Objectives were to assess patterns of blood cobalt levels over time in MoM THAs by head size; predictors of elevated cobalt levels; and associations between cobalt levels and clinical outcomes. We included all primary MoM THAs performed 1998–2011 with postoperative blood cobalt concentrations. We stratified the MoM THAs in ≤ 36 mm vs. > 36 mm. Overall, 526 MoM THAs were included: 427 with small and 99 with large heads. Considering patients with at least two serologies before revision (n = 205), cobalt levels were higher for patients with large compared to small heads (medians: 3.5 vs. 1.3, p < 0.001). We did not find any effect of time on cobalt levels between the two consecutive serologies (p > 0.42) or when using time as a continuous variable (p > 0.55). For large heads women were more likely to show elevated cobalt levels than men (adjusted OR = 3.56, 95

We aimed to compare the long-term outcomes of small-head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) to ceramic-on-polyethylene (CoP) THA using the same cup. All primary elective MoM and CoP THAs performed 1998–2011 were prospectively included in a local registry. Patients were followed until 31 December 2022. Outcomes were all-cause revision, complications and mortality. The uncemented Morscher 28 mm monobloc press-fit cup was used in all THAs. Overall, 3257 THAs were included, 864 MoM (mean age 63) and 2393 CoP THAs (mean age 72). Mean follow-up of the cohort was 12.9 years (maximum 26.8 years). Revision for any cause was performed in 85 MoM and 79 CoP THAs. Cumulative incidence of all-cause revision at 20 years was 13.2

In today’s health-care environment, the integration of artificial intelligence (AI) has become ubiquitous, revolutionizing practically all facets of medical practice. From electronic health records to the implementation of cobots and robots, AI has permeated the health-care sector, offering unprecedented opportunities and challenges. In this context, one may question the relevance and savvy of orthopaedic surgeons in their understanding of the consequences of this technological (r)evolution. We need to better comprehend the connections between our practice of orthopaedic surgery and the benefits and pitfalls provided by the penetration of AI into our professional activity.

Surgical education used to be simple. ‘See one, do one, teach one’ was Halsted’s (1852–1922) philosophy and for the better parts of the 19th and 20th centuries that was to be the way forward (1). Back in the day, students of surgery would actually pay the master for the educational expertise he dispensed. Surgery was generally a low-tech affair using instrumentation straight out of the forge or the workshop with no accreditations or bureaucratic approval processes needed. Surgical intervention was such that a so-inclined individual could learn by observation and then train, in the best of cases under the eye of a mentor, and then rapidly become a solo operator. The gamut of possible procedures could be mastered by a single surgeon, the dream of present-day administrators, although even then, some were more skilled at amputation and others at hernia repair. Economically all of this made sound sense and with this type of educational system hospitals did not have much to invest in the education of future surgeons.

We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced calcaneal fractures. At a mean of 6.5 years, we reviewed 70 patients with a calcaneal fracture who were divided into four groups: group 1, 18 patients with undisplaced fractures and a normal Böhler's angle (BA) who had been treated non-operatively; group 2, 23 with intra-articular fractures and a BA 10 degrees who had been treated surgically; and group 4, 16 with intra-articular fractures and a BA 10 degrees had a satisfactory functional outcome and those with displaced fractures who had non-operative treatment had a poor outcome. The [...] PAUL, M, PETER, Robin, HOFFMEYER, Pierre. Fractures of the calcaneum. A review of 70 patients. Journal of Bone and Joint Surgery. British Volume, 2004, vol. 86, no. 8, p. 1142-5

Cite this article: EFORT Open Rev 2021;6:1-2. DOI: 10.1302/2058-5241.6.211000

Cite this article: EFORT Open Rev 2021;6:387-389. DOI: 10.1302/2058-5241.6.210950

EFORT Open Rev 2021;6:823-824. DOI: 10.1302/2058-5241.6.212000

Purpose Short stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation. Methods Between April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2–9.73 years). Results During the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2–7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between − 10 and 0 was associated with lower HHS pain subscore ( p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1. Conclusion Patients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.

The main goal of this study was to determine the rate of return to sport (RTS) after shoulder arthroplasty.A systematic review of the literature was performed using the PRISMA guidelines. All clinical studies written in English, French or German, with a level of evidence of 1 to 4, and evaluating return to sport after shoulder arthroplasty, were included.A total of 23 studies were included with 2199 patients who underwent hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RSA). Mean age was 68 years (range 18 to 92.6), sex ratio (male:female) was 1:1.5. The surgery was performed on the non-dominant/dominant shoulder in 1:1.8 cases. The mean follow-up was 4.2 years. The rate of RTS was 75.5% with a mean time of 7 months. It was 77.4% for TSA, 75% for RSA and 71.2% for HA (P = non-significant).RTS after shoulder arthroplasty is high, regardless the type of arthroplasty, with a trend for a higher rate after TSA. Patients who were able to maintain a sport activity preoperatively had a greater chance of RTS after arthroplasty. Failure to RTS seems to be mostly linked to the severity of the underlying condition and length of preoperative disability. Cite this article: EFORT Open Rev 2021;6:771-778. DOI: 10.1302/2058-5241.6.200147.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation.

Cite this article: EFORT Open Rev 2020;5:568-569. DOI: 10.1302/2058-5241.5.200200.

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing.Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006

Cite this article: EFORT Open Rev 2020;5:742-742. DOI: 10.1302/2058-5241.5.200202

Frozen shoulder, a common and debilitating shoulder complaint, has been the subiect of uncertainty within the scientific literature and clinical practice. We performed an electronic PubMed search on all (1559) articles mentioning 'frozen shoulcier' 'adhesive capsulits' to understand arid qualify the rahge of naming, classification and natural history of the disease. We identified and reviewed six key thought leadership papers published in the past 10 years and all (24) systematic reviews published on frozen shoulder or adhesive capsulitis in the past Mveyeors This revealed that, while key thought leaders such as the ISAKOS Lipper Extremity Council are unequivocal that dhesive cop/u|0/ is an inappropriate term, the lorig-term and short-term trends showed the literature (63% of systematic reviews assessed) preferred 'adhesive capsulitis'. The literature was divided as to whether or not to classify the complaint as primary only (9 of 24) or primary and.s'econdary (9 of 24); six did not touch on classification. Furthermore; despite a systematic review in 2015 showing no evidence to support a three-phase self-limiting progression of frozen shoulder, 11 of 12 (.92 76) systematic reviews that mentioned phasing described a three-phase progression. Fight (33%) described it as 'self-limiting', three (130/0) described it as self-limitind in 'nearly aw or 'most' cases, and six (25%) stated that it was not selflimiting; seven (29%) did not touch on disease resolution. We call for a data and patient-oriented approach to the classification and description of the natural histoiy of the disease, and recornmend authors a nd clinicians (1) use the term 'frozen Shoulder' over 'adhesive capsulitis', (2) use am updated definition of the disease which recognizes the often severe pain suffered, and (3) avoid the confusing and potential harmful repetition of the natural history of ',fie disease as a three-phase, self-limiting condition.