1
|
Pelsma ICM, Kroon HM, Andela CD, van der Linden EMJ, Kloppenburg M, Biermasz NR, Claessen KMJA. Approach to the patient with controlled acromegaly and acromegalic arthropathy: clinical diagnosis and management. Pituitary 2024; 27:824-836. [PMID: 39485592 PMCID: PMC11632006 DOI: 10.1007/s11102-024-01465-1] [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] [Accepted: 10/14/2024] [Indexed: 11/03/2024]
Abstract
Following the description of an illustrative case of a 70-year-old female patient with longstanding active acromegaly and invalidating, progressive joint complaints, current insights regarding diagnosis, treatment, and long-term management of acromegalic arthropathy are summarized. Since clinical trials on this topic are lacking, the reported recommendations are based on extensive clinical and research experience with this clinical entity, and on established diagnostics and interventions in patients with other rheumatic diseases. The cornerstones of the management of acromegalic arthropathy remains normalization of growth hormone and insulin growth factor-1 levels. However, patients with severe or progressive acromegalic arthropathy require a multidisciplinary approach to determine adequate diagnostics and treatment options. Because of the high prevalence and invalidating character of acromegalic arthropathy, developing evidence-based effective prevention and treatment strategies, preferably by international collaboration within rare disease networks, e.g., Endo-ERN, is a clear unmet need.
Collapse
Affiliation(s)
- Iris C M Pelsma
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelie D Andela
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Basalt Rehabilitation Center, The Hague, The Netherlands
| | | | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
2
|
Akhtar M, Razick DI, Dhaliwal A, Guadagno K, Baig O, Wen J, Jundi M, Nadora D, Nadora D, Huish E. Effect of Preoperative Corticosteroid Injections on Postoperative Risk of Periprosthetic Joint Infection and Revision Surgery After Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e75473. [PMID: 39791093 PMCID: PMC11717139 DOI: 10.7759/cureus.75473] [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: 12/10/2024] [Indexed: 01/12/2025] Open
Abstract
In total joint arthroplasty, periprosthetic joint infection (PJI) can be devastating. Corticosteroid injections (CSIs) are commonly administered for temporary pain relief in the setting of various conditions. Therefore, the current systematic review aims to evaluate whether CSIs administered prior to total shoulder arthroplasty (TSA) are a risk factor for PJI and revision surgery. A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Scopus databases to identify studies evaluating outcomes in patients receiving CSIs prior to TSA. A meta-analysis comparing the risk of PJI between patients receiving CSIs at various time points versus those with no CSIs was performed. Seven studies comprising 49,786 patients who received CSIs were included. Most studies reported significantly higher odds of PJI and revision surgery when CSIs were administered within three months of TSA. The results of the meta-analysis found the risk of PJI was significantly higher when CSIs were administered within three months of TSA (risk ratio (RR): 1.12, 95% confidence interval (CI): 1.04-1.20, P = 0.002) but not greater than three months prior to TSA (RR: 1.02, 95% CI: 0.80-1.30, P = 0.85), relative to a control group undergoing TSA with no prior CSIs. Several studies have demonstrated that CSIs are associated with increased risks of PJI and revision surgery. A safe interval between CSI and subsequent TSA, to minimize the risk of PJI and revision surgery, appears to be around one to three months, with three months being the safest time period, as supported by the findings of our meta-analysis.
Collapse
Affiliation(s)
- Muzammil Akhtar
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Daniel I Razick
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | | | | | - Osamah Baig
- Ophthalmology, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Jimmy Wen
- Physical Medicine and Rehabilitation, California Northstate University College of Medicine, Elk Grove, USA
| | - Mustafa Jundi
- Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, USA
| | - Dawnica Nadora
- Dermatology, California Northstate University College of Medicine, Elk Grove, USA
| | - Denise Nadora
- Internal Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | - Eric Huish
- Orthopedics, San Joaquin General Hospital, French Camp, USA
| |
Collapse
|
3
|
Lalande S, Moffatt M, Smith T, Aggarwal V, Littlewood C. An Analysis of Publicly Available National Health Service Information Leaflets for Patients With Shoulder Osteoarthritis. Musculoskeletal Care 2024; 22:e70028. [PMID: 39694882 DOI: 10.1002/msc.70028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 11/26/2024] [Accepted: 12/10/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND Shoulder osteoarthritis is a common cause of pain, disability and difficulty sleeping. Patient information leaflets are produced by NHS Trusts with the aim of informing patients about their diagnosis and available treatment options. OBJECTIVES The aim of this study was to identify and describe the non-surgical management of people with shoulder osteoarthritis according to publicly available information leaflets produced by NHS Trusts. METHODS One reviewer undertook an electronic search using Google to identify publicly available patient-facing information leaflets (PIL) produced by NHS Trusts which detailed non-surgical management strategies for people with shoulder osteoarthritis. Relevant data were extracted by one reviewer and verified by two reviewers. RESULTS Seventeen PILs from 17 different UK NHS Trusts were identified ranging from December 2016 to February 2024. Information provided in the PIL varied, with topics including general osteoarthritis management, exercise, analgesia, injections, and surgical indications. No PIL covered all areas recommended in the NICE Osteoarthritis Management guidelines. CONCLUSION PILs developed and published by NHS Trusts are variable in content and do not fully reflect current clinical guidelines. High-quality research to inform consistent, clinically, and cost-effective treatment pathways, including information provision, for patients with shoulder osteoarthritis is needed.
Collapse
|
4
|
Lalande S, Moffatt M, Littlewood C. Shoulder osteoarthritis: A survey of current (2024) UK physiotherapy practice. Musculoskeletal Care 2024; 22:e1917. [PMID: 39010265 DOI: 10.1002/msc.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Shoulder osteoarthritis can cause significant pain and disability. It is thought that the wider principles of osteoarthritis management can be applied in the management of people with shoulder osteoarthritis, but most prior research has been conducted with people experiencing osteoarthritis of the hip and knee. There is a paucity of evidence to guide the non-surgical management of shoulder osteoarthritis and limited understanding of current physiotherapy practice. OBJECTIVE We aimed to investigate the current treatment recommendations by physiotherapists in the UK for people with shoulder OA. METHODS An online survey using a clinical vignette was designed and distributed to UK registered physiotherapists with experience of managing people with shoulder osteoarthritis, via social media and professional networks. Descriptive statistics were used to analyse demographic and multiple-choice questions, and free text responses were summarised narratively. RESULTS 114 respondents accessed the survey with 110 valid responses; 105 (95%) respondents would offer face-to-face consultations, with 89 (81%) respondents expecting to offer 2-4 appointments. 108 (98%) respondents would offer advice/education; 79 (72%) would offer weight management; 82 (75%) prescribed exercises to improve movement; and 101 (92%) offered exercises to increase strength. If a person lived with obesity or had a treatment preference, the majority of respondents would change their recommendations. CONCLUSION This is the first survey of NHS physiotherapy practice for people with shoulder osteoarthritis. The responses largely align with NICE guidelines; despite this alignment, it is not known whether such guideline-based care is acceptable to people with shoulder osteoarthritis or clinically effective.
Collapse
Affiliation(s)
- Stacey Lalande
- Airedale NHS Foundation Trust, Airedale General Hospital, Keighley, UK
| | - Maria Moffatt
- School of Health Sciences, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Chris Littlewood
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| |
Collapse
|
5
|
Prakash R, Gardner JE, Petric UB, Pathak R, Atem F, Jain NB. Association of Age and Sex at Onset With Glenohumeral Osteoarthritis: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:611-616. [PMID: 38207175 PMCID: PMC11178476 DOI: 10.1097/phm.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The aim of the present systematic review is to synthesize existing evidence (qualitative and quantitative) regarding age- and sex-specific differences with glenohumeral osteoarthritis. DESIGN The electronic databases PubMed, MEDLINE, and Web of Science were searched up to March 15, 2023. Articles reporting on the association of risk factors (age and sex) with glenohumeral osteoarthritis were considered. We used Newcastle-Ottawa Scale to assess study quality. Meta-analysis was conducted to quantitatively summarize the association of age and sex with glenohumeral osteoarthritis. RESULTS A total of 24 articles were retrieved for full-text review. Of 24 articles, 8 reporting age-specific and 5 articles reporting sex-specific associations with glenohumeral osteoarthritis were included. The odds ratio for the age (odds ratio = 3.18; 95% confidence interval = 1.10-15.92) and female sex (odds ratio = 1.78; 95% confidence interval = 0.95-3.42) were increased and observed statistically significant. CONCLUSIONS The present systematic review and meta-analysis suggests the role of increasing age as one of the significant contributors to glenohumeral osteoarthritis. However, association of female sex with glenohumeral osteoarthritis is least convincing. Future studies are required to understand the molecular mechanisms behind the contributory role of increasing age and female sex in the establishment of glenohumeral osteoarthritis.
Collapse
Affiliation(s)
- Ravi Prakash
- From the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas (RPr, RPa); Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, Georgia (JEG); University of Texas Southwestern Medical School, Dallas, Texas (UBP); Department of Biostatistics and Data Science, University of Texas Health Science Center, Houston, Texas (FA); and Department of Physical Medicine and Rehabilitation, Orthopedics, and Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas (NBJ)
| | | | | | | | | | | |
Collapse
|
6
|
Nazzal EM, Reddy RP, Solomon DA, Hughes JD, Rooney JG, Fourman MS, Hirsch D, Rodosky MW, Lin A. Total Shoulder Arthroplasty is associated With Less Pain and Better Functional Outcomes, but Humeral Head Resurfacing may be Preferred in Younger, Higher Demand Patients: A Short-Term Outcomes Study in Patients with Glenohumeral Osteoarthritis. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:400-406. [PMID: 38919741 PMCID: PMC11195037 DOI: 10.22038/abjs.2024.72211.3364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 04/17/2024] [Indexed: 06/27/2024]
Abstract
Objectives This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA). Methods A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected. Results A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications were equivalent. Conclusion While younger patients and heavy laborers had improved ER following HHR, their pain relief was greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic factors.
Collapse
Affiliation(s)
- Ehab M. Nazzal
- Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rajiv P. Reddy
- Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Jonathan D. Hughes
- Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James G. Rooney
- Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Mark W. Rodosky
- Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Freddie Fu Sports Medicine Center- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Watanabe A, Machida T, Takashima K, Hirooka T. Discovering the Forgotten Trauma Behind Chronic Shoulder Pain: The Critical Role of a Thorough Medical Interview. Cureus 2023; 15:e49173. [PMID: 38130510 PMCID: PMC10734337 DOI: 10.7759/cureus.49173] [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: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
We report a rare case of a patient experiencing pain and dysfunction attributable to bone fragments from a trauma sustained over two decades prior. A 43-year-old Japanese woman presented with persistent left shoulder pain. Initial radiographs revealed glenohumeral joint osteoarthritis, an unusual finding for her age. Her medical history included a previously overlooked traumatic dislocation of the left acromioclavicular joint over 20 years ago. Computed tomography scans later uncovered bone fragments below the coracoid process without signs of scapular or tuberosity fractures. The fragments were arthroscopically removed, resulting in significant pain relief. The patient's Shoulder Pain and Disability Index score improved from 60 to 9 at the six-month postoperative follow-up. This case underscores the importance of considering historical trauma in patients presenting with atypical shoulder pain and highlights the potential diagnostic value of revisiting a patient's medical history when unusual lesions are discovered.
Collapse
|
8
|
Galluccio F, Ng TKT, Fajardo Perez M, Yamak Altinpulluk E, Taverner M. Phenolysis for Advanced Shoulder Osteoarthritis: A Case Series of a Novel Ultrasound-Guided Approach to Anterior and Posterior Glenohumeral Articular Nerve Branches. Cureus 2023; 15:e47890. [PMID: 38034191 PMCID: PMC10682446 DOI: 10.7759/cureus.47890] [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: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION The shoulder is one of the joints most affected by osteoarthritis, with a prevalence of almost 20% in adults over 65 years of age. Various treatments have been proposed to control osteoarthritis pain, including radiofrequency, pulsed and thermal, and recently cryoanalgesia. We propose in this series of cases a new approach to analgesic therapy with chemical denervation with phenol. MATERIALS AND METHOD Patients who underwent phenolysis for shoulder osteoarthritis at our institutions in Italy and Australia between August 2022 and May 2023 were included. All patients included in our report provided written consent for publication. This chemical neurolysis technique consisted of two injections. First, the anterior shoulder capsule was denervated by a modified deep SHAC (Shoulder Anterior Capsule) approach to cover the anterior terminal articular branches of the axillary nerve, lateral pectoral nerve, and subscapularis nerve. Second, the posterior shoulder capsule was denervated by a posterior glenoid approach to cover the terminal articular branches of the suprascapular nerve (SSN). Results: We included a total of 11 patients in this case series. Ten of 11 patients were affected by shoulder osteoarthritis, of which three had rotator cuff tendinopathy and three had full-thickness cuff tears. One patient had chronic subluxation of a shoulder prosthesis. After treatment, all patients significantly reduced pain immediately after treatment and, two weeks later, recovered joint movement and improved quality of life. No adverse events or loss of motor function following treatment. CONCLUSION We presented a novel chemical approach to shoulder denervation, which was shown to be another effective way of improving pain and function in advanced glenohumeral arthritis.
Collapse
Affiliation(s)
- Felice Galluccio
- Department of Rheumatology and Pain Management, Fisiotech Lab Studio, Firenze, ITA
- Department of Pain Medicine, Morphological Madrid Research Center, Madrid, ESP
| | - Tony Kwun-Tung Ng
- Department of Pain Medicine, Frankston Pain Management, Melbourne, AUS
- Department of Anesthesiology, University of Hong Kong, Hong Kong, HKG
- Department of Anesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, HKG
- Department of Anesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong, HKG
- Department of Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei, TWN
| | - Mario Fajardo Perez
- Department of Pain Medicine, Morphological Madrid Research Center, Madrid, ESP
| | - Ece Yamak Altinpulluk
- Department of Anesthesia, Outcomes Research Consortium, Cleveland, USA
- Department of Education and Research, Regional Anesthesia and Pain Medicine, UltraDissection, Madrid, ESP
- Department of Anesthesiology Research, Ataturk University Medical School, Erzurum, TUR
- Department of Pain Medicine, Morphological Madrid Research Center, Madrid, ESP
| | - Murray Taverner
- Department of Pain Management, Frankston Pain Management, Melbourne, AUS
- Department of Perioperative Medicine, Monash University, Melbourne, AUS
- Department of Anesthesia and Perioperative Medicine, Monash University, Melbourne, AUS
| |
Collapse
|
9
|
Michener LA, Heitzman J, Abbruzzese LD, Bondoc SL, Bowne K, Henning PT, Kosakowski H, Leggin BG, Lucado AM, Seitz AL. Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association. Phys Ther 2023; 103:pzad041. [PMID: 37115808 PMCID: PMC10256270 DOI: 10.1093/ptj/pzad041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/02/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
A clinical practice guideline on glenohumeral joint osteoarthritis was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists, an occupational therapist, and a physician. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for physical therapist management of glenohumeral joint osteoarthritis. This clinical practice guideline is available in Spanish; see Supplementary Appendix 8.
Collapse
Affiliation(s)
- Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jill Heitzman
- Physical Therapy Program, Maryville University, St Louis, Missouri, USA
| | - Laurel D Abbruzzese
- Programs in Physical Therapy, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York City, New York, USA
| | - Salvador L Bondoc
- School of Health Sciences, Chatham University, Pittsburgh, Pennsylvania, USA
| | - Kristin Bowne
- Kristin Bowne Physical Therapy Inc, Napa, California
, USA
| | - Phillip Troy Henning
- Swedish Spine, Sports & Musculoskeletal Medicine - Issaquah, Seattle, Washington, USA
| | | | - Brian G Leggin
- Good Shepherd Penn Partners, Penn Therapy and Fitness, Philadelphia, Pennsylvania, USA
| | - Ann M Lucado
- Department of Physical Therapy, College of Health Professions, Mercer University, Macon, Georgia, USA
| | - Amee L Seitz
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
10
|
Shankar DS, Mojica ES, Colasanti CA, Blaeser AM, Ortega PF, Gonzalez-Lomas G, Jazrawi LM. Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections. Clin Shoulder Elb 2023; 26:32-40. [PMID: 36919505 PMCID: PMC10030987 DOI: 10.5397/cise.2022.01130] [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: 07/18/2022] [Accepted: 12/25/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. METHODS We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. RESULTS The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). CONCLUSIONS There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.
Collapse
Affiliation(s)
- Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Anna M Blaeser
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Paola F Ortega
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| |
Collapse
|
11
|
Tokgöz MA, Elma T, Yapar A, Özer M, Ataoğlu MB, Kanatli U. Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs? Turk J Med Sci 2023; 53:218-224. [PMID: 36945963 PMCID: PMC10387902 DOI: 10.55730/1300-0144.5576] [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: 11/10/2021] [Accepted: 10/10/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis. METHODS From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores. RESULTS The UCLA scores increased from the preoperative value of 19.1 ± 3.2 to 29.8 ± 4.8 at the last follow-up and increased by an average of 10.7 ± 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 ± 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001). DISCUSSION To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.
Collapse
Affiliation(s)
- Mehmet Ali Tokgöz
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tarık Elma
- Department of Orthopaedics and Traumatology, Private Medline Adana Hospital, Adana, Turkey
| | - Aliekber Yapar
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Özer
- Department of Orthopaedics and Traumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Muhammet Baybars Ataoğlu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
12
|
Valsamis EM, Beard D, Carr A, Collins GS, Brealey S, Rangan A, Santos R, Corbacho B, Rees JL, Pinedo-Villanueva R. Mapping the Oxford Shoulder Score onto the EQ-5D utility index. Qual Life Res 2023; 32:507-518. [PMID: 36169788 PMCID: PMC9911508 DOI: 10.1007/s11136-022-03262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE In order to enable cost-utility analysis of shoulder pain conditions and treatments, this study aimed to develop and evaluate mapping algorithms to estimate the EQ-5D health index from the Oxford Shoulder Score (OSS) when health outcomes are only assessed with the OSS. METHODS 5437 paired OSS and EQ-5D questionnaire responses from four national multicentre randomised controlled trials investigating different shoulder pathologies and treatments were split into training and testing samples. Separate EQ-5D-3L and EQ-5D-5L analyses were undertaken. Transfer to utility (TTU) regression (univariate linear, polynomial, spline, multivariable linear, two-part logistic-linear, tobit and adjusted limited dependent variable mixture models) and response mapping (ordered logistic regression and seemingly unrelated regression (SUR)) models were developed on the training sample. These were internally validated, and their performance evaluated on the testing sample. Model performance was evaluated over 100-fold repeated training-testing sample splits. RESULTS For the EQ-5D-3L analysis, the multivariable linear and splines models had the lowest mean square error (MSE) of 0.0415. The SUR model had the lowest mean absolute error (MAE) of 0.136. Model performance was greatest in the mid-range and best health states, and lowest in poor health states. For the EQ-5D-5L analyses, the multivariable linear and splines models had the lowest MSE (0.0241-0.0278) while the SUR models had the lowest MAE (0.105-0.113). CONCLUSION The developed models now allow accurate estimation of the EQ-5D health index when only the OSS responses are available as a measure of patient-reported health outcome.
Collapse
Affiliation(s)
- Epaminondas M. Valsamis
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| | - David Beard
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| | - Andrew Carr
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| | - Gary S. Collins
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, OX3 7LD UK
| | - Stephen Brealey
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD UK
| | - Amar Rangan
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD UK
| | - Rita Santos
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, YO10 5DD UK
| | - Belen Corbacho
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD UK
| | - Jonathan L. Rees
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| | - Rafael Pinedo-Villanueva
- grid.4991.50000 0004 1936 8948Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| |
Collapse
|
13
|
Pines Y, Gordon D, Alben M, Kwon YW, Zuckerman JD, Virk MS. Performance and responsiveness to change of PROMIS UE in patients undergoing total shoulder arthroplasty. J Orthop Res 2022; 40:2457-2464. [PMID: 35060155 DOI: 10.1002/jor.25263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023]
Abstract
The Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT) is a newer patient-reported outcome measure for upper extremity physical function. To date, no longitudinal study exists assessing PROMIS UE CAT responsiveness in patients undergoing shoulder arthroplasty. The purpose of this prospective longitudinal study is to report PROMIS UE CAT responsiveness to change and correlation to legacy instruments in patients undergoing total shoulder arthroplasty (TSA). Ninety-six patients (97 shoulders) undergoing TSA completed the PROMIS UE, Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) preoperatively and postoperatively at 6 weeks, 12 weeks, and after 6 months. Spearman's correlation coefficients (r) were calculated between PROMIS UE and other scores at each time-point. Responsiveness to change was assessed using the effect size (Cohen's d) and standardized response mean compared with the preoperative time-point. Floor and ceiling effects were also assessed. PROMIS UE CAT demonstrated positive responsiveness at all time-points after TSA. It demonstrated excellent correlation (range: 0.68-0.84) with ASES, SST, and OSS at all postoperative time-points, but the correlation was weaker (r < 0.6, except OSS) preoperatively. Only OSS and SST showed ceiling effects at the 6-12-month time-point (16.8% and 18.2%, respectively). PROMIS UE CAT responsiveness to change and strength of correlation with legacy instruments improves with time elapsed after TSA. Further quantification of meaningful responsiveness to change will require estimation of the minimal clinically important difference and substantial clinical benefit for PROMIS UE CAT.
Collapse
Affiliation(s)
- Yaniv Pines
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - Dan Gordon
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - Matthew Alben
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - Young W Kwon
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - Joseph D Zuckerman
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| |
Collapse
|
14
|
Larsen JB, Østergaard HK, Thillemann TM, Falstie-Jensen T, Reimer LCU, Noe S, Jensen SL, Mechlenburg I. Are progressive shoulder exercises feasible in patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy? Pilot Feasibility Stud 2022; 8:168. [PMID: 35922865 PMCID: PMC9347133 DOI: 10.1186/s40814-022-01127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the feasibility of progressive shoulder exercises (PSE) for patients with glenohumeral osteoarthritis (OA) or rotator cuff tear arthropathy (CTA). The aim of this study was to investigate whether 12 weeks of PSE is feasible in patients with glenohumeral OA or CTA eligible for shoulder arthroplasty. Moreover, to report changes in shoulder function and range of motion (ROM) following the exercise program. METHODS Twenty patients were included. Eighteen patients (11 women, 15 with OA), mean age 70 years (range 57-80), performed 12 weeks of PSE with one weekly physiotherapist-supervised and two weekly home-based sessions. Feasibility was measured by dropout rate, adverse events, pain, and adherence to PSE. At baseline and end of intervention, patients completed the Western Ontario Osteoarthritis of the Shoulder (WOOS) score and Disabilities of the Arm, Shoulder and Hand (DASH). Data to assess feasibility were analyzed using descriptive statistics. RESULTS Two patients dropped out and no adverse events were observed. Sixteen of the eighteen patients (89%) had a high adherence (≥ 70%) to the physiotherapist-supervised sessions. Acceptable pain levels were reported; in 76% of all exercise sessions with no numeric rating scale (NRS) score over five for any exercise. WOOS improved with a mean of 23 points (95% CI 13;33), and DASH improved with a mean of 13 points (95% CI 6;19). CONCLUSION Adherence to PSE was high and dropout rates were low. PSE is feasible, safe and may relieve shoulder pain, improve function and ROM in patients with glenohumeral OA or CTA. The patient-experienced gains after PSE seem clinically relevant and should be compared to arthroplasty surgery in a RCT setting. TRIAL REGISTRATION According to Danish law, this study did not need an approval by the Central Denmark Region Committee on Health Research Ethics. Approval from The Danish Data Protection Agency (journal number 1-16-02-15-20) was obtained.
Collapse
Affiliation(s)
- Josefine Beck Larsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
| | - Helle Kvistgaard Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Orthopeadic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Theis Muncholm Thillemann
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Lisa Cecilie Urup Reimer
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Sidsel Noe
- Department of Orthopeadic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Steen Lund Jensen
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| |
Collapse
|
15
|
Pilot study for treatment of symptomatic shoulder arthritis utilizing cooled radiofrequency ablation: a novel technique. Skeletal Radiol 2022; 51:1563-1570. [PMID: 35029737 DOI: 10.1007/s00256-022-03993-y] [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: 11/07/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce cooled radiofrequency nerve ablation (C-RFA) as an alternative to managing symptomatically moderate to severe glenohumeral osteoarthritis (OA) in patients who have failed other conservative treatments and who are not surgical candidates or refuse surgery. MATERIAL AND METHODS This prospective pilot study includes a total of 12 patients experiencing chronic shoulder pain from moderate to severe glenohumeral OA. Patients underwent anesthetic blocks of the axillary, lateral pectoral, and suprascapular nerves to determine candidacy for C-RFA treatment. Adequate response after anesthetic block was over 50% immediate pain relief. Once patients were deemed candidates, they underwent C-RFA of the three nerves 2-3 weeks later. Treatment response was evaluated using the clinically validated American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) to assess pain, stiffness, and functional activities of daily living. Follow-up outcome scores were collected up to 6 months after C-RFA procedure. RESULTS Twelve patients underwent C-RFA procedure for shoulder OA. VAS scores significantly improved from 8.8 ± 0.6 to 2.2 ± 0.4 6 months after the C-RFA treatment (p < 0.001). Patient's ASES score results significantly improved in total ASES from 17.2 ± 6.6 to 65.7 ± 5.9 (p < 0.0005). No major complications arose. No patients received re-treatment or underwent shoulder arthroplasty. CONCLUSION Image-guided axillary, lateral pectoral, and suprascapular nerve C-RFA has minimal complications and is a promising alternative to treat chronic shoulder pain and stiffness from glenohumeral arthritis.
Collapse
|
16
|
Pelsma ICM, Kroon HM, van Trigt VR, Pereira AM, Kloppenburg M, Biermasz NR, Claessen KMJA. Clinical and radiographic assessment of peripheral joints in controlled acromegaly. Pituitary 2022; 25:622-635. [PMID: 35726113 PMCID: PMC9345810 DOI: 10.1007/s11102-022-01233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Acromegalic arthropathy is a well-known phenomenon, occurring in most patients regardless of disease status. To date, solely hips, knees, hands, and spinal joints have been radiographically assessed. Therefore, this study aimed to assess the prevalence of joint symptoms and radiographic osteoarthritis (OA) of new, and established peripheral joint sites in well-controlled acromegaly. METHODS Fifty-one acromegaly patients (56% female, mean age 64 ± 12 years) in long-term remission for 18.3 years (median, IQR 7.2-25.4) were included. Nineteen patients currently received pharmacological treatment. Self-reported joint complaints were assessed using standardized interviews. Self-reported disability of the upper and lower limbs, and health-related quality of life (HR-QoL) were evaluated using validated questionnaires. Radiographic OA [defined as Kellgren & Lawrence (KL) ≥ 2] was scored using (modified) KL methods. RESULTS Radiographic signs of OA were present in 46 patients (90.2%) with ≥ 2 joints affected in virtually all of these patients (N = 44; 95.7%). Radiographic MTP1 OA was as prevalent as radiographic knee OA (N = 26, 51.0%), and radiographic glenohumeral OA was similarly prevalent as hip OA [N = 21 (41.2%) vs. N = 24 (47.1%)]. Risk factors for radiographic glenohumeral OA were higher pre-treatment IGF-1 levels [OR 1.06 (1.01-1.12), P = 0.021], and current pharmacological treatment [OR 5.01 (1.03-24.54), P = 0.047], whereas no risk factors for MTP1 joint OA could be identified. CONCLUSION Similar to previously-assessed peripheral joints, clinical and radiographic arthropathy of the shoulder and feet were prevalent in controlled acromegaly. Further studies on adequate management strategies of acromegalic arthropathy are needed.
Collapse
Affiliation(s)
- Iris C M Pelsma
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria R van Trigt
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim M J A Claessen
- Department of Medicine, Division of Endocrinology and Metabolism, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
17
|
Hong IS, Rao AJ, CarlLee TL, Meade JD, Hurwit DJ, Scarola G, Trofa DP, Schiffern SC, Hamid N, Connor PM, Fleischli JE, Saltzman BM. Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis. World J Orthop 2022; 13:631-643. [PMID: 36051376 PMCID: PMC9302032 DOI: 10.5312/wjo.v13.i7.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rotator cuff pathology is a very common source of shoulder pain. Similarly, osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms. Surgical management can be indicated for both pathologies, however, outcomes data is limited when examining rotator cuff repair (RCR) in the setting of glenohumeral arthritis (GHOA). Thus, this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.
AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.
METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017. Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity. Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis. Patients included had a minimum two year follow-up. Rate of conversion to total shoulder arthroplasty, complication rates following initial surgery, and patient-reported outcome measures were collected.
RESULTS A total of 142 patients were included. The number of patients that required total shoulder arthroplasty within two years after index surgery was low. 2/71 (2.8%) patients with GHOA, and 1/71 (1.4%) without GHOA. Following rotator cuff repair, both groups showed favorable patient-reported outcomes.
CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.
Collapse
Affiliation(s)
- Ian S Hong
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Allison J Rao
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Tyler L CarlLee
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Joshua D Meade
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Daniel J Hurwit
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Gregory Scarola
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York City, NY 10032, United States
| | - Shadley C Schiffern
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Nady Hamid
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC 28207, United States
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - Patrick M Connor
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - James E Fleischli
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - Bryan Michael Saltzman
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| |
Collapse
|
18
|
Dislocation Arthropathy of the Shoulder. J Clin Med 2022; 11:jcm11072019. [PMID: 35407627 PMCID: PMC8999818 DOI: 10.3390/jcm11072019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.
Collapse
|
19
|
Simon MJK, Coghlan JA, Hughes J, Wright W, Dallalana RJ, Bell SN. Mid-term outcomes of a stemless ceramic head anatomic total shoulder replacement. BMC Musculoskelet Disord 2022; 23:50. [PMID: 35033044 PMCID: PMC8760766 DOI: 10.1186/s12891-021-04988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background In an anatomic shoulder replacement (aTSR) good results have been reported with the use of a stemless humeral prosthesis. In vitro a ceramic articulation with polyethylene has been shown to produce less polyethylene wear particles than with metal. This study aims to evaluate clinical and radiographic results of a stemless aTSR with a ceramic head articulating with a polyethylene glenoid component, with mid-term follow-up. Methods All patients (n = 92) in this prospective study had an aTSR utilizing a stemless humeral component with a ceramic head and a cemented double pegged cemented polyethylene glenoid component for glenohumeral osteoarthritis. Pre- and postoperative clinical evaluations at 2 years were performed using the ASES score, Constant score, SPADI score, DASH score, VAS pain score, patient satisfaction and range of motion. There was a 5-year evaluation of SPADI, ASES, pain, and satisfaction, plus radiographic assessment of glenoid component radiolucent lines and humeral osteolysis. Results Seventy-four cases (68.1 ± 7.1 years) had a five-year follow-up and demonstrated active elevation improvement from 91.3° preoperatively to 151.1° (p < 0.001). Further improvement was identified with the ASES from 41.6 to 94.3, the SPADI from 62.9 to 4.3, VAS pain from 5.6 to 0.4 (0–10), and satisfaction levels were at 96%. Sixty-two cases had no glenoid radiolucent lines with a maximum Lazarus score of 2 in one patient. Constant scores, available up to 2 years, improved significantly from 30.3 to 77.9 (p < 0.001). There was one case that required revision for glenoid loosening. Conclusions Overall, the 5-year results of this ceramic head prosthesis demonstrated good radiographic and clinical outcomes. Trial registration ACTRN12613001183774. Registered: 29 October 2013 - Retrospectively registered. Australian New Zealand Clinical Trials Registry (ANZCTR).
Collapse
Affiliation(s)
- Maciej J K Simon
- Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, VIC, 3191, Australia. .,University Medical Center Schleswig-Holstein, Campus Kiel, Department of Orthopaedics and Trauma Surgery, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Jennifer A Coghlan
- Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, VIC, 3191, Australia.,Department of Surgery, (School of Clinical Sciences, Monash Health) Monash University, Monash University, Melbourne, VIC, Australia
| | - Jeff Hughes
- Sydney Shoulder and Elbow Associates, Chatswood, Sydney, Australia
| | | | | | - Simon N Bell
- Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, VIC, 3191, Australia.,Department of Surgery, (School of Clinical Sciences, Monash Health) Monash University, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
20
|
Cable BM, Farooqi AS, Tsai S, Plyler R, Lee A, Parisien RL, Kelly JD. Humeral Head Morphology Influences Outcomes of Arthroscopic Interposition Glenoid Patch Allograft for Glenohumeral Arthritis. Arthrosc Sports Med Rehabil 2021; 3:e1421-e1429. [PMID: 34712980 PMCID: PMC8527262 DOI: 10.1016/j.asmr.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/11/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose To determine short- to midterm patient-reported outcomes of arthroscopic soft-tissue interposition arthroplasty using acellular dermal allograft with a minimum follow-up of 1 year and to assess outcomes in patients with and without flattening of the humeral head. Methods Patients with a diagnosis of primary glenohumeral arthritis who underwent arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft from July 2010 to November 2019 were retrospectively enrolled. Inclusion criteria were a primary diagnosis of glenohumeral arthritis and Outerbridge 4 full-thickness cartilage loss of ≥50% of the glenoid articular surface. Patients underwent arthroscopic debridement, microfracture, and biological arthroscopic soft-tissue interposition arthroplasty with an acellular dermal matrix. Postoperative outcomes included American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Penn Shoulder Score (PSS), numeric rating scale (NRS) pain score, analgesic use, and conversion to total shoulder arthroplasty (TSA). Results were stratified according to humeral head morphology on preoperative radiographs. Results A total of 25 patients were included, with a mean age of 56.0 years (range 19.2 to 74.8) and a mean follow-up of 3.36 years (range 1.03 to 8.98). The mean postoperative ASES score was 64.1 (range 11.7 to 100.0), SANE score was 62% (range 5% to 100%), and PSS was 61.2 (range 10.6 to 97.9). Additionally, 56% of patients rated their shoulder function as improved or much improved, and 36% of patients converted to TSA at a mean of 2.35 years. Patients with and without humeral flattening had similar postoperative ASES scores (P = .44), SANE scores (P = .90), PSS (P = .73), and conversions to TSA (P = .83). Patients with humeral flattening were more likely to have shoulder pain at night (83.3% versus 28.6%, P = .02). Conclusion Arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft resulted in satisfactory short- to mid-term postoperative outcomes for younger patients with glenohumeral arthritis but demonstrated a TSA conversion rate of 36%. Patients with humeral head flattening also had satisfactory shoulder function but were more likely to experience shoulder pain at night. Level of Evidence Level IV, therapeutic case series
Collapse
Affiliation(s)
| | | | | | | | | | - Robert L. Parisien
- Address correspondence to Robert L. Parisien, M.D., University of Pennsylvania, Philadelphia, PA 19103, U.S.A.
| | | |
Collapse
|
21
|
Anatomic Total Shoulder Arthroplasty versus Hemiarthroplasty for Glenohumeral Osteoarthritis: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112110112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: Both anatomic total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (SHA) are used for the management of end-stage glenohumeral osteoarthritis (GHOA). The present study compared TSA and SHA in terms of clinical outcome and complication rate. Methods: This meta-analysis followed the PRISMA guidelines. In October 2021, the following databases were accessed: Web of Science, Google Scholar, Pubmed, Scopus. All clinical trials comparing anatomical TSA versus SHA for GHOA were considered. Results: Data from 11,027 procedures were retrieved. The mean length of the follow-up was 81.8 (16 to 223.20) months. The mean age of the patients was 61.4 ± 8.6 years, and 56.0% (5731 of 10,228 patients) were women. At last follow-up, the age-adjusted constant score was greater following TSA (p < 0.0001), as were active elevation (p < 0.0001), flexion (p < 0.0001), abduction (p < 0.0001), and American Shoulder and Elbow Surgeons Shoulder Score (p < 0.0001). Postoperative pain (p < 0.0001) and revision rate (p = 0.02) were lower in the TSA group. Conclusions: Anatomic TSA performed better than SHA in patients with GHOA.
