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ABSTRACT: Unicompartimental knee arthroplasty outcome is sometimes compared to total knee arthroplasty but various implant parameters might greatly influence this outcome. The objectives of this study were to report the results of a consecutive series of 172 all-polyethylene unicompartmental knee arthroplasties (UKAs) and to detail possible factors of success and failure.
It is possible to outline implant and technique factors determining success or failure in unicompartimental knee arthroplasty.
One hundred seventy-two HLS-type cemented resurfacing UKAs, with the femoral implant made of chrome-cobalt and the tibial implant tibial entirely in polyethylene (without anchorage studs) were consecutively implanted between 1988 and 2004 in 134 patients (111 females and 23 males) in our center according to the indications established in 1988, using the same technique for each surgery. The patients' mean age was 72.2 years (range, 25-90 years). The review rate was 83.7% (144 UKAs), with a mean follow-up of 62.3 months (range, 24-160 months). The series included 84 medial UKAs and 60 lateral UKAs. The clinical data were analyzed using the IKS criteria and the patients had a complete radiological evaluation before surgery and at the last follow-up.
The rate of satisfied or very satisfied patients was 97.2%. No pain or slight pain was found in 81% of the cases. The mean flexion was 133 degrees (range, 85-150 degrees). The mean knee score varied from 63.6 before surgery to 91.5 (90.4 for medial UKAs and 92.9 for lateral UKAs) and the function score from 63.6 to 83.8 (84.7 for medial UKAs and 82.6 for lateral UKAs). The mean range of motion was 133 degrees (range, 85-150 degrees), better than the medial UKAs for osteonecrosis. The mean residual deformity was 4 degrees varus for the medial UKAs and 2 degrees valgus for the lateral UKAs. A radiolucency was found in 23% of the cases (20% tibial and 3% femoral), nonprogressive in all cases. In 87.2% of the cases, the opposite femorotibial compartment remained radiologically normal. No progression to osteoarthritis in the femoropatellar joint required additional surgery. Sixteen patients required revision surgery: in six cases, the implant was removed and a total prosthesis implanted (one late infection, one case of involvement of the opposite compartment, and four cases of tibial component loosening). In the other cases, one tibial baseplate was changed, five arthroscopies were done, and four unicompartmental knee replacements were done on the opposite compartment. The Kaplan-Meier survival rate (taking into account the revisions with implant change) was 95.6. The results of this series were very satisfactory and were similar to recent series in the world literature that showed survival rates between 90 and 98% at 10 years, rates that are equivalent to those found for total knee replacements. The mean flexion range of motion found was higher than the majority of other recent series, probably because of the precise patient selection in the present study, a minimally invasive approach, and the femoral implant design with an ascending condylar posterior cut. The deterioration of the contralateral compartment is frequently reported, but was perhaps prevented by the absence of overcorrection and patient selection. In this series, none of the UKAs was revised for wear. We explain this by the systematic preservation of a moderate undercorrection, particularly for medial UKAs, the quality of the polyethylene, and a selection based on patient weight and age.
The option of an all-polyethylene tibial implant, with minimal bone cuts (femoral resurfacing), makes excellent long-term results possible.
Orthopaedics & Traumatology Surgery & Research 03/2009; 95(1):12-21. · 0.94 Impact Factor
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ABSTRACT: For hip prosthesis surgery, the challenge is to obtain optimal function of the instrumented hip but also to eliminate any limb length discrepancy, correct the femur offset and guarantee the center of rotation of the hip joint. Preoperative planning for total hip arthroplasty (THA) enables determination of the appropriate length for the prosthetic neck and the size and eventually the type of implants to use. From a prospective series of 86 patients who underwent first-intention THA for implantation of a noncemented prosthesis, we studied the precision of the outcome as function of the preoperative planning. We also ascertained whether the preoperative planning was sufficient to provide the measurements necessary for correct implant position.
