Arthroplasty of the Shoulder and Elbow

Implant sonication for the diagnosis of prosthetic elbow infection

“…Data on infection rates after elbow arthroplasty are sparse, with reported incidences of infection varying from 0% to 12% and averaging 5%. 4 The infection rate for procedures performed at our institution decreased from 9% (between 1973 and 1979) 11 to 3% (between 1981 and 1994), 18 likely because of the routine use of antibiotic-impregnated polymethyl methacrylate and careful handling of the surrounding soft tissue with improved surgical techniques.…”

Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results

“…19,20,25,37,43,47,49,50,70 Several techniques have been described to reconstruct severe bone loss of the glenoid, including staged revisions as well as the use of autografts and allografts. 1,2,4,7,12,13,19,41,52,53,54,55,68 All techniques have their inherent drawbacks, however, and no ideal approach to reconstruct severely deficient glenoids has so far been identified. The aim of this article is to present a new 1-stage technique that has been developed in our institution for glenoid reconstruction in the setting of massive uncontained glenoid bone loss.…”

Musculoskeletal System

“…With hemiarthroplasty, there is less risk for shoulder instability than with TSA, but there is also less consistent pain relief. 82 Physical Therapy after Shoulder Arthroplasty. Initial postoperative rehabilitation after TSA or shoulder • Straight-leg raises with isometric quad setting to ensure full knee-extension ROM should be achieved before lifting of leg off bed (i.e., no quad lag) • Active exercises for hip abduction and hip adduction in supine or standing to assist in controlling limb when getting into and out of bed Transfer, gait, and stair training with the appropriate assistive device should begin as soon as possible.…”

“…Therapeutic exercises during the immediate postoperative phase should include [82][83][84]86 : • Supine passive forward flexion with elbow flexed; patient may passively move involved arm by using opposite hand to guide the movement ( Figure 5-17, A) • Supine passive external rotation with arm at side and elbow flexed to no more than 30 degrees; patient may passively move involved arm by using a wand or cane • Pendulum exercises, clockwise and counterclockwise (see Figure 5-17, B) Based on the patient's surgical procedure, other therapeutic exercises might be encouraged by the surgeon; some of the listed exercises might also be postponed until later in the rehabilitation process. Outpatient physical therapy during which further hemiarthroplasty should emphasize functional mobility training to ensure independence with all ADLs, transfers, and ambulation and patient education on therapeutic exercises to minimize adhesion formation.…”

“…82 The success of this technique is primarily due to positioning the center of rotation of the shoulder more inferior and medial, which causes shoulder stability and function to rely heavily on the deltoid muscle. 88 The new position of the deltoid allows it to elevate the arm in the presence of rotator cuff deficiency.…”