BACKGROUND:Knee osteoarthritis increasingly affects active adults under 65 years of age. As total and unicompartmental knee arthroplasty (TKA/UKA) become common treatments, return to work (RTW) emerges as a key milestone in recovery. While age, obesity, and comorbidities have been identified as predictors, the specific impact of professional occupation remains underexplored. This prospective study addresses this gap by investigating (1) how socio-professional category (SPC) influences the duration of sick leave after knee arthroplasty; and (2) whether physically demanding jobs; higher body mass index (BMI), age, and/ or other demographic or clinical factors are associated with prolonged sick leave. HYPOTHESIS:The authors hypothesized that the type of profession is the most significant predictor of extended sick leave following knee arthroplasty. METHODS:A prospective, single-center study was conducted involving 120 professionally active patients aged 18-65 years who underwent TKA or UKA between February 2020 and December 2023. Sociodemographic data, job classification (using PCS-ESE 2017), job physical demands, and clinical characteristics were collected. RTW status was evaluated at three months postoperatively, with an additional follow-up at four months for patients with extended sick leave (>90 days). Univariate and multivariate logistic regression analyses were performed to identify predictors of prolonged sick leave (> 90 days). RESULTS:While patients in SPC-3 (executives and intellectual professions) and SPC-5 (employees) were significantly associated with prolonged sick leave in univariate analysis (OR = 0.35; 95% CI: 0.15-0.81; p = 0.014 and OR = 3.95; 95% CI: 1.73-8.98; p = 0.001, respectively), neither association was confirmed in multivariate analysis (SPC-3: OR = 1.52; 95% CI: 0.47-4.88; p = 0.484; SPC-5: OR = 2.41; 95% CI: 0.89-6.51; p = 0.0837). Secondly, physically demanding jobs strongly predicted extended sick leave, with nearly a fivefold increase in risk (OR = 4.58 95% CI:1.63-12.87; p = 0.0038). Thirdly, while a trend was observed for higher BMI to be associated with longer sick leave (OR = 1.09; 95% CI: 0.99-1.19; p = 0.060), no significant associations were found for sex, age, ASA score, length of hospital stay, discharge modality, or caregiver availability. CONCLUSION:Physically demanding occupations and not professional status are the main factors delaying return to work after knee arthroplasty. In contrast, traditional demographic factors such as sex, BMI and ASA score appear less influential. These findings highlight the importance of integrating occupational context and modifiable risk factors into preoperative planning to facilitate earlier RTW and optimize patient recovery trajectories. LEVEL OF EVIDENCE:II; prospective study.

BACKGROUND:Surgical correction of severe hallux valgus (HV) remains challenging. Surgical treatment may be joint preserving, such as Scarf osteotomy, or non-joint preserving, such as first metatarsophalangeal joint (MTP1) arthrodesis. To our knowledge, no study has directly compared these two procedures in severe HV. This study therefore aimed to address four questions: (1) Does MTP1 arthrodesis provide a higher rate of very satisfied patients than Scarf osteotomy at a minimum one-year follow-up? (2) Does it reduce the need for footwear adaptation? (3) Does it reduce residual pain? (4) Are complication rates different between the two procedures? HYPOTHESIS:We hypothesized that MTP1 arthrodesis would result in a higher rate of very satisfied patients than Scarf osteotomy. PATIENTS AND METHODS:A single-center, single-surgeon retrospective study was conducted between 2015 and 2021. Severe HV was defined as a lateral sesamoid displaced beyond 75% of the first intermetatarsal space on weight-bearing anteroposterior radiographs. Sixty-one feet in 47 patients (14 bilateral cases) with a minimum one-year follow-up were included: 25 treated by MTP1 arthrodesis and 36 by Scarf osteotomy, with a median follow-up of 52.5 months (IQR 34-80). The primary outcome was the rate of very satisfied patients at last follow-up, assessed by a self-administered questionnaire (very satisfied, satisfied, moderately satisfied, or dissatisfied). Secondary outcomes were footwear adaptation, persistent pain, complications, and recurrence. Radiographic outcomes were available for 57 feet (23 arthrodeses, 34 Scarf osteotomies). RESULTS:Arthrodesis was associated with better outcomes than Scarf osteotomy, including a higher rate of very satisfied patients, 15/25 (60%) versus 10/36 (28%) (p = 0.012), less footwear adaptation, 4/25 (16%) versus 16/36 (44%) (p = 0.025) and less persistent pain, 3/25 (12%) versus 14/36 (39%) (p = 0.022). Delayed wound healing occurred in 2/25 feet (8%) in the arthrodesis group and 3/36 (8%) in the Scarf group. In the Scarf group, hallux varus occurred in 3/34 feet (9%), MTP1 osteoarthritis in 9/34 (26%), and overall recurrence in 9/34 (26%). No nonunion, revision surgery, or hardware removal was recorded in either group. DISCUSSION:The comparison of severe HV treatment by MTP1 arthrodesis or Scarf osteotomy revealed a higher satisfaction rate and better functional outcomes in patients treated by MTP1 arthrodesis in our study. Despite the limitations of this study, MTP1 arthrodesis appears to be a valuable option for severe HV. LEVEL OF EVIDENCE:III; Retrospective comparative study.

BACKGROUND:Periprosthetic joint infection (PJI) is the most dramatic complication of total hip arthroplasty (THA). We investigated whether a one-stage arthroplasty using a cemented or uncemented stem was associated with better survival in terms of infection and mechanical complications. METHODS:Patients were selected from a PJI institutional registry of THA between 2003 and 2019. After matching the two groups by propensity score at a 1:3 ratio, 241 patients were finally included: 62 in the cemented group and 179 in the cementless group. The mean age of the population was 68 years (range, 25.1 to 91.4), and 45.2% (109 of 241) of the patients were women, with a mean body mass index of 26.9 (range, 15.6 to 46.4). The mean follow-up was 6.6 years (range, 0.1 to 18.1). To compare the overall survival rate between groups, Kaplan-Meier analysis was performed. RESULTS:The overall survival rate in our series was 93.3% [88.2 to 98.7] at 10 years. At the last follow-up, nine THAs had been reinfected: four relapses and five new infections. Regarding the reinfection-free survival rate, there was no significant difference (P = 0.62) between the cemented group (95.8% [90.2 to 100.0]) and the cementless group (94.1% [87.8 to 100.0]) at 10 years. At the last follow-up, 34 (14.1%) THAs had aseptic complications that required 30 revisions. Regarding the aseptic survival rate, there was no significant difference (P = 0.61) between the cemented group (81.8% [71.1 to 94.0]) and the cementless group (83.3% [72.8 to 95.2]) at 10 years. CONCLUSIONS:To our knowledge, this study is the first to compare outcomes between cemented and cementless stems in one-stage exchange PJI. There is no difference in reinfections or mechanical complication rates when a cemented or cementless stem is used in a one-stage revision THA exchange for PJI. Other parameters, in particular the shape of the femur and the patient's comorbidities, must be taken into account when choosing the type of stem to use. LEVEL OF EVIDENCE:Level III, case-control studies.

Background: Cementless stem extraction during hip arthroplasty revision can be challenging and sometimes requires a femoral opening to be performed with limited posterior femorotomy techniques been described. The study objective was to assess the efficacy of these techniques and the perioperative and postoperative complication rates. Methods: This study included 224 patients who underwent cementless stem revision. Stem extraction followed the same sequence: an initial endomedullary extraction attempt, followed by suspended posterior unicortical vertical diaphyseal femoral osteotomy. Metaphyseal extension of the osteotomy and lateral-distal cortical extension at the stem tip were performed if the procedure failed, followed by extended trochanteric osteotomy (ETO). The incidence rates of perioperative fracture, reimplanted stem type (standard or revision), postoperative subsidence, and fracture were analyzed. Results: Femoral opening was required in 15.6% of patients; 75% underwent limited femorotomy (28 patients, 75% suspended, and 25% extended), and 25% (7 patients) underwent ETO. Endomedullary extraction was performed in 84.4% (189) of the patients. The perioperative fracture rates were 16.9%, 0%, and 14.3% in the endomedullary, limited femorotomy, and ETO groups, respectively (P = .032). The standard stem utilization rates were 94.9%, 82.1%, 58.6%, and 28.6% (P < .001) for the endomedullary, limited femorotomy, perioperative fracture, and ETO groups, respectively. Postoperatively, the subsidence rates were 7.5%, 0%, and 28.6% (P = .042), and the fracture rates were 4.3%, 3.6%, and 0% (P > .999) in the endomedullary, limited osteotomy, and ETO groups, respectively. Conclusions: Limited femorotomy techniques are reliable methods for extracting cementless stems, when necessary, with a reduced risk of fracture. Postoperatively, these patients appear to have comparable stem subsidence and a low risk of fracture.

Background: Periprosthetic joint infection (PJI) of the hip is a significant complication traditionally managed via two-stage revision. While one-stage revision has gained traction due to reduced healthcare costs and the avoidance of multiple surgeries, its implementation requires strict surgical rigor and multidisciplinary coordination to ensure outcomes comparable to two-stage protocols. Objective: This article aims to define the prerequisites, pathophysiological rationale, and technical principles of one-stage revision arthroplasty for chronic hip PJI, while evaluating its clinical indications and success rates. Key Points: Successful management relies on a multidisciplinary team involving infectious disease specialists, microbiologists, and orthopedic surgeons. Pre-operative joint aspiration is essential, demonstrating 88% concordance with intra-operative cultures. The surgical procedure necessitates radical debridement of all infected soft tissue and complete removal of implants and cement, often requiring extended femoral osteotomies. Reconstruction utilizes modular revision implants, dual-mobility components, or structural allografts to address bone loss. Post-operative antibiotic therapy is typically administered for six to twelve weeks. Clinical data from a prospective cohort of 157 chronic PJI cases treated with one-stage revision showed a 95% infection-free survival rate at five years, even in cases involving resistant organisms or sinus tracts. Conclusion: One-stage revision arthroplasty is an effective strategy for the majority of hip PJI cases. By achieving high infection eradication rates and superior functional outcomes compared to two-stage procedures, it serves as a primary treatment option when managed within specialized referral centers.

BACKGROUND:Hip dislocation remains one of the most frequent complications of total hip arthroplasty (THA). To minimize the risk of dislocation, cup placement has traditionally been guided by a defined "safe zone". However, dislocations still occur even when the implant components are positioned within this zone, which may be due to the influence of spinopelvic motion on THA stability. This study aimed to (1) compare spinopelvic risk factors for dislocation between patients who experienced dislocations and those who did not after anterior-approach surgery and (2) analyze the risk factors associated with anterior versus posterior dislocations. HYPOTHESIS:Our hypothesis was that patients with dislocation of a total hip arthroplasty after the anterior approach had a higher rate of risk factors for adverse spinopelvic mobility and that implant versions, as well as hip lengths and offsets, play an important role in anterior and posterior dislocations. PATIENTS AND METHODS:Patient with dislocation were prospectively collected from August 2018 to August 2022. Out of a total of 6,166 THAs, 35 dislocations were recorded, and 7 patients were excluded. This single-center study included a prospective cohort of 28patients who experienced dislocations (19 anterior, 9 posterior) compared with a consecutive control cohort of 278 patients who did not, all of whom underwent primary THA via the anterior approach. Preoperative spinopelvic parameters such as lumbar flexion (LF), spinopelvic tilt (SPT), pelvic incidence (PI), and pelvic mobility (change in SPT [ΔSPT]) were analyzed in the control group using pelvic-femoral computed tomography and lateral X-rays. Patients who experienced dislocation underwent advanced postoperative functional analysis, in which spinopelvic parameters, implant version, hip length discrepancy, and femoral offset were assessed. RESULTS:The prevalence of spinopelvic risk factors was greater in the dislocation cohort than in the control cohort [SPT≤-10°: 42.5% vs. 10.5% (p < 0.001); LF ≤ 35°: 46.1% vs. 11.9% (p < 0.001); PI-lumbar lordosis (LL) ≥ 10°: 33.9% vs. 14.8% (p = 0.003); ΔSPT ≥ 20 ° from standing to seated: 50% vs. 8.3% (p < 0.001); and ΔSPT ≤-13 ° from supine to standing: 21.4% vs. 6.7% (p = 0.012)]. The mean combined anteversion (CA) was 35 ° (7°-53 °) in the anterior dislocation group and 24 ° (15°-30 °) in the posterior dislocation group. CONCLUSIONS:Patients with dislocations presented a high prevalence of spinopelvic risk factors. Anterior dislocations were linked to spinopelvic abnormalities rather than excessive CA. In contrast, posterior dislocations occurred in patients with low CA, especially at the expense of stem version and spinopelvic risk factors. Therefore, in patients undergoing anterior-approach THA, restricting implant anteversion may not be the primary factor in reducing the risk of anterior dislocation but may increase the risk of posterior dislocation in patients with adverse spinopelvic mobility. LEVEL OF EVIDENCE:III; Case-control study.

Lors d’une révision de prothèse totale de genou, l’obtention d’une tenue métaphysaire apporte une stabilité rotatoire et axiale à l’implant en plus du comblement d’une perte de substance osseuse métaphysaire. Cette troisième zone de stabilisation, complémentaire de la diaphyse et de l’épiphyse, permet de répartir les contraintes et d’adapter le mode de fixation et la longueur des tiges diaphysaires à chaque cas, selon sa complexité. Les manchons métaphysaires sont des pièces modulaires solidaires de la prothèse et ostéo-intégrables, procurant une fixation biologique secondaire. Ils sont disponibles en 5 tailles au tibia et au fémur. De forme conique et avec un dessin en marches d’escalier, ils sont revêtus de titane poreux, partiellement au tibia et soit partiellement soit totalement au fémur. Ce dessin favorise la compression de l’os, la stabilité et l’ostéo-intégration du manchon. Les pièces prothétiques elles-mêmes sont fixées aux manchons par un cône morse, avec une liberté de positionnement de±20° en rotation. Au tibia, la tige diaphysaire est fixée à l’embase tibiale qui traverse le manchon. Au fémur, elle est vissée à l’extrémité du manchon. Dans la gamme de prothèses de révision de la société DePuy Synthès, associée à ces manchons, un tibia unique à plateforme rotatoire peut servir pour plusieurs contraintes : postéro-stabilisée, semi-contrainte, charnière, avec un passage facile d’un modèle à l’autre au cours de la révision en cas de nécessité (faillite ligamentaire). La longueur de tige doit être adaptée au niveau de contrainte choisi. Les tiges des modèles semi-contraints peuvent être courtes si la métaphyse procure un bon ancrage primaire et on peut même s’en passer dans les cas les plus favorables. En revanche, pour les prothèses charnière, les contraintes initiales peuvent limiter les possibilités d’intégration du manchon et il faut leur associer des tiges d’au moins 75mm. Cet article décrit la technique, les résultats (comparables à ceux des cônes), les complications et les perspectives d’avenir de ce type de fixation. Niveau de preuve : V ; avis d’expert.

INTRODUCTION:The first results of cementless prosthesis were rather disappointing. However recent progress in methods of cementless fixation of prosthesis should lead to better results in terms of survival of these prostheses. The main objective is to compare the survival rate at last follow-up of UKA with cemented tibial or cementless. HYPOTHESIS:We hypothesize that UKAs with uncemented tibial implants have better survival compared to UKAs with cemented tibial implants. MATERIAL AND METHODS:This single center case-control study included 94 medial UKA with a cemented tibial component that were paired by propensity score matching to 94 medial UKA with a uncemented tibial component. The main evaluation criterion was the comparison of the survivorship of the UKA between a cemented tibial implant and those with a cementless tibial implant in terms of all-cause revision surgery at last follow-up. The secondary endpoints were the analysis of the causes of failure. RESULTS:The mean final follow-up was 6.1years (2.3). The overall survival rate in our serie of medial UKA was 92.4% [88.7%-96.3%] at five years. The overall survival rate in cemented group was and 91.5% [86.0%-97.3%] at five years and at 93.2% [88.1%-98.7%] at five years, in the uncemented group. No differences significant were observed in the two groups (p.value = 0.6). Only the tibial preoperative deformity was a risk factor of failure (HR: 1.11 [1.02, 1.20], value = 0.02). DISCUSSION:The use of a cemented or a cementless tibial component in a medial UKA did not influence the survival rate. LEVEL OF EVIDENCE:III; case control study.

BACKGROUND:The factors influencing return to work (RTW) after primary total hip arthroplasty (THA) remain a topic of debate. Understanding these factors is essential for optimizing postoperative recovery and patient counseling. This study aims to determine whether socio-professional status and clinical factors significantly influence the timing of RTW following elective hip replacement. The study addresses the following questions: (1) Does socio-professional status impact the timing of RTW after THA? (2) What clinical factors are associated with delayed RTW? (3) What is the typical length of sick leave for professionally active patients after THA? HYPOTHESIS:We hypothesize that socio-professional status and specific clinical factors, such as Body Mass Index (BMI) and postoperative complaints, significantly influence the timing of RTW after hip replacement. METHODS:A prospective cohort study was conducted, including 171 professionally active patients aged 18-65 years who underwent primary THA at an arthroplasty center in France between February 2020 and March 2021. Preoperative data on socio-professional status, job position, and clinical characteristics were collected. Occupations were categorized into six socio-professional groups based on physical demands. RTW status was assessed at 3 and 4 months postoperatively. Statistical analysis involved univariate and multivariate logistic regression to identify factors influencing RTW. RESULTS:Among the 171 patients (85 males, 86 females), the median age was 58 years (IQR: 53-61), and the median BMI was 25 kg/m² (IQR: 22-28) (24 (14%) patients had BMI >30 kg/m²). At the three-month follow-up, 136 patients (80%) had returned to work, with a median RTW time of 63 days (IQR: 58-76). The remaining 35 patients required an extended sick leave of 33 days (IQR: 8-42), with an overall median sick leave duration of 66 days (IQR: 60-90). Univariate analysis identified factors significantly associated with delayed RTW, including being an employee (OR = 2.386, 95% CI: 1.067-5.334 (p = 0.034)), higher BMI (OR = 1.114, 95% CI: 1.019-1.218 (p = 0.017)), and persistent postoperative complaints (OR = 4.476, 95% CI: 1.796-11.158 (p = 0.001)). Multivariate analysis confirmed that higher BMI (OR = 1.108, 95% CI: 1.004-1.223 (p = 0.041)) and persistent postoperative complaints (OR = 8.820, 95% CI: 3.172-24.529 (p < 0.001)) remained significant independent predictors of delayed RTW. CONCLUSION:Higher BMI and persistent postoperative complaints are the primary factors delaying return after total hip replacement, while socio-professional status shows a less significant impact when other factors are considered. These findings highlight the importance of addressing modifiable risk factors to facilitate a timely RTW and optimize patient outcomes. LEVEL OF EVIDENCE:IV; prospective study.