Collapse
|
22
|
Hanson P, Kivitz A, Mehra P, Kwong L, Cinar A, Lufkin J, Kelley SD. Safety and Systemic Exposure of Triamcinolone Acetonide Following Ultrasound-Guided Intra-Articular Injection of Triamcinolone Extended-Release or Standard Triamcinolone Acetonide in Patients with Shoulder Osteoarthritis: An Open-Label, Randomized Study. Drugs R D 2021; 21:285-293. [PMID: 34350546 PMCID: PMC8363704 DOI: 10.1007/s40268-021-00348-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Osteoarthritis (OA) is a major public health burden. While knee and hip joints are most commonly affected, the glenohumoral (shoulder) joint is also frequently involved. We evaluated the pharmacokinetics and safety/tolerability of triamcinolone acetonide extended-release (TA-ER) and triamcinolone acetonide crystalline suspension (TAcs) in patients with shoulder OA. METHODS In this phase 2, randomized, open-label, single-dose study (NCT03382262), adults with moderately-to-severely symptomatic shoulder OA for ≥ 6 months randomly received a single ultrasound-guided intra-articular (IA) injection of TA-ER 32 mg or TAcs 40 mg. Safety was evaluated throughout 12 weeks post-injection; blood samples for pharmacokinetic evaluations were collected pre-injection and through Day 85 post-injection. RESULTS Among 25 randomized patients, 12 received TA-ER and 13 received TAcs. Most patients were female (60%), and all had moderate (72%) or severe (28%) shoulder OA. Adverse events (AEs) were reported by four (33%) patients following TA-ER and three (23%) following TAcs injection. No AE was serious or led to study discontinuation. Systemic exposure following TAcs was approximately 1.5-fold higher than that following TA-ER injection (geometric mean [GM] AUC0-last 873,543 vs 557,602 h × pg/mL). GM Cmax was also higher in TAcs- than TA-ER-treated patients (2034 vs 1283 pg/mL). Bioequivalence testing confirmed lower systemic TA exposure following TA-ER than TAcs IA injection. CONCLUSION These pharmacokinetic data confirm protracted release of TA from TA-ER following IA injection in patients with shoulder OA. Lower peak and systemic TA exposure following TA-ER suggests TA-ER could potentially confer an improved systemic safety profile over TAcs. TRIAL REGISTRATION NUMBER NCT03382262 (December 22, 2017 retrospectively registered).
Collapse
Affiliation(s)
- Peter Hanson
- BioSolutions Clinical Research Center, La Mesa, CA, USA
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
| | - Purvi Mehra
- ARTEMIS Institute for Clinical Research, San Diego, CA, USA
| | - Louis Kwong
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Amy Cinar
- Flexion Therapeutics, Inc., Burlington, MA, 01803, USA
| | - Joelle Lufkin
- Flexion Therapeutics, Inc., Burlington, MA, 01803, USA
- Independent Consultant, Beverly, MA, USA
| | | |
Collapse
|
23
|
Guity MR, Sobhani Eraghi A, Hosseini-Baharanchi FS. Early postoperative pain as a risk factor of shoulder stiffness after arthroscopic rotator cuff repair. J Orthop Traumatol 2021; 22:25. [PMID: 34173872 PMCID: PMC8236012 DOI: 10.1186/s10195-021-00585-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of postoperative pain in incidence of shoulder stiffness (SS) after shoulder arthroscopy has not been thoroughly investigated. The present study was conducted to assess the effects of early postoperative pain (EPOP) on onset of SS after arthroscopic rotator cuff (RC) repair. MATERIALS AND METHODS In a retrospective analysis of a prospectively collected database, 335 patients who underwent arthroscopic RC repair were evaluated. RC tendons were sutured to the bone using the double-row technique. EPOP was evaluated 1 week after surgery using the visual analog scale (VAS). SS was assessed 3 months after surgery and was categorized into moderate or severe based on shoulder range of motion (ROM). Each type of complication including SS was identified and recorded. RESULTS Postoperative shoulder stiffness (POSS) was identified in 121 patients (36.2%) that was moderate in 86 patients (70.1%) and severe in 35 patients (28.9%). After 1 week, VAS pain score was equal to 7.7 ± 3.1 and 4.5 ± 2.1 in the patients with and without stiffness, respectively (p < 0.001). Diabetes and traumatic tear were found to be associated with postoperative stiffness (p = 0.046 and p < 0.001, respectively). Similar associations were found on multivariate analysis of data. VAS pain score was higher in the patients with severe stiffness compared with those with moderate stiffness (p < 0.001). CONCLUSIONS Our findings revealed that EPOP is associated with shoulder stiffness after arthroscopic RC repair. Therefore, strategies to ameliorate EPOP could be opted to decrease rate of POSS. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Mohammad Reza Guity
- Department of Orthopaedics, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sobhani Eraghi
- Department of Orthopaedics, Rasool Akram Medical Complex, Iran University of Medical Sciences, Niayesh Ave., Sattarkhan St, Tehran, Iran.
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
24
|
Mc Millan S, Ford E, Favorito P. Glenoid reconstruction with autologous humeral head for glenoid dysplasia in reverse shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:135-140. [PMID: 37588145 PMCID: PMC10426553 DOI: 10.1016/j.xrrt.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | | | - Paul Favorito
- The Christ Hospital Joint & Spine Center, Cincinnati, OH, USA
| |
Collapse
|
25
|
Rossi LA, Piuzzi NS, Shapiro SA. Glenohumeral Osteoarthritis: The Role for Orthobiologic Therapies: Platelet-Rich Plasma and Cell Therapies. JBJS Rev 2021; 8:e0075. [PMID: 32015271 PMCID: PMC7055935 DOI: 10.2106/jbjs.rvw.19.00075] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The glenohumeral (GH) joint ranks third on the list of the large joints that are most commonly affected by osteoarthritis, after the knee and the hip.
General nonsurgical modalities, including changes in daily activities, physical therapy, pharmacotherapy, and corticosteroid injections, constitute the mainstay of treatment. Most of these options, however, have shown moderate and short-term effectiveness. Arthroplasty techniques have proven to be successful for elderly patients. Nevertheless, replacement options are not optimal for younger patients because their functional demands are higher and prostheses have a finite life span. This has led to the search for new nonoperative treatment options to target this subgroup of patients. It has been suggested that orthobiologic therapies, including platelet-rich plasma (PRP) and cell therapies, present great promise and opportunity for the treatment of GH osteoarthritis. Despite the promising results that have been shown by cell therapies and PRP for treating degenerative joint conditions, additional studies are needed to provide more definitive conclusions.
