Brice Rubens-Duval - Academia.edu (original) (raw)
Papers by Brice Rubens-Duval
Elsevier Masson, Jun 5, 2015
Orthopaedics & Traumatology: Surgery & Research, 2017
What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-c... more What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips<!-Risk factors for dislocation of primary hip arthroplasty->, Orthopaedics and Traumatology: Surgery
European Journal of Orthopaedic Surgery & Traumatology
Purpose This case–control study aimed to assess the influence of BMI and PTS on subsequent ACL in... more Purpose This case–control study aimed to assess the influence of BMI and PTS on subsequent ACL injury affecting either ACL graft or the native ACL of the contralateral knee after primary ACL reconstruction. Methods A retrospective case–control study was performed using a cohort of patients who underwent arthroscopic ACL reconstruction between 2010 and 2020 using the same surgical procedure: Hamstring tendon autograft. The study group (group I) included all the patients (n = 94) during this period who sustained a subsequent ACL injury. The control group (group II) consisted of 94 patients randomly selected (matched Group I in terms of sex, age, and ACL graft) who did not sustain any further ACL injury. PTS was measured by two blinded surgeons on lateral knee view radiographs of the operated knee after primary ACL. BMI in kg/m2 was measured during the preoperative anesthesia consultation. Exclusion criteria were: non-true or rotated lateral knee radiographs of the operated knee post-A...
Orthopaedics & Traumatology: Surgery & Research, 2018
In complex fractures of the proximal tibial metaphysis and epiphysis, possible adverse outcomes a... more In complex fractures of the proximal tibial metaphysis and epiphysis, possible adverse outcomes after internal fixation include not only joint surface incongruity, but also lower limb malalignment requiring revision surgery. Navigation has been proven effective for the intra-operative control of lower limb alignment during osteotomy and knee arthroplasty. In complex traumatic fractures, temporary fixation by a locking screw plate allows sensor positioning followed by navigation manoeuvres to adjust lower limb alignment. If malalignment is found, the construct can be modified economically by altering the diaphyseal fixation without modifying the metaphyseal screws. The objective of this study was to describe the use of navigation in three patients who required internal fixation of tibial-plateau fractures.
![Research paper thumbnail of Erratum to “What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips” [Orthop. Traumatol. Surg. Res. 103 (2017) 663–8]](https://attachments.academia-assets.com/93379795/thumbnails/1.jpg)
](Orthopaedics & Traumatology: Surgery & Research, 2017
Knee Surgery, Sports Traumatology, Arthroscopy, 2016
osteotomies around the knee are navigated in our department. Provided that one uses a reproducibl... more osteotomies around the knee are navigated in our department. Provided that one uses a reproducible radiograph protocol, navigation allows to perform double-level osteotomies, both for genu varum and genu valgum, with optimal accuracy in order to avoid oblique joint line, which will be difficult to revise to TKA. Level of evidence IV.
Elsevier Masson, Aug 22, 2018
Orthopaedics & Traumatology: Surgery & Research, 2021
BACKGROUND The use of third-generation rotating-hinge knee prostheses has increased considerably ... more BACKGROUND The use of third-generation rotating-hinge knee prostheses has increased considerably in recent years. The more anatomical design of these prostheses, together with their controlled rotation system that reduces constraints generated by the single degree of liberty, have produced better outcomes. The objective of this study was to evaluate the clinical and radiological outcomes of revision knee arthroplasty for aseptic failure using rotating-hinge prostheses. HYPOTHESIS The rotating-hinge knee prostheses currently used in France provide significant improvements in function and self-sufficiency of patients undergoing revision knee arthroplasty, with outcomes comparable to those reported with constrained condylar knees. MATERIAL AND METHODS A multicentre retrospective study was conducted in 17 centres, under the auspices of the SoFCOT. The cohort consisted of 127 patients (127 knees) operated on before 2013. The main reasons for knee revision were aseptic loosening, major instability, mechanical failure, and extensor apparatus failure. Function and self-sufficiency were assessed using the International Knee Society (IKS) score and the Devane score, respectively. Survival was defined with all-cause surgical revision as the end point. RESULTS Mean follow-up was 67.3±11.8 months (range, 13-180 months). Significant improvements (p<0.001) were seen in the total IKS score (+42 points), the IKS function score (+12 points), and the knee IKS score (+30 points). Paradoxically, the Devane score decreased by 0.44 point. The 5-year survival rate was 77% (95% confidence interval, 0.70-0.85). Post-operative complications developed in 29% of patients (infection, n=12; aseptic loosening, n=11; and fracture, n=7). DISCUSSION Rotating-hinge prostheses provide satisfactory outcomes of knee arthroplasty revision and remain an effective option for complex cases, confirming our working hypothesis. Self-sufficiency diminished slightly. The long-term outcomes obtained using rotating-hinge prostheses were, however, less good than those seen with constrained condylar knees for aseptic TKA revision, and the complication rate was higher, although the population and local circumstances were different. Discernment is therefore in order when determining the indications of rotating-hinge prostheses. LEVEL OF EVIDENCE IV; retrospective cohort study.
