Aims. The current evidence comparing the two most common approaches for
Aims. The aim of this study was to report the incidence of implant-related complications, further operations, and their influence on the outcome in a series of patients who underwent primary
Aims. Scapular notching is thought to have an adverse effect on the outcome of
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. 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 Aims
Methods
Aims. This systematic review asked which patterns of complications are associated with the three
Aims. Rates of
The February 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following
Aims. Both anatomical and
Aims. Existing literature indicates that inferiorly inclined glenoid baseplates following
The February 2024 Shoulder & Elbow Roundup. 360. looks at: Does indomethacin prevent heterotopic ossification following elbow fracture fixation?; Arthroscopic capsular shift in atraumatic shoulder joint instability; Ultrasound-guided lavage with corticosteroid injection versus sham; Combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis; Are vascularized fibula autografts a long-lasting reconstruction after intercalary resection of the humerus for primary bone tumours?; Anatomical versus
Abstract. Objective. To investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing
Aims.
Introduction & Aims. Over the last decade, sensor technology has proven its benefits in total knee arthroplasty, allowing the quantitative assessment of tension in the medial and lateral compartment of the tibiofemoral joint through the range of motion (VERASENSE, OrthoSensor Inc, FL, USA). In reversal total shoulder arthroplasty, it is well understood that stability is primarily controlled by the active and passive structures surrounding the articulating surfaces. At current, assessing the tension in these stabilizing structures remains however highly subjective and relies on the surgeons’ feel and experience. In an attempt to quantify this feel and address instability as a dominant cause for revision surgery, this paper introduces an intra-articular load sensor for
Purpose. To evaluate the results of
Purpose:. To evaluate the results of
Glenoid bone grafting in
Patients with pain and loss of shoulder function
due to nonunion of a fracture of the proximal third of the humerus may
benefit from
Currently, the consensus regarding subscapularis tendon repair during a
Introduction.
Abstract. Background/Objectives. The incidence of
Introduction.
Aims of the study: To assess the results of one-stage revision of infected
The
Introduction. Total shoulder arthroplasty is the fastest growing joint replacement in recent years, with projected compound annual growth rates of 10% for 2016 through 2021 – higher than those of both the hip and knee combined.
Modern musculoskeletal modeling techniques have been used to simulate shoulders with
Glenoid baseplate positioning for
Backgrounds. The rigid fixation of glenoid base plate is essential for the prevention of dissociation of the construct in the
Introduction. The purpose of this study was to compare implant survivorship and functional outcomes in patients undergoing
We present a series of 18 consecutive cases of primary
Most common current surgical treatment options for cuff tear arthropathy (CTA) are hemiarthroplasty and
Aims. 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.
Aims. 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). . Methods. 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). Results. Uncemented stems had a significantly higher incidence of early
humeral stem migration (p <
0.001, RR 18.1, 95% confidence interval
(CI) 5.0 to 65.2) and non-progressive radiolucent lines (p <
0.001, RR 2.4, 95% CI 1.7 to 3.4), but a significantly lower incidence
of post-operative fractures of the acromion compared with cemented
stems (p = 0.004, RR 14.3, 95% CI 0.9 to 232.8). There was no difference
in the risk of stem loosening or revision between the groups. The
cemented stems had a greater relative risk of infection (RR 3.3,
95% CI 0.8 to 13.7), nerve injury (RR 5.7, 95% CI 0.7 to 41.5) and
thromboembolism (RR 3.9, 95% CI 0.2 to 66.6). The functional outcome
and range of movement were equivalent in the two groups. . Discussion. RSA performed with an uncemented stem gives them equivalent functional
outcome and a better complication profile than with a cemented stem.
The natural history and clinical relevance of early stem migration
and radiolucent lines found with uncemented stems requires further
long-term study. Take home message: This study demonstrates that uncemented stems
have at least equivalent clinical and radiographic outcomes compared
with cemented stems when used for
Surgeries for
Background. Stress fracture of the acromium and scapular spine is a common complication following
Musculoskeletal modeling techniques simulate
Introduction. This paper describes the kinetic and electromyographic contribution of principal muscles around the shoulder of a cohort of patients with
Patients over 70 years old have subclinical or impending rotator cuff dysfunction, raising concern about TSA in this population. The purpose of this study is to examine whether
Traditionally, open reduction and internal fixation (ORIF) and hemiarthroplasty (HA) have been the surgical treatments of choice for displaced proximal humerus fractures (PHF) despite high rates of fixation failure and tuberosity nonunion, especially in the elderly population with poor bone quality. Recently, there has been a significant increase in the use of
Utilization of
A
Introduction. Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations. Materials and Methods. Seven cadaveric scapulae were used as the template for optimal screw angulation and length for baseplate implantation. Total 21 cases (seven cases of each 3 surgeons) of
Failure of
Introduction. While shoulder elevation can be reliably restored following
Introduction.
Introduction. Inadequate stability of the baseplate is a leading cause of revision within
INTRODUCTION. Preoperative planning software for
Background:. The use of
Introduction. Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations. Materials and Methods. Seven cadaveric scapulae were used as the template for optimal screw angulation and length for baseplate implantation. Total 21 cases (seven cases of each 3 surgeons) of
Introduction.
INTRODUCTION. Determining proper joint tension in
Introduction:. Given that factors like center of rotation (COR), neck shaft angle, glenosphere diameter and component tilt alter the biomechanics of
Although
Introduction & Background. Clinical outcome after
Introduction. Current modeling techniques have been used to model the
There are a variety of sizes currently available for
INTRODUCTION. The advent of CT based 3D preoperative planning software for
Purpose:. The
The treatment of rotator cuff arthropathy due to irreparable massive rotator cuff tear is still challenging. We performed
There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. The aim of this study was to evaluate the cost-effectiveness of
Whilst the use of
Introduction:.
Introduction. The use of
Purpose:. Although short term outcomes of
This biomechanical study aims to assess the different designs of glenospheres in SMR
Introduction. Persistent problems and relatively high complication rates 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 scapular notching. The purpose of this study was to evaluate the clinical relevance of notching and to determine the anatomic and radiographic parameters that predispose to its occurrence. STUDY PROTOCOL: Seventy-seven consecutive shoulders of 76 patients of an average age of 71 years with an irreparable rotator cuff deficiency were treated with a reverse DELTA III shoulder arthroplasty and followed clinically and radiographically under fluoroscopic control for a minimum of 24 months (mean: 44, range: 24 to 96). The effect of glenoid cranial caudal component positioning and of the prosthesis–scapular neck angle on the development of inferior scapular notching and clinical outcome was assessed. RESULTS: All shoulders which developed notching did so in the first fourteen months. Forty-four percent of the shoulders had inferior scapular notching, 30% had posterior notching and anterior notching (8%) was rare. Osteophytes along the inferior scapula occurred in 27% of the shoulders. The angle between the glénosphère and the scapular neck (r=+0.677)) as well as the craniocaudal position of the glénosphère (r=+0.654) were highly correlated with inferior notching (p<
0.001). A notching index (notching index = height of prosthesis + (prosthesis scapular neck angle x 0.13) was calculated using the height of implantation of the glénosphère and the postoperative prosthesis scapular neck angle: This allowed a prediction of the occurrence of notching with a sensitivity of 91% and specificity of 88%. The height of implantation of the glenosphere had a greater influence on inferior notching than the prosthesis scapular neck angle by a factor of approximately 1:8. Inferior scapular notching was associated with a significantly poorer clinical outcome than absence of inferior notching: At final follow-up, the respective average subjective shoulder values were 62% and 71% (p=0.032), relative Constant scores were 72% and 83% (p=0.028), abduction strength was 4.3 versus 8.7 kilograms (p<
0.001), active abduction was 102° versus 118° (p=0.033) and flexion averaged 110° versus 127° (p=0.004). DISCUSSION: Inferior scapular notching after
Latissimus dorsi anterior to major transfers have been advocated in the setting of loss of external rotation and elevation in conjunction with reverse shoulder replacement. Reverse shoulder replacement is a prosthesis specifically designed for shoulders with poor rotator cuff function. In the vast majority of cases, some teres minor function at the minimum is maintained in shoulders destined for a reverse shoulder replacement. However, in certain circumstances there is complete loss of any external rotation, and a muscle transfer can be performed in order to restore some external rotation function. A reverse shoulder replacement in the absence of any rotator cuff function goes into obligate internal rotation with elevation. A minimum of external rotation strength is necessary in order to maintain the arm in normal rotation. The first tip is patient selection. Physical examination of active external rotation, external rotation strength and forward elevation should be just performed. A latissimus transfer is indicated in patients who cannot maintain their arm in neutral to at least a few degrees of external rotation. A lag sign is another physical examination finding which can indicate complete loss of rotator cuff function. The latissimus dorsi transfer is performed by first identifying and releasing the latissimus from its insertion on the anterior humerus. The arthroplasty is performed. The passage for the latissimus muscle is developed carefully and being mindful of the axillary nerve in particular. The latissimus is directed inferior to the nerve and around the medial and posterior aspect of the proximal humerus. Different ways of securing the transfer to the humerus have been described including bone tunnels and anchors. Often it is easier to place the anchors and/or the bone tunnels prior to inserting the humeral prosthesis. The latissimus is secured in the new position, enabling it to participate in external rotation. The value of this is difficult to clearly establish. Most studies are evidence level IV and there are no good comparative studies in a controlled patient population. This is a good option for shoulders with no active external rotation, but they may increase overall complication rate. Complications include dislocation, infection, and transient nerve palsy.
