Modern onco-orthopedic surgery was born in the 1970s, with the advent of polychemotherapy that opened the door to conservative limb surgery. French medical teams have very quickly grasped the notion of multidisciplinarity, which will ensure the soundness and guarantee the efficiency of patient care. The creation of the Groupe d'Etude des Tumeurs Osseuses, a company "daughter" of Sofcot in 1973, is evidence of this. Therefore, beyond care, the French teams and work are recognized in anatomo-pathological dismemberment and molecular signatures of bone tumors, in the anatomo-pathological identification of prognostic factors, and in the national network organization of actors from all specialties involved. On the surgical side, French teams very early developed innovative implants dedicated to joint reconstruction after wide resection, or for growing children, offering a solid biomechanical and surgical culture to current onco-orthopedists. Modern challenges in reconstruction offer today's surgeons a terrain of excellence for using modern 3D modeling techniques. Multidisciplinarity, scientific rigor and innovation are three pillars of the heritage passed on to the youngest for the promotion of French orthopaedics and the best patient care. LEVEL OF EVIDENCE: V; expert opinion.

Aims Cementless femoral fixation is widely used in total hip arthroplasty (THA), with increasing interest in shorter femoral component designs. These femoral components aim to preserve proximal bone, promote physiological load transfer, and facilitate minimally invasive approaches. Among these, ‘shortened’ femoral components, derived from conventional stems and retaining a diaphyseal extension, may offer advantages in terms of implant positioning. However, clinical evidence regarding their mechanical reliability remains limited. This study aimed to compare the two-year radiological stability of a shortened uncemented quadrangular femoral component with that of its conventional-length counterpart in patients undergoing THA for osteoarthritis. Methods We conducted a prospective, single-blind, randomized, noninferiority trial between January 2018 and December 2021. Patients undergoing primary THA were randomly assigned to receive either the conventional-length quadrangular femoral component or its shortened version. The primary outcome was femoral component migration at two years, assessed with Ein Bild Roentgen analyze - femoral component analysis (EBRA-FCA). Secondary outcomes included intraoperative and postoperative complication rates, as well as the 12-item Oxford Hip Score (OHS) at 12 months. Results A total of 143 hips were randomized, with 139 (70 conventional-length, 69 shortened) included in the clinical analysis. Per-protocol radiological analysis was carried out on 98 hips (49 hips per group). At two years, mean femoral component migration was 0.94 mm (SD 0.49) in the shortened-femoral component group and 0.86 mm (SD 0.52) in the conventional-length group. The upper bound of the 90% CI (–0.09 to 0.25) was below the prespecified noninferiority margin of 1 mm. No significant differences were observed in complication rates or functional outcomes (p > 0.05). Conclusion At two years, radiological outcomes of the shortened quadrangular femoral component were consistent with noninferiority compared with the conventional-length version. Although the planned sample size was not fully reached, the findings remained within the prespecified noninferiority margin. Cite this article: Bone Jt Open 2026;7(4):465–472.

La chirurgie onco-orthopédique moderne a pris naissance pendant les années 1970, avec l’avènement de la poly-chimiothérapie qui a ouvert la porte à la chirurgie conservatrice des membres. Les équipes médicales françaises ont très vite appréhendé la notion de multidisciplinarité, qui fera la solidité et garantira l’efficience des prises en charge des patients. La création du Groupe d’étude des tumeurs osseuses, société « fille » de la Sofcot dès 1973 en est le témoin. Dès lors, au-delà du soin, les équipes et les travaux français sont reconnus dans le démembrement anatomopathologique et les signatures moléculaires des tumeurs osseuses, dans l’identification anatomopathologique des facteurs pronostiques, et dans l’organisation en réseau national des acteurs de toutes les spécialités impliquées. Sur le plan chirurgical, les équipes françaises ont très tôt développé des implants innovants, dédiés à la reconstruction articulaire après résection large, ou pour les enfants en croissance, offrant une culture biomécanique et chirurgicale solide aux onco-orthopédistes actuels. Les défis modernes en matière de reconstruction offrent aux chirurgiens actuels un terrain d’excellence pour l’utilisation des techniques modernes de modélisation 3D. Multidisciplinarité, rigueur scientifique et innovation sont 3 piliers de l’héritage transmis aux plus jeunes, pour le rayonnement de l’orthopédie française et les meilleurs soins aux patients. Niveau de preuve IV.

