1
|
Liebhauser M, Hohenberger G, Lohberger B, Hauer G, Deluca A, Sadoghi P. Implant breakage after shoulder arthroplasty: a systematic review of data from worldwide arthroplasty registries and clinical trials. BMC Musculoskelet Disord 2023; 24:804. [PMID: 37821859 PMCID: PMC10565962 DOI: 10.1186/s12891-023-06922-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Implant breakage after shoulder arthroplasty is a rare complication after aseptic loosening, infection or persistent pain, resulting in malfunction of the components requiring revision surgery. This correlates with a high burden for the patient and increasing costs. Specific data of complication rates and implant breakage are available in detailed arthroplasty registries, but due to the rare occurrence and possibly underestimated value rarely described in published studies. The aim of this systematic review was to point out the frequency of implant breakage after shoulder arthroplasty. We hypothesized that worldwide arthroplasty registry datasets record higher rates of implant breakage than clinical trials. METHODS PubMed, MEDLINE, EMBASE, CINHAL, and the Cochrane Central Register of Controlled Trials database were utilized for this systematic review using the items "(implant fracture/complication/breakage) OR (glenoid/baseplate complication/breakage) AND (shoulder arthroplasty)" according to the PRISMA guidelines on July 3rd, 2023. Study selection, quality assessment, and data extraction were conducted according to the Cochrane standards. Case reports and experimental studies were excluded to reduce bias. The breakage rate per 100,000 observed component years was used to compare data from national arthroplasty registries and clinical trials, published in peer-reviewed journals. Relevant types of shoulder prosthetics were analyzed and differences in implant breakage were considered. RESULTS Data of 5 registries and 15 studies were included. Rates of implant breakage after shoulder arthroplasty were reported with 0.06-0.86% in registries versus 0.01-6.65% in clinical studies. The breakage rate per 100,000 observed component years was 10 in clinical studies and 9 in registries. There was a revision rate of 0.09% for registry data and 0.1% for clinical studies within a 10-year period. The most frequently affected component in connection with implant fracture was the glenoid insert. CONCLUSION Clinical studies revealed a similar incidence of implant failure compared to data of worldwide arthroplasty registries. These complications arise mainly due to breakage of screws and glenospheres and there seems to be a direct correlation to loosening. Periprosthetic joint infection might be associated with loosening of the prosthesis and subsequent material breakage. We believe that this analysis can help physicians to advise patients on potential risks after shoulder arthroplasty. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Martin Liebhauser
- Department of Traumatology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Gloria Hohenberger
- Department of Traumatology, State Hospital Feldbach, Fürstenfeld, Austria
| | - Birgit Lohberger
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Georg Hauer
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Amelie Deluca
- Department of Orthopedic Surgery, SKA Warmbad Villach, Villach, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria.
| |
Collapse
|
2
|
Schiffman CJ, Jurgensmeier K, Yao JJ, Wu JC, Whitson AJ, Jackins SE, Matsen FA, Hsu JE. Risk Factors for Stiffness Requiring Intervention After Ream-and-Run Arthroplasty. JB JS Open Access 2023; 8:e22.00104. [PMID: 37123506 PMCID: PMC10132725 DOI: 10.2106/jbjs.oa.22.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Ream-and-run arthroplasty can improve pain and function in patients with glenohumeral arthritis while avoiding the complications and activity restrictions associated with a prosthetic glenoid component. However, stiffness is a known complication after ream-and-run arthroplasty and can lead to repeat procedures such as a manipulation under anesthesia (MUA) or open surgical revision. The objective of this study was to determine risk factors associated with repeat procedures indicated for postoperative stiffness after ream-and-run arthroplasty. Methods We conducted a retrospective review of our shoulder arthroplasty database to identify patients who underwent ream-and-run arthroplasty and determined which patients underwent subsequent repeat procedures (MUA and/or open revision) indicated for postoperative stiffness. The minimum follow-up was 2 years. We collected baseline demographic information and preoperative and 2-year patient-reported outcome scores and analyzed preoperative radiographs. Univariate and multivariate analyses determined the factors significantly associated with repeat procedures to treat postoperative stiffness. Results There were 340 patients who underwent ream-and-run arthroplasty. The mean Simple Shoulder Test (SST) scores for all patients improved from 5.0 ± 2.4 preoperatively to 10.2 ± 2.6 postoperatively (p < 0.001). Twenty-six patients (7.6%) underwent open revision for stiffness. An additional 35 patients (10.3%) underwent MUA. Univariate analysis found younger age (p = 0.001), female sex (p = 0.034), lower American Society of Anesthesiologists (ASA) class (p = 0.045), posterior decentering on preoperative radiographs (p = 0.010), and less passive forward elevation at the time of discharge after ream-and-run arthroplasty (p < 0.001) to be significant risk factors for repeat procedures. Multivariate analysis found younger age (p = 0.040), ASA class 1 compared with class 3 (p = 0.020), and less passive forward elevation at discharge (p < 0.001) to be independent risk factors for repeat procedures. Of the patients who underwent open revision for stiffness, 69.2% had multiple positive cultures for Cutibacterium. Conclusions Younger age, ASA class 1 compared with class 3, and less passive forward elevation in the immediate postoperative period were independent risk factors for repeat procedures to treat postoperative stiffness after ream-and-run arthroplasty. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Corey J. Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
| | | | - Jie J. Yao
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
| | - John C. Wu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
| | - Anastasia J. Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
| | - Sarah E. Jackins
- Exercise Training Center, University of Washington, Seattle, Washington
| | - Frederick A. Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
| | - Jason E. Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
| |
Collapse
|
3
|
Levins J, Passarelli E, Adkins J, Molino J, Henry H, Paxton ES, Green A. Early outcome of humeral head replacement with glenoid reaming arthroplasty (Ream and Run) for treatment of advanced glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31:1846-1858. [PMID: 35276348 DOI: 10.1016/j.jse.2022.01.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Long-term outcomes of anatomic total shoulder arthroplasty (aTSA) can be compromised by glenoid loosening and failure. The purpose of this study was to evaluate the short- and midterm outcomes of humeral head replacement with glenoid reaming arthroplasty (Ream and Run) for the treatment of advanced glenohumeral osteoarthritis, and to identify associations between preoperative factors and outcomes. METHODS Forty-nine shoulders (mean age 60 ± 7 years) with minimum 2-year follow-up (mean 4.6 ± 1.7) were evaluated. Forty-three (87.8%) were male. Thirteen (26.5%) had previous nonarthroplasty shoulder surgery. There were 19 (38.8%) Walch type A and 30 (61.2%) type B glenoids. Pre- and postoperative shoulder motion, patient-reported outcomes (PROMs), and health-related quality of life (HRQoL) were assessed. Pre- and postoperative plain radiographs were evaluated. Mixed effects models were used to investigate factors associated with outcomes. RESULTS Active forward elevation and active external rotation improved from 111.7° ± 23.8° to 139.2° ± 21.1° and 13.3° ± 20.7° to 38.7° ± 14.7°, respectively (P < .001). The mean American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Simple Shoulder Test (SST), and visual analog scale (VAS) shoulder pain scores at the most recent follow-up were 86.6 ± 19.9, 10.1 ± 14.1, 10.5 ± 2.2, and 1.5 ± 2.3, respectively. The mean changes of PROMs were significant and exceeded the minimal clinically important difference for aTSA. The percentage maximal possible improvement for ASES, DASH, and SST were greater than 75%. Male sex (P < .008) and not having prior shoulder surgery (P < .04) were significantly associated with better absolute and greater change in PROMs. Age, preoperative shoulder motion, and Walch glenoid classification were not associated with PROMs. Five (10.2%, 95% confidence interval [CI] 1.8%-18.6%) patients underwent revision for pain. Three additional patients were dissatisfied at final follow-up without undergoing revision, resulting in 16.7% (95% CI 6.1%-27.2%) of patients being dissatisfied with their outcome after their initial RnR. Mean Short Form-6 Dimensions scores improved from 0.66 ± 0.12 to 0.77 ± 0.13 and mean EuroQol-5 Dimensions scores improved from 0.68 ± 0.20 to 0.85 ± 0.17 (P < .001). Improvement in HRQoL was significantly associated with nondominant arm treatment, increased age, and greater preoperative SST score. Annual medialization of the humeral head center of rotation was 0.56 ± 1.6 mm/yr. No radiographic measure was associated with long-term PROMs. CONCLUSION Ream and Run can provide significant and clinically important improvement in PROMs and HRQoL for a high percentage of patients at short- and midterm follow-up. This procedure is an appropriate alternative to aTSA in select patients.
Collapse
Affiliation(s)
- James Levins
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Emily Passarelli
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob Adkins
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Janine Molino
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - E Scott Paxton
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| |
Collapse
|
4
|
Matsen FA, Carofino BC, Green A, Hasan SS, Hsu JE, Lazarus MD, McElvany MD, Moskal MJ, Parsons IM, Saltzman MD, Warme WJ. Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty: The Ream-and-Run Procedure. JBJS Rev 2021; 9:01874474-202108000-00010. [PMID: 34432729 DOI: 10.2106/jbjs.rvw.20.00243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Glenoid component wear and loosening are the principal failure modes of anatomic total shoulder arthroplasty (aTSA). » The ream-and-run (RnR) procedure is an alternative glenohumeral arthroplasty for patients who wish to avoid the risks and limitations of a prosthetic glenoid component. » During the RnR procedure, the arthritic glenoid is conservatively reamed to a single concavity, while the prosthetic humeral component and soft tissues are balanced to provide both mobility and stability of the joint. » The success of the RnR procedure depends on careful patient selection, preoperative education and engagement, optimal surgical technique, targeted rehabilitation, and close postoperative communication between the surgeon and the patient. » While the RnR procedure allows high levels of shoulder function in most patients, the recovery can be longer and more arduous than with aTSA. » Patients who have undergone an RnR procedure occasionally require a second closed or open procedure to address refractory shoulder stiffness, infection, or persistent glenoid-sided pain. These second procedures are more common after the RnR than with aTSA.
Collapse
Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Andrew Green
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Mark D Lazarus
- Department of Orthopaedics, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Matthew D McElvany
- Department of Orthopaedics, The Permanente Medical Group, Santa Rosa, California
| | | | - I Moby Parsons
- The Knee, Hip and Shoulder Center, Portsmouth, New Hampshire
| | - Matthew D Saltzman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Winston J Warme
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
5
|
Arthroscopic management of glenohumeral arthritis in the young patient does not negatively impact the outcome of subsequent anatomic shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:2071-2079. [PMID: 34255098 DOI: 10.1007/s00264-021-05133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this study was to determine the impact of prior arthroscopic management of glenohumeral arthritis in the young patient on results of subsequent anatomic shoulder arthroplasty. METHODS Forty-three patients that had a total shoulder or ream-and-run arthroplasty with a history of arthroscopic management were matched to 86 patients without prior surgery. Each case was matched to two cases without prior arthroscopic surgery with similar age, sex, Walch classification, and type of arthroplasty. RESULTS Forty-three patients with a history of arthroscopic management were matched to 86 patients without prior surgery. The mean two year SST scores (10.3 vs. 9.9, p = 0.334), % MPI (75.4 vs. 73.0%, p = 0.687), two year SANE scores (79.6 vs. 79.8, p = 0.953), and % of patients to exceed SST score MCID (89 vs. 91%, p = 0.860) and SANE score MCID (86 vs. 75%, p = 0.180) were statistically similar in patients with prior arthroscopic debridement compared with those without prior arthroscopic debridement. The rate of MUA (9 vs. 6%, p = 0.480) and open revision (9 vs. 8%, p = 1.000) were statistically similar between groups. CONCLUSION Arthroscopic management of glenohumeral arthritis in patients aged 65 years and younger prior to anatomic shoulder arthroplasty was not associated with inferior outcomes for either total shoulder arthroplasty or ream-and-run arthroplasty.
Collapse
|
6
|
Hasan SS. Editorial Commentary: Superior Capsular Reconstruction Works Biomechanically but Should Be Used Selectively for Genuinely Irreparable Tears. Arthroscopy 2021; 37:411-414. [PMID: 33384096 DOI: 10.1016/j.arthro.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
Superior capsular reconstruction (SCR) has undergone extensive biomechanical and clinical study. Systematic review of biomechanical studies has shown that SCR functions to depress the humeral head and improve the glenohumeral register, which provides proof of concept. Clinical studies have shown the short-term effectiveness of SCR, but this is influenced by graft type and thickness, as well as surgical technique. These studies are mostly flawed because follow-up is brief, postoperative imaging is often lacking, and the results may not be generalizable. Multiple systematic reviews pooling the results of these various clinical studies have mostly produced diluted conclusions that are not clinically helpful. To date, there is a dearth of comparative studies to help guide the selection of SCR over other treatment options such as subacromial balloon spacer, partial repair with or without augmentation, tendon transfer, reverse shoulder arthroplasty, or even continued nonoperative care. Additionally, SCR is a salvage operation rather than an expedient alternative to careful mobilization of a rotator cuff tear for primary repair. Ultimately, large-scale, long-term imaging-based comparative clinical studies, rather than additional systematic clinical or biomechanical reviews, must provide the evidence needed to determine the precise indications and optimal technique for SCR.
Collapse
|
7
|
Wang KC, Jones A, Kambhampati S, Gilotra MN, Liacouras PC, Stuelke S, Shiu B, Leong N, Hasan SA, Siegel EL. CT-Based 3D Printing of the Glenoid Prior to Shoulder Arthroplasty: Bony Morphology and Model Evaluation. J Digit Imaging 2020; 32:816-826. [PMID: 30820811 DOI: 10.1007/s10278-019-00177-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
To demonstrate the 3D printed appearance of glenoid morphologies relevant to shoulder replacement surgery and to evaluate the benefits of printed models of the glenoid with regard to surgical planning. A retrospective review of patients referred for shoulder CT was performed, leading to a cohort of nine patients without arthroplasty hardware and exhibiting glenoid changes relevant to shoulder arthroplasty planning. Thin slice CT images were used to create both humerus-subtracted volume renderings of the glenoid, as well as 3D surface models of the glenoid, and 11 printed models were created. Volume renderings, surface models, and printed models were reviewed by a musculoskeletal radiologist for accuracy. Four fellowship-trained orthopaedic surgeons specializing in shoulder surgery reviewed each case individually as follows: First, the source CT images were reviewed, and a score for the clarity of the bony morphologies relevant to shoulder arthroplasty surgery was given. The volume rendering was reviewed, and the clarity was again scored. Finally, the printed model was reviewed, and the clarity again scored. Each printed model was also scored for morphologic complexity, expected usefulness of the printed model, and physical properties of the model. Mann-Whitney-Wilcoxon signed rank tests of the clarity scores were calculated, and the Spearman's ρ correlation coefficient between complexity and usefulness scores was computed. Printed models demonstrated a range of glenoid bony changes including osteophytes, glenoid bone loss, retroversion, and biconcavity. Surgeons rated the glenoid morphology as more clear after review of humerus-subtracted volume rendering, compared with review of the source CT images (p = 0.00903). Clarity was also better with 3D printed models compared to CT (p = 0.00903) and better with 3D printed models compared to humerus-subtracted volume rendering (p = 0. 00879). The expected usefulness of printed models demonstrated a positive correlation with morphologic complexity, with Spearman's ρ 0.73 (p = 0.0108). 3D printing of the glenoid based on pre-operative CT provides a physical representation of patient anatomy. Printed models enabled shoulder surgeons to appreciate glenoid bony morphology more clearly compared to review of CT images or humerus-subtracted volume renderings. These models were more useful as glenoid complexity increased.
Collapse
Affiliation(s)
- Kenneth C Wang
- Baltimore VA Medical Center, Baltimore, MD, USA. .,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA.
| | - Anja Jones
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Mohit N Gilotra
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Peter C Liacouras
- 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Radiology and Radiological Services & Naval Postgraduate Dental School, Uniform Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Brian Shiu
- Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Natalie Leong
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Eliot L Siegel
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
CORR Insights®: Do Massive Allograft Reconstructions for Tumors of the Femur and Tibia Survive 10 or More Years After Implantation? Clin Orthop Relat Res 2020; 478:525-526. [PMID: 31283734 PMCID: PMC7145089 DOI: 10.1097/corr.0000000000000856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
9
|
Abstract
The Walch B2 glenoid is characterized by a biconcave glenoid deformity, acquired glenoid retroversion, and posterior humeral head subluxation. Surgical reconstruction of the B2 glenoid remains a challenge. Surgical management options include arthroscopic debridement, hemiarthroplasty, anatomic total shoulder arthroplasty with eccentric reaming, bone grafting or augmented glenoid implants, and reverse total shoulder arthroplasty. Multiple factors dictate the optimal surgical management strategy.. This article describes each of these techniques and presents the current available literature in an effort to guide evidence-based decisions in the surgical management of the B2 glenoid deformity.
Collapse
Affiliation(s)
- Siddhant K Mehta
- Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA
| | - Alexander W Aleem
- Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA.
| |
Collapse
|
10
|
Garcia GH, Gowd AK, Liu JN, Malaret MR, Cabarcas BC, Romeo AA. Return to Sport Following Hemiarthroplasty With Concentric Reaming Versus Total Shoulder Arthroplasty: A Matched Pair Analysis. Orthopedics 2019; 42:276-284. [PMID: 31269217 DOI: 10.3928/01477447-20190627-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to establish functional outcomes regarding return to sport activity for patients receiving anatomical total shoulder arthroplasty (aTSA) vs the ream and run procedure (hemi RR). Patients who underwent hemi RR and who underwent aTSA with a polyethylene glenoid component for end-stage glenohumeral arthritis were retrospectively identified from 2000 to 2014. Patients were matched regarding age, body mass index, sex, and hand dominance. Patients were surveyed to determine their level of sport and satisfaction after surgery. At a mean follow-up of 69.1±24.8 months, a total of 26 hemi RR and 30 aTSA patients met inclusion/exclusion criteria. Mean±SD age at the time of surgery was 53.0±8.5 years. There was no statistical difference between the two cohorts regarding patients who reported no postoperative problems (69.2% vs 76.7%, P=.529), reoperation (11.5% vs 6.7%, P=.522), return to overall sport (94.4% vs 86.4%, P=.395), return to high-demand upper-extremity sport (92.3% vs 81.3%, P=.390), and return to same or better level of intensity sport (83.3% vs 72.7%, P=.424). Patients returned to sport at a mean of 7.5±5.7 months and 6.2±3.6 months in the hemi RR and aTSA cohorts, respectively (P=.485). Radiographic measurements of medialization (mean, -2.4±5.0 vs -2.2±5.7; P=.913) and postoperative decentering (mean, 3.6%±2.6% vs 4.3%±3.3%; P=.795) were equivalent for the two cohorts. Hemi RR was found to have high and equivalent rates of sporting outcomes, clinical outcomes, and radiographic outcomes compared with aTSA. As appropriately indicated patients are counseled for surgery, realistic expectations regarding sports should be discussed. [Orthopedics. 2019; 42(5):276-284.].
Collapse
|
11
|
Matsen FA, Whitson A, Jackins SE, Neradilek MB, Warme WJ, Hsu JE. Ream and run and total shoulder: patient and shoulder characteristics in five hundred forty-four concurrent cases. INTERNATIONAL ORTHOPAEDICS 2019; 43:2105-2115. [DOI: 10.1007/s00264-019-04352-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 01/28/2023]
|
12
|
Gowd AK, Garcia GH, Liu JN, Malaret MR, Cabarcas BC, Romeo AA. Comparative analysis of work-related outcomes in hemiarthroplasty with concentric glenoid reaming and total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:244-251. [PMID: 30269934 DOI: 10.1016/j.jse.2018.07.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomic total shoulder arthroplasty (aTSA) has demonstrated high levels of return to work, although there are fears of glenoid component loosening with higher work demand. METHODS A retrospective query was performed of all patients who received hemiarthroplasty with ream-and-run resurfacing (Hemi RR) between 2005 and 2014. Included patients were matched to an aTSA cohort by age, body mass index, sex, and hand dominance. Preoperative and postoperative work status, by level of duty and occupation, was collected. RESULTS Twenty-five patients receiving Hemi RR and 28 patients receiving TSA completed this questionnaire (82.8% compliance). Mean follow-up was 69.1 ± 24.8 months. In total, 100% of Hemi RR patients returned to work, and 89.3% of TSA patients returned to work (P = .091). The Hemi RR patients had higher rates of return to work for heavy-duty workers only (7 of 7 vs. 2 of 4, P = .038), although only 1 patient in the TSA group reported failure to work was due to shoulder reasons. Mean duration of return to work was 2.5 ± 4.8 months for patients receiving Hemi RR and 1.98 ± 2.6 months for those receiving TSA (P = .653). CONCLUSIONS Hemi RR had a high return to heavy-duty work, likely due to fewer surgeon-imposed restrictions. The results of this study may help manage return to work expectations after Hemi RR according to the level of duty and suggest Hemi RR is a viable option for heavy-duty laborers with end-stage glenohumeral arthritis.
Collapse
Affiliation(s)
- Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant H Garcia
- Division of Sports Medicine, Department of Orthopedic Surgery, Seattle Orthopedic Center, Seattle, WA, USA
| | - Joseph N Liu
- Division of Sports Medicine, Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Marissa R Malaret
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brandon C Cabarcas
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, The Rothman Institute, New York, NY, USA.
| |
Collapse
|
13
|
Virk MS, Thorsness RJ, Griffin JW, Kim J, Aiyash S, Malaret M, Romeo AA. Short-term Clinical Outcomes of Hemiarthroplasty With Concentric Glenoid Reaming: The Ream and Run Procedure. Orthopedics 2018; 41:e854-e860. [PMID: 30371927 DOI: 10.3928/01477447-20181023-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 06/29/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the short-term clinical and radiographic outcomes of humeral hemiarthroplasty and concentric glenoid reaming ("ream and run" procedure) and to compare the outcomes with those of total shoulder arthroplasty (TSA) for glenohumeral arthritis. Patients with glenohumeral arthritis who underwent the ream and run procedure with a minimum follow-up of 2 years were retrospectively reviewed. The primary outcome was revision to TSA. Secondary outcome measures included functional outcome scores, range of motion, and radiographic assessment. The outcome measures were compared with those of age- and sex-matched control patients who underwent anatomic TSA during the study period. One patient in the ream and run group required revision to TSA 14 months after the surgery because of excessive shoulder pain. There were significant improvements in the postoperative outcome scores and range of motion and external rotation in the ream and run group. Postoperative radiographs showed concentric glenoids without posterior subluxation in all except 1 shoulder. The outcome measures in the ream and run group were similar to those in the TSA control group except for active forward elevation and external rotation. The ream and run procedure provides improved pain relief and shoulder function at short-term follow-up for patients with shoulder arthritis. [Orthopedics. 2018; 41(6):e854-e860.].
Collapse
|
14
|
Affiliation(s)
- Frederick A Matsen
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA.
| |
Collapse
|
15
|
Survivorship of Hemiarthroplasty With Concentric Glenoid Reaming for Glenohumeral Arthritis in Young, Active Patients With a Biconcave Glenoid. J Am Acad Orthop Surg 2018; 26:e164-e166. [PMID: 29461306 DOI: 10.5435/jaaos-d-17-00788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
16
|
Somerson JS, Neradilek MB, Service BC, Hsu JE, Russ SM, Matsen FA. Clinical and Radiographic Outcomes of the Ream-and-Run Procedure for Primary Glenohumeral Arthritis. J Bone Joint Surg Am 2017; 99:1291-1304. [PMID: 28763415 DOI: 10.2106/jbjs.16.01201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ream-and-run procedure can provide improvement in shoulder function and comfort for selected patients with primary glenohumeral arthritis who wish to avoid a prosthetic glenoid component. The purpose of this study was to evaluate factors associated with medialization of the humeral head after this procedure as well as the relationship of medialization to the clinical outcome. METHODS We collected patient, shoulder, and procedure characteristics along with Simple Shoulder Test (SST) scores before surgery and at the time of follow-up. Medialization was determined by comparing the position of the humeral head prosthesis in relation to the scapula on postoperative baseline radiographs made within 6 weeks after surgery with that on comparable follow-up radiographs made ≥18 months after surgery. RESULTS Two-year clinical outcomes were available for 101 patients (95% were male). Comparable radiographs at postoperative baseline and follow-up evaluations were available for 50 shoulders. For all patients, the mean SST score (and standard deviation) increased from 4.9 ± 2.8 preoperatively to 10.3 ± 2.4 at the latest follow-up (p < 0.001). Significant clinical improvement was observed for glenoid types A2 and B2. Shoulders with a type-A2 glenoid morphology, with larger preoperative scapular body-glenoid angles, and with lower preoperative SST scores, were associated with the greatest clinical improvement. Clinical outcome was not significantly associated with the amount of medialization. CONCLUSIONS The ream-and-run procedure can be an effective treatment for advanced primary glenohumeral osteoarthritis in active patients. Further study will be necessary to determine whether medialization affects the clinical outcome with follow-up of >2 years. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jeremy S Somerson
- 1The University of Texas Medical Branch, Galveston, Texas 2The Mountain-Whisper-Light Statistics, Seattle, Washington 3Orthopaedic Surgery and Sports Medicine, Orlando Health, Orlando, Florida 4Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | | | | | | | | |
Collapse
|
17
|
Hasan SS. Revisiting the Socket: Commentary on an article by Jeremy S. Somerson, MD, et al.: "Clinical and Radiographic Outcomes of the Ream-and-Run Procedure for Primary Glenohumeral Arthritis". J Bone Joint Surg Am 2017; 99:e85. [PMID: 28763423 DOI: 10.2106/jbjs.17.00496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Samer S Hasan
- Mercy Health/Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio
| |
Collapse
|
18
|
Glenohumeral osteoarthritis and the young patient: current options for treatment. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Matsen FA, Russ SM, Vu PT, Hsu JE, Lucas RM, Comstock BA. What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties. Clin Orthop Relat Res 2016; 474:2496-2510. [PMID: 27457623 PMCID: PMC5052198 DOI: 10.1007/s11999-016-4990-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/13/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. QUESTIONS/PURPOSES We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? METHODS Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a "better" outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. RESULTS After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p < 0.001), lower baseline Simple Shoulder Test score (OR, 1.32; 95% CI, 1.23-1.42; p < 0.001), no prior shoulder surgery (OR, 1.79; 95% CI, 1.18-2.70; p = 0.006), humeral head not superiorly displaced on the AP radiograph (OR, 2.14; 95% CI, 1.15-4.02; p = 0.017), and glenoid type other than A1 (OR, 4.47; 95% CI, 2.24-8.94; p < 0.001). Neither preoperative glenoid version nor posterior decentering of the humeral head on the glenoid were associated with the outcomes. The model predictive of a better result was driven mainly by the six factors listed above. The area under the receiver operating characteristic curve generated from the cross-validated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as a better outcome). A cutoff probability of 0.68 yielded the best performance of the model with cross-validation predictions of better outcomes for 236 patients (80%) and worse outcomes for 58 patients (20%); sensitivity of 91% (95% CI, 88%-95%); specificity of 65% (95% CI, 53%-77%); positive predictive value of 92% (95% CI, 88%-95%); and negative predictive value of 64% (95% CI, 51%-76%). CONCLUSIONS We found six easy-to-determine preoperative patient and shoulder factors that were significantly associated with better outcomes of shoulder arthroplasty. A model based on these characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty. Future research could refine this model with larger patient populations from multiple practices. LEVEL OF EVIDENCE Level II, therapeutic study.
Collapse
Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
- Shoulder and Elbow Surgery, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Stacy M Russ
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Phuong T Vu
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Robert M Lucas
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| |
Collapse
|
20
|
Merolla G, Ciaramella G, Fabbri E, Walch G, Paladini P, Porcellini G. Total shoulder replacement using a bone ingrowth central peg polyethylene glenoid component: a prospective clinical and computed tomography study with short- to mid-term follow-up. INTERNATIONAL ORTHOPAEDICS 2016; 40:2355-2363. [PMID: 27506572 DOI: 10.1007/s00264-016-3255-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC). METHODS Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45-75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24-39). Early and late follow-up CT scans were available for 21/30 shoulders. RESULTS Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p < 0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p < 0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p < 0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05). DISCUSSION The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth. CONCLUSIONS The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.
