Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: Prospective evaluation of bone union, precision and maintenance of correction in 51 cases

SummaryIntroductionA medial opening wedge high tibial osteotomy (HTO), where the osteotomy site is filled, is often preferred to a lateral closing osteotomy, but filling the defect can lead to certain complications.HypothesisA medial opening HTO can be performed without filling the bone defect if fixation is carried out with a specially-designed stiff locking plate.Patients and methodsFifty-one patients, 37 to 72 years of age where followed prospectively and continuously from 2003 to 2006. A single surgical technique was used: medial opening HTO with locked plate fixation (TomoFix™, Synthes) but without filling the defect. The preoperative genu varum could not exceed 15°. The following were evaluated: time to return to weight-bearing, IKS functional score, long-leg standing film performed preoperative, postoperative and at follow-up to evaluate limb alignment and validate the precision of the correction and its stability over time. A measurement of the area of bone union in the osteotomy site was used to quantify the rate of union.ResultsBone union occurred at 4.5 months on average; two cases of incomplete union (7%) were found and revised with an autograft at 7 and 9 months. Lower-limb alignment was 7.5° of varus on average before surgery (3° to 15° varus, SD=2.85) and 1.2° of valgus on average after the surgery (4° varus to 5° valgus, SD=1.78). The correction was maintained at 1 year post-surgery. The average IKS knee score went from 69±15.5 (range 25 to 96) before surgery to 90±7.4 (range 66 to 98) at follow-up (P=0.0001). Full weight-bearing without assistance was possible after 3 months on average (range 1.5 to 8, SD=1.21). Forty-seven patients (92%) were fully weight-bearing after 2 months. Forty-eight patients were able to return to work and sporting activities at the same or a higher level than before the procedure.DiscussionBone union seems to happen more slowly when the defect is filled; however, there are doubts about radiological evaluation of bone union in different published studies. When osteotomy defect was left unfilled in this study, union and filling of 4/5 of the osteotomy site was obtained in 4.2 months for 49 of the 51 cases. Fixation with the locking plate is reliable and provides stable correction and the option for early weight-bearing.Level of proofLevel IV, prospective cohort study

Effects of GnRHa slow-release implants in the steroid profile of isolated couples of Arapaima gigas (Schinz, 1822).

The aim of the study were 1) to induce spawning of isolated broodstock pairs with GnRHa slow-release implant technique (Zohar and Mylonas, 2001) and monitor steroid levels in blood plasma; and 2) characterise cephalic secretions through proteomic and steroid analyses during reproduction and parental care post spawnin

Isolation, identification and characterisation of ballan wrasse Labrus bergylta plasma pigment

This work was supported by co-funding from Innovate U.K. (formerly Technology Strategy Board), Marine Harvest Scotland and Scottish Seafarms Ltd (project ref: 81199) as well as the University of Stirling, Impact studentship funding scheme. Mass spectrometry analysis was performed by the BSRC Mass Spectrometry Facility, University of St Andrews.This study confirmed that observations of blue-green colouration in plasma fractions of the ballan wrasse Labrus bergylta were caused by the linear tetra-pyrrole biliverdin and that the molecule was of the physiologically relevant IXα isomer. Accumulation appears driven by chromogenic association with an unknown protein moiety which precludes enzymatic reduction and would suggest active management. It was demonstrated that the pigment did not fluctuate relative to ontogeny, or indeed binary gender in the species of interest, but mobilisation and depletion in the subset of individuals undergoing sex change at the time of study supports a potential association with gender inversion processes. It is of note that although biliverdin does have some effect on external colouration, the evidence is indicative that crypsis is a supplementary function thus other factors must be considered.PostprintPeer reviewe

Severe corrosion after malpositioning of a metallic head over the Morse taper of a cementless hip arthroplasty. A case report

SummaryMorse tapers are frequently used in total hip replacement to achieve precise adjustment of lengths and femoral offset. Mechanically, they do not raise any specific problems so long as strict positioning requirements are observed and elements from different manufacturers are not mixed together. We report a case in which the implant induced unexplained pain at 2years, in relation to a defective fit between the metallic head and the Morse taper. Asymmetric partial fit of the head onto the taper was detected on control X-ray and was implicated as causing metallosis due to excessive release of metal debris from the Morse taper. Revision required femoral stem exchange because of the damage to the Morse taper as well as replacing the cup with new metal-metal bearings. Evolution was favorable at 3years’ follow-up. Most hip replacements include a Morse taper; the present clinical case is a reminder that strict positioning rules are to be respected, without which corrosion and wear may lead to mechanical failure