We analyzed a prospective series of patients who underwent first-intention THA from January 2004 through January 2006. To be eligible for inclusion, patients could not have a THA of the contralateral hip. The series was composed of 58 females and 28 males, mean age 70.2 years (range 45-93). The reasons for THA were primary degenerative disease (n=76) and aseptic osteonecrosis (n=10). The contalateral hip was intact and free of osteoarthritis with an anatomic presentation considered to be normal. The standard X-ray protocol included an anteroposterior view of the pelvis in the upright position and 10 degrees internal rotation obtained preoperatively and three months postoperatively. All radiographic measurements were made by the same investigator using a manual nondigitalized technique. We compared planning parameters (pivot size and type, length of the neck, and size of the cup) with the final outcome in order to determine the compliance with the preoperative planning. All operations were performed in the lateral supine position under general anesthesia and by the same surgeon. The posterolateral Moore approach was used. All implants were press fit without cement, both for the cup and for the femoral piece.
All planning parameters selected for study (offset, size of the head and the cup, length of the neck) were available for 32 hips, giving an overall conformity of 37%. The length of the neck was as planned in 75% of hips, the size of the cup in 62% and the size of the femoral stem in 64%. The offset defined preoperatively was never changed during the operation. Ideal implantation (+/- 5mm for all criteria selected for study) was obtained in 60% of hips; the height of the center of rotation was reproduced in 81% and the lateralization in 84%. Femur lateralization was reproduced in 75% of the hips and hip offset in 66%. Leg length discrepancy was avoided in 85% of the patients.
Preoperative planning reliably predicts the final offset of the implanted femoral stem. It is more difficult to predict the size of a press fit cup but in our experience the difference does not greatly affect restitution of the hip anatomy. We readily changed the length of the neck during the operation if necessary and have found that the leg length has been better with this approach. This leads to the observation that all of the planning parameters are not fully accurate because of the magnification effect, anatomic conditions, or possible defective execution. While the overall rate of conformity was low, looking at the results for each element separately provided a useful element for each phase of the operation. We recommend planning a medium length neck so it can be easily changed during the operation. The availability of offset measurements is particularly important to control hip lateralization and leg length. Current advances in computer-assisted surgery should be helpful in improving the imperfections of preoperative planning.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 07/2008; 94(4):368-75. · 0.37 Impact Factor
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ABSTRACT: Cartipatch is a third-generation autologous chondrocyte transplantation technique based on a chondrocyte-hydrogel combination specifically developed to overcome certain possible drawbacks of first- and second-generation techniques.
A prospective phase 2 clinical study was launched on 20 patients for the treatment of osteochondral and osteochondritis dissecans lesion on the femoral condyle. Outcome parameters were clinical scores, magnetic resonance imaging, and arthroscopic biopsy at 2 years.
All patients significantly improved clinically at 1 and 2 years. Six patients already reached the 2-year end point. Immunohistological examination revealed hyalinelike cartilage in all these cases.
These results illustrate the feasibility of the Cartipatch technology. A reproducible, precise, and quick implantation of the hydrogels is obtained. The fixation of the cell-loaded hydrogels is guaranteed under in vivo circumstances. The limited immunohistological data already available at 2 years postimplantation show hyalinelike cartilage, indicating that these hydrogels support the phenotypical stability of the cultured articular chondrocytes both in vitro as well as in vivo.
Techniques in Knee Surgery 11/2007; 6(4):253-258.
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ABSTRACT: We report the results of a retrospective analysis of 923 cases of first-intention total knee arthroplasties. The objective was to determine retrospectively the rate of surgical site infections, including all infections diagnosed during the first year, and to search for risk factors. We also wanted to present our surveillance system planned for a 10-year period.
From January 1994 to January 2004, first-intention total knee arthroplasty (TKA) was performed on 999 knees. HLS prostheses were implanted. At minimum 12 months, follow-up data was complete for 923 implants which constituted the study group. Female gender predominated (72%). Mean patient was 71 years (range 26-93). Anterior surgery was performed for 25% of the knees. Etiologies were osteoarthritis (87.5%), and rheumatoid polyarthritis (6.9%). Cefazolin was used for systematic preoperative (one injection) and postoperative (48 hr) antibiotic proxphylaxis. Vancomycin was used for patients with a contraindication for cefazolin. Information was collected from two sources: computerized consultation charts for all follow-up visits completed prospectively since 1995 et data collected by the Hygiene and Epidemiology Unit during the year following implantation. Data on surgical site infections was collected from the hospitalization files, outpatient files and control visits. Each case of infection was validated at an annual interdisciplinary meeting. We retained for analysis deep infections requiring revision surgery with identification of the causal agent on the intraoperative samples. We identified a subgroup of infections occurring during the first postoperative year, the delay generally retained for surgical site infections.
