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The Bone & Joint Journal
Vol. 98-B, Issue 7 | Pages 969 - 975
1 Jul 2016
Theivendran K Varghese M Large R Bateman M Morgan M Tambe A Espag M Cresswell T Clark DI

Aim

We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate.

Patients and Methods

We reviewed 125 consecutive primary reverse total shoulder arthroplasties (RTSA) implanted in 124 patients for rotator cuff arthropathy. There were 100 women and 24 men in the study group with a mean age of 76 years (58 to 89). The mean follow-up was 32 months (24 to 60). No patient was lost to follow-up.


The Bone & Joint Journal
Vol. 96-B, Issue 10 | Pages 1359 - 1365
1 Oct 2014
Large R Tambe A Cresswell T Espag M Clark DI

Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan–Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted.

Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.

Cite this article: Bone Joint J 2014;96-B:1359–65


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 204 - 204
1 Mar 2010
Large R Solaiman R Tham S
Full Access

The response of articular cartilage in joint dislocation is not well documented. We have previously demonstrated that the rate of chondrocyte apoptosis increased with duration of joint dislocation with a significant increase after 1 hour. The purpose of our study was to determine if early joint reduction reduced the rate of chondrocyte apoptosis.

Southern Health animal ethics approval was obtained. 36 Sprague-Dawley rats underwent surgical dislocation of the left hip and the hip was reduced after 1, 2 or 4 hours. The rats were then killed at 1 or 8 weeks. Histological assessment of the femoral heads was performed with H+E and TUNEL stain to determine if the apoptotic index (proportion of apoptotic cells present per high magnification field (X 400)) alter after joint reduction in the short to medium term.

The mean apoptotic index in the non traumatized right hip was 0.044 ± 0.031 (control). After joint reduction of 1 week the mean apoptotic indices were 0.069 ± 0.023 (1 hr), 0.064 ± 0.031 (2 hr) and 0.138 ± 0.060 (4 hrs). After joint reduction of 8 weeks the mean apoptotic indices were 0.062 ± 0.028 (1 hr), 0.108 ± 0.109 (2 hrs) and 0.135 ± 0.035 (4 hrs).

Our results suggests that joint reduction within 1 hour prevents worsening of apoptotic index and that there is a population of delayed apoptosis if the joint is left dislocated for 2 hours. The apoptotic index does not recover after 8 weeks.