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1.
Acta Orthop ; 95: 348-357, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38888103

ABSTRACT

BACKGROUND AND PURPOSE: International variation exists in the types of shoulder replacement used for treatment of specific diseases. Implant choice continues to evolve without high-quality evidence. Our aim was to evaluate trends in incidence rates of shoulder replacement and assess any recent changes in practice between countries by using registry data. METHODS: Patient characteristics, indication and year of surgery, type of replacement, and collection methods of patient-reported outcomes (PROMs) was extracted from 11 public joint registries. Meta-analyses examined use of reverse total shoulder replacement (RTSR) for osteoarthritis, cuff tear arthropathy, and acute fracture; use of anatomical total shoulder replacement (TSR) for osteoarthritis; and use of humeral hemiarthroplasty for fracture. RESULTS: The annual growth rate of shoulder replacements performed is 6-15% (2011-2019). The use of RTSR has almost doubled (93%). RTSR is now universally performed for cuff tear arthropathy (97.3%, 95% confidence interval [CI] 96.0-98.1). Its use for avascular necrosis, trauma, and inflammatory arthropathy is increasing. The use of RTSR was similar (43.1%, CI 30.0-57.2) versus TSR (44.7%, CI 31.1-59.1) for osteoarthritis. The types of PROMs used, collection time points, and response rates lack standardization. COVID-19 had a varying inter-registry impact on incidence rates. CONCLUSION: The incidence of shoulder replacements has grown. Use of RTSR has increased for all disease indications despite limited high-quality evidence driving this change in indications outside of cuff arthropathy. Consequently, less variation is observed in international practice. Existing differences now relate to use of newer implant types and methodology of PROMs collection, which prevents international comparison and outcome analysis.


Subject(s)
Arthroplasty, Replacement, Shoulder , Registries , Humans , Arthroplasty, Replacement, Shoulder/trends , Arthroplasty, Replacement, Shoulder/statistics & numerical data , Arthroplasty, Replacement, Shoulder/methods , Shoulder Joint/surgery , Osteoarthritis/surgery , Osteoarthritis/epidemiology , Rotator Cuff Tear Arthropathy/surgery , Rotator Cuff Tear Arthropathy/epidemiology , Hemiarthroplasty/trends , Hemiarthroplasty/methods , Hemiarthroplasty/statistics & numerical data
2.
J Bone Joint Surg Am ; 106(13): 1181-1188, 2024 Jul 03.
Article in English | MEDLINE | ID: mdl-38758820

ABSTRACT

BACKGROUND: Controversy exists regarding the ideal humeral component version to optimize humeral rotation and patient outcomes in reverse total shoulder arthroplasty (rTSA). METHODS: Patients undergoing primary rTSA for rotator cuff tear arthropathy, a massive rotator cuff tear, or primary osteoarthritis with a rotator cuff tear were randomized to placement of the humeral component in neutral version or 30° of retroversion. Shoulder active range of motion and strength and visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES), and Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) scores were collected up to 2 years postoperatively. The goal of the study was to determine whether humeral external rotation and internal rotation are affected by humeral component version following rTSA at 2 years postoperatively. RESULTS: Sixty-six patients were included in the analysis. The median follow-up was 26 months for the neutral and 27 months for the 30° retroversion group. No differences between the groups were observed with respect to the primary diagnosis, sex, age, body mass index, or American Society of Anesthesiologists (ASA) class. The 2 groups did not differ significantly in terms of improvement at 2 years in active shoulder abduction (p = 0.969), forward elevation (p = 1.000), internal rotation measured as the highest spinal level reached (p = 1.000), internal rotation with the arm abducted 90° (p = 0.451), external rotation (p = 0.362), or muscle strength in forward elevation (p = 1.000), abduction (p = 1.000), external rotation (p = 0.617), or internal rotation (p = 1.000). The 2 groups did not differ significantly in terms of improvement in postoperative ASES (p = 1.000), PROMIS-10 physical (p = 1.000), or VAS pain scores (p = 0.718) at the time of final follow-up. In the neutral version group, 1 patient underwent revision for instability and 1 for stiffness. One acromial stress fracture occurred in the 30° humeral retroversion group. Scapular notching was observed in 7 (21.2%) of the patients in neutral version group and 5 (15.2%) of the patients in the 30° retroversion group (p = 0.750). CONCLUSIONS: Securing the humeral component at neutral version or 30° of retroversion in rTSA resulted in similar active shoulder external rotation, internal rotation, forward elevation, abduction, and strength measurements, complication rates, and VAS pain, PROMIS-10 physical, and ASES scores at 2 years postoperatively. LEVEL OF EVIDENCE: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.


Subject(s)
Arthroplasty, Replacement, Shoulder , Range of Motion, Articular , Humans , Arthroplasty, Replacement, Shoulder/methods , Male , Female , Aged , Prospective Studies , Double-Blind Method , Middle Aged , Treatment Outcome , Humerus/surgery , Rotator Cuff Injuries/surgery , Shoulder Joint/surgery , Shoulder Joint/physiopathology , Rotator Cuff Tear Arthropathy/surgery , Osteoarthritis/surgery , Osteoarthritis/physiopathology , Shoulder Prosthesis , Patient Reported Outcome Measures , Pain Measurement
3.
Int Orthop ; 48(5): 1285-1294, 2024 May.
Article in English | MEDLINE | ID: mdl-38478022

ABSTRACT

PURPOSE: Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes. METHODS: Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up. RESULTS: Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27). CONCLUSIONS: The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.


Subject(s)
Arthroplasty, Replacement, Shoulder , Rotator Cuff Injuries , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Rotator Cuff/surgery , Rotator Cuff Injuries/complications , Rotator Cuff Injuries/diagnosis , Rotator Cuff Injuries/surgery , Prospective Studies , Shoulder/surgery , Shoulder Joint/surgery , Shoulder Joint/innervation , Arthroplasty, Replacement, Shoulder/adverse effects , Arthroplasty, Replacement, Shoulder/methods , Treatment Outcome , Retrospective Studies , Range of Motion, Articular
4.
J Shoulder Elbow Surg ; 33(6): e308-e321, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38430979

ABSTRACT

BACKGROUND: Prognostic factors for total shoulder arthroplasty (TSA) clinical outcomes are incompletely understood. This study investigates the associations of preoperative patient, disease-specific, and surgical factors with 1-year postoperative PENN Shoulder Score (PSS) in patients undergoing primary TSA. METHODS: Cleveland Clinic patients undergoing primary anatomic TSA (aTSA) or reverse TSA (rTSA) for glenohumeral osteoarthritis (GHOA) or rotator cuff tear arthropathy (CTA) between February 2015 and August 2019, and having complete preoperative and 1-year postoperative patient-reported outcome measures (PROMs), were included. Twenty preselected preoperative patient, disease-specific, and surgical factors were used to fit multivariable models for 1-year PSS and its subscores. RESULTS: Of 1427 eligible primary TSAs, 1174 had 1-year follow-up by PROMs (82%), with 1042 analyzed after additional exclusions, including 30% rTSAs for CTA (n = 308), 26% rTSAs for GHOA (n = 275), and 44% aTSAs for GHOA (n = 459). All PROMs showed statistically significant improvements postoperatively, with 89% of patients reaching an acceptable symptom state. Lower 1-year PSS was associated with younger age, female sex, current smoking, chronic pain diagnosis, history of prior surgery, worker's compensation claim, lower preoperative mental health, lower baseline PSS, absence of glenoid bone loss, and diagnosis-arthroplasty type (CTA-rTSA < GHOA-rTSA < GHOA-aTSA). The most important prognostic factors associated with 1-year PSS were diagnosis-arthroplasty type, baseline mental health status, and insurance status. CONCLUSIONS: Disease diagnosis, arthroplasty type, and several other baseline factors are strongly and individually associated with PROMs following primary TSA, with patients undergoing aTSA for GHOA demonstrating the highest PROM scores at 1-year follow-up. Patient, disease-specific, and surgical factors can be used to guide postoperative prognosis following primary TSA for improved preoperative patient counseling regarding expected outcomes of these procedures.


Subject(s)
Arthroplasty, Replacement, Shoulder , Osteoarthritis , Patient Reported Outcome Measures , Humans , Arthroplasty, Replacement, Shoulder/methods , Male , Female , Aged , Middle Aged , Osteoarthritis/surgery , Shoulder Joint/surgery , Rotator Cuff Tear Arthropathy/surgery , Retrospective Studies
5.
BMC Musculoskelet Disord ; 25(1): 204, 2024 Mar 07.
Article in English | MEDLINE | ID: mdl-38454432

ABSTRACT

BACKGROUND: The two major reverse shoulder arthroplasty (RSA) designs are the Grammont design and the lateralized design. Even if the lateralized design is biomechanically favored, the classic Grammont prosthesis continues to be used. Functional and subjective patient scores as well as implant survival described in the literature so far are comparable to the lateralized design. A pure comparison of how the RSA design influences outcome in patients has not yet been determined. The aim of this study was a comparison focused on patients with cuff tear arthropathy (CTA). METHODS: We analyzed registry data from 696 CTA patients prospectively collected between 2012 and 2020 in two specialized orthopedic centers up to 2 years post-RSA with the same follow-up time points (6,12 24 months). Complete teres minor tears were excluded. Three groups were defined: group 1 (inlay, 155° humeral inclination, 36 + 2 mm eccentric glenosphere (n = 50)), group 2 (inlay, 135° humeral inclination, 36 + 4 mm lateralized glenosphere (n = 141)) and group 3 (onlay, 145° humeral inclination, + 3 mm lateralized base plate, 36 + 2 mm eccentric glenosphere (n = 35)) We compared group differences in clinical outcomes (e.g., active and passive range of motion (ROM), abduction strength, Constant-Murley score (CS)), radiographic evaluations of prosthetic position, scapular anatomy and complications using mixed models adjusted for age and sex. RESULTS: The final analysis included 226 patients. The overall adjusted p-value of the CS for all time-points showed no significant difference (p = 0.466). Flexion of group 3 (mean, 155° (SD 13)) was higher than flexion of group 1 (mean, 142° (SD 18) and 2 (mean, 132° (SD 18) (p < 0.001). Values for abduction of group 3 (mean, 145° (SD 23)) were bigger than those of group 1 (mean, 130° (SD 22)) and group 2 (mean, 118° (SD 25)) (p < 0.001). Mean external rotation for group 3 (mean, 41° (SD 23)) and group 2 (mean, 38° (SD 17)) was larger than external rotation of group 1 (mean, 24° (SD 16)) (p < 0.001); a greater proportion of group 2 (78%) and 3 (69%) patients reached L3 level on internal rotation compared to group 1 (44%) (p = 0.003). Prosthesis position measurements were similar, but group 3 had significantly less scapular notching (14%) versus 24% (group 2) and 50% (group 1) (p = 0.001). CONCLUSIONS: Outcome scores of different RSA designs for CTA revealed comparable results. However, CTA patients with a lateralized and distalized RSA configuration were associated with achieving better flexion and abduction with less scapular notching. A better rotation was associated with either of the lateralized RSA designs in comparison with the classic Grammont prosthesis. LEVEL OF EVIDENCE: Therapeutic study, Level III.


Subject(s)
Arthroplasty, Replacement, Shoulder , Rotator Cuff Tear Arthropathy , Shoulder Joint , Shoulder Prosthesis , Humans , Arthroplasty, Replacement, Shoulder/methods , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Rotator Cuff/surgery , Prosthesis Design , Range of Motion, Articular , Treatment Outcome , Retrospective Studies
6.
BMC Musculoskelet Disord ; 25(1): 231, 2024 Mar 23.
Article in English | MEDLINE | ID: mdl-38521910