Background: Sarcoma resection involving major vascular structures of the extremities presents a complex surgical challenge. Limb preservation often requires immediate vascular reconstruction and soft tissue coverage to minimize complications, maintain functionality, and avoid secondary amputation. However, limited data exist on the outcomes of such combined procedures. The aim of this monocentric retrospective series study was to evaluate the early and midterm surgical and oncologic outcomes of immediate vascular and soft tissue reconstruction following sarcoma resection involving major limb vessels. Patients and methods: This retrospective study included consecutive patients undergoing en bloc resection of extremity soft tissue or bone sarcomas involving major vessels, followed by immediate vascular bypass and soft tissue flap reconstruction, at a single tertiary center between December 2019 and December 2024. Arterial and venous reconstructions used autografts or allografts; soft tissue coverage was achieved using free or pedicled flaps. Primary outcomes were limb salvage, flap survival, and bypass patency. Secondary outcomes included complications (Dindo–Clavien classification), wound healing time, and oncologic outcomes. Results: Seventeen patients (mean age, 50 years) underwent immediate vascular reconstruction (14 allografts, three autografts) and flap coverage (16 free flaps, one pedicled flap). R0 resection was achieved in 94%, with a 100% limb salvage rate, flap survival and vascular bypass patency. No local recurrences or secondary amputations occurred. At a mean follow-up of 26 months (range, 1–60 months), 35% developed distant metastases, and one patient (6%) died of disease progression. The overall complication rate was 100%, including 41% grade 3b and 30% grade 4a complications. Although 71% required reoperation for major complications, all limbs were ultimately preserved. Common complications included lymphedema (88%), lymphocele (76%), venous bypass thrombosis (65%), lymphorrhea (65%), operative site infection (65%), wound dehiscence (47%), arterial bypass stenosis (35%), and false-aneurysm rupture (30%). All wounds healed, with a mean healing time of 72 days. Univariate analysis identified operative site infection ( P = 0.005) and higher Dindo–Clavien grade ( P = 0.028) as factors significantly associated with venous bypass thrombosis. Conclusion: Combined immediate vascular and soft tissue reconstruction following sarcoma resection involving major vessels is a feasible and effective limb-salvage approach. Despite a high rate of early complications, satisfactory oncologic and functional outcomes can be achieved with a multidisciplinary surgical strategy.

Background:Reconstruction of diaphyseal bone defects of the lower limb after oncologic resection in children remains a major challenge. Several biological techniques are used, including the induced membrane technique (IMT), vascularized fibular graft (VFG), and combined allograft with vascularized fibula graft (CAVFG), but comparative data in pediatric populations remain limited. Questions/purposes:We asked: (1) What are the consolidation outcomes after biological reconstruction of pediatric lower-limb diaphyseal defects? (2) Which factors are associated with time to bone union? (3) What are the complication and revision profiles of these reconstruction strategies? Methods:We conducted a national multicenter retrospective study including pediatric patients (<18 years) who underwent diaphyseal resection of the femur or tibia for malignant bone tumors or adamantinoma between 2004 and 2024. Patients were reconstructed using IMT, VFG, or CAVFG. The primary endpoint was radiographic consolidation at 1 year. Secondary outcomes included overall union rate, time to union, complications, and revision surgery. Time-to-event analyses were performed using Kaplan-Meier and Cox regression models. Results:A total of 133 patients were included (IMT 69, VFG 22, CAVFG 42). Overall bone union was achieved in 72.9% of patients, with no significant difference between reconstruction techniques (IMT 75.4%, VFG 81.8%, CAVFG 64.3%; p = 0.272). Consolidation at 1 year, estimated by Kaplan-Meier analysis, occurred in 35.2% of cases. Median time to union was 18 months and did not differ significantly between techniques. Tibial localization was independently associated with higher union rates (OR 3.90, 95% CI 1.19-12.8; p = 0.024) and shorter time to union (HR 1.89, 95% CI 1.06-3.38; p = 0.032). Complications occurred in 64.1% of patients and 57% required revision surgery, without differences between techniques. Conclusion:Biological reconstruction of pediatric lower-limb diaphyseal defects allows limb salvage with acceptable union rates but prolonged healing and high complication rates. No technique demonstrated clear superiority, supporting an individualized reconstruction strategy based primarily on anatomical and mechanical considerations.

