Evolution of Stemless Reverse Shoulder Arthroplasty: Current Indications, Outcomes, and Future Prospects.

Reverse total shoulder arthroplasty (rTSA) is increasingly being used as a reliable option for various shoulder disorders with deteriorated rotator cuff and glenohumeral joints. The stemless humerus component for shoulder arthroplasties is evolving with theoretical advantages, such as preservation of the humeral bone stock and decreased risk of periprosthetic fractures, as well as clinical research demonstrating less intraoperative blood loss, reduced surgical time, a lower rate of intraoperative fractures, and improved center of rotation restoration. In particular, for anatomical total shoulder arthroplasty (aTSA), the utilization of stemless humeral implants is gaining consensus in younger patients. The current systematic review of 14 clinical studies (637 shoulders) demonstrated the clinical outcomes of stemless rTSA. Regarding shoulder function, the mean Constant-Murley Score (CS) improved from 28.3 preoperatively to 62.8 postoperatively. The pooled overall complication and revision rates were 14.3% and 6.3%, respectively. In addition, recent studies have shown satisfactory outcomes with stemless rTSA relative to stemmed rTSA. Therefore, shoulder surgeons may consider adopting stemless rTSA, especially in patients with sufficient bone quality. However, further long-term studies comparing survivorship between stemless and stemmed rTSA are required to determine the gold standard for selecting stemless rTSA.

Muscle activities during shoulder internal rotation differ in arm position: a preliminary quantitative analysis using positron emission tomography.

OBJECTIVE: To investigate the muscle activity patterns of the glenohumeral joint during internal rotation both with the arm at 0° and 90° of abduction using 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Six healthy male volunteers underwent PET examination after performing active glenohumeral internal rotation exercise using an elastic band both with the arm at 0° and 90° of abduction. As a control, PET scan under resting condition was also performed. The exercise was performed before and after 18 fluorodeoxyglucose injection. Each PET image was fused to the corresponding MRI to identify each muscle. The standardized uptake value (SUV) of each muscle was compared between the two arm positions. RESULTS: With the arm at 0° of abduction, the SUV increased significantly after exercise both in the middle and inferior 1/3 of the subscapularis, which were significantly higher than that of the superior 1/3 of the subscapularis (P < 0.05). The SUV of the inferior 1/3 of the subscapularis was significantly higher at 90° of abduction than at 0° of abduction and was significantly higher than that of the superior 1/3 at 90° of abduction (P < 0.01). The SUV after exercise in the inferior infraspinatus and teres minor increased. CONCLUSIONS: The middle and inferior parts of the subscapularis are the main shoulder internal rotators in 0° of abduction, whereas the inferior part of the subscapularis is the main internal rotator in 90° of abduction.

Fatty degeneration and wnt10b expression in the supraspinatus muscle after surgical repair of torn rotator cuff tendon.

PURPOSE: In the torn rotator cuff muscles, decreased expression of wnt10b prior to elevation of peroxisome proliferator-activated receptor γ (PPARγ) and CCAAT/enhancer-binding protein α (C/EBPα) has previously been reported. The purpose of this study is to elucidate the expression profiles of these adipogenesis-related genes after rotator cuff detachment and reattachment in a rabbit model. METHODS: We investigated gene expression profiles of PPARγ, C/EBPα, and wnt10b in different parts of rabbit supraspinatus (SSP) muscle after tendon detachment (n = 6 for each time point). In addition, we assessed expression of the same genes after SSP reattachment with different intervals from initial detachment (n = 6). Fatty degeneration of the SSP muscle was examined by Oil red-O staining. Gene expression profiles were examined by quantitative real-time polymerase chain reaction. RESULTS: After SSP detachment, Oil red-O-positive oil deposits increased after 3 weeks. In the SSP reattachment model, numerous Oil red-O-positive cells were present at 5-week reattachment, following 2- and 3-week detachment. PPARγ and C/EBPα messenger ribonucleic acid expression exhibited a significant increase at 2 and 3 weeks after SSP detachment and remained increased at 5-week reattachment after 2- and 3-week detachment. A decreased expression of wnt10b was observed from 1 week after SSP detachment. Expression of wnt10b was recovered not in the central area of the SSP muscle but in the periphery after reattachment. Adipogenic change was not observed when SSP tendon was reattached after 1-week detachment. CONCLUSIONS: These results may suggest that once the adipogenic transcription factors, PPARγ and C/EBPα, were elevated, repair surgery after rotator cuff tear could not prevent the emergence of fat in the SSP muscle.

Patient trends in orthopedic traumas and related disorders after tsunami caused by the Great East Japan Earthquake: An experience in the primary referral medical center.

BACKGROUND: In the Great East Japan Earthquake, the Japanese Red Cross Ishinomaki Hospital played an important role as a principal referral center within the Ishinomaki region, one of the most severely affected areas in eastern Japan. The present study describes the patient population, clinical characteristics, and time courses of the medical problems observed at this hospital. METHODS: A retrospective survey of medical logs and records was conducted on the first 2 weeks after the earthquake to characterize orthopedic traumas and related disorders treated during this catastrophe. Patient number, severity of injuries, number of patients secondarily transported to the referral medical centers in the inland area, and the number of surgeries performed during the study period were investigated. RESULTS: Totally, 7686 patients visited the hospital. Of which, 1807 patients suffered from exogenous diseases, such as trauma, burns, crush syndrome, deep venous thrombosis, and infectious diseases. Patients who suffered from hypothermia were the most frequently seen within the first 2 weeks after the earthquake. Interestingly, most patients' conditions were not severe and required only simple treatments. Four patients (0.2% of patients with exogenous diseases) were secondarily transported to the referral medical centers in the inland area and only four patients were surgically treated because of a lack of available implants, surgical devices, and electric power supply. DISCUSSION AND CONCLUSIONS: The Great East Japan Earthquake and subsequent tsunami, which occurred during an early spring afternoon, resulted in a unique orthopedic patient population, which included few severely injured patients compared with numerous deaths. We believe that each coastal region hospital should develop its own emergency medical care system to address future tsunami events while considering their surrounding environment. The information described in the present study should be important for preparation toward future events involving massive earthquakes followed by tsunami disasters.

Surgically resected undifferentiated carcinoma with osteoclast-like giant cells of the periampullary region involving the orifice of the papilla of Vater: Report of a case.

Undifferentiated carcinomas with osteoclast-like giant cells are rare periampullary neoplasms, which morphologically mimic giant cell tumors of the bone. The terminology, histogenesis, biological behavior, and chemosensitivity of these tumors, and their treatment protocol, remain controversial. We report the case of a 71-year-old man with periampullary carcinoma who underwent pancreaticoduodenectomy under the diagnosis of periampullary carcinoma. Histologically, the neoplasm was composed of undifferentiated cells and evenly spaced osteoclast-like giant cells. Liver and paraaortic lymph node metastases were detected 6 months later and were treated effectively with intravenous gemcitabine. The patient remains in remission 2 years after surgery.