Purpose of the study: Glenohumeral dysplasia is an uncommon cause of degenerative disease of the shoulder joint. In this context, arthroplasty is a therapeutic challenge due to the bony deformations.

Material and methods: Between 1998 and 2004, simple humeral prostheses were implanted in eight shoulders (seven patients, two men and five women, mean age 49.5 years). There was no procedure on the glenoid cavity. A Neer II was used for four shoulders (two dysplasic cases with short 63 mm stems) and a Neer III for four shoulders.

Results: At mean follow-up of 4.5 years (maximum 7 yers) the Neer outcome was satisfactory for five patients and non-satisfactory for two. Five of the seven patients were satisfied with their operation. The Constant scores improved: from 3.5 to 11.8 for pain, 9.8 to 16.6 for activity, and 13.8 to 24.4 for active mobility. Active anterior elevation was 114° on average, external rotation 25°, and internal rotation at level L3. The overall constant score was 52.8 points with a weighted score of 43%. Radiographically, there were no lucent lines around the humeral implant. Anterior dislocation occurred in one shoulder six months after the initial operation. Capsuloligament revision was performed but the implant was left in place. For one other shoulder, secondary rotator cuff tears limited the function outcome, but the prosthesis was not revised.

Discussion and conclusion: The results were average, but did allow our patients to resume nearly normal activity without pain. Looking at the failures in this small series suggests that the status of the rotator cuff is the main prognostic factor. Neither glenoid deformation nor the lack of replacement appeared to have an effect on the final outcome. Deformation of the proximal end of the humerus may require use of a shorter stem which should be available at the time of the operation.

Purpose: We evaluated the respective roles of acromioplasty and curettage of calcifications in arthroscopic treatment of calcifying tendinopathy of the rotator cuff.

Material and methods: We reviewed 41 cases of calcifying tendinopathy at mean 42 months. We retained for analysis only true calcifications identified at least 12 months after arthroscopy. All patients underwent acromioplasty and 13 underwent calcification curettage. The physical examination searched for subacromial impingement and cuff tendon suffering. The weighted Constant score was determined to assess outcome as excellent, good, fair, or poor. Patient satisfaction was assessed using three subjective questions. We searched for persistent calcification on the AP and Lamy lateral x-rays and quantified acromial resection by measuring the height of the subacromial space, the acromial arrow, and the type of acromion (Bigliani). Ultrasonography was performed to search for cuff lesions. Cuffs were classed as normal, atrophic or torn.

Results: After statistical analysis, the mean Constant score was found to have increased from 55 points to 80 points, with 88% excellent and good results (weighted Constant score > 85%). There was no significant difference between patients with and without calcification curettage (p> 0.1). Patients who were mobilised rapidly had a better outcome (p< 0.005). Subjectively, 88% of the patients were satisfied or very satisfied.These results were not correlated with duration of follow-up. The degree of preoperative calcification did not affect outcome, but persistent calcification (nine cases) had an unfavourable effect on outcome. Nevertheless, 80% of the calcifications without curettage did not resorb after acromioplasty. The type of acromion had an effect on outcome. Acromions which were not flat (type II or III) had an unfavourable influence. The degree of acromial correction had a significant effect on outcome, the Constant score increased proportionally with the height of the subacromial space and inversely with acromial arrow. Ultrasonography disclosed two cuff tears but in elderly subjects, probably due to degeneration.

Conclusion: Curettage of calcifications does not improve outcome of good quality acromioplasty. The stage of the calcification is not an indication for curettage. Furthermore, it appears that the impingement is partly the cause of persistent calcifications since 80% of them disappeared after acromioplasty alone.