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Lee HJ, Kim BK, Dan J. Does the proximal humeral bone quality influence alignment after reverse total shoulder arthroplasty with short humeral stems? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2137-2145. [PMID: 38557891 DOI: 10.1007/s00590-024-03909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE When compared to standard-length humeral stem in reverse total shoulder arthroplasty (RTSA), short humeral stems in RTSA require good proximal humeral metaphyseal bone quality to gain proper and secure fixation during prosthetic implantation. Shorter humeral stems potentially carry more risk of misalignment than standard or long humeral stems. The hypothesis was that misalignment of the short humeral stems is influenced by regional bone quality. METHODS RTSA with a short curved humeral stem with neck-shaft angle (NSA) default of 132.5° was reviewed. The study group included 35 cases at a mean age of 75.97 (± 6.23) years. Deltoid-tuberosity index (DTI) was measured to evaluate proximal humeral bone quality. The deltoid tuberosity index was measured at immediately above position of the upper end of the deltoid tuberosity. Stem alignment was given by the angle measured in degrees between the intramedullary humeral shaft axis and the axis of the humeral implant stem. RESULTS The patient's mean DTI was 1.37 ± 0.16 (median, 1.32; range, 1.12-1.80). 22 patients had poor bone quality (DTI < 1.4), compared to 13 patients with acceptable bone quality (DTI > 1.4). After RTSA, ten humeral components (29%) were neutrally aligned, whereas 25 humeral components (71%) were misaligned. There was no correlation between misalignment and DTI (r = 0.117; p = 0.504). But there was a strong correlation between misalignment and the patient's own NSA (r = - 0.47; p = 0.004). The postoperative stem position and stem misalignment are not associated with functional outcomes (p > 0.05). CONCLUSION The misalignment of the short curved humeral stem frequently occurs. Poor reginal humeral bone quality does not influence misalignment after RTSA with a short humeral stem. Postoperative stem alignment is associated with the patient's preoperative NSA and method of neck cut. The misalignment does not affect functional outcomes for midterm follow-up. Further long-term follow-up studies are needed to confirm its clinical relevance.
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Affiliation(s)
- Ho-Jae Lee
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea
| | - Byung-Kook Kim
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea
| | - Jinmyoung Dan
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea.
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Cho SH, Park CJ, Kim SJ, Lee KG, Baek GR, Chung MS, Hui AT, McGarry MH, Lee TQ, Jung S, Kim J, Kim YS. Varus-valgus alignment of humeral short stem in reverse total shoulder arthroplasty: does it really matter? J Shoulder Elbow Surg 2024:S1058-2746(24)00025-9. [PMID: 38242527 DOI: 10.1016/j.jse.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The utilization of short humeral stems in reverse total shoulder arthroplasty has gained attention in recent times. However, concerns regarding the risk of misalignment during implant insertion are associated with their use. METHODS Eight fresh-frozen cadaveric shoulders were prepared for dissection and biomechanical testing. A bespoke humeral implant was fabricated to facilitate assessment of neutral, varus, and valgus alignments using a single stem, and 10° was established as the maximum permissible angle for misalignments. Shift in humerus position and changes in deltoid length attributable to misalignments relative to the neutral position were evaluated using a Microscribe 3DLx system. The impingement-free range of motion, encompassing abduction, adduction, internal rotation, and external rotation (ER), was gauged using a digital goniometer. The capacity for abduction was evaluated at maximal abduction angles under successive loading on the middle deltoid. A specialized traction system coupled with a force transducer was employed to measure anterior dislocation forces. RESULTS Relative to the neutral alignment, valgus alignment resulted in a more distal (10.5 ± 2.4 mm) and medial (8.3 ± 2.2 mm) translation of the humeral component, whereas the varus alignment resulted in the humerus shifting more superiorly (11.2 ± 1.3 mm) and laterally (9.9 ± 0.9 mm) at 0° abduction. The valgus alignment exhibited the highest abduction angle than neutral alignment (86.2°, P < .001). Conversely, the varus alignment demonstrated significantly higher adduction (18.4 ± 7.4°, P < .001), internal rotation (68.9 ± 15.0°, P = .014), and ER (45.2 ± 10.5°, P = .002) at 0° abduction compared to the neutral alignments. Anterior dislocation forces were considerably lower (23.8 N) in the varus group compared to the neutral group at 0°ER (P = .047). Additionally, abduction capability was markedly higher in varus alignment at low deltoid loads than the neutral alignment (5N, P = .009; 7.5 N, P = .007). CONCLUSIONS The varus position enhances rotational range of motion (ROM) but increases instability, while the valgus position does not significantly impact ROM or instability compared to the neutral position.
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Affiliation(s)
- Sung-Hyun Cho
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan-Joo Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Jae Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung-Geun Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gyu Rim Baek
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Min-Shik Chung
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Aaron T Hui
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Sungwook Jung
- Central R&D Center, Corentec Co., Ltd., Seoul, Republic of Korea
| | - Jaewon Kim
- Central R&D Center, Corentec Co., Ltd., Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Luthringer TA, Horneff JG, Abboud JA. Stemless Reverse Shoulder Arthroplasty. J Am Acad Orthop Surg 2024; 32:e63-e72. [PMID: 37816186 DOI: 10.5435/jaaos-d-23-00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/20/2023] [Indexed: 10/12/2023] Open
Abstract
Since the Food and Drug Administration (FDA) approval nearly two decades ago, the indications for and utilization of reverse shoulder arthroplasty (RSA) have expanded considerably. Stemless RSA designs have been used in Europe since 2005, but have only recently been introduced in domestic Investigational Device Exemption trials. Potential advantages of stemless RSA are similar to those of stemless anatomic total shoulder arthroplasty, which may include fewer shaft-related complications, avoidance of stress shielding, bone preservation, and easier revision surgery. European data support similar outcomes between certain stemless RSA prostheses compared with that of stemmed RSA implants at early and mid-term follow-up. However, long-term outcomes remain to be seen and differences exist between the stemless RSA designs used in Europe and those being studied in domestic clinical trials. An understanding of the potential advantages and disadvantages of stemless RSA, differences between existing designs, and reported clinical outcomes is prudent for the safe and meaningful implementation of this new technology in the United States.
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Affiliation(s)
- Tyler A Luthringer
- From the Rothman Orthopaedic Institute, Philadelphia, PA (Luthringer and Abboud), the Carolina Orthopaedic and Neurosurgical Associates, Greenville-Spartanburg, SC (Luthringer), and the University of Pennsylvania, Philadelpha, PA (Horneff)
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Otworowski M, Grzelecki D, Starszak K, Boszczyk A, Piorunek M, Kordasiewicz B. Periprosthetic fractures after shoulder arthroplasty: a systematic review. EFORT Open Rev 2023; 8:748-758. [PMID: 37787477 PMCID: PMC10562946 DOI: 10.1530/eor-22-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Purpose The goal of this study was to review available literature on periprosthetic shoulder fractures to evaluate epidemiology, risk factors and support clinical decision-making regarding diagnostics, preoperative planning, and treatment options. Methods Two authors cross-checked the PubMed and Web of Science medical databases. The inclusion criteria were as follows: original human studies published in English, with the timeframe not limited, and the following keywords were used: 'periprosthetic shoulder fracture,' 'total shoulder arthroplasty periprosthetic fractures,' 'total shoulder arthroplasty fracture,' and 'total shoulder replacement periprosthetic fracture.' Seventy articles were included in the review. All articles were retrieved using the aforementioned criteria. Results The fracture rate associated with total shoulder arthroplasty varied between 0 and 47.6%. Risk factors for periprosthetic fractures were female gender, body mass index < 25 kg/m2, smoking, rheumatoid arthritis, and Parkinson's disease. The most commonly used classification is the Wright and Coefield classification. Periprosthetic fractures can be treated both, conservatively and operatively. Conclusion Periprosthetic fracture frequency after shoulder arthroplasty ranges from 0 to 47.6%. The most common location of the fracture is the humerus and most commonly occurs intraoperatively. The most important factor influencing treatment is stem stability. Fractures with stem instability require revision arthroplasty with stem replacement. Fractures with a stable stem depending on the location, displacement and bone stock quality can be treated both conservatively and operatively. For internal fixation plates with cables and screws are most commonly used.
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Affiliation(s)
| | - Dariusz Grzelecki
- Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Krzysztof Starszak
- Department of Human Anatomy, Medical University of Silesia, Katowice, Poland
| | - Andrzej Boszczyk
- Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland
| | | | - Bartłomiej Kordasiewicz
- Idea Ortopedia, Warsaw, Poland
- Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland
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Nabergoj M, Lädermann A, Authom T, Beaudouin E, Azar M, Wahab H, Leger O, Haight H, Harris H, Collin P. Stemless reverse shoulder arthroplasty: clinical and radiologic outcomes with minimum 2 years' follow-up. J Shoulder Elbow Surg 2023; 32:e464-e474. [PMID: 36905950 DOI: 10.1016/j.jse.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Recently, a stemless reverse shoulder arthroplasty (RSA) design was developed to preserve bone stock. Clinical and radiologic studies of this design in larger cohorts with >100 patients are not frequent. The purpose of this study was to present the clinical and radiologic results of a newly developed stemless RSA implant. The hypothesis was that this design would provide similar clinical and radiologic results to other stemless implants, as well as stemmed implants. METHODS Between September 2015 and December 2019, all patients who underwent primary RSA with a stemless Easytech prosthesis were considered eligible for inclusion in this prospective multicenter study. The minimum follow-up period was 2 years. Clinical outcomes consisted of the Constant score, adjusted Constant score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons shoulder score. Radiographic parameters included radiolucency, loosening, scapular notching, and specific geometric parameters. RESULTS Stemless RSA was performed in 115 patients (61 women and 54 men) at 6 different clinical centers. The average age at the time of surgery was 68.7 years. The average Constant score was 32.5 preoperatively and showed significant improvement to 61.8 at latest follow-up (P < .001). The Subjective Shoulder Value also demonstrated significant improvement postoperatively (from 27.0 to 77.5, P < .001). Scapular notching was observed in 28 patients (24.3%); humeral loosening, 5 (4.3%); and glenoid loosening, 4 (3.5%). The total complication rate was 17.4%. Eight patients (4 women and 4 men) underwent implant revision. CONCLUSION The clinical outcomes of the examined stemless RSA seem to be comparable to those of other humeral designs; however, the complication and revision rates are higher than those of historical controls. Surgeons should proceed with caution when using this implant until longer-term follow-up data are available.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Thierry Authom
- Infirmerie Protestante, Caluire et Cuire, France; La Clinique Saint Charles, Lyon, France
| | | | | | | | | | | | | | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France; Clinique Victor Hugo, Paris, France.
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Virani S, Leonidou A, Panagopoulos G, Holmes N, Sforza G, Relwani J, Levy O. Management of glenoid bone loss with impaction and structural bone grafting in reverse shoulder arthroplasty. Musculoskelet Surg 2023; 107:239-252. [PMID: 35598252 DOI: 10.1007/s12306-022-00747-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/11/2022] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Glenoid bone loss is a commonly encountered problem in complex primary and revision shoulder arthroplasty. Addressing glenoid bone loss is critical to avoid complications like early loosening, impingement, notching and instability. A large number of techniques like bone grafting using autograft or allograft, eccentric reaming, augmented base plates, patient-specific instrumentations and custom-made implants are available to tackle bone loss. MATERIALS AND METHODS We prospectively collected the data of all patients with glenoid defects undergoing primary or revision reverse shoulder replacement between 2004 and 2017. This included demographic data, ranges of motion, Constant-Murley score and Subjective Shoulder Value (SSV). A pre-operative CT scan was done as well to plan the surgery and calculate the glenoid version. At each follow-up, the clinical function and shoulder scores were assessed. Additionally, the radiographs were assessed for graft incorporation, evidence of lysis and calculation of glenoid version. RESULTS Between 2004 and 2017, 37 patients underwent glenoid bone grafting during reverse shoulder arthroplasty. Average age was 72 years (range 46-88). Indications for surgery were cuff tear arthropathy (6 patients); revision of failed other prosthesis (23); primary osteoarthritis (4); rheumatoid arthritis (3); and second-stage revision for infection (1). The glenoid defect was contained in 24 patients, and therefore, impaction graft with a combination of bone graft substitute and/or humeral head autograft was performed. In 13 patients the glenoid defect was severe and uncontainable and therefore a graft-implant composite glenoid was implanted using humeral head autograft or allograft. Average follow-up was 3.6 years (range 1-10). Mean Constant score improved from 34 before surgery to 63 after surgery. Mean SSV score improved from 0.9/10 to 8.3/10. Active movements improved significantly with forward elevation increasing from 54° to 123°; abduction from 48° to 123°; external rotation from 24° to 38°; internal rotation from 57° to 70°. Radiographs at final follow-up showed no radiolucencies around the glenoid component and no evidence of loosening of the implant. In 2 cases there was a grade I notching. There was 100% survivorship at the last follow-up. CONCLUSION Impaction bone grafting along with structural grafting when required is an effective and reproducible way of managing severe glenoid bone loss. This technique gives consistent and good clinical and radiological results.
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Affiliation(s)
- S Virani
- Reading Shoulder Unit, Reading, UK.
| | | | | | - N Holmes
- East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - G Sforza
- Reading Shoulder Unit, Reading, UK
| | - J Relwani
- East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - O Levy
- Reading Shoulder Unit, Reading, UK
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Wiethölter M, Akgün D, Plachel F, Minkus M, Karczewski D, Braun K, Thiele K, Becker L, Stöckle U, Moroder P. Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures. J Clin Med 2023; 12:jcm12093168. [PMID: 37176610 PMCID: PMC10179361 DOI: 10.3390/jcm12093168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and five scapula-sided cases of PPSFx. We used the unweighted Cohen's Kappa (κ) for measuring the intra-observer reliability and Krippendorff's alpha (α) for measuring the inter-observer reliability. The inter-rater reliabilities for the Wright & Cofield and Worland classifications were substantial for all groups. The expert and non-expert groups for UCPF also showed substantial inter-rater agreement. The all-rater group for the UCPF and the expert and non-expert group for the Kirchhoff classification revealed moderate inter-rater reliability. For the Kirchhoff classification, only fair inter-rater reliability was found for the non-expert group. Almost perfect intra-rater reliability was measured for all groups of the Wright & Cofield classification and the all-rater and expert groups of the UCPF. All groups of the Kirchhoff and Worland classifications and the group of non-experts for the UCPF had substantial intra-rater reliabilities. Regarding treatment recommendations, substantial inter-rater and moderate intra-rater reliabilities were found. Simple classification systems for PPSFx (Wright & Cofield, Worland) show the highest inter- and intra-observer reliability but lack comprehensiveness as they fail to describe scapula-sided fractures. The complex Kirchhoff classification shows limited reliability. The UCPF seems to offer an acceptable combination of comprehensiveness and reliability.
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Affiliation(s)
- Mats Wiethölter
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, 48149 Münster, Germany
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Marvin Minkus
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Karl Braun
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
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Lee HH, Park SE, Ji JH, Jun HS. Mid-term comparative study between the glenoid and humerus lateralization designs for reverse total shoulder arthroplasty: which lateralization design is better? BMC Musculoskelet Disord 2023; 24:290. [PMID: 37059977 PMCID: PMC10103464 DOI: 10.1186/s12891-023-06383-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION The complications of the conventional medialized design for reverse total shoulder arthroplasty (RSA) are increased scapular notching, and decreased external rotation and deltoid wrapping. Currently, lateralization design RSA, which avoid scapular notching and improve impingement-free range of motion, is commonly used. Especially, humeral lateralization design was most commonly used and glenoid lateralization design was preferred for glenoid abnormities. We compared mid-term clinical and radiologic outcomes of glenoid and humeral lateralization RSA in an Asian population in this study. MATERIALS AND METHODS We enrolled 124 shoulders of 122 consecutive patients (mean age 73.8 ± 6.8 years) who received glenoid or humeral lateralization RSA from May, 2012 to March, 2019. We divided these patients into two groups according to RSA using either glenoid or humeral lateralization design. These different designs were introduced consecutively in Korea. The clinical and radiological results of 60 glenoid lateralization RSA (Group I, 60 patients) and 64 humeral lateralization RSA (Group II, 62 patients) were retrospectively evaluated and also were compared between the two groups. All patients were followed for mean 3 years. RESULTS The clinical and radiologic outcomes of the two groups did not differ significantly, including scapular notching (p = 0.134). However, humeral lateralization RSA showed a larger glenoid-tuberosity (GT) distance (p = 0.000) and less distalization shoulder angle (DSA) (p = 0.035). The complication rate did not differ significantly either. But, revision surgery was performed for 2 humeral loosening in the Group II. CONCLUSION The clinical and radiologic outcomes of the two groups did not differ significantly, including scapular notching at mid-term follow-up. However, humeral lateralization design showed larger GT distance and less DSA. Humeral lateralization design RSA could preserve the normal shoulder contour due to a larger GT distance (more lateralization) and provide less deltoid tension due to less DSA (less distalization of COR).
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Affiliation(s)
- Hwan-Hee Lee
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Eun Park
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Korea.
| | - Hyun-Sik Jun
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
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Hasler A, Kriechling P, Passaplan C, Wieser K. Inadvertent, intraoperative, non- to minimally displaced periprosthetic humeral shaft fractures in RTSA do not affect the clinical and radiographic short-term outcome. Arch Orthop Trauma Surg 2023; 143:1-7. [PMID: 34091732 PMCID: PMC9886576 DOI: 10.1007/s00402-021-03930-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Little information is available on the clinical and radiographic outcome of intraoperative, non- to minimally displaced humeral fractures that occur during implantation of a stemmed, reverse shoulder prosthesis but are only recognized on routine postoperative radiographs. The goal of this study is to report the clinical and radiographic outcome for this rarely reported fracture type. MATERIALS AND METHODS 39 conservatively treated non- to minimally displaced intraoperative periprosthetic humeral fractures after stemmed RTSA were detected from our radiographic database between 1.1.2006 and 31.1.2018. Exclusion criteria were lack of patient consent, preoperative humeral fracture, and revision arthroplasties. Clinical (absolute and relative Constant score, the Subjective Shoulder Value) and radiographic (conventional radiographs) assessment was performed preoperatively, at 6 weeks (only radiographically) and at latest follow-up with a minimum follow-up of 2 years. RESULTS 35 patient's with a mean age of 72 years (range 32-88, SD ± 11 years) and a mean follow-up of 53 months (range 24-124, SD ± 31) were included in the study. At latest follow-up, all clinical outcome parameters except external rotation improved significantly. A complication rate of 17% (n:6) was recorded. At 6 weeks after the index surgery, none of the radiographs showed a fracture displacement or a sintering of the stem. At latest follow-up, all fractures were healed and no stem loosening was observed in any of the shoulders. CONCLUSIONS Non- to minimally displaced intraoperative periprosthetic humeral fractures in RTSA have an incidence of about 5% in this series of mainly uncemented press-fit stems. They generally heal without any further treatment and are not associated with stem loosening or compromise the clinical outcome after primary RTSA. Except slight restriction in the postoperative rehabilitation protocol, no further attention or action is needed.
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Affiliation(s)
- Anita Hasler
- Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland
| | - Philipp Kriechling
- Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland
| | - Caroline Passaplan
- Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland
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Periprosthetic Postoperative Humeral Fractures After Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1227-e1239. [PMID: 36026696 DOI: 10.5435/jaaos-d-21-01001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
The increased utilization of shoulder arthroplasty, including revision procedures, combined with rises in life expectancy, is expected to translate into a substantial increase in periprosthetic humeral fractures. The evaluation and management of these fractures needs to be updated to consider fractures that complicate anatomic and reverse arthroplasties and contemporary short-stem and stemless implants. Although conservative treatment is successful in a large proportion of these fractures, several surgical reconstructive techniques are required for the management of all fracture types. Surgical options include internal fixation, graft augmentation, standard revision procedures, and occasionally complex reconstructions including modular segmental prosthesis and allograft prosthetic composites. Most studies on the outcomes of periprosthetic humeral fractures have analyzed small samples and have typically reported on anatomic total shoulders with a standard-length humeral implant. Additional research is required to optimize the management of periprosthetic postoperative humeral fractures in the era of reverse arthroplasty, short stems, and stemless arthroplasty.
