Objective. To describe demographic data, clinical outcome and short-term survival after shoulder arthroplasty. Materials and Methods. The Danish Shoulder Arthroplasty Register was established in 2004. All 40 Danish hospitals and private clinics where shoulder arthroplasty are performed are participating. Since 2006 where the reporting to the register became mandatory the compliance of reporting has been 88.9%. Data are collected by an internet based clinical measuring system where the orthopaedic surgeon report data such as diagnosis, type of arthroplasty, and demographic data. The follow-up results are collected by sending a questionnaire to the patient 10–14 month after the operation. The questionnaire contains a Western Ontario Osteoarthritis of the Shoulder index (WOOS). Each question is answered on a visual analogue scale with a possible score ranging from 0–100. There are 19 questions and the total score is ranging from 0–1900. For simplicity of presentation the raw scores is converted to a percentage of a normal shoulder. Results. 2320 Shoulder arthroplasties were reported to the register between 2006 and 2008. There were 69.4% women. Median age was 70.6, range 16.3–96.3. 699 arthroplasties (30.0%) were due to osteoarthritis, 98 (4.2%) due to arthritis, 1182 (50.9%) due to a proximal humeral fracture, 179 (7.4%) due to rotator cuff arthropaty, 62 (2.7%) due to caput necrosis and 79 (3.4%) due to other pathology condition such as cancer and revision surgery. 1352 (58.3%) were stemmed hemi arthroplasty, 77 (3.3%) total shoulder arthroplasty, 596 (25.7%) resurfacing arthroplasty and 243 (10.5%) reverse shoulder arthroplasty. 1288 patients (55.5%) returned a complete questionnaire. Median WOOS for all arthroplasties was 58.2, range 0.0–100.0. Median WOOS for arthritis was 59.3, range 13.3–99.8, osteoarthritis 67.9, range 0.0–100.0, a proximal humeral fracture 54.2, range 0.0–100.0, rotator cuff arthropaty 65.6, range 0.0–98.3 and caput necrosis 48.9, range 3.9–95.2. 171 (7.4%) operations were revisions. The most common indications of revision were luxation (2.2%), infection (1.3%), loosening (0.7%) and glenoid attrition (0.6%). Conclusion. To our knowledge there is no previous study with such a large population presenting demographic data and clinical outcome after shoulder arthroplasty. We found good results for the groups of patients diagnosed with osteoarthritis, arthritis and cuff arthropaty. There were poorer results in the groups of patient diagnosed with a proximal humeral fracture and especially caput necrosis

Purpose of the study: Cell therapy proposes to fill gaps left by bone stock loss using osteocompetent cells (mesenchymatous stem cells, MSC). Preclinical results have been promising but still require improvement particularly concerning stress to the MSC during in vivo implantation. Stress results from sudden transfer i) from oxygen medium (21% O2) to a hypoxic medium (0–5% O2 because O2 diffusion is limited to 200 mm from a blood vessel), ii) a cell support to an osteoconductor support, et iii) a rich medium (fecal calf serum, FCS) to a medium with a limited supply of nutrients, hormones and growth factors diffusing from the environing biological fluids. The purpose of this study was to evaluate in vitro the impact of these different factors on MSC survival.

Material and methods: Human MSC(hMSC) harvested from bone marrow (n= 5 donors) and sheep MSC (sMSC) obtained with a preclinical model (n = 5 animal donors) were exposed for 48 h(hMSC) or 72h (sMSC) to the following transfers: i) rich medium (10% FCS) to poor medium (1% FCS), ii) plastic support to osteo-conductor supports (alumina, calcium carbonate), and iii) oxygen medium (21% O2) to hypoxic medium (6% O2). sMSC were also exposed to prolonged hypoxia (48–120h). Cell death was determined using image analysis after live/dead cell staining.

Results: The results demonstrated that MSC are: i) sensitive to a decrease from 10% to 0% FCS; 14% death of hMSC and 17% death of sMSC), ii) sensitive to transfer onto osteoconductor supports (sMSC on calcium carbonate: 23%), iii) very sensitive to prolonged hypoxia (120h) when combined with decreased FCS (sMSC: 23%; hMSC: 98%). A complementary study on the influence of hypoxia on differentiation properties of surviving sMSC is under way.

Conclusion: If the in vivo results concord with the in vitro results, i.e. if massive cell death is observed 4 days after implantation due to hypoxia, the current transplantation conditions will have to be revisited. Acceleration of neovascularization of in vivo implants which would shorten the period of hypoxia should allow better survival of implanted sMSC.

Background. The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. We aim to report the clinical and radiological outcomes of revision TAA at a high-volume centre in the UK. Methods. Retrospective review of 28 patients that underwent 29 revision TAA procedures using INBONE II prosthesis. Demographic, radiological, and patient reported outcome measures data were analysed. Results. The mean (range) duration from primary TAA to revision was 87.5 (16–223) months. The main indication for the revision was aseptic loosening of the primary TAA (82.8%). Additional procedures were required in 75.9% of patients. At mean (range) follow-up of 40 (24- 60) months, the infection, re-operation, and implant survival rates were 6.9%, 6.9% and 96.5% respectively. A significant postoperative improvement in the component alignment radiographic measures was observed. Osteolysis, subsidence, loosening and heterotopic ossification rates were comparable to other reports and did not influence the clinical outcome. A significant improvement was observed in the MOXFQ (all domains) and the EQ-5D (three domains) at 24 months postoperatively. Conclusions. Revision TAA using INBONE II was associated with good short-term survival and improvement in the postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at follow up. The relatively high survival rate in this series supports the notion that revision TAA is a satisfactory option for failed primary TAA

Introduction. Dislocation as a primary cause of revision has been on the increase in Sweden (14% in 2014). The increasing use of Dual Mobility cups (DMC) could well be explained by the increased revision burden due to dislocation, patients undergoing revision having increased comorbidities and reports that dual articular cup designs reduce the risk of dislocation. The aim of this study was to analyze the change in utilization pattern of the dual articular designs used in acetabular revision surgery in Sweden. The short-term survival of DMC was compared to traditional designs. Patients/Materials & Methods. During years 2004–2014, 1111 (925 cemented) revisions performed with a DMC design were reported to SHAR. About half (n=426) of these cases were first time revisions performed due to dislocation. During the same time period 520 dislocations were revised for dislocation using a standard cemented cup. There was no differences regarding the age, gender and primary diagnosis (p≥0.12) between the two groups. A second cup revision for all reasons and specifically for dislocation was used as end-point. Kaplan-Meier analysis was performed. Results. Survival analysis at 5 years for all reasons (91.6% versus 87.9% p=0.002) and especially for reoperation because of instability (96.7 versus 90.9 p<0.0005) favors the DMC group. Discussion. We found a lower risk for a second revision when a dual mobility cup is used in revisions performed due to dislocation. Conclusion. Our findings indicate that use of a cemented DMC could be considered in first time revisions performed due to dislocation. Longer follow-up is needed to establish any long-term clinical advantages when dual mobility cups are used in revisions

Aims

Advances in treatment have extended the life expectancy of patients with metastatic bone disease (MBD). Patients could experience more skeletal-related events (SREs) as a result of this progress. Those who have already experienced a SRE could encounter another local management for a subsequent SRE, which is not part of the treatment for the initial SRE. However, there is a noted gap in research on the rate and characteristics of subsequent SREs requiring further localized treatment, obligating clinicians to extrapolate from experiences with initial SREs when confronting subsequent ones. This study aimed to investigate the proportion of MBD patients developing subsequent SREs requiring local treatment, examine if there are prognostic differences at the initial treatment between those with single versus subsequent SREs, and determine if clinical, oncological, and prognostic features differ between initial and subsequent SRE treatments.

Aims

The aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time.

Purpose: The purpose of this work was to analyse and compare survival in patients with osteosarcoma (OS) or Ewing sarcoma (EW) of the pelvis as a function of treatment. Material and methods: This retrospective series included 31 patients with OS (n=15) or EW (n=16) of the pelvis who were given a homogeneous therapeutic sequence associating chemotherapy, surgery and/or radiotherapy. Mean follow-up was 37 months (2–144). Mean age was 20 years for EW and 28 years for OS. Localisations in the pelvis were: zone I (n=12), zone I and II (n=4), zone II (n=1), zone II and III (n=7), zone III (n=1), and zone I, II and III (n=6). All patients were given chemotherapy, 15 underwent surgery, and 16 were given radiotherapy alone. Five patients were given complementary radiotherapy after surgery. Actuarial survival curves were compared with the logrank test. Comparison factors were presence of surgical resection, presence of initial or secondary metastasis, tumour response (radiographic measure), and pathology (good or poor responder) after chemotherapy. Results: Five-year survival rate for patients with EW was 53%, 31% for OS. There was no significant difference in survival rates between tumour type. The only factor significantly correlated with lower survival rate was presence of initial metastasis. Discussion and conclusion : The pelvic localisation of osteosarcoma and Ewing sarcoma is a factor of poor prognosis. Unlike data reported in the literature, surgery did not appear to influence outcome, not being found to be a factor of better prognosis. Surgery does however appear to improve short-term survival. In the pelvic localisation, osteosarcoma appears to have a poorer prognosis in terms of survival than Ewing tumour

Purpose: Loosening of the humeral component is rarely a cause for revision shoulder surgery. Most long-term series are not large enough to stratify the many risk factors that might influence the survivorship of humeral component designs. The purpose of this study was to determine long-term survivorship of the Neer and Cofield humeral components and to define the risk factors associated with humeral component removal or revision. Method: 1584 primary Neer and Cofield shoulder arthroplasties (1423 patients) were performed at our institution from 1984 to 2004. There were 619 men (694 shoulders) and 804 women (890 shoulders), with a mean age at arthroplasty of 65.6 years (range, 16–94 years). Kaplan-Meier survivorship analysis was used to determine the effect of etiology of the disease, gender, age, surgery type (hemi versus total), fixation type (cemented versus noncemented), and the humeral component type (Neer II, Cofield I or II) on the estimated survival free of humeral component revision or removal. Results: There were 108 revisions and 17 removals of the humeral component. The overall rate of removal or revision of the humeral component was 7.9% with an average followup of 8.1 years. The rates of survivorship free of revision or removal of the humeral component for any reason was 94.8% at 5 years, 92% at 10 years, 86.7% at 15 years and 82.8% at 20 years. Seventy-one of 632 shoulders (11.2%) in patients younger than 65 years required humeral component revision or removal, whereas only 54 of 952 shoulders (5.7%) in patients 65 years and older required humeral component revision or removal (Odds ratio=2.1; 95% confidence interval, 1.5–3, p=0.001). Patients with posttraumatic arthritis had a higher risk of needing revision or removal of the humeral component (Odds ratio=2.1, 95% confidence interval 1.3–3.3) compared to osteoarthritis. Eighty-four of 526 shoulders (16.0%) with metal-back glenoid components required humeral component revision or removal, whereas only 41 of 1058 shoulders (3.9%) with non metal-backed glenoid components required humeral component revision or removal (Odds ratio=4.7; 95% confidence interval, 3.2–7, p=0.001). Conclusion: Younger age, replacement due to post-traumatic arthritis and presence of a metal-backed glenoid increased the likelihood of humeral component failure. Similar short-term survival can be achieved with Cofield II and Neer II humeral components

Partial knee arthroplasty (PKA), either medial or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty (PFA) are a good option in suitable patients and have the advantages of reduced operative trauma, preservation of both cruciate ligaments and bone stock, and restoration of normal kinematics within the knee joint. However, questions remain concerning long-term survival. The goal of this review article was to present the long-term results of medial and lateral UKA, PFA and combined compartmental arthroplasty for multicompartmental disease. Medium- and long-term studies suggest reasonable outcomes at ten years with survival greater than 95% in UKA performed for medial osteoarthritis or osteonecrosis, and similarly for lateral UKA, particularly when fixed-bearing implants are used. Disappointing long-term outcomes have been observed with the first generation of patellofemoral implants, as well as early Bi-Uni (ie, combined medial and lateral UKA) or Bicompartmental (combined UKA and PFA) implants due to design and fixation issues. Promising short- and med-term results with the newer generations of PFAs and bicompartmental arthroplasties will require long-term confirmation.

Cite this article: Bone Joint J 2015;97-B(10 Suppl A):9–15.

Objectives

In order to ensure safety of the cell-based therapy for bone regeneration, we examined in vivo biodistribution of locally or systemically transplanted osteoblast-like cells generated from bone marrow (BM) derived mononuclear cells.