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Background/Objectives: Periprosthetic joint infection (PJI) after shoulder arthroplasty is often treated with a two-stage approach, but the data on the mid- to long-term outcomes remain scarce. This study aimed to evaluate the clinical outcomes of two-stage revision arthroplasty for shoulder PJI with a minimum follow-up of five years. Methods: This retrospective study identified 59 shoulders in 58 patients who underwent the first stage of a two-stage revision arthroplasty for shoulder PJI at our institution between 2007 and 2018. Of these, 29 shoulders in 29 patients (49.2%) did not undergo reimplantation or the patient passed away before reaching five years of follow-up. The remaining 30 shoulders in 29 patients were included in the study. The clinical assessments included the active range of motion, the visual analogue scale (VAS) for pain, the Subjective Shoulder Value (SSV), the Constant Score (CS), and the 12-Item Short Form Survey (SF-12), supplemented by detailed clinical and radiological evaluations. Results: The mean age of the 29 patients was 75.9 ± 10.4 years. The average follow-up duration was 8.3 ± 2.8 years. The most common indications for primary shoulder arthroplasty were primary osteoarthritis (n = 12, 40%) and fractures (n = 12, 40%). At the first stage, nine cases (30%) showed negative cultures, while C. acnes and S. epidermidis were each identified in eight cases (26.7%). Four shoulders (13.3%) experienced recurrent infections. At the follow-up, the mean abduction was 86 ± 48.1°, the mean forward flexion was 97.8 ± 50.1°, the mean external rotation was 20.5 ± 19.9°, and the internal rotation reached the lumbosacral region. The mean VAS pain score was 1.5 ± 2.1, the mean SSV was 51.8 ± 28.4%, the mean CS was 54.6 ± 21.0, and the mean SF-12 was 81.0 ± 16.0. Conclusions: Two-stage revision arthroplasty for shoulder PJI results in satisfactory subjective and objective outcomes, with a low overall reinfection rate. However, the high rates of mortality and failure to reimplant must be carefully considered when managing expectations in this challenging cohort. [ABSTRACT FROM AUTHOR]

Instabilities of the sternoclavicular (SC) joint are a rare injury, accounting for only 3% of all injuries of the shoulder girdle. Although acute posterior dislocations are an emergency and require immediate surgical intervention, anterior instabilities (first and second degree according to Allman) can mostly be treated conservatively. Chronic and highly instable acute anterior instabilities often impose a significant limitation on the lives of affected patients. Currently, there is no established therapeutic algorithm in place. This retrospective case series with prospective collection of data was performed at a level I trauma center. Patients treated surgically for anterior SC joint instabilities between January 2013 and December 2019 and with a minimum follow-up of 24 months were included. The injuries comprised 6 acute anterior dislocations treated with tape cerclage in a "figure-of-8" configuration; 12 patients with chronic anterior SC instabilities were treated with autologous tendon grafts. For 1 highly unstable chronic anterior instability, in addition to the tendon graft, synthetic suture material was applied. The clinical evaluation consisted of a physical examination and a standardized questionnaire, which included subjective and objective shoulder scores. Of 24 patients, 19 (79%) with an average age of 32 ± 15 years were available for follow-up. A total of 63% of the patients were male. After a mean follow-up of 57 months, the mean age- and sex-adapted Constant-Murley Shoulder Score of acute anterior luxations amounted to 90 ± 20 points, the Nottingham Clavicle Score to 81 ± 22 points, and the Disability of the Arm, Shoulder and Hand Score to 11 ± 18 points. Chronic anterior instabilities had a mean Constant-Murley Shoulder Score of 90 ± 12 points, Nottingham Clavicle Score of 83 ± 17 points, and Disability of the Arm, Shoulder and Hand Score of 4 ± 5 points. The study shows a complication rate of 10%. Two patients underwent revision surgery. To conclude, monocortical SC joint fixation in a "figure-of-8" fashion presents a low risk for complication and a low revision rate and can achieve an equally good functional outcome after the treatment of highly unstable acute and chronic anterior SC joint instabilities as other published techniques. Our approach presents less risk to the neurovascular structures of the mediastinum than other published techniques requiring bicortical drilling, therefore making the technique more accessible to hospitals without a cardiothoracic surgical background. [ABSTRACT FROM AUTHOR]

Background: Snapping scapula syndrome (SSS) is a rare condition that is oftentimes debilitating. For patients whose symptoms are resistant to nonoperative treatment, arthroscopic surgery may offer relief. Because of the rarity of SSS, reports of clinical outcomes after arthroscopic SSS surgery are primarily limited to small case series and short-term follow-up studies. Purpose: To report minimum 5-year clinical and sport-specific outcomes after arthroscopic bursectomy and partial scapulectomy for SSS and to identify demographic and clinical factors at baseline associated with clinical outcomes at minimum 5-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic bursectomy and partial scapulectomy for SSS between October 2005 and February 2016 with a minimum of 5 years of postoperative follow-up were enrolled in this single-center study. Clinical outcome scores, including the 12-Item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) score for pain, were collected at a minimum 5-year follow-up. Additionally, it was determined which patients reached the minimal clinically important difference. Bivariate analysis was used to determine whether baseline demographic and clinical factors had any association with the outcome scores. Results: Of 81 patients eligible for inclusion in the study, follow-up was obtained for 66 patients (age 33.6 ± 13.3 years; 31 female). At a mean follow-up of 8.9 ± 2.5 years (range, 5.0-15.4 years), all of the outcome scores significantly improved compared with baseline. These included the ASES (from 56.7 ± 14.5 at baseline to 87.2 ± 13.9 at follow-up; P <.001), QuickDASH (from 38.7 ± 17.6 to 13.1 ± 14.6; P <.001), SANE (from 52.4 ± 21.2 to 82.7 ± 19.9; P <.001), SF-12 Physical Component Summary (from 39.7 ± 8.3 to 50.3 ± 8.2; P <.001), SF-12 Mental Component Summary (from 48.2 ± 11.7 to 52.0 ± 9.0; P = 0.014) and VAS pain (from 5.2 ± 2.1 to 1.4 ± 2.0; P <.001). The minimal clinically important difference in the ASES score was reached by 77.6% of the patients. Median postoperative satisfaction was 8 out of 10. It was found that 90.5% of the patients returned to sport, with 73.8% of the patients able to return to their preinjury level. At the time of final follow-up, 8 (12.1%) patients had undergone revision surgery for recurrent SSS symptoms. Older age at surgery (P =.044), lower preoperative SF-12 Mental Component Summary score (P =.008), lower preoperative ASES score (P =.019), and increased preoperative VAS pain score (P =.016) were significantly associated with not achieving a Patient Acceptable Symptom State on the ASES score. Conclusion: Patients undergoing arthroscopic bursectomy and partial scapulectomy for SSS experienced clinically significant improvements in functional scores, pain, and quality of life, which were sustained at a minimum of 5 years and a mean follow-up of 8.9 years postoperatively. Higher patient age, inferior mental health status, increased shoulder pain, and lower ASES scores at baseline were significantly associated with worse postoperative outcomes. [ABSTRACT FROM AUTHOR]