The rising number of morbidly obese patients may have significant consequences on the health care system. It may alter the effectiveness, safety as well as cost of certain surgical procedures. Reverse shoulder arthroplasty (RSA) is rapidly gaining in popularity. We investigated the effect of morbid obesity on outcomes, complications, disposition and cost in morbidly obese patients undergoing RSA in a 1: 3 case control series. Our joint registry was searched for all patients undergoing primary RSA (excluding fractures) with a minimum of 24 months follow-up from 2003–2010; 21 patients with Body Mass Index (BMI) > 35 were identified (follow-up 45 ± 16 months, 17 females and 4 males, age 69 ± 7) and compared to 63 matched control patients with BMI<30 (follow-up 48 ± 20, 50 females, age 71 ± 6). Outcome data was obtained pre- and postoperatively. Patients' Charlson-Deyo comorbidity index (CDI), total comorbidities, operative time, blood loss (EBL), hospitalization length, disposition, cost and complications were recorded.Background:
Methods:
Subchondral bone density (SBD) distribution is an important parameter regarding that may be important when considering implant stability. This parameter is a reflection of the loading experienced by the joint throughout the lifetime and may be useful in pre-surgical planning and implant design. Clinically, the question of the glenoid surface preparation for TSA/RSA remains controversial, despite numerous published studies on glenoid bone morphology. To address this question, there exists a need to develop a 3D quantitative method capable of analyzing the complex glenoid bone morphology at different depths from the surface. Computed tomographic osteoabsoptiomery (CT-OAM) evaluates SBD based on the Housfield Unit (HU) value of each pixel. In this pilot study, we aimed to analyze SBD distribution of the glenoid at different depths by means of CT-OAM in male TSA subjects. A study group of twenty male TSA patients (61–69y.o) were included in this study. Each subject obtained a pre-operative CT scan following a standardized protocol on the same CT scanner (1.25 mm slice thickness). Resultant DICOM 2D images were processed in custom-written program (VC++) and the surface of every glenoid was manually traced from the axial slices. Care was taken during the manual tracing process to exclude osteophytes and cyst formations from the resultant surface. Values of HU at every selected pixel on the surface of the glenoid were recorded. Subsequently, the layer of pixels at a 0.5 mm distance from the previous surface was virtually scraped and the HU values of new layer of pixels were recorded. This routine was repeated up to a depth of 5 mm from the glenoid surface, taking measurements on 11 virtual 3D surfaces with a thickness of 0.5 mm. Mean SBD distribution was reported for each layer and differences were compared using ANOVA and Fisher's post-hoc test.Introduction:
Materials and Methods:
We report the use of the reverse shoulder prosthesis in the revision of a failed shoulder hemiarthroplasty in 19 shoulders in 18 patients (7 men, 11 women) with severe pain and loss of function. The primary procedure had been undertaken for glenohumeral arthritis associated with severe rotator cuff deficiency. Statistically significant improvements were seen in pain and functional outcome. After a mean follow-up of 44 months (24 to 89), mean forward flexion improved by 26.4° and mean abduction improved by 35°. There were six prosthesis-related complications in six shoulders (32%), five of which had severe bone loss of the glenoid, proximal humerus or both. Three shoulders (16%) had non-prosthesis related complications. The use of the reverse shoulder prosthesis provides improvement in pain and function for patients with failure of a hemiarthroplasty for glenohumeral arthritis and rotator cuff deficiency. However, high rates of complications were associated with glenoid and proximal humeral bone loss.
