Shoulder Arthroplasty For Osteoarthritis Research Articles

Modeling highly crosslinked polyethylene vs. non–highly crosslinked polyethylene glenoid revision rates for anatomic shoulder arthroplasty in osteoarthritis including differing polyethylene glenoid fixation designs

BackgroundWe compared anatomic total shoulder arthroplasty (aTSA) for osteoarthritis to both highly crosslinked polyethylene (XLPE) and non–highly crosslinked polyethylene (non-XLPE) to determine the rate of revision for multiple patient and implant characteristics, modeling the effect of variation in glenoid fixation design (glenoid component type). MethodsData from a large national arthroplasty registry were analyzed for the period April 16, 2004, to December 31, 2022. The study population included all primary aTSA (stemmed and stemless shoulder arthroplasty) procedures with a primary diagnosis of osteoarthritis and performed using prostheses in current use. These procedures were grouped into 2 cohorts: all polyethylene-bearing glenoid components with either XLPE or non-XLPE. The cumulative percent revision was determined using Kaplan–Meier estimates of survivorship and hazard ratios from Cox proportional hazard models adjusted for age, sex, humeral head size, humeral fixation, type of primary (total stemmed or stemless anatomic), glenoid component type (modular and nonmodular metal-backed glenoid, cemented polyethylene glenoid, and polyethylene glenoid with modified central peg), and surgeon volume (after 2008). Possible interactions were examined. A subanalysis from January 1, 2017, captured the additional patient demographics of American Society of Anesthesiologists score, body mass index, and glenoid morphology. ResultsOf 11,003 aTSA procedures, the cumulative percent revision at 14 years for all XLPE glenoids (n = 3865) was 5.8% (95% confidence interval [CI] 3.9, 8.7), and 18.7% (95% CI 16.6, 21.0) for non-XLPE (n = 7138). XLPE had a lower rate of revision from 2 years (non-XLPE vs. XLPE 2 years + hazard ratio = 1.66, (95% CI 1.09, 2.53), P = .018) adjusting for age, sex, humeral head size, type of primary, humeral stem fixation, and glenoid component type. Overall, glenoid component type and polyethylene type were strongly associated (P < .001 and P = .021, respectively) with all-cause aTSA revision rates. The difference between non-XLPE and XLPE is observed across all polyethylene glenoid types. When considering procedures performed between 2017 and 2022, XLPE vs. non-XLPE rates of revision were not significantly different with extended adjustment at subanalysis, but loosening did not predominate for non-XLPE until year 6 of follow-up. ConclusionBoth the glenoid design and the type of polyethylene predict the revision rate for aTSA. However, the relative rates of revision between glenoid designs did not differ with polyethylene type. While the polyethylene type was not associated with aTSA revision rates in a more contemporary analysis, the incidence of loosening in non-XLPE prostheses combinations was higher from 6 years may explain this.

Reverse Shoulder Arthroplasty in Osteoarthritis Evaluation of the Results.

The aging structure of society results in a growing need for treatment of shoulder osteoarthritis. Reverse shoulder arthroplasty (RSA) has been developed to improve the motor function and strength of the shoulder joint without increasing the risk of dislocation. The aim of the study was to assess the change in quality of life and functional assessment of the shoulder joint after RSA in patients with osteoarthritis, based on the Oxford Shoulder Score (OSS) and an assessment of joint mobility parameters. A total of 10 patients were admitted to our centre for shoulder arthroplasty between August 2020 and October 2021. The assessment of the degenerative changes was based on the Walch classification and the Samelson &amp; Prieto classification. The OSS questionnaire was used to assess function of the affected shoulder joint and pain in each patient. The range of motion in the shoulder joint was assessed in the pre- and postoperative period. A follow-up examination was performed approximately 6 months after surgery. Analysis of the OSS scores revealed a mean value of 46 points preoperatively and 25 points postoperatively. The OSS scores six months after the procedure were an average of 20.5 points lower. A statistically significant improvement was noted in shoulder flexion (mean 37), abduction (42), external rotation (34), and internal rotation (5)(p&lt;0.05). Each patient reported reduced pain and demonstrated an increased range of motion in the affected shoulder joint and functional improvement.

Risk factors for postoperative blood transfusion after shoulder arthroplasty.

