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: It has been demonstrated that the anatomy of the distal femur differs by gender. The ratio of the mediolateral/anteroposterior distance, the shape of the distal femur, and the orientation of the trochlea differ between males and females. To adapt to these differences, prostheses specifically designed for female patients (TKAgender) were developed. The purpose of our study was to compare the first objective and subjective outcomes with these prostheses.

Material and methods: Thirty women who underwent bilateral surgery within a six month interval for degenerative joint disease of the knee between March 2006 and March 2008 were included in a comparative prospective study. The side receiving the gender implant was determined at random. Operative and postoperative protocols were the same excepting the femoral implant. Patients were not informed of which knee had received the gender prosthesis. Mean age in this series was 67 years and mean BMI 26. All implants were cemented. At minimum one year follow-up, objective and subjective analysis included specific questions concerning preference and quality of life presented by an independent observer.

Results: The Knee Society clinical scores were comparable in the two groups, as were the results for the different items of the KOOS score. For preferences: the patients preferred the gender knee in 75% of the cases (p< 0.01), they reported less noise or cracking sounds in the anterior part of the knee for 68% (p=0.03) and had the impression that the knee recovered faster in 64% (p=0.04).

Discussion: To our knowledge, this is the first report of results concerning implants specifically designed for female patients. At short-term, the only difference in the patients’ preference was a subjective feeling of less impairment for the patellar track. It will be interesting to follow these patients to assess the long-term impact on the patellofemoral articulation.

Most of computer-assisted computer assisted system rely on the peri-operative acquisition of the anterior pelvic plane defined as the plane crossing the two anterior iliac spine and the symphysis. The goal of this study was to evaluate in vivo and in vitro the accuracy of the anterior pelvic plane acquisition, considered as the reference for computer-assisted total hip arthroplasty (THA).

Cup placement was performed using an imageless computer-assisted system in thirty patients during THA. Post-operatively the position of the cup was evaluated on computed tomography using a validated tridimensional software. The differences between the perioperative and postoperative angles for abduction and anteversion were compared using a two-group pair test.

On two cadavers four clinicians performed ten times the anterior pelvic plane acquisition using three Methods: percutaneously, with ultrasound and by direct bony acquisition defined as the reference. The mean error for each anterior pelvic plane acquisition method was compared using a univariate variance model for repeated measurements.

In vivo, the mean difference between the perioperative and postoperative abduction angles was 4° and not statistically significant. For anteversion, the difference was 4° and not significant in patients with BMI < 27. The difference was 11° and significant in patients with BMI > 27 (p< 0.001). In vitro, the mean errors for rotation and tilt were respectively 3.8 ° and 19.25 ° for cutaneous acquisition, 2.8° and 6.2° for ultrasound acquisition method. The errors were statistically higher with the percutaneous method (p< 0.001).

According to our results, the accuracy of the standard percutaneous acquisition method of the anterior pelvic plane in computer-assisted THA is limited. The ultrasound acquisition method may represent a reliable alternative.

Improving the adaptation between the implant and the patient bone during total hip arthroplasty (THA) may improve the survival of the implant. This requires a perfect understanding of the tridimensional characteristics of the patient hip. The perfect evaluation of the tridimensional anatomy of the patient hip can be done pre-operatively using CT-scan and in case of important hip deformation, a custom implant can be used. When this solution is not available, modular necks may be a reliable alternative using standard x-rays and intraoperative adaptation. We aimed to evaluate:

The usefulness of modular neck to restore the anatomy of the hip and

We prospectively included 209 hips treated in our institution with a modular neck total hip arthroplasty between January 2006 and December 2007. All patients underwent a standard xrays evaluation in the same center according to the same protocol. Pre-operatively, the frontal analysis of the hip geometry was performed and the optimal center of rotation, CCD angle, neck length and lever arm was analyzed to choose the optimal modular neck shape among 9 available shape. These 9 frontal shapes are available in standard, anteverted or retroverted shapes, leading to 27 potential neck combinations. The mean patient age was 68 years and the mean BMI 26 Kg/m² All the procedures were performed supine using a Watson-Jones approach and the same anatomic stem. Intra-operatively the sagittal anatomy of the hip was analyzed and a standard, ante or retro modular necks were tested for the frontal shape defined pre-operatively.

