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Platelet-rich plasma (PRP) is a revolutionary treatment that harnesses the regenerative power of the body's own platelets to promote healing and tissue regeneration. While PRP therapy has emerged as a promising option for augmenting biologic healing in the shoulder, the complexity of shoulder disorders makes it difficult to draw definitive conclusions about the efficacy of PRP across different conditions and stages of disease. Our comprehensive review of twenty-four studies highlights the current state of PRP therapy in shoulder pathologies, revealing a wide variety of number of patients, control groups and results. Despite these challenges, the regenerative potential of PRP therapy is moderate in some conditions, with numerous studies demonstrating the positive effects. In conclusion, the authors of this study recommend the use of PRP therapy for adhesive capsulitis and rotator cuff repair of medium to large tears. However, they do not recommend the use of PRP for subacromial impingement or rotator cuff tears. It is up to the clinician's discretion to decide whether PRP therapy is appropriate for individual cases. However, there is still insufficient evidence to support the inclusion of PRP therapy in treatment protocols for other shoulder disorders. Therefore, further research is needed to fully explore the potential of PRP therapy in the treatment of various shoulder conditions.

Background: Retears after rotator cuff repair (RCR) have been associated with poor clinical results. Meaningful data regarding the role of arthroscopic revision RCR are sparse thus far. Purpose/Hypothesis: To investigate results after arthroscopic revision RCR. We hypothesized that (1) arthroscopic revision RCR would lead to improved outcomes, (2) the clinical results would be dependent on tendon integrity and (3) tear pattern, tendon involvement, and repair technique would influence clinical and structural results. Study Design: Case series; Level of evidence 4. Methods: During a 40-month period, 100 patients who underwent arthroscopic revision RCR were prospectively enrolled in this multicenter study. Outcomes were evaluated preoperatively, at 6 months (6M), and at 24 months (24M) using the Constant score (CS), the Oxford Shoulder Score (OSS), and the Subjective Shoulder Value (SSV). Tendon integrity at 2 years was analyzed using magnetic resonance imaging. A total of 13 patients (13%) were lost to follow-up, and 14 patients (14%) had a symptomatic retear before the 24M follow-up. Results: All clinical scores improved significantly during the study period (CS: preoperative, 44 ± 16; 6M, 58 ± 22; 24M, 69 ± 19 points; OSS: preoperative, 27 ± 8; 6M, 36 ± 11; 24M, 40 ± 9 points; SSV: preoperative, 43% ± 18%; 6M, 66% ± 24%; 24M, 75% ± 22%) ( P < .01). At 2 years, a retear rate of 51.8% (43/83) and a surgical revision rate of 12.6% (11/87) were observed. Mean full-thickness tear size decreased from 5.00 ± 1.61 cm2 to 3.25 ± 1.92 cm2 ( P = .041). Although the Sugaya score improved from 4.5 ± 0.9 to 3.7 ± 1.4 ( P = .043), tendon integrity did not correlate with better outcome scores. Previous open RCR, involvement of the subscapularis, chondral lesions of Outerbridge grade ≥2, and medial cuff failure were correlated with poorer SSV scores at 2 years ( P≤ .047). Patients with traumatic retears had better CS and OSS scores at 2 years ( P≤ .039). Conclusion: Although arthroscopic revision RCR improved shoulder function, retears were frequent but usually smaller. Patients with retears, however, did not necessarily have poorer shoulder function. Patient satisfaction at 2 years was lower when primary open RCR was performed, when a subscapularis tear or osteoarthritis was present, and when the rotator cuff retear was located at the musculotendinous junction. Patients with traumatic retears showed better functional improvement after revision.

Background. Prediction models for outcomes after orthopedic surgery provide patients with evidence-based post-operative outcome expectations. Our objectives were (1) to identify prognostic factors associated with the post-operative shoulder function outcome of the Oxford Shoulder Score (OSS) and (2) to develop and validate a prediction model for post-operative OSS. Methods. Patients undergoing arthroscopic rotator cuff repair (ARCR) were prospectively documented at a Swiss orthopedic tertiary care center. The first primary ARCR in adult patients with a partial or complete rotator cuff tear were included between October 2013 and June 2021. Twenty-two potential prognostic factors were used for prediction model development. Three sets of factors were compared in terms of overall performance (using Akaike’s Information Criterion and model bias) and discriminative ability (using R squared and Root Mean Squared Error). Results. A complete-case analysis of 1,310 patients was performed. Set 3 retained the following factors: age, sex, American Society of Anesthesiologists (ASA) classification, number of pre-operative steroid infiltrations, baseline OSS, baseline level of depression and anxiety, infraspinatus tear, tendon delamination and acromioclavicular joint resection. Linear regression and Tobit models had similar performance on both the training (R squared = 0.201 and 0.201, respectively) and test sets (R squared = 0.119 and 0.123, respectively). The Tobit model was slightly more consistent than the linear regression model after bootstrap validation (R squared = 0.189 compared to 0.161). Conclusion. A prediction model for patients undergoing ARCR was developed to provide patients and surgeons with individualized expectations for post-operative shoulder function outcomes.

Background and Hypothesis Morphologic analysis of the proximal humerus has been performed to provide information about regions of best bone quality for stemless implant fixation. However, implant design-related bone analysis regarding primary fixation strength has not been reported. The purpose of this study was to investigate bone volume fraction (BV/TV) and bone mineral density (BMD) in the spatial vicinity of humeral implant fixation and biomechanical performance following placement of two different stemless RSA designs. It was hypothesized that peripheral expandable implant fixation (PEF) would result in residual peri-implant bone with higher BMD and BV/TV and higher fixation strength compared to a central-hexagonal impaction fixation (CHIF) design. Methods Overall 25 human cadavers were prepped for stemless RSA using either a CHIF (n = 5) or PEF design (n = 20). Micro computed tomography scans were obtained post-preparation to analyze overall BV/TV and BMD in the anchoring region of 2 stemless implant designs. Bone volumes of paired specimens (each group n = 5) were further segmented and divided into three even planar subsections along the implantation direction with four additional radial sectors, each according to their anterior-posterior and medial-lateral direction. Following implantation, biomechanical testing was performed to evaluate ultimate failure load and stiffness of the 2 implants. Results Postpreparation paired humeral bone analysis revealed significantly greater residual peri-implant BMD (P 0.69) with significantly higher bone density for PEF (P= .003). Further division in proximal to distal planar subsections of paired specimens showed overall statistically higher BMD and BV/ TV for PEF (at least P 0.89 with significantly higher primary stability for PEF (P = .046). Conclusion Implant design in stemless RSA affects residual bone quality in the anchoring region and primary fixation strength. Peripheral implant anchoring along the insertion direction provides significantly higher residual peri-implant BMD and BV/TV to achieve improved primary fixation with a radial expandable anchoring implant compared to a central-hexagonal impacted design. Level of Evidence Basic Science Study; Anatomy Study; Imaging; Biomechanics

Background: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. Purpose/Hypothesis: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model’s predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. Results: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. Conclusion: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.

