1
|
Testa EJ, van der List JP, Waterman BR, Caldwell PE, Parada SA, Owens BD. Management of Bone Loss in Posterior Glenohumeral Shoulder Instability: Current Concepts. JBJS Rev 2024; 12:01874474-202404000-00005. [PMID: 38619382 DOI: 10.2106/jbjs.rvw.23.00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
» Posterior glenohumeral instability is relatively uncommon compared with anterior instability, but is becoming an increasingly recognized and surgically managed shoulder pathology.» Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head.» For posterior glenoid defects, posterior glenoid osteoarticular augmentation can be used, and posterior glenoid opening wedge osteotomy can be considered in cases of posterior instability with pathologic retroversion.» For humeral head lesions, several surgical treatment options are available including subscapularis transposition into the humeral head defect, autograft or allograft reconstruction, humeral rotation osteotomy, and shoulder arthroplasty.
Collapse
Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Paul E Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia
- Tuckahoe Orthopaedic Associates, Richmond, Virginia
| | - Stephen A Parada
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| |
Collapse
|
2
|
Haritinian EG, Stoica IC, Popescu R, Gheorghievici GL, Nové-Josserand L. Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series. BMC Musculoskelet Disord 2023; 24:82. [PMID: 36721138 PMCID: PMC9887796 DOI: 10.1186/s12891-023-06200-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified). METHODS This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables. RESULTS Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant -Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis. CONCLUSIONS In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.
Collapse
Affiliation(s)
- Emil George Haritinian
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Ioan Cristian Stoica
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Roman Popescu
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania
| | - Gavril Lucian Gheorghievici
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Laurent Nové-Josserand
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| |
Collapse
|
3
|
Saeed AZ, Pandit N, Jordan RW, Laprus H, D'Alessandro P, Lo IKY, Malik SS. Open and arthroscopic posterior bone block with iliac crest autograft for posterior shoulder instability - systematic review of clinical and radiological outcomes. Orthop Traumatol Surg Res 2022; 109:103424. [PMID: 36182090 DOI: 10.1016/j.otsr.2022.103424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/17/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Posterior shoulder instability (PSI) is a rare and challenging pathology to manage. The aim of this review was to assess and compare whether open and arthroscopic iliac crest bone graft (ICBG) bone block procedures succeeded in improving functional and clinical outcomes as well as radiological outcomes of union and graft resorption. HYPOTHESIS We hypothesised that there will be no difference in recurrence rate and functional outcome between open and arthroscopic procedures but there will be a higher complication rate with open bone block procedures. METHODS A systematic review was conducted in accordance with PRISMA guidelines using the online databases MEDLINE and Embase. The review was registered on the PROSPERO database. Studies of open or arthroscopic ICBG bone block procedures reporting patient reported outcome measures, recurrence, complications and progression to osteoarthritis and radiological outcomes of graft union and resorption were selected. Studies were appraised using the Methodical index for non-randomised studies (MINORS) tool. RESULTS 14 studies satisfied the inclusion criteria; five studies were arthroscopic and nine used open techniques. A total of 183 patients and 201 shoulders were included, mean age was 25 years range (14-75 years). Recurrent instability ranged from 0% to 12.5% for arthroscopic and 0% to 36.4% for open studies. Arthroscopic studies had statistically significant increases in numerous functional outcome scores but there was no evidence for similar improvements in open studies. Osteoarthritis at follow-up ranged from 12.5% to 47% in arthroscopic and 0% to 81.8% for open studies. Arthroscopic complication rate ranged from 6.7% to 75% compared to 0% to 80% for open studies. Majority of complications were metalware related requiring surgical intervention. Partial graft resorption ranged from 7.7-100% after arthroscopic and 4.8-100% after open procedures. High union rates were seen with both open and arthroscopic techniques. CONCLUSION This study highlights a lack of high-level evidence for arthroscopic and open posterior bone block procedures using ICBG to manage PSI. Functional and instability outcome scores showed significant improvement with arthroscopic ICBG bone block procedures however limited evidence was available for open studies. Metalwork related complications requiring revision and radiographic progression to osteoarthritis was high in both arthroscopic and open studies. LEVEL OF EVIDENCE IV, systematic review.
