Journal of shoulder and elbow arthroplasty最新文献

Background and objectives: The management of complex upper limb arthroplasty has received national guidelines supporting the use of a regional network. An upper limb network was established for both elbow and shoulder arthroplasty. This study evaluates the impact of establishing this network over a 5-year period.

Methods: Data were collected from network meetings from June 2017 to December 2022. Hospital-level National Joint Registry data were obtained for analysis of case volume.

Results: A total of 243 cases were discussed. Network discussion changed the management plan in 53% of cases. Only 8% of cases required transfer to the tertiary center. The proportional caseload at either hub or spoke hospitals did not change after creation of the network.

Discussion: Regional network discussion aids decision-making for complex cases, with further management options realized in over half of the cases presented. The discussion allowed every patient to gain the advantage of regional expertise while being managed conveniently at their local hospital.

Purpose: To assess the clinical and radiographic outcomes, at a minimum follow-up of 4 years, following HSA using pyrocarbon in patients that had prior open Latarjet.

Methods: The authors retrieved the records of 61 consecutive patients that underwent HSA with a pyrocarbon humeral head at 2 centers between December 2013 and October 2019. Eight patients (9 shoulders) had undergone previous Latarjet procedures without other surgical antecedents. Patients underwent radiological assessment, and clinical assessment including Constant score, Subjective Shoulder Value (SSV), and pain on VAS. Finally, range of motion was assessed, including active forward elevation and external rotation.

Results: The initial cohort of 9 shoulders, comprised 1 woman and 7 men (1 bilateral), aged 52.5 ± 5.2 at their index HSA, which was performed 27.7 ± 9.3 years following their prior Latarjet procedure. One shoulder required conversion to reverse shoulder arthroplasty, 3 years after HSA. The remaining 8 shoulders were assessed at 6.1 ± 1.6 years (range, 4-8) after the index HSA. Glenoid erosion only progressed in 1 shoulder from mild to moderate. The Constant score was 79.6 ± 12.7, pain on VAS was 1.0 ± 2.1, and SSV was 80.0 ± 25.6. The active forward elevation improved from 96°±41° to 151°±29°, and external rotation from 11°±17° to 32°±8°.

Conclusion: Patients that underwent HSA using pyrocarbon heads following prior Latarjet had satisfactory clinical scores, and glenoid erosion only progressed in 1 patient. Furthermore, only 1 patient required conversion to RSA. The clinical relevance is that HSA using pyrocarbon heads is a safe treatment and grants satisfactory clinical outcomes in patients with prior Latarjet.

Level of evidence: Level III, retrospective comparative study.

Background: Reverse shoulder arthroplasty (RSA) designs include multiple options for glenoid component lateralization, and humeral component lateralization and distalization (inlay/onlay constructs). The influence of combined glenoid lateralization, and humeral distalization on acromial and deltoid stresses is not well understood. The purpose of this study was to evaluate changes in deltoid and acromial stresses with variations in glenoid lateralization, and with inlay versus onlay humeral components in RSA.

Methods: Finite element analysis was performed using a RSA system with both inlay and onlay configurations. Variations in total glenoid lateralization from 3 to 9 mm were evaluated. Deltoid and acromial stresses were determined following virtual implantation and with 50° of external rotation.

Results: Increased glenoid lateralization resulted in greater stress of the deltoid and acromion. There was a modest increase in deltoid stress with glenoid lateralization alone (7% and 7.5% with progressive lateralization from 3 to 6 mm and 6 to 9 mm, respectively), but deltoid stress increased substantially with use of an onlay construct (60% at 9 mm of glenoid lateralization). Acromial stress correspondingly increased 37% with glenoid lateralization, and up to 117% with an onlay humeral construct.

Discussion: Increased lateralization of the glenoid component resulted in increased levels of deltoid and acromial stress. For a given amount of glenoid lateralization, utilization of an inlay stem decreased acromial and deltoid stresses compared to onlay constructs. These data allow surgeons to better understand the interactions of glenoid and humeral lateralization and distalization in the setting of contemporary RSA systems.Level of Evidence: Basic Science Study: Computer Modeling.

Purpose: To compare outcomes, between stemmed and stemless reverse shoulder arthroplasty (RSA) at a minimum follow-up of 5 years.

Methods: The authors retrospectively assessed a consecutive series of 45 patients that underwent RSA between September 2014 and October 2018 (23 stemless and 22 stemmed). All patients underwent plain anteroposterior and scapular Y-view radiographs for assessment immediately post-operatively and at final follow-up. At a minimum follow-up of 5 years, an independent observer assessed the clinical scores, including Constant score, QuickDASH score, and American Shoulder and Elbow Surgeons score.