Collapse
Affiliation(s)
| | - Nicolás S Piuzzi
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida.,Mayo Clinic Center for Regenerative Medicine, Rochester, Minnesota
| |
Collapse
|
26
|
Simon MJK, Aartsen VE, Coghlan JA, Strahl A, Bell SN. Shoulder injections with autologous conditioned serum reduce pain and disability in glenohumeral osteoarthritis: longitudinal observational study. ANZ J Surg 2021; 91:673-679. [PMID: 33609074 DOI: 10.1111/ans.16672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/22/2020] [Accepted: 01/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Currently, non-surgical treatments for glenohumeral osteoarthritis (GH-OA) mainly aim to reduce pain. Autologous conditioned serum (ACS), Orthokine, an interleukin-1 inhibitor from the patient's own blood has an anti-inflammatory effect. The objective was to determine whether intra-articular injections of this ACS improved symptoms in patients with GH-OA and delayed the need for a shoulder replacement. METHODS A total of 36 consecutive patients, 40 shoulders, with OA received up to 6-weekly intra-articular injections of ACS were included. Imaging of GH-OA, range of motion, visual analogue scale (VAS) pain, Shoulder Pain And Disability Index (SPADI), American Shoulder and Elbow Surgeons and Constant scores were assessed pre-injection and post treatment at 3 months. At a minimum of 2 years, VAS and SPADI scores and whether anyone had progressed to a shoulder replacement were recorded. RESULTS Outcomes 3 months post-ACS injections demonstrated on average statistically significant improvement (P < 0.05) of all measurements: SPADI (54.3 ± 21.5 vs 43.7 ± 23.7), Constant score (50.5 ± 14.1 vs 57.1 ± 17.4), VAS pain (4.8 ± 2.2 vs 3.7 ± 2.4) and range of motion. Of these, 16 shoulders progressed to a shoulder replacement, nine cases quickly (0.6 ± 0.2 years) and seven cases were delayed by 3.1 ± 1.7 years. The other 18 cases had significant improvement in pain, SPADI (58.0 ± 19.6 to 31.8 ± 21.4; P < 0.01) scores and no progression to a shoulder replacement at 3.6 ± 1.0 years follow-up. There was no correlation of glenoid Walch score or joint space with clinical outcome parameters. CONCLUSION ACS injections in the shoulder joint for OA can reduce pain and disability, and postpone the need for a shoulder replacement.
Collapse
Affiliation(s)
- Maciej J K Simon
- Department of Orthopaedics, The University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia
| | - Vivian E Aartsen
- Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.,School of Medicine, The University of Groningen, Groningen, The Netherlands
| | - Jennifer A Coghlan
- Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - André Strahl
- Department of Orthopaedics, The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon N Bell
- Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
27
|
Stemless Total Shoulder Arthroplasty With Orthobiologic Augmentation. Arthrosc Tech 2021; 10:e531-e538. [PMID: 33680788 PMCID: PMC7917302 DOI: 10.1016/j.eats.2020.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023] Open
Abstract
Total shoulder arthroplasty (TSA) has evolved over the years and is used for a variety of indications, with arthritis being the most common. Stemless TSA is a unique bone-preserving design that can eliminate rotational malalignment. Additionally, recent literature has found utility in the use of biological mesh and a platelet-rich plasma injection to improve healing. The purpose of this article is to outline the process of TSA using a stemless system and how to incorporate the use of amnion matrix and platelet-rich plasma into the surgical technique.
Collapse
|
28
|
Alashkham A, Soames R. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. Clin Anat 2020; 34:710-720. [PMID: 33191525 DOI: 10.1002/ca.23703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 01/03/2023]
Abstract
The key management of glenohumeral osteoarthritis is shoulder arthroplasty which aims to reduce pain and restore full shoulder function: it has increased in recent years. A detailed understanding of the anatomy of the glenoid and humeral head, as well as morphological changes of the glenoid in osteoarthritis, are important factors to consider when deciding on replacement components. This review begins with a brief introduction of the glenohumeral joint itself, and then considers the detailed anatomy of the glenoid fossa and humeral head, both of which are reported to have variable morphology. Several studies have been undertaken to assess various parameters, especially of the glenoid fossa including its shape, height, width, and articular surface area, version and inclination, in an attempt to define a standard classification that can be applied to surgical intervention. Nevertheless, no definitive consensus concerning the classification of these morphologies has been forthcoming, hence the need for this review. Following a consideration of these morphologies, the current state of knowledge regarding glenoid deformity in osteoarthritis, as well as its surgical management, is considered.
Collapse
Affiliation(s)
- Abduelmenem Alashkham
- Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,Human Anatomy Department, Faculty of Medicine, University of Zawia, Zawia, Libya
| | - Roger Soames
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| |
Collapse
|
29
|
Mansfield JT, Desai MJ. Axillary Peripheral Nerve Stimulation for Chronic Shoulder Pain: A Retrospective Case Series. Neuromodulation 2020; 23:812-818. [PMID: 31930660 DOI: 10.1111/ner.13096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/08/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the effect of axillary peripheral nerve stimulation (PNS) on pain reduction in patients with chronic shoulder pain. Chronic shoulder pain was defined as pain greater than six months originating from any of the following and not the result of a stroke: subacromial impingement syndrome/rotator cuff pathology, glenohumeral joint arthritis, acromioclavicular joint arthritis, adhesive capsulitis, or biceps tendinopathy. MATERIALS AND METHODS Eight adult patients with chronic shoulder pain, as defined above, who either did not respond to surgical intervention or who were deemed not ideal surgical candidates underwent permanent axillary PNS therapy. Follow-up ranged from 44 to 733 days (avg 445 days). The primary outcome was percent pain reduction, determined by the change in average numerical pain rating scale (NPRS). Additionally, secondary outcome measures were the change in opioid requirements and satisfaction rate. RESULTS Based on the ≥50% pain reduction for treatment success, 88% (7/8) were "responders." Overall average pain reduction was 67% and 70% among responders; 62.5% (5/8) of patients reported that they used opioids prior to axillary PNS therapy for pain relief. Among these patients, 100% reported decreased opioid use after axillary PNS implant, with an average reduction of 88% (based on self-reported reductions). Additionally, 100% (8/8) of patients reported that they would recommend this therapy to other patients suffering from chronic pain. CONCLUSIONS This retrospective case series provides level IV evidence supporting the use of axillary PNS therapy for the management of chronic shoulder pain. Additional, higher-level studies are required to further support its use.
Collapse
Affiliation(s)
- John Taylor Mansfield
- International Spine Pain & Performance Center, Washington, DC, USA.,Department of Rehabilitation Medicine, MedStar Georgetown University, Washington, DC, USA
| | - Mehul J Desai
- International Spine Pain & Performance Center, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.,Virginia Hospital Center, Director of Pain Medicine Division, Arlington, VA, USA
| |
Collapse
|