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Tortolano L, Misandeau Q, Inouri T, Paul M, Dompnier M, Flouzat-Lachaniette CH, Archer V. Patient information pathway in orthopedic surgery: Roles of ERAS and pharmacists. Orthop Traumatol Surg Res 2023; 109:103576. [PMID: 36754166 DOI: 10.1016/j.otsr.2023.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/14/2022] [Revised: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Enhanced Rehabilitation After Surgery (ERAS) pathways significantly improve the care of patients in orthopedic surgery. However, patient knowledge and memorization of the information provided are currently poorly documented. HYPOTHESIS The information provided by a postoperative pharmacist could have a positive impact on patient care, in particular by improving knowledge about their prosthesis. MATERIAL AND METHOD This prospective feasibility study included a cohort of 80 patients operated on for a hip or knee prosthesis and who received postoperative pharmacist interviews (POPI). These POPIs informed the patient about the prosthesis, the complications, positions to avoid, as well as the postoperative follow-up. The objective was to measure the patient's knowledge before and after the POPI. Qualitative and quantitative analyses, by indication and patient pathway, were performed. RESULTS The patient's knowledge before POPI was 70% correct. After POPI this rate rose to 91%. DISCUSSION Patients' knowledge was weak and heterogeneous, especially regarding the implanted prosthesis. The POPI led to significant improvement and standardization of knowledge which should contribute to the prevention of iatrogenic harm (positions to avoid, infection prevention, compliance with analgesics and anticoagulants). CONCLUSION A POPI with a pharmacist improves overall patient management during hip or knee arthroplasty. LEVEL OF EVIDENCE III; non-randomized prospective feasibility study.
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Affiliation(s)
- Lionel Tortolano
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France; Université Paris-Saclay, EA Matériaux et santé, 91400, Orsay, France.
| | - Quentin Misandeau
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Tinhinane Inouri
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Muriel Paul
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Mathilde Dompnier
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Créteil, France
| | - Valérie Archer
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
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Poudrel AS, Rosi G, Nguyen VH, Housset V, Flouzat-Lachaniette CH, Haiat G. Detection of periprosthetic fractures around the femoral stem by resonance frequency analysis: An in vitro study. Proc Inst Mech Eng H 2023:9544119231163632. [PMID: 36992542 DOI: 10.1177/09544119231163632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Periprosthetic femoral bone fractures are frequent complications of Total Hip Arthroplasty (THA) and may occur during the insertion of uncemented Femoral Stems (FS), due to the nature of the press-fit fixation. Such fracture may lead to the surgical failure of the THA and require a revision surgery, which may have dramatic consequences. Therefore, an early detection of intra-operative fractures is important to avoid worsening the fracture and/or to enable a peroperative treatment. The aim of this in vitro study is to determine the sensitivity of a method based on resonance frequency analysis of the bone-stem-ancillary system for periprosthetic fractures detection. A periprosthetic fracture was artificially created close to the lesser-trochanter of 10 femoral bone mimicking phantoms. The bone-stem-ancillary resonance frequencies in the range (2-12) kHz were measured on an ancillary instrumented with piezoelectric sensors, which was fixed to the femoral stem. The measurements were repeated for different fracture lengths from 4 to 55 mm. The results show a decrease of the resonance frequencies due to the fracture occurrence and propagation. The frequency shift reached up to 170 Hz. The minimum fracture length that can be detected varies from 3.1±1.7 mm to 5.9±1.9 mm according to the mode and to the specimen. A significantly higher sensitivity (p = 0.011) was obtained for a resonance frequency around 10.6 kHz, corresponding to a mode vibrating in a plane perpendicular to the fracture. This study opens new paths toward the development of non-invasive vibration-based methods for intra-operative periprosthetic fractures detection.
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Affiliation(s)
- Anne-Sophie Poudrel
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil
| | - Giuseppe Rosi
- Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil, France
| | - Vu-Hieu Nguyen
- Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil, France
| | - Victor Housset
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est Créteil, Créteil, France
- INSERM U955, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est Créteil, Créteil, France
- INSERM U955, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Haiat
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil
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Raffa ML, Nguyen VH, Hernigou P, Flouzat-Lachaniette CH, Haiat G. Stress shielding at the bone-implant interface: Influence of surface roughness and of the bone-implant contact ratio. J Orthop Res 2021; 39:1174-1183. [PMID: 32852064 DOI: 10.1002/jor.24840] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/06/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023]
Abstract
Short and long-term stabilities of cementless implants are strongly determined by the interfacial load transfer between implants and bone tissue. Stress-shielding effects arise from shear stresses due to the difference of material properties between bone and the implant. It remains difficult to measure the stress field in periprosthetic bone tissue. This study proposes to investigate the dependence of the stress field in periprosthetic bone tissue on (i) the implant surface roughness, (ii) the material properties of bone and of the implant, (iii) the bone-implant contact ratio. To do so, a microscale two-dimensional finite element model of an osseointegrated bone-implant interface was developed where the surface roughness was modeled by a sinusoidal surface. The results show that the isostatic pressure is not affected by the presence of the bone-implant interface while shear stresses arise due to the combined effects of a geometrical singularity (for low surface roughness) and of shear stresses at the bone-implant interface (for high surface roughness). Stress-shielding effects are likely to be more important when the bone-implant contact ratio value is low, which corresponds to a case of relatively low implant stability. Shear stress reach a maximum value at a distance from the interface comprised between 0 and 0.1 time roughness wavelength λ and tend to 0 at a distance from the implant surface higher than λ, independently from bone-implant contact ratio and waviness ratio. A comparison with an analytical model allows validating the numerical results. Future work should use the present approach to model osseointegration phenomena.
