Search Results (79)

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Lipoma arborescens (LA) is a rare, non-neoplastic, intra-articular, mass-like lesion with villous lipomatous proliferation that replaces and distends the synovium, particularly in the knee joint. A few cases have been sporadically reported to affect the shoulder, elbow, wrist, hip, and ankle. The authors would like to present a rare and unique case of LA in the elbow joint with significant osteoarthritis in a 24-year-old young man, which suggests that a longstanding pre-existing LA can give rise to severe degenerative arthritis even in young patients unless diagnosed early and adequately treated. Full article

Background: Ferrous metals are used extensively in the manufacturing of plates, pins, Kirschner wires (K-wires), and screws, and in the performance of partial and total joint replacement surgeries for the shoulder, elbow, and wrist joints. The primary surgical procedures commonly performed are hip and knee replacement surgeries. Metals possess a combination of high modulus, yield point, and ductility, rendering them well suited for load-bearing applications, as they can withstand significant loads without experiencing substantial deformations or permanent alterations in their dimensions. Application of metals and alloys is of prime importance in orthopedics as they lead the way to overcoming many issues encountered in implant use. In some instances, pure metals are used, but alloys consisting of two or more elements typically exhibit greater material characteristics, including corrosion resistance as well as toughness. The first item to address when selecting a metallic implant material is its biocompatibility. In this regard, three classes of materials are also commonly known as biomedical metals—316L stainless steel, pure titanium, and titanium alloys. Objective: The aim of this work is to create a model describing the material behavior and then simulate the metals under a load of 2300 N, which is equivalent to plastic loading. Methods: Under ten different case studies, a sub-routine was developed to combine the material characteristics of titanium and 316L stainless steel with the software. Results: The outcomes of the research were then investigated. A femur model was created using ANSYS software, and two materials, stainless steel and titanium, were used. The model was then exposed to a force of 2300 N. Full article

Background/Objectives: Pneumatocysts, characterized by gas-filled cavities, are commonly found in the spine and pelvis but are rarely observed in the scapula. In this report, we describe two rare cases of scapular pneumatocysts mimicking bone tumors and exhibiting different image findings. Case Report: Case 1. A 47-year-old man who presented with neck pain underwent radiography, followed by magnetic resonance imaging (MRI). MRI showed heterogeneity with low and high signals on fat-suppressed T2-weighted images, suggestive of enchondroma or fibrous dysplasia (FD). However, preoperative computed tomography (CT) revealed gas-filled cavities within the tumor, in continuity with the shoulder joint, confirming the diagnosis of a pneumatocyst. Case 2. A 58-year-old woman who presented with neck pain underwent similar examinations to Case 1. MRI showed homogeneity with high signals on fat-suppressed T2-weighted images, leading to a suspicion of solitary bone cysts and FD. Preoperative CT revealed gas-filled cavities within the tumor, but no continuity with the joint, leading to the diagnosis of a pneumatocyst. While the exact etiology of pneumatocysts remains unclear, two potential causes are as follows: (i) gas migration from the joint to the bone, and (ii) gas replacement in cystic tumors. Thus, CT is particularly valuable in confirming the presence of gas-filled cavities and aiding in diagnosis. Conclusions: This report highlights two extremely rare cases of scapular pneumatocysts, reflecting two potential etiologies. The utility of CT in the diagnosis of pneumatocyst has been clarified. Full article

Background: Over the past few decades, shoulder arthroplasty has evolved rapidly, driven by a growing demand for surgical solutions to degenerative, traumatic, and irreparable rotator cuff-related pathologies, particularly in an aging but increasingly active population. Objective: This narrative review aims to examine the main clinical indications and the most commonly used implant designs, highlighting differences in functional outcomes, complication rates, and revision rates between anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA). Methods: Articles published between 2011 and 2025 were selected through PubMed and the Australian Joint Replacement Registry reports from 2023 and 2024. The included studies comprised randomized controlled trials, systematic reviews, and meta-analyses involving adult patients treated for primary osteoarthritis, proximal humerus fractures, and massive irreparable rotator cuff tears. Results: ATSA remains the preferred option in younger patients with an intact rotator cuff, due to superior outcomes in mobility and prosthesis longevity. However, glenoid component loosening remains a significant limitation. Initially reserved for irreparable cuff tears and complex fractures, RTSA has seen a progressive expansion of its indications, offering lower revision rates and satisfactory functional results, particularly in elderly patients. Recent prosthetic innovations include stemless implants, augmented glenoid components, and convertible platforms. Conclusions: The choice between ATSA and RTSA should be individualized, based on patient-specific factors such as age, rotator cuff integrity, functional demands, and bone quality. Advances in implant materials and design, together with improved patient selection, have significantly enhanced clinical outcomes. Full article

