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Moen P, Patel JS, Simon P, Christmas K, Haidamous G, Frankle MA. Humeral Loosening in Reverse Shoulder Arthroplasty: An Analysis of 2,000 Cases. J Shoulder Elbow Surg 2023; 32:S53-S59. [PMID: 36822498 DOI: 10.1016/j.jse.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Humeral loosening is a rare complication in reverse shoulder arthroplasty (RSA) representing approximately 1% of total complications. The purpose of this study is to identify patients who underwent RSA and were revised due to loosening of the humeral component, identify patients who are at increased risk, and report on their surgical outcomes. MATERIALS AND METHODS A retrospective review of all patients who received a primary RSA or revision RSA (rRSA) by a single surgeon from 2002-2021 identified a total of 1,591 primary RSA and 751 rRSA procedures. These procedures were then organized based on indication for surgery. Further analysis was performed to identify RSAs that were subsequently revised due to aseptic loosening of the humeral component. A total of 41 surgeries met inclusion criteria for the study, which was any RSA or rRSA that was revised due to loosening of the humeral component. Exclusion criteria was revision for a reason other than humeral loosening, neurogenic arthritis, or revision for loosening that was not originally implanted by the senior author (9 surgeries). Ultimately, 32 surgeries met criteria for further analysis. These 32 surgeries were organized by indication for preceding RSA or rRSA and were assessed for an association between indication for RSA/rRSA and eventual revision for humeral loosening. Additionally, these procedures were compared to a "control cohort" of procedures that were not revised and that had minimum 2-years follow-up. To assess outcomes for these patients, pre- and postoperative SST, ASES, and ranges of motion were compared. Twenty procedures had sufficient data for outcomes analysis and were followed for an average of 54 months (range: 24-132 months). RESULTS In primary RSAs, procedures performed for fracture or fracture sequelae were associated with revision for humeral-sided loosening (p = 0.009). In rRSAs, procedures performed for failed hemiarthroplasty for CTA were associated with re-revision for humeral-sided loosening (p = 0.009). Nine percent of patients revised for humeral loosening required re-revision for recurrent humeral loosening. Analysis of patients with 2-year clinical follow-up for humeral-sided loosening showed improvement in ASES pain (p = 0.014), ASES function (p = 0.042), and total ASES scores (p = 0.007). CONCLUSION Humeral loosening is rare in RSA. In our cohort, 0.7% of primary RSAs performed and 2.8% of rRSAs performed were eventually revised for humeral loosening. Revisions of RSA for humeral loosening yield modest clinical improvements. Re-revision for humeral loosening was 6.3% of patients in our cohort.
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Affiliation(s)
- Patrick Moen
- Florida Orthopaedic Institute (FOI), Tampa, FL, USA
| | - Jay S Patel
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA
| | - Peter Simon
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA; Department of Medical Engineering, College of Engineering & Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kaitlyn Christmas
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA
| | - Georges Haidamous
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA
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El-Othmani MM, Zalikha AK, Crespi Z, Abbas KAJ, Haidamous G, Altawil Z, Goitz HT, Bouffard JA. Ultrasonography for the Busy Orthopaedic Surgeon: The Lower Extremity. Instr Course Lect 2023; 72:149-159. [PMID: 36534854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Ultrasonography has the potential to become a fundamental component of the diagnosis and management of musculoskeletal conditions and injuries. Moreover, in the context of modern healthcare systems that are focused on optimizing value, ultrasonography has the advantage of minimizing costs when compared with other advanced imaging modalities. Because of its low cost, lack of radiation exposure, speed, and capability to diagnose dynamic conditions, more orthopaedic surgeons are routinely integrating musculoskeletal ultrasonography into their daily practice. It is important to provide a comprehensive review of and approach to common musculoskeletal conditions of the lower extremity for the busy orthopaedic surgeon.
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Zalikha AK, El-Othmani MM, Crespi Z, Abbas KAJ, Haidamous G, Altawil Z, Bouffard JA, Goitz HT. Ultrasonography for the Busy Orthopaedic Surgeon: The Upper Extremity. Instr Course Lect 2023; 72:139-148. [PMID: 36534853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Ultrasonography is increasingly used in the diagnosis and treatment of musculoskeletal conditions and injuries. Ultrasonography possesses multiple advantages compared with other methods of imaging, including low cost, lack of radiation exposure, speed, and means for dynamic examination. Because of these advantages, many orthopaedic surgeons are routinely using ultrasonography to diagnose musculoskeletal conditions of the upper extremity. Musculoskeletal ultrasonography is technically challenging, but with proper guidance and practice, every orthopaedic surgeon can confidently integrate ultrasonography into their clinical practice.
