We wished to assess the usefulness of Inspace balloon arthroplasty (IBA), in our Upper limb unit by regular patient reviews prospectively. This prospective study was started adhering to local approval process. Patients were identified in routine clinical practice by three upper limb consultants presenting with pain and disability and diagnosis of cuff tear was established clinically and on MRI. The patients were explained of ‘available’ treatment options and an information leaflet about balloon arthroplasty provided. Patients were seen in 4 weeks, in a dedicated clinic to find out their willingness to participate. Consultant shoulder surgeons carried out all Balloon arthroplasties and where the cuff was reparable or contraindications identified were excluded from study. All the patients were reviewed by an independent clinician pre-operatively and post operatively using the assessment tools of Oxford Shoulder Scores (OSS), SF12 and VAS at 6 weeks, followed by 3, 6, 12 months and annually after. We performed a total of 32 IBA procedures. At the latest follow-up we identified that 24 patients have completed 2 years post procedure. Of these patients 1 deceased after 6 months, 3 were lost to follow up one each at 6, 12 and 24 months. Three were revised to reverse TSA. The OSS reflects that the positive difference of 10 in the average scores (24 pre-operative versus 34 at 2 years) noted at one year follow up were maintained at 2 years. Similar observations made analysing at 12 months and 2 years scores for the VAS pain scores of 3 at 2 years compared to pre-operative score of 6 and so were improvements in both physical & mental components of SF12. Our study observes that the IBA provides a sustainable pain relief and functional improvements over 2 years and may be a suitable alternative in physiologically compromised patients with irreparable RCT.
To determine the benefit of dissolvable Balloon Arthroplasy in managing patients with massive irreparable rotator cuff tears (RCT). This is prospective pilot study carried out adhering to the local approval process. Patients having massive cuff tear with pain or functional limitation were seen by consultants and MRI confirmed the diagnosis. The patients were explained of ‘all available’ treatment options and information leaflet about the new procedure balloon arthroplasty, provided. Patients were seen after 4 weeks in a dedicated clinic to find out if they were willing to participate. Patients were seen by a physiotherapist pre and post-operatively at 6 weeks then at 3, 6 and 12months in addition to medical follow-ups, using VAS, Oxford Shoulder, Constant and SF36 scores. All procedures were carried out by consultant shoulder surgeons and where the cuff was reparable or contraindications identified were excluded.Aim
Methods
Sutures are the most popular repair tool currently. However tuberosity “disappearance” with this is common; and touted as the prime cause for failure. In some studies biochemical lysis has been suggested to explain this. The aim of this study was to analyse the mode of failure.
The repairs were subjected to cyclical tension on the cuff musculature, and simultaneous gleno-humeral motion; using a test process we have described separately. During the entire process the repair site was videoed At the end of 8000 cycles the tuberosities were probed with a forceps, to record any movement in vertical, horizontal and axial planes. The humeral shaft was also rotated to check for dissociation between tuberosities and shaft.
21 fresh frozen shoulders were stripped of all tissues except the rotator cuff and the PMTI. In each specimen the tuberosities were osteotomised, and the humeral head dislocated. The top margin of the PMTI was sought and marked. A flat object was held on the top of the humeral head perpendicular to the shaft and the vertical height from upper edge of PMTI to this object was measured.
We found the average values for height to be larger than previously reported. Additionally the notion that the contra-lateral side can be used to calculate the height as a percentage of the length, accepting an error of +/− 0.5cm; was not corroborated. In 3 cases of the 9 pairs available a difference of 14, 7 and 6mm was seen. Lastly in certain cases a flimsy layer of fascia curved superiorly at the top margin, and we were in doubt as to whether to take this fascial extension as the top margin; in one case this flimsy layer also had muscular tissue attached. Though use of the fixed value had on our testing, a wider range than reported, we feel that PMTI is a useful landmark in these operations.