Operative Techniques in Orthopaedics最新文献

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Revision Reverse Total Shoulder Arthroplasty: Current Concepts and Operative Strategies 改良逆行全肩关节置换术：当前的概念和手术策略

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101150

Vaibhav R. Tadepalli MD , Vaya Chhabra , Pradip Ramamurti MD , Richard F. Nauert MD , Brian C. Werner MD

As the number of reverse total shoulder arthroplasties (rTSA) in the United States continues to increase, so will the number of revisions rTSAs conducted. Common indications for revision rTSA include instability, infection, humeral or glenoid component loosening or periprosthetic humeral fracture, and each indication for revision warrants specific preoperative management and intraoperative strategies. Accurate diagnosis and management of the patient is key, as failure to recognize the correct indication for revision may result in failure of the revision surgery. Revision rTSA is a technically challenging procedure. However, with diligent preoperative planning including serologic evaluation for infection, evaluation of bone loss and implant stability with computed tomography, anticipating need for bone grafting, and detailed identification of implanted components to plan for explantation, surgeons can avoid common pitfalls in the operating room. This review article will discuss the major indications for revision rTSA and provide insight and technical tips to assist with the surgical management of these challenging cases.

随着美国逆行全肩关节置换术（rTSA）的数量不断增加，逆行全肩关节置换术的翻修数量也在不断增加。rTSA翻修的常见适应症包括不稳定、感染、肱骨或肩关节部件松动或肱骨假体周围骨折，每个翻修适应症都需要特定的术前管理和术中策略。准确的诊断和患者的管理是关键，因为未能识别正确的指征翻修可能导致翻修手术的失败。修订rTSA是一个技术上具有挑战性的过程。然而，通过周密的术前计划，包括血清学评估感染、计算机断层扫描评估骨丢失和种植体稳定性、预测植骨需求、详细识别植入部件以计划植骨，外科医生可以避免手术室常见的陷阱。这篇综述文章将讨论修订rTSA的主要适应症，并提供见解和技术提示，以协助这些具有挑战性的病例的外科治疗。

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引用次数: 0

A Review of Preoperative Planning and Technical Considerations for Anatomic Total Shoulder Arthroplasty 解剖性全肩关节置换术的术前计划和技术考虑综述

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101147

Mikalyn T. DeFoor MD , Robert U. Hartzler MD , Andrew J. Sheean MD

Anatomic total shoulder arthroplasty (aTSA) is best performed in the setting of glenohumeral joint osteoarthritis with an intact rotator cuff tear in patients with symptoms refractory to appropriate nonoperative treatment. Mid- to long-term follow-up supports overall high patient satisfaction with low complications rates. As reverse total shoulder arthroplasty (rTSA) allows the surgeon to manage a broader range of shoulder problems with greater technical ease and fewer complications, it has become the more commonly used option over aTSA. Specifically, glenoid deformity, joint incongruity, and rotator cuff deficiency pose challenging technical considerations for aTSA. The purpose of this article is to review the appropriate patient selection, preoperative planning, perioperative and intraoperative technical considerations required to achieve a successful outcome if aTSA is chosen.

解剖性全肩关节置换术（aTSA）最适用于肩关节骨性关节炎伴完整肩袖撕裂且症状难以接受适当非手术治疗的患者。中长期随访支持患者总体满意度高，并发症发生率低。由于逆行全肩关节置换术（rTSA）允许外科医生以更大的技术难度和更少的并发症处理更广泛的肩关节问题，它已成为比aTSA更常用的选择。具体来说，肩关节畸形、关节不协调和肩袖缺陷对aTSA的技术考虑具有挑战性。本文的目的是回顾适当的患者选择，术前计划，围手术期和术中技术考虑需要达到成功的结果，如果选择aTSA。

引用次数: 0

Revision Anatomic Total Shoulder Arthroplasty Surgical Technique/Tips and Tricks 改良解剖全肩关节置换术技术/技巧和技巧

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101148

Benjamin E. Neubauer , Justin W. Griffin

In the United States, the use of total shoulder arthroplasty has grown significantly over the past decade, leading to an increased need for revision total shoulder arthroplasty. The most common causes for revision include instability, rotator cuff deficiency, infection, fractures, and component loosening. Although revisions are sometimes unavoidable, thoughtful preoperative planning and proper implant positioning, among other mitigation strategies, can help reduce this risk. A comprehensive evaluation is essential for determining the appropriate treatment modality, with computed tomography arthrography and metal suppression magnetic resonance imaging being particularly helpful depending on the etiology. Initial treatments may include conservative approaches, such as analgesic medications and physical therapy, but more commonly, surgical intervention is required. This typically involves revision total shoulder arthroplasty or conversion to reverse total shoulder arthroplasty, and in rare cases diagnostic arthroscopy or arthroscopic rotator cuff repair. Surgeons should be prepared for all potential treatments and complications, and a thorough work-up ensures that all possible scenarios are accounted for.

在美国，全肩关节置换术的使用在过去十年中显著增长，导致翻修全肩关节置换术的需求增加。最常见的翻修原因包括不稳定、肩袖缺陷、感染、骨折和部件松动。虽然手术矫正有时是不可避免的，但周全的术前计划和适当的植入物定位，以及其他缓解策略，可以帮助降低这种风险。综合评估对于确定合适的治疗方式至关重要，根据病因，计算机断层关节摄影和金属抑制磁共振成像特别有帮助。最初的治疗可能包括保守的方法，如镇痛药物和物理治疗，但更常见的是，需要手术干预。这通常包括翻修全肩关节置换术或转为反向全肩关节置换术，在极少数情况下，诊断性关节镜或关节镜下肩袖修复。外科医生应该为所有可能的治疗和并发症做好准备，彻底的检查可以确保所有可能的情况都得到考虑。

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引用次数: 0

Reverse Shoulder Arthroplasty for the Treatment of Proximal Humerus Fractures 肩关节置换术治疗肱骨近端骨折

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101151

Ehab M. Nazzal, Jaren LaGreca, Matthew F. Gong, Matthew Como, Jonathan D. Hughes

Proximal humerus fractures (PHFs) are relatively common fractures that are especially prevalent amongst the geriatric population. Various fracture patterns exist, ranging from minimally displaced fractures to fracture dislocations with multiple fragments. Traditionally, treatment strategies have included nonoperative management with a sling and gradual return to range of motion, as well as both open reduction internal fixation and hemiarthroplasty. Recently, there has been an increase in the frequency of utilization of reverse shoulder arthroplasty (RSA) as a treatment option for PHFs, to maximize mobility and function. The purpose of this article is to review current concepts for the treatment of PHFs, with a special focus on indications, technical pearls, clinical/functional outcomes, and complications for RSA as a definitive management strategy.

肱骨近端骨折（phf）是相对常见的骨折，在老年人群中尤为普遍。存在多种骨折模式，从最小位移骨折到多碎片骨折脱位。传统上，治疗策略包括非手术治疗，使用吊带和逐渐恢复活动范围，以及切开复位内固定和半关节置换术。最近，使用反向肩关节置换术（RSA）作为治疗phf的一种选择的频率有所增加，以最大限度地提高活动能力和功能。本文的目的是回顾目前phf治疗的概念，特别关注适应症、技术要点、临床/功能结果以及RSA作为明确管理策略的并发症。

引用次数: 0

Editorial Board (pick up from previous issue w/updates) 编辑委员会（选自上一期，并有更新）

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1053/S1048-6666(24)00067-3

引用次数: 0

Revolutionizing Shoulder Arthroplasty: The Transformative Impact of Extended Reality, Robotics, and Artificial Intelligence on Training, Planning, and Execution 革命性的肩关节成形术：扩展现实、机器人技术和人工智能对训练、计划和执行的变革性影响

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101153

Zaamin B. Hussain, Eric R. Wagner

Technological innovations in shoulder arthroplasty could play a major role in addressing problems of implant positioning, stability, and longevity and optimizing patient outcomes. This review discusses the role of extended reality, navigation, patient-specific instrumentation, robotics and artificial intelligence and their applications in training, preoperative planning and intraoperative execution. These nascent technologies have the potential to deliver extraordinary value to patients requiring shoulder arthroplasty but long-term prospective clinical data justifying their mainstream use is currently lacking.

