Bruno Ferré

282 Intérêt de la baropodométrie dynamique dans le diagnostic précoce des décompensations de l’hallux valgus

Introduction Il existe peu de donnees concernant la semiologie baropodometrique dans l’hallux valgus. Partant de l’analyse de dossiers d’avant pied nous essayons de montrer s’il existe des signes baropodometriques precoces, de perturbation de l’appui du premier rayon. Materiel Nous avons compare les donnees cliniques, radiologiques et baropodometriques de 105 pieds (35 femmes, 18 hommes, âge moyen 55 ans). L’angle MT1/MT2 : 1,26° a 22,02°moyenne 11,94° ecart-type 3,65. L’angle MT1/MT5 : 15,04° a 39,56° moyenne 28,13° ecart-type 4,76. Methodes Nous avons enregistre les angles et les differences de longueur des metatarsiens sur une radio de face. Une plateforme Novel et son logiciel Emed (Munich Germany) a permis d’enregistrer les forces d’appui. Nous avons divise la surface d’appui en dix zones : arriere et medio pied, les cinq metatarsiens, l’hallux, le deuxieme orteil et les orteils lateraux. Pour chaque zone, nous avons etudie la repartition de l’integrale force Temps (IFT) et a quel instant du pas survenait le maximum de force et de pression. Nous avons compare ces trois criteres en fonction de l’angle MT1/MT2 et du type de plainte fonctionnel du patient. Resultats Nous avons, au niveau des zones metatarsiennes, identifie quatre types de populations « baropodometrique » par rapport a la radio et a la clinique. Celle, asymptomatique ou l’IFT maximum se situait sur les metatarsiens moyens et ou l’instant de maxima de force et de pression etait simultane, situe dans le dernier quart du temps d’appui. Celle, souvent asymptomatique ou l’IFT etait maxima sur la tete du premier metatarsien mais ou la chronologie des maxima de force et de pression n’etait pas perturbee. Celle tres symptomatique ou l’IFT etait augmentee sur le MT1 et ou le maxima d’appui et de force se faisait tres tot par rapport aux autres metatarsiens (vers le milieu du temps d’appui). Celle ou il n’existait aucune systematisation tant de l’IFT que des instants des maxima. Discussion L’apparition d’un hallux valgus entraine une augmentation de la charge de la tete du MT1 (augmentation de l’IFT). Ensuite, a mesure que la deformation s’aggrave et que la metatarso-sesamoidienne se disloque, l’appui du premier rayon est plus precoce et se fait par la diaphyse du MT1 avant d’aboutir a une desorganisation temporelle de l’avant pied non systematisable. Conclusion L’etude baropodometrique dynamique de l’avant pied permets de predire si un hallux valgus va s’aggraver et si la correction que nous lui apportons va rester stable.

AFCP French Total Ankle Replacement Registry Activity Report of First 3 Years

Category: Ankle Arthritis Introduction/Purpose: In 2015-2016, renewal of the 5-yearly French health insurance financing of TAR requires exhaustive data. The French Foot Surgery Society (AFCP – project initiator and promoter), Lyon University Hospitals Clinical Research Unit (administrator and scientific manager) and manufacturers (operational financers) therefore launched a national TAR registry on June 18, 2012 (CNIL data protection approval). For each TAR, there are 3 forms: prosthesis patient data, reoperation, monitoring (optional).We present results for the first 3 years. Methods: Under the 3-party contract, manufacturers pay for 6-monthly reports and €32 per prosthesis to cover the reminder procedure (each company gives the Research Unit a monthly list of surgeons, and the Unit sends out 3 reminders to those who have not entered data). Every surgeon implanting TARs must file a pre-registration formula on the website; after verification, the administrator sends the center number and personal login. Registration takes 3-5 minutes; implant ID number is automatically provided after complete data input. Then surgeons distribute a legal information sheet plus passport (patients can alert the research unit directly in case of re-operation). From June 2012 to June 2015, 1276 of the 1,612TARs implanted in France were registered (79.2%): 514 Salto, 353 SaltoTalaris, 307 Hintegra, 81 Star, 21 Akile. 202 centers implanted TARs: 127 registered TARs in the Registry, 75 registered none. Ten centers registered more than 30 (737 TARs), and 36 only one; surgeon investment was proportional to number of TARs (41% registration rate in centers registering one TAR to 94% in centers registering more than 10 TARs). Results: Mean age at implantation was 63.4 years (18-91 years); etiology was mainly post-traumatic (49%), osteoarthritis on laxity (19%), primary (17%) or inflammatory (7%), with some hindfoot misalignment (21% varus >5°, 11% valgus >5°). Surgery comprised: 97% standard implants (MB thickness mainly 4 mm (26%) or 5 mm (25%)); tourniquet time, 89 min; malleolar fracture, 6.4%; associated Achilles lengthening, 20.9%; ligament plasty, 8.6%; osteotomy, 4.9%; arthrodesis, 2.3%. 528 patients (41.4%) had at least 1 follow-up form (wound healing delay 6.8%, infection 0.7%, DF 9.9°, PF 22.1°). At 3 years, 74 patients (5.8%) were reoperated on (17 patients (2%) at 2 yrs): i.e. 89 reoperations (1-4/patient). 51 patients (4%) had revision without implant removal (arthrolysis 33%, complementary osteotomy 11.5%, Achilles lengthening 9.8%, ligament plasty 6.6%, etc); 9 (0.7%) with partial TAR change (tibia 6 – talus 3); 14 (1.1%) with TAR removal (4 re-do TAR, 8 arthrodesis, 2 temporary spacer before arthrodesis). Conclusion: Follow-up was insufficient to assess survival. This registry procedure, closely followed by the health authorities, has overcome French surgeons’ aversion for registries (exhaustiveness 2% for French Hip registry). Exhaustiveness could be improved if taken into account for surgeons’ accreditation. But an independent annual telephone audit requested by HAS (French Health Authority) showed that at 1 year the registry detected only 29% of reoperations vs phone call survey of registry patients: registries are not the gold standard and probably overestimate the real survival rate.