P. Laffargue

University of Lille Nord de France, Lille, Nord-Pas-de-Calais, France

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Publications (77)71.47 Total impact

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    ABSTRACT: Introduction Après luxations et lésions ligamentaires bicroisées du genou, l’évaluation clinique des lésions des parties molles est difficile et une IRM est généralement réalisée. Hypothèse L’IRM est un examen fiable permettant un bilan précis et reproductible des lésions des parties molles après luxation ou lésion ligamentaire bicroisée du genou. Patients et méthode Quarante patients présentant des lésions ligamentaires bicroisées du genou ont été inclus dans cette étude prospective multicentrique. Tous ont eu une IRM du genou dans les 48 heures suivant l’accident. Trente-quatre patients ont été traités chirurgicalement. Une fiche d’interprétation standardisée de l’IRM a été créée. Cette fiche comprenait 17 items. La reproductibilité intra-observateur a été évaluée en comparant les résultats des interprétations de cinq chirurgiens réalisées à deux reprises à trois semaines d’intervalle. La reproductibilité inter-observateurss a été évaluée en comparant les résultats des interprétations de 40 IRM réalisées par trois binômes de chirurgiens. La pertinence des interprétations IRM était réalisée en comparant les résultats des chirurgiens à ceux d’un radiologue et avec les données des comptes rendus opératoires. Résultats La concordance globale intra-observateur et inter-observateurss était faible. En comparant les résultats du chirurgien à ceux du radiologue et des données opératoires, la concordance était faible. Discussion Après luxation ou lésion ligamentaire bicroisée du genou, un diagnostic précis est nécessaire. Notre étude met en évidence le manque de précision et de reproductibilité des interprétations par IRM de façon isolée pour le diagnostic lésionnel topographique. L’IRM doit être intégrée dans une évaluation complète avec un examen clinique précis et des radiographies de stress. Niveau de preuve Niveau 4, étude prospective cas-témoins.
    Revue de Chirurgie Orthopédique et Traumatologique 05/2013; 99(3):269–274. DOI:10.1016/j.rcot.2012.11.017
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    ABSTRACT: INTRODUCTION: After multiple-ligament injuries and dislocations of the knee, clinical assessment of the soft tissues is difficult and MRI is generally performed. HYPOTHESIS: MRI is a reliable examination, providing a precise and reproducible assessment of soft-tissue lesions after multiple-ligament injuries or dislocations of the knee. MATERIALS AND METHODS: Forty patients presenting multiple-ligament lesions of the knee were included in this multicenter prospective study. All had an MRI of the knee in the 48h following their accident. Thirty-four patients were treated surgically. A 17-item standardized interpretation guide was created. Intraobserver reproducibility was assessed by comparing the interpretations of five surgeons at two different times 3 weeks apart. Interobserver reproducibility was evaluated by comparing the results of the interpretations of 40 MRIs performed by three pairs of surgeons. The relevance of the MRI interpretations was determined by comparing the results of the surgeons to those of a radiologist and with the data from the surgical reports. RESULTS: The overall intraobserver and interobserver agreement was low. Comparing the surgeon's results with the radiologist's results and the surgical data, the agreement was low. DISCUSSION: After multiple-ligament injuries and dislocations of the knee, a precise diagnosis is necessary. This study provides an isolated demonstration of the lack of precision and reproducibility of MRI interpretations for the diagnosis of the lesion's topography. MRI should be integrated into a complete assessment with a precise clinical exam and stress X-rays. LEVEL OF EVIDENCE: Level IV, prospective case-control study.
