Early outcomes of THA using uncemented dual-mobility cups with additional fixation screws

Background: The use of fixation screws with uncemented cups is controversial particularly for dual mobility (DM) cups where perforation of the articular surface could compromise implant longevity. We aimed to compare outcomes of total hip arthroplasty (THA) using uncemented DM cups with supplementary screw fixation versus simple press-fit fixation. Methods: From 235 consecutive THAs performed using uncemented DM cups, 203 were fixed by simple press-fit and 32 fixed with additional screws. The Oxford hip score (OHS) and EuroQol 5 Dimensions (EQ-5D) score were available at 3.3±1.1 years. To enable direct comparison, each screw fixation cup was matched to three simple press-fit cups using propensity scores, based on age, sex and bone quality. Results: The two groups had equivalent age, body mass index, gender distribution, femoral morphology and bone quality. Compared to the press-fit group (n=96), the screw fixation group had more surgical antecedents (p=0.032), higher femoral neck angles (p=0.028), and received slightly larger cups (p=0.036). Revision was required for two (6%) screw fixation cups (only one implant-related) and one (1%) press-fit cup (none implant-related). There were no differences between OHS (19±8 vs 18±7, p=0.682) nor EQ-5D (0.63±0.37, p=0.257). Conclusions: Revision rates were greater for DM cups fixed with additional screws than for those fixed by simple press-fit, but clinical scores were equivalent. There was only one implant-related revision (acetabular fracture) in the screw fixation group and it is unclear whether this is related to the additional screws or to patient/surgical factors

A blood atlas of COVID-19 defines hallmarks of disease severity and specificity.

Treatment of severe COVID-19 is currently limited by clinical heterogeneity and incomplete description of specific immune biomarkers. We present here a comprehensive multi-omic blood atlas for patients with varying COVID-19 severity in an integrated comparison with influenza and sepsis patients versus healthy volunteers. We identify immune signatures and correlates of host response. Hallmarks of disease severity involved cells, their inflammatory mediators and networks, including progenitor cells and specific myeloid and lymphocyte subsets, features of the immune repertoire, acute phase response, metabolism, and coagulation. Persisting immune activation involving AP-1/p38MAPK was a specific feature of COVID-19. The plasma proteome enabled sub-phenotyping into patient clusters, predictive of severity and outcome. Systems-based integrative analyses including tensor and matrix decomposition of all modalities revealed feature groupings linked with severity and specificity compared to influenza and sepsis. Our approach and blood atlas will support future drug development, clinical trial design, and personalized medicine approaches for COVID-19

WHO global research priorities for antimicrobial resistance in human health

The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR

Les Reprises de ligamentoplastie du ligament croisé antérieur (à propos de 77 cas)

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

Anterior cruciate ligament revision: analysis and results from a series of 74 cases

