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Ward BA, Kowalsky MS. Treatment of race and ethnicity in shoulder and elbow research: An analysis of the most cited papers on rotator cuff repair. J Orthop 2024; 55:86-90. [PMID: 38665989 PMCID: PMC11039319 DOI: 10.1016/j.jor.2024.04.006] [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: 11/28/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Background This study examined the current approach to the inclusion of race and ethnicity among frequently referenced shoulder surgery literature and discussed guidance for best practices for the inclusion of race and ethnicity in shoulder research. Methods The shoulder literature were systematically reviewed for the most frequently cited studies discussing rotator cuff repair, total shoulder arthroplasty, and Bankart repair. All reviewed studies met the timeline criteria (2013-2022). Only studies with clinical outcomes were included. Review articles, meta-analyses, systematic reviews, basic science studies, or any manuscript that did not represent clinical outcomes research were excluded. Author, year issued, the journal in which the paper was published, study design, the number of subjects, duration of follow-up, independent variables, dependent variables, results, and conclusions were extracted from the articles that met the inclusion criteria. Whether race and/or ethnicity were included in the study design in any way was also recorded. For those studies in which race and ethnicity were included, a detailed analysis of the paper's treatment of race using the JAMA Updated Guidance on Reporting of Race and Ethnicity in Medical and Science Journals was performed and recorded. Results In the "rotator cuff repair" cohort of papers, there were 2 articles that mention race. Out of the 2 articles that mentioned race, neither included race appropriately using the JAMA Updated Guidance on Reporting of Race and Ethnicity in Medical and Science Journals. In the "Bankart repair" cohort of papers, each article lacked the mention of race among their patient population. The "total shoulder arthroplasty" manuscripts also did not include treatment of race and ethnicity in any way. Discussion Race and ethnicity and other social determinants of health can be used to understand the source of healthcare disparities. Unless a thoughtful and deliberate consideration of race and ethnicity is undertaken, their inclusion in clinical research can be a double-edged sword due to the potential race and ethnicity-centered treatment involvement can be rooted in fallacies. In shoulder surgery clinical research, race and ethnicity should be considered in concert with social factors that could exacerbate poor patient outcomes in our patient population. Level of evidence Level V.
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Affiliation(s)
| | - Marc S. Kowalsky
- ONS Foundation for Clinical Research & Education, Orthopedic & Neurosurgery Specialists, 40 Valley Drive 6, Greenwich Office Park, Greenwich, CT, 06831, USA
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Bindi VE, Buchanan TR, Cueto RJ, Hones KM, Wright TW, Schoch BS, King JJ, Hao KA. Mitigating the Risk of Instability After Reverse Shoulder Arthroplasty: A Critical Analysis Review of Patient and Surgical Factors. JBJS Rev 2024; 12:01874474-202409000-00001. [PMID: 39226391 DOI: 10.2106/jbjs.rvw.24.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
» Instability and dislocation after reverse shoulder arthroplasty may occur in up to 31% of patients. » Clinical risk factors for instability include younger age, male sex, increased body mass index, preoperative diagnosis of proximal humerus fracture or rotator cuff pathology, history of instability of the native shoulder or after surgery, and a medical history of Parkinson's disease. » Patients with rheumatoid arthritis and decreased proximity to the coracoid may also be at greater risk. » In patients at a high risk of instability, surgeons should consider a more lateralized prosthesis (particularly in patients with an incompetent rotator cuff), repairing the subscapularis (particularly when using a medialized prosthesis), and upsizing the glenosphere (>40 mm in male and 38-40 mm in female patients). » While potentially useful, less evidence exists for the use of a constrained liner (particularly with a lateralized glenosphere and/or in low-demand patients) and rotating the polyethylene liner posteriorly to avoid impingement.
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Affiliation(s)
- Victoria E Bindi
- College of Medicine, University of Florida, Gainesville, Florida
| | | | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, Florida
| | - Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Kevin A Hao
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
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Sullivan MH, Arguello AM, Barlow JD, Morrey ME, Rose PS, Sanchez-Sotelo J, Houdek MT. Comparison of reconstructive techniques for nonprimary malignancies in the proximal humerus. J Surg Oncol 2024; 130:64-71. [PMID: 38837768 DOI: 10.1002/jso.27693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 05/12/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Endoprostheses (EPC) are often utilized for reconstruction of the proximal humerus with either hemiarthroplasty (HA) or reverse arthroplasty (RA) constructs. RA constructs have improved outcomes in patients with primary lesions, but no studies have compared techniques in metastatic disease. The aim of this study is to compare functional outcomes and complications between HA and RA constructs in patients undergoing endoprosthetic reconstruction for proximal humerus metastases. METHODS We retrospectively reviewed our institutional arthroplasty database to identify 66 (56% male; 38 HA and 28 RA) patients with a proximal humerus reconstruction for a non-primary malignancy. The majority (88%) presented with pathologic fracture, and the most common diagnosis was renal cell carcinoma (48%). RESULTSS Patients with RA reconstructions had better postoperative forward elevation (74° vs. 32°, p < 0.01) and higher functional outcome scores. HA patients had more complications (odds ratio 13, p < 0.01), with instability being the most common complication. CONCLUSIONS Patients with nonprimary malignancies of the proximal humerus had improved functional outcomes and fewer complications after undergoing reconstruction with a reverse EPC compared to a HA EPC. Preference for reverse EPC should be given in patients with good prognosis and ability to complete postoperative rehabilitation.
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Affiliation(s)
- Mikaela H Sullivan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Karimi A, Reddy RP, Njoku-Austin C, Nazzal E, James MG, Lin A. Reverse total shoulder arthroplasty for primary osteoarthritis with restricted preoperative forward elevation demonstrates similar outcomes but faster range of motion recovery compared to anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:S104-S110. [PMID: 38485082 DOI: 10.1016/j.jse.2024.03.003] [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: 11/22/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RSA) has been increasingly utilized for a variety of shoulder pathologies that are difficult to treat with anatomical total shoulder arthroplasty (TSA). Few studies have compared the outcomes of TSA vs. RSA in patients with cuff intact glenohumeral osteoarthritis and poor preoperative forward elevation. This study aimed to determine whether there is a difference in functional outcomes and postoperative range of motion (ROM) between TSA and RSA in these patients. METHODS This retrospective cohort study included 116 patients who underwent RSA or TSA between 2013 and 2022 for the treatment of rotator cuff intact primary osteoarthritis with restricted preoperative forward flexion (FF) and a minimum 1-year follow-up. Each arthroplasty group was divided into 2 subgroups: patients with preoperative FF between 91° and 120° or FF lower than or equal to 90°. Patients' clinical outcomes, including active ROM, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and subjective shoulder value were collected. Clinical and radiographic complications were evaluated. RESULTS There was no significant difference between RSA and TSA in terms of sex (58.3% male vs. 62.2% male, P = .692), or follow-up duration (20.1 months vs. 17.7 months, P = .230). However, the RSA cohort was significantly older (72.0 ± 8.2 vs. 65.4 ± 10.6, P = .012) and weaker in FF and (ER) before surgery (P < .001). There was no difference between RSA (57 patients) and TSA (59 patients) in visual analog scale pain score (1.2 ± 2.3 vs. 1.3 ± 2.3, P = .925), subjective shoulder value score (90 ± 15 vs. 90 ± 15, P = .859), or American Shoulder and Elbow Surgeons score (78.4 ± 20.5 vs. 82.1 ± 23.2, P = .476). Postoperative active ROM was statistically similar between RSA and TSA cohorts in FF (145 ± 26 vs. 146 ± 23, P = .728) and ER (39 ± 15 vs. 41 ± 15, P = .584). However, internal rotation was lower in the RSA cohort (P < .001). This was also true in each subgroup. RSA led to faster postoperative FF and ER achievement at 3 months (P < .001). There was no statistically significant difference in complication rates between cohorts. CONCLUSION This study demonstrates that patients with glenohumeral osteoarthritis who have a structurally intact rotator cuff but limited preoperative forward elevation can achieve predictable clinical improvement in pain, ROM, and function after either TSA or RSA. Reverse arthroplasty may be a reliable treatment option in patients at risk for developing rotator cuff failure.
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Affiliation(s)
- Amin Karimi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA; Research Development Unit, Department of Orthopaedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Confidence Njoku-Austin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Ehab Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Michael G James
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
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Testa EJ, Glass E, Ames A, Swanson DP, Polisetty TS, Cannon DJ, Le K, Bowler A, Levy JC, Jawa A, Kirsch JM. Indication matters: effect of indication on clinical outcome following reverse total shoulder arthroplasty-a multicenter study. J Shoulder Elbow Surg 2024; 33:1235-1242. [PMID: 37944747 DOI: 10.1016/j.jse.2023.09.033] [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: 05/22/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND As the utilization and success of reverse total shoulder arthroplasty (RTSA) have continued to grow, so have its surgical indications. Despite the adoption of RTSA for the treatment of glenohumeral osteoarthritis (GHOA) with an intact rotator cuff and irreparable massive rotator cuff tears (MCTs) without arthritis, the literature remains sparse regarding the differential outcomes after RTSA among these varying indications. Thus, the purpose of this study was to examine the postoperative clinical outcomes of RTSA based on indication. METHODS A retrospective review of 2 large institutional databases was performed to identify all patients who underwent RTSA between 2015 and 2019 with minimum 2-year follow-up. Patients were stratified by indication into 3 cohorts: GHOA, rotator cuff tear arthropathy (CTA), and MCT. Baseline demographic characteristics were collected to determine differences between the 3 cohorts. Clinical outcomes were measured preoperatively and postoperatively, including active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation score, and visual analog scale pain score. Multivariate linear regression was performed to determine the factors independently predictive of the postoperative ASES score. RESULTS A total of 625 patients (383 with GHOA, 164 with CTA, and 78 with MCTs) with a mean follow-up period of 33.4 months were included in the analysis. Patients with GHOA had superior ASES scores (85.6 ± 15.7 vs. 76.6 ± 20.8 in CTA cohort [P < .001] and 75.9 ± 19.9 in MCT cohort [P < .001]), Single Assessment Numeric Evaluation scores (86 ± 20.9 vs. 76.7 ± 24.1 in CTA cohort [P < .001] and 74.2 ± 25.3 in MCT cohort [P < .001]), and visual analog scale pain scores (median [interquartile range], 0.0 [0.0-1.0] vs. 0.0 [0.0-2.0] in CTA cohort [P < .001] and 0.0 [0.0-2.0] in MCT cohort [P < .001]) postoperatively. Postoperative active forward elevation (P < .001) and improvement in active external rotation (P < .001) were greatest in the GHOA cohort compared with other indications. Multivariate linear regression demonstrated that the factors independently associated with the postoperative ASES score included a diagnosis of GHOA (β coefficient, 7.557 [P < .001]), preoperative ASES score (β coefficient, 0.114 [P = .009]), female sex (β coefficient, -4.476 [P = .002]), history of surgery (β coefficient, -3.957 [P = .018]), and postoperative complication (β coefficient, -13.550 [P < .001]). CONCLUSION RTSA for the treatment of GHOA generally has superior patient-reported and functional outcomes when compared with CTA and MCTs without arthritis. Long-term follow-up is needed to identify the lasting implications of such outcome differences.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Evan Glass
- Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA
| | - Andrew Ames
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Daniel P Swanson
- Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA
| | | | - Dylan J Cannon
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK, USA
| | - Kiet Le
- Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA; Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Adam Bowler
- Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA
| | - Jonathan C Levy
- Levy Shoulder Center at Paley Orthopedic & Spine Institute, Boca Raton, FL, USA
| | - Andrew Jawa
- Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA; Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Jacob M Kirsch
- Boston Sports and Shoulder Center Research Foundation, Waltham, MA, USA; Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA.
