This study aimed to assess the impact of using the metal-augmented glenoid baseplate (AGB) on improving clinical and radiological outcomes, as well as reducing complications, in patients with superior glenoid wear undergoing reverse shoulder arthroplasty (RSA). From January 2016 to June 2021, out of 235 patients who underwent primary RSA, 24 received a superior-AGB after off-axis reaming (Group A). Subsequently, we conducted propensity score matching in a 1:3 ratio, considering sex, age, follow-up duration, and glenoid wear (superior-inclination and retroversion), and selected 72 well-balanced matched patients who received a standard glenoid baseplate (STB) after eccentric reaming (Group B). Superior-inclination, retroversion, and lateral humeral offset (LHO) were measured to assess preoperative glenoid wear and postoperative correction, as well as to identify any complications. Clinical outcomes were measured at each outpatient visit before and after surgery.Aims
Methods
Reconstruction after osteoarticular resection of the proximal ulna for tumours is technically difficult and little has been written about the options that are available. We report a series of four patients who underwent radial neck to humeral trochlea transposition arthroplasty following proximal ulnar osteoarticular resection. Between July 2020 and July 2022, four patients with primary bone tumours of the ulna underwent radial neck to humeral trochlea transposition arthroplasty. Their mean age was 28 years (12 to 41). The functional outcome was assessed using the range of motion (ROM) of the elbow, rotation of the forearm and stability of the elbow, the Musculoskeletal Tumor Society score (MSTS), and the nine-item abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH-9) score.Aims
Methods
This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view.Aims
Methods
The aim of this study was to evaluate the kinematics of the elbow following increasing length of the radius with implantation of radial head arthroplasties (RHAs) using dynamic radiostereometry (dRSA). Eight human donor arms were examined by dRSA during motor-controlled flexion and extension of the elbow with the forearm in an unloaded neutral position, and in pronation and supination with and without a 10 N valgus or varus load, respectively. The elbows were examined before and after RHA with stem lengths of anatomical size, + 2 mm, and + 4 mm. The ligaments were maintained intact by using a step-cut lateral humeral epicondylar osteotomy, allowing the RHAs to be repeatedly exchanged. Bone models were obtained from CT scans, and specialized software was used to match these models with the dRSA recordings. The flexion kinematics of the elbow were described using anatomical coordinate systems to define translations and rotations with six degrees of freedom.Aims
Methods
Glenoid bone loss is a significant problem in the management of shoulder instability. The threshold at which the bone loss is considered “critical” requiring bony reconstruction has steadily dropped and is now approximately 15%. This necessitates accurate measurement in order that the correct operation is performed. CT scanning is the most commonly used modality and there are a number of techniques described to measure the bone loss however few have been validated. The aim of this study was to assess the accuracy of the most commonly used techniques for measuring glenoid bone loss on CT. Anatomically accurate models with known glenoid diameter and degree of bone loss were used to determine the mathematical and statistical accuracy of six of the most commonly described techniques (relative diameter, linear ipsilateral circle of best fit (COBF), linear contralateral COBF, Pico, Sugaya, and circle line methods). The models were prepared at 13.8%, 17.6%, and 22.9% bone loss. Sequential CT scans were taken and randomized. Blinded reviewers made repeated measurements using the different techniques with a threshold for theoretical bone grafting set at 15%.Aims
Methods
The survival of humeral hemiarthroplasties in patients with relatively intact glenoid cartilage could theoretically be extended by minimizing the associated postoperative glenoid erosion. Ceramic has gained attention as an alternative to metal as a material for hemiarthroplasties because of its superior tribological properties. The aim of this study was to assess the in vitro wear performance of ceramic and metal humeral hemiarthroplasties on natural glenoids. Intact right cadaveric shoulders from donors aged between 50 and 65 years were assigned to a ceramic group (n = 8, four male cadavers) and a metal group (n = 9, four male cadavers). A dedicated shoulder wear simulator was used to simulate daily activity by replicating the relevant joint motion and loading profiles. During testing, the joint was kept lubricated with diluted calf serum at room temperature. Each test of wear was performed for 500,000 cycles at 1.2 Hz. At intervals of 125,000 cycles, micro-CT scans of each glenoid were taken to characterize and quantify glenoid wear by calculating the change in the thickness of its articular cartilage.Aims
Methods
The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes. This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the Aims
Methods
Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided. This prospective study included 47 shoulders in 45 patients who underwent an open reconstruction of the rotator cuff using an interposition GraftJacket allograft to bridge irreparable cuff tears, between January 2007 and November 2011. The Oxford Shoulder Score (OSS), pain score, and range of motion (ROM) were recorded preoperatively and at one year and a mean of 9.1 years (7.0 to 12.5) postoperatively.Aims
Methods
The aim of this study was to compare the characteristics and outcomes of L-shaped and reverse L-shaped rotator cuff tears. A total of 82 shoulders (81 patients) after arthroscopic rotator cuff repair were retrospectively enrolled. The mean age of the patients was 62 years (SD 6), 33 shoulders (40.2%) were in male patients, and 57 shoulders (69.5%) were the right shoulder. Of these, 36 shoulders had an L-shaped tear (group L) and 46 had a reverse L-shaped tear (group RL). Both groups were compared regarding characteristics, pre- and postoperative pain, and functional outcomes. Muscle status was assessed by preoperative MRI, and re-tear rates by postoperative ultrasonography or MRI.Aims
Methods
Stemless humeral implants have been developed to overcome stem-related complications in total shoulder arthroplasty (TSA). However, stemless implant designs may hypothetically result in less stable initial fixation, potentially affecting long-term survival. The aim of this study is to investigate early fixation and migration patterns of the stemless humeral component of the Simpliciti Shoulder System and to evaluate clinical outcomes. In this prospective cohort study, radiostereometric analysis (RSA) radiographs were obtained in 24 patients at one day, six weeks, six months, one year, and two years postoperatively. Migration was calculated using model-based RSA. Clinical outcomes were evaluated using the visual analogue scale (VAS), the Oxford Shoulder Score (OSS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score.Aims
Methods
The use and variety of stemless humeral components in anatomical total shoulder arthroplasty (TSA) have proliferated since their advent in 2004. Early outcomes are reassuring but independent mid-term results are scarce. This independent study reports a consecutive series of 143 Eclipse stemless shoulder prostheses with a minimum five-year (5 to 10) follow-up. Outcomes of 143 procedures undertaken for all indications in 131 patients were reviewed, with subset analysis of those for osteoarthritis (OA) (n = 99). The primary outcome was the Oxford Shoulder Score (OSS) at a minimum of five years. Secondary outcomes were ranges of motion and radiological analysis of humeral radiolucency, rotator cuff failure, and glenoid loosening.Aims
Methods
The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial ligament “internal brace” reinforcement to treat irreparable massive rotator cuff tears, and report the preliminary results. This is a retrospective review of patients with irreparable massive rotator cuff tears undergoing fascia lata autograft bridging repair with artificial ligament “internal brace” reinforcement technique between January 2017 and May 2018. Inclusion criteria were: patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (dimension > 5 cm or two tendons fully torn), stage 0 to 4 supraspinatus fatty degeneration on MRI according to the Goutallier grading system, and an intact or reparable infraspinatus and/or subscapularis tendon of radiological classification Hamada 0 to 4. The surgical technique comprised two components: first, superior capsular reconstruction using an artificial ligament as an “internal brace” protective device for a fascia lata patch. The second was fascia lata autograft bridging repair for the torn supraspinatus. In all, 26 patients with a mean age 63.4 years (SD 6.2) were included.Aims
Methods
