Clinical Outcomes and Durability of Reverse Arthroplasty with Modified L’Episcopo Transfer for Combined Loss of Active Elevation and External Rotation

2013 ◽  
Vol 22 (10) ◽  
pp. e35
Author(s):  
Walter B. McClelland ◽  
Adam Rumian ◽  
Yannick Roussane ◽  
Pascal Boileau
Keyword(s):  
Clinical Outcomes ◽  
External Rotation ◽  
Reverse Arthroplasty

scholarly journals Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Taku Ukai ◽  
Goro Ebihara ◽  
Masahiko Watanabe
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
External Rotation ◽  
Posterolateral Approach ◽  
Level Of Evidence ◽  
Total Hip ◽  
Hip Flexion ◽  
Primary Total Hip Arthroplasty

Abstract Background This study aims to evaluate postoperative pain and functional and clinical outcomes of anterolateral supine (ALS) and posterolateral (PL) approaches for primary total hip arthroplasty. Materials and methods We retrospectively examined the joints of 110 patients who underwent primary total hip arthroplasty (THA). The ALS group was compared with the PL group using the pain visual analog scale (VAS) and narcotic consumption as pain outcomes. Functional outcomes included postoperative range of motion (ROM) of hip flexion, day on which patients could perform straight leg raising (SLR), day on which patients began using a walker or cane, duration of hospital stay, rate of transfer, and strength of hip muscles. Clinical outcomes included pre and postoperative Harris Hip Scores. Results No significant differences were found in the pain VAS scores or narcotic consumption between the two groups. The PL group could perform SLR earlier than the ALS group (P < 0.01). The ALS group started using a cane earlier (P < 0.01) and had a shorter hospital stay (P < 0.01) than the PL group. Degrees of active ROM of flexion at postoperative day (POD) 1 were significantly lower in the ALS group than in the PL group (P < 0.01). Regarding hip muscle strength, hip flexion was significantly weaker in the ALS group than in the PL group until 1-month POD (P < 0.01). External rotation from 2 weeks to 6 months postoperatively was significantly weaker in the PL group than in the ALS group (P < 0.01). Conclusion The ALS approach was more beneficial than the PL approach because ALS enabled better functional recovery of the strength of external rotation, improved rehabilitation, and involved a shorter hospital stay. Level of Evidence Level IV retrospective observational study.

Postoperative excessive anterior acetabular coverage is associated with decrease in range of motion after periacetabular osteotomy

2020 ◽  
pp. 112070002091037 ◽  
Author(s):  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Nao Shibanuma ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Internal Rotation ◽  
Hip Dysplasia ◽  
External Rotation ◽  
Periacetabular Osteotomy ◽  
Femoral Anteversion ◽  
Acetabular Coverage ◽  
3 Dimensional ◽  
The Relationship

Purpose: The aim of this study was to evaluate the relationship between acetabular 3-dimensional (3D) alignment reorientation and clinical range of motion (ROM) after periacetabular osteotomy (PAO). Methods: 50 patients (58 hips) with hip dysplasia participated in the study and underwent curved PAO. The pre- and postoperative 3D centre-edge (CE) angles and femoral anteversion were measured and compared with clinical outcomes, including postoperative ROM. Results: The correlation between pre- and postoperative acetabular coverage and postoperative ROM was evaluated. Postoperative abduction and internal rotation ROM were significantly associated with postoperative lateral CE angles (abduction; p < 0.001, internal rotation; p = 0.028); flexion and internal rotation ROM was significantly associated with postoperative anterior CE angles (flexion; p < 0.001, internal rotation; p = 0.028). Femoral anteversion was negatively correlated with postoperative abduction ( p = 0.017) and external rotation ( p = 0.047) ROM. Conclusion: Postoperative anterior acetabular coverage may affect internal rotation ROM more than the lateral coverage. Therefore, the direction of acetabular reorientation should be carefully determined according to 3D alignment during PAO.

scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xueliang Cui ◽  
Hui Chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
External Rotation ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Head Height

Abstract Background Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001). Conclusion For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes. Trial registration ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

scholarly journals Arthroscopic Bankart Repair vs. Open Latarjet Procedure: A Comparative Study of Clinical and Functional Results.

2020 ◽  
Author(s):  
Binod Sherchan ◽  
Saroj Rai ◽  
Nira Tamang ◽  
Siddhartha Dhungana ◽  
Laxmi Kanta Sharma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Rotation ◽  
Operating Cost ◽  
Bankart Repair ◽  
Dash Score ◽  
Latarjet Procedure ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Quick Dash

