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Pesenti S, Jouve JL, Morin C, Wolff S, Sales de Gauzy J, Chalopin A, Ibnoulkhatib A, Polirsztok E, Walter A, Schuller S, Abelin-Genevois K, Leroux J, Lechevallier J, Kabaj R, Mary P, Fuentes S, Parent H, Garin C, Bin K, Peltier E, Blondel B, Chopin D. Evolution of adolescent idiopathic scoliosis: results of a multicenter study at 20 years' follow-up. Orthop Traumatol Surg Res 2015; 101:619-22. [PMID: 26194208 DOI: 10.1016/j.otsr.2015.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/04/2015] [Accepted: 05/15/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To date there is no consensus on therapeutic indications in adolescent idiopathic scoliosis (AIS) with curvature between 30° and 60° at the end of growth. OBJECTIVE The objective of this study was to assess outcome in patients with moderate AIS. MATERIAL AND METHODS A multicenter retrospective study was conducted. Inclusion criteria were: Cobb angle, 30-60° at end of growth; and follow-up > 20 years. The data collected were angular values in adolescence and at last follow-up, and quality of life scores at follow-up. RESULTS A total of 258 patients were enrolled: 100 operated on in adolescence, 116 never operated on, and 42 operated on in adulthood. Mean follow-up was 27.8 years. Cobb angle progression significantly differed between the 3 groups: 3.2° versus 8.8° versus 23.6°, respectively; P < 0.001. In lumbar scoliosis, the risk of progression to ≥ 20° was significantly higher for initial Cobb angle > 35° (OR=4.278, P=0.002). There were no significant differences in quality of life scores. DISCUSSION Patients operated on in adolescence showed little radiological progression, demonstrating the efficacy of surgical treatment for curvature greater than 50°. Curvature greater than 40° was progressive and may require surgery in adulthood. Lumbar scoliosis showed greater potential progression than thoracic scoliosis in adulthood, requiring fusion as of 35° angulation. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- S Pesenti
- Service d'orthopédie pédiatrique, hôpital d'Enfants de la Timone, Aix-Marseille université de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - J-L Jouve
- Service d'orthopédie pédiatrique, hôpital d'Enfants de la Timone, Aix-Marseille université de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France
| | - C Morin
- Service d'orthopédie pédiatrique, institut Calot, rue du Docteur-Calot, 62600 Berck-sur-Mer, France
| | - S Wolff
- Service d'orthopédie, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - J Sales de Gauzy
- Service d'orthopédie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31029 Toulouse cedex, France
| | - A Chalopin
- Service d'orthopédie pédiatrique, hôpital d'Enfants, 7, quai Moncousu, 44000 Nantes, France
| | - A Ibnoulkhatib
- Service d'orthopédie pédiatrique, hôpital des Enfants, 330, avenue de Grande-Bretagne, 31029 Toulouse cedex, France
| | - E Polirsztok
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Walter
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - S Schuller
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - K Abelin-Genevois
- Service d'orthopédie pédiatrique, hôpital Femme-Mère-Enfants, CHU de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - J Leroux
- Clinique chirurgicale infantile, centre hospitalier universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - J Lechevallier
- Clinique chirurgicale infantile, centre hospitalier universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - R Kabaj
- Service d'orthopédie pédiatrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P Mary
- Service d'orthopédie pédiatrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - S Fuentes
- Service de neurochirurgie, Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - H Parent
- Centre du rachis, clinique Saint-Léonard, 18, rue de Bellinière, 49800 Trélazé, France
| | - C Garin
- Service d'orthopédie pédiatrique, hôpital Femme-Mère-Enfants, CHU de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - K Bin
- Service d'orthopédie pédiatrique, hôpital d'Enfants de la Timone, Aix-Marseille université de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Peltier
- Service d'orthopédie pédiatrique, hôpital d'Enfants de la Timone, Aix-Marseille université de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Blondel
- Service d'orthopédie pédiatrique, hôpital d'Enfants de la Timone, Aix-Marseille université de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France
| | - D Chopin
- Service de chirurgie rachidienne, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille, France
