Journal of shoulder and elbow arthroplasty最新文献

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.

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.

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.

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.

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.

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.

Background: Stemless shoulder arthroplasty was developed to restore the glenohumeral centre of rotation without violation of the humeral shaft. It allows the preservation of humeral bone stock. Complications related to stem malalignment and periprosthetic fractures can be avoided.

Patient and methods: This is a prospective observational study that reports outcomes of 46 patients who received stemless shoulder arthroplasty "Comprehensive Nano implant ®." The series includes Group (A): 30 anatomic and one hemiarthroplasty. Group (B): 15 reverse stemless replacement. Functional outcomes were assessed by visual analog score (VAS), satisfaction, range motion, Constant score, and American Shoulder and Elbow Score (ASES).

Results: The mean follow-up was 40.4  ±  12 months (range, 24 months to 60 months). Group (A): VAS and satisfaction improved by 5.3 and 67.5 points respectively. Constant score significantly improved from 28.5  ±  14.5 to 62.5  ±  23 P = <0.001. The radiological assessment showed the mean centre of rotation (COR) deviation was 2.8  ±  1.9 mm. 27% of patients have COR discrepancy of more than 4 mm. In Group (B), patients reported a significant improvement in VAS, Satisfaction, and ASES P  =  0.002, 0.002, and 0.003, respectively.Complications include shoulder pain with progressive loss of movements, aseptic loosening early subscapularis rupture, glenohumeral dislocations, and humeral component migration.

Conclusion: Anatomic Stemless total shoulder arthroplasty offers acceptable results and improvement of overall functional outcomes.

The location and course of the suprascapular nerve (SSN) to the glenohumeral joint places this nerve at risk when operating around the shoulder. Iatrogenic injury to the suprascapular nerve has been described in several different procedures including, rotator cuff repairs, posterior capsulorraphy, Bankart repairs, SLAP lesion repairs, Latarjet procedures, and shoulder arthroplasty. We present a case of iatrogenic suprascapular nerve injury due to superior glenoid baseplate screw placement following primary reverse shoulder arthroplasty (RSA), a novel approach to diagnosis of nerve injury, and treatment.

Press fit fixation is becoming more popular in RSA to preserve, in theory, bone capital. Several studies report that bone resorption can be very high around humeral stems depending on their size, shape and mode of fixation. The aim of the current study is to mid-term follow-up clinical and radiological result of a press fit ovoid regular stem RSA in non acute trauma cases.

Materials and methods: We performed a retrospective monocentric study of patients continuously implanted with the Humeris® stem RSA for degenerative change of the shoulder. Nineteen shoulders, in eighteen patients (74.6 y.o (from 69 to 81)), were available at minimum five years follow-up.

Results: The mean final adjusted Constant score was 111.9 (65 to 130), and the mean ASES score was 49.82 (10 to 60). Humeral resorption was observed in 21% of cases. We found a statistically significant (p = .014) lower adjusted Constant score in patients presenting with resorption on post-operative X-rays compared to those without resorption (115.6 vs. 98.25). Half cases of patients presenting a resorption underwent L'Episcopo procedure during surgery. Humeral resorption occurs the first year after surgery and do not increase even 8 years after surgery. Analysis demonstrated no correlation between the value of filling ratios and bone resorption.

Conclusion: The current study confirms a low rate of stress shielding around the studied stem, with rare bony resorption and no osteopenia around the humeral stem. This study highlights the importance of choosing the appropriate proximal shape and length of the humeral stem for press fit fixation in RSA.

Introduction: Current understanding of the biomechanical effects of treatment options for irreparable rotator cuff (RC) tears is lacking. This study examines how shoulder muscle lengths and excursions are affected by superior capsular reconstruction (SCR), bursal acromial reconstruction (BAR), and SCR with BAR, following a complete supraspinatus tear.

Method: Six fresh-frozen cadaveric shoulders were examined. Deltoid and RC muscle lengths were measured at 0, 30, 45, 60, and 90° of shoulder abduction under six conditions: (1) intact, (2) partially torn supraspinatus, (3) completely torn supraspinatus, (4) SCR, (5) SCR with BAR, and (6) BAR. Muscle excursions from 0-90° of abduction were then calculated.

Results: Subscapularis muscle lengths after SCR, BAR, and SCR with BAR were significantly greater (post-hoc Tukey HSD test; p < .01) compared to the other conditions. Supraspinatus, infraspinatus, teres minor, and deltoid lengths were not significantly different (ANOVA test; p > .01) between the conditions. All muscle excursions remained statistically similar between the conditions (ANOVA test; p > .01).

Conclusion: These findings demonstrate that the use of SCR, BAR, or SCR with BAR for a complete supraspinatus tear, may increase subscapularis muscle length while maintaining other shoulder muscle lengths. An increase in subscapularis length can allow for more effective subscapularis muscle strengthening and increased compensatory function in the long term. Additionally, all shoulder muscle excursions are preserved after partial or complete supraspinatus tears and after SCR, BAR, or SCR with BAR. Therefore, these surgical treatments can initially normalize shoulder muscle function during 0-90° of abduction, after an irreparable supraspinatus tear.