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1.
Orthop Clin North Am ; 51(2): 259-264, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138863

RESUMO

The relationship between obesity and glenohumeral osteoarthritis is relatively understudied. The purpose of this study was to better define this relationship by age- and gender-matching 596,874 patients across six body mass index (BMI) cohorts and determining the prevalence of glenohumeral osteoarthritis and the standardized rate of glenohumeral arthroplasty in each cohort. Individuals with a BMI over 24 were found to be at increased odds for developing glenohumeral osteoarthritis, compared to the normal BMI cohort, and individuals with a BMI over 30 were additionally found to be at increased odds for undergoing glenohumeral arthroplasty.


Assuntos
Artroplastia do Ombro , Obesidade/epidemiologia , Osteoartrite/epidemiologia , Articulação do Ombro/cirurgia , Índice de Massa Corporal , Estudos de Coortes , Humanos , Obesidade/complicações , Osteoartrite/cirurgia , Prevalência , Estudos Retrospectivos
2.
Bone Joint J ; 102-B(3): 365-370, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114820

RESUMO

AIMS: Patient-specific instrumentation has been shown to increase a surgeon's precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. METHODS: A case-based survey presented surgeons with a patient's history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts. RESULTS: A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x2 = 8.54; p = 0.014) and surgical planning (x2 = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017). CONCLUSIONS: The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: Bone Joint J 2020;102-B(3):365-370.


Assuntos
Artroplastia do Ombro/métodos , Tomada de Decisões , Imageamento Tridimensional , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Articulação do Ombro/diagnóstico por imagem
4.
Instr Course Lect ; 69: 575-582, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017752

RESUMO

Shoulder arthroplasty has traditionally been viewed as an inpatient procedure because of the inherent medical comorbidities associated with an aging population and the need for postoperative pain control. Recent studies have shown that in appropriately selected patients, shoulder arthroplasty procedures can be safely done as outpatient procedures and can deliver economic value in today's cost-conscious health care environment. Several factors help ensure a successful surgical outcome, including cooperation from the ambulatory anesthesia service, proper patient selection, and perioperative pain control. Postoperatively, provider availability is vital to complete a seamless patient experience. With appropriate algorithms and care plans in place, outpatient shoulder arthroplasty can be a safe and cost-efficient procedure. The advances pioneered by outpatient shoulder arthroplasty will also serve to benefit inpatient shoulder arthroplasty patients via improved pain control, perioperative education, and potentially decreased length of stay.


Assuntos
Artroplastia do Ombro , Idoso , Procedimentos Cirúrgicos Ambulatórios , Artroplastia , Humanos , Tempo de Internação , Pacientes Ambulatoriais , Seleção de Pacientes
5.
Instr Course Lect ; 69: 583-594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017753

RESUMO

The glenoid is considered a weak link in total shoulder arthroplasty because failure on the glenoid side is one of the most common reasons for revision of total shoulder arthroplasty. Glenoid wear is commonly seen in glenohumeral arthritis and compromises glenoid bone stock and also alters the native version and inclination of the glenoid. It is critical to recognize glenoid wear and correct it intraoperatively to avoid component malposition, which can negatively affect the survivorship of the glenoid implant. The end point of correction for the glenoid wear in shoulder arthroplasty is controversial, but anatomic glenoid component positioning is likely to improve long-term survivorship of the total shoulder arthroplasty. Preoperative three-dimensional (3-D) computer planning software, based on CT, is commercially available. It allows the surgeon to plan implant type (anatomic versus reverse), size, and position on the glenoid, and also allows for templating deformity correction using bone graft and/or augments. Guidance technology in the form of computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) allows the surgeon to execute the preoperative plan during surgery with a greater degree of accuracy and precision and has shown superiority to standard instrumentation. However, the proposed benefits of this technology including improved glenoid survivorship, reduced revision arthroplasty rate and cost-effectiveness have not yet been demonstrated clinically. In this review, we present the current evidence regarding PSI and CAS in managing glenoid deformity in total shoulder arthroplasty.


Assuntos
Artroplastia do Ombro , Cavidade Glenoide , Articulação do Ombro , Cirurgia Assistida por Computador , Artroplastia , Humanos , Imageamento Tridimensional
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 184-189, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030949

RESUMO

Objective: To summarize the effectiveness of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of the proximal humeral fracture. Methods: Between June 2014 and January 2018, 17 patients with deep infection and humeral head necrosis or bone nonunion after internal fixation of proximal humeral fractures were treated. There were 8 males and 9 females, aged from 52 to 78 years (mean, 63.8 years). The infection occurred at 19-66 months after the initial internal fixation (mean, 34.8 months). Microbial culture of joint fluid was positive in 14 cases and negative in 3 cases. The preoperative Constant score, American shoulder and elbow surgeons (ASES) score, and visual analogue scale (VAS) score were 36.41±8.65, 31.06±7.43, and 7.29±0.99, respectively. The preoperative ranges of forward flexion, abduction, external rotation were (45.88±12.46), (42.18±12.31), and (16.76±4.92)°, respectively. The preoperative range of internal rotation was buttock in 9 cases, lumbosacral joint in 3 cases, L 3 in 5 cases. At the first-stage surgery, the thorough debridement was done and the antibiotic-impregnated bone cement spacer was placed after the removal of internal fixation. After the infections disappeared, the two-stage reverse total shoulder arthroplasty was performed. The mean interval between the two procedures was 4.2 months (range, 3.0-6.5 months). Results: All the incisions healed primarily and no complications such as recurrent infection or vascular nerve injury occurred. All patients were followed up 15-32 months (mean, 22.0 months). At last follow-up, the ranges of forward flexion, abduction, and external rotation were (109.00±23.66), (98.53±16.92), (41.41±6.82)°, respectively; and the range of internal rotation was lumbosacral joint in 5 cases, L 3 in 8 cases, T 12 in 4 cases. The range of motion of shoulder joints at last follow-up was significant improved when compared with the preoperative range of motion ( P<0.05). The Constant score (64.88±8.70), ASES score (65.18±8.10), and VAS score (2.94±1.25) were significantly superior to the preoperative scores ( P<0.05). X-ray films showed that no prosthesis loosening occurred. Conclusion: Two-stage reverse total shoulder arthroplasty is an effective treatment for the postoperative deep infection after internal fixation of the proximal humeral fracture, which has advantages of low risk of infection recurrence, good shoulder function, and satisfactory short-term effectiveness.


Assuntos
Artroplastia do Ombro , Complicações Pós-Operatórias , Fraturas do Ombro , Articulação do Ombro , Idoso , Artroplastia do Ombro/efeitos adversos , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Resultado do Tratamento
7.
J Shoulder Elbow Surg ; 29(1): 58-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401130

RESUMO

BACKGROUND: The main limits of the Grammont design reverse shoulder arthroplasty (RSA) are loss of external rotation and scapular notching. They can be addressed with glenoid or humeral lateralization. The aim of the study was to compare outcomes of lateralized bony increased-offset RSA (BIO-RSA) vs. standard RSA in patients with an onlay 145° curved stem. METHODS: A comparative cohort study of 29 standard RSAs and 30 BIO-RSAs was performed. At 2 years postoperatively, Constant score, American Shoulder and Elbow Surgeons score, visual analog scale score, range of motion, and radiographs were evaluated. After comparison between the groups, patients were analyzed considering patients younger and older than 65 years. RESULTS: All parameters significantly improved after surgery in both groups. Postoperatively, the 2 groups did not show any clinical and radiographic differences (P > .05). In patients <66 years, BIO-RSA showed a significantly higher value of external rotation (49° ± 12° vs. 30° ± 19° [P = .025], elbow at side; 81° ± 17° vs. 56° ± 22° [P = .016], elbow at 90° of abduction) and a positive trend for all other parameters (P > .05). In patients >65 years, standard technique showed a positive trend for all the parameters (P > .05). No other significant differences were found. CONCLUSIONS: At 2 years of follow-up, the use of standard RSA or BIO-RSA in an implant with an onlay 145° curved stem provided similar outcomes. The humeral lateralization alone is sufficient to decrease notching and to improve external rotation. BIO-RSA increases external rotation in patients between 50 and 65 years old. Glenoid bone graft in RSA has a high incorporation rate (completed in 90%).


Assuntos
Artroplastia do Ombro/métodos , Cavidade Glenoide/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Idoso , Artroplastia do Ombro/instrumentação , Medicamentos Biossimilares , Transplante Ósseo , Feminino , Humanos , Úmero/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Artropatia de Ruptura do Manguito Rotador/complicações , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Prótese de Ombro , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 29(1): 79-85, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31405715

RESUMO

BACKGROUND: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. METHODS: Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20%. RESULTS: Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi-beach chair positioning. Patients experienced the largest oxygen saturation drop during semi-beach chair positioning. Transition from baseline to semi-beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi-beach chair interval (10%, P < .01) and the semi-beach chair to incision interval (7%, P < .01). CONCLUSIONS: Most patients experienced an intraoperative CDE, with greatest incidence during semi-beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi-beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.


Assuntos
Artroplastia do Ombro , Cérebro/metabolismo , Oxigênio/metabolismo , Posicionamento do Paciente , Idoso , Circulação Cerebrovascular , Feminino , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oximetria , Posicionamento do Paciente/efeitos adversos , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho
9.
J Shoulder Elbow Surg ; 29(1): 86-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31427227

RESUMO

BACKGROUND: Reverse total shoulder arthroplasty (RSA) is a widely accepted treatment for irreparable massive rotator cuff tear (mRCT) and cuff tear arthropathy (CTA), but its impact on activities of daily living (ADLs) remains unclear. METHODS: We retrospectively analyzed 77 patients (age range, 54-87 years; follow-up range, 36.1-120.3 months) with irreparable mRCT and CTA treated by medialized RSA between 2008 and 2015. Ten activities considered essential for daily living were selected and scored from 0 to 3. RESULTS: The mean visual analog scale scores during motion and University of California at Los Angeles and Constant scores significantly improved at final follow-up (all P < .001). Active forward flexion, external rotation at the side, and internal rotation to the posterior (IRp) were 92.5%, 79.6%, and 48.4% of the contralateral side, respectively, at final follow-up. Active forward flexion and external rotation at the side recovered within 6 months after surgery, similar to the level at final follow-up, but IRp did not reach the preoperative status until final follow-up. ADLs with mean scores of less than 2.0 at final follow-up were "wash the opposite shoulder," "wash the opposite axilla," "use a back pocket," "manage the toilet," and "wash the back" (only 36.4% of patients were able to wash their back at final follow-up). CONCLUSIONS: RSA for irreparable mRCT and CTA showed satisfactory clinical outcomes. However, IRp was associated with a limited range compared with the other shoulder motions; therefore, all ADLs associated with internal rotation demonstrated lower recovery rates than expected.


Assuntos
Atividades Cotidianas , Artroplastia do Ombro , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Rotação , Lesões do Manguito Rotador/fisiopatologia , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
10.
J Shoulder Elbow Surg ; 29(1): 146-149, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401127

