Lateralized vs. classic Grammont-style reverse shoulder arthroplasty for cuff deficiency Hamada stage 1-3: does the design make a difference?

BACKGROUND: Reverse shoulder arthroplasty (RSA) with a lateralized design is thought to improve outcomes. Our aim was to compare RSA with the classic Grammont prosthesis against a prosthesis with 135° inclination and a lateralized glenosphere for cuff-deficient shoulders. METHODS: Patients with irreparable massive posterosuperior rotator cuff tear Hamada grade 1-3 underwent RSA and were documented prospectively up to 24 months postsurgery. Comparative RSA groups were "lateralized" (L), with 135° humeral inclination and 36+4-mm lateralized glenosphere (n = 44), and "Grammont" (G), with 155° humeral inclination and 36+2-mm eccentric glenosphere (n = 23). Range of motion including the Apley scratch test, abduction strength, Constant-Murley score (CS), and Shoulder Pain and Disability Index (SPADI) were assessed. Anteroposterior and axial radiographs were evaluated at 24 months, and additional measurements of scapular neck and glenoid anatomy, baseplate and glenosphere position, center of rotation, humeral offset, and lateralization and distalization shoulder angles were made. Linear regression and mixed models adjusted for sex differences and preoperative values were applied. RESULTS: Overall CS and SPADI outcomes were not significantly different between groups (P ≥ .654). For group L, external rotation remained stable up to the 2-year follow-up and was higher than for group G (P = .012 ); a greater proportion of group L patients could reach the lumbar vertebra 3 (L3) (70% vs. 48% in group G) (P = .26). Group G had a higher inferior glenosphere overhang (P = .020) and center of rotation (COR) medialization (P < .001), whereas group L had higher humeral offset (P < .001) and lateralization shoulder angle (P < .001) with a trend toward higher baseplate positioning (P = .045). The rate of scapular notching was 2.9 times higher for group G than group L (P = .001). CONCLUSION: RSA with 135° humeral inclination and a lateralized glenosphere shows similar outcome scores as the classic Grammont design but enables better preservation of external rotation and reduces the rate of scapular notching compared with the classic Grammont design in Hamada 1-3 patients with irreparable posterosuperior tears.

Surgical resection of a giant intramuscular lipoma of the biceps brachii: a case report and review of the literature.

Lipomas are frequent benign soft-tissue tumors mainly located in the subcutis. Occasionally, subfascial or inter- or intramuscular lipomas are encountered. This case report describes the surgical management of a very rare giant intramuscular lipoma of the right biceps brachii muscle in a 71-year-old male patient. Preoperative magnetic resonance imaging as well as intraoperative photographs depict the complexity of this case and aid in the discussion about indications for surgery, as management guidelines of these deep-seated tumors are still inconsistent.

Limited reliability of grading scapular notching according to Nerot-Sirveaux on anteroposterior radiographs.

INTRODUCTION: Incidences of scapular notching (SN) in reverse shoulder arthroplasty (RSA) range between 0% and 96%, and controversy remain as to its relevance for patient outcome. We assessed the reliability of scapular notching (SN) grading based on the Sirveaux classification system using anteroposterior radiographs. MATERIALS AND METHODS: 206 RSA procedures with 5-year postoperative anteroposterior shoulder radiographs were classified independently by seven assessors according to Sirveaux (session 1). After a review meeting, three assessors re-classified the radiographs along with quality criteria (session 2). SN grading by the majority of assessors was taken as the reference. Classification interobserver reliability was analyzed using Kappa statistics. RESULTS: The incidence of SN was estimated at 53% and 37% at the first and second sessions, respectively. Interobserver reliability Kappa coefficients resulting from the first and second sessions were 0.27 and 0.43, respectively. Case selection based on radiographic quality criteria did not improve SN grading reliability in the second session. CONCLUSION: Agreement between individual surgeons was low when grading SN in RSA according to Sirveaux using anteroposterior radiographs. Consensus among several assessors may increase reliability in research settings.

[Posttraumatic and postoperative shoulder stiffness : Trauma, rotator cuff reconstruction, instability operations and shoulder arthroplasty]. / Posttraumatische und postoperative Schultersteife : Trauma, Rotatorenmanschettenrekonstruktion, Instabilitätsoperationen und Arthroplastik.

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.

Simultaneous Posterior Shoulder Dislocation and Acromioclavicular Joint Separation: Single-Stage Arthroscopic Treatment of Combined Injuries: A Case Report.

CASE: We report on a patient who received arthroscopic treatment after a unique traumatic combined injury comprising a posterior shoulder dislocation with posterior labrum damage, a reverse Hill-Sachs lesion, and a concomitant Rockwood type-V acromioclavicular joint dislocation. CONCLUSION: Arthroscopy was applied to address all pathologies in a single-stage procedure. The outcome of reduced operating and patient recovery time suggests that our intervention is ideal for this specific indication.

Does ORIF of rare scapular spine fractures sustained after reverse shoulder arthroplasty benefit elderly patients? A case-series appraisal.

PURPOSE: Scapular spine fractures sustained after reverse shoulder arthroplasty (RSA) are debilitating for elderly patients with osteoporosis. We examined the 1-year postoperative outcomes of open reduction and internal fixation (ORIF) in a small case-series, and hypothesised that patients undergoing surgical treatment for post-RSA scapular spine fractures would improve in function and pain. METHODS: Five consecutive RSA patients within our shoulder arthroplasty register who sustained a scapular spine fracture underwent ORIF using a double plating technique. Standard radiographs and clinical/patient-rated assessments of Constant-Murley (CS), Shoulder Pain And Disability Index (SPADI), Subjective Shoulder Value (SSV) and visual analogue scale (VAS) pain were made up to 12months post-ORIF. Patients were also asked to rate their satisfaction since the surgery. Post-ORIF complications were documented. All post-RSA data were used as a baseline measure for comparison with post-fracture outcomes. RESULTS: Mean CS, SPADI and SSV scores as well as pain were similar to pre-fracture scores. All patients improved in function and pain, and would undergo the same procedure again. Individual cases of iatrogenic pneumothorax and screw loosening were reported. CONCLUSIONS: ORIF is a viable option with adequate improvements in function and pain for elderly patients with debilitating scapular spine fractures after RSA.

Is labral hypotrophy correlated with increased acetabular depth?

Labral hypertrophy is a distinct feature in hip dysplasia. Occasionally, very small, hypotrophic labra are observed. However, there is no literature concerning this pathology. We investigated if the size of the labrum correlated with any radiologic parameters reflecting the amount of acetabular coverage. It was hypothezised that there is a negative correlation between labrum size and acetabular coverage. Labra were categorized into three groups depending on the relation between length of the articular sided surface and height of bony attachment. Labra with a height:length ratio of 2 were classified as hypotrophic, with a height:length ratio of 1 as normal and with a ratio of 0.5 as hypertrophic. Labral cross-sectional areas (CSA) were measured on radial magnetic resonance imaging-arthrography slices using the measuring tool of the PACS system of 20 hips with hypotrophic labra (group 1), 20 hips with normal labral appearance (group 2) and 10 hips with hypertrophic labra (group 3). These values were then analyzed against following parameters: neck-shaft-angle (NSA), lateral center-edge angle (LCE), acetabular index (AI), femoral extrusion index (FEI) and acetabular retroversion index (ARI). Analyses of variance were used to determine differences in mean values between the three groups. Mean labral CSA differed significantly between all groups (group 1: 12.1 ± 2.9 mm(2); group 2: 25.2 ± 6.2 mm(2); group 3: 41.1 ± 12.3 mm(2); P < 0.001). NSA, LCE, AI and FEI all showed a significant difference between group 3 and 1 or 2. The ARI showed no difference between groups. Stepwise linear regression analyses showed a significant correlation between LCE angle and labral CSA with a corrected R (2)-value of 0.301. Labral CSA correlates with the LCE. No statistically significant difference between groups 1 and 2 concerning the LCE, AI or FEI could be identified. Nevertheless, group 1 had the highest mean coverage of all groups, hips with hypertrophic labra the lowest.