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Lamb CJ, Ahmad A, Biedermann BM, Lin EH, Kotlier JL, Cruz CA, Petrigliano FA, Liu JN. Rehabilitation and Long Term Outcomes Including Return to Work or Sport Following Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2025; 18:173-181. [PMID: 39920554 PMCID: PMC11965055 DOI: 10.1007/s12178-025-09948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2025] [Indexed: 02/09/2025]
Abstract
PURPOSE OF REVIEW Reverse total shoulder arthroplasty has become an excellent surgical option for patients suffering from various shoulder pathologies including rotator cuff arthropathy, inflammatory arthritis and proximal humerus fractures. The goals of this operation are to reduce pain, restore function, and allow patients to be able to return to both work and sport. This article provides insight into the return to work and sport of patients who have undergone reverse total shoulder arthroplasty. RECENT FINDINGS Recent literature has demonstrated that patients who have undergone reverse total shoulder arthroplasty demonstrate high rates of return to work and sport. Variations in patient age, sex, work intensity, type of sport and rehabilitation protocols can also play a factor in being able to return to work and sport. Patients who have undergone reverse total shoulder arthroplasty are able to return to work and sport in a timely manner. A structured rehabilitation protocol, appropriate patient selection and excellent communication between surgeon and patient is crucial to achieve a successful return to work and sport.
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Affiliation(s)
- Christopher J Lamb
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Aamir Ahmad
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Brett M Biedermann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Eric H Lin
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA.
| | - Jacob L Kotlier
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Christian A Cruz
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA
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Selmi H, Tayyem M, Abishek J, Ridha A, Makki D, Ravenscroft M. Reverse Shoulder Arthroplasty in Patients With Rheumatoid Arthritis and Polymyalgia Rheumatica: A Clinical and Functional Review at Two Years. Cureus 2025; 17:e80191. [PMID: 40190962 PMCID: PMC11972440 DOI: 10.7759/cureus.80191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2025] [Indexed: 04/09/2025] Open
Abstract
Rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR) are chronic inflammatory conditions that can lead to destruction and disability of the glenohumeral joint, requiring joint replacement. Disease processes can lead to further joint erosion and eventual loosening of the glenoid component of an anatomical total shoulder arthroplasty. The use of reverse shoulder arthroplasty (RSA) for RA is widely discussed; however, there is a lack of evidence relating to the use of this procedure for PMR. We conducted this study to compare outcomes of RSA in the treatment of RA and PMR. We conducted a retrospective analysis of 30 RSA procedures, of which 18 were for RA and 12 were for PMR. All patients had significant rotator cuff damage. All patients received the same implant and the same rehabilitation protocol and were followed up at the same four intervals. At each follow-up, we assessed the range of motion and Oxford shoulder score (OSS) and undertook a radiological assessment. We found a significant increase in the reported OSS and range of motion in both groups. We noted improvements in forward flexion, abduction and external rotation in both groups. We identified a significant increase in the OSS and post-operative range of motion after RSA in patients with RA when compared to PMR. In conclusion, RSA remains a viable option for patients with inflammatory arthritis. However, patients with PMR show less pronounced improvement compared to those with RA.
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Affiliation(s)
- Hussain Selmi
- Trauma and Orthopaedics, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, GBR
| | - Mohammed Tayyem
- Trauma and Orthopaedics, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, GBR
| | - Joshua Abishek
- Trauma and Orthopaedics, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, GBR
| | - Ali Ridha
- Trauma and Orthopaedics, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, GBR
| | - Daoud Makki
- Trauma and Orthopaedics, Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, GBR
| | - Matt Ravenscroft
- Trauma and Orthopaedics, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, GBR
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Jacquot A, Cuinet T, Peduzzi L, Wong P, Gauci MO, Uhring J. Deltopectoral approach without subscapularis detachment for reverse shoulder arthroplasty. Technique and results of a safe and reproducible subscapularis-sparing approach. JSES REVIEWS, REPORTS, AND TECHNIQUES 2025; 5:14-21. [PMID: 39872348 PMCID: PMC11764111 DOI: 10.1016/j.xrrt.2024.09.006] [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: 01/30/2025]
Abstract
Background The importance of the subscapularis for reverse total shoulder arthroplasty has been demonstrated, especially for internal rotation and stability. In a deltopectoral approach, a detachment of the subscapularis is performed (tenotomy, tuberosity peeling, or osteotomy), but the tendon is not always repairable at the end. When it is repaired, healing is obtained in only 40%-76% of the cases, with potential consequences for the outcomes. The anterior muscle-sparing (AMS) approach is a deltopectoral approach with preservation of the subscapularis, providing a solution to these problems. We present the surgical technique and results. Methods In a retrospective study, we included our first 45 cases of reverse total shoulder arthroplasty performed with the AMS approach for a degenerative affection of the shoulder (massive rotator cuff tear, cuff tear arthropathy, primary glenohumeral arthritis, or rheumatoid arthritis), excluding traumatic and revision cases. The subscapularis was intact in all the cases. The mean age at inclusion was 74.1 years. No patients were lost at the minimum 24-month follow-up. All the patients underwent a clinical evaluation preoperatively and at the last follow-up, including Constant score, simple shoulder value, pain scale, and range of motion. An X-ray evaluation was conducted postoperatively and at the last follow-up to assess implant positioning and evolution. Results There was no intraoperative complication, and the mean operative time was 62 minutes. We observed a significant improvement in Constant score (from 36 to 70, P <.001), simple shoulder value (from 33 to 81, P <.001), pain (from 6.3 to 0.7, P <.001), strength (from 0.5 to 3.5, P <.001), and most of the active mobilities. Regarding internal rotation, 95% of the patients reached level L3 or higher. Glenoid positioning was considered optimal in more than 90% of the cases (inferior tilt and low position) without any occurrence of superior tilt or high position. The osteophytes could be totally removed in 8 out of 9 cases (88.9%). Six postoperative complications (13.3%) were reported: 1 infection (2.2%), 2 cases of traumatic glenoid loosening (4.4%), 2 acromion fractures (4.4%), and 1 hematoma (2.2%). There was no instability. Eighty percent of the patients could return home, with a mean hospital stay of 1.8 days. Conclusion The AMS approach is a safe and reproducible technique. The preservation of the subscapularis has potential benefits regarding internal rotation and stability. In the absence of tendon suture, rehabilitation can be started immediately without motion restriction, allowing for a fast recovery and return to autonomy.
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Affiliation(s)
- Adrien Jacquot
- Clinique Louis PASTEUR SAS, Unité de Chirurgie Orthopédique, Essey-les-Nancy, France
- Centre ARTICS, Chirurgie des Articulations et du Sport, Essey-lès-Nancy, France
| | - Thomas Cuinet
- Clinique Louis PASTEUR SAS, Unité de Chirurgie Orthopédique, Essey-les-Nancy, France
- Centre ARTICS, Chirurgie des Articulations et du Sport, Essey-lès-Nancy, France
- Centre Chirurgical Emile Galle, Unité de Chirurgie Orthopédique, Nancy, France
| | - Lisa Peduzzi
- Clinique Louis PASTEUR SAS, Unité de Chirurgie Orthopédique, Essey-les-Nancy, France
- Centre ARTICS, Chirurgie des Articulations et du Sport, Essey-lès-Nancy, France
- Centre Chirurgical Emile Galle, Unité de Chirurgie Orthopédique, Nancy, France
| | - Patrice Wong
- Clinique Louis PASTEUR SAS, Unité de Chirurgie Orthopédique, Essey-les-Nancy, France
- Centre ARTICS, Chirurgie des Articulations et du Sport, Essey-lès-Nancy, France
- Centre Chirurgical Emile Galle, Unité de Chirurgie Orthopédique, Nancy, France
| | | | - Julien Uhring
- Clinique Claude Bernard, Unité de Chirurgie Orthopédique, Metz, France
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Fleet CT, Kerrigan A, Langohr GDG, Johnson JA, Athwal GS. Coracoacromial ligament integrity influences scapular spine strain after reverse shoulder arthroplasty. JSES Int 2025; 9:283-289. [PMID: 39898219 PMCID: PMC11784478 DOI: 10.1016/j.jseint.2024.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Abstract
Background The purpose of this biomechanical study was to examine the effect of coracoacromial (CA) ligament state (intact vs. released) and arm position on acromial and scapular spine strain following reverse total shoulder arthroplasty (rTSA). Methods Eight cadaveric shoulders were implanted with a custom rTSA system and tested using an in-vitro shoulder simulator. The specimens were cycled through static range of motion in both abduction and forward elevation; first with the CA ligament in the "intact" state followed by the "released" state. Scapular spine strain was quantified via 4 strain gauges placed along anatomic locations on the acromion and scapular spine. Results Increases in strain were observed across all 4 strain gauge locations upon release of the CA ligament in both 0° of abduction and forward elevation. Increases in the mean strain were observed to be as great as 14% in abduction and 31% in forward elevation. The increases in strain at 0° elevation approached but did not reach statistical significance (P ≥ .072). At 90° of abduction and forward elevation, no increases in the mean strain were observed. The greatest strain was consistently observed with the arm positioned in 0° of forward elevation (P < .001). Discussion CA ligament release in the setting of rTSA resulted in increased scapular spine and acromial strain with the arm adducted, although these increases in strain were not statistically significant. Caution should be taken intraoperatively as the release of the CA ligament may alter scapular spine and acromion stresses from deltoid loading, which may increase the risk for postoperative scapular spine fracture.
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Affiliation(s)
- Cole T. Fleet
- Roth, McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Canada
| | - Alicia Kerrigan
- Roth, McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
| | - G. Daniel. G. Langohr
- Roth, McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Canada
- Department of Surgery, Western University, London, Canada
| | - James A. Johnson
- Roth, McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Canada
- Department of Surgery, Western University, London, Canada
| | - George S. Athwal
- Roth, McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
- Department of Surgery, Western University, London, Canada
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Ijichi T, Tabata N, Kawahara Y, Obata A, Tominaga M, Nakamura H, Inoue T. [Effects of Subject Position on Metal Artifact Reduction of a Reverse Shoulder Prosthesis Using Computed Tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:1165-1174. [PMID: 38777768 DOI: 10.6009/jjrt.2024-1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE To validate the effects of subject position on single energy metal artifact reduction (SEMAR) of a reverse shoulder prosthesis using computed tomography (CT). METHODS A water phantom with a reverse shoulder prosthesis was scanned at four positions on the XY plane of the CT gantry (on-center, 50 mm, 100 mm, and 150 mm from on-center in the negative direction of the X axis, respectively). We obtained images with and without SEMAR. The artifact index (AI) was measured via physical assessment. Scheffé's (Ura) paired comparison methods were performed with the amount of metal artifact by ten radiological technologists via visual assessment. RESULTS The AI was significantly reduced when using SEMAR. As the phantom moved away from the on-center position, the AI increased, and metal artifacts increased in Scheffé's methods. CONCLUSION SEMAR reduces metal artifacts of a reverse shoulder prosthesis, but metal artifacts may increase as the subject position moves away from the on-center position.
