Previous hemodynamics studies in shoulder arthroplasty only evaluated Western population and mainly focused on risk factors of transfusion. However, Asians are relatively small, and have higher bleeding risk due to prothrombin-clotting-factor polymorphisms. Therefore, it is not appropriate to apply the results of previously studies directly to Asians. Authors compare different hemodynamics depending on the types of shoulder arthroplasties, and evaluate predictors for transfusion in Asian population. Total 212 shoulder arthroplasties (26 fracture hemiarthroplasty (fHA), 49 anatomical total shoulder arthroplasty (aTSA), 132 reverse total shoulder arthroplasty (rTSA), and 5 revision surgery) from August 2004 to January 2016 were retrospectively reviewed. Demographics, surgical factors and perioperative hemodynamic factors were compared for each type of arthroplasty. Multivariate regression analysis was conducted to determine predictors for transfusion.Introduction
Methods
Clinical outcome after reverse total shoulder arthroplasty (RTSA) can be influenced by technical and implant-related factors, so the purpose of this study was to investigate whether individualizing humeral retroversion and subscapularis repair affect the clinical outcomes after RTSA. Authors retrospectively analyzed the prospectively collected data from 80 patients who underwent RTSA from January 2007 to January 2015 using same implant (Biomet Comprehensive® Reverse Shoulder System, Warsaw, Indiana). The mean follow up was 23.3 ± 1.7 (range, 12 ∼ 70) months. The retroversion of humeral component was decided according to native version estimated using shoulder CT in Group I (n=52), and fixed in 20° retroversion in Group II (n=28). Group I was subdivided into Group Ia (n=21, mean 19.3°), less than 20° of retroversion, and Group Ib (n=31, mean 31.9°), more than 20°. Intraoperative tenotomized subscapularis was repaired in 40 patients in Group I, and could not be repaired due to massive tear including subscapularis in remaining 12 patients. Clinical outcomes were evaluated with range of motion (ROM) and several clinical outcome scores.Introduction & Background
Material & Method
We examined data from a large prospectively collected dataset which followed up patients after Exeter total hip replacement (THR) - the Exeter Primary Outcome Study. We studied 78 patients who had total hip replacement for osteoarthritis on a morphologically normal hip, and in whom the other hip was also morphologically normal for comparison. All selected patients had complete patient outcome data at 1 and 5 years, and x-rays at 1 year were available. We measured accuracy of reconstruction on AP Pelvis radiographs. The parameters measured were difference in height of lesser trochanter from horizontal pelvic line (LLD); length from ASIS to greater trochanter (indicating abductor length, AL); length from symphysis to centre of femoral head (SFH); length from centre of head to axis of femur (offset). We examined clinical outcomes including gain of Oxford Hip Score (DOHS) at 1 and 5 years, absolute OHS at 1 and 5 years, and absolute SF-36 Physical Functioning and Role Physical scores at 1 and 5 years. Examining the ratios of AL, SFH, Offset, Offset to SFH ratio and LLD between side of THR and unaffected side all showed marked variation. Thus the ratio of SFH varied from 0.85 to 1.11. For further analysis we divided the patients into 3 groups on the basis of variability of the ratio from 1; we examined whether the clinical scores above varied between these 3 groups. 1 way ANOVA demonstrated no significant difference for any of the clinical outcomes for any of the 5 grouped x-ray variables. Accuracy of reconstruction has been shown to affect the risk of dislocation after THR. Our results indicate that clinical outcomes of total hip replacement appear resilient to some degree of surgical inaccuracy. Future trials of navigation should be designed to demonstrate not only improved accuracy but also improved clinical outcome.
