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Restoring the native center of rotation (COR) in total shoulder arthroplasty (TSA) has been shown to improve postsurgical function, subjective outcomes, and implant longevity. The primary purpose of this study was to compare postoperative radiographic restoration of the humeral COR between short-stem and stemless humeral implants by evaluating the mean COR shift between the 2 techniques. Secondary outcomes evaluated were comparisons of COR shift outliers, humeral head implant thickness and diameter, direction of COR shift, and neck-shaft angle (NSA).This study was a multicenter retrospective comparative study using a consecutive series of primary anatomic TSA patients who received either a short-stem or stemless humeral implant. Radiographically, COR and NSA were measured by 2 fellowship-trained surgeons using the best-fit circle technique on immediate postoperative Grashey radiographs.A total of 229 patients formed the final cohort for analysis that included 89 short stems and 140 stemless components. The mean COR shift for short stems was 2.7 mm (±1.4 mm) compared with 2.1 mm (±0.9 mm) for stemless implants (P .001). The percentage of short-stem implant patients with a2 mm COR difference from native was 66.0% (n = 62) compared with 47.4% (n = 64) for stemless (P = .006). The percentage of short-stem patients with a4 mm COR difference from native was 17.0% (n = 16) compared with 3.0% (n = 4) for stemless (P .001). The mean humeral implant head thickness for short stems was 18.7 ± 2.2 mm compared with 17.2 ± 1.3 mm for stemless implants (P .001). The mean humeral head diameter for short stems was 48.7 ± 4.4 mm compared with 45.5 ± 3.5 mm for stemless implants (P .001). The NSA for the short-stem cohort was 136.7° (±3.6°) compared with 133.5° (±6.0°) for stemless (P .001).Stemless prostheses placed during TSA achieved improved restoration of humeral head COR and were less likely to have significant COR outliers compared with short-stem implants. more...

Background and Hypothesis Morphologic analysis of the proximal humerus has been performed to provide information about regions of best bone quality for stemless implant fixation. However, implant design-related bone analysis regarding primary fixation strength has not been reported. The purpose of this study was to investigate bone volume fraction (BV/TV) and bone mineral density (BMD) in the spatial vicinity of humeral implant fixation and biomechanical performance following placement of two different stemless RSA designs. It was hypothesized that peripheral expandable implant fixation (PEF) would result in residual peri-implant bone with higher BMD and BV/TV and higher fixation strength compared to a central-hexagonal impaction fixation (CHIF) design. Methods Overall 25 human cadavers were prepped for stemless RSA using either a CHIF (n = 5) or PEF design (n = 20). Micro computed tomography scans were obtained post-preparation to analyze overall BV/TV and BMD in the anchoring region of 2 stemless implant designs. Bone volumes of paired specimens (each group n = 5) were further segmented and divided into three even planar subsections along the implantation direction with four additional radial sectors, each according to their anterior-posterior and medial-lateral direction. Following implantation, biomechanical testing was performed to evaluate ultimate failure load and stiffness of the 2 implants. Results Postpreparation paired humeral bone analysis revealed significantly greater residual peri-implant BMD (P 0.69) with significantly higher bone density for PEF (P= .003). Further division in proximal to distal planar subsections of paired specimens showed overall statistically higher BMD and BV/ TV for PEF (at least P 0.89 with significantly higher primary stability for PEF (P = .046). Conclusion Implant design in stemless RSA affects residual bone quality in the anchoring region and primary fixation strength. Peripheral implant anchoring along the insertion direction provides significantly higher residual peri-implant BMD and BV/TV to achieve improved primary fixation with a radial expandable anchoring implant compared to a central-hexagonal impacted design. Level of Evidence Basic Science Study; Anatomy Study; Imaging; Biomechanics more...

