Hopitaux Universitaires Paris Ile Of France Ouest

Boulogne-Billancourt, France

Hopitaux Universitaires Paris Ile Of France Ouest

Boulogne-Billancourt, France

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Merle C.S.,London School of Hygiene and Tropical Medicine | Fielding K.,London School of Hygiene and Tropical Medicine | Sow O.B.,Service de Pneumo phtisiologie | Gninafon M.,Center National Hospitalier Of Pneumophtisiologie | And 15 more authors.
New England Journal of Medicine | Year: 2014

Methods We conducted a noninferiority, randomized, open-label, controlled trial involving patients 18 to 65 years of age with smear-positive, rifampin-sensitive, newly diagnosed pulmonary tuberculosis in five sub-Saharan African countries. A standard 6-month regimen that included ethambutol during the 2-month intensive phase was compared with a 4-month regimen in which gatifloxacin (400 mg per day) was substituted for ethambutol during the intensive phase and was continued, along with rifampin and isoniazid, during the continuation phase. The primary efficacy end point was an unfavorable outcome (treatment failure, recurrence, or death or study dropout during treatment) measured 24 months after the end of treatment, with a noninferiority margin of 6 percentage points, adjusted for country.Results A total of 1836 patients were assigned to the 4-month regimen (experimental group) or the standard regimen (control group). Baseline characteristics were well balanced between the groups. At 24 months after the end of treatment, the adjusted difference in the risk of an unfavorable outcome (experimental group [21.0%] minus control group [17.2%]) in the modified intention-to-treat population (1356 patients) was 3.5 percentage points (95% confidence interval, -0.7 to 7.7). There was heterogeneity across countries (P = 0.02 for interaction, with differences in the rate of an unfavorable outcome ranging from -5.4 percentage points in Guinea to 12.3 percentage points in Senegal) and in baseline cavitary status (P = 0.04 for interaction) and body-mass index (P = 0.10 for interaction). The standard regimen, as compared with the 4-month regimen, was associated with a higher dropout rate during treatment (5.0% vs. 2.7%) and more treatment failures (2.4% vs. 1.7%) but fewer recurrences (7.1% vs. 14.6%). There was no evidence of increased risks of prolongation of the QT interval or dysglycemia with the 4-month regimen.Conclusions Noninferiority of the 4-month regimen to the standard regimen with respect to the primary efficacy end point was not shown. (Funded by the Special Program for Research and Training in Tropical Diseases and others; ClinicalTrials.gov number, NCT00216385.).Background Shortening the course of treatment for tuberculosis would be a major improvement for case management and disease control. This phase 3 trial assessed the efficacy and safety of a 4-month gatifloxacin-containing regimen for treating rifampinsensitive pulmonary tuberculosis. Copyright © 2014 Massachusetts Medical Society. All rights reserved.


Sommaire C.,CCOM UF 9406 | Penz C.,CCOM UF 9406 | Clavert P.,CCOM UF 9406 | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | And 3 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2012

Introduction: Bone defects in the humeral head or antero-inferior edge of the glenoid cavity increase recurrence risk following arthroscopic Bankart repair. The present study sought to quantify such preoperative defects using a simple radiological technique and to determine a threshold for elevated risk of recurrence. Materials and methods: A retrospective study conducted in two centers enrolled patients undergoing primary arthroscopic Bankart repair for isolated anterior shoulder instability in 2005. The principle assessment criterion was revision for recurrent instability. Quantitative radiology comprised: the ratio of notch depth to humeral head radius (D/R) on AP view in internal rotation; Gerber's X ratio between antero-inferior glenoid cavity edge defect length and maximum anteroposterior glenoid cavity diameter on arthro-CT scan; and the D1/D2 ratio between the glenoid joint surface diameters of the pathologic (D1) and healthy (D2) shoulders on Bernageau glenoid profile views. Seventy-seven patients were included, with a mean follow-up of 44 months (range, 36-54). Results: Overall recurrence rate was 15.6%. Recurrence risk was significantly greater when the humeral notch length was more or equal to 20% of the humeral head diameter and the Gerber ratio more or equal to 40%. On Bernageau views, mean D1/D2 ratio was 4.2% (range, 0-23%) in patients without recurrence, versus 5.1% (range, 0-19) in those with recurrence (P=0.003). Discussion: Beyond the above thresholds, bone defect as such contraindicates isolated arthroscopic stabilization. The D/R and Gerber ratios are simple and reproducible quantitative measurements can be taken in routine practice, enabling preoperative planning of complementary bone surgery as needed. Level of evidence: Level IV; retrospective cohort study. © 2012 Elsevier Masson SAS.


