The purpose of this study was to compare implant survivorship and functional outcomes in patients undergoing reverse total shoulder arthroplasty (RTSA) for acute proximal humeral fracture (PHF) with those undergoing elective RTSA in a population-based cohort study. Prospectively collected data from the New Zealand Joint Registry from 1999 to 2021 and identified 7,277 patients who underwent RTSA. Patients were categorized by pre-operative indication, including acute PHF (10.1%), rotator cuff arthropathy (RCA) (41.9%), osteoarthritis (OA) (32.2%), rheumatoid arthritis (RA) (5.2%) and old traumatic sequelae (4.9%). The PHF group was compared with elective indications based on patient, implant, and operative characteristics, as well as post-operative outcomes (Oxford Shoulder Score [OSS], and revision rate) at 6 months, 5 and 10 years after surgery. Survival and functional outcome analyses were adjusted by age, sex, ASA class and surgeon experience.Introduction
Methods
The purpose of this report was to describe a new arthroscopic finding in anterior cruciate ligament rupture: the presence of osteochondral injury beneath the posterior horn of the lateral meniscus. A single surgeon performed arthroscopic evaluation of 43 consecutive patients with ACL rupture within 12 months of injury. Nine patients (21 %) had a chondral lesion of the posterolateral tibia beneath the posterior horn of the lateral meniscus, not seen unless the meniscus was elevated with the arthroscopic probe. On four occasions a chondral loose body was identified and removed. Seven of the nine (78%) had an associated lateral meniscal tear and four (44 %) a chondral lesion of the lateral femoral condyle. MRI was not accurate in predicting the presence of a chondral lesion in those patients with a lesion that had an MRI preoperatively. We report a new arthroscopic finding in ACL rupture not previously mentioned in the literature. The clinical significance is that when chondral loose bodies are encountered of unknown origin, arthroscopic evaluation of the area beneath the posterior horn of the lateral meniscus should be involved in any systematic search for the lesion.
The purpose of the study was to undertake a radiological and clinical comparison of uncemented tibial base-plate fixation with porous or hydroxyapatite coating. Knees were examined radiologically according to Knee Society Guidelines with image intensifier screening and spot films to highlight the bone prosthesis interface. Clinical assessment was performed using the Knee Society Clinical Rating. Hydroxyapatite components were found to have significantly less radiolucent lines than porous coated. Seventy three percent of hydroxyapatite baseplates versus 28% of porous coated baseplates showed no radiolucent lines. All lucent lines in both groups appeared stable with a sclerotic margin and did not appear to be progressive or associated with component loosening. No knees showed any radiolucent lines around the stem in either group. Clinical assessment showed no significant difference between hydroxyapatite and porous coated components. If cementless fixation is to be utilised on the tibial side in knee replacement advantage should be taken of hydroxyapatite augmentation of the component.
