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Arenas-Miquelez A, Barco R, Cabo Cabo FJ, Hachem AI. Management of bone loss in anterior shoulder instability. Bone Joint J 2024; 106-B:1100-1110. [PMID: 39348897 DOI: 10.1302/0301-620x.106b10.bjj-2024-0501.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.
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Affiliation(s)
| | - Raul Barco
- La Paz University Hospital, Madrid, Spain
| | - Francisco J Cabo Cabo
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
| | - Abdul-Ilah Hachem
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
- Shoulder unit, Centro Medico Teknon, Barcelona, Spain
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Marigi EM, Elahi MA, Cancio-Bello AM, Duquin TR, Sperling JW. Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:442-450. [PMID: 37588463 PMCID: PMC10426651 DOI: 10.1016/j.xrrt.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision. Moreover, loading of the metaphyseal region rather than the diaphysial region with traditional stemmed implants can decrease stress shielding. When compared to stemmed-implants, stemless aTSA has demonstrated similar outcomes and complication rates. The purpose of this article is to analyze published outcomes and complications following the utilization of stemless aTSA. Additionally, key aspects of the surgical technique that may promote optimal results in stemless aTSA implantation are presented.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ali Elahi
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Thomas R. Duquin
- Department of Orthopaedics, State University of New York, Buffalo, NY, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Chillemi C, Paglialunga C, De Giorgi G, Proietti R, Carli S, Damo M. Outcome and revision rate of uncemented humeral head resurfacing: Mid-term follow-up study. World J Orthop 2021; 12:403-411. [PMID: 34189078 PMCID: PMC8223723 DOI: 10.5312/wjo.v12.i6.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/15/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Glenohumeral osteoarthritis (OA) is a common cause of pain and disability affecting nearly a third of the world’s population over 60 years of age. As in other joints, shoulder arthroplasty appears to be the most effective treatment. The implant design has evolved during time transitioning to shorter humeral stem lengths or even stemless components.
AIM To evaluate the medium-term outcome and survival of a cementless humeral head resurfacing (HHR) in a group of patients affected with OA or avascular necrosis.
METHODS This is a retrospective study of prospectively collected data using HHR in 23 patients (15 female and 8 male) after a 7.4 year follow-up. The collected data included clinical and radiographical evaluation. The Constant score, the visual analogue scale, and a clinical evaluation of range of motion were registered pre- and postoperatively. Fifteen patients affected with OA (2 cases of mild, 6 moderate, and 7 severe) and 10 with avascular necrosis (stage III according to Cruess classification) were enrolled. X-rays were evaluated to detect loosening signs, degenerative changes, and superior humeral head migration. Magnetic resonance preoperatively was also performed to assess the rotator cuff status. Tendon integrity was mandatory to implant the HHR.
RESULTS In total, 19 patients (21 shoulders) completed the follow-up. Data on 4 shoulders, in 4 patients, were lost because of prosthesis failure. The global revision rate was 16%. A statistically significant improvement in the mean Constant score, visual analogue scale, and range of motion have been reported. No signs of loosening were registered, while in 12 cases a glenoid erosion was found. The osteophytes appeared 7 times on the humeral side and 12 on the glenoid. Superior humeral migration was recorded in only 1 case.
CONCLUSION HHR remains a reasonable option in patients with an intact rotator cuff for the treatment of OA and avascular necrosis.
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Affiliation(s)
- Claudio Chillemi
- Department of Orthopaedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico, Latina 04100, Lazio, Italy
| | - Carlo Paglialunga
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Greta De Giorgi
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Riccardo Proietti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Stefano Carli
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
| | - Marco Damo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, ICOT, Latina 04100, Lazio, Italy
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Geervliet PC, Willems JH, Sierevelt IN, Visser CPJ, van Noort A. Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure. J Orthop Surg Res 2019; 14:474. [PMID: 31888675 PMCID: PMC6936124 DOI: 10.1186/s13018-019-1522-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Literature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure. METHODS Pre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients. RESULTS The inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19-3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure. CONCLUSION The CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm. TRIAL REGISTRATION Institutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.
