Partial Shoulder Research Articles

Dermal skeleton of the stem osteichthyan Ligulalepis from the Lower Devonian of New South Wales (Australia)

When first described based on isolated scales, Ligulalepis was assigned to thePalaeoniscoidea, a basal group of actinopterygians (ray-finned fishes). Recent cladisticanalyses, mainly based on skull and neurocranial characters, have mostly recovered thetaxon (or, ‘Ligulalepis’) as a stem osteichthyan. Here we present information on Ligulalepisdermal elements other than scales and skulls, that include a cheek fragment, a premaxilla,other marginal jaw elements and teeth, an accessory vomer, a partial shoulder girdle,incomplete spine-like elements, and a gular plate. The shoulder girdle and premaxilla compareclosely with those of basal actinopterygians, whereas the spine-like element showssome similarity to the distal end of the spines on medial dorsal plates of the Chinese LateSilurian stem osteichthyans Guiyu and Sparalepis, or alternatively to fin rays on the stemosteichthyan Dialipina. One of the jaw elements appears to be a compound jugal plate pluspart of the dentate maxilla, an arrangement not previously known in any Devonian stemosteichthyan, or actinopterygian. Histological structure of dermal plates somewhat resemblesthat of Meemannia, but pore openings in Ligulalepis lead only to the vascular canalnetwork at the base of the ornament layer and not to a pore canal network. Like previousphylogenetic analyses, our analysis incorporating post-cranial dermal skeleton charactersalso recovered Ligulalepis as a stem osteichthyan.

Smoking cessation prior to total shoulder arthroplasty: A systematic review of outcomes and complications.

We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery. A literature search was performed using the search terms "shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine]." Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges. Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly (p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications. Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended. Level III, Systematic Review.

Partial Shoulder Arthroplasty Guided by Three-dimensional Prototyping.

Three-dimensional (3D) printing technology is a reality in medicine. In Orthopedics and Traumatology, 3D printing guides a precise and tailored surgical treatment. Understanding and disseminating its applicability, use, and outcomes can foster academicism and improve patient care. This is a report of a rare case of a female young adult patient with osteonecrosis of the humeral head due to avascular necrosis developed in early childhood. The treatment was tailored and optimized with 3D printing, which helped determine the steps for partial humeral arthroplasty.

Correlation Between Implant Positioning and Functional Outcomes in Partial Shoulder Resurfacing.

Objective The present study aimed to correlate functional outcomes and implant positioning in a case series of partial shoulder resurfacing arthroplasties. Methods A total of 25 patients were assessed for range of motion, functional outcome per the University of California at Los Angeles (UCLA) score and radiographic findings. Pre- and postoperative data were compared. In addition, patients were grouped according to the cervical-diaphyseal angle (CDA) determined by an anteroposterior radiography and to the retroversion angle (RVA) determined by an axillary radiography. A CDA from 130° to 140° and a RVA from 20° to 40° consisted in ideal positioning (anatomical standard). Data were analyzed using the Wilcoxon signed-rank test, analysis of variance (ANOVA) followed by the Kruskal-Wallis test or the Mann-Whitney test as appropriate. Results The mean follow-up time was 48.3 months (12 to 67 months). The postoperative functional score (31.5) was higher than the preoperative score (15.5) ( p < 0.001). In 6 patients, the implant was in anatomical positioning, while implant positioning was considered “nonstandard” in 19 subjects. Seven patients had a CDA < 130°, and 14 patients had a CDA ranging from 130° to 140°; in addition, the CDA was > 140° in 4 subjects. The RVA was up to 20° in 15 patients and ranged from 20° to 40° in 10 subjects. Using these criteria to group patients, the postoperative clinical-functional parameters were not statistically different from the preoperative findings ( p > 0.05). Conclusion Partial shoulder resurfacing results in significant postoperative functional recovery in patients with degenerative joint diseases. However, implant positioning assessed by CDA and RVA does not correlate with clinical-functional outcomes and, therefore, it is an inaccurate indicator of surgical success. Level of Evidence IV; Case Series.

Lifetime Risk of Primary Shoulder Arthroplasty From 2008 to 2017: A Population-Level Analysis Using National Registry Data.

