The radical changes in prosthetic design made in the mid 1980s transformed the historically poorly performing reverse ball-and-socket total shoulder prosthesis into a highly successful salvage implant for pseudoparalytic, severely rotator cuff-deficient shoulders. Moving the center of rotation more medial and distal as well as implanting a large glenoid hemisphere that articulates with a humeral cup in 155° of valgus are the biomechanical keys to sometimes spectacular short- to mid-term results. Use of the reverse total shoulder arthroplasty device allows salvage of injuries that previously were beyond surgical treatment. However, this technique has a complication rate approximately three times that of conventional arthroplasty. Radiographic and clinical results appear to deteriorate over time. Proper patient selection and attention to technical details are needed to reduce the currently high complication rate.
Passive glenohumeral range of motion may be characteristically limited to specific shoulder pathologies. While pain associated with loss of range of passive external glenohumeral rotation is recognized as a salient feature in adhesive capsulitis, restriction of glenohumeral range of motion in calcific tendinitis of the supraspinatus tendon has never been studied.On the basis of clinical observation, we hypothesized that calcific tendinitis of the supraspinatus tendon is associated with loss of passive glenohumeral abduction without loss of external rotation.Cohort study; Level of evidence, 3.Ranges of passive glenohumeral rotation and abduction, which are measured with a standardized protocol in our institution, were retrospectively reviewed and compared for patients diagnosed with either adhesive capsulitis or calcific tendinitis of the supraspinatus tendon. A total of 57 patients met the inclusion criteria for the calcific tendinitis, and 77 met the inclusion criteria for the adhesive capsulitis group.When compared with the contralateral, unaffected shoulder, glenohumeral abduction in the calcific tendinitis group was restricted by a median of 10° (interquartile range [IQR], -20° to -5°) as opposed to glenohumeral external rotation, which was not restricted at all (median, 0°; IQR, 0° to 0°). The adhesive capsulitis group showed a median restriction of glenohumeral abduction of 40° (IQR, -50° to -30°) and a median restriction of passive glenohumeral external rotation of 40° (IQR, -60° to -30°).Calcific tendinitis of the supraspinatus does not typically cause loss of external rotation but is frequently associated with mild isolated restriction of abduction. This finding can be used to clinically differentiate adhesive capsulitis from calcific tendinitis.
Obtaining patient satisfaction is a key goal of surgical treatment. It was the purpose of this study to identify pre-, peri- and postoperative factors determining patient satisfaction after shoulder surgery, quantify their relative importance and thereby allow the surgeon to focus on parameters, which will influence patient satisfaction.We retrospectively reviewed 505 patients, who underwent either rotator cuff repair (n = 216) or total shoulder arthroplasty (n = 289). We examined 21 patient-specific and socio-demographic parameters as well as 31 values of the Constant-Score with regard to their impact on patient satisfaction.In the univariable analysis higher patient satisfaction was correlated with higher age, private health insurance, light physical work, retirement, primary surgery, non-smoking, absence of chronic alcohol abuse, absence of peri- or postoperative complications, operation performed by the medical director as well as various Constant Score sub-values (p < 0.05). In the multivariable analysis absence of peri- or postoperative complications (p = 0.008), little postoperative pain (p = 0.0001), a large range of postoperative active abduction (p = 0.05) and a high postoperative subjective shoulder value (p = 0.0001) were identified as independent prognostic factors for high satisfaction.After reconstructive shoulder surgery particular attention should be paid to prevention of complications, excellent perioperative pain control and restoration of abduction during rehabilitation. This study is first step towards a preoperative prediction model of a subjectively successful surgery as well as a tool to exclude irrelevant parameters in clinical routine.
