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1.
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
2.
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
3.
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
4.
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
5.
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
6.
Bone Joint J ; 101-B(10): 1272-1279, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564147

RESUMO

AIMS: To compare complication-related reoperation rates following primary arthroplasty for proximal humerus fractures (PHFs) versus secondary arthroplasty for failed open reduction and internal fixation (ORIF). PATIENTS AND METHODS: We identified patients aged 50 years and over, who sustained a PHF between 2004 and 2015, from linkable datasets. We used intervention codes to identify patients treated with initial ORIF or arthroplasty, and those treated with ORIF who returned for revision arthroplasty within two years. We used multilevel logistic regression to compare reoperations between groups. RESULTS: We identified 1624 patients who underwent initial arthroplasty for PHF, and 98 patients who underwent secondary arthroplasty following failed ORIF. In total, 72 patients (4.4%) in the primary arthroplasty group had a reoperation within two years following arthroplasty, compared with 19 patients (19.4%) in the revision arthroplasty group. This difference was significantly different (p < 0.001) after covariable adjustment. CONCLUSION: The number of reoperations following arthroplasty for failed ORIF of PHF is significantly higher compared with primary arthroplasty. This suggests that primary arthroplasty may be a better choice for patients whose prognostic factors suggest a high reoperation rate following ORIF. Prospective clinical studies are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B:1272-1279.


Assuntos
Artroplastia do Ombro/efeitos adversos , Redução Aberta/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Amplitude de Movimento Articular/fisiologia , Reoperação/estatística & dados numéricos , Fraturas do Ombro/cirurgia , Idoso , Artroplastia do Ombro/métodos , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Razão de Chances , Redução Aberta/métodos , Medição da Dor , Complicações Pós-Operatórias/fisiopatologia , Falha de Prótese , Estudos Retrospectivos , Medição de Risco , Fraturas do Ombro/diagnóstico por imagem , Resultado do Tratamento
7.
Bone Joint J ; 101-B(10): 1280-1284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564150

RESUMO

AIMS: A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty. PATIENTS AND METHODS: Between 2010 and 2018, 288 revision shoulder arthroplasty procedures requiring removal of a well-fixed humeral component were carried out at a tertiary referral centre by a single surgeon. The patient demographics, indications for surgery, and method of extraction were collected. RESULTS: Of the 288 revisions, 284 humeral stems (98.6%) were removed using the router bit extraction technique alone. Four humeral stems (1.39%) required an additional cortical window. Humeral osteotomy was not necessary in any procedure. Most of the humeral stems removed (78.8%) were cementless. Of the four humeral stems that required a cortical window, three involved removal of a hemiarthroplasty. Two were cemented and two were cementless. CONCLUSION: The router bit extraction technique removed a well-fixed humeral component in a very high proportion of patients (98.6%). This method allows surgeons to avoid more invasive approaches involving a cortical window or humeral osteotomy, and their associated complications. Cite this article: Bone Joint J 2019;101-B:1280-1284.


Assuntos
Artroplastia do Ombro/efeitos adversos , Remoção de Dispositivo/métodos , Hemiartroplastia/métodos , Falha de Prótese , Idoso , Artroplastia do Ombro/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Prótese de Ombro/efeitos adversos , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 28(11): e359-e376, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31630753

RESUMO

BACKGROUND: A systematic review was performed to investigate the impact of obesity on outcomes following total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). METHODS: Electronic databases and the grey literature were searched for studies that evaluated the influence of obesity (body mass index ≥ 30 kg/m2) on TSA and RTSA outcomes. A total of 15 studies were identified, with 10 studies reporting on predetermined outcomes considered in the TSA and RTSA population. Unadjusted data were pooled in a statistical meta-analysis where appropriate (Review Manager [RevMan], version 5.3) or summarized in narrative form. Effect sizes were expressed as odds ratios (ORs) for categorical data and weighted mean differences (WMDs) for continuous data. RESULTS: The findings suggested that patients who were obese were at increased odds of a dislocation (OR, 2.49; 95% confidence interval [CI], 2.32-2.66), fracture (OR, 1.92; 95% CI, 1.77-2.08), and revision (OR, 1.49; 95% CI, 1.40-1.58) following TSA or RTSA. Conversely, obesity had no influence on the odds of an unscheduled return to the operating theater (OR, 0.83; 95% CI, 0.43-1.61). Postoperative forward flexion in patients who were obese differed from that in patients who were not obese (WMD, -9.8°; 95% CI, -17.53° to -2.07°); however, no differences in other functional measures including abduction (WMD, -0.78; 95% CI, -7.27 to 5.71) and external rotation (WMD, -1.41; 95% CI, -5.11 to 2.29) were found. Although patients who were obese reported significantly higher levels of pain (WMD, 1.13; 95% CI, 0.21 to 2.06), the difference was not clinically relevant. CONCLUSIONS: Surgeons should consider advising patients who are obese of the greater risk of dislocation, fracture, and revision when considering elective TSA or RTSA. Findings are limited by confounding variables but further our understanding of additional risks associated with pre-existing obesity, which will promote better-informed decisions prior to proceeding with surgery.