    Orthopaedics & Traumatology Surgery & Research 03/2013; 99(3). DOI:10.1016/j.otsr.2012.11.016 · 1.17 Impact Factor
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    ABSTRACT: Purpose of the study This multicentre prospective study objective is to provide mid-term results and ten-year survival analysis of the original Natural Knee-I (NK-I) system as experienced by a group of surgeons performing, within various settings, primary total knee replacement (TKR) in the general population. Hypothesis The mid-term experience with this TKR system in the hands of independent surgical teams can duplicate the satisfaction level that was already published by the designer's group itself. Patient and method Two hundred and sixty-three primary TKR were performed by seven surgical teams (37 surgeons) and prospectively evaluated in four European countries. Mean age of the 263 patients (sex ratio, 2.7 females/one male) was 69 years (range, 35–92) and diagnosis was primary osteoarthritis in 85%. For the 247 TKR with complete operative data, approach was sub-vastus in 59%, posterior cruciate ligament was spared in 78%, patella was resurfaced in 56%, and 79% of reconstructions were totally cement-free. Fixation mode was only depending on the surgeon's choice. Results At 76 months average follow-up (range 24 – 190 months), modified Hospital for Special Surgery knee mean score improved from 48 points preoperatively to 83 points. Four reoperations and five revision procedures were required for eight knees. Over the 14-year survey period, the overall revision rate burden was 2% and revision rate per 100 observed component/year, 0.32. At ten years, survivorship (with revision for aseptic loosening as its end-point [two fully cementless knees]) was 98.6%. Discussion Both this multicentre study and data drawn from national registers provided outcomes with equivalent level of satisfaction at equivalent follow-up to those reported by the NK-I prosthesis designer. There was no significant difference between revision rates of cemented, hybrid or cementless reconstructions. Conclusion In non-designer orthopaedists’ hands, the NK-I system™, either with cemented or cementless fixation, provided satisfying mid-term results as normally expected in primary TKR with such a modern modular prosthesis. Level of evidence Level IV, prospective study.
    Resuscitation 11/2010; 96(7):838-839. DOI:10.1016/j.rcot.2010.09.003 · 3.96 Impact Factor
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    ABSTRACT: This multicenter prospective study objective is to provide midterm results and 10-year survival analysis of the original Natural Knee-I System™ as experienced by a group of surgeons performing, within various settings, primary total knee replacement (TKR) in the general population. The midterm experience with this TKR system in the hands of independent surgical teams can duplicate the satisfaction level that was already published by the designer's group itself. Two hundred and sixty-three primary TKR were performed by seven surgical teams (37 surgeons) and prospectively evaluated in four European countries. Mean age of the 263 patients (sex ratio, 2.7 females/1 male) was 69 years (range, 35-92) and diagnosis was primary osteoarthritis in 85%. For the 247 TKR with complete operative data, the approach was subvastus in 59%, posterior cruciate ligament was spared in 78%, patella was resurfaced in 56%, and 79% of reconstructions were totally cement-free. Fixation mode was only depending on the surgeon's choice. At 76 months average follow-up (range 24-190 months), modified Hospital for Special Surgery knee mean score improved from 48 points preoperatively to 83 points. Four reoperations and five revision procedures were required for eight knees. Over the 14-year survey period, the overall revision rate burden was 2% and revision rate per 100 observed component/year, 0.32. At 10 years, survivorship (with revision for aseptic loosening as its end-point [two fully cementless knees]) was 98.6%. Both this multicenter study and data drawn from national registers provided outcomes with equivalent level of satisfaction at equivalent follow-up to those reported by the NK-I prosthesis designer. There was no significant difference between revision rates of cemented, hybrid or cementless reconstructions. In non-designer orthopaedists' hands, the Natural Knee-I System™, either with cemented or cementless fixation, provided satisfying midterm results as normally expected in primary TKR with such a modern modular prosthesis. Level IV. Prospective study.
    Orthopaedics & Traumatology Surgery & Research 10/2010; 96(7):769-76. DOI:10.1016/j.otsr.2010.06.006 · 1.17 Impact Factor
  • Revue de Chirurgie Orthopédique et Traumatologique 12/2009; 95(8). DOI:10.1016/j.rcot.2009.10.011
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    ABSTRACT: Introduction Knee dislocation and bicruciate lesions are rare. Assessments of results from retrospective series carry an insufficient level of evidence. A prospective multicenter study was therefore set up, under the auspices of the French Society of Orthopedic Surgery. Material and methods The inclusion period covered the whole of 2007. Clinical, imaging (dynamic X-ray and MRI) and vascular (angioscan and arteriography) assessment was performed systematically. In patients over the age of 60 years, ligament lesions were always managed non-surgically; in those under the age of 60 years, surgery was considered in the absence of associated vascular lesion or open dislocation and if there was frontal laxity exceeding 15° or a posterior drawer test greater than 10 mm. The posterior cruciate ligament (PCL) and peripheral ligament tears were repaired or reinforced under arthroscopy or by arthrotomy. The anterior cruciate ligament was never operated on. In all other cases, management was conservative. Results Sixty-seven knees were included (55 male, 11 female; mean age: 37 years). Fifteen patients (25.4%) had bicruciate lesion, and 44 (74.6%) knee dislocation. Mean trauma-to-reduction interval was 3 hrs 50 min. Only one of the nine cases of popliteal artery lesion exhibited discernible distal pulse wave. Only three of these patients underwent vascular surgical repair. Twelve knees (five bicruciate lesions, seven dislocations) had isolated common peroneal nerve damage. Discussion This prospective study detailed the epidemiology and treatment of the lesions encountered, with the option of PCL and peripheral ligament reconstruction. The results, however, still require long-term analysis. Level of evidence Level IV prospective epidemiologic study.