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Affiliation(s)
- Tetsuya Ijichi
- Department of Radiology, Fukuoka University Chikushi Hospital
| | - Nariaki Tabata
- Department of Radiology, Fukuoka University Chikushi Hospital
| | - Yuna Kawahara
- Department of Radiology, Fukuoka University Chikushi Hospital
| | - Asami Obata
- Department of Radiology, Fukuoka University Chikushi Hospital
| | - Masaya Tominaga
- Department of Radiology, Fukuoka University Chikushi Hospital
| | | | - Toshirou Inoue
- Department of Radiology, Fukuoka University Chikushi Hospital
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O'Malley O, Craven J, Davies A, Sabharwal S, Reilly P. Outcomes following revision of a failed primary reverse shoulder arthroplasty. Bone Joint J 2024; 106-B:1293-1300. [PMID: 39481429 DOI: 10.1302/0301-620x.106b11.bjj-2024-0032.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: 11/02/2024]
Abstract
Aims Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and complications for patients undergoing revision of a RSA. Methods MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews were searched. Studies involving adult patients who underwent revision of a primary RSA for any indication were included. Those who underwent a RSA for failure of a total shoulder arthroplasty or hemiarthroplasty were excluded. Pre- and postoperative shoulder scores were evaluated in a random effects meta-analysis to determine the mean difference. The rates of re-revision and complications were also calculated. Results The initial search elicited 3,166 results and, following removal of duplicates and screening, 13 studies with a total of 1,042 RSAs were identified. An increase in shoulder scores pre- to postoperatively was reported in all the studies. Following revision of a RSA to a further RSA, there was a significant increase in the American Shoulder and Elbow Surgeons Score (mean difference 20.78 (95% CI 8.16 to 33.40); p = 0.001). A re-revision rate at final follow-up ranging from 9% to 32%, a one-year re-revision rate of 14%, and a five-year re-revision rate of 23% were reported. The complication rate in all the studies was between 18.5% and 36%, with a total incidence of 29%. Conclusion This is the largest systematic review of the outcomes following revision of a RSA. We found an improvement in functional outcomes after revision surgery, but the rates of re-revision and complications are high and warrant consideration when planning a revision procedure.
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Affiliation(s)
- Olivia O'Malley
- Cutrale Perioperative & Ageing Group, Department of Bioengineering, Imperial College, London, UK
| | | | - Andrew Davies
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Peter Reilly
- Cutrale Perioperative & Ageing Group, Department of Bioengineering, Imperial College, London, UK
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Kelly SR, Touhey DC, Smith MJ. Convertible-platform shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:594-599. [PMID: 39157239 PMCID: PMC11329054 DOI: 10.1016/j.xrrt.2023.09.010] [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: 08/20/2024]
Abstract
Background Shoulder arthroplasty has become an increasingly common procedure used to treat degenerative, inflammatory, and traumatic conditions of the glenohumeral joint. With a significant increase in primary anatomic and reverse total shoulder arthroplasty, revision procedures have likewise increased. Updates in shoulder arthroplasty have allowed for the convertibility of implants, which allows for the retention of both glenoid and humeral components during revision surgery. This review aims to highlight the epidemiology, indications, and outcomes of convertible-platform total shoulder arthroplasty procedures. Methods A review of the current literature surrounding convertible-platform shoulder arthroplasty was completed to highlight the advantages and disadvantages of commercially available instrumentation and implant systems as well as their outcomes. Discussion Leading causes of shoulder arthroplasty revision surgery include glenoid failure, implant instability, and rotator cuff dysfunction. Variations in implant design between inlay and onlay humeral components and metal-backed glenoid components are important considerations at the time of revision surgery. Advantages of convertible-platform systems include increased efficiency and decreased complications during revision procedures as well as shorter recovery, lower cost, and better functional outcomes. Limitations of convertible systems include poorly positioned components during the index procedure, excessive soft-tissue tensioning, and problems associated with metal-backed glenoid implants. Changes in arm length have also been documented. These findings indicate the benefit of additional research and design to improve the effectiveness and utility of convertible-platform shoulder arthroplasty systems.
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Affiliation(s)
- Shayne R. Kelly
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | | | - Matthew J. Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
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Rhee SM, Lee JW, Lee JU, Kim CH, Kim SY, Ham HJ, Kantanavar R, Rhee YG. Subscapularis Repair in Reverse Total Shoulder Arthroplasty: Differences in Outcomes Based on Preoperative Quality of Subscapularis Tendon. Indian J Orthop 2024; 58:747-754. [PMID: 38812870 PMCID: PMC11130088 DOI: 10.1007/s43465-024-01139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/23/2024] [Indexed: 05/31/2024]
Abstract
Purpose This study examines the influence of preoperative fatty infiltration (FI) of the subscapularis tendon (SBS) on outcomes following reverse total shoulder arthroplasty (rTSA) with SBS repair. Methods A cohort of 161 rTSA patients with SBS repair, followed for a mean of 45.3 months, was divided into three groups based on FI: Group A (intact upper and lower portions, n = 85), Group B (intact lower portions, n = 44), and Group C (fatty infiltrated in both portions, n = 32). The mean age was 74.5 years (range: 65-95). Results Preoperative FI displayed significant disparity among the groups: Group A (1.18 ± 0.60), Group B (2.95 ± 0.56), and Group C (4.0 ± 0.00) (p < .001). Group A exhibited a more positive trend in activities of daily living, particularly in toileting ability (81% in Group A, 68% in Group B, and 72% in Group C), although without statistical significance (p = 0.220). Complication rates varied: Group A had seven acromial fractures (8%), three cases of instability (3%), and six instances of scapular notching (7%). Group B experienced four acromial fractures (9%) and four cases of scapular notching (9%), while Group C had only one case of scapular notching (3%) (p = 0.733). Conclusion In cases characterized by favorable preoperative SBS quality, there was an elevation in functional internal rotation (IR) post-surgery, accompanied by an increased incidence of postoperative complications. Hence, careful consideration is advised when determining the necessity for SBS repair. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital #23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 130-872 Republic of Korea
| | - Joon Woo Lee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
| | - Jong Ung Lee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
| | - Cheol-Hwan Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
| | - Se Yeon Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
| | - Hyun Joo Ham
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
| | - Radhakrishna Kantanavar
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
| | - Yong-Girl Rhee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea
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Nizam Siron K, Kow RY, Md Amin NAN, Low CL, Wahid AN, Jasni F, Abidin MR, Mustfar SNS. Shoulder Arthroplasty: A Bibliometric Analysis Using the Scopus Database. Cureus 2024; 16:e61613. [PMID: 38962641 PMCID: PMC11221973 DOI: 10.7759/cureus.61613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 07/05/2024] Open
Abstract
Primary joint replacements are performed increasingly often worldwide, driven by an aging population, improvement in surgical techniques, and advancements in implant designs. While more attention has traditionally been focused on weight-bearing joints such as the hip and knee, shoulder replacement surgeries have gained increasing attention in recent years due to the population's demand for a better quality of life. Thus far, a comprehensive bibliometric analysis of shoulder arthroplasty-related publications using the Scopus database has not yet been conducted. This bibliometric analysis aims to fill this gap by reviewing the Scopus database from its inception until 2023 to examine the literature on shoulder arthroplasty. A total of 5300 publications meeting the selection criteria were included in this analysis. The turn of the century marked a significant turning point for the field of shoulder arthroplasty, with an increasing number of publications produced annually. This trend can be attributed to the improvement of implant designs, which have become more consistent and reliable over time. While the majority of articles were authored by researchers and clinicians from the United States of America (USA), publications by French authors had a higher scholarly impact in the field. There is a noticeable gap in research on shoulder arthroplasty in developing countries, possibly due to the prohibitively high cost of implants and the prioritization of other healthcare sectors. This bibliometric analysis, utilizing Scopus data, serves as a guiding light for researchers, clinicians, and policymakers, potentially fostering collaborative projects and guiding the development of future studies to further advance the field of shoulder arthroplasty, particularly in developing countries.
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Affiliation(s)
- Khairul Nizam Siron
- Department of Orthopedics, Traumatology, and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Ren Y Kow
- Department of Orthopedics, Traumatology, and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Nurul Ain N Md Amin
- Department of Orthopedics, Traumatology, and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Chooi L Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Azni N Wahid
- Mechatronics Engineering Department, International Islamic University Malaysia, Gombak, MYS
| | - Farahiyah Jasni
- Mechatronics Engineering Department, International Islamic University Malaysia, Gombak, MYS
| | - Mohd R Abidin
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Siti Nor S Mustfar
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
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Pastor MF, Nebel D, Degering A, Smith T, Karkosch R, Horstmann H, Ellwein A. Biomechanical comparison of single versus double plate osteosynthesis in acromion type III fractures. Orthop Rev (Pavia) 2024; 16:88396. [PMID: 38765296 PMCID: PMC10770366 DOI: 10.52965/001c.88396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the double-plate osteosynthesis for these fractures. Methods An acromion type III fracture according to classification of Levy was simulated in 16 human shoulder cadavers, and the specimens were randomly divided into two groups. Single-plate osteosynthesis was performed in the first group (locking compression plate) and double-plate osteosynthesis (locking compression plate and one-third tubular locking plate) in the second group. Biomechanical testing included cycling load and load at failure on a material testing machine. During the test, the translation was measured using an optical tracking system. Results The load at failure for the single-plate osteosynthesis was 167 N and for the double-osteosynthesis 233.7 N (P = 0.328). The average translation was 11.1 mm for the single-plate osteosynthesis and 16.4 mm for the double-plate osteosynthesis (P = 0.753). The resulting stiffness resulted in 74.7 N/mm for the single-plate osteosynthesis and 327.9 N/mm for the double-plate osteosynthesis (P = 0.141). Discussion Results of the biomechanical study showed that double-plate osteosynthesis had biomechanical properties similar to those of single-plate osteosynthesis for an acromion type III fracture at time point zero. The missing advantages of double-plate osteosynthesis can be explained by the choice of plate configuration.
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Vij N, Tummala S, Shahriary E, Tokish J, Martin S. Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty in Primary Glenohumeral Osteoarthritis With Intact Rotator Cuffs: A Meta-Analyses. Cureus 2024; 16:e57866. [PMID: 38725735 PMCID: PMC11081529 DOI: 10.7759/cureus.57866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
Traditional practice favors total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (PGHO) with an intact rotator cuff; however, the indications for reverse shoulder arthroplasty (RSA) have expanded to include PGHO. The purpose of this systematic review is to compare the mean differences in the range of motion and patient-reported outcomes between the TSA and RSA with an intact rotator cuff and to analyze the subgroup of the Walch type B2 glenoid. This IRB-exempt, PROSPERO-registered systematic review strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. A literature search of five databases revealed 493 articles, of which 10 were included for quantitative synthesis. Level III evidence studies with the diagnosis of PGHO and ≥2 years of follow-up were included. Studies without preoperative and postoperative data were excluded. The Newcastle-Ottawa scale was used to evaluate the methodologic quality of the included studies. Preoperative and postoperative range of motion and patient-reported outcomes were collected. The random-effects model was employed, and p < 0.05 was considered statistically significant. There were a total of 544 and 329 studies in the TSA group and RSA group, respectively. The mean age in the TSA group and RSA groups were 65.36 ± 7.06 and 73.12 ± 2.40, respectively (p = 0.008). The percentages of males in the TSA and RSA groups were 73.2% and 51.1%, respectively (p = 0.02). The mean differences in forward elevation, external rotation in adduction, internal rotation scale, visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE) scores were improved for both groups with no significant differences between the two. There were 9.6 times the revisions in the TSA group (8.8% vs. 0.91%; p = 0.014) and 1.5 times the complications in the TSA group (3.68% vs. 2.4%; p = 0.0096). Two hundred and forty-two glenoids were identified as Walch type B2 (126 in the TSA group and 116 in the RSA group). The mean ages in the B2 subgroup were 68.20 ± 3.25 and 73.03 ± 1.49 for the TSA and RSA, respectively (p = 0.25). The percentages of males in the B2 subgroup were 74.6% and 46.5% for the TSA and RSA groups, respectively (p = 0.0003). The ASES, SANE, forward elevation, and external rotation in the adduction results were descriptively summarized for this subgroup, with average mean differences of 49.0 and 51.2, 45.7 and 66.1, 77.6° and 58.6°, and 38.6° and 34.1° for the TSA and RSA groups, respectively. In the setting of primary glenohumeral osteoarthritis with an intact rotator cuff, the RSA has a similar range of motion and clinical outcomes but lower complication and revision rates as compared to the TSA. This may hold true in the setting of the B2 glenoid, although a high-powered study on this subgroup is required. Anatomic shoulder arthroplasty maintains an important role in select patients. Further studies are required to better elucidate the role of glenoid bone loss and posterior humeral head subluxation with regard to implant choice.
