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Bosch TP, Beeres FJP, Ferree S, Schipper IB, Camenzind RS, Hoepelman RJ, Link BC, Rompen IF, Babst R, van de Wall BJM. Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review. J Clin Med 2024; 13:3344. [PMID: 38893055 PMCID: PMC11172441 DOI: 10.3390/jcm13113344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.
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Affiliation(s)
- Thomas P. Bosch
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frank J. P. Beeres
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Steven Ferree
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands (R.J.H.)
| | - Inger B. Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Roland S. Camenzind
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Ruben J. Hoepelman
- Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands (R.J.H.)
| | - Björn-Christian Link
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Ingmar F. Rompen
- Department of Surgery, University Hospital Heidelberg, 69117 Heidelberg, Germany
| | - Reto Babst
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
| | - Bryan J. M. van de Wall
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Luzern, Switzerland
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García-Fernández C, Lopiz Y, Garríguez-Pérez D, Arvinius C, Ponz V, Echevarria M, Garrido A, Marco F. Do the humeral radiographic changes at 5-year follow-up affect the clinical outcomes of press-fit humeral stems in primary reverse shoulder arthroplasties? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1851-1863. [PMID: 38431896 DOI: 10.1007/s00590-024-03864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The purposes of this study were to analyze and compare the functional outcomes and radiological changes around the press-fit humeral components in two contemporary medialized reverse total shoulder arthroplasty (RTSA) systems at a minimum of 5-year follow-up. MATERIALS AND METHODS Between December 2003 and December 2015, 249 consecutive RTSAs were performed at our hospital. Of these, 68 primary uncemented RTSA met our inclusion criteria. The Constant-Murley score (CMS), the modified Constant score, a visual analog scale (VAS) and active shoulder range of motion (ROM) were measured pre- and postoperatively. Radiological assessment was performed by plain radiographs at a minimum of 5 years postoperatively. RESULTS At a mean follow-up of 80.2 months, there was no significant difference (p = .59) between the postoperative functional scores and range of motion of the two groups (Delta Xtend and Lima SMR). Radiological data of stress-shielding were observed in 38 patients (55.9%) being slightly more frequent in the Lima SMR group (21 patients) than in the Delta Xtend group (17 patients) (p = .62). CONCLUSIONS Our study shows that the good functional results are similar between the two uncemented RTSA systems used and that they do not depend on the presence of radiological changes (stress-shielding) in the humeral stem at a minimum 5-year follow-up.
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Affiliation(s)
- Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain.
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Daniel Garríguez-Pérez
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Camilla Arvinius
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Virginia Ponz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Marta Echevarria
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Ana Garrido
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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DeBernardis DA, Zhang T, Duong A, Fleckenstein CM, Almasri M, Hasan SS. Total shoulder arthroplasty in patients aged 80 years and older: a systematic review. J Shoulder Elbow Surg 2024; 33:425-434. [PMID: 37696486 DOI: 10.1016/j.jse.2023.08.003] [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: 03/20/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older. METHODS A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis. RESULTS A total of 15 studies evaluating 1685 primary aTSAs, 1170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. The postoperative active forward flexion and external rotation ranged from 138° to 150° and 45° to 48° after aTSA and from 83° to 139° and 16° to 47° after RSA, respectively. Postoperative visual analog scale pain scores ranged from 0 to 1.8 after aTSA and from 0 to 1.4 after RSA. Ninety-day mortality ranged from 0% to 3%, and perioperative complications ranged from 0% to 32%. Late complications ranged from 5.6% to 24% for aTSA patients and 3.5% to 29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0%-18%) and rotator cuff tear (5.6%-10%) after aTSA and scapular notching (0%-40%) and scapular fracture (4%-9.4%) after RSA. Reoperation rates ranged from 0% to 6% after aTSA and from 0% to 13% after RSA. CONCLUSIONS aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.
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Affiliation(s)
- Dennis A DeBernardis
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA; OrthoCincy, Edgewood, KY, USA
| | - Ting Zhang
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cassie M Fleckenstein
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Mahmoud Almasri
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA.
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Su F, Nuthalapati P, Feeley BT, Lansdown DA. Outcomes of anatomic and reverse total shoulder arthroplasty in patients over the age of 70: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:181-188. [PMID: 37588441 PMCID: PMC10426543 DOI: 10.1016/j.xrrt.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Both anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably improve pain and function for a variety of indications. However, there remain concerns about these procedures among elderly patients due to their general health, the potential for lesser functional gain, and the possible need for revision at an even older age. The purpose of this review is to compare the clinical outcomes, radiographic outcomes, and complications of ATSA and RTSA among patients older than 70 years. Methods A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. The inclusion criteria were studies with patients older than 70 years who were treated with a primary ATSA or RTSA and clinical results reported at a minimum of 2 years. All indications for primary RTSA except for tumor were included. Outcomes of interest included patient-reported outcomes (PROs), range of motion, patient satisfaction, radiographic changes, complication and revision rates, and implant survival. Results A total of 24 studies met the inclusion criteria. At a mean follow-up of 3.4 years for ATSA and 3.1 years for RTSA, there were significant improvements in pain, range of motion, and PROs for both prostheses. Patients who underwent ATSA generally had better motion and functional outcomes compared to those who underwent RTSA, though these comparisons were made across different indications for arthroplasty. The satisfaction rate was 90.9% after ATSA and 90.8% after RTSA. Furthermore, 10.2% of ATSA patients and 9.9% of RTSA patients experienced a surgical complication, whereas 2.3% of ATSA and 2.2% of RTSA patients underwent a revision. Secondary rotator cuff tear was the most common complication after ATSA, occurring in 3.7% of patients, but only 1.1% of patients required revision surgery. Both ATSA and RTSA implant survivorship was reported to range from 93.1% to 98.9% at 5- and 8-year follow-up, respectively. Patient mortality was estimated to be 19.3% with a mean time to death of 6.1 years. Conclusions Elderly patients with primary osteoarthritis and an intact rotator cuff can have predictable pain relief, restoration of functional range of motion, and significant improvement in PROs after ATSA with low complication rates. Secondary rotator cuff failure and revision arthroplasty occur infrequently at early to mid-term follow-up. Although elderly patients who underwent ATSA generally had better functional outcomes compared to those who underwent RTSA for differing indications, patient satisfaction after both procedures were similar.
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Affiliation(s)
- Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Drew A. Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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How common is nerve injury after reverse shoulder arthroplasty? A systematic review. J Shoulder Elbow Surg 2023; 32:872-884. [PMID: 36427756 DOI: 10.1016/j.jse.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nerve injury following reverse shoulder arthroplasty (RSA) is a known risk factor with wide ranging incidences reported. This systematic review evaluates the overall incidence of nerve injury following primary and revision RSA and summarizes the characteristics of the nerve injuries reported in the current literature. METHODS A systematic review was performed using separate database searches (Pubmed, Embase, Web of Science, Cochrane) following the PRISMA guidelines. Search criteria included the title terms "reverse shoulder," "reverse total shoulder," "inverted shoulder," and "inverted total shoulder" with publication dates ranging from 01/01/2010 to 01/01/2022. Studies that reported neurological injuries and complications were included and evaluated for primary RSA, revision RSA, number of nerve injuries, and which nerves were affected. RESULTS After exclusion, our systematic review consisted of 188 articles. A total of 40,146 patients were included, with 65% female. The weighted mean age was 70.3 years. The weighted mean follow-up was 35.4 months. The rate of nerve injury after RSA was 1.3% (510 of 40,146 RSAs). The rate of injury was greater in revision RSA compared to primary RSA (2.4% vs. 1.3%). Nerve injury was most common in RSAs done for a primary diagnosis of acute proximal humerus fracture (4.0%), followed by cuff tear arthropathy (3.0%), DJD (2.6%), and inflammatory arthritis (1.7%). Massive rotator cuff tears and post-traumatic arthritis cases had the lowest nerve injury rates (1.0% and 1.4%, respectively). The axillary nerve was the most commonly reported nerve that was injured in both primary and revision RSA (0.6%), followed by the ulnar nerve (0.26%) and median nerve (0.23%). Brachial plexus injury was reported in 0.19% of overall RSA cases. CONCLUSION Based on current English literature, nerve injuries occur at a rate of 1.3% after primary RSA compared with 2.4% after revision RSA. The most common nerve injury was to the axillary nerve (0.64%), with the most common operative diagnosis associated with nerve injury after RSA being acute proximal humerus fracture (4.0%). Surgeons should carefully counsel patients prior to surgery regarding the risk of nerve injury.
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Kao DS, Protzuk OA, O'Connell RS. Clinical outcomes of cemented vs. uncemented reverse total shoulder arthroplasty for proximal humerus fractures: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03400-1. [PMID: 36183281 DOI: 10.1007/s00590-022-03400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty is an established treatment method for comminuted proximal humerus fractures. Both cemented and uncemented techniques exist, with uncemented reverse total shoulder offering many theoretical advantages, including improved biologic fixation, absence of cement related complications, and ease of revision if necessary. There are few studies comparing the outcomes of the two techniques. METHODS The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search for studies assessing clinical outcomes of reverse total shoulder arthroplasty for proximal humerus fractures was performed of PubMed, Embase, Web of Science, and Cochrane Library. Main outcomes included Constant Score (CS), American Shoulder and Elbow Surgeons (ASES) score, and complication rate. Inclusion criteria were as follows: indication for arthroplasty was fracture; minimum one year follow up; article in English. Exclusion criteria were as follows: review articles; biomechanical or cadaver studies. Quality analysis was performed using the Cochrane Risk of Bias tool (RoB 2) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool. RESULTS A total of 682 studies were identified through the initial search, with 36 studies meeting all inclusion criteria. There were 24 studies investigating cemented technique, 10 studies examining uncemented technique, and two studies involving both techniques. There was no difference in mean follow up between patients receiving a cemented vs. uncemented rTSA (32.3 months vs. 30.6 months, p = 0.06). Patients who received a cemented rTSA had a significantly higher Constant-Murley score than those who received an uncemented rTSA (59.4 vs 55.9, p < .001). There was no difference between the two groups when comparing ASES Scores (77.5 vs 78.6, p = 0.54) and overall complication rates (11.1% vs 11.8%, p = 0.23). CONCLUSION Both cemented and uncemented rTSA are both valid options for treating acute proximal humerus fractures. Cemented rTSA may portend slightly improved clinical outcomes with similar overall complication rates compared to uncemented rTSA for proximal humerus fractures.
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Affiliation(s)
- David S Kao
- Virginia Commonwealth University Health, 1250 E. Marshall St., Richmond, VA, 23219, USA.
| | - Omar A Protzuk
- Virginia Commonwealth University Health, 1250 E. Marshall St., Richmond, VA, 23219, USA
| | - Robert S O'Connell
- Virginia Commonwealth University Health, 1250 E. Marshall St., Richmond, VA, 23219, USA
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Filho GDRM, Amaral MVG. Artroplastia do ombro no tratamento das fraturas da extremidade proximal do úmero: Conceitos atuais. Rev Bras Ortop 2022; 57:529-539. [PMID: 35966425 PMCID: PMC9365482 DOI: 10.1055/s-0040-1721359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Complex proximal humeral fractures, especially in elderly patients, often require arthroplastic surgical treatment. Traditionally, shoulder hemiarthroplasty (HA) is the method of choice, resulting in long implant survival and a painless shoulder; however, shoulder HA has heterogeneous clinical outcomes related to the correct position of the implant, both in terms of height and version, and the anatomical consolidation of tuberosities. Today, reverse shoulder arthroplasties are increasingly used to treat such fractures. These techniques result in better functional outcomes compared to HAs, especially regarding anterior flexion, but implant longevity has not been established. The development of specific prosthetic humeral components for the treatment of fractures, which were recently introduced in the clinical practice, led to better clinical outcomes.
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Affiliation(s)
- Geraldo da Rocha Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Galvão Amaral
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
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Rossi LA, Tanoira I, Ranalletta M, Kunze KN, Farivar D, Perry A, Chahla J. Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e101-e119. [PMID: 34737086 DOI: 10.1016/j.jse.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this systematic review was to compare functional outcomes, complications, and revision rates between cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs). METHODS A systematic search was performed in April 2021 within PubMed, Scopus Web of Science, and Cochrane Library databases for clinical studies reporting outcomes of RSA performed for PHF. Included studies were published in English, had a minimum 1-year follow-up, specified whether the humeral stem was cemented (cRSA) or uncemented (ucRSA), and were evidence level I-IV. Data including range of motion (ROM), functional status, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant-Murley score, visual analog scale (VAS) score, tuberosity healing, complications, and reoperations were extracted. DerSimonian-Laird random effects models with subgroup stratification analyses were applied to investigate differences in outcomes between patients with cRSA and ucRSA. RESULTS A total of 45 studies comprising 1623 patients were included. The overall pooled age was 75.9 ± 3.4 years. At a mean follow-up of 34.6 (range, 12-108) months, there were no significant differences in ROM, VAS score, Constant-Murley score, rate of tuberosity healing, or reoperation rates between the cRSA and ucRSA cohorts. The mean postoperative ASES score in the cRSA cohort (73.9, 95% CI 71.4-76.5) was significantly lower than the ucRSA cohort (82.9, 95% CI 75.9-90.0, P = .013). The incidence of postoperative all-cause complications was significantly lower in the cRSA cohort (5.5%, 95% CI 4.0%-6.9%) compared with the ucRSA cohort (9.7%, 95% CI 4.5%-14.9%, P = .044). CONCLUSION The use of uncemented humeral stems in RSA for PHF confers similar functional results to the use of cemented stems in terms of pain, range of motion, functional scores, and tuberosity healing. Although the rate of complications was significantly higher in the uncemented cohort compared with the cemented cohort (9.7% vs. 5.5%, respectively), the rate of reoperations was similar between the groups (1.6% vs. 1.9%, respectively). The uncemented reverse prosthesis seems to be a valid alternative for the management of patients with complex proximal humerus fractures.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Allison Perry
- University of Cincinnati College of Medicine, Chicago, IL, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, IL, USA
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Dolci A, Melis B, Verona M, Capone A, Marongiu G. Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review. Geriatr Orthop Surg Rehabil 2021; 12:21514593211059865. [PMID: 34900387 PMCID: PMC8664304 DOI: 10.1177/21514593211059865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The reverse shoulder arthroplasty is nowadays a treatment option for a variety of shoulder problems. As its incidence rose, also the number of complications increased, including intraoperative fractures. Significance We performed a systematic review and critical analysis of the current literature following the PRISMA guidelines. Our purpose was to: 1) determine incidence, causes, and characteristics of intraoperative fractures; 2) evaluate their current treatment options, possible related complications, reoperation rates, and the patients’ outcome; and 3) determine the overall incidence of each complication related to reverse shoulder arthroplasty. The articles were selected from PubMed medical database in April 2020 using a comprehensive search strategy. Rayyan software was used to support the selection process of the records. A descriptive and critical analysis of the results was performed. Results The study group included a total of 13,513 reverse shoulder arthroplasty procedures. The total number of complications was 1647 (rate 12.1%). The most common complication was dislocation (340 cases, rate 2.5%). Forty-six studies reported a total of 188 intraoperative fractures among the complications (rate 1.4%). The intraoperative fracture rate was 2.9% and 13.6% in primary and revision settings, respectively. There were 136 humeral fractures, 60% of them occurred in revision RSAs, during the removal of the previous implant, and involved the shaft in the majority of cases (39%). Glenoid fractures were 51 and occurred mostly during the reaming of the glenoid. We observed 7 further related complications (rate of 4%) and 3 reoperations (rate of 1.5%). The outcome was satisfactory in the majority of cases. Conclusions A comprehensive review on intraoperative fractures in reverse shoulder arthroplasties is presented. Results suggest favorable outcomes for all treatment methods, with a modest further complication rate. This investigation may aid in the treatment decision-making for these complications.
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Affiliation(s)
- Andrea Dolci
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Barbara Melis
- Orthopaedic and Sport Trauma Unit, Casa di Cura Policlinico Città di Quartu, Quartu Sant'Elena, Italy
| | - Marco Verona
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Antonio Capone
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Giuseppe Marongiu
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
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Garcia-Fernandez C, Lopiz Y, Arvinius C, Ponz V, Alcobía-Diaz B, Checa P, Galán-Olleros M, Marco F. Dislocation after reverse total shoulder arthroplasty using contemporary medialized modular systems. Can we still consider it such a frequent complication? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1525-1534. [PMID: 34591167 DOI: 10.1007/s00590-021-03131-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced the initially high complication and revision rates associated with this implant. However, instability continues to be a leading cause of reoperation after RTSA, being related in previous studies with medialized designs. The aim of this study was to determine the dislocation rate with the employment of two medialized modular systems of RTSA in our institution. MATERIALS AND METHODS A retrospective review of two different modular systems of RTSA (SMR Modular Shoulder System and Delta XTEND Reverse Shoulder) was performed between 2009 and 2017 with a minimum 3-year follow-up. Baseline demographic, clinical (Constant, ASES and ROM), and radiographic data were collected. Characteristics of postoperative instability cases were also evaluated. RESULTS 237 primary RTSA (41% SMR/59% Delta) and 34 revision RTSA (44% SMR/56% Delta) with a mean follow-up of 75.6 ± 5.2 months (79.2 SMR/86.3 Delta, p = .586) were included in the present study. Indications for primary RTSA were osteoarthritis, rotator cuff tear arthropathy and massive irreparable rotator cuff tear (64%), acute fracture (32%), and fracture sequelae (4%). Subscapularis tendon was always repaired in degenerative pathology and tuberosities reattached in traumatic cases. The mean age of the global series was 76.5 ± 5.3 years (75.8 SMR/78.6 Delta, p = .104) with a mean Constant/ASES score at final follow-up of 68.5 ± 4.3/72.9 ± 20.3 (71/68 SMR and 69/74 Delta, p = .653 and .642). Only 2 patients (one acute fracture and one fracture sequelae) suffered an early postoperative anterior dislocation (before 3 months) which represents a rate of .84% in primary cases and .73% including revision surgery. Closed reduction manoeuvres were not successful, and both patients required revision surgery. At the end follow-up, both were stable and had no further dislocations. CONCLUSION The dislocation rate after RTSA with the employment of two contemporary modular systems with a medialized centre of rotation is extremely low, especially when compared with the previously published series with the original Grammont design. Acute fracture and fracture sequelae were the main diagnoses associated with this instability. The reasons for the low dislocation rate are multifactorial, but the improvement in the baseplate position according to the more recent standards of "ideal position" and technical aspects such as subscapularis repair or tuberosity reattachment in fractures probably play an important role in this aspect.
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Affiliation(s)
- Carlos Garcia-Fernandez
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain.
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain.,Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Camilla Arvinius
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain
| | - Virginia Ponz
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain
| | - Borja Alcobía-Diaz
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain
| | - Pablo Checa
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain
| | - Maria Galán-Olleros
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain.,Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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11
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Lopiz Y, Galán-Olleros M, Rodriguez-Rodriguez L, García-Fernández C, Marco F. Radiographic changes around the glenoid component in primary reverse shoulder arthroplasty at mid-term follow-up. J Shoulder Elbow Surg 2021; 30:e378-e391. [PMID: 33197588 DOI: 10.1016/j.jse.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Some local events after reverse shoulder arthroplasty (RSA) occur without the patient experiencing symptoms and yet may be detected on diagnostic imaging, thereby serving as indicators of future complications that may require revision. Most of these events involve the glenoid component, but radiographic studies evaluating this component are scarce, especially medium- and long-term studies. This study aimed to analyze the radiographic changes around the glenoid component and determine the risk factors associated with the presence of these radiographic changes. MATERIALS AND METHODS A retrospective review of 105 primary Grammont-style RSAs implanted between 2003 and 2014 was conducted. Radiographic outcomes were evaluated in patients with ≥5 years of radiographic follow-up. Standardized digital radiographs obtained immediately postoperatively and at a minimum follow-up time of 5 years were analyzed to determine (1) glenoid component position (inclination and height) and (2) minor radiographic changes (Sirveaux grade 1 or 2 scapular notching; nondisplaced acromial fracture; radiolucent lines around 1 or 2 screws; Brooker grade 1a, 1b, or 2 heterotopic calcifications; or single screw rupture), as well as major radiographic changes (Sirveaux grade 3 or 4 scapular notching; radiolucent lines around ≥3 screws or central peg; Brooker grade 1c or 3 heterotopic calcifications; prosthetic dislocation; loosening or migration; or disassembly). RESULTS Major radiologic changes were identified in 14.3% of the cases. Bivariate analysis showed that more changes were associated with the arthroplasties implanted in the first years of the study (odds ratio [OR] = 0.81, P = .012). This time-related variable was also associated with inclination (OR = 0.88, P = .045) and height (OR = 0.75, P = .001), improving in arthroplasties implanted in the last years of the study. Multivariate analysis revealed an increased risk of severe scapular notching mainly associated with superior tilt (OR = 2.52, P = .036) and a high (OR = 2.68, P = .019) or excessively high (OR = 7.55, P = .013) position and an increased risk of loosening signs associated with superior tilt (OR = 8.92, P = 9.1 × 10-6). CONCLUSIONS The percentage of radiologic changes of the glenoid component in RSA is considerable, despite the detection of a decrease in their presence among the arthroplasties implanted outside the initial period. Superior tilt and an excessively high position appear to be associated with a severe degree of scapular notching development and increased risk of radiographic loosening signs. Knowledge of the factors associated with major radiologic changes in the medium-term follow-up will help to optimize the primary surgical technique for each patient and indication, improving implant survival in primary RSA surgery.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain.
| | - María Galán-Olleros
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, UGC de Reumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain
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12
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Shah SS, Roche AM, Sullivan SW, Gaal BT, Dalton S, Sharma A, King JJ, Grawe BM, Namdari S, Lawler M, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int 2020; 5:121-137. [PMID: 33554177 PMCID: PMC7846704 DOI: 10.1016/j.jseint.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
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Affiliation(s)
- Sarav S. Shah
- American Shoulder and Elbow Surgeons (ASES) Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
- Corresponding author: Sarav S. Shah, MD, 125 Parker Hill Ave, Boston, MA 02120, USA.
| | | | | | - Benjamin T. Gaal
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Stewart Dalton
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Arjun Sharma
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph J. King
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Brian M. Grawe
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Surena Namdari
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Macy Lawler
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Thomas W. Wright
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Kyle Flik
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Randall J. Otto
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Jones
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Andrew Jawa
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Peter McCann
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph Abboud
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Gabe Horneff
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Glen Ross
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Friedman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Douglas Boardman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
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13
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Shah SS, Gaal BT, Roche AM, Namdari S, Grawe BM, Lawler M, Dalton S, King JJ, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part I. JSES Int 2020; 4:929-943. [PMID: 33345237 PMCID: PMC7738599 DOI: 10.1016/j.jseint.2020.07.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this 2-part study was to systematically review each of the most common complications of RSA, limiting each search to publications in 2010 or later. In this part (part I), we examined (1) scapular notching (SN), (2) periprosthetic infection (PJI), (3) mechanical failure (glenoid or humeral component), and (4) neurologic injury (NI). Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 113 studies on SN, 62 on PJI, 34 on mechanical failure, and 48 on NI were included in our reviews. Univariate analysis was performed with the χ2 or Fisher exact test. Results The Grammont design had a higher SN rate vs. all other designs combined (42.5% vs. 12.3%, P < .001). The onlay humeral design had a lower rate than the lateralized glenoid design (10.5% vs. 14.8%, P < .001). The PJI rate was 2.4% for primary RSA and 2.6% for revision RSA. The incidence of glenoid and humeral component loosening was 2.3% and 1.4%, respectively. The Grammont design had an increased NI rate vs. all other designs combined (0.9% vs. 0.1%, P = .04). Conclusions Focused systematic reviews of the recent literature with a large volume of RSAs demonstrate that with the use of non-Grammont modern prosthesis designs, complications including SN, PJI, glenoid component loosening, and NI are significantly reduced compared with previous studies. As the indications for RSA continue to expand, it is imperative to accurately track the rates and types of complications to justify its cost and increased indications.
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Affiliation(s)
- Sarav S Shah
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Benjamin T Gaal
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Alexander M Roche
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Surena Namdari
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Brian M Grawe
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Macy Lawler
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Stewart Dalton
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joseph J King
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Grant E Garrigues
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Thomas W Wright
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Bradley S Schoch
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Kyle Flik
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Randall J Otto
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Richard Jones
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Andrew Jawa
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Peter McCann
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joseph Abboud
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Gabe Horneff
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Glen Ross
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Richard Friedman
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Eric T Ricchetti
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Douglas Boardman
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Robert Z Tashjian
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Lawrence V Gulotta
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
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O'Sullivan J, Lädermann A, Parsons BO, Werner B, Steinbeck J, Tokish JM, Denard PJ. A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis. J Shoulder Elbow Surg 2020; 29:1938-1949. [PMID: 32815808 DOI: 10.1016/j.jse.2020.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humerus fractures are common in the elderly population and are often treated with reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to compare tuberosity healing and functional outcomes in patients undergoing RSA with humeral inclinations of 135°, 145°, and 155°. METHODS A systematic review was performed of RSA for proximal humerus fracture using Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. Radiographic and functional outcome data were extracted to evaluate tuberosity healing according to humeral inclination. Analysis was also performed of healed vs. nonhealed tuberosities. RESULTS A total of 873 patients in 21 studies were included in the analysis. The mean age was 77.5 years (range of 58-97) and the mean follow-up was 26.2 months. Tuberosity healing was 83% in the 135° group compared with 69% in the 145° group and 66% in the 155° group (P = .030). Postoperative abduction was highest in the 155° group (P < .001). No significant difference was found in forward flexion, external rotation, or postoperative Constant score between groups. Patients with tuberosity healing demonstrated 18° higher forward flexion (P = .008) and 16° greater external rotation (P < .001) than those with unhealed tuberosities. CONCLUSION RSA for fracture with 135° humeral inclination is associated with higher tuberosity healing rates compared with 145° or 155°. Postoperative abduction is highest with a 155° implant, but there is no difference in in postoperative forward flexion, external rotation, or Constant score according to humeral inclination. Patients with healed tuberosities have superior postoperative forward flexion and external rotation than those with unhealed tuberosities.
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Affiliation(s)
- Joseph O'Sullivan
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Bradford O Parsons
- Department of Orthopedics, Mount Sinai Medical Center, New York, NY, USA
| | - Brian Werner
- Department of Orthopedics, University of Virginia, Charlottesville, VA, USA
| | | | - John M Tokish
- Department of Orthopedics, Mayo Clinic, Scottsdale, AZ, USA
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:781-801. [PMID: 31512086 DOI: 10.1007/s40258-019-00512-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, García-Fernández C, Picado AL, Marco F. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg 2019; 28:2259-2271. [PMID: 31500986 DOI: 10.1016/j.jse.2019.06.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures (PHFs) are among the most common fractures in elderly patients, but there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for their management. To date, no RCT has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for 3- or 4-part PHFs in elderly patients. METHODS This was a prospective RCT. The primary objective was to compare pain and function 12 months after fracture using the Constant score in patients aged 80 years or older with 3- and 4-part PHFs, treated by either RSA or nonoperative treatment. Secondary outcome measures included Disabilities of the Arm, Shoulder and Hand, visual analog scale (VAS), Short Form 12 (SF-12), EuroQol 5 Dimensions, and EQ-VAS scores. RESULTS We analyzed 30 nonoperative and 29 RSA patients with mean ages of 85 years and 82 years, respectively. No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes at 12 months' follow-up except the VAS pain score. The Constant scores were 55.7 in the nonoperative group and 61.7 in the RSA group (P = .071); the Disabilities of the Arm, Shoulder and Hand scores were 29 and 21, respectively (P = .075); the VAS scores were 1.6 and 0.9, respectively (P = .011); the physical SF-12 scores were 36 and 37, respectively (P = .709); the mental SF-12 scores were 43 and 42, respectively (P = .625); the EuroQol 5 Dimensions scores were 0.89 and 0.92, respectively (P = .319); and the EQ-VAS scores were 65 and 67, respectively (P = .604). CONCLUSIONS This study yields important evidence for the treatment of complex PHFs in elderly patients suggesting minimal benefits of RSA over nonoperative treatment for displaced 3- and 4-part PHFs. At short-term follow-up, the main advantage of RSA appeared to be less pain perception.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.