According to the pre-operative frontal planning, nonstandard necks were required in 24 % of the cases to restore the anatomy of the hip. Intra-operatively, a sagittal correction using anteverted neck was required in 5% of the cases and retroverted necks in 18% of the cases.

Harris hip score improved from 56 to 95 points at last follow-up. No leg length discrepancy greater than 1 cm was observed. Restoration of the lever arm (mean 39.3 mm, range 30 to 49 mm) and of the neck length (55.2, range 43 to 68 mm) was adapted for 95% compared to the non operate opposite side. No loosening was observed.

According to our results modular neck combined are useful and reliable to restore optimal hip geometry and in this series 25% of the patient would have had imperfect extra-medullary hip geometry with a standard prosthesis. The good clinical and radiological short-term results should be confirmed at longer follow-up.

Purpose of the study: Besides enabling a precise calculation of the needs for blood (in ml) for each type of orthopaedic surgery, an adequate estimation of average total blood loss (TBL) as a function of total blood volume (TBV) enables initiation of blood sparing techniques. Thus, when the balance is negative, erythropoietin could be advisable. The purpose of this work was to analyse the impact of prescribing erythropoietin as a function of the expected blood balance on the rate of homologous blood transfusions. We also wanted to determine the financial impact of this prescription strategy.

Material and methods: This prospective study included 229 patients (153 THA and 76 TKA) who underwent surgery from January 2005 to December 2008 with a standard anaesthesia, analgesia and surgical protocol. TBL was considered to be 10% of TBV for THA and TKA. Mean gain in serum haemoglobin (Hb) per injection of erythropoietin (1 ampoule Eprex) was 0.8 g/dl. Using the patient’s Hb level at the preop exam (Hbpreop), the anaesthetist determined the volume available (VA) for each patient and for each type of operation. When VA was negative, the Hb needed to reach the desired level (HbA) so that VA=0 (zero risk of transfusion) was calculated. The number of Eprex ampoules prescribed (amp) was determined from the formula: (HbA-Hbpreop)/0.8. Hb levels on day 0, day 1, day 3(discharge) and day 28 were noted, as were the number of homologous transfusions and the total number of ampoules of Eprex delivered.

Results: Sixty-six patient received one amp (33.2%), 96 had two amp (42%), 40 three amp (17.5%) and 17 four amp (7.4%). For 220 patients (92%), Eprex delivered was within the approved dose (92%). The mean Hb levels were: Hbpreop=12.4, HbA=13.5, Hbd0=13.9, Hbdischarge=11.2, and Hbd28=11.9. Total consumption was 456 amp instead of 916 (229x4), i.e. a savings of 460 amp corresponding to 173 880 euros (460 x 378 euros). There were six homologous transfusions (2.6%).

Discussion: In orthopaedic surgery, adapted prescription of erythropoietin as a function of the TBL enabled, in this series, a simplification of the prescription procedure and avoided the risks related to high Hb levels > 15g with a financial savings of 760 euros per operation (173880 euros for 229 patients) without increasing the rate of homologous transfusion. This strategy is currently being evaluated for prosthesis revision surgery.

Unicompartmental knee arthroplasty (UKA) is a logic procedure when osteoarthritis or avascular necrosis is limitad to one femorotibial compartment. The indications for the procedure includes osteoarthrosis or osteonecrosis with full-thickness loss of articular cartilage limited to one of the tibiofemoral knee compartments. Physical examination should ensure full range of knee motion. Frontal and sagittal knee stability has to be tested. A particular attention should be given to the state of the anterior cruciate ligament. The status of the patellofemoral joint should be analysed by physical examination and patellofemoral view at 30, 60 and 90° of flexion. Preoperative anteroposterior varus and valgus stress radiographs should be done to confirm the complete loss of articular cartilage in the involved compartment, the full thickness cartilage in the opposite compartment and the possibility of full correction of the deformity to neutral.

The so-called minimally invasive surgery (MIS) procedure using a specific instrumentation is able to provide quicker recovery since the extensor mechanism disruption is eliminated. More importantly the radiological evaluation has shown that precise implantation of the components is possible with an MIS approach which is important for the long term results of the arthroplasty. The clinical results at ten years of follow-up of cemented metal-backed UKA performed through a conventional approach have shown results comparable to those obtained with total knee arthroplasty. The in vivo kinematic evaluation of patients implanted with UKA has shown that kinematics similar to the normal knee can be obtained, enhancing the importance of a functional anterior cruciate ligament.