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Affiliation(s)
- Neeraj Vij
- Department of Orthopedic Surgery, University of Kansas School of Medicine-Wichita, Wichita, USA
| | | | - Eahsan Shahriary
- School of Public Health, University of California, Berkeley, Berkeley, USA
| | - John Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, USA
| | - Shelden Martin
- Department of Orthopedic Surgery, OrthoArizona, Phoenix, USA
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Castricini R, Galasso O, Mercurio M, Dei Giudici L, Massarini A, De Gori M, Castioni D, Gasparini G. Clinical outcomes are unchanged after a mean of 12 years after reverse shoulder arthroplasty: a long-term re-evaluation. JSES Int 2024; 8:185-190. [PMID: 38312267 PMCID: PMC10837693 DOI: 10.1016/j.jseint.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background The medium-term results of reverse shoulder arthroplasty (RSA) that has been performed by a single surgeon have been previously reported. The purpose of this study was to investigate the minimum 10-year clinical and radiographic outcomes of these patients. Methods In this prospective cohort study, 27 patients were evaluated after RSA for massive rotator cuff tear with or without eccentric osteoarthritis (OA) or concentric OA with the Constant-Murley Score (CMS), range of motion (ROM), and a radiologic assessment. Results At a mean 12-year follow-up, the CMS and ROM were significantly improved when compared with the baseline values (all P < .001). Once stratified by diagnosis, no difference in the ROM or total CMS was found between patients with massive rotator cuff tear with/without eccentric OA and those with concentric OA. Neither ROM nor CMS decreased when compared to the mid-term values of the previous study, for both the overall population and the diagnosis-stratified groups. Scapular notching was reported in 66.7% of cases that was similar to the data reported at mid-term follow-up. The calcification rate was 59.3% at the long-term evaluation, and there were no differences between the same case-series population (51.9%; P = .785) and the whole population at mid-term follow-up (47%; P = .358). Conclusion RSA led to excellent clinical and functional outcomes for patients up to 17 years postoperatively, and there was no decrease in the CMS over time. No loosening of implants was noted, and the rate of scapular notching was 66%, mostly grade 1 or 2.
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Affiliation(s)
- Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, “Villa Verde” Hospital, Fermo, Italy
- Department of Orthopaedic and Trauma Surgery, “Villa Maria Cecilia” Hospital, Cotignola, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Renato Dulbecco” University Hospital, Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Renato Dulbecco” University Hospital, Catanzaro, Italy
| | - Luca Dei Giudici
- Orthopedic Unit, Villa dei Pini Hospital, Civitanova Marche, Italy
| | - Alessandro Massarini
- Division of Orthopaedic and Trauma Surgery, “Villa Verde” Hospital, Fermo, Italy
- Department of Orthopaedic and Trauma Surgery, “Villa Maria Cecilia” Hospital, Cotignola, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, Basso Ionio Hospital, Soverato, Italy
| | - Davide Castioni
- Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Renato Dulbecco” University Hospital, Catanzaro, Italy
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Mocini F, Cerciello S, Corona K, Morris BJ, Saturnino L, Giordano MC. The effect of subscapularis repair in reverse total shoulder arthroplasty depends on the design of the implant: a comparative study with a minimum 2-year follow-up. Arch Orthop Trauma Surg 2024; 144:41-49. [PMID: 37596498 DOI: 10.1007/s00402-023-05025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION The role of the subscapularis (Ssc) tendon does not yet have a well-defined role in RSA. The purpose of the present study was to evaluate if the repair of the Ssc in RSA improves overall clinical and radiographic results and if it has the same results using a medialized design humeral stem compared to a lateralized design. METHODS Eighty-four consecutive patients undergoing RSA were retrospectively analyzed. Nine patients were lost at FU. Two implants with similar glenosphere design and different stem design (medialized and lateralized) were used. The Ssc was repaired in case of good quality of the fibers and reducibility without tension intraoperatively. Patients were divided into four groups for data analysis depending on whether they had received a medialized or lateralized design and Ssc repair or not. Patients were reviewed at an average follow-up of 40.8 ± 13.1 months. Clinical outcome measures included Active range of motion (ROM), strength, visual analog scale (VAS), Constant-Murley score (CMS), and the American Shoulder and Elbow Surgeons score (ASES). Radiographic evaluation at final follow-up was performed to assess scapular notching, stress shielding, and radiolucent lines. RESULTS No statistically significant clinical differences (p > 0.05) emerged between Lat/Ssc+ and Lat/Ssc-. Conversely, the patients belonging to the Med/Ssc- group reported statistically worse (p < 0.05) results than the Med/Ssc + group in terms of VAS, ASES and CMS. Statistically worse (p < .05) results in the Med/Ssc- group than in the Med/Ssc + were found also in active ROM achieved in FE, ABD, ER1 and ER2, and in the strength obtained in FE, ABD and ER2. Scapular notching was reported in 3 shoulders (15.7%) in Lat/Ssc+ group and in 7 shoulders (50%) in Lat/Ssc- group, while it was reported in 4 shoulders (14.2%) in Med/Ssc + group and in 6 shoulders (42.8%) in Med/Ssc- group. Stress shielding was observed in 6 cases in Lat/Ssc+ group (31.6%), in 8 cases in Lat/Ssc- group (57.1%), in 3 cases (10.7%) in Med/Ssc + group and 4 cases in Med/Ssc- group (28.6%). CONCLUSIONS Patients undergoing RSA show clinical improvements at mid-term follow-up with a low rate of complications, regardless of the use of a medialized or a lateralized humeral stem design. Ssc repair is associated with better functional outcomes in the cohort of medialized stem, while it did not yield significant differences in the cohort of lateralized stem. LEVEL OF EVIDENCE Level III; Retrospective Cohort Comparison; Treatment Study.
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Affiliation(s)
| | - Simone Cerciello
- Casa di Cura Villa Betania, Rome, Italy
- A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Brent J Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA
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Lee D, Lee J, Oh JH, Shin CS. Effect of subscapularis repair on joint contact forces based on degree of posterior-superior rotator cuff tear severity in reverse shoulder arthroplasty. Front Bioeng Biotechnol 2023; 11:1229646. [PMID: 38130822 PMCID: PMC10733495 DOI: 10.3389/fbioe.2023.1229646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Massive irreparable rotator cuff tears (RCTs) affect the clinical outcomes of reverse shoulder arthroplasty (RSA). However, the effects of subscapularis repair on the outcomes of RSA, based on the degree of posterior-superior RCTs, are unclear. This study aimed to examine the effect of subscapularis repair on three-dimensional joint contact forces (JCFs) based on the degree of posterior-superior RCT severity in RSA. Ten human in vivo experimental data were used as input to the musculoskeletal model. A six-degrees-of-freedom (DOF) anatomical shoulder model was developed and validated against three-dimensional JCFs. The 6-DOF musculoskeletal shoulder model of RSA was then developed by importing the reverse shoulder implant into the validated anatomical shoulder model. Based on the various types of posterior-superior RCT severity, inverse dynamic simulations of subscapularis-torn and subscapularis-repaired models of RSA were performed: from isolated supraspinatus tears to partial or massive tears of the infraspinatus and teres minor. The intact rotator cuff model of RSA was also simulated for comparison with the different types of models. Our results showed that the more posterior-superior RCTs progressed in RSA, the more superior JCFs were observed at 90°, 105°, and 120° abduction in the subscapularis-torn model. However, subscapularis repair decreased the superior JCF at those angles sufficiently. In addition, the teres minor muscle-tendon force increased as infraspinatus bundle tears progressed in both the subscapularis-torn and -repaired models, in order to compensate for the reduced force during abduction. However, the teres minor muscle-tendon force was not as high as that of the infraspinatus muscle-tendon, which could result in muscle force imbalance between repaired subscapularis and teres minor. Therefore, our results suggest that repairing the subscapularis and the repairable infraspinatus during RSA can improve glenohumeral joint stability in the superior-inferior direction by restoring muscle force balance between the anterior cuff (i.e., subscapularis) and posterior cuff (i.e., infraspinatus and teres minor). The findings of this study can help clinician decide whether to repair the rotator cuff during RSA to enhance joint stability.
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Affiliation(s)
- Donghwan Lee
- Department of Mechanical Engineering, Sogang University, Seoul, Republic of Korea
| | - Jinkyu Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic Korea
| | - Choongsoo S. Shin
- Department of Mechanical Engineering, Sogang University, Seoul, Republic of Korea
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Boekel P, Rikard-Bell M, Grant A, Brandon B, Doma K, O’Callaghan WB, Wilkinson M, Morse L. Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial. JSES Int 2023; 7:614-622. [PMID: 37426909 PMCID: PMC10328789 DOI: 10.1016/j.jseint.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Hypothesis Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation. Methods All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up. Results Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups. Conclusion IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.
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Affiliation(s)
- Pamela Boekel
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Matthew Rikard-Bell
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
| | - Benjamin Brandon
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Kenji Doma
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - William B. O’Callaghan
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
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Galicia-Zamalloa AL, Jiménez-Juárez M, Pérez-Briones A, Campos-Flores D. Reverse Shoulder Arthroplasty Associated With Unnoticed Glenohumeral Dislocation: A Case Report. Cureus 2023; 15:e42769. [PMID: 37663981 PMCID: PMC10469090 DOI: 10.7759/cureus.42769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Osteonecrosis of the humeral head is seen in rare cases of anterior shoulder dislocations. There are many different surgical procedures that have been developed to repair inveterate anterior glenohumeral dislocation. Reverse shoulder arthroplasty (RSA) is a type of surgery that has been shown to be very effective in patients with cuff tear arthropathy. A 63-year-old female came to our service with an inveterate glenohumeral dislocation. We identified the osteonecrosis of the humeral head and decided to treat her with a reverse shoulder arthroplasty. Osteonecrosis following a glenohumeral dislocation is a rare condition. Treatment with a reverse shoulder arthroplasty allows a fast recovery, good functional results, and a better quality of life.
