Introduction

the aim of this study was to analyse the long-term radiological changes following tsa in order to better understand the mechanisms responsible for loosening.

Purpose of the study: The purpose of this retrospective clinical and radiographic study was to analyse the long-term results obtained after Patte’s triple locking procedure for the treatment of anterior instability of the shoulder joint.

Material and methods: A questionnaire was sent to 574 patients who underwent the procedure performed by the same senior operator from 1986 to 2006. Variables studied wer the Walch-Duplay score (with pain score), patient satisfaction, postoperative complications and radiographic aspect.

Results: One hundred fifty patients (26%) responded and sent three radiographs. There were 107 men and 43 women, mean age 28.6±8.7 years (range 16–57). Mean follow-up was 14.6 years (range 2.8–22.6). One hundred seventeen patients (78%) were reviewed with follow-up greater than 10 years. Two patients (1.3%) experienced recurrent anterior instability; no revision was required. The Walch-Duplay scores were excellent or good in 146 patients (97.3%); 53% of patients were pain free; 34% had episodic pain, 9% moderate to mild pain and 4% severe pain. Resumption of sports activity was noted by 85% of patients. Overall, 79% of patients were very satisfied, 18% satisfied, and 3% not satisfied. Postoperative complications (2%) were one case each of infection, transient paresis of the musculocutaeous nerve, and superficial venous thrombosis. There were radiographic signs of an anomaly of the coracoids block in 13 patients (8%); non-union (n=3), lysis (n=4) fracture (n=2), migration (n=1), fracture of the ceramic washer (n=3). The block or washer overhang was noted in 19 patients (12.7%). Centred osteoarthritis was noted in 31% of patients (25% Samilson 1, 4% Samilson 2, 2% Samilson 3). There were two factors associated with long-term degenerative disease: age > 40 at surgery (p=0.02 and block overhang (p< 0.01).

Discussion: Patte’s triple locking procedure is an open procedure for the treatment of anterior shoulder instability. The technique is very minute and specific postoperative rehabilitation is needed. In these conditions, the operation is effective, providing good control of shoulder stability and allowing resumption of sports activities with a low complication rate. This study shows that long-term degenerative disease can be decreased if the patient undergoes surgery before the age of 40 years and if the coracoids block does not overhang.

Purpose of the study: The purpose of this retrospective analysis was to assess long-term clinical and radiological outcome of humeral stems inserted without cement for shoulder arthroplasty.

Material and methods: The series included 37 shoulder arthroplasties (11 simple humerus prostheses and 26 total shoulder arthroplasties) performed between 1985 and 1998. Press-fit humeral stems were used for these patients with primary and posttraumatic shoulder degeneration and osteonecrosis. There were 13 Neer II (3M) prostheses and 24 Modular Shoulder prostheses (3M) which were designed for implantation with cement. Mean follow-up was 9.2 years (range 5.8–13.6 years). This series included 22 women and 15 men, mean age 57.7 years (range 33–82). The Constant score and the Neer classification were noted. Lucent lines, endosoteal erosion, and stem migration or tilt were noted on plain x-rays. A stem was considered ‘at risk’ of loosening in the presence of tilt or migration or lucent lines measuring > 2 mm in > 3 zones.

Results: At last follow-up, the mean non-weighted Constant score was 57/100 (16/95) and according to Neer, outcome was satisfactory in 70%. There was no complication and no revision related to the cementless stem was needed. The radiographic analysis failed to identify any stem migration. Lucent lines were observed for 22 components (59%), endosteal erosion for 12 (32%) and tilt for 5 (14%). Seven stems were considered at risk (19%). The prevalence of at risk stems was not correlated with patient-related or disease-related features, nor to the type of prosthesis, the length of follow-up or clinical outcome in terms of pain, Constant score or Neer classification.

Discussion: Neer initially designed a humeral component to be inserted with cement. This technique provided a humeral fixation which was very reliable, with very few loosenings reported. It was nevertheless very difficult to remove the cemented stem. For this reason, certain surgeons continued to use these stems designed for cemented implantation in a press-fit manner for simple humeral prostheses and for total shoulder arthroplasty.

Conclusion: This study demonstrated the favorable results obtained using these press-fit stems for shoulder arthroplasty. The rate of clinical looseninf was low at long-term follow-up.

Purpose of the study: The purpose of this study was to compare mid-term results after total shoulder arthroplasty (TSA) versus simple humeral arthroplasty (SHA) for the treatment of primary centered osteoarthritic degeneration of the shoulder joint.

Material and methods: The series included 41 Aequalis prostheses (27 TSA, 14 SHA) implanted by the same surgeon. TSA was performed in 21 women and six men, mean age 68.3 years (range 51–78). SHA was performed in nine women and five men, mean age 68.3 years (range 58–83). The glenoid cavity presented concentric wear (type A) in 70% and asymmetric wear (type B) in 30% of patients undergoing TSA. Type A wear was observed in 57% of the patients undergoing SHA and type B (or C) wear in 43% of them. Mean follow-up was 35 months (range 24–49) for TSA and 37 months (24–59) for SHA. The Constant score and the Neer classification were noted. The position of the implants and lucent lines was noted on plain x-rays.

Results: For the TSA patients, the mean non-weighted Constant score was 82/100 points (gain of 48 points), anterior elevation was 151° (gain 54°), and active external rotation 44° (gain 29°). For the SHA patients, the mean non-weighted Constant score was 71/100 points (gain 41 points), active anterior elevation 135° (ain 46°), and active external rotation 43° (gain 28°). The Neer classification demonstrated excellent or satisfactory outcome for 93% of the TSA patients and 86% of the SHA patients. TSA was more effective than SHA for pain relief (p=0.045). Periglenoid lucent lines were observed for 63% of the TSA but with no loosening or complication for the glenoid component at last follow-up.

Discussion: Compared with a simple humeral prosthesis, total shoulder arthroplasty was more effective for the treatment of primary centered osteoarthritis of the shoulder joint.

Purpose: The purpose of this study is to analyze the anatomo-radiological results, the clinical results, and complications of minimally displaced fractures of the proximal humerus, treated by immediate, ambulatory self-passive mobilization, followed by a strengthening and propioceptive training program.

Materials and Methods: 12 patients, 7 females and 5 males, mean age 56.91 (SD: 15.76) were reviewed retrospectively at a mean of 28.33 months follow-up. All the patients were mobilized the day after the first visit, i.e. the day after the fracture in 7 patients (58.3%), up to 7 days after the fracture in 4 patients and 3 weeks after the fracture in one late referral. Over an average period of 5.8 months, an average 45.41 (SD: 20.83) sessions of rehabilitation, with a therapist, for each patient, were recorded. The patients were recommended to perform four sessions of self rehabilitation a day. Clinical evaluation included a questionnaire covering subjective evaluation, Activities of Daily Living (ADL) by means of the ASA index and the Constant’s score, and type and duration of rehabilitation. The radiological evaluation included review of the X-rays, from the initial traumatic event to the last follow up X-ray. An AP view with three rotations, outlet view and axillary view were performed for each patient. The fracture type, displacement, interval for union, glenohumeral osteoarthritis (according to the Samilson classification), type of acromion and osteoporosis, were recorded. Special attention was paid in detecting joint stiffness, algodystrophy, neurological impairment, malunion, further displacement, signs of avascular necrosis and post-traumatic osteoarthritis.

Results: The mean non adjusted Constant’s score at last follow up was 88.33 over 100 (SD: 11.45) an average of 96.01% compared to the contralateral side. 83% of patients were pain free, and 17% reported mild pain. Active motion was very satisfactory averaging 96.23% in forward flexion, 89.86% in external rotation with the hand at the side, and 90.22% in external rotation at 90° abduction, and a difference of 1.46 vertebral levels in active internal rotation, as compared to the contralateral shoulder. Passive motion was also analyzed in the same way. Power of the affected shoulder in forward elevation was on average 90.19% of the contralateral side. Impingement was tested by the Neer, Hawkins and Yocum signs: 4 patients (33.3%) reported at least one positive sign of impingement. The Jobe and Palm up tests were negative in 100% of patients. 11 patients were very satisfied and 1 patient satisfied. Joint stiffness developed in one case (8.3%), with 100° of forward elevation, 50° external rotation with the hand at the side, 50° external rotation at 90° abduction. No algodystrophy, no neurological impairment, no further displacement, no signs of avascular necrosis, no post-traumatic progression of osteoarthritis, were observed in any case. Union was achieved in all the 12 patients, in 2 cases with some degree of angulation.

Conclusions: Very good functional and radiological results were obtained with immediate passive mobilization of minimally displaced fractures of the proximal humerus. It is a safe method as all the fractures united and the rate of complication was very low especially without joint stiffness or RSD and with very good patient satisfaction.

Purpose of the study: The aim of this study was to evaluate the anatomical and technical limits of endoscopic rotator cuff repair. Anatomical results were also compared with functional assessment of the shoulder.

Material and methods: A multicentric serie of 87 patients presenting a full thickness rotator cuff tear repaired endoscopically was retrospectively reviewed at 25.4 months (mean) post surgery. Limits of the surgical technique were studied in correlation with functional results and anatomic radiographic evaluation (arthroscans in 93 p. 100).

Results: Anatomical repair (normal thickness and no contrast in the subacromial space on arthroscan) was achieved in 83 p. 100 of the rotator cuffs with limited damage to the frontal part of the supra spinatus tendon. This percentage fell to 57.8 p. 100 in case of posterior extension of the tear to the supra spinatus tendon and further dropped to 40.8 p. 100 in case of retraction to the apex of the humeral head. Functional outcome evaluated with the Constant score was strongly related to the radiographic cuff condition (p < 0.05). For distal and anterior tears of the supra spinatus tendon, the Constant score at revision was 89.8 points in cases with anatomic repair at revision. This score fell to 75 when the rotator cuff tear was evidenced radiographically (p < 0.0001). For tears involving the entire supra spinatus tendon repaired by arthroscopy, the functional difference at revision was 8 points on the Constant scale. Objective and subjective analysis of the surgical procedure identified significant peroperative elements predictive of clinical and anatomical outcome (difficult reduction, p < 0.05; subjective degree of solidity, p < 0.0001; anatomical aspect of the repaired cuff, p < 0.05).

Discussion: A comparison of our findings with data on equivalent lesions reported in the literature suggests that endoscopic surgery for rotator cuff tears offers both functional and anatomic results equivalent to those achieved with conventional open surgery. This assumes that the surgical procedure is carried out by surgeons experienced in shoulder arthroscopy who can precisely gauge the posterior/anterior extension of the tears and the limits of the surgical technique.