This study was aimed at identifying MRI findings related to total hip arthroplasty (THAs) infection using coronal STIR with metal artifact reduction sequences (MARS) at 1.5 T. This retrospective multicenter study included all patients with THAs who underwent 1.5 T MRI with MARS from December 2015 to April 2020. Two groups are as follows: an infected group and a non-infected group (including asymptomatic THAs and symptomatic non-infected THAs). MARS were either multi-acquisition with variable-resonance image combination (MAVRIC) or slice encoding for metal artifact correction (SEMAC). Imaging features were evaluated to assess their association with THA infection (including both symptomatic and asymptomatic patients). Sensitivity, specificity, and accuracy of these imaging findings were assessed, and inter-reader agreement (kappa, K) was determined. Sixteen patients with THAs had periprosthetic infection, compared with 46 THAs in the non-infected group. Bone edema extending to adjacent soft tissues, defined as a combination of femoral bone marrow edema, hyperintense cortical signal, periostitis, and overall soft tissue edema, had the greatest diagnostic performance for infection: 15/16(94

Background:Periprosthetic femoral fracture (PFF) is a raising concern following hip arthroplasty in Dorr type B and C femurs. Cemented Charnley-Kerboull (CK) stems implanted according to the "French paradox" through the Hueter anterior approach may represent a reliable option in this at-risk population, but the rate of early PFF in this specific setting remains unclear. Methods:From a prospectively collected database, all hemiarthroplasties using CK stems (AmisK, Medacta) implanted consecutively from 2017 to 2023 through the Hueter anterior approach in patients with Dorr type B and C femur were included. Results:A total of 670 CK stems were included. The mean follow-up was 31.2 ± 1.1 months (1-36). The mean age was 85.5 ± 8.0 years, and the mean body mass index was 22.1 ± 4.4 kg/m2. According to the Dorr classification, 357 (53.3%) hips were of Dorr type B, and 313 (46.7%) of Dorr type C. Among the 670 hemiarthroplasties, a total of 10 (1.49%; 95% confidence interval [CI], 0.57-2.41%) early PFFs were observed, including 5 in Dorr type B femurs (1.40%; 95% CI, 0.18-2.62%), and 5 in Dorr type C femurs (1.60%; 95% CI, 0.21-2.99%). No cases of severe bone cement implantation syndrome were reported. Conclusions:This study demonstrated that CK stems cemented according to the "French paradox" were associated with a low rate of early PFF (1.49%) in this extremely high-risk patient population. No cases of severe bone cement implantation syndrome were reported.

