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Nakazawa K, Manaka T, Hirakawa Y, Ito Y, Iio R, Oi N, Nakamura H. Bone mineral density around cementless short stems after reverse shoulder arthroplasty: changes over time and its relationship to stem positioning. JSES Int 2024; 8:119-125. [PMID: 38312281 PMCID: PMC10837704 DOI: 10.1016/j.jseint.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background There are numerous reports of bone adaptation observed on plain radiography studies after the use of cementless short stems in reverse shoulder arthroplasty. However, reports on changes in bone mineral density (BMD) around the stem using dual-energy X-ray absorptiometry (DEXA) are prominently absent. In the present study, we measured BMD around the stem using DEXA and investigated changes over time from postoperative year 1 to year 2. Additionally, the relationship between BMD changes, filling ratio, and stem alignment was examined. Methods Forty-seven patients with short cementless stems who could be assessed via DEXA at 1-2 years postoperatively were included. After dividing the zones around the stem into 5, the BMD in each zone was measured, in addition to BMD changes and amount of change from postoperative year 1 to year 2. The relationship between filling ratio and stem alignment on postoperative plain radiography was assessed. Results A significant decrease in BMD in zone 3 was observed between postoperative year 1 and year 2 (P = .02). Regarding filling ratio and stem alignment, a negative correlation between valgus stem alignment and BMD change observed in zone 1 (r = -0.470, P < .01). In addition, stem valgus greater than 6° correlated with a significant decrease in BMD in zone 1. (P = .01). No significant differences were found in the other zones. Furthermore, there was no correlation between filling ratio and BMD change. Conclusion In reverse shoulder arthroplasty cementless short stems, changes that that occurred between postoperative year 1 to year 2 demonstrated a decrease in BMD in zone 3. In addition, a decrease in BMD in zone 1 was observed with a stem alignment of valgus 6° or higher, suggesting that stem alignment within valgus 6° is required to prevent a decrease in BMD.
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Affiliation(s)
- Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Yoichi Ito
- Osaka Shoulder Center, Ito Clinic, Osaka, Japan
| | - Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Naoki Oi
- Osaka Shoulder Center, Ito Clinic, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Villatte G, Soleilhavoup M, Antoni M, Marcheix PS, Pereira B, Boisgard S, Descamps S, Erivan R. Assessment and trends in the methodological quality of the top 50 most cited articles in shoulder arthroplasty. Orthop Traumatol Surg Res 2023; 109:103702. [PMID: 37827452 DOI: 10.1016/j.otsr.2023.103702] [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: 03/14/2023] [Revised: 05/24/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Shoulder arthroplasty is increasingly frequent, and the associated literature is abundant. Citation rate is often considered a good means of assessing impact and scientific value. However, analysis of methodological quality is also essential in evidence-based medicine. OBJECTIVES (1) To identify the 50 most cited articles on shoulder arthroplasty, and (2) to assess the correlation between citation rate and methodological quality. The study hypothesis was that there is no correlation between citation rate and methodological quality. METHOD Articles were retrieved from PubMed and Google Scholar, identifying the 50 most cited articles on shoulder arthroplasty via the keywords "shoulder joint replacement", "shoulder arthroplasty", "anatomic shoulder prothesis", "reverse shoulder prothesis", and "glenohumeral arthritis". Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS) were calculated. RESULTS Mean citation rate for the 50 articles was 312.4±169.5 (range, 151-841.5), with a mean citation density of 18.8±10.6 (range, 4.7-46.7). 56% of the studies (28/50) were retrospective case series with level of evidence IV. There was no correlation between citation rate and methodological quality. DISCUSSION The 50 most cited articles on shoulder arthroplasty mostly showed low levels of methodological quality. There was no correlation between citation rate and methodological quality: the literature needs to be read with a critical eye. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Guillaume Villatte
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - Marion Soleilhavoup
- Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Maxime Antoni
- Centre orthopédique de l'orangerie, clinique de l'orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Roger Erivan
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
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Papadopoulos DV, Nikolaou VS, Masouros P, Babis GC, Imbriglia JE. The impact of glenoid parameters and implant overstuffing on functional outcomes of shoulder hemiarthroplasty in patients with glenohumeral joint arthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3531-3538. [PMID: 37212913 DOI: 10.1007/s00590-023-03584-0] [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: 03/10/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE The outcomes of shoulder hemiarthroplasty are highly dependent on the baseline glenoid morphology and the rotator cuff integrity. The objective of this study was to assess whether certain glenoid parameters and implant overstuffing are associated with worse clinical outcomes following shoulder hemiarthroplasty. METHODS We retrospectively reviewed 25 patients who underwent shoulder hemiarthroplasty for shoulder arthritis, with a mean follow-up of 5.3 years. The baseline glenoid morphology, the glenoid wear rate, the proximal humeral head migration and implant overstuffing were evaluated radiologically in all patients. The radiological parameters were correlated with the functional outcomes. RESULTS The Constant-Murley score, the ASES score, and the OSS score were significantly better for patients with a concentric baseline glenoid compared to those with an eccentric glenoid. The Constant-Murley score and the ASES score were also improved in patients without implant overstuffing compared to patients with implant overstuffing (p < 0.05). However, glenoid wear was not associated with worse functional outcomes (p = 0.23 for Constant-Murley score, p = 0.15 for ASES score and p = 0.27 for OSS score). Last, a worse Constant-Murley score was strongly correlated with proximal humeral head migration (p < 0.001), while worse ASES and OSS scores were moderately correlated with proximal humeral head migration (p < 0.001). CONCLUSION Our findings indicate that the results of hemiarthroplasty can be improved through careful selection of patients upon the baseline glenoid type morphology and proper implant sizing to avoid implant overstuffing. Moreover, glenoid wear is not associated with worse clinical outcomes, therefore shoulder hemiarthroplasty should be reconsidered as an alternative in younger patients with shoulder arthritis.
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Affiliation(s)
| | - Vasileios S Nikolaou
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | | | - George C Babis
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Jacquot A, Samargandi R, Peduzzi L, Mole D, Berhouet J. Infected Shoulder Arthroplasty in Patients Younger than 60 Years: Results of a Multicenter Study. Microorganisms 2023; 11:2770. [PMID: 38004781 PMCID: PMC10673608 DOI: 10.3390/microorganisms11112770] [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: 09/08/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a significant complication. This study aimed to explore the epidemiology and risk factors of shoulder PJI in patients aged 60 and younger, analyze treatment options, and evaluate outcomes after 1-year follow-up. Methods: In this retrospective multicentric observational study, data from 1404 shoulders in patients under 60 who underwent primary shoulder arthroplasty were analyzed. Patients with PJI and at least 1-year follow-up after infection treatment were included. Results: The study identified 55 shoulders with PJI, resulting in a 2.35% infection rate after primary shoulder arthroplasty in the young population. Male gender and reverse shoulder arthroplasty were risk factors for infection, while previous surgeries did not significantly contribute. The most common causative agents were Cutibacterium acnes and Staphylococcus epidermidis. Open washout had a 52.9% success rate for acute infections, while one-stage and two-stage revisions achieved infection control rates of 91.3% and 85.7%, respectively. Resection arthroplasty had an 81.8% success rate but poorer functional outcomes. Conclusions: PJI following shoulder arthroplasty in young patients is a significant concern. Preoperative planning should be carefully considered to minimize infection risk. Treatment options such as open washout and one-stage and two-stage revisions offer effective infection control and improved functional outcomes. Resection arthroplasty should be reserved for complex cases where reimplantation is not a viable option.
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Affiliation(s)
- Adrien Jacquot
- Centre for Chirurgie des Articulations et du Sport (ARTICS), 24 rue du XXIème Régiment d’Aviation, 54000 Nancy, France; (A.J.); (D.M.)
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France;
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Lisa Peduzzi
- Service de Chirurgie Orthopédique, Centre Hospitalo-Universitaire Nancy-Emile Galle, 49, rue Hermite CS 5211, 54052 Nancy, France;
| | - Daniel Mole
- Centre for Chirurgie des Articulations et du Sport (ARTICS), 24 rue du XXIème Régiment d’Aviation, 54000 Nancy, France; (A.J.); (D.M.)
| | - Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France;
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Ryan WK, Vander Voort WD, Saad MA, Wu E, Garcia-Nolen TC, Bayne CO, Szabo RM. The effect of shoulder prosthesis stem length on failure due to torsional loading. A biomechanical study in composite humeri. JSES Int 2023; 7:819-826. [PMID: 37719832 PMCID: PMC10499865 DOI: 10.1016/j.jseint.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Shoulder arthroplasty is becoming increasingly common. With evolving implant designs, multiple humeral stem options exist for the surgeon to choose from. New stemless and short-stem systems are modular, remove less native bone stock, and better adapt to patient anatomy. It has been suggested that shorter stem implants may be protective against periprosthetic fracture; however, this has not been mechanistically evaluated. Therefore, this study aimed to biomechanically test synthetic humeri with long-stem, short-stem, and stemless arthroplasty components in a torsional manner to evaluate their response to loading and characterize failure. Methods Twenty-four synthetic humeri were implanted with long stem, short stem, or stemless uncemented prosthesis, 8 in each group. Humeri were mounted in a custom testing jig with a morse taper interfacing with a mechanical testing system. After a 20N axial force, specimens were torsionally loaded to failure at 15 degrees/sec, with 50 Hz collection. Torque vs. rotation curves were generated for each specimen, and stiffness, yield, ultimate strength, and failure load were measured. ANOVA and post hoc pairwise comparisons were used to assess effect of stem type on mechanical test variable. The association of the stem type with fracture type was analyzed by a Fisher's Exact test. Statistical significance was set at P < .05. Results During torsional loading, long-stem implants were significantly stiffer than short or stemless implants. The angle of implant yielding was similar across stem designs; however, stemless implants had a lower yield torque. This correlated with a decreased yield energy in stemless compared to short stems as well. Maximum torque and failure torque was also significantly higher in short-stem and long-stem implants compared to stemless. Discussion Periprosthetic fractures in shoulder arthroplasty are a concern in low-energy trauma, and stem design likely plays a significant role in early implant-bone failure. Our results suggest stemless implants under torsional load fail at lower stress and are less stiff than stemmed implants. The failure mechanism of stemless implants through metaphyseal cancellous bone emphasizes the effect bone quality has on implant fixation. There is likely a balance of torsional stability to survive physiologic loads while minimizing diaphyseal stress and risk of diaphyseal periprosthetic fracture. This combined with revision and fixation options represent decisions the surgeon is faced with when performing shoulder arthroplasty.
