Long-term results of the Delta Xtend reverse shoulder prosthesis.

BACKGROUND: Reverse shoulder arthroplasty has become the standard treatment for cuff tear arthropathy and complex fractures of the proximal humerus. The Delta Xtend prosthesis (DePuy Synthes, Warsaw, IN, USA) was launched in 2006 and has shown good short-term results. Longer-term results are not yet available. METHODS: There were 126 primary Delta Xtend prostheses implanted in our center by 1 surgeon from October 2006 until December 2009. Of these, 38 patients died, 12 were lost to follow-up, and 2 needed early revision of the prosthesis. Follow-up of at least 8 years was available for 74 patients. At preoperative and postoperative visits, shoulder function and pain were evaluated using the age- and sex-adjusted Constant-Murley score (aCS). The satisfaction rate was evaluated on a visual analog scale (VAS). RESULTS: The mean follow-up in our population was 113.1 months. The mean aCS was 44.6% (standard deviation [SD], 19.2) preoperatively. It increased significantly (P < .001) after surgery to 75.8% (SD, 12.5) at 3 months and 91.1% (SD, 11.8) at 5 years. At the latest follow-up, the mean aCS was only 79.9% (SD, 17.7), which was significantly lower (P = .002) than the aCS at 5 years postoperatively. An overall survival rate of more than 97% was seen at 8 years of follow-up. CONCLUSION: This study confirms that the promising short-term results of the Delta Xtend prosthesis can be extended in the longer-term. However, further follow-up will be necessary to check whether the statistically significant decrease in the Constant-Murley score at latest follow-up, which was driven by a decrease in range of motion and power, continues or not.

Constitutional varus does not affect joint line orientation in the coronal plane.

BACKGROUND: In a previous study, we described the distribution of coronal alignment in a normal asymptomatic population and recognized the occurrence of constitutional varus in one of four individuals. It is important to further investigate the influence of this condition on the joint line orientation and how the latter is affected by the onset and progression of arthritis. QUESTIONS/PURPOSES: The purposes of this study are (1) to describe the distribution of joint line orientation in the coronal plane in the normal population; (2) to compare joint line orientation between patients with constitutional varus and neutral mechanical alignment; and (3) to compare joint line orientation between a cohort of patients with prearthritic constitutional varus and a cohort of patients with established symptomatic varus arthritis. METHODS: Full-leg standing hip-to-ankle digital radiographs were performed in 248 young healthy individuals and 532 patients with knee arthritis. Hip-knee-ankle (HKA) angle and tibial joint line angle (TJLA) were measured in the coronal plane. Patients were subdivided into varus (HKA ≤ -3°), neutral, and valgus (HKA ≥ 3°). RESULTS: The mean TJLA in healthy subjects was 0.3° (SD 2.0°). TJLA was parallel to the floor in healthy subgroups with neutral alignment (TJLA 0.3°, SD 1.9) and constitutional varus (TJLA 0.2°, SD 2.2°). In patients with symptomatic arthritis and varus alignment, the TJLA opened medially (mean -1.9°, SD 3.5°). CONCLUSIONS: Constitutional varus does not affect joint line orientation. Advanced medial arthritis causes divergence of the joint line from parallel to the floor. These findings influence decision-making for osteotomy and alignment in total knee arthroplasty.

Patellar tilt and thickness do not influence postoperative flexion in a high-flex design total knee arthroplasty.

PURPOSE: The purpose of this short-term study was to determine whether patellar thickness and tilt influence the postoperative flexion in a high-flex design total knee arthroplasty (TKA). METHODS: Between 2007 and 2009, 106 patients underwent surgery for TKA using rotating platform flex prosthesis (DePuy, Warsaw, Ind). All of them were suffering from end-stage osteoarthritis. All patients were evaluated preoperatively and at 12 months of follow-up. Maximum active, non-weight-bearing flexion was the primary outcome parameter. Standard standing antero-posterior and lateral weight-bearing radiographs were made. The patellofemoral joints were evaluated in skyline views taken with the knees at approximately 60° of flexion. Patellar thickness, patellar tilt, Caton-Deschamps indices and lower limb alignment were measured. RESULTS: The mean flexion observed before surgery was 125° ± 15° and after 1 year was 128° ± 13°. The mean patellar thickness preoperatively was 24.5 ± 2.9 and 25.8 ± 3.2 mm at 12 months after surgery. The mean patellar tilt before the procedure was 2.9° ± 4.1° and after 12 months of follow-up was -0.8° ± 5.0°. The mean preoperative hip-knee-ankle was 2.6° ± 6.2°. No significant correlation was found between postoperative patellar tilt and thickness and postoperative flexion (n.s.). CONCLUSIONS: Patellar tilt and thickness after TKA are factors that depend on the surgery. The resection of the patella can influence both patellar thickness and patellar tilt. By developing adequate surgical instruments, it would be possible to avoid the occurrence of an exaggerated patellar tilt or a major difference in patellar thickness. However, these two factors did not seem to influence the postoperative flexion in a high-flex design TKA, which can be seen as one of the most important outcome factors after TKA.