New radiographic monitoring indices for total trapeziometacarpal prostheses.

OBJECTIVE: The objective of this study is to propose and evaluate a method of monitoring implants via the calculation of a trapezial and metacarpal index from radiological measurements and to describe an initial patient analysis. METHODS: This retrospective study describes the trapezial index which reflects the trapezial bone stock not occupied by the trapezial cup, while the metacarpal index reflects the rate of metacarpal occupation by the prosthetic stem. Those indexes were used on a series of 20 patients with a Maïa™ prosthesis with a minimum follow-up of seven years. The indexes were measured immediately postoperatively and at the various annual check-ups. Four observers measured each index on two occasions, to obtain an inter- and intra-observer correlation coefficient. RESULTS: The average intra-observer correlation coefficient for the trapezium index was 0.94, for the metacarpal index 0.98. The inter-observer correlation coefficient was 0.93 for the trapezium index, 0.94 for the metacarpal index on average. The post-hoc calculated power was 0.98 as the number of subjects required was not usable. The mean immediate postoperative trapezial index was 45.74%, compared with a value at longest follow-up of 41.74%, reflecting a highly significant loss of height of 8,74%. The mean immediate postoperative metacarpal index was 77.69% compared with a mean value at longest follow-up of 78.99% indicating a non-significant increase in the index of 1,67%. CONCLUSION: Proposed indexes had excellent inter- and intra-observer correlation, the metacarpal one is stable over time whereas the trapezial one reveals changes in some patients, requiring further investigations. These simple and reproducible indexes allow precise monitoring of trapeziometacarpal prostheses and identify radiographic changes that should lead to additional examinations to improve survival of implants. LEVEL OF EVIDENCE: III, retrospective single cohort study.

Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases.

INTRODUCTION: The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling. HYPOTHESIS: Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria. MATERIAL AND METHODS: A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration. RESULTS: At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm). CONCLUSION: The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset. LEVEL OF EVIDENCE: IV; retrospective cohort study.

Use of Cannulated Screws for Primary Latarjet Procedures.

Background: Rapid consolidation of the bone block is paramount for the success of the Latarjet procedure. Noncannulated screws have shown satisfactory long-term bone block fusion, while cannulated screws are challenged with inferior mechanical properties and fusion rates. Purpose: To report outcomes of the Latarjet procedure using cannulated screws, notably bone block fusion and complication rates at 3 months, as well as clinical scores and return to sports at minimum 2 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: We reviewed the records of 124 consecutive patients (124 shoulders) who underwent primary Latarjet procedures using cannulated screws between 2015 and 2018. All patients underwent clinical examination at 3 months postoperatively, including range of motion and radiographs to assess graft fusion. The Walch-Duplay score, Rowe score, Subjective Shoulder Value, and visual analog scale for pain were collected at a minimum follow-up of 2 years. Results: Overall, 9 patients (7%) required reoperation: 7 (6%) had screw removal for unexplained residual pain, 1 (0.8%) had lavage for deep infection, and 1 (0.8%) had evacuation to treat a hematoma. Furthermore, 3 patients (2.4%) had recurrent instability, none of whom underwent reoperation. At 3-month follow-up, all 124 shoulders showed complete radiographic graft fusion, and at 40 ± 11 months (mean ± SD; range, 24-64 months), 88% of patients had returned to sport (109/124), the Walch-Duplay score was 86 ± 14, Rowe was 84 ± 15, Subjective Shoulder Value was 88 ± 11, and visual analog scale for pain was 1 ± 1. Conclusion: The clinical relevance of these findings is that 4.5-mm cannulated screws are safe and effective for primary Latarjet procedures and grant adequate graft healing, with low recurrence of instability and a high rate of return to sports.

Walch B2 glenoids: 2-dimensional vs 3-dimensional comparison of humeral head subluxation and glenoid retroversion.

