Primary Glenohumeral Osteoarthritis Research Articles

Outcomes of patients undergoing anatomical total shoulder arthroplasty with augmented glenoid components - a systematic review.

Glenoid loosening is an issue in anatomic total shoulder arthroplasty (a-TSA). This has been attributed to abnormal glenoid anatomy, common among these patients. Different alternatives have been proposed to tackle glenoid bone loss and restore joint alignment with augmented glenoid implants being increasingly used to deal with this problem. This systematic review aims to evaluate the clinical and radiological outcomes of patients undergoing augmented glenoid a-TSAs. Our hypothesis was that augmented glenoid components will lead to good patient outcomes with a low incidence of complications and revision procedures. MEDLINE, EMBASE, CENTRAL and CINHAL were searched from inception to February 2022 for information pertaining to outcomes of patients undergoing a-TSA with augmented glenoid implants. Eighteen studies reported on outcomes of 814 a-TSA (800 participants) with a mean follow-up of 3.7 years. Most studies (67%) were Type IV level of evidence. Almost 70% of participants underwent an a-TSA secondary to primary glenohumeral osteoarthritis. Most glenoids were type B2 (73%). Augmented glenoids material was mostly all-polyethylene (81%) with full wedge (45%) and stepped components (38%) designs being the most common. Most studies reported good clinical outcomes. 17 patients (4%) underwent a revision surgery. Our review found that patients undergoing a-TSA with augmented glenoid components report good outcomes at short-to-mid-term follow-up. Further research is warranted to determine if such outcomes remain similar in long term. Level III, Systematic Review of Therapeutic Studies.

Anatomic shoulder arthroplasty in Walch type C glenoid deformity: mid- to long-term outcomes.

Hypoplastic glenoid morphology in the setting of glenohumeral osteoarthritis is a rare yet complex surgical problem. Treatment of this patient population with anatomic total shoulder arthroplasty (aTSA) remains controversial. Furthermore, there is no gold-standard approach, with limited guidance for surgeons on the need for glenoid version correction in the setting of a dysplastic glenoid. The purpose of this study was to evaluate mid- to long-term outcomes and reoperation rates of aTSA for the treatment of primary glenohumeral osteoarthritis with Walch type C glenoid deformity. This observational, retrospective cohort study identified patients with a Walch type C glenoid who underwent aTSA at 2 institutions between 2007 and 2016. Patients were contacted to complete updated patient-reported outcome measures at a minimum of 5.5 years postoperatively. The outcome measures collected included the American Shoulder and Elbow Surgeons (ASES) score and Single Assessment Numeric Evaluation (SANE) score. Secondary outcomes included any additional surgical procedures on the operative shoulder, patient satisfaction, and willingness to undergo aTSA again. In total, 30 patients met the inclusion criteria, of whom 26 (86.7%) were able to be contacted to undergo final outcome evaluations. The mean age at the time of surgery was 61.3 years (range, 40.9-75.5 years), and 20 patients (76.9%) were men. The mean follow-up period was 8.5 years (range, 5.5-11.3 years) after surgery. Treatment was performed with an augmented component in 9 patients and with a standard component in 17. Of the 17 patients with non-augmented components, 9 underwent partial correction with asymmetrical reaming, 3 received a mini-inset glenoid component, and 2 had an anteriorly offset humeral component. At final follow-up, patients had a mean ASES score of 83.6 ± 16.7, ASES pain score of 24.7 ± 20.8, SANE score of 80.4 ± 20.9, and patient satisfaction rate of 84.1%. No statistically significant differences in any outcome measure were observed between patients with augmented glenoid components and those with non-augmented glenoid components. One revision to reverse shoulder arthroplasty was performed for instability at 7 years postoperatively after a traumatic dislocation. All patients reported that they would be willing to undergo the same surgical procedure again. Despite variance in glenoid reconstructive approach, aTSA provides satisfactory and sustained improvements in patient-reported outcomes in patients with glenoid dysplasia and primary glenohumeral osteoarthritis with a low revision rate at a mean of 8.5 years. Anatomic shoulder arthroplasty should remain a surgical option in patients with Walch type C glenoid deformity.

Factors Impacting Time to Total Shoulder Arthroplasty Among Patients with Primary Glenohumeral Osteoarthritis and Rotator Cuff Arthropathy Managed Conservatively with Corticosteroid Injections

Factors Impacting Time to Total Shoulder Arthroplasty Among Patients with Primary Glenohumeral Osteoarthritis and Rotator Cuff Arthropathy Managed Conservatively with Corticosteroid Injections

Total Shoulder Arthroplasty in Patients with a B2 Glenoid Addressed with Corrective Reaming: Mean 8-year Follow-up.

