RESUMEN
BACKGROUND: Posterior humeral subluxation (PHS) in B2 and B3 glenoid is a cause of asymmetric long-term stress on the glenoid and the potential reason for glenoid loosening in anatomic total shoulder arthroplasty and painful glenoid erosion in hemiarthroplasty with metallic heads. We hypothesized that corrective and concentric (C2) reaming of the glenoid associated with pyrocarbon hemiarthroplasty (HA-PYC) could improve the centering of the humeral head and decrease the risk of persistent painful glenoid erosion in young and active patients with B2 and B3 glenoid. METHODS: Between 2014 and 2020, 41shoulders (in 35 patients, mean age of 57.9 years) underwent HA-PYC combined with C2 reaming for B2 (n = 30) or B3 (n = 11) osteoarthritis. Patients were prospectively followed with computed tomography (CT) scans performed preoperatively, immediate postoperatively, and at last follow-up (>2 years). The primary outcomes were 3D-corrected CT scan measurements of glenoid version, PHS, and progression of glenoid erosion. Secondary outcomes included functional outcome scores, return to activities, and revision rate and complications. RESULTS: At a mean follow-up of 4.5 years (2-9.5 years), the prosthesis survival was 95% (39 of 41). No patient has been reoperated for painful glenoid erosion. The mean glenoid retroversion decreased from 17.1° ± 7.5° preoperatively to 8.3° ± 8.2° at last follow-up (P = .001), and the mean PHS from 74% to 56.5% (P = .001) based on the scapular plane and from 59.9% to 50.3% based on the glenoid plane. The humeral head was recentered in 97% according to the glenoid surface and 71% according to the scapular plane. Correction of PHS in the scapular plane was highly correlated to correction of glenoid retroversion (P < .001). CT scan measurements showed that the average total medialization was 3.7 ± 3.2 mm (2.0 ± 1.8 mm due to reaming and only 1.7 ± 2.4 mm due to erosion). The adjusted Constant Score increased from 43% ± 13% to 97% ± 16% and the Subjective Shoulder Value from 38% ± 14% to 84% ± 12% (P < .001). Overall, 84% of active patients returned to work, and all patients returned to sports. CONCLUSION: In B2 and B3 glenoid arthritis, corrective, concentric glenoid reaming combined with HA-PYC improves centering of the humeral head and shows a low risk of painful glenoid erosion at midterm follow-up. The combined procedure results in excellent functional outcomes and high prosthesis survivorship at midterm follow-up. HA-PYC and C2 reaming of the glenoid is an alternative shoulder arthroplasty for young/active patients with type B glenoid osteoarthritis who want to return to work or sports practice.
RESUMEN
Purpose: To determine the rate of complications attributable to the use of screw fixation during the Latarjet procedure and to delineate screw-related complications for open and arthroscopic Latarjet surgery. Methods: A systematic review of the literature was performed by querying MEDLINE and EMBASE computerized databases for relevant articles that reported clinical outcomes associated with the Latarjet procedure. Clinical studies of open and/or arthroscopic Latarjet surgery that employed screw fixation of the coracoid were included in our analysis. Results: From 692 articles identified initially, 32 studies met eligibility criteria. The study cohort comprised 2,758 shoulders, with a mean age of patients ranged from 17 to 62 years, and the mean duration of follow-up ranged from 0.3 to 25.6 years. Twenty-two studies reported outcomes of an open Latarjet technique whereas 10 studies reported on an arthroscopic Latarjet technique. Across all studies, the overall complication rate ranged from 1.4% to 36%. The rate of screw-related complications ranged from 0% to16%, and the rate of screw removal ranged from 0% to 18%. Among the subset of studies that reported specific indications for screw removal, the most common indications were pain and screw loosening. Reported rates of screw-removal among arthroscopic Latarjet procedures range from 0% to 18% and among open procedures range from 0% to 7.3%. Conclusions: (1) Up to one-third of the overall surgical complications associated with the Latarjet procedure may be related to the use of screw fixation, (2) arthroscopic Latarjet procedure did not decrease the rate of screw related complications. The reported rate of screw-removal may be higher after the arthroscopic Latarjet procedures (up to 18%) than after open procedures (up to 7,3%), and is mainly indicated for persistent shoulder pain and/or screw loosening. Level of Evidence: Level IV, systematic review of Level III-IV studies.