Long-term results and arthropathy following the modified Bristow–Latarjet procedure

The incidence of early osteoarthritis after the modified Bristow procedure has been the subject of several articles during the last decade. Recurrent dislocation, recurrent subluxation after surgery or the procedure itself have been suggested as the main causes of degenerative changes. We assessed 19 patients who underwent the Bristow procedure for recurrent anterior dislocations of the shoulder retrospectively. Only one redislocation occurred in 20 shoulders (six women and 13 men) with an average follow-up of 7.7 years. All patients were satisfied and experienced improved stability. Three patients showed arthritic changes (two mild and one moderate), which, surprisingly, were also seen in the opposite shoulder. We therefore conclude that the occurrence of arthropathic changes after surgical stabilisation is based on multiple factors, with the initial dislocation playing a major role.

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Résumé La fréquence dune arthrose précoce après lintervention de Bristow modifiée a été lobjet de plusieurs articles pendant la dernière décennie. Les récidives de luxation, la procédure chirurgicale elle-même ou des translations itératives après la chirurgie ont été suggérées comme les principales causes du processus dégénératif. Nous avons étudié rétrospectivement 19 malades qui ont subi lintervention de Bristow pour luxation antérieure récidivante de lépaule. Seulement une luxation sest produite sur vingt épaules (six femmes et 13 hommes) avec un suivi moyen de 7.7 années. Tous les malades ont été satisfaits avec une amélioration de la stabilité. Trois malades ont présenté une évolution arthrosique (2 moyennes et 1 modérée) laquelle, étonnamment, a aussi été vue dans lépaule opposée. Nous concluons par conséquent que la survenue de larthropathie après la stabilisation chirurgicale est multifactorielle, avec un rôle majeur de la luxation initiale.

     

Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up

This is the first report of clinical and radiologic outcomes for the CHARITE artificial disc with a minimum follow-up of 10 years. A total of 107 patients indicated for total lumbar disc replacement were implanted with the CHARITE prosthesis. Of these 107, 100 were followed for a minimum of 10 years (range 10-13.4 years). A total of 147 prostheses were implanted with 54 one-level and 45 two-level procedures and 1 three-level procedure. The prostheses were placed through a standard anterior retroperitoneal approach. Clinically, 62% had an excellent outcome, 28% had a good outcome, and 10% had a poor outcome. Of the 95 eligible to return to work, 88 (91.5%) either returned to the same job as prior to surgery or a different job. These included 63.2% (12) of those working in heavy labor employment returning to the same job. Mean flexion/extension motion was 10.3 degrees for all levels (12.0 degrees at L3-L4, 9.6 degrees at L4-L5, 9.2 degrees at L5-S1). Mean lateral motion was 5.4 degrees . In the sagittal plane, 9 (6.1%) were anterior of geometric center, 50 (34.0%) were centered, and 88 (59.9%) were posterior of center. In the frontal plane, 110 (75%) were centered, and 37 (25%) were noted to be lateral to center. Slight subsidence was observed in two patients, but they did not require further surgery. No subluxation of the prostheses and no cases of spontaneous arthrodesis were identified. There was one case of disc height loss of 1 mm. Five patients required a secondary posterior arthrodesis. A good or excellent clinical outcome rate of 90% and a return to work rate of 91.5% compare favorably with results described in the literature for fusion for the treatment of lumbar degenerative disc disease. With a minimum follow-up of 10 years, the CHARITE artificial disc demonstrated excellent flexion/extension and lateral range of motion with no significant complications.     

Primary total hip replacement in Ficat–Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year follow-up

European Journal of Orthopaedic Surgery & Traumatology - Results of total hip replacement (THR) for aseptic osteonecrosis are controversial and conflicting according to implant type and...     

Sprengel’s shoulder treated by the Woodward procedure: analysis of factors affecting functional and cosmetic outcome

Purpose

To report the functional and cosmetic results of cases with Sprengel’s shoulder who underwent the Woodward procedure.

Materials and methods

Twelve children were operated at a mean age of 5.58 years and reviewed at an average follow up of 31.83 months.

