Stress shielding following radial head arthroplasty: the impact of preoperative bone quality.

BACKGROUND: We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of stress shielding (SS) after a MoPyC radial head arthroplasty. MATERIALS AND METHODS: We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ± 14.90 (range, 25.00-91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ± 2.8 (range, 0.5-11). RESULTS: SS was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ± 0.09, 1.05 ± 0.18, and 0.79 ± 0.11, respectively. The presence of SS was significantly associated with MD:CW (adjusted odds ratio = 13.66; P = .001), and expansion of the stem (adjusted odds ratio = 3.78; P = .001). The amount of the SS was significantly correlated with expansion of the stem (aß 4.58; P < .001). CONCLUSIONS: Our study found that MD:CW was an independent risk factor of SS after MoPyc radial head arthroplasty. Autoexpansion of the MoPyc stem significantly increased the risk of SS and its extent. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study.

Short- to midterm outcomes of 139 pyrocarbon monopolar radial head arthroplasties.

BACKGROUND: The MoPyc radial head arthroplasty (RHA) is a monopolar implant with a pyrocarbon head that obtains rigid fixation via controlled expansion of the titanium stem. The aim of this study was to evaluate the short-term to midterm outcomes of MoPyc RHA. MATERIALS AND METHODS: Between 2002 and 2021, 139 MoPyc RHA were implanted in 139 patients with a RH fracture. The mean follow-up was 5.9 years ± 3.5 (range 1-16). Range of motion, mean Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand score, visual analog scale (VAS), radiographic outcome, and reason for failure were recorded. RESULTS: The mean MEP, Quick Disabilities of the Arm, Shoulder and Hand, and VAS scores were 89.1 ± 2.2 (range, 45-100), 17.5 ± 16.7 (range, 0-78), and 0.8 ± 1.6 (range, 0-50), respectively. Stress shielding (SS) and osteolysis around the stem were identified in 92 (66%) and 20 (14%) patients. A total of 47 (29%) patients experienced at least 1 complication and 29 (21%) of them required re-intervention. Persistent stiffness (n = 12; 9%) was the most common complication. No painful loosening was noted. Osteolysis around the stem, presence of an autoexpanding stem, and overstuffing were associated with a lower MEPS and an increase in VAS (P < .05). SS was associated with an increase in MEPS (adjusted beta coefficients= 6.92; P < .001) and lower VAS (adjusted beta coefficients= -0.69; P = .016). The autoexpending stem increased the likelihood of SS after RHA (adjusted odds ratio = 1.49; P = .001). CONCLUSIONS: A well-fixed MoPyc RHA provided satisfactory short to midterm outcomes, without painful loosening. However, the autoexpanding stem system was associated with poorer functional outcomes and increased the likelihood of SS.

Comparative biomechanical study of five systems for fixation of the coracoid transfer during the Latarjet procedure for treatment of anterior recurrent shoulder instability.

PURPOSE: This work compares the biomechanical resistance of five modes of fixation coracoid bone-block fixation during Latarjet open-air or arthroscopic procedures. The hypothesis is that these systems are equivalent. METHODS: Latarjet procedures were performed on cadavers, then the samples were subjected to an increasing tension until the fixation failed. Five systems were tested: two malleolar screws, one screw with washer, two 3.5-mm self-compressive screws, one 4-mm self-compressive screw associated with one 3-mm self-compressive screw, and endobutton. The main judgment criterion was the strength necessary for the failure of the fixation. The secondary criterion was the stiffness of the assembly. RESULTS: The single malleolar screw fixing has a lower breaking threshold than other fixings. There is no difference in strength concerning the other systems. The average strength is greater than the stresses of a shoulder during daily life activities. There is no difference regarding the secondary criterion. CONCLUSION: The use of a single screw is insufficient, but the other systems seems reliable. The use of small diameter self-compressive cannulated screws can provide a better result. This biomechanical work must be validated in clinical studies.

Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs.

Purpose There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results We found a significant improvement in pain ( p = 0.005) and grip strength ( p = 0.0021) as well as an improvement in pinch strength ( p = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( p = 0.002) and 3 ( p = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. Level of Evidence This is a Level IV study.

Midterm outcomes allograft prosthetic composite reconstruction for massive bone loss at the elbow.

