Short-term results of a new anatomic stemless shoulder arthroplasty - A prospective multicentre study.

Background: Anatomic total shoulder arthroplasty (TSA) has been continuously developed and current designs include stemless or canal-sparing humeral components. In the literature stemless and canal sparing TSA showed good clinical and radiographic results, which were comparable to stemmed TSA. Objective: The aim of this study was to determine the short-term clinical and radiological outcomes of a new stemless TSA design. Methods: A prospective multicentre study including 154 total shoulder arthroplasty patients with a follow up of 12 months was performed. At the time of follow up 129 patients were available for review. The adjusted Constant Murley score,1 Oxford Shoulder Score, EQ-5D-5L score and radiographs were examined preoperatively, 3 and 12 months after the implantation of the new stemless TSA implant GLOBAL ICON™ (DePuy Synthes, Warsaw, IN, USA). Complications were documented. Results: Implant Kaplan-Meier survivorship was 98.7% at 12 months. From baseline to 12 months follow-up, all scores showed a progressive significant mean improvement. The mean adjusted Constant score increased from 42.3 to 96.1 points (p<0.001). The Oxford Shoulder Score showed an increase of 21.6 points (p<0.001). The postoperative radiographs showed no continuous radiolucent lines, subsidence, aseptic loosening or progressive radiolucency, but one osteolytic lesion was observed. Only 2 prostheses were revised. Conclusion: The new GLOBAL ICON stemless TSA showed good clinical and radiographic results at short-term follow up which were comparable to early results of other stemless TSA. Further studies with longer follow up are needed in the future.

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy.

Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.

[Adjusted mechanical alignment: operative technique-Tips and tricks]. / Adjustiertes mechanisches Alignment: Operative Technik ­ Tipps und Tricks.

INTRODUCTION: Mechanical alignment (MA) is a standardized procedure that aims to achieve a neutrally aligned leg axis. An alignment of the prosthesis closer to the patient's anatomy can be an approach for better clinical outcomes. The surgical technique of adjusted mechanical alignment (aMA) presented here is a modified extension-gap-first technique that takes into account the natural ligamentous tension of the knee joint so that ligamentous releases can be avoided as far as possible. INDICATION: The aMA technique can be used for primary and secondary varus gonarthrosis of up to 20° of varus. SURGICAL TECHNIQUE: The aim of the operation is to achieve a balanced ligament tension through a femoral osseous correction rather than ligament releases. TEA and the sulcus line are marked to control the ligament-based femoral rotation. The osteophytes are removed to ensure a reliable ligament tension. A quantitative ligament tensioner is stretched with great care, and gap width as well as medial and lateral ligament tension are read off. In order to correct an extension gap asymmetry, instead of the typical medial soft tissue release, the asymmetry is compensated by a special femoral cutting block. Now, the flexion gap is assessed, whereby the transverse femoral rotation follows the soft tissue tension. The tensioner adjusts a rectangular flexion gap with balanced ligament tension. After a final balancing of the gaps, the femoral preparation is completed and the trial components are inserted. Here, the rotation of the tibial component is set by repeated flexion-extension cycles. DISCUSSION AND CONCLUSION: The technique presented combines a measured-resection technique with individual ligament tension. The maximum deviation of the femoral alignment in the coronal plane from the neutral alignment is 2.5°. In order to avoid problems, it is recommended, as with the described technique, to achieve a component alignment based on the patient anatomy by adjusting the femoral component. The measured-resection technique carries the risk of flexion instability. With the gap-balancing technique symmetrical ligament tension can be achieved, assuming precise proximal tibial cuts. When aligning the femoral component rotation, flexion gap stability and patella tracking should be considered. Long-term studies of high case numbers are necessary to evaluate the good short-term results of the presented surgical technique.

Revisiting the Safety of the Corneal Collagen Crosslinking Procedure: Evaluation of the Effect of Ultraviolet A Radiation on Retinal Function and Structure.

PURPOSE: To evaluate the effect of ultraviolet A radiation on retinal function and structure after the corneal collagen crosslinking procedure. METHODS: In the present prospective, single-center cohort study 17 eyes of 17 patients who underwent collagen crosslinking (Dresden protocol) for the treatment of corneal ectasia were examined preoperatively and at 2 and 6 weeks postoperatively with multifocal electroretinogram and optical coherence tomography. The P1 amplitude density (P1-AD) of the central retinal response was documented in 5 concentric rings, with ring 1 (R1) representing the foveal response and rings 2 to 5 (R2-R5) corresponding to successive annuli of stimulation. Visual acuity, corneal densitometry at the 0 to 2 mm zone and at the 2 to 6 mm annulus, and macular thickness (MT; central, 1 mm, 3 mm, and 5 mm zones) were recorded. RESULTS: The preoperative values of P1-AD were R1 = 109.96 ± 28.96, R2 = 49.8 ± 14.46, R3 = 29.85 ± 8.9, R4 = 19.33 ± 6.3, and R5 = 16.39 ± 5.48 nV/deg. At 2 weeks, these values were R1 = 77.54 ± 24.47, R2 = 36.55 ± 12.53, R3 = 21.53 ± 7.71, R4 = 15.3 ± 6.13, and R5 = 13.32 ± 5.48, showing a significant reduction for R1-R4 (P ≤ 0.026). The 6-week P1-AD was R1 = 99.8 ± 31.23, R2 = 40.67 ± 16.39, R3 = 24.98 ± 7.13, R4 = 16.35 ± 4.84, and R5 = 13.76 ± 3.98, showing no significant differences compared with preoperative values (P ≥ 0.054). Corneal densitometry increased significantly at 2 weeks (P < 0.001) and remained increased at 6 weeks (P < 0.001), showing statistically insignificant correlations with 2-week P1-AD (P ≥ 0.553). The central MT increased (P = 0.787), whereas MT at 1 mm (P = 0.444), 3 mm (P = 0.039), and 5 mm (P < 0.001) zones decreased. CONCLUSIONS: The return of P1-AD to preoperative (physiologic) values at 6 weeks confirms the safety standards of the duration and intensity of ultraviolet A radiation, as proposed by the Dresden protocol. However, temporary postoperative retinal dysfunction cannot be excluded.