Potential changes to French recommendations about peri-prosthetic infections based on the international consensus meeting (ICMPJI)

AbstractBackgroundDespite the large volume of studies on the prevention, diagnosis, and treatment of peri-prosthetic infections, surgical practice often rests on limited scientific evidence in this field. The vast International Consensus Meeting on Peri-prosthetic Joint Infection (ICMPJI) held in 2013 produced robust recommendations.HypothesisFrench consensus conference recommendations show no major differences with ICMPJI recommendations.Materials and methodsThe 207 recommendations developed by 300 experts at the ICMPJI were translated, and the translation was then examined by four reviewers, including 2 having participated in the consensus conference. The reviewers looked for any differences with French practices and recommendations.ResultsTwenty-three major differences or innovations were identified compared to French recommendations and standard practice. Among them, pre-operative screening for nasal or urinary micro-organisms is performed routinely in France but should be reserved according to the ICMPJI for symptomatic patients and/or patients at high risk for infection. The ICMPJI emphasizes the role for the operating room environment as a vector for infection; more specifically, the operating lamp handle and suction cannula deserve close attention. A wound discharge persisting longer than 5–7 days requires irrigation and debridement. This procedure is effective only within the first 3 post-operative months and/or the first 3 weeks after symptom onset and must include exchange of all modular implants. The ICMPJI warns against both irrigation-debridement in fungal infections (suggesting two-stage prosthesis replacement) and one-stage replacement in patients with sinus tracts. The use of spacers (articulating at the knee) is recommended in the event of two-stage prosthesis replacement.DiscussionThe ICMPJI recommendations differed in many ways with French recommendations and standard practice. They can be expected to impact practices in France, although a point worth noting is that only 1 of the 207 recommendations received unanimous agreement by the conference experts (keeping operating room traffic to a minimum)

Cephalic secretion of Arapaima gigas: sex steroids, peptides and proteins suggest roles in chemical communication and parental care.

Adults of the Amazon fish Arapaima gigas secrete a fluid from the cephalic canals of the lateral line system, whose biological role(s) along the reproductive cycle are unclear. Up-todate, the biochemical composition of this fluid has been poorly investigated in A. gigas as well as other teleosts. Hence, this study aimed to (1) investigate the potential pheromone release through this cephalic fluid, and (2) to characterise its proteome and peptidome by comparing males and females during and outside the parental care phase

Shelf arthroplasties long-term outcome: Influence of labral tears. A prospective study at a minimal 16 years’ follows up

SummaryIntroductionOsteoarthritis lesions extent and dysplasia severity (negative vertical center edge [CE] angle) are recognized as unfavorable criteria for the survival of shelf arthroplasties performed for correcting hip dysplasia. Labral tears have recently been described on dysplastic hips, indicating beginning osteoarthritis and worsening the risk of instability.HypothesisThe labral tears identified in the course of shelf arthroplasty procedures for correction of hip dysplasia carry a predictive value for the survival of this operation.ObjectivesEvaluate this hypothesis at the intermediate term in a long-term prospective observational study.Patient and methodsEighteen adult patients (18 dysplastic hips) having undergone shelf arthroplasty were included consecutively in a continuous prospective study. At the time the shelf arthroplasty was performed, a hip arthroscopic exam was carried out to search for and resect a labral tear if necessary. Fifteen patients were reviewed with a minimum follow-up of 16 years. Two patients died and one patient was lost to follow-up.ResultsDuring arthroscopic exploration, 10 hips presented labral tears (55.6%). At a mean follow-up of 16.3 years (range, 16–18 years), eight hips underwent hip arthroplasty. Of these hips, only one did not present a labral tear. The seven other hips had a tear of the labrum (p<0.001). The overall survival rate was 41.3%; it was 83.3% for hips with no labral tear and 15.2% for hips with a lesion of the labrum (p=0.048).Discussion and conclusionLabral tears had a negative impact on the outcome of shelf arthroplasty for hip dysplasia. This lesion therefore warrants being sought using appropriate exploration techniques (MRI or CT-arthrography) before shelf arthroplasty surgery. The existence of a preoperative labral tear does not seem to cast doubt on shelf arthroplasty itself. However, it should be identified so as to set objectives and expectations: long-term survival is significantly lower in the presence of a labral tear. It seems preferable to repair this type of lesion with arthroscopic guidance during shelf arthroplasty to prevent a potential source of residual pain, keeping in mind that secondary resection will be more difficult after covering the lesion.Level of evidenceLevel 3 prospective observational prognostic study

Radiographic preoperative templating of extra-offset cemented THA implants: How reliable is it and how does it affect survival?