The management of Walch B2 glenoid deformities in primary glenohumeral osteoarthritis is frequently debated. Previous literature has shown that the treatment of B2 glenoids with high-side reaming and anatomic total shoulder arthroplasty (TSA) perform well in the short-term, but is associated with an increased glenoid component failure rate in severe deformities. Therefore, many have explored alternative options, including augmented anatomic glenoid components and reverse shoulder arthroplasty. Our goal in this study is to provide mid-term radiographic and clinical outcomes after high-side reaming and anatomic TSA for B2 glenoids. Patients were followed both clinically and radiographically. Preoperative CT scans were used for retrospective analysis of deformity. Both preoperative and postoperative VAS pain, ASES score, and SST scores were collected. Radiographs were analyzed preoperatively and postoperatively for humeral head decentering relative to the glenoid vault, immediate glenoid seating, and final glenoid peg radiolucency. Of the original cohort of 59 patients (6 now deceased) reported at a mean radiographic follow-up of 3.4 years, 34 shoulders in 33 patients with B2 glenoids (mean retroversion 18.9°, range 4°-32°) were available for follow-up at a mean of 8.6 years (range 5.5-11.2) after high-side glenoid reaming with anatomic TSA. Three (5.1%) of the original 59 shoulder were revised. At final follow-up, 3 of 30 (10.0%) shoulders had radiographic glenoid component failure, but were unrevised. Glenoid component failure was associated with worse initial glenoid component seating (mean Lazarus score 1.2 vs. 2.0, p=0.002). Glenoid failure was also associated with increased posterior humeral head subluxation at 2-4 year follow-up (mean 5.6% vs 12.6%, p=0.045) and at final follow-up (mean 7.0% vs. 21%, p=0.002). There was no association between glenoid component failure and preoperative retroversion, inclination, or humeral head subluxation (all p>0.05). Glenoid component failure was associated with worse ASES (88 vs. 73) and VAS pain (0.8 vs. 2.1) scores (both p=0.03). At a mean of 8.6 years, 88% of shoulders available for follow-up had well-fixed glenoid components. Glenoid component failure was associated with poor initial glenoid component seating, with failed components having an average of 25% of the glenoid component not seated. Preoperative deformity such as glenoid retroversion, inclination, or humeral head subluxation did not predict glenoid component failure. This study supports that initial glenoid component seating and recurrence of posterior humeral head subluxation may be the most important factors for mid-term glenoid component survival in anatomic TSA in patients with B2 glenoids.

Reverse shoulder arthroplasty with preservation of the rotator cuff for primary glenohumeral osteoarthritis has similar outcomes to anatomic total shoulder arthroplasty and reverse shoulder arthroplasty for cuff arthropathy.

Indications for reverse total shoulder arthroplasty (RSA) have expanded to include individuals with intact rotator cuffs such as patients with severe glenoid deformity or with concern of future rotator cuff insufficiency. The purpose of this study was to compare outcomes of RSA with an intact rotator cuff to RSA for cuff arthropathy and anatomic total shoulder arthroplasty (TSA). We hypothesized that outcomes of RSA with an intact rotator cuff would be comparable to RSA for cuff arthropathy and TSA but with diminished range of motion (ROM) compared with TSA. Patients at one institution who underwent RSA and TSA between 2015 and 2020 with minimum 12-month follow-up were identified. RSA with preservation of the rotator cuff (+rcRSA) was compared to RSA for cuff arthropathy (-rcRSA) and anatomic TSA (TSA). Demographics and glenoid version/inclination were obtained. Pre- and postoperative ROM; patient-reported outcomes including visual analog scale (VAS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores; and complications were obtained. Twenty-four patients underwent+rcRSA, 69 underwent -rcRSA, and 93 underwent TSA. There were more women in the +rcRSA cohort (75.8%) than in the -rcRSA (37.7%, P=.001) and TSA (37.6%, P=.001) cohorts. Mean age of the +rcRSA cohort (71.1) was greater than that of TSA (66.0, P=.021) but similar to that of -rcRSA (72.4, P=.237). Glenoid retroversion was greater in +rcRSA (18.2°) compared with -rcRSA (10.5°, P=.011) but was similar to TSA (14.7°; P=.244). Postoperatively, there were no differences in VAS or ASES between+rcRSA vs. -rcRSA and +rcRSA vs. TSA. SSV was lower in +rcRSA (83.9) compared with -rcRSA (91.8, P=.021), but was similar to TSA (90.5, P=.073). Similar ROM was achieved in forward flexion, external rotation, and internal rotation at final follow-up between+rcRSA and -rcRSA, but TSA had greater external rotation (44° vs. 38°, P=.041) and internal rotation (6.5° vs. 5.0°, P=.001) compared with+rcRSA. There were no differences in complication rates. At short-term follow-up, preservation of the rotator cuff in RSA demonstrated similarly excellent outcomes and low complication rates compared with RSA with a deficient rotator cuff and TSA, except for slightly lower internal and external rotation compared with TSA. Although multiple factors deserve consideration when choosing between RSA and TSA, RSA with preservation of the posterosuperior cuff is a viable treatment option for glenohumeral osteoarthritis, particularly in patients with severe glenoid deformity or those at risk for future rotator cuff insufficiency.

The effect of subscapularis-specific rehabilitation following total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial

Patients undergoing a total shoulder arthroplasty (TSA) through a deltopectoral approach will require repair of the subscapularis tendon. There are no universal postoperative guidelines for rehabilitation of the subscapularis specifically. We hypothesize that the addition of a subscapularis-specific regimen will result in improved subscapularis strength and function. Adult patients undergoing anatomic TSA for the treatment of primary glenohumeral osteoarthritis were included. Patients were randomized into either the traditional rehabilitation (TR) control group or the subscapularis rehabilitation (SR) group, which consisted of the traditional therapy along with early and additional subscapularis exercises. Baseline demographics, patient-reported outcome measures (PROMs), range of motion (ROM), provocative tests, and subscapularis strength using a handheld dynamometer were measured preoperatively at the initial clinic visit (ICV) as well as 3 months, 6 months, and 1 year postoperatively. The primary outcome of interest was a comparison of subscapularis strength between cohorts relative to preoperative baseline, whereas secondary outcomes were functional, ROM, and PROMs. Sixty-six patients were included in the final analysis (32 TR vs. 34 SR). There were no statistically significant differences between cohorts at the ICV with regard to demographics, baseline subscapularis strength, functional testing, or PROMs. All postoperative time points demonstrated similar subscapularis strength testing between TR and SR groups (P>.05). Additionally, peak and average subscapularis strength testing at 3, 6, and 12 months postoperatively were similar to baseline ICV testing in both groups. Both groups demonstrated improvements across several provocative tests, ROM, and PROM outcome metrics at every postoperative time point as compared to baseline ICV values (P<.05). Patients undergoing anatomic TSA return to baseline internal rotation strength by 3 months postoperatively and demonstrate significant improvements in function, ROM, and several patient-reported outcome measures. The addition of early and focused subscapularis strengthening exercises does not appear to significantly impact any outcomes when compared to traditional rehabilitation programs.

Similar rates of revision surgery following primary anatomic compared with reverse shoulder arthroplasty in patients aged 70 years or older with glenohumeral osteoarthritis: a cohort study of 3791 patients

Reverse total shoulder arthroplasty (RTSA), initially indicated for cuff tear arthropathy, is increasingly used for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff. This is often done to avoid revision surgery in elderly patients for rotator cuff failure with anatomic total shoulder arthroplasty (TSA) despite traditionally good outcomes of TSA. We sought to determine whether there was a difference in outcomes for patients ≥70 years who receive RTSA compared to TSA for GHOA. A retrospective cohort study was conducted using data from a US integrated health care system's Shoulder Arthroplasty Registry. Patients ≥70 years who underwent primary shoulder arthroplasty for GHOA with an intact rotator cuff were included (2012-2021). RTSA was compared to TSA. Multivariable Cox proportional hazard regression was used to evaluate all-cause revision risk during follow-up, while multivariable logistic regression was used to evaluate 90-day emergency department (ED) visit, and 90-day readmission. The final study sample comprised 685 RTSA and 3,106 TSA. Mean age was 75.8 years (standard deviation 4.6) and 43.4% were male. After accounting for confounders, no significant difference in all-cause revision risk was observed for RTSA compared to TSA (hazard ratio=0.79, 95% confidence interval [CI]=0.39-1.58). The most common reason for revision following RTSA was glenoid component loosening (40.0%). Over half (54.0%) of revisions following TSA were for rotator cuff tear. No difference between procedure type was observed in likelihood for 90-day ED visits (odds ratio [OR]=0.94, 95% CI=0.71-1.26) and 90-day readmission (OR=1.32, 95% CI=0.83-2.09). RTSA and TSA for GHOA with an intact rotator cuff in patients ≥70 years had a similar revision risk, as well as likelihood for 90-day ED visits and readmissions. While revision risk was similar, the most common causes for revision were different with rotator cuff tears for TSA and glenoid component loosening for RTSA.

