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Tibial Valgus Osteotomy

The knee is composed of 3 parts: the femur, the tibia and the patella. In some cases, the axis of the lower extremity and therefore the knee is varus, or curved.

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As a result, more weight tends to pass through the medial compartment of the knee than the lateral part. This can damage the medial compartment and lead to premature wear of the cartilage and the meniscus.
In some cases, and when medical treatment is insufficient, realignment of the mechanical axis of the lower extremity may be indicated to straighten the knee.
This is a tibial valgus osteotomy.
A minimally invasive medial approach is used.
The osteotomy, which consists in cutting the top of the tibia, is performed under x-ray control. A lateral bone hinge is preserved intact so the cut can be opened up and the deformity corrected according to its magnitude.
Synthetic bone is inserted to promote consolidation.
A plate is fixed to hold the correction in place while it heals and to rapidly enable weight bearing.
The aim of the operation is to relieve the pain caused by the damage to the medial compartment of the knee and to slow down the onset of osteoarthritis.
The mechanical axis is restored and the forces redistributed.
Following the operation, crutches are used for 3 to 6 weeks to relieve the joint.

Standard or reverse shoulder replacement

The shoulder joint is composed of the shoulder blade and the head of the humerus. It is covered with the rotator cuff tendons and the deltoid muscle, which enable movement.

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Part 1
Osteoarthritis is the wear and tear of the cartilage on the humeral head and the glenoid cavity of the scapula.
A shoulder replacement is indicated in the case of osteoarthritis for which medical treatment is ineffective.
When the rotator cuff tendons in the shoulder are preserved, a so-called “anatomical” total shoulder replacement can be proposed.
An anterior incision is made in the shoulder.
The muscles are moved aside to expose the anterior shoulder tendon. Humeral head can then be exposed and cut.
Different rasps are used to prepare the surface for the insertion of the humeral implant.
The glenoid cavity is then exposed. The bone is specifically prepared using different cutters. The implant is second to place.
The implant is then reduced. Immobilization of the shoulder for 3 weeks followed by prompt rehabilitation will help ensure recovery of a painless, normal range of motion.

Part 2
With osteoarthritis and a pre-existing tear of the shoulder tendons, the humeral head tends to migrate upwards.
A standard anatomical replacement is not possible.
A reverse replacement is necessary that can offset the lack of tendons.
The same approach is used.
The humeral head is cut. Then, the bone is prepared with rasps to allow the placement of the socket-shaped humeral component.
The humeral glenoid is then exposed. The bone is prepared using different cutters. This preparation enable placement of a cementless component fixed with 4 screws in which the glenoid hemisphere can be inserted.
The 2 implants are put back into place. The deltoid muscle in the shoulder can once again assume its lifting role thanks to the shape of the implant.
The shoulder is no longer painful and full range of motion is generally restored.
Post-operative recovery is the same, with immobilization in a vest for 3 weeks.

Knee ligament reconstruction

The knee is a fundamental joint connecting the femur to the tibia and the fibula. It is composed of various structures, as illustrated in this video, which can be damaged or worn: menisci, cartilage, ligaments…

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The anterior cruciate ligament is a major ligament located in the middle of the knee which connects the femur to the tibia. It prevents forward translation and stabilises the knee during rotation. Its rupture results in instability and abnormal function during flexion and extension of the knee. In this case, it must be repaired. Anterior cruciate ligament reconstruction is performed arthroscopically. The old ligament is prepared and partially cleaned. Using a drill guide, a pin is accurately positioned where the anterior cruciate ligament inserts in the femur. This pin guides the drill bit to create the femoral tunnel. The same procedure is carried out on the tibia. A tunnel is created and ends at the natural tibial insertion of the anterior cruciate ligament.
The tendons harvested beforehand are passed through these tunnels, thus recreating the anterior cruciate ligament from where it is attached to the tibia to where it is attached to the femur. The tendons are attached using interference screws, which trap the tendons in the tibia and the femur. These screws will break down over time. As much of the old anterior cruciate ligament is retained as possible to help promote cell colonization on the new ligament. The stability of the knee is thus restored.
This operation is performed arthroscopically through small incisions using a camera to visualize the joint, thus minimising scarring and enabling faster recovery.

Shoulder arthroscopy – Rotator cuff repair

The shoulder is made up of the humerus, the collarbone and the scapula. This complex joint can suffer from various disorders or can no longer fulfil its role following a trauma.

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The shoulder tendons, which compose the rotator cuffs, are inserted in the upper extremity of the humerus. The acromion is part of the scapula and forms the top of the shoulder. The tendons rub against the acromion if it is too curved, resulting in irritation and rupture. The acromion is firstly trimmed in order to remove the impingement or excessive contact with the tendons. The bone of the humeral head is prepared to receive the anchors, which will enable the repair. The threads attached to these anchors are passed through the tendon and are tied together to reattach the tendon to the bone. The tendon is thus repaired and there is no longer any excess contact between the tendon and the acromion. As a result, the tendon can heal by averting repeated rupture. The shoulder thus recovers mobility and strength, and is no longer painful.
This operation is performed arthroscopically, without opening the shoulder, through small incisions using a camera to visualize the joint. The operation preserves the other shoulder muscles and enables rapid recovery.

Total hip replacement

Hip osteoarthritis is the wear of the cartilage, as explained in this video; it no longer protects the joint properly resulting in pain and difficulty in moving normally.

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The hip joint comprises the femoral head that articulates with the acetabulum. Osteoarthritis is the wear of the cartilage on the femoral head and the acetabulum.
A hip prosthesis comprises 2 main components. The worn femoral head is cut for the placement of the first component. The acetabulum is prepared using a motorised cutter for the impaction and the integration of the cotyloidal impant in the pelvis. The femur is then prepared using rasps for the insertion of the femoral stem of the correct size. The femoral head is then attached to the stem forming the second component. The hip replacement is complete. The hip recovers full mobility and is no longer painful. Cementless alumina-based implants are generally used providing optimal duration of the prosthesis. This replacement is performed using a minimally invasive anterior approach; all the hip muscles are preserved thus enabling rapid recovery and good stability. An incision can also be made in the groin for esthetic purposes.

Meniscal surgery

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The meniscus acts like a shock absorber in the joint between the femur and the tibia. There are two menisci: medial and lateral, which suffer two types of trauma. The first is a flap with a mobile fragment in the joint between the femur and the tibia, causing pain, discomfort and cartilage damage due to rubbing of the cartilage. The meniscal bell clapper must therefore be resected using small pliers and finely rectified using a small surgical knife with a vacuum system.
The second type of lesion is peripheral, that is to say, located around the edge of a well-vascularised area where the meniscus can heal. Miniature suturing instruments are used to repair the lesion. Several stitches help the lesion to heal rapidly, thus preserving the entire meniscus.
This surgery is performed arthroscopically through small incisions using a camera to visualize the joint, thus minimising scarring and enabling faster recovery.

Total knee replacement

The knee is a fundamental joint connecting the femur to the tibia and the fibula, and is composed of various structures, as illustrated in this video, that can be damaged or worn: menisci, cartilage, ligaments…

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The knee comprises three main compartments : the femur, the tibia and the patella. Knee osteoarthritis is the wear of the cartilage. Total knee replacement consists in replacing the worn femoral, tibial and patellar cartilage, whilst preserving the muscles, tendons and ligaments.
Firstly, the patella is moved aside. The femur cartilage is resected using specific guides in order to cut the cartilage accurately, and thus position the prosthesis correctly. Another guide is used to cut the tibial cartilage. The tibia is then prepared for the placement of the tibial implant. The other femoral component is then placed at the interface between the femur and the tibia. The patella is then prepared and the cartilage replaced. The patella is returned to its natural position and the prosthesis is ready for use. The knee recovers full mobility and is no longer painful. This operation is performed using a minimally invasive approach thus preserving the main knee muscle, the quadriceps, and enabling faster recovery.

Shoulder arthroscopy : Acromioplasty

The shoulder is made up of the humerus, the collarbone and the scapula. This complex joint can suffer from various disorders or can no longer fulfil its role following a trauma.

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The shoulder tendons are covered by what is called the acromion, which is part of the scapula. This acromion can be too curved or hooked causing premature contact with the tendons and thus rubbing during repeated movement of the shoulder. This irritates the tendons, which become inflamed and can rupture. The operation consists in resecting the inferior side of the acromion to flatten it and thus prevent the tendons from rubbing during movement. This is done using a small, motorised cutter, thus relieving the pain and preventing the premature wear of the tendons.
This operation is performed arthroscopically, without opening the shoulder, through small incisions using a camera to visualize the joint. The operation preserves the other shoulder muscles and enables rapid recovery.

Patella Dysfunction

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The quadriceps tendon connects the thigh muscle to the top of the patella, and the patellar tendon connects the bottom of the patella to a bump on the top of the tibia called the anterior tibial tuberosity. Two lateral bands, the lateral retinaculum and the medial retinaculum, stabilize the patella.

– If the lateral retinaculum is too tight, the patella exerts too much external pressure on the femoral cartilage, or trochlea.

The surgical procedure is performed arthroscopically, through two small incisions using a camera to view the joint, and consists in cutting the lateral retinaculum to relieve the excessive pressure and thus reduce the rubbing between the external part of the patella and the trochlea. The retinaculum will then heal, but more loosely.

