Since long-term outcome of teres major tendon transfer surgery
for irreparable posterosuperior rotator cuff (RC) tears is largely
unknown, the primary aim of this study was to evaluate the long-term
outcome of the teres major transfer. We also aimed to report on
the results of a cohort of patients with a similar indication for
surgery that underwent a latissimus dorsi tendon transfer. In this prospective cohort study, we reported on the long-term
results of 20 consecutive patients with a teres major tendon transfer
for irreparable massive posterosuperior RC tears. Additionally,
we reported on the results of the latissimus dorsi tendon transfer
(n = 19). The mean age was 60 years (47 to 77). Outcomes included
the Constant score (CS), and pain at rest and during movement using
the Visual Analogue Scale (VAS).Aims
Patients and Methods
The aim of this retrospective multicentre study was to evaluate
mid-term results of the operative treatment of Monteggia-like lesions
and to determine the prognostic factors that influence the clinical
and radiological outcome. A total of 46 patients (27 women and 19 men), with a mean age
of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion
were followed up clinically and radiologically after surgical treatment.
The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score
(MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder
and Hand (DASH) score were used for evaluation at a mean of 65 months
(27 to 111) postoperatively. All ulnar fractures were stabilized
using a proximally contoured or precontoured locking compression
plate. Mason type I fractures of the radial head were treated conservatively, type
II fractures were treated with reconstruction, and type III fractures
with arthroplasty. All Morrey type II and III fractures of the coronoid
process was stabilized using lag screws.Aims
Patients and Methods
We conducted a study to identify factors that are prognostic
of the outcome of extracorporeal shockwave therapy (ESWT) for calcific
tendinitis of the shoulder. Since 1998, patients with symptomatic calcific tendinitis of
the rotator cuff have been treated with ESWT using an electrohydraulic
mode shockwave device. One year after ESWT, patients were grouped
according to the level of resorption of calcification.Aims
Patients and Methods
To determine the incidence and timing of post-operative fevers
following shoulder arthroplasty and the resulting investigations
performed. A retrospective review was conducted of all patients undergoing
shoulder arthroplasty over a nine-year period. The charts of all
patients with a post-operative fever (≥ 38.6°C) were reviewed and
the results of all investigations were analysed.Aims
Patients and Methods
The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma. A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus.Objectives
Methods
Radial head arthroplasty (RHA) may be used in the treatment of
non-reconstructable radial head fractures. The aim of this study
was to evaluate the mid-term clinical and radiographic results of
RHA. Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23
women with either acute injuries (54) or with traumatic sequelae
(23) of a fracture of the radial head. Four designs of RHA were
used, including the Guepar (Small Bone Innovations (SBi)/Stryker;
36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten)
or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up
was 74.0 months (standard deviation (Aims
Patients and Methods
Few studies have evaluated the relationship between patients’
pre-operative expectations and the outcome of orthopaedic procedures.
Our aim was to determine the effect of expectations on the outcome
after primary anatomical total shoulder arthroplasty (TSA). We hypothesised
that patients with greater expectations would have better outcomes. Patients undergoing primary anatomical TSA completed the Hospital
for Special Surgery’s Shoulder Expectations Survey pre-operatively.
The American Shoulder and Elbow Surgeons (ASES), Shoulder Activity
Scale (SAS), Short-Form-36 (SF-36), and visual analogue scale (VAS)
for pain, fatigue, and general health scores were also collected
pre-operatively and two years post-operatively. Pearson correlations
were used to assess the relationship between the number of expectations
and the outcomes. Differences in outcomes between those with higher
and lower levels of expectations for each expectation were assessed
by independent samples Aims
Patients and Methods
Our aim was to investigate the prevalence of A total of 46 patients undergoing either an arthroscopic capsular
release or stabilisation had biopsies taken from the subcutaneous
fat and capsule of the shoulder at the time of surgery. These samples
were sent for culture in enrichment, and also for Nucleic Acid Amplification
testing. The prevalence of Aims
Patients and Methods
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. A randomised, placebo-controlled trial which included 54 patients
undergoing unilateral primary stemless anatomical or stemmed reverse
total shoulder arthroplasty was undertaken. Patients received either
100 ml saline (placebo, n = 27), or 100 ml saline together with
1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to
skin incision and during wound closure. Peri-operative blood loss
via an intra-articular drain was recorded and total blood loss was
calculated. The post-operative transfusion rate was documented.
