Aims

The aim of this study was to determine whether there is a correlation between the grade of humeral osteoarthritis (OA) and the severity of glenoid morphology according to Walch. We hypothesized that there would be a correlation.

Purpose: The aetiology of primary omarthrosis is still unclear. Typical radiological changes are joint space narrowing and the development of caudal osteophytes. The objective of the study is the analysis of the joint space of the shoulder in four different age groups.

Materials and Methods: Retrospective analysis of n=342 standardized X-rays (2002–2009) (true ap, axillary). Inclusion criteria: normal adulthood group I (n=60), instability group II (n=53), calcifying tendonitis of the supraspinatus tendon group III (n=109), advanced primary omarthrosis group IV (n=120). Measurement of joint space at three levels (ap: superior, central, inferior; axillary: anterior, central, posterior). Two independent measurements. Statistical analysis SPSS 17.0: U-Test acc. Mann and Whitney. Bivariate correlation analysis (Spearman), partial correlation analysis, intraclass correlation coefficient.

Results: Mean age group I 17.84±1.54, group II 31.6±11.8, group III 48.2±8.0, group IV 66.43 ±9.74 (p=0.001). Measurement joint space: interobserver reliability excellent in the ap-projection (r=0.887–0.910) and in the axillary projection (r=0.879–0.886). Joint space group I: 4.79mm±0.84 superior ap, 4.28mm±0.75 central ap, 4.57mm±0.80 inferior ap, 6.59mm±1.44 anterior axillary, 6.12mm±1.09 central axillary and 7.03mm±1.17 posterior axillary; group II: 3.78mm±0.99 superior ap, 3.12mm±0.73 central ap, 3.38mm±0.80 inferior ap, 3.92mm±1.08 anterior axillary, 3.92mm±0.77 central axillary and 4.79mm±1.18 posterior axillary; group III: 3.43mm±1.06 superior ap, 2.87mm±0.80 central ap, 3.25mm±0.79 inferior ap, 3.95mm±0.83 anterior axillary, 3.34mm±0.84 central axillary and 4.05mm±0.84 posterior axillary; group IV: 2.00mm±1.40 superior ap, 1.47mm±1.07 central ap, 1.48mm±1.93 inferior ap, 3.01mm±2.22 anterior axillary, 1.08mm±1.12 central axillary and 1.17mm±1.04 posterior axillary. The differences between the four groups for the joint space width are all statistically significant with p< 0.001 (except the difference between group I and group II for ap-central, ap-inferior and axillary anterior).

There is a significant negative correlation (r= −0,579–0,813) between the joint space width and patients age at all measured levels in both projections (p< 0.001). This negative correlation is only little smaller (r= −0,430–0,655) but still clearly significant for all measurements, if the patients with present osteoarthritis (group III) are excluded.

Conclusion: The data of the study show a decrease of joint space width in group I–IV in all measurements. This effect is negatively correlated with age. The data suggest that the decrease in joint space with loss of cartilage cover is an age-dependant process which is independent from the presence of osteoarthritis. This is in contrast to historical findings but in concordance with recent basic studies about cartilage ageing.

The pathogenesis of Calcifying Tendinitis (CT) is still not well established. Prognostic factors for outcome could not yet be identified. The purpose of this study was to evaluate the histologic features of calcific deposits (CD) and their correlation with radiologic and clinical findings.

122 patients with a radiologically confirmed CD were prospectively scheduled for arthroscopic shoulder surgery. According to their radiologic appearance (RA) the CD were graded as fluffy or sharply demarcated. Arthroscopic removal of the deposit was performed and biopsies were taken and embedded in methylmethacry-late. Sections were stained and also immunohistology was performed. Shoulder function was assessed with the Constant score (CS) and the SST.

Three distinct histologic stages (HS) of the CDs could be divided: calcification (I), fibrotic organisation (II) and ossification (III). Biopsies revealed 42x (34%) HS I, 18x (15%) HS II and 62x (51%) HS III deposits. 90% of the CD were located in the SSP tendon. 12 months after the operation the CS and the SST showed a significant improvement (p< 0.01). Forty percent of the patients with ossification (III) of the CD underwent unsuccessful shock wave therapy before. The preoperative RA as well as the HS of the CD did not predispose to postoperative outcome.

In this study three definite histologic stages of Calcifying Tendinitis were identified that have not been described previously. We underline the hypothesis that CT is an active cell mediated tissue process which can lead to production of primitive bone.

Introduction In view of the legal claim for quality assurance in Germany, complete documentation and a professional evaluation of shoulder arthroplasty procedures are indispensable.

Under the auspices of German AO International (DAOI), the German Society of Orthopeadics and Orthopeadic Surgery (DGOOC), the German Society of Trauma Surgery (DGU) and the German Society of Shoulder and Elbow Surgery (DVSE), and in collaboration with the MEM Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, the nationwide online Shoulder Arthroplasty Register was implemented.

Register setup The German Shoulder Arthroplasty Register consists of three online questionnaires, covering surgery for primary shoulder arthroplasty, follow-up examination, and revision surgery. Registered surgeons can access the questionnaires via Internet. For easier administration in clinics, paper copies of the questionnaires are also available. Online validation procedures check all entered data for completeness and plausibility. After passing these checks, data are sent to the central database. The centralization of the data collection is crucial for data unification and validity.

Advantages Participating surgeons benefit from descriptive real-time statistics of their patients, and constant benchmarking of their performance in comparison with the whole register is possible. With the documentation of complications, implant failures and revision surgery, quality assurance reports can be easily produced. Furthermore, X-ray images of special cases can be uploaded.

Perspective The German Shoulder Arthroplasty Register was launched in January 2006 and documentation is ongoing. First scientific results will be available in 2007.