Predictive factors for postoperative outcomes after reverse shoulder arthroplasty: a systematic review.

BACKGROUND: The use of reverse total shoulder arthroplasty (RTSA) has increased at a greater rate than other shoulder procedures. In general, clinical and functional outcomes after RTSA have been favorable regardless of indication. However, little evidence exists regarding patient specific factors associated with clinical improvement after RTSA. Predicting postoperative outcomes after RTSA may support patients and physicians to establish more accurate patient expectations and contribute in treatment decisions. The aim of this study was to determine predictive factors for postoperative outcomes after RTSA for patients with degenerative shoulder disorders. METHODS: EMBASE, PubMed, Cochrane Library and PEDro were searched to identify cohort studies reporting on predictive factors for postoperative outcomes after RTSA. Authors independently screened publications on eligibility. Risk of bias for each publication was assessed using the QUIPS tool. A qualitative description of the results was given. The GRADE framework was used to establish the quality of evidence. RESULTS: A total of 1986 references were found of which 11 relevant articles were included in the analysis. Risk of bias was assessed as low (N = 7, 63.6%) or moderate (N = 4, 36.4%). According to the evidence synthesis there was moderate-quality evidence indicating that greater height predicts better postoperative shoulder function, and greater preoperative range of motion (ROM) predicts increased postoperative ROM following. CONCLUSION: Preoperative predictive factors that may predict postoperative outcomes are: patient height and preoperative range of motion. These factors should be considered in the preoperative decision making for a RTSA, and can potentially be used to aid in preoperative decision making. LEVEL OF EVIDENCE: Level I; Systematic review.

[Serious shoulder injury after COVID-19 vaccination]. / Ernstige schouderproblematiek na covid-19-vaccinatie.

BACKGROUND: Since January 2021, over 24 million COVID-19 vaccines have been administered. Rarely vaccination in the deltoid muscle may lead to complications in the shoulder, called SIRVA (shoulder injury related to vaccine administration). General knowledge on SIRVA amongst doctors and other healthcare workers is lacking. However, due to the large amount of vaccinations which have been administered over the last year, SIRVA is seen more often. CASE REPORT: In this report, two cases of SIRVA due to septic arthritis and a shoulder abscess after administration of a COVID-19 vaccination, are described. CONCLUSION: SIRVA should be considered in case of shoulder complaints which persist longer than 48 hours after vaccination. Timely diagnosis and treatment by either the general practitioner or orthopaedic surgeon should be conducted to prevent long-term damage to the shoulder joint. Use of the correct vaccination technique is important to prevent the occurrence of SIRVA.

Extensive Achilles tendon ossification: Repair using a fascia lata graft.

Ossification of the Achilles tendon is a relatively common finding. However, a large ossification covering more than two third of the tendon is rarely seen. A 70 year old patient with a 12 cm long Achilles tendon ossification is discussed. The ossification was surgically removed and the tendon was subsequently reconstructed using a fascia lata autograft. Postoperatively the ankle was immobilised for 3 months. One year postoperatively the patient was completely recovered with the ability to stand on his toes, and minimal loss in range of motion. LEVEL OF CLINICAL EVIDENCE: 4.

Chevron versus Mitchell osteotomy in hallux valgus surgery: a comparative study.

Good clinical results have been reported for chevron and Mitchell osteotomies in mild hallux valgus (HV). The primary aim of the present study was to compare first metatarsal shortening after chevron and Mitchell osteotomies in HV. The secondary outcome measures were the degree of valgus correction, metatarsalgia, and patient satisfaction. A total of 84 patients were included in the present study and were treated from 2005 to 2007; 42 patients were in each group. The outcome measurements-first metatarsal length, HV angle, 1-2 intermetatarsal angle, satisfaction, and metatarsalgia-were taken preoperatively and at follow-up. The Mitchell osteotomy resulted in a significantly larger decrease in the first metatarsal length. No significant difference in transfer metatarsalgia was found. Approximately 30% of patients were mildly or not satisfied after HV surgery. Mitchell osteotomy leads to a larger decrease in the first metatarsal length. Patients with metatarsalgia performed poorly, and no significant differences in metatarsalgia were found. Preventing postoperative metatarsalgia is important for a successful outcome after HV surgery.