Pub Date : 2023-01-01DOI: 10.1177/24715492231152143
Edoardo Franceschetti, Pietro Gregori, Giancarlo Giurazza, Giuseppe Papalia, Auro Caraffa, Rocco Papalia
Background: The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants.
Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis.
Results: A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively.
Conclusions: Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients.
{"title":"Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis.","authors":"Edoardo Franceschetti, Pietro Gregori, Giancarlo Giurazza, Giuseppe Papalia, Auro Caraffa, Rocco Papalia","doi":"10.1177/24715492231152143","DOIUrl":"https://doi.org/10.1177/24715492231152143","url":null,"abstract":"<p><strong>Background: </strong>The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants.</p><p><strong>Methods: </strong>The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis.</p><p><strong>Results: </strong>A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively.</p><p><strong>Conclusions: </strong>Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/45/10.1177_24715492231152143.PMC9875319.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10586734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231157659
Hugues De La Selle, Tristan Lascar, Pascal Clappaz, Edouard Decrette, Floris van Rooij, Mo Saffarini, Laurent Obert
Purpose: To evaluate indications and factors that influence long-term clinical outcomes and revision rates for reverse shoulder arthroplasty (RSA) in shoulders with irreparable massive rotator cuff tears (mRCTs) or cuff tear arthropathies (CTAs).
Methods: The authors retrospectively evaluated a consecutive series of shoulders with no fracture sequelae that underwent primary RSA between 2011 and 2013. Independent observers collected demographic data, surgical techniques, and implant types, as well as primary outcome measures such as American Shoulder and Elbow Society (ASES) score and Constant score (CS).
Study design: Case series, level IV.
Results: From the initial series of 123 patients that underwent RSA, 29 patients died (24%) for reasons unrelated to the shoulder arthroplasty, 11 were lost to follow-up (9%), and 4 required revision surgery (3%). The final cohort of 79 patients comprised 55 women (70%), and 24 men (30%), aged 72.7 ± 7.0. At a final follow-up of 8.9 ± 0.6 years (range: 7.4-10.3) the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 76.6 ± 41.2, and ASES was 77.1 ± 20.3. Univariable analysis revealed no associations for absolute CS, but revealed that age-/sex-adjusted CS was significantly lower for patients with high blood pressure (β = -15.8, p = .025).
Conclusions: At a minimum follow-up of 7.4 years, the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 87.4 ± 24.1 and ASES was 77.1 ± 20.3. When stratifying the outcomes of RSA by indication, there were no significant differences in patients with mRCTs versus CTA in terms of absolute CS, age-/sex-adjusted CS, and ASES. Univariable analysis revealed no association with absolute and age-/sex-adjusted CS for type of indication or surgical approach.
目的:评价影响不可修复的大面积肩袖撕裂(mrct)或肩袖撕裂关节病(cta)患者进行反向肩关节置换术(RSA)的长期临床结果和翻修率的指征和因素。方法:作者回顾性评估了2011年至2013年间接受原发性RSA治疗的无骨折后遗症的连续肩部患者。独立观察员收集了人口统计数据、手术技术和植入物类型,以及主要结局指标,如美国肩肘协会(ASES)评分和恒定评分(CS)。研究设计:病例系列,iv级。结果:在最初的123例接受RSA的患者中,29例(24%)患者死于与肩关节置换术无关的原因,11例(9%)失去随访,4例(3%)需要翻修手术。最终队列79例患者,其中女性55例(70%),男性24例(30%),年龄72.7±7.0岁。最终随访8.9±0.6年(范围:7.4-10.3年),绝对CS为59.0±16.2,年龄/性别调整CS为76.6±41.2,ASES为77.1±20.3。单变量分析显示绝对CS与高血压患者无关联,但显示年龄/性别调整后的CS显著降低(β = -15.8, p = 0.025)。结论:在至少7.4年的随访中,绝对CS为59.0±16.2,年龄/性别调整CS为87.4±24.1,ASES为77.1±20.3。当按适应症对RSA的结果进行分层时,mrct患者与CTA患者在绝对CS、年龄/性别调整CS和ASES方面没有显著差异。单变量分析显示,适应症类型或手术入路与绝对CS和年龄/性别调整CS无关联。
{"title":"Reverse Shoulder Arthroplasty for Patients with Massive Rotator Cuff Tears or Cuff Tear Arthropathies at a Minimum Follow-up of 7 Years.","authors":"Hugues De La Selle, Tristan Lascar, Pascal Clappaz, Edouard Decrette, Floris van Rooij, Mo Saffarini, Laurent Obert","doi":"10.1177/24715492231157659","DOIUrl":"https://doi.org/10.1177/24715492231157659","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate indications and factors that influence long-term clinical outcomes and revision rates for reverse shoulder arthroplasty (RSA) in shoulders with irreparable massive rotator cuff tears (mRCTs) or cuff tear arthropathies (CTAs).</p><p><strong>Methods: </strong>The authors retrospectively evaluated a consecutive series of shoulders with no fracture sequelae that underwent primary RSA between 2011 and 2013. Independent observers collected demographic data, surgical techniques, and implant types, as well as primary outcome measures such as American Shoulder and Elbow Society (ASES) score and Constant score (CS).</p><p><strong>Study design: </strong>Case series, level IV.</p><p><strong>Results: </strong>From the initial series of 123 patients that underwent RSA, 29 patients died (24%) for reasons unrelated to the shoulder arthroplasty, 11 were lost to follow-up (9%), and 4 required revision surgery (3%). The final cohort of 79 patients comprised 55 women (70%), and 24 men (30%), aged 72.7 ± 7.0. At a final follow-up of 8.9 ± 0.6 years (range: 7.4-10.3) the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 76.6 ± 41.2, and ASES was 77.1 ± 20.3. Univariable analysis revealed no associations for absolute CS, but revealed that age-/sex-adjusted CS was significantly lower for patients with high blood pressure (β = -15.8, p = .025).</p><p><strong>Conclusions: </strong>At a minimum follow-up of 7.4 years, the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 87.4 ± 24.1 and ASES was 77.1 ± 20.3. When stratifying the outcomes of RSA by indication, there were no significant differences in patients with mRCTs versus CTA in terms of absolute CS, age-/sex-adjusted CS, and ASES. Univariable analysis revealed no association with absolute and age-/sex-adjusted CS for type of indication or surgical approach.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/02/10.1177_24715492231157659.PMC9941602.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10830848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231162302
Patrick J Carroll, Ujash Sheth, Patrick Henry
Background: Parkinson's disease is a degenerative neurological disorder that can cause both motor and nonmotor symptoms. Motor symptoms are associated with increasing the patient's falls risk. Shoulder arthroplasty surgery in this patient cohort is associated with more complications than non-Parkinsonian patients. We sought to identify any increase in complications associated with this patient cohort and any surgical considerations that ought to be taken in light of their disease process.
Methods: We performed a systematic review of articles using PubMed, MEDLINE, Cochrane Central, and Google Scholar. All studies which included any shoulder arthroplasty surgery for patients with Parkinson's disease were included.
Results: Complication rates were higher in patients with Parkinson's disease than in the normal arthroplasty cohort in all studies. There was significant heterogeneity between all 8 studies included in the systematic review. Complication rates ranged from 26% to 100%. Complications included subluxation, loosening, malunion, nonunion, scapular notching, stiffness, fracture, baseplate failure, dislocation, and infection. Reoperation rates ranged from 5% to 29%.
Conclusion: Compared to patients without Parkinson's disease undergoing shoulder arthroplasty, patients with Parkinson's disease achieved similar reductions in pain but inferior clinical function. The range of movement was less predictable, and complication rates were significantly higher in Parkinson's disease patients. This study will aid the surgeon and patient regarding surgical intervention, informed consent, and allow the surgeon to anticipate potential complications of shoulder arthroplasty in this patient cohort.
