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Authom T, Lascar T, Wahab H, Gournay A, Beaudouin E, Muller JH, Saffarini M, Nourissat G. Mid-Term to Long-Term Follow-Up of Stemless Anatomic Total Shoulder
Arthroplasty. J Shoulder Elb Arthroplast 2023; 7:24715492231163055. [PMID: 36968299 PMCID: PMC10031594 DOI: 10.1177/24715492231163055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/24/2023] Open
Abstract
Background The purpose was to report mid-term to long-term clinical outcomes in a
multicentre series of patients who received stemless total shoulder
arthroplasty (TSA). The hypothesis was that stemless TSA would be a safe and
effective treatment with satisfactory clinical outcomes. Methods Authors retrospectively reviewed records of 62 stemless TSAs implanted
between March 2013 and December 2014. Six were excluded because they had
fractures or muscular impairment, which left 56: primary osteoarthritis
(n = 49), rheumatoid arthritis (n = 4), avascular necrosis (n = 1), or
glenoid dysplasia (n = 2). Outcomes were absolute Constant Score (CS),
age-/sex-adjusted CS, and the American Shoulder and Elbow Surgeons (ASES)
score. Proportions of patients that achieved substantial clinical benefits
for absolute CS and ASES scores were determined. Results Of the 56 patients, 8 (14%) died (unrelated to TSA), 5 (9%) were lost to
follow-up, and 2 (4%) refused participation. One patient was reoperated for
infection with implant removal (excluded from analysis), and one for
periprosthetic fracture without implant removal. At 7.6 ± 0.5 years (range
6.8-9.3), the remaining 40 patients, aged 71.0 ± 8.5 years, achieved net
improvements of 40.7 ± 15.8 (CS), 62%±23% (age-/sex-adjusted CS), and
59.7 ± 16.4 (ASES). Of patients with complete absolute CS (n = 37) and ASES
score (n = 28), respectively, 33 (89%) and 27 (96%) achieved substantial
clinical benefits. Conclusions Stemless TSA yields improvements in functional outcomes at mid-term to
long-term that exceed the substantial clinical benefits of the absolute CS
and ASES score at a mean follow-up of 7.6 years. Although the findings of
this study revealed low complications and revision rates, more studies are
needed to confirm long-term benefits of stemless TSA. Level of evidence IV, case series.
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Affiliation(s)
| | | | | | | | | | | | - Mo Saffarini
- ReSurg S.A., Nyon, Switzerland
- Mo Saffarini, ReSurg S.A., Rue Saint-Jean
22, 1260 Nyon, Switzerland.
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Magosch P, Habermeyer P, Vetter P. Radiologic midterm results of cemented and uncemented glenoid components in primary osteoarthritis of the shoulder: a matched pair analysis. Arch Orthop Trauma Surg 2023; 143:225-235. [PMID: 34228153 DOI: 10.1007/s00402-021-04021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cemented all-polyethylene glenoid components are considered the gold standard in anatomic shoulder arthroplasty. New designs of cementless metal backed glenoid components showed promising early and midterm results. The aim of this matched-pair analysis was to compare the radiologic results of two cemented glenoid components and a cementless glenoid component in patients with primary osteoarthritis (OA). METHODS Sixty shoulders were clinically and radiologically evaluated after a mean follow-up of 59 months. Mean patient age was 70.4 years at surgery. Based on the design of the glenoid component (keel, peg, MB), 3 groups with, respectively, 20 shoulders were formed according to the matching criteria time of follow-up, patient age and gender. RLL and osteolysis in anteroposterior and axillary X-ray images were quantified and combined in a radiologic score (R-Score). Higher scores expressed worse radiologic outcomes. Further radiological parameters such as lateral glenohumeral offset (LGHO) and subluxation index were measured according to Walch. The functional results were documented using the age and gender normalized Constant-Murley score. RESULTS Postoperative R-Score was highest in pegged components (peg: 5.7, keel: 2.4, MB: 1.6; p < 0.001) when combining both radiographs and after separate analysis of anteroposterior radiographs. MB glenoids had the lowest R-score in axillary radiographs (peg: 2.2, keel: 1.4, MB: 0.6; MB vs. keel: p = 0.004, MB vs peg: p < 0.001). RLL were more common (p = 0.004) and severe (p = 0.005) in pegged glenoids (RLL incidence: 77.8%, RLL-score: 2.5) than in MB glenoids (RLL incidence: 30%, RLL-score 0.7) and tended (p = 0.084) to have a higher RLL-score than keeled glenoids (RLL incidence: 63.2%, RLL-score:1.4). Both the osteolysis score (keel vs. peg: p < 0.001, MB vs. peg p < 0.001) and the incidence of osteolysis (keel vs. peg: p = 0.008, MB vs peg: p = 0.003) were significant higher in pegged glenoids (peg: osteolysis score: 3.2, osteolysis incidence: 100%; keel: osteolysis score: 1.0, osteolysis incidence: 63.2%, MB: osteolysis score: 0.9, osteolysis incidence: 60%), while the osteolysis score in axillary images was lowest for MB glenoids (peg: 1.2, keel: 0.9, MB: 0.4; peg vs. MB: p = 0.009, keel vs. MB: p = 0.047). Osteolysis in the central axillary zone was least common in MB glenoids (peg: 50%, keel: 47.4%, MB: 15%; peg vs. MB p = 0.035, keel vs. MB p = 0.041). LGHO was highest in MB glenoids (peg: 54.1, keel: 54.5, MB: 57.8; p < 0.001) but did not increase radiographic loosening (r = 0.007; p = 0.958). Preoperative posterior humeral head subluxation seemed to affect incidence of RLL negatively (pre-op posterior decentered 64.3%, pre-op centered 31.9%; p = 0.201) but did not reach statistical significance. CONCLUSION Pegged glenoid components had a concerning rate of RLL and osteolysis. MB glenoid components had a better outcome in axillary radiographs concerning RLL and osteolysis. Increased LGHO did not increase radiographic loosening. LEVEL OF EVIDENCE Retrospective comperative treatment study Level III.
