Larger polyethylene glenospheres in reverse shoulder arthroplasty: are they safe?

BACKGROUND: Reverse shoulder arthroplasty is gaining popularity owing to its proven longevity and good outcome scores. Scapular notching remains a concern. This study aimed to assess the safety of larger polyethylene glenospheres with increased eccentricity in comparison with the more conventional metal bearings. The secondary effects on scapular notching, clinical outcomes, range of movement, and complications were also analyzed. METHODS: We conducted a 10-year retrospective review of 145 SMR reverse shoulder arthroplasties (LimaCorporate, Udine, Italy) in 132 patients with radiographs at a minimum of 2 years postoperatively. The primary outcome measure was the survivorship of the larger polyethylene glenospheres. Secondary outcomes were the presence and size of notching, subjective satisfaction score, American Shoulder and Elbow Surgeons score, Oxford Shoulder Score, range of motion, and shoulder-related complications. RESULTS: No failures of the polyethylene glenospheres were noted in the 10-year period. At a minimum of 2 years' follow-up, notching was noted in 16 (25%) of the metal glenospheres vs. 9 (11.1%) of the polyethylene glenospheres (P = .028). The mean Oxford Shoulder Score was lower for the metal glenospheres (P = .005). Range of motion, complications, and overall satisfaction were similar in both groups. CONCLUSION: The inverted bearing configuration demonstrated no failures at a minimum of 2 years' follow-up. A larger study is required to determine whether the decreased incidence and size of early notching are related to the bearing size or material.

The inter-teres approach to glenoid neck fractures: an alternative approach to glenoid fixation.

BACKGROUND: Scapula fractures are rare injuries that are generally treated nonoperatively. When surgery is performed, it is commonly undertaken through the posterior approach, which can be invasive and unforgiving on the soft tissues. We describe an alternative safe approach between teres major and minor that remains deep to a fascial sling formed by the combined infraspinatus and teres minor fasciae and deep to the primary nerve to teres minor, which is a terminal branch of the axillary nerve. METHODS: Between January 2008 and June 2014, there were 22 patients who underwent scapula fixation with this approach who were retrospectively identified and prospectively invited for clinical review by the American Shoulder and Elbow Surgeons (ASES) evaluation form and Constant score. Postoperative external rotation (ER) power in both abduction and adduction was also assessed. RESULTS: Five patients were lost to follow-up. All of the remaining patients were male with a mean age of 44.5 years (28-66 years). Mean follow-up time was 34.7 months (3-72 months). The mean ASES score for the 17 patients was 86.6 (41.6-100); the mean Constant score was 89.3 (22-100). The only significant factor affecting the ASES score was an ipsilateral neurologic upper limb injury. ER power was improved or equivalent to the contralateral side in 8 of the 10 patients assessed for ER; it was weaker in 2 patients, both of whom had surgical fixation of the vertebral border of the scapula. CONCLUSION: The inter-teres approach may be a safe alternative approach in glenoid fixation, although the loss of ER strength needs further evaluation.

Dislocation of a total hip arthroplasty following hip arthroscopy.

Arthroscopy is used increasingly in the diagnosis and treatment of hip disorders of both natural and prosthetic hip joints. Complications tend to be transient and self-resolving. This is the first report of a hip arthroscopy destabilizing a prosthetic hip resulting in dislocation of the joint.