Aims:Cementless femoral fixation is widely used in total hip arthroplasty (THA), with increasing interest in shorter femoral component designs. These femoral components aim to preserve proximal bone, promote physiological load transfer, and facilitate minimally invasive approaches. Among these, 'shortened' femoral components, derived from conventional stems and retaining a diaphyseal extension, may offer advantages in terms of implant positioning. However, clinical evidence regarding their mechanical reliability remains limited. This study aimed to compare the two-year radiological stability of a shortened uncemented quadrangular femoral component with that of its conventional-length counterpart in patients undergoing THA for osteoarthritis. Methods:We conducted a prospective, single-blind, randomized, noninferiority trial between January 2018 and December 2021. Patients undergoing primary THA were randomly assigned to receive either the conventional-length quadrangular femoral component or its shortened version. The primary outcome was femoral component migration at two years, assessed with Ein Bild Roentgen analyze - femoral component analysis (EBRA-FCA). Secondary outcomes included intraoperative and postoperative complication rates, as well as the 12-item Oxford Hip Score (OHS) at 12 months. Results:A total of 143 hips were randomized, with 139 (70 conventional-length, 69 shortened) included in the clinical analysis. Per-protocol radiological analysis was carried out on 98 hips (49 hips per group). At two years, mean femoral component migration was 0.94 mm (SD 0.49) in the shortened-femoral component group and 0.86 mm (SD 0.52) in the conventional-length group. The upper bound of the 90% CI (-0.09 to 0.25) was below the prespecified noninferiority margin of 1 mm. No significant differences were observed in complication rates or functional outcomes (p > 0.05). Conclusion:At two years, radiological outcomes of the shortened quadrangular femoral component were consistent with noninferiority compared with the conventional-length version. Although the planned sample size was not fully reached, the findings remained within the prespecified noninferiority margin.

Total hip arthroplasty (THA) is a major success in the management of osteoarthritis and is increasingly performed worldwide. As a result, complications related to hip prostheses—particularly periprosthetic femoral fractures (PPF)—are becoming more frequent, occurring in 4–5

Background Liposarcomas (LPS) are among the most common sarcomas, but gather a diversity of rare to ultrarare molecular subtypes whose presentations and natural histories are partially characterized. The aim of the work was to describe the presentation and outcome of the different LPS histotypes from the NETSARC+ registry. Methods NETSARC+ (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB), funded by the French INCA since 2010 aiming to improve the quality of care of sarcoma patients. Patients’ characteristics, treatment and outcomes are collected in a nationwide database. This work describes the outcome of all LPS confirmed by central review pathology review and integrated between 2010 and 2023 in the NETSARC+ database. Findings 11,132 liposarcomas are included in the database for an estimated incidence of 11.5/106/y. Median age was 65 (Q1–Q3: 53–74, range 0–97 y), with 6529 males (58.7%), with 4220 (37.9%) dedifferentiated (DDLPS), 1838 (16.5%) well differentiated LPS (WDLPS) & 2424 (21.8%) atypical lipomatous tumours (ALT), 1371 (12.3%) myxoid LPS (MyxLPS), 450 (4.0%) pleomorphic LPS (PLPS), 177 (1.6%) high grade myxoid LPS (HGMLPS), 24 (0.2%) mixed type liposarcomas (MTLPS), 14 (0.1%) myxoid pleomorphic LPS (MPLPS) and 614 (5.5%) non classified LPS (NCLPS). Age, sex and sites differed across histotypes, but overall, all histotypes were represent in all age groups and sites. We report first on a difference in the sex ratio of liposarcoma in different age groups. Women were less frequently affected with liposarcomas after 50, in DDLPS, MyxLPS and HGMLPS. The median overall survival of DDLPS was 144 months, significantly worse than that of MyxLPS (HR: 0.26 [95% CI 0.21–0.33]), PLPS (HR: 0.76 [95% CI 0.59–0.98]), HGMLPS (HR: 0.30 [95% CI 0.18–0.50]), WDLPS (HR: 0.30 [95% CI 0.24–0.37]), unclassified LPS (HR: 0.53 [95% CI 0.37–0.75]). In addition to a lower incidence, women aged >50 had a better relapse free and overall survival than male, while this was not observed in the group aged 50 or under. In multivariate analyses, size and age were independent prognostic factors for the most common subgroups, but specific prognostic parameters were observed in each molecular subgroup. Female >50 was an independent favorable prognostic factor for the largest groups of DDLPS. Interpretation In this nationwide series of pathology-confirmed LPS, the clinical presentation, management and survival of histotypes are very different with age-related sex differences favoring women >50. DDLPS is the subtype with the worse prognosis. Funding This work was supported by the following grants: NetSARC+ (INCA), RREPS (INCA), RESOS (INCA), INTERSARC+ (INCA), LabEx DEvweCAN (ANR-10-LABX-0061), LYriCAN+ (INCa-DGOS-INSERM-ITMO cancer_18,003), Ligue Nationale contre le Cancer, Ligue Contre le Cancer (Comité de l’Ain), Fondation ARC, and EURACAN (EU project 739521).