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Affiliation(s)
- Petra Magosch
- Shoulder Centre Prof. Habermeyer, Törringstrasse 6, 81675, Munich, Germany. .,Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Peter Habermeyer
- Shoulder Centre Prof. Habermeyer, Törringstrasse 6, 81675, Munich, Germany.,German Shoulder Centre, ATOS Clinic Munich, Effnerstrasse 38, 81925, Munich, Germany
| | - Philipp Vetter
- German Shoulder Centre, ATOS Clinic Munich, Effnerstrasse 38, 81925, Munich, Germany
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Ajibade DA, Yin CX, Hamid HS, Wiater BP, Martusiewicz A, Wiater JM. Stemless reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2022; 31:1083-1095. [PMID: 35051541 DOI: 10.1016/j.jse.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data. METHODS A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores. RESULTS We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate. CONCLUSIONS This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.
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Affiliation(s)
- David A Ajibade
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Clark X Yin
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Hussein S Hamid
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Alexander Martusiewicz
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA.
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Willems JIP, Hoffmann J, Sierevelt IN, van den Bekerom MPJ, Alta TDW, van Noort A. Results of stemless shoulder arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:35-49. [PMID: 33532085 PMCID: PMC7845565 DOI: 10.1302/2058-5241.6.200067] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another.
Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067
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Affiliation(s)
| | | | - Inger N Sierevelt
- Spaarne Gasthuis, Hoofddorp, The Netherlands.,Xpert Orthopedics, Amsterdam, The Netherlands
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Zheng Z, Yu C, Wei H. Injectable Hydrogels as Three-Dimensional Network Reservoirs for Osteoporosis Treatment. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:430-454. [PMID: 33086984 DOI: 10.1089/ten.teb.2020.0168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite tremendous progresses made in the field of tissue engineering over the past several decades, it remains a significant challenge for the treatment of osteoporosis (OP) due to the lack of appropriate carriers to improve the bioavailability of therapeutic agents and the unavailability of artificial bone matrix with desired properties for the replacement of damaged bone regions. Encouragingly, the development of injectable hydrogels for the treatment of OP has attracted increasing attention in recent years because they can serve either as a reservoir for various therapeutic species or as a perfect filler for bone injuries with irregular shapes. However, the relationship between the complicated pathological mechanism of OP and the properties of diverse polymeric materials lacks elucidation, which clearly hampers the clinical application of injectable hydrogels for the efficient treatment of OP. To clarify this relationship, this article summarized both localized and systematic treatment of OP using an injectable hydrogel-based strategy. Specifically, the pathogenesis of OP and the limitations of current treatment approaches were first analyzed. We further focused on the use of hydrogels loaded with various therapeutic substances following a classification standard of the encapsulated cargoes for OP treatment with an emphasis on the application and precautions of each category. A concluding remark on existing challenges and future directions of this rapidly developing research area was finally made. Impact statement Effective osteoporosis (OP) treatment remains a significant challenge due substantially to the unavailability of appropriate drug carriers and artificial matrices with desired properties to promote bone repair and replace damaged regions. For this purpose, this review focused on the development of diverse injectable hydrogel systems for the delivery of various therapeutic agents, including drugs, stem cells, and nucleic acids, for effective increase in bone mass and favorable osteogenesis. The summarized important guidelines are believed to promote clinical development and translation of hydrogels for the efficient treatment of OP and OP-related bone damages toward improved life quality of millions of patients.
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Affiliation(s)
- Zhi Zheng
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study and School of Pharmaceutical Science, University of South China, Hengyang, China
| | - Cuiyun Yu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study and School of Pharmaceutical Science, University of South China, Hengyang, China
| | - Hua Wei
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study and School of Pharmaceutical Science, University of South China, Hengyang, China
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Peng W, Ou Y, Wang C, Wei J, Mu X, He Z. The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis. J Orthop Surg Res 2019; 14:469. [PMID: 31884957 PMCID: PMC6936155 DOI: 10.1186/s13018-019-1515-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/11/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To systematically compare the short- to midterm effectiveness of stemless prostheses to that of stemmed prostheses for patients who underwent total shoulder arthroplasty (TSA) and to provide a guideline for clinical decision-making. METHODS PubMed, the Cochrane Library, and Web of Science were searched with the given search terms until July 2019 to identify published articles evaluating the clinical outcomes for stemless prostheses compared with stemmed prostheses for patients who underwent TSA. Data extraction and the quality assessment of the included studies were independently performed by two authors. Stata software 14.0 was used to analyze and synthesize the data. RESULTS Two randomized controlled trials and six case-controlled studies with a total of 347 shoulders were included in this meta-analysis. The results of this meta-analysis showed that there were no significant differences between the stemless and stemmed prostheses in terms of the Constant score, pain score, strength, activities of daily living, postoperative range of motion (ROM), and postoperative maximum active ROM. CONCLUSIONS This is the first meta-analysis reporting the clinical results of stemless TSA in the short- to midterm follow-up period. Both types of shoulder prostheses were similar in achieving satisfactory clinical outcomes.
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Affiliation(s)
- Wei Peng
- Department of Anatomy and Cell Biology, Justus-Liebig University, 35392, Giessen, Germany
| | - Yufu Ou
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Chenglong Wang
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Jianxun Wei
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xiaoping Mu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Zhian He
- Department of Orthopaedics, The Affiliated Chencun Hospital of Shunde Hospital, Southern Medical University, Foshan, 528300, China
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