Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty.

BACKGROUND: Short-stem press-fit humeral components have recently been developed in an effort to preserve bone in total shoulder arthroplasty (TSA), but few studies have reported outcomes of these devices. The purpose of this study was to evaluate the short-term clinical outcomes of an anatomic short-stem humeral component in TSA. We hypothesized that the implant would lead to significant functional improvement with low rates of radiographic loosening. METHODS: A multicenter retrospective review was performed of TSAs using an anatomic short-stem humeral component (Apex; Arthrex, Inc., Naples, FL, USA). The minimum follow-up was 2 years. Functional outcome was evaluated according to the American Shoulder and Elbow Surgeons score, Visual Analog Scale for pain, Single Assessment Numeric Evaluation, Simple Shoulder Test, and range of motion. A radiographic analysis was performed to evaluate component loosening. RESULTS: Sixty-four patients with a mean age of 64.1 years were available for follow-up at a mean of 25 months postoperatively. There were significant improvements in the Visual Analog Scale (6 to 2; P < .001), Simple Shoulder Test (4 to 10; P < .001), Single Assessment Numeric Evaluation (32 to 84; P < .001), and American Shoulder and Elbow Surgeons (37 to 80; P < .001) scores. Forward flexion improved from 116° to 148° (P < .001), external rotation improved from 30° to 57° (P < .001), and internal rotation improved from an average spinal level of S1 to L2 (P < .001). On radiographic examination, 9% of stems were deemed at risk for loosening, but there was no gross loosening in any patient. CONCLUSIONS: TSA with an anatomic press-fit short-stem humeral component is associated with significant improvements in clinical outcomes, without evidence of component loosening at short-term follow-up.

Diagnosis and Management of the Biceps-Labral Complex.

The long head of the biceps tendon (LHBT) is a common source of pathology. The biceps-labral complex (BLC) is the collective anatomic and clinical features shared by the biceps tendon and the superior labrum. LHBT pathology can be caused by inflammation, instability, or trauma. Numerous tests can be performed to determine the existence of biceps tendon and superior labrum anterior to posterior (SLAP) lesions; however, many of these tests do not have high sensitivity and specificity, which limit their clinical utility. Because it is difficult to diagnose both LHBT and SLAP pathology, management strategies are best guided by a strong clinical suspicion and imaging findings on either MRI or ultrasonography. Initial nonsurgical management of LHBT and SLAP pathology includes focused physical therapy, anti-inflammatory medications, and corticosteroid injections. If nonsurgical management fails, surgical techniques for the management of LHBT pathology include biceps anchor reattachment (SLAP repair), biceps tenotomy, and biceps tenodesis. Techniques for biceps tenodesis, which can be performed in either an arthroscopic or open manner, include soft-tissue tenodesis, suprapectoral tenodesis, and subpectoral tenodesis. If appropriately managed, patients with LHBT pathology often have excellent clinical outcomes.

A role for ATP-sensitive potassium channels in male sexual behavior.

ATP-sensitive potassium (K(+)(ATP)) channels regulate cell excitability and are expressed in steroid-responsive brain regions involved in sexual behavior, such as the preoptic area (POA) and medial basal hypothalamus (MBH). We hypothesized that K(+)(ATP) channels serve as a mechanism by which testosterone can control the electrical activity of neurons and consequently elicit male sexual responsiveness. RT-PCR analysis indicated that castration induces, while testosterone inhibits, mRNA expression of the K(+)(ATP) channel subunit Kir6.2 in both the POA and MBH of adult male rats. Intracerebral infusion of the pharmacological K(+)(ATP) channel inhibitor tolbutamide increased the proportion of long-term castrates displaying sexual behavior and restored mount frequency, intromission frequency, and copulatory efficacy to values observed in testes-intact animals. Infusions of tolbutamide, but not vehicle, also decreased latencies to mount and intromit in castrated males. Unilateral tolbutamide infusion directly into the POA significantly reduced mount latency of castrates; however, it did not affect other copulatory measures, suggesting that blockade of K(+)(ATP) channels in additional brain regions may be necessary to recover the full range of sexual behavior. These data indicate that blockade of K(+)(ATP) channels is sufficient to elicit the male sexual response in the absence of testosterone. Our observations are consistent with the hypothesis that testosterone modulates male sexual behavior by regulating K(+)(ATP) channels in the brain. Decreased channel expression or channel blockade may increase the excitability of androgen-target neurons, rendering them more sensitive to the hormonal, chemical, and somatosensory inputs they receive, and potentially increase secretion of neurotransmitters that facilitate sexual behavior.

Short-term Clinical Outcomes of Hemiarthroplasty With Concentric Glenoid Reaming: The Ream and Run Procedure.

The purpose of this study was to evaluate the short-term clinical and radiographic outcomes of humeral hemiarthroplasty and concentric glenoid reaming ("ream and run" procedure) and to compare the outcomes with those of total shoulder arthroplasty (TSA) for glenohumeral arthritis. Patients with glenohumeral arthritis who underwent the ream and run procedure with a minimum follow-up of 2 years were retrospectively reviewed. The primary outcome was revision to TSA. Secondary outcome measures included functional outcome scores, range of motion, and radiographic assessment. The outcome measures were compared with those of age- and sex-matched control patients who underwent anatomic TSA during the study period. One patient in the ream and run group required revision to TSA 14 months after the surgery because of excessive shoulder pain. There were significant improvements in the postoperative outcome scores and range of motion and external rotation in the ream and run group. Postoperative radiographs showed concentric glenoids without posterior subluxation in all except 1 shoulder. The outcome measures in the ream and run group were similar to those in the TSA control group except for active forward elevation and external rotation. The ream and run procedure provides improved pain relief and shoulder function at short-term follow-up for patients with shoulder arthritis. [Orthopedics. 2018; 41(6):e854-e860.].

Nonsurgical Management of Early-onset Scoliosis.

Early-onset scoliosis is potentially fatal if left untreated. Although surgical management with growing instrumentation may be necessary, this is not a panacea and is associated with high complication rates. Recent evidence has demonstrated that nonsurgical treatment can be an effective early management strategy in delaying or even precluding the need for surgery, especially surgery with growing instrumentation. The goal of both nonsurgical and surgical management is to control or correct the spinal curve to allow appropriate pulmonary development while delaying definitive fusion until an appropriate skeletal age. Although more commonly used to delay surgery, serial cast correction using the Cotrel and Morel elongation-derotation-flexion technique may result in complete correction in patients with infantile idiopathic scoliosis and smaller curve magnitudes.