Achilles tendon debridement, calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and athletic performance in patients with insertional Achilles tendinopathy.

BACKGROUND: Insertional Achilles tendinopathy is a frequent condition among physically active individuals. Extensive intratendinous pathologies may require partial tendon detachment, debridement and reconstruction of the tendon footprint. Positive functional outcomes are reported after the procedure, but literature on postoperative sport function is limited. METHODS: Pre- and postoperative sports capability and ankle function were assessed in 25 patients undergoing Achilles tendon debridement and double-row footprint reconstruction. RESULTS: The mean VAS score for pain during sport decreased significantly from 7.4 (SD, 2.5) to 1.2 (SD, 2.0) postoperatively (p < 0.001). Sports ability and subjective fitness levels increased significantly from 3.6 (SD 3.0) and 3.5 (2.2) to 8.8 (2.4) and 8.8 (2.2), respectively (p < 0.001). A trend from high-impact sports to low-impact sports was observed postoperatively. The subjective surgical outcome was good or excellent in 96 %. CONCLUSION: Our study shows improvement in postoperative sports ability and high patient satisfaction after insertional Achilles tendon debridement, and double-row tendon footprint reconstruction. LEVEL OF EVIDENCE: Level IV - retrospective case series.

Comparison of revision rates and epidemiological data of a single total knee arthroplasty system of different designs (cruciate retaining, posterior stabilized, mobile bearing, and fixed bearing): a meta-analysis and systematic review of clinical trials and national arthroplasty registries.

BACKGROUND: This study aimed to meta-analyze epidemiological data, revision rates, and incidences of different designs of a single Total Knee Arthroplasty System and compare these factors across different countries. METHODS: A systematic review was conducted on clinical studies and arthroplasty registries of ATTUNE TKA from 1999 to 2020. The main endpoints analyzed were revision rates and epidemiological data. RESULTS: The average age of patients was 67.8 years, with a gender distribution of 60% female and 40% male. The pooled average BMI was 29.4 kg/m2. Eight clinical studies showed a pooled revision rate per 100 observed CY of 0.5 (n = 1343 cases). Cumulative revision rates after 1, 3, and 5 years varied among registries, with the Swiss registry having the highest revision data (after 5 years: 6.3%) and the American registry having the lowest revision data (after 5 years: 1.7%). A comparison of the revision rates of mobile bearing and fixed bearing (41,200 cases) as well as cruciate retaining and posterior stabilized (n = 123,361 cases) showed no significant advantage in the first 5 years after implantation. CONCLUSION: In conclusion, pooled data from 41,200 cases of TKA with a single Total Knee Arthroplasty System in two arthroplasty registries revealed that there was no significant difference in revision rates between the mobile bearing and fixed bearing design within the first 5 years after implantation. In addition, a comparison of the revision rates in n = 123,361 cases showed no significant advantage for cruciate retaining or posterior stabilized in the first 5 years after implantation.

The Value of Computed Tomography-Based Planning in Shoulder Arthroplasty Compared to Intra-/Interobserver Reliability of X-ray Planning.

Background: Reversed total shoulder arthroplasty (RTSA) is an established surgery for many pathologies of the shoulder and the demand continues to rise with an aging population. Preoperative planning is mandatory to support the surgeon's understanding of the patient's individual anatomy and, therefore, is crucial for the patient's outcome. Methods: In this observational study, we identified 30 patients who underwent RTSA with two- and three-dimensional preoperative planning. Each patient underwent new two-dimensional planning from a medical student and an orthopedic resident as well as through a mid-volume and high-volume shoulder surgeon, which was repeated after a minimum of 4 weeks. The intra- and interobserver reliability was then analyzed and compared to the 3D planning and the implanted prosthesis. The evaluated parameters were the size of the pegged glenoid baseplate, glenosphere, and humeral short stem. Results: The inter-rater reliability showed higher deviations in all four raters compared to the 3D planning of the base plate, glenosphere, and shaft. The intra-rater reliability showed a better correlation in more experienced raters, especially in the planning of the shaft. Conclusions: Our study shows that 3D planning is more accurate than traditional planning on plain X-rays, despite experienced shoulder surgeons showing better results in 2D planning than inexperienced ones.

