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McDonald M, Timoteo TM, Schoch N. Contralateral preoperative templating for fracture reverse total shoulder arthroplasty: technique article and case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:362-369. [PMID: 37588500 PMCID: PMC10426702 DOI: 10.1016/j.xrrt.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Michael McDonald
- Grady Health System, Department of Orthopedic Surgery, Atlanta, GA, USA
| | - Taylor M. Timoteo
- Henry Ford Macomb, Department of Orthopedic Surgery, Clinton Township, MI, USA
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Han PF, Yang S, Wang YP, Hou XD, Li Y, Li XY. Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update. Exp Ther Med 2022; 24:637. [PMID: 36160890 PMCID: PMC9468857 DOI: 10.3892/etm.2022.11574] [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: 03/30/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022] Open
Abstract
The present meta-analysis was conducted to compare the safety and effectiveness of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in the treatment of osteoporotic proximal humeral fractures in elderly patients. The Embase, Pubmed Central, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical databases were searched between January 2009 and January 2022 to identify relevant studies. According to the search strategy, a total of 210 associated studies were retrieved and 16 were finally included. Review Manager 5.4 software was used for the data analysis. This study indicated that patients in the RSA group had significantly improved treatment outcomes compared with patients in the HA group, as assessed by Constant-Murley Shoulder Outcome Score (95% CI, 1.69-3.76; P<0.001), American Shoulder and Elbow Surgeons score (95% CI, 11.81-24.88; P<0.001) and shoulder range of motion (ROM; 95% CI, 3.41-9.07; P<0.001). However, the HA group was superior to the RSA group in terms of the Oxford Shoulder score (95% CI, 2.89-11.11; P<0.001). There was no significant statistical difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand score and complications. Overall, for the treatment of osteoporotic proximal humeral fractures in the elderly, the RSA group had improved postoperative ROM and functional scores compared with the HA group, without significant difference in the incidence of complications. However, HA remains a safe and reliable treatment option.
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Affiliation(s)
- Peng-Fei Han
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yue-Peng Wang
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Xue-Dong Hou
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yuan Li
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Xi-Yong Li
- Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Kennedy JS, Reinke EK, Friedman LGM, Cook C, Forsythe B, Gillespie R, Hatzidakis A, Jawa A, Johnston P, Nagda S, Nicholson G, Sears B, Wiesel B, Garrigues GE, Hagen C, Hong I, Roach M, Jones N, Mahendraraj K, Michaelson E, Bader J, Mauter L, Mengers S, Renko N, Strony J, Hart P, Steele E, Naylor A, Gaudette J, Sprengel K. Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. Arch Physiother 2021; 11:28. [PMID: 34886910 PMCID: PMC8662891 DOI: 10.1186/s40945-021-00121-2] [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: 02/10/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups. Methods This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over. Discussion RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy. Trial registration This study is registered as NCT03719859 at ClincialTrials.gov. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-021-00121-2.
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Affiliation(s)
- June S Kennedy
- Department of Physical and Occupational Therapy, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Lisa G M Friedman
- Department of Orthopedics, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA.,Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC, 27701, USA.,Duke Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Robert Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland, 11000 Euclid Ave, Cleveland, OH, 44106, United States
| | | | - Andrew Jawa
- Boston Sports and Shoulder Center, 40 Allied Dr., Suite 102, Dedham, MA, 02026, USA
| | - Peter Johnston
- Centers for Advanced Orthopaedics, 25500 Point Lookout Road, Leonardtown, MD, 20650, USA
| | - Sameer Nagda
- Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA, 22206, USA
| | - Gregory Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Benjamin Sears
- Western Orthopaedics, 1830 Franklin St, 450, Denver, CO, 80218, USA
| | - Brent Wiesel
- MedStar Orthopaedic Institute, 3800 Reservoir Road Northwest, Washington, DC, 20007, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
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Jo O, Borbas P, Grubhofer F, Ek ET, Pullen C, Treseder T, Ernstbrunner L. Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures. J Clin Med 2021; 10:4146. [PMID: 34575254 PMCID: PMC8468418 DOI: 10.3390/jcm10184146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/04/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.
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Affiliation(s)
- Olivia Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
| | - Christopher Pullen
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Thomas Treseder
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
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Nelson PA, Kwan CC, Tjong VK, Terry MA, Sheth U. Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis. J Shoulder Elb Arthroplast 2020; 4:2471549220949731. [PMID: 34497963 PMCID: PMC8282171 DOI: 10.1177/2471549220949731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure. METHODS A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan. RESULTS Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA. CONCLUSIONS Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.
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Affiliation(s)
- Patrick A Nelson
- Department of Orthopaedic Surgery, Northwestern University,
Chicago, Illinois
| | - Changyow C Kwan
- Department of Orthopaedic Surgery, Northwestern University,
Chicago, Illinois
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern University,
Chicago, Illinois
| | - Michael A Terry
- Department of Orthopaedic Surgery, Northwestern University,
Chicago, Illinois
| | - Ujash Sheth
- Department of Orthopaedic Surgery, Northwestern University,
Chicago, Illinois
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine trends, outcomes, and principles in treatment of proximal humerus fractures in the elderly with a critical focus on reverse shoulder arthroplasty as a developing treatment option. RECENT FINDINGS Recent literature shows an increase in reverse shoulder arthroplasty and a decrease in hemiarthroplasty performed for proximal humerus fractures. More predictable outcomes and lower revision rates are seen in older individuals treated primarily or secondarily with reverse shoulder arthroplasty compared to those treated with hemiarthroplasty. We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old).
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Affiliation(s)
- Brandon J Kelly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Chad M Myeroff
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA. .,Regions Hospital, Saint Paul, Minnesota, 640 Jackson St, MS 11503L, Saint Paul, MN, 55101, USA. .,TRIA Orthopaedic Center, Woodbury, MN, USA.
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Lapner PL, Rollins MD, Tuna MG, Netting C, Bader Eddeen A, van Walraven C. A Point-Based Model to Predict Absolute Risk of Revision in Anatomic Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2019; 3:2471549219883446. [PMID: 34497957 PMCID: PMC8282172 DOI: 10.1177/2471549219883446] [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: 04/22/2019] [Revised: 08/31/2019] [Accepted: 09/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background Total shoulder arthroplasty (TSA) has demonstrated good long-term
survivorship but early implant failure can occur. This study identified
factors associated with shoulder arthroplasty revision and constructed a
risk score for revision surgery following shoulder arthroplasty. Methods A validated algorithm was used to identify all patients who underwent
anatomic TSA between 2002 and 2012 using population-based data. Demographic
variables included shoulder implant type, age and sex, Charlson comorbidity
score, income quintile, diagnosis, and surgeon arthroplasty volume. The
associations of covariates with time to revision were measured while
treating death as a competing risk and were expressed in the Shoulder
Arthroplasty Revision Risk Score (SARRS). Results During the study period, 4079 patients underwent TSA. Revision risk decreased
in a nonlinear fashion as patients aged and in the absence of osteoarthritis
with no influence from surgery type or other covariables. The SARRS ranged
from −21 points (5-year revision risk 0.75%) to 30 points (risk 11.4%).
Score discrimination was relatively weak 0.55 (95% confidence interval:
0.530.61) but calibration was very good with a test statistic of 5.77
(df = 8, P = .762). Discussion The SARRS model accurately predicted the 5-year revision risk in patients
undergoing TSA. Validation studies are required before this score can be
used clinically to predict revision risk. Further study is needed to
determine if the addition of detailed clinical data including functional
outcome measures and the severity of glenohumeral arthrosis increases the
model’s discrimination.
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Affiliation(s)
- Peter Lc Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Meaghan D Rollins
- The Shoulder Center, Lakeridge Health Ajax and Pickering, Ajax, Ontario, Canada
| | - Meltem G Tuna
- Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Caleb Netting
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carl van Walraven
- The Shoulder Center, Lakeridge Health Ajax and Pickering, Ajax, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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8
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Rotman D, Giladi O, Senderey AB, Dallich A, Dolkart O, Kadar A, Maman E, Chechik O. Mortality After Complex Displaced Proximal Humerus Fractures in Elderly Patients: Conservative Versus Operative Treatment With Reverse Total Shoulder Arthroplasty. Geriatr Orthop Surg Rehabil 2018; 9:2151459318795241. [PMID: 30214828 PMCID: PMC6134485 DOI: 10.1177/2151459318795241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/08/2018] [Accepted: 07/21/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Proximal humerus fractures (PHFs) are a common fragility fracture and have been shown to increase mortality in elderly patients. In the last decade, reverse total shoulder arthroplasty (RTSA) was introduced as a reliable operative treatment option for this indication. In other fragility fractures, most notably hip fractures, urgent surgical treatment can reduce mortality. The purpose of this study is to evaluate whether treatment with RTSA can reduce 1-year mortality in elderly patients with complex displaced PHFs. Materials and Methods A retrospective study was performed to compare 1-year mortality between 2 groups of elderly patients (>75 years old) who presented to a level 1 trauma center emergency department with complex displaced PHFs. The conservative treatment group (n = 83; mean age, 83.7 years) presented from 2008 to 2010 when RTSA was not yet available, and treatment was nonoperative. The surgical treatment group (n = 62; mean age, 82.2 years) presented from 2012 to 2015 and underwent RTSA. Results One-year mortality was 8.1% (male 7.1%; female 8.3%) in the surgical treatment group and 10.8% (male 18.8%; female 9.0%) in the conservative treatment group. The reduction in mortality in the surgical treatment group was not significant (entire cohort P = .56; males P = .35; females P = .59). Discussion Recent studies failed to show better functional results after surgical treatment with RTSA when compared to conservative treatment. This study suggests that a benefit of surgical treatment with RTSA that was not examined until now might exist-a reduction in the increased mortality risk associated with PHFs. Conclusions There was no significant difference in 1-year mortality between the groups, although there was a trend showing lower mortality with RTSA, mostly in men. Further studies with larger populations and longer follow-up times are needed to determine whether this trend is of clinical significance.
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Affiliation(s)
- Dani Rotman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ornit Giladi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Berliner Senderey
- School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alison Dallich
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Kadar
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jonušas J, Banytė R, Ryliškis S. Clinical and radiological outcomes after reverse shoulder arthroplasty with less medialized endoprosthesis after mean follow-up time of 45 months. Arch Orthop Trauma Surg 2017; 137:1201-1205. [PMID: 28702700 DOI: 10.1007/s00402-017-2751-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate outcomes after reverse shoulder arthroplasty for the treatment of complex three- and four-fragment proximal humeral fractures after mean follow-up time of 45 months and to compare our results with the results published by other authors. MATERIALS AND METHODS Retrospectively we have analyzed 27 consecutive patients after total arthroplasty with less medialized reverse shoulder prosthesis used for the treatment of complex proximal humeral fracture. The median age and standard deviation was 67.5 ± 7.3 years (range 55-85). The average follow-up time was 45 months. Shoulder function was evaluated using Simple Shoulder Test and Constant scale. Patient satisfaction about the treatment was evaluated using Likert-type questionnaire. All patients were investigated radiologically for possible complications using standard lateral and anterior views. RESULTS All patients were satisfied (74%) or highly satisfied (26%). The mean total Constant-Murley score was 57.6 pts. (range 37.4-80.2). Mean total Simple Shoulder Test score was 73.5 pts. (range 49.8-100). There were two cases with heterotopic ossification and one with greater tubercle malposition. We found no signs of scapular notching, implant failure or loosening. CONCLUSIONS Results after reverse arthroplasty for complex proximal humeral fractures yield good clinical, functional, and radiological outcomes after mean follow-up time of 45 months. Results are comparable to other studies published in the recent literature.
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Affiliation(s)
- Justinas Jonušas
- Faculty of Medicine, Vilnius University, M. K. Čiurlonio Str. 21, 03101, Vilnius, Lithuania. .,, Eitminu St. 14-42, 12111, Vilnius, Lithuania.
| | - Rūta Banytė
- Vilnius University Clinic of Rheumatology, Orthopaedic and Reconstructive Surgery, Centre of Orthopaedic and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, 04130, Vilnius, Lithuania
| | - Sigitas Ryliškis
- Vilnius University Clinic of Rheumatology, Orthopaedic and Reconstructive Surgery, Centre of Orthopaedic and Traumatology, Republican Vilnius University Hospital, Šiltnamių Str. 29, 04130, Vilnius, Lithuania
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