Aim. To describe the impact of a failed DAIR in the further prognosis of the prosthesis after a PJI. Method. A retrospective multicentrically study was conducted, including 10 institutions from all over the country. PJI-confirmed patients who underwent DAIR clinical records were revised. Age, sex, relevant previous conditions, Charlson comorbidity score, previous surgery, PJI diagnosis and surgical and antibiotic treatment, from the index surgery onwards. DAIR failure was defined as the removal of the prosthesis and/or an antibiotic suppressive treatment. Results. 95 failed DAIR were identified, 43 of whom were treated with another DAIR (70% success rate), 20 with one-stage revision (75% success rate) and 25 with two-stage revision (92% success rate). As risk factors for the failure of a second DAIR, a non-specialized surgical team(p=.0034), mobile components exchange(p=.009) and polymicrobial infections(p=.03) were identified. Regarding to one-stage revisions, no risk factors were identified, and regarding to two-stage revisions, polymicrobial infection were identified (p=.028). Conclusions. A second DAIR could sabe up to 70% of the prosthesis in our series. Furthermore, the outcome of the subsequent one or two-stage revision does not seem to be affected bay the previous failed DAIR. In terms of risk factors of failure, non-specialized surgical team, no mobile components exchange, and polymicrobial infections were identified for the DAIR, and polymicrobial infections for the two-stage revisions

Aim. The frequency of arthroplasty among older people is increasing. Taking care of Prosthetic Joint infection (PJI) in this specific population is a challenge. The purpose of this multicentric retrospective study was to evaluate the bacterial epidemiology of hip and knee PJI in octogenarians and nonagenarians over ten years. Method. Data were collected using two softwares* in each of the 4 Centers participating. Inclusion criteria:. -. age ≥ 80 years PJI (knee or hip). -. between January 2007 and December 2016. -. microbiological data available (strains isolated from osteo-articular samples). Bacterial identification: biochemical methods, followed by Malditof since 2009. For Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacteriaceae, resistance profiles to antibiotics frequently used in PJI were collected. Antimicrobial susceptibility testing: disk diffusion (recommendations: French Society of Microbiology yearly updated). Results. 413 patients were included: median age was 85 years and sex ratio was 0.6. 137 were knee PJI and 276 hip. 34% of the infections occurred < 1 month after implantation, and 49% > 6 months after implantation. Among all bacterial isolates (N=817), there was 55% of Gram positive cocci and 36% of Gram negative rods. 112 (27%) were polymicrobial infections. There was a majority of gram negative rods (41%) among isolates from polymicrobial infections. Concerning drug resistance, there was a stable proportion of ESBL among Enterobacteria (16%), whereas Methicillin resistance among S. aureus decreased from 43% in 2007 to 12% in 2016. Conclusions. An important proportion of PJI in older patients are polymicrobials, and a lot of them involve gram negative rods, almost as frequently as S. aureus. These infections are difficult to treat, and resistance of gram negative strains is one of the obstacles to overcome among these patients where surgery is not always possible. * Sirweb (I2A) and Glims (MIPS)

Introduction: Vertebral compression fractures (VCFs) are the most common complications in patients with poor bone quality: trabecular bone discontinuity, occurring with aging, leads to trabecular loosening, subsequent microcracks and vertebral collaps. Percutaneous vertebral augmentations as vertebroplasty and kyphoplasty are minimally invasive surgical procedures developed for the management of symptomatic VCFs not responding to medical treatment, but related complications are not uncommon. The aim of this international multicentric study was to assess the reduction of pain, complications and results of Vesselplasty, a new kyphoplasty procedure. Material and Methods: From January 2006 to July 2008 we treated 327 VCFs in 264 patients, 193 women and 71 men (mean age 68 years). Procedures were managed by one or two C-arm fluoroscopic techniques. The highest level was D6 while more common were at the thoracolumbar junction. Patients were followed at 1, 6, 12 and 24 months using plain X-rays or reformatted CT images. Pain was evaluated with visual analog scale (VAS) and SF-36 assessed at baseline, after the procedure, and after 1, 6, 12 and 24 months. Data analysis was used Student-t test. All patients received antiosteoporosis medical treatment, pain medication, and physiotherapy. Results: We always performed transpedicular minimally invasive approches using Vessel-X. ®. with low-viscosity bone cement mixed with calcium sulphate. The average amount of cement injected, for each vertebral body, was 5cc (range 3.5–7cc). The mean preoperative scores of 8.3 (VAS), 12.6 (SF-36 Bodily Pain) and 10.9 (SF-36 Physical Function) were improved to 2.3, 54.9 and 52.2, respectively (P< 0.001) at 1 month follow-up and 2.1, 65.7 and 59.4, respectively (P< 0.001) at 12 month follow-up. No case reported pedicular or intracanal leaks of cement. Intradiscal leakages occurred in 20 levels (6.1% of total) but asymptomatic. Another VCF, within the first year after operation, took place in 29 patients, but only in 9 cases (3.4% of total) was an adjacent level. Conclusion and Discussion: Treatment of osteoporosis has made enormous advances in the past years, resulting in a wide range of options. Vesselplasty is a safe and effective minimally invasive procedure for pain relief associated with VCFs, and improves mobility and quality of life in these patients. Vesselplasty permits the interdigitation of bone filler materials into the surrounding trabecular bone: the double layers containers reduce the risk of leaks of cement and restore the vertebral height. We underline the importance of a global approach to the osteoporotic patients: the best treatment remains early diagnosis evaluating bone remodelling markers, lumbar and femoral DXA, thoraco-lumbar X-rays and risk fracture assessment to guarantee the most appropriated therapy as specific as possible

