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Background: Literature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears., Methods: A retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification., Results: The final sample consisted of 45 patients with an average age of 55 ± 9 years. After a mean follow-up time of 107 ± 54 months, the mean UCLA and DASH scores were 8.7 ± 1.3 and 42.2 ± 6.4, respectively. ROM and CMS showed statistically significant improvements (all P < .001). Before surgery, the mean CMS was 49% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 94.2% that of sex- and age-matched healthy individuals, and no patients showed CMS of 30 or less. The mean increase in the CMS was 41.4 ± 9.8 points (range, 23-60 points). The ultrasonographic assessment showed SSC tendon healing in 39 (86.7%) cases; tendon retear was recorded in 5 (13.3%) cases. All scores directly correlated with the healing of the tendon. A higher postoperative DASH score was associated with male sex (P = .039, β = 5.538) and a longer follow-up period (P = .044, β = 0.001). The postoperative CMS (P < .001) and UCLA scores (P = .001) were significantly higher in patients younger than 60 years of age at surgery than in older individuals., Conclusion: Arthroscopic repair of isolated SSC tears achieves excellent clinical and functional results at a mean of 9 years postoperatively, with a satisfactory healing rate. Better functional outcomes correlate with SSC tendon integrity and were observed in male patients and in those younger than 60 years at surgery., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

(1) Background : The aim of this study was to evaluate short- to mid-term clinical and radiological results in patients undergoing primary total hip arthroplasty (THA) with the use of a Selective Laser Melting 3D-printed highly porous titanium acetabular cup (Jump System Traser ® , Permedica Orthopaedics). (2) Methods : We conducted a retrospective study and collected prospective data on 125 consecutive patients who underwent primary THA with the use of highly porous titanium cup. Each patient was evaluated preoperatively and postoperatively with a clinical and radiological assessment. (3) Results : The final cohort consisted of 104 patients evaluated after a correct value of 52 (38-74) months. The median Harris Hip Score (HHS) significantly improved from 63.7 (16-95.8) preoperatively to 94.8 (38.2-95.8) postoperatively ( p < 0.001), with higher improvement associated with higher age at surgery (β = 0.22, p = 0.025). On postoperative radiographs, the average acetabular cup inclination and anteversion were 46° (30°-57°) and 15° (1°-32°), respectively. All cups radiographically showed signs of osseointegration with no radiolucency observed, or component loosening. (4) Conclusions : The use of this highly porous acetabular cup in primary THA achieved excellent clinical, functional, and radiological results at mid-term follow-up. A better clinical recovery can be expected in older patients. The radiological evaluation showed excellent osseointegration of the cup with complete absence of periprosthetic radiolucent lines.

Background: Several techniques have been adopted during primary reverse shoulder arthroplasty (RSA) to manage glenoid bone defect. Among bone grafts, humeral head autograft is currently the mainstream option. However, autologous humeral heads may be unavailable or inadequate, and allografts may be a viable alternative. The aim of the present study was to evaluate the functional and radiologic outcomes of femoral head allografts for glenoid bone defects in primary RSA., Methods: We conducted a retrospective study with prospective data collection enrolling 20 consecutive patients who underwent RSA with femoral head allografts for glenoid bone defects. Indications for surgery were eccentric cuff tear arthropathy in 10 cases (50%), concentric osteoarthritis in 9 cases (45%), and fracture sequelae in 1 case (5%). Each patient was evaluated preoperatively and at follow-up by radiologic and computed tomography (CT) and by assessing the range of motion (ROM) and the Constant-Murley score (CMS). A CT-based software, a patient-specific 3D model of the scapula, and patient-specific instrumentation were used to shape the graft and to assess the position of K-wire for the central peg. Postoperatively, CT scans were used to identify graft incorporation and resorption., Results: After a median follow-up of 26.5 months (24-38), ROM and CMS showed a statistically significant improvement (all P = .001). The median measures of the graft were as follows: 28 mm (28-29) for diameter, 22° (10°-31°) for angle, 4 mm (2-8 mm) for minimum thickness, and 15 mm (11-21 mm) for maximum thickness. Before the surgery, the median glenoid version was 21.8° (16.5°-33.5°) for the retroverted glenoids and -13.5° (-23° to -12°) for the anteverted glenoids. At the follow-up, the median postoperative baseplate retroversion was 5.7° (2.2°-1.5°) (P = .001), and this value was close to the 4° retroversion planned on the preoperative CT-based software. Postoperative major complications were noted in 4 patients: 2 dislocations, 1 baseplate failure following a high-energy trauma, and 1 septic baseplate failure. Partial graft resorption without glenoid component failure was observed in 3 cases that did not require revision surgery., Conclusion: The femoral head allograft for glenoid bone loss in primary RSA restores shoulder function, with CMS values comparable to those of sex- and age-matched healthy individuals. A high rate of incorporation of the graft and satisfactory correction of the glenoid version can be expected after surgery. The management of glenoid bone defects remains a challenging procedure, and a 15% risk of major complication must be considered., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care., Objective: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage., Methods: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility., Results: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category., Conclusions: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial., (©Alexander Tacey, Jack Behne, Rhiannon K Patten, Minh Truc Ngo, Rees Thomas, Jessica Ancilleri, Chelsea Bone, Angela Paredes Castro, Helen McCarthy, Katherine Harkin, Julia FM Gilmartin-Thomas, Amir Takla, Calum Downie, Jane Mulcahy, Michelle Ball, Jenny Sharples, Sarah Dash, Amy Lawton, Breanna Wright, Peter Sleeth, Tina Kostecki, Christopher Sonn, Michael J McKenna, Vasso Apostolopoulos, Rebecca Lane, Catherine M Said, Mary De Gori, Andrew McAinch, Phong Tran, Itamar Levinger, Alexandra Parker, Mary N Woessner, Michaela Pascoe. Originally published in JMIR Formative Research (https://formative.jmir.org), 08.12.2023.)

