Dr MICICOI Grégoire
Chirurgie de la hanche
Chirurgie du genou
Chef de clinique
Assistant des Hôpitaux de Nice
Secrétariat:
04.92.03.38.94
Mélina
Pathologies traitées
Genou
- Arthrose et lésions dégénératives du genou
- Déformation du membre inférieur
- Lésions méniscales
- Lésions ligamentaires du genou et traumatismes du patient sportif
- Instabilité fémoro-patellaire
- Lésions cartilagineuses du genou
Hanche
- Arthrose de hanche
Principales interventions
Genou
- Prothèses partielles et totales de genou
- Prothèses naviguées et alignement personnalisé du genou
- Révision prothétique du genou
- Reconstruction du ligament croisé antérieur & des ménisques
- Reconstruction multi-ligamentaire du genou
- Réparation méniscale – Greffe méniscale
- Ostéotomies autour du genou
- Reconstruction MPFL, abaissement tubérosité, trochléoplastie
- Allongement des membres
Hanche
- Prothèse totale de hanche par voie antérieure
- Révision prothèses totales de hanche
Cursus professionnel
- 2016 – 2021 : Internat de chirurgie orthopédique et traumatologie, IULS, CHU Nice
- 2021 – 2022 : Assistant spécialiste chirurgie orthopédique et traumatologique IULS, CHU Nice
- Depuis Nov. 2022 : Chef de Clinique chirurgie orthopédique et traumatologique IULS, CHU Nice
- Mars 2024 – Juin 2024 : Fellowship au Centre for Sports Orthopedics and Special Joint Surgery à Markgroeningen – Stuttgart
Diplômes d’État et Autres
- Oct 2018 Diplôme d’État de Docteur en médecine
- ‘’Stratégie et risques du remplacement prothétique bilatéral de hanche en une session opératoire’’
- Mars 2021 Thèse d’Université – Doctorat ès Sciences
- ‘’Anatomie et bases biomécaniques des ostéotomies autour du genou’’
- Sept 2022 Diplôme European Board of orthopaedics and Traumatology
- Sept 2022 Diplôme d’Études Spécialisées Complémentaires
- ‘’Reconstruction du ligament croisé antérieur chez les patients de plus de 50 ans à 10 ans de recul minimum’’
- Mars 2020 Meilleure communication SFHG
- Sept. 2021 Médaille d’Or des Hôpitaux de Nice, Université Côte d’Azur, CHU Nice
- Déc. 2021 Meilleur article du mois AJSM
- Oct. 2022 1er prix du Jury DESC interrégional
- Nov. 2022 Meilleure communication Genou SFHG – SOFCOT
- Nov. 2023 Médaillé d’Or au Collège Français de Chirurgie Orthopédique et Traumatologique
- Membre de la Société Française de Chirurgie Orthopédique et Traumatologique (SoFCOT)
- Membre de la Société Européenne de Chirurgie du Sport et d’Arthroscopie (ESSKA)
- Membre de la Société d’Arthroplastie Personnalisée (PAS)
- Membre Junior de la Société Française de Chirurgie de la Hanche et du Genou (SFHG)
- Membre du CA
- Membre du Collège des Jeunes Orthopédistes (CJO)
- Membre du CA – Représentant Europe (FORTE)
- Membre du au Collège Français de Chirurgie Orthopédique et Traumatologique (CFCOT)
Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion
Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion
Thomas Ripoll, Joseph Attas, Rayan Fairag, Michael Lopez, Jean-François Gonzalez, Roger Badet, Grégoire Micicoi
https://www.em-consulte.com/article/1676978
Abstract
Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture’s proximity to the popliteal vascular-nervous elements. Badet’s open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosyn-thesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series.
Level of evidence: IV;
Keywords : Posterior cruciate ligament avulsion fracture, Badet approach, Trans-medial gastrocnemius approach, Posterior cruciate ligament
Copyright © 2024 Publié par Elsevier Masson SAS.
Osteotomies for genu varum: Should we always correct at the tibia? A multicenter analysis of practices in France
Grégoire Micicoi, Matthieu Ollivier, Nicolas Bouguennec, Cécile Batailler, Nicolas Tardy , Goulven Rochcongar, Jean-Marie Fayard
https://pubmed.ncbi.nlm.nih.gov/38964499/
Abstract
Introduction: Tibial correction is often performed during a valgus-producing osteotomy for genu varum. However, overcorrection and the creation of a joint line obliquity (JLO) have been associated with unfavorable functional outcomes after high tibial osteotomy (HTO). The aims of this study were to analyze: 1) the corrections obtained after HTO; 2) the rationale behind the indication per the European Society for Sports Traumatology Surgery and Arthroscopy (ESSKA) recommendations; and 3) the correlation between the postoperative corrections obtained and functional outcomes.
Hypothesis: A significant number of patients who underwent an isolated HTO did not present an « ideal » theoretical indication based on the preoperative angles and correction targets to be performed.
Materials and methods: This multicenter study included 289 isolated HTOs. Demographic and morphometric data were anonymized and compiled in a database. Preoperative radiographic parameters were compared with the ESSKA consensus recommendations on osteotomies for genu varum. The consensus defined the « ideal » indication for performing an HTO as medial tibiofemoral compartment pain with significant tibial varus deformity (medial proximal tibial angle [MPTA]<85°), no significant femoral varus deformity (lateral distal femoral angle [LDFA]<90°), an expected postoperative obliquity of less than 5°, and a correction resulting in moderate tibial valgus (postoperative MPTA<94°). The incidence of patients with an « ideal » theoretical indication for isolated HTO and those with a theoretical indication not perfectly justified by the radiographic data and preoperative planning were recorded.
Results: Under the ESSKA consensus criteria, 25.3% (n=73) of isolated HTOs, 15.6% (n=45) of isolated femoral osteotomies, 9.3% (n=27) of double-level osteotomies, and 49.9% (n=144) of cases where no osteotomy was performed due to the lack of significant extra-articular tibial and/or femoral deformity were deemed justified. The presence of a preoperative femoral deformity and the absence of an « ideal » indication for HTO did not affect the postoperative Tegner Activity Scale or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p>0.05). A high preoperative hip-knee-ankle (HKA) angle and MPTA, which indicated less varus, were associated with a greater risk of there being no « ideal » theoretical indication for an HTO (coefficient of determination [R2]=0.19 and R2=1, respectively; p<0.001).
Conclusion: This study showed that isolated HTOs in current practice were not justified in a significant number of patients, even though they could lead to tibial overcorrection and excessive JLO. This did not impact the functional results of this series, but it might complicate the performance of a secondary knee arthroplasty. Nevertheless, some young patients in this series underwent a salvage osteotomy outside the « ideal » indications of the European recommendations.
Level of evidence: IV; case series.
Keywords: Anatomical correction; High tibial osteotomy; Joint line obliquity; Knee; Varus deformity.
Copyright © 2024 Elsevier Masson SAS. All rights reserved.
Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Writing Committee; Corentin Pangaud, Renaud Siboni, Jean-François Gonzalez, Jean-Noël Argenson, Romain Seil, Pablo Froidefond , Caroline Mouton, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/38880407/
Abstract
Background: Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes.
Methods: This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score.
Results: A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the « daily living »: 79.2 ± 5.3 versus 62.5 ± 2.3 (R2 = 0.05, P < .05) and « Quality of life » Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R2 = 0.02, P < .05).
Conclusions: This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA.
Level of clinical art evidence: III, Retrospective Cohort Study.
Keywords: Knee; functional result; mechanical alignment; native alignment; personalized surgery; phenotypes.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Grégoire Micicoi, Bernard de Geofroy, Julien Chamoux, Ammar Ghabi, Marc-Olivier Gauci, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez
https://pubmed.ncbi.nlm.nih.gov/38801888/
Abstract
Introduction: Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.
Hypothesis: Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.
Material and methods: This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative « hidden » blood loss. The risk of early dislocation (less than 6 months) was also analyzed.
Results: Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03).
Conclusion: This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.
Level of proof: III, comparative study of continuous series.
Keywords: Anterior approach; Blood loss; Cervical fractures; Dislocation; Hemiarthroplasty; Hip.
Copyright © 2024 Elsevier Masson SAS. All rights reserved.
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores
Bernard de Geofroy , Ammar Ghabi, Joseph Attas, Lolita Micicoi, Michael Lopez, Régis Bernard de Dompsure, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37923174/
Abstract
Introduction: The Harris Hip Score (HHS) and the Merle D’Aubigné Postel (MDP) score both provide an objective and subjective evaluation of hip function. These scores are collected during the follow-up of patients who have a hip disease. The objectives of this prospective study were (1) to analyze the differences between the two new French self-report versions of the HHS and MDP, and the traditional surgeon-assessed HHS and MDP; (2) to analyze the correlation between the self-report HHS and MDP and the surgeon-assessed HHS and MDP; (3) to analyze the floor and ceiling effects of the two self-report scores and the reliability of these self-report scores in operated and non-operated patients.
Hypothesis: The French self-report HHS and MDP are sufficiently reliable to accurately estimate the patient’s objective and subjective outcomes compared to the clinical examination done by a surgeon.
Methods: A prospective multicenter study was done with patients who had a hip disease. Two self-report questionnaires were completed by the patient, independently of the clinical examination done by the surgeon. The questionnaires were in French and consisted solely of checkboxes, with sample photos that corresponded to the various range of motion items in the HHS and MDP. The agreement between the self-report scores and the surgeon-assessed scores were evaluated using the intraclass correlation coefficient (ICC). Differences in the mean values were evaluated with a paired t test.
