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A'Court JJ, Chatindiara I, Fisher R, Poon PC. Does the stemless reverse arthroplasty compare to a conventional stemmed implant? Clinical and radiographic evaluation at 2 years' minimum follow-up. J Shoulder Elbow Surg 2024:S1058-2746(24)00144-7. [PMID: 38423251 DOI: 10.1016/j.jse.2024.01.030] [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: 09/20/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is a well-recognized treatment for many shoulder conditions, including rotator cuff arthropathy, primary glenohumeral joint arthritis, and rheumatoid arthritis, and can be used in both trauma and revision settings. Over the past 10 years, its popularity in New Zealand has been increasing, with a 6%-7% annual growth rate during this period. Stemless RSA designs have the following proposed advantages: They can preserve humeral bone stock, they can limit periprosthetic fractures, and they can be indicated in patients with abnormal diaphyseal humeral anatomy. To date, only 1 study has evaluated the outcomes of the Lima SMR Stemless implant. We present our data with an aim to report how the stemless reverse arthroplasty compares to a conventional stemmed implant. METHODS We performed a retrospective review of a consecutive series of patients treated at a single institution between 2015 and 2020. The endpoint was defined as final follow-up at a minimum of 2 years. Patients were excluded from the final analysis if they underwent revision. Thirty-three patients were identified as having undergone stemless RSA. Thirty patients had patient-reported outcome measures and radiographs at a minimum of 2 years' follow-up. Three patients had undergone revision within 2 years. The same sample size of stemmed RSAs (n = 33) was selected for comparison. RESULTS A total of 60 patients were included in the final analysis, of whom 30 underwent stemless RSA and 30 underwent stemmed RSA. The demographic characteristics of the 2 groups were comparable except age at operation, which showed a statistically significant difference (P = .001): 77 years (stemmed) vs. 65 years (stemless). The mean Oxford Shoulder Score was 40.1 in the stemless group vs. 40 in the stemmed group. The mean American Shoulder and Elbow Surgeons score was 72.9 in the stemless group vs. 79 in the stemmed group. Patient-reported outcome measures, pain scores, and satisfaction ratings were not statistically significantly different between the 2 groups. In terms of radiographic data, subsidence was observed in 2 patients in the stemless RSA group but the patients had no clinical symptoms. Also in the stemless RSA group, 1 patient had an acromial stress fracture and 1 patient had a superficial wound infection successfully treated with oral antibiotics. In terms of revisions in the stemless RSA group, 1 patient underwent revision owing to chronic infection, 1 underwent revision as a result of a periprosthetic fracture after a fall, and 1 underwent revision for gross instability. CONCLUSIONS The early results of sRSA are promising, and the stemless implant shows similar outcomes to a conventional stemmed implant.
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Affiliation(s)
- Jamie J A'Court
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand.
