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Resume Introduction La reconstruction par arthroplastie d’epaule inversee (PTEI) apres resection tumorale de l’humerus proximal est une option proposee afin de conserver la fonction du membre. L’utilisation d’une allogreffe manchonnant l’arthroplastie est une alternative a un implant massif et pourrait reconstituer le capital osseux de l’humerus proximal. L’objectif de notre etude etait d’evaluer a moyen terme l’evolution radio-clinique de ces implants composites. Methodes Les patients ayant ete operes d’une lesion tumorale maligne de l’humerus proximal avec resection/reconstruction par PTEI composite ont ete revus retrospectivement avec un recul minimum de 24 mois. L’evaluation clinique etait basee sur le score de Constant, le Subjective Shoulder Value (SSV) et le score ADLER. Un bilan radiographique standard permettait d’evaluer le degre de resorption de l’allogreffe et de rechercher les signes de descellement des implants. Resultats Onze patients ont ete inclus au recul moyen de 30 mois (24–84) ; l’âge moyen etait de 51 ans (19–87). La resection tumorale moyenne de 10 cm (6–17) etait en rapport avec les etiologies suivantes : chondrosarcomes (n = 6), osteosarcomes (n = 2), lymphomes B et metastases uniques (n = 3). Une allogreffe glenoidienne lateralisante associee a une reconstruction humerale a ete realisee dans 8 cas et un transfert tendineux de Latissimus Dorsi (LD) dans 5 cas. Le score de Constant moyen etait de 49 points, le SSV de 52 % et le score ADLER de 20 points. La lateralisation de l’implant glenoidien associee a un transfert tendineux ameliorait significativement l’elevation anterieure et la rotation externe. Radiographiquement, la consolidation de l’allogreffe humerale etait acquise dans 73 % des cas a la jonction avec l’humerus natif. En revanche, une osteolyse etait retrouvee en zone epiphyso-metaphysaire dans 64 % des cas. Aucun descellement de l’implant humeral n’a ete constate. L’allogreffe glenoidienne etait quant a elle resorbee dans tous les cas (8/8) sans occasionner de descellement de l’embase prothetique. Conclusion L’utilisation de PTEI composites en cas de resection massive est une solution acceptable d’un point de vue fonctionnel. Neanmoins, la resorption des allogreffes massives est inquietante et souleve la question de la poursuite de leur utilisation sur le versant glenoidien. Niveau de preuve IV.

Background: While 2 screws are traditionally used for coracoid bone block fixation, no gold standard technique has yet been established when using cortical buttons. Purpose: To compare anatomic and clinical outcomes of the arthroscopic Latarjet procedure using either 2 or 4 buttons for coracoid bone block fixation. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 23 patients with 4-button fixation (group 4B) were matched for age at surgery, sex, and follow-up to 46 patients who had 2-button fixation (group 2B). All patients underwent guided arthroscopic Latarjet (using coracoid and glenoid guides), and a tensioning device was used to rigidify the suture button construct and get intraoperative bone block compression. The primary outcome was assessment of bone block positioning and healing using computed tomography scans performed at 2 weeks and at least 6 months after surgery. The mean ± standard deviation follow-up was 49 ± 7 months (range, 24-64 months). Results: The bone block healing rate was similar in both groups: 91% in group 4B versus 95.5% in group 2B. The transferred coracoid was flush to the glenoid surface in 21 patients (91%) in group 4B and 44 patients (96%) in group 2B ( P = .6); it was under the equator in 22 patients (96%) in group 4B and 44 patients (96%) in group 2B ( P≥ .99). There was no secondary bone block displacement; the rate of bone block resorption was similar between the groups: 28% in group 4B and 23% in group 2B ( P = .71). Patient-reported outcomes, return to sports, and satisfaction were also similar between the groups. The operating time was significantly longer in group 4B (95 vs 75 minutes; P = .009). Conclusion: A 4-button fixation technique did not demonstrate any anatomic or clinical advantages when compared with a 2-button fixation technique, while making the procedure more complex and lengthening the operating time by 20 minutes. A 2-button fixation is simple, safe, and sufficient to solidly fix the transferred coracoid bone block. The use of drill guides allows accurate graft placement, while the use of a tensioning device to rigidify the suture button construct provides high rates of bone block healing with both techniques (>90%).

BACKGROUND Several studies have already reported good short-term results with a pyrocarbon unipolar radial head prosthesis (Pyc-uRHP). The aim was to evaluate the evolution from mid- to long-term clinical and radiographic outcomes of a Pyc-uRHP. METHODS This was a retrospective, single-center study. We followed up all the patients who underwent Pyc-uRHP surgery in our original study at 2 years of follow-up (52 patients), reaching a minimum of 7 years of clinical and radiologic follow-up. This study included 26 patients who underwent a clinical examination assessing mobility, the Mayo Elbow Performance Score, and the visual analog scale score and radiologic evaluation with anteroposterior and profile radiographs at a mean follow-up of 110 months (range, 78-162 months). The radiologic study analyzed signs of proximal osteolysis, stem loosening, capitellar wear, and humeroulnar osteoarthritis. RESULTS No patients required revision. Eight patients required reoperation: coronoid screw removal in 1 and arthrolysis for stiffness in 7. The mean time to reoperation was 11 months. The mean Mayo Elbow Performance Score at last follow-up was 96 ± 9 (of 100), with a pain score of 42 ± 7 (of 45), mobility score of 19 ± 2 (of 20), stability score of 10 (of 10), and function score of 25 (of 25). Comparison with clinical data from the mid-term delay did not reveal any significant difference. All patients presented with proximal osteolysis around the neck but without progression. No stem loosening was noted. The rates of humeroulnar osteoarthritis (12% at mid-term vs. 80% at last follow-up, P < .0001) and capitellar lesions (34% at mid-term vs. 80% at last follow-up, P = .001) increased significantly. CONCLUSION We have shown that a Pyc-uRHP at 9 years' follow-up provided stable and satisfactory clinical results. Osteolysis of the radial neck was always present but it did not evolve, and no stem loosening was noted. Finally, we have shown a clear worsening of radiologic humeroulnar osteoarthritis and capitellar lesions that remained asymptomatic.

