Experience with Tissue Bank Services in 2014 and 2020 in Turku, Finland.

BACKGROUND: The objective of a musculoskeletal tissue bank is to collect, test, store, and provide musculoskeletal tissue allografts required in orthopedic procedures. Strict exclusion criteria are followed when selecting suitable cadaver musculoskeletal tissue donors, and the allografts are procured under sterile conditions to avoid bacterial contamination. Tissue banking in Turku, Finland, began in 1972, and tissue bank services were last reviewed in 2003. This study aimed to review the operation of the musculoskeletal tissue bank in Turku, Finland, between 2014 and 2020 and to analyze the number, types, and contamination rate of the allografts procured from the cadaver donors. Potential donor-related factors causing bacterial contamination of the allografts and whether potential musculoskeletal tissue donors were overlooked among multiorgan donors were also studied. METHODS: A retrospective review of all cadaver musculoskeletal tissue donors used in the Hospital District of Southwest Finland Tyks Orto Musculoskeletal Tissue Bank during the study period was conducted, and data on the procured allograft was collected and presented. The donors were selected among patients treated in the intensive care unit (ICU) of Turku University Hospital (TYKS). RESULTS: A total of 28 cadaver donors were used, and 636 allografts were procured between 2014 and 2020. The bacterial contamination rate was 2.5%, which was lower than that in the previous international literature. The median treatment time in the ICU was significantly longer, and the median value of the highest C-reactive protein level was significantly higher in the group of donors with positive allograft bacterial cultures. CONCLUSIONS: The bacterial contamination rate in the tissue bank was low on an international scale. Some suitable musculoskeletal tissue donors were overlooked among multiorgan donors.

Proximal humeral fractures in Finland : trends in the incidence and methods of treatment between 1997 and 2019.

AIMS: Proximal humeral fractures (PHFs) are common. There is increasing evidence that most of these fractures should be treated conservatively. However, recent studies have shown an increase in use of operative treatment. The aim of this study was to identify the trends in the incidence and methods of treatment of PHFs in Finland. METHODS: The study included all Finnish inhabitants aged ≥ 16 years between 1997 and 2019. All records, including diagnostic codes for PHFs and all surgical procedure codes for these fractures, were identified from two national registers. Data exclusion criteria were implemented in order to identify only acute PHFs, and the operations performed to treat them. RESULTS: During the 23-year study period, 79,676 PHFs were identified, and 14,941 operations were performed to treat them. The incidence of PHFs steadily increased. In 2019, the overall incidence was 105 per 100,000 person-years (105). The sex-adjusted incidence for females was 147.1 per 105, and the age-adjusted incidence for patients aged ≥ 80 years was 407.1 per 105. The incidence of operative treatment for PHFs rose during the first half of the study period and decreased during the second half. The use of plate osteosynthesis in particular decreased. In 2019, the incidence of operative treatment for PHFs was 13.2 per 105, with 604 operations. CONCLUSION: Although the incidence of PHFs is steadily increasing, particularly in elderly females, the incidence of operative treatment is now decreasing, which is in line with current literature regarding their treatment. Cite this article: Bone Joint J 2022;104-B(1):150-156.

Radiographic geometry and clinical glenohumeral range of motion after reverse shoulder athroplasty, a retrospective cohort study.

BACKGROUND: The range of motion (ROM) in reverse shoulder arthroplasty (RSA), is mechanically limited by the surrounding bony obstacles especially in abduction and rotation planes. However, the clinical effect of implant positioning, prosthesis design, and individual differences in bone morphology, on ROM is obscure. The aim of this study was to investigate the correlation between radiographic geometry and clinical glenohumeral (GH) ROM after RSA. METHODS: RSA patients operated at Turku University Hospital during 2007-2013 were called for radiological and clinical follow-up. Pre- and postoperative true anteroposterior radiographs were obtained and the positioning of the center of rotation (COR) in relation to the surrounding bony structures was measured. Active and passive shoulder and GH abduction, flexion, internal and external rotation ROM were measured with goniometer. The Constant score (CS) and pain visual analogue scale (VAS) were recorded. The correlation between the radiographically measured parameters and the active and passive ROM and clinical outcome was statistically analyzed. RESULTS: 91 shoulders were available for analyses with a mean follow-up of 38.7 months ± SD 20 (range 12-83) months. 77% of the patients were female, the mean age was 73 (SD 9) years. The mean angle between the line of supraspinatus fossa, and the line between COR and lateral edge of the acromion (α-angle) was 127° (SD 14) and the mean angle between the lines from lateral edge of the acromion to COR, and from there to the superior edge of the greater tubercle (ß-angle) was 54° (SD 11). The mean active shoulder flexion at follow-up was 118° (SD 26), abduction 104° (SD 32), external rotation 41° (SD 22), internal rotation 77° (SD 21). The mean passive GH flexion was 80° (SD 19), abduction 67° (SD 15), external rotation 31° (SD 16) and internal rotation 34° (SD 14). The mean Constant score at follow-up was 53 (SD 18) and pain VAS 2 (SD 3). The positioning of the radiographically measured COR did not statistically significantly correlate with the ROM or clinical outcome scores. CONCLUSIONS: Postoperative radiographically measured two-dimensional geometry and positioning of the COR does not significantly correlate with the glenohumeral range of motion or clinical results after RSA. LEVEL OF EVIDENCE: Level 3, retrospective cohort study.

