Purpose of the study: Infection is a rare complication of shoulder arthroplasty (0–4% according to Cofield). Many therapeutic options are available. Here we evaluated the midterm results obtained after arthroplastic resection used for the treatment of acute or subacute infections.

Material and methods: This series included nine patients (five females and four males) treated by arthroplastic resection. The dominant side was involved in five patients. Mean age at implantation was 63.5 years. The cause was a traumatic event in six cases, the others involving centered osteoarthritic degeneration, with one excentered case and one radiation-induced necrosis. Mean age at removal was 66 years. Mean duration of implantation was 2.39 years. The infection was subacute (two months to one year) in one patient and chronic (longer than one year) in eight. Implants were: cemented seven Aequalis prostheses (four for trauma, two with humerus prosthesis only, one total arthroplasty), one Depuy delta III reversed prosthesis, and one long Neer stem. The mean Constant score was 57.166 and the subjective outcome was considered good in six shoulders, fair in one, and poor in two before the infection-related degradation. Outcome of treatment was assessed clinically (Constant score and subjective assessment), and radiographically. Blood cell counts, erthrocyte sedimentation rate, and C-reactive protein levels were noted preoperatively and at last follow-up. The bacteriological results were available in all cases. Treatment consisted in arthroplastic resection in all nine shoulders, one using a spacer. Mean duration of postoperative antibiotic therapy was four months.

Results: A staphylococcal infection was identified in eight of the nine patients. Intraoperative complications were noted in 20%. Bacteriological cure was achieved in all patients at mean follow-up of four years, but with a significant functional impact (mean Constant score 28 points). Pain relief was satisfactory or very satisfactory in 100%. The subjective outcome was noted fair or poor in eight of the nine patients.

Discussion: Our results are compared with the data in the literature from the two main international series (Cofield, Boileau).

Conclusion: Our technique enabled bacteriological cure in 100% of patients who were all pain free, but at the cost of lost function.

Purpose: Anterior tarsectomy (Méary procedure) has proven its efficacy for surgery of talipes cavus in adults. There has not however been any publication on long-term outcome. We reviewed 39 cases of pes cavus treated by tarsectomy and followed for a mean ten years. Our objective was to confirm long-term results and assess consequences on adjacent joints.

Material and methods: Mean age of the patients was 30 years. Neurological causes predominated (57.6%). Most of the deformations were complex, involving equin and varus deformation of the hindfoot, and pronation and adduction of the forefoot. The deformations were painful in 85% of the patients We used the AOFAS functional score to assess outcome. The preoperative x-rays demonstrated a Djian angle at 100° and a Tomeno angle at 23°.

Results: Mean final score was 69.2/100. The final result was considered excellent or good in 66% of the patients. Pain regressed considerably in 75% of the patients even though only 28% of the patients were totally symptom free. There was a spontaneous 6° reduction in the calcaneus inclination. Defective correction persisted in 80% of the patients but the Tomeno angle remained below 10° in 70%. Seventy-four percent of the feet had radiographic signs of degenerative joints, particularly the sub-talar and mediotarsal joints.

Discussion: There were only two preoperative criteria with prognostic value, aetiology which influenced the functional result and freedom of the hindfoot articulation which determined capacity for correction. Alignment, particularly hindfoot alignment, and degenerative joint disease influenced the functional outcome.

There was a correlation between the anatomic presentation and function, especially evident for the Méary-Tomeno line which must be re-established. While we obtained spontaneous correction of the compensating frontal and sagittal deformations of the hindfoot, specific procedures were required to alleviate claw toes and equinism. It is also important to preserve the Lisfranc space and the Chopart space. The corrective capacity of tarsectomy is limited. To achieve satisfactory anatomic and functional results, tarsectomy must be reserved for moderate pes cavus involving a sufficiently mobile forefoot with moderate and reducible calcaneal varus where the primordial joints can be saved.