Results: The analysis involved 89 patients. The self-report HHS was 2.7±3.7 points (/100) lower than the surgeon-assessed HHS, but this difference was not statistically significant (p=0.34). The self-report MDP was significantly less by 1.2±2.9 points (/18) than the surgeon-assessed MDP (p=0.01). The agreement between the self-report HSS and the surgeon-assessed HSS was excellent (ICC=0.86) as was the one between the self-report MDP and the surgeon-assessed MDP (ICC=0.75). There was a strong positive correlation between the surgeon-assessed and self-report HHS in operated patients (ICC= 0.84; R=0.75; p<0.001) and in non-operated patients (ICC=0.96; R=0.89; p<0.001). This positive correlation was also found between the surgeon-assessed and self-report MDP for operated patients (ICC=0.73; R=0.62; p<0.001) and non-operated patients (ICC=0.79; R=0.64; p<0.001). A ceiling effect (maximum of 100 points) was found in 22% of patients (20/89) for the self-report HHS and in 34% of patients (30/89) for the self-report MDP (maximum of 18 points). No floor effect was observed for either questionnaire.
Conclusion: The French version of the HHS self-report questionnaire is an excellent overall estimator of the HHS score for patients with hip osteoarthritis or fracture, whether operated or not. The addition of the MDP, whose self-report version is less accurate, is also a reliable tool. These self-report questionnaires, when validated on a larger scale, will be useful for the long-term follow-up of patients undergoing hip arthroplasty.
Level of evidence: III; prospective diagnostic study.
Keywords: Harris Hip score; Hip; Merle d’Aubigné Postel score; Patient Reported Outcome Measures; Self-Report Questionnaire.
Copyright © 2023 Elsevier Masson SAS. All rights reserved.
Acute compartment syndrome of the lower limbs: Fasciotomy or dermofasciotomy? A cadaver study of compartment pressures
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37890523/
Abstract
Background: Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments.
Hypothesis: Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value.
Material and methods: A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP15), >30mmHg (ICP30), and >50mmHg (ICP50). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy.
Results: Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05).
Conclusion: Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal.
Level of evidence: IV, experimental study.
Keywords: Compartment syndrome; Dermofasciotomy; Fasciotomy; Intracompartmental pressure; Leg.
Copyright © 2023 Elsevier Masson SAS. All rights reserved.
Early morbidity and mortality after one-stage bilateral shoulder arthroplasty
Early morbidity and mortality after one-stage bilateral shoulder arthroplasty
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37853140/
Abstract
Purpose: One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high.
Methods: A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders.
Results: There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction.
Conclusions: One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation.
Keywords: Bilateral arthroplasty; Comorbidity; Complications; One-stage bilateral surgery; Shoulder arthroplasty; Shoulder replacement.
© 2023. The Author(s) under exclusive licence to SICOT aisbl.
Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37758904/
Abstract
Purpose: The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.
Methods: This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman’s rank correlation coefficient.
Results: During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.
Conclusion: Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.
Level of evidence: IV, retrospective case series.
Keywords: Alignment; Cartier angle; Clinical outcomes; Implant positioning; Unicompartmental arthroplasty; Varus.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
A significant rate of tibial overcorrection with an increased JLO occurred after isolated high tibial osteotomy without considering international consensus
Matthieu Ollivier, Jae-Sung An, Kristian Kley, Raghbir Khakha, Levi Reina Fernandes, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37597039/
Abstract
Purpose: The recent ESSKA consensus recommendations defined indications and outlined parameters for osteotomies around a degenerative varus knee. The consensus collated these guidelines based on the published literature available to answer commonly asked questions including the importance of identifying the site and degree of the lower limb deformity. In the consensus, the authors suggest that a knee joint line obliquity (JLO) greater than 5° or a planned medial proximal tibial angle (MPTA) > 94° preferentially indicates a double level osteotomy (DLO) compared to an isolated opening wedge high tibial osteotomy (OWHTO). This study aimed to analyze the corrections performed on a cohort of isolated opening wedge high tibial osteotomies (OWHTOs) prior to the recent ESSKA recommendations, with a focus on the impact of knee joint line obliquity (JLO) and medial proximal tibial angle (MPTA) on the choice of osteotomy procedure.
Methods: This monocentric, retrospective study included 129 patients undergoing medial OWHTO for symptomatic isolated medial knee osteoarthritis (Ahlbäck grade I or II) and a global varus malalignment (hip-knee-ankle angle ≤ 177°). An automated software trained to automatically detect lower limb deformity was implemented using patients preoperative long leg alignment X-rays to identify suitability for an isolated HTO in knee varus deformity. Based on the ESSKA recommendations, the site of the osteotomy was identified as well as the degree of correction required. The ESSKA consensus considers avoiding an isolated high tibial osteotomy if the planned resultant knee joint line orientation exceeds 5 ̊ or MPTA exceeds 94°. A preoperative abnormal MPTA was defined by a value lower than 85° and a preoperative abnormal LDFA by a value greater than 90°. The cases of DLO or DFO suggested by the software and the number of extra-tibial anomalies were collected. Multiple linear regression models were developed to establish a relationship between preoperative values and the risk of being outside of ESSKA recommendations postoperatively.
Results: Based on ESSKA recommendations and on threshold values considered abnormal, the software suggested a DLO in 17.8% (n = 23/129) of cases, a distal femoral osteotomy in 27.9% (n = 36/129) of cases and advised against an osteotomy procedure in 24% (n = 31/129) of cases. The software detected a femoral anomaly in 34.9% (n = 45/129) of cases and an JLCA > 6° in 9.3% (n = 12/129). Postoperatively, the MPTA exceeds 94° in 41.1% (n = 53/129) and the JLO exceeds 5° in 29.4% (n = 38/129). On multivariate analysis, a high preoperative MPTA was associated with higher risk of postoperative MPTA > 94° (R2 = 0.36; p < 0.001). Similarly, the probability of the software advising a DLO or DFO was associated with the presence of an « normal » preoperative MPTA (R2 = 0.42; p < 0.001) or an abnormal preoperative LDFA (R2 = 0.48; p < 0.001) or a planned JLO > 5° (R2 = 0.27; p < 0.001).
Conclusions: Analysis of patients who underwent an isolated OWHTO prior to the ESSKA guidelines, demonstrated a significant rate of post-operative tibial overcorrection and a resultant increased JLO. Pre-operative planning that considers the ESSKA guidelines, allows for better identification of those patients requiring a DFO or DLO and avoidance of resultant post-operative deformities.
Level of evidence: IV, case-series.
Keywords: Anatomical correction; Joint line obliquity; Knee; Open-wedge high tibial osteotomy; Osteoarthritis; Varus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy
Axel Machado , Lolita Micicoi, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure , Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37326635/
Abstract
Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.
Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.
Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = – 0.15, p = 0.04) and function IKS (R = – 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.
Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.
Level of evidence: IV, case series.
Keywords: High tibia osteotomy; Joint line obliquity; Knee osteoarthritis; Medial closure; Valgus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2
Robin Rassat, Grégoire Micicoi, Christophe Jacquet, Sylvain Guy, Jean-Marie Fayard, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36377059/
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.
Materials and methods: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.
Results: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient’s age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05).
Conclusion: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.
Level of evidence: IV; retrospective cohort study.
Keywords: Closing wedge tibial osteotomy; Posterior tibial slope; Revision ACL reconstruction; Slope-decreasing tibial osteotomy.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
Clinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity
Alice Abs , Grégoire Micicoi, Raghbir Khakha, Jean-Charles Escudier, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36814769/
Abstract
Background: In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity.
Purpose/hypothesis: The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.
Study design: Cohort study; Level of evidence, 3.
Methods: Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test.
Results: A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001).
Conclusion: For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
Keywords: clinical outcome; complications; double-level osteotomy; joint line obliquity; open-wedge high tibial osteotomy.
© The Author(s) 2023.
Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy
Axel Machado , Lolita Micicoi, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37326635/
Abstract
Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.
Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.
Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = – 0.15, p = 0.04) and function IKS (R = – 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.
Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.
Level of evidence: IV, case series.
Keywords: High tibia osteotomy; Joint line obliquity; Knee osteoarthritis; Medial closure; Valgus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Comparative study of bilateral total hip arthroplasty in one or two stages
Comparative study of bilateral total hip arthroplasty in one or two stages
Grégoire Micicoi, Régis Bernard de Dompsure, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/35781050/
Abstract
Introduction: Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA).
Materials and methods: This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed.
Results: Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results.
Conclusion: Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis.
Level of evidence: III, retrospective comparative study.
Keywords: Bilateral; Complications; One session; Total hip arthroplasty.
Copyright © 2022. Published by Elsevier Masson SAS.
Patient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformities
Grégoire Micicoi, Boris Corin, Jean-Noël Argenson, Christophe Jacquet, Raghbir Khakha, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36058123/
Abstract
Background: Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.
Methods: Forty knees (32 patients) were included prospectively. All patients had patellofemoral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.
Results: Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 ± 1.1° for tibial torsion (axial plane), 0.8 ± 0.7° for MPTA (coronal plane) and 0.8 ± 0.6° for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 ± 1.4° for femoral anteversion (axial plane), 0.9 ± 0.9° for LDFA (coronal plane) and 0.9 ± 0.9° for PDFA (sagittal plane). The IKSG was improved from 58.0 ± 13.2° to 71.4 ± 10.9 (p = 0.04) and the IKSF from 50.2 ± 14.3 to 87.0 ± 6.9 (p < 0.001).
Conclusions: Using the PSCG for derotational osteotomy allows excellent correction accuracy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability. Level of clinical evidence II, prospective cohort study.
Keywords: Accuracy; Clinical outcomes; Derotational osteotomy; Patellofemoral instability; Patient-specific cutting guide; Torsional malalignment syndrome.
Copyright © 2022 Elsevier B.V. All rights reserved.
Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊
Robin Rassat, Grégoire Micicoi, Christophe Jacquet, Sylvain Guy, Jean-Marie Fayard, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36377059/
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.
Materials and methods: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.
Results: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient’s age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05).
Conclusion: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.
Level of evidence: IV; retrospective cohort study.
Keywords: Closing wedge tibial osteotomy; Posterior tibial slope; Revision ACL reconstruction; Slope-decreasing tibial osteotomy.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
Christophe Trojani, Grégoire Micicoi, Pascal Boileau
https://pubmed.ncbi.nlm.nih.gov/34329759/
Abstract
Introduction: Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments.
Hypothesis: Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension.
Material and methods: Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores).