ABSTRACT

BACKGROUND: The current study aimed to determine the changes in pre-and post-operative Pittsburg sleep quality index (PSQI) and Tampa scale of kinesiophobia (TSK) values ​​according to the Hamada classification in patients who underwent reverse shoulder arthroplasty (RSA) for rotator cuff tear arthropathy (RCTA). METHODS: One hundred and eight patients who underwent RSA for RCTA were reviewed retrospectively. The patients were divided into two groups with low grade (stages 1-2-3) (n = 49) and high grade (stages 4a-4b-5) (n = 59) according to the Hamada classification, which is the radiographic evaluation of RCTA. PSQI and TSK values ​​were calculated preoperatively, and post-operatively at the 6th week, 6th month, and 1st year. The change in PSQI and TSK values ​​between the evaluations and the effect of staging according to the Hamada classification on this change was examined. RESULTS: When compared in preoperative evaluations, PSQI and TSK scores were found to be lower in low-grade group 1 (7.39 ± 1.56, 51.88 ± 4.62, respectively) than in high-grade group 2 (10.47 ± 2.39, 57.05 ± 3.25, respectively) according to Hamada classification (both p < 0.001). In the postoperative evaluations, PSQI and TSK results decreased gradually compared to the preoperative evaluations, and there was a severe decrease in both parameters between the 6th-week and 6th-month evaluations (both p < 0.001). Preoperatively, 102 (95%) patients had sleep disturbance (PSQI ≥ 6), and 108 (100%) patients had high kinesiophobia (TSK > 37). In the 1st year follow-ups, sleep disturbance was observed in 5 (5%) patients and kinesiophobia in 1 (1%) patient. When the Hamada stages were compared, it was seen that there was a significant difference before the operation (both p < 0.001), but the statistically significant difference disappeared in the PSQI value in the 1st year (p = 0.092) and in the TSK value in the 6th month (p = 0.164) post-operatively. It was observed that Hamada staging caused significant differences in PSQI and TSK values ​​in the preoperative period but did not affect the clinical results after treatment. CONCLUSIONS: RSA performed based on RCTA improves sleep quality and reduces kinesiophobia. RCTA stage negatively affects PSQI and TSK before the operation but does not show any effect after the treatment.


Subject(s)
Arthroplasty, Replacement, Shoulder , Joint Diseases , Rotator Cuff Injuries , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Arthroplasty, Replacement, Shoulder/adverse effects , Arthroplasty, Replacement, Shoulder/methods , Rotator Cuff/surgery , Retrospective Studies , Kinesiophobia , Treatment Outcome , Rotator Cuff Tear Arthropathy/surgery , Joint Diseases/surgery , Sleep , Rotator Cuff Injuries/complications , Rotator Cuff Injuries/diagnostic imaging , Rotator Cuff Injuries/surgery , Shoulder Joint/surgery , Range of Motion, Articular
7.
J Shoulder Elbow Surg ; 33(7): 1570-1576, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38218405

ABSTRACT

PURPOSE: This study aimed to evaluate whether functional internal rotation (fIR) following reverse shoulder arthroplasty (RSA) differs based on diagnosis of either: primary osteoarthritis (OA) with intact rotator cuff, massive irreparable rotator cuff tear (MICT) or cuff tear arthropathy (CTA). METHODS: A retrospective review was carried out on RSAs performed by a single surgeon with the same implant over a 5-year period. Minimum 2-year follow-up was available in 235 patients; 139 (59.1%) were female, and the mean patient age was 72 ± 8 years. Additional clinical evaluation included the Subjective Shoulder Value and Constant score. Postoperative internal rotation was categorized as type I: hand to the buttock or hip; type II: hand to the lower lumbar region; or type III: smooth motion to at least the upper lumbar region. Type I was considered "nonfunctional" internal rotation, and type II and III were fIR. RESULTS: Preoperatively, internal rotation was classified as type I in 60 patients (25.5%), type II in 114 (48.5%), and type III in 62 (26%). Postoperatively, internal rotation was classified as type I in 70 patients (30%), type II in 86 (36%), and type III in 79 (34%). Compared with preoperative status, fIR improved significantly in OA patients (P < .001), with 49 (52.6%) classified as type II or III postoperatively. In CTA patients, there was no significant change (P = .352). In patients with MICTs, there was a significant loss in fIR postoperatively (P = .003), with 25 patients (30.8%) deteriorating to type I after having either type II or III preoperatively, and only 5 patients (6.1%) improving to either type II or III. CONCLUSIONS: Patients who undergo RSA for primary OA have a better chance of postoperative fIR improvement. A decrease in fIR is common after RSA for MICTs.


Subject(s)
Arthroplasty, Replacement, Shoulder , Range of Motion, Articular , Rotator Cuff Injuries , Humans , Female , Male , Aged , Retrospective Studies , Arthroplasty, Replacement, Shoulder/methods , Rotator Cuff Injuries/surgery , Middle Aged , Aged, 80 and over , Shoulder Joint/surgery , Shoulder Joint/physiopathology , Osteoarthritis/surgery , Rotator Cuff Tear Arthropathy/surgery , Rotator Cuff/surgery , Rotation
8.
J Shoulder Elbow Surg ; 33(7): 1448-1456, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38218402

ABSTRACT

BACKGROUND: Clinically significant outcome (CSO) benchmarks have been previously established for shoulder arthroplasty by assimilating preoperative diagnoses and arthroplasty types. The purpose of this study was to establish unique CSO thresholds and compare the time-to-achievement of these for reverse shoulder arthroplasty (RSA) for osteoarthritis (GHOA), RSA for rotator cuff arthropathy (RCA), and total shoulder arthroplasty (TSA) for GHOA. MATERIALS AND METHODS: Consecutive patients who underwent elective RSA for GHOA, TSA for GHOA, or RSA for RCA between February 2015 and May 2020, with 2-year minimum follow-up, were retrospectively identified from a prospectively maintained single surgeon registry. The American Shoulder and Elbow Surgeons (ASES) score was administered preoperatively and postoperatively at 2-week, 6-week, 3-month, 6-month, 1-year, and 2-year timepoints. Satisfaction and subjective overall improvement anchor questionnaires were administered at the time of final follow-up. Distribution-based methods were used to calculate the Minimal Clinically Important Difference (MCID), and anchor-based methods were used to calculate the Substantial Clinical Benefit (SCB) and the Patient Acceptable Symptom State (PASS) for each patient group. Median time to achievement, individual incidence of achievement at each time point, and cumulative incidence of achievement calculated using Kaplan-Meier survival curve analysis with interval censoring were compared between groups for each CSO. Cox-regression analyses were also performed to determine which patient factors were significantly associated with early or delayed achievement of CSOs. RESULTS: There were 471 patients eligible for study analysis: 276 RSA for GHOA, 107 TSA for GHOA, and 88 RSA for RCA. The calculated MCID, SCB, and PASS scores differed for each group. There were no significant differences in median time to achievement of any CSO between groups. Log-rank testing revealed that cumulative achievements significantly differed between groups for MCID (P = .014) but not for SCB (P = .053) or PASS (P = .620). On cox regression analysis, TSA patients had earlier achievement of SCB, whereas TSA and RSA for GHOA patients had earlier achievement of MCID. At 2-years, a significantly higher percentage of RSA for GHOA patients achieved MCID and SCB compared to RSA for RCA (MCID:100%, 95.5%, P = .003, SCB:94.6%, 86.4%, P = .036). CONCLUSION: Calculated CSO thresholds differ according to preoperative diagnosis and shoulder arthroplasty type. Patients undergoing TSA and RSA for GHOA achieve CSOs earlier than RSA for RCA patients, and a significantly higher percentage of RSA for GHOA patients achieve CSOs by 2 years compared to RSA for RCA patients.