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Haidamous G, Cabarcas B, Ohanisian L, Simon P, Christmas KN, Wilder L, Achors K, Mighell MA, Frankle MA. Does improved external rotation following reverse shoulder arthroplasty impact clinical outcomes in patients with rotator cuff pathology and external rotation less than 0°? J Shoulder Elbow Surg 2023; 32:68-75. [PMID: 35931335 DOI: 10.1016/j.jse.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/31/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to (1) evaluate whether improved external rotation (ER) in patients with preoperative ER <0° impacts their clinical outcomes following reverse shoulder arthroplasty (RSA) for rotator cuff (RC) pathology and (2) describe the differences in preoperative factors and postoperative outcomes in this patient population. Our hypothesis was that clinical outcomes would not be affected by improvement in ER using a lateralized glenosphere design. METHODS We retrospectively reviewed 55 patients with preoperative ER <0° who underwent primary RSA for RC pathology with lateralized glenosphere. Pre- and postoperative physician-reported ER was blindly measured using a videographic review of patients externally rotating their arm at the side. Patients were evaluated using 5 different patient-reported outcome score thresholds, measured at 12 months postoperatively: (1) minimal clinically important difference (MCID) for American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores (ie, ≥20-point increase); (2) MCID for Simple Shoulder Test (SST) scores (≥2.4-point increase); (3) visual analog scale (VAS) for pain score >0; (4) mean ASES score (≥75); and (5) mean SST score (≥6.8), each of which was used to stratify the patients into 2 groups-greater than or equal to vs. less than the threshold. This resulted in 5 different evaluations comparing the 2 groups for any difference in postoperative ER or preoperative factors, including Hamada and Goutallier scores. RESULTS Regardless of the measured outcome, there was no difference in either postoperative physician- or patient-reported ER between patients who achieved scores higher or lower than the thresholds. Both Hamada and Goutallier score distributions were not different between groups across all the evaluated outcomes. Patients who achieved the MCID for ASES had worse preoperative VAS pain (7 vs. 4, P = .011) and SST (1 vs. 3, P = .020) scores. Across all outcome thresholds, except MCID for SST, pain reduction (ΔVAS) was significantly more pronounced in patients exceeding the thresholds. Improved forward flexion rather than ER was observed in those who achieved the ASES (160° vs. 80°, P = .020) and SST MCIDs (150° vs. 90°, P = .037). Finally, patients who exceeded the thresholds experienced higher satisfaction rates. CONCLUSION Improvement in ER does not appear to impact patient-reported outcome measures, including ASES and SST in patients with preoperative ER <0° undergoing RSA with a lateralized glenosphere. Patients with more severe pain and worse function at baseline experience less postoperative pain and clinically significant improvement in their reported outcomes.
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Affiliation(s)
- Georges Haidamous
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Brandon Cabarcas
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Levonti Ohanisian
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - Kaitlyn N Christmas
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Lauren Wilder
- Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Kyle Achors
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Mighell
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Mark A Frankle
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, FL, USA.
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Haidamous G, Merimee S, Simon P, Denard PJ, Lädermann A, Mighell MA, Gorman RA, Frankle MA. Acromial fractures following reverse shoulder arthroplasty: the role of the acromial morphology and a comparison of clinical outcomes. J Shoulder Elbow Surg 2022; 31:S34-S43. [PMID: 35183742 DOI: 10.1016/j.jse.2022.01.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose was to evaluate the relationship between acromial morphology and the location of acromial fractures following reverse shoulder arthroplasty and determine whether fracture location and displacement impact clinical outcomes. METHODS We performed a multicenter retrospective review of reverse shoulder arthroplasties complicated by acromial fractures. Radiographs were compared to determine the differences in acromial morphology, as well as fracture orientation and pattern, between patients with Levy type I (n = 17) and Levy type II (n = 25) fractures. Patients with a minimum of 2 years' follow-up were selected to examine the association between clinical outcomes and fracture location and displacement. Twenty-two patients were stratified based on whether they achieved the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons score (20 points). The groups were then compared regarding fracture location and displacement using measurements such as the acromiohumeral distance. RESULTS The Levy type I group had a higher acromial slope than the Levy type II group (127° vs. 117°, P < .001). Levy type I fractures had a transverse pattern occurring in the coronal plane, whereas Levy type II fractures had an oblique pattern occurring in the sagittal plane (P < .001). At final follow-up, 12 of 22 patients (55%) achieved the MCID. Those who did not achieve the MCID had more displaced fractures including a lower acromiohumeral distance (8 mm vs. 20 mm, P = .007). There was no difference in the distribution of Levy type I and type II fractures based on the MCID cutoff (P = .093). CONCLUSION An increased acromial slope is associated with transverse fractures in the Levy I region, whereas a lower acromial slope is associated with oblique fractures in the Levy II region. Overall, 55% of patients achieved the MCID at mid-term follow-up. The outcomes of those who did not achieve the MCID became worse postoperatively, and this was associated with increased fracture displacement.
