Modern trabecular metal-backed glenoid components in total shoulder arthroplasty: What is the evidence? A systematic review.

BACKGROUND: A number of papers have been published reporting on the clinical performance of modern trabecular metal-backed glenoid components in total shoulder arthroplasty. However, no systematic review of the literature has been published to date. METHODS: The US National Library of Medicine (PubMed/MEDLINE), and the Cochrane Database of Systematic Reviews and EMBASE were queried for publications from January 1980 to October 2019 utilizing keywords pertinent to total shoulder arthroplasty, trabecular metal, and clinical outcomes. RESULTS: Overall, seven articles were included for analysis (322 operated shoulders, mean follow-up range: 2-4 years). The survival rate of modern trabecular metal-backed glenoid components was 96% (309 out of 322 cases) at 43 months mean follow-up, while the rate of aseptic loosening was 0.3% (1 out of 322 cases). There were 35 cases (10.9%) with glenoid component radiolucency (one of them required revision), and 37 cases (11.5%) of metal debris formation, with four of them undergoing revision. CONCLUSIONS: There was low quality evidence to show that the use of modern trabecular metal-backed glenoid components in total shoulder arthroplasty may be safe and effective at short-term follow-up. However, this analysis showed alarmingly high rates of both radiolucency of the glenoid component and metal debris formation which raise concern for potential failure of this glenoid component in the long term. Therefore, we feel that modern trabecular metal-backed glenoid components should be still used with caution as part of a structured surveillance or research program until we know if there is a detriment to the prosthesis in the medium to long term.Level: Systematic review, IV.

Excellent Clinical and Radiological Midterm Outcomes for the Management of Recurrent Anterior Shoulder Instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System: 3-Year Clinical Case Series With No Loss to Follow-Up.

PURPOSE: To evaluate the clinical, functional, and radiological midterm outcomes of the all-arthroscopic modified Eden-Hybinette procedure in patients with recurrent anterior shoulder instability. METHODS: A retrospective, single-center case series with prospectively collected data was conducted. The inclusion criterion was traumatic recurrent anterior shoulder instability with significant glenoid bone loss; patients with atraumatic or multidirectional instability were excluded. An all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double-pair button fixation was carried out. All patients were postoperatively assessed for recurrence and apprehension. Shoulder range of motion values and functional scores, including American Shoulder and Elbow Surgeons Score, Oxford instability, Rowe instability, and Walch-Dupplay, were recorded. Graft positions, healing, and absorption were evaluated with computed tomography. Comparisons of values were performed with paired t tests for normally distributed differences and with nonparametric Wilcoxon's signed rank test otherwise. RESULTS: The final study cohort included 28 patients, mean age 36 ± 10 years, and mean follow-up period 43 ± 6 months (range 36 to 53). Median glenoid bone loss was 12.4% (range 8% to 33%). No recurrence occurred, no subjective shoulder instability was reported, and no major complications were documented through the last follow-up. Postoperative shoulder range of motion had no significant differences compared with the healthy side. All final postoperative functional scores significantly increased to show excellent results compared with preoperative values. All grafts were positioned and healed optimally, and none was completely reabsorbed. CONCLUSIONS: The all-arthroscopic modified Eden-Hybinette procedure is safe, leading to excellent clinical and radiological midterm outcomes in patients with recurrent anterior shoulder instability. This technique restores glenoid bone defects and preserves the normal shoulder anatomy. LEVEL OF EVIDENCE: IV, therapeutic, retrospective case series.

Derotational Subtrochanteric Osteotomy and External Fixation for the Treatment of Neurogenic Hip Dislocation in Children with Cerebral Palsy: Could This Be a Viable Method of Treatment?

Purpose The treatment of painful and chronic dislocated hip in children with severe cerebral palsy (CP) is particularly demanding and controversial. Numerous surgical techniques have been described, and their outcomes vary a lot. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy (VDSO) and external osteosynthesis: (VDSOEO). Methods Six non-ambulatory children with spastic quadriplegia and chronic dislocated painful hips were treated. The technique involved a small incision on the subtrochanteric site of the osteotomy, followed by retention with a single-sided external osteosynthesis with rotational correction capability [swiveling clamp (SC)] for the reduction of the femur head in the acetabulum, and finally by the osteotomy. Hardware was removed without a second intervention four-six months postoperatively and after the osteotomy was healed. Evaluation of the method was based on clinical, functional, and radiological criteria. Results  Four patients achieved improved radiological scores. Two patients demonstrated resubluxation during the period of the osteotomy's healing process. However, no patients experienced pain, and all were able to sit post-surgery, while caregivers reported improved capacity for nursing care. Conclusions It is our strong belief that this approach can improve the quality of life in children with severe CP and painful and chronic dislocated hips. It is a viable and definitely less invasive procedure than classic pelvic or femur osteotomies.