Aims The outcomes with metal head hemiarthroplasties (HA) are contrasted, especially in young, active patients. An innovative Pyrocarbon interface was introduced in 2014 in order to decrease potential glenoid wear. The aim of this study is to evaluate survival and short-term results of HA with a pyrocarbon head. Methods We conducted a retrospective single-centre study: 30 consecutive patients underwent HA with pyrocarbon humeral head and were assessed with a minimum follow-up of 2 years. The mean age at surgery was 54 ± 13 years; 38% of patients (n = 13) had undergone surgery at least once on the affected shoulder. Depending on the aetiology, 4 groups were analyzed: group 1 (osteonecrosis, n = 12), group 2 (primary gleno humeral osteoarthritis, n = 10), group 3 (fracture sequelae, n = 4) and group 4 (revision, n = 4). Results A significant improvement in clinical results was documented at mean follow-up of 38 months: mean Constant score (preop 35 ± 15 vs. postop 67 ± 19 points; Conclusion HemiPYC provided satisfactory clinical outcomes without glenoid wear at short-term follow-up. Disappointing results were recorded in the case of severe fracture sequelae. Mid and long-term studies should be carried out to confirm these results. Level of evidence Level IV; Retrospective Study

To highlight the preoperative risk factors that influence postoperative patient satisfaction following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing.Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing.With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radiological follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV85%); and 47 patients in the second group (SSV85%).In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use (-8.41 (-13.64; -3.17) p=0.002), fatty infiltration (-3.65 (-6.24 -1.06) p=0.006) and workers compensation (-19.15 (-24.04; -14.27) p0.001). When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p=0.15) Conclusions: Smoking, fatty infiltration and patients in workers compensation are factors of poorer subjective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction.IV, cohort study.

Resume Introduction L’objectif est de decrire la technique, d’evaluer la faisabilite, ainsi que la pertinence clinique du bilan echographique lesionnel post-traumatique du coude realise par un chirurgien orthopediste. Methodes Neuf patients ont ete inclus dans cette etude monocentrique. L’examen clinique a evalue la douleur, les mobilites du coude, l’etat neurovasculaire, ainsi que le testing ligamentaire du coude. L’echographie etait realisee entre J7 et J15 en association avec des radiographies. L’echographie recherchait des lesions osseuses, du plan ligamentaire medial (coude flechi de 30 a 90 degres) et lateral (coude a 90 degres et en position du cobra), ainsi que des lesions de l’insertion des muscles epitrochleens et epicondyliens. La duree de l’echographie et l’echogenicite a ete evaluee. Resultats Quatre fractures osteochondrales de la tete radiale ont ete visualisees en echographie en plus des 4 fractures visualisees a la radiographie sans difference significative (p = 0,071). A l’examen clinique, 2 laxites en valgus et 5 laxites en varus ont ete retrouvees. L’echographie, realisee en aveugle, retrouvait une lesion du faisceau anterieur du ligament collateral medial (1 patient/2 avec une laxite en valgus) et 4 lesions du faisceau ulnaire du ligament collateral lateral (4 patients/5 avec une laxite en varus). Il n’a ete retrouve aucune lesion tendineuse des epicondyliens et epitrochleens. La duree pour effectuer une echographie a diminuer significativement au cours de l’etude (30 minutes en moyenne pour les 5 premiers patients et 24,8 minutes pour les 5 derniers ; p = 0,046). Trois patients n’ont pas pu etre mis dans la position du cobra et trois etaient peu echogenes. Discussion Le bilan echographique lesionnel post-traumatique du coude peut etre effectue par un chirurgien orthopediste selon une technique bien definie. Les lesions retrouvees par ultrasons coincident avec la symptomatologie clinique. La reproductibilite inter- et intra-observateur reste a evaluer. Niveau de preuve IV.

The aim was to evaluate the results of radial head prostheses (RHP) in Essex-Lopresti injury (ELI) and to compare results after RHP between acute and chronic ELI. Thirty-one patients treated with RHP for ELI were selected from a multicenter retrospective series of 310 RHP, with follow-up greater than two years. Two groups were acute ELI group (n=19, average diagnosis = 5+/−9 days) and chronic ELI group (n=12, average diagnosis 8.4+/−7.1 months). RHP was associated in some cases with K-wires: during acute ELI to stabilize the distal radio-ulnar joint (n=4) or during chronic ELI with ulnar osteotomy or palliative surgery (n=4). Clinical and radiologic evaluation was performed including analysis of the complications and revisions rates, pain level, range of motion, and MEPS (Mayo Elbow Performance Score) and DASH score (Disabilities of the Arm, Shoulder and Hand). At last follow-up (71+/−38 months), survival of RHP in the acute ELI group was 84% (16/19) and 92% (11/12) in the chronic ELI group without statistically significant difference. Flexion (acute=131degrees+/−13.4 vs chronic=22+/−12.8, p=0.041) and supination (ELI=71+/−16.8 vs chronic=58+/−17.4; p=0.045) were better in acute ELI group. The DASH score was also better in the acute group (15+/−9.1 versus 24+/−15.2, p=0.048). There was more advanced stage of humero-radial osteoarthritis in the chronic ELI group (0.7+/−0.5 versus 1.4+/−0.6, p=0.041). RHP in acute ELIs provide better clinical results, although RHPs are part of the therapeutic arsenal to treat chronic ELI.

Dynamic shoulder instability in children or adolescents, whose glenohumeral growth plates are still open, is a rare condition with an etiology that is hard to decipher. Atraumatic and recurrent forms are most common, contrary to adults. Disruptions to capsule and ligament maturation, muscle balance or bone growth can lead to glenohumeral instability. The etiology assessment, which needs to be multidisciplinary in atraumatic forms, aims to collect the medical history, analyze the direction of the instability, determine whether it is voluntary or involuntary, and look for a history of trauma, connective tissue abnormality, psychological disorder, neuromuscular pathology or congenital malformation. The initial treatment is conservative. It requires a multidisciplinary team when the shoulder instability is voluntary. Surgical treatment is reserved for symptomatic forms that do not respond to conservative treatment and have an impact on daily life and/or sports participation after a minimum of 6 months of well-conducted rehabilitation. The results of surgical stabilization mainly depend on the features of the instability, the anatomical structures damaged and the etiology. Episodes of recurrent instability in children/adolescents with open glenohumeral growth plates can fade in adulthood or can get worse with the development of structural damage. Early detection of poor outcomes and suitable treatment will help to limit the occurrence of osteoarthritis in the medium and long term.

