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Brindisino F, Lorusso M, Usai M, Pellicciari L, Marruganti S, Salomon M. Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists. Arch Physiother 2023; 13:12. [PMID: 37277886 DOI: 10.1186/s40945-023-00166-5] [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: 07/12/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups. MATERIALS AND METHODS This cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021. RESULTS Six-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension. In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6-12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3-4 weeks and higher than 90° at 6-12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication. CONCLUSIONS The clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Mariangela Lorusso
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | | | | | - Sharon Marruganti
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Mattia Salomon
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
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Weaver JS, Omar IM, Chadwick NS, Shechtel JL, Elifritz JM, Shultz CL, Taljanovic MS. Update on Shoulder Arthroplasties with Emphasis on Imaging. J Clin Med 2023; 12:jcm12082946. [PMID: 37109282 PMCID: PMC10143235 DOI: 10.3390/jcm12082946] [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: 01/20/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Shoulder pain and dysfunction may significantly impact quality of life. If conservative measures fail, advanced disease is frequently treated with shoulder arthroplasty, which is currently the third most common joint replacement surgery following the hip and knee. The main indications for shoulder arthroplasty include primary osteoarthritis, post-traumatic arthritis, inflammatory arthritis, osteonecrosis, proximal humeral fracture sequelae, severely dislocated proximal humeral fractures, and advanced rotator cuff disease. Several types of anatomic arthroplasties are available, such as humeral head resurfacing and hemiarthroplasties, as well as total anatomic arthroplasties. Reverse total shoulder arthroplasties, which reverse the normal ball-and-socket geometry of the shoulder, are also available. Each of these arthroplasty types has specific indications and unique complications in addition to general hardware-related or surgery-related complications. Imaging-including radiography, ultrasonography, computed tomography, magnetic resonance imaging, and, occasionally, nuclear medicine imaging-has a key role in the initial pre-operative evaluation for shoulder arthroplasty, as well as in post-surgical follow-up. This review paper aims to discuss important pre-operative imaging considerations, including rotator cuff evaluation, glenoid morphology, and glenoid version, as well as to review post-operative imaging of the various types of shoulder arthroplasties, to include normal post-operative appearances as well as imaging findings of complications.
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Affiliation(s)
- Jennifer S Weaver
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, 1161 21st Ave. S, MCN CCC-1118, Nashville, TN 37232, USA
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Nicholson S Chadwick
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, 1161 21st Ave. S, MCN CCC-1118, Nashville, TN 37232, USA
| | - Joanna L Shechtel
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, 1161 21st Ave. S, MCN CCC-1118, Nashville, TN 37232, USA
| | - Jamie M Elifritz
- Department of Radiology, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, USA
- Department of Pathology, University of New Mexico, New Mexico Office of the Medical Investigator, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Christopher L Shultz
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Mihra S Taljanovic
- Department of Radiology, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, USA
- Department of Medical Imaging, University of Arizona, 1501 N. Campbell, Tucson, AZ 85724, USA
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Jahic D, Suero EM, Marjanovic B. The Use of Computer Navigation and Patient Specific Instrumentation in Shoulder Arthroplasty: Everyday Practice, Just for Special Cases or Actually Teaching a Surgeon? Acta Inform Med 2021; 29:130-133. [PMID: 34584337 PMCID: PMC8443132 DOI: 10.5455/aim.2021.29.130-133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/27/2021] [Indexed: 01/13/2023] Open
Abstract
Background: The use of computer assisted surgery, navigation (NAV) in shoulder arthroplasty is still under discussion, regarding the clinical outcome and prosthesis longevity, especially when combining these factors with cost, time and surgeon’s experience. Beside the NAV, there has been in use patient-specific instrumentation (PSI) as an additional tool for more precise glenoid implant position. Surgical NAV and PSI for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty are in last years under observation and discussion. Objective: To critically review and evaluate the current literature regarding the use of computer navigation and PSI in shoulder arthroplasty. Methods: Critical review of the existing literature. Results: Cost-effectiveness, prosthesis longevity and revision arthroplasty rate have not yet been proven clinically. Moreover, heterogeneity is high in studies that include different positioning systems (NAV, PSI and standard instrumentation). Heterogeneity is due to differences in surgical technique, implants, surgeon’s expertise, radiographic image analysis technique. Conclusion: The use of navigation systems and PSI should be clinically proven in the shoulder arthroplasty. Independent experts’ opinion and independent high level studies lack at the moment. There will be still a lot of talk regarding this topic in future.
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Affiliation(s)
- Dzenan Jahic
- Orthopaedics and Traumatology Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Eduardo M Suero
- Department of General Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Benjamin Marjanovic
- Department for Arthroscopy and Sports Orthopaedics, Orthopaedic Hospital Valdoltra, Ankaran, Slovenia
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Computer-Assisted Surgery in Reverse Shoulder Arthroplasty: Early Experience. Indian J Orthop 2021; 55:1003-1008. [PMID: 34194658 PMCID: PMC8192603 DOI: 10.1007/s43465-020-00344-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the last decade, new technologies have been applied to shoulder arthroplasty. The aim of this work was to show that navigated RSA allows the surgeon to reach the planned version/inclination in all cases. In this article are shown preliminary data, advantages, disadvantages and limits of the technique. METHODS Eighteen computer-assisted reverse shoulder arthroplasty were performed. Preoperative glenoid version and inclination were evaluated with preoperative CT scan using Orthoblue® (Exactech, Gainesville, FL,USA) software, as well as baseplate type, planned glenoid component seating, planned postoperative version, planned postoperative inclination, intraoperative glenoid version/inclination, screw length and surgical time. A senior shoulder surgeon has analyzed the advantages, disadvantages and limitation of this kind of surgery. RESULTS Mean surgical time of the primary implants was 92 ± 12 min (min 75-max 110). Mean preoperative inclination was + 2.6° ± 6.4, mean preoperative version was - 7.6° ± 8.4. Mean planned postoperative inclination was - 2.7° ± 2.3, mean planned postoperative version was - 1.6° ± 2.9 and mean planned glenoid seating was 89% ± 8%. Planned settings were reached in all cases during surgery. Baseplate implanted were in nine cases 8° posterior augmented, in six cases standard and in three cases 10° superior augmented. Mean screw length was 33.5 mm ± 4.2 mm. No GPS system failure has been recorded. One coracoid fracture occurred during the first case. DISCUSSION Intraoperative navigation system is a reliable and user-friendly technology that allows the surgeon to reach planned glenoid positioning during surgery. Furthermore, this technology will allow the surgeon to compare clinical outcomes to component positioning data. The lack of humeral implant navigation is the main limit of this technique.
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Recent Trends, Technical Concepts and Components of Computer-Assisted Orthopedic Surgery Systems: A Comprehensive Review. SENSORS 2019; 19:s19235199. [PMID: 31783631 PMCID: PMC6929084 DOI: 10.3390/s19235199] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.
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