To identify the effect of surgical indication, patient factors, and perioperative characteristics on transfusion after shoulder arthroplasty (SA). Shoulder arthroplasties for osteoarthritis (OA) (N = 47), rotator cuff arthropathy (RCA) (N = 50), fracture (N = 76), revision (N = 66), and periprosthetic joint infection (PJI) (N = 35) performed at a single institution during a 6-year period were included. All other indications were excluded. Patient-based and surgical risk factors, including surgical indication, for postoperative allogeneic red blood cell transfusion were assessed with multivariate logistic regression analysis. A total of 274 SAs were included; transfusions were performed in 2% (2/97) of primary SAs for OA or RCA. Increased transfusion rates occurred in PJI (23%, p = 0.0006) and fracture (18%, p = 0.0018) cases. The mean preoperative hemoglobin (Hgb) was 12.2 ± 2.2 with PJI, 12.0 ± 2.1 with fracture, and 13.3 ± 1.6 g/dL for all other SAs. Independent risk factors for transfusion included lower preoperative hemoglobin (p < 0.001), PJI indication (p = 0.008), and fracture indication (p = 0.02), with no difference for fracture greater or less than 4 weeks old (p = 0.53). Risk factors for allogeneic red blood cell transfusion after SA were low preoperative hemoglobin and procedures for PJI or fracture.Level of Evidence: Level III, retrospective case-control study.

Shoulder Arthroplasty for a Fracture Is Not the Same as Shoulder Arthroplasty for Osteoarthritis: Implications for a Bundled Payment Model.

The Center for Medicare Services currently bundles all shoulder arthroplasties, total shoulder arthroplasty and reverse total shoulder arthroplasty, into one Diagnosis-Related Group on which bundled reimbursements are then further characterized. An arthroplasty performed for traumatic indications, such as fractures, may have a different postoperative course of care compared with the one being done for degenerative arthritis/osteoarthritis (OA), despite having the same Current Procedural Terminology (CPT) and Diagnosis-related Group code. The 2012 to 2016 American College of Surgeons-National Surgical Quality Improvement Program databases were queried using CPT-23472 to retrieve records of patients undergoing total shoulder arthroplasty/reverse total shoulder arthroplasty for degenerative arthritis/OA or proximal humerus fracture. A total of 8,283 (92.5%) and 667 (7.5%) patients underwent a shoulder arthroplasty for OA and proximal humeral fracture, respectively. After adjustment, the fracture group was associated with a higher risk for a longer length of stay of >2 days (P < 0.001), 30-day surgical complications (P = 0.005), revision surgeries within 30 days (P = 0.008), 30-day medical complications (P < 0.001), pulmonary embolism (P = 0.013), postoperative transfusions (P < 0.001), non-home discharge (P < 0.001), and 30-day readmissions (P < 0.001). Shoulder arthroplasty is associated with higher resource utilization when this procedure is performed for a fracture. As we move toward the era of bundled payment models, an appropriate risk adjustment based on the indication of surgery should be promoted to maintain the quality of care for all patients.

Low preoperative Constant score is a negative predictive factor for postoperative proprioception after total shoulder arthroplasty in osteoarthritis.

Shoulder proprioception in patients with glenohumeral osteoarthritis and the effect of total shoulder arthroplasty (TSA) on proprioception have been evaluated previously. Measuring proprioception with an active angle reproduction (AAR) test, proprioception remained unchanged or deteriorated in a short follow-up period after shoulder replacement. Therefore, the purpose of this prospective study was to evaluate the influence of the preoperative Constant score (CS) on postoperative proprioceptive outcome after TSA in patients with primary osteoarthritis to address the question of whether the preoperative state of shoulder function influences postoperative proprioceptive outcome. Twenty-four patients who received total shoulder arthroplasty (TSA) (n=24) for primary osteoarthritis of the shoulder were enrolled. After retrospectively analyzing the preoperative CS for 120 patients with primary osteoarthritis of the shoulder who received TSA, the patient group was divided into three subgroups according to preoperative functional assessment of the shoulder using the CS. Group one consisted of patients with CS<20, group two patients with CS 20-30, and group three patients with the best preoperative CS (>30). In all patients proprioception was examined 1day before the operation and 3months after surgery by 3D motion analysis with an AAR test and also CS. Postoperatively, proprioception in group one (CS<20) deteriorated significantly from 5.2° (SD 2.2) to 8.1° (SD 1.8); p=0.018. In group two, there were no significant changes from preoperative to postoperative status [8.7° (SD 2.1) vs. 9.3° (SD 2.7) (p=0.554)], likewise in group three [6.3° (SD 2.3) preoperatively vs. 6.9° (SD 3.3) postoperatively (p=0.617)]. Comparing the postoperative results, the best proprioception [6.9° (SD 3.3)] was found in the group that had the best preoperative CS (group three, CS>30). In conclusion, a low preoperative CS is a negative predictive factor for postoperative proprioception after TSA. We should keep that in mind when determining the best timepoint for shoulder replacement in patients with glenohumeral osteoarthritis.