{"title":"A Systematic Review of Shoulder Arthroplasty in Parkinson's Disease.","authors":"Patrick J Carroll, Ujash Sheth, Patrick Henry","doi":"10.1177/24715492231162302","DOIUrl":"https://doi.org/10.1177/24715492231162302","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease is a degenerative neurological disorder that can cause both motor and nonmotor symptoms. Motor symptoms are associated with increasing the patient's falls risk. Shoulder arthroplasty surgery in this patient cohort is associated with more complications than non-Parkinsonian patients. We sought to identify any increase in complications associated with this patient cohort and any surgical considerations that ought to be taken in light of their disease process.</p><p><strong>Methods: </strong>We performed a systematic review of articles using PubMed, MEDLINE, Cochrane Central, and Google Scholar. All studies which included any shoulder arthroplasty surgery for patients with Parkinson's disease were included.</p><p><strong>Results: </strong>Complication rates were higher in patients with Parkinson's disease than in the normal arthroplasty cohort in all studies. There was significant heterogeneity between all 8 studies included in the systematic review. Complication rates ranged from 26% to 100%. Complications included subluxation, loosening, malunion, nonunion, scapular notching, stiffness, fracture, baseplate failure, dislocation, and infection. Reoperation rates ranged from 5% to 29%.</p><p><strong>Conclusion: </strong>Compared to patients without Parkinson's disease undergoing shoulder arthroplasty, patients with Parkinson's disease achieved similar reductions in pain but inferior clinical function. The range of movement was less predictable, and complication rates were significantly higher in Parkinson's disease patients. This study will aid the surgeon and patient regarding surgical intervention, informed consent, and allow the surgeon to anticipate potential complications of shoulder arthroplasty in this patient cohort.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10014981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9200053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231211122
Daniel J Song, Nathan S Lanham, Rifat Ahmed, Michael L Knudsen, William N Levine, Charles M Jobin
Background There is limited data evaluating post-operative component position and fixation in reverse shoulder arthroplasty (RSA). Therefore, the purpose of this study was to evaluate baseplate position and fixation using routine pre-operative CT and post-operative radiographs. Methods A retrospective analysis of a series consecutive patient who underwent primary RSA was performed. Pre-operative and post-operative glenoid retroversion and inclination were measured using radiographs aligned with projection silhouettes of 3D scapula models in Mimics software. Baseplate retroversion and inclination were measured followed by evaluating for the presence of radiolucent lines (RLLs). Results Twenty-four patients met inclusion criteria. The average age was 73.4 ± 10.7 years (range, 45-89 years). Radiographic follow-up was 3.4 ± 1.3 years. Post-operative glenoid baseplate retroversion was 2 ± 10 degrees (range, 30 to −9). Post-operative glenoid baseplate inclination was 3.8 ± 9.1 (range, −13 to 19). Five (21%) RSAs had baseplate retroversion >10 degrees. Follow-up radiographs revealed no RLLs around the baseplate, central post, or peripheral screws in any patient. Conclusions Pre-operative CT imaging enabled evaluation of baseplate component placement and fixation on post-operative radiographs. Baseplate version was within 10 degrees of neutral in 79% (19/24) of patients. No RLLs or loss of fixation were found in any cases. Level of Evidence Level IV: Diagnostic Study.
{"title":"Post-operative Baseplate Radiographic Evaluation Using Routine pre-Operative CT","authors":"Daniel J Song, Nathan S Lanham, Rifat Ahmed, Michael L Knudsen, William N Levine, Charles M Jobin","doi":"10.1177/24715492231211122","DOIUrl":"https://doi.org/10.1177/24715492231211122","url":null,"abstract":"Background There is limited data evaluating post-operative component position and fixation in reverse shoulder arthroplasty (RSA). Therefore, the purpose of this study was to evaluate baseplate position and fixation using routine pre-operative CT and post-operative radiographs. Methods A retrospective analysis of a series consecutive patient who underwent primary RSA was performed. Pre-operative and post-operative glenoid retroversion and inclination were measured using radiographs aligned with projection silhouettes of 3D scapula models in Mimics software. Baseplate retroversion and inclination were measured followed by evaluating for the presence of radiolucent lines (RLLs). Results Twenty-four patients met inclusion criteria. The average age was 73.4 ± 10.7 years (range, 45-89 years). Radiographic follow-up was 3.4 ± 1.3 years. Post-operative glenoid baseplate retroversion was 2 ± 10 degrees (range, 30 to −9). Post-operative glenoid baseplate inclination was 3.8 ± 9.1 (range, −13 to 19). Five (21%) RSAs had baseplate retroversion >10 degrees. Follow-up radiographs revealed no RLLs around the baseplate, central post, or peripheral screws in any patient. Conclusions Pre-operative CT imaging enabled evaluation of baseplate component placement and fixation on post-operative radiographs. Baseplate version was within 10 degrees of neutral in 79% (19/24) of patients. No RLLs or loss of fixation were found in any cases. Level of Evidence Level IV: Diagnostic Study.","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135508724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231172371
Aparna Viswanath, Amy K Newell, Lindsay J Cunningham, Mike Walton, Puneet Monga, Steve Bale, Ian A Trail
Background: This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant.
Methods: We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up.
Results: Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported.
Conclusion: Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.
{"title":"Survivorship of Allologous Structural Bone Graft at a Minimum of 2 Years When Used to Address Significant Glenoid Bone Loss in Revision Shoulder Arthroplasty: A Computed Tomographic and Clinical Review.","authors":"Aparna Viswanath, Amy K Newell, Lindsay J Cunningham, Mike Walton, Puneet Monga, Steve Bale, Ian A Trail","doi":"10.1177/24715492231172371","DOIUrl":"https://doi.org/10.1177/24715492231172371","url":null,"abstract":"<p><strong>Background: </strong>This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant.</p><p><strong>Methods: </strong>We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up.</p><p><strong>Results: </strong>Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported.</p><p><strong>Conclusion: </strong>Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/9b/10.1177_24715492231172371.PMC10184218.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9486024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231192072
Dimitrios Varvitsiotis, Stefania Kokkineli, Christopher Feroussis, Nikos Apostolopoulos, Dimitrios Zakilas, John Feroussis
Background: The aim of this single-center study was to analyze the long-term clinical results of reverse shoulder arthroplasty in patients with massive, irreparable rotator cuff tears without glenohumeral arthritis.
Methods: A retrospective cohort study of 105 patients (115 shoulders) was conducted. The mean age of the patient group was 76 years (range, 65 to 87 years). The mean clinical follow-up was 9.4 years (range, 5 to 17 years). Pain, range of motion, and complication rates were analyzed pre-operatively and at the last follow-up.
Results: The mean Constant-Murley score increased from 29 points (range, 21 to 34 points) preoperatively to 68.1 points (range, 57 to 81 points) postoperatively (p<0.05). Scapular notching was present in 50 shoulders (43.5%) and it was grade 1 or 2 in 47 of 115 cases (40.9%) and grade 3 or 4 in 3 of 115 cases (2.6%). Complications occurred in 19 patients (17%). Seven patients (6%) underwent revision surgery. The mean satisfaction rate was 94%.
Conclusions: Reverse shoulder arthroplasty is a viable treatment for massive, irreparable rotator cuff tears without glenohumeral arthritis with satisfactory clinical outcomes and low complication and reoperation rates with a mean follow up of 9.4 years after surgery.
{"title":"Long-Term Results of Primary Reverse Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Without Glenohumeral Arthritis with a Mean Follow up of 9.4 Years.","authors":"Dimitrios Varvitsiotis, Stefania Kokkineli, Christopher Feroussis, Nikos Apostolopoulos, Dimitrios Zakilas, John Feroussis","doi":"10.1177/24715492231192072","DOIUrl":"https://doi.org/10.1177/24715492231192072","url":null,"abstract":"<p><strong>Background: </strong>The aim of this single-center study was to analyze the long-term clinical results of reverse shoulder arthroplasty in patients with massive, irreparable rotator cuff tears without glenohumeral arthritis.</p><p><strong>Methods: </strong>A retrospective cohort study of 105 patients (115 shoulders) was conducted. The mean age of the patient group was 76 years (range, 65 to 87 years). The mean clinical follow-up was 9.4 years (range, 5 to 17 years). Pain, range of motion, and complication rates were analyzed pre-operatively and at the last follow-up.</p><p><strong>Results: </strong>The mean Constant-Murley score increased from 29 points (range, 21 to 34 points) preoperatively to 68.1 points (range, 57 to 81 points) postoperatively (p<0.05). Scapular notching was present in 50 shoulders (43.5%) and it was grade 1 or 2 in 47 of 115 cases (40.9%) and grade 3 or 4 in 3 of 115 cases (2.6%). Complications occurred in 19 patients (17%). Seven patients (6%) underwent revision surgery. The mean satisfaction rate was 94%.</p><p><strong>Conclusions: </strong>Reverse shoulder arthroplasty is a viable treatment for massive, irreparable rotator cuff tears without glenohumeral arthritis with satisfactory clinical outcomes and low complication and reoperation rates with a mean follow up of 9.4 years after surgery.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/ae/10.1177_24715492231192072.PMC10413892.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231167104
Helen Razmjou, Monique Christakis, Diane Nam, Darren Drosdowech, Ujash Sheth, Amy Wainwright, Robin Richards
Purpose: The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined.
Materials and methods: This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss.
Results: Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were "ready" and those who were "not-ready" to have surgery. Gender (P = 0.037), overall health (P = .024), strength in external rotation (P = .002), pain severity (P = .001), ASES score (P < .0001), and expectations (P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery.
Conclusions: A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.
{"title":"Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process.","authors":"Helen Razmjou, Monique Christakis, Diane Nam, Darren Drosdowech, Ujash Sheth, Amy Wainwright, Robin Richards","doi":"10.1177/24715492231167104","DOIUrl":"https://doi.org/10.1177/24715492231167104","url":null,"abstract":"<p><strong>Purpose: </strong>The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined.</p><p><strong>Materials and methods: </strong>This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss.</p><p><strong>Results: </strong>Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were \"ready\" and those who were \"not-ready\" to have surgery. Gender (<i>P</i> = 0.037), overall health (<i>P</i> = .024), strength in external rotation (<i>P</i> = .002), pain severity (<i>P</i> = .001), ASES score (<i>P</i> < .0001), and expectations (<i>P</i> = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery.</p><p><strong>Conclusions: </strong>A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/db/10.1177_24715492231167104.PMC10064165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9241409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/24715492231167111
Alexandre Almeida, Aloir DO Junior, Samuel Pante, Luis F Gobbi, Marcelo G Vicente, Arivaldir B Oliboni, Ana P Agostini
Objective: The main objective was to evaluate the anterior flexion force (AFF) and the lateral abduction force (LAF) of patients who underwent reverse shoulder arthroplasty (RSA) and to compare the measured force with that in a similar-age control group. The secondary objective was to identify prognostic factors for muscle strength recovery.
Methods: Forty-two shoulders that underwent primary RSA between September 2009 and April 2020 met the inclusion criteria and were called the arthroplasty group (AG). The control group (CG) consisted of 36 patients. The mean AFF and the mean LAF were evaluated with a digital isokinetic traction dynamometer.
Results: The average AFF found in the AG was 15 N, while in the CG, the average AFF was 21 N (P < .001). The average LAF in the AG was 14 N (standard deviation [SD] 8 N), while in the CG the average LAF was of 19 N (SD 6 N) (P = .002). All prognostic factors studied in the AG showed no statistical significance: dominance (AFF 0.697/LAF 0.883), previous rotator cuff repair surgery (AFF 0.786/LAF 0.821), Hamada radiological classification (AFF 0.343/LAF 0.857), magnetic resonance imaging (MRI) pre-operative evaluation of the quality of the teres minor (AFF 0.131/LAF 0.229), suture of the subscapularis at the end of the arthroplasty procedure (AFF 0.961/LAF 0.325) and postoperative complications (AFF 0.600/LAF 0.960).
Conclusion: The mean AFF was 15 N, and the mean LAF was 14 N. The comparison of AFF and LAF with a CG showed a 25% reduction in muscle strength. It was not possible to demonstrate prognostic factors for muscle strength recovery after RSA.
目的:主要目的是评估逆行肩关节置换术(RSA)患者的前屈曲力(AFF)和外侧外展力(LAF),并将测量的力与相似年龄的对照组进行比较。次要目的是确定肌肉力量恢复的预后因素。方法:2009年9月至2020年4月期间,42例肩部接受了原发性RSA,符合纳入标准,称为关节成形术组(AG)。对照组(CG) 36例。用数字等速牵引测功机对平均AFF和平均LAF进行了评估。结果:胃中平均afn为15 N,胃中平均afn为21 N (P = 0.002)。所有预后因素:优势度(AFF 0.697/LAF 0.883)、既往肩袖修复手术(AFF 0.786/LAF 0.821)、滨田放射学分型(AFF 0.343/LAF 0.857)、磁共振成像(MRI)术前小圆肌质量评价(AFF 0.131/LAF 0.229)、肩周肌成形术结束时缝合(AFF 0.961/LAF 0.325)、术后并发症(AFF 0.600/LAF 0.960)均无统计学意义。结论:AFF平均为15 N, LAF平均为14 N, AFF与LAF与CG的比较显示肌肉力量降低25%。不可能证明RSA术后肌肉力量恢复的预后因素。
{"title":"Strength Assessment After Reverse Shoulder Arthroplasty.","authors":"Alexandre Almeida, Aloir DO Junior, Samuel Pante, Luis F Gobbi, Marcelo G Vicente, Arivaldir B Oliboni, Ana P Agostini","doi":"10.1177/24715492231167111","DOIUrl":"https://doi.org/10.1177/24715492231167111","url":null,"abstract":"<p><strong>Objective: </strong>The main objective was to evaluate the anterior flexion force (AFF) and the lateral abduction force (LAF) of patients who underwent reverse shoulder arthroplasty (RSA) and to compare the measured force with that in a similar-age control group. The secondary objective was to identify prognostic factors for muscle strength recovery.</p><p><strong>Methods: </strong>Forty-two shoulders that underwent primary RSA between September 2009 and April 2020 met the inclusion criteria and were called the arthroplasty group (AG). The control group (CG) consisted of 36 patients. The mean AFF and the mean LAF were evaluated with a digital isokinetic traction dynamometer.</p><p><strong>Results: </strong>The average AFF found in the AG was 15 N, while in the CG, the average AFF was 21 N (<i>P</i> < .001). The average LAF in the AG was 14 N (standard deviation [SD] 8 N), while in the CG the average LAF was of 19 N (SD 6 N) (<i>P</i> = .002). All prognostic factors studied in the AG showed no statistical significance: dominance (AFF 0.697/LAF 0.883), previous rotator cuff repair surgery (AFF 0.786/LAF 0.821), Hamada radiological classification (AFF 0.343/LAF 0.857), magnetic resonance imaging (MRI) pre-operative evaluation of the quality of the teres minor (AFF 0.131/LAF 0.229), suture of the subscapularis at the end of the arthroplasty procedure (AFF 0.961/LAF 0.325) and postoperative complications (AFF 0.600/LAF 0.960).</p><p><strong>Conclusion: </strong>The mean AFF was 15 N, and the mean LAF was 14 N. The comparison of AFF and LAF with a CG showed a 25% reduction in muscle strength. It was not possible to demonstrate prognostic factors for muscle strength recovery after RSA.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/7e/10.1177_24715492231167111.PMC10107961.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9389957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16eCollection Date: 2022-01-01DOI: 10.1177/24715492221137186
Brendan Y Shi, Alexander Upfill-Brown, Benjamin V Kelley, Dane J Brodke, Erik N Mayer, Sai K Devana, Thomas J Kremen, Christopher Lee
