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Yendluri A, Alexanian A, Lee AC, Megafu MN, Levine WN, Parsons BO, Kelly JD, Parisien RL. The variability of MCID, SCB, PASS, and MOI thresholds for PROMs in the reverse total shoulder arthroplasty literature: a systematic review. J Shoulder Elbow Surg 2024; 33:2320-2332. [PMID: 38754543 DOI: 10.1016/j.jse.2024.03.051] [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: 11/25/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) is a common procedure utilized to address degenerative pathologies of the glenohumeral joint and rotator cuff. Increased reliance on patient-reported outcome measures (PROMs) have placed emphasis on the utilization of the minimum clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS), and maximal outcome improvement (MOI) thresholds to assess the clinical efficacy of RTSA. In this study, we systematically reviewed the MCID, SCB, PASS, and MOI thresholds reported for PROMs following RTSA. METHODS PubMed, Embase, MEDLINE, Cochrane Library, and Google Scholar were queried for articles from January 1, 2000 to August 31, 2023 reporting MCID, SCB, PASS, or MOI values for PROMs following RTSA. Patient demographic data, study characteristics, MCID/SCB/PASS/MOI thresholds, and threshold calculation methods were extracted. RESULTS One hundred and forty-one articles were screened with 39 ultimately included, comprising 11,984 total patients that underwent RTSA. 34 (87%) studies reported MCID thresholds, 20 (51%) reported SCB, 5 (13%) reported PASS, and 2 (5%) reported MOI. 25/39 (64%) studies referenced a previous study when reporting MCID, SCB, PASS, or MOI values, 11 (28%) used an anchor-based method to calculate threshold values, 1 (3%) used a distribution-based method, and 2 (5%) used both anchor and distribution methods. There were 19 newly calculated MCID (11), SCB (5), PASS (1), and MOI (2) thresholds. For 5 of the 6 most utilized PROMs (ASES, SST, Constant, UCLA, and SPADI), the range of reported MCID values exceeded 50% of the most common threshold. For 3 of 6, the range of SCB values exceeded 25% of the most common threshold. CONCLUSION There is substantial variability in the MCID and SCB threshold values reported in the RTSA literature. Standardizing the methodologic calculation and utilization of MCID, SCB, PASS, and MOI thresholds for RTSA may allow for improved assessment of PROMs.
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Affiliation(s)
- Avanish Yendluri
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ara Alexanian
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alexander C Lee
- Department of Orthopedic Surgery, The Ohio State University, Columbus, OH, USA
| | | | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John D Kelly
- Department of Orthopedic Surgery, Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert L Parisien
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Li C, Wang Z, Ali MI, Long Y, Alike Y, Zhou M, Cui D, Zheng Z, Meng K, Hou J, Yang R. Sub-Acromioclavicular Decompression Increases the Risk of Postoperative Shoulder Stiffness after Arthroscopic Rotator Cuff Repair. Orthop Surg 2024. [PMID: 39340780 DOI: 10.1111/os.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/11/2024] [Accepted: 08/11/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVE The sub-acromioclavicular (SAC) decompression is often performed during arthroscopic rotator cuff repair. However, the impact of SAC decompression on patients with postoperative shoulder stiffness (POSS) are controversial and unclear. This study is aim to evaluate the impact of additional sub-acromioclavicular (SAC) decompression during arthroscopic rotator cuff repair on the postoperative shoulder stiffness (POSS) in patients. METHODS This retrospective study examined digital data from patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair at a local institution. Patient-reported outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) Score, the University of California-Los Angeles (UCLA) score, and visual analog scale (VAS) scores. Restricted shoulder mobility occurring within 6 months postoperatively, lasting more than 12 weeks, characterized by a passive forward flexion angle of <120° or an external rotation angle of <30°, with or without associated shoulder pain was identified as POSS. Factors affecting POSS were analyzed by binary logistic regression analysis. The patient-reported outcomes scores were analyzed by generalized estimating equations to examine the impact of SAC decompression. RESULTS A total of 155 patients met the set criteria and were included in the study. The analysis of binary logistic regression showed that diabetes (p = 0.001) and SAC decompression (p = 0.003) were independent factors for POSS. In the analysis of each follow-up point, only at the 3-month follow-up, the ASES scores (p = 0.003), UCLA scores (p = 0.045), and VAS scores (p = 0.005) showed significant differences between the SAC decompression group and the non-decompression group. For the intergroup comparison, the results showed a significant difference in the ASES scores (β = -4.971, p = 0.008), UCLA scores (β = -1.524, p = 0.019), and VAS scores (β = 0.654, p = 0.010) throughout the study duration between the SAC decompression group and the non-decompression group. CONCLUSION The findings of this study suggested that SAC decompression during arthroscopic rotator cuff repair increase the risk of POSS compared with those without the decompression, which indicate surgeons do not perform SAC decompression unless necessary.
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Affiliation(s)
- Cheng Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Zhiling Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Maslah Idiris Ali
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Yi Long
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Ymuhanmode Alike
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Min Zhou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Dedong Cui
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Zhenze Zheng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Ke Meng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
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Maturana C, Peterson B, Shi B, Mooney B, Clites T, Kremen TJ. Reverse total shoulder arthroplasty with proximal bone loss: a biomechanical comparison of partially vs. fully cemented humeral stems. J Shoulder Elbow Surg 2024; 33:2039-2047. [PMID: 38417733 PMCID: PMC11330736 DOI: 10.1016/j.jse.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The appropriate amount of cementation at the time of reverse total shoulder arthroplasty with significant proximal bone loss or resection is unknown. Extensive cementation of a humeral prosthesis makes eventual revision arthroplasty more challenging, increasing the risk of periprosthetic fracture. We analyzed the degree of subsidence and torque tolerance of humeral components undergoing standard cementation technique vs. our reduced polymethyl methacrylate (PMMA) protocol. Reduced cementation may provide sufficient biomechanical stability to resist physiologically relevant loads, while still permitting a clinically attainable torque for debonding the prosthesis. METHODS A total of 12 cadaveric humeri (6 matched pairs) underwent resection of 5 cm of bone distal to the greater tuberosity. Each pair of humeri underwent standard humeral arthroplasty preparation followed by either cementation using a 1.5-cm PMMA sphere at a location 3 cm inferior to the porous coating or standard full stem cementation. A 6-degree-of-freedom robot was used to perform all testing. Each humeral sample underwent 200 cycles of abduction, adduction, and forward elevation while being subjected to a physiologic compression force. Next, the samples were fixed in place and subjected to an increasing torque until implant-cement separation or failure occurred. Paired t tests were used to compare mean implant subsidence vs. a predetermined 5-mm threshold, as well as removal torque in matched samples. RESULTS Fully and partially cemented implants subsided 0.49 mm (95% CI 0.23-0.76 mm) and 1.85 mm (95% CI 0.41-3.29 mm), respectively, which were significantly less than the predetermined 5-mm threshold (P < .001 and P < .01, respectively). Removal torque between fully cemented stems was 45.22 Nm (95% CI 21.86-68.57 Nm), vs. 9.26 Nm (95% CI 2.59-15.93 Nm) for partially cemented samples (P = .021). Every fully cemented humerus fractured during implant removal vs. only 1 in the reduced-cementation group. The mean donor age in our study was 76 years (range, 65-80 years). Only 1 matched pair of humeri belonged to a female donor with comorbid osteoporosis. The fractured humerus in the partially cemented group belonged to that donor. CONCLUSION Partially and fully cemented humeral prostheses had subsidence that was significantly less than 5 mm. Partially cemented stems required less removal torque for debonding of the component from the cement mantle. In all cases, removal of fully cemented stems resulted in humeral fracture. Reduced cementation of humeral prostheses may provide both sufficient biomechanical stability and ease of future component removal.
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Affiliation(s)
- Carlos Maturana
- Anatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brandon Peterson
- Anatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA
| | - Brendan Shi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bailey Mooney
- Anatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tyler Clites
- Anatomical Engineering Group, Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Thomas J Kremen
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
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Bindi VE, Buchanan TR, Cueto RJ, Hones KM, Wright TW, Schoch BS, King JJ, Hao KA. Mitigating the Risk of Instability After Reverse Shoulder Arthroplasty: A Critical Analysis Review of Patient and Surgical Factors. JBJS Rev 2024; 12:01874474-202409000-00001. [PMID: 39226391 DOI: 10.2106/jbjs.rvw.24.00095] [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: 09/05/2024]
Abstract
» Instability and dislocation after reverse shoulder arthroplasty may occur in up to 31% of patients. » Clinical risk factors for instability include younger age, male sex, increased body mass index, preoperative diagnosis of proximal humerus fracture or rotator cuff pathology, history of instability of the native shoulder or after surgery, and a medical history of Parkinson's disease. » Patients with rheumatoid arthritis and decreased proximity to the coracoid may also be at greater risk. » In patients at a high risk of instability, surgeons should consider a more lateralized prosthesis (particularly in patients with an incompetent rotator cuff), repairing the subscapularis (particularly when using a medialized prosthesis), and upsizing the glenosphere (>40 mm in male and 38-40 mm in female patients). » While potentially useful, less evidence exists for the use of a constrained liner (particularly with a lateralized glenosphere and/or in low-demand patients) and rotating the polyethylene liner posteriorly to avoid impingement.
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Affiliation(s)
- Victoria E Bindi
- College of Medicine, University of Florida, Gainesville, Florida
| | | | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, Florida
| | - Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Kevin A Hao
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
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Warren ES, Hurley ET, Bethell MA, Loeffler BJ, Hamid N, Klifto CS, Anakwenze O. Tendon Transfers in Reverse Total Shoulder Arthroplasty: A Systematic Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00008. [PMID: 39137406 PMCID: PMC11321750 DOI: 10.5435/jaaosglobal-d-24-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE The purpose of this study was to evaluate clinical outcomes after tendon transfers in the setting of reverse total shoulder arthroplasty (RTSA). METHODS PubMed and Embase were searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to find primary clinical studies of any type of tendon transfer in the setting of RTSA. RESULTS Overall, 17 studies (level of evidence [LOE] I: 1, LOE II: 0, LOE III: 3, LOE IV: 13) met inclusion criteria, with 300 shoulders. Most patients were female (56.7%), with an average age of 68.7 years (range 19 to 89) and a mean follow-up of 46.2 months (range 6 to 174). 11 studies reported outcomes after combined latissimus dorsi and teres major transfer (LDTM) while eight studies reported on latissimus dorsi transfer only (LD). Improvements in commonly reported subjective and functional outcome measures were as follows: external rotation +32° (LDTM) and +30° (LD), flexion +65° (LDTM) and +59° (LD), Visual Analog Score -5.4 (LDTM) and -4.5 (LD), subjective shoulder value +43.8% (LDTM) and +46.3% (LD), and overall Constant score +33.8 (LDTM) and +38.7 (LD). The overall complication rate was 11.3%, including tendon transfer ruptures (0.7%), instability (3.0%), infection (2.0%), and nerve injury (0.3%). The all-cause repeat operation rate was 7.3%, most commonly for arthroplasty revision (5.3%). Subgroup analysis revealed that lateralized implants with tendon transfer resulted in markedly greater improvements in Constant score, flexion, ER1, and ER2 while medialized implants with tendon transfer had markedly greater improvements in Visual Analog Score, subjective shoulder value, and abduction. CONCLUSION Patients undergoing tendon transfer of either combined LDTM or latissimus dorsi alone in the setting of RTSA have markedly improved subjective and functional outcomes. A moderate incidence of complications (11.3%) was noted in this patient population.
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Affiliation(s)
- Eric S. Warren
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Eoghan T. Hurley
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Mikhail A. Bethell
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Bryan J. Loeffler
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Nady Hamid
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Christopher S. Klifto
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
| | - Oke Anakwenze
- From the Duke University School of Medicine, Duke University, Durham, NC (Dr. Warren and Dr. Bethell); the Department of Orthopaedic Surgery, Duke University, Durham, NC (Dr. Hurley, Dr. Klifto, and Dr. Anakwenze); the Department of Orthopedics, Atrium Health, Charlotte, NC (Dr. Loeffler and Dr. Hamid); and the OrthoCarolina Hand Center, Charlotte, NC (Dr. Loeffler and Dr. Hamid)
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Afetse EK, Jochl OM, Kanakamedala AC, Minas L, Hinz M, Ruzbarsky JJ, Millett PJ, Provencher MT. The impact of neurologic disorders on clinical and functional outcomes after shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2024:S1058-2746(24)00469-5. [PMID: 38992413 DOI: 10.1016/j.jse.2024.05.023] [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: 02/09/2024] [Revised: 04/21/2024] [Accepted: 05/10/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Patients with pre-existing neurologic disorders present a unique set of challenges for shoulder arthroplasty (SA) surgeons due to the presence of concomitant contractures, muscle weakness, and spasticity, which may affect outcomes and complication rates after SA. The goal of this systematic review was to evaluate the clinical and functional outcomes after SA in patients pre-existing with neurologic disorders, focusing on complication and reoperation rates. METHODS This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on outcomes after SA in patients with neurologic disorders. Study demographics and information on outcomes including patient-reported outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the Methodological Index for Nonrandomized Studies scoring system. RESULTS Twenty articles published between 1997 and 2023 met inclusion criteria. In total, 13,126 patients with neurologic conditions with 7 different neurologic disorders (Parkinson's disease, epilepsy and seizures, cerebral palsy, poliomyelitis, Charcot neuropathy, cerebrovascular disease, and multiple sclerosis) were included. The mean patient age was 64.3 years (range, 33.0-75.8 years), 51.4% of patients were male, and the mean postoperative follow-up time was 5.1 years (range, 1.4-9.9 years). Parkinson's disease was the most reported neurologic disorder (9 studies, 8033 patients), followed by epilepsy (4 studies, 3783 patients), and multiple sclerosis (1 study, 1077 patients). While these patients did experience improvements in outcomes following SA, high complication and revision rates were noted. CONCLUSIONS Patients with neurologic disorders demonstrate improvements in pain and function after SA but have higher reported complication and revision rates when compared with patients without neurologic conditions. This systematic review offers valuable data for both the surgeon and patient regarding anticipated clinical results and possible complications from SA in patients with neurologic disorders that may aid in shared decision-making when considering SA.
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Affiliation(s)
| | | | - Ajay C Kanakamedala
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Lucas Minas
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Maximilian Hinz
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Joseph J Ruzbarsky
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Pastor MF, Nebel D, Becker LM, Hurschler C, Karrer AA, Smith T. Does glenoid inclination affect the anterior stability of reverse total shoulder arthroplasty? A biomechanical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2353-2364. [PMID: 38592552 PMCID: PMC11291655 DOI: 10.1007/s00590-024-03898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The anterior stability of reverse total shoulder arthroplasty is affected by multiple factors. However, the effect of glenosphere inclination on stability has rarely been investigated, which is what this study aims to look into. METHODS Reverse shoulder arthroplasty was performed on 15 cadaveric human shoulders. The anterior dislocation forces and range of motion in internal rotation in the glenohumeral joint (primary measured parameters) were tested in a shoulder simulator in different arm positions and implant configurations, as well as with a custom-made 10° inferiorly inclined glenosphere. The inclination and retroversion of the baseplate as well as the distance between the glenoid and coracoid tip in two planes (secondary measured parameters) were evaluated on CT scans. RESULTS In biomechanical testing, the custom-made inclined glenosphere showed no significant influence on anterior stability other than glenoid lateralisation over all arm positions as well as the neck-shaft angle in two arm positions. The 6 mm lateralised glenosphere reduced internal rotation at 30° and 60° of glenohumeral abduction. In 30° of glenohumeral abduction, joint stability was increased using the 155° epiphysis compared with the 145° epiphysis. The mean inclination was 16.1°. The inclination was positively, and the distance between the glenoid and coracoid tip in the anterior-to-posterior direction was negatively correlated with anterior dislocation forces. CONCLUSIONS The custom-made inferiorly inclined glenosphere did not influence anterior stability, but baseplate inclination itself had a significant effect on stability.
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Affiliation(s)
- Marc-Frederic Pastor
- Department of Orthopaedic Surgery, Städtisches Klinikum Braunschweig gGmbH, Holwedestraße 16, 38118, Braunschweig, Germany
- Department of Orthopaedic Surgery, DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Dennis Nebel
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
| | - Lennart Mathis Becker
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Alba Aurora Karrer
- Department of Orthopaedic Surgery, DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Tomas Smith
- Department of Orthopaedic Surgery, DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
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Andriollo L, Pietramala S, Polizzi A, Niccoli G, Zattoni G, Morea V. Computer-Assisted Navigation in Reverse Shoulder Arthroplasty: Surgical Experience and Clinical Outcomes. J Clin Med 2024; 13:2512. [PMID: 38731041 PMCID: PMC11084768 DOI: 10.3390/jcm13092512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA.
