Clinique des Cedres

Cornebarrieu, France

Clinique des Cedres

Cornebarrieu, France
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Prudhon J.L.,Clinique des Cedres | Caton J.H.,Clinique Emilie de Vialar | Aslanian T.,Groupe lepine | Verdier R.,Groupe lepine
International Orthopaedics | Year: 2017

Introduction: Since the first measurement method of patella height in 1929 (Janssen), more than 16 methods have been described. Most of these measures are not suitable to measure patella height after total knee arthroplasty (TKA). One of us (JC) modified the original Caton Deschamps (oCD), index with a new relative index called modified Caton Deschamps (mCD) index, by using new landmarks. The purpose of this study was to determine how patella height is modified after TKA. Material and method: Sixty primary TKAs were consecutively prospectively enrolled. One type of implant was used (cementless postero-stabilized TKA, rotating plateau, cemented patella resurfacing). Patient’s characteristics, functional and radiological outcomes were recorded pre-operatively and at one year follow-up. Pre-operative and post-operative outcomes were compared by paired t-test. Post-operative outcomes were compared between groups by one-way analysis of variance. Results: Average difference between pre and post-operative mCD was 0.19 in this series. In 81.7% of cases, patella was lowered. Patients were classified in three groups according to patella height lowering. Between these three groups, no significant statistical differences (IKS score knee and function, range of motion) could be identified. Discussion: In TKA, patella assessment in sagittal plane is as important as frontal or horizontal planes. True patella infera (TPI) is mostly due to patella tendon shortening measured by oCD. Pseudo patella infera (PPI) measured by mCD is mostly due to joint line elevation (over femoral cut with an over thickness of the tibial component). In this study a moderate patella lowering (minor than 15%) does not have a significant impact on the functional results (IKS, ROM) nevertheless in 80% patella is lowered. The next step will be to analyze precisely what factors are influencing this lowering and what prevention could be suggested in primary and revision TKA. © 2017 SICOT aisbl

Collette M.,rue Jean Benaets | Cassard X.,Clinique des Cedres
Orthopaedics and Traumatology: Surgery and Research | Year: 2011

The Tape Locking Screw (TLS ®) system, developed in 2003, is a new anterior cruciate ligament (ACL) reconstruction method that is based on three principles: one hamstring tendon is harvested, prepared into a short (50 to 60mm), four to five strand closed loop, with a diameter of 8 to 10mm and a 500N pre-load; the tunnels are shorter than usual (10 or 15mm) and created in a retrograde manner to match the diameter of each end of the graft. Maximum press-fit into the bone recesses is obtained by a specific graft introduction method; femoral and tibial fixation is provided by polyethylene terephthalate tape strips, or TLS ® strips, that pass through each end of the closed tendon loop and attach to bone with a dedicated interference screw, the TLS ® screw.Our preliminary clinical evaluation consisted of a follow-up of 134 patients. © 2011 Elsevier Masson SAS.

Caton J.H.,Clinique Emilie de Vialar | Prudhon J.L.,Clinique des Cedres | Aslanian T.,Groupe lepine | Verdier R.,Groupe lepine
International Orthopaedics | Year: 2016

Introduction: We described in 1981 a method to evaluate patellar height in normal and symptomatic knees on sagittal X-ray view. This index is a frequently used method, yet it is not suitable after a total knee arthroplasty (TKA). Material and method: The original method measures the distance between the distal margin of the articular surface of the patella (point A) and the anterosuperior angle of the tibial plateau (point T), then the length of the patellar articular surface (AP). The index is AT/AP ratio (normal values range from 0.8 to 1.2). After TKA, the T landmark is no longer available, so we must define a new T’ landmark. This point is situated at the intersection between the line perpendicular to the tibial posterior cortex elevated at the tip of the fibular head and the tibial anterior cortex. This remarkable landmark can be identified before and after TKA, with a new relative index AT’/AP ratio. This modified method allows the comparison of patella height before and after TKA. Results: We have used this modified index with the collaboration of several authors during the testing of different models of TKA, with an accurate reproducibility. Repeatability (usually called intra-observer reliability) was good, with intra-class correlation coefficients (ICCs) between 0.58 and 0.75 among the observers. Reproducibility (usually called inter-observer reliability) was also considered as good, with ICC ranging from 0.64 to 0.72. Discussion: Patella height measurement has to be assessed with the original method (AT/AP) to detect patella infera that could influence the surgical approach. The correlation between original and modified indexes has to be assessed. The modification of patella height after TKA could be evaluated through the modified index and compared with functional results. © 2016 SICOT aisbl