Background: The medium-term results of reverse shoulder arthroplasty (RSA) that has been performed by a single surgeon have been previously reported. The purpose of this study was to investigate the minimum 10-year clinical and radiographic outcomes of these patients., Methods: In this prospective cohort study, 27 patients were evaluated after RSA for massive rotator cuff tear with or without eccentric osteoarthritis (OA) or concentric OA with the Constant-Murley Score (CMS), range of motion (ROM), and a radiologic assessment., Results: At a mean 12-year follow-up, the CMS and ROM were significantly improved when compared with the baseline values (all P  < .001). Once stratified by diagnosis, no difference in the ROM or total CMS was found between patients with massive rotator cuff tear with/without eccentric OA and those with concentric OA. Neither ROM nor CMS decreased when compared to the mid-term values of the previous study, for both the overall population and the diagnosis-stratified groups. Scapular notching was reported in 66.7% of cases that was similar to the data reported at mid-term follow-up. The calcification rate was 59.3% at the long-term evaluation, and there were no differences between the same case-series population (51.9%; P  = .785) and the whole population at mid-term follow-up (47%; P  = .358)., Conclusion: RSA led to excellent clinical and functional outcomes for patients up to 17 years postoperatively, and there was no decrease in the CMS over time. No loosening of implants was noted, and the rate of scapular notching was 66%, mostly grade 1 or 2., (© 2023 The Author(s).)

Background: Musculoskeletal conditions, including osteoarthritis (OA), are a leading cause of disability and chronic pain, and are associated with high rates of comorbid depression. However, signs of depression are often masked by pain. The aim of this study was to determine the prevalence and severity of depression and pain in individuals awaiting specialist orthopaedic consultation. A secondary objective was to determine the relationship between pain and depression, irrespective of demographic factors and clinical diagnosis., Methods: Cross-sectional analysis of individuals awaiting orthopaedic consultation at a public hospital in Melbourne, Australia. Relevant data were extracted from medical records and questionnaires. Descriptive statistics were used to summarise participant characteristics. The patient health questionnaire (PHQ-9) was used to assess depression and a numerical rating scale (NRS) was used to assess pain severity. Multiple linear regression analyses were used to establish the relationship between pain and depression., Results: Nine hundred and eighty-six adults (mean ± standard deviation, age = 54.1 ± 15.7 years, 53.2% women) participated in the study. OA was present in 56% of the population and 34% of the entire population had moderate depression or greater, 19% of which met the criteria for major depressive disorder. Moderate-to-severe pain was present in 79% of individuals with OA and 55% of individuals with other musculoskeletal complaints. Pain was significantly associated with depression scores (β = 0.84, adjusted R 2  = 0.13, P < 0.001), and this relationship remained significant after accounting for gender, age, education and employment status, OA status, number of joints affected and waiting time (β = 0.91, adjusted R 2  = 0.19, P < 0.001)., Conclusions: Depression affects one-third of individuals on an orthopaedic waitlist. A strong link between pain and depression in patients awaiting specialist orthopaedic consultation exists, indicating a need for an integrated approach in addressing pain management and depression to manage this complex and comorbid presentation., (© 2023. The Author(s).)

Background: Osteoarthritis (OA) is a chronic, progressive condition that can be effectively managed via conservative treatments including exercise, weight management and education. Offering these treatments contemporaneously and digitally may increase adherence and engagement due to the flexibility and cost-effectiveness of digital program delivery. The objective of this review was to summarise the characteristics of current digital self-management interventions for individuals with OA and synthesise adherence and attrition outcomes., Methods: Electronic databases were searched for randomised controlled trials utilising digital self-management interventions in individuals with OA. Two reviewers independently screened the search results and extracted data relating to study characteristics, intervention characteristics, and adherence and dropout rates., Results: Eleven studies were included in this review. Intervention length ranged from 6 weeks to 9 months. All interventions were designed for individuals with OA and mostwere multi-component and were constructed around physical activity. The reporting of intervention adherence varied greatly between studies and limited the ability to form conclusions regarding the impact of intervention characteristics. However, of the seven studies that quantified adherence, six reported adherence > 70%. Seven of the included studies reported attrition rates < 20%, with contact and support from researchers not appearing to influence adherence or attrition., Conclusions: Holistic digital interventions designed for a targeted condition are a promising approach for promoting high adherence and reducing attrition. Future studies should explore how adherence of digital interventions compares to face-to-face interventions and determine potential influencers of adherence., (© 2022. The Author(s).)