Background. One of the main concern about reverse shoulder arthoplasty for the treatment of rotator cuff deficiency is scapular notching that is still an unsolved issue for this particular prosthesis. The purpose of this multicentric retrospective study is to compare two different concept of reverse prosthesis, one with a concentric glenoshere and the other one with a new eccentric glenoshere design that aim to minimize scapular notching. Methods. From 2004 to 2009 67 patients were treated with a SMR reverse shoulder prosthesis (LIMA) with either concentric (figure 2) or eccentric glenosphere (figure 1). We selected for the study patients with criteria as much homogeneous as possible by the age and pathology. We then included for the study 25 patients (Group 1) with a concentric glenosphere and 21 (Group 2) with a eccentric glenosphere. All baseplates of concentric glenospheres were implanted with the most inferior aspect of baseplate that matched with the inferior glenoid ream, so that the glenosphere extended 4 mm beyond the glenoid inferiorly in order to minimize scapular notching. Every patient were followed clinically (Constant and Murley Score [C.S.] and Simple Shuolder test [S.S.T.]) and radiographically (notching, loosening and mechanical failure) with a minimum follow-up of 24 months. We also evaluated at the final follow-up psna (prosthesis-scapular neck angle), pgrd (peg glenoid rim distance) and DBSNG (distance between scapular neck and glenosfere). Results. At two years of follow up R.O.M. increased significantly in both groups especially in those with a eccentric glenosphere. Notably in patients with an eccentric glenosphere elevation improved from 66° to 148° and abduction from 60° to 115° while in those with a concentric glenosphere improved from 78° to 122° and 71° to 98° respectively for elevation and abduction. Outcomes for external-rotation and internal-rotation were very similar in both groups. 14 (56%) patients among those with a concentric glenosphere had scapular notching while we didn't have any notch in those with eccentric glenosphere even though we didn't find any significant different between the two groups in term of clinical outcomes and patient's satisfaction. The average C.S. increased from 38% to 69% in those with concentric SMR and from 30% to 74% in the other group. At the final follow-up PSNA, DBSNG and PGRD were respectively 88°, 3,2mm and 18,2 mm in group 1, while they were 92°, 4,3 mm and 21,2 mm in the group 2. Conclusions. Putting concentric glenosphere more inferiorly reduce the incidence of scapular notching but it doesn't solve the problem whereas, at medium follow-up, the new eccentric design seems to solved completely this issue. This study sustains PSNA, DBSNG, PGRD as reliable measures to predict scapular notching. Besides eccentric SMR glenosphere seems to increase R.O.M. mostly in flexion, abduction and adduction

Background

Septic arthritis diagnostic is an emergency which implies a treatment with antibiotics and hospitalization. The diagnosis is based on the cytobacteriological examination of the synovial fluid (SF), but direct bacteriological examination is insensitive, and the result of the culture is obtained only after several days. Therefore, there is still a need for a rapid, simple and reliable method for the positive diagnosis of septic arthritis. Such method must allow avoiding both unrecognized septic arthritis leading to major functional consequences, and overdiagnosis that will induce unnecessary expensive hospitalization and unjustified treatment. Mid-infrared (MIR) spectroscopy, that gives a metabolic profiling of biological fluids, has been proposed for early and fast diagnosis.