Assessment of early clinical parameters included the visual analogue
scale for pain (VAS), documentation of haematoma formation and adverse events.Aims
Patients and Methods
The aim of the present study was to compare the 30- and 90-day
re-admission rates and complication rates of outpatient and inpatient
total shoulder arthroplasty (TSA). The United States Medicare Standard Analytical Files database
was questioned to identify patients who had undergone outpatient
or inpatient TSA between 2005 and 2012. Patient characteristics
were compared between the two groups using chi-squared analysis. Multivariate
logistic regression analysis was used to control for differences
in baseline patient characteristics and to compare the two groups
in terms of post-operative complications within 90 days and re-admission
within 30 days and 90 days.Aims
Patients and Methods
Promising medium-term results from total shoulder arthroplasty
(TSA) have been reported for the treatment of primary osteoarthritis
in young and middle-aged patients. The aim of this study was to
evaluate the long-term functional and radiological outcome of TSA
in the middle-aged patient. The data of all patients from the previous medium-term study
were available. At a mean follow-up of 13 years (8 to 17), we reviewed
21 patients (12 men, nine women, 21 shoulders) with a mean age of
55 years (37 to 60). The Constant-Murley score (CS) with its subgroups
and subjective satisfaction were measured. Radiological signs of implant
loosening were analysed.Aims
Patients and Methods
Restoring the pre-morbid anatomy of the proximal humerus is a
goal of anatomical shoulder arthroplasty, but reliance is placed
on the surgeon’s experience and on anatomical estimations. The purpose
of this study was to present a novel method, ‘Statistical Shape
Modelling’, which accurately predicts the pre-morbid proximal humeral anatomy
and calculates the 3D geometric parameters needed to restore normal
anatomy in patients with severe degenerative osteoarthritis or a
fracture of the proximal humerus. From a database of 57 humeral CT scans 3D humeral reconstructions
were manually created. The reconstructions were used to construct
a statistical shape model (SSM), which was then tested on a second
set of 52 scans. For each humerus in the second set, 3D reconstructions
of four diaphyseal segments of varying lengths were created. These
reconstructions were chosen to mimic severe osteoarthritis, a fracture
of the surgical neck of the humerus and a proximal humeral fracture
with diaphyseal extension. The SSM was then applied to the diaphyseal
segments to see how well it predicted proximal morphology, using
the actual proximal humeral morphology for comparison.Aims
Materials and Methods
Rotator cuff tendinopathy has a multifactorial origin. Rejecting
the mechanistic theory has also led to abandoning operative treatment
at initial presentation in the first line. Physiotherapy exercise
programmes are the accepted first line treatment. The aim of this
study was to assess the long-term additional benefits of subacromial decompression
in the treatment of rotator cuff tendinopathy. This randomised controlled trial of 140 patients (52 men, 88
women, mean age 47.1 years; 18 to 60) with rotator cuff tendinopathy
extended previous work up to a maximum of 13 years. The patients
were randomised into two treatment groups: arthroscopic acromioplasty
and a supervised exercise treatment and a similar supervised exercise
treatment alone. Self-reported pain on a visual analogue scale (VAS)
was the primary outcome measure. Secondary measures were disability,
working ability, pain at night, Shoulder Disability Questionnaire
score and the number of painful days during the three months preceding
the final assessment.Aims
Patients and Methods
Manipulation under anaesthetic (MUA) is a recognised form of
treatment for patients with a frozen shoulder. However, not all
patients benefit. Some have persistent or recurrent symptoms. There
are no clear recommendations in the literature on the optimal management
of recurrent frozen shoulder after a MUA. We aimed to address this
issue in this study. We analysed a prospectively collected, single-surgeon, consecutive
series of patients who underwent MUA for frozen shoulder between
January 1999 and December 2015. The Oxford Shoulder Scores (OSS)
and range of movement were the outcome measures. Aims
Patients and Methods
We assessed the long-term (more than ten-year) outcomes of the
Kudo type-5 elbow prosthesis in patients with rheumatoid arthritis
