RESUMO
BACKGROUND: It is unclear whether hemiarthroplasty (HA) or reverse shoulder arthroplasty (RS) are superior for patients with cuff tear arthropathy (CTA) and preserved preoperative motion (elevation >90Ë). METHODS: This was a retrospective, single institution study. Patients who underwent RSA or HA for CTA were included if they had preserved preoperative motion with a minimum of 2 years of follow-up, or until complication/revision. Shoulder ROM and functional outcomes scores were obtained. RESULTS: Twenty-six HAs and 21 RSAs were evaluated at mean of 38.6 months (HA) and 36.3 months (RSA). Patients in the RSA group were significantly older at surgery (73.9 versus 65.1 years; P=0.003). Postoperatively, the mean change in active elevation was -15° for HA versus 26° for RSA, with RSA having significantly greater active elevation (153° versus 123°; P=0.01). There were no significant differences in final internal or external rotation between groups. Superior outcomes were seen for RSA versus HA for ASES score (84 vs. 66, P=0.003), Simple Shoulder Test (8.8 vs. 7.3, P=0.3), Single Assessment Numeric Evaluation (85 vs. 70, P=0.017), and 100mm VAS pain (7 vs. 33, P<0.001). CONCLUSION: In patients with CTA and preserved preoperative forward elevation, RSA provided greater pain relief, superior functional outcomes, and better ROM compared with HA.
RESUMO
Pseudoaneurysms adjacent to exostoses have been commonly reported in the femoral and popliteal arteries and only rarely in the upper extremity. We describe a case of an 18-year-old man with multiple hereditary exostoses who developed a brachial artery pseudoaneurysm after minor trauma to his right upper arm, adjacent to a known lesion. He was referred to a vascular surgeon who removed the pseudoaneurysm and repaired the artery with a saphenous vein graft. We encourage a high suspicion of vascular injury even after minor trauma when an osteochondroma is adjacent to a vascular structure.