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Jin H, Jiang S, Pavel V, Tadum Arthur Vithran D, Xiao W, Li Y. Global trends and research hotspots of reverse total shoulder arthroplasty: a bibliometric analysis from 1991 to 2022. EFORT Open Rev 2024; 9:297-308. [PMID: 38579787 PMCID: PMC11044086 DOI: 10.1530/eor-23-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Reverse total shoulder arthroplasty (rTSA) has been demonstrated to be an effective intervention for various shoulder disorders. The number of rTSA-related studies performed has increased annually over the past three decades. The Journal of Shoulder and Elbow Surgery had the highest number of publications and citations in the rTSA-related research domain and is therefore considered to be the most influential journal in this field. The USA published the most publications and established a high degree of cooperation with many countries worldwide. The University of Florida, the Hospital for Special Surgery, and Rush University, Mayo Clinic were representative and active institutions in this field. It is anticipated that advancements in prosthesis design, specifically with regards to lateralized design concepts, expanding indications for rTSA, a trend toward younger patient populations, and the management of postoperative complications will emerge as research hotspots in the following years. The most valuable publications, influential journals, major researchers, and leading countries were analyzed. The findings of our study will help researchers gain insights into current research hotspots and frontiers and shape their research focus in the field of rTSA.
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Affiliation(s)
- Hongfu Jin
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shide Jiang
- Department of Orthopaedics, The Central Hospital of Yongzhou, Yongzhou, Hunan, China
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Belarus
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Alexander N, Zdravkovic V, Spross C, Olach M, Jost B. Reversed total shoulder arthroplasty for rotator cuff arthropathy is associated with increased scapulothoracic motion: A longitudinal two-year kinematic study. Gait Posture 2024; 109:34-40. [PMID: 38262099 DOI: 10.1016/j.gaitpost.2024.01.011] [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: 09/17/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Reversed total shoulder arthroplasty (RTSA) is a standard surgical procedure for the treatment of rotator cuff tear arthropathy (CTA), aimed at restoring active arm elevation. Shoulder elevation relies on both scapulothroacic (ST) and glenohumeral (GH) motion, but RTSA computer planning primarily focuses on the GH joint due to challenges in visualizing scapulothroacic (ST) motion. RESEARCH QUESTION Does the scapulohumeral rhythm, by means of the relative contributions of ST rotation and GH elevation per degree of arm elevation, in a longitudinal setting for up to two years postoperatively after RTSA for CTA change? METHODS In a prospective longitudinal study, shoulder kinematics were studied in 20 patients (22 shoulders) before and at three, six, 12, and 24 months after RTSA implantation for CTA. Skin markers were tracked using 3D motion analysis. The relative ST and GH contributions per degree of arm elevation were assessed and were compared using statistical non-parametric mapping with Bayesian inference. RESULTS Mean arm elevation was 89 ± 33° preoperatively, 135 ± 28° at 3 months, 161 ± 20° at 6 months, 169 ± 18° at 12 months, and 165 ± 19° at 24 months. Between 48-66°, 62-93°, 53-94°, 60-97° and 72-104° of arm elevation at the measurement time points pre, 3-months, 6-months, 12-months and 24-months postoperatively, respectively, the ST rotation had a significantly greater contribution to arm elevation compared to GH elevation; a pattern that was not found in controls. SIGNIFICANCE While RTSA successfully restored active arm elevation through improved GH and ST motion, the scapulohumeral rhythm exhibited a consistent pattern up to two years postoperatively, resembling the preoperative state. In the midrange of motion, ST rotation dominated over GH elevation, potentially contributing to muscular fatigue and explaining the documented decline in functional outcomes over time after RTSA. The findings highlight the importance of incorporating ST kinematics into modern computer planning for RTSA.
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Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, Switzerland; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Spross
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Olach
- Department of Orthopaedics and Traumatology, Hospital Wil, Wil, Switzerland
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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Houdek MT, Sullivan MH, Broida SE, Barlow JD, Morrey ME, Moran SL, Sanchez-Sotelo J. Proximal Humerus Reconstruction for Bone Sarcomas: A Critical Analysis. JBJS Rev 2024; 12:01874474-202403000-00008. [PMID: 38466801 DOI: 10.2106/jbjs.rvw.23.00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
» The proximal humerus is a common location for primary bone tumors, and the goal of surgical care is to obtain a negative margin resection and subsequent reconstruction of the proximal humerus to allow for shoulder function.» The current evidence supports the use of reverse total shoulder arthroplasty over hemiarthroplasty when reconstructing the proximal humerus after resection of a bone sarcoma if the axillary nerve can be preserved.» There is a lack of high-quality data comparing allograft prosthetic composite (APC) with endoprosthetic reconstruction of the proximal humerus.» Reverse APC should be performed using an allograft with donor rotator cuff to allow for soft-tissue repair of the donor and host rotator cuff, leading to improvements in shoulder motion compared with an endoprosthesis.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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Turnbull LM, Hao KA, Bindi VE, Wright JO, Wright TW, Farmer KW, Vasilopoulos T, Struk AM, Schoch BS, King JJ. Anatomic versus reverse total shoulder arthroplasty outcomes after prior contralateral anatomic total shoulder arthroplasty in patients with bilateral primary osteoarthritis with an intact rotator cuff. INTERNATIONAL ORTHOPAEDICS 2024; 48:801-807. [PMID: 38032497 DOI: 10.1007/s00264-023-06044-w] [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: 07/22/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE We aimed to compare outcomes in patients that underwent bilateral anatomic total shoulder arthroplasty (aTSA) vs. aTSA/ reverse total shoulder arthroplasty (rTSA) for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA) to further elucidate the role of rTSA in this patient population. METHODS A single-institution prospectively collected shoulder arthroplasty database was reviewed for patients undergoing bilateral total shoulder arthroplasty (TSA) for RCI-GHOA with a primary aTSA and subsequent contralateral aTSA or rTSA. Outcome scores (SPADI, SST, ASES, UCLA, Constant) and active range of motion (abduction, forward elevation [FE], external and internal rotation [ER and IR]) were evaluated. Clinically relevant benchmarks (minimal clinically important difference [MCID], substantial clinical benefit [SCB], and patient acceptable symptomatic state [PASS]) were evaluated against values in prior literature. Incidence of surgical complications and revision rates were examined in qualifying patients as well as those without RESULTS Of the 55 bilateral TSA patients with an intact rotator cuff, 46 underwent aTSA/aTSA and 9 underwent aTSA/rTSA. At the time of the second TSA, patients undergoing aTSA/rTSA were older (71 ± 4 vs. 67 ± 7, P = .032) and more commonly had inflammatory arthritis (44% vs. 11%, P = .031). Mean time to the second TSA was shorter for aTSA/aTSA (2.3 ± 2.8 vs. 4.4 ± 3.6 years, P < .001). Postoperative outcomes were similar after the first aTSAs between groups with similar proportions achieving the MCID, SCB, and PASS (all P > .05). The 2nd TSAs between groups were similar preoperatively, but aTSA/rTSA had superior outcome scores, overhead motion, and active abduction compared to patients that underwent aTSA/aTSA. There were no differences in active ER and IR scores or complication rates between groups. CONCLUSION Patients with RCI-GHOA have excellent clinical outcomes after either aTSA/aTSA or aTSA/rTSA.
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Affiliation(s)
- Lacie M Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Victoria E Bindi
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA
| | - Terrie Vasilopoulos
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA.
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10
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Kim SH. Comparison between Anatomic Total Shoulder Arthroplasty and Reverse Shoulder Arthroplasty for Older Adults with Osteoarthritis without Rotator Cuff Tears. Clin Orthop Surg 2024; 16:105-112. [PMID: 38304222 PMCID: PMC10825258 DOI: 10.4055/cios23249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 02/03/2024] Open
Abstract
Background Many older adults with glenohumeral osteoarthritis without rotator cuff tears experience muscle atrophy and fatty degeneration. In these cases, range of motion (ROM) recovery and clinical results after total shoulder arthroplasty (TSA) could be poor, with low subjective satisfaction after surgery. The purpose of this study was to compare the clinical outcomes of anatomic TSA and reverse shoulder arthroplasty (RSA) in patients aged over 70 years with primary glenohumeral osteoarthritis without rotator cuff tears. We hypothesized that the clinical outcomes of anatomical TSA would be better than those of RSA. Methods This single-center, retrospective comparative study involved patients who underwent TSA or RSA from 2013 to 2020. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and active ROM preoperatively and at the follow-up. Walch classification and glenoid version angle were measured using preoperative computed tomography, and fatty infiltration of supraspinatus and infraspinatus muscles were checked through preoperative magnetic resonance imaging. Results Of the 67 patients included in this study, TSA was performed in 41 patients (TSA group), and RSA was performed in 26 patients (RSA group). The two groups had no clinical differences in the patients' preoperative demographic and radiographic data. At the final follow-up, both groups showed improved pain, ROM, and functional outcomes. Moreover, the TSA group demonstrated significantly better postoperative ASES (86.8 ± 6.3 vs. 81.6 ± 5.5, p = 0.001) and Constant-Murley (80.4 ± 5.7 vs. 73.4 ± 6.2, p < 0.001) scores than the RSA group. The TSA group showed a significantly better postoperative active ROM than the RSA group regarding forward flexion as well as external and internal rotations (p < 0.001). All patients in the RSA and TSA groups exceeded the minimal clinically important difference. Conclusions In older adult patients with degenerative glenohumeral osteoarthritis wherein the rotator cuff is preserved without excessive bone loss, anatomic TSA and RSA can improve pain, ROM, and clinical outcomes. However, clinical results and ROM were better with TSA than with RSA during the short- and mid-term follow-up periods.
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Affiliation(s)
- Seong Hun Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Cui H, Cheong J, McKenzie D, Gould D, Rele S, Patel M. Outcomes of conservative treatment of acromial and scapular spine stress fracture post reverse shoulder arthroplasty: a systematic review with meta-analysis. J Shoulder Elbow Surg 2023; 32:2613-2630. [PMID: 37573934 DOI: 10.1016/j.jse.2023.07.011] [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: 03/22/2023] [Revised: 06/25/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Acromial and scapular spine stress fractures are common complications post reverse shoulder arthroplasty. A systematic review with meta-analysis was conducted to evaluate the clinical outcomes of conservatively treated acromial and scapular spine stress fractures post reverse shoulder arthroplasty in comparison to nonfracture control. METHODS Embase, MEDLINE, and Web of Science were searched on September 9, 2022, using various terms related to fracture, acromion, scapula, and reverse shoulder arthroplasty. Meta-analysis using a random effects model was performed on common outcome scores. Risk of bias was assessed using the Joanna Briggs Institute tools for case-controlled studies. Sensitivity analysis was performed for imputed standard deviations and studies with <20 participants. RESULTS Thirteen studies with a total of 339 fracture and 3142 control patients were included in the systematic review. Meta-analysis was performed on 12 studies assessing active forward flexion, abduction, external rotation, Constant-Murley score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, pain score, Simple Shoulder Test, and Single Assessment Numeric Evaluation. Fracture patients experienced significantly poorer functional outcome compared with control patients when the fractures were managed conservatively. Levy III fractures tend to experience worse outcomes. Pain score did not demonstrate a statistically significant difference between the fracture and nonfracture cohort. DISCUSSION Currently, literature regarding surgical management is lacking, partially because of a dearth of high-quality literature but also hindered by a lack of standardized techniques. This review was limited by inclusion of studies of low evidence, small sample sizes, and inconsistency in outcome measurement and follow-up period. Overall, patients with acromial and scapular spine stress fractures treated conservatively are expected to have reduced shoulder function compared to nonfracture patients, with the spine of scapula fracture patients suffering the poorest outcomes. Future studies should aim to use the same sets of outcomes parameters to assess the patients at fixed time intervals and report outcomes stratified by Levy classification. This will enable interinstitutional collaboration and pooling of results.
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Affiliation(s)
- Haoze Cui
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Epworth Clinical School, Epworth HealthCare, Melbourne, VIC, Australia.
| | - Joel Cheong
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Epworth Clinical School, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean McKenzie
- Research Development and Governance, Epworth HealthCare, Melbourne, VIC, Australia; Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Daniel Gould
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Siddharth Rele
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Minoo Patel
- Musculoskeletal Institute, Epworth HealthCare, Melbourne, VIC, Australia; Faculty of Health and Engineering, Royal Melbourne Institute of Technology University, Melbourne, VIC, Australia
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12
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Sun S, Eichinger JK, Yao H, Friedman RJ. Three-dimensional finite element modeling of glenoid bone loss and baseplate fixation in reverse total shoulder arthroplasty. SEMINARS IN ARTHROPLASTY 2023; 33:768-774. [PMID: 39022765 PMCID: PMC11251874 DOI: 10.1053/j.sart.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Background Posterior glenoid bone loss is frequently observed in patients with osteoarthritis undergoing reverse total shoulder arthroplasty. Glenoid bone loss can reduce the baseplate back support area and the number of screws for fixation. The purpose of this study is to determine how initial baseplate fixation is affected by biomechanical factors introduced by glenoid bone loss such as reduced baseplate back support area and reduced screw number using three-dimensional finite element analysis. Methods Computerized tomography images of a healthy shoulder were selected and segmented to obtain the solid geometry. Solid models were generated with 100%, 75%, 67%, 50%, and 25% glenoid baseplate back support. With these geometries, two groups of finite element models were then built. In the bone loss areas, screws were maintained in one group of models but were removed in the other group of models. 750N compressive loading was applied along the direction parallel to the scapula axis. Maximum von Mises stress and maximum micromotion between the bone and implant were recorded and evaluated for each glenoid bone model. Results In the group of models where all screws remained in place, the maximum stress and maximum micromotion between the bone and implant exhibited minimal variation. The maximum stresses were 21.10MPa and the maximum micromotions were between 2-3 μm. However, in the group of models removing screws in the bone loss areas, maximum stress increased from 20MPa to 45MPa and maximum micromotion increased from 2 μm to 85 μm as the backside support area decreased from 100% to 25%. Discussion In conclusion, this three-dimensional finite element analysis study demonstrates that initial fixation can be achieved with approximately 1/3 posterior glenoid bone deficiency even without screw placement in the area of bone loss. Glenoid bone loss affects baseplate fixation mainly by reducing the screw numbers for fixation. If screws can be placed in the bone loss area, the decreased baseplate back support area will not result in increased stresses or micromotion leading to baseplate failure. This study suggests that surgeons should consider applying screws to the bone loss area if the remaining bone is able to hold the screw. Level of evidence Computer Modeling Study.
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Affiliation(s)
- Shuchun Sun
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Josef K. Eichinger
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, USA
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Richard J. Friedman
- Department of Bioengineering, Clemson University, Clemson, SC, USA
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
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13
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Gross BD, White CA, Wang KC, Patel AV, Parsons BO, Cagle PJ. The 50 most-cited articles in reverse shoulder arthroplasty. Shoulder Elbow 2023; 15:82-93. [PMID: 37974642 PMCID: PMC10649503 DOI: 10.1177/17585732231155123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 11/19/2023]
Abstract
Background Citation analyses have been used to understand the impact that a group of publications has on its field. As the techniques and indications of reverse total shoulder arthroplasty (RTSA) continue to expand, it is important to identify articles that can orient readers to the history, evolution, and current status of the body of RTSA literature. The purpose of this study was to identify and analyze the 50 most-cited articles related to RTSA. Methods Various Boolean queries were searched on the Clarivate Analytics Web of Science. Information collected included author name, publication year, country of origin, journal name, article type, total number of citations, and level of evidence. Results Top 50 most-cited articles amassed a total of 10,521 citations. The most-cited article was cited a total of 766 times. The most common study designs were case series (28) and cohort studies (9). Authors from the United States (24) contributed the most to included papers, followed by France (19) and Switzerland (8). Discussion The most-cited articles on RTSA are expert opinions, case studies, and cohort studies published by American authors. As RTSA continues to grow over the next decade, studies with higher levels-of-evidence may overtake articles included in this analysis.
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Affiliation(s)
- Benjamin D Gross
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Sudah SY, Faccone RD, Imam N, Patankar A, Manzi JE, Menendez ME, Nicholson A. Poor evidence is used to support commercial payers' coverage policies for shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:2222-2231. [PMID: 37247779 DOI: 10.1016/j.jse.2023.04.014] [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: 12/28/2022] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The incidence of shoulder arthroplasty has continued to increase over the past decade. In response, commercial payers have implemented strategies to control the medical requirement of these surgeries in attempt to contain the growing costs. For example, most payers require a prolonged trial of conservative management prior to shoulder arthroplasty for patients who may otherwise be surgical candidates. However, little is known regarding the evidence used to support these indications. The purpose of this study was to analyze the references used by commercial payers to substantiate their coverage policies for shoulder arthroplasty. METHODS Ten of the leading commercial payers for total shoulder arthroplasty were identified. Publicly available coverage policies were searched on the internet or requested directly from the payer via email or telephone. Cited references were reviewed independently by two authors for type of document, level of evidence, and mention of the efficacy of conservative management. RESULTS A total of 5 coverage policies were obtained with 118 references. The most common reference type was primary journal article (n = 70; 59.3%) followed by review or expert opinion articles (n = 35; 29.7%). Most references were of level IV evidence (n = 60; 52.2%), with only 6 (5.2%) of level I or II evidence. Only 4 (3.5%) references mentioned the efficacy of conservative management in patients who may be candidates for shoulder arthroplasty. CONCLUSION The majority of references used to substantiate the coverage policies for shoulder arthroplasty among major commercial payers within the United States are of low scientific evidence and fail to demonstrate the success of required nonoperative intervention strategies. Our study underscores the need for high-quality, comparative trials that evaluate the outcomes of conservative management vs. shoulder arthroplasty in end-stage glenohumeral osteoarthritis patients in order to determine the most cost-effective treatment algorithm.
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Affiliation(s)
- Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA.
| | - Robert D Faccone
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Nareena Imam
- Department of Orthopedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Aneesh Patankar
- Department of Orthopedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Joseph E Manzi
- Department of Orthopedics, Lenox Hill Hospital, New York City, NY, USA
| | - Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR, USA
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15
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Avendano JP, Sudah SY, Gencarelli P, Imam N, Manzi JE, Ghajar M, Menendez ME, Nicholson AD. The learning curve for anatomic and reverse total shoulder arthroplasty: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:150-159. [PMID: 37588447 PMCID: PMC10426533 DOI: 10.1016/j.xrrt.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Despite the rising incidence of anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) among surgeons, little is known about the learning curve associated with these procedures. The purpose of this systematic review was to (1) identify the learning curves associated with ATSA and RTSA, (2) evaluate the effect of the learning curves on clinical outcomes, and (3) determine the number of cases needed to achieve proficiency. Methods Four online databases [PubMed (NLM), MEDLINE (OVID), Cochrane Library (Wiley), and Scopus (Elsevier)] were systematically searched and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The search included results from the inception of each database to May 18, 2022. Data regarding study characteristics, patient demographics, learning curve analyses, patient reported outcome measures, range of motion, complication rates, and reoperation rates were collected. A quality assessment for each article was performed according to the Methodological Index for Nonrandomized Studies criteria. Results A total of 13 studies of fair to good quality were included for analysis (one of level II evidence, five of level III, and seven of level IV) with the majority originating from the United States [n = 8, 61.5%]. Overall, there were a total of 3381 cases (1861 RTSA and 1520 ATSA), with a mean patient age of 72.6 years [range: 45-92 years]. From the studies analyzed in this systematic review, for RTSA, the approximate average number of cases surgeons need to perform to move to an acceptable position on the RTSA learning curve is 25 cases. For ATSA, a wider range of 16-86 cases was derived as only two studies reported on ATSA. Conclusion Progression along the learning curve for RTSA and ATSA results in decreased operative times, improved patient-reported outcomes, and fewer complications. However, a true learning curve is difficult to quantify given the heterogeneity of reported outcome measures, individual surgeon experience at the time of data collection, and statistical analyses used across studies.
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Affiliation(s)
- John P. Avendano
- Department of Orthopedics, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
| | - Pasquale Gencarelli
- Department of Orthopedics, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nareena Imam
- Department of Orthopedics, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Mina Ghajar
- Rutgers University Libraries, New Brunswick, NJ, USA
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16
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Chalmers PN, Tashjian RZ, Keener JD, Sefko JA, Da Silva A, Morrissey C, Presson AP, Zhang C, Chamberlain AM. Active physical therapy does not improve outcomes after reverse total shoulder arthroplasty: a multi-center, randomized clinical trial. J Shoulder Elbow Surg 2023; 32:760-770. [PMID: 36690173 DOI: 10.1016/j.jse.2022.12.011] [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: 09/18/2022] [Revised: 11/20/2022] [Accepted: 12/11/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare range of motion (ROM) and patient-reported outcomes (PROs) between a structured home exercise program (HEP) and active, supervised physiotherapy (PT) after primary Reverse total shoulder arthroplasty (RTSA) by performing a multicenter randomized clinical trial. METHODS Patients undergoing primary RTSA at 2 centers were randomized to either a HEP group, in which they were given a handout and a rope pulley, or a PT group, in which they were given a standardized prescription. Surgical technique and implants were standardized. At baseline, 6 weeks, 3 months, and 1 year postoperatively, we obtained American Shoulder and Elbow Surgeons scores, Western Ontario Osteoarthritis Scores, visual analogue scale for pain scores, and measured ROM via videotape. On video, ROM was then measured by blinded observers. At all study visits, patients were asked how many days per week they were in PT and how many days a week they completed HEP to determine compliance and crossover. An a priori power analysis suggested 29 patients per group, 56 patients total to detect a difference of 30° in active forward elevation with a power of 0.8 at a 2-sided alpha of 0.05. RESULTS 89 patients were randomized, 43 to PT, and 46 to HEP. We obtained 1-year PRO follow-up on 83 patients (93%) and ROM follow-up on 73 patients (82%). Nine patients (20%) crossed over from HEP to PT and 2 patients (4%) crossed over from PT to HEP. Complications occurred in 13% of HEP and 17% of PT patients (P = .629). Using mixed models that account for baseline values, there were no significant differences between groups in PROs or ROM at final follow-up. CONCLUSION In this 2-center, randomized clinical trial, there were no significant differences in patient outcomes or ROM between HEP and PT after RTSA. These findings suggest that it may not be necessary to recommend PT as a protocol for all patients after RTSA.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Julianne A Sefko
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Adrik Da Silva
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Caellagh Morrissey
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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17
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Chamberlain AM, Aleem AW, Sefko JA, Steger-May K, Keener JD. Clinical outcomes after reverse shoulder arthroplasty in patients 60 years old and younger; medium-term results. JSES Int 2023; 7:277-284. [PMID: 36911784 PMCID: PMC9998887 DOI: 10.1016/j.jseint.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has been well-described as a surgical solution to manage rotator cuff tear arthropathy in elderly, low demand paitents. As experience has increased along with improvements in technique and implant design, RTSA has become increasingly used to manage more varied pathologic conditions of the shoulder in younger, more active patients. This study evaluates outcomes in a consecutive series of patients aged 60 years old and younger after undergoing RTSA. Methods There were 94 shoulders in 89 patients enrolled. Mean age of the cohort was 54.8 (range 18-60 years). Surgical indications included rotator cuff tear arthropathy, irreparable rotator cuff tear without arthritis, glenohumeral arthritis with erosive glenoid deformity, inflammatory arthropathy, proximal humerus fracture nonunion/malunion and failed prior shoulder arthroplasty. Sixty-one shoulders (70%) had undergone at least one prior surgery. Of these, 6 shoulders (6% of total cohort) had a prior failed arthroplasty. Clinical outcomes (American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index; visual analog scale pain), radiographic outcomes and complications were analyzed and assessed for correlation with patient demographic factors. Results The mean follow-up for this cohort was 4.9 years (range 2-12 years). Subjects experienced improvements in ASES score and pain (P < .001) and active forward elevation (88° preop to 135° postop, P < .001). Prior operation correlated with worse postoperative ASES and WOOS scores. Higher demand occupation correlated with less improvement in pain scores. The overall complication rate was 12%. Seven shoulders (7%) underwent an additional procedure. There was a 2% incidence of dislocation and a 4% incidence of acromial stress fracture. There was a 36% incidence of notching. Conclusion With medium-term follow-up, RTSA is a reliable and predictable operation to manage various pathologic conditions in patients aged 60 years or less. Patients predictably experience significant improvements in pain and range of motion while assuming a modest complication risk. Long-term study is needed to understand potential for late complications or implant failure.
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Affiliation(s)
- Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Julianne A Sefko
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Karen Steger-May
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, MO, USA
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18
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Denissen JJPM, Koenders N, van Hinte G, Groen F, van der Wees PJ, van der Geest ICM, Dierselhuis EF. Functional outcomes after reversed shoulder megaprosthesis following resection of malignant bone tumor in the proximal humerus: a systematic review and meta-analysis. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Early clinical outcomes following navigation-assisted baseplate fixation in reverse total shoulder arthroplasty: a matched cohort study. J Shoulder Elbow Surg 2023; 32:302-309. [PMID: 35998780 DOI: 10.1016/j.jse.2022.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate placement of the glenoid baseplate is an important technical goal of reverse total shoulder arthroplasty (RSA). The use of computer navigated instrumentation has been shown to improve the accuracy and precision of intraoperative execution of preoperative planning. The purpose of this study was to compare early clinical outcomes of patients undergoing navigated RSA vs. a non-navigated matched cohort. METHODS A retrospective review of a prospectively collected shoulder arthroplasty database was used to identify 113 patients from a single institution who underwent navigated primary RSA with a minimum 2-year follow-up. A matched cohort of 113 non-navigated RSAs was created based on sex, age, follow-up, and preoperative diagnosis. Preoperative and postoperative range of motion, functional outcome scores, and complications were reported. RESULTS A total of 226 shoulders with a mean age of 71 years were evaluated after navigated (113) or non-navigated (113) RSAs. The mean follow-up was 32.8 months (range: 21-54 months). At the final postoperative follow-up, the navigated group had better active forward elevation (135° vs. 129°, P = .023), active external rotation (39° vs. 32°, P = .003), and Constant scores (71.1 vs. 65.5, P = .003). However, when comparing improvements from the preoperative state, there was no statistically significant difference in range of motion or functional outcome scores between the groups. Complications occurred in 1.8% (2) of patients undergoing navigated RSA compared with 5.3% (6) in the non-navigated group (P = .28). Scapular notching (3.1% vs. 8.0%, P = .21) and revision surgery (0.9% vs. 3.5%, P = .37) were more common in non-navigated shoulders. CONCLUSION At early follow-up, navigated and non-navigated RSAs yielded similar rates of improvement in range of motion and functional outcome scores. Notching and reoperation was more common in non-navigated shoulders, but did not reach statistical significance. Longer follow-up and larger cohort size are needed to determine if intraoperative navigation lengthens the durability of RSA results and reduces the incidence of postoperative complications.
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20
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Cassart Masnou E, Ruiz Macarrilla L, Mora Solé E, García Perdomo D, Pérez Andrés R. Is the Position and Union of the Tuberosities Assessable by Means of the Simple Radiograph After Reverse Shoulder Arthroplasty for Complex Proximal Humerus Fractures? J Shoulder Elb Arthroplast 2023; 7:24715492231152149. [PMID: 36727142 PMCID: PMC9884950 DOI: 10.1177/24715492231152149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
Background The assessment of tuberosity position and union in reverse shoulder arthroplasty (RSA) for complex proximal humerus fractures (PHF) has been carried out by means of routine simple radiographs. To evaluate the interobserver agreement and intraobserver reproducibility of the simple radiograph in comparison to the CT scan. Methods The position and consolidation of the tuberosities in 2 radiographic projections and in a CT scan of 32 consecutive patients operated on a RSA for PHF was assessed by 5 observers. Interobserver agreement and intraobserver reproducibility in both imaging tests were also assessed. Results The interobserver agreement for the greater tuberosity position was 0.52 in the simple radiograph and 0.45 in the CT scan. For the greater tuberosity union, agreement was moderate in the simple radiograph (0.52), but fair in the CT scan (0.35). For the lesser tuberosity position and union, the agreement was fair in the radiograph and poor in the CT scan. Conclusion Only moderate agreement was observed in the assessment of the position and union of the tuberosities in the RSA for PHF in the simple radiograph and no improvement in it was seen for the 2D CT scan.
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Affiliation(s)
| | | | - E Mora Solé
- Hospital Universitari Germans Trias i Pujol,
Barcelona, Spain
| | | | - R Pérez Andrés
- Hospital Universitari Germans Trias i Pujol,
Barcelona, Spain
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21
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Arguello AM, Houdek MT, Barlow JD. Management of Proximal Humeral Oncologic Lesions. Orthop Clin North Am 2023; 54:89-100. [PMID: 36402514 DOI: 10.1016/j.ocl.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The proximal humerus is a common location for primary tumors, benign lesions, and metastatic disease. Advances in neoadjuvant and adjuvant therapy have allowed for limb-salvage surgery in most of the cases. There are numerous of options for surgical management of proximal humerus lesions and the decision to pursue one over another depends on factors such as age, comorbidities, pathology, location within the proximal humerus, planned resection margins/size of defect, and bone quality. Long-term outcomes for these techniques tend to be retrospective comparative studies, with recent studies highlighting the improved outcomes of reverse total shoulders.
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Affiliation(s)
- Alexandra M Arguello
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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22
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Humeral and Glenoid Version in Reverse Total Shoulder Arthroplasty: A Systematic Review. J Clin Med 2022; 11:jcm11247416. [PMID: 36556031 PMCID: PMC9781424 DOI: 10.3390/jcm11247416] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
There is increasing interest in reverse total shoulder arthroplasty (RTSA) as a reliable treatment for arthritic, rotator cuff deficient shoulders. Humeral and glenoid version are controversial parameters that can influence internal and external rotation, muscular forces, and implant stability as outcomes of RTSA. The aim of this study was to obtain an overview of the current knowledge on the effect of both humeral component version and glenoid component version and give recommendations on their most optimal degree for RTSA. A comprehensive quantitative review of the published literature on the effect of humeral version and glenoid version in RTSA was performed, to identify its influence on the range of movement, muscle forces, and intrinsic stability of the reverse prosthesis. Eleven studies were included: nine were biomechanical studies, one was a clinical-radiographic study, and one was an implant design consideration. Anterior stability can be improved by implanting the humeral component in neutral or with some anteversion. Glenoid component retroversion has been proven to reduce the likelihood of subluxation, while increasing ER and ROM at the same time. The study was conducted considering 5° anteversion; neutral; and 5°, 10°, and 20° retroversion of the glenoid component. Although a final opinion has not been yet expressed on the matter, the general consensus tends to agree on restoring 0° to 20° of retroversion of the humeral and glenoid component to yield the best outcomes.
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23
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Panther EJ, Hao KA, Wright JO, Schoch JJ, Ritter AS, King JJ, Wright TW, Schoch BS. Techniques for Decreasing Bacterial Load for Open Shoulder Surgery. JBJS Rev 2022; 10:01874474-202211000-00007. [PMID: 36821410 DOI: 10.2106/jbjs.rvw.22.00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
» Benzoyl peroxide (BPO) 5% has been shown to reduce Cutibacterium acnes load on the skin. BPO 5% with miconazole nitrate (MN) 2% may be beneficial, whereas BPO 5% with clindamycin cream 1% to 1.2% does not seem to have additive effects when compared with BPO 5% alone. Chlorhexidine gluconate solutions reduce the total bacterial load on the skin, but do not seem to have a significant effect on C. acnes. » ChloraPrep seems to be the best surgical skin preparation to decrease overall positive skin cultures. Preincisional hydrogen peroxide 3% application has been shown to be a cost-effective practice to inhibit growth of C. acnes. Vancomycin powder before deltopectoral interval closure has antimicrobial effects against C. acnes and is a cost-effective practice. Finally, Bactisure surgical lavage is protective against the formation of biofilms. » IV cefazolin has been shown to be more effective for shoulder arthroplasty infection prophylaxis than antibiotic alternatives such as vancomycin. Thus, patients with a questionable history of penicillin allergy should undergo additional testing. » For shoulder surgery infection prophylaxis, we recommend the use of BPO 5% cream for 5 days preoperatively with chlorhexidine wipes the night before and the morning of surgery. IV cefazolin should be administered perioperatively, and patients with a questionable history of penicillin allergy should be tested. Surgeons should consider preincisional application of hydrogen peroxide 3% for 5 minutes, followed by standard ChloraPrep preparation. Normal saline should be used for preclosure lavage. Finally, application of vancomycin powder deep to the deltopectoral interval closure should be considered.
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Affiliation(s)
- Eric J Panther
- College of Medicine, University of Florida, Gainesville, Florida
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Alaina S Ritter
- Department of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida
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Comparison of Reverse and Anatomic Total Shoulder Arthroplasty in Patients With an Intact Rotator Cuff and No Previous Surgery. J Am Acad Orthop Surg 2022; 30:941-948. [PMID: 36135928 DOI: 10.5435/jaaos-d-22-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study's purpose is to compare clinical and radiographic outcomes of primary anatomic total shoulder arthroplasty (aTSA) and primary reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis (OA) and an intact rotator cuff with no previous history of shoulder surgery using a single platform TSA system at a minimum follow-up of 2 years. METHODS A total of 370 aTSA patients and 370 rTSA patients matched for age, sex, and length of follow-up from an international multi-institutional Western Institutional Review Board approved registry with a minimum 2-year follow-up were reviewed for this study. All patients had a diagnosis of OA, an intact rotator cuff, and no previous shoulder surgery. All patients were evaluated and scored preoperatively and at latest follow-up using six outcome scoring metrics and four active range of motion measurements. RESULTS Mean follow-up was 41 months, and the mean age was 73 years. Preoperatively, the rTSA patients had lower outcome metrics and less motion. Postoperatively, aTSA and rTSA patients had similar clinical outcomes, motion, and function, with the only exception being greater external rotation in aTSA exceeding the minimal clinically important difference. Pain relief was excellent, and patient satisfaction was high in both groups. Humeral radiolucent lines were similar in both groups (8%). Complications were significantly higher with aTSA (aTSA = 4.9%; rTSA = 2.2%; P = 0.045), but revisions were similar (aTSA = 3.2%; rTSA = 1.4%; P = 0.086). CONCLUSION At a mean of 41 month follow-up, primary aTSA and rTSA patients with OA and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes. Greater external rotation was noted in aTSA patients at follow-up. However, aTSA patients had a significantly greater rate of complications compared with rTSA patients. rTSA is a viable treatment option in patients with an intact rotator cuff and no previous shoulder surgery, offering similar clinical outcomes with a lower complication rate. LEVEL OF EVIDENCE Level III.
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Zmistowski B, Cahill SV, Hill JR, Gibian JT, Sokrab R, Keener JD, Aleem AW. The rate and predictors of healing of repaired lesser tuberosity osteotomy in reverse total shoulder arthroplasty. JSES Int 2022; 7:10-15. [PMID: 36820440 PMCID: PMC9937848 DOI: 10.1016/j.jseint.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Evidence is building that a functional subscapularis improves function-specifically internal rotation tasks-following reverse total shoulder arthroplasty (rTSA). However, the optimal method for subscapularis repair during rTSA remains unknown with variable healing rates reported. This study aims to investigate the rate of and predictors for healing a lesser tuberosity osteotomy (LTO) following rTSA. Methods Following local institutional review board approval, patients with at least one-year follow-up for rTSA managed with an LTO and subsequent repair between March, 2017 and March, 2020 were retrospectively identified. Shoulders were selected for LTO repair based upon preoperative imaging and intraoperative assessment of subscapularis quality. All patients were implanted with a system consisting of a 150° or 155° (constrained) humeral neck-shaft angle and 2.5 to 4.5 millimeters (mm) of glenoid lateralization (Trabecular Metal Reverse Shoulder System; Zimmer Biomet, Warsaw, IN, USA). At a minimum of six months, radiographs were reviewed for an assessment of LTO healing by three independent reviewers. Healing was classified as displaced, fibrous union, or ossified union. For assessing predictors, the repair was considered intact if the LTO fragment was not displaced (fibrous union or ossified union). Results Sixty-five rTSA with LTO repair were performed in 64 patients. These patients had an average age of 67.2 years (range, 31-81) and 36 (55.4%; 36/65) were female. At an average follow-up of 15.2 months (range, 8-38), 50 cases (76.9%; 50/65) were classified as having an ossified union. The radiographic healing could not be assessed in a single case. Of the 14 cases without ossific union, 8 (12.3%; 8/65) were displaced and 6 (9.2%; 6/65) were classified as a fibrous union. In logistic regression, only combined humeral liner height predicted LTO displacement (odds ratio = 1.4 [95% confidence interval = 1.1-1.8]; P = .01). Humeral loosening was not found in any cases following LTO. Conclusion This analysis demonstrates that radiographic healing of LTO repair is more favorable than published rates of healing after subscapularis tenotomy or peel in the setting of rTSA. Subscapularis management with LTO provides the ability to monitor repair integrity with plain radiographs and a predictable radiographic healing rate. The integrity of subscapularis repair may be influenced by the use of thicker humeral liners. Further investigation is needed to determine the functional impact of a healed subscapularis following rTSA.
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Affiliation(s)
- Benjamin Zmistowski
- Corresponding author: Benjamin Zmistowski, MD, Department of Orthopedic Surgery, Washington University in St. Louis, 660 S. Euclid Ave. Campus Box 8233, St. Louis, MO 63110, USA.
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Neel GB, Boettcher ML, Eichinger JK, Friedman RJ. Clinical and radiographic outcomes following reverse total shoulder arthroplasty in patients 60 years of age and younger. J Shoulder Elbow Surg 2022; 31:1803-1809. [PMID: 35346847 DOI: 10.1016/j.jse.2022.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although initially indicated for use in older patients, reverse total shoulder arthroplasty (rTSA) is being increasingly used in younger patients. The purpose of this study is to compare the clinical and radiographic outcomes of patients aged <60 years to those aged 60-79 years following primary rTSA. METHODS 154 patients aged <60 years and 1763 patients aged 60-79 years were identified from an international multi-institutional Western Institutional Review Board-approved registry with a minimum 2 years' follow-up. All patients were evaluated and scored preoperatively and at latest follow-up using 5 outcome scoring metrics and 4 active range of motion (ROM) measurements. RESULTS Patients aged <60 years were more often male (P = .023), had a higher body mass index (P = .001), higher rates of previous surgery (57% vs. 27%, P < .001), higher rates of post-traumatic arthritis (11% vs. 5%, P < .001) and inflammatory arthropathy (13% vs. 4%, P < .001), and lower rates of rotator cuff tear arthropathy (25% vs. 38%, P = .006). There were no differences in ROM between the groups but patients aged <60 years had significantly lower function and outcome metric scores and higher pain scores at latest follow-up. Adverse event rates were similar between the 2 groups, but patients aged <60 years were more likely to require revision (5.2% vs. 1.8%, P = .004). Patients aged <60 years also had lower satisfaction scores (much better/better 86% vs. 92%, P = .006). CONCLUSION At a mean follow-up of 47 months, primary rTSA patients aged <60 years had worse clinical outcomes compared with those aged 60-79 years, with lower outcome scores, increased pain, lower function scores, and less patient satisfaction. Patients aged <60 years had higher rates of previous surgery, inflammatory arthropathy, and post-traumatic arthritis, whereas those aged 60-79 years had higher rates of rotator cuff tear arthropathy. Although complications were similar, younger patients had 3 times the risk of revision rTSA.
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Affiliation(s)
- Garrett B Neel
- Medical University of South Carolina, Charleston, SC, USA
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Rohman E, King JJ, Roche CP, Fan W, Kilian CM, Papandrea RF. Factors associated with improvement or loss of internal rotation after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:e346-e358. [PMID: 35167915 DOI: 10.1016/j.jse.2022.01.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Internal rotation (IR) with reverse total shoulder arthroplasty (rTSA) can be unpredictable. Identifying the factors associated with loss of or improved IR could aid preoperative patient counseling. This study quantifies the change in IR experienced by rTSA patients with nonfracture indications and identifies the patient, implant, and operative factors associated with IR loss or gain at 2-year minimum follow-up. METHODS A total of 1978 primary rTSA patients were analyzed from an international database of a single rTSA prosthesis to quantify IR at 2 years' minimum follow-up. rTSA patients were divided into 2 cohorts based on their preoperative IR score, with group 1 patients having less active IR as defined by a preoperative IR score ≤3 and group 2 patients having greater active IR as defined by a preoperative IR score ≥4 (ie, L5 or higher). For both group 1 and 2 patients, univariate and multivariate analyses were performed to quantify the risk factors associated with IR loss after rTSA. RESULTS Overall, 58.9% of rTSA patients experienced IR improvement and 17.0% lost IR after rTSA. The occurrence of IR loss or gain was dependent on preoperative IR score, as 73.2% of group 1 patients improved IR and only 40.1% of group 2 patients improved IR, whereas 31.0% of group 2 patients lost IR and only 6.3% of group 1 patients lost IR after rTSA. Numerous risk factors for IR loss were identified. For group 1 patients, male sex (P = .004, odds ratio [OR] = 2.056), tobacco usage (P = .004, OR = 0.348), larger humeral stem diameter (P = .008, OR = 0.852), and not having subscapularis repaired (P = .002, OR = 2.654) were significant risk factors for IR loss. For group 2 patients, male sex (P = .005, OR = 1.656), higher body mass index (P = .002, OR = 0.946), a diagnosis other than osteoarthritis (P < .001, OR = 2.189), nonaugmented baseplate usage (P < .001, OR = 2.116), and not having subscapularis repaired (P < .001, OR = 3.052) were significant risk factors for IR loss. CONCLUSION The majority of patients improve IR after rTSA in the nonfracture setting. rTSA patients with substantial IR prior to surgery had a greater probability for losing IR compared to patients with poor preoperative IR. Numerous risk factors for IR loss were identified; these risk factors are useful for counseling patients considering rTSA, as some patients are more likely to lose IR than others.
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Affiliation(s)
- Eric Rohman
- Park Nicollet TRIA Orthopedic Center, Maple Grove, MN, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Wen Fan
- Exactech, Gainesville, FL, USA
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Adams JE, Steinmann SP. Surgical management of osteoarthritis in the shoulder and elbow. J Hand Ther 2022; 35:413-417. [PMID: 35428566 DOI: 10.1016/j.jht.2022.02.002] [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] [Indexed: 02/03/2023]
Abstract
Interesting recent trends are apparent in the setting of shoulder and elbow pathology. There is an increase in utilization of shoulder arthroplasty for osteoarthritis and post traumatic arthritis. At the same time, there remain limited options for osteoarthritis of the elbow particularly in the young and or active patient. This manuscript details surgical options for osteoarthritis at the elbow and shoulder.
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Affiliation(s)
- Julie E Adams
- Department of Orthopedic Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA.
| | - Scott P Steinmann
- Department of Orthopedic Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
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Reverse total shoulder arthroplasty for fractures and posttraumatic sequelae is associated with inferior forward elevation strength: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Drager J, Polce EM, Fu M, Nemsick M, Huddleston HP, Forsythe B, Nicholson GP, Cole BJ, Verma NN, Garrigues GE. Patients undergoing anatomic total shoulder arthroplasty achieve clinically significant outcomes faster than those undergoing reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2523-2532. [PMID: 33711501 DOI: 10.1016/j.jse.2021.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinically significant outcome (CSO) benchmarks have been previously established for outcome assessment after total shoulder arthroplasty. However, the time required to achieve CSO improvement is not well understood. The purpose of this study was to (1) determine the time-dependent achievement of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) in patients undergoing either anatomic total shoulder (TSA) or reverse total shoulder arthroplasty (RTSA) and compare the results of the 2 populations and (2) identify variables associated with earlier or delayed achievement of each CSO. METHODS A prospectively maintained institutional registry was retrospectively queried for all patients receiving a primary TSA or RTSA between September 2, 2016-October 31, 2017. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was administered to all patients preoperatively and at standardized postoperative time periods: 5-7 months (6-month time point), 11-13 months (1-year time point), and 23-25 months (2-year time point). Cumulative percentages of CSO achievement were calculated using Kaplan-Meier survival curve analysis with interval censoring. A Weibull parametric survival regression analysis was used to investigate the influence of demographic and clinical variables on delayed or earlier CSO achievement. RESULTS A total of 153 patients (157 shoulders) undergoing TSA (n = 76) and RTSA (n = 81) were included in the study population. The RTSA cohort was older (70.2 ± 7.5 vs. 61.0 ± 8.4, P < .001), had a lower BMI (28.8 ± 5.9 vs. 31.5 ± 6.5, P = .006), and a greater proportion of females (53.1% vs. 32.9%, P = .017) relative to TSA. For SCB, there was a significant difference in the cumulative percentage of TSA and RTSA patients reaching this threshold at both the 6-month (77.3% vs. 59.0%, P = .024) and 2-year (92.0% vs. 79.5%, P = .048) time periods, with similar findings demonstrated for PASS. There was a significant difference in the average time required to achieve the PASS (TSA: 6.1 months vs. rTSA: 11.6 months, P = .009), but not the MCID (P = .407) or SCB (P = .153). Factors significantly associated with earlier achievement of more than 1 of the CSO benchmarks were regular preoperative physical exercise and diagnosis of rotator cuff tear without osteoarthritis. CONCLUSION Patients undergoing RTSA had lower rates of achieving SCB and PASS at both 6 months and 2 years compared to patients undergoing TSA. Patients undergoing RTSA on average required nearly double the time to achieve PASS compared with those undergoing TSA. In both groups, clinically significant improvement continued for the entire 2-year duration of study follow-up.
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Affiliation(s)
- Justin Drager
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Evan M Polce
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Michael Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Michael Nemsick
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Hailey P Huddleston
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Gregory P Nicholson
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Grant E Garrigues
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA.
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Preoperative factors associated with loss of range of motion after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e621-e628. [PMID: 33675967 DOI: 10.1016/j.jse.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) is a successful procedure, often allowing patients to achieve better range of motion (ROM) compared with their preoperative baseline. However, there is a subset of patients who either fail to improve or lose ROM postoperatively. These patients are at increased risk of poor satisfaction and patient-reported outcomes. To date, characteristics of this subset of patients have not been well described. The purpose of this study is to determine risk factors associated with loss of ROM after primary RTSA. METHODS A retrospective review using a commercial international RTSA database (Exactech Inc., Gainesville, FL, USA) of patients who underwent primary RTSA between 2007 and 2017 was performed. A total of 123 (7.7%) shoulders lost ≥10° of forward elevation (FE) (group 1, P1) and 183 (11.4%) lost ≥10° of external rotation (ER) (group 2, P2). Univariate and multivariate analyses were performed comparing these patients with control cohorts to evaluate risk factors for loss of motion. RESULTS Better preoperative abduction, FE, ER, and internal rotation were each associated with greater loss of FE (P1 < .001) and ER (P2 < .001) postoperatively. Higher preoperative Simple Shoulder Test (P1 < .001, P2 < .001), Constant (P1 < .001, P2 < .001), Shoulder Pain and Disability Index (P1 < .001, P2 < .001), American Shoulder Elbow Surgeons (P1 < .001), and University of California at Los Angeles (P1 < .001) scores were also strongly associated with loss of ROM postoperatively. Other factors associated with a higher risk of losing ROM included a diagnosis of irreparable rotator cuff tear (P1 = .038), rotator cuff arthropathy (P1 = .017, P2 ≤ .001), and inflammatory arthropathy (P1 = .021). After multivariate analysis, higher preoperative FE (P1 < .001), internal rotation (P1 = -.018), and weight (P1 = .008) remained significant predictors of loss of FE. Better preoperative FE (P2 = .003), ER (P2 < .001), and University of California at Los Angeles score (P2 < .001) remained significant predictors of loss of ER. Patients who lost FE or ER were more likely to report lower satisfaction scores than their counterparts who did not lose ROM (P1 < .001, P2 < .001). CONCLUSION Patients with greater preoperative shoulder ROM or higher patient-reported outcomes are at higher risk of losing ROM after primary RTSA. They are also at higher risk of reporting lower postoperative satisfaction, though the majority were still satisfied. Surgeons should strongly counsel patients with well-preserved preoperative function on the risk of loss of ROM.
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Baek Md CH, Kim Md JG, Lee Md DH, Baek GR. Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty? J Shoulder Elb Arthroplast 2021; 5:24715492211022171. [PMID: 34497968 PMCID: PMC8282135 DOI: 10.1177/24715492211022171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.
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Affiliation(s)
- Chang Hee Baek Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Jung Gon Kim Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Dong Hyeon Lee Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
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Malahias MA, Brilakis E, Chytas D, Gerogiannis D, Avramidis G, Antonogiannakis E. Functional Outcomes of Bilateral Reverse Total Shoulder Arthroplasty: A Systematic Review. JOINTS 2021; 7:188-198. [PMID: 34235384 PMCID: PMC8253605 DOI: 10.1055/s-0041-1730974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
Purpose
To answer the question whether bilateral reverse total shoulder arthroplasty (RTSA) is a safe and effective treatment which results in satisfactory clinical and functional outcomes with low complications rates. A second question to be answered was: what is the quality of the evidence of the already published studies which investigate the use of bilateral RTSA?
Methods
Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “reverse” AND “total” AND “shoulder” AND “arthroplasty” AND “clinical.” Descriptive statistics were used to summarize the data.
Results
From the 394 initial studies we finally selected and assessed 6 clinical studies which were eligible to our inclusion–exclusion criteria. The aforementioned studies included in total 203 patients (69% females; mean age range: 67.1–75 years; mean follow-up range: 12–61 months). From those, 168 patients underwent staged bilateral RTSA (mean duration between first and second operation range: 8–21.6 months) and the rest of them a unilateral RTSA as controlled treatment. Almost all mean clinical and functional scores, which were used to assess the therapeutic value of bilateral RTSA, depicted significant postoperative improvement in comparison with the mean preoperative values. The modified Coleman methodology score, which was used to assess the quality of the studies, ranged from a minimum of 36/100 to a maximum of 55/100.
Conclusion
Despite the lack of high-quality evidence, staged bilateral RTSA seems to be a safe and effective procedure for patients with cuff tear arthropathy, which results in significantly improved clinical and functional outcomes and low reoperations' rates.
Level of Evidence
Systematic review of level III-IV therapeutic studies.
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Affiliation(s)
| | | | - Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Pitocchi J, Plessers K, Wirix-Speetjens R, Debeer P, van Lenthe GH, Jonkers I, Pérez MA, Vander Sloten J. Automated muscle elongation measurement during reverse shoulder arthroplasty planning. J Shoulder Elbow Surg 2021; 30:561-571. [PMID: 32707326 DOI: 10.1016/j.jse.2020.07.007] [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: 03/20/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adequate deltoid and rotator cuff elongation in reverse shoulder arthroplasty is crucial to maximize postoperative functional outcomes and to avoid complications. Measurements of deltoid and rotator cuff elongation during preoperative planning can support surgeons in selecting a suitable implant design and position. Therefore, this study presented and evaluated a fully automated method for measuring deltoid and rotator cuff elongation. METHODS Complete scapular and humeral models were extracted from computed tomography scans of 40 subjects. First, a statistical shape model of the complete humerus was created and evaluated to identify the muscle attachment points. Next, a muscle wrapping algorithm was developed to identify the muscle paths and to compute muscle lengths and elongations after reverse shoulder arthroplasty implantation. The accuracy of the muscle attachment points and the muscle elongation measurements was evaluated for the 40 subjects by use of both complete and artificially created partial humeral models. Additionally, the muscle elongation measurements were evaluated for a set of 50 arthritic shoulder joints. Finally, a sensitivity analysis was performed to evaluate the impact of implant positioning on deltoid and rotator cuff elongation. RESULTS For the complete humeral models, all muscle attachment points were identified with a median error < 3.5 mm. For the partial humeral models, the errors on the deltoid attachment point largely increased. Furthermore, all muscle elongation measurements showed an error < 1 mm for 75% of the subjects for both the complete and partial humeral models. For the arthritic shoulder joints, the errors on the muscle elongation measurements were <2 mm for 75% of the subjects. Finally, the sensitivity analysis showed that muscle elongations were affected by implant positioning. DISCUSSION This study presents an automated method for accurately measuring muscle elongations during preoperative planning of shoulder arthroplasty. The results show that the accuracy in measuring muscle elongations is higher than the accuracy in indicating the muscle attachment points. Hence, muscle elongation measurements are insensitive to the observed errors on the muscle attachment points. Related to this finding, muscle elongations can be accurately measured for both a complete humeral model and a partial humeral model. Because the presented method also showed accurate results for arthritic shoulder joints, it can be used during preoperative shoulder arthroplasty planning, in which typically only the proximal humerus is present in the scan and in which bone arthropathy can be present. As the muscle elongations are sensitive to implant positioning, surgeons can use the muscle elongation measurements to refine their surgical plan.
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Affiliation(s)
- Jonathan Pitocchi
- Materialise, Heverlee, Belgium; Multiscale in Mechanical and Biological Engineering (M2BE), University of Zaragoza, Zaragoza, Spain; Biomechanics Section, KU Leuven, Leuven, Belgium.
| | - Katrien Plessers
- Materialise, Heverlee, Belgium; Biomechanics Section, KU Leuven, Leuven, Belgium
| | | | - Philippe Debeer
- Orthopaedics Section, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Institute for Orthopaedic Research and Training, Leuven, Belgium
| | | | - Ilse Jonkers
- Department of Biomedical Kinesiology, KU Leuven, Leuven, Belgium
| | - Maria Angeles Pérez
- Multiscale in Mechanical and Biological Engineering (M2BE), University of Zaragoza, Zaragoza, Spain
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O'Neill DR, King JJ, Farmer KW. Reverse total shoulder arthroplasty after iatrogenic axillary artery injury: a case report. J Shoulder Elbow Surg 2021; 30:e121-e128. [PMID: 33220415 DOI: 10.1016/j.jse.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Affiliation(s)
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
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Davey MG, Davey MS, Hurley ET, Gaafar M, Pauzenberger L, Mullett H. Return to sport following reverse shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2021; 30:216-221. [PMID: 32858195 DOI: 10.1016/j.jse.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to systematically review the evidence in the literature to ascertain the rate and timing of return to sport following reverse shoulder arthroplasty (RSA). METHODS A systematic literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the Embase, MEDLINE, and Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to sport following RSA. Statistical analysis was performed using SPSS. RESULTS Overall, 8 studies including 455 patients (464 shoulders) met our inclusion criteria. The majority of patients were female (77.7%), with an average age of 74.2 years. The overall rate of return to sport was 79.1%; with 66.7% of golfers, 74.3% of swimmers, 50.0%, of tennis players, 94.4% of joggers, and 69.7% of cyclists returning. In addition, 71.4% of patients returned to the same level of sporting activity. The average time to return to sport was 3.4 months with a mean follow-up of 34.0 months. DISCUSSION AND CONCLUSION The results from our systematic review show that the majority of patients are able to return to sport following RSA, with a large number returning to the same level of sport. However, results were modest in overhead athletes, with a concerning number unable to return to tennis post-RSA.
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Affiliation(s)
| | - Martin S Davey
- Royal College of Surgeons in Ireland, Dublin, Ireland; Sports Surgery Clinic, Dublin, Ireland
| | - Eoghan T Hurley
- Royal College of Surgeons in Ireland, Dublin, Ireland; Sports Surgery Clinic, Dublin, Ireland.
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Comparative Clinical Outcomes of Reverse Total Shoulder Arthroplasty for Primary Cuff Tear Arthropathy Versus Severe Glenohumeral Osteoarthritis With Intact Rotator Cuff: A Matched-Cohort Analysis. J Am Acad Orthop Surg 2020; 28:e1042-e1048. [PMID: 32345934 DOI: 10.5435/jaaos-d-19-00493] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/23/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to compare the short- to mid-term outcomes of patients who underwent reverse total shoulder arthroplasty (RTSA) for severe glenohumeral osteoarthritis (GHOA) with an intact rotator cuff (RC) to a matched rotator cuff arthropathy (RCA) cohort. METHODS Between 2004 and 2014, all patients who underwent RTSA for severe GHOA with a minimum 2-year follow-up were identified. Demographic and baseline variables were extracted from the medical records. Subjects were matched in the ratio of 1:2 to RTSA subjects with RCA, while controlling for the demographic and intraoperative variables. Postoperative active forward elevation (AFE), active external rotation, American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Scale (VAS), and Simple Shoulder Test were recorded. Complications and revision surgery rates were noted. Comparative multivariate analysis was performed. Preoperative Walch classification for each subject was obtained through radiograph review, and the impact of classification was assessed using one-way analysis of variance testing. RESULTS One hundred thirty-six patients were available with mean follow-up 32.3 ± 12.3 months. Baseline range of motion and patient reported outcome scores were similar between the groups (P > 0.05), except for Simple Shoulder Test (intact rotator cuff: 5.7 ± 7.4 versus RCA: 2.4 ± 1.8, P = 0.037). The intact RC group had significantly, superior absolute outcome measures for active external rotation (P = 0.006), and SST (P = 0.048), but not for SANE (P = 0.055), VAS (P = 0.464), ASES (P = 0.084), and AFE (P = 0.099). No notable difference was observed between the groups for improvement in motion, survey scores, or complications. Walch osteoarthritis classification did not impact the outcome measurements in the severe GHOA with the intact RC group (P > 0.05). DISCUSSION Patients who underwent RTSA for severe GHOA with intact RC demonstrate similar consistent improvement in outcomes to demographically similar patients with RCA. The severity of GHOA defined by the Walch classification did not impact the outcomes at the 2-year follow-up. LEVEL OF EVIDENCE Level III Therapeutic Study.
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Assessment of surgeon variability in preoperative planning of reverse total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons. J Shoulder Elbow Surg 2020; 29:2080-2088. [PMID: 32471752 DOI: 10.1016/j.jse.2020.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning software is gaining utility in reverse total shoulder arthroplasty (RTSA), particularly when addressing pathologic glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning a series of RTSA cases to identify differences in how surgeons consider optimal implant placement. This may help identify opportunities to establish consensus when correlating plan differences with clinical data. METHODS A total of 49 computed tomography scans from actual RTSA cases were planned for RTSA by 9 fellowship-trained shoulder surgeons using the same platform (Exactech GPS, Exactech Inc., Gainesville, FL, USA). Each case was planned a second time 6-12 weeks later. Variability within and between surgeons was measured for implant selection, version correction, inclination correction, and implant face position. Interclass correlation coefficients, and Pearson and Light's kappa coefficient were used for statistical analysis. RESULTS There was considerable variation in the frequency of augmented baseplate selection between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability ranged from 0.43 for version, 0.42 for inclination, and 0.25 for baseplate type. Pearson coefficients for intrasurgeon variability were 0.34 for version and 0.30 for inclination. Light's kappa coefficient for baseplate type was 0.61. CONCLUSIONS This study demonstrates substantial variability both between surgeons and between rounds for individual surgeons when planning RTSA. Although average differences between plans were relatively small, there were large differences in specific cases suggesting little consensus on optimal planning parameters and opportunities to establish guidelines based on glenoid pathoanatomy. The correlation of preoperative planning with clinical outcomes will help to establish such guidelines.
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Mananagement von Glenoiddefekten in der Schulterprothetik. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ode GE, Ling D, Finocchiaro A, Lai EY, Taylor SA, Dines J, Dines D, Warren R, Gulotta L. Clinical characteristics and patient-reported outcomes of total shoulder arthroplasty after anterior stabilization: a retrospective matched control study. J Shoulder Elbow Surg 2020; 29:S59-S66. [PMID: 32643610 DOI: 10.1016/j.jse.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Instability arthropathy is a known cause of glenohumeral osteoarthritis (OA) among patients with and without prior shoulder stabilization. This study aims to compare the clinical, radiographic, and patient-reported outcome measure (PROM) scores among total shoulder arthroplasty (TSA) patients with and without a history of shoulder stabilization. METHODS A case-control study was performed comparing 20 patients with a history of anterior shoulder stabilization (11 open, 9 arthroscopic) who underwent TSA to a matched cohort of 20 TSA patients without a history of shoulder surgery (mean follow-up = 2.8 years). Patients were matched by sex, age, and baseline American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score within 10 points (mean age 59.6 ± 9.6 years). Patient characteristics, operative findings, and preoperative and postoperative radiographic characteristics for both groups were reported. Comparisons were made regarding PROM scores (ASES, 12-Item Short Form Health Survey (SF-12), Shoulder Activity Scale [SAS], numeric rating scale for pain) at baseline, 2 years, and 5 years and patient satisfaction at 2 years. RESULTS Intraoperative findings of subscapularis scarring or attenuation was common among patients with prior anterior stabilization. The instability cohort did have a higher percentage of B2/B3 glenoid types than the OA cohort (45% vs. 15%), but this was not significantly different possibly because of the small sample size. At 2 years, both instability and OA groups reported significant improvement in pain, function, and activity level. There was no difference between groups on any PROMs or patient satisfaction level. At 5 years, instability patients had significantly lower scores on the ASES and the SF-12 PCS than the OA group. CONCLUSION There was notable alterations in both soft tissue and bony morphology among patients with prior anterior stabilization. After TSA, both instability and primary OA groups showed significant improvements at 2 years. However, PROMs for instability patients deteriorated at 5 years compared with the control group. Complex bony and soft tissue imbalances may contribute to more unpredictable long-term PROM scores. Thoughtful preoperative consideration of these factors should influence decision making regarding selection of TSA for management of OA in this complex patient cohort.
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Affiliation(s)
- Gabriella E Ode
- Department of Orthopaedics, Prisma Health-Upstate, Greenville, SC, USA.
| | - Daphne Ling
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Anthony Finocchiaro
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Emily Ying Lai
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua Dines
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David Dines
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Russell Warren
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence Gulotta
- The HSS Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Return to Sport after Anatomic and Reverse Total Shoulder Arthroplasty in Elderly Patients: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9051576. [PMID: 32456117 PMCID: PMC7291255 DOI: 10.3390/jcm9051576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/10/2023] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the rate of return to sport in elderly patients who underwent anatomic (ATSA) and reverse (RTSA) total shoulder arthroplasty, to assess postoperative pain and functional outcomes and to give an overview of postoperative rehabilitation protocols. A systematic search in Pubmed-Medline, Cochrane Library, and Google Scholar was carried out to identify eligible randomized clinical trials, observational studies, or case series that evaluated the rate of return to sport after RTSA or ATSA. Six retrospective studies, five case series, and one prospective cohort study were included in this review. The overall rate of return to sport was 82% (95% CI 0.76–0.88, p < 0.01). Patients undergoing ATSA returned at a higher rate (90%) (95% CI 0.80–0.99, p < 0.01) compared to RTSA (77%) (95% CI 0.69–0.85, p < 0.01). Moreover, the results showed that patients returned to sport at the same or a higher level in 75% of cases. Swimming had the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%). Thus, RTSA and ATSA are effective to guarantee a significative rate of return to sport in elderly patients. A slightly higher rate was found for the anatomic implant.
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Edwards GAD, McCann PA, Whitehouse MR, Wakeley CJ, Sarangi PP. The influence of fatty infiltration and muscle atrophy of the rotator cuff muscles on midterm functional outcomes in total shoulder resurfacing at six years' follow-up. Shoulder Elbow 2020; 12:91-98. [PMID: 32313558 PMCID: PMC7153209 DOI: 10.1177/1758573218811655] [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: 05/30/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND We report functional outcomes at six years in patients with varying degrees of fatty infiltration and atrophy of the rotator cuff muscles who have undergone anatomic total shoulder replacement. METHODS A retrospective analysis of case notes and magnetic resonance imaging scans of patients undergoing total shoulder replacement for primary glenohumeral arthritis was performed. Patients were grouped based upon their pre-operative magnetic resonance imaging findings for fatty infiltration, muscle area and tendinopathy. Post-operative functional outcomes were assessed using the Oxford Shoulder Score and Quick Disabilities of the Arm, Shoulder and Hand score. Post-operative measurements were made for active shoulder movements. RESULTS Thirty-two patients were reviewed at a mean of 67 months following surgery. All patients demonstrated fatty infiltration on their pre-operative magnetic resonance imaging scan. Muscle atrophy was shown in 22 patients and 12 had tendinopathy. Multiple regression analysis showed no correlation between the Oxford Shoulder Score (p = 0.443), the Quick Disabilities of the Arm, Shoulder and Hand score (p = 0.419), forward flexion (p = 0.170), external rotation (p = 0.755) and any of the pre-operative independent variables. DISCUSSION The degree of fatty infiltration, muscle atrophy and tendinopathy of the rotator cuff muscle on pre-operative magnetic resonance imaging scanning is not associated with functional outcome score or functional movement at medium-term follow-up following total shoulder replacement. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gray AD Edwards
- Bristol Royal Infirmary, Bristol, UK,Southmead Hospital, Bristol, UK,Gray AD Edwards, Department of Trauma and Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
| | - Philip A McCann
- Bristol Royal Infirmary, Bristol, UK,Southmead Hospital, Bristol, UK
| | - Michael R Whitehouse
- Southmead Hospital, Bristol, UK,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, UK,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | | | - Partha P Sarangi
- Bristol Royal Infirmary, Bristol, UK,Southmead Hospital, Bristol, UK
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Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older. INTERNATIONAL ORTHOPAEDICS 2020; 44:1131-1141. [PMID: 32130442 DOI: 10.1007/s00264-020-04501-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. METHODS Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. RESULTS RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). CONCLUSION RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.
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Comparison of Clinical Outcomes After Anatomic Total Shoulder Arthroplasty and Reverse Shoulder Arthroplasty in Patients 70 Years and Older With Glenohumeral Osteoarthritis and an Intact Rotator Cuff. J Am Acad Orthop Surg 2020; 28:e222-e229. [PMID: 31356423 DOI: 10.5435/jaaos-d-19-00166] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION As the indications for reverse shoulder arthroplasty (RSA) expand beyond traditional cuff tear arthropathy, the role of RSA in elderly patients with glenohumeral arthritis and an intact rotator cuff remains unclear. METHODS This retrospective cohort study included 135 patients who underwent RSA or total shoulder arthroplasty (TSA) at a single tertiary orthopedic center between 2005 and 2015 and were 70 years of age or older at the time of surgery. All patients had preoperative advanced imaging confirming an intact rotator cuff but active forward elevation less than 90°. Complications, reoperations, and patient survival were recorded from the medical record. Patient-reported outcomes (Pain visual analog scale, Satisfaction Score, American Shoulder and Elbow Surgeons [ASES], and Western Ontario Osteoarthritis of the Shoulder [WOOS]) and patient-reported range of motion were collected at a minimum of 2 years after procedure. RESULTS There was no significant difference in complication rate or revision surgery rate between patients undergoing TSA and RSA (complications 13.7% versus 12.1%, P = 0.810; reoperations 6.9% vs 3.0%, P = 0.418). There were no differences in patient-reported outcome measures between the two groups. Mean pain visual analog scale scores were low in both groups (0.72, SD 1.93 for TSA and 0.31, SD 0.72 for RSA). Satisfaction scores were high (86.1, SD 23.3 for TSA and 91.8, SD 9.0 for RSA, P = 0.286). Mean ASES and WOOS scores were also high in both groups (86 [SD 15.6] for TSA and 83 [SD 12.6] for RSA for ASES [P = 0.400] and 86 [SD 18.3] for TSA and 89 [SD 10.2] for RSA for WOOS [P = 0.400]). One hundred percent of subjects following RSA and 98% of subjects following TSA rated their forward elevation as full or nearly full (>135°) (P = 0.516). DISCUSSION Given the good clinical outcomes after both TSA and RSA, there may be an increased role for RSA in this elderly cohort to provide effective treatment of glenohumeral osteoarthritis. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Hu H, Liu W, Zeng Q, Wang S, Zhang Z, Liu J, Zhang Y, Shao Z, Wang B. The Personalized Shoulder Reconstruction Assisted by 3D Printing Technology After Resection of the Proximal Humerus Tumours. Cancer Manag Res 2019; 11:10665-10673. [PMID: 31920376 PMCID: PMC6934118 DOI: 10.2147/cmar.s232051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background The reverse shoulder arthroplasty (RSA) may be a promising alternative for proximal humerus tumours because of good postoperative shoulder function. However, the conventional reverse shoulder prosthesis can not meet individual needs and RSA has been associated with a relatively high complication rate. Therefore, implant design and surgical reconstruction technique warrant further study. Methods Between September 2015 and May 2018, 7 patients were treated via RSA after en-bloc resection of the proximal humerus tumours. A 3D-printed guiding baseplate was used to assist the implant of the 3D-printed glenoid prosthesis; a personalized humerus prosthesis was used to reconstruct the proximal humerus. The functional outcomes were assessed by range of motion (ROM) of the shoulder joint, Musculoskeletal Tumour Society (MSTS) functional score, and Toronto Extremity Salvage Score (TESS). We also analyzed tumour recurrence, metastases, and complications associated with the reconstruction procedure. Results All patients were observed for 14 to 36 months, with an average of 23.6 months. At the final follow-up, the mean MSTS score was 85.7% (range, 73.3–93.3%), and the mean TESS score was 90.0% (range, 84.1–95.9%). No instability, infection, scapular notching, loosening or fracture were observed in this series. One patient with GCT suffered from pulmonary metastasis, while one with osteosarcoma died because of pulmonary metastasis. Conclusion The 3D-printed guiding baseplate facilitated the accurate implantation of the glenoid prosthesis. The RSA based on a 3D-printed glenoid prosthesis and a personalized custom-made humerus prosthesis significantly improved the shoulder function and decreased the complication rate. Further studies of a larger scale with longer follow-up are required to validate this technology.
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Affiliation(s)
- Hongzhi Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Weijian Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Qianwen Zeng
- Department of Pediatrics, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Shangyu Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Zhicai Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Jianxiang Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, Hebei, 050051, People's Republic of China, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, People's Republic of China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Baichuan Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
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Axillary artery intimal dissection with thrombosis and brachial plexus injury after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:e393-e397. [PMID: 31636009 DOI: 10.1016/j.jse.2019.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 02/01/2023]
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Abstract
PURPOSE OF REVIEW Over the past decade, our understanding of the biomechanics of the reverse total shoulder arthroplasty (RTSA) has advanced, resulting in design adjustments, improved outcomes, and expanding indications. The purpose of this review is to summarize recent literature regarding the biomechanics of RTSA and the evolving indications for its use. RECENT FINDINGS While Grammont's principles of RTSA biomechanics remain pillars of contemporary designs, a number of modifications have been proposed and trialed in later generations to address complications such as impingement and glenoid failure. Clinical and biomechanical literature suggest that less medialized, more inferior glenospheres result in less impingement and notching. On the humerus, a more vertical neck cut is associated with less impingement. Indications for RTSA continue to expand beyond the classic indication of cuff tear arthropathy (CTA). Patients without a functional cuff but no arthritis now have a reliable option in the RTSA. RTSA has also replaced hemiarthroplasty as the implant of choice for displaced three- and four-part proximal humerus fractures in the elderly. Finally, updated design options and modular components now allow for treatment of glenoid bone loss, failed arthroplasty, and proximal humerus tumors with RTSA implants. Reverse total shoulder arthroplasty design has been modernized on both the glenoid and humerus to address biomechanical challenges of early implants. As outcomes improve with these modifications, RTSA indications are growing to address complex bony pathologies such as tumor and bone loss. Longitudinal follow-up of patients with updated designs and novel indications is essential to judicious application of RTSA technology.
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Luthringer TA, Kester BS, Kolade O, Virk MS, Alaia MJ, Campbell KA. Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times. J Shoulder Elb Arthroplast 2019. [DOI: 10.1177/2471549219882133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P = .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P = .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P < .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty.
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Affiliation(s)
- Tyler A Luthringer
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Benjamin S Kester
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Oluwadamilola Kolade
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Mandeep S Virk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Kirk A Campbell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
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Lucasti CJ, Namdari S. Acromial Stress Fractures: A Systematic Review. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:397-401. [PMID: 31742214 PMCID: PMC6802552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acromial stress fracture (ASF) is a unique complication of reverse shoulder arthroplasty (RSA) that can have substantial influence on clinical results. The purpose of this review is to describe demographics, functional outcomes, and union rates for cases of RSA complicated by ASF. METHODS A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify studies that reported results of RSA complicated by ASF. Searches were performed using PubMed and Scopus up to January 1, 2018. Five articles met inclusion and exclusion criteria. RESULTS ASF occurred in 61 (6.9%) of 874 RSA cases identified. 82% of patients who sustained an ASF were female. ASF cases were, on average, 7 years older than cases that were not complicated by ASF. While improved compared to their preoperative state, patients who sustained an ASF demonstrated significantly less improvement in pain, function, and ROM compared to RSA patients without ASF. CONCLUSION Women and older patients appear to be at greater risk for an ASF after RSA. Though nonunion rates are high, fair outcomes can still be achieved in cases of ASF after RSA. Further study is needed to identify modifiable and non-modifiable risk factors associated with the development of ASF.
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Affiliation(s)
- Christopher J Lucasti
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, usa
- Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, PA, usa
- Research performed at Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, pa, USA
| | - Surena Namdari
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, usa
- Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, PA, usa
- Research performed at Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, pa, USA
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Lung BE, Kanjiya S, Bisogno M, Komatsu DE, Wang ED. Preoperative indications for total shoulder arthroplasty predict adverse postoperative complications. JSES OPEN ACCESS 2019; 3:99-107. [PMID: 31334436 PMCID: PMC6620201 DOI: 10.1016/j.jses.2019.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although studies have shown improved pain, function, and patient satisfaction after total shoulder arthroplasty (TSA), preoperative factors predicting poor outcomes are unexplored. Comparison of postoperative complications between osteoarthritis (OA), cuff arthropathy (CA), and fracture patients is important for identifying at-risk patients. METHODS Primary TSAs from 2014 to 2016 with preoperative OA, CA, and proximal humerus fractures as indications were queried from the National Surgical Quality Improvement Program database. Short-interval postoperative complications were compared using multivariate binary logistic regression, and postoperative time to discharge between groups was analyzed using univariate analysis of variance with Tukey comparison. Statistical significance was defined as P < .05 using SPSS software version 23.0 (IBM Corp., Armonk, NY, USA). RESULTS Of 9684 TSA cases, the primary indication was OA in 6571 patients, CA in 725 patients, and fractures in 646 patients. Compared with fractures, OA patients had statistically significant lower risk of dislocation, readmission, return to operating room, nonhome discharge, surgical site infection, perioperative bleeding requiring transfusion, and pulmonary embolism (all P < .05). Statistically significant lower risk of dislocation, nonhome discharge, and transfusion was also found between CA and fracture patients (all P < .03). However, in comparing CA vs. OA as preoperative indications, only postoperative venous thromboembolism (odds ratio, 4.5; P = .01) and surgical site infection (odds ratio, 3.7; P = .007) were significant. Mean differences in discharge time were significant between both OA and CA groups compared with fractures (P < .001), but there was no significance between OA and CA (P = .116). CONCLUSION Proximal humerus fracture is a risk factor for increased postoperative complications compared with OA and CA. With new outcomes-based reimbursement models, nonroutine discharge and increased discharge time should be considered in arthroplasty planning.
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Affiliation(s)
- Brandon E. Lung
- School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Shrey Kanjiya
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Michael Bisogno
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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