Recent design improvements have increased the femorotibial area of contact to accommodate high flexion angles. Additionally our experience has demonstrated that modern UKA is a valid alternative for young and active patients with unicompartmental tibiofemoral noninflammatory disease, including both osteoarthritis and avascular necrosis. Compared to medial UKA lateral UKA represents in our experience only 5% of all UKA implantations.

However the long term results of lateral UKA compares at least equally with those reported for medial UKA.

Introduction: The International Knee Documentation Committee (IKDC) recommends use of the IKDC score to document subjective, objective and functional ACL outcome. To further improve knowledge concerning patient QOL after ACL reconstruction, an additional specific QOL questionnaire was developed. Using a combination of univariate and multivariate analysis the patient factors and surgical factors that influenced QOL 5- years after ACL reconstruction were determined.

Materials: 500 patients operated on for arthroscopic ACL reconstruction at our institution between 1997 and 2001 were prospectively enrolled. Patient psychosocial profile, sport expectations, knee exam, type of graft, associated lesion, type of anesthesia, complications, IKDC, KT 2000 at 6 moths, 1 year and 2 years were recorded. At five years, patients were asked to complete a 5-subscale validated QOL questionnaire for ACL deficiency. A multivariate analysis was performed to identify the factors influencing 5-year QOL.

Results: 203 patients completed the 5-years QOL questionnaire. Responders did not statistically differ from non responders. Patient subjective factors such as: patient expectations, pre-operative symptoms, work-school concerns, recreations concerns, social and psycho-social concerns were significantly (p< 0.05) and independently associated with the five-year QOL results. Objective factors such as meniscus tears and results of the KT 2000 (p< 0.05) were the two surgical factors correlated with 5-year QOL.

Discussion: In this large prospective study, most of the factors influencing the 5-year QOL results after ACL reconstruction were related to patient expectations, psycho-social, symptoms and work-sport concerns. The presence of a meniscus tear and greater KT 2000 laxity also contributed to poorer 5-year QOL results.

Introduction: The incidence of contralateral, second hip fractures after a first hip fracture is as high as 20% in the elderly. Femoroplasty using an injectable and resorbable bi-phosphonate loaded bone substitute to prevent controlateral hip fracture may represent a promising preventive therapy. We aimed to evaluate the biomechanical consequences of the femoroplasty using this bone substitute.

Materials and Methods: Twelve paired human cadaveric femora from donors with a mean age of 86 years (7 women and 6 men) were randomly assigned for femoroplasty and biomechanically tested for fracture load against their native contralateral control. Anterior–posterior and lateral radiographs and DXAscan’s were made before injection. Femoroplasty were performed under fluoroscopic guidance with an injectable and resorbable bi-phosphonate loaded bone substitute. All femurs were fractured by simulating a fall on the greater trochanter by an independent observer.

Results: Mean T-score of the tested femur were −3. Bone density was comparable for each pair of femur. All the observed fractures were Kyle II throchanteric fractures. Mean fracture load was 2786 Newton in the femoroplasty group (group F) versus 2116 Newton in the control group (group C) (p< 0.001). Fracture loads were always higher in the group F: mean 41.6% (mini: 1.2%/maxi:102.1%). Effect of femoroplasty was significantly superior for women and also correlated to initial bone density (p< 0.0001).

Discussion:According to our results, femoroplasty with an injectable and resorbable bi-phosphonate loaded bone substitute can provide significant biomechanical reinforcement of the proximal femur to prevent controlateral fracture.

Introduction: Women have gender specific shape of the distal femur. To fit these gender characteristics, gender specific femoral implants were developed for total knee arthroplasty (TKA). We aimed to compare

objective and subjective functional improvement;

Materials and Methods: 30 women (60 knees) operated on successively (6 months in between) for a bilateral TKA between March 2006 and March 2008 by the same surgeon were included in this prospective study. The same surgical protocol and the same post-operative management protocol were applied for both sides. Mean age was 67±3 and mean BMI 26±4 Kg/m². At a minimum follow-up of one year, evaluation objective and subjective functional improvement, patient satisfaction and preference and cost-utility analysis were performed double blind.

