Survivorship and complications of cementless compared to cemented posterior-stabilized total knee arthroplasties: A systematic review and meta-analysis

Purpose: Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries. Methods: Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis. Results: When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development. Conclusion: We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period

Evaluation des patients opérés d'une fracture fémorale proximale dans le cadre du programme Fragility Fracture durant la période de confinement belge

Introduction :The management of SARS-CoV-2 infection has completely reformed the medical sector. Between March 14 and May 17 2020, only urgent surgical operations remained, including the management of proximal femoral fractures. The aim of our study is to best qualify this population of surgical patients by evaluating some clinical and epidemiological characteristics and assessing the infection rate. Material and Methods :This is a retrospective, descriptive and mono-centric cohort study, which identifies all Fragility Fracture program patients who had surgery for a proximal femoral fracture between March 14, 2020 and May 17, 2020 in the CHU Tivoli. Overall we defined the population and analyzed clinical and biological characteristics of patients suspected of or suffering from COVID-19, but also patients who developed the infection during hospitalization, compared to patients considered healthy. Finally, we described our deceased cases. Results :We treated 18 proximal femoral fractures during this period. Eight patients were operated following the COVID-19 precautions. Six patients tested positive, 3 on admission and 3 who become infected during their time in hospital. There were no physiological or biological differences between patients on admission. The mortality rate for positive patients was 33%. Conclusion :Unlike other studies, our incidence of proximal femoral fractures did not decrease during this time. These fractures occur in patients with early stage COVID-19, however the mortality rate remains high.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Osteopoikilosis: Report of a patient with associated complex knee injuries and literature review

ABSTRACTIOsteopoikilosis (OPK) is a rare autosomal dominant hereditary disease with a prevalence estimated at 1/50000. Most of the time asymptomatic and benign, it can be misdiagnosed as other osteoblastic bone diseases (such as bone metastases) and lead to unnecessary stress and costly investigation. We report a 15-year-old boy with a complicated knee injury and associated OPK as well as a literature review.KEYWORDS Osteopoikilosis, Multiple sclerotic lesions, sclerosing bone dysplasiainfo:eu-repo/semantics/publishe

Arthrite septìque du genou causée par un germe inhabituel: à proposďun cas

Introduction: Osteo-articular infections witPi Streptococcus canis are rare. To our l<nowledge, only one case of septic osteoartiiritis witii S. canis is reported in the scientific literature. Clinical case: We report the case of a 55-year-old patient who presented with left gonalgia without trauma. He was bitten on the leg by his dog a few days earlier. The biological inflammatory syndrome was moderately significant. The complementary explorations allowed to set the diagnosis of septic osteoarthritis. Discussion: Streptococcus canis is mostly known in the veterinary area and only represents 1 % of the streptococcal infections in humans. This germ is mainly responsible of soft tissue infections but can also affect other areas. Conclusion: Septic arthritis with S. canis is a rare condition and is a therapeutic and diagnostic emergency. The puncture is essential before starting the antibiotherapy.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Survivorship and complications of cementless compared to cemented posterior-stabilized total knee arthroplasties: A systematic review and meta-analysis

Purpose: Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries. Methods: Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis. Results: When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development. Conclusion: We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period

Post-COVID-19 return to elective orthopaedic surgery—is rescheduling just a reboot process? Which timing for tests? Is chest CT scan still useful? Safety of the first hundred elective cases? How to explain the “new normality health organization” to patients?

