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Revision of total shoulder arthroplasty to hemiarthroplasty: results at mean 5-year follow-up. J Shoulder Elbow Surg 2023; 32:e160-e167. [PMID: 36347400 DOI: 10.1016/j.jse.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although there is a trend to manage failed anatomic total shoulder arthroplasties (aTSA) with revision to a reverse total shoulder arthroplasty, such revisions can be complicated by difficulties in baseplate fixation, instability, and acromial stress fractures. Some cases of failed aTSA may be safely revised to a hemiarthroplasty (HA). The objectives of this study were to report patient-reported outcomes after conversion from aTSA to HA and assess patient and shoulder characteristics associated with a successful outcome. METHODS Patients who underwent revision from aTSA to HA between 2009 and 2018 were contacted. Patient demographics, surgical history, intraoperative findings, and microbiology results were collected. Patient-reported outcomes were collected with minimum 2-year follow-up. Preoperative radiographic characteristics were reviewed for component positioning and component loosening. Patients with a clinically significant improvement exceeding the minimal clinically important difference (MCID) of the Simple Shoulder Test (SST) were compared with those patients who did not improve past the MCID. RESULTS Twenty-nine patients underwent conversion from aTSA to HA with a mean follow-up of 4.5 ± 1.8 years. Intraoperative glenoid or humeral component loosening was found in all 29 patients. Pain improved in 25 of 30 patients (87%), and mean pain scores improved from 6.2 ± 2.3 to 3.1 ± 2.4 (P < .001). SST scores improved from 4.1 ± 3.1 to 7.3 ± 3.2 (P < .001), and 18 of 29 patients (62%) had improvement above the SST MCID threshold of 2.4. The mean American Shoulder and Elbow Surgeons score at the latest follow-up was 64 ± 19, and the Single Assessment Numeric Evaluation score was 65 ± 23. Twenty-two of 29 (76%) patients were satisfied with the procedure. Four patients (14%) required conversion to total shoulder arthroplasty-2 to anatomic and 2 to reverse. An additional 3 patients (10%) had a revision HA performed. No significant differences in patient or shoulder characteristics were found in those patients who improved greater than the MCID of the SST compared patients who improved less than the MCID of the SST. Fifty-nine percent of patients had ≥2 positive cultures with the same bacteria, and 82% of these were with Cutibacterium. Seven of 8 patients (88%) with a loose humeral component had ≥2 positive cultures with the same bacteria. DISCUSSION Component loosening is a common failure mode after aTSA. Revision to HA can improve pain and patient-reported outcomes in most patients.
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Sharareh B, Yao JJ, Matsen FA, Hsu JE. What is the optimal management of a loose glenoid component after anatomic total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2023; 32:653-661. [PMID: 36343791 DOI: 10.1016/j.jse.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) provides excellent long-term clinical outcomes in the treatment of glenohumeral arthritis. However, symptomatic glenoid polyethylene loosening can be seen at intermediate follow-up and can lead to shoulder pain and dysfunction. The purpose of this study was to perform a systematic review of the available literature to determine the optimal management of symptomatic glenoid loosening with regard to reoperation and patient satisfaction following various approaches to symptomatic glenoid loosening. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies investigating revision arthroplasty for the treatment of glenoid loosening with clinical outcomes were identified. Clinical failure was defined as a repeat procedure after revision arthroplasty. RESULTS Overall, 14 studies met inclusion criteria that included 483 patients with a mean age of 66.5 ± 3.0 years who underwent revision arthroplasty for symptomatic glenoid loosening. There were 8 studies that discussed conversion to a hemiarthroplasty (HA, 148 patients), 7 studies that discussed glenoid reimplantation in a single setting (1-stage TSA, 157 patients), 2 studies that discussed glenoid reimplantation in a staged setting (2-stage TSA, 18 patients), and 2 studies that discussed conversion to a reverse shoulder arthroplasty (RSA, 164 patients). All patients underwent glenoid component removal. The length of follow-up was significantly shorter in the RSA group (41 months for RSA vs. 56 months for HA vs. 55 months for 1-stage TSA vs. 62 months for 2-stage TSA, P < .001). The reoperation rate at the final follow-up was 19% for the HA cohort, 20% for the 1-stage TSA cohort, 22% for the 2-stage TSA cohort, and 21% for the RSA cohort (P = .971). Patient satisfaction rate at the final follow-up was 62% for the HA cohort, 66% for the 1-stage TSA cohort, 71% for the 2-stage TSA cohort, and 86% for the RSA cohort (P = .045). Positive cultures were noted in 15% of patients with Cutibacterium acnes comprising 72% of positive cultures. CONCLUSIONS Overall, the optimal management of symptomatic glenoid loosening remains unclear. All 4 types of revision arthroplasty (HA, 1-stage TSA, 2-stage TSA, and RSA) had a similar reoperation rate (20%) at the latest follow-up. Conversion to RSA provided a higher proportion of patients satisfied with the procedure. However, the length of follow-up was significantly shorter than other groups, and therefore longer-term follow-up of this group is needed to determine if results are durable.
