In recent years, use of anatomic stemless total shoulder arthroplasty (AsTSA) has increased. Despite evidence to suggest good mid-term results at 2-year follow-up there is a paucity of evidence for longer term follow-up. This study aimed to investigate outcomes at a minimum of 5 years post-operatively following primary AsTSA. This study is a retrospective case series of all patients who underwent a Mathys Affinis AsTSA from July 2010 (first case) to August 2018 (to allow minimum 5-year follow-up). Clinical outcomes included revision rate, range of motion and patient reported outcomes (Oxford Shoulder Score and Numerical Satisfaction Score). Radiological outcome was assessment of radiolucent lines for Lazarus grading. A total of 105 stemless TSAs were implanted. Five patients underwent revision (4.8%). Seventy-five AsTSA's were included in the final study for analysis of 5-year outcomes. Median follow-up time was 6.1 years. Median age was 69 years old and 81% were female. Oxford shoulder score showed a range of 18 to 48, with a median score of 47. Satisfied or very Satisfied was selected in 94.37%. Median range of motion assessments showed forward elevation 160°, abduction 150°, external rotation 40°, and mode internal rotation was to the lumbar spine. No glenoid lucency was present in 79.7%. There were 9.5% with Lazarus Grade 1 lucency, 5.4% with Lazarus Grade 2, and 5.4% Lazarus Grade 3. No humeral lucency was observed. This cohort study demonstrates promising clinical and radiological outcomes for the Mathys Affinis Stemless TSA at minimum 5 years post-operatively.
Recurrent groin pain following periacetabular osteotomy (PAO) is a challenging problem. The purpose of our study was to evaluate the position and dynamics of the psoas tendon as a potential cause for recurrent groin pain following PAO. Patients with recurrent groin pain following PAO were identified from a single surgeon series. A total of 13 patients with 18 hips (4.7%) out of a 386 PAO, had recurrent groin pain. Muscle path of the psoas tendon was accurately represented using 3D models from CT data were created with Mimics software. A validated discrete element model using rigid body springs was used to predict psoas tendon movement during hip circumduction and walking.Abstract
Introduction
Methods
The extent to which hip arthroscopy (HA) treatments influence sexual function is not well described and limited to small cohorts. This study aims to describe trends in self-reported reported sexual function before and after HA. Adult (≥18 years) patients who underwent HA between 1/01/2012 and 31/10/2020 were extracted from the UK Non-Arthroplasty Hip Registry. International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected pre-operatively and at 6 and 12 months. The iHOT-12 then asks asking patients to quantify ‘how much trouble they experience with sexual activity because of their hip?’ with responses converted to a continuous scale (0–100) to measure function.Abstract
Introduction
Methods
Excessive glenoid retroversion and posterior wear leads to technical challenges when performing anatomic shoulder replacement. Various techniques have been described to correct glenoid version, including eccentric reaming, bone graft, posterior augmentation and custom prosthesis. Clinical outcomes and survivorship of a Stemless humeral component with cemented pegged polyethylene glenoid with eccentric reaming to partially correct retroversion are presented. Between 2010– 2019, 115 Mathys Affinis Stemless Shoulder Replacements were performed. 50 patients with significant posterior wear and retroversion (Walch type B1, B2, B3 and C) were identified. Measurement of Pre-operative glenoid retroversion and Glenoid component version on a post op axillary view was performed by method as described by Matsen FA. Relative correction was correlated with clinical and radiological outcome.Abstract
Aim
Patients and Methods
Over the last decade stemless shoulder arthroplasty has become increasingly popular. However, stability of metaphyseal loading humeral components remains a concern. This study aimed to assess the stability of the Affinis stemless humeral component using Radiostereometric analysis (RSA). Patients underwent total shoulder arthroplasty via a standardised technique with a press-fit stemless humeral component and a cemented pegged glenoid. Tantalum beads were inserted into the humerus at the time of operation. RSA of the relaxed shoulder was completed at weeks 1, 6, 13, 26, 52 and 104 post-operatively. Stressed RSA with 12 newtons of abduction force was completed from week 13 onwards. ABRSA 5.0 software (Downing Imaging Limited, Aberdeen) was used to calculate humeral component migration and induced movement. 15 patients were recruited. Precision was: 0.041, 0.034, 0.086 and 0.101 mm for Superior, Medial, Posterior and Total Point Motion (TPM) respectively. The mean TPM over 2 years was 0.24 (0.30) mm, (Mean (Standard deviation)). The mean rate of migration per 3 month time period decreased from 0.45 (0.31) to 0.02 (0.01) mm over 2 years. Mean inducible movement TPM peaked at 26 weeks at 0.1 (0.08) mm, which reduced to 0.07 (0.06) mm by 104 weeks when only 3 patients had measurable inducible motion. There was no clear trend in direction of induced movement. There were no adverse events or revisions required. We conclude migration of the humeral component was low with little inducible movement in the majority of patients implying initial and 2 year stability of the stemless humeral component.
