Charcot arthropathy of the shoulder associated with typical and atypical findings

We present a patient with a relatively rare condition: Charcot joint of the shoulder, with a rare complication, the first known example of combined neurovascular compression in this location. A 49‐year‐old man presented with neuropathic arthropathy of the shoulder caused by syringomyelia from a Chiari I malformation, leading to compression of both the brachial plexus and the axillary vein by mass effect from the synovitis. The brachial plexopathy resolved with surgical decompression and synovectomy, and the syringomyelia stabilized after Chiari decompression. A large acromioclavicular joint synovial cyst developed as a late complication, which was treated nonoperatively. Understanding neuropathic arthropathy can explain the spectrum of interrelated typical and atypical features in this case over long‐term follow‐up. Clin. Anat. 26:1017–1023, 2013. © 2012 Wiley Periodicals, Inc.     

Outcomes in total elbow arthroplasty in patients with haemophilia at the University of California,San Francisco: a retrospective review

Summary. Severe haemophilic arthropathy of the elbow is a significant cause of morbidity among adults with haemophilia. However, previous reports of total elbow arthroplasty (TEA) in the haemophilic population have been based on small numbers of patients with relatively short‐term follow‐up. The records of seven total elbow arthroplasties in six adult men with haemophilia at the University of California, San Francisco who underwent TEA over a period of 25 years were retrospectively reviewed. Type of haemophilia, age at time of TEA, HIV infection status, pre‐ and postoperative range‐of‐motion (ROM) scores, complications (including infections), need for subsequent surgical revision and functional outcomes were recorded. Four patients had severe factor VIII deficiency and two patients had severe factor IX deficiency. None of the patients had an inhibitor. The mean age at the time of surgery was 34 years (range, 22–46 years) and the mean follow‐up period was 118 months (range, 37–176 months). One of the six patients had TEA in both elbows. Five of the six patients were infected with HIV. There were no immediate perioperative complications. At a mean of 19.2 months postoperatively, ROM had improved in five of seven TEAs: mean flexion had increased from 110.7° (SD = 15.0) to 120.1° (SD = 14.5), whereas mean preoperative extension increased from ?44.3° (SD = 21.5) to ?36.9° (SD = 27.0). One patient required a revision at 30 months because of ulnar component loosening. This same patient sustained a staph epidermidis infection and ultimate removal of the prosthesis 15 years postoperatively. At a mean of 118 months postoperatively, five of six patients continued to report reduced pain and preserved functionality, with ability to perform normal daily activities. TEA resulted in favourable results in six of seven procedures. Our findings support the viability of TEA for individuals with severe haemophilic arthropathy of the elbow, especially to reduce pain and preserve or restore functionality. Level of evidence .  Level IV.     

Imaging of haemophilic arthropathy in growing joints: pitfalls in ultrasound and MRI

The purpose of this review was to summarize the current knowledge on the utilization of magnetic resonance imaging (MRI) and ultrasound (US) for assessing arthropathy in children and adolescents with haemophilia and to recognize the limitations of each imaging modality and pitfalls in the diagnosis of soft tissue and osteochondral abnormalities. Awareness of MRI and US limitations and pitfalls in the assessment of joints in persons with haemophilia is essential for accurate diagnosis and optimal management of haemophilic arthropathy.     

Reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty designs have gained popularity over the last few years due to their satisfactory functional results in patients with cuff‐tear arthropathy and other difficult reconstructive shoulder problems. These semiconstrained prostheses improve stability and active elevation in the absence of a functional rotator cuff by coupling a spherical glenoid component with a concave humeral component and increasing deltoid tension. Understanding the anatomy of the shoulder is critical in order to ensure secure fixation of the glenoid component, explore uncemented options for humeral component fixation, and determine the ideal soft‐tissue tension to provide the best functional outcome without increasing the risk of complications. Key anatomic elements to be considered for the successful implantation of a reverse prosthesis include the orientation and size of the glenoid vault, the scapular regions with better bone stock (coracoid, spine of the scapula), the internal geometry of the humeral medullary canal, and the effects of reverse arthroplasty on the deltoid and brachial plexus. Clin. Anat. 22:172–182, 2009. © 2008 Wiley‐Liss, Inc.