Anatomic Arthroplasty Research Articles

Experiences and outcomes in shoulder replacements in a district general hospital over 19 years.

This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000-2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes. Level of evidence: III.

Clinical results and computed tomography analysis of intuitive shoulder arthroplasty (ISA) stemless at a minimum follow-up of 2 years

IntroductionThe utilization of stemless anatomic total shoulder arthroplasty is on the rise. Epiphyseal fixation leads to radiological bone remodeling, which has been reported to exceed 40% in certain studies series. The aim of this study was to present the clinical and radiological outcomes of a stemless implant with asymmetric central epiphyseal fixation at an average follow-up of 31 months. MaterialsThis retrospective multicenter study examined prospective data of patients undergoing total anatomic arthroplasty with ISA Stemless implant and followed up at least 2 years. Clinical assessment included preoperative and final follow-up measurements of active range of motion (ROM), Constant score, and Subjective Shoulder Value (SSV). Anatomical epiphyseal reconstruction and bone remodeling at the 2-year follow-up were assessed by standardized Computed Tomography Scanner (CT scan). Statistical analysis employed unpaired Student's t-test or chi-squared test depending on the variable type, conducted using EasyMedStat software (version 3.22; www.easymedstat.com). ResultsFifty patients (mean age 68 years, 62% females) were enrolled, with an average follow-up of 31 months (24-44). Primary osteoarthritis (68%) with type A glenoid (78%) was the prevailing indication. The mean Constant score and SSV improved significantly from 38 ± 11 to 76 ± 11 (p<0.001) and from 31% ± 16 to 88% ± 15 (p<0.001) respectively at the last follow-up. Forward elevation, external rotation and internal rotation ROM increased by 39° ± 42, 28° ± 21 and 3,2 ± 2,5 points respectively, surpassing the Minimally Clinically Important Difference (MCID) after total shoulder arthroplasty. No revisions were necessary. CT scans identified 30% osteolysis in the posterior-medial calcar region, devoid of clinical repercussions. No risk factors were associated with bone osteolysis. ConclusionAt an average follow-up of 31 months, ISA Stemless implant provided favorable clinical results. CT analysis revealed osteolysis-like remodeling in the posterior-medial zone of the calcar (30%), without decline in clinical outcomes and revisions. Long-term follow-up studies are mandated to evaluate whether osteolysis is associated with negative consequences.

Reverse shoulder arthroplasty with an inverted-bearing prosthesis as revision procedure for failed anatomic and reverse shoulder arthroplasty: a long-term multicenter study

BackgroundDespite the increasing popularity of revision total shoulder arthroplasty (RTSA), studies directly comparing revision RTSA performed for different failed index procedures are limited. We therefore compared the results of revision RTSA between patients with a failed primary anatomic arthroplasty (total shoulder arthroplasty and hemiarthroplasty) and those with a failed primary RTSA to explore revision of which index procedure resulted in better long-term clinical outcomes. MethodsIn this prospective, multicenter, observational study, patients underwent revision RTSA using an inverted-bearing prosthesis. We recorded clinical scores, active range of motion, pain, satisfaction, and the rate of scapular notching. Complications and prosthesis survival were also noted. ResultsWe included 45 patients (45 shoulders) with revision RTSA for failed primary anatomic shoulder arthroplasty (30 patients) and RTSA (15 patients). Clinical and radiographic outcomes were recorded from 36 patients at a median follow-up of 101.6 months, and prosthesis survival was assessed from all 45 patients. At final follow-up, clinical scores (P < 0.05), abduction (P = 0.032), re-revision rate (P = 0.018), and prosthesis survival (P = 0.015) were significantly better in patients revised from failed primary anatomic shoulder arthroplasty than those from RTSA. However, pain, satisfaction, and overall complication rates were similar in both groups (P > 0.05). ConclusionsWe found better long-term clinical scores, abduction, and prosthesis survival rates after failed primary anatomic shoulder arthroplasty than after RTSA. Pain reduction and complication rates were comparable in both groups. Thus, anatomic shoulder arthroplasty remains an attractive option for primary arthroplasty in selected cases.

