[Evaluation of antibiotic curative treatments in a French orthopedic surgery unit]. / Evaluation des antibiothérapies curatives dans les services de chirurgie orthopédique d'un CHG.

INTRODUCTION: The aim of this study was to evaluate the technical quality and the relevance of antibiotics used in an orthopedic unit. DESIGN: A prospective and descriptive assessment was made of patients hospitalized in the orthopedic surgery department of our general hospital, receiving antimicrobial therapy. The relevance of antibiotics was evaluated using as a reference local guidelines previously validated by the antibiotics committee. RESULT: During the period of study, 37 of the 249 hospitalized patients received antibiotics (14.9 %). The reasons for hospitalization were mainly lower limb trauma (38 %) and an infectious disease (35 %). Hospital-acquired infections accounted for 16.2 % of antibiotic prescriptions. During the study, we observed that the dose regimen was inappropriate in 9 % of the cases, that the expected length of treatment was not indicated (76 %), and that the mode of administration was not mentioned in 8 % of the cases. Twenty five percent of combinations were not relevant. Finally, 27.3 % of prescriptions were not in conformity with guidelines. CONCLUSIONS: The quality and relevance of antibiotics used as curative treatments in the orthopedic surgery unit seem satisfactory for the dose regimen, the route and dose of administration and combinations used. We identified a few points which need to be improved: update and improvement of local antibiotherapy guidelines, promotion of training sessions for new prescribers in the institution.

Survival of cementless dual mobility socket with a mean 17 years follow-up.

PURPOSE OF THE STUDY: As part of the 2006 symposium of the French Hip and Knee Society devoted to the dual mobility socket, we report a retrospective multicentric series of 438 first-intention total hip prostheses with a dual mobility socket at a mean 17 years follow-up. The purpose of our report was to ascertain the 15-year survival of this socket and analyze failures. MATERIAL AND METHODS: The series included 438 primary replacements. This was a homogeneous multicentric series. The cementless sockets were 80 Novae-1 titanium Serf cups and 358 Novae-1 stainless steel Serf cups. All stems were inserted without cement: 185 Pf((R)) stainless steel screwed Serf stems, 228 PRO titanium screwed Serf stems, and 25 Corail stems. The mobile polyethylene insert was retaining. All of the heads were 22.2-mm chromium-cobalt heads. Degenerative hip disease was the main etiology and mean follow-up was 17 years (range, 12-20). Mean age at implantation was 54.8 years (range, 23-87). The actuarial method with a 95% confidence interval was used to determine the 15-year cup survival rate. RESULTS: At the last follow-up, none of the patients had presented an episode of early or late instability. Analysis of the socket at last follow-up showed 13 aseptic loosenings, 23 intraprosthetic dislocations, and seven replacements of the polyethylene insert for wear. The overall 15-year prosthesis survival rate was 89.2+/-8.7%. The overall 15-year socket survival rate was 96.3+/-3.7%. DISCUSSION: The fact that, at last follow-up, none of the implants had shown instability confirms the long-term stability of the dual mobility socket. The results in terms of 15-year survival confirm earlier reports. The main cause of failure was cup fixation, which is the weak point of this technique with the initial Novae cup design, which did not have hydroxyapatite coating. The second leading cause was intraprosthetic dislocation, which can be divided into three main categories. The first is intraprosthetic dislocation in a context of pure wear with normal function of the dual mobility socket; the retaining feature of the insert loses its efficacy due to wear. The second category is intraprosthetic dislocation in a context of cup loosening with a third-body effect and increased retention wear, in which case we consider that cup loosening is the primary event leading to rapid secondary wear and subsequent intraprosthetic dislocation. The third category is intraprosthetic dislocation caused by a blockage in a context of fibrosis or impingement involving severe heterotopic ossifications. We had only two femoral failures related to aseptic loosening, most certainly related to use of noncemented implants, which limits the extension of granulomas to the polyethylene. Studying the three series from Saint-Etienne more specifically, where three different configurations were used, it would appear that the titanium cup has a better survival rate and that the titanium used for the thinner necks may be an unfavorable factor for intraprosthetic dislocation.