BACKGROUND: Revision of a loose total elbow arthroplasty (TEA) is challenging, particularly in the context of massive bone loss (MBL). The use of an allograft prosthetic composite (APC) at the elbow is rare, typically reserved as a salvage procedure for MBL. Thus, limited data describing the outcomes of APCs are available in current literature. HYPOTHESIS: The authors hypothesize that short to midterm clinical outcomes of APC for MBL about the elbow are satisfactory. PATIENTS AND METHODS: Between 2009 and 2018, 6 APCs implanted with a semi-constrained Coonrad Morrey prosthesis were performed in 5 females and 1 male. Median patient age was 70 years (range, 49-76 years). The indication for revision was aseptic loosening in all 6 cases (6 humeral and 2 ulnar). Median follow-up was 3.5 years (range, 2-6.7 years). Functional outcomes including Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), range of motion (ROM), and radiographic outcomes were assessed for all patients. RESULTS: Median MEPS and VAS scores were 75 (range, 40-90), and 0 (range, 0-8) at latest follow-up, respectively. Median postoperative flexion-extension and prono-supination arcs were 90̊ (range, 70-140̊) and 150 (range, 100-160̊), respectively. Allograft incorporation was noted in 5 (83%) patients; all prostheses were well-fixed. In total, 4 patients (63%) experienced 5 complications (83%) including periprosthetic fracture (n=2), ulnar neuropathy (n=1), aseptic loosening (n=1), and wound dehiscence (n=1). Two (33%) required reoperation with prosthetic retention. CONCLUSION: Elbow reconstruction using allograft prosthetic composite is a viable option for patients with MBL following TEA. The midterm functional outcomes are satisfactory with no revisions required, despite a relatively high rate of complications. Further long-term studies with larger cohorts are needed to better elucidate long-term outcomes and reasons for failure. LEVEL OF EVIDENCE: IV; therapeutic study (case series [no, or historical, control group]).

What treatment for humeral shaft non-union? Case-series assessment of a strategy.

INTRODUCTION: Humeral shaft non-union is frequent, with severe clinical impact. Management, however, is poorly codified and there is no clear decision-tree. HYPOTHESIS: Analyzing our experience over the last 15years could enable a reproducible strategy to be drawn up, with a decision-tree based on the 2 main causes: failure of internal fixation, and infection. MATERIAL AND METHOD: Sixty-one patients were included in a retrospective cohort, with a mean 94 months' follow-p. The treatment strategy was based on screening first for infection then for mechanical stability deficit in case of prior internal fixation. Any fixation revision was associated to cancellous autograft. In case of suspected or proven infection, 2-stage treatment was implemented. In case of primary non-operative treatment, the strategy was based on the non-union risk on the Non-Union Scoring System (NUSS), with internal fixation and possible graft. RESULTS: There were 6 failures, for a consolidation rate of 90%; excluding patients not managed according to the study protocol, the consolidation rate was 95%. There was 1 case of spontaneously resolving postoperative radial palsy, and 3 patients required surgical revision. DISCUSSION: The present strategy achieved consolidation in most cases, providing the surgeon with a decision-tree for these patients. Infectious etiologies are often overlooked and should be a focus of screening. LEVEL OF EVIDENCE: IV, retrospective or historical series.

Anatomical study of the clitoris and its implications on female genital mutilation and surgical repair.

BACKGROUND: Worldwide, 200 million girls and women have been subjected to female genital mutilation. To restore the clitoral function and vulvar anatomy, clitoral repair has been performed since the 2000s. Nevertheless, there is a lack of precise and comprehensive data on the clitoral anatomy during surgical repair. This study aimed to precisely describe the terminal anatomies of the dorsal nerve and artery of the clitoris, and the clitoral neurovascular flap advancement for reconstruction in patients with female genital mutilation. METHODS: This study was performed on seven fresh female cadavers. The site of origin, diameter, length, and trajectory of each nerve and artery were recorded. The clitoral neurovascular flap advancement was measured after a midline transection of the suspensory ligament was performed and after extensive liberation of the dorsal bundles at their emergence from the pubic rami. RESULTS: At the distal point of the clitoral body, the width of the dorsal nerve and artery was 1.9 ± 0.3 mm and 0.9 ± 0.2 mm, respectively. The total length of the dorsal bundles was 6.6 cm (± 0.4). The midpart of the suspensory ligament was sectioned, which allowed a mean anteroposterior mobility of 2.7 cm (± 0.2). Extensive dissection of the neurovascular bundles up to their point of emergence from the suspensory ligament allowed a mean mobility of 3.4 ± 0.2 cm. CONCLUSION: We described the anatomical characteristics of the dorsal nerve and artery of the clitoris and the mobility of the clitoral neurovascular flap for reconstruction post clitoridectomy. This was done to restore the anatomic position of the glans clitoris while preserving and potentially restoring clitoral function in patients with female genital mutilation.