Twenty surgical site infections after TKA were identified during the 10-year surveillance period (2.1%). Mean follow-up was 43 months (range 12-123 months, median 37 months). The rate of surgical site infections occurring during the first postoperative year was 1.4%. Eighty-percent of the infections (n=16) occurred within the first two postoperative months. Two infections were diagnosed two to five years after surgery and two others more than five years after surgery due to hematogenous contamination. All of the observed infections involved a single causal germ. Agents identified were: Gram+ (90%) and Gram- (10%), with a clear predominance for Staphylococcus aureus (n=9). Infections developed 2.1-fold more often in patients with an inflammatory disease (rheumatoid polyarthritis). Age and body mass index did not differ between patients with and without surgical site infection.
The analysis of our series demonstrated the difficulties in conducting long-term surveillance.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2007; 93(6):582-7. · 0.37 Impact Factor
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ABSTRACT: The purpose of our study was to compare the clinical, functional and radiological results of two types of tibial components for the same total knee prosthesis (posterior stabilized HLS), all-polyethylene (group A) and metal-backed (group B), in order to answer the following question: does use of an all-polyethylene piece affect mid-term outcome of total knee arthroplasty (TKA)?
This was a retrospective comparative analysis of a single-center non-randomized consecutive series of 169 patients with an all-polyethylene posterior stabilized cemented gliding TKA. This series was matched with another retrospective series of 169 posterior stabilized cemented TKA with a metal-backed tibial piece. Matching factors were age, gender, etiology, and follow-up. The two series were extracted from our database which included all patients who underwent surgery for a TKA in the same institution (Lyon Civil Hospices) performed by one of the authors (PN) or under his responsibility between 1987 and 1996 for group A (all-poly) and between 1987 and 1997 for group B (metal-backed). Mean follow-up was 66 months. The IKS scores and radiological findings were recorded.
In group A, 96% of patients were satisfied, 93% in group B. The IKS knee score for group A was 89 +/- 10.8 and 88.3 +/- 11.9 for group B. The function score was 68 +/- 23.7 in group A and 71 +/- 24 in group B. Mean flexion was 113 degrees for both groups. Non-progressive lucent lines were noted in 27 cases in group A and 23 in group B. Revision TKA was performed for 18 knees in group A, including six with implant replacement (three of them for infection). In group B, there were ten revisions, seven with implant replacement including one with infection and three without implant replacement. The 10-year survival was 94.5% in group A and 93.64% in group B. There was no significant difference in the function and knee scores, the presence of lucent lines, and the number of implant replacements between group A and group B (p>0.05).
This study was unable to demonstrate any superiority in clinical and radiological results for TKA between the all-polyethylene and metal-backed options at five years follow-up.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2007; 93(4):364-72. · 0.37 Impact Factor
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ABSTRACT: A retrospective review of 29 patients (30 knees) was carried out who had previously undergone a single-stage combined ACL reconstruction with valgus upper tibial osteotomy for chronic ACL rupture coupled with early medial tibio-femoral arthritis. Of the 30 knees, 19 (63%) had had a previous medial meniscectomy. Major complications occurred in two knees resulting in stiffness. At a mean of 12 years follow-up (6-16 years) only five knees (17%) had progressed one arthritis grade. Fourteen patients (47%) returned to intensive sports, and a further 11 (37%) played moderate sports. The mean difference in anterior tibial translation with the opposite normal knee was 3 mm at review. It was concluded that the combined operation has a low morbidity, controls anterior laxity, allows many patients to return to sports, and does not result in a rapid progression of osteoarthritis.
The Knee 01/2005; 11(6):431-7. · 1.74 Impact Factor
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ABSTRACT: The present review analyzes the rare indications for sagittal knee osteotomies either for some complex cases of capsular and ligamentous laxities in combination with or without bony deformities in the sagittal plane. A thorough clinical and radiological analysis of the patients' knees is mandatory. We routinely recommend lateral standing X-rays to assess not only the bony structures, but also an abnormal knee laxity in the sagittal plane. We present different surgical options and preliminary results of these technically demanding procedures.
