Objective
To analyze the factors associated with response to anti–tumor necrosis factor (anti‐TNF) treatment and compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients ...with refractory noninfectious uveitis.
Methods
This was a multicenter observational study of 160 patients (39% men and 61% women; median age 31 years interquartile range 21–42) with uveitis that had been refractory to other therapies, who were treated with anti‐TNF (IFX 5 mg/kg at weeks 0, 2, 6, and then every 5–6 weeks n = 98 or ADA 40 mg every 2 weeks n = 62). Factors associated with complete response were assessed by multivariate analysis. Efficacy and safety of IFX versus ADA were compared using a propensity score approach with baseline characteristics taken into account. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (95% CIs) were calculated.
Results
The main etiologies of uveitis included Behçet's disease (BD) (36%), juvenile idiopathic arthritis (22%), spondyloarthropathy (10%), and sarcoidosis (6%). The overall response rate at 6 and 12 months was 87% (26% with complete response) and 93% (28% with complete response), respectively. The median time to complete response was 2 months. In multivariate analysis, BD and occurrence of >5 uveitis flares before anti‐TNF initiation were associated with complete response to anti‐TNF (SHR 2.52 95% CI 1.35–4.71, P = 0.004 and SHR 1.97 95% CI 1.02–3.84, P = 0.045, respectively). Side effects were reported in 28% of patients, including serious adverse events in 13%. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR 0.65 95% CI 0.25–1.71, P = 0.39), serious side effects (SHR 0.22 95% CI 0.04–1.25, P = 0.089), or event‐free survival (SHR 0.55 95% CI 0.28–1.08, P = 0.083).
Conclusion
Anti‐TNF treatment is highly effective in refractory inflammatory uveitis. BD is associated with increased odds of response. IFX and ADA appear to be equivalent in terms of efficacy.
In recent years, different alignments have been described for acetabular components in total hip arthroplasty (THA), to reduce the risk of impingement and edge loading. Currently there are 3 main ...options: mechanical (40° inclination/15° anteversion relative to the anterior pelvic plane), anatomic (40° inclination/anteversion parallel to the transverse ligament) and combined kinematic (according to spinal-pelvic parameters). There are no studies comparing all three in terms of impingement and edge loading. We therefore performed a retrospective case-control in-vitro study comparing risk of impingement and edge loading between the three alignments.
The study hypothesis was that combined kinematic alignment incurs significantly less risk of impingement and edge loading than do the other two types of alignment.
Using a THA planning system, we simulated the 3 alignments for 90 patients undergoing THA with a ceramic-on-ceramic bearing between November 2019 and January 2022; for each simulation, we recorded any prosthetic impingement or edge loading. The study endpoint was the rate of prosthetic impingement or edge loading between the 3 alignments.
With the mechanical alignment, 31% of patients (28/90) showed risk of impingement and 22% (20/90) risk of edge loading. With the anatomic alignment, 31% of patients (28/90) showed risk of impingement and 23.3% (21/90) risk of edge loading. With the combined kinematic alignment, 12.2% of patients (11/90) showed risk of impingement and 8.9% (8/90) risk of edge loading. Pairwise comparison showed that the combined kinematic alignment was associated with significantly less impingement and edge loading than the mechanical alignment (respectively, p=0.03 and p=0.022) or the anatomic alignment (respectively, p=0.03 and p=0.014), while the mechanical and anatomic alignments did not differ.
A combined kinematic cup alignment in THA significantly reduced the risk of impingement and edge loading compared to mechanical and anatomic alignments.
III, retrospective case-control study.
Abstract
Purpose
To define the more stable knot tightening of a suture bridge when a single limb is preserved.
Methods
Five different sutures were tested: No. 2 Ethibond (Ethicon), Hi-Fi (ConMed ...Linvatec), Sutblue (SBM), SingleFlat (SBM), Hi-Fi Ribbon (ConMed Linvatec). A Surgeon’s Knot was tied around a 30-mm circumference device, 6 times for each experiment. A single limb was kept to analyze failure modes of the knot. First step was to analyze which of pulling or sliding suture of the construct must be kept preventing failure of the knot. The cutting distance from the knot was evaluated at 1 mm and 4 mm with the suture loops pre-tensioned to 10 N and fixed to a second row after a 50 N tension load. The more stable construct was found: a single-pull load to 100 N and cyclic load (to 50 N for 30 cycles) experiments were conducted to evaluate the impact of cycling on knot loosening.
Results
The more stable construct was obtained when the non-post limb was tensioned, and the post limb was cut at 4 mm (
p
< 0.01). Loop circumference increased after each experiment for all tested sutures, independently of the preserved limb and the cutting distance. Elongation was significant for all tested sutures in all groups. Knot failure mostly occurred by slippage, only with tapes.
Conclusions
A suture-bridge construct with the non-post limb preserved and the post limb cut at a 4 mm distance from the knot provides with the best security. Sutures are safer than tapes in suture bridge.
Background:
The Simple Ankle Value (SAV) is a patient-reported outcome measure (PROM) in which patients grade their ankle function as a percentage of that of their contralateral uninjured ankle.
...Purpose/Hypothesis:
The primary aims of this study were to validate the SAV and evaluate its correlation with other PROMs. It was hypothesized that the SAV would be seen as a valid score that provides results comparable with those of the Foot and Ankle Ability Measure (FAAM) and the European Foot & Ankle Society (EFAS) score.
Study Design:
Cohort study (Diagnosis); Level of evidence, 2.
Methods:
Patients seen for an ankle or hindfoot tissue were divided into those treated operatively and nonoperatively. A control group of patients treated for issues outside of the foot and ankle was also created. All patients completed the SAV followed by the FAAM and the EFAS scores. Patients treated operatively completed the questionnaires before surgery and 3 months after surgery. Patients treated nonoperatively completed the questionnaires twice 15 days apart. The correlation between the SAV score, the FAAM score, and the EFAS score was estimated with the Spearman correlation coefficient.
Results:
A total of 209 patients (79 in the operative group, 103 in the nonoperative group, and 27 in the control group) were asked to complete the questionnaire, and all were included. The test-retest reliability of the SAV was excellent (intraclass correlation coefficient, 0.92; 95% CI, 0.88-0.94). No ceiling or floor effect was reported. Strong correlation was found between the SAV and the FAAM and EFAS scores. The SAV was able to discriminate patients from controls (54.18 ± 21.22 and 93.52 ± 9.589; P < .0001); however, SAV was not able to detect change from preoperative to 3 months postoperative (from 54.18 ± 21.22 to 62.53 ± 20.83; P = .44).
Conclusion:
Our study suggests that the SAV is correlated with existing accepted ankle PROMs. Further work with this PROM is needed to validate the questionnaire.
The placement of prostheses for a total hip arthroplasty (THA) is essential to limit complications and optimize functional results. In a recent study of more than 100 THA placed through a direct ...anterior approach using a traction table, we found that the mean anteversion of the cup was greater (30°) than recommended (20°). To explain this phenomenon, we considered that the anterior pelvic plane (APP), defined by the plane passing through the anterior-superior iliac spines and the pubic symphysis, which serves as a landmark for the placement and calculation of the anteversion of the cup, was not horizontal when the patient was lying on the traction table. This concept has not been evaluated so we conducted a prospective study to: 1) measure the position of the pelvis on a traction table; 2) compare to the standing position, 3) assess its impact on the anteversion of the cup.
The standing pelvic version is identical to the supine pelvic version on the traction table.
A prospective 3-month monocentric study was conducted. All patients operated on for a THA by a direct anterior approach, on a traction table, were included. The position of the pelvis was assessed by measuring the tilt of the APP on lateral pelvic X-rays, while on the traction table and while standing. The impact of the position of the pelvis on the positioning of the cup, as well as the anteversion, were measured using the EOS imaging system. The anatomic anteversion of the cup was measured in relation to the APP.
Fifty-eight patients were included (32 women, 26 men) with an average age of 67 years. The tilt of the supine APP was 6°±8.3 range of −10.5 to 31.0 (indicating a retroverted pelvis on the traction table). The difference between the tilt of the standing and lying APP (within 90°) was not significant (standing was on average 4.5° range of −11.0 to 27.0 versus lying on the table, was on average 6° range of −10.5 to 31.0 (p=0.75). A strong correlation was observed between the tilt of the supine APP and the anatomic anteversion of the cup (p<0.001). Thus, the more retroverted the pelvis was on the traction table, the lower the anatomic anteversion of the acetabular cup.
The supine pelvis on the traction table is not always horizontal and its position on the traction table is similar to its standing position, within 90 degrees. The analysis of the positioning of the preoperative pelvis appears to be essential in the planning of a THA through direct anterior approach using a traction table.
IV; Prospective Cohort Study.
Purpose
Undiagnosed and undertreated posterior malleolus fractures lead to early ankle instability and arthritis. A preoperative CT scan could improve the management of those fractures. This study ...assessed the benefits of a systematic ankle CT scanner to diagnose and manage posterior malleolus fracture.
Methods
A monocentric retrospective cohort study was conducted. Sixty consecutive patients with bimalleolar fractures were operated and underwent a preoperative CT scan. The mean age was 50.0 years old (18.6 years old) with a mean body mass index of 20.3 (kg/m
2
) (11.4 kg/m
2
) and 71.7% (43/60) of women. The primary outcome was the rate of posterior malleolus fragment diagnosed on X-rays and on CT scan. Secondly, interobserver and interobserver’s agreement were compared between conventional X-rays and CT scan.
Results
Thirty-five (58.3%) posterior fragment fractures were observed on X-rays and 53 (88.3%) on the preoperative CT scan (
p
< 0.01). The intraobserver reproducibility for X-rays was low (0.02 − 0.23; 0.27) and moderate for CT scan (0.45 0.0; 0.84). The interobserver reproducibility for X-rays was moderate (0.39 0.15; 0.60) and excellent for CT scan (0.78 0.0; 1.0).
Conclusion
A wide proportion of bimalleolar fractures are associated with posterior malleolus fractures and undiagnosed with standard X-rays. We advocate a systematic preoperative CT scan in the management of bimalleolar fractures.
Level of evidence
Level IV, retrospective cohort study.
Trial registration number
2218999v0, date of registration: 11/08/2020 (retrospectively registered).
Introduction:
Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, ...it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection.
Technique:
We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget’s disease.
Conclusions:
Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.
Purpose
The SARS-CoV-2 epidemic started in December 2019 in Wuhan. The lockdown was declared on March 16, 2020 in France. Our centre had to adapt daily practices to continue to take care of bone and ...soft tissue tumours and emergencies. Through this study, we wanted to assess the various procedures implemented during the lockdown period between March 17 and May 10.
Methods
A monocentric retrospective cohort study was conducted in Cochin Hospital (Paris, France). Patients included were those who had surgery during the lockdown period. To take care of COVID-19 positive and negative patients, various procedures have been set up: reverse transcriptase polymerase chain reaction (RT-PCR) tests for all hospitalized patients, a specific unit for COVID-positive patients, a specific surgical room, and use of protective personal equipment.
To allow the effectiveness of the procedures implemented, we evaluated the number of complications attributed to SARS-CoV-2 and the number of patients who became COVID positive during hospitalization.
Results
During the lockdown period, there were 199 procedures of three types of procedures in our centre: 79 traumatology procedures (39.7%), 76 of bone and soft tissues tumours (38.2%), and 44 procedures related to infection (22.1%). We observed 13 complications (6.5%) during hospitalization, and only one patient became COVID-19 positive during the hospitalization.
Conclusion
The COVID-19 epidemic has been a challenge for organization and adaptation to manage all COVID-19 positive and COVID negative. Through this study, we wanted to assess our procedures taken. They had been effective due to the low number of contamination and complications.
Purpose
Osteochondral defects have a limited capacity to heal and can evolve to an early osteoarthritis. A surgical possibility is the replacement of the affected cartilaginous area with a ...resurfacing device BioPoly™ RS Partial Resurfacing Knee Implant. The aim of this study was to report the clinical and survival outcomes of the BioPoly™ after a minimum follow-up of 4 years.
Methods
This study included all patients who had a BioPoly™ for femoral osteochondral defects greater than 1 cm
2
and at least ICRS grade 2. The main outcome was to observe the KOOS and the Tegner activity score were used to assess outcomes preoperatively and at the last follow-up. The secondary outcomes were the VAS for pain, the complications rate post-surgery and survival rate of BioPoly™ at the last FU.
Results
Eighteen patients with 44.4% (8/18) of women were included with a mean age of 46.6 years (11.4), a mean body mass index (BMI) of 21.5 (kg/m
2
) (2.3). The mean follow-up was 6.3 years (1.3). We found a significant difference comparing pre-operative KOOS score and at last follow-up respectively, 66.56(14.37) vs 84.17(7.656),
p
< 0.01. At last follow-up, the Tegner score was different respectively, 3.05(1.3) vs 3.6(1.3),
p
< 0.01. At 5 years, the survival rate was of 94.7%.
Conclusions
BioPoly™ is a real alternative for femoral osteochondral defects greater than 1 cm
2
and at least ICRS grade 2. It will be interesting to compare this implant to mosaicplasty technic and/or microfracture at 5 years postoperatively regarding clinical outcomes and survival rate.
Level of evidence
Therapeutic level III. Prospective cohort study.
Background
The use of a tibial stem for large deformities (> 10°) would reduce the incidence of pain. The aim of this study was to compare the effect of tibial stem on postoperative pain and aseptic ...loosening at the tibia in patients with a preoperative deformity > 10° in the frontal plane at 2 years follow-up.
Methods
This was a retrospective single-center case–control study. Ninety-eight patients with deformities greater than 10° in the frontal plane and a BMI > 30 kg/m
2
who had undergone posterior-stabilized (PS) total knee arthroplasty (TKA) with a tibial stem were matched using a propensity score to 98 patients who had undergone PS TKA without a tibial stem. The primary endpoint was the pain rate at 2 years. The secondary endpoints were the rate of aseptic loosening of the tibia at 2 years post-operatively.
Results
A significant difference was found in the rate of postoperative pain at 2 years. It was higher in the group without tibial stem compared with the group with tibial stem (41.8% vs 17.3%,
p
= 0.0003). In the group without tibial stem, 24.4% of pain was mild, 61% moderate and no severe pain. In the tibial stem group, 47.1% of pain was mild, 41.2% moderate and no severe pain. A radiolucent line (RLL) was present at 2 years in 26.5% of prostheses in the without tibial stem group and in 9.2% of prostheses in the tibial stem group (
p
= 0.002).
There was no difference between the two groups in terms of aseptic loosening.
Conclusion
The use of a tibial stem in primary TKA in patients with frontal deformities greater than 10° reduces postoperative pain and the presence of radiolucent lines.
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