Dissociation of Modular Total Hip Arthroplasty at the Neck-stem Interface: A Unique but Possible Complication.

 Mechanical failure of total hip arthroplasty (THA) is often related to dislocation of the hip. In hip arthroplasty with a dual-modularity prosthesis, the surgeon has to face the unique disadvantage of the dissociation of its components. Most cases reported are related to the dissociation of the neck-head interface and only an extremely small percentage is due to dissociation at the neck-stem interface. We report a case with dissociation at the neck-stem interface generated by a fall. Possible reasons for dissociation of the modular system are presented. An open reduction using the same neck system was performed. We suggest that surgeons should be aware of this particular problem, which is related to the nature of the system.

Multifocal Οsteomyelitis Localization after Pyomyositis in Children: Importance of Timely Response.

Pyomyositis is a rare bacterial infection that used to prevail in tropical areas for the past century. Nowadays though, more and more cases are reported in high-temperature climate areas. Diagnosis is often delayed due to the variance in clinical presentation, the challenging nature of physical examination of a child, and lack of specific laboratory investigating tools. When the diagnosis is delayed, the outcome may be unpredictable. Multifocal localization through hematogenous or direct spread that may affect the skeletal bone tissue is common. Timely diagnosis and response is a race against septic shock. We present a case series of seven children diagnosed with pyomyositis due to Staphylococcus aureus. High or less clinical suspicion has obviously affected the final outcome since two patients who were not treated in time were subjected to a life-threatening hazard. Five patients who were diagnosed and treated within the first three days after initiation of their symptoms had a predictable and good outcome without complications.

Strangling Congenital Constriction Ring Band of the Forearm with Fracture: A Rare Case Report.

Congenital constriction ring syndrome (CCRS) is a well-described pathological entity that is caused by fibrous bands that entrap parts of the fetus. The manifestations of this syndrome may vary a lot. We present a case of an almost intrauterine amputation of a fetus's upper limb. Our case is infrequent because the constriction band caused a fracture of the fetus's forearm during pregnancy. Both the band and the fracture resulted in ischemia to the hand and a salvage procedure was applied after birth. Not many authors have reported fractures due to constriction ring bands and even less have reported fractures of the upper limb. A literature review of this rare entity was conducted.

All-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill-Sachs Lesion Caused by Locked Posterior Shoulder Dislocation.

Purpose This study aims to investigate the clinical and functional outcomes of the all-arthroscopic McLaughlin procedure in a clinical series of patients suffering by neglected locked posterior shoulder dislocation. Methods A retrospective clinical study based on prospectively collected data was conducted in a single center regarding 10 patients with neglected locked posterior shoulder dislocation and concomitant reverse Hill-Sachs lesion, who were treated with the all-arthroscopic Mclaughlin procedure. The average humeral bone defect was 39 ± 7% according to the preoperative computed tomography evaluation. The mean time of follow-up was 77 ± 16 months (range, 63-104 months). Results No patient had suffered a new dislocation, whereas all of them were satisfied with the surgical outcome and returned to their previous activities of daily living. External rotation was restored to every patient studied from 0 degrees at the baseline. At the last follow-up, the median external rotation beside the body was 90 degrees (range, 50-90 degrees; p < 0.01) and the respective measurement at 90 degrees of abduction was 90 degrees (range, 80-90 degrees; p < 0.01). The active forward flexion was increased ( p < 0.01), from 60 degrees (range, 30-180 degrees) at the baseline to 180 degrees (range, 160-180 degrees) at the last follow-up and the internal rotation was gained ( p < 0.01) from the level of buttock (range, lateral thigh-T12) at the baseline to the T11 level (range, T7-L3) at the last follow-up. The median UCLA score was increased from 8 (range, 4-22) to 35 (range, 33-35; p < 0.01) and the Oxford instability score from 5 (range, 3-16) to 46 (range, 43-48; p < 0.01), respectively. Conclusion The arthroscopic McLaughlin procedure in substantial reverse Hills-Sachs lesion caused by locked posterior dislocation leads to excellent clinical and functional results in the long-term follow-up. Level of Evidence This is a therapeutic study, case series with no comparison group, Level IV.