| | - Idah Chatindiara
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Rachael Fisher
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Peter C Poon
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
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Nabergoj M, Lädermann A, Authom T, Beaudouin E, Azar M, Wahab H, Leger O, Haight H, Harris H, Collin P. Stemless reverse shoulder arthroplasty: clinical and radiologic outcomes with minimum 2 years' follow-up. J Shoulder Elbow Surg 2023; 32:e464-e474. [PMID: 36905950 DOI: 10.1016/j.jse.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Recently, a stemless reverse shoulder arthroplasty (RSA) design was developed to preserve bone stock. Clinical and radiologic studies of this design in larger cohorts with >100 patients are not frequent. The purpose of this study was to present the clinical and radiologic results of a newly developed stemless RSA implant. The hypothesis was that this design would provide similar clinical and radiologic results to other stemless implants, as well as stemmed implants. METHODS Between September 2015 and December 2019, all patients who underwent primary RSA with a stemless Easytech prosthesis were considered eligible for inclusion in this prospective multicenter study. The minimum follow-up period was 2 years. Clinical outcomes consisted of the Constant score, adjusted Constant score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons shoulder score. Radiographic parameters included radiolucency, loosening, scapular notching, and specific geometric parameters. RESULTS Stemless RSA was performed in 115 patients (61 women and 54 men) at 6 different clinical centers. The average age at the time of surgery was 68.7 years. The average Constant score was 32.5 preoperatively and showed significant improvement to 61.8 at latest follow-up (P < .001). The Subjective Shoulder Value also demonstrated significant improvement postoperatively (from 27.0 to 77.5, P < .001). Scapular notching was observed in 28 patients (24.3%); humeral loosening, 5 (4.3%); and glenoid loosening, 4 (3.5%). The total complication rate was 17.4%. Eight patients (4 women and 4 men) underwent implant revision. CONCLUSION The clinical outcomes of the examined stemless RSA seem to be comparable to those of other humeral designs; however, the complication and revision rates are higher than those of historical controls. Surgeons should proceed with caution when using this implant until longer-term follow-up data are available.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Thierry Authom
- Infirmerie Protestante, Caluire et Cuire, France; La Clinique Saint Charles, Lyon, France
| | | | | | | | | | | | | | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France; Clinique Victor Hugo, Paris, France.
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Innovations in Shoulder Arthroplasty. J Clin Med 2022; 11:jcm11102799. [PMID: 35628933 PMCID: PMC9144112 DOI: 10.3390/jcm11102799] [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] [Received: 03/05/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty.
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Ajibade DA, Yin CX, Hamid HS, Wiater BP, Martusiewicz A, Wiater JM. Stemless reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2022; 31:1083-1095. [PMID: 35051541 DOI: 10.1016/j.jse.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data. METHODS A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores. RESULTS We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate. CONCLUSIONS This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.
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Affiliation(s)
- David A Ajibade
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Clark X Yin
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Hussein S Hamid
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Alexander Martusiewicz
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA.
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Liu EY, Kord D, Yee NJ, Horner NS, Al Mana L, Leroux T, Alolabi B, Khan M. Stemless reverse total shoulder arthroplasty: a systematic review of short- and mid-term results. Shoulder Elbow 2021; 13:482-491. [PMID: 34659481 PMCID: PMC8512978 DOI: 10.1177/17585732211013356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Stemless reverse total shoulder arthroplasty is used to treat rotator cuff deficient arthropathies, rheumatoid arthritis, and osteoarthritis. It has several advantages over the stemmed implant including preservation of bone stock, reduced surgical time, and easier revision. METHODS A systematic search was conducted in MEDLINE, EMBASE, PubMed, and CENTRAL to retrieve all relevant studies evaluating stemless reverse total shoulder arthroplasty. RESULTS The literature search identified 1993 studies out of which 7 studies were included in this review; 324 patients underwent stemless reverse total shoulder arthroplasty with a weighted mean age of 74.1 (SD = 8.6, range = 38 to 93) years and a weighted mean follow-up time of 44 (SD = 6.6, range = 3 to 95) months. The included studies reported significant improvements in range of motion and functional scores comparable to stemmed reverse total shoulder arthroplasty. The weight mean flexion and abduction was (135 ± 12)° and (131 ± 12)° post-operatively, respectively. The weighted mean constant score increased from (26.7 ± 5.2) Patients (pts) to (63.0 ± 8.0) pts post-operatively. Overall complication and revision rate were 12.3% and 5.2%. CONCLUSION Early and mid-term results indicate stemless reverse total shoulder arthroplasty has similar clinical outcomes to stemmed reverse total shoulder arthroplasty. There was no radiological evidence of humeral loosening at the latest follow-up.