Introduction.- Some of the recommended alternatives to increase the cementless acetabular cups stability are the plasma sprayed porous coated and HA and the press-fit impaction. The incorporation of three peripheral fins improves final fixation avoiding micromotion at the immediate post operative period. From 1992 we have implanted 4068 cups, the majority of them in primary cases (78%). The rest 22% in revision cases.

Cup characteristics: hemispheric with fins to improve prumary fixation and HA coating; ring-long ystem in common with other Biomet models, reason why liner are interchangeables.

Material and methods.- 4.068 Bihapro cups (Biomet-Merck) were implanted at a multicenter study in three Hospitals, adjoined to the University, between 1992 and 2003. This is a press-fit model with a porous surface coated with HA and three peripheral fins to improve primary fixation and also dome holes to allow the use ob bone screws.

Prymary indication: osteoarthritis (76%), AVN (7%), fractures (8%), dysplasias (3%), rheumatoid arthritis (6%). Surgical approach: lateral (49%), posterolateral (34,2%), anterior (16,8%). Prophylaxis: antitrombotic (LMWH), antibiotic (1st generation cephalosporins), heterotopic ossification (indomethacin).

Results.- Results. 24 patients showed dislocation and 47 % had some degree of periarticular ossification one year alter surgery; the approach used did not show significative differences. The survival study was done using Kaplan-Meier’s curve. The end-point for failure in this study was the need to perform aesptic revision surgery; being the survival at 9 years of 99.49 % (CI 95 % 99.08 – 99.90). Seven cases needed revision surgery (0.3 %); two cases for migration of the cup and five cases for iterative dislocations.

Conclusions.- Acetabular cups with Plasma Spray Porous Coating in combination with HA, results stable at mid term. The supplementary fixation of the three peripheral fins avoids micromotion optimizing long-term fixation.

Introduction: The data reporting clinical and radiological outcomes after modern unicompartmental knee arthroplasty (UKA) for spontaneous avascular osteonecrosis are limited. We hypothesized that UKA for spontaneous osteonecrosis may be as reliable and durable as it is for osteoarthritis.

Materials and Methods: We retrospectively reviewed 40 cemented UKA operated for spontaneous osteonecrosis of the knee in two different centers between 1989 and 2004. Twenty-six patients were women and 14 men, mean patient age was 67 years (range, 45 to 84) and mean body mass index was 27.4 Kg/m2 (range, 18 to 44). Clinical and radiological evaluations were performed by an independent observer in each center according to the same protocol at a minimum follow-up of 3 years (mean 8 years; range, 3–17.5 years).

Results: The mean Knee Society Knee score improved from 60 preoperatively to 95 post-operatively. The mean Knee Society Function score improved from 50 preoperatively to 89 post-operatively. Restoration of an appropriate lower-limb mechanical axis was achieved for 36 knees (90%). Two knees were revised for aseptic loosening. The Kaplan–Meier survivorship was 95% at 12 years.

Discusssion and conclusion: Our data suggest UKA is a reasonable solution for restoring clinical function and radiological lower-limb alignment for spontaneous osteonecrosis of the knee, with a durable survivorship.

The abnormal shortening of a metatarsal (MT), being congenital or aquired, may cause functional problems, on altering feet support. Besides some deformities may be aestheticaly unacceptable to some patients, particularly females. We performed a retrospective, concurrent epide-miological revision on 28 records of patients that had MT lengthening for a short metatarsal. ( 21 patients with 9 bilateral.) These were the 4th. in 22 oportunities, followed by the 1st in 7, the 3rd. in 2 and the 5th. in 1. Etiology was in 20 cases congenital shortening, 2 shortening after equinus foot surgery and 1 after osteomyelitis. Seven cases had bilateral elongation, thus making 28 cases. Age ranged from 5 years to 20 years, with a mean 10 years. The indications for surgery were pain in 10 cases and aesthetic in 18 . All. were females except one.

The Caracas group used a modified mini Anderson apparatus. After 1992 the apparatus was modified for the last 4 cases for one that could be placed only on the dorsal aspect of foot, thus allowing weight bearing. The application was performed under image intensifier placing the threaded pins perpendicularly to the MTT with transversal diafisis osteotomy, starting the elongation between 5th and 10th day at a speed of 1.5 mm weekly at a range of 0.5 mm every second day, in a period from 3 weeks to 8 weeks with a mean of 5.5 weeks. Ten had unilateral lengthening (83.33) and 2 bilateraly (16.57%) making a total of 14 metatarsal lengthenings. All were females and all had elongation fix-ation callotaxis according to DeBastiani. The cases were operated from 1987 to 1994 and with more than 6 years follow up. Age ranged from 10 to 15 years in 10 cases and 16 to 20 in 2 patients. The MTT mostly involved was the 4th. in 12 patients (85.71%), 2 bilateral (14 MTT), and the 3rd in 2 cases (14.29%), . The shortest MTT lengthened measured 3.5 cmts. Lengthening obtained ranged from 5 mm. to 22 mm, with a mean of 14.3 mm. One patient obtained 5 mm. (7.14%), another 10 mm. (7.14%), one 11 (7.14%) and 1 15mm. (7.14%), 5 (35,71%) from 16mm. To 20 mm. and other 5 (35.71%) from 21mm. to 25mm.

Complications were pseudoarthrosis in 3 cases, delayed union in 1 case and angulation in 1. These were treated by reintervention and bone graft maintaining the lengthening in 4 and in the other, 1 pseudoarthrosis the lengthening was lost.

The Buenos Aires Group with 16 lengthenings in 11 patients,used an external apparatus with 2,3 or 4 joints and threded 1 mm pins fixed in the metatarsal to length, dorsally. . In some cases the proximal pin was fixed to third cuneiform and in 6 to the the distal in the proximal phalang to aviod bending. This last mentioned method were not used afterwards because correct alignment was obtained fixing the apparatus only in the metatarsal. The corticotomy was metaphysoepyphisary lenghthening 0.5 mm daily starting the 8th day. Hospitalization time ranged 2.5 days. Minimal follow up was 2.6 years. Nine of 11 cases recovered the normal metatarsal formula. Pain disappeared in cases that had it previously but aesthetic requirements were not always completely fulfilled, special with the 1st. MT. Mean elongation length was 17 mm. Mean percentage ogf elongation was 40%. Mean duration of total treatment was 112 days, making mean healing time index of 65 days per every centimeter elongated. No axial deviation ocurred. All cases healed at callus site. The case of osteomyelitis had bone graft at operation. Complications were 3 superficial infections at pin site and 1 case of recurrent deep infection. An elongation above 50% of original length of MT should be avoided.

Introduction. 20 cases of bone defect have been treated by the induced membrane technique avoiding allograft, microsurgery and amputation. Material and Methods. 9 cases of long bone defect (humerus and 2 bones arm) and 11 cases of bone defct at the hand have been included in this multicentric prospective study (3 centers). 11 cases were traumatic, 7 cases were septic non union and 2 cases were tumor. At hand level's bone reached at least one phalanx, and for long bone the mean defect was 5cm (3–11). All cases were treated by the induced membrane technique which consists in stable fixation, flap if necessary and in filling the void created by the bone defect by a cement spacer (PMMA). This technique needs a second stage procedure at the 2. nd. month where the cement is removed and the void is filled by cancellous bone. The key point of this induced membrane technique is to respect the foreign body membane which appeared around the cement spacer and which create a biologic chamber after the second time. Bone union was evaluated prospectively in each case by an surgeon not involved in the treatment by Xray and CT scan. Failure was defined as a non union at 1 year, or an uncontrolled sepsis at 1 month. Results. 3 cases failed to achieve bone union, 2 at hand level and 1 for long bone. No septic complications occured and all septic cases werre stopped. In 14 cases bone union was achieved with a delay of 5 months (1, 5–12). 2 biopsies allowed to proove us that osteoid tissue was created by the technic. At hand level all fingers have included. At shoulder and elbow level, function reached 75% of motion than controlateral side. Discussion. Masquelet first reported 35 cases of large bone defect of tibia non union treated by the induced membrane technic which allow to fill bone defect with cancellous bone alone. The cement spacer allows to induce a foreign body membrane which constitute a biological chamber. Works on animal model reported by Pellissier and Viatteau showed the properties of the membrane: secretion of growths factors (VEGF, TGFbéta1, BMP2) and osteoinductive activitie of the cells. The induced membrane seem to play the role of a neo periosteum. Using this technic is possible in emergency or in septic condition where bone defect can not been solved by shortening. This technic avoids to use microsurgical technic and the limit is the quantity of avalaible cancellous bone

Accuracy of implantation is an accepted prognostic factor for the long term survival of total knee replacement (TKR). The use of navigation demonstrated a significant higher accuracy of implant orientation in comparison to conventional methods. However, these systems are often thought to be technically demanding, to increase operating time and to involve a long learning curve. We performed a prospective, multicenter study to compare the accuracy of implantation of a TKR measured on post-operative X-rays in experienced and less experienced centers.

All centers used the same navigation system (Ortho-Pilot ®, Asculap, Tuttlingen, FRG): 4 had already a significant experience with it (group A – 182 cases), 9 centers were considered as beginners with less than 10 cases performed prior to the study (group B – 221 cases). Accuracy of implantation was measured on post-operative antero-posterior and lateral long leg X-rays with five items: mechanical femoro-tibial angle, coronal orientation of the femoral component, sagittal orientation of the femoral component, coronal orientation of the tibial component, sagittal orientation of the tibial component.

When the measured angle was in the expected range, one point was given. The accuracy note was defined as the sum of all points given for each patient, with a maximum of 5 points (all items fulfilled) and a minimum of 0 point (no item fulfilled). The mean accuracy note was compared in the two groups by a Student t-test at a 0.05 level of significance. Power of the study was 0.80.

There were no significant differences in pre-operative parameters between the two groups, except for the clinical KSS. The mean operative time was significantly longer in group B than in group A (110 minutes vs 90 minutes, p=0.01). However this difference occurred mainly during the first twenty cases in the beginner centres where we observed a clear tendency to achieve the same operative time as the experienced centres at the end of the study. The mean accuracy note was 4.3 ± 0.8 (range, 1 to 5) in the control group and 4.3 ± 0.9 (range, 1 to 5) in the study group (p > 0.05). The power of the study to detect a 0.25 point difference in the post-operative accuracy note was retrospectively calculated to be 0.80. There were no significant differences between the two groups for all individual radiographic items.

This study is, to our knowledge, the first one which investigates the learning curve of navigated TKR The used navigation system allowed a very accurate implantation of a TKR in both experienced and less experienced centers. There was no detectable learning curve with respect to accuracy of TKR implantation, clinical outcome and complication rate. The duration of the learning curve when considering the operating time was 30 cases.

Summary

open tibia fractures are best treated in an orthopaedic-plastic surgical multidisciplinary setting.

Purpose

Reverse shoulder prosthesis may lead to scapular notching, caused by attrition of the upper humeral component with scapular neck. We compared the clinical and radiographic results obtained with a SMR prosthesis, which allows a concentric or an eccentric glenosphere to be applied.

Introduction and Objectives: We compared the clinical and radiological results in patients under and over 40 years of age who had received a non-cemented alumina-alumina hip replacement.

Materials and Methods: We studied 337 Cerafit acetabular cups implanted in 4 hospitals in association with Multicone-Hydroxyapatite stems with alumina-alumina bearing surfaces. Group 1 consisted of 63 patients under 40 years of age and group 2 of 274 patients over 40 years of age. Mean follow-up was 59.0 months. Demographic data and clinical and radiological results of both groups were compared.

Results: There were no cases of primary arthritis in group 1, however severe hip dysplasia and juvenile rheumatoid arthritis were frequent (p< 0.001). Weight (p< 0.001) and degree of activity (p=0.003) were greater in group 2. Preoperative function (p=0.03) and mobility (p< 0.001) were worse in group 1. There were 3 cup revisions in group 1 and 4 (including an alumina breakage) in group 2. Survival with no revision due to any cause was 91.4+5.1% in group 1 and 97.0+ 1.1 in group 2 (p=0.4007). There were no noises. Clinical and radiological results were similar in both groups.

Discussion and Conclusions: Diagnoses were different in both groups, the younger patients were in worse conditions. In spite of these differences, the alumina-alumina prosthesis showed similar results in both groups in the medium term. Long-term follow-ups are necessary to confirm these results.

Aim

To determine whether delayed diagnosis (lapse from initial symptoms to the beginning of treatment) has influence on the possibilities of crossing the physis by the tumour, and/or on the outcome in pediatric patients with high grade metaphyseal osteosarcoma.

