Influence of humeral position of the Affinis Short stemless shoulder arthroplasty system on long-term survival and clinical outcome.

BACKGROUND: The purpose of this study was to evaluate the influence of humeral position of the Affinis Short implant in stemless anatomic total shoulder arthroplasties (STSAs) on clinical and radiologic results and mid- to long-term survival in the treatment of primary osteoarthritis (OA) of the shoulder. METHODS: Eighty patients treated with a stemless shoulder arthroplasty for OA of the shoulder were evaluated with a mean follow-up of 92 ± 14 months (range 69-116 months) by the Constant Score (CS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and active range of motion (ROM). Radiographic assessment for bone adaptations and humeral implant position was performed by plain radiographs. Comparison of the pre- and postoperative centers of rotation (CORs) was used to assess the restoration of the geometry of the humeral head. The appraisal of proper humeral component positioning was correlated with the functional outcomes. A Kaplan-Meier analysis was performed to investigate the influence of humeral implant position compared to survival time. Complications were noted. RESULTS: The ROM (P < .001), CS (P < .001), and DASH scores (P < .001) showed significant improvements after surgery for the entire series. The COR restoration was anatomic in 75% (n = 60) of all implants and in 25% (n = 20) nonanatomic implants (pre- and postoperative COR deviation of 2.7 ± 1.8 mm vs. 5.1 ± 3.2 mm, P = .0380). The humeral component position did not affect the functional outcome whereas the 10-year unadjusted cumulative survival rate for the anatomic group was significantly higher in comparison with the nonanatomic group (96.7% vs. 75%, P = .002). The radiologic evaluation revealed minor periprosthetic bone adaptions in various forms without clinical significance or further intervention. No revision was necessary because of a failed fixation of the stemless humeral component. CONCLUSIONS: Regarding the treatment of primary OA of the shoulder, STSA shows excellent long-term survival and clinical outcomes. In particular, STSA implants are able to restore the geometry of the humeral head. Nonanatomic reconstruction may influence the survival over the long term in different pathways. Further studies are necessary to elucidate the effect of humeral component position in STSA on function, pain, and implant survival rates.

Collagen 1 gel may improve the regenerative capacity of minced adult and preosteoarthritic cartilage.

PURPOSE: Minced cartilage implantation (MCI) is an evolving technique for the treatment of osteochondral lesions. It was hypothesised that mincing of cartilage may affect chondrocyte viability and phenotype and that embedding in collagen 1 gel results in an improved outcome. The objective of this study was to evaluate the impact of cartilage mincing and whether collagen 1 gel mediates beneficial effects on the chondrocyte phenotype and viability. METHODS: Human cartilage samples from 11 patients undergoing total knee arthroplasty were collected and minced according to the MCI protocol. Minced cartilage was cultured for 1 week with and without embedding in collagen 1 gel and was compared with unminced cartilage flakes as control. Quantitative reverse transcription-PCR and immunohistochemical staining for the chondrocyte marker genes SOX9, COL2, ACAN, COL10 and MMP13 were used to examine the chondrocyte phenotype. Cell death was assessed by the terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. RESULTS: Increased chondrocyte cell death of cultured cartilage after mincing was observed. Chondrocytes from minced cartilage exhibited significantly decreased expression and protein levels of homeostatic and hypertrophic chondrocyte markers. Embedding in collagen 1 gel showed no positive effect on viability. However, remarkable is the increased expression of ACAN and the preserved protein level of SOX9 in the collagen 1-embedded minced cartilage. CONCLUSIONS: This study shows that the mincing of cartilage leads to increased chondrocyte death and decreased expression of chondrocyte phenotypic marker genes after 7 days. The use of collagen 1 gel may improve the stability of the phenotype, which needs to be further elucidated. LEVEL OF EVIDENCE: Level III (therapeutic).

Best practice in digital orthopaedics.

Digitization in orthopaedics and traumatology is an enormously fast-evolving field with numerous players and stakeholders. It will be of utmost importance that the different groups of technologists, users, patients, and actors in the healthcare systems learn to communicate in a language with a common basis. Understanding the requirements of technologies, the potentials of digital application, their interplay, and the combined aim to improve health of patients, would lead to an extraordinary chance to improve health care. Patients' expectations and surgeons' capacities to use digital technologies must be transparent and accepted by both sides. The management of big data needs tremendous care as well as concepts for the ethics in handling data and technologies have to be established while also considering the impact of withholding or delaying benefits thereof. This review focuses on the available technologies such as Apps, wearables, robotics, artificial intelligence, virtual and augmented reality, smart implants, and telemedicine. It will be necessary to closely follow the future developments and carefully pay attention to ethical aspects and transparency.

Injection of autologous conditioned plasma combined with a collagen scaffold may improve the clinical outcome in shoulder impingement syndrome: a prospective study.

BACKGROUND: Shoulder impingement syndrome (SIS) is one of the most common diseases of the shoulder and can be addressed with various therapeutic concepts. Orthobiological agents such as platelet rich plasma with a low side effect rate gain importance in the conservative treatment of SIS. Currently, the knowledge about success rate influencing factors, such as the growth factors (GF) concentration or acromion type, is limited. The aim of this study was to analyze the clinical outcome in the therapy of external SIS using autologous conditioned plasma combined with recombinant human collagen scaffold (ACP/STR) injection in comparison with a corticosteroid-local anesthetic (CSA) injection. Additionally, the influence of potential limiting factors such as GF concentration, age and acromial morphology was proved. MATERIALS AND METHODS: This prospective pseudo-randomized trial recruited 58 patients with external SIS who received an ultrasound-guided subacromial injection either an ACP/STR or a CSA followed by physical therapy. Follow-up (FU) was performed at 6 weeks, 3 and 6 months. The outcome was assessed with Constant-Murley score, disability of arm, shoulder and hand score and simple shoulder test. The concentration of GF was measured using ELISA. RESULTS: During the FU, the improvement of outcome measures was observed with no differences between both groups. Shoulder force was significantly increased in the ACP/STR group (p < 0.01). We found no correlation between the amount of GF and age or gender in the ACP/STR patients. An acromion Bigliani type III predisposes for therapy failure (p < 0.001, OR = 56) in both treatment groups. CONCLUSIONS: Patients with SIS benefit regarding to PROMs after both ACP/STR and CSA injection and physical therapy. Patients who received ACP/STR obtained superior improvement in force. The quantity of GF did not vary depending on the age, so that ACP/STR can be a treatment option for SIS in elderly patients with multimorbidity. The presence of an acromion type III seems to be a predictive factor for limited effectivity of injections in the clinical management of SIS.