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Werthel JD, Fleurette J, Besnard M, Favard L, Boileau P, Bonnevialle N, Nové-Josserand L. Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study. J Shoulder Elbow Surg 2024; 33:300-305. [PMID: 37468031 DOI: 10.1016/j.jse.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023]
Abstract
HYPOTHESIS Rotator cuff repair remains associated with high retear rates, which range from 13% to 79%. The objective of this study was to evaluate the long-term clinical and structural results after revision rotator cuff repair at a minimum 10-year follow-up. METHODS We retrospectively studied the records of all patients who underwent revision rotator cuff repair in 3 different institutions between July 2001 and December 2007 with a minimum 10-year follow-up. A total of 54 patients (61% males, mean age 52 ± 6 years old) met the inclusion criteria. Outcome measures included pain (visual analog scale [VAS]), range of motion (ROM), Subjective Shoulder Value (SSV), and the Constant score. Superior migration, osteoarthritis, and acromiohumeral interval (AHI) were assessed on standard radiographs. Fatty infiltration and structural integrity of the repaired tendon were evaluated on magnetic resonance imaging or computed tomographic arthrogram. RESULTS At a mean 14.1 years (10.4-20.5), range of motion did not progress significantly in elevation and internal rotation between pre- and postoperation (158° [range, 100°-180°] to 164° [range, 60°-180°], P = .33, and L3 [range, sacrum-T12] to T12 [range, buttocks-T7], P = .34, respectively) and decreased in active external rotation from 45° (range, 10°-80°) to 39° (range, 10°-80°) (P = .02). However, VAS, SSV, and Constant score were all significantly improved at last follow-up (P < .001). AHI decreased significantly (P = .002) from 10 mm (7-14 mm) to 8 mm (0-12 mm). Two percent of the supraspinatus/infraspinatus tendons were Sugaya 1, 24% were Sugaya 2, 35% were Sugaya 3, 12% were Sugaya 4, and 27% were Sugaya 5. Goutallier score progressed for all muscles, but this did not reach significance and mean Goutallier remained <2 for all 4 muscles at last follow-up. Hamada score progressed from 0% >grade 2 preoperatively to 6% >grade 2 at last follow-up. CONCLUSION Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. The mild progression of fatty infiltration, AHI, and Hamada score suggests that despite high retear rates (39% of stage 4 and 5 in the Sugaya classification), revision repair could possibly have a protective role on the evolution toward cuff tear arthropathy.
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Affiliation(s)
- Jean-David Werthel
- Orthopedic Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
| | - Justine Fleurette
- Orthopedic Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Marion Besnard
- Orthopedic Department, Centre Hospitalier Intercommunal Amboise- Château-Renault, Amboise, France
| | - Luc Favard
- Orthopedic Department, CHRU Tours-Trousseau, Chambray-lès-Tours, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Groupe Kantys, Nice, France
| | | | - Laurent Nové-Josserand
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
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Chelli M, Walch G, Azar M, Neyton L, Lévigne C, Favard L, Boileau P. Glenoid lateralization and subscapularis repair are independent predictive factors of improved internal rotation after reverse shoulder arthroplasty. Int Orthop 2024; 48:127-132. [PMID: 38047939 DOI: 10.1007/s00264-023-06048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) has shown improvement in clinical outcomes for various conditions, although some authors expressed concern about the restoration of active internal rotation (AIR). The current study assesses preoperative and intraoperative predictive factors of AIR in patients having a Grammont-style RSA with a minimum five year follow-up. METHODS We conducted a retrospective multicentric study, including patients operated on with a 155° Grammont-style RSA for cuff-related pathology or primary osteoarthritis with posterior subluxation or an associated cuff tear. Patients were clinically evaluated at a minimum of five year follow-up. Patients with previous surgery or those who had a tendon transfer with the RSA were excluded. Demographic parameters, BMI, preoperative notes, and operative reports were obtained from medical records. AIR was graded according to the constant score system from 0 to 10. RESULTS A total of 280 shoulders in 269 patients (mean age at surgery, 74.9 ± 5.9 years) met the inclusion criteria and were analyzed. The average follow-up was 8.1 years (range, 5-16 years). Overall, AIR increased from 4.2 (SD 2.5, range 0 to 10) preoperatively to 5.9 (SD 2.6, range 0 to 10) at final follow-up. At the last follow-up, AIR increased in 56% of cases, was unchanged in 26% and decreased in 18%. In 188 shoulders (67%), internal rotation was functional and allowed patients to reach the level of L3 or higher. Multivariable linear regression found the following preoperative clinical factors predictive of worse AIR after RSA: male gender (ß = -1.25 [-2.10; -0.40]; p = 0.0042) and higher values of BMI (ß = -0.085 [-0.17; -0.0065]; p = 0.048). Two surgical factors were associated with better AIR after RSA: glenoid lateralization with BIO-RSA technique (ß = 0.80 [0.043; 1.56]; p = 0.039) and subscapularis repair (ß = 1.16 [0.29; 2.02]; p = 0.0092). CONCLUSIONS With a mean of eight year follow-up (5 to 16 years), internal rotation was functional (≥ L3 level) in 67% of operated shoulders after Grammont-style RSA; however, two patients out of ten had decreased AIR after surgery. Male patients and those with higher BMIs had worse AIR, with glenoid lateralization (using the BIO-RSA technique) and subscapularis repair, as they are predictive of increased AIR after RSA. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Mikaël Chelli
- ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France.
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Michel Azar
- ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France
| | - Lionel Neyton
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Luc Favard
- Service d'Orthopédie Traumatologie, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, Chambray-les-, Tours, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France
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Besnard M, Favard L, Benhenneda R. Arthroscopic advancement of the supraspinatus muscle and tendon for posterosuperior massive rotator cuff tears. Orthop Traumatol Surg Res 2023; 109:103536. [PMID: 36574836 DOI: 10.1016/j.otsr.2022.103536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 12/25/2022]
Abstract
The tension-free repair of retracted supraspinatus tears with the open muscle and tendon advancement technique first described by Debeyre in 1965 gave satisfactory clinical results. The purpose of this anatomical study was to test the feasibility of an arthroscopic supraspinatus advancement technique. A total of 10 cadaveric shoulders were operated. We assessed the feasibility, measured the slide distance, and recorded the position of the suprascapular nerve (SSN) for each shoulder. Reattachment of the tendon to its native footprint was achieved in all cases. The mean slide distance was 38.8 mm ± 3.6 (33-44). The SSN was released and tension-free in all shoulders. Arthroscopic advancement of the supraspinatus muscle and tendon enables complete rotator cuff repair in irreparable retracted posterosuperior tears and is a noteworthy alternative to the other techniques. Level of Evidence: IV.
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Affiliation(s)
- Marion Besnard
- Centre hospitalier inter-communal Amboise-Château-Renault, hôpital Robert-Debré, rue des Ursulines, BP 329, 37403 Amboise cedex, France
| | - Luc Favard
- Service de chirurgie orthopédique, centre hospitalier universitaire de Tours, université François-Rabelais de Tours, PRES centre-Val de Loire université, Tours, France; Faculté de médecine, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France
| | - Rayane Benhenneda
- Service de chirurgie orthopédique, centre hospitalier universitaire de Tours, université François-Rabelais de Tours, PRES centre-Val de Loire université, Tours, France; Faculté de médecine, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France.
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Yoon DJY, Odri GA, Favard L, Samargandi R, Berhouet J. Preoperative Planning for Reverse Shoulder Arthroplasty: Does the Clinical Range of Motion Match the Planned 3D Humeral Displacement? J Pers Med 2023; 13:jpm13050771. [PMID: 37240941 DOI: 10.3390/jpm13050771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The functional outcome after reverse shoulder arthroplasty (RSA) is closely linked to how much the humerus shifts because of the implants. While two-dimensional (2D) angle measurements have been used to capture this shift, it can be measured in three dimensions (3D) as the arm change position (ACP). In a previous study, the ACP was measured using 3D preoperative planning software with the passive virtual shoulder range of motion obtained after RSA. The main objective of this study was to evaluate the relationship between the ACP and the actual active shoulder range of motion measured after RSA. The hypothesis was that the ACP and the active clinical range of motion are related such that the ACP is a reliable parameter to guide the preoperative planning of an RSA. The secondary objective was to assess the relationship between 2D and 3D humeral displacement measurements. MATERIALS AND METHODS This prospective observational study enrolled 12 patients who underwent RSA and had a minimum follow-up of 2 years. The active range of motion in shoulder flexion, abduction, and internal and external rotation was measured. At the same time, ACP measurements were taken from a reconstructed postoperative CT scan, in addition to the radiographic measurements of humeral lateralization and distalization angles on AP views in neutral rotation. RESULTS The mean humeral distalization induced by RSA was 33.3 mm (±3.8 mm). A non-statistically significant increase in shoulder flexion was observed for humeral distalization beyond 38 mm (R2 = 0.29, p = 0.07). This "threshold" effect of humeral distalization was also observed for the gains in abduction, as well as internal and external rotations, which seemed better with less than 38 mm or even 35 mm distalization. No statistical correlation was found between the 3D ACP measurements and 2D angle measurements. CONCLUSION Excessive humeral distalization seems to be detrimental to joint mobility, especially shoulder flexion. Humeral lateralization and humeral anteriorization measured using the ACP seem to promote better shoulder range of motion, with no threshold effect. These findings could be evidence of tension in the soft tissues around the shoulder joint, which should be taken into consideration during preoperative planning.