Purpose: To assess the change in quality of life (QOL) and costs for patients with rotator cuff tears after arthroscopic rotator cuff repair (aRCR) compared with continued nonoperativemanagement, using real-world evidence. Methods: Patients indicated for aRCR were included in a prospective study and followed up to 2 years after surgery (postop) for allmeasurements. QOL (EQ-5D-5L) and shoulder function (Constant Score, Oxford Shoulder Score, subjective shoulder value) were assessed. Sixteen major insurance companies provided all-diagnoses direct medical costs in Swiss francs (CHF; 1 CHF ¼ 1.03 USD). Baseline data at recruitment and costs sustained over 1 year before surgery (preop) served as a proxy for nonoperative management. Total direct medical costs to gain 1 extra quality-adjusted life year (QALY) were calculated as the incremental costeffectiveness ratio (ICER; mean of 2 years postop compared with 1 year preop) from a societal perspective. Subgroup analyses were separately performed for traumatic (trauma-OP) and degenerative (degen-OP) rotator cuff tear patients. Sensitivity analyses for aRCR patients includedmore intensive nonoperative treatment with corresponding QOL gain. The relationship between QOL and shoulder function was explored using regression analysis. Results: For 153 aRCR patients (mean age 57 years; 63% male), themean EQ-5D index improved from 0.71 (preop) to 0.94 (1 year postop) and 0.96 (2 years postop). Mean total costs increased from 5,499 CHF (preop) to 17,116 CHF (1 year postop), then decreased to 4,226CHF (2 years postop). The ICER for all aRCR patients was 24,924 CHF/QALY (95%confidence interval [CI] 16,742 to 33,106) and 17,357 CHF/QALY (95% CI 10,951 to 23,763) and 36,474 CHF/QALY (95% CI 16,301 to 56,648) for the trauma-OP and degen-OP groups, respectively. QOL and shoulder function were significantly associated (P < .001). Conclusions: For RC patients treated at a specialized Swiss orthopaedic clinic, aRCR is a cost-effective intervention associated with clinically relevant improvement in QOL up to 2 years after repair compared with prior nonoperative management. Level of Evidence: Economic Analyses e Developing an Economic Model, Level II

Optimal management of partial anterosuperior rotator cuff tears is unknown. Our aim was to compare clinical and subjective outcomes of supraspinatus (SSP) repair patients treated with or without repair of an associated superior subscapularis (SSC) partial tear. SSP repair patients with an associated partial (Lafosse I) tear of the superior SSC tendon were retrospectively examined. Baseline and operative data and the outcomes of shoulder range of motion (ROM), pain level, strength, Constant-Murley Score, complications at 6 months as well as patient-reported Oxford Shoulder Score, Subjective Shoulder Value, and satisfaction at 6- and 24-month post-surgery were compared between patients with and without a repaired SSC tear. Mixed models and propensity-score matching were used to adjust baseline group differences. Of 75 eligible patients, 34 had an SSC repair and were younger with better baseline function. Non-repair surgeries were significantly shorter by 34 min (95% CI 23–45; p

Purpose To report complications after arthroscopic rotator cuff repairs (ARCRs) in a large patient cohort based on clinical application of a newly defined core event set (CES) and severity grading. Methods Consecutive primary ARCRs documented in a local clinical registry between February 2010 and September 2016 were included. Clinicians documented adverse events (AEs) reported until the final, 6-month postoperative follow-up according to the CES. The CES is an organized list of relevant AEs sorted into 3 intraoperative event groups (device, osteochondral, and soft tissue) and 9 postoperative event groups (device, osteochondral, pain, rotator cuff, surgical-site infection, peripheral neurologic, vascular, superficial soft tissue, and deep soft tissue). Severity was determined using an adaptation of the Clavien-Dindo classification. Cumulative complication risks were calculated per event group and stratified by severity and rotator cuff tear extent. Results A total of 1,661 repairs were documented in 1,594 patients (mean age, 57 years [standard deviation, 9 years]; 38% women); 21% involved partial tears. All events were recorded according to the CES. Intraoperative events occurred in 2.2% of repairs. We identified 329 postoperative events in 307 repairs (305 patients); 93% had 1 AE. The cumulative AE risk at 6 months was 18.5%; AE risks were 21.8% for partial tears, 15.8% for full-thickness single-tendon tears, 18.0% for tears with 2 ruptured tendons, and 25.6% for tears with 3 ruptured tendons. AE risks per event group were as follows: 9.4% for deep soft tissue, with shoulder stiffness (7.6%) being the most common event; 3.4% for persistent or worsening pain; 3.1% for rotator cuff defects; 1.7% for neurologic lesions; 0.8% for surgical-site infection; 0.7% for device; 0.4% for osteochondral; 0.2% for superficial soft tissue, and 0.1% for vascular. Most AEs had severity grades I (160 [49%]) and II (117 [36%]). Conclusions Comprehensive local AE documentation according to the CES and severity grading was possible and showed that about one-fifth of ARCRs were affected, mostly by one AE of low severity. Shoulder stiffness was the most frequent event. Level of Evidence Level IV, case series.