Purpose: To investigate associations between clinical and demographic parameters and Constant-Murley (CM) scores after subacromial balloon placement for massive, irreparable rotator cuff tears and to evaluate implant survival, shoulder function, and patient satisfaction., Methods: We prospectively analyzed patients with rotator cuff tears deemed irreparable on preoperative magnetic resonance imaging for whom nonoperative therapy was unsuccessful and who underwent balloon placement from 2014 to 2017 with minimum 1-year follow-up. Shoulder function was assessed using the CM score and the 12-Item Short Form Health Survey., Results: The study included 51 patients (22 women and 29 men) with a mean age at surgery of 63 years (range, 50-78 years). The mean follow-up period was 36 months (range, 24-56 months). The postoperative acromiohumeral interval and total preoperative CM score predicted the postoperative CM score at final follow-up. The implant survival rates were 92% at 6 and 12 months, 90% at 2 years, and 87% at 3 and 4 years. Five patients underwent reverse total shoulder arthroplasty, and 1 underwent latissimus dorsi tendon transfer. Postoperatively, mean CM scores (± standard deviation) improved for range of motion (from 11 ± 5.4 to 34 ± 6.8) and strength (from 13 ± 5.4 to 28 ± 12) (P < .01 for both). The total CM score improved from 27 ± 7.4 preoperatively to 77 ± 15 postoperatively (P < .01). The physical and mental component summary scores on the 12-Item Short Form Health Survey improved from 27 ± 5.0 to 51 ± 6.5 (P = .02) and from 44 ± 15 to 56 ± 8.0, respectively (P < .01). Thirty-eight patients reported excellent satisfaction, 8 were satisfied, and 5 were dissatisfied. Of the patients, 50 (98%) exceeded the minimal clinically important difference (≥10.4) and patient acceptable symptom state (≥44)., Conclusions: At mean 3-year follow-up, subacromial balloon spacer placement for massive, irreparable rotator cuff tears was associated with a significant improvement in shoulder function, limited need for revision surgery, and high patient satisfaction. A greater postoperative acromiohumeral interval and lower preoperative CM score predicted a lower postoperative CM score at final follow-up., Level of Evidence: Level IV, retrospective cohort study and treatment study., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Malignant glomus tumors (MGTs) are exceptional but pose diagnostic and therapeutic challenges. Wide resection is the recommended treatment method, however, no data are available concerning adjuvant therapies. We present an exceptional case of extradigital deep-seated MGT of the forearm, with an exceptional bone infiltration. Despite being treated with wide resection, the patient had an optimal functional outcome, no functional loss, no motor or sensitive deficits and has returned to his full daily activity., (Copyright © 2019 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Introduction: Partial-thickness rotator cuff tears are a common cause of shoulder pain and disability. Arthroscopic repair is an effective treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions, and transtendon repair and completion of the tear and repair are the surgical techniques commonly used to treat such lesions. Our aim was to retrospectively evaluate the minimum 24-month clinical and radiological results of PASTA., Materials and Methods: Patients suffering from PASTA lesion who underwent arthroscopic repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess the patients' functionality pre- and postoperatively. The postoperative patient assessment included the simple shoulder test (SST). Postoperative tendon integrity was evaluated by ultrasound examination., Results: 151 patients (153 shoulders) were retrospectively evaluated 73.9 (24-142) months after a completion-repair (94 cases) or transtendon repair (59 cases) of a PASTA lesion. The CMS significantly improved from 47.7 (22-63) preoperatively to 84.2 (62-100) postoperatively (p < 0.001). The mean postoperative SST score was 10.1 (5-12), and 95% of patients were satisfied with the surgery. No significant differences were noted between the two techniques in terms of postoperative CMS, SST score and satisfaction. Seventy-four and 43 cases treated with completion and repair and transtendon repair, respectively, performed ultrasound examination 66.1 (24-142) months after surgery. The overall retear rate was 13.7%, supraspinatus retears were observed in ten shoulder subjected to completion and repair (13.5%) and six shoulders subjected to transtendon repair (13.9%), and no significant differences were noted between the two techniques as for CMS (p = 0.896), SST (p = 0.973), satisfaction (p = 0.621) and retear (p = 0.999). Males and younger patients had a higher postoperative CMS (p values < 0.001), and SST score (p < 0.001 and p = 0.038, respectively)., Conclusions: Arthroscopic repair of PASTA lesion achieves high rates of repair integrity regardless of repair type and high levels of functional recovery and patient satisfaction 6 years after surgery.

