The modified Latarjet procedure in female patients: clinical outcomes and complications.

BACKGROUND: The aim of this study was to assess the short- and medium-term complications and clinical outcomes of female patients after a modified Latarjet procedure. A review of the literature was also conducted for outcomes of the modified Latarjet procedure in female patients and differences reported between male and female patients. METHOD: We retrospectively reviewed the clinical notes of all female patients who had modified Latarjet procedures from 2001 with at least 1 year of follow-up. Patients were interviewed for an Oxford Shoulder Score, Western Ontario Shoulder Instability Index, Oxford Shoulder Instability Score, and subjective shoulder value. A literature review was performed of the electronic database PubMed; 343 papers were assessed for clinical outcomes based on gender. RESULTS: Twenty-nine patients were available for inclusion in the study. There were 13 complications in 11 patients (34%). The median postoperative Western Ontario Shoulder Instability Index score was 433; Oxford Shoulder Score, 42; and Oxford Shoulder Instability Score, 36. The median subjective shoulder value was 87%. Of these patients, 37.5% returned to sport. The reoperation rate was 13.8%. We found no literature reporting the outcomes of the modified Latarjet procedure in female patients. CONCLUSION: There are no published data comparing outcomes of the modified Latarjet procedure in male and female patients. Female patients had a lower postoperative return to sport and shoulder scores after the modified Latarjet procedure compared with literature reports. Whereas female gender should not be a contraindication to the Latarjet procedure, selection of patients in this group may need to be more stringent.

Outcomes After Ulnar Nerve In Situ Release During Total Elbow Arthroplasty.

PURPOSE: Ulnar nerve (UN) lesions are a significant complication after total elbow arthroplasty (TEA), with potentially debilitating consequences. Outcomes from a center, which routinely performs an in situ release of the nerve without transposition, were investigated. METHODS: Eighty-three primary TEAs were retrospectively reviewed for the intraoperative management of the UN and presence of postoperative UN symptoms. RESULTS: Three patients had documented preoperative UN symptoms. One patient had a prior UN transposition. The nerve was transposed at the time of TEA in 4 of the remaining 82 elbows (5%). The indication for transposition in all cases was abnormal tracking or increased tension on the nerve after insertion of the prosthesis. Of the 4 patients who underwent UN transposition, 2 had postoperative UN symptoms. Both were neuropraxias, which resolved in the early postoperative period. The remaining 78 TEAs received an in situ release of the nerve. The incidence of postoperative UN symptoms in the in situ release group was 5% (4 of 78). Two patients had resolution of symptoms, whereas 2 continued to experience significant UN symptoms requiring subsequent transposition. Seven patients had preoperative flexion of less than 100°. Of these, 2 had a UN transposition at the time of TEA. Of the remaining 5 elbows with preoperative flexion less than 100°, 2 had postoperative UN symptoms after in situ release, with 1 requiring subsequent UN transposition. CONCLUSIONS: A 3% incidence of significant UN complications after TEA compares favorably with systematic reviews. We do not believe that transposition, which adds to the handling of the nerve and increases surgical time, is routinely indicated and should rather be reserved for cases with marked limitation of preoperative elbow flexion or when intraoperative assessment by the surgeon deems it necessary. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Total elbow arthroplasty in bleeding disorders: an additional series of 8 cases.

BACKGROUND: Total elbow arthroplasty (TEA) is a surgical option for an arthropathy secondary to a bleeding disorder. The literature consists of small case series. Our series provides further understanding into the outcomes of TEA in this population of patients. METHODS: Five patients underwent 8 primary TEAs for a bleeding disorder. Average age at time of surgery was 47 years. Four patients had hemophilia type A and 1 had von Willebrand disease. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS) and the visual analog scale (VAS) for pain. Follow-up radiographs were evaluated for signs of loosening and infection. RESULTS: Revision surgery was performed in 3 TEAs. Two revisions were performed for aseptic loosening (104 and 118 months postoperatively). The third elbow underwent an excision arthroplasty for a deep infection 44 months postoperatively. Mean follow-up for the primary TEAs still in situ (5 elbows) was 114 months. The mean VAS score improved from 8 to 0 and MEPS from 35 to 95. The mean flexion arc improved from 70° to 100°, and rotation improved from 60° to 160°. Mean follow-up for the revised TEAs (3 elbows) was 94 months. The mean VAS score improved from 7 to 0 and the MEPS from 40 to 85. The mean flexion arc improved from 60° to 95°, and rotation improved from 70° to 160°. CONCLUSIONS: Excellent clinical outcomes and an acceptable survival rate for TEAs, comparable with the nonhemorrhagic population, can be achieved in patients with bleeding disorders. Revision arthroplasty in this group of patients yields good clinical outcomes at medium-term follow-up.

Total elbow arthroplasty: outcomes after triceps-detaching and triceps-sparing approaches.

BACKGROUND: Total elbow arthroplasty (TEA) is associated with high complication rates compared with other large-joint arthroplasties. The frequency and type of complication may differ, depending on the surgical approach. A comparison of outcomes with triceps-off and triceps-on approaches was investigated. METHODS: Seventy-three patients underwent 83 primary TEAs between 2003 and 2012. Forty-six elbows had a triceps-off approach, and 37 had a triceps-on approach. Results were reviewed at a mean of 4.2 years. Cementing technique was graded according to Morrey's criteria, and clinical outcomes were assessed by means of the Mayo Elbow Performance Score. RESULTS: There was no statistically significant difference between the triceps-off and triceps-on groups with regard to the patient's age, gender, preoperative Mayo Elbow Performance Score or range of motion, or previous surgery on the affected elbow. Among patients who underwent a TEA for an inflammatory arthropathy, there was a significant difference in outcome between groups with regard to final flexion, extension, arc of motion, and pronation. Cementing technique in the triceps-off group was adequate in 70%. In the triceps-on group, cementing technique was adequate in 92%. The complication rate in the triceps-off group was 32.6% and included 7 triceps ruptures. Three patients who had attempted repairs of the triceps rupture developed deep infections requiring multiple further surgeries. The complication rate in the triceps-on group was 8.1%. CONCLUSION: A triceps-on approach in TEA results in consistently good clinical outcomes with no risk of triceps rupture, and the approach does not compromise the cement mantle. We believe that this approach will reduce complication rates in TEA.