Cemented humeral surface replacement for a locked posterior fracture-dislocation: a case report.

Posterior fracture-dislocations of the shoulder are uncommon and challenging lesions. We present the case of a 76-year-old male patient who sustained a locked posterior humeral head fracture-dislocation during a convulsion. Because more than 40% of the articular surface was involved, preserving the head was not possible. We treated the fracture with a cemented humeral surface replacement. The patient demonstrated good shoulder function and no instability on short-term follow-up. Surface replacement may be a valuable treatment option for fracture-dislocations of the shoulder with articular surface involvement.

Plain radiographs have limited sensitivity for glenohumeral cartilage lesions.

Glenohumeral cartilage lesions are frequently encountered during shoulder arthroscopy, but are not always represented on radiographs. We intended to define the diagnostic value of plain shoulder radiographs in detecting glenohumeral cartilage lesions. The radiographs of 167 patients undergoing shoulder arthroscopy were analyzed for signs of degenerative joint disease. Formal criteria indicating osteoarthritis (osteophytes, joint space narrowing, and sclerosis) were registered and correlated to cartilage lesions diagnosed during shoulder arthroscopy. The intrarater reliabilities were .920 (T.K.) and .953 (M.E.) and the interrater reliabilities were .802 (T.K. 1, M.E. 1), .909 (T.K. 2, M.E. 1), .922 (T.K. 1, M.E. 2), and .953 (T.K. 2, M.E. 2), indicating excellent agreement. There were 35 correct positive, 91 correct negative, 34 false negative, and 7 false positive radiographs. The sensitivity and specificity for any degree of cartilage lesion were 50.7% and 92.9%, respectively, and the positive and negative predictive values were 83.3% and 72.8%, respectively. For third- and fourth-grade cartilage lesions, the sensitivity was 76.0% and the positive and negative predictive values were 73.1% and 93.8%, respectively. While plain radiographs can often detect severe cartilage lesions, the sensitivity and negative predictive value are too low to reliably exclude cartilage lesions overall. In case of doubt, we recommend further radiological workup.

Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors.

In the advent of the EU guidelines 2004/23/EG and 2006/17/EG requiring extensive safety and quality steps in bone banking, the prevalence and risk of infection disease transmission from bone allograft needs to be reconsidered. Therefore, we prospectively reviewed the screening process of bone donations and the outcome of surgeries utilizing bone allografts from our internal hospital bone bank with regard to infections according to CDC criteria. One-hundred and eighty-eight allogenic bone transplantation procedures in 160 patients were followed-up for 12-64 months (mean 32 months). Bacterial infection occurred in 11 patients, the overall infection rate therefore was 6.9%. After review of the clinical and intraoperative findings, none of the infections were likely to have been caused by the bone graft. Although no follow-up serologic testing was performed, no HIV of hepatitis infections were observed. Frozen bone allografts derived from live donors and provided by hospitals can generally be considered safe. However, without new and relevant clinical expertise, continuing this technique will be impeded by the new EU guidelines and their national implementations.

The mini-incision mid-vastus approach for total knee arthroplasty.

OBJECTIVE: Rapid functional recovery and improved range of motion after total knee arthroplasty (TKA) without compromising implant position. INDICATIONS: Osteoarthritis of the knee requiring TKA. CONTRAINDICATIONS: Preoperative flexion < 80 degrees. Flexion contracture > 20 degrees. Body mass index > 40 kg/m(2). Fixed valgus deformity > 15 degrees. Relative: previous open surgery on the knee; systematic steroids (skin fragility); tall muscular males. SURGICAL TECHNIQUE: Straight skin incision over the medial third of the patella from 2 cm proximal to the patella, and then to the level of the tibial tuberosity. Extension of capsular incision 2 cm into the vastus medialis muscle from a point 2 cm proximal to the patella. Deep incision around the medial border of the patella and distally to the level of the tibial tuberosity. The patella is displaced laterally but is not everted in flexion. Knee flexion and extension as necessary to move the soft-tissue surgical window for proximal or distal exposure. Hyperflexion of the knee only for insertion of the tibial component. POSTOPERATIVE MANAGEMENT: Knee flexion exercises extension/flexion 0-0-70 degrees using continuous passive motion the day after surgery. Weight bearing to tolerance allowed at 1st day after surgery (walker, two crutches). Thrombosis prophylaxis. RESULTS: 69 patients with 74 TKAs done through the mini-incision mid-vastus approach were available with a minimum 1-year follow-up. A control group was evaluated retrospectively including 52 patients with 57 total knee replacements in which a standard medial parapatellar arthrotomy with patella eversion was used. At all clinical evaluations flexion and the ability to climb stairs were significantly superior in the mid-vastus group indicating a faster recovery and return to functional activities. There were no complications and the radiographic evaluation found no implant or limb malalignment, or signs of early loosening.

A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja.

Our aim in this study was to evaluate the prevalence of patella baja after total knee arthroplasty (TKA) using 2 different surgical techniques. Postoperative changes in patella height were measured on serial radiographs of 74 TKAs implanted using a mini-midvastus capsular approach without patella eversion (group 1) and 57 TKAs implanted using a standard medial parapatellar capsular approach with patella eversion (group 2). Preoperative and postoperative Knee Society scores, operative data, and complications were compared. With a cutoff level of 5% shortening, the prevalence was 12% in group 1 and 37% in group 2 (P = .001). The presence of patella baja was related to reduced flexion and increased pain as early as 1 year after TKA.

Durability of implant fixation after less-invasive total hip arthroplasty.

Less-invasive techniques for total hip arthroplasty (THA) have sparked an increased interest among orthopedic surgeons and patients. There has been concern regarding decreased surgical exposure and compromise in prosthesis durability. We present the first long-term outcome of THA performed via the mini-incision posterior approach to show the durability of implant fixation. We compare the clinical and radiographic findings with previously published findings of authors using the same femoral implant and standard surgical techniques over a similar follow-up period. Ninety implants were followed for 10 to 13 years. Clinical evaluation revealed a Harris Hip Score of 92.3. Radiographic evaluation revealed proximal bone atrophy in 57% and lucent lines in 14% of femurs and 11% of cups. Osteolysis was noted in 10% and was associated with polyethylene wear. There were no cases of aseptic stem loosening. Eight polyethylene inserts were revised for wear. These 10-year minimum follow-up findings are consistently comparable with previously published studies using the same implant and larger surgical approaches followed for a similar period. Mini-incision THA technique did not compromise the long-term clinical and radiographic findings when compared with conventional techniques.