Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up.

BACKGROUND: Traditional monoblock pegged glenoid components are implanted with cement, increasing operative time and potentially violating more bone than those inserted without cement. We study the early radiographic loosening and reoperation rate following uncemented fixation of a hybrid cage monoblock polyethylene glenoid component. METHODS: Between 2013 and 2015, a total of 51 shoulders underwent anatomic shoulder arthroplasty (TSA) using a hybrid ingrowth cage polyethylene glenoid component by a single surgeon, with a minimum follow-up of 2 years. In all cases, the glenoid component was placed without cement. Mean follow-up was 33 months (range, 24-57). The primary outcome was Lazarus scale-assessed radiographic loosening. Secondary outcomes included reoperation, range of motion (ROM), and patient-reported outcome measures (PROMs). RESULTS: Twelve glenoid components (24%) had radiolucent lines. Glenoid lines were rated grade 1, grade 2, and grade 5 (6, 4, and 2 shoulders, respectively). Six shoulders (12%) had humeral lucent lines. Two shoulders (4%) underwent reoperation, only 1 of these occurring due to isolated failure of the glenoid component. As a group, mean ROM and PROMs improved significantly compared with preoperative values and exceeded the minimal clinically important difference. CONCLUSION: Glenoid loosening remains a major concern at mid- to long-term follow-up of TSA. Placement of this hybrid cage monoblock polyethylene glenoid component in a completely uncemented fashion does not lead to early clinical loosening, after which bony ingrowth into the central cage can be expected. Uncemented fixation of this hybrid cage component appears to be a safe treatment option for patients undergoing primary TSA.

Early results of augmented anatomic glenoid components.

BACKGROUND: Augmented glenoid components restore the native joint line and preserve bone in shoulders with posterior glenoid bone loss. The purpose of this study was to compare the clinical and radiographic outcomes of augmented total shoulder arthroplasties (TSAs) vs. case-matched shoulders with standard implants to assess the early performance of a full-wedge augmented glenoid component. METHODS: Between 2010 and 2015, all TSAs using a full-wedge posteriorly augmented glenoid component with a minimum 2-year follow-up from a single institution were retrospectively reviewed. A total of 37 augmented TSAs were matched with 37 control shoulders with unaugmented glenoid components. The primary outcomes were revision and radiographic glenoid lucencies. Secondary outcomes included range of motion (ROM) and patient-reported outcomes (PROs). RESULTS: Both augmented and standard TSAs produced similar improvements in all ROM and PRO measures. Patients with augmented glenoid components were more likely to have type B2 or B3 deformities (P = .004). At final follow-up, 54% of augmented glenoids showed implant lucencies compared with 46% of control shoulders (P = .5). The mean Lazarus score remained similar between groups (1.5 vs. 1.2, P = .8). When 8° and 16° augmentations were compared, the 16° augmentation demonstrated a significantly higher mean Lazarus score (4.2 vs. 1.1, P = .03). Reoperation rates were similar between groups (5% vs. 3%, P = .6). DISCUSSION: Patients with posteriorly augmented glenoid components demonstrate similar improvements in ROM and PROs to patients with standard anatomic glenoid components. Radiographic loosening and revision rates were similar. However, a higher failure rate was seen with the 16° full-wedge augmentation, which is no longer used in our practice.

Salvage hip arthroplasty after failed fixation of proximal femur fractures.

We reviewed 46 patients who underwent salvage hip arthroplasty (SHA) for revision of failed cannulated screws (CS), sliding hip screws (SHS), or intramedullary nails (IMN). The primary objective was to determine differences in operative difficulty. SHA after failed femoral neck fixation was associated with lower intra-operative demands than after failed peri-trochanteric fractures. Similarly, analysis by the index implant found that conversion arthroplasty after failed CSs was associated with lower intra-operative morbidity than failed SHSs or IMNs; differences between SHS and IMN were not as clear. Importantly, intra-operative data in cases of failed SHSs were similar regardless of the original fracture type, showing the device played a larger role than the fracture pattern. Complications and revision surgery rates were similar regardless of fracture type or fixation device. Our results suggest that operative demands and subsequent patient morbidity are more dependent on the index device than the fracture pattern during SHA.

Evaluating Different Clinical Diagnosis of Anterior Cruciate Ligament Ruptures In Providers with Different Training Backgrounds.

INTRODUCTION: Previous studies have shown that provider training and the tests performed play a role in the accuracy of diagnosis of anterior cruciate ligament (ACL) injuries. The specific aim of the current study is to determine the examiner proficiency and accuracy in performing the different proactive tests of ACL rupture before and after the induction of anesthesia prior to a definitive surgical procedure. MATERIALS AND METHODS: A case series was performed from January of 2015 through July of 2015. Two examiners were included (an experienced orthopaedic sports surgeon with more than 16 years in practice and an experienced orthopaedic physician assistant with 6 years of clinical experience in orthopaedic sports medicine). Three different physical examination tests were used before and after the induction of anesthesia to the patient: 1) Lachman test, 2) pivot shift test, and 3) Lelli test. Relevant patient demographic information such as BMI, thigh girth, and calf girth were recorded. Diagnosis of ACL rupture had been established pre-operatively. RESULTS: Thirty three patients met the inclusion criteria (males: 21 (64%), female: 12 (36%)). High percent of false negative was found with pivot shift test for both before and after anesthesia when compared to the other two tests. The Lelli test seemed to be most favorable to both the surgeon and the physician assistant with at least 67% favorable, while the pivot shift was least often felt to be the most useful test. No relationship was found for either patients' thigh or patients' calf girths with the physical examination test results for both examiners for any of the three tests (p = 0.110). CONCLUSION: The diagnostic accuracy and limitations of the various tests for ACL injury need to be understood. Clinically, it is recommended performing at least two different examinations, as each test has its own specific limitations. Level of Evidence: III- Prospective Cohort Study without blinding.

Popliteal Artery Thrombosis After Open Reduction and Internal Fixation of the Patella: A Case Report.

CASE: A 31-year-old man presented with a right patellar fracture after a motor-vehicle accident. He had a history of a myocardial infarction and cerebrovascular accident, for which he reported taking aspirin and clopidogrel daily. One hour after surgery, an acute popliteal artery thrombosis was detected. The patient was ultimately successfully managed with endovascular placement of a catheter and a 14-hour infusion of tissue plasminogen activator. The patient had no further known thromboembolic events after 11 months of follow-up. CONCLUSION: High suspicion must be maintained for acute thromboembolic events in patients with a history of such events.