Results: Of the 45 patients that underwent RSA, 5 patients died (11%), 2 were revised due to infection (4%), and 4 patients were lost to follow-up (9%). This left a final cohort of 34 patients (18 stemless and 16 stemmed). Significant differences between groups were found immediately post-operatively for lateralisation shoulder angle (LSA) (p = 0.021), but at 5 years post-operative for distalisation shoulder angle (DSA) (p = 0.017) and QuickDASH scores (p = 0.041) (Table 4), while the outcomes were comparable for absolute Constant scores, ASES score, and range of motion. Finally, stemless RSA had a 17% complication rate, while stemmed RSA had a 31% complication rate.

Conclusion: Stemless RSA had significantly more lateralisation, and significantly less distalisation, compared to stemmed RSA. Furthermore, at a 5-year follow-up, stemless RSA granted significantly greater QuickDASH scores. Finally, stemless RSA had comparable complication rates as stemmed RSA. The clinical relevance of this study is that stemless RSA is a safe alternative to stemmed RSA, while granting comparable or greater scores.Level of Evidence: III, Comparative Study.

Background: When implanting a cemented humeral stem, a reliable method to prevent inappropriate extension and enable pressurization of cement in the intramedullary canal is required. The aim was to assess the outcomes of a dedicated humeral diaphyseal cement restrictor.

Methods: In total 218 shoulders (207 patients) were included in the study, all of whom underwent a cemented total shoulder arthroplasty and a retrospective review was performed. The primary outcomes of interest were device stability in the medullary canal, successful occlusion of the canal, cement extrusion and quality of cement mantle.

Results: The majority of the cohort was female (63.3%) males and the average patient age was 71.7 years (SD 8.45). In 81.7% the device was deemed to be stable in the medullary canal. The device was significantly more stable in primary (84.2%) compared to revision cases (64.3%, p = 0.02). In 69.7% Barrack grade A mantle quality was achieved, this was higher in primary cases (74.2%) compared to revision cases (39.3%) (p = 0.00006).

Discussion: We noted excellent cementation outcomes using a cement restrictor specifically designed for the diaphyseal humerus anatomy. However, this humeral specific restrictor was noted to be more stable in primary as compared to revision cases.

Introduction: Anatomic hemiarthroplasty (aHA) is a treatment option for non-reconstructable constructable multifragment proximal humeral fractures that preserves range of motion. Our study aims to evaluate the radiographic and clinical outcomes of patients who received a modular aHA with anatomical sizing of the tubercle-bearing metaphyseal components.

Materials and methods: The medical records of thirty-nine consecutive patients were reviewed. Patients were treated at a single institution with aHA as first-line treatment following a non-reconstructable constructable proximal humeral fracture. Tubercle resorption and cranialization of the aHA were analyzed using radiographic controls. Patient clinical function was assessed using the Constant Murley Score (CS).

Results: Twenty-four patients (62%) were available for clinical follow-up, with a mean CS of 54 points after a mean 56-month follow-up period. There was no significant difference in functional outcome on average between patients with healed tubercles (CS = 57) and resorbed tubercles (CS = 51). Radiographic follow-up was available in 33 patients (85%), demonstrating healed tubercles in 33% of the patients. Patients with resorbed tubercles had significant smaller acromio-humeral distances (AHD) than patients with healed tubercles (p = 0.043). A positive correlation was observed between greater AHD and increased constant scores (p = 0.022).

Conclusions: The final patient outcome measures demonstrated a positive correlation with a greater acromio-humeral distance and tubercle healing rates. However, the modular stem design with sizing of the metaphyseal components did not result in superior outcomes when compared with the literature.

Purpose: To evaluate both the short-term clinical and radiological results of reverse shoulder arthroplasty (RSA) with uncemented locked stem in the management of a proximal humerus fracture (PHFs) in the elderly.

Methods: Retrospective study including 40 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 24 months follow-up. In all the cases, the greater tuberosity (GT) was reattached with a standardized suture technique and a local horseshoe bone graft. All the patients were assessed at the 24-month follow-up with Constant-Murley Score (CMS) and Visual Analog Score (VAS). Radiographic healing of the greater tuberosity was noted in addition to stem locking screws radiographic changes. Complications and revision rates were reported.

Results: Mean final CMS for this cohort was 80 points. The greater tuberosity healed in the anatomic position in 90% of the cases (N = 36), obtaining an average CMS of 80 in these patients. Healing of the greater tuberosity did not occur in 10% of the cases (N = 4), obtaining an average CMS of 60. All patients scored above 100° in forward elevation with a mean of 140°. Mean active external rotation was 30°. Low-grade scapular notching was reported in <1% of the cases. Major complications were reported in one patient with an acromial fracture. No complications or loosening of stem locking screws were noted. There were no reoperations.

