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Sachinis NP, Yiannakopoulos CK, Berthold DP, Franz A, Beitzel K. Can we accelerate rehabilitation following reverse shoulder arthroplasty? A systematic review. Shoulder Elbow 2024; 16:214-227. [PMID: 38655406 PMCID: PMC11034463 DOI: 10.1177/17585732221144007] [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: 09/26/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 04/26/2024]
Abstract
Background There is no consensus concerning the rehabilitation protocol following reverse shoulder arthroplasty. Several patients are expecting to be able to use their arms for sports or recreation shortly after their operation. Methods This review was designed as an intervention systematic review with narrative analysis. Authors searched English literature in PubMed and Embase databases from 1/1/1989 until July 2022. Controlled studies comparing rehabilitation protocols for patients undergoing reverse shoulder arthroplasty were included. Data quality was examined with the Cochrane risk of a bias assessment tool for randomized trials, the Methodological Index for Non-Randomized studies (MINORS) tool, as well as the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. Results Three studies were finally analyzed. At 3 months post-op, forward flexion was found to be significantly higher in the early rehabilitation group (140.5, 95% confidence intervals (CIs): 135.10-145.89; the delayed rehabilitation group mean was 131.24, 95% CI: 125.73-136.74; p = 0.019). Twelve months post-op, no significant difference in any clinical or patient-reported outcome was shown. More complications were reported in the 6 weeks-delayed rehabilitation group. Discussion Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. The lack of strong evidence warrants the need for future controlled studies; subsequently, postoperative rehabilitation should be individualized.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K Yiannakopoulos
- IASO Hospital, Athens, Greece
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
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Hao KA, Cueto RJ, Gharby C, Freeman D, King JJ, Wright TW, Almader-Douglas D, Schoch BS, Werthel JD. Influence of lateralized versus medialized reverse shoulder arthroplasty design on external and internal rotation: a systematic review and meta-analysis. Clin Shoulder Elb 2024; 27:59-71. [PMID: 37957880 PMCID: PMC10938020 DOI: 10.5397/cise.2023.00577] [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: 07/01/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. METHODS We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model. RESULTS Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°-44°] vs. 27° [22°-32°], P<0.001) and postoperative improvement in ER (20° [15°-26°] vs. 10° [5°-15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 5 cohorts) versus 36% (n=177, 5 cohorts) of medialized implants. CONCLUSIONS Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair. Level of evidence: 2A.
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Affiliation(s)
- Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert J. Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christel Gharby
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - David Freeman
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J. King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W. Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Bradley S. Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jean-David Werthel
- Hopital Ambroise Pare, Orthopedic Department, Boulogne-Billancourt, France
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Doyle TR, Downey S, Hurley ET, Klifto C, Mullett H, Denard PJ, Garrigues GE, Menendez ME. Midterm outcomes of primary reverse shoulder arthroplasty: a systematic review of studies with minimum 5-year follow-up. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:1-7. [PMID: 38323206 PMCID: PMC10840579 DOI: 10.1016/j.xrrt.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Excellent short-term outcomes after reverse shoulder arthroplasty (RSA) have been reported, but longer term outcomes in the existing literature are sparse and vary widely. The purpose of this study is to systematically assess the existing literature to quantify functional outcomes and complication rates after RSA at a minimum of five years of follow-up. Methods A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic literature search of the PubMed and Embase databases was undertaken. Studies reporting outcomes after primary RSA for nontrauma-related indications with a minimum of 5-year follow-up were included. Results Overall, 20 studies satisfied all inclusion criteria. This represented 1591 shoulders in 1556 patients (32.1% males), with a mean age of 70.2 ± 5.0 years and mean follow-up of 8.8 years, or 106.2 ± 30.1 months (60-243). At final follow-up, the mean reported Constant Murley score was 62.1 ± 5.0 (49.0-83.0). The mean adjusted Constant Murley score was 83.5 ± 12.5 (58-111.9). The mean American Shoulder and Elbow Surgeons score was 81.8 ± 4.6, while the mean subjective shoulder value was 74.6 ± 6.4. Overall, 88% of patients rated their satisfaction as either good or very good. The range of active forward flexion, abduction, external, and internal rotation were respectively, 126° ± 13°, 106° ± 11°, 22° ± 11°, and 6° ± 2°. The overall rate of revision surgery was 4.9% (0%-45.5%). Regarding complications, the rate of prosthetic joint infection was 4.3% (0%-26.7%), shoulder dislocation was 3.7% (0%-20.4%), and acromial fracture was 2.0% (0%-8.8%). At final follow-up, 30.9% of shoulders had some degree of scapular notching. Conclusion This systematic review shows that RSA results in high satisfaction rates, good clinical outcomes, as well as modest complication and revision rates at minimum 5-year follow-up.
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Affiliation(s)
- Tom R. Doyle
- Sports Surgery Clinic, Dublin, Ireland
- Department of Surgery, University of Galway, Galway, Ireland
| | - Sophia Downey
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Castricini R, Mercurio M, Galasso O, Sanzo V, De Gori M, De Benedetto M, Orlando N, Gasparini G. Femoral head allograft for glenoid bone loss in primary reverse shoulder arthroplasty: functional and radiologic outcomes. J Shoulder Elbow Surg 2024; 33:e58-e67. [PMID: 37506998 DOI: 10.1016/j.jse.2023.06.027] [Citation(s) in RCA: 2] [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: 03/14/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Several techniques have been adopted during primary reverse shoulder arthroplasty (RSA) to manage glenoid bone defect. Among bone grafts, humeral head autograft is currently the mainstream option. However, autologous humeral heads may be unavailable or inadequate, and allografts may be a viable alternative. The aim of the present study was to evaluate the functional and radiologic outcomes of femoral head allografts for glenoid bone defects in primary RSA. METHODS We conducted a retrospective study with prospective data collection enrolling 20 consecutive patients who underwent RSA with femoral head allografts for glenoid bone defects. Indications for surgery were eccentric cuff tear arthropathy in 10 cases (50%), concentric osteoarthritis in 9 cases (45%), and fracture sequelae in 1 case (5%). Each patient was evaluated preoperatively and at follow-up by radiologic and computed tomography (CT) and by assessing the range of motion (ROM) and the Constant-Murley score (CMS). A CT-based software, a patient-specific 3D model of the scapula, and patient-specific instrumentation were used to shape the graft and to assess the position of K-wire for the central peg. Postoperatively, CT scans were used to identify graft incorporation and resorption. RESULTS After a median follow-up of 26.5 months (24-38), ROM and CMS showed a statistically significant improvement (all P = .001). The median measures of the graft were as follows: 28 mm (28-29) for diameter, 22° (10°-31°) for angle, 4 mm (2-8 mm) for minimum thickness, and 15 mm (11-21 mm) for maximum thickness. Before the surgery, the median glenoid version was 21.8° (16.5°-33.5°) for the retroverted glenoids and -13.5° (-23° to -12°) for the anteverted glenoids. At the follow-up, the median postoperative baseplate retroversion was 5.7° (2.2°-1.5°) (P = .001), and this value was close to the 4° retroversion planned on the preoperative CT-based software. Postoperative major complications were noted in 4 patients: 2 dislocations, 1 baseplate failure following a high-energy trauma, and 1 septic baseplate failure. Partial graft resorption without glenoid component failure was observed in 3 cases that did not require revision surgery. CONCLUSION The femoral head allograft for glenoid bone loss in primary RSA restores shoulder function, with CMS values comparable to those of sex- and age-matched healthy individuals. A high rate of incorporation of the graft and satisfactory correction of the glenoid version can be expected after surgery. The management of glenoid bone defects remains a challenging procedure, and a 15% risk of major complication must be considered.
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Affiliation(s)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
| | - Valentina Sanzo
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, Basso Ionio Hospital, Soverato, Italy
| | | | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", Fermo, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
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Ogrodzka-Ciechanowicz K, Kurzeja P, Sorysz T. Functional assessment and quality of life of patients after reverse total shoulder arthroplasty in the late follow-up period. J Back Musculoskelet Rehabil 2024; 37:1083-1090. [PMID: 38217584 DOI: 10.3233/bmr-230347] [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] [Indexed: 01/15/2024]
Abstract
BACKGROUND Due to the systematically increasing number of shoulder replacement procedures among older people, the need to assess their quality of life is becoming more and more important. OBJECTIVE The aim of the study was to functionally assess the shoulder joint and the quality of life of patients before and after reverse total shoulder arthroplasty (rTSA). METHODS The observational study included 15 patients after the rTSA procedure (randomly selected). The quality of life and shoulder joint function before and after rTSA were assessed using the following scales: SF-36, Constant-Murley Score, Disabilities of the Arm, Shoulder and Hand Scale (DASH) and the University of California-Los Angeles Shoulder Rating Scale (UCLA scale) and Simple Shoulder Test (SST). RESULTS There were statistically significant differences (p< 0.001) between measurements in the overall scores of the SF-36 questionnaire. Statistically significant differences (p< 0.001) were found between measurements in terms of the Constant-Murley, DASH, UCLA and SST scales results. CONCLUSIONS Reverse total shoulder arthroplasty significantly improved the patients' quality of life and the functional condition of the operated limb.