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Affiliation(s)
- Behnam Sharareh
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jie J Yao
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
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Ozdag Y, Baylor J, Hayes D, Grandizio LC. Arthroscopic Removal of the Polyethylene Glenoid Component After Total Shoulder Arthroplasty: A Systematic Review. J Shoulder Elb Arthroplast 2022; 6:24715492221142967. [PMCID: PMC9742720 DOI: 10.1177/24715492221142967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/09/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To identify prior studies of arthroscopic glenoid component removal after total shoulder arthroplasty (TSA) and understand indications, techniques and patient outcomes. Methods A search of the English language literature on arthroscopic removal of the glenoid component (ARGC) after TSA published between 2005 and 2021 was performed from MEDLINE and EMBASE databases. Articles with ARGC after TSA were identified and we recorded article characteristics as well as patient demographics and outcomes contained within the studies. Results A total of six publications (two case reports and four retrospective case series) detailing the outcome of ARGC performed on twenty-five shoulders were identified. The average time from index procedure to glenoid removal was 117 months and mean age at time of ARGC was 75 years. Although patient reported outcomes measures (PROMs) varied in type and reporting style, all articles reported improvements in PROMs. Twenty patients in this systematic review were evaluated for post-operative complications and the complication rate was found to be 15% (n = 3). There were 2 cases (18%) of superior migration of the humeral head relative to the glenoid and no reported cases of anterior or posterior humeral head subluxation. Two of 25 patients (8%) underwent subsequent open revision procedures. Conclusions The limited number of publications in this systematic review demonstrates that ARGC after TSA can result in improvements in both pain and PROMs. This less-invasive arthroscopic technique may be an alternative to open revision for lower demand patients; however, future prospective, comparative studies are necessary to better define indications.
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Affiliation(s)
- Yagiz Ozdag
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Jessica Baylor
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Daniel Hayes
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA,Louis C Grandizio, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Department of Orthopaedic Surgery, 16 Woodbine Lane, Danville, PA 17821, USA.
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Kunze KN, Krivicich LM, Brusalis C, Taylor SA, Gulotta LV, Dines JS, Fu MC. Pathogenesis, Evaluation, and Management of Osteolysis After Total Shoulder Arthroplasty. Clin Shoulder Elb 2022; 25:244-254. [PMID: 35971608 PMCID: PMC9471816 DOI: 10.5397/cise.2021.00738] [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: 12/14/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA—namely, periprosthetic joint infection—as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts.
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Davies A, Selmi H, Sabharwal S, Vella-Baldacchino M, Liddle AD, Reilly P. Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis. J Shoulder Elb Arthroplast 2022; 6:24715492221095991. [PMID: 35692902 PMCID: PMC9174976 DOI: 10.1177/24715492221095991] [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: 02/01/2022] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022] Open
Abstract
The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature.