Results: The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved.
Conclusion: Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term.
Level of evidence: IV, retrospective descriptive study.
Keywords: Genu recurvatum; High tibial flexion osteotomy; Opening wedge; Tibia; Tibial tuberosity.
Copyright © 2021. Published by Elsevier Masson SAS.
Lateral femoral closing wedge osteotomy in genu varum
Lateral femoral closing wedge osteotomy in genu varum
Matthieu Ollivier, Maxime Fabre-Aubrespy, Grégoire Micicoi, Matthieu Ehlinger, Lukas Hanak, Kristian Kley
https://pubmed.ncbi.nlm.nih.gov/34144255/
Abstract
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an « all in the tibia » correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is non-anatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
Keywords: Biplanar; Distal femur osteotomy; Hinge; Knee; Osteoarthritis; Surgical technique.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes
Léo-Pôhl Bardot, Grégoire Micicoi, Henri Favreau, Petr Zeman, Raghbir Khakha, Matthieu Ehlinger, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33486561/
Abstract
Purpose: Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.
Material and methods: This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).
Results: From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01).
Conclusion: Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.
Level of clinical evidence: III, retrospective comparative study.
Keywords: Genu varum; Joint line convergence; Knee; Osteotomy; Weight-bearing; Weight-bearing radiographs.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Osteotomy around the knee is planned toward an anatomical bone correction in less than half of patients
Grégoire Micicoi, Francesco Grasso, Kristian Kley, Henri Favreau, Raghbir Khakha, Matthieu Ehlinger, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33753267/
Abstract
Introduction: In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software.
Methods: CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/overcorrection at the site of the osteotomy resulting in abnormal bone morphology. A type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology.
Results: The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2=0.12, p<0.001) for both femoral (R2=0.06, p<0.001) and tibial (R2=0.07, p<0.001) abnormalities.
Conclusion: Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Osteoarthritis; Osteotomy.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Patellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slope
Mathieu Carissimi, Pierre Sautet, Dimitri Charre, Lukas Hanak, Matthieu Ollivier, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/34358712/
Abstract
Introduction: Open-wedge high tibial osteotomy (OWHTO) corrects coronal deformity and can impact sagittal parameters such as posterior tibial slope and patellar height. The aim of the present study was to analyze change in patellar height after medial OWHTO with respect to tibial and femoral-referenced indices.
Material and method: This single-center retrospective study included 129 patients undergoing isolated posteromedial OWHTO, without change in tibial slope, using patient-specific cutting-guides. Patellar height was assessed on Caton-Deschamps (CD), Insall-Salvati (IS) and Schröter indices. Posterior tibial slope and coronal femoral and tibial angles were also measured. X-rays were taken preoperatively and at 12 months, and analyzed by 2 independent observers.
Results: OWHTO modified the global lower-limb alignment (Δ=6.3±0.95̊, p<0.0001) and the proximal tibial deformity (Δ=7±0.88̊, p<0.0001). Posterior tibial slope and tibial (CD and IS) and femoral (Schröter) patellar height indices were unchanged. Intra- and inter-observer reproducibility was excellent (ICC 0.79-0.91). There were no correlations between HKA or MPTA angles and change in patellar height.
Conclusion: The present clinical series showed that patellar height was unchanged by isolated posteromedial OWHTO without change in tibial slope, using patient-specific cutting-guides, with whichever femoral or tibial reference index. The Schröter patellar femoral height index was highly reliable and is independent of proximal tibial changes in assessing patellar height, and can thus be recommended in the follow-up of OWHTO.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Open-wedge high tibial osteotomy; Patellar height; Posterior tibial slope.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees
Hamid Rahmatullah Bin Abd Razak, Grégoire Micicoi, Raghbir S Khakha, Matthieu Ehlinger, Ahmad Faizan, Sally LiArno, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33423093/
Abstract
Purpose: The aim of this study was to compare alignment parameters between patients undergoing high tibial osteotomy (HTO) for knee osteoarthritis (OA) and non-arthritic controls.
Methods: Pre-operative computed tomography images from 194 patients undergoing HTO for medial knee OA and 118 non-arthritic controls were utilized. All patients had varus knee alignment (mean age: 57 ± 11 years; 45% female). The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and non-weight-bearing joint line convergence angle (nwJLCA) were compared between « control group » and « HTO group ». Femoral and tibial phenotypes were also assessed and compared between groups. Variables found on univariate analysis to be different between the groups were entered into a binary logistic regression model.
Results: The mean age was lower (Δ = 4 ± 6 years, p = 0.024), body mass index (BMI) was higher (Δ = 1.1 ± 2.8 kg/m2, p = 0.032) and there were more females (Δ = 14%, p = 0.020) in the HTO group. The HTO group had more overall varus (7° ± 4.7° vs 4.8° ± 1.3°, p < 0.001). There was a significant difference in the mean mLDFA between the two groups with the HTO group having more femoral varus (88.7 ± 3.2° vs 87.3 ± 1.8°, p < 0.001). MPTA was similar between the groups (p = 0.881). Age was found to be a strong determinant for femoral varus (p = 0.03).
Conclusion: Patients undergoing HTO for medial knee OA have more femoral varus compared to non-arthritic controls while tibial morphology was similar. This will be an important consideration in pre-operating planning for realignment osteotomy in patients presenting with medial knee OA and warrants further investigation.
Level of evidence: III, retrospective comparative study.
Keywords: Femur; Joints; Knee; Morphology; Osteoarthritis; Osteotomy; Phenotype; Tibia.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Double level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients
Francesco Grasso, Pierre Martz, Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Lukas Hanak, Matthieu Ollivier, Christophe Jacquet
https://pubmed.ncbi.nlm.nih.gov/34536082/
Abstract
Purpose: Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years.
Methods: A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student’s t test was used to estimate evolution of functional outcomes.
Results: The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied.
Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.
Keywords: Accuracy; Clinical outcomes; Double level osteotomy; Joint line obliquity; Patient-specific cutting guide.
© 2021. The Author(s) under exclusive licence to SICOT aisbl.
Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals
Grégoire Micicoi, Christophe Jacquet, Raghbir Khakha, Sally LiArno, Ahmad Faizan, Romain Seil, Baris Kocaoglu, Simone Cerciello, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/34710345/
Abstract
Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature.
Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor.
Study design: Cross-sectional study; Level of evidence, 3.
Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics.
Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width (P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI (P = .012) and MMPTA (P = .02) were independent predictors according to ethnicity.
Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.
Keywords: ACL rupture; intercondylar notch width (NWI); lateral femoral condylar index (LFCI); morphological risk factors; posterior tibial slope.
Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database
Grégoire Micicoi, Christophe Jacquet, Akash Sharma, Sally LiArno, Ahmad Faizan, Kristian Kley, Sébastien Parratte, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32372282/
Abstract
Purpose: Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype.
Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.
Results: The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment.
Conclusion: Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus.
Level of clinical evidence: III, retrospective cohort study.
Keywords: Alignment; CT; HKA; HTO concepts; JLCA; Knee; LDFA; MPTA; Native; PPTA; Phenotypes.
Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion
P Mathon, G Micicoi, R Seil, B Kacaoglu, S Cerciello, F Ahmad, S LiArno, R Teitge, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32548676/
Abstract
Purpose: There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals’ lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.
Methods: Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.
Results: Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).
Conclusion: The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.
Level of evidence: Level III.
Keywords: Anteversion; Femoral neck version; Lower limb torsion; Tibial torsion; Torsional alignment.
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Adrian Wilson, Simone Cerciello, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32902758/
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee.The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery.The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome.This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA.We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy.Level of clinical evidence IV, narrative review.
Keywords: Joint line convergence angle; Osteotomy; Overcorrection; Soft tissue correction.
Dorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability
Grégoire Micicoi, Lolita Micicoi, Nicolas Dreant
https://pubmed.ncbi.nlm.nih.gov/32216521/
Abstract
The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24-127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability.Level of evidence: IV.
Keywords: Scapholunate dissociation; capsulodesis; carpal instability; ligamentous repair; wrist; wrist instability.
Comments on: ``Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?`` by N. Tardy, C. Steltzlen, N. Bouguennec, J.-L. Cartier, P. Mertl, C. Bataillé, et al. published in Orthop Traumatol Surg Res 2020;8S:S231-S236
Grégoire Micicoi, Henri Favreau, Christophe Jacquet, Matthieu Ehlinger, Matthieu Ollivier
One-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study
Grégoire Micicoi, Régis Bernard de Dompsure, Lolita Micicoi, Laurie Tran, Michel Carles, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/32265170/
Abstract
Background: One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates.
Hypothesis: In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA.
Material and method: Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction.
Results: Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08).
Discussion: One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip.
Level of evidence: III, matched case-control study.
Keywords: 1-stage procedure; Bilateral total hip arthroplasty; Complications; Hip osteoarthritis; Outcome; Postoperative morbidity; Unilateral.
Copyright © 2020. Published by Elsevier Masson SAS.
Accuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical method
Xavier Nicolau, François Bonnomet, Grégoire Micicoi, David Eichler, Matthieu Ollivier, Henri Favreau, Matthieu Ehlinger
https://pubmed.ncbi.nlm.nih.gov/32820360/
Abstract
Introduction: Medial valgus-producing tibial osteotomy (MVTO) is classically used to treat early medial femorotibial osteoarthritis. Long-term results depend on the mechanical femorotibial angle (HKA) obtained at the end of the procedure. A correction goal between 3 and 6° valgus is commonly accepted. Several planning methods are described to achieve this goal, but none is superior to the other.
Objective: The main objective was to compare the accuracy of the correction obtained using either the Hernigou table (HT) or a so-called conventional method (CM) for which 1° of correction corresponds to 1° of osteotomy opening. The secondary objective was to analyze the variations observed in the sagittal plane on the tibial slope and on the patellar height. The working hypothesis was that the HT allowed a more accurate correction and that the tibial slope and patellar height were modified in both groups.