Lateral Epicondylitis is a common condition caused by angiofibroblastic hyperplasia of the tendinous insertion. Its treatment is varied and includes rest, physiotherapy, corticosteroid injection and surgical release. Of late, the role of Platelet Rich Plasma (PRP) injections have been explored, with positive results. We prospectively assessed the outcomes of lateral epicondylitis treated with PRP injections and compared the outcomes of ultrasound guided and ‘blind’ injection. This was a single centre prospective cohort study. Patient were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) Score. PRP was injected into and around the common extensor origin either with or without ultrasound guidance. The primary outcome measure was DASH score at 3 months. 45 (23F:22M) patients were recruited. The mean age was 50 years (range 35 to 79). The mean duration of follow-up was 106 days. The average pre-injection DASH score for both groups combined was 45.5 (11.7–87.5). The mean DASH score at 3 months follow-up was 27.7. The ultrasound guided injection group had a mean improvement in DASH score from 45.5 to 31.2. The “blind” injection group had a mean improvement in DASH from 44.4 to 27.7. No complications were noted. There was no statistically significant difference in improvement in DASH score between the two groups. Our study provides further evidence to support of the use of PRP injections in the treatment of epicondylitis of the elbow. Interestingly, however, we found that the use of Ultrasound guidance does not appear to improve patient outcomes.
The best surgical treatment of lateral epicondylitis remains uncertain. Recently radiofrequency microtenotomy (RFMT) has been proposed as a suitable surgical treatment. We aim to compare open release with RFMT and present the results of our randomised controlled trial. Patients with symptoms of tennis elbow for at least 6 months who had failed to respond to conservative management were included in the trial. They were randomised to open release or RFMT. Outcome measures included grip strength, pain and DASH scores. 41 patients were randomised, 23 to RFMT and 18 to open release, 2 patients withdrew from the study. Our results show that both treatments give a significant benefit at all time points for DASH and pain scores, but only open release gives a significant improvement in grip strength. Comparing the two treatments the only significant difference is the open group have better pain scores at 6 weeks, but this is not seen at later follow up. In conclusion both groups have shown benefit from the treatments, but one is not shown to be clearly superior.
Frozen shoulder is a common condition that affects the working population. The longevity and severity of symptoms often results in great economic burden to health services and absence from work. This prospective cohort study aimed to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and any potential economic benefit to society. Patients were recruited prospectively. Data was gathered by way of questionnaire to ascertain demographics, previous primary care treatment and absence from work. Oxford Shoulder Score (OSS) was also calculated. Arthroscopic capsular release was performed and further data gathered at four week post-operative follow up. Economic impact of delay to treatment and cost of intervention was calculated using government data from the national tariff which costs different forms of treatment. Statistical analysis was then performed on the results. Twenty five patients enrolled. Mean pre-operative OSS: 37.4 (range 27–58, SD 7.4). Mean post-operative OSS: 15.9 (range 12–22, SD 2.3). P<0.01. Mean improvement in OSS: 21.5 (range 12–38, SD 7.1) The cost of non-operative treatment per patient was £3954. The cost of arthroscopic capsular release per patient was £1861, a difference of £2093. There were no complications Arthroscopic capsular release improved shoulder function on OSS within four weeks. The cost of arthroscopic capsular release is significantly less than the cost of treating the patients non-operatively. Early surgical intervention may improve symptoms quickly and reduce economic burden of the disease. A randomised controlled trial comparing timings of intervention would further elucidate potential benefits.