Metastatic osteosarcoma (MOS) has a poor prognosis, and few treatment options. This multicentre observational study provides real-world data on treatment patterns of patients with MOS in France. The primary objective was to describe treatment modalities of patients with MOS aged ≥12 years treated in 11 reference network centers. Secondary objectives were to assess time to next treatment (TTNT), overall survival (OS) and prognostic factors for TTNT and OS. From 2008 to 2018, 262 patients with MOS were included; 88 patients were metastatic at diagnosis, and 174 patients had a metastatic relapse. Median age at diagnosis was 26 (12-86). A total of 227 (86.6%) patients received systemic treatment in the metastatic setting, and 75 (28.6%) patients received more than two lines. Overall, 153 (58.4%) patients underwent at least a loco-regional procedure, and 50 patients (19.1%) participated in a clinical trial in the metastatic setting. Median OS from metastasis diagnosis was 21.5 months [95% CI 18.9-27.0], 23.0 months [95% CI 15.0-31.1] in the synchronous cohort, and 21.4 months [95% CI 18.7-29.7] in the metachronous cohort. Median TTNT was 8.2 months [95% CI 6.7-9.9], 5.7 months [95% CI 4.2-7.2], 3.7 months [95% CI 3.0-4.3], and 2.9 months [95% CI 1.8-3.9] in first, second, third, and fourth line. It was 7.6 months [95% CI 5.1-12.5], 6 months [95% CI 3.6-8.7], and 4.8 months [95% CI 2.9-7.5] for tyrosine kinase inhibitors such as regorafenib or cabozantinib in first, second, and third line. In MOS, the benefit of chemotherapy after first line is limited. TKIs show encouraging activity from first line. Inclusion in clinical trials should be prioritized.

Achieving Return to Sport (RTS) is crucial in managing ankle fractures for athletes. This study aimed to identify RTS factors post-surgical fixation of ankle fractures. A retrospective analysis was conducted on 93 active patients with surgically treated displaced or unstable ankle fractures from January 2020 to January 2021. The median follow-up was 2.12 years. Clinical, functional, and radiographic aspects were evaluated. Among the athletes, 82.8 % resumed sports post-surgery, with 26.9 % returning within 3 months and 75.3 % at 1 year. At 1 year, 40.9 % regained their pre-injury activity level. There was a significant association between RTS and AO/OTA fracture subtype (p = 0.038). Unimalleolar fractures had the best outcomes, with 100 % achieving RTS in a median of 4 months. Bimalleolar fractures had 80.77 % RTS in 6 months, and trimalleolar fractures had 65.22 % RTS in 8 months. AO/OTA subtypes B and C predicted lower RTS to pre-injury levels, with delayed recovery for bimalleolar and trimalleolar fractures. These findings underscore the impact of fracture severity on RTS, with more complex fractures leading to poorer and delayed recovery outcomes.

Metastatic chondrosarcoma (MCS) has a poor prognosis, and treatment options are scarce in this rare disease. This multicenter observational study provides real‐world data on treatment patterns of patients with MCS in France. Treatment characteristics, outcomes in terms of time to next treatment (TTNT) and overall survival (OS), and prognostic factors of patients ≥12‐year‐old treated for a MCS in nine French reference network centers were retrieved from the French Sarcoma Group prospective database. From 2008 to 2018, 127 patients with MCS were included, 31 were metastatic from diagnosis (synchronous cohort), 89 had a metastatic relapse, and 7 had locally advanced unresectable disease, of whom 4 developed secondary metastases (metachronous cohort). Median age at diagnosis was 61 years (14–90), 58.9% of patients received a systemic treatment with a median of 2 lines (1–6), 40.3% had a locoregional procedure on metastasis, and 9.7% of patients participated in a clinical trial at least once in the metastatic setting. Median OS from metastatic diagnosis was 12.7 months [95%CI 8.2, 14.9], without significant difference between the metachronous and synchronous cohorts. Median TTNT was 4.6 months [95%CI 3.0, 5.9], 3.4 months [95%CI 2.7, 4.8], and 3.4 months [95%CI 2.0, 7.9] in first, second, and third lines, respectively. In MCS, benefits of chemotherapies are very limited. Tyrosine kinase inhibitors such as regorafenib or pazopanib show some activity from first line. Locoregional treatment of metastasis is associated with survival and should be proposed when feasible. Inclusion in clinical trials should be prioritized.

