Outcome of biceps suspensionplasty for recurrent multidirectional shoulder instability.

INTRODUCTION: Recurrent multidirectional shoulder instability after failed capsular repair/plication, is a challenging treatment problem. The long head of the biceps has been identified as a structure that may be utilized as a checkrein to stop abnormal anterior and inferior translation of the humeral head. The purpose of this study is to analyse the outcomes of biceps suspensionplasty (BS) in the treatment of recurrent shoulder instability. METHODS: A retrospective review identified patients with recurrent multidirectional instability that underwent BS as part of a revision shoulder stabilization procedure. Clinical records were reviewed for demographics, pain, complications, recurrent instability, reoperations, and range of motion. Patients were also administered ASES/SST/SANE/Rowe and Oxford instability questionnaire at minimum of 2-year clinical follow-up. RESULTS: Five patients (7 shoulders) were included with a mean follow-up of 3.2 years (2-7 years). Patients had an average of 1.6 prior procedures (1-3). Average patient age was 24.2 years (18.7-32.4 years) and all were female. Four shoulders were treated open while 3 were treated arthroscopically with a capsular shift and biceps suspension. Four shoulders also underwent capsular reconstruction with allograft. At final follow-up three shoulders had recurrent inferior subluxation, although all patients considered their shoulders to be much better (4) or somewhat better (3) and none have undergone repeat surgery. CONCLUSION: In our series of patients, we found BS may be useful as an adjunct to a revision capsular shift or reconstruction. While 42.8% of patients experienced recurrent subluxations, this high-risk population demonstrated encouraging subjective results and avoiding joint arthrodesis in the short-term.

Operating room traffic is a major concern during total joint arthroplasty.

BACKGROUND: Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty(TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, andmay lead to increased rates of infection. QUESTION/PURPOSES: Our purposes were to (1) define the incidence of door opening during primary and revision TJA,providing a comparison between the two types of procedures,and (2) identify the causes of door opening in order to develop a strategy to reduce traffic in the operating room. METHODS: An observer collected data during 80 primary and 36 revision TJAs. Surgeries were performed under vertical, laminar flow. Operating room personnel were unaware of the observer, thus removing bias from traffic. The observer documented the number, reason, and personnel involved in the event of a door opening from time of tray opening to closure of the surgical site. RESULTS: The average operating time for primary and revision procedures was 92 and 161 minutes, respectively. Average door openings were 60 in primary cases and 135 in revisions, yielding per minute rates of 0.65 and 0.84, respectively. The circulating nurse and surgical implant representatives constituted the majority of OR traffic. CONCLUSIONS: Traffic in the OR is a major concern during TJA. Revision cases demonstrated a particularly high rate of traffic. Implementation of strategies, such as storage of instruments and components in the operating room and education of OR personnel, is required to reduce door openings in the OR.