Total shoulder replacement is a common elective procedure offered to patients with end stage arthritis. While most patients experience significant pain relief and improved function within months of surgery, some remain unsatisfied because of residual pain or dissatisfaction with their functional status. Among these patients, when laboratory workup eliminates infection as a possibility, corticosteroid injection (CSI) into the joint space, or on the periprosthetic anatomic structures, is a common procedure used for symptom management. However, the efficacy and safety of this procedure has not been previously reported in shoulder literature. A retrospective chart review identified primary TSA patients who subsequently received a CSI into a replaced shoulder from 2011 – 2018 by multiple surgeons. Patients receiving an injection underwent clinical exam, laboratory analysis to rule out infection, and radiographic evaluation prior to CSI. Demographic variables were recorded, and a patient satisfaction survey assessed the efficacy of the injection.Introduction and Objective
Materials and Methods
The purpose of this study was initially to examine the effect of tibial slope on anterior tibial translation in the ACL deficient knee measured objectively using the KT 1000 arthrometer. Patients were then evaluated one year post ACL reconstruction to determine the effect of tibial slope on the outcome of ACL reconstruction. One-hundred patients (male = 70, female 30) aged between 14 and 49 years (Mean = 28.70, SD 8.80) with a diagnosis of isolated anterior cruciate ligament rupture were prospectively recruited. All participants had intact ACLs of the contralateral limb. The following information was recorded for all patients preoperatively and one year post surgery; time from injury to surgery, IKDC objective and subjective assessment and KT 1000 arthrometer readings. Tibial slope was assessed from long tibial lateral x-rays as described by Dejour and Bonnin. Finally, assessment of the menisci occurred intra-operatively. Tibial slope was correlated with KT 1000, meniscal integrity and IKDC assessments. Patients underwent an arthroscopic hamstring ACL reconstruction using Endobutton and Intrafix fixation. All procedures were performed by one surgeon Pre Reconstruction – Bivariate correlations showed a significant correlation between tibial slope and KT 1000 ( Post Reconstruction – Eighty patients were evaluated at a one year post surgery. One patient had a rerupture. The mean KT 1000 difference was 1mm. KT 1000 was >
2mm in 9% and >
5mm in the re rupture only. The mean subjective IKDC score was 89. Using objective IKDC 89% were classified as normal, 10% as nearly normal and 1% as severely abnormal (the rerupture). Bivariate correlations showed no significant correlation between tibial slope and post operative KT 1000 ( This study demonstrates a significant relationship between increasing tibial slope and anterior tibial translation of the ACL deficient knee. The relationship did not exist in the post ACL reconstructed knee. However this needs to be investigated further with greater numbers and in the ACL revision group.
Microfracture is a stem cell stimulation technique to promote the healing of full thickness articulate cartilage defects Sixty-six patients have undergone microfracture for full thickness articulate cartilage defects over a five year period. All procedures were performed by one surgeon following the technique of Steadman. All patients were under 46, had an isolated chondral lesion, had a stable well aligned knee and were a minimum of one year post surgery. Patients were evaluated with a preoperative and follow up IKDC score, WOMAC score, KOOS Score, Tegner activity level and SF 36, VAS pain scores and overall knee function score. Failure was determined by the need for a secondary chondral procedure. Nine patients failed. Thus the overall success rate was 86%. The failure rate was higher with larger lesions. There was a significant improvement in IKDC score, WOMAC score, KOOS Score, Tegner activity level and SF 36, VAS pain scores and overall knee function score. Microfracture has a good success rate in the short to medium term with isolated full thickness articular cartilage lesions in the stable well aligned knee.
