The liner design is a key determinant of the constraint of a reverse total shoulder arthroplasty (rTSA). The aim of this study was to compare the degree of constraint of rTSA liners between different implant systems. An implant company’s independent 3D shoulder arthroplasty planning software (mediCAD 3D shoulder v. 7.0, module v. 2.1.84.173.43) was used to determine the jump height of standard and constrained liners of different sizes (radius of curvature) of all available companies. The obtained parameters were used to calculate the stability ratio (degree of constraint) and angle of coverage (degree of glenosphere coverage by liner) of the different systems. Measurements were independently performed by two raters, and intraclass correlation coefficients were calculated to perform a reliability analysis. Additionally, measurements were compared with parameters provided by the companies themselves, when available, to ensure validity of the software-derived measurements.Aims
Methods
Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the National Joint Registry (NJR), which collects data from England, Wales, Northern Ireland, Isle of Man and the States of Guernsey. NJR shoulder arthroplasty records were linked to Hospital Episode Statistics and the National Mortality Register. TSA and HA performed for osteoarthritis (OA) in patients with an intact rotator cuff were included. Metal and ceramic humeral head prostheses were matched within separate TSA and HA groups using propensity scores based on 12 and 11 characteristics, respectively. The primary outcome was time to first revision and the secondary outcome was non-revision reoperation.Aims
Methods
Acute and chronic injuries of the interosseus membrane can result in longitudinal instability of the forearm. Reconstruction of the central band of the interosseus membrane can help to restore biomechanical stability. Different methods have been used to reconstruct the central band, including tendon grafts, bone-ligament-bone grafts, and synthetic grafts. This Idea, Development, Exploration, Assessment, and Long-term (IDEAL) phase 1 study aims to review the clinical results of reconstruction using a synthetic braided cross-linked graft secured at either end with an Endobutton to restore the force balance between the bones of the forearm. An independent retrospective review was conducted of a consecutive series of 21 patients with longitudinal instability injuries treated with anatomical central band reconstruction between February 2011 and July 2019. Patients with less than 12 months’ follow-up or who were treated acutely were excluded, leaving 18 patients in total. Preoperative clinical and radiological assessments were compared with prospectively gathered data using range of motion and the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) functional outcome score.Aims
Methods
The aim of this study was to analyze how proximal radial neck resorption (PRNR) starts and progresses radiologically in two types of press-fit radial head arthroplasties (RHAs), and to investigate its clinical relevance. A total of 97 patients with RHA were analyzed: 56 received a bipolar RHA (Group 1) while 41 received an anatomical implant (Group 2). Radiographs were performed postoperatively and after three, six, nine, and 12 weeks, six, nine, 12, 18, and 24 months, and annually thereafter. PRNR was measured in all radiographs in the four radial neck quadrants. The Mayo Elbow Performance Score (MEPS), the abbreviated version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the patient-assessed American Shoulder and Elbow Surgeons score - Elbow (pASES-E) were used for the clinical assessment. Radiological signs of implant loosening were investigated.Aims
Methods
The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration.Aims
Methods
Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (Aims
Patients and Methods
The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible.Aims
Patients and Methods
Improvements in the evaluation of outcomes following peripheral nerve injury are needed. Recent studies have identified muscle fatigue as an inevitable consequence of muscle reinnervation. This study aimed to quantify and characterize muscle fatigue within a standardized surgical model of muscle reinnervation. This retrospective cohort study included 12 patients who underwent Oberlin nerve transfer in an attempt to restore flexion of the elbow following brachial plexus injury. There were ten men and two women with a mean age of 45.5 years (27 to 69). The mean follow-up was 58 months (28 to 100). Repeated and sustained isometric contractions of the elbow flexors were used to assess fatigability of reinnervated muscle. The strength of elbow flexion was measured using a static dynamometer (KgF) and surface electromyography (sEMG). Recordings were used to quantify and characterize fatigability of the reinnervated elbow flexor muscles compared with the uninjured contralateral side.Aims
Patients and Methods
The aim of the study was to analyze the results of primary tendon
reinsertion in acute and chronic distal triceps tendon ruptures
(DTTRs) in the general population. A total of 28 patients were operated on for primary DTTR reinsertions,
including 21 male patients and seven female patients with a mean
age of 45 years (14 to 76). Of these patients, 23 sustained an acute
DTTR and five had a chronic injury. One patient had a non-simultaneous
bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture
or dislocation. Comorbidities were present in four patients. Surgical
treatment included transosseous and suture-anchors reinsertion in
22 and seven DTTRs, respectively. The clinical evaluation was performed
using Mayo Elbow Performance Score (MEPS), the modified American
Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities
of the Arm, Shoulder and Hand score (QuickDASH), and the Medical
Research Council (MRC) Scale.Aims
Patients and Methods
We report the clinical results of glenoid osteotomy in patients
with atraumatic posteroinferior instability associated with glenoid
dysplasia. The study reports results in 211 patients (249 shoulders) with
atraumatic posteroinferior instability. The patients comprised 63
men and 148 women with a mean age of 20 years. The posteroinferior
glenoid surface was elevated by osteotomy at the scapular neck.
