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ABSTRACT: Glenoid loosening is the most common long-term complication occurring after total shoulder replacement. Imprecise cement technique and glenoid preparation may result in early radiolucent glenoid line formation. Early radiolucent lines may indicate inadequate initial fixation, which may contribute to early loosening. Improved cement techniques, refined instrumentation, and glenoid component design all may reduce early radiolucent lines. In our study, postoperative anteroposterior and axillary radiographs were obtained after 68 total shoulder replacements done by one surgeon using either an old free-hand, manual packing technique before November 1998 (n = 28) or a new instrument preparation and pressurization technique since November 1998 (n = 40). Three orthopaedic surgeons blindly reviewed the radiographs for the presence and thickness (mm) of radiolucent lines. The newer instrumented pressurization group had a lower incidence of radiolucent lines than the old manually packed group. In the new subgroup, pegged components had a lower incidence of radiolucent lines than keeled components. The incidence of radiolucent lines seems to be reduced using specially designed instruments, new glenoid designs, and modern cement techniques, which may lead to reduced long-term glenoid loosening. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 07/2005; · 2.53 Impact Factor
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ABSTRACT: Classification of fractures of the greater tuberosity has shown poor reliability, in part as a result of an inability to assess fracture displacement accurately. We used fluoroscopic images of prepositioned osteotomized greater tuberosity fragments in cadavers to determine the accuracy of radiographic interpretation, the interobserver reliability, and the effect that radiographs might have on surgical decision-making.
Twelve osteotomies of the greater tuberosity (three each with 2, 5, 10, and 15 mm of displacement) were created in whole-body cadavers. Six fluoroscopic images (anteroposterior views in external and internal rotation, anteroposterior views in neutral rotation with 15 degrees of cephalic and 15 degrees of caudal tilt, a lateral outlet view, and an axillary view) were made after each osteotomy. Four experienced orthopaedic surgeons measured displacement in millimeters on seventy-two randomized images. Four views in sequence (the anteroposterior view in internal rotation and the outlet view together, then the axillary view, and then the anteroposterior view in external rotation) of each osteotomy pattern were then viewed, and each surgeon was asked whether surgery would be indicated on the basis of each set of images.
No one fluoroscopic view was significantly more accurate than another. There was a trend toward increased accuracy of imaging of minimally displaced (</=5 mm) tuberosity fragments with the anteroposterior view in external rotation. When viewed sequentially, the anteroposterior view in external rotation, evaluated last, altered treatment in nine of forty-eight situations. There was substantial agreement (kappa = 0.71) among the surgeons with respect to their recommendations for treatment of the displaced greater tuberosities after they had inspected the four images.
To our knowledge, we are the first to examine the accuracy and reliability of interpreting images of known displacements of the greater tuberosity. Multiple radiographic views are needed to evaluate displacement of the greater tuberosity appropriately. The anteroposterior view in external rotation can profile the greater tuberosity and help demonstrate small displacements. Treatment decisions should be consistent between surgeons when multiple views are used.
The Journal of Bone and Joint Surgery 01/2005; 87(1):58-65. · 3.27 Impact Factor
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ABSTRACT: Many causes of suprascapular nerve entrapment have been described including a small spinoglenoid notch, a tight ligament, boney spurs, and ganglion cysts. In the current patient, suprascapular nerve entrapment was caused by a lipoma in the suprascapular notch. The patient presented with painful shoulder motion that could have been attributed to rotator cuff and acromioclavicular joint disease. However, magnetic resonance imaging and electromyography were consistent with suprascapular nerve entrapment. Treatment of the rotator cuff disease and excision of the lipoma led to resolution of the patient's symptoms. This case is presented as an unusual cause of suprascapular nerve entrapment with a review of its course and anatomy.
Clinical Orthopaedics and Related Research 07/2003; · 2.53 Impact Factor
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ABSTRACT: A retrospective review was conducted on 12 patients (mean age, 63 years) undergoing replacement arthroplasty with calcar grafting for humeral surgical neck nonunions. Patients were evaluated preoperatively for pain and range of motion and postoperatively by use of the American Shoulder and Elbow Surgeons and Constant scores. Indications included severe pain, disability, humeral head destruction, and inadequate bone stock. Nine patients were available for a mean of 69 months' follow-up. Eight underwent humeral head replacement, and one underwent total shoulder replacement. None required greater tuberosity osteotomy. Previously, open reduction-internal fixation had failed in 2 and closed reduction and percutaneous pinning had failed in 1. Calcar grafts were incorporated in 7 of 9 patients. Postoperative pain was absent in 7 and mild in 2. Mean active forward elevation improved by 64 degrees . Mean active external rotation improved by 45 degrees . Postoperatively, American Shoulder and Elbow Surgeons scores averaged 80 and Constant scores averaged 64. Replacement arthroplasty with calcar grafting is a reliable treatment option for surgical neck nonunions.
Journal of Shoulder and Elbow Surgery 15(1):12-8. · 2.75 Impact Factor