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Affiliation(s)
- Pieter C. Geervliet
- NoordWest Clinics, Department of Orthopedic Surgery, Shoulder Unit, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands
| | - Jore H. Willems
- NoordWest Clinics, Department of Orthopedic Surgery, Shoulder Unit, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands
| | | | | | - Arthur van Noort
- Spaarne Hospital, Spaarnepoort 1, 2134 TM Hoofddorp, the Netherlands
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Humeral head resurfacing is associated with less pain and clinically equivalent functional outcomes compared with stemmed hemiarthroplasty at mid-term follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:3203-3211. [PMID: 30915512 DOI: 10.1007/s00167-019-05382-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/25/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Humeral head resurfacing (HHR) is a less invasive, anatomic alternative to the conventional stemmed hemiarthroplasty in patients in whom isolated humeral head replacement is preferred. It was hypothesized that, in a mid-term cross-sectional subjective outcome analysis, HHR would have equivalent patient-reported and functional outcomes to stemmed hemiarthroplasty (HA). METHODS A total of 213 HHR and 153 HA procedures were performed at a single academic institution from 2000 to 2014. Of these, 106 HHR and 47 HA patients corresponding with 120 HHR and 55 HA shoulders responded to a survey that collected patient demographics, surgical outcomes, patient satisfaction, and self-reported range of motion scores using both bespoke and validated metrics. RESULTS Follow-up was longer in the HA group (9.4 ± 3.4 vs. 5.2 ± 1.8 years, p < 0.0001). Self-reported range of motion was equivalent between groups. Surgery was perceived as helpful following 76.7% of HHRs and 78.2% of HAs (p > 0.99). The ASES pain subscore was significantly worse in the HA group (25.2 ± 29.5 vs. 38.5 ± 12.7 after HHR, p < 0.0001), which translated into worse ASES total scores (45.1 ± 14.8 HA vs. 52.2 ± 23.7 HHR, p < 0.05). These findings were equivocal in responses received 2-8 years vs. ≥ 8 years after surgery. CONCLUSIONS Indications should be equivocal; humeral head resurfacing is a viable alternative to hemiarthroplasty, with equivalent patient satisfaction and reduced pain in the mid-term post-operative period. LEVEL OF EVIDENCE III.
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Progressive glenoid bone loss caused by erosion in humeral head resurfacing. DER ORTHOPADE 2019; 46:1028-1033. [PMID: 29063146 DOI: 10.1007/s00132-017-3483-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cementless surface replacement of the shoulder represents an alternative to conventional stemmed anatomic prostheses. Glenoid erosion is a well-known complication in hemiarthroplasty. However, there is limited data concerning radiographic evaluation and prognostic factors for this phenomenon. OBJECTIVES The aim of our study was to determine the development of glenoid erosion following shoulder resurfacing using a new measurement technique and detect potential prognostic factors. MATERIALS AND METHODS We performed a retrospective analysis on 38 shoulders undergoing humeral head resurfacing with a mean follow-up of 65.4 ± 43 months. Clinical and radiographic evaluation followed a standardized protocol including pre- and postoperative Constant score, active range of motion, and X‑rays in true anteroposterior view. Three independent observers performed measurements of glenoid erosion. RESULTS We found good interobserver reliability for glenoid erosion measurements (intraclass correlation coefficient [ICC] 0.74-0.78). Progressive glenoid erosion was present in all cases, averaging 5.5 ± 3.9 mm at more than 5 years' follow-up. Male patients demonstrated increased glenoid bone loss within the first 5 years (p < 0.04). The mean Constant score improved to 55.4 ± 23.6 points at the latest follow-up. Younger age was correlated to increased functional outcome. Revision rate due to painful glenoid erosion was 37%. CONCLUSIONS Glenoid erosion can be routinely expected in patients undergoing humeral head resurfacing. Painful glenoid erosion leads to deterioration in functional outcome and necessitates revision surgery in a high percentage of cases.
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Jaiswal A, Malhotra A, Hay S, Kelly CP. Revision shoulder arthroplasty for failed surface replacement hemiarthroplasty. Musculoskelet Surg 2018; 103:69-75. [PMID: 29744735 DOI: 10.1007/s12306-018-0541-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 05/01/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of this study was to assess the reasons of failure of shoulder surface replacement hemiarthroplasty (SRH) and to evaluate the outcome of revision surgery. METHOD The study group included 25 patients (26 shoulders) with failed SRHs. The mean time to revision surgery was 3.6 years. Their functional outcome was evaluated using adjusted Constant-Murley score at mean follow-up of 5.2 years (range 2-16 years). RESULT Most common cause of failure was glenoid erosion (42%) and progressive failure of rotator cuff (31%). Median adjusted Constant-Murley score at mean follow-up of 5.2 years was 51.6. Median adjusted Constant-Murley score in patients who had primary diagnosis of osteoarthritis and had revision performed to anatomic TSA (14 shoulders) was 85 (range 40-100) at mean follow-up of 5 years compared to 36.3 (range 20-66.3) in the remaining patients at 5.4 years, p = 0.00008. CONCLUSION Revision surgery for failed SRH can be technically challenging with variable results. Most common mode of failure was glenoid erosion. Functional outcomes are better in those with revision performed to anatomic TSA.
