Acromionectomy and deltoid deficiency: a solution.

UNLABELLED: Deltoid insufficiency after iatrogenic or traumatic acromionectomy results from separation of the deltoid from its origin and mechanical fulcrum. Subsequent retraction of the tendon and formation of subdeltoid adhesions to the cuff and humerus result in stiffness and pain. We evaluated clinical outcomes of patients treated with autogenous tricortical iliac crest bone graft combined with deltoid reconstruction or deltoidplasty for deltoid insufficiency after acromionectomy. We retrospectively reviewed four patients, three males, and one female treated with deltoidplasty reconstructions as revision surgery. Their mean age was 41 years, and the minimum followup was 41 months (mean, 50 months; range, 41-66 months). There were three work-related injuries. Outcomes evaluated were pain relief (visual analog score), American Shoulder and Elbow Surgeons score, cosmesis, and complications. The mean pain score improved from 8 (range, 3-10) preoperatively to 1 (range, 0-3) postoperatively. The mean American Shoulder and Elbow Surgeons score improved from 31 +/- 14 to 68 +/- 13. One patient required revision deltoidplasty for abductor weakness. Three patients underwent hardware removal. One patient who underwent concurrent latissimus dorsi transfer had limited functional improvement but decreased pain. Two patients had improved cosmesis. All had CT scans with three-dimensional reconstructions documenting union. All patients stated they would undergo the procedure again. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Analysis of transfusion predictors in shoulder arthroplasty.

BACKGROUND: We are not aware of any previous study that has examined predictive factors for blood transfusion after shoulder arthroplasty. We analyzed the association between clinical factors and the need for postoperative blood transfusion and documented the use and waste of predonated blood in a group of patients managed with shoulder arthroplasty. METHODS: A retrospective study of 119 patients who underwent 124 shoulder arthroplasties (including eighty-seven primary uncomplicated total shoulder arthroplasties, twenty-seven revision or complicated primary total shoulder arthroplasties, and ten hemiarthroplasties) from 2001 to 2004 was performed. Logistic regression analysis was conducted to determine which clinical variables were predictive of transfusion. RESULTS: A postoperative transfusion was received after thirty-one arthroplasties (25%). The strongest predictor of blood transfusion after shoulder arthroplasty was the preoperative hemoglobin level (likelihood ratio test = 37.8, p < 0.0001). Patients with a preoperative hemoglobin level of between 110 and 130 g/L had a five times greater estimated risk of transfusion than those with a level of >130 g/L (p < 0.001). Gender, body mass index, preoperative diagnosis, comorbid conditions, use of anticoagulants or aspirin, autologous predonation status, type of anesthesia, operative time, and decrease in hemoglobin or hematocrit were not predictors of blood transfusion. One hundred and two (78%) of the 131 predonated autologous units were discarded. Patients with a preoperative hemoglobin level of >130 g/L had the highest percentage of wasted units (90%; fifty-five of sixty-one). Preoperative autologous blood donation did not eliminate the risk of allogeneic blood transfusion in autologous donors. CONCLUSIONS: The preoperative hemoglobin level is the strongest predictor of blood transfusion after shoulder surgery, and individuals with a preoperative hemoglobin level of <110 g/L have the highest risk of transfusion. On the basis of these findings, we do not recommend autologous predonation for individuals with a preoperative hemoglobin level of >130 g/L, to avoid unnecessary expense and waste.