To estimate the lifetime risk of primary shoulder arthroplasty in Australia and to examine changes over time. For this retrospective population-level analysis, de-identified individual-level data on all primary partial shoulder arthroplasty (PSA) and total shoulder arthroplasty (TSA) procedures performed in Australia from 2008 to 2017 (n = 38,868) were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data and life tables were obtained from the Australian Bureau of Statistics. Lifetime risk of primary shoulder arthroplasty was calculated for each year using a standardized formula. Separate calculations were undertaken by sex and for PSA and TSA. The lifetime risk of shoulder arthroplasty increased significantly over time. For men, this risk more than doubled from 0.78% (95% confidence interval [95% CI] 0.73-0.84) in 2008 to 1.78% (95% CI 1.70-1.86) in 2017. Lifetime risk for women rose from 1.54% (95% CI 1.46-1.62) to 2.88% (95% CI 2.78-2.99) over the study period. This increase was predominantly driven by growth in lifetime risk of TSA. In contrast, lifetime risk of PSA decreased over time, from 0.25% (95% CI 0.22-0.28) in 2008 to 0.11% (95% CI 0.09-0.13) in 2017 for men, and from 0.55% (95% CI 0.51-0.60) to 0.11% (95% CI 0.09-0.13) for women. By the end of 2017, the lifetime risk of primary shoulder arthroplasty in Australia increased to 1 in 57 for men and 1 in 35 for women. Compared to declining PSA trends, there was substantial growth in TSA use over a decade. These data improve our understanding of the rising national burden of primary shoulder arthroplasty and can assist in planning to meet future surgical demand.

A New Erythrosuchid Archosauriform from the Middle Triassic Yerrapalli Formation of South-Central India

Erythrosuchid archosauriforms are quadrupedal carnivorous reptiles with a proportionally huge skull. They represent one of the first evolutionary radiations of medium to large predatory diapsids after the Permo–Triassic mass extinction. Erythrosuchids are known from Lower–Middle Triassic rocks of South Africa, Russia, and China, and there have been preliminary reports from the Middle Triassic Yerrapalli Formation of south-central India. Here we describe, compare and figure for the first time these Indian erythrosuchid remains. We erect the new genus and species Bharitalasuchus tapani based on a holotype and paratype that preserve tooth-bearing cranial fragments, at least 17 presacral vertebrae, some ribs and probable intercentra, and partial shoulder and pelvic girdles and hindlimb and allow recognizing a series of autapomorphies and unique combination of character states among erythrosuchids. Our phylogenetic analysis recovered Bharitalasuchus tapani most closely related to Shansisuchus shansisuchus and Chalishevia cothurnata from the late Anisian of China and Ladinian of Russia, respectively. The phylogenetic affinities of this new taxon and a revision of the tetrapod assemblage of the Yerrapalli Formation shed light on the age of this unit. The presence of the Wadiasaurus-Rechnisaurus-Bharitalasuchus association in the Yerrapalli Formation closely resembles the Sinokannemeyeria-Shansisuchus dicynodont-erythrosuchid association of late Anisian to early Ladinian Chinese units. This evidence supports a post-early–middle Anisian age, even possibly early Ladinian, for the Yerrapalli Formation. The presence of possibly one of the last erythrosuchids in India would indicate that the clade still retained both a northern and southern Pangean distribution before its extinction.

Giant cell tumor formation due to metallosis after open latarjet and partial shoulder resurfacing

Shoulder metallosis with giant cell tumor formation is rarely seen in shoulder surgery. With an increase in shoulder arthroplasty and complex revision shoulder surgeries, clinicians should have an index of suspicion for possible metallosis in patients that presents with unexplained persistent pain with metal components on both the glenoid and humeral side. This case describes a 43-yearold female with a history of six prior shoulder surgeries who presented with shoulder metallosis and giant cell tumor formation after a screw from her open Latarjet procedure began rubbing against her Hemicap implant. She successfully underwent a revision total shoulder arthroplasty for post traumatic arthritis with pectoralis major transfer for her chronic subscapularis rupture and had complete symptom resolution.

