Aims.
This study provides recommendations on the position
of the implant in reverse shoulder replacement in order to minimise
scapular notching and osteophyte formation. Radiographs from 151
patients who underwent primary reverse shoulder replacement with
a single prosthesis were analysed at a mean follow-up of 28.3 months
(24 to 44) for notching, osteophytes, the position of the glenoid
baseplate, the overhang of the glenosphere, and the prosthesis scapular
neck angle (PSNA). A total of 20 patients (13.2%) had a notch (16 Grade 1 and four
Grade 2) and 47 (31.1%) had an osteophyte. In patients without either
notching or an osteophyte the baseplate was found to be positioned
lower on the glenoid, with greater overhang of the glenosphere and
a lower PSNA than those with notching and an osteophyte. Female patients
had a higher rate of notching than males (13.3% Based on these findings we make recommendations on the placement
of the implant in both male and female patients to avoid notching
and osteophyte formation. Cite this article:
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 reverse shoulder arthroplasty (RSA). Methods. From January 2016 to June 2021, out of 235 patients who underwent primary RSA, 24 received a superior-AGB after off-axis reaming (Group A). Subsequently, we conducted propensity score matching in a 1:3 ratio, considering sex, age, follow-up duration, and glenoid wear (superior-inclination and retroversion), and selected 72 well-balanced matched patients who received a standard glenoid baseplate (STB) after eccentric reaming (Group B). Superior-inclination, retroversion, and lateral humeral offset (LHO) were measured to assess preoperative glenoid wear and postoperative correction, as well as to identify any complications. Clinical outcomes were measured at each outpatient visit before and after surgery. Results. There were no significant differences in demographic data and preoperative characteristics between the two groups. Both groups showed significant improvements in patient-reported outcome measures (visual analogue scale for pain, visual analogue scale for function, American Shoulder and Elbow Surgeons, Constant, and Simple Shoulder Test scores) from preoperative to final assessment (p < 0.001). However, AGB showed no additional benefit. Notably, within range of motion, Group B showed significant postoperative decrease in both external rotation and internal rotation, unlike Group A (p = 0.028 and 0.003, respectively). Both groups demonstrated a significant correction of superior-inclination after surgery, while patients in Group B exhibited a significant decrease in LHO postoperatively (p = 0.001). Regarding complications, Group A experienced more acromial stress fractures (3 cases; 12.5%), whereas Group B had a higher occurrence of
Aims.
The aim of this study was to investigate the effects of preoperative bisphosphonate treatment on the intra- and postoperative outcomes of arthroplasty of the shoulder. The hypothesis was that previous bisphosphonate treatment would adversely affect both intra- and postoperative outcomes. A retrospective cohort study was conducted involving patients undergoing arthroplasty of the shoulder, at a single institution. Two patients with no previous bisphosphonate treatment were matched to each patient who had received this treatment preoperatively by gender, age, race, ethnicity, body mass index (BMI), and type of arthroplasty. Previous bisphosphonate treatment was defined as treatment occurring during the three-year period before the arthroplasty. The primary outcome measure was the incidence of intraoperative complications and those occurring at one and two years postoperatively. A total of 87 patients were included: 29 in the bisphosphonates-exposed (BP+) group and 58 in the non-exposed (BP-) group. In the BP+ group, there were 26 female and three male patients, with a mean age of 71.4 years (51 to 87). In the BP- group, there were 52 female and six male patients, with a mean age of 72.1 years (53 to 88).Aims
Patients and Methods
Aims. The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes. Methods. This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the β-angle, the inclination of the glenoid component, inferior overhang,
Aims. Existing literature indicates that inferiorly inclined glenoid baseplates following reverse total shoulder arthroplasty (RSA) produce better outcomes compared to superiorly inclined baseplates. We aim to compare clinical outcomes for RSAs with superiorly and neutrally/inferiorly inclined lateralized glenospheres. Methods. We retrospectively reviewed 154 consecutive patients undergoing RSA between July 2015 and July 2017 by one single-fellowship trained surgeon (AJ). Two raters (KAM and MVS) independently measured glenoid inclination in preoperative and minimum two year follow-up radiographs (anteroposterior/Grashey) using the RSA angle. Inclination was then compared to patient-reported outcomes, range of motion (ROM), and independently assessed degree of
Aims. This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods. A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results. A total of 42 studies met the inclusion and exclusion criteria. Rates of
Introduction. The clinical impact of
Despite the high success rates of Reverse Shoulder replacements, complications of instability &
Introduction. Reverse shoulder replacement is a surgical option for cuff tear arthropathy. However
Aims. Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes. Methods. All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up. Results. The implant was revised in ten shoulders (5.2%) with a median time to revision of 21.2 months (interquartile range (IQR) 9.9 to 41.8). The Kaplan-Meier survivorship estimate at seven years was 95.9% (95% confidence interval (CI) 91.7 to 98; 35 RTSAs at risk) for aseptic mechanical failure of the glenoid and 94.8% (95% CI 77.5 to 96.3; 35 RTSAs at risk) for all-cause revision. Minimum five-year clinical and radiological outcomes were available for 103 and 98 RTSAs respectively with a median follow-up time of six years (IQR 5.2 to 7.0). Median postoperative Oxford Shoulder Score was 38 (IQR 31 to 45); median Constant and Murley score was 60 (IQR 47.5 to 70); median forward flexion 115° (IQR 100° to 125°); median abduction 95° (IQR 80° to 120°); and external rotation 25° (IQR 15° to 40°)
Radiological changes and differences between cemented and uncemented components of Grammont reverse shoulder arthroplasties (DePuy) were analysed at a mean follow-up of 9.6 years (8 to 12). Of 122 reverse shoulder arthroplasties implanted in five shoulder centres between 1993 and 2000, a total of 68 (65 patients) were available for study. The indications for reversed shoulder arthroplasty were cuff tear arthropathy in 48 shoulders, revision of shoulder prostheses of various types in 11 and massive cuff tear in nine. The development of
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 reverse shoulder arthroplasty (RSA)
with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed
for the treatment of rotator-cuff-deficient shoulders with glenohumeral
arthritis. A total of 97 arthroplasties in 92 patients (53 women
and 44 men, mean age 67 years (standard deviation (. sd. )
10, (49 to 85)) were retrospectively reviewed at a mean follow-up
of 50 months ((. sd. 25) (24 to 96)). The mean Oxford shoulder
score and subjective shoulder value improved from 47 (. sd. 9)
and 24 points (. sd. 18) respectively before surgery to 28
(. sd. 11) and 61 (. sd. 24) points after surgery (p <
0.001).
The mean pain at rest decreased from 5.3 (. sd. 2.8) to 1.5
(. sd. 2.3) (p <
0.001). The mean active forward elevation
and external rotation increased from 42. °. (. sd. 30)
and 9. °. (. sd. 15) respectively pre-operatively
to 78. °. (. sd. 39) and 24. °. (. sd. 17)
post-operatively (p <
0.001). A total of 20 patients required
further surgery for complications; 13 required revision of components.
No patient developed
Reverse shoulder arthroplasty is becoming a frequent treatment of choice for patients with shoulder disorders. Complication rates after reverse shoulder arthroplasty may be three-fold that of conventional total shoulder arthroplasty especially in high risk patient populations and diagnoses like revision arthroplasty, fracture sequelae, and severe glenoid bone loss. Complications include component malposition, stiffness, neurological injury, infection, dislocation or instability, acromial or scapular spine fractures,
Background. One of the main concern about reverse shoulder arthoplasty for the treatment of rotator cuff deficiency is
Purpose. Reverse shoulder prosthesis may lead to
Background.
Background. There has been increased focus on understanding the risk factors associated with
INTRODUCTION: The reverse DELTA III shoulder prosthesis can successfully relieve pain and restore function in cuff tear arthropathy. The most frequently reported complication is inferior
Introduction. Due to the predictability of outcomes achieved with reverse shoulder arthroplasty (rTSA), rTSA is increasingly being used in patients where glenoid fixation is compromised due to presence of glenoid wear. There are various methods to achieve glenoid fixation in patients with glenoid wear, including the use of bone grafting behind the glenoid baseplate or the use of augmented glenoid baseplates. This clinical study quantifies clinical outcomes achieved using both techniques in patients with severe glenoid wear at 2 years minimum follow-up. Methods. 80 patients (mean age: 71.6yrs) with 2 years minimum follow-up were treated by 7 fellowship trained orthopaedic surgeons using rTSA with bone graft behind the baseplate or rTSA with an augmented glenoid baseplate in patients with severe posterior glenoid wear. 39 rTSA patients (14 female, avg: 73.1 yrs; 25 male, avg: 71.5 yrs) received an augmented glenoid (cohort composed of 24 patients with an 8° posterior augment baseplate and 15 patients with a 10° superior augment baseplate) for treatment of CTA, RCT, and OA with a medially eroded scapula. 41 rTSA patients (27 female, avg: 73.0 yrs; 14 male, avg: 66.9 yrs) received glenoid bone graft (cohort composed of 5 patients with allograft and 36 patients with autograft) for treatment of CTA, RCT, and OA with a medially eroded scapula. Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, forward flexion, and internal/external rotation were also measured to quantify function. Average follow-up was 31.2 months (augment 28.3; graft 34.1). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements. Results. A comparison of pre-operative, post-operative, and pre-to-post improvement in outcomes are presented in Tables 1–3, respectively. No difference was noted in pre-operative, post-operative, and pre-to-post improvement in outcomes between cohorts. The augmented glenoid baseplate rTSA cohort had 0 complications for a complication rate of 0%; whereas, the rTSA glenoid bone graft cohort had 6 complications (including 2 glenoid loosenings/graft failures) for a complication rate of 14.6%. Additionally, radiographic follow-up information was available for 30 of 39 augmented baseplate patients (76.9%) and 27 of 41 bone graft patients (65.9%); where the augmented baseplate rTSA cohort had a
Introduction. Reverse shoulder prosthesis has been developed to treat the clinical and pathological condition noted as cuff tear arthropathy (CTA). The current models of reverse shoulder arthroplasty (RSA) expose the procedure to the risk of
Introduction: In most of the reported series,
Introduction. A common phenomenon occurring as a result of reverse total shoulder arthroplasties (RSA) is
Abstract. Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus. The main goal of the current study was to evaluate the functional and radiographic results after primary RSA of three or four-part fractures of the proximal humerus in elderly patients. Between 2012 and 2020, 70 consecutive patients with a recent three- or four-part fracture of the proximal humerus were treated with an RSA. There were 41 women and 29 men, with a mean age of 76 years. The dominant arm was involved in 42 patients (60%). All surgeries were carried out within 21 days. Displaced three-part fracture sustained in 16 patients, 24 had fracture dislocation and 30 sustained a four-part fracture of the proximal humerus. Patients were followed up for a mean of 26 months. The mean postoperative OSS at the end of the follow-up period was 32.4. The mean DASH score was 44.3. Tuberosity non-union occurred in 18 patients (12.6%), malunion in 7 patients (4.9%), heterotopic ossification in 4 patients (2.8%) and
Reverse shoulder arthroplasty (RSA) has an increasing effective use in the treatment of patients with a variety of diagnoses, including rotator cuff deficiency, inflammatory arthritis, or failed shoulder prostheses. Glenoid bone loss is not uncommonly encountered in these cases due to the significant wear. Severe bone loss can compromise glenoid baseplate positioning and fixation, consequently increasing the risk for early component loosening, instability, and
Glenoid bone grafting in reverse total shoulder arthroplasty (RTSA) has emerged as an effective method of restoring bone stock in the presence of complex glenoid bone loss, yet there is limited published evidence on efficacy. The aim of this study was to conduct an analysis of clinical and radiographic outcomes associated with glenoid bone grafting in primary RTSA. Patients who underwent a primary RTSA with glenoid bone grafting were retrospectively identified from the databases of two senior shoulder surgeons. Inclusion criteria included minimum of 12 months clinical and/or radiographical follow up. Patients underwent preoperative clinical and radiographic assessment. Graft characteristics (source, type, preparation), range of movement (ROM), patient-reported outcome measures (Oxford Shoulder Scores [OSS]), and complications were recorded. Radiographic imaging was used to analyse implant stability, graft incorporation, and notching by two independent reviewers. Between 2013 and 2021, a total of 53 primary RTSA procedures (48 patients) with glenoid bone grafting were identified. Humeral head autograft was used in 51 (96%) of cases. Femoral head allograft was utilised in two cases. Depending on the morphology of glenoid bone loss, a combination of structural (corticocancellous) and non-structural (cancellous) grafts were used to restore glenoid bone stock and the joint line. All grafts were incorporated at review. The mean post-operative OSS was significantly higher than the pre-operative OSS (40 vs. 22, p < 0.001). ROM was significantly improved post-operatively. One patient is being investigated for residual activity-related shoulder pain. This patient also experienced
Glenoid baseplate positioning for reverse total shoulder replacements (rTSR) is key for stability and longevity. 3D planning and image-derived instrumentation (IDI) are techniques for improving implant placement accuracy. This is a single-blinded randomised controlled trial comparing 3D planning with IDI jigs versus 3D planning with conventional instrumentation. Eligible patients were enrolled and had 3D pre-operative planning. They were randomised to either IDI or conventional instrumentation; then underwent their rTSR. 6 weeks post operatively, a CT scan was performed and blinded assessors measured the accuracy of glenoid baseplate position relative to the pre-operative plan. 47 patients were included: 24 with IDI and 23 with conventional instrumentation. The IDI group were more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane when compared to the conventional group (p=0.01). The IDI group had a smaller degree of error when the native glenoid retroversion was >10° (p=0.047) when compared to the conventional group. All other parameters (inclination, anterior/posterior plane, glenoids with retroversion <10°) showed no significant difference between the two groups. Both IDI and conventional methods for rTSA placement are very accurate. However, IDI is more accurate for complex glenoid morphology and placement in the superior-inferior plane. Clinically, these two parameters are important and may prevent long term complications of
Introduction:. Lateralization of reversed shoulder arthroplasty provides improvement in range of motion and decreases inferior
Purpose:. Although short term outcomes of reverse total shoulder arthroplasty (rTSA) have been promising, long-term success may be limited due to complications, including
Thoracic hyperkyphosis (TH – Cobb angle >40°) is correlated with rotator cuff arthropathy and associated with anterior tilting and protraction of scapula, impacting the glenoid orientation and the surrounding musculature. Reverse total shoulder arthroplasty (RTSA) is a reliable surgical treatment for patients with rotator cuff arthropathy and recent literature suggests that patients with TH may have comparable range of motion after RTSA. However, there exists no study reporting the possible link between patient-reported outcomes, humeral retroversion and TH after RTSA. While the risk of post-operative complications such as instability, hardware loosening,
BACKGROUND:. Bony increased-offset reverse shoulder arthroplasty (BIO-RSA) creates a long-necked scapula, providing the benefits of lateralization. Experience with allogenic bone grafting of the glenoid in shoulder arthroplasty is mainly based on its use with total shoulder arthroplasty (TSA). Therefore, our study objectives were: 1) verify if the use of BIO-RSA together with glenoid surface grafting with allogenic bone would provide similar benefits (clinical and functional) as found with autologous bone, 2) determine if allograft could be a good alternative in the absence of (good quality) autograft bone, and 3) to see if the allograft would incorporate with the native glenoid bone. METHODS:. We included 25 patients (19 female, 6 male) in this prospective study. Indications for BIO-RSA were: fracture sequalle (n = 9), revisions (n = 11), 4-part humerus fracture (n = 1), rheumatoid arthritis (n = 1) and cuff tear arthropathy (CTA) with poor humeral head bone quality/osteonecrosis (n = 3). Mean (± SD) age 70 ± 11 years (range, 44–86). Clinical evaluation consisted of ROM, Constant scores, patient satisfaction (Subjective Shoulder Value (SSV)) and noted complications. Radiographic and CT scan evaluation consisted of bone graft healing, bone graft resorption/lysis, glenoid component loosening, inferior
Knowledge of the premorbid glenoid shape and the morphological changes the bone undergoes in patients with glenohumeral arthritis can improve surgical outcomes in total and reverse shoulder arthroplasty. Several studies have previously used scapular statistical shape models (SSMs) to predict premorbid glenoid shape and evaluate glenoid erosion properties. However, current literature suggests no studies have used scapular SSMs to examine the changes in glenoid surface area in patients with glenohumeral arthritis. Therefore, the purpose of this study was to compare the glenoid articular surface area between pathologic glenoid cavities from patients with glenohumeral arthritis and their predicted premorbid shape using a scapular SSM. Furthermore, this study compared pathologic glenoid surface area with that from virtually eroded glenoid models created without influence from internal bone remodelling activity and osteophyte formation. It was hypothesized that the pathologic glenoid cavities would exhibit the greatest glenoid surface area despite the eroded nature of the glenoid and the medialization, which in a vault shape, should logically result in less surface area. Computer tomography (CT) scans from 20 patients exhibiting type A2 glenoid erosion according to the Walch classification [Walch et al., 1999] were obtained. A scapular SSM was used to predict the premorbid glenoid shape for each scapula. The scapula and humerus from each patient were automatically segmented and exported as 3D object files along with the scapular SSM from a pre-operative planning software. Each scapula and a copy of its corresponding SSM were aligned using the coracoid, lateral edge of the acromion, inferior glenoid tubercule,
Lateralization of the reverse arthroplasty may be desirable to more effectively tension the remaining rotator cuff, decrease
Abstract. Shoulder replacements have evolved and current 4th generation implants allow intraoperative flexibility to perform anatomic, reverse, trauma, and revision shoulder arthroplasty. Despite high success rates with shoulder arthroplasty, complication rates high as 10–15% have been reported and progressive glenoid loosening remains a concern. Objectives. To report medium term outcomes following 4th generation VAIOS® shoulder replacement. Methods. We retrospectively analysed prospectively collected data following VAIOS® shoulder arthroplasty performed by the senior author between 2014–2020. This included anatomical (TSR), reverse(rTSR), revision and trauma shoulder replacements. The primary outcome was implant survival (Kaplan-Meier analysis). Secondary outcomes were Oxford Shoulder Scores (OSS), radiological outcomes and complications. Results. 172 patients met our inclusion criteria with 114 rTSR, 38 anatomical TSR, and 20 hemiarthroplasty. Reverse TSR- 55 primary, 31 revision, 28 for trauma. Primary rTSR- 0 revisions, average 3.35-year follow-up. Revision rTSR-1 revision (4.17%), average 3.52-year follow-up. Trauma rTSR- 1 revision (3.57%), average 4.56-year follow-up OSS: Average OSS improved from 15.39 to 33.8 (Primary rTSR) and from 15.11 to 29.1 (Revision rTSR). Trauma rTSR-Average post-operative OSS was 31.4 Anatomical TSR38 patients underwent primary anatomical TSR, 8 were revisions following hemiarthroplasty. In 16/38 patients, glenoid bone loss was addressed by bone grafting before implantation of the metal back glenoid component. Mean age at time of surgery was 68.3 years (53 – 81 years). Mean follow-up was 34 months (12 – 62 months). The average Oxford shoulder score improved from 14 (7–30) to 30 (9–48). There were 3 revisions (7.8%); two following subscapularis failure requiring revision conversion to reverse shoulder replacement and one for glenoid graft failure. Conclusions. The medium-term results of the VAIOS® system suggest much lower revision rates across multiple configurations of the system than previously reported, as well as a low incidence of
Abstract. Background/Objectives. The incidence of reverse total shoulder replacement (rTSR) implantation is increasing globally, but apprehension exists regarding complications and associated challenges. We retrospectively analysed the senior author's series of rTSR from a tertiary centre using the VAIOS shoulder system, a modular 4th generation implant. We hypothesised that the revision rTSR cohort would have less favourable outcomes and more complications. Methods. 114 patients underwent rTSR with the VAIOS system, over 7 years. The primary outcome was implant survival. Secondary outcomes were Oxford shoulder scores (OSS), radiographic analysis (scapular notching, tuberosity osteolysis, and periprosthetic radiolucent lines) and complications. Results. There were 55 Primary rTSR, 31 Revision rTSR and 28 Trauma rTSR. Implant survival: Primary rTSR- 0 revisions, average 3.35-year follow-up. Revision rTSR-1 revision (4.17%), average 3.52-year follow-up. Trauma rTSR- 1 revision (3.57%), average 4.56-year follow-up OSS: Average OSS improved from 15.39 to 33.8 (Primary rTSR) and from 15.11 to 29.1 (Revision rTSR). Average post-operative OSS for the Trauma rTSR was 31.4 Radiological analysis and complications: Low incidence of
We have previously described the short-term outcome of the use of reverse shoulder arthroplasty in the treatment of acute complex proximal humeral fractures in the elderly. We now report the clinical and radiological outcome of 36 fractures at a mean of 6.6 years (1 to 16). Previously, at a mean follow-up of 6 years (1 to 12) the mean Constant score was 58.5; this was reduced to 53 points with the further follow-up. A total of 23 patients (63%) had radiological evidence of loosening of the glenoid component. Nevertheless, only one patient had aseptic loosening of the baseplate at 12 years’ follow-up. The reduction in the mean Constant score with longer follow-up and the further development of
Utilization of reverse total shoulder arthroplasty (RTSA) has steadily increased since its 2003 introduction in the American market. Although RTSA was originally indicated for elderly, low demand patients, it is now being increasingly used to treat rotator cuff arthropathy, humeral fractures, neoplasms and failed total and hemi shoulder arthroplasty. There is, therefore, a growing interest in bearing surface wear of RTSA polyethylene humeral liners. In the current study, we examined humeral liners retrieved as part of an IRB approved study to determine the amount of bearing surface wear. We hypothesized that wear of the bearing surface by intentional contact with the glenosphere (mode I) would be minor compared to that produced by
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 reverse shoulder arthroplasty (RSA), with retention
of the humeral stem and glenoid baseplate. This has the potential
to reduce morbidity and improve the results. . In a retrospective study of 14 patients (15 shoulders) with a
mean age of 70 years (47 to 83) we reviewed the clinical and radiological
outcome of converting an anatomical shoulder arthroplasty (ASA)
to a RSA using a convertible prosthetic system (SMR system, Lima,
San Daniele, Italy). . The mean operating time was 64 minutes (45 to 75). All humeral
stems and glenoid baseplates were found to be well-fixed and could
be retained. There were no intra-operative or early post-operative
complications and no post-operative infection. The mean follow-up was 43 months (21 to 83), by which time the
mean visual analogue scale for pain had decreased from 8 pre-operatively
to 1, the mean American Shoulder and Elbow Surgeons Score from 12
to 76, the mean Oxford shoulder score from 3 to 39, the mean Western
Ontario Osteoarthritis of the Shoulder Score from 1618 to 418 and
the mean Subjective shoulder value from 15 to 61. On radiological review, one patient had a lucency around the
humeral stem, two had stress shielding. There were no fatigue fractures
of the acromion but four cases of grade 1
BACKGROUND:. Few studies have evaluated at a medium-term follow-up the use of semiconstrained reverse shoulder arthroplasty (RSA) for primary glenohumeral osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy excluding any other shoulder disease. Moreover, data on patients' quality of life after this surgery are lacking. METHODS:. In this prospective cohort study, 80 patients were evaluated after an RSA for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy with the Constant-Murley score (CMS), ROM, and Short Form Health Survey (SF-36). A radiologic assessment was performed pre- and postoperatively. RESULTS:. At a mean 5-year follow-up, the cumulative survival rate was 97.3% and significant improvements in the CMS and ROM were observed when compared with the baseline values. The CMS was 93.2% of the sex- and age-matched normal values. The postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA. A 70%
Background. The use of reverse total shoulder arthroplasty considerably increased since first introduced by Paul Grammont in the late 1980s. Over the past few years, results from several mid- and long-term clinical studies have demonstrated good functional outcomes and pain relief. However, several complications, especially inferior glenoid notching, and high revision rates were reported in the literature. Improvements in prosthesis design should contribute to a lower complication rate and lesser amount of glenoid erosion. Few studies have reported the clinical outcome andcomplications of Anatomical Shoulder Inverse/ Reverse Prosthesis. This study documents 2- and 6-year clinical and radiological results following reversed shoulder arthroplasty using this novel prosthesis. Methods. We report the results for sixty-eight consecutive patients (seventy shoulders) with cuff tear arthropathy (CTA) treated with Anatomical Shoulder Inverse/Reverse Prosthesis between 2006 and 2008. Two groups were defined: (A) primary treatment and (B) revision. Clinical evaluation tools comprised Constant-Murley score (CS), range of motion, and a visual analog scale to assess pain. Radiographs (anteroposterior view in neutral position) were evaluated for notching and radiolucent lines. Any complications were recorded. Results. In total, 66 shoulders (94%) with a mean follow-up of 30.0 months were initially analysed. CS increased from preoperatively 20.2 to postoperatively 53.6 points. Inferior
Purpose: The purpose of this retrospective studies is to evaluate the real effectiveness, with clinical and radiologic evalutation, of the eccentric glenosphere and also how a correct position can prevent the
INTRODUCTION. The aim of this retrospective study is to evaluate clinically and radiographically the effectiveness of implanting an eccentric glenosphere and if a correct glenosphere positioning would avoid the occurrence of notching. METHODS. since 2006 40 patients with shoulder eccentric osteoarthritis were treated with reverse shoulder arthroplasty with a 36 mm eccentric glenosphere. We have selected 25 patients, with a minimum follow up of 24 months. The patients were clinically evaluated with the Constant score and SST and with X-ray, MRI and/or CT before and after surgery. At the follow up we evaluated the presence or absence of notch, and we measured the PSNA (prosthesis-scapular neck angle), the DBSNG (distance between the scapular neck angle and glenosphere), the PGRD distance (peg glenoid distance). Stastistical analysis was performed with a paired t test. RESULTS. In every patient the range of motion was improved. The AP X-ray did not show inferior
Aims. The eccentric glenosphere was principally introduced into reverse
shoulder arthroplasty to reduce the incidence of
Reverse total shoulder replacement is a viable surgical option for Cuff Tear Arthropathy. Short term results have been promising. Longer term follow-up has demonstrated a high rate of
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
Purpose: We hypothesized that lateralization of the RSA, with a glenoid bone graft taken from the osteotomised humeral head, would prevent those problems without increasing torque on the glenoid component by keeping the center of rotation within the glenoid. The objectives of this study were to describe the results of the first 12 patients that underwent a bony increased-offset RSA (BIO RSA). Method: Thirty-six shoulders in 34 consecutive patients with cuff tear arthritis (mean age 72 years, range 52–86 years) received a BIO RSA, consisted of a RSA incorporating an autogenous humeral head bone graft placed beneath the glenoid baseplate. A baseplate with a lengthened central peg (+25 mm) was inserted in the glenoid vault, securing the bone graft beneath the baseplate and screws. All patients underwent clinical and radiographic (computed tomography) review at a minimum 1-year follow-up. Results: All patients were satisfied or very satisfied and all had no or slight pain. Mean active elevation increased from 72° to 142° (p<
0.05), external rotation from 10° to 18° (p<
0.05) and internal rotation from L4 to L3 (p>
0.05). Constant Score improved from 27 to 63 points (p<
0.05). The Subjective Shoulder Value (SSV) increased from 27% to 73% (p<
0.05). Radiographically, the graft healed to the native glenoid in all cases and no graft resorption under the baseplate was observed. Complications included one patient with
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
Reverse total shoulder arthroplasty (R-TSA) converts the glenohumeral joint into a ball-and-socket articulation by implanting a metal glenosphere on the glenoid and a concave polyethylene articulation in the humerus. This design increases the stability of the shoulder and is indicated for the treatment of end-stage shoulder arthropathy with significant rotator cuff deficiency. To minimise the risk of loosening, the glenosphere is often medialised (to keep the center of rotation within glenoid bone). Since bone grafting under the glenosphere is recommended as an alternate method to medialisation, we studied the effect of glenosphere placement on the biomechanical efficiency of the deltoid. A musculoskeletal model of the shoulder was constructed using BodySIM (LifeModeler, Inc, San Clemente, CA). The model simulated active dynamic glenohumeral and scapulothoracic abduction in a shoulder implanted with an R-TSA. Muscle forces and gleno-humeral contact forces were computed during shoulder abduction. The following conditions were simulated:. R-TSA with the center of rotation unchanged;. medialisation of center of rotation by 16 mm;. medialisation reduced to 10 mm with a 6-mm bone graft; and. inferior placement of R-TSA by 4 mm to preserve soft-tissue tension and prevent
Introduction. While shoulder elevation can be reliably restored following reverse total shoulder arthroplasty (RTSA), patients may experience a loss of internal and external rotation. Several recent studies have investigated
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
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
Introduction:. Studies have demonstrated both clinical and radiological success of reverse shoulder arthroplasty (RTSA), with follow-up approaching 10-years. To date, most RTSA studies involve cemented fixation of the humeral components, and most involving uncemented RTSAs have used implants not necessarily designed for bony ingrowth. Cementless fixation utilizing proximally porous-coated (PPC) femoral implants has shown long term survivorship approaching 99% at greater than 10-years follow-up in total hip arthroplasty. Currently, the number of commercially available PPC RTSA implants is steadily growing, but there has been no published study examining clinical and radiographic outcomes in PPC, press-fit humeral stems. We hypothesized that the clinical and radiographic results of uncemented RTSA utilizing a PPC humeral stem would be similar to cemented RTSA stems when followed for at least 2-years. Methods:. A prospective, IRB approved RTSA outcomes registry with 261 patients that underwent RTSA by one fellowship-trained orthopaedic surgeon between 2005 and 2008 was reviewed. Inclusion criteria were diagnosis of cuff tear arthropathy or severe rotator cuff deficiency refractory to all other treatments, and minimum 2-year clinical and radiographic follow-up. Exclusion criteria were proximal humeral fractures, glenohumeral instability, rheumatoid arthritis, incomplete follow-up, and revision arthroplasty. Outcome measures included active forward elevation (aFE), active external rotation (aER), active internal rotation (aIR), Constant-Murley score (CS), Subjective Shoulder Value (SSV), visual analogue scale (VAS) pain, and American Shoulder and Elbow Surgeons (ASES) score. Radiographs at 2 weeks, 3 months, 1 year, 2 years and yearly thereafter were evaluated for humeral component position, osteolysis, humeral component radiolucent lines (RLLs), stress shielding, and
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
Reverse total shoulder arthroplasty (RSA) with glenoid bone grafting has become a common option for the management of significant glenoid bone loss and deformity associated with glenohumeral osteoarthritis. Despite the increasing utilization of this technique, our understanding of the rates of bone graft union, complications and outcomes are limited. The objectives of this systematic review are to determine 1) the overall rate of bone graft union, 2) the rate of union stratified by graft type and technique, 3) the reoperation and complication rates, and 4) functional outcomes, including range of motion (ROM) and functional outcome scores following RSA with glenoid bone grafting. A comprehensive search of MEDLINE, Embase, and CINAHL databases was completed for studies reporting outcomes following RSA with glenoid bone grafting. Inclusion criteria included clinical studies with greater than 10 patients, and minimum follow up of one year. Studies were screened independently by two reviewers and quality assessment was performed using the MINORs criteria. Pooled and frequency-weighted means and standard deviations were calculated where applicable. Overall, 15 studies were included, including nine retrospective case series (level IV), four retrospective cohort studies (level III), one prospective cohort study (level II) and one randomized control trial (level I). The entire cohort consisted of 555 patients with a mean age of 71.9±2.1 years and 70 percent female. The mean follow-up was 33.8±9.4 months. Across all procedures, 84.9% (N=471) were primary arthroplasties, and 15.1% (N=84) were revisions. The overall graft union rate was 89.2%, but was higher at 96.1% among studies that used autograft bone (9 studies, N=308). When stratified by technique, bone graft for the purposes of lateralization resulted in a 100% union rate (4 studies, N=139), while eccentric bone grafts used in asymmetric bone loss resulted in a lower union rate of 84.9% (10 studies, N=345). The overall revision rate was 6.5%, and was lowest following primary cases at 1.8% (11 studies, N=393). The pooled mean
A reverse total shoulder arthroplasty (RSA) is frequently performed in the revision setting. The purpose of this study was to report the clinical outcomes and complication rates following revision RSA (RRSA) stratified according to the primary shoulder procedure undergoing revision, including failed hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA), RSA, soft tissue repair (i.e., rotator cuff repair), and open reduction internal fixation (ORIF). A systematic review of the literature was performed using four databases (EMBASE, Medline, SportDISCUS, and Cochrane Controlled Trials Register) between January 1985 and September 2017. The primary outcomes of interest included active range-of-motion (ROM), pain, and functional outcome measures including the American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), and Constant-Murley (CS) Score. Secondary outcomes included complication rates, such as infection, dislocation, perioperative fracture, base plate failure, neurovascular injury, soft tissue injury, and radiological evidence of
Introduction. Reverse Total Shoulder Arthroplasty (rTSA) is an efficient treatment, to relieve from pain and to increase function. However,
Severe glenoid bone loss in patients with osteoarthritis with intact rotator cuff is associated with posterior glenoid bone loss and posterior humeral subluxation. Management of severe glenoid bone loss during shoulder arthroplasty is controversial and technically challenging and options range from humeral hemiarthroplasty, anatomic shoulder replacement with glenoid bone grafting or augmented glenoid component implantation, to reverse replacement with reaming to correct version or structural bone grafting or metallic augmentation of the bone deficiency. Shoulder replacement with severe glenoid bone loss is technically challenging and characterised by higher rates of complications and revisions. Hemiarthroplasty has limited benefit for pain relief and function especially if eccentric glenoid wear exists. Bone loss with >15 degrees of retroversion likely requires version correction include bone-grafting, augmented glenoid components, or reverse total shoulder replacement. Asymmetric reaming may improve version but is limited to 15 degrees of version correction in order to preserve subchondral bone and glenoid bone vault depth. Bone-grafting of glenoid wear and defects has had mixed results with graft-related complications, periprosthetic radiolucent lines, and glenoid component failure of fixation. Implantation of an augmented wedge or step polyethylene glenoid component improves joint version while preserving subchondral bone, but is technically demanding and with minimal short term clinical follow-up. A Mayo study demonstrated roughly 50% of patients with posteriorly augmented polyethylene had radiolucent lines and 1/3 had posterior subluxation. Another wedge polyethylene design had 66% with bone ingrowth around polyethylene fins at 3 years. Long term outcomes are unknown for these new wedge augmented glenoid components. Reverse shoulder arthroplasty avoids many risks of anatomic replacement glenoid component fixation and stability but is associated with a high complication rate (15%) including neurologic and baseplate loosening and often requires structural bone grafting behind the baseplate with suboptimal outcomes or metallic augmented baseplates with limited evidence and short term outcomes. Reverse replacement with baseplate bone grafting or metal augmentation is technically challenging due to limited native glenoid bone stock available for baseplate component ingrowth and long term fixation. Failure to correct glenoid superior inclination and restore neutral version within 10 degrees increases the risks of reverse baseplate failure of fixation, pull out, and failure of reverse replacement. Reverse baseplate failure rates in patients with severe glenoid bone loss and concomitant glenoid bone grafting range from 5–11%. The minimum native glenoid bony contact with the baseplate is unknown but likely is approximately 1cm of native bone contacting a central ingrowth post and a minority (∼15–25%) of native glenoid contacting the backside of the baseplate. Failure to correct posterior bone loss can lead to retroversion of the baseplate, reduced external rotation, posterior
Purpose. To evaluate the results of reverse total shoulder arthroplasty for complicated proximal humerus fractures in old ages. Materials and Methods. We retrospectively evaluated 13 cases who underwent reverse total shoulder arthroplasty for proximal humerus fracture, fracture-dislocation and nonunions of the fractures. Mean age was 77(68–87)years old and mean follow-up period was 15.2(12–26)months. four part fractures of proximal humerus in 7 cases, fracture-dislocation in 3 cases, locked dislocation with greater tuberosity in 2 cases, nonunion with defiency of rotator cuff in 1 case were included. We evaluated mean ASES, mean UCLA, mean KSS, mean SST and mean range of motion(ROM). Results. Postoperative mean ASES was 59(13–98.5), mean UCLA was 21(12–34), mean KSS was 62(21–94), mean SST was 5(1–11). Postoperative mean ROM was 103°(30°–135°) in forward flexion, 93°(30°–135°) in abduction, 21°(0°–45°) in external rotation and L4 level in internal rotation. The complications were not shown in any cases except for resolved heterotropic ossification. 4 cases demonstrated bony unions on greater tuberosity and 4 cases showed
Background.
Reverse total shoulder arthroplasty (RTSA) is a well established treatment that provides reproducible results in the treatment of shoulder arthritis and rotator cuff deficiency in the older patient population. However, the results of arthroplasty in younger, more active patients are currently unclear and not as predictable. The purpose of this study is to evaluate the mid-term results of RTSA for patients aged younger than 60 years. A retrospective review of twenty-six patients (twenty six RTSAs) with a mean age of 58.3 years was performed. Minimum follow-up of 5 years was available at a mean follow-up of 73.3 months postoperatively (range, 60–84 months). The preoperative conditions compelling RTSA were as follows: failed rotator cuff repair (17), fracture sequelae (5), failed arthroplasty (1), and cuff tear arthropathy (CTA) (3). We assessed range-of-motion and strength, visual analog scale, American Shoulder and Elbow Surgeons (ASES), and Constant scores. Radiographs were also evaluated for component loosening and
Purpose:. To evaluate the results of reverse total shoulder arthroplasty for complicated proximal humerus fractures in old ages. Materials and Methods:. We retrospectively evaluated 13 cases who underwent reverse total shoulder arthroplasty for proximal humerus fracture, fracture-dislocation and nonunions of the fractures. Mean age was 77 years old and mean follow-up period was 15.2(12–26) months. four part fractures of proximal humerus in 7 cases, fracture-dislocation in 3 cases, locked dislocation with greater tuberosity in 2 cases, nonunion with defiency of rotator cuff in 1 case were included (Fig. 1, Fig. 2, Fig. 3). We evaluated mean ASES, mean UCLA, mean KSS, mean SST and mean range of motion (ROM). Results:. Postoperative mean ASES was 59(13–98.5), mean UCLA was 21(12–34), mean KSS was 62(21–94), mean SST was 5(1–11). Postoperative mean ROM was 103° in forward flexion, 93° in abduction, 21° in external rotation and L4 level in internal rotation. 4 cases demonstrated bony unions on greater tuberosity and 4 cases showed
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
Introduction:. Reverse shoulder arthroplasty (RSA) is a reasonable treatment modality in patients with Cuff Tear Arthropaty and massive irreparable cuff tears. RSA has been shown to increase patient function and decrease pain. The aim of this study is to evaluate the clinical and radiographic results of a 44 polyethylene glenosphere. Methods:. Since 2008 we treated 88 patients with cuff tear arthropaty and irreparable massive cuff tear, using an RSA. We selected 80 patients with minimum FU of 24 months in which we used an implant with polyethylene glenosphere and metal humeral insert. Size of the glenosphere used was 44. All patients were assessed with the Constant score and with VAS. The shoulder ROM was measured preoperatively and postoperatively. Results:. Average age of the patients was 71 years old. Average duration of FU was 34 months. All measures improved significantly (p < 0.0001). The mean Constant improved from 15.6 to 60.2. VAS improved from 6 to 2,5. Forward flexion increased from 40 ° to 126,4 °, abduction from 41 ° to 103 °, external rotation from 15.1 to 17.3 and internal rotation increased by two level. We report 22 cases of
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, reverse shoulder arthroplasty is capable of addressing both rotator cuff disorders and glenohumeral deficiencies. The Aequalis Reversed Shoulder Prosthesis design is based on two bio-mechanical principles by Grammont; a medialized center of rotation located inside the glenoid bone surface and second, a 155 degree angle of inclination. Combined, they increase the deltoid lever arm by distalizing the humerus and make the prosthesis inherently stable. 24 consecutive primary reverse total shoulder arthroplasties were performed by a single surgeon for arthritis with rotator cuff compromise and 1 as a revision for a failed primary total shoulder replacement between December 2009 and October 2012. Patients were assessed postoperatively with the use of the DASH score, Oxford shoulder score, range of shoulder motion and plain radiography with Sirveaux score for
Purpose. While reverse shoulder arthroplasty (RSA) corrects vertical muscle imbalance, it cannot restore the horizontal imbalance seen in cuff-deficient shoulders with combined loss of active elevation and external rotation (CLEER). We report the medium-term results of the modified latissimus dorsi/teres major tendon transfer (L'Episcopo procedure) associated with RSA, performed via a single deltopectoral approach. Method. Sixteen CLEER patients underwent the procedure and were followed up at a mean of 49 months (range, 36–70). All patients had lost spatial control of their arm, were unable to maintain neutral rotation, and had abnormal infraspinatus and teres minor muscles on imaging. Outcome measures included Constant score (CS), Subjective Shoulder Value (SSV), and ADLER score (activities of daily living requiring external rotation). Results. Fifteen patients were satisfied or very satisfied. There were significant improvements (p<0.05) in active elevation (72 degrees to 139 degrees), active external rotation (−24 degrees to 4 degrees), CS (27 to 64), ADLER score (5.0 to 23.8) and SSV (23% to 77%). Active internal rotation decreased from 6 to 3 points.
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
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
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
Introduction. Reverse total shoulder arthroplasty continues to have a high complication rate, specifically with component instability and
Purpose: Despite good clinical results of the reverse total shoulder arthroplasty inferior
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
Most common current surgical treatment options for cuff tear arthropathy (CTA) are hemiarthroplasty and reverse total shoulder replacement. At our unit we have been using Reverse Total shoulder replacement (TSR) for CTA patients since 2001. We present our results of Reverse TSR in 64 patients (single surgeon) with a mean follow up of 2 years (Range 1 to 8 years). There were 45 males and 19 females in the study with a mean age of 70 years. Preoperative and postoperative Constant scores were collected by a team of specialist shoulder physiotherapists. Preoperatively plain radiographs were used to evaluate the severity of arthritis and bone stock availability. 90% patients showed an improvement in the Constant score post operatively. The mean improvement in Constant score was 25 points. The mean Pain Score (max 15) improved from 6.3 to 11.8; the mean ADL Score (max 20) improved from 6.8 to 12.3; the mean Range of Motion score (max 40) improved from 10.8 to 20.2; but the mean Power Score (max 25) only improved from 0.9 to 4.9. The differences in improvement were statistically significant in each category. A total 6 patients (10%) required 10 revision surgeries for various reasons. Two patients dislocated anteriorly who were treated by open reduction. Two patients required revision of the glenoid component due to loosening after a mean of 2 years. One patient required revision of the humeral component with strut grafting secondary to severe osteolysis. Only one patient required revision of both humeral and glenoid components secondary to malpositioning. Three patients died for reasons unconnected with their shoulder problems and surgery. Radiographic analysis at the latest follow up (mean 24 months) showed inferior glenoid notching in 40% cases. Heterotrophic ossification was not seen in our series. We conclude that reverse TSR is a viable option for treatment of cuff tear arthropathy however glenoid loosening and
Reverse total shoulder arthroplasty was developed to address the treatment of patients with Cuff Tear Arthropathy. Despite of the clinical improvements seen with initial reverse shoulder replacements, several mechanical problems remain.
We present a retrospective analysis of 50 cases of cuff tear arthropathy, treated over past seven year period by use of reverse geometry shoulder prosthesis. 98% follow-up was achieved with average follow up of 3 years. Mean (SD) age was 81.3 (9.2) years and female to male ratio was 5:1. Six patients had bilateral reverse geometry shoulder replacements. Patients were assessed with preoperative Oxford and American Shoulder and Elbow Scores Society score (pre-op ASES) and post-operative American Shoulder and Elbow Society Score (post-op ASES), Oxford, Constant and SF36 scores. Mean pre-op ASES was 22.29 (95%CI: 9.1 – 37.9) and post-op ASES score was 65.2 (95%CI: 48.5 – 81.9), (P<
0.001, Paired t-test). Mean post operative Oxford score was 27.25 (95% CI: 18.4 – 27.6). Mean post operative Constant score was 63.2 (95% CI: 52.6 – 79.6). X-ray review was performed to assess
We present a retrospective analysis of 50 cases of cuff tear arthropathy, treated over a seven year period by use of reverse geometry shoulder prosthesis. 98% follow-up was achieved with average follow up of 3 years. Mean (SD) age was 81.3 (9.2) years and female to male ratio was 5:1. Six patients had bilateral reverse geometry shoulder replacements. Patients were assessed with pre-operative American Shoulder and Elbow Score (pre-op ASES) and post-operative American Shoulder and Elbow Scores (post-op ASES), Oxford, Constant and SF36 scores. Mean pre-op ASES was 22.29 (95%CI: 9.1 – 37.9) and post-op ASES score was 65.2 (95%CI: 48.5 – 81.9), (P<
0.001, Paired t-test). Mean post operative Oxford score was 27.25 (95% CI: 18.4 – 27.6). Mean post operative Constant score was 63.2 (95% CI: 52.6 – 79.6). X-ray review was performed to assess
Purpose: This paper will present the types and rates of complications of an initial consecutive series of 100 reverse total shoulder arthroplasties (TSA). Method: Since 2004, the initial 100 consecutive reverse TSA were performed by a single US surgeon in 97 patients with an average age of 72 years. A deltopectoral approach was used in all cases. Diagnoses include 49 shoulders with cuff tear arthropathy, 24 with a failed prior shoulder arthroplasty, 23 with an irreparable rotator cuff tear, 2 with a malunion and post-traumatic arthritis, 1 with rheumatoid arthritis, and 1 with osteoarthritis. All patients had painful pseudoparalysis. Average follow-up was 8 months, with 77 patients having a minimum 2-month follow-up. Two patients have expired (unrelated to surgery), and 1 patient has been lost to follow-up. Results: Of the 100 shoulders, 9 had local perioperative complications (9%) including 2 dislocations requiring 1 open reduction and 1 closed reduction, 2 intraoperative glenoid fractures, 3 resolved mononeuropathies (radial, ulnar, and musculocutaneous), 1 resolving brachial plexopathy, 1 post-op hematoma, and 1 intraoperative broken screw head. Three of the 4 neuropathies occurred in revision arthroplasty shoulders. Six shoulders (6%) had systemic perioperative complications including subacute MI, DVT, PE, and C. difficile colitis. Two patients (2%) have had complications outside the perioperative period including 1 stable acromial fracture at 5 weeks post-op, and 1 patient with a subluxatable shoulder. No infections occurred. Other than the 2 dislocations and the acromial fracture, no radiographic complications, such as dissociation of the components or catastrophic failure of the glenosphere fixation, were observed. Seven shoulders (7%) had Grade 3
Purpose of the study: The aim of this biomechanical study was to assess the performance of the deltoid muscle in the absence of a rotator cuff using different models for shoulder prosthesis. Material and methods: A computer model reproducing the three dimensions of the glenohumeral joint was use to analyze the force of the deltoid muscle during abduction movements in shoulders devoid of a rotator cuff. The three heads of the deltoid were analyzed in order to determine the most effective level of muscle tension. The lever arm of the deltoid was measured from 0–90° abduction. Using this 3D model, we simulated implantation of six different models of reversed prostheses in order to assess the biomechanical situation which would be the most favorable for the deltoid. Performance of the normal deltoid was compared with the performance of the deltoid after implantation of an anatomic prosthesis and after implantation of an reversed prosthesis. Several variables were studied: medial offset of the center of rotation, lateral offset of the humerus, lengthening of the deltoid muscle. Results: Optimal deltoid performance (especially from 60–90° abduction) was observed if the center of rotation was offset medially and the humerus was offset laterally and lowered. A 10% increase in the length of the muscle fibres increased muscle performance 18%. Exaggerated lateral offest of the humerus increased deltoid performance between 30 and 60° abduction but lost its beneficial effect at 90° abduction. From 15° abduction, a
Lateralizing the center of rotation in reverse shoulder arthroplasty has been the subject of renewed interest due to complications associated with medialized center of rotation implants. Benefits of lateralization include: increased joint stability, decreased incidence of
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).