Background The role of glenosphere size in reverse shoulder arthroplasty (RSA) may be important in prosthetic stability, joint kinematics, rotator cuff tension and excursion, scapular impingement, humeral lateralization, deltoid wrap, and the occurrence of “notching.” This study compared short- and midterm clinical and radiographic outcomes for 2 different glenosphere sizes of a single RSA type with respect to implant positioning, glenoid size, and morphology. Methods This retrospective analysis included 68 RSA procedures that were prospectively documented in a local register during a 5-year postoperative period. Two glenosphere diameter sizes of 36 mm (n = 33) and 44 mm (n = 35) were used. Standard radiographs were made preoperatively (ie, baseline) and at 6, 12, 24, and 60 months after surgery. Range of motion, strength, the Constant-Murley score, and the Shoulder Pain and Disability Index were also assessed at all follow-up visits. The effect of glenosphere size on measured outcomes was adjusted for baseline values, patient gender, and humeral head diameter. Results No significant differences were found in the functional scores between treatment groups at all follow-up assessments. At the 12-month follow-up, patients with a 44-mm glenosphere had greater external rotation in adduction (mean difference, 12°; P = .001) and abduction strength (mean difference, 1.4 kg; P = .026) compared with those with the smaller implant. These differences remained at 60 months. Scapular notching was observed in 38% of all patients, without any relevant difference between the groups. Conclusion An increase in glenosphere diameter leads to a clinically moderate but significant increase in external rotation in adduction and abduction strength at midterm follow-up.

Ziel der superioren Kapselrekonstruktion bei partiell irreparablen Massenrupturen der Rotatorenmanschette (RM) ist die Verbesserung der Humeruskopfzentrierung im Vergleich zur alleinigen Partialrekonstruktion. Die Operationstechnik und erste Resultate werden beschrieben. Die Rekonstruktion des Kraftepaares Subskapularis und Infraspinatus durch eine Refixation von moglichst viel vitalem Sehnengewebe spielt eine zentrale Rolle. Der verbleibende Defekt wird prapariert und ausgemessen. Der Graft wird zugeschnitten, mittels Double-Pulley-Technik eingezogen und medial fixiert. Der laterale Rand wird in einer knotenfreien Transosseous-equivalent-Technik fixiert und das dorsale Intervall verschlossen. In der Studie von Mihata wurden unter Verwendung eines Fascia-lata-Autografts mit einem Follow-up von 34 Monaten signifikante Verbesserungen in allen gemessenen klinischen Parametern beschrieben. Die akromiohumerale Distanz vergroserte sich um 4,1 mm und bei 12 von 14 Patienten konnte die praoperative Flexion von 90° verbessert werden. In unseren kurzfristigen Resultaten (6 Monate Follow-up) von 20 Patienten mit einem dermalen Allograft zeigte sich ebenfalls eine signifikante Verbesserung von Anteversion/Abduktion, und dem Constant-Score (von 57 auf 65 Punkte; p = 0,021). Bei 4 Patienten mit einer praoperativen Abduktion

BACKGROUND: Shoulder arthroplasty (SA) complications require standardization of definitions and are not limited to events leading to revision operations. We aimed to define an international consensus core set of clinically relevant unfavorable events of SA to be documented in clinical routine practice and studies.METHODS: A Delphi exercise was implemented with an international panel of experienced shoulder surgeons selected by nomination through professional societies. On the basis of a systematic review of terms and definitions and previous experience in establishing an arthroscopic rotator cuff repair core set, an organized list of SA events was developed and reviewed by panel members. After each survey, all comments and suggestions were considered to revise the proposed core set including local event groups, along with definitions, specifications, and timing of occurrence. Consensus was reached with at least two-thirds agreement.RESULTS: Two online surveys were required to reach consensus within a panel involving 96 surgeons. Between 88% and 100% agreement was achieved separately for local event groups including 3 intraoperative (device, osteochondral, and soft tissue) and 9 postoperative event groups. Experts agreed on a documentation period that ranged from 3 to 24 months after SA for 4 event groups (peripheral neurologic, vascular, surgical-site infection, and superficial soft tissue) and that was lifelong until implant revision for other groups (device, osteochondral, shoulder instability, pain, late hematogenous infection, and deep soft tissue).CONCLUSION: A structured core set of local unfavorable events of SA was developed by international consensus to support the standardization of SA safety reporting. Clinical application and scientific evaluation are needed.

Shoulder arthroplasty for proximal humerus fracture sequelae is known to provide significant patient improvement, yet this outcome varies with time, prosthesis type, and fracture sequelae. We outline the expected course of postoperative shoulder pain and function in patients with anatomical (ASA) or reverse (RSA) shoulder arthroplasty following different fracture sequelae. Of 111 consecutive patients from our local shoulder arthroplasty registry, 32 underwent ASA for Boileau type 1 sequelae and 77 RSA patients were identified with Boileau types I, III, and IV. By 5 year post-surgery, there were 72 patients available. All patients underwent standardised ASA or RSA procedures with anatomical (Promos Standard; Lima SMR™; Arthrex Eclipse™; Univers™ II) or reverse prostheses (Promos Reverse®; Lima SMR™ Reverse; Univers Revers™; Aequalis® Reversed). Range of motion, Constant–Murley, Disability of the Arm, Shoulder and Hand (DASH), and Shoulder Pain and Disability Index (SPADI) scores were compared at 6, 12, 24, and 60 months postoperatively. We used generalised linear mixed models or random-effects ordered logistic regression to investigate postoperative changes of outcome parameters from baseline to follow-up time points for each group as well as for group comparisons. Range of motion and clinical scores improved until 24 months postoperatively and did not deteriorate thereafter, except for internal rotation of Boileau type III and IV patients and external rotation of RSA patients with type I and IV sequelae. At all follow-ups, ASA patients with Boileau type I sequelae had significantly better internal and external rotation versus patients with RSA and/or other Boileau types (p

Background The literature does not consistently report on complications associated with arthroscopic rotator cuff repair (ARCR). Valid comparison of the occurrence of complications between ARCR interventions requires standardization. This project was implemented to define a core set of negative (untoward) events associated with ARCR along with their terms and definitions, which should be systematically documented and reported in routine care and clinical research. Materials and methods A Delphi consensus process was applied. An international panel of experienced shoulder surgeons was nominated through professional societies and personal contacts. On the basis of a systematic review of terms and definitions, an organized list of relevant events associated with ARCR was developed and reviewed by panel members. Between each survey, all comments and suggestions were considered to revise the proposed core set, including local event groups along with definitions, specifications, and timing of occurrence . Consensus was defined as at least two-thirds agreement. Results Three successive online surveys were implemented involving 84 surgeons. Consensus with over 86% agreement was reached for a core list of local events including 3 intraoperative event groups (device, osteochondral, and soft tissue) and 9 postoperative event groups (device, osteochondral, pain, rotator cuff, surgical-site infection, peripheral neurologic, vascular, superficial soft tissue, and deep soft tissue). Experts agreed on a period for documentation of each event or group of events ranging from 3 to 24 months after ARCR. Conclusion A structured core set of local events associated with ARCR has been developed by international consensus. Further evaluation and validation in the context of clinical studies are required.