Results

The mean preoperative Cavendish grade for cosmetic evaluation was 3.17, which decreased to 1.25 postoperatively (statistically significant, p < 0.0005, Wilcoxon signed-rank test). Similarly, the range of abduction at the shoulder increased from a mean of 115.83° preoperatively to 153.33° at final review (p < 0.0005). Age had a negative correlation with both functional improvement (r = −0.55, Spearman correlation coefficient) and cosmetic improvement (r = −0.11), although the latter suggested a very weak association, if any. Cavendish grade improvement and increase in abduction had a strong positive association (r = 0.713). However, there was no correlation between the increase in abduction and lowering of the scapula achieved (r = 0.131). The presence of an omovertebral bar did not affect the final functional outcome, nor did the presence of associated congenital anomalies.

Conclusion

The Woodward procedure is a reliable method for obtaining uniformly predictable results in Sprengel’s shoulder. The surgery should be performed at a younger age in order to optimise the functional outcome.     

Can patients with psychological distress achieve comparable functional outcomes and satisfaction after hallux valgus surgery? A 2-year follow-up study

BackgroundThis study assessed the influence of preoperative mental health on functional outcomes and satisfaction, and the change in mental health after hallux valgus surgery.Methods383 patients who underwent scarf osteotomy were analyzed. Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society score (AOFAS) and SF-36 were assessed at 6 months and 2 years. The cohort was stratified into patients with and without psychological distress (i.e. SF-36 Mental Component Summary [MCS] <50 vs ≥50).ResultsAfter adjusting for demographics and baseline scores, VAS and AOFAS were poorer in the distressed group at 6 months. However, there was no difference in scores at 2 years and a similar proportion of patients were satisfied. SF-36 MCS in distressed patients significantly improved, but remained lower compared to non-distressed patients at follow-up.ConclusionsPatients with psychological distress undergoing hallux valgus surgery had poorer short-term outcomes, but these differences resolved at 2 years.     

Clinical and radiological outcomes using the LIMA SMR stemless implant—A 2-year follow-up in 49 patients

BackgroundSince the introduction of stemless anatomic total shoulder arthroplasty (TSA), many studies have been published on this specific group of TSA implants. The following study aimed to evaluate clinical and radiological short- to mid-term outcomes of the LIMA SMR stemless anatomical implant.MethodsWe prospectively evaluated the outcome of 53 TSAs in 52 patients, with a mean age of 58.45 years (range 47-78 years) at the time of implantation with a minimum follow-up of 2 years (range 24-47 months). All patients were physically and radiologically examined; the results were documented by the Constant-Murley Score and the Simple Shoulder Value.ResultsSignificant improvements from preoperative to latest follow-up were documented in Constant-Murley Score (29.0-75.84 pts; P < .001), active range of motion (abduction 84.7°-133.2°, flexion 95.3°-146.4°, and external rotation 12.7°-32.4°). The mean Simple Shoulder Value was 82.15% at the last follow-up. There was no complete loosening of the humeral component, but a lowering of bone mineral density (radiolucencies, RLL) was observed in anteroposterior or axially views—radiographs at the humeral component in 10.2% of the cases, most of them on the anteroposterior view at the calcar region. There was no statistical difference in the outcome of the patients with RLL compared with the ones without radiolucencies. Major complications or revisions did not occur.ConclusionThis study provides comparable improvement in functional, radiographic, and subjective mid-term results with other stemless anatomic implants.     

High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion: outcomes at six?years of follow-up

We prospectively evaluated outcomes of high-flexion total knee arthroplasty in 165 patients who had advanced arthritis with a minimum 120-degree pre-operative knee flexion, with a mean follow-up of 77 months. Patients were divided into two groups according to their ability to perform full-range (heel-to-buttock) pre-operative knee flexion (group A) and the inability to do so (group B). The overall clinical rating was “excellent” in 96% of patients and “good” in 4% of patients. Mean maximum knee flexion decreased from 137.9° to 134.8°, with no statistical difference between pre- and post-operative knee flexion. However, patients in group A had significantly decreased knee flexion (146.2° vs. 135.0°, p < 0.001), whereas patients in group B exhibited no change in knee flexion (133.7° vs. 134.7°, p = 0.14). We found that 14.7%, 36.5% and 43.0% of the studied patients could engage in kneeling, Thai polite style sitting and cross-legged sitting, respectively, with no significant differences between groups A and B. The survival rates for any reoperation and prosthesis-related problem (such as early loosening) at six years were 98.3% and 100%, respectively. At six-year follow-up in patients with well preserved pre-operative knee flexion, the high-flexion knee prosthesis provided a favourable outcome without improving knee flexion.     

