Journal of shoulder and elbow arthroplasty最新文献

Background: Glenoid bone loss is commonly encountered in cases of rotator cuff tear arthropathy and can create challenges during reverse shoulder arthroplasty. In this study, we sought to investigate the biomechanical properties of a new treatment option for superior glenoid defect, an augmented reverse total shoulder baseplate.

Methods: Three conditions were examined: non-augmented baseplate without defect, non-augmented baseplate with defect, and augmented baseplate with defect. The augmented baseplates included a 30-degree half wedge which also matched the created superior defect. The samples were cyclically loaded at a 60^° simulated abduction angle to mimic baseplate loosening. The migration and micromotion of the baseplate were measured on the superior edge using a 3D Digital Image Correlation System.

Results: The migration measured in the augmented baseplate showed no significant difference when compared to the no defect or defect cases. In terms of micromotion, the augmented baseplate showed values that were between the micromotions reported for the no defect and defect conditions, but not by a statistically significant amount.

Conclusion: This study provides biomechanical evidence that augmented baseplates can reduce the amount of micromotion experienced by the RSA construct in the presence of significant superior glenoid bone deficiency, but do not fully restore stability to that of a full contact non-augmented baseplate.

Introduction: Reverse total shoulder arthroplasty (RTSA) procedures are becoming increasingly more common. While the main complications are known, the management of clavicle fractures in patients with an ipsilateral RTSA is not well described. There are three case studies that document clavicular stress fractures following RTSA with an atraumatic etiology, and to our knowledge, no studies have described a traumatic clavicular fracture following RTSA.

Case: We describe the case of a 75-year-old woman with a traumatic clavicle fracture five years after RTSA for rotator cuff tear arthropathy. With minimal pain and subjective symptoms initially, the patient wished to pursue non-operative treatment. However, she eventually developed a painful non-union and pseudoparalysis of the shoulder with serial radiographs demonstrating progressive superior scapular tilting and scapular notching. Subsequent open reduction internal fixation of her clavicle fracture significantly improved her pain and function.

Conclusion: We report a traumatic clavicle fracture in the setting of RTSA that not only failed to heal but also resulted in scapular notching and shoulder pseudoparalysis that was improved with surgical stabilization of the fracture. It is possible that the setting of a semi-constrained RTSA, the resulting biomechanical imbalance may predispose to impaired fracture healing and non-union of the clavicle fracture.

Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.

Objective: To verify whether reverse baseplate positioning without the support of intraoperative three-dimensional technology is within the acceptable parameters in the literature and whether glenoid bone deformity (GBD) compromises this positioning.

Methods: Sixty-nine reverse shoulder arthroplasties were evaluated with volumetric computed tomography (CT). Two radiologists performed blinded CT scan analysis and evaluated baseplate position within 2mm of the inferior glenoid; the inclination and version of the baseplate in relation to the Friedman line; and upper and lower screw and baseplate metallic peg end point positionings. The patients were divided according to the presence of GBD for statistical analyses.

Results: The two radiologists concurred reasonably in their interpretations of the following analyzed parameters: baseplate position within 2mm of the inferior glenoid rim (97.1% and 95.7%), baseplate inclination (82.6% and 81.2%), baseplate version (69.6% and 56.5%), the upper screw reaching the base of the coracoid process (71% and 79.7%), the inferior screw remaining inside the scapula (88.4% and 84.1%), and the metallic peg of the baseplate considered intraosseous (88.4% and 72.5%).

Conclusion: Reverse baseplate positioning without intraoperative three-dimensional technology is within the acceptable parameters of the literature, except for baseplate version and upper screw position. GBD did not interfere with baseplate positioning in reverse shoulder arthroplasty.

Background: Reverse total shoulder arthroplasty (rTSA) offers tremendous promise for the treatment of complex pathologies beyond the scope of anatomic total shoulder arthroplasty but is associated with a higher rate of major postoperative complications. We aimed to design and validate a machine learning (ML) model to predict major postoperative complications or readmission following rTSA.

Methods: We retrospectively reviewed California's Office of Statewide Health Planning and Development database for patients who underwent rTSA between 2015 and 2017. We implemented logistic regression (LR), extreme gradient boosting (XGBoost), gradient boosting machines, adaptive boosting, and random forest classifiers in Python and trained these models using 64 binary, continuous, and discrete variables to predict the occurrence of at least one major postoperative complication or readmission following primary rTSA. Models were validated using the standard metrics of area under the receiver operating characteristic (AUROC) curve, area under the precision-recall curve (AUPRC), and Brier scores. The key factors for the top-performing model were determined.

Results: Of 2799 rTSAs performed during the study period, 152 patients (5%) had at least 1 major postoperative complication or 30-day readmission. XGBoost had the highest AUROC and AUPRC of 0.681 and 0.129, respectively. The key predictive features in this model were patients with a history of implant complications, protein-calorie malnutrition, and a higher number of comorbidities.

Conclusion: Our study reports an ML model for the prediction of major complications or 30-day readmission following rTSA. XGBoost outperformed traditional LR models and also identified key predictive features of complications and readmission.

Background: Distal humerus fractures not amenable to open reduction internal fixation (ORIF) present a unique dilemma, especially for patients that weight bear through assistive devices. The one accepted operative treatment for irreparable distal humerus fractures is total elbow arthroplasty (TEA). However, TEA commonly requires lifetime weight lifting restrictions and has limited long term results. Elbow hemiarthroplasty (EHA) represents an alternative treatment modality. This study reviews patients treated with EHA permitted to weight bear postoperatively.

Methods: Twelve patients underwent EHA for comminuted distal humerus fractures deemed non-reconstructable by ORIF. Patient survey data was collected retrospectively. All patients were allowed to weight bear as tolerated through the operative extremity. Outcome measures included Patient rated elbow evaluation (PREE), Mayo elbow performance score (MEPS), and whether revision surgery was required.

Results: The average MEPS score was 76.1 indicating fair outcomes and the average PREE score was 41. One patient required revision. Average follow up was 44.1 months. Three patients required an assistive device prior to injury.

Discussion: EHA serves as a viable option for non-reconstructable distal humerus fractures. EHA does not require a weight lifting restriction, which is a benefit over TEA. Overall, patients reported preserved functional capabilities but did report moderate pain. EHA demonstrated durability, although one patient required revision.

Conclusion: With growing interest in use of EHA, further studies are required to evaluate EHA as a superior treatment for patients with nonreconstructable traumatic distal humerus fractures; however, this study does support use in elderly patients with intermediate follow up.

Total elbow arthroplasties (TEA) have become more prevalent as indications expand. However, TEA complications remain a treatment conundrum. One such complication, periprosthetic joint infections (PJIs) have been reported to occur in up to 12% of all TEA procedures. Irrigation and debridement with retention of hardware and antibiotic suppression has a high failure rate. Two stage revisions of TEA, while more morbid, is an effective approach with previous studies showing a 79% eradication rate. These cases are often associated with periprosthetic bone loss, adding to the surgical complexity. In our case report, we present the case of a 59 year old diabetic male with a primary TEA secondary to a distal humerus fracture who developed a deep infection and was successfully treated with explantation, cue ball antibiotic cement arthroplasty, and humeroradial revision. This case report will discuss the cue ball antibiotic spacer technique and humeroradial revision as a salvage procedure in TEA revisions in the setting of extensive ulnar bone loss.

Background: There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure.

Methods: A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan.

Results: Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA.

Conclusions: Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.