Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries.

National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data. Second, we determined whether known risk factors for prosthetic failure are being recorded. Through a non-systematic literature review studies on registries were analyzed for included parameters. Seven national registries were scrutinized for the data collected and these were classified according to categories of risk factors for failure: patient-, implant and surgeon related, and other parameters. This shows a large heterogeneity of registered parameters between countries. The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.

Teaching hip surgery to orthopaedic residents: what's new?

PURPOSE: The purpose of this study is to provide an overview of the published literature on the existing educational methods used to teach surgical skills, with a specific focus on hip surgery, to orthopaedic residents. METHODS: A total of 31 articles were selected from a PubMed literature search on the topic of teaching surgical skills to orthopaedic residents, and 9 articles on hip surgery are included in this review. RESULTS: Although several methods are included in the published literature to teach orthopaedic residents, only arthroscopy of the knee and shoulder joint is well described. Hip arthroscopy has a steeper learning curve and thus the use of simulation training as a complementary teaching method is even more important. CONCLUSIONS: Currently, open surgery skills for joint arthroplasty are largely acquired by apprenticeship learning. Simulation training in the form of virtual reality could contribute to better performance of residents, decreasing operation time and improving patient safety.

Analysis of failures after the Bristow-Latarjet procedure for recurrent shoulder instability.

PURPOSE: Despite good clinical results and low recurrence rates, post-operative complications of coracoid process transfer procedures are not well understood. This study aims to evaluate the underlying failure mechanism in cases requiring major open revision surgery after prior Bristow or Latarjet stabilization. METHODS: Between January 2006 and January 2017, 26 patients underwent major open revision after primary Bristow or Latarjet procedure. Clinical notes and radiographic images were retrospectively reviewed for all cases to determine underlying pathology. Choice of treatment and clinical and radiographic outcome were similarly reported for all cases. RESULTS: The underlying failure mechanism was associated with non-union in 42.3%, resorption in 23.1%, graft malpositioning in 15.4%, and trauma or graft fracture in 19.2% of cases. Although none of the patients reported any dislocations, mean subjective shoulder score was 60.2% and WOSI scores averaged 709.3 points at final follow-up. Radiographic signs of deteriorating degenerative arthritis were seen in 34.6%. CONCLUSION: Graft non-union resulting in recurrent instability was the main indication for open revision surgery after Bristow or Latarjet procedure, followed by resorption, malpositioning, and graft fracture in this retrospective case series. Revision surgery consisted of a structural iliac crest bone graft in the majority of cases. Clinical and radiographic outcomes are predictably variable in this population of multioperated patients.