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Affiliation(s)
- Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Hussain Selmi
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | | | - Alex D. Liddle
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
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Monir JG, Hao KA, Abeyewardene D, O'Keefe KJ, King JJ, Wright TW, Schoch BS. Extra-short humeral heads reduce glenohumeral joint overstuffing compared with short heads in anatomic total shoulder arthroplasty. JSES Int 2021; 6:209-215. [PMID: 35252915 PMCID: PMC8888178 DOI: 10.1016/j.jseint.2021.11.013] [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] [Indexed: 11/19/2022] Open
Abstract
Background Rotator cuff tears and glenoid loosening remain the two most common causes for revision after anatomic total shoulder arthroplasty. Oversizing of the humeral head leads to increased contact force across the glenohumeral joint and is hypothesized to contribute to clinical and radiographic failure. The purpose of this study is to compare the rate of radiographic overstuffing between standard short humeral heads and newer extra-short heads with decreased lateral offset. Methods Fifty-five consecutive anatomic total shoulder arthroplasties performed using extra-short humeral heads were retrospectively reviewed and compared with age- and sex-matched controls receiving standard short heads. A total of 110 postoperative radiographs were analyzed using the Iannotti's perfect circle method to compare the prosthesis' center of rotation (COR) with the native humeral head COR. A difference in the COR of >3.0 mm was considered malpositioned. Malpositioning medially was considered overstuffed, and malpositioning laterally was considered understuffed. The direction of displacement of malpositioned prostheses was categorized using a quadrant system. Furthermore, we used a novel method to evaluate medial and superior overstuffing by measuring the displacement between the anatomic and prosthetic head positions along perpendicular axes. Results Using the Iannotti's perfect circle method, 56% of heads were malpositioned. Overstuffing occurred more frequently with short heads compared with extra-short heads (47% vs. 4%, P < .001). Conversely, understuffing occurred more frequently with extra-short heads (47% vs. 15%, P = .001). Malpositioned extra-short heads were most frequently placed in the inferomedial quadrant (93% vs. 24%, P < .001), whereas malpositioned short heads were most commonly placed in the superomedial quadrant (56% vs. 7%, P < .001). Our novel measurement method demonstrated that extra-short heads reduced medial overstuffing (2.8 ± 2.8 mm vs. 0.3 ± 2.0 mm, P < .001). Both extra-short and short heads had similar rates of superior malpositioning (1.6 ± 2.2 mm vs. 1.4 ± 1.5 mm, P = .683). Conclusion Routine use of extra-short humeral head sizes reduces the rate of medial glenohumeral joint overstuffing but not superior malpositioning. This is hypothesized to improve clinical outcomes, but future studies are needed to assess the relationship between improved humeral head fit and clinical outcomes.
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Affiliation(s)
- Joseph G. Monir
- Department Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A. Hao
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Dilhan Abeyewardene
- Orthopaedic Care Specialists, Hand & Upper Extremity Surgery, North Palm Beach, FL, USA
| | | | - Joseph J. King
- Department Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W. Wright
- Department Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S. Schoch
- Department of Orthopedics, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author: Bradley S. Schoch, MD, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
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Ravi V, Murphy RJ, Moverley R, Derias M, Phadnis J. Outcome and complications following revision shoulder arthroplasty : a systematic review and meta-analysis. Bone Jt Open 2021; 2:618-630. [PMID: 34382837 PMCID: PMC8384442 DOI: 10.1302/2633-1462.28.bjo-2021-0092.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analyzed using a meta-analysis of proportion, and continuous variables underwent comparative subgroup analysis. RESULTS A total of 112 studies (5,379 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (601/3,041), instability 19% (577/3,041), rotator cuff failure 17% (528/3,041), and infection 16% (490/3,041). Intraoperative complication and postoperative complication and reoperation rates were 8% (230/2,915), 22% (825/3,843), and 13% (584/3,843) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (91/230, 40%) and instability (215/825, 26%). Revision to reverse total shoulder arthroplasty (TSA), rather than revision to anatomical TSA from any index prosthesis, resulted in lower complication rates and superior Constant scores, although there was no difference in American Shoulder and Elbow Surgeons scores. CONCLUSION Satisfactory improvement in patient-reported outcome measures are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA. Cite this article: Bone Jt Open 2021;2(8):618-630.
