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Li T, Duey AH, Patel AV, White CA, Levy KH, Ranson WA, Cirino CM, Shukla D, Parsons BO, Flatow EL, Cagle PJ. Cemented vs. press-fit humeral stems: a matched cohort analysis at a mean follow-up of 10 years. J Shoulder Elbow Surg 2024:S1058-2746(24)00030-2. [PMID: 38242528 DOI: 10.1016/j.jse.2023.11.029] [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: 06/13/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Although cementation of humeral stems has long been considered the gold standard for anatomic shoulder arthroplasty (aTSA), cementless, or press-fit, fixation offers a relatively cheaper and less demanding alternative, particularly in the setting of a revision procedure. However, this approach has been accompanied by concerns of implant loosening and high rates of radiolucency. In the present study, we performed a propensity-matched comparison of clinical and patient-reported outcomes between cemented and cementless fixation techniques for aTSA. We hypothesized that cemented fixation of the humeral component would have significantly better implant survival while providing comparable functional outcomes at final follow-up. METHODS This study was a retrospective comparison of 50 shoulders undergoing aTSA: 25 using cemented humeral fixation vs. 25 using press-fit humeral fixation. Patients in the 2 groups were propensity matched according to age, sex, and preoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score. Primary outcome measures included range of motion (ROM) (forward elevation, external rotation, internal rotation), patient-reported outcomes (ASES, Simple Shoulder Test [SST], visual analog scale [VAS]), and implant survival. RESULTS At baseline, the 2 fixation groups were similar in regard to age, sex, body mass index, preoperative ASES score, and surgical indication. Mean follow-up was 11.7 ± 4.95 years in the cemented cohort and 9.13 ± 3.77 years in the press-fit cohort (P = .045). Both groups demonstrated significant improvements postoperatively in all included ROM and patient-reported outcomes. However, press-fit patients reported significantly better VAS, ASES, and SST scores. Mean VAS pain score was 1.1 ± 1.8 in press-fit patients and 3.2 ± 3.0 in cemented patients (P = .005). The mean ASES score was 87.7 ± 12.4 in press-fit patients and 69.5 ± 22.7 in cemented patients (P = .002). Lastly, the mean SST score was 9.8 ± 3.1 in press-fit patients and 7.7 ± 3.7 in cemented patients (P = .040). Both fixation techniques provided lasting implant survivorship with only a single revision operation in each of the cohorts. CONCLUSION Herein, we provide a propensity-matched, long-term comparison of patients receiving anatomic shoulder arthroplasty stratified according to humeral stem fixation technique. The results of this analysis illustrate that both types of humeral fixation techniques yield durable and significant improvements in shoulder function with similar rates of survival at 10 years of follow-up.
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Affiliation(s)
- Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akiro H Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth H Levy
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William A Ranson
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dave Shukla
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Larose G, Aibinder WR, Greene AT, Roche CP, Grey S, Faber KJ, Routman H, Antuña S, Wright T, Flurin PH, Zuckerman JD, Virk MS. Two-year minimum survivorship and radiographic analysis of a pressfit short humeral stem for total shoulder arthroplasty. JSES Int 2024; 8:191-196. [PMID: 38312300 PMCID: PMC10837737 DOI: 10.1016/j.jseint.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Newer generation humeral stem designs in total shoulder arthroplasty (TSA) are trending towards shorter lengths and uncemented fixation. The goal of this study is to report a 2-yr minimum clinical and radiographic outcomes of an uncemented short-stem press-fit humeral stem in anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA). Methods A retrospective multicenter database review was performed of all patients who received an uncemented short-length press-fit humeral stem (Equinoxe Preserve humeral stem, Exactech, Inc., Gainesville, FL, USA) in ATSA and RTSA with a minimum two-year follow-up. The primary outcome was the prevalence of humeral stems at risk of radiographic loosening. Secondary outcomes included evaluation of functional outcome scores and prevalence of revision TSA for humeral stem loosening. Two blinded observers performed radiographic analyses, which included humeral stem alignment, canal filling ratio, radiolucent lines, stress shielding (calcar and greater tuberosity), and changes in component position (subsidence and stem shift). At risk stems were defined by the presence of one or more of the following: humeral stem with shifting or subsidence, scalloping of the humeral cortex, or radiolucent lines measuring 2 mm or greater in 3 or more zones. Results 287 patients (97 ATSA and 190 RTSA) were included in this study. The mean follow-up was 35.9 (±6.1) months. There were significant improvements for all functional outcome scores (P < .05), range of motion (P < .05), and visual analogue pain scale pain (P < .05). The prevalence of humeral stem at risk of radiographic loosening was 1% in the ATSA group (1/97) and 18.4% in the RTSA group (35/190). Calcar resorption was seen in 34% of ATSA and 19% of RTSA, with severe resorption in 12.4% of ATSA and only 3.2% of RTSA. Greater tuberosity resorption was present in 3.1% of ATSA and 7.9% of RTSA. The mean canal filling ratio was 50.2% (standard deviation 11.2%). Using logistic regression, a significant positive correlation between canal filling ratio and stress shielding (P < .01) was seen for both calcar and tuberosity stress shielding. The revision surgery rate was 0% in ATSA compared to 1.6% in RTSA. Conclusion This retrospective study demonstrates a low revision rate and low prevalence of humeral stems at risk of radiographic loosening at two years with a press-fit short-stem humeral design in ATSA. Physiologic subsidence of humeral stems can account for higher prevalence of humeral stems at radiographic risk of loosening in RTSA compared to ATSA.
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Affiliation(s)
- Gabriel Larose
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Sean Grey
- Orthopedic and Spine Center of The Rockies, Fort Collins, CO, USA
| | | | - Howard Routman
- Palm Beach Shoulder Service at HCA Atlantis Orthopedics, Palm Beach, FL, USA
| | | | | | | | - Joseph D Zuckerman
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Albers S, Fal MF, Hudek R, Kircher J. [Conversion of anatomic to reverse shoulder arthroplasty : Does it make sense?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:131-136. [PMID: 36651968 DOI: 10.1007/s00132-022-04342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/19/2023]
Abstract
We can observe increasing numbers for the implantation of shoulder endoprostheses in developed industrial countries. This is accompanied by a certain number of revision surgeries. The conversion to reverse arthroplasty systems is by far the most common revision procedure. Depending on the primary implant and the individual situation, the surgical effort and consumption of resources can be substantial. Particularly favorable revision scenarios exist in the conversion of stemless primary implants that are part of a platform system and allow a partial exchange and easy conversion from anatomical to reverse implants.
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Affiliation(s)
- Sebastian Albers
- Schulter- und Ellenbogenchirurgie, ATOS Klinik Fleetinsel Hamburg, Admiralitätstr. 3-4, 20459, Hamburg, Deutschland
| | - Milad Farkhondeh Fal
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Robert Hudek
- Schulter- und Ellenbogenchirurgie, ATOS Klinik Fleetinsel Hamburg, Admiralitätstr. 3-4, 20459, Hamburg, Deutschland
| | - Jörn Kircher
- Schulter- und Ellenbogenchirurgie, ATOS Klinik Fleetinsel Hamburg, Admiralitätstr. 3-4, 20459, Hamburg, Deutschland. .,Klinik für Orthopädie und Unfallchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
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Bidwai R, Kumar K. Outcomes of different stem sizes in shoulder arthroplasty. J Orthop 2023; 35:37-42. [PMID: 36387763 PMCID: PMC9647328 DOI: 10.1016/j.jor.2022.10.009] [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: 06/11/2022] [Revised: 08/20/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background The successive refinement in implant design and operative technique alongwith improved understanding has resulted in increased incidence of total shoulder arthroplasty (TSA). Simultaneously, the indications of TSA have widened and include a range of shoulder pathologies. Methods Using the keywords and relevant literature, we have described an overview of the different stem sizes used in shoulder arthroplasty. Relevant description of clinical and radiological outcome is done with regards to different stem sizes. Discussion There are plethora of shoulder replacement systems, based on unique philosophy and having their own advantages and disadvantages. Additionally, the rise in ageing population had increased the need for revision TSA, thereby necessitating the judicious choice of implant at primary TSA. We further present the role of cemented and uncemented humeral stems and discuss the findings of finite element analysis. The choice of humeral stem size and use of cemented or uncemented stems have been reported to affect the clinical and radiological outcomes.
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Affiliation(s)
- Rohan Bidwai
- Aberdeen Upper Limb Unit, Department of Trauma and Orthopaedics, Woodend Hospital, NHS Grampian , Aberdeen, UK
| | - Kapil Kumar
- Aberdeen Upper Limb Unit, Department of Trauma and Orthopaedics, Woodend Hospital, NHS Grampian , Aberdeen, UK
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Xiang X. [Interpretation of 2020 American Academy of Orthopaedic Surgeons (AAOS) on the Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1403-1410. [PMID: 34779165 DOI: 10.7507/1002-1892.202105085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Based on peer-reviewed systematic reviews and randomized controlled trials published between January 2000 and June 2019 with regards to the management of glenohumeral joint osteoarthritis (GJO), the American Academy of Orthopaedic Surgeons (AAOS) established the clinical practice guidelines for the treatment of GJO. The guidelines provided practice recommendations including risk factors, non-surgical treatment, surgical treatment, prosthesis selection, and perioperative management for GJO. The recommendations were graded according to different evidence strength. This paper interprets the guidline in order to provide reference for domestic medical workers.
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Affiliation(s)
- Xianxiang Xiang
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
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Uribe JW, Zvijac JE, Porter DA, Saxena A, Vargas LA. Inlay total shoulder arthroplasty for primary glenohumeral arthritis. JSES Int 2021; 5:1014-1020. [PMID: 34766078 PMCID: PMC8569014 DOI: 10.1016/j.jseint.2021.07.014] [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] [Indexed: 11/04/2022] Open
Abstract
Background Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid replacement has been introduced in the past; however, clinical evidence remains limited. We hypothesized that patients with advanced glenohumeral arthritis demonstrate significant improvements in pain and function. Methods Prospective patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons score, a pain visual analog scale, and satisfaction. Range of motion was compared to the preoperative status. A sensitivity analysis examined responder rates and compared them to literature thresholds using the minimal clinically important difference and substantial clinical benefit. The preoperative glenoid morphology was determined using the Walsh classification. Zone-specific periprosthetic radiolucent lines were quantified at the last follow-up. Results Thirty-nine shoulders in 36 patients (3 bilateral) with a mean age of 65.9 years (26 males, 13 females) and a mean follow-up of 41.0 months were included. Ninety-three percent had grade III osteoarthritis, and 7% grade II. The glenoid Walsh classification included A1 (25%), A2 (25%), B1 (22%), B2 (25%), and C (3%). All PROs improved significantly (P < .001) with a mean American Shoulder and Elbow Surgeons score from 30.4 to 77.1, a pain visual analog scale from 8.1 to 1.5, and excellent (9.1/10) patient satisfaction. PRO-related responder rates for minimal clinically important difference and substantial clinical benefit were ≥85%. Forward elevation improved from 107° to 155°, and external rotation from 22° to 51°. One intraoperative glenoid rim fracture led to advanced radiolucency; no other clinically relevant lucency was observed. Conclusion Treatment with inlay total shoulder arthroplasty demonstrated significant functional improvement, excellent pain relief, and patient satisfaction in patients with advanced shoulder arthritis and various glenoid morphology types. Our initial results provide further support for this new option in primary shoulder replacement.
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Affiliation(s)
- John W Uribe
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
| | - John E Zvijac
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
| | - David A Porter
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
| | - Anshul Saxena
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
| | - Luis A Vargas
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
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Karssiens TJ, Gill JR, Sunil Kumar KH, Sjolin SU. Clinical results and survivorship of the Mathys Affinis Short, Short Stem Total Shoulder Prosthesis. Bone Jt Open 2021; 2:58-65. [PMID: 33537677 PMCID: PMC7842163 DOI: 10.1302/2633-1462.21.bjo-2020-0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. METHODS From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration. RESULTS Five shoulders underwent revision surgery (3.5%); three for rotator cuff failure, one for infection, and one for component malposition. Survivorship of the implant was 95.4% (95% confidence interval 90.1% to 97.9%) at five and nine years. Mean OSS improved significantly compared to preoperative values from 19.0 (1 to 35) to 43.3 (7 to 48) (p < 0.001). Radiological analysis was undertaken for 99 shoulders. This revealed humeral RLLs in one case (1%), glenoid RLLs in 15 cases (15.2%), and radiological rotator cuff failure in 22 cases (22.2%). CONCLUSION This prospective cohort study shows encouraging short- to mid-term survivorship and clinical and radiological results for the Mathys Affinis Short, Short Stem Total Shoulder Prosthesis.Level of Evidence: IVCite this article: Bone Jt Open 2021;2(1):58-65.
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Affiliation(s)
- Timothy James Karssiens
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - James Ritchie Gill
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Karadi Hari Sunil Kumar
- Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Søren Upton Sjolin
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
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Mencia MM, Goalan R, Skeete R. Atraumatic dissociation of a modular shoulder hemiarthroplasty: a case report and literature review. JSES Int 2020; 4:400-403. [PMID: 32490434 PMCID: PMC7256893 DOI: 10.1016/j.jseint.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, University of the West Indies, Trinidad
| | - Raakesh Goalan
- Department of Orthopaedics, Eric Williams Medical Sciences Complex, Trinidad
| | - Rondell Skeete
- Department of Surgery, Port of Spain General Hospital, Trinidad
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