Bankart versus Latarjet operation as a revision procedure after a failed arthroscopic Bankart repair.

BACKGROUND: An arthroscopic Bankart operation is the most common operative procedure to treat shoulder instability. In case of recurrence, both Bankart and Latarjet procedures are used as revision procedures. The purpose of this study was to compare the re-recurrence rate of instability and clinical results after arthroscopic revision Bankart and open revision Latarjet procedures following failed primary arthroscopic Bankart operations. METHODS: Consecutive patients operatively treated for shoulder instability at Turku University Hospital between 2002 and 2013 were analyzed. Patients who underwent a primary arthroscopic Bankart operation followed by a recurrence of instability and underwent a subsequent arthroscopic Bankart or open Latarjet revision operation with a minimum of 1 year of follow-up were called in for a follow-up evaluation. The re-recurrence of instability, Subjective Shoulder Value, and Western Ontario Shoulder Instability index were assessed. RESULTS: Of 69 patients, 48 (dropout rate, 30%) were available for follow-up. Recurrent instability symptoms occurred in 13 patients (43%) after the revision Bankart procedure and none after the revision Latarjet procedure. A statistically and clinically significant difference in the Western Ontario Shoulder Instability index was found between the patients after the revision Bankart and revision Latarjet operations (68% and 88%, respectively; P = .0166). CONCLUSIONS: The redislocation rate after an arthroscopic revision Bankart operation is high. Furthermore, patient-reported outcomes remain poor after a revision Bankart procedure compared with a revision Latarjet operation. We propose that in cases of recurring instability after a failed primary Bankart operation, an open Latarjet revision should be considered.

Low risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures.

BACKGROUND: Reverse shoulder arthroplasty (RSA) has gained popularity in the treatment of proximal humeral fractures (PHFs), especially in elderly patients. The purpose of this study was to investigate the use of RSA implants for acute PHFs and risk of revision, as well as risk factors for revision. METHODS: RSA implants for acute PHFs were identified from the Nordic Arthroplasty Register Association registry data from 2004 to 2016. Kaplan-Meier survival analysis was used to calculate implant survival. Cox multiple regression analysis was used to calculate the adjusted revision rate for sex, age, country of operation, and year of surgery. RESULTS: The study included 1523 RSA implants for PHFs (84% women; average age, 77 years; average follow-up time, 2.5 years). The 5-year cumulative implant survival rate was 97% (confidence limits, 95.5% and 98%). Revision was performed for 33 implants (2%). The most common reason for revision was instability, occurring in 11 cases (0.7%), followed by fracture, occurring in 6 (0.4%), and infection, occurring in 5 (0.3%). Four different arthroplasty brands were used in this cohort, with the Delta Xtend in two-thirds of cases (n = 1025). Age younger than 60 years and male sex were associated with slightly higher rates of revision; however, these differences did not reach statistical significance (hazard ratio of 2.02 with P = .075 and hazard ratio of 3.23 with P = .057, respectively). CONCLUSION: The use of RSA for acute PHFs is increasing in the Nordic countries. The short-term risk of revision is low. The main reason for revision of RSA for this indication is instability.

Risk and risk factors for revision after primary reverse shoulder arthroplasty for cuff tear arthropathy and osteoarthritis: a Nordic Arthroplasty Register Association study.

