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Ponce RB, Wrenn SP, White AE, Healy R, Brusalis CM, Cirino CM, Blaine TA, Taylor SA. Shoulder arthroplasty in the upper extremity weight-bearing patient: a systematic review of clinical outcomes and complications. J Shoulder Elbow Surg 2024:S1058-2746(24)00384-7. [PMID: 38810910 DOI: 10.1016/j.jse.2024.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Patients who rely on their upper extremities for ambulation, or upper extremity ambulators (UEAs), place considerable stress on their shoulders through the use of assistive devices like walkers, crutches, canes, and wheelchairs. It has been postulated that UEAs may be at increased risk for complications following shoulder arthroplasty. This study aimed to systematically review the literature related to (1) patient-reported outcomes measures (PROMs), (2) functional outcomes, and (3) complications in UEAs who undergo shoulder arthroplasty. METHODS A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes of shoulder arthroplasty in UEAs. Patient demographics, clinical characteristics, patient-reported outcomes measures, radiographic outcomes, and postoperative range of motion were collected and compared to control patients (ie bipedal ambulators) from the constituent studies. RESULTS A total of eight studies evaluating 248 UEA cases and 206 control cases were included for review. Ambulatory assistive devices utilized by UEAs included walkers (39%), wheelchairs (38%), canes (22%), and a crutch (<1%). Among UEA cases, 197 (79%) reverse total shoulder arthroplasty (TSA), 37 (15%) anatomic TSA, and 14 (6%) hemiarthroplasty were performed. Overall, patients exhibited significant improvements in mean American Shoulder and Elbow Surgeons scores, Constant-Murley scores, Simple Shoulder Test scores, and Visual Analog Scale scores postoperatively. Among 3 studies that included comparison with control groups of bipedal ambulators, no significant differences in outcomes were identified. The overall clinical complication rate was 17% for UEAs compared to 9.1% for controls. The rate of revision surgery was 7.7% for UEAs and 4.9% for bipedal ambulators. CONCLUSIONS UEAs experience satisfactory pain relief, functional improvements, and good subjective outcomes following shoulder arthroplasty. However, complication and revision rates are higher compared to those for bipedal ambulators, and the majority of UEAs undergo reverse shoulder arthroplasty compared to anatomic TSA.
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Affiliation(s)
- Robert B Ponce
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean P Wrenn
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex E White
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Ryan Healy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | | | - Carl M Cirino
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Theodore A Blaine
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Haratian A, Deadwiler B, Dobitsch A, Bolia IK, Thompson AA, Hasan LK, Okonkwo K, Liu JN, Weber AE, Petrigliano FA, Gamradt SC. Return to sport criteria following upper extremity surgery in athletes-part 4: shoulder arthroplasty procedures: a scoping review. J ISAKOS 2023; 8:364-371. [PMID: 37393032 DOI: 10.1016/j.jisako.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To describe the reported return to sports (RTS) criteria following all types of shoulder arthroplasty procedures in athletes. METHODS This scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) as a guide. A comprehensive search was conducted in four electronic databases (Scopus, Pubmed/MEDLINE, Web of Science, and Google Scholar Advanced Search) in the English Language that reported a minimum of 1 RTS criterion in athletes after shoulder arthroplasty. The data were aggregated and summarized as frequencies, means, and standard deviations. RESULTS Thirteen studies were included, with a total of 942 athletes with a mean age of 68.7 years. The most commonly used RTS criterion was time from surgery (range 3-6 months), reported by 7/13 (54%) of all studies, followed by restrictions on contact sports (36%). Other reported RTS criteria included no lifting/limited lifting (3/13, 23%), physician clearance based on assessment (3/13, 23%), return per patient tolerance (2/13, 15%), and upon return to full range of motion (ROM) and strength in the operated shoulder (1/13, 8%). Three studies (3/13, 23%) allowed for an unrestricted RTSpostoperatively. CONCLUSION Thirteen studies reported one or more RTS criteria following shoulder arthroplasty, with time after surgery being the most common RTS criterion used. These results emphasise the need for interprofessional discussions and communication amongst surgeons, physical therapists, and athletic trainers to establish evidence-based RTS criteria following arthroplasty and promote a safe and effective return to sport.
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Affiliation(s)
- Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Brittney Deadwiler
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Andrew Dobitsch
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Ashley A Thompson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Kamso Okonkwo
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA.
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
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How common is nerve injury after reverse shoulder arthroplasty? A systematic review. J Shoulder Elbow Surg 2023; 32:872-884. [PMID: 36427756 DOI: 10.1016/j.jse.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nerve injury following reverse shoulder arthroplasty (RSA) is a known risk factor with wide ranging incidences reported. This systematic review evaluates the overall incidence of nerve injury following primary and revision RSA and summarizes the characteristics of the nerve injuries reported in the current literature. METHODS A systematic review was performed using separate database searches (Pubmed, Embase, Web of Science, Cochrane) following the PRISMA guidelines. Search criteria included the title terms "reverse shoulder," "reverse total shoulder," "inverted shoulder," and "inverted total shoulder" with publication dates ranging from 01/01/2010 to 01/01/2022. Studies that reported neurological injuries and complications were included and evaluated for primary RSA, revision RSA, number of nerve injuries, and which nerves were affected. RESULTS After exclusion, our systematic review consisted of 188 articles. A total of 40,146 patients were included, with 65% female. The weighted mean age was 70.3 years. The weighted mean follow-up was 35.4 months. The rate of nerve injury after RSA was 1.3% (510 of 40,146 RSAs). The rate of injury was greater in revision RSA compared to primary RSA (2.4% vs. 1.3%). Nerve injury was most common in RSAs done for a primary diagnosis of acute proximal humerus fracture (4.0%), followed by cuff tear arthropathy (3.0%), DJD (2.6%), and inflammatory arthritis (1.7%). Massive rotator cuff tears and post-traumatic arthritis cases had the lowest nerve injury rates (1.0% and 1.4%, respectively). The axillary nerve was the most commonly reported nerve that was injured in both primary and revision RSA (0.6%), followed by the ulnar nerve (0.26%) and median nerve (0.23%). Brachial plexus injury was reported in 0.19% of overall RSA cases. CONCLUSION Based on current English literature, nerve injuries occur at a rate of 1.3% after primary RSA compared with 2.4% after revision RSA. The most common nerve injury was to the axillary nerve (0.64%), with the most common operative diagnosis associated with nerve injury after RSA being acute proximal humerus fracture (4.0%). Surgeons should carefully counsel patients prior to surgery regarding the risk of nerve injury.
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Sano T, Adler JR. Chronic Shoulder Dislocation on the Unaffected Side of a Patient With Hemiparesis. Cureus 2023; 15:e34358. [PMID: 36874756 PMCID: PMC9975288 DOI: 10.7759/cureus.34358] [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: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Chronic shoulder dislocation has been noted to be difficult to cure due to concomitant injuries of the soft tissue, articular cartilage, and bone. The present study reports a rare case of a patient with hemiparesis suffering chronic shoulder dislocation on the unaffected side. The patient was a 68-year-old female. She developed left hemiparesis due to cerebral bleeding at 36 years of age. Her right shoulder was dislocated for three months. A computed tomography scan and magnetic resonance imaging (MRI) showed a significant anterior glenoid defect, and the subscapularis, supraspinatus, and infraspinatus were atrophic. An open reduction with transfer of the coracoid, Latarjet's method was performed. The rotator cuffs were simultaneously repaired using McLaughlin's method. The glenohumeral joint was temporarily fixed with Kirschner wires for three weeks. There was no redislocation during the 50-month follow-up period. Even though radiographs noted progression of osteoarthritis in the glenohumeral joint, the patient reacquired shoulder function for ativities of daily living including weight-bearing ability.
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Affiliation(s)
- Tomohiko Sano
- Department of Orthopaedics, Owase General Hospital, Owase, JPN
| | - John R Adler
- Department of Orthopaedics, Owase General Hospital, Owase, JPN
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Skedros JG, Cronin JT, Finlinson ED, Langston TD, Adondakis MG. Manual wheelchair use leads to a series of failed shoulder replacements: A case report and literature review. Clin Case Rep 2022; 10:e06374. [PMID: 36188047 PMCID: PMC9508804 DOI: 10.1002/ccr3.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
Manual wheelchair users place high stress on their shoulders. We describe a 69-year-old male who developed end-stage shoulder osteoarthritis from chronic manual wheelchair (MW) use. Three prosthetic total shoulder replacements failed, reflecting his refusal to transition to an electric wheelchair. MW use must be avoided in some of these patients.
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Affiliation(s)
- John G. Skedros
- Department of Orthopaedic SurgeryThe University of UtahSalt Lake CityUtahUSA
- Utah Orthopaedic SpecialistsSalt Lake CityUtahUSA
- Intermountain Medical CenterSalt Lake CityUtahUSA
| | | | | | - Tanner D. Langston
- Department of RadiologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Micheal G. Adondakis
- Department of RadiologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Abstract
Two percent of the general population are wheelchair-dependent. The shoulder takes on the weight-bearing locomotor function, and tends with age to develop degenerative pathologies, notably in the rotator cuff. The association between weight-bearing shoulder and rotator cuff tear raises several questions: what are the mechanisms by which wheelchair propulsion and transfer overload the shoulder, and what specificities do the lesions display? They occur in younger patients than in the rest of the population, after about 15 years' fairly constant wheelchair use. As well as the classical supraspinatus damage, an anterior cuff extension is the most frequent case. Is there a particular clinical presentation of cuff tear in this population? As the shoulder cannot be functionally protected, pain is constant and asymptomatic cuff tear is rare. Any pain after 12 years' wheelchair use requires morphologic exploration. How does treatment strategy differ for the weight-bearing shoulder? More than the classic quest for compensation, in the weight-bearing shoulder, the rotator cuff should be protected against any local aggression by systematic surgical recalibration of the subacromial space, and all lesions should be repaired, to avoid extension. Are functional results to be expected to be poorer in this population? On condition that the suture is protected by postponing any transfer beyond 4 months and that the shoulder is protected on a daily basis, analytic results and healing rates are comparable to those in the general population. However, general complications and skin complications are more frequent and require postoperative care in a specialized center.
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Gasbarro G, Galvin JW, Prete A, Barghi A, Obeidallah A, Warner JJP. Shoulder arthroplasty in dwarfism: A case report of pseudoachondroplasia with 17-year follow-up. Orthop Rev (Pavia) 2021; 13:8605. [PMID: 33936571 PMCID: PMC8082169 DOI: 10.4081/or.2021.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/20/2020] [Indexed: 11/23/2022] Open
Abstract
The purpose of this case report is to report the long-term outcome following shoulder hemiarthroplasty in a patient with dwarfism. A 60-year old female with pseudoachondroplasia dwarfism presented 17 years post-operative with a Subjective Shoulder Value of 90% and minimal pain. Custom designed implants were critical for surgical success. Preoperative planning with a CT scan was important in assessing glenoid dysplasia and determining the feasibility of glenoid resurfacing. The emergence of 3D CT virtual preoperative planning tools can further assist in the recognition of deformity to determine if custom designed implants are needed. Shoulder arthroplasty in dwarfism can lead to excellent long-term outcomes.
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Affiliation(s)
- Gregory Gasbarro
- Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph W Galvin
- Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Prete
- Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
| | - Ameen Barghi
- Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
| | - Aisha Obeidallah
- Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jon J P Warner
- Shoulder Service, Massachusetts General Hospital, Boston, MA, USA
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Kirsch JM, Namdari S. Rehabilitation After Anatomic and Reverse Total Shoulder Arthroplasty: A Critical Analysis Review. JBJS Rev 2020; 8:e0129. [PMID: 32224631 DOI: 10.2106/jbjs.rvw.19.00129] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Postoperative rehabilitation is believed to be essential in optimizing clinical outcome and function following shoulder arthroplasty. Despite this long-held notion, there is a paucity of high-quality evidence to guide rehabilitation protocols and practice. For patients undergoing anatomic total shoulder arthroplasty (ATSA), there are insufficient comparative data regarding type or duration of sling utilization. Based on current evidence, there is no appreciable benefit to early motion compared with a delayed-motion protocol following ATSA. There is insufficient literature to support the use of formal physical therapy over a physician-directed program following ATSA. At the present time, no high-quality evidence exists to guide the postoperative rehabilitation of patients undergoing reverse total shoulder arthroplasty (RTSA). Prospective randomized controlled trials evaluating postoperative management and rehabilitation following ATSA and RTSA are needed to guide best practices and optimize clinical outcomes.
