Implant breakage after shoulder arthroplasty: a systematic review of data from worldwide arthroplasty registries and clinical trials.

BACKGROUND: Implant breakage after shoulder arthroplasty is a rare complication after aseptic loosening, infection or persistent pain, resulting in malfunction of the components requiring revision surgery. This correlates with a high burden for the patient and increasing costs. Specific data of complication rates and implant breakage are available in detailed arthroplasty registries, but due to the rare occurrence and possibly underestimated value rarely described in published studies. The aim of this systematic review was to point out the frequency of implant breakage after shoulder arthroplasty. We hypothesized that worldwide arthroplasty registry datasets record higher rates of implant breakage than clinical trials. METHODS: PubMed, MEDLINE, EMBASE, CINHAL, and the Cochrane Central Register of Controlled Trials database were utilized for this systematic review using the items "(implant fracture/complication/breakage) OR (glenoid/baseplate complication/breakage) AND (shoulder arthroplasty)" according to the PRISMA guidelines on July 3rd, 2023. Study selection, quality assessment, and data extraction were conducted according to the Cochrane standards. Case reports and experimental studies were excluded to reduce bias. The breakage rate per 100,000 observed component years was used to compare data from national arthroplasty registries and clinical trials, published in peer-reviewed journals. Relevant types of shoulder prosthetics were analyzed and differences in implant breakage were considered. RESULTS: Data of 5 registries and 15 studies were included. Rates of implant breakage after shoulder arthroplasty were reported with 0.06-0.86% in registries versus 0.01-6.65% in clinical studies. The breakage rate per 100,000 observed component years was 10 in clinical studies and 9 in registries. There was a revision rate of 0.09% for registry data and 0.1% for clinical studies within a 10-year period. The most frequently affected component in connection with implant fracture was the glenoid insert. CONCLUSION: Clinical studies revealed a similar incidence of implant failure compared to data of worldwide arthroplasty registries. These complications arise mainly due to breakage of screws and glenospheres and there seems to be a direct correlation to loosening. Periprosthetic joint infection might be associated with loosening of the prosthesis and subsequent material breakage. We believe that this analysis can help physicians to advise patients on potential risks after shoulder arthroplasty. LEVEL OF EVIDENCE: III.

[Ankle dislocation without osseous lesions]. / Luxation des oberen Sprunggelenks ohne ossäre Läsion.

Approximately 7-10% of all emergency department patients are diagnosed with distortion of the upper ankle joint. A dislocation of the upper ankle joint without fracture is described in the literature as being very rare. In 33-50% the ankle dislocations are at least first-degree open and associated with a fracture of the tibia, the fibula or the talus. We report the course, treatment and results 12 months after trauma of a posteromedial first-degree open dislocation of the upper ankle joint without fracture. To our knowledge, there is no record of this pathology mentioned in the German language literature.

Total Hip Arthroplasty Improves the Quality-Adjusted Life Years in Patients Who Exceeded the Estimated Life Expectancy.

BACKGROUND: Hip osteoarthritis is a leading cause of functional decline and disability in the elderly. Although patients older than 80 years could significantly benefit from an elective total hip arthroplasty (THA), they pose a significant challenge to both anesthesiologist and arthroplasty surgeon. The purpose of this study was to report the clinical outcomes, complication rate, mortality, and quality-adjusted life year (QALY) of THA in patients who already exceeded the average life expectancy. METHODS: Patients treated with elective THA for debilitating hip osteoarthritis and already exceeded the average life expectancy in Switzerland (n = 100) were included. The complication rate, QALY, and 30-day, 1-year, and midterm mortality were assessed retrospectively. RESULTS: The overall complication rate was 12%. The 30-day and 1-year mortality was 3% and 6%, respectively. The Harris hip score increased significantly from an average of 50 preoperative to 93 points postoperative. Most of the patients (98%) had an improvement in the Harris hip score that was above the threshold for minimally significant change, whereas 75% reported an increase that exceeded the moderate improvement threshold. The average QALY was 4 years. CONCLUSION: THA might be a safe and cost-effective procedure for improving pain, function, and quality of life with low mortality in selected elderly patients who already exceeded the average life expectancy. Hence, the arthroplasty surgeons should not hesitate to operate relatively active, independent, and cognitively intact elderly patients having debilitating hip osteoarthritis based only on the patient's age. Nevertheless, careful patient selection, surgical indications, and aggressive perioperative optimization might be necessary to minimize the risk of preoperative complications.

