The purpose of this study was to describe the outcome after reversed Delta III shoulder prosthesis in patients with rheumatoid arthritis (RA) and irreparable rotator cuff tear. Fifteen patients (17 joints) were prospectively analysed using the Constant-Murley score (CS). Comprehensive outcome measure was carried out by means of four widely used questionnaires as well as clinical and radiographic examinations at an average of 24.3 months postoperatively. The CS improved significantly from 19 to 59.5 points. The mental (MSC) and physical (PCS) component summary score of the Short Form 36 (SF-36) reached 108% and 77%, respectively, while the DASH (Disabilities of the Arm, Shoulder, and Hand) was 58% of a comparative norm population. Remaining deficits were documented by SPADI (Shoulder Pain and Disability; 54.4 points) and ASES (clinical and patient-orientated American Shoulder and Elbow Surgeons; 84.3 and 61.3 points, respectively). No radiological signs of loosening were found, but scapular notching occurred in four cases.Reversed arthroplasty provides a substantial improvement of shoulder function in patients with RA. The high incidence of notching is of concern.Resume Résultats à court terme de la prothèse inversée de type Delta III chez les patients porteurs d'une arthrite rhumatoïde et d'une lésion irréparable de la coiffe. Objectif: décrire le devenir du patient après mise en place d'une prothèse d'épaule inversée type Delta III, chez les patients présentant une arthrite rhumatoïde (RA) et des lésions irréparables de la coiffe. Méthode: 15 patients (17 articulations) ont été analysés de façon prospective en utilisant le score de Constant Murley (CS). Le devenir clinique des patients a été exploré grâce à 4 questionnaires utilisés communément tant sur le plan clinique que radiographique avec un examen en moyenne à 24,3 mois post-opératoires. Résultats: le score de Constant a été amélioré de façon significative passant de 19 à 59,5 points. Le score MCS et PCS ainsi que le score SF-36 sont passés respectivement de 108 à 77%, le score DASH à 58% comparables à la norme de la population. Les déficits résiduels ont été randomisés par le score SPADI 54,4 points et ASES respectivement de 84,3 à 61,3 points. Aucun signe radio de descellement mais 4 cas d'encoche scapulaire ont été relevés. En conclusion, la prothèse inversée d'épaule permet d'avoir une amélioration très substantielles chez les patients présentant une arthrite rhumatoïde. La fréquence importante des encoches est à surveiller.

The SALTO prosthesis provided good clinical and functional results and we believe helps validate the concept of anatomic replacement.

Although the agreement analysis was performed for the German translation of the two questionnaires, analogous results can be expected also for other languages. It should be noted that the results do not allow for judging which of the scores is better suited to give a valid statement on patient outcome in treatment of hindfoot disorders. To verify which of these two scores is better suited to represent hindfoot-dysfunction a subsequent study using instrumental gait analysis and surface EMG is being carried out.

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ObjectiveAfter cross-cultural adaption for the German translation of the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS-AHS) and agreement analysis with the Foot Function Index (FFI-D), the following gait analysis study using the Oxford Foot Model (OFM) was carried out to show which of the two scores better correlates with objective gait dysfunction.Design and participantsResults of the AOFAS-AHS and FFI-D, as well as data from three-dimensional gait analysis were collected from 20 patients with mild to severe ankle and hindfoot pathologies.Kinematic and kinetic gait data were correlated with the results of the total AOFAS scale and FFI-D as well as the results of those items representing hindfoot function in the AOFAS-AHS assessment. With respect to the foot disorders in our patients (osteoarthritis and prearthritic conditions), we correlated the total range of motion (ROM) in the ankle and subtalar joints as identified by the OFM with values identified during clinical examination ‘translated’ into score values. Furthermore, reduced walking speed, reduced step length and reduced maximum ankle power generation during push-off were taken into account and correlated to gait abnormalities described in the scores. An analysis of correlations with CIs between the FFI-D and the AOFAS-AHS items and the gait parameters was performed by means of the Jonckheere-Terpstra test; furthermore, exploratory factor analysis was applied to identify common information structures and thereby redundancy in the FFI-D and the AOFAS-AHS items.ResultsObjective findings for hindfoot disorders, namely a reduced ROM, in the ankle and subtalar joints, respectively, as well as reduced ankle power generation during push-off, showed a better correlation with the AOFAS-AHS total score—as well as AOFAS-AHS items representing ROM in the ankle, subtalar joints and gait function—compared with the FFI-D score.Factor analysis, however, could not identify FFI-D items consistently related to these three indicator parameters (pain, disability and function) found in the AOFAS-AHS. Furthermore, factor analysis did not support stratification of the FFI-D into two subscales.ConclusionsThe AOFAS-AHS showed a good agreement with objective gait parameters and is therefore better suited to evaluate disability and functional limitations of patients suffering from foot and ankle pathologies compared with the FFI-D.