Arthroscopy of the hip : management of femoro-acetabular conflicts before the osteoarthritic stage.

editorial reviewedHip arthroscopy is a technique that has been shown to be effective in the treatment of femoro-acetabular lesions. These are related either to an anomaly on the anterior aspect of the femoral neck ("cam effect") or an anomaly at the level of the acetabular margin ("pincer effect") or a combination of both. The main arthroscopic gesture for the cam conflict consists of a femoroplasty, i.e. a regularization of the anterior bone bump. Other gestures, such as reinsertion of the labrum and cartilage repair, can be contemplated during the same operation. In a pincer conflict, an acetabuloplasty associated with re-insertion of the labrum can be performed. Hip arthroscopy is a technique in progress in terms of the surgical technique as well as the number of skilled surgeons. It aims to slow down the osteoarthritic evolution of the hip joint in the context of femoro-acetabular conflicts. However, it remains a tech¬nique with a long learning curve and possible side effects or complications are not to be neglected.L’arthroscopie de hanche est une technique qui s’est révélée efficace pour le traitement de certains conflits fémoro-acétabulaires. Ces derniers sont liés soit à une anomalie du col fémoral sur son versant antérieur («effet came»), soit à une anomalie du bord du cotyle («effet tenaille»), soit l’association des deux. Le geste arthrosco¬pique principal consiste en une fémoroplastie lors du conflit de type came, c’est-à-dire une régularisation du «bump osseux»; d’autres gestes, tels que la réinsertion du labrum et une réparation cartilagineuse peuvent être réalisés au cours du même geste opératoire. Lors d’un conflit de type tenaille, une acétabuloplastie associée à une réinsertion du labrum peut être réalisée. L’arthroscopie de hanche est une technique en progression, tant au niveau des gestes qui peuvent être réalisés ainsi qu’au niveau du nombre d’opérateurs. Elle cherche à ralentir l’évolution arthrosique de l’articulation de la hanche dans le cadre des conflits fémoro-acétabulaires. Elle reste, cependant, une technique grevée d’une courbe d’apprentissage longue et d’effets secondaires ou de complications non négligeables

Unsatisfactory outcomes in myasthenia gravis: influence by care providers

Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. ‘Unchanged', ‘worse', ‘exacerbation' and ‘died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P=0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P=0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcome

Coxalgia

editorial reviewedCoxalgia is one of the most common painful complaints in orthopedic surgery. The management of a "traumatic" hip is relatively well codified, however atraumatic coxalgia is more difficult to diagnose and explore. The history and a well-conducted clinical examination are essential for the management of coxalgia. The diagnosis is already well oriented by a simple X-ray and the presence or absence of inflammatory signs on the blood test. This article aims to provide a guideline for the diagnostic approach to coxalgia

How I explore… a non-traumatic gonalgia

peer reviewedBecause the knee is the joint of the human body with the largest surface, it is no wonder that gonalgia is one of the most common complaints in the general population. Although the management of a painful traumatic knee is relatively well standardized, that of a non-traumatic knee pain is less codified. History and a rigorous systematic cli- nical examination play a key role in the management of nontraumatic gonalgia. The diagnostic approach is mainly guided by the inflammatory or mechanical nature of the pain and its topography. This article aims to clarify the dia- gnostic approach to gonalgia without notion of prior trauma

Unsatisfactory outcomes in myasthenia gravis: influence by care providers.

Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes