Aims. 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. Methods. All patients in the registry who underwent a primary rTSA between January 2014 and December 2016 using an anterosuperior or
The October 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomized, placebo-controlled trial; Superior capsular reconstruction partially restores native glenohumeral loads in a dynamic model; Gene expression in glenoid articular cartilage varies in acute instability, chronic instability, and osteoarthritis; Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic shoulder surgery; Level of pain catastrophizing rehab in subacromial impingement: secondary analyses from a pragmatic randomized controlled trial (the SExSI Trial); Anterosuperior versus
Aims. Despite the expansion of arthroscopic surgery of the shoulder,
the open
Treatment of proximal humerus fractures (PHF) is controversial in many respects, including the choice of surgical approach for fixation when using a locking plate. The classic
Despite the expansion of arthroscopic surgery
of the shoulder, the open
Aim. Clavicular osteotomy was described as an adjunct to
The
Fractures and nonunions of the proximal humerus are increasingly treated by open reduction and internal fixation. The extended
Proximal humeral fractures are common fractures that may lead to severe functional disability. In open reduction and internal fixation of these fractures
Purpose: The purpose of this multicentric study was to report results obtained with the Aequalis system using the simple humeral or total prosthesis, at at least two years follow-up in patients with shoulder joint degeneration and non-repairable rotator cuff tears. Material and methods: Sixty-eight Aequalis arthroplasties were performed between 1992 and 1998. Outcome was assessed on the basis of the Constant score and radiological findings. Female gender predominated (78%) in this series with a mean age of 72 years. There were 62 simple humeral implantations and six total shoulder arthroplasties. The
Anatomic and accurate placement of components is a primary goal in all arthroplasty procedures. Unique to total shoulder arthroplasty, challenging glenoid exposure and osteoarthritic glenoid deformity offer significant challenges and impediments to this goal. Despite thorough pre-operative planning strategies and contemporary cannulated pin-based shoulder systems, it is often times still difficult to accurately aim the guide pin to the medial border of the scapula when the deformity is substantial or exposure is difficult. Even small errors in guide pin position can result in problems with final component version, inclination and glenoid vault perforation. In addition, a malpositioned glenoid component has been shown to have a negative impact on implant longevity and clinical performance. Image-based patient specific instrumentation has been available in the lower extremity for nearly a decade with reliable results. The application of similar technology in the shoulder has demonstrated reliable positioning of the guide pin to a pre-operative plan with subsequent accurate placement of the glenoid component. This surgical demonstration will feature one of the currently available CT-based patient specific glenoid guides using a standard
Hemi shoulder arthroplasty is a rather successful procedure although revision surgery due to secondary glenoid erosion is reported in more than 25%. The downside of common shoulder arthroplasty is that in a
Aim. Recent studies have indicated that the presence of P. acnes in the skin of the shoulder and around the acromion is higher than other body regions like the knee or the hip. The aim of this study was to estimate the presence of P. acnes in a real set of primary shoulder arthroplasty, after skin preparation with chlorhexidine and administration of empirical antibiotic therapy. Method. A prospective observational study involving 63 patients undergoing primary shoulder arthroplasty was designed. In all patients two skin biopsies with a 3 mm dermal punch and one subcutaneous tissue sample after surgical incision were obtained. Skin biopsies were obtained at the most anterior part of the surgical wound in case of superior approach and at the upper part in the
Introduction. The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly common in the treatment of rotator cuff arthropathy. In recent years indications for use have expanded to include elderly patients in whom either internal fixation is not possible due to fracture configuration, poor bone quality, or presence of a rotator cuff deficiency. There is however relatively little evidence to support its use in these circumstances. Objective. This study aims to assess the viability of RSA as a salvage procedure in the treatment of complex proximal humeral fractures or irreducible dislocations, quantified in terms of functional outcome, complication rates and patient reported satisfaction. Methods. All patients presenting between January 2011 and December 2013 with a complex 3- or 4-part humeral fracture or a delayed presentation with an irreducible non-acute dislocation, treated with salvage RSA were eligible for inclusion. All operations were performed in a single centre by one of two specialist upper limb surgeons. Standard
This study reviews the use of intramedullary fibular allograft in treating nonunion of the humeral neck in 11 patients. Nine women and two men with a mean age of 76 years (63 to 89) were followed up for a mean of 61 months (14 to 72). The nonunion was exposed through a
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
Introduction: Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis, which makes stable fixation difficult. Locking plates are intended to provide superior mechanical stability. The NCB. ®. -PH (Non-Contact-Bridging for the Proximal Humerus) plate is a locking plate of the latest generation that allows both open and minimally invasive (MI) application. Methods: In a prospective multicenter study 131 patients were treated (n = 78 open, n = 53 MI). The open procedure was performed using a standard
Background. Total Shoulder Arthroplasty (TSA) has been shown to improve the function and pain of patients with severe degeneration. Recently, TSA has been of interest for younger patients with higher post-operative expectations; however, they are treated using traditional surgical approaches and techniques, which, although amenable to the elderly population, may not achieve acceptable results with this new demographic. Specifically, to achieve sufficient visualization, traditional TSA uses the highly invasive
Aims: The purpose of this study was to evaluate the efficacy of the inverted Delta 3 prosthesis in nonreconstructable massive rotator cuff tear. Methods: 31 inverted Delta 3 prostheses were performed between October 1999 and February 2002. The average age was 72.8 years old (65–84) and the average follow-up was 17.8 months (3–36). A
The purpose of this study was to look at the results of using the Copeland surface replacement in the treatment of arthritis of the shoulder. We report the results of 61 Type 3 Copeland surface replacements in 57 patients. Operations were performed in 33 cases of Rheumatoid Arthritis, 27 cases of Osteoarthritis and 1 case of posttraumatic arthritis. Hemiar-throplasty was performed via a
In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 four-part) using a blade plate and a standard
Introduction. The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly common in the treatment of rotator cuff arthropathy. Standard RSA technique involves medialising the centre of rotation (COR) maximising the deltoid lever arm and compensating for rotator cuff deficiency. However reported complications include scapular notching, prosthetic loosening and loss of shoulder contour. As a result the use of Bony Increased Offset Reverse Shoulder Arthroplasty (BIO-RSA) has been gaining in popularity. The BIO-RSA is reported to avoid these complications by lateralising the COR using a modified base plate, longer central post and augmentation with cancellous bone graft harvested from the patients humeral head. Objectives. This study aims to compare the outcome in terms of analgesic effect, function and satisfaction, in patients treated with standard RSA and BIO-RSA. Methods. All cases were performed in a single centre by one of two upper limb consultant orthopaedic surgeons over a consecutive 2-year period. At time of listing for operation, the decision as to whether to undertake a bony-increased offset reverse total shoulder was made. Standard
The axillary nerve injuries most commonly are observed after trauma such as contusion-stretch, gunshot wound, laceration and iatrogenic injuries. Two of the most commons causes seem to be the glenohumeral dislocation and the proximal humerus fractures. The axillary nerve may sustain a simple contusion, or its terminal elements may be avulsed from the deltoid muscle. Compressive neuropathy in the quadrilateral space also has been reported (quadrilateral space syndrome, Calhill and Palmer, 1983). The axillary nerve injuries incidence represents less than 1% of all nerve injuries. Aim: The purpose of this study was to analyze outcome in patients, who presented with injuries to the axillary nerve. Material and methods: We report a series of 15 cases of axillary nerve lesions, which were operated between 1995 and 2002. These injuries resulted from shoulder injury either with or without fracture and or dislocation. Patients were operated between 3 to 6 months after trauma and an anterior
Purpose: To audit the improvement in function gained in patients with cuff tear arthropathy (CTA) using the reversed geometry delta 3 prosthesis and to balance this against operative and postoperative complications encountered. Method: 20 consecutive patients with CTA were assessed using the ASES and Constant scores pre and postoperatively. Results: All patients reported a marked improvement in post-operative pain relief. Average elevation increased from 49° to 102°. Function improved significantly. On the downside this is a technically difficult procedure in a group of patients whose average age was 81 (73–91) but whose biological age was higher. Technical difficulties arise from access to the glenoid, in particular to the inferior margin of the glenoid through a deltoid splitting approach. For this reason the surgical approach was changed to an extended
Our aim was to analyse radiological outcome of proximal humerus fractures treated with Philos plate and to assess its usefulness in treatment of malunion and non-union. Seventy-seven patients were treated with Philos plate (24 men and 53 women). Mean age was 61 years (15–88). There were 66 acute fractures, 6 nonunion, 4 mal-union and one periprosthetic fracture. Acute fractures included 29 two part, 30 three part and five 4 part fractures. Seven had associated dislocation. There were two head splitting fractures.
Purpose of the study: The purpose of this study was to determine the feasibility and reproducibility of a new arthroscopic procedure combining a Bristow-Latarjet lock with Bankart reinsertion of the lambrum. Material and methods: Forty-seven consecutive patients with significant bone defects in the glenoid and a deficient capsule were treated arthroscopically: arthroscopic Bankart had failed in six. The procedure was performed exclusively arthroscopically using a special instrumentation: after its osteotomy and identification of the axiallary nerve, the coracoids was passed through the subcapular muscle with its tendon; the block was fixed on the scapular neck after 90° lateral rotation so as to prolong the natural concavity of the glenoid. Anchors and sutures were then used to refix the capsule and the labrum onto the glenoid border, leaving the block in an extra-articular position. Follow-up included a physical examination and standard x-rays at 45, 90 and 180 days; 31 patients had a postoperative scan. Three independent operators read the images. Results: The procedure was completed arthroscopically in 41 of 47 patients (8%); conversion to a
Scapular notching is of concern in reverse shoulder arthroplasty and has been suggested as a cause of glenoid loosening. Our purpose was to analyze in a large series the characteristics and the consequences of the notch and then to enlighten the causes in order to seek some solutions to avoid it. 430 consecutive patients (457 shoulders) were treated by a reverse prosthesis for various etiologies between 1991 and 2003 and analyzed for this retrospective multicenter study. Adequate evaluation of the notch was available in 337 shoulders with a follow-up of 47 months (range, 24–120 months). The notch has been diagnosed in 62% cases at the last follow-up. Intermediate reviews show that the notch is already visible within the first postoperative year in 82% of these cases. Frequency and grade extension of the notch increase significantly with follow-up (p<
0.0001) but notch, when present, is not always evolutive. At this point of follow-up, scapular notch is not correlated with clinical outcome. There is a correlation with humeral radiolucent lines, particularly in metaphyseal zones (p=0.005) and with glenoid radiolucent lines around the fixation screws (p=0.006). Significant preoperative factors are: cuff tear arthropathy (p=0.0004), muscular fatty infiltration of infraspinatus (p=0.01), narrowing of acromio-humeral distance (p<
0.0001) and superior erosion of the glenoid (p=0.006). It was more frequent with superolateral approach than with
Introduction: Various surgical techniques existed for the treatment of three and four part proximal humeral fractures with variable outcomes. The aim of this study is to present a technique using small materials, to preserve all the biologic principles of fracture fixation, in the treatment of these challenging injuries. Material: We perform a study taking as inclusion criteria: 3 and 4 parts proximal, closed, humeral fractures, treated surgically by open reduction and a modular biological internal fixation. Surgical technique: Through a standard
Background. In elderly patients with complex proximal humerus fractures and osteoporotic bone reconstruction is not always possible. Although hemiarthroplasty is an alternative, non-union or tuberosity migration can lead to inferior functional results. Implantation of a Reverse Total Shoulder Arthroplasty (RTSA) seems to be an interesting alternative. In the present study we retrospectively analyzed the short-term results of RTSA for complex proximal humerus fractures in the elderly. Methods. From 31.10.2005 to 20.07.2010 RTSA was performed in 29 patients (average age 80 years [67;90], 25 women, 4 man) with subcapital, three- or four-part fracture of the proximal humerus as a primary treatment. All procedures were performed using the Anatomical Inverse Shoulder (Zimmer) with fracture stem. A
The Copeland Shoulder Arthroplasty is a cementless, pegged humeral head surface replacement. The design is based on the principle of minimal bone resection and has been in clinical use since 1986. The only published series to date, that of Levy and Copeland, reported results for 103 patients which were comparable to those obtained with stemmed implants. We report the outcome at our institution using the same prosthesis with a hydroxyapatite coating. 81 shoulders (74 patients) underwent resurfacing hemiarthroplasty through an anterior
Background: Avascular necrosis is a well recognised complication of displaced proximal humeral fractures irrespective of conservative and operative treatment. The reported rate of AVN with open reduction and internal fixation varies from 22 to 40%. The aim of our study was to look at the functional outcome and the incidence of AVN with operative treatment using locking plate with a minimum 3 year follow up. Materials and methods: We retrospectively reviewed a consecutive series of 50 patients with displaced proximal humerus fractures treated with ORIF from 2002 to 2004. All patients were operated by the two senior authors employing anterior
The benefit of open stabilization for recurrent shoulder instability is well known, however there have been recent reports of postoperative dysfunction of the subscapularis tendon following open shoulder surgery (Habermeyer et al, Scheibel et al). We present our findings in patients who have undergone an open anterior stabilization using a subscapularis split approach. We reviewed 48 patients (49 shoulders), who were treated by the senior author (SB) from 2003–2005. They all underwent an open anterior stabilization of shoulder through a
We evaluated the results of Cementless Surface Replacement Arthroplasty (CSRA) of the shoulder in 67 patients with advanced glenohumeral destruction who have an intact rotator cuff. Between november 2002 and december 2008, 70 CSRA (32 Copeland/ Biomet and 38 SMRR/ Lima) were implanted in 67 patients. A
Aim: To evaluate the results of internal fixation of displaced proximal humeral fractures with a locking plate system. Material and Methods: Between 2002 and 2003, 126 patients presented to our shoulder unit with proximal humeral fractures. Of these, 22 healthy active patients with displaced two to four-part fractures underwent open reduction and internal fixation with a locking compression plate system (Philos, Stratec UK Ltd). Their average age was sixty-two years. They were evaluated clinically and radiologically at 4, 12, 26 weeks or until union. Objective assessment was measured by the Constant scoring system, subjective assessment by the Oxford shoulder questionnaire. Surgical Technique: Through an anterior
Introduction. Persistent problems and relatively high complication rates with reverse total shoulder arthroplasty (RTSA) are reported (1, 2). It is assumed that some of these complications are affected by improper intraoperative soft tissue tension. Achieving proper intraoperative soft tissue tension is an obvious surgical goal. However, intraoperative soft tissue tension measurements and methods for RTSA have not been reported. One way to quantify soft tissue tension is to measure intraoperative joint forces using an instrumented prosthesis. Hence, we have developed an instrumented RTSA to measure shoulder joint forces intraoperatively. The goal of this study was to measure intraoperative shoulder joint forces during RTSA. Materials and Methods. The instrumented shoulder prosthesis measures the contact force vector between the glenosphere and humeral tray. This force sensor is a custom instrumented trial implant that can be used with an existing RTSA system (EQUINOXE, Exactech Inc, Gainesville, FL) just as a standard trial implant is used. Four uniaxial foil strain gauges (QFLG-02-11-3LJB, Tokyo Sokki Kenkyujo Co., Ltd., JP) are instrumented inside the sensor. Using a calibration matrix, the three force components were calculated from four strain gauge outputs (3). Sixteen patients who underwent RTSA took part in this IRB approved study. All patients were greater than 50 years of age and willing to review and sign the study informed consent form. After obtaining informed consent for surgery, a standard
Background: The Bankart repair remains a safe and effective method for repairing instability in shoulder injuries. We report the results of a large series of patients treated using this technique. Materials and Methods: We retrospectively reviewed 136 consecutively treated patients with either anterior, antero-inferior or multidirectional shoulder instability over a 7-year period from 1999–2006 with a minimum of 2-year follow-up. All patients underwent open bankart repair through a
Purpose of the study: The reversed total shoulder prosthesis is one of the treatments currently proposed for excentered glenoid osteoarthritic degeneration with massive rotator cuff tears. In light of the mediocre or at best highly variable results obtained with osteosynthesis or humeral arthroplasty for four-fragment fractures of the proximal humerus, indications for the reversed total shoulder prosthesis have been widened to include this category of traumatology patients. The purpose of this prospective study was to report outcome with the reversed prosthesis used for complex fracture of the proximal humerus in subjects aged over 70 years. Material and methods: Ten patients, mean age 76 years, underwent surgery performed by the same surgeon to insert a Delta (DePuy) reversed prosthesis for four-fragment complex displaced fracture of the proximal humerus. The
Introduction and Aims: Isolated rupture of the subscapularis tendon is an uncommon condition that has generally been treated by early surgical repair. However, very little information is available regarding functional outcome following surgery. The purpose of this study was to evaluate patient reported outcome following surgical repair with a minimum follow-up of 12 months. Method: Thirteen consecutive patients underwent arthroscopy followed by open surgical repair of an isolated traumatic rupture of the subscapularis tendon. A
Introduction: The reverse shoulder arthroplasty (RSA) is becoming increasingly common and the indications expanded. The objective of this study is to report the indications and results of RSA in a large multicenter study. Methodology: A retrospective, multicenter study was conducted including all RSA implanted between 1992 and 2002 in five centers in France. Of 457 patients involved in this study, 243 patients (53%) had cuff pathology: 149 had cuff tear arthropathy, 48 had massive cuff tears, and 45 had failed cuff surgery. Ninety-nine (22%) had revision of previous prostheses. Sixty (13%) had fracture-related problems. Twenty-six (6%) had osteoarthritis and two percent each had rheumatoid arthritis, tumors or other conditions. Three hundred and eighty-nine (85%) shoulders were available for review with greater than 2 years follow-up. The average age at review was 75.6 years (range, 22–92). The average follow-up was 43.5 months (range, 24–142). Results: Significant improvement was noted in Constant scores for pain (3.5 to 12.1), activity (5.8 to 15.1), mobility (12.1 to 24.5), and strength (1.3 to 6.1) (p<
.0001). Active elevation improved, but active internal and external rotation did not. The results were dependent on the indication. Cuff tear arthropathy had the best results while revision procedures had the worst. Young age, preoperative stiffness, teres minor deficiency, tuberosity non-union and preoperative complaints of pain rather than loss of function tended to be associated with inferior results. The
Humeral shaft fractures are among the most frequent fractures encountered in Orthopaedic Traumatology. Their treatment can be either conservative or operative depending on the location (proximal, middle or distal third), type (spiral, oblique, or transverse), radial nerve involvement, concomitant presence of thoracic injuries that preclude general anesthesia, as well as surgeon’s experience. Non union or delayed union complicates some of the conservatively and very few of the operatively treated fractures. We report of our experience with the management of humeral shaft non unions in 28 patients treated at our institution from 1990 to 2000. Six were male and twelve female aging from 21 to 68 years (mean 45 years).The interval between initial injury and operation varied from 6 months to 3 years (average 10 months).Regarding the location of non union,20 cases were located in the middle, 6 cases in the upper and 2 cases in the distal third. Operative technique: under general anesthesia using anterolateral approach for middle and distal third and
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
Purpose: The reverse shoulder arthroplasty (RSA) is becoming increasingly common and the indications expanded. The objective of this study is to report the indications and results of RSA in a large multicenter study. Method: A retrospective, multicenter study was conducted including all RSA implanted between 1992 and 2002 in five centers in France. Of 457 patients involved in this study, 243 patients (53%) had cuff pathology: 149 had cuff tear arthropathy, 48 had massive cuff tears, and 45 had failed cuff surgery. Ninety-nine (22%) had revision of a previous arthroplasty. Sixty (13%) had fracture-related problems. Twenty-six (6%) had osteoarthritis and two percent each had rheumatoid arthritis, tumors or other conditions. Three hundred and eighty-nine (85%) shoulders were available for review at a mean follow-up of 44 months (range, 24–142). The average age at review was 76 years (range, 22–92). Results: Overall, significant improvement was noted in Constant scores for pain (3.5 to 12.1), activity (5.8 to 15.1), mobility (12.1 to 24.5) and strength (1.3 to 6.1) (p<
0.0001). Active elevation improved (p<
0.0001), but active internal and external rotation did not. The results were dependent on the indication. Cuff tear arthropathy had the best results while revision procedures had the worst. Young age, preoperative stiffness, teres minor deficiency, tuberosity non-union and preoperative complaints of pain rather than loss of function tended to be associated with inferior results. The
Purpose: Reverse shoulder arthroplasty (RSA) is becoming increasingly common for a variety of indications. The most common postoperative complication is instability. The objectives of this study are to describe causes of RSA instability and preventive and treatment recommendations. Method: All members of the American Shoulder and Elbow Society were asked for cases of RSA instability. We retrospectively reviewed 52 cases in 52 patients, performed by 13 surgeons. The mean age was 67.5 years (range, 36–83). The mean follow-up was 32.7 months (range, 3–43). Results: The etiology included: cuff tear arthropathy (14 patients); revision arthroplasty (13 patients); fracture sequelae (6 patients); and other (6 patients). Twenty-four patients had previous shoulder surgery. All patients had a
