Failed rotator cuff repairs can pose a clinical challenge to the treating orthopedic surgeon. There are many nonsurgical and surgical options available to address the failed rotator cuff repair. Surgical options include revising the primary repair, partial or nonanatomic repair, tendon transfer, biological augmentation or use of tissue-engineered grafts for reconstruction, or total joint arthroplasty (typically with a modern reverse total shoulder arthroplasty system). The treating surgeon must assess the patient's functional status, health status, and expectations in order to customize the appropriate treatment plan for addressing the failed rotator cuff repair. With the abundance of treatment options available, there is typically an adequate solution to help the patient regain function and experience less pain.
Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature. Traditionally, TKA is performed supine, with the aid of knee-positioning devices allowing for hip flexion and range of motion of the knee to facilitate ease of surgical intervention. However, TKA using traditional positioning would not be possible in the presence of ipsilateral hip arthrodesis preventing hip motion. This case report describes a TKA performed for a 72-year-old woman with end-stage osteoarthritis of the right knee, ipsilateral hip arthrodesis, and leg-length discrepancy as the sequelae of slipped capital femoral epiphysis. We describe novel surgical positioning to be used to facilitate TKA in the absence of ipsilateral hip motion with bed modifications and the use of an extremity positioning device.
Objectives: To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively.Design: Retrospective multicenter analysis.Setting: Five level-one trauma centers.
Patients/Participants:Two hundred ten patients (152 F; 58 M), average age 64, with 112 left-and 98 right-sided low-energy proximal humerus fractures (OTA/AO 11-A-C).Intervention: All patients were initially treated nonoperatively and were followed for an average of 231 days. Radiographic translation in the sagittal and coronal planes was measured. Patients with anterior translation were compared with those with posterior or no translation. Patients with $80% anterior humeral translation were compared with those with ,80% anterior translation, including those with no or posterior translation.Main Outcomes: The primary outcome was failure of nonoperative treatment resulting in surgery and the secondary outcome was symptomatic malunion.Results: Nine patients (4%) had surgery, 8 for nonunion and 1 for malunion. All 9 patients (100%) had anterior translation. Anterior translation compared with posterior or no sagittal plane translation was associated with failure of nonoperative management requiring surgery (P = 0.012). In addition, of those with anterior translation, having $80% anterior translation compared with ,80% was also associated with surgery (P = 0.001). Finally, 26 patients were diagnosed with symptomatic malunion, of whom translation was anterior in 24 and posterior in 2 (P = 0.0001).
Conclusions:In a multicenter series of proximal humerus fractures, anterior translation of .80% was associated with failure of nonoperative care resulting in nonunion, symptomatic malunion, and potential surgery.
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