-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The purpose of this study was to examine the mid- to long-term functional outcome and implant survival of total shoulder arthroplasty (TSA) in adults aged 55 years or younger with primary glenohumeral arthritis. The hypothesis was that TSA would lead to improvement in functional outcome but that implant survival would decline between 5 years and 10 years postoperatively. MATERIALS AND METHODS: Between 1992 and 2004, 52 TSAs were implanted in 8 centers for primary glenohumeral arthritis in patients aged 55 years or younger. Minimum follow-up of 5 years was available in 50 patients at a mean of 115.5 months postoperatively. Kaplan-Meier survivorship analysis was performed, and clinical outcome was assessed. RESULTS: After TSA, adjusted Constant scores improved from 37.0% to 73.4% and forward flexion improved from 97° to 128° (P < .001). The adjusted Constant score was 80.0 in patients free of revision of the glenoid compared with 43.6 in the group requiring revision of the glenoid (P < .001). Survivorship of the glenoid component with revision surgery for glenoid loosening as the endpoint was 98% (95% confidence interval, 89.4%-100%) at 5 years and 62.5% (95% confidence interval, 40.6%-81.2%) at 10 years. Factors associated with survival of the glenoid included anatomic humeral component positioning and a compaction glenoid preparation technique. CONCLUSIONS: At 5 years' follow-up, TSA leads to improvement in functional outcome and a satisfactory implant survival rate of 98% in young adults with primary glenohumeral arthritis. However, the 10-year survival rate of TSA was only 62.5% in patients aged 55 years or younger at the time of surgery.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 01/2013; · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the prognostic factors and limitations of anatomic unconstrained shoulder arthroplasty, performed without tuberosity osteotomy, for the treatment of secondary glenohumeral arthritis following posttraumatic cephalic collapse or necrosis of the humeral head, defined as type-1 fracture sequelae.
Fifty-five patients with type-1 fracture sequelae treated with anatomic shoulder arthroplasty were included in this retrospective single-center cohort study. All anatomic humeral prostheses were implanted without performing a greater tuberosity osteotomy. Glenoid resurfacing was performed in forty-four patients (80%). Clinical and radiographic analysis was performed at a mean of fifty-two months (range, twenty-four to 180 months) postoperatively.
Four reoperations (7%) were performed, including two revisions in patients who required glenoid resurfacing because of glenoid erosion after hemiarthroplasty. At the time of the latest follow-up, 93% of patients were satisfied or very satisfied, and the mean Subjective Shoulder Value (SSV) was 81%. There were significant improvements in the mean Constant score (from 32 to 69 points), active anterior elevation (from 88° to 141°), external rotation (from 6° to 34°), and internal rotation (from the buttock to L3). Significantly poorer results were associated with proximal humeral deformity in varus and with fatty infiltration of the rotator cuff muscles. Patients with proximal humeral deformity, specifically varus or valgus malunion of the greater tuberosity, had a mean Constant score that was 10 points lower and active elevation that was almost 20° less than patients with no such deformity. The poorest results were observed in patients with varus malunion.