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Affiliation(s)
- Ana Luisa Galicia-Zamalloa
- Orthopaedics and Traumatology, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla, Puebla, MEX
| | - Margoth Jiménez-Juárez
- Orthopaedics and Traumatology, Instituto de Seguridad y Servicios Sociales para Trabajadores del Estado, Puebla, MEX
| | - Andrés Pérez-Briones
- Orthopaedics and Traumatology, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla, Puebla, MEX
| | - David Campos-Flores
- Orthopaedics, Instituto de Seguridad y Servicios Sociales para Trabajadores del Estado, Puebla, MEX
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Brindisino F, Lorusso M, Usai M, Pellicciari L, Marruganti S, Salomon M. Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists. Arch Physiother 2023; 13:12. [PMID: 37277886 DOI: 10.1186/s40945-023-00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups. MATERIALS AND METHODS This cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021. RESULTS Six-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension. In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6-12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3-4 weeks and higher than 90° at 6-12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication. CONCLUSIONS The clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Mariangela Lorusso
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | | | | | - Sharon Marruganti
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Mattia Salomon
- Department of Clinical Science and Traslational Medicine, University of Roma "Tor Vergata", Rome, Italy
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Blanke F, Enghusen C, Enz A, Haasters F, Lutter C, Mittelmeier W, Tischer T. Assessment of the Value of Registries in Shoulder Arthroplasty Using Reverse Arthroplasty as an Example. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:280-289. [PMID: 34937099 DOI: 10.1055/a-1644-2032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION As a consequence of the Swedish model, endoprosthesis registers have become increasingly important worldwide. Due to the increasing number of joint replacements at the shoulder, these are being increasingly included in the register databases - in addition to interventions at the hip and knee joint. In this study, the value of endoprosthesis registers is investigated, using the example of shoulder endoprosthetics and including a comparison with clinical studies. MATERIAL AND METHODS The annual reports of 32 different endoprosthesis registers with data on hip, knee and/or shoulder arthroplasty were analysed. The number of operations and demographic patient data for all areas of endoprosthetics were examined. In addition, a more detailed consideration of variables such as the primary diagnosis, the cause of the revision, the revision rate depending on risk factors and patient-reported outcome measures (PROM scores) was carried out exclusively for the shoulder joint endoprostheses. Using the example of the inverse shoulder prosthesis, clinical studies were compared to registry data with special regard to the revision rate. RESULTS A total of 20 endoprosthesis registers could be included, 9 of these collected data on shoulder arthroplasty. The main primary diagnoses were osteoarthritis (40.6%), rotator cuff defect arthropathy (30.2%) and fractures (17.6%). The most commonly used shoulder joint endoprosthesis was the inverse prosthesis (47.3%). The proportion of revision surgeries in total shoulder arthroplasty operations was less than 10% in all registers. In addition to the revision rate, the PROM scores were sometimes used in the registers to evaluate the success of the prosthesis. Compared to registry data, clinical studies showed more heterogeneous data with a significantly higher revision rate of over 10% in long-term follow-up - using the example of the inverse shoulder prosthesis. CONCLUSION Register data are a valuable source of information in shoulder arthroplasty and can make a significant contribution to the quality assurance of endoprosthetic treatments. Compared to clinical studies, they primarily provide data on durability of different endoprosthesis and give lower revision rates. Clinical studies use PROM scores and clinical and radiological examinations to focus only on individual implants and surgical centres on the one hand and much more on the functional results on the other.
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Affiliation(s)
- Fabian Blanke
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock, Rostock, Deutschland
- Orthopädische Klinik, Schön Klinik München Harlaching, München, Deutschland
| | - Charlotte Enghusen
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock, Rostock, Deutschland
| | - Andreas Enz
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock, Rostock, Deutschland
| | - Florian Haasters
- Orthopädische Klinik, Schön Klinik München Harlaching, München, Deutschland
| | - Christoph Lutter
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock, Rostock, Deutschland
| | - Wolfram Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock, Rostock, Germany
| | - Thomas Tischer
- Orthopädische Klinik und Poliklinik, Universitätsklinikum Rostock, Rostock, Deutschland
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Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med 2023; 16:145-153. [PMID: 36867393 PMCID: PMC10043097 DOI: 10.1007/s12178-023-09823-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. RECENT FINDINGS Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6 weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.
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Gipsman AM, Ihn HE, Iglesias BC, Azad A, Stone MA, Omid R. Spatial Anatomy of the Radial Nerve in the Extended Deltopectoral Approach. Orthopedics 2023; 46:e31-e37. [PMID: 36206514 DOI: 10.3928/01477447-20221003-07] [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: 02/03/2023]
Abstract
The goal of this study was to define safe zones to prevent radial nerve injury in an extended deltopectoral approach. Relative distances of the upper margin (UMRN) and lower margin (LMRN) of the radial nerve to the proximal and distal borders of the pectoralis major and deltoid insertions were measured in 20 cadaveric arms. Four proximal humeral zones were identified (zone I, proximal border of the pectoralis major tendon to the proximal border of the deltoid tendon; zone II, proximal border of the deltoid tendon to the distal border of the pectoralis major tendon; zone III, distal border of the pectoralis major tendon to the distal border of the deltoid tendon; and zone IV, distal to the distal border of the deltoid tendon). On fluoroscopic measurement, mean distances between the UMRN and the proximal border of the pectoralis major tendon and the proximal border of the deltoid tendon were 71.6±2.1 mm and 26.2±2.5 mm, respectively. The incidence of the radial nerve in the spiral groove within each defined zone was as follows: zone I, 0%; zone II, 50%; zones III and IV, 100%. There was a significant association between anatomic zone and radial nerve entry into the spiral groove, χ2(3, N=88)=64.53, P<.001. The proximal border of the pectoralis major tendon to the proximal border of the deltoid tendon (zone I) is a safe location to avoid injury to the radial nerve. We recommend placing cerclage wires proximal to zone I from lateral to medial to avoid entrapment of the radial nerve. [Orthopedics. 2023;46(1):e31-e37.].
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21
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Engel NM, Holschen M, Schorn D, Witt KA, Steinbeck J. Results after primary reverse shoulder arthroplasty with and without subscapularis repair: a prospective-randomized trial. Arch Orthop Trauma Surg 2023; 143:255-264. [PMID: 34236460 PMCID: PMC9886633 DOI: 10.1007/s00402-021-04024-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Indications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not. METHODS 50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant-Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients. RESULTS Patients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°-60°) vs. 32° (20°-45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13-90) vs. 69.5 (40-79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA. CONCLUSION SSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery.
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Affiliation(s)
- Nina Myline Engel
- Department of Orthopedic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
- Department of Orthopedic Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
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22
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Preuss FR, Fossum BW, Peebles AM, Eble SK, Provencher MT. Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:437-441. [PMID: 37588468 PMCID: PMC10426677 DOI: 10.1016/j.xrrt.2022.05.006] [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
Hypothesis/Background There is no consensus on whether to repair the subscapularis in the setting of reverse total shoulder arthroplasty (rTSA). There have been an assortment of studies showing mixed results regarding shoulder stability and postoperative strength outcomes when looking at subscapularis repair in rTSA. The purpose of this systematic review was to investigate differences in biomechanical strength outcomes of cadaveric subscapularis repair vs. no repair in rTSA.Increased force will be required to move the shoulder through normal range of motion (ROM) in cadaveric rTSA shoulders with the subscapularis repaired when compared with no subscapularis repair. Methods A comprehensive literature review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The databases used to search the keywords used for the concepts of subscapularis, reverse total shoulder arthroplasty, and muscle strength were PubMed (includes MEDLINE), Embase, Web of Science, Cochrane Reviews and Trials, and Scopus. Original, English-language cadaveric studies evaluating rTSA and subscapularis management were included, with subscapularis repair surgical techniques and strength outcomes being evaluated for each article meeting inclusion criteria. Results The search yielded 4113 articles that were screened for inclusion criteria by 4 authors. Two articles met inclusion criteria and were subsequently included in the final full-text review. A total of 11 shoulders were represented between these 2 studies. Heterogeneity of the data across the 2 studies did not allow for meta-analysis. Hansen et al found that repair of the subscapularis with rTSA significantly increased the mean joint reaction force and the force required by the posterior deltoid, total deltoid, infraspinatus, teres minor, total posterior rotator cuff, and pectoralis major muscles. Giles et al found that rotator cuff repair and glenosphere lateralization both increased total joint load. Conclusion The present review of biomechanical literature shows that repair of the subscapularis in the setting of rTSA can effectively restore shoulder strength by increasing joint reactive forces and ROM force requirements of other rotator cuff muscles and of the deltoid muscle. Available biomechanical evidence is limited, and further biomechanical studies evaluating the strength of various subscapularis repair techniques are needed to evaluate the effects of these techniques on joint reactive forces and muscle forces required for ROM.
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Affiliation(s)
- Fletcher R. Preuss
- David Geffen School of Medicine at The University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Matthew T. Provencher
- The Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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Castagna A, Borroni M, Dubini L, Gumina S, Delle Rose G, Ranieri R. Inverted-Bearing Reverse Shoulder Arthroplasty: Consequences on Scapular Notching and Clinical Results at Mid-Term Follow-Up. J Clin Med 2022; 11:jcm11195796. [PMID: 36233664 PMCID: PMC9572577 DOI: 10.3390/jcm11195796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Scapular notching following reverse shoulder arthroplasty (RSA) is caused by both biological and mechanical mechanisms. Some authors postulated that osteolysis that extends over the inferior screw is caused mainly by biological notching. Inverted-bearing RSA (IB-RSA) is characterized by a polyethylene glenosphere and a metallic humeral liner, decreasing the poly debris formation and potentially reducing high grades of notching. This study aims to report the results of IB-RSA on a consecutive series of patients at mid-term follow-up, focusing on the incidence of Sirveaux grade 3 and 4 scapular notching. Methods: A retrospective study on 78 consecutive patients who underwent primary IB-RSA between 2015−2017 was performed. At a 4 years minimum follow-up, 49 patients were evaluated clinically with Constant score (CS), Subjective shoulder value (SSV), American Shoulder and Elbow score (ASES), pain and range of motion, and with an X-ray assessing baseplate position (high, low), implant loosening, and scapular notching. Results: At a mean follow-up of 5.0 ± 0.9, all the clinical parameters improved (p < 0.05). One patient was revised for an infection and was excluded from the evaluation, two patients had an acromial fracture, and one had an axillary neuropraxia. Scapular notching was present in 13 (27%) patients (six grade 1, seven grade 2) and no cases of grade 3 and 4 were observed. Scapular nothing was significantly associated with high glenoid position (p < 0.001) and with lower CS (70 ± 15 vs. 58 ± 20; p = 0.046), SSV (81 ± 14 vs. 68 ± 20; p = 0.027), ASES (86 ± 14 vs. 70 ± 22; p = 0.031), and anterior elevation (148 ± 23 vs. 115 ± 37; p = 0.006). A 44 mm- compared to 40 mm-glenosphere was associate with better CS (63 ± 17 vs. 78 ± 11; p = 0.006), external (23 ± 17 vs. 36 ± 17; p = 0.036), and internal rotation (4.8 ± 2.7 vs. 7.8 ± 2.2; p = 0.011). Conclusions: IB-RSA is a safe and effective procedure for mid-term follow-up. Inverting biomaterials leads to a distinct kind of notching with mainly mechanical features. Scapular notching is associated with a high baseplate position and has a negative influence on range of motion and clinical outcome.
