Long-term clinical study to explore the curative effect and mechanism of the treatment of adult chronic osteomyelitis by implant Osteoset T. The study object were 65 case adult chronic osteomyelitis patient from November 1977 to April 2003 in a University-based hospital. Age ranged from 18 to 69 years old. 40 cases were treated by general debridement (Method I); 25 cases were treated by general debridement and implant Osteoset T in dead space (Methods II). Stage IA(The UTMB Staging System) osteomyelitis 39 cases; The Organism was Staphylococcus Aureus 28 cases. In all cases (group A), 40 cases were treated with Method I (group AI), 25 cases were treated with Method II (group AII). The majority of the patients, 39 resulted as Stage IA (group B); 22 were treated with Method I (group BI) and 17 cases were treated with Method II (groupBII). Finally, 28 patients were chronic Staph Aureus osteomyelitis (Group C); 13 were treated with Method I (group CI) and 15 cases with Method II (group CII); Followed from 36 to 334 months, mean 75.0 months. Then respectively evaluate and analysis analyze the success rate of different method with standard. The success rate of group BI was 59.09%, group BII was 94.12%, contrast the success rate there was significant difference (p<
0.05). The success rate of group AI was 60.00%, group AII was 80.00%. The success rate of group CI was 46.15%, group CII was 80.00%. The use of Osteoset T has demostrated better healing rate than left the empty cavity there after debridement and irrigation. Osteoset T can local delivery antibiotic, filler of the dead space, It can be mixed with different antibiotics, reduces the hospitalization time, reduces the number of operation. Unfortunately, Osteoset dos not help with the bone growth.
The widely used classification systems (King and Lenke) are useful for documentation of the deformities. Unfortunately explicit guidelines for surgery are not clear. A multi-centre database with pre and postoperative patient data including photographic images and x-rays will be very useful in decision making. It will allow surgeons to find similar cases in the database that will help them in their decision making for surgical planning and execution. Furthermore it will provide extensive data to perform outcome studies, and to develop general treatment guidelines. Surgery for spinal deformities will become more evidence based and less dependent on the individual surgeons judgement.
The patient data can also be stored and printed as a PDF-file, so that it can be used as a patient chart and for patient information purposes. Scolisoft allows the user to select patients based on all the individual characteristics, e.g. curve classification. For pre-operative planning of a specific deformity, a cohort of patients with the same deformity (patient demographics, curve pattern, bending films etc) can be selected and the postoperative results viewed. With the same selection tool, cohorts of patients can be selected for outcome studies. Furthermore Scolisoft provides the possibility of discussing difficult cases with other spine surgeons using the system. Finally, complications are registered according to the existing Scoliosis Research Society complication registry system.
The system already has the possibility for documenting other spine pathology such as sagittal plane deformities, fractures and spondylolisthesis.
Hydroxylapatite (HA) is widely employed as coating of cementless hip stems. Nevertheless there is a deficiency of long-term follow-up studies, and none, to our knowledge, with a ceramic on ceramic coupling, that it is important to avoid the effect of polyethylene wear on stem survival. Between June 1990 and December 1991, 151 prostheses with an anatomic fully HA-coated cobalt-chrome stem, alumina bearing surfaces, and a threaded Ti-6Al-4V cup, were implanted in 147 consecutive patients (57 males, 90 females, average age 58 years). All were primary surgeries, there were no specific exclusions. Ten died for unrelated causes to the surgery, one died from postoperative complications; thirty nine of the surviving patients were lost to follow-up. The Merle D’Aubigné and Postel score was recorded before and after surgery at each review. An anteroposterior view and a frog-lateral view of the involved hip were taken at each follow-up review. The results were analysed by the Kaplan-Meier method to estimate the cumulative probability of revision. In two cases, the prosthesis was completely removed with Gilderstone’s procedure because of septic loosening. Among the others, 10 cups required revision surgery for aseptic loosening, and 6 stems were revised for thigh pain. The mean Merle D’Aubigné rating improved from 10 before operation to 16.4. Bone stability was recorded in all cases but three in which there was a painfree fibrous stability. The Kaplan-Meier analysis at 12 years predicted asurvival rate for the prosthesis of 86% (95% CI 79 to 92), and for the stem of 93.8% (95% CI 89.7 to 98). At 12 years the HA-coated stem has shown an overall good outcome while the threaded non HA-coated cup employed had a bad survival that had influenced the survival of the prosthesis. In conclusion we are confident to consider HA a viable and effective coating.
Three cases of patients affected with massive bone defects are reported, in which over 50% of the segments are involved. The treatment options considered were original and not yet described in literature. The patients were affected with: partial agenesia of the tibia, congenital hypoplasia and pseudoarthrosis of the femur, and massive post-traumatic bone defect. In all these cases the Ilizarov’s method was applied. In the first case, instead of carrying out an osteotomy and callotasis of the residual bone tissue, an osteotomy was performed close to the tibiofibular syndesmosis and a distraction at this level was executed. In the second case of pseudoarthrosis with antecurvatum of the proximal femur of 135°, varus of 100°, length discrepancy of 63%, a multiplanar gradual correction of the proximal deformity of the femur was carried out followed by a distal lengthening. The third case concerning the pluri-fragmented exposed diaphyseal fracture of the tibia and fibula, with massive bone loss, was treated by restoring all the small fragments, even those without periosteal connections, to increase the proximal and distal bone mass. Once the fusion of the fragments occurred, a proximal osteotomy and callotasis was performed to rejoin the fracture’s segments.
Dysplasia epiphysealis hemimelica is a rare congenital abnormality of enchondral ossification of one or more epiphyses, thus determining an asymmetrical growth in that bone district. We are here considering 2 cases. The first case regards a 4-month-old female baby with an irreducible flexion of the right knee. The X-rays highlighted an area of different density with irregular contours and multiple ossifications; the MRI showed a bone lesion with osteocartilaginous structure in contiguity with the medial condyle; during the operation a osteocartilaginous formation partially fused with the medial condyle was observed. The second case regards a 10-month-old male baby, with a medial malleolus swelling. The X-ray highlighted an area of different density with irregular contours and multiple ossifications, medial to the epiphyseal nucleus of the talus; the MRI showed an osteocartilaginous lesion in contiguity with the talus; during the operation an osteo-cartilaginous formation fused with the talus was observed. The histological findings confirmed in both cases the presence of cartilaginous and bone tissue in absence of pathological lesions. Being a lesion of malformative origin, the early removal of the abnormal ossification nuclei will permit to avoid the secondary lesions described in literature, like asymmetrical growth of the limb and functional limitation.
Evaluation took place after an average of 5.3 years of follow up (range 1.7–10.6 years) and consisted of a questionnaire, elbow function assessment and anteroposterior and lateral radiographs in a standard way. Pre- and postoperative range of motion was analysed with the paired T-test. Pain scores and EFAS scores postoperatively were analysed using the independent sample T-test. The survival of the prosthesis was calculated from the time of implant to the time of revision or occurrence of radiolucencies.
In group 2 five patients died of an unrelated course and no revisions have taken place, one TEP is loose on X-ray (after two years) with a suspicion of septic loosening The EFAS scores (87 in group 1 and 91 in group 2) and range of motion (84 degrees in group 1 and 90 degrees in group 2) were the same in both groups.
There was correlation between fluoroscopic copies and virtual trajectories. This image guidance system may not only aid in the placement of pedicle instrumentation but also assist the senior surgeon in trainee supervision.
Key points for successful fixation are absolute rotational stability and satisfactory circumferential bone-bone contact at the time of surgery. Postoperative regimen consisted of hip, followed by progressive bracing and toe-touch weight-bearing for 6 weeks, weight-bearing.
According to MSTS, results were satisfactory in 90% of the patients, with average score 91% (75%–96%).
The fibrocartilaginous labrum acetabulare enlarges the acetabular socket and contributes to the stability of the femoral head. In DDH the labrum is everted and pushed upward by the femoral head. In the dislocated hip the labrum is often inverted into the acetabular cavity and obstructs anatomic reduction. In the past, excision of the labrum was performed to allow the reduction of the femoral head. The aim of this study was to evaluate the position of the labrum in early detected decentered hips and its role in the early treatment of DDH. During the eleven-year period from 1992–2002, 21,709 neonates (43,418 hips) were examined both by ultrasound and by Ortolanis test to establish the diagnosis of DDH. According to Grafs classification the following hips were present: 298 type D-hips, 252 type IIIa, 4 type IIIb and 20 type IV. Therefore 431 of the patients (356 females and 75 males) showed 574 sonographically unstable hips affected by DDH (1.32%). Due to its echogenic structure, the fibrocartilaginous labrum is clearly visible by ultrasound. In type D, type IIIa, and type IIIb it was always located cranially to the femoral head; in type IV it was located medially to the femoral head. The average age of the children at the time of the diagnosis was 42 33 days (mean value SD). Ortolanis test was positive in 61 hips (10.63%) and negative in the remainder of the hips (89.37%). 21.5 % of the cases were diagnosed within the second week of life, 52.9 % between the third and the eighth week, and 25.5 % after the eighth week. The labrum was not inverted in any of these cases, nor was an open reduction necessary in order to remove it as an obstacle to the closed reduction. Only the ultrasound examination allowed the early diagnosis of the unstable decentered hips. The importance of the labrum decreases when an early diagnosis can be made and an early treatment can be performed.
Loosening of the glenoid component after total shoulder arthroplasty is the most common indication for revision surgery and the reason for 40% of postoperative complications. Presupposing that implants would survive better in areas with higher bone mineral density (BMD), we aimed to determine BMD of the cancellous part of the glenoid and the dimensions of its cortical bone. Using spiral CT scans of the left and right shoulders of 45 men and 25 women with no shoulder pathology, we assessed the BMD of the anterior, middle and posterior subcortical planes of the cancellous part of the glenoid at the superior, middle and inferior levels. The cortical thickness was measured at corresponding sites. In both sexes, at all three levels we found the posterior plane had the highest BMD and cortical thickness. These findings indicate that BMD varies between planes and areas of cancellous bone in the glenoid. This may influence the engineering of future implants.
Average interval between the two surgical stages was 5.5 months (range, 2 weeks to 13 months). Systemic antibiotics were administered to all patients for a minimum period of 6 weeks after removal of the infected implant. The revision stem was cemented in 5 patients and not cemented in 13 patients. All the acetabular components were uncemented. In one patient, the second stage procedure consisted exclusively in removal of the spacer and debridement, owing to persisting infection sustained by Staph. aureus + Staph. epidermidis.
Recurrence of infection (Staph. aureus) occurred in 1 patient and was treated by resection-arthroplasty. Aseptic loosening of the stem was observed in 1 patient, who was subsequently treated by stem revision. Average Harris Hip Score was 78 points (range, 65 to 90 points).
Lumbar disc replacement with a modern articulating disc prosthesis was first done in 1984, using the Charité SB I prosthesis. Since then other discs, easier to implant, have been developed (Prodisc, Maverick, Centurion). We present short-term (6 to 18 month) clinical results of implantation of 121 Centurion disc prostheses in 93 consecutive patients. This modular three-component titanium/polyethylene disc is inserted as one unit and suitable for minimal interventional approaches. The mean age of the patients was 43 years (23 to 63). The primary diagnosis was degenerative disc disease, with 16 patients having symptoms of spinal stenosis. Forty-four patients underwent single-level disc replacements and 28 double-level disc replacements. Nine patients had a fusion of another level at the time of the index procedure and 12 patients had disc replacement at a junctional level after previous fusion procedures. At 6-month follow-up of 50 patients, clinical outcome was excellent in 27 patients, good in 16, fair in four and poor in three. The Oswestry score improved from 51.2 ±16.0 preoperatively to 13.2 ± 17.8 (p <
0.01) at 6 months. One of the first 29 patients was lost to follow-up. In the other 28 there were 16 excellent, seven good, three fair and two poor outcomes. The Oswestry score improved from 49.7 ± 17.5 preoperatively to 13.0 ± 14.9 (p <
0.01) at 1 year. Good short-term clinical results were achieved in a heterogeneous patient group, largely with advanced disc degeneration and severe disc space narrowing. Using a new insertion mechanism, posterior placement within the disc space and disc space distraction could be reliably achieved even in preoperatively collapsed and immobile disc spaces.
This paper introduces a new biological material for the treatment and augmentation of ligament and tendon deficiencies, and presents a variety of uses in orthopaedic conditions. The membrane was originally tested and used in cardiac valve replacement, where it is still in use. Manufactured from bovine pericardial tissue, the collagen biolink membrane is treated chemically by cross-linking with gluteraldehyde. Aldehydes are chemically capped to prevent inflammatory response. The result is a strong collagenous material that provides a non-stretch bio-integrate for ligament replacement/augmentation. The membrane is fashioned to meet the particular ligament/tendon requirement. This material is well suited for use in foot and ankle surgery, as well as in other situations, especially rotator cuff surgery. It may revolutionise ligament and tendon surgery.
The objective of this study was to determine the tensile strength of the different components of rotator cuff tendons. A test bench that performs tests at consistent rupture speed was used to do separate tensile tests on 10-mm strips of capsular and tendinous layers in four fresh frozen cadaveric shoulders. The layers were left attached only on the humeral side. The maximum force was comparable but the elongation of the outer part of the tendon was greater, indicating that the capsular part would tear first. On average, a 10-mm strip of capsular layer failed at 170N with elongation of 7 mm, while a 10-mm strip of tendinous layer failed at 230N with elongation of 10 mm. Using six fresh frozen cadaveric shoulders, we went on to determine the strength of the rotator hood, a thin layer of tendon extending beyond the tuberosity major and connecting the supraspinatus to the subscapularis via the bicipital tunnel. The rotator hood ruptured at a mean force of 70 N. We concluded that the two layers of the cuff contribute equally to the strength. It is therefore important to repair both layers. The difference in elongation of the tendinous and capsular layers makes the capsular layer more vulnerable to elongation stress. The rotator hood is a strong and important structure, and it is important to repair it.
After many patients, some of whom were unexpectedly young, had presented with medial migration of the hemi-prosthetic head and erosion of the glenoid, we decided 2 years ago to do preoperative DEXA on all shoulder replacement patients. The aim was first to determine normal bone mineral density (BMD) of the glenoid and secondly to predict which patients would be at risk. We used the same DEXA method as for the hip. The glenoid was divided into three areas, numbered R1, R2 and R3, and we determined BMD in each of them. Preliminary studies showed that patients fell into two groups. In one, BMD in the R2 and R3 areas was in the range 0.3 to 0.5. Most often the patients in this group were younger or had acute trauma and the contralateral shoulder was not pathological. BMD in the other group was in the range 0.9 to 1.3. Nearly all patients with OA of the shoulder fell into this group. In this ongoing study, patients are followed up annually with clinical examination and standard radiographs. Follow-up to date has only been 2 years. So far no medial migration of the hemi-prosthetic head has been noted in patients in the group with BMD between 0.9 to 1.3.
After gaining experience from 1990 to 2003 using the Cincinnati incision in the surgical treatment of congenital clubfoot, we were able to extend its use to the early surgical treatment of congenital vertical talus (CVT). Eight of the 172 feet were affected by CVT; four were idiopathic, three were associated with arthrogriposis and one with cerebral palsy. The average age of the six children at the time of the operation was 13.5 months (range 6–27 months). We performed a posterior, medial and lateral release of the subtalar joint and of the talona-vicular joint. The reduction of the talus was performed using a K-wire placed through the posterolateral aspect of the talus in its longitudinal axis. After the calcaneus was reduced from its everted position, a second K-wire was placed through the calcaneus and into the talus. The medial talonavicular joint capsule was opened and the redundant capsule reconstructed. Peroneal tendon lengthening was performed in five cases. The radiological evaluation, according to Hamanishi, showed preoperatively a talo-first metatarsal angle of 94° (NV: 3.3 ± 6.4 SD) and a calcaneal-first metatarsal angle of 54° (NV: −9 ± 4.5 SD); postoperatively the values were 24° and 7°, respectively. There were no wound complications or avascular necrosis of the talus. With the Cincinnati incision we were able to visualise the talo-calcaneal and talo-navicular dislocation in all three spatial planes. It also allowed us to correct the deformity in all three mentioned planes and in a single-step procedure.
From 1990 to 2003 the Ilizarov technique was used to treat 41 patients affected by the following congenital or acquired deformities : post-poliodeformity (n=8), hemimelia (n=6), pseudoachondroplasia (n=5), idiopathic genu valgum/varum (n=5), hypoplasia (n=3), osteomyelitis with growth arrest (n=3), DDH (n=2), rickets (n=2), Blount disease (n=2), Ollier disease (n=1), Perthes disease (n=1), arthrogryposis (n=1), hypochondroplasia (n=1) and congenital genu flexum (n=1). Post-traumatic deformities and simple leg-length discrepancies were excluded. The majority of the patients (26/41) presented with multi-planar deformities with the following average degrees: varus 22°, valgus 21°, internal rotation 36°, external rotation 42°, antecurvatum 20° and recurvatum 15°. The average leg-length discrepancy was 6 cm (range 2–10 cm). In total, 66 segments (30 femurs and 36 tibias) in 50 limbs were treated. The rotational corrections were performed at a rate of 4 mm/day; the angular corrections at the rate of 1.5 mm/day on the concave side and 0.75 mm/day on the convex side. The rotational correction occurred on the regenerate. The average correction time was 44 days, the healing time 86 days.The results were: excellent (correct mechanical axis, normal ROM and no limping) in 14 cases, good (correct mechanical axis, limping and reduced ROM) in 24 cases, fair (residual deformity, limping and joint contracture) in three cases, poor (residual deformity, limping and rigid joints) in none. The complications were: five pin tract infections and three fractures.
The authors present their experience using osteogenic protein 1 (OP-1; “Osigraft”) in the treatment of recalcitrant atrophic pseudoarthrosis (PA) of the limbs in patients in whom osteosynthesis surgery failed at least two to four, and more, times. All patients with PA who were treated showed a preoperative radiographic pattern of severe bone atrophy surrounding the peri-fracture zone, without evident signs of reparative activity. All osteosynthesis hardware showed clear evidence of mechanical failure (rupture or mobilisation) so they were changed in all patients during the surgery. From January 2003 to February 2004 we used Osigraft to treat 10 patients with an atrophic PA at the following level: two femurs, three humera, one forearm, three tibiae (1/4 distal) and one tibia (1/3 medium). Osigraft was associated in seven patients with an autograft and in three patients with an allograft plus platelet growth factors (one distal femur, one distal tibia and one humerus). Mean age of patients was 38 years (range: 22–54) and mean duration of disease from the initial trauma was 36 months (range 26–40). The radiological aspect of the newly formed bone, both endostal and periostal, was very similar to that observed in primary healing, with an inter-fragmentary callus as observed in similar cases treated since the beginning with the most appropriate therapy and that healed after the first operation. In all cases we observed healing of the PA focus in a time period of 6–11 months (mean 8.5) with a satisfactory functional recovery in eight cases; in two cases residual articular stiffness, one knee and one ankle, will require arthroscopic surgery. Because of the limited number of patients treated with this new method, we can only draw preliminary conclusions. However, compared with our previous experience, we can confirm that Osigraft (OP-1) significantly contributes to bone healing whenever biological reparative potential is strongly compromised because of the type of original trauma, the long time elapsed since then and the many preceding surgeries. Healing times, even if they appear to be quite long, are actually short considering the severity of our cases, usually requiring further surgery for PA not healing after the third intervention (more than 30 %) and cured, if reached, in 12–18 months.
The common factor in all (mechanical) prosthetic failure mechanisms is the induction of osteolysis around the endoprosthesis with subsequent prosthetic migration and finally loosening of the prosthesis. Both initial prosthesis-bone fixation and long-term prosthesis survival depend on the quality of the peri-prosthetic bone mass. The effects of treatment of RA patients with prednison are inhibition of osteoblastic activity and inhibition of calcium resorption from the intestines. The bone mass loss during the first six months of prednison treatment is substantial and will seldom be regained. Bisphosphonates are known to decrease osteoclastic activity and may therefore stop osteolysis at the bone-prosthesis interface. The aim of the study was to evaluate a possible association of bisphosphonates with reduced migration of total knee prostheses (Interax, Howmedica Osteonics, Rutherfort, USA) in a high-risk group. Roentgen Stereophotogrammetric Analysis (RSA-CMS, Medis, The Netherlands) was used to measure the micromotion. Retrospectively a group of nine RA patients treated with prednison (non-bisphosphonates group) and a group of fourteen RA patients (bisphosphonates group) treated with prednison in combination with bisphosphonates (Etidronate) were included from a prospective randomized study of 82 patients ( At the two-year follow-up evaluation, functional scores and knee scores did not differ significantly among the two groups. At the two-year follow-up evaluation, the non-bisphosphonates group subsided −0.47 ± 0.8 mm, and the bisphosphonates components subsided 0.07 ± 2.9 mm. In the analysis of variance with repeated measurements, with correction for follow-up time, sedimentation rate, and prosthesis fixation type, the bisphosphonates group migrated 1.20 mm less in the total migration (95% c.i.: 1.07–1.30 mm) compared to the non-bisphosphonates group. In this study, bisphosphonates medication in addition to corticosteroid medication was associated with reduced migration of knee prostheses compared to corticosteroid medication alone.
The relationship with adamantinoma remains unclear, follow-up is suggested.
Revision surgery was performed six months to seven years after arthroplasty. Arthrodesis was required for pain related or not to implant loosening or talar necrosis. One patient developed a major deviation of the hind foot secondary to progressive loosening. One patient developed infection early. An iliac graft was used to fill the bone defect in eight patients. An anterior plate-screw fixation was used for six patients, crossed screws for one, a tibiotalar nail for one, and an external fixator for one (with infection).
Objective: Starting from results of studies made in the last ten years about the presence of myofibroblasts as the main cells involved into fibro-contractile disease, we investigated if this cells were also involved into pathogenesis of club foot deformities. Methods: Specimens removed surgically from five patients affected by congenital club foot were investigated. Each specimen was cut in three parts: the first, was fixed for optical microscopy in formalin; the second was fixed for trasmission electron microscopy (TEM) in glutaraldehyde and postfixed in osmium tetroxide; the third was immediately placed in cold (4°C) tissue culture medium. We have stained the first part of each specimen with: haematoxylineosin, Pasini, Masson, Congo red, Van Gieson, Martius scarlet blue and immunostaining for a-smooth muscle actin (a-SM actin). The third part of each specimen, dissected into 2mm. cubes, was place in standard medium and cultured at 37°C. On the cultured cells, we have valued metalloproteinases and a-SM actin expressions. Moreover, a part of culture cells, when reached confluence, were detached with trypsin-EDTA and centrifuged for 10 min. at 2000 rpm. to obtain a pellet, subsequently fixed for TEM. Results: Optical and electron microscopy have showed, only in one of our cases, the presence of myofibroblast’s clusters in the Henry’s nodule and in the medial and lateral fibrous nodules, that are characteristic nodule of congenital club foot. Conclusions: Starting from the results of our studies, we would like to study in detail the role of myofibroblast in the pathogenesis of club foot.
We report on six men and two women (mean age 42.5 years) who had sustained posterior dislocation of the shoulder in motor vehicle accidents (three), falls (two), equestrian accidents (two), cycling accidents (one) and in a fainting spell (one). In four patients, the dislocation was the only injury, but two had humeral shaft fractures, one a humeral neck fracture and the fourth a glenoid and humeral shaft fracture. The mean delay to diagnosis was 14 weeks (2 to 21). In three patients a medical officer, a general practitioner and a radiologist missed the dislocations, but in five orthopaedic surgeons missed them. Four patients had only anteroposterior radiographs of their shoulder taken, one had anteroposterior and lateral scapular views, and three had anteroposterior and lateral radiographs of the humerus. Four patients underwent hemi-arthroplasties and the other four open reduction and McLaughlin procedures. Though rare, posterior dislocations are often missed. Careful examination, especially in the absence of external rotation, can eliminate this. In the presence of a fracture, a dislocation or injury to the joint above and below must be excluded. Anteroposterior and lateral scapular views alone are inadequate in trauma cases and an axillary or modified axillary view should be done. If there is any doubt, CT should be performed.
We evaluated the effectiveness of arthroscopic repair in patients with shoulder instability owing to a bony fragment as part of the Bankart lesion, using spiked Suretacs, sutures and anchors. Over a two-year period, we followed up 23 of 25 consecutive cases, all with a bony fragment as part of the Bankart lesion. The mean age of patients, all of whom were male, was 21 years (17 to 35). Almost all injuries were sustained playing sports. Patients were clinically evaluated at six weeks and 20 weeks postoperatively and interviewed telephonically. Full arthroscopic examination was performed in a lateral decubitus position. The affected capsular structures and labrum, with its attached bony fragment, were fully mobilised. The bony fragment was always attached to the capsular structures, with labral ring intact. We used a spiked Suretac anchor to reattach the bony fragment to its original anatomical position, and Mitek anchors and no. 1 Ticron sutures for individual reattachment of the capsule and ligaments. Postoperatively patients were immobilised in a shoulder sling for six weeks. Early restricted active and passive movements were advised. Patients routinely received postoperative physical and biokinetic rehabilitation. The mean follow up period was 16 months (5 to 29). There was no redislocation or subjective instability. This technique yields excellent results, but because it is technically difficult should be used only by experienced shoulder arthroscopists with thorough knowledge of pathological shoulder anatomy.
In shoulder arthroplasty the glenoid component remains a problem. Hemi-arthroplasty requires less theatre time and gives rise to fewer complications. The question is whether the results of hemi-arthroplasty are inferior to those of total shoulder arthroplasty. We assessed 189 patients who since July 1994 had undergone hemi-arthroplasty or total shoulder arthroplasty, excluding patients who suffered fractures, malunion or nonunion. In 77 patients (41%) the glenoid was replaced. The mean age of patients was 62 years. All humeral and glenoid components were cemented. Preoperative and postoperative assessments included pain (visual analogue scale), muscle strength, range of motion, functional activities and Constant shoulder scores. At this early stage, total shoulder arthroplasty appears to give slightly better functional results than hemi-arthroplasty. However, there were five (6.5%) complications associated with the glenoid components, including glenoid component fracture, loosening and migration. Hemi-arthroplasty eliminates concerns about glenoid wear and glenoid complications, and we believe total shoulder arthroplasty should be reserved for specific problems.