It has been hypothesized that proximal radial neck resorption (PRNR) following press-fit radial head arthroplasty (RHA) is due to stress-shielding. We compared two different press-fit stems by means of radiographs to investigate whether the shape and size of the stems are correlated with the degree of PRNR. The radiographs of 52 RHAs were analyzed both at 14 days postoperatively and after two years. A cylindrical stem and a conical stem were implanted in 22 patients (group 1) and 30 patients (group 2), respectively. The PRNR was measured in the four quadrants of the radial neck and the degree of stem filling was calculated by analyzing the ratio between the prosthetic stem diameter (PSD) and the medullary canal diameter (MCD) at the proximal portion of the stem (level A), halfway along the stem length (level B), and distally at the stem tip (level C).Aims
Methods
This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.Aims
Methods
Ultrasound (US)-guided injections are widely used in patients with conditions of the shoulder in order to improve their accuracy. However, the clinical efficacy of US-guided injections compared with blind injections remains controversial. The aim of this study was to compare the accuracy and efficacy of US-guided compared with blind corticosteroid injections into the glenohumeral joint in patients with primary frozen shoulder (FS). Intra-articular corticosteroid injections were administered to 90 patients primary FS, who were randomly assigned to either an US-guided (n = 45) or a blind technique (n = 45), by a shoulder specialist. Immediately after injection, fluoroscopic images were obtained to assess the accuracy of the injection. The outcome was assessed using a visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV) and range of movement (ROM) for all patients at the time of presentation and at three, six, and 12 weeks after injection.Aims
Methods
Despite recent advances in arthroscopic rotator cuff repair, re-tear rates remain high. New methods to improve healing rates following rotator cuff repair must be sought. Our primary objective was to determine if adjunctive bone marrow stimulation with channelling five to seven days prior to arthroscopic cuff repair would lead to higher Western Ontario Rotator Cuff (WORC) scores at 24 months postoperatively compared with no channelling. A prospective, randomized controlled trial was conducted in patients undergoing arthroscopic rotator cuff repair. Patients were randomized to receive either a percutaneous bone channelling of the rotator cuff footprint or a sham procedure under ultrasound guidance five to seven days prior to index surgery. Outcome measures included the WORC, American Shoulder and Elbow Surgeons (ASES), and Constant scores, strength, ultrasound-determined healing rates, and adverse events.Aims
Methods
The purpose of this study was to evaluate the cost of reverse shoulder arthroplasty (RSA) for patients with a proximal humerus fracture, using time-driven activity based costing (TDABC), and to compare treatment costs with reimbursement under the Healthcare Resource Groups (HRGs). TDABC analysis based on the principles outlined by Kaplan and a clinical pathway that has previously been validated for this institution was used. Staffing cost, consumables, implants, and overheads were updated to reflect 2019/2020 costs. This was compared with the HRG reimbursements.Aims
Methods
Conservative treatment of moderately displaced proximal humeral head fractures yields good clinical results, but secondary fragment displacement may occur. Identification of those fractures at risk of displacement may influence initial decision-making. A total of 163 shoulders in 162 patients with conservatively treated isolated proximal humeral fractures were included. The fractures occurred between January 2015 and May 2018. The mean age of the patients was 69 years (26 to 100) and the mean follow-up was 144 days (42 to 779). The fractures were classified according to Neer. Scores for osteoporosis (Tingart, Deltoid Tuberosity Index (DTI)) and osteoarthritis (OA) of the glenohumeral joint were assessed. Translation of the head on follow-up radiographs of more than 10 mm was defined as displacement. Eccentric head index (EHI) describes the offset of the humeral head centre in relation to the diaphyseal axis. The ratio was estimated on anteroposterior (AP) and Neer views. Medial hinge was considered intact if the medial cortex proximal and distal to the fracture was in line on AP view.Aims
Methods
Patient-specific instrumentation has been shown to increase a surgeon’s precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. A case-based survey presented surgeons with a patient’s history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts.Aims
