Prognostic Factors in Arthroplasty in the Rheumatoid Shoulder

Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact.     

An evaluation of the anatomical basis of the Biceps Load tests I and II for superior labral anterior and posterior (SLAP) lesions

Both Biceps Load tests I and II rely on an increase in tension in the long head of biceps to identify a superior labral anterior and posterior (SLAP) lesion. This study aimed to evaluate the anatomical basis of Biceps Load tests I and II by measuring activity in the long head of biceps in the two clinical tests. Activity in the long head of biceps was measured in 12 healthy young participants using surface electromyography. Activity was only minimally increased in both Biceps Load I and II compared with the resting position. In the absence of convincing support for the anatomical basis of the test, investigations of diagnostic accuracy need to be replicated in order for the reported high accuracy of Biceps Load I and II tests to be supported with confidence.     

Orientation to dissection: Assisting students through the transition

Human dissection continues to be strongly argued for teaching human anatomy to medical students and is technically and emotionally demanding. An orientation to dissection and the laboratory are provided for students before beginning their work because students' and families' reactions to dissection are often complex. This study explored medical students' experiences of attending an orientation to human dissection and the anatomy laboratory. Students' reactions, feelings, and thoughts were enquired about 1 year after beginning dissection at the University of Auckland, New Zealand. Qualitative research methods, specifically one-on-one semistructured interview were utilized. Third-year medical students self-selected into the study and were interviewed 1 year after entering the laboratory. Transcribed audiotapes of the interviews were analyzed for themes across the interviews. One year after dissection students have vivid memories with differing ways of viewing the body that may help or hinder with dissection. The themes presented include orientation, student anticipation, psychological approach to the body, normalizing-continuing disquiet, and social reference. The orientation eases student entry into the laboratory. There can be ongoing feelings of ambivalence regards the body for some students. Novel findings include that students not only have their own feelings to deal with but also those of friends and family who question them and may feel uncomfortable with the idea of them dissecting. Even one year after beginning dissection, students may emotionally struggle with their work and may require further support, including how they talk about sensitive topics with other people.     

肩胛盂骨折的手术治疗

目的探讨肩胛盂骨折的分型、手术治疗指征和方法。方法对8例肩胛盂骨折手术治疗患者临床资料进行分析,根据改良Idebery肩胛盂骨折分型:Ⅰ型3例,Ⅱ型1例,Ⅲ型2例,Ⅴ型2例。分别采用切开复位重建钢板和拉力螺钉固定。结果患者均获随访,时间6~41个月,平均14.2个月。根据美国肩肘协会评分标准进行肩关节功能评分,为55~100分,平均85.6分,优5例,良1例,可1例,差1例。结论肩胛骨盂缘骨折块移位≥1 cm、前缘骨折块≥25%、后缘骨折块≥33%,或盂窝骨折肩关节面不平整≥5 mm及盂肱关节不稳定均需手术治疗。对肩胛盂骨折采用改良Idebery分型,有利于指导临床手术治疗,且手术疗效满意。     

Arthroscopic glenoid retrieval in failed TSA: Search and rescue

Aseptic loosening of the glenoid is one of the most common reasons for revision surgery. Radiographs often demonstrate lucencies, of which only a small percentage are clinically significant. Diagnosing a loose glenoid can therefore be extremely challenging. Arthroscopy may be used to diagnose and remove the polyethylene in select patients where revision surgery is contraindicated. Results demonstrate acceptable outcomes and clinically significant improvements in preoperative pain and function.     

Lucent lines and glenoid components: What do they portend?

Glenoid component radiolucent lines following total shoulder arthroplasty are not uncommon postoperative radiographic findings and their incidence varies. With time, a certain percentage of radiolucent lines progress and potentially compromise component stability. The incidence of radiographic lucency progresses from 9% to 27% and then 73% at 2, 5, and 15 years, respectively. Radiolucent lines can be caused by posterior glenoid wear, inflammatory arthritis, design factors such as a metal-backed glenoid implant, and improper implantation techniques where the prosthesis is not fully seated or cement is used to fill a defect. Intraoperative techniques to prevent lucent lines include removing minimal bone from the glenoid vault and pressurizing cement into the cancellous bone at time of glenoid component implantation. Furthermore, a pegged glenoid component rather than a keel type is preferred, as this has been associated with a lower incidence of radiolucent lines.