The treatment of symptomatic articular cartilage defects of the knee has evolved tremendously in the past decade. Previously, there were limited treatment options available to patients who suffered from either partial-thickness or full-thickness cartilage lesions. Because articular cartilage has a limited capacity for healing, patients were often treated symptomatically until they became candidates for osteotomy or total joint replacement. Recently, both reparative and restorative procedures have been developed to address this significant source of morbidity in young active patients. Microfracture is a reparative technique that induces a healing response to occur in an area of articular cartilage damage. Osteochondral autografts and allografts in addition to autologous chondrocyte implantation are restorative techniques aimed at recreating a more normal articular surface. Both types of procedures have been developed to alleviate the symptoms associated with focal chondral defects, as well as limit their potential to progress to a diffuse degenerative arthritis. Treatment can vary depending on both cartilage defect and patient factors. This article summarizes the various treatment options that have recently become available.

Hemiarthroplasty can provide good long-term results in rotator cuff-deficient patients with glenohumeral arthritis. Patients who have preoperative forward elevation of >or=90 degrees benefit the most. A low complication rate can be expected for this procedure.

Hemiarthroplasty can provide good long-term results in rotator cuff-deficient patients with glenohumeral arthritis. Patients who have preoperative forward elevation of > or =90 degrees benefit the most. A low complication rate can be expected for this procedure.

Introduction: Accurate restoration of the humeral joint line during shoulder arthroplasty is critical to maximizing outcomes. However, clinical studies show that both resurfacing and stemmed arthroplasty systems routinely do not restore the articular surface accurately, even by experienced surgeons. The purpose of this study was to evaluate surgeons' ability to recreate the 3-dimensional geometry of the proximal humerus using a newly developed arthroplasty system. Methods: The difference in articular surface location before and after arthroplasty was measured using a new nonspherical arthroplasty system which uses a calibrated multiplanar osteotomy technique matching bone removal thickness to implant thickness. Eight human cadaver specimens were measured at 9 separate point locations over the articular surface from a fixed reference point on the lateral humerus. We repeated the measurements after bone preparation with the implant trial. Articular surface points >3.0 mm from their original location were considered outliers, based on literature. Results: Average absolute deviation of each point on the articular surface measured 0.9 AE 0.7 mm (range: 0.0-2.7 mm) from preoperative to postoperative articular surface location. All (72/72) points measured were below the 3.0 mm outlier threshold from their original location. Conclusion: Surgeons using the new system, ie, using a nonspherical head design and a calibrated multiplanar osteotomy surgical technique, were able to restore the joint line accurately with minimal (<1.0 mm) change from preop, with no outliers. Arthroplasty systems matching bone removal directly to implant thickness potentially may improve the reproducibility of arthroplasy and improve shoulder kinematics compared to traditional systems.

Background: Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods: The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as DCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canalsparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with DCOR !3.0 mm were deemed clinically significant outliers. Results: The average DCOR in the MPO group was 1.7 AE 1.2 mm versus 2.8 AE 1.5 mm in the stemmed group (P ¼.00005). The incidence of outliers was lower (14.5% vs 40.0%, P ¼.005), and there were more cases with a DCOR 1.0 mm (32.7% vs 3.6%, P ¼.0001) in the MPO group compared to the stemmed group. Conclusion: The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.