Introduction: The treatment of Complex Proximal Humeral Fractures and Fractures associated with Dislocation is not still resolved. Internal Fixation sometimes is not possible due to comminuted and osteoporotic bone which is commonly found in this kind of Fractures. The use of Hemiarthroplasty in this situation, not always achieves a good functional outcome, usually related to a Non Union or Malunion of the Tuberosities. We began using Reversed Shoulder Arthroplasty in this Fractures due to good results this implant had had in Glenohumeral Arthritis associated a Rotator Cuff Deficiency. Material and Methods: From January 2004 to December 2008 we have treated 50 patients with Complex Proximal Humeral Fractures with a Reversed Shoulder Arthroplasty,38 were women and 12 were men with a mean age of 76 (38–84). The mean follow-up time was 20 months (10–36). We have used a Lima Reversed Arthroplasty in all the cases. The dominant arm were involved in 65 % of the patients. The Deltopectoral approach were used in all the cases. Thirty-five patients (70 %) were treated in less than 30 days after the fracture and 15 (30 %) were treated 30 days or more since the fracture happened. The operations were performed by 6 surgeons, but only 3 of them have performed more than 10 operations. We used the Constant Score and the American Shoulder and Elbow Score to evaluate the outcome of the implant. The preoperative movement were estimated on the mobility score of the contralateral shoulder. Results: The mean Constant and the mean modified Constant Score were 55 (23 to 73) and 70 (34 to 95). The average range of motion was 105 (45–140) for anterior elevation and 100 (35–125) for abduction. The mean modified American Shoulder and Elbow Surgeon was 64 (44–82). The average operation time was 105 minutes with a range (60–170). The main clinical complications has been: Three intraoperative Fractures of Glenoid, 2 post operative Glenoid Fractures, 2 Brachial Plexus Paralysis, 2 cases of Cubital Neuroapraxia, 2 Dislocations of the Prosthesis,2 superficial infections and 1 deep infection. Radiography it has been found
The current evidence comparing the two most common approaches for reverse total shoulder arthroplasty (rTSA), the deltopectoral and anterosuperior approach, is limited. This study aims to compare the rate of loosening, instability, and implant survival between the two approaches for rTSA using data from the Dutch National Arthroplasty Registry with a minimum follow-up of five years. All patients in the registry who underwent a primary rTSA between January 2014 and December 2016 using an anterosuperior or deltopectoral approach were included, with a minimum follow-up of five years. Cox and logistic regression models were used to assess the association between the approach and the implant survival, instability, and glenoid loosening, independent of confounders.Aims
Methods
The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula. We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification.Aims
Methods
Introduction. The treatment of complex fractures of the proximal humerus still raises controversy, particularly in those 3 or 4 part fragments fractures, which are at risk for osteosynthesis (poor fixation in poor bone) or for secondary avascular necrosis. Conventional hemi-arthroplasty has currently remained the most common surgical treatment, but the recovery of active mobility remains incomplete and disappointing. 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. Material and Medthod. We hereby present the results obtained in 43 consecutive patients (41 women and 2 men) which were retrospectively reviewed with a mean follow-up of 21 months (5–58). The mean age was 78 years-old (64–97). There were 5 three-part fractures, 26 four-part fractures and 12 four-part fracture dislocations. All patients were clinically and radiologically assessed, except two, who deceased with incomplete follow-up data. Results. The clinical outcome was satisfactory with a mean active forward elevation of 97° and a mean active external rotation in abduction (ER 2) of 30°. The mean Constant score was 44 points (16–69). The mean ponderate score was 66% (25–97%). The mean pain score was 12.5/15, the mean activity score was 10.9/20, the mobility score was 17.6/40 and the strength score was 3.6/25. The mean ponderate score of the controlateral shoulder was 105 %(80–130). 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
The August 2024 Shoulder & Elbow Roundup360 looks at: Comparing augmented and nonaugmented locking-plate fixation for proximal humeral fractures in the elderly; Elevated five-year mortality following shoulder arthroplasty for fracture; Total intravenous anaesthesia with propofol reduces discharge times compared with inhaled general anaesthesia in shoulder arthroscopy: a randomized controlled trial; The influence of obesity on outcomes following arthroscopic rotator cuff repair; Humeral component version has no effect on outcomes following reverse total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial; What is a meaningful improvement after total shoulder arthroplasty by implant type, preoperative diagnosis, and sex?; The safety of corticosteroid injection prior to shoulder arthroplasty: a systematic review; Mortality and subsequent fractures of patients with olecranon fractures compared to other upper limb osteoporotic fractures.
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 purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed.Aims
Methods
It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analyzed using a meta-analysis of proportion, and continuous variables underwent comparative subgroup analysis.Aims
Methods
Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (Aims
Patients and Methods
The reasons for failure of a hemirthroplasty (HA) when used to
treat a proximal humeral fracture include displaced or necrotic
tuberosities, insufficient metaphyseal bone-stock, and rotator cuff
tears. Reverse total shoulder arthroplasty (rTSA) is often the only
remaining form of treatment in these patients. The aim of this study
was to evaluate the clinical outcome after conversions from a failed
HA to rTSA. A total of 35 patients, in whom a HA, as treatment for a fracture
of the proximal humerus, had failed, underwent conversion to a rTSA.
A total of 28 were available for follow-up at a mean of 61 months
(37 to 91), having been initially reviewed at a mean of 20 months
(12 to 36) postoperatively. Having a convertible design, the humeral
stem could be preserved in nine patients. The stem was removed in
the other 19 patients and a conventional rTSA was implanted. At
final follow-up, patients were assessed using the American Shoulder
and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs.Aims
Material and Methods
Patients with a failed reverse shoulder arthroplasty (RSA) have limited salvage options. The aim of this study was to determine the outcome of revision RSA when used as a salvage procedure for a failed primary RSA. We reviewed all revision RSAs performed for a failed primary RSA between 2006 and 2012, excluding patients with a follow-up of less than two years. A total of 27 revision RSAs were included in the study. The mean age of the patients at the time of revision was 70 years (58 to 82). Of the 27 patients, 14 (52% were female). The mean follow-up was 4.4 years (2 to 10).Aims
Patients and Methods
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 reverse shoulder arthroplasty (RSA). A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4).Aims
Patients and Methods
To date, there is insufficient evidence available to compare
the outcome of cemented and uncemented fixation of the humeral stem
in reverse shoulder arthroplasty (RSA). A systemic review comprising 41 clinical studies was performed
to compare the functional outcome and rate of complications of cemented
and uncemented stems in RSA. These included 1455 cemented and 329
uncemented shoulders. The clinical characteristics of the two groups
were similar. Variables were compared using pooled frequency-weighted means
and relative risk ratios (RR).Aims
Methods
The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score.Aims
Patients and Methods
We present the medium-term clinical results of a reverse total
shoulder arthroplasty with a trabecular metal glenoid base plate. We reviewed 125 consecutive primary reverse total shoulder arthroplasties
(RTSA) implanted in 124 patients for rotator cuff arthropathy. There
were 100 women and 24 men in the study group with a mean age of
76 years (58 to 89). The mean follow-up was 32 months (24 to 60).
No patient was lost to follow-up.Aim
Patients and Methods
Heterotopic ossification (HO) occurs after arthroplasty, especially
total hip arthroplasty. In this study we describe the incidence,
evolution, morphology and clinical consequences of HO following
reverse shoulder arthroplasty. This is a single-centre retrospective study of 132 consecutive
patients who received a Delta III or Delta Xtend reverse total shoulder
arthroplasty between 2006 and 2013 for the treatment of cuff tear
arthropathy. There were 96 women and 36 men. Their mean age at the
time of surgery was 69 years (49 to 89) and the mean follow-up was
36 months (12 to 84). The incidence, evolution, morphology and clinical
consequences of HO using the Constant-Murley score (CS) were analysed.
A modified Brooker classification of HO of the hip was used.Aims
Patients and Methods