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Affiliation(s)
| | - Piotr Kurzeja
- Institute of Health Sciences, University of Applied Sciences in Nowy Targ, Nowy Targ, Poland
| | - Tomasz Sorysz
- Trauma and Orthopedic Department, Gabriel Narutowicz Municipal Specialist Hospital in Krakow, Poland
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Castricini R, Galasso O, Mercurio M, Dei Giudici L, Massarini A, De Gori M, Castioni D, Gasparini G. Clinical outcomes are unchanged after a mean of 12 years after reverse shoulder arthroplasty: a long-term re-evaluation. JSES Int 2024; 8:185-190. [PMID: 38312267 PMCID: PMC10837693 DOI: 10.1016/j.jseint.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background The medium-term results of reverse shoulder arthroplasty (RSA) that has been performed by a single surgeon have been previously reported. The purpose of this study was to investigate the minimum 10-year clinical and radiographic outcomes of these patients. Methods In this prospective cohort study, 27 patients were evaluated after RSA for massive rotator cuff tear with or without eccentric osteoarthritis (OA) or concentric OA with the Constant-Murley Score (CMS), range of motion (ROM), and a radiologic assessment. Results At a mean 12-year follow-up, the CMS and ROM were significantly improved when compared with the baseline values (all P < .001). Once stratified by diagnosis, no difference in the ROM or total CMS was found between patients with massive rotator cuff tear with/without eccentric OA and those with concentric OA. Neither ROM nor CMS decreased when compared to the mid-term values of the previous study, for both the overall population and the diagnosis-stratified groups. Scapular notching was reported in 66.7% of cases that was similar to the data reported at mid-term follow-up. The calcification rate was 59.3% at the long-term evaluation, and there were no differences between the same case-series population (51.9%; P = .785) and the whole population at mid-term follow-up (47%; P = .358). Conclusion RSA led to excellent clinical and functional outcomes for patients up to 17 years postoperatively, and there was no decrease in the CMS over time. No loosening of implants was noted, and the rate of scapular notching was 66%, mostly grade 1 or 2.
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Affiliation(s)
- Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, “Villa Verde” Hospital, Fermo, Italy
- Department of Orthopaedic and Trauma Surgery, “Villa Maria Cecilia” Hospital, Cotignola, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Renato Dulbecco” University Hospital, Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Renato Dulbecco” University Hospital, Catanzaro, Italy
| | - Luca Dei Giudici
- Orthopedic Unit, Villa dei Pini Hospital, Civitanova Marche, Italy
| | - Alessandro Massarini
- Division of Orthopaedic and Trauma Surgery, “Villa Verde” Hospital, Fermo, Italy
- Department of Orthopaedic and Trauma Surgery, “Villa Maria Cecilia” Hospital, Cotignola, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, Basso Ionio Hospital, Soverato, Italy
| | - Davide Castioni
- Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Renato Dulbecco” University Hospital, Catanzaro, Italy
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Familiari F, Ammendolia A, Rupp MC, Russo R, Pujia A, Montalcini T, Marotta N, Mercurio M, Galasso O, Millett PJ, Gasparini G, de Sire A. Efficacy of intra-articular injections of hyaluronic acid in patients with glenohumeral joint osteoarthritis: A systematic review and meta-analysis. J Orthop Res 2023; 41:2345-2358. [PMID: 37314198 DOI: 10.1002/jor.25648] [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: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/15/2023]
Abstract
Symptomatic primary glenohumeral (GH) joint osteoarthritis (OA) can be challenging to treat. Hyaluronic acid (HA) has emerged as a promising treatment for the nonsurgical management of GH-OA. In this systematic review with meta-analysis, we aimed to evaluate the current evidence regarding the efficacy of intra-articular HA on pain relief in patients suffering from GH-OA. A total of 15 studies (only randomized controlled trials providing data at the end of the intervention) were included. The relevant studies were selected based on the following PICO model: P: patients with diagnosis of shoulder OA; I: HA infiltrations as therapeutic intervention administered; C: no restriction for comparators assessed; O: pain, in terms of visual analog scale (VAS) or numeric rating scale. The risk of bias among the included studies was estimated using the PEDro scale. A total of 1023 subjects were analyzed. Comparing HA injections combined with physical therapy (PT) compared to PT alone resulted in superior scores, showing an overall effect size (ES) of 4.43 (p = 0.00006). Moreover, pooled analysis of VAS pain scores demonstrated a significant improvement in the ES of the HA in comparison with corticosteroid injections (p = 0.002). On average, we reported a PEDro score of 7.2. A total of 46.7% of studies showed probable signs of a randomization bias. The findings of this systematic review and meta-analysis showed that IA injections of HA might be effective on pain relief with significant improvements compared to baseline and compared to corticosteroid injections in patients affected by GH-OA.
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Affiliation(s)
- Filippo Familiari
- Division of Orthopaedic and Trauma Surgery, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, Catanzaro, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, Catanzaro, Italy
- Division of Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Raffaella Russo
- Division of Nutrition Clinic, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Arturo Pujia
- Division of Nutrition Clinic, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Research Center on Prevention and Treatment of Metabolic Diseases (CR METDIS), Magna Graecia University, Catanzaro, Italy
| | - Tiziana Montalcini
- Research Center on Prevention and Treatment of Metabolic Diseases (CR METDIS), Magna Graecia University, Catanzaro, Italy
- Division of Nutrition Clinic, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, Catanzaro, Italy
- Division of Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Michele Mercurio
- Division of Orthopaedic and Trauma Surgery, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Olimpio Galasso
- Division of Orthopaedic and Trauma Surgery, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, Catanzaro, Italy
| | - Peter J Millett
- The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Giorgio Gasparini
- Division of Orthopaedic and Trauma Surgery, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, Catanzaro, Italy
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, Catanzaro, Italy
- Division of Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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İlyas G, Egeli E. Does Reverse Shoulder Arthroplasty Improve Function and Quality of Life in Patients With Rotator Cuff Tear Arthropathy? Cureus 2023; 15:e42896. [PMID: 37664251 PMCID: PMC10474821 DOI: 10.7759/cureus.42896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background This study aims to determine the change in functional capacity and quality of life in patients who underwent reverse shoulder arthroplasty (RSA) due to rotator cuff tear arthropathy (RCTA). Methodology A total of 89 patients who underwent RSA due to RCTA between 2016 and 2022 were included in the study, as examined by the senior author. The Constant-Murley Score (CMS) was used for functional assessment, whereas the Short Form-36 (SF-36) was used for quality-of-life evaluation. The assessment scores before and after the surgery were compared to the reference values of CMS and SF-36 scores, as determined by reference studies, based on age groups. The change in functional capacity and quality of life with RSA was calculated. In addition, the impact of age and body mass index (BMI) on the results was examined. Results No differences were found in demographic data except for BMI (p = 0.026). CMS did not reach the reference values of a normal shoulder during the 12-month postoperative period. However, a significant increase of 156% in comparison to the preoperative values was detected (p < 0.001). In the postoperative period, there was a statistically significant improvement in SF-36 scores compared to preoperative scores, except for social functioning (p = 0.099) and vitality (p = 0.255) (for all other parameters, p < 0.001). In patients under the age of 65 years, all parameters except for physical functioning, physical role, and social functioning statistically reached the reference values. A decrease in CMS scores was noted with an increase in BMI, and the negative correlation further increased in the postoperative period (preoperative: r = -0.274, 12-month postoperative: r = -0.476). Conclusions RSA performed for RCTA leads to an improvement in functional outcomes and quality of life. Although there was a considerable improvement after surgery for CMS compared to preoperatively, it was observed that normal shoulder reference values could not be reached. For SF-36, it was observed that it reached normal shoulder reference values, especially in patients over 65 years of age.
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Affiliation(s)
- Gökhan İlyas
- Orthopedics and Traumatology, Uşak University, Uşak, TUR
| | - Ercument Egeli
- Orthopedics and Traumatology, Uşak Esme State Hospital, Uşak, TUR
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Brindisino F, Lorusso M, Usai M, Pellicciari L, Marruganti S, Salomon M. Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists. Arch Physiother 2023; 13:12. [PMID: 37277886 DOI: 10.1186/s40945-023-00166-5] [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: 07/12/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups. MATERIALS AND METHODS This cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021. RESULTS Six-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension. In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6-12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3-4 weeks and higher than 90° at 6-12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication. CONCLUSIONS The clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Mariangela Lorusso
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | | | | | - Sharon Marruganti
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Mattia Salomon
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
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Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med 2023; 16:145-153. [PMID: 36867393 PMCID: PMC10043097 DOI: 10.1007/s12178-023-09823-5] [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] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. RECENT FINDINGS Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6 weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.
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Lee S, Kim DH, Kim SG, Cho CH. Does reverse shoulder arthroplasty improve emotional status and quality of life in patients with rotator cuff insufficiency? Prospective sequential follow-up study. J Shoulder Elbow Surg 2023; 32:1-8. [PMID: 36206986 DOI: 10.1016/j.jse.2022.08.026] [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: 06/11/2022] [Revised: 08/01/2022] [Accepted: 08/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study was to investigate sequential changes of emotional status and quality of life after reverse shoulder arthroplasty (RSA) for rotator cuff insufficiency and to determine the predictors that can affect postoperative clinical outcomes. This study was conducted to prove the hypothesis that RSA would improve emotional status and quality of life. METHODS Fifty patients undergoing RSA for rotator cuff insufficiency were prospectively included. Evaluation using the visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value, Hospital Anxiety and Depression Scale (HADS), and Abbreviated scale of World Health Organization Quality of Life (WHOQOL-BREF) was performed before surgery and at 1.5, 3, 6, and 12 months after surgery. RESULTS The mean visual analog scale pain score, HADS-depression score, and HADS-anxiety score showed a significant decrease from 6.6, 13.3, and 13.9 before surgery to 1.5, 3.9, and 3.7 after 12 months after surgery, respectively (all P < .001). The mean ASES score, WHOQOL-BREF score, and subjective shoulder value showed a significant improvement from 28.5, 32.3, and 23.6% to 81.3, 79.1, and 78.4%, respectively (all P < .001). All outcome measurements showed a significant improvement from 6 weeks after RSA. In multivariate analysis, age was an independent predictor of the final ASES score and WHOQOL-BREF score (P = .037 and .004, respectively). CONCLUSION This study showed a sequential improvement of emotional status and quality of life as well as functional recovery with pain relief from 6 weeks after RSA in patients with rotator cuff insufficiency. Especially, younger patients had better postoperative functional ability and quality of life. These findings suggest that RSA for rotator cuff insufficiency provides a rapid improvement of emotional status and quality of life.
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Affiliation(s)
- Seungha Lee
- Department of Orthopedic Surgery, Ulsan City Hospital, Ulsan, Republic of Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Soon Gu Kim
- Education Support Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.
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12
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DeBernardis DA, Lynch JC, Radack T, Austin LS. Return to driving following anatomic and reverse shoulder arthroplasty: a comparative analysis. J Shoulder Elbow Surg 2022; 32:e191-e199. [PMID: 36528223 DOI: 10.1016/j.jse.2022.11.003] [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: 08/16/2022] [Revised: 10/20/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The currently recommended time to return to driving following shoulder arthroplasty is controversial. The purpose of this study was to determine patient-specific factors associated with early return to driving after anatomic (aTSA) and reverse total shoulder arthroplasty (RTSA). METHODS All patients aged >18 years undergoing primary aTSA or RTSA at a single institution over a 3-year period were retrospectively identified. Patients were emailed a questionnaire to determine time to postoperative return to driving and frequency of driving prior to and following surgery. Patients who did not drive prior to surgery or did not complete the questionnaire were excluded from analysis. Multivariate analysis was used to determine patient-specific factors associated with early return to driving (within 2 weeks following surgery) and delayed return (>6 weeks following surgery). RESULTS Four hundred six patients were included for analysis (aTSA = 214, RTSA = 192). Patients undergoing aTSA were significantly younger (68 vs. 74 years) and drove more frequently both pre- and postoperatively than the RTSA cohort. One hundred percent of patients returned to driving postoperatively. Patients undergoing aTSA more commonly demonstrated earlier return to driving than RTSA patients (34% vs. 20%). Factors associated with increased odds of early return to driving included male sex (aTSA) and compliance with surgeon instruction (aTSA). Decreased odds of early return was associated with waiting to drive until cessation of sling use (RTSA), older age (RTSA), and increased body mass index (RTSA). The presence of surgical complications (aTSA) and prolonged use of narcotics (RTSA) were associated with return to driving >6 weeks following surgery. No difference in the rate of motor vehicle accidents was found between patients returning to driving <2 vs. >2 weeks postoperatively. CONCLUSION Patients undergoing aTSA return to driving sooner than those undergoing RTSA. Early return to driving appears to be influenced by patient sex, age, BMI, narcotic and sling use, and compliance with surgeon instruction, but does not appear to result in a high incidence of postoperative MVA.
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Affiliation(s)
- Dennis A DeBernardis
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
| | - Jeffrey C Lynch
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Tyler Radack
- The Rothman Institute at Jefferson University, Philadelphia, PA, USA
| | - Luke S Austin
- The Rothman Institute at Jefferson University, Philadelphia, PA, USA
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Reverse total shoulder arthroplasty pain and function: new perspectives from a 10-year multicenter study at the 7-year follow-up. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04702-z. [PMID: 36436065 DOI: 10.1007/s00402-022-04702-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) can decrease shoulder pain and improve function. However, results reportedly deteriorate as patients approach mid-term follow-up and little is known about how this impacts physical health-related quality of life (PHRQOL) and mental health-related quality of life (MHRQOL). The study hypothesis was that shoulder function, pain, and medication use for pain would influence PHRQOL and MHRQOL. METHODS This prospective cohort study involving subjects from 6 orthopedic clinics and 12 fellowship-trained surgeons evaluated the influence of RTSA on PHRQOL, MHRQOL, shoulder function, pain, instability, and medication use over the initial 7 years of a 10-year study, and device survivorship and revision rates. Clinical examination, the American Shoulder and Elbow Surgeons (ASES) score, Short Form (SF)-12 PHRQOL and MHRQOL assessments, the single assessment numeric shoulder function evaluation (SANE), visual analog scale (VAS) shoulder pain and instability scores, shoulder pain, medication use for pain, surgery satisfaction, survivorship and revision rate data were collected pre-RTSA, and at 6-week, 6-month, 1-year, 2-year, 3-year, 5-year, and 7-year follow-ups. RESULTS Two hundred participants (108 female) of 69 ± 8.3 years of age, with gross rotator cuff deficiency (poor tissue quality or impaired dynamic stability) (n = 92), glenohumeral joint osteoarthritis (n = 88), failed primary total shoulder arthroplasty (n = 8), non-united humeral head fracture (n = 6) or 3-4 section comminuted humeral head fracture (n = 6) underwent pre-RTSA evaluation. Device survivorship was 94%. Friedman two-way ANOVA and Wilcoxon test pairwise comparisons revealed that compared to pre-RTSA, median active shoulder flexion (+ 25°) and external rotation (+ 10°) mobility improved by 6 months (p < 0.0001) and remained improved. Shoulder flexion (+ 1 grade), abduction, external rotation (+ 0.5 grade), and internal rotation strength (+ 1 grade) also improved by 6 months (p < 0.0001) and remained improved. ASES (+ 26.8), SANE (+ 17.5) and VAS pain (- 5.7) scores improved by 6 weeks (p < 0.0001) and remained improved, as medication use for shoulder pain decreased (- 24.6%) (p < 0.0001). SF-12 PHRQOL scores improved by 6 months (+ 11.5) and remained improved (p < 0.0001). Significant Spearman Rho correlations were observed between shoulder function (ASES or SANE) and SF-12 PHRQOL (r ≥ 0.52) and MHRQOL (r ≥ 0.20) scores (p < 0.0001) supporting the relationship between shoulder function and quality of life. Trend analysis revealed changing shoulder function, pain, and PHRQOL relationships between 2 and 3 years, and 5 and 7 years post-RTSA (Chi-Square, p < 0.05). CONCLUSION Excellent device survival and good-to-excellent perceived shoulder function, and PHRQOL improvements were observed. Secondary objectives of improved shoulder mobility, strength, pain and instability were also achieved. In contrast to previous reports, subjects did not display shoulder mobility or perceived function deterioration by the 7-year follow-up. Following chronic pain relief at 6 weeks post-RTSA, subjects appear to balance PHRQOL and shoulder pain relationships at the 6-month and 1-year post-RTSA follow-ups. Careful evaluation at this time may help patients with higher pain levels and lower function expectations reverse these trends, or patients with lower pain levels and higher function expectations to optimize RTSA use and longevity.
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Galvin JW, Kim R, Ment A, Durso J, Joslin PMN, Lemos JL, Novikov D, Curry EJ, Alley MC, Parada SA, Eichinger JK, Li X. Outcomes and complications of primary reverse shoulder arthroplasty with minimum of 2 years' follow-up: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e534-e544. [PMID: 35870805 DOI: 10.1016/j.jse.2022.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA. METHODS A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles. RESULTS Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%). DISCUSSION Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores.
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Affiliation(s)
| | - Ryan Kim
- Boston University School of Medicine, Boston, MA, USA
| | - Alexander Ment
- The University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | | | | - David Novikov
- Boston University School of Medicine, Boston, MA, USA
| | - Emily J Curry
- Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Xinning Li
- Boston University School of Medicine, Boston, MA, USA.
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15
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Outcome of geriatric proximal humeral fractures: a comparison between reverse shoulder arthroplasty versus open reduction and internal fixation. OTA Int 2022; 5:e188. [PMID: 35949265 PMCID: PMC9359012 DOI: 10.1097/oi9.0000000000000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
Objectives: In view of the increased attention to reverse shoulder arthroplasty (rTSA) as a treatment for complex proximal humeral fractures in the elderly, the present study analyzes in-hospital complications and the postoperative management of rTSA versus open reduction and internal fixation (ORIF). Methods: We retrospectively reviewed patients hospitalized from 2016 to 2018 for proximal humeral fractures (ICD-9 codes: S42.21), III- and IV-part, who underwent an ORIF with locking plates, rTSA or nonoperative treatment. In-hospital complications and postoperative management in both groups were included in the analysis. Results: We included n 190 patients (ORIF 90, rTSA 71, nonoperative 29), more likely to be female (82.1% vs 17.9%; P < .01) with an average age of 82years (min. 72, max. 99; SD 6.4). The ORIF and the rTSA groups showed comparable complication rates (15.6% vs 15%, P = .87) but with a significantly shorter hospital stay (8.6 vs 11.5days; P = .01) and shorter duration of surgery (72.9 vs 87.2 minutes; P = .01) in the ORIF group. Significantly more patients after ORIF achieved an independent life postoperatively (53.3% vs 40.8%; P = .013). Conclusions: In this retrospective analysis, ORIF is related to a shorter duration of surgery, a shorter hospital stay and a higher likelihood of independence. Despite the popularity of the rTSA, ORIF remains a reliable treatment option for proximal humeral fractures in the elderly. Level of evidence: III
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16
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Mathew JI, Nicholson AD, Finocchiaro A, Okeke L, Dines DM, Dines JS, Taylor SA, Warren RF, Gulotta LV. Outcomes of shoulder arthroplasty by year of index procedure: are we getting better? J Shoulder Elbow Surg 2022; 31:245-251. [PMID: 34592407 DOI: 10.1016/j.jse.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether postoperative patient-reported outcomes improved over time following anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). METHODS We performed a retrospective analysis of prospectively collected patient-reported outcomes from our institution's registry between 2008 and 2018 (N = 1899). American Shoulder and Elbow Surgeons (ASES) scores at a minimum of 2 years postoperatively were required. Univariable linear models were used to test the association between year of surgery and improvement in ASES scores at 2- and 5-year follow-up, as well as any association with age, sex, primary or revision surgery, hand dominance, American Society of Anesthesiologists classification, rotator cuff status, primary diagnosis, and Walch classification. Multivariable models were created to analyze ASES score improvement by index year while controlling for significant factors. RESULTS In the univariable analysis, 5-year ASES difference scores increased each year by a mean of 1.65 (P < .001; 95% confidence interval [CI], 0.75-2.55) for TSA, 2.50 (P = .014; 95% CI, 0.52-4.49) for RTSA, and 1.64 (P < .001; 95% CI, 0.81-2.47) for the overall population. Patient sex, American Society of Anesthesiologists classification, rotator cuff status, primary diagnosis, Walch classification, and revision procedures were also significant factors affecting ASES scores. On multivariable analysis controlling for these factors, 5-year ASES difference scores were still significantly associated with year of surgery, increasing each year by a mean of 2.20 (P < .001; 95% CI, 0.91-3.50) for TSA, 4.83 (P < .001; 95% CI, 1.17-8.49) for RTSA, and 1.66 (P < .001; 95% CI, 0.81-2.51) for the entire population. CONCLUSION Both anatomic TSA and RTSA patients reported increasing ASES difference scores at 5-year follow-up as time passed. These findings may indicate that advances in shoulder arthroplasty have resulted in better patient outcomes over time. Further research is needed to clarify which factors influence improvements in outcomes, particularly for revision procedures.