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Affiliation(s)
- Maria Letizia Raffa
- Univ Paris Est Creteil, CNRS, MSME, Créteil, F-94010, France.,SUPMECA, EA 7393 QUARTZ Laboratory, Saint-Ouen 93407, France
| | - Vu-Hieu Nguyen
- Univ Paris Est Creteil, CNRS, MSME, Créteil, F-94010, France.,Univ Gustave Eiffel, MSME, Marne-la-Vallée, F-77454, France
| | - Philippe Hernigou
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, Créteil, France.,INSERM U955, IMRB Université Paris-Est, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, Créteil, France.,INSERM U955, IMRB Université Paris-Est, Créteil, France
| | - Guillaume Haiat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208, Créteil, F-94010, France
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Martinot P, Dartus J, Justo A, Riouach H, Cremer P, Flouzat-Lachaniette CH, Hernigou P, Kerboull L, Chiron P. Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? Case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years' follow-up. Orthop Traumatol Surg Res 2020; 106:1561-1568. [PMID: 33121926 DOI: 10.1016/j.otsr.2020.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Avascular necrosis of the femoral head often progresses to femoral head collapse if not treated. Conservative treatment yields highly variable results and is not standardised, mainly because it is typically evaluated in small patient populations. This led us to conduct a large retrospective comparative study with the goals of 1) analysing survival and functional outcomes, 2) looking for differences in survival between core decompression techniques (standard versus augmented), and 3) studying the risk factors for femoral head collapse and revision by arthroplasty. HYPOTHESIS Core decompression limits the number of patients who suffer femoral head collapse requiring arthroplasty at 2 years' follow-up. METHODS This multicentre, comparative, retrospective study analysed 330 patient records (1975-2016) where at least 2 years' follow-up was available. Sixty-two patients were excluded from the analysis: 5 had a stage III with collapse, 5 were lost to follow-up, 2 died within 24 months of the procedure and 50 had incomplete data. The study included 263 patients with a mean age of 42 years (15.7-70). In the Ficat classification, there were 51 cases of stage I necrosis, 186 cases of stage II and 22 cases of stage II with crescent sign (transition stage). The Kerboull angle on radiographs was between 5° and 20° in 40 patients, between 20° and 40° in 107 patients, between 40° and 60° in 52 patients and more than 60° in 29 patients. A standard core decompression was done in 79 patients and an augmented one in 184 patients. The more severe AVN cases (stage II) were more likely to be treated by augmented CD (160/184 patients, 87%) than by standard CD (48/79 patients, 61%) (p<0.001). RESULTS In the 263 patients, the overall survival (no arthroplasty at 2 years) was 73% (196/263). At 2 years, the survival rate (without arthroplasty) was 71% (56/79) in the standard CD group versus 76% (140/184) in the augmented CD group. This difference was significant when adjusted for Ficat stage and Kerboull angle [HR=0.457, 95% CI (0.247-0.844) (p=0.012)]. When the survival data was adjusted to the Ficat stage, augmented CD was better than standard CD with 10-year survival of 58.1% vs. 57.9% (p=0.0082). More than 30% necrosis volume increased the risk of failure [HR=3.291 95%CI (1.494-7.248) (p=0.0031)]. Also, a Kerboull angle above 60° increased the risk of failure [HR=3.148 95%CI (1.346-7.5) (p=0.0083)]. CONCLUSION After 2 years, CD for non-collapsed femoral head AVN prevents collapse and revision to arthroplasty in 73% of cases (196/268). Augmented CD improves the 2-year survival and the long-term survival after adjusting for preoperative characteristics (Kerboullangle and Ficat stage). The risk of collapse and need for arthroplasty is greater in patients with 30% necrosis volume on MRI and Kerboull angle above 60°. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Pierre Martinot
- University of Lille, CHU de Lille, Hôpital Salengro, Hauts de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
| | - Julien Dartus
- University of Lille, CHU de Lille, Hôpital Salengro, Hauts de France, 59000 Lille, France; Service d'orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Arthur Justo
- Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Hicham Riouach
- Hôpital Gabriel-Montpied, CHU de Clermont Ferrand BP 69, 63003 Clermont Ferrand cedex 01, France
| | - Paul Cremer
- CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | | | - Philippe Hernigou
- Hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Luc Kerboull
- Codirecteur du symposium de la SOFCOT, Marcel-Kerboull Institute, 39, rue Buffon, 75005 Paris, France
| | - Philippe Chiron
- Département de chirurgie orthopédique, traumatologique et réparatrice, Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
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- SOFCOT, 56, rue Boissonade, 75014 Paris, France
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Bouthors C, Prost S, Court C, Blondel B, Charles YP, Fuentes S, Mousselard HP, Mazel C, Flouzat-Lachaniette CH, Bonnevialle P, Sailhan F. Correction to: Outcomes of surgical treatments of spinal metastases: a prospective study. Support Care Cancer 2019; 28:2137. [PMID: 31811488 DOI: 10.1007/s00520-019-05213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The correct name of F. Saihlan should be F. Sailhan.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - S Prost
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - C Court
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - B Blondel
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Y P Charles
- Orthopedic and Traumatology Surgery Department, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Fuentes
- Neurosurgery Department, La Timone Hospital, AP-HM, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - H P Mousselard
- Orthopedic and traumatology surgery department, La Pitié-Salpétrière Hospital, AP-HP, Parix VI University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - C Mazel
- Orthopedic and traumatology surgery department, Institut Mutualiste Montsouris, Paris V University, 42 Boulevard Jourdan, 75014, Paris, France
| | - C H Flouzat-Lachaniette
- Orthopedic and traumatology surgery department, Mondor Hospital, APHP, Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - P Bonnevialle
- Orthopedic and traumatology surgery department, Riquet Pierre-Paul Hospital, Place du Docteur Baylac,, TSA 40031-31059, Toulouse cedex 9, France
| | - F Sailhan
- Orthopedic and traumatology surgery department, Cochin Hospital, APHP, Paris V University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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6
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Dubory A, Rosi G, Tijou A, Lomami HA, Flouzat-Lachaniette CH, Haïat G. A cadaveric validation of a method based on impact analysis to monitor the femoral stem insertion. J Mech Behav Biomed Mater 2019; 103:103535. [PMID: 31778909 DOI: 10.1016/j.jmbbm.2019.103535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/17/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
The success of cementless hip arthroplasty depends on the primary stability of the femoral stem (FS). It remains difficult to assess the optimal impaction energy to guarantee the FS stability while avoiding bone fracture. The aim of this study is to compare the results of a method based on the use of an instrumented hammer to determine the insertion endpoint of cementless FS in a cadaveric model with two other methods using i) the surgeon proprioception and ii) video motion tracking. Different FS were impacted in nine human cadaveric femurs. For each configuration, the number of impacts realized when the surgeon felt that the FS was correctly inserted was noted Nsurg. For each impact, the insertion depth E was measured and an indicator D was determined based on the time-variation of the force. The impact number Nvid (respectively Nd), corresponding to the end of the migration phase, was estimated analyzing the evolution of E (respectively D). The respective difference between Nsurg, Nvid and Nd was similar and lower than 3 for more than 85% of the configurations. The results allow a validation of the use of an impact hammer to assess the moment when the surgeon should stop the impaction, paving the way towards the development of a decision support system to assist the surgeon.
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Affiliation(s)
- Arnaud Dubory
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France; INSERM U955, IMRB Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Giuseppe Rosi
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil, 94010, France
| | - Antoine Tijou
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil, 94010, France
| | - Hugues Albini Lomami
- INSERM U955, IMRB Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Guillaume Haïat
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil, 94010, France.
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Eymard F, Pigenet A, Rose C, Bories A, Flouzat-Lachaniette CH, Berenbaum F, Chevalier X, Houard X, Nourissat G. Contribution of adipocyte precursors in the phenotypic specificity of intra-articular adipose tissues in knee osteoarthritis patients. Arthritis Res Ther 2019; 21:252. [PMID: 31775901 PMCID: PMC6882235 DOI: 10.1186/s13075-019-2058-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/08/2019] [Indexed: 01/15/2023] Open
Abstract
Background Intra-articular adipose tissues (IAATs) are involved in osteoarthritis (OA) pathophysiology. We hypothesize that mesenchymal cells residing in IAATs may account for the specific inflammatory and metabolic patterns in OA patients. Methods Adipocyte precursors (preadipocytes and dedifferentiated fat cells (DFATc)) from IAATs (infrapatellar and suprapatellar fat pads) and autologous subcutaneous adipose tissues (SCATs) were isolated from knee OA patients. The ability of these precursors to differentiate into adipocytes was assessed by oil red O staining after 14 days of culture in adipogenic medium. The gene expression of adipocyte-related transcription factors (C/EBP-α and PPAR-γ) and development-related factors (EN1 and SFRP2) were analyzed. The inflammatory pattern was assessed by RT-qPCR and ELISA (interleukin 6 (IL-6), IL-8, Cox2, and prostaglandin E2 (PGE2)) after a 24-h stimulation by IL-1β (1 ng/mL) and by conditioned medium from OA synovium. Results IAAT preadipocytes displayed a significantly higher ability to differentiate into adipocytes and expressed significantly more C/EBP-α mRNA than SCAT preadipocytes. IAAT preadipocytes expressed significantly less EN-1 and SFRP2 mRNA than SCAT preadipocytes. Unstimulated IAAT preadipocytes displayed a less inflammatory pattern (IL-6, IL-8, and Cox2/PGE2) than SCAT preadipocytes. In contrast, the response of IAAT preadipocytes to an inflammatory stimulus (IL-1β and conditioned media of OA synovium) was exacerbated compared to that of SCAT preadipocytes. Similar results were obtained with DFATc. Conclusion IAAT adipocyte precursors from OA patients have a specific phenotype, which may account for the unique phenotype of OA IAATs. The exacerbated response of IAAT preadipocytes to inflammatory stimulation may contribute to OA pathophysiology.
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Affiliation(s)
- Florent Eymard
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France.,Department of Rheumatology, AP-HP Henri Mondor Hospital, F-94010, Créteil Cedex, France
| | - Audrey Pigenet
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France
| | - Cindy Rose
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France
| | - Anouchka Bories
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France
| | | | - Francis Berenbaum
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France. .,Department of Rheumatology, AP-HP Saint-Antoine Hospital, Labex Transimmunomics, DHU i2B, F-75012, Paris, France. .,INSERM UMR-S 938 "Metabolism and Age-related Joint Diseases", Saint-Antoine Research Center, 27 rue Chaligny, F-75571, Paris Cedex 12, France.
| | - Xavier Chevalier
- Department of Rheumatology, AP-HP Henri Mondor Hospital, F-94010, Créteil Cedex, France
| | - Xavier Houard
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France
| | - Geoffroy Nourissat
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012, Paris, France.,Groupe Ramsay Générale de Santé, Clinique Maussins Nollet, F-75019, Paris, France
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Raffa ML, Nguyen VH, Tabor E, Immel K, Housset V, Flouzat-Lachaniette CH, Haiat G. Dependence of the primary stability of cementless acetabular cup implants on the biomechanical environment. Proc Inst Mech Eng H 2019; 233:1237-1249. [DOI: 10.1177/0954411919879250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biomechanical phenomena occurring at the bone–implant interface during the press-fit insertion of acetabular cup implants are still poorly understood. This article presents a nonlinear geometrical two-dimensional axisymmetric finite element model aiming at describing the biomechanical behavior of the acetabular cup implant as a function of the bone Young’s modulus Eb, the diametric interference fit ( IF), and the friction coefficient µ. The numerical model was compared with experimental results obtained from an in vitro test, which allows to determine a reference configuration with the parameter set: μ* = 0.3, [Formula: see text], and IF* = 1 mm for which the maximal contact pressure tN = 10.7 MPa was found to be localized at the peri-equatorial rim of the acetabular cavity. Parametric studies were carried out, showing that an optimal value of the pull-out force can be defined as a function of μ, Eb, and IF. For the reference configuration, the optimal pull-out force is obtained for μ = 0.6 (respectively, Eb = 0.35 GPa and IF = 1.4 mm). For relatively low value of µ ( µ < 0.2), the optimal value of IF linearly increases as a function of µ independently of Eb, while for µ > 0.2, the optimal value of IF has a nonlinear dependence on µ and decreases as a function of Eb. The results can be used to help surgeons determine the optimal value of IF in a patient specific manner.
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Affiliation(s)
- Maria Letizia Raffa
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil, France
| | - Vu-Hieu Nguyen
- Université Paris-Est, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil, France
| | - Elisabeth Tabor
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil, France
| | - Katharina Immel
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil, France
- Aachen Institute for Advanced Study in Computational Engineering Science (AICES), RWTH Aachen University, Aachen, Germany
| | - Victor Housset
- Service de Chirurgie Orthopédique et Traumatologique du Centre Hospitalier Universitaire Henri Mondor, Créteil, France
- Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique du Centre Hospitalier Universitaire Henri Mondor, Créteil, France
- Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, Créteil, France
| | - Guillaume Haiat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil, France
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Bouthors C, Prost S, Court C, Blondel B, Charles YP, Fuentes S, Mousselard HP, Mazel C, Flouzat-Lachaniette CH, Bonnevialle P, Saihlan F. Outcomes of surgical treatments of spinal metastases: a prospective study. Support Care Cancer 2019; 28:2127-2135. [PMID: 31396747 DOI: 10.1007/s00520-019-05015-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Owing to recent advances in cancer therapy, updated data are required for clinicians counselling patients on treatment of spinal metastases. OBJECTIVE To analyse the outcomes of surgical treatments of spinal metastases. METHODS Prospective and multicentric study that included consecutively patients operated on for spinal metastases between January 2016 and January 2017. Overall survival was calculated with the Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratio (HR) analysing mortality risk according to preoperative Karnofsky performance status (KPS), mobility level and neurological status. RESULTS A total of 252 patients were included (145 males, 107 females) aged a mean 63.3 years. Median survival was 450 days. Primary cancer sites were lung (21%) and breast (19%). Multiple spinal metastases involved 122 patients (48%). Concomitant skeletal and visceral metastases were noted in 90 patients (36%). Main procedure was laminectomy and posterior fixation (57%). Overall, pain and mobility level were improved postoperatively. Most patients had normal preoperative motor function (50%) and remained so postoperatively. Patients "bedbound" on admission were the less likely to recover. In-hospital death rate was 2.4% (three disease progression, one septic shock, one pneumonia, one pulmonary embolism). Complication rate was 33%, deep wound infection was the most frequent aetiology. Higher mortality was observed in patients with poorest preoperative KPS (KPS 0-40%, HR = 3.1, p < 0.001) and mobility level ("bedbound", HR = 2.16, p < 0.001). Survival seemed also to be linked to preoperative neurological function. CONCLUSION Surgical treatments helped maintain reasonable condition for patients with spinal metastases. Intervention should be offered before patients' condition worsen to ensure better outcomes.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - S Prost
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - C Court
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - B Blondel
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Y P Charles
- Orthopedic and Traumatology Surgery Department, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Fuentes
- Neurosurgery Department, La Timone Hospital, AP-HM, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - H P Mousselard
- Orthopedic and traumatology surgery department, La Pitié-Salpétrière Hospital, AP-HP, Parix VI University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - C Mazel
- Orthopedic and traumatology surgery department, Institut Mutualiste Montsouris, Paris V University, 42 Boulevard Jourdan, 75014, Paris, France
| | - C H Flouzat-Lachaniette
- Orthopedic and traumatology surgery department, Mondor Hospital, APHP, Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - P Bonnevialle
- Orthopedic and traumatology surgery department, Riquet Pierre-Paul Hospital, Place du Docteur Baylac,, TSA 40031-31059, Toulouse cedex 9, France
| | - F Saihlan
- Orthopedic and traumatology surgery department, Cochin Hospital, APHP, Paris V University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Tijou A, Rosi G, Vayron R, Lomami HA, Hernigou P, Flouzat-Lachaniette CH, Haïat G. Monitoring cementless femoral stem insertion by impact analyses: An in vitro study. J Mech Behav Biomed Mater 2018; 88:102-108. [PMID: 30144721 DOI: 10.1016/j.jmbbm.2018.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/07/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
The primary stability of the femoral stem (FS) implant determines the surgical success of cementless hip arthroplasty. During the insertion, a compromise must be found for the number and energy of impacts that should be sufficiently large to obtain an adapted primary stability of the FS and not too high to decrease fracture risk. The aim of this study is to determine whether a hammer instrumented with a force sensor can be used to monitor the insertion of FS. Cementless FS of different sizes were impacted in four artificial femurs with an instrumented hammer, leading to 72 configurations. The impact number when the surgeon empirically felt that the FS was fully inserted was noted Nsurg. The insertion depth E was assessed using video motion tracking and the impact number Nvid corresponding to the end of the insertion was estimated. For each impact, two indicators noted I and D were determined based on the analysis of the variation of the force as a function of time. The pull-out force F was significantly correlated with the indicator I (R2 = 0.67). The variation of D was analyzed using a threshold to determine an impact number Nd, which is shown to be closely related to Nsurg and Nvid, with an average difference of around 0.2. This approach allows to determine i) the moment when the surgeon should stop the impaction procedure in order to obtain an optimal insertion of the FS and ii) the FS implant primary stability. This study paves the way towards the development of a decision support system to assist the surgeon in hip arthroplasty.
