To evaluate humeral and glenoid bone loss in patients surgically treated for shoulder instability as factors of recurrence.

During the period 2000–2008, 114 patients (103 men and 11 women) with mean age of 28 yrs underwent arthroscopic treatment for shoulder instability by the same surgeon. Mean age of the 1st shoulder dislocation was 20,89 yo and the average number of dislocations per patient was 17,14. Glenoid bone loss was found in all patients (16 Large, 59 Medium, 29 Small), as well as Hill Sachs lesions (66 Large, 23 Medium, 8 Small) or both. Thirteen (13) patients had an “inverted pear” glenoid shape. Seventy five (75) were into sports and for 57 (76%) of them this involved Overhead/Contact activities. Also 20 patients presented joint hypermobility. Complete follow up existed for 92 patients and it ranged from 4–108 months (Mean=44). The recurrence of instability and the functional outcome were evaluated post-op using the Rowe Zarins Score.

Recurrence of instability was noted in 5 patients (4,38%). All of them presented Hill Sachs lesions and glenoid bone loss (2 Large, 2 Medium, 1 Small) but without an “inverted pear” glenoid shape or joint hypermobility. All 5 of them were into Overhead/Contact sports activities (2 Professional: Mean=15hr/w and 3 Amateur: Mean=2,5hr/w). The post op Rowe Zarins Score ranged from 80–100 (Mean=95,11).

From the evaluation of our data, it seems that humeral and glenoid bone loss do not significantly contribute to the recurrence of arthroscopically treated shoulder instability.

This paper aims to evaluate the Remplissage arthroscopic technique as described by Eugene Wolf used in patients with traumatic shoulder instability that present glenoid bone loss and Hill Sachs defects.

In our study 28 patients (5 women and 23 men) with mean age of 31 yrs underwent arthroscopic stabilization of the shoulder by the same surgeon during 2007–2008 period. All patients presented Hill Sachs lesion, 11 of them had medium or large glenoid bone loss, 10 had an “inverted pear” glenoid shape, 4 had been revised for stabilization in the same shoulder and 14 presented joint hypermobility. Mean age for the age of 1st dislocation was 20,1 yrs and our follow up ranged from 5–28 months (Mean=18). The recurrence of instability and the functional outcome were evaluated pre-op and postop with the Rowe Zarins Score. The post op rehabilitation was performed by a specialist.

None of the patients presented recurrent instability. The Rowe Zarins Score raised from a mean pre op score of 23,33 (15–60) to a mean post op score of 97,11 (75–100) (p< 0.05). All the patients that were into sports activities before the presentation of shoulder instability began training again and our post op evaluation of the shoulder’s ROM showed a decrease in the external rotation from 0°–15°.

The infraspinatus tenodesis and posterior capsulodesis in patients with humeral bone loss seems to offer so far excellent post op results despite the slight decrease in the external rotation of the shoulder.

To analyze the relationship between functional outcome and tissue quality after arthroscopic rotator cuff repair.

One hundred and forty-five patients who had undergone arthroscopic repair of rotator cuff tear, during the period of 2003–2008, were evaluated. All operations were performed under the same surgeons. The mean follow-up period was 2.4±1.2 years (range, 0.5 to 5 ys). The patients were devided in two groups:

patients with good tissue quality and

As good tissue quality is defined the tendon with enough mass for suturing (thickness> 3mm) and good elasticity (the footprint is covered properly under tendon traction with tissue grasper). The independent variable studied here was the tissue quality of rotator cuff tendon. Clinical outcomes preoperatively and postoperatively, were assessed with use of ASES, CONSTANT and UCLA scores. Statistical analysis was performed by using STATA 8.0.

Good tissue quality was identified in 119 patients (82%) and poor tissue quality in 26 (18%) patients respectively. At the follow up the patients with good tissue quality achieved Constant score: 86.85±12.49, ASES score: 84±3.4, UCLA score: 28.7±1.9 and the patients with poor tissue quality achieved Constant score: 62.35±13.85, ASES score: 61.49±8.9, UCLA score: 21±3.2. Significant difference between the two groups concerning the clinical outcome was observed after adjusted the data for age. Besides high correlation was noticed between old age and increased rate of poor tissue quality (r=0.88).

Better clinical outcomes are expected in patients associated with good tissue quality, adjusted for age. So the tissue quality is positively correlated with the final functional outcome.

This study reports the results of hybrid stem fixation in difficult revision hip arthroplasties where proximal femoral bone stock loss was severe.

Twenty-six revision arthroplasties (21 women and 5 men, aged from 58 to 86 years), were performed between 1998 and 2008. The indication for surgery was aseptic loosening. In all cases, stabilization of the stem presented problems because of severe proximal femoral bone stock loss (due to extensive periprosthetic osteolytic defects), or because of iatrogenic defects or surgical procedures (attempts to remove the stem and cement with fenestration or extended osteotomy). The average follow-up was 48 months (range 16 to 120).

Primary stability is necessary for the successful definite fixation of a cementless implant by bone. When this was not possible (because of proximal cortical insufficiency), we used a modular distally cemented long stem, bypassing the area of bone defect for at least 6–7 cm. Proximally bone defects were grafted and osteotomy was closed with cerclage wires.

Four stems (15%) had an asymptomatic subsidence (3 stems subsided less than 3–4 mm and 1 stem about 15mm). No stem was revised to date. Major complications did not occur. The mean Harris hip score improved from 32 points preoperatively to 82.3 points (at the most recent evaluation).

Hybrid fixation offers the advantage of initial and secure stability of the cemented stem on the short term, until stabilization of the entire implant by bone occurs. Thus early subsidence and loosening is avoided and on the long term benefits of the cementless fixation are attained. Our results support the method of hybrid fixation in patients with severe femoral bone loss (and consequently problematic stabilization), when primary stability is needed.

The evaluation of the results obtained after a long term follow up (over 60 months) from patients that were treated arthroscopically for shoulder instability.

In our paper we evaluated 116 patients (108 men and 8 women) with mean age of 24 yo, that were treated surgically by the same surgeon from 1999–2004. Seventy seven (77) of them (66,4%) were into sports activities and during pre op clinical examination 15 patients (12,9%) were diagnosed with joint hypermobility syndrome taking into account the Beighton criteria. Arthroscopic findings showed that 80 of them (68,9%) had some kind of bone loss, either glenoid (7 Large, 23 Medium, 6 Small) or Hill Sachs lesion (28 Large, 30 Medium, 20 Small) and in 8 patients an “inverted pear” glenoid shape was found. Our follow up ranged from 60–117 months (Mean=84) and the recurrence of instability and functional outcome were evaluated post-op using the Rowe Zarins Score.

Recurrent instability presented in 7 patients. Five (5) of them was due to high energy accidents, one was due to non-compliance and one was involuntary. Of these patients 5 presented Hill Sachs lesion, 3 showed glenoid bone loss (2 Large, 1 Small) and in none of them an “inverted pear” glenoid shape was found. All recurrent cases were into some kind of Overhead/Contact sports activity (6 Amateur, 1 Professional). The post op Rowe Zarins Score ranged from 80–100 (Mean=95,53).

The arthroscopic treatment of glenohumeral instability is an excellent method that provides similar or better results when compared to the open surgical treatment and with clear advantages over the latter because of lower morbidity, better cosmetic effect and lower total cost.