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Lemaster NG, Hettrich CM, Jacobs CA, Heebner N, Westgate PM, Mair S, Montgomery JR, Uhl TL. Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear? Clin Orthop Relat Res 2021; 479:1982-1992. [PMID: 33835100 PMCID: PMC8373537 DOI: 10.1097/corr.0000000000001750] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported measures guide physicians in clinical decision making and therefore it is critical to determine what clinical factors are associated with these scores. Psychological and physical factors are commonly studied separately in patients with rotator cuff tears to determine their influence on outcomes. It is well established that psychological distress and scapular motion change in the presence of a symptomatic rotator cuff tear. However, these factors have not been studied simultaneously in a clinical setting to determine their association with shoulder outcome scores. QUESTION/PURPOSE After controlling for relevant confounding variables, what physical and psychological factors are associated with better (1) American Shoulder and Elbow Surgeons (ASES) scores for function, (2) ASES pain scores, and (3) total ASES scores? METHODS Fifty-nine patients with a potential symptomatic rotator cuff tear were recruited and agreed to participate in this cross-sectional study. Of those, 85% (50 of 59) met eligibility criteria for a primary diagnosis of an MRI-confirmed symptomatic partial-thickness or full-thickness rotator cuff tear without a history of shoulder surgery. Demographics, rotator cuff tear size, arm flexion, and clinical scapular motion during active arm flexion were evaluated by experienced examiners using standardized procedures. Patients completed the ASES questionnaire and the Optimal Screening for Prediction of Referral and Outcomes-Yellow Flag assessment form, which measures 11 different pain-related psychological distress symptoms. Three separate stepwise multiple linear regression analyses were performed for ASES pain, function, and total scores, with significance set at p < 0.05. RESULTS This model found that ASES function scores were associated with four factors: older age, increased arm flexion, increased percentage of scapular external rotation during arm flexion, and increased scores for acceptance of chronic pain (adjusted r2 = 0.67; p = 0.01). Those four factors appear to explain 67% of the observed variance in ASES function scores in patients with rotator cuff tears. Furthermore, increased percentage of scapular external rotation during arm flexion and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.36; p < 0.01) were associated with better ASES pain scores. And finally, better ASES total scores were associated with four factors: increased arm flexion, increased percentage of scapular upward rotation, increased scapular external rotation during arm flexion, and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.65; p < 0.001). CONCLUSION Our results favor adopting a comprehensive biopsychological clinical assessment for patients with rotator cuff tears that specifically includes humeral and scapular motion, fear-avoidance behaviors, and pain coping behaviors along with demographics. These particular physical and psychological variables were found to be associated with the ASES and, therefore, should be clinically examined simultaneously and targeted as part of a tailored treatment plan. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Nicole G. Lemaster
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Cale A. Jacobs
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Nick Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Scott Mair
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Tim L. Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Holsters L, Sadeghi N, Gendera H, Groen V, Bruls V, Lambers Heerspink O. Influence of humeral stem inclination in reverse shoulder arthroplasty on range of motion: a meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:102-112. [PMID: 37588151 PMCID: PMC10426706 DOI: 10.1016/j.xrrt.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Hypothesis The reverse shoulder arthroplasty, as introduced by Grammont, has had many modifications over time. One of these modifications was reducing the neck-shaft angle (NSA) from 155 degrees to 135 degrees. Biomechanical studies indicated that lowering the NSA increases external rotation and reduces abduction and the incidence of scapular notching. The purpose of this study was to compare range of motion, functional outcome measures, and complications in patients undergoing reverse shoulder arthroplasty, depending on the NSA, through a systematic review and meta-analysis. Methods A literature search was conducted (articles published from January 1985 to January 2020) in the PubMed/MEDLINE, Embase, and CINAHL databases and the Cochrane library. All studies reporting outcomes after primary reverse shoulder arthroplasty for osteoarthritis and rotator cuff-related disease were included. Patients were divided into 2 groups: a medialized design (MD) with an NSA of 150-155 degrees and a lateralized design (LD) with an NSA of less than 150 degrees. Pooled effects were calculated in the form of mean differences and 95% confidence intervals (CIs). Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies - of Interventions tool for non-Randomized Controlled Trials and the Risk Of Bias 2 tool for Randomized Controlled Trials. Results A total of 21 studies and 3134 arthroplasties were included: 1366 with an MD and 1678 with an LD. The mean age was 73.0 years (MD 74.0 and LD 72.5). A direct comparative meta-analysis was not feasible, and therefore, all data were compared using the minimal clinically important difference. The MD group demonstrated a larger improvement in abduction (56.76°, 95% CI 37.03-76.49) than the LD group (48.52°, 95% CI 28.27-68.78), however the LD group demonstrated a larger improvement in external rotation with the arm at the side (MD: 7.69°, 95% CI 0.01-15.37; LD: 16.14° 95% CI 7.18-25.09). When looking at the postoperative range of motion, the MD group had more abduction than the LD group (MD: 136.28°, 95% CI 127.36-145.20; LD: 127.77° 95% CI 117.02-138.52). Both designs had a comparable improvement in the Constant Murley score (MD 42.04 points, LD 41.14 points). Lowering the NSA was accompanied by a decrease in dislocation rate (MD: 4.6%; LD: 1.4%; P value .037) and notching rate (MD: 40.3%; LD: 17.3%; P value <.0001). Conclusion In our analysis, lowering the NSA decreases the amount of abduction but increases the amount of external rotation. This change in range of motion is accompanied by less scapular notching and dislocations. There is no clear impact on functional outcome measures.
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Affiliation(s)
- Lode Holsters
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Nasrât Sadeghi
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Helene Gendera
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Vincent Groen
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Vivian Bruls
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
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Shah SS, Roche AM, Sullivan SW, Gaal BT, Dalton S, Sharma A, King JJ, Grawe BM, Namdari S, Lawler M, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int 2020; 5:121-137. [PMID: 33554177 PMCID: PMC7846704 DOI: 10.1016/j.jseint.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
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Affiliation(s)
- Sarav S. Shah
- American Shoulder and Elbow Surgeons (ASES) Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
- Corresponding author: Sarav S. Shah, MD, 125 Parker Hill Ave, Boston, MA 02120, USA.
| | | | | | - Benjamin T. Gaal
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Stewart Dalton
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Arjun Sharma
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph J. King
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Brian M. Grawe
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Surena Namdari
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Macy Lawler
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Thomas W. Wright
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Kyle Flik
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Randall J. Otto
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Jones
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Andrew Jawa
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Peter McCann
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph Abboud
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Gabe Horneff
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Glen Ross
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Friedman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Douglas Boardman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
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Kirsch JM, Namdari S. Rehabilitation After Anatomic and Reverse Total Shoulder Arthroplasty: A Critical Analysis Review. JBJS Rev 2020; 8:e0129. [PMID: 32224631 DOI: 10.2106/jbjs.rvw.19.00129] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Postoperative rehabilitation is believed to be essential in optimizing clinical outcome and function following shoulder arthroplasty. Despite this long-held notion, there is a paucity of high-quality evidence to guide rehabilitation protocols and practice. For patients undergoing anatomic total shoulder arthroplasty (ATSA), there are insufficient comparative data regarding type or duration of sling utilization. Based on current evidence, there is no appreciable benefit to early motion compared with a delayed-motion protocol following ATSA. There is insufficient literature to support the use of formal physical therapy over a physician-directed program following ATSA. At the present time, no high-quality evidence exists to guide the postoperative rehabilitation of patients undergoing reverse total shoulder arthroplasty (RTSA). Prospective randomized controlled trials evaluating postoperative management and rehabilitation following ATSA and RTSA are needed to guide best practices and optimize clinical outcomes.