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Bonnevialle N, Geiss L, Cavalié L, Ibnoulkhatib A, Verdeil X, Bonnevialle P. Skin preparation before hip replacement in emergency setting versus elective scheduled arthroplasty: bacteriological comparative analysis. Orthop Traumatol Surg Res 2013; 99:659-65. [PMID: 24029588 DOI: 10.1016/j.otsr.2013.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip arthroplasty needs to be performed in an emergency setting after intracapsular femur neck fracture, whereas pain makes preoperative skin preparation of the limb difficult and it may therefore be incomplete. To date no study has analyzed the patient's skin bacteriological status in these surgical conditions. HYPOTHESIS The skin's bacterial flora is quantitatively and qualitatively different in the trauma context compared to an elective scheduled arthroplasty for chronic hip disease. MATERIALS AND METHODS Two groups of patients, undergoing hip arthroplasty and having the same preparation at the time of surgery but different skin preparation procedures the day before and the day of surgery, were prospectively compared: 30 patients operated on in an emergency setting for fracture (group A) had no skin preparation and 32 patients operated on in scheduled surgery (group B). Group A had no skin disinfection before going into surgery, whereas group B followed a predefined protocol the day before surgery. Skin samples were taken on gelose at three different stages of skin preparation at the time of surgery (before and after detersive cleaning, and at the end of the surgery) and on two sites (inguinal and greater trochanter). The bacteriological analysis took place after 48 hours of incubation. RESULTS Before detersive cleaning, group A had 3.6 times more bacteria than group B in the trochanter region and 2.7 times more in the inguinal area. After detersive cleaning, the contamination rate in the trochanter area was similar in both groups (group A: 10%; group B: 12.5%), but different in the inguinal region (group A: 33%; group B: 3%; P=0.002). At the end of the surgery, no difference was identified. Coagulase-negative Staphylococcus and Bacillus cereus accounted for 44% and 37%, respectively, of the bacteria isolated. In addition, the frequency of pathogenic non-saprotrophic bacteria was higher in group A (38%) compared to group B (6%). At a mean follow-up of 9.7 months (range: 8-11 months), no infection of the surgical site was identified. CONCLUSION The dermal flora is more abundant and different when the patient is managed in an emergency context. Although effective in the trochanter area, cutaneous detersive cleaning in the operating room is insufficient in the inguinal area and the frequency of pathogenic bacteria warrants identical rigor in preoperative preparation in all situations. LEVEL OF EVIDENCE III. Prospective case - control study.
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Affiliation(s)
- N Bonnevialle
- Institut de l'appareil locomoteur, centre hospitalier universitaire de Toulouse, place Baylac, 31059 Toulouse cedex, France.
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Bonnevialle N, Ibnoulkhatib A, Mansat P, Rongières M, Mansat M, Bonnevialle P. Outcomes of two surgical revision techniques for recurrent anterior shoulder instability following selective capsular repair. Orthop Traumatol Surg Res 2013; 99:455-63. [PMID: 23665026 DOI: 10.1016/j.otsr.2012.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/21/2012] [Accepted: 12/30/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Conventional capsulolabral reconstruction for anterior shoulder instability fails with recurrent instability in up to 23% of cases. Few studies have evaluated surgical revision strategies and outcomes. The objective of this study was to evaluate clinical and radiographic outcomes in a homogeneous series of surgical revisions after selective capsular repair (SCR). HYPOTHESIS Observed anatomic lesions can guide the choice between repeat SCR and coracoid transfer (Latarjet procedure). MATERIALS AND METHODS From January 2005 to January 2009, 11 patients with trauma-related recurrent anterior shoulder instability (episodes of subluxation and/or dislocation) after SCR were included. Mean age was 31 years (range, 19-45 years). At revision, a glenoid bony defect was present in six patients. Repeat SCR was performed in five patients and coracoid transfer in six patients. RESULTS After a mean follow-up of 40 months (range, 24-65 months), no patient had experienced further episodes of instability. However, four patients had a positive apprehension test. External rotation decreased significantly by more than 20° after both techniques. The Simple Shoulder Test, Walch-Duplay, and Rowe scores were 10.5, 79, and 85, respectively. No patient had a subscapularis tear. Of these 11 patients, nine were able to resume their sporting activities and eight reported being satisfied or very satisfied with the subjective outcome. Radiographs showed fibrous non-union of the coracoid transfer in one patient. CONCLUSION In patients with recurrent anterior shoulder instability after SCR, repeat SCR and coracoid transfer produce similarly satisfactory outcomes. The size of the glenoid bone defect may be the best criterion for choosing between these two procedures. However, open revision surgery may decrease the range of motion, most notably in external rotation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- N Bonnevialle
- Toulouse-Purpan University Hospital Center, place Baylac, 31059 Toulouse cedex, France.
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