Effect of age, gender, and body mass index on incidence and satisfaction of a Popeye deformity following biceps tenotomy or tenodesis: secondary analysis of a randomized clinical trial.

BACKGROUND: The purpose of this study was to determine the incidence of Popeye deformity following biceps tenotomy vs. tenodesis and evaluate risk factors and subjective and objective outcomes. METHODS: Data for this study were collected as part of a randomized clinical trial in which patients aged ≥18 years undergoing arthroscopic shoulder surgery for a long head of the biceps tendon lesion were allocated to undergo tenotomy or tenodesis. The primary outcome measure for this secondary analysis was rate of Popeye deformity at 24 months postoperation as determined by an evaluator blinded to group allocation. Those with a deformity indicated their satisfaction with the appearance of their arm on a 10-cm visual analog scale, rated their pain and cramping, and completed the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and the Western Ontario Rotator Cuff index. Isometric elbow flexion and supination strength were also measured. Cohen kappa was calculated to measure inter-rater reliability between patient and evaluator on the presence of a deformity. Logistic regression was performed to identify predictors of presence or absence of a Popeye deformity. RESULTS: One hundred fourteen patients were randomly assigned to 2 groups, of which 42 to the tenodesis group and 45 to the tenotomy group completed a 24-month follow-up. Based on clinical observation, the odds of a Popeye in the tenotomy group were 4.3 times greater than in the tenodesis group (P = .018) with incidence of 33% (15/45) and 9.5% (4/42), respectively. Surgical technique was the only significant predictor of perceived deformity, with male gender trending toward significance (odds ratio 7.33, 95% confidence interval 0.867-61.906, P = .067). Mean (standard deviation) satisfaction score of those with a deformity regarding appearance of their arm was 7.3 (2.6). Increasing satisfaction was correlated with increasing age (r = 0.640, P = .025), but there was no association with gender (r = -0.155, P = .527) or body mass index (r = -0.221, P = .057). Differences in subjective outcomes were dependent on whether the Popeye was clinician- or self-assessed. CONCLUSION: The odds of developing a perceived Popeye deformity was 4.3 higher after tenotomy compared to tenodesis based on clinician observation. Male gender was trending toward being predictive of having a deformity. Pain and cramping were increased in those with a self-reported Popeye. Younger patients were significantly less satisfied with a deformity despite no difference in functional outcomes at 24 months. Thus, biceps tenodesis may be favored in younger male patients to minimize the risk of Popeye and the risk of dissatisfaction in the appearance of their arm following surgery.

Radiostereometric analysis of keeled versus pegged glenoid components in total shoulder arthroplasty: a randomized feasibility study.

BACKGROUND: This study aimed to assess differences in the fixation and functional outcomes between pegged and keeled all-polyethylene glenoid components for standard total shoulder arthroplasty. METHODS: Patients were randomized to receive a keeled or pegged all-polyethylene glenoid component. We used model-based radiostereometric analysis (RSA) to assess glenoid fixation and subjective outcome measures to assess patient function. Follow-up examinations were completed at 6 weeks and 6, 12 and 24 months after surgery. Modifications to the RSA surgical, imaging and analytical techniques were required throughout the study to improve the viability of the data. RESULTS: Stymied enrolment resulted in only 16 patients being included in our analyses. The RSA data indicated statistically greater coronal plane migration in the keeled glenoid group than in the pegged group at 12 and 24 months. Functional outcome scores did not differ significantly between the groups at any follow-up. One patient with a keeled glenoid showed high component migration after 24 months and subsequently required revision surgery 7 years postoperatively. CONCLUSION: Despite a small sample size, we found significant differences in migration between glenoid device designs. Although clinically these findings are not robust, we have shown the feasibility of RSA in total shoulder arthroplasty as well as the value of a high-precision metric to achieve objective results in a small group of patients.

CONTEXTE: Cette étude avait pour objet d'évaluer les différences sur le plan de la fixation et des résultats fonctionnels entre les composants glénoïdiens à plots et à quille, tous deux en polyéthylène, dans une arthroplastie totale traditionnelle de l'épaule. MÉTHODES: La répartition des composants glénoïdiens en polyéthylène à plots et à quille a été faite de façon aléatoire. Nous nous sommes servis de modèles d'analyses radiostéréométriques (ARS) pour évaluer la fixation glénoïdienne et les indicateurs de résultats subjectifs, ce qui nous a ainsi permis d'évaluer les résultats fonctionnels des patients. Quatre examens de suivi ont été réalisés après la chirurgie : à 6 semaines, puis à 6 mois, à 12 mois et à 24 mois. Tout au long de l'étude, des ajustements ont été apportés aux modèles d'ARS de la chirurgie, de l'imagerie et des analyses afin d'améliorer la viabilité des données. RÉSULTATS: Des problèmes liés au recrutement ont fait en sorte que nous n'avons retenu que 16 patients dans le cadre de nos analyses. Les données d'ARS ont montré une migration statistiquement plus grande du plan frontal dans le groupe quille que dans le groupe plots à 12 et à 24 mois. Les résultats fonctionnels étaient sensiblement les mêmes d'un groupe à l'autre, peu importe le moment du suivi. Un patient du groupe quille a présenté une migration très importante du composant après 24 mois; il a dû subir une chirurgie de révision 7 ans après la chirurgie initiale. CONCLUSION: Malgré la petite taille de l'échantillon, nous avons observé des différences significatives dans la migration des composants, selon le type utilisé. Même si ces observations ne permettent pas d'arriver à des conclusions robustes d'un point de vue clinique, nous avons montré qu'il est possible d'avoir recours aux ARS en contexte d'arthroplastie totale de l'épaule et démontré la valeur associée à l'utilisation de mesures de haute précision pour l'obtention de résultats objectifs chez un petit groupe de patients.