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Affiliation(s)
- Jacob M Kirsch
- Departments of Orthopaedic Surgery and Shoulder and Elbow Surgery, The Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- Departments of Orthopaedic Surgery and Shoulder and Elbow Surgery, The Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania
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21
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Grey B, Rodseth RN, Roche SJ. Humeral Stem Loosening Following Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2019; 6:e5. [PMID: 29762342 DOI: 10.2106/jbjs.rvw.17.00129] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The timing and the factors contributing to aseptic stem loosening remain poorly understood. METHODS We performed a systematic review that identified 75 articles; 65 of the included articles were case series (Level-IV evidence), 8 were cohort studies (7 Level III, 1 Level II), and 2 were prospective randomized controlled trials (Level I). A meta-analysis of 1,660 cemented and 805 uncemented RSA stems was performed. We compared the rates of aseptic stem loosening, humeral radiolucent lines, and revision for stem loosening (1) between cemented and uncemented stems in cohorts with short and long mean follow-up periods (<5 and ≥5 years) as well as in all cohorts combined, and (2) among different etiological subgroups. RESULTS Aseptic stem loosening occurred more commonly in the cohort with long compared with short follow-up time (2% versus 0.8%, p = 0.01). When comparing cemented with uncemented stems, there was no significant difference in the rates of aseptic stem loosening or revision for stem loosening in either the short or long-term follow-up groups. Humeral radiolucent lines were more common with cemented compared with uncemented stems (15.9% versus 9.5%, p = 0.002). Analyzed by etiology, the highest rate of aseptic stem loosening occurred in the tumor subgroup (10.8%), followed by RSA as a revision procedure after a failed arthroplasty (3.7%). No stems in the acute fracture or fracture sequelae subgroups developed aseptic stem loosening. CONCLUSIONS Aseptic stem loosening occurred more commonly in cohorts with longer follow-up. There were no differences in the rates of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Patients treated with RSA following excision of proximal humeral tumors and RSA as a revision procedure after a failed arthroplasty were at greater risk of aseptic stem loosening. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ben Grey
- Shoulder and Elbow Unit, Princess Alice Unit, Department of Orthopaedics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Reitze N Rodseth
- Department of Anaesthetics, Grey's Hospital, Pietermaritzburg, South Africa.,Department of Anaesthetics, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stephen J Roche
- Shoulder and Elbow Unit, Princess Alice Unit, Department of Orthopaedics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Leite LMB, Lins-Kusterer L, Belangero PS, Patriota G, Ejnisman B. QUALITY OF LIFE IN PATIENTS WHO HAVE UNDERGONE REVERSE SHOULDER ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2019; 27:269-272. [PMID: 31839737 PMCID: PMC6901153 DOI: 10.1590/1413-785220192705222929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To evaluate the health-related quality of life (HRQoL) of patients who have
undergone reverse shoulder arthroplasty (RSA) for rotator cuff arthropathy
(RCA). Methods: A retrospective study with 35 patients who underwent RSA from August 2007 to
July 2015. We collected clinical data and applied the 36-item Short Form
Health Survey (SF-36). Results: Of the 35 patients, 29 (82.9%) were female, and mean age was 75.71 years,
ranging from 50 to 89 years. The dominant side was frequently affected
(68.6%), and most of the cases were Hamada type 3 (57.1%). The Mackenzie
approach was used in 30 patients (85.7%). Physical and mental HRQoL was not
associated with severity of RCA before RSA. Lower scores for Physical
Functioning, Role Physical, Bodily Pain, and Physical Component Summary
(PCS) were associated with other orthopedic comorbidities. Vitality, Role
Emotional, Mental Health, and Mental Component Summary (MCS) were
significantly higher in patients without depression. Orthopedic comorbidity
and depression predicted lower PCS and longer follow-up time predicted
better PCS scores. Depression was also a predictor of the MCS. Conclusion: Patients who had undergone RSA for RCA had good HRQoL. Longer follow-up time
was associated with better HRQoL. Good results were maintained over the
follow-up period. Level of evidence II, retrospective study.
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Hurd WJ, Morrow MM, Miller EJ, Adams RA, Sperling JW, Kaufman KR. Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty. J Geriatr Phys Ther 2019; 41:126-133. [PMID: 28060054 DOI: 10.1519/jpt.0000000000000112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore, the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA. MATERIALS This study implemented a prospective, repeated-measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-reported instruments included pain, Disabilities of Arm, Shoulder and hands (DASH), and physical component summary (PCS) of the 36-Item Short Form Health Survey. Objective limb activity (mean activity value, m/s/min epoch; inactive time, %; low activity, %; and high activity, %) was captured with triaxial accelerometers worn on the upper and lower arm. A repeated-measures ANOVA tested for differences across time. The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity. RESULTS Patient-reported measures improved after surgery (pain, P < .01; DASH, P < .01; PCS, P = .01). No change in limb activity was found at 1 year compared with preoperative values for mean (forearm, P = 1.00; arm, P = .36), inactivity (forearm, P = .33; arm, P = .22), low (forearm, P = .77; arm, P = .11) or high (forearm, P = 1.00; arm, P = .20) activity. There was a relationship between pain and DASH scores 1 year after surgery (P = .04) but not before surgery (P = .16), or 2 months after surgery (P = .30). There was no relationship between pain and PCS scores at any time point (preoperative, P = .97; 2 months, P = .21; 1 year, P = .08) nor pain and limb activity (forearm: preoperative, P = .36; 2 months, P = .67; 1 year, P = .16; arm: preoperative, P = .97; 2 months, P = .59; 1 year, P = .51). CONCLUSIONS RSA reduced pain and enhanced patient-perceived function. Objectively measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wendy J Hurd
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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24
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Galvin JW, Kenney R, Curry EJ, Parada SA, Eichinger JK, Voloshin I, Li X. Superior Capsular Reconstruction for Massive Rotator Cuff Tears. JBJS Rev 2019; 7:e1. [DOI: 10.2106/jbjs.rvw.18.00072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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25
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Rojas J, Choi K, Joseph J, Srikumaran U, McFarland EG. Aseptic Glenoid Baseplate Loosening After Reverse Total Shoulder Arthroplasty. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00132] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Comparative Utilization of Reverse and Anatomic Total Shoulder Arthroplasty: A Comprehensive Analysis of a High-volume Center. J Am Acad Orthop Surg 2018; 26:e504-e510. [PMID: 30161057 DOI: 10.5435/jaaos-d-17-00075] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to determine how reverse and total shoulder arthroplasty (RTSA and TSA) comparative utilization, postoperative diagnoses, demographics, and perioperative data have changed between 2005 and 2015. METHODS This was a single-center retrospective review of all primary TSAs and RTSAs. RESULTS Our cohort included 1,192 RTSAs and 1,600 TSAs. Although both RTSA and TSA volume increased, RTSA increased from 27% to 52% of shoulder arthroplasty. The number of RTSAs performed for osteoarthritis and irreparable rotator cuff tears increased, and the proportion of RTSAs performed for rotator cuff tear arthropathy decreased. The mean age decreased for RTSA and TSA, and American Society of Anesthesiologists scores increased for both. DISCUSSION Over the past decade, RTSA has become the most common primary shoulder arthroplasty, reflecting the clinical success of the procedure. This increase is due to both an increase in the number of RTSAs performed for rotator cuff tear arthropathy as well as expanding surgical indications for RTSA. LEVEL OF EVIDENCE Retrospective, level IV.
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Helmkamp JK, Bullock GS, Amilo NR, Guerrero EM, Ledbetter LS, Sell TC, Garrigues GE. The clinical and radiographic impact of center of rotation lateralization in reverse shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2018; 27:2099-2107. [PMID: 30340806 DOI: 10.1016/j.jse.2018.07.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/24/2018] [Accepted: 07/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) has been widely adopted in the United States since its approval by the United States Food and Drug Administration in 2003. Advancements in metallurgy and design (including locking screws) have yielded clinically successful prostheses with a lateralized center of rotation (COR). This systematic review compared postsurgical outcomes and failure rates for lateral vs. medial COR RSA. We hypothesized that progressive lateralization of the COR results in greater ROM, improved clinical outcome scores, fewer acromial stress fractures, and less notching but a higher rate of glenoid implant baseplate failure and dislocation. METHODS PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched from inception through June 7, 2017, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighteen articles were included after final review. Studies were stratified on whether a prosthesis with a lateral or medial COR was used. Comparisons included shoulder range of motion (ROM), functional outcome scores, and reported complications. RESULTS RSA demonstrated significant improvements in outcome scores postsurgery regardless of prosthesis type. Overall, this study found no clear difference in outcome scores between the lateralized and medialized COR groups. The lateralized COR group displayed increased postoperative ROM. There was a higher reported incidence of scapular notching with medial COR prostheses. Otherwise, there were no clear differences in complications between the 2 groups. DISCUSSION The data suggest no significant differences exist between groups in outcome scores. The lateralized COR prosthesis showed increased postoperative external rotation and decreased scapular notching. Additional well-constructed randomized controlled trials would allow more effective comparison of these prosthesis designs.
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Affiliation(s)
- Joshua K Helmkamp
- School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nnamdi R Amilo
- School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Evan M Guerrero
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Leila S Ledbetter
- Medical Center Library, Duke University Medical Center, Durham, NC, USA
| | - Timothy C Sell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Castricini R, Familiari F, De Gori M, Riccelli DA, De Benedetto M, Orlando N, Galasso O, Gasparini G. Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28623414 DOI: 10.1007/s00167-017-4609-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effectiveness of tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. The null hypothesis was that there is no difference in functional scores between the tenotomy and tenodesis groups. METHODS A total of 69 patients with a combined supraspinatus tear and LHBT lesion aged over 40 years entered this prospective comparative study and were randomly assigned to the arthroscopic LHB tenotomy or tenodesis group. Fifty-five patients (31 in the tenotomy group and 24 in the tenodesis group) were available for the 6- and 24-month post-operative evaluations. RESULTS There were no statistically significant differences in post-operative Constant and Murley score, quality of life, pain, and strengths between groups. Higher rates of Popeye's sign were noted 6 and 24 months post-operatively in the tenotomy group compared to tenodesis. CONCLUSIONS Although tenotomy is affected by a higher incidence of cosmetic deformity, there is no superiority of arthroscopic tenodesis over tenotomy in the treatment of LHBT lesion as a concomitant procedure to an arthroscopic repair of the supraspinatus tendon in terms of functional outcomes, quality of life, pain, and strength measured 6 and 24 months post-operatively. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
| | - Daria Anna Riccelli
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
| | - Massimo De Benedetto
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Catanzaro, Italy
| | - Nicola Orlando
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy.
