Is the prognosis the same for periprosthetic joint infections due to Staphylococcus aureus versus coagulase-negative staphylococci? A retrospective study of 101 patients with 2-year minimum follow-up.

BACKGROUND: Staphylococcus aureus (SA) and Coagulase-negative staphylococci (CoNS) are often responsible for infections of total hip arthroplasty (THA) and total knee arthroplasty (TKA). One of the main differences between these two microorganisms is their virulence, with SA presumed to be more virulent; however, few studies have specifically investigated the impact of this virulence. This inspired us to carry out a retrospective study to evaluate whether the healing rate differed between SA and CoNS infections. HYPOTHESIS: We hypothesised that the healing rate is lower for SA prosthetic joint infections. MATERIALS AND METHODS: This was a retrospective study of 101 consecutive Staphylococcus infection cases that occurred between 2007 and 2011. There were 56 men and 45 women with an average age of 69 years (range 23-95). The infection was associated with TKA in 38 cases and THA in 63 cases. Thirty-two percent of patients had one or more comorbidities with infectious potential. In our cohort, there were 32 SA infections (31.7 %) and 69 CoNS infections (68.3 %) with 58 of the infections being methicillin-resistant (15 SA and 43 CoNS); there were 27 polymicrobial infections (26.7 %). RESULTS: With a minimum 24-month follow-up after the end of antibiotic treatment, the healing rate was 70.3 % overall (71 patients). The healing rate was 75 % in the SA group (24 patients) versus 68.1 % (47 patients) in the CoNS group (P = 0.42). CONCLUSION: Our hypothesis was not confirmed: the healing rate of SA prosthetic joint infections was not lower than that of CoNS infections. LEVEL OF EVIDENCE: III, retrospective case-control study

Biomechanical study of ACL reconstruction grafts

There are no published studies describing the strength quadrupled gracilis tendon alone and quadrupled semitendinosus tendon alone in the configuration used for anterior cruciate ligament (ACL) reconstruction. The primary objective was to compare the mechanical properties of grafts used for ACL reconstruction during a tensile failure test. The secondary objective was to evaluate the effect of uniform suturing on graft strength. Fifteen pairs of knees were used. The mechanical properties of five types of ACL grafts were evaluated: patellar tendon (PT), sutured patellar tendon (sPT), both hamstring tendons (GST4), quadrupled semitendinosus (ST4), and quadrupled gracilis (G4). Validated methods were used to perform the tensile tests to failure and to record the results. Student's t-test was used to compare the various samples. The maximum load to failure was 630.8N (± 239.1) for the ST4, 473.5N (± 176.9) for the GST4, 413.3N (± 120.4) for the sPT, and 416.4N (± 187.7) for the G4 construct. Only the ST4 had a significantly higher failure load than the other grafts. The sPT had a higher failure load than the PT. The ST4 construct had the highest maximum load to failure of all the ACL graft types in the testing performed here. Uniform suturing of the grafts improved their ability to withstand tensile loading

Triple osteotomy of the pelvis for Legg-Calve-Perthes disease: a mean fifteen year follow-up.

PURPOSE: This study presents the results of a prospective consecutive cohort of patients with Legg-Calvé-Perthes disease (LCPD) operated with triple osteotomy of the pelvis (TOP) between 1989 and 2005. We attempted to determine whether the results of TOP remain stable with time and consequently lower the risk of subsequent osteoarthritis. The primary study aims were to determine the maintenance of head coverage and joint congruity, and functional outcomes of this surgery. METHODS: Forty-five patients with a mean follow-up of 15.2 years (range eight to 24) were included. RESULTS: At latest follow-up, two patients were lost to follow-up, and two required a surgical reoperation. Cumulative maintenance of head coverage and joint congruity rate for all TOP was 84.6 % (95 % CI: 82.3-90.6 %) at 15 years. Factors significantly associated with poor long-term results were the age at diagnosis and Greene index. CONCLUSION: TOP in LCPD provides satisfactory and reproducible long-term clinical results

Can the gracilis replace the anterior cruciate ligament in the knee? A biomechanical study