AimsWe aimed to address the question on whether there is a place for shoulder stabilization surgery in patients who had voluntary posterior instability starting in childhood and adolescence, and later becoming involuntary and uncontrollable.MethodsConsecutive patients who had an operation for recurrent posterior instability before the age of 18 years were studied retrospectively. All patients had failed conservative treatment for at least six months prior to surgery; and no patients had psychiatric disorders. Two groups were identified and compared: voluntary posterior instability starting in childhood which became uncontrollable and involuntary (group VBI); and involuntary posterior instability (group I). Patients were reviewed and assessed at least two years after surgery by two examiners.ResultsIn all 38 patients (40 shoulders) were included: group I (20 shoulders), with involuntary posterior instability (onset at 14 years of age (SD 2.3), and group VBI (20 shoulders), with initially voluntary posterior instability (onset at 9 years of age (SD 2.6) later becoming involuntary (16 years of age (SD 3.5). Mean age at surgery was 20 years (SD 4.6 years; 12 to 35). A posterior bone block was performed in 18 patients and a posterior capsular shift in 22. The mean follow-up was 7.7 years (2 to 18). Recurrence of posterior instability was seen in nine patients, 30% in group VBI (6/20 shoulders) and 15% in group I (3/20 shoulders) (p > 0.050). At final follow-up, the shoulder's of two patients in each group had been revised. No differences between either group were found for functional outcomes, return to sport, subjective, and radiological results.ConclusionAlthough achieving stability in patients with so-called voluntary instability, which evolves into an involuntary condition, is difficult, shoulder stabilization may be undertaken with similar outcomes to those patients treated surgically for involuntary instability. Cite this article: Bone Joint J 2020;102-B(12):1760–1766.

Background In palliative surgery on the distal radio-ulnar joint (DRUJ), ulnar head resection and the Sauve–Kapandji procedure are often followed by instability and radio-ulnar convergence. The objective of this study was to evaluate the stability of the DRUJ after modified matched distal ulnar resection performed alone or with partial or complete wrist arthrodesis. Hypothesis A modification of matched distal ulnar resection, consisting in reconstruction of the sixth compartment and dorsalisation of the extensor carpi ulnaris, minimises these complications, regardless of the cause and associated procedures. Patients and methods A single-centre retrospective study was conducted in 46 patients (50 wrists) who underwent modified matched distal ulnar resection. The 50 wrists fell into three groups: total wrist arthrodesis according to Millender, n = 21 (TWA group); radius to proximal row arthrodesis, n = 17 (RPRA group); and isolated matched distal ulnar resection, n = 12 (IMDUR group). Seventy per cent of patients had rheumatoid arthritis. Each patient underwent a clinical and radiographic assessment, with an analysis of radio-ulnar convergence, DRUJ stability, and ulno-carpal impingement, as well as of ulnar translation of the carpus in the IMDUR group. Results After the mean follow-up of 8.2 ± 5.4 years, 62% of patients were pain-free, with a mean VAS pain score of 1.3 ± 2.1, and 90% of patients said they would have the procedure again. Clinical and radiographic instability due to excessively proximal resection was noted in 2 (4%) wrists, of which 1 required repeat surgery. Ulno-carpal impingement due to excessively distal resection occurred in 2 (4%) wrists. No significant ulnar translation of the carpus was noted in the IMDUR group (DiBenedetto: 0.011 ± 1.9). Range of motion was similar in the three groups (mean pronation = 77 ± 17°; and mean supination = 79 ± 8°) (p > 0.05). Mean grip strength was 85 ± 35% compared to the other side. Discussion Our modification of matched distal ulnar resection minimises the complications specific of other ulnar head resection techniques or of the Sauve–Kapandji procedure, namely, radio-ulnar convergence and DRUJ instability. Level of proof IV; retrospective comparative study.

To evaluate whether ultrasonography can be used to explore the medial and lateral ligament structures during the acute phase of a closed elbow injury.A single-center, prospective study performed between December 2019 and June 2020, including patients who suffered a radial head fracture or elbow dislocation. Two radiologists did a blinded analysis using ultrasonography of visibility, injury grade, and presence of bone avulsion for the radial collateral ligament (RCL), lateral ulnar collateral ligament (LUCL), annular ligament (AL), and anterior (MCLant) and posterior bundles (MCLpost) of the medial collateral ligament. The inter-rater agreement was calculated. The ultrasonography findings were compared with the intraoperative findings in the patients who subsequently underwent surgery.Forty patients were included (28 radial head fractures and 12 elbow dislocations). The inter-rater agreement was strong for all the study parameters (kappa between 0.65 and 1), except for the visibility of the LUCL (kappa 0.52) and the visibility and appearance of the MCLpost (kappa 0.54 and 0.47, respectively). The injured ligaments were thicker than their contralateral counterparts (p 0.05). In the 10 patients who underwent surgery, the radiological-surgical correlation was 100% for the RCL and medial ligaments and 70% for the LUCL.Ultrasonography is a reproducible examination that can be used to assess the damage to elbow ligaments during the acute phase following an injury. This examination could be incorporated into the exploration protocol for elbow injuries during the preoperative assessment and to adapt the treatment.