This study aims to evaluate the effect of postoperative blood recovery with reinfusion drains on hematologic parameters and blood transfusion rate in patients undergoing total joint arthroplasty. Three-hundred-and-forty-four patient records were reviewed and 271 patients were included in the study; 56.8% of patients were treated with postoperative cell salvage procedure using reinfusion drains (PCS) and 43.2% had closed-suction drain (CSD) postoperatively. In comparison to the CSD group, the PCS group showed higher hemoglobin (Hb) levels on the first and second days postoperatively but no statistical differences were noted at the day of discharge. 75.2% and 37.7% of patients required blood transfusions in the CSD and PCS groups, respectively. The PCS group had a lower number of blood transfusions than the CSD group. At multivariate analysis, Hb loss rate was related to preoperative Hb values, total amount of drained blood and chronic antiplatelet therapy. The number of blood transfusions was related to preoperative Hb values, closed-suction drains, preoperative platelet count, TKA surgery and BMI. This study supports the use of PCS with reinfusion drains after THA and TKA at least for the short-term.

This study aims to report the minimum 2-year follow-up results of the tantalum monoblock cup in primary THA and to identify possible outcome predictors. Eighty-eight porous tantalum monoblock acetabular cup in primary THA were reviewed. The Harris Hip Score (HHS) and the Short Form-36 Health Survey (SF-36) were used for the evaluation of outcomes. Radiographic evaluation included acetabular component orientation, presence of bone gaps, radiolucent lines, new bone formation and heterotopic ossifications. After a mean follow-up of 55.4±19.5 months, no component revision was noted. The HHS improved from 43.6±14.6 to 88.3±8.4 (P less than 0.001). The mean physical domain of the SF-36 did not significantly differ from that of age-matched, healthy subjects (P=0.072); the mean mental component of the SF-36 was significantly higher than that of age-matched, healthy subjects (P less than 0.001). Negative determinants of postoperative HHS (total adjusted R2=0.328) using tantalum monoblock cups were age at surgery (R2=0.164, P less than 0.001), female sex (R2=0.103, P less than 0.001), and acetabular inclination (R2=0.084, P equals 0.003).

Purpose: To compare the effectiveness of tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. The null hypothesis was that there is no difference in functional scores between the tenotomy and tenodesis groups., Methods: A total of 69 patients with a combined supraspinatus tear and LHBT lesion aged over 40 years entered this prospective comparative study and were randomly assigned to the arthroscopic LHB tenotomy or tenodesis group. Fifty-five patients (31 in the tenotomy group and 24 in the tenodesis group) were available for the 6- and 24-month post-operative evaluations., Results: There were no statistically significant differences in post-operative Constant and Murley score, quality of life, pain, and strengths between groups. Higher rates of Popeye's sign were noted 6 and 24 months post-operatively in the tenotomy group compared to tenodesis., Conclusions: Although tenotomy is affected by a higher incidence of cosmetic deformity, there is no superiority of arthroscopic tenodesis over tenotomy in the treatment of LHBT lesion as a concomitant procedure to an arthroscopic repair of the supraspinatus tendon in terms of functional outcomes, quality of life, pain, and strength measured 6 and 24 months post-operatively., Level of Evidence: I.

Treatment of bone metastases is often palliative, aiming at pain control and stabilization or prevention of pathological fractures. However, a complete resection with healing purposes can be performed in selected cases. The aim of our work was to evaluate the survival of megaprostheses used for reconstruction after bone metastases. Between January 2001 and March 2015, we implanted 169 Megasystem-C® (Waldemar LINK® GmbH & Co. KG, Hamburg, Germany) after bone metastasis resection. Patients, 95 females and 74 males, were operated at an average age of 61 (12-87) years for proximal femoral resection in 135 (79.9%) cases, distal femur in 24 (14.2%), proximal tibia in 6 (3.6%), total femur in 3 (1.8%) and intercalary femur in 1 (0.6%). Mostly, breast cancer metastases (30.8%), kidney (17.8%) and lung (14.2%) were treated. At an average follow-up of 21 (1-150) months, we found a 99.4% overall limb salvage and a 96.1% overall survival rate at 1 year, 92.8% at 2 years, and 86.8% at 5 and 10 years. We found 9 (5.3%) mobilization cases of the proximal femoral implant, 3 needed surgical reduction; 2 (1.2%) cases of aseptic loosening of the prosthetic stem; 2 (1.2%) periprotetic infection cases, one requiring a 2-stage revision. Few literature studies have evaluated the survival of megaprosthetic implant in the treatment of bone metastases. Our data show how in this specific context the rate of complications is significantly lower than expected in general orthopedic orthopedic surgery. The use of modular prostheses is a valid reconstructive strategy after bone metastasis resection in selected patients. The rate of short-term complications is exceptionally low; further studies will have to confirm this in the longer term.