Anatomic shoulder arthroplasty: the correlation between patient resilience, mental health, and outcome

Recovery from anatomic shoulder arthroplasty may be enhanced in patients with good mental health and the resilience to participate in the prescribed postoperative rehabilitation program. To test this concept, we utilized validated and reliable scales in determining whether resilience and mental health are associated with the outcome of anatomic arthroplasty. 399 patients (195 ream and run (RnR) and 204 anatomic total shoulder (aTSA)) were surveyed at a mean follow-up of 6.3 ± 3.3 years. Preoperative variables included age, sex, body mass index (BMI), history of prior shoulder surgery, diabetes, visual analog scale for pain (VAS), Simple Shoulder Test (SST) scores, and Veteran's RAND-12 Mental Component Score (VR-12 MCS). Outcomes collected included the SST, American Shoulder and Elbow Surgeons Score (ASES), revision rate, and patient satisfaction. Resilience was documented using the Connor Davidson Resilience Scale-10 (CD RISC-10) at latest follow-up. Univariable and multivariable regression analyses were used to identify factors significantly associated with follow-up postoperative SST, ASES and satisfaction. In the univariable analysis, CD RISC-10 was positively correlated with postoperative SST, ASES and satisfaction after both RnR and aTSA. Mean CD RISC-10 scores were higher in the RnR cohort (34.3 ± 4.8 vs. 32.5 ± 6.2 for aTSA, p<0.001). Male sex and lower preoperative VAS were correlated with higher ASES after RnR; VR-12 MCS was positively correlated with all outcomes except SST after RnR. In the multivariable linear regression analysis, CD RISC-10 was independently associated with postoperative SST, ASES and satisfaction scores in aTSA patients. In the RnR cohort, CD RISC-10 was only correlated with satisfaction. VR-12 MCS was correlated with ASES and satisfaction after RnR. In this study of anatomic arthroplasties, increased resilience and better mental health were correlated with better outcomes. RnR patients had higher resilience than aTSA patients. Greater resilience was associated with better outcomes after anatomic total shoulder arthroplasty. Better mental health was associated with superior outcomes after the ream and run procedure.

Periprosthetic fractures in patients with consequences of shoulder joint traumas.

Complications of shoulder joint traumas stand as a significant concern in modern traumatology. Various forms of endoprosthetics offer the potential to restore lost function resulting from fractures or dislocations of the proximal humerus. In the context of a significant deficiency in the rotator cuff of the shoulder (RC) in elderly patients with notably aged injuries, reverse endoprosthetics (RE) emerges as a justifiable choice. The accrued experience from the widespread adoption of anatomical arthroplasty of the shoulder joint (PS) has significantly influenced the evolution of this approach. Complications and progressive failures with short-term outcomes prompted the quest for solutions to the challenges posed by complex fractures and dislocations through the method of reverse arthroplasty, originally devised for treating rotatory arthropathy of the shoulder. However, the extensive application of RE has not consistently yielded excellent and good results in all cases of post-fracture and dislocation consequences. Mechanical complications, particularly periprosthetic fractures, are prevalent in RE and occur three times more frequently than in anatomical total arthroplasty of the shoulder joint. The urgency of this problem, considering the diminished rehabilitation potential of patients against the backdrop of intraoperative or postoperative fractures of the humerus and scapula, leading to a persistent deficit in the function of the shoulder joint, underscores the necessity of this study.

Revision reverse shoulder arthroplasty has similar outcomes to primary reverse shoulder arthroplasty at 5 Year average follow-up

BackgroundShoulder arthroplasty is a successful procedure that provides pain relief and improvements in function and range of motion. Anatomic and reverse shoulder arthroplasty are both effective procedures, and their indications continue to expand. We look at the outcomes of revision reverse total shoulder arthroplasty and compare it to the outcomes of primary reverse and anatomic total shoulder arthroplasty. MethodsWe identified patients undergoing total shoulder arthroplasty at our institution between the years of 2010 and 2020. Data was prospectively collected and retrospectively reviewed for post-operative range of motion and strength in patients with revision surgery and compared to controls. Measurements were collected preoperatively and postoperatively including range of motion and strength in the affected and unaffected shoulder. We collected patient reported outcome measures in person and via phone to identify subjective outcomes of total shoulder arthroplasty. Average final follow-up was 5.27 years. ResultsOur total patient sample was split between three groups: those with primary anatomic arthroplasty those who underwent primary reverse arthroplasty, and those who were revised to a reverse shoulder arthroplasty. All three groups had significant improvements in abduction and forward elevation from their pre-operative baseline to two years follow-up. Primary reverse had a significant improvement over revision reverse in abduction at one year follow-up. For all other range of motion measurements, there was no statistically significant difference at 2 years between primary and revision reverse shoulder arthroplasty. Patient reported outcomes had a significant increase from pre-op to most recent follow-up in all three groups. ConclusionOverall, our data suggest there is an improvement in outcomes with both primary and revision surgeries, and that results after revision reverse total shoulder arthroplasty may be comparable to primary reverse total shoulder arthroplasty.