Accuracy and Reliability of Computerized Surgical Planning Software in Anatomic Total Shoulder Arthroplasty.

The primary purpose of this study was to assess the concordance between preoperatively determined implant parameters using CT-based planning software and surgically implanted prostheses. Secondarily, we sought to evaluate the agreement between preoperative plans performed by surgeons at different levels of training. Patients with primary glenohumeral osteoarthritis who underwent anatomic total shoulder arthroplasty (aTSA) and had a preoperative CT scan according to Blueprint (Stryker, Mahwah, NJ) protocol to be used for preoperative planning were included. A cohort of short-stemmed (SS) and stemless cases performed between October 2017 and December 2018 was randomly selected from an institutional database for the study. Planning was performed separately by four observers at different levels of orthopedic training at a minimum of six months following the actual surgery. Concordance between the surgical decisions during planning and the actually utilized implants was calculated. Additionally, inter-rater agreement was analyzed using the intra-class correlation coefficient (ICC). Implant parameters assessed were glenoid size, backside radius of curvature, and the need for posterior augment, in addition to humeral stem/nucleus size, head size, head height, and head eccentricity. Twenty-one patients were included (10 stemmed and 11 stemless) with a cohort comprising 12 (57%) females with a median age of 62 years (IQR 59.5,67). There was a total of 544 decision possibilities based on the above parameters. The total number of decisions that matched surgical data was 333 (61.2%). Prediction of glenoid component augmentation need and size was the variable that matched most with surgical data (83.3%), whereas nucleus/stem size was the worst (42.9%). Interobserver agreement was excellent in one variable, good in three variables, moderate in one, and poor in two. The best interobserver agreement was with regard to head height. Preoperative planning using CT-based software may be more accurate for the glenoid component when compared to humeral-sided parameters. Specifically, planning may be most helpful in determining the need and the size of glenoid component augmentation. Utilizing computerized software demonstrates high reliability, even among surgeons early in their orthopedic training.

Hemiarthroplasty versus total shoulder arthroplasty in B2 glenoids with an intact rotator cuff: a long-term matched cohort analysis

Walch B2 glenoids present unique challenges to the shoulder arthroplasty surgeon, particularly in young, active patients who may wish to avoid the restrictions typically associated with an anatomic total shoulder arthroplasty (TSA). Long-term data are limited when comparing hemiarthroplasty (HA) and TSA for patients with an intact rotator cuff. The purpose of our study was to compare the long-term outcomes of HA vs. TSA in a matched analysis of patients with B2 glenoids, primary osteoarthritis (OA), and an intact rotator cuff. A retrospective review was performed of all patients who underwent HA or TSA between January 2000 and December 2011 at a single institution. Inclusion criteria were primary OA, Walch B2 glenoid morphology, an intact rotator cuff intraoperatively, at least 2 years of clinical follow-up, or revision within 2 years of surgery. Fifteen HAs met inclusion criteria and were matched 1:2 with 30 TSAs using age, sex, body mass index, and implant selection. Clinical outcomes including range of motion (ROM), visual analog scale (VAS) for pain, subjective shoulder value score, American Shoulder and Elbow Surgeons (ASES) score, complications, and revisions were recorded. Postoperative radiographs were reviewed to assess for stem loosening, humeral head subluxation, glenoid loosening, and glenoid erosion. A total of 15 HAs and 30 TSAs met inclusion criteria at a mean follow-up of 9.3 years. The mean age at the time of surgery was 60.2 years for HA and 65.4 years for TSA (P= .08). Both cohorts had significant improvements in ROM, subjective shoulder value, and VAS pain scores (P < .001). TSA had higher postoperative ASES scores compared to HA (P= .03) and lower postoperative VAS pain scores (P= .03), although the decrease in pain from preoperatively to final follow-up was not significantly different between HA and TSA (P= .11). HAs were more likely to have posterior humeral subluxation (P < .001) and stem lucencies (P= .02). Revisions occurred in 11.1% of the cohort with no difference for HA and TSA (P= .73). At nearly 10 years of follow-up, HA and TSA both showed significant improvements in ROM and pain when performed for primary glenohumeral OA in B2 glenoids with intact rotator cuffs. Compared to HA, TSAs had less posterior humeral subluxation, less stem lucencies, higher ASES scores, and lower postoperative VAS pain scores. However, our study failed to demonstrate a difference in ROM, complication, or revision rates between HA and TSA.

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections.