(RA). We reviewed 41 elbows (Larsen Grade IV, n = 21; Grade V, n =
20) in 31 patients with RA who had undergone a Kudo type-5 total
elbow arthroplasty (TEA) between 1994 and 2003, and had been followed
up for more than ten years. The humeral component was cementless
and the all-polyethylene ulnar component cemented in every patient. Clinical
outcome was assessed using the Mayo elbow performance score. We
calculated the revision rate and evaluated potential risk factors
for revision. The duration of follow-up was a mean 141 months (120
to 203).Aims
Materials and Methods
The aim of this study was to assess hypertrophy of the extra-articular
tendon of the long head of biceps (LHB) in patients with a rotator
cuff tear. The study involved 638 shoulders in 334 patients (175 men, 159
women, mean age 62.6 years; 25 to 81) with unilateral symptomatic
rotator cuff tears. The cross-sectional area (CSA) of the LHB tendon
in the bicipital groove was measured pre-operatively in both shoulders
using ultrasound. There were 154 asymptomatic rotator cuff tears
in the contralateral shoulder. Comparisons were made between those
with a symptomatic tear, an asymptomatic tear and those with no
rotator cuff tear. In the affected shoulders, the CSAs were compared
in relation to the location and size of the rotator cuff tear. Aims
Patients and Methods
In the initial development of total shoulder arthroplasty (TSA),
the humeral component was usually fixed with cement. Cementless
components were subsequently introduced. The aim of this study was
to compare the long-term outcome of cemented and cementless humeral
components in arthroplasty of the shoulder. All patients who underwent primary arthroplasty of the shoulder
at our institution between 1970 and 2012 were included in the study.
There were 4636 patients with 1167 cemented humeral components and
3469 cementless components. Patients with the two types of fixation
were matched for nine different covariates using a propensity score
analysis. A total of 551 well-balanced pairs of patients with cemented
and cementless components were available after matching for comparison
of the outcomes. The clinical outcomes which were analysed included loosening
of the humeral component determined at revision surgery, periprosthetic
fractures, post-operative infection and operating time.Aims
Patients and Methods
Radiostereometric analysis (RSA) allows an extremely accurate
measurement of early micromotion of components following arthroplasty. In this study, RSA was used to measure the migration of 11 partially
cemented fluted pegged glenoid components in patients with osteoarthritis
who underwent total shoulder arthroplasty using an improved surgical
technique (seven men, four women, mean age 68). Patients were evaluated
clinically using the American Shoulder and Elbow Surgeons (ASES)
and Constant-Murley scores and by CT scans two years post-operatively. Aims
Patients and Methods
Advances in arthroscopic techniques for rotator cuff repair have
made the mini-open approach less popular. However, the mini-open
approach remains an important technique for repair for many surgeons.
The aims of this study were to compare the integrity of the repair,
the function of the shoulder and satisfaction post-operatively using
these two techniques in patients aged >
50 years. We identified 22 patients treated with mini-open and 128 patients
treated with arthroscopic rotator cuff repair of July 2007 and June
2011. The mean follow-up was two years (1 to 5). Outcome was assessed
using the American Shoulder and Elbow Surgeons (ASES) and Simple
Shoulder Test (SST) scores, and satisfaction. The integrity of the repair
was assessed using ultrasonography. A power analysis ensured sufficient
enrolment.Aims
Patients and Methods
The appropriate management for patients with a degenerative tear
of the rotator cuff remains controversial, but operative treatment,
particularly arthroscopic surgery, is increasingly being used. Our
aim in this paper was to compare the effectiveness of arthroscopic
with open repair of the rotator cuff. A total of 273 patients were recruited to a randomised comparison
trial (136 to arthroscopic surgery and 137 to open surgery) from
19 teaching and general hospitals in the United Kingdom. The surgeons
used their usual preferred method of repair. The Oxford Shoulder
Score (OSS), two years post-operatively, was the primary outcome
measure. Imaging of the shoulder was performed at one year after
surgery. The trial is registered with Current Controlled Trials,
ISRCTN97804283.Aims
Patients and Methods