Conclusion: In the elderly population, reverse shoulder arthroplasty utilizing a fracture-specific locking stem, low-profile metaphysis, suture-friendly groove, meticulous suture technique, and local bone grafting allows adequate fixation, variable prosthesis height adjustment, and enhances greater tuberosity healing. This approach yields positive short-term clinical outcomes without complications related to the stem's locking screws.

Level of evidence: Level IV Retrospective Case Series.

Purpose: To investigate whether the preoperative shoulder range of motion (ROM), would increase the risk of postoperative shoulder stiffness, or whether it would be associated with other preoperative patient characteristics.

Methods: The authors retrospectively analysed the 372 shoulders that underwent rotator cuff repair by 4 surgeons, between January 2010 and January 2011. All patients were followed up at 3 and 6 months by 2 independent observers to collect the ROM, including active forward elevation (AFE), passive forward elevation (PFE), and external rotation (ER), as well as subjective shoulder value (SSV).

Results: Of the initial cohort of 372 patients, 10 were lost to follow-up (2.7%), leaving a final cohort of 362 patients available for outcome assessment at a minimum follow-up of 6 months. Of the 362 patients, 281 did not require corticosteroid infiltration, 68 received corticosteroid infiltrations for shoulder stiffness with no apparent cause, and 13 received corticosteroid infiltrations for other reasons. None of the variables were associated with infiltration for shoulder stiffness. Older patients had greater SSV scores (β = 0.3; 95% CI [0.1, 0.6]; P = .015), while both manual and repetitive workers had lower SSV scores (β = -10.7; 95% CI [-15.8, -5.6]; P < .001, and β = -10.2; 95% CI [-15.1, -5.3]; P < .001).

Conclusion: Postoperative SSV was significantly associated with age, as well as manual or repetitive work. Furthermore, postoperative PFE, AFE, and ER were significantly associated with preoperative PFE. Finally, at 3 and 6 months postoperative, patients who required infiltration for shoulder stiffness had significantly lower PFE, AFE, and ER compared to patients who did not require infiltration.

Level of evidence: IV, Case series.

Background: Acromioclavicular (AC) joint trauma is a frequent sports injury. Modified Weaver Dunn (MWD) is a commonly used technique to address this injury. However, tendinous grafts (Autogenous Palmaris Longus or Semitendinosus tendons) are increasingly being used due to the biologic weakness of MWD.

Methods: Three search was done until January 2024 with data extraction consisting of adverse events (infections and failures), Constant-Murley score, American Shoulder and Elbow Surgeons score, and postoperative coracoclavicular distance.

Results: Four studies were included in this metaanalysis. Tendinous graft was shown to have statistically better ASES and Constant-Murley scores. Furthermore, there were no difference in adverse events, and postoperative coracoclavicular distance.

Conclusion: The tendinous graft showed no differences in adverse events, and postoperative coracoclavicular distance when compared to modified Weaver Dunn. However, it showed higher postoperative ASES and Constant-Murley score without analysis of the minimal clinical important difference making the difference solely statistical.

Level of evidence: 3.

Background: Although glenoid bone grafting and metallic augmented baseplates have demonstrated success in restoring the glenohumeral joint line in the recent literature, there remain no consensus guidelines defining the use of one versus the other.

Methods: Between 2017 and 2020, 15 primary RTSA with screw-in metallically augmented glenoid baseplates were identified and 2:1 matched by age, sex, and body mass index with primary bony-augmented glenoid baseplate patients. Patients with previous glenoid implantation or fracture were excluded. Charts, routine radiographic series (Grashey, Scapula Y, Axillary lateral), and 3-dimensional computed tomography (3D CT) scans were retrospectively reviewed. Structural patient-specific metal or bony augmentation was indicated based on preoperative glenoid morphology as identified by 3D CT. Aseptic failure was identified as hardware breakage and/or shift in glenoid baseplate component position.

Results: There were 45 eligible cases with mean age of 65.7 years (range 44-85 years) and 65.5 years (range 42-82 years) for the metallic-augmented and bone graft group, respectively. Correspondingly, mean follow up was 22.6 months (range 12-53 months), and 27.3 months (range 11-53 months). At latest follow up, there were no baseplate failures in the metallic augment group and 2 baseplate failures (7%) in the bone graft group at a mean of 42.5 months (range 32-53 months) postoperatively. Mean age of the bone failure group was 64.5 years (range 64-65 years).

Conclusion: Contemporary reversed shoulder arthroplasty glenoid baseplate designs appear to have low incidence of failure. Further analysis is necessary to determine if a critical degree of glenoid retroversion or inclination is preferable with a specific form of augmentation.

Level of evidence: III; Retrospective Cohort Comparison.