in heart failure patients with a high-risk profile (analysis from the SHIFT trial)

Aims Early start and patient profile-oriented heart failure (HF) management has been recommended. In this post hoc analysis from the SHIFT trial, we analysed the treatment effects of ivabradine in HF patients with systolic blood pressure (SBP) < 110 mmHg, resting heart rate (RHR) ≥ 75 b.p.m., left ventricular ejection fraction (LVEF) ≤ 25%, New York Heart Association (NYHA) Class III/IV, and their combination. Methods and results The SHIFT trial enrolled 6505 patients (LVEF ≤ 35% and RHR ≥ 70 b.p.m.), randomized to ivabradine or placebo on the background of guideline-defined standard care. Compared with placebo, ivabradine was associated with a similar relative risk reduction of the primary endpoint (cardiovascular death or HF hospitalization) in patients with SBP < 110 and ≥110 mmHg [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.74–1.08 vs. HR 0.80, 95% CI 0.72–0.89, P interaction = 0.34], LVEF ≤ 25% and >25% (HR 0.85, 95% CI 0.72–1.01 vs. HR 0.80, 95% CI 0.71–0.90, P interaction = 0.53), and NYHA III–IV and II (HR 0.83, 95% CI 0.74–0.94 vs. HR 0.81, 95% CI 0.69–0.94, P interaction = 0.79). The effect was more pronounced in patients with RHR ≥ 75 compared with <75 (HR 0.76, 95% CI 0.68–0.85 vs. HR 0.97, 95% CI 0.81–0.1.16, P interaction = 0.02). When combining these profiling parameters, treatment with ivabradine was also associated with risk reductions comparable with patients with low-risk profiles for the primary endpoint (relative risk reduction 29%), cardiovascular death (11%), HF death (49%), and HF hospitalization (38%; all P values for interaction: 0.40). No safety concerns were observed between study groups. Conclusions Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern

Time to benefit of heart rate reduction with ivabradine in patients with heart failure and reduced ejection fraction

Aims: In the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial, ISRCTN70429960) study, ivabradine reduced cardiovascular death or heart failure (HF) hospitalizations in patients with heart failure and reduced ejection fraction (HFrEF) in sinus rhythm and with a heart rate (HR) ≥70 bpm. In this study, we sought to determine the clinical significance of the time durations of heart rate reduction and the significant treatment effect on outcomes among patients with HFrEF. Methods and results: The time to statistically significant reduction of the primary outcome (HF hospitalization and cardiovascular death) and its components, all-cause death, and HF death, were assessed in a post-hoc analysis of the SHIFT trial in the overall population (HR ≥70 bpm) and at HR ≥75 bpm, representing the approved label in many countries. Compared to placebo, the primary outcome and HF hospitalizations were significantly reduced at 102 days, while there was no effect on cardiovascular death, all-cause death, and HF death at HR ≥70 bpm. In the population with a baseline HR ≥75 bpm, a reduction of the primary outcome occurred after 67 days, HF hospitalization after 78 days, cardiovascular death after 169 days, death from HF after 157 days and all-cause death after 169 days. Conclusion: Treatment with ivabradine should not be deferred in patients in sinus rhythm with a HR of ≥70 bpm to reduce the primary outcome and HF hospitalizations, in particular in patients with HR ≥75 bpm. At HR ≥75 bpm, the time to risk reduction was shorter for reduction of hospitalization and mortality outcomes in patients with HFrEF after initiation of guideline-directed medication, including beta blockers at maximally tolerated doses

Magnetically controlled growing rod in early onset scoliosis: a 30-case multicenter study