Contexte Les facteurs influençant le retour au travail (RTW) après une arthroplastie totale de hanche (PTH) primaire restent sujets à débat. Comprendre ces facteurs est essentiel pour optimiser la récupération postopératoire et les conseils aux patients. Cette étude vise à déterminer si le statut socioprofessionnel et certains facteurs cliniques influencent significativement le délai de retour au travail après une arthroplastie de hanche programmée. L’étude aborde les questions suivantes : (1) Le statut socioprofessionnel a-t-il un impact sur le délai de retour au travail après PTH ? (2) Quels facteurs cliniques sont associés à un retour au travail retardé ? (3) Quelle est la durée typique de l’arrêt de travail chez les patients actifs professionnellement après une PTH ? Hypothèse Nous faisons l’hypothèse que le statut socioprofessionnel et certains facteurs cliniques, tels que l’indice de masse corporelle (IMC) et les plaintes postopératoires, influencent significativement le délai de retour au travail après une arthroplastie de hanche. Méthodes Une étude de cohorte prospective a été menée auprès de 171 patients actifs professionnellement, âgés de 18 à 65 ans, ayant bénéficié d’une PTH primaire dans un centre spécialisé en arthroplastie en France, entre février 2020 et mars 2021. Les données préopératoires sur le statut socioprofessionnel, le poste occupé et les caractéristiques cliniques ont été recueillies. Les professions ont été réparties en six catégories socioprofessionnelles en fonction des exigences physiques du travail. Le retour au travail a été évalué à 3 et 4 mois postopératoires. L’analyse statistique comprenait des régressions logistiques univariées et multivariées pour identifier les facteurs influençant le retour au travail. Résultats Parmi les 171 patients inclus (85 hommes, 86 femmes), l’âge médian était de 58 ans (IQR : 53–61), et l’IMC médian de 25kg/m2 (IQR : 22–28) (24 patients (14 %) présentaient un IMC>30kg/m2). À 3 mois postopératoires, 136 patients (80 %) étaient retournés au travail, avec un délai médian de 63 jours (IQR : 58–76). Les 35 patients restants ont nécessité une prolongation d’arrêt de travail de 33 jours (IQR : 8–42), avec une durée médiane totale d’arrêt de 66 jours (IQR : 60–90). L’analyse univariée a identifié plusieurs facteurs significativement associés à un retour au travail retardé, notamment le statut d’employé (OR=2,386 ; IC95 % : 1,067–5,334 ; p=0,034), un IMC élevé (OR=1,114 ; IC95 % : 1,019–1,218 ; p=0,017), et la persistance de plaintes postopératoires (OR=4,476 ; IC95 % : 1,796–11,158 ; p=0,001). L’analyse multivariée a confirmé que l’IMC élevé (OR=1,108 ; IC95 % : 1,004–1,223 ; p=0,041) et les plaintes postopératoires persistantes (OR=8,820 ; IC95 % : 3,172–24,529 ; p<0,001) étaient des prédicteurs indépendants significatifs d’un retour au travail retardé. Conclusion Un IMC élevé et la persistance de plaintes postopératoires sont les principaux facteurs retardant le retour au travail après une PTH, tandis que le statut socioprofessionnel semble avoir un impact moindre lorsqu’on prend en compte les autres facteurs. Ces résultats soulignent l’importance d’agir sur les facteurs de risque modifiables pour favoriser un retour au travail précoce et améliorer les résultats postopératoires. Niveau de preuve IV ; étude prospective.

BACKGROUND:In 2014, based on biomechanical test results, the use of cementless Meije Duo™ (Corin, Cirencester, UK) stems (sizes 1 and 2) was contraindicated for patients weighing more than 60 kg to mitigate the risk of fracture. There is no data regarding the in vivo behavior of such components, therefore we did a retrospective study aiming to evaluate the incidence of stem breakage or failure in these patients, considering weight and activity level, with a minimum follow-up of four years. HYPOTHESIS:There is no greater risk of implant breakage for patients not following the ISO 7206-4 standard. METHODS:This retrospective, single-center, multi-operator study was conducted at a specialized hip prosthetic surgery center. It included all consecutive patients who received an cementless Meije Duo™ femoral stem (sizes 1 or 2) between 2007 and 2014, with at least four years of postoperative follow-up. Weight changes, complication occurrence, and the need for surgical revision were evaluated, alongside radiographic assessments for stem subsidence or non-integration. RESULTS:A total of 251 stems were analyzed, with a mean follow-up of 88 months (range, 77-109). Primary THA was performed in 241 cases (96%) and 10 (4%) were revision surgeries. The mean age at surgery was 59.3 years (range, 53-66 years), and the average weight was 66.2 kg (range, 40-103 kg). One hundred and fifty-eight THAs (62.9%, 158/251) were over 60 kg at the time of surgery. No stem breakages were observed at the final follow-up. Seven adverse events occurred (3.2%), including two dislocations, one instance of non-osseointegration, one case of femoral stem subsidence at three months without stem revision, and three femoral stem revisions (1.2%) (1 instance of subsidence at one year, 1 mechanical pain at seven years, 1 non-osseointegration following a periprosthetic fracture at 5 months). A significant increase in patient weight was observed (p = 0.02): 60% of THAs (140/233) experienced weight gain, with an average increase of 5 kg (range: 0.5-33 kg). Sixteen patients (6.8%, 16/233) had an inclusion weight <60 kg but > 60 kg at the last follow-up. Finally, the Devane score remained stable or increased in 176 patients (77.2%, 176/228). DISCUSSION:No stem breakage was observed in this cohort of patients considered at risk. A postoperative increase in body weight was noted in several cases, with some patients exceeding the weight limits set by the ISO 7206-4 standard. While these findings do not directly question the validity of the standard, they suggest that weight at the time of implantation may not be the sole parameter to consider when assessing the risk of stem breakage. LEVEL OF EVIDENCE:IV; retrospective study, therapeutic study.