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Affiliation(s)
- Weston K. Ryan
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | | | - Maarouf A. Saad
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Edward Wu
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Christopher O. Bayne
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Robert M. Szabo
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
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McBride AP, Ross M, Duke P, Hoy G, Page R, Dyer C, Taylor F. Shoulder joint arthroplasty in young patients: Analysis of 8742 patients from the Australian Orthopaedic Association National Joint Replacement Registry. Shoulder Elbow 2023; 15:41-52. [PMID: 37692877 PMCID: PMC10492526 DOI: 10.1177/17585732211058717] [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: 05/24/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 09/12/2023]
Abstract
Background Shoulder replacement is a reliable treatment for the relief of pain and improvement of function in patients with glenohumeral arthritis, rotator cuff arthropathy, osteonecrosis and fracture. Limited data is available comparing revision rates for the different types of shoulder replacement when used in younger patients. This study aims to compare the survivorship of hemi resurfacing, stemmed hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty in younger patients using data from a large national arthroplasty registry. Methods Data from the Australian Orthopaedic Association National Joint Replacement Registry was obtained for the period 16 April 2004-31 December 2018. The study population included all shoulder arthroplasty patients aged <65 years. These were stratified into two groups: <55 years and 55-64 years. A total of 8742 primary shoulder arthroplasty procedures were analysed (1936 procedures in the <55 years and 6806 in the 55-64 years age group). Results In the <55 years age group, there was no difference in revision rate for total shoulder arthroplasty versus reverse total shoulder arthroplasty at any time point. Reverse total shoulder arthroplasty had a lower revision rate after six months when compared to hemi resurfacing (HRA) (p = 0.031). Also, reverse total shoulder arthroplasty had a higher early rate of revision in the first 12 months compared to hemiarthroplasty (p = 0.018). However, from 2 years reverse total shoulder arthroplasty had a lower revision rate overall (p = 0.029).In the 55-64 years patient age group, reverse total shoulder arthroplasty had a lower earlier revision rate. This was statistically significant compared to hemi resurfacing (HRA) (p = 0.028), hemiarthroplasty (p = 0.049) and total shoulder arthroplasty (p < 0.001). Conclusion This study demonstrated that for patients aged <55 years there was no significant difference in the rate of revision when total shoulder arthroplasty and reverse total shoulder arthroplasty were compared. reverse total shoulder arthroplasty had a lower rate of revision when compared to hemi resurfacing and hemiarthroplasty after 2 years. reverse total shoulder arthroplasty had the lowest comparative revision rate in patients aged 55-64 years overall.
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Affiliation(s)
| | - Mark Ross
- Brisbane Hand and Upper limb Research Institute, Brisbane, Australia
| | - Phil Duke
- Brisbane Hand and Upper limb Research Institute, Brisbane, Australia
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, Australia
| | - Richard Page
- University Hospital and St John of God Hospital Geelong, Barwon Centre of Orthopaedic Research and Education, Deakin University; Australian Orthopaedic Association National Joint Replacement Registry, Queensland, Australia
| | - Chelsea Dyer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Fraser Taylor
- Gold Coast University Hospital, Southport, Australia
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Jeong HJ, Kim SW, Rhee SM, Yeo JH, Heo K, Oh JH. Subacromial notching after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:1876-1885. [PMID: 37024040 DOI: 10.1016/j.jse.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Scapular notching is a well-known postoperative complication of reverse total shoulder arthroplasty (RTSA). However, subacromial notching (SaN), a subacromial erosion caused by repeated abduction impingement after RTSA, has not been previously reported in a clinical setting. Therefore, this study aimed to assess the risk factors and functional outcomes of SaN after RTSA. METHODS We retrospectively reviewed the medical records of 125 patients who underwent RTSA with the same design between March 2014 and May 2017 and had at least 2 years of follow-up. SaN was defined as subacromial erosion observed at the final follow-up but not on the X-ray 3 months after surgery. Radiologic parameters representing the patient's native anatomy and degrees of lateralization and/or distalization during surgery were evaluated using preoperative and 3 months postoperative X-rays. The visual analogue scale of pain, active range of motion, and American Shoulder and Elbow Surgeons score were assessed preoperatively and at the final follow-up to evaluate the functional outcomes of SaN. RESULTS SaN occurred in 12.8% (16/125) of enrolled patients during the study period. Preoperative center of rotation-acromion distance (P = .009) and postoperative humerus lateralization offset, which evaluated the degree of lateralization after RTSA (P = .003), were risk factors for SaN. The preoperative center of rotation-acromion distance and postoperative humerus lateralization cutoff values were 14.0 mm and 19.0 mm, respectively. The visual analogue scale of pain (P = .01) and American Shoulder and Elbow Surgeons score (P = .04) at the final follow-up were significantly worse in patients with SaN. CONCLUSIONS SaN might adversely affect postoperative clinical outcomes. As SaN correlated with patients' anatomical characteristics and degree of lateralization during RTSA, the implant's degree of lateralization should be adjusted according to the patient's own anatomical characteristics.
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Affiliation(s)
- Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Woo Kim
- Department of Orthopaedic Surgery, Nalgae Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ji Hyun Yeo
- Department of Orthopaedic Surgery, Hanam S Hospital, Hanam, Republic of Korea
| | - Kang Heo
- Department of Orthopaedic Surgery, Chambaro hospital, Seoul, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Bidwai R, Kumar K. Outcomes of different stem sizes in shoulder arthroplasty. J Orthop 2023; 35:37-42. [PMID: 36387763 PMCID: PMC9647328 DOI: 10.1016/j.jor.2022.10.009] [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: 06/11/2022] [Revised: 08/20/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background The successive refinement in implant design and operative technique alongwith improved understanding has resulted in increased incidence of total shoulder arthroplasty (TSA). Simultaneously, the indications of TSA have widened and include a range of shoulder pathologies. Methods Using the keywords and relevant literature, we have described an overview of the different stem sizes used in shoulder arthroplasty. Relevant description of clinical and radiological outcome is done with regards to different stem sizes. Discussion There are plethora of shoulder replacement systems, based on unique philosophy and having their own advantages and disadvantages. Additionally, the rise in ageing population had increased the need for revision TSA, thereby necessitating the judicious choice of implant at primary TSA. We further present the role of cemented and uncemented humeral stems and discuss the findings of finite element analysis. The choice of humeral stem size and use of cemented or uncemented stems have been reported to affect the clinical and radiological outcomes.
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Affiliation(s)
- Rohan Bidwai
- Aberdeen Upper Limb Unit, Department of Trauma and Orthopaedics, Woodend Hospital, NHS Grampian , Aberdeen, UK
| | - Kapil Kumar
- Aberdeen Upper Limb Unit, Department of Trauma and Orthopaedics, Woodend Hospital, NHS Grampian , Aberdeen, UK
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Petrosyan AS, Egiazaryan KA, Panin MA, Ratyev AA, Albawareed OA. Evolution of shoulder arthroplasty. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-2-117-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the more than century-long history of shoulder arthroplasty, scientists have gone from primitive ivory designs to high-tech implants made of rare metal alloys. Along the way, surgeons and inventors have faced challenges, made mistakes, and succeeded. This literature review reflects trends in the development of shoulder arthroplasty, evolutionary changes in endoprosthesis designs and principles of surgical treatment of shoulder pathology, from the late 19th century to the present. This paper details the stages of formation of the major modern philosophies of shoulder arthroplasty, such as those of Ch. Neer (anatomical prosthetics), P.M. Grammont (reversible prosthetics), and J. Zippel (surface prosthetics). In the 70s and 80s of the 20th century the components of shoulder prostheses as well as their fitting techniques continued to be improved from a biomechanical point of view. It was found that if the shoulder head and scapular component have different radii of curvature during arthroplasty, a shoulder-b lade mismatch is formed. A non-congruent joint (the radius of curvature of the head is smaller than the radius of curvature of the glenoid component) increases eccentric loads on the scapula joint implant, increases the risk of implant fracture, and reduces stability in the joint. However, such a joint allows reproduction of the natural gliding of the head. Restricting the required glide increases stress at the fixation site and can lead to loosening of the glenoid component. A number of studies have shown that a mismatch of more than 10 mm increases the risk of loosening and fractures of the scapular component, while a mismatch of 5-7 mm can be considered optimal, as it provides long-term survival of the glenoid component and the best reproduction of normal movements in the shoulder joint.
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Accuracy of free-hand humeral head resection planned on 3D-CT models in shoulder arthroplasty: an in vitro analysis. Arch Orthop Trauma Surg 2022; 142:3141-3147. [PMID: 33978808 DOI: 10.1007/s00402-021-03931-y] [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: 12/29/2020] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Three-dimensional planning of humeral head osteotomy in shoulder arthroplasty (SA) is understudied. This study evaluated whether a standard osteotomy technique along the anterosuperior anatomic neck (ASOT) could be surgically reproduced as pre-operatively planned on 3D-CT models. MATERIAL AND METHODS Pre-operative planning in 12 cadaver shoulders was performed on a 3D-CT model of the humerus to calculate the planned osteotomy plane (planned OP). The osteotomy was then performed using a free-hand technique, and a post-operative CT scan was obtained for analysis (performed OP). Planes were compared with regards to inclination, retroversion, and resected humeral head thickness so the accuracy could be quantified. RESULTS The absolute errors between the performed and planned OP were 2° (0-10°), 5° (0-14°), and 4 mm (1-7 mm) for inclination, retroversion, and resected head thickness, respectively. Deviation < 10° for inclination and retroversion and < 5 mm for resected humeral head thickness between planned and performed OP was achieved in 92%, 83%, 58% of cases, respectively. No differences were found for inclination (p = 0.289), whereas retroversion and resected head thickness were smaller than planned (p ≤ 0.027). CONCLUSIONS Pre-operative planning of the ASOT using a 3D-CT model is accurate within a threshold of 10° when using a free-hand technique in 92% of cases for inclination. Retroversion and resected head thickness differed from the pre-operative plan, thereby limiting the unrestricted use of humeral head osteotomy planning from 3D-CT models in SA. These findings are a reference for further studies to develop and quantify the accuracy of pre-operative planning software including cutting guides for SA using 3D-CT models. LEVEL OF EVIDENCE Basic science article.
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Filho GDRM, Amaral MVG. Artroplastia do ombro no tratamento das fraturas da extremidade proximal do úmero: Conceitos atuais. Rev Bras Ortop 2022; 57:529-539. [PMID: 35966425 PMCID: PMC9365482 DOI: 10.1055/s-0040-1721359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Complex proximal humeral fractures, especially in elderly patients, often require arthroplastic surgical treatment. Traditionally, shoulder hemiarthroplasty (HA) is the method of choice, resulting in long implant survival and a painless shoulder; however, shoulder HA has heterogeneous clinical outcomes related to the correct position of the implant, both in terms of height and version, and the anatomical consolidation of tuberosities. Today, reverse shoulder arthroplasties are increasingly used to treat such fractures. These techniques result in better functional outcomes compared to HAs, especially regarding anterior flexion, but implant longevity has not been established. The development of specific prosthetic humeral components for the treatment of fractures, which were recently introduced in the clinical practice, led to better clinical outcomes.
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Affiliation(s)
- Geraldo da Rocha Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Galvão Amaral
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
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Clinical outcomes of reverse total shoulder arthroplasty for elective indications versus acute 3- and 4-part proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e14-e21. [PMID: 34454040 DOI: 10.1016/j.jse.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has continued to increase in clinical utility and popularity as an effective treatment for cuff tear arthropathy (CTA), irreparable rotator cuff tears (RCTs), osteoarthritis, and acute 3- and 4-part proximal humeral fractures. Performing RTSA for acute proximal humeral fractures presents the unique challenges of tuberosity management, bone loss, and instability compared with elective indications such as CTA or irreparable RCTs. The purpose of this study was to compare the clinical outcomes, active range of motion (ROM), radiographic outcomes, and complications between patients undergoing elective RTSA (RTSA-E) and those undergoing RTSA for fracture (RTSA-F). METHODS A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We queried 3 electronic databases (Embase, Cochrane, and PubMed) using the search term "reverse" AND "shoulder" AND "arthroplasty." Studies investigating the clinical outcomes of RTSA for traumatic and/or elective indications were included. Studies were excluded if they included RTSA performed for fracture sequelae, inflammatory arthritis, post-traumatic osteoarthritis, or avascular necrosis. Data collected included patient demographic characteristics, subjective outcome measurements, ROM, and complications. The pooled means and proportions along with their 95% confidence intervals were generated by a random-effects model that incorporated the between-study variations in weighting. RESULTS A total of 134 studies (11,651 shoulders) investigating the clinical outcomes of RTSA-E patients and 66 studies (3117 shoulders) investigating RTSA-F patients were included in this systematic review. Analysis of patient-reported outcomes demonstrated that RTSA-F patients experienced significantly lower Constant scores than RTSA-E patients; however, relative Constant scores, Simple Shoulder Test scores, Disabilities of the Arm, Shoulder and Hand scores, American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores were similar. RTSA-F patients also had significantly lower forward elevation, abduction, and external rotation. RTSA-F patients experienced tuberosity complications at a significantly higher rate than RTSA-E patients (25.9% vs. 4.1%). There was no significant difference between the 2 groups in terms of other complications such as heterotopic ossification, radiographic loosening, revision, nerve injury, postoperative stiffness, infection, dislocation, and component loosening. DISCUSSION RTSA performed for acute 3- and 4-part proximal humeral fractures yields overall worse clinical outcomes and active ROM compared with RTSA performed for elective indications including CTA, massive irreparable RCTs, and osteoarthritis with deformity. Tuberosity healing may be a major contributing factor to the difference in clinical outcomes. In the setting of RTSA-F, patient and surgeon expectations may need to be tempered and appropriate measures undertaken to optimize tuberosity healing.
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13
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Gamma camera imaging (bone scan) in orthopedics: Wrist, elbow and shoulders. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Miyatake K, Fukuta S, Tonogai I, Wada K, Higashino K, Mikami H, Yonezu H, Sairyo K, Tsuruo Y. Influence of the glenoid baseplate position on the direction and length of the superior and inferior locking screws. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:185-190. [DOI: 10.2152/jmi.69.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Katsutoshi Miyatake
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Shoji Fukuta
- Department of Orthopaedic Surgery, Kochi National Hospital, Kochi, Japan
| | - Ichiro Tonogai
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopaedic Surgery, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Hiroshi Mikami
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Hiroshi Yonezu
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy and Cell biology, Tokushima University, Tokushima, Japan
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Analysis of the coaptation role of the deltoid in reverse shoulder arthroplasty. A preliminary biomechanical study. PLoS One 2021; 16:e0255817. [PMID: 34407093 PMCID: PMC8372985 DOI: 10.1371/journal.pone.0255817] [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] [Received: 04/22/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background Lateralization of the glenoid implant improves functional outcomes in Reverse Shoulder Arthroplasty. Lateralization does not appear to impact the Deltoid’s Moment Arm. Therefore, the stabilizing effect described in the literature would not be the result of an increase this moment arm. A static biomechanical model, derived from Magnetic Resonance Imaging, can be used to assess the coaptation effect of the Middle Deltoid. The objective of this study was to analyze the impact of increasing amounts of glenoid lateralization on the moment arm but also on its coaptation effect. Methods Eight patients (72.6 ± 6.5 years) operated for Reverse Shoulder Arthroplasty were included in the study. Three-dimensional models of each shoulder were created based on imaging taken at 6 months postoperative. A least square sphere representing the prosthetic implant was added to each 3D models. A static biomechanical model was then applied to different planar portions of the Middle Deltoid (from 3D models), first without lateralization and then with simulated lateralization of 6, 9 and 12mm. This static model enables to compute a Coaptation/Elevation Ratio and to measure the Deltoid’s Moment Arm. The inter- and intra-rater agreement of the 3D models was evaluated. Results One patient was excluded due to motion during imaging. The inter- and intra-rater agreement was over 0.99. The ratio increased starting at 6 mm of lateralization (p<0.05), compared to the initial position. The moment arm was not affected by lateralization (p<0.05), except in two slices starting at 9 mm (S1 p<0.05 and S2 p<0.05). Conclusion Our hypothesis that the Middle Deltoid’s coaptation role would be greater with glenosphere lateralization was confirmed. This trend was not found in the moment arm, which showed little sensitivity to lateralization. The stabilizing effect therefore appears to stem from the coaptation role of the Middle Deltoid.
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Wodarek J, Shields E. Stemless Total Shoulder: A Review of Biomechanical Fixation and Recent Results. J Shoulder Elb Arthroplast 2021; 5:24715492211008408. [PMID: 34993377 PMCID: PMC8492026 DOI: 10.1177/24715492211008408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.
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Affiliation(s)
- Jeremy Wodarek
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Edward Shields
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
- Orthopedic Associates of Muskegon, Muskegon, Michigan
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17
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Stemless Total Shoulder Arthroplasty With Orthobiologic Augmentation. Arthrosc Tech 2021; 10:e531-e538. [PMID: 33680788 PMCID: PMC7917302 DOI: 10.1016/j.eats.2020.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023] Open
Abstract
Total shoulder arthroplasty (TSA) has evolved over the years and is used for a variety of indications, with arthritis being the most common. Stemless TSA is a unique bone-preserving design that can eliminate rotational malalignment. Additionally, recent literature has found utility in the use of biological mesh and a platelet-rich plasma injection to improve healing. The purpose of this article is to outline the process of TSA using a stemless system and how to incorporate the use of amnion matrix and platelet-rich plasma into the surgical technique.
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18
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Wang KC, Jones A, Kambhampati S, Gilotra MN, Liacouras PC, Stuelke S, Shiu B, Leong N, Hasan SA, Siegel EL. CT-Based 3D Printing of the Glenoid Prior to Shoulder Arthroplasty: Bony Morphology and Model Evaluation. J Digit Imaging 2020; 32:816-826. [PMID: 30820811 DOI: 10.1007/s10278-019-00177-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
To demonstrate the 3D printed appearance of glenoid morphologies relevant to shoulder replacement surgery and to evaluate the benefits of printed models of the glenoid with regard to surgical planning. A retrospective review of patients referred for shoulder CT was performed, leading to a cohort of nine patients without arthroplasty hardware and exhibiting glenoid changes relevant to shoulder arthroplasty planning. Thin slice CT images were used to create both humerus-subtracted volume renderings of the glenoid, as well as 3D surface models of the glenoid, and 11 printed models were created. Volume renderings, surface models, and printed models were reviewed by a musculoskeletal radiologist for accuracy. Four fellowship-trained orthopaedic surgeons specializing in shoulder surgery reviewed each case individually as follows: First, the source CT images were reviewed, and a score for the clarity of the bony morphologies relevant to shoulder arthroplasty surgery was given. The volume rendering was reviewed, and the clarity was again scored. Finally, the printed model was reviewed, and the clarity again scored. Each printed model was also scored for morphologic complexity, expected usefulness of the printed model, and physical properties of the model. Mann-Whitney-Wilcoxon signed rank tests of the clarity scores were calculated, and the Spearman's ρ correlation coefficient between complexity and usefulness scores was computed. Printed models demonstrated a range of glenoid bony changes including osteophytes, glenoid bone loss, retroversion, and biconcavity. Surgeons rated the glenoid morphology as more clear after review of humerus-subtracted volume rendering, compared with review of the source CT images (p = 0.00903). Clarity was also better with 3D printed models compared to CT (p = 0.00903) and better with 3D printed models compared to humerus-subtracted volume rendering (p = 0. 00879). The expected usefulness of printed models demonstrated a positive correlation with morphologic complexity, with Spearman's ρ 0.73 (p = 0.0108). 3D printing of the glenoid based on pre-operative CT provides a physical representation of patient anatomy. Printed models enabled shoulder surgeons to appreciate glenoid bony morphology more clearly compared to review of CT images or humerus-subtracted volume renderings. These models were more useful as glenoid complexity increased.
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Affiliation(s)
- Kenneth C Wang
- Baltimore VA Medical Center, Baltimore, MD, USA. .,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA.
| | - Anja Jones
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Mohit N Gilotra
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Peter C Liacouras
- 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Radiology and Radiological Services & Naval Postgraduate Dental School, Uniform Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Brian Shiu
- Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Natalie Leong
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Eliot L Siegel
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
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19
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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: 11] [Impact Index Per Article: 2.8] [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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20
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Schiefer M, Siqueira G, Figueira A, Souza PM, Monteiro MT, Motta Filho G. Integração óssea e prevalência de linhas radiotransparentes ao redor dos pinos de componentes glenoidais minimamente cimentados na artroplastia total de ombro. Rev Bras Ortop 2020; 57:120-127. [PMID: 35198119 PMCID: PMC8856858 DOI: 10.1055/s-0040-1715509] [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] [Received: 02/17/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component.
Methods
Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component.
Results
Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results.
Conclusion
Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results.
Level of evidence
IV; Case series; Treatment study.
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Affiliation(s)
- Márcio Schiefer
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Gláucio Siqueira
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Alan Figueira
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Patrícia Martins Souza
- Departamento de Radiologia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Martim Teixeira Monteiro
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
| | - Geraldo Motta Filho
- Departamento de Ortopedia, Instituto Nacional de Ortopedia e Traumatologia (INTO), Rio de Janeiro, RJ, Brasil
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Vora M, Sing DC, Curry EJ, Kamal RN, Li X. National Trends in the Surgical Treatment of Chronic Rotator Cuff Tear in Patients Without Arthritis. Orthopedics 2020; 43:e409-e414. [PMID: 32602925 DOI: 10.3928/01477447-20200619-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/28/2019] [Indexed: 02/03/2023]
Abstract
Both rotator cuff repair (RCR) and reverse total shoulder arthroplasty (RTSA) are effective treatment options for chronic large degenerative rotator cuff tear (RCT) in the elderly. The goal of this study was to evaluate national trends for surgical management of chronic RCT among patients without glenohumeral arthritis. The authors conducted a retrospective review from 2007 to 2015 using the PearlDiver database. The study included patients who had the International Classification of Diseases, Ninth Revision, diagnosis of chronic RCT without shoulder arthritis. Procedural codes from the Current Procedural Terminology and the International Classification of Diseases, Ninth Revision, were used to identify patients undergoing RCR or RTSA. Chi-square analysis assessed differences between the groups, and Cochran-Armitage trend tests were used to evaluate trends over time. Overall, 428,651 patients had chronic RCT without arthritis; 364,141 (84.9%) were treated nonoperatively, 53,566 (12.5%) underwent RCR, and 10,944 (2.6%) underwent RTSA. Patients who were 60 to 79 years old had the highest rate of surgical intervention (70.8% of all surgical patients), with 69.2% and 78.4% who underwent RCR and RTSA, respectively. A 3-fold increase in RTSA use was noted among patients 60 years and older vs patients younger than 60 years. Overall revision rates 2 years after RCR and RTSA among patients 60 to 79 years old were 13.0% and 3.7%, respectively. Revision rates after RCR remained constant over time (9.3% to 13.0%; P=.082), whereas revision rates after RTSA decreased significantly over time (12.1% to 2.2%; P=.016). Older patients were more likely to be treated nonoperatively compared with younger patients, but among those patients treated with RTSA, there was a 3-fold increase in the use of RTSA in patients older than 60 years compared with patients younger than 60 years. Further, the authors found that revision rates after RTSA decreased over time (from 12% to 2%), suggesting better implant design, improved knowledge of implant positioning, and increased surgical proficiency. [Orthopedics. 2020;43(5):e409-e414.].
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22
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Meshram P, Pawaskar A, Kekatpure A. 3D CT scan-based study of glenoid morphology in Indian population: Clinical relevance in design of reverse total shoulder arthroplasty. J Clin Orthop Trauma 2020; 11:S604-S609. [PMID: 32774036 PMCID: PMC7394810 DOI: 10.1016/j.jcot.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The knowledge of normal anatomy of glenoid in a population has relevance in terms of comparison with other regional and national population. Furthermore, it could enable clinicians to judge whether the available sizes of reverse total shoulder arthroplasty (RTSA) prosthesis could provide optimal fit for the glenoid in Indian patients. METHODS We evaluated consecutive 200 3-dimensional chest CT scans of 50 male and 50 female patients which included both shoulder joints and done for non-orthopaedic diseases at a tertiary care institute. The glenoid height, width, and version were measured using commercially available computer program. RESULTS Mean age of the patents was 38.6 ± 13.8 years (range, 19-59 years). The mean glenoid height was 33.9 ± 3.1 mm and maximum glenoid width was 24.2 ± 2.1 mm. Mean glenoid version in the study population was a retroversion of 3.47 ± 4.7°. The maximum glenoid width of 45% female and 15% male patients was less than 25 mm which is the diameter of smallest available glenoid baseplate among the commonly used RTSA systems. CONCLUSIONS The normal glenoid size of a large cohort of Indian population studied was smaller than that reported in cohorts from western countries. The glenoid width of substantial proportion of patients, especially female patients, was less than the diameter of smallest available glenoid baseplate. Clinical studies are needed in future in Indian patients undergoing RTSA to evaluate the glenoid bone-baseplate mismatch and ascertain the necessity of development of smaller size glenoid baseplate for optimal prosthesis fit in Indian patients.
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Affiliation(s)
- Prashant Meshram
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Aditya Pawaskar
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Aashay Kekatpure
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, India
- Corresponding author. Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, India, Maharashtra, 442004, India.
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Ajdari N, Tempelaere C, Masouleh MI, Abel R, Delfosse D, Emery R, Dini D, Hansen U. Hemiarthroplasties: the choice of prosthetic material causes different levels of damage in the articular cartilage. J Shoulder Elbow Surg 2020; 29:1019-1029. [PMID: 31948834 DOI: 10.1016/j.jse.2019.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemiarthroplasty has clear advantages over alternative procedures and is used in 20% of all shoulder joint replacements. Because of cartilage wear, the clinical outcome of hemiarthroplasty is unreliable and controversial. This paper suggests that the optimal choice of prosthetic material may reduce cartilage degeneration and improve the reliability of the procedure. The specific objectives were to assess 3 materials and assess how the severity of arthritis might affect the choice of prosthetic material. METHODS A CoCr alloy, an AL2O3 ceramic, and a polycarbonate urethane polymer (PCU) were mechanically tested against 5 levels of human osteoarthritic cartilage (from intact to severely arthritic, n = 45). A high friction coefficient, a decrease in Young's modulus, an increase in permeability, a decrease in relaxation time, an increase in surface roughness, and a disrupted appearance of the cartilage after testing were used as measures of cartilage damage. The biomaterial that caused minimal cartilage damage was defined as superior. RESULTS The CoCr caused the most damage. This was followed by the AL2O3 ceramic, whereas the PCU caused the least amount of damage. Although the degree of arthritis had an effect on the results, it did not change the trend that CoCr performed worst and PCU the best. DISCUSSION AND CONCLUSION This study indicates that ceramic implants may be a better choice than metals, and the articulating surface should be as smooth as possible. Although our results indicate that the degree of arthritis should not affect the choice of prosthetic material, this suggestion needs to be further investigated.
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Affiliation(s)
- Niloofar Ajdari
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Christine Tempelaere
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK; Department of Orthopaedic Surgery, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Maryam Imani Masouleh
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Richard Abel
- Department of Surgery and Cancer, Charing Cross Campus, London, UK
| | | | - Roger Emery
- Department of Surgery and Cancer, St. Mary's Hospital, London, UK
| | - Daniele Dini
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Ulrich Hansen
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK.