Auregan J.-C.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Bohu Y.,Hopitaux Universitaires Paris Ile Of France Ouest | Lefevre N.,Clinique du Sport Paris V | And 2 more authors.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2014

PURPOSE: We aimed to determine the rate of local recurrence, the rate of postoperative complications, and the functional outcome at final follow-up of surgical and nonsurgical treatment approaches for pigmented villonodular synovitis (PVNS) of the knee.METHODS: Medline, Embase, and the Cochrane Library were systematically searched for studies that reported the results of treatment for any type of PVNS between January 1, 1950, and August 1, 2013. Two authors extracted the data independently using predefined data fields including study quality indicators.RESULTS: Sixty studies (1,019 patients) met the inclusion criteria. Thirty-five presented data on the treatment of localized pigmented villonodular synovitis (LPVNS), 40 on diffuse pigmented villonodular synovitis (DPVNS), 1 on extra-articular LPVNS, and 7 on DPVNS with extra-articular involvement. Many therapeutic options were reported. Depending on these options, DPVNS recurred in 8% to 70% of the series and LPVNS recurred in 0% to 8% of the series. For LPVNS, the 2 most-reported options were open localized synovectomy and arthroscopic local synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (8.7% for open synovectomy and 6.9% for arthroscopic synovectomy) and postoperative complications (<1% for open synovectomy and 0% for arthroscopic synovectomy). For DPVNS, the 2 most-reported options were open total synovectomy and arthroscopic total synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (22.6% for open synovectomy and 16.1% for arthroscopic synovectomy). However, we found a lower rate of reported complications between open synovectomy (19.3%) and arthroscopic synovectomy (0%). Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy seemed to decrease the rate of local recurrence in DPVNS cases with a high risk of recurrence. Finally, we found a great heterogeneity in the way the functional results were reported, and no valid conclusion could be made based on the data we extracted.CONCLUSIONS: We found no difference in local recurrence rates after open or arthroscopic surgery for either LPVNS or DPVNS. However, a lower rate of postoperative complications was reported after arthroscopic surgery for DPVNS.LEVEL OF EVIDENCE: Level IV, systematic review of Level IV therapeutic studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.


Pansard E.,Center for Sport Medicine and Orthopaedic Surgery | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Vardi G.,Center for Sport Medicine and Orthopaedic Surgery | Greeff E.,Center for Sport Medicine and Orthopaedic Surgery | And 2 more authors.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2015

PURPOSE: To assess the ability of 2 independent surgical techniques, an inside-out technique and an outside-in technique, using bony landmarks on the femoral wall, to place the anterior cruciate ligament graft anatomically.METHODS: A retrospective single-center study was conducted in 2012 and included patients who underwent anterior cruciate ligament reconstruction. Two techniques were used: The lateral condylar wall was visualized from the anterolateral portal and tunnels were drilled "outside-in" in one group, whereas viewing was performed from the anteromedial portal and retrograde drilling ("inside-out") was performed in the other group. The primary outcome measure was the placement of the tunnel center point on postoperative computed tomography scans with 3-dimensional reconstruction, according to the radiographic quadrant method of Bernard and Hertel. The measurements were compared with optimal placements according to Bird et al. Their reliability was assessed with Spearman (rho) and intraclass correlation coefficients.RESULTS: Forty patients were included, with 20 in each group; the mean age was 29.8 ± 9.6 years, and there were 33 men and 7 women. The interobserver reliability and intraobserver reliability of measurements were good, with a Spearman ρ between 0.46 (P = .002) and 0.93 (P < .001) and an intraclass correlation coefficient between 0.44 (P = .001) and 0.86 (P < .001). The femoral tunnel positions of both techniques were close to the previously published anatomic placements, but there was a significant difference between our results and the theoretical position in proximal-distal measurements (P = .01). There was no difference in the anteroposterior measurements. There was no statistical difference in the accuracy of placement of the femoral tunnel center point between these 2 independent techniques.CONCLUSIONS: The direct arthroscopic visualization of bony landmarks seems sufficient for accurate positioning of the femoral tunnel whatever the drilling technique. This finding is clinically relevant because the routine use of direct measurement techniques or intraoperative radiographs may not be necessary to obtain anatomic tunnel placement.LEVEL OF EVIDENCE: Level IV, case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.


Bauer T.,Hopitaux Universitaires Paris Ile Of France Ouest | Gaumetou E.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,Hopitaux Universitaires Paris Ile Of France Ouest | And 2 more authors.
Journal of Foot and Ankle Surgery | Year: 2015