Orthopaedics & Traumatology: Surgery & Research, 2021
INTRODUCTION Hinged total knee arthroplasty (TKA) implants are a commonly used option during revi... more INTRODUCTION Hinged total knee arthroplasty (TKA) implants are a commonly used option during revision or even primary surgery, but their complications are not as well-known due to the rapid adoption of gliding implants. The literature is inconsistent on this topic, with studies having a small sample size, varied follow-up duration and very different indications. This led us to carry out a large multicenter study with a minimum follow-up of 5 years to evaluate the complications after hinged TKA in a non-tumoral context based on the indications of primary arthroplasty, aseptic surgical revision or fracture treatment around the knee. HYPOTHESIS Hinged TKA was associated with a high complication rate, no matter the indication. MATERIAL AND METHODS Two hundred ninety patients (290 knees) were included retrospectively between January 2006 and December 2011 at 17 sites, with a minimum follow-up of 5 years. The patients were separated into three groups: primary surgery (111 patients), aseptic revision surgery (127 patients) and surgery following a recent (< 3 months) fracture (52 patients: 13 around the TKA and 39 around the knee treated by hinged TKA). Patients who had an active infection the knee of interest were excluded. All the patients were reviewed based on a standardized computer questionnaire validated by the SOFCOT. RESULTS The mean follow-up was 71 ± 39 months [range, 0 to 188]. Of the 290 patients included in the study, 108 patients (37%) suffered at least one complication and 55 patients (19%) had to undergo revision surgery: 16 in the primary TKA group (16/111, 14% of primary TKA), 28 in the revision surgery group (28/127, 22% of revision TKA) and 11 in the fracture treatment group (11/52, 21% of fracture TKA). The complications due to the hinged TKA for the entire cohort from most to least common were stiffness (41/290, 14%), chronic postoperative pain (37/290, 13%), infection (32/290, 11%), aseptic loosening (23/290, 8%), general complications (20/290, 7%), extensor mechanism complications (19/290, 6%), periprosthetic fracture (9/290, 3%), mechanical failure (2/290, 0.7%). In the primary TKA group, the main complication leading to re-operation was infection (12/111, 11%), while it was loosening for the revision TKA group (15/127, 12%) and infection (8/52, 15%) for the fracture TKA group. DISCUSSION The 37% complication rate for hinged TKA implants is high, with 19% of them requiring re-operation. The frequency of complications differed depending on the context in which the hinged implant was used (primary, revision, fracture). The complications requiring revision surgery were major ones that prevented patients from preserving their autonomy (infection, symptomatic loosening, fracture, implant failure). The most found complications - stiffness and chronic pain - rarely led to revision. LEVEL OF EVIDENCE IV; retrospective cohort study.
Conférences D'enseignement 2019, 2019
International Orthopaedics, 2021
The aims of this study were (1) to collect prospectively all tibial plateau fractures admitted to... more The aims of this study were (1) to collect prospectively all tibial plateau fractures admitted to our department, over two ski seasons, and to classify them according to the Schatzker and AO classifications; (2) to assess if these classifications are accurate enough to include all types of fractures; and (3) to compare theses fractures with the series found in the literature, which included very few or no skiing accidents. During the 2016-2017 and 2017-2018 ski seasons, we prospectively included 116 tibial plateau fractures caused by downhill skiing accidents. All patients underwent standard X-rays and 2D and 3D CT scans. The fractures were classified according to the AO and Schatzker revisited classifications. The full series consisted of 56 males (48%) and 60 females (52%), aged 49 ± 16 years (18-77). There were 60 type B (52%) and 56 type C fractures (48%) for AO classification and 45.5% types I, II and III and 54.5% types IV, V and VI for Schatzker classification. Thirty-five frontal fractures (30%) were not differentiated under the AO classification and, likewise, associated tibial spine fractures (28.5%) were not differentiated in the Schatzker classification. We were also unable to classify anterior tibial tuberosity fractures (14.5%) and fibula head fractures (8%). The anatomo-pathological types were not so different from road traffic accidents. Contrary to our hypothesis, the anatomical-pathological damage in tibial plateau fractures resulting from downhill skiing accidents was barely any different from those found in road traffic accidents. However, despite progress in classifications with the emergence of 3D CT scans, it is still not always possible to categorise all fractures within a given classification.