[Survival of dual mobility socket with a mean 17 years follow-up]. / Etude d'une série de 438 cupules non cimentées à double mobilité

PURPOSE OF THE STUDY: Within the framework of the 2007 symposium of the French Hip and Knee Society devoted to the dual mobility socket, we report a retrospective multicentric series of 438 first-intention total hip prostheses with a dual mobile socket at 17 years mean follow-up. The purpose of our report was to ascertain the 15-year survival and analyze failures. MATERIAL AND METHODS: The series included 438 first-intention prostheses. This was a homogeneous multicentric series. Sockets were: 80 Novae-1 titanium Serf cups and 358 Novae-1 stainless steel Serf cups. All stems were inserted without cement: 185 Pf) stainless steel screwed Serf stems, 228 PRO titanium screwed Serf stems, 25 Corail stems. The mobile polyethylene insert was retaining. All of the heads were 22.2mm chromium-cobalt heads. Degenerative hip disease was the main etiology and mean follow-up was 17.18 years (range: 12-20). Mean age at implantation was 54.8 years (range: 23-87). The actuarial method with 95% interval of confidence was used to determine the 15-year cup survival. RESULTS: At last follow-up, none of the patients had presented an episode of early or late instability. Analysis of the socket at last follow-up showed: 13 aseptic loosenings, 23 intraprosthetic dislocations, and seven replacements of the polyethylene insert for wear. The overall 15-year prosthesis survival was 89.2+/-8.7%. The overall 15-year socket survival was 96.3+/-3.7%. DISCUSSION: The fact that at last follow-up none of the implants had exhibited instability confirms the long-term stability of the dual mobility socket. The results in terms of 15-year survival confirm earlier reports. The main cause of failure was cup fixation, which is the weak point of this technique with the initial Novae cup, which did not have hydroxyapatite coating. The second leading cause was intraprosthetic dislocation, which can be divided into three main categories. The first is intraprosthetic dislocation in a context of pure wear with normal function of the dual mobility; the retaining feature of the insert looses its efficacy due to wear. The second category is intraprosthetic dislocation in a context of cup loosening with a third-body effect and increased retention wear, in which case we consider that the cup loosening is the primary event leading to secondary rapid wear and subsequent intraprosthetic dislocation. The third category is intraprosthetic dislocation cause by a cam effect in a context of fibrosis or impingement involving a large calcification. We have had only two femoral failures by aseptic loosening, most certainly related to use of noncemented implants, which limits the extension of granulomas to the polyethylene. Studying more specifically the three series from Saint-Etienne where three different configurations were used, it would appear that the titanium cup has a better survival and that the titanium used for the thinner necks would be an unfavorable factor for intraprosthetic dislocation.

[Use of a bilobed flap for the treatment of mucous cysts]. / Utilisation d'un lambeau bilobé pour le traitement des kystes mucoïdes juxta-unguéaux.

INTRODUCTION: In the case of mucous cysts with attenuated skin, the authors suggest radical excision of the cyst together with the overlying skin. The skin defect is repaired with a bilobed flap whose donor site is left to heal by secondary intention. This surgical procedure also allows exploration of other areas of mucoid degeneration and repair of the proximal nail fold when necessary. METHOD: Twenty-six patients with an average age of 59 years (27 cysts), were operated with this procedure. Nail bed deformities were present in 55% of the cases. The cyst and the overlying skin were radically excised in conjunction with a dorsal capsulectomy; the use of the bilobed flap made the dissection easier, and flap translation allowed cover of the capsulectomy area and simultaneous repair of the nail fold in eight cases. RESULTS: Patients were reviewed with an average follow-up of 13.7 months. Seventy percent of the patients had no pain, and in 85% of the cases there was no loss of motion. Cosmetic appearance was satisfactory, and nail bed deformities disappeared or clearly subsided in 86% of the cases. One patient developed recurrence. DISCUSSION: Many surgical procedures have been described for mucous cysts treatment. This simple procedure allows radical excision of the cyst and the attenuated skin with low risk for the germinal matrix, precise location of cyst origin, repair of the nail fold and good skin cover in the capsulectomy area.