This pilot study reports the clinical outcomes of a combination of partial subscapularis tendon transfer and small-head hemiarthroplasty in patients with rotatator cuff arthropathy. A total of 30 patients (30 shoulders; eight men and 22 women) with a mean age of 74 years (55 to 84) were assessed at a mean follow-up of 31 months (24 to 60). The inclusion criteria were painful cuff tear arthropathy with normal deltoid function and a non-degenerative subscapularis muscle and tendon and a preserved teres minor.

Outcome was assessed using the University of California Los Angeles score, the Japanese Orthopaedic Association score, and the Oxford Shoulder Score. Radiographic measurements included the centre of rotation distance and the length of the deltoid.

All clinical scores were significantly improved post-operatively. The active flexion and external rotation improved significantly at the most recent follow-up (p < 0.035). Although the mean centre of rotation distance changed significantly (p < 0.001), the mean length of the deltoid did not change significantly from the pre-operative value (p = 0.29). The change in the length of the deltoid with < 100° flexion was significantly less than that with > 100° (p < 0.001).

Progressive erosion of the glenoid was seen in four patients. No patient required revision or further surgery.

A combination of partial subscapularis tendon transfer and small-head hemiarthroplasty effectively restored function and relieved pain in patients with rotator cuff arthropathy.

Cite this article: 2015;97-B:1090–5.

Various surgical treatment were reported on rheumatoid shoulder. However, there were no recommended surgeries in the Japanese 2^nd basic published text of rheumatoid disease. We had performed total shoulder arthroplasty(TSA) and humeral head replacement (HHR) in patient with Rheumatoid shoulder from 1992.

The aim of this study was to compare the outcome of humeral head replacement, 2^nd generation TSA and 3^rd generation TSA in patients followed more than 5 years with rheumatoid shoulder.

Introduction

Although Total elbow arthroplasty (TEA) generally provides favorable clinical outcomes, its complications have been reported with high rate compared with other joints. Previously, we used the Bryan & Morrey approach in TEA, which included separating the triceps muscle subperiosteally from the olecranon; however, since 2008, in order to prevent skin trouble and deficiency of the triceps, we performed TEA by MISTEA method, which required no removal of the subcutaneous tissue in the region of the olecranon and no release or stripping of the triceps tendon.

Introduction

We performed humeral head replacement (HHR) with smaller head for closing the cuff defect in patients of cuff tear arthropathy (CTA). And also, if the cuff defect could not close by decreasing the head size, we add muscle tendon transfer such as latissimus dorsi transfer for posterosuperior defect and pectoralis major transfer for anterosuperior defect.

Introduction

In recently, Reverse shoulder arthroplasty (RSA) in patients with irreparable rotator cuff tear has been worldwidely performed. Many studies on RSA reported a good improvement in flexion of the sholulder, however, no improvement in external rotation (ER)and internal rotation motion (IR). Additionally, RSA has some risks to perform especially in younger patients, because high rates of complications such as deltoid stretching and loosening, infection, neurologic injury, dislocation, acromial fracture, and breakage of the prosthesis after long-term use were reported. Favard et al noted a 72% survival with a Constant-Murley score of <30 at 10 years with a marked break occurring at 8 years. Boileau et al noted caution is required, as such patients are often younger, and informed consent must obviously cover the high complication rate in this group, as well as the unknown longer-term outcome. Its use should be limited to elderly patients, arguably those aged over 70 years, with poor function and severe pain related to cuff deficiency. We developed a novel strategy in 2001, in which we used the humeral head to close the cuff defect and move the center of rotation medially and distally to increase the lever arm of the deltoid muscle.

Purpose

In total elbow arthroplasty (TEA), especially for elbows with condyle defect due to rheumatoid arthritis or trauma, determination of rotation alignment of implants is often difficult. To develop a navigation system for TEA, selecting bony landmarks that can be identified intraoperatively is important. Therefore, we developed a new roentgen free navigation system such as special alignment jigs for TEA based on CT data of normal elbows. The aim of this study was to evaluate alignments of implants after MIS-TEA using the new systems. And also, we reported that 6 bony landmarks on the elbow showed small variability in normal elbows by CT examinations and were considered to be usable as intraoperative landmarks for determining rotational position of implants last year. Especially in RA elbow, posterior aspect of humerus and ulnar aspect of proximal part of ulna were able to be identified even if there is a large bone defect that extends to the lateral or/and medial epicondyle.

We used a new roentgen free navigation system in TEA with using Solar elbow from 2009. The aim of this study was to evaluate alignments of implants after MIS-TEA using the new systems by CT examinations.

In recently, reverse shoulder arthroplasty for rotator cuff deficient arthritis is widely used in the world. However, a high complication rate was reported and worried about long-term results after reverse shoulder arthroplasty. From 2001, we performed a novel strategy for these cases such as rotator cuff reconstruction w/ or w/o muscle transfer and a humeral head replacement with using smallest head to decrease joint volume. The aim of this study was to investigate with clinical outcomes after this surgery more than two years follow-up.

From 1996, we were added fenestration between coronoid fossa, and olecranon fossa at the time of debridement arthroplasty termed extensive debridement arthroplasty with medial and lateral approach.The purpose of this study is to investigate clinical results of extensive debridement arthroplasty.

17 cases could be followed more than two years. Their averaged age was 57.3 years old. Two elbows had a previous history of debridement arthroplasty. In preoperative averaged flexion angle was 105 and averaged extension was 28C Clinical evaluation was performed with the elbow score of Japanese Orthopedic Association Preoperative averaged JOA score was 54.6 points In ray study we investigated whether the fenestration was open or closed.

In all cases, their symptoms improved D All patients returned to their former occupations satisfied with the clinical results Infection postoperative fracture and ectopic ossification were not observed.The averaged JOA score was 91 points Postoperative averaged flexion was 127 averaged extention was 12_Improvement of extension was 16 and that of flexion was 22 Closure of the fenestration was observed in five elbows Osteophyte formations of the coronoid process and olecranon was seen in 4 elbows

The JOA score of pain and ROM of these results were superior compared with any reports of debridement arthroplasty.The JOA score and results of ROM were superior when the fenestration was open.To maintain the fenestration hole open some modification will be necessary

Short term results of extensive debridement arthroplasty showed satisfactory results in terms of pain relief and Improvement of ROM, especially in extension.