The advent of modular implants aims to minimise morbidity associated with revision of hemiarthroplasty or total shoulder arthroplasty (TSA) to reverse shoulder arthroplasty (RSR) by allowing retention of the humeral stem. This systematic review aimed to summarise outcomes following its use and reasons why modular humeral stems may be revised.

A systematic review of Pubmed, Medline and EMBASE was performed according to PRISMA guidelines of all patients undergoing revision of a modular hemiarthroplasty or TSA to RSR. Primary implants, glenoid revisions, surgical technique and opinion based reports were excluded. Collected data included demographics, outcomes and incidence of complications.

277 patients were included, with a mean age of 69.8 years (44-91) and 119 being female. Revisions were performed an average of 30 months (6-147) after the index procedure, with the most common reason for revision being cuff failure in 57 patients. 165 patients underwent modular conversion and 112 underwent stem revision. Of those that underwent humeral stem revision, 18 had the stem too proximal, in 15 the stem was loose, 10 was due to infection and 1 stem had significant retroversion. After a mean follow up of 37.6 months (12-91), the Constant score improved from a mean of 21.8 to 48.7. Stem revision was associated with a higher complication rate (OR 3.13, 95% CI 1.82-5.39).

The increased use of modular stems has reduced stem revision, however 40% of these implants still require revision due to intra-operative findings. Further large volume comparative studies between revised and maintained humeral stems post revision of modular implants can adequately inform implant innovation to further improve the stem revision rate.

Background: A common question asked by patients who have undergone knee arthroplasty is whether they will activate the security scanners at airports. This has become a greater issue for the patient in the post 9/11 era.

This study surveys our patients to determine their experiences at airport security, establishes the detectability of common orthopaedic implants in an airport security scanner

Materials and Methods: A survey of a single surgeon series of knee arthroplasty patients was conducted to ascertain the frequency with which they activated airport security scanners. Their experiences were documented and their preferences for identification were ascertained.

A volunteer with metal implants strapped on and patients with implants in-situ walked through a gate scanner at a UK airport. Also, standard operating procedures at UK airports were ascertained.

Results: 150 patients were surveyed. 61 male, 89 female with an average age of 71 years.

There were 111 total knee replacements (TKR), 20 unicompartmental knee replacements (UKR), 2 bilateral UKR replacements, 17 bilateral TKR.

Unlike previous studies from the U.K., virtually all patients with a TKR activated the gate scanner. Conversely, those with unicompartmental replacements did not.

Patients are concerned about this possibility but are not informed at time of surgery and do not know what the procedures are if their implant is detected.

The patient with the bilateral UKR did not set off the scanners where as the patient with the TKR did.

A variety of surprisingly large trauma implants escaped detection.

Conclusion: In contrast to previous work this study demonstrates that patients with TKR do activate the scanner, possibly due to heightened security. Other implants do to a variable extent. Patients are concerned about this possibility and should be made aware both of this and the further checks to which they will be exposed. Our survey demonstrated differences in how passengers with metal implants are screened by airport security around the World and particularly in the United States. In line with the International Air Transport Association (IATA) we propose the development of a more harmonised approach to screen international travellers.