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The purpose of this study was to compare the short-term clinical and radiographic outcomes of a lateralized glenoid construct with either a central screw or post. Methods: A multicenter retrospective study was conducted of reverse shoulder arthroplasties (RSAs) with minimum 2-year clinical followup. All RSAs implanted had a 135° neck shaft angle (NSA) and a modular circular baseplate. The patients were divided into two cohorts based on the type of central fixation for their glenoid baseplates (central post (CP) vs. central screw (CS)). The clinical outcomes, rates of revisions, and available radiographs were evaluated. Results: In total, 212 patients met the study criteria. Postoperatively, both groups improved over their preoperative baseline. There were no significant differences between the cohorts in any PROs at 2 years postoperatively. No findings of gross loosening were identified in either cohort. Implant survival was 98.6% at 2 years. Conclusions: When using a lateralized glenoid implant with a 135° NSA inlay humeral component, both central post and central screw baseplate fixation provide good clinical outcomes, survivorship, and improvements in ROM at 2 years. There is no difference in loosening or revision rates between the types of baseplate fixation at a minimum of 2 years postoperatively.
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BACKGROUD: The 155° Grammont reverse shoulder replacement has a long track record of success, but also a high radiographic notching rate. The increased distance between the scapular pillar and the humeral component theoretically decreases postoperative notching. The glenoid component can be shifted inferiorly relative to the glenoid; however, there also is some concern that shifting the glenoid component too far inferiorly (inferior glenoid component overhang > 3.5 mm) may compromise long-term stability of the glenoid component. This study was conducted to determine if clinical outcomes, scapular notching, and complications vary with more inferior placement of the glenoid component. METHODS: A retrospective analysis of prospectively collected data was performed in order to compare radiographic outcomes (notching rate and signs of glenoid loosening or component disassembly) and clinical outcomes (range of motion, Constant score, subjective shoulder value, and complication rate) of all patients who underwent reverse shoulder replacement with the glenosphere positioned either flush with the inferior rim of the glenoid (flush group) or with at least 3.5 mm of inferior overhang (overhang group) at a minimum follow-up of 60 months. Ninety-seven patients ultimately met the inclusion criteria, with 41 patients with flush glenoid component and 56 patients with at least 3.5 mm of inferior overhang. RESULTS: Average follow-up was 97.8 months. The overhang group had a lower rate of radiographic notching (37% vs. 82.5%, p < 0.05), better clinical outcomes (improvement in Constant score: +40 vs. +32, p = 0.036), and higher subjective shoulder value (79 vs. 69, p = 0.026) than the flush group. No difference in complications between groups was found. CONCLUSIONS: In this study, at least 3.5 mm of inferior glenosphere overhang relative to the inferior rim of the glenoid was associated with the lower notching rate without negative effect on the clinical outcomes in 155° Grammont-style reverse shoulder replacement. Therefore, no increase in complications should be expected when using this surgical technique.
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Artroplastia do Ombro , Articulação do Ombro , Artroplastia do Ombro/efeitos adversos , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Escápula/diagnóstico por imagem , Escápula/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Recent studies have shown variations in glenoid bone density in asymmetric wear patterns but have yet to analyze non-arthritic or concentrically worn glenoids. QUESTIONS/PURPOSES: The purpose of this study is to characterize and compare subchondral glenoid bone densities in both non-arthritic and A1, A2, B1, B2 and B3 osteoarthritic glenoids, as well as to assess uniformity in symmetric and asymmetric erosion wear patterns. METHODS: In all, 150 computerized tomography (CT) scans containing equal numbers of non-arthritic (N), A1, A2, B1, B2 and B3 glenoids were segmented semi-automatically. Each reconstructed glenoid was divided first into anterior and posterior quadrants, and then further subdivided into four quadrants. Volumes of interest (VOI) were defined at depths of 0-2.5mm (Zone A), 2.5-5mm (Zone B) and 5-7.5mm (Zone C). Average bone densities were measured at each VOI depth and in each quadrant. RESULTS: Osteoarthritic glenoids had higher mean bone densities than N glenoids. Mean bone densities were uniform amongst all quadrants for N glenoids, but not for osteoarthritic glenoids. In A1 glenoids, the antero-superior quadrant was less dense in Zone C. A2 glenoids had increased bone density measured posteriorly in Zones B and C. In B1 and B2 glenoids, Zones B and C demonstrated increased bone densities of posterior quadrants compared to anterior quadrants. B3 glenoids presented similar results as A1 and A2 glenoids. Cystic changes were more pronounced in anterior quadrants of A2, B1, B2 and B3 glenoids. CONCLUSION: This study demonstrates that osteoarthritic glenoids have greater bone density than non-arthritic glenoids, independent of depth of interest. It also confirms that N glenoids have uniform erosion wear patterns and that B1 and B2 glenoids have irregular wear patterns. It is the first study to reveal that A1, A2 and B3 glenoids, though geometrically symmetrical, have irregular bony densities similar to B2 glenoids. These findings have clinical implications for reaming the glenoid and implant fixation. LEVEL OF EVIDENCE: Basic Science, Anatomy, Imaging.
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Cavidade Glenoide , Osteoartrite , Articulação do Ombro , Densidade Óssea , Cavidade Glenoide/diagnóstico por imagem , Humanos , Osteoartrite/diagnóstico por imagem , Escápula , Articulação do Ombro/diagnóstico por imagemRESUMO
BACKGROUND: Axillary radiographs traditionally have been considered sufficient to identify concentric glenoid wear in osteoarthritic shoulders; however, with variable glenoid wear patterns, assessment with use of computed tomography (CT) has been recommended. The purpose of the present study was to compare the use of axillary radiographs and mid-glenoid axial CT scans to identify glenoid wear. METHODS: Preoperative axillary radiographs and mid-glenoid axial CT scans for 330 patients who underwent anatomic total shoulder arthroplasty were reviewed. Five independent examiners with differing levels of experience characterized the glenoid morphology as either concentric or eccentric. The morphologies determined with use of axillary radiographs and CT scans were assessed for correlation, and both intraobserver and interobserver consistency were calculated. RESULTS: Concentric wear identified with use of radiographs was confirmed with use of CT scans in an average of 61% of cases (range, 53% to 76%). Intraobserver consistency averaged 75% for radiographs and 73% for CT scans. There was significant interobserver consistency, as higher levels of training corresponded with greater consistency between imaging analyses (p < 0.001). The most senior observer identified the highest proportion of concentric wear on radiographs (p < 0.001), showed the greatest consistency between attempts when using CT (p < 0.001), and had the greatest agreement of radiographs and CT evaluating glenoid morphology (p < 0.001). CONCLUSIONS: For the experienced shoulder surgeon, concentric glenoid wear identified on axillary radiographs will appear concentric on 2-dimensional CT in approximately 75% of cases. Obtaining a CT scan to confirm glenoid wear patterns most greatly benefits less-experienced surgeons. Across all levels of experience, axillary radiographs and single-slice, mid-glenoid CT scans appear insufficient for consistently predicting wear patterns. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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INTRODUCTION: Recurrent anterior glenohumeral instability has been studied in the young population and limited evidence is available for adolescent patients. Our study is a retrospective review of patients aged <17 years who underwent open Latarjet procedure. METHODS: Forty-five patients were available for review. Clinical outcomes were assessed by range of movements, stability, Walch-Duplay score (WDS), Rowe score (RS), Constant-Murley score (CMS), Subjective Shoulder Value (SSV), and return to sport. Radiographs were reviewed for osteoarthritis and complications. RESULTS: The median age of patients was 15.7 years (13-17), and 56% had hyperlaxity. The median follow-up time was 6.6 years (3-26). The median postoperative movements showed recovered elevation (175°), external rotation (60°), and internal rotation (T9 level). Seventy-five percent of patients returned to the same level of sport, and 98% were satisfied. Clinical outcomes showed WDS, RS, and CMS scores of 85, 95, and 84 points, respectively, and an SSV of 95%. Twenty percent of patients described mild postoperative pain, and 1 had persistent stiffness. Other complications included 24% subjective apprehension, 4% redislocation, 4% wound problems, and 2% infection. Nine percent of cases had postoperative arthritis. The overall reoperation rate was 11%: 1 open washout for infection and 4 arthroscopic screw removal due to persistent pain. We found that hyperlaxity, female sex, and large or deep Hill-Sachs lesions were frequently associated with persistent apprehension at the last follow-up. CONCLUSIONS: The open Latarjet procedure provides a low rate of recurrent instability with acceptable complication rates in the long term for skeletally immature patients. It is an effective, safe treatment option without any significant glenoid growth disturbance.
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Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/métodos , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Lesões de Bankart/cirurgia , Feminino , Humanos , Masculino , Satisfação do Paciente , Amplitude de Movimento Articular , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Volta ao Esporte , Rotação , Articulação do Ombro/diagnóstico por imagem , Escala Visual AnalógicaRESUMO
BACKGROUND: The Latarjet procedure is often used to treat shoulder instability in younger patients. Little is reported on the outcomes of this procedure in older (≥40 years) populations. The purpose of this study was to evaluate the clinical and radiographic outcomes of patients aged 40 years or older with recurrent anterior shoulder instability who underwent open Latarjet stabilization. METHODS: A total of 168 patients aged 40 years or older were treated surgically for recurrent anterior shoulder instability with an open Latarjet procedure between 1988 and 2014. Bankart lesions or anteroinferior glenoid fractures were confirmed preoperatively with a computed tomography arthrogram. Outcomes were assessed with preoperative and postoperative physical examinations, clinical outcome scoring, and radiographic examinations. RESULTS: Ninety-nine patients with complete data were available with a mean follow-up period of 13 years (range, 3-23 years). At the time of final follow-up, 94% of patients did not have recurrence of instability. Of the patients, 90% were satisfied or very satisfied with their outcomes and 54% returned to their preinjury level of activity. The overall complication rate was 21% (the most common complications being subjective apprehension [9%] and recurrent instability [6%]), with 9% of patients requiring reoperation. A full-thickness rotator cuff requiring repair was identified in 22% of patients. CONCLUSIONS: The Latarjet procedure is an effective treatment option for older patients (aged ≥ 40 years) with recurrent anterior shoulder instability in the setting of an anteroinferior capsulolabral and/or bony injury.
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Lesões de Bankart/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Adulto , Idoso , Artroplastia/efeitos adversos , Artroplastia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Recidiva , Reoperação , Estudos Retrospectivos , Escápula/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Since Walch and colleagues originally classified glenoid morphology in the setting of glenohumeral osteoarthritis, several authors have reported varying levels of interobserver and intraobserver reliability. We propose several modifications to the Walch classification that we hypothesize will increase interobserver and intraobserver reliability. METHODS: We propose the addition of the B3 and D glenoids and a more precise definition of the A2 glenoid. The B3 glenoid is monoconcave and worn preferentially in its posterior aspect, leading to pathologic retroversion of at least 15° or subluxation of 70%, or both. The D glenoid is defined by glenoid anteversion or anterior humeral head subluxation. The A2 glenoid has a line connecting the anterior and posterior native glenoid rims that transects the humeral head. Using 3-dimensional computed tomography glenoid reconstructions, 3 evaluators used the original Walch classification and the modified Walch classification to classify 129 nonconsecutive glenoids on 4 separate occasions. Reliabilities were assessed by calculating κ coefficients. RESULTS: Interobserver reliabilities improved from an average of 0.391 (indicating fair agreement) using the original classification to an average of 0.703 (substantial agreement) using the modified classification. Intraobserver reliabilities improved from an average of 0.605 (moderate agreement) to an average of 0.882 (nearly perfect agreement). CONCLUSION: When 3-dimensional glenoid reconstructions and the modified Walch classification described herein are used, improved interobserver and intraobserver reliabilities are obtained.