Collapse
Affiliation(s)
- Abu Z Saeed
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK.
| | - Nikhil Pandit
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, B15 2TH Birmingham, UK
| | - Hubert Laprus
- Saint-Luke's Hospital, Bystrzańska 94B, 43-309 Bielsko-Biała, Poland
| | - Peter D'Alessandro
- Orthopaedic Research Foundation of Western Australia, 25, Queenslea Drive, WA 6010 Claremont, Australia
| | - Ian K Y Lo
- University of Calgary, 2500, University Drive Northwest, AB T2N 1N4 Calgary, Canada
| | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK
| |
Collapse
|
4
|
Woodard DR, Hutton JD, Phipatanakul WP, Syed HM. Whole humeral head osteochondral allograft with glenoid bone block augmentation after chronic locked bilateral anterior shoulder dislocations in an adolescent patient: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:384-390. [PMID: 37588871 PMCID: PMC10426693 DOI: 10.1016/j.xrrt.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- David R. Woodard
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Wesley P. Phipatanakul
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Hasan M. Syed
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|
5
|
Bone Block Augmentation of the Posterior Glenoid for Recurrent Posterior Shoulder Instability Is Associated With High Rates of Clinical Failure: A Systematic Review. Arthroscopy 2022; 38:551-563.e5. [PMID: 34332053 DOI: 10.1016/j.arthro.2021.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether posterior glenoid bone block augmentation performed for the treatment of recurrent posterior shoulder instability succeeds in restoring stability and is associated with rates of complications or clinical failures comparable to other glenoid bone augmentation procedures. METHODS A comprehensive search of PubMed, MEDLINE, and EMBASE databases was performed. Level of evidence studies I to IV pertaining to posterior bone block augmentation reporting on outcomes or complications were included. The search was carried out in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Screening of titles, abstracts, and manuscripts with application of inclusion and exclusion criteria yielded 17 full-text articles reporting on 269 shoulders undergoing bone block augmentation. Surgical technique varied between studies with regard to graft type (iliac crest, 13 studies; scapular spine, 2; acromion, 1; distal tibia allograft, 1), graft positioning (medial to 1.5 cm lateral to glenoid surface, equatorial to subequatorial), and open versus arthroscopic technique (open, 10 studies; arthroscopic, 4; both, 3). Four of the 8 studies with pre- and postoperative patient-reported outcomes (PROs) showed significant improvements in these outcomes at final follow-up. The postoperative outcomes ranged from 60 to 90 for Rowe scores (n = 7 studies) and 79 to 90 for Walch-Duplay scores (n = 7 studies). Complications were commonly encountered, with high rates of recurrent instability (0% to 73%) and revision procedures (0% to 67%) across different studies. CONCLUSION Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in PROs, and complications are frequently observed. The substantial heterogeneity across studies and the small number of patients precludes any substantive judgements as to the superiority of one surgical technique over another. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
Collapse
|
6
|
Sahu D, Rathod V, Phadnis A, Shyam A. Results and complications of head-preserving techniques in chronic neglected shoulder dislocation: a systematic review. J Shoulder Elbow Surg 2021; 30:685-694. [PMID: 33197594 DOI: 10.1016/j.jse.2020.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral head-preserving procedures may be needed for chronic neglected shoulder dislocation because the presenting age of the patient is often reported to be less than 45 years. The aim of this systematic review was to evaluate the results of the various head-preserving procedures for chronic anterior dislocation (CAD) and chronic posterior dislocation (CPD). This review also aimed to evaluate the results of conservative neglect for CAD. METHODS PubMed, Embase, and Cochrane library databases were queried for studies that reported on results of head-preserving procedures for CAD or CPD and for studies that reported on the results of conservative neglect for CAD. Case reports, review articles, acute dislocations, and fracture-dislocations were excluded. The results of the different techniques were pooled for further evaluation. RESULTS Seventeen