Return to Sports and Clinical Results After All-Arthroscopic Biceps Tenodesis Using a 2.7-mm Knotless PEEK Suture Anchor.

Background: The long head of the biceps tendon (LHBT) is a well-known source of pain in the shoulder, especially in active patients. Purpose: To evaluate the outcomes and return-to-sports rate after all-arthroscopic suprapectoral tenodesis of the LHBT using a small knotless anchor. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, 27 patients-who underwent all-arthroscopic tenodesis of the LHBT using a 2.7-mm knotless polyether ether ketone anchor-were evaluated. Sports activities, the return-to-sports rate, and other sports-related parameters (eg, pain during sports, level of sports) were examined. Sports-related data, the Constant score with isometric force (at 90° of abduction in the scapular plane), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, the visual analog scale (VAS) score for satisfaction, range of motion, and the presence of a Popeye deformity were assessed at a mean follow-up of 15.3 ± 8.7 months. The data were initially analyzed using descriptive statistics. Results: The postoperative ASES, Constant, and SST scores were 81.61, 85.74 and 8.85, respectively. Of the 27 patients, 4 patients (14.8%) showed a Popeye deformity. Preoperatively, 25 patients (92.6%) participated regularly in some type of sports activity. All 25 patients (100.0%) were able to return to sports activities after surgery. 24 (96.0%) returned to the same level preoperatively, with 88.0% (22/25) within 6 months. Patient satisfaction with the outcome was high (VAS score: 2.15 ± 2.78). Neither bicipital groove pain nor cramping was reported. There were no signs of osteolytic bone around the anchor or a fracture of the humeral bone. Conclusion: Our clinical results after using a 2.7-mm knotless anchor for LHBT tenodesis as well as the return-to-sports rate were satisfying. Using an anchor this size can lower the risk of cortical bone damage and therefore the risk of fractures of the humeral head while still enabling patients to perform at a high level.

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study.

INTRODUCTION: Short stems are a valuable option in young patients undergoing total hip arthroplasty (THA) because of their bone stock preserving properties facilitating revision hip arthroplasty. Although the effect of obesity on conventional THA is well studied, data about short stem THA in obese patients are lacking. Therefore, this study aimed to investigate the influence of obesity on complications, revisions, and outcome after short stem THA. MATERIALS AND METHODS: This multicenter, observational cohort study included patients undergoing short stem THA with the optimys prosthesis. Follow-up examinations were performed at specific intervals up to 7 years postoperatively. Operation characteristics, general and specific complications, revisions, VAS rest pain, VAS load pain, VAS patient satisfaction, and Harris Hip Score (HHS) were recorded and statistically compared between obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients. RESULTS: Of the 224 patients included with a mean follow-up of 87.2 months (range 81.9-104.0), 69 were assigned to the OB group and 155 to the non-OB group. A minimally invasive approach was significantly less often selected in obese patients (p = 0.049), whereas operating time and length of hospital stay were not significantly different. The rate of general and specific complications did not significantly differ between both groups. Survival of the optimys prosthesis was 99.1% at 7-year follow-up and one patient per group had to undergo revision surgery. VAS rest pain, load pain, and satisfaction improved from preoperatively to postoperatively in both groups without a significant difference between both groups. While the HHS was improved from preoperatively to postoperatively, obese patients showed a significantly lower HHS at the 7-year follow-up (p = 0.01) but still exhibited an excellent scoring above the PASS threshold. CONCLUSION: Short stem THA with the optimys prosthesis is a safe and effective option also in obese patients with an excellent clinical outcome and a low complication rate.

Subsidence analysis of a cementless short stem THA using EBRA-FCA - A seven-year prospective multicentre study.