Introduction Les sarcomes de tissus mous (STM) sont des tumeurs malignes du tissu conjonctif, caractérisés par une grande hétérogénéité dans leurs présentations, résultant en une variabilité des stratégies thérapeutiques entre les centres de référence. Néanmoins, les résultats cliniques issus d’un service de chirurgie orthopédique et traumatologique d’un centre hospitalo-universitaire sont peu documentés. Nous avons évalué le taux de récidive locale à 5 ans de recul des patients pris en charge selon notre stratégie locale et opérés dans notre service, labellisé pour la prise en charge des STM et des sarcomes osseux, ainsi que la survie globale et les taux de métastase et de reprises chirurgicales. Nous avons également analysé les facteurs de risque de ces évènements. Hypothèse Notre hypothèse était que nos résultats étaient relativement similaires à ceux des autres centres de référence. Matériels et méthodes Nous avons étudié 466 STM des membres et du tronc opérés de 2012 à 2019. L’âge médian des patients était de 57 ans, dont 259 hommes (56 %). Parmi eux, nous comptions 351 tumeurs naïves (75 %) ; 18 patients (4 %) avaient une atteinte ganglionnaire et 33 patients (7 %) avaient une métastase à la prise en charge initiale. Il y avait 315 sarcomes de taille supérieure à 5cm (72 %). Les sarcomes étaient localisés en profondeur pour 385 cas (83 %) et au membre inférieur proximal dans 352 cas (76 %). Nous avions 216 sarcomes (52 %) de grade 3. Les sous-types histologiques les plus fréquents étaient : le sarcome indifférencié à cellules pléiomorphes (n=104, 22 %), myxofibrosarcome (n=82, 18 %), synovialosarcome (n=45, 10 %) et liposarcome myxoïde et/ou à cellules rondes (n=42, 9 %). Concernant les traitements, 414 patients (89 %) ont eu une chirurgie conservatrice, 261 patients (56 %) ont eu une radiothérapie, et 138 patients (30 %) ont eu une chimiothérapie. Résultats À 5 ans de recul, le taux de récidive locale était de 14 % (intervalle de confiance à 95 % [IC 95 %]=10–18 %). Les facteurs de risque étaient le mode de présentation non naïf (hazard ratio [HR]=1,80, IC 95 %=1,04–3,11, p=0,037), le caractère superficiel de la tumeur (HR=2,14, IC 95 %=1,20–3,83, p=0,01), le grade 3 (HR=1,86, IC 95 %=1,22–2,83, p=0,004), les limites de résection chirurgicale positives (HR=2,47, IC 95 %=1,44–4,24, p=0,001) et la réalisation d’une chimiothérapie (HR=0,51, IC 95 %=0,30–0,87, p=0,014). La survie globale était de 60 % (IC 95 % 55–66 %). L’incidence des métastases était de 28 % (IC 95 % 23–33 %). Enfin, le taux de reprises chirurgicales était de 40 % (IC 95 % 36–45 %). Conclusion Dans notre service universitaire de chirurgie orthopédique et traumatologique, les résultats étaient relativement comparables à ceux de la littérature issus des autres centres spécialisés, à orientation oncologique exclusive ou non. Niveau de preuve IV ; étude rétrospective.

INTRODUCTION:Soft tissue sarcomas (STS) are malignant tumors of connective tissue, characterized by a wide heterogeneity in their presentations, resulting in variable therapeutic strategies between reference centers. However, clinical outcomes from an orthopedic and trauma surgery department of university hospitals are poorly documented. We evaluated the 5-year local recurrence rate of patients managed according to our local strategy and operated in our department, which is certified for the management of both soft tissues and bone sarcomas. We also assessed overall survival, metastasis and reoperation rates, as well as risk factors associated with these events. HYPOTHESIS:Our hypothesis was that our results were relatively similar to those from other reference centers. MATERIALS AND METHODS:We analyzed 466 cases of STS of the limbs and trunk operated on between 2012 and 2019. The median patient age was 57 years, including 259 men (56%). Among them, 351 tumors (75%) were treatment-naïve; 18 patients (4%) had lymph node involvement, and 33 patients (7%) presented with metastases at initial management. There were 315 sarcomas larger than 5 cm (72%). Sarcomas were located deep in 385 cases (83%) and in the proximal lower limb in 352 cases (76%). A total of 216 sarcomas (52%) were grade 3. The most frequent histologic subtypes were undifferentiated pleomorphic sarcoma (n = 104, 22%), myxofibrosarcoma (n = 82, 18%), synovial sarcoma (n = 45, 10%), and myxoid and/or round cell liposarcoma (n = 42, 9%). Regarding treatments, 414 patients (89%) underwent limb-sparing surgery, 261 (56%) received radiotherapy, and 138 (30%) received chemotherapy. RESULTS:At 5 years of follow-up, the local recurrence rate was 14% (95% confidence interval [CI] = 10-18%). Independent risk factors were non-naïve presentation (hazard ratio [HR] = 1.80, 95% CI = 1.04-3.11, p = 0.037), superficial tumor location (HR = 2.14, 95% CI = 1.20-3.83, p = 0.01), grade 3 histology (HR = 1.86, 95% CI = 1.22-2.83, p = 0.004), positive surgical margins (HR = 2.47, 95% CI = 1.44-4.24, p = 0.001), and administration of chemotherapy (HR = 0.51, 95% CI = 0.30-0.87, p = 0.014). Overall survival was 60% (95% CI = 55-66%). The incidence of metastases was 28% (95% CI = 23-33%), and the rate of reoperations was 40% (95% CI = 36-45%). CONCLUSION:In our university orthopedic and trauma surgery department, the oncological outcomes were comparable to those reported in the literature from other specialized centers, whether with exclusively oncologic activity or not. LEVEL OF EVIDENCE:IV; retrospective study.

Purpose (the aim of the study): Osteoarthritis (OA) is a general joint disease characterized by a progressive destruction of cartilage extending to bone and synovial tissue and can affect different types of joints. OA induces marked changes in synovial tissues, which may display aberrant physiologic responses to mechanical stimuli and could contribute to impair joint homeostasis and exacerbate inflammatory process particularly in the early phase of the disease. Several previous studies have highlighted that the content of glutamine in OA synovial fluid is altered indicating that glutamine is likely to be an important substrate for articular cells.