Does long-term follow-up and monitoring of primary shoulder arthroplasty identify failing implants requiring revision?

Published scoping review has identified evidence paucity related to long-term follow-up of shoulder arthroplasty. We aim to report effectiveness of elective primary shoulder arthroplasty surveillance in identifying failing implants requiring revision. A prospective database recording shoulder arthroplasty and subsequent follow-up surveillance in a shoulder unit was analyzed. Shoulder arthroplasty was performed by 4 fellowship-trained shoulder surgeons for accepted elective indications including the use of anatomic arthroplasty in arthritic shoulders with intact rotator cuff and a reverse prosthesis being used in rotator cuff-deficient shoulders and rotator cuff-competent arthritic shoulders when deemed preferable by the treating surgeon. All shoulder arthroplasty implants used had achieved a minimum 7A Orthopaedic Data Evaluation Panel (ODEP) rating. The included shoulder arthroplasties were performed between May 1, 2004, and December 31, 2021, with minimum 1-year follow-up. Surveillance program involves specialist physiotherapist review at 1, 2, 3, 5, 8, 10, and 15 years postoperatively, including clinical examination, outcome scoring, and radiographs. Patient-initiated review occurred between time points if a patient requested assessment because of symptoms. Outcome measures include ratio of failing implants identified by surveillance and patient-initiated review, with number of surveillance reviews offered and proportion that identified a failing implant requiring revision calculated. A total of 1002 elective primary shoulder arthroplasty with minimum 1-year follow-up were performed (547 reverse total shoulder arthroplasty [rTSA], 234 anatomic total shoulder arthroplasty [aTSA], and 221 hemiarthroplasty [HA]). A total of 238 patients died prior to December 31, 2022, resulting in 4019 surveillance appointments offered. Thirty-eight prostheses required revision ≥1 year postoperatively (6 rTSA, 9 aTSA, and 23 HA), with surveillance identifying requirement in 53% (33% rTSA, 56% aTSA, and 57% HA) and patient-initiated review in 47%. Mean years from implantation to revision was 5.2 (2.7 rTSA, 3.6 aTSA, and 6.6 HA). Revision indications included rotator cuff failure (56% aTSR and 43% HA) and glenoid erosion (57% HA). This is the first series reporting effectiveness of shoulder arthroplasty surveillance in identifying implants requiring revision. Surveillance identified more than half of implants requiring revision, although only 0.5% of appointments identified revision requirement. Surveillance enrolment may influence patient-initiated review utilization; therefore, similar studies using only patient-initiated follow-up would help inform recommendations.

Update on Shoulder Arthroplasties with Emphasis on Imaging.

Shoulder pain and dysfunction may significantly impact quality of life. If conservative measures fail, advanced disease is frequently treated with shoulder arthroplasty, which is currently the third most common joint replacement surgery following the hip and knee. The main indications for shoulder arthroplasty include primary osteoarthritis, post-traumatic arthritis, inflammatory arthritis, osteonecrosis, proximal humeral fracture sequelae, severely dislocated proximal humeral fractures, and advanced rotator cuff disease. Several types of anatomic arthroplasties are available, such as humeral head resurfacing and hemiarthroplasties, as well as total anatomic arthroplasties. Reverse total shoulder arthroplasties, which reverse the normal ball-and-socket geometry of the shoulder, are also available. Each of these arthroplasty types has specific indications and unique complications in addition to general hardware-related or surgery-related complications. Imaging-including radiography, ultrasonography, computed tomography, magnetic resonance imaging, and, occasionally, nuclear medicine imaging-has a key role in the initial pre-operative evaluation for shoulder arthroplasty, as well as in post-surgical follow-up. This review paper aims to discuss important pre-operative imaging considerations, including rotator cuff evaluation, glenoid morphology, and glenoid version, as well as to review post-operative imaging of the various types of shoulder arthroplasties, to include normal post-operative appearances as well as imaging findings of complications.

Culturing explants for Cutibacterium at revision shoulder arthroplasty: an analysis of explant and tissue samples at corresponding anatomic sites.

