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.
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.
Achilles tenotomy is a recognised step in the Ponseti technique for the correction of idiopathic congenital talipes equinovarus in most percutaneous cases. Its use has been limited in part by concern that the subsequent natural history of the tendon is unknown. In a study of 11 tendons in eight infants, eight tendons were shown to be clinically intact and ten had ultrasonographic evidence of continuity three weeks after tenotomy. At six weeks after tenotomy all tendons had both clinical and ultrasonographic evidence of continuity.