Der Orthopäde 03/2004; 33(2):193-200. · 0.51 Impact Factor
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ABSTRACT: Kniegelenknahe Flexions- oder Extensionsosteotomien sind seltene Eingriffe. Die Indikation zur operativen Behandlung eines solchen Kniegelenks ist abhngig von der funktionellen Beeintrchtigung und hierbei insbesondere der Instabilitt des Kniegelenks bei Belastung (seltener wegen Schmerzen), dem klinischen und dem radiologischen Befund. Dem knchernen Eingriff zur Korrektur der Deformitt ist in einigen Fllen eine periphere oder zentrale Bandplastik des Kniegelenks hinzuzufgen.Zur properativen Abklrung ist eine eingehende rntgenologische Abklrung unabdingbar. Hier muss eine beginnende Arthrose ausgeschlossen und die Neigung des Tibiaplateaus bestimmt werden. Darber hinaus fhren wir routinemig gehaltene Aufnahmen zur Bestimmung der vorderen und hinteren Schublade durch. Im Falle einer begleitenden vorderen oder hinteren Kreuzbandruptur sollte die Notwendigkeit einer begleitenden Bandplastik mit diskutiert werden.The present review analyzes the rare indications for sagittal knee osteotomies either for some complex cases of capsular and ligamentous laxities in combination with or without bony deformities in the sagittal plane. A thorough clinical and radiological analysis of the patients knees is mandatory.We routinely recommend lateral standing X-rays to assess not only the bony structures, but also an abnormal knee laxity in the sagittal plane. We present different surgical options and preliminary results of these technically demanding procedures.
Der Orthopäde 01/2004; 33(2):193-200. · 0.51 Impact Factor
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ABSTRACT: The purpose of this work was to study the morphology of the patella in search of dysplasia typical of objective patellar dislocation.
One hundred forty patients (190 knees), 80 women and 60 men, who underwent surgery between 1988 and 1999 were included in this study. Mean age was 22.6 years (range 13-47). Patellar morphology was analyzed on the preoperative lateral x-rays (n=190) taken at 30 degrees flexion. The apex of the patella was measured as well as the length of the patellar tendon. The width of the patella was measured on the computed tomography scan (n=158). For 64 knees, magnetic resonance images of the patella were available on which the length and width of the patella, the articular surface, and the patellar tendon were measured. Ninety contralateral knees were symptom free and x-rays were available for 67.
According to the Grelsamer classification, 80% of the patellae presented a normal apex. The length of the patellar apex was significantly shorter when the patellar ligament was longer. Using the Wiberg classification, men had more dysplasic patellae (grade C) (p=0.007). There was also a correlation between the Wiberg classification and the Maldague classification. The length of the medial border of the patella and the patellar angle were 2 factors directly related to the Wiberg classification. Mean width of the patella was 39.1 mm (computed tomography measurements). The mean length of the patellar tendon was 53.8 on the magnetic resonance images with a mean articular surface measuring 30.8 mm, a mean patellar length measuring 40.6 mm, and a mean width measuring 38.7 mm. There was no correlation between trochlear dysplasia and patellar morphology.
There is little data in the literature concerning patellar morphology since Wiberg's work in 1941. The hypothesis of patellar dysplasia rather than trochlear dyplasia, the principal factor involved in objective patellar dislocation, has not been explored extensively. The presence of a hypoplasic medial border, Wiberg grade C, or a short patellar apex suggests that a particular patellar morphotype would be involved in objective patellar dislocation.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 12/2003; 89(7):605-12. · 0.37 Impact Factor
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ABSTRACT: Ten-year outcome of anterior cruciate ligament (ACL) reconstruction was previously reported (1992-1993) for 148 patients who had ACL free grafts associated with extra-articular tenodesis. In this retrospective study, we examined the functional and radiological changes observed 17 years after surgery in patients whose menisci were intact or repaired at ACL reconstruction (46 cases). These patients were operated on between 1978 and 1983.
Between January and April 1999, 28 patients were reviewed clinically and radiographically. Nine other patients responded to a questionnaire and three of them sent their x-rays. Two patients had died since the last review and 7 were lost to follow-up. Mean age at follow-up was 41 years. The IKDC classification was A 18.5%, B 51%, C 22.2%, D 7.4% in 26 patients reviewed with the passive radiological Lachman. At subjective analysis (n=37), 70% of the patients were very satisfied and 27% were satisfied. At radiological analysis (n=31), the AP or lateral single-limb stance views and the AP two-limb weight bearing views at 45% flexion demonstrated preosteoarthritis in 22% and osteoarthritis in 3%. Residual anterior tibial translation was the same at 11 years and 17 years follow-up.
