Shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis.

BACKGROUND: Shoulder arthroplasty after native shoulder infection is an uncommon problem with limited outcomes data. The purpose of this study was to evaluate the rates of reinfection and clinical outcomes after shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis. METHODS: Between 1977 and 2009, 24 shoulders underwent shoulder arthroplasty for postinfectious glenohumeral arthritis. Twenty-three were monitored for a minimum of 2 years (mean, 8.3 years) or until reoperation. Complications and clinical and radiographic results were documented at the most recent follow-up. RESULTS: Of the 23 shoulders, 23 had no pain or mild or moderate pain after vigorous activity. Pain scores improved from 4.5 to 2.1 points after shoulder arthroplasty (P < .001). The mean shoulder abduction improved from 62° to 110° (P < .001), and the mean external rotation improved from 14° to 47° (P < .001). Subjectively, the result in 16 of the 23 shoulders was rated as much better or better. Five shoulders required reoperation, with 2 having an infectious cause. The Neer rating was excellent in 2 shoulders, satisfactory or successful in 9, and unsatisfactory or unsuccessful in 12. Radiographic follow-up showed 3 glenoids and 3 humeral components were at risk for loosening. CONCLUSIONS: Shoulder arthroplasty for the treatment of the sequelae of an infected shoulder can be performed with a low risk of reinfection. The higher-than-expected rate of clinical or radiographic loosening remains concerning for culture negative infection. Although overall pain and motion can be expected to improve, unsatisfactory clinical results are not uncommon and may be secondary to the initial insult of infection.

Non-Hodgkin's lymphoma of the knee diagnosed by arthroscopy.

We report a case of non-Hodgkin's lymphoma of the knee diagnosed by arthroscopy in an otherwise healthy, active 31-year-old woman. Plain radiographs were unremarkable and magnetic resonance imaging findings indicated the presence of a posterior horn medial meniscal tear. The patient underwent arthroscopy for a planned partial medial meniscectomy. However, on joint visualization, hyperemic hypertrophic synovitis was found. Tissue samples were collected and sent for histopathologic testing that revealed diffuse large B cells. The patient was referred to the oncology department where 2 lesions on her lung were also found. Malignant disease should be in the mindset of the orthopaedic surgeon when a patient presents with constant pain, an unusual history, atypical response to conventional treatment, or a diagnostic dilemma.

Radiographic analysis of polyethylene glenoid components using modern cementing techniques.

The purpose of this study was to examine the initial radiographic appearance and changes occurring over time in patients who have undergone total shoulder arthroplasty by modern methods of bone preparation and current cement techniques. Sixty-five patients underwent seventy total shoulder arthroplasties by use of a cemented all-polyethylene, keeled glenoid component. The surface radius was equal to the radius of a one-piece humeral component. The mean clinical follow-up was 4.18 years (range, 2-8.6 years); radiographic follow-up averaged 3.9 years (range, 2-8.6 years). Three observers evaluated radiographs 1 to 2 months postoperatively and at final follow-up. The glenoid component was considered at risk for clinical problems if there was a complete lucent line surrounding the component and some part of the line was 1.5 mm or greater in width or two of three or all three observers identified a shift in component position. Similarly, a humeral component was judged to be at risk if three or more zones had lucent lines 2 mm or greater in width or a shift in component position had occurred. On the early radiographs, 10 glenoid components had incomplete lucencies behind the keel. On the most recent radiographs, 59 glenoid components had incomplete lucent lines and 3 had complete lucent lines. Eight components were judged to have shifted in position. When data for lucent lines and shifting were combined, 10 (14%) of the glenoid components were at risk. At follow-up, no cemented humeral components were at risk whereas 3 (6%) of the 54 tissue ingrowth components were at risk for clinical loosening. Given the number of shoulders in this study, there were no associations between radiographic changes and clinical results. Improvements have occurred in glenoid component fixation. However, additional advances are possible and may occur from improved surgical technique, decreased particle-related osteolysis, enhanced joint kinematics, or novel fixation methods.

