Aims. The aim of this study was to report the outcomes of different treatment options for glenoid loosening following
Aims. This study aimed to assess the impact of using the metal-augmented glenoid baseplate (AGB) on improving clinical and radiological outcomes, as well as reducing complications, in patients with superior glenoid wear undergoing
Objectives. To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after
Aims. Acromial fractures following
Aims.
Inherent disadvantages of reverse shoulder arthroplasty
designs based on the Grammont concept have raised a renewed interest
in less-medialised designs and techniques. The aim of this study
was to evaluate the outcome of
Aims. Patients with a failed
The aim of this study was to analyze the results of reverse shoulder
arthroplasty (RSA) in patients with type 1 sequelae of a fracture
of the proximal humerus in association with rotator cuff deficiency
or severe stiffness of the shoulder. A total of 38 patients were included: 28 women and ten men. Their
mean age at the time of arthroplasty was 73 years (54 to 91). Before
the RSA, 18 patients had been treated with open reduction and internal
fixation following a fracture. A total of 22 patients had a rotator
cuff tear and 11 had severe stiffness of the shoulder with < 0°
of external rotation. The mean follow-up was 4.3 years (1.5 to 10).
The Constant score and the range of movement of the shoulder were
recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as
well as CT or arthro-CT scans; radiographs were also performed at
final follow-up.Aims
Patients and Methods
Aims. The aim of this study was to use national registry database information to estimate cumulative rates and relative risk of revision due to infection after
Introduction. The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly common in the treatment of rotator cuff arthropathy. Standard RSA technique involves medialising the centre of rotation (COR) maximising the deltoid lever arm and compensating for rotator cuff deficiency. However reported complications include scapular notching, prosthetic loosening and loss of shoulder contour. As a result the use of Bony Increased Offset
The indications for reverse shoulder arthroplasty
(RSA) continue to be expanded. Associated impairment of the deltoid
muscle has been considered a contraindication to its use, as function
of the RSA depends on the deltoid and impairment of the deltoid
may increase the risk of dislocation. The aim of this retrospective
study was to determine the functional outcome and risk of dislocation
following the use of an RSA in patients with impaired deltoid function.
Between 1999 and 2010, 49 patients (49 shoulders) with impairment
of the deltoid underwent RSA and were reviewed at a mean of 38 months
(12 to 142) post-operatively. There were nine post-operative complications (18%),
including two dislocations. The mean forward elevation improved
from 50° ( These results suggest that pre-operative deltoid impairment,
in certain circumstances, is not an absolute contraindication to
RSA. This form of treatment can yield reliable improvement in function
without excessive risk of post-operative dislocation. Cite this article:
The outcome of an anatomical shoulder replacement
depends on an intact rotator cuff. In 1981 Grammont designed a novel
large-head
Aims. The purpose of this study was to evaluate the cost of
Hypothesis.
The aim of the study was to assess the rate of greater tuberosity non union in
Background:. While
Scapular notching is a common problem following
The reverse ball and socket shoulder replacement, employing a humeral socket and glenosphere, has revolutionized the treatment of patients with arthritis and rotator cuff insufficiency. The RSP (DjO Surgical, Inc., Austin, Texas) is one such device, characterized by a lateral center of rotation and approved for use in the United States since 2004. Multiple studies by the implant design team have documented excellent outcomes and low revision rates for the RSP, but other published outcomes data are relatively sparse. The objective of this study is to report on the complications and early outcomes in the first consecutive 60 RSPs implanted in 57 patients by a single shoulder replacement surgeon between 2004 and 2010. Forty-four patients were female and mean age at the time of
Introduction.
In
Crosby and Colleagues described 24 scapula fractures in 400
Aims. Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and
Aims. The purpose of this study was to determine whether there were long-term differences in outcomes of
Abstract. Background. The influence of diagnosis on outcomes after
Although,
If a modular convertible total shoulder system
is used as a primary implant for an anatomical total shoulder arthroplasty,
failure of the prosthesis or the rotator cuff can be addressed by
converting it to a
Background. Glenoid baseplate fixation for
We investigated the functional outcome in patients
who underwent
Treatment of complex proximal humeral fractures remains controversial. In situations where accurate fracture reduction and fixation cannot be obtained, arthroplasty may be the preferred surgical option. The traditional operation of hemiarthroplasty in these situations is technically challenging, and a good functional outcome is dependent on reduction and healing of the tuberosities.
Arthritis of the glenohumeral joint accompanied by an irreparable tear of the rotator cuff can cause severe pain, disability and loss of function, particularly in the elderly population. Anatomical shoulder arthroplasty requires a functioning rotator cuff, however,
Introduction:.
Manufacturers of
Abstract.
We used an inverted shoulder arthroplasty in 43 consecutive patients with a mean age of 78 years (65 to 97) who had sustained a three- or four-part fracture of the upper humerus. All except two were reviewed with a mean follow-up of 22 months (6 to 58). The clinical outcome was satisfactory with a mean active anterior elevation of 97° (35° to 160°) and a mean active external rotation in abduction of 30° (0° to 80°). The mean Constant and the mean modified Constant scores were respectively 44 (16 to 69) and 66% (25% to 97%). Complications included three patients with reflex sympathetic dystrophy, five with neurological complications, most of which resolved, and one with an anterior dislocation. Radiography showed peri-prosthetic calcification in 36 patients (90%), displacement of the tuberosities in 19 (53%) and a scapular notch in ten (25%). Compared with conventional hemiarthroplasty, satisfactory mobility was obtained despite frequent migration of the tuberosities. However, long-term results are required before
Failed internal fixation of a fracture of the
proximal humerus produces many challenges with limited surgical options.