Lifetime risk of primary shoulder arthroplasty over a decade: a population-level analysis

Purpose: Lifetime risk estimates can serve as a marker for disease burden in a population and enable health funders and the health workforce to plan for healthcare demand. While the lifetime risk of hip and knee arthroplasty have previously been estimated at national levels, this approach has not yet been applied to shoulder arthroplasty. This study aimed to quantify the lifetime risk of primary shoulder arthroplasty in Australia, and examine changes in lifetime risk over a ten-year period. Methods: De-identified individual-level data on all primary partial shoulder arthroplasty (PSA) and total shoulder arthroplasty (TSA) procedures performed in Australia from 1 January 2008 to 31 December 2017 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The AOANJRR has a near-complete capture rate (>98.8%) of all hip, knee and shoulder arthroplasties performed in Australia, and registry data are validated against state-level health department data using a sequential multi-level matching process. The full collection of AOANJRR national shoulder arthroplasty data commenced in 2008. Population data and life tables (incorporating life expectancy and all-cause mortality) were obtained from the Australian Bureau of Statistics. The lifetime risk of primary PSA and primary TSA was calculated for each year from 2008-2017 using AOANJRR data, population data and life tables data, according to a standardised formula. Separate calculations were undertaken for males and females. Results: From 2008 to 2017, a total of 38,868 primary shoulder arthroplasties were performed. Of these, 5,979 (15%) were PSA procedures and the majority (N=32,889, 85%) were TSA procedures. Glenohumeral osteoarthritis was the most common reason for both PSA (53% in 2017) and TSA (57% in 2017). The lifetime risk of PSA decreased significantly for both sexes over time. For males, lifetime risk decreased from 0.25% (95% CI 0.22% to 0.28%) in 2008 to 0.11% (95% CI 0.09% to 0.13%) in 2017. For females, lifetime risk decreased from 0.55% (95% CI 0.51% to 0.60%) to 0.11% (95% CI 0.09% to 0.13%). In contrast, there was a significant increase in the lifetime risk of TSA. For males, this tripled from 0.54% (95% CI 0.49% to 0.58%) in 2008 to 1.68% (95% CI 1.60% to 1.76%) in 2017. For females, lifetime risk more than doubled from 0.99% (95% CI 0.92% to 1.05%) to 2.77% (95% CI 2.67% to 2.88%). Conclusions: Compared to declining PSA trends, there was substantial growth in TSA use over a decade. To put these findings in context, the lifetime risk of TSA in Australia increased to 1 in 60 for males and 1 in 40 for females by the end of 2017. The steep increase in lifetime risk of TSA over time probably relates to addressing previously unmet need for surgery, given the increasing availability of skilled surgeons trained to perform the procedure and advances in prosthesis design and materials. Greater awareness among patients and health professionals of successful outcomes following TSA may have also contributed to the observed growth. These data improve our understanding of the rising national burden of primary TSA, and can assist in planning to meet future surgical demand. The methods used for this study can also be re-applied in future years for ongoing population-level surveillance and to facilitate a planned international comparison.

Humeral Head Osteonecrosis: Outcomes of Hemiarthroplasty After Minimum 10-Year Follow-Up.

Objective To analyze long-term functional and radiographic results of partial shoulder replacement for humeral head osteonecrosis. Methods Retrospective review of thirteen cases, with a mean postoperative follow-up of 17 years (range 10 to 26 years). The findings from the last follow-up were compared to those in which the patients had one year of postoperative follow-up. Functional assessment consisted of shoulder movement measurements and application of the University of California, Los Angeles (UCLA) shoulder score. All patients underwent radiographic examination to measure glenoid erosion, proximal humeral migration and lateral glenohumeral dislocation. Results Glenoid erosion increased over time significantly ( p < 0.05). Paradoxically, all active shoulder movements also improved ( p < 0.05), while UCLA scores remained the same. Radiographic deterioration was not correlated with clinical function. We had an 84.7% survival rate for arthroplasties after a mean time of 16 years. Conclusions Early functional outcomes were maintained in the long run and do not correlate with radiographic deterioration (increased erosion of the glenoid).

Easily Conducted Tests During the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months.

Background: Prognostic models can estimate the recovery of arm functioning after stroke, guide the selection of individual training strategies, and inform patient selection in clinical trials. Several models for early prediction of arm recovery have been proposed, but their implementation has been hindered by insufficient external validation, limited evidence of their impact on patient outcomes, and reliance on predictors that are not feasible in regular clinical practice.Objectives: To determine the predictive value of new and previously reported tests that can be easily conducted in regular clinical settings for early prognosis of two levels of favorable arm recovery at 6 months post-stroke.Methods: We performed a secondary analysis of merged data (n = 223) from two Scandinavian prospective longitudinal cohorts. The candidate predictors were seven individual tests of motor function and the sensory function measured by the Fugl-Meyer Assessment of Upper Extremity within 7 days post-stroke, and the whole motor section of this assessment. For each candidate predictor, we calculated the adjusted odds ratio (OR) of two levels of residual motor impairment in the affected arm at 6 months post-stroke: moderate-to-mild (≥32 points on the motor section of the Fugl-Meyer Assessment of Upper Extremity, FMA-UE) and mild (FMA-UE ≥ 58 points).Results: Patients with partial shoulder abduction (OR 14.6), elbow extension (OR 15.9), and finger extension (OR 9.5) were more likely to reach FMA-UE ≥ 32. Patients with full function on all individual motor tests (OR 5.5–35.3) or partial elbow extension, pronation/supination, wrist dorsiflexion and grasping ability (OR 2.1–18.3) were more likely to achieve FMA-UE ≥ 58 compared with those with absent function. Intact sensory function (OR 2.0–2.2) and moderate motor impairment on the FMA-UE (OR 7.5) were also associated with favorable outcome.Conclusions: Easily conducted motor tests can be useful for early prediction of arm recovery. The added value of this study is the prediction of two levels of a favorable functional outcome from simple motor tests. This knowledge can be used in the development of prognostic models feasible in regular clinical settings, inform patient selection and stratification in future trials, and guide clinicians in the selection of individualized training strategies for improving arm functioning after stroke.Clinical Trial Registration: ClinicalTrials.gov: NCT02250365, NCT01115348.

Anesthetic management of bilateral partial shoulder replacement - An uncommon case

Anesthetic management of bilateral partial shoulder replacement - An uncommon case

Return to sports and work after partial shoulder replacement surgery.

Shoulder hemiarthroplasty is a particularly attractive treatment option in young active patients, where revision surgery is an issue and aglenoid replacement might be necessary in the long run. These patients often ask about the possibility of returning to sport and work after surgery. The purpose of this investigation was to analyze whether patients undergoing shoulder hemiarthroplasty (HSA) are able to successfully return to sports activities and work after surgery. This study included 42patients treated with HSA. Two subgroups were built: patients who had participated in sports less than 5years prior to surgery (groupA: n= 29, 69%) and those who had not done so (groupB: n= 13, 31%). Evaluation was based on aquestionnaire asking about types of sports, frequency of sports activity, and the time taken to return to sports and work, as well as about limitations in occupational life. Patients' mean age at the time of surgery was 56.3± 12.7years in groupA and 66.9± 13.8years in groupB. Mean follow-up was 5.5years (range 2.5-12years). In groupA, 18patients (62%) had participated in sports up to the time of surgery and 12(41%) had returned to the same level of sports activity at final follow-up. The rate of return to preoperative sports activity was 67%. Swimming was one of the most favorable sports (92%). Of the cohort patients, 2(5%) had to change their profession due to surgery. Most patients were retired at follow-up. Patients who were sportingly active prior to HSA were able to return to sports after surgery in 67% of cases. This study confirms that patients treated by hemiarthroplasty of the shoulder joint can return to sports and work, even at medium-term follow-up.

Incidence and Risk Factors for Venous Thromboembolic Events After Open Shoulder Surgery

Background Although venous thromboembolic (VTE) events are known to develop after lower extremity surgery, there is little research on the risk of VTE after upper extremity surgery. The aim of this study is to identify the risk factors for VTE in patients undergoing open shoulder surgery. Methods We used International Classification of Diseases, 9th Revision, Clinical Modification procedure codes to identify patients in the Nationwide Inpatient Sample (NIS) from 1998 to 2011 who underwent open shoulder surgery. Patients were tracked to determine the incidence of VTE after surgery and stratified by demographics, comorbidities, and hospital characteristics. Risk factors were analyzed using multivariate analysis. Results A total of 315 423 open shoulder procedures were identified in the NIS from 1998 to 2011, of which 1420 (0.45%) carried a diagnosis of VTE, with 873 (0.27%) cases of pulmonary embolism, and 976 (0.31%) cases of deep vein thrombosis. The VTE incidence was similar in common shoulder surgeries, including total shoulder replacement (0.28%), partial shoulder replacement (0.51%), open reduction internal fixation of humerus (0.73%), and open rotator cuff repair (0.28%). Patients with VTE were older, male, African-American, and had a longer hospital stay (14.0 days compared with 3.2 days for patients without VTE). Comorbidities associated with higher risk of VTE included hypercoagulability (odds ratio [OR]: 5.62, P &lt; .001), cancer (OR: 2.51, P &lt; .001), congestive heart failure (OR: 2.01, P &lt; .001), electrolyte abnormalities (OR: 2.1, P &lt; .001), and obesity (OR: 1.46, P &lt; .001). Conclusions There is a low overall risk of VTE after open shoulder surgery. Risk factors for VTE in this population should be used in conjunction with current guidelines to update recommendations for postoperative prophylactic treatment.

The use of partial prosthesis in shoulder surgery

Introduction. Indications for the use of partial shoulder prosthesis are dislocated four-part fractures and multi-part and four-part fractures-dislocations, impressive fractures of the humeral head (including involvement of more than 40% of the articular surface) and ?head splitting? fractures of humerus. The aim of this study was to present the results of the application of partial shoulder prosthesis at the Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina in Novi Sad and identify risk groups among the participants. Material and Methods. The study, which was retrospective, included 22 patients who had undergone the partial shoulder arthroplasty in the period from 2005 to 2015 at the Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. The functional results were evaluated on the basis of the Constant Shoulder Score. Results. The study sample consisted of 15 women and 7 men, whose mean age was 64.9 ? 9.1 years. The average time from the injury to surgery was 13.3 days. According to the Constant scoring scale, the result was excellent in 6 (27%) patients, good in 3 (14%), fair in 7 (32%), and poor in 6 (27%) participants. 75% of participants said they were satisfied with the results of the operation. Conclusion. Partial shoulder prosthesis gives good functional results and allows resumption of activities of daily living. Better results were obtained within the subjective segments (pain, daily activities, vitality), which points out a greater subjective patient?s satisfaction in relation to the measured functio?nal outcome.

Mıd_term follow-up evaluation of plate osteosynthesis and hemiartroplasty results in multi-part fractures of teh proximal humerus

The present objective was to retrospectively evaluate factors affecting functional outcome of multipart proximal humeral fracture treated with fixation or hemiarthroplasty. Included were 58 patients (19 women, 39 men; average age: 51.04 years; range 22-78 years) who underwent surgery for Neer type III or IV proximal humeral fractures between 2007 and 2012. All participants attended follow-up of at least 2 years. A total of 35 patients underwent open reduction and anatomical plate fixation; 23 underwent partial shoulder replacement. Patients were evaluated according to Constant-Murley shoulder scoring at final follow-up examination. Evaluated impacts on functional outcome included age, gender, American Society of Anesthesiologists (ASA) Physical Status classification, trauma energy, type of fracture, and time to surgery. Mean follow-up duration was 47.25±13.29 (25-76) months. Mean Constant-Murley score was 58.65±18.62 (65.77±18.67 for the fixation group, 47.82±12.52 for the hemiarthroplasty group; p=0.001). When impact of independent variables on functional scores was assessed, ASA score and type of fracture were found to significantly affect functional outcome in the fixation group, and trauma energy was found to significantly affect functional outcome in the hemiarthroplasty group. Complications were detected in 20 patients (34.5%) upon final examination, 14 of whom (70%) had rotator cuff deficiency. Though improved functional results may be obtained using plate fixation in the surgical treatment of multipart proximal humeral fractures, the high rates of rotator cuff failure associated with both surgical methods should be considered.

