Lucent Lines Research Articles

Clinical and Radiographic Outcomes of the Infinity Total Ankle Arthroplasty System

Category: Ankle Arthritis Introduction/Purpose: We report our early results of the Infinity Total Ankle Arthroplasty (TAA) system, a third generation, constrained implant, recently introduced to the UK market. Methods: All ankles were uncemented and standard instrumentation was used. Patients were reviewed at 3, 6 and 12 months for radiological and clinical assessment including Ankle Osteoarthritis Score (AOS), Visual Analogue Scale (VAS) and subjective component of AOFAS Ankle/Hindfoot score. Results: Mean age was 66 (range 42-88), 14 females and 21 males. The mean follow-up 12 months (range, 4-18 months), and no patients were lost to follow-up. The diagnosis was post-traumatic in 15 cases, primary osteoarthritis in 15 and inflammatory arthritis in 5 cases. Preoperative coronal alignment deformity was < 10 degrees in 54%, 10-20 degrees in 43% and >20 degrees in 3%. Mean AOS score improved from from 64 to 24, AOFAS score improved from 19/70 to 49/70 and VAS from 7.0 to 2.0. Tibial component subsidence was noted in 1 case (3%), and asymptomatic periprosthetic lucent lines in 6 cases (17%). No ankles were revised. Complications included intraoperative medial malleolar fracture (8.5%), delayed wound healing (14%), tibial osteotomy non-union (3%), and regional pain syndrome (3%). The mean radiographic coronal plane alignment of the tibial component was 1.9 degrees varus (range, 5.3 varus to 1.7 valgus) and its mean sagittal plane alignment 2.8 (range -1.7 to 8.5) degrees dorsiflexion. Conclusion: Our early experience has demonstrated good patient outcomes, low complication rate and reproducible alignment with the Infinity implant.

Tritanium acetabular wedge augments: short-term results.

Reconstruction of acetabular defects in total hip arthroplasty (THA) presents a great challenge to orthopaedic surgeons. Previous studies have reported on the use and outcomes of trabecular metal acetabular augments for the reconstruction of acetabular defects. However, no study has been conducted evaluating the short-term results of tritanium acetabular wedge augments for the reconstruction of acetabular defects in THA. A retrospective study was conducted using a prospective database at a single institution including primary and revision THA patients from January 2013 to December 2014. Patients were included if they received a tritanium acetabular wedge augment system and had a minimum of 2-year follow-up (average 2.2 years ±0.3, range, 2-2.6 years). Demographic data and outcomes data [Harris Hip Score-HHS and Short Form (SF)-36] was collected. Radiographic data was also collected on THA revision cases (Paprosky classification), developmental dysplasia of the hip (DDH) cases (Crowe classification), and radiographic follow-up using DeLee and Charnley's classification system. There were 4 revision THA patients, 3 DDH patients, and 1 patient with posttraumatic arthritis. At the latest radiographic follow-up, there were no lucent lines in DeLee and Charnley Zones I, II or III. During the follow-up period, there was no open revision surgery. The SF-36 physical score significantly improved from preoperative measurement (29.6±2.2) to postoperative measurement (52.2±8.7, P=0.003), and the SF-36 mental score also significantly improved from preoperative assessment (34.5±4.5) to postoperative assessment (52.2±7.5, P=0.003). Total HHS scores also significantly improved postoperatively (P=0.02), with significant improvements in both the pain score (P=0.01) and function score (P=0.02). Tritanium acetabular wedge augments in this short follow-up case series exhibit high clinical outcome scores, no radiographic lucency, and no early failures.

Reverse total shoulder arthroplasty in wheelchair-dependent patients

Wheelchair-dependent patients have a high incidence of shoulder pathology, often causing severe impairment. This study reports outcomes of wheelchair-dependent lower extremity-impaired patients with symptomatic shoulder arthritis or severe rotator cuff pathology treated with reverse total shoulder arthroplasty (RTSA). Data for 19 wheelchair-dependent patients who had an RTSA for symptomatic arthritis or rotator cuff pathology, or both, were obtained from the University of Florida Shoulder Arthroplasty Database. Included were 16 of 19 shoulders with adequate follow-up averaging 40 months. Functional outcome scores included the Simple Shoulder Test, University of California Los Angeles Shoulder Rating Scale, Shoulder Pain and Disability Index, American Shoulder and Elbow Surgeons score, Constant score, and 12-item Short Form (SF-12) health survey. Objective measures were active elevation, external rotation, and internal rotation. Radiographs were evaluated for lucent lines, notching, and prosthetic loosening. All measured parameters, except the SF-12, significantly improved at the final follow-up. Functional outcome scores included Shoulder Pain and Disability Index, 45; Simple Shoulder Test, 7; American Shoulder and Elbow Surgeons, 73; University of California Los Angeles Shoulder Rating Scale, 30; Constant, 70; and SF-12, 33. Active elevation was 112°, and active external rotation was 29°. Most patients (83%) were satisfied. The complication rate was 25%; baseplate failure and dislocation occurred early, and periprosthetic humeral fracture secondary to infection occurred late. The notching rate was 42%. Shoulder pain and dysfunction due to arthritis and rotator cuff pathology can result in the loss of independence in wheelchair-dependent patients. We investigated whether RTSA can sustain the increased loads placed by these patients during transfers. Wheelchair-dependent patients can benefit from an RTSA for shoulder pain and dysfunction but must accept worsened impairment during the immediate postoperative period and a higher complication rate than the general population treated with an RTSA.

Clinical, Radiologic, and Pathologic Findings of Subdural Osteoma: A Case Report.

We present a case of a subdural osteoma. A 29-year-old female presented with a 3-year history of headaches. Computed tomography scan revealed a homogeneous high-density lesion isolated from the inner table of the frontal bone (a lucent dural line) in the right frontal convexity. Magnetic resonance imaging revealed an extra-axial lesion with a broad base without dural tail sign and punctate enhancement pattern characteristic of abundant adipose tissue. Upon surgical excision, we found a hard bony mass clearly demarcated from the dura. The mass displayed characteristics of an osteoma upon histological examination. The symptom was relieved after operation.

Compared fixation and survival of 280 lateralised vs 527 standard cementless stems after two years (1–7)

BackgroundRestoring the native hip anatomy increases hip prosthesis survival, whereas increased femoral lateralisation creates high torque stresses that may alter prosthesis fixation. After finding lucent lines around cementless lateralised stems (Corail™, DePuy Synthes, St Priest, France) in several patients, we evaluated the effects of lateralisation in a large case-series. The objective of our study was to compare lateralised vs standard stems of identical design in terms of radiological osteo-integration and survival. HypothesisLateralised stems, despite being used only when indicated by the anatomical parameters, carry a higher risk of impaired osteo-integration. Materials and methodsA retrospective study was conducted in 807 primary total hip arthroplasties (THAs) performed between 2006 and 2010 in 798 patients with a mean age of 65±14.2 years. Lateralised stems were used in 280 cases (Corail High Offset KHO, n=169; and Corail coxa vara KLA, n=111 cases) and standard stems in 527 cases (Corail KA). Mean follow-up was 2.3 years (range, 1–7 years). The clinical evaluation included determination of the Postel-Merle d’Aubigné (PMA) score. Bone fixation and stability of the implants were assessed by determining the Engh and Massin score and the ARA score on the radiographs at last follow-up. Femoral, acetabular and global offset values were determined before and after THA. Nobles's Canal Flare Index was computed. Survival was estimated using the Kaplan-Meier method with surgical revision for aseptic loosening as the end-point. ResultsThe PMA score improved from 12 (10–15) pre-operatively to 17.7 (14–18) (P<0.05). After THA, in the lateralised stem group, femoral offset was restored in 217 (77%) hips and the mean change vs the pre-operative offset value was −2mm; in the standard stem group, femoral offset was restored in 440 (83.5%) hips and the mean change was +1mm. The Engh and Massin score values were similar in the standard stem and lateralised stem groups (24.4±2.2 and 22.6±2.4, respectively, NS). Revision for aseptic loosening was required in 5 patients with lateralised stems (3 KHO and 2 KLA) versus none of the patients with standard stems. There were no cases of excessive femoral offset and the mean change in offset was −2.3mm (−5.3 to −1.1). Noble's index was increased (4.27±0.5 for the loosened lateralised stems, 3.65±0.8 for the well-fixed lateralised stems and 3.82±0.6 for the standard stems), with no significant difference across groups. Overall survival after 3.5 years of follow-up was 94.6% (95% confidence interval, 88.4–100%) with lateralised stems and 100% with standard stems (P<0.05). DiscussionThe risk of aseptic loosening was significantly higher with the lateralised stem (5/280, 1.8%) than with the standard stem (n=0). Our findings indicate a need for careful preparation to obtain primary fixation of lateralised stems. Level of evidenceIII, retrospective case-control study.