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
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FERREIRA ARNALDOAMADO, MALAVOLTA EDUARDOANGELI, ASSUNÇÃO JORGEHENRIQUE, GRACITELLI MAUROEMILIOCONFORTO, OCAMPOS GUILHERMEPEREIRA, TRINDADE EVELINDAMARRAMON. QUALITY OF LIFE IN PATIENTS WITH ROTATOR CUFF ARTHROPATHY. ACTA ORTOPEDICA BRASILEIRA 2017; 25:275-278. [PMID: 29375259 PMCID: PMC5782863 DOI: 10.1590/1413-785220172506173893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/26/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales. METHODS This cross-sectional study with controls paired by sex and age compared patients with rotator cuff arthropathy with surgical indication for reverse shoulder arthroplasty. The groups were compared according to the SF-12, ASES, and VAS scales. RESULTS The groups consisted of 38 individuals, 28 women. The SF-12 demonstrated a significant difference in the physical component, with the cases scoring 31.61 ± 6.15 and the controls 49.39 ± 6.37 (p<0.001). For the mental component, the difference was not significant, with the cases scoring 44.82 ± 13.18 and the controls 48.96 ± 8.65 (p=0.109). The cases scored 7.34 ± 2.11 on the VAS and 31.26 ± 15.12 on the ASES, while the controls scored 0.55 ± 1.31 and 97.53 ± 6.22, respectively (p<0.001). CONCLUSION Patients with rotator cuff arthropathy had poorer results for the physical component of the SF-12 than the controls. They also had poorer functional results according to the ASES scale, and more pain according to the VAS. Level of Evidence III, Case Control Study.
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Affiliation(s)
- ARNALDO AMADO FERREIRA
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - EDUARDO ANGELI MALAVOLTA
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - JORGE HENRIQUE ASSUNÇÃO
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - MAURO EMILIO CONFORTO GRACITELLI
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - GUILHERME PEREIRA OCAMPOS
- . Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - EVELINDA MARRAMON TRINDADE
- . São Paulo State Health Technology Assessment Network, São Paul State Department of Health, São Paulo, SP, Brazil
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30
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Budeyri A, Garofalo R, Krishnan SG. Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty–Affirms. ACTA ACUST UNITED AC 2017. [DOI: 10.1053/j.sart.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Goetzmann T, Molé D, Aisene B, Neyton L, Godeneche A, Walch G, Sirveaux F, Jacquot A. A Short and Convertible Humeral Stem for Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2017. [DOI: 10.1177/2471549217722723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Daniel Molé
- Centre chirurgical Émile Gallé, Nancy, France
| | | | - Lionel Neyton
- Générale de Santé, Hôpital Privé Jean Mermoz, Centre orthopédique Santy, Lyon, France
| | - Arnaud Godeneche
- Générale de Santé, Hôpital Privé Jean Mermoz, Centre orthopédique Santy, Lyon, France
| | - Gilles Walch
- Générale de Santé, Hôpital Privé Jean Mermoz, Centre orthopédique Santy, Lyon, France
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Dornan GJ, Katthagen JC, Tahal DS, Petri M, Greenspoon JA, Denard PJ, Burkhart SS, Millett PJ. Cost-Effectiveness of Arthroscopic Rotator Cuff Repair Versus Reverse Total Shoulder Arthroplasty for the Treatment of Massive Rotator Cuff Tears in Patients With Pseudoparalysis and Nonarthritic Shoulders. Arthroscopy 2017; 33:716-725. [PMID: 27939409 DOI: 10.1016/j.arthro.2016.08.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the most cost-effective treatment strategy for patients with massive rotator cuff tears and pseudoparalysis of the shoulder without osteoarthritis of the glenohumeral joint (PP without OA). Specifically, we aimed to compare arthroscopic rotator cuff repair (ARCR) versus reverse total shoulder arthroplasty (RTSA) and investigate the effect of patient age on this decision. METHODS A Markov decision model was used to compare 3 treatment strategies for addressing PP without OA: (1) ARCR with option to arthroscopically revise once, (2) ARCR with immediate conversion to RTSA on potential failure, and (3) primary RTSA. Hypothetical patients were cycled through the model according to transition probabilities, meanwhile accruing financial costs, utility for time in health states, and disutilities for surgical procedures. Utilities were derived from the Short Form-6D scale and expressed as quality-adjusted life-years. Model parameters were derived from the literature and from expert opinion, and thorough sensitivity analyses were conducted. TreeAge Pro 2015 software was used to construct and assess the Markov model. RESULTS For the base-case scenario (60-year-old patient), ARCR with conversion to RTSA on potential failure was the most cost-effective strategy when we assumed equal utility for the ARCR and RTSA health states. Primary RTSA became cost-effective when the utility of RTSA exceeded that of ARCR by 0.04 quality-adjusted life-years per year. Age at decision did not substantially change this result. CONCLUSIONS Primary ARCR with conversion to RTSA on potential failure was found to be the most cost-effective strategy for PP without OA. This result was independent of age. Primary ARCR with revision ARCR on potential failure was a less cost-effective strategy. LEVEL OF EVIDENCE Level IV, economic and decision analysis.
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Affiliation(s)
- Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - J Christoph Katthagen
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Dimitri S Tahal
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | | | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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33
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Is there evidence that the outcomes of primary anatomic and reverse shoulder arthroplasty are getting better? INTERNATIONAL ORTHOPAEDICS 2017; 41:1235-1244. [DOI: 10.1007/s00264-017-3443-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
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Abrams JS. Patients Reporting Outcomes: Are We Getting It Right?: Commentary on an article by Frederick A. Matsen III, MD, et al.: "Relationship Between Patient-Reported Assessment of Shoulder Function and Objective Range-of-Motion Measurements". J Bone Joint Surg Am 2017; 99:e24. [PMID: 28244923 DOI: 10.2106/jbjs.16.01453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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35
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Quality of Life and Functional Results of Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears. Arthroscopy 2017; 33:261-268. [PMID: 27614389 DOI: 10.1016/j.arthro.2016.06.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/05/2016] [Accepted: 06/10/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the minimum 2-year results and possible outcomes of arthroscopic partial repair in different patterns of irreparable rotator cuff tears (RCTs). METHODS Patients suffering from an irreparable supraspinatus and a reparable infraspinatus tendons who underwent arthroscopic partial repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess patients' functionality pre- and postoperatively. Postoperative patient assessment included the Simple Shoulder Test (SST) and the Short Form Health Survey questionnaire (SF-36). A postoperative range of motion, CMS, and strength were compared with the contralateral side. Postoperative SF-36 was compared with age- and sex-matched norms. RESULTS Ninety patients (95 shoulders) were reviewed after a mean follow-up of 7 (range 2-12) years. The subscapularis tendon was intact in 80 shoulders and torn but completely reparable in the remaining 15 shoulders. The CMS improved from 39.1 ± 8.4 (10-61) to 76.3 ± 9.7 (32-93) (P < .001). The mean postoperative SST was 9.1 ± 2.2 (1-12). Although the patients had lower postoperative abduction and internal rotation, strength in abduction and CMS in comparison with the measurements from the contralateral side, the median postoperative SF-36 physical and mental component summaries were 98% and 100% of the matched norms. No significant differences were found in postoperative outcomes according to the RCT pattern. Males showed significantly higher strengths in abduction (B = -1.384, 95% confidence interval [CI] -2.144 to -0.624, η2 = 0.123, P < .001, 95% power), external rotation (B = -3.646, 95% CI -5.2 to -2.092, η2 = 0.189, P < .001, 100% power), and internal rotation (B = -3.867, 95% CI -5.676 to -2.057, η2 = 0.162, P < .001, 99% power) than females. Significantly higher ranges of abduction (η2 = 0.431, P = .019, 98% power) and external rotation (η2 = 0.417, P < .03, 97% power) were noted in younger patients. Higher strengths in abduction (η2 = 0.495, P = .002, 100% power) and internal rotation (η2 = 0.464, P = .006, 99% power) were also reported in these patients. CONCLUSIONS When there is an irreparable supraspinatus but there is still the possibility to repair the infraspinatus and subscapularis, the arthroscopic partial cuff repair should be considered as an effective surgical option. Indeed, a significant clinical improvement can be achieved and, differently from pure symptomatic surgical procedures, this technique represents a reasonable effort to restore, at least in part, the shoulder joint functionality. Successful and reliable results can be expected at an average 7-year follow-up, regardless of the RCT pattern. Female and older patients have a greater likelihood of lower functional outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Chalmers BP, Wagner ER, Sperling JW, Cofield RH, Sanchez-Sotelo J. Treatment and Outcomes of Reverse Shoulder Arthroplasty Dislocations. J Shoulder Elb Arthroplast 2017. [DOI: 10.1177/2471549217695260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brian P Chalmers
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Eric R Wagner
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - John W Sperling
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Robert H Cofield
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
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Affiliation(s)
- Kamal I Bohsali
- 1Jacksonville Orthopaedic Institute, Jacksonville Beach, Florida 2Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 3Department of Orthopaedics, University of Texas HSC-San Antonio, San Antonio, Texas
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Castricini R, Galasso O, Riccelli DA, Familiari F, De Benedetto M, Orlando N, Gasparini G. Arthroscopic Partial Repair of Irreparable, Massive Rotator Cuff Tears. Arthrosc Tech 2017; 6:e143-e147. [PMID: 28373953 PMCID: PMC5368352 DOI: 10.1016/j.eats.2016.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/10/2016] [Indexed: 02/03/2023] Open
Abstract
Several treatment options for chronic, massive rotator cuff tears exist, and they include debridement with possible biceps tenotomy or tenodesis, open or arthroscopic partial repair, muscle or tendon transfer, superior capsule reconstruction, synthetic patch augmentation, and reverse total shoulder arthroplasty. The aim of this technique article is to describe our preferred surgical option for irreparable, massive rotator cuff tears with an irreparable supraspinatus, a reparable infraspinatus, and an intact or reparable subscapularis tendon.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic & Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Olimpio Galasso