Caton J.H.,Clinique Emilie de Vialar | Prudhon J.L.,Clinique des Cedres | Ferreira A.,Clinique du Parc | Aslanian T.,Groupe Lepine | Verdier R.,Groupe Lepine
International Orthopaedics | Year: 2014

Purpose: Mid- and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85% survivorship at 25-year follow-up. However, dislocation still remains an unsolved problem. Dislocation may occur throughout the patient's and implant's life. The aim of this study is to answer the question: does a dual mobility cup (DMC) decrease the dislocation risk? Methods: We report comparative results at ten years of follow-up of two groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n =215) and the other one with a DMC (group 2, n =105). Results: In group 1, 26 dislocations (12.9%) occurred. In group 2 only one dislocation (0.9%) occurred. This dislocation was successfully reduced by closed reduction, without any recurrence. This difference was statistically significant (p =0.0018). In group 1, the reason for revision was recurrent dislocation in 21 cases. Five patients were revised for other reasons. The global revision rate was 12.9%. In group 2, two patients needed revision surgery for aseptic loosening. The global revision rate was 2.1%. This difference was statistically significant (p =0.054). The goal was reached for the patients of group 2 who had more risks factors for dislocation (age, aetiology, American Society of Anesthesiologists and Devane scores) than those of group 1. Conclusions: When using a DMC, we observed a low rate of dislocation in primary THA (0.9%). This surgical choice seems to be a safe and effective technique in Charnley-type THA, especially in a high-risk population. © Springer-Verlag 2014.

Prudhon J.-L.,Clinique des Cedres | Ferreira A.,Clinique du Parc | Verdier R.,Groupe Lepine
International Orthopaedics | Year: 2013

Purpose: The dual mobility cup introduced in France by Gilles Bousquet has been used in total hip replacement in high-risk patients. This device acts as a large ball implant and significantly reduces the risk of dislocation following hip arthroplasty. Published French literature has focused on low rates of dislocation and long-term follow-up similar to the low-friction arthroplasty. Methods: We retrospectively reviewed a continuous series of 105 cases of dual mobility cup Quattro (Groupe Lépine, Genay, France) implanted from 2000 to 2002. Selection of the patients requiring a primary hip replacement depended on risk criteria such as age, hip disease and activity score. The dual mobility cup was associated with a modular cemented femoral component and a 22.2-mm stainless steel head. Results: One dislocation occurred one month after the index surgery requiring no revision surgery. According to the Kaplan-Meier method, survival probability was 95.0 % (95 % confidence interval 81.5-98.8) at ten years of follow-up. Conclusions: Based on clinical outcome and patient assessment we conclude that the dual mobility cup is a reliable option to decrease dislocation risk without increasing polyethylene wear. © 2013 Springer-Verlag Berlin Heidelberg.

Prudhon J.L.,Clinique des Cedres | Steffann F.,Clinique des Cedres | Ferreira A.,Clinique du Parc Lyon | Verdier R.,Groupe lepine | And 2 more authors.
International Orthopaedics | Year: 2014