This study clearly demonstrates that ACL reconstruction associated with extra-articular tenodesis can provide good functional and radiological results at 17 years mean follow-up for patients with preserved (sound or sutured) menisci. The status of the medial meniscus at long-term follow-up appears to be the key feature determining the low rate of degenerative changes.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 05/2002; 88(2):157-62. · 0.37 Impact Factor
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ABSTRACT: We report a retrospective series of 83 patients (86 knees) who underwent reconstruction surgery for chronic anterior knee laxity. The purpose of this study was to analyze mid-term results and assess prognosis factors.
All patients underwent artrhoscopic reconstruction of the anterior cruciate ligament using a central one-third patellar tendon graft. Full follow-up data were available for 51 patients (52 knees) and partial data for 24 others (25 knees). Eight patients (9 knees) were lost to follow-up. The IKDC criteria were used to analyze outcome at a mean 6 years post-surgery.
Graft failure was observed in 5 knees and a graft tears after a new sprain was seen at 3 years. The patients were satisfied or very satisfied in 88.5% of the cases. The Trillat-Lachman test revealed a persistent dampened brake in 5 knees and a frank click in 4 (7.7%). Complete movement was recovered in all knees excepting 2 exhibiting persistent flexion. Residual laxity (active Lachman test) was 5 mm in 81.5% of the cases, between 6 and 10 mm in 17%, and greater than 10 mm in only 1 case (2.5%). IKDC scores were A=25%, B=50%, C=21% and D=4%. Forty-two patients (61%) returned to their sports activities and 9 of the 12 high-level athletes resumed competition at the same level as preoperatively. Arthroscopy enabled a well- or very well-positioned femoral tunnel in 88% of the cases, conditioning final IKDC outcome (p<0.02). There was a correlation between the meniscal status and residual laxity.
This study demonstrated a high proportion (21%) of patients with an incomplete repair (21% IKDC class C) with a residual laxity greater than 5 mm and a late hard brake. Simple patellar tendon graft provided insufficient repair of the anterior cruciate ligament. The subjective outcome was better than the objective outcome since 88.5% of the patients were satisfied or very satisfied (patients seen at last follow-up or contacted by telephone). Good objective outcome was correlated with good femoral position of the transplant and preservation of the meniscus. Failures were explained by poor position of the transplant, long-standing laxity, and renewal of sports activities too early.
Arthroscopic repair of the anterior cruciate ligament is a reliable procedure, but as failures are observed, indications should take into consideration the type of laxity and the status of the meniscus. For unique anterior laxity, the central one-third patellar tendon graft gives good results. For advanced anterior laxity, augmentation with an extra-articular lateral tenodesis would be necessary.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 04/2002; 88(2):130-8. · 0.37 Impact Factor
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ABSTRACT: The aim of this paper is to report the outcome in four patients in whom the graft (bone-patellar tendon-bone) was dropped onto the operating-room floor during anterior cruciate ligament reconstruction, and was then re-implanted after decontamination by topic antibiotic treatment.
Between 1992 and 1996, 1038 anterior cruciate ligament reconstructions were performed. In four cases, the bone-patellar-tendon-bone graft was dropped onto the operating theater floor. The graft was then soaked in rifamycin at a concentration of 0.8 mg/ml in normal saline for 10 mn, and soaked in gentamycin at 0.6 mg/ml for a further 10 mn. Finally, the graft was washed in physiological saline. All cases had been given a loading dose of second generation cephalosporin (cefamandole), after deflating the tourniquet. Post-operatively, the patients were given amoxicillin and clavulanic acid for 15 days. The patients were reviewed radiologically and clinically (IKDC form) with a mean follow-up of 24 months.
Post operatively all patients had an uncomplicated recovery. No wound problems was observed in 3 of the four patients achieved an IKDC grade A knee. The final patient had a grade B, after 55 month follow-up. All patients recovered their initial sport level. The radiological Lachman test shows a mean differential value of 0.3 mm.
Dropping the graft during ACL reconstruction is a very rare problem. In this event, the surgeon can choose several options: Harvesting an other site, sterilizing the graft by irradiation, autoclaving, ethylene oxyde..., or using a topical antibiotic treatment. Cooper showed, in an in vitro study that the contamination rate was halved by antibiotic soaking of the graft.
We used a topic antibiotic treatment with success in all four cases. We feel warranted the implantation of a graft which has been dropped, and then antibiotic soaked. The patient should of course be informed and told to report any sign or symptom of infection. On the strength of this result, we would like to propose a decontamination protocol which can be used in this sort of incident, fortunately very rare.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/1999; 85(7):740-3. · 0.37 Impact Factor
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ABSTRACT: Restoration of the normal mechanical axis of the knee and balancing of the surrounding soft tissues have been shown to have an important bearing on the final outcome of total knee arthroplasty. In knees with severe congenital varum deformity these goals may be difficult to achieve.
In four patients with osteoarthritis and severe congenital knee varum deformity of more than 15 degrees, we performed a high tibial valgus osteotomy with opening wedge, combined during the same procedure with total knee arthroplasty.
As correction of the extra-articular deformity was obtained by the osteotomy, in none of the cases it was necessary to perform extensive soft tissue release or advancement to restore alignment. Postoperative X-rays demonstrated restoration of the normal mechanical axis in three cases, but in one case the angular correction of the osteotomy was insufficient and we observed a 9 degrees residual varus deformity.
The osteoarthritic knee must be mechanically realigned for any total knee arthroplasty to be successful in the long term. Most commonly angular deformities are manifestations of the arthritis process, but sometimes, like in congenital varus deformity of the tibia, part of the deformation can be extra-articular in origin. In these cases, restoring alignment and stability may be difficult to achieve. The association of high tibial valgus osteotomy with total knee arthroplasty permits the correction of the extra-articular deformity, by the osteotomy, without performing extensive soft tissue release, as would be needed in total knee arthroplasty alone.
Total knee arthroplasty associated with high tibial valgus osteotomy seems to be a technically satisfying alternative in patients with osteoarthritis and severe congenital varus deformity of the tibia.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/1999; 85(7):749-56. · 0.37 Impact Factor
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ABSTRACT: Purpose of the studyWe report the results of a retrospective analysis of 923 cases of first-intention total knee arthroplasties. The objective was to determine retrospectively the rate of surgical site infections, including all infections diagnosed during the first year, and to search for risk factors. We also wanted to present our surveillance system planned for a 10-year period.Material and methodsFrom January 1994 to January 2004, first-intention total knee arthroplasty (TKA) was performed on 999 knees. HLS1 prostheses were implanted. At minimum 12 months, follow-up data was complete for 923 implants which constituted the study group. Female gender predominated (72%). Mean patient was 71 years (range 26-93). Anterior surgery was performed for 25% of the knees. Etiologies were osteoarthritis (87.5%), and rheumatoid polyarthritis (6.9%). Cefazolin was used for systematic preoperative (one injection) and postoperative (48hr) antibiotic proxphylaxis. Vancomycin was used for patients with a contraindication for cefazolin. Information was collected from two sources: computerized consultation charts for all follow-up visits completed prospectively since 1995 et data collected by the Hygiene and Epidemiology Unit during the year following implantation. Data on surgical site infections was collected from the hospitalization files, outpatient files and control visits. Each case of infection was validated at an annual interdisciplinary meeting. We retained for analysis deep infections requiring revision surgery with identification of the causal agent on the intraoperative samples. We identified a subgroup of infections occurring during the first postoperative year, the delay generally retained for surgical site infections.ResultsTwenty surgical site infections after TKA were identified during the 10-year surveillance period (2.1%). Mean follow-up was 43 months (range 12-123 months, median 37 months). The rate of surgical site infections occurring during the first postoperative year was 1.4%. Eighty-percent of the infections (n=16) occurred within the first two postoperative months. Two infections were diagnosed two to five years after surgery and two others more than five years after surgery due to hematogenous contamination. All of the observed infections involved a single causal germ. Agents identified were: Gram+ (90%) and Gram- (10%), with a clear predominance for Staphylococcus aureus (n=9). Infections developed 2.1-fold more often in patients with an inflammatory disease (rheumatoid polyarthritis). Age and body mass index did not differ between patients with and without surgical site infection.ConclusionThe analysis of our series demonstrated the difficulties in conducting long-term surveillance.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur.
