Ducat A.,University Pierre and Marie Curie |
Sariali E.,University Pierre and Marie Curie |
Lebel B.,Cote Of Nacre Teaching Hospital |
Mertl P.,North Hospital |
And 11 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2012
Introduction: Valgus high tibial osteotomy is considered to be an effective treatment for unicompartmental medial osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. However, the effects on posterior tibial slope of closing- or opening-wedge osteotomies remain controversial. Hypothesis: We analyzed the modifications of tibial slope after opening- and closing-wedge high tibial osteotomies and compared the results of these two procedures. We hypothesized that there was no difference in postoperative tibial slope between opening and closing-wedge osteotomies. Patients and methods: This prospective consecutive nonrandomized multicenter study was conducted between January 2008 and March 2009 and included 321 patients: 205 men and 116 women. A total of 224 patients underwent an opening-wedge high tibial osteotomy and 97 a closing-wedge osteotomy. The mean age was 52 years±9 and the mean body mass index was 28kg/m 2±5. The main etiology was primary arthritis. Posterior tibial slope was measured preoperatively and at the last follow-up on a lateral radiograph in relation to the posterior tibial cortex. Results: In the opening-wedge group, a definite 0.6° increase in tibial slope (P= 0.016) was observed. In the closing-wedge group, a definite 0.7° decrease in tibial slope (P= 0.02) was found. Fourteen percent of the opening-wedge osteotomies increased tibial slope by 5° or more versus only 2% of the closed-wedge osteotomies (P< 0.001). Twelve percent of the closing-wedge high tibial osteotomies led to a decrease of 5° or more of the tibial slope versus 7% of the opening-wedge osteotomies (P< 0.02). Discussion and conclusion: These results confirm what is generally reported in the literature, i.e., an increase in tibial slope in opening-wedge high tibial osteotomy and a decrease in the slope in closing-wedge osteotomies. These tibial slope changes appear to be very limited in this series, less than 1° on average. However, there was a bias since the open-wedge technique was preferred in cases with substantial varus deformity. We emphasize the importance of surgical technique to avoid alteration of the tibial slope, particularly in opening-wedge high tibial osteotomy for which we recommend a release of posterior soft tissue and a complete osteotomy of the posterior cortex of the tibia. Level of evidence: III. Prospective consecutive nonrandomized multicenter study. © 2011 Elsevier Masson SAS.
Perottino F.,Escartons Hospital |
Barnoud R.,University Claude Bernard Lyon 1 |
Ambrun A.,Croix Rousse Teaching Hospital |
Poupart M.,Croix Rousse Teaching Hospital |
And 2 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2010
Objective: To describe diagnostic and therapeutic management of a rare parotid lesion: sclerosing polycystic adenosis. Patient and method: We report a case of persistent right intraparotid tumefaction. Results: A 68-year-old man was referred with a right parotid nodule of 2 years' evolution. Cytology diagnosed pleomorphic adenoma, verified on MRI. Conservative subtotal parotidectomy diagnosed sclerosing polycystic adenosis. Over 1 year's regular follow-up, there were no signs of local recurrence. Conclusion: Sclerosing polycystic adenosis of the parotid gland is a rare and recently described entity presenting several analogies to the much more frequent cystic mastitis. Although benign and well-delimited, it requires complete exeresis of the parotid, due to a non-negligible risk of recurrence. © 2010.