According to standards, the heel soles of running shoes are currently tested with an energy absorption of 5 J. This study offers an alternative method to improve the measurement of cushioning properties. The new method uses the ratio of absorbed energy to applied force and determines the maximum of this ratio (optimum or shoulder point) and the associated optimal force, energy, and displacement. This method was applied to 112 shoe models using compression testing. The method was found to be insensitive to strain rates and identified shoes that were over-, well-, or under-designed (running before, at, or after the shoulder point, respectively) relative to the range of the first ground reaction force peak (0.700–2 kN). The optimum ratio was between 0.6 J/kN (barefoot shoes) and 11.2 J/kN (Puma RuleBreaker), the optimal energy was between 0.5 and 40.6 J, the optimal force was between 0.1 and 4.6 kN, and the optimal displacement was between 3 and 23 mm. Participants ran at or near the shoulder point (within the design forgiveness range) unless they were too heavy and ran at their preferred running speed. This study proposes replacing current standards with the new method, allowing consumers to make informed decisions regarding injury prevention while running. Full article

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. Full article

Background/Objectives: The vast amount of research and data on periprosthetic joint infection (PJI) is focussed on infections in hip and knee replacements. This article aims to highlight the special features of PJI in shoulders. Methods: This narrative review is based on the recent and most relevant literature regarding PJI in general, and in shoulders in particular. Results: While the majority of findings for PJI in hips and knees can be transferred to infected shoulder arthroplasties, shoulder PJI represents a unique entity with a different microbial profile and its own diagnostic challenges. Conclusions: As profound evidence for shoulder PJI is lacking, diagnostic and therapeutic algorithms should be transferred from those for PJI in hips and knees. Further research is necessary to determine optimal management of shoulder PJI. Full article

Metabolic syndrome (MetS) associated with Osteoarthritis (OA) is an increasingly recognised entity. Whilst the degenerative pattern in cuff-tear arthropathy (CTA) has been well documented, the biological processes behind primary shoulder OA and CTA remain less understood. This study investigates transcriptomic differences in these conditions, alongside the impact of MetS in patients undergoing total shoulder replacement. In a multi-centre study, 20 OA patients undergoing total shoulder replacement were included based on specific treatment indications for OA and cuff-tear arthropathy as well as 25 patients undergoing rotator cuff repair (RCR) as a comparator group. Tissues from subchondral bone, capsule (OA and RCR), and synovium were biopsied, and RNA sequencing was performed using Illumina platforms. Differential gene expression was conducted using DESeq2, adjusting for demographic factors, followed by pathway enrichment using the mitch package. Gene expressions in CTA and primary OA was differentially affected. CTA showed mitochondrial dysfunction, GATD3A downregulation, and increased cartilage degradation, while primary OA was marked by upregulated inflammatory and catabolic pathways. The effect of MetS on these pathologies was further shown. MetS further disrupted WNT/β-catenin signalling in CTA, and in OA. Genes such as ACAN, PANX3, CLU, and VAT1L were upregulated, highlighting potential biomarkers for early OA detection. This transcriptomic analysis reveals key differences between end-stage CTA and primary glenohumeral OA. CTA shows heightened metabolic/protein synthesis activity with less immune-driven inflammation. Under MetS, mitochondrial dysfunction (including GATD3A downregulation) and altered Wnt/β-catenin signalling intensify cartilage and bone damage. In contrast, primary OA features strong complement activation, inflammatory gene expression, and collagen remodelling. MetS worsens both conditions via oxidative stress, advanced glycation end products, and ECM disruption—particularly, increased CS/DS degradation. These distinctions support targeted treatments, from antioxidants and Wnt modulators to aggrecanase inhibitors or clusterin augmentation. Addressing specific molecular disruptions, especially those amplified by MetS, may preserve shoulder function, delay surgical intervention, and improve long-term patient outcomes. Full article