Complications of shoulder arthroplasty for osteoarthritis with posterior glenoid wear

BackgroundAnatomical total shoulder arthroplasty (TSA) for glenohumeral osteoarthritis (OA) and severe posterior glenoid wear may entail early postoperative complications (recurrence of posterior subluxation, glenoid loosening). To avoid these mechanical problems, reverse shoulder arthroplasty (RSA) has recently been proposed, mainly for its intrinsic stability. Our purpose was to present the results of TSA and RSA in glenohumeral OA with posterior glenoid wear of at least 20°. HypothesisBy virtue of its constrained design, RSA could prevent recurrence of posterior subluxation and limit the occurrence of mechanical complications. Materials and methodsA consecutive series of 23 patients (27 shoulders) were treated for glenohumeral OA with total shoulder prostheses: 19 TSAs and 8 RSAs. Mean age was 70years (range, 47–85years), mean retroversion angle 28° (20°–50°) and mean subluxation index 74% (57–89%). Constant Score, Subjective Shoulder Value (SSV), QuickDASH and Simple Shoulder Test (SST) were measured, and radiological examinations were performed at a mean follow-up of 52months (24–95months). ResultsTSA and RSA patients respectively displayed Constant Scores of 65 and 65, SSV of 79% and 74%, QuickDASH of 16 and 27, and SST of 88 and 78. Two patients underwent surgical revision of TSA because of glenoid loosening; 52% of TSA patients presented complete radiolucent lines and 11% recurrence of posterior subluxation. ConclusionComplications are frequently observed after shoulder arthroplasty for OA with severe glenoid retroversion. RSA could be an alternative to TSA for selected patients, independently of rotator cuff status. Studies on RSA in this specific indication with longer follow-up are now needed. Level of evidenceLevel IV; retrospective case series.

Osteoarthritis: Overcoming the Slippery Slope

Shoulder arthroplasty for osteoarthritis can be challenging because of eccentric posterior wear of the glenoid, glenoid retroversion, and concomitant posterior subluxation of the humeral head. Various techniques are available to restore a centered head: anterior capsulectomy, preferential anterior glenoid reaming, offset humeral head components, anteversion of the humeral component, posterior capsule plication sutures, and the use of a dual-radius glenoid prosthesis, in which the internal (articular) radius is designed to match the curvature of the humeral head prosthesis, while the external (nonarticular) radius corresponds to the overall size of the glenoid.

Shoulder Arthroplasty versus Hip and Knee Arthroplasties

Although outcomes of shoulder, hip, and knee arthroplasties have been well-described, there have been no studies directly comparing the outcomes of these procedures as treatments for osteoarthritis. We compared the inpatient mortality, complications, length of stay, and total charges of patients who had shoulder arthroplasty for osteoarthritis with those of patients who had hip and knee arthroplasties for osteoarthritis. A review of the Maryland Health Services Cost Review Commission discharge database identified 994 shoulder arthroplasties, 15,414 hip arthroplasties, and 34,471 knee arthroplasties performed for osteoarthritis from 1994 to 2001. There were no in-hospital deaths after shoulder arthroplasty, whereas 27 (0.18%) and 54 (0.16%) deaths occurred after hip and knee arthroplasties, respectively. Compared with patients who had hip or knee arthroplasties, patients who had shoulder arthroplasties had, on average, a lower complication rate, a shorter length of stay, and fewer total charges. The latter had 1/2 as many in-hospital complications, were 1/6 as likely to have a length of stay 6 days or greater, and were 1/10 as likely to be charged more than $15,000. We believe shoulder arthroplasty is as safe as the more commonly performed major joint arthroplasties.