Shoulder Arthroplasty For Treatment Research Articles

Application of three-dimensional printed total scapula for reverse shoulder arthroplasty in treatment of scapular tumors

To investigate the effectiveness of three-dimensional (3D) printed total scapula for reverse shoulder arthroplasty in the treatment of scapular tumors. Between November 2017 and December 2021, 5 patients with scapular tumors were treated by reverse shoulder arthroplasty with 3D printed total scapula. There was 1 male and 4 females. The age ranged from 44 to 59 years, with an average of 50.4 years. There were 2 cases of chondro sarcoma, 1 case of high-grade osteosarcoma, 1 case of lung cancer with scapular metastasis, and 1 case of ligamentoid fibromatosis recurrence. The disease duration was 4-8 months, with an average of 5.8 months. According to the Musculoskeletal Tumor Society (MSTS) scapular girdle classification criteria, 4 cases of tumors involved both S1 and S2 zones, and 1 case involved S2 zone. The tumor diameters ranged from 4.2 to 11.2 cm, with an average of 6.1 cm. The operation time, intraoperative blood loss, and blood transfusion were recorded. During follow-up, the MSTS score was used to evaluate the recovery of limb function of the patients. The sink depth of the affected shoulder, complications, and oncological outcomes were observed. The position of the prosthesis was reviewed by imaging. The operation time ranged from 155 to 230 minutes, with an average of 189 minutes. The intraoperative blood loss was 100-1 500 mL, with a median of 600 mL. Two patients were received blood transfusion of 800 mL and 1 850 mL respectively during operation. All incisions healed by first intention, and no complications such as infection occurred. All patients were followed up 4-22 months, with an average of 13 months. Two patients died at 8 and 15 months after operation respectively due to multiple metastases and organ failure. At last follow-up, the MSTS score of all patients was 73%-83%, with an average of 77.4%. The affected shoulder was 2-4 cm lower than the contralateral side, with an average of 3 cm. Imaging examinations showed that no prosthesis loosening, dislocation, or fracture occurred during follow-up. Reverse shoulder arthroplasty with 3D printed total scapula can obtain good shoulder function and appearance. Patients have high acceptance and satisfaction with this surgical method.

Reversed shoulder arthroplasty in treatment of proximal humeral fractures – early results in Department of Orthopaedics, Traumatology and Oncology, Regional Hospital in Torun, Poland

Introduction. Proximal humeral fractures (PHF) are a frequent finding, and still growing part of it needs to be treated operatively. Extending life expectancy, increasing percentage of osteoporotic fractures and progressive patients’ demand force surgeons to seek the best solutions of treating complex fractures. Just some teen years ago older patients who suffered a severe PHF were doomed to shoulder dysfunction. Today we can offer them a reversed shoulder arthroplasty (RSA) Purpose. The aim of the paper was a clinical evaluation of the patients who were treated with RSA in a Regional Hospital. Material and Methods. In years 2017-2021 in our department there were performed 41 RSAs and 5 TSAa (total anatomic shoulder arthroplasty). Earlier in 2010-2017 we performed 26 hemiarthroplasties. The procedures were done via delto-pectoral approach. The implant used were Aequalis Reversed Fracture (Tornier) and SMR (Lima). Results. The patients were evaluated in a simplified manner after 6 months postop. Functional active range of motion and VAS score were noted. Conclusions. In our department RSA is a well adopted method of treating complex PHFs, especially in elderly patients, and it yields overall good results and great percentage of satisfied patients.

Reverse total shoulder arthroplasty for treatment of complex proximal humeral fractures

Objective To evaluate the clinical results of reverse total shoulder arthroplasty for the treatment of complex proximal humeral fractures.Methods From August 2008 to August 2012,40 consecutive patients underwent reverse total shoulder arthroplasty for the treatment of complex proximal humeral fracture and were followed up for no less than one year.They were 8 men and 32 women with an average age of 73.4 years (range,67 to 86 years).The dominant side was affected in 24 patients.Of the 30 patients with fresh fracture or fracture-dislocation,the average duration from injury to surgery was 11.4 days; 5 were three-part,22 fourth-part and 3 head-split by the Neer classification.Of the 10 patients with obsolete fracture or fracture-dislocation,the average duration from injury to surgery was 509.0 days; 7 were complicated with locking dislocation,and 3 old fracture nonunion or malunion.Results The mean follow-up time was 24.9 months (range,12 to 60 months).At the last follow-up,the forward elevation averaged 134.9°,external rotation 24.7° and internal rotation the L3 level.The visual analogue scale (VAS) pain score averaged 0.9 (from 0 to 5),American Shoulder and Elbow Surgeons (ASES) score 77.3 (from 50 to 98),Constant-Murley score 73.4 (from 44 to 90),and University of California at Los Angeles (UCLA) score 28.1 (from 19 to 34).One patient was found with stress fracture of the acromion postoperatively.There were no complications like infection,prosthetic loosening or neurovascular injury related to the surgery.Conclusion Reverse total shoulder arthroplasty for complex proximal humeral fractures may yield good clinical results with a high healing rate of tuberosities. Key words: Shoulder fractures; Arthroplasty, replacement; Prostheses and implants