Reimplantation of a shoulder arthroplasty after a previous infected arthroplasty.

Currently, there is little information on the results of reimplantation after previous resection for an infected shoulder arthroplasty. The purpose of this study was to determine the rate of recurrent infection and clinical results. Between 1975 and 2000, 4 patients with a resection arthroplasty from a previously infected shoulder arthroplasty underwent subsequent reimplantation of a prosthesis. The time interval from resection arthroplasty to reimplantation ranged from 7 months to 5.5 years. The mean clinical follow-up was 7.4 years (range, 2-15 years). There were no patients with recurrent infection. At the most recent follow-up, 2 patients had no pain, 1 had slight pain, and 1 had moderate pain. Mean elevation improved from 60 degrees to 80 degrees, and external rotation improved from 13 degrees to 50 degrees. With regard to patient satisfaction, 1 patient was much better, 2 were better, and 1 was the same. There were 2 satisfactory results and 2 unsatisfactory results. Reimplantation of a shoulder arthroplasty after a previous resection arthroplasty for infection can be performed with a low risk of reinfection. However, arthroplasty in this setting is especially challenging because of the potential for significant bone and soft-tissue deficits. These challenges can compromise the clinical results.

Radial tunnel syndrome caused by ganglion cyst: treatment by arthroscopic cyst decompression.

Compressive neuropathies of the radial nerve at the elbow can lead to one of 2 clinical entities. Posterior interosseous syndrome is primarily a motor deficiency of the posterior interosseous nerve, and radial tunnel syndrome presents as pain along the radial tunnel and extensor muscle mass. The radial nerve can be compressed at a number of sites around the elbow. In addition, numerous mass lesions reported in the literature can cause compressive neuropathy of the radial nerve at the elbow. Standard surgical management for persistent radial tunnel syndrome that is refractory to nonsurgical treatment is open decompression of the radial nerve. Cysts occurring in other joints are commonly treated arthroscopically. Supraglenoid cysts of the shoulder, meniscal cysts in the knee, and dorsal wrist ganglia are routinely treated with arthroscopic decompression or excision with management of the underlying etiology of the cyst. We present a case of radial tunnel syndrome caused by a ganglion cyst of the proximal radioulnar joint that was treated using arthroscopic excision of the cyst and decompression of the radial nerve.

Shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis.

BACKGROUND: Currently, no studies on shoulder arthroplasty after a previous infection of the shoulder have been published, as far as we know. The purpose of this study was to evaluate the rates of reinfection and the clinical results after shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis. METHODS: Between 1975 and 2000, thirteen patients with a history of infection of the shoulder that resulted in severe glenohumeral arthritis underwent shoulder arthroplasty. One patient who had been followed for less than two years was excluded. Therefore, twelve shoulders that had been followed for a minimum of two years (mean, 9.7 years) or until the time of revision surgery were included in the study. Complications, clinical results (pain, satisfaction, and range of motion), and radiographic results were documented at the time of the latest follow-up. RESULTS: No patient in this study had had a known reinfection at the time of the latest follow-up. Overall pain scores improved from 4.8 to 2.5 points after implantation of a prosthesis. Eight of the twelve patients had no pain or mild or moderate pain only after vigorous activity. The mean shoulder abduction improved from 75 degrees to 117 degrees, and the mean external rotation improved from 13 degrees to 36 degrees. Subjectively, only six of the twelve patients rated the result as much better or better. The results in the eight patients who underwent a full rehabilitation program were better than those in the four patients who underwent a limited-goals rehabilitation program. CONCLUSION: Shoulder arthroplasty for the treatment of the sequelae of an infected shoulder can be performed with a low risk of reinfection. While overall pain and motion can be expected to improve, unsatisfactory clinical results that are related to the destructive effects of the initial infection are not uncommon.