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Lädermann A, Chiu JCH, Cunningham G, Hervé A, Piotton S, Bothorel H, Collin P. Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties? Orthop Traumatol Surg Res 2020; 106:241-246. [PMID: 32057747 DOI: 10.1016/j.otsr.2019.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/29/2019] [Accepted: 12/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Shorter humeral stems were developed to improve bone preservation, vascularity and osteointegration in reverse total shoulder arthroplasty (RSA). While some studies examined the relationship between canal filling and radiographic changes, none evaluated the association between stem alignment and canal fill ratio (CFR). HYPOTHESIS The hypothesis was that stem misalignment after RSA would be associated with lower CFR. PATIENTS AND METHODS The authors retrospectively reviewed immediate postoperative radiographs of 157 patients, comprising 56 men (36%), who underwent RSA with a short uncemented stem with neck shaft angle (NSA) default of 145°. The parameters included postoperative NSA and metaphyseal CFR, both measured with excellent inter-observer agreement. Uni- and multivariable linear regressions were performed to determine associations between postoperative NSA and 5 variables (CFR, gender, age, BMI, and surgical approach). RESULTS Postoperative NSA was 149°±8°, exceeding 5° of varus in 15 shoulders (9%) and 5° of valgus in 60 shoulders (38%), and CFR was 58%±8%. CFR was lower in shoulders with varus stem alignment (54%±6%) than shoulders with neutral stem alignment (59%±8%, p=0.033). Multivariable regression revealed that postoperative NSA increased with age (beta: 0.20; p=0.008), was higher for shoulders operated with the subscapularis- and deltoid-sparing approach (beta: 3.82; p=0.040) but lower for men (beta: -4.14; p=0.002). CONCLUSIONS Stem misalignment exceeded 5° in 47% of the shoulders. Women, older age, and subscapularis- and deltoid-sparing approach are associated with greater risks of valgus stem positioning, while lower CFR seems to be associated with greater risks of varus stem positioning. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
- 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; Division of Orthopaedics and Trauma Surgery, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Joe Chih-Hao Chiu
- Department of Orthopaedic Sports Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Grégory Cunningham
- 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
| | - Anthony Hervé
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Sébastien Piotton
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260 Nyon, Switzerland.
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
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Das AK, Wright AC, Singh J, Monga P. Does posterior half-wedge augmented glenoid restore version and alignment in total shoulder arthroplasty for the B2 glenoid? J Clin Orthop Trauma 2020; 11:S275-S279. [PMID: 32189953 PMCID: PMC7067996 DOI: 10.1016/j.jcot.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Walch type B2 has biconcave glenoid with posterior erosion, bone loss and humeral head subluxation. This leads to decreased glenohumeral contact area and increased contact pressure. During total shoulder arthroplasty(TSA), uncorrected retroversion causes eccentric loading and failure of glenoid component. It also leads to humeral head decentring with posterior rim loading, early glenoid wear and component loosening. This study aims to review anatomical restoration of glenoid version and humeral head centring in TSA with B2 glenoid using CT scans. METHODS This is a retrospective review of TSA for glenohumeral osteoarthritis with B2 Glenoid morphology. All polyethylene posterior wedge augmented glenoid component was used. All patients underwent pre and post surgery CT Scans. Glenoid version was calculated using neoglenoid line and medial scapular border as reference point. Post-operative humeral head centering was calculated using offset of centre of rotation of humeral head with plane of scapula on axial CT-Scan. RESULTS Study had 10 patients with 11 TSA between June 2017 and July 2018. Mean age was 59(45-80)years. Mean preoperative retroversion was 16(13-23)degrees. This was corrected to a mean of 0° retroversion postoperatively. 63% had good radiological correction (0-5° retroversion). Humeral head was well centered post-operatively with mean humeral scapula alignment offset of 2.1(0.8-4.5) mm posteriorly. All cases had well-centered humeral head postoperatively with offset less than 5 mm. CONCLUSIONS Total shoulder replacement in B2 glenoid is technically demanding. Our radiological results show favourable outcome in terms of correction of gelenoid retroversion and eliminating posterior instability using wedge glenoid component. LEVEL OF EVIDENCE IV.
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Manzi JE, Ruzbarsky JJ, Rauck RC, Gulotta LV, Dines JS, Dines DM. Failed Proximal Humerus Osteosynthesis Using Intramedullary Fibular Strut Allograft Conversion to Reverse Shoulder Arthroplasty. Tech Hand Up Extrem Surg 2020; 24:7-12. [PMID: 31436758 DOI: 10.1097/bth.0000000000000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Comminuted proximal humerus fractures are more frequently being treated utilizing an intramedullary fibular strut allograft to assist with open reduction internal fixation. Although this technique has led to improved outcomes, avascular necrosis, rotator cuff failure, and/or prominent hardware may still occur necessitating conversion to reverse shoulder arthroplasty. The presence of an intramedullary strut allograft makes this conversion technically demanding and creates certain potential complications unique to this group. This manuscript details the conversion of a proximal humerus open reduction internal fixation with a fibular strut allograft to reverse shoulder arthroplasty including presurgical workup, surgical techniques, and pitfalls for undertaking this increasingly common scenario.
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Arias-de la Torre J, Garcia X, Smith K, Romero-Tamarit A, Puigdomenech E, Muñoz-Ortiz L, Evans JP, Martín V, Molina AJ, Torrens C, Pons-Cabrafiga M, Pallisó F, Valderas JM, Espallargues M. Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review. J Clin Med 2019; 8:E2063. [PMID: 31771221 PMCID: PMC6947222 DOI: 10.3390/jcm8122063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant-Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.
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Affiliation(s)
- Jorge Arias-de la Torre
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 León, Spain;
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AB, UK
| | - Xavier Garcia
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
| | - Kayla Smith
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
| | - Arantxa Romero-Tamarit
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
| | - Elisa Puigdomenech
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
| | - Laura Muñoz-Ortiz
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
| | - Jonathan P. Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX1 2LU, UK; (J.P.E.); (J.M.V.)
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Vicente Martín
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 León, Spain;
| | - Antonio J. Molina
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 León, Spain;
| | - Carles Torrens
- Hospital del Mar, Department of Orthopaedic Surgery and Trauma, 08003 Barcelona, Spain;
| | - Miquel Pons-Cabrafiga
- Department of Orthopaedic Surgery and Trauma, Sant Rafael University Hospital, 08035 Barcelona, Spain;
| | - Francesc Pallisó
- Department of Orthopaedic Surgery and Trauma, Santa María University Hospital, 25198 Lleida, Spain;
| | - Jose María Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX1 2LU, UK; (J.P.E.); (J.M.V.)
| | - Mireia Espallargues
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
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Rasmussen JV, Harjula J, Arverud ED, Hole R, Jensen SL, Brorson S, Fenstad AM, Salomonsson B, Äärimaa V. The short-term survival of total stemless shoulder arthroplasty for osteoarthritis is comparable to that of total stemmed shoulder arthroplasty: a Nordic Arthroplasty Register Association study. J Shoulder Elbow Surg 2019; 28:1578-1586. [PMID: 31043348 DOI: 10.1016/j.jse.2019.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the short-term survival rate of total stemless, metaphyseal fixated, shoulder arthroplasty with that of total stemmed shoulder arthroplasty in the treatment of osteoarthritis. METHODS Data were collected by the national arthroplasty registries in Denmark, Finland, Norway, and Sweden and merged into 1 dataset under the umbrella of the Nordic Arthroplasty Register Association. For the present study, we included all patients with osteoarthritis treated with either stemless (n = 761) or stemmed (n = 4398) shoulder arthroplasty from 2011 to 2016. RESULTS A total of 21 (2.8%) stemless and 116 (2.6%) stemmed shoulder arthroplasties were revised. The 6-year unadjusted cumulative survival rates were 0.953 for stemless shoulder arthroplasty and 0.958 for stemmed shoulder arthroplasty, P = .77. The most common indication for revision of both arthroplasty types was infection. Five (0.7%) stemless and 16 (0.4%) stemmed shoulder arthroplasties were revised because of loosening of either the glenoid or the humeral component. In the multivariate cox regression model, which included age, category, gender, year of surgery, previous surgery, and arthroplasty type, the hazard ratio (HR) for revision of the stemless shoulder arthroplasty was 1.00 (95% confidence interval [CI], 0.63-1.61), P = .99, with the stemmed shoulder arthroplasty as reference. Male gender (HR = 1.50 [95% CI, 1.06-2.13], P = .02) and previous surgery (HR = 2.70 [95% CI, 1.82-4.01], P < .001) were associated with increased risk of revision. CONCLUSION The short-term survival of total stemless shoulder arthroplasty appears comparable with total stemmed shoulder arthroplasty, but longer observation time is needed to confirm whether they continue to perform equally.
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Affiliation(s)
- Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Jenni Harjula
- Department of Orthopaedics and Traumatology, Turku University and University Hospital, Turku, Finland
| | - Erica D Arverud
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden
| | - Randi Hole
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Steen L Jensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Stig Brorson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Björn Salomonsson
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden
| | - Ville Äärimaa
- Department of Orthopaedics and Traumatology, Turku University and University Hospital, Turku, Finland
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Pinto MC, Archie AT, Mosher ZA, Ransom EF, McGwin G, Fehringer EV, Brabston EW, Ponce BA. Radiographic restoration of native anatomy: a comparison between stemmed and stemless shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1595-1600. [PMID: 30982698 DOI: 10.1016/j.jse.2019.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder arthroplasty is a reliable procedure for patients with degenerative glenohumeral disease, and reproduction of native shoulder anatomy leads to superior outcomes. The aim of this study was to compare the ability of stemmed and stemless implants to radiographically restore native glenohumeral anatomy. METHODS Shoulder arthroplasties were performed in 79 patients, with 58 receiving a stemless implant and 21 receiving a stemmed implant. Preoperative and postoperative radiographs were assessed for humeral head height, humeral head centering, humeral head medial offset, humeral head diameter, humeral neck angle, and lateral humeral offset by 2 independent viewers. Measurements were scored and summed to identify the anatomic reconstruction index (ARI). Radiographic measurements were compared using the Student t test, and significance was set at P < .05 for all statistical analyses. Interobserver agreement of radiographic analyses was assessed using the intraclass correlation coefficient, finding excellent reliability (intraclass correlation coefficient, 0.92). RESULTS Five of six radiographic measurements along with the calculated ARI demonstrated no differences between stemmed and stemless shoulder implants (humeral head diameter, P = .651; humeral head height, P = .813; humeral head medial offset, P = .592; lateral humeral offset, P = .311; humeral head centering, P = .414; and ARI, P = .862). Stemless implants showed improved restoration of the native humeral neck angle (0° for stemless vs. -3° for stemmed, P = .017). CONCLUSION Radiographic restoration of anatomy is similar for stemmed and stemless shoulder arthroplasty implants.
