Short term results of anatomic stemless shoulder replacement with peripheral neck fixation.

Background: Most of the current stemless implants are using a central neck fixation design. Easytech Stemless replacements (FX Solutions®, Viriat, France) were developed promoting the idea of peripheral fixation of the stemless implant. The aim of this study was to analyze clinical and radiological results of this stemless TSA implanted for osteoarthritis (OA). Methods: A retrospective study of patients who received TSA with the Easytech® Anatomical Shoulder System (FX Solutions®, Viriat, France) for OA was completed at five clinical sites. Preoperative and minimum 2 year follow-up Constant Scores and X-rays were evaluated. Two independent orthopedic surgeons analyzed X-rays to assess anatomy reconstruction and component migration. Revisions and serious adverse effects were reviewed. Results: 129 patients were analyzed with an average follow-up of 37.47 months (24-54). Seven patients had a revision surgery and one of these resulted in the removal of the Anchor Base. The postoperative Constant Scores showed significant improvement with a mean raw Constant Score of 73.78 (38.0-100.0, mean increase 40.96, P < .0001) and mean adjusted Constant Score of 99.14 (42.20-133.30, mean increase 55.68, P < .0001). Radiographic review demonstrated that no modification of the center of rotation (COR) at minimum 24 months was greater than 3 mm and in comparison to preoperative radiographs, restoration of COR was lateralized in 25% of the cases, medialized in 61.5% and 13.5% had no change in COR. The mean value of the cervico-diaphyseal angle was 130.2° (114; 149) at 3 weeks and 129.9° (113.5; 144.0) at 2 years, demonstrating no significant difference (P = .16). 36 patients (35%) had calcar remodeling. Univariate and multivariate logistic regression found no significant factor, which was associated with the variation of the cervico-diaphyseal angle over time, center of rotation, calcar remodeling, or final Constant Score. The Walch B2 and C glenoid subset of patients (n = 13) had overall survival rate of 90.9% [95% CI 75.4-100.0] vs. 98.0% [95% CI 95.3-100.0] in other glenoid types (P < .01). Walch B2/C patients were 4.44 [95% CI 1.13, 17.6] times more likely to have a Constant Score <85 (P = .03). Conclusions: The peripheral fixation of the Easytech® Anatomical Shoulder System for OA provides excellent clinical results and imaging stability at minimum two year follow-up. Elderly age, gender and BMI do not affect the stability.

Stemless reverse shoulder arthroplasty: clinical and radiologic outcomes with minimum 2 years' follow-up.

BACKGROUND: Recently, a stemless reverse shoulder arthroplasty (RSA) design was developed to preserve bone stock. Clinical and radiologic studies of this design in larger cohorts with >100 patients are not frequent. The purpose of this study was to present the clinical and radiologic results of a newly developed stemless RSA implant. The hypothesis was that this design would provide similar clinical and radiologic results to other stemless implants, as well as stemmed implants. METHODS: Between September 2015 and December 2019, all patients who underwent primary RSA with a stemless Easytech prosthesis were considered eligible for inclusion in this prospective multicenter study. The minimum follow-up period was 2 years. Clinical outcomes consisted of the Constant score, adjusted Constant score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons shoulder score. Radiographic parameters included radiolucency, loosening, scapular notching, and specific geometric parameters. RESULTS: Stemless RSA was performed in 115 patients (61 women and 54 men) at 6 different clinical centers. The average age at the time of surgery was 68.7 years. The average Constant score was 32.5 preoperatively and showed significant improvement to 61.8 at latest follow-up (P < .001). The Subjective Shoulder Value also demonstrated significant improvement postoperatively (from 27.0 to 77.5, P < .001). Scapular notching was observed in 28 patients (24.3%); humeral loosening, 5 (4.3%); and glenoid loosening, 4 (3.5%). The total complication rate was 17.4%. Eight patients (4 women and 4 men) underwent implant revision. CONCLUSION: The clinical outcomes of the examined stemless RSA seem to be comparable to those of other humeral designs; however, the complication and revision rates are higher than those of historical controls. Surgeons should proceed with caution when using this implant until longer-term follow-up data are available.

Mid-Term to Long-Term Follow-Up of Stemless Anatomic Total Shoulder Arthroplasty.