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Affiliation(s)
- Antoine Tijou
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Giuseppe Rosi
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Romain Vayron
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Hugues Albini Lomami
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Philippe Hernigou
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Guillaume Haïat
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France.
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11
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Bosc R, Tijou A, Rosi G, Nguyen VH, Meningaud JP, Hernigou P, Flouzat-Lachaniette CH, Haiat G. Influence of soft tissue in the assessment of the primary fixation of acetabular cup implants using impact analyses. Clin Biomech (Bristol, Avon) 2018; 55:7-13. [PMID: 29625357 DOI: 10.1016/j.clinbiomech.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 02/08/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The acetabular cup (AC) implant primary stability is an important determinant for the success of cementless hip surgery but it remains difficult to assess the AC implant fixation in the clinic. A method based on the analysis of the impact produced by an instrumented hammer on the ancillary has been developed by our group (Michel et al., 2016a). However, the soft tissue thickness present around the acetabulum may affect the impact response, which may hamper the robustness of the method. The aim of this study is to evaluate the influence of the soft tissue thickness (STT) on the acetabular cup implant primary fixation evaluation using impact analyses. METHODS To do so, different AC implants were inserted in five bovine bone samples. For each sample, different stability conditions were obtained by changing the cavity diameter. For each configuration, the AC implant was impacted 25 times with 10 and 30 mm of soft tissues positioned underneath the sample. The averaged indicator Im was determined based on the amplitude of the signal for each configuration and each STT and the pull-out force was measured. FINDINGS The results show that the resonance frequency of the system increases when the value of the soft tissue thickness decreases. Moreover, an ANOVA analysis shows that there was no significant effect of the value of soft tissue thickness on the values of the indicator Im (F = 2.33; p-value = 0.13). INTERPRETATION This study shows that soft tissue thickness does not appear to alter the prediction of the acetabular cup implant primary fixation obtained using the impact analysis approach, opening the path towards future clinical trials.
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Affiliation(s)
- Romain Bosc
- NSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Faculté de Médecine, Créteil, France; Université Paris Est, Créteil, France; Hopital Henri Mondor, Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, 50, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
| | - Antoine Tijou
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Giuseppe Rosi
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Vu-Hieu Nguyen
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Jean-Paul Meningaud
- Hopital Henri Mondor, Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, 50, avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Philippe Hernigou
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Guillaume Haiat
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, 61 Avenue du Général de Gaulle, Créteil 94010, France
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12
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Flouzat-Lachaniette CH, Jullien N, Bouthors C, Beohou E, Laurent B, Bierling P, Dubory A, Rouard H. A novel in vivo porcine model of intervertebral disc degeneration induced by cryoinjury. International Orthopaedics (SICOT) 2018; 42:2263-2272. [DOI: 10.1007/s00264-018-3971-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/01/2018] [Indexed: 01/07/2023]
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13
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Tijou A, Rosi G, Hernigou P, Flouzat-Lachaniette CH, Haïat G. Ex Vivo Evaluation of Cementless Acetabular Cup Stability Using Impact Analyses with a Hammer Instrumented with Strain Sensors. Sensors (Basel) 2017; 18:s18010062. [PMID: 29280982 PMCID: PMC5796378 DOI: 10.3390/s18010062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/14/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022]
Abstract
The acetabular cup (AC) implant stability is determinant for the success of cementless hip arthroplasty. A method based on the analysis of the impact force applied during the press-fit insertion of the AC implant using a hammer instrumented with a force sensor was developed to assess the AC implant stability. The aim of the present study was to investigate the performance of a method using a hammer equipped with strain sensors to retrieve the AC implant stability. Different AC implants were inserted in five bovine samples with different stability conditions leading to 57 configurations. The AC implant was impacted 16 times by the two hammers consecutively. For each impact; an indicator IS (respectively IF) determined by analyzing the time variation of the signal corresponding to the averaged strain (respectively force) obtained with the stress (respectively strain) hammer was calculated. The pull-out force F was measured for each configuration. F was significantly correlated with IS (R² = 0.79) and IF (R² = 0.80). The present method has the advantage of not modifying the shape of the hammer that can be sterilized easily. This study opens new paths towards the development of a decision support system to assess the AC implant stability.
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Affiliation(s)
- Antoine Tijou
- Laboratoire de Modélisation et de Simulation Multi-Echelle, CNRS, UMR CNRS 8208, 61 Avenue du Général de Gaulle, 94010 Créteil, France;
| | - Giuseppe Rosi
- Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, Université Paris-Est, 61 Avenue du Général de Gaulle, 94010 Créteil, France;
| | - Philippe Hernigou
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; (P.H.); (C.-H.F.-L.)
- Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; (P.H.); (C.-H.F.-L.)
- Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Guillaume Haïat
- Laboratoire de Modélisation et de Simulation Multi-Echelle, CNRS, UMR CNRS 8208, 61 Avenue du Général de Gaulle, 94010 Créteil, France;
- Correspondence: ; Tel.: +33-1-45-17-14-31
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14
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Bouveau V, Potage D, Dubory A, Chevallier R, Meningaud JP, Niddam J, Flouzat-Lachaniette CH. A Distally Based Sartorius Muscle Flap for a Gustilo Grade-III Open Fracture of the Lateral Femoral Condyle and the Head of the Fibula with a Complex Soft-Tissue Defect: A Case Report and Review of the Literature. JBJS Case Connect 2017; 7:e93. [PMID: 29244658 DOI: 10.2106/jbjs.cc.17.00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of lower-limb trauma associated with an extensive soft-tissue defect around the knee joint, which led to the exposure of bone and the metalwork that was used for the management of the associated fractures. Coverage was performed with a distally based sartorius muscle flap in a single-stage procedure, allowing good recovery with a nice aesthetic and functional outcome at the 1-year follow-up. Additionally, we discuss alternative options for the coverage of severe soft-tissue defects based on the clinical context. CONCLUSION A distally based sartorius muscle flap may be a suitable alternative for coverage of complex soft-tissue defects around the knee joint.
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Affiliation(s)
- Victoire Bouveau
- Departments of Orthopaedic Surgery (V.B., D.P., A.D., R.C., and C.-H.F.-L) and Plastic Surgery (J.-P.M and J.N.), Hôpital Henri Mondor (Assistance Publique-Hôpitaux de Paris), Université Paris Est Créteil (UPEC), Créteil Cedex, France
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15
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Abstract
Based on the exceptional tribological behaviour and on the relatively low biological activity of ceramic particles, Ceramic-on-Ceramic (CoC) total hip arthroplasty (THA) presents significant advantagesCoC bearings decrease wear and osteolysis, the cumulative long-term risk of dislocation, muscle atrophy, and head-neck taper corrosion.However, there are still concerns regarding the best technique for implantation of ceramic hips to avoid fracture, squeaking, and revision of ceramic hips with fracture of a component.We recommend that surgeons weigh the potential advantages and disadvantages of current CoC THA in comparison with other bearing surfaces when considering young very active patients who are candidates for THA. Cite this article: Hernigou P, Roubineau F, Bouthors C, Flouzat-Lachaniette C-H. What every surgeon should know about Ceramic-on-Ceramic bearings in young patients. EFORT Open Rev 2016;1:107-111. DOI: 10.1302/2058-5241.1.000027.
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Abstract
The objective of this article is to review data on joint distraction used to treat knee osteoarthritis. Joint distraction is a surgical procedure in which the two bony ends of the joint are gradually pulled apart then kept separated for 2 months in an external fixation frame. Weight bearing is continued to ensure variations in hydrostatic pressure within the joint. In published studies, joint distraction provided substantial clinical and structural improvements in patients with knee osteoarthritis, delaying joint replacement surgery for at least 2 years. Animal studies showed that joint distraction was associated with decrease in the secondary inflammatory response, cartilage breakdown, and subchondral bone remodeling. In vitro, the intermittent application of hydrostatic pressure stimulated the production of extracellular matrix, particularly in joints with osteoarthritis. Nevertheless, several considerations invite caution when considering the more widespread use of joint distraction. Published studies have short follow-ups and small sample sizes. In addition, the high frequency of pin tract infection is of concern, since most patients eventually require knee replacement surgery. These two considerations indicate a need for longer-term prospective studies of patient cohorts.
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Affiliation(s)
- Charles-Henri Flouzat-Lachaniette
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - François Roubineau
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - Clémence Heyberger
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique et traumatologique, hôpital Henri-Mondor, AP-HP-UPEC, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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17
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Hernigou P, Trousselier M, Roubineau F, Bouthors C, Chevallier N, Rouard H, Flouzat-Lachaniette CH. Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress. Clin Orthop Surg 2016; 8:1-8. [PMID: 26929793 PMCID: PMC4761591 DOI: 10.4055/cios.2016.8.1.1] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 12/28/2022] Open
Abstract
Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis.
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Matthieu Trousselier
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - François Roubineau
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Charlie Bouthors
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Nathalie Chevallier
- EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Helene Rouard
- EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
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18
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Flouzat-Lachaniette CH, Ratte L, Poignard A, Auregan JC, Queinnec S, Hernigou P, Allain J. Minimally invasive anterior lumbar interbody fusion for adult degenerative scoliosis with 1 or 2 dislocated levels. J Neurosurg Spine 2015; 23:739-46. [DOI: 10.3171/2015.3.spine14772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Frequent complications of posterolateral instrumented fusion have been reported after treatment of degenerative scoliosis in elderly patients. Considering that in some cases, most of the symptomatology of adult degenerative scoliosis (ADS) is a consequence of the segmental instability at the dislocated level, the use of minimally invasive anterior lumbar interbody fusion (ALIF) to manage symptoms can be advocated to reduce surgical morbidity. The purpose of this study was to evaluate the midterm outcomes of 1- or 2-level minimally invasive ALIFs in ADS patients with 1- or 2-level dislocations.
METHODS
A total of 47 patients (average age 64 years; range 43–80 years) with 1- or 2-level ALIF performed for ADS (64 levels) in a single institution were included in the study. An independent spine surgeon retrospectively reviewed all the patients’ medical records and radiographs to assess operative data and surgery-related complications. Clinical outcome was reported using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for lumbar and leg pain. Intraoperative data and complications were collected. Fusion and risk for adjacent-level degeneration were assessed.
RESULTS
The mean follow-up duration was 3 years (range 1–10 years). ODI, and back and leg pain VAS scores were significantly improved at last follow-up. A majority of patients (74%) had a statistically significant improvement in their ODI score of more than 20 points at latest follow-up and 1 had a worsening of his disability. The mean operating time was 166 minutes (range 70–355 minutes). The mean estimated blood loss was 410 ml (range 50–1700 ml). Six (5 major and 1 minor) surgical complications (12.7% of patients) and 13 (2 major and 11 minor) medical complications (27.7% of patients) occurred without death or wound infection. Fusion was achieved in 46 of 47 patients. Surgery resulted in a slight but significant decrease of the Cobb angle, and improved the pelvic parameters and lumbar lordosis, but had no effect on the global sagittal balance. At latest follow-up, 9 patients (19.1%) developed adjacent-segment disease at a mean of 2 years’ delay from the index surgery; 4 were symptomatic but treated medically, and none required iterative surgery.
CONCLUSIONS
Single- or 2-level minimally invasive fusion through a minimally invasive anterior approach in some selected cases of ADS produced a good functional outcome with a high fusion rate. They were associated with a significantly lower rate of complications in this study than the historical control.
