We assessed the predictive value of the macroscopic and detailed microscopic appearance of the coracoacromial ligament, subacromial bursa and rotator-cuff tendon in 20 patients undergoing subacromial decompression for impingement in the absence of full-thickness tears of the rotator cuff. Histologically, all specimens had features of degenerative change and oedema in the extracellular matrix. Inflammatory cells were seen, but there was no evidence of chronic inflammation. However, the outcome was not related to cell counts. At three months the mean
The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up. After ethical approval (reference: 17/YH/0318), patients were identified and invited to participate in this observational study. Inclusion criteria included: 1) severe glenoid bone loss necessitating the need for custom implants; 2) patients with definitive glenoid and humeral components implanted more than 2 years prior; 3) ability to comply with patient reported outcome questionnaires. After seeking consent, included patients underwent clinical assessment utilising the
Abstract. Background. The influence of diagnosis on outcomes after reverse shoulder arthroplasty (RSA) is not completely understood. The purpose of this study was to compare clinical outcomes of different pathologies. Methods. A total of 78 RSAs were performed for the following diagnoses: (1) rotator cuff tear arthropathy(RCA), (2) massive cuff tear(MCT) with osteoarthritis(OA), (3) MCT without OA, (4) arthritis, (5) acute proximal humerus fracture. Mean follow up 36 months (upto 5 years) Range of motion,
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
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
The treatment of massive chronic tears is problematic. The re-tear rate following surgery for extensive cuff tears remains high, and there is little consensus regarding optimum treatment. To investigate the outcome of a cohort of patients who had open repair of an extensive cuff tear using the Leeds Kuff patch as an augment. A retrospective cohort study of consecutive patients with a massive cuff tear who had surgery in our regional elective orthopaedic centre over a two year period from January 2015 to Dec 2016. All patients followed identical rehabilitation protocols, supervised by physiotherapists with an interest in the shoulder. Outcomes assessment was undertaken at a minimum of 12 months by a registrar or physiotherapist who was not part of the treating team. Pre-op data collection included; range of motion, pain
Background. Functional outcomes of conservatively managed, valgus impacted proximal humeral fractures are poor. Operative fixation can improve results but can be technically challenging. We prospectively assessed outcomes following fixation of valgus unstable proximal humeral fractures with a novel hybrid fixed angle blade plate, at a minimum of 12 months follow up. Methods. A new hybrid fixed angle blade plate design (Fx Plate, Exactech, Gainesville, USA) was used by the senior author to treat patients with displaced and potentially valgus unstable proximal humeral fractures, at our institution between November 2012 and March 2014. The study was approved by the research and development department. Outcomes were prospectively assessed using the Oxford and Constant shoulder scores and quality of life was assessed using the SF-36 questionnaire. Radiographs were taken at regular intervals to assess fracture healing. Results. In total 12 patients were identified and included in the study. All patients had comminution of the medial calcar, with potentially valgus unstable fracture patterns. Six of the patients had two-part displaced fractures, whereas six had three and four-part fractures. One patient died for reasons unrelated to surgery and three others were lost to follow up. Average follow up after surgery was 15.4 months (Range 12–20 months). At final follow up the average
Clavicular hook plates have been used over the last decade in the treatment of lateral clavicular fractures with good rates of union reported throughout the literature. Fewer studies have reported the functional outcome of these patients and some have reported potential soft tissue damage post plate removal. We aimed to review the functional outcomes alongside union rates in patients treated with hook plates for lateral clavicular fractures. In this retrospective case series, 21 patients with traumatic lateral third clavicular fractures were included. 15 had Neer type II fractures, 4 Neer type III fractures, 1 patient had a Neer type I fracture and 1 radiograph was not able to be classified. All patients were treated with clavicular hook plates at the same district general hospital by five experienced surgeons between March 2010 and February 2015 adhering to the same surgical protocol. All patients had standard physiotherapy and post operative follow up. Plates were removed when radiological union was achieved in all but one patient who had the plate removed before union was achieved due to prolonged non-union. Patients were followed up post plate removal and evaluated clinically using the
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
Reverse total shoulder arthroplasty (RTSA) provides a surgical alternative to conventional shoulder arthroplasty in the rotator cuff deficient shoulder. Short term data has shown consistent improvements in pain and function but higher complication and failure rates have also been reported. The aims of this study were to identify the early and late complications of RTSA, to establish the frequency of glenoid notching, and to assess the post-operative functional outcomes. 21 patients (22 joints) treated with RTSA at Glasgow Royal Infirmary (GRI) between April 2006 and October 2010 were retrospectively reviewed. Indications for surgery included cuff tear arthropathy, revision hemiarthroplasty and fracture malunion. Complication rates were obtained by analysis of follow up data from Bluespier and case notes. Glenoid notching was graded from x-rays by multiple observers using the Sirveaux classification. Outcome was assessed using the
This protocol describes a pragmatic multicentre
randomised controlled trial (RCT) to assess the clinical and cost
effectiveness of arthroscopic and open surgery in the management
of rotator cuff tears. This trial began in 2007 and was modified
in 2010, with the removal of a non-operative arm due to high rates
of early crossover to surgery. Cite this article: