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1.
PLoS One ; 17(5): e0268075, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35511898

RESUMO

BACKGROUND: Short-stem implants in shoulder arthroplasty were recently developed and reported clinical outcomes are good. However, radiological analysis often reveals humeral stem misalignment in the frontal plane, along with high filling ratios that can lead to proximal bone remodeling under stress shielding. The aim of this cadaveric study was to test whether using compactors for standard-length (> 100 mm) stems to implant short (< 100 mm) stems reduces the risk of stem misalignment without compromising in terms of a higher filling ratio. METHODS: In a cadaveric study, twenty short stems were implanted using instrumentation for standard-length stems. Alignment and filling ratios were evaluated on anteroposterior radiographs for both the compactors and the stems. The angular deviations (α) from the humeral axis of the compactors and the short stems were measured. Misalignment was defined as |α| > 5°. Metaphyseal and diaphyseal filling ratios were calculated and defined as either high (≥ 0.7) or low (< 0.7). RESULTS: The median angular deviations of the compactors and the short stems were respectively 1.6° (range, 0.03 to 5.9°) and 1.3° (range, 0.3 to 9.6°). Nineteen of the 20 compactors (95%) and 17/20 short stems (85%) were correctly aligned. The proportions of correctly aligned compactors and stems were not significantly different (95% CI, -0.33 to 0.11; Z-test of proportions p = .60), and the respective angular deviations were significantly correlated (Spearman ρ = .60, p = 0.006). The diaphyseal and metaphyseal filling ratios of the compactors and the stems were all low. CONCLUSIONS: In this series of 20 implants in cadavers, the narrow short humeral stems implanted with compactors for standard-length stems were correctly aligned with the humeral axis. This approach may be a way to achieve both correct frontal alignment and low filling ratios.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Prótese de Ombro , Cadáver , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Desenho de Prótese , Articulação do Ombro/cirurgia , Resultado do Tratamento
2.
JBJS Rev ; 10(5)2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35536998

RESUMO

¼: The majority of proximal humeral fractures (PHFs) in patients who are ≥65 years of age are treated nonoperatively, but certain complex fracture patterns benefit from surgical intervention. However, there continues to be debate regarding the indications for surgery and the optimal surgical treatment (repair versus replacement) in this population. ¼: Reverse total shoulder arthroplasty (RTSA) has grown in popularity for surgical treatment of fracture-dislocations and displaced complex PHFs in patients who are ≥65 years of age; it has definite advantages over surgical repair and hemiarthroplasty, but this finding requires additional higher-quality evidence. ¼: RTSA provides early pain relief and return of shoulder function as well as predictable elevation above shoulder level in the forward plane, but the indications for and understanding of the effect of timing on RTSA after a PHF continue to evolve. ¼: RTSA for an acute PHF is indicated in patients who are ≥65 years of age with 3- and 4-part fracture-dislocations, head-split fractures, and severely displaced fractures, and is an option in patients who are not able to tolerate nonoperative treatment of severely displaced 3- and 4-part fractures. ¼: RTSA is also indicated as a salvage operation for PHFs that have failed initial surgical repair (i.e., fixation failure, implant failure, rotator cuff failure, or osteonecrosis) and is an option for symptomatic nonunion or malunion after nonoperative treatment.


Assuntos
Artroplastia do Ombro , Hemiartroplastia , Fraturas do Ombro , Articulação do Ombro , Idoso , Artroplastia do Ombro/efeitos adversos , Hemiartroplastia/efeitos adversos , Humanos , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
3.
J Am Acad Orthop Surg ; 30(10): 457-465, 2022 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-35511506

RESUMO

Anatomic total shoulder arthroplasty provides pain relief and improved quality of life for patients suffering from glenohumeral arthritis. The 10-year survival rate for these implants has been most recently reported at 96%. As the number of shoulder arthroplasties per year increases, it is important to evaluate factors associated with failure. Patient-specific variables such as age, sex, medical comorbidities, a history of previous shoulder surgery, and rotator cuff integrity can influence implant survival. Both surgeon and hospital volume have been shown to affect perioperative outcomes. Implant design and glenoid pathoanatomy are important structural considerations because both have a causal relationship with survivorship. Modifiable factors, such as smoking, body mass index, and alcohol or opioid consumption, should be addressed preoperatively when possible. Modifiable factors that pertain to surgery are equally as important; it is the responsibility of the surgeon to be aware of the reported outcomes for varying implants and technique-related pearls and pitfalls. For those perioperative factors that are nonmodifiable, it is prudent to counsel patients accordingly because these individuals may be more likely to require an eventual revision procedure.


Assuntos
Artroplastia do Ombro , Osteoartrite , Articulação do Ombro , Artroplastia do Ombro/métodos , Humanos , Osteoartrite/cirurgia , Qualidade de Vida , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Sobrevivência , Resultado do Tratamento
4.
Int J Comput Assist Radiol Surg ; 17(6): 1017-1027, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35489006

RESUMO

PURPOSE: Reverse shoulder arthroplasty (RSA) is an effective surgery for severe shoulder joint diseases. Traditionally, the preoperative planning procedure of RSA is manually conducted by experienced surgeons, resulting in prolonged operating time and unreliable drilling paths of the prosthetic fixation screws. In this study, an automatic surgical planning algorithm for RSA was proposed to compute the optimal path of screw implantation. METHODS: Firstly, a cone-shaped space containing alternative paths for each screw is generated using geometric parameters. Then, the volume constraint is applied to automatically remove inappropriate paths outside the bone boundary. Subsequently, the integral of grayscale value of the CT is used to evaluate the bone density and to compute the optimal solution. An automatic surgical planning software for RSA was also developed with the aforementioned algorithms. RESULTS: Twenty-four clinical cases were used for preoperative planning to evaluate the accuracy and efficiency of the system. Results demonstrated that the angles among the prosthetic fixation screws were all within constraint angle(45°), and the stability rate of the planned prosthesis was 94.92%. The average time for the automatic planning algorithm was 4.39 s, and 83.96 s for the whole procedure. Repetitive experiments were also conducted to demonstrate the robustness of our system, and the variance of the stability coefficient was 0.027%. CONCLUSIONS: In contrast to the cumbersome manual planning of the existing methods for RSA, our method requires only simple interaction operations. It enables efficient and precise automatic preoperative planning to simulate the ideal placement of the long prosthetic screws for the long-term stability of the prosthesis. In the future, it will have great clinical application prospects in RSA.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Densidade Óssea , Parafusos Ósseos , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X/métodos
5.
J Shoulder Elbow Surg ; 31(6S): S143-S151, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35413431

RESUMO

BACKGROUND: Lack of sleep is associated with adverse effects on postsurgical pain and recovery. We hypothesized that a multimodal sleep pathway, including nonpharmacologic sleep hygiene interventions and the use of zolpidem and melatonin, could improve patient analgesia and sleep after total shoulder arthroplasty. METHODS: We performed a prospective randomized controlled study in which patients undergoing anatomic and reverse total shoulder arthroplasty were treated with or without an interventional multimodal sleep pathway. This pathway included nursing-directed nonpharmacologic measures that promote sleep hygiene and pharmacologic interventions with low-dose zolpidem and melatonin at bedtime. All patients underwent a standardized multimodal analgesia protocol with scheduled acetaminophen, naproxen, and gabapentin, as well as a single-shot interscalene regional nerve block. RESULTS: This study enrolled 125 patients (64 in control group and 61 in interventional group) with similar demographic characteristics. The interventional group showed less oral morphine milligram equivalent (MME) consumption on postoperative day (POD) 0 (44.8 ± 36.1 MMEs vs. 60.9 ± 42.1 MMEs, P = .01) and showed a trend toward lower POD 0 visual analog scale pain scores (2.6 ± 1.8 vs. 3.3 ± 3.0, P = .06). Visual analog scale pain scores and MME consumption were similar on POD 1. The interventional group showed a longer objective sleep duration by quantitative wrist actigraphy (5.9 ± 3.1 hours vs. 4.6 ± 2.7 hours, P = .008), with better sleep quality assessed by the Leeds Sleep Evaluation Questionnaire (0-100 scale; 50.3 ± 26.8 vs. 38.5 ± 27.8, P = .01). The 2 groups showed similar satisfaction with pain management (89.2% vs. 79.6%, P = .16) and sleep management (82.1% vs. 76.8%, P = .48). There was no difference in the length of inpatient stay (32.2 ± 14.8 hours vs. 34.1 ± 12.8 hours, P = .44). CONCLUSION: In the setting of a regional and multimodal analgesia recovery plan for shoulder arthroplasty patients undergoing inpatient observation, the use of an interventional sleep pathway appears to be safe and beneficial, with improved analgesia, reduced opioid use, increased sleep duration, and improved reported sleep quality during the postoperative recovery period.


Assuntos
Analgesia , Artroplastia do Ombro , Melatonina , Analgesia/métodos , Analgésicos Opioides , Artroplastia do Ombro/efeitos adversos , Humanos , Melatonina/uso terapêutico , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Sono , Zolpidem/uso terapêutico
6.
J Shoulder Elbow Surg ; 31(6S): S158-S165, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35378314

RESUMO

INTRODUCTION: The Grammont-style reverse shoulder arthroplasty (RSA) relies on medialization and distalization of the shoulder center of rotation. Lateralized designs have recently gained popularity. The amount of lateralization, however, remains a controversial topic. The purpose of this study was to correlate the change in humeral offset (HO) with outcomes and complications following RSA. We hypothesized that a lateralized HO following RSA would be associated with improved range of motion (ROM), better patient-reported outcomes (PROs), and fewer complications. MATERIALS AND METHODS: A consecutive series of 104 patients (109 shoulders) was retrospectively evaluated. All patients underwent primary RSA by 2 shoulder and elbow fellowship-trained orthopedic surgeons at 2 different centers. Inclusion criteria was a primary RSA with at least 1-year follow-up. All patients had the HO measured on a preoperative and a postoperative Grashey radiograph, and the change in HO was calculated (ΔHO = PostHO-PreHO). A negative value was defined as a medialized HO and a positive value as a lateralized HO. ROM and primary outcomes, including forward elevation (FE), external rotation (ER), internal rotation (IR), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, were collected. Complications and revisions were also reported. RESULTS: The mean age was 72 years with a mean follow-up of 22.3 months. The average FE (92° vs. 148°), ER (34° vs. 44°), SSV (35% vs. 87%), and ASES score (37.2 vs. 81.2) increased significantly (all P < .01) compared with preoperative values. The HO was medialized postoperatively in 63 shoulders and lateralized in 46 shoulders. No statistically significant differences in the mean values for postoperative FE (147° vs. 146°, P = .892), ER (43° vs. 45°, P = .582), IR (L3 vs. L3, P = .852), SSV (88% vs. 85%, P = .476), and ASES score (81.3 vs. 81.1, P = .961) were found between the groups. However, there was significantly more improvement in ER in the lateralized HO cohort than the medialized cohort (16° vs. 7°, P = .033). Six shoulders, 5 medialized and 1 lateralized HO, demonstrated scapular notching and remained asymptomatic. Five shoulders, 4 medialized and 1 lateralized HO, experienced at least 1 instability incident, and 2 shoulders with medialized HO had an acromion/scapular spine fracture. Overall, 2 shoulders with medialized HO underwent revision surgery because of instability. CONCLUSIONS: Although RSA provides significant improvement in ROM and PROs regardless of postoperative HO, restoring baseline HO or lateralization beyond baseline may be favorable for improving ER and decreasing complications following RSA.


Assuntos
Artroplastia do Ombro , Fraturas do Ombro , Articulação do Ombro , Prótese de Ombro , Idoso , Artroplastia do Ombro/efeitos adversos , Humanos , Úmero/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
7.
J Shoulder Elbow Surg ; 31(6S): S78-S82, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35381357

RESUMO

BACKGROUND: Shoulder arthroplasty surgery volume continues to increase yearly. As the prevalence of shoulder replacement continues to rise, there will be a growing number of revision surgeries performed for a variety of indications. Understanding patient outcomes and recovery time following these procedures is critical, particularly as it relates to revision surgery, which generally has worse outcomes and longevity than primary arthroplasty. The point at which the peak of potential improvement is reached can be defined as the point of maximal medical improvement (MMI). The timing to MMI has previously been reported in the literature following both primary anatomic and reverse total shoulder arthroplasty. However, to our knowledge, timing to MMI following revision shoulder arthroplasty has not been defined. The purpose of the present study, therefore, is to establish the time to MMI following aseptic revision shoulder arthroplasty using validated patient-reported outcome measures. MATERIALS AND METHODS: A retrospective cohort study was conducted following patients who underwent aseptic revision shoulder arthroplasty over a defined 3-year period. Multiple fellowship-trained shoulder and elbow surgeons from a single institution performed all operations. Those with at least 24 months of follow-up and multiple time points of postoperative patient-reported outcome scores were included in the analysis. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and Single Assessment Numeric Evaluation (SANE) scores were prospectively recorded and followed over time. Exclusion criteria included revision surgeries done for infection, staged procedures following infection, and revision for periprosthetic fracture. RESULTS: Twenty-two patients met inclusion criteria. The mean preoperative ASES and SANE scores were 41.8 and 30.5, respectively. There was a trend toward improvement in both the ASES and SANE scores through the 6-9-month postoperative follow-up point, at which point clinically significant improvement was achieved, with mean values of, respectively, 76.9 and 81.2. No further improvement was achieved 9 months after surgery, although scores were generally maintained through an average final follow-up of 30 months, with final ASES and SANE scores of 70.1 and 67.8, respectively. CONCLUSIONS: Following aseptic revision shoulder arthroplasty, clinically significant improvements in patient-reported outcome scores are seen up to 9 months postoperatively, the point at which MMI is achieved. These findings serve to guide clinicians in counseling patients regarding their expected postoperative recovery following revision shoulder arthroplasty.


Assuntos
Artroplastia do Ombro , Artroplastia de Substituição , Articulação do Ombro , Artroplastia do Ombro/efeitos adversos , Humanos , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento
8.
Orthop Clin North Am ; 53(2): 205-213, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365265

RESUMO

In this article, the authors review the incidence and causes of iatrogenic peripheral nerve injuries following shoulder arthroplasty and provide preventative measures to decrease nerve injury rate and management options. They describe common direct and indirect causes of injury such as laceration and retractor use versus arm positioning and lengthening, respectively. Preventative measures include an understanding of anatomy and high-risk locations in the shoulder, minimizing extreme ranges of arm motion and utilization of intraoperative nerve monitoring. Lastly, the authors review diagnosis and management of neurologic symptoms including how and when to use electrodiagnostic studies, nerve grafts, transfers, or muscle/tendon transfers.


Assuntos
Artroplastia do Ombro , Traumatismos dos Nervos Periféricos , Artroplastia/efeitos adversos , Artroplastia do Ombro/efeitos adversos , Humanos , Incidência , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Fatores de Risco
9.
Orthop Clin North Am ; 53(2): 215-221, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365266

RESUMO

Brachial plexus injuries can have a significant impact on patient outcomes following RTSA by slowing the overall recovery and return of function. Risk factors for brachial plexopathy include traction injury related to arm positioning and exposure during the procedure, direct nerve injury from surgical dissection, and compression injury from retractor placement. Risk of nerve injury can be minimized by limiting the time spent with the arm extended and externally rotated and avoiding excessive traction on the arm during humeral preparation and implant insertion. Prompt identification of postoperative brachial plexopathy is important to optimize the recovery of function.


Assuntos
Artroplastia do Ombro , Neuropatias do Plexo Braquial , Plexo Braquial , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/terapia , Humanos , Prognóstico , Fatores de Risco
10.
Can J Anaesth ; 69(5): 614-623, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35237953

RESUMO

PURPOSE: The high-thoracic erector spinae plane block (HT-ESPB) has been reported as an effective analgesic modality for the shoulder region without phrenic nerve palsy. The goal of this study was to compare the HT-ESPB as a phrenic nerve-sparing alternative to an interscalene block for total shoulder arthroplasty. METHODS: Thirty patients undergoing total shoulder arthroplasty at Stanford Health Care (Palo Alto, CA, USA) were enrolled in a double-blind randomized controlled trial. We randomized 28 patients to receive either an interscalene or HT-ESPB perineural catheter preoperatively; 26 patients were included in the final analysis. The study was powered for the primary outcome of incidence of hemidiaphragmatic paralysis in the postanesthesia care unit (PACU). Other outcome measures included incentive spirometry volume, brachial plexus motor and sensory exams, adverse events, pain scores, and opioid consumption. RESULTS: The incidence of hemidiaphragmatic paralysis in the HT-ESPB catheter group was significantly lower than in the interscalene catheter group (0/12, 0% vs 14/14, 100%; P < 0.001). No statistically significant differences were found in pain scores and opioid consumption (in oral morphine equivalents) between the interscalene and HT-ESPB groups through postoperative day (POD) 2. Nevertheless, the mean (standard deviation) point estimates for opioid consumption for the HT-ESPB group were higher than for the interscalene group in the PACU (HT-ESPB: 24.8 [26.7] mg; interscalene: 10.7 [21.7] mg) and for POD 0 (HT-ESPB: 20.5 [25.0] mg; interscalene: 6.7 [12.0] mg). In addition, cumulative postoperative opioid consumption was significantly higher at POD 0 (PACU through POD 0) in the HT-ESPB group (45.3 [39.9] mg) than in the interscalene group (16.6 [21.9] mg; P = 0.04). CONCLUSIONS: This study suggests that continuous HT-ESPB can be a phrenic nerve-sparing alternative to continuous interscalene brachial plexus blockade, although the latter provided superior opioid-sparing in the immediate postoperative period. This was a small sample size study, and further investigations powered to detect differences in analgesic and quality of recovery score endpoints are needed. STUDY REGISTRATION: www. CLINICALTRIALS: gov (NCT03807505); registered 17 January 2019.


RéSUMé: OBJECTIF: Le bloc des muscles érecteurs du rachis du haut thorax (BMER-HT) a été rapporté comme une modalité analgésique efficace pour la région de l'épaule et ce, sans paralysie du nerf phrénique. L'objectif de cette étude était de comparer ce bloc en tant qu'alternative épargnant le nerf phrénique à un bloc interscalénique pour l'arthroplastie totale de l'épaule. MéTHODE: Trente patients bénéficiant d'une arthroplastie totale de l'épaule au centre de soins Stanford Health Care (Palo Alto, CA, États-Unis) ont été recrutés dans une étude randomisée contrôlée à double insu. Nous avons randomisé 28 patients à recevoir un cathéter périneural interscalénique ou un BMER-HT en préopératoire; 26 patients ont été inclus dans l'analyse finale. Le calcul de puissance de l'étude a été effectué pour répondre au critère d'évaluation principal, qui était l'incidence de paralysie hémidiaphragmatique en salle de réveil. Les autres issues mesurées comprenaient les volumes de spirométrie, les examens moteurs et sensoriels du plexus brachial, les événements indésirables, les scores de douleur et la consommation d'opioïdes. RéSULTATS: L'incidence de paralysie hémidiaphragmatique dans le groupe cathéter BMER-HT était significativement plus faible que dans le groupe cathéter interscalénique (0/12, 0 % vs 14/14, 100 %; P < 0,001). Aucune différence statistiquement significative n'a été observée dans les scores de douleur et la consommation d'opioïdes (en équivalents morphine par voie orale) entre les groupes interscalénique et BMER-HT jusqu'au jour postopératoire (JPO) 2. Néanmoins, en salle de réveil, les estimations ponctuelles moyennes (écart type) de la consommation d'opioïdes pour le groupe BMER-HT étaient plus élevées que pour le groupe interscalénique (BMER-HT : 24,8 [26,7] mg; interscalénique : 10,7 [21,7] mg), ainsi qu'au JPO 0 (BMER-HT : 20,5 [25,0] mg; interscalénique: 6,7 [12,0] mg). De plus, la consommation cumulative d'opioïdes postopératoires était significativement plus élevée au JPO 0 (salle de réveil jusqu'au JPO 0) dans le groupe BMER-HT (45,3 [39,9] mg) que dans le groupe interscalénique (16,6 [21,9] mg; P = 0,04). CONCLUSION: Cette étude suggère que le BMER-HT continu peut être une alternative au bloc interscalénique continu du plexus brachial pour épargner le nerf phrénique, bien que le bloc interscalénique ait fourni une épargne d'opioïdes supérieure en période postopératoire immédiate. Il s'agissait d'une étude de petite taille d'échantillon, et d'autres études visant à détecter les différences dans les scores des critères d'évaluation en matière d'analgésie et de qualité de la récupération sont nécessaires. ENREGISTREMENT DE L'éTUDE: www.clinicaltrials.gov (NCT03807505); enregistrée le 17 janvier 2019.


Assuntos
Artroplastia do Ombro , Bloqueio do Plexo Braquial , Analgésicos Opioides , Bloqueio do Plexo Braquial/efeitos adversos , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Paralisia/complicações , Nervo Frênico , Ombro/cirurgia
11.
J Biomech ; 135: 111050, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35313249

RESUMO

The purpose of this study was to determine how implant characteristics affect in vivo shoulder kinematics after reverse shoulder arthroplasty (RSA). Kinematics of the affected upper limb were measured in 32 participants during five motions (scapular plane abduction, hand-to-head, hand-to-back, internal/external rotation at 90° abduction, and circumduction) using optical motion capture. Shoulder abduction, plane of elevation, and internal/external rotation range of motion (ROM), peak angles, and continuous kinematics waveforms were calculated for each motion. Multiple regression was used to identify associations between kinematics and implant characteristics of lateralization, humeral retroversion, glenosphere size, glenosphere tilt, glenoid eccentricity, and implant neck-shaft angle (135° or 145°). Less humeral retroversion was associated with greater shoulder rotation ROM (p = 0.036) and greater plane of elevation ROM (p = 0.024) during circumduction, while less eccentricity was associated with more posterior plane of elevation during hand-to-back (p = 0.021). The 145° implant was associated with greater internal/external shoulder rotation ROM (p < 0.001), greater internal shoulder rotation (p = 0.002), and greater plane of elevation ROM (p = 001) during the hand-to-back. The 145° implant was also associated with more internal/external rotation ROM (p = 0.043) during shoulder rotation and more abduction ROM during circumduction (p = 0.043). During the hand-to-back motion, individuals having 135° neck-shaft angle implants were more abducted from 21 to 51% of the motion and were less internally rotated from 70 to 100% of the motion, while more lateralization was associated with less internal rotation from 90 to 100% of the motion. Retroversion and implant neck-shaft angle are the primary implant characteristics associated with in vivo shoulder kinematics during complex motions after RSA.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Fenômenos Biomecânicos , Humanos , Desenho de Prótese , Amplitude de Movimento Articular , Ombro , Articulação do Ombro/cirurgia , Extremidade Superior
12.
Clin Orthop Surg ; 14(1): 112-118, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35251548

RESUMO

BACKGROUND: The purpose of this study was to determine the number of patients lost to follow-up yearly in shoulder arthroplasty and investigate the characteristics of the patients lost to follow-up that may differ from those not lost to follow-up. METHODS: All shoulder arthroplasties performed from January 2008 to December 2014 were retrospectively reviewed. The number of patients lost to follow-up was determined yearly. Independent variables included age, sex, body mass index (BMI), diagnosis, type of prostheses, living condition, smoking, alcohol intake, American Society of Anesthesiologists (ASA) score, in-hospital length, surgery length, living area, preoperative Constant score, last Constant score available, and complications. Number of deaths was recorded. RESULTS: This study included 251 patients. There was an accumulation of 86 patients (34.3%) lost to follow-up after a maximum of 8 years. During the first year, 9.9% of the patients were lost to follow-up, 18.3% in the second year, 25.1% in the third year, 28.7% in the fourth year, 31.5% in the fifth year, 33.9% in the sixth year, and 34.3% in the seventh year. Patients with severe obesity had 2.44 times greater risk of being lost to follow-up (hazard ratio [HR], 2.44; p < 0.001). Elderly patients were also at higher risk (HR, 1.05; p < 0.001). Increases in the ASA score raised the risk of being lost (HR, 1.93; p < 0.001). Patients with complications had a lower risk (43%) of being lost (HR, 0.57; p = 0.018) at the 8-year follow-up. At the 2-year follow-up, the patients with acute fractures and fracture sequelae had a higher risk of being lost to follow-up (HR, 2.44; p = 0.002), and the patients with complications were not significantly different from those without complications (HR, 0.54; p = 0.12). CONCLUSIONS: The longer the follow-up in shoulder arthroplasty, the greater the number of patients lost to follow-up, reaching 34.3% by the seventh year. Patients lost to follow-up were not random in shoulder arthroplasty: older patients, severely obese patients, and those with higher ASA scores were at higher risk of being lost to follow-up, but reasons for being lost to follow-up changed through time and depending on when they were assessed.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Idoso , Artroplastia , Artroplastia do Ombro/efeitos adversos , Humanos , Perda de Seguimento , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento
13.
Clin Orthop Surg ; 14(1): 119-127, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35251549

RESUMO

BACKGROUND: The purpose of this study was to evaluate the clinical and radiologic outcomes of reverse total shoulder arthroplasty (RTSA) using a small glenoid baseplate in patients with a small glenoid and to analyze the contributing factors to scapular notching. METHODS: A total of 71 RTSAs performed using a 25-mm baseplate were evaluated at a mean of 37.0 ± 3.3 months. Shoulder function was evaluated using American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE) for satisfaction, and active range of motion. Scapular neck angle (SNA), prosthesis-scapular neck angle (PSNA), peg glenoid rim distance (PGRD), and sphere bone overhang distance (SBOD) were measured to assess the effects on scapular notching. RESULTS: Shoulder function (ASES: 39.4 ± 13.8 preoperative vs. 76.2 ± 9.5 at last follow-up, p < 0.001), VAS for pain (6.1 ± 1.8 vs. 1.7 ± 1.4, p < 0.001), SANE for satisfaction (7.0 ± 11.8 vs. 83.4 ± 15.3, p < 0.001), and active forward flexion (115.6° ± 40.1° vs. 141.6° ± 17.2°, p < 0.001) were significantly improved. The mean diameter of the inferior glenoid circle was 26.0 ± 3.0 mm and the mean glenoid vault depth was 24.0 ± 4.5 mm. Scapular notching was found in 13 patients (18.3%) and acromial fracture in 2 patients (2.8%). There were no significant differences in preoperative SNA and PSNA at postoperative 3 years between patients with and without scapular notching (101.6° ± 10.5° and 110.8° ± 14.9° vs. 97.3° ± 13.3° and 104.9° ± 12.4°; p = 0.274 and p = 0.142, respectively). PGRD and SBOD were significantly different between patients with scapular notching and without scapular notching (24.8 ± 1.6 mm and 2.6 ± 0.5 mm vs. 21.9 ± 1.9 mm and 5.8 ± 1.9 mm; p < 0.001 and p < 0.001, respectively). CONCLUSIONS: RTSA using a 25-mm baseplate in a Korean population who had relatively small glenoids demonstrated low complication rates and significantly improved clinical outcomes. Scapular notching can be prevented by proper positioning of the baseplate and glenosphere overhang using size-matched glenoid baseplates.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Humanos , Estudos Prospectivos , Amplitude de Movimento Articular , Escápula/diagnóstico por imagem , Escápula/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
14.
J Shoulder Elbow Surg ; 31(6S): S71-S77, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35247576

RESUMO

BACKGROUND: Although reverse total shoulder arthroplasty (RSA) is considered a safe surgical option in elderly patients, large-scale analyses of complications and mortality after RSA in patients 80 years and older are scarce. The goals of the current study were to identify revision, complication, and early mortality rates after RSA in patients 80 years and older and compare these to younger patients. METHODS: The PearlDiver Database, which contains services rendered to Medicare, Medicaid, and commercial insurance patients, was queried for patients undergoing RSA using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/ICD-10) procedure codes. Patients were separated into 2 groups based on their age: 80 years and older and <80 years of age. The incidence of revision arthroplasty, medical, and surgical complications after RSA were extracted. Multivariate regression was used to compare revision arthroplasty and complication rates between groups. Statistical significance was set at P <.05. RESULTS: A total of 29,430 cases of RSA were included, with 486 cases in patients 80 years and older (median age, 80 years; age range, 2 years). Patients 80 years and older had 1- and 2-year revision rates of 3.9% and 5.1%, compared with the younger cohort at 3.0% and 3.1%, respectively. In patients 80 years and older, there were higher rates of deep venous thrombosis (DVT) (odds ratio [OR] 2.87, 95% CI 1.5-4.97), urinary tract infection (OR 1.42, 95% CI 1.01-1.94), acute renal failure (OR 2.18, 95% CI 1.44-3.17), and pneumonia (OR 1.75, 95% CI 1.09-2.68) within 90 days postoperatively. Ninety-day surgical complications were similar between the cohorts; however, younger patients experienced higher rates of dislocation, stiffness, periprosthetic fracture, and implant complications 1 year postoperatively. Patients 80 years and older had a significantly higher 90-day mortality rate at 2.7% compared with 1.5% in younger patients (P = .002). CONCLUSIONS: RSA is a generally safe procedure even in patients 80 years and older, with low complication and revision rates. Patients 80 years and older had higher early mortality and medical complication rates, including DVT, renal failure, and pneumonia than patients <80 years of age. However, patients 80 years and older had lower rates of dislocation, periprosthetic fracture, and implant-related complication at 1 year postoperatively.