Background: Metaphyseal fixation of short stem THA allows for minimally invasive surgery, less bone removal, improved bone load transfer and reduced stress shielding. Short stems facilitate the anatomic restoration i.a. of leg length, femoroacetabular offset, and center of rotation. However, metaphyseal fixation might cause impaired primary and/or secondary stability resulting in an inherent tendency for early axial migration and aseptic loosening eventually. The objective of this study was to investigate the long-term outcome and migration pattern of a calcar-guided short stem. Methods: In a prospective multicenter study, 213 patients (224 THAs) were enrolled. Patients were followed for up to 84 months postoperatively. Clinical outcome was assessed using the Harris Hip Score and the VAS for pain and satisfaction. Standardized and calibrated radiographs were screened i.a. for stress shielding and loosening. Einzel-Bild-Roentgen-Analyse - femoral component analysis (EBRA-FCA) was used to detect longitudinal subsidence. Results: At 7 year follow-up, n = 139/224 cases were available for analysis. All clinical parameters improved significantly (p < 0.001) and improvement persisted. There were no radiographic changes indicating stress shielding. EBRA-FCA revealed a mean subsidence of -1.44 mm followed by a stabilization. Weight >80 kg (p = 0.115), BMI <30 kg/m2 (p = 0.282), male gender (p = 0.246), and age <65 years (p = 0.304) seemed to be associated with a higher risk for migration. The cumulative revision rate was 2.23%. Revisions due to stem migration (0.89%) occurred early (mean time between index surgery and revision: 3.3 months). Conclusions: If at all, there appears to be a pronounced initial subsidence, which stabilizes thereafter. Stem migration was rarely a compelling reason for failure or revision. Demographics do not seem to have a significant effect on migration pattern. The absence of radioluce lines, resorption or hypertrophy of the proximal femora support the hypothesis of a reduced stress shielding for metaphyseal anchoring short stems.

Learning Curve for Short-Stem Total HIP Arthroplasty through an Anterolateral Approach.

Background and Objectives: Short-stem total hip arthroplasty has become increasingly popular in recent years. While many studies have shown excellent clinical and radiological results, very little is known about the learning curve for short-stem total hip arthroplasty through an anterolateral approach. Therefore, the aim of this study was to determine the learning curve for short-stem total hip arthroplasty among five residents in training. Materials and Methods: We performed retrospective data analysis of the first 30 cases of five randomly selected residents (n = 150 cases) with no experience before the index surgery. All patients were comparable, and several surgical parameters and radiological outcomes were analyzed. Results: The only surgical parameter with a significant improvement was the surgical time (p = 0.025). The changes in other surgical parameters and radiological outcomes showed no significant changes; only trends can be derived. As a result, the correlation between surgical time, blood loss, length of stay, and incision/suture time can also be seen. Only two of the five residents showed significant improvements in all examined surgical parameters. Conclusions: There are individual differences among the first 30 cases of the five residents. Some improved their surgical skills faster than others. It could be assumed that they assimilated their surgical skills after more surgeries. A further study with more than 30 cases of the five surgeons could provide more information on that assumption.

Periprosthetic knee joint infection caused by Brucella melitensis which was first -osteoarticular brucellosis or osteoarthrosis: A case report.

BACKGROUND: Brucellosis is the most common zoonosis worldwide and is endemic in the Middle East, Africa, Asia, and Latin America. However, it is uncommon in Central Europe, and periprosthetic infections caused by Brucella are therefore rare. Due to the low prevalence and nonspecific clinical presentation of the disease, accurate diagnosis can be challenging; no gold standard currently exists for treating brucellosis. CASE SUMMARY: Here, we present a 68-year-old Afghan woman living in Austria with a periprosthetic knee infection caused by Brucella melitensis. The interval from total knee arthroplasty to septic loosening was five years. A profound medical history and examinations suggested that the patient had been suffering from unrecognized chronic osteoarticular brucellosis prior to total knee arthroplasty. She was successfully treated by two-stage revision surgery and combined antibiotic therapy over three months. CONCLUSION: Clinicians should consider brucellosis as a possible cause of chronic arthralgia and periprosthetic infection in patients originating from countries with a high brucellosis burden.

Facet joint violation after open and percutaneous posterior instrumentation: a comparative study.

PURPOSE: Posterior instrumentation is the state-of-the-art surgical treatment for fractures of the thoracic and lumbar spine. Options for pedicle screw placement comprise open or minimally invasive techniques. Open instrumentation causes large approach related muscle detachment, which minimally invasive techniques aim to reduce. However, concerns of accurate pedicle screw placement are still a matter of debate. Beside neurological complications due to pedicle screw malplacement, also affection of the facet joints and thus motion dependent pain is known as a complication. The aim of this study was to assess accuracy of pedicle screw placement concerning facet joint violation (FJV) after open- and minimally invasive posterior instrumentation. METHODS: A retrospective data analysis of postoperative computer tomographic scans of 219 patients (1124 pedicle screws) was conducted. A total of 116 patients underwent open screw insertion (634 screws) and 103 patients underwent minimally invasive, percutaneous screw insertion (490 screws). RESULTS: In the lumbar spine (segments L3, L4, L5), there were significantly more and higher grade (open = 0.55 vs. percutaneous = 1.2; p = 0.001) FJV's after percutaneously compared to openly inserted screws. In the thoracic spine, no significant difference concerning rate and grade of FJV was found (p > 0.56). CONCLUSION: FJV is more likely to occur in percutaneously placed pedicle screws. Additionally, higher grade FJV's occur after percutaneous instrumentation. However, in the thoracic spine we didn't find a significant difference between open and percutaneous technique. Our results suggest a precise consideration concerning surgical technique according to the fractured vertebrae in the light of the individual anatomic structures in the preop CT.

The Effect of Strength Training on Undetected Shoulder Pathology in Asymptomatic Athletes: An MRI Observational Study.

BACKGROUND: Data on the effects of weight training on joint morphology are mostly restricted to muscle gain. However, in many circumstances, it is not stated if there are negative consequences for the joints and their surrounding components. This study was conducted to explore whether long-term excessive resistance training (RT) causes hidden pathological alterations in the shoulder. METHODS: A total of eleven asymptomatic sportsmen (22 shoulders) underwent clinical and radiological examination of both shoulder joints. All participants had engaged in bodybuilding for at least four years, at least three times per week, and for at least four hours per week. All participants were examined clinically using the Constant Murley Score (CMS), Simple Shoulder Test (SST), UCLA Activity Test, and a specially designed questionnaire. All participants received a bilateral shoulder MRI. The MRI scans were checked for pathology using a checklist. RESULTS: Maximum scores were observed for the SST and UCLA Activity Test. The CMS was 97.7 points on average (range, 87-100). RT had been conducted for a mean of 10.7 years (range, 4-20), for an average of 8.8 h a week (range, 4-12). MRI examinations revealed two supraspinatus tendinopathies (9.1%), one labral change (4.5%), three humeral tuberosity cysts (13.6%), fourteen acromioclavicular (AC) joint hypertrophies (63.6%), five AC joint osteophytes (22.7%), and ten signs of AC joint inflammation (45.5%). CONCLUSIONS: The research results show that strength is associated with MRI-documented AC joint pathology. However, it appears that RT may not negatively affect other anatomical structures of the shoulder.

Clinical and Radiologic Outcomes after Anatomical Total Shoulder Replacement Using a Modular Metal-Backed Glenoid after a Mean Follow-Up of 5.7 Years.

Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of 25 participants as well as the longevity after implantation of an anatomic shoulder prosthesis with a recent, modular cementless flat metal-backed glenoid component after a mean follow-up of 5.7 years. Methods: Clinically, the Simple Shoulder Test (SST), UCLA Activity Score (UCLA), and Constant Murley Score (CMS) were evaluated. Radiographically, the radiolucent lines (RLs), humeral head migration (HHM), and lateral glenohumeral offset (LGHO) were assessed. Survival was calculated with Kaplan−Meier curves and life-table analysis. Results: The mean CMS at follow-up was 46.2 points (range: 14−77; SD: 19.5). In terms of the SST score, the average value was 6.5 points (range: 1−10; SD: 3.5). The UCLA activity score showed a mean value of 5.9 points (range: 1−9; SD: 2.1). There were 17 revisions after a mean follow-up of 68.2 months (range: 1.8−119.6; SD: 27.9). HHM occurred in every patient, with a mean measurement of 6.4 mm (range: 0.5−13.4; SD: 3.9; p < 0.0001). The mean LGHO between the initial postoperative and follow-up images was 2.6 mm (range: 0−4.0; SD: 1.5; p < 0.0001). RLs were found in 22 patients (88%) around the glenoid and in 21 patients (84%) around the humeral head prosthesis. Conclusion: The clinical and radiographic outcomes after metal-backed glenoids were poor at 2.2 to 8.4 years of follow-up. We determined devastating survival in the majority of cases (68%), with mostly inlay wear (71%) as the main reason that led to revision surgery. The use of metalback genoids cannot be recommended based on the data of this study.