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Affiliation(s)
- Eva Y Liu
- Faculty of Health Sciences, McMaster
University, Hamilton, Canada
| | - Dorsa Kord
- Faculty of Health Sciences, McMaster
University, Hamilton, Canada
| | - Nicholas J Yee
- Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
| | - Nolan S Horner
- Department of Surgery, McMaster
University, Hamilton, Canada
| | - Latifah Al Mana
- Department of Surgery, McMaster
University, Hamilton, Canada
| | - Timothy Leroux
- Department of Surgery, University of
Toronto, Toronto, Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster
University, Hamilton, Canada
| | - Moin Khan
- Department of Surgery, McMaster
University, Hamilton, Canada,Moin Khan, McMaster University, 50 Charlton
Avenue, East Hamilton, Ontario, Canada L8N 4A6.
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Lee J, Consigliere P, Fawzy E, Mariani L, Witney-Lagen C, Natera L, Buch B, Atoun E, Sforza G, Amar E, Levy O. Accelerated rehabilitation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e545-e557. [PMID: 33418090 DOI: 10.1016/j.jse.2020.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postoperative rehabilitation is considered essential and indeed routine practice following rTSA. However, the optimal approach to postoperative rehabilitation is unknown, based on protocols for anatomic TSA, and published literature is sparse, as is the quantity and quality of research evidence. The aim of this study is to outline the accelerated rehabilitation protocol (with immediate activity and no immobilization at all) following reverse total shoulder arthroplasty (rTSA) and assess its safety and effectiveness compared to the more conservative rehabilitation protocols of immobilization in a sling for 6 weeks and for 3 weeks. MATERIALS AND METHODS Between July 2005 and October 2017, a total of 357 consecutive rTSA in 320 patients underwent a primary rTSA and were included in the study. Patients were divided into 3 groups depending on rehabilitation protocol (6 and 3 weeks' postoperative immobilization, respectively, for groups 1 and 2, and no immobilization for group 3). Patients were assessed preoperatively and reviewed at 3 weeks, 3, 6, and 12 months, and yearly thereafter postoperatively. Constant score (CS), Subjective Shoulder Value (SSV), patient satisfaction, and pain scores were used at each appointment and patients assessed both clinically and radiographically. RESULTS Mean age at surgery was 76 years (range 40-93). At 1-year follow-up, the CS improved from 16.6 (adjusted 23.9) to 63.2 (adjusted 91.5) in group 1 (n = 114), from 21.5 (adjusted 30.7) to 67.7 (adjusted 98.4) in group 2 (n = 125), and from 22.6 (adjusted 31.3) to 66.6 (adjusted 94.9) in group 3 (n = 118). Pain score improved from 3.1/15 preoperatively to 12.5/15 postoperatively in group 1, from 3.5/15 to 13/15 in group 2, and from 3.7/15 to 12.5/15 in group 3. SSV improved to 8.5/10, 8.6/10, and 8.1/10 for groups 1, 2, and 3, respectively. Mean range of motion (ROM) improved to 142° elevation and 131° abduction in group 1, 153° elevation and 144° abduction in group 2, and 149° elevation and 146° abduction in group 3. No statistically significance differences were observed in CS, SSV, patient satisfaction, pain, and ROM between the 3 groups. Less postoperative complications were observed in group 3 (No immobilization). CONCLUSION Accelerated rehabilitation regime post rTSA without immobilization is safe and lead to reliable good clinical results and quick return to function. This study confirms noninferiority of the accelerated rehabilitation regime with fewer postoperative complications related to falls. Accelerated rehabilitation regime post rTSA have further psychological and emotional advantage to the patient, with earlier return to normal function and regaining independence. We recommend the accelerated rehabilitation regime without immobilization following rTSA.
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Affiliation(s)
- Jonathan Lee
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Paolo Consigliere
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Ernest Fawzy
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Laura Mariani
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | | | - Luis Natera
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Hospital General de Granollers, Avinguda Francesc Ribas s/n, Granollers, Barcelona, Spain; Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Berta Buch
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, Granollers, Barcelona, Spain; Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Giuseppe Sforza
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK; Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel; Faculty of Health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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