Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome

We have analysed retrospectively the influence of different sources of knee deformity on failure of closing wedge high tibial valgus osteotomy (HTO). Preoperative frontal plane varus deformities of the lower extremity, distal femur and proximal tibia, and medial convergence of the knee joint line were assessed on a standard whole leg radiograph in 76 patients. Using the logistic regression model, the probability of survival for HTO was 77% (SD 4%) at 10-years follow-up. Varus deformity of the lower extremity ( 3 degrees ) were identified as preoperative risk factors for conversion to arthroplasty (P = 0.03 and P = 0.006). We found no evidence that varus inclination of the proximal tibia or distal femur influences long-term survival of HTO

Custom stems for femoral deformity in patients less than 40 years of age: 70 hips followed for an average of 14 years

Background and purpose Femoral deformity associated with osteoarthritis is a challenge for both the surgeon and the implant. Many of the patients with these deformities are young. Standard implants can be difficult to fit into these femurs. We prospectively evaluated the outcome of custom uncemented femoral stems in young patients

Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Materials and methods Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years). Results Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results

Can the Reamer/Irrigator/Aspirator System replace anterior iliac crest grafting when treating long bone nonunion?

Introduction: Autologous bone graft is the gold standard for filling bone defects associated with diaphyseal nonunions. It is typically harvested from the anterior iliac crest (AIC) despite the high complication rate. The Reamer/Irrigator/Aspirator System (RIA) was developed to recover the reaming aspirate and use it as autograft. Initially described for harvesting bone from the femur, the bone volume available is similar to the AIC site; however, its use directly at nonunion sites has been studied very little. Hypotheses: Compared to AIC harvesting, RIA at a non-union site will result in (1) sufficient bone volume, (2) similar time to union and union rate, (3) lower morbidity. Results: Two groups of patients received an autograft for aseptic nonunion of the tibia or femur for a bone defect up to 2 cm: the RIA group (n = 30) was followed prospectively and received an autograft by RIA while the AIC group (n = 29) was reviewed retrospectively and received an autograft by AIC. We compared the time to union and union rate, operative time, intake of analgesics, duration of hospital stay and complication rate between groups. The RIA provided sufficient bone, 60 cm 3 on average in a reliable manner. The union rate was similar between groups: 90% (RIA) and 89.7% (CIA) (p = 0.965), while the time to union was shorter in the RIA group (8.63 ± 1.47months vs. 10.08 ± 1.7 months) (p = 0.006). The operative time (p < 0.0001), analgesic intake (p = 0.013), length of stay (p < 0.0001) and immediate complication rate (p = 0.0195) were higher in the AIC group. Discussion: For the treatment of aseptic long bone nonunion, autograft harvested by the RIA from the nonunion site results in similar union rate and time to union as AIC grafts without additional complications. Level of evidence: IV, comparative retrospective study

Le déport fémoral offset : concept anatomique, définitions, mesure, rôle dans la planification et la réalisation d’une arthroplastie de hanche

Il s’agit d’un recueil de travaux indépendants, anatomoradiologiques, et cliniques, destiné à faire le point des connaissances sur le rôle du déport fémoral dans la planification, la réalisation et le résultat des arthroplasties totales de hanche. Le déport fémoral (offset) est la distance entre l’axe diaphysaire et le centre de la tête fémorale. Il existe une bonne corrélation entre celui-ci, bras de levier et force des muscles abducteurs. La latéralisation est indépendante des caractéristiques ndomédullaires. Le bras de levier des abducteurs est fortement corrélé à l’angle d’attaque du moyen fessier. Il existe une corrélation entre offset et forme du canal médullaire. À taille égale, les formes latéralisées ont un centre de tête plus bas. Une étude radiographique, comparant les mesures de l’offset obtenues par des radiographies conventionnelles et par tomodensitométrie chez 50 patients, a montré que les radiographies sous-estimaient le déport. En fait, la planification en deux dimensions méconnaît les rotations, alors que le plan horizontal est indispensable pour planifier l’intervention et le respect de l’offset. Une étude prospective randomisée, comparant prothèse totale et resurfac¸age, conclut que le resurfac¸age réduit le déport par rapport à une arthroplastie conventionnelle mais que cette réduction n’affecte pas la fonction clinique. Une étude de 120 prothèses à col modulaire a montré que leur utilisation assurait une meilleure restauration de l’offset prothétique, mais soulignait aussi le risque d’erreurs qui pouvaient ainsi être induites. Une étude rétrospective de prothèses à offset augmenté (Lubinus 117◦) montrait que leur survie à sept ans était légèrement inférieure au même implant d’angulation standard évalué dans le registre suédois. La navigation permet au moyen d’un logiciel spécifique une évaluation précise de longueur et déport lors de l’implantation d’une prothèse totale de hanche, motivant dans 29 % des cas une modification par rapport au planning initial défini par des calques. La discussion et le niveau de preuve sont rapportés dans chacun des travaux. En conclusion, la restauration de l’architecture de la hanche est indispensable à une bonne fonction et longévité des arthroplasties. Cela impose planification, implants adaptés et contrôles opératoires

Effectiveness of extracorporeal life support for patients with cardiogenic shock due to intractable arrhythmic storm

International audienceAbstracts of the Heart Failure 2015 and the 2nd World Congress on Acute Heart Failure, Seville, Spain, 23–26th May 2015. Moderated Poster Session 6 – Advanced heart failur

Clinical, anatomopathological and immunohistochemical findings of a transitional cell carcinoma from nasal cavity, frontal and ethmoidal sinus with meningoencephalic invasion in a dog

Background: Primary neoplasms of the nasal cavity and sinuses are uncommon in domestic animals, most of which are of epithelial origin, being adenocarcinoma the most common tumor diagnosed in this region. Some malignant nasal cavity neoplasms may invade the brain causing clinical neurological signs, as well as purulent nasal secretion and epistaxis. Case Description: A case of neoplasm is reported in a 14-year-old pincher presenting dyspnea, epistaxis and neurological alterations. Necropsy revealed the presence of a mass in the oral cavity vestibule, and another in the whole nasal cavity with invasion of the cribiform plate, meninges and brain. Squamous cells carcinoma was diagnosed in the oral cavity and transitional carcinoma in the nasal cavity. The immunohistochemistry confirmed that the brain infiltration was of the same origin as the nasal cavity neoplasm. Conclusion: The present report describes a rare case of transitional carcinoma of the nasal cavity as well as the frontal and ethmoidal sinuses with brain invasion, confirmed by immunohistochemistry. It is extremely important for veterinarians to include neoplasms in their differential diagnoses, when these animals show chronic respiratory signs and neurological alterations that do not improve with appropriate treatment, always associating with complementary exams, for correct diagnosis establishment and prognosis formulation