Severe Rotator Cuff Deficiency Research Articles

Concomitant latissimus dorsi tendon transfer during reverse total shoulder arthroplasty does not improve active external rotation or clinical outcomes in patients with external rotation deficit.

To assess the role of latissimus dorsi tendon transfer (LDT) concomitant with reverse total shoulder arthroplasty in patients with external rotation (ER) deficit secondary to severe rotator cuff deficiency with and without glenohumeral arthritis. Patients with a positive external lag sign and <10° of active external rotation (aER) treated with reverse shoulder arthroplasty at a single institution with a minimum 12-month follow-up were retrospectively identified from a prospective database. Basic demographic information along with preoperative and postoperative range of motion (ROM) measures, American Shoulder and Elbow Surgeons score (ASES), Visual Analog Scale (VAS) pain, and Subjective Shoulder Value scores were obtained. Statistical analysis was performed to compare ROM and functional outcomes between patients who underwent concomitant LDT and those with no transfer (NT). The LDT (n=31) and NT (n=33) groups had similar age, sex distributions, and follow-up length average (24 vs. 30months). No differences were found between groups at baseline, final follow-up, or magnitude of change for ASES, VAS pain, and Subjective Shoulder Value scores. Baseline ROM measures were similar, except for the LDT group having slightly less aER (-8° vs. 0°; P=.004). In addition, all postoperative ROM measures including aER were similar, except for a slight improvement in active internal rotation in the NT group. The majority of patients were satisfied with their outcome (LDT 84% (n=26); NT 87% (n=27); P=.72). Patients with ER deficit secondary to severe rotator cuff deficiency with and without glenohumeral arthritis undergoing reverse total shoulder arthroplasty do not have significantly improved ER or patient-reported outcome measures with LDT.

The evaluation of reverse shoulder lateralization on deltoid forces and scapular fracture risk: A computational study

Reverse shoulder arthroplasty (RSA) can treat severe rotator cuff deficiency, but its medialized design of the shoulder's center of rotation (CoR) has been associated with scapular notching. Although lateralization of CoR provides a larger impingement-free range of motion, the changes in component positioning alter the biomechanics and may cause unforeseen complications. This work quantified the muscle forces and predicted the scapula fracture risk by coupling dynamic simulation analysis with finite element modeling. To identify bone failure patterns, the results were analyzed using three common failure measures. A parametric study showed greater lateralization produced higher strain/stress concentrations in the scapular spine (Levy Region Type II), with approximately a 10% increase for the 12 ​mm lateralized scenario, compared to a neutral configuration. Significant differences in fracture risk patterns were found between the maximum principal stress/strain results and the von Mises stress results. The lateralized configurations could increase the muscle and joint reaction forces during abduction and induce scapular fracture. Studying the effects of RSA lateralization on scapular fracture risk can help guide the continued optimization of RSA performance and surgical techniques. The findings of relationships between the loading style and bone failure measures can provide valuable insight into the investigation of bone failure criteria.

Feasibility of image-based augmented reality guidance of total shoulder arthroplasty using microsoft HoloLens 1

ABSTRACT Total Shoulder Arthroplasty (TSA) is a shoulder replacement procedure to treat severe rotator cuff deficiency, primarily caused by osteoarthritis in elderly patients. One of the critical factors in reducing postoperative complications is accurate drilling of a centring hole on the glenoid surface at a precise position and orientation. While the drilling path is planned pre-operatively on 3D diagnostic images, the absence of visual guidance during surgery can lead to low reproducibility. In this paper, we present the design and feasibility analysis of a marker-less image-based registration pipeline using the Microsoft HoloLens 1 and its built-in sensors to guide glenoid drilling during TSA. Our solution intra-operatively registers the pre-operative 3D scan to the exposed glenoid surface both with and without occlusion. Our results provide a breakdown of the sources contributing to registration error. In addition to the commonly discussed errors (SLAM-based head tracking, partial overlap etc.), we find that the poor performance of the depth sensing camera becomes a major source of error. We further find that partial overlap between the source and target remains a large concern for registration in high occlusion scenarios. This work begins to characterise the depth sensor error and suggests future work towards image-based augmented reality guidance.

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.