Culturing of deep tissues obtained at revision arthroplasty for Cutibacterium is a key component of diagnosing a periprosthetic infection. The value of culturing explanted components has not been well described. This study sought to answer the following questions: (1) How does the culture positivity of explant cultures compare with that of deep tissue cultures? (2) How often are explant cultures positive when tissue cultures are not, and vice versa? (3) How does the bacterial density in explant cultures compare with that in tissue cultures? A total of 106 anatomic arthroplasties revised over a 7-year period were included. Explant (humeral head, humeral stem, and glenoid) and tissue (collar membrane, humeral canal tissue, and periglenoid tissue) specimens were sent for semiquantitative Cutibacterium culture. We compared culture positivity and bacterial density when cultures of an explant and tissue adjacent to the implant were both available. Explants had positive cultures at a higher rate than adjacent tissue specimens for most anatomic sites. Of the shoulders that had Cutibacterium growth, a higher proportion of explants were culture positive when tissue samples were negative (23%-43%) than vice versa (0%-21%). The Cutibacterium density was higher in explants than in tissues. Considering only the results of tissue samples, 16% of the shoulders met our threshold for infection treatment (≥2 positive cultures); however, with the inclusion of the results for explant cultures, additional 14% of cases-a total of 30%-met the criteria for infection treatment. In this group of patients, culturing explants in addition to tissue cultures increased the sensitivity for detecting Cutibacterium in revision shoulder arthroplasty.

Impact of previous non-arthroplasty surgery on clinical outcomes after primary anatomic shoulder arthroplasty

The objectives of this study were to address the following questions regarding previous non-arthroplasty surgery prior to primary anatomic shoulder arthroplasty (either total shoulder arthroplasty [TSA] or ream-and-run arthroplasty): (1) To what degree is primary anatomic shoulder arthroplasty after prior non-arthroplasty surgery associated with inferior clinical outcomes and higher revision rates compared with arthroplasty without previous surgery? (2) Does type, approach, or timing of previous surgery affect outcomes after anatomic arthroplasty? A retrospective review of a primary shoulder arthroplasty database was performed and identified 640 patients undergoing anatomic shoulder arthroplasty (345 TSAs and 295 ream-and-run arthroplasties). Of these patients, 183 (29%) underwent previous non-arthroplasty surgery. Baseline and demographic information, 2-year postoperative outcome scores, and revision surgical procedures with associated culture results were collected. In patients undergoing TSA, previous non-arthroplasty surgery was associated with a significantly lower 2-year Simple Shoulder Test (SST) score(P = .010), percentage maximum possible improvement (MPI) (P = .024), and Single Assessment Numeric Evaluation (SANE) score(P < .001) and a higher rate of reoperation (P < .001). In patients undergoing ream-and-run arthroplasty, previous non-arthroplasty surgery was associated with a nonsignificantly lower 2-year SST score, percentage MPI, and SANE score and higher reoperation rate. Prior fracture surgery carried a higher risk of reoperation than other types of surgery including rotator cuff repair and instability surgery. Among TSA and ream-and-run arthroplasty cases with prior non-arthroplasty surgery, prior open surgery and the time interval from most recent surgery were associated with nonsignificant differences in the 2-year SST score, percentage MPI, SANE score, and revision risk. Previous surgery is associated with inferior clinical outcomes and higher revision rates in patients undergoing index TSA but not in those undergoing the ream-and-run procedure. Patients with previous fracture surgery carry the highest risk of reoperation.

Revision of failed hemiarthroplasty and anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty

The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Revision of failed anatomic arthroplasty to reverse total shoulder arthroplasty has shown promise alongside concerning complication rates. Patients who underwent revision shoulder arthroplasty during a 7-year period at a tertiary care health system were identified. Presurgical and operative data were analyzed for 110 patients who met inclusion and exclusion criteria. Patients were contacted at a mean follow-up of 57 ± 26 months (range, 23-113 months) from revision surgery for functional outcomes scores, reoperations, and implant survival. Implant survival was 92% at 2 years and 74% at 5 years. Mean American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, and visual analog scale pain scores were 63 ± 24 (range, 5-97), 60 ± 25 (range, 0-100), and 2.9 ± 2.9 (range, 0-10), respectively. Seventy percent of patients were "very satisfied" or "satisfied with their outcome. Complications occurred in 18 patients (20%), and 10 patients (11%) underwent reoperation. Modest patient results and satisfaction can be achieved with revision of a failed anatomic arthroplasty to a reverse total shoulder arthroplasty. As is typical of revision surgery, complications are common and can compromise results. Further study is needed to identify factors that may contribute to successful outcomes.

