Objectives

The appropriate treatment for chronically infected TKR is controversial. One-stage exchange is believed to be possible only in selected cases, but the respective indications and contra-indications and the criteria of selection are not fully validated. We wanted to test the relevance of the commonly used selection criteria by comparing two groups of patients: the control group operated on with a routine one-stage exchange without selection criteria, and the study group operated on by one stage exchange on selected patients only. We hypothesized that selected one-stage exchange gives fewer failures than routine one-stage exchange procedure.

Purpose of the study: Little work has been done to assess outcome of rotator cuff tear repair in young adults aged less than 40 years. The purpose of our study was to assess the clinical and anatomic outcomes in a continuous series of arthroscopic rotator cuff repairs performed in patients aged less than 40 years.

Material and method: This was a retrospective analysis (2004–2007) of 15 young patients (age 18–39 years, mean 32.7 years) with rotator cuff tears confirmed on the arthroscan. All tears were repaired arthroscopically using the same reinsertion technique with anchors. Patients underwent bilateral assessment (SSV, Constant) at at least 12 months follow-up. A control imaging with injection (arthroscan or arthroMRI) was available in 12 of 15 patients.

Results: The series included 7 female and 8 male patients, 13 right and 2 left shoulders; 14 of 15 shoulders were on the dominant side. The time from symptom onset to surgery was 26 months on average. Patients were reviewed at mean 31 months follow-up. Preoperative range of motion was preserved in all patients. The mean preoperative Constant score was 55.5 on the operated side and 91.4 on the other side. The preoperative arthroscan demonstrated partial deep tears of the supraspinatus or infraspinatus in 5 patients with a posterosuperior impingement. The ten other shoulders exhibited full thickness tears of the supraspinatus. At last follow-up, the mean Constant score was 77.2 (range 44–90) with significant improvement of all partial scores except force. Patients resumed their former occupational activities at mean 8 months (range 1–36); resumption of sports activities occurred during the 7th month. Subjective satisfaction rate was 81.7%. Postoperative imaging with injection showed a healed cuff in 83% of the shoulders reviewed (10/12).

Discussion: Rotator cuff tears are exceptional in young subjects aged less than 40 years; there is considerable potential for worsening. Outcome after rotator cuff repair is very age dependent. It is important to diagnose these tears early to enable early repair; the anatomic results are good and persistent in younger patients.

Purpose of the study: It has been demonstrated that navigation systems improve the quality of implantation of total knee arthroplasty (TKA). The definitions of the reference alignment for the femur are not however consensual. We wanted to define the different alignments of the femur on the lateral view, including the femoral head and comparing the alignments with those defined by the measured axes during navigated implantation.

Material and methods: We analysed 30 navigated TKA or unicompartmental prosthesis implantations. The following lines were drawn on the pre and postoperative lateral telemetric views: anatomic axis aligned on the anterior cortical of the femur, mechanical alignment n°1 (centre of the femoral head to the most distal point of the Blumensaat line), mechanical alignment n°2 (centre of the femoral head to the junction between the anterior two-thirds and the posterior third of the femoral condyles). The anatomic diaphyseal alignment was taken as the reference and the angles between this reference line and the other lines was measure. In addition, the sagittal orientation of the femoral component measured during the operation by the navigation system in relation to the n°2 mechanical alignment was noted; this orientation was also measured on the postoperative lateral telemetric views in relation to this same mechanical alignment.

Results: The mean difference between the anatomic cortical alignment and the reference was 0.3 (−1 to +). The mean difference between the n°1 mechanical alignment and the reference was −1.1 (−5 to +3). The mean difference between the mechanical alignment n°2 and the reference was 0.8 (−4 to 4). The mean intraoperative sagittal orientation of the femoral component was 0.0 (−2 to 2). The mean postoperative sagittal orientation of the femoral component was 1.1 (−4 to 6).

Discussion: The differences between the orientations of the different sagittal alignments of the femur were minimal. The cortical axis has a smaller variance and could be considered as the most reliable reference, but this alignment does not include the femoral anteversion. The difference between the sagittal orientation of the femoral component as measured by the navigation system and as measured on the postoperative x-rays was also minimal, and probably of no significance clinically.

Conclusion: The choice of the sagittal alignment of the femur is of little importance. The intraoperative navigated measurement of the sagittal orientation of the femoral component is reliable.

Introduction: The lumbosacral medulla is vascularized by the Adamkiewicz arteria which irrigates the anterior spinal arteria. Occlusion or section of the Adamkiewicz arteria may induce an ischemia of the medulla during anterior or transforaminal spine surgery. An angiography allows to determine the exact topography of this artery. The purpose of this study was to describe its preoperative topography and to analyze the impact of angiography on the surgical strategy.

Methods: In this retrospective study, 100 preoperative medullar angiographies, performed by a vascular radiologist between january 1998 and august 2007, were reviewed. Surgical indications were: 50 vertebrectomies in tumors, 20 anterior fusions in dorsolumbar fractures, 10 anterior fusions in malunions, 10 anterior releases in scoliosis, 3 transpedicular osteotomies, 7 disc hernias (T7-L4). The level and the side of foraminal entrance of the Adamkiewicz arteria and collateral arterias irrigating the anterior spinal arteria were analyzed. We looked for the occurence of postoperative ischemic signs of the medulla. Modifications of surgical planning because of Adamkiewicz’ arteria topography were noted. The possibilities of preoperative tumor embolisation were analyzed.

Results: The Adamkiewicz arteria was always localized between T8 and L3. It was present at the foraminal levels L1/L2 or L2/L3 in 48% of the cases. The left side was concerned in 65% of the cases. A modification of the surgical strategy was noted in 16% of the cases: 12 side changements of operative approach, 4 contra-indications for anterior surgery. An ischemic syndrome of the anterior lumbosacral medulla were not found. In the group of tumors, the preoperative angiography allowed to perform a selective embolisation of tumor vessels in 80% of the cases. In all other cases, the tumor vascularisation was common with the vascularisation of the medulla which could have made the embolisation dangerous.

Conclusion: Although the occurence of a lumbosacral medullar ischemia secondary to an Adamkiewicz arteria lesion is rarely reported in the literature, the preoperative angiography reduces this potential risk. The exact knowledge of the anterior medullar vascularisation allows to better plan the surgical strategy and to adapt the side of operative approach. Furthermore, the angiography enables to perform a selective embolisation of tumors safely.