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Affiliation(s)
- A Jaiswal
- Upper Limb Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
| | - A Malhotra
- Upper Limb Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - S Hay
- Upper Limb Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - C P Kelly
- Upper Limb Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Maier MW, Hetto P, Raiss P, Klotz M, Bülhoff M, Spranz D, Zeifang F. Cementless humeral head resurfacing for degenerative glenohumeral osteoarthritis fails at a high rate. J Orthop 2018; 15:349-353. [PMID: 29881151 DOI: 10.1016/j.jor.2018.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/18/2018] [Accepted: 02/18/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose The aim of the study was to examine clinical and radiographic results of a cementless humeral surface and to evaluate prognostic parameters for implant failure. Methods 34 shoulders were examined preoperatively and after a mean 2.7 years. Radiographic parameters, Constant scores (CS) and complications were recorded. Results The mean CS improved from 27 to 51 points. Eight patients (24%) had an implant revision for secondary glenoid erosion. In the revision group was an increase of the LGHO of 8.4%. Conclusions The study shows a high revision-rate (24%). Predictor for an implant failure was an operative changing of the LGHO.
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Affiliation(s)
- Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Pit Hetto
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Patric Raiss
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Bülhoff
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - David Spranz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Zeifang
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Clinical and radiological results 7 years after Copeland shoulder resurfacing arthroplasty in patients with primary glenohumeral osteoarthritis: an independent multicentre retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:15-22. [PMID: 28776109 DOI: 10.1007/s00590-017-2023-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/27/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this multicentre cohort study was to evaluate the midterm outcomes and survival after cementless stemless resurfacing arthroplasty (CSRA) in a series of 33 shoulders in 27 patients with primary osteoarthritis. METHODS Clinical outcome assessment included: Constant-Murley score (CMS); Simple Shoulder Test (SST); Disability of Arm, Shoulder, Hand (DASH); EuroQol-5D (EQ-5D) utility scores; Numerous Rating Scale (NRS) for pain. Radiographs were assessed by two independent observers for oversizing, radiolucency, glenohumeral subluxation, glenoid erosion and subsidence. Correlations between the clinical and radiological outcomes were calculated. Complications were registered, and revision and survival rates were calculated. RESULTS Mean age at time of surgery and mean follow-up time were, respectively, 67.7 (range 50.2-85.1) and 7.2 years (range 5.7-9.3 years). Means (SD) for CMS, age- and gender-adjusted CMS, SST, DASH and EQ-5D utility scores were: 56.4 (20.2), 76.5 (25.0), 54.0 (29.8), 37.6 (23.3) and 0.8 (0.1), respectively. NRS for pain was 2.0 and 3.8, respectively, in rest and during activities. Radiographic assessment of the CSRAs showed oversizing in 54.5%; radiolucency in 18.2%; superior glenohumeral subluxation in 33.3%; glenoid erosion in 45.5%; and subsidence in 3.0%. Perioperative complications did not occur. Revision surgery was performed in one patient (3.0%). CONCLUSION For primary osteoarthritis, the CSRA showed good clinical but poor radiological outcomes at midterm follow-up.
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Ramhamadany E, Modi CS. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss. World J Orthop 2016; 7:343-354. [PMID: 27335809 PMCID: PMC4911517 DOI: 10.5312/wjo.v7.i6.343] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/16/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023] Open
Abstract
The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures.
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Abstract
This review discusses the evaluation and management of bone loss in glenohumeral instability. The glenohumeral joint may experience a dislocation or subluxation associated with traumatic injury or through repetitive atraumatic events. Nearly 62% of cases with recurrent dislocation have both Hill-Sachs and bony Bankart defects. Treatment of unstable bone defects may require soft-tissue repair, bone grafting, or both, depending on the size and nature of the defects. The most common treatment is isolated soft-tissue repair, leaving the bone defects untreated, although emerging evidence supports directly addressing these bony defects.
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Rasmussen JV, Olsen BS, Sorensen AK, Hróbjartsson A, Brorson S. Resurfacing hemiarthroplasty compared to stemmed hemiarthroplasty for glenohumeral osteoarthritis: a randomised clinical trial. INTERNATIONAL ORTHOPAEDICS 2014; 39:263-9. [PMID: 25159010 DOI: 10.1007/s00264-014-2505-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to conduct a randomised, clinical trial comparing stemmed hemiarthroplasty and resurfacing hemiarthroplasty in the treatment of glenohumeral osteoarthritis. METHODS A total of 40 shoulders (35 patients) were randomised to stemmed hemiarthroplasty or resurfacing hemiarthroplasty and evaluated three and 12 months postoperatively using the Constant-Murley score (CMS) and Western Ontario Osteoarthritis of the Shoulder (WOOS) index. RESULTS There were no statistically significant differences in age, gender or pre-operative scores except for WOOS at baseline. Two patients were lost to follow-up. Significant improvements in CMS and WOOS were observed at one year after both arthroplasty designs. At one year, the mean CMS was 48.9 (range 6-80) after resurfacing hemiarthroplasty and 59.1 (range 0-88) after stemmed hemiarthroplasty {mean difference 10.2 [95 % confidence interval (CI) -3.3 to 23.6], P = 0.14}. The mean WOOS was 59.2 (range 5.2-100.0) and 79.4 (range 12.8-98.6), respectively [mean difference 20.2 (95 % CI 3.4-36.9), P = 0.02]. No major complications occurred and there were no revisions. CONCLUSIONS The effects of resurfacing hemiarthroplasty tended to be inferior to those of stemmed hemiarthroplasty. It is unclear whether this reflects a real difference in effect or baseline differences due to the limited number of randomised patients. We suggest there is a need for a larger, more definitive trial.
