Anterior tarsectomy long-term results in adult pes cavus.

PURPOSE OF THE STUDY: Anterior tarsectomy for pes cavus in adults is designed to relieve pain and correct the deformity. The present study reports radiological and clinical results with anterior tarsectomy in 39 cases of pes cavus. MATERIAL AND METHODS: The study concerned 39 cavus feet in 33 patients (22 males, 11 females; mean age: 31 years, range 16-49 years). Clinical outcome was assessed in terms of pain, function and motion, using the AOFAS classification. Radiological assessment (anteroposterior and lateral stress X-ray, views with Méary superficial wire-marking) measured the Djian angle, talometatarsal alignment, talar slope, calcaneal slope, calcaneal valgus, and osteoarthritis stage in adjacent joints. RESULTS: Mean follow-up was 9.8 years (range, 1-25). Mean AOFAS score at follow-up was 69.2/100 points (range, 14-100). Pain decreased considerably in 75% of cases, and 68% of patients recovered normal activity. The foot was aligned correctly in 67% of cases. At last follow-up, pes cavus remained undercorrected in 80% of feet, but mean Djian angle had improved from 100 degrees to 111.3 degrees. Calcaneal valgus improved from 30.8 degrees to 24.8 degrees and the podoscopic footprint was normal in 51% of feet. In 74% of feet, adjacent joints presented progressive osteoarthritic degeneration. Subjectively, 70% of patients were very satisfied or satisfied with minor reservations. Objective outcome was excellent or good in 66% of feet. DISCUSSION AND CONCLUSION: Outcome in terms of function, motion, complications and satisfaction was good, although pain relief results were poor. Anterior tarsectomy is able to correct initial pes cavus deformity and compensate anomalies of the hindfoot, but its correction capacity is limited, and its efficacy in case of clawfoot is poor. Anterior tarsectomy spares the adjacent Chopart complex and Lisfranc joints while inducing hypermobility, and leads to arthritis in 74% of cases. Better results are obtained in cases of reestablishment of the Méary-Tomeno line and of hindfoot valgus, as well as in cases of correction of equinus and clawfoot deformities. Worse results are observed in case of neurological evolutive disease or insufficient correction of the preceding deformities. LEVEL OF EVIDENCE: Level IV. Therapeutic Study.

[Hydroxyapatite-coated Esop modular femoral stem: three to ten year outcome in 155 cases]. / La prothèse fémorale Esop revêtue d'hydroxyapatite à modularité métaphysodiaphysaire: résultats à 5 ans de recul moyen d'une cohorte de 155 implants.

PURPOSE OF THE STUDY: Primary and secondary stability of the Esop prosthesis depends exclusively on cementless metaphyseal anchoring. This modular implant is composed of an hydroxyapatite-coated metaphysis on which a diaphyseal piece is added intraoperoperatively simply to act as a centering device. The purpose of this retrospective analysis of a consecutive series was to assess primary and secondary stability of the Esop implant by measuring axial migration over time. MATERIAL AND METHODS: Between 1995 and 2001, 172 primary total hip arthroplasties (THAs) were performed with the Esop femoral implant and the Atlas III acetabular implant. Six patients lost to follow-up and eleven patients who died were excluded from the analysis. The review thus concerned 155 THA in 128 patients (66 women and 32 men), mean age 57 years (age range 28-77 years), 53% with an occupational activity at the time of surgery. Degenerative hip disease and aseptic osteonecrosis were present in 87% of patients. Imagika, a dedicated software, was used to measure axial migration and overall offset of the THA at four distinct times: on the immediate pre- and postoperative films, after introduction of weight-bearing, and at last follow-up (mean 61 months, range 35-114 months). Survival and clinical and radiographic outcome were also assessed with the Postel-Merle-d'Aubigné (PMA) score. RESULTS: THA survival was 98%, all causes of failure included. The PMA score showed 97% excellent, very good or good outcome. Axial migration greater than 5 mm was demonstrated in ten hips (6.4%). Among these ten, seven exhibited migration during the first month than did not move further up to last follow-up. Comparison between the pre- and postoperative images revealed a 10 mm reduction in offset in 38% of hips, showing that the hip rotation center was medialized. DISCUSSION: Migration observed in ten implants corresponded to restablization at weight-bearing in seven. There was no correlation with the clinical outcome or poor radiological osteointegration. CONCLUSION: Primary and secondary stabilization of the Esop implant is satisfactory. In this series, the rotation center of the hip was globally medialized so that it would be useful to have available lateralized implants.