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Affiliation(s)
- Jacob M Kirsch
- Departments of Orthopaedic Surgery and Shoulder and Elbow Surgery, The Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- Departments of Orthopaedic Surgery and Shoulder and Elbow Surgery, The Rothman Institute-Thomas Jefferson University, Philadelphia, Pennsylvania
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Marigi EM, Statz JM, Sperling JW, Sanchez-Sotelo J, Cofield RH, Morrey ME. Shoulder arthroplasty in patients with cerebral palsy: a matched cohort study to patients with osteoarthritis. J Shoulder Elbow Surg 2020; 29:483-490. [PMID: 31563508 DOI: 10.1016/j.jse.2019.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cerebral palsy (CP) often experience shoulder impairment via spasticity, muscle contractures, and joint instability. Currently, few studies investigate shoulder arthroplasty (SA) in patients with CP. This study reviewed the outcomes of both anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) in patients with CP. METHODS Over a 30-year-period, 5 patients undergoing SA (2 TSA, 3 RSA) with a diagnosis of CP were identified. The cohort included 4 male patients with a mean age of 50.4 years (range, 44-58 years). CP patients were matched 1:2 based on age, sex, body mass index, and year of surgery with a group of patients undergoing SA for osteoarthritis (OA). RESULTS Survival from implant revision for both TSA and RSA in CP was 100% at both 2 and 5 years postoperatively. Clinical complications were only observed in 2 patients after TSA, with 1 patient requiring revision at 14 years postoperatively. Collectively, there was no difference in the rate of complications and implant survival between patients with CP vs. OA. Prior to the surgical procedure, all CP patients had severe or moderate pain, with no moderate or severe pain postoperatively. Notable postoperative increases from preoperative baselines were noted in forward elevation (57°-106°), abduction (48°-84°), and external rotation (30°-64°). RSA had significantly improved postoperative abduction compared to TSA (97° vs. 64°, P < .01). CONCLUSIONS SA is a safe, durable procedure in patients with CP to clinically improve pain, function, and satisfaction. RSA was associated with better function and fewer complications than TSA.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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MacInnes SJ, Mackie KE, Titchener A, Gibbons R, Wang AW. Activity following reverse total shoulder arthroplasty: What should surgeons be advising? Shoulder Elbow 2019; 11:4-15. [PMID: 31447940 PMCID: PMC6688158 DOI: 10.1177/1758573218793648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) is now the most frequently performed form of shoulder arthroplasty. There is currently no consensus on recommended levels of activity and sport following RTSA. The aim of this review is to outline the current evidence and provide a guide for surgeons on what to advise their patients regarding activity level following RTSA. METHODS A systematic review of the literature was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed using the electronic databases PubMed and Medline. Included studies were of level 1 to 4 evidence in the English language evaluating complications and return to sport after RTSA. RESULTS Eleven studies were selected and included a total of 621 patients (67% female) with a mean age of 73 years (range 22-92). All of the included patients participated in sports prior to RTSA. The rate of return to sport ranged from 60 to 86% and varied with the level of sport activity. Mean time to return to sport after surgery varied greatly between studies. CONCLUSIONS Return to sport is tolerated following RTSA; however, studies are short to medium term only and although the reported complication rate is low, the studies did not include radiographic evaluation. Longer term studies with subgroup analysis evaluating common recreational activities after RTSA are required, particularly in the younger population, in order to establish clear post-operative guidelines.
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Affiliation(s)
| | | | | | | | - Allan W Wang
- Sir Charles Gairdner Hospital, Nedlands,
Australia,Department of Surgery, University of
Western Australia, Nedlands, Australia,Allan W Wang, Department of Orthopaedics,
Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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