Background: The purpose was to report mid-term to long-term clinical outcomes in a multicentre series of patients who received stemless total shoulder arthroplasty (TSA). The hypothesis was that stemless TSA would be a safe and effective treatment with satisfactory clinical outcomes. Methods: Authors retrospectively reviewed records of 62 stemless TSAs implanted between March 2013 and December 2014. Six were excluded because they had fractures or muscular impairment, which left 56: primary osteoarthritis (n = 49), rheumatoid arthritis (n = 4), avascular necrosis (n = 1), or glenoid dysplasia (n = 2). Outcomes were absolute Constant Score (CS), age-/sex-adjusted CS, and the American Shoulder and Elbow Surgeons (ASES) score. Proportions of patients that achieved substantial clinical benefits for absolute CS and ASES scores were determined. Results: Of the 56 patients, 8 (14%) died (unrelated to TSA), 5 (9%) were lost to follow-up, and 2 (4%) refused participation. One patient was reoperated for infection with implant removal (excluded from analysis), and one for periprosthetic fracture without implant removal. At 7.6 ± 0.5 years (range 6.8-9.3), the remaining 40 patients, aged 71.0 ± 8.5 years, achieved net improvements of 40.7 ± 15.8 (CS), 62%±23% (age-/sex-adjusted CS), and 59.7 ± 16.4 (ASES). Of patients with complete absolute CS (n = 37) and ASES score (n = 28), respectively, 33 (89%) and 27 (96%) achieved substantial clinical benefits. Conclusions: Stemless TSA yields improvements in functional outcomes at mid-term to long-term that exceed the substantial clinical benefits of the absolute CS and ASES score at a mean follow-up of 7.6 years. Although the findings of this study revealed low complications and revision rates, more studies are needed to confirm long-term benefits of stemless TSA. Level of evidence: IV, case series.

Green synthesis of multifunctional carbon coated copper oxide nanosheets and their photocatalytic and antibacterial activities.

The studies of metal oxides in environmental remediation of chemical and biological pollutants are gaining colossal importance. Herein, we report the facile synthesis of multifunctional copper oxide nanosheets (CuO NS) using an aqueous extract of Rhazya stricta. The phytochemical investigation of R. stricta indicated the presence of saponins, tannins, and reducing sugars, responsible for the reduction and stabilization of CuO NS. A UV-Visible spectrophotometer initially confirmed the fabrication of CuO NS with specific Surface Plasmon Resonance at 294 nm. Field Emission Scanning Electron Microscopy (FE-SEM), Fourier-transform infrared spectroscopy FTIR, and XRD were further used to characterize the CuO NS. The obtained CuO NS were poly-dispersed with an average size of 20 nm. Interestingly these particles were aligned together in 3D cubical sheets layered above each other via self-assembly. The as-synthesized CuO NS showed enhanced antibacterial potential (17.63 mm, overall mean inhibition zone) in comparison to the known antibiotics (11.51 mm, overall mean inhibition zone) against both Solanaceous crop's wilt-causing bacteria (Ralstonia solanacearum and Clavibacter michiganensis). Furthermore, the appreciable photocatalytic potential of CuO NS has also been observed, causing 83% degradation of methylene blue (MB) upon solar irradiation. The synthesis methodology is devoid of any toxic waste or by-products. It could be used to produce eco-friendly CuO nanomaterial for industrial uses.

Quantitative analysis of electroplated nickel coating on hard metal.

Electroplated nickel coating on cemented carbide is a potential pretreatment technique for providing an interlayer prior to diamond deposition on the hard metal substrate. The electroplated nickel coating is expected to be of high quality, for example, indicated by having adequate thickness and uniformity. Electroplating parameters should be set accordingly for this purpose. In this study, the gap distances between the electrodes and duration of electroplating process are the investigated variables. Their effect on the coating thickness and uniformity was analyzed and quantified using design of experiment. The nickel deposition was carried out by electroplating in a standard Watt's solution keeping other plating parameters (current: 0.1 Amp, electric potential: 1.0 V, and pH: 3.5) constant. The gap distance between anode and cathode varied at 5, 10, and 15 mm, while the plating time was 10, 20, and 30 minutes. Coating thickness was found to be proportional to the plating time and inversely proportional to the electrode gap distance, while the uniformity tends to improve at a large electrode gap. Empirical models of both coating thickness and uniformity were developed within the ranges of the gap distance and plating time settings, and an optimized solution was determined using these models.