Purpose of the study: ACDF is the cervical surgical technique the most widely used for the treatment of severe discopathy in rugby players. Different techniques have been applied, with no real consensus for the technical procedures or the postoperative rehabilitation. The goal is to normalise the surgical treatment and rehabilitation for elite rugby players who have had a cervical fusion for discopathy with the objective of resuming rugby three months postoperatively.

Material and methods: This was a retrospective study including 85 high-level rugby players (professional and semi-professional players) operated on by three surgeons from 2003 to 2008 for one or two levels presenting discal herniation (levels C3 to T1) with cervicobrachial nevralgia unresponsive to conservative treatment. Postoperative function was assessed with the cervical handicap index, a visual analogue scale for pain, consumption of analgesics, and possibility to resume rugby at three months. Flexion-extension radiographs of the cervical spine were obtained. All patients underwent ACDF using a Peek cage filled with autologous iliac bone fixed with a plate or a compressive staple. The patient completed a self-administered satisfaction questionnaire during follow-up. The radiographs and the clinical exam were done by an independent observer (GG).

Results: Mean follow-up was 26 months (4–55). Mean operative time was 50 minutes (30–70). Mean hospital stay 2.3 days (1–3). There was no difference between plate and staple fixation. There were no major postoperative complications. Fusion was radiographically achieved in all cases. All patients played competition rugby three months after surgery. At last follow-up, seven players had interrupted rugby playing for personal reasons or for other intercurrent medical conditions. Seventy-eight percent stated their clinical situation had improved and that they were satisfied.

Conclusion: The results of this series confirm the pertinence of this method to achieve effective fusion authorising resumption of rugby playing three months postoperatively. Use of a Peek cage filled with autologous bone and stabilised with fixation appears to be necessary to allow rapid functional rehabilitation exercises using a programme of three phases of one month. The normalisation of the treatment for sever cervical discopathies in the high-level rugby player appears to be possible and safe, compared with data in the literature.

Purpose: A pre- and postoperative radiographic analysis of 50 total knee arthroplasties (TKA) was performed to determine the femorotibial correction angle and the tibial and femoral mechanical angles obtained as a function of the initial bony deformity. The preoperative angle beyond which correction was not achieved was determined.

Material and methods: This prospective single-centre study included 50 TKA (25 men and 25 women), mean age 69.1 years (range 53–83). Degenerative disease involved the right knee in 21 cases and the left knee in 29. A Wallaby I TKA (semi-restrained with preservation of the posterior cruciate ligament) was implanted in all cases. Three angles were calculated on the AP loaded knee: AFT (femorotibial angle), AFM (femoral mechanical angle), ATM (tibial mechanical angle). For each angle, statistic analysis was performed on four groups of patients: group I: overall population, group II: patients with normal axis (178°< AFT< 182°; 88°< AFM< 92°; 88)< ATM< 92°), group III: patients with varus (AFT> 182°; AFM> 92°; ATM> 92°), and group IV: patients with valus (AFT< 178°; AFM< 88°; ATM< 88°). Non-parametric tests (Spearman rank test and MacNemar symmetry test) were performed on SAS software for statistical analysis with p< 0.05 considered as significant.

Results: Pre- and postoperative AFT showed: significant improvement of the mean (> 3.44° in group I, > 6.87° in group III, and > 6.12° in group IV). There was no significant difference in group II. Pre- and postoperative AFM showed: constant but non-significant improvement in groups I and III (> 3°) and constant and significant improvement in groups III and IV (> 2.5°). Pre- and postoperative ATM showed: significant improvement in groups I and III (> 3°), constant but non-significant improvement in group IV (n=4). There was no group II. An ATM > 94° was the threshold angle beyond which correction was not obtained.

Discussion: Taken together, the results of this study confirm the reliability of the Wallaby I instrumentation for achieving a correct postoperative mechanical axis. These results are comparable with data in the literature (with or without preservation of the posterior cruciate ligament). However, the correction of the bony deformity obtained depended uniquely on the initial deformity of the tibia. Extreme deformity of the tibia should be corrected with osteotomy or with a more restrained prosthesis.

Purpose: Talonavicular arthritis, associated or not with rear foot deformity, is common in patients with rheumatoid arthritis. The work by Steinhauser and Gérard demonstrated the usefulness of talonavicular arthrodesis for the treatment of this rear foot disorder. The purpose of this study was to assess outcome after this surgical technique in patients with rheumatoid polyarthritis.

Material and methods: Between 1988 and 1998, 26 feet (24 men, 2 women, 17 right, 7 left) were operated by the same surgeon. Mean age of the patients at surgery was 51 years. Mean delay from disease onset to talonavicular arthrodesis was 13 years. Postoperative immobilisation lasted 45 days. Mean follow-up was five years (1–10).

Results: Patients were very satisfied or satisfied in 92.3% of the cases. Mean pre- and postoperative pain score was 8.14 and 1.77 respectively (p = 0.0001). Normal shoes could be worn by 37.5 and 66.7% of the patients pre- and postoperatively. Patient independence was significantly improved (p = 0.0001). The postoperative analysis of the plantar prints demonstrated pes planus and pes cavus. In 29.2 and 12.5%, the mean postoperative tibiocalcaneal angle was 0.78° with pes varus in eight cases (2°–10°). The mean Djean angle was 122.3° and 122.8° pre- and postoperatively (p = 0.24). Three talocrural joints (11.5%) that were intact preoperatively had degraded at last follow-up. The statistical analysis showed that clinical outcome was not affected by the postoperative aspect of the foot. There were three cases of tight non-union (11.5%) two of which were asymptomatic and two cases of infection (7.5%) requiring revision surgery. These complications led to two poor outcomes.

Discussion: The rate of non-union varies in published series from 3 to 37%. The rate observed in our series has led us to delay weight bearing. The residual varus found in eight feet, related to a shortened medial column, may warrant intertalonavicular grafting.

Conclusion: Talonavicular arthrodesis is a useful procedure despite a significant risk of complications.