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Affiliation(s)
- Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Rozzano (Mi), 20090 Milan, Italy
- IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano (Mi), 20089 Milan, Italy
| | - Mario Borroni
- IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano (Mi), 20089 Milan, Italy
| | - Luigi Dubini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Rozzano (Mi), 20090 Milan, Italy
| | - Stefano Gumina
- Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Roma, Italy
- Istituto Clinico Ortopedico Traumatologico (ICOT), Via Franco Faggiana 1668, 04100 Latina, Italy
| | - Giacomo Delle Rose
- IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano (Mi), 20089 Milan, Italy
| | - Riccardo Ranieri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Rozzano (Mi), 20090 Milan, Italy
- Correspondence: ; Tel.: +39-33-8857-1926
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Skedros JG, Cronin JT, Finlinson ED, Langston TD, Adondakis MG. Manual wheelchair use leads to a series of failed shoulder replacements: A case report and literature review. Clin Case Rep 2022; 10:e06374. [PMID: 36188047 PMCID: PMC9508804 DOI: 10.1002/ccr3.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
Manual wheelchair users place high stress on their shoulders. We describe a 69-year-old male who developed end-stage shoulder osteoarthritis from chronic manual wheelchair (MW) use. Three prosthetic total shoulder replacements failed, reflecting his refusal to transition to an electric wheelchair. MW use must be avoided in some of these patients.
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Affiliation(s)
- John G. Skedros
- Department of Orthopaedic SurgeryThe University of UtahSalt Lake CityUtahUSA
- Utah Orthopaedic SpecialistsSalt Lake CityUtahUSA
- Intermountain Medical CenterSalt Lake CityUtahUSA
| | | | | | - Tanner D. Langston
- Department of RadiologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Micheal G. Adondakis
- Department of RadiologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Bilateral Reverse Shoulder Prosthesis Long-therm Follow-up: A Case Report. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1110985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: Reverse shoulder prosthesis is a method used after massive rotator cuff tears. It is a surgical method used to improve shoulder functions and to cope with pain. Long-term results of physiotherapy programs applied after surgery are insufficient. The aim of this study is to investigate the long-term results of reverse shoulder prosthesis applied to both shoulders.
Methods: A 66-year-old female patient with a rotator cuff tear on both shoulders was included in the study. After surgery, 40 sessions of physiotherapy were applied to the left shoulder and 45 sessions of physiotherapy to the right shoulder, and the right shoulder was followed for 6 years and the left shoulder for 8 years. VAS for pain, goniometer for active range of motion, and constant shoulder score questionnaire for functionality were used in the evaluations.
Results: Significant differences were found in the preoperative and postoperative evaluation in terms of pain, activities of daily living and active range of motion of the patient. While the preoperative Constant scores were 32 for the left shoulder and 34 for the right shoulder, the postoperative Constant scores were calculated as 84 for both shoulders.
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Olson JJ, Galetta MD, Keller RE, Oh LS, O'Donnell EA. Systematic review of prevalence, risk factors, and management of instability following reverse shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:261-268. [PMID: 37588866 PMCID: PMC10426617 DOI: 10.1016/j.xrrt.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability following RSA. Methods A systematic review of the PubMed, EMBASE, MEDLINE, Scopus, and Cochrane Library databases was performed according to PRISMA guidelines. Inclusion criteria included primary RSA cohorts ≥ 100 patients, revision RSA cohorts of any size, and minimum 1-year follow-up. The primary outcome of interest was postoperative instability. MINORS criteria were used to assess study bias. Descriptive statistical analysis was performed with data reported as ranges. Results Seventeen studies that included 7885 cases of RSA were reviewed. The mean follow-up ranged from 12 to 84 months. Mean age ranged from 64 to 77 years old, and males represented 19 to 39% of cohorts. There were 204 (2.5%) dislocations in 7885 cases, accounting for a rate of instability from 0.4 to 49% across all studies. By intervention, instability rates ranged from 1 to 5% (primary RSA cases), 1 to 49% (revision RSA cases only), and 0.4 to 10% (mixed cohorts). Subscapularis insufficiency and proximal humerus fractures, and fracture sequelae (malunion and nonunion) were identified as risk factors for instability. Closed reduction and casting and revision RSA were reported as successful treatment strategies with acceptable rates of stable prostheses (28-100% and 55-100%, respectively, across studies). Hemiarthroplasty or resection arthroplasty due to recurrent instability was not uncommon after 2 or more episodes of instability. Conclusion Instability following RSA occurs infrequently (1-5%) following primary RSA and more commonly following revision RSA (1-49%). RSA for acute proximal humerus fracture and fracture sequelae carries a higher risk of instability. Subscapularis repair appears to be a protective factor. While instability may be successfully treated with closed management or revision RSA, recurrent instability may ultimately require hemiarthroplasty or resection arthroplasty.
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Affiliation(s)
- Jeffrey J. Olson
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Michael D. Galetta
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Rachel E. Keller
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Luke S. Oh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Evan A. O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
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Kirsch JM, Patel M, Hill BW, McPartland C, Namdari S, Lazarus MD. Preoperative Single Assessment Numeric Evaluation Score Predicts Poor Outcomes After Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears Without Arthritis. Orthopedics 2022; 45:215-220. [PMID: 35245141 DOI: 10.3928/01477447-20220225-07] [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: 02/03/2023]
Abstract
Limited clinical evidence is available to help to predict poor outcomes after reverse shoulder arthroplasty (RSA) among patients with massive rotator cuff tears without glenohumeral arthritis. A retrospective case-control study was performed for patients who underwent RSA for massive rotator cuff tear without glenohumeral arthritis (Hamada score ≤3) and had a minimum of 2 years of follow-up. Preoperative risk factors for poor outcomes were subsequently analyzed. Sixty patients (mean age, 71.4±7.4 years) met the inclusion criteria. Of these, 18 (30%) patients had poor outcomes (case group). The case group had significantly worse postoperative Single Assessment Numeric Evaluation (SANE) (61.6±29.5 vs 84.9±14.1, respectively; P=.002), American Shoulder and Elbow Surgeons (58.9±22.5 vs 82.2±14.2, respectively; P<.001), and Simple Shoulder Test (5.4±3.6 vs 8.5±2.4, respectively; P=.002) scores compared with the control group. Patients with poor outcomes had significantly higher preoperative SANE scores compared with control subjects (40.4±28.4 vs 18.8±15.7, respectively; P=.021). The results of this study suggest that patients with better overall preoperative function, as represented by higher SANE scores, have a greater likelihood of poor functional outcomes after RSA for massive rotator cuff tears without glenohumeral arthritis. For these patients, alternative treatment options should be considered. [Orthopedics. 2022;45(4):215-220.].
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The Role of Humeral Neck-Shaft Angle in Reverse Total Shoulder Arthroplasty: 155° versus <155°—A Systematic Review. J Clin Med 2022; 11:jcm11133641. [PMID: 35806927 PMCID: PMC9267919 DOI: 10.3390/jcm11133641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/19/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to have updated scrutiny of the influence of the humeral neck-shaft angle (HNSA) in patients who underwent reverse shoulder arthroplasty (RSA). A PRISMA-guided literature search was conducted from May to September 2021. Clinical outcome scores, functional parameters, and any complications were reviewed. Eleven papers were identified for inclusion in this systematic review. A total of 971 shoulders were evaluated at a minimum-follow up of 12 months, and a maximum of 120 months. The sample size for the "HNSA 155°" group is 449 patients, the "HNSA 145°" group involves 140 patients, and the "HSNA 135°" group comprises 291 patients. The HNSA represents an important variable in choosing the RSA implant design for patients with rotator cuff arthropathy. Positive outcomes are described for all the 155°, 145°, and 135° HSNA groups. Among the different implant designs, the 155° group show a better SST score, but also the highest rate of revisions and scapular notching; the 145° cohort achieve the best values in terms of active forward flexion, abduction, ASES score, and CMS, but also the highest rate of infections; while the 135° design obtains the best results in the external rotation with arm at side, but also the highest rate of fractures. High-quality studies are required to obtain valid results regarding the best prosthesis implant.
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Survivorship of Reverse Shoulder Arthroplasty According to Indication, Age and Gender. J Clin Med 2022; 11:jcm11102677. [PMID: 35628804 PMCID: PMC9145012 DOI: 10.3390/jcm11102677] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
Background. The indications for reverse shoulder arthroplasty (RSA) have been widely expanded, but only a few studies report the long-term survival of these implants. Our objective was to report the long-term survivorship of a large series of RSAs implanted for different etiologies. Methods. A retrospective multicenter study including all the RSAs was performed in six shoulder-specialized centers with at least 2 years of follow up. We reviewed 1611 RSAs, operated between 1993 and 2010, including 497 cuff-tear arthropathies (CTA), 239 revision RSAs, 188 massive cuff tears (MCT), 185 fracture sequelae (FS), 183 failed previous cuff repairs (FCR), and 142 primary osteoarthritis (POA). The mean follow-up was 5.6 ± 3.9 years (range 2−20). Results. Overall, 266 RSAs (16.5%) had at least one complication leading to 64 reoperations (4.0%) and 110 revision surgeries (6.8%). The most frequent complications were infection (3.8%), instability (2.8%), and humerus-related complications (2.8%). At 10 years, the survival without revision surgery was 91.0% in primary RSAs and 80.9% in revision RSAs for failed arthroplasty (p < 0.001). In the primary RSA group, MCT and FCR led to 10-year survivals for over 95% but fracture sequelae and tumors had the lowest 10-year survivals (83.9% and 53.1%). Younger patients had a lower 10-year survival. In revision RSAs, male patients had a significantly lower survival than females (72.3% vs. 84.5% at 10 years, p = 0.020). Discussion. Primary RSA for cuff-deficient shoulders or POA leads to a high 10-year survival, but revision RSA or primary RSA for FS and tumors are at high-risk for revision. Surgeons should be aware of high rates of complications and lower survival rates of RSA in younger patients, in males, and in RSAs for revision surgery.
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Stadecker M, Gu A, Ramamurti P, Fassihi SC, Wei C, Agarwal AR, Bovonratwet P, Srikumaran U. Risk of revision based on timing of corticosteroid injection prior to shoulder arthroplasty. Bone Joint J 2022; 104-B:620-626. [PMID: 35491573 DOI: 10.1302/0301-620x.104b5.bjj-2021-0024.r3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Corticosteroid injections are often used to manage glenohumeral arthritis in patients who may be candidates for future total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (rTSA). In the conservative management of these patients, corticosteroid injections are often provided for symptomatic relief. The purpose of this study was to determine if the timing of corticosteroid injections prior to TSA or rTSA is associated with changes in rates of revision and periprosthetic joint infection (PJI) following these procedures. METHODS Data were collected from a national insurance database from January 2006 to December 2017. Patients who underwent shoulder corticosteroid injection within one year prior to ipsilateral TSA or rTSA were identified and stratified into the following cohorts: < three months, three to six months, six to nine months, and nine to 12 months from time of corticosteroid injection to TSA or rTSA. A control cohort with no corticosteroid injection within one year prior to TSA or rTSA was used for comparison. Univariate and multivariate analyses were conducted to determine the association between specific time intervals and outcomes. RESULTS In total, 4,252 patients were included in this study. Among those, 1,632 patients (38.4%) received corticosteroid injection(s) within one year prior to TSA or rTSA and 2,620 patients (61.6%) did not. On multivariate analysis, patients who received corticosteroid injection < three months prior to TSA or rTSA were at significantly increased risk for revision (odds ratio (OR) 2.61 (95% confidence interval (CI) 1.77 to 3.28); p < 0.001) when compared with the control cohort. However, there was no significant increase in revision risk for all other timing interval cohorts. Notably, Charlson Comorbidity Index ≥ 3 was a significant independent risk factor for all-cause revision (OR 4.00 (95% CI 1.40 to 8.92); p = 0.036). CONCLUSION There is a time-dependent relationship between the preoperative timing of corticosteroid injection and the incidence of all-cause revision surgery following TSA or rTSA. This analysis suggests that an interval of at least three months should be maintained between corticosteroid injection and TSA or rTSA to minimize risks of subsequent revision surgery. Cite this article: Bone Joint J 2022;104-B(5):620-626.