The functional and oncological results after scapulectomy for scapular tumours: 2–16-year results

Twenty-five patients underwent scapulectomy for various tumours between 1989 and 2005. We describe 23 patients with scapular tumours who were followed-up for a minimum of 2 years after scapulectomy. The average age was 29 years, and two-thirds of the patients were male. Nineteen patients had malignant neoplasms, of which chondrosarcoma was most common, followed by Ewing’s sarcoma. Surgical staging was by Enneking’s system, with stage IIB being the most frequent. Fifteen patients underwent total scapulectomy, and the rest had their glenoid retained. With an average follow-up period of 66.7 months (23–202 months), functional and oncological outcomes were evaluated for all patients. Two patients had superficial wound infections requiring antibiotics, and one had skin necrosis requiring skin cover. Functional outcome was satisfactory in 13 patients. Cosmetically and emotionally acceptable surgery, scapulectomy made 19 patients continuously disease free, while four patients died of disease. The 5-year survival rate of 19 patients with malignant tumours was 75.9%. Retention of the glenohumeral articulation (subtotal) resection gives superior functional results.

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Résumé Etude de 23 patients opérés par scapulectomie pour tumeur entre 1989 et 2005 et suivi au minimum 2 ans. L’age moyen était de 29 ans et 2/3 des patients étaient des hommes. La tumeur était maligne chez 19 patients, le chondrosarcome étant le plus frequent suivi par le sarcome d’Ewing. Le stade chirurgical était noté selon le système de Enneking, et le stade II B était le plus frequent. Quinze patients avaient une scapulectomie totale, les autres avaient la glène conservée. Avec un suivi moyen de 66,7 mois (23–202), le devenir fonctionnel et oncologique était évalué pour tous les patients. Deux patients avaient une infection superficielle et un autre une nécrose cutanée nécessitant une couverture chirurgicale. L’évolution fonctionnelle était favourable pour 13 patients. Esthétiquement et émotionnellement acceptable ces scapulectomies avaient pour résultats 19 patients indemnes de maladie tandis que 4 décédaient de la maladie. La survie à 5 ans des 19 patients avec tumeur maligne était de 75,9%. La scapulectomie sub-totale avec conservation de la glène donnait de meilleurs résultats fonctionnels.

     

Medium-term outcomes of C3�C6 laminoplasty for cervical myelopathy: a prospective study with a minimum 5-year follow-up

C3–6 laminoplasty preserving muscle insertions into the C7 spinous process is reportedly associated with a significantly decreased frequency of postoperative axial neck pain. However, no prospective study has reported medium-term outcomes of C3–6 laminoplasty. The purpose of this study was to elucidate medium-term outcomes after C3–6 laminoplasty. Subjects comprised 31 patients with cervical myelopathy who underwent C3–6 laminoplasty preserving all bilateral muscles attached to the C2 and C7 spinous processes and were followed for ≥5 years. Clinical and radiological data were prospectively collected. Neurological status was assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate or mild. Sagittal alignment of the cervical spine and progression of ossification of the posterior longitudinal ligament (OPLL) were assessed by comparing serial lateral radiographs. Mean JOA score improved significantly from 10.6 before surgery to 14.7 at the time of maximum recovery, and slightly declined to 14.3 at final follow-up. In six patients who developed late deterioration, these conditions were unrelated to the cervical spine. As of final follow-up, only one patient (3.2%) had complained of axial neck pain persisting for 5 years. Although progression of OPLL was found in 63.6% of patients, none had experienced neurological deterioration due to this progression. At final follow-up, sagittal alignment of the cervical spine was more lordotic than before surgery. Medium-term outcomes of C3–6 laminoplasty were satisfactory. Frequencies of persistent axial neck pain and loss of cervical lordosis after surgery remained significantly decreased for ≥5 years postoperatively.