Collapse
Affiliation(s)
- Giovanni Merolla
- Shoulder and Elbow Unit, D. Cervesi Hospital, Via L.V. Beethoven 5, Cattolica (RN), 47841, Italy.
| | - Giovanni Ciaramella
- Shoulder and Elbow Unit, D. Cervesi Hospital, Via L.V. Beethoven 5, Cattolica (RN), 47841, Italy
| | - Elisabetta Fabbri
- Research and Innovation Department, AUSL della Romagna, Rimini, Italy
| | | | - Paolo Paladini
- Shoulder and Elbow Unit, D. Cervesi Hospital, Via L.V. Beethoven 5, Cattolica (RN), 47841, Italy
| | - Giuseppe Porcellini
- Shoulder and Elbow Unit, D. Cervesi Hospital, Via L.V. Beethoven 5, Cattolica (RN), 47841, Italy
| |
Collapse
|
21
|
Piponov HI, Savin D, Shah N, Esposito D, Schwartz B, Moretti V, Goldberg B. Glenoid version and size: does gender, ethnicity, or body size play a role? INTERNATIONAL ORTHOPAEDICS 2016; 40:2347-2353. [DOI: 10.1007/s00264-016-3201-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/11/2016] [Indexed: 11/25/2022]
|
22
|
Abstract
The number of shoulder arthroplasty procedures has increased dramatically in recent years, with the primary indication being osteoarthritis (OA). Thus, morphology and subchondral bone changes associated with OA may be important factors to consider when choosing a replacement component. For surgical treatment, many implant options exist and survivability is often dependent on patient age, activity level, and progression of OA. In the placement of these replacement components, patient-specific guides now exist to improve component positioning, with the goal to improve long-term survivability by ensuring that intra-operative placement meets component design.
Collapse
Affiliation(s)
- Nikolas K Knowles
- The University of Western Ontario, London, ON, Canada.
- Roth McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Joseph's Health Care, London, ON, Canada.
- Collaborative Training Program in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.
| | - Louis M Ferreira
- The University of Western Ontario, London, ON, Canada.
- Roth McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Joseph's Health Care, London, ON, Canada.
- Collaborative Training Program in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.
| | - George S Athwal
- The University of Western Ontario, London, ON, Canada.
- Roth McFarlane Hand and Upper Limb Centre, Surgical Mechatronics Laboratory, St. Joseph's Health Care, London, ON, Canada.
- Collaborative Training Program in Musculoskeletal Health Research and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.
| |
Collapse
|
23
|
Matis N, Ortmaier R, Moroder P, Resch H, Auffarth A. [Posttraumatic arthrosis of the glenohumeral joint. From partial resurfacing to reverse shoulder arthroplasty]. Unfallchirurg 2015; 118:592-600. [PMID: 26013392 DOI: 10.1007/s00113-015-0021-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Arthroplasty of symptomatic sequelae after fractures of the proximal humerus is a demanding procedure for surgeons. Exact preoperative planning is crucial in order to achieve acceptable functional results. OBJECTIVE Discussion of preoperative considerations in planning the procedure and choosing the appropriate implant taking the osseous anatomy and surrounding soft tissue situation into consideration. METHODS Selective literature review and description of personal experience. RESULTS The geometry and consolidation status of bone fragments as well as the conditions of the surrounding soft tissue have to be taken into account and influence the choice of implant used. Insufficient planning will not only cause intraoperative technical problems but can also greatly influence the subjective patient assessment of the postoperative outcome. Unequal strain distribution can cause early loosening of components resulting in malfunctioning of the implant. In this respect, knowledge of the position and consolidation status of fractured tuberosities with respect to the humeral shaft is essential and allows an approximate estimation of the achievable outcome. This is taken into account by the classification of Boileau which can also help to decide on which type of implant to use. Because such cases are scarce, reported results in the literature are heterogeneous, which is discussed in this article. CONCLUSION Each case needs a thorough and individualized preoperative assessment along with exact planning and should therefore be reserved for experienced shoulder surgeons only.
Collapse
Affiliation(s)
- N Matis
- Univ. Klink für Unfallchirurgie und Sporttraumatologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich,
| | | | | | | | | |
Collapse
|