Fixation for the millennium: the shoulder.

Charles Neer designed his original prosthesis in 1951. It was made of cast cobalt chrome alloy and was only press-fit. There was not any significant loosening in his original series, but patients complained of easy fatigability. This finding was attributed to glenoid issues and a cemented glenoid replacement was introduced in 1973. High rates of lucencies were reported and raised issues regarding fixation. Cementless glenoid components have been found to have fewer lucencies but require metal backing. Higher failure rates have been reported for the cementless design versus the cemented glenoids. With humeral fixation, symptomatic loosening is not a problem with cement or coated press-fit fixation. Long-term outcome studies with cemented and uncemented stems have shown the incidence of humeral loosening to be low. Fixation of humeral components should be based on bone quality, patient age, prosthetic design, and surgeon preference.

Postoperative pain control following arthroscopic release of adhesive capsulitis: a short-term retrospective review study of the use of an intra-articular pain catheter.

PURPOSE: The purpose of this study was to examine the effectiveness of an arthroscopically placed intra-articular pain catheter for controlling postoperative pain and also review the results following arthroscopic release of refractor adhesive capsulitis. TYPE OF STUDY: Retrospective clinical trial. METHODS: Twenty-three consecutive cases (20 patients) of arthroscopic adhesive capsulitis release in which an intra-articular pain catheter was used were reviewed. Follow-up ranged from 12 to 37 months (average, 22.4 months). An intra-articular catheter was placed under direct arthroscopic visualization from a superior approach into the glenohumeral joint. Postoperatively, patients were injected with 10 mL of 0.5% bupivacaine every 6 hours as needed. Preoperatively, all patients had filled out a questionnaire based on the American Shoulder and Elbow Surgeons (ASES) outcome guidelines and examined for range of motion. Postoperatively, patients were asked for their precatheter and postcatheter injection pain level based on the visual analog scale (1 to 10 points, 1 = no pain). Patients were then examined for range of motion and retested with the outcome questionnaire. An ASES Shoulder Score Index was calculated for each patient before and after the procedure. RESULTS: The average forward elevation preoperatively was 102 degrees and external rotation at the side was 4.5 degrees. At most recent follow-up, average forward elevation was 169 degrees with external rotation at the side 47 degrees. The Shoulder Score Index increased from an average of 37.1 out of 100 to 90.9 (P <.001). Before being injected with anesthetic through the catheter, patients had an average visual analog scale score of 8.1. Postinjection average pain level was 1.2 (P <.001) and all patients indicated that the pain catheter significantly reduced postoperative pain. Nineteen of 20 patients were satisfied with the procedure. CONCLUSIONS: Placement of an intra-articular pain catheter for delivery of bupivacaine was highly effective in controlling postoperative pain. In all cases, postoperative pain was essentially eliminated and this substantially assisted with range of motion exercises. Near complete restoration of range of motion without pain was achieved in 95% of the patients.