Assuntos
Artroplastia do Ombro/efeitos adversos , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Fatores de Risco , Resultado do Tratamento
9.
Bone Joint J ; 101-B(9): 1107-1114, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474140

RESUMO

AIMS: The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). MATERIALS AND METHODS: A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. RESULTS: There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). CONCLUSION: Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107-1114.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Úmero/cirurgia , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos , Cimentos para Ossos , Cimentação , Humanos , Complicações Pós-Operatórias , Falha de Prótese , Recuperação de Função Fisiológica , Reoperação , Resultado do Tratamento
10.
J Shoulder Elbow Surg ; 28(11): 2061-2071, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542325

RESUMO

BACKGROUND: Shoulder arthroplasty (SA) complications require standardization of definitions and are not limited to events leading to revision operations. We aimed to define an international consensus core set of clinically relevant unfavorable events of SA to be documented in clinical routine practice and studies. METHODS: A Delphi exercise was implemented with an international panel of experienced shoulder surgeons selected by nomination through professional societies. On the basis of a systematic review of terms and definitions and previous experience in establishing an arthroscopic rotator cuff repair core set, an organized list of SA events was developed and reviewed by panel members. After each survey, all comments and suggestions were considered to revise the proposed core set including local event groups, along with definitions, specifications, and timing of occurrence. Consensus was reached with at least two-thirds agreement. RESULTS: Two online surveys were required to reach consensus within a panel involving 96 surgeons. Between 88% and 100% agreement was achieved separately for local event groups including 3 intraoperative (device, osteochondral, and soft tissue) and 9 postoperative event groups. Experts agreed on a documentation period that ranged from 3 to 24 months after SA for 4 event groups (peripheral neurologic, vascular, surgical-site infection, and superficial soft tissue) and that was lifelong until implant revision for other groups (device, osteochondral, shoulder instability, pain, late hematogenous infection, and deep soft tissue). CONCLUSION: A structured core set of local unfavorable events of SA was developed by international consensus to support the standardization of SA safety reporting. Clinical application and scientific evaluation are needed.


Assuntos
Artroplastia do Ombro/efeitos adversos , Atitude do Pessoal de Saúde , Consenso , Técnica Delfos , Humanos , Inquéritos e Questionários
11.
BMC Musculoskelet Disord ; 20(1): 374, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416443

RESUMO

BACKGROUND: The number of hip, knee and shoulder arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched an initiative (called PaRIS Initiative) for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the launch of the Initiative in Italy given that IOR hosts the Registry of Orthopedic Prosthetic Implants (RIPO), a region-wide registry which collects joint implant data from all the hospitals in the Emilia-Romagna Region. In this specific geographic area information related to PROMs after joint replacement is unknown. This paper describes the protocol of a study (PaRIS-IOR) that aims to implement the collection of a set of PROMs within an existing implant registry in Italy. The study will also investigate the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. METHODS: The PaRIS-IOR study is a prospective, single site, cohort study that consists of the administration of PROMs questionnaires to patients on the list for elective arthroplasty. The questionnaires will be administered to the study population within 30 days before surgery, and then at 6 and 12 months following surgery. The study population will consist of consecutive adult patients undergoing either hip, knee or shoulder arthroplasty. The collected data will be linked with those routinely collected by the RIPO in order to assess the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. DISCUSSION: The PaRIS-IOR study could have important implications in targeting the factors influencing functional outcomes and quality of life reported by patients after hip, knee and shoulder arthroplasty, and will also represent the first systematic collection of PROMs related to arthroplasty in Italy. TRIAL REGISTRATION: Protocol version (1.0) and trial registration data are available on the platform www.clinicaltrial.gov with the identifier NCT03790267 , first posted on December 31, 2018.