PURPOSE: Preliminary results of magnetically controlled growing rods (MCGR) are encouraging. However, only short case series of MCGR for the treatment of early onset scoliosis (EOS) have been reported. Our aim was to evaluate its effectiveness and complications. METHODS: We report a 30-case retrospective, consecutive, multicenter series of MCGR. Effectiveness was judged upon: deformity correction and difficulties to achieve desired distraction. Secondary endpoints included complications and revision surgeries. RESULTS: Median age at surgery was 9.1 years (5-13). Mean follow-up was 18.4 months (12-33.9). Mean Cobb angle was 66° preoperatively and 44° at latest follow-up. MCGR has avoided an average of 2.03 scheduled surgical procedures per patient compared to traditional growing rod (GR). The intended total length gain was 40.1 mm per patient (5-140) and the total measured length gain was 21.9 mm (45.5% discrepancy). There were 24 complications: 7 proximal pull-outs of the hooks, 3 rod breakages, 6 failures of the lengthening of which 4 complete blockages and 2 complete blockages followed by backtracking, 1 proximal junctional kyphosis, 1 wound dehiscence, 1 superficial infection, 1 deep infection requiring implant removal, 1 pulmonary embolism, 1 pulmonary insufficiency, 1 secondary lumbar scoliosis, and 1 painful outpatient distraction. Eight patients had a gradual loss of effectiveness of distractions. There were 13 revision surgeries in 9 patients. CONCLUSIONS: MCGR provides satisfactory deformity correction and avoids repeated surgical procedures for lengthening. However, it has substantial complication rate. Although less frequent than in GR, the law of diminishing returns also applies to MCGR

Efficacy of ivabradine in heart failure patients with a high-risk profile (analysis from the SHIFT trial)

Aims: Early start and patient profile‐oriented heart failure (HF) management has been recommended. In this post hoc analysis from the SHIFT trial, we analysed the treatment effects of ivabradine in HF patients with systolic blood pressure (SBP) &lt; 110 mmHg, resting heart rate (RHR) ≥ 75 b.p.m., left ventricular ejection fraction (LVEF) ≤ 25%, New York Heart Association (NYHA) Class III/IV, and their combination. Methods and results: The SHIFT trial enrolled 6505 patients (LVEF ≤ 35% and RHR ≥ 70 b.p.m.), randomized to ivabradine or placebo on the background of guideline‐defined standard care. Compared with placebo, ivabradine was associated with a similar relative risk reduction of the primary endpoint (cardiovascular death or HF hospitalization) in patients with SBP &lt; 110 and ≥110 mmHg [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.74–1.08 vs. HR 0.80, 95% CI 0.72–0.89, P interaction = 0.34], LVEF ≤ 25% and &gt;25% (HR 0.85, 95% CI 0.72–1.01 vs. HR 0.80, 95% CI 0.71–0.90, P interaction = 0.53), and NYHA III–IV and II (HR 0.83, 95% CI 0.74–0.94 vs. HR 0.81, 95% CI 0.69–0.94, P interaction = 0.79). The effect was more pronounced in patients with RHR ≥ 75 compared with &lt;75 (HR 0.76, 95% CI 0.68–0.85 vs. HR 0.97, 95% CI 0.81–0.1.16, P interaction = 0.02). When combining these profiling parameters, treatment with ivabradine was also associated with risk reductions comparable with patients with low‐risk profiles for the primary endpoint (relative risk reduction 29%), cardiovascular death (11%), HF death (49%), and HF hospitalization (38%; all P values for interaction: 0.40). No safety concerns were observed between study groups. Conclusions: Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern

New Technologies in Knee Arthroplasty: Current Concepts

Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling

Kinematic and static analysis of the lower limb after unicompartmental knee arthroplasty performed by conventional technique or robotic-assisted surgery

