Aims. The purpose of this study was to assess the prevalence of depression and anxiety symptoms in patients undergoing
The risk of falls in patients undergoing orthopedic procedures is particularly significant in terms of health and socioeconomic effects. The literature analyzed closely this risk following procedures performed on the lower limb, but the implications following procedures on the upper limb remain to be investigated. Interestingly, it is not clear whether the increased risk of falling in patients undergoing
Introduction and Objective. Postoperative pain control in
Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following orthopedic procedures. This systematic review evaluated the impact of preoperative opioid use in patients undergoing
Adequate visual clarity is paramount to performing arthroscopic
Adequate visual clarity is paramount to performing arthroscopic
Introduction and Objective. Tranexamic acid (TXA) is used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in trauma, spinal surgery, and lower limb arthroplasty. The aim of this study is to investigate the clinical effectiveness of TXA in all types of
Interscalene brachial plexus block is the standard regional analgesic technique for
The primary objectives of this study were to: 1) identify risk factors for subsequent surgery following initial treatment of proximal humerus fractures, stratified by initial treatment type; 2) generate risk prediction tools to predict subsequent
Introduction. The impact of prior ipsilateral
Aims. The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of
This study was performed to evaluate the efficacy of interscalene block combined with general anaesthetic for common surgical procedures of shoulder and the potential of this procedure for providing day case
Blood transfusion requirement in
Background. This clinical study was performed to establish the prevalence of deep vein thrombosis and pulmonary embolism after
The evaluation of our results from the use of transscalen block in
This clinical study was performed to establish the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after
Challenging cases in
Thirty years ago, rotator cuff surgery was exceedingly uncommon and shoulder arthroplasty almost unknown. Surgery for shoulder instability was largely empirical, non-anatomical and frequently unsuccessful. With the help of arthroscopy and MR scanning, a complex array of labral, ligament and tendon pathologies can now be recognised and treated, precisely and predictably. Anatomy-restoring arthroscopic techniques have largely replaced open stabilisation surgery. As life expectancy rises and citizens remain active into their seventh and eighth decades, the call for rotator cuff surgery has risen dramatically. Complex tendon transfers have expanded the indications for cuff surgery. Open repair has in part been supplanted by increasingly sophisticated arthroscopic techniques. The potential use of orthobiologics and stem cells promises further advances in the foreseeable future. Following the successful development of humeral hemiarthroplasty, and later of total shoulder replacement, surgical techniques and clinical indications for arthroplasty are now well refined. Predictable outcomes have been further enhanced by the present generation of ‘anatomic’ prostheses. More recently, the ‘rediscovery’ and improvement of semi-constrained (reverse) prostheses has transformed the previously dismal outlook for sufferers of cuff arthropathy and similar conditions. Many Australian Orthopaedic Association trainees undertake post-specialisation fellowships in
Background: Proprionibacterium acnes (P. acnes) is a skin commensal which is often interpreted as a contaminant when found in cultures of surgical specimens. However, recent reports suggest that P. acnes can be identified as the causative micro-organism of infection. Furthermore P. acnes infections occur more often after
Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general anaesthetic and its potential for use in increasing the provision of day case
Post-operative pain is well recognised in patients undergoing
Frozen shoulder is a recognised complication
following simple arthroscopic
Purpose of Study: This study was done to assess the efficacy of EQ5D (EuroQol), a simple quality of life (QOL) score. The study was designed to test the feasibility and reliability of using this simple QOL score alongside Constant score following arthroscopic
There has been concern over the safety of the upright position for
The aim of the study is to compare the postoperative pain relief provided by continuous perfusion of wound by bupivacaine and fentanyl with that of patient controlled analgesia using morphine in elective
The aim of the study is to compare the postoperative pain relief provided by continuous perfusion of wound by bupivacaine and fentanyl with that of patient controlled analgesia using morphine in elective
A panel of experts in the field of
Purpose: The objectives of this study were to correlate the clinical course of all patients with positive intra-operative P. acnes cultures in revision
This paper retrospectively reviews the type and outcome of
At present patients who require shoulder hemiarthroplasty in our unit routinely have two units of blood cross matched pre-operatively. Our observation was that blood transfusion rarely required after open
Multiple secondary surgical procedures of the shoulder, such as soft-tissue releases, tendon transfers, and osteotomies, are described in brachial plexus birth palsy (BPBP) patients. The long-term functional outcomes of these procedures described in the literature are inconclusive. We aimed to analyze the literature looking for a consensus on treatment options. A systematic literature search in healthcare databases (PubMed, Embase, the Cochrane library, CINAHL, and Web of Science) was performed from January 2000 to July 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The quality of the included studies was assessed with the Cochrane ROBINS-I risk of bias tool. Relevant trials studying BPBP with at least five years of follow-up and describing functional outcome were included.Aims
Methods
Introduction: We present a double blinded prospective randomized controlled trial between viscoseal and intraarticular diamorphine injection in shoulder arthroscopy. Materials &