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Affiliation(s)
| | - Stephanie Merimee
- Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA; Department of Medical Engineering, University of South Florida College of Engineering and Morsani College of Medicine, Tampa, FL, USA
| | - Patrick J Denard
- Southern Oregon Orthopedics, Oregon Shoulder Institute, Medford, OR, USA
| | - 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
| | - Mark A Mighell
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - R Allen Gorman
- Translational Research, Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA
| | - Mark A Frankle
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Haidamous G, Lädermann A, Hartzler RU, Parsons BO, Lederman ES, Tokish JM, Denard PJ. Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty. Shoulder Elbow 2022; 14:39-47. [PMID: 35154401 PMCID: PMC8832695 DOI: 10.1177/1758573220936234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose was to evaluate the relationship of component size and position to postoperative range of motion following reverse shoulder arthroplasty. The hypothesis was that increased lateralization, larger glenospheres, and a decreased acromiohumeral distance would be associated with excellent postoperative range of motion. METHODS A retrospective multicenter study was performed at a minimum of one year postoperatively on 160 patients who underwent primary reverse shoulder arthroplasty with a 135° humeral component. Outcomes were stratified based on postoperative forward flexion and external rotation into excellent (n = 42), defined as forward flexion >140° and external rotation > 30°, or poor (n = 36), defined as forward flexion <100° and external rotation < 15°. Radiographic measurements and component features were compared between the two groups. RESULTS A larger glenosphere size was associated with an excellent outcome (p = 0.009). A 2-mm posterior offset humeral cup (p = 0.012) and an increased inferior glenosphere overhang (3.1 mm vs 1.4 mm; p = 0.002) were also associated with excellent outcomes. Humeral lateralization and distalization were not associated with an excellent outcome.Conclusion: Larger glenosphere size and inferior positioning as well as posterior humeral offset are associated with improved postoperative range of motion following reverse shoulder arthroplasty. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | | | | | - Evan S Lederman
- University of Arizona College of Medicine Phoenix and the Orthopedic Clinic Association, Phoenix, AZ, USA
| | | | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA,Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA,Patrick J Denard, Southern Oregon Orthopedics, 2780 E. Barnett Road, Suite 200, Medford, OR 97530, USA.
