Ten-year clinical and magnetic resonance imaging evaluation after repair of isolated subscapularis tears.

HYPOTHESIS: The purpose was to evaluate long-term clinical outcomes and tendon structural integrity after repair of isolated subscapularis (SSC) tendon tears. METHODS: Sixty-one patients who underwent repair of isolated SSC tears were evaluated. The mean interval from symptom onset to surgery was 5.3 months. Shoulder function was investigated using the Constant score and Subjective Shoulder Value (SSV). Structural integrity of the repair and quality of the repaired tendon were assessed using magnetic resonance imaging. Independent preoperative factors affecting clinical outcomes, including patient sex, age, smoking habits, injections, dominant shoulder, profession, and tear onset (chronic vs. traumatic), were evaluated. RESULTS: A total of 35 patients (9 women and 26 men; mean age, 54 years) were included at the final 10-year follow-up because 21 patients were lost to follow-up and 5 underwent reoperations. The mean Constant score improved from 55.1 points preoperatively to 75.4 points postoperatively (P = .001). The postoperative SSV was 80.9, and the retear rate was 12.9%. Postoperative fatty infiltration increased in 26% of the patients with grades 3-4, but it was not related to lower clinical outcomes. Multivariable regression analysis revealed no correlation among the preoperative factors, including sex, age, smoking habits, injections, dominant shoulder, profession, and tear onset, and the postoperative Constant score, SSV, and tendon healing. CONCLUSION: At a mean of 10 years after repair of isolated SSC tears, clinical results were satisfactory and functional improvement was maintained in the long term. Severe fatty infiltration increased with time, but it was not related to clinical outcomes and the retear rate.

Surgical treatment of mid-shaft clavicle fractures by minimally invasive internal fixation facilitated by intra-operative external fixation: A preliminary study.

BACKGROUND: Mid-shaft clavicle fractures are common and may require surgery. The objective of this study in adults with high-risk mid-shaft clavicle fractures was to evaluate the clinical and radiological outcomes of a minimally invasive surgical technique involving a minimally invasive approach, fracture reduction, temporary intra-operative external fixation, and locking plate internal fixation. HYPOTHESIS: This minimally invasive surgical technique for mid-shaft clavicle fractures ensures satisfactory radiographic fracture healing and medium-term functional outcomes, with a short immobilisation, rapid return to sports, and low complication rate. MATERIAL AND METHOD: A retrospective review was performed of patients managed using our minimally invasive surgical technique between 1 January 2012 and 31 December 2016. The primary outcome measure was the 3-month radiographic healing rate. The secondary outcome measures were duration of post-operative immobilisation, 3- and 6-month QuickDASH scores, and post-operative complications. RESULT: A total of 19 patients were included, 18 males and 1 female with a mean age of 37 years. Radiographic healing was consistently achieved within 3 months. Immobilisation duration was 3 weeks. The mean QuickDASH score was 23.75 after 3 months and 7.5 after 6 months. Return to sports occurred after 3 months. The only complication was transient paraesthesia in the distribution of the C8 nerve root in 1 patient. DISCUSSION: The management of mid-shaft clavicle fractures remains controversial. The high complication rates associated with conventional surgical techniques make treatment decisions difficult. A surgical technique characterised by temporary intra-operative external fixation to facilitate minimally invasive internal fixation may have a lower complication rate and shorter immobilisation requirements compared to conventional surgery. LEVEL OF EVIDENCE: IV, retrospective observational study.

Curative treatment of prosthetic joint infection in patients younger than 80 vs. 80 or older.

OBJECTIVE: Prosthetic joint infection (PJI) is a serious complication of joint replacement surgery. The major pharmacological and surgical treatments required by PJI increase the risk of peri-operative complications in elderly patients. The increase in life expectancy combined with procedural advances make these treatments possible even in the oldest patients. Here, our objective was to compare the characteristics and outcomes of curative PJI treatment in patients < 80 years vs. ≥ 80 years. METHODS: A prospective single-center design was used to compare the characteristics and outcomes of curative treatment for hip or knee PJI in patients < 80 years and ≥ 80 years admitted in 2004-2014. RESULTS: Of 765 patients admitted for PJI, 590 were < 80 years and 124 were ≥ 80 years. Medical history and comorbidities were similar in the two groups. The older group had a significantly higher proportion of patients with American Society of Anesthesiologists Scores ≥ 3 and with streptococcal infection (20% vs. 13%, P < 0.05). After complete surgical excision and prolonged antibiotic therapy, the only event whose frequency differed significantly between the two groups was PJI-related death, which was more common in the older patients (6.5% vs. 0.8%, P < 0.05). The 2-year survival rate after one-stage exchange arthroplasty was > 90% in the ≥80 year group. CONCLUSION: Patients aged 80 years or older are eligible for the same curative pharmacological and surgical PJI treatments used in their younger counterparts. Before surgery, the risk/benefit ratio of the major surgical procedure required to treat PJI must be assessed on a case-by-case basis.

What is the rate of patients undergoing a total hip arthroplasty after core decompression and insertion of a tantalum rod in osteonecrosis of the femoral head: a systematic review.

PURPOSE: Core decompression (CD) may be effective when performed during the early stages of osteonecrosis of the femoral head (ONFH). Tantalum may be added as a rod that would allow putting some mechanical constraints on the femoral head. We aimed to estimate the rate of total hip arthroplasty after CD and insertion of a tantalum rod during early stages of OFNH. METHODS: We searched systematically Medline via PubMed and the Cochrane Library. Our primary endpoint was the rate of patients undergoing a total hip arthroplasty after CD and insertion of a tantalum rod. Secondary endpoints were the delay between the initial surgery and the arthroplasty, the functional improvement, and the rate of complications. RESULTS: We included seven  studies reporting the results of 232 patients (297 hips) that were operated on by CD and insertion of a tantalum rod. At a mean follow-up of 26.97 months, 24.63% of the included hips underwent a hip arthroplasty (6-56%, SD = 17.34%). The mean delay between the initial surgery and the arthroplasty was 14.94 months (10.20-22.90; SD = 5.25), the mean improvement of Harris Hip Score was 27.66 (20.20-36.90; SD = 6.48), and the mean rate of femoral fracture was 2.43% (0-13%, SD = 4.89%). CONCLUSION: CD and insertion of a tantalum rod may represent a solution in order to improve the mechanical support and to give a rate of conversion in arthroplasty that is acceptable.

Three-dimensional volume measurement of coracoid graft osteolysis after arthroscopic Latarjet procedure.

BACKGROUND AND HYPOTHESIS: The Latarjet procedure has been shown to be a reliable method to prevent recurrent anterior shoulder instability. Coracoid bone graft osteolysis is a potential catastrophic complication and can lead to recurrent instability. The purpose of our study is to present a novel quantitative method to measure the amount of coracoid bone osteolysis using 3-dimensional (3D) computed tomography (CT) scan imaging. MATERIALS AND METHODS: This is a prospective study with 15 patients (16 shoulders) who underwent an arthroscopic Latarjet procedure. Three-dimensional CT scans were obtained at 6 weeks and 6 months. Using volumetric analysis, we quantified the amount of bone loss using our described method. Interobserver reliability and intraobserver reliability were calculated. RESULTS: On the basis of our new volumetric analysis of the arthroscopic Latarjet procedure using 3D CT scans, we found that the superior half of the coracoid bone graft undergoes a significant amount of osteolysis at 6 months postoperatively. The interobserver reliability and intraobserver reliability were excellent. DISCUSSION: This study presents a reproducible method to quantify and compare coracoid bone graft osteolysis after an arthroscopic Latarjet procedure. We also developed a description system that may be used for comparison studies. To our knowledge, this is the first method that quantifies the amount of coracoid bone graft osteolysis using more accurate 3D CT scanning. CONCLUSION: The 3D analysis we propose is a valid method to measure the amount of coracoid bone graft osteolysis after an arthroscopic Latarjet procedure. Our description system may guide the surgeon regarding possible revision surgery when faced with significant osteolysis of the coracoid bone graft.

Feasibility of individual patient data meta-analyses in orthopaedic surgery.

BACKGROUND: The number of individual patient data meta-analyses published is very low especially in surgical domains. Our aim was to assess the feasibility of individual patient data (IPD) meta-analyses in orthopaedic surgery by determining whether trialists agree to send IPD for eligible trials. METHODS: We performed a literature search to identify relevant research questions in orthopaedic surgery. For each question, we developed a protocol synopsis for an IPD meta-analysis and identified all related randomized controlled trials (RCTs) with results published since 2000. Corresponding authors of these RCTs were sent personalized emails that presented a project for an IPD meta-analysis corresponding to one of the research questions, with a link to the protocol synopsis, and asking for IPD from their RCT. We guaranteed patient confidentiality and secure data storage, and offered co-authorship and coverage of costs related to extraction. RESULTS: We identified 38 research questions and 273 RCTs related to these questions. We could contact 217 of the 273 corresponding authors (79 %; 56 had unavailable or non-functional email addresses) and received 68/273 responses (25 %): 21 authors refused to share IPD, 10 stated that our request was under consideration and 37 agreed to send IPD. Four corresponding authors required authorship and three others asked for financial support to send the IPD. Overall, we could obtain IPD for 5,110 of 33,602 eligible patients (15 %). Among the 38 research questions, only one IPD meta-analysis could be potentially initiated because we could receive IPD for more than 50 % of participants. CONCLUSION: The present study illustrates the difficulties in initiating IPD meta-analyses in orthopaedic surgery. Significant efforts must be made to improve data sharing.