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The Bone & Joint Journal
Vol. 96-B, Issue 6 | Pages 724 - 729
1 Jun 2014
Murgier J Reina N Cavaignac E Espié A Bayle-Iniguez X Chiron P

Slipped upper femoral epiphysis (SUFE) is one of the known causes of cam-type femoroacetabular impingement (FAI). The aim of this study was to determine the proportion of FAI cases considered to be secondary to SUFE-like deformities.

We performed a case–control study on 96 hips (75 patients: mean age 38 years (15.4 to 63.5)) that had been surgically treated for FAI between July 2005 and May 2011. Three independent observers measured the lateral view head–neck index (LVHNI) to detect any SUFE-like deformity on lateral hip radiographs taken in 45° flexion, 45° abduction and 30° external rotation. A control group of 108 healthy hips in 54 patients was included for comparison (mean age 36.5 years (24.3 to 53.9).

The impingement group had a mean LVHNI of 7.6% (16.7% to -2%) versus 3.2% in the control group (10.8% to -3%) (p < 0.001). A total of 42 hips (43.7%) had an index value > 9% in the impingement group versus only six hips (5.5%) in the control group (p < 0.001). The impingement group had a mean α angle of 73.9° (96.2° to 53.4°) versus 48.2° (65° to 37°) in the control group (p < 0.001).

Our results suggest that SUFE is one of the primary aetiological factors for cam-type FAI.

Cite this article: Bone Joint J 2014; 96-B:724–9.


The Bone & Joint Journal
Vol. 95-B, Issue 8 | Pages 1064 - 1068
1 Aug 2013
Cavaignac E Lafontan V Reina N Pailhé R Warmy M Laffosse JM Chiron P

The significance of weight in the indications for unicompartmental knee replacement (UKR) is unclear. Our hypothesis was that weight does not affect the long-term rate of survival of UKRs.

We undertook a retrospective study of 212 UKRs at a mean follow-up of 12 years (7 to 22). The patients were distributed according to body mass index (BMI; < vs ≥ 30 kg/m2) and weight (< vs ≥ 82 kg). Kaplan-Meier survivorship analysis was performed and ten-year survival rates were compared between the sub-groups. Multimodal regression analysis determined the impact of the various theoretical contraindications on the long-term rate of survival of UKR.

The ten-year rates of survival were similar in the two weight subgroups (≥ 82 kg: 93.5% (95% confidence interval (CI) 66.5 to 96.3); < 82 kg: 92.5% (95% CI 82.5 to 94.1)) and also in the two BMI subgroups (≥ 30 kg/m2: 92% (95% CI 82.5 to 95.3); < 30 kg/m2: 94% (95% CI 78.4 to 95.9)). Multimodal regression analysis revealed that weight plays a part in reducing the risk of revision with a relative risk of 0.387, although this did not reach statistical significance (p = 0.662). The results relating weight and BMI to the clinical outcome were not statistically significant. Thus, this study confirms that weight does not influence the long-term rate of survival of UKR.

Cite this article: Bone Joint J 2013;95-B:1064–8.


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.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 2 | Pages 275 - 277
1 Mar 2003
Nehme A Bone S Gomez-Brouchet A Tricoire J Chiron P Puget J

We describe a 46-year-old woman who presented at intervals of seven years with osteonecrosis of the outer end of both clavicles. The clinical, radiological features and the appearances of the bone scans are described. Although the condition may be confused with osteolysis there is a clear histological distinction between the two conditions. If the symptoms fail to respond to conservative treatment, excision of the outer end of the clavicle is recommended.