The purpose of this study was to compare outcome of arthroscopic stabilization of the shoulder using knotted and knotless anchors and two rehabilitation regimes. This is a retrospective study of 58 patients who underwent arthroscopic shoulder stabilization over a five year period (2005–2009). There were two groups of patients. In group A stabilization was performed using absorbable anchors with a knotted technique using No.1 PDS suture. This group had an early mobilization regime. In group B a knotless anchor technique was used with PEEK anchors and nonabsorbable sutures. The patients in this group were immobilised in a sling for 6 weeks. There were a total of 58 patients, 37 in group A and 21 in group B. The mean age of patients undergoing the procedure was 35.7. There were a total of 23 males and 14 females in group A and 15 males and 6 females in group B. The number of dislocations prior to surgery ranged from 0 to multiple times a day. Patients had a mean follow up of 5 years (three to seven years - 2005 to 2009) and subjective shoulder function was evaluated using Oxford instability score and self-assessment questionnaire.Objective
Method
The best method of stabilisation of the ankle syndesmosis remains a topic of debate; a relatively recent development is the ankle tightrope – a tensionable fibrewire suture device. Despite over 30,000 successful surgeries reported, evidence supporting its use when compared with screw fixation remains extremely limited. We retrospectively compared two consecutive groups of patients whose syndesmotic injuries were stabilised either with a tightrope or screws. The aim of our study was to compare complications arising after insertion of these devices. All patients undergoing tightrope stabilisation of the syndesmosis between January 2006 and February 2009 were included as the treatment group. The control group was made up of a similar number of consecutive patients who underwent screw stabilisation between November 2010 and January 2011. Data was obtained through theatre records, case notes and from the local PACS X-ray system. Eighteen eligible cases were identified in the tightrope group compared with sixteen eligible cases treated with screws. Both groups had similar baseline demographics with respect to distribution of age and gender. Twenty two percent (n = 4) of tightropes were removed secondary to wound breakdown or knot prominence. Other complications included persistent Our study demonstrates that in our hands a relatively high complication rate exists with tightrope stabilisation, whereas few problems are seen with screw fixation.Discussion
Stabilisation of the ankle syndesmosis remains a topic of debate regarding the best method of fixation; the most recent development is the ankle tightrope - a tensionable fibrewire suture. Despite over thirty thousand successful surgeries(1) reported, evidence supporting its use remains extremely limited. The aim of our study was to identify complications arising after insertion of this device for syndesmotic instability. All patients undergoing tightrope stabilisation of the ankle syndesmosis in Aberdeen Royal Infirmary between January 2006 and February 2009 inclusive were incorporated in our study. Patient identifier data was collated at the time of operation by a research nurse with case records collected and analysed by the authors at the end of the study period. Nineteen cases were identified with one subsequently excluded due to death. Of the remaining patients thirteen were male and five female. Age ranged from sixteen to fifty-eight years. Five patients required tightrope fixation alone, the remainder necessitating bony fixation according to AO recommendations. Time in cast immobilisation ranged from five to eight weeks, time to full weight bearing six to ten weeks and time to discharge eight weeks to fifteen months. In this series, 22% of tightropes were removed secondary to wound breakdown or knot prominence. Other complications included syndesmotic widening(11%), knot prominence without removal(5.5%) and synostosis(5.5%). Incontrast to previously published literature (2,3,4,5,6) this, the second largest series to date, demonstrates a high complication rate(44%) - perhaps the tightrope is not as advantageous as initially thought.