Background Restoration of shoulder stability after humeral avulsion of glenohumeral ligament (HAGL) lesions can be achieved with arthroscopy, yet limited evidence exists on its benefit. We evaluated objective and subjective outcomes after arthroscopic refixation of a HAGL lesion. Methods Between 2009 and 2012, 8 patients were treated arthroscopically for anterior shoulder instability associated with a HAGL lesion and invited for a follow-up examination. Radiographic assessment of joint centering and osteoarthritis, clinical assessment including Constant and Rowe scores, and complications as well as functional outcomes using the Western Ontario Shoulder Instability Index, Subjective Shoulder Value, and Simple Shoulder Test were documented. Results Six patients were postoperatively examined at a median time of 29 months (range, 12-38). Four patients had up to 6 previous luxation events. Two patients had a concomitant labral lesion, and another 2 had an associated rotator cuff tear. Positive preoperative apprehension and relocation test results for 5 patients were negative at follow-up. No neurologic lesion was noted both before and after surgery. Shoulder motion did not improve significantly; lower internal and external rotation relative to the contralateral shoulder was reported. The Rowe score improved significantly from baseline (median score change, 65 points; P = .027), with 2 and 4 patients rating “good” and “excellent” at follow-up, respectively. Final median Constant score, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, and Simple Shoulder Test scores were 77.3 points, 91.0 points, 90%, and 87.5 points, respectively. Conclusion Arthroscopic stabilization of a HAGL lesion is a safe, feasible, and reproducible technique. In our patient cohort, good shoulder stability could be achieved with high patient satisfaction.

We hypothesized that treatment of rotator cuff arthropathy (RCA) with reverse shoulder arthroplasty (RSA) and an additional latissimus dorsi transfer (LDT) in patients with an active external rotation deficit (ERD) would restore external rotation (ER) with concomitant deterioration in internal rotation.In our cohort study, 26 RCA patients with an active ERD (ie, positive lag sign and maximum active ER of 0°) underwent RSA between September 2007 and February 2015; LDT was completed in 13 of these patients. In addition, 88 control patients without ERD who underwent only RSA were identified. Clinical outcomes of strength, range of motion, Constant-Murley score, and Shoulder Pain and Disability Index score, as well as complications, were documented 6, 12, 24, and 60 months postoperatively. We made comparative analyses using statistical mixed models.The LDT procedure extended the surgical time by 26 minutes (P = .003). LDT patients had up to 22° better postoperative active ER than control patients (P .001), although this was accompanied by an internal rotation deficit (77% vs 46% of control patients could not reach the lumbosacral region, P = .010). We calculated a 23% risk of local procedure-related complications for RSA patients with an active ERD and LDT.Patients with RCA and an active ERD seem to benefit from an LDT, although this is accompanied by the potential loss of internal rotation. This additional procedure is associated with an extended surgical time as well as a possible increase in the risk of a complication occurring.

Fur einen validen internationalen Vergleich der Ergebnisse von chirurgischen Eingriffen ist eine Standardisierung der Erfassung von Komplikationen notwendig. Ziel unseres Projekts ist ein Komplikationserfassungsbogen („Core Set“) nach arthroskopischer Rotatorenmanschettenrekonstruktion (ARMR). Grundlage des Projekts bildet eine systematische Literaturrecherche inklusive Reviews, klinische Studien und Fallberichte nach Komplikationen nach ARMR. Alle Fachbegriffe von Komplikationen und deren Definitionen wurden extrahiert. Eine erste Vorschlagsliste wurde im Rahmen eines Delphi-Prozesses von einer internationalen Expertengruppe evaluiert. Fur jede Komplikation oder Gruppe von Komplikationen wurde ein Konsens (mindestens Zweidrittelmehrheit) gesucht. Die Definition der Komplikationen, deren Spezifikation und der Zeitrahmen des postoperativen Auftretens waren ebenfalls in den Konsensusprozess integriert. Innerhalb der ARMR-Studie konnten 242 Fachbegriffe fur lokale Komplikationen extrahiert werden. Fur einzelne Ereignisse wurden mehrere Fachbegriffe bzw. Definitionen gefunden. Eine erste Vorschlagsliste wurde in einer Delphi-Befragung von 59 Experten bearbeitet. Teilweise konnte ein Konsens erreicht werden. Die Literatur berichtet nicht konsequent uber chirurgische Komplikationen nach ARMR. Diese Arbeit dient als Grundlage fur die Entwicklung von standardisierten Komplikationsdefinitionen und eines einheitlichen Dokumentationsprozesses von Komplikationen nach ARMR. Die Standardisierung der Komplikationen nach Schulterarthroplastik ist in einem zweiten Projekt geplant.

Traditionally, the long head of the biceps tendon (LHBT) and the labrum have been viewed as two separate entities. However, these entities are now considered to be an interdependent complex. The biceps-labral complex (BLC) describes an anatomical and biomechanical complex. The BLC consists of three zones: the inside contains the glenoid labrum and its attachment to the LHBT, the so-called biceps anchor; the junction includes the part of the tendon crossing the articular margin to the bicipital groove and its stabilizing system, the biceps pulley; and the third zone consists of the extra-articular part of the LHBT, from the articular boundary to its musculotendinous transition and the biceps tunnel.

Background Well-documented clinical data registers are valuable for assessing the effectiveness of surgical interventions.