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Affiliation(s)
- Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark,
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Rasmussen JV. Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis. Acta Orthop 2014; 85:1-23. [PMID: 24930800 DOI: 10.3109/17453674.2014.922007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.
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Affiliation(s)
- Jeppe V Rasmussen
- Department of Orthopedic Surgery Herlev University Hospital Herlev Ringvej 75, 2730 Herlev Denmark Phone: +45 38381926
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Hwang N, Modi CS, Drew SJ, Turner SM. Mid-term results of Copeland shoulder cementless surface replacement arthroplasty from an independent centre. Shoulder Elbow 2014; 6:75-80. [PMID: 27582918 PMCID: PMC4935077 DOI: 10.1177/1758573213517227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/27/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study reports our experience of Copeland shoulder cementless surface replacement arthroplasty (CSRA) and whether glenoid microfracture influences the progression of glenoid erosion. METHODS One-hundred-and-twelve CSRAs were performed in 101 patients between 2002 and 2007. Eighty-three patients were alive at the median follow-up time of 72 months (range 9 to 121 months; interquartile range 46 to 93 months). Assessment included an Oxford shoulder score (OSS), patient satisfaction score and plain radiographs. RESULTS The mean (range) OSS was 27 (7 to 48) and 64 of 73 (87.7%) patients were 'very satisfied' or 'satisfied' with their shoulder. Twenty-three (20.5%) shoulders had over 2 mm of glenoid erosion. Microfracture was performed in 43 of 112 shoulders (38.4%) and did not influence the progression of glenoid erosion. Further surgery was performed in 27 (24.1%) shoulders, including 15 revisions, eight arthrolyses and four subacromial decompressions. Revision to total shoulder arthroplasty was performed in 14 : 10 for glenoid erosion; one each for loosening, periprosthetic fracture, deep infection, and chronic pain. One was revised to reverse arthroplasty for chronic pain. CONCLUSIONS CSRA performed in an independent centre reproduces the functional outcomes reported by the designer. Glenoid erosion, however, was a common occurrence and the main cause of revision - microfracture did not influence its progression.
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Affiliation(s)
- Nicholas Hwang
- Nicholas Hwang, Warwick Orthopaedics, Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK. Tel.: +44 (0)24 7696 4000. E-mail:
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Jerosch J, Sokkar SM, Neuhaeuser C, Abdelkafy A. Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1075-83. [PMID: 24664451 DOI: 10.1007/s00590-014-1434-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/23/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Humeral resurfacing arthroplasty represents an alternative option to hemiarthroplasty for treatment of cuff tear arthropathy (CTA), with the advantages as follows: suitability for relatively young and high-demand patients because of preservation of bone stock and no loss of length, less invasive surgery, shorter operation time, no risk of periprosthetic stem fractures, and revision surgery can be undertaken easily. In the current study, resurfacing arthroplasty in combination with latissimus dorsi tendon transfer for CTA was performed. Three hypotheses: first, humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer would improve the overall functional outcome in patients with CTA. Second, this combination would improve humeral external rotation. Third, this combination would improve abduction and shoulder elevation. METHODS Study was conducted as an observational case series. Fourteen patients (nine ♀ and five ♂) having CTA were included. Follow-up was carried out at the end of the 28th month for all patients. Constant Score was used for follow-up evaluation. Dorso-axillary approach was used for latissimus dorsi tendon transfer and ventral deltopectoral approach for Copeland resurfacing. Tendons were fixed to the greater tuberosity with two anchors. RESULTS The absolute Constant Score significantly improved from 34 preoperatively to 69 postoperatively, relative Constant Score from 42 to 91%, elevation from 95° to 138°, abduction from 88° to 147°, and external rotation from 16° to 22° (not significant). CONCLUSION Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients having CTA with preserved subscapularis function has satisfactory short-term functional clinical outcome. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Joerg Jerosch
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, AM Hasenberg 46, 41462, Neuss, Germany,
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Iagulli ND, Field LD, Hobgood ER, Hurt JA, Charles R, O'Brien MJ, Savoie FH. Surface Replacement Arthroplasty of the Humeral Head in Young, Active Patients: Midterm Results. Orthop J Sports Med 2014; 2:2325967113519407. [PMID: 26535268 PMCID: PMC4555521 DOI: 10.1177/2325967113519407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The treatment of glenohumeral arthritis in young, active patients remains controversial. Standard total shoulder arthroplasty in this patient group has not obtained the same satisfaction rate as in older patients. One surgical option that has emerged is humeral resurfacing. Hypothesis: Humeral head surface replacement arthroplasty (SRA) would provide satisfactory clinical outcomes in active patients, allowing them to maintain their normal lifestyle without activity restrictions. Study Design: Case series; Level of evidence, 4. Methods: From 2004 to 2007, all consecutive surface replacement arthroplasties of the humerus performed at the authors’ institution were identified and retrospectively reviewed, and 118 patients who underwent SRA during this time were identified. This study included patients younger than 60 years who wished to maintain an active lifestyle; 52 of the 118 patients met the inclusion criteria. University of California at Los Angeles (UCLA) shoulder scores and subjective shoulder value (SSV) scores were used to measure clinical outcomes at an average follow-up of 6 years (range, 4-8 years). Of the 52 patients meeting the inclusion criteria, 48 were contacted and examined for the study, with 4 patients lost to follow-up. Results: The mean postoperative UCLA score was 28.03, with 1 patient requiring revision because of pain and glenoid wear. The mean SSV was 92% (range, 0%-100%), with 3 patients restricting their activity because of the shoulder. Forty-seven of the 48 contacted patients stated that, given the option, they would have the same surgery again. One patient required revision surgery because of pain. Conclusion: Surface replacement arthroplasty provided reasonable results in patients younger than 60 years with high activity demands with a low rate of revision at midterm follow-up.