Methods: Twenty adult patients undergoing arthroscopic subacromial decompression were randomised into two groups. The Viscoseal group received 10ml of Viscoseal and 10ml of 0.5% bupivacaine injected into the subacromial bursa at completion of the procedure (n=10). The matched control group received 10mg diamorphine and 10mls of 0.5% bupivacaine (n=10). All procedures were performed by the senior author. The patients were blinded to the injections given. Post-operative regimes were standardised and all patients were assessed by visual analogue pain scores at recovery and 1, 2, 6, 12 &
24 hours post-operative. The presence or absence of nausea and time to discharge were also noted. Results: The mean age of the Viscoseal group was 53 (range 34–70) years and in the control group 59 (32–85) years. In the Viscoseal group 40% of patients were discharged on the same day, while there were no early discharges in the diamorphine group this difference did not reach statistical significance (P=0.054 by Fisher’s exact test). There were no significant differences in post-operative pain score or the fraction pain-free between the two groups or in supplementary analgesic drug doses given (all P>
0.08). Only 10% of the Viscoseal group were nauseous post-operatively compared to 60% of the control group (P=0.03 by Fisher’s exact test). Discussion: Arthroscopic surgery has never been more popular. Patients like smaller scars, early discharge and quick return to daily life and work; for surgeons arthroscopic surgery is skilful, satisfying and digitally recordable; and the NHS benefits from reduced hospital stay and post-operative complications. Review of the literature involving the use of viscoseal in
Aims: Intra-bursal versus inter-scalene post-operative effective pain control for Arthroscopic
The aim of the study is to assess the use of patient-based questionnaires in the evaluation of
Background Various methods of analgesia have been described for
Background: Diagnostic and operative codes are routinely collected on every patient admitted to hospital in England and Wales (hospital episode statistics, HES). Linked data allows post-operative complications to be associated with the primary operative procedure, even if patients are re-admitted following a successful discharge. Morbidity and mortality data on
Suturing of portals following arthroscopic
Suturing of portals following arthroscopic
Introduction. Rehabilitation after shoulder arthroplasty is a fundamental in enabling patients achieve a good functional outcome. Therapists must consider the underlying diagnosis, operative technique employed and rotator cuff integrity, amongst other factors, in order to select the most appropriate exercise regime. There is an absence of comprehensive studies in the literature with regard to shoulder rotational exercises. Therefore, this study aimed to describe the shoulder girdle muscle activation strategies during eight commonly cited rotational shoulder exercises. Method. Thirty healthy subjects with no history of shoulder problems participated in the study. EMG was recorded from 16 shoulder girdle muscles (surface electrodes: anterior, middle and posterior deltoid, upper, middle and lower trapezius, upper and lower latissimus dorsi, upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis and rhomboid major) using a telemetry based EMG system. Five external and three internal rotation exercises were included (table 1). Signal acquisition and processing were in accordance with standardised guidelines. Amplitude normalisation was to external and internal rotation maximum voluntary contraction as appropriate. Mean EMG amplitudes between exercises were compared using repeated measures ANOVA. Data for muscle groups was calculated by averaging the activation of the component muscles. Results. External Rotation Exercises: significantly higher levels of deltoid activation were seen in external rotation at 90° abduction compared to the other external rotation exercises (73.7% vs 12.4–27.2%; p < 0.001). Peri-scapular muscle activation was highest in external rotation at 90° abduction and prone external rotation (76.7–83.2% vs 28.2–45.5%; p = 0.013 − <0.001). Activation of latissimus dorsi and teres major was significantly higher during prone external rotation (64.1% vs 18.1–48.4%; p < 0.001). Activation of the rotator cuff muscles was similar across all exercises. Internal Rotation Exercises: the highest deltoid activity was seen during internal rotation at 90°abduction, followed by zero-position internal rotation. It was lowest during internal rotation at 0°abduction (261.6% vs 190.1% vs 40.9%; p = 0.003 − <0.001). A similar activation pattern was also seen for peri-scapular muscles. The highest activation of pectoralis major was seen during zero-position internal rotation (25.4% vs 4.9–15.7%; p = 0.002 − <0.001). Significantly higher levels of rotator cuff activation were seen during internal rotation at 90° abduction (325.0% vs 94.0–188.3%; p = 0.005–0.017). Discussion and Conclusion. This study provides a comprehensive description of muscles activation during common rotational shoulder exercises. It enables therapists to target specific muscles for rehabilitation following
The purpose of this study is the evaluate the net promotor score of arthroscopic subacromial decompression and rotator cuff repair. The Friends and Family Test, a variant of the Net Promoter Score, was adapted for the National Health Service to evaluate overall patient satisfaction and how likely patients are to recommend an intervention. It ranges from −100 to 100. Positive scores indicate good performance. This study quantifies the scores in 71 patients at 1 year following arthroscopic sub acromial decompression and rotator cuff repair. All of the procedures were performed by 1 consultant shoulder specialist. The patient filled out a shoulder questionnaire pre-operatively, at 6 months and 1 year. The score was 72 for subacromial decompression (n = 32) and 85 for rotator cuff repair +/− decompression (n = 39). Oxford shoulder score was also taken and had a rise of 4.3 and 6.9 respectively. Our study indicates that these procedures are highly valued and are recommended by patients according to the Friends and Family Test. The results of the Friends and Family Test correlated well with postoperative functional improvement and satisfaction. We conclude from this study that a compound score based on the Friends and Family Test is a useful addition to traditional measures of patient satisfaction.
The literature shows that interscalene anaesthesia (ISA) offers many advantages over general anaesthesia(GA) for arthroscopic surgery. There are benefits intra-operatively, a decrease in post-operative complications and a decrease in hospital stay. However patient satisfaction and acceptance of interscalene anaesthesia has not been fully assessed. We wanted to prospectively assess patient choice and satisfaction with interscalene anaesthesia compared to general anesthesia. Fifty patients undergoing subacromial arthroscopic decompression and suitable for either anaesthetic technique, were prospectively identified between August and December 2006. The anaesthetic team discussed the pros and cons of general anaesthesia versus interscalene anaesthesia and the patient choose the type of anaesthesia. The same anaesthetic team and senior author managed and operated on all the patients in the study. Post-operatively patients filled out a questionnaire, which assessed patient choice, experience and satisfaction with type of anaesthesia undertaken. Forty-sic patients successfully completed the questionnaire (27 female, 19 male, average age 59). Seventy-six percent of patients felt that they really understood the pros and cons of each anaesthetic type. Seventy-eight percent of patients felt that they really had the choice in determining their anaesthesia. Twenty-six choose ISA and twenty choose GA. Post-operative complications were less in the ISA group versus the GA group; pain(5.23ISA, 5.75GA), nausea(11%ISA, 35%GA), vomiting(0 ISA, 1GA), and drowsiness(19% ISA, 70%GA). Hospital stay was shorter in ISA patients compared to GA patients. All patients claimed to be satisfied with their choice and none would in retrospect change it. Patients who choose interscalene anaesthesia had less post-operative pain, nausea, vomiting, drowsiness and shorter hospital stays then those patients who choose general anaesthesia for their
Rotator cuff or long head of biceps tendon tears are common in patients with degenerative shoulder rotator cuff disease. Most often they are investigated with an MRI scan. Diagnosis prior to surgery is useful for the appropriate surgical planning. We present 63 consecutive patients who had arthroscopic
Challenging shoulder cases will be presented and discussed by a panel of experts in the field. Emphasis will be on restoring glenohumeral anatomy, repairing or reconstructing the rotator cuff, and supervising rehabilitation. Different surgical options and new emerging technologies will be reviewed while highlighting the pros and cons of each.
A variety of challenging shoulder pathology will be presented to a panel of expert shoulder surgeons for their diagnostic evaluation, decision making, surgical management and aftercare. They will discuss the decision making processes and management options to consider in striving to obtain optimal outcomes.
Shoulder arthroplasty is increasing and can lead to excellent results for the proper indicators. We will review cases of primary shoulder arthroplasty as well as complex cases. Furthermore we will present complications of shoulder arthroplasty and how they are successfully managed.
We developed a 12-item questionnaire for completion by patients having shoulder operations other than stabilisation. A prospective study of 111 patients was undertaken before operation and at follow-up six months later. Each patient completed the new questionnaire and the SF36 form. Some filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon assessed the Constant shoulder score. The single score derived from the questionnaire had a high internal consistency. Reproducibility, examined by test-retest reliability, was found to be satisfactory. The validity of the questionnaire was established by obtaining significant correlations in the expected direction with the Constant score and the relevant scales of the SF36 and the HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. Changes in scores were compared with the patients’ responses to postoperative questions about their condition. The standardised effect size for the new questionnaire compared favourably with that for the SF36 and the HAQ. The new questionnaire was the most efficient in distinguishing patients who said that their shoulder was much better from all other patients. The shoulder questionnaire provides a measure of outcome for shoulder operations which is short, practical, reliable, valid and sensitive to clinically important changes.
Of 22 infants aged between 11 and 29 months who underwent a combined reconstruction of the upper brachial plexus and shoulder for the sequelae of a birth injury, 19 were followed up for two or more years. The results were evaluated using a modified Gilbert scale. Three patients required a secondary procedure before follow-up. Three patients had a persistent minor internal rotation contracture. All improved by at least two grades on a modified Gilbert scale.
The October 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomized, placebo-controlled trial; Superior capsular reconstruction partially restores native glenohumeral loads in a dynamic model; Gene expression in glenoid articular cartilage varies in acute instability, chronic instability, and osteoarthritis; Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic
Aim. A significant number of patients undergoing shoulder arthroplasty surgery have C acnes contamination at the end of the primary surgery. The objective of this study is to determine whether patients with C acnes contamination at the end of their primary
Objectives. The long head of the biceps (LHB) is often resected in
Aims. Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery. Methods. Using the ClinicalTrials.gov (CTG) and the International Clinical Trials Registry Platform (ICTRP) databases, we comprehensively surveyed clinical trials of decellularized tissue use in orthopaedic surgeries registered before 1 September 2022. We evaluated the clinical results, tissue processing methods, and commercial availability of the identified products using academic literature databases and manufacturers’ websites. Results. We initially identified 4,402 clinical trials, 27 of which were eligible for inclusion and analysis, including nine
Shoulder replacement surgery is a well-established orthopaedic procedure designed to significantly enhance patients’ quality of life. However, the prevailing preoperative admission practices within our tertiary
Introduction. This study aimed to assess the relationship between preparation times and operative procedures for elective orthopaedic surgery. A clearer understanding of these relationships may facilitate list organisation and thereby contribute to improved operating theatre efficiency. Methods. Two years of elective orthopaedic theatre data was retrospectively analysed. The hospital medical information unit provided de- identified data for 2015 and 2016 elective orthopaedic cases, from which were selected seven categories of procedures with sufficient numbers to allow further analysis - primary hip and knee replacement, spinal surgery,
Orthopaedic surgeons prescribe more opioids than any other surgical speciality. Opioids remain the analgesic of choice following arthroscopic knee and
Orthopaedic surgeons prescribe more opioids than any other surgical speciality. Opioids remain the analgesic of choice following arthroscopic knee and
Aim. Diagnosis of periprosthetic shoulder infections (PSI) is difficult as they are mostly caused by low-virulent bacteria and patients do not show typical infection signs, such as elevated blood markers, wound leakage, or red and swollen skin. Ultrasound-guided biopsies for culture may therefore be an alternative for mini-open biopsies as less costly and invasive method. The aim of this study was to determine the diagnostic value and reliability of ultrasound-guided biopsies for cultures alone and in combination polymerase chain reaction (PCR), and/or synovial markers for preoperative diagnosis of PSI in patients undergoing revision
Single shot interscalene blocks are an effective analgesic for arthroscopic
Introduction. Acromial and scapular fractures are a rare but difficult complication with reverse total shoulder arthroplasty (rTSA), with an incidence rate reported from 1–10%. The risk factors associated with these fractures types is largely unknown. The goal of this study is to analyze the clinical outcomes, demographic and comorbidity data, and implant sizing and surgical technique information from 4125 patients who received a primary rTSA with one specific prosthesis (Equinoxe, Exactech, Inc) and were sorted based on the radiographic documentation of an acromial and/or scapula fracture (ASF) to identify factors associated with this complication. Methods. 4125 patients (2652F/1441M/32 unspecified; mean age: 72.5yrs) were treated with primary rTSA by 23 orthopaedic surgeons. Revision and fracture reverse arthroplasty cases were excluded. The radiographic presence of each fracture was documented and classified using the Levy classification method. 61 patients were identified as having ASF, 10 patients had fractures of the Type 1, 32 patients had Type 2, and 18 patients had Type 3 fractures according to Levy's classification. One fracture was not classifiable. Pre-op and post-op outcome scoring, ROM as well as demographic, comorbidity, implant, and surgical technique information were evaluated for these 61 patients and compared to the larger cohort of patients to identify any associations. A two-tailed, unpaired t-test identified differences (p<0.05). Results. The overall rate of ASF was 1.48% with the average time after surgery occurring at 12.9 ± 17.9 months (range 1 day to 78 months). Men had an ASF rate of 0.69% (10 of 1441); whereas women had a rate of 1.92% (51 of 2652). Patients with ASF were observed to be significantly shorter than patients without ASF (65.1 in vs 63.3 in, p=0.0004). ASF were more common in females (p=0.0019), have Rheumatoid Arthritis (p=0.0051), Cuff Tear Arthropathy (p=0.0093), or previous