Assuntos
Estudos Observacionais como Assunto , Medidas de Resultados Relatados pelo Paciente , Projetos de Pesquisa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/estatística & dados numéricos , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/instrumentação , Artroplastia do Ombro/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
12.
Iowa Orthop J ; 39(1): 63-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413676

RESUMO

Background: The primary indication for reverse shoulder arthroplasty (RSA) is rotator cuff arthropathy caused by a deficient rotator cuff. Cuff deficiency in patients is highly variable in its distribution and extent, with mechanical implications that may significantly affect post-operative recovery. This study investigated the effects of variable cuff deficiency on the propensity for impingement between the scapula and humeral component and resulting subluxation, the source of two common complications (scapular notching and instability). Methods: Five different finite element models of an RSA were analyzed with varying degrees of rotator cuff deficiency: (1) baseline, with intact subscapularis, infraspinatus and teres minor, (2) no subscapularis, (3) no subscapularis or infraspinatus, (4) no infraspinatus, and (5) no infraspinatus or teres minor. The supraspinatus was not included in any models, as it is absent in rotator cuff arthropathy. Each model was moved through a prescribed arc of 45° internal/ external rotation originating from neutral. Results: Greater rotator cuff deficiency was associated with more impingement and larger magnitudes of subluxation. The largest subluxation (7.5 mm) and highest impingement-related contact stress (479 MPa) was in the model lacking all rotator cuff muscle groups. Posterior subluxation was present in most models lacking the infraspinatus, while anterior subluxation was present in all models lacking the subscapularis. Conclusions: This study helps clarify how different rotator cuff deficiencies influence shoulder stability following RSA and can ultimately help predict which patients may be at greater risk for impingement-related scapular notching and subluxation. Clinical Relevance: Surgeons should carefully consider the nature of the rotator cuff deficiency and its influence on impingement and instability when planning for RSA.Level of Evidence: V.


Assuntos
Artroplastia do Ombro/métodos , Instabilidade Articular/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Lesões do Manguito Rotador/complicações , Síndrome de Colisão do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Artropatias/etiologia , Artropatias/cirurgia , Instabilidade Articular/fisiopatologia , Pontuação de Propensão , Medição de Risco , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia
13.
Iowa Orthop J ; 39(1): 69-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413677

RESUMO

Background: Shoulder arthroplasty has been shown to improve function in patients with advanced shoulder disease. However, the response to surgery and final outcomes are not easily predictable. This study assessed the effect of residual pain, age, sex, diabetes, hypertension, and depression on changes and status at one-year following arthroplasty with respect to shoulder function and overall physical and mental health status. Methods: A retrospective analysis of a prospective cohort of 140 patients tested preoperatively and one-year following shoulder arthroplasty was conducted at our tertiary hospital. Pearson's correlations and multiple regression analysis were performed to test the impact of predictors on shoulder pain and function assessed using the American Shoulder and Elbow Surgery (ASES) questionnaire, and on physical and mental health assessed using the Short Form-12. Results: Pain and female sex were significant predictors of poorer function at one-year (R = .56, p = .001); and with other predictors, they explained 32% of the variability in function. The explained variability of changes in function scores was 15% with pain being the only significant predictor. Physical health was lower in older patients (r = -.31, p < .05) and was less predictable for physical health change scores (12%) and the physical status at one-year (14%). Conclusions: Residual pain is associated with poorer function status and less clinical benefits. Female sex is not associated with less change in function which suggests that men and women get equal benefit from the surgery. Advanced age relates to poorer physical health and to a lesser extent physical change over the year.Level of Evidence: III.


Assuntos
Artroplastia do Ombro/métodos , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/cirurgia , Dor de Ombro/cirurgia , Inquéritos e Questionários , Adulto , Idoso , Artroplastia do Ombro/efeitos adversos , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/reabilitação , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Articulação do Ombro/fisiopatologia , Dor de Ombro/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
14.
J Shoulder Elbow Surg ; 28(11): 2147-2152, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31405716

RESUMO

BACKGROUND: Tumors may necessitate resection of a substantial portion of the proximal humerus and surrounding soft tissues, making reconstruction challenging. We evaluated outcomes in patients undergoing treatment of tumors of the proximal humerus with reverse total shoulder arthroplasty (rTSA) or shoulder hemiarthroplasty. METHODS: Patients who underwent rTSA (n = 10) or shoulder hemiarthroplasty (n = 37) for tumors of the proximal humerus in 2009 to 2017 were reviewed. Of these patients, 27 had died, leaving 20 for review. The mean follow-up period of the survivors was 27.1 months. They were evaluated clinically and contacted to determine the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and visual analog scale score. RESULTS: Postoperative complications occurred in 13 hemiarthroplasty patients (34%). Tumor recurrence occurred in 3 hemiarthroplasty patients (7.9%), whereas in the rTSA group, 1 patient (10%) had a postoperative complication, with no recurrences. One hemiarthroplasty patient required revision surgery with rTSA to improve shoulder function. Six dislocations and two subluxations occurred in the hemiarthroplasty group, whereas no subluxations occurred in the rTSA group (P = .14). Mean range of motion was 85° of forward flexion for rTSA patients (n = 10) compared with 28° for hemiarthroplasty patients (P < .001). The mean American Shoulder and Elbow Surgeons score was 63 for hemiarthroplasty patients (n = 5) and 59 for rTSA patients (n = 4). The mean Simple Shoulder Test scores were 3.8 and 2.4, respectively. The mean visual analog scale pain scores were 2.4 and 2.5, respectively. CONCLUSION: Reverse total shoulder arthroplasty can reproducibly reconstruct the shoulder in patients requiring oncologic proximal humerus resection. Patients have good outcomes, better range of motion, and no increase in instability rates compared with hemiarthroplasty.


Assuntos
Artroplastia do Ombro/métodos , Neoplasias Ósseas/cirurgia , Hemiartroplastia , Recidiva Local de Neoplasia/etiologia , Articulação do Ombro/fisiopatologia , Idoso , Artroplastia do Ombro/efeitos adversos , Neoplasias Ósseas/patologia , Epífises/cirurgia , Feminino , Seguimentos , Hemiartroplastia/efeitos adversos , Humanos , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Reoperação , Luxação do Ombro/etiologia , Articulação do Ombro/cirurgia , Resultado do Tratamento
15.
J Shoulder Elbow Surg ; 28(10): 2023-2030, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31405717

RESUMO

BACKGROUND: Results of anatomic shoulder arthroplasty for glenohumeral osteoarthritis with severe glenoid retroversion are unpredictable with a high rate of glenoid loosening. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, with good early results. We sought to confirm this at longer follow-up (minimum 5 years). The study hypothesis was that early results would endure over time. METHODS: We retrospectively reviewed all RSAs performed in 7 centers from 1998 to 2010. The inclusion criteria were primary glenohumeral osteoarthritis with B1, B2, B3, or C glenoid. Forty-nine shoulders in 45 patients fulfilled the criteria. Bone grafting was performed in 16 cases. Clinical outcomes were evaluated with the Constant score (CS) and shoulder range of motion. RESULTS: The mean total CS increased from 30 preoperatively to 68 points (P < .001) with significant improvements in all the subsections of the CS and range of motion. Scapular notching was observed in 20 shoulders (43%), grade 1 in 5 (11%), grade 2 in 7 (15%), grade 3 in 5 (11%), and grade 4 in 3 (6%). The glenoid bone graft healed in all the shoulders. Partial inferior lysis of the bone graft was present in 8 cases (50%). Scapular notching and glenoid bone graft resorption had no influence on the CS (P = .147 and P = .798). CONCLUSION: RSA for the treatment of primary glenohumeral osteoarthritis in patients with posterior glenoid deficiency and humeral subluxation without rotator cuff insufficiency resulted in excellent clinical outcomes at a minimum of 5 years of follow-up.


Assuntos
Artroplastia do Ombro/métodos , Cavidade Glenoide/cirurgia , Osteoartrite/cirurgia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Artroplastia do Ombro/efeitos adversos , Transplante Ósseo , Feminino , Seguimentos , Cavidade Glenoide/patologia , Humanos , Masculino , Osteoartrite/complicações , Amplitude de Movimento Articular , Estudos Retrospectivos , Luxação do Ombro/complicações , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
16.
J Shoulder Elbow Surg ; 28(12): e410-e421, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31383411