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Nourissat G, Corsia S, Muller JH, Saffarini M, Lenoble E. Mid- to long-term clinical outcomes after press-fit short stem reverse shoulder arthroplasty. JSES Int 2022; 6:896-902. [DOI: 10.1016/j.jseint.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Buch B, Vall M, Consigliere P, Guillén JA, Cruz E, Natera L. Short Stems and Stemless Shoulder Arthroplasty: Current Concepts Review. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:633-647. [PMID: 36258746 PMCID: PMC9569137 DOI: 10.22038/abjs.2021.53555.2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Historically, the shoulder arthroplasty humeral component has been designed for the management of infections, tumours and fractures. In all these cases the stem was needed as a scaffold. Original humeral components were not developed for use in shoulder arthritis, so these designs and derivates had a long stem. The newest humeral implants innovations consist in shortening of the implant, or even removing the whole stem, to rely on stemless fixation at the level of the metaphysis. This implies the advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, easier implant removal at revision, and humeral component placement independent from the humeral diaphyseal axis. Nowadays, surgeons try to balance the need for a stable fixation of the humeral component with the potential need for revision surgery. Complications of revision shoulder arthroplasty are related to the need for removing a well-fixed humeral stem, the length of the procedure, and the need to treat severe bone loss.
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Affiliation(s)
- Berta Buch
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain, Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - María Vall
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain, Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, United Kingdom
| | - Josep Antón Guillén
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain
| | - Enric Cruz
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain
| | - Luis Natera
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain
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Initial and 1-Year Radiographic Comparison of Reverse Total Shoulder Arthroplasty With a Short Versus Standard Length Stem. J Am Acad Orthop Surg 2022; 30:e968-e978. [PMID: 35297792 DOI: 10.5435/jaaos-d-21-01032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In an effort to preserve bone, humeral stems in reverse total shoulder arthroplasty (RTSA) have gradually decreased in length. The purpose of this study was to compare the immediate postoperative radiographic appearance of short-length with standard-length RTSA stems. METHODS Patients who underwent RTSA using a press-fit standard-length or short-length humeral implant with a consistent geometry (Univers Revers or Revers Apex) were evaluated in a multicenter retrospective review. Initial postoperative radiographs were used to assess initial alignment and filling ratios. In addition, radiographs were evaluated for early signs of stress shielding and/or loosening. Clinical outcome scores and range of motion were also evaluated. RESULTS Overall, 137 short-length stems and 139 standard-length stems were analyzed. Initial radiographs demonstrated a significantly higher percentage of stems placed in neutral alignment in the short-stem group (95.6% vs 89.2%, P = 0.045). Similar metaphyseal filling ratios were seen between groups, but a significantly higher diaphyseal filling ratio was observed in the short-stem group (57% vs 34%, P < 0.001). Less calcar osteolysis (2.2% vs 12.9%; P = 0.001) and fewer overall number of radiographic changes (tuberosity resorption, lucencies, and subsidence) (0.7% vs 5.0%; P = 0.033) were seen with short stems compared with the standard-length stems. CONCLUSION RTSA with a short-stem humeral implant demonstrates excellent radiographic outcomes, including low rates of loosening and subsidence at 1 year, with less early calcar osteolysis compared with a standard-length stem. LEVEL OF EVIDENCE III (Case-control).
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A 135° Short Inlay Humeral Stem Leads to Comparable Radiographic and Clinical Outcomes Compared to a Standard-Length Stem for Reverse Shoulder Arthroplasty. JSES Int 2022; 6:802-808. [PMID: 36081694 PMCID: PMC9446177 DOI: 10.1016/j.jseint.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Humeral stem length in reverse total shoulder arthroplasty (RTSA) has decreased in recent years in an attempt to preserve more bone and facilitate stem removal in the revision setting. The purpose of this study was to compare the clinical and radiographic outcomes of a short- to standard-length stem RTSA. The authors hypothesized that there would be no difference in radiographic or clinical outcomes at short-term follow-up. Methods Patients who underwent RTSA using a press-fit standard- or short-length humeral component with a consistent geometry (Univers Revers, or Revers Apex; Arthrex, Inc., Naples, FL, USA) were evaluated in a multicenter retrospective review. The minimum clinical follow-up was 2 years. Immediate postoperative radiographs were used to assess initial alignment and filling ratios. In addition, radiographs at 2 years were evaluated for signs of stress shielding and/or loosening. Clinical outcome scores and range of motion were evaluated at the final follow-up and compared between groups. Results A total of 220 patients with short-stem RTSA and 357 patients with standard-length stem RTSA were analyzed. There was no difference in baseline function between short- and standard-length stem patients. Patients in the short stem group had higher postoperative American Shoulder and Elbow Surgeons (84.6 vs. 80.8; P = .014) and Western Ontario Osteoarthritis of the Shoulder (86.5 vs. 82.7; P = .025). Patients in the short stem group also had greater postoperative active forward flexion (139° vs. 132°; P = .003) and internal rotation with the arm at 90° of abduction (43° vs. 32°; P < .001) than patients in the standard-length group. Radiographically, there was a higher metaphyseal (P = .049) and diaphyseal (P < .001) fill ratio in the short stem group, although there was no difference in postoperative alignment, radiographic signs of loosening, or revision for loosening between groups (all P > .05). Conclusion A short inlay stem leads to comparable radiographic findings and revision-free survival compared with a standard-length stem when placed with a press-fit technique for RTSA. Clinical outcomes are also equivalent or slightly improved with a short stem compared with a standard-length stem.
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Ajibade DA, Yin CX, Hamid HS, Wiater BP, Martusiewicz A, Wiater JM. Stemless reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2022; 31:1083-1095. [PMID: 35051541 DOI: 10.1016/j.jse.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data. METHODS A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores. RESULTS We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate. CONCLUSIONS This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.
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Affiliation(s)
- David A Ajibade
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Clark X Yin
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Hussein S Hamid
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Alexander Martusiewicz
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA.
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Predictors of poor and excellent outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:294-301. [PMID: 34411725 DOI: 10.1016/j.jse.2021.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Favorable clinical and functional outcomes can be achieved with reverse total shoulder arthroplasty (RSA). Given the expanding utilization of RSA in the United States, understanding the factors that influence both excellent and poor outcomes is increasingly important. METHODS A single-surgeon prospective registry was used to identify patients who underwent RSA from 2015 to 2018 with a minimum of 2 years' follow-up. An excellent postoperative clinical outcome was defined as a final American Shoulder and Elbow Surgeons (ASES) score in the top quartile of ASES scores. A poor outcome was defined as an ASES score in the bottom quartile. Logistic regression was used to determine preoperative characteristics associated with both excellent and poor outcomes. RESULTS A total of 338 patients with a mean age of 71.5 years (standard deviation [SD], 6.4 years) met the inclusion and exclusion criteria. The average preoperative ASES score for the entire cohort was 35.3 (SD, 16.4), which improved to 82.4 (SD, 16.1) postoperatively (P < .001). Univariate analysis demonstrated that a diagnosis of primary osteoarthritis (OA), private insurance, and higher preoperative ASES scores were significantly associated with achieving excellent outcomes (P < .01 for all). Variables predictive of poor outcomes were workers' compensation status (P = .03), depression (P = .02), a preoperative diagnosis of rotator cuff tear arthropathy (P < .01), preoperative opioid use (P < .01), a higher number of allergies (P < .01), and prior ipsilateral shoulder surgery (P < .01). Multivariate regression analysis demonstrated that OA (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.2-26.5; P = .03) and private insurance (OR, 2.7; 95% CI, 1.12-6.5; P = .02) correlated with excellent outcomes whereas a higher number of reported allergies (OR, 0.83; 95% CI, 0.71-0.97; P = .02), self-reported depression (OR, 0.39; 95% CI, 0.16-0.99; P =.04), a history of ipsilateral shoulder surgery (OR, 0.36; 95% CI, 0.15-0.87; P =.02), and preoperative opioid use (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were predictive of poor outcomes. CONCLUSIONS A preoperative diagnosis of primary OA is the strongest predictor of excellent clinical outcomes following RSA. Patients with an increasing number of reported allergies, self-reported depression, a history of ipsilateral shoulder surgery, and preoperative opioid use are significantly more likely to achieve poor outcomes after RSA. Given the increasing utilization of RSA, this information is important to appropriately counsel patients regarding postoperative expectations.