The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P&lt;0.05. The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

Good clinical and radiological outcomes of anatomic total shoulder arthroplasty with a novel convertible all polyethylene glenoid with hybrid fixation: minimum 2-year follow-up

BackgroundThe ideal glenoid implant for anatomic total shoulder arthroplasty (aTSA) is one that provides sound fixation and allows ease of conversion to a reverse shoulder arthroplasty should the clinical need arise. This study is the first to report a consecutive series of patients treated with a novel convertible all polyethylene glenoid with hybrid fixation. The aim of the study was to evaluate the clinical, functional, and radiological outcomes of aTSA, for treatment of primary glenohumeral joint osteoarthritis using the SMR TT Hybrid Glenoid. MethodsThis is a prospective study including consecutive patients from two centers in New Zealand and Sweden. Between August 29, 2017 and April 22, 2020, 103 patients received an aTSA for osteoarthritis with the SMR TT Hybrid Glenoid implant (LimaCorporate, San Daniele del Friuli, Italy). Ninety-seven patients had a minimum follow-up of 24 months and were therefore included in this study. There were 45 female and 52 male patients. The average age at the time of surgery was 68.2 years (range 49-81 years). Preoperative and postoperative clinical evaluations were performed using the American Shoulder and Elbow Surgeons score and the Oxford Shoulder Score. Preoperative and postoperative range of motion measures were conducted using a goniometer. Standardized Grashey and axillary lateral radiographs were utilized to assess for evidence of glenoid and humeral component failure and loosening. ResultsThe mean follow-up duration was 2.3 years (range 2.0-4.6 years). The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 29.0 ± 12.4 and 90.3 ± 14.5, respectively (P < .001). The mean preoperative and postoperative Oxford Shoulder Scores were 21.0 ± 6.7 and 45.3 ± 4.4, respectively (P < .001). We found significant improvements in the range of motion, with mean forward flexion increasing from 87° to 155° and abduction 73° to 149°, respectively. Radiologically, there was no evidence of glenoid or humeral component failure or loosening. Six patients had evidence of reduced bone density around the humeral component. Two patients had repair of traumatic rupture of subscapularis tendon in the early postoperative period. None of the patients had revision of the glenoid or humeral components. ConclusionsPatients treated with an aTSA with the SMR TT Hybrid Glenoid, a novel glenoid implant that has the potential to simplify the process of revision, achieved promising clinical and radiologic results at a minimum of two years.

Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear. We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO. From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001]. Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.

Day of surgery cancellation in total shoulder arthroplasty: an analysis of surgical cancellation etiologies

BackgroundCancellation of elective total shoulder arthroplasty (TSA) is an expected occurrence. The typical cost of canceled elective surgeries is estimated to be $3000 per patient and can lead to hospital losses of nearly $1 million per year. With the growing interest of same-day TSA, understanding and minimizing unexpected same-day cancellation will reduce impact on patients, surgeons, and health care system. The purpose of the study is to identify the frequency and causes of unexpected same-day cancellations in TSA and determine which treatment path those patients take following their cancellation. MethodsA consecutive series of 1189 TSA (anatomic and reverse) patients operated at a single-academic institution across two tertiary care hospitals from 2010 to 2020 were reviewed. All patients who were scheduled for TSA and subsequently canceled were identified. The etiology of cancellation, time to rescheduling, date of actual TSA procedure, and subsequent work-up were recorded. Descriptive statistics of the canceled patient cohorts were analyzed. Univariate analysis, chi-square test, and analysis of variance were used to compare patients who canceled on the day of surgery (DOS) to prior to surgery. ResultsOf the 1189 TSA patients, 964 were TSA for primary glenohumeral osteoarthritis or cuff tear arthropathy. Ninety-eight (10.2%) TSA had cancellations, of which 49.0% were on the DOS. Most common causes of DOS cancellations were due to medical reasons (45.8%) and anesthesia-related complications (27.1%). Infection (40.9%) was the most frequent medical reasons for cancellations. Fifty-four percent of the anesthesia-related complication cancellations underwent additional diagnostic and therapeutic intervention, despite 100 % of those patients receiving preoperative clearance. DiscussionDOS cancellations in TSA are unavoidable, but there are modifiable factors that can minimize the risk of cancellation. Contrary to studies that attributed cancellations to inadequate cardiovascular-related medical clearance, our study found that the majority of these cancellations are due to infection-related issues. A higher proportion of patients with inadequate medical clearance will cancel prior to the DOS. Despite preoperative optimization, certain patient risk factors need additional diagnostic and therapeutic interventions prior to undergoing shoulder arthroplasty. Through coordination and planning, health care providers and patients can identify those factors and address these issues early on to avoid cancellation and ultimately proceed with a TSA.

