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The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 485 - 492
1 Apr 2018
Gauci MO Bonnevialle N Moineau G Baba M Walch G Boileau P

Aims

Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components.

Materials and Methods

A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan–Meier survivorship analysis was performed with revision as the endpoint.


The Bone & Joint Journal
Vol. 99-B, Issue 12 | Pages 1561 - 1570
1 Dec 2017
Laumonerie P Reina N Kerezoudis P Declaux S Tibbo ME Bonnevialle N Mansat P

Aims

The primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation.

Materials and Methods

Four electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 69 - 69
1 Dec 2017
Girard M Arboucalot M Faraud A Delclaux S Bonnevialle N Delobel P Mansat P
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Aim

Infections after total elbow arthroplasty are more frequent than after other joint arthroplasties. Therapeutic management varies depending of the patient status, the time of diagnosis of the infection, the status of the implant as well as the remaining bone stock around the implants.

Method

Between 1997 and 2017, 180 total elbow arthroplasties were performed in our department. Eleven (6%) sustained a deep infection and were revised. Infection occurred after prosthesis of first intention in 4 and after a revision procedure in 7. Etiologies were: rheumatoid arthritis in 6, trauma sequela in 4 and osteosarcoma in 1. There were 7 women and 4 men of 59 years on average (22–87). Delay between the prosthesis and the diagnosis of infection was 66 months (0.5–300). The infection was stated as acute (<3week) in one, subacute (between 3 week and 3 months) in 1, and chronic (>3 months) in 9. Isolated bacteria were: Staphylococcus (10), Streptococcus (1), P. acnes (1), and Proteus mirabilis (1). Infection were poly microbial in 2 cases. A simple lavage with debridement was performed in 3 cases (Group 1), a 2-stage revision in 4 (Group 2), and a definitive removal of the prosthesis in 4 (Group 3). Adapted antibiotics were prescribed for all patients during at least 6 weeks.


The Bone & Joint Journal
Vol. 99-B, Issue 9 | Pages 1197 - 1203
1 Sep 2017
Laumonerie P Reina N Ancelin D Delclaux S Tibbo ME Bonnevialle N Mansat P

Aims

Radial head arthroplasty (RHA) may be used in the treatment of non-reconstructable radial head fractures. The aim of this study was to evaluate the mid-term clinical and radiographic results of RHA.

Patients and Methods

Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23 women with either acute injuries (54) or with traumatic sequelae (23) of a fracture of the radial head. Four designs of RHA were used, including the Guepar (Small Bone Innovations (SBi)/Stryker; 36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten) or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up was 74.0 months (standard deviation (sd) 38.6; 24 to 141). The indication for further surgery, range of movement, mean Mayo Elbow Performance (MEP) score, quick Disabilities of the Arm, Shoulder and Hand (quickDASH) score, osteolysis and positioning of the implant were also assessed according to the design, and acute or delayed use.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 525 - 525
1 Nov 2011
Delannis Y Mansat P Bonnevialle N Peter O Chemama B Bonnevialle P
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Purpose of the study: The articulated external fixator of the elbow joint is often useful for the treatment of trauma victims. It can neutralise dislocation forces and protect osteosynthesis assemblies and ligament repairs while authorising early mobilisation. This work reports our indications and application of this type of fixator, as well as the expected clinical and radiographic outcomes.

Material and methods: From 1995 to 2008, 34 patients had an external fixator of the elbow in our unit, in combination with classical treatment. Two groups of patients were distinguished, those with a traumatic injury requiring emergency care (n=15, group 1: six dislocations, two fracture-dislocations, and seven complex fractures), and those treated outside an emergency context (n=10, group 2: ten chronic dislocations or subluxations, four stiff joints, one infection, four material disassemblies). Eighteen patient were reviewed retrospectively, clinically and radiographically. The DASH score and the Mayo Elbow Performance Score (MEPS) were noted. The Broberg and Morrey classification was used for osteoarthritis.