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Affiliation(s)
- Nicholas D Iagulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Larry D Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA
| | - E Rhett Hobgood
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA
| | - James A Hurt
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. ; Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA
| | - Ryan Charles
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael J O'Brien
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Abstract
BACKGROUND AND PURPOSE Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome. METHODS We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12-44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch. RESULTS Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7-69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small. INTERPRETATION We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior results were found in the presence of increased eccentric preoperative glenoid wear. Total shoulder arthroplasty should be considered in these patients.
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Affiliation(s)
- Tomas Smith
- Shoulder, Knee, and Sports Medicine, Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover, Germany
| | - Andre Gettmann
- Shoulder, Knee, and Sports Medicine, Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover, Germany
| | - Mathias Wellmann
- Shoulder, Knee, and Sports Medicine, Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover, Germany
| | - Frederic Pastor
- Shoulder, Knee, and Sports Medicine, Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover, Germany
| | - Melena Struck
- Shoulder, Knee, and Sports Medicine, Orthopaedic Clinic of Hanover Medical School at the Annastift Hospital, Hanover, Germany
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Outcome of Copeland shoulder resurfacing arthroplasty with a 4-year mean follow-up. J Shoulder Elbow Surg 2013; 22:1352-8. [PMID: 23562291 DOI: 10.1016/j.jse.2013.01.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/16/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Published data on the outcome of Copeland shoulder resurfacing arthroplasty (CSRA) are limited. This observational case series study reports the functional and radiological outcome of CSRA during a mean follow-up of 4 years and highlights the correlation between key outcome measures. METHODS One-hundred two consecutive patients with osteoarthritis (OA-47.1%), rheumatoid arthritis (RA-40.2%), rotator cuff arthropathy (RCA-8.8%), and avascular necrosis (AVN-3.9%) underwent CSRA. The outcome assessment included pain and satisfaction, physical limitation, Oxford Shoulder score (OSS), Constant score (CS), and SF-12. Imaging was reviewed for glenoid morphology (Walch classification) and humeral head (HH) migration. RESULTS Highest patient satisfaction and lowest pain levels were related to the primary pathology with AVN best followed by OA, RA, and with RCA having the poorest outcome. Comparing the two largest groups the CS was significantly higher in OA (61 ± 21.3) than RA (44 ± 20.5). OSS showed a significant correlation with CS and physical subscale of SF-12. Walch type A (67.6%) and HH migration (47%) were the commonest radiographic observations. OSS, CS, pain, and satisfaction were significantly different between migration and nonmigration groups. CONCLUSION The CSRA resulted in satisfactory outcome in many patients. AVN and OA were associated with the best and RCA with the poorest results. The CSRA was associated with glenoid erosion and HH migration particularly in RCA. CSRA remains an option in the treatment of arthritic conditions of the shoulder but its future use may be limited to younger patients where implanting a glenoid may be regarded as problematic.
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Merolla G, Bianchi P, Lollino N, Rossi R, Paladini P, Porcellini G. Clinical and radiographic mid-term outcomes after shoulder resurfacing in patients aged 50 years old or younger. Musculoskelet Surg 2013; 97 Suppl 1:23-29. [PMID: 23588832 DOI: 10.1007/s12306-013-0261-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/03/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE Humeral resurfacing is a treatment option to conventional shoulder arthroplasty, conferring the advantages to preserve the bone stock and the normal joint geometry. Aim of the current study was to report clinical and radiographic mid-term outcomes in a population of 60 patients, aged 50 years or younger, who underwent shoulder resurfacing in osteoarthritis. METHODS The mean age was 48 ± 8.4, 36 were male and 24 female, dominant arm in 43 cases. Glenoid arthritis was treated in 36 cases (60 %) using a meniscus allograft in 22 cases, biologic patch in 4 cases and microfractures in 10 cases. Clinical and radiographic assessment was performed with Constant-Murley score and standard X-ray. RESULTS At an average follow-up of 44 months, the mean values of the constant score increased of 30 points (p < 0.05), the pain decreased of 4.56 points (p < 0.05) and the Simple Shoulder Test increased of 4.3 points (p < 0.05). We found lower scores (p > 0.05) in 9 patients (15 %) treated for glenoid arthritis using homologous meniscus (7 cases) and biologic patch (2 cases). A significant narrowing of joint space (5.92 mm postoperative versus 1.65 mm at 37 months) (p < 0.05) was found in the 22 cases treated with meniscus interposition. In 4 cases with type A2 preoperative glenoid morphology and in 9 cases type B1, we registered significantly lower scores compared with the overall study population (p < 0.01). Five unsatisfied patients (7 %), underwent to meniscus removal and glenoid reaming in 3 cases and conversion in total shoulder arthroplasty in 2 cases. CONCLUSIONS Resurfacing arthroplasty is an effective device in young patients with advanced glenohumeral arthropathy; however, the high rate of postoperative glenoid erosion and the failure of biologic allograft lead us to consider glenoid replacement as the best option to improve clinical outcomes.
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Affiliation(s)
- G Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Via L. Van Beethoven 1, Cattolica, RN, Italy.
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Mansat P, Coutié AS, Bonnevialle N, Rongières M, Mansat M, Bonnevialle P. Resurfacing humeral prosthesis: do we really reconstruct the anatomy? J Shoulder Elbow Surg 2013; 22:612-9. [PMID: 23149276 DOI: 10.1016/j.jse.2012.07.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of a resurfacing shoulder arthroplasty is to reproduce the individual's anatomy while preserving the bone stock of the humeral head. This study investigated the hypothesis that resurfacing the humeral prosthesis restores normal glenohumeral relationships and correlates with the final clinical results. MATERIALS AND METHODS A resurfacing shoulder implant was performed in 61 patients (64 shoulders). Indications were primary osteoarthritis in 26, secondary osteoarthritis in 21, avascular necrosis in 4, rheumatoid arthritis in 4, dysplasia in 4, and for others indications in 5. RESULTS At an average of 36 months (range, 24-65) of follow-up , the Constant score reached 68 points and the Quick-Disabilities of Arm, Shoulder and Hand score reached 28 points. Preoperative and postoperative radiographic analysis showed a decrease of the humeral head diameter (51 ± 5 vs 48 ± 5 mm) and of the height of the humeral head (21 ± 4 vs 19 ± 2 mm), without modification of the radius of curvature or the height of the center of rotation. The medial humeral offset increased from 3.3 ± 3.5 to 6.4 ± 3 mm and the lateral offset from 6.8 ± 9 to 10.4 ± 9 mm. The implant was mainly in varus postoperatively compared with preoperative values (122° ± 11° vs 134° ± 7°). Postoperative radiographic analysis and at the last follow-up did not show any significant difference, except for the increase of the depth of the glenoid from 4.2 ± 1.4 to 4.9 ± 1.8 mm. CONCLUSIONS The resurfacing shoulder arthroplasty reproduces the normal anatomy and compensates glenohumeral wear. However, there was a tendency to position the prosthesis in varus because of technical imperfections. With follow-up, medialization of the humerus with glenoid wear was observed and was correlated in some patients with reappearance of pain.
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Affiliation(s)
- Pierre Mansat
- Orthopedic and Traumatology Department, Centre Hospitalier Universitaire de Toulouse Purpan, Toulouse, France.
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Deladerrière JY, Szymanski C, Vervoort T, Budzik JF, Maynou C. Geometrical analysis results of 42 resurfacing shoulder prostheses: A CT scan study. Orthop Traumatol Surg Res 2012; 98:520-7. [PMID: 22857891 DOI: 10.1016/j.otsr.2012.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/20/2012] [Accepted: 03/19/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shoulder resurfacing arthroplasty was introduced in Scandinavia in the early 1980s then developed by SA Copeland. HYPOTHESIS Resurfacing prostheses restore the normal anatomy of the proximal humerus. Here, our objective was to evaluate humeral resurfacing prosthesis position on radiographs and computed tomography (CT) images. MATERIALS AND METHODS We retrospectively reviewed 42 consecutive cases seen at a single centre between 2004 and 2009. Mean patient age was 65 years. CT was performed routinely before prosthesis implantation and at re-evaluation. The Copeland Mark III(®) (Biomet France SARL, 26903 Valence, France) implant was used in 32 cases and the Aequalis Resurfacing Head(®) (Tornier France, 38334 Saint-Ismier, France) in 10 cases. The post-implantation CT images were used to measure the angle of inclination, medial humeral offset, lateral glenohumeral offset, and version of the implant. RESULTS Mean follow-up was 18 months. Compared to baseline, no significant changes were found at re-evaluation for the angle of inclination or lateral glenohumeral offset. In contrast, medial humeral offset increased by 3.47mm, and excessive anteversion of 4.23° compared to the bicondylar line was noted. DISCUSSION Humeral head resurfacing prostheses restore the overall anatomy of the proximal humeral head. Our CT scan evaluation protocol seems reproducible and enables an evaluation of implant geometry. In our experience, resurfacing arthroplasty restored the native humeral offset. Inadequate retroversion was noted and was probably related to insufficient exposure during surgery. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- J-Y Deladerrière
- Department of Orthopaedic Surgery A, Lille University Regional Hospital Center, R.-Salengro Hospital, rue Emile-Laine, 59037 Lille cedex, France.
