Long-term impact of scapular notching after reverse shoulder arthroplasty.

BACKGROUND: Because it medializes the centre of rotation, one of the drawbacks of reverse shoulder arthroplasty (RSA) is the risk of impingement between the humerus and lateral border of the scapula resulting in scapular notching. The long-term impact of this notching is not well known, either on function or the risk of glenoid loosening. The aim of this longitudinal study was to analyze the drawbacks of this notching. METHODS: Between 1993 and 2006, 81 patients (91 shoulders) underwent RSA for primary glenohumeral osteoarthritis or massive cuff tear with or without osteoarthritis. This cohort was followed longitudinally with post-operative assessments done at one to two  years (T1), three to eight  years (T2), and nine+ years (T3). Before T3, 25 patients had died, nine were lost to follow-up, five  had the implants changed, and seven  had incomplete records. Thus, 45 shoulders were available for follow-up beyond nine years (mean follow-up of 12 years) and were used to determine the long-term impact of notching. Survival curves were generated using the occurrence of Sirveaux grade 3 or 4 notching and the presence of aseptic glenoid loosening as endpoints. RESULTS: The survivorship before grade 3 or 4 notching developed was 83% at five years, 60% at 10 years, and 43% at 15 years. In the end, aseptic glenoid loosening occurred in four shoulders, all of which had developed grade 4 notching. No glenoid loosening occurred in the population with grade 0, 1, 2, or 3 notching (p = 0.02). The Constant score significantly decreased between T2 and T3, although it was not different between shoulders with and without advanced notching. CONCLUSIONS: Beyond the second year post-RSA, the number of shoulders with grade 3 or 4 notching increases steadily up to the longest follow-up. Grade 4 notching always preceded the occurrence of late glenoid loosening. The functional outcomes become significantly worse after the 9th year post-RSA, although they were not correlated to the presence of high-grade scapular notching.

Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10-year retrospective study.

INTRODUCTION: Orthopedic and trauma surgery is the specialty for which claims for compensation are most often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filing claims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2) analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. HYPOTHESIS: The epidemiological profile of proceedings seeking damages in France is consistent with the data from European and American studies. MATERIALS AND METHODS: An observational, retrospective, single-center study of all claims for damages between 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospital was carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, and financial consequences were analyzed. RESULTS: Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726 procedures). A significant increase in the number of cases (p=0.040) was found over a 10-year period. Of these, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission (CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for an amicable settlement. The most common reason for which patients filed claims was hospital-acquired infections, with 36/71 (50.7%) cases. Twenty-nine complaints (40.8%) resulted in monetary damages being awarded to the patient, with an average award of € 28,301 (€ 2,400-299,508). Damage awards were significantly higher (p<0.05) for cases involving surgery on a lower limb than those involving an upper limb. CONCLUSION: Claims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital-acquired infections are the main reason for disputes in our specialization. LEVEL OF EVIDENCE: IV, retrospective study.

Chronic instability of the thumb metacarpo-phalangeal joint: Seven-year outcomes of three surgical techniques.

BACKGROUND: Severe sprain of the thumb metacarpo-phalangeal joint (TMCPJ) is a common injury whose functional outcome is good when repair is performed at the acute stage. The diagnosis is often missed, however, leading to chronic instability. The optimal treatment of chronic TMCPJ instability is controversial. The objective of this study was to compare the clinical outcomes of the three main surgical techniques used to treat chronic TMCPJ instability. HYPOTHESIS: Arthrodesis is the best surgical option when ligament repair is not feasible. MATERIAL AND METHODS: This single-centre retrospective study included all patients managed surgically between 2000 and 2012 for chronic post-traumatic TMCPJ instability using any of the three following techniques: primary repair, ligament reconstruction, and arthrodesis. Subjective and objective outcomes and complication rates at last follow-up were compared across these three techniques. RESULTS: Of 67 included patients, 55 were re-evaluated, after a mean follow-up of 84 months (range: 24-164 months). Among them, 48 (87.3%) were satisfied or very satisfied with the outcome. Pain relief was significantly better in the arthrodesis group. Mean Quick-DASH scores were 17.4 (range: 0.0-89.5) with primary repair, 25.7 (range: 0.0-58.3) with ligament reconstruction, and 17.8 (range: 0.0-50.0) with arthrodesis. Mean pinch-test strength compared to the normal side was 89% with primary repair, 84% with ligament reconstruction, and 94% with arthrodesis. In the ligament reconstruction group, 6 of the 10 patients had instability at last follow-up and the proportion of patients describing themselves as fully recovered was significantly smaller than in the other groups. Four failures were recorded at last follow-up. CONCLUSION: Surgery to treat chronic TMCPJ instability produces good outcomes. Primary repair deserves preference whenever possible. In contrast to previous reports, outcomes after ligament reconstruction were not better compared to arthrodesis. LEVEL OF EVIDENCE: IV, retrospective study.

A ten-year prospective outcome study of Pi2 pyrocarbon spacer arthroplasty in carpometacarpal joint osteoarthritis.

Surgical management of carpometacarpal osteoarthritis may use many techniques. Pi2 (pyrocarbon interposition implant) arthroplasty is one possible solution after total trapeziectomy. The present study assessed clinical and radiological results in Pi2 arthroplasty at a minimum 10years' follow-up. Forty-two consecutive cases underwent surgery between March 2003 and April 2005; 29 were followed up for a mean of 125.49months (10.5years). A total of 96.6% of patients were very satisfied or satisfied. Range of motion improved, especially in opposition (mean Kapandji score, 9.60), with no major aggravation of metacarpophalangeal extension. Postoperative pinch strength was 5.9kg and grip 24.2kg. Mean time to resuming daily activities was 76days (range, 30-240days). At last follow-up, mean QuickDash score was 19.9 and overall PWRE score 16.4 out of 100. Bone remodeling, mainly in the scaphoid, was found in 48.2% of cases, and was stable between 5 and 10years, with no clinical or functional significance. Two implant dislocations (4.6%) occurred, not requiring surgical revision. Implant survival was 100%. The results of free Pi2 arthroplasty at more than 10years confirmed that this is a valid solution for the treatment of advanced carpometacarpal osteoarthritis, on condition that surgical technique is very precise.

Arthroscopic treatment of septic arthritis of the knee in children.

INTRODUCTION: Childhood septic arthritis of the knee is a serious disease that can impair growth and cause serious functional sequelae. There are few data on arthroscopic treatment in children, and series were always less than 20 cases. HYPOTHESIS: The objective of this study was to assess clinical and radiographic results of arthroscopic drainage combined with antibiotic therapy for the treatment of childhood septic arthritis of the knee. The hypothesis was that arthroscopic treatment is also effective in children. MATERIALS AND METHODS: A retrospective study, conducted between January 2003 and December 2012, included patients under 15 years of age with septic arthritis of the knee treated by arthroscopic drainage with a minimum of 2 years' follow-up. RESULTS: Fifty-six patients, with a mean age at surgery of 3.4 years (range, 3 months to 12 years), were included. Staphylococcus aureus was the most common causative organism. Two patients (3.6%) had recurrence, successfully treated by repeat arthroscopic drainage. Mean Lysholm score was 96.9 (range, 70-100) and mean KOOS-Child pain, symptoms, daily life, sports and quality of life scores were respectively 97 (81-100), 95 (75-100), 98 (89-100), 93 (71-100) and 95 (70-100) at a mean 65 months' follow-up. Ranges of motion were normal. Radiology found no joint damage. DISCUSSION AND CONCLUSION: Arthroscopic drainage combined with antibiotic treatment is a simple and effective treatment for childhood septic arthritis of the knee and is for our reference attitude. It can also be indicated in case of recurrence. LEVEL OF EVIDENCE: IV, retrospective study.