    Revue de Chirurgie Orthopédique et Traumatologique 12/2009; 95(8):743-750. DOI:10.1016/j.otsr.2009.10.005
  • Revue de Chirurgie Orthopédique et Traumatologique 10/2009; 95(6). DOI:10.1016/j.rcot.2009.07.007
  • Revue du Rhumatisme 04/2009; 76(4):367-373. DOI:10.1016/j.rhum.2008.04.026
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    ABSTRACT: Los factores de riesgo de infección relativos al paciente pueden evaluarse en ortopedia con el sistema NNIS (National Nosocomial Infection Surveillance), que tiene en cuenta datos que son poco o nada modulables: estado del paciente según la escala ASA, duración de la intervención, tipo de intervención, etc. El riesgo de infección también depende de otros factores, de los que los principales ejercen su efecto en el período perioperatorio. Algunos de esos numerosos factores son relativos al paciente (flora cutánea, portador de staphylococcus aureus resistente a la meticilina [SARM], enfermedad subyacente, infección preexistente, paciente politraumatizado, etc.), y otros se relacionan con el entorno directo del paciente (quirófano, calidad del aire y del agua, higiene del equipo quirúrgico y de enfermería, material, etc.). El paciente politraumatizado tiene un riesgo especial de infección debido a la lesión traumática múltiple, a las lesiones viscerales y a los procedimientos invasivos de resucitación. Se debe actuar esencialmente sobre este segundo grupo de factores para disminuir el riesgo infeccioso. Sobre todo en el período perioperatorio, los procedimientos validados permiten disminuir el riesgo de contaminación: preparación del paciente, normas de los quirófanos, lavado quirúrgico de las manos, calidad del aire y del agua, profilaxis antibiótica adecuada, tratamiento de otras afecciones, duración de la hospitalización prequirúrgica, etc. Respecto a la internación en sala séptica, se ha demostrado en un estudio reciente que la eliminación de esta modalidad puede aumentar el riesgo de contaminación por SARM. Los textos legales (producidos por el Comité Local de Infecciones Nosocomiales) y las obligaciones de trazabilidad tienden a uniformar y optimizar los métodos de prevención. La información al paciente sobre el riesgo de infección y sus consecuencias es un imperativo del ejercicio de la ortopedia y la traumatología.
    01/2009; 1(1):1–18. DOI:10.1016/S2211-033X(09)71600-7
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    ABSTRACT: Purpose of the studyMost imageless navigation systems for computer-assisted (CAS) total hip arthroplasty (THA) aim at orientating the cup with regard to the anterior pelvic plane (APP). However, these systems have some limitations: 1) the adequate position is not well defined to prevent impingement and dislocation; 2) dynamic variation of the APP according to activities (sitting, climbing stairs, etc.) are not integrated in determining the adequate orientation; 3) intraoperative assessment of the APP is not reliable with conventional tools, requiring ultrasound or two-stage identification. To address these issues, we developed an imageless CAS system without using APP, based on a kinematic approach of the hip joint. This system does not use the APP as the reference plane to orient the cup. The systemhelps the surgeon to orient the cup in relation to the cone describing the hip joint range of motion. The purpose of this study was to detail the technique and to analyze preliminary results. Materials and methodsTwenty-four primary cementless THAs were implanted using CAS Pleos™ with optoelectronic tracking system (18 women, 6 men; mean age, 67 ± 7.8 years, age range, 54–83 years) because of primary osteoarthritis. Two optoelectronic sensors are fixed percutaneously on the pelvis and the distal femur. The acetabulum is prepared first, followed by the femur using reamers and broaches of increasing size. The last broach placed in the femur was equipped with a large head adapted to the newly prepared acetabulum. The range of hip motion is recorded to determine the maximal range of motion cone. The acetabular cup is thus positioned so that the prosthesis range of motion totally covers the maximal range of motion of the hip joint. ResultsThe Postel-Merle-d’Aubigné score improved from 8.1 ± 3.2 (range, 3–13) preoperatively to 17.1 ± 0.8 (range, 16–18) at last follow-up. There were no complaints of patients about the sensor insertion and no cases of hematoma or fracture. Operative time was 35–40 min longer for the first four cases and was progressively reduced by 15–20 min for the last four cases. Mean leg length discrepancy was 5.6 ± 7.5 mm (range, 0–25 mm) before implantation and 0.6 ± 3 mm (range, −5 to 10 mm) at last follow-up, eighteen were equal. Mean frontal cup inclination was 47 ± 7° (range, 38–60°). After