Total Anatomic Shoulder Arthroplasty Research Articles

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.

Short-stem uncemented anatomical shoulder replacement for osteoarthritis in patients older than 70 years: is it appropriate?

BackgroundDespite a new trend to systematically use reverse shoulder arthroplasty (RSA) in elderly population regardless of the indication, total anatomical shoulder arthroplasty can get good functional results in this population. The purpose of this study was to evaluate clinical and radiological outcomes of uncemented short-stem anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis in patients older than 70 years and to compare these results to a matched population with an uncemented short-stem RSA.MethodsIn this retrospective monocentric study, clinical outcomes were based on constant score (Cst), subjective shoulder value (SSV) score, and range of motion. The aim of radiographic analysis was to identify glenoid component loosening and humeral bone remodeling around the uncemented short stem.ResultsAt an average follow-up of 44 ± 12.5 months, 32 uncemented short-stem TSA in 31 patients with a minimum of 2 years of follow-up were included and were compared to 32 uncemented RSA. Fifty three percent of the patients had “a forgotten prosthesis”. ROM was significantly improved in all cases. Cst reached 73 ± 9 pts and SSV 90 ± 10.8% (P < .001). In 8 patients with repairable supraspinatus tendon tears, clinical outcomes were not statistically different from patients with an intact rotator cuff: Cst (77 ± 6.2 points vs 72 ± 9.6 points, P = .3) and SSV (88 ± 11.5% vs. 91 ± 10.5%; P = .59). The type of glenoid wear (A vs B) did not influence the constant score: 73 ± 9 points versus 74 ± 11 points respectively; P = .81. Despite a complication rate of 6% (n = 2), no prosthesis revision was performed. At last follow-up, range of motion was better in the TSA group compared to the RSA group for internal (7.8 ± 1.3 vs 6.25 ± 2; P = .001) and external (47 ± 14 vs 24 ± 21; P < .001) rotations. The postoperative SSV score was also better in the TSA group (91.3 ± 10% vs 82.2 ± 13%; P = .002).ConclusionsAt medium-term, uncemented short-stem anatomic TSA in patients older than 70 years provided satisfactory clinical results. Patients have forgotten their prosthesis in over 50% of cases. This prosthetic design is still indicated in this patient population in case of primary osteoarthritis with a functional rotator cuff with an almost normal rotator cuff muscle trophicity.

Anatomic shoulder arthroplasty

Arthroplasty has become a reliable treatment for degenerative joint diseases of the shoulder. Implant designs have developed over the last 60 years to address the initial problems encountered in arthroplasty: restoration of function and implant loosening. Although reverse shoulder arthroplasty (RSA) has become the most commonly performed type of shoulder replacement in the UK, total anatomical shoulder arthroplasty (TSA) has remained as a well-established treatment for osteoarthritis in patients with a competent rotator cuff. Patients with osteoarthritis treated with TSA can nowadays expect a lasting, significant improvement in pain and function. Nonetheless, controversies exist regarding the indications for humeral hemiarthroplasty and the use of stemless prostheses and other, newer implant designs. Interestingly, changes in the design of glenoid components have not led to significant improvements in clinical performance with time, and cemented all-polyethylene components remain the most reliable option. Lower glenoid aseptic loosening rates are probably best achieved by optimizing the restoration of natural humeral head anatomy.

Short, Medium and Long Term Complications After Total Anatomical Shoulder Arthroplasty.

Total shoulder arthroplasty (TSA) is an effective approach for the treatment of a variety of clinical conditions affecting the shoulder, including osteoarthritis, inflammatory arthritis and osteonecrosis, and the number of TSA implanted has grown exponentially over the past decade. This review gives an update of the major complications, mainly infections, instability and loosening, encountered after TSA, based on a corpus of recent publications and a dynamic approach: The review focuses on the causes of glenoid loosening, which account for 80% of the complication, and underlines the importance of glenoid positioning in the recovery of early shouder function and in the long term survival rate of TSA.

Geometrical analysis of stemless shoulder arthroplasty: a radiological study of seventy TESS total shoulder prostheses.

The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy. This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint. Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1 ± 2 mm (range -3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was -1 ± 3 mm (range -9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was -3 ± 12° (range -26 to 20°). Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.

New design of a cementless glenoid component in unconstrained shoulder arthroplasty: a prospective medium-term analysis of 143 cases.

The uncemented glenoid implants in total anatomical shoulder arthroplasty are likely to be accused of problems like dissociations, secondary rotator cuff tear, and wear of polyethylene (PE). This work is a clinical and radiological prospective review of 143 cases of anatomical total shoulder arthroplasty using a new metal back uncemented glenoid implant (MB) in order to see if this new implant induces those complications. A total of 143 cases were operated between 2003 and 2011. In a first part, the whole series of 143 cases was radiologically studied in order to quantify the lateralisation induced by the MB implant. In a second study, 37 cases had a mean follow-up of 38 months (24–75, mean 32) and served for the clinical and radiological final study. Pre- and postoperative clinical evaluation was done using the Constant–Murley score and the simple shoulder test from Matsen. The final X-rays served to detect an eventual secondary narrowing of the joint space and to analyse the frequency of radio lucent lines (RLL) and loosenings. Despite a small radiological lateralisation in comparison with the normal contralateral side (0.36 cm, p = 0.02), the clinical results after 2 years were similar to the published cemented glenoid implants series but without any RLL, glenoid loosening or joint narrowing. Some dissociations occured in the beginning and definitely eliminated by a design modification of the PE tray. The discussion tried to show that, despite a still short follow-up, this series is encouraging to continue to use this new MB implant. Different applications of the concept of universality and conversion are discussed, this tray been also the support of a glenosphere in reverse arthroplasty.

The case for the metal-backed glenoid design in total anatomical shoulder arthroplasty

After 38 years of unchallenged reign of cemented full polyethylene glenoid implants, the main problem of anatomical shoulder arthroplasty is still glenoid loosening, also the main cause of failure. A certain concern regarding uncemented metal back components in total anatomical shoulder arthroplasty has developed, due to problems evoked in the literature. This work is a comprehensive bibliographical review of the different clinical and biomechanical studies of noncemented glenoid implants. Those publications often showed a high rate of failure of uncemented glenoid implants, but their arguments appeared often theoretical or based on old and/or nonadapted devices. In conclusion, the authors emphasise that research on new designs of metal back components needs to go on.