Is unicompartmental-to-unicompartmental revision knee arthroplasty a reliable option? Case-control study

AbstractBackgroundIn selected patients with failed unicompartmental knee arthroplasty (UKA), revision UKA is a reliable option and may even provide lower morbidity rates and better functional outcomes compared to revision total knee arthroplasty.Material and methodsIn a multicentre retrospective study of 425 knees requiring revision surgery after UKA, 36 knees were managed with revision UKA.ResultsOf the 36 knees, 3 (8.33%) required iterative revision surgery, for aseptic loosening. After a mean follow-up of 8.3 years, the mean IKS knee and function scores were high (93.81/100 and 90.77/100, respectively).DiscussionIn carefully selected patients, UKA-to-UKA revision performed according to a rigorous operative technique deserves a role in the surgical strategy for failed UKA.Level of evidenceIII, multicentre retrospective case-control study

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations

The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. Methods A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. Results The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. Conclusion Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe retur

Comparative Results From a National Joint Registry Hip Data Set of a New Cross-Linked Annealed Polyethylene vs Both Conventional Polyethylene and Ceramic Bearings.

Major concerns in hip arthroplasty concern the fate of bearing surfaces. Highly cross-linked polyethylene materials (HXLPE) currently demonstrate successful in vitro results with new technical procedures of cross-linking the polyethylene material, whereas processing the polyethylene below its melting temperature to produce so-called "annealed HXLPE" would allow retention of important mechanical properties. Data released by the National Joint Registry of England and Wales addressing in 45,877 hips the same Trident uncemented cup, allowed us to compare the performance of a consecutive cohort of patients implanted with the newest generation of annealed HXLPE acetabular bearings (X3: 21,470) vs 2 consecutive nonselected cohorts, one with conventional polyethylene (N2vac: 8225) and one with ceramic-on-ceramic (CoC) hip bearings (AL: 16,182). The main end point in survivorship has been first defined as revision for any cause, then for any cause which could be related to a failure of the bearing couple. At 6-year follow-up, all Trident cups demonstrated encouraging global survival cumulative rates all between 95% and 99%. A first study demonstrated better survivorship with X3-HXLPE liners vs conventional ultrahigh molecular weight polyethylene. On the second parallel study, the cumulative survival rates were better for X3 liners as compared to CoC bearings. Moreover, when ranking the yearly cumulative percent revision rates, again the best results were obtained with X3 liners with small alumina heads (cumulative percent revision rate at 0.298). Within the frame of this Trident study, the use of this X3 highly cross-linked annealed polyethylene could be considered as a reliable alternate solution to CoC bearings

Cross-cultural adaptations of the Oxford-12 HIP score to the French speaking population.

BACKGROUND: An objective measurement of surgical procedures outcomes is inherent to professional practices quality control; this especially applies in orthopaedics to joint replacement outcomes. A self-administered questionnaire offers an attractive alternative to surgeon's judgement but is infrequently used in France for these purposes. The British questionnaire, the 12-item Oxford Hip Score (OHS) was selected for this study because of its ease of use. HYPOTHESIS: The objective of this study was to validate the French translation of the self-assessment 12-item Oxford Hip Score and compare its results with those of the reference functional scores: the Harris Hip Score (HHS) and the Postel-Merle d'Aubigné (PMA) score. MATERIALS AND METHODS: Based on a clinical series of 242 patients who were candidates for total hip arthroplasty, the French translation of this questionnaire was validated. Its coherence was also validated by comparing the preoperative data with the data obtained from the two other reference clinical scores. RESULTS: The translation was validated using the forward-backward translation procedure from French to English, with correction of all differences or mistranslations after systematized comparison with the original questionnaire in English. The mean overall OHS score was 43.8 points (range, 22-60 points) with similarly good distribution of the overall value of the three scores compared. The correlation was excellent between the OHS and the HHS, but an identical correlation between the OHS and the PMA was only obtained for the association of the pain and function parameters, after excluding the mobility criterion, relatively over-represented in the PMA score. DISCUSSION AND CONCLUSION: Subjective questionnaires that contribute a personal appreciation of the results of arthroplasty by the patient can easily be applied on a large scale. This study made a translated and validated version of an internationally recognized, reliable self-assessment score available to French orthopaedic surgeons. The results obtained encourage us to use this questionnaire as a complement to the classical evaluation scores and methods

Validation de la version française du score de hanche d'Oxford-12

Fondement L'appréciation objective du résultat des actes chirurgicaux fait partie de la démarche d'évaluation des pratiques professionnelles, notamment en chirurgie orthopédique pour le résultat des prothèses articulaires. Dans cette optique, les questionnaires « auto-administrés » par les patients offrent une solution séduisante, mais peu utilisée en France. Le questionnaire anglais Oxford Hip Score en 12 questions (OHS-12) a été sélectionné pour cette étude en raison de sa facilité d'utilisation. Hypothèse Le but de ce travail était de valider la traduction française du score d'autoévaluation Oxford-12 et d'en confronter les résultats à ceux des scores fonctionnels de références, de Harris (HHS) et de Merle d'Aubigné (PMA). Matériel et méthode À partir d'une série clinique de 242 patients candidats à une arthroplastie de hanche, une validation de la traduction en langue française de ce questionnaire a été réalisée, ainsi qu'une évaluation de sa cohérence par confrontation des données obtenues en préopératoire avec celles provenant des deux scores cliniques de référence. Résultats La traduction a été validée selon le processus de traduction inverse du français à l'anglais avec correction de toute déviation ou contresens après comparaison systématisée avec le questionnaire original anglais. La moyenne du score global OHS-12 était de 43,8 points (22 à 60 points) avec une bonne distribution de la valeur globale des trois scores comparés. La corrélation était excellente entre OHS et HHS, mais une corrélation de niveau identique entre OHS et PMA n'a été obtenue que pour l'association des paramètres douleur et fonction, après exclusion du critère mobilité relativement surreprésenté dans le score PMA. Discussion et conclusion Le recours à des questionnaires subjectifs qui apportent une appréciation personnelle du résultat de l'arthroplastie par le patient est facilement applicable à grande échelle. Ce travail permet de mettre à la disposition des chirurgiens orthopédistes français une version traduite et validée d'un score d'autoévaluation fiable et internationalement reconnu. Les résultats obtenus nous incitent à privilégier l'utilisation de ce questionnaire en complément des scores et méthodes d'évaluation classiques