Objectives. The purpose of this study was to examine the bactericidal efficacy of hydrogen peroxide (H. 2. O. 2. ) on Cutibacterium acnes (C. acnes). We hypothesize that H. 2. O. 2. reduces the bacterial burden of C. acnes. Methods. The effect of H. 2. O. 2. was assessed by testing bactericidal effect, time course analysis, growth inhibition, and minimum bactericidal concentration. To assess the bactericidal effect, bacteria were treated for 30 minutes with 0%, 1%, 3%, 4%, 6%, 8%, or 10% H. 2. O. 2. in saline or water and compared with 3% topical H. 2. O. 2. solution. For time course analysis, bacteria were treated with water or saline (controls), 3% H. 2. O. 2. in water, 3% H. 2. O. 2. in saline, or 3% topical solution for 5, 10, 15, 20, and 30 minutes. Results were analyzed with a two-way analysis of variance (ANOVA) (p < 0.05). Results. Minimum inhibitory concentration of H. 2. O. 2. after 30 minutes is 1% for H. 2. O. 2. prepared in saline and water. The 3% topical solution was as effective when compared with the 1% H. 2. O. 2. prepared in saline or water. The controls of both saline and water showed no reduction of bacteria. After five minutes of exposure, all mixtures of H. 2. O. 2. reduced the percentage of live bacteria, with the topical solution being most effective (p < 0.0001). Maximum growth inhibition was achieved with topical 3% H. 2. O. 2. . Conclusion. The inexpensive and commercially available topical solution of 3% H. 2. O. 2. demonstrated superior bactericidal effect as observed in the minimum bactericidal inhibitory concentration, time course, and colony-forming unit (CFU) inhibition assays. These results support the use of topical 3% H. 2. O. 2. for five minutes before surgical skin preparation prior to
Objectives. Indocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the rotator cuff tendon in the clinical setting. Methods. Twenty-six patients were evaluated from October 2016 to December 2017. The participants were categorized into three groups based on their diagnoses: the rotator cuff tear group; normal rotator cuff group; and adhesive capsulitis group. After establishing a posterior standard viewing portal, intravenous administration of ICG at 0.2 mg/kg body weight was performed, and fluorescence images were recorded. The time from injection of the drug to the beginning of enhancement of the observed area was measured. The hypovascular area in the rotator cuff was evaluated, and the ratio of the hypovascular area to the anterolateral area of the rotator cuff tendon was calculated (hypovascular area ratio). Results. ICG fluorescence angiography allowed for visualization of blood flow in the rotator cuff in all groups. The adhesive capsulitis group showed significantly earlier enhancement than the other groups. Furthermore, the adhesive capsulitis group had a significantly smaller hypovascular area ratio than the other groups. Conclusion. ICG fluorescence angiography allowed for evaluation of real-time blood flow of the rotator cuff in arthroscopic
To evaluate a peri-operative protocol developed to facilitate day case open
OBJECTIVE: To evaluate a peri-operative protocol developed to facilitate day case open
During shoulder arthroplasty the native functionality of the diseased shoulder joint is restored, this functionality is strongly dependent upon the native anatomy of the pre-diseased shoulder joint. Therefore, surgeons often use the healthy contralateral scapula to plan the surgery, however in bilateral diseases such as osteoarthritis this is not always feasible. Virtual reconstructions are then used to reconstruct the pre-diseased anatomy and plan surgery or subject-specific implants. In this project, we develop and validate a statistical shape modeling method to reconstruct the pre-diseased anatomy of eroded scapulae with the aim to investigate the existence of predisposing anatomy for certain shoulder conditions. The training dataset for the statistical shape model consisted of 110 CT images from patients without observable scapulae pathologies as judged by an experienced shoulder surgeon. 3D scapulae models were constructed from the segmented images. An open-source non-rigid B-spline-based registration algorithm was used to obtain point-to-point correspondences between the models. The statistical shape model was then constructed from the dataset using principle component analysis. The cross-validation was performed similarly to the procedure described by Plessers et al. Virtual defects were created on each of the training set models, which closely resemble the morphology of glenoid defects according to the Wallace classification method. The statistical shape model was reconstructed using the leave-one-out method, so the corresponding training set model is no longer incorporated in the shape model. Scapula reconstruction was performed using a Monte Carlo Markov chain algorithm, random walk proposals included both shape and pose parameters, the closest fitting proposal was selected for the virtual reconstruction. Automatic 3D measurements were performed on both the training and reconstructed 3D models, including glenoid version, critical shoulder angle, glenoid offset and glenoid center position. The root-mean-square error between the measurements of the training data and reconstructed models was calculated for the different severities of glenoid defects. For the least severe defect, the mean error on the inclination, version and critical shoulder angle (°) was 2.22 (± 1.60 SD), 2.59 (± 1.86 SD) and 1.92 (± 1.44 SD) respectively. The reconstructed models predicted the native glenoid offset and centre position (mm) an accuracy of 0.87 (± 0.96 SD) and 0.88 (± 0.57 SD) respectively. The overall reconstruction error was 0.71 mm for the reconstructed part. For larger defects each error measurement increased significantly. A virtual reconstruction methodology was developed which can predict glenoid parameters with high accuracy. This tool will be used in the planning of