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Affiliation(s)
- Diane Ji Yun Yoon
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Inserm U1132 BIOSCAR, Université Paris Cité, 75010 Paris, France
| | - Guillaume-Anthony Odri
- Inserm U1132 BIOSCAR, Université Paris Cité, 75010 Paris, France
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire Lariboisière, 75010 Paris, France
| | - Luc Favard
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Equipe Reconnaissance de Forme et Analyse de l'Image, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Université de Tours, 64 Avenue Portalis, 37200 Tours, France
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Berhouet J, Samargandi R, Favard L, Turbillon C, Jacquot A, Gauci MO. The Real Post-Operative Range of Motion Differs from the Virtual Pre-Operative Planned Range of Motion in Reverse Shoulder Arthroplasty. J Pers Med 2023; 13:jpm13050765. [PMID: 37240935 DOI: 10.3390/jpm13050765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to analyze the real range of motion (RoM) measured in patients operated on for reverse shoulder arthroplasty (RSA) and compare it to the virtual RoM provided by the preoperative planning software. HYPOTHESIS There was a difference between virtual and real RoM, which can be explained by different factors, specifically the scapula-thoracic (ST) joint. METHODS Twenty patients with RSA were assessed at a minimum follow-up of 18 months. Passive RoM in forward elevation abduction, without and with manually locking the ST joint, and in external rotation with arm at side were recorded. The humerus, scapula, and implants were manually segmented on post-operative CTs. Post-operative bony structures were registered to preoperative bony elements. From this registration, a post-operative plan corresponding to the real post-operative implant positioning was generated and the corresponding virtual RoM analysis was recorded. On the post-operative anteroposterior X-rays and 2D-CT coronal planning view, the glenoid horizontal line angle (GH), the metaphyseal horizontal line angle (MH), and the gleno-metaphyseal angle (GMA) were measured to assess the extrinsic glenoid inclination, as well as the relative position of the humeral and glenoid components. RESULTS There were some significant differences between virtual and post-operative passive abduction and forward elevation, with (55° and 50°, p < 0.0001) or without ST joint participation (15° and 27°, p < 0.002). For external rotation with arm at side, there was no significant difference between planning (24° ± 26°) and post-operative clinical observation (19° ± 12°) (p = 0.38). For the angle measurements, the GMA was significantly higher (42.8° ± 15.2° vs. 29.1°± 18.2°, p < 0.0001), and the GH angle, significantly lower on the virtual planning (85.2° ± 8.8° vs. 99.5° ± 12.5°, p < 0.0001), while the MH was not different (p = 0.33). CONCLUSIONS The virtual RoM given by the planning software used in this study differs from the real post-operative passive RoM, except for external rotation. This can be explained by the lack of ST joint and soft tissues simulation. However, in focusing on the virtual GH participation, the simulation looks informative. Some modifications between the glenoid and humerus starting positions before running the motion analysis could be provided for making it more realistic and predictive of the RSA functional results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julien Berhouet
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
- Equipe Reconnaissance de Forme et Analyse de l'Image, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Université de Tours, 64 Avenue Portalis, 37200 Tours, France
| | - Ramy Samargandi
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Luc Favard
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
| | - Céline Turbillon
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
| | - Adrien Jacquot
- Centre for Chirurgie des Articulations et du Sport (ARTICS), 24 rue du XXIème Régiment d'Aviation, 54000 Nancy, France
| | - Marc-Olivier Gauci
- Institut Locomoteur et du Sport, Hôpital Pasteur 2, 30 Voie Romaine, 06000 Nice, France
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Barret H, Mansat P, Langlais T, Favard L, Chammas M, Coulet B. After failed radial head arthroplasty, what are the options? Risk factors and results of revisions in a multicenter study. J Clin Orthop Trauma 2023; 38:102128. [PMID: 36860992 PMCID: PMC9969247 DOI: 10.1016/j.jcot.2023.102128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/08/2022] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Few multicenter studies have analyzed the outcome of revision surgery of radial head arthroplasties (RHA) in the medium term follow up. The objective is twofold: to determine the factors associated with revision of RHAs and to analyze the results of revision with 2 surgical techniques: isolated removal of the RHA or revision with a new RHA (R-RHA). Hypothesis There are associated factors of RHA revision and RHA revision results in satisfactory clinical and functional outcomes. Methods Twenty-eight patients were included in this multicenter retrospective study, with all surgical indications for initial RHA being traumatic/post-traumatic. The mean age was 47 ± 13 years with a mean follow-up of 70 ± 48 months. This series included two groups: the isolated RHA removal group (n = 17) and the revision RHA with new radial head prosthesis (R-RHA) group (n = 11). Evaluation was clinical and radiological with univariate and multivariate analysis. Results Two factors associated with RHA revision were identified: a pre-existing capitellar lesion (p = 0.047) and a RHA placed for a secondary indication (<0.001). Revision for all 28 patients resulted in improved pain (pre-op Visual Analog Scale 4.7 ± 3 vs. post-op 1.57 ± 2.2, p < 0.001), mobilities (pre-op flexion 118 ± 20 vs. post-op 130 ± 13, p = 0.03; pre-op extension -30 ± 21 vs post-op -20 ± 15, p = 0.025; pre-op pronation 59 ± 12 vs post-op 72 ± 17, p = 0.04; pre-op supination 48 ± 2 vs post-op 65 ± 22, p = 0.027) and functional scores. Mobility and pain control were, for stable elbows, satisfactory in the isolated removal group. When the initial or revision indication was instability, the DASH (Disabilities of the Arm, Shoulder and Hand = 10 ± 5) and MEPS (Mayo Elbow Performance score = 85 ± 16) scores were satisfactory in the R-RHA group. Discussion In the case of a radial head fracture, RHA is a satisfactory first-line solution without pre-existing capitellar injury, its results being much weaker in the case of ORIF failure and fracture sequelae. In case of RHA revision, isolated removal or R-RHA adapted according to the pre-operative radio-clinical exam. Level of evidence IV.
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Affiliation(s)
- Hugo Barret
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Pierre Mansat
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | - Tristan Langlais
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | - Luc Favard
- Trousseau University Hospital, Tours, France
| | - Michel Chammas
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. Withdrawal notice to "Does anterior arthroscopic acromioplasty modify critical shoulder angle?" [Orthop. Traumatol. Surg. Res. 107 (2021) 102936, https://doi.org/10.1016/j.otsr.2021.102936]. Orthop Traumatol Surg Res 2023; 109:103516. [PMID: 36732004 DOI: 10.1016/j.otsr.2022.103516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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Garret J, Godenèche A, Boileau P, Molé D, Etzner M, Favard L, Lévigne C, Sirveaux F, Walch G. Midterm results of pyrocarbon interposition shoulder arthroplasty: good outcomes after posttraumatic osteonecrosis without malunion of the tuberosities. JSES Int 2022; 6:787-794. [PMID: 36081691 PMCID: PMC9446222 DOI: 10.1016/j.jseint.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In vitro data demonstrate the potential benefits of the pyrocarbon as a bearing material against cartilage or bone. And pyrocarbon-free interposition arthroplasty has been used with positive outcomes for over 10 years for hand and wrist joint replacements. This study reports the midterm results of a Pyrocarbon Interposition Shoulder Arthroplasty (PISA) in primary and secondary glenohumeral osteoarthritis and in avascular osteonecrosis. Methods This prospective noncontrolled, multicenter study included 67 consecutive patients who underwent PISA in France and Sweden. Results A cohort of 48 patients, aged 50 ± 12 years, was available for clinical assessment at a mean follow-up of 67.6 ± 9.3 months. A favorable change was reported with a mean absolute Constant score improvement of 32 ± 20 points. The highest Constant score improvement was observed in patients with avascular osteonecrosis (42 ± 18 points; P ≤ .0001). Between the earliest and the latest follow-up, radiographic analyses revealed only 2 major glenoid erosions and 4 tuberosity thinnings and thus that 86.4% of 44 shoulders remained stable with no or minor radiologic evolutions. The survival rate was 84 % at 65 months of follow-up considering all causes of revision. Conclusion The radiographic findings seem to confirm the interest of pyrocarbon in preserving bony surfaces. But the risk of tuberosity thinning suggests considering the use of PISA with caution in most degenerative glenohumeral joint pathologies, although the midterm outcomes highlight PISA as a suitable solution for patients presenting with posttraumatic osteonecrosis without malunion of the tuberosities and with an intact rotator cuff.
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Lanznaster D, Bruno C, Bourgeais J, Emond P, Zemmoura I, Lefèvre A, Reynier P, Eymieux S, Blanchard E, Vourc’h P, Andres CR, Bakkouche SE, Herault O, Favard L, Corcia P, Blasco H. Metabolic Profile and Pathological Alterations in the Muscle of Patients with Early-Stage Amyotrophic Lateral Sclerosis. Biomedicines 2022; 10:biomedicines10061307. [PMID: 35740329 PMCID: PMC9220134 DOI: 10.3390/biomedicines10061307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 12/26/2022] Open
Abstract
Diverse biomarkers and pathological alterations have been found in muscle of patients with Amyotrophic lateral sclerosis (ALS), but the relation between such alterations and dysfunction in energetic metabolism remains to be investigated. We established the metabolome of muscle and serum of ALS patients and correlated these findings with the clinical status and pathological alterations observed in the muscle. We obtained data from 20 controls and 17 ALS patients (disease duration: 9.4 ± 6.8 months). Multivariate metabolomics analysis identified a distinct serum metabolome for ALS compared to controls (p-CV-ANOVA < 0.035) and revealed an excellent discriminant profile for muscle metabolome (p-CV-ANOVA < 0.0012). Citramalate was discriminant for both muscle and serum. High lauroylcarnitine levels in muscle were associated with low Forced Vital Capacity. Transcriptomics analysis of key antioxidant enzymes showed an upregulation of SOD3 (p = 0.0017) and GLRX2(1) (p = 0.0022) in ALS muscle. Analysis of mitochondrial enzymatic activity in muscle revealed higher complex II/CS (p = 0.04) and lower LDH (p = 0.03) activity in ALS than in controls. Our study showed, for the first time, a global dysfunction in the muscle of early-stage ALS patients. Furthermore, we identified novel metabolites to be employed as biomarkers for diagnosis and prognosis of ALS patients.
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Affiliation(s)
- Débora Lanznaster
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Correspondence:
| | - Clément Bruno
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Biochimie et Biologie Moléculaire, CHU de Tours, 37000 Tours, France
| | - Jérôme Bourgeais
- CNRS ERL7001, EA 7501 GICC, Université de Tours, 37000 Tours, France; (J.B.); (O.H.)
| | - Patrick Emond
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Médecine Nucléaire In Vitro, CHU de Tours, 37000 Tours, France
| | - Ilyess Zemmoura
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Neurochirurgie, CHU de Tours, 37000 Tours, France
| | - Antoine Lefèvre
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
| | - Pascal Reynier
- Service de Biochimie et Biologie Moléculaire, CHU d’Angers, 49000 Angers, France;
- Mitovasc-Mitolab, UMR CNRS6015-INSERM1083, 49000 Angers, France
| | - Sébastien Eymieux
- Plateforme IBiSA de Microscopie Electronique, Université de Tours et CHU de Tours, 37000 Tours, France; (S.E.); (E.B.)
- INSERM U1259, Université de Tours, 37000 Tours, France
| | - Emmanuelle Blanchard
- Plateforme IBiSA de Microscopie Electronique, Université de Tours et CHU de Tours, 37000 Tours, France; (S.E.); (E.B.)
- INSERM U1259, Université de Tours, 37000 Tours, France
| | - Patrick Vourc’h
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Biochimie et Biologie Moléculaire, CHU de Tours, 37000 Tours, France
| | - Christian R. Andres
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Biochimie et Biologie Moléculaire, CHU de Tours, 37000 Tours, France
| | | | - Olivier Herault
- CNRS ERL7001, EA 7501 GICC, Université de Tours, 37000 Tours, France; (J.B.); (O.H.)
| | - Luc Favard
- Service de Neurologie, CHU de Tours, 37000 Tours, France;
| | - Philippe Corcia
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Neurologie, CHU de Tours, 37000 Tours, France;
| | - Hélène Blasco
- UMR 1253, iBrain, Université de Tours, INSERM, 37000 Tours, France; (C.B.); (P.E.); (I.Z.); (A.L.); (P.V.); (C.R.A.); (P.C.); (H.B.)
- Service de Biochimie et Biologie Moléculaire, CHU de Tours, 37000 Tours, France
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Berhouet J, Jacquot A, Walch G, Deransart P, Favard L, Gauci MO. Preoperative planning of baseplate position in reverse shoulder arthroplasty: Still no consensus on lateralization, version and inclination. Orthop Traumatol Surg Res 2022; 108:103115. [PMID: 34653644 DOI: 10.1016/j.otsr.2021.103115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In the context of reverse shoulder arthroplasty, some parameters of glenoid baseplate placement follow established golden rules, while other parameters still have no consensus. The assessment of glenoid wear in the future location of the glenoid baseplate varies among surgeons. The objective of this study was to analyze the inter-observer reproducibility of glenoid baseplate 3D positioning during virtual pre-operative planning. METHOD Four shoulder surgeons planned the glenoid baseplate position of a reverse arthroplasty in the CT scans of 30 degenerative shoulders. The position of the glenoid guide pin entry point and the glenoid baseplate center was compared between surgeons. The baseplate's version and inclination were also analyzed. RESULTS The 3D positioning of the pin entry point was achieved within ± 4 mm for nearly 100% of the shoulders. The superoinferior, anteroposterior and mediolateral positions of the baseplate center were achieved within ± 2 mm for 77.2%, 67.8% and 39.4% of the plans, respectively. The 3D orientation of the glenoid baseplate within ± 10° was inconsistent between the four surgeons (weak agreement, K=0.31, p=0.17). DISCUSSION The placement of the glenoid guide pin was very consistent between surgeons. Conversely, there was little agreement on the lateralization, version and inclination criteria for positioning the glenoid baseplate between surgeons. These parameters need to be studied further in clinical practice to establish golden rules. Three-dimensional information from pre-operative planning is beneficial for assessing the glenoid deformity and for limiting its impact on the baseplate position achieved by different surgeons. LEVEL OF EVIDENCE III. Case control study.