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Affiliation(s)
- Vinayak Ravi
- Brighton and Sussex Medical School, Brighton, UK
| | - Richard James Murphy
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Robert Moverley
- University Hospitals Dorset NHS Foundation Trust, Poole Hospital, Poole, UK
| | - Mina Derias
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Joideep Phadnis
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
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Bartels DW, Marigi E, Sperling JW, Sanchez-Sotelo J. Revision Reverse Shoulder Arthroplasty for Anatomical Glenoid Component Loosening Was Not Universally Successful: A Detailed Analysis of 127 Consecutive Shoulders. J Bone Joint Surg Am 2021; 103:879-886. [PMID: 33764935 DOI: 10.2106/jbjs.20.00555] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component loosening is a primary cause of failure of anatomical total shoulder arthroplasty (TSA) and is commonly associated with glenoid bone loss. The purpose of the present study was to evaluate the outcome and survival following revision to a reverse total shoulder arthroplasty (RSA) for the treatment of loosening of a polyethylene cemented glenoid component in the setting of failed TSA. METHODS Between 2010 and 2017, 151 shoulders underwent revision to RSA for the treatment of loosening of an anatomical polyethylene glenoid component. Shoulders with staged reconstruction for the treatment of infection were excluded. One hundred and twenty-seven patients (67 women and 60 men) had a single-stage reconstruction and were available for follow-up. The mean age at the time of surgery was 70 years (range, 41 to 93 years). In all cases, the humeral component was revised and a standard glenoid baseplate was utilized. Bone graft was used at the discretion of the treating surgeon. Medical records and radiographs were reviewed to collect demographic, intraoperative, and postoperative data; to quantify glenoid bone loss; and to determine the radiographic outcome. The mean duration of follow-up was 35 months (range, 24 to 84 months). RESULTS Revision to RSA resulted in significant improvements in terms of pain and motion. Sixteen shoulders (13%) underwent revision surgery for the treatment of baseplate loosening. Radiographic baseplate loosening was present in 6 additional shoulders (overall rate of baseplate loosening, 17%). Intraoperative fracture or fragmentation of the greater tuberosity occurred in 30 shoulders (24%). Other reoperations included resection for deep infection (3 shoulders), arthroscopic biopsies for unexplained persistent pain (2 shoulders), humeral tray exchange for dislocation (2 shoulders), revision for humeral loosening (1 shoulder), irrigation and debridement for hematoma (1 shoulder), and internal fixation of periprosthetic fracture (1 shoulder) (overall reoperation rate, 20%). Among shoulders with surviving implants at the time of the most recent follow-up, pain was rated as none or mild in 83 shoulders (65.4%) and the average active elevation and external rotation were 132° and 38°, respectively. With the numbers available, no risk factors for failure could be identified. CONCLUSIONS Revision RSA for the treatment of loosening of an anatomical polyethylene component was associated with a 17% glenoid mechanical failure rate. Although this procedure resulted in improvements in terms of pain and function, it was not universally successful and thus needs further refinement in order to improve outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Risk Factors for Re-Revision Surgery in Shoulder Arthroplasty. J Am Acad Orthop Surg 2020; 28:e1049-e1058. [PMID: 32224701 DOI: 10.5435/jaaos-d-19-00635] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/23/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Revision shoulder arthroplasty is an expensive undertaking with notable morbidity to the patient and less predictable outcomes. Therefore, it is important to avoid even further surgery in these patients. We sought to report the annual revision burden from a large integrated healthcare system and identify patient and operative factors that may predispose patients to revision failure, necessitating further surgery. METHODS Annual revision burden as a proportion of the overall shoulder arthroplasties performed from 2005 to 2017 was obtained. Patients who underwent aseptic revision between 2005 and 2017 comprised the study sample. Patient characteristics