Les prothèses unicompartimentales (PUC) sont des alternatives intéressantes à la prothèse totale lorsque l’atteinte est mono-compartimentale. Leurs résultats sont très satisfaisants et l’obtention d’un genou indolore ou oublié est plus probable qu’avec une prothèse totale. Néanmoins la technique chirurgicale est exigeante et doit suivre des règles strictes pour obtenir une fonction et une survie optimales. En effet les risques principaux lors des PUC sont le mal positionnement et le malalignment, liés essentiellement à des erreurs techniques, et qui peuvent entrainer une révision chirurgicale précoce. L’assistance robotique peut constituer une aide importante pour la mise en place des PUC. Cela a été démontré à plusieurs reprises. Dans notre service de chirurgie orthopédique, nous avons analysés les résultats cliniques et radiologiques des PUC médiales ou latérales. Nous avons retrouvé une réduction du risque de positionnement aberrant des implants fémoraux et tibiaux. Nous avons mis en évidence que le dimensionnement des prothèses était plus fiable avec une assistance robotique qu’avec une technique conventionnelle. Le taux de révisions des PUC était également plus faible dans le groupe opéré avec assistance robotique que dans le groupe de technique conventionnelle. Il n’y avait en revanche pas de différence significative sur les résultats cliniques (scores fonctionnels et scores objectifs) entre les deux groupes à moyen terme. Les scores cliniques utilisés en pratique clinique sont peu discriminants et sont probablement insuffisants pour différencier ces deux techniques chirurgicales. Par ailleurs nous n’avons pas retrouvés de complications spécifiques de l’assistance robotique au cours de nos différentes études. Plusieurs études ont évalué la marche des patients afin d’avoir un examen plus objectif sur la récupération fonctionnelle en post opératoires de prothèses de genou. L’objectif était d’évaluer la récupération d’un schéma de marche le plus proche possible de celui d’un genou natif. Nos travaux ont mis en évidence qu’il n’y avait pas de différence significative de l’axe fémorotibial mécanique entre les mesures radiologiques (appui bipodal, statique lors de la pangonométrie), par l’assistance robotique (acquisition dynamique sans appui) et lors de l’analyse de la marche (acquisition dynamique en charge). Ces trois types de mesures sont donc comparables et fiables les unes par rapport aux autres. Les patients atteints d’arthrose fémoro-tibiale interne ont également un mouvement varisant lors de la mise en charge comparé aux autres phases d’appui, partiellement réductible lors de PUC interne. Ces différents travaux nous ont permis de réaliser une étude prospective randomisée comparant l’analyse de la marche chez des patients opérés de PUC médiale avec technique conventionnelle versus avec assistance robotique. Cette étude, portant sur deux groupes de 33 patients chacun, confirmait que les résultats cliniques n’étaient pas significativement différents entre les deux techniques chirurgicales. Il n’a pas été retrouvé de différence significative sur le positionnement radiologique des implants. L’analyse de la marche a mis en évidence une réduction significative de la déformation en varus du membre inférieur en postopératoire d’une PUC médiale que ce soit avec une technique conventionnelle ou avec une assistance robotique, par rapport au préopératoire. En revanche il n’a pas été retrouvé de différence significative sur le cycle de marche entre les deux groupes. Il existe donc un réel bénéfice de l’assistance robotique sur le positionnement des implants dans les PUC médiales, avec notamment l’absence de positionnements aberrants des implants. Par contre il n’a pas été démontré une amélioration clinique ou fonctionnelle actuellement, y compris sur l’analyse de la marche. Des investigations supplémentaires restent encore à réaliser, notamment une évaluation clinique et radiologique à plus long terme.Unicompartmental knee arthroplasty (UKA) are interesting alternatives to total knee arthroplasty (TKA) when the osteoarthritis is mono-compartmental. Their results are very satisfactory and obtaining a painless or forgotten knee is more likely than with a TKA. Nevertheless, the surgical technique is demanding and must follow strict rules to obtain optimal function and survival. Indeed, the main risks during UKA are implants mal-positioning and malalignment, mainly due to technical errors, and which can lead to early surgical revision. Robotic assistance can be an interesting tool to perform UKA. In our orthopedic surgery department, we analyzed the clinical and radiological results of medial or lateral UKA. We found a reduction in the risk of outliers for the implants positioning. We have shown that the implants sizing was more reliable with robotic-assisted technique than with a conventional technique. The rate of UKA revisions was also lower with robotic-assisted technique compared than conventional technique. In contrast, there was no significant difference in clinical outcomes (functional scores and objective scores) between the two groups in the medium term. The clinical scores used in clinical practice are not very selective and are probably insufficient to differentiate these both surgical techniques. Furthermore, we did not find any specific complications of robotic-assisted surgery during our various studies. Several studies have assessed patients' walking in order to have a more objective examination of the functional recovery after UKA. The aim was to assess recovery from a gait pattern as close as possible to that of a native knee. Our work demonstrated that there was no significant difference in the mechanical femorotibial axis between the radiological measurements (full weight bearing, static during long leg radiograph), by robotic-assisted system (dynamic acquisition without weight bearing) and during gait analysis (dynamic acquisition with full weight bearing). These three types of measurements are therefore comparable and reliable with respect to each other. Patients with medial femorotibial osteoarthritis also have varus movement during weight-bearing compared to other phases of support, which is partially reducible during medial UKA. These various studies enabled us to carry out a prospective randomized study comparing the gait analysis in patients operated of medial UKA with conventional technique versus with robotic-assisted technique. This study, assessing two groups of 33 patients, confirmed that the clinical results were not significantly different between both surgical techniques. No significant difference was found in the radiological positioning of the implants. The gait analysis showed a significant reduction in the varus deformity of the lower limb postoperatively with a medial UKA, either with conventional technique or with robotic-assisted technique, compared to preoperatively. However, there was no significant difference in the gait cycle between both groups. There is therefore a real benefit of robotic-assisted surgery on the implants positioning in medial UKA, in particular with the outliers of implants positioning. On the other hand, no clinical or functional improvement has currently been demonstrated, including on the gait analysis. Further investigations still need to be carried out, in particular a longer term clinical and radiological evaluation