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Affiliation(s)
- Julien Berhouet
- Université de Tours-Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie 1C, Avenue de la République, 37170 Chambray-les-Tours, France; Université de Tours-Ecole d'Ingénieurs Polytechnique Universitaire de Tours-Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Equipe Reconnaissance de Forme et Analyse de l'Image, 64 Avenue Portalis, 37200 Tours, France.
| | - Adrien Jacquot
- Chirurgie des Articulations et du Sport, Centre ARTICS, 24 rue du XXIème Régiment d'Aviation, 54000 Nancy, France
| | - Gilles Walch
- Centre Orthopédique Santy, Unité Epaule, 24 Avenue Paul Santy, 69008 Lyon, France
| | | | - Luc Favard
- Université de Tours-Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie 1C, Avenue de la République, 37170 Chambray-les-Tours, France
| | - Marc-Olivier Gauci
- Institut Locomoteur et du Sport, Hôpital Pasteur 2, 30 Voie Romaine, 06000 Nice, France
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Abduh W, Berhouet J, Samargandi R, Favard L. Clinical results and radiological bony adaptations on a cementless short-stem prosthesis - A comparative study between anatomical and reverse total shoulder arthroplasty. Orthop Traumatol Surg Res 2022; 108:103262. [PMID: 35248791 DOI: 10.1016/j.otsr.2022.103262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Although the use of short stem and stemless shoulder prosthesis is trending, the surgical outcome may vary due to varying biomechanics. Objectives were to evaluate and compare the short-term clinical results and radiological changes between anatomical total shoulder arthroplasty (TSA) and reverse TSA (rTSA) with a short-stem humeral design. HYPOTHESIS There is no clinical and radiological difference between TSA and rTSA using a short-stem humeral design. METHODS This retrospective study included 66 patients who underwent TSA and rTSA (33 patients each) with a minimum 2-year follow-up. Radiographic findings, including preoperative Tingart cortical index (TCI), postoperative filling ratios of metaphysis (FRmet) and diaphysis (FRdia), bone adaptations, and osteolysis around the humeral stem at the immediate postoperative period, and the most recent follow-up were measured. Pre and postoperative Constant-Murley score, subjective shoulder value (SSV), and complications were noted. RESULTS At a mean follow-up of 27 (range 24-50) months, FRmet was significantly higher in rTSA group than the TSA group (0.65 vs. 0.60, p=0.009). Bone resorption was similar in both groups (p=0.76) and was correlated to a lower TCI value of<2.9mm (p=0.02). Despite significant clinical improvement in individual groups, the comparison between groups was non-significant (p>0.05). Negative correlation was observed between TCI and total clinical score (p=0.045) in TSA group, active external rotation (p=0.019), activity (p=0.005), SSV (p=0.008) and total score (p=0.025) in rTSA group. Radiographic changes were not influenced by patient characteristics and clinical results (p>0.05). CONCLUSION Although no radiographic difference was observed between TSA and rTSA, better short-term clinical results observed with the usage of the short-stem humeral design prosthesis are encouraging. LEVEL OF EVIDENCE III; Retrospective cohort study.
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Affiliation(s)
- Waleed Abduh
- Department of Orthopedic, King Fahad General Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Julien Berhouet
- Orthopedic surgery and traumatology department, universitary hospital Trousseau of Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Ramy Samargandi
- Orthopedic surgery and traumatology department, universitary hospital Trousseau of Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Luc Favard
- Orthopedic surgery and traumatology department, universitary hospital Trousseau of Tours, avenue de la République, 37170 Chambray-lès-Tours, France
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. Does isolated arthroscopic anterior acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2022; 108:103040. [PMID: 34389495 DOI: 10.1016/j.otsr.2021.103040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Critical shoulder angle (CSA)>35° correlates significantly with primary rotator cuff tear and re-tear after repair. Acromial axial orientation varies between individuals. The present study aimed to assess the impact of strictly anterior acromioplasty on CSA. HYPOTHESIS CSA is reduced by arthroscopic anterior acromioplasty. MATERIAL AND METHODS A single-center retrospective study included patients receiving isolated arthroscopic acromioplasty between January 2016 and December 2017. Exclusion criteria comprised history of surgery and fracture or dislocation of the shoulder. Pre- and post-operative AP shoulder radiographs were taken. The angle subtended by a line between the inferior and superior edges of the glenoid and a line between the inferior edge of the glenoid and the most lateral point on the acromion was measured. RESULTS One hundred and two patients were included: mean age, 50.5±10.1 years (range, 23-82 years). Mean CSA was 34.7±4.4° (range, 26-48°) preoperatively and 31.7±3.7° (range, 23-40°) postoperatively (p<0.001). In the group with CSA >35°, the decrease was significant: 34.4±3.2° (range, 28-40°) versus 38.9±2.8° (range, 36-48°) (p<0.001), with 64% CSA <35° after isolated anterior acromioplasty. DISCUSSION CSA was decreased by arthroscopic acromioplasty. However, in 36% of cases with preoperative CSA >35°, CSA was not normalized. CONCLUSION Anterior arthroscopic acromioplasty significantly reduced CSA in the overall population, and especially in case of high CSA. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10 Boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
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Hohmann E, Glatt V, Tetsworth K, Bak K, Beitzel K, Bøe B, Calvo E, Di Giacomo G, Favard L, Franceschi F, Funk L, Glanzmann M, Imhoff A, Lädermann A, Levy O, Ludvigsen T, Milano G, Moroder P, Rosso C, Siebenlist S, Abrams J, Arciero R, Athwal G, Burks R, Gillespie R, Kibler B, Levine W, Mazzocca A, Millett P, Ryu R, Safran M, Sanchez-Sotelo J, Savoie FB, Sethi P, Shea K, Verma N, Warner JJ, Weber S, Wolf B. Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons. Arthroscopy 2022; 38:1051-1065. [PMID: 34655764 DOI: 10.1016/j.arthro.2021.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American with European shoulder surgeon preferences. METHODS Nineteen surgeons from North America (North American panel [NAP]) and 18 surgeons from Europe (European panel [EP]) agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤60% for an item, the results were carried forward into round 4. For round 4, the panel members outside consensus (>60%, <80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%. RESULTS There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the workup; magnetic resonance imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of nonoperative treatment for a minimum of 6 months. The NAP was likely to routinely prescribe nonsteroidal anti-inflammatory drugs (NAP 89%; EP 35%) and consider steroids for impingement (NAP 89%; EP 65%). CONCLUSIONS Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of no-operative treatment for a minimum of 6 months. The panel also agreed that subacromial decompression is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to nonsurgical measures. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Erik Hohmann
- Department of Orthopaedic Surgery and Sportsmedicine, Valiant Clinic/Houston Methodist, Dubai, United Arab Emirates.
| | - Vaida Glatt
- University of Texas Health Science Centre, San Antonio, Texas, U.S.A
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Orthopaedic Research Centre of Australia, Sydney, Australia
| | | | - Klaus Bak
- Adeas Hospitals Skodsborg&Parken, Copenhagen, Denmark.
| | | | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway.
| | - Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Universidad Autonoma, Madrid, Spain.
| | | | - Luc Favard
- Tours University Hospital, University of Tours, France.
| | | | - Lennard Funk
- Upper Limb Unit, Wrightington Hospital, Wrightington, UK.
| | | | - Andreas Imhoff
- Department of Orthopaedic Sports Medicine, Technical University Munich, Germany.
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, Berkshire, United Kingdom; The Israeli Shoulder Institute, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel.
| | - Tom Ludvigsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway.
| | - Giuseppe Milano
- Unit of Orthopaedics and Traumatology, University of Brescia, Italy.
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Centrum for Muskuloskeletale Chirurgie, Charite Universitätsmedizin Berlin, Germany.
| | | | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University Munich, Germany.
| | - Jeffrey Abrams
- Princeton Orthopeadic Associates Princeton, New Jersey , USA.
| | - Robert Arciero
- Department of Orthopaedic Surgery, UCONN Health, Farmington, CT, USA.
| | - George Athwal
- Roth/McFarlane Hand&Upper limb Centre, St Joseph's Health Care, London, Ontario, Canada.
| | | | - Robert Gillespie
- Department of Orthopaedics Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA.
| | - Ben Kibler
- Lexington Orthopaedic Clinic, Sports Medicine Center Lexington, Kentucky, USA.
| | - William Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center New York, NY, USA.
| | - Augustus Mazzocca
- Department of Orthopaedic Surgery, UCONN Health, Farmington, CT, USA.
| | | | - Richard Ryu
- The Ryu Hurvitz Orthopaedic Clinic, Santa Barbara, California, USA.
| | - Marc Safran
- Department of Orthopaedic Surgery, Stanford University Stanford, CA, USA.
| | | | - Felix Buddy Savoie
- Department of Orthopaedic Surgery, Tulane University New Orleans, LA, USA.
| | - Paul Sethi
- The ONS Sports and Shoulder Service, Greenwich, CT, USA.
| | - Kevin Shea
- Department of Orthopaedic Surgery, UCONN Health, Farmington, CT, USA.
| | - Nikhil Verma
- Midwest Orthopaedics at Rush University, Chicago, IL, USA.
| | - Jon Jp Warner
- Massachusetts General Hospital, The Boston Shoulder Institute Boston, MA USA.
| | | | - Brian Wolf
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA USA.
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Floquet A, Roulet S, Favard L. Long-term outcomes of coracoid bone block osteolysis: two case reports. Pan Afr Med J 2022; 42:274. [DOI: 10.11604/pamj.2022.42.274.36403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022] Open
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Abstract
Aims The aim of this study was to describe a quantitative 3D CT method to measure rotator cuff muscle volume, atrophy, and balance in healthy controls and in three pathological shoulder cohorts. Methods In all, 102 CT scans were included in the analysis: 46 healthy, 21 cuff tear arthropathy (CTA), 18 irreparable rotator cuff tear (IRCT), and 17 primary osteoarthritis (OA). The four rotator cuff muscles were manually segmented and their volume, including intramuscular fat, was calculated. The normalized volume (NV) of each muscle was calculated by dividing muscle volume to the patient’s scapular bone volume. Muscle volume and percentage of muscle atrophy were compared between muscles and between cohorts. Results Rotator cuff muscle volume was significantly decreased in patients with OA, CTA, and IRCT compared to healthy patients (p < 0.0001). Atrophy was comparable for all muscles between CTA, IRCT, and OA patients, except for the supraspinatus, which was significantly more atrophied in CTA and IRCT (p = 0.002). In healthy shoulders, the anterior cuff represented 45% of the entire cuff, while the posterior cuff represented 40%. A similar partition between anterior and posterior cuff was also found in both CTA and IRCT patients. However, in OA patients, the relative volume of the anterior (42%) and posterior cuff (45%) were similar. Conclusion This study shows that rotator cuff muscle volume is significantly decreased in patients with OA, CTA, or IRCT compared to healthy patients, but that only minimal differences can be observed between the different pathological groups. This suggests that the influence of rotator cuff muscle volume and atrophy (including intramuscular fat) as an independent factor of outcome may be overestimated. Cite this article: Bone Jt Open 2021;2(7):552–561.
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Affiliation(s)
- Jean-David Werthel
- Hôpital Ambroise Paré, Boulogne-Billancourt, France.,Laboratory of Medical Information Processing, Brest, France
| | | | - Valérie Burdin
- Laboratory of Medical Information Processing, Brest, France
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Jean Chaoui
- Wright Medical, Montbonnot, France.,Tornier, Montbonnot, France.,Imascap, Plouzané, France.,Stryker, Kalamazoo, Michigan, USA
| | - Gilles Walch
- Centre Orthopédique Santy, Lyon, France.,Ramsay Générale de Santé, Hôpital Privé Jean Mermoz Lyon, Lyon, France
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Mazaleyrat M, Favard L, Boileau P, Berhouet J. Humeral osteolysis after reverse shoulder arthroplasty using cemented or cementless stems comparative retrospective study with a mean follow-up of 9 years. Orthop Traumatol Surg Res 2021; 107:102916. [PMID: 33812096 DOI: 10.1016/j.otsr.2021.102916] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/19/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The cause of proximal humeral osteolysis after reverse shoulder arthroplasty (RSA) remains controversial. The primary objective of our study was to compare the radiographic outcomes of Grammont-type RSA when a cemented stem is used versus when a cementless stem is used. The secondary objective was to identify the cause of these radiographic changes, especially for the cementless stems. HYPOTHESIS More proximal humerus bone loss occurs when a cementless humeral stem is used. METHODS With a minimum follow-up of 5 years, two paired cohorts were compared retrospectively: 70 RSA with cemented stem and 70 RSA with cementless stem. Using the radiographs made at the final follow-up visit, we looked for tuberosity resorption, signs of stress shielding, the presence of periprosthetic radiolucent lines and scapular notching. RESULTS At a mean follow-up of 9 years (5.0-20.6), the RSA revision rate was 1.8% in the cemented group and 3.6% in the cementless group (p=1). Tuberosity resorption was twice as common in the cementless group: 59% versus 30% (p<0.001). Signs of stress shielding such as osteopenia were only present in the cementless group. In both groups, tuberosity resorption was often associated with scapular notching. In the shoulders with tuberosity resorption, stage≥3 scapular notching was more common in the cementless group (p=0.001). DISCUSSION For the cementless stems, proximal humeral osteolysis can in part be attributed to stress shielding. The relationship between notching and tuberosity resorption in the two groups also suggests a secondary biological cause. LEVEL OF EVIDENCE III; Comparative retrospective study.