Introduction La position du bassin dans le plan sagittal peut varier considérablement entre différentes positions fonctionnelles. L’adaptation de la position de la cupule en fonction de la relation entre le rachis et la hanche de chaque individu avant prothèse peut prévenir le risque de conflit prothétique. Pris individuellement, les facteurs de risque de cinématique lombopelvienne défavorables peuvent être difficiles à utiliser pour prédire avec une précision suffisante les patients à risque et l’utilisation de classifications ou algorithmes peut être complexe, le plus souvent associée à des valeurs bornées et dont l’association en pratique courante dans l’évaluation du risque peut être difficile. Hypothèse Nous avons fait l’hypothèse que la déconstruction de la matrice de données incluant l’âge et les paramètres lombopelviens (TP, LL, IP, FL et IP-LL) corrélée avec l’analyse de la cinématique lombopelvienne pourrait être utilisée pour définir une relation hanche rachis individualisée. Matériel et méthode Nous avons appliqué une analyse archétypale, qui est une approche probabiliste, basée sur les données et non supervisée, à une cohorte complète de phénotypes de 330 patients avant prothèse totale de hanche pour définir le profil lombopelvien de chaque individu en utilisant les paramètres lombopelviens sans valeur seuil. Pour chaque archétype, nous avons analysé la cinématique lombopelvienne, non implémentée dans la création des archétypes. Résultats Une méthode d’apprentissage non supervisée a révélé sept archétypes avec des profils de cinématique lombopelvienne distincts allant de −8,9° à 13,15° (p=0,0001) de la position debout à assise et de −5,35° à −10,81° (p=0,0001) de la position allongée à debout. L’archétype 1, représente le patient « idéal » (A1), avec des patients jeunes et sans anomalie lombopelvienne et le moins de risque d’anomalie de mobilité. Suivent 3 archétypes sans déséquilibre sagittal en fonction de leur lordose lombaire et incidence pelvienne, de la plus élevée à la plus faible (archétypes 2 à 4), l’archétype 4 exposant à un risque d’anomalie de cinématique lombopelvienne plus important par rapport aux autres. Puis 2 archétypes avec déséquilibre sagittal : l’archétype 5 avec bassin immobile dans le plan horizontal de la position debout à assise en bascule antérieure et l’archétype A6 avec un important tilt pelvien postérieur debout probablement compensatoire du déséquilibre et associé à la plus grande anomalie de cinématique lombopelvienne. Enfin l’archétype 7 avec rachis lombaire le plus raide sans déséquilibre sagittal et une importante cinématique défavorable de la position debout à assise. Conclusion Une approche archétypale des patients avant la pose d’une prothèse de hanche peut affiner les caractéristiques diagnostiques et pronostiques associées à la relation hanche–rachis et a réduit l’hétérogénéité, améliorant ainsi la caractérisation lombopelvienne. Cette stratification des risques d’anomalie de la cinématique lombopelvienne pourrait permettre de cibler les patients ayant besoin d’une adaptation de la position ou type des implants avant chirurgie prothétique. Niveau de preuve IV étude rétrospective.

INTRODUCTION:The position of the pelvis in the sagittal plane can vary considerably between different functional positions. Adapting the position of the acetabular cup in relation to the alignment between the spine and the hip of each individual, prior to prosthesis placement, can prevent the risk of prosthetic impingement. Taken individually, risk factors for unfavorable spinopelvic kinematics can be difficult to interpret when trying to precisely predict which patients are at risk. Furthermore, the use of classifications or algorithms can be complex, most often associated with limited values and often difficult to apply in current practices of risk assessment. HYPOTHESIS:We hypothesized that the deconstruction of the data matrix including age and spinopelvic parameters (SPT, LL, PI, LF and PI-LL) correlated with the analysis of spinopelvic kinematics could be used to define an individualized hip-spine relationship. MATERIAL AND METHOD:We applied archetypal analysis, which is a probabilistic, data-driven and unsupervised approach, to a complete phenotype cohort of 330 patients before total hip arthroplasty to define the spinopelvic profile of each individual using the spinopelvic parameters without threshold value. For each archetype, we analyzed the spinopelvic kinematics, not implemented in the creation of the archetypes. RESULTS:An unsupervised learning method revealed seven archetypes with distinct spinopelvic kinematic profiles ranging from -8.9 ° to 13.15 ° (p = 0.0001) from standing to sitting and -5. 35 ° to -10.81 ° (p = 0.0001) from supine to standing. Archetype 1 represents the "ideal" patient (A1); young patients without spinopelvic anomaly and the least at risk of mobility anomaly. Followed by 3 archetypes without sagittal imbalance according to their lumbar lordosis and pelvic incidence, from the highest to the lowest (archetypes 2-4), archetype 4 exposing a greater risk of spinopelvic kinematic anomaly compared to others. Then 2 archetypes with sagittal imbalance: archetype 5, with an immobile pelvis in the horizontal plane from standing to sitting position in anterior tilt and archetype A6, with significant posterior pelvic tilt standing, likely compensating for the imbalance and associated with the greatest anomaly of spinopelvic kinematics. Finally, archetype 7 with the stiffest lumbar spine without sagittal imbalance and significant unfavorable kinematics from standing to sitting. CONCLUSION:An archetypal approach to patients before hip replacement can refine diagnostic and prognostic features associated with the hip-spine relationship and reduced heterogeneity, thereby improving spinopelvic characterization. This risk stratification of spinopelvic kinematic abnormalities could make it possible to target patients who require adapted positioning or types of implants before prosthetic surgery. LEVEL OF EVIDENCE:IV retrospective study.