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Hernigou P, Flouzat-Lachaniette CH, Delambre J, Poignard A, Allain J, Chevallier N, Rouard H. Osteonecrosis repair with bone marrow cell therapies: state of the clinical art. Bone 2015; 70:102-9. [PMID: 25016964 DOI: 10.1016/j.bone.2014.04.034] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [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: 02/12/2014] [Revised: 04/14/2014] [Accepted: 04/22/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Hip osteonecrosis is a pathological condition resulting from cellular impairment due to reduction in osteoblast activity and local mesenchymal stem cell populations. Cell-based therapies might aid in overcoming these deficiencies by providing stem cells and other progenitor cells to potentially improve the local cellular environment in the affected hip. METHODS A PubMed search, using the search terms "hip osteonecrosis" and "mesenchymal stem cells", was conducted in December 2013. A total of 15 publications were identified and reviewed for clinical outcomes. FINDINGS Clinical studies of patients with osteonecrosis treated with mesenchymal stem cells showed beneficial effects. No unexpected adverse events were identified in these studies. Core decompression was the usual method for autologous bone marrow cell implantation into the femoral head. However, other methods have been used such as arterial or venous delivery. A rationale for the use of cytotherapy, as well as the different descriptions of the techniques of implantation MSCs (autologous vs. allogenic, concentration vs. expansion), is provided in the context of treating hip osteonecrosis. Current problems and future challenges with cytotherapy and associated techniques are discussed. This article is part of a Special Issue entitled "Stem Cells and Bones".
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Affiliation(s)
- Philippe Hernigou
- Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France.
| | | | - Jerome Delambre
- University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - Alexandre Poignard
- Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - Jerome Allain
- Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - Nathalie Chevallier
- EFS Cell Therapy Facility, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - Helene Rouard
- EFS Cell Therapy Facility, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
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20
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Eymard F, Pigenet A, Citadelle D, Flouzat-Lachaniette CH, Poignard A, Benelli C, Berenbaum F, Chevalier X, Houard X. Induction of an inflammatory and prodegradative phenotype in autologous fibroblast-like synoviocytes by the infrapatellar fat pad from patients with knee osteoarthritis. Arthritis Rheumatol 2014; 66:2165-74. [PMID: 24719336 DOI: 10.1002/art.38657] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 04/01/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The infrapatellar fat pad (IFP) of the knee joint has an inflammatory phenotype in osteoarthritis (OA). Its close proximity to the synovial membrane suggests that the IFP could be involved in the induction of OA synovitis. This study was undertaken to investigate the response of fibroblast-like synoviocytes (FLS) to autologous IFP and subcutaneous adipose tissue (SCAT) from patients with severe knee OA. METHODS Samples of IFP, SCAT, and autologous synovial membrane tissue close to the IFP were harvested during surgery from 28 patients with end-stage knee OA. FLS from 14 patients were stimulated with autologous IFP- or SCAT-conditioned medium, and levels of messenger RNA (mRNA) expression and protein release of interleukin-6 (IL-6), IL-8, secretory phospholipase A2 (sPLA2 ), cytosolic PLA2 , cyclooxygenase 2 (COX-2), microsomal prostaglandin E synthase, prostaglandin E2 (PGE2 ), and matrix metalloproteinases (MMPs) 1, 3, 9, and 13 were evaluated. Both IFP- and SCAT-conditioned medium were evaluated by enzyme-linked immunosorbent assay for secretion of IL-6, soluble IL-6 receptor (sIL-6R), IL-8, tumor necrosis factor α (TNFα), PGE2 , IL-1β, and interferon-γ. In addition, OA FLS were treated with PGE2 receptor antagonists to evaluate the contribution of IFP-derived PGE2 to the inflammatory response of FLS to the IFP. RESULTS Stimulation of OA FLS with IFP-conditioned medium induced the mRNA expression and protein release of IL-6, IL-8, sPLA2 , COX-2, PGE2 , and MMPs 1, 3, 9, and 13. The extent of stimulation was consistently stronger with IFP-conditioned medium than with SCAT-conditioned medium. Moreover, secretion of IL-6, sIL-6R, IL-8, TNFα, and PGE2 was greater in IFP-conditioned medium than in SCAT-conditioned medium, especially PGE2 , whose secretion was 75-fold stronger in IFP-conditioned medium (P < 0.0001). PGE2 receptor antagonists dose-dependently inhibited the release of IL-6, IL-8, and PGE2 by IFP-stimulated FLS. CONCLUSION This study showed that the IFP has a potential role in the induction of synovial inflammation in patients with severe knee OA. Furthermore, secretion of PGE2 by the IFP may be involved in the OA inflammatory process.
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Affiliation(s)
- Florent Eymard
- Sorbonne University, Université Pierre et Marie Curie Paris 6, INSERM (UMR S938), and DHU i2B, Paris, France, and AP-HP, Hôpital Henri Mondor, Créteil, France
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Allain J, Delecrin J, Beaurain J, Poignard A, Vila T, Flouzat-Lachaniette CH. Stand-alone ALIF with integrated intracorporeal anchoring plates in the treatment of degenerative lumbar disc disease: a prospective study on 65 cases. Eur Spine J 2014; 23:2136-43. [DOI: 10.1007/s00586-014-3364-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Flouzat-Lachaniette CH, Ghazanfari A, Bouthors C, Poignard A, Hernigou P, Allain J. Bone union rate with recombinant human bone morphogenic protein-2 versus autologous iliac bone in PEEK cages for anterior lumbar interbody fusion. International Orthopaedics (SICOT) 2014; 38:2001-7. [DOI: 10.1007/s00264-014-2301-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/09/2014] [Indexed: 11/29/2022]
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Hernigou P, Homma Y, Flouzat-Lachaniette CH, Poignard A, Chevallier N, Rouard H. Cancer risk is not increased in patients treated for orthopaedic diseases with autologous bone marrow cell concentrate. J Bone Joint Surg Am 2013; 95:2215-21. [PMID: 24352775 DOI: 10.2106/jbjs.m.00261] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is concern that regenerative cell-based therapies could result in increased risk of tumor formation. We investigated the long-term risks for systemic and site-specific cancers in patients who had received autologous bone marrow-derived stromal progenitor cells to treat orthopaedic lesions. METHODS A total of 1873 patients were treated from 1990 to 2006 with bone marrow-derived concentrated cells. Patients were monitored for cancer incidence from the date of the first operation (1990) until death, or until December 31, 2011. The mean follow-up time was 12.5 years (range, five to twenty-two years). The average number of colony-forming unit fibroblasts returned to the patients was 483,000 fibroblasts (range, 62,000 to 2,095,000 fibroblasts). The primary outcome was to evaluate with radiographs and/or magnetic resonance imaging the risk of tumorigenesis at the cell therapy treatment sites. The secondary outcome was to evaluate the risk of cancer diagnosed in areas other than the treatment site during the follow-up period. The relative risk of cancer was expressed as the ratio of observed and expected number of cases, that is, the standardized incidence ratio, according to the cancer incidence in the French population. RESULTS No tumor formation was found at the treatment sites on the 7306 magnetic resonance images and 52,430 radiographs among the 1873 patients. Fifty-three cancers were diagnosed in areas other than the treatment site. On the basis of cancer incidence in the general population during the same period, the expected number of cancers was between ninety-seven and 108 for the same age and sex distribution. The range of the standardized incidence ratio for the follow-up period was between 0.49 and 0.54 (95% confidence interval, 0.30 to 0.80). CONCLUSIONS This study found no increased cancer risk in patients after application of autologous cell-based therapy using bone marrow-derived stromal progenitor cells either at the treatment site or elsewhere in the patients after an average follow-up period of 12.5 years.