The aim of this study was to evaluate the clinical outcomes after
the use of a
Scapular notching is of concern in
BACKGROUND:. Few studies have evaluated at a medium-term follow-up the use of semiconstrained
Background. The purpose of this study was to determine if thresholds regarding the percentage of maximal improvement in the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgery (ASES) score exist that predict “excellent” patient satisfaction (PS) following reverse total shoulder arthroplasty (RSA). Methods. Patients undergoing RSA using a single implant system were evaluated pre-operatively and at a minimum 2-year follow-up. Receiver-operating-characteristic (ROC) curve analysis determined thresholds to predict “excellent” PS by evaluating the percentage of maximal improvement for SST and ASES. Pre-operative factors were analyzed as independent predictors for achieving SST and ASES thresholds. Results. 198 (SST) and 196 (ASES) patients met inclusion criteria. For SST and ASES, ROC analysis identified 61.3% (p<.001) and 68.2% (p<.001) maximal improvement as the threshold for maximal predictability of “excellent” satisfaction respectively. Significant positive correlation between the percentage of maximum score achieved and “excellent” PS for both groups were found (r=.440, p<.001 for SST score; r=0.417, p<.001 for ASES score). Surgery on the dominant hand, greater baseline VAS Pain, and cuff arthropathy were independent predictors for achieving the SST and ASES threshold. Conclusion. Achievement of 61.3% of maximal SST score improvement and 68.3% of maximal ASES score improvement represent thresholds for the achievement of “excellent” satisfaction following RSA. Independent predictors of achieving these thresholds were dominant sided surgery and higher baseline pain VAS scores for SST, and rotator cuff arthropathy for ASES. Keywords. Percentage of maximal improvement; Predictors; American Shoulder and Elbow Surgery Score; Simply Shoulder Test;
Objective:. Evaluation of the early results of the implementation of
Purpose of study:.
The use of shorter humeral stems in
The purpose of this study is to quantify the distribution of bone density in the scapulae of patients undergoing
The purpose was to evaluate the results of
Introduction and Objective. In recent years, along with the extending longevity of patients and the increase in their functional demands, the number of annually performed RSA and the incidence of complications are also increasing. When a complication occurs, the patient often needs multiple surgeries to restore the function of the upper limb. Revision implants are directly responsible for the critical reduction of the bone stock, especially in the shoulder. The purpose of this paper is to report the use of allograft bone to restore the bone stock of the glenoid in the treatment of an aseptic glenoid component loosening after a
Introduction:.
Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty. This systematic review and meta-analysis evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We performed searches of Medline (Ovid), Embase (Ovid), and PubMed from their dates of inception to January 2022. From included studies, we analyzed data for preoperative and postoperative range of motion (ROM), patient-reported functional outcomes, and complication rates.Aims
Methods
The objective of this study is to report the epidemiology and results of treatment of deep infection after a
Purpose:
Purpose. While
Purpose. While treating fracture sequelae (FS) with unconstrained prostheses has been shown to give inferior or unpredictable outcomes, the literature is still scant regarding their treatment with
Introduction: The
Background:. Currently, there are a variety of different reverse shoulder implant designs but few anatomic studies to support the optimal selection of prosthetic size. This study analyzed the glenohumeral relationships of patients who underwent
Purpose:. While the use of press-fit humeral components has been accepted in total shoulder arthroplasty, few studies focus on the outcomes after uncemented reverse total shoulder arthroplasty. The purpose of this study is to compare the radiographic and functional results of uncemented and cemented humeral fixation in reverse total shoulder arthroplasty. Materials/Methods:. A retrospective review was performed identifying all patients that underwent reverse total shoulder arthroplasty (RTSA) between May 2007 and December 2010. Medical records and a prospective research database were reviewed for demographic, operative, and clinical information. Inclusion criteria were a primary reverse total shoulder arthroplasty from one manufacturer with a grit-blasted humeral metaphyseal stem and minimum follow-up of 2 years. Exclusion criteria included shoulder arthroplasty for fractures, fracture sequelae, or inflammatory arthropathy. Antibiotics were not routinely added to the cement. The radiographic and functional outcomes were compared between the uncemented and cemented groups. Statistical analysis was performed using the Fisher Exact test to compare the dichotomous variables between the groups. The functional outcome data between the groups was calculated using the two-tailed Wilcoxon Rank Sum test. Results:. Ninety-seven patients (58 females, 39 males) with 100 RTSA were identified and met the inclusion criteria from 214 arthroplasties performed in the study period. Radiographic and clinical 2-year follow-up was available in 80% (51 RTSAs) of the uncemented group (mean 2.7 years) and in 89% (32 RTSAs) of the cemented group (mean 3.5 years). Most common diagnosis was rotator cuff arthropathy (83%). Average age at surgery was 72 years (range 55–93 years). Humeral loosening was seen only in 1 patient (2%) in the uncemented group and in 1 patient (3.1%) in the uncemented group. Periprosthetic humerus fractures were seen in 5 patients (9.8%) in the uncemented group and in 1 patient (3.1%) in the cemented group with only the one in the cemented group requiring component revision. Infection was seen in 1 patient (2%) in the uncemented group and in none in the cemented group. Overall component revision rate was 5.9% in the uncemented group and 6.3% in the cemented group with one in each group relating to humeral component failure. Comparison of complication rates, change in functional outcome scores, and change in range of motion showed no significant differences between the uncemented and cemented components. Conclusion:. Press-fitting of the humeral component in
Introduction.
Background:. While
Purpose: The
Introduction. Good outcomes in
Introduction:. The complex 3D geometry of the scapula and the variability among individuals makes it difficult to precisely quantify its morphometric features. Recently, the scapular neck has been recognized as an important morphometric parameter particularly due to the role it plays in scapular notching, which occurs when the humeral component of a
Background:. It is not well known how different external loads influence shoulder kinematics and muscle activity in patients with shoulder prostheses. Study objective: define shoulder kinematics and determine the scapulothoracic contribution to total shoulder motion, in combination with shoulder muscle activity and the degree of co-contraction, of patients with total (TSA) and
While
Massive uncontained glenoid defects are a difficult surgical problem requiring reconstruction in the setting of either primary or revision total shoulder arthroplasty. Our aim is to present a new one-stage technique that has been developed in our institution for glenoid reconstruction in the setting of massive uncontained glenoid bone loss. We utilise a modified delto-pectoral approach to perform our dual biology allograft autograft glenoid reconstruction. The native glenoid and proximal femoral allograft are prepared and shaped to create a precisely matched contact surface, which permits axial compression to secure fixation. The surface of the glenoid is lateralised to at least the level of the coracoid. The central cancellous femoral allograft is removed and impaction autografting is performed prior to implantation of a glenoid base plate with 25-mm long centre peg. Two screws are inserted into the best quality native scapular bone available to ensure compression. A
Background: The orientation and the position of glenoid are two factors which have been pointed out as a cause of notch in case of
INTRODUCTION. Glenosphere disengagement can be a potential serious default in
Total shoulder arthroplasty (TSA) and Reverse Total shoulder arthroplasty (RSA) are two of the most performed shoulder operations today. Traditionally postoperative rehabilitation included a period of immobilisation, protecting the joint and allowing time for soft tissue healing. This immobilisation period may significantly impact a patient's quality of life (Qol)and ability to perform activities of daily living (ADL's). This period of immobilisation could be safely avoided, accelerating return to function and improving postoperative QoL. This systematic review examines the safety of early mobilisation compared to immobilisation after shoulder arthroplasty focusing on outcomes at one year. A systematic review was performed as per the PRISMA guidelines. Results on functional outcome and shoulder range of motion were retrieved. Six studies were eligible for inclusion, resulting in 719 patients, with arthroplasty performed on 762 shoulders, with information on mobilisation protocols on 736 shoulders (96.6%) and 717 patients (99.7%). The patient cohort comprised 250 males (34.9%) and 467 females (65.1%). Of the patients that successfully completed follow-up, 81.5% underwent RSA (n = 600), and 18.4% underwent TSA (n = 136). Overall, 262 (35.6%) patients underwent early postoperative mobilisation, and 474 shoulders were (64.4%) immobilised for a length of time. Immobilised patients were divided into three subgroups based on the period of immobilisation: three, four, or six weeks. There were 201 shoulders (27.3%) immobilised for three weeks, 77 (10.5%) for four weeks and 196 (26.6%) for six weeks. Five of the six manuscripts found no difference between clinical outcomes at one year when comparing early active motion versus immobilisation after RSA or TSA. Early mobilisation is a safe postoperative rehabilitation pathway following both TSA and RSA. This may lead to an accelerated return to function and improved quality of life in the postoperative period.Methods
Reverse total shoulder arthroplasty (rTSA) can be used in complex cases when the glenoid requires reconstruction. In this study, a baseplate with composite bone autograft and a central trabecular titanium peg was implanted, and its migration was assessed for two years postoperatively using radiostereometric analysis (RSA). A total of 14 patients who underwent a rTSA with an autograft consented to participate. Of these, 11 had a primary rTSA using humeral head autograft and three had a revision rTSA with autograft harvested from the iliac crest. The mean age of the patients was 66 years (39 to 81). Tantalum beads were implanted in the scapula around the glenoid. RSA imaging (stereographic radiographs) was undertaken immediately postoperatively and at three, six, 12, and 24 months. Analysis was completed using model-based RSA software. Outcomes were collected preoperatively and at two years postoperatively, including the Oxford Shoulder Score, the American Shoulder and Elbow Score, and a visual analogue score for pain. A Constant score was also obtained for the assessment of strength and range of motion.Aims
Methods
The primary goals of successful rTSA (Reverse Total Shoulder Arthroplasty) are pain relief, improved shoulder motion and function with the restoration of patient independence. These goals can be achieved by optimal prosthesis design and surgical technique. Historically there have been two predominant reverse shoulder design philosophies: the traditional valgus 155-degree neck-shaft angle with a medialised center of rotation introduced by Dr. Grammont, and the more recent varus 135-degree neck-shaft angle with a lateralised center of rotation, developed by Dr. Frankle. The latter design has reported lower incidences of scapular notching, coupled with improved adduction and external rotation. Over time, an understanding of the factors which resulted in clinical complications and those that contributed to the clinical success of both these design philosophies has been analyzed and widely publicised. With the currently available reverse prostheses the surgeon is required to be committed to one design philosophy or the other. This commitment to one singular design may hinder surgeons from the ability to individualise each case regardless of patient anatomy, rotator cuff condition, arthritic state and post-operative expectation. Recently, a system has been launched which offers both design philosophies in one system, providing unsurpassed intra-operative flexibility. This allows the surgeon to adapt to each individual case and choose either design philosophy based on patient condition and anatomy, thus optimizing patient outcome. The treatment of proximal humeral fractures has historically included Hemi Arthroplasty (HA) or Total Shoulder Arthroplasty (TSA). However, rTSA has recently become the surgery of choice for many fracture treatments based on more reproducible results. Certain implant characteristics are gaining favor in the treatment of proximal humerus fractures namely:
Press fit humeral stems - which avoid the risks of cement in-between the tuberosities which has been reported to compromise healing. Proximal ‘box-shape’ geometry - which enables rotational stability especially in cases with proximal bone loss to promote reconstruction leading to improved healing. 135-degree neck-shaft angle - allowing a higher and more anatomic tuberosity position for more stable fixation maintains anatomical integrity of the tuberosities which has been reported as a critical factor for retaining rotator cuff function.
The eccentric glenosphere was principally introduced into reverse
shoulder arthroplasty to reduce the incidence of scapular notching.
There is only limited information about the influence of its design
on deltoid power and joint reaction forces. The aim of our study was to investigate how the diameter and
eccentricity of the glenosphere affect the biomechanics of the deltoid
and the resultant joint reaction forces. Different sizes of glenosphere and eccentricity were serially
tested in ten cadaveric shoulders using a custom shoulder movement
simulator.Aims
Methods
Radiological changes and differences between cemented and uncemented components of Grammont
The combination of an irreparable tear of the rotator cuff and destructive arthritis of the shoulder joint may cause severe pain, disability and loss of independence in the aged. Standard anatomical shoulder replacements depend on a functioning rotator cuff, and hence may fail in the presence of tears in the cuff. Many designs of non-anatomical constrained or semi-constrained prostheses have been developed for cuff tear arthropathy, but have proved unsatisfactory and were abandoned. The DePuy Delta III reverse prosthesis, designed by Grammont, medialises and stabilises the centre of rotation of the shoulder joint and has shown early promise. This study evaluated the mid-term clinical and radiological results of this arthroplasty in a consecutive series of 50 shoulders in 43 patients with a painful pseudoparalysis due to an irreparable cuff tear and destructive arthritis, performed over a period of seven years by a single surgeon. A follow-up of 98% was achieved, with a mean duration of 39 months (8 to 81). The mean age of the patients at the time of surgery was 81 years (59 to 95). The female to male ratio was 5:1. During the seven years, six patients died of natural causes. The clinical outcome was assessed using the American Shoulder and Elbow score, the Oxford Shoulder Score and the Short-form 36 score. A radiological review was performed using the Sirveaux score for scapular notching. The mean American Shoulder and Elbow score was 19 (95% confidence interval (CI) 14 to 23) pre-operatively, and 65 (95% CI 48 to 82) (paired The mean maximum elevation improved from 55° pre-operatively to 105° at final follow-up. There were seven complications during the whole series, although only four patients required further surgery.