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Affiliation(s)
- Monica Stadecker
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Chapman Wei
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Amil Raj Agarwal
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Patawut Bovonratwet
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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31
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Preuss FR, Eble SK, Peebles AM, Osuna-Garcia A, Provencher CAPTMT. Shoulder strength outcomes after reverse total shoulder arthroplasty: a systematic review and descriptive synthesis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:131-134. [PMID: 37587955 PMCID: PMC10426537 DOI: 10.1016/j.xrrt.2021.11.004] [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
Hypothesis and Background There is no differences in abduction, internal rotation, or external rotation strength after reverse total shoulder arthroplasty (rTSA) with or without subscapularis repair. Repair of the subscapularis can be effective in the setting of rTSA. However, consensus has yet to be reached on whether postoperative strength after rTSA differs based on subscapularis management. The purpose of this review is to evaluate shoulder strength outcomes after rTSA with and without subscapularis tendon repair. Methods A comprehensive literature review was conducted using the key terms "subscapularis" AND "reverse total shoulder arthroplasty" AND "muscle strength" in PubMed, Embase, Web of Science, Cochrane Reviews and Trials, and Scopus. Original, English-language studies evaluating shoulder strength outcomes after rTSA published from January 1, 2000, to present were evaluated. Strength outcomes reported included abduction strength (kg) and internal rotation strength (kg) using an electric spring balance and external rotation strength (lb) using a handheld dynamometer. Heterogeneity of data in the included studies did not allow for meta-analysis. Resuts The search yielded 4253 unique results, which were screened for inclusion according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two articles met eligibility criteria and were included in the final full-text review. A total of 267 shoulders were represented, 111 with subscapularis repair and 156 without subscapularis repair. No significant differences in abduction (P = .39), internal rotation (P = .09), and external rotation (P = .463) strength were observed between subscapularis repair and nonrepair groups. Conclusion There were no differences in abduction, internal rotation, or external rotation strength after rTSA with or without subscapularis repair. The literature on postoperative strength outcomes after rTSA is limited, and further study in this area is warranted.
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Affiliation(s)
- Fletcher R. Preuss
- David Geffen School of Medicine at The University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Antonia Osuna-Garcia
- Louise M. Darling Biomedical Library, The University of California Los Angeles, Los Angeles, CA, USA
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Bülhoff M, Zeifang F, Welters C, Renkawitz T, Schiltenwolf M, Tross AK. Medium- to Long-Term Outcomes after Reverse Total Shoulder Arthroplasty with a Standard Long Stem. J Clin Med 2022; 11:2274. [PMID: 35566400 PMCID: PMC9103013 DOI: 10.3390/jcm11092274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/02/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Long-term clinical and radiographic outcome data after standard cemented long-stem reverse shoulder arthroplasty (RSA) remain underreported. The aim of this study is to report on medium- to long-term data of patients over 60 years of age. Methods: The same type of RSA (Aequalis Reverse II, Memphis, TN, USA) was implanted in 27 patients with a mean age of 73 years (range 61−84). Indications for RSA were cuff tear arthropathy (CTA) in 25 cases and osteoarthritis (OA) in two cases. Pre- and postoperative Constant Score was assessed and component loosening, polyethylene wear, scapular notching and revision rates were recorded at a mean clinical follow-up (FU) of 127.6 months (SD ± 33.7; range 83−185). Results: The mean-adjusted CS (aCS) improved from 30.0 (range 10−59) to 95.0 (range 33−141) points (p < 0.001). Glenoid loosening was found in two (9.1%) and stem loosening was found in three (13.6%) cases. Polyethylene wear was observed in four (18.2%) cases. Scapular notching appeared in 15 (68.2%) cases but was not associated with poor aCS (p = 0.423), high levels of pain (p = 0.798) or external rotation (p = 0.229). Revision surgery was necessary in three (11.1%) cases. Conclusions: RSA with a cemented standard long stem leads to improvement in forward elevation, abduction and pain after a mean FU of 10 years. However, external rotation does not improve with this prosthetic design. Moreover, scapular notching is observed in the majority of cases, and revision rates (11.1%) as well as humeral loosening rates (13.6%) remain a concern. Level of evidence: Level 4, retrospective cohort study.
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Affiliation(s)
- Matthias Bülhoff
- Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.B.); (T.R.); (M.S.)
| | - Felix Zeifang
- Ethianum Clinic Heidelberg, Voßstraße 6, 69115 Heidelberg, Germany;
| | - Caroline Welters
- Clinic for Dermatology, Munich Municipal Hospital Group, Thalkirchnerstrasse 48, 80337 Munich, Germany;
| | - Tobias Renkawitz
- Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.B.); (T.R.); (M.S.)
| | - Marcus Schiltenwolf
- Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.B.); (T.R.); (M.S.)
| | - Anna-K. Tross
- Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (M.B.); (T.R.); (M.S.)
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Abstract
The 3D printing technology is a relatively new procedure with a high potential, especially in the field of shoulder surgery. The 3D printing procedures are increasingly being developed and also gaining new users. Principally, 3D printing procedures can be applied preoperatively in planning the surgical procedure, patient clarification and in teaching; however, the technology is increasing being used intraoperatively. In addition to intraoperative visualization of the models, 3D printing permits the use of individual and specific instruments and implants. This allows the precise transfer of the preoperative planning to the surgical procedure. Inaccuracies are mainly caused by soft tissues. The 3D printing can be beneficial in the fields of arthroplasty, shoulder instability as well as orthopedic trauma. The literature shows promising results in relation to duration of surgery, blood loss and clinical results of the procedure. On the other hand, it is still unclear which indications warrant the use of 3D printing. Other aspects that raise questions are the time of planning, the production time and the additional cost that the use of 3D printing entails. Nonetheless, 3D printing represents a meaningful enhancement of the portfolio of surgeons, which becomes highly beneficial and useful in complex situations. Furthermore, this procedure enables a certain amount of flexibility when reacting to certain circumstances.
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Devana SK, Shah AA, Lee C, Gudapati V, Jensen AR, Cheung E, Solorzano C, van der Schaar M, SooHoo NF. Development of a Machine Learning Algorithm for Prediction of Complications and Unplanned Readmission Following Reverse Total Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2022; 5:24715492211038172. [PMID: 35330785 PMCID: PMC8938598 DOI: 10.1177/24715492211038172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Reverse total shoulder arthroplasty (rTSA) offers tremendous promise for the treatment of complex pathologies beyond the scope of anatomic total shoulder arthroplasty but is associated with a higher rate of major postoperative complications. We aimed to design and validate a machine learning (ML) model to predict major postoperative complications or readmission following rTSA. Methods We retrospectively reviewed California's Office of Statewide Health Planning and Development database for patients who underwent rTSA between 2015 and 2017. We implemented logistic regression (LR), extreme gradient boosting (XGBoost), gradient boosting machines, adaptive boosting, and random forest classifiers in Python and trained these models using 64 binary, continuous, and discrete variables to predict the occurrence of at least one major postoperative complication or readmission following primary rTSA. Models were validated using the standard metrics of area under the receiver operating characteristic (AUROC) curve, area under the precision–recall curve (AUPRC), and Brier scores. The key factors for the top-performing model were determined. Results Of 2799 rTSAs performed during the study period, 152 patients (5%) had at least 1 major postoperative complication or 30-day readmission. XGBoost had the highest AUROC and AUPRC of 0.681 and 0.129, respectively. The key predictive features in this model were patients with a history of implant complications, protein-calorie malnutrition, and a higher number of comorbidities. Conclusion Our study reports an ML model for the prediction of major complications or 30-day readmission following rTSA. XGBoost outperformed traditional LR models and also identified key predictive features of complications and readmission.
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Affiliation(s)
- Sai K Devana
- David Geffen School of Medicine UCLA, Los Angeles, CA, USA
| | - Akash A Shah
- David Geffen School of Medicine UCLA, Los Angeles, CA, USA
| | | | - Varun Gudapati
- David Geffen School of Medicine UCLA, Los Angeles, CA, USA
| | | | - Edward Cheung
- David Geffen School of Medicine UCLA, Los Angeles, CA, USA
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Etcheson JI, Mohamed NS, Dávila Castrodad IM, Remily EA, Wilkie WA, Edwards WO, Keleman MN, Nace J, Delanois RE. National Trends for Reverse Shoulder Arthroplasty After the Affordable Care Act: An Analysis From 2011 to 2015. Orthopedics 2022; 45:97-102. [PMID: 34978514 DOI: 10.3928/01477447-20211227-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated nationwide patient trends and health care costs for reverse shoulder arthroplasty (RSA) after 2014. This study uses a large validated nationwide database to retrospectively assess changes in patient and hospital demographic features, hospital costs, and hospital charges for inpatient RSA procedures before and after implementation of the Affordable Care Act. The National Inpatient Sample database was used to identify all patients who underwent RSA between January 2011 and December 2015, yielding 163,171 patients (63.4% female; mean age, 72 years). Categorical data were assessed with chi-square/Fisher's exact test, and continuous data were assessed with analysis of variance. There was an increased proportion of RSA recipients identifying as Hispanic (4.1% to 4.8%) and Native American (0.1% to 0.4%; P<.0001). The proportion of patients who had Medicaid (1.4% to 2.4%) and private insurance (15.1% to 16.6%) increased as well (P<.0001). A decrease in mean hospital costs occurred between 2011 and 2015 (-$256; P=.002), whereas an increase occurred in hospital charges (+$6,314; P<.001). These findings provide insight on RSA use and patient demographic trends in the United States. Additionally, these results help to capture the effects of extended health coverage and new reimbursement models on hospital costs and charges. [Orthopedics. 2022;45(2):97-102.].
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Frank JK, Siegert P, Plachel F, Heuberer PR, Huber S, Schanda JE. The Evolution of Reverse Total Shoulder Arthroplasty-From the First Steps to Novel Implant Designs and Surgical Techniques. J Clin Med 2022; 11:1512. [PMID: 35329837 PMCID: PMC8949196 DOI: 10.3390/jcm11061512] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. RECENT FINDINGS Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont's design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing.