An attractive method for osteoarthritis (OA) staging is the measurement of biochemical markers in biological fluids, which could reflect dynamic and quantitative changes in joint remodeling and therefore disease progression. Proteome analysis has been recognized as one of the most effective tools to explore biomarkers as it can furnish a wealth of information in both diagnosis and prognosis of diseases. We have recently described an innovative tool for peptidome and lipidome profiling of fluids based on mesoporous aluminosilicate (MPAS) and Matrix-Assisted Laser Desorption/Ionization time-of-flight Mass Spectrometry (MALDI-TOF MS). The aim of this study was to analyze peptide profiles of human synovial fluid in patients with different grade of OA using MALDI-TOF-MS technique in order to identify potential markers of disease progression. Twenty-five patients older than 50 years and affected by primary knee OA diagnosed according to clinical and radiological criteria were enrolled. For each patient a synovial fluid sample was aspirated from the affected knee and analyzed using MALDI-TOF-MS technique. A statistically significant difference in the normalized area of two peaks (m/z=1865 and m/z=2021) was detected among different stages of OA. The 2 peaks were identified as Complement C3 peptide fragments: C3f and C3f Des-Arg. The expression levels of these two peptides (m/z=1865 and 2021) decreased with the progression of OA degrees severity (ρs=-0.434, p=0.03, and ρs=-0.532, p=0.006, respectively). This marker may be a useful tool for assessing the severity of knee OA and it may be a novel target for drug discovery, specifically for the development of disease modifying OA drugs. However further studies are required to clarify the role of C3f in OA pathogenesis.

Background: The purpose of the study was to use the cumulative summation (CUSUM) test to assess the learning curve during the introduction of a new surgical technique (patient-specific instrumentation) in total knee arthroplasty (TKA) in an academic department., Methods: The first 50TKAs operated on at an academic department using patient-specific templates (PSTs) were scheduled to enter the study. All patients had a preoperative computed tomography scan evaluation to plan bone resections. The PSTs were positioned intraoperatively according to the best-fit technique and their three-dimensional orientation was recorded by a navigation system. The position of the femur and tibia PST was compared to the planned position for four items for each component: coronal and sagittal orientation, medial and lateral height of resection. Items were summarized to obtain knee, femur and tibia PST scores, respectively. These scores were plotted according to chronological order and included in a CUSUM analysis. The tested hypothesis was that the PST process for TKA was immediately under control after its introduction., Results: CUSUM test showed that positioning of the PST significantly differed from the target throughout the study. There was a significant difference between all scores and the maximal score. No case obtained the maximal score of eight points. The study was interrupted after 20 cases because of this negative evaluation., Conclusion: The CUSUM test is effective in monitoring the learning curve when introducing a new surgical procedure. Introducing PST for TKA in an academic department may be associated with a long-lasting learning curve. The study was registered on the clinical.gov website (Identifier NCT02429245)., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the minimum 2-year results and possible outcomes of arthroscopic partial repair in different patterns of irreparable rotator cuff tears (RCTs)., Methods: Patients suffering from an irreparable supraspinatus and a reparable infraspinatus tendons who underwent arthroscopic partial repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess patients' functionality pre- and postoperatively. Postoperative patient assessment included the Simple Shoulder Test (SST) and the Short Form Health Survey questionnaire (SF-36). A postoperative range of motion, CMS, and strength were compared with the contralateral side. Postoperative SF-36 was compared with age- and sex-matched norms., Results: Ninety patients (95 shoulders) were reviewed after a mean follow-up of 7 (range 2-12) years. The subscapularis tendon was intact in 80 shoulders and torn but completely reparable in the remaining 15 shoulders. The CMS improved from 39.1 ± 8.4 (10-61) to 76.3 ± 9.7 (32-93) (P < .001). The mean postoperative SST was 9.1 ± 2.2 (1-12). Although the patients had lower postoperative abduction and internal rotation, strength in abduction and CMS in comparison with the measurements from the contralateral side, the median postoperative SF-36 physical and mental component summaries were 98% and 100% of the matched norms. No significant differences were found in postoperative outcomes according to the RCT pattern. Males showed significantly higher strengths in abduction (B = -1.384, 95% confidence interval [CI] -2.144 to -0.624, η 2  = 0.123, P < .001, 95% power), external rotation (B = -3.646, 95% CI -5.2 to -2.092, η 2  = 0.189, P < .001, 100% power), and internal rotation (B = -3.867, 95% CI -5.676 to -2.057, η 2  = 0.162, P < .001, 99% power) than females. Significantly higher ranges of abduction (η 2  = 0.431, P = .019, 98% power) and external rotation (η 2  = 0.417, P < .03, 97% power) were noted in younger patients. Higher strengths in abduction (η 2  = 0.495, P = .002, 100% power) and internal rotation (η 2  = 0.464, P = .006, 99% power) were also reported in these patients., Conclusions: When there is an irreparable supraspinatus but there is still the possibility to repair the infraspinatus and subscapularis, the arthroscopic partial cuff repair should be considered as an effective surgical option. Indeed, a significant clinical improvement can be achieved and, differently from pure symptomatic surgical procedures, this technique represents a reasonable effort to restore, at least in part, the shoulder joint functionality. Successful and reliable results can be expected at an average 7-year follow-up, regardless of the RCT pattern. Female and older patients have a greater likelihood of lower functional outcomes., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Periprosthetic joint infection remains one of the most challenging and pervasive complications following megaprosthetic replacement after tumor resection. The authors conducted a systematic review of the literature for clinical studies that reported a risk factor analysis for perimegaprosthetic joint infections. The search included English-language studies published up to July 2015. Eight studies fulfilled the inclusion criteria. Identified factors mostly related to both surgical procedure and hospitalization. Physicians should consider these results when discussing the outcomes of limb salvage surgery with patients and trying to reduce the overall burden of perimegaprosthetic joint infections. [Orthopedics. 2017; 40(1):e11-e16.]., (Copyright 2016, SLACK Incorporated.)

Background: Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has been recently introduced for treatment of irreparable, posterosuperior massive rotator cuff tears. We sought to evaluate the functional outcomes of this technique and to check for possible outcome predictors., Methods: The study reviewed 86 patients (aged 59.8 ± 5.9 years) who underwent an arthroscopic-assisted latissimus dorsi tendon transfer after 36.4 ± 9 months of follow-up. Of these, 14 patients (16.3%) sustained an irreparable massive rotator cuff tear after a failed arthroscopic rotator cuff repair. The Constant and Murley score (CMS) was used to assess patients' functionality preoperatively and at follow-up., Results: As a group, the CMS improved with surgery from 35.5 ± 6.1 to 69.5 ± 12.3 (P < .001). A lower preoperative CMS and a previous failed rotator cuff repair resulted in lower postoperative range of motion (P = .044 and P = .007, respectively) and CMS (P = .042 and P = .018, respectively). A previous rotator cuff repair resulted in lower satisfaction with surgery (P = .009). Gender and age did not affect the clinical outcomes., Conclusions: Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior massive rotator cuff tears in pain relief, functional recovery, and postoperative satisfaction. Patients with lower preoperative CMS and a history of failed rotator cuff repair have a greater likelihood of having a lower clinical result. However, the favorable values of summary postoperative scores do not exclude these patients as candidates for arthroscopic-assisted LDTT., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate what factors might predict the results of arthroscopic stabilization for anterior shoulder instability., Methods: One hundred and forty-three patients averaging 25 (15-58) years with traumatic anterior shoulder instability who underwent arthroscopic stabilization were reviewed at a median follow-up of 81 (24-172) months. Sixty-two (56.4 %) individuals were involved in contact sport activities, and there were 40 (30 %) patients who had only one dislocation prior to having surgery. Rowe score was measured preoperatively and at follow-up., Results: Thirty-three (23.1 %) patients experienced recurrent instability 12 (1-120) months after surgery, and 15 of those underwent further surgery. There was a statistically significant lower risk of failure (p = 0.027) for patients who had a surgical procedure after only one episode of shoulder dislocation. Patients treated after the second or further episode of shoulder dislocation exhibited a mean odds ratio for failure of 3.8 (95 % confidence interval 1.2-11.6, p = 0.044) with regard to first-time dislocators. The Rowe score significantly improved from a preoperative value of 25 (5-55) to a postoperative value of 100 (40-100) (p < 0.001). A significantly higher postoperative Rowe score was found in patients older than 24 years of age at the operation (p = 0.011) and in patients with less than eight dislocations prior to surgery (p = 0.05)., Conclusions: These results suggest that better functional results following arthroscopic stabilization can be expected in patients over 24 years of age and in those with a fewer number of dislocations preoperatively. A lower rate of recurrence can be expected if the patient undergoes surgery after the first episode of dislocation., Level of Evidence: Prognostic study, Level II.

The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1-167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure ( p = 0.921), nor to the reconstruction site ( p = 0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions ( p = 0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