Pyrocarbon Proximal Interphalangeal Joint Arthroplasty: Minimum Five-Year Follow-Up

To report the outcomes, complications, and survivorship of pyrocarbon proximal interphalangeal joint arthroplasty at a minimum of 5-year follow-up. A review of 97 implants in 72 consecutive patients from our joint arthroplasty database was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure; Quick Disabilities of the Arm, Shoulder, and Hand score; and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. Diagnosis was osteoarthritis in 60 joints, rheumatoid arthritis in 12 joints, psoriatic arthritis in 11 joints, and trauma in 14 joints. The average follow-up was 118 months (range, 60-164 months). The mean arc of motion was 35° (range, 0° to 90°). There was no difference in grip strength between operated and nonoperated side. Of the 97 implants, 36 required additional surgery, of which 14 were revised and 22 required reconstruction around a retained implant. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 33 (range, 10-69) and 35 (range, 0-93), respectively. Mean visual analog scores for pain, satisfaction, and appearance were 2 (range, 0-8), 7 (0-10), and 8 (0-10), respectively. All implants had a lucent line with nearly all classified as either Herren grade 2 or 3. Progressive loosening was seen in 48% of implants. Implant survival as assessed by Kaplan-Meier was 85% at both 5 and 10 years. Good pain relief and maintenance of preoperative arc of motion was achieved with no major deterioration over time. Most implant revisions were performed within 24 months of the index procedure. Currently progressive loosening was not translated into revision surgery. Implant revision rate was higher than with other prostheses. Therapeutic IV.

Role of G-CSF treatment in recurrent miscarriage on the expression of FoxP3, VEGF, VEGF-R2 and c-kit in first trimester pregnancy specimens

Although total shoulder arthroplasty has demonstrated better clinical outcomes than hemiarthroplasty, glenoid component loosening is a common complication. Recently, a novel partially cemented all-polyethylene fluted central peg bone-ingrowth component was introduced.Forty-two consecutive total shoulder arthroplasties from 2003 to 2007 performed by a single surgeon were evaluated radiographically and clinically with American Shoulder and Elbow Surgeons (ASES) scores and range of motion.The average follow-up was 80 months (63-114); the average forward elevation improved from 107° to 137°, and external rotation improved from 30° to 37° at the latest follow-up. The average ASES score improved from 50 to 84. There was a strong correlation with the mean peripheral peg lucent line score (Lazarus score), which was 0.81, with the mean anchor peg lucent line score, which was 0.50 (P < .001). An analysis of polyethylene before and after cross-linking revealed a strong correlation between components with cross-linking and the Lazarus scores and the central fluted peg scores. Overall, there was 97% survivorship at 80 months. On radiographs, 81% of the central fluted pegs had complete incorporation with no lucent lines. These lucent lines correlated with lower ASES scores, suggesting that loosening of the glenoid decreases functional outcome.Care should be taken in preparing the central fluted peg as perforation of the vault can lead to central flute peg lucent line formation, whereas perforation of the peripheral pegs does not seem to negatively affect the outcome.

Differentiating Pneumothorax from the Common Radiographic Skinfold Artifact.

Pneumothorax can be a critical medical condition. The radiographic curvilinear appearance of pneumothorax can be mimicked by a skinfold artifact. Radiographic differentiation of the two entities is achieved in most cases by careful analysis of the characteristics of the linear shadow and its course. A thin, sharply defined opaque density representing the visceral pleura is the hallmark of pneumothorax. The added density of a skinfold presents as a broad opacity, which is outlined laterally by a sharply defined lucent line as a result of the Mach band effect and adjacent air. Unlike pneumothorax, a skinfold produces a line that does not follow the expected course of visceral pleura. Additional features, such as the absence of increased lucency laterally and the projection of lung markings across the curvilinear shadow, can help in the correct identification of skinfolds. Repeating the chest radiograph or using other imaging modalities can be considered in difficult cases.

Five- to ten-year follow-up with a partially cemented all-polyethylene bone-ingrowth glenoid component

Although total shoulder arthroplasty has demonstrated better clinical outcomes than hemiarthroplasty, glenoid component loosening is a common complication. Recently, a novel partially cemented all-polyethylene fluted central peg bone-ingrowth component was introduced. Forty-two consecutive total shoulder arthroplasties from 2003 to 2007 performed by a single surgeon were evaluated radiographically and clinically with American Shoulder and Elbow Surgeons (ASES) scores and range of motion. The average follow-up was 80months (63-114); the average forward elevation improved from 107° to 137°, and external rotation improved from 30° to 37° at the latest follow-up. The average ASES score improved from 50 to 84. There was a strong correlation with the mean peripheral peg lucent line score (Lazarus score), which was 0.81, with the mean anchor peg lucent line score, which was 0.50 (P<.001). An analysis of polyethylene before and after cross-linking revealed a strong correlation between components with cross-linking and the Lazarus scores and the central fluted peg scores. Overall, there was 97% survivorship at 80months. On radiographs, 81% of the central fluted pegs had complete incorporation with no lucent lines. These lucent lines correlated with lower ASES scores, suggesting that loosening of the glenoid decreases functional outcome. Care should be taken in preparing the central fluted peg as perforation of the vault can lead to central flute peg lucent line formation, whereas perforation of the peripheral pegs does not seem to negatively affect the outcome.

Lucent lines and glenoid components: What do they portend?

Glenoid component radiolucent lines following total shoulder arthroplasty are not uncommon postoperative radiographic findings and their incidence varies. With time, a certain percentage of radiolucent lines progress and potentially compromise component stability. The incidence of radiographic lucency progresses from 9% to 27% and then 73% at 2, 5, and 15 years, respectively. Radiolucent lines can be caused by posterior glenoid wear, inflammatory arthritis, design factors such as a metal-backed glenoid implant, and improper implantation techniques where the prosthesis is not fully seated or cement is used to fill a defect. Intraoperative techniques to prevent lucent lines include removing minimal bone from the glenoid vault and pressurizing cement into the cancellous bone at time of glenoid component implantation. Furthermore, a pegged glenoid component rather than a keel type is preferred, as this has been associated with a lower incidence of radiolucent lines.

Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly

The purpose of this study was to review the survivorship, radiologic and clinical outcomes of reverse shoulder arthroplasty (RSA) used for the treatment of 3-part and 4-part proximal humeral fractures in the elderly. Between 2003 and 2009, 29 shoulders in 28 elderly patients (87% female) with a 3-part or 4-part fractures were managed with RSA in Brisbane, Australia. Clinical and radiologic outcomes of this continuous cohort were retrospectively reviewed at an average follow-up of 54.9 months. Average age at surgery was 79 years. Survivorship and radiologic outcome assessment for all patients was undertaken. Seven patients died, and 1 was unavailable for clinical review, leaving 21 shoulders in 20 patients available for clinical review. There were no revisions of the reverse prosthesis. Mean average pain was 2.19 of 100 (standard deviation [SD], 6.97). Mean American Shoulder and Elbow Surgeons score was 89.3 (SD, 13.65). Mean normalized Constant score was 88.03 (SD, 11.24). Grade 1 scapular notching was observed radiologically in 4 shoulders. A scapular spur was observed in 7 shoulders. Class 1 heterotopic ossification was seen in 4 shoulders. Nonprogressive lucent lines were seen in 2 shoulders. Nonprogressive radiolucency was observed around the superior screw in 3 shoulders. No loosening of the glenoid baseplate or of the humeral component was observed. There was 1 complication of an axillary nerve palsy, which spontaneously resolved by 12 months after surgery. RSA using the shoulder technique described in this series provides good clinical and radiologic outcomes in elderly patients with 3-part and 4-part fractures.

Glenoid revision is best treated with glenoid implants: Affirms

Radiographic lucency adjacent to the glenoid component is a common finding after a total shoulder arthroplasty. In fact, the majority of patients with this entity are asymptomatic and require no management. However, when there is documented progression of lucent lines, leading to clinically symptomatic loosening, revision total shoulder arthroplasty is warranted. Treatment options for revision surgery are guided by the amount of glenoid bone loss and include either reimplanation or removal. When feasible, reimplantation of the glenoid yields superior clinical results. Reimplantation strategies include reimplantation without bone grafting, one-stage reimplantation with bone grafting, two-stage reimplantation with bone grafting, and reimplantation with the use of glenoid augments. If bone loss precludes, the clinician may consider implant removal with either biologic resurfacing or hemiarthroplasty.