Analyses cinématique et statique du membre inférieur après pose de prothèses unicompartimentales internes implantées avec soit un ancillaire mécanique soit une assistance robotique.

Unicompartmental knee arthroplasty (UKA) are interesting alternatives to total knee arthroplasty (TKA) when the osteoarthritis is mono-compartmental. Their results are very satisfactory and obtaining a painless or forgotten knee is more likely than with a TKA. Nevertheless, the surgical technique is demanding and must follow strict rules to obtain optimal function and survival. Indeed, the main risks during UKA are implants mal-positioning and malalignment, mainly due to technical errors, and which can lead to early surgical revision. Robotic assistance can be an interesting tool to perform UKA. In our orthopedic surgery department, we analyzed the clinical and radiological results of medial or lateral UKA. We found a reduction in the risk of outliers for the implants positioning. We have shown that the implants sizing was more reliable with robotic-assisted technique than with a conventional technique. The rate of UKA revisions was also lower with robotic-assisted technique compared than conventional technique. In contrast, there was no significant difference in clinical outcomes (functional scores and objective scores) between the two groups in the medium term. The clinical scores used in clinical practice are not very selective and are probably insufficient to differentiate these both surgical techniques. Furthermore, we did not find any specific complications of robotic-assisted surgery during our various studies. Several studies have assessed patients' walking in order to have a more objective examination of the functional recovery after UKA. The aim was to assess recovery from a gait pattern as close as possible to that of a native knee. Our work demonstrated that there was no significant difference in the mechanical femorotibial axis between the radiological measurements (full weight bearing, static during long leg radiograph), by robotic-assisted system (dynamic acquisition without weight bearing) and during gait analysis (dynamic acquisition with full weight bearing). These three types of measurements are therefore comparable and reliable with respect to each other. Patients with medial femorotibial osteoarthritis also have varus movement during weight-bearing compared to other phases of support, which is partially reducible during medial UKA. These various studies enabled us to carry out a prospective randomized study comparing the gait analysis in patients operated of medial UKA with conventional technique versus with robotic-assisted technique. This study, assessing two groups of 33 patients, confirmed that the clinical results were not significantly different between both surgical techniques. No significant difference was found in the radiological positioning of the implants. The gait analysis showed a significant reduction in the varus deformity of the lower limb postoperatively with a medial UKA, either with conventional technique or with robotic-assisted technique, compared to preoperatively. However, there was no significant difference in the gait cycle between both groups. There is therefore a real benefit of robotic-assisted surgery on the implants positioning in medial UKA, in particular with the outliers of implants positioning. On the other hand, no clinical or functional improvement has currently been demonstrated, including on the gait analysis. Further investigations still need to be carried out, in particular a longer term clinical and radiological evaluation.Les prothèses unicompartimentales (PUC) sont des alternatives intéressantes à la prothèse totale lorsque l’atteinte est mono-compartimentale. Leurs résultats sont très