The Patellar Instability Probability Calculator: A Multivariate-Based Model to Predict the Individual Risk of Recurrent Lateral Patellar Dislocation.

BACKGROUND: Predicting the risk of recurrence is of great interest when counseling patients after primary lateral patellar dislocation (LPD). PURPOSE: To investigate a multivariate model to predict the individual risk of recurrent LPD. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The study population included patients with primary LPD, knee imaging, and a minimum 2-year follow-up after nonoperative treatment. Data including patient characteristics and anatomic patellar instability risk factors were collected retrospectively from 7 national study centers. Bivariate and multivariate regression analyses were carried out to identify risk factors for recurrent LPD and to generate an accuracy-optimized model for out-of-sample prediction. RESULTS: In total, 115 of 201 patients (57%) experienced recurrent LPD within 2 years after primary LPD. Age ≤16 years at primary LPD (odds ratio [OR], 5.0), history of contralateral instability (OR, 2.4), and trochlear dysplasia (Dejour type B-D: OR, 2.5; lateral trochlear inclination ≤12°: OR, 2.7) were significant risk factors for recurrent LPD (P < .05). The prediction accuracy including these 3 risk factors was 79%. Patella alta, an increased tibial tubercle to trochlear groove distance, and patellar tilt had neither an association with increased recurrence rates nor an influence on prediction accuracy of recurrent LPD. CONCLUSION: Young age and trochlear dysplasia are major risk factors for early recurrent LPD. A multivariate model including age at primary LPD, lateral trochlear inclination, and history of contralateral LPD achieved the highest prediction accuracy. Based on these findings, the patellar instability probability calculator is proposed to estimate the individual risk of early recurrence when counseling patients after primary LPD.

Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery.

BACKGROUND: Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. METHODS: Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. RESULTS: Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were "normal" in 15 and 14 patients, "nearly normal" in 11 and 7 patients, and "abnormal" in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test. CONCLUSIONS: Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.

Functional and radiological outcomes after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: short-term results.

BACKGROUND: Severe acetabular defects require special treatment with either impaction bone grafting, metal augmented cups or cup-cage constructs. Even these options are often not adequate, especially in hips with Paprosky type 3 defects with loss of anterior and posterior columns. This study investigates the clinical and radiological outcomes of custom-made acetabular components (© Materialise NV, Leuven, Belgium) for Paprosky type 3 defects. METHODS: Sixteen patients were eligible for this trial, nine of whom agreed to be included. All of them completed one year of follow-up. The Harris hip score and the Oxford hip score were used to compare pre- and postoperative functional outcomes. Radiological follow-up comprised anteversion and inclination of the implanted cup and offset measurements in both hips (femoral, medial, ischial offset and center of rotation). Statistical analyses were performed with IBM SPSS Statistics. RESULTS: The mean follow-up time of the nine patients was 12.2 months (range: 10-18). The Oxford hip score and Harris hip score improved from 19.8 and 50.1 to 29.4 and 68.8, respectively (p = 0.009 and 0.01). There were complications in three cases (33.3%), which led to one re-revision (11.1%). Radiologic follow-up showed restoration of the height of the center of rotation and of the global offset. Significant difference was detected in the femoral offset. CONCLUSIONS: The functional and radiological outcomes are promising. However, long-term outcomes still need to be examined. LEVEL OF EVIDENCE: Therapeutic Level IV.

Minimally invasive surgery for intra-articular calcaneus fractures: a 9-year, single-center, retrospective study of a standardized technique using a 2-point distractor.