肩关节置换术的技术创新可以在解决假体定位、稳定性和寿命问题以及优化患者预后方面发挥重要作用。本文综述了扩展现实、导航、患者专用仪器、机器人和人工智能及其在培训、术前计划和术中执行中的应用。这些新兴技术有潜力为需要肩关节置换术的患者提供非凡的价值，但目前缺乏证明其主流应用的长期前瞻性临床数据。

引用次数: 0

Shoulder Arthroplasty 肩膀关节成形术

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101154

Jonathan D. Hughes

引用次数: 0

Contributors (pick up from previous issue w/updates) 贡献者（从以前的问题和更新中挑选）

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1053/S1048-6666(24)00069-7

引用次数: 0

Reverse Shoulder Arthroplasty: History, Indications, Design, Outcomes, and Complications 反向肩关节置换术：历史、适应症、设计、结果和并发症

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1016/j.oto.2024.101149

J. Austin Stratton BS, Steve H. Bayer MD, Justin W. Arner MD

The reverse total shoulder arthroplasty (rTSA) has become an increasingly common procedure with rapidly expanding indications. The purpose of this review is to summarize the history of the rTSA, provide an overview of modern implant design, and discuss the expanding indications for primary rTSA, rTSA in the revision setting, and the associated outcomes. The Grammont rTSA was introduced in 1985 for the treatment of cuff tear arthroplasty (CTA). Due to complications including scapular notching, stress fracture of the acromion and scapular spine, and instability, subsequent iterations have included glenoid component lateralization, changes in glenoid baseplate positioning, variations in humeral neck shaft angle, and inlay vs onlay humeral component design. Modernization of the rTSA design has resulted in expanding indications beyond CTA, including irreparable cuff tear, primary osteoarthritis, and fracture. Modern rTSA designs have demonstrated improvement in patient reported outcomes and pain from preoperative baseline with high patient satisfaction. However, rates of scapular notching increase over time and functional outcomes remain limited by deficits in range of motion, especially with internal rotation. An ideal implant configuration has not been identified, but navigation and extended reality are emerging areas of study that may improve implant placement and patient outcomes.

反向全肩关节置换术（rTSA）已成为一种越来越普遍的手术，适应症迅速扩大。本综述的目的是总结rTSA的历史，提供现代种植体设计的概述，并讨论原发性rTSA的适应症，rTSA在翻修环境中的应用，以及相关的结果。gramont rTSA于1985年推出，用于治疗袖带撕裂关节成形术（CTA）。由于并发症包括肩胛骨切迹、肩峰和肩胛骨应力性骨折以及不稳定，随后的迭代包括肩胛假体偏侧、肩胛基板定位的改变、肱骨颈轴角度的变化以及肩关节假体的镶嵌与镶嵌设计。rTSA设计的现代化导致了CTA以外适应症的扩大，包括不可修复的袖带撕裂、原发性骨关节炎和骨折。现代rTSA设计已经证明了患者报告的结果和术前基线疼痛的改善，患者满意度高。然而，随着时间的推移，肩胛骨切迹的发生率增加，功能结果仍然受到活动范围的限制，特别是内旋。理想的种植体结构尚未确定，但导航和扩展现实是新兴的研究领域，可以改善种植体的放置和患者的预后。

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Table of Contents (pick up from previous issue w/updates) 目录（选自上一期的内容和更新）

IF 0.2 Q4 ORTHOPEDICS

Operative Techniques in Orthopaedics

Pub Date : 2024-12-01 DOI: 10.1053/S1048-6666(24)00068-5

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