Long-term impact of scapular notching after reverse shoulder arthroplasty.

BACKGROUND: Because it medializes the centre of rotation, one of the drawbacks of reverse shoulder arthroplasty (RSA) is the risk of impingement between the humerus and lateral border of the scapula resulting in scapular notching. The long-term impact of this notching is not well known, either on function or the risk of glenoid loosening. The aim of this longitudinal study was to analyze the drawbacks of this notching. METHODS: Between 1993 and 2006, 81 patients (91 shoulders) underwent RSA for primary glenohumeral osteoarthritis or massive cuff tear with or without osteoarthritis. This cohort was followed longitudinally with post-operative assessments done at one to two  years (T1), three to eight  years (T2), and nine+ years (T3). Before T3, 25 patients had died, nine were lost to follow-up, five  had the implants changed, and seven  had incomplete records. Thus, 45 shoulders were available for follow-up beyond nine years (mean follow-up of 12 years) and were used to determine the long-term impact of notching. Survival curves were generated using the occurrence of Sirveaux grade 3 or 4 notching and the presence of aseptic glenoid loosening as endpoints. RESULTS: The survivorship before grade 3 or 4 notching developed was 83% at five years, 60% at 10 years, and 43% at 15 years. In the end, aseptic glenoid loosening occurred in four shoulders, all of which had developed grade 4 notching. No glenoid loosening occurred in the population with grade 0, 1, 2, or 3 notching (p = 0.02). The Constant score significantly decreased between T2 and T3, although it was not different between shoulders with and without advanced notching. CONCLUSIONS: Beyond the second year post-RSA, the number of shoulders with grade 3 or 4 notching increases steadily up to the longest follow-up. Grade 4 notching always preceded the occurrence of late glenoid loosening. The functional outcomes become significantly worse after the 9th year post-RSA, although they were not correlated to the presence of high-grade scapular notching.

Radiocarpal dislocations and fracture-dislocations: Injury types and long-term outcomes.

INTRODUCTION: Radiocarpal dislocation (RCD) and fracture-dislocations (RCFD) are severe but rare injuries for which the treatment and outcomes are not well defined. The aim of this retrospective study was to describe the prevalence of the various injury types and their long-term outcomes. PATIENTS AND METHODS: Between 1992 and 2014, 41 patients with RCFD were seen at our institution. According to the Dumontier classification, there were 4 cases of type 1 and 37 cases of type 2. Thirteen patients were reviewed again after a mean follow-up of 168 months (20-260). RESULTS: Among these 41 patients, 6 required secondary wrist fusion. At the latest follow-up evaluation, flexion-extension amplitude was 100° (25°-152°), grip strength was 86% of the contralateral side (10kgf-112kgf), the mean VAS for pain was 1.3 (0-5), the mean QuickDASH was 23 (0-59) and the mean PWRE was 27 (0-75). Six patients developed osteoarthritis in the radiocarpal and midcarpal joints. DISCUSSION: For cases of RCD, when reduction and stabilization have been confirmed by a dorsal approach, there is no reason to perform volar capsule and ligament suturing. For cases of RCFD, after anatomical reduction, radiostyloid pinning can be performed and an open surgical approach is not always required. Radiolunate fusion is a good solution for treating secondary instability. CONCLUSION: The good functional outcomes and absence of osteoarthritis can be attributed to the effective reduction and radiocarpal stabilization, along with the absence of radial and intracarpal marginal fractures. LEVEL OF EVIDENCE: IV, retrospective.

Shoulder patient-specific guide: First experience in 10 patients indicates room for improvement.

BACKGROUND: Implantation of the glenoid component of a total shoulder prosthesis can be facilitated by using a patient-specific guide (PSG) designed to ensure replication of the preoperatively planned position. The objective of this study was to assess the reliability and accuracy of a PSG in replicating the planned glenoid component position during total shoulder arthroplasty (TSA). HYPOTHESIS: Additional criteria should be used for 3D preoperative planning and PSG design to further improve the accuracy of glenoid component positioning. MATERIAL AND METHODS: We studied 10 patients who underwent TSA with use of a PSG to position the glenoid component after preoperative 3D planning. Postoperative glenoid version and tilt were measured and compared to the planned values. We also used new criteria to assess implant rotation and global 3D position, as well as accuracy of the 3D pilot hole for the glenoid guide-pin. RESULTS: Mean errors in glenoid position were -1.7°±4.4° for version, -0.4°±4.9° for tilt, and 6.0°±13.5° for rotation. Mean difference in global orientation of the glenoid implant versus the planned value was 4.9°±2.5°. Mean 3D discrepancy in glenoid pilot hole position was 2.9±0.5mm; the discrepancy was greater in the mediolateral direction (1.9±0.9mm) than in the supero-inferior (1.1±1.2mm) and antero-posterior (0.8±1.2mm) directions. DISCUSSION: The poor performance of the PSG in controlling rotation and reaming may explain the difference in global glenoid position compared to the planned value. Improvements in PSG design to incorporate these two parameters deserve consideration. LEVEL OF EVIDENCE: II, prospective cohort study.