Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases.

Background The complication rate after total elbow arthroplasties is higher than for other arthroplasties. Purpose The purpose of this study was to evaluate the complications and revision rate after 100 semi-constrained total elbow arthroplasties from various types of aetiologies performed in our university hospital. Methods One hundred linked semiconstrained total elbow arthroplasties were performed and were reviewed with 24 months minimum follow-up. Indications were rheumatoid arthritis (45), trauma (33), revisions (16) and others (6). Results At five years average follow-up (range, 2–11), the complication rate was 37 %. Most frequent complications were ulnar nerve involvement (9 %) and triceps insufficiency (7 %). Five implants were aseptically loosed. The infection rate was 4 % with loosening of the implant in two. Four fract humerus proximal or distal to the stem. The radial nerve was injured in two cases. Failure of the locking system of the prosthesis was noted in one case and a fracture of the ulnar component was found in another patient. A revision surgery was performed in 13 cases (13 %). At follow-up 94 prostheses were still in place and the survival rate was 98 % at five years and 86 % at ten years. Conclusion Total elbow arthroplasty remains a difficult procedure with sometimes a high rate of complications necessitating revision procedures. Selection of the patients, a rigorous surgical technique, and a systematic follow-up are prerequisite to limit this incidence

Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability

PURPOSE: The aim of this study was to evaluate mid-term outcomes of Bankart repair with Hill-Sachs remplissage (BHSR) and to highlight prognostic factors of failure. METHODS: Thirty-four patients operated on for anterior shoulder instability with BHSR were enrolled in a prospective non-randomised study. Clinical and radiographic evaluation was performed at 1.5, three, six months and yearly thereafter. Outcome measures included Rowe and Walch-Duplay score. RESULTS: At mean follow-up of 35 months (24-63), the Rowe and Walch-Duplay scores reached respectively 92.7 and 88.2 points. The mean deficit in external rotation was 6° in ER1 and 1° in ER2 (p = 0.4, p = 0.9 respectively). Five patients (14.7%) had a recurrence of instability and three others had a persistent anterior apprehension. In the failure group, the Hill-Sachs lesion was deeper (26% vs 19% of the humeral diameter; p = 0.04) and range of motion at 1.5 months postoperatively was greater. Age at surgery, pre-operative instability severity index score (ISIS), hyperlaxity, type and level of sport, amount of glenoid bone loss had no correlation with failure rate. CONCLUSIONS: The rate of failure at mid-term follow-up of BHSR was higher than commonly reported. The premature recovery of range of motion seems to be a clinical sign of failure at follow-up. Moreover, in case of deep Hill-Sachs lesion (>20%) an alternative procedure should be considered

Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up

PURPOSE: The purpose of this study was to evaluate long-term clinical and anatomic results after open rotator cuff repair. MATERIALS AND METHOD: Fifty-three patients were included in this study. Rotator cuff tears were limited to one tendon in 34, and two tendons or more in 19. The supraspinatus tendon was involved alone in 30 cases, and the subscapularis in four. Clinical, radiographic and MRI evaluations were performed for all patients at ten-year minimum follow-up. RESULTS: At 11.4-years average follow-up, satisfactory results were obtained with improvement on pain level, in range of motion with a gain in active anterior elevation and in external rotation as well as in strength in abduction. Absolute Constant score reached 74.7 points and adjusted Constant score 99.6%. SSV was 82.5% with a SST score of 10 points. Osteoarthritis changes increased with follow-up with osteoarthritis lesion in 69% of the cases. MRI evaluation found a re-tear of the repair in 42% of the cases: 30% when only the supraspinatus tendon was initially involved, and 63% when two or more tendons were repaired. Tear size and quality of the repair were the most important prognosis factors for re-tear of the repair. No correlation was found between the occurrence of a new tear and the clinical outcome. CONLCUSION: Surgical repair of chronic rotator cuff tendon tear can produce consistent and lasting pain relief and improvement in range of motion. Re-tear of the repair was not correlated with degradation of clinical results. Best results were obtained for isolated supraspinatus tear with a complete surgical repair

Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis

BACKGROUND: The arthroscopic Latarjet with double-button fixation is a guided procedure recently proposed to treat anterior shoulder instability with glenoid bone loss. The goal of this study was to report intraoperative and early postoperative complications and to analyze the learning curve. METHODS: This was a prospective, nonrandomized study that included 88 patients. Intraoperative or postoperative complications as well as adverse events and operative time were recorded. Clinical outcomes were evaluated at 2 weeks, 1.5 months, and at the last follow-up. Radiologic analysis was based on an immediate postoperative computed tomography scan. RESULTS: The intraoperative complications or adverse events rate was 3.3%: 1 conversion to open surgery, 1 bone block fracture, and 1 instrumentation problem. The postoperative complication rate was 6.8%: 4 coracoid migrations, and 2 subluxations. None of these complications occurred beyond the 10th case performed. The average operative time significantly decreased with surgical experience (r = -0.8426; 95% confidence interval, -0.9074 to -0.7384; P < .0001) to reach 76 ± 12 minutes (range, 62-95 minutes) at 30 cases. Radiologically, 90% of the bone blocks were flush and subequatorial beyond the 30th case. At a mean follow-up of 12.6 months (range, 6-24 months), Walch-Duplay and Rowe scores were 80 and 81 points, respectively. CONCLUSIONS: At short-term follow-up, the arthroscopic Latarjet procedure with double-button fixation exhibited a low complication rate. Operative time significantly improved with surgical experience and was optimized after 30 cases. Early clinical results confirmed that this procedure can be safe and reliable