RESUMO

BACKGROUND: We aimed to demonstrate that supervised machine learning (ML) models can better predict postoperative complications after total shoulder arthroplasty (TSA) than comorbidity indices. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program database was queried from 2005-2017 for TSA cases. Training and validation sets were created by randomly assigning 80% and 20% of the data set. Included variables were age, body mass index (BMI), operative time, smoking status, comorbidities, diagnosis, and preoperative hematocrit and albumin. Complications included any adverse event, transfusion, extended length of stay (>3 days), surgical site infection, return to the operating room, deep vein thrombosis or pulmonary embolism, and readmission. Each SML algorithm was compared with one another and to a baseline model using American Society of Anesthesiologists (ASA) classification. Model strength was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and the positive predictive value (PPV) of complications. RESULTS: We identified a total of 17,119 TSA cases. Mean age, BMI, and length of stay were 69.5 ± 9.6 years, 31.1 ± 6.8, and 2.0 ± 2.2 days. Percentage hematocrit, BMI, and operative time were of highest importance in outcome prediction. SML algorithms outperformed ASA classification models for predicting any adverse event (71.0% vs. 63.0%), transfusion (77.0% vs. 64.0%), extended length of stay (68.0% vs. 60.0%), surgical site infection (65.0% vs. 58.0%), return to the operating room (59.0% vs. 54.0%), and readmission (64.0% vs. 58.0%). SML algorithms demonstrated the greatest PPV for any adverse event (62.5%), extended length of stay (61.4%), transfusion (52.2%), and readmission (10.1%). ASA classification had a 0.0% PPV for complications. CONCLUSION: With continued validation, intelligent models could calculate patient-specific risk for complications to adjust perioperative care and site of surgery.


Assuntos
Artroplastia do Ombro/efeitos adversos , Complicações Pós-Operatórias/etiologia , Aprendizado de Máquina Supervisionado , Fatores Etários , Idoso , Transfusão de Sangue/estatística & dados numéricos , Índice de Massa Corporal , Comorbidade , Bases de Dados Factuais , Feminino , Previsões/métodos , Hematócrito , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Curva ROC , Reoperação/estatística & dados numéricos , Albumina Sérica/metabolismo , Fumar
17.
J Shoulder Elbow Surg ; 28(12): 2447-2456, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31402204

RESUMO

BACKGROUND: Reverse total shoulder arthroplasty (RSA) with glenoid bone grafting has become a common option for management of glenoid bone loss associated with glenohumeral osteoarthritis. The objectives of this review were to determine (1) the rate of graft union, (2) the revision and complication rates, and (3) functional outcomes following primary RSA with glenoid bone grafting. METHODS: A comprehensive search of the MEDLINE, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was completed for studies reporting clinical outcomes following primary RSA with glenoid bone grafting. Pooled and frequency-weighted means were calculated where applicable. RESULTS: Overall, 11 studies and 393 patients were included in the study. The mean patient age was 73 ± 2.2 years, and the mean follow-up period was 34 ± 10 months. The overall graft union rate was 95%, but the rate was 97% among cases using autograft bone (8 studies, n = 254). When stratified by technique, concentric bone grafts had a 100% union rate (4 studies, n = 139). Conversely, eccentric grafts had an overall union rate of 92% (7 studies, n = 240), which improved to 94% when using autograft bone (4 studies, n = 115). At final follow-up, the revision rate was 2%, the complication rate was 18%, and there was consistent improvement in range of motion and functional outcome scores. CONCLUSION: Glenoid bone grafting during primary RSA results in excellent early-term clinical outcomes, low complication and revision rates, and high rates of graft union.


Assuntos
Artroplastia do Ombro/métodos , Transplante Ósseo/métodos , Cavidade Glenoide/cirurgia , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Transplante Ósseo/efeitos adversos , Humanos , Osteoartrite/cirurgia , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Reoperação , Articulação do Ombro/fisiopatologia , Transplante Autólogo , Transplante Homólogo
18.
J Am Acad Orthop Surg ; 27(16): e734-e742, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31283541

RESUMO

INTRODUCTION: Preoperative opioid use has recently been associated with increased perioperative pain. This study evaluates the effect of preoperative opioid use on postoperative pain and duration of opioid use after total shoulder arthroplasty (TSA). METHODS: We retrospectively identified 138 TSAs (69.1% reverse and 30.9% anatomic) between January 2013 and April 2017 that met inclusion criteria. Patients were stratified into two groups based on opioid usage within the 4 weeks before surgery. Primary outcome was resting pain at 3 months postoperatively using a 10-point numerical rating scale system. Duration of postoperative opioid consumption was also recorded and compared between cohorts. RESULTS: The opioid cohort (n = 50) reported significantly greater resting pain and pain with activity at 3 months postoperatively, at which time the reported numerical rating scale pain scores were 1.6 and 2.8 points greater in the opioid cohort compared with the non-opioid cohort (P < 0.001). Preoperative opioid use strongly predicted postoperative opioid use at all follow-up time points (P < 0.0001). DISCUSSION: Preoperative opioid consumption is associated with higher pain and increased duration of opioid use after TSA.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Ombro/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
19.
J Shoulder Elbow Surg ; 28(12): 2301-2307, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31311751

RESUMO

BACKGROUND: The impact of scapula notching on reverse total shoulder arthroplasty (rTSA) clinical outcomes is controversial. The purpose of this study was to conduct a sufficiently statistically powered analysis to quantify the impact of scapular notching on midterm rTSA outcomes. METHODS: There were 324 rTSA patients with 5 years of minimum follow-up evaluated. Patients were stratified according to the presence of a scapular notch at latest follow-up; radiographs were also assessed at each time point for patients with notching to determine the time for notch grade development. A 2-tailed, unpaired t-test compared preoperative, postoperative, and preoperative to postoperative outcomes between cohorts. RESULTS: There were 324 patients having an average follow-up of 75.1 months assessed; 47 (14.5%) patients had scapular notching. For scapular notching patients, the average notching grade was 1.7 ± 0.8 (24 grade 1, 15 grade 2, and 8 grade 3). The average time to notch development was 51.4 ± 24.1 months; grade 1, grade 2, and grade 3 notches developed at 49.0 ± 22.1 months, 57.5 ± 22.6 months, and 71.6 ± 15.8 months, respectively. No preoperative differences were observed between cohorts. At latest follow-up, scapular notching patients had significantly worse outcome scores and significantly less active abduction, forward flexion, and strength. Finally, scapular notching patients had significantly more complications, revisions, and humeral radiolucent lines. CONCLUSIONS: Scapular notching patients had significantly worse clinical outcomes and less range of motion than patients without scapular notching; these differences exceeded the minimal clinically important difference threshold for several outcome metrics. Based on these results, we recommend minimizing scapular notching through patient and implant selection and technique modification.


Assuntos
Artroplastia do Ombro , Escápula/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Complicações Pós-Operatórias/etiologia , Radiografia , Amplitude de Movimento Articular , Escápula/patologia , Escápula/cirurgia , Articulação do Ombro/cirurgia , Fatores de Tempo , Resultado do Tratamento
20.
Trials ; 20(1): 427, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300025

RESUMO

BACKGROUND: Stemless shoulder arthroplasty systems with uncemented metaphyseal fixation have been used for glenohumeral osteoarthritis since 2004 (Hawi, et al. BMC Musculoskelet Disord 17:376, 2016). The stemless design has several theoretical advantages compared with the stemmed shoulder arthroplasty systems: restoring patients' anatomy; preserving humeral bone stock; and few complications in component removal if the need for a revision arthroplasty arises. The purpose of the study is to compare the short-term, patient-reported outcome of stemless and stemmed total shoulder arthroplasty (TSA). MATERIALS AND METHODS: A randomized clinical trial will be conducted. Eighty patients with clinical and radiological signs of primary or post-traumatic glenohumeral osteoarthritis, computed tomography (CT) scan-verified adequate glenoid bone stock, and no total rupture of rotator cuff tendons verified by a magnetic resonance imaging (MRI) scan will be randomly allocated to a stemless or stemmed TSA. The primary outcome will be the Western Ontario Osteoarthritis Shoulder (WOOS) score at 12 months. Secondary outcomes are the WOOS score at three months and the Oxford Shoulder Score (OSS) and EQ-5D at 3 and 12 months. All complications, including glenoid and humeral component loosening, instability, rotator cuff tear, intraoperative and postoperative periprosthetic fracture, nerve injury, infection, deltoid injury, and symptomatic deep venous thrombosis, will be reported. DISCUSSION: Findings will provide patients with better information about the potential benefits and harms of stemless and stemmed TSA and will assist shoulder surgeons and patients in decision-making. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03877315 . Registered on 13 March 2019.


Assuntos
Artroplastia do Ombro/instrumentação , Osteoartrite/cirurgia , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Articulação do Ombro/cirurgia , Prótese de Ombro , Artroplastia do Ombro/efeitos adversos , Fenômenos Biomecânicos , Dinamarca , Avaliação da Deficiência , Humanos , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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