The aim of this study was to investigate the impact of the introduction of a Patient Blood Management (PBM) programme in elective orthopaedic surgery on immediate pre-operative anaemia, red blood cell (RBC) mass loss, and transfusion.Orthopaedic operations (hip, n=3,062; knee, n=2,953; and spine, n=2,856) performed between 2008 and 2011 were analysed. Period 1 (2008), was before the introduction of the PBM programme and period 2 (2009 to 2011) the time after its introduction. Immediate pre-operative anaemia, RBC mass loss, and transfusion rates in the two periods were compared.In hip surgery, the percentage of patients with immediate pre-operative anaemia decreased from 17.6% to 12.9% (p<0.001) and RBC mass loss was unchanged, being 626±434 vs 635±450 mL (p=0.974). Transfusion rate was significantly reduced from 21.8% to 15.7% (p<0.001). The number of RBC units transfused remained unchanged (p=0.761). In knee surgery the prevalence of immediate pre-operative anaemia decreased from 15.5% to 7.8% (p<0.001) and RBC mass loss reduced from 573±355 to 476±365 mL (p<0.001). The transfusion rate dropped from 19.3% to 4.9% (p<0.001). RBC transfusions decreased from 0.53±1.27 to 0.16±0.90 units (p<0.001). In spine surgery the prevalence of immediate pre-operative anaemia remained unchanged (p=0.113), RBC mass loss dropped from 551±421 to 404±337 mL (p<0.001), the transfusion rate was reduced from 18.6 to 8.6% (p<0.001) and RBC transfusions decreased from 0.66±1.80 to 0.22±0.89 units (p=0.008).Detection and treatment of pre-operative anaemia, meticulous surgical technique, optimal surgical blood-saving techniques, and standardised transfusion triggers in the context of PBM programme resulted in a lower incidence of immediate pre-operative anaemia, reduction in RBC mass loss, and a lower transfusion rate.
We compared six patients with a mean age of 70 years (49 to 80) with severe bilateral, painful glenohumeral joint destruction who underwent a single-stage bilateral total shoulder replacement, with eight patients of mean age 61 years (22 to 89) who underwent bilateral total shoulder replacement in two stages, at a mean interval of 18 months (6 to 43). The overall function, pain and strength improved significantly in both groups. The subjective shoulder value, relative Constant score, active external rotation and the strength were improved significantly more in the single-stage group. Active elevation, abduction and overall function improved, significantly more in the single-stage group. Both the total duration of hospitalisation and the time off work per shoulder were substantially shorter in the single-stage group. The overall rate of complication was lower in the single-stage group. Our findings indicated that single-stage bilateral total shoulder replacement yielded significantly better clinical results with shorter hospitalisation and rehabilitation than staged replacement, and was not associated with any increase in complications.
The Diablerets Massif, in the Swiss Prealps, acts as a topographical barrier for northward and westward winds, contributing to the weather conditions and numerous hazards present in the area (avalanches, floods, landslides, etc.). Two main catchments emerge from this massif. The Dar River catchment originates at the Sex Rouge Glacier, comes down through a glacial circus, a series of cascades, and makes a sharp left turn before bordering the massif with a southwest direction. It joins the Grande Eau River catchment, which stems from the aggregation of torrents in the Creux du Champ, a steep-walled, complex-glacial circus followed by a U-shaped valley. After the confluence of both rivers, the Grande Eau crosses the village of Les Diablerets, a major tourist destination in the area. The erosion and sedimentation dynamics in both catchments are similar, with an increasing production of available sediment in the upper part of the catchments in recent years, due to glacial melt and permafrost degradation. As well as a gradual unearthing of the bedrock in the Dar river due to the erosion of moraine deposits after the first cascade, and increased sedimentation after the second cascade. In the Grande Eau, the enlargement of erosion areas in the top part of the circus has caused numerous debris flow events along the tributaries. These large volumes of transported sediments produce a very dynamic environment, with lateral erosion and a series of small landslides on both sides of the river. The sediment excess is managed through extraction, carried out by the municipality, before the main river crosses the town, but remains a major problem for the inhabitants. Large flooding events such as the June 2005 event are relatively rare, but small debris flows caused by very localized storm cells have become increasingly common throughout the valley, as well as high discharge events. Expected changes in climate, as depicted by the official Swiss climate change hydrological scenarios (HydroCH2018), include wetter regimes in winter and spring, and drier summers. This is already visible through recent events, such as the November 14th 2023 event, characterized by a high river discharge, and the debris flow of December 13th 2023, near Aigremont. The dynamics in both catchments were studied using historical aerial images, topographical data, LiDAR scans, wildlife cameras and meteorological data. Changes in the morphology of the riverbed, caused by major natural events in the last 50 years, have been established. Available sediment and erosion rates, as well as erosion and accumulation zones, have been determined for the Dar catchment and will be calculated for the upper part of the Grande Eau catchment. The aforementioned events as well as other particularities in the daily and seasonal dynamics of both catchments related to their source areas have also been analyzed, using the time-lapses for the wildlife cameras and precipitation data. Using the identified source zones for debris flow hazard and the river dynamics we expect to model potential large events in these catchments, comparing single and multi-phase event scenarios, including damming and outburst.