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery (P.H., C.-H.F.-L., and A.P.) and EFS Cell Therapy Facility (N.C. and H.R.), University Paris East, Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. E-mail address for P. Hernigou:
| | - Yasuhiro Homma
- Juntendo University, Hongo 2-1-1, Bunko-Ku, Tokyo 113-8421, Japan
| | - Charles-Henri Flouzat-Lachaniette
- Department of Orthopaedic Surgery (P.H., C.-H.F.-L., and A.P.) and EFS Cell Therapy Facility (N.C. and H.R.), University Paris East, Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. E-mail address for P. Hernigou:
| | - Alexandre Poignard
- Department of Orthopaedic Surgery (P.H., C.-H.F.-L., and A.P.) and EFS Cell Therapy Facility (N.C. and H.R.), University Paris East, Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. E-mail address for P. Hernigou:
| | - Nathalie Chevallier
- Department of Orthopaedic Surgery (P.H., C.-H.F.-L., and A.P.) and EFS Cell Therapy Facility (N.C. and H.R.), University Paris East, Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. E-mail address for P. Hernigou:
| | - Helene Rouard
- Department of Orthopaedic Surgery (P.H., C.-H.F.-L., and A.P.) and EFS Cell Therapy Facility (N.C. and H.R.), University Paris East, Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France. E-mail address for P. Hernigou:
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Flouzat-Lachaniette CH, Younes C, Delblond W, Dupuy N, Hernigou P. The natural progression of adult elbow osteonecrosis related to corticosteroid treatment. Clin Orthop Relat Res 2012; 470:3478-82. [PMID: 22926494 PMCID: PMC3492606 DOI: 10.1007/s11999-012-2550-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 08/07/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients with corticosteroid treatment, the elbow is a rare site of osteonecrosis; there is little information about the rate and risk factors of disease progression in symptomatic and asymptomatic elbows. QUESTION/PURPOSES We determined the delay between the beginning of corticosteroid treatment and different stages of osteonecrosis and which stage and dose of steroids influenced disease progression. METHODS Osteonecrosis related to corticosteroids was diagnosed by MRI in 50 elbows of 35 adult patients. Thirty elbows were asymptomatic at initial evaluation (19 with Stage I, 11 with Stage II osteonecrosis). Among the 20 elbows symptomatic at initial evaluation, 13 had radiographic evidence of osteonecrosis without collapse (Stage II) and seven had lesions evident only on MRI (Stage I). RESULTS At latest followup (average, 17 years; range, 10-25 years), of the 30 previously asymptomatic elbows, pain developed in 24 and collapse occurred in 14; of the 20 previously symptomatic elbows, 15 showed collapse (seven initially with Stage I, eight with Stage II osteonecrosis). The average time between diagnosis and collapse was 8 and 5 years, respectively, for symptomatic elbows with Stages I and II osteonecrosis. Stage at initial visit, development of pain, and continuation of peak doses of corticosteroids were risk factors for disease progression in asymptomatic elbows. In symptomatic elbows, the extent in contact with the articular surface and lesion location were the main risk factors for disease progression. CONCLUSIONS Untreated asymptomatic and symptomatic elbow osteonecrosis related to corticosteroids has a moderate likelihood of elbow collapse, with decrease in ROM, but none of the patients in this case series followed for 10 to 20 years had elbow arthroplasty. LEVEL OF EVIDENCE Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Chaib Younes
- Department of Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - William Delblond
- Department of Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - Nicolas Dupuy
- Department of Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East, Hôpital Henri Mondor, 94010 Creteil, France
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Flouzat-Lachaniette CH, Delblond W, Poignard A, Allain J. Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases. Eur Spine J 2012; 22:766-74. [PMID: 23053759 DOI: 10.1007/s00586-012-2524-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 09/07/2012] [Accepted: 09/22/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. METHODS This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. RESULTS Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. CONCLUSIONS Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.
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Affiliation(s)
- Charles-Henri Flouzat-Lachaniette
- Institut du Rachis, Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor, AP-HP, UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Creteil Cedex, France.
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Flouzat-Lachaniette CH, Guidon J, Allain J, Poignard A. An uncommon case of Mycoplasma hominis infection after total disc replacement. Eur Spine J 2012; 22 Suppl 3:S394-8. [PMID: 23001380 DOI: 10.1007/s00586-012-2511-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 05/27/2012] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Beside mechanical complications, the majority of adverse events after total disc arthroplasty (TDA) are related to the surgical approach. Septic complications are very uncommon and only one previous case has been published. The objective of this article is to describe the clinical circumstances, treatment, and outcomes of septic complication after TDA at L4-L5, involving an uncommon pathogen (Mycoplasma hominis). METHODS A 38-year-old woman underwent a MobiDisc(®) TDA at L4-L5 level for discogenic pain. One month postoperatively, she complained of acute low back and abdominal pain associated with fever (39 °C). C-reactive protein level was elevated (197 mg/L; normal <5 mg/L) and the white blood cell count was normal (7 × 10(9)/L; normal 4-10 × 10(9)/L). A computerized tomography (CT) showed a left psoas-based retroperitoneal abscess. Treatment consisted of open debridement, drainage and empirical antibiotic therapy. Intraoperative cultures yielded M. hominis after 7 days incubation. Antibiotic therapy was adapted and discontinued after 2 months. The patient had failed to mention earlier that she had been suffering from abnormal vaginal discharge for some time and was using an intrauterine contraceptive device. RESULTS At 1.5-year follow-up, review confirmed healing of the infection with biological normalization without residual collection, radiolucent lines or osteolysis around the prosthesis at radiographs, CT and MRI. CONCLUSIONS Mycoplasma hominis can be involved as an extragenital pathogen in musculoskeletal infections. Because its culture and identification are difficult, special media and real-time PCR are required in case of postoperative deep wound infection after anterior lumbar spine surgery, especially in the case of previous genitourinary infections, to decrease the delay in diagnosis and treatment.
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Affiliation(s)
- Charles-Henri Flouzat-Lachaniette
- Hôpital Henri Mondor, AP-HP - UPEC, Institut du Rachis - Service de Chirurgie Orthopédique et Traumatologique, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil Cedex, France.
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Flouzat-Lachaniette CH. [What can the patient do after knee or hip arthroplasty?]. Rev Prat 2012; 62:648-649. [PMID: 22730793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Flouzat-Lachaniette CH. [At-risk situations for knee osteoarthritis]. Rev Prat 2012; 62:630-634. [PMID: 22730787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Osteoarthritis is the most common joint disease in the world, and the knee is the most affected joint. It is a multifactorial disease in which degenerative factors, genetics, hormonal and mechanical factors are involved. Several at-risk situations are particularly well identified: the anterior cruciate ligament rupture, meniscectomy, knee injuries, varus or valgus knee malalignment and obesity. The reconstruction of the anterior cruciate ligament is intended to limit the risk of secondary meniscal lesion. No long-term study found any evidence that surgery would prevent knee osteoarthritis. The extent of the meniscectomy should be kept to a minimum to prevent the risk of secondary osteoarthritis. It is essential to promote programs against obesity by targeting priority patients who have other risk factors such as a history of meniscectomy or knee injury, or knee malalignment.
