Shoulder Arthroplasty Cases Research Articles

Increasing Incidence of Shoulder Arthroplasty in the United States

The number of total shoulder arthroplasties performed in the United States increased slightly between 1990 and 2000. However, the incidence of shoulder arthroplasty in recent years has not been well described. The purpose of the present study was to examine recent trends in shoulder hemiarthroplasty and total shoulder arthroplasty along with the common reasons for these surgical procedures in the United States. We modeled the incidence of shoulder arthroplasty from 1993 to 2008 with use of the Nationwide Inpatient Sample. On the basis of hemiarthroplasty and total shoulder arthroplasty cases that were identified with use of surgical procedure codes, we conducted a design-based analysis to calculate national estimates. While the annual number of hemiarthroplasties grew steadily, the number of total shoulder arthroplasties showed a discontinuous jump (p < 0.01) in 2004 and increased with a steeper linear slope (p < 0.01) since then. As a result, more total shoulder arthroplasties than hemiarthroplasties have been performed annually since 2006. Approximately 27,000 total shoulder arthroplasties and 20,000 hemiarthroplasties were performed in 2008. More than two-thirds of total shoulder arthroplasties were performed in adults with an age of sixty-five years or more. Osteoarthritis was the primary diagnosis for 43% of hemiarthroplasties and 77% of total shoulder arthroplasties in 2008, with fracture of the humerus as the next most common primary diagnosis leading to hemiarthroplasty. The number of shoulder arthroplasties, particularly total shoulder arthroplasties, is growing faster than ever. The use of reverse total arthroplasty, which was approved by the United States Food and Drug Administration in November 2003, may be part of the reason for the greater increase in the number of total shoulder arthroplasties. A long-term follow-up study is warranted to evaluate total shoulder arthroplasty in terms of patient outcomes, safety, and implant longevity.

Principles of glenoid component design and strategies for managing glenoid bone loss in revision shoulder arthroplasty in the absence of infection and rotator cuff tear

The number of total shoulder arthroplasty (TSA) cases continues to grow each year. With the increasing number of procedures being performed, there, in turn, will exist a greater need for revision procedures. Failure of a shoulder arthroplasty can result from soft-tissue problems, bony deficiencies, infection, and component wear or loosening. Component loosening and osseous deficiencies may occur on the humeral and/or glenoid side. Multiple studies have identified glenoid component loosening as one of the more common causes necessitating revision after TSA. Glenohumeral joint instability in the setting of rotator cuff deficiency is also a common cause of glenoid loosening. Eccentric loading of the glenoid from proximal humeral migration leads to increased stress at the bonecement or bone-implant interface, commonly referred to as the ‘‘rocking horse phenomenon.’’ Eccentric loading, instability, and glenoid loosening may also result from incomplete glenoid seating, glenoid or humeral component malpositioning, or tuberosity malunion. The importance of glenoid implantation becomes evident when one considers

Anteromedial approach for shoulder arthroplasty: Current indications, complications, and results

The anteromedial approach to the shoulder with detachment of the anterior deltoid from its clavicular and anterior acromial origins is a method of enhancing exposure for difficult shoulder arthroplasty cases. The aim of this study is to describe the current frequency of use, indications, complications, and results of this approach. Between 2000 and 2003, 723 consecutive shoulder arthroplasties were performed. In 110 (15%) an anteromedial approach was used. Patient data; previous surgery; indications for surgery; pain, motion, and strength before and after surgery; complications; and the need for reoperation were assessed. This approach was used in 9.5% of primary cases and 39% of revision cases. Seventy percent had had previous surgery. For primary arthroplasty, the most frequent diagnoses were osteoarthritis and the sequelae of fractures. In revision cases the most common diagnoses were instability and glenoid loosening. The structural indications for the anteromedial approach were severe scarring, protection of a frail deltoid, improvement in rotator cuff or glenoid exposure, protection of osteopenic bone, or enhancement of exposure in oncologic cases or resections. Ninety patients had more than 2 years of follow-up. Pain improved after primary and revision arthroplasty. Motion only improved in primary arthroplasty. There was little change in strength. No proximal deltoid detachments or other approach-related complications were identified. The anteromedial approach is a reliable technique to improve surgical exposure in difficult shoulder arthroplasty cases. When performed adequately, it can be applied safely without anterior deltoid detachment or clinically evident major complications.

Neurovascular injury after shoulder hemiarthroplasty: A case report and review of the literature

Since shoulder replacement was introduced for the treatment of complex proximal humeral fractures by Neer et al 13 Neer II, C. Brown Jr., T. McLaughlin H. Fracture of the neck of the humerus with dislocation of the head fragment. Am J Surg. 1953; 85: 252-258 Abstract Full Text PDF PubMed Scopus (107) Google Scholar in 1951, its use has grown exponentially. 2 Aval S.M. Durand Jr., P. Shankwiler J.A. Neurovascular injuries to the athlete's shoulder: part I. J Am Acad Orthop Surg. 2007; 15: 249-256 PubMed Google Scholar Neer and Morrison 14 Neer II, C. Morrison D. Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am. 1988; 70: 1154-1162 PubMed Google Scholar reported that replacement of the shoulder joint is one of the most technically demanding of the current joint replacement procedures. Despite its clinical success, complications do occur. 15 Norris T. Iannotti J. A prospective outcome study comparing humeral head replacement and total shoulder replacement for primary osteoarthritis of the shoulder. Presented at the 12th Opening Meeting of the American Shoulder and Elbow Surgeons. Ga, AtlantaFebruary 1996 Google Scholar , 16 Passannante A. Spinal anesthesia and permanent neurologic deficit after interscalene block. Anesth Analg. 1996; 82: 873-874 PubMed Google Scholar , 23 Stableforth P. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br. 1984; 66: 104-108 PubMed Google Scholar Although neurologic injury is a rare complication, with an estimated incidence of 1% to 4% in shoulder arthroplasty cases, 6 Cofield R. Complications of shoulder arthroplasty. Instructional Course Lecture No. 317. Presented at the American Academy of Orthopaedic Surgeons Annual Meeting. Calif, San FranciscoFebruary 1993 Google Scholar , 11 Lynch N.M. Cofield R.H. Silbert P.I. Hermann R.C. Neurologic complications after total shoulder arthroplasty. J Shoulder Elbow Surg. 1996; 5: 53-61 Abstract Full Text PDF PubMed Scopus (166) Google Scholar we are unaware of definite data on the prevalence of vascular or combined neurovascular injury. We present a patient who had complete transection of the axillary artery and the distal posterior cord after shoulder hemiarthroplasty.