Background:Fluorosis is an endemic disease of India which causes compressive cervical and/or dorsal myelopathy. This study aims to evaluate the role of surgical management in the crippling fluorosis along with evaluation of radiological imaging as screening/diagnosing tool for the disease.Materials and Methods:This is a prospective cohort study of 33 patients operated at tertiary care center having nontraumatic involvement of spinal cord affecting neurology with history, clinical and radiological features (Ossified Posterior Longitudinal Ligament-, Ossified Ligamentum flavum) suggesting fluorosis as the cause of compression. Outcomes were measured in terms of improvement in Nurick grading, Rankins scale, spasticity, Oswestry Disability Index, modified Japanese Orthopaedic Association scores.Results:Spinal fluorosis is a male predominant disease affecting the elderly after years of fluorine intake. Cervical and/or dorsal spine are predominantly involved at multiple levels (>=2). Diagnosis of the disease poses difficulty due to lack of established laboratory parameters with high sensitivity, availability, and lack of awareness among surgeons. Skeletal survey alone has >90% sensitivity for diagnosing the disease. Once evaluated properly, decompression at correctly identified levels invariably improves the spasticity and quality of life immediately post-surgery. At final followup, there was on average improvement of 2 scales in nurick grade, rankins scale and ashworth grading whereas average improvement in ODI, mJOA and dorsal specific mJOA were 52%, 3.17 points and 2.7 points respectively. However, preoperative counselling for “apparent neurological deterioration” in immediate postoperative period is very important. Complications like infection and dural tear have to be prevented with special surgical tactics.Conclusion:Skeletal survey along with computed tomography and magnetic resonance imaging is cost-effective modality for the screening/diagnosis for fluorosis. Once developed, surgery, either curative or palliative, is the best treatment at crippling stage of the disease.

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

Background: This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up.Methods: From November 2008 to December 2016, 23 patients (57.5 ± 4.4 years; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was 4.7 ± 4.0 years (range, 2?12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated.Results: ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last follow-up (<i>p</i><0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (<i>p</i>=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study.Conclusions: LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.

Background: Bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) was proposed which uses autograft harvested from the patient’s humeral head to lateralize the glenoid baseplate. This technique provided the lateralization of the center of rotation and the reduction of the scapular notching. Few studies have reported outcomes of BIO-RSA in the Asian population. We reported the first report of clinical and radiological outcomes of BIO-RSA in the Asian population at mid-term follow-up. Methods: From June 2012 to August 2017, a total 38 patients with average age of 73±6 years operated by the BIO-RSA technique with minimum two-year follow-up (average 36.7±16 months) were enrolled in our study. Indications of the BIO-RSA were rotator cuff tear arthropathy, massive irreparable cuff tear without osteoarthritis, primary osteoarthritis with glenoid defect, recurrent shoulder dislocation with massive cuff tear, and glenoid fracture sequela. We excluded patients with acute proximal humerus fracture, avascular necrosis and revision RSA performed using allo- or autograft. We evaluated clinical and radiological outcomes of BIO-RSA at the last follow-up. Results: VAS, ASES, UCLA, and SST scores improved significantly from preoperative (average-5, 39.4, 16.2, 3.9) to postoperative (average- 1.7, 78.9, 28.3, 7.8, p-value < 0.05). All range of motion except internal rotation improved significantly at the last follow-up (p-value <0.05) and the bone graft was incorporated with the native glenoid in all the cases (100%). However, scapular notching was observed in 23/38 (60.5%) of patients. Intraoperative complications were three metaphyseal fractures and one inferior screw malpositioning. Postoperative complications included one heterotropic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection. Conclusions: BIO-RSA results in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantage of glenoid lateralization were observed in our study along with similar complications rates as compared to conventional RTSA, we observed higher rates of scapular notching to previously reported rates in BIO-RSA studies.

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