Results: Knee Society knee score and Knee Osteoarthritis Outcome Score (KOOS) improvements were comparable in both groups. However, 75% of the women preferred their gender TKA (p< 0.001). 68% of the women described less crepitus or anterior knee bothering after gender TKA (p=0.003) and 64% had faster recovery with the gender implant (p< 0.001). The cost-utility analysis was favorable for the gender knee.

Discussion: No objective or subjective superiority in terms of functional improvement was shown with gender specific implants at this short-term follow-up. However significant differences in terms of patient satisfaction and preference and a favorable cost-utility analysis were observed. These results should now be confirmed at longer-follow-up. Despite comparative functional improvement, patient satisfaction and preference were higher for the side implanted with a gender specific TKA in this prospective comparative study.

Introduction and Method: For 16 years, now, we have been using custom made femoral stems (titanium stem, HA coated) based on preoperative patient CT scans in young patients presenting with symptomatic osteoarthritis of the hip. The aim was to provide optimum initial fit-and-fill of the stem in the femoral medullary canal, conferring the best chance of secondary osteoin-tegration. This, with a goal of long term survivorship. The custom stem also enables dialling-in correction of the (often abnormal) femoral neck version (in young patients presenting with arthritis) to a more normalised 15 degrees of anteversion.

Results: We present the long term results (5–16 year, mean of 10 years), clinical, survivorship and radiological, of 312 primary total hip arthroplasties in 280 patients, all of whom were under the age of 50 years of age (mean age 40).

At 10 years we have a survivorship, if femoral aseptic loosening is used as an end point, of 97.6%. There was a deep infection rate of 1.2%, and a dislocation rate of 1.9%. There were no cases of thigh pain, and no intra-operative femoral neck/shaft fractures.

Discussion: The under 50’s with hip arthritis requiring total hip arthroplasty are a highly challenging group, they are young, active and tend to have distorted anatomy. Our results are superior to those previously published using either cemented or standard uncemented stems. Thus, justifying the increased initial financial outlay on the custom-made stem.

Introduction: morphological analysis of the general shape of the bones and of their particular variations according to the patient age, gender and pathology is an important step to improve the orthopedic management. We aimed to performed a gender specific analysis of the bi and tridimensional anatomy of the distal femur in vitro and in vivo.

Materials and Methods: in vitro data were obtained from CT-scan performed on 92 dry men femurs and 52 dry women femurs. Using a manual contouring method and a segmentation method, tridimensional reconstructions were obtained and according to two different algorithms, the regions of discrepancies between men and women were determined. An automatic calculation of 59 defined measurements was then performed. In vivo data providing from 59 CT-scans of men femur and 73 CT-scan of women femurs were acquired. Standardized bidimensional measurements at the level of the trochlear cut were performed.

Results: in vivo, statistically significant differences were observed for the: medio-lateral distance (M-Ld women=7.4±0.4cm vs M-Ld men=8.4±0.5cm; p< 0.0001), anteroposterior distance (A-Pd women=5.9±0,4cm vs A-Pd men= 6.4±0.4cm; p< 0.0001) and for the ratio anterior-posterior distance/medio-lateral distance (p< 0.0001). The trochlear groove angle was comparable in the two groups. In vitro, the tridimensional shape of the distal femur was more trapezoidal in women than in men. Medio-lateral distances were also statistically greater in men than in women (p< 0.01), the ratio anterior-posterior distance/medio-lateral distance was also statistically greater in men than in women (p< 0.01) and the Q angle more open in women than in men (p< 0.01).

Discussion: Three types of differences between men and women were observed in this gender specific evaluation of the distal femur anatomy. First, for a same anteroposterior distance, the medio-lateral distance was smaller in women. Second, the global shape of the distal femur was more trapezoidal in women and third the Q angle was more open in women. This gender specific anatomy should be clinically considered when performing total knee arthroplasty in women and gender specific implants may be required.

Introduction: Due to the diversity of the prosthetic implants for hip arthroplasty, a better matching between the implant and the intra and extra-medullary characteristic of the patient anatomy is now possible. This adaptation however requires a perfect understanding of the tridimensional characteristics of the patient hip anatomy. Little data are available in the literature. We aimed to analyze the muscular and bony anatomy of the hip at the time of arthroplasty.