Material and method: In this monocentric and retrospective study, two senior surgeons operated on 39 knees (18 in the CM group, 21 in the HT group) between January 1, 2009 and December 31, 2014. The operator was unique for each group and expert in the technique used. The correction objective chosen for each patient, and written in the operative report, was considered as the one to be achieved. The surgical correction was the difference between the pre-operative and immediate post-operative data (< 5 J) for the mechanical tibial angle (MTA) and the hip-knee-ankle (HKA) angle. Surgical accuracy, where a value close to 0 is optimal, was the absolute value of the difference between the surgical correction performed and the goal set by the surgeon.
Results: The median surgical accuracy on the MTA was 3.5° [0.2-7.4] versus 1.4° [0-4.1] in the CM and HT groups, respectively (p = 0.006). In multivariate analysis, with the same objective, the CM had a significantly lower accuracy of 1.9° ± 0.8 (p = 0.02). For HKA, the median accuracy was 3.1° [0.3-7.3] versus 0.8° [0-5] in the CM and HT groups, respectively (p = 0.006). Five (5/18, 28%) and 16 (16/21, 76%) knees were within 3° of the target in the CM and HT groups, respectively (p = 0.004). The median tibial slope increased in both groups. This increase was significantly greater in the CM group compared with the HT group, with 5.5° [- 0.3-13] versus 0.5 [- 5.2-5.6], respectively (p < 0.001). The median Caton-Deschamps index decreased (patella lowered) in both groups after surgery, by – 0.21 [- 1.03; – 0.05] and – 0.14 [- 0.4-0.16], but without significant difference (p = 0.19). In univariate analysis, changes in tibial slope and patellar height were not significantly related to frontal surgical correction performed according to ΔMTA (R2 = 0.07; p = 0.055) and (R2 = – 0.02; p = 0.54) respectively.
Discussion: The correction set by the surgeons was achieved with greater accuracy and more frequently in the HT group, confirming the working hypothesis. The HT is therefore recommended as a simple way of achieving the set objective; the tibial slope and patellar height were modified unaffected by the frontal correction performed.
Keywords: Accuracy; Knee surgery; Navigation; Open wedge osteotomy; Tibial osteotomy.
Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Grégoire Micicoi, Régis Bernard de Dompsure, Laurie Tran, Michel Carles, Pascal Boileau, Nicolas Bronsard, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/31591065/
Abstract
Background: Advantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss.
Hypothesis: 1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used.
Material and methods: A single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA.
Results: We included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108-255minutes) in the PA group (p<0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5-11 days) in the AA group, and 8.2 days (range, 3-13 days) in the PA group (p<0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58).
Discussion: In selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used.
Level of evidence: III, comparative study of consecutive patients.
Keywords: Bilateral total hip replacement; Early complications; Hip osteoarthritis; Mortality; One-stage surgery.
Copyright © 2019. Published by Elsevier Masson SAS.
- SOFCOT, Novembre 2017
- Short-term mortality and complications after one-stage bilateral total hip arthroplasty : Is it safe ? Doi : 10.1016/j.rcot.2017.09.134
- SOFCOT, Novembre 2018
- PTH bilatérales en une session opératoire : complications tardives, résultats et courbe de survie
- BELGIAN HAND GROUP, Mai 2018
- Carpal Ligamentous Instability : Dorsal intercarpal ligament capsulodesis for chronic scapholunate instability.
- SOFCOT, Novembre 2019
- Ostéotomie tibiale de flexion pour Genu Recurvatum Ligamentaire Pathologique
- SOFCOT, Novembre 2019 – SFHG, Mars 2020
- PTH bilatérales en une session opératoire versus PTH unilatérales : analyse comparative
- NSC, Juin 2020 – SESSEC, Décembre 2020 (visio)
- The Overtensioned Biceps Tenodesis As a Cause of Postoperative Persistent Shoulder Pain
- NSC, Juin 2020
- The Open Latarjet Procedure Long-term Follow-up (10-25 years)
- CAOS, Juin 2021
- Erreurs de correction après ostéotomies autour du genou
- EHS, Septembre 2021
- Single-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty : a retrospective case-matched study
- SOFCOT, Novembre 2021
- La stratégie du remplacement prothétique bilatéral de hanche en une session opératoires diminue les risques
- SOFCOT, Novembre 2021
- L’alignement neutre résulte d’un tibia vara et d’un fémur valgus : analyse des morphotypes chez des patients d’âge moyen non arthrosiques
- SOFCOT, Novembre 2021
- Anomalies osseuses fémorales et tibiales « associées » aux lésions du ligament croisé antérieur : exploration 3D d’une population non atteinte
- ISAKOS, Novembre 2021
- Usual Definition Of Femoral And Tibial Bony Risk Factors Of Anterior Cruciate Ligament Tears Identify More Than 50% Healthy Individuals To Be At Risk
- ISAKOS, Novembre 2021
- Patients With Varus Knee Osteoarthritis Undergoing High Tibial Osteotomy Exhibit More Femoral Varus But Similar Tibial Morphology Compared to Non-Arthritic Varus Knees
- SOFCOT, Novembre 2021
- Table ronde : BHR
- ESSKA, Avril 2022
- Femoral and tibial bony risk factors for anterior cruciate ligament injuries are present in more than 50% of healthy individuals
- ESSKA, Avril 2022
- Patient’s specific cutting guides allow precise triplanar correction of femoral and tibial torsional deformities
- ESSKA, Avril 2022
- Half of open-wedge high tibial osteotomy lead to persistent postoperative anatomical abnormalities
- SOFCOT, Novembre 2022
- Syndrome de loge aigu des membres inférieurs : fasciotomie isolée ou dermo- fasciotomie ? Etude cadavérique des pressions des loges
- SOFCOT, Novembre 2022
- Survie et résultats à long terme du resurfaçage de hanche
- SOFCOT, Novembre 2022
- Les reprises de resurfaçage en prothèse totale de hanche donnent-elles de bons résultats ?
- SOFCOT, Novembre 2022
- L’inégalité de longueur des membres inférieurs après PTH bilatérale péjore les résultats cliniques
- SOFCOT, Novembre 2022
- Les doubles-ostéotomies réalisées avec guides de coupe personnalisés permettent une meilleure précision de correction mais des résultats cliniques comparables aux techniques conventionnelles
- SOFCOT, Novembre 2022
- Les guides de coupe personnalisés permettent une correction précise pour les dérotations des déformations fémorales et tibiales
- SOFCOT, Novembre 2022
- Table ronde : Ostéotomie
- SOFCOT, Novembre 2023
- Discussion de dossiers : hanche
- SOFCOT, Novembre 2023
- Combien de patients peuvent réellement bénéficier d’une ostéotomie tibiale de valgisation isolée sans modification majeure de l’interligne articulaire ?
- SOFCOT, Novembre 2023
- Table ronde : PTH bilatérale en un ou deux temps
- SOFCOT, Novembre 2023
- Influence des variations de phénotypes selon la classification CPAK sur les résultats fonctionnels après arthroplastie totale de genou réalisée par alignement mécanique
- SOFCOT, Novembre 2023
- Influence de l’alignement sur les résultats cliniques après ostéotomie tibiale de varisation par fermeture médiale
- SOFCOT, Novembre 2023
- La cicatrice épiphysaire tibiale proximale est-elle un repère fiable dans la planification des ostéotomies ?
- SOFCOT, Novembre 2023
- Peut-on évaluer les scores fonctionnels de hanche par questionnaires auto-administrés ?
- SOFCOT, Novembre 2023
- Reconstruction du ligament croisé antérieur chez les patients de plus de 50 ans : analyse des résultats à 10 ans de recul minimum
- ABAOT, Brussels, Mars 2024
- Exploring the Knee
- SFHG, Lille, Avril 2024
- Etude des marqueurs prédictifs de transfusion postopératoire après arthroplastie totale de genou : utilisation d’un outil de machine learning
- ESSKA, Milan, Mai 2024
- Restoring the preoperative phenotype according to the cpak (coronal plane alignement of the knee) classification after total knee arthroplasty leads to better functional results
- Practical Course Orthopedics, Juin 2024
- Lecture : Management of a degenerative meniscus lesion in 2024
- SOFCOT, Novembre 2024
- Symposium : Raideur après arthroplastie totale de genou
- SOFCOT, Novembre 2024
- Table ronde : Réussir la prothèse totale de genou après 85 ans
- Certificat diplômant des techniques de plastinations anatomiques (Sept. 2016)
- DIU Chirurgie de la Main et du Membre Supérieur (Juin 2018)
- DIU Pathologie locomotrice liée à la pratique du sport (Juin 2018)
- DU Microchirurgie (Juin 2018)
- DIU Pathologie Chirurgicale du Genou (Juin 2019 )
- DIU Échographie pour le chirurgien du Membre Supérieur (Juin 2019 )
- DU Pathologie de la Hanche (Sept. 2020 )
- DIU Arthroscopie (Sept. 2021)
- DIU Chirurgie de l’Épaule et du Coude (Oct. 2021)
- DIU d’Expertise Médico-Légale (Janvier 2024)
- DIU d’Écho-chirurgie du membre inférieur (Juin 2024)
- 2012 à 2014 Moniteur d’Anatomie – 200 étudiants /an |Faculté de médecine de Nice
- Depuis nov 2020 Enseignement au DIU Pathologie locomotrice liée à la pratique du sport| Faculté de médecine de Nice
- Depuis nov 2022 Enseignement en Sémiologie Orthopédique et Traumatologie | Faculté de médecine de Nice
- Depuis nov 2022 Organisation des cours aux externes au sein de l’iULS
- Depuis avril 2023 Conférences d’enseignements aux externes | Faculté de médecine de Nice
- Depuis Janvier 2024 Enseignement au DU d’Initiation à la Médecine d’Urgence – Base de la traumatologie ostéo-articulaire
- Depuis sept 2017 IFSI | Enseignement en Anatomie de l’appareil locomoteur et de Chirurgie orthopédique
- Depuis sept 2021 IBODE | Enseignement dispensé des techniques opératoires en Chirurgie Orthopédique et Traumatologie
- Depuis nov 2022 | Enseignement dispensé à l’Institut de Formation en Masso-Kinésithérapie
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Prix et distinctions
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- Mars 2020 Meilleure communication SFHG
- Sept. 2021 Médaille d’Or des Hôpitaux de Nice, Université Côte d’Azur, CHU Nice
- Déc. 2021 Meilleur article du mois AJSM
- Oct. 2022 1er prix du Jury DESC interrégional
- Nov. 2022 Meilleure communication Genou SFHG – SOFCOT
- Nov. 2023 Médaillé d’Or au Collège Français de Chirurgie Orthopédique et Traumatologique
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Sociétés savantes
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- Membre de la Société Française de Chirurgie Orthopédique et Traumatologique (SoFCOT)
- Membre de la Société Européenne de Chirurgie du Sport et d’Arthroscopie (ESSKA)
- Membre de la Société d’Arthroplastie Personnalisée (PAS)
- Membre Junior de la Société Française de Chirurgie de la Hanche et du Genou (SFHG)
- Membre du CA
- Membre du Collège des Jeunes Orthopédistes (CJO)
- Membre du CA – Représentant Europe (FORTE)
- Membre du au Collège Français de Chirurgie Orthopédique et Traumatologique (CFCOT)
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Publications
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Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion
Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion
Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion
Thomas Ripoll, Joseph Attas, Rayan Fairag, Michael Lopez, Jean-François Gonzalez, Roger Badet, Grégoire Micicoi
https://www.em-consulte.com/article/1676978
Abstract
Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture’s proximity to the popliteal vascular-nervous elements. Badet’s open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosyn-thesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series.