Lateralization of the glenosphere in reverse shoulder arthroplasty decreases arm lengthening and demonstrates comparable risk of nerve injury compared with anatomic arthroplasty: a prospective cohort study

Grammont-style reverse shoulder arthroplasty (RSA) has an increased risk of nerve injury compared with anatomic total shoulder arthroplasty (TSA) due to arm lengthening. We hypothesized that an RSA with a lateralized glenosphere and 135° neck-shaft angle would reduce humeral lengthening and decrease the risk of nerve injury to the level of a TSA. The study prospectively enrolled 50 consecutive patients undergoing RSA (n = 30) or TSA (n = 20) as determined by a power analysis based on previous research for our institution. Intraoperative neuromonitoring was used to detect nerve alerts during 4 distinct stages of the procedure. Preoperative and postoperative arm lengths were measured on scaled radiographs. Patients were examined immediately postoperatively and at follow-up visits for neurologic complications. Mean motor and sensory nerve alerts per case were similar for TSA and RSA (motor: TSA, 1.5 ± 2; RSA, 1.5 ± 2; P = .96; sensory: TSA, 0.6 ± 0.9; RSA, 0.2 ± 0.6; P = .06). The mean change in arm length was 3 ± 7 mm in the TSA cohort vs. 14 ± 7 mm in the RSA cohort (P = .0001). Temporary neurologic changes postoperatively were noted in 1 TSA and 1 RSA patient, amounting to a 4% incidence of nerve injury. An RSA design with a lateralized glenosphere and a lower neck-shaft angle decreases arm lengthening compared with the Grammont design. The reduction in lengthening appears to eliminate the historically increased risk of neurologic injury associated with RSA relative to TSA.

Analysis of 4063 complications of shoulder arthroplasty reported to the US Food and Drug Administration from 2012 to 2016

Most of the literature on shoulder arthroplasty failure comes from high-volume centers. These reports tend to exclude the experience of community orthopedic surgeons, who perform most of the shoulder joint replacements. We analyzed the failure reports mandated by the US Food and Drug Administration for all hospitals. Each reported event from 2012 to 2016 was characterized by implant, failure mode, and year of surgery. For the 1673 anatomic arthroplasties, the most common failure modes were glenoid component failure (20.4%), rotator cuff/subscapularis tear (15.4%), pain/stiffness (12.9%), dislocation/instability (11.8%), infection (9%), and humeral component loosening (5.1%). For the 2390 reverse arthroplasties, the most common failure modes were dislocation/instability (32%), infection (13.8%), glenosphere-baseplate dissociation (12.2%), failed/loosened baseplate (10.4%), humeral component dissociation/tray fracture (5.5%), difficulty inserting the baseplate (4.8%), and difficulty inserting the glenosphere (4.2%). Although the percentage distribution among the different failure modes was relatively consistent over the years of this study, the percentage distribution of these failure modes differed substantially among different implant manufacturers. The Food and Drug Administration database reveals modes of shoulder arthroplasty failure that are not emphasized in the published literature, such as rotator cuff tear, infection, and postoperative pain/stiffness for anatomic total shoulder arthroplasty and implant dissociation and baseplate failure for reverse shoulder arthroplasty. Knowledge of these failure modes may help inform surgical technique and implant design in ways that will lower the risk of implant failure in the future.

Bleeding in primary shoulder arthroplasty.

The aim of this investigation was to analyse "total blood loss" (TBL), "blood transfusion rate" (BT) and the "amount of transfused blood units" (BU) between the different primary shoulder arthroplasty (SA) types: reverse, anatomical and stemless. Only primary SA was included. Further goal was to identify risk factors for TBL, amount of BU and BT rate. A retrospective charts analysis of patients who received primary SA for degenerative shoulder pathology in our institution between 2004 and 2016 was performed. The demographic data, co-morbidities, haemoglobin and hematocrit level, BT rate, amount of transfused BU etc. were collected. TBL was estimated. Linear regression, log-linear poisson regression and logistic regression were used to compare the outcomes TBL, amount of transfused BU and BT rate, respectively, between different prosthesis types. Of 278 patients included in this study 209 received reverse, 57 anatomical and 12 stemless SA. Mean TBL was 392.7ml in reverse, 394.6ml in anatomical and 298.3ml in stemless SA. The BT rate and mean amount of BU were, respectively, 14.4% and 0.32 in reverse and 8.77% and 0.23 in anatomical SA. None of the patients with stemless arthroplasty received BT. Significant risk factors for elevated TBL are operation time, higher BMI, male sex. Significant risk parameters for BT and higher amount of transfused BU are low BMI, cemented arthroplasty, coronary heart disease, ASA score > 2 and previous therapy with vitamin K antagonists. Although there were little differences between the blood transfusion rates in reverse vs. anatomical arthroplasty, there was no difference in total blood loss between these different prosthesis types. None of the patients with stemless arthroplasty received blood transfusion. There are various risk factors affecting total blood loss and blood transfusion rate. However, risk parameters influencing blood transfusion may be different to them affecting total blood loss.