PURPOSE:This prospective clinical cohort was undertaken to determine the long-term risks of reinfection and all-cause aseptic failure after 1-stage exchange total knee arthroplasties (TKA) in a large series of consecutive patients with periprosthetic joint infection (PJI) following TKA. HYPOTHESIS:One-stage exchange for chronic PJI is an effective strategy, even in a non-selected population. PATIENTS AND METHODS:Non-selected patients (152 with 154 PJI) undergoing 1-stage-exchange TKA for PJI (January 2003-August 2015) were prospectively included and monitored for ≥2 years. PJI following TKA satisfying Musculoskeletal Infection Society diagnostic criteria were documented by microbiological culture results of preoperative joint aspirates and/or intraoperative samples. The cumulative incidences of total reinfections (i.e., relapses or new infections) and aseptic revisions were assessed. The mean follow-up (FU) duration was 7.5 years post-reimplantation. RESULTS:At the last follow-up, 35 knees had developed reinfections: 7 relapses and 28 new infections, with respective 14-year cumulative incidences of 4.8% and 20.6%. The 2-, 5- and 14-year cumulative total reinfection incidences were 12.3%, 21.3% and 24.3%, respectively. Respective 2-, 5-, 10- and 14-year aseptic component-revision incidences were 0.7%, 3.2%, 5.4% and 13.4%. Multivariate analysis retained male sex (HR 3.27, p < 0.01) and preoperative atrial fibrillation (HR 3.03; p = 0.01) as being significantly associated with greater risk of reinfection. CONCLUSIONS:One-stage-exchange TKA with aggressive debridement for chronic PJI is apparently a valid strategy, even for non-selected patients. It was associated with a low relapse rate, prevented morbidity and avoided economic social costs of 2-stage exchange. New infections with a different microorganism were observed more frequently and occurred even after years of FU. LEVEL OF EVIDENCE:II; Therapeutic.

IntroductionL’hallux valgus (HV) sévère est une entité moins fréquente mais dont le traitement est plus difficile. Le traitement peut être conservateur ou non. L’objectif principal de cette étude était d’évaluer le taux de satisfaction des opérés entre deux séries d’HV sévères corrigés par ostéotomie Scarf ostéosynthésée par plaque ou par arthrodèse de la première articulation métatarso-phalangienne (MTP1) avec un recul minimum d’un an. L’hypothèse était que l’arthrodèse est meilleure en termes de satisfaction et de qualité de résultats.Matériel et méthodesUne étude ambispective, monocentrique, mono-opérateur a été menée entre 2015 et 2021. Soixante et un pieds (25 arthrodèses et 36 Scarf) ont été inclus avec un suivi médian de 52,6 mois. Les données recueillies étaient la satisfaction, l’adaptation au chaussage, les douleurs persistantes, les complications et les récidives.RésultatsLes HV opérés par arthrodèse avaient de meilleurs résultats fonctionnels avec p<0,001 ; un taux de satisfaction de 92 % (60 % très satisfaits et 32 % satisfaits) vs 75 % dans le groupe Scarf (28 % très satisfaits et 47 % satisfaits), une moindre adaptation au chaussage (16 % vs 45 %) et présentaient moins de douleurs persistantes (12 % vs 42 %). Les complications et reprises semblent plus importantes dans le groupe Scarf. Le groupe Scarf retrouvait 3 évolutions en hallux varus (9 %) et 9 récidives (26 %).ConclusionLa comparaison du traitement des HV sévères par arthrodèse métatarso-phalangienne ou ostéotomie Scarf a fait apparaître un meilleur taux de satisfaction et de meilleurs résultats fonctionnels pour les HV opérés par arthrodèse de la MTP1. Elle n’a pas mis en évidence de différence significative des taux de complications et reprises, mais la présence d’hallux varus et hypocorrections dans le groupe Scarf.Niveau de preuveIII ; étude de cohorte ambispective.

Malgré le succès régulier des prothèses totales de hanche (PTH), certains patients en restent parfois insatisfaits. Une question posée par certains patients, en particulier à la vue des implants, est le poids que l’implant ajoute à leur hanche. Pourtant, il n’existe que très peu de données pour guider les chirurgiens dans leur réponse. Le but de cette étude était donc de comparer le poids de prothèses totales de hanche avec le poids de tissus enlevés. Que le poids des prothèses totales de hanche excède celui des tissus enlevés. Une étude prospective a été conduite sur 104 patients, sans interférer au planning chirurgical. Pour tenir compte de différences de design des implants, en particulier en termes de fixation de la tige, nous avons inclus à la fois des tiges sans ciment (n = 51) et cimentées (n = 53). Pendant l’intervention, le poids des os et tissus mous, ainsi que celui du ciment non utilisé fut mesuré. Le poids des implants a été fourni par le fabricant. Que les implants soient cimentés ou non, ils sont significativement plus lourds que les os et tissus mous enlevés. Le gain médian de poids était de 145 g [123–168] avec l’implant sans ciment et de 241 g [221–364] avec l’implant cimenté. L’analyse en régression multivariée des facteurs du patient ou de l’implant influençant la prise de poids après PTH a montré que la prise de poids diminuait avec l’IMC du patient (β = -1,0, IC à 95 % : -2,0 - -0,1 (p = 0,034)). En revanche, le gain de poids augmentait légèrement avec le poids total de l’implant (β = 0,7, IC à 95 % : 0,6 - 0,8 (p = <0,001)). De plus, la prise de poids était plus importante chez les femmes (β = 19,0, IC 95 % : 9,1–29,0 (p = <0,001) (hommes 150 g [135–219], femmes 211 g [157–250] (p = 0,010)) et les patients implantés avec une tige cimentée (β = 40,0, IC à 95 %, 19,4 - 46,5, p = <0,001). Les modèles actuels sont à l’origine d’un gain de poids de deux à trois fois le poids enlevé lors d’une PTH. Bien que les conséquences cliniques d’un tel gain de poids ne soient pas claires, ce résultat peut s’avérer utile pour répondre aux questions des patients. III, étude cas témoins.

Purpose Immediate revision refers to a reoperation that involves resetting, draping, and exchanging the implant, after wound closure in total hip arthroplasty. The purpose of this study is to investigate the impact of immediate revision after total hip arthroplasty on subsequent infection and complication rates. Methods A total of 14,076 primary total hip arthroplasties performed between 2010 and 2020 were identified in our institutional database, of which 42 underwent immediate revision. Infection rates were determined 2 years after the index arthroplasty. The cause and type of revision, duration of primary and revision surgeries, National Nosocomial Infections Surveillance score, implant type, changes in implants, complications, and preoperative and intraoperative antibiotic prophylaxis were all determined. Results No infections were observed within 2 years after the index arthroplasty. Leg length discrepancy (88%, n = 37) and dislocation (7.1%, n = 3) were the main causes of immediate revision. In most cases of discrepancy, the limb was clinically and radiologically longer before the immediate revision. The mean operative time was 48 ± 14 min for the primary procedure and 23.6 ± 9 min for the revision. The time between the first incision and last skin closure ranged from 1 to 3 h. None of the patients were extubated between the two procedures. Two patients had a National Nosocomial Infections Surveillance score of 2, 13 had a score of 1, and 27 had a score of 0. Conclusion Immediate revision is safe for correcting clinical and radiological abnormalities, and may not be associated with increased complication or infection rates. Study design Retrospective cohort study; level of evidence, 3.

PURPOSE:Although rare, fractures of ceramic components are difficult to revise, mainly due to the presence of residual ceramic debris that can cause catastrophic wear of the replacement components. Modern ceramic-on-ceramic bearings are suggested to improve outcomes of revision total hip arthroplasty (THA) for ceramic fractures. However, there are few published reports of mid-term outcomes of revision THA using ceramic-on-ceramic bearings. We evaluated clinical and radiographic outcomes of 10 patients who received ceramic-on-ceramic bearings during revision THA for ceramic fractures.METHODS:All patients but one received fourth-generation Biolox Delta bearings. Clinical evaluation was performed using the Harris hip score at latest follow-up, and all patients received a radiographic evaluation to analyze the fixation of the acetabular cup and of the femoral stem. Osteolytic lesions and the presence of ceramic debris were noted.RESULTS:After a mean follow-up of 8.0 years, there were no complications or implant failures, and all patients reported satisfaction with their implant. The average Harris hip score was 90.6. There was neither osteolysis nor loosening, but despite our extensive synovial debridement, ceramic debris was noted in the radiographs of five patients (50%).CONCLUSION:We report excellent mid-term outcomes, with no implant failures after eight years despite ceramic debris being found in a significant proportion of patients. We conclude that modern ceramic-on-ceramic bearings are an advantageous option for the revision of THA due to the fracture of initial ceramic components.

The aim of this study was to compare the weight of the total knee arthroplasty (TKA) implants and the weight of the natural knee. A prospective study was conducted with two different brands of cemented primary TKA. During the procedure, we collected the removed bone, soft tissues and the post-implantation cement and weighed them all separately at the end. In both groups, the implants plus cement were significantly heavier than the removed bone and soft tissues. The average weight gained was 266.7 ± 35.1 g for group 1 and 279.1 ± 48.7 g for group 2. This significant local weight gained after TKA is a new parameter that should be taken into account for further studies and when creating new implants.

PURPOSE The 6-item Foot Posture Index (FPI-6) is a reliable tool for the evaluation of foot deformities. Our aim was to translate and cross-culturally validate the FPI-6 for use in French-speaking countries and to determine the intra-rater and inter-rater reliability of the French version. METHODS Cross-cultural adaptation was performed according to guidelines. Two clinicians assessed the FPI-6 in 52 asymptomatic individuals. We evaluated intra- and inter-rater reliability with the intraclass correlation coefficients (ICC), correlations (p-value < 0.05) and Bland-Altman plots. Standard error of measurement (SEM) and minimum detectable change (MDC95) were determined. RESULTS For the cross-cultural adaptation, we modified several items of the FPI-6 user guide and added footnotes to ensure correct interpretation. ICC of the total FPI-6 scores were 0.94 to 0.96 for the intra- and inter-rater reliability for dominant and non-dominant lower limb. Correlations were significant (p < 0.001); r 0.88 to 0.92. Total score SEM was 0.68 to 0.78 and MDC95 was 1.58 to 1.82. CONCLUSIONS Intra- and inter-rater reliability of this French version of the FPI-6 was excellent for the total score and good to excellent for each item. The French FPI-6 can be used in French-speaking countries. The identification of SEM and MDC scores is useful for clinical interpretation.