Reconstruction du ligament fémoro-patellaire médial dans les luxations épisodiques de la rotule (étude anatomique in vitro, résultats cliniques, analyse du positionnement des tunnels osseux : Travail du Service de Chirurgie Orthopédique et Traumatologique : Centre Albert Trillat : Groupement Hospitalier Nord : Professeur Philippe Neyret)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Confrontation de la planification radiographique préopératoire et des données postopératoires lors de la mise en place des prothèses totales de hanche non cimentées

PURPOSE OF THE STUDY: For hip prosthesis surgery, the challenge is to obtain optimal function of the instrumented hip but also to eliminate any limb length discrepancy, correct the femur offset and guarantee the center of rotation of the hip joint. Preoperative planning for total hip arthroplasty (THA) enables determination of the appropriate length for the prosthetic neck and the size and eventually the type of implants to use. From a prospective series of 86 patients who underwent first-intention THA for implantation of a noncemented prosthesis, we studied the precision of the outcome as function of the preoperative planning. We also ascertained whether the preoperative planning was sufficient to provide the measurements necessary for correct implant position. MATERIAL AND METHODS: We analyzed a prospective series of patients who underwent first-intention THA from January 2004 through January 2006. To be eligible for inclusion, patients could not have a THA of the contralateral hip. The series was composed of 58 females and 28 males, mean age 70.2 years (range 45-93). The reasons for THA were primary degenerative disease (n=76) and aseptic osteonecrosis (n=10). The contalateral hip was intact and free of osteoarthritis with an anatomic presentation considered to be normal. The standard X-ray protocol included an anteroposterior view of the pelvis in the upright position and 10 degrees internal rotation obtained preoperatively and three months postoperatively. All radiographic measurements were made by the same investigator using a manual nondigitalized technique. We compared planning parameters (pivot size and type, length of the neck, and size of the cup) with the final outcome in order to determine the compliance with the preoperative planning. All operations were performed in the lateral supine position under general anesthesia and by the same surgeon. The posterolateral Moore approach was used. All implants were press fit without cement, both for the cup and for the femoral piece. RESULTS: All planning parameters selected for study (offset, size of the head and the cup, length of the neck) were available for 32 hips, giving an overall conformity of 37%. The length of the neck was as planned in 75% of hips, the size of the cup in 62% and the size of the femoral stem in 64%. The offset defined preoperatively was never changed during the operation. Ideal implantation (+/- 5mm for all criteria selected for study) was obtained in 60% of hips; the height of the center of rotation was reproduced in 81% and the lateralization in 84%. Femur lateralization was reproduced in 75% of the hips and hip offset in 66%. Leg length discrepancy was avoided in 85% of the patients. DISCUSSION AND CONCLUSION: Preoperative planning reliably predicts the final offset of the implanted femoral stem. It is more difficult to predict the size of a press fit cup but in our experience the difference does not greatly affect restitution of the hip anatomy. We readily changed the length of the neck during the operation if necessary and have found that the leg length has been better with this approach. This leads to the observation that all of the planning parameters are not fully accurate because of the magnification effect, anatomic conditions, or possible defective execution. While the overall rate of conformity was low, looking at the results for each element separately provided a useful element for each phase of the operation. We recommend planning a medium length neck so it can be easily changed during the operation. The availability of offset measurements is particularly important to control hip lateralization and leg length. Current advances in computer-assisted surgery should be helpful in improving the imperfections of preoperative planning

Clinical outcome after percutaneous flexor tenotomy in forefoot surgery

The aim of this study was to evaluate the outcome of the percutaneous flexor tenotomy. We compared the results of two groups. The first group included 23 patients who underwent forefoot surgery without percutaneous flexor tenotomy, and the second group included 50 patients who underwent the same procedure combined with percutaneous flexor tenotomy for claw toe deformities, secondary to shortening metatarsal Scarf osteotomy. The average follow-up was 11.6 months. Three algoneurodystrophies were noted. No delayed wound healing was observed. Functional dissatisfaction rate (18% vs.17.4%) and toe pulp contact defect (12% vs. 8.7%) were not significantly different in the two groups. Toe grasping defect rate (10% vs. 4.3%) was superior in the tenotomy group. Five recurring claw toe deformities of the second toe were noted in the tenotomy group. Percutaneous flexor tenotomy is a simple, rapid, and efficient method to correct reducible secondary claw toe deformities. However, despite a significant postoperative loss of toe grasping function, no patient reported major dissatisfaction

Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy

This is a radiographic study of ankylosing spondylitis patients with severe fixed kyphotic deformity who underwent pedicle subtraction osteotomy. Our goal was to measure and validate new angle to assess global kyphosis and to evaluate the radiological outcomes after surgery. This is the first report which describes new angle to assess global kyphosis (T1-S1). Pre and postoperative controls were compared according to the Pelvic Incidence. The sagittal parameters ankylosing spondylitis patients were compared with 154 asymptomatic patients. In addition to the pelvic parameters and the C7 tilt, we used the spino-sacral angle. Pelvic incidence in ankylosing spondylitis patients was higher than asymptomatic population (61 vs. 51°). For a same tilt of C7 for both groups, the low pelvic incidence group had a lower sacral slope and pelvic tilt and a higher global kyphosis (spino-sacral angle = 90°) than the high pelvic incidence group (spino-sacral angle = 98°). In the adult volunteers, the C7 tilt and spino-sacral angle measured, respectively, 95 and 135°. The preoperative C7 tilt measured 73° and increased to 83° (p = 0.0025). The preoperative spino-sacral angle measured 96° and increased to 113.3° (p = 0.003). A low pelvic incidence pelvis has a lower sacral slope than in high pelvic incidence and can support a bigger kyphosis. All the parameters were improved by the pedicle subtraction osteotomy, but the average spino-sacral angle remained lower than the control group. When C7 tilt was useful to assess the improvement of the balance, SSA allowed a better evaluation of the correction of kyphosis itself