Werthel, J-D.

Aim: Compare the effect of Latarjet and Trillat procedures on glenohumeral stability and range of motion. Background: Little is known about the impact of the location of the sling effect on joint stability and range of motion. Methods: 12 cadaveric shoulders were cleaned of soft tissue except for the subscapularis, conjoined tendon, and anterior capsule. A custom-made apparatus generating anterior humeral translation and joint compression was used. The machine applied compression load in the medial direction. The subscapularis and conjoint tendon were loaded. Internal/external range of motion and joint stability were assessed at 0°, 30° and 60° glenohumeral abduction. Range of motion was assessed by rotating the humeral shaft. Joint stability was assessed at maximum external rotation, translating the humerus. Specimen were tested in five conditions: 1) intact shoulder, 2) 6-mm bony glenoid defect (20% defect) 3) Trillat procedure, 4) Latarjet procedure with subscapularis split at the junction between its superior 2/3rds and inferior 1/3 rd, 5) Latarjet procedure with subscapularis split at the superior 1/3rds and inferior 2/3rds. Means were compared with a full factorial-repeated measures ANOVA with pairwise post hoc comparisons. Results: Peak translation force and stability ratio were significantly lower with the glenoid defect when compared to the intact and all the repaired conditions at all levels of glenohumeral abduction. The level of the subscapularis split had no significant influence on these values and no significant difference could be found between Trillat and Latarjet procedures. Range of motion in internal and external rotation were not significantly different between the different conditions. Conclusions: Joint stability and range of motion after a Latarjet are not impacted by the location of the subscapularis muscle split. Trillat and Latarjet techniques provide comparable stabilization of the joint, even in the presence of a critical bony defect of the glenoid.

Aims In the initial development of total shoulder arthroplasty (TSA), the humeral component was usually fixed with cement. Cementless components were subsequently introduced. The aim of this study was to compare the long-term outcome of cemented and cementless humeral components in arthroplasty of the shoulder. Patients and Methods All patients who underwent primary arthroplasty of the shoulder at our institution between 1970 and 2012 were included in the study. There were 4636 patients with 1167 cemented humeral components and 3469 cementless components. Patients with the two types of fixation were matched for nine different covariates using a propensity score analysis. A total of 551 well-balanced pairs of patients with cemented and cementless components were available after matching for comparison of the outcomes. The clinical outcomes which were analysed included loosening of the humeral component determined at revision surgery, periprosthetic fractures, post-operative infection and operating time. Results The overall five-, ten-, 15- and 20-year rates of survival were 98.9%, 97.2%, 95.5%, and 94.4%, respectively. Survival without loosening at 20 years was 98% for cemented components and 92.4% for cementless components. After propensity score matching including fixation as determined by the design of the component, humeral loosening was also found to be significantly higher in the cementless group. Survival without humeral loosening at 20 years was 98.7% for cemented components and 91.0% for cementless components. There was no significant difference in the risk of intra- or post-operative fracture. The rate of survival without deep infection and the mean operating time were significantly higher in the cemented group. Conclusion Both types of fixation give rates of long-term survival of > 90%. Cemented components have better rates of survival without loosening but this should be weighed against increased operating time and the risk of bony destruction of the proximal humerus at the time of revision of a cemented humeral component. Cite this article: Bone Joint J 2017;99-B:666–73.