There is no "gold standard" for the type of plate to be used for distal extra articular humeral fractures; the most used is plating of each column. The objective was to evaluate the short-term clinical and radiological results of a Y- anatomical and innovative locking plate (YALP).The hypothesis is: this anatomical and innovative locking plate will produce satisfactory and reliable results on extra-articular distal humerus fracture superior to double plate fixation.In a retrospective observational multicenter study, all patients with a distal humerus fracture type 13 A2.2 according to AO classification fixed with a new Y-plate (YALP) were compared to the results of double plate fixation for the same type of fracture. With a follow-up of more than 12 months, the objective and subjective clinical elbow criteria as well as the overall function of the upper limb and radiological assessment were collected.With an average follow up of 24 ± 11 months, 26 patients met the inclusion criteria and received a YALP and 24 patients received double plate. All patients whose fracture had healed except one were pain-free (mean VAS 0.3 ± 0.6). All patients had good subjective results (mean SEV 96% ± 4). Elbow function was excellent (mean total MEPS 96 ± 4) with normal triceps strength (23/24 patients had a triceps strength graded 5/5 and one patient 4/5) and range of motion (flexion 139 ± 8, extension -7 ± 8 and pronosupination greater than 155 degrees). The operating time was shorter in the YALP group (84+/-23 minutes versus 97+/-28 minutes, p=0.03). The double plate group had more complications; The overall complication rate was significantly higher (p=0.02) in the double90-degree plate group (12/24, 50%) with four nonunions, four symptomatic ulnar nerves, three hardware removals for pain and one radial nerve injury versus 5/26 complications (19%, p=0.02) in the Y-plate group : one iliac graft for nonunion, 1 plate removal due to functional discomfort, 1 twisted YALP, 1 broke interfragmentary screw and one symptomatic ulnar nerve. DASH, SEV, MEPS scores and flexion-extension range were better in the YALP group Discussion: YALP produces satisfactory results in supracondylar fractures of the distal humerus. The results of YALP appear to be better than the results with two 90 plates for the same fracture type with a shorter operative time and easier management of fractures with proximal diaphyseal extension.III; Case control study.

Background: Despite a new trend to systematically use reverse shoulder arthroplasty (RSA) in elderly population regardless of the indication, total anatomical shoulder arthroplasty can get good functional results in this population. The purpose of this study was to evaluate clinical and radiological outcomes of uncemented short-stem anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis in patients older than 70 years and to compare these results to a matched population with an uncemented short-stem RSA. Methods: In this retrospective monocentric study, clinical outcomes were based on constant score (Cst), subjective shoulder value (SSV) score, and range of motion. The aim of radiographic analysis was to identify glenoid component loosening and humeral bone remodeling around the uncemented short stem. Results: At an average follow-up of 44 ± 12.5 months, 32 uncemented short-stem TSA in 31 patients with a minimum of 2 years of follow-up were included and were compared to 32 uncemented RSA. Fifty three percent of the patients had “a forgotten prosthesis”. ROM was significantly improved in all cases. Cst reached 73 ± 9 pts and SSV 90 ± 10.8% (P

Background: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. Purpose: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. Results: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears ( P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination ( P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated ( P = .027). Conclusion: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

Resume Introduction Le traitement chirurgical des ruptures aigues du tendon du biceps distal est recommande dans la population active pour eviter la perte de force, en particulier en supination et en flexion du coude. Hypothese La technique de double incision avec mobilisation immediate pour la rupture aigue du tendon du biceps distal est sure et fournit de bons resultats apres 2 ans chez les patients actifs. Materiel et methodes Soixante-quatorze hommes (47 ± 7 ans) avec des ruptures distales aigues de biceps ont ete inclus dans cette etude monocentrique retrospective. Tous les patients ont ete operes avec la technique de double incision modifiee par Morrey. Le tendon a ete reinsere grâce a des sutures transosseuses dans la tuberosite du biceps. Les patients ont ete autorises a effectuer une mobilisation immediate. Un suivi minimum de deux ans etait requis pour l’evaluation clinique et radiologique. Resultats Seize patients ont ete perdus de vue. Au total, 58 patients ont ete analyses avec un suivi moyen de 53 ± 19 mois. L’echelle d’evaluation de la douleur etait de 0,22 ± 0,7. Les resultats moyens d’amplitude de mouvement comprenaient l’extension −1° ± 2°, la flexion 138° ± 6°, la pronation 72° ± 16° et la supination 81° ± 10°. Le rapport de force en flexion etait de 94 ± 8 % et en supination de 90,5 ± 12 % par rapport au membre controlateral. La valeur subjective du coude et le score DASH etaient respectivement de 94 ± 6 % et 7,5 ± 9 %. Tous les patients etaient satisfaits ou tres satisfaits et tous, sauf un, sont retournes a leur sport anterieur. Nous avons note 2 ossifications heterotopiques et un patient a eu besoin d’une reintervention pour synostose radio-ulnaire. Aucune re-rupture ni lesion nerveuse n’a ete observee. Discussion Une technique par double voie d’abord pour la reinsertion du tendon du biceps distal est une procedure peu invasive avec des resultats fiables. La modification par Morrey de la procedure initiale associee a une mobilisation precoce est associee a un faible taux de complications et limite l’apparition de synostoses ou d’ossifications. Niveau de preuve IV, serie de cas, sans groupe de comparaison.

Introduction Surgical treatment of distal biceps tendon ruptures is recommended in an active population to avoid loss of strength, especially in supination and flexion. Hypothesis A double incision repair technique with immediate postoperative mobilization for acute distal biceps tendon ruptures is safe and provides good results after 2 years in active patients. Material and methods Seventy-four men (47 ± 7 years) with acute tears of the distal biceps tendon tears were included in this retrospective single-center study. All patients were operated using the double-incision repair technique described by Morrey. The tendon was inserted with transosseous sutures into the biceps tuberosity. Patients were allowed to perform immediate postoperative active mobilization. A minimum follow-up of two years was required including clinical and radiological evaluation. Results Sixteen patients were lost to follow up leaving 58 (78%) patients for analysis with a mean follow-up of 53 ± 19 months. At final follow-up, the mean evaluation for pain on the VAS scale was 0.22 ± 0.7. Mean range of motion results included extension −1° ± 2°, flexion 138° ± 6°, pronation 72° ± 16° and supination 81° ± 10°. The strength ratio in flexion was 94 ± 8% and in supination 90.5 ± 12% compared to the contralateral limb. Subjective elbow value and DASH score were respectively 94 ± 6% and 7.5 ± 9%. All patients were satisfied or very satisfied and all except one returned to their previous sport. We noticed 2 heterotopic ossifications and one patient needed a reoperation for a radioulnar synostosis. Neither re-rupture nor nerve injury were observed. Discussion A double incision technique for distal biceps tendon repair is a minimally invasive procedure with reliable results. Morrey's modification of the initial procedure associated with early mobilization is associated with a low rate of complications and limited the occurrence of synostosis or ossifications. Level of evidence IV, case series, with no comparison group.