Methods
Accurate measurement of the glenoid version is important in performing total shoulder arthroplasty (TSA). Our aim was to evaluate the Ellipse method, which involves formally defining the vertical mid-point of the glenoid prior to measuring the glenoid version and comparing it with the ‘classic’ Friedman method. This was a retrospective study which evaluated 100 CT scans for patients who underwent a primary TSA. The glenoid version was measured using the Friedman and Ellipse methods by two senior observers. Statistical analyses were performed using the paired Aims
Methods
The aim of this study was to compare the osseous reactions elicited by all-suture, polyetheretherketone (PEEK), and two different biodegradable anchors used during rotator cuff repair. Transosseous-equivalent rotator cuff repair was performed in 73 patients. The patients were divided into two groups, in both of which two different medial-row anchors were used. In group 1, anchor A comprised 30% β-tricalcium phosphate (TCP) + 70% fast-absorbing poly lactic-co-glycolic acid copolymer (85% polylactic acid enantiomers + 15% polyglycolic acid) and anchor B comprised all-sutures. In group 2, anchor C comprised 23% micro β-TCP + 77% polylactic acid enantiomers and anchor D comprised PEEK polymer. There were 37 patients in group 1 and 36 patients in group 2. The presence and severity of fluid collection around anchors and healing of the rotator cuff were assessed using MRI scans, approximately one year postoperatively. The severity of the collection was graded as 0 (no perianchor fluid signal), 1 (minimal perianchor fluid), 2 (local collection of fluid), 3 (fluid collection around the whole length of the anchor but of a diameter less than twice the anchor diameter), or 4 (fluid collection around the whole length of the anchor and of a diameter greater than twice the anchor diameter).Aims
Patients and Methods
Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA). A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4).Aims
Patients and Methods
Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure. In this prospective trial, 62 consecutive patients (14 women (23%), 48 men (77%); median age 61 years (interquartile range (IQR) 54 to 65)) with trauma-related FTRCT underwent arthroscopic single-row repair within six weeks of trauma. Tendon integrity was assessed one year after surgery using the Sugaya score on MR images. Patients were followed up with Western Ontario Rotator Cuff (WORC) index, EuroQol visual analogue scale (EQ VAS), and the Constant–Murley score (CS) two years after repair.Aims
Patients and Methods
The aim of this study was to evaluate two hypotheses. First,
that disruption of posterior bundle of the medial collateral ligament
(PMCL) has to occur for the elbow to subluxate in cases of posteromedial
rotatory instability (PMRI) and second, that ulnohumeral contact
pressures increase after disruption of the PMCL. Six human cadaveric elbows were prepared on a custom-designed
apparatus which allowed muscle loading and passive elbow motion
under gravitational varus. Joint contact pressures were measured
sequentially in the intact elbow (INTACT), followed by an anteromedial
subtype two coronoid fracture (COR), a lateral collateral ligament (LCL)
tear (COR + LCL), and a PMCL tear (COR + LCL + PMCL).Aims
Materials and Methods
Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair. Two finite element (FE) models were used to determine the risk of dislocation of the shoulder during 30 activities of daily living (ADLs) for the intact glenoid and after creating anterior osseous defects of increasing magnitudes. A Bankart repair was simulated for each size of defect, and the shoulder was tested under loading conditions that replicate Aims
Patients and Methods
Aims
Materials 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
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 analyse the effect of altered viewing
perspectives on the measurement of the glenopolar angle (GPA) and
the differences between these measurements made on 3D CT reconstructions
and anteroposterior (AP) scapular view radiographs. The influence of the viewing perspective on the GPA was assessed,
as were the differences in the measurements of the GPA between 3D
CT reconstructions and AP scapular view radiographs in 68 cadaveric
scapulae.Aims
Materials 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 eccentric glenosphere was principally introduced into reverse
shoulder arthroplasty to reduce the incidence of scapular notching.
