Background In a retrospective multicenter study, we evaluated the efficiency and outcomes of the different therapeutic options for infection after reversed shoulder arthroplasty. Methods Thirty-two ...patients were reoperated on for infection after reversed shoulder arthroplasty between 1996 and 2011. The mean age was 71 (55-83) years. The involved implants were primary prostheses in 23 cases and revision prostheses in 9 cases. The average preoperative Constant score was 34 (11-69). Six of these patients needed 2 successive procedures. A total of 38 procedures were performed: débridement (13), 1-stage (5) or 2-stage revision (14), or implant removal (6). At last follow-up (mean, 36 months; range, 12-137 months), every patient had clinical, biologic, and radiographic evaluation. Results Infections were largely caused by coagulase-negative staphylococci (56%) and Propionibacterium acnes (59%). The complication rate was 26%. At last follow-up, 26 patients were free of infection (81%). The final Constant score was 46 (12-75). After débridement with implant retention, the mean Constant score was 51 (29-75), but the healing rate was only 54%. Implant revision (1 or 2 stage) led to better functional results than implant removal (46 vs. 25; P = .001), with similar healing rates (73% and 67%, respectively). Patients with low initial impairment (Constant score > 30) were not significantly improved by surgical treatment. Conclusion Débridement is the less aggressive option but exposes patients to healing failure. It should be proposed as a first treatment attempt. Revision of the implant is technically challenging but preserves shoulder function, with no higher rate of residual infection compared with implant removal.
Background Reverse shoulder arthroplasty leads to arm lengthening. Different techniques have been described to determine postoperative lengthening. The purpose of this study was to evaluate the ...reliability of the acromiohumeral distance (AHD) in determining arm lengthening after reverse shoulder arthroplasty. Methods At 2 centers, 44 patients who had received an onlay design reverse shoulder arthroplasty were observed for a minimum of 6 months. Examination followed a standardized protocol including preoperative and postoperative radiographs on anteroposterior view in neutral rotation. Two orthopedic surgeons independently performed the measurements in random order. Results Mean arm lengthening averaged 2.5 cm (range, 0.3-3.9 cm) according to AHD measurement. Significant differences in interobserver and intraobserver variability for postoperative AHD measurements were found ( P < .01). The mean intrapatient difference was 0.5 cm (range, 0.02-1.5 cm). Conclusion According to our study, the AHD is not a reliable measurement technique to determine arm lengthening after reverse shoulder arthroplasty.
Background:
Considering the long head of biceps (LHB) management, important cultural differences exist among the surgeons around the world, especially when repairing small isolated distal ...supraspinatus tears under arthroscopy. In the perspective of an international survey to analyze our practice regarding biceps management in small rotator cuff tears, the aim is to collect all the possible LHB abnormalities according to literature review, before considering that the LHB could be normal or pathologic.
Indications:
The SFA (Société Francophone d’Arthroscopie) behind its research biceps group summarized these abnormalities in a description analysis called the “biceps box” concept, which was validated with a strong inter-rater reliability. The aim is to present the description analysis using a common language with short video records for each abnormality described to reproduce “intraoperatively” the different possible scenarios the surgeon has to encounter during arthroscopic evaluation.
Technique Description:
The description of the “biceps box” concept classifies lesions of the LHB, with so-called intrinsic lesions, for which the LHB should be considered pathological: partial rupture or delamination, fissuring, lateral or medial instability or subluxation, hypertrophy with an hourglass figure; and so-called extrinsic lesions, for which the LHB should be considered healthy: damage to the pulley without bicipital instability, exposure of the articular portion of the biceps by rupture of the supraspinatus tendon, inflammation of the superficial surface of the tendon, presence of type 1 or 2 superior labral anterior to posterior (SLAP) lesions, or a chondral print.
Results:
We present the 10 possible scenarios with video records according to our description analysis.
Discussion/Conclusion:
The LHB could be considered as a pain generator in certain situations which are still not completely clear. The indication of biceps tenotomy or tenodesis depends on the interpretation of the surgeon of these abnormalities as a pathologic or a normal condition. The next step is to use these videos in an international survey to assess cultural differences regarding the management and eventually find a consensus regarding treatment options for each abnormality.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Graphical Abstract
This is a visual representation of the abstract.
Introduction As the revision number of shoulder arthroplasties increases, we focused on the difficulties of extracting or converting the humeral stem. The purpose of this multicentric study was to ...assess the outcomes and the radiographic results of a new, short, and convertible humeral stem (Aequalis Ascend™ Flex, Tornier SAS–Wright Medical Inc®, Bloomington, MN, USA), which could settle these complex revision problems. Methods Sixty-six primary shoulder replacements were enrolled with an average follow-up of 25.6 months (24–30.8 months). There were 24 reversed shoulder arthroplasty (RSA) and 42 anatomical shoulder arthroplasty. The functional outcomes were evaluated with the Constant-Murley score (CS) and the active range of motion. Humeral stems were radiologically analyzed at the last follow-up with special care to mechanical complications and bone resorption. Results The average CS improved from 30 preoperatively to 74 postoperatively (P < .0001) for anatomical shoulder replacements and from 21 to 63 (P < .0001) for RSA. The active anterior elevation and external rotation improved from 97° and 6° to 163° and 46°, respectively, for anatomical prosthesis (P < .0001) and from 79° and 10° to 139° and 28°, respectively, for RSA (P < .0001). No mechanical complication or loosening was reported. The comparison between postoperative and last follow-up X-rays showed a tendency to medial cortical bone thinning in some cases without any clinical relevance. Conclusion Two years follow-up of this short stem showed promising clinical and radiographic results without implant-related complication. Further X-rays study would be necessary. Level of evidence: IV
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