- Department of Orthopaedic & Trauma Surgery, “Magna Graecia” University, Catanzaro, Italy,Address correspondence to Olimpio Galasso, M.D., Department of Orthopaedic & Trauma Surgery, “Magna Graecia” University and “Mater Domini” University Hospital, Viale Europa, 88100 Catanzaro, Italy.Department of Orthopaedic & Trauma Surgery“Magna Graecia” University and “Mater Domini” University HospitalViale Europa88100 CatanzaroItaly
| | - Daria Anna Riccelli
- Department of Orthopaedic & Trauma Surgery, “Magna Graecia” University, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic & Trauma Surgery, “Magna Graecia” University, Catanzaro, Italy
| | - Massimo De Benedetto
- Department of Orthopaedic & Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Nicola Orlando
- Department of Orthopaedic & Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic & Trauma Surgery, “Magna Graecia” University, Catanzaro, Italy
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Hasan S, McGee A, Garofolo G, Hamula M, Oh C, Kwon Y, Zuckerman J. Changes in Driving Performance Following Shoulder Arthroplasty. J Bone Joint Surg Am 2016; 98:1471-7. [PMID: 27605691 DOI: 10.2106/jbjs.15.00162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND With this study, we sought to quantify perioperative changes in driving performance among patients who underwent anatomic or reverse shoulder arthroplasty. METHODS Using a driving simulator, 30 patients (20 anatomic and 10 reverse total shoulder arthroplasties) were tested preoperatively and at 2 weeks (PO2), 6 weeks (PO6), and 12 weeks (PO12) postoperatively. The total number of collisions, centerline crossings, and off-road excursions (when the vehicle traversed the lateral road edge), and scores on a visual analog scale (VAS) for pain and the Shoulder Pain and Disability Index (SPADI) were recorded at each driving trial. RESULTS The mean number of collisions increased from 5.9 preoperatively to 7.4 at PO2 and subsequently decreased to 5.6 at PO6 and 4.0 at PO12 (p = 0.0149). In addition, the number of centerline crossings decreased from 21.4 preoperatively to 16.3 at PO12 (p < 0.05). Multivariate analysis of the data demonstrated that increased VAS for pain scores, older age, and less driving experience had a negative impact on driving performance. CONCLUSIONS Driving performance returned to preoperative levels at 6 weeks after shoulder arthroplasty. By 12 weeks postoperatively, patients demonstrated improved driving performance compared with preoperative performance. On the basis of our findings, clinicians can suggest a window of 6 to 12 weeks postoperatively for the gradual return to driving. However, for patients of older age, with less driving experience, or with greater pain, a return to driving at closer to 12 weeks postoperatively should be recommended. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Saqib Hasan
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Alan McGee
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Garret Garofolo
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Mathew Hamula
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Cheongeun Oh
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Young Kwon
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Joseph Zuckerman
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
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Makhni EC, Swart E, Steinhaus ME, Mather RC, Levine WN, Bach BR, Romeo AA, Verma NN. Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears. Arthroscopy 2016; 32:1771-80. [PMID: 27132772 DOI: 10.1016/j.arthro.2016.01.063] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. METHODS An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. RESULTS For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. CONCLUSIONS Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these patients. LEVEL OF EVIDENCE: Level II, economic decision analysis.
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Affiliation(s)
- Eric C Makhni
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Eric Swart
- Department of Orthopedic Trauma, Carolinas Medical Center, Charlotte, North Carolina, U.S.A
| | - Michael E Steinhaus
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Richard C Mather
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Bernard R Bach
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Higgins LD. Editorial Commentary: Cost-Effectiveness of Orthopaedic Procedures: "A Nickel Ain't Worth a Dime Anymore" - Yogi Berra. Arthroscopy 2016; 32:1781-3. [PMID: 27594328 DOI: 10.1016/j.arthro.2016.06.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 02/02/2023]
Abstract
Although cost-effectiveness research has assumed a critical role in decision making in medicine, it, by definition, must be derived from solid, germane, reproducible data. The absence of such high-quality data tends to induce compromises in analysis that may degrade a scientific article's seemingly intuitive message.
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Lawrence C, Williams GR, Namdari S. Influence of Glenosphere Design on Outcomes and Complications of Reverse Arthroplasty: A Systematic Review. Clin Orthop Surg 2016; 8:288-97. [PMID: 27583112 PMCID: PMC4987313 DOI: 10.4055/cios.2016.8.3.288] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/12/2016] [Indexed: 11/15/2022] Open
Abstract
Background Different implant designs are utilized in reverse shoulder arthroplasty. The purpose of this systematic review was to evaluate the results of reverse shoulder arthroplasty using a traditional (Grammont) prosthesis and a lateralized prosthesis for the treatment of cuff tear arthropathy and massive irreparable rotator cuff tears. Methods A systematic review of the literature was performed via a search of two electronic databases. Two reviewers evaluated the quality of methodology and retrieved data from each included study. In cases where the outcomes data were similar between studies, the data were pooled using frequency-weighted mean values to generate summary outcomes. Results Thirteen studies met the inclusion and exclusion criteria. Demographics were similar between treatment groups. The frequency-weighted mean active external rotation was 24° in the traditional group and 46° in the lateralized group (p = 0.0001). Scapular notching was noted in 44.9% of patients in the traditional group compared to 5.4% of patients in the lateralized group (p = 0.0001). The rate of clinically significant glenoid loosening was 1.8% in the traditional group and 8.8% in the lateralized group (p = 0.003). Conclusions Both the traditional Grammont and the lateralized offset reverse arthroplasty designs can improve pain and function in patients with diagnoses of cuff tear arthropathy and irreparable rotator cuff tear. While a lateralized design can result in increased active external rotation and decreased rates of scapular notching, there may be a higher rate of glenoid baseplate loosening.
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Affiliation(s)
- Cassandra Lawrence
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald R Williams
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability. INTERNATIONAL ORTHOPAEDICS 2016; 40:2581-2588. [PMID: 27492723 DOI: 10.1007/s00264-016-3253-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/18/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE The main purpose of this study is to establish which of two methods is more reliable in glenoid assessment for instability in pre-operative planning. Accordingly, we have studied the intra- and inter-observer reliability of glenoid parameters with the use of two-dimensional (2D) and three-dimensional (3D) reconstructed computed tomography (CT) images. METHODS One hundred glenoids were measured with the use of 2D-CT and 3D-CT (in 3D orientation) by two independent observers (one experienced and one inexperienced). Measurements were repeated after one week for 30 randomly selected glenoids. RESULTS The intra-class correlation coefficient (ICC) for inter-observer reliability was significantly greater for 3D-CT (0.811 to 0.915) than for 2D-CT (0.523 to 0.925). All intra-observer reliability values for 3D-CT were near perfect (0.835 to 0.997), while those for 2D-CT were less reliable (0.704 to 0.960). A dependent t-test showed that, for both observers, almost all glenoid parameters (except R and d) differed significantly (p < 0.05) between 2D and 3D measurement methods. CONCLUSIONS Therefore, it can be concluded that 3D glenoid reconstructions are more reliable for glenoid bone loss assessment than 2D-CT. The results suggest that quantifying a glenoid defect with the use of 2D image only-even if performed by an experienced orthopaedic surgeon-is prone to errors. Differences in measurements between and within observers can be explained by plane setting and identifying glenoid rim in 2D-CT. Accordingly, we recommend that glenoid measurements should be performed in 3D orientation using 3D reconstruction obtained from CT images for pre-operative assessments, which are crucial for surgical planning.
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Wong SE, Zhang AL, Berliner JL, Ma CB, Feeley BT. Preoperative patient-reported scores can predict postoperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25:913-9. [PMID: 27039669 DOI: 10.1016/j.jse.2016.01.029] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty and reverse total shoulder arthroplasty are increasingly used to improve pain and function in patients with glenohumeral arthritis or cuff tear arthropathy. Our objective was to determine if preoperative patient-reported outcome measures predict which patients will achieve clinically meaningful improvements after shoulder arthroplasty. METHODS Preoperative and 1-year postoperative 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and American Shoulder and Elbow Surgeons (ASES) pain and function scores were prospectively collected from 107 patients who underwent total or reverse shoulder arthroplasty. The minimum clinically important difference (MCID) defined meaningful clinical improvement. Receiver operating characteristic analysis was used to calculate threshold values and C statistic. Multivariate logistic regression analysis was performed to determine preoperative measures that were indicative of achieving the MCID postoperatively. RESULTS Threshold values below which patients were more likely to achieve MCID were 12 for ASES function, 25 for ASES pain, 46 for SF-12 PCS, and 42 for SF-12 MCS. Multivariate analysis revealed that preoperative ASES function (area under the curve, 0.79; P = .006) and ASES pain (area under the curve, 0.90; P < .001) measures were predictive of achieving the MCID postoperatively. Patients with higher preoperative SF-12 MCS scores had a higher likelihood of achieving MCID for each measure. CONCLUSION We determined threshold values that predict clinically meaningful improvement after shoulder arthroplasty. Patients with higher preoperative mental health scores and lower physical function and pain scores were more likely to gain significant benefits from surgery. These results can be used to facilitate shared decision-making and to forecast expected benefits after shoulder arthroplasty.
