Glenoid component insertion in total shoulder arthroplasty: comparison of three techniques for drying the glenoid before cementation.

This prospective randomized study compared the immediate postoperative periglenoid radiolucencies among 3 glenoid-drying techniques used in total shoulder arthroplasty. Seventy-one consecutive patients with primary osteoarthritis underwent total shoulder arthroplasty by use of 1 prosthetic system with convex-back, keeled, polyethylene glenoid components; the same modern, instrumented pressurization technique was used to cement all glenoids. Of the shoulders, 21 had glenoid implants cemented after bony preparation with thrombin-soaked gel foam, 24 after compressed gas lavage, and 26 after saline solution lavage with sponge drying. The immediate postoperative anteroposterior radiographs were examined to evaluate the presence of periglenoid radiolucencies. Of the patients, 29 (41%) had radiolucencies evident immediately postoperatively, with all radiolucencies occurring in the faceplate zones. The mean total radiolucent line score was 0.63 (P = .94), with no significant difference among cementing preparation techniques (P = .89). Prosthetic mismatch did not differ among glenoid preparation techniques (P = .86). There was no statistical association between prosthetic mismatch and radiolucent line score either across (P = .62) or within (P = .99) the glenoid preparation groups. The associated costs in the gel foam group and compressed gas lavage group were 70 times higher than the cost in the saline solution lavage group. All radiolucencies were noted in the faceplate zones, with no radiolucency greater than 2 mm. Preparation of the glenoid surface for cementing showed no significant difference among the 3 techniques studied, although the material costs were significantly higher in the gel foam and compressed gas lavage groups compared with the saline solution lavage group.

Biomechanical testing of cadaveric specimens: importance of bone mineral density assessment.

The bone density of cadaveric specimens is highly variable and has a significant effect on the results of biomechanical testing but it is not often assessed before testing is performed in the lab. Bone mineral density (BMD) tests such as dual X-ray absorptiometry (DXA) are widely available, easy to perform and correlate highly and significantly with bone strength in many modes of failure. We present the results of two different studies performed on cadaveric foot and ankle specimens. In these studies the results vary significantly according to BMD, and this effect is not always eliminated with the use of matched pairs of cadaveric specimens.

Incidence of perihepatic adhesions in ectopic gestation.

OBJECTIVE: To compare the incidence of perihepatic adhesions in patients undergoing surgery for ectopic pregnancy with the incidence in patients undergoing elective laparoscopic sterilization. Fitz-Hugh-Curtis syndrome is a perihepatitis that usually occurs as a complication of pelvic inflammatory disease. Perihepatic adhesions may be an aftereffect of the acute hepatic episode, and because the cause of ectopic gestation is thought to be salpingitis, women with an ectopic gestation may also have a higher prevalence of coexisting perihepatic adhesions. METHODS: We reviewed charts of 97 women who had undergone laparoscopy or laparotomy for ectopic pregnancy (study group) and 116 women who had laparoscopic sterilization (control group). We recorded all perihepatic, pelvic, or abdominal adhesions that were documented at the time of surgery. Medical histories and sites of adhesions in the two groups were compared. RESULTS: The incidence of perihepatic adhesions was 14% in the study group compared with 3% in the control group (P < .01). For the total patient population, a history of pelvic infection correlated positively with the presence of perihepatic adhesions (P < .01), and the study (ectopic) group had a higher incidence of previous pelvic infection. CONCLUSION: Compared with control subjects, significantly more women with ectopic pregnancies had perihepatic adhesions. In women who have history of pelvic infection or ectopic pregnancy, physicians should inquire about long-term right upper quadrant pain. The inclusion of lysis of perihepatic adhesions in the preoperative consent form may be useful.