Background Revision of prior hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) to reverse shoulder arthroplasty (RSA) is a technically challenging procedure with high complication rates. The purpose of this study was to compare intraoperative complications between convertible humeral stems and nonconvertible humeral stems stratified by stem length for conversion of TSA or HA to RSA. Materials and methods A multicenter retrospective analysis of patients undergoing revision of a primary TSA or HA to RSA was conducted. Patients were divided into 2 groups based on convertible or nonconvertible humeral stem design from the index surgery. The primary outcome measures were the following intraoperative variables and complications: total operative time, blood loss, intraoperative fracture, overall complication rate, and blood transfusions. Rates were compared between groups and analyzed according to primary stem length for the nonconvertible group. Results A total of 279 patients were included in the study, 70 with convertible stems and 209 with nonconvertible stems. About 70% of convertible stems were successfully retained. Operative time was similar between the 2 groups overall. Patients with nonconvertible stems had higher intraoperative blood loss (P = .0001), higher overall complication rate (P = .009), and greater risk of intraoperative fracture (P = .002). Revising stemless and short stems to RSA had significantly reduced operative time compared to standard length stems (97 and 116 minutes vs. 141 minutes, P Conclusion In revision of anatomic TSA to RSA, convertible stems lead to lower blood loss and intraoperative fracture rate compared to nonconvertible stems when broadly including all stem types. However, differences appear to be based on stem type. Among nonconvertible stems, revision of short stem and stemless implants are associated with reduced operative time compared to standard length stems. Revision of stemless implants to RSA is associated with the shortest operative time of all implant types as well as a similar rate of intraoperative fracture compared to convertible stems. Level of Evidence Level III; Retrospective Cohort Comparative Study more...

The long-term results of shoulder arthroplasty using stemless humeral head components with a mean follow-up period10 years were not available until now. The aim of this study was to evaluate the long-term results of shoulder arthroplasty using a stemless humeral head component.Since 2005, we have documented stemless humeral head replacement prospectively. Seventy-five patients with a mean age of 57 years at surgery (40 hemi-shoulder arthroplasties [HSAs] and 35 total shoulder arthroplasties [TSAs], 38 women and 37 men) were clinically and radiologically followed up after a mean period of 126 months (range, 105-157 months). Functional results were documented using the age- and sex-normalized Constant-Murley score (CMS) (ie, relative CMS).The relative CMS improved significantly (P.0001) from 56% preoperatively to 90% postoperatively. Its subcategories of pain (8 points preoperatively vs. 12 points postoperatively, P.0001), activities of daily living (10 points vs. 15 points, P.0001), range of motion (20 points vs. 29 points, P.0001), and strength (7 points vs. 11 points, P = .011) improved significantly as well. There was no significant difference in preoperative CMS vs. postoperative CMS, as well as its subcategories, between HSA (44.8 points vs. 67.1 points, P.0001) and TSA (44.4 points vs. 68.9 points, P = .004). Clinically and radiologically, we observed no loosening of the stemless humeral head component. Stress shielding around the humeral component was not detected. Upward migration of the humeral head was observed in 17.5% of patients (21.6% with HSA and 11.5% with TSA, P = .303). No implant failure was observed on the humeral side. At follow-up, 18.3% of patients had rotator cuff deficiency (13.9% with HSA and 25% with TSA, P = .280). Overall, 9.3% of stemless shoulder arthroplasties were revised to reverse TSAs (5% of HSAs and 14.3% of TSAs, P = .097). TSA showed a trend for a higher revision rate than HSA. Secondary glenoid wear occurred in 64.3% of HSAs, and none of the HSAs were converted to TSAs. We observed an incomplete radiolucent line2 mm in 30.4% and glenoid loosening in 11.4% of cemented glenoid components. Kaplan-Meier analysis revealed a 10-year survivorship rate of 96.5% and an estimated 13-year survivorship rate of 90.1% for stemless humeral components.Stemless humeral head replacement showed no loosening and a significant improvement in shoulder function after a mean period of 11 years. The long-term clinical and radiologic results as well as the survivorship of anatomic shoulder arthroplasty using a stemless humeral head implant are comparable to the long-term results of standard stemmed anatomic shoulder arthroplasty. more...

Background The re-tear rate after supraspinatus tendon (SSP) repair is high despite optimization of surgical techniques. The critical shoulder angle (CSA) > 35° has been identified as a risk for re-tear. Surgical reduction of the CSA performing additional lateral acromioplasty (ALAP) is intended to reduce the risk. Objective We aimed to evaluate the effect of ALAP on the re-tear rate in patients with a CSA > 35° after SSP repair. Patients and methods The study included 49 shoulders fulfilling predefined inclusion criteria. The patients were assigned to two groups; group I (25 SSP) was additionally treated with an ALAP. In group II (24 SSP) standard acromioplasty was performed during reconstruction. Magnetic resonance imaging and a clinical examination (Constant Score; CS) were performed 12 months after surgery. Results After 15 months group I showed a re-tear rate of 20%, a decreased CSA (mean 38.0° preoperatively vs. 34.5° postoperatively) and an increase in CS (mean 53.9 vs. 84.6). After 16 months group II showed a re-tear rate of 16.7%, no difference between pre- and postoperative CSA (37.8° vs. 37.6°), and an increase in CS (48.9 vs. 84.5). There was no difference between the groups in terms of re-tears and postoperative CS (p = 0.4557), but there was a significant difference in postoperative CSA (p 35° did not have a worse clinical outcome and no increased rate of re-tears compared with patients with a mechanically reduced CSA. Conclusion Additive lateral acromioplasty does not decrease the re-tear rate after arthroscopic SSP repair. However, ALAP significantly decreases the CSA to normal values. more...