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Affiliation(s)
- Julia K. Frank
- Vienna Shoulder and Sports Clinic, Baumgasse 20A, 1030 Vienna, Austria
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with the AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria;
| | - Paul Siegert
- 1st Orthopaedic Department, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130 Vienna, Austria;
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130 Vienna, Austria
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Mitte, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Philipp R. Heuberer
- HealthPi Medical Center, Wollzeile 1/3, 1010 Vienna, Austria;
- Austrian Research Group for Regenerative and Orthopaedic Medicine, 1010 Vienna, Austria
| | - Stephanie Huber
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Center Vienna-Meidling, 1140 Vienna, Austria;
| | - Jakob E. Schanda
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with the AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria;
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130 Vienna, Austria
- AUVA Trauma Center Vienna-Meidling, Kundratstraße 37, 1120 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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Gonzalez FF, Fonseca R, Leporace G, Pitta R, Giordano MN, Chahla J, Metsavaht L. Three-dimensional kinematic evaluation of scapulohumeral rhythm after reverse shoulder arthroplasty: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:8-16. [PMID: 37588296 PMCID: PMC10426534 DOI: 10.1016/j.xrrt.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The movement of the arm relative to the trunk results from 3-dimensional (3D) coordinated movements of the glenohumeral (GH) and scapulothoracic (ST) joints and dictates the scapulohumeral rhythm (SHR). Alterations in SHR increase joint overload and may lead to low functional scores, pain, and failures in patients undergoing reverse total shoulder arthroplasty (RSA). The goal of this systematic review and meta-analysis was to examine 3D SHR kinematics after RSA and compare it to that of asymptomatic shoulders. Methods A systematic review and meta-analysis of articles in English were performed using PubMed, Embase, Cochrane Library, and SciELO. Additional studies were identified by searching bibliographies. Search terms included "Reverse shoulder arthroplasty", "3D", and "scapula". It was selected cross-sectional studies that reported SHR with 3D motion analysis systems in patients who underwent RSA and asymptomatic controls. Two authors independently performed the extraction of articles using predefined data fields, including study quality indicators. Results Data from four studies were included in quantitative analysis, totaling 48 shoulders with RSA and 63 asymptomatic shoulders. Pooled analyses were based on random-effects model (DerSimonian-Laird). A statistically smaller SHR ratio was observed in the RSA group than that in the control group (P < .00001), meaning a greater contribution of ST joint in relation to GH joint for arm elevation. The standardized mean difference was -1.16 (95% confidence interval: -1.64, -0.67). A sensitivity analysis with three more studies that had imputed data on control group did not change the direction of the effect. The standardized mean difference on sensitivity analysis was -0.60 (P = .03; 95% confidence interval: -1.13, -0.06). It was detected as "not important heterogeneity" within the comparison (I2: 22%). Chi-square was not statistically significant (Chi2: 3.85), and I2 was 22%. Tau2 was not zero (Tau2: 0.05). Sensitivity analysis showed an I2 of 74%, which might represent substantial heterogeneity, Chi-square was not statistically significant (Chi2: 23.01), and Tau2 was not zero (Tau2: 0.37). Conclusion This study found that RSA shoulders have an increased contribution of ST joint during arm elevation, compared with asymptomatic shoulders. More movement in ST joint in proportion to GH joint increases GH joint contact forces, which could lead to component loosening or other complications. Further studies should address the clinical implications of this kinematic finding.
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Affiliation(s)
- Felipe F. Gonzalez
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil
- Post Graduation Program of Clinical Radiology, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Raphael Fonseca
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Gustavo Leporace
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil
- Post Graduation Program of Clinical Radiology, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Rafael Pitta
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Marcos N. Giordano
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Leonardo Metsavaht
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil
- Post Graduation Program of Clinical Radiology, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
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Razmjou H, van Osnabrugge V, Anunciacion M, Nunn A, Drosdowech D, Roszkowski A, Szafirowicz A, Boljanovic D, Wainwright A, Nam D. Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty. J Shoulder Elb Arthroplast 2022; 5:24715492211023302. [PMID: 34993379 PMCID: PMC8492033 DOI: 10.1177/24715492211023302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence.Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications. Results In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position. Conclusion Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.
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Affiliation(s)
- Helen Razmjou
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Varda van Osnabrugge
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Anunciacion
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Nunn
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Darren Drosdowech
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Ania Roszkowski
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Analia Szafirowicz
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dragana Boljanovic
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Wainwright
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diane Nam
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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[Clavicle stress fracture following reverse shoulder arthroplasty]. DER ORTHOPADE 2022; 51:246-250. [PMID: 34989823 PMCID: PMC8894215 DOI: 10.1007/s00132-021-04205-6] [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] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
Wir stellen den seltenen Fall einer Insuffizienzfraktur der Klavikula nach Implantation einer inversen Schulterendoprothese (RSA) vor. Als Ursache solcher Frakturen wird eine vermehrte Zugbelastung durch den Musculus deltoideus nach RSA diskutiert. In den wenigen verfügbaren Fallberichten zeigten die betroffenen Patienten deutliche Funktionseinschränkungen. Die Versorgung erfolgte im vorliegenden Fall mit Plattenosteosynthese. Trotz intraoperativ gutem Korrekturergebnis kam es im Verlauf ohne Trauma zum Osteosyntheseversagen mit weiterer Dislokation der Fraktur.
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Luciani P, Farinelli L, De Berardinis L, Gigante A. The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal. Front Surg 2021; 8:624100. [PMID: 34938765 PMCID: PMC8685248 DOI: 10.3389/fsurg.2021.624100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure. Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM). Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system. Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario. Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM. Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.
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Affiliation(s)
- Pierfrancesco Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
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Dolci A, Melis B, Verona M, Capone A, Marongiu G. Complications and Intraoperative Fractures in Reverse Shoulder Arthroplasty: A Systematic Review. Geriatr Orthop Surg Rehabil 2021; 12:21514593211059865. [PMID: 34900387 PMCID: PMC8664304 DOI: 10.1177/21514593211059865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The reverse shoulder arthroplasty is nowadays a treatment option for a variety of shoulder problems. As its incidence rose, also the number of complications increased, including intraoperative fractures. Significance We performed a systematic review and critical analysis of the current literature following the PRISMA guidelines. Our purpose was to: 1) determine incidence, causes, and characteristics of intraoperative fractures; 2) evaluate their current treatment options, possible related complications, reoperation rates, and the patients’ outcome; and 3) determine the overall incidence of each complication related to reverse shoulder arthroplasty. The articles were selected from PubMed medical database in April 2020 using a comprehensive search strategy. Rayyan software was used to support the selection process of the records. A descriptive and critical analysis of the results was performed. Results The study group included a total of 13,513 reverse shoulder arthroplasty procedures. The total number of complications was 1647 (rate 12.1%). The most common complication was dislocation (340 cases, rate 2.5%). Forty-six studies reported a total of 188 intraoperative fractures among the complications (rate 1.4%). The intraoperative fracture rate was 2.9% and 13.6% in primary and revision settings, respectively. There were 136 humeral fractures, 60% of them occurred in revision RSAs, during the removal of the previous implant, and involved the shaft in the majority of cases (39%). Glenoid fractures were 51 and occurred mostly during the reaming of the glenoid. We observed 7 further related complications (rate of 4%) and 3 reoperations (rate of 1.5%). The outcome was satisfactory in the majority of cases. Conclusions A comprehensive review on intraoperative fractures in reverse shoulder arthroplasties is presented. Results suggest favorable outcomes for all treatment methods, with a modest further complication rate. This investigation may aid in the treatment decision-making for these complications.
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Affiliation(s)
- Andrea Dolci
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Barbara Melis
- Orthopaedic and Sport Trauma Unit, Casa di Cura Policlinico Città di Quartu, Quartu Sant'Elena, Italy
| | - Marco Verona
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Antonio Capone
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
| | - Giuseppe Marongiu
- Department of Surgical Sciences, Orthopaedic and Trauma Clinic, Policlinico Universitario D. Casula, University of Cagliari, Monserrato, Cagliari, Italy
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Medialized versus Lateralized Center of Rotation in Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245868. [PMID: 34945160 PMCID: PMC8703399 DOI: 10.3390/jcm10245868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
One of the original biomechanical principles of reverse total shoulder arthroplasty (RTSA) is medialization of the center of rotation (COR) relative to the native level of the glenoid. Several authors have proposed the lateralized center of rotation, which is characterized by a lateralized (L) glenoid and medialized (M) humeral component. The aim of this review is to compare the clinical and functional outcomes of COR in medialized (M-RTSA) and lateralized (L-RTSA) RTSA in patients with uniform indications and treatment through a meta-analysis. A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Clinical Answers was conducted from April to May 2021. Twenty-four studies were included in the qualitative synthesis, and 19 studies were included in the meta-analysis. Treatment with RTSA resulted in positive post-operative outcomes and low complication rates for both groups. Statistically relevant differences between L-RTSA group and M-RTSA group were found in post-operative improvement in external rotation with arm-at-side (20.4° and 8.3°, respectively), scapular notching rates (6.6% and 47.7%) and post-operative infection rates (1% and 7.7%). Both lateralized and medialized designs were shown to improve the postoperative outcomes. Nevertheless, a lateralized COR resulted in greater post-operative external rotation.
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Kennedy JS, Reinke EK, Friedman LGM, Cook C, Forsythe B, Gillespie R, Hatzidakis A, Jawa A, Johnston P, Nagda S, Nicholson G, Sears B, Wiesel B, Garrigues GE, Hagen C, Hong I, Roach M, Jones N, Mahendraraj K, Michaelson E, Bader J, Mauter L, Mengers S, Renko N, Strony J, Hart P, Steele E, Naylor A, Gaudette J, Sprengel K. Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. Arch Physiother 2021; 11:28. [PMID: 34886910 PMCID: PMC8662891 DOI: 10.1186/s40945-021-00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups. Methods This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over. Discussion RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy. Trial registration This study is registered as NCT03719859 at ClincialTrials.gov. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-021-00121-2.
