Background: The purpose of this study is to assess the incidence of acromial stress fractures in a population of reverse shoulder arthroplasties (RSA) and determine potential risk factors for fracture. Patients and Methods: Between August 2004 and December 2013, 1082 primary RSA were performed at a single institution. Twelve (1.11%) patients were diagnosed with a postoperative acromial stress fracture. This group was casematched to a control group of 48 shoulders. Clinical and radiographic risk factors for fracture were assessed. Results: Compared to controls, fractures were less satisfied with their outcome despite equivalent American Shoulder and Elbow Surgeons scores, pain scores, and range of motion. Osteoporosis was significantly associated with acromial fractures (P ¼.027). A smaller lateral offset of the greater tuberosity, greater arm lengthening, and a thinner acromion were more common in the fracture group (P ¼.026, P ¼.004, and P ¼.008, respectively). Conclusions: In summary, postoperative acromial stress fractures appear to be incidental lesions with little influence on the outcome after RSA. The combination of a thin acromion and superior migration of the humeral head increase the risk of acromial fracture. Lateralized designs that do not excessively verticalize the deltoid line of pull on the acromion may decrease the risk of postoperative acromial fractures.

Background Cartilage degeneration is common in the aged, and aged chondrocytes are inferior to juvenile chondrocytes in producing cartilage-specific extracellular matrix. Mesenchymal stem cells (MSCs) are an alternative cell type that can differentiate toward the chondrocyte phenotype. Aging may influence MSC chondrogenesis but remains less well studied, particularly in the bovine system. Questions/purposes The objectives of this study were (1) to confirm age-related changes in bovine articular cartilage, establish how age affects chondrogenesis in cultured pellets for (2) chondrocytes and (3) MSCs, and (4) determine age-related changes in the biochemical and biomechanical development of clinically relevant MSC-seeded hydrogels. Methods Native bovine articular cartilage from fetal (n = 3 donors), juvenile (n = 3 donors), and adult (n = 3 donors) animals was analyzed for mechanical and biochemical properties (n = 3-5 per donor). Chondrocyte and MSC pellets (n = 3 donors per age) were cultured for 6 weeks before analysis of biochemical content (n = 3 per donor). Bone marrow-derived MSCs of each age were also cultured within hyaluronic acid hydrogels for 3 weeks and analyzed for matrix deposition and mechanical properties (n = 4 per age). Results Articular cartilage mechanical properties and collagen content increased with age. We observed robust matrix accumulation in three-dimensional pellet culture by fetal chondrocytes with diminished collagen-forming capacity in adult chondrocytes. Chondrogenic induction of MSCs was greater in fetal and juvenile cell pellets. Likewise, fetal and juvenile MSCs in hydrogels imparted greater matrix and mechanical properties. Conclusions Donor age and biochemical microenvironment were major determinants of both bovine chondrocyte and MSC functional capacity. Clinical Relevance In vitro model systems should be evaluated in the context of age-related changes and should be benchmarked against human MSC data.

Articular cartilage pathology is common in the aged population. Numerous studies have shown that aged chondrocytes (CHs) are inferior to juvenile CHs in their ability to proliferate and produce cartilage-specific extracellular matrix proteins, potentially limiting their use in tissue engineering applications for cartilage restoration [1,2]. Mesenchymal stem cells (MSCs) are an alternative cell type that can be expanded in vitro while maintaining their ability to differentiate into cell types comparable to articular chondrocytes. However, organismal aging also influences human MSC proliferation [3,4] and multi-potential differentiation [5], though for chondrogenesis these findings are mixed, with some suggesting that aged progenitor cells retain their chondrogenic capacity [6]. The objective of this study was to assess age related differences in donor-matched CH and MSC potential for chondrogenic repair. In addition, the effects of the chondrogenic growth factor TGF-β3 on CHs and MSCs were evaluated.

Case: An 87-year-old woman presented with a popliteal skin lesion due to polyethylene wear 13 years following a left total knee arthroplasty. Excisional biopsy through a posterior approach was performed. Histology showed inflammation with granulomas and birefringent foreign body particles in the skin. Cultures remained negative, and revision knee arthroplasty was performed. Conclusions: A popliteal skin lesion due to polyethylene wear disease in total knee arthroplasty has not previously been described. Patients with an atypical inflammation of the skin with an underlying joint implant should be referred to an orthopaedic surgeon, and dermal biopsies should be checked for birefringent material. Level of Evidence: Level V.