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Zhang J, Tang X, Zhang Q, Wang X, Guo Z, He Y. Mid-Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis. Orthop Surg 2023; 15:2116-2123. [PMID: 37232062 PMCID: PMC10432454 DOI: 10.1111/os.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE The effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid-term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy. METHODS This retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at each follow-up time. Ultimately, magnetic resonance imaging (MRI) and X-ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two-way repeated-measures ANOVA or generalized estimation equations. RESULTS A total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow-up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow-up scores were better than preoperative scores (p < 0.05) but worse than those of the 6-month postoperative follow-up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6-month postoperative follow-up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow-up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow-up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05). CONCLUSION ARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.
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Affiliation(s)
- Jie‐chao Zhang
- Department of Orthopaedic SurgeryGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xiao‐ye Tang
- Department of Orthopaedic SurgeryGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Qian Zhang
- Department of Orthopaedic SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiChina
| | - Xue‐peng Wang
- Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Zi‐cheng Guo
- Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yong He
- Department of Orthopaedic SurgeryGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
- Institute of Arthritis Research in Integrative MedicineShanghai Academy of Traditional Chinese MedicineShanghaiChina
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Ajdari N, Tempelaere C, Masouleh MI, Abel R, Delfosse D, Emery R, Dini D, Hansen U. Hemiarthroplasties: the choice of prosthetic material causes different levels of damage in the articular cartilage. J Shoulder Elbow Surg 2020; 29:1019-1029. [PMID: 31948834 DOI: 10.1016/j.jse.2019.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemiarthroplasty has clear advantages over alternative procedures and is used in 20% of all shoulder joint replacements. Because of cartilage wear, the clinical outcome of hemiarthroplasty is unreliable and controversial. This paper suggests that the optimal choice of prosthetic material may reduce cartilage degeneration and improve the reliability of the procedure. The specific objectives were to assess 3 materials and assess how the severity of arthritis might affect the choice of prosthetic material. METHODS A CoCr alloy, an AL2O3 ceramic, and a polycarbonate urethane polymer (PCU) were mechanically tested against 5 levels of human osteoarthritic cartilage (from intact to severely arthritic, n = 45). A high friction coefficient, a decrease in Young's modulus, an increase in permeability, a decrease in relaxation time, an increase in surface roughness, and a disrupted appearance of the cartilage after testing were used as measures of cartilage damage. The biomaterial that caused minimal cartilage damage was defined as superior. RESULTS The CoCr caused the most damage. This was followed by the AL2O3 ceramic, whereas the PCU caused the least amount of damage. Although the degree of arthritis had an effect on the results, it did not change the trend that CoCr performed worst and PCU the best. DISCUSSION AND CONCLUSION This study indicates that ceramic implants may be a better choice than metals, and the articulating surface should be as smooth as possible. Although our results indicate that the degree of arthritis should not affect the choice of prosthetic material, this suggestion needs to be further investigated.
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Affiliation(s)
- Niloofar Ajdari
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Christine Tempelaere
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK; Department of Orthopaedic Surgery, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Maryam Imani Masouleh
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Richard Abel
- Department of Surgery and Cancer, Charing Cross Campus, London, UK
| | | | - Roger Emery
- Department of Surgery and Cancer, St. Mary's Hospital, London, UK
| | - Daniele Dini
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Ulrich Hansen
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK.
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Postacchini R, Carbone S, Canero G, Ripani M, Postacchini F. Reverse shoulder prosthesis in patients with rheumatoid arthritis: a systematic review. INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2916-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Oungoulian SR, Durney KM, Jones BK, Ahmad CS, Hung CT, Ateshian GA. Wear and damage of articular cartilage with friction against orthopedic implant materials. J Biomech 2015; 48:1957-64. [PMID: 25912663 DOI: 10.1016/j.jbiomech.2015.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/31/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to measure the wear response of immature bovine articular cartilage tested against glass or alloys used in hemiarthroplasties. Two cobalt chromium alloys and a stainless steel alloy were selected for these investigations. The surface roughness of one of the cobalt chromium alloys was also varied within the range considered acceptable by regulatory agencies. Cartilage disks were tested in a configuration that promoted loss of interstitial fluid pressurization to accelerate conditions believed to occur in hemiarthroplasties. Results showed that considerably more damage occurred in cartilage samples tested against stainless steel (10 nm roughness) and low carbon cobalt chromium alloy (27 nm roughness) compared to glass (10 nm) and smoother low or high carbon cobalt chromium (10 nm). The two materials producing the greatest damage also exhibited higher equilibrium friction coefficients. Cartilage damage occurred primarily in the form of delamination at the interface between the superficial tangential zone and the transitional middle zone, with much less evidence of abrasive wear at the articular surface. These results suggest that cartilage damage from frictional loading occurs as a result of subsurface fatigue failure leading to the delamination. Surface chemistry and surface roughness of implant materials can have a significant influence on tissue damage, even when using materials and roughness values that satisfy regulatory requirements.
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Affiliation(s)
- Sevan R Oungoulian
- Departments of Mechanical Engineering, Biomedical Engineering, and Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Krista M Durney
- Departments of Mechanical Engineering, Biomedical Engineering, and Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Brian K Jones
- Departments of Mechanical Engineering, Biomedical Engineering, and Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Christopher S Ahmad
- Departments of Mechanical Engineering, Biomedical Engineering, and Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Clark T Hung
- Departments of Mechanical Engineering, Biomedical Engineering, and Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Gerard A Ateshian
- Departments of Mechanical Engineering, Biomedical Engineering, and Orthopaedic Surgery, Columbia University, New York, NY, USA.
