Reverse total shoulder arthroplasty (RTSA) is a commonly performed operation for a variety of pathologies. Despite excellent short-term outcomes, complications are commonly encountered. Recurrent instability occurs in up to 31% of cases, often due to components placed with too little tension. Acromial stress fractures can occur in up to 7% of cases, often due to components placed in too much tension. Despite these concerns, there is little evidence evaluating the intraoperative tension and glenohumeral contact forces (GHCF) during RTSA. The purpose of this study was to measure the intraoperative GHCF during RTSA. 26 patients were enrolled after obtaining IRB approval. Inclusion criteria were patients undergoing primary RTSA. An instrumented strain gauge implant was designed to attach to an Exactech Equinoxe (Gainesville, FL) baseplate during RTSA. A specially designed trial glenosphere was then attached to the instrumented baseplate. Wires from the strain gauges were connected to a 24-bit analog input and placed outside the operative field to a computer that measure the forces. After joint reduction, GHCF were measured in neutral, passive flexion, passive abduction, passive scaption and passive external rotation (ER). Five patients were excluded due to wire calibration issues.Introduction
Methods
We aim to show that our series of Avon Patellofemoral Joint Replacements (APFJR) with over 5 year follow up, have comparable functional, radiological and revision rate results to other published reports. Retrospective analysis occurred of all consecutive cases of APFJR from October 1999 and January 2010. All operations were performed by the senior author (AL). Each patient had both clinical and radiological follow up. Patient demographics, pre and post op Oxford Knee scores and complications were all recorded. An independent post operative radiological review took place to check for loosening and progression of disease. Revision to Total Knee Replacement (TKR) was taken as the endpoint.Aim
Methods
This study aims to show that our series of Avon Patellofemoral Joint Replacements (APFJR) with over 5 year follow up, have comparable functional, radiological and revision rate results to other published reports. Retrospective analysis occurred for all consecutive cases of APFJR from October 1999 and January 2010; all operations were performed by the senior author (AL). Each patient had both clinical and radiological follow up. Patient demographics, pre and post op Oxford Knee scores and complications were all recorded. An independent post-operative radiological review took place to check for loosening and progression of disease. Revision to Total Knee Replacement was taken as the endpoint. 83 consecutive APFJR's were implanted in 56 patients for established isolated patellofemoral arthritis. The average age was 68.2(34-95) with 18 males and 38 females. The mean follow-up was 5.4 years (1.25 to 11). There were 5 revisions with the five-year survival rate being 95.2% (95% confidence interval 88.12% - 99.88%). The median Pre Op Oxford knee score was 17 of 48 points (interquartile range 11 to 21) showed significant improvement when compared to the median Post Op Oxford knee score of 35 (interquartile range 26 to 41). There was one superficial infection, no deep infections and one transient sciatic nerve palsy. These results compare very closely to those in the designing surgeon's series (Ackroyd et al JBJS Br 2007). These results reveal satisfactory survivorship and functional outcome results in the medium term leading to increased confidence in the use of this patellofemoral arthroplasty.
To correlate the surgical and MRI findings in acute lateral patellar dislocation and to determine the accuracy of MRI in identifying location of MFPL injury. it's a retrospective study. Patients with first time dislocation of patella were admitted after reviewing in fracture clinic and MRI was arranged. Surgical repair of MFPL was performed within 2 weeks of injury. Arthroscopy was performed at the same time to remove osteochondral fragments and to confirm the diagnosis by viewing the area of haemorrhage deep to medial retinaculum. MRI was reported by consultant radiologist with a special interest in musculoskeletal system. MRI and surgical finding were compared.Aim
Methods
The role of magnetic resonance arthrography (MRA) in the evaluation of patients with femeroacetabular impingement (FAI) to assess femoral head-neck junction asphericity and labral pathology is well established. However, in our experience the presence of acetabular cysts on MRA, which may signify underlying full thickness articular cartilage delamination and progression towards arthropathy, is also an important feature. We retrospectively reviewed 142 hips (mean age 32 years, 47 men, 95 women), correlating the findings on MRA with those found at the time of open surgical hip debridement to ascertain the prevalence of acetabular cysts and the association with underlying acetabular changes. Fifteen MRA's demonstrated features consistent with underlying acetabular cystic change. At the time of surgery, this was confirmed in eleven cases that demonstrated a full thickness articular chondral flap (carpet lesion) and an underlying acetabular cyst. The sensitivity, specificity, positive predictive value and negative predictive value of MRA in relation to acetabular cysts was 55%, 96.7%, 73.3% and 92.9% respectively. We believe acetabular cysts on MRA to be a significant finding. Such patients are likely to have an associated full thickness chondral lesion and features of early degenerative change, influencing outcome and prognosis. Our clinical practise has changed to reflect this finding. For those patients with cysts on MRA, we are less likely to offer open debridement and favour arthroscopic intervention followed by arthroplasty when symptoms dictate. We believe hip preservation surgeons should be aware of the significance of acetabular cysts and be prepared to adjust treatment options accordingly.