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Affiliation(s)
- Stephanie E Wong
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA.
| | - Alan L Zhang
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan L Berliner
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
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Castricini R, De Benedetto M, Familiari F, De Gori M, De Nardo P, Orlando N, Gasparini G, Galasso O. Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears. J Shoulder Elbow Surg 2016; 25:658-65. [PMID: 26589917 DOI: 10.1016/j.jse.2015.08.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic-assisted latissimus dorsi tendon transfer (LDTT) has been recently introduced for treatment of irreparable, posterosuperior massive rotator cuff tears. We sought to evaluate the functional outcomes of this technique and to check for possible outcome predictors. METHODS The study reviewed 86 patients (aged 59.8 ± 5.9 years) who underwent an arthroscopic-assisted latissimus dorsi tendon transfer after 36.4 ± 9 months of follow-up. Of these, 14 patients (16.3%) sustained an irreparable massive rotator cuff tear after a failed arthroscopic rotator cuff repair. The Constant and Murley score (CMS) was used to assess patients' functionality preoperatively and at follow-up. RESULTS As a group, the CMS improved with surgery from 35.5 ± 6.1 to 69.5 ± 12.3 (P < .001). A lower preoperative CMS and a previous failed rotator cuff repair resulted in lower postoperative range of motion (P = .044 and P = .007, respectively) and CMS (P = .042 and P = .018, respectively). A previous rotator cuff repair resulted in lower satisfaction with surgery (P = .009). Gender and age did not affect the clinical outcomes. CONCLUSIONS Our results support the effectiveness of arthroscopic-assisted LDTT in the treatment of patients with an irreparable, posterosuperior massive rotator cuff tears in pain relief, functional recovery, and postoperative satisfaction. Patients with lower preoperative CMS and a history of failed rotator cuff repair have a greater likelihood of having a lower clinical result. However, the favorable values of summary postoperative scores do not exclude these patients as candidates for arthroscopic-assisted LDTT.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Massimo De Benedetto
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Pasquale De Nardo
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Nicola Orlando
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy.
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy
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Abstract
Since its introduction in the USA in 2003, reverse total shoulder arthroplasty (RTSA) has been used with increasingly frequency as surgeons have observed the remarkable improvement in pain, range of motion, and function associated with this implant. RTSA was initially used exclusively for elderly, low demand individuals with end-stage rotator cuff tear arthropathy. However, RTSA is now being increasingly successfully employed for the management of irreparable rotator cuff tears, glenohumeral osteoarthritis with an intact rotator cuff, acute proximal humerus fractures, the sequelae of proximal humerus fractures, neoplasms of the proximal humerus, inflammatory arthropathy, young patients and failed anatomic total shoulder arthroplasty and hemiarthroplasty. While long-term outcomes are pending, short- and mid-term follow-up results suggest that in experienced hands, RTSA may be a reasonable treatment for many previously difficult to treat pathologies within the shoulder.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA.
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA.
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Oliva F, Piccirilli E, Bossa M, Via AG, Colombo A, Chillemi C, Gasparre G, Pellicciari L, Franceschetti E, Rugiero C, Scialdoni A, Vittadini F, Brancaccio P, Creta D, Buono AD, Garofalo R, Franceschi F, Frizziero A, Mahmoud A, Merolla G, Nicoletti S, Spoliti M, Osti L, Padulo J, Portinaro N, Tajana G, Castagna A, Foti C, Masiero S, Porcellini G, Tarantino U, Maffulli N. I.S.Mu.L.T - Rotator Cuff Tears Guidelines. Muscles Ligaments Tendons J 2016; 5:227-63. [PMID: 26958532 DOI: 10.11138/mltj/2015.5.4.227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources.
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Affiliation(s)
- Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Michela Bossa
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Alessio Giai Via
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | | | - Claudio Chillemi
- Department of Orthopaedic and Traumatology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Giuseppe Gasparre
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Leonardo Pellicciari
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Clelia Rugiero
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Alessandro Scialdoni
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | | | - Domenico Creta
- Physical Therapy and Rehabilitation Service, Private Hospital "Madre Fortunata Toniolo", Bologna, Italy
| | - Angelo Del Buono
- Orthopaedics and Traumatology, Ospedale Sant'Anna, Sanfermo della Battaglia, Como, Italy
| | - Raffaele Garofalo
- Shoulder Service, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Asmaa Mahmoud
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit Biomechanics Laboratory "M. Simoncelli" D. Cervesi Hospital, Cattolica, Italy
| | - Simone Nicoletti
- Department of Orthopaedics and Traumatology, San Jacopo Hospital, Italy
| | - Marco Spoliti
- Department of Orthopaedics and Traumatology, San Camillo Hospital, Rome, Italy
| | - Leonardo Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - Johnny Padulo
- Sport Science, University e-Campus, Novedrate, Italy; Tunisian Research Laboratory "Sports Performance Optimization", National Center of Medicine and Science in Sport, Tunis, Tunisia
| | - Nicola Portinaro
- UO Pediatric Orthopaedics, Humanitas Research Hospital, Milano, Italy
| | | | - Alex Castagna
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Rozzano, Milano, Italy
| | - Calogero Foti
- Department of Physical and Rehabilitation medicine, School of Medicine, University of Rome "Tor Vergata", Italy
| | - Stefano Masiero
- Department of Physical and Rehabilitation Medicine, University of Padua, Italy
| | - Giuseppe Porcellini
- Shoulder and Elbow Unit Biomechanics Laboratory "M. Simoncelli" D. Cervesi Hospital, Cattolica, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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48
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The effect of glenosphere size on functional outcome for reverse shoulder arthroplasty. Musculoskelet Surg 2016; 100:115-20. [PMID: 26861683 DOI: 10.1007/s12306-015-0396-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/19/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) is an effective surgery for a variety of patients with difficult shoulder pathology. Since postsurgical outcomes are often variable, there has been great effort made to optimize the design and use of these implants. Previous studies demonstrated an association between increased glenosphere size and improved range of motion. The purpose of this study is to assess the relationship between glenosphere size, range of motion, and functional outcome scores. METHODS This is a retrospective cohort study of 140 patients (148 shoulders) undergoing reverse shoulder arthroplasty. All patients were assessed pre- and postoperatively for range of motion, Constant score, ASES score, and Subjective Shoulder Value. Improvements in these variables were compared for patients treated with three different glenosphere sizes (36, 40, 42 mm). RESULTS All groups had a mean improvement in range of motion and functional outcome scores, but there were no statistically significant differences between groups when controlling for preoperative differences. CONCLUSIONS Our findings do not support a strong role for glenosphere size as a singular factor affecting range of motion or patient-reported outcome following RSA. These problems are most likely due to the multifactorial nature of shoulder dynamics. For this reason, assessing the effect a single surgical or biomechanical parameter on function has been challenging.
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49
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Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization. Knee Surg Sports Traumatol Arthrosc 2016; 24:406-13. [PMID: 26377097 DOI: 10.1007/s00167-015-3785-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/08/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate what factors might predict the results of arthroscopic stabilization for anterior shoulder instability. METHODS One hundred and forty-three patients averaging 25 (15-58) years with traumatic anterior shoulder instability who underwent arthroscopic stabilization were reviewed at a median follow-up of 81 (24-172) months. Sixty-two (56.4 %) individuals were involved in contact sport activities, and there were 40 (30 %) patients who had only one dislocation prior to having surgery. Rowe score was measured preoperatively and at follow-up. RESULTS Thirty-three (23.1 %) patients experienced recurrent instability 12 (1-120) months after surgery, and 15 of those underwent further surgery. There was a statistically significant lower risk of failure (p = 0.027) for patients who had a surgical procedure after only one episode of shoulder dislocation. Patients treated after the second or further episode of shoulder dislocation exhibited a mean odds ratio for failure of 3.8 (95 % confidence interval 1.2-11.6, p = 0.044) with regard to first-time dislocators. The Rowe score significantly improved from a preoperative value of 25 (5-55) to a postoperative value of 100 (40-100) (p < 0.001). A significantly higher postoperative Rowe score was found in patients older than 24 years of age at the operation (p = 0.011) and in patients with less than eight dislocations prior to surgery (p = 0.05). CONCLUSIONS These results suggest that better functional results following arthroscopic stabilization can be expected in patients over 24 years of age and in those with a fewer number of dislocations preoperatively. A lower rate of recurrence can be expected if the patient undergoes surgery after the first episode of dislocation. LEVEL OF EVIDENCE Prognostic study, Level II.
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50
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Postacchini R, Paoloni M, Carbone S, Fini M, Santilli V, Postacchini F, Mangone M. Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty. J Biomech 2015. [PMID: 26194874 DOI: 10.1016/j.jbiomech.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.
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Affiliation(s)
- Roberto Postacchini
- Department of Orthopedic Surgery, Israelitic Hospital, Italian University Sport and Movement, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.
| | - Stefano Carbone
- Department of Orthopedic Surgery, Sapienza University, Rome, Italy
| | | | - Valter Santilli
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy
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