Outcomes Between Stemmed and Stemless Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Both stemmed and stemless designs for total shoulder arthroplasty (TSA) have demonstrated efficacious outcomes for the surgical treatment of primary glenohumeral joint osteoarthritis. The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of stemmed versus stemless TSA in randomized controlled trials. We hypothesized that there would be no differences in Constant Score (CS), range of motion, or adverse events, such as periprosthetic fracture and/or revision surgery. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature was done using MEDLINE, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Registry of Controlled Trials, Embase, and Web of Science databases. Outcomes of interest included CS, range of motion, and adverse events (periprosthetic fracture and revision). Summary effect estimates of the mean difference between stemmed and stemless TSA for each outcome were estimated in random effects models. The search yielded 301 articles with 4 appropriate for qualitative analysis, including the results of 229 stemmed and 358 stemless TSAs. No significant difference was observed in postoperative CS (P = 0.36), forward flexion (P = 0.93), abduction (P = 0.30), or external rotation (P = 0.34) between stemmed and stemless TSA. No significant difference was observed in change in CS (P = 0.27), forward flexion (P = 0.25), or external rotation (P = 0.74). A change in abduction was significantly different between stemmed and stemless TSA (standardized mean difference = -0.64; 95% confidence interval, -1.20 to -0.08) in favor of stemmed TSA (P = 0.02), attributed to preoperative differences. No significant difference was observed in periprosthetic fractures (P = 0.07) or revision (P = 0.90). TSA with stemless versus stemmed humeral components was not associated with notable differences in functional and clinical outcomes. No difference was observed between stemmed and stemless designs in postoperative forward flexion, abduction, or external rotation. Similarly, there was no difference in change in forward flexion or external rotation. A markedly greater improvement in abduction was observed with stemmed TSA, likely due to the lower preoperative motion in the stemmed cohort in one of the studies. No differences were observed between stemmed and stemless designs in the rate of humeral fracture or risk of revision. Level II; systematic review and meta-analysis of prospective randomized controlled trials.

Intra-articular hyaluronic acid plus sorbitol injections for the management of severe glenohumeral osteoarthritis in a former female volleyball player

The glenohumeral joint is the third most common joint to be affected by osteoarthritis (OA). Practising volleyball can lead to shoulder arthritis due to repetitive mechanical stress on the shoulder joint. The first step of management of primary glenohumeral OA usually is the non-operative treatment, with intra-articular injections representing one of the most utilized treatments. The aim of this study is to report the outcomes of a series of three injections of hyaluronic acid (HA) plus sorbitol in a patient with severe glenohumeral OA. An 81-year-old female former volleyball player presented to our Rehabilitation Unit with more than 15 years history of shoulder pain and functional limitation. Since she refused to undergo surgery, we proposed her intra-articular injections of HA plus sorbitol. Outcome evaluation was made up to 12 months from the last injection by means of the Constant-Murley score and the Disability of the Arm, Shoulder and Hand questionnaire. Three injections of HA plus sorbitol for three weeks in a row in a patient with severe glenohumeral OA led to important improvements in pain reduction and better functionality at all follow-ups. Larger studies including more patients and with longer follow-ups are needed to confirm the consistency of these findings.

Humeral osteophyte size and clinical outcomes after anatomic total shoulder arthroplasty

BackgroundThe severity of primary glenohumeral osteoarthritis (PGOA) has been associated with advanced radiographic findings including inferior humeral head osteophytes. The primary objective of this study is to analyze for any correlation between the size of the inferior humeral head osteophyte and functional outcomes in patients undergoing anatomic total shoulder arthroplasty (TSA) for PGOA. MethodsA retrospective review of a multi-surgeon database was performed to identify all patients with PGOA from 2015 to 2019 with a minimum of two-year clinical follow-up. Preoperative anteroposterior and Grashey views were used for all included patients to obtain measurements of the inferior humeral osteophyte. Two groups at the extremes of osteophyte width were identified: 1) patients with absent or minimal osteophytes (lowest quartile of width, < 4.9 mm) and those with large osteophytes (highest quartile of width, > 10.1 mm). Change in active range of motion (ROM) from baseline, patient-reported outcomes (PROs), strength and complications were assessed at a minimum of 2 years postoperatively and compared between the two groups. ResultsDemographics were similar for the large osteophyte group (n = 57) and small osteophyte group (n = 56). There was a higher percentage of patients with more significant glenoid deformity in the large osteophyte group compared to the small osteophyte group (P = .009 for A1 deltoid). The large osteophyte group had significantly more restricted preoperative ROM for all measures (P < .05 for all). There were no significant differences in final ROM achieved between the two groups. Patients in the large osteophyte group had greater improvement from baseline for external rotation at the side (31° vs 21°, P = .015), external rotation at 90° abduction (38° vs 20°, P = .004), and internal rotation at 90° abduction (30° vs 12°, P < .001) compared to the small osteophyte group. Overall, there were very few differences between the small and large osteophyte groups in final PROs, with the exception of a higher American Shoulder and Elbow Surgeons score in the large osteophyte group (90.8 vs 85.9, P = .048). ConclusionPatients with large humeral osteophytes have significantly greater restrictions in preoperative ROM compared to patients with small osteophytes. Patients with large osteophytes experience greater improvements in rotational motion after anatomic TSA compared to patients with small osteophytes, although the final ROM achieved was similar between groups. Overall, PROs after anatomic TSA were similar between patients with small and large osteophytes preoperatively.