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Affiliation(s)
- Martim C Pinto
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam T Archie
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary A Mosher
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin F Ransom
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Geral McGwin
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward V Fehringer
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W Brabston
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A Ponce
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Biomechanical comparison of 2 augmented glenoid designs: an integrated kinematic finite element analysis. J Shoulder Elbow Surg 2019; 28:1166-1174. [PMID: 30876745 DOI: 10.1016/j.jse.2018.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/10/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Augmented glenoid implants are available to help restore the biomechanics of the glenohumeral joint with excessive retroversion. It is imperative to understand their behavior to make a knowledgeable preoperative decision. Therefore, our goal was to identify an optimal augmented glenoid design based on finite element analysis (FEA) under maximum physiological loading. METHODS FEA models of 2 augmented glenoid designs-wedge and step-were created per the manufacturers' specifications and virtually implanted in a scapula model to correct 20° of retroversion. Simulation of shoulder abduction was performed using the FEA shoulder model. The glenohumeral force ratio, relative micromotion, and stress levels on the cement mantle, glenoid vault, and backside of the implants were compared between the 2 designs. RESULTS The force ratio was 0.56 for the wedge design and 0.87 for the step design. Micromotion (combination of distraction, translation, and compression) was greater for the step design than the wedge design. Distraction measured 0.05 mm for the wedge design and 0.14 mm for the step component. Both implants showed a similar pattern for translation; however, compression was almost 3 times greater for the step component. Both implants showed high stress levels on the cement mantle. At the glenoid vault and on the implants, the stress levels were 1.65 MPa and 6.62 MPa, respectively, for the wedge design and 3.78 MPa and 13.25 MPa, respectively, for the step design. CONCLUSION Implant design slightly affects joint stability; however, it plays a major role regarding long-term survival. Overall, the augmented wedge design provides better implant fixation and stress profiles with less micromotion.
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Bülhoff M, Spranz D, Maier M, Raiss P, Bruckner T, Zeifang F. Mid-term results with an anatomic stemless shoulder prosthesis in patients with primary osteoarthritis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:170-174. [PMID: 30956025 PMCID: PMC6599416 DOI: 10.1016/j.aott.2019.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 02/24/2019] [Accepted: 03/17/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The introduction of a stemless prosthesis in shoulder arthroplasty represents a novel design whereby the proximal humerus is restored anatomically, while leaving the diaphysis of the humerus untouched. The aim of this study was to present the mid-term results of total evolutive shoulder system (TESS; Biomet®), a stemless shoulder prosthesis. METHODS The study included 38 consecutive patients (18 men and 20 women; mean age: 66 years; range: 55-81 years) treated with shoulder arthroplasty between 2009 and 2011 with TESS for primary glenohumeral arthritis. Total shoulder arthroplasty (TSA) was performed in 28 cases (74%), hemi-shoulder arthroplasty (HSA) in 10 (26%). Constant score, active range of motion, patient satisfaction rate, and radiological assessment were analyzed. Mean time of follow-up was 37 months. RESULTS Constant score improved from 21.8 points (28.6 adjusted for age) preoperatively to 74.1 points (86.6 adjusted for age) postoperatively. Active range of motion increased significantly from the pre- to postoperative status. Eighty-nine percent were very satisfied or satisfied with shoulder replacement surgery. One cemented glenoid was revised due to aseptic loosening. None of the components were found to be loose at the final follow-up. No signs of stress shielding were seen. CONCLUSIONS This study shows promising results of this implant concept in the short- to mid-term. These results are comparable with the results achieved with long-established arthroplasty designs. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Matthias Bülhoff
- Centre for Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany.
| | - David Spranz
- Centre for Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Michael Maier
- Centre for Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Patric Raiss
- OCM - Orthopädische Chirurgie München, Steinerstr. 6, München, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 103.3, Heidelberg, Germany
| | - Felix Zeifang
- Ethianum Clinic Heidelberg, Voßstr. 6, Heidelberg, Germany
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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: 61] [Impact Index Per Article: 12.2] [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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Navarro SM, Haeberle HS, Khlopas A, Newman JM, Karnuta JM, Mont MA, Ramkumar PN. Short-term outcomes after anatomic total shoulder arthroplasty in patients with osteoarthritis versus osteonecrosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:48. [PMID: 30906752 DOI: 10.21037/atm.2018.12.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The outcomes of anatomic total shoulder arthroplasty (TSA) for glenohumeral osteoarthritis (OA) have been extensively reported in the literature. However, there is a paucity of short-term outcomes data on perioperative and post-operative outcomes in patients receiving TSA for either glenoid or humeral head osteonecrosis (ON). We compared the short-term outcomes of TSA performed on patients who had glenohumeral OA and those who had ON. Specifically, we compared: (I) demographics; (II) length-of-stay (LOS); and (III) 30-day postoperative complication rates. Methods Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to select 7,066 patients with a diagnosis of glenohumeral OA or ON who underwent TSA between January 1st, 2008 and December 31st, 2015. Propensity score matching was performed based on age, sex, race, and body mass index (BMI) with a 3:1 ratio of OA to ON patients. As a result, 387 patients who had a primary diagnosis of OA were compared with 129 patients who had ON. Analyses addressed perioperative complications and hospital disposition factors-including LOS and 30-day post-operative complications-using bivariate and logistic regression models. Results Overall complication rates were low in both groups, at 6.1% and 5.4% for the ON and OA cohorts respectively. The ON cohort had more comorbidities, including higher Charlson/Devo and American Society of Anesthesiologists (ASA) scores (P<0.05). Hospital disposition factors were not statistically different between the 2 groups. While not statistically significant, the ON cohort had a longer average (21.1% longer, P>0.05), an increased risk for developing any complication [odds ratio (OR) =2.07; 95% confidence interval (CI), 0.94 to 4.57; P=0.07], and a 134% higher risk for developing a minor complication compared to the OA (OR =2.34; 95% CI, 1.01 to 5.42; P=0.047). Conclusions Although the patient populations who develop ON or shoulder OA have differences, there are not statistically or clinically meaningful differences in the short-term outcomes after anatomic TSA. Future studies are required to examine if differences exist in the long-term follow-up between the two groups.
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Affiliation(s)
- Sergio M Navarro
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Heather S Haeberle
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate, New York, NY, USA
| | - Jaret M Karnuta
- Department of Orthopaedic Surgery, Case Western University School of Medicine, Cleveland, OH, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Marcheggiani Muccioli GM, Guerra E, Roberti di Sarsina T, Alesi D, Fratini S, Cammisa E, Rinaldi VG, Lullini G, Rotini R, Zaffagnini S. Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review. JOINTS 2018; 6:173-176. [PMID: 30582106 PMCID: PMC6301844 DOI: 10.1055/s-0038-1675800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/07/2018] [Indexed: 11/02/2022]
Abstract
Periprosthetic shoulder infection (PSI) is an emerging pathology which requires many improvements in diagnosis and treatment to obtain a satisfying success rate. Different approaches have been described. This article summarizes current concepts of diagnostic process and main treatments described in the literature.
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Affiliation(s)
| | - Enrico Guerra
- Shoulder and Elbow Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Fratini
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Vito Gaetano Rinaldi
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- Laboratory of Movement Analysis and Functional-Clinical Evaluation of Prosthesis, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
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Bornes TD, Rollins MD, Lapner PLC, Bouliane MJ. Subscapularis Management in Total Shoulder Arthroplasty: Current Evidence Comparing Peel, Osteotomy, and Tenotomy. J Shoulder Elb Arthroplast 2018. [DOI: 10.1177/2471549218807772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The optimal approach to management of the subscapularis in total shoulder arthroplasty (TSA) is controversial. Options include the subscapularis tenotomy, lesser tuberosity osteotomy (LTO), and peel. This review provides a summary of subscapularis anatomy and function, outcomes associated with subscapularis management options in TSA, and postoperative subscapularis deficiency. Based on the available literature, LTO appears to result in improved function and subscapularis integrity relative to tenotomy, while peel and LTO have generally led to equivalent outcomes. The highest level of evidence to date is derived from a randomized controlled trial that demonstrated that outcomes following peel and LTO were not significantly different. There is currently a paucity of high-quality evidence as most studies have consisted of small retrospective series with varying outcome measures. Furthermore, the optimal approach to establishing the diagnosis of subscapularis deficiency following TSA is unclear.