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Imageamento Tridimensional , Osteoartrite/classificação , Osteoartrite/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Artroplastia do Ombro/métodos , Humanos , Osteoartrite/cirurgia , Reprodutibilidade dos Testes , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The purpose of this study was to outline the epidemiologic criteria of humerus fractures after traumatic injuries. All patients admitted to the trauma service at the authors' institution between 2005 and 2011 were entered into a prospective database. The authors obtained data on age, sex, injury mechanism, presence and location of humerus fracture, associated injuries, mortality, Injury Severity Score, treatment, and length of stay. Patients were matched to a group of patients with pelvic fractures with similar Injury Severity Scores to investigate whether significant differences existed between the 2 groups. Of the 11,007 trauma patients admitted, 209 (1.9%) had a humerus fracture. Associated fractures occurred in 154 (73.7%) patients. The mortality rate for all trauma patients during this period was 4.5%; it was 12% among those with humerus fractures and 21% among those with humeral shaft injuries. Several significant differences existed between the humerus fracture group and the pelvic fracture group. Visceral injuries were more common in the pelvic group, whereas associated fractures and head injuries were more common in the humerus fractures group. Age, sex, and length of stay were also significantly different between the 2 groups, but mortality was not significantly different. Humerus fractures in polytrauma patients are often associated with multiple injuries and a high mortality rate, especially for patients with humeral shaft fractures. A comprehensive evaluation of the patient is necessary.
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Tempo de Internação/estatística & dados numéricos , Traumatismo Múltiplo/mortalidade , Ossos Pélvicos/lesões , Centros de Traumatologia/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Fraturas do Úmero/mortalidade , Incidência , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Pennsylvania/epidemiologia , Fatores de Risco , Distribuição por Sexo , Análise de Sobrevida , Adulto JovemRESUMO
BACKGROUND: Arthrodesis is currently the most commonly performed surgical procedure for the treatment of arthritis of the first metatarsophalangeal (MTP) joint. Hemiarthroplasty of the first MTP joint has been shown to have inferior clinical results and higher revision rates. The objective of this study was to assess the clinical outcome of the salvage of failed hallux phalangeal hemiarthroplasty with conversion to arthrodesis. METHODS: A retrospective review of patients who underwent salvage of the first MTP joint hemiarthroplasty with conversion to arthrodesis was performed. Preoperative assessment included the visual analog pain (VAP) scale and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI). Postoperative outcomes were graded via AOFAS-HMI, VAP, and Foot and Ankle Ability Measure (FAAM). RESULTS: Twenty-one hemiarthroplasties were converted to arthrodesis in 21 patients, with 18 available for follow-up included in the study. There were 13 women and 5 men. Local autologous bone graft was used in 12 cases, while 6 patients required tricortical iliac crest bone graft for the treatment of extensive bone loss. At final follow-up, at a mean of 4.3 years, the average VAS pain score had diminished to 0.75 from 7.8 preoperatively out of 10, while the mean AOFAS-HMI improved from 36.2 out of 100 preoperatively to 85.3 out of 90 (modified to exclude first MTP motion). The mean FAAM ADL/sports were 97.3/91.3, respectively. All patients achieved fusion although at a longer interval than primary fusions. CONCLUSIONS: Conversion from a failed hallux phalangeal hemiarthroplasty to arthrodesis showed similar success to primary arthrodesis which was achieved in the majority of cases with the use of regional bone graft for small defects. However, the time to fusion was longer than that of primary arthrodesis, and it sometimes required structural bone graft for augmentation. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Artrodese , Articulação Metatarsofalângica/cirurgia , Transplante Ósseo , Feminino , Hemiartroplastia , Humanos , Ílio/transplante , Masculino , Medição da Dor , Estudos Retrospectivos , Falha de TratamentoRESUMO
The objective of this meta-analysis was to compare outcomes of posterior cruciate-retaining and posterior stabilized prostheses. A computerized literature search was conducted to identify randomized controlled trials comparing the clinical outcomes of cruciate-retaining and posterior-stabilized designs. The table of contents of four major Orthopaedic journals and the references section of two arthroplasty text books were reviewed to identify other relevant studies. Ultimately, 1114 patients (1265 knees) were compared. Statistical analysis revealed a significant difference in flexion and range of motion in favor of posterior-stabilized knees, but no difference in complication rates. The clinical importance of this remains unknown. The decision to use one design versus the other should rest with the surgeon's preference and comfort with a particular design.
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Artroplastia do Joelho/métodos , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento ArticularRESUMO
BACKGROUND: Hip fracture is a common yet serious injury sustained by the elderly patient and represents one of the major healthcare challenges today. The aim of this study was to better define the unique characteristics of treating nonagenarian peritrochanteric hip fractures and their subsequent complications during hospital stay. METHODS: Seven hundred twenty-two patients underwent surgery for isolated fracture around the femoral neck. These patients were divided into one of three age groups: A, <50 years; B, 51-89 years; and C, >90 years. We performed a retrospective chart review to compare these groups in terms of patient characteristics, comorbidities, postoperative complications, fracture type, type of surgery performed, and mortality rate. RESULTS: There was no difference in time to surgery between groups. Comorbidities were similar in groups B and C but were higher than group A. Nonagenarians received a significantly greater percentage of hemiarthroplasties compared with those aged 51 years to 89 years. Cardiac complications were significantly higher in group C. In patients with sustained cardiac complications, the odds ratio for mortality was 15.88. CONCLUSIONS: Our results suggest that groups B and C were not significantly different pre- or intraoperatively. Nevertheless, there is an increase in cardiac complications and mortality in nonagenarians postoperatively. Nonagenarians should undergo similar treatment in the operating room compared with less elderly patients with the caveat that older patients, especially those with cardiac disease, may be more at risk for complication. The surgeon must evaluate the elderly patient with a hip fracture on a case-by-case basis, while ignoring chronological age. LEVEL OF EVIDENCE: III, prognostic study.
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Fixação de Fratura/métodos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Previous studies have yet to compare outcomes of conversion to hip arthroplasty from screw and side plate vs cephalomedullary nail. Seventy-six patients at our institution underwent hip conversion after fixation failure. We performed a retrospective chart review to compare perioperative outcomes in these 2 groups. Both operative time (P = .020) and blood loss (P = .041) were significantly greater in patients converted from cephalomedullary nail. Greater length of stay in this group trended to significance (P = .101). Perioperative complications were similar. Recent practice patterns reveal a dramatic increase in the use of cephalomedullary nails despite lack of evidence suggesting their clinical superiority in certain fracture patterns. Our results suggest that conversion to total hip arthroplasty after internal fixation with cephalomedullary nail is a more complex procedure than is conversion from screw and side plate. The surgeon should consider possible later hip conversion and these results when choosing the appropriate fixation implant.
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Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Pinos Ortopédicos , Idoso , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
Current best evidence supports observation for peripheral nerve palsies following a fracture of the humerus unless associated with an open fracture. However, the indications for nerve exploration with humerus gunshot fractures are unclear. All patients aged 18 to 89 years who were treated for a gunshot fracture of the humerus at an academic trauma center between 2004 and 2008 were retrospectively reviewed. Patient demographics, fracture characteristics, fracture healing, nerve injury, and intraoperative findings were examined. Twelve patients were identified, of which 6 had nerve palsies at presentation. Three patients had an isolated single nerve palsy, and all recovered spontaneously within 90 days with observation. The other 3 patients had a concomitant brachial artery laceration, and all required a secondary nerve procedure, including 1 primary nerve repair for a near complete transection and 2 re-explorations with neurolysis due to lack of spontaneous recovery by 90 days. Nerve palsies are common after gunshot fractures of the humerus, but nerve transections are uncommon. We observed 1 nerve transection in 12 cases. However, in all 3 cases with a brachial artery injury, a nerve injury required surgical intervention. Subsequently, we recommend continued observation of isolated nerve palsies associated with gunshot fractures of the humerus. However, consider early nerve exploration of palsies when associated with a concomitant vascular injury.