Purpose The purpose of this study was to determine whether a four-strand gracilis-only construct possesses the biomechanical properties needed to act as an anterior cruciate ligament (ACL) reconstruction graft. Methods This was a pilot study with 32 cadaver specimens. The biomechanical properties of three types of grafts were determined using validated tensile testing methods: patellar tendon (BTB), both hamstring tendons together (GST4) and gracilis alone (G4). Results The maximum load at failure of the G4 was 416.4 N (±187.7). The GST4 and BTB had a maximum load at failure of 473.5 N (±176.9) and 413.3 N (±120.4), respectively. The three groups had similar mean maximum load and stiffness values. The patellar tendon had significantly less elongation at failure than the other two graft types. Conclusions The biomechanical properties of a four-strand gracilis construct are comparable to the ones of standard grafts. This type of graft would be useful in the reconstruction of the anteromedial bundle in patients with partial ACL ruptures

Cadaveric study comparing the biomechanical properties of grafts used for knee anterolateral ligament reconstruction

Purpose: To measure the biomechanical properties (maximum load, stiffness, and elongation) of the anterolateral ligament (ALL), gracilis, and iliotibial band (ITB) within the same subject. METHODS: Thirteen unpaired knees were used (7 women, 6 men). The donors had a mean age at death of 54 years (range: 37 to 70 years). The mechanical properties of two types of ALL grafts were evaluated: ITB and two-strand gracilis. The mechanical properties of ALL were also measured. Validated methods were used to perform the tensile tests to failure and to record the results. Student's t-test was used to compare the various samples. RESULTS: The maximum load to failure was 141 N (±40.6) for the ALL, 200.7 N (±48.7) for the gracilis, and 161.1 N (±27.1) for the ITB. Only the gracilis had a significantly higher failure load than ITB and ALL (P = .001 and P = .03). The stiffness was 21 N mm-1 (±8.2) for the ALL, 131.7 N mm-1 (±43.7) for the gracilis, and 39.9 N mm-1 (±6) for the ITB. The elongation at failure was 6.2 mm (±3.2) for the ALL, 19.9 mm (±6.5) for the gracilis, and 20.8 mm (±14.7) for the ITB. CONCLUSIONS: The gracilis had the highest maximum load to failure. The ITB's mechanical properties most closely resemble those of the ALL. CLINICAL RELEVANCE: The biomechanical properties of each potential ALL graft can be factored in when deciding which type of graft to use

In situ pinning in slipped capital femoral epiphysis: long-term follow-up studies

Management of moderately displaced slipped capital femoral epiphysis (SCFE) is debated, mostly because of the risks related to open reduction on one hand, and subsequent evolution toward femoroacetabular impingement (FAI) on the other. METHOD: All SCFE cases treated with in situ fixation (ISF) and a minimum of ten years of follow-up beyond skeletal maturity were analysed in a retrospective multicentre study. Coxometry parameters were measured. Long-term results of ISF were meanwhile analysed at our Institution. RESULTS: A total of 222 patients were included. Patient reported outcome measurements were related to the severity of the initial slip. It suggested a 35.5° threshold for slip angle beyond which FAI was more frequent. Only slight remodelling at the head-neck junction is to be expected. CONCLUSION: Based on these findings, it seems reasonable to perform ISF only in SCFE with a slip angle below 35°

Results of non-operative treatment of olecranon fracture in over 75-year-olds

INTRODUCTION: Surgery is the gold-standard treatment of displaced olecranon fracture, but is associated with numerous complications, especially in the elderly. Functional results of non-operative treatment in this population have never been analyzed in a prospective study. STUDY HYPOTHESIS: Non-operative treatment of isolated olecranon fracture with stable elbow-joint in over 75-year-olds gives functional results comparable to those of surgery as reported in the literature, with fewer complications. MATERIAL AND METHODS: A prospective study analyzed functional results of non-operative treatment of isolated closed Mayo I and II olecranon fracture with stable elbow, in patients aged ≥75 years. The principal assessment criterion was functional recovery on the Mayo Elbow Performance Score (MEPS) and QuickDASH at 6 months. RESULTS: Twenty-two fractures in 21 patients were included. Mean MEPS was 95.26/100 (range, 85-100), and mean QuickDASH 4.3 (range, 0-29.55). Eighteen fractures showed osteoarthritis of the olecranon. There were no cases of elbow instability. There were no complications. DISCUSSION: Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications. TYPE OF STUDY: Single-center prospective observation cohort study

Cryotherapy With Dynamic Intermittent Compression Improves Recovery From Revision Total Knee Arthroplasty

BACKGROUND: The goal of this study was to assess the efficacy of cryotherapy with dynamic intermittent compression (CDIC) in relieving postoperative pain, decreasing blood loss, and improving functional scores after revision total knee arthroplasty (rTKA). METHODS: We conducted a prospective case-control study (level of evidence: I) to evaluate the efficacy of CDIC on postoperative bleeding, pain, and functional outcomes after rTKA. Forty-three cases were included at a single institution and divided in 2 groups: a control group without CDIC (n = 19) and an experimental group with CDIC (n = 24). Bleeding was evaluated by calculating total blood loss, pain at rest was evaluated with a visual analog scale on postoperative day 3, and function was assessed using the Oxford score at 6 months postoperatively. The comparative analysis was performed using the Fisher exact test. RESULTS: The CDIC group had significantly lower total blood loss (260 vs 465 mL; P < .05), significantly less pain on day 3 (1 vs 3; P < .05), and a significantly higher functional score (42 vs 40; P < .05) than the control group. CONCLUSION: This is the first report dealing with the use of CDIC after rTKA. According to our results, it improves the recovery of patients who underwent rTKA; thus, it should be integrated into our daily practice

Hamstring graft incorporation according to the length of the graft inside tunnels

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction with a quadrupled semitendinosus (ST4) graft is an evolution of the standard technique with 2 hamstring tendons (semitendinosus + gracilis [STG]). However, there is no published comparison of how well these 2 types of hamstring grafts are incorporated into the bone tunnels. Because the ST4 graft is shorter, there is less graft material inside the tunnels. PURPOSE: To use magnetic resonance imaging (MRI) to compare graft incorporation in the tibial bone tunnels 1 year after ACL reconstruction with either an STG graft or ST4 graft. STUDY DESIGN: Cohort study. METHODS: Sixty-two patients who underwent ACL reconstruction were enrolled prospectively: 31 with an ST4 graft and 31 with an STG graft. The same surgical technique, fixation method, and postoperative protocol were used in both groups. Graft incorporation and ligamentization were evaluated with MRI after 1 year of follow-up. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel enlargement, signal intensity at the bone-graft interface, and graft signal according to the Howell scale. The number of participants needed to show that the mean SNQ did not differ between the 2 techniques was 31 in each group (with a 1-sided alpha of 2.5% and a 1-sided beta of 10.0%). The Student t test was used to compare the distribution of continuous secondary endpoints. RESULTS: The mean SNQ was 5.2 ± 4.5 for the STG group and 5.9 ± 3.7 for the ST4 group ( P = .5100). The mean tibial tunnel widening was 93.7% ± 51.7% for the STG group versus 80.0% ± 42.9% for the ST4 group ( P = .2605). The groups did not differ in signal intensity at the bone-graft interface ( P = .7502) or in graft signal according to the Howell scale ( P = .4544). CONCLUSION: At the 1-year postoperative follow-up, incorporation and ligamentization of the STG and ST4 grafts were the same based on MRI analysis. The results were at least as good with the ST4 technique as with the standard STG technique in terms of incorporation and ligamentization

Knee chondrosarcoma secondary to Ollier’s disease: a report of one case with twelve-year follow-up

Management of low-grade chondrosarcomas secondary to Ollier’s disease is generally radical. We report here a case of conservative treatment of a knee tumor with reconstruction of the lower femoral extremity with a hinged total knee prosthesis, cemented and coupled with a massive femoral allograft, with a twelve-year follow-up