We present the medium-term clinical results of a reverse total
shoulder arthroplasty with a trabecular metal glenoid base plate. We reviewed 125 consecutive primary reverse total shoulder arthroplasties
(RTSA) implanted in 124 patients for rotator cuff arthropathy. There
were 100 women and 24 men in the study group with a mean age of
76 years (58 to 89). The mean follow-up was 32 months (24 to 60).
No patient was lost to follow-up.Aim
Patients and Methods
Medium-term results of the Discovery elbow replacement
are presented. We reviewed 51 consecutive primary Discovery total
elbow replacements (TERs) implanted in 48 patients. The mean age
of the patients was 69.2 years (49 to 92), there were 19 males and
32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69).
A total of six patients were lost to follow-up. Statistically significant
improvements in range movement and Oxford Elbow Score were found
(p <
0.001). Radiolucent lines were much more common in, and
aseptic loosening was exclusive to, the humeral component. Kaplan–Meier
survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for
aseptic loosening. In four TERs, periprosthetic infection occurred
resulting in failure. A statistically significant association between
infection and increased BMI was found (p = 0.0268). Triceps failure
was more frequent after the Mayo surgical approach and TER performed
after previous trauma surgery. No failures of the implant were noted. Our comparison shows that the Discovery has early clinical results
that are similar to other semi-constrained TERs. We found continued
radiological surveillance with particular focus on humeral lucency
is warranted and has not previously been reported. Despite advances
in the design of total elbow replacement prostheses, rates of complication
remain high. Cite this article:
The response of articular cartilage in joint dislocation is not well documented. We have previously demonstrated that the rate of chondrocyte apoptosis increased with duration of joint dislocation with a significant increase after 1 hour. The purpose of our study was to determine if early joint reduction reduced the rate of chondrocyte apoptosis. Southern Health animal ethics approval was obtained. 36 Sprague-Dawley rats underwent surgical dislocation of the left hip and the hip was reduced after 1, 2 or 4 hours. The rats were then killed at 1 or 8 weeks. Histological assessment of the femoral heads was performed with H+E and TUNEL stain to determine if the apoptotic index (proportion of apoptotic cells present per high magnification field (X 400)) alter after joint reduction in the short to medium term. The mean apoptotic index in the non traumatized right hip was 0.044 ± 0.031 (control). After joint reduction of 1 week the mean apoptotic indices were 0.069 ± 0.023 (1 hr), 0.064 ± 0.031 (2 hr) and 0.138 ± 0.060 (4 hrs). After joint reduction of 8 weeks the mean apoptotic indices were 0.062 ± 0.028 (1 hr), 0.108 ± 0.109 (2 hrs) and 0.135 ± 0.035 (4 hrs). Our results suggests that joint reduction within 1 hour prevents worsening of apoptotic index and that there is a population of delayed apoptosis if the joint is left dislocated for 2 hours. The apoptotic index does not recover after 8 weeks.