Background The aim of this study was to assess the timing and location of cortical bone resorption after total shoulder arthroplasty with an uncemented rectangular stem and investigate its effect on shoulder function up to 5 years after implantation. Methods Between June 2003 and September 2006, 183 consecutive total shoulder arthroplasties were performed, 133 of which received a cementless rectangular stem as indicated by primary or post-traumatic osteoarthritis (OA). The 5-year postoperative follow-up rate was 80%. Standardized radiographic controls and clinical assessments were performed at 6 weeks, 6 months, and 1, 2, and 5 years. Results Twenty-two patients (17%) showed full-thickness cortical bone resorption, 21 of whom were diagnosed with Sperling zone 2 resorption. The maximum craniocaudal distance of full resorption averaged 19.1 mm (range, 5.6-46.7 mm). The median distance progressed significantly from 9.6 mm to 13.8 mm between 6 and 12 months ( P = .005). The risk of bone resorption was 3.1 times higher for post-traumatic OA patients than for those with primary OA. The occurrence of bone resorption increased significantly with increasing stem diameters relative to the humeral diameter. There was no significant effect of bone resorption on functional outcome. Conclusion Full-thickness cortical bone resorption in the proximal posterolateral humerus after receipt of a cementless rectangular stem has a prevalence of 17%, mostly occurring within the first year after surgery. Risk factors include age, post-traumatic conditions, and larger stem sizes relative to the humerus. This is a radiographic phenomenon without significant impairment of function or need for revision within 5 years after surgery.

Purpose To investigate the 2-year postoperative clinical and subjective outcomes after arthroscopic rotator cuff repair (ARCR) with xenologous porcine dermal patch augmentation compared with ARCR alone. Methods Patients aged 60 years or older with a complete supraspinatus (SSP) tendon tear underwent primary ARCR with a transosseous-equivalent technique. By use of a matched-pair comparative trial design, a consecutive series of 20 patients receiving additional xenologous porcine dermal patch augmentation (patch group) was matched by tear location with 20 patients who received ARCR only (control group). Prior conservative treatment failed in all patients. Patients with concomitant pathologies precluding accurate repair assessment, partial or open reconstruction, or a latissimus dorsi and/or pectoralis major muscle transfer were excluded. Patients reported daily pain levels for 10 days after surgery. Clinical parameters and various patient-reported outcome scores were documented preoperatively and at 3, 6, and 24 months after surgery. Repair integrity was determined by magnetic resonance imaging or ultrasound at 24 months. Adverse events were recorded. Group outcome differences were analyzed with t tests, Fisher exact tests, and mixed models. Results Patients in both groups were aged 67 years on average (range, 60-74 years), and 70% of patients were men. Patients in the patch group had slightly more SSP fatty infiltration preoperatively. Patch surgical procedures were on average 22 minutes longer than control interventions ( P = .003). At 24 months, 4 patients and 9 patients were diagnosed with a recurrent SSP tendon defect in the control group (n = 20) and patch group (n = 19), respectively (relative risk, 2.4; P = .096). Of 11 defects (85%) identified as medial cuff failure, 8 occurred in the patch group. Pain rated by all patients decreased from postoperative day 1 to day 10 without any significant group difference ( P = .348). No significant group differences were noted for other outcome parameters, and recurrent defects had no relevant effect on functional outcomes. Local complications (including recurrent defects) occurred in 8 patients in the control group and 12 in the patch group ( P = .343). Conclusions Our pilot study supports the view that an SSP tear repair with porcine dermal xenograft augmentation does not benefit patients in terms of reducing the risk of a recurrent tendon defect or improving shoulder function up to 24 months after surgical repair. Level of Evidence Level III, therapeutic study, retrospective comparative trial.

A transparent, reliable and accurate reporting of complications is essential for an evidence-based evaluation of shoulder arthroplasty (SA). We systematically reviewed the literature for terms and definitions related to negative events associated with SA.Various biomedical databases were searched for reviews, clinical studies and case reports of complications associated with SA. Any general definition of a complication, classification system, all reported terms related to complications and negative events with their definitions were extracted. Terms were grouped and organised in a hierarchical structure. Definitions of negative events were tabulated and compared.From 1086 initial references published between 2010 and 2014, 495 full-text papers were reviewed. Five reports provided a general definition of the term "surgical complication" and 29 used a classification system of complications. A total of 1399 extracted terms were grouped based on similarities and involved implant or anatomical parts. One hundred and six reports (21.4%) defined at least one negative event for 28 different terms. There were 64 definitions related to humeral or glenoid loosening, and 25 systems documenting periprosthetic radiolucency. Other definitions considered notching, stress shielding, implant failure and tuberosity malposition.A clear standardised set of SA complication definitions is lacking. Few authors reported complications based on definitions mainly considering radiological criteria without clinical parameters. This review should initiate and support the development of a standardised SA complication core set.

Background:The exact role of platelet-rich plasma (PRP) in rotator cuff tendon reconstruction remains unclear.Purpose/Hypothesis:This study investigated whether an intraoperative pure PRP injection, compared with a local anesthetic injection, improves patient-reported outcomes at 3 and 6 months after arthroscopic rotator cuff repair. The hypothesis was that pure PRP improves patient-reported outcomes (Oxford Shoulder Score [OSS]) at 3 and 6 months after surgery and has the same pain-reducing effect compared with a postoperative subacromial local anesthetic (ropivacaine) injection.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Between January 2011 and November 2012, a total of 120 patients who underwent arthroscopic double-row repair of a supraspinatus tendon rupture were randomized to receive either pure PRP by an injection at the footprint (PRP group; n = 60) or ropivacaine injected in the subacromial region (control group; n = 60). Seventy-eight percent of patients had other concomitant tears. All patients, surgeons, and follow-up investigators were blinded. Clinical parameters and various outcome scores (Constant-Murley shoulder score; OSS; patient American Shoulder and Elbow Surgeons score; quick Disabilities of the Arm, Shoulder and Hand score; EuroQol 5 dimensions) were documented preoperatively and at 3, 6, and 24 months postoperatively. The repair integrity was assessed by magnetic resonance imaging or ultrasound at 24 months. Furthermore, a pain diary was completed within the first 10 postoperative days, and adverse events were recorded. Group outcome differences were analyzed using t tests, Fisher exact tests, and mixed models.Results:The final follow-up rate was 91%. An associated tear of the subscapularis tendon was diagnosed in 23% of PRP-treated patients and 36% of control patients. Three months after surgery, the mean (±SD) OSS was 32.9 ± 8.6 in PRP-treated patients and 30.7 ± 10.0 in control patients ( P = .221). No significant differences were noted for other outcome parameters as well as at 6 and 24 months postoperatively. Smoking was a significant effect modifier. Pain for both groups decreased from postoperative day 1 to 10 without any significant group difference ( P = .864). Six (12.2%) and 11 (20.8%) patients were diagnosed with a recurrent supraspinatus tendon defect in the PRP and control groups, respectively ( P = .295). Twenty-two (40.7%) and 18 (30.5%) PRP-treated and control patients, respectively, experienced a local adverse event within 24 months ( P = .325).Conclusion:Patients treated with pure PRP showed no significantly improved function at 3, 6, and 24 months after arthroscopic repair compared with control patients receiving ropivacaine; however, a similar pain reduction was documented in both groups. The negative influence of smoking on the effect of pure PRP requires further investigation.Registration:NCT01266226 ( ClinicalTrials.gov ).

This study compared clinical and radiographic outcomes of patients undergoing resurfacing total shoulder arthroplasty (TSA) with those treated with a stemmed TSA. Patients with primary osteoarthritis who underwent humeral resurfacing (RES) or stemmed (STA) TSA were identified in our shoulder arthroplasty register for retrospective analysis. Standard radiographs and clinical/patient-rated assessments were made up to 24 months post-surgery. Implant revisions were assessed. Patients were frequency-matched in a 1:1 (RES:STA) ratio based on gender and age, and compared with regard to operation time and shoulder function (Constant, SPADI and Quick DASH scores). Mixed models with statistical adjustments were applied. From 2006 to 2014, 44 RES and 137 STA operations were performed in 157 patients; one and two revisions were recorded in the RES and STA group, respectively. The final matched cohort included a total of 69 patients and 37 operations per treatment group. Resurfacing TSA was 17 min shorter (95%CI: 5–28) compared to the stemmed procedure (p = 0.005). RES and STA patients showed significant functional improvement six months post-implantation, yet all measured scores did not differ between the groups at 2 years (p ≥ 0.131). The status of static centering of the humeral head, acromiohumeral distance, and a lack of signs of implant loosening were also similar between treatments. Similar 24-month post-operative radiological and functional outcome is achieved by RES and STA patients, even with a shorter RES surgery time. Larger cohorts and longer follow-up are required to better assess implant survival.

Background Rectangular cementless femur shaft prostheses have a higher primary stability than round shafts. A novel rectangular humeral shaft design was tested with two questions: does the rectangular design cause a higher fracture risk during implantation than round designs, and does it increase the torsional stiffness? Materials and methods Two series with six paired human humeri (total 24) were tested on one side with the rectangular shaft and on the contralateral side with a round shaft. In the first series, the shaft implantation was carried out with a constant speed of 100 mm/min and the maximum force was measured when the fracture occurred. In the second series, the implants were preloaded with 50 N and then rotated at 2° per second with monitoring of the torsional torque. Results The maximum force at fracture showed no significant difference for the two designs (p = 0.34). Higher age and low bone density reduced the force required for fracture. The rectangular shaft showed significant higher torsional moments (p

Background Implant functionality has clearly increased over the past decades because of improvements in total shoulder arthroplasty systems. This means that prostheses are now being implanted in younger patients with high sports activity. Hypothesis The implantation of the total shoulder arthroplasty does not mainly influence the sports activity. Study Design Case series; Level of evidence, 4. Methods One hundred consecutive patients with unilateral total shoulder arthroplasty, followed for at least 1 year, were included in the study. Assessment preoperatively and 1 year and 2 years after operation included clinical examination and a validated questionnaire (Constant, Shoulder Pain and Disability Index [SPADI], and Disabilities of the Arm, Shoulder and Hand [DASH] scores, and the Short Form 36 [SF-36]). In addition, all patients received a sports questionnaire developed in house. Results Of the 55 patients who took part in sports before having shoulder disease, 49 (89%) were still able to participate after a mean follow-up of 2.8 years (range, 1.3-4.6 years). Seventeen patients had given up sports before total shoulder arthroplasty; 11 of them resumed activities after joint replacement but 6 did not start again. No patient had to stop sports because of the total shoulder arthroplasty. The sports most commonly mentioned were swimming (10 patients [20.4%]), golf (8 patients [16.3%]), cycling (8 patients [16.3%]), and fitness training (8 patients [16.3%]). Strength and range of motion, as well as the physical component summary (PCS) of the SF-36 and the Constant score (CS) after total shoulder arthroplasty, were significantly better in the sports group (49 of 100; PCS = 46, CS = 77) than in the nonsports group (45 of 100; PCS = 41,CS = 71). Eighteen patients (36.7%) stated that even after joint replacement, they still suffered restrictions on their sports activities because of shoulder problems. Whereas the overall mean age at follow-up was 68.9 years (range, 26-92 years), the mean age of patients participating in sports was significantly lower than in the nonsports group (63 vs 70 years; P = .002). Conclusion Total shoulder arthroplasty allows patients to participate in sports without significant restriction of their level of activity. The probability of being able to do sports postoperatively—if done preoperatively—is high. Long-term studies are needed to determine whether the greater loading on the joint will lead to more rapid wear and a higher rate of loosening with time.

Die Ergebnismessung und -beurteilung nach orthopadischen Interventionen gewinnt zunehmend an Bedeutung. Allerdings gibt es fur deutschsprachige Patienten mit Instabilitaten des Schultergelenks kein krankheitsspezifisches Messinstrument zur Selbstbeurteilung. Ziel war es, den „Western Ontario Instability Index“ (WOSI) in einem standardisierten Prozess von der englischen in eine deutsche Version zu ubersetzen und zu testen. Fur den Ubersetzungs- und Anpassungsprozess wurden die Richtlinien der „American Association of Orthopeadic Surgeons“ befolgt. Fur die Testung des Sprachverstandnisses wurden 20 gesunde Probanden, fur die Testung der Reliabilitat und Validitat 30 Patienten mit Schulterinstabilitat befragt. Zur Beurteilung der ubersetzten Version wurden als Gutekriterien die Homogenitat, Reliabilitat und Konstruktvaliditat untersucht. Die Test-Retest-Reliabilitat im Gesamtscore mit einem „Intra Class Correlationscoeffizient“ (ICC) von 0,87 und den Subscores mit einem ICC von 0,73 (Sport, Freizeit und Arbeit), 0,81 (Empfinden), 0,82 (korperliche Symptome) und 0,90 (Lebensgewohnheiten) war mehrheitlich hoch. Die interne Konsistenz der Skala lag mit 0,89 (Cronbachs α) im Gesamtscore relativ hoch. Der WOSI deckt ein breites Spektrum von Symptomen und Funktionseinschrankungen bei Schulterinstabilitat ab. Die deutsche Ubersetzung zeigt in der Beurteilung der Fragebogenverstandlichkeit, Homogenitat, Reliabilitat und Validitat gute Ergebnisse und stellt somit ein geeignetes Messinstrument zur Selbstbeurteilung der Schulterinstabilitat dar.

Our goal was to evaluate the objective and subjective midterm outcome after revision of a failed shoulder arthroplasty with a reverse design prosthesis. Twenty consecutive patients with 21 revisions of a primary shoulder arthroplasty using reverse shoulder prosthesis Delta III® were followed up postoperatively for a mean of 46 months including clinical and radiological examination. Complications were recorded and Constant score, DASH and SF36 were assessed. With the numbers given a significant reduction of pain was achieved from 8.7 to 3.0 (p

Exakte Wiederherstellung der glenohumeralen Gelenkstruktur auch bei komplexen anatomischen Verhaltnissen durch hohe Prothesenmodularitat in Verbindung mit In-situ-Montage; Moglichkeit des spateren Umstiegs auf inverses Design durch kompatiblen Schaft. Primare Omarthrose, sekundare Gelenkzerstorung nach vorangegangener Fraktur oder deren Behandlung, Humeruskopfnekrose oder entzundlichen Zerstorungen, Revisionen von Defektsituationen, z.B. nach Hemiprothese. Allgemeine Kontraindikation fur totalen Schultergelenkersatz, zusatzlich funktioneller Ausfall der Rotatorenmanschette, fortgeschrittene Osteoporose, enge Markraumverhaltnisse, z.B. bei juveniler rheumatoider Arthritis. Nach deltopektoralem Zugang, freier Resektion des Humeruskopfes entlang anatomischen Landmarken und schrittweisem Aufraspeln des Humerusschafts wird zuerst der Vierkantschaft eingebracht, danach wird mit Hilfe des Body die notwendige Hohe wiederhergestellt, und anschliesend werden mit dem Inklinationsset die richtige Version und Inklination eingestellt. Der asymmetrische Prothesenkopf mit nichtzentrischer Passung ermoglicht die exakte Wiederherstellung des anatomischen Drehzentrums. Implantation des zementierten Glenoids und Prufung von Bewegungsumfang und Weichteilspannung. Bei Bedarf Austausch einzelner Komponenten und Neuaufbau in situ. Eine prospektive Auswertung der ersten 146 Patienten mit 1-Jahres-Verlaufskontrolle ergab Verbesserungen im Bereich Schmerz von durchschnittlich 151% und in der Funktion von 98% ohne signifikante Unterschiede fur zugrundeliegende Indikationen. Wahrend der Lernkurve traten vier Schaftsprengungen auf, die alle durch intraoperative Cerclagen versorgt werden konnten. Nach Anpassung der Operationstechnik und Entwicklung von Empfehlungen uber das Verhaltnis von Schaftgrose zu Humerusmarkraum waren keine weiteren Schaftsprengungen zu verzeichnen. Eine traumatische sowie eine atraumatische Kopfdrehung wurden in diesem Zeitraum beobachtet und sollten mit einem neu konzipierten Drehmomentschlussel kunftig verhindert werden. Durch den modularen Aufbau der Prothese konnen auch komplexe Pathologien wie z.B. bei rheumatoider Arthritis beseitigt und ahnlich gute funktionelle Resultate erzielt werden.

The purpose of this report is to assess the association of concomitant biceps tenodesis in total shoulder arthroplasty with treatment success 1 year after total shoulder arthroplasty. Of 136 consecutive shoulders (124 patients) undergoing primary total shoulder arthroplasty between 2003 and 2006, 54 (39.7%) underwent biceps tenodesis. For each patient, we obtained potential preoperative confounding data, such as age; gender; presence of rheumatoid arthritis; Short Form 36; number of previous shoulder operations; Disabilities of the Arm, Shoulder and Hand score; Shoulder Pain and Disability Index score; and insurance status. At the 1-year follow-up, we calculated the Constant score of all patients (ranging from 0 [worst] to 100 [best]). We first determined the crude association of concomitant biceps tenodesis with 1-year treatment success (Constant score ≥80) and then fitted a multivariate model correcting for potential confounders to assess the adjusted association of the biceps tenodesis on treatment success. The total number of treatment successes was 46 of 136 shoulders (33.8% of all prosthesis implantations). The crude association (odds ratio) of a concomitant biceps tenodesis with treatment success was 2.38 (95% confidence interval [CI] 1.15 to 4.93; P = .02). When adjusting for potential confounders, we found that this association slightly increased to 2.97 (95% CI 1.00 to 8.85; P = .05). Concomitant biceps tenodesis appears to have a favorable effect on 1-year treatment success after total shoulder arthroplasty.

Statins are widely used in clinics to lower cholesterol levels. Recently, they have been shown to positively affect bone formation and bone mass in a rat model. The aim of this study was to investigate the effect of pravastatin, simvastatin and lovastatin on the osteoblastic differentiation of human mesenchymal stem cells (MSCs) in vitro. Cell number, alkaline phosphatase (ALP) activity, matrix mineralization and gene expression pattern were determined. Pravastatin did not affect cell differentiation. Simvastatin and lovastatin enhanced bone morphogenetic protein 2 (BMP-2) mRNA levels. In contrast, ALP activity and mRNA levels were suppressed by statins, as well as the DNA content and cell activity (MTT). An increase in apoptotic events was observed at high concentrations of statins, along with high Ca-45 incorporation. Lower concentrations of statins did not increase apoptotic staining, but also failed to induce calcification. When statin-induced calcification did occur, the morphology of the deposits was very different from the conventional nodule formation; the calcium was laid down along the membranes of the rounded cells suggesting it was as a result of cell death. Our results indicate that statins are not able to differentiate human MSCs into osteoblasts and that high concentrations of statins (>1 microM) have a cytotoxic effect.