Our study confirmed that the outcomes of anatomic shoulder arthroplasty for the treatment of type-1 fracture sequelae are good and predictable when deformation of the proximal humerus is acceptable(i.e., when no greater tuberosity osteotomy is necessary). The results were negatively affected by proximal humeral varus deformity and by fatty infiltration of the rotator cuff on imaging studies. In such cases, reverse shoulder arthroplasty may be more appropriate, especially in elderly patients.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 12/2012; 94(23):2186-94. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: HYPOTHESIS AND BACKGROUND: Reimplantation of a new glenoid component for symptomatic glenoid failure after total shoulder arthroplasty (TSA) is a well-established surgical strategy. In case of aseptic glenoid loosening or failure, revision of TSA by reimplantation of a cemented glenoid implant would be a reliable therapeutic option. MATERIALS AND METHODS: This retrospective multicenter study included 42 TSAs with symptomatic failed glenoids revised by reimplantation of an all-polyethylene (PE), cemented glenoid component. All patients were reviewed clinically and radiologically, with a mean follow-up of 74 months. RESULTS: The failed initial glenoid component was metal backed in 32 cases and PE cemented in 10. The main cause of glenoid failure was component loosening in 19 cases (46%) and PE wear or dissociation in 23 (54%). Associated complications were very frequent, including rotator cuff tears, subscapularis insufficiency, and prosthesis instability. At last follow-up, 7 patients (17%) had already been re-revised because of symptomatic recurrent glenoid loosening. The overall rate of recurrent glenoid loosening (re-revision plus radiologic loosening) was 67%. Soft-tissue problems and prosthetic instability were significantly associated with recurrent loosening. Of the 10 associated bone grafts performed during the revision procedure, all were partially or totally lysed. At follow-up, the mean Constant score was 57 points (gain of 16 points) and the mean active anterior elevation was 125° (gain of 19°). CONCLUSION: This study suggests that revision of a TSA with reimplantation of an all-PE cemented glenoid component does not solve the problem of glenoid loosening. Soft-tissue failure and prosthetic instability are underestimated preoperatively and may explain, in part, the high rate of recurrent glenoid loosening.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 10/2012; · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Recent studies have reported the theoretic amount of coracoid graft available for harvesting with the Latarjet procedure. Our aim was to investigate the actual dimensions of coracoid grafts harvested using a standardized technique. We also hoped to confirm previous recommendations regarding placement of the inferior glenoid drill hole to avoid lateral overhang of the graft. MATERIALS AND METHODS: Intraoperative measurements were taken after coracoid graft harvesting and preparation during the Latarjet procedure. Specifically, we measured the length of coracoid, thickness of coracoid, distance from the inferior drill hole to the lateral margin of the graft, distance between drill holes, width at the level of the superior drill hole, and width at the level of the inferior drill hole. RESULTS: Data were collected from 76 Latarjet procedures (67 men, 9 women). Patients were an average age of 28.7 years (range 16-67 years). Mean measurements were length of coracoid graft, 26.4 ± 2.9 mm; thickness, 9.3 ± 1.4 mm; distance from the edge of the inferior drill hole to the lateral margin of the graft, 5.7 ± 1.1 mm; distance between drill holes, 7.8 ± 1.9 mm; width at the level of the superior drill hole, 14.1 ± 1.8 mm; and width at the level of the inferior drill hole, 13.3 ± 1.8 mm. CONCLUSIONS: Using a standardized surgical technique that does not violate the coracoclavicular ligaments, a coracoid graft greater than 25 mm can routinely be harvested for the Latarjet procedure. The inferior glenoid drill hole should typically be placed at least 7 mm from the glenoid margin to avoid lateral overhang.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 08/2012; · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Glenohumeral instability is a common problem in young and active patients. Both open and arthroscopic procedures have proven to be effective options. In cases with large bone defects on the glenoid side or on the humeral head or in contact sports, arthroscopy leads to a high risk of recurrence. We report the results of the modified Latarjet procedure in a population of 26 soccer players affected by chronic anterior instability. To our knowledge there are no previous reports on the results of this procedure when used in a homogeneous group of sportsmen. MATERIALS AND METHODS: Twenty-six patients (28 shoulders) were retrospectively reviewed. We analyzed the roles of the players, the levels at which they played, and the average amount of hours that they trained before their injury and after surgery. Moreover, the type of bone loss detected on a preoperative imaging study and its relevance to the patient's sporting comeback was recorded. RESULTS: Eight-five months after surgery the mean Duplay score was 89.3; most of the players came back to the play at the same sporting level. Ninety-three percent of the patients were happy or very happy with their functional results. One patient underwent a redislocation. CONCLUSIONS: Our series is the first in the literature to refer to a homogeneous group of soccer players. According to our results, and other series, the Latarjet procedure seems to be the gold standard in the treatment of chronic anterior instability in patients with large bone defects and in sportsmen playing contact sports.
Journal of Orthopaedics and Traumatology 07/2012;
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Anterior instability in rugby players is characterized by the common finding of a bony lesion, which has been identified as a potential cause of recurrence after soft-tissue reconstruction. The Latarjet-Patte procedure is effective in the treatment of recurrent anterior instability in collision sports such as rugby union. METHODS: We retrospectively assessed 34 rugby players (37 shoulders) stabilized with the Latarjet-Patte procedure. The mean follow-up was 12 years. All patients underwent clinical and radiographic assessment preoperatively and at final follow-up. Functional evaluation was performed with the Walch-Duplay and Rowe scores. A visual analog scale score for the evaluation of pain and the subjective shoulder value were recorded. In addition, all patients completed a questionnaire regarding the return to playing rugby. RESULTS: No recurrence of either dislocation or subluxation occurred. Persistent apprehension on clinical examination was present in 5 patients (14%). A bony lesion of the glenoid was present in 73% and a Hill-Sachs lesion in 68%. Sixty-five percent of the patients returned to playing rugby; only 1 patient did not return to playing rugby because of his shoulder. The mean Walch-Duplay and Rowe scores were 86 and 93 points, respectively. The mean subjective shoulder value was 90%. Radiographic healing of the bone block was observed in 89% of cases. At final follow-up, 11 patients (30%) had minor arthritic changes, with no cases of moderate or severe arthritis. CONCLUSION: The Latarjet-Patte procedure provides a reliable method for stabilizing the shoulder, resulting in a return to playing rugby in a high number of cases without increasing the risk of long-term arthritic degradation.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 05/2012; · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Scapular notching is a common worrying finding after reverse total shoulder arthroplasty (RSA). Eccentric glenospheres have recently been developed in an attempt to prevent notching. The purpose of this study was to evaluate the clinical and radiological results of RSA with an eccentric glenosphere and compare the incidence and the severity of scapular notching using a concentric glenosphere.
A prospective evaluation was performed of 57 consecutive RSA performed over a two-year period. At a minimum of two years postoperatively, 47 RSAs with a mean 30.4 months follow-up were evaluated clinically and radiographically and compared to a historical control group of concentric glenospheres performed by the same surgeon.
The mean Constant score significantly increased (from 32.4 to 71.8) postoperatively (p < 0.0001). Active forward flexion and external rotation also significantly increased (p < 0.0001). Overall, scapular notching was present in 19 shoulders (40.4 %). Grade 1 notching was observed in 13 shoulders (27.7 %), grade 2 in five shoulders (10.6 %), grade 3 in one shoulder (2.1 %), and grade 4 in no shoulders. There was no significant difference in the incidence (p = 0.289) of notching between the eccentric and concentric glenospheres. However, the severity of notching was significantly decreased (p = 0.011) with an eccentric glenosphere. The postoperative Constant score was not significantly different between patients with or without notching (p = 0.651).
A Grammont type RSA with eccentric glenosphere can result in good clinical outcomes. An eccentric glenosphere does not prevent notching, but decreases the severity of scapular notching at early follow-up.
International Orthopaedics 04/2012; 36(8):1647-53. · 2.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Biconcave glenoids in primary osteoarthritis represent a challenge because of the associated static posterior instability of the humeral head and secondary posterior glenoid erosion. This study evaluated the influence of different preoperative radiographic measurements on the outcome of total shoulder arthroplasty (TSA), particularly regarding the development of complications.
We retrospectively evaluated 92 anatomic TSAs performed in 75 patients with primary osteoarthritis and a biconcave glenoid. All patients underwent preoperative imaging with an axial computed tomography arthrogram. Measurements were taken for posterior bone erosion depth and ratio as well as humeral head subluxation. Clinical outcomes were evaluated with the Constant score.
At an average follow up of 77 months (range, 14-180 months), 15 revisions (16.3%) were performed for glenoid loosening (6.5%), posterior instability (5.5%), or soft tissue problems (4.3%). At the final follow-up, the mean Constant score improved significantly from 32.4 to 68.8 points (P = .0001). Subjectively, 66.3% of patients were very satisfied or satisfied. Glenoid loosening was observed in 20.6% and was significantly associated with posterior bone erosion in depth (P = .005) and wear ratio (P = .02), humeral head subluxation (P = .01), and neoglenoid (P = .002) and intermediate glenoid retroversion (P = .001). Dislocation was correlated only with neoglenoid retroversion (P = .01).
Performing TSA in patients with osteoarthritis and biconcave glenoids resulted in acceptable clinical outcomes but a very high rate of complications. We found that the preoperative measurement of the neoglenoid retroversion was best for predicting postoperative complications in terms of glenoid loosening and dislocation.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 03/2012; 21(11):1526-33. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Secondary rotator cuff dysfunction is a recognized complication following shoulder arthroplasty. We hypothesized that the rate of secondary rotator cuff dysfunction would increase with follow-up and result in less satisfactory clinical and radiographic outcomes. Our aim was to investigate the rate of secondary rotator cuff dysfunction following shoulder arthroplasty for primary osteoarthritis and identify factors associated with the dysfunction.