Level of evidence: IV;
Keywords : Posterior cruciate ligament avulsion fracture, Badet approach, Trans-medial gastrocnemius approach, Posterior cruciate ligament
Copyright © 2024 Publié par Elsevier Masson SAS.
CloseOsteotomies for genu varum: Should we always correct at the tibia? A multicenter analysis of practices in FranceOsteotomies for genu varum: Should we always correct at the tibia? A multicenter analysis of practices in France
Grégoire Micicoi, Matthieu Ollivier, Nicolas Bouguennec, Cécile Batailler, Nicolas Tardy , Goulven Rochcongar, Jean-Marie Fayard
https://pubmed.ncbi.nlm.nih.gov/38964499/
Abstract
Introduction: Tibial correction is often performed during a valgus-producing osteotomy for genu varum. However, overcorrection and the creation of a joint line obliquity (JLO) have been associated with unfavorable functional outcomes after high tibial osteotomy (HTO). The aims of this study were to analyze: 1) the corrections obtained after HTO; 2) the rationale behind the indication per the European Society for Sports Traumatology Surgery and Arthroscopy (ESSKA) recommendations; and 3) the correlation between the postoperative corrections obtained and functional outcomes.
Hypothesis: A significant number of patients who underwent an isolated HTO did not present an « ideal » theoretical indication based on the preoperative angles and correction targets to be performed.
Materials and methods: This multicenter study included 289 isolated HTOs. Demographic and morphometric data were anonymized and compiled in a database. Preoperative radiographic parameters were compared with the ESSKA consensus recommendations on osteotomies for genu varum. The consensus defined the « ideal » indication for performing an HTO as medial tibiofemoral compartment pain with significant tibial varus deformity (medial proximal tibial angle [MPTA]<85°), no significant femoral varus deformity (lateral distal femoral angle [LDFA]<90°), an expected postoperative obliquity of less than 5°, and a correction resulting in moderate tibial valgus (postoperative MPTA<94°). The incidence of patients with an « ideal » theoretical indication for isolated HTO and those with a theoretical indication not perfectly justified by the radiographic data and preoperative planning were recorded.
Results: Under the ESSKA consensus criteria, 25.3% (n=73) of isolated HTOs, 15.6% (n=45) of isolated femoral osteotomies, 9.3% (n=27) of double-level osteotomies, and 49.9% (n=144) of cases where no osteotomy was performed due to the lack of significant extra-articular tibial and/or femoral deformity were deemed justified. The presence of a preoperative femoral deformity and the absence of an « ideal » indication for HTO did not affect the postoperative Tegner Activity Scale or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p>0.05). A high preoperative hip-knee-ankle (HKA) angle and MPTA, which indicated less varus, were associated with a greater risk of there being no « ideal » theoretical indication for an HTO (coefficient of determination [R2]=0.19 and R2=1, respectively; p<0.001).
Conclusion: This study showed that isolated HTOs in current practice were not justified in a significant number of patients, even though they could lead to tibial overcorrection and excessive JLO. This did not impact the functional results of this series, but it might complicate the performance of a secondary knee arthroplasty. Nevertheless, some young patients in this series underwent a salvage osteotomy outside the « ideal » indications of the European recommendations.
Level of evidence: IV; case series.
Keywords: Anatomical correction; High tibial osteotomy; Joint line obliquity; Knee; Varus deformity.
Copyright © 2024 Elsevier Masson SAS. All rights reserved.
CloseRestoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional ResultsRestoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Writing Committee; Corentin Pangaud, Renaud Siboni, Jean-François Gonzalez, Jean-Noël Argenson, Romain Seil, Pablo Froidefond , Caroline Mouton, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/38880407/
Abstract
Background: Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes.
Methods: This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score.
Results: A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the « daily living »: 79.2 ± 5.3 versus 62.5 ± 2.3 (R2 = 0.05, P < .05) and « Quality of life » Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R2 = 0.02, P < .05).
Conclusions: This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA.
Level of clinical art evidence: III, Retrospective Cohort Study.
Keywords: Knee; functional result; mechanical alignment; native alignment; personalized surgery; phenotypes.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
CloseTotal blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approachTotal blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Grégoire Micicoi, Bernard de Geofroy, Julien Chamoux, Ammar Ghabi, Marc-Olivier Gauci, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez
https://pubmed.ncbi.nlm.nih.gov/38801888/
Abstract
Introduction: Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.
Hypothesis: Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.
Material and methods: This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative « hidden » blood loss. The risk of early dislocation (less than 6 months) was also analyzed.
Results: Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03).
Conclusion: This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.
Level of proof: III, comparative study of continuous series.
Keywords: Anterior approach; Blood loss; Cervical fractures; Dislocation; Hemiarthroplasty; Hip.
Copyright © 2024 Elsevier Masson SAS. All rights reserved.
CloseCan hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scoresCan hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores
Bernard de Geofroy , Ammar Ghabi, Joseph Attas, Lolita Micicoi, Michael Lopez, Régis Bernard de Dompsure, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37923174/
Abstract
Introduction: The Harris Hip Score (HHS) and the Merle D’Aubigné Postel (MDP) score both provide an objective and subjective evaluation of hip function. These scores are collected during the follow-up of patients who have a hip disease. The objectives of this prospective study were (1) to analyze the differences between the two new French self-report versions of the HHS and MDP, and the traditional surgeon-assessed HHS and MDP; (2) to analyze the correlation between the self-report HHS and MDP and the surgeon-assessed HHS and MDP; (3) to analyze the floor and ceiling effects of the two self-report scores and the reliability of these self-report scores in operated and non-operated patients.
Hypothesis: The French self-report HHS and MDP are sufficiently reliable to accurately estimate the patient’s objective and subjective outcomes compared to the clinical examination done by a surgeon.
Methods: A prospective multicenter study was done with patients who had a hip disease. Two self-report questionnaires were completed by the patient, independently of the clinical examination done by the surgeon. The questionnaires were in French and consisted solely of checkboxes, with sample photos that corresponded to the various range of motion items in the HHS and MDP. The agreement between the self-report scores and the surgeon-assessed scores were evaluated using the intraclass correlation coefficient (ICC). Differences in the mean values were evaluated with a paired t test.
Results: The analysis involved 89 patients. The self-report HHS was 2.7±3.7 points (/100) lower than the surgeon-assessed HHS, but this difference was not statistically significant (p=0.34). The self-report MDP was significantly less by 1.2±2.9 points (/18) than the surgeon-assessed MDP (p=0.01). The agreement between the self-report HSS and the surgeon-assessed HSS was excellent (ICC=0.86) as was the one between the self-report MDP and the surgeon-assessed MDP (ICC=0.75). There was a strong positive correlation between the surgeon-assessed and self-report HHS in operated patients (ICC= 0.84; R=0.75; p<0.001) and in non-operated patients (ICC=0.96; R=0.89; p<0.001). This positive correlation was also found between the surgeon-assessed and self-report MDP for operated patients (ICC=0.73; R=0.62; p<0.001) and non-operated patients (ICC=0.79; R=0.64; p<0.001). A ceiling effect (maximum of 100 points) was found in 22% of patients (20/89) for the self-report HHS and in 34% of patients (30/89) for the self-report MDP (maximum of 18 points). No floor effect was observed for either questionnaire.
Conclusion: The French version of the HHS self-report questionnaire is an excellent overall estimator of the HHS score for patients with hip osteoarthritis or fracture, whether operated or not. The addition of the MDP, whose self-report version is less accurate, is also a reliable tool. These self-report questionnaires, when validated on a larger scale, will be useful for the long-term follow-up of patients undergoing hip arthroplasty.
Level of evidence: III; prospective diagnostic study.
Keywords: Harris Hip score; Hip; Merle d’Aubigné Postel score; Patient Reported Outcome Measures; Self-Report Questionnaire.
Copyright © 2023 Elsevier Masson SAS. All rights reserved.
CloseAcute compartment syndrome of the lower limbs: Fasciotomy or dermofasciotomy? A cadaver study of compartment pressuresAcute compartment syndrome of the lower limbs: Fasciotomy or dermofasciotomy? A cadaver study of compartment pressures
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37890523/
Abstract
Background: Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments.
Hypothesis: Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value.
Material and methods: A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP15), >30mmHg (ICP30), and >50mmHg (ICP50). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy.
Results: Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05).
Conclusion: Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal.
Level of evidence: IV, experimental study.
Keywords: Compartment syndrome; Dermofasciotomy; Fasciotomy; Intracompartmental pressure; Leg.