There is an ongoing debate about the potential of patch augmentation to improve biomechanical stability and healing associated with rotator cuff repair. The biomechanical properties of three different patch-augmented rotator cuff repair techniques were assessed in vitro and compared with a standard repair. Dermal collagen patch augmentation may increase the primary stability and strength of the repaired tendon in vitro, depending on the technique used for patch application. Forty cadaveric sheep shoulders with dissected infraspinatus tendons were randomized into four groups (n = 10/group) for tendon repair using a knotless double-row suture anchor technique. A xenologous dermal extracellular matrix patch was used for augmentation in the three test groups using an “integrated”, “cover”, or “hybrid” technique. Tendons were preconditioned, cyclically loaded from 10 to 30 N at 1 Hz, and then loaded monotonically to failure. Biomechanical properties and the mode of failure were evaluated. Patch augmentation significantly increased the maximum load at failure by 61 % in the “cover” technique test group (225.8 N) and 51 % in the “hybrid” technique test group (211.4 N) compared with the non-augmented control group (140.2 N) (P ≤ 0.015). For the test group with “integrated” patch augmentation, the load at failure was 28 % lower (101.6 N) compared with the control group (P = 0.043). There was no significant difference in initial and linear stiffness among the four experimental groups. The most common mode of failure was tendon pullout. No anchor dislocation, patch disruption or knot breakage was observed. Additional patch augmentation with a collagen patch influences the biomechanical properties of a rotator cuff repair in a cadaveric sheep model. Primary repair stability can be significantly improved depending on the augmentation technique.

The authors introduce a new functional classification of rheumatoid arthritis of the wrist. Unlike the classifications used today, it includes the aspect of the natural course of rheumatoid arthritis. The goal of this paper is to identify radiologic indicators that will classify rheumatoid arthritis into stable forms of the disease (Types I and II) and unstable forms of the disease (Type III). Of 144 wrists examined, the first available radiograph and the radiograph obtained at the time of the first surgery were assessed. The indicators measured were: carpal height ratio, ulnar translocation, radial rotation, and scapholunate dissociation. Noting the changes that occurred each year in these indicators, it was possible to identify a significant difference between stable forms (Types I and II) and unstable forms (Type III) for the parameters carpal height ratio, ulnar translocation, and scapholunate dissociation. The distribution of the indicators allowed the definition of three values: the 100% value, the cut off point, and the lower threshold value. Combining the three radiologic parameters at those values markedly enhanced the possibility to classify rheumatoid arthritis of the wrist. With the help of the three radiologic indicators carpal height ratio, ulnar translocation, and scapholunate dissociation, it is possible to classify wrists with an early stage of rheumatoid arthritis according to the Schulthess classification. The early identification of destabilizing forms of rheumatoid arthritis becomes possible, making the choice and timing of the surgical intervention easier. Wrists with a progressive unstable form of rheumatoid arthritis may be stabilized earlier.

Persistent horizontal instability after acute acromioclavicular (AC) joint separation may provoke unsatisfactory results of conservative treatment.the arthroscopically assisted double flip button stabilization of acute horizontally unstable grade III and IV AC joint disruptions results in full functional restoration and stable radiological reposition.21 patients treated for an acute grade III or IV AC joint separation were enrolled. Clinical assessment at least 2-year postoperative included the constant score (CS) and the simple shoulder test. A panorama stress view, bilateral axial view and an AC view were obtained for radiographic evaluation.19 individuals (mean 37 years; 17 men) with 16 Rockwood type III and 3 type IV injuries were available for examination 24–51 months postoperatively. The mean CS was 90.2 points (SD 6.5) with no statistically significant difference between CS and age-adjusted normative values. The mean Simple Shoulder Test scored 11.5 points (range 8–12). Loss of reduction of more than 2 mm in the coronal plane stress views was present in 6 patients (32 %) with no associated loss of functional outcome. Two of four reported complications in four patients were treated surgically (one open revision with graft augmentation for coracoid implant break out, one arthroscopic capsular release for persistent glenohumeral stiffness).Arthroscopically assisted double flip button stabilization for acute grade III and IV AC joint separation restores fully horizontal stability and age-expected shoulder function, resulting in high patient satisfaction, despite a loss of reduction observed radiographically in approximately one-third of patients.IV.

The lormation of thermal nitrogen oxides (NO x ) in turbulent, nonpremixed hydrogen-air flames is analyzed on the basis of experimental and numerical data. Detailed measurements of the mean velocities and the Reynolds stress tensor were performed, which in combination with the species and temperature measurements of Barlow and Carter, now form a complete data set. Earlier experimental studies showed that the ratio of the NO x emission index and the residence time is proportional to the square root of a Damkohler number. This scaling law implies a strong dependence of NO formation on turbulence-chemistry interaction which must be considered by any modeling approach. Two combustion models, a Lagrange IEM model and a laminar flamelet model, were used for the numerical simulation of these flames in order to identify the relevant parameters that lead to the observed NO scaling law. The expected trend of the NO emission was obtained only with the Lagrange IEM model, despite similar predictions of global properties of the flames. The analysis revealed that the scaling law is a consequence of different radical concentration levels. The radical concentration levels are controlled by the slow recombination reactions. These slow chemical reactions must be modeled separately with some kind of reaction progress variable. This was shown to be successful with the Lagrange IEM combustion model.

Periprothetische Infekte nach Ellenbogengelenkersatz stellen eine schwere Komplikation dar und sind eine therapeutische Herausforderung. Die Erfahrungen in der Behandlung von Ellenbogenprotheseninfekten beruhen auf Fallserien mit relativ begrenzten Fallzahlen. Daher gibt es bisher auch kein definiertes Behandlungskonzept.

Ein postoperativer Infekt kann einem Operateur selten zum Vorwurf gemacht werden – auser die Infekte haufen sich. Die hier analysierten Infektsituationen hatten bei korrekter Nachsorge oder adaquatem operativem Vorgehen vermieden oder zumindest in einem fruheren Stadium erfasst und therapiert werden konnen. Die postoperative Betreuung des Patienten ist ebenso wichtig wie die korrekte Indikationsstellung und die technische Ausfuhrung eines Eingriffs. Enorme Fortschritte bringt die enge Zusammenarbeit mit einem spezialisierten Knocheninfektiologen. Die minutiose Betreuung durch den Infektiologen mit entsprechend engen Nachkontrollen zeitigt Erfolge, die noch vor Kurzem gar nicht fur moglich gehalten wurden.