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Giannotti S, Bottai V, Ghilardi M, Dell'osso G, Guido G. Shoulder resurfacing with Durom Cup: clinical and radiological re-assessment. J Orthop Sci 2012; 17:545-50. [PMID: 22752205 DOI: 10.1007/s00776-012-0256-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 05/30/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of this study was to analyze and report functional and radiological results obtained with the Durom™ Shoulder Cup. METHODS From 2004 to 2009, 42 consecutive shoulder resurfacing prostheses were implanted in a cohort of forty patients with morphologically and functionally healthy rotator cuff. Those cases were evaluated preoperatively and postoperatively after an average of 33.5 months on the basis of Constant score, ASES score, and X-rays. RESULTS The Constant score increased from 29.88 points preoperatively to 82.34 after a mean follow-up period of 33.5 months. The ASES score went from 30.55 points preoperatively to 76.61. Radiologically we noticed neither radiolucent lines nor any aseptic loosening of the prosthetic cup. In the post-operative X-rays evaluation we found no significant central migration of the humeral head from the first postoperative X-ray. CONCLUSIONS The good functional results observed with a mean follow-up of approximately 3 years doubtless resulted from the reduction in implant-placement error, as a result of the resurfacing procedure, and from the normal rotator cuff function. This technique facilitates surgical reconstruction of the anatomical and biomechanical conditions required for physiological function of the shoulder.
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Merolla G, Sperling JW, Paladini P, Porcellini G. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg 2011; 95:215-224. [PMID: 21567154 DOI: 10.1007/s12306-011-0138-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 04/22/2011] [Indexed: 05/30/2023]
Abstract
Shoulder osteoarthritis affect about 32% of patients over 60 years. Conservative treatment are recommended to restore shoulder function while shoulder arthroplasty remains the standard treatment for severe osteoarthritis. When conservative therapies fail and surgical approach is precluded, viscosupplementation with HA may be the treatment of choice. Currently, there is minimal information available comparing the results of Hylan G-F 20 and corticosteroid injections for the treatment of shoulder osteoarthritis. Therefore, the purpose of this study was to examine the results of these two treatments at specific time points with validated outcome measurements. Retrospective comparative cohort study. The study population included 84 patients, 51 of whom treated with Hylan G-F 20 and 33 with a corticosteroid. Gleno-humeral osteoarthritis was graded according to Samilson-Prieto classification and rotator cuff was assessed with MRI. Both groups received three injections 1 week apart and were evaluated using a Visual Analog Scale (VAS) for pain and satisfaction, the Shoulder Pain and Disability Index (SPADI) and the Constant-Murley scale. Outcomes were registered at 1, 3, and 6 months. The Hylan G-F 20 group showed a significant pain reduction (P < 0.05), improvement in the Constant-Murley, SPADI scores (P < 0.05), and satisfaction (P < 0.01) at all three follow-up times. Pain, clinical scores, and subjective satisfaction in the corticosteroid group improved in the first post treatment month only (P < 0.05) compared with the baseline. Overall, lower clinical advantages were found in patients with greater degree of osteoarthritis and rotator cuff tears. Intra-articular injections with Hylan G-F 20 are effective in reducing pain for up to 6 months in gleno-humeral osteoarthritis whereas corticosteroids injections resulte in improvement at 1 month only. In patients with severe osteoarthritis and/or full-thickness, RC tears results tended to be worse.
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Affiliation(s)
- Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Italy.