evaluated for re-revision risk included age, sex, body mass index (BMI), race, and diabetes status, whereas surgical characteristics included surgeon cumulative revision volume, revision procedure type, and top reason for revision by primary procedure type. Multivariable Cox proportional hazards regression was used to evaluate the association between the specified factors and re-revision risk. RESULTS From 2005 to 2017, revisions represented 5.3% to 7.8% of all shoulder arthroplasty procedures performed. Factors associated with re-revision surgery risk by procedure type included increasing BMI and hemiarthroplasty revision procedure compared with reverse total shoulder arthroplasty (RTSA) revision procedure for hemiarthroplasty primaries; diabetes, revision because of instability, and lower cumulative surgeon revision procedure volume for RTSA primaries; and TSA revision procedure compared with RTSA revision procedure for TSA primaries. CONCLUSION The annual revision shoulder arthroplasty volume increased over the study period. Patient factors, including BMI and diabetes were associated with higher re-revision risks for hemiarthroplasty and RTSA primaries, respectively. RTSA revised for instability had a higher risk of re-revision compared with other indications. TSA and hemiarthroplasty requiring aseptic revision may be best treated with RTSA as opposed to another TSA or hemiarthroplasty. Further studies are needed to verify these findings and identify how the mechanism of failure may affect the procedure selection in the revision setting. LEVEL OF EVIDENCE Level III.
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Zhang B, Chen G, Fan T, Chen Z. Resurfacing hemiarthroplasty versus stemmed hemiarthroplasty for glenohumeral osteoarthritis: a meta-analysis. ARTHROPLASTY 2020; 2:25. [PMID: 35236453 PMCID: PMC8796565 DOI: 10.1186/s42836-020-00045-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/10/2020] [Indexed: 01/11/2023] Open
Abstract
Background Though total shoulder arthroplasty (TSA) has been an acknowledged treatment option for glenohumeral osteoarthritis, resurfacing hemiarthroplasty (RHA) and stemmed hemiarthroplasty (SHA) may be preferred in some circumstances by surgeons, especially for treating young or active patients. However, decision-making between the RHA and SHA is controversial. Therefore, we conducted a meta-analysis to systematically compare two surgical procedures in terms of postoperative functional outcomes, range of motion (ROM), pain relief, complication rates, risk of revision. Methods The PubMed, Embase, Web of Science and Cochrane Library were searched from inception to January 1, 2020, for all articles that compared the clinical effectiveness and safety of RHA with SHA. All eligible studies were selected based on certain screening criteria. Two investigators independently conducted the quality assessment and extracted the data. Fixed-effect and random-effect models were used for pooled results according to the degree of heterogeneity. All statistical analyses were performed by employing Stata software 14.0. Results A total of six comparative studies involving 2568 shoulders (1356 RHA and 1212 SHA) were included in the final analysis. Patients were followed up for at least 1 year in each study. Pooled results showed that RHA was associated with a better visual analog scale (SMD 0.61, p = 0.001) but higher revision rates (OR 1.50, p = 0.016) when compared to SHA. There were no significant differences in functional outcomes, such as Constant-Murley score (SMD 0.06, P = 0.878), American Shoulder and Elbow Surgeons score (SMD 0.05, P = 0.880), Western Ontario Osteoarthritis of the Shoulder index (SMD 0.43, p = 0.258) and quick-Disabilities of the Arm, Shoulder and Hand score (SMD 0.06, p = 0.669). In addition, no differences were observed in forward flexion (SMD 0.16, p = 0.622), external rotation (SMD -0.17, P = 0.741) and overall complication rates (OR 1.42, p = 0.198). Conclusion This is the first meta-analysis to investigate the clinical efficacy and safety of RHA in comparison with SHA for the treatment of glenohumeral osteoarthritis. The results demonstrated that the two surgical techniques were equivalent in terms of postoperative functional outcomes and complication rate. However, RHA provided greater pain relief but posed a higher risk for revision than SHA. More high-quality studies with long-term follow up are warranted to give more convincing evidence.