Between 1991 and 2003, in ten European centers, 704 total shoulder arthroplasties were performed for primary glenohumeral osteoarthritis. Complete radiographic and clinical follow-up of more than five years was available for 518 shoulders. The diagnosis of secondary rotator cuff dysfunction was made when moderate or severe superior subluxation of the prosthetic humeral head was present on radiographs. Multivariate logistic regression identified factors associated with the development of rotator cuff dysfunction. Kaplan-Meier survivorship analysis was performed, with the end point being secondary rotator cuff failure. Clinical outcome was assessed with use of the Constant score, a subjective assessment of the shoulder, and an evaluation of shoulder motion.
At an average of 103.6 months (range, sixty to 219 months) after shoulder arthroplasty, the rate of secondary rotator cuff dysfunction was 16.8%. Survivorship free of secondary cuff dysfunction was 100% at five years, 84% at ten years, and 45% at fifteen years. Duration of follow-up (p < 0.0001), implantation of the glenoid implant with superior tilt (p < 0.001), and fatty infiltration of the infraspinatus muscle (p < 0.05) were risk factors for the development of secondary cuff dysfunction. Patients with secondary rotator cuff dysfunction had significantly worse clinical outcomes (Constant score, subjective assessment, and range of motion; p < 0.0001) and radiographic results (radiolucent line score, radiographic loosening, glenoid component migration; p < 0.0001).
In this study, rates of secondary rotator cuff dysfunction with moderate or severe superior subluxation of the prosthetic humeral head increased with the duration of follow-up and significantly influenced the clinical and radiographic outcome of total shoulder arthroplasty performed for primary glenohumeral osteoarthritis. Preoperative fatty infiltration of the infraspinatus muscle and implantation of the glenoid component with superior tilt were prognostic factors.
The Journal of Bone and Joint Surgery 03/2012; 94(8):685-93. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Posterosuperior glenoid impingement (PSGI) is the repetitive impaction of the supraspinatus tendon insertion on the posterosuperior glenoid rim in abduction and external rotation. While we presume the pain is mainly caused by mechanical impingement, this explanation is controversial. If nonoperative treatment fails, arthroscopic débridement of tendinous and labral lesions has been proposed but reportedly does not allow a high rate of return to sports. In 1996, we proposed adding abrasion of the bony posterior rim, or glenoidplasty.
After arthroscopic assessment of internal impingement in abduction-extension-external rotation, extensive posterior labral and partial tendinous tear débridement is performed. Glenoidplasty involves recognition of a posterior glenoid spur and when present subsequent abrasion with a motorized burr.
We retrospectively reviewed 27 throwing athletes treated between 1996 and 2008. Age averaged 27 years. CT arthrogram showed bony changes on the posterior glenoid rim in 21 shoulders. We evaluated 26 of the 27 patients at a minimum followup of 19 months (mean, 47 months; range, 19-123 months).
Eighteen of the 26 patients resumed their former sport level. Six improved but had to change to an inferior sport level or another sport. Two patients did not improve after the procedure, one of whom changed sport practice. There were no complications or posterior instability. In the 15 patients who had radiographs at followup times from 20 to 87 months, we observed no arthritis or osteophyte.
Comparison with an earlier series of soft tissue débridement shows glenoidplasty improves the likelihood of resuming a former sport level in patients with PSGI.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 03/2012; 470(6):1571-8. · 2.53 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The goal of this study was to compare 2 consecutive series of 240 reverse total shoulder arthroplasties (TSA) in order to evaluate if the increase in surgeon experience modified the indications, clinical and radiographic results, and rate of complications.
Two hundred forty reverse TSA performed between July 2003 and March 2007 were clinically and radiographically evaluated by an independent examiner with a minimum follow-up of 2 years and compared with a previous published study (240 cases implanted by the same 2 surgeons between May 1995 and June 2003).
The main etiology remained cuff tear arthropathy with an increase noted between the 2 studies. The rate of revision arthroplasty as an etiology decreased from 22.5% to 9.1%. Conversely, the rate of rheumatoid arthritis increased from 0.4% to 6.3%. The average postoperative Constant score was significantly better than the first series (66.9 vs 59.7, P < .001). The postoperative complication rate decreased with increased experience (from 19% to 10.8%), with dislocations reducing (from 7% to 3.2%), and infections reducing (from 4% to 0.9%). However, the number of nerve palsies increased. The revision rate decreased from 7.5% to 5%. The rate of glenoid notching remained stable, but the severity of notching decreased.
Experience did not lead us to operate on younger patients, but significantly modified patient selection, results, and complications. Increased experience with the reverse shoulder arthroplasty did not reduce the rate of glenoid notching.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 02/2012; 21(11):1470-7. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to radiographically analyze the long-term glenoid migration patterns following total shoulder arthroplasty to better understand the factors responsible for loosening.
Complete radiographic follow-up of more than five years was available for 518 total shoulder arthroplasties performed for primary glenohumeral osteoarthritis with use of an anatomically designed prosthesis with a cemented, all-polyethylene, keeled glenoid component. Radiographs were assessed for humeral head subluxation, periprosthetic radiolucent lines, and shifting of the position of the glenoid component. The type of migration of the glenoid was defined according to the direction of tilt, or as subsidence in the case of medial migration.
Definite radiographic evidence of glenoid loosening was observed in 166 shoulders (32%) and was characterized by radiolucency of ≥2 mm over the entire bone-cement interface in thirty shoulders and by a migration of the glenoid component (shift or subsidence) in 136 shoulders. Three predominant patterns of migration of the glenoid component were observed: superior tilting in fifty-two shoulders (10%), subsidence in forty-one shoulders (7.9%), and posterior tilting in thirty-three shoulders (6.4%). Superior tilting of the glenoid was associated with three risk factors: low positioning of the glenoid component, superior tilt of the glenoid component on the immediate postoperative coronal plane radiographs, and superior subluxation of the humeral head (p < 0.05 for all). Subsidence of the glenoid component was associated with the use of reaming to optimize the seating and positioning of the glenoid component (p < 0.001). Posterior tilting of the glenoid component was associated with preoperative posterior subluxation (i.e., a Walch type-B glenoid) and with excessive reaming (p < 0.01 for both).
The three patterns of migration observed in this study underscore the potential importance of the supporting bone beneath the glenoid component. In some shoulders, use of a keel or pegs to provide fixation of a polyethylene component in the absence of good support from subchondral bone may not be sufficient to resist compressive and eccentric forces, resulting in loosening. Preserving subchondral bone may be important for long-term longevity of the glenoid component.
The Journal of Bone and Joint Surgery 01/2012; 94(2):145-50. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Reverse total shoulder arthroplasty was developed in the late 1980s for elderly patients with rotator cuff arthropathy. Several biomechanical advantages of the reverse shoulder arthroplasty result in improved deltoid function, which improves shoulder motion and function compared to other types of shoulder arthroplasty. The main indication for the reverse prosthesis is painful rotator cuff tear arthropathy. The indications for reverse shoulder arthroplasty have continued to expand since it was first performed in the United States in 2004. Although the results of reverse total shoulder arthroplasty have been generally favorable, the complication rate is higher than that of conventional total shoulder arthroplasty. Complications include those common to other shoulder procedures (infection, instability, and nerve injury) and those unique to reverse total shoulder arthroplasty (scapular notching, glenoid baseplate failure, component disassociation, and scapular stress fractures). It is helpful for orthopaedic surgeons to understand ways to avoid these complications and methods with which to treat them.
Instructional course lectures 01/2012; 61:157-68.
-
[show abstract]
[hide abstract]
ABSTRACT: The reverse shoulder arthroplasty emerged as a potential solution for those patients who could not be managed effectively with a conventional total shoulder arthroplasty. Grammont revolutionized the design by medializing and distalizing the center of rotation and utilizing a large convex glenoid surface and concave humeral component with a neck-shaft angle of 155°. This design has been highly successful in cuff deficient shoulders, and indications continue to broaden. Many mid-term studies have improved upon the early encouraging results. Long-term studies are starting to emerge, demonstrating good survivorship, but progressive functional and radiographic deterioration continue to be concerning. Careful patient selection and attention to appropriate technique are required to reduce the current high rate of complications. New prosthesis designs are continuing to develop to address some of these limitations.