Reverse Total Shoulder Arthroplasty: Early Outcome and Complication Report

BACKGROUND: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute.METHODS: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid.RESULTS: The mean Constant score increased from 31.4 to 53.8 (p &lt; 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p &lt; 0.001, 4.0 to 6.7, p &lt; 0.001) and active forward flexion improved from 96.9degrees to 125.6degrees (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving).CONCLUSIONS: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

Porous tantalum shells and augments for acetabular cup revisions

The purpose of this study was to evaluate early functional results of revision hip arthroplasty with pelvic bone loss revised with porous tantalum (PT) acetabular components. Twenty-five consecutive patients (25 hips) with loose acetabular components after total hip arthroplasty with a minimum of Paprosky IIa pelvic bone loss treated with PT cups with and without modular augments were retrospectively reviewed. Clinical outcomes were assessed using Harris hip score, and Western Ontario and McMaster Universities scores. Mean follow-up was 20.5 months and no patient was lost during follow-up. The average Harris hip score, and Western Ontario and McMaster Universities scores improved from 40 and 36 preoperatively to 79 and 73 postoperatively, respectively. No statistically significant differences in functional outcome scores were found between the group with moderate (Paprosky IIa, b) and severe (Paprosky IIc or more) acetabular bone loss. At the most recent radiographic evaluation, 24 cups demonstrated no lucent lines and 1 cup had lucent lines but remained well fixed. One cup was revised for traumatic dislocation but was found well fixed at open reduction. There were no septic or aseptic failures in this series. While awaiting longer-term follow-up studies, trabecular metal components show sufficient primary stability and appear suitable for revision hip arthroplasty with acetabular bone loss.

Experience with the Coonrad-Morrey total elbow arthroplasty: 78 consecutive total elbow arthroplasties reviewed with an average 5 years of follow-up

The Coonrad-Morrey total elbow arthroplasty is a linked implant. This study investigated the hypotheses that reliable results can be obtained in rheumatoid patients and in traumatic conditions and that the survival rate is similar to or better than what has been published for nonlinked implants. Surgery was performed on 70 consecutive patients (78 elbows) for an inflammatory arthritis (45elbows) or a traumatic condition (33 elbows: 18 acute fractures of the distal humerus, 10 nonunions, and 5 post-traumatic arthritis). At an average of 5 years of follow-up (2 to 11 years), the mean Mayo Elbow Performance Score for the group that had inflammatory arthritis (89 ± 13 points) was significantly higher than that for the group with a traumatic condition (80 ± 17 points). The QuickDASH score was not significantly different according to the etiology. Radiolucencies were observed in 17 cases around the humeral component and in 14 cases around the ulnar component. Bushing wear was observed in 14 cases. There were 27 complications, and 9 of them went to a revision procedure. The survival rate was 97.7% at 5 years and 91.0% at 10years if we consider revision for aseptic loosening as an endpoint. The Coonrad-Morrey total elbow arthroplasty allows treatment of a large spectrum of causes with satisfactory results. Better results have been obtained for rheumatoid patients than for patients with trauma. The rate of complication remains high even if the rate of implant revision stays low. However, the increased incidence of lucent lines around the ulnar component with follow-up and bushing wear are of concern.

Editor’s Spotlight/Take 5: Comparative Responsiveness and Minimal Clinically Important Differences for Idiopathic Ulnar Impaction Syndrome (DOI 10.1007/s11999-013-2843-8)

Editor’s Spotlight/Take 5: Comparative Responsiveness and Minimal Clinically Important Differences for Idiopathic Ulnar Impaction Syndrome (DOI 10.1007/s11999-013-2843-8)

Radiographic survival in total shoulder arthroplasty

Glenoid component loosening is thought to be a major cause of failure. This study assesses radiographic and clinical failure in shoulder arthroplasty, identifying factors predictive of loosening. Three-hundred two shoulder arthroplasties were implanted utilizing a cemented, keeled glenoid component, mean clinical follow-up 8.6 years. One-hundred fifty one shoulders had preoperative, early postoperative, and most recent radiographs, mean radiographic follow-up 8.0 years, minimum 4 years or less if revision was performed (2 cases). Fifty-two of 151 glenoid components (34%) showed a shift in position or a complete lucent line ≥1.5 mm. Four humeral components (3%) shifted or showed a 2-mm lucency in 3 zones. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years were 99% (95% CI) (98-100%) and 67% (95% CI) (58-78%). Glenoid components with lines at the keel on initial radiographs were at risk for radiographic failure, hazard ratio 4.6 95% CI 1.2-17.2, P=.02. No associations were found between radiographic survival and age, gender, diagnosis, glenoid erosion, and preoperative or early subluxation. Late subluxation superiorly was associated with the glenoid at risk for radiographic failure (P=.006). Glenoid component survivals free from revision at 5 and 10 years for the 302 shoulders were 99% (95% CI) (97-100%) and 93% (95% CI) (90-97%). Glenoid radiolucencies are seldom seen early, except beneath the faceplate. Glenoid radiolucencies develop, with notable changes 5 or more years following surgery. Humeral components seldom loosen. Revision rates remain low. The high frequency of late radiographic changes dictates the need for innovation.