studies were selected for qualitative analysis. These were further subdivided into 9 studies for the CAD group and 11 studies for the CPD group. In the CAD intervention group, 53 shoulders in 7 studies were managed by 5 different head-preserving techniques. The choice of procedure to stabilize the shoulder after open reduction varied between coracoid transfer, capsulolabral repair, remplissage, and Putti-Platt procedure and acromiohumeral K-wire fixation. High resubluxation rates and early arthrosis were reported after open reduction techniques for CAD. In the CAD conservative group, 8 shoulders in 2 studies were managed by conservative methods. In the CPD group, the 2 most common techniques, McLaughlin or modified McLaughlin and bone grafting, were used to treat 74 shoulders in 7 studies and showed good functional outcomes. CONCLUSION The choice of open reduction and stabilization technique for CAD was highly variable between the different studies and led to a wide variation in the reported outcomes with a high number of complications such as resubluxation and early arthrosis. The conservative treatment of CAD led to poor functional results. The choice of treatment for CPD was mostly between 2 techniques-McLaughlin and modified McLaughlin reconstruction or the bone graft reconstruction-and they consistently led to good functional outcomes with less complications.
Collapse
Affiliation(s)
- Dipit Sahu
- Mumbai Shoulder Institute, Jupiter Hospital Thane, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.
| | | | | | - Ashok Shyam
- Indian Orthopaedics Research Group, Mumbai, Maharashtra, India
| |
Collapse
|
7
|
Paparoidamis G, Iliopoulos E, Narvani AA, Levy O, Tsiridis E, Polyzois I. Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management. Chin J Traumatol 2021; 24:18-24. [PMID: 32980216 PMCID: PMC7878447 DOI: 10.1016/j.cjtee.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm. METHODS Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade. RESULTS A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively. CONCLUSION The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.
Collapse
Affiliation(s)
- Georgios Paparoidamis
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom,Academic Orthopaedic Department, Papageorgiou General Hospital, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, and CORE Lab, CIRI - AUTh, Thessaloniki, Greece
| | - Efthymios Iliopoulos
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom
| | - A. Ali Narvani
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom,Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom
| | - Ofer Levy
- Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, and CORE Lab, CIRI - AUTh, Thessaloniki, Greece,International Center for Arthroplasty & Robotic Orthopaedic Surgery (ICAROS), European Interbalkan Medical Center, Thessaloniki, Greece
| | - Ioannis Polyzois
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom,Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom,Surrey Orthopaedic Clinic, United Kingdom,Corresponding author. The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom.
| |
Collapse
|
8
|
Zhao J. Arthroscopic Reduction of a Chronic Locked Posterior Shoulder Dislocation. Arthrosc Tech 2020; 9:e2063-e2070. [PMID: 33381420 PMCID: PMC7768308 DOI: 10.1016/j.eats.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/03/2023] Open
Abstract
Posterior shoulder dislocation is a rare condition. It is easily overlooked and often appears in a chronic locked status, which makes the reduction difficult, even through open procedures. Few reports in the literature have described an isolated arthroscopic reduction because it is difficult to elevate the humeral head to the level of the glenoid surface and obtain anterior-posterior soft-tissue balance. On the basis of an analysis of the mechanisms of the locking of the humeral head and the soft-tissue imbalance, we describe a set of arthroscopic shoulder release and reduction techniques, which include mainly the removal of rotator interval tissue; a thorough subscapularis release from the coracoid, the conjoined tendon, and the glenoid; and a 360° capsule-muscle release from the glenoid and the scapula. The described technique is an effective method to obtain a medial-to-lateral humeral head reduction and anterior-to-posterior soft-tissue balance. The introduction of this technique will provide a practical tool for surgeons to realize an arthroscopic shoulder reduction in the case of a chronic locked posterior shoulder dislocation.
Collapse
Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
| |
Collapse
|
9
|
Thangarajah T, Falworth M, Lambert SM. Anatomical shoulder arthroplasty in epileptic patients with instability arthropathy and persistent seizures. J Orthop Surg (Hong Kong) 2018; 25:2309499017717198. [PMID: 28659057 DOI: 10.1177/2309499017717198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Epileptic seizures can cause shoulder dislocation, recurrent instability and eventually arthritis. The purpose of this study was to report the results, complications and rate of revision surgery following anatomical shoulder arthroplasty in epileptic patients with instability arthropathy. METHODS A consecutive series of eight patients with epilepsy underwent anatomical shoulder arthroplasty for recurrent shoulder instability and were retrospectively reviewed after a mean of 4.7 years (range, 2-7.5 years). These included three total shoulder replacements and five humeral resurfacing hemiarthroplasty procedures. RESULTS Mean age of the cohort was 33 years (range, 17-44). All patients experienced post-operative grand mal seizures. Two patients with hemiarthroplasty required further surgery due to painful glenoid erosion. No residual cases of instability were noted. Mean active forward elevation and external rotation improved following surgery. The Oxford Shoulder Score improved from 15 pre-operatively (range, 7-22) to 26 post-operatively (range, 12-45) ( p = 0.031). This was accompanied by an increase in the mean Subjective Shoulder Value, which improved from 29 (range, 10-80) pre-operatively to 53 (range, 15-90) post-operatively ( p=0.042). CONCLUSIONS Anatomical shoulder arthroplasty may offer a solution for the treatment of instability arthropathy in patients with epilepsy and persistent seizures.
Collapse
Affiliation(s)
- Tanujan Thangarajah
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mark Falworth
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Simon M Lambert
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
10
|
Abstract
Locked posterior dislocation of the shoulder is very rare. Seizures and trauma are the most common causes of this injury.There is no current benchmark treatment strategy for these rare cases.This study has shown that reconstruction of the shoulder joint in an anatomical way in acute and chronic cases up to 16 weeks provides good results.The purpose of this study is to evaluate the results of different treatment procedures with outcomes and to compare the results of the same procedures in acute and chronic cases. Cite this article: EFORT Open Rev 2017;3:15-23. DOI: 10.1302/2058-5241.3.160089.
Collapse
|
11
|
Thangarajah T, Higgs D, Bayley JIL, Lambert SM. Glenohumeral arthrodesis for recurrent types II and III shoulder instability. J Shoulder Elbow Surg 2017; 26:687-691. [PMID: 27856264 DOI: 10.1016/j.jse.2016.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study reports the clinical outcome after glenohumeral arthrodesis for recurrent type II (atraumatic structural) and type III (muscle patterning nonstructural disorder) shoulder instability. METHODS A retrospective review was conducted at a single facility. Eight consecutive patients (7 women and 1 man) with recurrent shoulder instability underwent arthrodesis and were monitored for a mean of 57 months (range, 24-123 months). Mean age at the time of surgery was 47 years (range, 21-73 years). RESULTS Bony union was achieved in all patients at a mean time to fusion of 3 months (range, 1-11 months). No complications, such as routine removal of the metalwork or loosening, were noted. No residual perceived glenohumeral instability was reported, and no patient developed scapulothoracic instability or painful scapular dyskinesis. The mean Oxford Shoulder Instability Score improved from 8 preoperatively (range, 0-19) to 32 postoperatively (range, 16-41; P = .001). This was accompanied by an increase in the mean subjective shoulder value, which improved from 22 (range, 0-50) preoperatively to 73 (range, 50-100) postoperatively (P = .004). CONCLUSION In our series, glenohumeral arthrodesis was associated with no complications and was able to reduce pain, eliminate instability, and improve functional outcome. It should therefore be considered in this patient population.
Collapse
Affiliation(s)
- Tanujan Thangarajah
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Deborah Higgs
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - J Ian L Bayley
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Simon M Lambert
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|