Reverse Shoulder Arthroplasty Research Articles

Efficacy of arthroscopic assisted lower trapezius tendon transfer versus reverse shoulder arthroplasty in patients with posterosuperior irreparable rotator cuff tear without arthritis: retrospective propensity score matching study.

Shoulder dysfunction, including loss of active forward elevation (FE) and external rotation (ER), is challenging in posterosuperior irreparable rotator cuff tears (PSIRCTs). We compared the clinical outcomes of reverse shoulder arthroplasty (RSA) and arthroscopy-assisted lower trapezius tendon transfer (aLTT) in PSIRCTs patients without arthritis. Approximately 29 patients were included in each group (RSA group and aLTT group), using retrospective propensity score matching based on demographic variables with a minimum 2-year follow-up period. Clinical results were compared with the visual analogue scale score, Constant shoulder score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and activities of daily living requiring active external rotation (ADLER) score, active range of motion and rotational strength between the two groups. Subsequently, the arthritic change of shoulder joint was evaluated using the acromiohumeral distance (AHD) and Hamada grade. The clinical outcomes were significantly improved in both groups. However, ADLER score (20.6 ± 4.0 vs. 27.3 ± 3.7, p < .001), ER at 0° of abduction (34.2 ± 13.2 vs. 47.5 ± 11.1, p < .001), ER at 90° of abduction (49.6 ± 15.4 vs. 66.5 ± 19.5, p < .001) and ER strength (16.4 ± 4.0 vs. 24.1 ± 9.1, p < .001) of aLTT group were significantly better than that of RSA group. No significant increase of AHD and no significant progression of arthritis change were observed in aLTT group. Although both RSA and aLLT improved overall patient outcomes postoperatively, aLTT was superior in clinical scores, notably the ADLER score, active ER, and ER strength in PSIRCTs patients without arthritis. These findings suggest that aLTT could be a first-line joint-preserving treatment option for PSIRCTs patients without arthritis, given the longevity and related complications associated with arthroplasty. III.

Improving outcomes in shoulder arthroplasty: A case series on the GPS-navigated bulk humeral autograft technique.

The purpose of this case series is to evaluate the efficacy and safety of the GPS-navigated humeral head (HH) autograft technique in the setting of primary reverse total shoulder arthroplasty (rTSA) for severe glenoid bone loss. A database of prospectively enrolled patients was reviewed to identify patients who underwent GPS navigated primary rTSA with HH autograft (N = 8). Variables collected pre-operatively and at last follow up included demographics, active range of motion (ROM), patient reported outcome measures radiographic measures, complications, and revisions. Mean age was 59.5 (range: 45-80), mean BMI was 26.8 (range: 18-37) and 5 patients were male. At final follow up (median: 24 months), patients had a mean increase in forward flexion of 44 (p = 0.003), external rotation of 27 (p = 0.039), internal rotation score of 1.1 (p = 0.048), global function score of 4.8 (p < 0.001), American Shoulder and Elbow Surgeons score of 44 (p < 0.001), and decrease in visual analog scale pain of 5 (p < 0.001). Two patients had evidence of glenoid component loosening at 3 years post-operatively, however only one was symptomatic requiring a revision operation. Our findings demonstrate significant improvement in ROM, pain relief, and shoulder function following GPS-navigated primary rTSA with bulk HH autograft. IV.

Discharge with home health services following primary total shoulder arthroplasty does not adversely affect 90-day ED visits or readmissions.

Discharging patients with the addition of home health services (HHS) has been postulated to reduce the risk for perioperative complications and, thereby, 90-day ED visits and readmissions following elective total shoulder arthroplasty (TSA). A retrospective review of primary anatomic (aTSA) and reverse shoulder arthroplasty (rTSA) cases from January 2016 through April 2024 was performed. Demographic data, including age, marital status, body mass index (BMI), smoking status, self-identified race, Area Deprivation Index (ADI) score, modified 5-item fragility index (mFI-5), and surgical indication was collected. Discharge with or without HHS, and whether a patient had access to a postoperative home health aide (HHA), were also recorded. Regression analysis was utilized to determine the association between discharge with HHS and both postoperative 90-day ED return and readmission. There were 327 patients included, including 161 (49%) aTSA and 166 (51%) rTSA. A total of 121 (37%) patients were discharged with HHS, of which 49 (40%) also had access to a HHA during the postoperative period. There was no significant difference in patients who were discharged with HHS compared with those who were discharged without HHS with regards to either 90-day return to the ED (OR 1.15, 95% CI 0.58-2.30, P = 0.692) or all-cause unplanned 90-day readmissions (OR 0.79, 95% CI 0.29-2.19, P = 0.652). Discharge with HHS following elective TSA, even in the setting of increased patient age and fragility, results in similar 90-day postoperative healthcare utilization compared with those discharged to self-care. Level III (Retrospective cohort).

The Effect of Socioeconomic Status and Social Deprivation on Outcomes Following Reverse Shoulder Arthroplasty: Data From an Urban Academic Center.

Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis pose notable financial and symptomatic burdens on the aging population. This study aims to determine how social determinants of health affect patient-reported outcomes following reverse total shoulder arthroplasty (rTSA), the surgical treatment for cuff tear arthropathy and glenohumeral osteoarthritis. A single-center retrospective review was conducted for patients who underwent rTSA between 2017 and 2022. Zip codes were used to determine income levels, as defined by the U.S. Department of Housing and Urban Development (HUD) and the Federal Reserve (FED). Social disadvantage was quantified using Social Deprivation Index (SDI). The American Shoulder and Elbow Score (ASES) was obtained by chart review or calls at a minimum 2-year follow-up. Statistical analysis was notable done using analysis of variance, Kruskal-Wallis, and Pearson chi-square tests. A total of 121 patients met inclusion criteria. Of those included, 101 patients (83%) had 2-year ASES scores. Patients were divided into three cohorts based on HUD income status, FED income status, and SDI score. A difference was observed in 2-year ASES scores when stratified by HUD subgroups (P = 0.011); however, no difference was observed in 2-year ASES scores between FED or SDI subgroups. Analysis yielded no differences in pain scores, range of motion, total length of hospital stay, complications, or revision rates between all subgroups (all, P > 0.05). The results of this study yielded no notable difference in postoperative ASES scores between FED classes or SDI subgroups. Although a difference was observed in ASES scores between HUD classes, it may be clinically negligible. Contrary to previous literature, socioeconomic status and social deprivation did not affect postoperative outcomes within our patient population. Social determinants of health did not affect outcomes of patients undergoing a rTSA within the first 2 years after surgery. III.

Evaluation and Management of Rotator Cuff Tears Following Shoulder Dislocation.

This review aims to summarize the epidemiology, associated pathology, and treatment options for rotator cuff tears following shoulder dislocations and to provide a treatment algorithm for these complex injuries. Rotator cuff tears after shoulder dislocations most often occur in patients older than 40 and may be more prevalent in women. Up to 50% of these patients may have concomitant Bankart lesions. Patients treated nonoperatively generally have worse functional outcomes and higher pain scores than those who undergo rotator cuff repair. However, further studies are needed to elucidate when the rotator cuff can be repaired in isolation versus in combination with capsulolabral stabilization. Reverse total shoulder arthroplasty is a viable treatment option for elderly patients with irreparable cuff tears after dislocation or post-instability arthropathy. Patients who sustain a shoulder dislocation should be evaluated for a rotator cuff tear, particularly if older than 40. Those with post-instability full-thickness rotator cuff tears benefit from surgical treatment. Further research is needed to clarify when additional stabilization procedures should be performed alongside rotator cuff repair.

Functional Outcomes of Patients With Proximal Humerus Fractures Treated With Primary Versus Salvage Reverse Shoulder Arthroplasty: A Cohort Study of 41 Patients

Functional Outcomes of Patients With Proximal Humerus Fractures Treated With Primary Versus Salvage Reverse Shoulder Arthroplasty: A Cohort Study of 41 Patients

Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System).

Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System).

Acromion and Scapular Spine Fractures in Reverse Total Shoulder Arthroplasty An XFEM Study.

Acromion and Scapular Spine Fractures in Reverse Total Shoulder Arthroplasty An XFEM Study.

Treatment of B2 type glenoids with anatomic vs. reverse total shoulder arthroplasty: a retrospective review.

Treatment of B2 type glenoids with anatomic vs. reverse total shoulder arthroplasty: a retrospective review.

Stemless reverse total shoulder arthroplasty: a systematic review and meta-analysis.

Stemless reverse total shoulder arthroplasty: a systematic review and meta-analysis.

Pullout strength of screws used for baseplate fixation in reverse shoulder arthroplasty: A cadaveric study

Pullout strength of screws used for baseplate fixation in reverse shoulder arthroplasty: A cadaveric study

Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

Lower Socioeconomic Status is not Associated with Worse 2-year Outcomes Following Reverse Total Shoulder Arthroplasty

Lower Socioeconomic Status is not Associated with Worse 2-year Outcomes Following Reverse Total Shoulder Arthroplasty

A Novel Percutaneous Device Enabling both Local Anesthetic Delivery and Electrical Stimulation (Neuromodulation) of Peripheral Nerves for Pain Following Orthopaedic Surgery: An Initial Feasibility Technical Report

Introduction Pain following orthopaedic surgical procedures remains undertreated due to inadequate analgesic options. One possible solution is a novel device currently under investigation. The RELAY system (Gate Science, Moultonborough, NH) is comprised of a basic catheter-over-needle device to allow ultrasound-guided percutaneous insertion, leaving a perineural catheter after simple withdrawal of the internal needle. A single-injection bolus of local anesthetic may be quickly administered. Following surgery, the catheter may be attached to a portable infusion pump to provide an ambulatory continuous peripheral nerve block. Unlike previously described perineural catheters, the RELAY has an embedded wire and integrated pulse generator that permit stimulation of the targeted peripheral nerve(s) for up to 28 days. We here provide the first description of this novel device when used to provide postoperative analgesia. Case Report A 67-year-old woman undergoing unilateral (right), primary reverse total shoulder arthroplasty provided written, informed consent and had a RELAY inserted under ultrasound guidance with a single pass. A single-injection nerve block was induced with lidocaine 2% (10 mL) and bupivacaine 0.5% (10 mL), both with epinephrine. A ropivacaine 0.2% infusion was initiated with a portable infusion pump via the catheter. Following surgery, the patient reported no surgical pain and her pulse stimulator initiated with a current of 2.2 mA. She was discharged home with the device in situ. Postoperative day (POD) 1 her maximum and average pain measured with a numeric rating scale (NRS) were 3 and 1. During her ropivacaine infusion her worst and average pain scores were 1 and 0, respectively. Following POD 4 (ropivacaine reservoir exhaustion on POD 3) she experienced no pain with active stimulation. The catheter/lead was removed at home by her caretaker without difficulty on POD 7. Conclusions This new device represents a feasible intervention for postoperative pain management in ambulatory settings and further investigation is warranted.

Proximal humerus fractures: Treatment controversies.

The treatment of proximal humerus fractures is challenging, and significant controversy exists even regarding which patients are indicated for surgical treatment. When surgery is indicated, open reduction and internal fixation is the most common type of treatment. Arthroplasty is reserved for unreconstructible fractures. Hemiarthroplasty may not provide good, reliable function but may be the best option in younger or middle-aged patients when fracture fixation is not feasible. While several studies reported no benefit of surgical treatment in elderly patients, more recent literature showed better outcomes with reverse total shoulder arthroplasty.

Revision reverse shoulder arthroplasty: Current concepts for the glenoid

Revision reverse shoulder arthroplasty: Current concepts for the glenoid

Anatomic versus reverse shoulder replacement: Are we asking the right questions and what are the answers?

Anatomic versus reverse shoulder replacement: Are we asking the right questions and what are the answers?

Mistakes and Complications in Reverse Shoulder Arthroplasty

Background. In recent decades, the number of reverse shoulder arthroplasties has increased significantly, and the number and diversification of complications has also increased. Objective. This study aims to analyze the structure and nature of mistakes and complications that occur during reverse shoulder arthroplasty. Materials and Methods. We observed 21 patients (20 males and 1 female) aged 36 to 81 years (mean age 54.61 ± 11.89 years) who underwent reverse shoulder arthroplasty. Among them, 16 cases of complications and 5 mistakes were identified. Results. In 2 patients, strategic mistakes led to the development of complications. The complications were diverse. The most common was prosthesis dislocation (5 cases, 23.8% of the total number of complications and mistakes). Purulent-necrotic complications were observed in 4 patients (19%), aseptic instability of the prosthesis components occurred in 3 patients (14.3%), acromion stress fractures due to overload were noted in 2 patients (9.5%), and secondary adhesive capsulitis with severe adduction and internal rotation contractures was observed in 2 patients (9.5%). Conclusions. The most common complications following reverse shoulder arthroplasty were prosthesis dislocation and purulent-necrotic complications. The main causes of dislocation were uncompensated shortening of the humerus and significant medialization and, in some cases, inclination of the prosthesis head. A strategic mistake in reverse shoulder arthroplasty is performing the procedure in patients with total traumatic injury to the deltoid muscle or irreparable damage to the axillary nerve (n. axillaris). An important tactical mistake is neglecting, when possible, the complete restoration of the rotator cuff, which significantly reduces flexion and rotational movements in the shoulder joint.

Comprehensive Survival Analysis of Reverse Shoulder Arthroplasty: Do Gender, Age, and Surgical Indication Influence Prosthesis Survivorship?

Comprehensive Survival Analysis of Reverse Shoulder Arthroplasty: Do Gender, Age, and Surgical Indication Influence Prosthesis Survivorship?

Proximal humerus fracture: old and new, established and doubtful, conservative and operative aspects

Proximal humeral fractures are not only frequent injuries but also serve as an important indicator for a possibly underlying osteoporosis. Therefore, in addition to fracture management, timely diagnostics and treatment of the osteoporosis should also be prioritized. The decision between a conservative and surgical treatment approach requires adifferentiated consideration of the fracture morphology, individual patient characteristics and functional expectations. Conservative treatment can be an adequate alternative in specific cases, particularly in geriatric patients with low functional demands; however, the standardization of this treatment approach remains challenging. Surgical interventions have proven effective, especially for complex fractures, with reverse shoulder arthroplasty emerging as areliable option. Various augmentation and fixation techniques, such as the combination of locking plates with fibular grafts or double plating osteosynthesis, demonstrate biomechanical advantages and can improve the primary stability. Innovative technologies, including 3D planning, intraoperative navigation and robotics, offer new possibilities for optimizing implant placement and can contribute to improvement of long-term clinical outcomes. Economic analyses suggest that reverse arthroplasty can provide not only clinical benefits in selected cases but can also be cost-effective; however, further evaluation of the long-term impact on the healthcare system is required.