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Mandava NK, Sethi PM, Routman HD, Liddy N, Haidamous G, Denard PJ. Opioid requirement after rotator cuff repair is low with a multimodal approach to pain. J Shoulder Elbow Surg 2021; 30:e399-e408. [PMID: 33144226 DOI: 10.1016/j.jse.2020.09.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current practices may aim to blunt rather than understand postoperative pain. Perhaps the most common serious complication of arthroscopic rotator cuff repair (ARCR) is persistence of opiate medication intake. Patients still receive upwards of 80 oxycodone 5 mg pills, or 600 morphine milligram equivalents (MMEs), leading more than 20% of opioid-naïve subjects to continue to fill opioid prescriptions beyond 180 days after surgery. Developing evidence-based guidelines for narcotic prescription after ARCR presents an opportunity for orthopedic surgeons to address the opioid epidemic. PURPOSE The purpose of this study was (1) to prospectively determine the requirements for opiate medications after ARCR, and (2) to create an evidence-based guideline for postoperative prescription, in contrast to the anecdotal or expert panel recommendations that currently exist. We further investigated whether a liposomal bupivacaine (LB) interscalene never block (ISNB) would reduce pain and opiate consumption compared with standard bupivacaine ISNB (control) for ARCR. METHODS The study enrolled 100 patients who underwent primary ARCR surgery. Patients were provided with postoperative "pain journals" to document their daily pain on a numerical rating scale, satisfaction with pain management using the Likert scale, and track their daily oxycodone 5 mg pill consumption during the 14-day postoperative period. Enrolled patients were further randomized to receiving an LB (experimental) or standard bupivacaine (control) ISNB. RESULTS A total of 77% of all patients required fewer than 15 pills postoperatively. The LB group consumed an average of 1.7 fewer pills (13.0 MMEs) on postoperative day (POD) 1 (P = .02) and reported statistically lower pain during PODs 1 and 2 (P = .01 and P = .006), as well as cumulatively throughout the study period (P = .03). In addition, LB patients remained opioid-free at a higher rate (44% vs. 15% in controls, P = .03). CONCLUSION With a multimodal approach, the majority of patients undergoing ARCR can manage postoperative pain with 15 or fewer oxycodone 5 mg tablets (112.5 MMEs) and maintain a high degree of satisfaction. The addition of an LB ISNB may further reduce the consumption of postoperative narcotics compared with a standard ISNB. This study provides evidence that may be used for surgeon guidelines in the effort to reduce opioid prescriptions after ARCR.
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Affiliation(s)
- Nikhil K Mandava
- Orthopaedic & Neurosurgery Specialists, ONS Foundation, Greenwich, CT, USA
| | - Paul M Sethi
- Orthopaedic & Neurosurgery Specialists, ONS Foundation, Greenwich, CT, USA.
| | | | - Nicole Liddy
- Orthopaedic & Neurosurgery Specialists, ONS Foundation, Greenwich, CT, USA
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Sethi PM, Mandava NK, Liddy N, Denard PJ, Haidamous G, Reimers CD. Narcotic requirements after shoulder arthroplasty are low using a multimodal approach to pain. JSES Int 2021; 5:722-728. [PMID: 34223421 PMCID: PMC8245905 DOI: 10.1016/j.jseint.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background Recent "multimodal" approaches to pain, although understudied, have shown promise in reducing reliance on narcotics in shoulder arthroplasty (SA). Many surgeons report being unsure of how many narcotic pills to prescribe after the surgery. As result, patients are prescribed upwards of 60 oxycodone 5-mg pills for a 6-to-12-week treatment period despite studies showing postoperative pain can be managed without any medication at all. Purpose The purpose of this multicenter study was to prospectively determine the number of opiate pills required after SA to develop generalizable, evidence-based prescription guidelines for surgeons. We hypothesized that opioid prescription would be low using a multimodal approach to pain management. Methods The study enrolled 63 patients undergoing SA. Subjects received either an interscalene nerve block with liposomal bupivacaine, standard bupivacaine, or a local infiltration standard bupivacaine field block based on preference. All subjects were provided with postoperative "Pain Journals" to document their daily pain on a Numerical Rating Scale and daily opioid consumption during the 14-day postoperative period. Results Overall, patients consumed an average of 8.6 oxycodone 5-mg pills (64.5 morphine milligram equivalents) after SA. Seventy-nine percent of patients required 15 or fewer oxycodone 5-mg pills, and 27% successfully managed their postoperative pain with zero opioids. Average pain remained low for patients in all groups. Conclusion With a multimodal approach, most patients undergoing SA can manage postoperative pain with 15 or fewer oxycodone 5-mg tablets, or 112.5 morphine milligram equivalents. The addition of a liposomal bupivacaine interscalene nerve block may further reduce the consumption of postoperative narcotics compared with a standard interscalene nerve block. This study provides evidence that may be used for surgeon guidelines in the effort to reduce opioid prescriptions after SA.
