Preservation and repair of the hip joint capsule causes an 88-%-reduction of the dislocation rate in primary THA in this large series including 1972 cases, operated via the Bauer or the anterolateral approach. Several authors reported comparable results after THA using similar techniques of soft tissue and capsular repair through the posterior or posterolateral approach. Sparing and reconstructing the hip joint capsule therefore seems to reduce the dislocation rate after primary THA by one order of magnitude regardless of the surgical approach and, especially, if the acetabular origin is preserved. Capsule-related specific complications such as an increased revision rate, malfunction or pain were neither recorded in our study nor by others. Thus, careful preservation and reconstruction of the hip joint capsule may be expressly recommended in primary THA.

Objective: To evaluate the clinical outcomes of reverse shoulder arthroplasty (RSA) in elderly patients with proximal humeral fractures and assess the role of tuberosity healing on the outcome. Design: Case series. Setting: Multicenter clinical study of Level-2 trauma centers. Patients/Participants: We included 81 patients with a mean age of 78.5 ± 6.5 years (range, 58.5–90.9 years) and a nonreconstructable proximal humeral fracture. Intervention: Modular reverse fracture shoulder arthroplasty. Main Outcome Measurements: We determined range of motion, constant score, and the American Shoulder and Elbow Surgeons Shoulder Score as clinical outcomes and evaluated tuberosity healing at 6 weeks, 6 months, 1 year, and 2 years. Results: Tuberosities healed in most patients; 37 patients had completely healed tuberosities, and 33 patients had partially healed tuberosities, whereas 11 patients had unhealed tuberosities. However, no significant differences were found in the functional outcomes among the 3 groups (P > 0.05). Conclusions: Our results with a modular reverse prosthesis confirmed similar constant scores, American Shoulder and Elbow Surgeons Shoulder Scores, and tuberosity healing rates as reported in the current clinical evidence for RSA. We could not confirm that tuberosity healing improved functional outcomes; however, it should be noted that tuberosity healing was assessed using standard radiographs. Nevertheless, our study strengthens the consensus that RSA can be recommended for well-selected elderly patients with complex displaced proximal humeral fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The explosion of data volumes in enterprise environments and limited budgets have triggered the need for multitiered storage systems. With the bulk of the data being extremely infrequently accessed, tape is a natural fit for storing such data. In this paper we present our approach to a file storage system that seamlessly integrates disk and tape, enabling a bottomless and cost-effective storage architecture that can scale to accommodate Big Data requirements. The proposed system offers access to data through a POSIX filesystem interface under a single global namespace, optimizing the placement of data across disk and tape tiers. Using a self-contained, standardized and open filesystem format on the removable tape media, the proposed system avoids dependence on proprietary software and external metadata servers to access the data stored on tape. By internally managing the tape tier resources, such as tape drives and cartridges, the system relieves the user from the burden of dealing with the complexities of tape storage. Our implementation, which is based on the GPFS and LTFS filesystems, demonstrates the applicability of the proposed architecture in real-world environments. Our experimental evaluation has shown that this is a very promising approach in terms scalability, performance and manageability. The proposed system has been productized by IBM as LTFS Enterprise Edition.

ZusammenfassungDie Behandlung ausgeprägter glenoidaler Knochendefekte ist herausfordernd. Patientenindividuelle glenoidale Implantate stellen diesbezüglich ein neues Verfahren dar, welches mit enormen potenziellen Vorteilen behaftet ist. Die eigenen Erfahrungen zeigen, dass mit dieser Technologie einerseits der glenoidale Knochendefekt reproduzierbar wiederherzustellen ist und andererseits eine stabile Verankerung und eine hochpräzise Implantatpositionierung entsprechend der präoperativen Planung erzielt werden kann. Dies stellt sich besonders im Vergleich zu Alternativverfahren, wie der knöchernen Glenoidaugmentation, als substanzieller Vorteil der Technik für diese häufig hochdefizitären und anspruchsvollen Situationen dar. Nach Durchführung einer Computertomographie (CT) der Schulter wird präoperativ das individuelle Implantatdesign dreidimensional detailliert computergestützt geplant. Von zentraler Bedeutung für die korrekte und planungsgetreue Positionierung des definitiven Implantats während der Operation ist eine präzise Einbringung eines Kirschner-Drahts mittels PSI(„patient specific instrumentation“)-Guide.. Nach Fixation der glenoidalen Komponente kann diese mit Standardimplantaten des jeweiligen Systems kombiniert werden. Die aktuell vorhandene Literatur ist ermutigend und zeigt, dass kurzfristig signifikante klinische Erfolge mit dem Verfahren erzielbar sind. Weitere Forschung im Sinne von biomechanischen Untersuchungen und längeren Nachuntersuchungszeiträumen ist wünschenswert, um die Wertigkeit des Verfahrens weiter zu präzisieren.

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