| | - Borja Alcobía-Díaz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - María Galán-Olleros
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Amanda López Picado
- Clinical Trials and Research Unit, Clínico San Carlos Hospital, IdISSC, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain
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Arias-de la Torre J, Garcia X, Smith K, Romero-Tamarit A, Puigdomenech E, Muñoz-Ortiz L, Evans JP, Martín V, Molina AJ, Torrens C, Pons-Cabrafiga M, Pallisó F, Valderas JM, Espallargues M. Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review. J Clin Med 2019; 8:E2063. [PMID: 31771221 PMCID: PMC6947222 DOI: 10.3390/jcm8122063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant-Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.
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Affiliation(s)
- Jorge Arias-de la Torre
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 León, Spain;
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AB, UK
| | - Xavier Garcia
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
| | - Kayla Smith
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
| | - Arantxa Romero-Tamarit
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
| | - Elisa Puigdomenech
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
| | - Laura Muñoz-Ortiz
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
| | - Jonathan P. Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX1 2LU, UK; (J.P.E.); (J.M.V.)
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Vicente Martín
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 León, Spain;
| | - Antonio J. Molina
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 León, Spain;
| | - Carles Torrens
- Hospital del Mar, Department of Orthopaedic Surgery and Trauma, 08003 Barcelona, Spain;
| | - Miquel Pons-Cabrafiga
- Department of Orthopaedic Surgery and Trauma, Sant Rafael University Hospital, 08035 Barcelona, Spain;
| | - Francesc Pallisó
- Department of Orthopaedic Surgery and Trauma, Santa María University Hospital, 25198 Lleida, Spain;
| | - Jose María Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX1 2LU, UK; (J.P.E.); (J.M.V.)
| | - Mireia Espallargues
- Agency for Health Quality and Assessment of Catalonia (AQuAS), 08005 Barcelona, Spain; (X.G.); (K.S.); (A.R.-T.); (E.P.); (L.M.-O.); (M.E.)
- Health Services Research on Chronic Patients Network (REDISSEC), 28029 Madrid, Spain
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18
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Grey B, Rodseth RN, Roche SJ. Humeral Stem Loosening Following Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2019; 6:e5. [PMID: 29762342 DOI: 10.2106/jbjs.rvw.17.00129] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The timing and the factors contributing to aseptic stem loosening remain poorly understood. METHODS We performed a systematic review that identified 75 articles; 65 of the included articles were case series (Level-IV evidence), 8 were cohort studies (7 Level III, 1 Level II), and 2 were prospective randomized controlled trials (Level I). A meta-analysis of 1,660 cemented and 805 uncemented RSA stems was performed. We compared the rates of aseptic stem loosening, humeral radiolucent lines, and revision for stem loosening (1) between cemented and uncemented stems in cohorts with short and long mean follow-up periods (<5 and ≥5 years) as well as in all cohorts combined, and (2) among different etiological subgroups. RESULTS Aseptic stem loosening occurred more commonly in the cohort with long compared with short follow-up time (2% versus 0.8%, p = 0.01). When comparing cemented with uncemented stems, there was no significant difference in the rates of aseptic stem loosening or revision for stem loosening in either the short or long-term follow-up groups. Humeral radiolucent lines were more common with cemented compared with uncemented stems (15.9% versus 9.5%, p = 0.002). Analyzed by etiology, the highest rate of aseptic stem loosening occurred in the tumor subgroup (10.8%), followed by RSA as a revision procedure after a failed arthroplasty (3.7%). No stems in the acute fracture or fracture sequelae subgroups developed aseptic stem loosening. CONCLUSIONS Aseptic stem loosening occurred more commonly in cohorts with longer follow-up. There were no differences in the rates of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Patients treated with RSA following excision of proximal humeral tumors and RSA as a revision procedure after a failed arthroplasty were at greater risk of aseptic stem loosening. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ben Grey
- Shoulder and Elbow Unit, Princess Alice Unit, Department of Orthopaedics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Reitze N Rodseth
- Department of Anaesthetics, Grey's Hospital, Pietermaritzburg, South Africa.,Department of Anaesthetics, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stephen J Roche
- Shoulder and Elbow Unit, Princess Alice Unit, Department of Orthopaedics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Gasbarro G, Crasto JA, Rocha J, Henry S, Kano D, Tarkin IS. Reverse Total Shoulder Arthroplasty for Geriatric Proximal Humerus Fracture Dislocation With Concomitant Nerve Injury. Geriatr Orthop Surg Rehabil 2019; 10:2151459319855318. [PMID: 31218093 PMCID: PMC6558531 DOI: 10.1177/2151459319855318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Preoperative axillary nerve palsy is a contraindication to reverse total shoulder arthroplasty (rTSA) due to the theoretical risk of higher dislocation rates and poor functional outcomes. Treatment of fracture-dislocations of the proximal humerus with rTSA is particularly challenging, as these injuries commonly present with concomitant neurologic and soft tissue injury. The aim of the current study was to determine the efficacy of rTSA for this fracture pattern in geriatric patients presenting with occult or profound neurologic injury. Methods A retrospective case series of all shoulder arthroplasty procedures for proximal humerus fractures from February 2006 to February 2018 was performed. Inclusion criteria were patients aged greater than 65 years at the time of surgery, fracture-dislocations of the proximal humerus, and treatment with rTSA. Patients with preoperative nerve injuries were compared to patients without overt neurologic dysfunction. Forward elevation, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analog Scale (VAS), and Subjective Shoulder Value (SSV) were obtained at final follow-up. Results Forty-six rTSA for acute fracture were performed during the study period, 16 patients met the inclusion criteria and 5 (31%) presented with overt preoperative nerve injuries. At mean 3.1 years follow up, there were no postoperative complications including dislocations and final forward elevation was similar between study groups. Patients with overt nerve palsy had higher QuickDASH and VAS scores with lower SSV and self-rated satisfaction. Discussion In the majority of patients with or without overt nerve injury, rTSA reliably restored overhead function and led to good or excellent patient-rated treatment outcomes. Overt nerve palsy did not lead to higher complication rates, including dislocation. Despite greater disability and less satisfaction, complete or partial nerve recovery can be expected in the majority of patients. Conclusion Nerve injury following proximal humeral fracture dislocation may not be an absolute contraindication to rTSA.
