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DeBernardis DA, Zhang T, Duong A, Fleckenstein CM, Almasri M, Hasan SS. Total shoulder arthroplasty in patients aged 80 years and older: a systematic review. J Shoulder Elbow Surg 2024; 33:425-434. [PMID: 37696486 DOI: 10.1016/j.jse.2023.08.003] [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: 03/20/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older. METHODS A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating the outcomes of primary and revision anatomic (aTSA) and reverse (RSA) total shoulder arthroplasty in patients 80 years and older were included for analysis. RESULTS A total of 15 studies evaluating 1685 primary aTSAs, 1170 primary RSAs, 69 RSAs performed for fracture, and 45 revision RSAs were included for review. The postoperative active forward flexion and external rotation ranged from 138° to 150° and 45° to 48° after aTSA and from 83° to 139° and 16° to 47° after RSA, respectively. Postoperative visual analog scale pain scores ranged from 0 to 1.8 after aTSA and from 0 to 1.4 after RSA. Ninety-day mortality ranged from 0% to 3%, and perioperative complications ranged from 0% to 32%. Late complications ranged from 5.6% to 24% for aTSA patients and 3.5% to 29% for patients undergoing RSA for all indications. Common complications included glenoid loosening (0%-18%) and rotator cuff tear (5.6%-10%) after aTSA and scapular notching (0%-40%) and scapular fracture (4%-9.4%) after RSA. Reoperation rates ranged from 0% to 6% after aTSA and from 0% to 13% after RSA. CONCLUSIONS aTSA and RSA in this population are safe and effective, demonstrating low rates of perioperative mortality and reoperation, durability that exceeds patient longevity, satisfactory postoperative range of motion, and excellent pain relief. Late complication rates appear to be similar for aTSA and RSA.
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Affiliation(s)
- Dennis A DeBernardis
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA; OrthoCincy, Edgewood, KY, USA
| | - Ting Zhang
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cassie M Fleckenstein
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Mahmoud Almasri
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA.
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Dragonas CG, Mamarelis G, Dott C, Waseem S, Bajracharya A, Leivadiotou D. Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis. J Shoulder Elb Arthroplast 2023; 7:24715492231206685. [PMID: 37808225 PMCID: PMC10559711 DOI: 10.1177/24715492231206685] [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: 06/16/2023] [Revised: 08/14/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear. Materials and Methods We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO. Results From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001]. Conclusion Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.
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Affiliation(s)
- Christos G. Dragonas
- Department of Trauma and Orthopaedics, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Georgios Mamarelis
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health Trust, London, UK
| | - Cameron Dott
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health Trust, London, UK
| | - Saima Waseem
- Department of Trauma and Orthopaedics, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Abhijit Bajracharya
- Department of Trauma and Orthopaedics, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Dimitra Leivadiotou
- Department of Trauma and Orthopaedics, Princess Alexandra Hospital NHS Trust, Harlow, UK
- Department of Trauma and Orthopaedics, Rivers Hospital, Sawbridgeworth, UK
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Italia K, Jomaa M, Pareyon R, Hollman F, Cutbush K, Gupta A. Outcomes and survivorship of anatomic total shoulder arthroplasty: current concepts. J ISAKOS 2023; 8:284-288. [PMID: 37100117 DOI: 10.1016/j.jisako.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Total shoulder arthroplasty (TSA) has been the gold standard of care for end-stage glenohumeral arthritis. Outcomes are varied and have been affected by both patient and implant characteristics. Patient factors, such as age, preoperative diagnosis, and preoperative glenoid morphology, can affect the outcomes after TSA. Similarly, the different glenoid and humeral component designs significantly affect the survivorship of TSA. Significant evolution has occurred in the design of the glenoid component with the aim of decreasing the glenoid-sided causes of failure in TSA. On the other hand, focus on the humeral component has been increasing as well, with a trend towards using shorter humeral stems. This article aims to look at the outcomes of TSA as affected by the various patient characteristics and design options for the glenoid and the humeral components. This review also aims to compare survivorship data from global literature and the Australian joint replacement registry and to provide insights into the implant combination that may provide the best patient outcome.
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Affiliation(s)
- Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Queensland, 4000, Australia.
| | - Mohammad Jomaa
- Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Queensland, 4000, Australia; Greenslopes Private Hospital, Brisbane, Queensland, 4120, Australia; St Andrew's War Memorial Hospital, Brisbane, Queensland, 4000, Australia
| | - Roberto Pareyon
- Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Queensland, 4000, Australia; Greenslopes Private Hospital, Brisbane, Queensland, 4120, Australia; St Andrew's War Memorial Hospital, Brisbane, Queensland, 4000, Australia
| | - Freek Hollman
- Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Queensland, 4000, Australia; Greenslopes Private Hospital, Brisbane, Queensland, 4120, Australia; St Andrew's War Memorial Hospital, Brisbane, Queensland, 4000, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Queensland, 4000, Australia; St Andrew's War Memorial Hospital, Brisbane, Queensland, 4000, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, Queensland, 4000, Australia; Greenslopes Private Hospital, Brisbane, Queensland, 4120, Australia
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Su F, Nuthalapati P, Feeley BT, Lansdown DA. Outcomes of anatomic and reverse total shoulder arthroplasty in patients over the age of 70: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:181-188. [PMID: 37588441 PMCID: PMC10426543 DOI: 10.1016/j.xrrt.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Both anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably improve pain and function for a variety of indications. However, there remain concerns about these procedures among elderly patients due to their general health, the potential for lesser functional gain, and the possible need for revision at an even older age. The purpose of this review is to compare the clinical outcomes, radiographic outcomes, and complications of ATSA and RTSA among patients older than 70 years. Methods A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. The inclusion criteria were studies with patients older than 70 years who were treated with a primary ATSA or RTSA and clinical results reported at a minimum of 2 years. All indications for primary RTSA except for tumor were included. Outcomes of interest included patient-reported outcomes (PROs), range of motion, patient satisfaction, radiographic changes, complication and revision rates, and implant survival. Results A total of 24 studies met the inclusion criteria. At a mean follow-up of 3.4 years for ATSA and 3.1 years for RTSA, there were significant improvements in pain, range of motion, and PROs for both prostheses. Patients who underwent ATSA generally had better motion and functional outcomes compared to those who underwent RTSA, though these comparisons were made across different indications for arthroplasty. The satisfaction rate was 90.9% after ATSA and 90.8% after RTSA. Furthermore, 10.2% of ATSA patients and 9.9% of RTSA patients experienced a surgical complication, whereas 2.3% of ATSA and 2.2% of RTSA patients underwent a revision. Secondary rotator cuff tear was the most common complication after ATSA, occurring in 3.7% of patients, but only 1.1% of patients required revision surgery. Both ATSA and RTSA implant survivorship was reported to range from 93.1% to 98.9% at 5- and 8-year follow-up, respectively. Patient mortality was estimated to be 19.3% with a mean time to death of 6.1 years. Conclusions Elderly patients with primary osteoarthritis and an intact rotator cuff can have predictable pain relief, restoration of functional range of motion, and significant improvement in PROs after ATSA with low complication rates. Secondary rotator cuff failure and revision arthroplasty occur infrequently at early to mid-term follow-up. Although elderly patients who underwent ATSA generally had better functional outcomes compared to those who underwent RTSA for differing indications, patient satisfaction after both procedures were similar.
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Affiliation(s)
- Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Drew A. Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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White CA, Duey A, Zaidat B, Li T, Quinones A, Cho SK, Kim JS, Cagle PJ. Does age at surgery influence short-term outcomes and readmissions following anatomic total shoulder arthroplasty? J Orthop 2023; 37:69-74. [PMID: 36974091 PMCID: PMC10039114 DOI: 10.1016/j.jor.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/30/2022] [Accepted: 02/15/2023] [Indexed: 03/29/2023] Open
Abstract
Background Increasing age has been associated with adverse outcomes in various orthopedic procedures including anatomic total shoulder arthroplasty (aTSA). Moreover, both indications and the ages at which the procedure is done has expanded. For these reasons, it is important to characterize the impact age has on complication and readmission rates following shoulder replacement. Methods The National Readmissions Database was used to identify patients who underwent aTSA between the years 2016-2018. Patients were stratified into five cohorts based on age at surgery: 18-49, 50-59, 60-69, 70-79, and 80+ years old. We analyzed and compared data related to patient demographics, length of stay, readmission and complication rates, and healthcare charges. A multivariate analysis was used to identify the independent impact of age on complication rates. Results 42,505 patients were included with 1,541, 6,552, 16,364, 14,694, 3,354, patients in the 18-49, 50-59, 60-69, 70-79, and 80+ years old cohorts respectively. Length of stay had a stepwise increase with age increases (p < 0.001), however total charges were comparable between cohorts (p = 0.40). Older patients were more likely to experience intraoperative complications, pulmonary embolism complications, and postoperative infection, but were less likely to experience hardware, surgical site, and prosthetic joint complications. Older patients had higher rates of readmission. Age was an independent predictor for higher 30-/90-day readmission, postoperative/intraoperative complication, and respiratory complication rates. Increasing age provided a protective measure for prosthetic complications surgical site infection. Conclusion This study identified multiple differences in complication rates following aTSA based on age at surgery. Overall, age had varying effects on intraoperative and postoperative complication rates at short-term follow-up. However, increasing age was associated with longer lengths of stay and increased readmission rates. Surgeons should be aware of the identified complications that are most prevalent in each age group and use this information to avoid adverse outcomes following shoulder replacement surgery.
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Affiliation(s)
- Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Akiro Duey
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Bashar Zaidat
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Troy Li
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Addison Quinones
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Jun S. Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
| | - Paul J. Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York, NY, 10019, USA
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Baumgarten KM. Is stemless total shoulder arthroplasty indicated in elderly patients? J Shoulder Elbow Surg 2023; 32:260-268. [PMID: 36162630 DOI: 10.1016/j.jse.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Stemmed anatomic total shoulder arthroplasty has represented the gold standard for the treatment of glenohumeral osteoarthritis with an intact rotator cuff for decades. To the author's knowledge, no study has specifically examined the outcomes of stemless, modular total shoulder arthroplasty in elderly patients. The hypothesis of this study was that stemless anatomic total shoulder arthroplasty in elderly patients (age ≥70 years) would have equivalent clinical and radiographic outcomes compared with a younger population (age <70 years). MATERIALS AND METHODS A prospectively collected database of patients undergoing primary, modular, stemless anatomic total shoulder arthroplasty for osteoarthritis was retrospectively reviewed. Patient-determined outcomes including the Western Ontario Osteoarthritis Index (WOOS) score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Simple Shoulder Test score, and Shoulder Activity Level score were recorded preoperatively and postoperatively at 1 year and 2 years. Preoperative and 1-year postoperative range of motion was recorded. Postoperative radiographs were examined to assess for radiographic evidence of complications. RESULTS Stemless arthroplasty was planned in 116 patients. Seven patients underwent conversion intraoperatively to a stemmed prosthesis. There was no difference between patients aged <70 yr and those aged ≥70 years who required intraoperative deviation from the preoperative plan to a stemmed prosthesis (5.8% vs 6.4%, P = .90). At the time of stemless arthroplasty, 64 patients were aged <70 yr and 44 patients were aged ≥70 years. Between the 2 groups, there were no clinically or statistically significant differences in WOOS, ASES, and SANE scores at baseline, 1-year follow-up, or 2-year follow-up. The changes in all scores from baseline to 2 years were similar between the group aged <70 yr and the group aged ≥70 years. There was no difference in the percentage of patients achieving the minimal clinically important difference or substantial clinical benefit in either group after shoulder arthroplasty at 2-year follow-up. There was no difference between the 2 groups in terms of final postoperative range of motion or change in range of motion for any metric examined. There was no evidence of radiographic complications in either group. CONCLUSIONS Age ≥70 years does not appear to be a contraindication to stemless anatomic total shoulder arthroplasty. Postoperative improvements in patient-determined outcome scores, the percentage of patients achieving clinically important outcomes for the ASES, SANE, and WOOS scores, and postoperative range of motion were similar between patients aged <70 yr and those aged ≥70 years. There was no difference between the groups regarding the patients who required intraoperative deviation from the preoperatively planned stemless prosthesis to a stemmed prosthesis. Neither age group demonstrated a radiographically apparent complication.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Lee D, Lee R, Fassihi SC, Stadecker M, Heyer JH, Stake S, Rakoczy K, Rodenhouse T, Pandarinath R. Risk Factors for Blood Transfusions in Primary Anatomic and Reverse Total Shoulder Arthroplasty for Osteoarthritis. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:217-225. [PMID: 35821928 PMCID: PMC9210430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of this study was to determine risk factors for blood transfusion in primary anatomic and reverse total shoulder arthroplasty (TSA) performed for osteoarthritis. METHODS Patients who underwent anatomic or reverse TSA for a diagnosis of primary osteoarthritis were identified in a national surgical database from 2005 to 2018 by utilizing both CPT and ICD-9/ICD-10 codes. Univariate analysis was performed on the two transfused versus non-transfused cohorts to compare for differences in comorbidities and demographics. Independent risk factors for perioperative blood transfusions were identified via multivariate regression models. RESULTS 305 transfused and 18,124 nontransfused patients were identified. Female sex (p<0.001), age >85 years (p=0.001), insulin-dependent diabetes mellitus (p=0.001), dialysis dependence (p=0.001), acute renal failure (p=0.012), hematologic disorders (p=0.010), disseminated cancer (p<0.001), ASA ≥ 3 (p<0.001), and functional dependence (p=0.001) were shown to be independent risk factors for blood transfusions on multivariate logistic regression analysis. CONCLUSION Several independent risk factors for blood transfusion following anatomic/reverse TSA for osteoarthritis were identified. Awareness of these risk factors can help surgeons and perioperative care teams to both identify and optimize high-risk patients to decrease both transfusion requirements and its associated complications in this patient population. Level of Evidence: III.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Safa C. Fassihi
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Jessica H. Heyer
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Thomas Rodenhouse
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Rajeev Pandarinath
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
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Altintas B, Horan MP, Dornan GJ, Pogorzelski J, Godin JA, Millett PJ. The Recovery Curve of Anatomic Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis: Mid-term Results at a Minimum of 5 Years. JSES Int 2022; 6:587-595. [PMID: 35813142 PMCID: PMC9264145 DOI: 10.1016/j.jseint.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Excellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA. Methods Patients who underwent primary anatomic TSA over 5 years ago were included: Short-Form 12 Physical Component Summary, American Shoulder and Elbow Surgeons scores, Quick Disabilities of the Arm Shoulder and Hand Score, Single Assessment Numeric Evaluation, and patient satisfaction were assessed. Linear mixed-effects models were used to model progression in PROs longitudinally. Unadjusted models and models controlling for sex and age were constructed. Results Eighty-one patients (91 shoulders) were included. Significant improvements from the preoperative period to 1 year postoperatively in the median American Shoulder and Elbow Surgeons (48 to 93; P < .001), Quick Disabilities of the Arm Shoulder and Hand Score (42 to 11; P < .001), Single Assessment Numeric Evaluation (50 to 91; P < .001), and Short-Form 12 Physical Component Summary (35 to 53; P = .004) scores were noted. No significant decrease was observed for any of the outcome scores. Median satisfaction at the final follow-up was 10 out of 10. At 1, 2, 3, 4, 5, 6, and 7 years postoperatively, 77%, 64%, 79%, 57%, 86%, 56%, and 78% of patients, respectively, reported sports participation equal to or slightly below preinjury level. There was no association between the glenoid morphology and functional outcomes. Conclusion Patients undergoing anatomic TSA for primary GHOA showed excellent improvement in PROs and satisfaction in the first year, and these results were maintained postoperatively for a minimum of 5 years. Age- and sex-adjusted models or glenoid morphology did not substantially alter any trends in PROs postoperatively.
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Affiliation(s)
- Burak Altintas
- Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonathan A. Godin
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
- Corresponding author: Peter J. Millett, MD, MSc, Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
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Kim H, Kim CH, Kim M, Lee W, Jeon IH, Lee KW, Koh KH. Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis. J Orthop Traumatol 2022; 23:3. [PMID: 34993646 PMCID: PMC8738793 DOI: 10.1186/s10195-022-00625-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/01/2022] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. MATERIALS AND METHODS The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. RESULTS Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = - 10.28, 95% CI: - 16.69 to - 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06-0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73-65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07-1.57, P = 0.16). CONCLUSION A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. LEVEL OF EVIDENCE Level IV, Meta-analysis.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea
| | - Wonsun Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea
| | - Kwang Won Lee
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea.
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Shimada Y, Takahashi N, Sugaya H, Matsuki K, Tokai M, Hashimoto E, Ochiai N, Ohtori S. Clinical outcomes of anatomic total shoulder arthroplasty for primary shoulder osteoarthritis did not differ between elderly and younger Japanese patients. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:361-366. [PMID: 37588717 PMCID: PMC10426710 DOI: 10.1016/j.xrrt.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Few studies on the outcomes of anatomic total shoulder arthroplasty (aTSA) in Asian populations have been reported. In addition, approximately one-third of primary aTSA were performed for patients 80 years or older in Japan, but the indication of aTSA for the primary shoulder osteoarthritis in the elderly population remained unclear. The purposes of this study were (1) to investigate clinical outcomes of aTSA in Japanese patients with primary glenohumeral osteoarthritis and (2) to compare clinical outcomes between patients 80 years or older and 70 years or younger. We hypothesized that aTSA would yield favorable outcomes in Japanese patients and that the outcomes of aTSA in patients 80 years or older would be comparable to those 70 years or younger. Methods Patient records were retrospectively reviewed to collect patients who underwent aTSA for glenohumeral osteoarthritis between August 2011 and September 2017. The inclusion criterion of this study was aTSA performed for glenohumeral osteoarthritis. Exclusion criteria were as follows: (1) secondary osteoarthritis, (2) revision surgery, and (3) < 24-month follow-up. Range of motion (ROM) and Constant score were evaluated, and complications were investigated. Rotator cuff integrity was assessed by ultrasonography. We compared the outcomes between patients 80 years or older and 70 years or younger. Results Seventy-seven shoulders (72 patients) met the study criteria. There were 14 men and 58 women with a mean age of 75 years (range, 57-93 years) at the time of surgery. The mean follow-up was 40 months (range, 24-84 months). The Constant score significantly improved from preoperative 54 (range, 35-78) to postoperative 89 (range 69-100, P = .03). Range of motion also showed significant improvement after surgery: flexion, 90° (range, 60°-130°) to 140° (range, 90°-170°); external rotation at the side, from 7° (range, -10 to 60°) to 40° (range, 5°-70°); internal rotation, from buttock (range, buttock-L3) to L2 level (range, buttock-T8) (P <.001 for all). Postoperative subscapularis tendon tears were detected in 3 shoulders (5%). Complications other than rotator cuff tears were observed in 5 shoulders (6%). Postoperative Constant score and ROM significantly improved in both elderly and younger patients without significant differences. Conclusion The clinical outcomes after aTSA in the Japanese population demonstrated significant improvements in ROM and Constant score with a low complication rate in the mid-term follow-up. aTSA should be indicated even in elderly patients because they also demonstrated comparable outcomes to younger patients.
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Affiliation(s)
- Yohei Shimada
- Funabashi Orthopedic Sports Medicine & Joint Center, Funabashi, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan
| | | | | | - Keisuke Matsuki
- Funabashi Orthopedic Sports Medicine & Joint Center, Funabashi, Japan
| | - Morihito Tokai
- Tokyo Sports & Orthopaedic Clinic, Toshima, Tokyo, Japan
| | - Eiko Hashimoto
- Department of Orthopedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan
| | - Nobuyasu Ochiai
- Department of Orthopedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan
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Jensen AR, Tangtiphaiboontana J, Marigi E, Mallett KE, Sperling JW, Sanchez-Sotelo J. Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly. J Shoulder Elbow Surg 2021; 30:S131-S139. [PMID: 33484829 DOI: 10.1016/j.jse.2020.11.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relative indications of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) continue to evolve. Some surgeons favor RSA over TSA for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff due to fear of a postoperative (secondary) rotator cuff tear in this age group. However, RSA is associated with unique complications and a worse functional arc of motion compared with TSA. Therefore, it is important to understand the clinical outcomes and rates of revision surgery and secondary rotator cuff tears in elderly patients undergoing TSA. METHODS Between January 1, 2010, and December 31, 2017, 377 consecutive TSAs were performed for primary GHOA in 340 patients 70 years of age or older. The mean age at surgery was 76.2 years (standard deviation [SD], 4.9). Clinical evaluation included pain, motion, and American Shoulder and Elbow Surgeons score. Radiographs were reviewed for preoperative morphology and postoperative complications. All complications and reoperations were recorded. The average clinical follow-up time was 3.3 years (SD, 2.0). Statistical analyses were performed, and Kaplan-Meier implant survival estimates were calculated. For all analyses, a P value <.05 was considered statistically significant. RESULTS The mean pain visual analog scale and American Shoulder and Elbow Surgeons score at the final follow-up were 1.6 (SD, 2.2) and 78.0 (SD, 17.8), respectively. Forward elevation and external rotation increased from 96° (SD, 30°) and 26° (SD, 20°) preoperatively to 160° (SD, 32°) and 64° (SD, 26°) postoperatively (P < .001 for each). The percentage of patients who had internal rotation to L5 or greater increased from 24.8% preoperatively to 71.8% postoperatively (P < .001). Revision surgery was performed in 3 shoulders (0.8%), and the 5-year implant survival estimate was 98.9% (95% confidence interval: 97.3%-100%). There were 3 medical (0.8%), 10 minor surgical (2.7%), and 5 major surgical (1.3%) complications. No shoulder had radiographic evidence of humeral component loosening, whereas 7 (2%) had evidence of some degree of glenoid component loosening. In total, there were 5 secondary rotator cuff tears (1.3%), of which 2 (0.5%) required revision surgery. CONCLUSION Elderly patients with primary GHOA and an intact rotator cuff have excellent clinical and radiographic outcomes after anatomic TSA, with high implant survival rates and a low incidence of secondary rotator cuff tears in the first 5 postoperative years. Age greater than 70 by itself should not be considered an indication for RSA over TSA.
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Affiliation(s)
- Andrew R Jensen
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | | | - Erick Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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12
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Monir JG, Powers WK, King JJ, Wright TW, Schoch BS. Articular surface failure in hybrid anatomic glenoid components: a unique failure mechanism. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:787-793. [PMID: 34131831 DOI: 10.1007/s00590-021-03050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Glenoid loosening is a common failure mechanism of anatomic total shoulder arthroplasty (TSA). New hybrid fixation glenoids allow bony ingrowth and decrease the rates of glenoid loosening. The purpose of this study is to describe a new failure mode of polyethylene dissociation from the ingrowth cage in a single implant design. METHODS A retrospective review was performed using an institutional shoulder arthroplasty database of a single hybrid cage glenoid (Exactech, Gainesville, FL). Implants demonstrating this failure mechanism were investigated. RESULTS Five out of 206 (2.4%) primary TSAs with cage glenoids performed at our institution and 2 referred for revision suffered glenoid articular face failure. Mean age was 57 (range 38-67 years). Two of 7 failures (29%) occurred secondary to trauma. Failure occurred at mean 14 months after index arthroplasty (range 0-30 months). Revision occurred at mean 24 months after index arthroplasty (range 6-39 months). Six of the 7 patients (86%) had posteriorly augmented glenoids. All 6 patients who had available pre-failure radiographs demonstrated off-axis deviation between the peripheral pegs and central cage (mean 4.8°, range 3°-6°), which may predispose the implant to failure by pre-stressing the material interface. CONCLUSION Failure between the glenoid articular face and the central ingrowth cage is a unique failure mechanism to modular hybrid ingrowth glenoids. We hypothesize that this is predisposed by off-axis drilling leading to pre-stressing of the material interface. Surgeons should be aware of the existence of this failure mechanism, particularly when seeing patients with acute pain after an otherwise unproblematic TSA.
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Affiliation(s)
- Joseph G Monir
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - William K Powers
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopedics, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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13
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Short-stem uncemented anatomical shoulder replacement for osteoarthritis in patients older than 70 years: is it appropriate? JSES Int 2021; 5:656-662. [PMID: 34223411 PMCID: PMC8245993 DOI: 10.1016/j.jseint.2021.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite a new trend to systematically use reverse shoulder arthroplasty (RSA) in elderly population regardless of the indication, total anatomical shoulder arthroplasty can get good functional results in this population. The purpose of this study was to evaluate clinical and radiological outcomes of uncemented short-stem anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis in patients older than 70 years and to compare these results to a matched population with an uncemented short-stem RSA. Methods In this retrospective monocentric study, clinical outcomes were based on constant score (Cst), subjective shoulder value (SSV) score, and range of motion. The aim of radiographic analysis was to identify glenoid component loosening and humeral bone remodeling around the uncemented short stem. Results At an average follow-up of 44 ± 12.5 months, 32 uncemented short-stem TSA in 31 patients with a minimum of 2 years of follow-up were included and were compared to 32 uncemented RSA. Fifty three percent of the patients had “a forgotten prosthesis”. ROM was significantly improved in all cases. Cst reached 73 ± 9 pts and SSV 90 ± 10.8% (P < .001). In 8 patients with repairable supraspinatus tendon tears, clinical outcomes were not statistically different from patients with an intact rotator cuff: Cst (77 ± 6.2 points vs 72 ± 9.6 points, P = .3) and SSV (88 ± 11.5% vs. 91 ± 10.5%; P = .59). The type of glenoid wear (A vs B) did not influence the constant score: 73 ± 9 points versus 74 ± 11 points respectively; P = .81. Despite a complication rate of 6% (n = 2), no prosthesis revision was performed. At last follow-up, range of motion was better in the TSA group compared to the RSA group for internal (7.8 ± 1.3 vs 6.25 ± 2; P = .001) and external (47 ± 14 vs 24 ± 21; P < .001) rotations. The postoperative SSV score was also better in the TSA group (91.3 ± 10% vs 82.2 ± 13%; P = .002). Conclusions At medium-term, uncemented short-stem anatomic TSA in patients older than 70 years provided satisfactory clinical results. Patients have forgotten their prosthesis in over 50% of cases. This prosthetic design is still indicated in this patient population in case of primary osteoarthritis with a functional rotator cuff with an almost normal rotator cuff muscle trophicity.
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Kleim BD, Garving C, Brunner UH. RSA, TSA and PyC hemi-prostheses: comparing indications and clinical outcomes using a second-generation modular short-stem shoulder prosthesis. Arch Orthop Trauma Surg 2021; 141:1639-1648. [PMID: 33025070 PMCID: PMC8437863 DOI: 10.1007/s00402-020-03529-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The goal of this study was to provide an insight into the clinical results after modular short-stem shoulder arthroplasty for various indications. MATERIALS AND METHODS A consecutive cohort study of 76 patients followed up for 23-55 (mean 31.4) months. 23 anatomical (TSA), 32 reverse (RSA) and 21 hemi-prostheses with a pyrocarbon head (PyC), using a modular short stem with proximal porous coating were implanted. Range of motion, pain and Constant score (CS) were recorded. Comparisons of pre- vs postoperative outcomes, between prosthesis types and indications, were made. RESULTS All prosthesis types brought about a significant improvement (p < 0.05) in all measured outcomes. TSA had a significantly higher increase in the CS than PyC and RSA (p = 0.002 and 0.003, respectively). TSA produced superior gains in all ROM compared with RSA (p < 0.02). RSA brought about significantly smaller improvements in internal rotation than TSA and PyC (p = 0.0001 and 0.008, respectively). TSA had greater pain relief than PyC (p = 0.02). TSA with Walch A glenoids seemed to improve more than type B in the CS. PyC patients with Walch B glenoids improved more than Walch A (p = 0.03). When implanted due to Osteoarthritis (OA), PyC had a comparable final outcome to TSA (p = 0.95), although the preoperatively worse TSA patients had a greater improvement in the CS (p = 0.026). The outcome of RSA did not differ between indications, but Walch A glenoids tended to improve more. CONCLUSIONS Using a second-generation short-stem shoulder prostheses, TSA achieves the best clinical improvements overall, especially for OA with a Walch A glenoid. Despite refixation of the subscapularis tendon in all cases, RSA has inferior internal rotation than TSA and PyC, suggesting a mechanical limitation. OA, a Walch B glenoid and arthritis caused by instability seem to be ideal indications when considering PyC.
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Affiliation(s)
- Benjamin D. Kleim
- grid.411095.80000 0004 0477 2585Teaching Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany ,grid.6936.a0000000123222966Present Address: Department of Sports Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr 22, 81675 Munich, Germany
| | - Christina Garving
- grid.411095.80000 0004 0477 2585Teaching Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrich H. Brunner
- grid.411095.80000 0004 0477 2585Teaching Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
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15
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Outcomes after primary reverse total shoulder arthroplasty in patients with comorbid anxiety and depressive disorders: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Uy M, Wang J, Horner NS, Bedi A, Leroux T, Alolabi B, Khan M. Cemented humeral stem versus press-fit humeral stem in total shoulder arthroplasty: a systematic review and meta-analysis. Bone Joint J 2019; 101-B:1107-1114. [PMID: 31474140 DOI: 10.1302/0301-620x.101b9.bjj-2018-1369.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). MATERIALS AND METHODS A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. RESULTS There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). CONCLUSION Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107-1114.
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Affiliation(s)
- M Uy
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - J Wang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - N S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - A Bedi
- MedSport, University of Michigan, Ann Arbor, Michigan, USA
| | - T Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - B Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - M Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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Results of total shoulder arthroplasty in patients aged 55 years or younger versus those older than 55 years: an analysis of 1135 patients with over 2 years of follow-up. J Shoulder Elbow Surg 2019; 28:861-868. [PMID: 30591214 DOI: 10.1016/j.jse.2018.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The results of anatomic total shoulder arthroplasty (TSA) in younger patients have not been clearly elucidated. The purpose of this study was to compare early outcomes after TSA in patients aged 55 years or younger versus patients older than 55 years. METHODS A total of 1135 patients who were treated with TSA for glenohumeral arthritis and had a mean follow-up period of over 4 years were retrospectively reviewed. Etiologies included osteoarthritis (n = 1044), osteonecrosis (n = 35), inflammatory arthritis (n = 34), and post-traumatic arthritis (n = 22). Validated outcome measures, range of motion, and patient satisfaction were recorded. Preoperative and postoperative metrics were compared, and a multivariate analysis was performed to isolate age from sex, body mass index, previous surgery, and diagnosis as independent factors. RESULTS Female patients, patients with a history of surgery, and patients with a diagnosis of osteonecrosis were more likely to undergo TSA when aged 55 years or younger. Both age groups showed similar preoperative range of motion and showed no differences in recorded outcome scores. Postoperatively, patients older than 55 years had slightly greater active abduction (P = .004) and internal rotation (P = .030). A higher percentage of patients older than 55 years rated their outcome as better or much better compared with those aged 55 years or younger (P = .003). CONCLUSIONS Female sex, a history of surgery, and a diagnosis of osteonecrosis were associated with undergoing TSA when aged 55 years or younger. Despite similar preoperative function and minor differences in postoperative range of motion and outcome scores, patients aged 55 years or younger reported lower overall satisfaction with their TSA.
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18
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Craig RS, Lane JCE, Carr AJ, Furniss D, Collins GS, Rees JL. Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England. BMJ 2019; 364:l298. [PMID: 30786996 PMCID: PMC6380386 DOI: 10.1136/bmj.l298] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To provide accurate risk estimates of serious adverse events after elective shoulder replacement surgery for arthritis, including age and sex specific estimates of the lifetime risk of revision surgery. DESIGN Population based cohort study. SETTING Hospital episode statistics for NHS England, including civil registration mortality data. PARTICIPANTS 58 054 elective shoulder replacements in 51 895 adults (aged ≥50 years) between April 1998 and April 2017. MAIN OUTCOME MEASURES The lifetime risk of revision surgery, calculated using an actuarial life table approach and the cumulative probability method. Rates of serious adverse events at 30 and 90 days post-surgery: pulmonary embolism, myocardial infarction, lower respiratory tract infection, acute kidney injury, urinary tract infection, cerebrovascular events, and all cause death. Secondary outcome measures were the number of surgeries performed each year and Kaplan-Meier estimates of revision risk at 3, 5, 10, and 15 years. RESULTS The number of shoulder replacements performed each year increased 5.6-fold between 1998 and 2017. Lifetime risks of revision surgery ranged from 1 in 37 (2.7%, 95% confidence interval 2.6% to 2.8%) in women aged 85 years and older to 1 in 4 (23.6%, 23.2% to 24.0%) in men aged 55-59 years. The risks of revision were highest during the first five years after surgery. The risk of any serious adverse event at 30 days post-surgery was 1 in 28 (3.5%, 3.4% to 3.7%), and at 90 days post-surgery was 1 in 22 (4.6%, 4.4% to 4.8%). At 30 days, the relative risk of pulmonary embolism compared with baseline population risk was 61 (95% confidence interval 50 to 73) for women aged 50-64. Serious adverse events were associated with increasing age, comorbidity, and male sex. 1 in 5 (21.2%, 17.9% to 25.1%) men aged 85 years and older experienced at least one serious adverse event within 90 days. CONCLUSIONS Younger patients, particularly men, need to be aware of a higher likelihood of early failure of shoulder replacement and the need for further and more complex revision replacement surgery. All patients should be counselled about the risks of serious adverse events. These risks are higher than previously considered, and for some could outweigh any potential benefits. Our findings caution against unchecked expansion of shoulder replacement surgery in both younger and older patients. The more accurate age and sex specific estimates of risk from this study are long overdue and should improve shared decision making between patients and clinicians. STUDY REGISTRATION ClinicalTrials.gov NCT03573765.
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Affiliation(s)
- Richard S Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Zhu Y, Hsueh P, Zeng B, Chai Y, Zhang C, Chen Y, Wang Y, Maimaitiaili T. A prospective study of coracoclavicular ligament reconstruction with autogenous peroneus longus tendon for acromioclavicular joint dislocations. J Shoulder Elbow Surg 2018; 27:e178-e188. [PMID: 29397294 DOI: 10.1016/j.jse.2017.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/28/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomic coracoclavicular (CC) ligament reconstruction (ACCR) provides good outcomes for Rockwood type III and VI acromioclavicular (AC) joint dislocations. Various grafts have been used, but complications from graft harvesting are not uncommon. This study examined the clinical and radiographic outcomes of patients with AC joint dislocations repaired with the autogenous anterior half of the peroneus longus tendon (AHPLT) to achieve ACCR. METHODS Patients with a Rockwood type III to V AC joint dislocation and magnetic resonance imaging of the disruption of the CC ligaments, as well as the AC capsule, were prospectively recruited. Patients received ACCR using an autogenous AHPLT graft and were evaluated clinically and radiographically preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS A total of 18 patients (mean age, 51 years) were prospectively recruited and received an autogenous AHPLT graft ACCR. Fifteen patients completed clinical and radiographic follow-up examinations at 12 months. The mean Constant score (CS) was 51 preoperatively and 93 at 12 months (P <.005). No significant difference was noted at 12 months between the CS of the injured and contralateral shoulder. The mean American Orthopedic Foot and Ankle Society score at 12 months was 99, and this was not different from the value at any other time point. Loss of reduction occurred in 10 patients (56%), and tunnel widening was observed in 9 (50%), but neither was significantly correlated with functional outcome. CONCLUSION Autogenous AHPLT appears to be a reliable tendon graft source for CC ligament reconstruction.
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Affiliation(s)
- Yu Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peilin Hsueh
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bingfang Zeng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yimin Chai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yunfeng Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Yuchen Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tuerxun Maimaitiaili
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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20
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Giardella A, Ascione F, Mocchi M, Berlusconi M, Romano AM, Oliva F, Maradei L. Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients. Muscles Ligaments Tendons J 2017; 7:271-278. [PMID: 29264338 DOI: 10.11138/mltj/2017.7.2.271] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation.The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly. Materials and methods The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proximal humeral three- and four- parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2.The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control. Results We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudoarthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required. Conclusion Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA compared with ORIF, confirming that rTSA is one of the best treatment in proximal humeral fractures in the elderly patients, which rotator cuff status frequently is poor and degenerating. The few radiological complications do not seem to have influence on active ROM and Constant Score, both the first and the second group of patients. Level of evidence Level IV, Case Series, Surgical.
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Affiliation(s)
- Antonio Giardella
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Francesco Ascione
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Mattia Mocchi
- Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Marco Berlusconi
- Unìtà Operativa di Traumatologia II, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Alfonso Maria Romano
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Leonardo Maradei
- Unità Operativa di Chirurgia Mini-Invasiva, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy
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21
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Garret J, Godeneche A, Boileau P, Molé D, Etzner M, Favard L, Levigne C, Sirveaux F, Gauci MO, Dezaly C, Walch G. Pyrocarbon interposition shoulder arthroplasty: preliminary results from a prospective multicenter study at 2 years of follow-up. J Shoulder Elbow Surg 2017; 26:1143-1151. [PMID: 28214173 DOI: 10.1016/j.jse.2017.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/17/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The concept of free interposition arthroplasty proved successful for small joints of the hand, wrist, and foot, particularly after the use of implants coated with pyrocarbon, which enhanced their tribologic and elastic properties. The present study reports preliminary outcomes of a pyrocarbon-coated interposition shoulder arthroplasty (PISA) implant. METHODS This was a prospective study of 67 consecutive patients who underwent shoulder PISA at 9 centers. The mean age at surgery was 51 years, with only 12 patients older than 60 years. The indications for surgery were primary glenohumeral arthritis in 42, avascular necrosis in 13, and secondary arthritis in 12 patients. RESULTS Revision surgery was performed in 7 patients (10.4%), 2 (3.0%) were lost to follow-up, and the outcome assessments were incomplete in 3 (4.4%). This left 55 patients, aged 49.3 ± 12.0 years, with complete outcomes assessments at a mean follow-up of 26.8 ± 3.4 months. The Constant score improved from 34.1 ± 15.1 preoperatively to 66.1 ± 19.7 postoperatively. The radiographic findings revealed erosion in 6 glenoids and thinning of 3 humeral tuberosities. CONCLUSION In a cohort of young arthritic patients, PISA renders clinical scores and implant survival comparable to those of hemishoulder arthroplasty but remain inferior to those results reported for total shoulder arthroplasty. The study enabled identification of contraindications and potential causes of failure that wererelated to the concept of free interposition and smaller radius of curvature of the sphere. Until long-term results are available, this type of innovative implant should remain to be tested in a few specialized shoulder centers.
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Affiliation(s)
| | | | - Pascal Boileau
- Institut Universitaire de Locomotion et du Sport, Hôpital Pasteur 2, Nice, France
| | - Daniel Molé
- Centre Chirurgical Emile Gallé, Nancy, France
| | | | - Luc Favard
- Service de Chirurgie Orthopédique, Hôpital Trousseau, Tours, France
| | | | | | - Marc-Olivier Gauci
- Institut Universitaire de Locomotion et du Sport, Hôpital Pasteur 2, Nice, France
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22
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Ho AG, Gowda AL, Wiater JM. WITHDRAWN: Stemless humeral component in total shoulder arthroplasty: 2-year age-related clinical outcomes. J Shoulder Elbow Surg 2016:S1058-2746(16)00131-2. [PMID: 27090008 DOI: 10.1016/j.jse.2016.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/31/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Anthony G Ho
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Ashok L Gowda
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA.
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