Background: The incidence of deep vein thrombosis (DVT) after shoulder replacement surgery is not well documented. Evidence that exists on thromboprophylaxis for upper limb surgery is based on level III and level IV studies. The hypothesis for the current study was that the incidence of DVT following shoulder replacement would be less than the published prevalence in hip and knee arthroplasties.

Background: Reverse shoulder arthroplasty (RSA) has increased in popularity and its indications have subsequently been expanded. With its increased use, the complication rates have also increased. Complications requiring additional surgeries have the highest morbidity and cost. The aim of this study was to determine the indications for additional surgery following RSA. Methods: All the surgical and clinical notes of patients treated with an RSA at our institution over a nine-year period were retrospectively reviewed. Sixty-seven RSAs met the inclusion criteria and their records were reviewed to assess their indication for surgery, complications, as well as microbiology results if infection was present. Results: Surgical reintervention was required in 16 (23.9%) RSAs. The prevalence was lowest in rotator cuff arthropathy and glenohumeral arthritis (nine RSAs or 18.4%), followed by failed hemi-or total shoulder arthroplasty (four RSAs or 36.4%) and highest if performed for uncommon conditions (two RSAs or 66.7%). Instability was an early complication, occurring in 10.7% of cases and accounting for 37.8% of all reinterventions. Infection was a late complication, occurring in 6.0% of cases and accounting for 48.6% of all reinterventions. The most common organisms identified were Staphylococcus epididermidis (n=4), Escherichia coli (n=3), Staphylococcus aureus (n=2) and Klebsiella pneumonia (n=2). Conclusions: RSA has the most reliable outcomes if performed for rotator cuff arthropathy and glenohumeral osteoarthritis. Instability and infection are the most common indications for surgical reintervention, and once present, often require repeated surgeries to be successfully treated. These complications should be avoided, as they are major contributors to morbidity and cost.

Introduction: Many patients suffer from a decrease in grip strength due to various conditions of the wrist, including osteoarthritis. A stable painless wrist is essential for normal function of the hand. Many patients are offered a total wrist fusion to alleviate their pain and increase their grip. There is a dearth of literature investigating the effect of total wrist arthrodesis on grip strength utilising the same side as a reference. Methods: A prospective study was done to determine change in grip strength and patient-reported outcome measurements postoperatively as compared to same-side pre-operative values in subjects undergoing total wrist arthrodesis with a minimum follow-up of one year. Grip strength was measured pre-operatively and at least one year post-operatively using the Jamar® (Patterson Medical) dynamometer in the standardised method as part of set protocol. Functional outcomes were assessed by the patients completing Disabilities of Arm, Shoulder and Hand (DASH) scores, pre-operatively and at one-year follow-up. The differences in measures were assessed using a paired samples T-test, as well as percentage changes between measurements. Results: Twenty-two patients were evaluated, with a mean age of 49.6 years (range 19-85). The mean follow-up was 27 months (12-52 months). The grip strength in the affected hand improved on average by 12.6 kg (p<0.001; CI 95% [7.7, 17.3]). The grip in the affected hand was 84.5% compared to the pre-operative value of the unaffected side (32.8 kg vs 38.8 kg; p<0.001). The DASH score improved by 27.8 points (p=0.1). Conclusion: Total wrist fusion remains a reliable procedure to restore a power grip at the expense of wrist movement. It is a suitable option for a high-demand patient with an isolated wrist problem.