Minimally invasive sacroiliac joint fusion secondary to lumbosacral fusion: Clinical and functional results at 2years of follow-up.

INTRODUCTION: Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion. MATERIALS AND METHODS: We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years' follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion. RESULTS: The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery. DISCUSSION: After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included. CONCLUSION: Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally. LEVEL OF EVIDENCE: IV, retrospective study.

Identification and treatment of potentially destabilizing Vancouver B-lesser trochanter periprosthetic fracture ("New B2"): A 33-case series.

INTRODUCTION: A new type of periprosthetic fracture, between Vancouver-SoFCOT types A and B, was recently described and labeled "new B2". It occurs intraoperatively or in the early postoperative period, on cementless implants, and features a posteromedial cortical fragment around the lesser trochanter. The main aim of the present study was to report clinical and radiological results in a series of 33 cases of what is better called Vancouver B-lesser trochanter (VB-LT) fracture. The secondary objective was to identify risk factors. The study hypothesis was that VB-LT fracture might occur in the late postoperative course. MATERIAL AND METHOD: A2 single-center retrospective study included all patients with postoperative periprosthetic VB-LT fracture diagnosed on standard X-ray. Treatment was operative or non-operative depending on femoral implant subsidence and the patient's general health status. RESULTS: There were 33 VB-LT fractures out of 445 periprosthetic femoral fractures (7.5%), in 27 women and 6 men; all were postoperative, at a mean 47 months (range, 1 day to 20 years). Mean subsidence of the femoral stem was 8.8mm, in 73% of cases (24 out of 33 implants). The 9 VB-LT1 fractures (without subsidence) were treated non-operatively, without secondary displacement. Thirteen of the 24 VB-LT2 fractures (with subsidence) were managed by stem exchange and cerclage; 3 other patients had isolated stem exchange, 2 had isolated internal fixation by cerclage, and 6 in poor health were managed non-operatively. At a mean 28 months' follow-up (range, 6-48 months), mean PMA score was 15.5 (range, 10-18), Harris Hip score 72.4 (range, 43-100) and Parker score 7.2 (range, 4-9). All cases showed osseointegration and implant stability; there was 1 case of non-union, without impact on stability. CONCLUSION: Postoperative Vancouver B-lesser trochanter fracture seemed specific to cementless implants and did not occur exclusively in the early postoperative period. Non-operative treatment gave good results when there was no implant subsidence (type VB-LT1). LEVEL OF EVIDENCE: IV, retrospective.

Same-day bilateral total knee replacement versus unilateral total knee replacement: A comparative study.

INTRODUCTION: Bilateral total knee arthroplasty (TKA) in a single session is rarely done in France, mainly due to the increased risk of perioperative and late complications. The primary objective of this study was to compare the complication rates of same-day bilateral TKA (TKA bilat) with that of unilateral TKA (TKA unilat). The hypothesis was bilateral TKA increases the rate of early and late complications in a group of selected patients (ASA 1 or 2, less than 80 years of age). MATERIAL AND METHODS: Retrospective comparative study of 91 bilat TKA and 182 unilat TKA cases operated on between 2009 and 2016 (1 bilat TKA paired with 2 controls). The patients were matched based on age, sex, indication and ASA score. The minimum follow-up was 2 years. Mortality along with early and late complications were documented. The secondary endpoints were implant survival, functional outcomes, and patient satisfaction. RESULTS: The early mortality rate was zero in both groups. The early complication rate was lower in the bilat TKA group (9%) than in the unilat TKA group (22%) (p<0.001). The late complications did not differ between groups. Implant survival at 5 years was 99% (95% CI=[95.6-99.7]) in the bilat TKA group and 97% (95% CI=[92.8-98.8]) in the unilat TKA group. The autologous blood transfusion rate was 33% in the bilat TKA group and 2.2% in the unilat TKA group (p<0.001). There was no difference between groups in the satisfaction rate or the KOOS and New IKS scores. A larger share of patients in the unilat TKA group (54%) said they had forgotten about their knee than in the bilat TKA group (43%) (p=0.036). DISCUSSION: There were few early complications in the bilat TKA group. There was no significant difference in the number of late complications, survival, functional scores, or patient satisfaction between the two groups. The transfusion rate was higher in the bilat TKA group, while the forgotten knee rate was higher in the unilat TKA group. CONCLUSION: Our hypothesis was not confirmed: in the context of this study, in patients who are ASA 1 or 2, and less than 80 years old, same-day bilateral TKA does not increase the complication rate relative to unilateral TKA. LEVEL OF EVIDENCE: III, comparative study of continuous paired cases.

One-session bilateral total knee replacement: Late complications and survivorship.

INTRODUCTION: The early morbidity and mortality of one-session bilateral total knee arthroplasty (1-session BTKA) has been reported in the medical literature. However, there is less information about the long-term clinical impact of this strategy. The aim of this study was to report on the late complications (>90 days), clinical outcomes (KOOS and new KSS) along with the survivorship of 1-session BTKA. We hypothesised that 1-session BTKA will cause few late complications and that the implant survival will meet the criteria of the National Institute for Health and Clinical Excellence (NICE). METHODS: This single-centre retrospective study analysed a cohort of ASA-1 and ASA-2 patients who underwent 1-session BTKR over an 8-year period (2009 to 2016). The cohort consisted of 116 patients (66% women, 34% men) with mean age at inclusion of 69 years (32-85 years); 22% of patients were ASA-1 and 78% were ASA-2. The implant-related, infection-related or mechanical complications that occurred more than 90 days after the operation, the clinical outcomes (KOOS and New KSS) and radiological outcomes, along with the survivorship were determined during the scheduled follow-up visits at 3 months, 6 months and 1 year postoperative and during the long-term follow-up or during an intercurrent event. RESULTS: No patients were lost to follow-up. Fifteen complications occurred (6.5%): four infections, four patellar problems (three cases of clunk syndrome and one of patellofemoral pain), four cases of stiffness, two of unexplained pain and one femoral periprosthetic fracture. Eight patients were readmitted to the hospital (7%); seven were reoperated (3%) and two implants were revised (1%). The functional outcomes (KOOS and New KSS) were significantly improved and 87% of patients were satisfied or very satisfied with this procedure. At a mean follow-up of 5 years, the survivorship estimated using the Kaplan-Meier method was 98.4% (95% CI: 0.933-0.996). CONCLUSION: Performing 1-session BTKA is a reliable strategy as it produces a low rate of late complications, excellent medium-term functional outcomes and survivorship that meets NICE criteria, thus confirming our hypothesis. LEVEL OF EVIDENCE: IV, retrospective case series.