Orthopaedics & Traumatology: Surgery & Research, 2021
BACKGROUND Peri-prosthetic hip fractures (PPHFs) are serious complications whose treatment is gen... more BACKGROUND Peri-prosthetic hip fractures (PPHFs) are serious complications whose treatment is generally difficult due to their predominance in elderly patients with bone frailty and other comorbidities. The Vancouver classification is the most widely used and is helpful for assisting treatment decisions. However, its value for predicting morbidity and mortality has not been assessed. The objective of this retrospective study was to assess post-operative morbidity and mortality according to the fracture type in the Vancouver classification. HYPOTHESIS Post-operative morbidity and mortality vary across fracture types in the Vancouver classification. METHODS A single-centre retrospective study was conducted from 1st January 2010 to 31st December 2015. All patients who had surgery for a PPHF were included. There were 88 patients, including 66 (75%) females, and mean age was 82 years. The patients were re-evaluated at least 3 years after surgery. The distribution of the fracture types was as follows: Vancouver (V) A, n=7; VB, n=63 (VB1, n=30; VB2, n=23; and VB3, n=10); and VB3, n=18. Data on the pre-operative status (self-sufficiency, comorbidities, ASA score, etc.) were extracted from the admission files. Morbidity and mortality were evaluated globally and according to the Vancouver type, using the patient files and telephone calls to determine self-sufficiency scores (Parker, Katz, and Lawton) and functional scores (Merle d'Aubigné-Postel [MAP] score and Harris Hip Score [HHS]). RESULTS Post-operative medical complications were very common (33 [37.5%] patients) and correlated with the severity of the fracture. Similarly, the mortality rate at last follow-up varied significantly (p<0.05) with the severity of the fracture, as follows: VA, 28.5%; VB1, 40%; VB2, 47.8%; VC, 55.6%; and VB3, 66.7%). In the overall population, loss of self-sufficiency was 20%, 14%, and 26% according to Parker, Katz, and Lawton, respectively; loss of function was 13.9% and 13.3% according to the MAP score and HHS (p<0.05). All the self-sufficiency scores (Parker, Katz, and Lawton) and functional scores (MAP and HHS) decreased post-operatively in proportion to the severity of the fracture (very small losses for VA and greatest losses for VB3) (p<0,05). CONCLUSION The short- and medium-term mortality rates in our cohort of patients with PPHFs were high and chiefly dependent on the severity of the fractures. The self-sufficiency and functional scores were better in the group with VA fractures than in the groups with VB1, VB2, VC, and VB3 fractures. In any case, early weight-bearing is without doubt a key factor in limiting the impact of PPHFs on the functional outcome and on mortality. LEVEL OF EVIDENCE IV, retrospective study.
International Orthopaedics, 2019
Purpose The aim of this study was to compare clinical and laximetric results in chronic, isolated... more Purpose The aim of this study was to compare clinical and laximetric results in chronic, isolated posterior cruciate ligament (PCL) rupture repairs, using either a hamstring graft or an artificial ligament (ligament advanced reinforcement system (LARS®)). Methods Sixteen patients presenting with an isolated unilateral PCL rupture were included in this retrospective study. Initially, eight underwent a PCL reconstruction using a hamstring tendon autograft (hamstring group), and over a later period, eight further patients underwent a reconstruction using an artificial ligament with a new procedure. Results Fifteen patients were male and one female, with an average age of 29.3 years. All patients were operated on within an average time of 18 months post-injury. Pre-operative posterior laxity was equivalent ( p = 0.309), 18.25 mm on average for the hamstring group and 18.75 mm for the LARS group. With an average follow-up of 24 months, residual posterior laxity was significantly improved, decreasing from 18.25 to 7.37 mm for the hamstring group ( p < 0.05) with a median at 7.5 mm and from 18.75 to 5.25 mm for the LARS group ( p < 0.05) with a median at 5 mm. The improvement in laxity for the hamstring group was 60% and 71.5% for the LARS group. The LARS group compares favourably ( p = 0.003 and 0.01). Tegner activity level improved significantly following ligamentoplasty, with no difference between the two groups ( p = 0.4). Likewise, there was no significant difference in the Lysholm and IKDC scores between the two groups ( p = 0.4). Conclusion The initial hypothesis of this study was proven correct. Nevertheless, a longer term study is necessary to assess the consequences of residual laxity in hamstring grafts and the long-term behaviour and tolerance of the LARS artificial ligament.
Revue de Chirurgie Orthopédique et Traumatologique, 2016
Resume Introduction Notre objectif etait d’evaluer les resultats fonctionnels et radiologiques a ... more Resume Introduction Notre objectif etait d’evaluer les resultats fonctionnels et radiologiques a long terme, du traitement chirurgical des disjonctions acromioclaviculaires (DAC) aigues de type IV et V de Rockwood, par un hauban appuye sur une broche. Methodes Etude observationnelle transversale de cohorte monocentrique non randomisee basee sur 25 epaules operees entre janvier 2002 et decembre 2004, comprenant 23 hommes et 2 femmes âges en moyenne de 35 ± 11 ans (24–46). Etaient evalues : score de Constant (absolu et pondere), Quick DASH, subjective shoulder value (SSV), l’EVA au repos et en activite, et l’aspect radiographique en cas de doleances cliniques. Resultats Le recul moyen etait de 150 ± 17 mois (133–167). Le score de Constant absolu moyen etait de 88 ± 17 (71–105) ; le Constant pondere de 92,5 ± 12,5 (80–105) ; le Quick DASH moyen de 15,5 ± 7 (8,5–22,5) ; le SSV moyen de 88 ± 17 % (71–105) ; l’EVA au repos de 0,2 ± 0,7 (−0,5–0,9) ; l’EVA en activite de 1,4 ± 2,3 (−0,9–3,7). Huit pour cent des patients avaient un score de Constant pondere inferieur a 70 %. Dix-sept ont beneficie de radiographies et 8 avaient une arthrose acromioclaviculaire. La distance coracoclaviculaire moyenne etait de 12,3 ± 4,3 mm (8–16,6) et la distance acromioclaviculaire moyenne de 5 ± 5 mm (0–10). Le taux de recidive etait de 8 %. Conclusion Le traitement des DAC par hauban appuye sur une broche est une technique fiable donnant de bons resultats fonctionnels a long terme. L’incidence des recidives est faible et les patients sont peu symptomatiques (8 %). Niveau de preuve IV. Etude retrospective.
Orthopedics, 2006
Soft tissue balance during total knee arthroplasty (TKA) procedures may be challenging to achieve... more Soft tissue balance during total knee arthroplasty (TKA) procedures may be challenging to achieve in knees with severe valgus or varus deformities. The purpose of this study was to evaluate the role of navigation in predicting soft tissue release during 90 computer-assisted TKA procedures performed within a 2-year period. Fourteen soft tissue releases were performed, 13 of which were for genu varum, including 9 deep medial collateral ligaments and 4 deep and superficial medial collateral ligaments, and 1 for genu valgum deformity. Forty-one cases were intraoperatively overcorrectable (45.5%), and 20 cases were reducible to a neutral axis. The results proved that navigation can predict the need to perform a soft tissue release during computer-assisted TKA.
Revue de Chirurgie Orthopédique et Traumatologique, 2018
Resume Les fractures complexes metaphyso-epiphysaires de l’extremite proximale du tibia peuvent c... more Resume Les fractures complexes metaphyso-epiphysaires de l’extremite proximale du tibia peuvent conduire, outre le defaut de reduction articulaire, a un defaut d’axe du membre inferieur apres osteosynthese, necessitant une reprise chirurgicale. La navigation est un outil qui a fait ses preuves pour controler en peroperatoire l’axe mecanique du membre inferieur dans les osteotomies et les arthroplasties du genou. Elle est utilisable en chirurgie traumatologique, pour ces fractures complexes, en realisant une osteosynthese temporaire par une plaque a vissage verrouille, permettant la mise en place des capteurs et la realisation des manœuvres de navigation pour controler l’axe du membre inferieur. Il est possible de reprendre le montage a minima en cas d’anomalie de l’axe, en modifiant la fixation diaphysaire sans toucher aux vis metaphysaires. L’objectif de ce travail etait de presenter son utilisation au cours de 3 osteosyntheses de fractures du plateau tibial.
Navigation of Uni knee arthroplasty (UKA) is not common. Usually the software includes navigation... more Navigation of Uni knee arthroplasty (UKA) is not common. Usually the software includes navigation of the tibial as well as the femoral implant. In order to simplify the surgical procedure we thought that navigation of the tibial plateau alone could be a good option. Since 2005 we have been using a mobile bearing UKA of which the ancillary is based on dependent bone cuts. The tibial cut is made first and the femoral cut is automatically performed using cutting blocks inserted between the tibial cut and the distal end of the femur. Although we are satisfied with this procedure, it is not rare we have some difficulties getting the right under correction needed to get a good long-term result. The aim of this paper was to present our computer-assisted UKA technique and our preliminary radiological results in genu varum (17 cases) as well as genu valgum (6 cases) deformities. The series was composed of 23 patients, 10 females and 13 males, aged from 63 to 88 years old (mean age: 75 +/− 8)...
Revue de Chirurgie Orthopédique et Traumatologique, 2021
Resume Introduction L’utilisation de prothese charniere a pivot rotatoire (PCPR) de troisieme gen... more Resume Introduction L’utilisation de prothese charniere a pivot rotatoire (PCPR) de troisieme generation a considerablement augmente ces dernieres annees. Les progres effectues au niveau de leur dessin plus anatomique et leur systeme « d’echappee rotatoire » ont permis d’obtenir de meilleurs resultats. L’objectif de cette etude etait d’evaluer les resultats cliniques et radiologiques d’une revision aseptique de prothese totale de genou (PTG) par une PCPR. L’hypothese etait que les PCPR actuellement posees en France, permettent une amelioration significative de la fonction et de l’autonomie des patients lors des revisions de PTG avec des resultats comparables aux protheses postero-stabilisees a contrainte augmentee (PPSCA) rapportes dans la litterature. Materiel et methode Il s’agissait d’une etude retrospective multicentrique menee dans 17 centres, sous l’egide de la SOFCOT. La serie comprenait 127 patients (127 genoux) operes avant 2013. Les principales indications de reprise etaie...
Resume Introduction Les protheses totales de genou (PTG) charnieres constituent une option freque... more Resume Introduction Les protheses totales de genou (PTG) charnieres constituent une option frequente en cas de reprise chirurgicale ou de chirurgie primaire mais leurs complications sont moins bien connues depuis l’essor des protheses a glissement. La litterature reste heterogene sur le sujet, avec des etudes aux effectifs souvent limites, au recul variable et avec des indications tres differentes. Aussi nous avons mene une large etude multicentrique au recul minimal de 5 ans afin d’evaluer les complications apres PTG charniere hors tumeur en fonction de l’indication sur genou natif, en cas de reprise chirurgicale aseptique ou dans un contexte traumatique. Hypothese L’hypothese etait que les PTG charnieres avaient un taux de complications eleve quel que soit l’indication. Materiel et methode Deux-cent quatre-vingt-dix patients (290 genoux) ont ete inclus de facon retrospective, de janvier 2006 a decembre 2011 dans 17 centres, avec un recul minimal de 5 ans. Les patients ont ete sepa...
Elsevier Masson, Jun 5, 2015
Orthopaedics & Traumatology: Surgery & Research, 2017
What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-c... more What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips<!-Risk factors for dislocation of primary hip arthroplasty->, Orthopaedics and Traumatology: Surgery
European Journal of Orthopaedic Surgery & Traumatology
Purpose This case–control study aimed to assess the influence of BMI and PTS on subsequent ACL in... more Purpose This case–control study aimed to assess the influence of BMI and PTS on subsequent ACL injury affecting either ACL graft or the native ACL of the contralateral knee after primary ACL reconstruction. Methods A retrospective case–control study was performed using a cohort of patients who underwent arthroscopic ACL reconstruction between 2010 and 2020 using the same surgical procedure: Hamstring tendon autograft. The study group (group I) included all the patients (n = 94) during this period who sustained a subsequent ACL injury. The control group (group II) consisted of 94 patients randomly selected (matched Group I in terms of sex, age, and ACL graft) who did not sustain any further ACL injury. PTS was measured by two blinded surgeons on lateral knee view radiographs of the operated knee after primary ACL. BMI in kg/m2 was measured during the preoperative anesthesia consultation. Exclusion criteria were: non-true or rotated lateral knee radiographs of the operated knee post-A...
Orthopaedics & Traumatology: Surgery & Research, 2018
In complex fractures of the proximal tibial metaphysis and epiphysis, possible adverse outcomes a... more In complex fractures of the proximal tibial metaphysis and epiphysis, possible adverse outcomes after internal fixation include not only joint surface incongruity, but also lower limb malalignment requiring revision surgery. Navigation has been proven effective for the intra-operative control of lower limb alignment during osteotomy and knee arthroplasty. In complex traumatic fractures, temporary fixation by a locking screw plate allows sensor positioning followed by navigation manoeuvres to adjust lower limb alignment. If malalignment is found, the construct can be modified economically by altering the diaphyseal fixation without modifying the metaphyseal screws. The objective of this study was to describe the use of navigation in three patients who required internal fixation of tibial-plateau fractures.
Orthopaedics & Traumatology: Surgery & Research, 2017
Knee Surgery, Sports Traumatology, Arthroscopy, 2016
osteotomies around the knee are navigated in our department. Provided that one uses a reproducibl... more osteotomies around the knee are navigated in our department. Provided that one uses a reproducible radiograph protocol, navigation allows to perform double-level osteotomies, both for genu varum and genu valgum, with optimal accuracy in order to avoid oblique joint line, which will be difficult to revise to TKA. Level of evidence IV.
Elsevier Masson, Aug 22, 2018
Orthopaedics & Traumatology: Surgery & Research, 2021
BACKGROUND The use of third-generation rotating-hinge knee prostheses has increased considerably ... more BACKGROUND The use of third-generation rotating-hinge knee prostheses has increased considerably in recent years. The more anatomical design of these prostheses, together with their controlled rotation system that reduces constraints generated by the single degree of liberty, have produced better outcomes. The objective of this study was to evaluate the clinical and radiological outcomes of revision knee arthroplasty for aseptic failure using rotating-hinge prostheses. HYPOTHESIS The rotating-hinge knee prostheses currently used in France provide significant improvements in function and self-sufficiency of patients undergoing revision knee arthroplasty, with outcomes comparable to those reported with constrained condylar knees. MATERIAL AND METHODS A multicentre retrospective study was conducted in 17 centres, under the auspices of the SoFCOT. The cohort consisted of 127 patients (127 knees) operated on before 2013. The main reasons for knee revision were aseptic loosening, major instability, mechanical failure, and extensor apparatus failure. Function and self-sufficiency were assessed using the International Knee Society (IKS) score and the Devane score, respectively. Survival was defined with all-cause surgical revision as the end point. RESULTS Mean follow-up was 67.3±11.8 months (range, 13-180 months). Significant improvements (p<0.001) were seen in the total IKS score (+42 points), the IKS function score (+12 points), and the knee IKS score (+30 points). Paradoxically, the Devane score decreased by 0.44 point. The 5-year survival rate was 77% (95% confidence interval, 0.70-0.85). Post-operative complications developed in 29% of patients (infection, n=12; aseptic loosening, n=11; and fracture, n=7). DISCUSSION Rotating-hinge prostheses provide satisfactory outcomes of knee arthroplasty revision and remain an effective option for complex cases, confirming our working hypothesis. Self-sufficiency diminished slightly. The long-term outcomes obtained using rotating-hinge prostheses were, however, less good than those seen with constrained condylar knees for aseptic TKA revision, and the complication rate was higher, although the population and local circumstances were different. Discernment is therefore in order when determining the indications of rotating-hinge prostheses. LEVEL OF EVIDENCE IV; retrospective cohort study.
Orthopaedics & Traumatology: Surgery & Research, 2021
INTRODUCTION Hinged total knee arthroplasty (TKA) implants are a commonly used option during revi... more INTRODUCTION Hinged total knee arthroplasty (TKA) implants are a commonly used option during revision or even primary surgery, but their complications are not as well-known due to the rapid adoption of gliding implants. The literature is inconsistent on this topic, with studies having a small sample size, varied follow-up duration and very different indications. This led us to carry out a large multicenter study with a minimum follow-up of 5 years to evaluate the complications after hinged TKA in a non-tumoral context based on the indications of primary arthroplasty, aseptic surgical revision or fracture treatment around the knee. HYPOTHESIS Hinged TKA was associated with a high complication rate, no matter the indication. MATERIAL AND METHODS Two hundred ninety patients (290 knees) were included retrospectively between January 2006 and December 2011 at 17 sites, with a minimum follow-up of 5 years. The patients were separated into three groups: primary surgery (111 patients), aseptic revision surgery (127 patients) and surgery following a recent (< 3 months) fracture (52 patients: 13 around the TKA and 39 around the knee treated by hinged TKA). Patients who had an active infection the knee of interest were excluded. All the patients were reviewed based on a standardized computer questionnaire validated by the SOFCOT. RESULTS The mean follow-up was 71 ± 39 months [range, 0 to 188]. Of the 290 patients included in the study, 108 patients (37%) suffered at least one complication and 55 patients (19%) had to undergo revision surgery: 16 in the primary TKA group (16/111, 14% of primary TKA), 28 in the revision surgery group (28/127, 22% of revision TKA) and 11 in the fracture treatment group (11/52, 21% of fracture TKA). The complications due to the hinged TKA for the entire cohort from most to least common were stiffness (41/290, 14%), chronic postoperative pain (37/290, 13%), infection (32/290, 11%), aseptic loosening (23/290, 8%), general complications (20/290, 7%), extensor mechanism complications (19/290, 6%), periprosthetic fracture (9/290, 3%), mechanical failure (2/290, 0.7%). In the primary TKA group, the main complication leading to re-operation was infection (12/111, 11%), while it was loosening for the revision TKA group (15/127, 12%) and infection (8/52, 15%) for the fracture TKA group. DISCUSSION The 37% complication rate for hinged TKA implants is high, with 19% of them requiring re-operation. The frequency of complications differed depending on the context in which the hinged implant was used (primary, revision, fracture). The complications requiring revision surgery were major ones that prevented patients from preserving their autonomy (infection, symptomatic loosening, fracture, implant failure). The most found complications - stiffness and chronic pain - rarely led to revision. LEVEL OF EVIDENCE IV; retrospective cohort study.
Conférences D'enseignement 2019, 2019
International Orthopaedics, 2021
The aims of this study were (1) to collect prospectively all tibial plateau fractures admitted to... more The aims of this study were (1) to collect prospectively all tibial plateau fractures admitted to our department, over two ski seasons, and to classify them according to the Schatzker and AO classifications; (2) to assess if these classifications are accurate enough to include all types of fractures; and (3) to compare theses fractures with the series found in the literature, which included very few or no skiing accidents. During the 2016-2017 and 2017-2018 ski seasons, we prospectively included 116 tibial plateau fractures caused by downhill skiing accidents. All patients underwent standard X-rays and 2D and 3D CT scans. The fractures were classified according to the AO and Schatzker revisited classifications. The full series consisted of 56 males (48%) and 60 females (52%), aged 49 ± 16 years (18-77). There were 60 type B (52%) and 56 type C fractures (48%) for AO classification and 45.5% types I, II and III and 54.5% types IV, V and VI for Schatzker classification. Thirty-five frontal fractures (30%) were not differentiated under the AO classification and, likewise, associated tibial spine fractures (28.5%) were not differentiated in the Schatzker classification. We were also unable to classify anterior tibial tuberosity fractures (14.5%) and fibula head fractures (8%). The anatomo-pathological types were not so different from road traffic accidents. Contrary to our hypothesis, the anatomical-pathological damage in tibial plateau fractures resulting from downhill skiing accidents was barely any different from those found in road traffic accidents. However, despite progress in classifications with the emergence of 3D CT scans, it is still not always possible to categorise all fractures within a given classification.
