Orthopédie et Traumatologie | Louvain Médical

Gonarthrosis in obese patients: practical recommendations

Barbora Bocankova, Stéphanie Meirlaen, Emmanuel Thienpont Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Obesity prevalence is rapidly growing and becoming a critical health issue, especially in developed countries. Obesity and life expectancy increase are the main reasons for the rising incidence of osteoarthritis (OA). Obese patients greatly benefit from surgical OA treatment and should therefore not be denied any intervention, including knee arthroplasty, regardless of their body mass index.

Conservative measures, such as lifestyle modification, exercise, and pharmacological treatment with systematic slow-acting drugs for OA (SYSADOA) like glucosamine sulphate, chondroitine sulphate or curcumine, topical or oral non-steroidal anti-inflammatory drugs, and intra-articular steroids or hyaluronic acid injections should be tried before resorting to knee surgery. Minimally invasive knee prosthesis, respecting soft tissue as much as possible, might be particularly beneficial for obese patients, reducing complication rates and improving outcome. However, further studies are needed to confirm this trend.

Hallux valgus: What to tell the patient in the first line?

Maxime Fasseaux, Olivier Cornu, Dan Putineanu, Karim Tribak Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Hallux valgus is the most common disease of the forefoot. Its etiology remains unclear, but is influenced by genetics. This condition can cause incapacitating and even disabling problems. It can have several presentations, the clinical and radiological severity of which will guide the treatment.

The level of evidence regarding first-line management remains poor. This article aims to explore the conservative treatment possibilities and their limits, and attempts to provide answers to the questions most frequently asked by patients.

Patients with mild to moderate hallux valgus, or severe hallux valgus, can have their pain relieved without surgical management. It is not yet established that conservative treatment can actually slow down disease progression, but future studies could explore this possibility.

Conservative treatment is based on adapting the footwear, wearing insoles or orthoses, physiotherapy, level I analgesics, as well as lifestyle and dietary adaptations.

In patients who do not respond to conservative treatment and have significant deformity, surgical treatment can be proposed. This treatment yields a satisfaction rate of approximately 80%

Medium-term survival rate of dual mobility Polarcup® cup in primary hip arthroplasty

Juan Toussaint (1), Julien Vanderplasschen (1), Didier Postlethwaite (2) Published in the journal : October 2022 Category : Orthopédie et Traumatologie

The purpose of this study was to evaluate the medium-term survival of a dual mobility (D.M.) new generation cup: Polarcup® (Smith&Nephew, Fort Worth, Texas) in primary hip arthroplasty, in a population over the age of 70 (mean in our study: 80 years old). In comparison with other studies, our results are similar in terms of medium-term implant survival (100% after 9 years of follow-up, with the occurrence of nine periprosthetic femur fractures long after the operation). This type of cup is indicated for patients with a high risk of dislocation, aged between 70 and 75 years old, with neurological pathologies, alcoholism, low muscle trophicity and prosthesis revision, as well as tumor pathology requiring cementing of the cup in a Kerboull cross-type reconstruction ring. Wear problems occurred at the beginning of the first-generation DM cups use because the surface condition and the geometry of the prosthetic neck are involved in these wear phenomena. This led to the current preference for stems with smooth necks without extraction notches and highly cross-linked polyethylene. Currently, despite a wear and survival rate comparable to that of fixed polyethylene, the risk of intra-prosthetic dislocation (2%) specific to this type of implant should make their use cautious, especially in young and active patients (1). A more widespread use in patients over 70 years of age, supported by the significant reduction in the dislocation risk, as well as the very favorable medium-term survival results of new generation D.M. implants demonstrated by the Australian 2021 registry, could lead to a significant economic advantage (2).

Rhizarthrosis: What should be proposed to patients suffering from pain at the base of the thumb?

Ghady El Khoury1, Olivier Barbier1, Antoine Vanderlinden1, Xavier Libouton1 Published in the journal : July 2022 Category : Orthopédie et Traumatologie

Rhizarthrosis, which is also called trapeziometacarpal osteoarthritis, is one of the most common sites affected by osteoarthritis. The initial symptoms of pain progressively evolve to result in thumb deformity with functional deficits. Standard radiography is the examination of choice to establish the diagnosis. The initial treatment is conservative and consists of immobilization by orthosis, analgesics, physiotherapy, or infiltrations. When this treatment fails, surgical interventions may be proposed, sush as trapeziectomy or trapeziometacarpal prosthesis.