SummaryIntroductionSecuring femoral offset should in theory improve hip stability and abductor muscles moment arms. As problems arise mainly in case of originally increased offset (>40mm), a range of extra-offset stems is available; the exact impact in terms of fixation, however, is not known.HypothesisExtra-offset stems should more reliably reestablish original femoral offsets exceeding 40mm than standard femoral components, limiting instability risk without possible adverse effect on fixation.ObjectiveTo compare the ability of five commonly available femoral stem designs to restitute offset exceeding 40mm, and to assess function and cement fixation at a minimum 6 years’ follow-up in a stem conceived to reproduce such offset.Patients and methodsA continuous series of 74 total hip replacements (THR) in hips with increased (>40mm) femoral offset was studied. All underwent preoperative X-ray templating on Imagika™ software to assess offset reproduction by five models of stem: four standard, and one Lubinus SP2™ extra-offset stem. A retrospective clinical and X-ray study was conducted with a minimum 6 years’ follow-up on the Lubinus SP2™ 117° stems used to try to reproduce offset in the 74 THRs.ResultsApart from the increased (>40mm) offset, the cervicodiaphyseal angle was consistently <135°, <130° in 60 femurs (81%) and <125° in 45 (60%). Planning showed the four standard stems to induce (>5mm femoral offset reduction in 50–83% of cases, versus only 25% with the Lubinus SP2™ 117°). All 74 hips received Lubinus SP2™ 117° stems: at a mean 78 months FU (range, 70–94mo), their mean Postel-Merle d’Aubigné score was 17±1.8 (range, 13–18). Five of the 74 THRs underwent surgical revision: three cases of loosening, in which the stem was replaced, and two of instability, without change of stem. Loosening was not related to offset reproduction quality; two of the three cases were due to initial cementing defect, and the third occurred in a femur with previous history of two osteotomies. There were four cases of dislocation (5.4%: two primary, which were not operated on, and two recurrent, managed by acetabular revision), despite good reproduction of the preoperative offset in three of the four cases. Mean 7-year implant survivorship was 95.1% (±4.8).Discussion and conclusionThe anatomic form of the Lubinus™ SP2 117° should in theory provide a uniform cement mantle. Survivorship, however, is less good than for regular offset versions (126° or 135°). On the other hand, it does reproduce anatomy in case of >40mm offset, providing extra offset of more than 51mm. The slightly shorter survivorship requires more long-term surveillance.Level of evidenceLevel IV, retrospective study

Technique to treat iliopsoas irritation after total hip replacement: Thickening of articular hip capsule through an abridged direct anterior approach

AbstractIliopsoas irritation due to acetabular cup component impingement following total hip arthroplasty (THA) is usually treated by infiltration or by distal iliopsoas tenotomy in case of recurrence; however, this can result in an active flexion deficit of the thigh. To prevent this complication, we developed an original technique that we performed between 2012 and 2014 in patients with recurrent impingement following extraarticular corticosteroid injections. This included 5 patients (mean age: 64 [53–75] years old) in whom we performed an ambulatory bursectomy by the Hueter approach and placed a polyglactin 910 (Vicryl™) mesh plate on the entire anterior hip capsule. After a mean follow-up of 12months (9–29months), anterior pain had decreased in all patients with improvement and an increase in the Oxford-12 (mean: 15 points [10–19]), Merle d’Aubigné (mean: 2.5 points [1–5]) and Harris (mean: 18 points [10–29]) scores. No flexion deficits were observed. An infected postoperative hematoma had to be drained but was cured at follow-up. This simple procedure provides satisfactory results and preserves THA function. It does not jeopardize future procedures and is an alternative option in case of unsuccessful conservative treatment

Canulação como técnica de baixo custo para identificação do sexo e condição reprodutiva em fêmeas de pirarucu Arapaima gigas.

Descreve os estágios de maturação gonadal nas fêmeas para que as biópsias ovarianas coletadas por meio da canulação possam auxiliar na identificação da maturidade sexual das fêmeas e assim aumentar as chances de sucesso no processo de formação de casais para reprodução