Orthopaedics & Traumatology: Surgery & Research, 2021
BACKGROUND Peri-prosthetic hip fractures (PPHFs) are serious complications whose treatment is gen... more BACKGROUND Peri-prosthetic hip fractures (PPHFs) are serious complications whose treatment is generally difficult due to their predominance in elderly patients with bone frailty and other comorbidities. The Vancouver classification is the most widely used and is helpful for assisting treatment decisions. However, its value for predicting morbidity and mortality has not been assessed. The objective of this retrospective study was to assess post-operative morbidity and mortality according to the fracture type in the Vancouver classification. HYPOTHESIS Post-operative morbidity and mortality vary across fracture types in the Vancouver classification. METHODS A single-centre retrospective study was conducted from 1st January 2010 to 31st December 2015. All patients who had surgery for a PPHF were included. There were 88 patients, including 66 (75%) females, and mean age was 82 years. The patients were re-evaluated at least 3 years after surgery. The distribution of the fracture types was as follows: Vancouver (V) A, n=7; VB, n=63 (VB1, n=30; VB2, n=23; and VB3, n=10); and VB3, n=18. Data on the pre-operative status (self-sufficiency, comorbidities, ASA score, etc.) were extracted from the admission files. Morbidity and mortality were evaluated globally and according to the Vancouver type, using the patient files and telephone calls to determine self-sufficiency scores (Parker, Katz, and Lawton) and functional scores (Merle d'Aubigné-Postel [MAP] score and Harris Hip Score [HHS]). RESULTS Post-operative medical complications were very common (33 [37.5%] patients) and correlated with the severity of the fracture. Similarly, the mortality rate at last follow-up varied significantly (p<0.05) with the severity of the fracture, as follows: VA, 28.5%; VB1, 40%; VB2, 47.8%; VC, 55.6%; and VB3, 66.7%). In the overall population, loss of self-sufficiency was 20%, 14%, and 26% according to Parker, Katz, and Lawton, respectively; loss of function was 13.9% and 13.3% according to the MAP score and HHS (p<0.05). All the self-sufficiency scores (Parker, Katz, and Lawton) and functional scores (MAP and HHS) decreased post-operatively in proportion to the severity of the fracture (very small losses for VA and greatest losses for VB3) (p<0,05). CONCLUSION The short- and medium-term mortality rates in our cohort of patients with PPHFs were high and chiefly dependent on the severity of the fractures. The self-sufficiency and functional scores were better in the group with VA fractures than in the groups with VB1, VB2, VC, and VB3 fractures. In any case, early weight-bearing is without doubt a key factor in limiting the impact of PPHFs on the functional outcome and on mortality. LEVEL OF EVIDENCE IV, retrospective study.
International Orthopaedics, 2019
Purpose The aim of this study was to compare clinical and laximetric results in chronic, isolated... more Purpose The aim of this study was to compare clinical and laximetric results in chronic, isolated posterior cruciate ligament (PCL) rupture repairs, using either a hamstring graft or an artificial ligament (ligament advanced reinforcement system (LARS®)). Methods Sixteen patients presenting with an isolated unilateral PCL rupture were included in this retrospective study. Initially, eight underwent a PCL reconstruction using a hamstring tendon autograft (hamstring group), and over a later period, eight further patients underwent a reconstruction using an artificial ligament with a new procedure. Results Fifteen patients were male and one female, with an average age of 29.3 years. All patients were operated on within an average time of 18 months post-injury. Pre-operative posterior laxity was equivalent ( p = 0.309), 18.25 mm on average for the hamstring group and 18.75 mm for the LARS group. With an average follow-up of 24 months, residual posterior laxity was significantly improved, decreasing from 18.25 to 7.37 mm for the hamstring group ( p < 0.05) with a median at 7.5 mm and from 18.75 to 5.25 mm for the LARS group ( p < 0.05) with a median at 5 mm. The improvement in laxity for the hamstring group was 60% and 71.5% for the LARS group. The LARS group compares favourably ( p = 0.003 and 0.01). Tegner activity level improved significantly following ligamentoplasty, with no difference between the two groups ( p = 0.4). Likewise, there was no significant difference in the Lysholm and IKDC scores between the two groups ( p = 0.4). Conclusion The initial hypothesis of this study was proven correct. Nevertheless, a longer term study is necessary to assess the consequences of residual laxity in hamstring grafts and the long-term behaviour and tolerance of the LARS artificial ligament.
Revue de Chirurgie Orthopédique et Traumatologique, 2016
Resume Introduction Notre objectif etait d’evaluer les resultats fonctionnels et radiologiques a ... more Resume Introduction Notre objectif etait d’evaluer les resultats fonctionnels et radiologiques a long terme, du traitement chirurgical des disjonctions acromioclaviculaires (DAC) aigues de type IV et V de Rockwood, par un hauban appuye sur une broche. Methodes Etude observationnelle transversale de cohorte monocentrique non randomisee basee sur 25 epaules operees entre janvier 2002 et decembre 2004, comprenant 23 hommes et 2 femmes âges en moyenne de 35 ± 11 ans (24–46). Etaient evalues : score de Constant (absolu et pondere), Quick DASH, subjective shoulder value (SSV), l’EVA au repos et en activite, et l’aspect radiographique en cas de doleances cliniques. Resultats Le recul moyen etait de 150 ± 17 mois (133–167). Le score de Constant absolu moyen etait de 88 ± 17 (71–105) ; le Constant pondere de 92,5 ± 12,5 (80–105) ; le Quick DASH moyen de 15,5 ± 7 (8,5–22,5) ; le SSV moyen de 88 ± 17 % (71–105) ; l’EVA au repos de 0,2 ± 0,7 (−0,5–0,9) ; l’EVA en activite de 1,4 ± 2,3 (−0,9–3,7). Huit pour cent des patients avaient un score de Constant pondere inferieur a 70 %. Dix-sept ont beneficie de radiographies et 8 avaient une arthrose acromioclaviculaire. La distance coracoclaviculaire moyenne etait de 12,3 ± 4,3 mm (8–16,6) et la distance acromioclaviculaire moyenne de 5 ± 5 mm (0–10). Le taux de recidive etait de 8 %. Conclusion Le traitement des DAC par hauban appuye sur une broche est une technique fiable donnant de bons resultats fonctionnels a long terme. L’incidence des recidives est faible et les patients sont peu symptomatiques (8 %). Niveau de preuve IV. Etude retrospective.