Contexte Plusieurs autoquestionnaires évaluent la fonction de la hanche en pratique clinique (HOOS-12, Oxford-12). Cependant, leur utilisation est parfois complexe. Des études récentes ont montré qu’une question unique peut évaluer efficacement la fonction articulaire. Nous avons développé le test SHV (Simple Hip Value), une question permettant aux patients d’évaluer leur fonction de hanche de 0 à 100. Nous avons mené une étude prospective afin d’évaluer la pertinence du test SHV en le comparant aux scores Oxford-12 et HOOS-12, et d’évaluer la capacité de discrimination et la reproductibilité de ce test. Hypothèse L’évaluation de la fonction de la hanche par un questionnaire rempli par le patient (PROM) à question unique est fiable et utile dans la pratique clinique. Patients et méthodes Nous avons inclus 74 patients ayant reçu une prothèse totale de hanche entre novembre 2020 et avril 2021 dans notre centre. Le SHV, HOOS-12 et Oxford-12 ont été administrés 18 mois après la chirurgie, avec des valeurs ramenées sur 100 points. Un deuxième test contenant les 3 questionnaires a été resoumis à 20 patients choisis aléatoirement dans ce groupe pour évaluer la reproductibilité du test. Pour évaluer la capacité de discrimination de notre test, 20 témoins ont été sélectionnés pour répondre aux trois questionnaires. Résultats Les résultats ont montré des scores médians de 90,0 (interquartile range [IQR] : 80,0 ; 95,0) pour le SHV, 88,5 (IQR : 77,1 ; 95,8) pour le Oxford-12 et 79,1 (IQR65,1 ; 93,2) pour le HOOS-12. Le SHV était fortement corrélé avec le Oxford-12 (coefficient de Spearman : 0,63) et le HOOS-12 (coefficient de Spearman : 0,66). Le SHV différait significativement du groupe contrôle (90,0 vs 100,0 dans le groupe contrôle ; p<0,001) et avait une excellente reproductibilité (coefficient de corrélation interclasse (CCI) : ICC : 0,82). Discussion Le SHV est un outil fiable, reproductible et discriminant pour évaluer la fonction de la hanche après la pose d’une prothèse totale de hanche, offrant ainsi une approche simplifiée et pratique pour les praticiens. Niveau de preuve III ; étude prospective comparative diagnostique.

INTRODUCTION:The planning step that precedes a total hip arthroplasty (THA) procedure is crucial. Digital planning software programs are being increasingly used, although few studies have reported on the reliability of such tools. Furthermore, no studies have been conducted on the mediCAD® software, despite it being widely used in France. This led us to conduct a retrospective study to: (1) assess the accuracy of this planning software, (2) determine the intra- and inter-rater reliability, (3) determine how obesity affects the accuracy of planning. HYPOTHESIS:THA planning is accurate and reliable when using the mediCAD® software. PATIENTS AND METHODS:This was a single center, retrospective study. One hundred one consecutive cases performed by a single experienced surgeon were planned retrospectively by two blinded surgeons on two separate occasions. The acetabular cup was cemented in 90 hips (89%), cementless in 11 hips (11%). A dual mobility cup was used in 21 hips (21%). The femoral stem was cemented in 60 hips (59%). The endpoint was the number of exact plans, defined as the same size as the actual implants. An acceptable match was defined as a difference of one size. The match was unacceptable if the planned and implanted size differed by more than 2 for the acetabular cup or by more than 1 size for the femoral stem. The intra-rater and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI). RESULTS:Exact agreement was found by the first rater for 15 planned acetabular cups (15%) and for 45 planned femoral stems (45%) relative to the implants used. The second rater reached exact agreement for 20 planned acetabular cups (20%) and 50 planned femoral stems (50%). The intra-rater reliability for the acetabular cup was average (ICC = 0.57; 95%CI [0.43-0.69]) and poor (ICC = 0.38 95%CI [0.20-054]) for the 1st and 2nd rater, respectively. The intra-rater reliability for the femoral stem was poor for the 1st rater (ICC = 0.47 95%CI [0.30-0.61]) and the 2nd rater (ICC = 0.45 95%CI [0.29-0.60]). The interobserver reliability was low for the planned acetabular cup (ICC = 0.39 95%CI [0.21-0.54]) and the planned femoral stem (ICC = 0.42 95%CI [0.24-0.57]). Overall, when combining the two raters, exact prediction of the acetabular cup was achieved in 31 hips (19%) in non-obese patients and in 7 hips (21%) in obese patients (p = 0.62). DISCUSSION:This study found acceptable reliability of the mediCAD® software. Experience level, radiograph magnification affected the planning outcome in this study, but obesity did not. We currently do not have the ability to incorporate a reliable radiological scale for two-dimensional templating. Some surgeons prefer using a CT scan, but this costs more than conventional radiographs and exposes the patient to more radiation. This study shows that the mediCAD® software can provide satisfactory output for the preoperative planning of THA. LEVEL OF EVIDENCE:III; retrospective, diagnostic, comparative study.