Material and Methods: data acquisition was performed according a standardized CT-scan in the same center for all patients within the standard workup before arthroplasty. Standardized measurements were obtained after automatic tridimensional bone reconstructions using dedicated software. 549 femurs in 469 patients including primitive coxarthrosis (COX), dysplasic development of the hip (DDH) and aseptic osteonecrosis (ONA) were analyzed. Mean age was 58 and 70% of the patients were women. Tridimensional reconstruction of the muscular anatomy of the hip was performed for 30 patients using manual contouring on dedicated software. Characteristics of the bony and muscular anatomy were then analyzed according to the etiology and correlations between bony and muscular anatomy were evaluated.

Results: Concerning the bone analysis, mean offset was 23.2 ±1.5mm in the DDH group, 40.5±1.2 mm in the COX group and 29.6± 0.9mm in the ONA group(p< 0.001). Neck-shaft angle was 132±25º in the DDH group, 130±0.5º in the COX group and 134±1º in the ONA group (p< 0.001). Mean anteversion was 33±3.5º in the DDH group, 25±3.8º in the COX group and 16±3.2º in the ONA group (p< 0.001). Concerning the muscular analysis, gluteus medius and minimus volumes were correlated with the body mass index and with the gender, but not with patient age (p: NS). Location of the muscular insertion of the gluteus medius and minimus on the greater trochanter were correlated with the femoral anteversion.

Discussion: The results of our study demonstrated that bony and muscular anatomical characteristics were correlated with the etiology of the degenerative joint disease, with the patient body mass index and gender. Surgeons should be aware of these characteristics to improve the patient anatomy reconstruction during the arthroplasty.

Introduction: The data reporting clinical and radiological outcomes after modern unicompartmental knee arthroplasty (UKA) for spontaneous avascular osteonecrosis are limited. We hypothesized that UKA for spontaneous osteonecrosis may be as reliable and durable as it is for osteoarthritis.

Materials and Methods: We retrospectively reviewed 40 cemented UKA operated for spontaneous osteonecrosis of the knee in two different centers between 1989 and 2004. Twenty-six patients were women and 14 men, mean patient age was 67 years (range, 45 to 84) and mean body mass index was 27.4 Kg/m2 (range, 18 to 44). Clinical and radiological evaluations were performed by an independent observer in each center according to the same protocol at a minimum follow-up of 3 years (mean 8 years; range, 3–17.5 years).

Results: The mean Knee Society Knee score improved from 60 preoperatively to 95 post-operatively. The mean Knee Society Function score improved from 50 preoperatively to 89 post-operatively. Restoration of an appropriate lower-limb mechanical axis was achieved for 36 knees (90%). Two knees were revised for aseptic loosening. The Kaplan–Meier survivorship was 95% at 12 years.

Discusssion and conclusion: Our data suggest UKA is a reasonable solution for restoring clinical function and radiological lower-limb alignment for spontaneous osteonecrosis of the knee, with a durable survivorship.

A clinical and radiographic study was conducted on 97 total hip arthroplasties (79 patients) performed for congenital hip dislocation using three-dimensional custom cementless stem. The mean age was 48 years (17 to 72). The mean follow up was 123 months (83 to 182).

According to Crowe, there were 37 class 1, 28 class 2, 13 class 3 and 19 class 4. The average lengthening was 25 mm (5 to 58 mm), the mean femoral anteversion 38.6° (2° to 86°) and the correction in the prosthetic neck −23.6° (71° to 13°). The average Harris hip score improved from 58 to 93 points. Six hips (6.2%) required a revision. The survival rate was 97.7% ± 0.3% at 13 years.

Custom cementless stem allows anatomical reconstruction and good functional results in a young and active population with disturbed anatomy, while avoiding a femoral osteotomy.

The purpose of this study was to review the results of biceps tenodesis and biceps reinsertion in the treatment of type II SLAP lesions.

We conducted a retrospective cohort study of a continuous series of patients. Only isolated type II SLAP lesions were included: twenty-five cases from January 2000 to April 2004. Exclusion criteria included associated instability, rotator cuff rupture and previous shoulder surgery. Ten patients (ten men) with an average age of thirty-seven years (range, 19–57) had a reinsertion of the long head of the biceps tendon (LHB) to the labrum with two suture anchors. Fifteen patients (nine men and six women) with an average age of fifty-two years (range, 28–64) underwent biceps tenodesis in the bicipital groove. All patients were reviewed by an independent examiner.