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Panagopoulos GN, Pugliese M, Leonidou A, Butt F, Jaibaji M, Megaloikonomos PD, Consigliere P, Sforza G, Atoun E, Levy O. Acute versus delayed reverse total shoulder arthroplasty for proximal humeral fractures: a consecutive cohort study. J Shoulder Elbow Surg 2022; 31:276-285. [PMID: 34400290 DOI: 10.1016/j.jse.2021.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of displaced proximal humeral fractures (PHFs) remains controversial. Open reduction-internal fixation (ORIF) can be challenging, especially in elderly patients with poor bone quality, whereas hemiarthroplasty has had unpredictable outcomes. Conservative treatment may result in severe fracture sequelae with poor outcomes, requiring late reverse total shoulder arthroplasty (RTSA) in many cases. The past few years have seen a shift toward the use of RTSA for the treatment of PHFs. The aim of this study was to compare the outcomes of RTSA between patients with acute fractures and patients who underwent delayed RTSA for fracture sequelae. Our hypothesis was that the outcomes of RTSA for acute PHFs would be better than those of delayed RTSA for fracture sequelae. METHODS We followed up 36 patients with a mean age of 79.1 years who underwent primary RTSA for acute PHFs and 56 patients with a mean age of 72.1 years who underwent RTSA in delayed fashion for fracture sequelae, including failed ORIF. The minimum follow-up period was 24 months. The mean follow-up period was 39.3 months in the acute RTSA group and 56.6 months in the delayed RTSA group. Demographic data, radiographs, and surgery data were prospectively collected and analyzed. At final follow-up, range of motion and radiographic analysis findings, as well as the Subjective Shoulder Value (SSV) and Constant score (CS), were recorded. RESULTS The clinical results favored the group undergoing acute RTSA for acute PHFs, with a mean SSV of 8.3 of 10 and adjusted CS of 88.9% compared with a mean SSV of 8.0 of 10 and adjusted CS of 77.6% in the group undergoing late RTSA for fracture sequelae-but without statistically significant differences between the groups. Although the acute RTSA group showed slightly better range-of-motion values, no statistically significant differences were found between the groups. No intraoperative complications occurred. The time from injury to the regaining of good pain-free function was significantly shorter in the acute RTSA group. CONCLUSION Although there were no statistically significant differences in outcomes between early RTSA for acute PHFs and late RTSA for fracture sequelae, the time from injury to the regaining of good pain-free function was significantly shorter in the acute RTSA group. Therefore, we advocate early RTSA for acute PHFs in elderly patients to provide a quicker recovery and an early return to good predictable outcomes with a much shorter period of pain and discomfort. In cases of failed conservative treatment, malunion, or failed ORIF, salvage RTSA has the potential to provide a good outcome.
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Affiliation(s)
| | - Mattia Pugliese
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Faisal Butt
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Monketh Jaibaji
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | | | | | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Rev 2021; 6:1097-1108. [PMID: 34909228 PMCID: PMC8631242 DOI: 10.1302/2058-5241.6.210039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The initial reverse shoulder arthroplasty (RSA), designed by Paul Grammont, was intended to treat rotator cuff tear arthropathy in elderly patients. In the early experience, high complication rates (up to 24%) and revision rates (up to 50%) were reported.The most common complications reported were scapular notching, whereas clinically more relevant complications such as instability and acromial fractures were less commonly described.Zumstein et al defined a 'complication' following RSA as any intraoperative or postoperative event that was likely to have a negative influence on the patient's final outcome.High rates of complications related to the Grammont RSA design led to development of non-Grammont designs, with 135 or 145 degrees of humeral inclination, multiple options for glenosphere size and eccentricity, improved baseplate fixation which facilitated glenoid-sided lateralization, and the option of humeral-sided lateralization.Improved implant characteristics combined with surgeon experience led to a dramatic fall in the majority of complications. However, we still lack a suitable solution for several complications, such as acromial stress fracture. Cite this article: EFORT Open Rev 2021;6:1097-1108. DOI: 10.1302/2058-5241.6.210039.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick J. Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Virani S, Holmes N, Al-Janabi M, Watts C, Brooks C, Relwani J. Intermediate to long term results of stemless metaphyseal reverse shoulder arthroplasty: A five to nine year follow-up. J Clin Orthop Trauma 2021; 23:101611. [PMID: 34692406 PMCID: PMC8517546 DOI: 10.1016/j.jcot.2021.101611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Shoulder arthroplasty incidence is increasing as is the volume of revision surgeries. Revision surgery is easier if humeral bone stock is preserved with minimal bone defects and osteolysis. This has led to an increased focus on the development of various short stemmed and stemless implants which provides stable fixation whilst preserving humeral bone stock. PURPOSE To review the medium to long term clinical and radiological outcomes, complications and survival rates of a stemless reverse shoulder prosthesis. PATIENTS AND METHOD Patients with a minimum follow-up of 60 months following a reverse stemless shoulder arthroplasty were deemed eligible. Clinical and radiological data on twenty-one patients operated between 2009 and 2014 were recorded prospectively. Survivorship and patient recorded symptoms with the end point of revision surgery were recorded. RESULTS Mean follow-up of 78 months (60-114 months). Mean range of active elevation was 136° (80-170°). Mean range of active abduction and active external rotation was 122° (70-170°) and 47° (10-75°) respectively. Mean Oxford score improved from 12 pre-operatively to 44 at final follow up (p < 0.0001). Mean Constant Murley Score improved from 18 to 72 (p < 0.0001). Mean ADLEIR score of 13 pre-operatively increased to 32 post-operatively (p < 0.0001). Notching was seen in 23.5% of cases and no radiolucent areas were observed around the glenoid component. There were two cases of post traumatic peri-prosthetic fractures that were managed conservatively and one case of deep-seated infection that required a washout. The survivorship at the most recent follow-up was 100%. CONCLUSION The advantages of bone preservation with the stemless metaphyseal prosthesis combined with encouraging medium to long term clinical and radiological results are very promising, particularly with the improved post-operative patient satisfaction scores. This is the first study that reports the results with a minimum of 5 year follow-up and has the longest mean follow-up period. CLINICAL RELEVANCE The reverse stemless shoulder prosthesis is an effective and reliable option for elective shoulder arthroplasty.
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Liu EY, Kord D, Yee NJ, Horner NS, Al Mana L, Leroux T, Alolabi B, Khan M. Stemless reverse total shoulder arthroplasty: a systematic review of short- and mid-term results. Shoulder Elbow 2021; 13:482-491. [PMID: 34659481 PMCID: PMC8512978 DOI: 10.1177/17585732211013356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Stemless reverse total shoulder arthroplasty is used to treat rotator cuff deficient arthropathies, rheumatoid arthritis, and osteoarthritis. It has several advantages over the stemmed implant including preservation of bone stock, reduced surgical time, and easier revision. METHODS A systematic search was conducted in MEDLINE, EMBASE, PubMed, and CENTRAL to retrieve all relevant studies evaluating stemless reverse total shoulder arthroplasty. RESULTS The literature search identified 1993 studies out of which 7 studies were included in this review; 324 patients underwent stemless reverse total shoulder arthroplasty with a weighted mean age of 74.1 (SD = 8.6, range = 38 to 93) years and a weighted mean follow-up time of 44 (SD = 6.6, range = 3 to 95) months. The included studies reported significant improvements in range of motion and functional scores comparable to stemmed reverse total shoulder arthroplasty. The weight mean flexion and abduction was (135 ± 12)° and (131 ± 12)° post-operatively, respectively. The weighted mean constant score increased from (26.7 ± 5.2) Patients (pts) to (63.0 ± 8.0) pts post-operatively. Overall complication and revision rate were 12.3% and 5.2%. CONCLUSION Early and mid-term results indicate stemless reverse total shoulder arthroplasty has similar clinical outcomes to stemmed reverse total shoulder arthroplasty. There was no radiological evidence of humeral loosening at the latest follow-up.
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Affiliation(s)
- Eva Y Liu
- Faculty of Health Sciences, McMaster
University, Hamilton, Canada
| | - Dorsa Kord
- Faculty of Health Sciences, McMaster
University, Hamilton, Canada
| | - Nicholas J Yee
- Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
| | - Nolan S Horner
- Department of Surgery, McMaster
University, Hamilton, Canada
| | - Latifah Al Mana
- Department of Surgery, McMaster
University, Hamilton, Canada
| | - Timothy Leroux
- Department of Surgery, University of
Toronto, Toronto, Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster
University, Hamilton, Canada
| | - Moin Khan
- Department of Surgery, McMaster
University, Hamilton, Canada,Moin Khan, McMaster University, 50 Charlton
Avenue, East Hamilton, Ontario, Canada L8N 4A6.
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21
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Is suture cerclage fixation a valid treatment for intraoperative nondisplaced calcar fractures in reverse total shoulder arthroplasties? JSES Int 2021; 5:673-678. [PMID: 34223414 PMCID: PMC8245986 DOI: 10.1016/j.jseint.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Implantation rates of reverse total shoulder arthroplasties continue to grow worldwide. Despite satisfying results, a distinct number of complications persist. Intraoperative fractures of the humeral shaft might occur in a certain number of cases. The literature is sparse regarding incidence and treatment options. This study analyzed the treatment using suture cerclage or stainless-steel-cable cerclage. Methods Our prospectively followed-up cohort of 860 patients who received primary reverse total shoulder arthroplasty in a tertiary referral hospital between September 2005 and August 2018 was screened for intraoperative medial humeral calcar fractures. The patients were retrospectively analyzed as per the treatment algorithm using (1) suture cerclage with FiberWire, (2) cable cerclage with stainless steel cable, or (3) no intervention. The outcome was radiologically and clinically (Subjective Shoulder Value and Constant score) evaluated. Results A total of 39 (4.5%) intraoperative calcar fractures of the humeral shaft were identified with 29 cases available for analysis at a mean follow-up time of 52 ± 27 months. Sixteen of them were treated with suture cerclage, 7 with metal cable cerclage, and 6 without intervention. All fractures were nondisplaced or could be reduced anatomically and healed without any stem subsidence or loosening within the first 4.5 months. The intervention groups reached similar values for the Subjective Shoulder Value (68%±27% vs. 79%±19%, suture vs. cable) and relative Constant score (65 % ± 25 % vs. 75 % ± 23). Conclusion Intraoperative medial calcar fractures can be sufficiently treated with metal or suture cerclage fixation. High-strength polyblend-polyethylene sutures seem to be a valid therapeutic option for selected medial calcar fractures of the humerus. In selected cases, however, benign neglect can result in excellent results as well.
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22
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Kostretzis L, Konstantinou P, Pinto I, Shahin M, Ditsios K, Papadopoulos P. Stemless reverse total shoulder arthroplasty: a systematic review of contemporary literature. Musculoskelet Surg 2021; 105:209-224. [PMID: 34003464 DOI: 10.1007/s12306-021-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy and other degenerative shoulder diseases. In recent years, aiming for bone stock preservation has led to the design of metaphyseal humeral components without a stem. The aims of this study were to evaluate the complication and reintervention rates, as well as the clinical and radiographic outcomes in patients who underwent reverse shoulder arthroplasty (RSA) with stemless implants. METHODS A systematic review of the literature was completed until May 2020 using PubMed, EMBASE, CINAHL and Cochrane databases, according to PRISMA guidelines. RESULTS The literature search revealed 2942 studies, of which 13 were included in this review, with a total of 517 patients and a mean follow-up between 6.4 and 101.6 months. The total complication rate was 6.5%, while 3.3% were humeral associated complications. Finally, the rate of shoulders that underwent a reintervention was 6.7%, with 1.4% relating to a humeral component reason. Stemless RSA led to substantial improvements in patient reported outcome measures and range of motion across all studies. Scapular notching was reported in 15.2%, and lucencies around humeral component were reported in 0.8% of shoulders. CONCLUSION Stemless RSA resulted in low complication and reintervention rates at the mid-term follow-up. The reported clinical and radiological outcomes showed that these prostheses have at least equivalent outcomes with their stemmed counterparts. Further studies are required to investigate the long-term longevity and performance of the stemless humeral implants. LEVEL OF EVIDENCE Level IV; Systematic Review.
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Affiliation(s)
- L Kostretzis
- Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, 5415 Boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada.
| | - P Konstantinou
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
| | - I Pinto
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
| | - M Shahin
- Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, 5415 Boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - K Ditsios
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
| | - P Papadopoulos
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
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Tross AK, Woolson TE, Nolte PC, Schnetzke M, Loew M, Millett PJ. Primary reverse shoulder replacement with a short stem: A systematic literature review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:7-16. [PMID: 37588633 PMCID: PMC10426698 DOI: 10.1016/j.xrrt.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Total shoulder arthroplasty implant designs have continued to evolve over the years. One recent change has been the shortening of the humeral component to preserve bone stock and to facilitate revision surgery. Despite promising clinical results, radiographic bone adaptions occur frequently in short-stem total shoulder arthroplasty, and limited data exist on short-stem reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to provide an overview about the functional and radiographic outcomes after an uncemented short-stem RSA, as well as identify areas of clinical importance that are underreported in the current literature. Methods A systematic review of the literature was performed in accordance with the PRISMA guidelines using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Clinical outcome studies reporting on short-stem RSA outcomes with evidence level I-IV were included. Demographics, clinical and radiological outcomes, as well as complications and revision data were systematically analyzed and described. Results Ten studies, published between 2014 and 2019, reporting on 555 shoulders with a mean follow-up of 32 months (range, 20-99.6 months) met the inclusion criteria. For all studies cuff tear arthropathy was the main indication for RSA (36%), followed by primary osteoarthritis (20%). Clinical outcome was reported in nine of ten studies, with range of motion improving in all studies. Six of the seven studies that used the Constant score (CS) demonstrated significant improvement (27.9 points to 69.3 points in weighted means). All studies reported on radiographic changes and bone adaptions. Among these, scapular notching was the most commonly observed (60 out of 327 cases, 18%) but without any described implication on clinical outcomes. No stem loosening was recorded at any final follow-up. A total of 63 complications (12.9%) were reported, with scapula fractures being the most commonly reported complication. Revision surgery was necessary in 24 cases (4.9%). Conclusion Good clinical results, comparable with long-stem RSAs, are reported at short-term follow-up for short-stem RSAs. Humeral bone adaptions occur frequently but aseptic stem loosening is not a matter of concern at short-term follow-up. An area of clinical importance that is under-reported is the relation between filling ratio and stem alignment in short-stem RSA.
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Affiliation(s)
- Anna K. Tross
- Steadman Philippon Research Institute, Vail, CO, USA
- Heidelberg University Hospital, Clinic for Orthopedics and Trauma Surgery, Heidelberg, Germany
| | | | - Philip C. Nolte
- Steadman Philippon Research Institute, Vail, CO, USA
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Heidelberg, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Heidelberg, Germany
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Markus Loew
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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24
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Willems JIP, Hoffmann J, Sierevelt IN, van den Bekerom MPJ, Alta TDW, van Noort A. Results of stemless shoulder arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:35-49. [PMID: 33532085 PMCID: PMC7845565 DOI: 10.1302/2058-5241.6.200067] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another.
Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067
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Affiliation(s)
| | | | - Inger N Sierevelt
- Spaarne Gasthuis, Hoofddorp, The Netherlands.,Xpert Orthopedics, Amsterdam, The Netherlands
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25
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Lau SC, Large R. Acromial fracture after reverse total shoulder arthroplasty: a systematic review. Shoulder Elbow 2020; 12:375-389. [PMID: 33281942 PMCID: PMC7689606 DOI: 10.1177/1758573219876486] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/27/2019] [Accepted: 07/27/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The reverse total shoulder arthroplasty has become the most common method of arthroplasty of the shoulder. The complication of acromial or scapular stress fracture deserves consideration to describe incidence and determine whether prosthetic design or patient factors act as risk factors. METHODS A systematic review of the literature was performed including the EMBASE, Medline and the Cochrane Library in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The search returned 565 articles. After exclusion, 25 papers remained. In total, 208 fractures were reported in the literature, with an overall incidence of 5% and stress fractures were more common than post-traumatic ones; 24 fractures underwent osteosynthesis and there were nine revision arthroplasty surgeries. Outcomes worsened after fracture - whether treated with surgery or not. In patients with scapular base fractures, there was an improvement in functional outcome scores after surgery. Heterogeneous reporting of the risk factors prior to fractures, treatment methods and outcomes made recommendations weak. DISCUSSION Acromial stress fracture after reverse total shoulder arthroplasty occurs relatively commonly but is poorly reported in the literature. It is unclear whether immobilisation, fixation or revision arthroplasty is the best treatment, although fixation may offer a better outcome. In future, reports should aim for greater consistency to allow a better understanding of this condition.
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Affiliation(s)
- Simon C Lau
- Simon C Lau, Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia.
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26
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Ragusa PS, Vadhera A, Jang JM, Ali I, McFarland EG, Srikumaran U. Nonoperative Treatment of Periprosthetic Humeral Shaft Fractures After Reverse Total Shoulder Arthroplasty. Orthopedics 2020; 43:e553-e560. [PMID: 32956468 DOI: 10.3928/01477447-20200910-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
Few studies report on periprosthetic humeral shaft fractures after reverse total shoulder arthroplasty (RTSA). The authors evaluated outcomes of 5 patients with this complication who were initially treated nonoperatively. Of 152 patients who underwent RTSA at the authors' institution from 2012 to 2017, 4 experienced periprosthetic humeral shaft fractures. One patient was referred to the authors for fracture treatment. All 5 patients were initially treated nonoperatively. The mean duration of follow-up was 11.5 months (range, 1.5-26 months). The authors analyzed time to fracture union, Single Assessment Numeric Evaluation (SANE) score, visual analog scale (VAS) score for pain, and active shoulder range of motion. Fracture union occurred in 4 patients treated nonoperatively at a mean of 4.4 months. Mean SANE score was 55 of 100 (range, 20-85). Mean VAS score was 3.4 of 10 (range, 0-8). Mean forward elevation was 83° (range, 45°-110°); mean abduction was 65° (range, 45°-80°); and mean external rotation with the arm at the side was 15° (range, 0°-30°). Many factors must be considered when customizing treatment for patients with periprosthetic fracture after RTSA. This case series indicates that nonoperative treatment of postoperative periprosthetic humeral shaft fractures can be successful. [Orthopedics. 2020;43(6):e553-e560.].
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27
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Tross AK, Lädermann A, Wittmann T, Schnetzke M, Nolte PC, Collin P, Raiss P. Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty-A Multicenter Study. J Clin Med 2020; 9:jcm9103362. [PMID: 33092155 PMCID: PMC7590048 DOI: 10.3390/jcm9103362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a frequent finding and that a subsidence of >5 mm (mm) is associated with an inferior clinical outcome. METHODS A total of 139 patients with an average age of 73 ± 9 years were included. The clinical and radiological outcome was evaluated at a minimum follow-up (FU) of 12 months. RESULTS No humeral component loosening was present at a mean FU of 18 (range, 12-51) months. Mean Constant Score (CS) and Subjective Shoulder Value (SSV) improved significantly from 34.3 ± 18.0 points and 37.0 ± 19.5% preoperatively to 72.2 ± 13.4 points and 80.3 ± 16.5% at final FU (p < 0.001). The average subsidence of the USSP was 1.4 ± 3.7 mm. Subsidence of >5 mm was present in 15 patients (11%). No association between a subsidence >5 mm and CS or SSV was found (p = 0.456, p = 0.527). However, a subsidence of >5 mm resulted in lower strength at final FU (p = 0.022). Complications occurred in six cases (4.2%), and the revision rate was 3.5% (five cases). CONCLUSIONS Although subsidence of USSP is a frequent radiographic finding it is not associated with loosening of the component or a decrease in the clinical outcome at short term FU. LEVEL OF EVIDENCE Level 4, retrospective study.