BACKGROUND: Reverse shoulder arthroplasty (RSA) has gained increasing popularity in the treatment of rotator cuff tear arthropathy (CTA). The purpose of this study was to evaluate the survival of RSA and the risk factors for revision following RSA. METHODS: RSA patients with CTA or osteoarthritis were identified from the Nordic Arthroplasty Register Association registry data (2004-2013). Kaplan-Meier survival analysis was used to calculate survival probabilities. Cox multiple regression analysis was used to calculate revision rates adjusted for sex, arthroplasty brand, age (<70 years), and year of surgery. RESULTS: The study included 1904 patients with RSA (1904 RSAs) (69% women; mean age, 74 years; age range, 35-97 years). Revision was performed in 95 patients (5%), with a 10-year cumulative revision rate of 0.91. The most common reason for revision was infection (n = 42), followed by loosening (n = 16) and instability (n = 12). Most revisions occurred less than 6 months after the primary operation. Men had a significantly increased risk of revision compared with women (risk ratio, 3.8; 95% confidence interval, 2.4-6.1). The most common implants were the Delta Xtend (n = 1366) and Delta Mark III (n = 246). The risk of revision of the Delta Mark III was 2.1 (95% confidence interval, 1.1-4.3) compared with the Delta Xtend. Age and year of surgery were not statistically significantly associated with risk of revision. CONCLUSION: The overall midterm risk of revision after RSA for CTA was low (5%). The most common reason for early revision was infection. Male sex was associated with a significantly increased risk of revision.

Surgery or conservative treatment for rotator cuff tear: a meta-analysis.

PURPOSE: Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear. METHOD: Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis. RESULTS: Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p = 0.012) in 1-year follow up but below the level of minimal clinically important difference. CONCLUSION: There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality. Implications for Rehabilitation There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear. As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.

A comparative 18F-FDG PET/CT imaging of experimental Staphylococcus aureus osteomyelitis and Staphylococcus epidermidis foreign-body-associated infection in the rabbit tibia.

BACKGROUND: 18F-FDG-PET imaging has emerged as a promising method in the diagnosis of chronic osteomyelitis commonly due to Staphylococcus aureus. The inaccuracy of 18 F-FDG-PET in the detection of periprosthetic joint infections may be related to the predominance of low-virulent S. epidermidis strains as the causative pathogen. We have compared the18F-FDG-PET characteristics of S. aureus osteomyelitis and foreign-body-associated S. epidermidis infections under standardized laboratory conditions. METHODS: Twenty-two rabbits were randomized into three groups. In group 1, a localized osteomyelitis model induced with a clinical strain of S. aureus was applied. In groups 2 and 3, a foreign-body-associated infection model induced with a clinical or laboratory strain of S. epidermidis was applied. A small block of bone cement was surgically introduced into the medullary cavity of the proximal tibia followed by peri-implant injection of S. aureus (1 × 105 CFU/mL) or one of the two S. epidermidis (1 × 109 CFU/mL) strains with an adjunct injection of aqueous sodium morrhuate. In group 1, the cement block was surgically removed at 2 weeks but left in place in groups 2 and 3 in order to mimic foreign-body-associated S. epidermidis infections. At 8 weeks, the animals were imaged using 18 F-FDG PET/CT. The presence of bacterial infection was confirmed by cultures, and the severity of bone infections was graded by means of radiography, peripheral quantitative CT, and semi-quantitative histology. RESULTS: The S. aureus strain caused constantly culture-positive osteomyelitis. The clinical S. epidermidis strain resulted in foreign-body-associated infections, while the laboratory S. epidermidis strain (ATCC 35983) induced only occasionally culture-positive infections. There was a correlation (r = 0.645; P = 0.013) between semi-quantitative score of leukocyte infiltration and the 18 F-FDG uptake in animals with positive cultures. Standardized uptake value (SUV) of the infected bones was twofold (P < 0.001) in S. aureus animals compared with S. epidermidis animals, but there was only a trend (P = 0.053, ANOVA) in the differences of the corresponding SUV ratios. This was due to the altered 18 F-FDG uptake of the contralateral tibias probably reflecting a systemic impact of severe osteomyelitis. CONCLUSION: The peri-implant inoculation of S. epidermidis, reflecting low virulence of the pathogen and limited leukocyte infiltration, was characterized by low 18 F-FDG uptake.