Subject(s)
Arthroplasty, Replacement, Shoulder , Osteoarthritis , Humans , Arthroplasty, Replacement, Shoulder/methods , Male , Female , Aged , Retrospective Studies , Middle Aged , Osteoarthritis/surgery , Treatment Outcome , Shoulder Joint/surgery , Minimal Clinically Important Difference , Rotator Cuff Tear Arthropathy/surgery
9.
J Shoulder Elbow Surg ; 33(3): e162-e174, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37473904

ABSTRACT

BACKGROUND: Disabling cuff tear arthropathy (CTA) is commonly managed with reverse shoulder arthroplasty (RSA). However, for patients with CTA having preserved active elevation, cuff tear arthropathy hemiarthroplasty (CTAH) may offer a cost-effective alternative that avoids the complications unique to RSA. We sought to determine the characteristics and outcomes of a series of patients with CTA managed with these procedures. MATERIALS AND METHODS: We retrospectively reviewed 103 patients with CTA treated with shoulder arthroplasty, the type of which was determined by the patient's ability to actively elevate the arm. Outcome measures included the change in the Simple Shoulder Test (SST), the percent maximum improvement in SST (%MPI), and the percentage of patients exceeding the minimal clinically important difference for the change in SST and %MPI. Postoperative x-rays were evaluated to assess the positions of the center of rotation and the greater tuberosity for each implant. RESULTS: Forty-four percent of the 103 patients were managed with CTAH while 56% were managed with RSA. Both arthroplasties resulted in clinically significant improvement. Patients having RSA improved from a mean preoperative SST score of 1.7 (interquartile range [IQR], 0.0-3.0) to a postoperative score of 6.3 (IQR, 2.3-10.0) (P < .01). Patients having CTAH improved from a preoperative SST score of 3.1 (IQR, 1.0-4.0) to a postoperative score of 7.6 (IQR, 5.0-10.) (P < .001). These improvements exceeded the minimal clinically important difference. Instability accounted for most of the RSA complications; however, it did not account for any CTAH complications. The postoperative position of the center of rotation and greater tuberosity on anteroposterior radiographs did not correlate with the clinical outcomes for either procedure. CONCLUSION: For 103 patients with CTA, clinically significant improvement was achieved with appropriately indicated CTAH and RSA. In view of the lower cost of the CTAH implant, it may provide a cost-effective alternative to RSA for patients with retained active elevation.


Subject(s)
Arthroplasty, Replacement, Shoulder , Hemiarthroplasty , Rotator Cuff Injuries , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Rotator Cuff Tear Arthropathy/surgery , Rotator Cuff Tear Arthropathy/etiology , Arthroplasty, Replacement, Shoulder/adverse effects , Hemiarthroplasty/adverse effects , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Retrospective Studies , Treatment Outcome , Rotator Cuff Injuries/diagnostic imaging , Rotator Cuff Injuries/surgery , Rotator Cuff Injuries/etiology , Range of Motion, Articular
10.
Eur J Orthop Surg Traumatol ; 34(1): 311-317, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37490066

ABSTRACT

PURPOSE: Although there are concerns about nonunion of the greater tuberosity or shoulder weakness, hemishoulder arthroplasty (HSA) is a viable treatment option for irreducible four-part proximal humerus fractures-dislocation without rotator cuff tear arthropathy. This study aims to analyze the long-term radiological and functional outcomes of HSA. METHODS: This study enrolled 36 patients who underwent HSA due to irreducible four-part proximal humerus fracture-dislocation without rotator cuff tear arthropathy between March 2005 and May 2020. The exclusion group included 10 reverse total shoulder arthroplasty patients. The mean age and mean follow-up period were 68.6 years old and 48.6 months, respectively. Radiological assessments, such as vertical and horizontal greater tuberosity position, greater tuberosity healing, and implant position, were evaluated. Clinically, American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion were evaluated. RESULTS: The greater tuberosity union rate was 55.6% (n = 20), with 44.4% (n = 16) experiencing nonunion, malunion, and bone resorption. The mean vertical and horizontal greater tuberosity positions showed significant difference at last follow-up compared to immediate postoperation. The retroversion of the implant was 23.8 ± 4.61°, and the acromio-humeral interval was 7.6 ± 1.34 mm. The mean last follow-up ASES and CMS were 39.5 ± 4.03 and 55.4 ± 10.41, respectively. The mean active forward flexion, abduction, internal rotation, and external rotation were 100.9 ± 15.04°, 92.5 ± 14.47°, 44.2 ± 12.83°, and 42.5 ± 15.32°, respectively. CONCLUSION: In long-term follow-up, the greater tuberosity was superiorly migrated and externally rotated. Active forward flexion and abduction in the last follow-up were significantly limited. However, in terms of pain relief, a satisfactory result was seen.