Introduction: The two historically dominant surgical options for displaced geriatric proximal humerus (PHFx) fractures are open reduction internal fixation (ORIF) and hemiarthroplasty (HA). However, shoulder arthroplasty (SA), predominantly in the form of reverse total shoulder arthroplasty (RTSA), has emerged as an attractive treatment option. We aim to compare the utilization trends, complications, and costs associated with surgical management of geriatric proximal humerus fractures (PHFs) between 2010 and 2019. We hypothesized that 1) the proportion of patients undergoing SA would increase over time, 2) the short-term complication rate in patients undergoing SA would decline over time, and 3) hospital related costs would decline for SA patients over time.
Patients and methods: The National Inpatient Sample was queried from 2010 to 2019 to identify all PHFx in patients aged 65 or older that underwent ORIF, SA, or HA. Multivariable regression was used to evaluate differences between fixation methods regarding health care utilization metrics, hospital costs, and index hospital complications. The primary outcome of interest was the method of surgical management utilized in the treatment of geriatric PHFs, and secondary outcomes of interest included hospitalization cost, length of stay (LOS), discharge destination and index hospitalization complications.
Results: A total of 105 886 geriatric patients that underwent surgical management of PHFx were identified. While the proportion undergoing ORIF decreased from 59% to 29%, the proportion undergoing SA increased from 9% to 67%. Hospital costs decreased over time for patients treated with SA and increased for those treated with ORIF. Compared to ORIF, SA was associated with higher cost, decreased length of stay, and lower mortality and complication rates.
Conclusion: Over the last decade, SA has become the most common surgical treatment modality performed for geriatric PHFx. Index hospital complications are reduced in SA patients compared to ORIF patients, driven largely by a lower rate of blood transfusion. Although costs are decreasing and average length of stay is now lower in SA patients compared to ORIF patients, SA remains associated with higher hospital costs overall.
{"title":"Increasing Rate of Shoulder Arthroplasty for Geriatric Proximal Humerus Fractures in the United States, 2010-2019.","authors":"Brendan Y Shi, Alexander Upfill-Brown, Benjamin V Kelley, Dane J Brodke, Erik N Mayer, Sai K Devana, Thomas J Kremen, Christopher Lee","doi":"10.1177/24715492221137186","DOIUrl":"https://doi.org/10.1177/24715492221137186","url":null,"abstract":"<p><strong>Introduction: </strong>The two historically dominant surgical options for displaced geriatric proximal humerus (PHFx) fractures are open reduction internal fixation (ORIF) and hemiarthroplasty (HA). However, shoulder arthroplasty (SA), predominantly in the form of reverse total shoulder arthroplasty (RTSA), has emerged as an attractive treatment option. We aim to compare the utilization trends, complications, and costs associated with surgical management of geriatric proximal humerus fractures (PHFs) between 2010 and 2019. We hypothesized that 1) the proportion of patients undergoing SA would increase over time, 2) the short-term complication rate in patients undergoing SA would decline over time, and 3) hospital related costs would decline for SA patients over time.</p><p><strong>Patients and methods: </strong>The National Inpatient Sample was queried from 2010 to 2019 to identify all PHFx in patients aged 65 or older that underwent ORIF, SA, or HA. Multivariable regression was used to evaluate differences between fixation methods regarding health care utilization metrics, hospital costs, and index hospital complications. The primary outcome of interest was the method of surgical management utilized in the treatment of geriatric PHFs, and secondary outcomes of interest included hospitalization cost, length of stay (LOS), discharge destination and index hospitalization complications.