Total shoulder replacement is a successful treatment for gleno-humeral osteoarthritis. However, components loosening and painful prostheses, related to components wrong positioning, are still a problem for those patients who underwent this kind of surgery. CT-based intraoperative navigation system is a suitable option to improve accuracy and precision of the implants as previously described in literature for others district. Eleven reverse shoulder prostheses were performed at Modena Polyclinic from October 2018 to April 2019 using GPS CT-based intraoperative navigation system (Exactech, Gainsville, Florida). In the preoperative planning, Walch classification was used to assess glenoid type. The choice of inclination of the glenoid component, the screw length, as well as the inclination of the reamer was study and recorded using specific software using the CT scan of shoulder of each patient (Fig.1, Fig.2). Intraoperative and perioperative complications were recorded. Three patients were male, eight were female. Mean age was 72 years old (range 58=84). Three glenoid were type B2, six cases were B1, two case were type C1.Introduction
Method
Finite element analysis (FEA) is widely used to study micromotion between the glenoid baseplate and bone, as a pre-clinical indicator for clinical stability in reverse total shoulder arthroplasty (rTSA). Various key parameters such as the number, length, and angle of screws have been shown to influence micromotion [1]. This study explores the influence of screw preloads, an insufficiently studied parameter. Specifically, two rTSA configurations with 18mm and 48mm peripheral screws (PS) were analyzed without screw preloads, followed by analysis of the 48mm PS configuration with an experimentally measured screw preload. FEA models were created to simulate a fixation experiment inspired by ASTM F2028-14. The rTSA configurations used here have a superior and an inferior PS. The assemblies were virtually implanted into a synthetic bone block as per surgical technique. Sliding contacts were defined to model the interface between screw threads-bone, and between baseplate-bone. To determine the screw preload experimentally, the 48mm screw (n=5) was inserted through a hole in a metal plate, which rested on top of a Futek washer load cell, placed on top of the foam block with a predrilled pilot hole (Figure 1). The screw was inserted using a torque driver until the average human factors torque for the screw driver handle was reached. The resulting axial compressive load due to screw insertion was measured by the washer load cell. Two step analyses were performed using Ansys version 17.2 for 18mm and 48mm PS, where 756N axial and shear loads were applied sequentially. The model with the 48mm PS was then analyzed in a four step analysis; preload inferior and superior screws, followed by applying the axial and shear loads (Figure 2). Peak overall micromotion including tangential and normal components at the baseplate-bone interface was compared for all three models.INTRODUCTION
METHODS
We retrospectively reviewed 21 patients (22 shoulders) who presented with deep infection after surgery to the shoulder, 17 having previously undergone hemiarthroplasty and five open repair of the rotator cuff. Nine shoulders had undergone previous surgical attempts to eradicate their infection. The diagnosis of infection was based on a combination of clinical suspicion (16 shoulders), positive frozen sections (>
5 polymorphonuclear leukocytes per high-power field) at the time of revision (15 shoulders), positive intra-operative cultures (18 shoulders) or the pre-operative radiological appearances. The patients were treated by an extensive debridement, intravenous antibiotics, and conversion to a reverse shoulder prosthesis in either a single- (10 shoulders) or a two-stage (12 shoulders) procedure. At a mean follow-up of 43 months (25 to 66) there was no evidence of recurrent infection. All outcome measures showed statistically significant improvements. Mean abduction improved from 36.1° (
The purpose of this study is to catalogue humeral problems with reverse total shoulder arthroplasty and define their influence on outcome. A multicenter retrospective review of 399 reverse humeral arthroplasties implanted between January 1994 and April 2003, yielded seventy-nine patients with humeral problems. We define a clinical humeral problem as an event that alters the expected rehab or postoperative course. Perioperative problems are fractures within the stem zone while postoperative problems involve fractures distal to the stem, prosthetic disassembly and subsidence. Radiologic problems include humeral loosening and radiolucencies of greater than 2 mm that have not had a clinical impact. All radiographs were available and reviewed by three orthopaedic surgeons. Objective results were rated according to the Constant score; active forward flexion and external rotation were recorded; and subjective outcome was noted. We identified twenty-six intra-operative fractures and eleven postoperative fractures. There were four cases of disassembly, three cases of subsidence, and fifteen cases of radiographic loosening. At a mean follow-up of forty-seven months, average active elevation was 111.3 degrees, external rotation was 7.0 degrees, and absolute Constant score improved from 21.9 to 50.1 points. Seventy-one percent of the patients were satisfied or very satisfied. Intra-operative humeral fractures were associated with poor final Constant score (42.3), poor range of motion and increased shoulder pain (p=0.001 for all items). Constant score for those revision patients who experienced a fracture was lower by 9.6 points (p=0.0347) than those patients who underwent a reverse prosthesis for revision surgery without a fracture. Constant score for those patients with a postoperative fracture averaged 47.2 (range, 8–70). A re-operation was performed in seven of the cases (9%). Intra-operative humeral fractures occur commonly when a reverse prosthesis is indicated for revision; humerotomy is not protective, however, and is not recommended for all humeral revisions. Fractures, either intraoperative or post-operative, result in lower Constant scores. Any patient who received an intervention for a humeral problem yielded a lower constant score. While postoperative Constant scores improved in all categories, they were lower than those patients who did not sustain a humeral complication.
Acromial and scapular fractures are a rare but difficult complication with reverse total shoulder arthroplasty (rTSA), with an incidence rate reported from 1–10%. The risk factors associated with these fractures types is largely unknown. The goal of this study is to analyze the clinical outcomes, demographic and comorbidity data, and implant sizing and surgical technique information from 4125 patients who received a primary rTSA with one specific prosthesis (Equinoxe, Exactech, Inc) and were sorted based on the radiographic documentation of an acromial and/or scapula fracture (ASF) to identify factors associated with this complication. 4125 patients (2652F/1441M/32 unspecified; mean age: 72.5yrs) were treated with primary rTSA by 23 orthopaedic surgeons. Revision and fracture reverse arthroplasty cases were excluded. The radiographic presence of each fracture was documented and classified using the Levy classification method. 61 patients were identified as having ASF, 10 patients had fractures of the Type 1, 32 patients had Type 2, and 18 patients had Type 3 fractures according to Levy's classification. One fracture was not classifiable. Pre-op and post-op outcome scoring, ROM as well as demographic, comorbidity, implant, and surgical technique information were evaluated for these 61 patients and compared to the larger cohort of patients to identify any associations. A two-tailed, unpaired t-test identified differences (p<0.05).Introduction
Methods
As reverse total shoulder arthroplasty (RTSA) systems expand with longer durations in vivo, so does the concern and potential complications of wear, debris and osteolysis. Despite some other profound attempts, no wear testing method has stood out to compare implants across systems and labs. The main reasons may have been the diverse sources of forces and motions used in testing, widely different wear amounts which resulted and the general lack of dedicated shoulder simulators. To add a dedicated shoulder simulator to hip and knee simulators would burden the resources of any testing lab. In this study we propose a shoulder wear test method which addresses the above. Harnessing the wealth of force-motion data from telemetrized shoulder implants from the Bergman's group in Berlin, we synthesized their results to devise a wholistic multi-axes simulation regime for reverse shoulders. The alignment and motions of the humeral cup and the glenosphere were kept anatomically correct (relative to each other) and yielded a physiologically realistic wear-inducing articulation. However, we opted for a very unusual installation/orientation of the whole implant system to allow a twelve station AMTI (hip) simulator to be adapted for this study. The shoulder constructs were aligned with novel fixtures such that the machine's vertical compressive force mimicked the average forces of the shoulder found from the in vivo telemetry data in magnitude and nominal direction. Aligned thus, a patient with a shoulder installed would neither stand, nor lie down, but be oriented in a composite angle relative the simulator original axes. Each anatomic shoulder motion would be achieved by unique computed combinations of the three simulator motion actuators, none of which would be aligned anatomically for the shoulder on its own. The maximum ranges of cyclic shoulder motion achieved with the constraints of the simulator were 38°–79° of forward elevation repeated in two separate (15°and 45°) elevation planes. The change of elevation plane inherently involved abduction-adduction motion, and simultaneously also involved variation of internal-external rotation within a 57° range. Each elevation rise (twice per cycle) was also accompanied by a sinusoidally rising and falling compressive load in the range 50N–1700N. The test method was tested (!) by simulating for 2.5 million of the above (double-elevation) cycles and gravimetrically measuring wear of twelve 36 mm size RTSA systems. We compared six systems having vitamin E-infused highly cross-linked polyethylene bearings (100 kGy radiation) to six controls with a medium cross-linked polyethylene of half the radiation dose. Significant wear resulted for the control bearing material (average 17.9 ± 0.851 mg/MC) which was no less than many hips and knees. Multiply (and statistically significantly, p < 0.001) less average wear (3.42 ± 0.22 mg/MC) resulted for the highly cross linked bearings. The above demonstrated the effectiveness of the test method. Significant wear resulted under physiologically realistic cyclic motion and forces with strong discrimination between two systems whose bearing materials were known to be different in resilience to wear. Using novel fixtures and unusual orientation to utilize a standard commercially available joint simulator promises efficacy of the test method and utility across different labs.
This clinical study analyzes the long-term outcomes and potential complications of the Grammont's reverse prosthesis in case of trauma in elderly population. Between January 1993 and May 2010, thirty-seven consecutive patients with 26 three- and four-part fractures and 11 fracture-dislocations, mean age 75 (58 to 92) were evaluated with a mean follow-up of 7.3 years. Eight complications occurred: 2 complex sympathetic dystrophies, 3 dislocations, 2 deep infections and one aseptic loosening of the base-plate leading to 3 re-operations and 2 prosthesis revisions. The mean Constant's score dropped from 55 at two year follow-up to 52 (20 to 84) at last revision because of an augmentation of the pain and a diminution of the strength which represented 67% of the mean score for the injured side. Mean modified Constant's score was 68. Only 58% were satisfied or very satisfied because of poor internal and external rotations avoiding nourishment with utensils, dressing and personal hygiene when the dominant side was involved. Two complete glenoid borders, fourteen stable inferior spurs, twenty-one inferior scapular notches including ten of them with medial proximal humeral bone loss or radio lucent lines between the bone and the cement were observed. Notches were more important in size when the follow-up was longer. 62% of the patients had worrying images. The crossing of the clinical and radiological data showed a degradation of the mean Constant's score (41) for pain and strength in cases of notches with troubling proximal humeral images. In spite of only one case of aseptic loosening at 12 year follow-up, results are disappointing and complications and revisions rates important. The functional result is never equal to the pre-broken state. New developments in design, bearing surfaces and surgical technique and a more long term results will refine the role of the reverse concept for fracture.
The aim of this study was to evaluate whether CT-based pre-operative planning, integrated with intra-operative navigation could improve glenoid baseplate fixation and positioning by increasing screw length, reducing number of screws required to obtain fixation and increasing the use of augmented baseplate to gain the desired positioning. Reverse total shoulder arthroplasty (RSA) successfully restores shoulder function in different conditions. Glenoid baseplate fixation and positioning seem to be the most important factors influencing RSA survival. When scapular anatomy is distorted (primitive or secondary), optimal baseplate positioning and secure screw purchase can be challenging. Twenty patients who underwent navigated RSA (oct 2018 and feb 2019) were compared retrospectively with twenty patients operated on with a conventional technique. All the procedures were performed by the same surgeon, using the same implant in cases of eccentric osteoarthritis or complete cuff tear. Exclusion criteria were: other diagnosis as proximal humeral fractures, post-traumatic OA previously treated operatively with hardware retention, revision shoulder arthroplasty.Introduction and Objective
Materials and Methods
The aim of this retrospective and mono centric study is to expose results and complications of the reverse concept in the elderly in case of trauma. We therefore ask whether clinically the patients recover a pre-broken state, whether the radiological follow-up shows critical images and whether the rate of complications is important. We reviewed the outcome of forty-two patients operated consecutively by the same surgeon at a mean follow-up of 9.1 years (range, 1–19 years). There were four men and thirty-eight females, mean age 75 (range, 58–92 years), with 28 complex four-part fractures and 14 fracture-dislocations. There was no re-fixation of the tubercles because of a poor bone quality. Six complications occurred: 2 complex sympathetic dystrophies treated by medication, 2 early dislocations (one superior because of an impingement in adduction between the humeral stem and the remnants of the tubercles solved by their ablation without further problems and one anterior caused by the voluntary 10° ante-version of the humeral component to improve internal rotation leading to the reorientation of the stem), 1 deep infection solved by debridement and drainage for an early postoperative Acinetobacter infection without further problems and one aseptic loosening of the base-plate with a broken screw and no wear at 12-year follow-up leading to implant a classic base-plate because of a fair bone stock and efficient primary grip after impaction. The mean Constant score dropped from 55 at one year to 52 (20 to 84) at last revision which represented 67% of the mean score for the injured side. Mean adjusted Constant score was 68. Only 58% of the patients were satisfied or very satisfied because of poor rotations avoiding nourishment with utensils, dressing andpersonal hygiene. When the dominant arm was affected, the patients lost frequently their autonomy. Two patients with 42-mm glenospheres had complete 2-mm radiolucent lines at four- and eight-year follow-up. Inferior spurs were seen in 15 cases (35%). They were stable after emergence without functional impact or radiographic evolution. They appeared at a mean of 2.5 years (range, 1–6 years). Scapular notching was seen in 23 cases (55% of the patients), all appeared before two-year follow-up. Eleven notches were stable with a sclerotic border and without critical humeral images. Twelve were progressive with a proximal humeral bone loss (n = 7) or a radiolucent line (n = 5). In these cases, there was a negative effect on the Constant score: 41 points instead of 57 for notches without critical images. Our experience reported in the present study has somewhat weakened our enthusiasm for this procedure. 42% of the patients were unsatisfied because of poor rotations and the functional results were never equal to the pre-injury state. 33% of the radiological images found were critical. 14% of the patients had a severe complication. Such results do not allow us to validate in the long-term the concept of RSA in recent trauma of proximal humerus. So nowadays, our elective indication is a woman for a non-dominant arm, over seventy years old with poor physiology and important osteoporosis.
The aim of this retrospective study is to expose results and complications of the reverse concept in trauma. We therefore ask whether clinically the patients recover a pre-broken state, whether the radiological follow-up show worrisome images and whether the rate of complications is important. We reviewed thirty-seven consecutive patients with 26 three- and four-part fractures and 11 fracture-dislocations, mean age 75 (range, 58–92 years) with a minimum follow-up of one year (mean, 7.3 years; range, 1–17 years). Eight complications occurred: 2 complex sympathetic dystrophies, 3 dislocations, 2 deep infections and one aseptic loosening of the base-plate leading to 3 re-operations and 2 prosthesis revisions. The mean Constant score dropped from 55 at one year to 52 (20 to 84) at last revision which represented 67% of the mean score for the injured side. Mean adjusted Constant score was 68. 42% of the patients considered the results to be unsatisfactory because of poor rotations avoiding nourishment with utensils, dressing and personal hygiene when the dominant extremity was involved. We observed two complete borders between the base plate and the glenoid, fourteen stable inferior spurs which did not affect function and twenty-one inferior scapular notches including ten of them with medial proximal humeral bone loss or radio lucent lines between the cement border and the humerus. Notching increased in size with longer follow-up. Notching, accompanied by changes in proximal humerus, was associated with the weakest mean Constant score (41). The functional results were not equal to the pre-injury state. When the dominant arm was affected, the patients lost frequently their autonomy. 60% of the radiological images found were worrying. 22% of the patients had a severe complication. New developments in design, bearing surfaces and surgical technique and long term studies may support the role of the reverse concept for fracture.
Reverse total shoulder arthroplasty (RTSA) provides an alternative to standard total shoulder arthroplasty in the treatment of selected complex shoulder problems including failed shoulder replacements. The purpose of this report is to present outcome of RTSA using Comprehensive Reverse System (CRS) as either primary or revision treatment choice. Between September 2010 and April 2012, 54 patients (36 females, 18 males) with the mean age of 68.4 (±10) underwent RTSA-CRS. In 27 patients RTSA-CRS was performed as a revision due to failed previous arthroplasty. Primary underlying conditions included AVN (2), massive irreparable rotator cuff tear (2), primary osteoarthritis (7), post-traumatic osteoarthritis (2), rheumatoid arthritis (6), and rotator cuff arthropathy (8). It was not possible to complete the operation in 6 patients (4 revisions group 2 AVN cases) due to substantial glenoid erosion. Preoperative CT scan was performed in 50% of patients to assess the bony stock of the glenoid. In some patients ultrasound and MRI were performed to acquire additional information. A total of 46 patients were followed-up by means of antroposterior and axial plain X-rays, pain and satisfaction level (VAS/0–10), stiffness, Constant Score, Oxford Shoulder Score, SF-12 (Physical and mental Subscales), and range of movement for a mean duration of 6.5 months (±4.2).BACKGROUND
PATIENTS AND MATERIALS
The following study start from an idea of the evaluation of the osteointegration in the bone cage of the Equinoxe Reverse shoulder prosthesis. The aim of the study is to assess the values of Bone Mineral Density (BMD) in periprosthetic areas, in patients undergoing shoulder arthroplasty with implants of the Equinoxe system by Excatech, Inc. To better understand the steps of osteointegration time of the bone cage with the glenoid The objectives of the work are not only expanded to the value of osteointegration, but could also be useful for the evaluation of both mechanical and septic loosening of the stem of the glenoid. In the period from November 2011 to May 2012, 15 patients were evaluated. All patients were subjected to bone densitometry type of DXA within the first 15 days after surgery and at 3 months after surgery. The patients are all part of a homogeneous group for anatomical glenoid Were excluded from the study all patients who were no significant alterations of the head and the glenoid. The acquisitions were performed with the patient in an oblique position, with limb in a neutral position, in order to obtain images in the coronal plane “true” of the joint. Were subsequently calculated values of BMD is around the stem with the 7 areas used by Gruen for the hip prosthesis and peripherally to the central peg using 3 areas, superiorly, medially and inferiorly to the same.Introduction
