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Smith KL, Karimi A, Harlow ER, Gillespie RJ, Chen RE. Defining patient satisfaction after reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2024; 33:2298-2305. [PMID: 38719073 DOI: 10.1016/j.jse.2024.03.036] [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: 11/06/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The prevalence of reverse total shoulder arthroplasty (rTSA) has grown rapidly. As indications for the procedure expand, the proportion of patients who have satisfactory outcomes after rTSA has not been well defined. This systematic literature review explores overall patient satisfaction after rTSA and defines patient satisfaction based on indication for surgery. METHODS A literature search was performed for studies describing patient satisfaction after rTSA in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Papers were included if they investigated patient satisfaction after rTSA at a minimum of 2-year follow-up. Data were collected on patient demographics, including age, gender, and body mass index. Follow-up duration, indication for surgery, and patient reported outcome measures relating to patient satisfaction were also recorded. RESULTS There were a total of 5234 patients and 5288 shoulders from the 45 included studies. The overall study population was 61.2% female and the average age was 71.1 years (range 23-99). Satisfaction results were recorded at final follow-up, with average follow-up of 49.1 months (range 24-228). Overall patient satisfaction ranged from 77.7% to 87.8%, depending on patient satisfaction patient reported outcome measures. When stratified by diagnosis, patients with a diagnosis of glenohumeral osteoarthritis (GHOA) rated better satisfaction on all metrics when compared to patients with a diagnosis of cuff tear arthropathy or massive rotator cuff tear. CONCLUSION This systematic review demonstrated that patients who undergo rTSA for either GHOA, cuff tear arthropathy, or massive rotator cuff tear are generally satisfied with their procedure, with the rate of satisfaction highest in GHOA. Focusing on patient satisfaction may provide the best overall assessment of health care quality in a very understandable and tangible form. Overall satisfaction rate is valuable information for patient education and can be utilized as part of effective surgical counseling.
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Affiliation(s)
- Kira L Smith
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Amir Karimi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ethan R Harlow
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raymond E Chen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Amouyel T, Szymanski C, Rodrigues V, Saab M, Maynou C. Poor clinical outcomes and high rates of dislocation after modular reverse shoulder arthroplasty for proximal humeral oncologic resection. INTERNATIONAL ORTHOPAEDICS 2024; 48:1331-1339. [PMID: 38403733 DOI: 10.1007/s00264-024-06122-7] [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: 11/27/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The shoulder is the most common site for upper extremity tumors. The aim of the study was to analyze the outcomes and the complications of modular reverse shoulder arthroplasty (RSA) after proximal humerus resection. METHODS We retrospectively included 15 consecutive patients who underwent a modular MUTARS™ RSA reconstruction after proximal humerus tumour resection between 2017 and 2020. The mean age was 52 years. Their clinical outcomes were assessed using the Constant-Murley score and the MSTS shoulder. Radiological outcomes were assessed based on the presence of loosening, osteolysis, and scapular notching. Complications such as dislocation, oncological recurrence, and infection were assessed. Mean follow-up time was 32.9 months (24 to 45). RESULTS The mean adjusted Constant score was 50.7% (min 22, max 81), and the mean MSTS score was 15.6 (min 4, max 26). We had no loosening, osteolysis, or scapular notching on the radiographs at last follow-up. We had a high complication rate of 53%: one infection, one oncological recurrence, and six dislocations (40%), of which five were re-operated. CONCLUSION In our experience, the MUTARS™ Implantcast™ modular RSA has poor functional results and a high rate of dislocation in the case of large proximal humerus resections below the distal insertion of the deltoid.
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Affiliation(s)
- Thomas Amouyel
- UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Univ. Lille, CHU Lille, Service d'orthopédie 1, 59000, Lille, France.
| | - Christophe Szymanski
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
| | - Valentin Rodrigues
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
| | - Marc Saab
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
| | - Carlos Maynou
- Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France
- Université de Lille Nord de France, Lille, France
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Protzuk O, Schmidt RC, Craig JM, Weber M, Isaacs J, O'Connell R. Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear After Radial to Axillary End-to-Side Transfer: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00031. [PMID: 38363874 DOI: 10.2106/jbjs.cc.23.00526] [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: 02/18/2024]
Abstract
CASE A 60-year-old man sustained a massive irreparable rotator cuff tear and axillary nerve palsy with deltoid dysfunction after an anterior shoulder dislocation. He underwent staged reverse end-to-side radial-to-axillary nerve transfer with return of deltoid function allowing for subsequent reverse shoulder arthroplasty. At 1 year postoperatively, he returned to full activity. CONCLUSION Irreparable rotator cuff tears complicated by axillary nerve palsy can be effectively treated with a staged approach of nerve transfer followed by reverse shoulder arthroplasty.
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Affiliation(s)
- Omar Protzuk
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - R Cole Schmidt
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Justin M Craig
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Matt Weber
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Robert O'Connell
- Division of Sports Medicine, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
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Lee KJ, Jang YH, Nam JH, Yoo HJ, Kim SH. Spontaneous Deltoid Tear in Cuff Tear Arthropathy and Its Effect on the Outcome of Reverse Total Shoulder Arthroplasty: A Comparison Using Propensity Score Matching. Clin Orthop Surg 2023; 15:627-636. [PMID: 37529192 PMCID: PMC10375814 DOI: 10.4055/cios22343] [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: 10/27/2022] [Revised: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 08/03/2023] Open
Abstract
Background Deltoid function critically influences the results of reverse total shoulder arthroplasty (RTSA), and spontaneous deltoid attrition tears are frequently detected in cuff tear arthropathy (CTA) patients; however, the clinical impacts of these tears on RTSA outcomes are undetermined. Our aim was to determine the effect of spontaneous deltoid attrition tears on postoperative outcomes after RTSA without an additional deltoid procedure. Methods Seventy-two patients who underwent RTSA for CTA with preoperative magnetic resonance imaging (MRI) and a minimum clinical follow-up of 1 year (mean, 32 months) were retrospectively reviewed in the study. Patients with a history of previous shoulder surgery or injury were excluded. The presence and location of deltoid attrition tears were determined in preoperative MRI. Propensity score matching (1:1) was performed to construct tear and no-tear groups. Finally, 21 patients, matched with respect to age, sex, hand dominance, symptom duration, medical comorbidity (obesity, diabetes mellitus, and coronary artery disease), Hamada grade, and implant type, were assigned to each group. Clinical outcomes (functional scores, isometric power, and range of motion) in the two groups were compared. Results Deltoid attrition tears were detected in 21 of the 72 enrolled cases (29.1%). Anterolateral deltoid was the most frequent location and no tear was detected in the posterior deltoid. The tear rate increased with disease severity (Hamada G2, 4.8%; G3, 23.8%; > G4, 71.4%). No pre- or postoperative clinical variables differed significantly between the tear and no tear groups. Conclusions Deltoid attrition tears were detected in 29% of CTA patients who underwent RTSA. The most common site was the anterolateral region and tear prevalence tended to increase with CTA progression. However, RTSA was found to provide satisfactory outcomes regardless of the presence of a deltoid attrition tear.
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Affiliation(s)
- Kyung Jae Lee
- Department of Orthopedic Surgery, Chung-Ang University Medical Center, Chung-Ang University School of Medicine, Seoul, Korea
| | - Young Hoon Jang
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ji Hoon Nam
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Hartzler RU, Ardebol J, Denard PJ. Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement. Arthrosc Tech 2022; 11:e2097-e2102. [PMID: 36457409 PMCID: PMC9706133 DOI: 10.1016/j.eats.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Acromial stress fracture is a well-known complication after reverse shoulder arthroplasty. Although some patients are asymptomatic, others may present with reproducible pain to palpation and signs of impingement. Generally, the initial mode of treatment is conservative; however, surgical intervention is considered in patients with painful nonunion and displaced fragments. Although open reduction techniques are most common, Levy type I fragments may be amenable to excision. This technical note provides a stepwise approach to arthroscopic excision for painful nonunited acromial stress fractures after reverse shoulder arthroplasty.
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Affiliation(s)
- Robert U. Hartzler
- San Antonio Orthopaedic Group (TSAOG), Burkhart Research Institute for Orthopaedics (BRIO), San Antonio, Texas, U.S.A.,Address correspondence to Robert U. Hartzler, M.D., M.S., The San Antonio Orthopaedic Group, 19138 US Hwy 281 N, San Antonio, TX 78258, U.S.A.
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Fiore M, Sambri A, Giannini C, Zucchini R, De Cristofaro R, De Paolis M. Anatomical and reverse megaprosthesis in proximal humerus reconstructions after oncologic resections: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142:2459-2469. [PMID: 33721053 DOI: 10.1007/s00402-021-03857-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
AIM Anatomic (AN) Endoprosthesis (EPR) reconstructions of the shoulder after intra-articular proximal humerus (Malawer type 1) resections are characterized by early recovery and low complications rate. However, shoulder instability and limited mobility can occur. Reverse shoulder (RS) EPR has been introduced to improve functional outcome. The aim of this systematic review is to evaluate shoulder reconstructions with AN or RS EPR after Malawer type 1 resection, comparing complications and functional results. METHODS Through an electronic systematic search of PubMed, articles concerning EPR after shoulder Malawer type 1 resections were reviewed. Complications rate, range of motion (ROM) and functional outcome (Musculoskeletal Society Tumor Society-MSTS score) of AN and RS EPR were evaluated. RESULTS Sixteen studies were included. A similar complication rate was observed between AN and RS EPR rate (26.4% and 22.4%, respectively, p = 0.37). Soft tissue failure was the most frequent complication and cause of revision in both groups. Mean post-operative flexion and abduction ROM and MSTS scores were significantly higher in RS EPR, particularly among patients with preserved deltoid function (p = 0.013, p = 0.025 and p = 0.005, respectively). CONCLUSIONS Anatomic and reverse shoulder EPR represent safe and effective implants for shoulder reconstruction, with similar implant stability and complication rates. RS EPR significantly improves post-operative ROM and functional outcomes, especially when at least a partial function of the abductor apparatus is preserved.
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Affiliation(s)
- Michele Fiore
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Andrea Sambri
- Alma Mater Studiorum, University of Bologna, Bologna, Italy. .,IRCCS Policlinico di Sant'Orsola, Bologna, Italy.
| | - Claudio Giannini
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Riccardo Zucchini
- IRCCS Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
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Callamand G, Barret H, Saint-Genez F, Bonnevialle P, Mansat P, Bonnevialle N. Reconstruction by allograft-prosthetic composite reverse shoulder arthroplasty after proximal humerus tumor resection: Clinical and radiographic assessment at a minimum 2years' follow-up. Orthop Traumatol Surg Res 2022; 108:102957. [PMID: 33962047 DOI: 10.1016/j.otsr.2021.102957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) is an option to conserve limb function after resection of proximal humerus malignancy. An allograft-composite RSA is an alternative to a tumor prosthesis, and can restore proximal humeral bone stock. The aim of the present study was to assess medium-term radiographic and clinical results for such composite implants. METHODS Patients with malignant proximal humerus tumor treated by resection and reconstruction by composite RSA were retrospectively analyzed at a minimum 24months' follow-up. Clinical assessment used Constant score, Subjective Shoulder Value (SSV) and ADLER score. Standard radiographic work-up assessed allograft absorption and screened for implant loosening. RESULTS Eleven patients were included, with a mean age of 51years (range: 19-87years) and mean 30months' follow-up (range: 24-84months). Mean tumor resection was 10cm (range: 6-17cm). Etiologies comprised chondrosarcoma (n=6), osteosarcoma (n=2), B-cell lymphoma (n=1) and single metastasis (n=2). Bony increased-offset allograft was associated to humerus reconstruction in 8 cases, and latissimus dorsi tendon transfer in 5 cases. Mean Constant score was 49 points, SSV 52%, and ADLER score 20 points. Increased glenoid implant offset associated to tendon transfer significantly improved anterior elevation and external rotation. Radiographic allograft consolidation to the native humerus was acquired in 73% of cases, while osteolysis in the epiphyseal-metaphyseal zone was found in 64%. There were no cases of humeral implant loosening. Glenoid allograft absorption was systematic (8/8 cases), without inducing loosening of the implant baseplate. CONCLUSION Composite reverse shoulder arthroplasty is functionally effective after massive resection. However, allograft absorption is a drawback, casting doubt on continued use on the glenoid side. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gabriel Callamand
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France.
| | - Hugo Barret
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Florian Saint-Genez
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Paul Bonnevialle
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Pierre Mansat
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
| | - Nicolas Bonnevialle
- Service d'orthopedie-traumatologie, centre hospitalier universitaire de Toulouse-Purpan, Toulouse, France
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Wheelwright JC, Featherall J, Kazmers NH, Tashjian RZ, Chalmers PN. Revision Reverse Total Shoulder Arthroplasty With Pectoralis Major Transfer for Anterior Deltoid Deficiency: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00020. [PMID: 36099468 DOI: 10.2106/jbjs.cc.22.00034] [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: 06/15/2023]
Abstract
CASE A 70-year-old male patient presented with anterior deltoid weakness from Parsonage-Turner neuropathy status post failed nerve transfer and a failed total shoulder arthroplasty with pseudoparalysis. The patient underwent revision to a reverse total shoulder arthroplasty with concomitant pectoralis major transfer to substitute for the anterior deltoid. An excellent functional result was attained as early as 6 weeks after surgery. CONCLUSION Pectoralis major transfer can be an effective treatment option for isolated anterior deltoid insufficiency, even in the setting of a reverse total shoulder arthroplasty.
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Affiliation(s)
| | - Joseph Featherall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Reverse total shoulder arthroplasty for fractures and posttraumatic sequelae is associated with inferior forward elevation strength: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Radiological changes, infections and neurological complications after reverse shoulder arthroplasty related to different design types and their rates: Part II. EFORT Open Rev 2021; 6:1109-1121. [PMID: 34909229 PMCID: PMC8631237 DOI: 10.1302/2058-5241.6.210040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Early reported complication rates with the Grammont-type reverse shoulder arthroplasty (RSA) were very high, up to 24%.A 'problem' is defined as an intraoperative or postoperative event that is not likely to affect the patient's final outcome, such as intraoperative cement extravasation and radiographic changes. A 'complication' is defined as an intraoperative or postoperative event that is likely to affect the patient's final outcome, including infection, neurologic injury and intrathoracic central glenoid screw placement.Radiographic changes around the glenoid or humeral components of the RSA are very frequently observed and described in the literature.High complication rates related to the Grammont RSA design led to development of non-Grammont designs which led to a dramatic fall in the majority of complications.The percentage of radiological changes after RSA is not negligible and remains unsolved, despite a decrease in its occurrence in the last decade. However, such changes should be now considered as simple problems because they rarely have a negative influence on the patient's final outcome, and their prevalence has dramatically decreased.With further changes in indications and designs for RSA, it is crucial to accurately track the rates and types of complications to justify its new designs and increased indications. Cite this article: EFORT Open Rev 2021;6:1109-1121. DOI: 10.1302/2058-5241.6.210040.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Rev 2021; 6:1097-1108. [PMID: 34909228 PMCID: PMC8631242 DOI: 10.1302/2058-5241.6.210039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The initial reverse shoulder arthroplasty (RSA), designed by Paul Grammont, was intended to treat rotator cuff tear arthropathy in elderly patients. In the early experience, high complication rates (up to 24%) and revision rates (up to 50%) were reported.The most common complications reported were scapular notching, whereas clinically more relevant complications such as instability and acromial fractures were less commonly described.Zumstein et al defined a 'complication' following RSA as any intraoperative or postoperative event that was likely to have a negative influence on the patient's final outcome.High rates of complications related to the Grammont RSA design led to development of non-Grammont designs, with 135 or 145 degrees of humeral inclination, multiple options for glenosphere size and eccentricity, improved baseplate fixation which facilitated glenoid-sided lateralization, and the option of humeral-sided lateralization.Improved implant characteristics combined with surgeon experience led to a dramatic fall in the majority of complications. However, we still lack a suitable solution for several complications, such as acromial stress fracture. Cite this article: EFORT Open Rev 2021;6:1097-1108. DOI: 10.1302/2058-5241.6.210039.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick J. Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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12
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Goetti P, Denard PJ, Collin P, Ibrahim M, Mazzolari A, Lädermann A. Biomechanics of anatomic and reverse shoulder arthroplasty. EFORT Open Rev 2021; 6:918-931. [PMID: 34760291 PMCID: PMC8559568 DOI: 10.1302/2058-5241.6.210014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
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Affiliation(s)
- Patrick Goetti
- Division of Orthopaedics and Trauma Surgery, Centre Hospitalier |Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick J. Denard
- Denard Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States
| | - Philippe Collin
- Collin Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Mohamed Ibrahim, Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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13
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Bayram S, Erşen A. Reverse shoulder arthroplasty for corticosteroid-induced deltoid myopathy in a patient with systemic lupus erythematosus: a case report. Clin Shoulder Elb 2021; 24:178-182. [PMID: 34488299 PMCID: PMC8423528 DOI: 10.5397/cise.2021.00241] [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: 04/11/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
A 50-year-old woman who had been previously diagnosed with systemic lupus erythematosus consulted our clinic for pain and weakness in her right shoulder. On examination, she had an atrophied deltoid muscle, a painful right shoulder on movement, and a tender mass in the deltoid area. The patient was diagnosed with corticosteroid-induced deltoid myopathy, shoulder pain, and loss of range of motion that did not resolve with conservative treatment. We decided to perform reverse shoulder arthroplasty. No complications were observed at the last follow-up visit at 3 years postoperative. Unlike deltoid insufficiency that results from axillary nerve injury, deltoid myopathy due to corticosteroid use contains intact fibers,. Therefore, we increased the effectivity of the remaining deltoid fibers by extending the moment arm of the anterior fibers using reverse shoulder arthroplasty and achieved reliable improvements in clinical symptoms and function without increasing the risk of dislocation.
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Affiliation(s)
- Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Deltoid defect from a trans-deltoid synovial cyst in a patient undergoing reverse shoulder arthroplasty: a case report. JSES Int 2020; 5:138-141. [PMID: 33554178 PMCID: PMC7846677 DOI: 10.1016/j.jseint.2020.10.001] [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: 11/22/2022] Open
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15
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Dogger MN, Bemmel AFV, Alta TDW, van Noort A. Conversion to reverse shoulder arthroplasty fifty-one years after shoulder arthrodesis: A case report. World J Orthop 2020; 11:465-472. [PMID: 33134109 PMCID: PMC7582107 DOI: 10.5312/wjo.v11.i10.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with a shoulder arthrodesis generally experience restriction in range of motion and limitations in activities of daily living. In addition, up to one-third of the patients deals with serious peri scapular pain. The conversion of a shoulder arthrodesis in a reverse shoulder arthroplasty (RSA) has been described as an effective treatment to achieve better function and decreased pain, although literature is sparse. We present the case of a conversion from a painful shoulder arthrodesis to RSA, after a 51 years interval.
CASE SUMMARY A 71-year-old male presented with severe peri scapular pain and limited function 51 years after shoulder arthrodesis. Preoperative workup showed a normal bone stock of the glenoid and an intact axillary nerve, but atrophic posterior part of the deltoid muscle. The shoulder arthrodesis was successfully converted to RSA. Twelve months postoperative the patient was very satisfied. He has no pain at rest, nor with exercise and experienced definite improvements in activities of daily living, despite his limited range of motion.
CONCLUSION Conversion from shoulder arthrodesis to a RSA can be performed safely, with a high chance of peri scapular pain relief; even after a longstanding arthrodesis.
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Affiliation(s)
- Melissa N Dogger
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, Netherlands
| | | | - Tjarco D W Alta
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, Netherlands
| | - Arthur van Noort
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, Netherlands
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Allograft-Composite Reverse Shoulder Arthroplasty for Malignant Tumor of the Proximal Humerus. Tech Hand Up Extrem Surg 2020; 25:94-101. [PMID: 33044287 DOI: 10.1097/bth.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Composite-allograft reverse shoulder arthroplasties are a surgical alternative in malignant tumor reconstructions following segmental bone resection of the proximal humerus. They allow reinsertion of the rotator cuff tendons and reliable restoration of humeral height, increasing prosthetic stability and mobility. Preoperative local tumor extension assessment must be thorough and a strict surgical technique must be followed to obtain satisfactory functional results. The indications for this procedure include a strictly intraosseous tumor of the proximal humerus corresponding to an S3-S4 A resection following criteria provided by the Musculoskeletal Tumor Society as described by Enneking and colleagues in 1990. Certain conditions must question the procedure such as extended S3-S4-S5 bone resections, partial sacrifice of the deltoid muscle, preoperative deltoid impairment, and glenohumeral arthrectomy. Here, we report technical details and indications of composite-allograft reverse shoulder arthroplasty in the context of tumor segmental resection of the proximal humerus, especially in the humeral preparation.
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Shah SS, Roche AM, Sullivan SW, Gaal BT, Dalton S, Sharma A, King JJ, Grawe BM, Namdari S, Lawler M, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int 2020; 5:121-137. [PMID: 33554177 PMCID: PMC7846704 DOI: 10.1016/j.jseint.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
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Affiliation(s)
- Sarav S. Shah
- American Shoulder and Elbow Surgeons (ASES) Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
- Corresponding author: Sarav S. Shah, MD, 125 Parker Hill Ave, Boston, MA 02120, USA.
| | | | | | - Benjamin T. Gaal
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Stewart Dalton
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Arjun Sharma
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph J. King
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Brian M. Grawe
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Surena Namdari
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Macy Lawler
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Thomas W. Wright
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Kyle Flik
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Randall J. Otto
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Jones
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Andrew Jawa
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Peter McCann
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph Abboud
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Gabe Horneff
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Glen Ross
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Friedman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Douglas Boardman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
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Predicting outstanding results after reverse shoulder arthroplasty using percentage of maximal outcome improvement. J Shoulder Elbow Surg 2019; 28:1223-1231. [PMID: 30910258 DOI: 10.1016/j.jse.2018.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether thresholds regarding the percentage of maximal improvement in the Simple Shoulder Test (SST) score and American Shoulder and Elbow Surgeons (ASES) score exist that predict excellent patient satisfaction after reverse shoulder arthroplasty (RSA). METHODS Patients undergoing RSA with a single implant system were evaluated preoperatively and at a minimum 2-year follow-up. Receiver operating characteristic curve analysis determined thresholds to predict excellent patient satisfaction by evaluating the percentage of maximal improvement for SST and ASES scores. Preoperative factors were analyzed as independent predictors for achieving SST and ASES score thresholds. RESULTS There were 198 (SST score) and 196 (ASES score) patients who met inclusion criteria. For SST and ASES scores, receiver operating characteristic curve analysis identified 61.3% (P < .001) and 68.2% (P < .001) maximal improvement as the threshold for maximal predictability of excellent satisfaction, respectively. Significant positive correlation between the percentage of maximum score achieved and excellent patient satisfaction for both groups was found (r = 0.440 [P < .001] for SST score; r = 0.417 [P < .001] for ASES score). Surgery on the dominant hand, greater baseline visual analog scale pain score, and cuff arthropathy were independent predictors for achieving the SST and ASES score threshold. CONCLUSION Thresholds for the achievement of excellent satisfaction after RSA were 61.3% of maximal SST score improvement and 68.3% of maximal ASES score improvement. Independent predictors of achieving these thresholds were dominant-sided surgery and higher baseline visual analog scale pain scores for the SST score and rotator cuff arthropathy for the ASES score.
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Gasbarro G, Crasto JA, Rocha J, Henry S, Kano D, Tarkin IS. Reverse Total Shoulder Arthroplasty for Geriatric Proximal Humerus Fracture Dislocation With Concomitant Nerve Injury. Geriatr Orthop Surg Rehabil 2019; 10:2151459319855318. [PMID: 31218093 PMCID: PMC6558531 DOI: 10.1177/2151459319855318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Preoperative axillary nerve palsy is a contraindication to reverse total shoulder arthroplasty (rTSA) due to the theoretical risk of higher dislocation rates and poor functional outcomes. Treatment of fracture-dislocations of the proximal humerus with rTSA is particularly challenging, as these injuries commonly present with concomitant neurologic and soft tissue injury. The aim of the current study was to determine the efficacy of rTSA for this fracture pattern in geriatric patients presenting with occult or profound neurologic injury. Methods A retrospective case series of all shoulder arthroplasty procedures for proximal humerus fractures from February 2006 to February 2018 was performed. Inclusion criteria were patients aged greater than 65 years at the time of surgery, fracture-dislocations of the proximal humerus, and treatment with rTSA. Patients with preoperative nerve injuries were compared to patients without overt neurologic dysfunction. Forward elevation, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analog Scale (VAS), and Subjective Shoulder Value (SSV) were obtained at final follow-up. Results Forty-six rTSA for acute fracture were performed during the study period, 16 patients met the inclusion criteria and 5 (31%) presented with overt preoperative nerve injuries. At mean 3.1 years follow up, there were no postoperative complications including dislocations and final forward elevation was similar between study groups. Patients with overt nerve palsy had higher QuickDASH and VAS scores with lower SSV and self-rated satisfaction. Discussion In the majority of patients with or without overt nerve injury, rTSA reliably restored overhead function and led to good or excellent patient-rated treatment outcomes. Overt nerve palsy did not lead to higher complication rates, including dislocation. Despite greater disability and less satisfaction, complete or partial nerve recovery can be expected in the majority of patients. Conclusion Nerve injury following proximal humeral fracture dislocation may not be an absolute contraindication to rTSA.
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Affiliation(s)
- Gregory Gasbarro
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jared A Crasto
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah Henry
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daiji Kano
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ivan S Tarkin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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20
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Berglund DD, Damodar D, Vakharia RM, Moeller EA, Giveans MR, Horn B, Mijic D, Levy JC. Predicting outstanding results after anatomic total shoulder arthroplasty using percentage of maximal outcome improvement. J Shoulder Elbow Surg 2019; 28:349-356. [PMID: 30404717 DOI: 10.1016/j.jse.2018.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether thresholds in the percentage of maximal improvement in the Simple Shoulder Test (SST) or American Shoulder and Elbow Surgeons (ASES) score exist for predicting "excellent" patient satisfaction after total shoulder arthroplasty (TSA). METHODS A retrospective query identified patients who underwent TSA with a minimum of 2 years' follow-up. Preoperative and postoperative SST and ASES scores and postoperative patient satisfaction were recorded. Receiver operating characteristic curve analyses were performed to determine thresholds in the percentage of maximal improvement in the SST and ASES scores that predict excellent satisfaction. Univariate and multivariate analyses determined preoperative factors that predicted achievement of these thresholds. RESULTS A total of 301 and 319 patients had at least 2 years' follow-up for the SST score and ASES score, respectively. We determined 72.1% of maximal improvement in the SST score to be the threshold for excellent satisfaction (area under the curve, 0.777; 95% confidence interval, 0.712-0.841; P < .001). We determined 75.6% of maximal improvement in the ASES score to be the threshold for excellent satisfaction (area under the curve, 0.799; 95% confidence interval, 0.743-0.856; P < .001). Both groups showed significant positive correlations between percentage of maximal score achieved and excellent satisfaction (r = 0.396 for SST score [P < .001] and r = 0.325 for ASES score [P < .001]). Younger age was the only independent predictor for achieving the SST score threshold. No independent predictors existed for the ASES score threshold. CONCLUSION Achievement of 72.1% of maximal SST score improvement and achievement of 75.6% of maximal ASES score improvement represent thresholds for achievement of excellent satisfaction after TSA. Most preoperative factors did not have an impact on the likelihood of achieving these thresholds.
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Affiliation(s)
| | - Dhanur Damodar
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Ellie A Moeller
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Brandon Horn
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA; Witham Orthopaedic Associates, Lebanon, IN, USA
| | - Dragomir Mijic
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
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Sirveaux F. Reconstruction techniques after proximal humerus tumour resection. Orthop Traumatol Surg Res 2019; 105:S153-S164. [PMID: 29958931 DOI: 10.1016/j.otsr.2018.04.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 02/02/2023]
Abstract
Reconstruction of the proximal humerus after tumour resection is a surgical challenge. The goal consists not only in reconstructing the resected bone segment, but also in restoring a stable and mobile shoulder. The choice of the technique depends on the status of the soft-tissues at the end of the resection. The preoperative work-up must determine the oncological goals of the resection and identify the structures that can be spared. When deltoid muscle function is preserved, a reverse prosthesis offers the best stability and mobility outcomes. The objective of this work is to describe the indications and techniques used in the various available reconstruction methods. Shoulder mobilities are restored using some of these methods and lost with others. Emphasis is put on the reverse shoulder prosthesis, with a description of its variants (standard prosthesis, cement sleeve, allograft-prosthesis composite, and massive prosthesis) and a discussion of the management of its early complications. When performing reverse shoulder arthroplasty, glenoid implant preparation and positioning are crucial to achieve stability, and humeral length restoration will govern soft-tissue tension. Latissimus dorsi tendon transfer is required to restore active external rotation if the posterior rotator cuff tendons have been removed. Allograft-anatomic prosthesis composites, osteo-cartilaginous allografts, arthrodesis, and spacer prostheses are proposed for patients in whom the local conditions preclude implantation of a reverse shoulder prosthesis.
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Affiliation(s)
- François Sirveaux
- CHRU, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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22
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Abstract
A variety of reasons exist for failure of arthroplasty performed for management of proximal humerus fracture. Revision surgery for these failures is complex and has a high likelihood of inferior outcomes compared with primary arthroplasty. Successful management requires consideration of various modes of failure including tuberosity malunion or resorption, rotator cuff deficiency, glenoid arthritis, bone loss, component loosening, stiffness, or infection. Although revision to a reverse shoulder arthroplasty is an appealing option to address instability, rotator cuff dysfunction, and glenoid arthritis, there are concerns with higher complication rates and inferior results compared with primary reverse replacement. Any treatment plan should appropriately address the cause for failure to optimize outcomes.
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23
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Options of bipolar muscle transfers to restore deltoid function: an anatomical study. Surg Radiol Anat 2018; 41:911-919. [DOI: 10.1007/s00276-018-2159-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Boutsiadis A, Lenoir H, Denard PJ, Panisset JC, Brossard P, Delsol P, Guichard F, Barth J. The lateralization and distalization shoulder angles are important determinants of clinical outcomes in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:1226-1234. [PMID: 29602633 DOI: 10.1016/j.jse.2018.02.036] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) designs vary in the lateralization and distalization geometry, which may affect functional outcomes. The purpose was to determine the effect of RSA lateralization and distalization on final functional outcomes by using the "lateralization shoulder angle" (LSA) and the "distalization shoulder angle" (DSA). METHODS Forty-six consecutive patients who underwent RSA for cuff tear arthropathy were retrospectively evaluated. Functional outcome and radiographs were evaluated at a minimum of 2 years postoperatively and compared between implants with or without glenoid lateralization and with or without humeral-sided lateralization. Anteroposterior shoulder radiographs were used to evaluate the LSA and DSA. RESULTS Both angles showed substantial to almost perfect intrarater and inter-rater agreement. Higher LSA values were found in more lateralized RSAs (P = .027), and values between 75° and 95° were correlated with better active external rotation (quadratic regression analysis R2 = 0.553, P < .001). Postoperative active anterior elevation (R2 = 0.2, P = .008), Constant (rs = 0.29, P = .05), and Activities of Daily Living Requiring External Rotation scores (rs = 0.4 P = .007) had a positive correlation with the LSA. The quadratic regression analysis also showed that a DSA between 40° and 65° resulted in better active anterior elevation (R2 = 0.4, P < .001) and abduction (R2 = 0.4, P < .001). The negative correlation between the LSA and DSA (rs = -0.7, P < .001) revealed that, according to the implant used, the more distally the RSA is placed the less lateralization is achieved. CONCLUSIONS The LSA and the DSA are reproducible measurements that may be used to estimate "lateralization and distalization" after RSA. These measurements are correlated with postoperative clinical outcomes.
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Affiliation(s)
- Achilleas Boutsiadis
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Hubert Lenoir
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | - Jean-Claude Panisset
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Paul Brossard
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Philippe Delsol
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Frédéric Guichard
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France.
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25
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Lopiz Y, Rodriguez-González A, Martín-Albarrán S, Marcelo H, García-Fernández C, Marco F. Injury to the axillary and suprascapular nerves in rotator cuff arthropathy and after reverse shoulder arthroplasty: a prospective electromyographic analysis. J Shoulder Elbow Surg 2018; 27:1275-1282. [PMID: 29475786 DOI: 10.1016/j.jse.2017.12.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. METHODS Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. RESULTS Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN. CONCLUSIONS Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery.
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Affiliation(s)
- Yaiza Lopiz
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.
| | - Alberto Rodriguez-González
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Susana Martín-Albarrán
- Department of Clinical Neurophysiology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Hector Marcelo
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain
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Abstract
Since the introduction of reverse total shoulder arthroplasty (RTSA) in 1987 (in Europe) and 2004 (in the United States), the number of RTSAs performed annually has increased. Although the main indication for RTSA has been rotator cuff tears, indications have expanded to include several shoulder conditions, many of which involve dysfunction of the rotator cuff. RTSA complications have been reported to affect 19% to 68% of patients and include acromial fracture, haematoma, infection, instability, mechanical baseplate failure, neurological injury, periprosthetic fracture and scapular notching. Current controversies in RTSA include optimal baseplate positioning, humeral neck-shaft angle (135° versus 155°), glenosphere placement (medial, lateral or bony increased offset RTSA) and subscapularis repair. Improvements in prosthesis design, surgeon experience and clinical results will need to occur to optimize this treatment for many shoulder conditions.
Cite this article: EFORT Open Rev 2018;3:58–69 DOI: 10.1302/2058-5241.3.170044
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedics and Traumatology, Villa del Sole Clinic, Italy
| | - Jorge Rojas
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, USA
| | - Mahmut Nedim Doral
- Department of Orthopaedics and Traumatology, Hacettepe University, Turkey
| | - Gazi Huri
- Department of Orthopaedics and Traumatology, Hacettepe University, Turkey
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, USA
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27
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Lädermann A, Tay E, Scheibel M. Subscapularis-On Approach in Reverse Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2018. [DOI: 10.1177/2471549218808818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using a subscapularis- and deltoid-preserving anterior approach is an option for patients undergoing reverse shoulder arthroplasty. Outcomes are better at short term than compared with the standard deltopectoral approach. Maintaining the integrity of the subscapularis tendon and preserving the deltoid muscle minimizes the need for postoperative immobilization and rehabilitation, allowing the patient to achieve active shoulder range of motion more rapidly, without increasing the incidence of shoulder dislocation. Overall length of hospital stay and duration of postoperative physical therapy are minimized, leading to significant economic gain. Future studies with longer follow-up are required to document the potential long-term benefits of this surgical technique. Level of Evidence of the study: Review, Level IV
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Eileen Tay
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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28
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Pre-operative factors influence the recovery of range of motion following reverse shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 41:2135-2142. [DOI: 10.1007/s00264-017-3573-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/30/2017] [Indexed: 11/25/2022]
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Essilfie A, McKnight B, Heckmann N, Rick Hatch GF, Omid R. Revision reverse total shoulder arthroplasty in a patient with preoperative deltoid insufficiency: a case report. J Shoulder Elbow Surg 2017. [PMID: 28622984 DOI: 10.1016/j.jse.2017.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Anthony Essilfie
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
| | - Braden McKnight
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - George F Rick Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Reza Omid
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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Valenti P, Maqdes A, Werthel JD. Clinical and radiological outcomes after reverse shoulder arthroplasty in patients with failed deltoid or latissimus dorsi transfers. A review of ten cases. INTERNATIONAL ORTHOPAEDICS 2017; 41:2143-2148. [DOI: 10.1007/s00264-017-3520-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/14/2017] [Indexed: 11/24/2022]
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Chalmers BP, Wagner ER, Sperling JW, Cofield RH, Sanchez-Sotelo J. Treatment and Outcomes of Reverse Shoulder Arthroplasty Dislocations. J Shoulder Elb Arthroplast 2017. [DOI: 10.1177/2471549217695260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brian P Chalmers
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Eric R Wagner
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - John W Sperling
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Robert H Cofield
- Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota, MN, USA
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Reverse shoulder arthroplasty after radial-to-axillary nerve transfer for axillary nerve palsy with concomitant irreparable rotator cuff tear. J Shoulder Elbow Surg 2017; 26:e23-e28. [PMID: 27939281 DOI: 10.1016/j.jse.2016.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
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Garofalo R, Flanagin B, Castagna A, Calvisi V, Krishnan SG. Massive irreparable rotator cuff tear and associated deltoid tear. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment? J Orthop Sci 2016; 21:753-758. [PMID: 27559023 DOI: 10.1016/j.jos.2016.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/11/2016] [Accepted: 07/19/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Rupture of the anterior and middle deltoid muscle associated with rotator cuff tear arthropathy (RCA) could result in a definitive loss of shoulder function. The purpose of this study was to evaluate clinical outcomes after a concomitant reverse shoulder arthroplasty (RSA) and deltoid repair under these circumstances. MATERIALS AND METHODS Between 2006 and 2012, 18 consecutive patients with a mean age of 69.7 years, affected by massive irreparable rotator cuff tear and associated dehiscence or rupture of anterior and middle deltoid muscle underwent this operation through a modified anterosuperior approach. Four patients referred a previous shoulder surgery and deltoid tear was iatrogenic. The other 14 cases had an attritional deltoid tears. The average follow-up was 64 months (range 25-121 months). RESULTS The mean active anterior elevation passed from a preoperative mean of 53 ± 9.1 (range 45-70) to 132.7 ± 11.6° (85-155°), active external rotation passed from a preoperative mean value of 22.4 ± 3.6° (range 18-26) to an average of 33.7 ± 4.7° (range 30-40°). Mean Constant score increased from 42 ± 6.1 (range 31-51) pre-operatively to 72.3 ± 8.2 (range 57-82) post-operatively. At final review, deltoid contour subjectively was satisfactory to all patients with no palpable defects. CONCLUSION RSA associated with a repair of deltoid tear could be a viable surgical option in cases of tear involving the anterior and middle deltoid associated with a RCA. Patient with a preoperative chronic axillary nerve neuropathy associated with a deltoid muscle tear should be cautioned about the possibility of lower functional outcomes.
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Affiliation(s)
- Raffaele Garofalo
- Upper Limb Unit, F Miulli Hospital, Acquaviva delle Fonti, BA, Italy.
| | - Brody Flanagin
- The Shoulder Center, Baylor University Medical Center at Dallas, USA.
| | | | - Vittorio Calvisi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy
| | - Sumant G Krishnan
- The Shoulder Center, Baylor University Medical Center at Dallas, USA.
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Alta TDW, Willems WJ. Once an arthrodesis, always an arthrodesis? J Shoulder Elbow Surg 2016; 25:232-7. [PMID: 26344871 DOI: 10.1016/j.jse.2015.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/28/2015] [Accepted: 07/08/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND An arthrodesis of the shoulder is historically a solution for severe shoulder joint problems, for which no prosthetic solution is deemed possible. With the introduction of the reverse shoulder arthroplasty (RSA), which is intrinsically stable at the glenohumeral joint, it seems logical to consider conversion of a painful arthrodesis into a RSA, provided that the deltoid was not destroyed during the arthrodesis. METHODS Four patients (2 men, 2 women; age 46-66 years) with a longstanding arthrodesis (5-11 years) visited our clinic with a painful shoulder (mainly around the scapula) with the request to provide more mobility. In all, the shoulder was fused in 60° to 80° of abduction, 20° to 40° of flexion, and 40° to 50° of internal rotation. All patients refused an osteotomy as treatment for the pain. A preoperative electromyelogram showed activity in at least the posterior or middle parts of the deltoid, or both. They were offered revision of arthrodesis to a reverse prosthesis. All complications, especially instability, were discussed. Surgery was performed through the previous deltopectoral scar. In 3 cases, the osteotomy was lateral to the original joint line, providing some lateralization. RESULTS Follow-up was 22 to 60 months. The Constant-Murley score improved from 15-21 to 30-60. No dislocations occurred. All patients were satisfied, especially with the increased, although not impressive, rotations. Pain did not disappear but decreased considerably, from visual analog scale 8-10 to 0-4. CONCLUSION Conversion into a RSA is a safe procedure in patients with a painful arthrodesis and grossly intact deltoid, providing better glenohumeral mobility (especially rotations), leading to improved patient satisfaction.
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Affiliation(s)
| | - W Jaap Willems
- Orthopaedic Clinic "de Lairesse", Amsterdam, The Netherlands
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Phadnis J, Huang T, Watts A, Krishnan J, Bain GI. Cemented or cementless humeral fixation in reverse total shoulder arthroplasty? Bone Joint J 2016; 98-B:65-74. [DOI: 10.1302/0301-620x.98b1.36336] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims To date, there is insufficient evidence available to compare the outcome of cemented and uncemented fixation of the humeral stem in reverse shoulder arthroplasty (RSA). Methods A systemic review comprising 41 clinical studies was performed to compare the functional outcome and rate of complications of cemented and uncemented stems in RSA. These included 1455 cemented and 329 uncemented shoulders. The clinical characteristics of the two groups were similar. Variables were compared using pooled frequency-weighted means and relative risk ratios (RR). Results Uncemented stems had a significantly higher incidence of early humeral stem migration (p < 0.001, RR 18.1, 95% confidence interval (CI) 5.0 to 65.2) and non-progressive radiolucent lines (p < 0.001, RR 2.4, 95% CI 1.7 to 3.4), but a significantly lower incidence of post-operative fractures of the acromion compared with cemented stems (p = 0.004, RR 14.3, 95% CI 0.9 to 232.8). There was no difference in the risk of stem loosening or revision between the groups. The cemented stems had a greater relative risk of infection (RR 3.3, 95% CI 0.8 to 13.7), nerve injury (RR 5.7, 95% CI 0.7 to 41.5) and thromboembolism (RR 3.9, 95% CI 0.2 to 66.6). The functional outcome and range of movement were equivalent in the two groups. Discussion RSA performed with an uncemented stem gives them equivalent functional outcome and a better complication profile than with a cemented stem. The natural history and clinical relevance of early stem migration and radiolucent lines found with uncemented stems requires further long-term study. Take home message: This study demonstrates that uncemented stems have at least equivalent clinical and radiographic outcomes compared with cemented stems when used for reverse total shoulder arthroplasty. Cite this article: Bone Joint J 2016;98-B:65–74
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Affiliation(s)
- J. Phadnis
- Brighton and Sussex University Hospitals, Preston
Road, Brighton, UK
| | - T. Huang
- The Second Xiangya Hospital of Central
South University Changsha, Hunan Province, P.R., China
| | - A. Watts
- Repatriation General Hospital,
B-Block, Level 1, 216
Daws Road, Daw Park Adelaide, South, Australia
| | | | - G. I. Bain
- Flinders University, Adelaide, SA, Australia
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Cáceres-Sánchez L, Mesa-Mateo A, Barrionuevo-Sánchez F, García-Benítez B, Expósito-Triano S. Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rudge WBJ, Sewell MD, Al-Hadithy N, Wallace CN, Lambert SM. Shoulder linked arthroplasty in patients with obstetric brachial plexus palsy can improve quality of life and function at short-term follow-up. J Shoulder Elbow Surg 2015; 24:1473-80. [PMID: 25958212 DOI: 10.1016/j.jse.2015.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/26/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with obstetric brachial plexus palsy (OBPP) are prone to develop degenerative shoulder disease at a younger age than the general population. To date, no reports have been published on the complexities or outcome of shoulder arthroplasty (SA) in this unique patient group. METHODS We reviewed of 9 SAs in 9 patients (3 men and 6 women) with OBPP with mean follow-up 5.1 years (range, 2.6-7.6 years). Patients were a mean age of 29 years (range, 16-56 years). Patients had undergone a mean of 3 previous operations (range, 2-6). All patients underwent linked constrained SA. RESULTS The mean Oxford Shoulder Score increased from 8 (range, 3-10) preoperatively to 21 (range, 12-32) at the final follow-up (P < .001) predominantly due to pain relief. Mean range of active forward elevation and abduction improved from 35° and 39° to 46° and 45°, respectively. Patients improved significantly in 2 of 8 Short-Form 36-Item health-related quality of life domains, bodily pain (P = .013) and mental health (P = .035), and the overall physical component summary score (P = .006). Range of motion had mild improvements. Three required reoperation (33%), comprising 1 excision of heterotopic ossification, 1 trimming of a prominent screw, and 1 deltoid rupture repair. CONCLUSIONS SA is effective at relieving pain and health-related quality of life for young patients with OBPP; however, compared with the general population, the complication rate is high and functional gains are small.
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Affiliation(s)
- Will B J Rudge
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, UK
| | - Mathew David Sewell
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, UK
| | - Nawfal Al-Hadithy
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, UK.
| | - Charles N Wallace
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, UK
| | - Simon M Lambert
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, UK
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Lädermann A, Gueorguiev B, Charbonnier C, Stimec BV, Fasel JHD, Zderic I, Hagen J, Walch G. Scapular Notching on Kinematic Simulated Range of Motion After Reverse Shoulder Arthroplasty Is Not the Result of Impingement in Adduction. Medicine (Baltimore) 2015; 94:e1615. [PMID: 26402829 PMCID: PMC4635769 DOI: 10.1097/md.0000000000001615] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Impingement after reverse shoulder arthroplasty (RSA) is believed to occur from repetitive contact in adduction between the humeral component and the inferior scapular pillar. The primary purpose of this biomechanical study was to confirm the presence of different types of impingement and to examine which daily-life movements are responsible for them. A secondary aim was to provide recommendations on the type of components that would best minimize notching and loss of range of motion (ROM). The study included 12 fresh frozen shoulder specimens; each had a computed tomography (CT) image of the entire scapula and humerus in order to acquire topological information of the bones before RSA implantation. Cyclic tests were run postimplantation with 3 shoulders in each modalities. To quantify bone loss due to impingement, 3-dimensional anatomical models of the scapula were reconstructed from the CT scans and compared to their intact states. We found 8 bony impingements in 7 specimens: 2 at the lateral acromion, 1 at the inferior acromion, 4 scapular notching, and 1 with the glenoid resulting to wear at the 3:00 to 6:00 clock-face position. Impingements occurred in all kinds of tested motions, except for the internal/external rotation at 90° of abduction. The 3 specimens tested in abduction/adduction presented bone loss on the acromion side only. Scapular notching was noted in flexion/extension and in internal/external rotation at 0° of abduction. The humeral polyethylene liner was worn in 2 specimens--1 at the 6:00 to 8:00 clock-face position during internal/external rotation at 0° of abduction and 1 at the 4:00 clock-face position during flexion/extension. The present study revealed that 2 types of impingement interactions coexist and correspond to a frank abutment or lead to a scapular notching (friction-type impingement). Scapular notching seems to be caused by more movements or combination of movements than previously considered, and in particular by movements of flexion/extension and internal/external rotation with the arm at the side. Polyethylene cups with a notch between 3 and 9 o'clock and lower neck-shaft angle (145° or 135°) may play an important role in postoperative ROM limiting scapular notching.
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Affiliation(s)
- Alexandre Lädermann
- From the Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin (AL); Faculty of Medicine, University of Geneva (AL); Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva (AL); AO Research Institute Davos, Davos (BG, IZ, JH); Artanim Foundation, Medical Research Department (CC); Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland (BVS, JHF); and Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital GDS, Lyon, France (GW)
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Postacchini R, Paoloni M, Carbone S, Fini M, Santilli V, Postacchini F, Mangone M. Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty. J Biomech 2015. [PMID: 26194874 DOI: 10.1016/j.jbiomech.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.
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Affiliation(s)
- Roberto Postacchini
- Department of Orthopedic Surgery, Israelitic Hospital, Italian University Sport and Movement, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.
| | - Stefano Carbone
- Department of Orthopedic Surgery, Sapienza University, Rome, Italy
| | | | - Valter Santilli
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy
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[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:439-46. [PMID: 26004517 DOI: 10.1016/j.recot.2015.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/15/2014] [Accepted: 02/06/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. MATERIAL AND METHOD A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. RESULTS After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. DISCUSSION AND CONCLUSIONS After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock.
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Abstract
The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three- and four-part proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Inferior results with plate osteosynthesis are often a result of complications of humeral head osteonecrosis, loss of fixation, and screw penetration through the humeral head, whereas major concerns with hemiarthroplasty are tuberosity resorption, malunion, and nonunion resulting in pseudoparalysis. Comparative studies support the use of reverse shoulder arthroplasty in elderly patients with complex proximal humerus fractures because the functional outcomes and relief of pain are reliably improved. Repair and union of the greater tuberosity fragment during reverse shoulder arthroplasty demonstrates improved external rotation, clinical outcomes, and patient satisfaction compared with outcomes after tuberosity resection, nonunion, or resorption. Satisfactory results can be obtained with careful preoperative planning and attention to technical details.
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Bonnevialle N, Mansat P, Lebon J, Laffosse JM, Bonnevialle P. Reverse shoulder arthroplasty for malignant tumors of proximal humerus. J Shoulder Elbow Surg 2015; 24:36-44. [PMID: 24927883 DOI: 10.1016/j.jse.2014.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/31/2014] [Accepted: 04/08/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) provides an alternative for shoulder girdle reconstruction after wide transarticular resection of the proximal humerus for malignant tumor. The aim of this study was to evaluate midterm outcomes of this therapeutic option. METHODS Ten patients with RSA were included and reviewed with 24 months of minimum follow-up. Proximal resection of malignant tumor included the "V" deltoid insertion in 4 patients. The humeral stem was coated (with an allograft in 2 patients and a cement mantel in 3) or left uncoated (5 patients). RESULTS At a mean follow-up of 42 months, among 8 prosthesis available for evaluation (2 patients died), the Constant and Murley score averaged 52 points, the 11-item version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score averaged 29.5 points, the Subjective Shoulder Value averaged 58%, and the Musculoskeletal Tumor Society score averaged 20.25 points. Mean forward active elevation reached 122°, external rotation at side was -2°, and internal rotation was to L4. Three prostheses were unstable. The involvement of "V" deltoid insertion at surgery trended to worsen the clinical outcome. Atrophy of the anterior deltoid occurred in most of patients who had a previous transdeltoid biopsy. Radiographic evaluation found 1 stem loosening, 1 stem at risk, and 3 scapular notches without glenoid loosening. CONCLUSION Use of RSA after resection of a malignant tumor of the proximal humerus seems to be an acceptable option to preserve function. However, radiographic evolution is worrisome, and long-term study remains necessary to validate this therapeutic option with follow-up.
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Affiliation(s)
- Nicolas Bonnevialle
- Service d'Orthopédie-Traumatologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France.
| | - Pierre Mansat
- Service d'Orthopédie-Traumatologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Julie Lebon
- Service d'Orthopédie-Traumatologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Jean-Michel Laffosse
- Service d'Orthopédie-Traumatologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Paul Bonnevialle
- Service d'Orthopédie-Traumatologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
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Middleton C, Uri O, Phillips S, Barmpagiannis K, Higgs D, Falworth M, Bayley I, Lambert S. A reverse shoulder arthroplasty with increased offset for the treatment of cuff-deficient shoulders with glenohumeral arthritis. Bone Joint J 2014; 96-B:936-42. [DOI: 10.1302/0301-620x.96b7.32946] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p < 0.001). The mean pain at rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p < 0.001). The mean active forward elevation and external rotation increased from 42°(sd 30) and 9° (sd 15) respectively pre-operatively to 78° (sd 39) and 24° (sd 17) post-operatively (p < 0.001). A total of 20 patients required further surgery for complications; 13 required revision of components. No patient developed scapular notching. The Bayley–Walker prosthesis provides reliable pain relief and reasonable functional improvement for patients with symptomatic cuff-deficient shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time. Cite this article: Bone Joint J 2014;96-B:936–42.
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Affiliation(s)
- C. Middleton
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - O. Uri
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. Phillips
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - K. Barmpagiannis
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - D. Higgs
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - M. Falworth
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - I. Bayley
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. Lambert
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
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Arm lengthening after reverse shoulder arthroplasty: a review. INTERNATIONAL ORTHOPAEDICS 2013; 38:991-1000. [PMID: 24271331 DOI: 10.1007/s00264-013-2175-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/28/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications. METHODS Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I-IV relevant to search terms. RESULTS Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent. CONCLUSIONS Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.
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