Patients using a neutral rotation brace post proximal humerus fracture fixation have improved functional outcome and external rotation of the shoulder compared to patients using a standard polysling. Patients who have proximal humerus fracture fixation with extramedullary plates and screws have a risk of reduced range of movement especially external rotation. Gerber et al showed that the average external rotation after fixation of proximal humeral fractures was 39 degrees in their patient cohort compared to a normal range of 80–100 degrees. This can lead to reduced function and poor patient related outcomes. Geiger et al showed that in a cohort of 28 patients, poor functional outcome was noted in 39.3% with an average Constant-Murley Score of 57.9. Current practice is to utilise a polysling holding the shoulder in internal rotation post-shoulder fixation. Patients usually wear the sling for up to 6 weeks. We believe that this increases the risk of adhesion formation with the shoulder in internal rotation in the shoulder joint. Therefore this can cause loss of external rotation in the shoulder joint. We believe that holding the shoulder in a neutral alignment, with a neutral rotation brace post-fixation, will enable an increased rate of external rotation post-operatively thus improving external rotation and functional outcome. There is currently no literature comparing the different slings used post-operatively and we believe that this study would be the first of its kind. It would have a substantial change in the way clinicians manage proximal humeral fractures and will potentially reduce the numbers of re-operations to divide adhesions or perform capsular releases. Secondary benefits include a potential earlier return to full function and work and improved patient satisfaction. Study proposal: Prospective Randomised Controlled Trial of the neutral rotation brace compared to the standard, currently used, polysling post proximal humerus fracture fixation. No blinding of either participants or clinicians. Three surgeons utilising similar fixation techniques via the
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
The aim of this study was to assess the medium-term results of the Copeland cementless surface replacement of the shoulder for rheumatoid arthritis. Between 1986 and 1998, 75 patients with rheumatoid arthritis had a cementless surface replacement. They were 58 females and 17 males with a mean age 60 years (range: 24 to 88 years). The mean follow-up was 6 years (range: 2 to 14 years). The functional outcome was assessed using the Constant score and a patient satisfaction scale. The mean Constant score was 53.4 points for total shoulder replacements (76 age/ sex adjusted) and 47.9 points for hemiarthroplasty (71 age/ sex adjusted). Forward elevation improved from 50 degrees to 104 degrees for total shoulder replacements and from 47 degrees to 101 degrees for hemiarthroplasty. Seventytwo patients (96%) considered the shoulder to be better or much better. 3 patients (4%) felt the shoulder was the same. The
Aims: The revision of hemi or total arthroplasty represents a difficult challenge for a shoulder surgeon. The purpose of this study was to report the results of a retrospective series of 30 reverse prosthesis. Materials and Methods: 17 patients were female, 13 were male; the mean age was 68 (45–84). 14 patients had at least 2 surgeries before the arthroplasty. Of the failed arthroplasties, 26 were hemiarthroplasties and 4 were total shoulder arthroplasties. The indication for the revision of hemiarthroplasty were: 10 migration of the tuberosities, 7 secondary rotator cuff tears, 5 were stiff, 2 glenoiditis,, one humeral loosening and one sepsis. The indication for the revision of total arthroplasty were 3 loosenning of the glenoïd component and 2 secondary rotator cuff tear with a superior ascension of the humeral head. The rotator cuff was always irreparable. We used mainly a
Purpose: Nonunion of the surgical neck of the humerus can occur after orthopaedic or poorly-adapted surgery after displaced subtuberosity or cephalotuberosity fracture. The purpose of this study was to report functional and radiographic outcome after treatment with shoulder prosthesis. Material and methods: Twenty-two patients who had a non-constrained shoulder prosthesis were included in this retrospective multicentric study. Mean age was 70 years and mean follow-up was 45 months (range 2 – 9 years). The initial fracture had two fragments in six patients and was a three-fragment fracture involving the head and the tubercle in thirteen and a four-fragment fracture in three. Orthopaedic treatment was given in ten cases and surgical osteosynthesis was used in twelve. Time from fracture to implant insertion was 20 months. The
Purpose: We report the satisfactory results obtained in a retrospecive multicentric series of 80 shoulder prostheses implanted for aseptic osetonecrosis of the head of the humerus. Material and methods: Seventy-four patients (43 men, 31 women, men age 59 years) with aseptic osteonecrosis of the head of the humerus treated with a shoulder prosthesis were reviewed at least two years after surgery. The mean weighted score before surgery was 37%. Twenty-six total prostheses and 54 humeral prostheses were implanted via the
To devise an operative approach to the management of acute posterior fracture-dislocation of the shoulder which restores or retains normal proximal humeral anatomy and allows the early restoration of a complete, stable range of motion. Since 1996 we have treated four male patients (five shoulders) aged between 19 and 54 years at the time of first dislocation with autogenous iliac grafting of the anterior humeral head defect for acute and acuteon-chronic posterior dislocation of the shoulder. Two patients had epilepsy: one of these patients had bilateral dislocations. Two patients had motorbike RTAs. The