RESUMO

BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) shoulder score and the Single Assessment Numeric Evaluation (SANE) measure shoulder function. Relative to the ASES questionnaire, the SANE questionnaire is shorter and easier to score. We sought to determine (1) the correlation between ASES and SANE scores preoperatively and at 2 years postoperatively in patients undergoing rotator cuff repair (RCR) or shoulder arthroplasty and (2) the correlation between the change in ASES scores and change in SANE scores. METHODS: We reviewed the records of 107 patients who underwent RCR (n = 74) or shoulder arthroplasty (n = 33), which included patients undergoing total shoulder arthroplasty (n = 18) and reverse total shoulder arthroplasty (n = 15), at our institution from 2014 to 2015 and who completed the ASES and SANE questionnaires preoperatively and at least 2 years postoperatively. Pearson correlation coefficients were calculated to determine the relationship between SANE and ASES scores in RCR patients and arthroplasty patients (both total shoulder arthroplasty and reverse total shoulder arthroplasty) at each time point. RESULTS: In the RCR group, correlations between SANE and ASES scores were moderately positive preoperatively (r = 0.30) and strongly positive postoperatively (r = 0.86). In the arthroplasty group, correlations between SANE and ASES scores were moderately positive preoperatively (r = 0.46) and strongly positive postoperatively (r = 0.78). CONCLUSION: SANE scores correlate positively with ASES scores postoperatively in patients undergoing RCR. Therefore, SANE scores, together with clinician-based and combination scores, can be used to assess postoperative shoulder function in these patients.


Assuntos
Artroplastia do Ombro , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Período Pós-Operatório , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do Tratamento , Adulto Jovem
11.
J Shoulder Elbow Surg ; 29(1): 195-201, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31420222

RESUMO

BACKGROUND: If patients susceptible to poor clinical outcomes could be predicted before reverse shoulder arthroplasty (RSA), it would help to set reasonable postsurgical patient expectations in the preoperative setting. Our hypothesis was that the preoperative electromyographic (EMG) activity of the deltoid and upper trapezius muscles would be correlated with clinical outcomes of patients undergoing RSA. METHODS: EMG activity of the deltoid and upper trapezius muscles was measured in 25 patients scheduled to undergo RSA during 3 motions: shrugging, forward flexion, and abduction. Their postoperative clinical results were assessed prospectively during regular outpatient visits, including strength, active range of motion (ROM), pain, and functional scores. The correlations between the preoperative EMG activities and clinical results were analyzed. RESULTS: Postoperative shoulder strength after RSA was increased in patients with greater preoperative EMG activity of the middle deltoid and upper trapezius. Preoperative EMG activity of the anterior or middle deltoid muscle was associated with active ROM in flexion or abduction, whereas EMG activity of the posterior deltoid was associated with active ROM in external rotation. CONCLUSIONS: Shoulder strength after RSA was positively correlated with preoperative EMG activity of the deltoid and upper trapezius. Active ROM after RSA was positively correlated with preoperative EMG activity of the deltoid. Therefore, preoperative EMG measurements of the deltoid and upper trapezius may predict clinical outcomes after RSA.


Assuntos
Artroplastia do Ombro , Músculo Deltoide/fisiopatologia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Músculos Superficiais do Dorso/fisiopatologia , Idoso , Artroplastia do Ombro/métodos , Músculo Deltoide/cirurgia , Eletromiografia , Feminino , Humanos , Masculino , Movimento , Força Muscular , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular , Rotação , Músculos Superficiais do Dorso/cirurgia , Resultado do Tratamento
12.
J Shoulder Elbow Surg ; 29(1): 202-209, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31492619

RESUMO

The purpose of this study was to evaluate outcomes of reverse total shoulder arthroplasty (RTSA) in patients aged ≤65 years. MEDLINE, Embase, and PubMed were searched for relevant studies from database inception to September 18, 2018. All studies that evaluated RTSA in patients aged ≤65 years were included. Two independent reviewers screened all studies and performed a quality assessment. In the total of 6 studies reviewed, 245 participants underwent RTSA, with the most common indications being failed rotator cuff repair and rotator cuff tear arthropathy. Postoperative functional outcomes indicated a significant level of improvement across all reported outcomes at a mean follow-up of 49 months (range, 19-140 months) (P < .05). The pooled mean complication rate was 18% (n = 44/245), and this higher rate may be due to 36% of patients undergoing an RTSA for a failed arthroplasty procedure and the inclusion of older studies that lacked modern implants and techniques. Although there is a significant improvement in functional outcomes at midterm follow-up for RTSA in the patients aged ≤65 years, the pooled complication rates are high. However, the results of this systematic review are limited because of the heterogenous patient population undergoing surgery for various indications, including revision arthroplasty. Long-term studies and registry data are required using current modern techniques and implants to provide an accurate assessment of outcomes following RTSA in a young patient population.


