Preoperative diagnosis and rotator cuff status impact functional internal rotation following reverse shoulder arthroplasty.

PURPOSE: This study aimed to evaluate whether functional internal rotation (fIR) following reverse shoulder arthroplasty (RSA) differs based on diagnosis of either: primary osteoarthritis (OA) with intact rotator cuff, massive irreparable rotator cuff tear (MICT) or cuff tear arthropathy (CTA). METHODS: A retrospective review was carried out on RSAs performed by a single surgeon with the same implant over a 5-year period. Minimum 2-year follow-up was available in 235 patients; 139 (59.1%) were female, and the mean patient age was 72 ± 8 years. Additional clinical evaluation included the Subjective Shoulder Value and Constant score. Postoperative internal rotation was categorized as type I: hand to the buttock or hip; type II: hand to the lower lumbar region; or type III: smooth motion to at least the upper lumbar region. Type I was considered "nonfunctional" internal rotation, and type II and III were fIR. RESULTS: Preoperatively, internal rotation was classified as type I in 60 patients (25.5%), type II in 114 (48.5%), and type III in 62 (26%). Postoperatively, internal rotation was classified as type I in 70 patients (30%), type II in 86 (36%), and type III in 79 (34%). Compared with preoperative status, fIR improved significantly in OA patients (P < .001), with 49 (52.6%) classified as type II or III postoperatively. In CTA patients, there was no significant change (P = .352). In patients with MICTs, there was a significant loss in fIR postoperatively (P = .003), with 25 patients (30.8%) deteriorating to type I after having either type II or III preoperatively, and only 5 patients (6.1%) improving to either type II or III. CONCLUSIONS: Patients who undergo RSA for primary OA have a better chance of postoperative fIR improvement. A decrease in fIR is common after RSA for MICTs.

Sexual dimorphism of the posterior condylar offset of the femur and the medial posterior slope of the tibia in non-arthritic knees of Egyptian adults: an MRI study.

BACKGROUND: The aim of this magnetic resonance imaging (MRI) study was to investigate controversial sexual dimorphism of the posterior condylar offset of the femur (the offset) and the posterior slope of the tibia (the slope) in non-arthritic knees of Egyptian adults. METHODS: On 100 male and 100 female MRIs of non-arthritic knees, linear measurements of the distal part of the femur (the offset) and the angular measurements of the proximal part of the tibia (the slope) were performed and compared regarding sex and ethnicity. The intraclass correlation coefficient (ICC) was used to test the interrater agreement. RESULTS: Both offsets and the lateral offset ratio were larger in males (p < 0.001), the medial offset ratio, and the medial slope in females (p from < 0.001 to 0.007), whereas the lateral slope was sex-free (p = 0.41). Irrespective of sex, however, the medial offset with its ratio, and the medial slope were larger than their counterparts (p < 0.001). Our means of the offsets, their ratios, and the slopes mostly differed from those of other ethnicities (p from ≤ 0.001 to 0.004). ICCs > 0.8 proved MRI's precision was high. CONCLUSION: There was a sexual dimorphism of both the offset and the medial slope in non-arthritic knees of Egyptian adults. We believe future designs of knee implants should consider these differences in order to improve postoperative range of motion and patients' satisfaction after total knee arthroplasty. Level of evidence Level III Retrospective Cohort Study. Trial registration ClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.

Anthropometric measurements of non-arthritic knees in an Egyptian population: an MRI-based study.

BACKGROUND: Knee anthropometric characteristics were evaluated for different ethnicities; however, data from North African populations are deficient. The primary aim was to investigate the Egyptian knees' anthropometric characteristics as a representative of North African populations. Secondary aims are as follows: (1) to study the anthropometric gender difference, (2) to compare results with other ethnic groups, and (3) to study the mismatch in comparison to geometric characteristics of modern TKA implant designs. METHODS: Two hundred normal knee MRI scans (100 females and 100 males, aging from 18 to 60) were obtained for analysis. Linear measurements (anteroposterior (AP), mediolateral (ML), and aspect ratio (AR)) of the planned cut surface of the distal femur (f) and the proximal tibia (t) were evaluated. RESULTS: A significant difference between both sexes was found, males had larger measurements in anteroposterior [fAP: 60.97 ± 3.1 vs 54.78 ± 3.3 (P < 0.001), tAP: 46.89 ± 3.0 vs 41.35 ± 2.9 (P < 0.001)] and mediolateral [fML: 74.89 ± 3.2 vs 67.29 ± 3.7 (P < 0.001), tML: 76.01 ± 3.0 vs 67.26 ± 3.2 (P < 0.001)], the mean femoral and tibial AP and ML measurements were different from other ethnic groups. None of the seven studied TKA systems matched the largest ML or the smallest AP dimensions of the distal femur in the current study population. CONCLUSION: A significant difference was found between males' and females' knee anthropometric characteristics. Some of the commonly used TKA implants in our area could not provide a perfect fit and coverage. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03622034 , registered on July 28, 2018.