Shoulder arthroplasty following gastric bypass, do complications follow?

Previous reports have shown an increased risk of complications after arthroplasty in the obese population. It remains unclear if gastric bypass surgery prior to shoulder arthroplasty modifies the complication and failure rate. The purpose of this study is to assess the complication and re-operation rates following shoulder arthroplasty in this population. Between 2002 and 2012, 39 shoulders with prior gastric bypass underwent shoulder arthroplasty (3 HA, 16 TSA, 20 RSA). The mean time from the gastric bypass to arthroplasty was 13years (range, 0.7-32). Shoulders were followed for a minimum of twoyears (mean, 3.8years) or until re-operation. Outcome measures included pain, range of motion, satisfaction, modified Neer ratings, and ASES scores. Complications occurred in seven shoulders (18%), with five requiring re-operation. There was no common failure mechanism. Re-operations occurred for aseptic glenoid loosening, periprosthetic fracture, and unexplained pain. Those shoulders with complications were similar to those without in regard to age, sex, and BMI. Complications were more common following anatomic arthroplasty compared to reverse arthroplasty (5 vs 1, p=0.06); however, complications were not improved compared to historical controls with morbid obesity. Overall, pain improved significantly from 4.8 pre-operatively to 2.3 postoperatively (p<0.001). All groups, regardless of arthroplasty type, demonstrated significant improvements in forward elevation and external rotation. Gastric bypass surgery prior to shoulder arthroplasty leads to clinical improvement in both pain and range of motion. Prior gastric bypass surgery does not result in a lower surgical complication rate compared to previously published reports in the morbidly obese population. Level 4, case series.

Reverse shoulder arthroplasty

Reverse polarity total shoulder arthroplasty is an innovation primarily designed to treat the rotator cuff-deficient shoulder by increasing constraint and thereby addressing the challenges of pseudoparalysis. Forward elevation can be regained, pain and quality of life can be improved. Recently, there has been an expansion in both the breadth of indications and the volume of surgeries performed. We aim to review current practice and direction of travel. The impact of rotator cuff tear arthropathy (CTA) is often significant and disabling. This condition is associated with painful arthrosis of the shoulder in conjunction with instability, which allows the humeral head to escape antero-superiorly. The resulting loss of function in the shoulder is aptly described as ‘pseudoparalysis’. Figure 1 shows the normal deltoid function around a shoulder with an intact soft-tissue envelope, and the superior migration that results when the superiorly directed force vector is not neutralised. Conventional anatomical arthroplasty of the shoulder fails to restore function in these patients due to the inadequate stability of the joint around a central point of pivot, combined with an inability of the surrounding muscles to compensate for a weak or torn rotator cuff. Fig. 1 Proximal migration in cuff tear arthropathy with resulting deltoid dysfunction- schematic This combination results in a complex and disabling condition that has vexed shoulder surgeons since the early days of development in shoulder arthroplasty systems. A better understanding of shoulder biomechanics and the mechanisms of failure in total shoulder arthroplasty led to the development of reverse shoulder arthroplasty (RSA) designs. While the original indication was CTA, there has been a rapid expansion of indications to include a spectrum of pathologies: proximal humeral fractures and trauma sequelae; massive cuff tears; tumours; primary glenohumeral osteoarthritis (OA); and the revision of failed shoulder arthroplasties. Themistocles Gluck most likely developed a shoulder arthroplasty in the …