BACKGROUND: A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative. Surgical treatment strategies include open reduction and internal fixation (ORIF) techniques, as well as a variety of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the Traumacenter Linz over a 9-year period. METHODS: All patients with calcaneal fractures treated at the Traumacenter Linz between 2007 and 2015 were included in this study. The patients records were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between injury and operative treatment were analyzed. The number of secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. RESULTS: A minimally invasive 2-point-distractor method was used in 85.8% (n = 182) of all operatively managed calcaneal fractures (n = 212) in our department. The majority of the operations (88.7%) were performed within 2 days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n = 9) of the subtalar joints in the entire study population. CONCLUSIONS: Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. The rate of secondary arthrodesis in the study cohort was comparable to that in the literature. LEVEL OF EVIDENCE: IV.

Femoral bone remodeling after short-stem total hip arthroplasty: a prospective densitometric study.

PURPOSE: Due to improved prosthesis designs and surgical techniques, indications for total hip arthroplasty (THA) now include younger and more active patients. Preserving bone stock and soft tissue in these patients is paramount to allow for future revision. Designed for anatomical reconstruction, short femoral stems have the potential to reduce adaptive bone loss and stress shielding. To confirm this, we evaluated bone remodeling around a short femoral stem and the accuracy of hip joint reconstruction. METHODS: This prospective observational study involved 46 patients with short-stem THA for clinical and radiographic analysis. We evaluated bone remodeling by Gruen zone using dual-energy X-ray absorptiometry in 45 patients and assessed the accuracy of hip joint reconstruction using caput-collum-diaphyseal angles. Additionally, we reported functional scores and pain. RESULTS: Patients were followed for a mean of 24.1 (SD 2.2) months. Bone mineral density increased mainly in the lateral region (Gruen zones 2 and 3) and in the distal-medial region (Gruen zone 5), suggestive of lateral loading. Most caput-collum-diaphyseal angles remained stable after surgery, especially in patients with varus hips. Harris Hip Scores improved significantly, from 57.2 (SD 20.0) pre-operatively to 97.2 (SD 4.0) at 24 months post-operatively (P < 0.0001). Finally, we encountered one peri-operative dislocation but no post-operative complications. CONCLUSION: Short femoral stems successfully limited stress shielding and minimized periprosthetic bone loss without compromising primary stability. We were able to accurately reconstruct anatomical relationships in most patients. Finally, excellent clinical outcomes and low complication rates confirmed the favourable results of short-stem THA. TRIAL REGISTRATION: DRKS00017076.

Sleep improvement after hip arthroplasty: a study on short-stem prosthesis.

PURPOSE: The purpose of this study was to evaluate sleep disturbance prospectively before and after short-stem hip arthroplasty. METHODS: A prospective study on 25 patients undergoing a primary unilateral total short-stem hip replacement was conducted. Patients were observed for six months. To evaluate the sleep quality and daytime sleepiness, the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used. To assess the general physical health status, we used the Short Form 36 Health Survey (SF-36). Pain was recorded on a visual analog scale. RESULTS: The physical health status of the patients improved significantly (p < 0.05) during the six month follow-up period in seven out of nine categories. During the first post-operative week, the sleep quality stayed on an equal level to the pre-operative state, following a steady improvement over the next months (6 months p = 0.00). The daytime sleepiness showed a significant improvement during all the follow-ups (6 months p = 0.00). Pain decreased significantly from baseline to six months post-operatively (p = 0.00). There was no correlation between pain and sleep quality or pain and daytime sleepiness. CONCLUSION: According to our results, patients undergoing short-stem total hip arthroplasty can expect a 50% improvement of sleep quality and physical function six months after surgery.

Repair failure increases the risk of developing secondary glenohumeral osteoarthritis: A long-term follow-up after open repair of large subscapularis tendon tears.