Introduction. Lateralizing the center of rotation (COR) of
The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair. All patients with a history of rotator cuff repair who underwent RSA between 2000 and 2015 with a minimum follow-up of two years were eligible for inclusion as the study group. Outcomes, including the American Shoulder and Elbow Surgeons (ASES) scores, were compared with a matched control group of patients who underwent RSA without having previously undergone rotator cuff repair.Aims
Patients and Methods
Introduction:.
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 scapular notching. To manage severe glenoid bone deficiencies, bone grafts are commonly used. Although, many studies report outcome of bone grafting in revision RSA, the literature on humeral head autograft for glenoid bone loss in primary RSA is less robust. The purpose of this study is to evaluate the clinical and radiographic outcomes of primary RSA with humeral head autograft for glenoid bone loss at our institution. Institutional review board approval was obtained to retrospectively review the records of 22 consecutive primary RTSA surgeries in 21 patients with humeral head autograft for glenoid bone loss between January 2008 and December 2016. Five patients died during follow-up, three were unable to be contacted and one refused to participate, leaving a final study cohort of 12 patients with 13 shoulders that underwent RSA. All patients had a clinical evaluation including detailed ROM and clinical evaluation using the American Shoulder and Elbow Surgeons (ASES) Score, Constant Score, Western Ontario Osteoarthritis of the Shoulder Index (WOOS), and Short Form-12 (SF-12) questionnaires. Preoperative and postoperative plain radiographs and CT scans were assessed for component position, loosening, scapular notching, as well as graft incorporation, resorption, or collapse. There were 6 males and 6 females, with an average age of 74 ± 6.8 years. The average BMI was 31.7 ± 5.3, and the median ASA score was 3. Average follow-up was 3.4 ± 1.1 years. The average postoperative range of motion measurements for the operative arm are: flexion = 120 ± 37, abduction = 106 ± 23, external rotation = 14 ± 12, internal rotation at 90 degrees of abduction = 49 ± 7, external rotation at 90 degrees of abduction = 50 ± 28. Average functional scores are: ASES: 76.9 ± 19.2, WOOS: 456 ± 347, SF12 physical: 34.2 ± 8.2, SF12 mental: 54.1 ± 10.2, Constant Score: 64.6 ± 14. No evidence of hardware loosening or evidence of bone graft resorption were encountered. On CT, the average of pre operative B-angle was 79.3 ± 9.3 while the pre operative reverse shoulder angle was 101.4 ± 28. Glenoid retroversion average on CT was 13.3 ± 16.6. Post operative baseplate inclination average was 82 ± 7.4 while the baseplate version 7.8 ±10. The operative technique was able to achieve up to 30 degrees of inclination correction and up to 50 degrees of version correction. In conclusion, primary reverse shoulder arthroplasty with humeral head autograft for glenoid bone loss provides excellent ROM and functional outcomes at mid-term follow-up. This technique has a high rate of bone incorporation and small risk of bone resorption at mid term follow up.
Retrieval analysis is an important aspect of medical device development. Examination of retrieved devices allows device developers to close the design loop, understand the performance of devices, and validate assumptions made and methods used during preclinical testing. We provide an overview of the implant retrieval analysis performed at the Implant Research Center at Drexel University on reverse total shoulder systems retrieved after short to medium term implantation. We have examined 18 reverse total shoulders, retrieved at revision surgery after short to mid-term implantation (average 1.4 years, maximum 3.3 years). The average age at revision was 71 years old (st dev 11 years). Our evaluations included analysis of glenosphere bearing surface damage, evaluation of tribocorrosion at the modular junctions, visual assessment of polyethylene humeral bearing surface damage, quantitative analysis of polyethylene wear.INTRODUCTION
METHODS
Modern total shoulder arthroplasty seeks to produce a construct that reproduces the kinematics and stability of the native glenohumeral joint. The latest 4th generation implants are modular, adaptable, and capable of use as either anatomic or reverse shoulder arthroplasty components. During surgery, these implants are “universal”; post-operatively, they are “convertible”. Recent work has demonstrated that reverse shoulder arthroplasty components may indeed be the emerging standard of care for most (if not all) shoulder arthroplasty indications. As this new frontier develops, the use of a convertible/universal implant creates the flexibility to individually choose the best surgical option for each patient.
Machine learning is a relatively novel method to orthopaedics which can be used to evaluate complex associations and patterns in outcomes and healthcare data. The purpose of this study is to utilize 3 different supervised machine learning algorithms to evaluate outcomes from a multi-center international database of a single shoulder prosthesis to evaluate the accuracy of each model to predict post-operative outcomes of both aTSA and rTSA. Data from a multi-center international database consisting of 6485 patients who received primary total shoulder arthroplasty using a single shoulder prosthesis (Equinoxe, Exactech, Inc) were analyzed from 19,796 patient visits in this study. Specifically, demographic, comorbidity, implant type and implant size, surgical technique, pre-operative PROMs and ROM measures, post-operative PROMs and ROM measures, pre-operative and post-operative radiographic data, and also adverse event and complication data were obtained for 2367 primary aTSA patients from 8042 visits at an average follow-up of 22 months and 4118 primary rTSA from 11,754 visits at an average follow-up of 16 months were analyzed to create a predictive model using 3 different supervised machine learning techniques: 1) linear regression, 2) random forest, and 3) XGBoost. Each of these 3 different machine learning techniques evaluated the pre-operative parameters and created a predictive model which targeted the post-operative composite score, which was a 100 point score consisting of 50% post-operative composite outcome score (calculated from 33.3% ASES + 33.3% UCLA + 33.3% Constant) and 50% post-operative composite ROM score (calculated from S curves weighted by 70% active forward flexion + 15% internal rotation score + 15% active external rotation). 3 additional predictive models were created to control for the time required for patient improvement after surgery, to do this, each primary aTSA and primary rTSA cohort was subdivided to only include patient data follow-up visits >20 months after surgery, this yielded 1317 primary aTSA patients from 2962 visits at an average follow-up of 50 months and 1593 primary rTSA from 3144 visits at an average follow-up of 42 months. Each of these 6 predictive models were trained using a random selection of 80% of each cohort, then each model predicted the outcomes of the remaining 20% of the data based upon the demographic, comorbidity, implant type and implant size, surgical technique, pre-operative PROMs and ROM measures inputs of each 20% cohort. The error of all 6 predictive models was calculated from the root mean square error (RMSE) between the actual and predicted post-op composite score. The accuracy of each model was determined by subtracting the percent difference of each RMSE value from the average composite score associated with each cohort.Introduction
Methods
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. 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 scapular notching. Statistical analysis was conducted by an independent institutional statistician.Introduction:
Methods:
A better understanding of the rate of improvement associated with aTSA and rTSA is critical to establish accurate patient expectations for treatment to reduce pain and restore function; more realistic patient expectations pre-operatively may lead to greater patient satisfaction post-operatively. To this end, this study quantifies the rate of improvement in outcomes of aTSA and rTSA using 5 different scoring metrics for 1641 patients with one platform shoulder arthroplasty system. 1641 patients (mean age: 69.3yrs) were treated by 14 orthopaedic surgeons using one platform shoulder system (Exactech, Inc). 729 patients received aTSA (65.3yrs; 384F/345M) for treatment of degenerative arthritis and 912 patients received rTSA (72.5yrs; 593F/319M) for treatment of CTA/RCT/OA. Each patient was scored pre-operatively and at various follow-up intervals (3 months, 6months, annually, etc) using the SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, active forward flexion, and active/passive external rotation were also measured. 4439 total follow-up reports were analyzed (1851 and 2588 rTSA). Improvements in outcome using each metric score were calculated and normalized on a 100 point scale. The rate of improvement was analyzed using a 40 point moving filter treadline and with a 3rd order polynomial treadline over the entire range of follow-up.Introduction
Methods
Reverse TSA initially followed Grammont's dictum that the center of rotation (COR) must be in the bone (“medial” COR). Others have argued for a more lateral COR, which can be a challenge if glenoid bone stock has been medially eroded. When bone loss must be made up, and/or the COR lateralised, the options include use of bone graft or use of metal. Metal constructs produce a cantilever-loading situation, with substantial bending moments applied to the bone-implant junction. Use of bone graft allows remodeling with living bone, so that ultimately the forces are applied to the bone-implant junction in a more compressive pattern. The author's preference is to have at least 30% of the circumference of the baseplate contact living bone while the rest may be made up with bone graft which can remodel. It is important to have a deep keel penetrate the cortex medially.