Materials and Methods
Reverse total shoulder arthroplasty (RTSA) can partially restore lost range of motion (ROM). Active motion restoration is largely a function of RTSA joint constraint, limiting impingement, and muscle recruitment; however, it may also be a function of implant design. The aim of this computational study was to examine the effects of implant design parameters, such as neck-shaft (N-S) angle and glenoid lateralization, on impingement-free global circumduction range of motion (GC-ROM). GC-ROM summarizes the characteristically complex, wide-ranging envelope of glenohumeral motion into a single quantity for ease of comparison. Nine computational models were used to investigate implant parameters. The parameters examined were N-S angles of 135°, 145°, and 155° in combination with glenoid lateralizations (0, 5, and 10 mm). Static positioning of the humerus was defined by an elevation direction angle, elevation angle, and rotation. The humerus was rotated from the neutral position (0° of rotation and elevation), and then elevated in different elevation directions until impingement was detected. Abduction occurred at an elevation direction angle of 0°, while flexion and extension occurred at elevation direction angles of 90° and −90°, respectively. Elevation direction angles ranged from −180° to 180°. Elevation ranged from 0° and 180°. Rotations ranged from −45° to 90°, where negative and positive rotations represented external and internal rotation, respectively. For each rotation angle, a plot of maximum elevation in each elevation plane was created using polar coordinates (radius = elevation, angle = elevation direction). The area enclosed by the resulting points, normalized with respect to the implant with a 145° N-S angle and 5 mm lateralization, was calculated. The sum of these areas defined the GC-ROM.Introduction
Methods
Cuff tear arthropathy represents a challenging problem to the shoulder arthoplasty surgeon. Poor results of conventional total shoulder arthroplasty in cuff deficient shoulders due to glenoid component loosening have meant hemiarthroplasty has been the traditional preferred option. Recently reverse total shoulder arthroplasty (RSA) has gained increasing popularity due to a clinical perception of an improved functional outcome. This is despite the lack of comparative data, particularly in relation to modern hemiarthroplasty prostheses. The aim of this study was to compare the early functional results of Hemiarthroplasty versus RSA in the management of cuff-tear arthropathy. Patients were identified from the New Zealand National Joint Registry and matched for age, sex, and American Society of Anesthesiologists scores.102 primary hemiarthroplasties performed for cuff tear arthropathy were compared with 102 RSAs performed for the same diagnosis. Oxford shoulder scores (OSS) were collected prospectively at 6 months and five years post operatively together with mortality and revision rates.Background
Material and Methods
Cuff tear arthropathy represents a challenge to the shoulder arthoplasty surgeon. The poor results of conventional total shoulder arthroplasty in cuff deficient shoulders secondary to glenoid component loosening have meant hemiarthroplasty has traditionally been the preferred surgical option. Recently reverse total shoulder arthroplasty (RSA) has gained increasing popularity due to a clinical perception of an improved functional outcome, despite the absence of comparative data. The aim of this study was to compare the early functional results of Hemiarthroplasty versus RSA in the management of cuff-tear arthropathy. 102 primary hemiarthroplasties performed for cuff tear arthropathy were compared against 102 RSAs performed for the same diagnosis. Patients were identified from the New Zealand National Joint Registry and matched for age, sex, and American Society of Anesthesiologists (ASA) scores. Oxford shoulder scores (OSS) were collected at 6 months and 5 years post operatively and were compared between the two groups, together with mortality and re-revision rates. There were 51 males and 51 females in each group, with a mean age of 71.6 in the Hemiarthroplasty group and 72.6 in the RSA group. The mean ASA score was 2.2 in both groups. The mean OSS was 31.1 in the hemiar-throplasty group and 38.1 in the RSA group. At follow up, there were 7 revisions in the hemiarthroplasty group and 5 in the RSA group. No difference in mortality was seen between the two groups. This study provides the first direct evidence of a improved functional outcome of RSA compared to Hemiarthroplasty in the treatment of patients with cuff tear arthropathy. Longer term follow up is needed to confirm that the improved function is maintained, and that late complications such as component loosening remain comparable between the two groups.
Bony healing of tuberosities around shoulder prostheses is difficult to obtain in the elderly patient. We hypothesized that reattachment of the tuberosities, performed in combination with bone grafting, around a specific reverse shoulder fracture-prosthesis (RSFP) would favour improved tuberosity healing and shoulder mobility in elderly patients with displaced proximal humerus fractures. We included 49 patients (50 shoulders)(45 female, 4 male) in this prospective study. Mean (± SD) age 80 ± 4 years (range, 70–88). Clinical evaluation consisted of ROM, VAS (pain), Constant scores, patient satisfaction (Subjective Shoulder Value (SSV)) and noted complications. Radiological evaluation consisted of tuberosity healing and component loosening. Mean follow-up 18 ± 8 months (12–39).BACKGROUND:
METHODS:
Synthesis and hemi-prosthesis give well known radiological results for acute proximal complex humeral fractures in elderly population. We wanted to expose the radiological outcome of the reverse concept in this indication. From 1993 to 2008, forty four DELTA III were implanted for thirty three three-part and four-part displacements and eleven fracture-dislocations, in 3 males for 41 females, with an average age of seventy five years. The results were estimated with AP and LAMY profile Xrays. Because of ten deceases and three moving, thirty one cases were reviewed with a mean follow-up of 6.3 years, range 1 to 15. The radiographs showed : two 2-mm thick borders on the glenoid at four and eight years with a scapular notch at 11 years and an aseptic loosening of the base plate at 12 years with a broken polar inferior screw. The patient underwent an easy surgical revision because of a fair bone stock. There was no wear of the polyethylene. According to the NEROT classification, nineteen inferior scapular notches were observed with a mean occurrence time of 4.6 years. The seven type-1 notches appeared at a mean of 2 years and the five type-2 notches at a mean of 4.3 years. We observed four type-3 notches which reached the inferior screw at 5,6,7 and 8 years, and three type-4 notches which extended beyond the inferior screw at 6,7 and 8 year follow-up, respectively. There seem to be two distinct patters of notches: mechanical, stable proximal humeral bone loss because of an impingement between the humeral component and the inferior scapular pillar and biological, progressive in size, evolving over time with proximal humeral bone loss because of polyethylene disease; the longer the follow-up, the more severe the notch. Fourteen inferior spurs, stable after emergence, were reported with a mean occurrence time of 2.5 years range 1 to 6 years. One joint ossification occurred at 6 months and was stable at 6 year follow-up. The humeral results consisted in five medial (5,6,710, and 11 years) proximal bone looses and three bone-cement interface medial borders on the two thirds of the height of the stem at a mean follow-up of 5 years. In these eight cases, there was a notch associated. We reported one case of septic humeral loosening at 2 year follow-up. For acute proximal humeral complex fractures in elderly population, when re-fixation of the tubercles on the classical orthopaedics devices is impossible, the use of a DELTA III prosthesis shows, with a mean follow-up of 6.3 years, worrying images in 70% of the cases. These images are on the glenoid in 70% of the cases, appeared before seven years in 86% and are progressive in 50% of the cases. But, we have only one re-intervention for an aseptic loosening of the base plate at a twelve year evolution. New developments in design and bearing surfaces and a more long term results will probably provide more durable utilization of the reverse concept in this indication.