Background The etiology of degenerative supraspinatus tendon (SSP) tear is still subject to discussion. Objectives Our objective was to correlate clinical, radiological, and intraoperative signs of mechanical outlet impingement in patients with degenerative SSP tears. Materials and methods This prospective study included 100 patients with degenerative SSP tears that required surgery. Preoperatively, clinical impingement signs and radiological parameters (critical shoulder angle [CSA], acromion type according to Bigliani, acromion index [AI]) were recorded. Intraoperatively, the extent of the rupture and grinding marks on the bottom of the acromion were assessed. Results Of the 100 patients, 59 had clinical impingement signs preoperatively; 90 patients had at least one positive radiological sign (CSA > 35°, AI > 0.67, acromion type II or III). In 23 patients a partial tear, in 55 patients a full thickness tear, and in 22 patients an additional infraspinatus tendon tear were found. In 10 cases no grinding marks at the bottom of the acromion during arthroscopy were found. In 75 cases moderate grinding marks and in 15 cases severe marks with bare bone at the bottom of the acromion were found. There was no statistically significant correlation between preoperative impingement signs and arthroscopic grinding marks (p = 0.83) or between clinical signs and radiological parameters (p = 0.44). There was no significant correlation between extent of the rupture, extent of grinding marks or radiological impingement parameters (p = 0.16; p = 0.26). Conclusion We could not verify a correlation between clinical and radiological impingement sign and arthroscopic impingement parameters. Based on our study, degenerative SSP tear cannot be characterized as the result of a mechanical outlet impingement. more...

Subacromial decompression is one of the most frequently performed procedures in the setting of arthroscopic shoulder surgery and typically includes acromioplasty. However, the indication for acromioplasty remains a subject of debate. Possible complications involve deltoid muscle insufficiency due to an excessive removal of the anterior acromion. This case report is intended to draw attention to this particular complication and its management. more...

Calcifying tendinitis is a very common pathology in the shoulder region, which may be acute or chronic. The rotator cuff, particularly the supraspinatus tendon, is most frequently affected. The tendons of the rotator cuff undergo a natural cycle of destruction and regeneration. The development of calcifying tendinitis is caused by defective tendon repair. Typical is a chronic course with acute pain exacerbation, which leads to medical presentation. Treatment options range from conservative therapy including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and shock wave therapy, to surgical therapy with arthroscopic removal of the calcific focus. This article discusses the current stage-dependent therapeutic concepts and provides a treatment recommendation. more...

The purpose of our study was to evaluate the clinical and radiological results of a new anatomic convertible cementless glenoid component. Forty-eight patients with a mean age of 67.3 years were clinically and radiologically followed-up with a mean of 49 months. Indications for glenoid replacement were A2 glenoid wear in 21.7%, B1 glenoid wear in 28.3%, B2 glenoid wear in 28.3%, B3 glenoid wear in 13%, D glenoid wear in 2.2%, and glenoid component loosening in 6.5%. The Constant-Murley score improved significantly (p more...

Using natural gas and sustainable biogas as feed, high-temperature pyrolysis represents a potential technology for large-scale hydrogen production and simultaneous carbon capture. Further utilization of solid carbon accruing during the process (i. e., in battery industry or for metallurgy) increases the process's economic chances. This study demonstrated the feasibility of gas-phase methane pyrolysis for hydrogen production and carbon capture in an electrically heated high-temperature reactor operated between 1200 and 1600 °C under industrially relevant conditions. While hydrogen addition controlled methane conversion and suppressed the formation of undesired byproducts, an increasing residence time decreased the amount of byproducts and benefited high hydrogen yields. A temperature of 1400 °C ensured almost full methane conversion, moderate byproduct formation, and high hydrogen yield. A reaction flow analysis of the gas-phase kinetics revealed acetylene, ethylene, and benzene as the main intermediate products and precursors of carbon formation. more...