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Otte RS, Naylor AJ, Blanchard KN, Cancienne JM, Chan W, Romeo AA, Garrigues GE, Nicholson GP. Salvage reverse total shoulder arthroplasty for failed anatomic total shoulder arthroplasty: a cohort analysis. J Shoulder Elbow Surg 2020; 29:S134-S138. [PMID: 32643607 DOI: 10.1016/j.jse.2020.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed anatomic total shoulder arthroplasty (TSA) is increasing in incidence. The purpose of this study was to analyze the results of RTSA as a revision salvage procedure for failed TSA and identify factors that influenced those outcomes. METHODS All anatomic TSAs that were revised to RTSAs in adult patients, under the care of 2 senior surgeons at a single academic center from 2006 to 2018, were queried and reviewed. Cases in which hemiarthroplasty or RTSA was revised to RTSA were excluded. Electronic medical records and survey databases were reviewed for each subject. Demographic and surgical details were reviewed and analyzed with descriptive statistics. Preoperative and postoperative range of motion (ROM) including active forward elevation and active external rotation were evaluated. Patient-reported outcome surveys including the American Shoulder and Elbow Surgeons survey, Single Assessment Numeric Evaluation, and visual analog scale for pain were collected and analyzed. Improvement in ROM and outcome survey measures was assessed with 2-sample t tests. Complication and reoperation rates were analyzed with descriptive statistics. RESULTS A total of 75 patients (32 men and 43 women) were available for analysis at a mean of 22.3 months. The subjects were aged 60.3 ± 11.3 years at the time of TSA and 64.6 ± 9.7 years at the time of RTSA. The average period between TSA and RTSA was 4.3 years. The 3 most common indications for revision RTSA were painful arthroplasty (n = 62, 82.7%), rotator cuff failure (n = 56, 74.7%), and unstable arthroplasty (n = 25, 33.3%), but the majority of patients had multiple indications for surgery (n = 69, 92%). Significant improvements were found in all outcome measures from the time of failed TSA diagnosis to most recent follow-up after salvage RTSA with the exception of active external rotation: American Shoulder and Elbow Surgeons score, 39 ± 15 preoperatively vs. 62 ± 25 postoperatively; Single Assessment Numeric Evaluation, 27 ± 23 vs. 60 ± 30; visual analog scale pain score, 5 ± 2 vs. 3 ± 3; and active forward elevation, 79° ± 41° vs. 128° ± 33°. Major complications occurred in 21 patients (28.4%) after salvage RTSA, and 9 (12%) underwent reoperation. CONCLUSIONS RTSA for failed TSA can improve pain, function, and quality-of-life measures in patients with various TSA failure etiologies. However, postoperative ROM and patient-reported outcomes do not reach the values seen in the primary RTSA population.
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Affiliation(s)
| | - Amanda J Naylor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | | | - William Chan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Rasmussen JV, Hole R, Metlie T, Brorson S, Äärimaa V, Demir Y, Salomonsson B, Jensen SL. Anatomical total shoulder arthroplasty used for glenohumeral osteoarthritis has higher survival rates than hemiarthroplasty: a Nordic registry-based study. Osteoarthritis Cartilage 2018; 26:659-665. [PMID: 29474992 DOI: 10.1016/j.joca.2018.02.896] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report the10-year survival rates of different shoulder arthroplasty types used for glenohumeral osteoarthritis. DESIGN Data from 2004 to 2013 was prospectively collected by the national shoulder arthroplasty registers in Denmark, Norway and Sweden and merged into a harmonized dataset under the umbrella of the Nordic Arthroplasty Register Association. The common dataset included data that all three registers could deliver and where consensus regarding definitions could be made. Revision was defined as removal or exchange of any component or the addition of a glenoid component. RESULTS The cumulative survival rates at 10 years after resurfacing hemiarthroplasty (RHA) (n = 1,923), stemmed hemiarthroplasty (SHA) (n = 1,587) and anatomical total shoulder arthroplasty (TSA) (n = 2,340) were 0.85, 0.93 and 0.96 respectively (P < 0.001, Log rank test). RHA (HR: 2.5; CI 1.9-3.4, P < 0.001) and SHA (HR: 1.4; CI 1.0-2.0, P < 0.04) had an increased risk of revision compared to TSA. Gender, age and period of surgery were included in the Cox regression model. For patients below 55 years, the 10-year cumulative survival rates were 0.75 (RHA, n = 354), 0.81 (SHA, n = 146), and 0.87 (TSA, n = 201). CONCLUSIONS Anatomical TSA had the highest implant-survival rate. Young patients had, independently of the arthroplasty type, lower implant-survival rates. The treatment of young patients with end-stage osteoarthritis remains a challenge.
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Affiliation(s)
- J V Rasmussen
- Department of Orthopaedic Surgery, Herlev Hospital, Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - R Hole
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - T Metlie
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - S Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - V Äärimaa
- Departments of Orthopaedics and Traumatology, Turku University and University Hospital, Turku, Finland.
| | - Y Demir
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden.
| | - B Salomonsson
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden.
| | - S L Jensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
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Anatomic Total Shoulder Arthroplasty Using a Self-Pressurizing Pegged Bone-Preserving Cemented Glenoid Component: A 2- to 5-Year Follow-up Study. J Shoulder Elb Arthroplast 2018. [DOI: 10.1177/2471549217750478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: High rates of radiographic loosening have been reported with various glenoid designs. Many available designs sacrifice most of the bone at the central portion of the glenoid vault, creating large areas of deficiency when revision becomes necessary. The purpose of this study was to report the 2- to 5-year outcome of shoulder arthroplasty using a bone-preserving all-polyethylene glenoid components with self-pressurizing pegs. Methods: Between August 2011 and December 2014, 202 consecutive anatomic total shoulder arthroplasties (TSAs) were performed by a single surgeon with implantation of a self-pressurizing cemented pegged glenoid component in 190 patients (12 patients had both shoulders replaced). Patients were followed up prospectively and evaluated for pain, motion, strength, American Shoulder and Elbow Surgeons (ASES) scores, and radiographic changes. The mean follow-up time was 2.7 (2–5) years. Results: TSA improved pain and function reliably. At the most recent follow-up, 94% of the shoulders had no or mild pain. Motion included 154 ± 25° of elevation, 68 ± 18° of external rotation, and median internal rotation to T10 (range, iliac crest to T4). The most recent average ASES score was 82 ± 15 points. Early postoperative radiographs showed no radiolucent lines. No humeral or glenoid component was considered radiographically loose at the most recent follow-up. Complications requiring reoperation included subscapularis insufficiency (4), posterior instability (2), deep infection (1), stiffness (1), and a painful loose body (1). No components were revised for loosening. Conclusions: Anatomic TSA using a cemented bone-preserving all-polyethylene pegged self-pressurizing glenoid component provided satisfactory clinical outcomes and survival at 2 to 5 years.
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Moore DD, Moravek JE, Baker EA, Salisbury MR, Baker KC, Wiater JM. Exploring Failure of Total Shoulder Arthroplasty Systems Through Implant Retrieval, Radiographic, and Clinical Data Analyses. J Shoulder Elb Arthroplast 2017. [DOI: 10.1177/2471549217705322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Drew D Moore
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - James E Moravek
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Erin A Baker
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, Michigan
| | - Meagan R Salisbury
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, Michigan
| | - Kevin C Baker
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, Michigan
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan
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