Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders.

OBJECTIVE: To provide new epidemiological data regarding the prevalence, distribution and macroscopic features of shoulder rotator cuff calcific tendinopathy (calcific tendinopathy), and to identify the characteristics of calcific deposits associated with shoulder pain. MATERIALS AND METHODS: Three hundred and two female volunteers (604 shoulders) who had been referred to a gynaecological clinic participated in the study. The subjects underwent a high-resolution ultrasonography of both shoulders, and those with a diagnosis of calcific tendinopathy compiled a standardized questionnaire relating to shoulder symptoms. We determined the prevalence of symptomatic and asymptomatic rotator cuff calcific tendinopathy, and compared differences in distribution and macroscopic features of the symptomatic and asymptomatic calcifications. RESULTS: The prevalence of calcific tendinopathy was 17.8% (103 shoulders). Ninety-five shoulders (15.7%) were symptomatic; of these, calcific tendinopathy was found in 34 shoulders (33%) on imaging. Of the 509 asymptomatic (84.3%) shoulders, calcific tendinopathy was observed in 69 cases (67%). Among tendons, supraspinatus (53.4%) and infraspinatus (54.6%) were the most frequently involved. The majority of calcific deposits were of maximum diameter between 2 and 5 mm (77.9%), and were linear in form (69.9%). The involvement of multiple tendons and a location in the supraspinatus tendon were found to be significantly correlated with pain (p = 0.023, p = 0.043 respectively), as were age (p = 0.041) and an excessive body mass index (p = 0.024). CONCLUSION: In this sample from the general population of working age females, both intrinsic factors (location in supraspinatus, multiple tendon involvement) and extrinsic variables (age, abnormally high BMI) were correlated with pain in calcific tendinopathy. LEVEL OF EVIDENCE: Level III, cross-sectional study, prevalence study.

Survivorship at minimum 10-year follow-up of a rotating-platform, mobile-bearing, posterior-stabilised total knee arthroplasty.

PURPOSE: To evaluate prospectively the long-term clinical and radiographic results and survivorship of a rotating-platform, posterior-stabilised knee prosthesis at minimum 10 years (mean 11.5 ± 1.41 years), and to test the hypothesis that this design would have a mechanical survivorship greater than 95%. METHODS: Between 2000 and 2002, 160 consecutive patients (166 knees) underwent total knee arthroplasty using a rotating-platform, posterior-stabilised prosthesis, and clinical and radiographic follow-up data were gathered prospectively. RESULTS: One hundred and seven patients (112 knees) were available for final follow-up. Five patients (3%) had undergone revision surgery, giving a Kaplan-Meier survival rate of 96.6% for all causes of failure. No spin-out of the polyethylene insert was observed. The mean visual analogue scale, Knee Society and Oxford Knee Scores showed statistically significant improvements (p < 0.001). On radiographs, two cases (2.4%) had radiolucent lines >2 mm, and no patient had osteolysis. CONCLUSIONS: The absence of osteolysis at minimum 10 years seems to support our hypothesis that this design may be able to reduce peri-prosthetic bone resorption in the long term. The survivorship was greater than 95% and is comparable to the best results reported for this type of knee prosthesis in the literature. The clinical scores are reasonable, given the presence of various disabling concomitant pathologies and the relatively advanced mean age of the study population. This study is clinically relevant because it adds valuable information to the limited data regarding the long-term survivorship and performance of rotating-platform knee prostheses and, more specifically, of a single knee design. LEVEL OF EVIDENCE: IV.

Intraoperative validation of navigated limb measurements in THA using a pinless femoral array.

Appropriate limb length (LL) and femoral offset (OS) after total hip arthroplasty (THA) are crucial for a successful and lasting outcome. However, intraoperative assessment is difficult. Computed navigation is effective but the use of radiation and of invasive bone references is cause of concern. Imageless, pinless navigation systems have been shown to be accurate in experimental studies. However, almost no clinical validation has been performed. We used a minimally-invasive computer-navigated system (MICNS) in conjunction with an imageless measurement technique for implanting 60 consecutive THAs. Head/neck trial components of different size were applied, and the differences in LL and femoral OS measurements were recorded and compared to the implant manufacturer's specifications, corrected for the anatomical variations of each patient. The imageless MICNS revealed a valid and accurate intra-operative tool for measuring LL and femoral OS in vivo.