Aims

The purpose of the present study was to evaluate the impact of intravenous tranexamic acid on the reduction of blood loss, transfusion rate, and early post-operative clinical outcome in total shoulder arthroplasty.

Hemi shoulder arthroplasty is a rather successful procedure although revision surgery due to secondary glenoid erosion is reported in more than 25%. The downside of common shoulder arthroplasty is that in a deltopectoral approach the subscapularis tendon needs to be detached for exposure of the humeral head. Refixation of subscapularis tendon is associated with a retear rate of 4%, furthermore with progressing fatty muscle infiltration and loss of function. In case of revision surgery a second subscapularis tendon detachment is even more associated with worse function. Thus, arthroscopic humeral head resurfacing is an expedient alternative for minimal invasive humeral head arthroplasty without compromising subscapularis function. The purpose of this study was to report first clinical and subjective results after arthroscopic-assisted resurfacing of the humeral head.

For this prospective case series, 24 patients (7 females, 17 males; mean age 59 years, range 42–73 years) undergoing arthroscopic-assisted partial shoulder resurfacing with the partial eclipse prosthesis were included in the study. Clinical conditions and subjective assessments were evaluated before surgery and annually thereafter using the Constant score (CS), active range of motion (ROM), visual analog scale (VAS) for pain, and the American Shoulder and Elbow Surgeons scale (ASES). Radiological outcomes and major complications were monitored.

The mean CS for all patients improved significantly from 51 points preoperatively to 83 points 12 months after surgery (p=0.005). Trends towards increasing ROMs were detected. Subjective scores significantly improved from baseline to the 1-year follow-up (VAS: from 6.4 to 2.5, p=0.010; ASES: from 47 to 76, p=0.026). The majority of patients (88%) stated that they would undergo the procedure again. Revisions were indicated in 17% due to progression of osteoarthritis.

Arthroscopic-assisted partial humeral head resurfacing as a minimal invasive procedure with the advantages of bone stock preservation and intact subscapularis tendon allowed immediate postoperative active mobilization and provided significant improvements in subjective outcome. In case of revision surgery a primary situation was encountered with postoperative results comparable to primary arthroplasty.

In the past century several shoulder reconstruction systems with different types of prostheses and fixation methods have been developed to improve shoulder arthroplasty, especially to cover a wide range of pathologies and revision situations. The aim of this prospective trial was to report clinical and radiological mid-term results of a stemless humeral head replacement with metaphyseal hollow screw fixation.

A consecutive series of 147 shoulders in 138 patients (84 female, 54 male; mean age of 67 years, range 40–84) undergoing stemless humeral head arthroplasty were considered for this single-centre trial. We prospectively followed 120 shoulders (40 hemi- and 80 total-arthroplasties) for an average of five years or until a reoperation. Patient's clinical and functional outcome was evaluated according to the Constant score and active range of motions (ROM) was measured. Patient's satisfaction with the treatment was evaluated. Additionally, operating times and complications were recorded. Radiological assessment for radiolucencies or implant migration was performed.

The mean Constant score significantly increased from 35 points preoperatively to 62 points at the last follow-up (p<0.001). All subcomponents (pain, daily activity, ROM, strength) of the Constant score were significantly (p<0.001) higher at follow-up. Active flexion improved from 90° to 150° (p<0.001), active abduction from 78° to 120° (p<0.001), and active external rotation from 20° to 40° (p<0.001) between preoperative and last clinical assessment. Furthermore, 54% of the patients were very satisfied, 34% satisfied, and 12% unsatisfied. Operating times of the new stemless prosthesis were significantly shorter compared to a stemmed prosthesis. Over the follow-up period, all humeral head components were radiological centred, changing radiolucencies were detected; however no implant loosening occurred. Revision surgery for implant loosening only occurred in the metal-backed glenoid component with hollow screw fixation; otherwise no complication due to implant loosening was detected.

The promising five-year results suggest that the concept of this stemless humeral head replacement might be an expedient alternative to existing shoulder replacements. Anatomical cutting of the humeral head and hollow screw fixation allow a familiar access to the glenoid combined with a shaft independent, less complex bone-sparing surgery along with shorter operating times and favourable revision situation.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) has been reported as gold standard for the treatment of advanced hallux rigidus and is a well-documented procedure. However, many patients demand a mobile MTPJ and therefore joint sparing procedures like MTPJ-arthroplasty have gained popularity. The aim of the present study was to present first mid-term results after hemiarthroplasty to treat advanced osteoarthritis of the first MTPJ.

Between April 2006 and October 2013, a total of 81 hemiprostheses (AnaToemic®, Arthrex) in 71 consecutive patients (44 females, 27 male, 10 bilateral; mean age, 58 [range, 45–82]) were implanted at the St. Vincent Hospital Vienna (Austria). The indication for surgery was persistent MTPJ pain after failed conservative treatment combined with radiologic evidence of osteoarthritis (advanced hallux rigidus grade II-IV). Patients were clinically examined using the American Orthopaedic Foot and Ankle Society (AOFAS) score before surgery and at the final follow-up visit. Patient's satisfaction with the treatment was recorded. Radiological results were evaluated using standard x-rays and revision surgeries were documented.

The mean preoperative AOFAS Scores significantly increased from 51 to 88 points after an average follow-up duration of 5 years (p<0.001). Most patients (76%) were either very satisfied or satisfied with the procedure. Radiological assessment showed some kind of radiolucencies on the base plate, whereas the stem of the prosthesis was well integrated in most of the cases; however clinical outcome was not affected by minor radiolucent lines on the base plate. In the majority of patients the implant was in situ at last follow-up. If revision surgery, due postoperative pain or implant loosening, was required; it occurred within 12 to 36 months.

According to our promising mid-term results with a MTPJ-hemiprostheses, we conclude that MTPJ-arthroplasty is an effective alternative treatment modality for anatomical reconstruction of the first MTPJ with the benefit to reduce pain and maintain mobility.

Introduction

Patient-specific instrumentation (PSI) is a contemporary method to optimize accuracy of alignment in total knee arthroplasty (TKA). As the potential benefits come at the cost of increased economic and logistic expenses, there is great scientific and practical interest in the actual advantages and reliability of such systems. Therefore, the purpose of the present study was to compare clinical results, radiological limb alignment, and three-dimensional (3D)-component positioning between conventional instrumentation (CVI) and a computed tomographic (CT)-based PSI in primary TKA.

Background

Tranexamic acid is an antifibrinolytic drug that has been shown to successfully reduce postoperative blood loss in total knee and hip arthroplasty. However, the efficacy of TXA following total shoulder arthroplasty has not been reported.

Background

The use of reverse total shoulder arthroplasty considerably increased since first introduced by Paul Grammont in the late 1980s. Over the past few years, results from several mid- and long-term clinical studies have demonstrated good functional outcomes and pain relief. However, several complications, especially inferior glenoid notching, and high revision rates were reported in the literature. Improvements in prosthesis design should contribute to a lower complication rate and lesser amount of glenoid erosion. Few studies have reported the clinical outcome andcomplications of Anatomical Shoulder Inverse/ Reverse Prosthesis. This study documents 2- and 6-year clinical and radiological results following reversed shoulder arthroplasty using this novel prosthesis.