Reverse total shoulder replacement: approaches and current controversies

Reverse total shoulder arthroplasty (RTSA) is a well-accepted treatment option for a number of pathologies including glenohumeral arthropathy with severe rotator cuff deficiency, revision of anatomic arthroplasty, rheumatoid arthritis, reconstruction after tumor resection, and severe fractures in the elderly. Despite advances in RTSA, significant challenges persist and continue to inspire innovation in technique and design. This review outlines the pervasive challenges of RTSA and the strategies that have been developed for these challenges. The anterosuperior and deltopectoral approaches have both been used successfully for RTSA, with considerations that render each approach applicable in certain scenarios. Pertinent issues related to the glenoid component center around determining the ideal position for the center of rotation and the ideal degree of baseplate tilt. On the humeral component side, debate exists regarding the optimal humerosocket inclination and the role for humeral component lateralization. With conflicting or limited data pertaining to these topics, there remains room for continued research, improvement, and innovation.

Total Joint Replacement and Return to Sports

Background: An increasing number of physically active patients not only need to know if they will basically be able to engage in sports after undergoing arthroplasty. They also would like to know whether or not they will be able to resume their preoperative activity levels. This article aims to provide an overview of recent data regarding the following questions on hip, knee and shoulder arthroplasty: (1) What is the impact of physical activity on an endoprosthesis? (2) What level of sports can be achieved after an arthroplasty procedure? (3) What types of sport are recommended for patients with an endoprosthesis? Methods: PubMed-based review of the literature. Narrative review focusing on current data from the years 2010 to 2016. Results: The commonly known recommendation to exercise low-impact sports such as hiking, swimming, cycling or golf at a moderate intensity remains valid for all types of prostheses in all joints. There is broad consensus that the benefits of these sports outweigh the negative effects. Having undergone total hip or knee arthroplasty, most patients with a high preoperative activity level return to sports after 3-6 months, albeit with a clear tendency to lower intensity and a shift from high-impact to low-impact sports. Some key questions have to be answered regarding the effects of low-impact sports that are exercised with high intensity, the effects resulting from high-impact sports, effects specific to different types of sport, and possibilities provided by different prosthesis types. In this context, a lot remains to be done to investigate the limits between positive and negative effects resulting from physical activity of varying intensity. New data suggests that generally a higher physical performance level may be achieved than has been traditionally recommended. Early results of unicondylar knee prostheses are far better than those achieved with bicondylar prostheses. In contrast to expert recommendations, shoulder endoprostheses show the highest postoperative activity levels after inverted arthroplasty, followed by anatomic arthroplasty, and the lowest activity level after the implantation of a hemiprosthesis. Conclusion: There is a significant discrepancy between previous expert recommendations and the actual activity levels that may be achieved after the implantation of a joint prosthesis. Future studies have to define the sports level, the type of sports and the type of prosthesis that provide a positive benefit-risk ratio using state-of-the-art low-abrasion bearing surfaces and prosthesis designs.

Clinical and Radiographic Mid-Term Outcomes After Total Shoulder Replacement: A Retrospective Study Protocol Including 400 Anatomical and Reverse Prosthetic Implants.

To obtain outcomes data on anatomical and reverse total shoulder arthroplasty by analysis of clinical scores and standard radiographs. 400 consecutive series of patients replaced with anatomical and reverse total shoulder arthroplasty (minimum 3 years follow-up). retrospective monocenter. Demographics, clinical scores (Constant-Murley) as available, shoulder X-ray (AP, outlet and axillary views) . Postoperative radiographhs and clinical scores. Adverse events and complications to be reported as occurred since implantation. Data collected will be summarized and analyzed for statistical significance.

Glenoid Dysplasia.

Glenoid dysplasia is a developmental anomaly of the scapula that is characterized by a bony deficiency of the posteroinferior glenoid and the adjacent scapular neck. Glenoid dysplasia may occur as a primary isolated condition or in association with various syndromes. It is thought to be related to defective ossification of the inferior glenoid precartilage. Radiographs typically demonstrate bilateral, symmetric dysplasia of the scapular neck with a range of associated bony changes. Glenoid dysplasia has been associated with instability and premature glenohumeral arthritis, although the clinical presentation is highly variable. Symptoms are delayed or mitigated as a result of compensatory glenoid labral hyperplasia. The treatment of glenoid dysplasia remains challenging. Nonsurgical treatment is reasonably successful in younger patients, but premature degenerative changes frequently occur. Although favorable results can be obtained with the use of anatomic arthroplasty, continued subluxation and glenoid component failure can lead to unacceptable outcomes.