The association between anterior shoulder joint capsule thickening and glenoid deformity in primary glenohumeral osteoarthritis.

Anterior shoulder joint capsule thickening is typically present in osteoarthritic shoulders, but its association with specific patterns of glenoid wear is incompletely understood. We sought to determine the relationship between anterior capsular thickening and glenoid deformity in primary glenohumeral osteoarthritis. We retrospectively identified 134 consecutive osteoarthritic shoulders with magnetic resonance imaging and computed tomography scans performed. Axial fat-suppressed magnetic resonance imaging slices were used to quantify the anterior capsular thickness in millimeters, measured at its thickest point below the subscapularis muscle. Computed tomography scans were used to classify glenoid deformity according to the Walch classification, and an automated 3-dimensional software program provided values for glenoid retroversion and humeral head subluxation. Multinomial and linear regression models were used to characterize the association of anterior capsular thickening with Walch glenoid type, glenoid retroversion, and posterior humeral head subluxation while controlling for patient age and sex. The anterior capsule was thickest in glenoid types B2 (5.5mm, 95% confidence interval [CI]: 5.0-6.0) and B3 (6.1mm, 95% CI: 5.6-6.6) and thinnest in A1 (3.7mm, 95% CI: 3.3-4.2; P<.001). Adjusted for age and sex, glenoid types B2 (odds ratio: 4.4, 95% CI: 2.3-8.4, P<.001) and B3 (odds ratio: 5.4, 95% CI: 2.8-10.4, P<.001) showed the strongest association with increased anterior capsule thickness, compared to glenoid type A1. Increased capsular thickness correlated with greater glenoid retroversion (r=0.57; P<.001) and posterior humeral head subluxation (r=0.50; P<.001). In multivariable analysis, for every 1-mm increase in anterior capsular thickening, there was an adjusted mean increase of 3.2° (95% CI: 2.4-4.1) in glenoid retroversion and a 3.8% (95% CI: 2.7-5.0) increase in posterior humeral head subluxation. Increased thickening of the anterior shoulder capsule is associated with greater posterior glenoid wear and humeral head subluxation. Additional research should determine whether anterior capsular disease plays a causative role in the etiology or progression of eccentric glenohumeral osteoarthritis.

Is there a correlation between humeral osteoarthritis and glenoid morphology according to Walch?

AimsThe aim of this study was to determine whether there is a correlation between the grade of humeral osteoarthritis (OA) and the severity of glenoid morphology according to Walch. We hypothesized that there would be a correlation.MethodsOveral, 143 shoulders in 135 patients (73 females, 62 males) undergoing shoulder arthroplasty surgery for primary glenohumeral OA were included consecutively. Mean age was 69.3 years (47 to 85). Humeral head (HH), osteophyte length (OL), and morphology (transverse decentering of the apex, transverse, or coronal asphericity) on radiographs were correlated to the glenoid morphology according to Walch (A1, A2, B1, B2, B3), glenoid retroversion, and humeral subluxation on CT images.ResultsIncreased humeral OL correlated with a higher grade of glenoid morphology (A1-A2-B1-B2-B3) according to Walch (r = 0.672; p < 0.0001). It also correlated with glenoid retroversion (r = 0.707; p < 0.0001), and posterior humeral subluxation (r = 0.452; p < 0.0001). A higher humeral OL (odds ratio (OR) 1.17; 95% confidence interval (CI) 1.03 to 1.32; p = 0.013), posterior humeral subluxation (OR 1.11; 95% CI 1.01 to 1.22; p = 0.031), and glenoid retroversion (OR 1.48; 95% CI 1.30 to 1.68; p < 0.001) were independent factors for a higher glenoid morphology. More specifically, a humeral OL of ≥ 13 mm was indicative of eccentric glenoid types B2 and B3 (OR 14.20; 95% CI 5.96 to 33.85). Presence of an aspherical HH in the coronal plane was suggestive of glenoid types B2 and B3 (OR 3.34; 95% CI 1.67 to 6.68).ConclusionThe criteria of humeral OL and HH morphology are associated with increasing glenoid retroversion, posterior humeral subluxation, and eccentric glenoid wear. Therefore, humeral radiological parameters might hint at the morphology on the glenoid side.Cite this article: Bone Jt Open 2022;3(6):463–469.