BACKGROUND Revision total elbow arthroplasty (TEA) has increased, especially in young patients with high functional expectations. The objective of this study was to evaluate the long-term results of revision TEA with a single semiconstrained prosthesis. METHODS Thirty-four revision TEAs were performed with a Coonrad/Morrey prosthesis in 32 patients; 2 patients had bilateral procedures. The mean patient age was 61 years (range, 22 to 76 years), and the revision TEA was performed at a mean time of 7.8 years (range, 1.6 to 21 years) after the primary TEA. Etiologies for revisions were humeral and ulnar aseptic loosening (n = 14), ulnar aseptic loosening (n = 8), humeral aseptic loosening (n = 6), septic arthritis (n = 4), and unstable unlinked prostheses (n = 2). Clinical and radiographic evaluations were performed with systematic preoperative infection workup and quantification of bone loss. The mean follow-up was 11.4 years (range, 2 to 21 years). RESULTS The Mayo Elbow Performance Score (MEPS) at the last follow-up was excellent in 6 cases, good in 18 cases, fair in 8 cases, and poor in 2 cases, with a mean improvement (and standard deviation) between the preoperative values at 42.4 ± 16.1 points and the postoperative values at 81.8 ± 12 points (p < 0.001). The mean pain scores improved significantly from 6.7 ± 1.3 points preoperatively to 1.4 ± 1.4 points postoperatively (p < 0.001). The flexion-extension arc increased significantly (p = 0.02) from 74° ± 27° preoperatively to 100° ± 31° postoperatively. The total number of complications was 29 in 19 revision TEAs (56%). Twenty of the 29 complications simply required monitoring without surgical intervention. Six repeat surgical procedures were required, and 3 implant revisions (9%) were performed. CONCLUSIONS Revision TEA with a semiconstrained prosthesis can provide good clinical results that can be maintained during follow-up. The rate of complications is high. Proper evaluation of the risk-benefit ratio is essential for each revision TEA and should be discussed with the patient. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Resume Introduction Dans la chirurgie palliative de l’articulation radio-ulnaire distale (RUD), resection de tete ulnaire et intervention de Sauve-Kapandji sont frequemment compliquees d’instabilite et de convergence radio-ulnaire. L’hypothese est que les resultats de la resection oblique basse de l’ulna selon Watson modifiee avec reconstruction du plancher du 6e compartiment et dorsalisation de l’extenseur ulnaire du carpe minimise ces complications quels que soit les etiologies et les gestes associes. Materiels Il s’agit d’une etude monocentrique retrospective de 46 patients (50 poignets) operes d’une arthroplastie RUD selon Watson modifie comportant 3 groupes : 21 arthrodeses totales du poignet selon la technique de Millender (groupe AT) ; 17 arthrodeses radius-premiere rangee (groupe ARP) ; 12 resections partielles isolees selon Watson (groupe RI). Soixante pour cent des patients avaient une polyarthrite rhumatoide. L’evaluation a ete clinique et radiographique avec analyse de la convergence radio-ulnaire, de la stabilite RUD, des eventuels conflits ulno-carpiens et du glissement ulnaire du carpe dans le groupe RI. Resultats Avec un recul moyen de 8,2 ± 5,4 ans, 62 % des patients etaient non douloureux avec une EVA moyenne de 1,3 ± 2,1 et 90 % des patients referaient l’intervention. Il y avait 4 % d’instabilite clinique et radiographique par resection trop proximale (2 cas dont 1 reopere). Quatre pour cent de conflit ulno-carpien par resection trop distale ont ete notes. Le glissement ulnaire du carpe n’etait pas significatif dans le groupe RI (DiBenedetto : 0,011 ± 1,9). Les mobilites etaient comparables entre les 3 groupes (pronation moyenne = 77 ± 17° ; supination moyenne = 79 ± 8°) (p > 0,05). La force moyenne du Grasp etait de 85 ± 35 % par rapport au cote controlateral. Discussion La technique de resection basse de tete ulnaire selon Watson modifiee permet de minimiser les complications specifiques aux autres techniques de resection de tete ulnaire ou a l’intervention de Sauve-Kapandji a type de convergence radio-ulnaire et d’instabilite RUD. Niveau de preuve IV ; etude retrospective comparative.

We aimed to address the question on whether there is a place for shoulder stabilization surgery in patients who had voluntary posterior instability starting in childhood and adolescence, and later becoming involuntary and uncontrollable.Consecutive patients who had an operation for recurrent posterior instability before the age of 18 years were studied retrospectively. All patients had failed conservative treatment for at least six months prior to surgery; and no patients had psychiatric disorders. Two groups were identified and compared: voluntary posterior instability starting in childhood which became uncontrollable and involuntary (group VBI); and involuntary posterior instability (group I). Patients were reviewed and assessed at least two years after surgery by two examiners.In all 38 patients (40 shoulders) were included: group I (20 shoulders), with involuntary posterior instability (onset at 14 years of age (SD 2.3), and group VBI (20 shoulders), with initially voluntary posterior instability (onset at 9 years of age (SD 2.6) later becoming involuntary (16 years of age (SD 3.5). Mean age at surgery was 20 years (SD 4.6 years; 12 to 35). A posterior bone block was performed in 18 patients and a posterior capsular shift in 22. The mean follow-up was 7.7 years (2 to 18). Recurrence of posterior instability was seen in nine patients, 30% in group VBI (6/20 shoulders) and 15% in group I (3/20 shoulders) (p0.050). At final follow-up, the shoulder's of two patients in each group had been revised. No differences between either group were found for functional outcomes, return to sport, subjective, and radiological results.Although achieving stability in patients with so-called voluntary instability, which evolves into an involuntary condition, is difficult, shoulder stabilization may be undertaken with similar outcomes to those patients treated surgically for involuntary instability. Cite this article