Background: Total elbow arthroplasty (TEA) has evolved over time from a salvage procedure to a successful treatment of end-stage primary and secondary arthritis. However, the aseptic loosening and the associated reduced survival rate are still concerning. Thus, TEA is typically contraindicated in young and active patients where high-demand activities would promote aseptic loosening. For this reason, postoperative weightlifting limitations are often suggested, yet there is no consensus. The aim of this survey was to collect and analyze the current practice concerning the weightlifting restrictions following elbow arthroplasties among members of the Italian Society of Shoulder and Elbow Surgery (Società Italiana Chirurgia Spalla e Gomito, SICSeG). Methods: An online survey on the lifting restrictions after elbow arthroplasties was submitted to all members of the SICSeG. Results: In total, 36 members of the Italian society completed the survey. Only five consultants (13.8%) have experience with all the implants analyzed, of whom only three have experience with more than 10 implants per year. Concerning the comprehensive number of elbow arthroplasties performed per year, most of the respondents (45.7%) reported fewer than five surgeries per year, whereas only two surgeons claimed more than 20 procedures. Of the 36 respondents, 32 (88.9%) reported lifelong lifting limitations after linked TEA. In detail, these lifting restrictions were 10 lb in 14 responders (38.9%) and 5 lb in 15 responders (41.7%) performing linked TEA. A lifelong lifting limitation gradually decreased after unlinked TEA and hemiarthroplasty (HA) being advised by 82.8% (24/36) and 64.5% (20/36), respectively. Conclusions: To increase implant longevity, most Italian surgeons advise lifting restrictions after TEA. More than 80% of the responders agreed with suggesting lifelong limitations, but a greater variability was found in the amount of weight to which the patients are restricted. Currently, the lack of consensus on the optimal weightlifting restrictions after elbow replacements emphasizes the need for more studies focusing on elbow joint loading during different activities of daily life to improve implant survival rates. Full article

Background/Objectives: Testosterone replacement therapy (TRT) has become increasingly common, particularly for patients with symptomatic hypogonadism or individuals undergoing gender-affirming therapy. The current literature is inconclusive on the association between TRT and orthopedic surgery. This study sought to examine outcomes of reverse total shoulder arthroplasty (RSA) in patients receiving TRT. Methods: A retrospective cohort of RSA patients from 2010 to 2022 was queried using the PearlDiver database. Patients were included if they underwent RSA with at least 2 years of follow-up. Patients who underwent at least 90 days of TRT prior to their surgery were matched by Charlson Comorbidity Index, age, and gender to a control cohort. Univariate analysis using chi-squared tests and Student’s t-tests were used to compare demographics outcomes between groups. Results: A total of 1906 patients were identified who used TRT within 90 days of undergoing RSA, and these patients were matched to a control cohort of 1906 patients. Patients who used TRT within 90 days did not have significantly different rates of revision RSA (12.01%) compared to those without use (11.02%) (p = 0.335). Furthermore, between the TRT group and the control group, PJI rates (1.42% vs. 1.63%; p = 0.597) and periprosthetic fracture rates (0.58% vs. 1.05%, p = 0.105) were not significantly different. Conclusions: This study demonstrated that TRT use within 90 days of RSA does not increase the rates of revision, fracture, or infection. These results can assist surgeons when evaluating patients on TRT who also may be candidates for RSA. Full article

The structural deformation monitoring of civil infrastructures can be performed using different geomatic techniques: topographic measurements with total stations and levels, TLS (terrestrial laser scanning) acquisitions, and drone-based SfM (structure from motion) photogrammetric surveys, among others, can be applied. In this work, these techniques are used for the floodgate gaps and the rubber joints deformation monitoring of the MOSE system (Modulo Sperimentale Elettromeccanico), the civil infrastructure that protects Venice and its lagoon (Italy) from high waters. Since the floodgates are submerged most of the time and cannot be directly measured and monitored using high-precision data, topographic surveys were performed in accessible underwater tunnels. In this way, after the calculation of the coordinates of some reference points, the coordinates of the floodgate corners were estimated knowing the geometric characteristics of the system. A specific activity required the acquisition of the TLS scans of the stairwells in the shoulder structures of the Treporti barrier because many of the reference points fixed on the structures were lost during the placement of elements on the seabed. They were replaced with new points whose coordinates in the project/as-built reference system were calculated by applying the Procrustean algorithm by means of homologous points. The procedure allowed the estimation of the transformation parameters with maximum residuals of less than 2.5 cm, a value in agreement with the approximation of the real concrete structures built. Using the obtained parameters, the coordinates of the new reference points were calculated in the project reference system. Once the 3D orientation of all caissons in the barrier was reconstructed, the widths of the floodgate gaps were estimated and compared with the designed values and over time. The obtained values were validated in the Treporti barrier using a drone-based SfM photogrammetric survey of the eight raised floodgates, starting from the east shoulder caisson. The comparison between floodgate gaps estimated from topographic and TLS surveys, and those obtained from measurements on the 3D photogrammetric model, provided a maximum difference of 1.6 cm. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is one of the most common complications after joint replacement. Two-stage revision remains the standard of care in chronic infections. The aim of this systematic review was to investigate the outcomes, complications, and eradication rates of two-stage revision surgery to treat PJI of the shoulder, elbow, hip, and knee. Methods: A total of 36 studies were included. Patient demographics, follow-up, the visual analog scale (VAS) for pain, the Constant–Murley score (CMS) for shoulder, the Harris Hip Score (HHS) for hip, the Knee Society Score (KSS) for knee, the range of motion (ROM), number and types of complications, and eradication rate were recorded. Results: A total of 2484 patients were identified, of whom 145, 29, 1269, and 1041 underwent two-stage revision surgery for shoulder, elbow, hip, and knee infections, respectively. The overall mean follow-up was 5.7 ± 4.5 years. The overall mean time of re-implantation was 20.8 ± 21.3 weeks. The most common causative bacteria were Cutibacterium acnes (32.7%) for shoulder, Methicillin-Sensitive Staphylococcus aureus (44.4%) for elbow, and Staphylococcus coagulase negative (CNS) (31.3% and 23%) for hip and knee infection, respectively. The mean overall preoperative VAS score was 6.7 ± 2.3, while, postoperatively, the mean score was 4.5 ± 2.7 (p < 0.001). A total of 2059 out of 2484 patients (82.9%) experienced eradication. Conclusions: Two-stage revision is an effective procedure to treat PJI with an overall eradication rate of 83%. A significant recovery of functionality and a decrease in residual pain can be achieved after surgery. Aseptic loosening and re-infection were the most common complications in shoulder and hip infections. Death rate was high in knee infections. Full article

Background: Rotator cuff (RC) repair leads to less than optimal results when dealing with massive lesions, so the use of scaffolds as biological support has been proposed to improve RC repair site biology. The present study aims to evaluate the clinical and radiographical outcomes of a series of patients suffering from massive or irreparable RC tears treated with patch (porcine or human scaffolds) repair (augmentation or bridging). Methods: Twenty-three patients with a minimum follow-up of 24 months were subjectively, clinically, and radiographically assessed before and after surgery. Three different patient-related outcome measurements (PROMs) (American Shoulder and Elbow Surgeons score, Constant score, visual analog scale) were used for the subjective and clinical evaluation, while plain radiographs and magnetic resonance imaging where employed for radiographical follow-up. Results: Regardless of the technique (augmentation or bridging) or type of scaffold (porcine or human) employed, at follow-up, all patients experienced a statistically significant improvement in all PROMs and clinically. Conclusions: Patch repair represents a valid salvage procedure in massive or irreparable RC tears, improving the quality of life and eventually delaying the need for prosthetic replacement. Full article

(1) Background: The aims of this study were to compare serial changes in outcome measures in the early postoperative period after rotator cuff repair (RCR), anatomical total shoulder replacement (ATSR), and reverse total shoulder replacement (RTSR). (2) Methods: In total, 143 patients who underwent RCR (n = 47), ATSR (n = 46), and RTSR (n = 50) were included. The visual analogue scale (VAS) for pain, the activity of daily living (ADL) score, and the American Shoulder and Elbow Surgeons (ASES) score were completed. (3) Results: At 3 months, the recovery rate for the VAS pain score was 43.7% in the RCR, 89.1% in the ATSR, and 78.4% in RTSR. The recovery rate for the ADL score was 36.3%, 69.5%, and 76.4%. The recovery rate for ASES score was 40.9%, 79.5%, and 77.4%. For all outcome measures, a lower recovery rate was observed in the RCR group than in the ATSR and RTSR groups. At 6 months after surgery, the recovery rate for the VAS pain score was 69.9%, 100%, and 90.3%. The recovery rate for the ADL score was 66.8%, 92.8%, and 91.5%. The recovery rate for the ASES score was 68.7%, 96.5%, and 90.9%. (4) Conclusion: Compared with ATSR and RTSR, a slower recovery rate was observed for RCR, measured to be approximately 40% at 3 months and 70% at 6 months after surgery. Rapid improvement in pain and shoulder function was achieved after ATSR and RTSR, with a recovery rate of over 70% at 3 months and over 90% at 6 months after surgery. Full article