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Geervliet PC, Somford MP, Winia P, van den Bekerom MPJ. Long-term results of shoulder hemiarthroplasty in patients with rheumatoid arthritis. Orthopedics 2015; 38:e38-42. [PMID: 25611418 DOI: 10.3928/01477447-20150105-58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/10/2014] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis affecting the shoulder is typically associated with destruction of the glenohumeral joint and rotator cuff impairment, which can result in severe glenoid erosion. Following hemiarthroplasty, severe glenoid erosion has also frequently been observed. The authors' aim was to retrospectively evaluate the outcome of cemented shoulder hemiarthroplasty in patients with rheumatoid arthritis. The authors performed 45 cemented hemiarthroplasties in 36 patients with rheumatoid arthritis involving the shoulder as well as associated rotator cuff compromise between 1995 and 2008. All patients were analyzed radiologically and clinically using patient-reported outcome measures. Mean±SD visual analog pain scale score was 3±2. Mean±SD Constant score was 55±16. Mean±SD validated Dutch version of the Disabilities of the Arm Shoulder and Hand (DASH) score was 42±19. No radiograph showed loosening of the implant at follow-up. One patient needed an arthrotomy and capsulotomy because of persistent pain and limited range of motion. Tissue cultures taken during this second operation were negative for infection. No major revision surgery was necessary within the follow-up period. Cemented hemiarthroplasty is a viable treatment option for glenohumeral arthritis in patients with rheumatoid arthritis. Long-term results show acceptable results and low complication rates in this case series for this specific group. A randomized, controlled trial comparing hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty is necessary to draw definite conclusions in this specific patient population.
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Berth A, Pap G, Lohmann C. Indikationsspezifische mittelfristige Ergebnisse der anatomischen Kurzschaft-Schulterprothese. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s11678-012-0162-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2011; 20:146-57. [PMID: 21134666 DOI: 10.1016/j.jse.2010.08.001] [Citation(s) in RCA: 546] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 07/28/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Matthias A Zumstein
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet II, University of Nice Sophia-Antipolis, Nice, France
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Hambright D, Henderson RA, Cook C, Worrell T, Moorman CT, Bolognesi MP. A comparison of perioperative outcomes in patients with and without rheumatoid arthritis after receiving a total shoulder replacement arthroplasty. J Shoulder Elbow Surg 2011; 20:77-85. [PMID: 20655764 DOI: 10.1016/j.jse.2010.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 03/18/2010] [Accepted: 03/20/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The long-term survival rate of total shoulder arthroplasty (TSA) is comparable to hip and knee arthroplasty. Although TSA is considered a safe and effective procedure with low complications in patients with osteoarthritis and rheumatoid arthritis (RA), data are lacking on perioperative complications. Complication rates and hospital disposition differences between patients with and without RA who underwent TSA were investigated. We hypothesized that RA patients would have poorer perioperative outcomes after TSA. MATERIALS AND METHODS Data from the Nationwide Inpatient Sample was used to capture 25,398 patients between 1988 and 2005 who underwent TSA. Of these, 1,186 patients had a primary diagnosis of RA and were compared with 24,212 patients without RA. Analyses addressed perioperative complications and hospital disposition factors using bivariate and logistic regression models. RESULTS Overall complication rates were exceptionally low in both groups. Hospital disposition factors were significantly different between the 2 groups. The RA cohort had shorter average lengths of stay, higher likelihood of routine discharge, and lower inflation-adjusted cost before and after adjustment for covariates. DISCUSSION The occurrence of complications in the perioperative setting was less than 1% for both study groups in most variables investigated, and there were only minimal differences in perioperative complications between the groups. The significant differences in hospital disposition factors suggest that patients with RA may have less complex hospital stays and may be more comfortable being discharged under their own care. Recent studies describing the overall improvement in the management of patients with RA may also help explain these findings. CONCLUSIONS The findings suggest that the perioperative complications of a total shoulder replacement for patients with and without RA are similar. Contrary to our expectations, TSA patients with RA had shorter and less costly hospital stays and were more likely to have routine discharge. Complications are likely more long-term in nature than detected in this study and require longer follow-up beyond perioperative periods for fruition.
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Affiliation(s)
- Dustin Hambright
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Irlenbusch U, Forke L, Fuhrmann U, Gebhardt K, Rott O. Zur Differenzialindikation anatomischer und inverser Schulterendoprothesen bei chronischer Polyarthritis. Z Rheumatol 2009; 69:240-9. [DOI: 10.1007/s00393-009-0441-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Surgical treatment of patients with rheumatoid arthritis of the shoulder should be one part of a concept of conservative and surgical treatment. In addition to disease-modifying agents, local minimally invasive surgery can avoid structural damage to the shoulder and furthermore achieve a restitution of shoulder function. According to Larsen Stage 0-III, an arthroscopic synovectomy and bursectomy can achieve a good prognosis and help to avoid further structural damage to the rheumatoid shoulder. Minimally invasive procedures in the surgery of the rheumatoid shoulder lead to less immobilisation and faster rehabilitation, to the benefit of the joints in the operated limb, much like therapy of the knee. It is also possible to treat associated pathologies with minimally invasive surgery, such as bursitis, small rotator cuff defects, and synovitis of the acromioclavicular joint, as well as synovectomy of the glenohumeral joint Good results can be achieved in these cases using minimally invasive surgery. However, minimally invasive reconstructive procedures are limited in the rheumatoid shoulder.
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