CT-scan measurement, mean anteversion of the femoral implant was 16.8 ± 9.2° (0–31°). The mean cup anteversion was 25.2 ± 9.2° (range, 8–40°) for “anatomical anteversion”. Only 10 of the 24 cups were orientated inside the Lewinnek safe zone (there was only one dislocation that was traumatic with a cup orientated in the safe zone). ConclusionThis method can be used in routine procedures without lengthening operative time significantly. It safely controls leg length and helps position the cup. This study demonstrates that there is no ideal position for the cup that can be used for all patients. Because of the wide range of inclination and anteversion figures, 58% of the cups were outside the safe zone recommended by Lewinnek.
    Interactive Surgery 10/2008; 3(3):119-126. DOI:10.1007/s11610-008-0083-5
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/2008; 94 Suppl(6):S211-4. · 0.55 Impact Factor
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    ABSTRACT: Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options. Three prospective studies were carried out in order to answer to these questions: (1) is it possible with anatomical reduction and stable fixation to lower the non union and osteonecrosis rate? (2) is functional treatment of Garden 1 fractures successful in more than 65 years patients? (3) what criteria are useful to choose the kind of arthroplasty for more than 65 years patients? For the 64 patients between 50 and 65 years old included in the first study, 44 ORIF and 17 prostheses were performed. No open reduction was performed in this series despite a 34% malreduction rate. The risk for displacement after functional treatment of Garden 1 fractures is 31%. For patients over 65 years old, almost fractures are treated in this series by an arthroplasty. The one-year mortality rate after displaced femoral neck fracture was 17%. Functional results were better in total hip prosthesis group than in bipolar or unipolar group. Non cemented stems were not safer than cemented ones in frail patients. For young patients, ORIF should be the treatment of choice: the initial displacement and its effects on the femoral head vascularisation, the quality of reduction and fixation are the two most significant factors for good outcome. For Garden 1, fractures in patients 65 years old or more, it is proposed to performed an internal fixation despite in two thirds of the cases, it should be unnecessary because non identification of predictive factors of failure. For patients over 65 years old, the type of arthroplasty to perform in displaced fractures is to be chosen according to the preoperative mobility and comorbidities. Because of acetabular erosion with long-term follow-up, it is clearly indicated to perform total hip replacement for patients with life expectancy of 10 years or more. For frail patients, unipolar arthroplasty is the best option. The place for bipolar or uncemented implants is not yet well-defined and more prospective trials are needed. In this multicentric study, results appear quite different in terms of mortality, or functional status. These differences seem to be related to technical choice, geriatric care, nutritional consideration or surgical organisation, all factors that may be of major importance for prognostic.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/2008; 94 Suppl(6):S108-32. DOI:10.1016/j.rco.2008.06.006 · 0.55 Impact Factor
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/2008; 94(6):211-214. DOI:10.1016/j.rco.2008.07.252 · 0.55 Impact Factor
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    ABSTRACT: Early loosening, before a three-year follow-up, has been observed with cemented cups having a metal-on-metal insert in a polyethylene cup. The metal-on-metal bearing has been incriminated as the source of the problem because of its rigidity (particularly for small cups measuring less than 50 mm) and the creation of stress conditions unfavorable for a cemented fixation. The purpose of this retrospective study was to determine whether this phenomenon is observed when the cement is fixed not directly into the bone, but via a Muller reinforcement ring. From 1998 to 2004, 23 arthroplasties using a cemented Metasul cup in a reinforcement ring were implanted in 22 patients (16 women and six men) aged on average 44 years (range 24-56 years). The series included six primary total hip arthroplasties (three for dysplasia, two for protrusions, one for rheumatoid arthritis and one for arthritic degradation) and seventeen revisions (two septic). The Metasul cup (Zimmer-Centerpulse) combined a 28 mm modular head anchored in a femoral implant (two cemented, 21 pressfit) and a polyethylene cup with a Metasul insert (13 of 23 measuring<50mm). In all