Single-stage revision for total shoulder arthroplasty infection. Results at a minimum 2 years follow-up.

INTRODUCTION: Similar to the management of periprosthetic joint infections of the lower limb, one-stage revision in total shoulder arthroplasty (TSA) infections is an option that has been highlighted in scientific publications since the early 2010s. However, there are only a few studies which validate this treatment and determine its scope of application in relation to two-stage treatment. HYPOTHESIS: Single-stage revision for infected TSA is a reliable treatment allowing good infection control and satisfactory functional results. METHODS: This single-center retrospective series of 34 consecutive patients operated on between 2014 and 2020 for a one-stage prosthetic revision was evaluated at a minimum of 2 years of follow-up. All of the patients included underwent revision shoulder arthroplasty during this period with the diagnosis of infection confirmed by microbiological analysis of surgical samples. Patients who did not benefit from a bipolar revision were excluded. All patients were followed at least 2 years after the intervention. Clinically suspected recurrence of infection was confirmed by a periprosthetic sample under radiographic guidance. Functional clinical outcomes as well as mechanical complications were also reported. RESULTS: The average follow-up was 40.4 months (24-102±21.6). A septic recurrence was observed in three patients (8.8%). A mechanical complication was present in four patients (14.7%), and three (11.8%) required at least one surgical revision. The mean Constant-Murley score at the last follow-up was 49 (42-57±21.83). DISCUSSION: Single-stage revision for shoulder periprosthetic joint infection results in a success rate of 91.2% with satisfactory functional results after more than 2 years of follow-up. LEVEL OF EVIDENCE: IV; retrospective study.

Functional and/or hygienic surgery of the hypertonic upper limb.

Neuro-orthopedic complications of the upper limb affect all of its joints and lead to a multitude of clinical pictures. The clinical assessment, which should be multidisciplinary, will have to answer basic questions to define the goal(s) and the appropriate surgical strategy. What is the patient's and family's complaint? What is the possible utility of the deformities? What is the type of deformity? Is it reducible or not? What is the contribution of the upper limb deformities versus that of any associated injuries to the discomfort? Several difficulties exist in the clinical assessment: evaluation of the antagonists especially the wrist extensor muscles; the intrinsic deformity component, which can be masked by the extrinsic component when retracted, the muscles responsible for a wrist flexion contracture and the complex shoulder deformities. Many patients have multiple deformities, which creates a problem for the hierarchy of corrections depending on the objectives. The answer to these questions helps to define a clear objective that will be formalized in a contract with the patient and subsequently to define the surgical strategy. Surgery is based on a simple principle: relax the muscles on the side of the deformity, either by selective neurotomy if there is a simple hypertonia, or by a tendon procedure if the muscle is retracted; compensate for the antagonists if they are deficient, and potentially stabilize the joint. Conservative procedures are preferred to preserve the possibility of functional recovery in the future. The wide range of medical and surgical solutions allows the patient's care to be personalized. In the upper limb, the results are better for hygienic, positioning, and analgesic objectives. They remain more difficult to obtain for functional objectives, due to the biomechanical complexity of gripping.

Does intermeniscal ligament tenodesis affect meniscal allograft extrusion? Retrospective comparative study at a minimum follow-up of 2 years.

INTRODUCTION: Meniscal allograft transplantation (MAT) is indicated for the treatment of post-meniscectomy syndrome in young patients who do not have severe cartilage loss. While its clinical effectiveness is well established in the short- and mid-term, it does not appear to stop the progression of osteoarthritis. Meniscal extrusion often occurs early on and is irreversible. The aim of this study was to evaluate results of arthroscopic MAT combined with reconstruction of the intermeniscal ligament (IML). HYPOTHESIS: Concurrent reconstruction of the IML decreases the incidence of early allograft extrusion when compared to conventional soft-tissue techniques. MATERIALS AND METHODS: This was a retrospective single-centre comparative study of 55 patients operated between 2011 and 2018. The 34 patients who met the inclusion criteria were divided into two subgroups: the IML group (MAT with IML repair, n=14) and the non-IML group (MAT without IML repair, n=20). Clinical outcomes consisted of the KOOS at the last follow-up visit and the surgical revision rate. MRI was performed at a minimum of 12 months (mean 34±25 months) to determine absolute and relative meniscal extrusion, sagittal anterior and posterior extrusion, and cartilage coverage in the frontal and sagittal planes. RESULTS: The KOOS score was not significantly different between the two groups. There were no reoperations in the IML group, but there were four in the non-IML group (13%) (p=0.13). Meniscal extrusion of the allograft occurred in 43% of patients (6/14) in the IML group versus 85% (17/20) in the non-IML group (p<0.03). Absolute meniscal extrusion was 2.9mm ([2.2-3.6] SD=1.2) in the ILM group versus 5.4 mm ([4.1-6.7] SD=2.9) (p=0.004) in the non-ILM group. DISCUSSION: Adding ILM tenodesis or reconstruction can significantly limit early extrusion of the meniscal allograft. Clinical outcomes at a mean of 34 months are not different when compared to standard procedure. These patients should be re-evaluated in the long term to determine whether the incidence of osteoarthritis is lower with ILM tenodesis. LEVEL OF EVIDENCE: III; case-control study.