Method: We enrolled 78 consecutive patients (79 cases) in a prospective study. Mean interval between index surgery and revision was 12.9 years. Mean age at revision was 75.5 years. Two types of cementless DMC were used: a standard DMC in 68 cases with low-grade bone defect (Paprosky grade 1 and 2), and a specific design reconstruction DMC in 11 cases with severe bone loss (Paprosky grade 3).Results: At two years of follow-up, 68 patients were reviewed; four were lost to follow-up., and six patients were deceased. We identified three types of situations at risk:standard risk (33 cases), Paprosky grade 1 or 2; medium risk (37 cases), revision for recurrent instability (21), periprosthetic fractures (14) or severe loosening Paprosky grade 3 without femorotomy (2); high risk (nine cases), revision for severe loosening with a femorotomy. One (1.3 %) patient dislocated her hip at one month without recurrence. Revision rate for dislocation was 0 %; two (2.7 %) early mechanical failures occurred.Purpose: Dislocation is a frequent complication in total hip arthroplasty (THA) revision. Cup fixation is the second concern. In order to know outcomes at two years, we prospectively followed a continuous series of 78 patients to demonstrate that cementless dual-mobility cup (DMC) used in revision THA is safe as regards dislocation risk and bone fixation.Conclusion: Considering outcomes of this series, cementless DMC can be suggested in THA revision surgery. © 2014, SICOT aisbl.

Caton J.,Clinique Emilie De Vialar | Prudhon J.L.,Clinique des Cedres
International Orthopaedics | Year: 2011

Background: Since 1962, the low friction arthroplasty (LFA) developed by Sir John Charnley has spread widely throughout the world. Many series have reported long-term results. Polyethylene (PE) wear is well known. The average wear ratio is about 0.1 mm a year. Many factors may influence that wear process. Purpose: The authors describe two different series of patients operated upon with Charnley's total hip arthroplasty (THA) using the original cemented stem and a non modular 22.2-mm head, with a cemented full polyethylene acetabular socket. Outcomes confirm excellent patient function after 25 years. They emphasise the fact that PE is the weak point of total hip arthroplasty. Function may be excellent even though PE wear is significant. In several cases, no wear at the maximum follow-up was detectable. Results: This study confirms different publications relating long-term follow-up with LFA. During a Charnley meeting in Lyon, we published a survival curve of 85% after 25 years. Berry et al. published a 86.5% survival curve (J Bone Joint Surg Am 84:171-177, 2002). In 1995, Luc and Marcel Kerboul published a 77% survival rate after 20 years in young patients under 40 years old at the time of the surgery. In 2009, Callaghan et al. published a series of 35 years follow-up with a ratio of 78% survivorship (J Bone Joint Surg Br 91:2617-2621). Conclusion: Could the long-term results be improved? Through recent decades,many solutions have been introduced to improve the survivorship of THA including bearing surfaces such as alumina-on-alumina and metal-on-metal. Different problems have occurred with these solutions. LFA might be improved by working on the nature and the quality of the head. Improvements might also be obtained by working on the quality and the hardness of the acetabular socket. © The Author(s) 2011.

PubMed | Clinique des Cedres, Sanatorio Allende, Southern Oregon Orthopedics, Arthrex Inc. and 3 more.
Type: Journal Article | Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2016

Arthroscopic remplissage of a Hill-Sachs lesion is classically described as a capsulotenodesis of the infraspinatus within the posterolateral humeral head. The aim of this cadaveric study was to evaluate the anatomic relationship between the position of anchors and sutures placed for remplissage and the infraspinatus and teres minor. The hypothesis was that remplissage actually corresponds to a capsulomyodesis of the infraspinatus and teres minor muscles.A two-anchor arthroscopic remplissage was performed followed by open dissection of ten fresh-frozen human cadaveric shoulders. The exit point of sutures related to muscle-tendon unit as well as the distance between the anchors and the rotator cuff was measured.The superior sutures were localized generally in the infraspinatus, near the musculotendinous junction. The inferior sutures passed through the teres minor muscle in seven of ten cases. The distance between the superior and inferior anchors and the posterolateral greater tuberosity was 14 2 and 12 3 mm, respectively.Arthroscopic remplissage is a capsulomyodesis of infraspinatus and teres minor rather than a capsulotenodesis of the infraspinatus alone as previously believed. Muscular damage may explain posterosuperior pain observed in patients who underwent remplissage.

