Arthritis Of Shoulder Research Articles

PROMIS Global-10 performs poorly relative to legacy shoulder instruments in patients undergoing total shoulder arthroplasty for glenohumeral arthritis.

The PROMIS Global-10 is a 10-item questionnaire that assesses general health-related quality of life. There is a paucity of research on the utility of the PROMIS Global-10 in the evaluation of orthopedic conditions. The aim of this study is to compare PROMIS Global-10 and legacy shoulder-specific patient-reported outcome measures (PROMs) in patients undergoing total shoulder arthroplasty (TSA) for shoulder arthritis. This retrospective cohort study included patients who underwent TSA for shoulder arthritis and completed preoperative and 1-year postoperative surveys. Primary outcome measures were the physical (PROMIS-P) and mental (PROMIS-M) components of PROMIS Global-10. The legacy PROMs included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Shoulder Activity Scale (SAS). Analyses included postoperative changes for each outcome, correlations between measures and a responsiveness assessment. A total of 170 patients met inclusion criteria. Average age and body mass index were 67.7 ± 7.8 years and 28.0 ± 4.9, respectively. All legacy PROMs and PROMIS-P were significantly higher at 1-year follow-up compared with the preoperative level (P < .0001), whereas PROMIS-M did not change (P = .06). Preoperatively, both PROMIS components were either poorly correlated with all legacy PROMs (r < .04, P < .05) or not correlated at all (P > .05). Postoperatively, PROMIS-M was poorly correlated with all legacy PROMs (r < .04, P < .01), whereas PROMIS-P had fair correlation with ASES (r = .5, P < .0001) and poor correlation with SANE and SAS (r < .04, P < .01). A floor effect was observed for SANE, and SANE and ASES had a ceiling effect. The effect sizes for SANE and ASES were high (d = 2.01 and 2.39 respectively), whereas the effect size for SAS was moderate (d = 0.65), and the effect sizes for the PROMIS measures were small (d < .5). ASES was the most responsive measure and PROMIS-M was the least responsive. PROMIS Global-10 had limited correlation with legacy PROMs and was less responsive at 1-year follow-up in patients following TSA. The Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA.

The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

BackgroundThe success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°.MethodsA total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group.ResultsThe median (min/max) values for the 231 shoulders were 8° (− 23°/56°) for the inclination angle, − 11°(− 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders.ConclusionOur findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact.Level of evidenceLevel III.

Effect of Insurance Status on Clinical Outcomes After Shoulder Arthroplasty.

Shoulder arthroplasty is an effective treatment option for patients with symptomatic shoulder arthritis and rotator cuff arthropathy. Although there have been reports of variations in complication rates according to insurance type, few studies have examined the effect of payer status on functional outcomes. Patients who underwent elective shoulder arthroplasty performed by a single fellowship-trained surgeon and had a minimum of 1 year of follow-up were queried. Patient characteristics were compared across insurance types. Each patient completed the American Shoulder and Elbow Surgeons (ASES) questionnaire preoperatively and postoperatively. A generalized linear mixed model was specified to predict ASES score at 1 year and included preoperative ASES score as an adjustment variable. A total of 84 patients underwent 91 procedures. Before surgery, ASES score differed by insurance type (P=.014), with lower scores in the Medicaid cohort compared with the private insurance cohort (20.4 vs 38.8, P=.009). After controlling for baseline ASES score, postoperative ASES score at 1-year follow-up differed by insurance type (P<.001). Patients with private insurance had better ASES scores (85.6) than patients with Medicaid (55.2) (P<.001) and workers' compensation (57.1) (P=.028). Patients with Medicare (80.6) had better ASES scores at follow-up compared with those with Medicaid (P<.001). Patients with Medicaid are at risk for significantly lower postoperative functional outcome scores after shoulder arthroplasty compared with patients with private insurance and Medicare. In this study, patients with Medicaid had lower preoperative ASES scores compared with other groups. These observed differences are likely multifactorial and should be acknowledged when counseling patients. [Orthopedics. 2020;43(6):e523-e528.].

Glenohumeral Resurfacing in Young, Active Patients With End-Stage Osteoarthritis of the Shoulder

Treatment of end-stage glenohumeral arthritis in young patients is a challenge; however, there is a lack of consensus on optimal treatment algorithms. A thorough history and physical examination are essential. Nonoperative treatments should first be attempted, whereas surgical options range from arthroscopic debridement to arthroplasty. One arthroplasty option is glenohumeral resurfacing with the objective of maintaining more native anatomy and bone stock. The described treatment includes a hemi-cap implant for the humerus and inlay polyethylene glenoid. While hemi-caps have been successfully used for decades, inlay glenoid implants are a more modern treatment, with the objective of less glenoid loosening, the typical complication and failure method in young patients. With the potential for greater longevity and preservation of anatomy, glenohumeral resurfacing for end-stage shoulder arthritis is an important treatment option to consider before total shoulder arthroplasty. This Technical Note describes resurfacing of the glenohumeral joint in a young, active patient presenting with extensive osteoarthritis on both the glenoid and humerus after a previous failed Trillat stabilization.

Do Modern Designs of Metal-Backed Glenoid Components Show Improved Clinical Results in Total Shoulder Arthroplasty? A Systematic Review of the Literature.

Background:Despite the increased popularity of reverse total shoulder arthroplasty, total shoulder arthroplasty is the standard treatment for advanced shoulder arthritis in young adult patients. Conventional metal-backed glenoid (MBG) designs result in more loosening and revision surgery compared with cemented polyethylene glenoid components. However, modern MBG designs have been recently devised to overcome such drawbacks.Purpose:To compare the radiolucency, loosening, and failure rates of modern MBG designs with those of conventional designs.Study Design:Systematic review; Level of evidence, 4.Methods:A search for relevant articles was carried out using the PubMed, Cochrane Library, and Embase databases using MeSH (Medical Subject Headings) terms and natural keywords. A total of 362 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed categorical data, such as the presence of loosening, failure, and revision surgery. The main outcome was the rate of revision surgery or failure. Subgroup analysis according to follow-up duration was performed to reduce heterogeneity.Results:A total of 25 articles (2036 shoulders) were included; 15 articles (1579 shoulders) involved a conventional MBG design, and 10 (457 shoulders) involved a modern design. The mean age of the patients was 64.2 and 66.5 years in the conventional and modern design groups, respectively, with a mean follow-up duration of 102.0 and 56.1 months, a mean gain of forward elevation of 35.1° and 61.7°, and a mean gain of external rotation of 24.2° and 39.2°. The rate of radiolucency was 48.0% and 16.7%, the rate of loosening was 11.2% and 4.9%, and the rate of revision was 15.9% and 2.4%, for the conventional and modern design groups, respectively. Subgroup analysis according to follow-up duration showed that the rates of loosening and revision were significantly lower in the modern design group (P < .001).Conclusion:Our findings suggest that modern MBG designs showed significantly lower loosening and failure rates than conventional designs. The overall results of the comparison, including loosening, failure, change in range of motion, and clinical scores, indicate that modern MBG designs are promising. More long-term follow-up studies on modern MBGs should be conducted.

Reverse Total Shoulder Arthroplasty with a Superior Augmented Glenoid Component for Favard Type-E1, E2, and E3 Glenoids.