Copyright © 2023 Elsevier Masson SAS. All rights reserved.
CloseEarly morbidity and mortality after one-stage bilateral shoulder arthroplastyEarly morbidity and mortality after one-stage bilateral shoulder arthroplasty
Early morbidity and mortality after one-stage bilateral shoulder arthroplasty
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37853140/
Abstract
Purpose: One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high.
Methods: A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders.
Results: There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction.
Conclusions: One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation.
Keywords: Bilateral arthroplasty; Comorbidity; Complications; One-stage bilateral surgery; Shoulder arthroplasty; Shoulder replacement.
© 2023. The Author(s) under exclusive licence to SICOT aisbl.
CloseRestoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplastyRestoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37758904/
Abstract
Purpose: The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.
Methods: This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman’s rank correlation coefficient.
Results: During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.
Conclusion: Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.
Level of evidence: IV, retrospective case series.
Keywords: Alignment; Cartier angle; Clinical outcomes; Implant positioning; Unicompartmental arthroplasty; Varus.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseA significant rate of tibial overcorrection with an increased JLO occurred after isolated high tibial osteotomy without considering international consensusA significant rate of tibial overcorrection with an increased JLO occurred after isolated high tibial osteotomy without considering international consensus
Matthieu Ollivier, Jae-Sung An, Kristian Kley, Raghbir Khakha, Levi Reina Fernandes, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37597039/
Abstract
Purpose: The recent ESSKA consensus recommendations defined indications and outlined parameters for osteotomies around a degenerative varus knee. The consensus collated these guidelines based on the published literature available to answer commonly asked questions including the importance of identifying the site and degree of the lower limb deformity. In the consensus, the authors suggest that a knee joint line obliquity (JLO) greater than 5° or a planned medial proximal tibial angle (MPTA) > 94° preferentially indicates a double level osteotomy (DLO) compared to an isolated opening wedge high tibial osteotomy (OWHTO). This study aimed to analyze the corrections performed on a cohort of isolated opening wedge high tibial osteotomies (OWHTOs) prior to the recent ESSKA recommendations, with a focus on the impact of knee joint line obliquity (JLO) and medial proximal tibial angle (MPTA) on the choice of osteotomy procedure.
Methods: This monocentric, retrospective study included 129 patients undergoing medial OWHTO for symptomatic isolated medial knee osteoarthritis (Ahlbäck grade I or II) and a global varus malalignment (hip-knee-ankle angle ≤ 177°). An automated software trained to automatically detect lower limb deformity was implemented using patients preoperative long leg alignment X-rays to identify suitability for an isolated HTO in knee varus deformity. Based on the ESSKA recommendations, the site of the osteotomy was identified as well as the degree of correction required. The ESSKA consensus considers avoiding an isolated high tibial osteotomy if the planned resultant knee joint line orientation exceeds 5 ̊ or MPTA exceeds 94°. A preoperative abnormal MPTA was defined by a value lower than 85° and a preoperative abnormal LDFA by a value greater than 90°. The cases of DLO or DFO suggested by the software and the number of extra-tibial anomalies were collected. Multiple linear regression models were developed to establish a relationship between preoperative values and the risk of being outside of ESSKA recommendations postoperatively.
Results: Based on ESSKA recommendations and on threshold values considered abnormal, the software suggested a DLO in 17.8% (n = 23/129) of cases, a distal femoral osteotomy in 27.9% (n = 36/129) of cases and advised against an osteotomy procedure in 24% (n = 31/129) of cases. The software detected a femoral anomaly in 34.9% (n = 45/129) of cases and an JLCA > 6° in 9.3% (n = 12/129). Postoperatively, the MPTA exceeds 94° in 41.1% (n = 53/129) and the JLO exceeds 5° in 29.4% (n = 38/129). On multivariate analysis, a high preoperative MPTA was associated with higher risk of postoperative MPTA > 94° (R2 = 0.36; p < 0.001). Similarly, the probability of the software advising a DLO or DFO was associated with the presence of an « normal » preoperative MPTA (R2 = 0.42; p < 0.001) or an abnormal preoperative LDFA (R2 = 0.48; p < 0.001) or a planned JLO > 5° (R2 = 0.27; p < 0.001).
Conclusions: Analysis of patients who underwent an isolated OWHTO prior to the ESSKA guidelines, demonstrated a significant rate of post-operative tibial overcorrection and a resultant increased JLO. Pre-operative planning that considers the ESSKA guidelines, allows for better identification of those patients requiring a DFO or DLO and avoidance of resultant post-operative deformities.
Level of evidence: IV, case-series.
Keywords: Anatomical correction; Joint line obliquity; Knee; Open-wedge high tibial osteotomy; Osteoarthritis; Varus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseNormo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomyNormo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy
Axel Machado , Lolita Micicoi, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure , Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37326635/
Abstract
Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.
Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.
Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = – 0.15, p = 0.04) and function IKS (R = – 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.
Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.
Level of evidence: IV, case series.
Keywords: High tibia osteotomy; Joint line obliquity; Knee osteoarthritis; Medial closure; Valgus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseSlope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2
Robin Rassat, Grégoire Micicoi, Christophe Jacquet, Sylvain Guy, Jean-Marie Fayard, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36377059/
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.
Materials and methods: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.
Results: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient’s age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05).
Conclusion: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.
Level of evidence: IV; retrospective cohort study.
Keywords: Closing wedge tibial osteotomy; Posterior tibial slope; Revision ACL reconstruction; Slope-decreasing tibial osteotomy.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
CloseClinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus DeformityClinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity
Alice Abs , Grégoire Micicoi, Raghbir Khakha, Jean-Charles Escudier, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36814769/
Abstract
Background: In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity.
Purpose/hypothesis: The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.
Study design: Cohort study; Level of evidence, 3.
Methods: Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test.
Results: A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001).
Conclusion: For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
Keywords: clinical outcome; complications; double-level osteotomy; joint line obliquity; open-wedge high tibial osteotomy.
© The Author(s) 2023.
CloseNormo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomyNormo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy
Axel Machado , Lolita Micicoi, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37326635/
Abstract
Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.
Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.
Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = – 0.15, p = 0.04) and function IKS (R = – 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.
Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.
Level of evidence: IV, case series.
Keywords: High tibia osteotomy; Joint line obliquity; Knee osteoarthritis; Medial closure; Valgus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseComparative study of bilateral total hip arthroplasty in one or two stagesComparative study of bilateral total hip arthroplasty in one or two stages
Comparative study of bilateral total hip arthroplasty in one or two stages
Grégoire Micicoi, Régis Bernard de Dompsure, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/35781050/
Abstract
Introduction: Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA).
Materials and methods: This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed.
Results: Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results.
Conclusion: Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis.
Level of evidence: III, retrospective comparative study.
Keywords: Bilateral; Complications; One session; Total hip arthroplasty.
Copyright © 2022. Published by Elsevier Masson SAS.
ClosePatient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformitiesPatient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformities
Grégoire Micicoi, Boris Corin, Jean-Noël Argenson, Christophe Jacquet, Raghbir Khakha, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36058123/
Abstract
Background: Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.
Methods: Forty knees (32 patients) were included prospectively. All patients had patellofemoral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.
Results: Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 ± 1.1° for tibial torsion (axial plane), 0.8 ± 0.7° for MPTA (coronal plane) and 0.8 ± 0.6° for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 ± 1.4° for femoral anteversion (axial plane), 0.9 ± 0.9° for LDFA (coronal plane) and 0.9 ± 0.9° for PDFA (sagittal plane). The IKSG was improved from 58.0 ± 13.2° to 71.4 ± 10.9 (p = 0.04) and the IKSF from 50.2 ± 14.3 to 87.0 ± 6.9 (p < 0.001).
Conclusions: Using the PSCG for derotational osteotomy allows excellent correction accuracy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability. Level of clinical evidence II, prospective cohort study.
Keywords: Accuracy; Clinical outcomes; Derotational osteotomy; Patellofemoral instability; Patient-specific cutting guide; Torsional malalignment syndrome.
Copyright © 2022 Elsevier B.V. All rights reserved.
CloseSlope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊
Robin Rassat, Grégoire Micicoi, Christophe Jacquet, Sylvain Guy, Jean-Marie Fayard, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36377059/
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.
Materials and methods: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.
Results: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient’s age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05).
Conclusion: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.
Level of evidence: IV; retrospective cohort study.
Keywords: Closing wedge tibial osteotomy; Posterior tibial slope; Revision ACL reconstruction; Slope-decreasing tibial osteotomy.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
CloseHigh tibial flexion osteotomy for symptomatic ligamentous genu recurvatumHigh tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
Christophe Trojani, Grégoire Micicoi, Pascal Boileau
https://pubmed.ncbi.nlm.nih.gov/34329759/
Abstract
Introduction: Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments.
Hypothesis: Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension.
Material and methods: Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores).
Results: The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved.
Conclusion: Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term.
Level of evidence: IV, retrospective descriptive study.
Keywords: Genu recurvatum; High tibial flexion osteotomy; Opening wedge; Tibia; Tibial tuberosity.
Copyright © 2021. Published by Elsevier Masson SAS.
CloseLateral femoral closing wedge osteotomy in genu varumLateral femoral closing wedge osteotomy in genu varum
Lateral femoral closing wedge osteotomy in genu varum
Matthieu Ollivier, Maxime Fabre-Aubrespy, Grégoire Micicoi, Matthieu Ehlinger, Lukas Hanak, Kristian Kley
https://pubmed.ncbi.nlm.nih.gov/34144255/
Abstract
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an « all in the tibia » correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is non-anatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
Keywords: Biplanar; Distal femur osteotomy; Hinge; Knee; Osteoarthritis; Surgical technique.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
CloseGlobal varus malalignment increase from double-leg to single-leg stance due to intra-articular changesGlobal varus malalignment increase from double-leg to single-leg stance due to intra-articular changes
Léo-Pôhl Bardot, Grégoire Micicoi, Henri Favreau, Petr Zeman, Raghbir Khakha, Matthieu Ehlinger, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33486561/
Abstract
Purpose: Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.
