Purpose of the study: Three-screw fixation is the classical treatment for true Garden I in the elderly patient. Complication rates have been high in the literature. Furthermore, in this context outcome for arthroplasty after failed osteosynthesis is less satisfactory than first-intention arthroplasty. This is why functional treatment of Garden I fractures of the neck of the femur has been proposed, including rapid return to the upright position and strict radiographic and clinical control. The purpose of this work was to first evaluate the results of this management option for true Garden I fractures in patients aged over 65 years and second to search for factors predictive of secondary displacement.

Material and methods: All patients aged over 65 years and admitted to the unit for true Garden I fractures from January 2005 to December 2006 were included in this prospective study. A functional treatment including early return to the upright position and walking test on day 1 was instituted, followed by radiographic controls on days 2, 7, 14, 21, and 45 then at 3 months and one year. Referral to a rehabilitation centre at discharge on day 5 was scheduled if there was no displacement. In the event of a displacement, arthroplasty was performed. Fifty-seven patients, mean age 82.8±8.5 years (range 65–99) were included. The radiographic and clinical follow-ups were made by an independent observer.

Results: The displacement rate was 29.8%. These patients were treated by arthroplasty. In the group of patients without displacement, at minimum one year follow-up, there has been no need for surgical revision excepting one case of osteonecrosis at one year requiring implantation of a total prosthesis. The mean Parker score in this group was 6.4 and the mean Harris score 83, it was 85 in the arthroplasty group. Among the predictive factors identified at multivariate analysis were: age, gender, side, type of fracture, fracture orientation, degree of valgus or sagittal displacement, general status. Displacement was not statistically predictive.

Discussion: The results of our prospective study show that 70% of patients included were treated successfully without surgery, confirming reports in the literature and justifying utilisation of this management strategy.

Purpose of the study: Because of the growing number of aseptic loosening of total hip arthroplasty (THA), a reliable biological marker would be useful to diagnosis osteolysis early and non-invasively while avoiding the risk of false positives. The purpose of this study was to analyse the value of the interleukin-10(IL10)-alphaTNF ratio in serum and synovial fluid as a marker of THA aseptic loosening.

Material and methods: Blood synovial fluid samples were collected in 27 volunteers with a cemented THA (group THA) and 30 healthy subjects comparable for age and gender who were programmed for total hip arthroplasty because of primary osteoarthritis (group OA). We analysed: locally by the level of alphaTNF and IL10 in the supernate of differentiated THP-1 with and without adjunction of synovial fluid (SF); in the bloodstream the production of alphaTNA and IL10 by monocytes; the correlation between serum and SF levels and the presence or not of loosening.

Results: In the THA group, SF induced a relative decrease in IL10 strangly not associated with an increase in alphaTNF. However, the IL10/alphaTNF ratio was significantly lower in the OA group. Circulating monocytes produced more alphaTNF in the THA group while there was no significant difference in the production of IL10 by the two groups. However, the IL10/alphaTNF ratio was significantly higher (2-fold) in the THA group. Regarding serum cytokine levels, there was a local accumulation of alphaTNF in the THA group and IL10 in the OA group.

Discussion: The IL10/alphaTNF ratio alone was significantly correlated with aseptic loosening, locally and in the general bloodstream. IL10 or alphaTNF did not alone correlate in all conditions. These results show that use of this ratio appears to be more effective than assay of a single proinflammatory cytokine for the early diagnosis of aseptic loosening. The validity of this ratio is supported by its local and general correlation. A comparative prospective study in healthy subjects using a non-invasive method (except for the blood samples) should be conducted to confirm the clinical pertinence of this marker.