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Affiliation(s)
- Matthieu Mazaleyrat
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, avenue de la république, CHRU de Tours, 37170 Chambray-lès-Tours, France
| | - Luc Favard
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, avenue de la république, CHRU de Tours, 37170 Chambray-lès-Tours, France
| | - Pascal Boileau
- Institut universitaire Locomoteur et du Sport, CHU Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Julien Berhouet
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, avenue de la république, CHRU de Tours, 37170 Chambray-lès-Tours, France.
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Bacle G, Berhouet J, Favard L. ["Wrist fractures: especially articular and not without complications…"]. Rev Prat 2021; 71:436. [PMID: 34161014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Guillaume Bacle
- "Orthopédie, CHU Trousseau, Université de Tours, Tours Cedex, France"
| | - Julien Berhouet
- "Orthopédie, CHU Trousseau, Université de Tours, Tours Cedex, France"
| | - Luc Favard
- "Orthopédie, CHU Trousseau, Université de Tours, Tours Cedex, France"
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Bacle G, Berhouet J, Favard L. ["Frequent fractures in adults and the elderly."]. Rev Prat 2021; 71:427-435. [PMID: 34161013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Guillaume Bacle
- "Orthopédie, CHU Trousseau, Université de Tours, Tours Cedex, France"
| | - Julien Berhouet
- "Orthopédie, CHU Trousseau, Université de Tours, Tours Cedex, France"
| | - Luc Favard
- "Orthopédie, CHU Trousseau, Université de Tours, Tours Cedex, France"
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Barret H, Favard L, Mansat P, Winter M, Clavert P, Sirveaux F, Chammas M, Coulet B. Results of radial head prostheses implanted during Essex-Lopresti syndrome in multicentric study. Int Orthop 2021; 45:1549-1557. [PMID: 33686504 DOI: 10.1007/s00264-021-04987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
AIMS The aim was to evaluate the results of radial head prostheses (RHP) in Essex-Lopresti injury (ELI) and to compare results after RHP between acute and chronic ELI. PATIENTS AND METHODS Thirty-one patients treated with RHP for ELI were selected from a multicenter retrospective series of 310 RHP, with follow-up greater than two years. Two groups were acute ELI group (n=19, average diagnosis = 5+/-9 days) and chronic ELI group (n=12, average diagnosis 8.4+/-7.1 months). RHP was associated in some cases with K-wires: during acute ELI to stabilize the distal radio-ulnar joint (n=4) or during chronic ELI with ulnar osteotomy or palliative surgery (n=4). Clinical and radiologic evaluation was performed including analysis of the complications and revisions rates, pain level, range of motion, and MEPS (Mayo Elbow Performance Score) and DASH score (Disabilities of the Arm, Shoulder and Hand). RESULTS At last follow-up (71+/-38 months), survival of RHP in the acute ELI group was 84% (16/19) and 92% (11/12) in the chronic ELI group without statistically significant difference. Flexion (acute=131degrees+/-13.4 vs chronic=22+/-12.8, p=0.041) and supination (ELI=71+/-16.8 vs chronic=58+/-17.4; p=0.045) were better in acute ELI group. The DASH score was also better in the acute group (15+/-9.1 versus 24+/-15.2, p=0.048). There was more advanced stage of humero-radial osteoarthritis in the chronic ELI group (0.7+/-0.5 versus 1.4+/-0.6, p=0.041). CONCLUSION RHP in acute ELIs provide better clinical results, although RHPs are part of the therapeutic arsenal to treat chronic ELI.
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Affiliation(s)
- Hugo Barret
- Department of Orthopaedic Surgery, iULS, University of Nice Sophia-Antipolis, Nice, France.
| | - Luc Favard
- Trousseau University Hospital, Tours, France
| | - Pierre Mansat
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | | | | | - François Sirveaux
- Division of Orthopaedics and Trauma Surgery, Centre Chirurgical Émile-Gallé, Nancy, France
| | - Michel Chammas
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
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20
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Favard L, Bacle G, Berhouet J. [Frequent fractures in adults and the elderly]. Rev Prat 2021; 71:e106. [PMID: 34161049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Luc Favard
- Orthopédie, CHU Trousseau, université de Tours, 37044 Tours Cedex, France
| | - Guillaume Bacle
- Orthopédie, CHU Trousseau, université de Tours, 37044 Tours Cedex, France
| | - Julien Berhouet
- Orthopédie, CHU Trousseau, université de Tours, 37044 Tours Cedex, France
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21
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Favard L, Bacle G, Berhouet J. ["Management of fractures of the upper end of the femur"]. Rev Prat 2021; 71:e107. [PMID: 34161050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Luc Favard
- Orthopédie, CHU Trousseau, université de Tours, 37044 Tours Cedex, France
| | - Guillaume Bacle
- Orthopédie, CHU Trousseau, université de Tours, 37044 Tours Cedex, France
| | - Julien Berhouet
- Orthopédie, CHU Trousseau, université de Tours, 37044 Tours Cedex, France
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Kany J, Benkalfate T, Favard L, Teissier P, Charousset C, Flurin PH, Coulet B, Hubert L, Garret J, Valenti P, Werthel JD, Bonnevialle N. Osteoarthritis of the shoulder in under-50 year-olds: A multicenter retrospective study of 273 shoulders by the French Society for Shoulder and Elbow (SOFEC). Orthop Traumatol Surg Res 2021; 107:102756. [PMID: 33316450 DOI: 10.1016/j.otsr.2020.102756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) of the shoulder in under-50 year-olds is rare, and treatment is delicate. Shoulder replacement incurs frequent long-term risk of progression and a high revision rate, making it unsuited to young active patients. The aim of the present study was to determine the epidemiology of shoulder OA in under-50 year-olds and to assess the clinical results of the various treatment options. HYPOTHESIS The main study hypothesis was that well-conducted non-operative treatment can allow shoulder replacement to be postponed. The secondary hypothesis was that anatomic total shoulder arthroplasty (TSA) is the treatment of choice when other options fail. MATERIALS AND METHODS A multicenter retrospective study included primary (POA) and post-instability osteoarthritis (PIOA) in patients aged≤50years at symptom onset. Exclusion criteria comprised post-traumatic OA, rheumatoid arthritis and necrosis. Two hundred and sixty-six patients for 273 shoulders were included from 13 shoulder surgery centers: 2 types of non-operative treatment (28 by platelet-rich plasma [PRP] and 88 by viscosupplementation), 73 arthroscopies, and 150 implantations (62 humeral hemiarthroplasties [HA], comprising 10 hemi-metal, 24 hemi-pyrocarbon and 28 hemi-resurfacing; 77 anatomic total prostheses, and 11 reverse prostheses). Minimum follow-up was 12 months for non-operative treatment and 24 months for arthroplasty (some patients having both). Endpoints comprised Constant score, Subjective Shoulder Value (SSV) and number of complications/revision procedures. RESULTS Mean age at treatment was 43 years (range, 23-65 years), with 75% male predominance. Symptom onset was earlier in PIOA than in POA: 36 vs. 39 years (range, 20-50 years). PRP and viscosupplementation postponed implantation by a mean 3.5 years in 86% of cases, as did arthroscopy in 56%. ER1 restriction was the most negative factor. At 74 months' follow-up for HA and 95 months for TSA, mean Constant score was significantly lower for HA (56 vs. 67; p=0.004), with higher rates of complications (31% vs. 11%) and implant exchange (13% vs. 9%). DISCUSSION/CONCLUSION PRP, viscosupplementation and arthroscopy allow implantation to be postponed until the shoulder becomes stiff and painful. In case of failure, TSA is the most effective solution in the medium-term. LEVEL OF EVIDENCE IV a; therapeutic study - investigating the results of treatment.
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Affiliation(s)
- Jean Kany
- Clinique de l'union, 31240 Saint-Jean, France.
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- SOFEC, 34, rue du 11 Novembre, 44110 Châteaubriant, France
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23
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Mazaleyrat M, Favard L, Garaud P, Boileau P, Berhouet J. Press-fit vs. cemented humeral stem fixation for reverse shoulder arthroplasty: functional outcomes at a mean follow-up of 9.5 years. J Shoulder Elbow Surg 2021; 30:72-79. [PMID: 32838951 DOI: 10.1016/j.jse.2020.04.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is a reliable, long-term treatment option for degenerative shoulder pathology. However, the functional outcomes degrade around the fifth year postoperation, particularly for internal and external rotation. Long-term radiographic changes have been reported around the humeral stem, depending on the fixation method. OBJECTIVES The primary objective was to compare the clinical outcomes of RSAs by fixation method-cemented vs. press-fit-after a minimum follow-up of 5 years. We hypothesized that proximal humeral osteolysis impacts the functional outcomes. DESIGN AND METHODS Our study compared 2 matched cohorts: 56 RSAs with cemented stems and 56 RSAs with press-fit stems. We evaluated all the patients using the Constant-Murley score (CMS) and range of motion (ROM), which we measured preoperatively and at the final follow-up visit. We evaluated radiographs from the final follow-up visit to look for proximal humeral osteolysis with tuberosity resorption, signs of stress shielding, periprosthetic radiolucent lines, and scapular notching. RESULTS At a mean follow-up of 9.5 years (5-21), regardless of the fixation method, the RSA procedure helped to improve the CMS and active joint ROM postoperatively, except for internal and external rotation with elbow at side in the press-fit group. Shoulder ROM was significantly better in the group with cemented stems for anterior elevation (P < .001), abduction (P = .006), and external (P = .02) and internal rotation with elbow at side (P = .02). The CMS did not differ between groups. The presence of tuberosity resorption or scapular notching had no effect on the CMS and active ROM in either group. Osteopenia, which was more prevalent in the press-fit group, had no impact on the functional outcome. CONCLUSION There was no significant difference between groups in the CMS, although the active shoulder ROM was significantly worse in the press-fit group. This difference could be attributed to more frequent tuberosity resorption in this group.
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Affiliation(s)
- Matthieu Mazaleyrat
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France; Faculté de médecine, Université de Tours, Centre-Val de Loire, Chambray-lès-Tours, France.
| | - Luc Favard
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France; Faculté de médecine, Université de Tours, Centre-Val de Loire, Chambray-lès-Tours, France
| | - Pascal Garaud
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France; Faculté de médecine, Université de Tours, Centre-Val de Loire, Chambray-lès-Tours, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, CHU Nice, Hôpital Pasteur 2, Nice, France
| | - Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France; Faculté de médecine, Université de Tours, Centre-Val de Loire, Chambray-lès-Tours, France
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. WITHDRAWN: Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2020:S1877-0568(20)30111-0. [PMID: 32276845 DOI: 10.1016/j.otsr.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
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 https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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Werthel JD, Deransart P, Sanchez-Sotelo J, Favard L. Letter to the Editor regarding: "Clinical results of bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with an onlay 145° curved stem in patients with cuff tear arthropathy: a comparative study". J Shoulder Elbow Surg 2020; 29:e130-e132. [PMID: 32197772 DOI: 10.1016/j.jse.2019.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/27/2019] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Chambray les Tours, France
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Collin P, Betz M, Herve A, Walch G, Mansat P, Favard L, Colmar M, François Kempf J, Thomazeau H, Gerber C. Clinical and structural outcome 20 years after repair of massive rotator cuff tears. J Shoulder Elbow Surg 2020; 29:521-526. [PMID: 31594728 DOI: 10.1016/j.jse.2019.07.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Short- and mid-term outcomes after massive cuff tear repair are well reported, but there is no documentation of the clinical and structural outcomes at 20 years of follow-up. The hypothesis of the present study was that at 20 years, deterioration of the shoulder would have occurred and led to a substantial number of reoperations. METHODS The authors retrospectively recalled all 127 patients operated for massive rotator cuff tears in 1994 at 6 different centers. At the 20-year follow-up, 26 patients died and 35 were lost to follow-up. Thirteen (10.2%) had been reoperated. This left 53 patients for personal clinical assessment. Forty-nine consented to standardized radiographic evaluation for assessment of osteoarthritis, 36 patients underwent magnetic resonance imaging, allowing assessment of tendon healing, atrophy, and fatty infiltration (FI) of the cuff muscles. RESULTS The final Constant-Murley score (CS) was 68 ± 17.7 (range, 8-91) vs. 44 ± 15.3 (range, 13-74) preoperatively (P < .05). The final Subjective Shoulder Value (SSV) was 73% ± 23% (range, 0-100). Retears (Sugaya IV and V) were found in 17 cases (47%). Nine patients (17%) had cuff tear arthropathy (Hamada stage 4). The CS and SSV for the shoulders with FI stages III or IV were significantly inferior (53 ± 19 points and 65% ± 14% respectively) than for those with FI stages 0-II (respectively, 71.6 ± 6 points and 73% ± 4%) (P < .05). CONCLUSIONS Twenty years after surgical repair of massive rotator cuff tears, the functional scores remain satisfactory, and the rate of revision is low.
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Affiliation(s)
| | | | | | | | | | | | | | - Jean François Kempf
- Service de chirurgie orthopédique et de la main (CCOM), Illkirch-Graffenstaden, France
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Rol M, Favard L, Berhouet J. Factors associated with internal rotation outcomes after reverse shoulder arthroplasty. Orthop Traumatol Surg Res 2019; 105:1515-1519. [PMID: 31680017 DOI: 10.1016/j.otsr.2019.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/11/2019] [Accepted: 07/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) was introduced in 1985 by Grammont for patients with gleno-humeral osteoarthritis and severe rotator cuff damage. Internal rotation (IR) is limited in some patients after RSA. The objective of this study was to identify pre- and intra-operative factors associated with good IR outcomes 6 months after RSA. HYPOTHESIS The condition of the residual cuff (usually the sub-scapularis and teres minor) and inferior glenosphere overhang are the main factors associated with IR outcomes after RSA. MATERIAL AND METHOD A total of 36 patients who underwent RSA between 2 November 2015 and 10 January 2017 were enrolled prospectively. The inclusion criterion was massive rotator cuff tear with or without osteoarthritis and gleno-humeral osteoarthritis with asymmetrical glenoid wear. The pre-operative work-up included determination of the Constant score, Subjective Shoulder Value (SSV), and passive and active motion ranges; standard radiographs; and computed tomography. The same clinical and radiological parameters were recorded in all patients during a visit 6 months after surgery. RESULTS After surgery, all motion ranges were improved except IR with the elbow by the side (IR1, ability to place the hand on the back). IR1 to or above L3 was significantly associated with a lower body mass index (p=0.04), good passive IR before surgery (p=0.056), a smaller pre-operative glenoid inclination angle, and greater glenosphere overhang (p=0.03). Neither the condition of the sub-scapularis nor sub-scapularis repair were significantly associated with post-operative IR1. IR1 was significantly more limited in patients whose teres minor was normal. CONCLUSION Satisfactory active IR1 correlated with good passive IR1. IR1 was better in thin individuals who had non-concentric gleno-humeral osteoarthritis. Inferior glenosphere overhang of 6mm or more was associated with a greater range of IR. LEVEL OF EVIDENCE IV, prospective observational cohort study.
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Affiliation(s)
- Morgane Rol
- Service d'orthopédie traumatologie, Université François-Rabelais-de-Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-les-Tours, France.
| | - Luc Favard
- Service d'orthopédie traumatologie, Université François-Rabelais-de-Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-les-Tours, France
| | - Julien Berhouet
- Service d'orthopédie traumatologie, Université François-Rabelais-de-Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-les-Tours, France
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Bonnevialle N, Ohl X, Clavert P, Favard L, Frégeac A, Obert L, Chantelot C, Gallinet D, Boileau P. Should the supraspinatus tendon be excised in the case of reverse shoulder arthroplasty for fracture? Eur J Orthop Surg Traumatol 2019; 30:231-235. [PMID: 31586235 DOI: 10.1007/s00590-019-02572-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/26/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE In the case of reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs) with tuberosity reconstruction, it is unclear whether the supraspinatus tendon continues to play a role. The aim of this study was to evaluate the clinical and radiological outcomes of RSA for PHFs in a large cohort of elderly patients and compare the results in the case of supraspinatus excision or preservation. METHODS In this retrospective multicentre study, 150 patients (mean age 77 years, 93% female) were reviewed and radiographed with a minimum follow-up of 24 months. The same Grammont prosthetic design was used in all cases (inclination angle 155°, non-lateralised glenosphere). Patients were divided into two groups: Group A (n = 117) underwent supraspinatus excision and Group B supraspinatus preservation (n = 33). Complications were recorded, and shoulder function, active mobility and subjective results were assessed. RESULTS At a mean follow-up of 59 months, there was no statistical difference in the complication rate (6% vs. 6.8%, p = 1), mean Constant score (61 points vs. 59 points, p = 0.52), simple shoulder value (74% vs. 73.9%, p = 0.9), active anterior elevation (125° vs. 128°, p = 0.45) and internal rotation (4.9 points vs. 4.1 points, p = 0.2). However, mean active external rotation was better in Group A (22° vs. 13°, p = 0.01). The greater tuberosity healing rate in satisfactory position did not differ statistically between the groups (68% vs. 55%, p = 0.14). CONCLUSION In the case of RSA with tuberosity reconstruction for acute PHFs, there is no clear evidence that supraspinatus preservation is advantageous.
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Affiliation(s)
- Nicolas Bonnevialle
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France.
| | - Xavier Ohl
- Orthopaedic Department, University Hospital, Reims, France
| | | | - Luc Favard
- Trousseau University Hospital, Tours, France
| | - Anne Frégeac
- AERCOT, iULS, University Hospital Pasteur, Nice, France
| | | | | | | | - Pascal Boileau
- Department of Orthopaedic Surgery, iULS, University of Nice Sophia-Antipolis, Nice, France
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Herve A, Thomazeau H, Favard L, Colmar M, Mansat P, Walch G, Betz M, Kempf JF, Collin P. Clinical and radiological outcomes of osteoarthritis twenty years after rotator cuff repair. Orthop Traumatol Surg Res 2019; 105:813-818. [PMID: 31204180 DOI: 10.1016/j.otsr.2019.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Outcomes of open or arthroscopic rotator cuff repairs are well reported in the literature. The purpose of the study was to evaluate the prevalence and clinical impact of osteoarthritis 20 years following rotator cuff repair. The hypothesis was that, at long follow-up, most shoulders would have developed gleno-humeral osteoarthritis. METHODS The authors retrospectively recalled all 322 patients, operated for rotator cuff tears in 1994 at 6 different centres, for clinical and radiographic assessment. At 20 years of follow-up, 24 were re-operated (5 arthroplasty) and 53.4% were lost to follow-up. This left 126 patients, had been clinically assessed, had Magnetic Resonance Images (MRI) that allowed anatomic assessment of tendon healing (Sugaya), fatty infiltration (Goutallier), and X rays in order to analyse arthritis without head migration (Samilson) and with head migration (Hamada and Fukuda). Only patients with complete data were selected. RESULTS Mean aged was 52.3 years (25.3-68.6) at index operation. The Constant score was 45.3±19.6 preoperatively to 67.4±18.7 points at 20 years. The SSV was 73.5±21 postoperatively. The rate of osteoarthritis was 29%. Osteoarthritis was associated with a significant inferior Constant score compared to the non-arthritic group (61 versus 71 points, p=0.02), mainly due to a significant lower strength (5.4 versus 8.7 points, p=0.007). Massive rotator cuff tears were significantly associated with a higher rate of osteoarthritis. Only 4,8% patients after cuff repear needed a reverse shoulder arthroplasty. Significantly less osteoarthritis was observed when the rotator cuff repair remained intact. Suprasupinatus retear had a significant influence on fatty infiltration of the infrasupinatus muscle and on the progression towards osteoarthritis. CONCLUSION Twenty years after open rotator cuff repair, the rate of osteoarthritis was 29%. Massive rotator cuff tears were significantly associated with a higher rate of osteoarthritis. Less osteoarthritis was observed when suprasupinatus healed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anthony Herve
- CHU Pontchaillou, 2, rue Henri le Guilloux, 35033 Rennes Cedex 9, France.
| | - Hervé Thomazeau
- CHU Pontchaillou, 2, rue Henri le Guilloux, 35033 Rennes Cedex 9, France
| | - Luc Favard
- CHU Tours, 49, boulevard Béranger, 37000 Tours, France
| | - Michel Colmar
- Hôpital Privé des Côtes d'Armor, 12, rue François-Jacob, 22190 Plérin, France
| | - Pierre Mansat
- CHU Toulouse Purpan, 1, place du docteur Baylac, 31300 Toulouse, France
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz, 24, avenue Paul Santy, 69008 Lyon, France
| | - Michael Betz
- Uniklik Balgrist, Blümlisalpstrasse, 65 8006 Zürich, Switzerland
| | - Jean-François Kempf
- Service de chirurgie orthopédique et de la main (CCOM), 10, avenue Achille Baumann 67403 Illkirch-Graffenstaden, France
| | - Philippe Collin
- Clinique Privé Saint-Grégoire 6, boulevard de la Boutière, 35768 Saint-Grégoire, France
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Berhouet J, Favard L, Boas D, Voisin T, Slimane M. Thoughts on a new surgical assistance method for implanting the glenoid component during total shoulder arthroplasty. Part 1: Statistical modeling of the native premorbid glenoid. Orthop Traumatol Surg Res 2019; 105:203-209. [PMID: 30765310 DOI: 10.1016/j.otsr.2018.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/12/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to identify points on the scapula that can be used to predict the anatomy of the native premorbid glenoid. MATERIAL AND METHODS Forty-three normal scapulas reconstructed in 3D and positioned in a common coordinate system were used. Twenty points distributed over the blade of the scapula (portion considered normal and used as a reference) and the glenoid (portion considered pathological and needing to be reconstructed) were captured manually. Thirteen distances (X) between two points not on the glenoid and 31 distances (Y) between two points of which at least one was on the glenoid were then calculated automatically. A multiple linear regression model was applied to calculate the Y distances from the X distances. The best four equations were retained based on their coefficient of determination (R2) to explain a point on the glenoid being reconstructed (p<0.05). In the first scenario, the glenoid was modeled assuming it was completely destroyed. In the second scenario, only the inferior portion of the glenoid was worn. RESULTS For a completely destroyed glenoid, the mean error for a chosen distance for a given point on the glenoid was 2.4 mm (4.e-3mm; 12.5mm). For a partially damaged glenoid, the mean error was 1.7mm (4.e-3mm; 6.5mm) for the same distance evaluated for a given point on the glenoid. DISCUSSION/CONCLUSION The proposed statistical model was used to predict the premorbid anatomy of the glenoid with an acceptable level of accuracy. A surgeon could use this information during the preoperative planning stage and during the actual surgery by using a new surgical assistance method.
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Affiliation(s)
- Julien Berhouet
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France; Western France Orthopedics Society (SOO)/HUGORTHO, 18, rue de Bellinière, 49800 Trélazé, France.
| | - Luc Favard
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François Rabelais de Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-les-Tours, France; Western France Orthopedics Society (SOO)/HUGORTHO, 18, rue de Bellinière, 49800 Trélazé, France
| | - David Boas
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
| | - Théo Voisin
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
| | - Mohamed Slimane
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
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Lädermann A, Schwitzguebel AJ, Edwards TB, Godeneche A, Favard L, Walch G, Sirveaux F, Boileau P, Gerber C. Glenoid loosening and migration in reverse shoulder arthroplasty. Bone Joint J 2019; 101-B:461-469. [DOI: 10.1302/0301-620x.101b4.bjj-2018-1275.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.