AbstractPurposeThe long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery.MethodsA retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19?ResultsBefore surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72–120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization.ConclusionsResumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period.info:eu-repo/semantics/publishe

Psychometric properties of the Cumulated Ambulation Score French translation

AbstractObjective:To examine measurement properties (inter-rater reliability, agreement, validity, and responsiveness) of the Cumulated Ambulation Score French translation in patients with hip fracture.Design:Methodological study.Setting:A 20-bed orthopedic unit and 20-bed geriatric unit.Subjects:About 140 consecutive patients with a mean (SD) age of 83 (12) years.Interventions:The English version of the Cumulated Ambulation Score used to evaluate basic mobility was translated into French following international guidelines. Two raters independently assessed all patients on postoperative days one, two, three, and 30 after a hip fracture surgery. Relative and absolute inter-rater reliability and responsiveness (effect size for improvement from postoperative day two to 30) were evaluated. Convergent validity was analyzed by Spearman’s correlation coefficient comparing the Cumulated Ambulation Score with two other measures on postoperative day two and 30.Main measure:Cumulated Ambulation Score.Results:The weighted Kappa value ranged from 0.89 to 1.0. The standard error of measurement and the smallest real difference of the Cumulated Ambulation Score ranged, respectively, from 0.12 to 0.23 and from 0.32 to 0.6 points, while the effect size reached 1.03 (95% CI 0.87–1.26). There was a strong positive correlation comparing the Cumulated Ambulation Score with the French Tinetti Assessment Tool (r ⩾ 0.83) and the French Mini Motor Test (r ⩾ 0.79).Conclusions:Our findings indicate that the Cumulated Ambulation Score’s French version is a reliable and valid tool to assess patients’ basic mobility with hip fractures.info:eu-repo/semantics/publishe

Risk of vascular injury when screw drilling for tibial tuberosity transfer

Purpose: During tibial tubercle transfer, popliteal vessels are at risk from drills and screws. The risk is around 0.11%, as described in the literature. We reviewed knee injected CT scan for analysis of the location of arteries, identified landmarks allowing minimizing risks, and defined a safe zone. Material and method: Distances between the posterior cortex and arteries were measured on CT scans from 30 adults (60 knees) at three levels (proximal part of the tibial tuberosity, 20 mm and 40 mm distally). Data were used to create a “risk map” with different angular sectors where the frequency of the presence of arteries was analyzed in each area. We also analyzed the position of 68 screws of 47 patients who underwent a medial tibial tuberosity transfer. Results: The nearest distance between artery and the posterior tibial cortex was found at the level corresponding to the top of the tuberosity with less than 1 mm, while the largest distance was found at the distal level. We were able to define a safe zone for drilling through the posterior tibial cortex which allows a safe fixation for the screws. This zone corresponds to the medial third of the posterior cortex. When the safe zone is not respected, screws that overtake the posterior cortex may be close to arteries as observed for 37 of the 68 screws analyzed. Conclusion: We described new landmarks and recommendations to avoid this complication during tibial tuberosity transfer.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Effects of press-fit biphasic (collagen and HA/βTCP) scaffold with cell-based therapy on cartilage and subchondral bone repair knee defect in rabbits.

Human spontaneous osteonecrosis of the knee (SPONK) is still challenging as the current treatments do not allow the production of hyaline cartilage tissue. The aim of the present study was to explore the therapeutic potential of cartilage regeneration using a new biphasic scaffold (type I collagen/hydroxyapatite) previously loaded or not with concentrated bone marrow cells. Female rabbits were operated of one knee to create articular lesions of the trochlea (three holes of 4 × 4mm). The holes were left empty in the control group or were filled with the scaffold alone or the scaffold previously loaded with concentrated bone marrow cells. After two months, rabbits were sacrificed and the structure of the newly formed tissues were evaluated by macroscopic, MRI, and immunohistochemistry analyses. Macroscopic and MRI evaluation of the knees did not show differences between the three groups (p > 0.05). However, histological analysis demonstrated that a higher O'Driscoll score was obtained in the two groups treated with the scaffold, as compared to the control group (p  0.05) but subchondral bone repair was significantly thicker in scaffold-treated groups than in the control group (1 mm for the control group vs 2.1 and 2.6 mm for scaffold groups). Furthermore, we observed that scaffolds previously loaded with concentrated bone marrow were more reabsorbed (p < 0.05). The use of a biphasic scaffold previously loaded with concentrated bone marrow significantly improves cartilage lesion healing