Résumé Cette étude rétrospective d'une série continue de 100 patients opérés pour une reprise de ligamentoplastie du ligament croisé antérieur (LCA) entre 1996 et 2004 avait pour but d'apprécier le résultat fonctionnel et de déterminer d'éventuels facteurs pronostiques. La série comportait 74 ligamentoplasties du LCA avec un recul supérieur à 1 an. L'évaluation fonctionnelle a utilisé le score IKDC. La laxité a été mesurée par l'arthromètre KT-1000 et par des radiographies dynamiques. La reconstruction ligamentaire a été réalisée 78 mois en moyenne après l'intervention initiale et dans 93 % des cas sous arthroscopie. Une autogreffe a été utilisée dans tous les cas, avec 57 % de tendons rotuliens, 20 % de tendons quadricipitaux, 18 % de tendons ischio-jambiers, 4 % de tendons rotuliens associés à un tendon quadricipital et 1 % de fascia lata. Le recul moyen est de 21,2 mois. Le score IKDC subjectif moyen était de 71,7 sur 100 et 78 % des genoux étaient considérés comme normaux ou presque normaux à l'examen. Les mesures arthrométriques ont montré un gain moyen en laxité différentielle de 5 mm ± 3 pour le test maxi-manuel. Les radiographies dynamiques ont montré un gain moyen en laxité différentielle de 3 mm ± 4 sur le compartiment médial et de 2 mm ± 4,5 sur le compartiment latéral. L'existence de lésions méniscales (24 cas) a favorisé la dégradation arthrosique et l'existence de lésions cartilagineuses (33 cas) ont altéré le résultat fonctionnel. Les reprises de ligamentoplastie du LCA n'ont pas donné un résultat fonctionnel aussi bon que lors d'une plastie de première intention. L'utilisation initiale d'un ligament synthétique, l'existence de lésions méniscales et cartilagineuses ont été un facteur péjoratif. Purpose of the study This was a retrospective series of patients who underwent revision ligamentoplasty of the anterior cruciate ligament (ACL). We wanted to assess the functional outcome after this type of surgery and search for potential prognostic factors. Material and methods The series included 74 patients, mean age 34 years (range 21-59 years). The initial ligamentoplasty was performed with a synthetic ligament (n = 16), an autograft (n = 57) or an allograft (n = 1). Differential laxity (KT-1000 maximal manual) was 7 ± 2.5 mm. Anterior drawer was measured on the stress x-rays in 20° flexion: medial 8 ± 4.7 mm, lateral 8.3 ± 4.9 mm. Mean time to revision surgery was 78 months. Reconstruction was performed arthroscopically in 69 knees. The implant used for the revision reconstruction was an autograft: patellar tendon (n = 42), quadriceps tendon (n = 15), hamstring tendon (n = 13), patellar tendon and quadriceps tendon (MacInJones) (n = 3), fascia lata (n = 1). A meniscal tear was noted in 24 knees and a cartilage lesion in 35. Results Outcome was assessed at mean 21.2 months follow-up. The mean IKDC function score was 71.7 (range 21.8-100). 78% of patients considered their knee normal or nearly normal and 88% presented a positive Lachmann. Mean differential laxity measured with KT-1000 (maximal manual) was 2 ± 1.7 mm. Stress x-rays revealed a mean differential laxity measured at 3.7 ± 2.3 mm medially and 6.3 ± 4.3 mm laterally. The presence of a meniscal lesion favored osteoarthritic degradation. Presence of chondral lesions altered the functional outcome significantly and limited resumption of sports activities. An initial repair using a synthetic ligament affected the functional outcome after revision surgery and favored or aggravated chondral lesions. Discussion The clinical results we have obtained with revision ACL ligamentoplasty are comparable to pervious series reported in the literature. The functional outcome is not as good as after first-intention repair, especially if the initial plasty was done with a synthetic ligament and the knee presented meniscal or cartilage damage

Reconstruction simultanée des 2 ligaments croisés par un transplant autogène unique: Technique et résultats à propos de 25 laxités chroniques