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Affiliation(s)
- Anna-K. Tross
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany;
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital Meyrin, Avenue Jacob-Daniel Maillard 31217 Meyrin, Switzerland;
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Thomas Wittmann
- OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany;
| | - Marc Schnetzke
- German Joint Centre, ATOS Clinic Heidelberg Bismarckstraße 9, 69115 Heidelberg, Germany;
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen on the Rhine, Germany;
| | - Philip-C. Nolte
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen on the Rhine, Germany;
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), 6 Boulevard de la Boutière, 35768 Saint-Grégoire, France;
| | - Patric Raiss
- OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany;
- Correspondence:
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Holmes N, Virani S, Relwani J. Use of reverse stemless shoulder arthroplasty in a patient with multiple hereditary exostosis. J Clin Orthop Trauma 2020; 11:S752-S755. [PMID: 32999551 PMCID: PMC7503150 DOI: 10.1016/j.jcot.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Multiple hereditary exostosis (MHE) is the formation of benign, cartilage-capped bony outgrowths predominantly extending from the metaphysis of long bones that presents with reduction in growth, deformity, restricted motion, short stature and premature osteoarthritis. AIM To review the clinical and radiological results of a stemless reverse shoulder arthroplasty in a case of MHE. CASE 81-year-old, right hand dominant short-statured retired male engineer with long standing shoulder pain and restricted movements on the background of an old proximal humeral fracture managed conservatively.The radiographs revealed osteoarthritis and a mal-united proximal humerus fracture on the background of MHE with 3 plane bone deformity and a lack of medullary canal. RESULTS The patient underwent a stemless reverse shoulder arthroplasty. At 6 months post operatively the patient had recovered well with a range of movement including: forward flexion 110°, external rotation 20° and abduction of 80°. Internal rotation remained limited to buttocks. Improved ADLIER, Subjective shoulder value and Constant Murley score compared to pre-operative figures. CONCLUSION The stemless humeral component relies on metaphyseal impaction for stability. When the humeral canal is malformed or in presence of malunited distal fractures, it circumvents the need of navigating a deformed diaphysis with encouraging postoperative results.
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29
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Shah SS, Roche AM, Sullivan SW, Gaal BT, Dalton S, Sharma A, King JJ, Grawe BM, Namdari S, Lawler M, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int 2020; 5:121-137. [PMID: 33554177 PMCID: PMC7846704 DOI: 10.1016/j.jseint.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
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Affiliation(s)
- Sarav S. Shah
- American Shoulder and Elbow Surgeons (ASES) Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
- Corresponding author: Sarav S. Shah, MD, 125 Parker Hill Ave, Boston, MA 02120, USA.
| | | | | | - Benjamin T. Gaal
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Stewart Dalton
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Arjun Sharma
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph J. King
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Brian M. Grawe
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Surena Namdari
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Macy Lawler
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Thomas W. Wright
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Kyle Flik
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Randall J. Otto
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Jones
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Andrew Jawa
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Peter McCann
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph Abboud
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Gabe Horneff
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Glen Ross
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Friedman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Douglas Boardman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
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30
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Shah SS, Gaal BT, Roche AM, Namdari S, Grawe BM, Lawler M, Dalton S, King JJ, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part I. JSES Int 2020; 4:929-943. [PMID: 33345237 PMCID: PMC7738599 DOI: 10.1016/j.jseint.2020.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this 2-part study was to systematically review each of the most common complications of RSA, limiting each search to publications in 2010 or later. In this part (part I), we examined (1) scapular notching (SN), (2) periprosthetic infection (PJI), (3) mechanical failure (glenoid or humeral component), and (4) neurologic injury (NI). Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 113 studies on SN, 62 on PJI, 34 on mechanical failure, and 48 on NI were included in our reviews. Univariate analysis was performed with the χ2 or Fisher exact test. Results The Grammont design had a higher SN rate vs. all other designs combined (42.5% vs. 12.3%, P < .001). The onlay humeral design had a lower rate than the lateralized glenoid design (10.5% vs. 14.8%, P < .001). The PJI rate was 2.4% for primary RSA and 2.6% for revision RSA. The incidence of glenoid and humeral component loosening was 2.3% and 1.4%, respectively. The Grammont design had an increased NI rate vs. all other designs combined (0.9% vs. 0.1%, P = .04). Conclusions Focused systematic reviews of the recent literature with a large volume of RSAs demonstrate that with the use of non-Grammont modern prosthesis designs, complications including SN, PJI, glenoid component loosening, and NI are significantly reduced compared with previous studies. As the indications for RSA continue to expand, it is imperative to accurately track the rates and types of complications to justify its cost and increased indications.
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Affiliation(s)
- Sarav S Shah
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Benjamin T Gaal
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Alexander M Roche
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Surena Namdari
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Brian M Grawe
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Macy Lawler
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Stewart Dalton
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joseph J King
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Grant E Garrigues
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Thomas W Wright
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Bradley S Schoch
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Kyle Flik
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Randall J Otto
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Richard Jones
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Andrew Jawa
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Peter McCann
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joseph Abboud
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Gabe Horneff
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Glen Ross
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Richard Friedman
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Eric T Ricchetti
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Douglas Boardman
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Robert Z Tashjian
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Lawrence V Gulotta
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
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31
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Affiliation(s)
- Brianna Fram
- Department of Orthopaedic Surgery at Thomas Jefferson University and the Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Alexandra Elder
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- Department of Orthopaedic Surgery at Thomas Jefferson University and the Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Brusalis CM, Taylor SA. Periprosthetic Fractures in Reverse Total Shoulder Arthroplasty: Current Concepts and Advances in Management. Curr Rev Musculoskelet Med 2020; 13:509-519. [PMID: 32506260 DOI: 10.1007/s12178-020-09654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Expanded indications for reverse total shoulder arthroplasty (RSA) have raised awareness of associated complications, including periprosthetic fractures. The purpose of this article was to provide a comprehensive update on how, when, and why RSA-related periprosthetic fractures occur, as well as to describe the current treatment strategies. RECENT FINDINGS Periprosthetic acromial and scapular spine fractures occur in up to 4.3% of cases and periprosthetic humeral fractures occur in approximately 3.5% of RSA procedures. Fractures of the coracoid process and clavicle have also been reported. Current literature has identified several risk factors for intraoperative or postoperative fracture, including underlying osteoporosis, revision arthroplasty, use of a superiorly placed screw during metaglene fixation, and disruption of the scapular ring by transection of the coracoacromial ligament. Periprosthetic fracture associated with RSA is a clinically significant event that warrants prolonged postoperative vigilance, timely diagnosis, and shared patient decision-making regarding treatment. Further research is needed to identify optimal treatment strategies and characterize long-term clinical outcomes following RSA-related periprosthetic fracture.
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Affiliation(s)
| | - Samuel A Taylor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. .,Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA.
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33
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Outcomes of reverse shoulder arthroplasty using a short stem through a superolateral approach. J Shoulder Elbow Surg 2020; 29:1197-1205. [PMID: 31812588 DOI: 10.1016/j.jse.2019.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/26/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasties have progressed in recent decades to become the most popular type of arthroplasty. Short stems with metaphyseal fixation have been developed to preserve bone stock and facilitate possible revision. Accurate positioning of these implants can be challenging using the superolateral approach. OBJECTIVE This study aimed to evaluate the clinical and radiologic results of reverse short-stem arthroplasties using a superolateral approach with a minimum of 2 years' follow-up. METHODS Between January 2015 and December 2016, a total of 76 patients underwent reverse shoulder arthroplasty surgery (79 shoulders) using a short uncemented humeral stem for shoulder arthritis with irreparable rotator cuff tear. Arthroplasties for post-traumatic osteoarthritis were excluded. Functional outcomes were assessed using Constant Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and range of motion. Radiographic analysis was used to evaluate component loosening, implant position, and implant filling ratio. RESULTS The mean age was 70.8 years. At a mean of 38.8-month follow-up, there were significant improvements in Constant score (44.2 to 87.9, P < .001), ASES score (36.2 to 84.3, P < .001), and VAS score (6.8 to 0.4, P < .001). Forward flexion improved from 89°to 131°(P < .001), and external rotation improved from 25° to 36°(P < .001). No evidence of periprosthetic loosening was visible. Mean varus of the humeral stem was 1°(±6°). The mean glenoidal inclination was 98°(±7°), which corresponds to a lower tilt of 8°. The average filling ratio was between 50% and 60% in both the metaphysis and the diaphysis. CONCLUSION The clinical results obtained in this study were satisfying, with a significantly low complication rate. Hence, short-stem reverse shoulder arthroplasty using a superolateral approach, while taking particular care to protect the deltoid, remains our method of choice.
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Abstract
PURPOSE OF REVIEW Our understanding of the reverse total shoulder arthroplasty (RTSA) has grown exponentially since Grammont first introduced his design in 1985. There are a multitude of implant-related variables to consider when performing RTSA. The purpose of this article is to provide a review of these design considerations. RECENT FINDINGS Current literature demonstrates that the traditional Grammont prosthesis has over 90% survivorship at 10 years. Despite these promising results, there have been concerns raised over the significant rate of scapular notching observed. As a result, the traditional RTSA design has been modified to minimize this complication and maximize impingement-free motion. Modern RTSA designs with a cementless, curved, short-stemmed eccentric onlay humeral component combined with a large, lateralized glenosphere placed in 10° of inferior tilt with > 3.5 mm of inferior overhang have been found to provide excellent results. However, all implant design features must be considered on a case-by-case basis to optimize outcome for each patient. Humeral and glenoid implant design variables have evolved as the biomechanics of RTSA have been further elucidated. Consideration of these variables allows the surgeon to maximize joint efficiency, improve impingement-free range of motion, decrease the risk of scapular notching, preserve bone stock, and minimize the risk of instability.
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Affiliation(s)
- Ujash Sheth
- Department of Orthopaedic Surgery, Northwestern University, 259 East Erie, 13th Floor, Chicago, IL, 60611, USA.
| | - Matthew Saltzman
- Department of Orthopaedic Surgery, Northwestern University, 259 East Erie, 13th Floor, Chicago, IL, 60611, USA
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Leonidou A, Virani S, Buckle C, Yeoh C, Relwani J. Reverse shoulder arthroplasty with a cementless short metaphyseal humeral prosthesis without a stem: survivorship, early to mid-term clinical and radiological outcomes in a prospective study from an independent centre. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:89-96. [PMID: 31432259 DOI: 10.1007/s00590-019-02531-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The use of reverse total shoulder arthroplasty has increased for the management of cuff-deficient glenohumeral joint arthritis and fractures. With bone preservation being a major target in reverse shoulder arthroplasty, metaphyseal humeral components without a stem were developed. The aim of this study is to present the survivorship, functional and radiological outcomes of a novel short metaphyseal prosthesis without a diaphyseal stem from an independent centre. METHODS Clinical function and radiological features of patients undergoing stemless reverse shoulder arthroplasty were prospectively recorded. Patients' demographics, indications for surgery, complications, functional and radiological assessment at the final follow-up as well as survivorship with the end point of revision for any reason were recorded. RESULTS Between 2009 and 2016, 36 patients received 37 reverse shoulder arthroplasties with the stemless Verso prosthesis. Mean age of the patients was 76.9 years. The most common indication for surgery was cuff tear arthropathy. Mean follow-up was 3 years (range 1-7 years). Oxford shoulder score improved from an average of 11 pre-operatively (range 2-19) to 44 post-operatively (range 29-48) (p < 0.0001). There was one case of a deep post-operative infection that needed washout, liner exchange with retention of the prosthesis. Radiographic analysis showed no lucencies, or stress shielding around the humeral or glenoid components. Constant score at the final follow-up was on average 63 (range 35-86). Activities of daily living with requirement for internal and external rotation score (ADLEIR) was on average 12 pre-operatively (range 0-27) and 31 post-operatively (range 18-36) (p < 0.0001). There was 100% survivorship of the prosthesis in this early to mid-term study. CONCLUSION This early to mid-term prospective study demonstrates excellent survivorship and radiological results of the Verso reverse shoulder replacement. It needs a simple reproducible technique, and the results have been replicated at an independent centre. This study underlines its survivorship in the early to mid-term and confirms lower incidence of complications such as instability, notching, loosening and the need for revision surgery. Most importantly, it conserves the humeral bone stock for revision arthroplasties in the future. Our results are similar to those of the currently published literature.
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Affiliation(s)
| | | | | | - Clarence Yeoh
- East and North Hertfordshire NHS Trust, Stevenage, UK
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Tan MT, Read JW, Bokor DJ. Does proximal porous coating in short-stem humeral arthroplasty reduce stress shielding? Shoulder Elbow 2019; 11:56-66. [PMID: 31447946 PMCID: PMC6688152 DOI: 10.1177/1758573218773533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Short-stem humeral designs in shoulder arthroplasty have been introduced recently. A retrospective cohort study was conducted to determine if newer proximal porous titanium coating in humeral short stems produced clinical and radiologic improvements. METHOD Short-stem humeral implants (Tornier Ascend, Wright Medical) were used in 46 anatomical total shoulder replacements from October 2012 to December 2015. Clinical and radiologic measures were analyzed at one- and two-year follow-up. RESULTS Nineteen shoulders received earlier grit blasted stems (Ascend Monolithic), and 27 shoulders received the later stems with proximal titanium porous coating (Ascend Flex). At two-year follow-up, radiographic changes and stress shielding were similar. Medial cortical thinning were more frequently observed in Monolithic (18 of 19) compared to Flex stems (19 of 27) on the PA films, though this was not statistically significant (P = 0.061). Clinical outcome scores improved regardless of the stem type used and independent of the radiologic adaptations on plain films. One participant with the Ascend Flex developed glenoid component failure and rotator cuff tear and was subsequently revised. DISCUSSION Clinical and radiological outcomes are similar in both short-stem designs. Proximal titanium porous coating may reduce medial calcar cortical thinning but it does not prevent it. KEY MESSAGE When compared to similarly designed uncoated grit-blasted stems, proximally porous coated humeral short stems produced similar clinical and radiological results. The proximal titanium porous coating may reduce medial cortical thinning.
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Affiliation(s)
- Martin T Tan
- Sydney Medical School, University of Sydney, Sydney, Australia,Martin T Tan, Sydney Medical School, Edward Ford Building A27, The University of Sydney, NSW 2006, Australia.
| | - John W Read
- Macquarie Medical Imaging, Macquarie University Hospital, Sydney, Australia
| | - Desmond J Bokor
- Bone and Joint Clinical Program, Macquaire University Hospital, Sydney, Australia
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King JJ, Dalton SS, Gulotta LV, Wright TW, Schoch BS. How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?: A systematic review. Bone Joint J 2019; 101-B:627-634. [PMID: 31154841 DOI: 10.1302/0301-620x.101b6.bjj-2018-1187.r1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature. MATERIALS AND METHODS A systematic review using the search terms "reverse shoulder", "reverse total shoulder", or "inverted shoulder" was performed using PubMed, Web of Science, and Cochrane databases between 1 January 2010 and 31 March 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were included if they reported on RSA outcomes and the incidence rate of acromial and/or scapular spine fractures. The rate of these fractures was evaluated for primary RSA, revision RSA, RSA indications, and RSA implant design. RESULTS The review included 90 articles out of 686 identified after exclusions. The incidence rate of acromial and/or scapular spine fractures was 2.8% (253/9048 RSAs). The fracture rate was similar for primary and revision RSA (2.8% vs 2.1%; p = 0.4). Acromial fractures were most common after RSA for inflammatory arthritis (10.9%) and massive rotator cuff tears (3.8%). The incidence was lowest in RSA for post-traumatic arthritis (2.1%) and acute proximal humerus fractures (0%). Lateralized glenosphere design had a significantly higher rate of acromial fractures compared with medial glenosphere designs. CONCLUSION Based on current English literature, acromial and/or scapular spine fractures occur at a rate of 2.8% after RSA. The incidence is slightly more common after primary compared with revision arthroplasty. Also, higher rates of acromial fractures are reported in RSA performed for inflammatory arthritis and in the lateralized glenoid design. Cite this article: Bone Joint J 2019;101-B:627-634.
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Affiliation(s)
- J J King
- Department of Orthopaedics and Rehabilitation, Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida, USA
| | - S S Dalton
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - L V Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - T W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - B S Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
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Raiss P, Schnetzke M, Wittmann T, Kilian CM, Edwards TB, Denard PJ, Neyton L, Godenèche A, Walch G. Postoperative radiographic findings of an uncemented convertible short stem for anatomic and reverse shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:715-723. [PMID: 30473242 DOI: 10.1016/j.jse.2018.08.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several short-stemmed press-fit humeral components have been developed in recent years for anatomic total shoulder arthroplasty (TSA) as well as reverse shoulder arthroplasty (RSA). Varying radiographic outcomes have been reported, with some studies reporting concerning rates of aseptic loosening. This study analyzed the radiographic findings of a press-fit convertible short-stemmed humeral component in both TSA and RSA. METHODS There were 150 anatomic TSAs (group 1) and 77 RSAs (group 2) analyzed radiographically at a minimum follow-up of 2 years postoperatively. Plain radiographs were reviewed for stem loosening, alignment, signs of stress shielding, and the filling ratio. RESULTS At final follow-up, 49% of group 1 and 65% of group 2 had no evidence for radiographic changes. In those with radiographic changes, low bone adaptions were found in 83% and high adaptions in 17% in both groups. Larger stem sizes with higher filling ratios were associated with high radiographic adaptions in both groups (P = .02). The overall filling ratios were higher in group 2 (P = .002). Cortical contact of the stem led to higher bone adaptions (P = .014). CONCLUSIONS The short humeral component analyzed in this study showed encouraging survival rates without aseptic loosening. Radiographic changes are associated with a higher filling ratio and cortical contact of the stem. Surgeons should aim to achieve fixation with the minimal required canal filling to minimize radiographic changes with the uncemented humeral component used in this study.
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Affiliation(s)
- Patric Raiss
- OCM (Orthopädische Chirurgie München) Clinic, München, Germany.
| | - Marc Schnetzke
- Berufsgenossenschaftliche-Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Wittmann
- OCM (Orthopädische Chirurgie München) Clinic, München, Germany
| | | | | | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Kazley JM, Cole KP, Desai KJ, Zonshayn S, Morse AS, Banerjee S. Prostheses for reverse total shoulder arthroplasty. Expert Rev Med Devices 2019; 16:107-118. [DOI: 10.1080/17434440.2019.1568237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Keegan P. Cole
- Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | | | | | - Samik Banerjee
- Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Micheloni GM, Salmaso G, Berti M, Bortolato S, Zecchinato G, Momoli A, Giaretta S. Cementless metaphyseal reverse shoulder arthroplasty: our preliminary experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:47-53. [PMID: 30714998 PMCID: PMC6503425 DOI: 10.23750/abm.v90i1-s.8064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/26/2023]
Abstract
Reverse shoulder arthroplasty (rTSA) is a largely used procedure with a wide variety of indications. The incidence of this surgery is increased in recent years and the literature expects similar trend for the future. Metaphyseal stem rTSA seems to be a promising solution considering major objectives the preservation of humeral bone stock and ease of revision. In our study we analyzed 19 patients treated with cementless metaphyseal stem rTSA for osteoarthritis (group A) and acute fractures (group B). In group A (7 patients) the average Constant score improved from 21,57 (16-29) to 56,85 (38-72), the average SST improved from 2,29 (1-4) to 9,43 (8-12) and the mean VAS score improved from 14,29 to 4,86. In group B (12 patients) the mean Constant-Murlay score at last follow up was 42,17; the average SST was 7 and average pain score was 8,92. Overall active range-of-motion (ROM) improved significantly. Surgical considerations, clinical (analyzing Constant score and Simple Shoulder Test) and radiological short-term outcomes are encouraging, with low rate of complications. Long term follow-up studies are necessary to confirm our findings and the potential benefits related to these implants. (www.actabiomedica.it)
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Affiliation(s)
- Gian Mario Micheloni
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico P. Confortini, Verona, Italy.
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Oh HK, Lim TK. Short Humeral Stems in Shoulder Arthroplasty. Clin Shoulder Elb 2018; 21:105-110. [PMID: 33330161 PMCID: PMC7726382 DOI: 10.5397/cise.2018.21.2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 11/25/2022] Open
Abstract
Since the introduction of shoulder arthroplasty by Neer in 1974, the design of not only the glenoid component but also the humeral component used in shoulder arthroplasty has continually evolved. Changes to the design of the humeral component include a gradually disappearing proximal fin; diversified surface finishes (such as smooth, grit-blasted, and porous coating); a more contoured stem from the originally straight and cylindrical shape; and the use of press-fit uncemented fixation as opposed to cemented fixation. Despite the evolution of the humeral component for shoulder arthroplasty, however, stem-related complications are not uncommon. Examples of stem-related complications include intraoperative humeral fractures, stem loosening, periprosthetic fractures, and stress shielding. These become much more common in revision arthroplasty, where patients are associated with further complications such as surgical difficulty in extracting the humeral component, proximal metaphyseal bone loss due to stress shielding, intraoperative humeral shaft fractures, and incomplete cement removal. Physicians have made many attempts to reduce these complications by shortening the stem of the humeral component. In this review, we will discuss some of the limitations of long-stem humeral components, the feasibility of replacing them with short-stem humeral components, and the clinical outcomes associated with short-stemmed humeral components in shoulder arthroplasty.
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Affiliation(s)
- Hwang Kyun Oh
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tae Kang Lim
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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Goetzmann T, Molé D, Aisene B, Neyton L, Godeneche A, Walch G, Sirveaux F, Jacquot A. A Short and Convertible Humeral Stem for Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2017. [DOI: 10.1177/2471549217722723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Daniel Molé
- Centre chirurgical Émile Gallé, Nancy, France
| | | | - Lionel Neyton
- Générale de Santé, Hôpital Privé Jean Mermoz, Centre orthopédique Santy, Lyon, France
| | - Arnaud Godeneche
- Générale de Santé, Hôpital Privé Jean Mermoz, Centre orthopédique Santy, Lyon, France
| | - Gilles Walch
- Générale de Santé, Hôpital Privé Jean Mermoz, Centre orthopédique Santy, Lyon, France
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Saltzman BM, Leroux T, Collins MJ, Arns TA, Forsythe B. Short Stem Reverse Total Shoulder Arthroplasty Periprosthetic Type A Fracture. Orthopedics 2017; 40:e721-e724. [PMID: 28399323 DOI: 10.3928/01477447-20170404-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Abstract
Alterations have been made over the years to the standard reverse total shoulder arthroplasty (RTSA) prosthetic components in an effort to decrease adverse events; this has led to the advent of a short humeral stem prosthesis. To the authors' knowledge, there are no reports describing the complication of a traumatic periprosthetic Wright and Cofield classification type A fracture with use of a short metaphyseal humeral stem component for RTSA. The authors describe a 49-year-old woman with this pathology who was treated with open reduction and internal fixation using a proximal humerus locking plate, unicortical and bicortical screw fixation, and a cerclage wire construct without the need to violate the shoulder joint or revise components. Three months postoperatively, she was instructed to begin active range of motion in physical therapy. At 13 months postoperatively, the patient rated her pain level at an average 5 of 10 in severity, with active assisted scaption to 125°, external rotation to 15°, and internal rotation to L5. Radiographs at this time revealed a well-healed fracture. This not only indicates the previously unreported occurrence of such a complication pattern, which was thought rare with the advent of the short humeral RTSA stem, but also provides a viable intraoperative strategy for open reduction and internal fixation with a proximal humerus locking plate, unicortical and bicortical screw fixation, and a cerclage wire construct without the need to violate the shoulder joint. [Orthopedics. 2017; 40(4):e721-e724.].
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Levy O, Walecka J, Arealis G, Tsvieli O, Della Rotonda G, Abraham R, Polyzois I, Jurkowski Z, Atoun E. Bilateral reverse total shoulder arthroplasty-functional outcome and activities of daily living. J Shoulder Elbow Surg 2017; 26:e85-e96. [PMID: 27856265 DOI: 10.1016/j.jse.2016.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 08/07/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years, providing good shoulder elevation, yet less predictable rotations. Good rotations are crucial for performance of activities of daily living (ADLs), including personal hygiene. Concerns remain regarding bilateral rTSA over lack of rotations bilaterally and resultant difficulties with ADLs. This study examined the outcome of patients with bilateral rTSA in restoration of function and ADLs. METHODS Data were prospectively collected for 19 patients (15 women, 4 men; 38 shoulders), with a mean age of 74.5 years, who underwent staged bilateral rTSA between 2007 and 2013. Mean follow-up was 48.4 months (range, 24-75 months). Patients were evaluated clinically using the Constant score, patient's satisfaction, Subjective Shoulder Value, and the Activities of Daily Living External and Internal Rotations (ADLEIR) score. Video clips were also recorded for documentation at all visits. RESULTS Mean duration between staged operations was 18.2 months (range, 3-46 months). The Constant score improved from 18.7 to 65.1 points (age- and sex-adjusted, 100.2). Elevation improved from 57.5° to 143°, internal rotation (IR) from 9° to 81° (30 shoulders could reach above the sacroiliac joint), and external rotation (ER) from 20° to 32° (35 shoulders had >20° ER in adduction, 31 shoulders had full ER in elevation). The Subjective Shoulder Value improved from 2.1 of 10 to 9.2 of 10. Mean ADLEIR score was 33 of 36 (P < .001 for all). Most patients resumed their leisure and sport activities (gardening, golf, swimming, bowling). CONCLUSION Bilateral rTSA results in marked and predictable improvement in all movements, pain relief, and functional outcomes, with high patient satisfaction and high ADLEIR score. All patients were able to perform perineal hygiene after their rTSA. Most patients had no limitation in ADLs and their leisure activities.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
| | - Joanna Walecka
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - George Arealis
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Giuseppe Della Rotonda
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ioannis Polyzois
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Zac Jurkowski
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
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Affiliation(s)
- Kamal I Bohsali
- 1Jacksonville Orthopaedic Institute, Jacksonville Beach, Florida 2Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 3Department of Orthopaedics, University of Texas HSC-San Antonio, San Antonio, Texas
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A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3256931. [PMID: 28105417 PMCID: PMC5220426 DOI: 10.1155/2016/3256931] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
Reversed total shoulder arthroplasty is a popular treatment in rotator cuff arthropathy and in displaced proximal humeral fractures in elderly. In 2016, 29 models of commercially available designs express this popularity. This study describes all the different design parameters available on the market. Prosthetic differences are found for the baseplate, glenosphere, polyethylene, and humeral component and these differences need to be weighed out carefully for each patient knowing that a gain in one mechanical parameter can balance the loss of another. Patient specific implants may help in the future.
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Levy O, Narvani A, Hous N, Abraham R, Relwani J, Pradhan R, Bruguera J, Sforza G, Atoun E. Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study. J Shoulder Elbow Surg 2016; 25:1362-70. [PMID: 26923308 DOI: 10.1016/j.jse.2015.12.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder prostheses are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff. Bone preservation is becoming a major goal in shoulder replacement surgery. Metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone. This study evaluated the clinical and radiologic outcomes at 2 to 7 years using a novel short metaphyseal reverse total shoulder arthroplasty (rTSA) prosthesis without a diaphyseal stem. METHODS Between 2005 and 2010, 102 consecutive patients underwent rTSA with this implant, and 98 (20 men, 78 women) were available for follow-up. Mean age was 74.4 years (range, 38-93 years). Indications were cuff tear arthropathy, 65; fracture sequelae, 12; rheumatoid arthritis, 13; failed rotator cuff repair, 3; cuff deficiency with loosening of anatomic prosthesis, 3; and acute trauma, 2; with 17 of these as revisions. RESULTS Patients' satisfaction (Subjective Shoulder Value) improved from 8 of 100 to 85 of 100. The Constant score improved from 14 to 59 (age- and sex-adjusted, 86; P < .0001). Range of motion improved from 47° to 129° in elevation, 10° to 51° in external rotation, and 21° to 65° in internal rotation. Radiographic analysis showed no lucencies, subsidence, or stress shielding around the humeral or glenoid components. Glenoid notching was found in 21 patients (18 grade 1-2; 3 grade 3). CONCLUSIONS The short metaphyseal rTSA design without a diaphyseal stem shows encouraging short- to midterm results, with excellent pain relief and shoulder function, restoration of good active range of motion, and high patient satisfaction scores. The design of this implant seems to result in improved rotational movements, low incidence of glenoid notching, and no implant loosening, subsidence, or stress shielding.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
| | - Ali Narvani
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Nir Hous
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Jai Relwani
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Riten Pradhan
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
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Short to mid-term results of stemless reverse shoulder arthroplasty in a selected patient population compared to a matched control group with stem. INTERNATIONAL ORTHOPAEDICS 2016; 40:2115-2120. [DOI: 10.1007/s00264-016-3249-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022]
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Revision shoulder arthroplasty from resurfacing to non-cemented short-stem reverse prosthesis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cisneros LGN, Atoun E, Abraham R, Tsvieli O, Bruguera J, Levy O. Revision shoulder arthroplasty: does the stem really matter? J Shoulder Elbow Surg 2016; 25:747-55. [PMID: 26821560 DOI: 10.1016/j.jse.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/07/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of a failed shoulder arthroplasty represents a complex and difficult problem for the treating surgeon, with potential difficulties and complications that are related to the need to remove a well-fixed stem. The aim of this study is to compare the intraoperative complications, postoperative complications, and outcome of revisions from stemmed arthroplasties (STAs) with those from surface replacement arthroplasties (SRAs). METHODS From 2005 to 2012, 40 consecutive revision shoulder arthroplasties were performed at our institute: 17 from STAs and 23 from SRAs. Perioperative events, operation time, blood loss, intraoperative fractures, and use of structural allograft were recorded. Clinical and radiologic outcomes were analyzed. RESULTS Operation time, need for humeral osteotomy, need for structural allograft, and number of intraoperative fractures were significantly higher in the STA group. Blood loss, drop in hemoglobin level, need for blood transfusion, and hospitalization time were also higher in the STA group, but these differences were not statistically significant. Reoperation was performed in 3 patients in the SRA group. A significant clinical improvement was observed in both groups. The Constant score was higher in the SRA group. CONCLUSION Revision of STAs is a more demanding procedure. The postoperative complication rate was slightly higher in the SRA group. The group with revision of SRAs showed slightly better clinical and radiographic results, but there was no statistically significant difference between the groups.
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Affiliation(s)
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
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