Assuntos
Artroplastia do Ombro , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Fatores de Tempo , Resultado do Tratamento
13.
J Shoulder Elbow Surg ; 29(1): 44-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401131

RESUMO

BACKGROUND: The purpose was to determine the risk and outcomes of primary shoulder arthroplasties in patients with immunosuppression who had undergone solid organ transplantation. METHODS: Using a single institution's total joint registry, we reviewed 30 primary shoulder arthroplasties in 25 post-transplantation patients, including 12 total shoulder arthroplasties, 10 hemiarthroplasties, and 8 reverse shoulder arthroplasties, between 1985 and 2012. Therapy and patient variables were recorded, including immunosuppressive therapy protocols, the date of preceding solid organ transplantation, and specific medications taken in the perioperative period. We matched a cohort of control patients for age, sex, type of implant, and year of surgery at a ratio of 4:1. Two groups were compared regarding mortality risk, complications, and clinical outcomes (pain score, range of motion, and American Shoulder and Elbow Surgeons score). RESULTS: No periprosthetic infections occurred in the post-transplantation group at a mean follow-up of 39 months. However, the post-transplantation group showed an increased risk of periprosthetic fractures compared with the control group (hazard ratio, 8.18; 95% confidence interval, 1.22-70.98; P = .03). Despite the increase in fractures, the overall number of complications did not differ between the groups. Furthermore, postoperative shoulder function and outcome scores were not significantly different between patients who had a prior transplant and those who did not. CONCLUSION: Primary shoulder arthroplasty in patients with immunosuppression who underwent solid organ transplantation is a successful procedure to treat glenohumeral arthritis. In contrast, there may be an increased risk of periprosthetic fractures in patients with a history of a solid organ transplant.


Assuntos
Artroplastia do Ombro/efeitos adversos , Hemiartroplastia/efeitos adversos , Hospedeiro Imunocomprometido , Transplante de Órgãos , Fraturas Periprotéticas/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
14.
J Shoulder Elbow Surg ; 29(1): e1-e10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31451348

RESUMO

BACKGROUND: We evaluated survival and midterm results of pyrocarbon interposition shoulder arthroplasty (PISA) in arthritic patients younger than 65 years. METHODS: Fifty-eight PISAs (InSpyre; Tornier-Wright, Bloomington, MN, USA), implanted in 56 patients between 2010 and 2015, were prospectively observed. The mean age at surgery was 52 ± 13 years. The cause was primary osteoarthritis (18), fracture sequelae (16), post-instability arthritis (15), aseptic necrosis (3), inflammatory disease (2), and failed hemiarthroplasty (4); 34 shoulders (61%) had previously undergone surgery. Glenoid erosion was assessed in 4 grades according to the Sperling classification. Humeral erosion was also assessed in 4 grades. Multivariate analysis was used to determine predisposing risk factors for both humeral and glenoid erosion. RESULTS: At a mean follow-up of 47 ± 15 months, survival rate was 90%. Six patients (10%) required conversion to reverse total shoulder prosthesis for painful glenoid erosion (n = 2) and humeral erosion with greater tuberosity stress fractures (n = 4). The mean Constant score and subjective shoulder value significantly increased from 36 ± 14 points to 70 ± 15 points and 32% ± 14% to 75% ± 19%, respectively (P < .001). Humeral medialization was observed in 78% of the cases with increased pain score. Uncorrected anteroposterior implant subluxation (12 cases) was associated with lower Constant score (50 points vs. 72 points; P = .02) and lower subjective shoulder value (53% vs. 78%; P = .002). On multivariate analysis, no risk factors for glenoid or humeral erosion were found. CONCLUSION: At midterm follow-up, PISA does not protect from progressive glenoid erosion and can lead to greater tuberosity erosion and stress fractures. Longer follow-up is required to see whether PISA survival will be superior to that of hemiarthroplasty.


Assuntos
Artroplastia do Ombro/instrumentação , Osteoartrite/cirurgia , Articulação do Ombro/fisiopatologia , Prótese de Ombro , Adulto , Idoso , Artroplastia do Ombro/efeitos adversos , Carbono , Feminino , Seguimentos , Fraturas de Estresse/etiologia , Cavidade Glenoide/diagnóstico por imagem , Humanos , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Reoperação/instrumentação , Fatores de Risco , Luxação do Ombro/etiologia , Fraturas do Ombro/etiologia , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos
15.
Orthop Clin North Am ; 51(1): 87-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739883

RESUMO

Proximal humeral bone loss in revision shoulder arthroplasty poses a significant obstacle to achieving stable and reliable fixation of the humeral stem. It is important to identify and classify this bone loss preoperatively, which can range from epiphyseal to substantial diaphyseal bone loss. There are several reconstructive options that can address the varying levels of bone loss, including cemented long-stem fixation, a composite construct using proximal humeral allograft or femoral allograft, proximal humeral endoprosthetic replacement, or total humeral replacement. All of these are viable reconstructive options that have demonstrated adequate to good outcomes.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia de Substituição/efeitos adversos , Úmero/patologia , Aloenxertos/transplante , Artroplastia de Substituição/métodos , Cimentos para Ossos , Reabsorção Óssea/classificação , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/patologia , Epífises/patologia , Epífises/cirurgia , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Prótese Articular , Complicações Pós-Operatórias/cirurgia , Período Pré-Operatório , Próteses e Implantes , Radiografia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
16.
Bone Joint J ; 101-B(12): 1520-1525, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787000

RESUMO

AIMS: Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. PATIENTS AND METHODS: Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. RESULTS: One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. CONCLUSION: Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520-1525.


Assuntos
Artroplastia do Ombro , Dor de Ombro/cirurgia , Fatores Etários , Idoso de 80 Anos ou mais , Artroplastia do Ombro/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Dor de Ombro/etiologia , Dor de Ombro/mortalidade , Dor de Ombro/fisiopatologia , Resultado do Tratamento
17.
J Surg Orthop Adv ; 28(4): 290-294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886767

RESUMO

Recent literature suggests that many online patient resources are poor in quality and lack important clinical information. The purpose of this study was to investigate the value of online resources available to patients considering shoulder arthroplasty. A total of 84 websites were discovered with the terms "total shoulder replacement" (TSR) and "reverse shoulder replacement" (RSR), they were reviewed and graded for quality and accuracy. Overall quality scores were low for TSR and RSR websites, 22.8/45 (95% confidence interval (CI): 19.9-25.6) and 24.2/45 (95% CI: 21.6-26.9), respectively. The authorship of a website significantly influenced the quality for both TSR (p = 0.013) and RSR (p = 0.048). When comparing search rank to quality scores, websites that appeared earlier demonstrated significantly higher quality scores, TSR (p = 0.017) and RSR (p = 0.018). Overall, most websites were accurate but provided incomplete information. Websites authored by professional societies have higher quality scores than websites authored by medical providers or commercial entities. (Journal of Surgical Orthopaedic Advances 28(4):290-294, 2019).


Assuntos
Artroplastia do Ombro , Ortopedia , Humanos , Disseminação de Informação , Internet , Ombro
18.
Rev Med Suisse ; 15(675): 2299-2302, 2019 Dec 11.
Artigo em Francês | MEDLINE | ID: mdl-31840959

RESUMO

Total shoulder arthroplasty has become an effective treatment option, for both pain relief and restoration of shoulder range of motion. The key factor limiting long-term prosthetic survival remains glenoid implant loosening. Proper glenoid implant positioning and orientation during surgery was shown to significantly reduce complication rates. The emergence of new technologies now allows for three-dimensional (3D) surgical planning, patient-specific instrumentation and augmented-reality-based intraoperative navigation. Such novel tools have been developed to aid and improve the surgeon's performance. The future will tell whether the gains in term of surgical precision will also translate into better functional outcomes for patients and prolonged survival of glenoid implants.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Artroplastia do Ombro/métodos , Humanos , Imageamento Tridimensional , Amplitude de Movimento Articular , Resultado do Tratamento
19.
Zhongguo Gu Shang ; 32(12): 1123-1127, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870071

RESUMO

OBJECTIVE: To investigate clinical results of reverse total shoulder arthroplasty in treating old fracture of proximal humerus in elderly patients. METHODS: From January 2012 to December 2017, 12 elderly patients with old proximal humeral fractures were treated with reverse total shoulder arthroplasty. There were 5 males and 7 females with an average age of 70.2 years old (ranged from 63 to 81 years old) and an average course of 12.3 months (ranged from 9 to 18 months). VAS score was used to evaluate the degree of pain relief of shoulder joint, Constant-Murley score was used to evaluate the improvement of shoulder joint function and observe the complications during and after operation. RESULTS: All the 12 patients were followed up with an average duration of 22.3 months (ranged from 15 to 56 months). At the latest follow-up, the VAS score was 1.9±1.4, and Constant-Murley score was 83.4±8.4. Among them, shoulder joint flexion was (92.5±7.7)°, abduction was (90.4±14.3)°, external rotation was(31.9±10.0)°, and internal rotation was(58.9±13.1)°. There was statistical significance before and after treatment(P<0.05). There were 2 cases with glenoid notch. The imaging findings were grade I and grade II respectively. No loosening was found during follow-up. No infection, acromial fracture, prosthesis loosening, axillary nerve injury and other complications occurred. CONCLUSIONS: Reverse total shoulder arthroplasty in treating old proximal humeral fractures in elderly patients can achieve satisfactory results, however, indications and complications should be noted.


Assuntos
Artroplastia do Ombro , Fraturas do Ombro , Articulação do Ombro , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Úmero , Masculino , Pessoa de Meia-Idade , Ombro , Fraturas do Ombro/cirurgia , Resultado do Tratamento
20.
Unfallchirurg ; 122(12): 925-933, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31713643

RESUMO

Apart from primary or idiopathic frozen shoulder, the secondary form of glenohumeral stiffness can also develop after trauma or surgery. The cause for these secondary forms of restricted range of motion can be distinguished into intra-articular and extra-articular factors. Posttraumatic stiffness can develop after minor or major trauma to the bony or soft tissues of the shoulder girdle. After minor trauma the course and clinical presentation is similar to the primary form as pathomorphological correlates are often not detectable; therefore, treatment protocols are adapted according to those for primary shoulder stiffness. Shoulder stiffness after major trauma is mainly caused by scarring and adhesions of gliding structures and often necessitates surgical release if resolution under conservative treatment fails. Postoperative shoulder stiffness is a common problem after rotator cuff surgery or fracture fixation, even though incidences vary widely between different surgical procedures. Apart from the abovementioned scarring, overstuffing implants or tightening of soft tissue structures can lead to restricted range of motion. Stiffness after shoulder arthroplasty is rare and should prompt further diagnostic work-up to differentiate implant, surgery or patient-specific causes. Furthermore, an inflammatory shoulder stiffness similar to the primary or minor trauma form can develop after surgery. Reviewing the literature, shoulder stiffness has been reported most often after rotator cuff reconstruction surgery, followed by fracture fixation surgery, instability operations and lastly shoulder arthroplasty.


Assuntos
Artroplastia do Ombro , Artropatias , Lesões do Manguito Rotador , Lesões do Ombro , Articulação do Ombro , Humanos , Amplitude de Movimento Articular , Manguito Rotador , Lesões do Manguito Rotador/cirurgia , Lesões do Ombro/complicações , Lesões do Ombro/cirurgia , Resultado do Tratamento
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