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Affiliation(s)
- June S Kennedy
- Department of Physical and Occupational Therapy, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Lisa G M Friedman
- Department of Orthopedics, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA.,Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC, 27701, USA.,Duke Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Robert Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland, 11000 Euclid Ave, Cleveland, OH, 44106, United States
| | | | - Andrew Jawa
- Boston Sports and Shoulder Center, 40 Allied Dr., Suite 102, Dedham, MA, 02026, USA
| | - Peter Johnston
- Centers for Advanced Orthopaedics, 25500 Point Lookout Road, Leonardtown, MD, 20650, USA
| | - Sameer Nagda
- Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA, 22206, USA
| | - Gregory Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Benjamin Sears
- Western Orthopaedics, 1830 Franklin St, 450, Denver, CO, 80218, USA
| | - Brent Wiesel
- MedStar Orthopaedic Institute, 3800 Reservoir Road Northwest, Washington, DC, 20007, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
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Jo YH, Kim DH, Lee BG. When should reverse total shoulder arthroplasty be considered in glenohumeral joint arthritis? Clin Shoulder Elb 2021; 24:272-278. [PMID: 34875733 PMCID: PMC8651594 DOI: 10.5397/cise.2021.00633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Anatomical total shoulder arthroplasty (TSA) has been used widely in treatment of glenohumeral osteoarthritis and provides excellent pain relief and functional results. Reverse total shoulder arthroplasty (RSA) was created to treat the complex problem of rotator cuff tear arthropathy. RSA also has been performed for glenohumeral osteoarthritis even in cases where the rotator cuff is preserved and has shown good results comparable with TSA. The indications for RSA are expanding to include tumors of the proximal humerus, revision of hemiarthroplasty to RSA, and revision of failed TSA to RSA. The purposes of this article were to describe comprehensively the conditions under which RSA should be considered in glenohumeral osteoarthritis, to explain its theoretical background, and to review the literature.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hong Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review. J Clin Med 2021; 10:jcm10245745. [PMID: 34945040 PMCID: PMC8703663 DOI: 10.3390/jcm10245745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prosthesis selection, design, and placement in reverse total shoulder arthroplasty (RTSA) affect post-operative results. The aim of this systematic review was to evaluate the influence of the humeral stem version and prosthesis design (inlay vs. onlay) on shoulder function following RTSA. METHODS A systematic review of the literature on post-operative range of motion (ROM) and functional scores following RTSA with specifically known humeral stem implantations was performed using MEDLINE, Pubmed, and Embase databases, and the Cochrane Library. Functional scores included were Constant scores (CSs) and/or American Shoulder and Elbow Surgeons (ASES) scores. The patients were organised into three separate groups based on the implanted version of their humeral stem: (1) less than 20° of retroversion, (2) 20° of retroversion, and (3) greater than 20° of retroversion. RESULTS Data from 14 studies and a total of 1221 shoulders were eligible for analysis. Patients with a humeral stem implanted at 20° of retroversion had similar post-operative mean ASES (75.8 points) and absolute CS (68.1 points) compared to the group with humeral stems implanted at less than 20° of retroversion (76 points and 62.5 points; p = 0.956 and p = 0.153) and those implanted at more than 20° of retroversion (73.3 points; p = 0.682). Subjects with humeral stem retroversion at greater than 20° tended towards greater active forward elevation and external rotation compared with the group at 20° of retroversion (p = 0.462) and those with less than 20° of retroversion (p = 0.192). Patients with an onlay-type RTSA showed statistically significantly higher mean post-operative internal rotation compared to patients with inlay-type RTSA designs (p = 0.048). Other functional scores and forward elevation results favoured the onlay-types, but greater external rotation was seen in inlay-type RTSA designs (p = 0.382). CONCLUSIONS Humeral stem implantation in RTSA at 20° of retroversion and greater appears to be associated with higher post-operative outcome scores and a greater range of motion when compared with a retroversion of less than 20°. Within these studies, onlay-type RTSA designs were associated with greater forward elevation but less external rotation when compared to inlay-type designs. However, none of the differences in outcome scores and range of motion between the humeral version groups were statistically significant.
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Georgoulas P, Fiska A, Ververidis A, Drosos GI, Perikleous E, Tilkeridis K. Reverse Shoulder Arthroplasty, Deltopectoral Approach vs. Anterosuperior Approach: An Overview of the Literature. Front Surg 2021; 8:721054. [PMID: 34869550 PMCID: PMC8636448 DOI: 10.3389/fsurg.2021.721054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Reverse shoulder arthroplasty (RSA) has become an optimal treatment for numerous orthopedic entities, such as rotator cuff tear arthropathies, pseudoparalysis, fracture sequelae, acute fractures, failed arthroplasties, osteoarthritis, and rheumatoid arthritis, and is linked with relief of topical pain and regaining of functionality. Presently, RSA has been conducted through anterosuperior (AS) or deltopectoral (DP) approach. The aim of the study was to discuss both approaches and to examine broadly their features to render a comparison in terms of clinical effectiveness. An electronic search in PubMed, EMBASE, and Google Scholar databases was performed, using combinations of the following keywords: RSA, DP approach, AS approach, notching, and cuff tear arthropathy. A total of 61 studies were found, and 16 relevant articles were eventually included. Currently published literature has not shown significant diversities in the clinical course due to approach preference; risk of instability seems to be greater in DP approach, while regarding scapular notching and fracture rates the findings were conflicted. In addition, the AS approach has been associated with decreased risk of acromial and scapular spine fractures. In conclusion, both surgical approaches have shown similar clinical outcomes and effectiveness concerning pain and restoring range of motion (ROM) in rotator cuff tear arthropathies. In the future, further investigations based on large-scale well-designed studies are required to address clinical gaps allowing in-depth comparison of both approaches.
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Affiliation(s)
- Paraskevas Georgoulas
- Department of Orthopedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Aliki Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Ververidis
- Department of Orthopedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios I Drosos
- Department of Orthopedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Konstantinos Tilkeridis
- Department of Orthopedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Kostretzis L, Konstantinou P, Pinto I, Shahin M, Ditsios K, Papadopoulos P. Stemless reverse total shoulder arthroplasty: a systematic review of contemporary literature. Musculoskelet Surg 2021; 105:209-224. [PMID: 34003464 DOI: 10.1007/s12306-021-00710-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy and other degenerative shoulder diseases. In recent years, aiming for bone stock preservation has led to the design of metaphyseal humeral components without a stem. The aims of this study were to evaluate the complication and reintervention rates, as well as the clinical and radiographic outcomes in patients who underwent reverse shoulder arthroplasty (RSA) with stemless implants. METHODS A systematic review of the literature was completed until May 2020 using PubMed, EMBASE, CINAHL and Cochrane databases, according to PRISMA guidelines. RESULTS The literature search revealed 2942 studies, of which 13 were included in this review, with a total of 517 patients and a mean follow-up between 6.4 and 101.6 months. The total complication rate was 6.5%, while 3.3% were humeral associated complications. Finally, the rate of shoulders that underwent a reintervention was 6.7%, with 1.4% relating to a humeral component reason. Stemless RSA led to substantial improvements in patient reported outcome measures and range of motion across all studies. Scapular notching was reported in 15.2%, and lucencies around humeral component were reported in 0.8% of shoulders. CONCLUSION Stemless RSA resulted in low complication and reintervention rates at the mid-term follow-up. The reported clinical and radiological outcomes showed that these prostheses have at least equivalent outcomes with their stemmed counterparts. Further studies are required to investigate the long-term longevity and performance of the stemless humeral implants. LEVEL OF EVIDENCE Level IV; Systematic Review.
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Affiliation(s)
- L Kostretzis
- Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, 5415 Boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada.
| | - P Konstantinou
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
| | - I Pinto
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
| | - M Shahin
- Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, 5415 Boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - K Ditsios
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
| | - P Papadopoulos
- 2nd Department of Orthopaedic Surgery, G.Gennimatas Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece
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Ascione F, Panni AS, Braile A, Corona K, Toro G, Capuano N, Romano AM. Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties, a systematic review: part II-problems and reinterventions. J Orthop Traumatol 2021; 22:49. [PMID: 34826010 PMCID: PMC8626544 DOI: 10.1186/s10195-021-00613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. METHODS This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (1 January 2000 to 14 April 2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar, employing several combinations of keywords: "reverse shoulder arthroplasty," "reverse shoulder prosthesis," "inverse shoulder arthroplasty," "inverse shoulder prosthesis," "problems," "complications," "results," "outcomes," "reoperation," and "revision." RESULTS Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with overall reoperation and revision rates of 1.7% and 2.6%, respectively. CONCLUSIONS Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas no humeral fractures or stem loosening were reported with short stems. Infections (1.3%) were the most common reason for component revision, followed by instability (0.8%). LEVEL OF EVIDENCE Systematic review IV.
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Affiliation(s)
- Francesco Ascione
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy. .,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.
| | - Alfredo Schiavone Panni
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Adriano Braile
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | - Giuseppe Toro
- Dipartimento Multidisciplinare Di Specialità Medico-Chirurgiche Ed Odontoiatriche, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Nicola Capuano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy
| | - Alfonso M Romano
- Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via Petrarca 35, 80123, Napoli (NA), Italy.,Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
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Lateralization in Reverse Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10225380. [PMID: 34830659 PMCID: PMC8623532 DOI: 10.3390/jcm10225380] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/05/2022] Open
Abstract
Indications for Reverse Shoulder Arthroplasty (RSA) have been extended over the last 25 years, and RSA has become the most frequently implanted shoulder arthroplasty worldwide. The initial Grammont design with medialization of the joint center of rotation (JCOR), placement of the JCOR at the bone–implant interface, distalization and semi-constrained configuration has been associated with drawbacks such as reduced rotation and range of motion (ROM), notching, instability and loss of shoulder contour. This review summarizes new strategies to overcome these drawbacks and analyzes the use of glenoid-sided, humeral-sided or global bipolar lateralization, which are applied differently by surgeons and current implant manufacturers. Advantages and drawbacks are discussed. There is evidence that lateralization addresses the initial drawbacks of the Grammont design, improving stability, rates of notching, ROM and shoulder contour, but the ideal extent of lateralization of the glenoid and humerus remains unclear, as well as the maximal acceptable joint reaction force after reduction. Overstuffing and spine of scapula fractures are potential risks. CT-based 3D planning as well as artificial intelligence will help surgeons with planning and execution of appropriate lateralization in RSA. Long-term follow-up of lateralization with new implant designs and implantation strategies is needed.
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Heifner JJ, Kumar AD, Wagner ER. Reverse shoulder arthroplasty used for revision of reverse shoulder arthroplasty: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:329-334. [PMID: 37588710 PMCID: PMC10426696 DOI: 10.1016/j.xrrt.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background As reverse shoulder arthroplasty (RSA) cases increase, so too will the need to revise subsequent failures. Many of the complications associated with revising anatomic total shoulder and hemiarthroplasty have been adequately addressed by RSA including glenoid bone deficiency, instability, and functional outcomes. However, the risk for complication when revising a failed reverse prosthesis may be more pronounced with increased bone and soft tissue deficiency. The ability for the reversed prosthesis to accommodate these insufficiencies following a prior reversed prosthesis is unclear. Methods PubMed, Embase, and Google Scholar were queried for articles which fit the inclusion criteria of a reversed prosthesis used to revise a failed primary reverse prosthesis with a minimum follow-up of 12 months and clinical outcome reporting. Results After exclusions, 9 studies reporting on 242 reverse shoulders with a mean follow-up of 40.29 months were analyzed. The differences between preoperative and postoperative weighted means were not significant for Constant (P = .26), American Shoulder and Elbow Surgeons Shoulder score (P = .61), SSV (P = .57), and visual analog scale for pain (P = .48). Functional improvements in elevation (74°-102°) and external rotation (18°-21°) were consistent with those reported for primary reverse procedures, although differences in preoperative and postoperative measures were not statistically significant. Patient satisfaction was 89% with a major complication rate of 25%. Discussion The reverse shoulder prosthesis has proven satisfactory in revising hemiarthroplasty and anatomic total shoulder arthroplasty. The current results indicate RSA is also a satisfactory treatment option when revising a prior reverse prosthesis. Inherent to revision shoulder surgery is the obstacle of humeral and glenoid bone loss, an attenuated soft-tissue envelope, and instability. The reverse prosthesis may adequately address these commonly confronted difficulties with its inherent design characteristics. RSA provides a secure glenoid fixation for bone grafting, the ability to increase construct stability with component sizing, and a reliance on the deltoid for function. As our learning about revision of RSA improves, so will our ability to preemptively address potential issues which may lead to decreased complications in these cases. Despite the 25% rate of major complication, patients reported satisfaction of 89% which demonstrates the improvements in function and pain relief that are provided by the reverse prosthesis.
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Affiliation(s)
| | - Anjali D. Kumar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric R. Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Director of Upper Extremity Surgery Research, Atlanta, GA, USA
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