Slipped capital femoral epiphysiolysis (SCFE) is a rare condition with a unknown aetiopathogenesis. An early diagnosis and treatment is essential to minimize premature degeneration of the joint. The authors reviewed the cases treated between 1980 and 2005 in our institution. This study was aimed at evaluating patients with hip epiphysiolysis surgically treated by canullated screws or pinning and previously controlled by short-term follow-up, in order to evaluate radiographic medium/ long term evolution, looking for evidence of degenerative arthritis or femoroacetabular impingement. We performed a retrospective review of the clinical notes and radiographs of all patients with slipped upper femoral epiphysis who were surgically treated at our institution between January 1980 and December 2005. These patients performed radiographs to detect evidence of osteonecrosis, chondrolysis, degenerative arthritis or femoroacetabular impingment. To grade the radiological osteoarthritic changes the grading system of Kellgren and Lawrence was used. These changes were correlated with the existence of femoroacetabular impingement. The radiological results were correlated with the Loder'sclassification of stability and the morphological classification. 43 patients were reviewed, corresponding to 47 treated hips. AP and Lowenstein x-ray views were taken in all patients. The alfa angle and the head-shaft angle were measured in the Lowenstein view (frog-leg). Of 16 patients with impingement only 1 patient didn't present pistol grip deformity. 4 contralateral hips also presented the deformity. The mean alfa angle was 99,4. 43% of the patients with unstable hips have impingment. In stable hips this percentage is of 35%. The Patrick test was positive in 30% of the hips with SCFE and only 17% of the unafected hips. The Kellgren and Lawrence scale was very diferent between trhe SCFE and control groups, with 43% grade 2, 17% grade 3 and 6% grade 4, versus 30% grade 2, 6% grade 3 and 0% grade 4. Some patients show bilateral pistol grip deformity and clinical signs of impingment, despite only having one hip with SCFE

We evaluated the results of Cementless Surface Replacement Arthroplasty (CSRA) of the shoulder in 67 patients with advanced glenohumeral destruction who have an intact rotator cuff. Between november 2002 and december 2008, 70 CSRA (32 Copeland/ Biomet and 38 SMRR/ Lima) were implanted in 67 patients. A deltopectoral approach was used in 34 cases and an anterosuperior approach in 36 cases. Patients were assessed using Constant score, a patient satisfaction score and a detailed radiographic analysis. The mean follow up was 3.4 years (range 1 to 7.5 years). The mean Constant score improved preoperatively from 17.6 points (range 2–55) to an average postoperative score of 66.1 (range 13–91). The pain score improved from 1.13 points (range 0–6) to 12.3 points (range 3–15). The forward flexion and external rotation improved from 71° (range 20 to 140) and 0° (range −40 to +45) to 143° (range 60 to180) and 34.4° (range −20 to +60) respectively. Complications included: 1 subscapularis detachment, 5 secondary rotator cuff tear, 1sepsis, 3 patients with shoulder stiffness. No shift in implant position was observed. 11 humeral components developed radiolucencies at the prosthesis-bone interface. The radiographic analysis involved a system of dividing the prosthesis/bone interface into 5 zones. The best clinical results were significantly achieved in patients with necrosis compared with osteoarthritis (Constant Score, ant. elevation, ext. Rotation). Using regression analysis we found that changes in the head-shaft angle position of the implant (valgus/varus placement of the CSRA) significantly predicted the age and sex adjusted Constant score. When the inclination angle of the humeral head decreases, the adjusted Constant score increases. In the same model, we also found that the lateral offset of the humerus significantly predicted the adjusted Constant score. When the lateral offset of the humerus decreases, the adjusted Constant score increases. The medialization of the glenoid significantly and negatively predicted the Constant score. Conclusion. CSRA of the shoulder outcomes have been comparable with those of stemmed arthroplasties. Radiolucent lines occur with follow up and most of the time located in the S1 area. Glenoid wear and humeral head lateralization negatively impact the clinical score. Cementless Shoulder resurfacing is a viable alternative to conventional shoulder arthroplasty

We treated 47 patients with a mean age of 57 years (22 to 88) who had a proximal humeral fracture in which there was a severe varus deformity, using a standard operative protocol of anatomical reduction, fixation with a locking plate and supplementation by structural allografts in unstable fractures. The functional and radiological outcomes were reviewed.

At two years after operation the median Constant score was 86 points and the median Disabilities of the Arm, Shoulder and Hand score 17 points. Seven of the patients underwent further surgery, two for failure of fixation, three for dysfunction of the rotator cuff, and two for shoulder stiffness. The two cases of failure of fixation were attributable to violation of the operative protocol. In the 46 patients who retained their humeral head, all the fractures healed within the first year, with no sign of collapse or narrowing of the joint space. Longer follow-up will be required to confirm whether these initially satisfactory results are maintained.