Complex proximal humerus fractures account for 10% of fractures in patients over 65 years of age. With the emergence of new implants, there is growing trend towards surgical management of these types of fractures, despite the lack of clinical evidence of its superiority over a conservative option. Orthopaedic surgeons' perception plays a large role in the surgical decision making for complex proximal humerus fractures in the elderly. No studies have been conducted to date to examine factors that influence the surgical decision-making in orthopaedic surgeons in regards to these types of fractures. A self-administered questionnaire was sent to orthopaedic surgeons. It included demographic questions as well as clinical vignettes assessing the risk / benefit perception of orthopaedic surgeons in different situations. Orthopaedic surgeons self-reported the proportion of proximal humerus fractures that were treated surgically in patients during the last year. Univariate analyzes were conducted to identify the factors that influenced the operation rates. A total of 127 orthopaedic surgeons completed the questionnaire. The response rate was 37%. The risk / benefit perception of surgical management varied according to the type of practice, year of training, operation rate as well as the ease of the surgeon in performing
The October 2014 Shoulder &
Elbow Roundup. 360 . looks at: PRP is not effective in tennis elbow; eccentric physiotherapy effective in subacromial pain; dexamethasone in
Since 2004, hospitals and other providers are paid based on the work they do. This in turn is largely based on the “Office of Population Censuses and Surveys” codes (OPCS) and the “Health Care Resource Group” (HRG) codes. Audits have proven that inaccurate coding can lead to significant clinical and financial implication. Through our clinical audit works, we have assessed the current coding practices and examined potential financial shortfalls. Fifty five arthroscopic
A reverse total shoulder arthroplasty (RSA) is frequently performed in the revision setting. The purpose of this study was to report the clinical outcomes and complication rates following revision RSA (RRSA) stratified according to the primary
This is a case series of a senior surgeon's experience; the purpose being to illustrate the problems encountered when using bio-absorbable anchors for various indications in
Purpose of the study:. The purpose of the study was to evaluate the possible causes or risk factors for the occurrence of venous thrombotic events (VTE) after shoulder arthroscopy. Methods:. Two cases that occurred in the practice were evaluated for the study. Evaluation of their medical history, procedures and post-operative care was made. The information was evaluated for possible risk factors that could have led to the VTE. Literature reports were also evaluated. All the relevant data (personal and literature) was used to determine risk factors that could help identify high risk patients undergoing arthroscopic
Aim. Cutibacterium acnes is a significant cause of late-onset spinal implant infection (SII). In addition, usual preoperative prophylactic measures may be insufficient to prevent C. acnes operating site colonisation and infection, as demonstrated for prosthetic
Introduction. Reverse total shoulder arthroplasty (RTSA) is a semi-constrained joint replacement with an articulating cobalt-chromium glenosphere and ultra-high molecular weight polyethylene (PE). Because of its limited load bearing, surgeons and implant manufacturers have not elicited the use of highly cross-linked PE in the shoulder, and to date have not considered excessive PE wear in the reverse shoulder a primary concern. As the number of
BACKGROUND. Telerehabilitation has been shown to both promote effective recovery after shoulder arthroplasty and may improve adherence to treatment. Such systems require demonstration of feasibility, ease of use, efficacy, patient and clinician satisfaction, and overall cost of care, and much of this data has yet to be provided. Few augmented reality rehabilitation approaches have been developed to date. Evidence suggests augmented reality rehabilitation may be equivalent to conventional methods for adherence, improvement of function, and relief of pain seen in these musculoskeletal conditions. We proposed that the development of an augmented reality rehabilitation platform during the pre and postoperative period (including post-shoulder arthroplasty) could be used to track patient activity and range of motion as well as promote recovery. METHODS. A prototype augmented reality platform equipped with a motion sensor system optimised for the upper arm was developed to be used to validate 4 arcs of shoulder motion and complete directed upper arm exercises designed for post-shoulder arthroplasty rehabilitation was built and tested. This system combined augmented reality instructions and motion tracking to follow patients over the course of their therapy, along with a telehealth patient-clinician interface. FINDINGS. The augmented reality platform was tested to validate shoulder range of motion examination similar to that of standard goniometer measurements. Healthy test subjects without shoulder pain or prior
