Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose.

INTRODUCTION: The opinion on the necessity of patella resurfacing has been deeply divided in the scientific community. There are three approaches to the management of the patella in total knee arthroplasty (TKA). The first method involves always resurfacing the patella, the second method involves never resurfacing it, and the third method involves resurfacing the patella only under specific circumstances. Different data support each of these strategies, but no consensus on the best management has been reached. METHODS: This is a retrospective study of 106 cases of TKA (including 29 resurfaced patellas and 77 non-resurfaced patellas), over 5 years, at the Trauma-Orthopedics Department of the Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco. Our objective is to conduct a comparative study between TKA with patella resurfacing and those without resurfacing, by analyzing the functional and radiological results obtained after the operation, to show each technique's advantages and disadvantages. RESULTS: The average age of our patients was 65 years with extremes ranging from 46 to 80 years. There was a clear female predominance with a sex ratio of 0.2. The left side was predominantly affected. Primary gonarthrosis was the main diagnosis. Our results showed no significant difference between the two groups in terms of patient satisfaction and Knee Society Score (KSS). Nevertheless, complications generated by resurfacing, such as infection, anterior pain, stiffness, and loosening of the patellar component, as well as additional costs and increased operative time, were observed. In the majority of meta-analyses, there was no discernible difference in clinical and functional results between the resurfaced and non-resurfaced groups, suggesting that patellar resurfacing is not beneficial and, therefore, unnecessary. CONCLUSION: It appears that regular resurfacing is not necessary. However, there is agreement that resurfacing the patella is the best course of action for patients with inflammatory arthropathy, considerable patella malalignment, and severe patellofemoral osteoarthritis. There are arguments in favor of each of the patella resurfacing techniques, but none of them are particularly compelling, each of these strategies has its advantages and should not be considered bad. The final decision, therefore, rests on each surgeon's practice, training, and experience.

[Squamous cell carcinoma in a patient with chronic osteomyelitic lesion: a case report]. / Carcinome épidermoïde survenant sur une lésion d'ostéomyélite chronique: rapport de cas.

Squamous cell carcinoma associated with chronic osteomyelitis is rare. However, it must be suspected in patients with modification of common local symptoms. Delayed diagnosis can be fatal. Repeated biopsies can greatly help physicians who treat patients. We report the case of a 47-year-old patient diagnosed with carcinomatous degeneration associated with chronic osteomyelitis fistulized to the skin. Amputation was performed.

[Compartment syndrome complicating tennis leg: about a case]. / Syndrome de loges compliquant un tennis leg: rapport de cas.

Tennis-leg is a partial or total disinsertion of the medial head of the gastrocnemius muscle from its musculoskeletal junction. Patients receiving adequate treatment generally have favorable outcome. Tennis leg is rarely associated with major complications such as acute compartment syndrome. We report the case of a judo athlete with disinsertion of the right medial head of the gastrocnemius muscle complicated by acute compartment syndrome. Emergency aponeurotomy was required.

[Schwannoma of the sciatic nerve: a case report]. / Schwannome du nerf sciatique: à propos d´un cas.

Schwannomas of the sciatic nerve are rare tumors. They are mainly manifested by sciatic neuralgia rather than by sensory-motor deficits. We report the case of a 30-year-old female patient with right buttock pain for 1 year. Palpation revealed a positive Tinel sign. A magnetic resonance imaging (MRI) was performed which objectified a roughly rounded, regular mass of 2 cm in diameter in intimate contact with the large sciatic nerve. A complete excision of the tumor was carried out. This excision allowed the pain to disappear and the pathology examination concluded with a plexiform schwannoma.

[The association of stromal mesenchymal cells with the bone substitute for the treatment of non-union of long bones, an alternative to autologous spongy grafts: a case report]. / L´association de cellules mésenchymateuses stromales au substitut osseux pour le traitement des pseudarthroses des os longs, une alternative aux greffes spongieuses autologues: à propos d´un cas.

Bone is the most transplanted human tissue. Surgical interventions for bone repair are necessary for various pathologies such as nonunion, osteoporosis or osteonecrosis. Although autologous bone grafts remain the benchmark for bone regeneration, they unfortunately have a number of disadvantages: the need for a second intervention and the limited amount of tissue removed. Synthetic bone substitutes overcome some of these drawbacks, but their osteoinductive properties do not make it possible to treat significant bone losses. Cellular therapies based on mesenchymal stromal stem cells (MSC) in combination with bone substitutes may be alternatives to autologous bone grafting. It is in this context that we report the case of a patient with congenital dysplasia treated for non-union of the femur. The association of mesenchymal stem cells with bone substitute allowed us to obtain consolidation after 6 months.

[Total hip replacement as a result of coxalgia: about 10 cases]. / Prothèse totale de hanche dans les séquelles de coxalgie: à propos de 10 cas.

Coxalgia causes osteocartilaginous destructions of the hip joint; these lesions are responsible for severe pain leading to functional discomfort and limitations in everyday life. Their surgical treatment is still not well established. The aim of our study was to demonstrate the interest of total hip arthroplasty associated with anti-tuberculous chemotherapy to improve patients' quality of life. We report a retrospective study of 10 cases of total hip replacement following coxalgia at the Department of Orthopaedics and Trauma of Rabat University Hospital from 2002 to 2011. The average age of our patients was 38 years. The discovery of coxalgia was made under different circumstances according to the patients. The surgical approach we used was exclusively posterolateral (Moore). All prostheses were cemented. Four patients required acetabulum reconstruction. Intraoperative biopsy was positive in a patient, negative in the remaining nine. All patients underwent anti-tuberculous treatment. No recurrence was noted after a minimum follow-up of 3 years. Results according to Merle d'Aubigné score were considered good. In case of advanced bone destruction with badly tolerated functional impact in mature subject, total hip arthroplasty always associated with effective anti-tuberculous chemotherapy is the treatment of choice for sequelae of coxalgia.

[Cubitus varus: external subtraction osteotomy, should it still be recommended? Retrospective study of 25 cases]. / Cubitus varus: l'ostéotomie de soustraction externe a-t-elle toujours sa place? Etude rétrospective à propos de 25 cas.

Cubitus varus or malunion is most often secondary to displaced supracondylar fractures of the lower end of the humerus in children. Various surgical techniques have been proposed with different success rates but also with different reported complication rates. Our retrospective study of 25 cases diagnosed at the University Hospital of Rabat evaluated the results of the technique of external subtraction which was used in our training to handle this deformation.

The Monteggia fracture: series of 20 cases.

The Monteggia fracture is one of the pitfalls of conventional diagnosis of upper limb trauma. Through a retrospective study of 20 cases diagnosed at the Department of Orthopaedic Surgery and Traumatology, University Hospital Center, Ibn Sina, Mohamed V University, Rabat, Morocco, between 2010 and 2014, we have tried to do an update on the management of Monteggia fractures either at of paraclinical exams or the surgical management. We support the idea that the dislocation of the radial head should be sought systematically to any isolated fracture of the ulna, for not to miss fracture Monteggia authentic. Rehabilitation of the upper limb must be done as soon as possible.