There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.Aims
Methods
Rotator cuff disease (RCD) can considerably decrease quality of life. Here, we investigated whether health-related quality of life (HRQoL) influences the need for surgery in patients with RCD. We performed an analysis of 417 patients with symptomatic RCD who were recruited from two hospitals between June 2008 and December 2014 to be randomized to receive non-surgical or surgical treatment. After a three-month rehabilitation period, 36-Item Short-Form Health Survey questionnaire (SF-36), shoulder pain (visual analogue scale (VAS)), and shoulder function (Constant-Murley score) data were available from 191 still-symptomatic patients who were eligible for surgery. A control group was formed from 87 excluded patients who were no longer eligible for surgery due to relief of symptoms.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
There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal.Aims
Methods
Aims. To determine the incidence and timing of post-operative fevers
following shoulder arthroplasty and the resulting investigations
performed. Patients and Methods. 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. Results. A total of 2167 cases (in 1911 patients) were included of whom
92 (4.2%) had a documented fever. Obese cases had a significantly
greater risk for fever (relative risk 1.53; 95% confidence interval
1.02 to 2.32; p = 0.041). Investigations were performed in 43/92
cases (46.7%), with a diagnosis being made in six cases (6.6% of
the total, two of whom had their diagnosis made post-discharge). Conclusion. Around one in 25 cases develop a fever following shoulder arthroplasty;
most have no infective
The aim of this study was to determine whether there is a correlation between the grade of humeral osteoarthritis (OA) and the severity of glenoid morphology according to Walch. We hypothesized that there would be a correlation. Overal, 143 shoulders in 135 patients (73 females, 62 males) undergoing shoulder arthroplasty surgery for primary glenohumeral OA were included consecutively. Mean age was 69.3 years (47 to 85). Humeral head (HH), osteophyte length (OL), and morphology (transverse decentering of the apex, transverse, or coronal asphericity) on radiographs were correlated to the glenoid morphology according to Walch (A1, A2, B1, B2, B3), glenoid retroversion, and humeral subluxation on CT images.Aims
Methods
Corticosteroid injections are often used to manage glenohumeral arthritis in patients who may be candidates for future total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (rTSA). In the conservative management of these patients, corticosteroid injections are often provided for symptomatic relief. The purpose of this study was to determine if the timing of corticosteroid injections prior to TSA or rTSA is associated with changes in rates of revision and periprosthetic joint infection (PJI) following these procedures. Data were collected from a national insurance database from January 2006 to December 2017. Patients who underwent shoulder corticosteroid injection within one year prior to ipsilateral TSA or rTSA were identified and stratified into the following cohorts: < three months, three to six months, six to nine months, and nine to 12 months from time of corticosteroid injection to TSA or rTSA. A control cohort with no corticosteroid injection within one year prior to TSA or rTSA was used for comparison. Univariate and multivariate analyses were conducted to determine the association between specific time intervals and outcomes.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
The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed.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
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 primary aim of this retrospective study was to identify the
incidence of heterotopic ossification (HO) following elective and
trauma elbow arthroplasty. The secondary aim was to determine clinical
outcomes with respect to the formation of heterotopic ossification. A total of 55 total elbow arthroplasties (TEAs) (52 patients)
performed between June 2007 and December 2015 were eligible for
inclusion in the study (29 TEAs for primary elective arthroplasty
and 26 TEAs for trauma). At review, 15 patients (17 total elbow
arthroplasties) had died from unrelated causes. There were 14 men
and 38 women with a mean age of 70 years (42 to 90). The median
clinical follow-up was 3.6 years (1.2 to 6) and the median radiological follow-up
was 3.1 years (0.5 to 7.5).Aim
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
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
The factors that predispose to recurrent instability and revision
stabilization procedures after arthroscopic Bankart repair for anterior
glenohumeral instability remain unclear. We sought to determine
the rate and risk factors associated with ongoing instability in
patients undergoing arthroscopic Bankart repair for instability
of the shoulder. We used the Statewide Planning and Research Cooperative System
(SPARCS) database to identify patients with a diagnosis of anterior
instability of the shoulder undergoing arthroscopic Bankart repair
between 2003 and 2011. Patients were followed for a minimum of three
years. Baseline demographics and subsequent further surgery to the ipsilateral
shoulder were analyzed. Multivariate analysis was used to identify
independent risk factors for recurrent instability.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
Depression can significantly affect quality of life and is associated
with higher rates of medical comorbidities and increased mortality
following surgery. Although depression has been linked to poorer
outcomes following orthopaedic trauma, total joint arthroplasty
and spinal surgery, we wished to examine the impact of depression
in elective total shoulder arthroplasty (TSA) as this has not been
previously explored. The United States Nationwide Inpatient Sample (NIS) was used
to identify patients undergoing elective TSA over a ten-year period.