Material and methods: This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).
Results: From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01).
Conclusion: Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.
Level of clinical evidence: III, retrospective comparative study.
Keywords: Genu varum; Joint line convergence; Knee; Osteotomy; Weight-bearing; Weight-bearing radiographs.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseOsteotomy around the knee is planned toward an anatomical bone correction in less than half of patientsOsteotomy around the knee is planned toward an anatomical bone correction in less than half of patients
Grégoire Micicoi, Francesco Grasso, Kristian Kley, Henri Favreau, Raghbir Khakha, Matthieu Ehlinger, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33753267/
Abstract
Introduction: In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software.
Methods: CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/overcorrection at the site of the osteotomy resulting in abnormal bone morphology. A type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology.
Results: The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2=0.12, p<0.001) for both femoral (R2=0.06, p<0.001) and tibial (R2=0.07, p<0.001) abnormalities.
Conclusion: Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Osteoarthritis; Osteotomy.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
ClosePatellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slopePatellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slope
Mathieu Carissimi, Pierre Sautet, Dimitri Charre, Lukas Hanak, Matthieu Ollivier, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/34358712/
Abstract
Introduction: Open-wedge high tibial osteotomy (OWHTO) corrects coronal deformity and can impact sagittal parameters such as posterior tibial slope and patellar height. The aim of the present study was to analyze change in patellar height after medial OWHTO with respect to tibial and femoral-referenced indices.
Material and method: This single-center retrospective study included 129 patients undergoing isolated posteromedial OWHTO, without change in tibial slope, using patient-specific cutting-guides. Patellar height was assessed on Caton-Deschamps (CD), Insall-Salvati (IS) and Schröter indices. Posterior tibial slope and coronal femoral and tibial angles were also measured. X-rays were taken preoperatively and at 12 months, and analyzed by 2 independent observers.
Results: OWHTO modified the global lower-limb alignment (Δ=6.3±0.95̊, p<0.0001) and the proximal tibial deformity (Δ=7±0.88̊, p<0.0001). Posterior tibial slope and tibial (CD and IS) and femoral (Schröter) patellar height indices were unchanged. Intra- and inter-observer reproducibility was excellent (ICC 0.79-0.91). There were no correlations between HKA or MPTA angles and change in patellar height.
Conclusion: The present clinical series showed that patellar height was unchanged by isolated posteromedial OWHTO without change in tibial slope, using patient-specific cutting-guides, with whichever femoral or tibial reference index. The Schröter patellar femoral height index was highly reliable and is independent of proximal tibial changes in assessing patellar height, and can thus be recommended in the follow-up of OWHTO.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Open-wedge high tibial osteotomy; Patellar height; Posterior tibial slope.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
ClosePatients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus kneesPatients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees
Hamid Rahmatullah Bin Abd Razak, Grégoire Micicoi, Raghbir S Khakha, Matthieu Ehlinger, Ahmad Faizan, Sally LiArno, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33423093/
Abstract
Purpose: The aim of this study was to compare alignment parameters between patients undergoing high tibial osteotomy (HTO) for knee osteoarthritis (OA) and non-arthritic controls.
Methods: Pre-operative computed tomography images from 194 patients undergoing HTO for medial knee OA and 118 non-arthritic controls were utilized. All patients had varus knee alignment (mean age: 57 ± 11 years; 45% female). The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and non-weight-bearing joint line convergence angle (nwJLCA) were compared between « control group » and « HTO group ». Femoral and tibial phenotypes were also assessed and compared between groups. Variables found on univariate analysis to be different between the groups were entered into a binary logistic regression model.
Results: The mean age was lower (Δ = 4 ± 6 years, p = 0.024), body mass index (BMI) was higher (Δ = 1.1 ± 2.8 kg/m2, p = 0.032) and there were more females (Δ = 14%, p = 0.020) in the HTO group. The HTO group had more overall varus (7° ± 4.7° vs 4.8° ± 1.3°, p < 0.001). There was a significant difference in the mean mLDFA between the two groups with the HTO group having more femoral varus (88.7 ± 3.2° vs 87.3 ± 1.8°, p < 0.001). MPTA was similar between the groups (p = 0.881). Age was found to be a strong determinant for femoral varus (p = 0.03).
Conclusion: Patients undergoing HTO for medial knee OA have more femoral varus compared to non-arthritic controls while tibial morphology was similar. This will be an important consideration in pre-operating planning for realignment osteotomy in patients presenting with medial knee OA and warrants further investigation.
Level of evidence: III, retrospective comparative study.
Keywords: Femur; Joints; Knee; Morphology; Osteoarthritis; Osteotomy; Phenotype; Tibia.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseDouble level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patientsDouble level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients
Francesco Grasso, Pierre Martz, Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Lukas Hanak, Matthieu Ollivier, Christophe Jacquet
https://pubmed.ncbi.nlm.nih.gov/34536082/
Abstract
Purpose: Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years.
Methods: A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student’s t test was used to estimate evolution of functional outcomes.
Results: The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied.
Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.
Keywords: Accuracy; Clinical outcomes; Double level osteotomy; Joint line obliquity; Patient-specific cutting guide.
© 2021. The Author(s) under exclusive licence to SICOT aisbl.
CloseFemoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy IndividualsFemoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals
Grégoire Micicoi, Christophe Jacquet, Raghbir Khakha, Sally LiArno, Ahmad Faizan, Romain Seil, Baris Kocaoglu, Simone Cerciello, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/34710345/
Abstract
Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature.
Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor.
Study design: Cross-sectional study; Level of evidence, 3.
Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics.
Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width (P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI (P = .012) and MMPTA (P = .02) were independent predictors according to ethnicity.
Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.
Keywords: ACL rupture; intercondylar notch width (NWI); lateral femoral condylar index (LFCI); morphological risk factors; posterior tibial slope.
CloseNeutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT databaseNeutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database
Grégoire Micicoi, Christophe Jacquet, Akash Sharma, Sally LiArno, Ahmad Faizan, Kristian Kley, Sébastien Parratte, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32372282/
Abstract
Purpose: Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype.
Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.
Results: The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment.
Conclusion: Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus.
Level of clinical evidence: III, retrospective cohort study.
Keywords: Alignment; CT; HKA; HTO concepts; JLCA; Knee; LDFA; MPTA; Native; PPTA; Phenotypes.
CloseHealthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsionHealthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion
P Mathon, G Micicoi, R Seil, B Kacaoglu, S Cerciello, F Ahmad, S LiArno, R Teitge, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32548676/
Abstract
Purpose: There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals’ lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.
Methods: Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.
Results: Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).
Conclusion: The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.
Level of evidence: Level III.
Keywords: Anteversion; Femoral neck version; Lower limb torsion; Tibial torsion; Torsional alignment.
CloseManaging intra-articular deformity in high Tibial osteotomy: a narrative reviewManaging intra-articular deformity in high Tibial osteotomy: a narrative review
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Adrian Wilson, Simone Cerciello, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32902758/
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee.The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery.The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome.This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA.We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy.Level of clinical evidence IV, narrative review.
Keywords: Joint line convergence angle; Osteotomy; Overcorrection; Soft tissue correction.
CloseDorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instabilityDorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability
Grégoire Micicoi, Lolita Micicoi, Nicolas Dreant
https://pubmed.ncbi.nlm.nih.gov/32216521/
Abstract
The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24-127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability.Level of evidence: IV.
Keywords: Scapholunate dissociation; capsulodesis; carpal instability; ligamentous repair; wrist; wrist instability.
CloseComments on: ``Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?`` by N. Tardy, C. Steltzlen, N. Bouguennec, J.-L. Cartier, P. Mertl, C. Bataillé, et al. published in Orthop Traumatol Surg Res 2020;8S:S231-S236Comments on: ``Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?`` by N. Tardy, C. Steltzlen, N. Bouguennec, J.-L. Cartier, P. Mertl, C. Bataillé, et al. published in Orthop Traumatol Surg Res 2020;8S:S231-S236
Grégoire Micicoi, Henri Favreau, Christophe Jacquet, Matthieu Ehlinger, Matthieu Ollivier
CloseOne-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched studyOne-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study
Grégoire Micicoi, Régis Bernard de Dompsure, Lolita Micicoi, Laurie Tran, Michel Carles, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/32265170/
Abstract
Background: One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates.
Hypothesis: In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA.
Material and method: Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction.
Results: Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08).
Discussion: One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip.
Level of evidence: III, matched case-control study.
Keywords: 1-stage procedure; Bilateral total hip arthroplasty; Complications; Hip osteoarthritis; Outcome; Postoperative morbidity; Unilateral.
Copyright © 2020. Published by Elsevier Masson SAS.
CloseAccuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical methodAccuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical method
Xavier Nicolau, François Bonnomet, Grégoire Micicoi, David Eichler, Matthieu Ollivier, Henri Favreau, Matthieu Ehlinger
https://pubmed.ncbi.nlm.nih.gov/32820360/
Abstract
Introduction: Medial valgus-producing tibial osteotomy (MVTO) is classically used to treat early medial femorotibial osteoarthritis. Long-term results depend on the mechanical femorotibial angle (HKA) obtained at the end of the procedure. A correction goal between 3 and 6° valgus is commonly accepted. Several planning methods are described to achieve this goal, but none is superior to the other.
Objective: The main objective was to compare the accuracy of the correction obtained using either the Hernigou table (HT) or a so-called conventional method (CM) for which 1° of correction corresponds to 1° of osteotomy opening. The secondary objective was to analyze the variations observed in the sagittal plane on the tibial slope and on the patellar height. The working hypothesis was that the HT allowed a more accurate correction and that the tibial slope and patellar height were modified in both groups.
Material and method: In this monocentric and retrospective study, two senior surgeons operated on 39 knees (18 in the CM group, 21 in the HT group) between January 1, 2009 and December 31, 2014. The operator was unique for each group and expert in the technique used. The correction objective chosen for each patient, and written in the operative report, was considered as the one to be achieved. The surgical correction was the difference between the pre-operative and immediate post-operative data (< 5 J) for the mechanical tibial angle (MTA) and the hip-knee-ankle (HKA) angle. Surgical accuracy, where a value close to 0 is optimal, was the absolute value of the difference between the surgical correction performed and the goal set by the surgeon.
Results: The median surgical accuracy on the MTA was 3.5° [0.2-7.4] versus 1.4° [0-4.1] in the CM and HT groups, respectively (p = 0.006). In multivariate analysis, with the same objective, the CM had a significantly lower accuracy of 1.9° ± 0.8 (p = 0.02). For HKA, the median accuracy was 3.1° [0.3-7.3] versus 0.8° [0-5] in the CM and HT groups, respectively (p = 0.006). Five (5/18, 28%) and 16 (16/21, 76%) knees were within 3° of the target in the CM and HT groups, respectively (p = 0.004). The median tibial slope increased in both groups. This increase was significantly greater in the CM group compared with the HT group, with 5.5° [- 0.3-13] versus 0.5 [- 5.2-5.6], respectively (p < 0.001). The median Caton-Deschamps index decreased (patella lowered) in both groups after surgery, by – 0.21 [- 1.03; – 0.05] and – 0.14 [- 0.4-0.16], but without significant difference (p = 0.19). In univariate analysis, changes in tibial slope and patellar height were not significantly related to frontal surgical correction performed according to ΔMTA (R2 = 0.07; p = 0.055) and (R2 = – 0.02; p = 0.54) respectively.
Discussion: The correction set by the surgeons was achieved with greater accuracy and more frequently in the HT group, confirming the working hypothesis. The HT is therefore recommended as a simple way of achieving the set objective; the tibial slope and patellar height were modified unaffected by the frontal correction performed.
Keywords: Accuracy; Knee surgery; Navigation; Open wedge osteotomy; Tibial osteotomy.
CloseEarly morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approachEarly morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Grégoire Micicoi, Régis Bernard de Dompsure, Laurie Tran, Michel Carles, Pascal Boileau, Nicolas Bronsard, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/31591065/
Abstract
Background: Advantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss.
Hypothesis: 1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used.
Material and methods: A single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA.
Results: We included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108-255minutes) in the PA group (p<0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5-11 days) in the AA group, and 8.2 days (range, 3-13 days) in the PA group (p<0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58).
Discussion: In selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used.
Level of evidence: III, comparative study of consecutive patients.
Keywords: Bilateral total hip replacement; Early complications; Hip osteoarthritis; Mortality; One-stage surgery.
Copyright © 2019. Published by Elsevier Masson SAS.
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Communications
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- SOFCOT, Novembre 2017
- Short-term mortality and complications after one-stage bilateral total hip arthroplasty : Is it safe ? Doi : 10.1016/j.rcot.2017.09.134
- SOFCOT, Novembre 2018
- PTH bilatérales en une session opératoire : complications tardives, résultats et courbe de survie
- BELGIAN HAND GROUP, Mai 2018
- Carpal Ligamentous Instability : Dorsal intercarpal ligament capsulodesis for chronic scapholunate instability.
- SOFCOT, Novembre 2019
- Ostéotomie tibiale de flexion pour Genu Recurvatum Ligamentaire Pathologique
- SOFCOT, Novembre 2019 – SFHG, Mars 2020
- PTH bilatérales en une session opératoire versus PTH unilatérales : analyse comparative
- NSC, Juin 2020 – SESSEC, Décembre 2020 (visio)
- The Overtensioned Biceps Tenodesis As a Cause of Postoperative Persistent Shoulder Pain
- NSC, Juin 2020
- The Open Latarjet Procedure Long-term Follow-up (10-25 years)
- CAOS, Juin 2021
- Erreurs de correction après ostéotomies autour du genou
- EHS, Septembre 2021
- Single-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty : a retrospective case-matched study
- SOFCOT, Novembre 2021
- La stratégie du remplacement prothétique bilatéral de hanche en une session opératoires diminue les risques
- SOFCOT, Novembre 2021
- L’alignement neutre résulte d’un tibia vara et d’un fémur valgus : analyse des morphotypes chez des patients d’âge moyen non arthrosiques
- SOFCOT, Novembre 2021
- Anomalies osseuses fémorales et tibiales « associées » aux lésions du ligament croisé antérieur : exploration 3D d’une population non atteinte
- ISAKOS, Novembre 2021
- Usual Definition Of Femoral And Tibial Bony Risk Factors Of Anterior Cruciate Ligament Tears Identify More Than 50% Healthy Individuals To Be At Risk
- ISAKOS, Novembre 2021
- Patients With Varus Knee Osteoarthritis Undergoing High Tibial Osteotomy Exhibit More Femoral Varus But Similar Tibial Morphology Compared to Non-Arthritic Varus Knees
- SOFCOT, Novembre 2021
- Table ronde : BHR
- ESSKA, Avril 2022
- Femoral and tibial bony risk factors for anterior cruciate ligament injuries are present in more than 50% of healthy individuals
- ESSKA, Avril 2022
- Patient’s specific cutting guides allow precise triplanar correction of femoral and tibial torsional deformities
- ESSKA, Avril 2022
- Half of open-wedge high tibial osteotomy lead to persistent postoperative anatomical abnormalities
- SOFCOT, Novembre 2022
- Syndrome de loge aigu des membres inférieurs : fasciotomie isolée ou dermo- fasciotomie ? Etude cadavérique des pressions des loges
- SOFCOT, Novembre 2022
- Survie et résultats à long terme du resurfaçage de hanche
- SOFCOT, Novembre 2022
- Les reprises de resurfaçage en prothèse totale de hanche donnent-elles de bons résultats ?
- SOFCOT, Novembre 2022
- L’inégalité de longueur des membres inférieurs après PTH bilatérale péjore les résultats cliniques
- SOFCOT, Novembre 2022
- Les doubles-ostéotomies réalisées avec guides de coupe personnalisés permettent une meilleure précision de correction mais des résultats cliniques comparables aux techniques conventionnelles
- SOFCOT, Novembre 2022
- Les guides de coupe personnalisés permettent une correction précise pour les dérotations des déformations fémorales et tibiales
- SOFCOT, Novembre 2022
- Table ronde : Ostéotomie
- SOFCOT, Novembre 2023
- Discussion de dossiers : hanche
- SOFCOT, Novembre 2023
- Combien de patients peuvent réellement bénéficier d’une ostéotomie tibiale de valgisation isolée sans modification majeure de l’interligne articulaire ?
- SOFCOT, Novembre 2023
- Table ronde : PTH bilatérale en un ou deux temps
- SOFCOT, Novembre 2023
- Influence des variations de phénotypes selon la classification CPAK sur les résultats fonctionnels après arthroplastie totale de genou réalisée par alignement mécanique
- SOFCOT, Novembre 2023
- Influence de l’alignement sur les résultats cliniques après ostéotomie tibiale de varisation par fermeture médiale
- SOFCOT, Novembre 2023
- La cicatrice épiphysaire tibiale proximale est-elle un repère fiable dans la planification des ostéotomies ?
- SOFCOT, Novembre 2023
- Peut-on évaluer les scores fonctionnels de hanche par questionnaires auto-administrés ?
- SOFCOT, Novembre 2023
- Reconstruction du ligament croisé antérieur chez les patients de plus de 50 ans : analyse des résultats à 10 ans de recul minimum
- ABAOT, Brussels, Mars 2024
- Exploring the Knee
- SFHG, Lille, Avril 2024
- Etude des marqueurs prédictifs de transfusion postopératoire après arthroplastie totale de genou : utilisation d’un outil de machine learning
- ESSKA, Milan, Mai 2024
- Restoring the preoperative phenotype according to the cpak (coronal plane alignement of the knee) classification after total knee arthroplasty leads to better functional results
- Practical Course Orthopedics, Juin 2024
- Lecture : Management of a degenerative meniscus lesion in 2024
- SOFCOT, Novembre 2024
- Symposium : Raideur après arthroplastie totale de genou
- SOFCOT, Novembre 2024
- Table ronde : Réussir la prothèse totale de genou après 85 ans
- SOFCOT, Novembre 2017
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Diplômes
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- Certificat diplômant des techniques de plastinations anatomiques (Sept. 2016)
- DIU Chirurgie de la Main et du Membre Supérieur (Juin 2018)
- DIU Pathologie locomotrice liée à la pratique du sport (Juin 2018)
- DU Microchirurgie (Juin 2018)
- DIU Pathologie Chirurgicale du Genou (Juin 2019 )
- DIU Échographie pour le chirurgien du Membre Supérieur (Juin 2019 )
- DU Pathologie de la Hanche (Sept. 2020 )
- DIU Arthroscopie (Sept. 2021)
- DIU Chirurgie de l’Épaule et du Coude (Oct. 2021)
- DIU d’Expertise Médico-Légale (Janvier 2024)
- DIU d’Écho-chirurgie du membre inférieur (Juin 2024)
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Enseignement
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- 2012 à 2014 Moniteur d’Anatomie – 200 étudiants /an |Faculté de médecine de Nice
- Depuis nov 2020 Enseignement au DIU Pathologie locomotrice liée à la pratique du sport| Faculté de médecine de Nice
- Depuis nov 2022 Enseignement en Sémiologie Orthopédique et Traumatologie | Faculté de médecine de Nice
- Depuis nov 2022 Organisation des cours aux externes au sein de l’iULS
- Depuis avril 2023 Conférences d’enseignements aux externes | Faculté de médecine de Nice
- Depuis Janvier 2024 Enseignement au DU d’Initiation à la Médecine d’Urgence – Base de la traumatologie ostéo-articulaire
- Depuis sept 2017 IFSI | Enseignement en Anatomie de l’appareil locomoteur et de Chirurgie orthopédique
- Depuis sept 2021 IBODE | Enseignement dispensé des techniques opératoires en Chirurgie Orthopédique et Traumatologie
- Depuis nov 2022 | Enseignement dispensé à l’Institut de Formation en Masso-Kinésithérapie