The role of eccentric and offset humeral head variations in total shoulder arthroplasty

Humeral head variations were developed based on anatomic and biomechanical advantages; however, the effect of this expanded prosthetic inventory has yet to be investigated clinically. This study seeks to determine whether prosthetic variety has led to better outcomes, has led to similar outcomes facilitating joint reconstruction, or created any unanticipated complications. One hundred sixty primary total shoulder arthroplasties were performed for osteoarthritis. Patients received 52 standard, 60 eccentric, and 48 offset humeral heads. Head geometry was selected intraoperatively during trialing based on a complementing relationship to the glenoid throughout a near-normal range of motion. Patients had 2 years of follow-up or follow-up until reoperation (mean, 4.7 years; range, 0.8-8.3 years). Mean pain scores decreased from 4.5 to 1.9 on a 5-point scale (P < .001), mean elevation increased from 94° to 150°, mean external rotation increased from 22° to 57° (P < .001), larger lucent lines (≥ 1.5 mm) or change in glenoid position occurred around 19 components, and survivorship was 98% (95% confidence interval, 97%-100%) at 1 year and 98% (95% confidence interval, 95%-100%) at 5 years. No difference among head configurations was found for any of these outcomes. Evolution of designs has provided options to more accurately re-create anatomy including changes caused by osteoarthritis. At the length of follow-up in this study, clinical outcomes, radiographic performance, and survivorship are equivalent when applying these humeral head variations, and no special complications have developed.

Radiographic results of fully uncemented trabecular metal reverse shoulder system at 1 and 2 years' follow-up

The purpose of this study was to assess the short-term radiographic outcome of a fully uncemented reverse total shoulder arthroplasty (RTSA) system. We reviewed the radiographs of 98 consecutive patients undergoing uncemented RTSA. All patients had a standardized series of radiographs taken at 2 weeks, 1 year, and 2 years postoperatively. Humeral stems were evaluated for radiolucent lines by zone and component subsidence. Evaluation for scapular notching and radiolucency surrounding the baseplate implant within the glenoid vault was also performed. At 1 year, 93.9% of humeral stems had no lucent lines and 6.1% had less than 2 mm of lucency. Of the scapulae, 76.6% showed no evidence of notching, 21.4% had type 1 scapular notching, and 2.0% had type 2 notching at 1 year. At 2 years, 89.5% of humeral stem components had no lucent lines and 10.5% had less than 2 mm of lucency. Fifty-seven percent of scapulae had no notching, 34.2% had type 1 notching, 5.3% had type 2 notching, and 2.6% had type 3 notching. No stems had lucency in more than 1 zone or lucency ≥ 2 mm; 9.2% had subsidence of 2 mm or less. No glenoid components had any lucency around the baseplate or screws. Cementless trabecular metal porous-coated implants for RTSA are associated with secure glenoid fixation and minimal radiographic evidence of humeral stem loosening or subsidence at short-term follow-up. The rates of scapular notching found in our study are comparable to previous studies and did not affect implant stability.

Total Hip Arthroplasty in Teenagers: An Alternative to Hip Arthrodesis

Debilitating arthritis in teenage patients is a complex problem with limited surgical options. Hip arthrodesis is unpopular amongst patients, and contemporary total hip arthroplasty (THA) may be a promising alternative. We report on the outcomes of THA in patients less than 20 years of age. All consecutive teenage patients undergoing THA at a tertiary referral centre were reviewed. Mean follow-up was 3.4 years (range 0.6-6.8) and 9 patients had at least 5 years follow-up. There were 51 THAs in 43 patients with a mean age of 17 years (range 12-19). The commonest indication was osteonecrosis (35 cases), mostly secondary to slipped upper femoral epiphysis (15 cases). Forty-six were uncemented and 5 were reverse hybrid THAs of which 7 were computer assisted design/manufacture (CADCAM) components. The commonest bearing surface used was ceramic on ceramic (40 cases). The survival rate was 96% and there were 2 complications. At latest follow-up, the mean Harris hip score was 90 (range 68-99) and UCLA activity score was 6 (range 4-9). Radiological analysis showed 2 patients with lucent lines around the acetabular component, but no signs of osteolysis or wear. We report good short to intermediate term survivorship and outcomes, and feel THA represents a valid alternative option to hip arthrodesis.