Introduction: Reverse shoulder arthroplasty (RSA) is an option to conserve limb function after resection of proximal humerus malignancy. An allograft-composite RSA is an alternative to a tumor prosthesis, and can restore proximal humeral bone stock. The aim of the present study was to assess medium-term radiographic and clinical results for such composite implants. Methods: Patients with malignant proximal humerus tumor treated by resection and reconstruction by composite RSA were retrospectively analyzed at a minimum 24 months’ follow-up. Clinical assessment used Constant score, Subjective Shoulder Value (SSV) and ADLER score. Standard radiographic work-up assessed allograft absorption and screened for implant loosening. Results: Eleven patients were included, with a mean age of 51 years (range, 19-87 years) and mean 30 months’ follow-up (range, 24-84 months). Mean tumor resection was 10 cm (range, 6-17 cm). Etiologies comprised chondrosarcoma (n=6), osteosarcoma (n=2), B-cell lymphoma (n=1) and single metastasis (n=2). Bony increased-offset allograft was associated to humerus reconstruction in 8 cases, and latissimus dorsi tendon transfer in 5 cases. Mean Constant score was 49 points, SSV 52%, and ADLER score 20 points. Increased glenoid implant offset associated to tendon transfer significantly improved anterior elevation and external rotation. Radiographic allograft consolidation to the native humerus was acquired in 73% of cases, while osteolysis in the epiphyseal-metaphyseal zone was found in 64%. There were no cases of humeral implant loosening. Glenoid allograft absorption was systematic (8/8 cases), without inducing loosening of the implant baseplate. Conclusion: Composite reverse shoulder arthroplasty is functionally effective after massive resection. However, allograft absorption is a drawback, casting doubt on continued use on the glenoid side. Level of evidence: IV.

OBJECTIVEThe best predictors of height gain due to surgical correction are the number of fused vertebrae and the degrees of the corrected Cobb angle. Existing studies of predictive models measured the radiographic spinal height and did not report the clinical height gain. The aims of this study were to determine the best predictive factors of clinical height gain before surgical correction, construct a predictive model using patient population data for machine learning, and test the performance of this model on a validation population.METHODSThe authors reviewed 145 medical records of consecutive patients who underwent surgery that included placement of posterior spinal instrumentation and fusion for idiopathic scoliosis between 2012 and 2016. Standing and sitting clinical heights were measured before and after surgery in patients who had been surgically treated under similar conditions. Multivariate analysis was then performed and the results were used to develop a predictive model for height gain after surgery. The data from the included patients were randomly assigned to a learning set or a test set.RESULTSIn total, 116 patients were included in the analysis, for whom the average postoperative clinical height gain in a standing position was 4.2 ± 1.8 cm (range 0–11 cm). The best prediction model was calculated as follows: standing clinical height gain (cm) = 1 − 0.023 × sitting clinical height (cm) − 0.19 × Risser stage + 0.058 × Cobb preoperative angle (°) + 0.021 × T5–12 kyphosis (°) + 0.14 × number of levels fused. In the validation cohort, 91% of the predicted values had an error of less than one-half of the actual height gain.CONCLUSIONSThis predictive model formula for calculating the potential postoperative height gain after surgical treatment can be used preoperatively to inform idiopathic scoliosis patients of what outcomes they may expect from posterior spinal instrumentation and fusion (taking into account the model’s uncertainty).

Introduction The present study aimed to describe the technique of ultrasound traumatic elbow lesion assessment performed by an orthopedic surgeon. Methods Nine patients were included in a single-center study. Clinical examination assessed pain, ranges of elbow motion, neurovascular status and elbow ligament testing. Ultrasound was associated to radiography between days 7 and 15, screening for lesions of the bone, medial ligament (in 30-90° flexion), lateral ligament (elbow at 90° in cobra position) and epitrochlear and epicondylar muscle insertions. Ultrasound scanning time and echogenicity were assessed. Results Four radial head osteochondral fractures were detected on ultrasound in addition to the 4 fractures seen on radiography, without significant difference (p = 0.071). Clinical examination found 2 cases of valgus laxity and 5 of varus laxity. Ultrasound, performed blind to radiography, found 1 medial collateral ligament anterior bundle lesion (in 1 of the 2 patients with valgus laxity) and 4 lateral collateral ligament ulnar bundle lesions (in 4 of the 5 patients with varus laxity). There were no epicondylar or epitrochlear tendon lesions. Scanning time decreased significantly over the study period, from a mean 30 minutes in the first 5 cases to a mean 24.8 minutes in the last 5 (p = 0.046). Three patients could not be put in the cobra position, and 3 showed poor echogenicity. Discussion Ultrasound assessment of traumatic elbow lesions could be performed by an orthopedic surgeon on a well-defined protocol. Lesions on ultrasound matched clinical symptomatology. Inter- and intra-observer reproducibility remain to be assessed. Level of evidence IV.

Dans la chirurgie palliative de l’articulation radio-ulnaire distale (RUD) pour arthropathie ± associee a un conflit ulno-carpien et a une instabilite, les principaux reproches faits aux resections de tete ulnaire sont le risque d’instabilite, de convergence radio-ulnaire et de glissement ulnaire du carpe. L’objectif est d’evaluer la resection oblique basse selon Watson avec reconstruction du plancher du 6e compartiment et dorsalisation de l’extenseur ulnaire du carpe (ECU). Il s’agit d’une etude monocentrique retrospective de 50 patients operes d’une arthroplastie RUD selon Watson modifie. L’evaluation clinique a comporte une analyse de la douleur, des mobilites et des scores fonctionnels : DASH score, Mayo Wrist Score (MWS) et Patient-Rated Wrist Evaluation (PRWE). Radiographiquement ont ete analyses la convergence ulnaire, les eventuels conflits ulno-carpiens, la luxation RUD et le glissement ulnaire (indices de Chamay et DiBenedetto). Cette serie de patients comportait 3 groupes ayant eu une resection selon Watson modifie : 21 arthrodeses totales du poignet selon Millender (groupe AT) ; 17 arthrodeses radius-premiere rangee (groupe ARP) ; 12 resections partielles isolees selon Watson (groupe ARI). Avec un recul moyen de 8,2 ± 5,4 ans, 62 % des patients sont non douloureux. Quatre-vingt-dix pour cent des patients referaient l’intervention. Le taux de satisfaction global est de 77 ± 20 %. Les resultats cliniques sont comparables (p > 0,05) entre les 3 groupes avec une pronation moyenne de 77° ± 17° et une supination moyenne de 79°±8°. Par rapport au cote controlateral, le Grasp moyen est de 85 ± 35 %. Les scores fonctionnels ne montrent pas de difference statistiquement significative entre les groupes (p > 0,05). Le DASH Score est de 29 ± 10, le PRWE de 49 ± 30 et le MWS de 61 ± 14. Le taux de reprise chirurgicale est de 2 %. Radiologiquement, aucun patient ne presente de subluxation RUD. Les cliches dynamiques retrouvent 4 % de convergence ulnaire. Le glissement ulnaire du carpe (differentiel entre pre- et postoperatoire) n’est pas significatif dans le groupe ARI (DiBenedetto : 0,011 ± 1,9 et Chamay 0,016 ± 2 ; p > 0,05). Les risques d’instabilite et de convergence radio-ulnaires sont considerablement reduits par la resection oblique basse selon Watson avec reconstruction du plancher du 6e compartiment et dorsalisation de ECU. La resection oblique basse selon Watson montre son efficacite dans la chirurgie palliative de l’articulation RUD pour arthropathie ± associee a un conflit ulno-carpien et a une instabilite.