There is only limited information about the influence of its design
on deltoid power and joint reaction forces. The aim of our study was to investigate how the diameter and
eccentricity of the glenosphere affect the biomechanics of the deltoid
and the resultant joint reaction forces. Different sizes of glenosphere and eccentricity were serially
tested in ten cadaveric shoulders using a custom shoulder movement
simulator.Aims
Methods
To prevent insufficiency of the triceps after
total elbow arthroplasty, we have, since 2008, used a triceps-sparing ulnar
approach. This study evaluates the clinical results and post-operative
alignment of the prosthesis using this approach. We reviewed 25 elbows in 23 patients. There were five men and
18 women with a mean age of 69 years (54 to 83). There were 18 elbows
with rheumatoid arthritis, six with a fracture or pseudoarthrosis
and one elbow with osteoarthritis. Post-operative complications included one intra-operative fracture,
one elbow with heterotopic ossification, one transient ulnar nerve
palsy, and one elbow with skin necrosis, but no elbow was affected
by insufficiency of the triceps. Patients were followed for a mean of 42 months (24 to 77). The
mean post-operative Japanese Orthopaedic Association Elbow Score
was 90.8 (51 to 100) and the mean Mayo Elbow Performance score 93.8
(65 to 100). The mean post-operative flexion/extension of the elbow
was 135°/-8°. The Manual Muscle Testing score of the triceps was
5 in 23 elbows and 2 in two elbows (one patient). The mean alignment
of the implants examined by 3D-CT was 2.8° pronation (standard deviation
( The triceps-sparing ulnar approach allows satisfactory alignment
of the implants, is effective in preventing post-operative triceps
insufficiency, and gives satisfactory short-term results. Cite this article: 2015;97-B:1096–1101.
We report our experience with glenohumeral arthrodesis
as a salvage procedure for epilepsy-related recurrent shoulder instability.
A total of six patients with epilepsy underwent shoulder fusion
for recurrent instability and were followed up for a mean of 39 months
(12 to 79). The mean age at the time of surgery was 31 years (22
to 38). Arthrodesis was performed after a mean of four previous
stabilisation attempts (0 to 11) in all but one patient in whom
the procedure was used as a primary treatment. All patients achieved
bony union, with a mean time to fusion of 2.8 months (2 to 7). There
were no cases of re-dislocation. One revision was undertaken for
loosening of the metalwork, and then healed satisfactorily. An increase
was noted in the mean subjective shoulder value, which improved
from 37 (5 to 50) pre-operatively to 42 (20 to 70) post-operatively
although it decreased in two patients. The mean Oxford shoulder
instability score improved from 13 pre-operatively (7 to 21) to
24 post-operatively (13 to 36). In our series, glenohumeral arthrodesis
eliminated recurrent instability and improved functional outcome. Fusion
surgery should therefore be considered in this patient population.
However, since the majority of patients are young and active, they
should be comprehensively counselled pre-operatively given the functional
deficit that results from the procedure. Cite this article:
We explored the trends over time and the geographical
variation in the use of subacromial decompression and rotator cuff
repair in 152 local health areas (Primary Care Trusts) across England.
The diagnostic and procedure codes of patients undergoing certain
elective shoulder operations between 2000/2001 and 2009/2010 were extracted
from the Hospital Episode Statistics database. They were grouped
as 1) subacromial decompression only, 2) subacromial decompression
with rotator cuff repair, and 3) rotator cuff repair only. The number of patients undergoing subacromial decompression alone
rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence
interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95%
CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked
in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably
in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)). Given the lack of evidence for the effectiveness of these operations
and the significant increase in the number of procedures being performed
in England and elsewhere, there is an urgent need for well-designed
clinical trials to determine evidence of clinical effectiveness. Cite this article: Bone Joint J 2014;96-B:70–4.
The glenopolar angle assesses the rotational
alignment of the glenoid and may provide prognostic information
and aid the management of scapula fractures. We have analysed the
effect of the anteroposterior (AP) shoulder radiograph rotational
offset on the glenopolar angle in a laboratory setting and used
this to assess the accuracy of shoulder imaging employed in routine
clinical practice. Fluoroscopic imaging was performed on 25 non-paired scapulae
tagged with 2 mm steel spheres to determine the orientation of true
AP views. The glenopolar angle was measured on all the bony specimens
rotated at 10° increments. The mean glenopolar angle measured on
the bone specimens in rotations between 0° and 20° and thereafter
was found to be significantly different (p <
0.001). We also obtained
the AP radiographs of the uninjured shoulder of 30 patients treated
for fractures at our centre and found that none fitted the criteria
of a true AP shoulder radiograph. The mean angular offset from the
true AP view was 38° (10° to 65°) for this cohort. Radiological
AP shoulder views may not fully project the normal anatomy of the scapular
body and the measured glenopolar angle. The absence of a true AP
view may compromise the clinical management of a scapular fracture. Cite this article:
