Ninety-day complication rate based on 532 Latarjet procedures in Dutch hospitals with different operation volumes.

BACKGROUND: In this study, we aimed to provide insight into the 90-day complication rates following the Latarjet procedure. Data from 2015 were collected from multiple hospitals in the Netherlands, with different volumes of Latarjet procedures. Our second aim was to examine which patient and surgical factors were associated with complications. METHODS: We conducted a retrospective chart review of 13 hospitals between 2015 and 2022. Data regarding complications within 90 days of Latarjet procedures were extracted. The effect of sex, age, body mass index (BMI), smoking, previous shoulder operations, fixation material, hospital volume, screw size, and operation time on the complication rate was assessed by multivariable logistic regression analysis. RESULTS: Of the 532 included patients, 58 (10.9%) had complications. The most common complications were material failure (n = 19, 3.6%) and nerve injury (n = 13, 2.4%). The risk of complications was lower for male patients than for female patients (odds ratio, 0.40; 95% confidence interval, 0.21-0.77; P = .006). Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time were not associated with complications. CONCLUSION: The 90-day complication rate after the Latarjet procedure was 10.9% and was higher in female patients than in male patients. Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time did not affect complication rates. We advise setting up a national registry to prevent under-reporting of complications.

Capsulorraphy with Achilles allograft augmentation for shoulder instability in patients with Ehlers-Danlos syndrome.

BACKGROUND: Surgical management of shoulder instability in patients with Ehlers-Danlos syndrome (EDS) remains challenging secondary to the pathologic nature of their connective tissue. Allograft reconstruction of the shoulder capsule in EDS has the potential to increase stability by providing healthier connective tissue. The purpose of this study was to report the surgical technique and outcome of open capsulorraphy and augmentation of the anterior capsule with an Achilles tendon allograft in patients with shoulder instability in the setting of EDS. METHODS: Five shoulders (4 patients) with EDS and severe anteroinferior or multidirectional instability underwent open capsular shift combined with Achilles allograft augmentation of the anterior capsule. Patients were evaluated for pain, motion, recurrent instability, subjective shoulder value, American Shoulder and Elbow Surgeons score, complications, and reoperations. The mean follow-up time was 3.6 years (range, 2-5 years). RESULTS: Shoulder stability was restored in 4 of 5 (80%) shoulders. At the final follow-up, the mean subjective shoulder value and American Shoulder and Elbow Surgeons scores were 84 and 77.3, respectively. One shoulder developed recurrent posterior instability after an injury 1.6 years after the index procedure. The mean pain visual analog scale was 7 preoperatively and 2 at the most recent follow-up. Before surgery, all patients reported the use of narcotic pain medication, whereas at the most recent follow-up, only the one patient who had experienced recurrence reported moderate pain. Except for the shoulder that required revision surgery for posterior shoulder instability, there were no complications or other reoperations. CONCLUSION: Open capsulorraphy with Achilles allograft augmentation improved stability and pain in 4 of 5 shoulders with instability in the setting of EDS. In this small case series of patients with EDS, Achilles tendon allograft augmentation was safe and effective as a primary or revision surgical procedure for anterior shoulder instability. A larger patient cohort with longer follow-up is needed to confirm these findings.

Treatment of coracoid process fractures: a systematic review.

INTRODUCTION: The coracoid process is a small hook-shaped feature on the scapula and a key structure of the superior shoulder suspensory complex (SSSC). Fractures of the coracoid are rare. Therefore, no consensus exists regarding treatment of coracoid process fractures. Systematically review indications, outcomes and complications of traumatic coracoid process fractures in adults, and to provide a treatment algorithm. MATERIALS AND METHODS: A systematic review was performed to identify all relevant studies on the treatment of coracoid process fractures. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: Eight case series, with a total of 110 coracoid process fractures, were included. All studies were of moderate methodological quality. Of the fractures, 78% were Ogawa type I fractures, 13% Ogawa type II and 9% were unclassified. Conservative treatment showed good results in most Ogawa type II fractures and type I fractures without associated disruptions of the SSSC. Most Ogawa type I fractures with associated disruptions of the SSSC received surgical treatment showing good results. CONCLUSION: Based on moderate quality studies, surgical treatment may be considered in Ogawa type I fractures with multiple disruptions of the SSSC. A conservative treatment seems sufficient in other fracture types.

Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities?

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.

Once an arthrodesis, always an arthrodesis?

BACKGROUND: An arthrodesis of the shoulder is historically a solution for severe shoulder joint problems, for which no prosthetic solution is deemed possible. With the introduction of the reverse shoulder arthroplasty (RSA), which is intrinsically stable at the glenohumeral joint, it seems logical to consider conversion of a painful arthrodesis into a RSA, provided that the deltoid was not destroyed during the arthrodesis. METHODS: Four patients (2 men, 2 women; age 46-66 years) with a longstanding arthrodesis (5-11 years) visited our clinic with a painful shoulder (mainly around the scapula) with the request to provide more mobility. In all, the shoulder was fused in 60° to 80° of abduction, 20° to 40° of flexion, and 40° to 50° of internal rotation. All patients refused an osteotomy as treatment for the pain. A preoperative electromyelogram showed activity in at least the posterior or middle parts of the deltoid, or both. They were offered revision of arthrodesis to a reverse prosthesis. All complications, especially instability, were discussed. Surgery was performed through the previous deltopectoral scar. In 3 cases, the osteotomy was lateral to the original joint line, providing some lateralization. RESULTS: Follow-up was 22 to 60 months. The Constant-Murley score improved from 15-21 to 30-60. No dislocations occurred. All patients were satisfied, especially with the increased, although not impressive, rotations. Pain did not disappear but decreased considerably, from visual analog scale 8-10 to 0-4. CONCLUSION: Conversion into a RSA is a safe procedure in patients with a painful arthrodesis and grossly intact deltoid, providing better glenohumeral mobility (especially rotations), leading to improved patient satisfaction.

Four-dimensional computed tomography scans facilitate preoperative planning in snapping scapula syndrome.

HYPOTHESIS: Because a 4-dimensional CT scan (4D CT) is able to provide a moving 3-dimensional (3D) image in real time in patients with snapping scapula syndrome, a 4D CT scan should be able to demonstrate bony impingement of the scapula on the posterior thorax. This study was performed to determine if 4D CT scans aid the clinician in defining the size and location of the scapular bone causing impingement in patients with snapping scapula syndrome. MATERIALS AND METHODS: Between October 2009 and August 2013, 12 patients (median age, 26.5 years; range 15-55 years) with snapping scapula syndrome were investigated with 4D CT. The images formed produced a dynamic volume-rendered reconstruction of the scapulothoracic joint that displayed its movements and any dynamic area of impingement of the scapula on surrounding bony structures. Asymmetry between symptomatic and asymptomatic scapulae was used to determine the radiologic cause of the patient's symptoms. After the failure of conservative management, 8 patients underwent surgery for their condition. RESULTS: Five patients demonstrated bony contact of the scapula on the posterior thoracic ribs. Four patients demonstrated no bony contact but close apposition of the scapula to the posterior thoracic ribs. Three patients demonstrated no bony impingement but abnormal movement of the second and third rib caused by a soft-tissue tethering structure. CONCLUSION: The 4D CT scan images defined pathology well in patients with snapping scapula syndrome and improved assessment of the amount and location of the scapular bone and soft tissue causing symptoms.

The active and passive kinematic difference between primary reverse and total shoulder prostheses.

BACKGROUND: Reverse shoulder arthroplasty (RSA) and total shoulder arthroplasty (TSA) effectively decrease pain and improve clinical outcome. However, indications and biomechanical properties vary greatly. Our aim was to analyze both active and passive shoulder motion (thoracohumeral [TH], glenohumeral [GH], and scapulothoracic [ST]) and determine the kinematic differences between RSAs and TSAs. METHODS: During 3 range-of-motion (ROM) tasks (forward flexion, abduction, and axial rotation), the motion patterns of 16 RSA patients (19 shoulders), with a mean age of 69 ± 8 years (range, 58-84 years), and 17 TSA patients (20 shoulders), with a mean age of 72 ± 10 years (range, 53-87 years), were measured. The mean length of follow-up was 22 ± 10 months (range, 6-41 months) for RSA patients and 33 ± 18 months (range, 12-87 months) for TSA patients. Kinematic measurements were performed with a 3-dimensional electromagnetic tracking device. RESULTS: All patients showed better passive than active ROM. This difference was significantly larger for RSA patients than for TSA patients (TH in sagittal plane, 20° vs 8° [P = .001]; GH in sagittal plane, 16° vs 7° [P = .003]; TH in scapular plane, 15° vs 2° [P < .001]; GH in scapular plane, 12° vs 0° [P < .001]; and ST in scapular plane, 3° vs -2° [P = .032]). This finding also showed that in the scapular plane, TSA patients showed hardly any difference between active and passive ROM. Furthermore, TSA patients had 16° to 17° larger active TH motion, 15° larger active GH motion, and 8° larger active ST motion compared with RSA patients. The GH-ST ratios showed similar figures for both types of prostheses. CONCLUSION: TSA patients have larger active TH motion because in the scapular plane, they completely use the possible GH motion provided by the prosthetic design. This larger active ROM in TSA patients only applies for elevation and abduction, not for axial rotation or passive ROMs.

Long-term follow-up of Sprengel's deformity treated with the Woodward procedure.

BACKGROUND: Sprengel's deformity is a congenital anomaly of the shoulder with superior displacement and rotation of the hypoplastic scapula. The functional impairment and misshapen appearance of the shoulder can be minimized with different surgical techniques. The aim of this study was to evaluate the long-term results after correction of Sprengel's deformity using the Woodward procedure. METHODS: In this retrospective study, 8 shoulders were examined at 3 different periods in time. The average follow-up was 14.7 years (range, 8-26). Range of motion, Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score, and simple shoulder test (SST) were obtained to evaluate shoulder function. Scapula placement and degenerative disease were assessed by radiographic examination and the Rigault's classification. Cavendish grading was used to evaluate cosmetic appearance. RESULTS: Mean age at the time of surgery had been 8 years and 9 months. Mean follow-up was 13.5 years. Abduction improved by 41° in the first year after surgery, with final improvement of 56° at long-term follow-up. At the latest follow-up evaluation, the mean Constant score was 85 points, the DASH score 14.59 points, and the SST 9.5 points. Radiographs showed superior displacement of the involved scapula in all cases, with no signs of degenerative disease of the shoulder. Cavendish grade improved from grade 3 preoperatively to grade 1 or 2 at the latest follow-up examination. No long-term complications had occurred. CONCLUSION: The Woodward procedure shows to be an effective surgical procedure to improve shoulder function as well as cosmetic appearance in patients with Sprengel's deformity.

Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff Repair: A Systematic Review and Meta-analysis.

BACKGROUND: Outcomes of rotator cuff repair (RCR) are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear. PURPOSE: To assess the role of delay to surgery on the outcomes of RCR in the literature. STUDY DESIGN: Systematic review with meta-analysis; Level of evidence, 4. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. All studies assessing outcomes after RCR-either retear rates or patient-reported outcome measures (PROMs)-and reporting delay to surgery were identified through June 2021 in PubMed, Embase, and Cochrane. Inclusion criteria consisted of traumatic injuries, mean age <65 years, minimum 6-month follow-up, and assessment of retear rates with radiologic examination or reporting of PROMs. Random-effect models were used to assess outcomes, reported in odds ratio (OR) or mean difference (MD) with 95% CIs. RESULTS: A total of 8118 patients were included from 33 studies, with a mean age of 59 years (range, 53-64) and mean follow-up of 3.0 years (range, 0.5-8.2), among whom 53% were male and 74% had dominant-side injury. Patients undergoing surgery >3 months after injury did not have significantly higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; P = .700), lower Constant-Murley score (MD, -6.2 [95% CI, -16.4 to 4.1]; P = .240), or lower ASES score (American Shoulder and Elbow Surgeons; MD, -12.9 [95% CI, -26.0 to -0.2]; P = .050) compared with those having surgery within 3 months. Similarly, delaying surgery for 6 months did not result in higher retear rates (OR, 1.7 [95% CI, 0.8 to 3.7]; P = .190) or lower PROMs. Delaying surgery for 1 year, however, led to an increased likelihood of retear when compared with <1 year (OR, 2.9 [95% CI, 2.1 to 4.0]; P < .001), and this was similar for the 2-year cutoff (OR, 5.9 [95% CI, 1.1 to 32.1]; P = .040). It was also noted that patients with an intact cuff at follow-up had a mean 3.9 months' shorter time from injury to surgery than patients with retear (95% CI, 1.0-6.8 months; P = .009). CONCLUSION: This systematic review with meta-analysis found that delaying rotator cuff surgery for 3 to 6 months did not lead to higher retear rates or inferior PROMs as compared with undergoing earlier surgery. However, delaying surgery for ≥1 year clearly resulted in higher retear rates after RCR. This study is limited by relying on retrospective studies, and larger prospective studies are needed to confirm these findings. REGISTRATION: CRD42021240720 (PROSPERO).

The new 4-dimensional computed tomographic scanner allows dynamic visualization and measurement of normal acromioclavicular joint motion in an unloaded and loaded condition.

OBJECTIVE: Using 4-dimensional computed tomographic scanner to determine the motion pattern of the acromioclavicular (AC) joint during adduction of the arm, with and without resisted superior elevation. METHODS: Sixteen healthy volunteers (5 women and 11 men; mean ± SD age, 42 ± 11 years). Four different motions were measured: AC joint width, anteroposterior translation, superoinferior translation, and opening of the superior aspect of the joint. Measurements between arm positions of neutral, adduction, and loaded were compared. RESULTS: Predominant movement is posterior translation (1.1 ± 0.9 mm, P = 0.001); in the coronal plane, superior translation of the clavicle (0.6 ± 0.5 mm, P = 0.001) and some opening of the superior joint space. Changes in the AC joint width and anteroposterior translation were significantly related to age (P = 0.016 and P = 0.006). CONCLUSIONS: Four-dimensional computed tomographic scans record the motion pattern of an asymptomatic AC joint and demonstrated that in adduction plus resisted elevation of the arm, the main movement of the AC joint is posterior and superior translation of the clavicle.

Are shoulders with a reverse shoulder prosthesis strong enough? A pilot study.

BACKGROUND: It has been suggested that limited active ROM of reverse shoulder prostheses relates to lack of strength. However, the postoperative strength has not been quantified. QUESTIONS/PURPOSES: We therefore measured joint torques in patients with reverse shoulder prostheses and correlated torques with functional scores. METHODS: We recruited 33 patients (age, 72 ± 8 years) with a reverse prosthesis (37 shoulders, 21 primary and 16 revisions). We obtained Constant-Murley, DASH, and Simple Shoulder Test ([D]SST) scores, and performed two isokinetic protocols (abduction/adduction and external/internal rotation) at 60° per second. Minimum followup was 4 months (average, 23 months; range, 4-63 months). RESULTS: Twenty-three patients (24 shoulders; 13 primaries, 11 revisions) were able to perform at least one of the defined tasks. Mean abduction and adduction torques were 15 Nm ± 7 Nm and 16 Nm ± 10 Nm (19%-78% of normal shoulders). External and internal rotation tasks could be performed by only 13 patients (14 shoulders; nine primary, five revisions) generating 9 Nm ± 4 Nm and 8 Nm ± 3 Nm, respectively (13%-71% of normal shoulders). We found moderate correlations between Constant-Murley, DASH and (D)SST (D = Dutch translation) scores and abduction and external rotation. CONCLUSIONS: Patients with a reverse prosthesis had reduced strength when compared with normal values reported in the literature (only 65% of patients could perform the protocol). This effect was greatest for external rotation and might explain clinical outcomes with which a moderately strong relationship was observed. Our observations suggest limited strength is a major factor in reduced ROM.

Kinematic and clinical evaluation of shoulder function after primary and revision reverse shoulder prostheses.

HYPOTHESIS: Results of the reverse shoulder prosthesis on pain are generally satisfying; however, active range of motion (ROM) is often not optimal, especially after revision. A kinematic and clinical analysis of the reverse prosthesis was performed to provide more precise information on its glenohumeral motion pattern. We hypothesized that the difference in the primary and revision cases is due to differences in the motion in the glenohumeral joint. MATERIALS AND METHODS: The motion pattern of 31 patients with a reverse prosthesis (35 shoulders, 19 primary and 16 revisions) was measured during 3 active ROM tasks-forward flexion, abduction, and axial rotation. Average age was 71 ± 8 years (range, 58-85 years). Average follow-up was 23 ± 14 months (range, 4-63 months). Kinematic measurements were performed with a 3-dimensional electromagnetic tracking device. Clinical evaluation was performed by obtaining Constant score, Disabilities of Arm, Shoulder and Hand (DASH) score, and the Simple Shoulder Test (SST). Acromial-prosthetic distance was measured on anteroposterior radiographs. RESULTS: Primary placed prostheses showed significantly better active glenohumeral motion than revisions for forward flexion (71° ± 18° vs 53° ± 26°, P < .05), abduction (64° ± 15° vs 46° ± 24°, P < .05), and active external rotation (31° ± 25° vs 13° ± 16°, P < .05). Constant score improved for the whole group from 24 (range, 5-47) to 50 (range, 8-87; P < .001), for the primary group from 28 (range, 13-47) to 60 (range, 8-87; P < .001) and for revisions from 20 (range, 5-47) to 38 (range, 11-73; P < .001). Acromial-prosthetic distance showed no significant correlation for active glenohumeral motion. Five shoulders with a deficient teres minor muscle showed no significant decrease of external rotation. CONCLUSION: Active ROM is better in primary placed prosthesis, and this difference takes place mainly in the glenohumeral joint. In all our patients, Constant scores improved significantly postoperatively. However, we could not find any clinical correlating parameters to explain this difference.