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Affiliation(s)
- Paul M Sethi
- Orthopedic and Neurosurgery Specilaists Foundation, Greenwich, CT, USA
| | - Nikhil K Mandava
- Orthopedic and Neurosurgery Specilaists Foundation, Greenwich, CT, USA
| | - Nicole Liddy
- Orthopedic and Neurosurgery Specilaists Foundation, Greenwich, CT, USA
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Abstract
PURPOSE OF REVIEW Superior capsular reconstruction (SCR) is a surgical procedure that has been developed to provide an alternative for joint preservation in patients with massive irreparable rotator cuff tears. The purpose of this review is to assess the improvements in biomechanical properties and functional outcomes of this novel procedure. RECENT FINDINGS Biomechanically, SCR decreases superior translation and subacromial contact pressure. Glenoid fixation is maximized with three anchors, while margin convergence to any remaining rotator cuff improves stability, and findings vary based on graft type. Clinically, SCR has been associated with improvement in functional outcome in the setting of an isolated procedure, or in conjunction with rotator cuff repair. Outcomes appear to be dependent upon indications. However, in select cases, SCR may even be successful in reversing pseudoparalysis. SCR seems to lead to improved biomechanics for the cuff-deficient shoulder resulting in satisfactory functional outcomes. While surgical techniques have evolved, further research is needed to optimize graft healing and longer follow-up studies are needed to continue to refine indications for SCR as a joint preservation effort in the setting of irreparable massive rotator cuff tears without arthritis.
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Affiliation(s)
- Matthew P. Noyes
- Department of Orthopaedic Surgery, Aultman Hospital, Northeast Ohio University College of Medicine, 3684 Dressler Rd., Canton, OH 44718 USA
| | | | | | | | - Patrick J. Denard
- Southern Oregon Orthopaedics, Medford, OR USA
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR USA
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Haidamous G, Lädermann A, Frankle MA, Gorman RA, Denard PJ. The risk of postoperative scapular spine fracture following reverse shoulder arthroplasty is increased with an onlay humeral stem. J Shoulder Elbow Surg 2020; 29:2556-2563. [PMID: 32713666 DOI: 10.1016/j.jse.2020.03.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the effects of lateralization and distalization on scapular spine fracture (SSF) after reverse shoulder arthroplasty (RSA). The hypothesis was that postoperative distalization would increase the risk of SSF, whereas lateralization would not. METHODS A multicenter retrospective review was performed at a minimum of 1 year postoperatively on primary RSAs with 3 different implants, 2 with an inlay design (n = 342) and 1 with an onlay design (n = 84). Functional outcome, range of motion, stem design, and radiographic measurements, including acromiohumeral distance and lateralization, were compared between groups with and without fracture. RESULTS The incidence of SSF in the onlay group (11.9%) was significantly higher compared with the inlay group (4.7%; P = .043). Postoperative acromiohumeral distance was approximately 4 mm higher in the SSF group (37.5 mm) compared with the control group (33.7 mm; P = .042), whereas lateralization was similar between the 2 groups (52.8 mm vs. 53.9 mm; P = .362). Higher return to activity (92.1% vs. 71.4%; P < .001) as well as postoperative forward flexion was observed in the group without fracture (135° vs. 120°; P = .009). CONCLUSION Increased postoperative distalization is associated with an increased risk of SSF after RSA. An onlay stem resulted in a 10 mm increase in distalization compared with an inlay stem, and a 2.5 times increased risk of SSF. Lateralization, however, does not appear to increase the risk of SSF.
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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, University Hospitals of Geneva, Geneva, Switzerland
| | | | - R Allen Gorman
- Foundation for Orthopaedic Research & Education, Tampa, FL, USA
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
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Abstract
BACKGROUND Arthroscopic biceps tenodesis (ABT) high in the groove can be achieved using an inlay or an onlay technique. However, there is little information comparing outcomes between the 2. PURPOSE To compare postoperative healing and functional outcomes of ABT high in the groove performed using either an onlay or an inlay technique. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was performed on patients undergoing ABT at the articular margin (high in the groove) at a single center over a 2-year period. An inlay technique using an interference screw was performed during the first year, followed by an onlay technique using a knotless suture anchor during the second. Tendon healing, elbow flexion strength, functional outcome, and complications were evaluated at a postoperative minimum of 1 year. RESULTS A total of 37 patients with inlay and 53 with onlay ABTs were available for follow-up. There was no difference in range of motion, functional outcome scores, or elbow flexion strength between the groups. A postoperative popeye deformity was noted in 27% of patients in the inlay group as compared with 9.4% of the onlay group (P = .028). Four patients (10.8%) in the inlay group required revision surgery (2 of which were biceps tenodesis related) as compared with 0% in the onlay group (P = .015). CONCLUSION An onlay technique using a knotless suture anchor for ABT at the top of the articular margin is an acceptable alternative to an inlay technique using an interference screw. The onlay technique was associated with lower rates of postoperative popeye deformity and revision surgery as compared with the inlay technique.