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Affiliation(s)
- Luca Andriollo
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Silvia Pietramala
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alberto Polizzi
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
| | - Giuseppe Niccoli
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
| | - Guido Zattoni
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
| | - Vincenzo Morea
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
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Nové-Josserand L, Nerot C, Colotte P, Guery J, Godenèche A. Reverse shoulder arthroplasty for primary glenohumeral osteoarthritis: significantly different characteristics and outcomes in shoulders with intact vs. torn rotator cuff. J Shoulder Elbow Surg 2024; 33:850-862. [PMID: 37633591 DOI: 10.1016/j.jse.2023.07.027] [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: 04/25/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To compare outcomes of reverse shoulder arthroplasty (RSA) for primary osteoarthritis (OA) with and without rotator cuff (RC) tears to those with secondary OA due to RC tears. METHODS We reviewed records of all patients who received RSA for primary OA or secondary OA. All patients had preoperative radiographs, computed tomographic arthrography (CTA), and/or magnetic resonance imaging (MRI) scans of their shoulders to assess their etiology, glenoid morphology, and fatty infiltration. Pre- and postoperative (at minimum follow-up of 2 years) Constant scores and range of motion were compared between patients who had RSA for primary OA with and without RC tears to those with secondary OA due to RC tears. RESULTS Of the initial cohort of 605 shoulders (583 patients), 153 were lost to follow-up (25.3%), 25 required revision with implant removal (4.1%), and 13 died of causes unrelated to the surgery (2.1%), and left a final cohort of 414 patients. Of the final cohort, 97 had primary OA with intact RC, 62 had primary OA with RC tears, and 255 had secondary OA. Postoperative Constant scores were significantly higher for primary OA with intact RC (73.8 ± 14.3), compared with both primary OA with RC tears (66.1 ± 14.6, P < .001) and secondary OA (64.1 ± 14.8, P < .001). There were no differences in pre- or postoperative scores between primary OA with RC tears and secondary OA. CONCLUSION At 2 or more years following RSA, Constant scores were significantly higher for primary OA with intact RC, compared to either primary OA with RC tears or secondary OA, whereas there were no differences in pre- or postoperative scores of shoulders that had primary OA with RC tears vs. secondary OA. The authors recommend distinguishing primary OA with intact RC from primary OA with RC tears, as the two have considerably different characteristics and prognosis following RSA.
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Affiliation(s)
- Laurent Nové-Josserand
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France; SoFEC - French Shoulder and Elbow Society, Paris, France
| | - Cecile Nerot
- SoFEC - French Shoulder and Elbow Society, Paris, France; Reims University Hospital, Reims, France
| | - Philippe Colotte
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France; SoFEC - French Shoulder and Elbow Society, Paris, France
| | - Jacques Guery
- SoFEC - French Shoulder and Elbow Society, Paris, France; Polyclinique du Val de Loire, ELSAN, Nevers, France
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Alexander N, Zdravkovic V, Spross C, Olach M, Jost B. Reversed total shoulder arthroplasty for rotator cuff arthropathy is associated with increased scapulothoracic motion: A longitudinal two-year kinematic study. Gait Posture 2024; 109:34-40. [PMID: 38262099 DOI: 10.1016/j.gaitpost.2024.01.011] [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: 09/17/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Reversed total shoulder arthroplasty (RTSA) is a standard surgical procedure for the treatment of rotator cuff tear arthropathy (CTA), aimed at restoring active arm elevation. Shoulder elevation relies on both scapulothroacic (ST) and glenohumeral (GH) motion, but RTSA computer planning primarily focuses on the GH joint due to challenges in visualizing scapulothroacic (ST) motion. RESEARCH QUESTION Does the scapulohumeral rhythm, by means of the relative contributions of ST rotation and GH elevation per degree of arm elevation, in a longitudinal setting for up to two years postoperatively after RTSA for CTA change? METHODS In a prospective longitudinal study, shoulder kinematics were studied in 20 patients (22 shoulders) before and at three, six, 12, and 24 months after RTSA implantation for CTA. Skin markers were tracked using 3D motion analysis. The relative ST and GH contributions per degree of arm elevation were assessed and were compared using statistical non-parametric mapping with Bayesian inference. RESULTS Mean arm elevation was 89 ± 33° preoperatively, 135 ± 28° at 3 months, 161 ± 20° at 6 months, 169 ± 18° at 12 months, and 165 ± 19° at 24 months. Between 48-66°, 62-93°, 53-94°, 60-97° and 72-104° of arm elevation at the measurement time points pre, 3-months, 6-months, 12-months and 24-months postoperatively, respectively, the ST rotation had a significantly greater contribution to arm elevation compared to GH elevation; a pattern that was not found in controls. SIGNIFICANCE While RTSA successfully restored active arm elevation through improved GH and ST motion, the scapulohumeral rhythm exhibited a consistent pattern up to two years postoperatively, resembling the preoperative state. In the midrange of motion, ST rotation dominated over GH elevation, potentially contributing to muscular fatigue and explaining the documented decline in functional outcomes over time after RTSA. The findings highlight the importance of incorporating ST kinematics into modern computer planning for RTSA.
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Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, Switzerland; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Spross
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Olach
- Department of Orthopaedics and Traumatology, Hospital Wil, Wil, Switzerland
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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11
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Stenson JF, Mills ZD, Dasari SP, Whitson AJ, Hsu JE, Matsen FA. Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:e162-e174. [PMID: 37473904 DOI: 10.1016/j.jse.2023.06.014] [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: 03/28/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Disabling cuff tear arthropathy (CTA) is commonly managed with reverse shoulder arthroplasty (RSA). However, for patients with CTA having preserved active elevation, cuff tear arthropathy hemiarthroplasty (CTAH) may offer a cost-effective alternative that avoids the complications unique to RSA. We sought to determine the characteristics and outcomes of a series of patients with CTA managed with these procedures. MATERIALS AND METHODS We retrospectively reviewed 103 patients with CTA treated with shoulder arthroplasty, the type of which was determined by the patient's ability to actively elevate the arm. Outcome measures included the change in the Simple Shoulder Test (SST), the percent maximum improvement in SST (%MPI), and the percentage of patients exceeding the minimal clinically important difference for the change in SST and %MPI. Postoperative x-rays were evaluated to assess the positions of the center of rotation and the greater tuberosity for each implant. RESULTS Forty-four percent of the 103 patients were managed with CTAH while 56% were managed with RSA. Both arthroplasties resulted in clinically significant improvement. Patients having RSA improved from a mean preoperative SST score of 1.7 (interquartile range [IQR], 0.0-3.0) to a postoperative score of 6.3 (IQR, 2.3-10.0) (P < .01). Patients having CTAH improved from a preoperative SST score of 3.1 (IQR, 1.0-4.0) to a postoperative score of 7.6 (IQR, 5.0-10.) (P < .001). These improvements exceeded the minimal clinically important difference. Instability accounted for most of the RSA complications; however, it did not account for any CTAH complications. The postoperative position of the center of rotation and greater tuberosity on anteroposterior radiographs did not correlate with the clinical outcomes for either procedure. CONCLUSION For 103 patients with CTA, clinically significant improvement was achieved with appropriately indicated CTAH and RSA. In view of the lower cost of the CTAH implant, it may provide a cost-effective alternative to RSA for patients with retained active elevation.
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Affiliation(s)
- James F Stenson
- Orthopedic Surgery, Einstein Healthcare Network, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Zachary D Mills
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Suhas P Dasari
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
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12
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Chelli M, Walch G, Azar M, Neyton L, Lévigne C, Favard L, Boileau P. Glenoid lateralization and subscapularis repair are independent predictive factors of improved internal rotation after reverse shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024; 48:127-132. [PMID: 38047939 DOI: 10.1007/s00264-023-06048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) has shown improvement in clinical outcomes for various conditions, although some authors expressed concern about the restoration of active internal rotation (AIR). The current study assesses preoperative and intraoperative predictive factors of AIR in patients having a Grammont-style RSA with a minimum five year follow-up. METHODS We conducted a retrospective multicentric study, including patients operated on with a 155° Grammont-style RSA for cuff-related pathology or primary osteoarthritis with posterior subluxation or an associated cuff tear. Patients were clinically evaluated at a minimum of five year follow-up. Patients with previous surgery or those who had a tendon transfer with the RSA were excluded. Demographic parameters, BMI, preoperative notes, and operative reports were obtained from medical records. AIR was graded according to the constant score system from 0 to 10. RESULTS A total of 280 shoulders in 269 patients (mean age at surgery, 74.9 ± 5.9 years) met the inclusion criteria and were analyzed. The average follow-up was 8.1 years (range, 5-16 years). Overall, AIR increased from 4.2 (SD 2.5, range 0 to 10) preoperatively to 5.9 (SD 2.6, range 0 to 10) at final follow-up. At the last follow-up, AIR increased in 56% of cases, was unchanged in 26% and decreased in 18%. In 188 shoulders (67%), internal rotation was functional and allowed patients to reach the level of L3 or higher. Multivariable linear regression found the following preoperative clinical factors predictive of worse AIR after RSA: male gender (ß = -1.25 [-2.10; -0.40]; p = 0.0042) and higher values of BMI (ß = -0.085 [-0.17; -0.0065]; p = 0.048). Two surgical factors were associated with better AIR after RSA: glenoid lateralization with BIO-RSA technique (ß = 0.80 [0.043; 1.56]; p = 0.039) and subscapularis repair (ß = 1.16 [0.29; 2.02]; p = 0.0092). CONCLUSIONS With a mean of eight year follow-up (5 to 16 years), internal rotation was functional (≥ L3 level) in 67% of operated shoulders after Grammont-style RSA; however, two patients out of ten had decreased AIR after surgery. Male patients and those with higher BMIs had worse AIR, with glenoid lateralization (using the BIO-RSA technique) and subscapularis repair, as they are predictive of increased AIR after RSA. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Mikaël Chelli
- ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France.
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Michel Azar
- ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France
| | - Lionel Neyton
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Luc Favard
- Service d'Orthopédie Traumatologie, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, Chambray-les-, Tours, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France
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Spek RWA, Spekenbrink-Spooren A, Vanhommerig JW, Jonkman N, Doornberg JN, Jaarsma RL, Jutte PC, van der Veen HC, van Noort A, van den Bekerom MPJ. Primary reverse total shoulder arthroplasty for fractures requires more revisions than for degenerative conditions 1 year after surgery: an analysis from the Dutch Arthroplasty Register. J Shoulder Elbow Surg 2023; 32:2508-2518. [PMID: 37327989 DOI: 10.1016/j.jse.2023.05.013] [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: 03/11/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although reverse total shoulder arthroplasty (RTSA) is considered a viable treatment strategy for proximal humeral fractures, there is an ongoing discussion of how its revision rate compares with indications performed in the elective setting. First, this study evaluated whether RTSA for fractures conveyed a higher revision rate than RTSA for degenerative conditions (osteoarthritis, rotator cuff arthropathy, rotator cuff tear, or rheumatoid arthritis). Second, this study assessed whether there was a difference in patient-reported outcomes between these 2 groups following primary replacement. Finally, the results of conventional stem designs were compared with those of fracture-specific designs within the fracture group. MATERIALS AND METHODS This was a retrospective comparative cohort study with registry data from the Netherlands, generated prospectively between 2014 and 2020. Patients (aged ≥ 18 years) were included if they underwent primary RTSA for a fracture (<4 weeks after trauma), osteoarthritis, rotator cuff arthropathy, rotator cuff tear, or rheumatoid arthritis, with follow-up until first revision, death, or the end of the study period. The primary outcome was the revision rate. The secondary outcomes were the Oxford Shoulder Score, EuroQol 5 Dimensions (EQ-5D) score, numerical rating scale score (pain at rest and during activity), recommendation score, and scores assessing change in daily functioning and change in pain. RESULTS This study included 8753 patients in the degenerative condition group (mean age, 74.3 ± 7.2 years) and 2104 patients in the fracture group (mean age, 74.3 ± 7.8 years). RTSA performed for fractures showed an early steep decline in survivorship: Adjusted for time, age, sex, and arthroplasty brand, the revision risk after 1 year was significantly higher in these patients than in those with degenerative conditions (hazard ratio [HR], 2.50; 95% confidence interval, 1.66-3.77). Over time, the HR steadily decreased, with an HR of 0.98 at year 6. Apart from the recommendation score (which was slightly better within the fracture group), there were no clinically relevant differences in the patient-reported outcome measures after 12 months. Patients who received conventional stems (n = 1137) did not have a higher likelihood of undergoing a revision procedure than those who received fracture-specific stems (n = 675) (HR, 1.70; 95% confidence interval, 0.91-3.17). CONCLUSION Patients undergoing primary RTSA for fractures have a substantially higher likelihood of undergoing revision within the first year following the procedure than patients with degenerative conditions preoperatively. Although RTSA is regarded as a reliable and safe treatment option for fractures, surgeons should inform patients accordingly and incorporate this information in decision making when opting for head replacement surgery. There were no differences in patient-reported outcomes between the 2 groups and no differences in revision rates between conventional and fracture-specific stem designs.
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Affiliation(s)
- Reinier W A Spek
- Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia; Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
| | | | | | - Nini Jonkman
- Department of Epidemiology, OLVG, Amsterdam, The Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; Shoulder and Elbow Expertise Center, Amsterdam, The Netherlands; Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Maier SP, Prabhat AM, Collins JE, von Keudell A, Earp B, Zhang D. Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Versus Rotator Cuff Arthropathy. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00013. [PMID: 37867245 PMCID: PMC10593265 DOI: 10.5435/jaaosglobal-d-23-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Reverse total shoulder arthroplasty (RSA) is used to treat a variety of shoulder-related pathologies. This study compared medium-term clinical outcomes of less than 10-year follow-up in patients treated with RSA for proximal humerus fracture (PHF) versus rotator cuff arthropathy (RCA). METHODS This retrospective review was conducted at two tertiary care centers, in which self-reported clinical outcomes were assessed using four validated instruments, that is, American Shoulder and Elbow Society (ASES) score, Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS), and shoulder subjective value (SSV). Statistical analyses were performed using linear or logistic regression with generalized estimating equations. RESULTS Of the 189 patients included in this study, 70 were treated for fracture and 119 for RCA. At a mean postoperative follow-up of 6.4 years, the means were 79.7 for ASES score, 20.8 for SPADI-Total, 0.8 for VAS, and 77.1 for SSV. After adjusting models for covariates, there was no significant difference in average SSV (P = 0.7), VAS (P = 0.7) or SPADI-Pain (P = 0.2) between PHF and RCA cohorts; however, the RCA cohort reported significantly better outcomes in ASES scores (P = 0.002), SPADI-Disability (P < 0.0001), and SPADI-Total (P = 0.0001). DISCUSSION Patients with RCA and PHF treated with RSA achieved similar medium-term outcomes in several domains, particularly postoperative pain levels; however, patients with PHF reported greater perceived disability. RSA is an effective pain-controlling procedure, but patients may have variable functional outcomes based on the indication for surgery.
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Affiliation(s)
- Stephen P Maier
- From the Harvard Combined Orthopaedic Residency Program, Boston, MA (Dr. Maier II); the Harvard Medical School, Boston, MA (Ms. Prabhat); the Brigham and Women's Hospital, Boston, MA (Dr. Collins); the Division of Orthopaedic Trauma, Bispebjerghospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. von Keudell, Dr. Earp, and Dr. Zhang)
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Stewart BP, Hawthorne BC, Dorsey CG, Wellington IJ, Cote M, Mazzocca A. Reverse Shoulder Arthroplasty Patients Younger Than 60 Years Old Exhibit Lower Clinically Significant Single Assessment Numeric Evaluation (SANE) Scores Compared to Older Patients. Cureus 2023; 15:e46492. [PMID: 37927713 PMCID: PMC10624330 DOI: 10.7759/cureus.46492] [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] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The incidence of reverse shoulder arthroplasty (RTSA) in the United States has increased. Patients under 60 years old with failed rotator cuff repairs or degenerative joint disease with glenoid deformity may be candidates for RTSA and contribute to this increase. The single assessment numeric evaluation (SANE) score is a reliable post-operative scoring technique when compared with other post-operative measures. This study aimed to compare the effect of age on the likelihood of reaching clinically significant SANE scores following RTSA. METHODS A multicenter retrospective review was performed with a consecutive series of RTSA from December 2015 to September 2021. Patients were stratified into groups based on their age at the time of operation: (1) less than 60 years old, (2) 60-69 years old, (3) 70-79 years old, and (3) greater than 80 years old. The proportions of patients in all cohorts reaching and surpassing clinically significant thresholds at each visit were determined. Likelihood ratios were determined for each age cohort to compare the likelihood of reaching clinically significant SANE scores. RESULTS A total of 292 of 885 (33%) patients had completed survey data over two years and were included in the study. The 70-79-year-old group was 3.152 (p=.035) times more likely to achieve minimal clinically important difference (MCID) and 2.125 (p=.048) times more likely to achieve patient-acceptable symptomatic state (PASS) compared with patients <60 years old. The cohort who was 80+ years old was also 4.867 (p=.045) times more likely to achieve MCID compared to the <60-year-old cohort. The <60 cohort had the lowest proportion of all patient cohorts achieving MCID. CONCLUSION A lower proportion of patients younger than 60 years old undergoing RTSA achieved clinically significant post-operative SANE scores. The 70-79-year-old age group was more likely to reach MCID and PASS, and the patients who were 80+ years old were more likely to reach MCID compared to patients younger than 60 years old.
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Affiliation(s)
| | | | | | | | - Mark Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Augustus Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
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Godenèche A, Nérot C, Girard M, Bonnevialle N, Kany J, Saffarini M, Nové-Josserand L, Collotte P. Reverse shoulder arthroplasty renders better clinical scores at a minimum follow-up of two years for patients with no rotator cuff deficiency operated by the deltopectoral approach. INTERNATIONAL ORTHOPAEDICS 2023; 47:2285-2293. [PMID: 37453983 DOI: 10.1007/s00264-023-05872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The purpose of this multi-centre study was to report outcomes of a large cohort of reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years and to determine patient and surgical factors that influence postoperative outcomes. The hypothesis was that surgical indication, surgical approach, and implant design would affect clinical outcomes significantly. METHODS The authors reviewed records of 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff (RC) tears, secondary OA due to RC tears, and irreparable massive rotator cuff tears (mRCT). The deltopectoral (DP) approach was used in 540 and the anterosuperior (AS) approach in 203. Pre- and postoperative Constant scores (CS) were recorded. Multivariable linear analyses were performed to determine if CS was associated with indications for surgery, surgical approach, or implant design. RESULTS Of the 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised, leaving 501 for analysis. At a mean follow-up of 3.2 ± 0.9 years, net improvement in CS was 29.2 ± 17.0. Multivariable analyses revealed that postoperative CS decreased with age and was worse in shoulders that had preoperative rotator cuff deficiency and in shoulders operated by the AS approach. Multivariable analyses also revealed worse net improvement in shoulders operated for secondary OA due to RC tears or for irreparable mRCT, as well as shoulders operated by the AS approach. CONCLUSION This large multi-centre study confirms that, at two or more years following RSA, Constant scores are not associated with implant design, but rather with rotator cuff deficiency and surgical approach. Multivariable analysis revealed that postoperative CS was worse for shoulders with preoperative rotator cuff deficiency and for shoulders operated by the AS approach. Multivariable analysis also revealed that net improvement in CS was worse in shoulders treated for secondary OA due to RC tears and for shoulders with irreparable mRCT, as well as for shoulders operated by the AS approach.
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Affiliation(s)
- Arnaud Godenèche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
| | - Cécile Nérot
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
- Département d'Orthopédie et Traumatologie, CHU de Reims, Reims, France
| | - Mathieu Girard
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Toulouse, France
| | - Nicolas Bonnevialle
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
- CHU de Purpan, 31000, Toulouse, France
| | - Jean Kany
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
- Clinique de l'union, Ramsay Santé, 31240, Saint-Jean, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Laurent Nové-Josserand
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
| | - Philippe Collotte
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
- SoFEC-French Shoulder and Elbow Society, 75014, Paris, France
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Velasquez Garcia A, Abdo G, Sanchez-Sotelo J, Morrey ME. The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2023; 11:01874474-202308000-00008. [PMID: 37616447 DOI: 10.2106/jbjs.rvw.23.00038] [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: 08/26/2023]
Abstract
BACKGROUND Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in preoperative planning, conventional instrumentation may lead to considerable inaccuracy in implant positioning unless patient-specific guides are used. Optical navigation has the potential to improve accuracy and precision when implanting a reverse shoulder arthroplasty baseplate. This systematic review aimed to analyze the most recent evidence on the accuracy and precision of glenoid baseplate positioning using intraoperative navigation and its potential impact on component selection and surgical time. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The PubMed, Scopus, and EMBASE databases were queried in July 2022 to identify all studies that compared navigation vs. conventional instrumentation for reverse shoulder arthroplasty. Data of deviation from the planned baseplate version and inclination, the use of standard or augmented glenoid components, and surgical time were extracted. Quantitative analysis from the included publications was performed using the inverse-variance approach and Mantel-Haenszel method. RESULTS Of the 2,048 records identified in the initial query, only 10 articles met the inclusion and exclusion criteria, comprising 667 shoulders that underwent reverse total shoulder arthroplasty. The pooled mean difference (MD) of the deviation from the planned baseplate position for the clinical studies was -0.44 (95% confidence interval [CI], -3.26; p = 0.76; I2 = 36%) for version and -8.75 (95% CI, -16.83 to -0.68; p = 0.02; I2 = 83%) for inclination, both in favor of navigation. The odds ratio of selecting an augmented glenoid component after preoperative planning and navigation-assisted surgery was 8.09 (95% CI, 3.82-17.14; p < 0.00001; I2 = 60%). The average surgical time was 12 minutes longer in the navigation group (MD 12.46, 95% CI, 5.20-19.72; p = 0.0008; I2 = 71%). CONCLUSIONS Preoperative planning integrated with computer-assisted navigation surgery seems to increase the accuracy and precision of glenoid baseplate inclination compared with the preoperatively planned placement during reverse total shoulder arthroplasty. The surgical time and proportion of augmented glenoid components significantly increase when using navigation. However, the clinical impact of these findings on improving prosthesis longevity, complications, and patient functional outcomes is still unknown. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Clínica Universidad de los Andes, Santiago, Chile
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Internal Medicine Residency Program, New York Medical College at St Mary's General Hospital, Valhalla, New York
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Hsieh YC, Kuo LT, Hsu WH, Tsai YH, Peng KT. Comparison of Outcomes after Arthroscopic Rotator Cuff Repair between Elderly and Younger Patient Groups: A Systematic Review and Meta-Analysis of Comparative Studies. Diagnostics (Basel) 2023; 13:1770. [PMID: 37238254 PMCID: PMC10217625 DOI: 10.3390/diagnostics13101770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to compare the outcomes of arthroscopic rotator cuff repair (ARCR) surgery between younger and older patients. We performed this systematic review and meta-analysis of cohort studies comparing outcomes between patients older than 65 to 70 years and a younger group following arthroscopic rotator cuff repair surgery. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and other sources for relevant studies up to 13 September 2022, and then assessed the quality of included studies using the Newcastle-Ottawa Scale (NOS). We used random-effects meta-analysis for data synthesis. The primary outcomes were pain and shoulder functions, while secondary outcomes included re-tear rate, shoulder range of motion (ROM), abduction muscle power, quality of life, and complications. Five non-randomized controlled trials, with 671 participants (197 older and 474 younger patients), were included. The quality of the studies was all fairly good, with NOS scores ≥ 7. The results showed no significant differences between the older and younger groups in terms of Constant score improvement, re-tear rate, or other outcomes such as pain level improvement, muscle power, and shoulder ROM. These findings suggest that ARCR surgery in older patients can achieve a non-inferior healing rate and shoulder function compared to younger patients.
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Affiliation(s)
- Yu-Chieh Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (Y.-C.H.); (Y.-H.T.); (K.-T.P.)
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (Y.-C.H.); (Y.-H.T.); (K.-T.P.)
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (Y.-C.H.); (Y.-H.T.); (K.-T.P.)
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Su F, Nuthalapati P, Feeley BT, Lansdown DA. Outcomes of anatomic and reverse total shoulder arthroplasty in patients over the age of 70: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:181-188. [PMID: 37588441 PMCID: PMC10426543 DOI: 10.1016/j.xrrt.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Both anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably improve pain and function for a variety of indications. However, there remain concerns about these procedures among elderly patients due to their general health, the potential for lesser functional gain, and the possible need for revision at an even older age. The purpose of this review is to compare the clinical outcomes, radiographic outcomes, and complications of ATSA and RTSA among patients older than 70 years. Methods A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. The inclusion criteria were studies with patients older than 70 years who were treated with a primary ATSA or RTSA and clinical results reported at a minimum of 2 years. All indications for primary RTSA except for tumor were included. Outcomes of interest included patient-reported outcomes (PROs), range of motion, patient satisfaction, radiographic changes, complication and revision rates, and implant survival. Results A total of 24 studies met the inclusion criteria. At a mean follow-up of 3.4 years for ATSA and 3.1 years for RTSA, there were significant improvements in pain, range of motion, and PROs for both prostheses. Patients who underwent ATSA generally had better motion and functional outcomes compared to those who underwent RTSA, though these comparisons were made across different indications for arthroplasty. The satisfaction rate was 90.9% after ATSA and 90.8% after RTSA. Furthermore, 10.2% of ATSA patients and 9.9% of RTSA patients experienced a surgical complication, whereas 2.3% of ATSA and 2.2% of RTSA patients underwent a revision. Secondary rotator cuff tear was the most common complication after ATSA, occurring in 3.7% of patients, but only 1.1% of patients required revision surgery. Both ATSA and RTSA implant survivorship was reported to range from 93.1% to 98.9% at 5- and 8-year follow-up, respectively. Patient mortality was estimated to be 19.3% with a mean time to death of 6.1 years. Conclusions Elderly patients with primary osteoarthritis and an intact rotator cuff can have predictable pain relief, restoration of functional range of motion, and significant improvement in PROs after ATSA with low complication rates. Secondary rotator cuff failure and revision arthroplasty occur infrequently at early to mid-term follow-up. Although elderly patients who underwent ATSA generally had better functional outcomes compared to those who underwent RTSA for differing indications, patient satisfaction after both procedures were similar.
