We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant staphylococcus aureus in one and Escherichia coli in one. Two multibacterial and nine monobacterial infections were seen. Post-operatively, patients were treated with intravenous cefazolin for at least three days and in all antibiotic therapy was given for at least three months. Severe pain (3 of 11) or severe limitation of function (3 of 11) are not necessarily seen. A fistula was present in eight, but function was not affected. All but one patient were considered free of infection after one-stage revision at a median follow-up of 24 months, and without antibiotic treatment for a minimum of six months. One patient had a persistent infection despite a second staged revision, but is now free of infection with a spacer. Complications included posterior dislocation in one, haematoma in one and a clavicular fracture in one. At the most recent follow-up the median post-operative Constant-Murley score was 55, 6% adjusted for age, gender and dominance. A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.

Hypothesis: The purpose of this study was to investigate the three dimensional orientation of the glenoid plane and the scapular plane. Different definitions of the glenoid plane were used and different planes were measured and we hypothesed that the 3-D plane with the least variation would be best to define the most reliable glenoid plane. Methods: We studied 150 CT scans from non-pathological shoulders from patients between 18 and 80. The scapular plane and five different glenoid planes were determined: an inferior, anterior, posterior, superior and neutral glenoid plane. Of all planes version and inclination angles were measured. Because all examinations were done in a standardized position to the coronal, sagittal and transverse plane of the body the scapular plane could be defined versus the coronal, sagittal and transverse planes of the body. Results: The version (mean: 3.76) of the inferior glenoid plane showed a significantly lower standard deviation than the version of the anterior (p<0.001), posterior (p=0.001) and superior (p=0.001) glenoid plane (ANOVA). For inclination all planes have a similar variance. The scapular plane was different between gender ( P=0.022) and correlated with age. Conclusion: This study showed that the retroversion of the inferior glenoid is reasonably constant. The osseous anthropometry of the inferior glenoid can offer a reproducible point of reference to be used in prosthetic surgery of the shoulder. Revision of the MS. Ref. No.: JSES-D-09-00274Comments from the Editors and Reviewers: Associate Editor's comment: Unfortunately the reviewer are not convinced that this study adds much useful new data to literature. Weak points are: Indication for CT scan examination of the contralateral shoulder not given: The patients that were included had a CT scan examination of the contralateral (pathologic) shoulder for instability (30), AC-joint arthritis (33), Rotator Cuff tears (33), (partial (5), Full thickness (28)), calcifying tendinitis (12), frozen shoulder (8), subacromial impingement (17), tendinitis of the long head of biceps brachii (12), fractures of the proximal humerus (5). Those pathologies are included in the manuscript.A special selection (Instability, osteoarthritis, cuff tear arthropathy) might have influenced the results. This is a study about the normal shoulder and we hope to do in the future studies on the pathological shoulder as one might expect this might differ from the normal shoulder. The clinical examination of the shoulder as well as the history was negative of the included shoulder and this is mentioned in the manuscript.Ethical considerations: Was the consensus of the patients for the scan of the contralateral shoulder and the ethical committee given (difference of exposure both versus one shoulder?). Ethical approval was cleared from the ethics committee (EC/2009-099/Svdm). The patients received no extra irradiation because it is difficult to impossible to positioning one shoulder more central in the CT-scan to narrow the window of exposure an...

For surgical treatment to be successful, the instability must be attributable to mechanical factors that can be modified by surgery. Because of better knowledge of the pathology, a more specific surgery can be performed. This lesion-specific surgery has improved clinical results compared to non-anatomic stability procedures, particularly when that surgery has been performed arthroscopically.

Total shoulder replacement has been shown to provide predictable pain relief and functional improvement in patients with glenohumeral arthritis. Loosening of the glenoid component remains the most frequent indication for revision surgery at long-term follow-up. The component most widely used is an all-polyethylene keeled or pegged design cemented to the glenoid cavity of the scapula. The glenoid is small and its cup-shaped morphology allows only a restricted site for limited fixation devices. This is particularly so in revision surgery where there are often large bony defects of the glenoid. In an anatomical study, we investigated the scapula in order to identify substantial bony pillars for better component fixation. Forty cadaveric shoulders (mean age 86, range 67-101) were dissected, the glenoids were denuded from cartilage, and the subchondral and cancellous bone was removed. Two bony pillars approaching the glenoid were consistently identified in all scapulae investigated. These pillars were outlined by three cortices and orientated to the circle formed by the rim of the inferior quadrants of the glenoid. One pillar is directed inferiorly near the margo lateralis and the other pillar is directed superiorly into the spine of the scapula. We defined these pillars in length and direction, and three-dimensionally located them in relation to the joint surface. This study demonstrated two bony pillars as important anatomical landmarks in the scapula. They were constant in presence, surgically accessible, and have not been described before. These results can be used as a guideline in the development of prosthetic designs to improve the fixation of glenoid components.

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