Background. The purpose of this study was to determine if thresholds regarding the percentage of maximal improvement in the Simple Shoulder Test (SST) and American Shoulder and
A commonly misunderstood principle in medical literature is statistical significance. Often, statistically non-significant or negative results are thought to be evidence for equivalence; mistakenly validating treatment modalities and putting patients at risk. This study examines the prevalence of misinterpretation of negative results of superiority trials in orthopaedic literature and outlines the need for a non-inferiority or equivalence research design. Four orthopaedic journals – Journal of Paediatric Orthopaedics A, Journal of Bone and Joint Surgery American Volume, Journal of Arthroplasty and Journal of Shoulder and
BACKGROUND. Abnormal glenoid version positioning has been recognized as a cause of glenoid component failure caused by the rocking horse phenomenon. In contrast, the importance of the glenoid inclination has not been investigated. MATERIALS AND METHODS. The computed tomography scans of 152 healthy shoulders were evaluated. A virtual glenoid component was positioned in 2 different planes: the maximum circular plane (MCP) and the inferior circle plane (ICP). The MCP was defined by the best fitting circle of the most superior point of the glenoid and 2 points at the lower glenoid rim. The ICP was defined by the best fitting circle on the rim of the inferior quadrants. The inclination of both planes was measured as the intersection with the scapular plane. We defined the force vector of the rotator force couple and calculated the magnitude of the shear force vector on a virtual glenoid component in both planes during glenohumeral abduction. RESULTS. The inclination of the component positioned in the MCP averaged 95° (range, 84°–108°) and for the ICP averaged 111° (range, 94°–126°). A significant reduction in shear forces was calculated for the glenoid component in the ICP vs the MCP: 98% reduction in 60° of abduction to 49% reduction in 90° of abduction. CONCLUSION. Shear forces are significantly higher when the glenoid component is positioned in the MCP compared with the ICP, and this is more pronounced in early abduction. Positioning the glenoid component in the inferior circle might reduce the risk of a rocking horse phenomenon. Copyright © 2015 Journal of Shoulder and
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 shoulder surgery, both at home and abroad, and there is a steady flow of young overseas fellows through Australian shoulder units. The Shoulder and Elbow Society of Australia, founded in 1990 as a loose grouping of interested colleagues, now boasts over 70 active members. Australian surgeons and researchers are well represented in the prestigious Journal of Shoulder and
Objective:. Total elbow joint arthroplasty has limited longevity and is therefore not appropriate for younger rheumatoid arthritis patients. Arthroplasty using an inter-positional membrane may be another surgical option for this population. However, clinical results for joint arthroplasty using the inter-positional membrane have not traditionally been favorable because rheumatoid activity could not be controlled. Today, rheumatoid activity can be controlled with biologics; therefore, the utility of the inter-positional membrane procedure was re-evaluated. Methods:. An 8×6 cm sheet of fascia was detached from the patient's tensor fascia lata muscle to produce a JK membrane. The fascia was stretched on a frame and kept in a 2% chromic acid potassium solution for 24 hours. Then, the fascia was exposed to direct sunlight in order to reduce the dichromic acid. The fascia was washed out in running water for 24 hours and was then stored in phenol with the addition of 70% alcohol. Elbow arthroplasties were performed on three elbow joints in two young female patients. The first case had a significantly damaged right elbow joint with severe joint dysfunction. A JK membrane arthroplasty was done for the first case in 2003, when this patient was 34 years old. Biologics were administered with methotrexate after the surgery. The second case demonstrated bilateral ankylosed elbows due to idiopathic juvenile arthritis. Bilateral JK membrane arthroplasties were performed in 2010, when this patient was 32 years old. Several operative and manual manipulations were necessary in order to increase the range of motion following surgery. Biologics were administered with cyclosporine. Results:. Joint function was significantly improved in all three joints without pain after the JK membrane elbow arthroplasties. In case one, the JOA (Japan Orthopaedic Association) elbow score improved from 21 points before surgery to 85 points after surgery and active elbow flexion improved to 110 degrees following surgery. In case two, the JOA elbow score was 55 and 82 points in the right elbow and 52 and 83 points in left elbow before and after surgery, respectively. In case two, active flexion improved to 120 degrees for the right elbow and 110 degrees for the left
In May 2012, in airports across the globe, seven
orthopaedic surgeons bravely said goodbye to their loved ones, and
slowly turned towards their respective aircraft. Filled with expectation
and mild trepidation they stepped into the unknown… the ABC fellowship
of 2012.