The purpose of the study was to evaluate if use of the ArthroCare Radiofrequency Ablation Wand caused excess heating and collateral damage to the surrounding tissues during Arthroscopic Subacromial Decompression. Cadaveric studies have shown worryingly high temperatures are reached when using Radiofrequency Ablation Wands in arthroscopic shoulder surgery. We are unaware of any published literature which assesses these temperature rises in the clinical setting. 10 patients were recruited to participate in the study. A standard Arthroscopic Subacromial Decompression was performed using continuous flow irrigation with intermittent use of the Radiofrequency Ablation Wand for soft tissue debridement. The temperature of the irrigation fluid in the subacromial bursa and the outflow fluid from the suction port of the wand were measured continuously during the procedure using fibre-optic thermometers. Temperatures above 45oC in the subacromial bursa were deemed to be unsafe. The mean peak temperature recorded in the subacromial bursa was 28.6oC (23.49 – 31.94oC) with a mean rise from baseline of 6.1oC. The mean peak temperature recorded from the outflow fluid from the wand was 73.1oC (69.09 – 76.1oC) with a mean rise from baseline of 47.66oC. Significantly high temperatures were noted in the outflow fluid from the wand but this was not evident in the subacromial bursa itself. Although high temperatures are generated at the tip of the wand this does not appear to be transmitted to the surrounding irrigation fluid in the subacromial bursa. We therefore conclude that safe temperatures are maintained within the bursa when using this device, thereby minimizing damage to the surrounding tissues, meaning collateral thermal damage is unlikely.
The aetiology of Panner’s disease is unknown. Thrombophilic states have been implicated in Perthes’ disease but remain controversial. The relationship, if any, between thrombophilia and Panner’s disease is not known. A 7 year old boy presented with pain and restriction of motion in one elbow with no history of trauma. Radiographs confirmed Panner’s disease. A thrombophilia screen showed an abnormal activated protein C resistance test consistent with the presence of Factor V Leiden in the heterozygous state. Thrombophilia may predispose to thrombotic venous occlusion in bone leading to intramedullary hypertension, anoxia and avascular necrosis. This may explain the aetiology of some cases of Panner’s disease. Resistance to activated protein C is a common heritable thrombophilia. The incidence in the UK is around 1.75%. It is caused by a CGA to CAA substitution at position 1691 of the Factor V Leiden gene. This blocks the binding of activated protein C to prothrombotic Factor V producing thrombophilia. Factor V Leiden carriers are three times more likely to experience clinical venous thrombosis than non-carriers. Whilst this risk does not warrant lifelong anticoagulation, thromboembolic events are more likely to cause problems than Panner’s disease which is essentially self-limiting. Affected patients should avoid other risk factors such as smoking or the combined contraceptive pill. As Factor V Leiden is common in our population, its presence in this patient may be incidental. Thrombophilia screening should be considered for patients with Panner’s disease. This enables appropriate counselling if a thrombophilic condition is found.
Fractures and fracture dislocations involving the lower lumbar spine and lumbosacral junction are uncommon. These high velocity injuries are often associated with neurological deficit, incontinence and dural tears. The accepted treatment has been posterior stabilisation with fusion, but loss of reduction has often been reported. We reviewed our experience over the past four years in the management of eight male patients, two of whom sustained injuries in motor vehicle accidents and two in falls from a height. Two patients had L5/S1 traumatic spondylo-listhesis with no neurological deficit. Of the six patients with fracture dislocations of L3/4, four had translation in the sagittal and coronal planes and incomplete neurological deficit. Associated injuries in four patients included an ankle fracture, multiple rib fractures, dislocation of knee and hip, and a fracture dislocation of the midfoot. Following satisfactory reduction, seven patients were treated by posterior spinal fusion (PSF) with instrumentation. One patient had anterior decompression, strut-grafting and posterior instrumentation. Three patients had dural tears. In three patients treated by single segment PSF, reduction was not maintained. The maintenance of alignment was attributed to stable facet joints in one patient, two-segment instrumentation in three, and anterior strut grafting in one. One patient developed postoperative wound sepsis, which settled after repeated debridement and antibiotic treatment. Symptoms of nerve root compression improved in two of the four patients with neurological deficit. Posterior reduction and instrumentation alone did not maintain reduction in these severe injuries. Anterior column support and multisegmental instrumentation may be required where there is marked vertebral body compression and neurological deficit.