The present study compared the clinical results of open neurectomy versus a percutaneous procedure for Morton's disease. This was a retrospective study comparing the functional results after 2 surgical procedures: open neurectomy and a percutaneous procedure (with deep transverse metatarsal ligament release and distal metatarsal osteotomies). The present study included 52 patients (26 in each group), and the mean follow-up period was 4 (range 2 to 7) years. The patient evaluation criteria included the presence of painful symptoms of Morton's disease, American Orthopaedic Foot and Ankle Society (AOFAS) functional scale score, patient satisfaction, and delay for recovery. Percutaneous treatment of Morton's disease and open neurectomy produced complete relief of pain in 25 of 26 patients in each group. At the latest follow-up visit, the mean AOFAS score had significantly improved from 36±11 preoperatively to a mean of 89±18 (. p<.001). After 2years, the functional improvement obtained with the percutaneous procedure persisted, with a stable AOFAS score (96±10). Persistent metatarsalgia was reported by patients who had undergone open neurectomy, with a significantly decreased AOFAS score (81±21, p=.009). The percutaneous procedure for Morton's disease provided excellent functional outcomes (AOFAS score >90) significantly more often with a shorter delay than after open neurectomy (. p=.03). At the latest follow-up visit, metatarsalgia due to plantar hyperpressure or bursitis and requiring plantar orthotics was present in 11 of 26 patients (44%) after open neurectomy and in 1 of 26 patients (4%) after the percutaneous procedure (. p=.002). Percutaneous treatment of Morton's disease is a reliable procedure providing results as good as those after open neurectomy, with significantly better outcomes in the longer term and a lower rate of late metatarsalgia. © 2015 American College of Foot and Ankle Surgeons.


Cournapeau J.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,University of Versailles
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Introduction: In France, approximately 36,000 anterior cruciate ligament (ACL) reconstruction surgical procedures are performed every year. Technical progress, in particular arthroscopy, has made surgery more precise, but more expensive. In a context of healthcare cost containment, the increase in the cost of technology must be compared to the improved outcome for the patients. The main aim of this study was to determine all material costs related to ACL reconstruction using hamstring tendons. This study also compared the material costs between the two arthroscopic techniques: standard or "all-inside". Materials and methods: A retrospective study of material costs was performed in 2011. With the standard technique, the tibial tunnel was drilled from outside to inside, while with the all-inside technique two tunnels were drilled from inside to outside. All of the material used from the first swab to the final bandage was reported. It was classified into three categories: reusable arthroscopy material, disposable arthroscopic material, and disposable surgical supplies. The costs were those of our supplier in 2011 (Arthrex™) and based on Public Hospitals of Paris (AP-HP) public contract tariffs. Results: Standard ligament reconstruction was less expensive than the all-inside technique: 791.59. € versus 931.06. € excluding taxes (hors taxes [HT]), respectively. The largest percentage of expenses was allocated to disposable material use (81 and 84%). Discussion: Possible avenues of savings are limited: all the material used was necessary. To control costs, correct use and good maintenance of instruments are the most important elements. Level of evidence: Level IV. Economic and decision analyses, retrospective study. © 2013 Elsevier Masson SAS.


Maqdes A.,Hopitaux Universitaires Paris Ile Of France Ouest | Levy B.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,University of Versailles
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Purpose: This study describes the use of standard shoulder arthroscopy techniques to remove a proximal humerus locking plate following proximal humerus fracture. The goal of this study was to assess the feasibility and results of this technique. Methods: This was a retrospective non-comparative study. Inclusion criteria were fracture union when hardware was removed, significant residual glenohumeral stiffness after 6 months of physiotherapy, arthrogenic screw(s) and/or osteonecrosis (partial or complete) of the humeral head resulting in significant pain. Results: Eleven patients were included in this study. Surgery was successful in all cases, and surgery lasted a mean of 105 ± 10.5 min. Patients' mean age was 54.6 ± 10.6 years and the mean hospital stay 1.6 ± 0.8 days. No patient was lost to follow-up. At the mean last follow-up of 17.7 ± 23.4 months, pain and all functional parameters improved significantly: the Constant score (43.4 ± 8.8 vs 60.5 ± 0.3, p = 0.003), the visual analogue pain score (4.7 ± 1.5 vs 2.8 ± 2.3, p = 0.012), the shoulder abduction (77.7 ± 18.6 vs 104.5 ± 27.3, p = 0.004), the flexion (85.9 ± 30.7 vs 97.7 ± 27.7, p = 0.026) and the external rotation (15 ± 12 vs 31.8 ± 13.6, p = 0.004). Internal rotation improved from L3 to T12. All seven patients who practiced sports before the initial fracture had returned to sports approximately 6 months postoperatively. No infections or wound dehiscence occurred. Conclusion: Shoulder arthroscopy was found to be feasible for removal of hardware following proximal humeral fracture and can be associated with diagnostic and therapeutic arthroscopy and glenohumeral arthrolysis if required. Level of evidence: Case series with no comparison group, Level IV. © 2013 Springer-Verlag Berlin Heidelberg.


Bauer T.,Hopitaux Universitaires Paris Ile Of France Ouest
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Percutaneous methods can be used to perform many surgical procedures on the soft tissues and bones of the forefoot, thereby providing treatment options for all the disorders and deformities seen at this site. Theoretical advantages of percutaneous surgery include lower morbidity rates and faster recovery with immediate weight bearing. Disadvantages are the requirement for specific equipment, specific requirements for post-operative management, and lengthy learning curve. At present, percutaneous hallux valgus correction is mainly achieved with chevron osteotomy of the first metatarsal, for which internal fixation and a minimally invasive approach (2. cm incision) seem reliable and reproducible. This procedure is currently the focus of research and evaluation. Percutaneous surgery for hallux rigidus is simple and provides similar outcomes to those of open surgery. Lateral metatarsal malalignment and toe deformities are good indications for percutaneous treatment, which produces results similar to those of conventional surgery with lower morbidity rates. Finally, fifth ray abnormalities are currently the ideal indication for percutaneous surgery, given the simplicity of the procedure and post-operative course, high reliability, and very low rate of iatrogenic complications. The most commonly performed percutaneous techniques are described herein, with their current indications, main outcomes, and recent developments. © 2013 Elsevier Masson SAS.


Roumazeille T.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Rousselin B.,Hopitaux Universitaires Paris Ile Of France Ouest | Bongiorno V.,Hopitaux Universitaires Paris Ile Of France Ouest | And 3 more authors.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2015

INTRODUCTION: Meniscal allograft transplantation seems to be a valid therapeutic option to restore the knee function and limit the development of osteoarthritis after menisectomy. No surgical technique has been shown to provide better results than others. The main objective of this study was to assess graft healing after arthroscopic meniscal allograft transplantation without bone plugs.METHODS: This retrospective study included all patients who underwent arthroscopic meniscal allograft transplantation during 2005-2010. The meniscal horns were fixed through two tibia tunnels without bone plugs. The primary endpoint was graft healing according to Henning's criteria on MR arthrography (MRA) at 6-month follow-up. The secondary endpoints were the KOOS questionnaire, the IKDC score, measurement of the joint space and meniscal extrusion on both MRA at 6-month and MRI at last follow-up. The series included 22 patients, mean age 37 ± 7.5 years. The allograft was lateral in 20 cases and medial in 2 cases. The mean follow-up was 4.4 ± 1.6 years with one lost to follow-up.RESULTS: MR arthrography was performed in 14/21 patients at 6-months of follow-up: 8/14 (57.1%) had total graft healing, 2/14 (14.3%) partial healing and 4/14 (28.6%) no healing. At final follow-up, all functional scores had significantly improved. The average pre- and post-operative joint space thickness was similar. MRI showed meniscal extrusion in 75% of patients.CONCLUSION: The meniscal allograft transplantation without bone plugs effectively treats painful and functional sequellae of meniscectomies. The graft healed in most patients at 6-month follow-up. The long-term clinical relevance of meniscal extrusion has to be evaluated.LEVEL OF EVIDENCE: Retrospective study, Level IV.


Le Moulec Y.P.,Hopitaux Universitaires Paris Ile Of France Ouest | Bauer T.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,Hopitaux Universitaires Paris Ile Of France Ouest
Orthopaedics & traumatology, surgery & research : OTSR | Year: 2014

BACKGROUND: Difficulties in knee exposure during revision total knee arthroplasty (RTKA) may require tibial tubercle osteotomy (TTO). The main objective of this study was to assess union after TTO hinged on the lateral soft tissues and fixed using circumferential cable cerclage during RTKA.HYPOTHESIS: Non-union is uncommon with this technique.PATIENTS AND METHODS: We retrospectively included consecutive patients who underwent RTKA between 2008 and 2010 with TTO. Chevron osteotomy was performed and the fragment was left hinged laterally on the tibialis anterior muscle then fixed using circumferential cerclage with one or two steel cables. The primary evaluation criterion was TTO union as assessed on radiographs. Secondary evaluation criteria were time to union, osteotomy fragment migration, patellar height, and the IKS score at last follow-up. We included 65 patients with a mean age of 72±11.3 years including 39 (60%) undergoing septic revision and 26 (40%) aseptic revision. Mean follow-up was 27.8±10.7 months; there was 1 early death, which was unrelated to the surgery, and another patient was lost to follow-up.RESULTS: TTO union was achieved in 59/63 (93.7%) patients. Fragment migration occurred in 4 (6.3%) patients. Mean time to union was 16.9±5.1 weeks overall, 12.4±2.0 in the aseptic revision group, and 18.9±4.8 in the septic revision group (P=0.0005). Patellar height at last follow-up was not significantly changed compared to the preoperative value (P=0.09). At last follow-up, the mean IKS knee and function scores were significantly improved (P<10-5).CONCLUSION: TTO hinged on the lateral soft tissues and fixed by circumferential cable cerclage ensured union in the vast majority of patients, with a low rate of tubercle migration.LEVEL OF EVIDENCE: IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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