Results of a new stemless shoulder prosthesis: radiologic proof of maintained fixation and stability after a minimum of three years' follow-up.

HYPOTHESIS: In total shoulder arthroplasty, the humeral component, particularly the stem, can be involved in some of the complications and technical difficulties increase in posttraumatic arthritis with proximal humeral malunion. To decrease the intraoperative complications related to the stem, the TESS (Biomet Inc, Warsaw, IN) humeral implant, was designed in 2004 hypothesis that we can obtain a good fixation with a stemless prosthesis. This investigation reports the preliminary results of this prosthesis with more than 3 years of follow-up. METHODS: Between March 2004 and June 2005, 70 patients underwent 72 shoulder replacements with the TESS humeral prosthesis. Sixty-three patients were reviewed with a follow-up of more than 36 months (average, 45.2 months; range, 36-51 months). The mean preoperative Constant score was 29.6. RESULTS: Gain in active mobility was 49 degrees for forward flexion and 20 degrees for external rotation. The postoperative Constant score was 75. Radiographic analysis showed no radiolucencies or implant migration. Functional results are comparable with previous reports on prosthetic glenohumeral replacement. DISCUSSION: Our clinical results are similar to this with classical prosthesis. The humeral head removal facilitates the glenoid exposure and implantation. After the initial cases any specific complication was seen. CONCLUSIONS: Owing to the automatic central positioning of the implant, an anatomic reconstruction was achieved. In malunions, no tuberosity osteotomy was required. At 3 years of follow-up, there is radiologic evidence of maintained implant stability. These encouraging preliminary results confirm our belief that a stemless prosthesis can be used to obtain an anatomic reconstruction of the proximal humerus. A longer-term follow-up study is needed to validate these results.

Treatment of shoulder calcifications of the cuff: a controlled study.

OBJECTIVES: About 1 in 10 patients with shoulder calcifications complains of chronic pain. Removal techniques have been developed. We carried out the first randomized study to validate bursoscopy (BS) and (needling fragmentation irrigation) (NFI) versus a control group (CT). METHODS: 102 shoulders (96 patients) with calcifications >5 mm whose medical treatment had failed (>4 months) were first injected using a corticosteroid; 49 shoulders improved by more than 70%. The other 53 shoulders were randomized in 3 groups: NFI (n=16), BS (n=20), and CT (n=17). All patients were reviewed at T 1-4-12-24 months. RESULTS: After 4 months, we observed respectively in groups NFI-BS-CT: 62%, 65% and 29% patients showing global improvements >70% (NFI vs CT: p=0.03; BS vs CT: p=0.02); -37%, -29% and -11% pain VAS variation (ns), +16%, +12% and -15% Constant score variation (NFI vs CT: p=0.03; BS vs CT: p=0.02), and -58%, -77% and +4% area calcification variation (NFI vs CT: p=0.005; BS vs CT: p=0.0002; BS vs NFI: p=0.01). After 24 months, results were maintained in NFI and BS groups, and in the CT group only 6/17 patients were still improved. There were no significant differences between NFI and BS groups. Three partial tears of the cuff were found using MRI in failures, (1 in each group). CONCLUSION: NFI and BS are now validated removal techniques of shoulder calcifications when there is chronic pain and other medical treatments have failed. Results were maintained after 24 months, and were similar between NFI and BS. However NFI could be preferred because of its simplicity and low cost.

Shoulder pain and disability: comparison with MR findings.

OBJECTIVE: The objective of our study was to compare the level of disability induced by shoulder pain as reported by patients on the L'Insalata Self-Administered Questionnaire (SAQ) with shoulder MRI results. MATERIALS AND METHODS: One thousand seventy-nine consecutive patients referred for shoulder MRI were asked to complete the L'Insalata SAQ. Results from the L'Insalata SAQ and MRI were cross-tabulated and analyzed with multivariable linear regression. RESULTS: No statistical relationship could be found between the level of pain, impairment, and disability as reported on the L'Insalata SAQ and the location and size of full-thickness tears of the rotator cuff as observed on MRI. Pain and disability are significantly linked to the presence of supraspinatus tendon lesions and the presence of bursitis, but these factors contribute little to the symptoms. Patients with biceps tendinopathy did not experience increased pain when compared with patients without biceps tendinopathy or with biceps tendon rupture. CONCLUSION: No statistical relationship was found between the level of pain and disability and the size and location of full-thickness tears of the rotator cuff.