Arthroscopic partial shoulder resurfacing.

The purpose of this study was to report patients' clinical and subjective outcomes 2 years after arthroscopic-assisted partial resurfacing of the humeral head. In this prospective case series, 11 patients (4 females, 7 males; median age, 59 years; range 47-72) underwent arthroscopic-assisted partial shoulder resurfacing between April 2010 and March 2011. Clinical conditions and subjective assessments were evaluated before surgery and at 6 weeks, 3 and 6 months, and then annually after surgery using the Constant score (CS), active range of motion (ROM), the visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons scale (ASES), and the subjective shoulder value (SSV). Radiological outcomes and major complications were monitored. The mean CS improved significantly from 54.6 ± 13.6 preoperatively to 72.9 ± 17.2 points 6 weeks postoperatively (P = 0.009). At the 2-year follow-up, the mean CS had further increased to 86.5 ± 14.3 points (P < 0.001). Trends towards increasing ROMs were detected. VAS, ASES, and SSV significantly improved from baseline to the first follow-up and maintained improvement after 2 years. One patient required revision surgery owing to a technical failure and two patients because of rapidly progressive osteoarthritis. Ten of 11 patients (91 %) claimed that they would undergo arthroscopic partial shoulder resurfacing again. Arthroscopic-assisted partial humeral head resurfacing, which has the advantages of bone stock preservation and the maintenance of an intact subscapularis tendon, allowed immediate postoperative mobilization and provided significant improvements in subjective outcomes, especially for pain relief in active patients without severe glenoid cartilage wear. Therapeutic case series, Level IV.

Intraosseousschwannoma: A Case Report and Review

Bony schwannoma is a rare benign tumour derived from Schwann cells of nerve fibres in the bone. It accounts for less than 1% of bony benign tumour, and prone to occur in the sacrum and mandible, occurrence in scapula is very rare. Here we report a 50-year-old woman with the chief complaint of pain in the left scapula. Imaging examination showed a giant, irregular, swelling lesion with distinct border involving the left scapula, extending into the left shoulder glenoid and pressing the surrounding soft tissues. Needle biopsy showed that the tumour was composed of spindle cells with S-100 protein positive, mimicking a benign neurogenic tumour. Then a complete excision was performed by removing the tumour and the surrounding tissues including partial left shoulder glenoid. Histologically, Antoni type A areas were the predominant microscopic pattern with occasional alternation by Antoni type B areas. Immunohistochemistry found that the neoplastic cells were scatteredly positive for S-100 protein. All these features suggest a diagnosis of an intraosseousschwannoma of the left scapula. Follow-up of the patient for ten months found no recurrence or sign of other tumours following complete tumour resection without any adjuvant therapy. In conclusion, this case of giant intraosseousschwannoma of the scapula is a rare benign bony tumour, and its diagnosis combined with clinical, imaging and pre-operative needle biopsy is important to guide further therapy, and avoid overtreatment.