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Affiliation(s)
- A. 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
| | - A. J. Schwitzguebel
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - T. B. Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas, USA
| | - A. Godeneche
- Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital, Lyon, France
| | - L. Favard
- Service Orthopédie Traumatologie, CHU Trousseau, Tours, France
| | - G. Walch
- Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital, Lyon, France
| | - F. Sirveaux
- Division of Orthopaedics and Trauma Surgery, Centre Chirurgical Émile-Gallé, Nancy, France
| | - P. Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L’Archet–University of Nice Sophia-Antipolis, Nice, France
| | - C. Gerber
- Department of Orthopaedics, University Hospital, Balgrist, Zurich, Switzerland
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Berhouet J, Slimane M, Facomprez M, Jiang M, Favard L. Views on a new surgical assistance method for implanting the glenoid component during total shoulder arthroplasty. Part 2: From three-dimensional reconstruction to augmented reality: Feasibility study. Orthop Traumatol Surg Res 2019; 105:211-218. [PMID: 30522851 DOI: 10.1016/j.otsr.2018.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/13/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main goal of this study was to propose a new method of surgical assistance for the implantation of a total shoulder prosthesis, with the use of augmented reality (AR). The advantage of this approach is that it supplements information, on the one hand pre-existing or disappeared due to a pathological process, such as the premorbid glenoid, and on the other hand already existing but not accessible to the surgeon during the procedure, such as the so-called "hidden" face of the scapula. MATERIAL AND METHODS Several information preparation steps were needed. The first consisted in the three-dimensional (3D) rendering of the pathological glenoid, from a point cloud corresponding to the premorbid glenoid based on previously developed regression equations. A library of "healthy" generic glenoids was then created by hierarchical bottom-up analysis. From this database, a so-called adequate normal generic glenoid was fused and matched to the pathological glenoid reconstructed using a morphing technique. An experimental AR application was constructed. Smart glasses were used to display the prepared 3D information. RESULTS A pathological 3D glenoid was reconstructed and used for the AR application. A complete display of the scene, reconstructed glenoid and full scapula was obtained. However, an offset from reality was observed. The main limitations were technical, related to the connected tool itself and the operating software. DISCUSSION/CONCLUSION This was a feasibility study of the different steps required to apply AR, from information preparation to its visualization. A new parameter crossing experiment is needed to optimize each step of this process. LEVEL OF EVIDENCE IV, Basic science study.
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Affiliation(s)
- Julien Berhouet
- Service d'orthopédie traumatologie 1C, faculté de médecine de Tours, université François-Rabelais de Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France; Société d'orthopédie de L'Ouest (SOO)/HUGORTHO, 18, rue de Bellinière, Trélazé, France.
| | - Mohamed Slimane
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - Maxime Facomprez
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - Min Jiang
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - Luc Favard
- Service d'orthopédie traumatologie 1C, faculté de médecine de Tours, université François-Rabelais de Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Société d'orthopédie de L'Ouest (SOO)/HUGORTHO, 18, rue de Bellinière, Trélazé, France
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Boileau P, Alta TD, Decroocq L, Sirveaux F, Clavert P, Favard L, Chelli M. Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities? J Shoulder Elbow Surg 2019; 28:437-444. [PMID: 30573429 DOI: 10.1016/j.jse.2018.08.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Reverse Shoulder Arthroplasty (RSA) may be indicated in displaced proximal humerus fractures in elderly patients. We hypothesized that tuberosity fixation and healing around the prosthesis would result in better outcomes and patient satisfaction. METHODS Thirty-eight acute displaced or dislocated 3- and 4-part fractures in elderly patients were treated with reattachment of the tuberosities around a RSA. The mean age at surgery was 80 ± 4 years (range, 70-88 years). A specific reverse fracture stem that incorporated a cancellous bone autograft (harvested from the fractured head) and a standardized suturing technique for tuberosity fixation were used in all operations. Patients were evaluated and radiographed with a minimum 2-year follow-up (mean 36 ± 8 months). RESULTS The tuberosity union rate was 84% (32 of 38). There were 4 tuberosity resorptions and 2 tuberosity migrations with nonunion, which were associated with significantly lower subjective results (Subjective Shoulder Value of 65% vs. 83%, P = .029) and lower active mobility in forward elevation (115° ± 26° vs. 141° ± 25°, P = .023) and external rotation (11° ± 12° vs. 27° ± 12°, P = .010). Among the 5 disappointed patients, 3 presented with tuberosity resorption and 2 with tuberosity migration and nonunion. CONCLUSIONS Despite the advanced age of the patients, tuberosity reattachment and use of bone graft results in a high rate of tuberosity healing. Tuberosity reconstruction and healing in reverse shoulder arthroplasty for fractures improves active forward elevation, external rotation, and patient satisfaction.
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Affiliation(s)
- Pascal Boileau
- iULS-University Institute of Locomotion and Sport, Pasteur 2 Hospital, University of Côte d'Azur UCA, Nice, France.
| | - Tjarco D Alta
- Orthopaedic Surgery and Traumatology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands
| | - Lauryl Decroocq
- iULS-University Institute of Locomotion and Sport, Pasteur 2 Hospital, University of Côte d'Azur UCA, Nice, France
| | | | - Philippe Clavert
- Centre de Chirurgie Orthopédique et de la Main, Illkirch-Graffenstaden, France
| | - Luc Favard
- Chirurgie orthopédique et traumatologique, Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Mikaël Chelli
- iULS-University Institute of Locomotion and Sport, Pasteur 2 Hospital, University of Côte d'Azur UCA, Nice, France
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Collin P, Thomazeau H, Walch G, Gerber C, Mansat P, Favard L, Colmar M, Kempf JF, Hervé A, Betz M. Clinical and structural outcome twenty years after repair of isolated supraspinatus tendon tears. J Shoulder Elbow Surg 2019; 28:196-202. [PMID: 30322753 DOI: 10.1016/j.jse.2018.07.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated the clinical and structural outcome 20 years after repair of isolated supraspinatus tendon tears. We hypothesized that the results would deteriorate over time. MATERIALS AND METHODS For this retrospective multicenter study, 137 patients were recalled for a clinical and imaging assessment. Six patients (4.3%) had died from unrelated causes, 52 (38.0%) were lost to follow-up, and 13 (9.5%) had undergone reoperations. This left 66 patients for clinical evaluation. Radiographs and magnetic resonance imaging were additionally performed for 45 patients, allowing assessment of osteoarthritis, tendon healing, fatty infiltration (FI), and muscle atrophy. RESULTS The Constant Score (CS) improved from 51.5 ± 14.1 points preoperatively to 71 points (P < .05) with a mean Subjective Shoulder Value (SSV) of 77.2% ± 22%. Tendon discontinuity (Sugaya IV-V) was present in 19 of 45 patients (42 %), and there was advanced FI (Goutallier III-IV) of the supraspinatus in 12 (27%) and of the infraspinatus muscle in 16 (35%). Supraspinatus atrophy was present in 12 patients (28%), advanced arthritis in 6, and cuff tear arthropathy in 12 (30%). The CS and SSV were significantly inferior for shoulders with FI of stages III to IV (P < .05). The CS was lower in cuff tear arthropathy and correlated with infraspinatus FI. CONCLUSIONS At 20 years after surgical repair of isolated supraspinatus tears, the clinical outcome remains significantly above the preoperative state. FI of the infraspinatus is the most influential factor on long-term clinical outcome.
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Affiliation(s)
- Philippe Collin
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France.
| | - Herve Thomazeau
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Gilles Walch
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Christian Gerber
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Pierre Mansat
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Luc Favard
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Michel Colmar
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Jean François Kempf
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Anthony Hervé
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
| | - Michael Betz
- Institut Locomoteur de l'Ouest Saint Gregoire (Vivalto Sante), Saint Gregoire, France
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Agout C, Berhouet J, Spiry C, Bonnevialle N, Joudet T, Favard L. Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients. Orthop Traumatol Surg Res 2018; 104:S189-S192. [PMID: 30077657 DOI: 10.1016/j.otsr.2018.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Massive rotator cuff tears (RCTs) account for 10% to 40% of all RCTs and over 80% of re-tears. The objectives of this prospective study were to assess functional outcomes 6 and 12 months after starting non-operative therapy for an irreparable massive RCT and to identify predictors of good outcomes of non-operative treatment. HYPOTHESIS Non-operative treatment deserves to be tried because it can produce improvements in patients with irreparable massive RCTs. MATERIAL AND METHODS A prospective multicenter (12 centres) study was conducted between March 2015 and March 2016. Consecutive patients managed non-operatively for RCTs involving two or more tendons including one with a fatty infiltration score greater than 2 were included. Non-operative treatment consisted in rehabilitation and sub-acromial corticosteroid injections. Functional outcomes were assessed based on the Constant score and Subjective Shoulder Value (SSV) after 3, 6, and 12 months. RESULTS Of 71 included patients, 3 underwent surgery during the study year, leaving 68 patients for the analysis of 12-month outcomes. Significant improvements were noted after 12 months in the Constant score (from 40.7 at baseline to 57.7 after 6 months and 57.1 after 12 months), in each of its items except force, and in the SSV. Constant score values after 6 and 12 months were not significantly different. No significant differences in functional outcomes were found across initial tear type. CONCLUSION Non-operative treatment produces significant functional gains in patients with irreparable massive RCTs. These gains are obtained after 6 months. Surgery can therefore be considered if the outcome is unsatisfactory after 6 months. LEVEL OF EVIDENCE III, prospective study.
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Affiliation(s)
- Charles Agout
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Julien Berhouet
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Clément Spiry
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Nicolas Bonnevialle
- Département d'orthopédie traumatologie, hôpital Riquet, CHU de Toulouse, 31059 Toulouse, France
| | - Thierry Joudet
- Clinique chirurgicale du Libournais, 119, rue de la Marne, 33500 Libourne, France
| | - Luc Favard
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
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- 15, rue Ampère, 92500 Rueil-Malmaison, France
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Lignel A, Berhouet J, Loirat MA, Collin P, Thomazeau H, Gallinet D, Boileau P, Favard L. Reverse shoulder arthroplasty for proximal humerus fractures: Is the glenoid implant problematic? Orthop Traumatol Surg Res 2018; 104:773-777. [PMID: 30059761 DOI: 10.1016/j.otsr.2018.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/16/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) is a key tool in the orthopedic trauma surgeon's arsenal, especially when faced with a proximal humerus fracture in older patients. However, few studies have focused on the glenoid side of RSA in this indication as the implant is placed in a generally healthy scapula. HYPOTHESIS Glenoid implants for RSA after trauma are well positioned and do not often cause complications. MATERIAL AND METHODS Retrospective multicenter study of 513 patients who underwent RSA because of a proximal humerus fracture. The mean follow-up was 55 months. Radiographs were used to assess the height and tilt of the glenoid implant, along with the development of scapular notching or loosening. The clinical outcomes were determined based on the Constant score. RESULTS At the last follow-up, 44% of shoulders had scapular notching, 7% of which were severe (stages 3-4). This notching was progressive, with two resulting in loosening. The rate of severe notching was higher in patients with a high glenoid implant (62.5% vs. 42.3%, p=0.03) or glenosphere with superior tilt (58.3% vs. 37.8%, p=0.02). Nine patients had confirmed loosening and 63 had potential loosening. This was more common in cases with superior tilt (9.3% vs. 0.4%, p<0.001). Patients with a high glenoid implant had a lower Constant score (57 vs. 45, p<0.001). There fewer cases of severe notching when a lateralized glenoid implant was used (0% vs. 7%, p<0.05) and/or the humeral implant had a smaller neck-shaft angle (implants<155°: 3% vs. implants at 155°: 8.5%, p=0.03). DISCUSSION AND CONCLUSION Glenoid loosening and severe scapular notching are related to poor positioning and/or incorrect orientation of the glenosphere. Implant selection is important, as there is little to no notching when less-angled humeral implants and lateralized glenoid implants are used. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | | | | | | | - David Gallinet
- Upper Limb Orthopedic Surgery University, 25000 Besançon, France
| | | | - Luc Favard
- Upper Limb Orthopedic Surgery University, 25000 Besançon, France
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Clavert P, Kling A, Sirveaux F, Favard L, Mole D, Walch G, Boileau P. Reverse shoulder arthroplasty for instability arthropathy. International Orthopaedics (SICOT) 2018; 43:1653-1658. [DOI: 10.1007/s00264-018-4123-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
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Agout C, Berhouet J, Bouju Y, Godenèche A, Collin P, Kempf JF, Favard L. Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc 2018; 26:2490-2497. [PMID: 29411080 DOI: 10.1007/s00167-018-4854-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although good short-term and mid-term outcomes are reported for rotator cuff repair, few studies have investigated long-term outcome with clinical and MRI evaluation. The hypothesis was that 10 years following repair of rotator cuff tear, the clinical and anatomic results depend on the extension of the tear. METHODS The records of all 965 patients who underwent repair of rotator cuff tears in 2003 were retrieved. The patients were reviewed in 2014 for evaluation at a minimum follow-up of 10 years. A total of 511 patients were evaluated clinically, of whom 397 were also evaluated using MRI. There were 289 isolated supraspinatus tears (SS), 94 tears with posterior extension (P), 92 with anterior extension (A) and 36 with anteroposterior (AP) extension. RESULTS The Constant score had significantly improved from 53.8 ± 14.7 preoperatively to 77.7 ± 12.1 (P < 0.0001) at 10 years, with no significant difference between the four groups. The rate of retear (Sugaya IV, V) was lower in the SS group (19%) and higher in the P (32%) and AP groups (31%). At review, infraspinatus fatty degeneration was significantly greater (Fuchs > 2) in the P (P < 0.001) and AP (P < 0.001) groups and subscapularis fatty degeneration was significantly greater (Fuchs > 2) in the A (P < 0.001) and AP (P < 0.001) groups. The rate of osteoarthritis (Samilson > 2) was significantly higher at 11% (P = 0.001) in the A group. The failure rate was significantly lower (P = 0.044) in the SS group (25%) than the massive rotator cuff tear groups (A, P and AP groups) (35%). Complications occurred in 51 shoulders (10%) and repeat surgery was required in 62 shoulders (12%), with no difference between the four groups. CONCLUSIONS The long follow-up period of this study, large series of patients and MRI evaluation of tendon repair allowed us to demonstrate that 10 years following rotator cuff tear repair, between 68 and 81% of tendons had healed. These findings are of value in predicting response to surgical treatment. Tears with posterior extension had a higher risk of retear. However, surgical repair appeared to give a good functional outcome whatever the type of tear, despite the overall rate of complications and repeat surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Charles Agout
- Services de Chirurgie Orthopédique 1 et 2, Hôpital Trousseau, CHRU de Tours, Avenue de la République, 37170, Chambray-Lès-Tours, France.
| | - Julien Berhouet
- Services de Chirurgie Orthopédique 1 et 2, Hôpital Trousseau, CHRU de Tours, Avenue de la République, 37170, Chambray-Lès-Tours, France
| | - Yves Bouju
- Institut de la Main Nantes-Atlantique, Clinique Jeanne-d'Arc, 21 Rue Des Martyrs, 44100, Nantes, France
| | - Arnaud Godenèche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz (Ramsay Général De Santé), Lyon, France
| | | | - Jean-François Kempf
- Centre de Traumatologie, Hôpitaux Universitaires de Strasbourg, Illkirch-Graffenstaden, France
| | - Luc Favard
- Services de Chirurgie Orthopédique 1 et 2, Hôpital Trousseau, CHRU de Tours, Avenue de la République, 37170, Chambray-Lès-Tours, France
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Berhouet J, Rol M, Spiry C, Slimane M, Chevalier C, Favard L. Shoulder patient-specific guide: First experience in 10 patients indicates room for improvement. Orthop Traumatol Surg Res 2018; 104:45-51. [PMID: 29246481 DOI: 10.1016/j.otsr.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/04/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Implantation of the glenoid component of a total shoulder prosthesis can be facilitated by using a patient-specific guide (PSG) designed to ensure replication of the preoperatively planned position. The objective of this study was to assess the reliability and accuracy of a PSG in replicating the planned glenoid component position during total shoulder arthroplasty (TSA). HYPOTHESIS Additional criteria should be used for 3D preoperative planning and PSG design to further improve the accuracy of glenoid component positioning. MATERIAL AND METHODS We studied 10 patients who underwent TSA with use of a PSG to position the glenoid component after preoperative 3D planning. Postoperative glenoid version and tilt were measured and compared to the planned values. We also used new criteria to assess implant rotation and global 3D position, as well as accuracy of the 3D pilot hole for the glenoid guide-pin. RESULTS Mean errors in glenoid position were -1.7°±4.4° for version, -0.4°±4.9° for tilt, and 6.0°±13.5° for rotation. Mean difference in global orientation of the glenoid implant versus the planned value was 4.9°±2.5°. Mean 3D discrepancy in glenoid pilot hole position was 2.9±0.5mm; the discrepancy was greater in the mediolateral direction (1.9±0.9mm) than in the supero-inferior (1.1±1.2mm) and antero-posterior (0.8±1.2mm) directions. DISCUSSION The poor performance of the PSG in controlling rotation and reaming may explain the difference in global glenoid position compared to the planned value. Improvements in PSG design to incorporate these two parameters deserve consideration. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- J Berhouet
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France; Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais-de-Tours, 64, avenue Portalis, 37200 Tours, France.
| | - M Rol
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
| | - C Spiry
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
| | - M Slimane
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais-de-Tours, 64, avenue Portalis, 37200 Tours, France
| | - C Chevalier
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
| | - L Favard
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François-Rabelais-de-Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-Les-Tours, France
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Agout C, Rosset P, Druon J, Brilhault J, Favard L. Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10-year retrospective study. Orthop Traumatol Surg Res 2018; 104:11-15. [PMID: 29247818 DOI: 10.1016/j.otsr.2017.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Orthopedic and trauma surgery is the specialty for which claims for compensation are most often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filing claims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2) analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. HYPOTHESIS The epidemiological profile of proceedings seeking damages in France is consistent with the data from European and American studies. MATERIALS AND METHODS An observational, retrospective, single-center study of all claims for damages between 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospital was carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, and financial consequences were analyzed. RESULTS Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726 procedures). A significant increase in the number of cases (p=0.040) was found over a 10-year period. Of these, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission (CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for an amicable settlement. The most common reason for which patients filed claims was hospital-acquired infections, with 36/71 (50.7%) cases. Twenty-nine complaints (40.8%) resulted in monetary damages being awarded to the patient, with an average award of € 28,301 (€ 2,400-299,508). Damage awards were significantly higher (p<0.05) for cases involving surgery on a lower limb than those involving an upper limb. CONCLUSION Claims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital-acquired infections are the main reason for disputes in our specialization. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- C Agout
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - P Rosset
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - J Druon
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - J Brilhault
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - L Favard
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
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Rol M, Favard L, Berhouet J. Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data. International Orthopaedics (SICOT) 2017; 42:1347-1355. [DOI: 10.1007/s00264-017-3616-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bacle G, Gregoire JM, Patat F, Clavert P, de Pinieux G, Laulan J, Lakhal W, Favard L. Anatomy and relations of the infraspinatus and the teres minor muscles: a fresh cadaver dissection study. Surg Radiol Anat 2016; 39:119-126. [DOI: 10.1007/s00276-016-1707-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
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Jacquot A, Sirveaux F, Roche O, Favard L, Clavert P, Molé D. Surgical management of the infected reversed shoulder arthroplasty: a French multicenter study of reoperation in 32 patients. J Shoulder Elbow Surg 2015; 24:1713-22. [PMID: 25957111 DOI: 10.1016/j.jse.2015.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND In a retrospective multicenter study, we evaluated the efficiency and outcomes of the different therapeutic options for infection after reversed shoulder arthroplasty. METHODS Thirty-two patients were reoperated on for infection after reversed shoulder arthroplasty between 1996 and 2011. The mean age was 71 (55-83) years. The involved implants were primary prostheses in 23 cases and revision prostheses in 9 cases. The average preoperative Constant score was 34 (11-69). Six of these patients needed 2 successive procedures. A total of 38 procedures were performed: débridement (13), 1-stage (5) or 2-stage revision (14), or implant removal (6). At last follow-up (mean, 36 months; range, 12-137 months), every patient had clinical, biologic, and radiographic evaluation. RESULTS Infections were largely caused by coagulase-negative staphylococci (56%) and Propionibacterium acnes (59%). The complication rate was 26%. At last follow-up, 26 patients were free of infection (81%). The final Constant score was 46 (12-75). After débridement with implant retention, the mean Constant score was 51 (29-75), but the healing rate was only 54%. Implant revision (1 or 2 stage) led to better functional results than implant removal (46 vs. 25; P = .001), with similar healing rates (73% and 67%, respectively). Patients with low initial impairment (Constant score > 30) were not significantly improved by surgical treatment. CONCLUSION Débridement is the less aggressive option but exposes patients to healing failure. It should be proposed as a first treatment attempt. Revision of the implant is technically challenging but preserves shoulder function, with no higher rate of residual infection compared with implant removal.
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Affiliation(s)
- Adrien Jacquot
- Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France.
| | - François Sirveaux
- Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France
| | - Olivier Roche
- Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France
| | - Luc Favard
- Orthopaedic & Traumatologic Surgery Department, Hopital Trousseaux, Tours, France
| | - Philippe Clavert
- Orthopaedic Surgery and Hand Surgery Center, Illkirch Graffenstaden, Strasbourg, France
| | - Daniel Molé
- Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France
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Vernet E, Bacle G, Marteau E, Favard L, Laulan J. Lateral elbow ligamentoplasty by autologous tendon graft in posterolateral rotatory instability: Results in 18 cases at a mean 5 years' follow-up. Orthop Traumatol Surg Res 2015; 101:S199-202. [PMID: 25890807 DOI: 10.1016/j.otsr.2015.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Posterolateral rotatory instability is the most frequent form of elbow instability. This clinical entity, described by O'Driscoll et al. in 1991, concerns young subjects following elbow trauma. Diagnosis is founded on symptomatology and positive posterolateral rotatory instability test. Treatment is based on reconstruction of the ulnar bundle of the lateral collateral ligament. The present study assessed medium-term clinical and radiological results in lateral ligamentoplasty for posterolateral elbow instability. MATERIALS AND METHODS A retrospective continuous single-center series included 19 cases: 11 male, 8 female, operated on between 1995 and 2010; mean age was 37.8 years (range, 20-63 years). Surgery consisted in lateral ulnar collateral ligament reconstruction by autologous palmaris longus tendon graft following Nestor et al. (1992). RESULTS Eighteen patients were assessed at a mean 61 months' follow-up. Mean time off work was 3.2 months (range, 2-7 months); all patients returned to work. No revision surgery was required. Mean range of motion in flexion, extension, pronation and supination was respectively 135°, 8°, 84° and 76°. Instability test was systematically negative at follow-up. Mean Mayo Clinic and Quick-DASH scores were respectively 90 (range, 60-100) and 21 (range, 0-63). All patients were satisfied or very satisfied with their result. CONCLUSION Lateral ulnar collateral ligament reconstruction by autologous palmaris longus tendon graft provided reliable and lasting results. We consider it to be the reference treatment for chronic instability, and sometimes in acute post-traumatic instability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Vernet
- Services de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main et du Membre Supérieur, CHRU de Tours, 37044 Tours cedex 09, France
| | - G Bacle
- Services de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main et du Membre Supérieur, CHRU de Tours, 37044 Tours cedex 09, France
| | - E Marteau
- Services de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main et du Membre Supérieur, CHRU de Tours, 37044 Tours cedex 09, France
| | - L Favard
- Services de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main et du Membre Supérieur, CHRU de Tours, 37044 Tours cedex 09, France
| | - J Laulan
- Services de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main et du Membre Supérieur, CHRU de Tours, 37044 Tours cedex 09, France.
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Gadea F, Bouju Y, Berhouet J, Bacle G, Favard L. Deltopectoral approach for shoulder arthroplasty: anatomic basis. Int Orthop 2015; 39:215-25. [PMID: 25592830 DOI: 10.1007/s00264-014-2654-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The deltopectoral approach is a common surgical procedure for shoulder arthroplasty. Many surgeons are familiar with this procedure, but certain steps are still controversial. This is the case for the management of subscapularis, where surgeons must choose between tenotomy and the lesser tuberosity osteotomy. METHODS This article is conceived as a toolkit for the inexperienced surgeons, describing our tips and tricks to facilitate final exposure of the glenoid. For experienced surgeons, we analysed the tricky portions of the deltopectoral approach, comparing them with what is classically reported in the literature. RESULTS We describe an original technic for subscapularis reattachment after lesser tuberosity osteotomy in order to improve its stability. The medial part of the fragment is secondarily sculpted to obtain a step shape, which will be applied against the base of the prosthetic cup in a sort of "corner buttress". CONCLUSIONS Our work, based on our personal experience, confirms that there is no preferred single deltopectoral approach but, rather, multiple options. When embarking on this "shoulder highway", we encourage surgeons to respect the successive anatomic planes, which we believe is the only way to ensure easy and atraumatic dissection. KEY POINTS - The safe plane for going around the humeral head and positioning retractors is the plane of the subacromial deltoid bursa. - Always stay close to the bone during capsule release, whether on the humeral or glenoid side. - Never go medially to the conjoint tendon or its deep face.
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Affiliation(s)
- Francois Gadea
- Tours University Hospital Center, Orthopaedics and Trauma I, François Rabelais University, Trousseau Hospital, Tours, France,
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Abstract
BACKGROUND Arthroscopic subacromial decompression (acromioplasty) is widely held to be effective, although pain may persist after the procedure. The objective of this study was to evaluate the proportion of patients with residual pain (i.e., the failure rate) after isolated subacromial decompression and to look for predictors of failure. MATERIAL AND METHOD We conducted a retrospective multicentre study of 108 patients managed with isolated arthroscopic subacromial decompression between 2007 and 2011, for any reason. We excluded patients in whom surgical procedures on the rotator cuff tendons were performed concomitantly. Data were collected from the medical records, a telephone questionnaire, and radiographs obtained before surgery and at last follow-up. Failure was defined as persistent pain (visual analogue scale score>3) more than 6 months after surgery and at last follow-up. RESULTS The failure rate was 29% (31/108). Two factors significantly predicted failure, namely, receiving workers' compensation benefits for the shoulder condition and co-planing. Heterogeneous calcific tendinopathy and deep partial-thickness rotator cuff tears were also associated with poorer outcomes, but the effect was not statistically significant. DISCUSSION Co-planing may predict failure of subacromial decompression, although whether this effect is due to an insufficient degree of co-planing or to the technique itself is unclear. Nevertheless, in patients with symptoms from the acromio-clavicular joint, acromio-clavicular resection is probably the best option. Receiving workers' compensation benefits was also associated with treatment failure, as a result of well-known parameters related to the social welfare system. CONCLUSION Isolated arthroscopic subacromial decompression is effective in 70% of cases. We recommend the utmost caution if co-planing is considered and/or the patient receives workers' compensation benefits for the shoulder condition, as these two factors are associated with a significant increase in the failure rate. LEVEL OF EVIDENCE IV (retrospective study).
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Affiliation(s)
- A Bouchard
- Hôpital d'Instruction des Armées Bégin Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - J Garret
- Clinique du Parc, 69000 Lyon, France
| | - L Favard
- Hôpital Trousseau, CHU de Tours, 37000 Tours, France
| | - H Charles
- 13, place Philippe Lebon, 59000 Lille, France
| | - D Ollat
- Hôpital d'Instruction des Armées Bégin Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France
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Berhouet J, Garaud P, Slimane M, Nicot J, Banah J, Waynberger E, Favard L. Effect of scapular pillar anatomy on scapular impingement in adduction and rotation after reverse shoulder arthroplasty. Orthop Traumatol Surg Res 2014; 100:495-502. [PMID: 24998086 DOI: 10.1016/j.otsr.2014.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/29/2014] [Accepted: 03/11/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Notching of the scapular pillar is the main radiographic complication seen during follow-up of reverse shoulder arthroplasties. Several recommendations pertaining to the implantation technique and glenoid component design have been suggested. No studies have investigated potential anatomic risk factors for inferior scapular impingement. HYPOTHESIS A specific anatomic shape of the scapular pillar promotes the development of notching. MATERIALS AND METHODS The Aequalis Reversed(®) (Tornier Inc., Edina, MN, USA) prosthesis was implanted into 40 cadaver scapulae. We measured maximal range-of-motion (ROM) in internal rotation, external rotation, and adduction. The anatomic specimens were then imaged using two-dimensional computed tomography (CT) and the scapular neck angle, surface area under the scapular pillar, and distance from the central glenosphere peg to the inferior glenoid rim were measured. Associations between these CT parameters and ROM values were assessed using statistical independence tests. RESULTS ROM values were greatest when the surface area under the scapular pillar was above 0.8 cm(2) (P<0.5). This feature combined with a scapular neck angle less than 105° produced the largest ROM values (P<0.5). DISCUSSION The scapular neck angle alone is not sufficient to identify a scapular morphology that increases the risk of notching. The surface area under the scapular pillar, in contrast, discriminates between scapulae with and without a high risk of notching. The surface area under the scapular pillar is influenced by the inferior glenoid offset. CONCLUSION We were unable to define a specific scapular shape at high risk for notching. The prevention of notching should rely chiefly on a rigorous glenoid component implantation technique, with particular attention to the inferior offset. LEVEL OF EVIDENCE III, experimental study.
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Affiliation(s)
- J Berhouet
- Service d'orthopédie traumatologie 2A, CHRU Trousseau, faculté de médecine de Tours, université François-Rabelais de Tours, 1C, avenue de la République, 37170 Chambray-les-Tours, France; Laboratoire d'informatique, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France.
| | - P Garaud
- Service d'orthopédie traumatologie 2A, CHRU Trousseau, faculté de médecine de Tours, université François-Rabelais de Tours, 1C, avenue de la République, 37170 Chambray-les-Tours, France
| | - M Slimane
- Laboratoire d'informatique, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - J Nicot
- Laboratoire d'informatique, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - J Banah
- Laboratoire d'informatique, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - E Waynberger
- Service de radiologie, clinique Saint-Gatien, 8, place de la Cathédrale, 37000 Tours, France
| | - L Favard
- Service d'orthopédie traumatologie 2A, CHRU Trousseau, faculté de médecine de Tours, université François-Rabelais de Tours, 1C, avenue de la République, 37170 Chambray-les-Tours, France
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Le Nail LR, Bacle G, Marteau E, Corcia P, Favard L, Laulan J. Isolated paralysis of the serratus anterior muscle: surgical release of the distal segment of the long thoracic nerve in 52 patients. Orthop Traumatol Surg Res 2014; 100:S243-8. [PMID: 24703793 DOI: 10.1016/j.otsr.2014.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Isolated serratus anterior (SA) paralysis is a rare condition that is secondary to direct trauma or overuse. Patients complain of neuropathic pain and/or muscle pain secondary to overexertion of the other shoulder stabilizing muscles. As the long thoracic nerve (LTN) passes along the thorax, it can be compressed by blood vessels and/or fibrotic tissue. The goal of the current study was to evaluate the outcomes of surgical release of the distal segment of the LTN in cases of isolated SA paralysis. PATIENTS AND METHODS This was a retrospective study of 52 consecutive cases operated on between 1997 and 2012. The average patient age was 32 years (range 13-70). Patients had been suffering from paralysis for an average of 2 years (range 4-259 months); the paralysis was complete in 52% of cases. Every patient underwent a preoperative electroneuromyography (ENMG) assessment to confirm that only the SA was affected and there were no signs of re-innervation. RESULTS Every patient had abnormal intraoperative findings. There were no complications. All patients showed at least partial improvement following the procedure. The improvement was excellent or good in 45 cases (86.7%), moderate in 4 cases (7.7%) and slight in 3 cases (5.6%). In 32 cases (61.5%), the winged scapula was completely corrected; it was less prominent in 19 cases and was unchanged in one case. The best outcomes following surgical release occurred in patients who presented without preoperative or neuropathic pain and were treated within 18 months of paralysis. DISCUSSION Isolated SA paralysis due to mechanical injury resembles entrapment neuropathy. We discovered signs of LTN compression or restriction during surgery. Surgical release of the distal segment of the LTN is a simple, effective treatment for pain that provides complete motor recovery when performed within the first 12 months of the paralysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- L R Le Nail
- Hand Surgery Unit, Orthopaedic Surgery Department 1 and 2, Hôpital Trousseau, Centre Hospitalier Régional Universitaire, 37044 Tours cedex, France
| | - G Bacle
- Hand Surgery Unit, Orthopaedic Surgery Department 1 and 2, Hôpital Trousseau, Centre Hospitalier Régional Universitaire, 37044 Tours cedex, France
| | - E Marteau
- Hand Surgery Unit, Orthopaedic Surgery Department 1 and 2, Hôpital Trousseau, Centre Hospitalier Régional Universitaire, 37044 Tours cedex, France
| | - P Corcia
- Neurology Department, Hôpital Bretonneau, Centre Hospitalier Régional Universitaire, 37044 Tours cedex, France
| | - L Favard
- Hand Surgery Unit, Orthopaedic Surgery Department 1 and 2, Hôpital Trousseau, Centre Hospitalier Régional Universitaire, 37044 Tours cedex, France
| | - J Laulan
- Hand Surgery Unit, Orthopaedic Surgery Department 1 and 2, Hôpital Trousseau, Centre Hospitalier Régional Universitaire, 37044 Tours cedex, France.
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Berhouet J, Garaud P, Favard L. Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study. Orthop Traumatol Surg Res 2013; 99:887-94. [PMID: 24211248 DOI: 10.1016/j.otsr.2013.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND A common disadvantage of reverse shoulder arthroplasty is limitation of the range of arm rotation. Several changes to the prosthesis design and implantation technique have been suggested to improve rotation range of motion (ROM). HYPOTHESIS Glenoid component design and degree of humeral component retroversion influence rotation ROM after reverse shoulder arthroplasty. MATERIAL AND METHODS The Aequalis Reversed™ shoulder prosthesis (Tornier Inc., Edina, MN, USA) was implanted into 40 cadaver shoulders. Eight glenoid component combinations were tested, five with the 36-mm sphere (centred seating, eccentric seating, inferior tilt, centred with a 5-mm thick lateralised spacer, and centred with a 7-mm thick lateralised spacer) and three with the 42-mm sphere (centred with no spacer or with a 7-mm or 10-mm spacer). Humeral component position was evaluated with 0°, 10°, 20°, 30°, and 40° of retroversion. External and internal rotation ROMs to posterior and anterior impingement on the scapular neck were measured with the arm in 20° of abduction. RESULTS The large glenosphere (42 mm) was associated with significantly (P<0.05) greater rotation ROMs, particularly when combined with a lateralised spacer (46° internal and 66° external rotation). Rotation ROMs were smallest with the 36-mm sphere. Greater humeral component retroversion was associated with a decrease in internal rotation and a significant increase (P<0.05) in external rotation. The best balance between rotation ROMs was obtained with the native retroversion, which was estimated at 17.5° on average in this study. DISCUSSION Our anatomic study in a large number of cadavers involved a detailed and reproducible experimental protocol. However, we did not evaluate the variability in scapular anatomy. Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. In addition, no previous studies assessed rotation ROMs. CONCLUSION Rotation ROM should be improved by the use of a large-diameter glenosphere with a spacer to lateralise the centre of rotation of the gleno-humeral joint, as well as by positioning the humeral component at the patient's native retroversion value.
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Affiliation(s)
- J Berhouet
- Université François-Rabelais de Tours, Faculté de Médecine de Tours, CHRU Trousseau, Service d'orthopédie traumatologie 2A, 1C, avenue de la République, 37170 Chambray-les-Tours, France.
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