Indications For Total Shoulder Arthroplasty Research Articles

Preoperative indications for total shoulder arthroplasty predict adverse postoperative complications

BackgroundAlthough studies have shown improved pain, function, and patient satisfaction after total shoulder arthroplasty (TSA), preoperative factors predicting poor outcomes are unexplored. Comparison of postoperative complications between osteoarthritis (OA), cuff arthropathy (CA), and fracture patients is important for identifying at-risk patients.MethodsPrimary TSAs from 2014 to 2016 with preoperative OA, CA, and proximal humerus fractures as indications were queried from the National Surgical Quality Improvement Program database. Short-interval postoperative complications were compared using multivariate binary logistic regression, and postoperative time to discharge between groups was analyzed using univariate analysis of variance with Tukey comparison. Statistical significance was defined as P < .05 using SPSS software version 23.0 (IBM Corp., Armonk, NY, USA).ResultsOf 9684 TSA cases, the primary indication was OA in 6571 patients, CA in 725 patients, and fractures in 646 patients. Compared with fractures, OA patients had statistically significant lower risk of dislocation, readmission, return to operating room, nonhome discharge, surgical site infection, perioperative bleeding requiring transfusion, and pulmonary embolism (all P < .05). Statistically significant lower risk of dislocation, nonhome discharge, and transfusion was also found between CA and fracture patients (all P < .03). However, in comparing CA vs. OA as preoperative indications, only postoperative venous thromboembolism (odds ratio, 4.5; P = .01) and surgical site infection (odds ratio, 3.7; P = .007) were significant. Mean differences in discharge time were significant between both OA and CA groups compared with fractures (P < .001), but there was no significance between OA and CA (P = .116).ConclusionProximal humerus fracture is a risk factor for increased postoperative complications compared with OA and CA. With new outcomes-based reimbursement models, nonroutine discharge and increased discharge time should be considered in arthroplasty planning.

Short-term rates of radiolucency after primary total shoulder arthroplasty using a cementless metal-backed pegged polyethylene glenoid.

Total shoulder arthroplasty has shown good clinical efficacy in treating primary and secondary degenerative conditions of the glenohumeral joint. Glenoid loosening, however, remains the commonest cause of failure. The purpose of this study was to investigate the rate of radiographic periprosthetic lucency associated with the use of an uncemented, pegged, metal-backed polyethylene glenoid component. A retrospective, single-centre study using the Epoca (Synthes, Paoli, Pennsylvania) metal-backed glenoid component. Operations were performed by two experienced consultant upper limb surgeons. Radiographs were analysed for immediate post-operative component seating and periprosthetic radiolucent lines at predefined regular post-operative intervals. Intra- and inter-observer reliability was assessed to improve validity of results. Mean age and follow-up was 72 (48-91) years and 2.5 years (2-5), respectively. Main indications for total shoulder arthroplasty were primary osteoarthritis, rheumatoid arthritis, revision for failed hemi-arthroplasty and acute fracture. Ninety-six per cent of components were completely seated post-operatively. Fifty-four (95%) of the 57 shoulders had no periprosthetic radiolucent lines at most recent follow-up. Complete post-operative glenoid seating was significantly associated with the absence of later periprosthetic radiolucency (p < 0.01). This study reports low early radiolucency rates with the pegged, uncemented, metal-backed polyethylene glenoid prosthesis used. Excellent post-operative glenoid seating is associated with a significantly lower rate of radiolucency. Longer follow-up data are required to confirm these early promising results.Level of evidence: Therapeutic, level IV.

Total shoulder arthroplasty with an uncemented soft-metal-backed glenoid component

Loosening associated with cemented polyethylene glenoid components is a major concern following total shoulder arthroplasty (TSA). The purpose of this study was to investigate the clinical and radiographic results associated with use of a novel uncemented soft-metal-backed glenoid component (SMBG), with a minimum follow-up of 2 years. Twenty-two patients (19 women) underwent TSA using a uncemented SMBG. The mean age was 68.5 years (range, 49-84). Mean follow-up was 50 months (range, 24-89). Indications for TSA were primary osteoarthritis (10), post-traumatic osteoarthritis (8), steroid-induced avascular necrosis (2), crystalline arthropathy (1), and arthritis secondary to systemic lupus erythematodes (1). Subjective and objective parameters were assessed. Loosening and polyethylene wear were evaluated. Mean absolute Constant scores improved from 29.1 to 65.9 points (P < .001), age- and sex-adjusted Constant scores improved from 40.1 to 87.7% (P < .001), and subjective shoulder values improved from 35% to 75.2% (P < .001). Mean pain scores improved from 4.2 points to 13.1 (P < .001). Three cases had a fractured glenoid component. Only these 3 had a definite loosening. Polyethylene wear was found in 2 cases. Use of an uncemented SMBG component yields controversial results. Osteointegration appears possible and loosening signs have virtually not been observed. Conversely, the current implant can be associated with a high failure rate (13.6%) because of implant fractures despite short follow-up. As loosening seems absent or minimal but implant stability insufficient, design changes need to be performed and tested in view of solving the implant failure problem while preserving the actually excellent bone-implant interface characteristics.

Trends in the epidemiology of total shoulder arthroplasty in the United States from 1990–2000

Longitudinal trends in epidemiology and utilization of total shoulder arthroplasty (TSA) have not been previously reported. We evaluated trends in the distribution of age, race, hospital volume and teaching status, outcomes, and indications for TSA during the last decade. TSA cases (n = 12,758) were extracted from the 1990-2000 Nationwide Inpatient Sample databases. TSA trends were obtained for 3 time periods: 1990-1993 (period I), 1994-1997 (period II), and 1998-2000 (period III). Between 1990 and 2000, there were minor increases in the rate of TSA in most age groups. Ninety-three percent of the patients undergoing TSA in all 3 time periods were white. An increased proportion of patients were operated on in high volume hospitals in period III as compared with period I. Patients discharged to inpatient rehabilitation facilities after surgery had longer lengths of in-hospital stays as compared with those discharged home. Osteoarthritis was diagnosed in an increasing proportion of patients undergoing TSA (56.6% in period I versus 70.9% in period III). There was a minor increase in the rate of TSA, and almost no change in use of TSA by nonwhites from 1990 through 2000. Efforts to understand and narrow this apparent underutilization of TSA among nonwhites are required. Further research should determine whether the observed shift of TSA to high volume centers improves surgical outcomes.