Aims. Corticosteroid injections are often used to manage glenohumeral arthritis in patients who may be candidates for future total shoulder arthroplasty (TSA) or
Inverted shoulder arthroplasty has been initially proposed for the treatment of omarthrosis secondary to deficient rotatory cuffs, however its use in acute traumatology has not been yet investigated.
The mean ASES score was 9 points (0–19) out of 24. The mean DASH score was 44 points (0–92) out of 100. Post-operative complications included 3 reflex sympathetic dystrophies, 5 regressive neurological complications, 1 loosening of the deltoid suture, 1 anterior dislocation and 1 acromion fracture. There was no infection. Radiographs at last follow-up showed peri-prosthetic calcifications in 36 cases, displacements of the tuberosities in 19 cases and scapular notches in 10 cases (1 type III, 3 type II and 6 type I notches). No migration of the prosthetic components was observed.
Aims. Scapular notching is a frequently observed radiographic phenomenon
in
From 1993 to 2008, 44 DELTA III prostheses were implanted for 33 three-part and four-part displacements and 11 fracture-dislocations, in 3 males for 41 females, with an average age of seventy five years. The results were estimated with AP and profile X-rays. Ten patients died and and three moved. Thirty one cases were reviewed with a mean follow-up of 6.3 years, range 1 to 15. The radiographs showed:
two 2-mm thick borders on the glenoid at four and eight years. one aseptic loosening of the base plate at twelve years with a broken polar inferior screw. nineteen inferior scapular notches at a mean occurrence time of 4.6 years: the longer the follow-up, the more severe the notch with two distinct patters of notches: mechanical, stable, because of an impingement between the humeral component and the pillar and biological, progressive in size, evolving over time with proximal humeral bone loss (five medial resorptions and three bone-cement interface medial borders) because of polyethylene disease. fourteen inferior spurs, stable after emergence at a mean occurrence time of 2.5 years. one joint ossification at 6 months and stable at 6 years. one septic humeral loosening at 2 years. In elderly patients with trauma, when attachment of the tubercles on the classical orthopaedics devices is impossible, the use of a RSA leads to precocious worrying and progressive images but with only one re-intervention for an aseptic loosening of the base plate at a twelve year evolution. New developments in design and bearing surfaces, new surgical techniques of implantation and a more long term results will probably provide more durable utilization of the reverse concept for this indication.
Synthesis and hemi-prosthesis give well known radiological results for acute proximal complex humeral fractures in elderly population. We wanted to expose the radiological outcome of the reverse concept in this indication. From 1993 to 2007, forty one DELTA III were implanted for thirty two three-part and four-part displacements and nine fracture-dislocations, in 3 males for 38 females, with an average age of seventy five years. The results were estimated with AP and LAMY profile X-rays. Because of nine deceases and two moving, thirty cases were reviewed with a mean follow-up of 6.5 years, range 1 to 14. The radiographs showed: two 2-mm thick borders on the glenoid at four and eight years with a scapular notch at 11 years and an aseptic loosening of the base plate at 12 years with a broken polar inferior screw. The patient underwent an easy surgical revision because of a fair bone stock. There was no wear of the polyethylene. According to the NEROT classification, seventeen inferior scapular notches were observed with a mean occurrence time of 4.7 years. The seven type-1 notches appeared at a mean of 2 years and the five type-2 notches at a mean of 4.3 years. We observed three type-3 notches which reached the inferior screw at 5,6 and 7 years, and two type-4 notches which extended beyond the inferior screw at 6 and 7 years follow-up, respectively. There seem to be two distinct patters of notches: mechanical, stable proximal humeral bone loss because of an impingement between the humeral component and the inferior scapular pillar and biological, progressive in size, evolving over time with proximal humeral bone loss because of polyethylene disease; the longer the follow-up, the more severe the notch. Fourteen inferior spurs, stable after emergence, were reported with a mean occurrence time of 2.5 years range 1 to 6 years. One joint ossification occurred at 6 months and was stable at 6 year follow-up. The humeral results consisted in four medial (5,6,7 and 10 years) proximal bone looses and two bone-cement interface medial borders on the two thirds of the height of the stem at 5 year follow-up. In these six cases, there was a notch associated. We reported one case of septic humeral loosening at 2 year follow-up. For acute proximal humeral complex fractures in elderly population, when re-fixation of the tubercles on the classical orthopaedics devices is impossible, the use of a DELTA III prosthesis shows, with a mean follow-up of 6.5 years, worrying images in 70% of the cases. These images are on the glenoid in 70% of the cases, appeared before seven years in 86% and are progressive in 50% of the cases. But, we have only one re-intervention for an aseptic loosening of the base plate at a twelve year evolution. New developments in design and bearing surfaces and a more long term results will probably provide more durable utilization of the reverse concept in this indication.