Uncorrected superior glenoid wear in patients managed with reverse total shoulder arthroplasty (rTSA) can result in increased complications, including baseplate failure. The present study quantifies the clinical and radiographic outcomes of patients with Favard type-E1, E2, and E3 glenoid deformity who were managed with rTSA with use of a superior or superior/posterior augmented glenoid baseplate. We retrospectively reviewed the records for 68 patients with shoulder arthritis and Favard type-E1, E2, or E3 glenoid deformity who were managed with primary rTSA and a 10° superior augmented or 10° superior/8° posterior augmented baseplate. The mean duration of follow-up was 40 months (range, 24 to 85 months). Outcomes were assessed preoperatively and at the latest follow-up with shoulder range of motion and use of outcome scores including the Simple Shoulder Test (SST), University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Shoulder Pain and Disability Index (SPADI) score. Radiographs were evaluated preoperatively and at the time of the latest follow-up. Differences in preoperative and postoperative range of motion and outcome metrics were assessed with use of a 2-tailed Student t test. The majority of patients experienced clinically meaningful improvements in terms of pain and function following rTSA with a superior or superior/posterior augment, with 94% of patients rating themselves as "much better" (73.5%) or "better" (20.5%) at the time of the latest follow-up. At least 88% of the patients exceeded the minimum clinically important difference (MCID) threshold, and 75% of patients exceeded the substantial clinical benefit (SCB) threshold, for each of the clinical outcome metrics and range of motion. Five complications were reported (prevalence, 7.4%), including acromial stress fracture (2 patients), posttraumatic scapular neck fracture (1 patient), chronic shoulder pain (1 patient), and aseptic glenoid loosening (1 patient). The present short-term clinical and radiographic study demonstrated that shoulder arthropathy with superior glenoid wear patterns (Favard types E1, E2, and E3) can be successfully treated with rTSA with a superior or superior/posterior augmented baseplate. Longer-term clinical and radiographic follow-up is necessary to confirm that these promising short-term results are durable. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Automated muscle elongation measurement during reverse shoulder arthroplasty planning

Adequate deltoid and rotator cuff elongation in reverse shoulder arthroplastyis crucial to maximize postoperative functional outcomes and to avoid complications. Measurements of deltoid and rotator cuff elongation during preoperative planning can support surgeons in selecting a suitable implant design and position. Therefore, this study presented and evaluated a fully automated method for measuring deltoid and rotator cuff elongation. Complete scapular and humeral models were extracted from computed tomography scans of 40 subjects. First, a statistical shape model of the complete humerus was created and evaluated to identify the muscle attachment points. Next, a muscle wrapping algorithm was developed to identify the muscle paths and to compute muscle lengths and elongations after reverse shoulder arthroplasty implantation. The accuracy of the muscle attachment points and the muscle elongation measurements was evaluated for the 40 subjects by use of both complete and artificially created partial humeral models. Additionally, the muscle elongation measurements were evaluated for a set of 50 arthritic shoulder joints. Finally, a sensitivity analysis was performed to evaluate the impact of implant positioning on deltoid and rotator cuff elongation. For the complete humeral models, all muscle attachment points were identified with a median error < 3.5 mm. For the partial humeral models, the errors on the deltoid attachment point largely increased. Furthermore, all muscle elongation measurements showed an error < 1 mm for 75% of the subjects for both the complete and partial humeral models. For the arthritic shoulder joints, the errors on the muscle elongation measurements were <2 mm for 75% of the subjects. Finally, the sensitivity analysis showed that muscle elongations were affected by implant positioning. This study presents an automated method for accurately measuring muscle elongations during preoperative planning of shoulder arthroplasty. The results show that the accuracy in measuring muscle elongations is higher than the accuracy in indicating the muscle attachment points. Hence, muscle elongation measurements are insensitive to the observed errors on the muscle attachment points. Related to this finding, muscle elongations can be accurately measured for both a complete humeral model and a partial humeral model. Because the presented method also showed accurate results for arthritic shoulder joints, it can be used during preoperative shoulder arthroplasty planning, in which typically only the proximal humerus is present in the scan and in which bone arthropathy can be present. As the muscle elongations are sensitive to implant positioning, surgeons can use the muscle elongation measurements to refine their surgical plan.

Return to Golf After Shoulder Arthroplasty: A Systematic Review

Background: The number of golfers aged ≥65 years has increased in recent years, and shoulder arthritis is prevalent in this age group. Guidelines for return to golf (RTG) after shoulder arthroplasty have not been fully established. Purpose: To review the data available in the current literature on RTG after shoulder arthroplasty. Study Design: Systematic review. Methods: A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. Two independent reviewers searched PubMed, Embase, and the Cochrane Library using the terms “shoulder,”“arthroplasty,”“replacement,” and “golf.” The authors sought to include all studies investigating RTG after total shoulder arthroplasty (TSA), shoulder hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA). Outcomes of interest included indications for shoulder arthroplasty, surgical technique, rehabilitation protocol, amount of time between surgery and resumption of golf activity, and patient-reported outcome measures. Results: A total of 10 studies were included, 2 of which reported on golf performance after shoulder arthroplasty. The other 8 studies described return to sports after shoulder arthroplasty with golf-specific data for our analysis. Three studies that included patients who underwent TSA reported RTG rates ranging from 89% to 100% after mean follow-up periods of 5.1 to 8.4 months. Two studies included patients who underwent TSA and HA and reported RTG rates of 77% and 100% after mean intervals of 5.8 and 4.5 months, respectively. Two studies included patients who underwent RSA, with RTG rates of 50% and 79% after mean postoperative intervals of 5.3 and 6 months, respectively. One study included only patients undergoing HA, with an RTG rate of 54% and a mean RTG time of 6.5 months. Varying surgical procedures and baseline patient characteristics precluded our ability to draw conclusions regarding surgical technique, rehabilitation protocol, or patient-reported outcome measures among studies reporting these data. Conclusion: Most patients who undergo a shoulder arthroplasty procedure can expect to resume playing golf approximately 6 months after the index procedure. The rate of return may be lower after RSA and HA as compared with anatomic TSA. The data presented in our review can help physicians counsel patients who wish to continue golf participation after a shoulder arthroplasty procedure.

National Trends in the Surgical Treatment of Chronic Rotator Cuff Tear in Patients Without Arthritis.

Both rotator cuff repair (RCR) and reverse total shoulder arthroplasty (RTSA) are effective treatment options for chronic large degenerative rotator cuff tear (RCT) in the elderly. The goal of this study was to evaluate national trends for surgical management of chronic RCT among patients without glenohumeral arthritis. The authors conducted a retrospective review from 2007 to 2015 using the PearlDiver database. The study included patients who had the International Classification of Diseases, Ninth Revision, diagnosis of chronic RCT without shoulder arthritis. Procedural codes from the Current Procedural Terminology and the International Classification of Diseases, Ninth Revision, were used to identify patients undergoing RCR or RTSA. Chi-square analysis assessed differences between the groups, and Cochran-Armitage trend tests were used to evaluate trends over time. Overall, 428,651 patients had chronic RCT without arthritis; 364,141 (84.9%) were treated nonoperatively, 53,566 (12.5%) underwent RCR, and 10,944 (2.6%) underwent RTSA. Patients who were 60 to 79 years old had the highest rate of surgical intervention (70.8% of all surgical patients), with 69.2% and 78.4% who underwent RCR and RTSA, respectively. A 3-fold increase in RTSA use was noted among patients 60 years and older vs patients younger than 60 years. Overall revision rates 2 years after RCR and RTSA among patients 60 to 79 years old were 13.0% and 3.7%, respectively. Revision rates after RCR remained constant over time (9.3% to 13.0%; P=.082), whereas revision rates after RTSA decreased significantly over time (12.1% to 2.2%; P=.016). Older patients were more likely to be treated nonoperatively compared with younger patients, but among those patients treated with RTSA, there was a 3-fold increase in the use of RTSA in patients older than 60 years compared with patients younger than 60 years. Further, the authors found that revision rates after RTSA decreased over time (from 12% to 2%), suggesting better implant design, improved knowledge of implant positioning, and increased surgical proficiency. [Orthopedics. 2020;43(5):e409-e414.].

Arthroscopic Removal of an Intra-Articular Migrating Plant Awn Associated with Septic Shoulder Joint Arthritis in a Dog

Abstract Objective The aim of this study was to describe the clinical presentation, advanced imaging findings and outcomes of arthroscopic treatment of a bacterial septic shoulder arthritis caused by the penetration of a migrating plant awn in a dog. Case Report A 10-month-old, 11 kg, sexually intact male Cocker Spaniel was diagnosed with septic arthritis of the right scapulohumeral joint. Computed tomography revealed marked articular effusion and thickening of the capsule of the right shoulder joint. Ultrasound of the shoulder identified a bilinear hyperechoic structure located within the joint consistent with a plant (grass) awn. Arthroscopy was used for foreign body removal. Antibiotic treatment was prescribed according to bacteriologic sensitivity tests. Treatment was successful: the dog completely recovered and under high levels of activity showed neither clinical signs nor recurrence of lameness on follow-up at 6 and 24 weeks after surgery. Conclusion Migrating plant awn can be the cause of septic arthritis in a dog. The combination of advanced imaging techniques and arthroscopy allowed accurate diagnosis, reduced the risk of surgical complications and shortened recovery time in this patient. Considering the benefits of minimally invasive techniques, arthroscopy represents an excellent option for the treatment of dogs with similar intra-articular foreign bodies.

Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection

The outcomes of reverse total shoulder arthroplasty (RTSA) surgery for the sequelae of former septic native joint shoulder arthritis are unknownbut might be inferior to patients without prior bacterial arthritis. We performed a single-center case-control study embedded in our prospective RTSA cohort. We matched all patients withprior infections in a 1:1 ratio with patients who underwent RTSA for other indications. The matching variables wereindication for surgery, age, sex, dominant/nondominant shoulder, and body mass index. We evaluated outcomes by Constant score and active function. Among 1249 patients in the RTSA cohort, 14 were operated for sequelae of previous native shoulder joint infections. Although both groups significantly improved from preoperative to postoperative values, the outcome of postinfectious patients was clearly inferior in comparison with the control group (absolute [38 ± 17 vs. 75 ± 8, P < .01], relative Constant score [47 ± 19 vs. 88 ± 9, P< .01], Constant pain score [11.0 ± 3.1 vs. 14.3 ± 1.3, P < .01], subjective shoulder value [43 ± 26 vs. 85 ± 10, P < .01], abduction [70 ± 43 vs. 148 ± 29°, P = .001], and elevation [82 ± 49° to 131 ± 16°, P = .02]). Moreover, in the postinfectious group, overall surgical complications occurred in 36%, with the need for revision in 21%. There was, however, no recurrence of infection in any of the patients' shoulders. RTSA for end-stage postinfectious joint disease is associated with a high number of complications and reoperations. Clinical outcomes are inferior to those without past infection.

Complications and mortality in patients with chronic kidney disease undergoing total shoulder arthroplasty

Shoulder arthroplasty (SA) provides pain relief and functional improvement in patients with shoulder arthritis. With increasing incidence of SA, there is a growing effort to risk-stratify these patients to diminish complication rates. The aim of this study is to quantify complication risk, resource utilization, and mortality of patients with chronic kidney disease (CKD) who are undergoing SA (both non-dialysis dependent and dialysis dependent) to identify any disease-severity relationship with delirious SA outcomes. We queried the Nationwide Inpatient Sample database for patients with and without diagnosis of CKD SA from 2007 to 2015. Additional patient comorbidities were stratified using the Elixhauser comorbidity index. Outcomes of interest include mortality, non-surgical and surgical complications, and resource utilization metrics. Multivariate logistical regression was run to determine odds ratios for development of these complications in the non-dialysis dependent (NDD) and dialysis-dependent cohort (DD). Between 2007 and 2015, the prevalence of patients with CKD undergoing SA more than doubled. On univariate analysis, mortality, non-surgical and surgical complications, and all resource-utilization metrics were increased in CKD patients, with a direct disease-severity-dependent relationship; the rate of inpatient mortality in the DD cohort after SA was 32 times higher than patients without CKD ( p <0.001). The association between CKD and complication rates, and the disease-severity relationship was conserved on multivariate analysis. The OR for mortality in the DD cohort was 10.6 ( p <0.001). Patients with CKD undergoing SA had a far greater risk of mortality, development of postoperative surgical and non-surgical complications, and resource utilization metrics during the postoperative inpatient stay after SA. CKD is an independent risk for a detrimental postoperative course after SA, and this relationship is worsened in patients requiring dialysis. The CKD population represents a potentially hazardous candidate for elective SA. Level III

Arthroscopic Fixation of a Large Osteochondral Fragment From the Glenoid After First Episode Dislocation

Osteochondral lesions of the glenoid are not so uncommon after traumatic cases of shoulder dislocation and can be a challenge to the shoulder surgeon because of the technical difficulty and the potential to progression to shoulder arthritis. An all-arthroscopic technique of fixation of a large osteochondral fragment is used to allow optimal visualization and reduction, minimize the morbidity of the open approach, and provide good functional results.

Clinical Results after Arthroscopic Treatment of Septic Shoulder with Proximal Bone Involvement.

If osteomyelitis is confined to the proximal humerus, arthroscopic debridement with multiple punctures at the infected bone might be sufficient to eradicate the septic shoulder with bone involvement. From 2005 to 2017, 15 patients received arthroscopic debridement with multiple punctures. We included patients with septic shoulder arthritis with proximal bone involvement and excluded patients with glenohumeral joint destruction or extension of bone involvement to the diaphysis of the humerus. We performed multiple punctures for drainage of proximal humerus after complete arthroscopic debridement of septic soft tissue. Infection laboratory studies and postoperative magnetic resonance image were evaluated. For clinical outcome measurements, range of motion, pain visual analog scale, functional visual analog scale, American shoulder elbow surgeon scores, constant scores, and simple shoulder test were evaluated. There were 11 males and 4 females with a mean age of 53years (range 28-73years). Mean follow-up was 32months (range 12-115months). There was no reinfection case. The postoperative C-reactive protein levels were normalized in all. The postoperative magnetic resonance image showed no bony involvement of the proximal humerus in all patients except one patient. The clinical scores and range of motion were significantly improved postoperatively. Six patients underwent secondary surgery for rotator cuff tear at a mean time period of 25months (range 4-104months) from the index period. Septic shoulder with proximal bone involvement can be successfully treated with arthroscopic debridement with multiple punctures. Level IV, treatment study.

The Prognostic Value of a Novel Magnetic Resonance Imaging-Based Classification for Septic Arthritis of the Shoulder.

The purposes of the present study were (1) to create a magnetic resonance imaging (MRI)-based classification system for septic shoulder arthritis and to show the results of arthroscopic debridement based on the classification in eradicating the infection, and (2) to determine the distribution of the Gächter stages, which are determined on the basis of arthroscopic findings only, in each grade of the novel classification system. The present study included 31 patients who underwent arthroscopic debridement for the treatment of acute septic arthritis of the shoulder between January 2001 and December 2015. The mean duration of follow-up was 2.3 years. The included patients were assessed with use of a novel classification system based on preoperative radiographic and MRI findings. MRI findings were classified as Grade I (only synovitis or joint effusion), Grade II (marrow edema in the bare area of the humeral head), Grade III (cartilaginous erosion), Grade IV (osseous erosion), and Grade V (osseous erosion on MRI also observed on radiographs). No changes on radiographs were observed in Grades I to IV. The intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated. The overall reinfection rate was 54.8% (17 of 31). Among patients with Grade-I, II, III, IV, and V involvement, the reinfection rates were 0 of 4, 1 of 6, 2 of 4, 9 of 12, and 5 of 5, respectively. A diverse distribution of Gächter stages were found in each grade of the novel classification system, with the exception of Grade V. The ICCs for interobserver and intraobserver reliability were 0.81 and 0.80 for the novel classification system. The ICCs for interobserver and intraobserver reliability were 0.75 and 0.78 for Gächter stages. This novel classification system for the grading of acute shoulder infections on the basis of radiographs and MRI allows preoperative grading of septic arthritis to be performed objectively. Patients who were classified as Grade III or higher in the novel classification system had higher reinfection rates than those who were classified as Grade I or II and required more aggressive treatment to eradicate the infection.

A prospective study on role of hydraulic distension along with steroid under local anaesthesia in the management of frozen shoulder

Introduction: Frozen shoulder” is a chronic condition characterized by gradually progressive, painful restriction of all shoulder joint movement, with slow spontaneous recovery of either partial or complete movement over a period of time. Although many treatment options have been proposed for the frozen shoulder syndrome, each has limitations. Hydro dilation technique was developed in order to loosen the reported contraction and adhesion. we evaluated the Range of movement and pain relief of shoulder following “Hydraulic distension under local anaesthesia along with a steroid” pre and post distension. Material and methods: A prospective observational study was conducted in the department of orthopaedics at RLJ hospital attached to Sri Devaraj Urs Medical College between June 2018 to November 2019 for a period of 1.5 year. All the Patients with Peri arthritis shoulder and age above 30 years were included in the study. After obtaining the informed consent from the patients, Demographic data, History, Clinical Examination and details of investigations were recorded in study proforma. The pain and functional scoring used as per “The society of American Shoulder and elbow surgeons” and follow-up was done at 3 weeks, 6 weeks and 12 weeks after procedure. IBM SPSS version 22 was used for statistical analysis. Results: Total 50 patients were included in the study. The average age of the study population was 52.68 ± 9.79. There were no patients with complete disability. Marked pain (grade 1) was observed on presentation in 46(92%) of the subjects. Post distension only 9(18%) had pain. Flexion, abduction, internal rotation, external rotation movements of the shoulder have improved post distention and were statistically significant at 3rd, 6th, 12 th week. The mean ASES was 36.04 ± 5.84 at base line, it was 67.6 ± 7.64 at 6th week and 91.04 ± 8.68 at 12th week. The differences in the ASES score at 6th week and 12th week follow up period with baseline value were statistically significant (P value

How orthopedic surgeons can impact opioid use and dependence in shoulder arthroplasty

BackgroundConsidering that the United States is facing a crisis with opioid misuse and orthopedists are the third largest provider of these prescriptions, it is important to delineate risk factors associated with use and dependence. Our purpose was to identify risk factors for and patient characteristics of increased opioid use and postoperative opioid dependence in total shoulder arthroplasty (TSA) patients.MethodsThis was a retrospective study of 752 TSA patients who underwent surgery in 1 health care system from 2012-2016. Recorded variables included demographics and opioid prescriptions from prescription drug monitoring programs. Preoperative and postoperative opioid dependence was defined as continuous opioid prescriptions for at least 3 months prior to or after surgery. Statistical analyses and odds ratio analyses were performed.ResultsOf the 752 patients in total, 241 (32%) became or remained postoperatively dependent whereas 68% (511) were able to wean off of opioids by 3 months. In the preoperatively dependent cohort, only 27% were able to wean off opioids at 1 month and 53%, by 3 months postoperatively. Odds ratio calculations showed that patients with preoperative opioid use had a 3.52 (95% confidence interval, 2.433-5.089) times increased risk of postoperative dependence compared with opioid-naive patients. Of those receiving postoperative opioid refills, 69% were provided these refills by their orthopedic surgeons.Discussion and conclusionsAlthough the majority of TSA patients weaned off of opioids after surgery, our results demonstrate a 3.5 times higher risk of postoperative dependence in patients who used preoperative opioids. Orthopedists were major contributors to continued postoperative opioid use, and increased efforts to minimize opioid prescriptions before, during, and after TSA may help curtail overuse and dependence. These results highlight the hazard that preoperative opioid use entails for shoulder arthritis patients.

Pseudo paralysis of the shoulder and increased C-reactive protein are predictive factors for septic shoulder in children superior to other clinical symptoms: A retrospective case series of 25 patients

PurposeThe aim of the study was to evaluate predictable parameters with the highest sensitivity used in the diagnosis of children septic shoulder arthritis.MethodsAll children treated in our paediatric orthopaedic hospital between 2000 and 2017 with intraoperative verified septic arthritis of the shoulder were included in this retrospective study. Diagnostic procedures e.g. ultrasound, MRI, radiograph or blood samples as well as typical clinical symptoms were evaluated as predictable parameters for septic shoulder arthritis in paediatric patients. Descriptive statistics as well as sensitivity analysis were performed.ResultsIn all, 25 children, 20 boys and five girls, aged from eight days to 15 years, were included for further statistical analysis. All parameters included were tested for sensitivity with binomial confidence intervals (Cis) of 95%. Predictive parameters with highest sensitivity were pseudo paralysis (100%, CI 0.86 to 1.00) and C-reactive protein (CRP) (96%, CI 0.79 to 0.99) superior to temperature (52%, CI 0.3 to 0.73), white blood count (11%, CI 0.01 to 0.34), radiograph (21%, CI 0.04 to 0.50), ultrasound (71%, CI 0.47 to 0.88) or MRI (100%, CI 0.78 to 1.00).ConclusionThe diagnosis of a septic arthritis of the shoulder in children can be challenging for the clinician and especially for the resident doctor. Clinical symptoms such as pseudo paralysis and increased CRP level must be considered as predictive markers not to delay further diagnostics and treatment.Level of EvidenceIV

Morphometric study of glenoid cavity of scapulae in north Indian population with clinical significance

Introduction: Shoulder arthroplasty offers pain relief and improvement in patients of shoulder arthritis. It need proper fixation of glenoid cavity to prevent loosening, a common cause for surgery. As glenoid cavity is small, it permits only a tight spot for limited fixation devices. So, knowledge of the morphological data of various parameters of glenoid cavity is of utter importance. Materials and Methods: An observational cross-Sectional study was done on 66 unpaired human scapulae. They belong to adult population of North India and of unknown sex. Superior-inferior diameter and Anterior-posterior diameter of maximum distance at the glenoid cavity were measured and based on these measurements index of glenoid cavity calculated. Result and Discussion: The shape of the glenoid cavity was classified on basis of the presence or absence of a notch on the glenoid rim as pear shaped, inverted comma shaped and oval shaped. All the parameters exhibit a greater value for the right side. The ethnic and racial variations could be the explanation for difference seen between the values of present study and that of other workers. The above mentioned parameters may be taken into consideration while doing shoulder arthroplasty and designing glenoid prostheses for North Indian population. Conclusion: Extensive and detail knowledge of various data of the glenoid cavity measurements is important for the anatomists, orthopaedicians, prosthetists, and anthropologists. Keywords: Glenoid cavity, Glenoid notch, Shape of Glenoid cavity, Glenoid prostheses, Shoulder arthroplasty.

Gonococcal osteomyelitis in a pediatric patient with disseminated gonococcal infection: Implications for antimicrobial management.

We report a case of a female teenager with gonococcal septic arthritis of the right shoulder that also caused osteomyelitis of the humeral head. Infection with Neisseria gonorrhoeae is a frequently diagnosed sexually transmitted infection in the sexually active teenage population and disseminated gonococcal infection (DGI) is the most common systemic manifestation of acute gonorrhea. DGI commonly involves acute arthritis, tenosynovitis and dermatitis with less common complications of endocarditis, hepatitis and meningitis. In contrast, osteomyelitis has only rarely been reported as a result of gonococcal infection. Clinicians need to be aware of this unusual manifestation of DGI as a prolonged duration of antimicrobial treatment may be needed to assure complete resolution of this infection.