Anatomic vs. reverse shoulder arthroplasty for glenohumeral osteoarthritis with intact rotator cuff: a retrospective comparison of patient-reported outcomes using the systems outcomes database with up to 5-year follow-up

BackgroundThe growing enthusiasm for the use of reverse shoulder arthroplasty (RSA) in the treatment of primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff is based on data derived from single-center studies with limited generalizability and follow-up. This study compared patient-reported outcomes (PROs) between RSA and total shoulder arthroplasty (TSA) for the treatment of primary GHOA with up to 5-year follow-up and examined temporal trends in the treatment of GHOA between 2012 and 2021. MethodsA retrospective review was performed on patients with primary GHOA undergoing primary arthroplasty surgery from the Surgical Outcomes System global registry between 2012 and 2021. PROs including the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and visual analog scale (VAS) for pain were compared between RSA and TSA at 1, 2, and 5 years postoperatively. ResultsA total of 4451 patients were included, with 2693 (60.5%) undergoing TSA and 1758 (39.5%) undergoing RSA. Both RSA and TSA provided clinically excellent outcomes at 1 year postoperatively (ASES: 80.8 ± 17.9 vs. 85.9 ± 15.2, respectively; SANE: 74.8 ± 24.7 vs. 79.5 ± 22.9; VAS pain: 1.3 ± 2.0 vs. 1.1 ± 1.7; all P < .05) that were maintained at 2 years (ASES: 81.3 ± 19.3 vs. 87.3 ± 14.9; SANE: 74.8 ± 26.2 vs. 79.7 ± 24.7; VAS pain: 1.3 ± 2.1 vs. 1.0 ± 1.6; all P < .05) and 5 years (ASES: 81.7 ± 16.5 vs. 86.9 ± 15.3; SANE: 71.6 ± 28.5 vs. 78.2 ± 25.9; VAS pain: 1.0 ± 1.7 vs. 1.0 ± 1.7; all P < .05), with statistical significance favoring TSA. After controlling for age and sex, there was an adjusted difference of 4.5 units in the ASES score favoring TSA (P = .005) at 5 years postoperatively but no differences in adjusted SANE (P = .745) and VAS pain (P = .332) scores. The use of RSA for GHOA grew considerably over time, from representing only 17% of all replacements performed for GHOA in 2012 to nearly half (47%) in 2021 (P < .001). ConclusionRSA as a treatment for GHOA with an intact rotator cuff seems to yield PROs that are largely clinically equivalent to TSA extending to 5 years postoperatively. The observed statistical significance favoring TSA appears to be of marginal clinical benefit based on established minimal clinically important differences and may be a result of the large sample size. Further research using more granular clinical data and examining differences in range of motion and complications is warranted as it may change the value analysis.

The recovery curve of anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis: midterm results at a minimum of 5 years.

BackgroundExcellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA.MethodsPatients who underwent primary anatomic TSA over 5 years ago were included: Short-Form 12 Physical Component Summary, American Shoulder and Elbow Surgeons scores, Quick Disabilities of the Arm Shoulder and Hand Score, Single Assessment Numeric Evaluation, and patient satisfaction were assessed. Linear mixed-effects models were used to model progression in PROs longitudinally. Unadjusted models and models controlling for sex and age were constructed.ResultsEighty-one patients (91 shoulders) were included. Significant improvements from the preoperative period to 1 year postoperatively in the median American Shoulder and Elbow Surgeons (48 to 93; P < .001), Quick Disabilities of the Arm Shoulder and Hand Score (42 to 11; P < .001), Single Assessment Numeric Evaluation (50 to 91; P < .001), and Short-Form 12 Physical Component Summary (35 to 53; P = .004) scores were noted. No significant decrease was observed for any of the outcome scores. Median satisfaction at the final follow-up was 10 out of 10. At 1, 2, 3, 4, 5, 6, and 7 years postoperatively, 77%, 64%, 79%, 57%, 86%, 56%, and 78% of patients, respectively, reported sports participation equal to or slightly below preinjury level. There was no association between the glenoid morphology and functional outcomes.ConclusionPatients undergoing anatomic TSA for primary GHOA showed excellent improvement in PROs and satisfaction in the first year, and these results were maintained postoperatively for a minimum of 5 years. Age- and sex-adjusted models or glenoid morphology did not substantially alter any trends in PROs postoperatively.