satisfaisants et l’obtention d’un genou indolore ou oublié est plus probable qu’avec une prothèse totale. Néanmoins la technique chirurgicale est exigeante et doit suivre des règles strictes pour obtenir une fonction et une survie optimales. En effet les risques principaux lors des PUC sont le mal positionnement et le malalignment, liés essentiellement à des erreurs techniques, et qui peuvent entrainer une révision chirurgicale précoce. L’assistance robotique peut constituer une aide importante pour la mise en place des PUC. Cela a été démontré à plusieurs reprises. Dans notre service de chirurgie orthopédique, nous avons analysés les résultats cliniques et radiologiques des PUC médiales ou latérales. Nous avons retrouvé une réduction du risque de positionnement aberrant des implants fémoraux et tibiaux. Nous avons mis en évidence que le dimensionnement des prothèses était plus fiable avec une assistance robotique qu’avec une technique conventionnelle. Le taux de révisions des PUC était également plus faible dans le groupe opéré avec assistance robotique que dans le groupe de technique conventionnelle. Il n’y avait en revanche pas de différence significative sur les résultats cliniques (scores fonctionnels et scores objectifs) entre les deux groupes à moyen terme. Les scores cliniques utilisés en pratique clinique sont peu discriminants et sont probablement insuffisants pour différencier ces deux techniques chirurgicales. Par ailleurs nous n’avons pas retrouvés de complications spécifiques de l’assistance robotique au cours de nos différentes études. Plusieurs études ont évalué la marche des patients afin d’avoir un examen plus objectif sur la récupération fonctionnelle en post opératoires de prothèses de genou. L’objectif était d’évaluer la récupération d’un schéma de marche le plus proche possible de celui d’un genou natif. Nos travaux ont mis en évidence qu’il n’y avait pas de différence significative de l’axe fémorotibial mécanique entre les mesures radiologiques (appui bipodal, statique lors de la pangonométrie), par l’assistance robotique (acquisition dynamique sans appui) et lors de l’analyse de la marche (acquisition dynamique en charge). Ces trois types de mesures sont donc comparables et fiables les unes par rapport aux autres. Les patients atteints d’arthrose fémoro-tibiale interne ont également un mouvement varisant lors de la mise en charge comparé aux autres phases d’appui, partiellement réductible lors de PUC interne. Ces différents travaux nous ont permis de réaliser une étude prospective randomisée comparant l’analyse de la marche chez des patients opérés de PUC médiale avec technique conventionnelle versus avec assistance robotique. Cette étude, portant sur deux groupes de 33 patients chacun, confirmait que les résultats cliniques n’étaient pas significativement différents entre les deux techniques chirurgicales. Il n’a pas été retrouvé de différence significative sur le positionnement radiologique des implants. L’analyse de la marche a mis en évidence une réduction significative de la déformation en varus du membre inférieur en postopératoire d’une PUC médiale que ce soit avec une technique conventionnelle ou avec une assistance robotique, par rapport au préopératoire. En revanche il n’a pas été retrouvé de différence significative sur le cycle de marche entre les deux groupes. Il existe donc un réel bénéfice de l’assistance robotique sur le positionnement des implants dans les PUC médiales, avec notamment l’absence de positionnements aberrants des implants. Par contre il n’a pas été démontré une amélioration clinique ou fonctionnelle actuellement, y compris sur l’analyse de la marche. Des investigations supplémentaires restent encore à réaliser, notamment une évaluation clinique et radiologique à plus long terme