Assuntos
Artroplastia do Ombro , Fraturas Periprotéticas , Articulação do Ombro , Idoso , Idoso de 80 Anos ou mais , Artroplastia/efeitos adversos , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Pré-Escolar , Humanos , Medicare , Fraturas Periprotéticas/etiologia , Complicações Pós-Operatórias/etiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento , Estados Unidos/epidemiologia
15.
J Shoulder Elbow Surg ; 31(6S): S63-S70, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35341970

RESUMO

BACKGROUND: We aimed to characterize the long-term clinical and radiographic outcomes of total shoulder arthroplasty (TSA) in patients aged < 60 years. We hypothesized meaningful improvements in shoulder functionality and pain with TSA and an acceptably low rate of prosthesis complications and revisions. METHODS: This was a retrospective cohort study of 29 patients (34 shoulders) undergoing TSA before age 60 years with a minimum follow-up period of 10 years. Shoulder range of motion, functionality (American Shoulder and Elbow Surgeons and Simple Shoulder Test scores), and pain (visual analog scale score) were evaluated. Radiographs were assessed for lateral humeral offset, the acromiohumeral interval, and glenoid loosening. RESULTS: The mean age of the patients was 54.4 ± 5.5 years (range, 35.5-59.8 years), with a mean follow-up period of 16.1 ± 4.5 years (range, 10.0-26.1 years). In patients aged < 60 years, TSA significantly improved forward elevation (from 119° ± 26° to 146° ± 21°, P = .0002), external rotation (from 21° ± 25° to 52° ± 15°, P = .0001), and internal rotation (from L5 to L1, P = .002). Additionally, TSA significantly increased American Shoulder and Elbow Surgeons scores (from 32 ± 20 to 64 ± 27, P = .0008) and Simple Shoulder Test scores (from 3 ± 2 to 7 ± 4, P = .0004) and reduced visual analog scale pain scores (from 7 ± 3 to 3 ± 3, P = .0001). Radiographically, there was no significant difference in mean lateral humeral offset (13 ± 6 mm vs. 10 ± 12 mm, P = .472) or the mean acromiohumeral interval (20 ± 4.2 mm vs. 16 ± 6 mm, P = .061) between immediate postoperative and final follow-up radiographs. Radiographic evidence of glenoid loosening was noted in 2 patients. Complications occurred in 6 patients (17.6%), all of which were cases of aseptic glenoid loosening. Ultimately, 4 patients underwent conversion to a reverse TSA and 2 underwent arthroscopic glenoid removal. The rate of prosthesis survivorship was 97.1% (95% confidence interval [CI], 91.4%-100%) at 10 years, 85.4% (95% CI, 73.7%-97.2%) at 15 years, and 80.1% (95% CI, 65.1%-98.4%) at 20 years. DISCUSSION: TSA consistently improved shoulder functionality and reduced pain while limiting the need for further revisions. These findings suggest that TSA is a viable treatment option for glenohumeral arthritis in younger patients.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Prótese de Ombro , Adulto , Artroplastia do Ombro/efeitos adversos , Seguimentos , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
16.
Comput Methods Programs Biomed ; 219: 106751, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35306286

RESUMO

BACKGROUND: The number of Total Shoulder Arthroplasties (TSA) has increased in these last years with significant increase of clinical success. However, glenoid component loosening remains the most common cause of failure. OBJECTIVE: In this study we evaluated the critical conditions to predict short and medium-term performance of the uncemented anatomical Comprehensive® Total Shoulder System using a finite element model that was validated experimentally. METHODS: The finite element models of an implanted shoulder analysed included total shoulder components with pegs. The models were simulated in 3 phases of adduction: 45°, 60° and 90° to determine the most critical situation. Two different bone-implant fixation conditions were considered: post-surgery and medium term (2 years). RESULTS: These show that the critical condition is for the shoulder in 90° adduction were the highest contact stress (70 MPa) was observed in the glenoid component. Relatively to the interface implant-bone strains, the maximum (-16000 µÎµ) was observed for the short-term in the lateral region of the humerus. The highest micromotions were observed in the central fixation post of the glenoid component, ranging from 20 to 25 µm, and 325 µm in the lateral plane of the humeral component. CONCLUSION: The predicted results are in accordance with clinical studies published and micromotions of the humeral component can be used to predict loosening and to differentiate shoulder implant designs.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Artroplastia do Ombro/métodos , Análise de Elementos Finitos , Desenho de Prótese , Ombro/cirurgia , Articulação do Ombro/cirurgia
17.
Instr Course Lect ; 71: 347-360, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35254793

RESUMO

Shoulder arthroplasty has become an increasingly common option for the management of glenohumeral osteoarthritis in younger, higher demand, and athletic individuals. Patients with shoulder arthritis in whom nonsurgical measures fail and who are not candidates for arthroscopic treatment may be evaluated for shoulder arthroplasty. Available options include shoulder hemiarthroplasty, with or without biologic glenoid resurfacing, total shoulder arthroplasty, and less commonly reverse total shoulder arthroplasty. The orthopaedic surgeon should be aware of the evolution and current use of the different shoulder replacement techniques in young active patients with glenohumeral osteoarthritis. In addition, it is important to review practical guidelines and issues with the implementation of those techniques when treating patients with shoulder arthritis who want to return to sport activity postoperatively.


Assuntos
Artroplastia do Ombro , Hemiartroplastia , Osteoartrite , Articulação do Ombro , Envelhecimento , Atletas , Humanos , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
18.
Instr Course Lect ; 71: 361-376, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35254794

RESUMO

Periprosthetic joint infection (PJI) of the shoulder is a potentially devastating complication following shoulder arthroplasty. It is important to review the workup of PJI in the shoulder, including recently developed diagnostic criteria for shoulder PJI, along with detailed examination of the most common causative organism, Cutibacterium acnes. Treatment strategies for PJI of the shoulder include antibiotic therapy, surgical options, and what to do with unexpected positive cultures in revision arthroplasty. Surgeons should be familiar with bony and soft-tissue reconstructive options following explantation of an infected shoulder prosthesis.


Assuntos
Artrite Infecciosa , Artroplastia do Ombro , Infecções Relacionadas à Prótese , Articulação do Ombro , Artroplastia do Ombro/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/terapia , Reoperação/efeitos adversos , Ombro/cirurgia , Articulação do Ombro/microbiologia , Articulação do Ombro/cirurgia
19.
Instr Course Lect ; 71: 377-384, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35254795

RESUMO

Stemless humeral components for shoulder arthroplasty represent the fourth generation of modern prosthetic shoulder implants. Because of their metaphyseal fixation, the implantation technique is rather straightforward and preserves the humeral canal from violation. Substantial benefits have been highlighted with such a design, including less perioperative morbidity, independence from the proximal humeral anatomy, preservation of bone stock, ease of potential revision surgeries, and limited risk of complex periprosthetic fractures. Initially conceived to better re-create the center of rotation of the humeral head in anatomic arthroplasties, their use has been successfully extended to reverse total shoulder arthroplasty. Provided that contraindications are respected (eg, poor proximal humeral bone quality, proximal humerus fractures, patients who are elderly and/or overweight), short-term and midterm functional outcomes as well as postoperative complications appear to be similar to those of traditional stemmed implants, without increased risk of loosening of the humeral component.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Prótese de Ombro , Idoso , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Humanos , Cabeça do Úmero/cirurgia , Úmero/anatomia & histologia , Úmero/cirurgia , Desenho de Prótese , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos , Resultado do Tratamento
20.
Bone Joint J ; 104-B(3): 401-407, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35227098

RESUMO

AIMS: The aim of this study was to report the incidence of implant-related complications, further operations, and their influence on the outcome in a series of patients who underwent primary reverse total shoulder arthroplasty (RTSA). METHODS: The prospectively collected clinical and radiological data of 797 patients who underwent 854 primary RTSAs between January 2005 and August 2018 were analyzed. The hypothesis was that the presence of complications would adversely affect the outcome. Further procedures were defined as all necessary operations, including reoperations without change of components, and partial or total revisions. The clinical outcome was evaluated using the absolute and relative Constant Scores (aCS, rCS), the Subjective Shoulder Value (SSV) scores, range of motion, and pain. RESULTS: The overall surgical site complication rate was 22% (188 complications) in 152 patients (156 RTSAs; 18%) at a mean follow-up of 46 months (0 to 169). The most common complications were acromial fracture (in 44 patients, 45 RTSAs; 5.3%), glenoid loosening (in 37 patients, 37 RTSAs; 4.3%), instability (in 23 patients, 23 RTSAs; 2.7%), humeral fracture or loosening of the humeral component (in 21 patients, 21 RTSAs; 2.5%), and periprosthetic infection (in 14 patients, 14 RTSAs; 1.6%). Further surgery was undertaken in 79 patients (82 RTSAs) requiring a total of 135 procedures (41% revision rate). The most common indications for further surgery were glenoid-related complications (in 23 patients, 23 RTSAs; 2.7%), instability (in 15 patients, 15 RTSAs; 1.8%), acromial fractures (in 11 patients, 11 RTSAs; 1.3%), pain and severe scarring (in 13 patients, 13 RTSAs; 1.5%), and infection (in 8 patients, 8 RTSAs; 0.9%). Patients who had a complication had significantly worse mean rCS scores (57% (SD 24%) vs 81% (SD 16%)) and SSV scores (53% (SD 27%) vs 80% (SD 20%)) compared with those without a complication. If revision surgery was necessary, the outcome was even further compromised (mean rCS score: 51% (SD 23%) vs 63% (SD 23%); SSV score: 4% (SD 25%) vs 61% (SD 27%). CONCLUSION: Although the indications for, and use of, a RTSA are increasing, it remains a demanding surgical procedure. We found that about one in five patients had a complication and one in ten required further surgery. Both adversely affected the outcome. Cite this article: Bone Joint J 2022;104-B(3):401-407.


Assuntos
Artroplastia do Ombro , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Prótese de Ombro/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
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