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Affiliation(s)
- Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Drew A. Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures and Sequalae Compared to Non-Fracture Indications: A Matched Cohort Analysis of Outcome and Complications. J Clin Med 2023; 12:jcm12062097. [PMID: 36983100 PMCID: PMC10051829 DOI: 10.3390/jcm12062097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/10/2023] Open
Abstract
Background: With the increase in utility and popularity of the reverse total shoulder arthroplasty (RTSA) within the last decades, indications for RTSA have expanded. As well as the established indications such as cuff tear arthropathy and massive irreparable rotator cuff tears, RTSA for complex proximal humeral fractures in elderly patients has been proven to be a reliable treatment option. Methods: A prospectively enrolled RTSA database of 1457 RTSAs implanted between September 2005 and November 2020 was reviewed. Patients treated with RTSA for a complex proximal humerus fracture and fracture sequalae (F-RTSA) were 1:1 matched with a group of patients who were treated electively with RTSA for indications other than a fracture (E-RTSA). Matching criteria included sex, age, length of follow-up and body mass index. Evaluation after a minimum of 2 years follow-up included evaluation of the absolute and relative Constant–Murley score (aCS; rCS), subjective shoulder value (SSV), range of motion (ROM) assessment and complications. Results: Each of the matched cohorts comprised 134 patients with a mean follow-up of 58 ± 41 months for the fracture group and 58 ± 36 months for the elective group. The mean age for both groups was 69 ± 11 years in the F-RTSA and 70 ± 9 years for the E-RTSA group. There were no significant differences in clinical outcome measures including aCS, rCS and SSV (p > 0.05). There was a significant difference in mean active external rotation with 20° ± 18° in the F-RTSA group compared with 25° ± 19° in the E-RTSA group (p = 0.017). The complication rate was not significantly different, with 41 complications in 36 shoulders in the F-RTSA and 40 complications in 32 shoulders in the E-RTSA group (p = 0.73). The main complication for the F-RTSA group was dislocation of the greater tuberosity (6%), whereas acromial fractures (9%) were the leading complication in the E-RTSA group. There was also no significant difference in revision rate comparing F-RTSA with E-RTSA (10% vs. 14%; p = 0.25). Conclusions: RTSA for complex proximal humeral fractures and its sequalae leads to a comparable clinical outcome as that for patients treated electively with RTSA for indications other than fracture. There was, however, a significant difference in active external rotation, with inferior rotation in patients undergoing RTSA for fracture. This valuable information can help in requesting informed consent of patients with proximal humeral fractures.
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Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med 2023; 16:145-153. [PMID: 36867393 PMCID: PMC10043097 DOI: 10.1007/s12178-023-09823-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. RECENT FINDINGS Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6 weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.
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De La Selle H, Lascar T, Clappaz P, Decrette E, van Rooij F, Saffarini M, Obert L. Reverse Shoulder Arthroplasty for Patients with Massive Rotator Cuff Tears or Cuff Tear Arthropathies at a Minimum Follow-up of 7 Years. J Shoulder Elb Arthroplast 2023; 7:24715492231157659. [PMID: 36824060 PMCID: PMC9941602 DOI: 10.1177/24715492231157659] [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: 09/16/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose To evaluate indications and factors that influence long-term clinical outcomes and revision rates for reverse shoulder arthroplasty (RSA) in shoulders with irreparable massive rotator cuff tears (mRCTs) or cuff tear arthropathies (CTAs). Methods The authors retrospectively evaluated a consecutive series of shoulders with no fracture sequelae that underwent primary RSA between 2011 and 2013. Independent observers collected demographic data, surgical techniques, and implant types, as well as primary outcome measures such as American Shoulder and Elbow Society (ASES) score and Constant score (CS). Study design Case series, level IV. Results From the initial series of 123 patients that underwent RSA, 29 patients died (24%) for reasons unrelated to the shoulder arthroplasty, 11 were lost to follow-up (9%), and 4 required revision surgery (3%). The final cohort of 79 patients comprised 55 women (70%), and 24 men (30%), aged 72.7 ± 7.0. At a final follow-up of 8.9 ± 0.6 years (range: 7.4-10.3) the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 76.6 ± 41.2, and ASES was 77.1 ± 20.3. Univariable analysis revealed no associations for absolute CS, but revealed that age-/sex-adjusted CS was significantly lower for patients with high blood pressure (β = -15.8, p = .025). Conclusions At a minimum follow-up of 7.4 years, the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 87.4 ± 24.1 and ASES was 77.1 ± 20.3. When stratifying the outcomes of RSA by indication, there were no significant differences in patients with mRCTs versus CTA in terms of absolute CS, age-/sex-adjusted CS, and ASES. Univariable analysis revealed no association with absolute and age-/sex-adjusted CS for type of indication or surgical approach.
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Affiliation(s)
- Hugues De La Selle
- Orthopaedics Department, Hôpital privé Sainte-Marie – Ramsay Santé, Chalon-sur-Saône, France
| | - Tristan Lascar
- Orthopaedics Department, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Pascal Clappaz
- Orthopaedics Department, Pôle Chirurgie Orthopédique, Bourg-en-Bresse, France
| | - Edouard Decrette
- Orthopaedics Department, Centre Épaule Hôpital Privé d'Antony, Antony, France
| | - Floris van Rooij
- ReSurg SA, Nyon, Switzerland,Floris van Rooij, ReSurg SA, Rue Saint-Jean 22, 1260 Nyon, Switzerland.
| | | | - Laurent Obert
- Orthopaedics Department, Hôpital Jean Minjoz, Besançon, France
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Velasquez Garcia A, Abdo G. Does computer-assisted navigation improve baseplate screw configuration in reverse shoulder arthroplasty? A systematic review and meta-analysis of comparative studies. J Orthop 2023; 36:29-35. [PMID: 36582549 PMCID: PMC9793209 DOI: 10.1016/j.jor.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/18/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Navigation technologies have improved accuracy and precision in positioning glenoid components during shoulder arthroplasty. The influence of navigation on baseplate screw placement has not been independently investigated. This study aimed to evaluate and synthesize the best scientific evidence on the influence of intraoperative navigation on the length and number of screws for primary baseplate fixation in reverse total shoulder arthroplasty procedures. Methods In August 2022, PubMed, Scopus, and Embase databases were accessed. We analyzed the screw purchase length, the number of screws required for the fixation of the baseplate, and the proportion of cases fixed with two screws in all clinical trials, comparing navigation to standard instrumentation for reverse shoulder arthroplasty. Following an evaluation of the heterogeneity of the studies, DerSimonian-Laird random-effects models were utilized to merge data from separate studies. Results The systematic search revealed a total of 2034 articles. After excluding duplicates and irrelevant studies, 633 shoulder arthroplasties from 6 trials were included in the analysis. The pooled mean difference in screw purchase length was 5.839 mm (95 %CI 4.496 to 7. 182) in favor of navigation (P < .001). In addition, significant differences were also found in the number of screws per case (- 0.547, 95 %CI -0.890 to -0.203, P = .002) and in the proportion of cases fixed with two screws (Odds Ratio 3.182 95 %CI 1.057 to 9.579, P = .040) in favor of the navigation group. Conclusions Intraoperative navigation improves the baseplate screw placement, allowing for a greater screw purchase length and fewer screws to achieve primary fixation of the glenoid component during reverse shoulder arthroplasty. It is unclear whether these improvements will increase the longevity of the prosthesis or the clinical outcomes of the patients.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Clinica Universidad de Los Andes, Santiago, Chile
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- St Mary's General Hospital, Department of Graduate Medical Education, Internal Medicine Residence Program, Passaic, NJ, USA
- Department of Basic Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
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Blaber O, Hadley CJ, Gutman MJ, Bishop ME, Namdari S, Romeo AA, Erickson BJ. Prior Acromioplasty Provides Similar Outcomes and Rate of Postoperative Complications Including Acromial Fracture After Reverse Total Shoulder Arthroplasty: A Retrospective Matched-Cohort Analysis. Arthrosc Sports Med Rehabil 2022; 5:e263-e266. [PMID: 36866289 PMCID: PMC9972002 DOI: 10.1016/j.asmr.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/20/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose To compare outcomes of reverse total shoulder arthroplasty (RTSA) in patients with prior arthroscopic acromioplasty versus a control group of patients with no history of acromioplasty. Methods We performed a retrospective matched-cohort study of patients from a single institution who underwent RTSA with a history of acromioplasty from 2009 to 2017 with a minimum 2-year follow-up period. Patients' clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons shoulder score and Simple Shoulder Test, visual analog scale, and Single Assessment Numeric Evaluation surveys. Postoperative radiographs and patient charts were reviewed to determine whether patients sustained a postoperative acromial fracture. Charts were reviewed to determine range of motion and postoperative complications. Patients were matched on a 1:1 basis to a cohort of patients who underwent RTSA without a history of acromioplasty, and comparisons were performed using t and χ2 tests. Results Forty-five patients who underwent RTSA with a history of acromioplasty met the inclusion criteria and completed the outcome surveys. There were no significant differences between cases and controls in post-RTSA American Shoulder and Elbow Surgeons, visual analog scale, Simple Shoulder Test, or Single Assessment Numeric Evaluation outcome scores. There was no difference in the postoperative acromial fracture rate between cases and controls (P = .577). Overall, more complications occurred in the study group (n = 6, 13.3%) compared with the control group (n = 4, 8.9%); however, this difference was not statistically significant (P = .737). Conclusions After RTSA, patients who have undergone a prior acromioplasty have similar functional outcomes without a significant difference in the rate of postoperative complications compared with patients with no history of acromioplasty. Furthermore, previous acromioplasty does not increase the risk of acromial fracture after RTSA. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Olivia Blaber
- Sidney Kimmel Medical College, Thomas Jefferson, University, Philadelphia, Pennsylvania, U.S.A
| | | | - Michael J. Gutman
- Sidney Kimmel Medical College, Thomas Jefferson, University, Philadelphia, Pennsylvania, U.S.A
| | - Meghan E. Bishop
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Surena Namdari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Anthony A. Romeo
- Shoulder, Elbow, Sports Surgery Dupage Medical Group, Downers Grove, Illinois, U.S.A
| | - Brandon J. Erickson
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.,Address correspondence to Brandon J. Erickson, M.D., Rothman Orthopaedic Institute, 176 Third Ave, New York, NY 10003, U.S.A.
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The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population. J Clin Med 2022; 11:jcm11195832. [PMID: 36233699 PMCID: PMC9570675 DOI: 10.3390/jcm11195832] [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: 09/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Proximal humerus fracture (PHF) is a common injury in the older population. While the majority of these fractures are treated non-operatively, a small subset of patients may benefit from surgical treatment. However, there continues to be an ongoing debate regarding the indications and ideal surgical treatment strategy. The use of reverse total shoulder arthroplasty (RTSA) has resulted in a paradigm shift in the treatment of PHFs in the older population. Unique biomechanical principles and design features of RTSA make it a suitable treatment option for PHFs in the older population. RTSA has distinct advantages over hemiarthroplasty and internal fixation and provides good pain relief and a reliable and reproducible improvement in functional outcomes. As a result, there has been an exponential increase in the volume of RTSA in the older population in last decade. The aim of this paper is to review the current concepts, outcomes and controversies regarding the use of RTSA for the treatment of PHFs in the older population.
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Nourissat G, Corsia S, Muller JH, Saffarini M, Lenoble E. Mid- to long-term clinical outcomes after press-fit short stem reverse shoulder arthroplasty. JSES Int 2022; 6:896-902. [DOI: 10.1016/j.jseint.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ng JPH, Tham SYY, Kolla S, Kwan YH, Tan JCH, Teo TWW, Wee ATH, Toon DH. Short-term comparative outcomes between reverse shoulder arthroplasty for shoulder trauma and shoulder arthritis: a Southeast Asian experience. Clin Shoulder Elb 2022; 25:210-216. [PMID: 35971606 PMCID: PMC9471824 DOI: 10.5397/cise.2022.00822] [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: 02/03/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Reverse shoulder arthroplasty (RSA), first introduced as a management option for cuff tear arthropathy, is now an accepted treatment for complex proximal humeral fractures. Few studies have identified whether the outcomes of RSA for shoulder trauma are comparable to those of RSA for shoulder arthritis. Methods This is a retrospective, single-institution cohort study of all patients who underwent RSA at our institution between January 2013 and December 2019. In total, 49 patients met the inclusion criteria. As outcomes, we evaluated the 1-year American Shoulder and Elbow Surgeons (ASES) and Constant shoulder scores, postoperative shoulder range of motion, intra- and postoperative complications, and cumulative revision rate. The patients were grouped based on preoperative diagnosis to compare postoperative outcomes across two broad groups. Results The median follow-up period was 32.8 months (interquartile range, 12.6–66.6 months). The 1-year visual analog scale, range of motion, and Constant and ASES functional scores were comparable between RSAs performed to treat shoulder trauma and that performed for arthritis. The overall complication rate was 20.4%, with patients with a preoperative diagnosis of arthritis having significantly more complications than those with a preoperative diagnosis of trauma (34.8% vs. 7.7%). Conclusions Patients who underwent RSA due to a proximal humeral fracture or dislocation did not fare worse than those who underwent RSA for arthritis at 1 year, in terms of both functional and radiological outcomes.
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Olson JJ, Galetta MD, Keller RE, Oh LS, O'Donnell EA. Systematic review of prevalence, risk factors, and management of instability following reverse shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:261-268. [PMID: 37588866 PMCID: PMC10426617 DOI: 10.1016/j.xrrt.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability following RSA. Methods A systematic review of the PubMed, EMBASE, MEDLINE, Scopus, and Cochrane Library databases was performed according to PRISMA guidelines. Inclusion criteria included primary RSA cohorts ≥ 100 patients, revision RSA cohorts of any size, and minimum 1-year follow-up. The primary outcome of interest was postoperative instability. MINORS criteria were used to assess study bias. Descriptive statistical analysis was performed with data reported as ranges. Results Seventeen studies that included 7885 cases of RSA were reviewed. The mean follow-up ranged from 12 to 84 months. Mean age ranged from 64 to 77 years old, and males represented 19 to 39% of cohorts. There were 204 (2.5%) dislocations in 7885 cases, accounting for a rate of instability from 0.4 to 49% across all studies. By intervention, instability rates ranged from 1 to 5% (primary RSA cases), 1 to 49% (revision RSA cases only), and 0.4 to 10% (mixed cohorts). Subscapularis insufficiency and proximal humerus fractures, and fracture sequelae (malunion and nonunion) were identified as risk factors for instability. Closed reduction and casting and revision RSA were reported as successful treatment strategies with acceptable rates of stable prostheses (28-100% and 55-100%, respectively, across studies). Hemiarthroplasty or resection arthroplasty due to recurrent instability was not uncommon after 2 or more episodes of instability. Conclusion Instability following RSA occurs infrequently (1-5%) following primary RSA and more commonly following revision RSA (1-49%). RSA for acute proximal humerus fracture and fracture sequelae carries a higher risk of instability. Subscapularis repair appears to be a protective factor. While instability may be successfully treated with closed management or revision RSA, recurrent instability may ultimately require hemiarthroplasty or resection arthroplasty.
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Affiliation(s)
- Jeffrey J. Olson
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Michael D. Galetta
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Rachel E. Keller
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Luke S. Oh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Evan A. O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
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Imiolczyk JP, Brunner U, Imiolczyk T, Freislederer F, Endell D, Scheibel M. Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11102835. [PMID: 35628961 PMCID: PMC9145800 DOI: 10.3390/jcm11102835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
Head-split fractures are proximal humerus fractures (PHF) that result from fracture lines traversing the articular surface. While head-split fractures are rare, surgical treatment of these complex injuries can be extremely challenging and is associated with high rates of complications. Treatment using primary reverse shoulder arthroplasty (RSA) has been associated with moderate complication rates and reproducible clinical results. The aim of this study was to evaluate clinical and radiographic outcomes, and complication rates of RSA for head-split PHF. Twenty-six patients were evaluated based on Constant Score (CS) and range of motion of both shoulders and Subjective Shoulder Value (SSV). Radiographic analysis evaluated tuberosity healing, prosthetic loosening and scapular notching. Patients achieved good clinical results with a CS of 73.7 points and SSV of 82% after a mean follow-up of 50 months. The relative CS comparing operated versus the unaffected shoulder was 92%. Greater tuberosity healing was achieved in 61%. Patients who suffered a high-energy trauma reached a significantly greater functional outcome. Patients who suffered multifragmentation to the humeral head performed the worst. There were no cases of loosening; scapular notching was visible in two cases. The complication rate was 8%. RSA is an adequate treatment option with for head-split PHF in elderly patients.
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Affiliation(s)
- Jan-Philipp Imiolczyk
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, 13353 Berlin, Germany
- Correspondence: (J.-P.I.); (M.S.)
| | - Ulrich Brunner
- Department of Trauma and Orthopedic Surgery, Krankenhaus Agatharied, 83734 Hausham, Germany;
| | - Tankred Imiolczyk
- Department of Mathematics, University of Mannheim, 68131 Mannheim, Germany;
| | - Florian Freislederer
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland; (F.F.); (D.E.)
| | - David Endell
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland; (F.F.); (D.E.)
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, 13353 Berlin, Germany
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland; (F.F.); (D.E.)
- Correspondence: (J.-P.I.); (M.S.)
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Tashiro E, Takeuchi N, Kozono N, Nabeshima A, Teshima E, Nakashima Y. Risk of penetration of the baseplate peg in reverse total shoulder arthroplasty for an Asian population. INTERNATIONAL ORTHOPAEDICS 2022; 46:1063-1071. [PMID: 35119492 DOI: 10.1007/s00264-022-05328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Baseplate positioning may affect clinical outcome after reverse total shoulder arthroplasty (RTSA). The aim of this study was to evaluate the risk of penetration of the baseplate peg in RTSA. METHODS Forty-four patients with rotator cuff arthropathy or massive rotator cuff tears were included. Using their computed tomography data, ten insertion patterns of the baseplate pegs were simulated. First, in the axial plane, the baseplate was placed perpendicular to the Friedman axis (Friedman placement) and parallel to the glenoid surface (glenoid placement). Second, each of these placements were classified into the following groups: The baseplate peg was placed 2 mm anterior to the long axis of the glenoid (group A2), 1 mm anterior (group A1), on the long axis (group C0), 1 mm posterior (group P1), and 2 mm posterior (group P2). Cases in which the baseplate peg was within the scapular neck were defined as non-penetration, and the non-penetration rates among each group were evaluated and compared between sexes, and their relationship with patient height was evaluated. RESULTS In both the Friedman and glenoid placements, the non-penetration rate was significantly higher in groups A2 (68.2% and 70.5%) and A1 (65.9% and 65.9%) compared with groups P1 (18.2% and 29.5%) and P2 (9.1% and 13.6%; p < 0.001) and in males than in females (p < 0.05). Furthermore, the non-penetration rate tended to be higher as the patient's height increased. CONCLUSIONS It is recommended that the baseplate peg be placed anterior to the long axis of the glenoid.
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Affiliation(s)
- Eiji Tashiro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Naohide Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Naoya Kozono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Ei Teshima
- Department of Orthopaedic Surgery, Saiseikai Yahata General Hospital, Kitakyushu, 805-0050, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
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Shah NS, Foote AM, Steele CA, Woods OA, Schumaier AP, Sabbagh RS, Schramm VT, Grawe BM. Does preoperative disease severity influence outcomes in reverse shoulder arthroplasty for cuff tear arthropathy? J Shoulder Elbow Surg 2021; 30:2745-2752. [PMID: 34015436 DOI: 10.1016/j.jse.2021.04.035] [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: 01/17/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The degree of symptomatic disease and functional burden has been demonstrated to influence patient results and satisfaction in total hip and knee arthroplasty. Although the relationship between preoperative diagnosis and patient outcomes has been an area of study for reverse total shoulder arthroplasty (RTSA), the influence of the progression of cuff tear arthropathy (CTA) has not yet been examined. The purpose of this study was to evaluate whether preoperative radiographic disease burden and scapular geometry impact patient outcomes and satisfaction in a cohort of patients with CTA treated with RTSA. METHODS Eighty-six patients were treated for CTA with RTSA performed by the senior author (B.G.) between September 2016 and September 2018 and were enrolled in an institutional registry. At the time of initial evaluation, the baseline American Shoulder and Elbow Surgeons (ASES) score, patient demographic characteristics, history of shoulder surgery, and presence of pseudoparalysis were collected. Radiographs were obtained to evaluate the critical shoulder angle, acromial index, and progression of CTA as assessed by Hamada grading and the Seebauer classification. Patients were contacted to reassess the ASES score and their satisfaction with the improvement in their shoulder function. RESULTS A total of 79 patients (91.6%) were available for evaluation at a minimum of 24 months of follow-up. Multivariate logistic regression modeling revealed that scapular geometry measurements (critical shoulder angle and acromial index) and the degree of CTA (Seebauer and Hamada classifications) were not associated with worse outcomes as assessed by the ASES score. However, degenerative changes as assessed by the Hamada grade (odds ratio, 0.13 [95% confidence interval, 0.02-0.86]; P = .03) and preoperative ASES score (odds ratio, 1.04 [95% confidence interval, 1.01-1.07]; P = .008) were independently associated with higher satisfaction at 24 months of follow-up. CONCLUSION The results indicate that patients with greater CTA disease progression did not show differing outcomes after RTSA compared with patients with milder disease. In contrast, both poorer preoperative function and degenerative changes as assessed by the Hamada classification were associated with greater satisfaction after RTSA for CTA. Given the broad spectrum of disease in CTA, there is likely a corresponding range in patient expectations that requires further study to maximize patient satisfaction.
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Affiliation(s)
- Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Austin M Foote
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Chase A Steele
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Olivia A Woods
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adam P Schumaier
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Ramsey S Sabbagh
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Violet T Schramm
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Neyton L, Nigues A, Van Rooij F, Zhang S, Collin P. Clinical and radiographic outcomes of reverse shoulder arthroplasty using a hybrid baseplate fixation mechanism. JSES Int 2021; 5:1049-1054. [PMID: 34766083 PMCID: PMC8569011 DOI: 10.1016/j.jseint.2021.07.006] [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] [Indexed: 12/04/2022] Open
Abstract
Background Despite the success of reverse shoulder arthroplasty (RSA), complication rates remain high (13% to 25%), due to instability, infection, and glenoid component loosening, which can lead to revision. The aim of the present study was to report the early clinical outcomes of RSA using a new hybrid baseplate design, in comparison with the literature on other common RSA baseplates. Methods The authors retrospectively analyzed the records of 142 patients (142 shoulders) who underwent primary RSA using a hybrid baseplate design by the senior surgeons between May 2014 and December 2018. Preoperative and postoperative assessments included the Constant score (CS) and range of motion, including active forward elevation, external rotation, and internal rotation. Results Of the initial cohort of 142 patients, 13 were lost to follow-up (8.6%), 2 died (1.3%), and 8 required reoperations with implant removal (5.3%). The remaining 119 patients comprised 71 women (60%) and 48 men (40%), aged 73.6 ± 7.3 years at index surgery, 43 of whom required bony increased offset (36%). At a minimum follow-up of 2 years, the CS improved by 37.3 ± 16.1, active forward elevation increased by 51.2° ± 38.1°, external rotation increased by 16.4° ± 25.0°, and internal rotation increased by 1.5 ± 3.2. Conclusion At a minimum follow-up of 2 years after RSA using a new hybrid baseplate system, the CS and range of motion were satisfactory and comparable to those in recent systematic reviews. The findings of this study suggest that this hybrid baseplate system provides satisfactory outcomes in the short term, although longer follow-up studies are needed to validate its long-term efficacy.
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Affiliation(s)
- Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Memoz, Centre Orthopédique Santy, Lyon, France
| | - Ana Nigues
- Ramsay Santé, Hôpital Privé Jean Memoz, Centre Orthopédique Santy, Lyon, France
| | | | - Sheng Zhang
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Burrus MT, Denard PJ, Lederman E, Gobezie R, Werner BC. Reverse total shoulder arthroplasty for patients with preserved active elevation and moderate-to-severe pain: a matched cohort study. JSES Int 2021; 6:1-6. [PMID: 35141668 PMCID: PMC8811383 DOI: 10.1016/j.jseint.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Patients undergoing reverse total shoulder arthroplasty (RTSA) predictably report reduced pain and improved function postoperatively. However, it is not known if patients with differing preoperative active motion achieve the same benefit after surgery. The purpose of the present study is to evaluate patient-reported outcomes (PROs), range of motion (ROM), and satisfaction after RTSA in patients with moderate-to-severe pain with preserved active preoperative ROM compared with matched controls with restricted preoperative active ROM. Methods A multicenter shoulder arthroplasty registry was utilized to identify patients with at least two-year clinical follow-up after RTSA with a 135° implant. The study cohort with preserved motion included patients with greater than one standard deviation above the overall mean for preoperative forward elevation (FE) (140°) as well as a preoperative visual analog pain scale (VAS) ≥ 5.0. The control cohort with more restricted motion had preoperative FE of less than 140° and also with preoperative VAS ≥5.0. The control patients were matched 2:1 to study patients by age (±2 years), sex, and preoperative VAS (±1.5). Outcomes measured were as follows: PROs, ROM, strength, and strength and satisfaction. Results Twenty-seven patients were identified that comprised the preserved preoperative FE study cohort; 54 patients were included in the restricted elevation cohort as controls. The groups were similar at baseline for demographics, surgical diagnoses, and most PROs, other than the Constant-Murley, which was higher in the preserved motion cohort. At two years postoperatively, both cohorts demonstrated similar PROs, strength, and ROM (other than internal rotation with the arm abducted 90 degrees) and had a similar number of patients who rated the RTSA as meeting or exceeding their expectations. The change in ROM from preoperatively was significantly different with the restricted cohort, achieving a larger increase in forward flexion (51 ± 26° vs. −13 ± 35°, P < .001). Conclusion Patients indicated for RTSA with preserved preoperative FE and moderate pain achieve similar final ROM, pain reduction, increases, and strength compared with patients who undergo RTSA with restricted preoperative FE. Despite losing on average 13 degrees of FE from preoperatively by two years postoperatively, patients with preserved preoperative FE are comparably satisfied with their outcome.
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Affiliation(s)
| | | | | | | | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
- Corresponding author: Brian C. Werner, MD, University of Virginia, 400 Ray C. Hunt Drive, Ste 330 Charlottesville, VA 22903, USA.
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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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