Die operative Versorgung posttraumatischer Omarthrosen stellt eine besondere Herausforderung dar, da es sich haufig um jungere Patienten mit deutlicher Verformung des proximalen Humerus handelt. In der vorliegenden Studie werden die mittelfristigen Ergebnisse nach Versorgung posttraumatischer Omarthrosen mittels schaftfreier Schulterprothesen dargestellt. Im Schulterprothesenregister der Deutschen Vereinigung fur Schulter- und Ellenbogenchirurgie e. V. (DVSE) sind insgesamt 1052 vollstandig dokumentierte primarimplantierte Prothesen erfasst, davon wurden 46 Schultern mittels schaftfreier Prothese bei posttraumatischer Omarthrose mit einem Mindestnachuntersuchungszeitraum von 2 Jahren versorgt. Das durchschnittliche Follow-up betrug 4,1 (3,7–7,6) Jahre. Alle Bewegungsrichtungen verbesserten sich signifikant. Der absolute Constant-Score verbesserte sich insgesamt von 29,9 auf 65 Punkte. Subjektiv waren 25 (54 %) der Patienten sehr zufrieden, 14 (30 %) zufrieden. 4 (9 %) waren unzufrieden und 1 Patient enttauscht. 2 Patienten machten keine Angaben. 22 Patienten wiesen eine A1- (48 %), 10 eine A2- (22 %), 4 eine B1- und 2 eine B2-Pfanne nach Walch auf. Bei 8 Patienten lagen keine Angaben zur Pfannenveranderung vor. 10 Patienten wurden mit einem Glenoidersatz versorgt. Bei 9 Patienten fand eine Rekonstruktion der Supraspinatussehne statt, in 5 Fallen wurde die Refixation der Subscapularissehne als kritisch beurteilt. Der Humeruskopf war bei 40 Patienten (87 %) radiologisch zentriert. Einmal fand sich ein Lysesaum um die Schaftkomponente. Einmal fand ein Wechsel auf eine inverse Prothese statt. Die Versorgung der posttraumatischen Omarthrose mit einer schaftlosen Prothese als Alternative zur inversen Prothese stellt im mittelfristigen Verlauf eine gute Therapieoption gerade bei jungeren Patienten dar. 84 % der Patienten waren mit der Versorgung zufrieden. more...

In a novel process, CO2 and CH4 from the off‐gases of the coke oven and blast furnace are used in homogeneous reforming of those greenhouse gases to valuable syngas, a mixture of H2 and CO. Synthetic mixtures of the off‐gases from those large apparatuses of steel industry are fed to a high‐temperature, high‐pressure flow reactor at varying temperature, pressure, residence time, and mixing ratio of coke oven gas (COG) to blast furnace gas (BFG). In this study, a maximal reduction of 78.5 % CO2 and a CH4 conversion of 95 % could be achieved at 1350 °C, 5.5 bar, and a COG/BFG ratio of 0.6. Significant carbonaceous deposits were formed but did not block the reactor tube in the operational time window allowing cyclic operation of the process. These measurements were based on prior thermodynamic analysis and kinetic predictions using an elementary‐step reaction mechanism., A new concept and proof‐of‐principle of a novel process is presented for the reduction of CO2 emissions occurring in the steel industry. The potential of using off‐gases of the coke oven and blast furnace for the dry reforming of the CH4 to valuable syngas is investigated theoretically and experimentally. A maximal reduction of 78.5 % CO2 and a CH4 conversion of 95 % was achieved at conditions relevant for the steel industry. more...

In a novel process, CO$_{2}$ and CH$_{4}$ from the off‐gases of the coke oven and blast furnace are used in homogeneous reforming of those greenhouse gases to valuable syngas, a mixture of H$_{2}$ and CO. Synthetic mixtures of the off‐gases from those large apparatuses of steel industry are fed to a high‐temperature, high‐pressure flow reactor at varying temperature, pressure, residence time, and mixing ratio of coke oven gas (COG) to blast furnace gas (BFG). In this study, a maximal reduction of 78.5 % CO$_{2}$ and a CH$_{4}$ conversion of 95 % could be achieved at 1350 °C, 5.5 bar, and a COG/BFG ratio of 0.6. Significant carbonaceous deposits were formed but did not block the reactor tube in the operational time window allowing cyclic operation of the process. These measurements were based on prior thermodynamic analysis and kinetic predictions using an elementary‐step reaction mechanism. more...

Additional pathologies accompanying calcific tendinitis of the rotator cuff still remain unknown. The hypothesis of this study was that there are various additional pathologies accompanying calcific tendinitis, which might need further treatment. This study aimed to document intra-articular pathologies and investigate whether the location and spread of calcific tendinitis are associated with intra-articular pathologies and impairment in range of motion. Arthroscopy was performed on 53 patients for chronic calcific tendinitis. Documentation included demographic baseline variables, intraoperative findings of all structures in the glenohumeral joint, range of motion, joint laxity under general anesthesia, and basic details of intraoperative procedures. In all, 189 additional pathologies were found, 77 during intra-articular arthroscopy. Of all extra- and intra-articular pathologies, 74 and 70%, respectively, required surgical treatment. A mean of 3.6 additional pathologic findings per patient were observed; 19% of all patients had multiple (i. e., ≥2) calcific spots. The main additional pathologies were bursitis (87%), type II–III acromion (Bigliani classification, 70%), and synovitis (47%). No statistical significance was found for any associations tested between the localization of the deposit and the documented pathologies. Patients with symptomatic, chronic calcific tendinitis of the shoulder may suffer from multiple and therapeutically relevant disorders of the glenohumeral joint requiring surgical care. The frequency of findings underlines the importance of a diagnostic and therapeutic arthroscopy of the shoulder in order to ensure that surgeons properly address intra-articular pathologies. more...

Die Implantation einer anatomischen Schultertotalprothese fuhrt bei fortgeschrittenem Glenoidverbrauch zu einer hoheren Lockerungsrate der Glenoidkomponente und schlechteren funktionellen Ergebnissen. Ziel der Auswertung der Daten des Deutschen Schulterendoprothesenregisters war zu klaren, ob die Implantation einer inversen Schulterprothese bei fortgeschrittenem bikonkavem Glenoidverbrauch Typ B2 nach Walch im Vergleich zur anatomischen Schulterprothese Vorteile aufweist. 1052 vollstandig dokumentierte primar implantierte Prothesen konnten nach Datenbereinigung mit einem Mindestnachuntersuchungszeitraum von 2 Jahren in die Auswertung eingeschlossen werden. 119 Patienten wiesen ein B2-Glenoid auf. Bei 86 Patienten wurde eine anatomische und bei 33 Patienten eine inverse Prothese implantiert. Der durchschnittliche Nachuntersuchungszeitraum betrug 47,6 Monate. Nach anatomischer als auch nach inverser Prothesenimplantation verbesserte sich der Constant Score mit seinen Subkategorien und auch das aktive Bewegungsausmas signifikant durch die Prothesenimplantation. Im funktionellen Ergebnis zeigten sich bisher keine Unterschiede zwischen beiden Implantattypen, wohingegen Revisionseingriffe signifikant haufiger nach inverser Prothese (21,2 %) (haufigste Indikationen: 3 % Glenospharenlockerung, 6 % Protheseninstabilitat) als nach anatomischer Prothese (12,8 %) (11,6 % Glenoidlockerung, 1,2 % Protheseninstabilitat) erfolgten, obwohl anatomische Prothesen eine hohere Rate an Glenoidlockerungen aufwiesen. Die funktionellen als auch radiologischen Ergebnisse sind fur beide Prothesentypen mit der Literatur vergleichbar, obwohl es sich um Registerdaten (Daten der Versorgungsqualitat) handelt. more...

Several stemless shoulder implants are available on the market, but only a few studies have presented results with sufficient mid- to long-term follow-up. The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement.This is a prospective cohort study evaluating the stemless shoulder prosthesis since 2005. Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders; 17 underwent total shoulder replacement, and 32 underwent hemiarthroplasty. Forty-three patients were clinically and radiologically monitored after a mean of 9 years (range, 90-127 months; follow-up rate, 88%). The indications for shoulder replacement were primary osteoarthritis in 7 shoulders, post-traumatic in 24, instability in 7, cuff tear arthropathy in 2, postinfectious arthritis in 1, and revision arthroplasty in 2.The Constant-Murley Score improved significantly from 52% to 79% (P .0001). The active range of motion also increased significantly for flexion from 101° to 118° (P = .022), for abduction from 79° to 105° (P = .02), and for external rotation from 21° to 43° (P .0001). Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention. No revision caused by loosening or countersinking of the humeral implant was observed.The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation standard shoulder arthroplasty. more...

Bipolar dislocation of the clavicle is rare. In the literature, every reported bipolar dislocation of the clavicle is caused by a traumatic injury with loss of function of the affected shoulder. Currently, there is no recommendation to treat. A conservative treatment can be tried first to achieve adequate shoulder function. If this cannot be achieved, surgical treatment will be indicated. In the literature, many options for surgical treatment are described. This article presents a case of a chronic Rockwood V injury with chronic anterior sternoclavicular joint instability. The special feature of this case was the arthroscopically assisted stabilization of the acromioclavicular joint (ACJ) with the ipsilateral semitendinosus tendon graft and the open stabilization of the sternoclavicular joint (SCJ) with the ipsilateral gracilis tendon graft. A lateral fracture of the clavicle in the course of the postoperative treatment was treated with a plate osteosynthesis. At follow-up after six months, the postoperative shoulder function was restored. The ACJ and the SCJ were stable in clinical and radiographic examination. This case report shows the first surgical treatment using two tendon grafts for combined stabilization of the ACJ and SCJ. more...

An increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement. Patients (n = 32) who had received microfracturing of the shoulder were retrospectively enrolled, of whom 5 had received shoulder replacements after a mean time of 47 months. Of these patients, 23 completed the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant–Murley Scores in addition to an additional subjective questionnaire. Patients were then clinically examined and received x‑ray analysis of the operated shoulder. Data from an additional 4 patients were acquired by telephone interview. Mean follow-up was 105 months. Of the included patients, 13/27 patients reported no pain, 12/27 patients moderate pain. Of these 12, 6/27 reported pain only at night and 3/27 only during rest. Concerning the outcome of surgery, 19/27 patients were “satisfied” or “very satisfied”. There was a statistically significant increase in internal rotation, but no further differences in the range of motion pre- and postoperatively. Patients without any signs of osteoarthritis before surgery showed statistically significantly better outcomes. There was a statistically significant increase in radiological signs of osteoarthrosis in pre- versus postoperative patients. Patients with bipolar lesions showed statistically significantly poorer Subjective Shoulder Value (SSV) results. Even though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty. more...

BACKGROUND: Shoulder arthroplasty (SA) complications require standardization of definitions and are not limited to events leading to revision operations. We aimed to define an international consensus core set of clinically relevant unfavorable events of SA to be documented in clinical routine practice and studies.METHODS: A Delphi exercise was implemented with an international panel of experienced shoulder surgeons selected by nomination through professional societies. On the basis of a systematic review of terms and definitions and previous experience in establishing an arthroscopic rotator cuff repair core set, an organized list of SA events was developed and reviewed by panel members. After each survey, all comments and suggestions were considered to revise the proposed core set including local event groups, along with definitions, specifications, and timing of occurrence. Consensus was reached with at least two-thirds agreement.RESULTS: Two online surveys were required to reach consensus within a panel involving 96 surgeons. Between 88% and 100% agreement was achieved separately for local event groups including 3 intraoperative (device, osteochondral, and soft tissue) and 9 postoperative event groups. Experts agreed on a documentation period that ranged from 3 to 24 months after SA for 4 event groups (peripheral neurologic, vascular, surgical-site infection, and superficial soft tissue) and that was lifelong until implant revision for other groups (device, osteochondral, shoulder instability, pain, late hematogenous infection, and deep soft tissue).CONCLUSION: A structured core set of local unfavorable events of SA was developed by international consensus to support the standardization of SA safety reporting. Clinical application and scientific evaluation are needed. more...

The purpose of our study was to evaluate the clinical and radiological results of a new anatomic convertible cementless glenoid component.Forty-eight patients with a mean age of 67.3 years were clinically and radiologically followed-up with a mean of 49 months. Indications for glenoid replacement were A2 glenoid wear in 21.7%, B1 glenoid wear in 28.3%, B2 glenoid wear in 28.3%, B3 glenoid wear in 13%, D glenoid wear in 2.2%, and glenoid component loosening in 6.5%.The Constant-Murley score improved significantly (p 0.0001) from 50% pre-OP to 103% post-OP. Patients with a B3 glenoid type according to Walch achieved a significant (p = 0.044) lower Constant-Murley Sscore post-OP compared to patients with a B1 glenoid type (88% vs 106%). The mean subluxation index changed significantly (p 0.0001) from 0.54 pre-OP to 0.46 post-OP. At the metal-back bone interface an incomplete radiolucent line 1 mm was observed in two cases (4.2%) and an incomplete radiolucent line 2 mm was observed in another two cases (4.2%). PE dissociation occurred in two cases. No glenoid loosening was observed. The implant related revision rate was 4.2% (2 cases). All components (n = 612.5%) requiring conversion to reverse were converted without any further complications or loosening.Good functional results can be achieved in cases with a B1 and a B2 glenoid after anatomic shoulder arthroplasty using the described metal back glenoid. A conversion from an anatomic to a reverse glenoid component were possible in all cases without any further complications. Conversion of the anatomic glenoid component to a reverse system alleviates revision surgery. more...

The aim of this study was to investigate whether the etiology of a rotator cuff tear (RCT) influences structural tendon healing and clinical outcome after arthroscopic rotator cuff repair (RCR). The hypothesis was that there is a difference between patients with a sudden onset of symptoms following a traumatic event and those with degenerative lesions. Out of a group of 50 patients enrolled in a previously published prospective investigation, 48 underwent arthroscopic RCR. The acute trauma group (tGA) consisted of 25 patients diagnosed with RCT immediately after trauma, while the chronic degenerative group (dGB) comprised 23 individuals without trauma. After at least 17 months (mean: 27.2), 42 patients underwent clinical and ultrasound examination. The mean age of the patients was 57.9 years in the tGA and 61.0 years in the dGB. The overall drop-out rate was 9.3 %. Average strength was 67.4 N in the tGA and 54.75 N in the dGB. The rate of nonhealing as detected by ultrasound was 13.6 % in the tGA and 9.5 % in the dGB. Arthroscopic RCR leads to favorable clinical and functional outcomes in both traumatic and degenerative RCT. There were no significant differences in outcome. more...

Highlights • Overstuffing is a serious yet avoidable complication of radial head arthroplasty. • Overstuffing severely alters elbow joint kinematics and leads to capitellar erosion. • Radiocapitellar arthroplasty can be a salvage procedure in such cases. • Limited clinical data is available thus far regarding radiocapitellar arthroplasty. • The possibility for early failure due to ulnohumeral erosion has to be considered., Introduction Radiocapitellar arthroplasty represents a possible treatment option for isolated osteoarthritis of the radial column. We report the first case of early failure of this procedure. Presentation of case We present the case of a 41-year old male who sustained a terrible triad injury to his right elbow and subsequently underwent radial head arthroplasty. Due to overstuffing of the radial head prosthesis, capitellar erosion occurred and radiocapitellar arthroplasty was thus performed. Only one year later, conversion of the radiocapitellar replacement to total elbow arthroplasty was required as a result of progressive ulnohumeral osteoarthritis. Discussion According to the currently limited clinical data, radiocapitellar arthroplasty provides satisfactory results. However, biomechanical analysis shows that available prostheses do not sufficiently reproduce the radiocapitellar anatomy. The design of the prosthesis might thus have contributed to the rapid progression of ulnohumeral erosion following radiocapitellar arthroplasty although the poor outcome may also be attributed to the trauma itself along with the inadequate initial treatment. Conclusions The indication for radiocapitellar arthroplasty warrants careful consideration given the results of biomechanical analysis and the early failure due to progressive ulnohumeral erosion seen in the present case. more...

Die arthroskopische Rotatorenmanschettenrekonstruktion ist heute ein etabliertes Verfahren, Lasionen der Rotatorenmanschette (RM) zu behandeln. Ihre Anfange nahm sie Ende der 1980er Jahre in den USA und wurde dann in den 1990er Jahren auch in Europa und Deutschland begonnen. Seit Anfang des Jahrtausends wurde diese Technik auch in unserem Vorgehen eingefuhrt und schrittweise von den Autoren beherrscht und verbessert. Heute stellt die arthroskopische RM-Rekonstruktion das Standardverfahren zur Versorgung von RM-Rupturen in auf Schulterchirurgie spezialisierten Zentren dar. Diese Arbeit soll die eigene Entwicklung von den Anfangen bis heute aufzeigen mit besonderer Rucksicht auf Technik, Probleme und Ergebnisse. more...

Bipolar dislocation of the clavicle is rare. In the literature, every reported bipolar dislocation of the clavicle is caused by a traumatic injury with loss of function of the affected shoulder. Currently, there is no recommendation to treat. A conservative treatment can be tried first to achieve adequate shoulder function. If this cannot be achieved, surgical treatment will be indicated. In the literature, many options for surgical treatment are described. This article presents a case of a chronic Rockwood V injury with chronic anterior sternoclavicular joint instability. The special feature of this case was the arthroscopically assisted stabilization of the acromioclavicular joint (ACJ) with the ipsilateral semitendinosus tendon graft and the open stabilization of the sternoclavicular joint (SCJ) with the ipsilateral gracilis tendon graft. A lateral fracture of the clavicle in the course of the postoperative treatment was treated with a plate osteosynthesis. At follow-up after six months, the postoperative shoulder function was restored. The ACJ and the SCJ were stable in clinical and radiographic examination. This case report shows the first surgical treatment using two tendon grafts for combined stabilization of the ACJ and SCJ. more...