The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions’ safety and efficacy. Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of subacromial impingement syndrome which the treating clinician thought was suitable for treatment with a subacromial injection. Consenting patients were randomly allocated 1:1 to a patient-blinded subacromial injection of CSI (standard care) or APS. The primary outcome measures of this study relate to rates of recruitment, retention, and compliance with intervention and follow-up to determine feasibility. Secondary outcome measures relate to the safety and efficacy of the interventions.Aims
Methods
Introduction: Injury to the distal third of the axillary artery is well recognised as a complication of proximal humeral fractures. However the risk of iatrogenic injury at
The primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate selective fixation for patients at risk of nonunion. From 2008 to 2017, 215 patients (mean age 57 yrs (17 to 18), 61% female (n = 130/215)) with a nonoperatively managed humeral diaphyseal fracture were retrospectively identified. Union was achieved in 77% (n = 165/215) after initial nonoperative management, with 23% (n = 50/215) uniting after surgery for nonunion. The EuroQol five-dimension three-level health index (EQ-5D-3L) was obtained via postal survey. Multiple regression was used to determine the independent influence of patient, injury, and management factors upon the EQ-5D-3L. An incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-year (QALY) gained was considered cost-effective.Aims
Methods
This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events.Aims
Methods
Aim. The purpose of this study was to compare the presence of P.acnes on the skin after topical pre-operative application with benzoyl peroxide (BPO) to chlorhexidine soap (CHS) and whether this also affected skin recolonization after surgical preparation and draping. Method. Forty volunteers – twenty-four men and sixteen women were randomized to pre-operative topical treatment at home with either CHS or BPO in the area of a delto-pectoral approach of their left shoulder. The right served as a control. Five skin swabs were taken in a standardized manner on different occasions: before and after topical treatment, after surgical skin preparation and sterile draping and 120 minutes after draping. A fifth sample was taken on the contralateral untreated side as a control when the patient was draped. The draping took place in an operating room with laminar air flow and skin preparation was performed for 2 minutes with 0.5% chlorhexidine solution in 70% ethanol according to the recommendations of the Swedish National Board of Health and Welfare. Bacterial colonies were then analyzed on agar plates by colony forming units (CFU) and surface characteristics. P.acnes were identified with matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) mass spectrometry. Results. Topical treatment with BPO significantly reduced the presence of P.acnes as CFU on the skin after surgical preparation. P.acnes was found in 1/20 subjects of the BPO group, and 7/20 in the CHS-group (p<0.044). The results remained after two hours (p<0.048). Topical treatment with BPO before surgical skin preparation significantly decreased the presence of CFU (p-value 0.035). Conclusions. Topical preparation with BPO before
The aim of this study is to evaluate the change in incidence rate of shoulder arthroplasty, indications, and surgeon volume trends associated with these procedures between January 2003 and April 2021 in the province of Nova Scotia, Canada. A total of 1,545 patients between 2005 and 2021 were analyzed. Patients operated on between 2003 and 2004 were excluded due to a lack of electronic records. Overall, 84.1% of the surgeries (n = 1,299) were performed by two fellowship-trained upper limb surgeons, with the remainder performed by one of the 14 orthopaedic surgeons working in the province.Aims
Methods
Frozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients’ symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB. The Therapeutic Injections For Frozen Shoulder (TIFFS) study is a single centre, parallel, two-arm, randomized clinical trial. Participants will be allocated on a 1:1 basis to either a GHJ corticosteroid injection or SSNB. Participants in both trial arms will then receive physiotherapy as normal for frozen shoulder. The primary analysis will compare the Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include OSS at six and 12 months, range of shoulder movement at three months, and Numeric Pain Rating Scale, abbreviated Disabilities of Arm, Shoulder and Hand score, and EuroQol five-level five-dimension health index at three months, six months, and one year after injection. A minimum of 40 patients will be recruited to obtain 80% power to detect a minimally important difference of ten points on the OSS between the groups at three months after injection. The study is registered under ClinicalTrials.gov with the identifier NCT04965376.Aims
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The June 2023 Shoulder & Elbow Roundup360 looks at: Proximal humerus fractures: what does the literature say now?; Infection risk of steroid injections and subsequent reverse shoulder arthroplasty; Surgical versus non-surgical management of humeral shaft fractures; Core outcome set needed for elbow arthroplasty; Minimally invasive approaches to locating radial nerve in the posterior humeral approach; Predictors of bone loss in anterior glenohumeral instability; Does the addition of motor control or strengthening exercises improve rotator cuff-related shoulder pain?; Terminology and diagnostic criteria used in patients with subacromial pain syndrome.