Background: The posterior subluxation and glenoid version in Walch B2 glenoids are routinely assessed by 2-dimensional (2D) computed tomography (CT). Different methods of calculation are used to analyze these parameters. Alternatively, the rising use of 3-dimensional (3D) planification tools in arthroplasty requires the clarification if the 3D measurements are equivalent to 2D. The aim of this study was to compare B2 glenoids characteristics between 2D CT assessment method and 3D automated software method. Methods: CT scans from patients who underwent a shoulder arthroplasty were identified. In the 2D method, measurement of glenoid version was determined. Measurement of the humeral head subluxation (HHS) (scapula axis method) was determined by the percentage of the humeral head posterior to the Friedman line (scapula axis). Three-dimensional analysis allowed an automated segmentation of the humerus and scapula, definition of scapular planes, and determination of glenoid version and HHS. Results: Fifty-one CT scans met inclusion criteria. The intraobserver and interobserver reliability of the 2D retroversion (RV) and 2D HHS intraclass correlation coefficient was excellent (intraclass correlation coefficient>0.9).The median RV was 16° [12-20] in 2D and 19° [16-23] in 3D (P < .0001). The median subluxation was 71% [66-75] in 2D and 81% [78-86] in 3D (P < .0001). Linear regression analysis demonstrated low positive correlation between RV and subluxation in 2D and 3D (R2 = 0.31 and R2 = 0.23, respectively). Discussion/Conclusion: The assessment of version and HHS in Walch B2 glenoids between 2D CT and a 3D planification were significantly different. Low correlation between RV and HHS was observed (2D and 3D assessment).

Arthroscopy training in France: A resident perception and self-assessment.

BACKGROUND: Arthroscopic surgery is a steadily expanding component of orthopaedic practice that changes continuously as new techniques and indications develop. The many arthroscopy training activities offered to residents include fellowships, practice on cadaver specimens and simulators, and teaching in the operating room. Current practices for arthroscopy training of orthopaedic residents in France have not yet been evaluated. The objectives of this study were to describe current arthroscopy training practices and to assess the perceptions and expectations of residents and junior physicians in France, in order to contribute to the development of a new training strategy for residents. HYPOTHESIS: Residents and junior physicians perceive gaps in their arthroscopy training. METHODS: Between November 2018 and February 2019, the Junior French Arthroscopy Society (Société Francophone d'Arthroscopie Junior, SFAJ) conducted a descriptive epidemiological survey of 918 residents, clinical fellows, and junior physicians in orthopaedic surgery departments in France. The data were collected via an online questionnaire sent by e-mail. The questionnaire had items on demographics; perceptions of, and expectations about, arthroscopy skills training during the residency; and experience in performing arthroscopic procedures. RESULTS: Of the 918 residents, 106 responded to the questionnaire. Most respondents were near the end of their training: 26 (24.8%) were 4th-year residents, 23 (21.6%) were 5th-year residents, 15 (14.3%) were clinical fellows, and 13 (12.4%) were junior physicians. Among respondents, 42 (40%) had performed fewer than 5 simple arthroscopy procedures as the main operator and 73 (69.5%) felt they were not, or would not be, capable of performing arthroscopic procedures without supervision by the end of their residency. CONCLUSION: The survey findings highlighted the challenges encountered by French orthopaedics residents in acquiring satisfactory arthroscopy skills during their residency. They also suggested avenues for improvement such as simulator training or the development of training on cadaver specimens. LEVEL OF EVIDENCE: IV, descriptive survey.

Bone-borne distractor versus tooth-borne distractor for orthodontic distraction after surgical maxillary expansion: The patient's point of view.

INTRODUCTION: Orthodontic distraction after surgical maxillary expansion is a mode of treatment regularly used in the context of transverse maxillary constriction. There is, however, no consensus in the literature as to the type of distractor (bone-borne or tooth-borne) that should be used. PATIENTS AND METHOD: This retrospective study compared orthodontic distraction using a bone-borne or a tooth-borne distractor from the point of view of tolerance, ease of use and overall patient satisfaction, by means of a questionnaire completed by patients undergoing maxillary expansion surgery in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital between January 2013 and March 2015. The efficacy of the two distractors was also assessed. RESULTS: Thirty-two patients were included: 10 in the bone-borne distractor group and 22 in the tooth-borne group. Sixty percent of patients questioned found the bone-borne distractor easy to use compared with 32% for the tooth-borne distractor (P=0.167). Tolerance was noted to be comparable and acceptable by the two groups. The overall satisfaction rate was high for both groups at over 90%, and was correlated with ease of use and clear information. The average space gain between the first molars was 11.1mm with the bone-borne device and 10.7mm for the tooth-borne appliance. CONCLUSION: The use of a bone-borne distractor for orthodontic distraction after maxillary expansion surgery appears to be an effective, simple and well-tolerated alternative to the use of a tooth-borne distractor. According to patients, this distractor also appears easier to use than the traditional Hyrax-type distractor. This ease of use is correlated with overall satisfaction.