Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA.

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.

Background: The aim of this study is to assess the diagnostic value of the alpha (α)-defensin lateral flow (ADLF) test in a group of patients with suspected shoulder periprosthetic joint infections (PJIs) and its usefulness and correlation with other diagnostic tests in the decision-making process. Methods: This retrospective single-center study was conducted between 2018 and 2023. Alpha -defensin was measured using an ADLF test kit. The final diagnosis of shoulder PJI was confirmed or ruled out based on the Musculoskeletal Infection Society criteria. Results: After selecting patients based on the exclusion criteria, the final study group comprised 22 patients. Of all patients, the test was positive in five cases. The ADLF test was false-positive in two patients and was false-negative in zero patients. The test was truly negative in 17 cases, resulting in a sensitivity of 100.00% (95% CI, 100.00%–100.00%) and a specificity of 89.47% (95% CI, 76.65%–102.3%). The positive predictive value was 60.00% (95% CI, 39.53%–80.47%) and the negative predictive value was 100.00% (95% CI, 100.00%–100.00%). The accuracy of the α-defensin test was found to be 90.9%. Conclusions: Although this study has limitations such as small sample size and research design, the ADLF test has proven to be a useful diagnostic tool. It can serve as a supplement to traditional tests, providing additional support to orthopedic surgeons in both preoperative and intraoperative diagnosis, especially in its ability to exclude the possibility of a PJI. Level of evidence: III.

Recently a modification of the DAA in lateral decubitus, called ALDI, has been proposed to obtain a better surgical exposure and to facilitate surgeons accustomed to the other hip approach. In this paper we report our early experience with the ALDI approach for total hip arthroplasty (THA) and to compare outcomes between ALDI and posterolateral approach (PLA) in a retrospective investigation. We have identified THA performed from September 2017 to January 2020. We collected patients demographic, clinical and radiographic data by our electronic hospital database. The ALDI group included 60 hips and the PLA group included 219 hips. These patients underwent to strict follow-up in the first 3 post-operative months. Compared to the PLA, the ALDI approach showed clinical outcomes significantly higher in the first month of follow-up. The PLA group has a lower operative time and a greater mean hospital length of stay. No blood transfusions were administered in the ALDI group while the 1.4% of patients in the PLA group needed blood transfusion. Cup anteversion and inclination angles were significantly wider in the PLA group. THA dislocation occurred in seven patients of the PLA group. No femoral cutaneus nerve palsy was recorded in the ALDI group. The ALDI approach can represent a quickly and safe solution for surgeons who are accustomed to the PLA who want to perform THA in DAA. Our preliminary experience is encouraging in terms of clinical and radiographic parameters although the operative time needs to be improved.

Objective. The management of Mason type II and III radial head fractures (RHF) is still a debated topic. In the past, the only treatment of choice was radial head resection (RHR) but, as surgical techniques and instrumentation have advanced, internal screw fixation (ORIF) has gained popularity. The aim of this paper is to compare in a retrospective analysis the outcomes of ORIF and RHR in these fracture patterns in young patients. Methods. A total of 37 patients (age between 20 and 60 years old) affected by Mason type 2 and 3 RHF and surgically treated were collected by means of our electronic hospital database. Sixteen patients underwent RHR, and 21 patients underwent ORIF with mini screws. Functional outcomes and scores as well as the radiographs were recorded during follow-up. Results. After 22.17 months (range 12-45) of mean follow-up, the mean DASH, UCLA and MEPS scores showed no significant differences between groups (p: 0.26; 0.21; 0.23). The VAS score was unfavorable in the ORIF group compared to the RHR group (p: 0.43) although not statistically significant. Conclusions. The gold standard in the management of these fractures is not universally recognized. The advantages and complications of both techniques as well as of the RH arthroplasty are abundantly described. Our outcomes support RHR as a possible treatment choice in multi-fragmentary fractures of RH in young patients while minimizing complications.