The June 2024 Shoulder & Elbow Roundup360 looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; acid for rotator cuff repair: a systematic review and meta-analysis of randomized controlled trials; Metal or ceramic humeral head total shoulder arthroplasty: an analysis of data from the National Joint Registry; Platelet-rich plasma has better results for long-term functional improvement and pain relief for lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials; Quantitative fatty infiltration and 3D muscle volume after nonoperative treatment of symptomatic rotator cuff tears: a prospective MRI study of 79 patients; Locking plates for non-osteoporotic proximal humeral fractures in the long term; A systematic review of the treatment of primary acromioclavicular joint osteoarthritis.
Introduction. Glenoid inclination, defined as the angle formed by the intersection of a line made of the most superior and inferior points of the glenoid and a line formed by the supraspinatus fossa, has been postulated to impact the mechanical advantage of the rotator cuff in shoulder abduction. An increase in glenoid inclination has previously been reported in patients with massive rotator cuff tears and multiple studies have correlated rotator cuff tears to an increase of the critical shoulder angle, an angle comprised of both the glenoid inclination and acromical index. Glenoid inclination is best measured by the B-angle as it has been shown to be both an accurate and reliable. The purpose of this study was to determine the correlation of glenoid inclination and the presence of degenerative rotator cuff tears. Methods. Data was prospectively collected for study patients assigned to one of two groups. The tear group consisted of patients with degenerative, atraumatic rotator cuff tears, confirmed by MRI and the control group consisted of healthy volunteers without shoulder pain. Inclusion criteria for both groups included age 45 or older. Exclusion criteria included history of previous
The June 2023 Wrist & Hand Roundup360 looks at: Residual flexion deformity after scaphoid nonunion surgery: a seven-year follow-up study; The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders; Bite injuries to the hand and forearm: analysis of hospital stay, treatment, and costs; Outcomes of acute perilunate injuries - a systematic review; Abnormal MRI signal intensity of the triangular fibrocartilage complex in asymptomatic wrists; Patient comprehension of operative instructions with a paper handout versus a video: a prospective, randomized controlled trial; Can common hand surgeries be undertaken in the office setting?; The effect of corticosteroid injections on postoperative infections in trigger finger release.
There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.Aims
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Background: After
Both anatomical and reverse total shoulder arthroplasty (aTSA and rTSA) provide functional improvements. A reported benefit of aTSA is better range of motion (ROM). However, it is not clear which procedure provides better outcomes in patients with limited foward elevation (FE). The aim of this study was to compare the outcome of aTSA and rTSA in patients with glenohumeral osteoarthritis (OA), an intact rotator cuff, and limited FE. This was a retrospective review of a single institution’s prospectively collected shoulder arthroplasty database for TSAs undertaken between 2007 and 2020. A total of 344 aTSAs and 163 rTSAs, which were performed in patients with OA and an intact rotator cuff with a minimum follow-up of two years, were included. Using the definition of preoperative stiffness as passive FE ≤ 105°, three cohorts were matched 1:1 by age, sex, and follow-up: stiff aTSAs (85) to non-stiff aTSAs (85); stiff rTSAs (74) to non-stiff rTSAs (74); and stiff rTSAs (64) to stiff aTSAs (64). We the compared ROMs, outcome scores, and complication and revision rates.Aims
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This study aimed to investigate the estimated change in primary and revision arthroplasty rate in the Netherlands and Denmark for hips, knees, and shoulders during the COVID-19 pandemic in 2020 (COVID-period). Additional points of focus included the comparison of patient characteristics and hospital type (2019 vs COVID-period), and the estimated loss of quality-adjusted life years (QALYs) and impact on waiting lists. All hip, knee, and shoulder arthroplasties (2014 to 2020) from the Dutch Arthroplasty Register, and hip and knee arthroplasties from the Danish Hip and Knee Arthroplasty Registries, were included. The expected number of arthroplasties per month in 2020 was estimated using Poisson regression, taking into account changes in age and sex distribution of the general Dutch/Danish population over time, calculating observed/expected (O/E) ratios. Country-specific proportions of patient characteristics and hospital type were calculated per indication category (osteoarthritis/other elective/acute). Waiting list outcomes including QALYs were estimated by modelling virtual waiting lists including 0%, 5% and 10% extra capacity.Aims
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