Subject(s)
Arthroplasty, Replacement, Shoulder , Hemiarthroplasty , Rotator Cuff Tear Arthropathy , Shoulder Fractures , Shoulder Joint , Humans , Aged , Rotator Cuff Tear Arthropathy/surgery , Shoulder/surgery , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Hemiarthroplasty/adverse effects , Hemiarthroplasty/methods , Arthroplasty, Replacement, Shoulder/methods , Shoulder Fractures/diagnostic imaging , Shoulder Fractures/surgery , Humerus/surgery , Treatment Outcome , Range of Motion, Articular , Retrospective Studies
11.
J Shoulder Elbow Surg ; 33(7): 1555-1562, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38122891

ABSTRACT

BACKGROUND: Component positioning affects clinical outcomes of reverse shoulder arthroplasty, which necessitates an implantation technique that is reproducible, consistent, and reliable. This study aims to assess the accuracy and precision of positioning the humeral component in planned retroversion using a forearm referencing guide. METHODS: Computed tomography scans of 54 patients (27 males and 27 females) who underwent primary reverse shoulder arthroplasty for osteoarthritis or cuff tear arthropathy were evaluated. A standardized surgical technique was used to place the humeral stem in 15° of retroversion. Version was assessed intraoperatively visualizing the retroversion guide from above and referencing the forearm axis. Metal subtraction techniques from postoperative computed tomography images allowed for the generation of 3D models of the humerus and for evaluation of the humeral component position. Anatomical humeral plane and implant planes were defined and the retroversion 3D angle between identified planes was recorded for each patient. Accuracy and precision were assessed. A subgroup analysis evaluated differences between male and female patients. RESULTS: The humeral retroversion angle ranged from 0.9° to 22.8°. The majority (81%) of the measurements were less than 15°. Mean retroversion angle (±SD) was 9.9° ± 5.8° (95% CI 8.4°-11.5°) with a mean percent error with respect to 15° of -34% ± 38 (95% CI -23 to -44). In the male subgroup (n = 27, range 3.8°-22.5°), the mean retroversion angle was 11.9° ± 5.4° (95% CI 9.8°-14.1°) with a mean percent error with respect to 15° of -21% ± 36 (95% CI -6 to -35). In the female subgroup (n = 27, range 0.9°-22.8°), mean retroversion angle was 8.0° ± 5.5° (95% CI 5.8°-10.1°) and the mean percent error with respect to 15° was -47% ± 36 (95% CI -32 to -61). The differences between the 2 gender groups were statistically significant (P = .006). CONCLUSION: Referencing the forearm using an extramedullary forearm referencing system to position the humeral stem in a desired retroversion is neither accurate nor precise. There is a nonnegligible tendency to achieve a lower retroversion than planned, and the error is more marked in females.


Subject(s)
Arthroplasty, Replacement, Shoulder , Forearm , Humerus , Tomography, X-Ray Computed , Humans , Female , Male , Arthroplasty, Replacement, Shoulder/methods , Aged , Forearm/surgery , Forearm/diagnostic imaging , Humerus/surgery , Humerus/diagnostic imaging , Middle Aged , Osteoarthritis/surgery , Osteoarthritis/diagnostic imaging , Shoulder Joint/surgery , Shoulder Joint/diagnostic imaging , Shoulder Prosthesis , Retrospective Studies , Aged, 80 and over , Rotator Cuff Tear Arthropathy/surgery , Rotator Cuff Tear Arthropathy/diagnostic imaging
12.
J Shoulder Elbow Surg ; 33(1): 121-129, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37414355

ABSTRACT

BACKGROUND: In reverse shoulder arthroplasty (RSA), there are a plethora of measurements regarding implant lateralization and distalization to optimize the center of rotation. Two specific measurements known as the "lateralization shoulder angle" (LSA) and "distalization shoulder angle" (DSA) have been the recent focus of studies to assess their association with RSA and postoperative function. The aim of this study was to evaluate the prognostic clinical value of the LSA and DSA in a large cohort of patients with cuff tear arthropathy (CTA) who were treated with different RSA systems. METHODS: Two local shoulder arthroplasty registries were reviewed for all RSA patients documented to have undergone a radiologic assessment and complete 2-year follow-up examination. The main inclusion criterion was primary RSA in patients with CTA. Patients with either a complete teres minor tear, os acromiale, or acromial stress fracture reported between the time of surgery and the 24-month follow-up were excluded. Five RSA implant systems with 4 neck-shaft angles (NSAs) were assessed. The Constant score, Subjective Shoulder Value, and range of motion at 2 years were correlated with both the LSA and DSA assessed on 6-month anteroposterior radiographs. Linear and parabolic univariable regressions were calculated for both shoulder angles, for each prosthesis system, and for the entire patient cohort. RESULTS: Between May 2006 and November 2019, there were a total of 630 CTA patients who had undergone primary RSA. Of this large cohort of patients, 270 were treated with the Promos Reverse prosthesis system (NSA, 155°); 44, Aequalis Reversed II (NSA, 155°); 62, Lima SMR Reverse (NSA, 150°); 25, Aequalis Ascend Flex (NSA, 145°); and 229, Univers Revers (NSA, 135°). The mean LSA was 78° (standard deviation [SD], 10°; range, 6°-107°), and the mean DSA was 51° (SD, 10°; range, 7°-91°). The average Constant score at 24 months' follow-up was 68.1 points (SD, 13 points; range, 13-96 points). Neither the linear nor parabolic regression calculations for the LSA or DSA revealed significant associations with any of the clinical outcomes. CONCLUSION: Different patients may achieve different clinical outcomes despite having identical LSA and DSA values. There is no association between angular radiographic measurements and 2-year functional outcomes after RSA.


Subject(s)
Arthroplasty, Replacement, Shoulder , Rotator Cuff Tear Arthropathy , Shoulder Joint , Shoulder Prosthesis , Humans , Shoulder/surgery , Rotator Cuff Tear Arthropathy/surgery , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Treatment Outcome , Rupture/surgery , Range of Motion, Articular , Retrospective Studies
13.
J ISAKOS ; 8(6): 398-403, 2023 12.
Article in English | MEDLINE | ID: mdl-37839703

ABSTRACT

Reverse shoulder arthroplasty is typically indicated for patients with severe shoulder osteoarthritis, rotator cuff tear arthropathy, or proximal humerus fractures that have failed to heal properly. The primary goal of reverse shoulder arthroplasty is to improve shoulder function and reduce pain, while also restoring the ability to perform daily activities. There is a growing body of evidence supporting the effectiveness of reverse shoulder arthroplasty in improving shoulder function and reducing pain in patients with severe shoulder osteoarthritis or rotator cuff tear arthropathy. Reverse shoulder arthroplasty is associated with significant improvements in shoulder function and pain reduction compared to non-surgical treatments. This paper aims to summarize current knowledge, practices and present a summary of the long-term effects of reverse shoulder arthroplasty (RSA) on patient outcomes, including how these outcomes are defined and what measures are typically used to assess them. It will also cover newer definitions of outcomes for RSA that have been developed in recent years in order to better understand the long-term effects of the procedure on patient-reported outcomes and functional ability, as well as information on revision surgery and implant survivorship, and the future of RSA (3D-navigation, patient-specific instrumentation, robotics and artificial intelligence) and its effects on outcomes.


Subject(s)
Arthroplasty, Replacement, Shoulder , Osteoarthritis , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Rotator Cuff Tear Arthropathy/surgery , Arthroplasty, Replacement, Shoulder/methods , Shoulder Joint/surgery , Artificial Intelligence , Treatment Outcome , Osteoarthritis/surgery , Pain
14.
Rev. esp. salud pública ; 97: e202309080, Sept. 2023. graf, ilus
Article in Spanish | IBECS | ID: ibc-226218

ABSTRACT

Fundamentos: La causa más común de dolor de hombro son los cuadros clínicos relacionados con problemas del manguitorotador. Uno de los tratamientos más habituales es la cirugía artroscópica. El objetivo del estudio fue describir las característicasclínicas y epidemiológicas de los pacientes sometidos a este tipo de cirugías en España. Métodos: Se realizó un estudio de tipo descriptivo, observacional y de corte transversal con noventa participantes. Se recogieronlos datos de edad, sexo, realización de actividad laboral con sobreuso de miembros superiores (MMSS), índice de masa corporal (IMC),consumo de tabaco, diagnóstico de diabetes, realización de actividad física-deportiva y antecedentes de tratamientos prequirúrgicos.Finalmente, se realizó un análisis descriptivo de las variables y un análisis de correlaciones, mediante la prueba estadística de Pearson y Spearman según el tipo de variable.Resultados: La media de edad fue de 57,21 años con una desviación estándar (DE) de 8,5 (Intervalo de Confianza [IC] del 95%,55,41-59,00). En cuanto a su IMC, la media fue de 28,49 con una DE de 4,9 (IC del 95%, 27,49-29,53), siendo el 35,6% personas conobesidad (IMC mayor de 30). El diagnóstico médico de los sujetos fue en un 51,1% de rotura total del manguito rotador. Por otro lado,la intensidad de realización de actividad física fue de una hora o menos a la semana en el 87,8% de la muestra. Por último, en relacióncon el tratamiento previo de fisioterapia, el 69,7% de los sujetos habían recibido algún tipo de intervención. Conclusiones: Las características demográficas y clínicas encontradas están en consonancia con las de otras poblacionesestudiadas previamente, y los factores de asociación entre ellas refrendan los factores de riesgo ya señalados previamente (edad,obesidad, sobreuso de MMSS), cobrando especial importancia la edad avanzada.(AU)


Background: The most common cause of shoulder pain is clinical pictures related to rotator cuff problems. One of the mostcommon treatments is arthroscopic surgery. The objective was to describe the clinical and epidemiological characteristics of patientsundergoing this type of surgery in Spain. Methods: A descriptive, observational and cross-sectional study with ninety participants was carried out. Data on age, sex, perfor-mance of work activity with overuse of upper limbs, body mass index (BMI), smoking habit, diagnosis of diabetes, performance of physi-cal-sports activity and history of pre-surgical treatments were collected. Finally, a descriptive analysis of the variables and an analysis ofcorrelations were carried out, using the Pearson and Spearman statistical test according to the type of variable.Results: The mean age was 57.21 years with a standard deviation (SD) of 8.5 (95% CI, 55.41-59.00). Regarding their BMI, the meanwas 28.49 with a SD of 4.9 (95% CI, 27.49-29.53), with 35.6% being obese (BMI greater than 30). The medical diagnosis of the subjectswas 51.1% total rotator cuff tear. On the other hand, the intensity of physical activity was one hour or less per week in 87.8% of thesample. Finally, in relation to the previous physiotherapy treatment, 69.7% of the subjects had received some type of intervention. Conclusions: The demographic and clinical characteristics found are consistent with those of other previously studied populations,and the association factors between them endorse the previously mentioned risk factors, with advanced age gaining special importance.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Rotator Cuff , Rotator Cuff Tear Arthropathy , Rotator Cuff Injuries , Shoulder Injuries , Pain Management , Shoulder/surgery , Pain , General Surgery , Demography , Epidemiology, Descriptive , Cross-Sectional Studies , Physical Therapy Specialty , Rehabilitation , Shoulder Pain/rehabilitation , Shoulder Pain/therapy , Body Mass Index , Exercise Therapy
15.
Clin Orthop Surg ; 15(4): 627-636, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37529192

ABSTRACT

Background: Deltoid function critically influences the results of reverse total shoulder arthroplasty (RTSA), and spontaneous deltoid attrition tears are frequently detected in cuff tear arthropathy (CTA) patients; however, the clinical impacts of these tears on RTSA outcomes are undetermined. Our aim was to determine the effect of spontaneous deltoid attrition tears on postoperative outcomes after RTSA without an additional deltoid procedure. Methods: Seventy-two patients who underwent RTSA for CTA with preoperative magnetic resonance imaging (MRI) and a minimum clinical follow-up of 1 year (mean, 32 months) were retrospectively reviewed in the study. Patients with a history of previous shoulder surgery or injury were excluded. The presence and location of deltoid attrition tears were determined in preoperative MRI. Propensity score matching (1:1) was performed to construct tear and no-tear groups. Finally, 21 patients, matched with respect to age, sex, hand dominance, symptom duration, medical comorbidity (obesity, diabetes mellitus, and coronary artery disease), Hamada grade, and implant type, were assigned to each group. Clinical outcomes (functional scores, isometric power, and range of motion) in the two groups were compared. Results: Deltoid attrition tears were detected in 21 of the 72 enrolled cases (29.1%). Anterolateral deltoid was the most frequent location and no tear was detected in the posterior deltoid. The tear rate increased with disease severity (Hamada G2, 4.8%; G3, 23.8%; > G4, 71.4%). No pre- or postoperative clinical variables differed significantly between the tear and no tear groups. Conclusions: Deltoid attrition tears were detected in 29% of CTA patients who underwent RTSA. The most common site was the anterolateral region and tear prevalence tended to increase with CTA progression. However, RTSA was found to provide satisfactory outcomes regardless of the presence of a deltoid attrition tear.


Subject(s)
Arthroplasty, Replacement, Shoulder , Rotator Cuff Injuries , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Arthroplasty, Replacement, Shoulder/methods , Rotator Cuff Tear Arthropathy/surgery , Retrospective Studies , Propensity Score , Treatment Outcome , Rupture/surgery , Shoulder Joint/surgery , Rotator Cuff Injuries/diagnostic imaging , Rotator Cuff Injuries/surgery , Range of Motion, Articular
16.
J ISAKOS ; 8(5): 306-317, 2023 10.
Article in English | MEDLINE | ID: mdl-37301479

ABSTRACT

The reverse shoulder arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Unlike previous reverse shoulder prosthesis characterized by unsatisfactory results and a high glenoid implant failure rate, the Grammont design has immediately shown good clinical outcomes. This semi constrained prosthesis solved the issues of the very first designs by medializing and distalizing the center of rotation with an increased stability of the replacement of the component. The indication was initially limited to cuff tear arthropathy (CTA). It has then been expanded to irreparable massive cuff tears and displaced humeral head fractures. The most frequent problems of this design are a limited postoperative external rotation and scapular notching. Different modifications to the original Grammont design have been proposed with the aim of decreasing the risk of failure and complications and improving the clinical outcomes. Both the position and version/inclination of the glenosphere and the humeral configuration (e.g. neck shaft angle) influence the RSA outcomes. A lateralized glenoid (whether with bone or metal) and a 135° Inlay system configuration leads to a moment arm which is the closest to the native shoulder. Clinical research will focus on implant designs reducing bone adaptations and revision rate, strategies to prevent more effectively infections. Furthermore, there is still room for improvement in terms of better postoperative internal and external rotations and clinical outcomes after RSA implanted for humeral fracture and revision shoulder arthroplasty.


Subject(s)
Arthroplasty, Replacement, Shoulder , Joint Prosthesis , Rotator Cuff Tear Arthropathy , Shoulder Joint , Shoulder Prosthesis , Humans , Arthroplasty, Replacement, Shoulder/methods , Shoulder Joint/surgery , Rotator Cuff Tear Arthropathy/surgery
17.
J Shoulder Elbow Surg ; 32(10): 1981-1987, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37230288

ABSTRACT

BACKGROUND: Rotator cuff tear arthropathy (CTA) carries a significant symptomatic burden for patients. Reverse shoulder arthroplasty (RSA) is an effective treatment intervention for CTA. Disparities in musculoskeletal medicine are well documented; however, there is a paucity of literature on how social determinants of health affect utilization rates. The purpose of this study is to determine how social determinants of health affect the utilization rates of RSA. METHODS: A single-center retrospective review was conducted for adult patients diagnosed with CTA between 2015 and 2020. Patients were divided by those who underwent RSA and those who were offered RSA but did not undergo surgery. Each patient's zip code was used to determine the most specific median household income in the US Census Bureau database and compared to the multistate metropolitan statistical area median income. Income levels were defined by the US Department of Housing and Urban Development's (HUD's) 2022 Income Limits Documentation System and the Federal Reserve's (FED's) Community Reinvestment Act. Because of numeric restrictions, patients were grouped into racial cohorts of Black, White, and all other races. RESULTS: Patients of other races had significantly lower odds of continuing to surgery compared with White patients in models controlled for median household income (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18-0.81, P = .01), HUD's 3 income levels (OR 0.36, 95% CI 0.18-0.74, P = .01), and FED's income levels (OR 0.37, 95% CI 0.17-0.79, P = .01). There was no significantly different odds of going on to surgery between FED income levels and median household income levels, but when compared with those with low HUD income, those below median had significantly lower odds of going on to surgery (OR 0.43, 95% CI 0.23-0.80, P = .01). CONCLUSION: Although contradictory to reported health care utilization for Black patients, our study supports reported disparities in utilization for other ethnic minorities. These findings may suggest that improvements in utilization efforts targeted Black-identifying patients but not necessarily other ethnic minorities. The findings of this study can help providers understand how social determinants of health play a role in the utilization of care for CTA and direct mitigation efforts to reduce disparities in access to adequate orthopedic care.


Subject(s)
Arthroplasty, Replacement, Shoulder , Rotator Cuff Injuries , Rotator Cuff Tear Arthropathy , Shoulder Joint , Adult , Humans , Rotator Cuff Tear Arthropathy/surgery , Shoulder Joint/surgery , Arthroplasty, Replacement, Shoulder/adverse effects , Treatment Outcome , Arthroplasty , Retrospective Studies , Rotator Cuff Injuries/surgery , Rotator Cuff Injuries/etiology
18.
Clin Orthop Relat Res ; 481(8): 1464-1470, 2023 08 01.
Article in English | MEDLINE | ID: mdl-36853879

ABSTRACT

BACKGROUND: The severity of glenohumeral osteoarthritis (OA) as demonstrated by preoperative radiographs and patient-reported pain plays an important role in the indication for anatomic total shoulder arthroplasty (aTSA). In hip and knee research, data about the effect of the severity of preoperative radiographic OA on the outcome of total joint arthroplasty have been mixed. For shoulder replacement, we are unsure of the effects of radiographic severity on outcomes. QUESTIONS/PURPOSES: This study investigated whether the preoperative radiographic severity of glenohumeral OA is associated with improvement in pain and function after aTSA. We asked, (1) does the severity of glenohumeral OA correlate with improvement in patient-reported outcomes after TSA (delta American Shoulder and Elbow Surgeons score [postoperative-preoperative], delta Single Assessment Numeric Evaluation, delta Simple Shoulder Test, and delta VAS)? (2) Is having mild osteoarthritis associated with not meeting the minimum clinically important differences in preoperative and postoperative American Shoulder and Elbow Surgeons scores? METHODS: An institutional query of patients who underwent aTSA for OA was performed between January 2015 and December 2018. A total of 1035 patients were eligible; however, only patients with adequate preoperative radiographs and patient-reported outcome measures collected preoperatively and at a minimum of 2 years postoperatively were included. Patients with proximal humerus fractures, inflammatory arthropathy, cuff tear arthropathy, prior ipsilateral rotator cuff repair, brachial plexus injury or neuromuscular disorder, workers compensation, periprosthetic joint infection, or revision surgery within 2 years were excluded. Patient characteristics, comorbidities, and prior shoulder surgery were recorded. The severity of OA was classified based on the modified Samilson-Prieto and Walch classification. The association between Samilson-Prieto grade and patient-reported outcome measures (American Shoulder and Elbow Surgeons Score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and VAS score) was evaluated. Radiographic characteristics, patient demographics, comorbidities, and prior surgery were also evaluated for the potential risk of not achieving improvement in the minimum clinically important difference (16.1) with respect to the American Shoulder and Elbow Surgeons score. The American Shoulder and Elbow Surgeons score is scored 0 to 100, with higher scores representing less pain and better function. A total of 206 patients (20% of those eligible) with a mean follow-up of 2.3 years were included. Twenty-three patients had Samilson-Prieto Grade I, 38 had Grade II, 57 had Grade III, and 88 had Grade IV. RESULTS: There were no differences in improvements (delta) between the groups and between patient-reported outcome scores (American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and VAS). Compared with patients with more severe osteoarthritis (Samilson-Prieto Grades II, III, and IV), a higher proportion of patients with less severe osteoarthritis (Grade I) did not exceed the minimum clinical important difference for the American Shoulder and Elbow Surgeons score (22% [five of 23] versus 4% [seven of 183]; odds ratio 0.14 [95% confidence interval 0.04 to 0.520]; p = 0.006). CONCLUSION: The improvement in patient-reported outcome measure scores was similar regardless of radiographic severity after aTSA. Surgeons should use caution when recommending surgery to patients with less severe OA because a higher percentage did not improve, based on the minimum clinically important difference. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
Arthroplasty, Replacement, Shoulder , Osteoarthritis , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Arthroplasty, Replacement, Shoulder/adverse effects , Arthroplasty, Replacement, Shoulder/methods , Treatment Outcome , Osteoarthritis/diagnostic imaging , Osteoarthritis/surgery , Osteoarthritis/complications , Pain , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Retrospective Studies , Range of Motion, Articular
19.
Clin Orthop Surg ; 15(1): 135-144, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36778983

ABSTRACT

Background: Reverse total shoulder arthroplasty (RTSA) has become the treatment of choice for the management of massive rotator cuff tears combined with cuff tear arthropathy, and many novel designs have been proposed to overcome the shortcomings of classic RTSA. This study sought to evaluate and compare RTSA outcomes among patients with cuff tear arthropathy treated by a medialized inlay humerus implant with a neck shaft angle of 155° or a lateralized onlay implant with a neck shaft angle of 145°. Methods: A retrospective review of 32 inlay implants and 32 onlay implants was performed. The active range of motion (ROM), visual analog scale (VAS) for pain, motor power for elevation and external rotation, and functional scores including the American Shoulder and Elbow Surgeons score, Constant score, and Korean Shoulder Scoring system were assessed before surgery, at 3, 6, and 12 months after surgery, and at the last follow-up at least 24 months after surgery. Scapular notching, lateral humeral offset, and deltoid wrapping offset were assessed for radiographic evaluation. Results: The preoperative demographic data of both groups showed no significant differences (p > 0.05). The mean follow-up period was 24.9 months. Significant improvements in forward flexion, functional scores, and pain VAS score were observed in both groups at the last follow-up. No significant differences in ROM or functional scores were found between two groups at each time point, except that the onlay implant group exhibited a significantly greater range of external rotation at 3 and 12 months after surgery and at the last follow-up. The rate of scapular notching and the final power improvement did not show significant differences between the groups. Conclusions: Primary RTSA using inlay or onlay humerus implants was associated with recovery from pseudoparalysis and good clinical outcomes. However, RTSA with onlay humerus implantation led to clinically superior results in terms of external rotation.


Subject(s)
Arthroplasty, Replacement, Shoulder , Rotator Cuff Injuries , Rotator Cuff Tear Arthropathy , Shoulder Joint , Humans , Arthroplasty, Replacement, Shoulder/methods , Shoulder Joint/surgery , Rotator Cuff Tear Arthropathy/surgery , Treatment Outcome , Humerus/surgery , Rotator Cuff Injuries/surgery , Retrospective Studies , Pain/surgery , Range of Motion, Articular
20.
J Orthop Sci ; 28(3): 567-572, 2023 May.
Article in English | MEDLINE | ID: mdl-35151566

ABSTRACT

BACKGROUND: The aim of this study was to investigate glenoid wear in patients with humeral head replacement with a smaller humeral head, who were observed for >5 years, and to examine the relationship between radiographic changes and clinical outcome. METHODS: In this study, 41 shoulders of 41 patients (13 men, 28 women) were followed up for >5 years. The mean patient age at the time of surgery was 70.5 years. The average follow-up period at short-term was 26.0 months, and intermediate-term was 66.5 months. We classified glenoid wear into four grades (i.e., Grade 0 to Grade 3). Age, sex, clinical scores, and range of motion were investigated in relation to the grade of glenoid wear. Radiographs of glenoid wear evaluated in the short-term were subsequently compared to radiographs obtained in the intermediate-term period. RESULTS: At the final follow-up, 16 (39%) patients had Grade 0 wear, 11 (27%) patients had Grade 1 wear, 10 (24%) patients had Grade 2 wear, and 4 (10%) patients had Grade 3 wear. The University of California-Los Angeles score, Japanese Orthopaedic Association score, and active forward flexion were significantly lower in the Grade 3 patients; however, Grade 3 patients did not have significant pain. No significant difference in age, sex, Constant score, active external rotation, and active internal rotation in relation to the grade of glenoid wear was observed. In total, 25 (61%) patients showed a progression of glenoid wear. Cases in which glenoid wear progressed after 4 years after surgery were rare. Two patients of Grade 3 underwent total shoulder arthroplasty revision at 16 months and 38 months, respectively. CONCLUSIONS: Glenoid wear occurred in 61% of patients at 5 years follow-up. Pain of Grade 3 patients was mild, therefore, if pain is not severe, revision surgery may not be necessary.


Subject(s)
Arthroplasty, Replacement, Shoulder , Arthroplasty, Replacement , Joint Prosthesis , Rotator Cuff Tear Arthropathy , Shoulder Joint , Male , Humans , Female , Aged , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Rotator Cuff Tear Arthropathy/surgery , Treatment Outcome , Humeral Head/diagnostic imaging , Humeral Head/surgery , Pain/surgery , Range of Motion, Articular , Retrospective Studies , Follow-Up Studies
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