High-dose antibiotic-loaded acrylic cement (ALAC) is used for managing peri-prosthetic joint infections (PJIs). The marked increase in resistant high-virulence bacteria is drawing the attention of physicians toward alternative antimicrobial formulations loaded into acrylic bone cement. The aim of this in vitro study was to determine the elution kinetics of 14 different high-dose ALACs. All ALAC samples showed a burst release of antibiotics in the first hour, progressively decreasing over time, and elution curves strictly adhered to a nonlinear regression analysis formula. Among aminoglycosides, commonly seen as the most appropriate antibiotics to be loaded into the bone cement, the highest elution rate was that of tobramycin. Among the glycopeptides, a class of antibiotics that should be considered to treat PJIs because of the prevalence of aminoglycoside resistance, vancomycin showed better elution than teicoplanin. Clindamycin, which can be associated with aminoglycosides to prepare ALACs and represents a useful option against the most common pathogens responsible for PJIs, showed the highest absolute and relative elutions among all the tested formulations. A noticeable elution was also detected for colistin, an antibiotic of last resort for treating multidrug-resistant bacteria. The current study demonstrates theoretical advantages in the preparation of ALAC for some antibiotics not routinely used in the clinical setting for PJIs. The use of these antibiotics based on the infecting bacteria sensitivity may represent a useful option for physicians to eradicate PJIs. In vivo testing should be considered in the future to confirm the results of this study., (Copyright 2014, SLACK Incorporated.)

This report presents an adult patient suffering from knee osteoarthritis and gross hypertrophy of the synovium, preoperatively interpreted as a nonspecific synovial reaction. The patient underwent a total knee replacement and a complete synovectomy was performed. Histological examination disclosed a synovial hemangioma, which is a rare intra-articular, benign tumor of youth.

Background: Modern semiconstrained reverse shoulder arthroplasty (RSA) has shown a great improvement in function and range of motion (ROM) in different etiologies, including revision surgery, sequelae of fractures, or tumors. Few studies have evaluated RSA for primary glenohumeral osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy excluding any other shoulder disease, and data on patients' quality of life after this surgery are lacking., Methods: In this prospective cohort study, 80 patients were evaluated after an RSA for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy with the Constant-Murley score (CMS), ROM, and Short Form Health Survey (SF-36). A radiologic assessment was performed preoperatively and postoperatively in 62 of these patients., Results: At a mean 5-year follow-up, the cumulative survival rate was 97.3% and significant improvements in the CMS and ROM were observed when compared with the baseline values. The CMS was 93.2% of the sex- and age-matched normal values. The postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA. The length of follow-up was found to be associated with the severity of scapular notching., Conclusions: This study introduces new predictors for surgical outcomes, and it shows that patients who had undergone RSA a mean of 5 years earlier exhibit similar functionality and health-related quality of life with respect to healthy controls. Physicians should consider these results when discussing the outcomes of this surgery with patients., Level of Evidence: Level IV, Case series, treatment study., (Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Background: Minimally invasive distal metatarsal osteotomy (MIDMO) is a common technique used to correct the hallux valgus deformity, but controversy remains regarding the expected outcomes of this surgery., Methods: Seventy-two patients (85 feet) suffering from hallux valgus underwent MIDMO with a modified Bösch technique. Patients were prospectively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and the AOFAS recovery rate was calculated. Before surgery and at follow-up, the hallux valgus (HVA), intermetatarsal (IMA), and distal metatarsal articular (DMAA) angles were measured, and the severity of disease was categorized according to the preoperative HVA. The tibial sesamoid position and articular congruence were evaluated. Postoperative complications were noted., Results: After an average follow-up of 73.3 ± 38.1 months, the total AOFAS score improved from 47.6 ± 13.3 to 87.3 ± 11.5 (P < .001). The HVA decreased from 34.7 ± 8.2 to 14.8 ± 7.8 degrees, the IMA from 14.7 ± 4 to 6.6 ± 3.6 degrees, and the DMAA from 20.9 ± 9.8 to 9 ± 6.6 degrees (P < .001 for all). Postoperative improvement in AOFAS was inversely related to the preoperative severity of disease (P < .001, β = -.378). Sixteen (18.8%) deformity recurrences were noted, 9 of which were observed in patients with preoperative HVA more than 40 degrees. Worse preoperative congruence of the metatarsophalangeal joint and tibial sesamoid position correlated with a higher rate of recurrence of the disease after surgery (P = .001, β = -.353 and P < .001, β = .427, respectively)., Conclusions: Satisfactory clinical and radiological results can be expected after MIDMO, but caution should be exercised when using this technique because of the likelihood of possible complications (29.4% overall complication rate). Predictors of surgical outcomes can be used to select the best candidates for this surgery., Level of Evidence: Level IV, case series.

Purpose: To assess the long-term results of anterior cervical discectomy and fusion using the Cloward procedure for the treatment of cervical spondylotic myelopathy, and to identify possible clinical outcome predictors., Methods: A total of 14 cases with a 10-year postoperative follow-up were available (82.4 % of the surviving patients). Patients underwent preoperative and postoperative neurological examination. The symptom severity was graded according to the Nurick scale. MRI measurements were obtained preoperatively. Cervical spine radiographs were obtained preoperatively and at the time of follow-up., Results: The mean improvement of the clinical status of patients on the Nurick scale was 1.43 ± 0.51 (range 1-2) with respect to the baseline values (p < 0.001), with a 62.5 % recovery rate. A positive association between the improvement of the Nurick scale and the length of follow-up was detected with an age-adjusted univariate analysis (p = 0.042). The Nurick grade improvement was also directly related to preoperative lower limb hyperreflexia (p = 0.039), spasticity (p = 0.017), and bladder dysfunction (p = 0.048). At the time of follow-up, an adjacent discopathy was noted above and below the operated level(s) in eight and six patients, respectively., Conclusions: The Cloward technique is a safe and effective procedure for the treatment of cervical spondylotic myelopathy. The patients' preoperative neurological status and the length of follow-up affect the grade of postoperative ambulatory improvement.