BACKGROUND: The subscapularis musculotendinous unit provides a stabilizing effect on the glenohumeral joint and thus, enables normal active range of motion. As pathologies of the subscapularis tendon (SSC) are diagnosed with increased regularity, treatment strategies and their long-term consequences are of relevant interest. Therefore, the primary objective of this retrospective case series was to evaluate clinical and radiological long-term results after open repair of large SSC tears. HYPOTHESIS: Repair failure negatively influences clinical outcomes and the progression of secondary glenohumeral osteoarthritis (OA). METHODS: Between 1998 and 2007, 24 patients with traumatic large (Lafosse III and IV) SSC tears were treated with an open transosseous repair technique. Of those, 20 patients (83%) with a mean age of 55±8 years (range, from 31 to 68 years) at the time of surgery were subjected to a long-term follow-up after a mean of 14±3 years (range, from 10 to 18 years). The Subjective Shoulder Value (SSV), the Constant Score (CS), the University of California at Los Angeles (UCLA) Shoulder Score, and the American Society for Shoulder and Elbow Surgeons (ASES) Score were obtained. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity. The progression of secondary glenohumeral OA from pre- to postoperative was analyzed using the collective instability arthropathy (CIA) score. RESULTS: One patient (5%) had to undergo revision surgery due to a symptomatic re-tear of the SSC tendon. Besides that, the mean SSV of the affected shoulder was 83%±12, the CS 78±10, the UCLA 32±2, and the ASES 89±14 points, respectively. MRI revealed a re-tear of the SSC tendon in 4 patients (29%). On the affected shoulder, glenohumeral OA progressed significantly from pre- (CIA, 0.3±0.5) to postoperative (CIA, 1.7±0.9; p=0.003) and was significantly associated with repair failure (p=0.040). CONCLUSION: Open repair of large SSC tears yielded good clinical long-term results. Nevertheless, repair failure was common and, in the further course, negatively affected clinical outcomes and the progression of secondary glenohumeral OA. LEVEL OF EVIDENCE: IV; retrospective case series.

Return to sports after glenoid reconstruction using an implant-free iliac crest bone graft.

PURPOSE: The purpose of this study was to evaluate sports ability and the rate of return to sports after implant-free iliac bone graft for recurrent, anterior shoulder instability and anterior glenoid bone loss. Subgroups of younger and older patients and patients who had previous arthroscopic Bankart surgery and those who did not have such surgery before implant-free iliac bone graft were formed and compared. METHODS: We retrospectively analyzed 34 patients; 14 patients had previous arthroscopic Bankart surgery, and 20 patients did not have the surgery; The median age at the time of iliac bone graft was 35.3 years (range, 23 to 75), 17 patients were over the age of 35, and 17 patients were under the age of 35. The mean follow-up was 40 months (range: 25 to 56). RESULTS: All the 34 patients were engaged in pre- and post-operative sport, which represents a return to sport rate of 100%. Although the number of sport disciplines decreased significantly from 6 before the operation to 4.8 after the operation (p=0.002), the number of sports sessions per week did not change significantly, and the duration per session did not change significantly. More than two-thirds of all patients returned to sports within 6 months. Overall, 41% of patients changed sport disciplines, 15% of whom cited shoulder-related causes; however, all patients returned to the same sport level. CONCLUSIONS: Overall and within the subgroups, the return to sport rate after implant-free iliac bone grafting was high, with a high sense of well-being. The number of sport disciplines decreased significantly and more than one-third of the patients changed disciplines, of which 15% percent changed due to shoulder-related causes. The sport level remained equal, and no other parameters changed significantly compared with the time before the onset of restrictive shoulder symptoms.

Return to Sport After Short-Stem Total Hip Arthroplasty.

OBJECTIVES: Information about sport activity after short-stem total hip arthroplasty (THA) is scarce in the literature. We therefore aimed to evaluate the rate of return to sport after short-stem THA. METHODS: We evaluated the sport pattern, rate of return to sport, activity level, extent of sport activity, and subjective rating and sense of well-being in 137 patients (137 hips) after short-stem THA. The minimum follow-up time was 18 months. All results were analyzed according to gender (male and female) and age (≤60, >60-≤70, and >70 years). RESULTS: Ninety-two percent of all patients practiced sport before surgery, and 91% of the patients returned to sport. Most patients returned to sport within the first 6 months after surgery. There was a decline in the number of sport disciplines from preoperatively to postoperatively, which was from 2.9 to 2.6 (P = 0.025). High-impact activities decreased postoperatively, but most low-impact activities did not change significantly. Eighty percent of all patients were involved in recreational sports. CONCLUSION: In this study, we observed an excellent rate of return to sport after short-stem THA. Most patients returned to the same level of sport activity that they had before the onset of restricting symptoms, with the majority of patients having a great sense of well-being during and after sports, and almost no pain in the affected hip.