Rotator cuff repair augmentation with platelet rich plasma

Rotator cuff tendon tears are a common source of shoulder pain and combine both traumatic and degenerative issues. Despite multiple surgical techniques to improve bone to tendon healing, recurrent tearing of the rotator cuff is still a significant postoperative issue. Platelet-rich plasma (PRP) is a fraction of whole blood containing powerful growth factors and cytokines. Basic science and preclinical studies suggest PRP may be useful for tendon repair or regeneration. Rotator cuff studies, however, have produced conflicting results based on PRP formulation, surgical technique, and size of the tendon tear. This chapter explores and summarizes the available evidence to determine the efficacy of arthroscopic rotator cuff repair in patients with full-thickness rotator cuff tears who were concomitantly treated with PRP

Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty

OBJECTIVES: Unicompartmental knee arthroplasty (UKA) is a potential treatment for isolated bone on bone osteoarthritis when limited to a single compartment. The risk for revision of UKA is three times higher than for total knee arthroplasty (TKA). The aim of this review was to discuss the different revision options after UKA failure. MATERIALS AND METHODS: A search was performed for English language articles published between 2006 and 2016. After reviewing titles and abstracts, 105 papers were selected for further analysis. Of these, 39 papers were deemed to contain clinically relevant data to be included in this review. RESULTS: The most common reasons for failure are liner dislocation, aseptic loosening, disease progression of another compartment and unexplained pain. UKA can be revised to or with another UKA if the failure mode allows reconstruction of the joint with UKA components. In case of disease progression another UKA can be added, either at the patellofemoral joint or at the remaining tibiofemoral joint. Often the accompanying damage to the knee joint doesn't allow these two former techniques resulting in a primary TKA. In a third of cases, revision TKA components are necessary. This is usually on the tibial side where augments and stems might be required. CONCLUSIONS: In case of failure of UKA, several less invasive revision techniques remain available to obtain primary results. Revision in a late stage of failure or because of surgical mistakes might ask for the use of revision components limiting the clinical outcome for the patients

Five-year experience of cementless Oxford unicompartmental knee replacement

Purpose Cementless unicompartmental knee replacement (UKR) was introduced to address some of the problems that can occur following cemented UKR. The aim of this study was to report the 5-year experience of the first 512 medial cementless Oxford UKR implanted by two surgeons for the recommended indications. Methods The first consecutive 512 cementless Phase 3 Oxford UKRs implanted by two surgeons for the recommended indications between June 2004 and October 2013 were prospectively identified and followed up independently. All the procedures were carried out through a minimally invasive approach without eversion or dislocation of the patella. Patients were assessed clinically pre-operatively and at 1, 2, 5, 7 and 10 years after surgery with functional outcome scores and radiographs. Results There were eight reoperations of which six were revisions giving a 5-year survival of 98 % (95 % CI 94–100 %). At a mean follow-up of 3.4 years (1.0–10.2), the mean OKS was 43 (SD 7), AKSS (objective) was 81 (SD 13), and AKSS (functional) was 86 (SD 17). The first 120 cases had a minimum follow-up of 5 years (mean 5.9; range 5–10.2). In these patients, the mean OKS was 41 (SD 8), AKSS (objective) was 81 (SD 14), and AKSS (functional) was 82 (SD 18). There were no femoral radiolucencies and no complete tibial radiolucencies. 11 % of tibial components had partial radiolucent lines; the remaining 89 % had no radiolucencies. Conclusion The clinical results are as good as or better than those previously reported for cemented fixation. The radiographic results are better with secure bony attachment to the implants in every case. Level of evidence IV