Current Reviews in Musculoskeletal Medicine 12/2011; 4(4):183-90.
-
[show abstract]
[hide abstract]
ABSTRACT: Aseptic glenoid component loosening remains a common problem in total shoulder arthroplasty (TSA). This study presents long-term prospective follow-up of 2 cemented all-polyethylene glenoid components with different backside design geometry and the effect on the presence and progression of radiolucent lines (RLLs).
Fifty-six TSAs were performed for primary osteoarthritis. Two surgeons used an identical technique to implant 32 flat-back and 24 convex-back glenoids. In particular, the glenoid components were cemented after a minimal reaming and bone compaction. Standardized postoperative radiologic and clinical follow-up was at 2 and 10 years. Three independent observers evaluated the x-ray images for RLLs around the base plate and keel. The results were analyzed for progression and influencing factors.
At 10 years, progression of RLL was seen in both components, but there was no difference between the 2 glenoid designs (P = .16). Younger patient age (P = .03), hand dominance (P = .017), and presence of early RLLs (P = .018) were significant factors for progression of RLLs. Constant scores deteriorated with progression of RLLs (P = .006). The glenoid revision rate at 10 years was 5%.
At 10 years there was no difference in the presence or progression of RRLs between a flat-back and a convex-back glenoid all-polyethylene design. Young age, hand dominance, and poor implantation technique influence glenoid RLLs and affect the clinical result of TSA.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2011; 20(8):1217-23. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our purpose was to evaluate if, in case of aseptic glenoid loosening and failure in anatomical total shoulder arthroplasty (TSA), revision by a reverse shoulder arthroplasty (RSA) is a reliable therapeutic option.
Retrospective multicenter cohort study of 37 consecutive anatomical TSA revised by RSA for aseptic glenoid loosening or failure. The decision to implant a RSA was related to the presence of associated complications: rotator cuff tears (n = 24), subscapularis insufficiency (n = 29), prosthetic instability (n = 13), and glenoid bone deficiency (n = 37). The patients were reviewed clinically and radiographically at a mean follow-up of 47 months (range, 24-104).
Eighty-six percent of the patients were satisfied or very satisfied. The average Constant score increased from 24 to 55 pts (P < .0001) and active anterior elevation from 68° to 121° (P < .0001). Twenty-two of the 29 (76%) associated bone grafts were incorporated in the glenoid. Eight patients (21%) needed a subsequent reoperation because of recurrent or new complications: glenoid loosening (n = 3), prosthetic anterior instability (n = 3), and humeral subsidence (n = 2); the reverse prosthesis had to be converted to a hemiarthroplasty in 1 patient and removed in another.
Revision with a RSA is a reliable therapeutic option which provides the double benefit of glenoid bone stock reconstruction by fixing the bone graft with the help of the baseplate and screws and of solving the problem of soft tissue insufficiency and prosthetic instability. However, surgeons should be aware that the rate of postoperative complications and subsequent reoperations is high, and that the surgical technique is demanding.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 10/2011; 21(3):342-9. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Rheumatoid arthritis affecting the shoulder is typically associated with rotator cuff compromise and can also result in severe glenoid erosion. Since reverse shoulder arthroplasty is capable of addressing both rotator cuff disorders and glenoid bone deficiencies, our aim was to evaluate the outcome of reverse shoulder arthroplasty in patients with rheumatoid arthritis and either or both of these associated conditions.
We performed eighteen primary reverse total shoulder arthroplasties in sixteen patients with rheumatoid arthritis involving the shoulder as well as associated rotator cuff compromise and/or severe erosion of the glenoid bone between 2002 and 2007. Patients were assessed with use of the Constant score, patient satisfaction score, subjective shoulder value, range of shoulder motion, and imaging studies.