Orthopedics, 2006
Soft tissue balance during total knee arthroplasty (TKA) procedures may be challenging to achieve... more Soft tissue balance during total knee arthroplasty (TKA) procedures may be challenging to achieve in knees with severe valgus or varus deformities. The purpose of this study was to evaluate the role of navigation in predicting soft tissue release during 90 computer-assisted TKA procedures performed within a 2-year period. Fourteen soft tissue releases were performed, 13 of which were for genu varum, including 9 deep medial collateral ligaments and 4 deep and superficial medial collateral ligaments, and 1 for genu valgum deformity. Forty-one cases were intraoperatively overcorrectable (45.5%), and 20 cases were reducible to a neutral axis. The results proved that navigation can predict the need to perform a soft tissue release during computer-assisted TKA.
Revue de Chirurgie Orthopédique et Traumatologique, 2018
Resume Les fractures complexes metaphyso-epiphysaires de l’extremite proximale du tibia peuvent c... more Resume Les fractures complexes metaphyso-epiphysaires de l’extremite proximale du tibia peuvent conduire, outre le defaut de reduction articulaire, a un defaut d’axe du membre inferieur apres osteosynthese, necessitant une reprise chirurgicale. La navigation est un outil qui a fait ses preuves pour controler en peroperatoire l’axe mecanique du membre inferieur dans les osteotomies et les arthroplasties du genou. Elle est utilisable en chirurgie traumatologique, pour ces fractures complexes, en realisant une osteosynthese temporaire par une plaque a vissage verrouille, permettant la mise en place des capteurs et la realisation des manœuvres de navigation pour controler l’axe du membre inferieur. Il est possible de reprendre le montage a minima en cas d’anomalie de l’axe, en modifiant la fixation diaphysaire sans toucher aux vis metaphysaires. L’objectif de ce travail etait de presenter son utilisation au cours de 3 osteosyntheses de fractures du plateau tibial.
Navigation of Uni knee arthroplasty (UKA) is not common. Usually the software includes navigation... more Navigation of Uni knee arthroplasty (UKA) is not common. Usually the software includes navigation of the tibial as well as the femoral implant. In order to simplify the surgical procedure we thought that navigation of the tibial plateau alone could be a good option. Since 2005 we have been using a mobile bearing UKA of which the ancillary is based on dependent bone cuts. The tibial cut is made first and the femoral cut is automatically performed using cutting blocks inserted between the tibial cut and the distal end of the femur. Although we are satisfied with this procedure, it is not rare we have some difficulties getting the right under correction needed to get a good long-term result. The aim of this paper was to present our computer-assisted UKA technique and our preliminary radiological results in genu varum (17 cases) as well as genu valgum (6 cases) deformities. The series was composed of 23 patients, 10 females and 13 males, aged from 63 to 88 years old (mean age: 75 +/− 8)...
Revue de Chirurgie Orthopédique et Traumatologique, 2021
Resume Introduction L’utilisation de prothese charniere a pivot rotatoire (PCPR) de troisieme gen... more Resume Introduction L’utilisation de prothese charniere a pivot rotatoire (PCPR) de troisieme generation a considerablement augmente ces dernieres annees. Les progres effectues au niveau de leur dessin plus anatomique et leur systeme « d’echappee rotatoire » ont permis d’obtenir de meilleurs resultats. L’objectif de cette etude etait d’evaluer les resultats cliniques et radiologiques d’une revision aseptique de prothese totale de genou (PTG) par une PCPR. L’hypothese etait que les PCPR actuellement posees en France, permettent une amelioration significative de la fonction et de l’autonomie des patients lors des revisions de PTG avec des resultats comparables aux protheses postero-stabilisees a contrainte augmentee (PPSCA) rapportes dans la litterature. Materiel et methode Il s’agissait d’une etude retrospective multicentrique menee dans 17 centres, sous l’egide de la SOFCOT. La serie comprenait 127 patients (127 genoux) operes avant 2013. Les principales indications de reprise etaie...
Resume Introduction Les protheses totales de genou (PTG) charnieres constituent une option freque... more Resume Introduction Les protheses totales de genou (PTG) charnieres constituent une option frequente en cas de reprise chirurgicale ou de chirurgie primaire mais leurs complications sont moins bien connues depuis l’essor des protheses a glissement. La litterature reste heterogene sur le sujet, avec des etudes aux effectifs souvent limites, au recul variable et avec des indications tres differentes. Aussi nous avons mene une large etude multicentrique au recul minimal de 5 ans afin d’evaluer les complications apres PTG charniere hors tumeur en fonction de l’indication sur genou natif, en cas de reprise chirurgicale aseptique ou dans un contexte traumatique. Hypothese L’hypothese etait que les PTG charnieres avaient un taux de complications eleve quel que soit l’indication. Materiel et methode Deux-cent quatre-vingt-dix patients (290 genoux) ont ete inclus de facon retrospective, de janvier 2006 a decembre 2011 dans 17 centres, avec un recul minimal de 5 ans. Les patients ont ete sepa...