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Affiliation(s)
- Troy D Bornes
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Meaghan D Rollins
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter LC Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin J Bouliane
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
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Operative shoulder instability injury management in Australian Football League players: A case series. J Sci Med Sport 2018; 21:760-764. [DOI: 10.1016/j.jsams.2017.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/31/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022]
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Outcomes of shoulder arthroplasty in diabetic patients as assessed by peri-operative A1C. INTERNATIONAL ORTHOPAEDICS 2018; 42:1923-1934. [DOI: 10.1007/s00264-018-3874-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
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Pandya J, Johnson T, Low AK. Shoulder replacement for osteoarthritis: A review of surgical management. Maturitas 2018; 108:71-76. [DOI: 10.1016/j.maturitas.2017.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/05/2017] [Accepted: 11/14/2017] [Indexed: 01/08/2023]
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Dey R, Roche S, Rosch T, Mutsvangwa T, Charilaou J, Sivarasu S. Anatomic variations in glenohumeral joint: an interpopulation study. JSES OPEN ACCESS 2018; 2:1-7. [PMID: 30675559 PMCID: PMC6334885 DOI: 10.1016/j.jses.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background This study focused on the unique aspect of investigating shoulder morphometric differences between 2 distinct populations. Methods We used 90 computed tomography images of cadaveric shoulders for this study; 45 scans belonged to the South African (SA) cohort (49.74 ± 15.4 years) and the rest were Swiss (CH; 53.8 ± 21 years). The articulating surfaces of the glenohumeral joint were extracted, and their morphometric features, such as head circular diameter, glenoid and humeral head radius of curvature, head height, and humeral height, were measured. Results The mean interpopulation difference in the circular diameter of the humerus was 2.0 mm (P = .017) and 1.86 mm (P > .05) in the anterior-posterior and superior-inferior directions, respectively. The difference in the radius of curvature between the populations was 1.17 mm (P = .037). The SA shoulders were found to be longer than the CH shoulders by 8.4 mm (P > .05). There was no significant difference in the glenoid radius of curvature. The SA shoulders had higher glenohumeral mismatch (P = .005) and lower conformity index (P = .001) in comparison to the CH shoulders. Conclusion This study presents anatomic differences between African and European glenohumeral articulating surfaces. The results suggest that the glenohumeral geometry is both gender and population specific, and future joint replacements may be designed to address these differences.
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Affiliation(s)
- Roopam Dey
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Steven Roche
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Theo Rosch
- Jakaranda Hospital, Pretoria, South Africa
| | - Tinashe Mutsvangwa
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Johan Charilaou
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Corresponding author: Sudesh Sivarasu, PhD, Department of Human Biology, UCT Medical Campus, 7.17, Anatomy Building, Anzio Road, Observatory, Cape Town 7935, South Africa. (S. Sivarasu).
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Singhal K, Rammohan R. Going forward with reverse shoulder arthroplasty. J Clin Orthop Trauma 2018; 9:87-93. [PMID: 29628689 PMCID: PMC5884055 DOI: 10.1016/j.jcot.2017.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 10/05/2017] [Indexed: 01/13/2023] Open
Abstract
Rotator cuff is a vital structure of glenohumeral joint, the dysfunction of which leads to debilitating pain and restricted movement. Arthroplasty using unconstrained anatomical prosthesis for treating these conditions have not been successful in the past. Reverse Shoulder Arthroplasty (RSA) is a novel technique specifically designed to address end stage glenohumeral arthritis in rotator cuff deficient joint. Short and mid-term studies have demonstrated a significant improvement in pain and range of motion of the shoulder joint. However there is a very high complication rate in comparison to total and hemiarthroplasty of shoulder joint. Over the years, there has been a steady increase in RSAs performed, both in volume and the indications for its use. This article discusses the biomechanical aspects, indications and critically reviews the clinical outcome following Reverse Shoulder Arthroplasty.
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Affiliation(s)
| | - Rammohan R
- Trauma & Orthopaedics, Princess of Wales Hospital, Bridgend, CF311RQ, United Kingdom
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The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: An anatomic study. Injury 2017; 48:2042-2049. [PMID: 28711169 DOI: 10.1016/j.injury.2017.06.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure. METHODS A total of 22 human cadaveric shoulder specimens were used in this study. The axillary and suprascapular nerves were dissected, and radiopaque threads were sutured onto the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans of the specimens were performed, and the distance of the nerves to bony landmarks at the humerus and the glenoid were measured. RESULTS The distance of the inferior glenoid rim to the axillary nerve averaged 13.6mm (5.8-27.0mm, ±5.1mm). In the anteroposterior direction, the distance between the axillary nerve and the humeral metaphysis averaged 8.1mm (0.6-21.3mm, ±6.5mm). The distance of the glenoid centre to the suprascapular nerve passing point under the transverse scapular ligament measured 28.4mm (18.9-35.1mm, ±3.8mm) in the mediolateral direction and 10.8mm (-4.8 to 25.3mm, ±6.1mm) in the anteroposterior direction. The distance to the spinoglenoid notch was 16.6mm (11.1-24.9mm, ±3.4mm) in the mediolateral direction and -11.8mm posterior (-19.3 to -4.7mm, ±4.7mm) in the anteroposterior direction. CONCLUSIONS Implantation of rTSA components endangers the axillary nerve because of its proximity to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling and extraosseous screw placement during glenoid baseplate implantation in rTSA place the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid notch of 11mm and to the suprascapular notch of 19mm.
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The effect of glenoid component version and humeral polyethylene liner rotation on subluxation and impingement in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1718-1725. [PMID: 28545718 DOI: 10.1016/j.jse.2017.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A previously validated finite element modeling approach was used to determine how changes in glenoid component version and polyethylene liner rotation within the humeral component affect the arm abduction angle at which impingement between the inferior glenoid and the polyethylene liner occurs as well as the amount of subluxation generated by that impingement. MATERIALS AND METHODS Five glenoid component versions (5° anteversion; neutral; 5°, 10°, and 20° retroversion) and 7 polyethylene liner rotations (20° and 10° anterior; neutral; 10°, 20°, 30°, and 40° posterior) were considered, resulting in 35 different clinically representative models. The humerus was internally and externally rotated and extended and flexed, and the resulting impingement and subluxation were measured. To further analyze more global trends and to identify implantations least prone to subluxation, polyethylene liner rotation was additionally varied in coarser 30° increments across the entire 360° range. RESULTS All subluxation caused by impingement occurred during external rotation and extension, and external rotation produced nearly 10-fold more subluxation than extension. Neutral glenoid component version was associated with the least amount of subluxation for all polyethylene liner rotations. Posteriorly rotated polyethylene liners, which place the thick inferior region of the component away from the scapula, produced the least amount of subluxation. The 90° and 120° posterior liner rotations produced no subluxation, whereas the 30° and 60° anterior liner rotations produced the greatest amount of subluxation. CONCLUSION These results indicate that rotating modern radially asymmetric humeral polyethylene liners posteriorly can reduce the risk of subluxation leading to dislocation and increase external rotation range of motion.
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Outcomes of shoulder arthroplasty in haematopoietic stem cell transplant patients. INTERNATIONAL ORTHOPAEDICS 2017; 41:2555-2564. [PMID: 28791443 DOI: 10.1007/s00264-017-3553-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND With the growing population of patients undergoing haematopoietic stem cell transplants (HSCTs), the demand for shoulder arthroplasty (SA) in this population can be expected to increase. No studies in the literature have examined the outcomes of SA in HSCT patients. PATIENTS AND METHODS A retrospective review of 11 SAs in 10 patients with previous HSCT was performed. We characterized the clinical outcomes, survivorship, and peri-operative complication rates in patients who underwent SA after receiving a HSCT. We also performed a subanalysis based on implant and transplant type. RESULTS Seven of ten patients died with average two and five year post-operative patient survival rates of 70% +/- 14% and 47% +/- 17%, respectively. At average follow up of 4.2 years of the seven patients with two year followup, pain and range of motion improved with SA (p = 0.0625-0.2500). At final follow-up, five of seven shoulders were rated as satisfactory or excellent with modified Neer ratings. Two and five year survival rates free of re-operation were 100% +/- 0% and 67% +/- 27%, respectively. There were no other complications. No differences in outcomes were seen based on implant or transplant type besides RSA being associated with greater mortality risk (p = 0.0424, hazard ratio = 10.6). CONCLUSIONS Patients with previous HSCT who undergo SA can expect to have good pain relief, range of motion improvement, subjective satisfaction, and low peri-operative complication rate with appropriate choice of implant. However, surgeons must inform patients about realistic post-operative outcomes given the high post-operative mortality rate. LEVEL OF EVIDENCE Level IV, Prognosis.
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Carvalho CD, Andreoli CV, Pochini ADC, Ejnisman B. Use of cuff tear arthroplasty head prosthesis for rotator cuff arthropathy treatment in elderly patients with comorbidities. EINSTEIN-SAO PAULO 2017; 14:520-527. [PMID: 28076600 PMCID: PMC5221379 DOI: 10.1590/s1679-45082016ao3372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/19/2016] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical and functional behavior of patients undergoing cuff tear arthroplasty at different stages of the disease. Methods Cuff tear arthroplasty hemiarthroplasties were performed in 34 patients with rotator cuff arthropathy and associated comorbidities, classified according to Seebauer. The mean age was 76.3 years, and the sample comprised 23 females (67.6%) and 11 males (32.4%). The mean follow-up period was 21.7 months, and evaluations were performed using the Visual Analog Scale for pain and the Constant scale. Results There were no statistically significant differences in the mean reduction in the Visual Analog Scale or in the Constant scale increase between the female and male groups. The variation between the pre- and postoperative Visual Analog Scale and Constant scale evaluations was significant. There was also no statistically significant difference between the Seebauer classification groups regarding the mean Visual Analog Scale reduction, or the mean Constant scale increase. Conclusion Cuff tear arthroplasty shoulder hemiarthroplasty is a good option for rotator cuff arthropathy in patients with comorbidities.
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Affiliation(s)
- Cassiano Diniz Carvalho
- Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Carlos Vicente Andreoli
- Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto de Castro Pochini
- Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Petrillo S, Longo UG, Papalia R, Denaro V. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review. Musculoskelet Surg 2017; 101:105-112. [PMID: 28444541 DOI: 10.1007/s12306-017-0474-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/17/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE To report the outcomes and complications of reverse shoulder arthroplasty (RSA) in massive irreparable rotator cuff tears (MIRCT) and cuff tear arthropathy (CTA). METHODS A systematic review of the literature contained in Medline, Cochrane, EMBASE, Google Scholar and Ovid databases was conducted on May 1, 2016, according to PRISMA guidelines. The key words "reverse total shoulder arthroplasty" or "reverse total shoulder prostheses" with "rotator cuff tears"; "failed rotator cuff surgery"; "massive rotator cuff tears"; "irreparable rotator cuff tears"; "cuff tear arthropathy"; "outcomes"; "complications" were matched. All articles reporting outcomes and complications of RSA for the management of MIRCT or CTA were included. The comparison between preoperative and postoperative clinical scores, as well as range of motion (ROM), was performed using the Wilcoxon-Mann-Whitney test. P values lower than 0.05 were considered statistically significant. RESULTS Seven articles were included in our qualitative synthesis. A statistically significant improvement in all clinical scores and ROM was found comparing the preoperative value with the postoperative value. The degrees of retroversion of the humeral stem of the RSA do not influence the functional outcomes in a statistically significant fashion. There were 17.4% of complications. The most frequent was heterotopic ossification, occurring in 6.6% of patients. Revision surgery was necessary in 7.3% of patients. CONCLUSIONS RSA restores pain-free ROM and improves function of the shoulder in patients with MIRCT or CTA. However, complications occur in a high percentage of patients. The lack of level I studies limits the real understanding of the potentials and limitations of RSA for the management of MIRCT and CTA.
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Affiliation(s)
- S Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy.
- Centro Integrato di Ricerca (CIR), Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - U G Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
- Centro Integrato di Ricerca (CIR), Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
- Centro Integrato di Ricerca (CIR), Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - V Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
- Centro Integrato di Ricerca (CIR), Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Statz JM, Schoch BS, Sanchez-Sotelo J, Sperling JW, Cofield RH. Shoulder arthroplasty for locked anterior shoulder dislocation: a role for the reversed design. INTERNATIONAL ORTHOPAEDICS 2017; 41:1227-1234. [PMID: 28361219 DOI: 10.1007/s00264-017-3450-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/13/2017] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Locked anterior shoulder dislocation (LASD) is an uncommon condition associated with bone, articular cartilage, and soft tissue damage. In selected cases, shoulder arthroplasty (SA) may be the best treatment. The purpose of this study was to assess outcomes of SA for LASD. MATERIALS AND METHODS Between 1976 and 2013, 19 SAs [three hemiarthroplasties (HA), seven total shoulder arthroplasties (TSA), and nine reverse shoulder arthroplasties (RSA), mean age 62 years] were performed for LASD. Shoulders were followed for at least two years (range, 2-30 years, mean 7.1). Clinical and radiographic outcomes were studied. RESULTS/DISCUSSION Three SAs required re-operation, two TSAs for early redislocation and one HA for late, painful glenoid arthrosis. Four additional shoulders (two TSA, two HA) were unstable at most recent follow-up. Pain improved from 4.7 to 2.2 (p < 0.0001) out of 5, elevation from 51 to 94 degrees (p = 0.004), and external rotation from 1 to 34 degrees (p = 0.01). There were two excellent, seven satisfactory, and ten unsatisfactory modified Neer ratings. Compared to TSA/HA, RSA experienced fewer re-operations (0 vs. 3, hazard ratio, 2.03*10^-9, p = 0.0844) and instability (0 vs. 6, p = 0.0108). Similar post-operative pain (p = 0.2192), range of motion (p = 0.2432-0.5299), strength (p = 0.2099), satisfaction (p = 0.6563), outcomes scores (p = 0.0683-0.0933), and complication rate (p = 0.3698) were seen with RSA vs. TSA/HA. CONCLUSIONS RSA for the treatment of chronic LASD provides greater pain relief, and improvement in range of motion (ROM) compared to TSA/HA. Anatomic SA is associated with a high rate of instability not seen with RSA. Therefore, anatomic SA (TSA/HA) is likely not indicated in these difficult circumstances. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA.
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
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Hawi N, Magosch P, Tauber M, Lichtenberg S, Martetschläger F, Habermeyer P. Glenoid deformity in the coronal plane correlates with humeral head changes in osteoarthritis: a radiographic analysis. J Shoulder Elbow Surg 2017; 26:253-257. [PMID: 27720560 DOI: 10.1016/j.jse.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND A variety of measurements can be used to assess radiographic osteoarthritic changes of the shoulder. This study aimed to analyze the correlation between the radiographic humeral-sided Samilson and Prieto classification system and 3 different radiographic classifications describing the changes of the glenoid in the coronal plane. METHODS The study material included standardized radiographs of 50 patients with idiopathic osteoarthritis before anatomic shoulder replacement. On the basis of radiographic measurements, the cases were evaluated using the Samilson and Prieto grading system, angle β, inclination type, and critical shoulder angle by 2 independent observers. RESULTS Classification measurements showed an excellent agreement between observers. Our results showed that the humeral-sided Samilson and Prieto grading system had a statistically significant good correlation with angle β (observer 1, r = 0.74; observer 2, r = 0.77; P < .05) and a statistically significant excellent correlation with the inclination type of the glenoid (observer 1, r = 0.86; observer 2, r = 0.8; P < .05). A poor correlation to the critical shoulder angle was observed (r = -0.14, r = 0.03; P > .05). CONCLUSIONS The grade of humeral-sided osteoarthritis according to Samilson and Prieto correlates with the glenoid-sided osteoarthritic changes of the glenoid in the coronal plane described by the angle β and by the inclination type of the glenoid. Higher glenoid-sided inclination is associated with higher grade of osteoarthritis in primary shoulder osteoarthritis.
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Affiliation(s)
- Nael Hawi
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Trauma Department, Hannover Medical School, Hannover, Germany.
| | - Petra Magosch
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany; University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Sven Lichtenberg
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | | | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
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Brennan-Olsen SL, Page RS, Lane SE, Lorimer M, Buchbinder R, Osborne RH, Pasco JA, Wluka AE, Sanders KM, Ebeling PR, Graves SE. Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data. BMC Musculoskelet Disord 2016; 17:291. [PMID: 27421770 PMCID: PMC4947280 DOI: 10.1186/s12891-016-1134-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/17/2016] [Indexed: 11/17/2022] Open
Abstract
Background Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007–11 for all Australians aged ≥40 years. Methods Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling. Results During 2007–11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales. Conclusions Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.
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Affiliation(s)
- Sharon L Brennan-Olsen
- School of Medicine, Deakin University, Geelong, Australia. .,Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia. .,Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia. .,Epi-Centre for Healthy Aging, IMPACT Strategic Research Centre, Deakin University, (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.
| | - Richard S Page
- School of Medicine, Deakin University, Geelong, Australia.,Barwon Orthopaedic Research Unit, Barwon Health, Geelong, Australia
| | - Stephen E Lane
- School of Medicine, Deakin University, Geelong, Australia.,Barwon Health Biostatistics Unit, Barwon Health, University Hospital, Geelong, Australia.,School of BioSciences, University of Melbourne, Melbourne, Australia
| | - Michelle Lorimer
- Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Melbourne, Australia.,Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Australia
| | - Richard H Osborne
- School of Health and Social Development, Deakin University, Melbourne, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Melbourne, Australia
| | - Kerrie M Sanders
- Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia.,Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Peter R Ebeling
- Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia
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49
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Pinder EM, Ong JCY, Bale RS, Trail IA. Ten questions on prosthetic shoulder infection. Shoulder Elbow 2016; 8:151-7. [PMID: 27583013 PMCID: PMC4950280 DOI: 10.1177/1758573216632464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/18/2016] [Indexed: 01/02/2023]
Abstract
Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.
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Affiliation(s)
| | | | | | - Ian A Trail
- Professor Ian A Trail, Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK.
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50
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Shin JJ, Saccomanno MF, Cole BJ, Romeo AA, Nicholson GP, Verma NN. Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:1951-60. [PMID: 25145944 DOI: 10.1007/s00167-014-3229-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/08/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Irreparable ruptures of the subscapularis tendon lead to impaired function of the shoulder and presents a surgically complex problem. Transfer of the pectoralis major tendon has been reported as a possible treatment option. The purpose of this systematic review is to critically examine the outcomes of pectoralis major transfers for the treatment of irreparable subscapularis tears. METHODS A systematic review of the literature was performed using search of electronic databases. No language restrictions were applied. Case reports, review articles, and operative techniques without outcome data were excluded. All the outcomes reported by each study were analyzed and when possible, data were pooled to generate frequency-weighted values to summarize outcomes. RESULTS Eight studies with a total 195 shoulders were included in this systematic review. The mean age of patients was 58.8 years (range 18-81 years) and the mean follow-up was 33.4 months (range 6-80 months). Constant scores improved from a mean pre-operative score of 37.8 ± 6.8, to a mean postoperative score of 61.3 ± 6.5 (p < 0.0001). Pain scores could not be pooled as different scales were used. Nevertheless, a trend in pain reduction was noted in all papers. Functional outcomes were less favorable in patients with massive rotator cuff tears or previous shoulder replacements. Moreover, the Constant scores were significantly higher in patients following subcoracoid transfer of the pectoralis major tendon compared to patients who received supracoracoid transfer (p < 0.001). The overall reported incidence of postoperative nerve palsy is low (one transient musculocutaneous nerve palsy and one axillary nerve dysfunction out of 195 cases). CONCLUSIONS The systematic review based on frequency-weighted means demonstrated improvement in shoulder function, strength and pain relief after pectoralis major transfer for irreparable subscapularis tear. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jason J Shin
- Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada.
| | | | - Brian J Cole
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, IL, USA
| | - Anthony A Romeo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, IL, USA
| | - Gregory P Nicholson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, IL, USA
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