Editorial : Current Concepts and Recent Developments in Shoulder Surgery

Over the course of the last 2 decades the field of shoulder has greatly expanded, both in terms of elective, and trauma surgery. Developments in implant manufacture and bearing surfaces have allowed the development of a range of arthroplasty systems, allowing total and and partial shoulder replacement surgery to progress from conception to the reliable range of procedures and implants we now see. Degenerate shoulder disease is becoming a more common problem for clinicians in the UK and throughout the world, with osteoarthritis one of the most common presenting complaints to shoulder surgeons. Furthermore, rheumatoid disease remains a widespread problem, and the use of shoulder replacement surgery, reverse shoulder replacement, and partial replacement surgery such as hemiresurfacing and hemiarthroplasty of the shoulder have become valuable treatment options for these conditions. This hot topic issue contains two articles summarising the indications for, technicalities of, and clinical outcomes of total and reverse arthroplasty of the shoulder, and hemiarthroplasty and hemiresurfacing, giving a brief overview of the technology and the technicalities of the procedures. In addition to reviews relating to surgery for degenerate and inflammatory shoulder disease, this editorial contains several articles describing the pathology and treatment for common shoulder conditions. For instance, shoulder impingement syndrome is comprehensively reviewed, bringing together a summary of the recent literature relating to the treatment of this common but often disabling condition. Adhesive capsulitis is discussed in depth in an article which describes the common misconceptions of the pathophysiology and natural history of the condition, and also describes the evidence base for the common treatment modalities. Shoulder trauma is covered by several articles in this hot topic issue. Principally discussed in the article on proximal humerus fractures, bony trauma to the shoulder has been treated with increasing success in recent years with the advent of locking plate technology and the development of reverse shoulder arthroplasty, which is a valuable alternative to traditional acute hemiarthroplasty procedures used for complex fracture and fracture-dislocations of the shoulder. Furthermore, the review article on outcomes of treatment for fractures of the clavicle draws together the evidence base which has greatly expanded for the surgical and non surgical treatment of these injuries. Describing the more clinical aspects of elective and acute shoulder surgery, two articles discuss the clinical assessment of the shoulder and the considerations for pre-and peri operative care. Complimenting the latter of these, an overview of anaesthesia in shoulder surgery is included. These articles will enable both newly trained and experience shoulder surgeons and their allied specialist colleagues to update themselves on recent evidence and trends on the subject. Finally, adding some historical basis and giving a more modern context to this hot topic issue, are two articles discussing the history of shoulder surgery and future concepts. We hope that this issue provides and illuminating account of the present understanding of common shoulder pathology, the clinical aspects, and the current trends in various different treatment modalities.

Evaluation of the Results from Partial Arthroplasty for Treating Shoulder Osteoarthrosis

ObjectiveIn this study we aim at statistically evaluating the results of the surgical treatment of the osteoarthrosis of the shoulder (OAS) with partial shoulder arthroplasty (PSA) and at correlating them with the several variables involved. MethodsIn this study we evaluated 36 shoulders of 31 patients with OAS who underwent treatment with PSA in the Grupo de Ombro e Cotovelo (Group of Shoulders and Elbows) of the Department of Traumatology and Orthopedics of the Faculdade de Ciências Médicas da Santa Casa de São Paulo – Pavillion Fernandinho Simonsen between January, 1989 and November, 2010. Patients who underwent PSA and who had a post-operative follow-up of at least 12 months were included in the study. Results’ After the surgery the range of elevation, external rotation, internal rotation and the UCLA scale improved (with average differences of 35̊, 27̊, 4̊ and 17 points, respectively), with a significant level of 5% (p < 0.05). For the same level of significance, the relation between a satisfactory UCLA and two variables was found: patients with maximum age of 60 years old at the moment of the surgery and patients that underwent tenotomy of the long head of biceps. ConclusionPatients under 60 who underwent surgery and patients who underwent tenotomy of the long head of biceps achieved better results.

Avaliação dos resultados da artroplastia parcial no tratamento da osteoartrose de ombro

ObjectiveIn this study we aim at statistically evaluating the results of the surgical treatment of the osteoarthrosis of the shoulder (OAS) with partial shoulder arthroplasty (PSA) and at correlating them with the several variables involved. MethodsIn this study we evaluated 36 shoulders of 31 patients with OAS who underwent treatment with PSA in the Grupo de Ombro e Cotovelo (Group of Shoulders and Elbows) of the Department of Traumatology and Orthopedics of the Faculdade de Ciências Médicas da Santa Casa de São Paulo – Pavillion Fernandinho Simonsen between January, 1989 and November, 2010. Patients who underwent PSA and who had a post-operative follow-up of at least 12 months were included in the study. ResultsAfter the surgery the range of elevation, external rotation, internal rotation and the UCLA scale improved (with average differences of 35°, 27°, 4° and 17 points, respectively), with a significant level of 5% (p < 0.05). For the same level of significance, the relation between a satisfactory UCLA and two variables was found: patients with maximum age of 60 years old at the moment of the surgery and patients that underwent tenotomy of the long head of biceps. ConclusionPatients under 60 who underwent surgery and patients who underwent tenotomy of the long head of biceps achieved better results.