</p><p><strong>Results: </strong>A total of 105 886 geriatric patients that underwent surgical management of PHFx were identified. While the proportion undergoing ORIF decreased from 59% to 29%, the proportion undergoing SA increased from 9% to 67%. Hospital costs decreased over time for patients treated with SA and increased for those treated with ORIF. Compared to ORIF, SA was associated with higher cost, decreased length of stay, and lower mortality and complication rates.</p><p><strong>Conclusion: </strong>Over the last decade, SA has become the most common surgical treatment modality performed for geriatric PHFx. Index hospital complications are reduced in SA patients compared to ORIF patients, driven largely by a lower rate of blood transfusion. Although costs are decreasing and average length of stay is now lower in SA patients compared to ORIF patients, SA remains associated with higher hospital costs overall.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b1/f5/10.1177_24715492221137186.PMC9677166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40702409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-21eCollection Date: 2022-01-01DOI: 10.1177/24715492221127686
Elias G Joseph, Aleksandr Krichmar, Mohammad Nadir Haider, Thomas R Duquin
Background: To evaluate the clinical, functional, radiographic, and survival outcomes in patients undergoing reverse total shoulder arthroplasty (RSA) with uncemented stem fixation for proximal humerus fractures.
Materials and methods: This is a retrospective cohort study that evaluated a consecutive series of patients with proximal humerus fractures undergoing RSA. Clinical data, radiographs, and re-operation rates were reviewed in patients selected for uncemented stem fixation. The same parameters were compared to the remainder of the cohort undergoing cemented stem fixation.
Results: The uncemented group (n = 16, median total follow-up = 108 weeks) and cemented group (n = 12, median total follow-up = 223 weeks, p = 0.110) did not differ statistically in pre-operative demographic, post-operative outcomes or incidence of complications. Two patients (12.5%) in the uncemented group required a reoperation (Week 52 and 180) versus none in the cemented group.
Conclusion: Uncemented stem fixation in RSA for proximal humerus fractures does not yield worse results than cemented stem fixation in properly selected patients. Prospective non-inferiority trials comparing outcomes are recommended.
{"title":"Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Using Uncemented Stems, a Single Center Study.","authors":"Elias G Joseph, Aleksandr Krichmar, Mohammad Nadir Haider, Thomas R Duquin","doi":"10.1177/24715492221127686","DOIUrl":"https://doi.org/10.1177/24715492221127686","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the clinical, functional, radiographic, and survival outcomes in patients undergoing reverse total shoulder arthroplasty (RSA) with uncemented stem fixation for proximal humerus fractures.</p><p><strong>Materials and methods: </strong>This is a retrospective cohort study that evaluated a consecutive series of patients with proximal humerus fractures undergoing RSA. Clinical data, radiographs, and re-operation rates were reviewed in patients selected for uncemented stem fixation. The same parameters were compared to the remainder of the cohort undergoing cemented stem fixation.</p><p><strong>Results: </strong>The uncemented group (n = 16, median total follow-up = 108 weeks) and cemented group (n = 12, median total follow-up = 223 weeks, p = 0.110) did not differ statistically in pre-operative demographic, post-operative outcomes or incidence of complications. Two patients (12.5%) in the uncemented group required a reoperation (Week 52 and 180) versus none in the cemented group.</p><p><strong>Conclusion: </strong>Uncemented stem fixation in RSA for proximal humerus fractures does not yield worse results than cemented stem fixation in properly selected patients. Prospective non-inferiority trials comparing outcomes are recommended.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/1f/10.1177_24715492221127686.PMC9500255.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33482814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}