The mean Constant score improved from 22.5 to 64.9 points at a mean of 3.8 years (range, 2.1 to 7.0 years) postoperatively. The patients were either very satisfied or satisfied with the outcome of the surgery in seventeen of the eighteen shoulders. The mean subjective shoulder value was 68.6% postoperatively. Active forward elevation improved from 77.5° to 138.6°, and external rotation with the arm in 90° of abduction improved from 16.9° to 46.1°. The mean Constant score improved from 28.0 points to 74.3 points in shoulders in which the teres minor muscle was normal before the surgery, and it improved from 20.8 to 54.6 points in shoulders with an atrophic teres minor muscle. Scapular notching was observed in ten of the eighteen shoulders. A fracture involving the acromion, acromial spine, coracoid, or greater tuberosity was observed either intraoperatively or postoperatively in four of the eighteen shoulders. One case of transient axillary nerve injury was noted. There were no cases of dislocation, infection, or component loosening. None of the patients required revision surgery for any reason.
Comparatively good outcomes were observed in the short to intermediate term after reverse shoulder arthroplasty in patients with rheumatoid arthritis. However, surgeons should be aware of the risk of intraoperative and postoperative fractures in this patient group.
The Journal of Bone and Joint Surgery 10/2011; 93(20):1915-23. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Posterior glenoid augmentation with a bone graft is sometimes required in the management of posterior shoulder instability. We describe a new arthroscopic technique that consists of passing the graft through an anatomic portal: the rotator interval. This approach diminishes the damage on posterior structures. We believe that this less invasive approach might allow earlier motion recovery and reduce the complications related to an extensive or blind posterior approach.
Clinical relevance: New technique relevant to arthroscopic management of posterior glenohumeral instability.
Techniques in Shoulder and Elbow Surgery 08/2011; 12(3):67–71.
-
[show abstract]
[hide abstract]
ABSTRACT: Reverse shoulder arthroplasty (RSA) can improve anterior active elevation (AAE) by lengthening of the deltoid and hence increasing its lever arm. However, evaluations of functional outcomes of RSA have shown variable improvements in the range of motion. The aim of our study was to correlate humeral and arm lengthening to postoperative AAE.
We reviewed 183 RSAs with a minimum follow-up of 1 year. Lengthening of the humerus and the arm was evaluated in relation to the contralateral side.
We observed mean humeral lengthening of 0.2 ± 1.4 cm (range, -4.7 to +5.2 cm) and mean arm lengthening of 1.6 ± 1.9 cm (range, -5.1 to +5.4 cm). Postoperative AAE was 140° ± 27° (range, 30° to 180°). We found no significant correlation between lengthening or shortening of the humerus and AAE (P = .169). Shortening of the arm led to a mean AAE value of 122°; lengthening of 0 and 1 cm, mean AAE of 140°; lengthening of greater than 1 cm to 2.5 cm, mean AAE of 144°; and lengthening of greater than 2.5 cm, mean AAE of 147°. When we compared patients with lengthening of the arm and those with shortening, the postoperative AAE was significantly greater after arm lengthening, 145° versus 122°, with a mean difference of 23° (95% confidence interval, 13° to 33°) (P < .001).
This study shows that shortening of the arm reduced AAE. With respect to arm lengthening, a lengthening threshold was not found. An objective assessment of deltoid lengthening is possible preoperatively, intraoperatively, and postoperatively, and this measure seems to correlate with the functional outcome.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 08/2011; 21(3):336-41. · 1.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although the teres minor has received little attention in the literature compared to the other musculotendinous units of the rotator cuff, it is an important component of shoulder function. Our purpose was to study the appearance of the teres minor muscle on CT and MRI images in various patterns of rotator cuff tears.
We analyzed the appearance of the teres minor according to the Walch classification (normal, hypertrophic, atrophic, or absent) in 1,332 CT and in 240 MRI images of rotator cuff tears and we correlated it with the type of rotator cuff tears, time period between initial onset of symptoms and diagnostic imaging, age of the patient at the time of imaging, and degree of fatty infiltration of other rotator cuff muscles.
The teres minor was classified as normal in 90.8% of cases, hypertrophic in 5.8%, atrophic in 3.2%, and absent in 0.2%. Significant variability existed in the appearance of the teres minor muscle among different patterns of rotator cuff tears in the CT (P < 0.0001) and MRI groups (P < 0.0001). The teres minor appeared most frequently hypertrophic in anterior tears and atrophic in posterior-superior tears.
The teres minor was normal in most rotator cuff tears. A morphologic classification system allowed the appearance of the teres minor to be defined in isolated and multiple rotator cuff tears in CT and MRI images.
Skeletal Radiology 05/2011; 40(10):1335-44. · 1.54 Impact Factor
