Reproducibility of length measurements of the lower limb by using EOS™.

BACKGROUND: Lower-limb discrepancy following total hip arthroplasty is the third-most common reason for patient dissatisfaction in orthopaedic surgery. Therefore, accurate planning and evaluation methods are mandatory. The main aim of this study was to evaluate the reliability of the EOS™ system by establishing and comparing the reproducibility of lower-limb automatic and manual 3D measurements. We hypothesized that the reproducibility of the lower-limb measurements is similar regardless of the method used and with an agreement higher than 0.95 for the length parameters. MATERIALS AND METHODS: This study utilized an EOS radiological database of 112 patients. Two independent observers performed two rounds of lower-limb measurements twice, either in manual 3D or automatic 3D mode. The intra- and inter-observer reproducibility was evaluated by the calculation of the intra-class coefficient for each measurement method. The methods were then compared. RESULTS: The intra- and inter-observer reproducibility for length measurements found with the manual and automatic 3D methods was always > 0.98. There was no significant difference in the reproducibility between the two measurement modes, with the exception of the offset, hip-knee-shaft, and neck-shaft angles. CONCLUSION: Our results indicate a very good reproducibility of EOS™ length measurement, regardless of the method used. Automated 3D mode is preferred for the collection of angular and offset measurements. Furthermore, manual mode measurements are not affected by surgical history. Level of evidence IV.

Comparison of the reliability of leg length and offset data generated by three hip replacement CAOS systems using EOS™ imaging.

INTRODUCTION: Computer-assisted orthopaedic surgery (CAOS) theoretically will help to optimise total hip arthroplasty (THA) results. Although CAOS systems have become more sophisticated, they are not widely used, partially because of their suspect reliability. To assess reliability of these systems, we carried out a study with multiple objectives in mind: (1) establish and compare the accuracy of the leg length (LL) measurement from three CAOS systems; (2) analyse the correlation of LL and offset data generated by these CAOS systems with those of the EOS™ imaging system; (3) determine if the goals of leg length restoration with ±2 and ±5 mm were achieved; (4) evaluate why certain cases fails. HYPOTHESIS: The three CAOS systems have the same accuracy for LL, and their error is less than or equal to 0.6mm. MATERIAL AND METHODS: We retrospectively studied 106 cases of primary THA where preoperative and postoperative measures of leg length had been performed with an EOS™ imaging system. The cases were placed in three groups, depending on which CAOS system had been used: group A (Amplivision™, amplitude), group B (Hip Express™, Brainlab), group P (THS™, Praxim). The accuracy of the leg length data was calculated by finding the difference between the data from each CAOS system and the gold-standard EOS measurements. RESULTS: The leg length accuracy was -0.846 [-5 to 9], -0.675 [-9 to 18] and 0.542 mm [-5 to 13], respectively for groups A, B and P. The accuracy was significantly lower in group A than B (P=0.044) and group P (P=0.038). The Pearson correlation coefficient for CAOS and EOS measurements was 0.189, 0.701 and 0.891 for leg length and 0.668, 0.202 and 0.680 for offset, for groups A, B and P, respectively. No difference between groups were observed relative to the leg length objectives being achieved within ±2 mm (P=0.61) and ±5 mm (P=0.314). There were no differences in terms of the number of CAOS failures: three in group A, one in group B and three in group P (P=0.06). CONCLUSION: The Praxim™ and Brainlab™ CAOS systems had similar accuracy for leg length measurements, and both were better than the Amplitude™ system. Only the Praxim™ had an error of less than 0.6mm. All the CAOS systems had values less than 1mm, which is considered excellent. LEVEL OF EVIDENCE: Level IV, retrospective study.

Median nerve compression in carpal tunnel caused by a giant lipoma.

A lipoma is a common, benign soft-tissue tumor that rarely arises in the upper limb. When one does occur in the hand, the location of the lipoma can cause nerve compression, which can mimic carpal tunnel symptoms. Magnetic resonance imaging is the visualization modality of choice for diagnosis and surgical planning of lipomas. Surgical resection is recommended to relieve the neurological manifestations of this disease. The surgeon should always suspect liposarcoma first before voluminous, atypical, or recurrent tumors are considered.

Reconstruction of closed rupture of thumb flexor tendon pulleys with a single free palmaris longus tendon graft: a case report and review of literature.

Closed rupture of thumb flexor tendon pulleys is extremely rare. Several techniques have already been described for finger pulley reconstruction. Various techniques based on prior anatomic and biomedical studies have been proposed for thumb pulley reconstruction, in which one or two of the three pulleys are replaced. In the present study, we describe an original technique using a single, free palmaris longus (PL) autograft for thumb pulley reconstruction.

Efficacy of tranexamic acid on blood loss after primary cementless total hip replacement with rivaroxaban thromboprophylaxis: A case-control study in 70 patients.

INTRODUCTION: Perioperative blood loss is a frequent cause of complications in total hip replacement (THR). The present prospective study assessed the efficacy of tranexamic acid (Exacyl(®)) in reducing blood loss in primary THR associated to rivaroxaban (Xarelto(®)) thromboprophylaxis. HYPOTHESIS: Tranexamic acid associated to rivaroxaban reduces blood loss. MATERIAL AND METHOD: A prospective case-control study included 70 primary cementless THRs performed by a single surgeon on a standardized technique, between September 2009 and September 2010. Thirty-seven patients received perioperative tranexamic acid; all patients received rivaroxaban thromboprophylaxis. RESULTS: There was no significant difference between the two groups in terms of peroperative blood-loss volume or rates of thromboembolic or ischemic events or hematoma. Postoperative blood loss, D0-5 differential hemoglobinemia and real blood loss (in mL 100% hematocrit) were significantly lower in the tranexamic acid group. No transfusions were required in the tranexamic acid group, versus four in the control group. DISCUSSION: Tranexamic acid associated to direct anti-Xa (antithrombin-independent) oral anticoagulants was effective in reducing postoperative blood loss, improving hemoglobinemia at 5 days and reducing transfusion rates. The results also confirmed the efficacy of and tolerance for rivaroxaban thromboprophylaxis in primary THR, with no clinical thrombotic events induced by the association of tranexamic acid with rivaroxaban. CONCLUSIONS: Tranexamic acid is a simple means of reducing postoperative blood loss in THR, without increased risk of thromboembolism when associated to rivaroxaban thromboprophylaxis. LEVEL OF EVIDENCE: Level III prospective case-control study.