There is little information about the management
of peri-prosthetic fracture of the humerus after total shoulder replacement
(TSR). This is a retrospective review of 22 patients who underwent
a revision of their original shoulder replacement for peri-prosthetic
fracture of the humerus with bone loss and/or loose components.
There were 20 women and two men with a mean age of 75 years (61
to 90) and a mean follow-up 42 months (12 to 91): 16 of these had
undergone a previous revision TSR. Of the 22 patients, 12 were treated
with a long-stemmed humeral component that bypassed the fracture.
All their fractures united after a mean of 27 weeks (13 to 94).
Eight patients underwent resection of the proximal humerus with
endoprosthetic
We prospectively reviewed 14 patients with deficiency of the proximal pole of the scaphoid who were treated by rib osteochondral
Between 1996 and 2008, nine patients with severe post-traumatic arthritis underwent revision of a failed interposition
The aim of this study was to compare a third-generation
cementing procedure for glenoid components with a new technique
for cement pressurisation. In 20 pairs of scapulae, 20 keeled and
20 pegged glenoid components were implanted using either a third-generation
cementing technique (group 1) or a new pressuriser (group 2). Cement penetration
was measured by three-dimensional (3D) analysis of micro-CT scans.
The mean 3D depth of penetration of the cement was significantly
greater in group 2 (p <
0.001). The mean thickness of the cement
mantle for keeled glenoids was 2.50 mm (2.0 to 3.3) in group 1 and
5.18 mm (4.4 to 6.1) in group 2, and for pegged glenoids it was 1.72 mm
(0.9 to 2.3) in group 1 and 5.63 mm (3.6 to 6.4) in group 2. A cement
mantle <
2 mm was detected less frequently in group 2 (p <
0.001). Using the cement pressuriser the proportion of cement mantles
<
2 mm was significantly reduced compared with the third-generation
cementing technique.
We treated 43 patients (38 women and 5 men) with osteoarthritis of the basal joint of the thumb by non-cemented
Between 1976 and 2004, 38 revision arthroplasties (35 patients) were performed for aseptic loosening of the humeral component. The mean interval from primary
Advanced osteoarthritis of the wrist or the distal articulation of the lunate with the capitate has traditionally been treated surgically by arthrodesis. In order to maintain movement, we performed proximal row carpectomy with capsular interposition
Between 1986 and 1994, 13 patients with mobile painful arthritic elbows were treated by distraction interposition
The Motec cementless modular metal-on-metal ball-and-socket
wrist
We performed 88 primary ball-and-socket
We have performed a form of lunate
We have examined the relief from pain and the functional outcome in 18 patients who underwent resection
We reviewed the records and radiographs of 381 patients with rheumatoid arthritis who had undergone silastic metacarpophalangeal joint
Between 1990 and 1996 we performed 20 consecutive ulnohumeral
We have undertaken a prospective clinical and radiological analysis of 124 shoulder arthroplasties (113 patients) carried out for osteoarthritis. The clinical results showed improvement in the absolute Constant score and the American Shoulder and Elbow Surgeons score of 22 and 43, respectively. Both were statistically significant (p <
0.001). There was no significant difference in the scores after hemiarthroplasty and total arthroplasty in those patients with an intact rotator cuff. When revision was used as the end-point for survival at ten years, survival of 86%, or 90% if glenoid components made of Hylamer sterilised in air were omitted, was obtained in primary osteoarthritis. The most common cause for revision in the hemiarthroplasty group was glenoid pain at a mean of 1.5 years; in the total arthroplasty group it was loosening of the glenoid at a mean of 4.5 years. Analysis of pre-operative factors showed that the risk of gross loosening of the glenoid increased threefold when there was evidence of erosion of the glenoid at operation. Shoulder arthroplasty should not be delayed once symptomatic osteoarthritis has been established and should be undertaken before failure of the cuff or erosion of the glenoid are present.
We present six patients with chronic dislocation of the elbow who were treated by primary semiconstrained total elbow arthroplasty. All were women with a mean age of 65 years (51 to 76), the mean interval between dislocation and surgery was 17 weeks (5 to 52) and the mean follow-up 58 months (24 to 123). The most dramatic improvement was in function. The mean American Shoulder and Elbow Surgeon score was 5.2 times better (p <
0.001) and the mean total range of movement increased from 33° to 121° (p <
0.001) after operation. Three patients developed wear of polyethylene. One required revision for a periprosthetic fracture, and another required a bushing exchange. Primary semiconstrained elbow arthroplasty provides significant, predictable functional improvement. Potential solutions for wear of polyethylene include a different operative technique or design of implant. Despite the high incidence of such wear, total elbow arthroplasty should be considered as a viable treatment option for chronic dislocation of the elbow in elderly patients.
This study aimed to define the histopathology of degenerated humeral head cartilage and synovial inflammation of the glenohumeral joint in patients with omarthrosis (OmA) and cuff tear arthropathy (CTA). Additionally, the potential of immunohistochemical tissue biomarkers in reflecting the degeneration status of humeral head cartilage was evaluated. Specimens of the humeral head and synovial tissue from 12 patients with OmA, seven patients with CTA, and four body donors were processed histologically for examination using different histopathological scores. Osteochondral sections were immunohistochemically stained for collagen type I, collagen type II, collagen neoepitope C1,2C, collagen type X, and osteocalcin, prior to semiquantitative analysis. Matrix metalloproteinase (MMP)-1, MMP-3, and MMP-13 levels were analyzed in synovial fluid using enzyme-linked immunosorbent assay (ELISA).Aims
Methods
The optimal choice of management for proximal humerus fractures (PHFs) has been increasingly discussed in the literature, and this work aimed to answer the following questions: 1) what are the incidence rates of PHF in the geriatric population in the USA; 2) what is the mortality rate after PHF in the elderly population, specifically for distinct treatment procedures; and 3) what factors influence the mortality rate? PHFs occurring between 1 January 2009 and 31 December 2019 were identified from the Medicare physician service records. Incidence rates were determined, mortality rates were calculated, and semiparametric Cox regression was applied, incorporating 23 demographic, clinical, and socioeconomic covariates, to compare the mortality risk between treatments.Aims
Methods
We systematically reviewed all the evidence published
in the English language on proximal interphalangeal joint (PIPJ)
replacement, to determine its effectiveness on the function of the
hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome
with a minimum of one year’s follow-up. Quality was assessed using
the Cowley systematic review criteria modified for finger-joint
replacements. Of 319 articles identified, only five were adequately
reported according to our quality criteria; there were no randomised
controlled trials. PIPJ
There are few reports in the literature of the diagnosis and treatment of the infected shoulder arthroplasty. Most deal with resection