Successful Management of Type 2 Diabetes with Lifestyle Intervention: A Case Report.

BACKGROUND: The prevalence of diabetes is growing worldwide. The primary symptom of diabetes mellitus is elevated blood sugar. This is usually treated with lifestyle intervention and drugs according to an algorithm based on glycated hemoglobin (HbA1c) levels. We present the case of a patient who successfully managed his type 2 diabetes solely through lifestyle modification. CASE REPORT: A 45-year-old businessman with a body mass index of 27 kg/m2 was examined within a secondary prevention program in Austria. His HbA1c was 9.7%-type 2 diabetes mellitus was diagnosed. General recommendations for lifestyle were given and metformin was prescribed. Upon his diagnosis the patient searched for all the information he could get about diabetes and implemented this new knowledge in his everyday life. He had a strong desire to defeat his disease and he wanted to stop using medications. He identified some nutritional ingredients and spices that affected his blood sugar in a positive way. He stopped taking metformin after 4 weeks and handled his diabetes with his personal lifestyle program. Three months after the diagnosis his HbA1c was 6.4%; after 6 months he had an HbA1c of 6.0% without the use of medication. DISCUSSION: Usually, multiple drug therapy is necessary to handle high blood glucose levels. Our business manager ate as much as before his diagnosis but he modified the contents of his diet so that the lifestyle intervention was not hard for him. General recommendations for lifestyle modification usually include: more exercise, reduced sugar and monosaccharides, and less alcohol and nicotine. With the knowledge of the effects of specific dietary ingredients, it might be possible to modify a regular diet in such a way as to benefit people with type 2 diabetes, to substantially improve quality of life.

Early locking plate removal following open reduction and internal fixation of proximal humeral fractures could prevent secondary implant-related complications.

INTRODUCTION: Proximal humeral fracture is a common cause of morbidity in the elderly and poses a challenge for the orthopedic surgeon. Open reduction and internal fixation (ORIF) with a locking plate is associated with high rate of secondary implant-related complications (IRC). Early implant removal could potentially reduce the risk of IRC and further improve the outcome in relatively asymptomatic patients. The purpose of this study was to evaluate the clinical and radiologic outcomes following implant removal. METHODS: A total of 56 patients with an average age of 63 ±â€¯13 years and a mean follow-up of 29 months were evaluated retrospectively following removal of a locking plate in the proximal humerus. Postoperative functional outcomes were evaluated with the Constant-Score, Subjective shoulder value and Quick-DASH score. RESULTS: Early implant removal resulted in high functional outcomes with 96% of the patients reporting an improvement of their shoulder function following implant removal. No intraoperative complications were reported. Avascular necrosis (AVN) of the humeral head occurred in 12.5% of the patients, but no secondary screw cut-out was reported. CONCLUSION: Early implant removal might be a safe option to avoid secondary IRC with significant subjective functional improvement also in asymptomatic patients. Although early implant removal cannot reverse the process of AVN, it could potentially prevent secondary IRC and subsequent glenohumeral cartilage destruction.

Power Point Therapy: An Effective and Simple Treatment for Subacute Back Pain - A Randomized Controlled Trial.

OBJECTIVE: Subacute low back pain is a frequent problem with the danger of chronification. Conventional treatment options are not always effective. Power Point therapy (PPT) is a novel approach that uses reflexological insights and can be easily applied by practitioners and patients. METHODS: Randomized, active controlled study comparing 10 units of PPT of 10 min each, with 10 units of standard physiotherapy of 30 min each. Outcomes were functional scores (Roland Morris Disability, Oswestry, McGill Pain Questionnaire, Linton-Halldén - primary outcome) and health-related quality of life (SF-36), as well as blinded assessments by clinicians (secondary outcome). RESULTS: Eighty patients consented and were randomized, 41 to PPT, 39 to physiotherapy. Measurements were taken at baseline, after the first and after the last treatment (approximately 5 weeks after enrolment). Multivariate linear models of covariance showed significant effects of time and group (p < 0.001) and for the quality of life variables also a significant interaction of time by group (p < 0.001). Clinician-documented variables showed significant differences at follow-up (p = 0.05 to p < 0.0001). DISCUSSION: Both physiotherapy and PPT improve subacute low back pain significantly. PPT is likely more effective and should be studied further.