Joint awareness in osteoarthritis of the hip and knee evaluated with the 'Forgotten Joint' Score before and after joint replacement.

PURPOSE: To utilize the 'Forgotten Joint' Score (FJS), a 12-item questionnaire analysing the ability to forget the joint, for comparing preoperative status in osteoarthritic patients scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA). Higher scores represent a better result with a maximum of 100. The hypothesis of this study was that a preoperative difference in favour of hip arthritis could eventually explain why THA is cited more often as a forgotten joint than TKA. METHODS: A prospective cohort study was conducted in 150 patients with either tricompartmental knee (n = 75) or hip osteoarthritis (n = 75). Patients completed FJS-12 scores preoperatively and 1 year postoperatively. RESULTS: A similar preoperative FJS-12 was observed for hip (22 (15)) and knee osteoarthritis (24 (17)) (n.s.). The postoperative FJS-12 score was significantly higher for THA (80 (24)) than for TKA (70 (27)) (p < 0.05). High reliability after 6 weeks was observed for the preoperative FJS-12 test-retest reliability (ICC = 0.87) in TKA. A preoperative floor effect of 15 % in THA and 0 % in TKA was found as well as a postoperative ceiling effect of 33 % in THA and 9 % in TKA. CONCLUSIONS: The clinical relevance of utilizing the FJS-12 as an instrument to evaluate outcome is strongly proposed for knee arthroplasty. In general, one is not aware of a healthy joint during the ADL, and it can therefore be regarded as 'forgotten'. The preoperative FJS-12 Score is a powerful tool to provide patients with clearer insights into their positive evolution after surgery. The use of the FJS-12 in THA is a topic for further research, as this study found that floor and ceiling effects limit its usefulness in studies evaluating clinical outcome in this area. LEVEL OF EVIDENCE: II.

[Treatment of trochanteric fractures of the femur using the gamma nail (apropos of a series of 92 cases)]. / Traitement des fractures trochantériennes du fémur par le clou gamma (à propos d'une série de 92 cas).

The authors treat inter- and subtrochanteric fractures with the Gamma nail. This device, which can be placed through the skin, immediately gives a stable internal fixation and offers possibilities of compression during and after surgery without any risk of head perforation. The authors discuss the results and complications of 92 operated cases reassessed after a delay of 6 to 28 months. The average age was 78 years, and 95% of the patients had been injured in home accidents. The surgical technique must be strict. Weight-bearing is complete 48 hours postoperatively, whatever the type of fracture, in 82% of the patients. Early standing postoperatively has allowed a definitive reduction in the general complications which are otherwise frequent in this type of fracture. The authors analyze the various complications they experienced during and after the surgery. Six complications during surgery have been noted and result from technical errors. These include 4 diaphyseal fractures, one case of reamer breakage and one case of drill breakage. Thirteen complications occurred after surgery: 3 diaphyseal fractures, 3 loose screws, one pseudarthrosis and 6 painful diaphyses. The authors also noted that painful diaphysis occurs when the cervical diaphysis angle of the nail is greater than 130 degrees.

[Avulsion-fracture of the subscapular muscle]. / Avulsion-fracture du muscle sous-scapulaire.

The authors report a case of avulsion-fracture of the humeral insertion of the subscapularis muscle, treated by surgery. They discuss this lesion and review the literature.