In the reattachment group, the average follow-up was thirty-five months (range, 24–69); three patients underwent subsequent biceps tenodesis for persistent pain, three others were disappointed because of an inability to return to their previous level of sport, and the remaining four were very satisfied. The average Constant score improved from sixty-five to eighty-three points. In the tenodesis group, the average follow-up was thirty-four months (range, 24–68). No patient required revision surgery. Subjectively, one patient was disappointed (atypical residual pain), two were satisfied and twelve were very satisfied. All patients returned to their previous level of sports, and the average Constant score improved from fifty-nine to eighty-nine points.

The results of labral reattachment were disappointing in comparison to biceps tenodesis. Thus, arthroscopic biceps tenodesis can be considered as an effective alternative to reattachment in the treatment of isolated type II SLAP lesions. By moving the origin of the biceps to an extra-articular position, we eliminated the traction on the superior labrum and the source of pain; furthermore, range of motion and strength are unaltered allowing for a return to a pre-surgical level of activity.

We retrospectively reviewed 35 cemented unicompartmental knee replacements performed for medial unicompartmental osteoarthritis of the knee in 31 patients ≤50 years old (mean 46, 31 to 49). Patients were assessed clinically and radiologically using the Knee Society scores at a mean follow-up of 9.7 years (5 to 16) and survival at 12 years was calculated. The mean Knee Society Function Score improved from 54 points (25 to 64) pre-operatively to 89 (80 to 100) post-operatively (p < 0.0001). Six knees required revision, four for polyethylene wear treated with an isolated exchange of the tibial insert, one for aseptic loosening and one for progression of osteoarthritis.

The 12-year survival according to Kaplan-Meier was 80.6% with revision for any reason as the endpoint. Despite encouraging clinical results, polyethylene wear remains a major concern affecting the survival of unicompartmental knee replacement in patients younger than 50.

Purpose of the study: Malposition of the acetabular implant of a total hip arthroplasty can provoke dislocation, limited joint movement, and early wear. The purpose of this prospective randomized study was to assess the efficacy of a image-free navigation system to achieve correct acetabular position for total hip arthroplasty.

Material and methods: The navigation software for the acetabular component used intraoperative anatomic acquisition. The prospective randomized study included two groups of 20 patients. In the first group, the acetabular implant was inserted using the computer-assisted system and in the second using the conventional method. The same operator performed all procedures via an anterolateral approach and using the same non-cemented hemispheric cup. The postoperative assessment was performed by an independent investigator who noted the cup inclination on the standard ap view and cup anteversion on the computed tomography; then using a dedicated system for 3D reconstruction, the same values were determined one month after surgery.

Results: Each group included ten men and ten women, mean age 63 years and mean body mass index 24. For the computed-assisted group, mean additional operative time for navigation was 13 minutes (range 8–20 min). The intraopeartive concordance with the surgeons subjective impression was excellent for 12 patients and good for 8. Mean intraoperative values were for the computer-assisted group were: for operative mode: inclination 30° (25–46°), anteversion 14° (0–25°), radiographic mode: inclination 35° (25–47°), anteversion 13° (0–26°), anatomic mode: inclination 36°, anteversion 19° (0–27°). There was no significant difference between the intraoperative and postoperative values for the computer-assisted group. There was no significant difference between the average values between the computer-assisted and conventional groups but the standard deviation was smaller in the computer-assisted group.

Discussion and conclusion: The image-free navigation system enables reliable positioning of the prosthetic cup for total hip arthroplasty and increases the precision of acetabular implantation without increasing significantly operative time. This first step must be integrated into the computerized preoperative planning for total hip arthroplasty. The next step will be to use the navigation system for implanting the femoral component.

Purpose of the study: Arthroscopic reinsertion of SLAP lesions is the most commonly used approach. Tenodesis of the long biceps could be proposed as an alternative to reinsertion. The purpose of our study was to report the results of tenodesis and reinsertions for the treatment of type II SLAP lesions.

