Clinical and radiological results 7 years after Copeland shoulder resurfacing arthroplasty in patients with primary glenohumeral osteoarthritis: an independent multicentre retrospective study

Purpose

The aim of this multicentre cohort study was to evaluate the midterm outcomes and survival after cementless stemless resurfacing arthroplasty (CSRA) in a series of 33 shoulders in 27 patients with primary osteoarthritis.

Methods

Clinical outcome assessment included: Constant–Murley score (CMS); Simple Shoulder Test (SST); Disability of Arm, Shoulder, Hand (DASH); EuroQol-5D (EQ-5D) utility scores; Numerous Rating Scale (NRS) for pain. Radiographs were assessed by two independent observers for oversizing, radiolucency, glenohumeral subluxation, glenoid erosion and subsidence. Correlations between the clinical and radiological outcomes were calculated. Complications were registered, and revision and survival rates were calculated.

Results

Mean age at time of surgery and mean follow-up time were, respectively, 67.7 (range 50.2–85.1) and 7.2 years (range 5.7–9.3 years). Means (SD) for CMS, age- and gender-adjusted CMS, SST, DASH and EQ-5D utility scores were: 56.4 (20.2), 76.5 (25.0), 54.0 (29.8), 37.6 (23.3) and 0.8 (0.1), respectively. NRS for pain was 2.0 and 3.8, respectively, in rest and during activities. Radiographic assessment of the CSRAs showed oversizing in 54.5%; radiolucency in 18.2%; superior glenohumeral subluxation in 33.3%; glenoid erosion in 45.5%; and subsidence in 3.0%. Perioperative complications did not occur. Revision surgery was performed in one patient (3.0%).

Conclusion

For primary osteoarthritis, the CSRA showed good clinical but poor radiological outcomes at midterm follow-up.

     

Rheumatoid arthritis: a risk factor for deep venous thrombosis after total knee arthroplasty? Comparative study with osteoarthritis

Background  

Recent advances in the understanding of blood coagulation processes favor an inflammatory basis for thrombotic events. In this study, thrombotic risk after total knee arthroplasty (TKA) was assessed and compared between patients with rheumatoid arthritis (RA) and those with osteoarthritis (OA).     

Increased use of total shoulder arthroplasty for osteoarthritis and improved patient-reported outcome in Denmark, 2006–2015: a nationwide cohort study from the Danish Shoulder Arthroplasty Registry

Background and purpose — Osteoarthritis has become the most common indication for shoulder arthroplasty in Denmark, and the treatment strategies have changed towards the use of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty. We investigated whether changes in the use of arthroplasty types have changed the overall patient-reported outcome from 2006 to 2015.

Patients and methods — We included 2,867 shoulder arthroplasties performed for osteoarthritis between 2006 and 2015 and reported to the Danish Shoulder Arthroplasty Registry. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 1 year was used as patient-reported outcome. The raw score was converted to a percentage of a maximum score. General linear models were used to analyze differences in WOOS.

Results — The proportion of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty increased from 3% and 7% in 2006 to 53% and 27% in 2015. The mean WOOS score was 70 (SD 26) after resurfacing hemiarthroplasties (n = 1,258), 68 (SD 26) after stemmed hemiarthroplasty (n = 500), 82 (SD 23) after anatomical total shoulder arthroplasties (n = 815), and 74 (SD 23) after reverse shoulder arthroplasties (n = 213). During the study period, the overall WOOS score increased with 18 (95% CI 12–22) in the univariate model and 10 (CI 5–15) in the multivariable model, and the WOOS scores for anatomical total shoulder arthroplasty increased by 14 (CI 5–23).

Interpretation — We found an increased WOOS score from 2006 to 2015, which was primarily related to a higher proportion of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty towards the end of the study period, and to improved outcome of anatomical total shoulder arthroplasty.     

The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years

The concept of a dual articulation acetabular cup was developed by Prof. Bousquet in 1974. This concept has been shown to provide high stability after revision and primary total hip arthroplasty. The aim of our study was to evaluate the incidence of prosthetic instability in a consecutive homogeneous series of 384 primary dual mobility cups. Incidence of instability and implant survival were evaluated. Mean follow-up was 15.3 years (range, 12–20). There was no early or late instability. On the acetabular side there were 13 aseptic loosenings, 14 intraprosthetic dislocations, and seven polyethylene wear cases that required replacement of the liner. The cumulative survival rate of the dual-articulation acetabular cup using surgical revision for aseptic loosening as the endpoint was 95.9% ± 4.1% at 18 years postoperatively. Our series proves the good long term behaviour of dual-articulation acetabular components in primary arthroplasty. Their excellent survivorship rate and the absence of episodes of prosthetic instability increase our confidence in this concept.