Lateralization of the reverse arthroplasty may be desirable to more effectively tension the remaining rotator cuff, decrease scapular notching, improve the cosmetic appearance of the shoulder, and improve stability as well as the arc of motion prior to impingement. There are two primary options to lateralise a reverse shoulder arthroplasty: bone graft with a long post (BIO-RSA) vs. using metal. The two metal options generally include a thicker glenosphere or a thicker glenoid baseplate. Potential benefits of a BIO-RSA include lateralization of the glenoid center of rotation but without placing the center of rotation lateral to the prosthetic-bone interface. By maintaining the position of the center of rotation, the shear forces at the prosthesis-bone interface are lessened and are converted to compressive forces which will minimise glenoid failure. Edwards et al. performed a prospective study on a bony increased offset reverse arthroplasty. Among the 18 shoulders in the BIO-RSA group, the incidence of notching was 78% compared to controls 70%. The graft completely incorporated in 12 (67%), partially incorporated in 4 (22%), and failed to incorporate in 2 (11%). Frankle et al. reported on the minimum 5-year follow-up of reverse arthroplasty with a central compression screw and a lateralised glenoid component. The survivorship was 94% at 5 years. There were seven (9%) cases of scapular notching and no patient had glenoid baseplate loosening or baseplate failure. The authors noted that the patients maintained their improved function and radiographic results at a minimum of five years. In summary, lateralisation of the glenosphere is an attractive option to improve the outcome of reverse arthroplasty. Benefits of lateralisation with metal rather than bone graft include elimination of concern over bone graft healing or resorption. In addition, the procedure has the potential to be more precise with the exact offset amount known pre-operatively as well as improved efficiency of the procedure. Preparing the graft takes additional OR time and there is variable quality of the bone graft.
The clinical impact of scapular notching is controversial. Some reports suggest it has no impact while others have demonstrated it does negatively impact clinical outcomes. The goal of this clinical study is to analyze the pre- and post-operative outcomes of 415 patients who received rTSA with one specific prosthesis (Equinoxe; Exactech, Inc). 415 patients (mean age: 72.2yrs) with 2 years minimum follow-up were treated with rTSA for CTA, RCT, and OA by 8 fellowship trained orthopaedic surgeons. 363 patients were deemed to not have a scapular notch by the implanting surgeon at latest follow-up (72.1 yrs; 221F/131M) whereas 52 patients were deemed to have a scapular notch at latest follow-up (73.3 yrs; 33F/19M). 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 38.1 months (No Notch: 37.2; Notch: 44.4). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.Introduction
Methods
Use of a baseplate with a smaller diameter in reverse shoulder arthroplasty has been recommended, especially in patients with a small glenoid or insufficient bony stock due to severe glenoid wear. However, effect of a smaller baseplate on stability of the glenoid component has not been evaluated. The purpose of this study was to determine whether a smaller baseplate (25 mm) is beneficial to the initial primary stability of the glenoid component compared to that with a baseplate of a commonly used size (29 mm) by finite element analysis. Computed tomography (CT) scans of fourteen scapulae were acquired from cadavers with no apparent deformity or degenerative change. Glenoid diameter corresponding to the diameter of the inferior circle of glenoid was measured using a caliper and classified into the small and large glenoid groups based on 25mm diameter. CT slices were used to construct 3-dimensional models with Mimics (Materialise, Leuven, Belgium). A corresponding 3D Tornier Aequalis® Reversed Shoulder prosthesis model was generated by laser scanning (Rexcan 3D Laser Scanner, Solutionix, Seoul, Korea). Glenoid components with 25mm and 28mm diameter of the baseplate were implanted into the scapular of small and large glenoid group, respectively. Finite element models were constructed using Hypermesh 11.0 (Altair Engineering, Troy, MI, USA) and a reverse engineering program (Rapidform 3D Systems, Inc., Rock Hill, SC, USA). Abaqus 6.10 (Dassault Systemes, Waltham, MA) was used to simulate 30o, 60o, and 90o glenohumeral abduction in the scapular plane. Single axial loads of 686N (1 BW) at angles of 30o, 60o, and 90o abduction were applied to the center of the glenosphere parallel to the long axis of the humeral stem. Relative micromotion at the middle and inferior thirds bone–glenoid component interface, and distribution of bone stress under the glenoid component and around the screws were analyzed. Wilcoxon's rank-sum test was used for statistical comparison and p < 0.05 was considered as a minimum level of statistical significance.Background
Methods
Both anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty are the standard of care for various end-stage degenerative conditions of the glenohumeral joint. Osteoarthritis (OA) is the most common indication for aTSA while Rotator Cuff Tear Arthropathy (CTA) is the most common indication for rTSA. Worldwide, the usage of both aTSA and rTSA has increased significantly due in part, to the predictability of acceptable outcomes achieved with each prosthesis type. The aim of this study is to quantify outcomes using 5 different metrics and compare results achieved for each indication using one platform total shoulder arthroplasty system which utilizes the same humeral component and instrumentation to perform both aTSA or rTSA. 200 patients (70.9 ± 7.3 yrs) were treated by two orthopaedic surgeons using either aTSA or rTSA. 73 patients received aTSA (67.4 ± 8.0 yrs) for treatment of OA (PHF: 64 patients; YM: 9 patients) and 127 patients received a rTSA (72.9 ± 6.1 yrs) for treatment of CTA (PHF: 53 patients; YM: 74 patients). These patients were scored pre-operatively and at latest follow-up using the SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, forward flexion, and external rotation were also measured. The average follow-up for all patients was 31.4 ± 9.7 months (aTSA: 32.5 ± 12.1 months; rTSA: 30.8 ± 8.0 months). A Student's two-tailed, unpaired t-test was used to identify differences in pre-operative, post-operative, and pre-to-post-operative improvements in results, where p < 0.05 denoted a significant difference.Introduction
Methods
Posterior glenoid wear is common with glenohumeral osteoarthritis. To correct posterior wear, surgeons may eccentrically ream the anterior glenoid to restore version. However, eccentric reaming undermines prosthesis support by removing unworn anterior glenoid bone, compromises cement fixation by increasing the likelihood of peg perforation, and medializes the joint line which has implications on joint stability. To conserve bone and preserve the joint line when correcting glenoid version, manufacturers have developed posterior augment glenoids for aTSA and rTSA applications. This clinical study quantifies outcomes achieved using posteriorly augmented aTSA/rTSA glenoid implants in patients with severe posterior glenoid wear at 2 years minimum follow-up. 47 patients (mean age: 68.7yrs) with 2 years minimum follow-up were treated by 5 fellowship trained orthopaedic surgeons using either 8° posteriorly augmented aTSA/rTSA glenoid components in patients with severe posterior glenoid wear. 24 aTSA patients received posteriorly augmented glenoids (65.8 yrs; 7F/17M) for OA and 23 rTSA patients received posteriorly augmented glenoids (71.8 yrs; 9F/14M) for treatment of CTA and OA. Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active abduction, forward flexion, and external rotation were also measured to quantify function. Average follow-up was 27.5 months (aTSA 29.4; rTSA 25.5). A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.Introduction
Methods
to determine if the deltoid, conjoint tendon and long head of the triceps provide sufficient soft tissue tension to stabilize a RTSA, and; to determine the influence of loading direction, arm rotation, shoulder position and polyethylene thickness on stability of a RTSA. The hypotheses were:
that the deltoid, conjoint tendon and long head of the triceps provide sufficient soft tissue tension to stabilize a RTSA, and; that arm rotation, shoulder position and loading direction would affect stability and increased polyethylene thickness would be associated with increased stability.
We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.
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. 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.Introduction
Methods