Results of stemless shoulder arthroplasty: a systematic review and meta-analysis.

Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures.Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up.Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates.Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem.Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy.Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn.There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another. Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067.

Conversion to reverse shoulder arthroplasty fifty-one years after shoulder arthrodesis: A case report.

BACKGROUND: Patients with a shoulder arthrodesis generally experience restriction in range of motion and limitations in activities of daily living. In addition, up to one-third of the patients deals with serious peri scapular pain. The conversion of a shoulder arthrodesis in a reverse shoulder arthroplasty (RSA) has been described as an effective treatment to achieve better function and decreased pain, although literature is sparse. We present the case of a conversion from a painful shoulder arthrodesis to RSA, after a 51 years interval. CASE SUMMARY: A 71-year-old male presented with severe peri scapular pain and limited function 51 years after shoulder arthrodesis. Preoperative workup showed a normal bone stock of the glenoid and an intact axillary nerve, but atrophic posterior part of the deltoid muscle. The shoulder arthrodesis was successfully converted to RSA. Twelve months postoperative the patient was very satisfied. He has no pain at rest, nor with exercise and experienced definite improvements in activities of daily living, despite his limited range of motion. CONCLUSION: Conversion from shoulder arthrodesis to a RSA can be performed safely, with a high chance of peri scapular pain relief; even after a longstanding arthrodesis.

Suprapectoral versus subpectoral tenodesis for Long Head Biceps Brachii tendinopathy: A systematic review and meta-analysis.

BACKGROUND: Suprapectoral long head biceps (LHB) tenodesis and subpectoral LHB tenodesis are both commonly performed surgical procedures. Due to the more proximal position of the suprapectoral tenodesis site this technique may be accompanied with more postoperative pain in the bicipital groove and cramping pain in the biceps muscle. We hypothesized that subpectoral tenodesis is associated with a better clinical outcome than suprapectoral tenodesis. METHODS: A literature search was conducted in PubMed and Embase from January 2000 to July 2019 with the terms "biceps" and "tenodesis". Only comparing studies reporting on American Shoulder Elbow Score (ASES), VAS for anterior shoulder pain, Constant Murley Score (CMS), pain in the bicipital groove and Popeye deformity following suprapectoral and subpectoral tenodesis were included. Quality assessment of included articles was performed using the Coleman score. RESULTS: Seven comparative studies with 409 patients reporting the results of LHB suprapectoral and subpectoral tenodesis were included. A significant, but clinically irrelevant difference in ASES (mean difference 2.15) p=0.01 was observed. No significant difference in CMS (mean difference 0.09), VAS for anterior shoulder pain (mean difference 0.01), Popeye deformity (odds ratio 3.19) and persistent bicipital pain (odds ratio 2.66). The Coleman score ranged between 53 and 87. CONCLUSION: Based on this meta-analysis we found a significantly, though not clinically relevant difference in ASES in favour of subpectoral LHB tenodesis when compared with suprapectoral LHB tenodesis. Comparable results were found with regard to outcome scores, pain in the bicipital groove and avoiding a Popeye deformity.

New insights in the treatment of acromioclavicular separation.

A direct force on the superior aspect of the shoulder may cause acromioclavicular (AC) dislocation or separation. Severe dislocations can lead to chronic impairment, especially in the athlete and high-demand manual laborer. The dislocation is classified according to Rockwood. Types I and II are treated nonoperatively, while types IV, V and VI are generally treated operatively. Controversy exists regarding the optimal treatment of type III dislocations in the high-demand patient. Recent evidence suggests that these should be treated nonoperatively initially. Classic surgical techniques were associated with high complication rates, including recurrent dislocations and hardware breakage. In recent years, many new techniques have been introduced in order to improve the outcomes. Arthroscopic reconstruction or repair techniques have promising short-term results. This article aims to provide a current concepts review on the treatment of AC dislocations with emphasis on recent developments.

Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery.

INTRODUCTION: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision indication and differences between total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) in hemiarthroplasty (HA) revision surgery. MATERIALS AND METHODS: All patients with an indication for revision of HA were retrospectively included. Clinical evaluation consisted of pre- and post-operative constant scores, disability of arm-shoulder-hand-score (DASH), Dutch translation of the simple shoulder test ((D)SST), Oxford shoulder score test (OSS), short form (SF-36) and the complication rate. RESULTS: From July 1994 to July 2008, 39 patients (40 shoulders) underwent revision arthroplasty. Of 19 patients (19 shoulders) we obtained a complete follow-up. The mean age at revision surgery 69 ± 10 years (range: 46-83) and the mean follow-up 41 ± 31 months (range: 10-113). In 7 cases TSA was used for revision when the cuff was intact, 12 times RSA was performed. The indications for the revision were glenoid erosion (n = 4), humeral component malposition (n = 2), cuff-pathology (n = 12) and infection (n = 1). Postoperative constant score 51.7 ± 11.4 for TSA and 31.1 ± 18.7 for RSA (P = 0.008). The DASH was 48.3 ± 25.1 and 68.7 ± 17.5, respectively (P = 0.09). DSST showed 6 ± 4 and 4 ± 4 (P = 0.414). OSS 41.3 ± 10.1 and 28.1 ± 10.3 (P = 0.017). SF-36 43.3 ± 22.1 and 24.5 ± 12.8 (P = 0.072). Four shoulders (21%) presented four complications. CONCLUSIONS: In this study, revision surgery showed poor to reasonable postoperative results and better clinical outcome for TSA. When a revision after HA was needed, and the soft-tissue component of the shoulder was intact, a TSA proved to be a preferable solution.

Isokinetic strength differences between patients with primary reverse and total shoulder prostheses: muscle strength quantified with a dynamometer.

BACKGROUND: Range of motion after total shoulder arthroplasty is better than after reverse shoulder arthroplasty, however with similar clinical outcome. It is unclear if this difference can only be found in the different range of motion or also in the force generating capacity. QUESTIONS: (1) are isokinetically produced joint torques of reverse shoulder arthroplasty comparable to those of total shoulder arthroplasty? (2) Does this force-generating capacity correlate with functional outcome? METHODS: Eighteen reverse shoulder arthroplasty patients (71years (SD 9years)) (21 shoulders, follow-up of 21months (SD 10months)) were recruited, 12 total shoulder arthroplasty patients (69years (SD 9years)) (14 shoulders, follow-up of 35months (SD 11months)). Pre- and post-operative Constant-Murley scores were obtained; two isokinetic protocols (ab-/adduction and ex-/internal rotations) at 60°/s were performed. FINDINGS: Twelve of 18 reverse shoulder arthroplasty patients generated enough speed to perform the test (13 shoulders). Mean ab-/adduction torques are 16.3Nm (SD 5.6Nm) and 20.4Nm (SD 11.8Nm). All total shoulder arthroplasty patients generated enough speed (14 shoulders). Mean ab-/adduction torques are 32.1Nm (SD 13.3Nm) and 43.1Nm (SD 21.5Nm). Only 8 reverse shoulder arthroplasty patients (9 shoulders) could perform ex-/internal rotation tasks and all total shoulder arthroplasty patients. Mean ex-/internal rotation torques are 9.3Nm (SD 4.7Nm) and 9.2Nm (SD 2.1Nm) for reverse shoulder arthroplasty, and 17.9Nm (SD 7.7Nm) and 23.5Nm (SD 10.6Nm) for total shoulder arthroplasty. Significant correlations between sub-scores: activity, mobility and strength and external rotation torques for reverse shoulder arthroplasty. Moderate to strong correlation for sub-scores: strength in relation to abduction, adduction and internal rotation torques for total shoulder arthroplasty. INTERPRETATION: Shoulders with a total shoulder arthroplasty are stronger. This can be explained by the absence of rotator cuff muscles and (probably) medialized center of rotation in reverse shoulder arthroplasty. The strong correlation between external rotation torques and post-operative Constant-Murley sub-scores demonstrates that external rotation is essential for good clinical functioning in reverse shoulder arthroplasty.

Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads.

BACKGROUND: Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1 kg and elastic resistance). METHODS: Shoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. FINDINGS: The scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1 kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. INTERPRETATION: Differences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load.