– Retraction of the lateral retinaculum is often associated with a lateral position of the patella, which is due to the off-centre insertion of the patellar tendon owing to the position of the tibial tuberosity bump, which is also in an abnormally lateral position. In addition, this situation results in excess rubbing on the lateral side of the trochlea and causes pain in the kneecap and sometimes its dislocation.

In addition to retinaculum release, the therapeutic procedure consists in repositioning the tuberosity, released beforehand by an incision of a few centimeters, in the centre of the knee and then fixing it with two screws to realign the patellar tendon in the centre of the trochlear groove.
Correct patella tracking is restored and the excessive rubbing that caused the pain in the patella and the cartilage damage is eliminated.

Any cartilage damage can be treated at the same time. Once consolidated, it is often useful to remove the screws.

Knee Cartilage Damage

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Cartilage damage can be divided into three categories:
* Firstly, a small section of cartilage can come away from the joint with a piece of bone attached.
This type of lesion can heal. The fragment can be reattached using a screw to enable stabilization and consolidation of the cartilage.
The surface of the joint is thus restored.
Once consolidated, it is often useful to envisage removing the screw.

* The second possible scenario is damage to the cartilage alone, which breaks into several fragments that come away in the joint causing pain and blocking.
The fragments are removed arthroscopically.
The damaged area where the bone is exposed is thus abraded. A technique called Pridie drilling is used to create micro-holes to induce fibrocartilaginous healing with recovery of 80% of the mechanical function of normal cartilage.
A few weeks, or even a few months, are necessary for the surface of the cartilage to heal.

* Finally, a fragment can come away with a piece of subchondral bone. Both bone and cartilage are lost in this case and the fragment, altered and worn, cannot be reattached.
It is thus necessary to reconstruct the cartilage but also the subchondral bone.
To do this, bone and cartilage plugs are harvested from a location on the surface of the knee where the cartilage is of little use. The damaged site is prepared and these samples are grafted.
Several plugs are often required; we thus talk of “Mosaicplasty”.
In this case, it is also necessary to wait several weeks for complete osteochondral consolidation and restoration of the joint surface.

These procedures are all performed arthroscopically, through two small incisions using a camera to view the joint. After the operation, it is necessary to use crutches to move around for several weeks to keep the weight off the knee, as healing is significantly improved with decreased mechanical stress due to weight.

Unicompartimental Knee Replacement

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Osteoarthritis of the knee can affect just one compartment of the knee, femorotibial or femoropatellar.
In this case, we talk of isolated knee osteoarthritis, which only concerns one third of the joint surface of the knee.
As two-thirds of the surface remain intact, we can envisage a unicompartmental knee replacement, in other words only replace the area of worn cartilage.
A minimally invasive approach is thus used.
The cartilage surfaces damaged by knee osteoarthritis are resected. Specific cutting guides are placed on the tibial and femoral surfaces to ensure the correct positioning of the tibial and femoral implants.
All the other structures, ligaments, tendons and remaining knee cartilage, are conserved.
To deal with isolated knee osteoarthritis, a unicompartmental replacement helps preserve the natural sensations in the knee joint. Moreover, recovery after the operation is faster than with total knee replacement, and in over 70 % of cases the lifespan of the implant exceeds 20 years.

Shoulder Stabilization

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The shoulder joint is comprised of the humeral head that articulates with the glenoid cavity of the scapula.
Ligaments surround and stabilize the joint capsule.
In the event of a luxation, that is the dislocation of the joint, these damaged ligaments render the shoulder unstable, resulting in recurrent luxations.

– In the case of an unstable shoulder where the bone lesions and stress on the joint are relatively minor, the first technique consists in tightening the ligaments arthroscopically, that is through small incisions using a camera to view the joint.
The anterior zone of ligament detachment is abraded to optimize healing.
Anchors are implanted in the glenoid bone near the surface of the cartilage with threads that are then passed through the ligaments to reinsert and tighten them.
The shoulder is thus stabilized, which helps prevent recurrent luxations whilst conserving the natural environment of the shoulder.

– Sometimes, damage that is more significant can result in an unstable shoulder. Particularly in the case of bone damage, whether it entails the humeral head or the glenoid cavity, the Latarjet bone graft technique is preferred. This operation consists in removing the end of the coracoid where the biceps muscle is attached.
The bone fragment is then placed in the damaged part of the glenoid cavity and secured with screws. Displacing this bone fragment has no effect on function.
The lost bone is replaced and the modified insertion of the biceps dynamically stabilizes the humeral head with the biceps muscles thus preventing luxation.
Choosing this technique to stabilize the shoulder enables rapid resumption of very demanding activities and considerably limits the risk of relapse.
It can be performed using a non-invasive minimal anterior approach.