Samy Bendaya

Healthy vs. osteoarthritic hips: A comparison of hip, pelvis and femoral parameters and relationships using the EOS® system

BACKGROUND Osteoarthritis is a debilitating disease, for which the development path is unknown. Hip, pelvis and femoral morphological and positional parameters relate either to individual differences or to changes in the disease state, both of which should be taken into account when diagnosing and treating patients. These have not yet been comprehensively quantified. Previous imaging studies have been limited by a number of factors: supine rather than standing measurements; high radiation dose; a limited field of view; and 2D rather than 3D measurements. EOS®, a new radiographic imaging modality that acquires simultaneous frontal and lateral (sagittal) X-ray images of the full body, allows 3D reconstruction of the hip, pelvis and lower limb. The aim of the study was to explore similarities and differences between healthy and osteoarthritis groups. METHODS Two groups of subjects, 30 healthy and 30 with hip osteoarthritis, were assessed and compared for pelvic, acetabular and femoral parameters in the standing position. FINDINGS There were not only significant differences between groups but also considerable overlap amongst the individuals. Sacral slope, acetabular angle of Idelberger and Frank, femoral mechanical angle and femoral head eccentricity as well as right-left asymmetries in centre-edge acetabular angle and femoral head diameter were higher on average in osteoarthritic patients compared to healthy subjects, whereas acetabular abduction was lower in the osteoarthritic group (P<0.05). Correlations were identified between key parameters in both groups. INTERPRETATION Differences between the groups suggest either degenerative changes over time or inherent differences between individuals that may contribute to the disease progression. These data provide a basis for longitudinal and post-surgery studies. Due to the considerable variability amongst individuals and the considerable overlap between groups, patients should be evaluated individually and at multiple joints when planning hip, knee and spine surgery.

Good vs Poor Results After Total Hip Arthroplasty: An Analysis Method Using Implant and Anatomic Parameters With the EOS Imaging System

BACKGROUND Existing imaging techniques and single-parameter analyses, in nonfunctional positions, fail to detect the differences between patients with good vs poor results after total hip arthroplasty. METHODS The present study developed an analysis method using the EOS full-body, low-dose, biplanar, weightbearing imaging system to compare good vs poor patients after total hip arthroplasty and to report on our preliminary experiences (17 good, 18 poor). RESULTS All revision cases were found to have at least 4 high or low implant or anatomic parameters relative to the good group. These included acetabular cup orientation, sagittal pelvic tilt, sacral slope, femoral offset, and neck-shaft angle. Acetabular cup orientation differed significantly between groups. CONCLUSION With the EOS system, a large cohort can be studied relatively quickly and at low dose, which could lead to patient-specific guidelines.

Balance and Walking Training in Ataxic Neuropathies

Neuropathies are characterized by a sensorimotor deficit of the extremities, especially the lower limbs. According to the clinical signs, they can be divided into motor, sensory or trophic forms. With regard to the sensory forms, the main disorders are subjective and objective sensory disorders without motor impairment. Ataxic neuropathies are severe deep sensory disorders that, in turn, cause balance and walking disorders, with a reduction of distal sensitivity on tuning fork testing and greater imbalance with eyes closed (Romberg sign).

Isokinetic assessment of trunk muscles in facioscapulohumeral muscular dystrophy type 1 patients

Facioscapulohumeral muscular dystrophy type 1 is the third most common inherited myopathy. Its severity is proportionate to the loss of microsatellite D4Z4 repetitions, which are below 10. Patients suffer from weakness in facial muscles, shoulder girdles and ankle dorsiflexors. Trunk impairment is reported in few studies. To assess correlation between D4Z4 number of repetitions in facioscapulohumeral muscular dystrophy type 1 patients and trunk extensors and flexors isokinetic peak torque, 48 patients with southern Blot confirmed facioscapulohumeral muscular dystrophy type 1 were enrolled to perform clinical evaluation (Riccis Clinical Severity Scoring, Berg Balance Scale, Functional Reach Test, timed up-and-go test, six-minute walk test, functional independence measure) and trunk isokinetic assessment. Trunk extensors and flexors isokinetic peak torque at 60°/sec were significantly correlated with number of D4Z4 microsatellite repetitions, sex, weight and age-independent (r = 0.391 [0.121; 0.662], p < 0.006 and r = 0.334 [0.028; 0.641], p < 0.033, respectively). Riccis Clinical Severity Scoring was significantly correlated to trunk extensors isokinetic peak torque at 60°/sec, sex and weight-independent (r = -0.743 [-0.938; -0.548], p < 0.0001). This study demonstrates moderate correlation between pathologic compression of D4Z4 microsatellite array and trunk extensors isokinetic strength among facioscapulohumeral muscular dystrophy type I patients.