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Pak T, Menendez ME, Gobezie R, Sears BW, Lederman E, Werner BC, Denard PJ. Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid. JSES Int 2024; 8:522-527. [PMID: 38707585 PMCID: PMC11064686 DOI: 10.1016/j.jseint.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Lateralization in reverse shoulder arthroplasty (RSA) decreases bony impingement and improves rotational range of motion, but has been theorized to increase the risk of subacromial notching (SaN). The purpose of this study was to evaluate the presence of SaN following RSA and its relationship with lateralization with a 135° inlay humeral component. The secondary purpose was to assess the association of SaN with functional outcomes. Methods A retrospective review was performed from a multicenter prospectively collected database on patients who underwent primary RSA from 2015 to 2021. All RSAs were performed with a 135° inlay humeral component. SaN was defined as bony erosion with sclerotic margins on the undersurface of the acromion on final follow-up radiographs not present preoperatively. Postoperative implant positioning (inclination, distalization, and lateralization) were evaluated on minimum 1-year postoperative radiographs. Regression analyses were performed on implant and clinical variables to assess for risk factors. A separate analysis was performed to determine the association of SaN with clinical outcomes. Results SaN was identified in 13 out of 442 shoulders (2.9%). Age, sex, body mass index, smoking status, diabetes mellitus, arm dominance had no relationship with SaN. Neither glenoid sided lateralization nor humeral offset were associated with SaN risk. Other implant characteristics such as distalization, glenosphere size, and postoperative inclination did not influence SaN risk. The presence of SaN did not affect patient-reported outcomes (American Shoulder and Elbow Surgeons: P = .357, Visual Analog Scale: P = .210) or range of motion. Conclusion The rate of SaN is low and not associated with glenoid or humeral prosthetic lateralization when using a 135° inlay humeral component. When SaN occurs, it is not associated with functional outcomes or range of motion at short-term follow-up.
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Affiliation(s)
- Theresa Pak
- Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | | | | | | | - Evan Lederman
- University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Brian C. Werner
- University of Virginia Health System, Charlottesville, VA, USA
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Ameziane Y, Imiolczyk JP, Steinbeck J, Warnhoff M, Moroder P, Scheibel M. [Reverse Shoulder Arthroplasty - Current Concepts]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:211-228. [PMID: 38518806 DOI: 10.1055/a-2105-3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Due to first promising long term outcome data, reverse shoulder arthroplasty experienced an immense increase of usage during the past decade. Moreover, the initial Grammont concept has constantly been refined and adapted to current scientific findings. Therefore, clinical and radiological problems like scapular notching and postoperative instability were constantly addressed but do still remain an area of concern.This article summarises current concepts in reverse shoulder arthroplasty and gives an overview of actual indications like cuff tear arthropathy, severe osteoarthritis, proximal humerus fractures, tumours, fracture sequelae as well as revision surgery and their corresponding clinical and radiological results.
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Haase L, Ina J, Harlow E, Chen R, Gillespie R, Calcei J. The Influence of Component Design and Positioning on Soft-Tissue Tensioning and Complications in Reverse Total Shoulder Arthroplasty: A Review. JBJS Rev 2024; 12:01874474-202404000-00002. [PMID: 38574183 DOI: 10.2106/jbjs.rvw.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
» Reverse total shoulder arthroplasty was designed to function in the rotator cuff deficient shoulder by adjusting the glenohumeral center of rotation (COR) to maximize deltoid function.» Adjustments in the COR ultimately lead to changes in resting tension of the deltoid and remaining rotator cuff, which can affect implant stability and risk of stress fracture.» Soft-tissue balance and complication profiles can be affected by humeral component (version, neck shaft angle, and inlay vs. onlay) and glenoid component (sagittal placement, version, inclination, and lateralization) design and application.» A good understanding of the effects on soft-tissue balance and complication profile is critical for surgeons to best provide optimal patient outcomes.
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Affiliation(s)
- Lucas Haase
- University Hospitals of Cleveland, Cleveland, Ohio
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Hirakawa Y, Manaka T, Ito Y, Nakazawa K, Iio R, Kubota N, Nakamura H, Collin P. Comparison of short-term clinical outcomes and radiographic changes in Grammont reverse shoulder arthroplasty between the French and Japanese populations: A propensity score-matched analysis. J Orthop Sci 2024; 29:128-132. [PMID: 36437153 DOI: 10.1016/j.jos.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/15/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although Grammont-style reverse total shoulder arthroplasty (RSA) showed excellent clinical results in Europe, its utility for Asian populations remains unclear. This study aimed to compare the French and Japanese populations in terms of range of motion (ROM), functional outcomes, and scapular notching rates in patients who underwent standard Grammont-style RSA. We hypothesized that RSA for the Japanese population may not provide as good ROM and functional results at the final follow-up as that for the French population. METHODS A total of 25 Japanese patients undergoing RSA were propensity score matched to 25 French patients undergoing RSA. The patients were matched for four different covariates using a propensity score analysis. The minimum follow-up period was 2 years. We investigated differences between the populations with respect to body size and shoulder joint ROM and Constant score (CS) measured preoperatively and at the final follow-up. Scapular notching was examined using radiographs at the final follow-up. RESULTS The average height and weight of the French and Japanese patients were 164 cm and 70 kg and 152 cm and 56 kg, respectively. Anterior elevation (AE), external rotation (ER) at the side, internal rotation (IR), and CS total changed from 101° to 145°, 17° to 15°, 4.5 points to 5.5 points, and 36 points to 72 points, respectively, in the French population and from 63° to 119°, 8.5° to 13°, 4.6 points to 4 points, and 28 points to 58 points, respectively, in the Japanese population. AE improved in both the groups; ER and IR remained unchanged before and after surgery. The frequency of scapular notching (>grade 1) was higher in the Japanese population (56%) than in the French population (20%) (p = 0.019). CONCLUSIONS Grammont-style RSA improved AE and CS in both the populations, but AE and CS were significantly higher in the French population than in the Japanese population at the final follow-up. Scapular notching frequently occurs in the Japanese population.
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Affiliation(s)
- Yoshihiro Hirakawa
- Ishikiriseiki Hospital, 18-28, Yayoi-town, Higashi-osaka City 579-8026, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
| | - Yoichi Ito
- Osaka Shoulder Center, Ito Clinic, 1-10-12, Ueda, Matsubara-city, Osaka 580-0016, Japan
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Naoya Kubota
- Ishikiriseiki Hospital, 18-28, Yayoi-town, Higashi-osaka City 579-8026, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
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Kim JS, Kim SH, Kim SC, Park JH, Kim HG, Lee SM, Yoo JC. Effect of using a small baseplate on the radiological and clinical outcomes of reverse total shoulder arthroplasty in Asian patients. Bone Joint J 2023; 105-B:1189-1195. [PMID: 37909149 DOI: 10.1302/0301-620x.105b11.bjj-2023-0450.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes. Methods This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the β-angle, the inclination of the glenoid component, inferior overhang, scapular notching, the location of the central cage in the baseplate within the vault and the mismatch in size between the glenoid and baseplate. Clinical evaluations included the range of motion (ROM) and functional scores. In subgroup analysis, comparisons were performed between those in whom the vault of the glenoid was perforated (VP group) and those in whom it was not perforated (VNP group). Results Perforation of the vault of the glenoid (p = 0.018) and size mismatch in height (p < 0.001) and width (p = 0.013) were significantly more frequent in the ST group than in the SM group. There was no significant difference in the clinical scores and ROM in the two groups, two years postoperatively (all p > 0.05). In subgroup analysis, the VP group had significantly less inferior overhang (p = 0.009), more scapular notching (p = 0.018), and more size mismatch in height (p < 0.001) and width (p = 0.025) than the VNP group. Conclusion In Asian patients with a small glenoid, using a 29.5 mm small baseplate at the time of RSA was more effective in reducing size mismatch between the glenoid and the baseplate, decreasing the incidence of perforation of the glenoid vault, and achieving optimal positioning of the baseplate compared with the use of a 33.8 mm standard baseplate. However, longer follow-up is required to assess the impact of these findings on the clinical outcomes.
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Affiliation(s)
- Jae S Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Seung H Kim
- Department of Orthopaedic Surgery, Saeroun Hospital, Seoul, South Korea
| | - Su C Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jong H Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Hyun G Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Sang M Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jae C Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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6
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Kobayashi EF, Oak SR, Miller BS, Bedi A. Treatment of Massive Rotator Cuff Tears with Reverse Shoulder Arthroplasty. Clin Sports Med 2023; 42:157-173. [DOI: 10.1016/j.csm.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Meade JD, Jackson GR, Schallmo MS, Young B, Parisien RL, Trofa DP, Connor PM, Schiffern S, Hamid N, Saltzman BM. Comorbidity scores reported in anatomic and reverse total shoulder arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2022; 46:2089-2095. [PMID: 35666300 DOI: 10.1007/s00264-022-05462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Due to the aging population, the number of reverse shoulder arthroplasty (RSA) and anatomic shoulder arthroplasty (TSA) continue to increase annually. Although outcome measures are frequently reported in literature for patients who undergo shoulder arthroplasty, no studies have analyzed reporting of patient comorbidities in this population. The purpose of this study was to evaluate reporting of comorbidity indices in shoulder arthroplasty literature and assess how this reporting may inform management and outcomes. METHODS A database was compiled systematically using PubMed to identify articles pertaining to shoulder arthroplasty published between 2019 and 2021. The search terms, "reverse shoulder arthroplasty" and "anatomic shoulder arthroplasty," were used to identify clinical studies. Non-clinical (e.g., translational and basic science) and review articles were excluded. Included studies were then analyzed for reporting of comorbidity indices. RESULTS A total of 199 articles were included in this review and reported comorbidities. Of these, 15.6% (31 of 199) pertained to TSA, while 84.4% (168 of 199) pertained to RSA. Within this review, 57.8% (115 of 199) articles utilized comorbidity scores, while 42.2% (84 of 199) reported only comorbid diagnoses. Among the scores utilized, the American Society of Anesthesiologists (ASA) physical status classification system was the most widely used among both the TSA (52.9%, 9 of 17) and the RSA studies (58.2%, 57 of 98). Additional scores within the RSA literature included the Charlson Comorbidity Index (CCI) (35.3%, 6 of 17), the Charlson Comorbidity Index by Deyo et al. (J Clin Epidemiol. 45(6):613-9, 1992) (CCI-Deyo; 5.9%, 1 of 17), the Modified Charlson Comorbidity Index (modified-CCI) (5.9%, 1 of 17), the Elixhauser et al. (Med Care. 36(1):8-27, 1998) Comorbidity Measure (ECM) (11.8%, 2 of 17), and the Modified Frailty Index (mFI) (5.9%, 1 of 17). With the TSA literature, the additional comorbidity scores included the CCI (30.6%, 30 of 98), the CCI-Deyo (6.1%, 6 of 98), the modified-CCI (1.0%, 1 of 98), the ECM (8.2%, 8 of 98), the Factor-5 modified Frailty Index (mFI-5) (1.0%, 1 of 98), and the mFI (1.0%, 1 of 98). CONCLUSION The reporting of comorbidity indices is an important factor when considering patient outcomes and complications reported in shoulder arthroplasty literature. Although the reporting of these scores appears to be more prevalent in current literature, there is no standard or consistency in terms of which scores are reported. Given this diversity in comorbidity scores, further research is necessary to develop a single standardized score to properly analyze the effect of comorbidities on shoulder arthroplasty patient outcomes.
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Affiliation(s)
- Joshua D Meade
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.,Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Garrett R Jackson
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
| | - Michael S Schallmo
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
| | - Bradley Young
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
| | | | - David P Trofa
- Columbia University Medical Center, New York, NY, 10032, USA
| | - Patrick M Connor
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.,Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Shadley Schiffern
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.,Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Nady Hamid
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.,Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA. .,Atrium Health Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA.
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Ascione F, Panni AS, Braile A, Corona K, Toro G, Capuano N, Romano AM. Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties, a systematic review: part II-problems and reinterventions. J Orthop Traumatol 2021; 22:49. [PMID: 34826010 PMCID: PMC8626544 DOI: 10.1186/s10195-021-00613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. METHODS This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (1 January 2000 to 14 April 2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar, employing several combinations of keywords: "reverse shoulder arthroplasty," "reverse shoulder prosthesis," "inverse shoulder arthroplasty," "inverse shoulder prosthesis," "problems," "complications," "results," "outcomes," "reoperation," and "revision." RESULTS Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with overall reoperation and revision rates of 1.7% and 2.6%, respectively. CONCLUSIONS Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas no humeral fractures or stem loosening were reported with short stems. Infections (1.3%) were the most common reason for component revision, followed by instability (0.8%). LEVEL OF EVIDENCE Systematic review IV.
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Affiliation(s)
- Francesco Ascione
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy. .,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.
| | - Alfredo Schiavone Panni
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Adriano Braile
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | - Giuseppe Toro
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Nicola Capuano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy
| | - Alfonso M Romano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy.,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
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10
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Lee JH, Chun YM, Kim DS, Lee DH, Shin SJ. Early restoration of shoulder function in patients with the Grammont prosthesis compared to lateralized humeral design in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2533-2542. [PMID: 33813010 DOI: 10.1016/j.jse.2021.03.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to compare the clinical outcomes and radiographic parameters of patients after reverse shoulder arthroplasty (RSA) between the Grammont prosthesis and lateralized humeral design prosthesis. METHODS A total of 114 patients who underwent RSA with a lateralized humeral design (group L; 71 shoulders) and medialized humeral design (group M; 43 shoulders) prosthesis for cuff tear arthropathy or irreparable rotator cuff tear were enrolled. Clinical outcomes including visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores and range of motion (ROM) were serially followed up at postoperative 3, 6, 12, and 24 months. Radiographic parameters were measured to evaluate preoperative and postoperative status. RESULTS Both prostheses demonstrated similar clinical outcomes and shoulder function preoperatively and at postoperative 2 years (P >.05). However, patients in group M had significantly better postoperative active forward flexion (postoperative 3 months, 115° ± 12° vs. 101° ± 14°; P <.001; 6 months, 125° ± 13° vs. 118° ± 13°; P <.013) and abduction (3 months, 105° ± 12° vs. 98° ± 12°; P = .002); VAS (3 months, 3.1 ± 1.2 vs. 3.7 ± 1.4; P = .031; 6 months, 2.3 ± 1.1 vs. 2.8 ± 1.3; P = .038); ASES (3 months, 64.2 ± 7.0 vs. 60.4 ± 9.2; P = .022; 6 months, 70.6 ± 6.0 vs. 66.6 ± 8.1; P = .007); and Constant scores (6 months, 59.6 ± 6.9 vs. 55.7 ± 9.3; P = .020). Group L showed a significantly lower rate of scapular notching than group M (15.5% vs. 41.8%; P < .001). The position of the proximal humerus in group L was more lateralized and less distalized than in group M after RSA. CONCLUSIONS RSA with both the Grammont and lateralized humeral design prostheses provided similar shoulder ROM restoration and functional improvements at a minimum of 2 years. However, patients with a humeral lateralized prosthesis showed slower recovery of shoulder function and ROM up to postoperative 6 months despite a lower incidence of scapular notching.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Doo-Sup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Republic of Korea
| | - Doo-Hyung Lee
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
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11
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Ascione F, Schiavone Panni A, Braile A, Corona K, Toro G, Capuano N, Romano AM. Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I-complications). J Orthop Traumatol 2021; 22:27. [PMID: 34236540 PMCID: PMC8266956 DOI: 10.1186/s10195-021-00592-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/28/2021] [Indexed: 01/18/2023] Open
Abstract
Background Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. Methods This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (01.01.2000–14.04.2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar employing several combinations of keywords: “reverse shoulder arthroplasty,” “reverse shoulder prosthesis,” “inverse shoulder arthroplasty,” “inverse shoulder prosthesis,” “problems,” “complications,” “results,” “outcomes,” “reoperation,” “revision.” Results Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with an overall reoperation rate of 1.7% and overall revision rate of 2.6%. Conclusions Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem in RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas short stems reported no humeral fractures or stem loosening. Infections (1.3%) proved to be the most common reason for component revision, and instability had a complication rate of 0.8%. Level of evidence Systematic review IV
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Affiliation(s)
- Francesco Ascione
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, NA, Italy. .,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.
| | - Alfredo Schiavone Panni
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Adriano Braile
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | - Giuseppe Toro
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Nicola Capuano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, NA, Italy
| | - Alfonso M Romano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, NA, Italy.,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
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12
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Matsuki K, Hoshika S, Ueda Y, Tokai M, Takahashi N, Sugaya H, Banks SA. Three-dimensional kinematics of reverse shoulder arthroplasty: a comparison between shoulders with good or poor elevation. JSES Int 2021; 5:353-359. [PMID: 34136839 PMCID: PMC8178639 DOI: 10.1016/j.jseint.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Various factors may be related to outcomes of reverse shoulder arthroplasty (RSA) including patient and surgical factors. Differences in shoulder kinematics might be associated with poor function after RSA; however, kinematic differences between shoulders with good or poor elevation have not been elucidated. The purpose of this study was to compare RSA kinematics between shoulders with good or poor elevation. Methods The study included 28 shoulders with a minimum 6-month follow-up after RSA using Grammont-type prostheses. Subjects comprised 17 men and 11 women with the mean age of 75 years (range, 63-91). Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional scapular implant models. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images, and 3-dimensional kinematics of implants were computed. Kinematics and glenosphere orientation were compared between shoulders with good (>90 degree) or poor (<90 degree) scapular plane abduction. Results Nineteen and 9 shoulders were assigned to the good- and poor-elevation groups, respectively. There were no significant differences between the groups in age, sex, height, weight, preoperative range of motion, or Constant score, but body mass index in the poor elevation shoulders was significantly larger than that in the good elevation shoulders. There were no significant differences in glenosphere (upward/downward rotation, anterior/posterior tilt, internal/external rotation) or glenohumeral (internal/external rotation, abduction/adduction) kinematics between the good and poor elevation shoulders. Scapulohumeral rhythm was significantly higher in the good elevation shoulders than the poor elevation shoulders (P = .04). Glenosphere superior tilt was 2.3° ± 4.2° in the good-elevation group and 8.1° ± 8.9° in the poor-elevation group, and the difference was statistically significant (P = .03). Discussion Shoulders with good elevation after RSA demonstrated better scapulohumeral rhythm than those with poor elevation, though there were no significant differences in glenosphere and glenohumeral kinematics. It may be important for better elevation to achieve good glenohumeral motion in shoulders with RSA. Glenosphere orientations may affect postoperative shoulder function.
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Affiliation(s)
- Keisuke Matsuki
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
- Corresponding author: Keisuke Matsuki, MD, PhD, Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan.
| | - Shota Hoshika
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Yusuke Ueda
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Morihito Tokai
- Tokyo Sports & Orthopaedic Clinic, Toshima, Tokyo, Japan
| | - Norimasa Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | | | - Scott A. Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
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13
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Factors Influencing Appropriate Implant Selection and Position in Reverse Total Shoulder Arthroplasty. Orthop Clin North Am 2021; 52:157-166. [PMID: 33752837 DOI: 10.1016/j.ocl.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reverse shoulder arthroplasty has increased in popularity and has provided improved but somewhat variable results. These variable outcomes may be related to many factors, including implant design, component positioning, specific indication, and patient anatomy. The original Grammont design provided a solution to the high failure rate at the time but was found to have a high rate of scapular notching and poor restoration of rotation. Modern lateralized designs are more consistent in reducing scapular notching while improving range of motion, especially in regards to external rotation. This review article summarizes the effects of modern reverse shoulder prostheses on outcomes.
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14
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In vivo measurement of distance between scapular neck and polyethylene insert during active external rotation in shoulders with Grammont type reverse prosthesis. Clin Biomech (Bristol, Avon) 2021; 84:105341. [PMID: 33798841 DOI: 10.1016/j.clinbiomech.2021.105341] [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: 10/05/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scapular notching is a frequently observed complication after reverse shoulder arthroplasty. Impingement of the humeral plastic insert against the scapular neck is believed to be the cause of notching. There have been no in vivo studies that analyzed the positional relationship between the scapular neck and humeral insert. The purpose of this study was to measure the distance between the scapular neck and insert in shoulders with Grammont-type prostheses during active external rotation at the side. METHODS Eighteen shoulders with Grammont-type prostheses were enrolled in this study. There were 13 males and 5 females, and the mean age at surgery was 74 years (range, 63-91). Fluoroscopic images were recorded during active external rotation at the side from maximum internal to external rotation at an average of 14 months (range, 7-24) after surgery. Implant kinematics were determined with three-dimensional models of the implants and fluoroscopic images using model-image registration techniques. Based on the implant kinematics, the closest distance between the scapular neck and insert was computed at each 5° increment of glenohumeral internal/external rotation. RESULTS Mean glenohumeral abduction during rotation was 17°-22°. The mean distance between the neck and insert was approximately 1 mm throughout the activity. The separation distance tended to narrow with arm external rotation, but the change was not significant. INTERPRETATION The small distance between the scapular neck and insert in early post-operative reverse shoulder arthroplasty patients may be associated with the high incidence of scapular notching in Grammont-type prostheses.
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15
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Abstract
AIMS This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). METHODS A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde's non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). RESULTS A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. CONCLUSION This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design. Cite this article: Bone Joint J 2021;103-B(5):813-821.
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Affiliation(s)
| | | | | | - Jonathan P Evans
- Royal Devon and Exeter Foundation Trust, Exeter, UK.,Health Services and Policy Research Unit, University of Exeter Medical School, Exeter, UK
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16
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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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17
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Schoch BS, Vasilopoulos T, LaChaud G, Wright TW, Roche C, King JJ, Werthel JD. Optimal glenosphere size cannot be determined by patient height. J Shoulder Elbow Surg 2020; 29:258-265. [PMID: 31500985 DOI: 10.1016/j.jse.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenosphere size remains 1 surgeon-controlled variable that can affect patient outcomes following reverse shoulder arthroplasty (RSA). There remains no objective criterion to guide surgeons in choosing glenosphere size. This study's purpose was to evaluate range of motion (ROM) as a function of patient height and glenosphere size to determine the optimal glenosphere size based on patient height. METHODS We retrospectively reviewed 589 primary RSAs from a multicenter shoulder arthroplasty database of a single RSA system with multiple glenosphere sizes. Shoulders were separated into groups based on glenosphere size (38 or 42 mm). Predictive accuracy was calculated in relation to height and sex for predicting glenosphere size. Improvements in active ROM and patient-reported outcome measures (PROMs) were compared based on glenosphere size as a function of height. RESULTS Logistic regression analysis demonstrated a strong association of height and sex with surgeon selection of glenosphere size, with shorter heights preferentially treated with 38-mm glenospheres and taller heights with 42-mm glenospheres. There were no statistically significant interaction effects of glenosphere size and height on improvements in ROM or PROMs. These results indicate that for a given glenosphere size, there is not an optimal height range to maximize improvements in postoperative outcome measures. DISCUSSION Height and sex are highly correlated with a surgeon's choice of glenosphere size. However, on the basis of improvements in ROM and PROMs, no recommendation can be made for surgeons to select a particular glenosphere size based on a patient's height. Surgeons should consider other variables when selecting a glenosphere size.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Terrie Vasilopoulos
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Gregory LaChaud
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | - Joseph J King
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Jean David Werthel
- Department of Orthopedic Surgery, Hopital Ambroise Paré, Boulogne-Billancourt, France
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18
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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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19
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Kendall MC. Letter to the Editor regarding McLaughlin et al: "Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study". J Shoulder Elbow Surg 2019; 28:e29. [PMID: 30100177 DOI: 10.1016/j.jse.2018.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/15/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02818, USA.
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