Material and methods: This was a consecutive monocentric comparative series analyzed retrospectively. Isolated type II SLAP lesions treated arthroscopically were retained for study: 25 cases treated from January 2000 to May 2004. Exclusion criteria were: associated instability, associated cuff tears, history of surgery. The long biceps tendon was reinserted on the glenoid tubercle using two threads mounted on resorbable anchors in ten patients (all men), mean age 27.5 years (range 19–57 years). Tenodesis of the long biceps in the gutter was performed in fifteen patients (six women and nine men), mean age 52.2 years (range 28–64 years). All patients were reviewed by an independent observer.

Results: In the reinsertion group, mean follow-up was 35 months (range 12–57 months). Three patients had revision tenodesis due to persistent pain and three others were disappointed because they were unable to resume their former sport. Four others were very satisfied. The mean Constant score improved from 65 to 83 points. Force was 16 kg in flexion and 5 kg in supination. In the tenodesis group, mean follow-up was 34 months (range 12–56 months). There were no revision procedures in this group. Subjectively, one patient was disappointed (atypical pain), two were satisfied and 12 very satisfied. The mean Constant score improved from 59 to 89 points. Force was 14.5 kg in flexion and 4.8 kg in supination.

Discussion: This series showed that results obtained with reinsertions can be disappointing: three revisions and three disappointed patients among ten procedures. In the tenodesis group, 14 of 15 patients were satisfied or very satisfied. Tenodesis of the long head of the biceps can be considered as an alternative to reinsertion for the treatment of type II SLAP lesions, particularly in older athletes.

Purpose of the study: Depending on the series, fractures of the anteroinferior glenoid labrum have been reported in 3% to 90% of patients with anterior shoulder instability. These fractures disrupt the physiological glenoid concavity and shorten the effective length of the glenoid arch. Indications for treatment depend on the size of the fragment and range from osteosynthesis to resection or suture. We hypothesized that these lesions could be treated arthroscopically (Bankart procedure with fragment suture). The purpose of this work was to analyze clinical and radiological outcome observed in nine patients with anterior instability associated with significant glenoid fracture.

Material and methods: This was a monocentric study of a continuous series of nine glenoid fractures associated with anteromedial dislocation in nine patients (three women and six men), mean age 35.5 years (range 17–75 years). Preoperatively, all of the fractures were considered to involve more than 25% of the glenoid surface. After detaching the capsulolabral lesion with the bony fragment and avivement of the anterior border, the Bankart procedure was performed with anchors and resorbable sutures. The shoulder was strapped for six weeks with passive rehabilitation (pendulum movements) initiated early.

Results: Mean follow-up was 27 months (range 12–48 months). There were no cases of recurrent instability. Seven patients were very satisfied and two were satisfied. Eight patients were able to resume their sports activities at the same level. Apprehension developed in all patients. At last follow-up, joint motion was normal for eight of the nine patients, the Duplay score was 100 for eight patients and 45 for one. All bony lesions healed in an anatomic position (six analyzed with plain x-rays and three with CT scan).

Discussion and conclusion: This short series demonstrates that glenoid fractures can be treated arthroscopically with concomitant treatment of the capsulolabroligament complex in order to reconstruct the glenoid arch, an essential element for restoring shoulder stability. It is thus necessary to identify bony lesions preoperatively to determine the most appropriate therapeutic approach. A long-term follow-up will be useful to assess the rate of recurrent instability and validate this therapeutic option.

We have evaluated in vitro the accuracy of percutaneous and ultrasound registration as measured in terms of errors in rotation and version relative to the bony anterior pelvic plane in computer-assisted total hip replacement, and analysed the intra- and inter-observer reliability of manual or ultrasound registration.

Four clinicians were asked to perform registration of the landmarks of the anterior pelvic plane on two cadavers. Registration was performed under four different conditions of acquisition. Errors in rotation were not significant. Version errors were significant with percutaneous methods (16.2°; p < 0.001 and 19.25° with surgical draping; p < 0.001), but not with the ultrasound acquisition (6.2°, p = 0.13). Intra-observer repeatability was achieved for all the methods. Inter-observer analysis showed acceptable agreement in the sagittal but not in the frontal plane.

Ultrasound acquisition of the anterior pelvic plane was more reliable in vitro than the cutaneous digitisation currently used.