Results: At mean 4.3 years follow-up, for groups 1 and 2, the DASH scores were 35 and 25 points and the MEPS scores 74 and 74 points respectively. In group 1, the range of motion was 63° for flexion-extension; the elbow was centred and stable in all cases except 2 (one posterior subluxation). Six elbows presented moderate to severe osteoarthritis. In group 2, the range of motion was 80° flexion-extension; the elbow was centred and stable in all cases except one (one posterior subluxation). Moderate to severe osteoarthritis was noted in five elbows. There were four complications: two cases of transient (ulnar and radial) paralysis, one fracture of the humerus on a pin track, and one superficial pin track infection.

Discussion: This study demonstrates that the articulated external fixation can maintain the reduction during the healing process for complex elbow trauma where stability is compromised. The morbidity is low and functional outcomes favourable. Early mobilization of these injured elbows can limit secondary stiffness. The prognosis remains a function of the initial injury and the quality of the associated treatments.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 497 - 498
1 Nov 2011
Chiron P Laffosse J Loïc-Paumier F Bonnevialle N
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Purpose of the study: Transadductor approaches to the hip joint have been described in the spastic child. Ludl-off as well as Ferguson pass behind the short adductor and the pectineus, a narrow route with a risk of injuring the obturator nerve. We describe a simple minimally invasive approach.

Material and method: The incision is made with the hip in the flexion, external rotation, abduction, from the pubic insertion of the long adductor following along the mass of the muscle for 6 to 8 cm. The aponeurosis of the long adductor is cut just deep enough to see the muscle fibres. Careful finger dissection of the muscle sheath common to the three anterior adductor muscles leads directly to the lesser trochanter. Two forceps are inserted on either side of the lesser trochanter, exposing the lesser trochanter and the tendon of the iliopsoas muscle. Dissection of the iliopsoas muscle held aside (follow the tendon on its lateral aspect leading to the vessels). An angled spreader is positioned between the anterior aspect of the capsule and the medial border of the tendon, displacing the tendon laterally and exposing the capsule. Extra-articular exposure of the capsule with a rugine to displace the posterior medial circumflex pedicle. Longitudinal incision of the capsule continued along the inter-trochanteric line to the peri-acetabular region. The medial as well as the anterior aspect of the neck can be visualized by rotating the hip. The inferior and anterior portion of the head is visible: the iliopubic branch and the entire superior and medial wall of the acetabulum can be exposed.

Results: We performed 29 medial approaches. Nine for periprostheic pain, four for fresh fracture of the femoral head during posterior dislocation, four for old fractures of the femoral head during posterior dislocation, three for chondromatosis, three for tumours of the femoral head or the acetabulum, six for retractile periarthritis without arthroplasty. Hip arthroplasty (7) or not (6), median pain could be induced by the presence of retractile periarthritis with presence of synovial adherences to the femoral neck penetrating into the joint space; release relieved pain in 11/13.

Conclusion: The medial approach to the hip joint is a useful orthopaedic technique with a rapid learning curve.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 534 - 534
1 Nov 2011
Chemama B Bonnet E Archambaud M Cauhépé C Brouchet A Bonnevialle N Mansat P Bonnevialle P
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Purpose of the study: Propionibacterium acnes (PBA) is an anaerobic Gram-positive commensal bacillus of human skin which can cause bone and joint infections (Lutz 2005, Zeller 200, Levy 2008). The purpose of this work was to evaluate over a given period the frequency of PBA infections and the reality of its role as a pathogenic organism.

Material and methods: A retrospective survey of activity from 2006 to 2008 using bacteriology laboratory data identified 34 patients (22 male and 12 female) with at least one sample collected during an orthopaedic or traumatology surgical procedure that was positive for PBA. The mean number of positive samples was 3.6; 17 from the thoracic limb, 17 from the pelvic limb, involving 16 arthroplasties (4 hips, 6 knees, 5 shoulders, 1 elbow), 13 osteosynthesis procedures, 3 cuff repairs and 1 acromioclavicular procedure. Six of 20 histology samples showed a septic granuloma.

Results: The PBA was the only germ isolated in 18 cases; it was associated with other bacteria in 16 cases. Other blood tests were abnormal (WBC 6800 leukocytes, CRP 25mg/L en average). According to the Lutz classification, three groups of infection could be identified: certain infection with clinical signs and at least two positive samples (n=12), possible with clinical signs but only one positive sample (n=5), and probable without clinical signs and one or more positive samples (n=17). Of the 12 patients in the first group, eight had material (three shoulder prostheses, three hips, one knee and one femoral nail), which had to be removed for six with use of a cemented spacer in four. Mean duration of antibiotics was five weeks. Four patients in this group have not yet achieved cure. In the second group, all samples were taken from a thoracic limb and had another germ in four cases; all patients have achieved cure. In the third group, the samples were systematic (two shoulder arthroplasties, two repeated cuff repairs, five revision prostheses, four nonunions and four material removal); only one sample was positive in ten cases and only five patients were given antibiotics; all achieve cure.

Discussion: This series is in agreement with the literature: frequent localization on a thoracic limb, association with another germ, questionable attribution to PBA. Patients meeting the criteria of the first group should be treated. If a PBA infection is suspected, samples should be repeated, with prolonged culture; this attitude should be validated prospectively.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 1 | Pages 103 - 109
1 Jan 2010
Laffosse J Espié A Bonnevialle N Mansat P Tricoire J Bonnevialle P Chiron P Puget J

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months’ follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure.

At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively).

We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 272 - 272
1 Jul 2008
CHEMAMA B BONNEVIALLE N MANSAT P BONNEVIALLE P GASTON A MANSAT M
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Purpose of the study: Locked centromedullary nailing (LCMN) has become the gold standard treatment for fractures of the femur (I. Kempf, Chirurgie 91 ; 117 : 478 / Borel R.C.O. 93 ; 79,553 / Wolinsky J. trauma 99, 46 : 382). Nevertheless, the SOFCOT 2004 round table emphasized the frequency of complications related to inappropriate material and techniques. The series studied had several biases: multicentric recruitment, materials with different designs, high percentage of patients lost to follow-up. In order to overcome these shortcomings we reviewed retrospectively a consecutive series of LCMN performed in a single center from 2001 to 2002, attempting to be as exhaustive as possible.

Material and methods: The study group included 78 patients (81 LCMN) aged 30 years on average (range 16–87 years) with male predominance (69%). A large proportion of patients were traffic accident victims (44% two-wheel vehicles, 42% four-wheel vehicles). The fracture was open in 8% and 65% of patients had multiple fractures (11% floating knees, 23% multiple trauma). The fractures were simple (43%), wedge (47%) and comminutive (10%). Time to operation was 7.4 hr on average for 83% of patients. Mean reaming was 12 mm (range 11–14 mm). An 11-mm (range 10–13 mm) static Grosse and Kempf (Stryker) nail was used in all patients. Intraoperative complications occurred in 8% of cases with no effect on bone healing.

Results: Three patients died from severe head trauma. Five patients were lost to follow-up. Written follow-up data were available for six patients and 64 patients were reviewed clinically. Among the 70 fractures with known outcome, four had not healed (with two screw failures and one nail failure). Knee motion was normal in all patients. Anteroposterior and lateral alignment was normal (±5°) in 94% with no leg length discrepancy (< 10 mm)in 87%. The nail was withdrawn in 84% of patients and the withdrawal procedure was complicated in three cases (hematoma, screw failure). Mean hospital stay for single-fracture patients was 9.7 days for nailing and 2.2 days for nail removal.

Discussion: LCMN is a reliable technique which provides constant clinical results when applied with rigorous technique. The logistics is resource intensive. Nonunion can be revised with the same method. A new nailing with second reaming should be performed early in the event of late healing.