We evaluated survival and midterm results of pyrocarbon interposition shoulder arthroplasty (PISA) in arthritic patients younger than 65 years.Fifty-eight PISAs (InSpyre; Tornier-Wright, Bloomington, MN, USA), implanted in 56 patients between 2010 and 2015, were prospectively observed. The mean age at surgery was 52 ± 13 years. The cause was primary osteoarthritis (18), fracture sequelae (16), post-instability arthritis (15), aseptic necrosis (3), inflammatory disease (2), and failed hemiarthroplasty (4); 34 shoulders (61%) had previously undergone surgery. Glenoid erosion was assessed in 4 grades according to the Sperling classification. Humeral erosion was also assessed in 4 grades. Multivariate analysis was used to determine predisposing risk factors for both humeral and glenoid erosion.At a mean follow-up of 47 ± 15 months, survival rate was 90%. Six patients (10%) required conversion to reverse total shoulder prosthesis for painful glenoid erosion (n = 2) and humeral erosion with greater tuberosity stress fractures (n = 4). The mean Constant score and subjective shoulder value significantly increased from 36 ± 14 points to 70 ± 15 points and 32% ± 14% to 75% ± 19%, respectively (P.001). Humeral medialization was observed in 78% of the cases with increased pain score. Uncorrected anteroposterior implant subluxation (12 cases) was associated with lower Constant score (50 points vs. 72 points; P = .02) and lower subjective shoulder value (53% vs. 78%; P = .002). On multivariate analysis, no risk factors for glenoid or humeral erosion were found.At midterm follow-up, PISA does not protect from progressive glenoid erosion and can lead to greater tuberosity erosion and stress fractures. Longer follow-up is required to see whether PISA survival will be superior to that of hemiarthroplasty.

Introduction Le conflit glenoidien postero-superieur (CPS) touche des jeunes patients sportifs de lancer. Son diagnostic est difficile et les solutions therapeutiques ne font pas consensus dans la litterature. L’objectif de cette etude est d’analyser les differents types de chirurgie realises pour les conflits glenoidiens postero-superieur et leurs resultats en termes de reprise du sport et de satisfaction des patients. Methodes Etude retrospective mono-centrique. Tous les patients operes d’un CPS dans le service ont ete revus. Le diagnostic de CPS vrai etait retenu pour les patients pratiquant un sport a risque et presentant au moins 2/4 criteres parmi : augmentation de la RE2, diminution de la RI2, lesion labrale postero-superieure, lesion de la face profonde de la coiffe postero-superieure. Etaient analyses la reprise du sport au meme niveau, le delai a la reprise du sport, la satisfaction des patients, la presence d’arthrose au dernier recul, l’amelioration du score KJOC et les complications ou reprises eventuelles. Le recul moyen etait de 7,8 ans (1–13). Resultats Vingt-sept patients ont ete operes entre novembre 2006 et mars 2018. Notre population etait composee a 67 % d’hommes, 100 % des patients pratiquaient un sport a risque et 75 % en competition. L’âge moyen au moment de la chirurgie etait de 30 ans (15–49). 63 % presentaient une lesion labrale posterieure, 89 % une lesion de la face profonde de la coiffe. Une SLAP lesion etait retrouvee chez 10 patients. La chirurgie incluait un debridement de coiffe (n = 20), une glenoidoplastie (n = 16), une tenodese du long biceps (n = 16), une reinsertion du labrum posterieur (n = 12), une acromioplastie (n = 9) et une reparation du sus-epineux par ancre (n = 2). 96 % des patients etaient satisfaits par la chirurgie. La reprise du sport au meme niveau a ete possible dans 75 % des cas, a un delai moyen de 10,5 mois. La duree de reprise au meme niveau etait de 3 ans. L’amelioration du score KJOC etait superieure en cas de glenoidoplastie et de tenodese du long biceps. Conclusion. Les patients operes d’un CPS etaient dans l’immense majorite satisfaits par la chirurgie. La glenoidoplastie apparait comme le traitement de choix, de meme que la tenodese du biceps en cas d’extension superieure des lesions labrales.

Introduction La butee coracoidienne sous arthroscopie permet de traiter l’instabilite anterieure d’epaule. La fixation par boutons corticaux a montre son efficacite sur le positionnement et la consolidation de la butee. L’objectif de cette etude etait de savoir si 2 doubles endo-boutons apportaient un meilleur positionnement de la butee osseuse a 15 jours postoperatoire par rapport a un seul double endo-bouton. Materiel et methodes Il s’agissait d’une etude de faisabilite prospective monocentrique, realisee entre juillet 2016 et janvier 2017. Quatorze patients ont beneficie d’une butee 4 boutons (Groupe 4B) contre 44 patients avec une butee 2 boutons (Groupe 2B). Un ancillaire adapte avec des guides glenoidiens et coracoidiens specifiques etait utilise. Les patients etaient immobilises dans une attelle rotation neutre et revus a 15 jours postoperatoires. Des radiographies de l’epaule et un scanner de controle permettaient d’analyser la position de la butee. La duree operatoire etait mesuree et les complications per- et postoperatoires repertoriees. Resultats Le groupe 4B etait compose exclusivement de sujets masculins avec des patients plus jeunes (24 ans vs 28 ans ; p > 0,05). Radiologiquement, les groupes etaient comparables. Aucune difference n’etait constatee sur un geste associe a la butee. A quinze jours, les scanners montraient une position affleurante, sous equatoriale et sans rotation de la butee chez 41 patients (93 %) du groupe 2B versus 13 patients (93 %) du groupe 4B (p > 0, 05). La duree operatoire etait significativement allongee dans le groupe 4B par rapport au groupe 2B (93 vs 74 minutes ; p > 0,01). Discussion Le groupe 4 boutons etait essentiellement compose de sujets masculins en raison de la taille coracoidienne necessaire pour pouvoir mettre en place les deux doubles boutons. On ne retrouvait pas de benefice sur le positionnement a 15 jours avec 4 boutons. Conclusion La fixation des butees par 4 boutons ne montre pas de benefice a court terme pour le positionnement de la butee par rapport a la fixation par 2 boutons. La mise en place de 4 boutons complique la procedure et allonge le temps operatoire. Le suivi de ces patients permettra de savoir si la double fixation amene ou non un benefice en termes de consolidation et de resorption osseuse de la butee.

Introduction Le traitement chirurgical de la rupture aigue du biceps distal est recommande. Il permet d’eviter la perte de force, en particulier en flexion et en supination. L’objectif de cette etude etait d’evaluer la securite et les resultats a moyen terme d’une double voie d’abord selon Morrey modifie associee a une mobilisation precoce avec un suivi minimum de 2 ans. Materiel et methodes Soixante quatorze hommes (47 ans ± 7) avec une rupture aigue du biceps distal ont ete inclus lors de cette etude monocentrique prospective. Ils ont tous beneficie d’une reparation par double voie d’abord selon la technique de Morrey modifie. Le tendon du biceps etait reinsere avec des sutures trans-osseuses au sein de la tuberosite bicipitale. Une mobilisation immediate etait recommandee. Un suivi minimum de 2 ans etait requis avec une evaluation clinique et radiologique. Resultats Seize patients ont ete perdus de vue. Cinquante-huit patients ont ete analyses avec un suivi moyen de 53 ± 19 mois. L’echelle visuelle analogique etait de 0,22 ± 0,7. L’extension etait mesuree a −1° ± 2°, la flexion a 138° ± 6°, la pronation a 72° ± 16° et la supination a 81° ± 10° en moyenne. Le ratio force en flexion et en supination etait respectivement de 94 ± 8 % et 90,5 ± 12 % compare au cote controlateral. Le score subjectif du coude etait 94 ± 6 % et le score de DASH de 7,5 ± 9 %. Tous les patients etaient satisfaits ou tres satisfaits et tous ont repris leur activite sportive hormis un patient. Nous avons remarque deux ossifications heterotopiques et un patient a ete reopere pour une synostose radio ulnaire. Ni re-rupture ni atteinte nerveuse n’ont ete observe. Discussion Les points forts de cette etude sont le caractere prospectif, un nombre important de patients et un suivi a plus de deux ans. Cette technique necessite une certaine courbe d’apprentissage. Son indication chez des patients jeunes, de surcroit travailleur manuel, est averee avec un reel benefice sur la force et la douleur pour le patient. Conclusion Cette double voie d’abord chirurgical pour la reparation des ruptures aigues du biceps distale est une technique mini-invasive, fiable et reproductible. La technique de Morrey modifie associee a une mobilisation precoce fournit un faible taux de complications et limite probablement le nombre de synostose radio ulnaire.

Introduction Les revisions de protheses totales d’epaule anatomique (PTEA) combinent souvent perte de substance osseuse (PDSO) et deficience de la coiffe des rotateurs. Le changement prothetique par prothese totale d’epaule inversee (PTEI) est une option therapeutique possible. Objectif Rapporter les resultats a plus de 5 ans des revisions de PTEA par PTEI. Materiel et methodes Etude multicentrique retrospective (2003–2010) incluant 1955 patients operes d’une PTEI et revus avec 5 ans de recul minimum, 85/1955 PTEI (4,3 %) ont ete implantees pour revision de PTEA. Il y avait 26 perdus de vue et 11 deces, laissant 48 PTEI chez 48 patients (31 femmes, 17 hommes). Le diagnostic initial etait majoritairement une arthrose primaire (69 %). La reprise survenait a 91 mois en moyenne. Les motifs de reprise etaient multiples : descellement glenoidien (75 %), lesions de coiffe (68 %), usure du polyethylene sur MB (38 %). Trente (63 %) patients avaient un implant glenoidien cimente en polyethylene (PE), 18 (37 %) un metal back (MB). Les patients ont ete revus et radiographies avec un recul moyen etait de 8,5 ans (60 a 191 mois). Resultats Quinze complications sont survenues (infection, instabilite, descellement unipolaire), dont 2 reoperes sans changement d’implant, 5 avec revision d’implant. Les revisions etaient exclues de l’analyse fonctionnelle. Resultats fonctionnels : elevation = 124 ± 5 (+ 46°), rotation externe = 12 ± 3 (−7°), rotation interne = 3 points (inchangee), douleurs =2 ± 1/10 (−4/10), Constant = 57 ± 3( + 33), subjective shoulder value = 65 % ± 4( + 33 %). Les PDSO etaient plus importantes en cas de PE (28/30) qu’en cas de MB (11/18). Une perte de substance humerale proximale (60 %) entrainait une baisse significative des mobilites. Cinq PTEA etaient converties en PTEI avec un adaptateur metaphysaire sans difference de resultat. Une chirurgie precedant la PTEA etait correlee a de moins bonnes mobilites postoperatoires. Discussion Les motifs de revisions de PTEA par PTEI sont multiples et souvent associes (descellement glenoidien, ruptures de coiffe, usure du PE infections). LA PTEI presente l’avantage de permettre de traiter dans le meme temps la deficience de la coiffe et les PPDSO glenoidiennes (en fixant les greffes osseuses grâce a la platine). Les antecedents chirurgicaux et les PDSO humerales proximales donnent de mauvais resultats fonctionnels. L’infection doit systematiquement etre suspectee chez les patients raides avec antecedents de chirurgies multiples. Les protheses modulaires semblent presenter un interet dans les reprises de PTEA. Conclusion La PTEI est une option fiable et durable pour reviser les PTEA, mais au prix d’un taux de complications et de reprises important.