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Management of a periprosthetic fracture after humeral head resurfacing total shoulder replacement: a case report. J Shoulder Elbow Surg 2011; 20:e18-21. [PMID: 21600790 DOI: 10.1016/j.jse.2011.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/06/2011] [Accepted: 02/11/2011] [Indexed: 02/01/2023]
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Pritchett JW. Long-term results and patient satisfaction after shoulder resurfacing. J Shoulder Elbow Surg 2011; 20:771-7. [PMID: 21106400 DOI: 10.1016/j.jse.2010.08.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 08/05/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder resurfacing has regained popularity in recent years. This report presents the long-term (>20 years) results of this procedure with regard to patient satisfaction and implant survival. MATERIALS AND METHODS We followed up 61 patients who underwent shoulder resurfacing procedures (74 shoulders) for a minimum of 20 years or until death (7 additional patients were lost to follow-up). The mean patient age at the time of surgery was 58 years. There were 41 total resurfacing procedures and 33 hemi-resurfacing procedures. The humeral component consisted of a cup with a short central peg that was placed either with or without cement. The glenoid was resurfaced with a cemented polyethylene or polyurethane component. RESULTS Patient satisfaction was 95%, and the survivorship of the humeral prostheses was 96%. There were no periprosthetic fractures, dislocations, or infections. Two humeral components were revised to stemmed prostheses (one for loosening and one for unexplained pain), and one was revised from a cementless to a cemented resurfacing prosthesis. Twelve cemented polyethylene glenoid prostheses had radiolucencies, but only three produced symptoms requiring revision surgery; three polyurethane glenoid prostheses showed severe wear radiographically, but none was loose or required revision surgery. There were 7 revision procedures, 6 with good results. CONCLUSIONS Shoulder resurfacing is a successful procedure for the majority of patients, with high rates of patient satisfaction, long-term survivorship of the humeral prosthesis, and few complications.
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Cementless surface replacement arthroplasty of the shoulder with biologic resurfacing of the glenoid. J Shoulder Elbow Surg 2009; 18:915-9. [PMID: 19328017 DOI: 10.1016/j.jse.2009.01.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 09/12/2008] [Accepted: 01/12/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND We report a retrospective review of surface replacement hemiarthroplasty of the shoulder with biologic resurfacing of the glenoid, for relatively young patients suffering from advanced glenohumeral arthritis. It was hoped that the resurfacing fascia would prevent glenoid erosion for a period of time. METHODS This surgery was performed by two surgeons between 1996 and 2005. The indications for the arthroplasty were severe pain and limitation of function, in relatively young patients with advanced glenohumeral arthritis but an intact rotator cuff. RESULTS Eighteen shoulders, with an average follow-up of 4.8 years (range 2-10.6), were available for assessment. The average age was 54.8 years. Postoperative Constant-Murley Score averaged 71.4 points; the mean sex- and age-adjusted Constant Score was 83.9%. The mean American Shoulder and Elbow Surgeons score was 74.4 points. Average active forward elevation was 130 degrees. Eighty three percent of the patients were satisfied with the long-term result. Radiographic follow-up demonstrated that none of the prostheses was loose; however moderate to severe glenoid erosion was present in 56% of shoulders. CONCLUSIONS We conclude that this procedure is useful in the treatment of younger patients suffering from advanced glenohumeral arthritis of the shoulder; however the interposed anterior capsule did not protect the glenoid from mid-term erosion by the humeral prosthesis. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Feeley BT, Fealy S, Dines DM, Warren RF, Craig EV. Hemiarthroplasty and total shoulder arthroplasty for avascular necrosis of the humeral head. J Shoulder Elbow Surg 2008; 17:689-94. [PMID: 18657449 DOI: 10.1016/j.jse.2008.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 03/01/2008] [Accepted: 03/21/2008] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to review the outcome of patients with osteonecrosis of the humeral head, based on etiology and treatment with either hemiarthroplasty or total shoulder arthroplasty (TSA). Sixty-four shoulders, with an average age of 57 years, were evaluated at a mean of 4.8 years. Outcomes included L'Insalata and American Shoulder and Elbow Surgeons (ASES) scores, as well as range of motion (ROM). The overall ASES score was 67, average flexion was 127 degrees, and external rotation was 49 degrees. Outcomes did not differ based on etiology, but ROM was decreased with post-traumatic osteonecrosis. There was no difference in outcome or ROM between hemiarthroplasty and TSA. The complication rate was significantly higher with TSA (22%) than with hemiarthroplasty (8%). Achieving ROM in patients with post-traumatic osteonecrosis remains difficult. TSA was associated with a higher complication rate and decreased mobility and should be reserved for patients with stage V osteonecrosis.
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Affiliation(s)
- Brian T Feeley
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
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Dawson CK, Rolf RH, Holovacs TF. The Management of Localized Articular Cartilage Lesions of the Humeral Head in the Athlete. OPER TECHN SPORT MED 2008. [DOI: 10.1053/j.otsm.2008.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Surface replacement arthroplasty of the shoulder offers the ability to restore anatomy and biomechanics of the glenohumeral joint, if sufficient humeral bone stock of at least 60% of the humeral head is preserved and no severe deformity is present. The implantation following the individual anatomy helps to avoid complications such as prosthetic malpositioning and periprosthetic fractures. While the use of a glenoid component is technically demanding, revision to a stem prosthesis is relatively easy because of bone stock preservation. Indications for humeral head resurfacing are osteoarthritis (OA), rheumatoid arthritis (RA), avascular necrosis stages 2-4, and stable forms of cuff tear arthropathy (CTA). Published results for OA and RA are comparable to those obtained with modern modular stem prostheses; the use in CTA appears promising under "limited goals criteria."
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Affiliation(s)
- A Werner
- Klinik Fleetinsel, Admiralitätstrasse 3-4, 20459, Hamburg, Germany.
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