Purpose of the study: The pathophysiology of reflex dystrophy or type I complex regional pain syndrome remains poorly understood, but the cost is considerable in terms of public health expenditures both for programmed and emergency orthopedic surgery. We present a historical cohort assessed to evaluate the usefulness of vitamin C for the prevention of reflex dystrophy in programmed foot and ankle surgery.

Material and methods: The study included two groups of patients treated in two successive periods: July 2002 to June 2003 and July 2003 to June 2004. All patients underwent foot and ankle surgery performed by the same senior surgeon. Diabetic feet were excluded. The first group (185 feet, 177 patients) was not given any particular preventive treatment. The second group (235 feet, 215 patients) was given one gram vitamin C for 45 days. The diagnosis of reflex dystrophy was retained on the basis of clinical and radiological arguments noted at follow-up visits with the operator. Several factors were studied: gender, age, type of disease condition, history of reflex dystrophy, psychological context, duration of tourniquet, cast immobilization.

Results: Reflex dystrophy occurred in 18 feet in group

1 (9.6%) and in 4 (1.7%) in group 2. The difference was significant. Presence of a history of dystrophy was significantly associated with development of dystrophy (RR=10.4). A psychological context appeared to increase the risk of dystrophy (RR 2.6) but did not reach significance. There was no statistical relationship with age, gender, duration of tourniquet, type of disease condition, or surgical procedure performed.

Discussion: Vitamin C has been found to be effective in the prevention of reflex dystrophy after wrist fractures. Data in the literature is scarce on dystrophy of the foot and ankle. Our study provided objective evidence of the usefulness of vitamin C for the prevention of reflex dystrophy in foot and ankle surgery patients, a complication frequently observed in our control group (9.6%). The psychological context and history of dystrophy increase the risk of dystrophy.

Conclusion: Vitamin C is associated with a lower risk of reflex dystrophy in the postoperative period after foot and ankle surgery. We advocate preventive treatment with vitamin C.

Purpose of the study: The aim of this retrospective study was to analyze the results obtained with the femoropa-tellar self-centering prosthesis and to confirm its usefulness and limitations for the treatment of femoropatellar osteoarthritis.

Material and methods: This continuous series of 57 patients, mean age 65.6 years underwent surgery fro 1986 to 2003 for implantation of a self-centering prosthesis. Most (60%) presented osteoarthritis on a dysplasic knee; others presented primary osteoarthritis (31%) or trauma sequelae (9%). Mean follow-up was 74.5 months (range 12–180 months). Functional outcome was assessed with the IKS and activity daily living (ADL) scales. The radiographic study enabled 3D analysis of the implant position.

Results: At last follow-up, the mean IKS score was 157.3/200. The mean ADL score was 73.8 (range 48.8–96.3). The IKS score gave 66.7% good and the ADL score, which takes into consideration all daily life functions, 57% very good outcome. Outcome was best in patients with trochlear dysplasia. The eleven knees requiring revision for a total knee arthroplasty (24%) had initially a narrower trochlear angle (p=0.02) and a thicker patella (p=0.02). In these patients, the initial prosthesis protruded more anteriorly (p=0.004) and the horizontal axis was greater (p=0.02).

Discussion: The results of this series are less satisfactory than in the literature, but assessments may depend on the scores used since there was a 10% difference between the ADL and IKS scores. The results were better in the group of patients undergoing surgery for osteoarthritis due to dysplasia, in agreement with De Cloedt and Argenson. Analysis of the radiological parameters enabled identification of technical errors leading to failure. A successful femoropatellar prosthesis depends basically on two factors: technical precision and patient selection.

Conclusion: These results led us to avoid widening indications for femoropatellar prostheses, which are already in our experience rather limited (2%). For us, patients aged 50–70 years with advanced-stage femo-ropatellar osteoarthritis due to dysplasia and no other anomaly and who have not responded to conservative treatment would be the population of choice. The lack of any technical problem for revision total knee arthroplasty is an argument in favor of the femoropatellar prosthesis.