Hintergrund Nach einem Sturz ist vor allem bei alteren Patienten die Unterscheidung zwischen degenerativer und traumatischer Rotatorenmanschettenruptur (RMR) relevant fur die therapeutischen Entscheidungen. Ziel dieser Studie ist die Erhebung relevanter Daten daruber, ob es sich im individuellen Fall um eine akute oder chronische Ruptur handelt. more...

The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair. A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39–74) and follow-up was 30.81 months (12–72). True anterior–posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded. Eighteen cases with recurrent tears (17.4 %) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711 ± 0.065 and for patients without recurrent tears 0.710 ± 0.064 (p more...

Die moderne Ara der Schulterendoprothetik resultiert aus der Weiterentwicklung des 1951 von Charles Neer entwickelten Neer-Prothesensystems. Dieser Artikel gibt einen Uberblick uber die Entwicklung und die Implantatcharakteristika der Schulterendoprothesen mit ihren Vor- und Nachteilen sowie den Indikationen zur anatomischen Rekonstruktion des Glenohumeralgelenks. Abschliesend werden die Langzeitergebnisse in Abhangigkeit der Atiologie der Omarthrose dargestellt. more...

Mit zunehmendem Alter und steigendem Aktivitatsgrad alterer Mitburger nimmt die Bedeutung der Erkrankungen und Verletzungen der Rotatorenmanschette stetig zu. Zum einen tolerieren die betroffenen Menschen immer seltener Einschrankungen in ihrer Leistungsfahigkeit, zum anderen steigt die Nachfrage nach konservativen und operativen Masnahmen dieses Patientenkollektivs. Ziel dieses Artikels ist es, Ursachen, klinische Prasentation und Diagnostik zu erortern. Ferner sollen die konservativen Masnahmen, wie auch die Indikationen zu verschiedenen OP-Techniken diskutiert und dargestellt werden. more...

The aim of this study was to evaluate the midterm results and complications of a total shoulder arthroplasty implanted with a metal-backed, bone-ingrowth glenoid component.In total, 62 patients (65 shoulders) diagnosed with primary osteoarthritis were treated with total shoulder arthroplasty with a cementless glenoid component. The mean age was 66 years (range, 54-85 years). Fifty-three patients were evaluated after a mean of 64 months (range, 26-85 months). Functional results were documented by use of the age- and sex-adjusted Constant score. Radiolucent line (RLL) assessment of the glenoid component was performed by use of true anteroposterior and axillary views.The Constant score improved significantly from 49% preoperatively to 89.8% postoperatively (P .0001). Active range of motion improved significantly for flexion (from 118° to 146°), abduction (from 87° to 133°), and external rotation (from 21° to 44°) (P.0001). In 3 cases (5.7%), RLLs of 1 mm or less were present, and 1 case (1.8%) had an RLL of 2 mm or less in 1 zone. Glenoid component loosening occurred in 5 cases (9.4%) because of breakage of the cage screw. Four of these patients presented preoperatively with a type B1 glenoid and one patient with type A2. Two of the patients who underwent revision also had a complete tear of the rotator cuff. The revision rate was 11.3% (6 patients) after a mean of 68 months.After midterm follow-up, clinical outcomes of patients operated on with a cementless, metal-backed glenoid implant improved significantly. However, an unacceptable rate of complications and revisions was found. Glenoid loosening predominantly occurred in patients with preoperative eccentric glenoid morphology and was also related to cranial migration of the proximal humerus during the follow-up period. more...

Zusammenfassung Verletzungen des Acromioclavikular-Gelenks kommen bei einer Vielzahl von Sportarten vor und fuhren zu einer Sportpause des Verletzten. Hochrasanz- und Kontaktsportarten stellen die Mehrzahl der betroffenen Sportarten dar. Die Klassifizierung des AC-Verletzung erfolgt heute nach Rockwood und entsprechend des Schweregrades wird eine konservative oder operative Therapie im akuten Fall empfohlen. Die rechtzeitige, Stadien adaptierte Therapie fuhrt zu zufriedenstellenden Ergebnissen und einer hohen Ruckkehrrate zum Sport. Ubersehene oder nicht suffizient akut therapierte Falle bedurfen selten einer sekundaren Stabilisierung. Diese ist operativ aufwandig und die Ergebnisse sind schlechter als bei Primarversorgung. more...

The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head.The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads.In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P .0001) and a decentered apex in the transverse plane in 52%.It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes. more...