Background Normal function of the upper limb is seldom restored after limb-sparing surgery for tumors of the proximal humerus. The literature suggests superior shoulder function is achieved in the short term with reverse total shoulder arthroplasty compared to other techniques when performed for conditions with rotator cuff deficiency. It is unclear whether this superiority is maintained when reverse total shoulder arthroplasty is performed for tumors. Questions/purposes When performed for tumors, we determined whether reverse total shoulder arthroplasty restores function and improves motion, the complications associated with the surgery, and whether reverse total shoulder arthroplasty with autologous grafting is associated with bone resorption.
Patients and MethodsWe retrospectively reviewed 14 patients who had undergone reverse total shoulder arthroplasty for tumors of the proximal humerus. Four patients died, leaving nine patients for review. The surviving patients were evaluated clinically and radiographically. The minimum followup was 0.6 years (mean, 7.7 years; range, 0.6-12 years). Results At last followup, mean active abduction was 157°a nd mean functional Constant-Murley score was 76%. One patient had a deep infection and one developed a loose prosthesis; both were treated with single-stage exchange. At last followup, both patients had reasonable function without evidence of infection or loosening. Radiographic graft resorption was seen in all but one patient. Conclusions Our observations suggest, at medium-term followup, reverse total shoulder arthroplasty is a reasonable option for tumors of the proximal humerus. It has low morbidity, restores a mean active abduction of 157°, and limits the impairment of activities of daily living.
This study is the first to describe the detailed anatomy of the human ACL with respect to its course and footprints using a 3D approach. It confirms the large difference and inter-patient variability between the tibial and femoral footprint area with the former being significantly smaller. The best-fit cylinder concept illustrates the recruitment pattern of the native ACL where in extension the postero-lateral fibres are recruited and in flexion rather the antero-medial bundle, which can be valuable information in reconstructive purposes. The best-fit cylinder and central axis concept offers additional insights into the optimal tunnel placement at the tibial and femoral footprint in order to cover the largest portion of the native ACL soft tissue, aiming for optimal ACL reconstruction.
To substantiate the validity and relevance of the mobile-bearing knee prosthesis design compared to the fixed-bearing design, concerning the clinical outcome, this review was conducted. Articles published in 6 major orthopaedic journals were screened. Only randomized controlled trials, which investigate the clinical outcome, were included. The clinical outcome parameters of each study were analysed. Despite the numerous quantities of publications in orthopaedic literature, we could conclude, that only a few of them are randomized controlled trials. Although better kinematics of mobile-bearing knee prosthesis designs compared to fixed-bearing knee prosthesis designs are reported, no superiority of one of the bearing designs concerning clinical outcome could be revealed. Because no superiority of one of the designs concerning revision rate, survival and outcome can be found, the cheaper one should be the one to be recommended. For this reason, we advise that further research, comparing the costs and cost-benefit of mobile-bearing compared to fixed-bearing knee prosthesis designs, should be performed.
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