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Résumé  Le concept de cupule à double mobilité a été inventé par le Professeur Gilles BOUSQUET en 1974. Ce concept a permis de mettre en évidence une importante stabilité des hanches, notamment après révision mais également dans les prothèses totales de hanches de première intention. Le but de cette étude est d’évaluer l’incidence et l’instabilité sur une série homogène consécutive de 384 hanches traitées avec cupule à double mobilité. Le taux d’instabilité des implants sur les patients survivants a été évalué. Le suivi moyen a été de 15,3 ans (de 12 à 20 ans) au plus long recul, il n’y a aucune instabilité ni primaire, ni tardive. Par contre, il existe 13 descellements aseptiques acétabulaires, 14 luxations intra prothétiques, 7 usures du polyéthylène qui ont nécessité un remplacement du PE. Le taux de survie cumulé de cette cupule à double mobilité est de 95,9% ± à 18 ans si l’on prend comme critère la révision pour descellement aseptique. Cette série prouve le bon devenir à long terme de cette articulation dans les prothèses totales primaires, avec un excellent taux de survie et l’absence de phénomènes de luxation inhérentes à ce concept.

     

Long-term outcome 19 years after childhood IgA nephritis: a retrospective cohort study

We evaluated the natural long-term outcome after childhood IgA nephritis. Altogether 55 patients with biopsy-proven IgA nephritis were identified, 37 (67%) responded to the health questionnaire and 31 (56%) participated in the medical examination after a mean follow-up of 18.7 years (SD 6.2; range 8.5–29.8). The results of medical examination, onset data and the re-analysis of original biopsies of 31 participants were used when analyzing the predictive factors for persistent nephropathy, i.e. constant proteinuria/hematuria or end-stage renal disease (ESRD). All patients’ medical history data were obtained from regional hospitals and renal survival data from the national kidney register. Six (11%) of the 55 identified patients had developed ESRD. Sixteen (52%) of the 31 participants were not attending for regular follow-up visits after the acute phase. Twenty-two (71%) had renal symptoms and 12 (39%) were receiving drugs for hypertension/proteinuria at their latest follow-up visit. The chronicity index and total biopsy score in the first renal biopsy were higher in patients with persistent nephropathy or ESRD than in those without (p=0.022 and p=0.014, respectively). Nine (69%) of the 13 subjects who had been over 16 years of age at diagnosis had persistent nephropathy or ESRD, compared with 4 (22%) of the 18 subjects who had been under 16 years of age (relative risk 3.1, 95% CI 1.2–8.0). Pregnancy complications were common: 12 (55%) of the 22 pregnancies had been complicated by proteinuria and/or hypertension, and the prematurity rate was 30%. Long-term follow-up during adulthood is needed even after mild childhood IgA nephritis, especially in women during and after pregnancy.     

The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients

When unicompartmental knee arthroplasty (UKA) failure occurs, a revision procedure to total knee arthroplasty (TKA) is often necessary. We compared the long-term results of this procedure to primary TKA and evaluated whether they are clinically comparable. Twenty-one patients underwent UKA conversion to TKA between 1991 and 2000. The results of these patients were compared to the group of 28 primary TKA patients with the same age, sex and operation time point. The long-term outcomes were evaluated using clinical and radiological analysis. The mean follow-up period of the patients was 10.5 years. The UKA revision patients were more dissatisfied, as measured by the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scale (0–100 mm) compared to the primary TKA patients (pain 18.1/7.8; p = 0.014; stiffness 25.7/14.4, p = 0.024; physical function 19.0/14.8, p = 0.62). Two patients were revised twice in the UKA revision group. There was one revision in the primary TKA group (p = 0.39). Improvement in range of motion (ROM) was better in the TKA patients compared to the UKA revision patients (8.2°/–2.6°, p = 0.0001). We suggest that UKA conversion to TKA is associated with poorer clinical outcome as compared to primary TKA.     

Patella in total knee arthroplasty: to resurface or not to��a cohort study of staged bilateral total knee arthroplasty

The aim of this study was to assess medium term results of patellar resurfacing in total knee arthroplasty, specifically looking at anterior knee pain, patellofemoral function and need for reoperation. A prospective cohort study was conducted with patients undergoing staged bilateral knee arthroplasty with the patella being resurfaced only on one side. This was due to change in the clinical practice of the senior author. Sixty patients were reviewed clinically and radiologically on a regular basis. The surgery was either performed or supervised by the senior author in all cases. All patients received the cemented press-fit condylar© prosthesis. The Knee Society clinical rating system was used. Scores were recorded pre-operatively and post-operatively at three months, one year, two years and three yearly thereafter. The mean age of patients in the study group was 75 years (range: 62–89 years). There were 42 women and 18 men in the study. The mean duration of follow-up was 4.5 years (range: 2–12 years). There was no significant difference in the pre-operative scores in both groups. There were significantly better scores (p < 0.05) on the resurfaced side as compared to the non-resurfaced side at final follow-up. No revision was carried out for patellofemoral complications on the resurfaced side. Four patients required revision in the form of patellar resurfacing on the non-resurfaced side for persistent anterior knee pain. Patellar resurfacing is recommended in total knee arthroplasty for better functional outcome with regards to anterior knee pain and patellofemoral function.     

Initial experience with a synthetic sealant PleuraSeal™ after pulmonary resections: a prospective study with retrospective case matched controls

The objective of this study was to evaluate postoperative outcome and efficacy of a hydrogel tissue sealant for prevention of alveolar leakage after open lung resections.