HYDROTHERMAL ABLATION IN RECURRENT OR CHRONIC OLECRANON BURSITIS: A PROSPECTIVE STUDY.

BACKGROUND: Olecranon bursitis can be difficult to treat, resulting in persistent or recurrent symptoms. Bursectomy is a frequently applied treatment option for refractory cases but has high complication rates. This is the first in-vivo study to investigate the safety and efficacy of hydrothermal ablation, a new treatment modality for recurrent or chronic olecranon bursitis that aims to cause thermal obliteration of the bursal lining by irrigation with heated saline. METHODS: First, a pilot animal trial was set up to determine a safe irrigation temperature window. Second, in a human trial the bursae of patients with chronic, recurrent or refractory olecranon bursitis were irrigated with a 3 mL/s flow of physiological saline for a duration of 180 seconds at temperatures between 50 and 52 °C. Patients were followed up for 6 months, allowing for assessment of the surgical site to screen for adverse events, volumetric ultrasound assessment of the bursae, and collection of QuickDASH, Patient Global Impression and Clinical Global impression scores, as well as data on return to activities or work. RESULTS: 24 elbows were prospectively included and underwent a full cycle of hydrothermal ablation. The mean age was 58.4 years (range 40.5 - 81.5), including 20 male and 4 female patients. None had clinical signs of septic bursitis. Bursal fluid cultures were positive in only one case. The average preoperative bursal volume was 11.18 cc (range 4.13-30.75). 18 out of 24 elbows (75%) were successfully treated, showing a complete remission of symptoms or decided improvement within 6 weeks and without any signs of recurrence during the entire follow-up period of 6 months. The average reduction of ultrasound-measured bursal volume was 91.9% in the group of patients that responded to treatment. In patients without recurrence the mean QuickDASH-scores before and after treatment were 13.6 (range 0-50) and 3.1 (range 0-27.5) respectively, showing a statistically significant improvement. All patients were able to fully return to work within 6 weeks after the index procedure. No serious adverse events were encountered. Moderate local adverse events were found in 2 patients. Increasing temperatures of irrigation did not result in a higher treatment efficacy. CONCLUSION: Hydrothermal ablation at temperatures between 50 and 52 degrees is a safe treatment option for recurrent or chronic olecranon bursitis with less complications than open bursectomy and a comparable efficacy.

Postoperative rehabilitation in elbow surgery.

Postoperative rehabilitation plays a crucial role in the treatment of elbow pathology. Depending on the type of surgery, the elbow may need to be protected. As a general rule, the elbow should not be immobilized for a prolonged period after surgery. A removable splint can be used to protect the soft-tissues immediately postoperative and the patient is encouraged to remove the splint several times daily to mobilize the elbow. Dynamic articulated braces can be used to encourage movement while ligament or tendon repairs are being protected. Literature on postoperative elbow rehab is scarce. In this paper we provide practical guidelines for specific surgical procedures.

Is bone grafting always necessary in revision reverse total shoulder arthroplasty with uncontained glenoid bone defects?

BACKGROUND: Patients with an uncontained glenoid bone defect can still successfully undergo a reverse total shoulder arthroplasty (RTSA). Currently, there is a tendency toward reconstruction of the premorbid glenoid plane with bone grafts, which is technically demanding. We investigated whether central peg positioning in the spine pillar (CPPSP) is a more feasible alternative to the use of bone grafts. METHODS: This study included 60 revisions to an RTSA with uncontained glenoid bone defects. Patients were treated with bone grafts in 29 cases and with the CPPSP technique in 31 cases. We assessed clinical results using the Constant score and assessed the complication rate. RESULTS: The Constant score changed from 42 to 69 points in the CPPSP group and from 47 to 60 points in the bone graft group. This difference in the increase in the Constant score was significant (P = .031) owing to a significant difference in strength in favor of the CPPSP group. The overall complication rate was 37.7% (20 of 53 patients), with a reoperation rate of 18.9% (10 of 53). Dislocations occurred only in the CPPSP group (n = 3), and loosening of the glenoid occurred only in the bone graft group (n = 3). CONCLUSION: Patients with uncontained glenoid bone defects undergoing revision to an RTSA obtain similar clinical results with the CPPSP technique compared with the use of bone grafts. The CPPSP technique is a valid alternative but results in different complications.

Long-term follow-up of patients with a high critical shoulder angle and acromion index: is there an increased retear risk after arthroscopic supraspinatus tendon repair?

BACKGROUND: The effect of the acromion index (AI) and critical shoulder angle (CSA) on the short-term healing rate after arthroscopic repair of the supraspinatus tendons is already known. Long-term effects have not been published yet. PURPOSE: Long-term evaluation of the effect of the AI and CSA on the postoperative healing rate and clinical results after arthroscopic repair of the supraspinatus tendon. METHODS: Patients with a symptomatic, single-tendon, full-thickness supraspinatus tear in whom nonoperative management had failed were treated with an arthroscopic repair. Preoperative radiographs were used to measure CSA and AI. Eight years postoperatively, magnetic resonance imaging (MRI) studies were performed and evaluated on repair integrity. Patient-reported outcome measurements were collected pre- and postoperatively. RESULTS: Thirty-one patients were evaluated 8 years postoperatively. The mean age at the time of surgery was 61 ± 9 years. MRI evaluation showed that 20 patients (65%) had an intact repair and 11 (35%) had a full-thickness retear. No significant differences were found between the intact and retear groups regarding age (P = .605), initial tear size (P = .485), retraction grade (P = .439), and all PROMs. The mean CSA for the intact group (33° ± 1°) was significantly lower than the CSA in the retear group (38° ± 1°; P = .004). Eighteen patients (58%) had a CSA ≥35°, and 9 (50%) among them had a retear and 9 (50%) had an intact repair.The mean AI for the intact group (0.72 ± 0.11) was significantly lower than the AI in the retear group (0.81 ± 0.08 ; P = .021). Seventeen patients (55%) had an AI ≥0.75, and 9 (53%) among them had a retear and 8 had an intact repair. If the AI was ≥0.75, the odds ratio of having a retear was 6.19 (P = .045). No progressive worsening of PROMs and clinical results could be demonstrated related to a higher CSA or AI during the entire follow-up. CONCLUSION: At long-term follow-up, a higher CSA has the tendency to have an increased rate of retear after arthroscopic supraspinatus tendon repair, but this was not significant. A higher AI significantly increased the retear risk. A higher CSA and AI did not impair the clinical results over time. An AI ≥0.75 was associated with a 6-fold increase in risk of retear after arthroscopic supraspinatus tendon repair.