Acromion to greater tuberosity distance as a predictor of functional outcomes after reverse shoulder arthroplasty.

What's New in Shoulder and Elbow Surgery.

BackgroundInferior scapular notching is a complication unique to reverse shoulder arthroplasty. The most efficient technique to avoid inferior scapular notching has been reported to be lateralization of the glenoid offset. This study aims to compare radiological and functional outcomes of the DELTA Xtend® Reverse Shoulder System Lateralized Glenosphere Line Extension (intervention group) with the Standard DELTA Xtend® Reverse Shoulder System (control group). We hypothesize that the lateralization improves the patient outcome by decreasing the risk of inferior scapular notching without increasing the risk of migration and loosening of glenoid component.MethodsIn this randomized controlled trial, all Danish citizens with rotator cuff arthropathy or degeneration of the glenohumeral joint with severe posterior wear and allocated for a reverse total shoulder arthroplasty at the department of orthopaedic surgery at Herlev and Gentofte Hospital, Copenhagen University Hospital, will be considered for participation. The exclusion criteria are as follows: below 50 years of age, cognitive or linguistic impairment, insufficient glenoid bone stock, previous fracture in the upper extremity and autoimmune-mediated inflammatory arthritis. There will be included a total of 122 patients of which 56 will participate in the radiostereometric analysis. This number of patients allows 20% to drop out. The co-primary outcomes are the pattern and magnitude of the migration of the glenoid component assessed by radiostereometric analysis and the Western Ontario Osteoarthritis of the Shoulder index. The secondary outcomes are inferior scapular notching, patient-reported and functional outcomes (Oxford shoulder score, Constant-Murley score and pain), side effects and complications, changes in bone mineral density and economy. The included patients will be examined before the surgery, within 1 week and 3, 6, 12 and 24 months after.DiscussionNo previous studies have compared the conventional reverse shoulder arthroplasty with the lateralized reverse shoulder arthroplasty in a randomized controlled trial regarding migration and functional outcome. Furthermore, radiostereometric analysis has not been used to evaluate the migration of reverse shoulder arthroplasty in a randomized controlled trial. This study intends to determine which treatment has the most optimal outcome for the benefit of future patients with an indication for reverse shoulder arthroplasty.Trial registrationThe study has been notified to Pactius and has approval number P-2021-231. Furthermore, the study will be registered on Clinicaltrials.gov before starting the inclusion.

Determining patient acceptable symptom states from patient reported outcome measures following reverse shoulder arthroplasty: Constant-murley, UCLA, Oxford Shoulder Scores

What's New in Shoulder and Elbow Surgery.

Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty

Background: The purpose of this study was to investigate clinical outcomes and structural integrity after arthroscopic repair of anterosuperior massive rotator cuff tears (RCTs) and to compare clinical outcomes between healed and retear groups. Hypothesis: The authors hypothesized that although both groups would exhibit improved clinical outcomes compared with their preoperative status, the healed group would have better clinical outcomes than the retear group, and in the retear group, the subscapularis retear subgroup would have inferior outcomes compared with the intact subscapularis repair subgroup. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 73 of 90 eligible patients who underwent arthroscopic repair of an anterosuperior massive RCT. Functional outcomes after 2-year follow-up were assessed using the visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) shoulder score, and active range of motion. Patients were assigned to the healed group (group H, n = 34) or retear group (group R, n = 39) based on magnetic resonance arthrography results at 6 months postoperatively. Group R was composed of subgroup R1 (subscapularis retear) and subgroup R2 (intact subscapularis repair). Results: Retearing occurred in 53% of patients. At 2-year follow-up, group H exhibited better outcomes for all functional scores versus group R, respectively (P < .001): VAS pain score (1.0 vs 2.1), SSV (90.2 vs 77.4), ASES score (90.8 vs 76.6), and UCLA shoulder score (31.0 vs 24.9). Within both groups, all scores improved significantly compared with preoperative values (P < .001). At follow-up, group H had significantly better forward flexion (P = .018) and internal rotation (P = .002) than group R; within both groups, active range of motion improved in all planes compared with the preoperative condition (P < .001). Subgroup R1 exhibited inferior outcomes versus subgroup R2, respectively: VAS pain score (2.6 vs 1.5; P = .012), ASES score (70.9 vs 83.6; P = .013), SSV (70.9 vs 85.4; P = .005), and UCLA shoulder score (22.0 vs 28.5; P = .001). Conclusion: After arthroscopic repair of anterosuperior massive RCTs, 53% of patients exhibited retearing. The healed group had better functional outcomes than the retear group. The subscapularis retear subgroup exhibited significantly inferior outcomes compared with the intact subscapularis repair subgroup.

Minimal Clinically Important Differences for Oxford, Constant, and University of California Los Angeles Shoulder Scores After Reverse Shoulder Arthroplasty to Allow Interpretation of Patient-Reported Outcome Measures and Future Statistical Power Analyses

The treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function. We (1) evaluated ROM, pain level, and American Shoulder and Elbow Surgeons scores of patients who had a reverse total shoulder arthroplasty for displaced three- and four-part proximal humerus fracture and (2) identified clinical and radiographic complications from the procedure. We retrospectively reviewed 30 patients in three institutions who had undergone a primary reverse total shoulder arthroplasty for displaced three- or four-part proximal humerus fractures. Mean age was 77years (range, 65-94years). Minimum followup was 12months (mean, 23months; range, 12-36months). Mean postoperative American Shoulder and Elbow Surgeons score was 78 (range, 36-98), mean active forward flexion was 139° (range, 90°-180°), and mean active external rotation was 27° (range, 0°-45°). Mean American Shoulder and Elbow Surgeons pain score was 0.7 (range, 0-5) and mean visual analog scale pain score was 1.1 (range, 0-5). Complications were identified in three of 30 patients (10%). At short term, reverse total shoulder arthroplasty relieved pain and improved function. The complication rate compared favorably with those reported for other treatment alternatives. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Hypothesis and BackgroundRecently, the indication of reverse total shoulder arthroplasty (RTSA) has expanded beyond rotator cuff arthropathy to include treatment of complex acute proximal humeral fracture (PHF). Limited previous studies have compared the long-term clinical and functional outcomes of patients undergoing RTSA for PHF versus elective indications for degenerative conditions. The purpose of this study was to compare implant survivorship, reasons for revision and functional outcomes in patients undergoing RTSA for acute PHF with those undergoing elective RTSA in a population-based cohort study. MethodsProspectively collected data from the New Zealand Joint Registry from 1999 to 2021 and identified 6,862 patients who underwent RTSA. Patients were categorized by preoperative indication, including PHF (10.8%), rotator cuff arthropathy (RCA) (44.5%), osteoarthritis (OA) (34.1%), rheumatoid arthritis (RA) (5.5%) and old traumatic sequelae (5.1%). Revision-free implant survival and functional outcomes (Oxford Shoulder Score (OSS) at 6-months, 5- and 10-years follow-up) were adjusted by age, sex, American Society of Anesthesiologists (ASA) class and surgeon experience and compared. ResultsRevision-free implant survival at 10 years for RTSA for PHF was 97.3%, compared to 96.1%, 93.7%, 92.8% and 91.3% for OA, RCA, RA and traumatic sequelae, respectively. When compared with RTSA for PHF, the adjusted risk of revision was significantly higher for traumatic sequelae (hazard ratio [HR] = 2.3; p = 0.023) but not for other elective indications. The most common reason for revision in the PHF group was dislocation/instability (42.9%), which was similar to the OA (47.6%) and traumatic sequelae (33.3%) groups. At 6 months post-surgery, OSS were significantly lower for the PHF group compared to RCA, OA and RA groups (31.1 vs. 35.6, 37.7, 36.5, respectively, p < 0.001), and similar to traumatic sequelae (31.7, p = 0.431). At 5 years, OSS were only significantly lower for PHF compared to OA (37.4 vs 41.0, p <0.001) and there was no difference between PHF and other groups. At 10 years, there were no significant differences between groups. ConclusionsRTSA for PHF demonstrated reliable long-term survivorship and functional outcomes compared to elective indications. Despite lower functional outcomes in the early postoperative period for the PHF group, implant survivorship was similar in patients undergoing RTSA for the primary indication of acute PHF compared to RCA, OA and RA; and superior compared to the primary indication of traumatic sequelae.

An international, multicenter cohort study comparing 6 shoulder clinical scores in an asymptomatic population

To assess whether the integrity of rotator cuff repairs has an impact on functional outcomes, as well as pain scores, after surgery. Systematic review and meta-analyses performed for Level Ι, ΙΙ and ΙΙΙ studies that presented functional outcome scores and radiological assessment of integrity following rotator cuff repair. Extracted data included patient demographics, functional outcome scores [Constant Score, University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) shoulder score, visual analogue scale (VAS) Pain score], as well as assessment of repair integrity on radiological investigations. A meta-analysis was performed using weighted means and a random effects model. Twelve studies were included in the final analysis. Average re-tear rate for the 800 included patients was 22% at a mean follow-up of 27.5 months after surgery. Patients with intact repairs had a significantly higher Constant Score (8.61 points, p < 0.00001), UCLA shoulder score (2.96 points, p < 0.0001) and ASES shoulder score (9.49 points, p < 0.0006). Patients with intact repairs also reported lower pain VAS Pain scores by 0.62 points (p < 0.0004). Our results show better functional outcome and pain scores in patients with intact rotator cuffs at follow-up when compared to those that have re-torn. This difference is equivalent to the published Minimal Clinically Important Difference for the ASES but not Constant Scores. This review has also highlighted that shoulder strength in patients with intact cuff repairs is likely to be greater than in patients with a failed repair.

Functional and radiologic outcomes of uncemented reverse shoulder arthroplasty in proximal humeral fractures: cementing the humeral component is not necessary

Inferior Glenoid HyperOSTosis (GHOST) Lesion Development Following Reverse Total Shoulder Arthroplasty

SMR TT Augmented 360 baseplates: how do they compare to standard baseplates in reverse shoulder arthroplasty? Minimum 2 years' clinical and radiographic follow-up.

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