Are the Current Size Options of Glenoid Baseplates for Reverse Shoulder Arthroplasty Sufficient for our Local Population?: 現有反置式人工肩關節置換術中盂底板組件的大小選項是否滿足我們本地人口的需要？

Background/PurposeReverse shoulder arthroplasty (RSA) is an effective treatment for patients who suffer from shoulder pain and dysfunction associated with a variety of shoulder pathologies including severe rotator cuff deficiency with or without glenohumeral arthritis. It has been widely used in European countries and the United States and is now gaining popularity in Asia, including Hong Kong. However, there are only limited size options available for glenoid baseplates, with 25 mm being the smallest size in some commonly used systems. The aim of our study is to perform computerized tomography (CT) measurements of the glenoid dimension in the Chinese population and to see if the current glenoid baseplate component size option is sufficient for our local population. MethodsA total of 70 CT scans of shoulder regions were analysed. Measurements included maximum superoinferior height and the anteroposterior height. ResultsThe glenoid dimensions were smaller compared to those from previous studies in Caucasian counterparts. Some 41% of female glenoids had widths measuring < 25 mm (25 mm being the smallest size available in some commonly used RSA systems). ConclusionAlthough there are only limited size options available for the glenoid baseplate in RSA, from our data, it should be able to cover most patients in our local population. However, surgeons should exercise special care when contemplating performing reverse shoulder replacement for small size females in our local population.

Early results after modular non-cemented reverse total shoulder arthroplasty: a prospective single-centre study of 38 consecutive cases

BackgroundThis study evaluated the outcome of a third generation modular non-cemented reverse total shoulder arthroplasty (RTSA) in incongruent glenohumeral degeneration with severe rotator cuff deficiency. Materials and methodsThirty-eight consecutive RTSA with a mean age of 72years (range 58-89 years) were prospectively enrolled. Mean follow-up was 24months (range 21-29 months). Pain and standardized clinical functional scores were monitored. Radiographic and MRI findings have been scored and correlated to clinical outcome and complication rate. ResultsPreoperative pain decreased significantly from VAS 8 to 2 at 24months postop., as ROM improved significantly, by at least doubling preoperative values of elevation, abduction, and external rotation. Nevertheless, internal rotation languished. The preoperative median constant was 18 points and 70 points 24months postop. (p<0.001). Initial median DASH was 95 vs. 50 2years after surgery (p<0.001). Median prospective ASES was 23 (IQR 8-33) vs. 70 points (p<0.001) at final follow-up. Each outcome measurement improved significantly at 6, 12, and 24months follow-up. There was no significant correlation between pre-operative radiographic findings of osseous and/or soft-tissue degeneration and short-term clinical outcome and/or complication rate (13 %). At final follow-up, 54 % showed radiographic signs of inferior scapular notching. There was no revision and/or loosening observed. ConclusionRSTA with this modular system results in significant pain relief and improvement of functional clinical outcomes. However, longevity of the device is currently unknown.

Elucidating Trends in Revision Reverse Total Shoulder Arthroplasty: A Retrieval Study Evaluating Clinical, Radiographic, and Functional Outcomes Data

Since obtaining FDA approval in 2004, reverse total shoulder arthroplasty (RTSA) has become an accepted surgical treatment for patients with severe rotator cuff deficiency. This study seeks to explore relationships between damage modes in explanted RTSA components, potential patient and radiographic risk factors, and functional data, in order to elucidate trends in RTSA failure.

Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up

Most studies of reverse total shoulder arthroplasty (RTSA) involve cemented humeral stems. To our knowledge, this is the first study to compare the results of cementless RTSA, using a porous-coated stem designed for uncemented fixation, with cemented RTSA. A prospective database of patients undergoing RTSA was retrospectively reviewed for patients with a diagnosis of cuff tear arthropathy or severe rotator cuff deficiency with minimum 2-year follow-up. Of these, 37 patients had cemented RTSA and 64 patients had cementless RTSA. Outcome measures included Constant-Murley scores, American Shoulder and Elbow Surgeons scores, visual analog pain scale scores, range of motion, patient satisfaction, and radiographic evidence of complication. Compared with preoperative values, both cohorts demonstrated significant improvements (P<.01) in all functional scores, active forward elevation, and active internal rotation. There was no significant difference (P>.05) in comparing the changes in these values after surgery between the cemented and cementless cohorts. On radiographic evaluation, there was no evidence of loosening or humeral components "at risk" of loosening in either group. There was no significant difference (P=1.0) in the incidence of humeral component radiolucent lines between the cemented and uncemented cohorts. There was no significant difference (P=.30) in the incidence of scapular notching between the cemented (n=8) and uncemented (n=10) cohorts. Cementless fixation of a porous-coated RTSA humeral stem provides clinical and radiographic outcomes equivalent to those of cemented stems at minimum 2-year follow-up. With advantages such as simplified operative technique, no cement-related complications, greater ease of revision, and long-lasting biologic fixation, uncemented fixation may provide several benefits over cemented fixation.

Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty

Reverse shoulder arthroplasty is being used with greater frequency for patients with severe rotator cuff deficiency. There are several commercially available reverse shoulder devices, each with different glenosphere options. The purpose of this study was to determine: (1) forces at the baseplate-bone interface in glenospheres with centers of rotation located concentrically and eccentrically to the center of the baseplate; and (2) if baseplate-bone forces can be optimized by altering tilt of the baseplate. A validated computer model was used to compare concentric glenospheres with neutral offset to eccentrically offset glenospheres (6 mm inferior or 6 mm lateral) in 3 baseplate tilts: 15° inferior, neutral, or 15° superior. A baseplate, simulated bone, screws, and humeral component were modeled, and forces underneath the baseplate were calculated as the arm was abducted through 90° of glenohumeral motion. For lateral and concentric glenospheres, inferior tilt provides the most even distribution of forces (mean difference in force between superior and inferior portions of baseplate: 11.3 N and 24.7 N, respectively) and superior tilt provides the most uneven distribution of forces (109.3 N and 78.7 N, respectively). For inferior eccentric glenospheres, inferior tilt provides the most uneven distribution of forces (58.7 N) and neutral tilt provides the most even distribution of forces (27.7 N). This is the first study to investigate force distribution under the baseplate in inferior eccentric glenospheres. Although inferior tilting of the baseplate is recommended for concentric and laterally offset glenospheres, this same recommendation may be detrimental to inferiorly offset glenospheres and warrants further investigation.

Reverse total shoulder arthroplasty improves function in cuff tear arthropathy.

Early failure due to glenoid loosening with anatomic total shoulder arthroplasty in patients with severe rotator cuff deficiency led to the development of the reverse ball-and-socket shoulder prosthesis. The literature reports improved short-term pain and function scores following modern reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy (CTA). We therefore sought to confirm previously reported short-term improvements in pain, function scores, and range of motion, in patients treated with RTSA for CTA and to identify clinical complications and radiographic notching. We retrospectively reviewed 67 patients who underwent 71 primary RTSAs for CTA. The average age was 74 years (range, 54-92 years). All were preoperatively and postoperatively assessed using Constant-Murley and American Shoulder and Elbow Society (ASES) scores. We identified complications and examined radiographs for notching. The minimum followup was 12 months (average, 24 months; range, 12-58 months). Average Constant-Murley scores improved from 28 preoperatively to 62 postoperatively. Average ASES scores improved from 26 to 76. Subjective Shoulder Value (SSV) improved from 23 to 77. Active forward flexion improved from 61° preoperatively (range, 0°-137°) to 121° postoperatively (range, 52°-170°). Active external rotation was not affected. Thirty-five of the 71 shoulders (49%) showed radiographic notching. The overall complication rate was 23%. No patient required reoperation. One patient required closed reduction of a perioperative dislocation. RTSA for CTA results in functional improvement, with a low complication rate. However, the longevity of the device is currently unknown. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Reverse Shoulder Arthroplasty for the Treatment of Rotator Cuff Deficiency

Early designs of reverse shoulder arthroplasty components for the treatment of glenohumeral arthritis associated with severe rotator cuff deficiency in some cases have been associated with mechanical failure. The purpose of this study was to perform a prospective outcomes study of reverse shoulder arthroplasty performed with use of 5.0-mm peripheral locking screws for baseplate fixation and a lateralized center of rotation for the treatment of a rotator cuff deficiency. From February 2004 to March 2005, 112 patients (114 shoulders) were treated with a reverse shoulder arthroplasty as part of a United States Food and Drug Administration Investigational Device Exemption study. Ninety-four patients (ninety-six shoulders) were available for a minimum follow-up of two years. Of the ninety-six shoulders, thirty-seven had a primary rotator cuff deficiency, thirty-three had a previous rotator cuff operation, twenty-three had a previous arthroplasty, and three had a proximal humeral nonunion. The patients were prospectively followed clinically (the American Shoulder and Elbow Surgeons [ASES] score, the Simple Shoulder Test [SST], and self-reported satisfaction) and radiographically (mechanical failure, loosening, and notching). Patients were videotaped while performing a standard active range-of-motion protocol before and after treatment. These videos were then analyzed in a blinded fashion by three independent observers using a digital goniometer. At two years, the average total ASES scores had improved from 30 preoperatively to 77.6; the average ASES pain scores, from 15 to 41.6; and the average SST scores, from 1.8 to 6.8 (p < 0.0001 for all). Blinded analysis of range of motion showed that average abduction improved from 61 degrees preoperatively to 109.5 degrees (p < 0.0001); average flexion, from 63.5 degrees to 118 degrees (p < 0.0001); and average external rotation, from 13.4 degrees to 28.2 degrees (p < 0.0001). The patients rated the outcome as excellent in fifty-three shoulders (55%), good in twenty-six (27%), satisfactory in eleven (12%), and unsatisfactory in six (6%). There was no evidence of mechanical failure of the baseplate or scapular notching in any of the patients. Six of the ninety-four patients in this study had a complication. Recent advances in reverse shoulder arthroplasty have allowed for improvement in patient outcomes while minimizing early mechanical failure and scapular notching and decreasing the overall complication rate at short-term follow-up.

A Shoulder Hemiarthroplasty with a Tendon Muscle Transfer for Glenohumeral Arthritis associated with Severe Rotator Cuff Deficiency

A Shoulder Hemiarthroplasty with a Tendon Muscle Transfer for Glenohumeral Arthritis associated with Severe Rotator Cuff Deficiency

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Objective: To assess the short-term clinical and radiographic outcomes of the reverse total shoulder arthroplasty. Methods: After FDA approval of the reverse total shoulder arthroplasty (TSA) in 2004, a consecutive series of the first sixty-two patients treated with this prosthesis by a single surgeon was prospectively initiated through an IRB-approved protocol. All patients presented with signs and symptoms of painful glenohumeral arthritis combined with severe rotator cuff deficiency, anterosuperior shoulder instability, and/or a painful, dysfunctional failed shoulder arthroplasty.

Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency

We report the use of the reverse shoulder prosthesis in the revision of a failed shoulder hemiarthroplasty in 19 shoulders in 18 patients (7 men, 11 women) with severe pain and loss of function. The primary procedure had been undertaken for glenohumeral arthritis associated with severe rotator cuff deficiency. Statistically significant improvements were seen in pain and functional outcome. After a mean follow-up of 44 months (24 to 89), mean forward flexion improved by 26.4 degrees and mean abduction improved by 35 degrees . There were six prosthesis-related complications in six shoulders (32%), five of which had severe bone loss of the glenoid, proximal humerus or both. Three shoulders (16%) had non-prosthesis related complications. The use of the reverse shoulder prosthesis provides improvement in pain and function for patients with failure of a hemiarthroplasty for glenohumeral arthritis and rotator cuff deficiency. However, high rates of complications were associated with glenoid and proximal humeral bone loss.

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency

Patients who have pain and dysfunction from glenohumeral arthritis associated with severe rotator cuff deficiency have few treatment options. The goal of this study was to retrospectively evaluate the short-term results of arthroplasty with use of the Reverse Shoulder Prosthesis in the management of this problem. We report the results for sixty patients (sixty shoulders) with a rotator cuff deficiency and glenohumeral arthritis who were followed for a minimum of two years. Thirty-five patients had no previous shoulder surgery, whereas twenty-three had had either an open or arthroscopic rotator cuff repair, one had had a subacromial decompression, and one had had a biceps tendon repair. All patients were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons scoring system for pain and function and with visual analog scales for pain and function. They were also asked to rate their satisfaction with the outcome. The shoulder range of motion was measured preoperatively and postoperatively. The average age of the patients was seventy-one years. The average duration of follow-up was thirty-three months. All measures improved significantly (p < 0.0001). The mean total score on the American Shoulder and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score, from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for function on the visual analog scale improved from 2.7 to 6.0, and the score for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion increased from 55.0 degrees to 105.1 degrees , and abduction increased from 41.4 degrees to 101.8 degrees . Forty-one of the sixty patients rated the outcome as good or excellent; sixteen were satisfied, and three were dissatisfied. There were a total of thirteen complications in ten patients (17%). Seven patients (12%) had eight failures, requiring revision surgery to another Reverse Shoulder Prosthesis in five patients (one shoulder had two revisions) and revision to a hemiarthroplasty in two patients because of deep infection. The data from this study suggest that arthroplasty with the Reverse Shoulder Prosthesis may be a viable treatment for patients with glenohumeral arthritis and a massive rotator cuff tear. However, future studies will be necessary to determine the longevity of the implant and whether it will provide continued improvement in function.

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency&lt;sbt aid="1022701"&gt;A Minimum Two-Year Follow-up Study of Sixty Patients&lt;/sbt&gt;

Patients who have pain and dysfunction from glenohumeral arthritis associated with severe rotator cuff deficiency have few treatment options. The goal of this study was to retrospectively evaluate the short-term results of arthroplasty with use of the Reverse Shoulder Prosthesis in the management of this problem. We report the results for sixty patients (sixty shoulders) with a rotator cuff deficiency and glenohumeral arthritis who were followed for a minimum of two years. Thirty-five patients had no previous shoulder surgery, whereas twenty-three had had either an open or arthroscopic rotator cuff repair, one had had a subacromial decompression, and one had had a biceps tendon repair. All patients were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons scoring system for pain and function and with visual analog scales for pain and function. They were also asked to rate their satisfaction with the outcome. The shoulder range of motion was measured preoperatively and postoperatively. The average age of the patients was seventy-one years. The average duration of follow-up was thirty-three months. All measures improved significantly (p < 0.0001). The mean total score on the American Shoulder and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score, from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for function on the visual analog scale improved from 2.7 to 6.0, and the score for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion increased from 55.0 degrees to 105.1 degrees, and abduction increased from 41.4 degrees to 101.8 degrees. Forty-one of the sixty patients rated the outcome as good or excellent; sixteen were satisfied, and three were dissatisfied. There were a total of thirteen complications in ten patients (17%). Seven patients (12%) had eight failures, requiring revision surgery to another Reverse Shoulder Prosthesis in five patients (one shoulder had two revisions) and revision to a hemiarthroplasty in two patients because of deep infection. The data from this study suggest that arthroplasty with the Reverse Shoulder Prosthesis may be a viable treatment for patients with glenohumeral arthritis and a massive rotator cuff tear. However, future studies will be necessary to determine the longevity of the implant and whether it will provide continued improvement in function.

Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency.

Hemiarthroplasty for the treatment of shoulders with glenohumeral arthritis and severe rotator cuff deficiency has been reported to provide reasonable clinical results. The purposes of this study were to determine the clinical and radiographic results of hemiarthroplasty for this condition and to identify pathological and technical factors that may influence its outcome. Thirty patients (thirty-three shoulders) managed with hemiarthroplasty because of glenohumeral arthritis and a massive, irreparable tear of the rotator cuff were followed for an average of five years (range, two to eleven years). Eight shoulders had undergone a prior acromioplasty and resection of the coracoacromial ligament. A small prosthetic head was used in three shoulders; a medium head, in twenty-six; and a large head, in four. Clinical results were graded according to the limited-goals criteria of Neer et al. The mean pain score decreased from 4.2 points preoperatively to 2.2 points at the time of the most recent follow-up (p = 0.0001). However, at the time of the most recent follow-up, nine shoulders (27%) had moderate pain at rest (four shoulders) or pain with activity (five shoulders). Mean active elevation improved from 72 degrees (range, 30 degrees to 150 degrees) to 91 degrees (range, 40 degrees to 165 degrees) (p = 0.008). Anterosuperior instability occurred in seven shoulders and was associated with a history of subacromial decompression (p = 0.04). The result was graded as successful for twenty-two shoulders (67%). Shoulder hemiarthroplasty provides marked pain relief in three-quarters of patients with glenohumeral arthritis and severe rotator cuff deficiency. It is a reconstructive option that provides durable results, but it may be complicated by instability and progressive bone loss.