A body spica was applied to maintain the arm perpendicular to the
glenoid for two weeks postoperatively. Clinical results were evaluated
using the Rowe score and Japan Shoulder Society Shoulder Instability
Score (JSS-SIS); bone union, osteoarthrosis, and articular congruity
were examined on plain radiographs.Aims
Patients 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
Improvements in the evaluation of outcome after nerve transfers
are required. The assessment of force using the Medical Research
Council (MRC) grades (0 to 5) is not suitable for this purpose.
A ceiling effect is encountered within MRC grade 4/5 rendering this
tool insensitive. Our aim was to show how the strength of flexion
of the elbow could be assessed in patients who have undergone a
re-innervation procedure using a continuous measurement scale. A total of 26 patients, 23 men and three women, with a mean age
of 37.3 years (16 to 66), at the time of presentation, attended
for review from a cohort of 52 patients who had undergone surgery
to restore flexion of the elbow after a brachial plexus injury and
were included in this retrospective study. The mean follow-up after
nerve transfer was 56 months (28 to 101, standard deviation (Aims
Methods
We report our experience of performing an elbow
hemiarthroplasty in the treatment of comminuted distal humeral fractures
in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72;
56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after
surgery. Functional outcome was measured with the Mayo Elbow Performance
Score (MEPS) and range of movement. The disabilities of the arm,
shoulder and hand questionnaire (DASH) was used as a patient rated
evaluation. Complications and ulnar nerve function were recorded.
Plain radiographs were obtained to assess prosthetic loosening,
olecranon wear and heterotopic bone formation. The mean extension deficit was 23.5° (0° to 60°) and mean flexion
was 126.8° (90° to 145°) giving a mean arc of 105.5° (60° to 145°).
The mean MEPS was 90 (50 to 100) and a mean DASH score of 20 (0
to 63). Four patients had additional surgery for limited range of
movement and one for partial instability. One elbow was revised
due to loosening, two patients had sensory ulnar nerve symptoms,
and radiographic signs of mild olecranon wear was noted in five
patients. Elbow hemiarthroplasty for comminuted intra-articular distal
humeral fractures produces reliable medium-term results with functional
outcome and complication rates, comparable with open reduction and
internal fixation and total elbow arthroplasty. Cite this article:
Patients with pain and loss of shoulder function
due to nonunion of a fracture of the proximal third of the humerus may
benefit from reverse total shoulder replacement. This paper reports
a prospective, multicentre study, involving three hospitals and
three surgeons, of 35 patients (28 women, seven men) with a mean
age of 69 years (46 to 83) who underwent a reverse total shoulder
replacement for the treatment of nonunion of a fracture of the proximal humerus.
Using Checchia’s classification, nine nonunions were type I, eight
as type II, 12 as type III and six as type IV. The mean follow-up
was 51 months (24 to 99). Post-operatively, the patients had a significant
decrease in pain (p <
0.001), and a significant improvement in
flexion, abduction, external rotation and Constant score (p <
0.001), but not in internal rotation. A total of nine complications
were recorded in seven patients: six dislocations, one glenoid loosening
in a patient who had previously suffered dislocation, one transitory
paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant
reduction in pain, improvement in function and a high degree of
satisfaction. However, the rate of complications, particularly dislocation,
was high. Cite this article:
Resurfacing of the humeral head is commonly used
within the UK to treat osteoarthritis (OA) of the shoulder. We present
the results of a small prospective randomised study of this procedure
using the Global CAP prosthesis with two different coatings, Porocoat
and DuoFix hydroxyapatite (HA). We followed two groups of ten patients
with OA of the shoulder for two years after insertion of the prosthesis
with tantalum marker beads, recording pain, Constant–Murley and
American Shoulder and Elbow Surgeons (ASES) outcome scores, and
using radiostereometric analysis to assess migration. The outcomes
were similar to those of other series, with significant reductions
in pain (p = 0.003) and an improvement in the Constant (p = 0.001)
and ASES scores (p = 0.006). The mean migration of the prosthesis
three months post-operatively was 0.78 mm (0.51 to 1.69) and 0.72
mm (0.33 to 1.45) for the Porocoat and DuoFix groups, respectively.
Analysis of variance indicated that the rate of migration reached
a plateau after three months post-operatively in both groups. At
follow-up of two years the mean migration was 1 mm ( The addition of a coating of HA to the sintered surface does
not improve fixation of this prosthesis. Cite this article:
We assessed the clinical results, radiographic
outcomes and complications of patients undergoing total shoulder replacement
(TSR) for osteoarthritis with concurrent repair of a full-thickness
rotator cuff tear. Between 1996 and 2010, 45 of 932 patients (4.8%)
undergoing TSR for osteoarthritis underwent rotator cuff repair.
The final study group comprised 33 patients with a mean follow-up
of 4.7 years (3 months to 13 years). Tears were classified into small
(10), medium (14), large (9) or massive (0). On a scale of 1 to
5, pain decreased from a mean of 4.7 to 1.7 (p = <
0.0001), the
mean forward elevation improved from 99° to 139° (p = <
0.0001),
and the mean external rotation improved from 20° (0° to 75°) to
49° (20° to 80°) (p = <
0.0001). The improvement in elevation
was greater in those with a small tear (p = 0.03). Radiographic
evidence of instability developed in six patients with medium or
large tears, indicating lack of rotator cuff healing. In all, six
glenoid components, including one with instability, were radiologically
at risk of loosening. Complications were noted in five patients,
all with medium or large tears; four of these had symptomatic instability
and one sustained a late peri-prosthetic fracture. Four patients
(12%) required further surgery, three with instability and one with
a peri-prosthetic humeral fracture. Consideration should be given to performing rotator cuff repair
for stable shoulders during anatomical TSR, but reverse replacement
should be considered for older, less active patients with larger
tears. Cite this article:
We have compared three different methods of treating
symptomatic non-traumatic tears of the supraspinatus tendon in patients
above 55 years of age. A total of 180 shoulders (173 patients) with
supraspinatus tendon tears were randomly allocated into one of three
groups (each of 60 shoulders); physiotherapy (group 1), acromioplasty and
physiotherapy (group 2) and rotator cuff repair, acromioplasty and
physiotherapy (group 3). The Constant score was assessed and followed
up by an independent observer pre-operatively and at three, six
and twelve months after the intervention. Of these, 167 shoulders were available for assessment at one
year (follow-up rate of 92.8%). There were 55 shoulders in group
1 (24 in males and 31 in females, mean age 65 years (55 to 79)),
57 in group 2 (29 male and 28 female, mean age 65 years (55 to 79))
and 55 shoulders in group 3 (26 male and 29 female, mean age 65
years (55 to 81)). There were no between-group differences in the
Constant score at final follow-up: 74.1 ( Cite this article:
Treatment of an infected total elbow replacement
(TER) is often successful in eradicating or suppressing the infection.
However, the extensor mechanism may be compromised by both the infection
and the surgery. The goal of this study was to assess triceps function
in patients treated for deep infection complicating a TER. Between
1976 and 2007 a total of 217 TERs in 207 patients were treated for
infection of a TER at our institution. Superficial infections and
those that underwent resection arthroplasty were excluded, leaving
93 TERs. Triceps function was assessed by examination and a questionnaire.
Outcome was measured using the Mayo Elbow Performance Score (MEPS). Triceps weakness was identified in 51 TERs (49 patients, 55%).
At a mean follow-up of five years (0.8 to 34), the extensor mechanism
was intact in 13 patients, with the remaining 38 having bone or
soft-tissue loss. The mean MEPS was 70 points (5 to 100), with a
mean functional score of 18 (0 to 25) of a possible 25 points. Infection following TER can often be eradicated; however, triceps
weakness occurs in more than half of the patients and may represent
a major functional problem. Cite this article:
