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Wilcox B, Campbell RJ, Low A, Yeoh T. Management of glenoid bone loss in primary reverse shoulder arthroplasty. Bone Joint J 2022; 104-B:1334-1342. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0819.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty. Methods This systematic review and meta-analysis evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We performed searches of Medline (Ovid), Embase (Ovid), and PubMed from their dates of inception to January 2022. From included studies, we analyzed data for preoperative and postoperative range of motion (ROM), patient-reported functional outcomes, and complication rates. Results A total of 13 studies (919 shoulders) were included in the analysis. The mean age of patients at initial evaluation was 72.2 years (42 to 87), with a mean follow-up time of 40.7 months (24 to 120). Nine studies with 292 rTSAs evaluated the use of bone graft and five studies with 627 rTSAs evaluated the use of augmented glenoid baseplates. One study was analyzed in both groups. Both techniques demonstrated improvement in patient-reported outcome measures and ROM assessment, with augmented prostheses outperforming bone grafting on improvements in the American Shoulder and Elbow Surgeons Score. There was a higher complication rate (8.9% vs 3.5%; p < 0.001) and revision rate among the bone grafting group compared with the patients who were treated with augmented prostheses (2.4% vs 0.6%; p = 0.022). Conclusion This review provides strong evidence that both bone graft and augmented glenoid baseplate techniques to address glenoid bone loss give excellent ROM and functional outcomes in primary rTSA. The use of augmented base plates may confer fewer complications and revisions. Cite this article: Bone Joint J 2022;104-B(12):1334–1342.
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Affiliation(s)
- Ben Wilcox
- Department of Orthopaedics, John Hunter Hospital, Newcastle, Australia
| | - Ryan J. Campbell
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Adrian Low
- University of Sydney, Sydney, Australia
- Department of Orthopaedic Surgery, Sydney Adventist Hospital, Sydney, Australia
| | - Timothy Yeoh
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Sydney, Australia
- Norwest Private Hospital, Sydney, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
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Contribution of Different Impairments to Restricted Knee Flexion during Gait in Individuals with Cerebral Palsy. J Pers Med 2022; 12:jpm12101568. [PMID: 36294708 PMCID: PMC9604873 DOI: 10.3390/jpm12101568] [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: 08/24/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
The coexistence of overlapping impairments modulates the knee pattern in the swing phase of walking in children with cerebral palsy (CP). The impact and contribution of each impairment to the reduction of knee range-of-motion is unknown. The aim of the study was to establish the gradation of the impact of individual coexisting impairments on the knee flexion range-of-motion. Passive range-of-motion, selective motor control, strength, and spasticity from 132 patients (Male = 76, Female = 56, age:11 ± 4 years) with spastic CP were tested with clinical tools. Knee flexion range-of-motion at terminal stance, pre-swing, and initial swing phases were assessed by gait analysis. Hypertonia (β = −5.75) and weakness (β = 2.76) of knee extensors were associated with lower range of knee flexion (R2 = 0.0801, F = 11.0963, p < 0.0001). The predictive factors (R2 = 0.0744, F = 7.2135, p < 0.0001) were strength (β = 4.04) and spasticity (β = −2.74) of knee extensors and strength of hip flexors (β = −2.01); in swing those were knee extensors hypertonia (β = −2.55) and passive range of flexion (β = 0.16) (R2 = 0.0398, F = 3.4010, p = 0.01). Hypertonia of knee extensors has the strongest impact on knee flexion range-of-motion; secondary is the strength of knee extensors. The knee extensors strength with knee extensors hypertonia and strength of hip flexors contributes in stance. Knee extensors hypertonia with passive knee flexion range-of-motion contributes in swing.
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Comparison of the Results of Primary Versus Repeat Hamstrings Surgical Lengthening in Cerebral Palsy. J Pediatr Orthop 2021; 40:e1024-e1025. [PMID: 32868516 DOI: 10.1097/bpo.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rethlefsen SA, Hanson AM, Wren TAL, Abousamra O, Kay RM. Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy. J Child Orthop 2020; 14:415-420. [PMID: 33204349 PMCID: PMC7666790 DOI: 10.1302/1863-2548.14.200154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Surgery is often required for fixed knee flexion contractures in patients with neuromuscular conditions. Anterior distal femoral hemiepiphysiodesis (ADFH) is an alternative to distal femoral extension osteotomy (DFEO) in skeletally immature patients. ADFH is typically not accompanied by patellar tendon shortening surgery (PTS). Our purpose was to compare ADFH alone versus ADFH with PTS for treatment of fixed knee flexion contractures and crouched gait in children with cerebral palsy (CP). METHODS Retrospective review of pre- and postoperative gait analysis data for children with CP who underwent ADFH alone, or ADFH with PTS. Data were analysed using linear mixed models to control for covariates. RESULTS In total, 25 participants (42 limbs) were included, 17 male and eight female, mean age at surgery 12.9 (sd 1.9) years. Both groups experienced significant improvement in popliteal angle, knee extension range of motion (ROM) and knee extension in stance phase. Greater improvement was seen for all variables in the ADFH/PTS group, mainly due to greater popliteal angle and knee flexion during gait preoperatively in that group (p ≤ 0.02) rather than the procedure performed (p ≥ 0.19). There was no difference between groups postoperatively. Rate of contracture resolution was 0.5° to 1.0° per month, faster in larger contractures (p = 0.02). CONCLUSIONS ADFH with and without PTS is effective in improving knee extension in skeletally immature patients with CP, correcting contractures at a rate of 0.5° to 1.0° per month. Combined ADFH and PTS surgery may be preferable in patients with larger contractures of up to 30° to 35°. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Susan A. Rethlefsen
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Correspondence should be sent to Susan Rethlefsen, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS 69, Los Angeles, CA 90027, USA. E-mail:
| | - Alison M. Hanson
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA
| | - Tishya A. L. Wren
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Oussama Abousamra
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Robert M. Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard MS#69, Los Angeles, CA 90027, USA,Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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