Introduction: Insulin-like growth factor I (IGF-I) regulates articular cartilage homeostasis. During osteoarthritis (OA), the anabolic responses of chondrocytes to IGF-I are likely to be prevented by the enhanced production of IGF-binding proteins (IGFBPs), especially IGFBP-3. The aim of this study is to evaluate whether the architectural transcription factor high mobility group A1 (HMGA1) influences IGFBP-3 overexpression in vitro, in cultured chondrocytic cell lines, and ex vivo, in human osteoarthritic cartilage compared to healthy human cartilage controls., Methods: Quantitative real-time reverse transcription-PCR (qRT-PCR) was performed to assess the relative transcript levels of HMGA1 and IGFBP-3 in vitro, in the human chondrocytic cell lines T/C-28a4 and C-28/I2. An electrophoretic mobility shift assay (EMSA), chromatin immunoprecipitation (ChIP) and transient transfection assays were performed to investigate the HMGA1-IGFBP-3 gene interaction. Samples of articular cartilage were harvested from osteoarthritic patients and controls and analyzed by qRT-PCR for HMGA1 and IGFBP-3 mRNA levels., Results: A parallelism between HMGA1 protein levels and IGFBP-3 gene expression has been observed in T/C-28a4 and C-28/I2 cells. The interaction of HMGA1 with the IGFBP-3 gene promoter has been demonstrated by EMSA and ChIP. In transient transfections, IGFBP-3 promoter activity increased in cells overexpressing HMGA1 and decreased in cells pretreated with siRNA detected against HMGA1. IGFBP-3 mRNA expression was higher in cartilage from patients with OA, where the increased expression of IGFBP-3 closely paralleled the increased expression of HMGA1 mRNA., Conclusions: Our observations indicate that increased HMGA1 expression in human chondrocytes is associated with increased expression of IGFBP-3. It is tempting to speculate that, through the regulation of IGFBP3 expression, HMGA1 may act as a pathogenetic factor for OA.

Several studies dealing with the pathomechanisms of OA refer to MMP-1, -3, -7, -8, and -13 whereas a smaller number of investigations have pointed out the pathogenic role of gelatinases in OA. These gelatinases are best known for their involvement in pulmonary, myocardial, and neoplastic disease but they are emerging as important proteases implicated in the OA progression. This paper highlights the role of the gelatinases as emerging factors in OA pathogenesis through the regulation of subchondral bone resorption and microvascular invasion. The most significant new findings over the last year that add to our knowledge of the activity of these proteins in OA have been reported.

Due to the limited life expectancy and the supposed higher morbidity with complete arterial grafting, extensive arterial graft in the elderly is still questioned. It was the aim of this study to evaluate transit time flow and clinical, biochemical and echocardiographic results of elderly patients undergoing coronary artery bypass grafting (CABG) with either saphenous vein (SV) or radial artery (RA) employed as the second conduit of choice. The present study evaluates clinical and flowmetric results of a prospective series of elderly patients (>or=70 years old) undergoing RA CABG (75 patients, Group A) or SV CABG (163 patients, Group B) during isolated myocardial revascularization, performed either off-pump (OPCABG) and on-pump during the last 5 years at a single academic institution (between January 2003 and December 2007). Transit time flowmetric (TTF) maximum and mean flow, pulsatility index (P.I.), and graft flow reserve (GFR) were compared. Hospital outcome was analyzed. Clinical data were compared between the two groups and one-year follow-up was completed. The two groups showed comparable preoperative and intraoperative variables. When TTF analysis was considered, patients undergoing RA grafting demonstrated a significantly higher maximum (systolic) and mean flow compared to SV grafting, either in circumflex, diagonal, and right coronary territory. Pulsatility index was significantly lower in the RA group in circumflex, diagonal, and right coronary grafts. Furthermore, when GFR was calculated significantly higher values were found in RA conduits in the circumflex, diagonal, and right coronary grafts. Comparable troponin I leakage was detected between the two groups. Postoperative variables addressing hospital outcome were similar in the two groups. When echocardiographic data were analyzed, no differences were recorded in postoperative recovery of left ventricular ejection fraction and wall motion score index. One-year follow-up showed better freedom from acute cardiovascular events in the RA group (P = 0.04). Our data show that despite comparable clinical, biochemical, and echocardiographic results in elderly patients undergoing RA or SV grafting, better flowmetric results - in terms of GFR, mean flow, and pulsatility index - can be detected in arterial conduits.