options

Issues

Rotator cuff

- often deficient

Bone stock

- often deficient

Glenoid

- often posterior version 

Management

Options

1.  TSR

Indications

- cuff intact

Epidemiology

Male & Females > 60 years

- X-ray evidence of OA

Symptomatic 

- 25% females

- 15% males

Affected joints

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

Issues

Limb alignment

Risk that late posterolateral corner reconstruction will fail in the setting of the varus knee

- varus knee alignment and varus thrust in stance phase

- consider osteotomy first in this setting

Results

Posterolateral Corner Reconstruction

Moulton et al. Am J Sports Med 2016

- systematic review of PCL reconstruction for chronic injuries

- 450 patients

NHx

Natural History of ACL deficient knee is variable

- functional instability 15% - 90%

- progression to OA is variable

Depends on level of patient demands / activity

1.  Late meniscal injury in ACL deficient knee

15-25%

2.  Function

Daniels Am J Sports Med 1994

- 292 ACL defecients knees

Goals

1. Equal leg lengths

- goal is mild to moderate isolated discrepancy

2. Unequal leg lengths

- goal with paralysis / equinus foot

- aim 1-2 cm short for clearance

3. Level Pelvis

- should use blocks to estimate functional correction

4. Vertical LS Spine

- vertical spine more important than level pelvis

Definition

Langerhan's Cell Histiocytosis

- non-neoplastic disorder

- characterised by infiltration by histiocytic cells (Monocyte / macrophage lineage)

Group of granulomatous inflammatory processes of unknown aetiology

- involve the reticuloendothelial component of the bone marrow, parenchymal organs, and skin

Types 

E - H - L

Epidemiology

0.05% incidence

- rare due to stabilising effect of rib cage

- even more rare to have symptoms

Reasoning

1.  Discs are narrower

2.  Foramina larger

3.  Thoracic spine

- facet joints orientated for rotation

- lumbar spine for flexion extension

- flexion is typically the motion which ruptures annulus

Anatomy