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Affiliation(s)
| | | | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, Oregon, USA.,Department of Orthopaedic and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
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Denard PJ, Haidamous G, Gobezie R, Romeo AA, Lederman E. Short-term evaluation of humeral stress shielding following reverse shoulder arthroplasty using press-fit fixation compared with cemented fixation. J Shoulder Elbow Surg 2020; 29:906-912. [PMID: 31911215 DOI: 10.1016/j.jse.2019.09.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the functional outcomes and humeral stress shielding of a reverse shoulder arthroplasty (RSA) placed with either cement or press-fit fixation. The hypothesis was that there would be no difference in functional outcomes or stress shielding. METHODS We performed a multicenter retrospective review of primary RSAs performed with standard-length stems. The stems were identical in geometry and coating with the only variable being whether the stems were secured with cement or by a press-fit technique. The functional outcomes and radiographs of 93 press-fit stems and 26 cemented stems were reviewed at a minimum of 2 years postoperatively. RESULTS Significant improvements were noted in all ranges of motion and functional outcomes from baseline (P < .001), but no difference was found between the groups (P > .05). Calcar osteolysis was seen in 43% of press-fit and 58% of cemented stems (P = .266). Proximal lateral stress shielding was more common in the press-fit group (68%) than in the cemented group (25%) (P = .045). Adaptive changes were considered low in 97% of press-fit stems, and there were no cases of tuberosity resorption. No evidence of loosening or humeral component shift was noted in either group. CONCLUSION At short-term follow-up, no differences in functional outcomes or stem loosening were found between press-fit fixation and cemented fixation of an RSA humeral stem. Proximal stress shielding was more common with press-fit fixation with the stem in this study, but the overall changes were considered low in 97% of cases. Further study is needed to evaluate the mid- to long-term differences regarding stress shielding.
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Affiliation(s)
- Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
| | | | | | | | - Evan Lederman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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El Rassi G, Matta J, Haidamous G, Brogard P, Clavert P, Kempf JF, Irani J. Arthroscopic treatment of non-homogeneous calcifying tendinitis of the rotator cuff. Springerplus 2016; 5:190. [PMID: 27026886 PMCID: PMC4769244 DOI: 10.1186/s40064-016-1792-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Abstract
The purpose of this study is to investigate the clinical outcome of arthroscopic treatment for patients with non-homogeneous infiltrated calcifying tendinitis of the rotator cuff (type III), and to assess the optimal method for this arthroscopic treatment. We retrospectively reviewed the charts of 81 patients who underwent arthroscopic treatment for non-homogeneous infiltrated calcifying tendinitis of the rotator cuff (type III). Patients were divided into two groups: Group A (n = 31) consisted of patients who underwent excision of calcification, and Group B comprised patients who underwent acromioplasty alone (n = 50). The clinical outcome of treatment was assessed using Constant-Murley score. Twenty-three of the 81 patients were males and 58 were females. The mean duration of symptoms from onset to the first clinic visit was 3.88 years (SD ± 3.06 years). The right side was involved in 47 patients, the left side in 34 patients, and none had bilateral involvement. Patients from Group B had higher 16 improvement of their Constant-Murley score (from 48.96 to 88.06) when 17 compared to group A (from 45.39 to 67.23). Treatment of type III calcifying tendinitis is different than type I and II. Subacromial decompression may be considered in all patients suffering from type III non-homogeneous infiltrated calcifying tendinitis of the shoulder.
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Affiliation(s)
- George El Rassi
- Department of Orthopaedic Surgery, Saint George Hospital, P.O. Box 166378, Ashrafieh, Beirut, 1100 2807 Lebanon
| | - Jihad Matta
- Department of Orthopaedic Surgery, Saint George Hospital, P.O. Box 166378, Ashrafieh, Beirut, 1100 2807 Lebanon
| | - Georges Haidamous
- Department of Orthopaedic Surgery, Saint George Hospital, P.O. Box 166378, Ashrafieh, Beirut, 1100 2807 Lebanon
| | - Patrik Brogard
- Department of Orthopaedic Surgery, Illkirch Hospital, Strasbourg, France
| | - Philipe Clavert
- Department of Orthopaedic Surgery, Illkirch Hospital, Strasbourg, France
| | | | - Jihad Irani
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
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