Between 2002 and 2012, 224 060 patients underwent elective TSA.Aims
Patients and Methods
Inherent disadvantages of reverse shoulder arthroplasty
designs based on the Grammont concept have raised a renewed interest
in less-medialised designs and techniques. The aim of this study
was to evaluate the outcome of reverse shoulder arthroplasty (RSA)
with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed
for the treatment of rotator-cuff-deficient shoulders with glenohumeral
arthritis. A total of 97 arthroplasties in 92 patients (53 women
and 44 men, mean age 67 years (standard deviation ( The Bayley–Walker prosthesis provides reliable pain relief and
reasonable functional improvement for patients with symptomatic
cuff-deficient shoulders. Compared with other designs of RSA, it
offers a modest improvement in forward elevation, but restores external
rotation to some extent and prevents scapular notching. A longer
follow-up is required to assess the survival of the prosthesis and
the clinical performance over time. Cite this article:
To compare radiographic failure and re-operation rates of anatomical
coracoclavicular (CC) ligament reconstructional techniques with
non-anatomical techniques after chronic high grade acromioclavicular
(AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide
healthcare system to identify surgical technique, complications,
radiographic failure and re-operations. Procedures fell into four
categories: Aims
Patients and Methods
Our aim was to compare the outcome of arthroscopic
release for frozen shoulder in patients with and without diabetes.
We prospectively compared the outcome in 21 patients with and 21
patients without diabetes, two years post-operatively. The modified
Constant score was used as the outcome measure. The mean age of
the patients was 54.5 years (48 to 65; male:female ratio: 18:24),
the mean pre-operative duration of symptoms was 8.3 months (6 to
13) and the mean pre-operative modified Constant scores were 36.6
(standard deviation ( Cite this article:
The indications for reverse shoulder arthroplasty
(RSA) continue to be expanded. Associated impairment of the deltoid
muscle has been considered a contraindication to its use, as function
of the RSA depends on the deltoid and impairment of the deltoid
may increase the risk of dislocation. The aim of this retrospective
study was to determine the functional outcome and risk of dislocation
following the use of an RSA in patients with impaired deltoid function.
Between 1999 and 2010, 49 patients (49 shoulders) with impairment
of the deltoid underwent RSA and were reviewed at a mean of 38 months
(12 to 142) post-operatively. There were nine post-operative complications (18%),
including two dislocations. The mean forward elevation improved
from 50° ( These results suggest that pre-operative deltoid impairment,
in certain circumstances, is not an absolute contraindication to
RSA. This form of treatment can yield reliable improvement in function
without excessive risk of post-operative dislocation. Cite this article:
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:
In this study, we evaluated patient-reported
outcomes, the rate of revision and the indications for revision
following resurfacing hemiarthroplasty of the shoulder in patients
with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing
hemiarthroplasty and reported to the Danish Shoulder Arthroplasty
Registry (DSR), between January 2006 and December 2010 were included.
There were 772 patients (837 arthroplasties) in the study. The Western
Ontario Osteoarthritis of the Shoulder (WOOS) index was used to
evaluate patient-reported outcome 12 months (10 to 14) post-operatively.
The rates of revision were calculated from the revisions reported
to the DSR up to December 2011 and by checking deaths with the Danish National
Register of Persons. A complete questionnaire was returned by 688 patients (82.2%).
The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties
(7.5%) required revision; the cumulative five-year rate of revision
was 9.9%. Patients aged <
55 years had a statistically significant
inferior WOOS score, which exceeded the minimal clinically important
difference, compared with older patients (mean difference 14.2 (8.8;
95% CI 19.6; p <
0.001), but with no increased risk of revision.
There was no significant difference in the mean WOOS or the risk
of revision between designs of resurfacing hemiarthroplasty. 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:
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:
Lateral epicondylitis, or ’tennis elbow’, is
a common condition that usually affects patients between 35 and
55 years of age. It is generally self-limiting, but in some patients
it may continue to cause persistent symptoms, which can be refractory
to treatment. This review discusses the mechanism of disease, symptoms
and signs, investigations, current management protocols and potential
new treatments. Cite this article:
