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ABSTRACT: It is unclear whether repaired rotator cuffs heal in older patients and whether the function in those shoulders compares with those of similarly aged patients with untreated tears.
We questioned whether, in patients 65 years of age and older, shoulders with rotator cuff repairs that remained intact would have Simple Shoulder Test (SST) scores and Constant scores similar to those of untreated individuals with intact rotator cuffs.
We retrospectively reviewed 39 patients (42 shoulders) 65 years of age and older in whom 42 full-thickness rotator cuff tears were repaired with a mini open technique. All patients completed SST and Constant scores 12 to 60 months postoperatively; all patients also had ultrasound at those times to assess the status of the repair. These findings were compared with 200 untreated similarly aged shoulders assessed in the same fashion.
Shoulders with healed repairs (33 of 42) had similar mean SST scores and Constant scores to those in untreated shoulders with intact rotator cuffs. Those with healed repairs also had higher SST and Constant scores than those with unhealed repairs. Finally, shoulders with healed repairs had higher SST and Constant scores than those with untreated tears.
When rotator cuffs healed the function was comparable to that of similarly-aged patients without tears and better than that of patients with untreated tears.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 09/2009; 468(6):1521-5. · 2.53 Impact Factor
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ABSTRACT: Total shoulder arthroplasties (TSA) are being performed more commonly for treatment of arthritis, although fewer than either hip (THA) or knee (TKA) arthroplasties. Total shoulder arthroplasty also provides general health improvements that are comparable to THA. One study suggests TSAs are associated with lower morbidity and mortality than THAs and TKAs. To confirm and extend that study, we therefore examined the association of patient characteristics (sociodemographics, comorbid illness, and other risk factors) with 30-day complications for patients undergoing TSAs, THAs, or TKAs. We used data from the Veterans Administration (VA) National Surgical Quality Improvement Program (NSQIP) for fiscal years 1999 to 2006. Sociodemographics, comorbidities, health behaviors, operative factors, and complications (mortality, return to the operating room, readmission within 14 days, cardiovascular events, and infections) were available for 10,407 THAs, 23,042 TKAs, and 793 TSAs. Sociodemographic features were comparable among groups. The mean operative time was greater for TSAs (3.0 hours) than for TKAs (2.2 hours) and THAs (2.4 hours). The 30-day mortality rates were 1.2%, 1.1%, and 0.4% for THAs, TKAs, and TSAs, respectively. The corresponding postoperative complication rates were 7.6%, 6.8%, and 2.8%. Adjusting for multiple risk factors, complications, readmissions, and postoperative stays were less for TSAs versus THAs and TKAs. In a VA population, TSAs required more operative time but resulted in shorter stays, fewer complications, and fewer readmissions than THAs and TKAs. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 08/2009; 468(3):717-22. · 2.53 Impact Factor
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ABSTRACT: The objective was to determine whether arm and radiographic beam positional changes affect the acromiohumeral interval (AHI) in radiographs of healthy shoulders.
Controlling for participant's height and position as well as radiographic beam height and angle, from 30 right shoulders of right-handed males without shoulder problems four antero-posterior (AP) radiographic views each were obtained in defined positions. Three independent, blinded physicians measured the AHI to the nearest millimeter in 120 randomized radiographs. Mean differences between measurements were calculated, along with a 95% confidence interval.
Controlling for observer effect, there was a significant difference between AHI measurements on different views (p< 0.01). All pair-wise differences were statistically significant after adjusting for multiple comparisons (all p values<0.01).
Even in healthy shoulders, small changes in arm position and radiographic beam orientation affect the AHI in radiographs.
Skeletal Radiology 03/2008; 37(6):535-9. · 1.54 Impact Factor
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ABSTRACT: The purpose of this study was to assess the impact of total shoulder arthroplasty on the self-assessed health status of a large series of patients with glenohumeral osteoarthritis. In 91 patients we were able to compare the 8 quantitative domains of Short Form-36 (SF-36) before surgery and at 30 to 60 months after surgery. These preoperative and postoperative scores were compared with data from an age- and gender-matched control population. These results were also compared with those reported for patients who underwent other common, effective surgical procedures. Preoperative SF-36 values were significantly lower than population controls for 6 of 8 SF-36 domains (physical function, social function, physical role function, emotional role function, vitality, and comfort). Patients improved significantly in 4 of 8 SF-36 domains at 30 to 60 months after total shoulder arthroplasty: physical role function (P <.01), comfort (P <.01), social function (P <.01), and mental health (P <.05). Although the improvements were significant and similar to the postoperative scores reported for total hip arthroplasty and coronary bypass procedures, the scores did not reach those of the general population.
Journal of Shoulder and Elbow Surgery 12(2):158-63. · 2.75 Impact Factor