Purpose: The purpose of this study was to conduct a multicentric comparison of total knee arthroplasty using the conventional technique versus digitalized navigation.

Material and methods: A prospective comparative study was conducted in five centres in 821 patients using the same implant (Search®, Aesculap, Chaumont): 555 procedures with the Orthopilot® navigation system (Aesculap, tutligen, group 1) and 266 conventional procedures, group 2). Radiographic results were analysed by an independent investigator who examined telemetric images obtained three months after surgery.

Results: The mechanical femorotibial axis was within desired limits (3° frontal deformation) in 88.6% of the knees in group 1 and in 72.2% of the knees in group 2 (p< 0.001). The rate of unacceptable implantations (> 5° deviation) was 2.5% in group 1 and 9.8% in group 2).

Frontal orientation of the femoral component was satisfactory in 89.4% of the knees in group 1 and in 77.1% in group 2. Sagittal orientation of the femoral component was satisfactory in 75.5% of the knees in group 1 and in 70.7% of the knees in group 2. Frontal orientation of the tibial component was satisfactory in 91.9% of the knees in group 1 and in 83.5% of the knees in group 2. The sagittal orientation of the tibial piece was satisfactory in 81.3% of the knees in group 1 and in 69.9% of the knees in group 2. Optimal implantation, considering all criteria studied, was achieved in 275 patients (49.5%) in group 1 and in 82 patients (30.8%) in group 2 (p< à.001). Ther was no difference in results between centres.

Discussion: Computer-assisted navigation facilitated prosthesis implantation with the desired orientation in comparison with manual instrumentation. The number of unacceptable implantations was significantly lower. After a short learning curve, the reliability of this system has proven very satisfactory, facilitating its use since this study.

Introduction

The current investigation includes a retrospective review of the experience of five Institutions with distal femur megaprostheses for tumor over a twenty year period, to analyze the incidence and etiology of failure, using a new classification system based upon the failure modes.

Introduction

The causes for revision of primary total hip arthroplasty (THA) are various and quite well known. The developing use of dual-mobility THA (DM-THA) seems a relevant option to decrease the risk of instability. Due to lack of long-term follow-up, this innovative retentive concept is suspected to increase the risk of polyethylene (PE) wear. The aim of the study was to analyse the causes for DM-THA revision and assess whether or not its occurrence is different from that of fixed-standard (FS) THA, particularly for aseptic loosening or wear and/or osteolysis.

Purpose: The best strategy to adopt for the long head of the biceps during total shoulder arthroplasty for centred primary joint degeneration remains a controversial issue. We analysed the influence of long head of the biceps (LHB) tenodesis on outcome.

Material and methods: From retrospective multicentric series of 766 shoulder prostheses implanted for centred primary degeneration of the shoulder joint, we selected 625 shoulders with sufficient data concerning the LHB. We defined two groups: 131 shoulders with LHB tenodesis and 494 shoulders with a preserved LHB. We analysed clinical outcome with the Constant score and subjective outcome at two years. We identified four groups: 70 humeral prostheses without tenodesis, 10 humeral prostheses with tenodesis, 424 total shoulder arthroplastues without tenodesis, and 121 total shoulder arthroplasties with tenodesis.

Results: The Constant score was significantly better in the tenodesis group (74.7) than in the group without tenodesis (70.8). This significant difference was also found for the weighted score and likewise for active anterior elevation and active external rotation in position 1. There was no difference concerning postoperative fatty degeneration. By subgroups, the analysis showed significant improvement in the Constant score for humeral prostheses with tenodesis and total shoulder arthroplasty with tenodesis over the same implants without tenodesis. This same significant difference was observed for the 364 patients who had a minimum follow-up of 36 months: tenodesis improved the Constant score, the weighted Constant score, active anterior elevation, and active external rotation.

Discussion: The causal role of the LHB in shoulder pain is now well documented in the literature. Several authors have advocated tenotomy or tenodesis of the LHB during surgical treatment of rotator cuff tears. The same is not true for shoulder arthroplasty for the treatment of primary degeneration. Dines and Hersch reported their experience with ten patients with a painful total shoulder arthroplasty who were improved with arthroscopic tenotomy or tenodesis.

Conclusion: Our large series confirms that tenodesis of the LHB is preferable during implantation of a humeral prosthesis or a total shoulder prosthesis for the treatment of centred primary joint degeneration with good results that persist over time.

Aims

With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic.

Abstract