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Poignard A, Flouzat-Lachaniette CH, Amzallag J, Galacteros F, Hernigou P. The natural progression of symptomatic humeral head osteonecrosis in adults with sickle cell disease. J Bone Joint Surg Am 2012; 94:156-62. [PMID: 22258003 DOI: 10.2106/jbjs.j.00919] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis of the humeral head is a frequent complication in adults with sickle cell disease. However, little is known about the rate of, and the factors influencing, progression of symptomatic shoulder osteonecrosis in patients with this disease. METHODS Eighty-two adult patients with sickle cell disease and symptomatic osteonecrosis of the humeral head (104 shoulders) were identified with magnetic resonance imaging (MRI) between 1985 and 1993. Nineteen of the eighty-two patients were homozygous for hemoglobin S (S/S genotype), thirty-seven had hemoglobin S/hemoglobin C (S/C), and twenty-six had hemoglobin S/beta-thalassemia (S/T). Shoulder osteonecrosis was graded with the method of Cruess with an adaptation for MRI as proposed by Steinberg et al. for hip osteonecrosis. Annual radiographs were obtained. At the initial evaluation, thirty-eight symptomatic shoulders were designated as stage I (with osteonecrosis seen only on MRI), forty-two symptomatic shoulders were designated as stage II (radiographic evidence without collapse), and twenty-four symptomatic shoulders were designated as stage III or IV (a crescent line or collapse). RESULTS Partial or total repair with a decrease in the size of the osteonecrotic lesion or in the stage was never observed on MRI. At the time of the most recent follow-up (average, twenty years; range, fifteen to twenty-four years), collapse had occurred in eighty-nine shoulders (86%). The mean interval between the onset of pain and collapse was six years (range, six months to seventeen years; median, eight years). Of the 104 symptomatic shoulders, sixty-three (61%) with collapse worsened clinically until surgical treatment was needed. The principal risk factors for development of shoulder osteonecrosis in adults with sickle cell disease were the presence of hip osteonecrosis and the S/T or S/C genotype. The rate and risk of progression of the lesion until collapse occurred were significantly related to the S/S genotype, to a stage of II, to a large size of the osteonecrotic lesion, and to a medial or posterior location of the lesion. CONCLUSION Untreated symptomatic shoulder osteonecrosis related to sickle cell disease has a high likelihood of progressing to humeral head collapse, and the natural evolution in the long term requires surgical treatment for many of these patients.
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Affiliation(s)
- Alexandre Poignard
- University Paris-Est Creteil, Hôpital Henri Mondor, 94010 Creteil, France
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Hernigou P, Filippini P, Flouzat-Lachaniette CH, Batista SU, Poignard A. Constrained liner in neurologic or cognitively impaired patients undergoing primary THA. Clin Orthop Relat Res 2010; 468:3255-62. [PMID: 20376709 PMCID: PMC2974891 DOI: 10.1007/s11999-010-1340-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND THA performed in patients with cognitive deficits or neuromuscular diseases has been associated with a high postoperative dislocation rate. The constrained liner reportedly provides stability in patients with recurrent dislocation. However, achieving stability could be offset by early loosening when used in patients with neurologic diseases. QUESTIONS/PURPOSES We therefore asked whether constrained liners had a higher risk of loosening when used in primary THA for patients with neurologic diseases. METHODS We retrospectively reviewed a 144 patients (164 hips) with neuromuscular disease who had a constrained polyethylene insert from 1999 to 2004 and compared them to another 120 patients (132 hips) with neuromuscular disease operated on immediately before this period (from 1994 to 1998) who had a conventional polyethylene insert. RESULTS Thirty-three (25%) of the 132 hips without a constrained liner were known to have had at least one dislocation and 21 had revision for recurrent dislocation. Ten other hips had revision for loosening of the cup. The survival rate was 82% at 5 years and 77% at 10 years with revision due to recurrent dislocation or loosening of the cup as the endpoint. With a constrained liner, at minimum 5-year followup (mean, 7 years; range, 5-10 years), the incidence of complications, particularly dislocation, was decreased (three dislocations among 164 hips; 2%), with one revision for recurrent dislocation and one revision for loosening. CONCLUSIONS This constrained acetabular component provides durable protection against dislocation without substantial increased loosening at midterm followup.
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 94010, Creteil, France.
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Hernigou P, Flouzat-Lachaniette CH, Roussignol X, Poignard A. The natural progression of shoulder osteonecrosis related to corticosteroid treatment. Clin Orthop Relat Res 2010; 468:1809-16. [PMID: 19763721 PMCID: PMC2882009 DOI: 10.1007/s11999-009-1094-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [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: 05/06/2009] [Accepted: 08/31/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about the rate and factors of progression of shoulder osteonecrosis (ON) related to corticosteroids. PURPOSE We retrospectively evaluated 125 patients (215 shoulders) with humeral head ON diagnosed by MRI to determine the delay between corticosteroid treatment and the different stages and factors influencing the progression of the disease. METHODS Seventy-four of the shoulders had asymptomatic Stage I ON, 58 had asymptomatic Stage II ON, 46 had symptomatic Stage I ON, and 37 had symptomatic Stage II ON. The minimum followup was 10 years (average, 14 years; range, 10-20 years). The delay between the beginning of the corticosteroid treatment and the diagnosis of ON of the humeral head averaged 15 months (range, 6-24 months). RESULTS We observed partial or total regression on MRI only in patients with asymptomatic Stage I ON. At last followup, pain had developed in 98 (74%) and collapse had occurred in 71 (54%) of the 132 previously asymptomatic shoulders. Of the 83 symptomatic shoulders, 68 (82%) had collapsed at the final followup. The time between diagnosis and collapse averaged 10 years for patients with symptomatic Stage I ON and 3 years for patients with symptomatic Stage II ON. CONCLUSIONS Stage at initial visit, occurrence of pain, and continuation of peak doses of corticosteroids predicted progression of disease in asymptomatic shoulders, whereas in the symptomatic shoulders, extent and location of the lesion were the main risk factors for progression. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels.
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 94010 Creteil, France
| | | | - Xavier Roussignol
- Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 94010 Creteil, France
| | - Alexandre Poignard
- Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 94010 Creteil, France
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Abstract
Two black patients from Africa presented idiopathic tumoral calcinosis. This rare disease, defined by the presence of calcified deposits in peri-articular tissues remains poorly elucidated. Pathogenesis is still hypothetical. The diagnosis can be established with careful physical examination and appropriate complementary exams, allowing early complete surgical resection without biopsy. Pathology examination is required for formal differential diagnosis. The present tumors were particularly large, but did not produce signs of compression. In the first patient, the tumor developed after pregnancy in the zone of antibiotic injections. The second patient presented multiple bilateral symmetrical localizations with bone invasion. Histology confirmed the nature of the lesions and revealed bony metaplasie in the first patient, an element rarely described. Prognosis is excellent with early treatment. Recurrence is the rule in the event of incomplete resection. We discuss the appropriate diagnostic and therapeutic management.
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Affiliation(s)
- G Mathieu
- Service d'Orthopédie et de Traumatologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris Cedex 10.
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