Cassard X.,Clinique des Cedres | Cavaignac E.,Toulouse University Hospital Center | Maubisson L.,Toulouse 1 University Capitole | Bowen M.,NorthShore Orthopaedics
Journal of Pediatric Orthopaedics | Year: 2014

Background: The management of anterior cruciate ligament (ACL) tears in growing patients must balance activity modification with the risk of secondary (meniscal and cartilaginous) lesions, and surgical intervention, which could adversely affect skeletal growth. Many ACL reconstruction techniques have been developed or modified to decrease the risk of growth disturbance. We have not found any description of ACL reconstruction using a single hamstring, short graft implanted into intraepiphyseal, retroreamed sockets. Our hypothesis was that the technique that we used restored the knee stability and did not cause any growth disturbances. Methods: We retrospectively studied 28 patients (20 boys, 8 girls) who presented with a unilateral ACL tear and open growth plates. We performed short graft ligament reconstruction with the semitendinosus folded into 4 strands around 2 polyethylene terephthalate tapes. The graft was implanted into sockets that were retroreamed in the femoral and tibial epiphysis and the tapes were fixed remotely by interference screws. After a minimum period of 2 years, we evaluated the comparative knee laxity, the radiographic limb morphology, the appearance of secondary lesions, and the functional outcomes using the Lysholm and Tegner scores. Comparative analyses were performed using the Student t test with subgroups depending on the type of fixation used. Results: The mean age of the patients was 13 years (range, 9 to 15 y). The mean follow-up was 2.8 years (range, 2 to 5 y). The mean difference in laxity at 134 N was 0.3 mm, as determined using a GNRB arthrometer. No patients reported meniscal symptoms or degenerative changes. We found no angular deformity or leg length inequality. Two patients suffered a recurrent ACL tear. Conclusions: The preliminary results from this series are consistent with prior studies demonstrating that intraepiphyseal ACL reconstruction is a safe reliable alternative for the pediatric population. Study design: Case series; level of evidence 4. Copyright © 2013 by Lippincott Williams & Wilkins.

Murgier J.,Institute Of Lappareil Locomoteur | Cassard X.,Clinique des Cedres
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Background: Cryotherapy is a useful adjunctive analgesic measure in patients with postoperative pain following anterior cruciate ligament (ACL) surgery. Either static permanent compression or dynamic intermittent compression can be added to increase the analgesic effect of cryotherapy. Our objective was to compare the efficacy of these two compression modalities combined with cryotherapy in relieving postoperative pain and restoring range of knee motion after ligament reconstruction surgery. Hypothesis: When combined with cryotherapy, a dynamic and intermittent compression is associated with decreased analgesic drug requirements, less postoperative pain, and better range of knee motion compared to static compression. Materials and methods: We conducted a case-control study of consecutive patients who underwent anterior cruciate ligament reconstruction at a single institution over a 3-month period. Both groups received the same analgesic drug protocol. One group was managed with cryotherapy and dynamic intermittent compression (Game Ready®) and the other with cryotherapy and static compression (IceBand®). Results: Of 39 patients, 20 received dynamic and 19 static compression. In the post-anaesthesia recovery unit, the mean visual analogue scale (VAS) pain score was 2.4 (range, 0-6) with dynamic compression and 2.7 (0-7) with static compression (P= 0.3); corresponding values were 1.85 (0-9) vs. 3 (0-8) (P= 0.16) after 6. hours and 0.6 (0-3) vs. 1.14 (0-3) (P= 0.12) at discharge. The cumulative mean tramadol dose per patient was 57.5. mg (0-200. mg) with dynamic compression and 128.6. mg (0-250. mg) with static compression (P= 0.023); corresponding values for morphine were 0. mg vs. 1.14. mg (0-8. mg) (P < 0.05). Mean range of knee flexion at discharge was 90.5° (80°-100°) with dynamic compression and 84.5° (75°-90°) with static compression (P= 0.0015). Conclusion: Dynamic intermittent compression combined with cryotherapy decreases analgesic drug requirements after ACL reconstruction and improves the postoperative recovery of range of knee motion. Level of evidence: Level III, case-control study. © 2014 Elsevier Masson SAS.

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