Résumé Les cas de rupture ancienne des 2 ligaments croisés sont rares et leur prise en charge n'est pas codifiée. Leur reconstruction dans le même temps chirurgical est, dans la littérature, une option récente datant de 1996, avec seulement 44 cas recensés dans 6 publications où ils étaient mélangés à des cas récents, posant d'autres problèmes. Nous rapportons les résultats de 25 genoux opérés entre 1983 et 2004 avec une technique utilisant un seul transplant provenant du système extenseur et une seule voie d'abord.Un long transplant tendon rotulien-rotule-tendon quadricipital de 30 cm a été utilisé. Vingt-cinq genoux qui présentaient une laxité et une instabilité majeures ont été opérés dont 14 avaient déjà subi une ou 2 opérations. Le tiroir différentiel antérieur était de 10 ± 3 mm en dedans et de 9 ± 5 mm en dehors, le tiroir postérieur à 70? était de 15 ± 4 mm en dedans et de 10 ± 6 mm en dehors. La laxité antéropostérieure totale du compartiment médial était de 29 mm et la laxité du compartiment latéral était de 30 mm. Les résultats fonctionnels, au recul moyen de 6,5 ans (1 à 21), ont été satisfaisants (sauf dans 3 cas) avec reprise de l'activité professionnelle, mais peu d'activité sportive et aucun genou n'a été classé A dans la cotation de l'IKDC, ce qui corrobore les résultats de la littérature. Les résultats anatomiques jugés sur le tiroir radiologique étaient modestes puisque le gain moyen sur le tiroir antérieur était de 4 et 5 mm dans les 2 compartiments médial et latéral et sur le tiroir postérieur, de 5 mm en dedans et de 3 mm en dehors. La laxité périphérique a été mieux corrigée. La reconstruction simultanée avec cette technique a plusieurs avantages : une seule voie d'abord antérieure, un seul transplant avec lequel on fait en plus une plastie latérale, une courte immobilisation avec une rééducation rapide. Purpose of study Chronic tears of both cruciate ligaments are rarely encountered. Management practices have varied. One-stage reconstruction of both ligaments using arthroscopically implanted allografts was proposed starting in 1996 for such chronic laxity but only 44 cases have been reported in six papers mixed in with recent cases raising very different problems. Treatments using allografts or autogenous grafts or both implanted arthroscopically have often been combined with open surgery. We report a retrospective analysis of 25 knees treated with the same technique from 1983 to 2004: reconstruction with a single transplant taken from the extensor system. Material and methods A 30-cm lenght patella tendon-patella-quadriceps tendon graft was harvested. The patellar block was fixed in a hole drilled under the tibial spine, the patellar tendon replacing the posterior cruciate ligament and the quadriceps tendon passing through the lateral condyle and replacing the anterior cruciate ligament before implantation on Gerdy's tubercle, this also creating an extra-articular plasty with the same implant. Medial, lateral and posterior plasties were performed, depending on the radiographic assessment of laxity. Twenty-five knees with major laxity and instability were operated on, including 14 in two-stage operations. The differential anterior drawer was 10±3 mm medially and 9±5 mm laterally. The posterior drawer at 70? was 15±4 mm medially and 10±6 degrees laterally. The total anteroposterior laxity of the medial compartment was 29 mm, it was 30 mm for the lateral compartment. Lateral laxity was considered major (>10?) in 17 knees and medial laxity in 7. Lateral and medial laxities were associated in eleven knees. Hyper-extension was very severe in five knees. Results Functional outcome at mean 6.5 years follow-up (range 1-21) was satisfactory (except in three knees) allowing renewed occupational activity. Resumption of sports activity was less marked and none of the knees was in IKDC class A, corroborating results in the literature. Anatomic outcome was assessed on the radiological drawer decrease which was modest, mean gain in the anterior drawer measuring 4 and 5 mm in the medial and lateral compartments and mean gain in the posterior drawer measuring 5 mm medially and 3 mm laterally. Peripheral laxity was corrected for best. Discussion Classically, one or other of the cruciate ligaments is repaired, sometimes both, but in a two-stage procedure associating two different methods and autogenous tendon grafts. One-stage reconstruction of both cruciate ligaments with a single autogenous graft and a wide approach has not led to any complications. One-stage reconstruction using this technique has several advantages: one anterior incision, single transplant which also enables lateral plasty, short immobilization time with rapid rehabilitation

Can Patients Practice Strenuous Sports After Uncemented Ceramic-on-Ceramic Total Hip Arthroplasty?

Contains fulltext : 190865.pdf (publisher's version ) (Open Access

L’ochronose ou la maladie du cartilage noir

Nous rapportons deux observations de patients atteints d’ochronose. Cette pathologie autosomique récessive est très rare (1/1 000 000) et secondaire à une enzymopathie. Elle se manifeste d’abord cliniquement par des dépôts noirs au niveau cutanéomuqueux, puis par un ensemble de symptômes, notamment articulaires, conduisant à une arthropathie destructrice des grosses articulations. Sa découverte est souvent tardive, mais son dépistage doit être précoce et, pour les chirurgiens orthopédistes, si possible en préopératoire afin d’éviter tout risque d’endocardite infectieuse dont elle est extrêmement pourvoyeuse. Ces patients nécessitent une prise en charge pluridisciplinaire adaptée, associant des mesures sociales évidentes et un traitement symptomatique. Le traitement médicamenteux en cours de validation semble efficace sur les symptômes articulaires