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Affiliation(s)
- Gregory Gasbarro
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jared A Crasto
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah Henry
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daiji Kano
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ivan S Tarkin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Dillon MT, Prentice HA, Burfeind WE, Chan PH, Navarro RA. The increasing role of reverse total shoulder arthroplasty in the treatment of proximal humerus fractures. Injury 2019; 50:676-680. [PMID: 30738568 DOI: 10.1016/j.injury.2019.01.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hemiarthroplasty of the shoulder is a well established treatment for proximal humerus fractures not amenable to open reduction internal fixation. However, orthopedic surgeons have recently increased utilization of reverse total shoulder arthroplasty (RTSA) in the treatment of these injuries. The purpose of this study was to evaluate the use of hemiarthroplasty and RTSA between 2009 and 2016 for the treatment of proximal humerus fractures within a large United States integrated healthcare system. MATERIALS AND METHODS A descriptive study was conducted using our integrated healthcare system's Shoulder Arthroplasty Registry. Shoulder arthroplasty cases performed for an acute proximal humerus fracture between the years of 2009 and 2016 were identified. Revision rates were determined, as well as changes in age and gender distribution of the cohort during the study period. RESULTS In 2015, RTSA utilization surpassed that of hemiarthroplasty for the first time in the healthcare system. The utilization of RTSA in the treatment of proximal humerus fractures increased from 4.5% of all arthroplasties in 2009 to 67.4% of arthroplasties in 2016. During the study period, patients undergoing hemiarthroplasty were younger and less likely to be female. Crude revision rate was 4.0% for hemiarthroplasty and 3.2% for RTSA. CONCLUSIONS RTSA is increasingly being utilized for the treatment of proximal humerus fractures and now appears to be the treatment of choice. While hemiarthroplasty appears to be falling out of favor in the treatment of fractures of the shoulder, surgeons may still be preferentially using the procedure in younger patients.
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Affiliation(s)
- Mark T Dillon
- Department of Orthopedic Surgery, The Permanente Medical Group, Sacramento, CA, USA.
| | | | | | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | - Ronald A Navarro
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Harbor City, CA USA
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21
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Hughes K, Bellringer S, Chan G, Dodd L, Hook S. Regarding reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures. Injury 2019; 50:617. [PMID: 30642624 DOI: 10.1016/j.injury.2018.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/28/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Katie Hughes
- Trauma and Orthopaedic Department, St. Richard's Hospital, Chichester, UK.
| | - Simon Bellringer
- Trauma and Orthopaedic Department, St. Richard's Hospital, Chichester, UK.
| | - Gareth Chan
- Trauma and Orthopaedic Department, St. Richard's Hospital, Chichester, UK.
| | - Laurence Dodd
- Trauma and Orthopaedic Department, St. Richard's Hospital, Chichester, UK.
| | - Samantha Hook
- Trauma and Orthopaedic Department, St. Richard's Hospital, Chichester, UK.
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22
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Gallinet D, Ohl X, Decroocq L, Dib C, Valenti P, Boileau P. Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic review and meta-analysis. Orthop Traumatol Surg Res 2018; 104:759-766. [PMID: 29969722 DOI: 10.1016/j.otsr.2018.04.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The indications for surgical treatment of displaced proximal humerus fractures in older patients have gradually changed in the past 10 years: fewer hemiarthroplasty (HA) procedures but more reverse shoulder arthroplasty (RSA) procedures are being done. The aim of this study was to determine the clinical and radiological outcomes, the complications, reoperations and revisions of RSA and to compare them with those of HA. MATERIAL AND METHODS A systematic review of the literature published between January 2006 and February 2016 was carried out to identify studies reporting or comparing results of HA and RSA for proximal humerus fractures in patients above 65 years of age. These studies were classified based on their quality and level of evidence. Of the 67 studies that were identified and reviewed, 22 were chosen for the analysis. RESULTS The functional outcome (Constant score) after RSA is significantly better and more reproducible that the one obtained after HA. RSA provides significantly better active range of motion in forward flexion and abduction than HA. Conversely, active internal and external rotation are worse after RSA than HA. Reattachment of the tuberosities around the RSA improves the rotation ability. Even if the tuberosities do not heal, the functional outcomes are satisfactory after RSA but not HA due to a major functional deficit. The tuberosity healing rate around the RSA does not decline with age, contrary to HA where age is a negative factor. The overall complication rate is higher after RSA than HA; however the reoperation rate is equal. The revision rate for implant change is higher after HA. CONCLUSION Compared to HA, RSA provides more reproducible function with better recovery of active forward flexion and abduction, even when the tuberosities are not reattached or do not heal properly. The poor rotation ability can be improved by reinserting the tuberosities. While the complication rate after RSA is higher than after HA, the reoperation rate is equal, and the revision rate is lower. LEVEL OF EVIDENCE IV, Systematic review of literature.
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Affiliation(s)
- David Gallinet
- 3, chemin des écoles des Tilleroyes, Bat Séquoia park, 25000 Besancon, France
| | - Xavier Ohl
- Service de chirurgie orthopédique et traumatologique, CHU de Reims, hôpital maison-blanche, 45, rue Cognacq-Jay, 51092 Reims, France
| | - Lauryl Decroocq
- Université de la Côte d'Azur (UCA), CHU de Nice, hôpital Pasteur 2, institut universitaire locomoteur et Sport (iULS), 30, avenue de la voie Romaine, 06000 Nice, France
| | - Choukry Dib
- Institut de la main, 6, square Jouvenet, 75016 Paris, France
| | | | - Pascal Boileau
- Université de la Côte d'Azur (UCA), CHU de Nice, hôpital Pasteur 2, institut universitaire locomoteur et Sport (iULS), 30, avenue de la voie Romaine, 06000 Nice, France.
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- 56, rue Boissonade, 75014 Paris, France
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23
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García-Fernández C, Lopiz Y, Rizo B, Serrano-Mateo L, Alcobía-Díaz B, Rodríguez-González A, Marco F. Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures. Injury 2018; 49 Suppl 2:S22-S26. [PMID: 30219143 DOI: 10.1016/j.injury.2018.06.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/22/2018] [Accepted: 06/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study evaluates the clinical outcomes in patients with proximal humerus fractures (PHF) treated with reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed fixation that have more than 5 years of follow-up. MATERIALS AND METHODS This is a retrospective study of 270 RTSA. The inclusion criteria for this study consisted of patients initially treated with either open reduction and plate fixation (ORIF) or fixation using an intramedullary nail (IMN), who were managed with a single-stage revision to a RTSA, and had a minimum of 24 months clinical and radiological follow-up. Six patients with failed fixation of displaced PHF were revised with RTSA. One patient was excluded from the study because she died. Five shoulders were reviewed for the purpose of this study. The patients were evaluated using Constant score, relative Constant score and visual analogue scale for pain. RESULTS The mean follow-up was 89 months (65-108). The mean absolute Constant score improved from 31, 81 to 44, 2 and the relative Constant score improved from 31,81% to 67,2%. Mean VAS improved from 6, 8 to 2. One patient rated their outcome excellent, 1good, 1 satisfied and 2 poor. CONCLUSION RTSA is an appropriate treatment as a revision surgery for failed fixation of PHF. Patients should be adequately warned that they will improve their function but may have complications following this salvage procedure.
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Affiliation(s)
- Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Belén Rizo
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Laura Serrano-Mateo
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Borja Alcobía-Díaz
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Alberto Rodríguez-González
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Hemiarthroplasty for proximal humerus fractures with conservation of the whole humeral head as autograft: does it improve greater tuberosity healing? INTERNATIONAL ORTHOPAEDICS 2018; 43:1155-1164. [DOI: 10.1007/s00264-018-3995-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
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25
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FERREIRA ARNALDOAMADO, MALAVOLTA EDUARDOANGELI, ASSUNÇÃO JORGEHENRIQUE, GRACITELLI MAUROEMILIOCONFORTO, OCAMPOS GUILHERMEPEREIRA, TRINDADE EVELINDAMARRAMON. QUALITY OF LIFE IN PATIENTS WITH ROTATOR CUFF ARTHROPATHY. ACTA ORTOPEDICA BRASILEIRA 2017; 25:275-278. [PMID: 29375259 PMCID: PMC5782863 DOI: 10.1590/1413-785220172506173893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/26/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales. METHODS This cross-sectional study with controls paired by sex and age compared patients with rotator cuff arthropathy with surgical indication for reverse shoulder arthroplasty. The groups were compared according to the SF-12, ASES, and VAS scales. RESULTS The groups consisted of 38 individuals, 28 women. The SF-12 demonstrated a significant difference in the physical component, with the cases scoring 31.61 ± 6.15 and the controls 49.39 ± 6.37 (p<0.001). For the mental component, the difference was not significant, with the cases scoring 44.82 ± 13.18 and the controls 48.96 ± 8.65 (p=0.109). The cases scored 7.34 ± 2.11 on the VAS and 31.26 ± 15.12 on the ASES, while the controls scored 0.55 ± 1.31 and 97.53 ± 6.22, respectively (p<0.001). CONCLUSION Patients with rotator cuff arthropathy had poorer results for the physical component of the SF-12 than the controls. They also had poorer functional results according to the ASES scale, and more pain according to the VAS. Level of Evidence III, Case Control Study.
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Affiliation(s)
- ARNALDO AMADO FERREIRA
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - EDUARDO ANGELI MALAVOLTA
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - JORGE HENRIQUE ASSUNÇÃO
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - MAURO EMILIO CONFORTO GRACITELLI
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - GUILHERME PEREIRA OCAMPOS
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - EVELINDA MARRAMON TRINDADE
- . São Paulo State Health Technology Assessment Network, São Paul State Department of Health, São Paulo, SP, Brazil
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26
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Lopiz Y, García-Fernández C, Arriaza A, Rizo B, Marcelo H, Marco F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1581-1588. [PMID: 28408254 DOI: 10.1016/j.jse.2017.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose of this study was to determine the complications, rate of healing, and functional results of glenoid bone grafting in primary or revision surgery with reverse shoulder arthroplasty. METHODS We retrospectively reviewed 23 patients with glenoid bone loss who underwent primary or revision surgery using a glenoid bone graft with a minimum follow-up of 2 years. Range of motion and the Constant, American Shoulder and Elbow Surgeons, and visual analog scale scores were obtained from preoperative assessment and the latest follow-up visit. Radiographic evaluation included analysis of plain radiographs as well as preoperative and follow-up computed tomography. RESULTS Three patients were excluded from the study. Allografts were used in 13 cases and autografts in 7 cases. The mean Constant score improved from 30.7 ± 9.4 to 51.3 ± 13.4 (P < .001). At a mean follow-up of 26 months, computed tomography imaging revealed that the glenoid bone graft was fully incorporated in 95% of cases. No statistically significant differences were found on analysis of the clinical and radiographic outcomes related to the graft source. There was a 20% postoperative complication rate: 1 case of aseptic glenoid component loosening, 1 surgical wound hematoma, 1 acromial fracture, and a symptomatic grade 3 scapular notching. CONCLUSIONS The use of bone grafts in glenoid defects is a useful technique by which, in the majority of cases, single-stage reconstruction surgery may be performed, even in the presence of severe bone loss. Incorporation rates are high, with satisfactory clinical outcome.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain; Departamento de Cirugía, Complutense University, Madrid, Spain.
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
| | - Alvaro Arriaza
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
| | - Belen Rizo
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
| | - Hector Marcelo
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Madrid, Spain; Departamento de Cirugía, Complutense University, Madrid, Spain
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Wolfensperger F, Grüninger P, Dietrich M, Völlink M, Benninger E, Schläppi M, Meier C. Reverse shoulder arthroplasty for complex fractures of the proximal humerus in elderly patients: impact on the level of independency, early function, and pain medication. J Shoulder Elbow Surg 2017; 26:1462-1468. [PMID: 28372970 DOI: 10.1016/j.jse.2017.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/21/2016] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study investigated early functional outcome, quality of life, and the level of independency in elderly patients after primary reverse shoulder arthroplasty (RSA) for complex fractures of the proximal humerus. METHODS This was a prospective case series that included 33 patients, aged ≥70 years, with a high level of independency who received RSA for complex fractures of the humerus (Orthopaedic Trauma Association B2/C) from January 2012 to April 2014. RESULTS Level of independency, quality of life (Short Form 36 Health Survey score), early functional outcome (Constant-Murley score, Disabilities of the Arm, Shoulder and Hand Outcome Measure), and pain medication (World Health Organization grading) were obtained at the 6-month follow-up and 1 year after surgery. The Constant-Murley score was 64 ± 14 after 6 months and 71 ± 12 at 1 year (P < .001), reaching 87% compared with the contralateral shoulder. The Disabilities of the Arm, Shoulder and Hand score reached 29 ± 20 at 6 months and 30 ± 21 at 1 year. The Short Form 36 score was comparable to normative data. After 6 months, 84% of our study group were back at their previous level of independency. Within 1 year, this rate increased to 91%. At the 1-year follow-up, analgesia intake was back at the level before the injury in 97% of the patients. CONCLUSIONS Primary RSA provides good early functional results, reliable pain control, and excellent restoration of an independent life style in elderly patients. Thus, RSA may be considered for active patients with a high demand on shoulder function.
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Affiliation(s)
| | | | | | - Mathias Völlink
- Department of Orthopedics, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Emanuel Benninger
- Department of Orthopedics and Traumatology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Michel Schläppi
- Department of Orthopedics and Traumatology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christoph Meier
- Department of Orthopedics and Traumatology, Kantonsspital Winterthur, Winterthur, Switzerland
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Roberson TA, Granade CM, Hunt Q, Griscom JT, Adams KJ, Momaya AM, Kwapisz A, Kissenberth MJ, Tolan SJ, Hawkins RJ, Tokish JM. Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg 2017; 26:1017-1022. [PMID: 28139385 DOI: 10.1016/j.jse.2016.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups. METHODS A retrospective review was performed on all 3- and 4-part proximal humeral fractures treated with either RSA or nonoperative treatment with minimum 1-year follow-up. All patients in the nonoperative cohort were offered RSA but declined. Objective patient data were obtained from medical records. Patient-reported outcomes including visual analog scale score, Single Assessment Numeric Evaluation score, Penn Shoulder Score, American Shoulder and Elbow Surgeons score, resiliency score, and Veterans Rand-12 scores were obtained at follow-up. Statistical analysis was performed by use of the Student t test for continuous variables and χ2 analysis for nonparametric data. RESULTS We analyzed 19 nonoperative and 20 RSA patients with a mean follow-up period greater than 2 years (29 months in nonoperative group and 53 months in RSA group). There were no differences in range of motion between groups (forward elevation, 120° vs 119° [P = .87]; external rotation, 23° vs 31° [P = .06]). No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes. Among patients receiving RSA, there was no difference in outcomes in those undergoing surgery less than 30 days after injury versus those receiving delayed RSA. CONCLUSIONS This study suggests that there are minimal benefits of RSA over nonoperative treatment for 3- and 4-part proximal humeral fractures in older adults.
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Affiliation(s)
- Troy A Roberson
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | - Charles M Granade
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Quinn Hunt
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - James T Griscom
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | | | - Amit M Momaya
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | | | | | - Stefan J Tolan
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | | | - John M Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
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29
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Savin DD, Zamfirova I, Iannotti J, Goldberg BA, Youderian AR. Survey study suggests that reverse total shoulder arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly. INTERNATIONAL ORTHOPAEDICS 2016; 40:1919-25. [PMID: 27194158 DOI: 10.1007/s00264-016-3227-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The role of reverse total shoulder arthroplasty (RTSA) for three and four-part proximal humerus fractures is evolving. However, there does not appear to be a clear consensus amongst surgeons. The purpose of this study is to further define the standard of care, assessing surgeon preference and treatment considerations for management of such fractures. METHODS Orthopaedic surgeons were surveyed on their training, practice setting, and experience regarding management of four-part proximal humerus fractures. The survey also presented five representative cases to assess treatment preferences. RESULTS Two hundred five surgeons responded to the survey with fellowship training in shoulder and elbow surgery (114), orthopaedic trauma (35) or sports medicine/other training (56). There was no difference between respondents with years in practice and confidence with performing RTSA, however, surgeons in the academic setting were more confident in performing the surgery. Surgeons preferred RTSA for management of four-part fractures in patients over age 65. However, they also trended to favour hemiarthroplasty with higher co-morbidities. Physicians with more than 11 years of experience were more likely to choose hemiarthroplasty for older and high comorbidity patients. RTSA was not the preferred treatment method for younger, active patients. Patient age and fracture pattern had a greater influence on the surgeon's decision. CONCLUSIONS There is a consensus in our study population that RTSA is the preferred treatment for four-part proximal humerus fractures for elderly patients with patient age and fracture pattern being the most important factors in making management decisions. LEVEL OF EVIDENCE Level III - Case controlled study.
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Affiliation(s)
- David D Savin
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, Room E270, M/c 844, Chicago, IL, 60612, USA.
| | - Ina Zamfirova
- Center for Advance Care, Russell Institute for Research and Innovation, 1700 Luther Lane. STE 1410, Park Ridge, IL, 60068, USA
| | - Joseph Iannotti
- Cleveland Clinic Main Campus, Mail Code A41 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Benjamin A Goldberg
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, Room E270, M/c 844, Chicago, IL, 60612, USA
| | - Ari R Youderian
- South County Orthopedic Specialists, 24331 El Toro Road #200, Laguna Woods, CA, 92637, USA
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30
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de Beer J, Bhatia DN. Arthroplasty of the shoulder joint. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2016; 10:57-8. [PMID: 27186056 PMCID: PMC4857531 DOI: 10.4103/0973-6042.180716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Joe de Beer
- Cape Shoulder Institute, Cape Town, South Africa
| | - Deepak N Bhatia
- Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
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31
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Ihle C, Ateschrang A, Grünwald L, Stöckle U, Saier T, Schröter S. Health-related quality of life and clinical outcomes following medial open wedge high tibial osteotomy: a prospective study. BMC Musculoskelet Disord 2016; 17:215. [PMID: 27189005 PMCID: PMC4870804 DOI: 10.1186/s12891-016-1076-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/11/2016] [Indexed: 12/23/2022] Open
Abstract
Background Open wedge high tibial osteotomy (HTO) is an established method for the treatment of patients with varus malalignment and medial compartment osteoarthritis. In these patients, health-related quality of life (HRQL) can be improved by using this procedure. The purpose of the present study consisted in evaluating HRQL up to 18 months after HTO, comparing the results to values of the German normal population, and in analyzing the impact of preoperative HRQL on the postoperative clinical result. It was hypothesized that normal values in physical and mental health can be achieved within 18 months after operation. Study design: Prospective case series. Level of evidence: IV. Methods 120 patients were included in this prospective case series from 12/2008 to 12/2011. All patients underwent open wedge HTO without a bone graft using the TomoFixTM plate. HRQL was assessed by using the SF-36 questionnaire, preoperatively, as well as 6, 12, and 18 months postoperatively. Regular scoring, norm-based scaling, and the physical and mental component summary scores (PCS and MCS) were evaluated. Clinical outcome was assessed by using Lequesne, Lysholm, HSS and IKDC Score. Results HRQL could be described in 96 patients. The PCS of HRQL showed a statistically significant pre- to postoperative improvement (30.2 ± 13.4 to 45.9 ± 13.5 after 18 months). A reduced preoperative mental component summary score (MCS) resulted in lower values of each clinical score (p < 0.05) and in a prolonged duration of incapacity for work (MCS < 50:15.0 ± 12.8 weeks, vs. MCS ≥ 50: 9.1 ± 4.8 weeks, p < 0.05). MCS values improved from the pre- to postoperative measurements and comparable values to the normal population were reached already within 6 months after surgery (46.0 ± 14.9 pre-operatively and 48.5 ± 13.7 after 6 months), and after 18 months even a score of 49.5 ± 12.4 was achieved. Conclusion Lower preoperative mental component score results in reduced postoperative clinical outcome and prolonged duration of incapacity for work after HTO. In contrast to PCS, MCS showed comparable values to the normal population within 6 months after HTO.
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Affiliation(s)
- Christoph Ihle
- BG Traumacenter Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Atesch Ateschrang
- BG Traumacenter Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Leonard Grünwald
- BG Traumacenter Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Ulrich Stöckle
- BG Traumacenter Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Tim Saier
- BG Traumacenter Murnau, Prof.-Küntscher-Str. 8, Murnau, Germany
| | - Steffen Schröter
- BG Traumacenter Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
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