cases, the cup was fixed with low-viscosity cement in a Myller metal reinforcement ring fixed with screws (Zimmer-Centerpulse). All patients were reviewed clinically and radiographically at a mean 5-year follow-up (range 3-8 years). Acetabular and femoral fixation were analysed (search for lucency and implant migration). Revision was not necessary in any patient for failure of the acetabular fixation. The mean Postel-Merle-d'Aubigné score improved from 12.9 points (range 7-17) to 17.5 points (range 16-18). The radiographic analysis did not reveal any sign of lucency between the cup and ring, nor any migration of the ring. There was no evidence of femoral osteolysis but one femoral revision was needed due to fracture of the lateral cortical identified six weeks after implantation. Cementing the metal-on-metal cup into a reinforcement ring can avoid the risk of loosening observed after direct cementing into bone. In our study, the large number of small cups (13/23) would have been expected to produce a high rate of acetabular lucent lines and/or a high rate of early revision, as reported by others, as early as 24 months. Our series was also different from others by the use of pressfit femoral implants in most patients, which should reduce the risk of cement debris in the bearing. Longer follow-up will be necessary to confirm the good results observed to date which suggest that direct cementing of the cup into the bone should be incriminated rather than the metal-on-metal bearing to explain the reported failure of cemented Metasul cups.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2008; 94(4):346-53. · 0.55 Impact Factor
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    ABSTRACT: Purpose of the studyEarly loosening, before a three-year follow-up, has been observed with cemented cups having a metal-on-metal insert in a polyethylene cup. The metal-on-metal bearing has been incriminated as the source of the problem because of its rigidity (particularly for small cups measuring less than50mm) and the creation of stress conditions unfavorable for a cemented fixation. The purpose of this retrospective study was to determine whether this phenomenon is observed when the cement is fixed not directly into the bone, but via a Muller reinforcement ring.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2008; 94(4):346-353. DOI:10.1016/j.rco.2007.11.004 · 0.55 Impact Factor
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    ABSTRACT: The main concern of patients with longer life expectancies and of patients who are younger and more active is the longevity of their total hip arthroplasty. We retrospectively reviewed 83 cementless total hip arthroplasties in 73 patients implanted with metal-on-metal articulation. All patients were younger than 50 years old (average age, 41 years) at the time of the index procedure, and 80% of the patients had an activity level graded 4 or 5 when measured with the system of Devane et al. A 28-mm Metasul articulation was used with three different cementless titanium acetabular components. At the most recent followup (average, 7.3 years), the average Merle d'Aubigné-Postel score improved from a preoperative 11.1 points to 17.4 points. We observed no radiographic evidence of component loosening. Ten acetabular components had lucency limited to one zone. The 10-year survivorship with the end point of revision (ie, exchange of at least one prosthetic or bearing component) was 100% (95% confidence interval, 90%-100%). Metasul bearings with cementless acetabular components remain promising in this high-risk younger patient population. However, additional followup strategies are recommended to determine any possible long-term deleterious effects associated with the dissemination of metallic ions. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2008; 466(2):340-6. DOI:10.1007/s11999-007-0045-y · 2.88 Impact Factor
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 12/2007; 93(8):865-866. DOI:10.1016/S0035-1040(07)78475-1 · 0.55 Impact Factor
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2007; 93(7):89-89. DOI:10.1016/S0035-1040(07)79497-7 · 0.55 Impact Factor
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2007; 93(7):133-133. DOI:10.1016/S0035-1040(07)79584-3 · 0.55 Impact Factor
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2007; 93(7):144-145. DOI:10.1016/S0035-1040(07)79606-X · 0.55 Impact Factor

Publication Stats

616 Citations
71.47 Total Impact Points

Institutions

  • 2004–2010
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 1997–2006
    • Centre Hospitalier Régional Universitaire de Lille
      • Division of Psychiatry
      Lille, Nord-Pas-de-Calais, France
  • 2002
    • CHRU de Strasbourg
      Strasburg, Alsace, France