Introduction: The restoration of the anatomical centre of rotation can be achieved in total shouder arthroplasty (TSA) using newly developed modular shoulder prosthesis (Promos), anchored with rectangled, non-cemented shaft. Especially patients with complex pathological destructions due to rheumatoid arthritis (RA) should benefit from this feature. So far it was not clear, whether the concept works in their poor bone stock too. The aim of this prospective study was to assess outcome and complication rate of patients with RA and Omarthrosis (OA) after TSA with Promos prosthesis.

Materials and Methods: All patients that received a TSA either due to OA or due to RA were prospectively recorded and evaluated 6 and 12 month after surgery. Functional outcome and quality of life was charged with a standardized scores set (DASH, Constant-Murley score, SPADI, ASES and SF-36, all normalized from 0=worst to 100=best) and compared with normative data as well as with data from a retrospective control, operated with an Aequalis prosthesis. Number and types of complications were recorded and the radiological findings evaluated from an independent observer.

Results: Although RA patients (n=8) did not reach the same functional results than OA patients (n=53) operated with Promos“ prostheses (DASH 78 in OA vs. 67.4 in RA, CS 74.3 in OA vs. 67.6 in RA) the difference between both indication groups was significantly smaller than for the Aequalis prosthesis (p< 0.001). Whereas RA patients after Promos“ prosthesis revealed functional deficits ranging from −6.7 in the Constant score, −10.6 in the DASH to −11.1 in the SPADI, this difference was larger in the Aequalis group with −16.4 in the Constant score, −25.2 in the DASH and −19.6 in the SPADI. Radiological findings and complication rate did not differ significantly.

Discussion: The newly developed modular design of the Promos prosthesis seems to offer better features to restore the complex anatomy, especially in RA patients. The required cementless shaft anchorage is not associated with a higher complication risk. Methodological issues limit the comparison of the two studies and the differences have to be proven in a prospective, comparative study therefore.

Introduction: In the evaluation of the major joints, self assessment tools have become wide spread aiming at a more precise quantification of joint function. Different tools have been developed for the elbow joint. However, there are only few data on the relationship between subjective self-assessment of joint function and objective measures.

We developed a comprehensive assessment set for the evaluation of subjective elbow function and objective clinical findings and investigate long-term results after implantation of GSB III Elbow arthroplasties in a first study. The PREE-G was cross-culturally adapted, following the recommendations of the American Association of Orthopedic Surgeons.

Material and Methods: 79 patients (56 female, 23 male, mean age 64 years) after elbow arthroplasty between 1984 and 1996 due to rheumatoid (59) or posttraumatic (20) arthritis underwent an assessment of the joint function using the PREE, the Short Form 36 (SF-36), the Disabilities of Arm, Shoulder, Hand (DASH)) and the modified American Shoulder and Elbow Surgeons (mASES) for a clinical evaluation. In 62 patients implantation was performed unilaterally and in 17 patients bilaterally, resulting in 96 elbow joints altogether. The mean follow up time was 11,2 years

Results: In the SF-36 score, the mean physical component scale (PCS) was worse (37,2 vs 41,7, p=0,004), the mean mental component scale (MCS) better (52,3 vs 50,3, p=0,092) than normative values of a German population. Subjective assessment by the PREE revealed a mean of 66,8, by the mASES of 63,1 and by the DASH of 56,5 points. Clinical examination resulted in a mean mASES score of 71,6 points. Comparison between the patients self assessment and the objective score revealed a significant correlation between the DASH (r=0,46, p< 0,001), PREE (p=0,54, p< 0,001) and mASES (r=0,60, p< 0,001) with the clinical mASES. In contrast, no significant correlation was found between the physical component scale (PCS) and mental component scale (MCS) of SF-36 and the clinical mASES. Also the patients assessment scores DASH, PREE and mASES showed a strong significant correlation among one another (r=0,74–0,92, p< 0,001) and (PCS) (r=0,58–0,75, p< 0,001) but not with the (MCS) of SF-36.

Conclusion: Assessment of long term results after elbow arthroplasty yielded favourable clinical and subjective results. The clinical outcome tended to be higher than results of the patient self-rated scores. Hereby, the newly developed assessment set proved to be a feasible tool for a comprehensive assessment of elbow function. In addition to clinical outcome assessment, with this set it is possible to gain important and new insights on the relationship between objective measures and subjective patients-assessment of elbow disorders and postoperative conditions.

Introduction Shoulder prosthesis of the third generation should allow a better restoration of the center of rotation in the replaced humeral head and a better adaptation to anatomical complex situations. Finally this should lead to an improved functional outcome compared with common types of prosthesis. We performed a retrospective study using the far most accepted scores to assess functional outcome and quality of lifer in order to compare our results with the clinical literature.

Materials and Methods 107 patients with a total of 111 prosthesis out of 127 patients were evaluated 3 to 4 years after implantation of a cemented prosthesis of the third generation (Aequalis″< caron> ) combined with a pegged Glenoid. The functional outcome was evaluated with the following scores: DASH, ASES, SPADI and Constant score (CS). Quality of life was rated using short form 36 (SF-36). Further data were recorded using a comorbidity self-assessment, a sociodemographic and a transition questionnaire. Patient data from SF-36, DASH and Constant Score were compared with normative data from age-, sex- and comorbidity corrected control groups. Paired, non-parametric testing was performed with the Wilcoxon-Test and Bonferroni correction. Radiographs were taken in three standard planes and the glenoid was evaluated according to Lazarus et al.

Results The Constant score at the time of follow up reached with 72±16 97% of the norm population. The subscore pain improved in average from 3 to 12 (maximum 15) and the subscore mobility from 14 to 32 (maximum 40).

Patients with primary arthrosis (n=44) and patients with posttraumatic arthrosis (n=39) had no functional deficits compared to the normal population in contrast to patients with RA (n=17). They showed significantly functional deficits (p< 0.001) in the DASH score as well as in the physical sum scale of the SF-36 (p=0.008). The majority of glenoids showed an incomplete lyses around one dowel (grade I in 70%). Less than 2% showed grade III or IV.

Discussion Implantation of a shoulder prosthesis of the third generation leads to good functional results compared with the control population. Functional and physical deficits remain in patients with an underlying RA. Glenoid loosening seems to be of minor concern. Our results prove the good clinical results that are reported in the literature, however they have to be proven with a longer follow-up.