Abstract Background The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and open Latarjet procedure for recurrent dislocation of the shoulder. Secondary aims were to assess and compare the cost-effectiveness, satisfaction and complications, including recurrence and infection. Methods We retrospectively evaluated the patients who underwent either arthroscopic Bankart repair with or without Remplissage procedure or open Latarjet procedure between May 2015 and May 2018. The preoperative data were collected from the hospital records, and the postoperative data were collected during the follow-up visit. At the final follow-up, 41(male=32, female=9) patients in the Bankart group and 40(male=34 and female=6) patients in the Latarjet group were included in the study. Clinical outcomes were assessed using the ASES score, Rowe score, and Quick DASH score. A self-constructed scale that consisted of satisfied and dissatisfied was used to measure the level of satisfaction. Any complications were recorded in every follow-up visit. Collected data were analyzed using SPSS version 25. Results There was no statistically significant difference regarding the age (p=0.401), gender (p=0.569), site of involvement (p=0.158), number of preoperative dislocations (p=0.085), follow-up (p=0.061), between the two groups. Similarly, no statistically significant difference existed regarding the ASES score (p=0.388), Rowe score (p=0.211), and Quick DASH score (p=0.713). The average external rotation was 83 degrees in the Bankart group and 85 degrees in the Latarjet group (p=0.140). Functional satisfaction was higher in the Laterjet group compared to the Bankart group (p=0.482). Hundred percent of the patients were cosmetically satisfied in the Bankart group, whereas only 32(80%) patients were cosmetically satisfied in the Latarjet group (p=0.002). There was a significantly higher operating cost for arthroscopic Bankart repair compared to open Latarjet procedure (p<0.001). Three patients had a recurrence in the Bankart group, whereas no recurrence occurred in the Latarjet group. And, 2 superficial infections occurred in the Latarjet group. Conclusion These results provide the fact that arthroscopic Bankart repair might be a fancy and minimally invasive procedure, Latarjet procedure should still be a priority in a developing country like Nepal, where financial cost is a huge burden.

Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

2020 ◽  
pp. 175857322091682
Author(s):  
John-Rudolph H Smith ◽  
Darby A Houck ◽  
Jessica A Hart ◽  
Jonathan T Bravman ◽  
Rachel M Frank ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
English Language ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

scholarly journals Arthroscopic Latarjet for Recurrent Shoulder Instability

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 582 ◽  
Author(s):  
Castricini ◽  
Longo ◽  
Petrillo ◽  
Candela ◽  
De Benedetto ◽  
...  
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
External Rotation ◽  
University Of California ◽  
Simple Shoulder Test ◽  
Recurrent Shoulder Instability ◽  
Arthroscopic Latarjet ◽  
Contralateral Shoulder

Background and Objectives: The all-arthroscopic Latarjet (aL) procedure was introduced to manage recurrent shoulder instability. Our study aimed to report the outcomes of aL procedures with the Rowe, University of California-Los Angeles (UCLA), simple shoulder test (SST) scores, and range of motion (ROM) in external rotation at a minimum follow-up of 2 years. Material and Methods: A total of 44 patients presenting recurrent shoulder instability were managed with aL procedure. Clinical outcomes were assessed at a mean follow-up of 29.6 ± 6.9 months. The postoperative active ROM was measured and compared with the contralateral shoulder. The Rowe, UCLA, and SST scores were administered preoperatively and postoperatively. Results: No patients experienced infections or neuro-vascular injuries. Seven (15%) patients required revision surgery. After surgery, the external rotation was statistically lower compared to the contralateral shoulder, but it improved; clinical outcomes also improved in a statistically significant fashion. Conclusions: The aL produced good results in the management of recurrent shoulder instability, but the complication rate was still high even in the hands of expert arthroscopist.

Posterolateral Corner Reconstruction Using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee

2018 ◽  
Vol 31 (10) ◽  
pp. 1031-1036 ◽  
Author(s):  
Jarret Woodmass ◽  
Thomas Sanders ◽  
Nick Johnson ◽  
Isabella Wu ◽  
Aaron Krych ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
External Rotation ◽  
Case Series ◽  
Posterolateral Corner ◽  
Rotational Instability ◽  
Level Of Evidence ◽  
Full Extension ◽  
Injured Knee

AbstractInjury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational instability. Multiple PLC reconstruction techniques have been described, including one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament knee injuries (MKLIs) with grade III varus instability. Patients were identified through a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up of 2 years were included. Patients were assessed for clinical laxity grade, range of motion, and functional outcomes using Lysholm and International Knee Documentation Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7 (range: 16–52) and a mean follow-up of 52.2 months (range: 24–93 months) were included. Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26, respectively. Mean range of motion was –1.1 to 122.8. In full extension, two patients (10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%) patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed PLC reconstruction can reliably restore varus stability when performed on patients with MLKIs and type C posterolateral instability with hyperextension external rotation recurvatum deformity. Satisfactory functional outcome scores were achieved in the majority of patients. This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series.

scholarly journals Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3014
Author(s):  
Katia Corona ◽  
Simone Cerciello ◽  
Gianluca Ciolli ◽  
Lorenzo Proietti ◽  
Riccardo D'Ambrosi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Subscapularis Tendon ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Reverse Total Shoulder

Introduction: Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated. The purpose of the present meta-analysis was to compare the outcomes of the primary lateralized RSAs with and without subscapularis repair in terms of range of motion, clinical outcomes, dislocations, and complications rate. Materials and Methods: A systematic literature search in MEDLINE (Pubmed), Embase, and the Cochrane Central Register of Controlled Trials database was carried up to December 2020. A data extraction form was developed to collect select data from the included studies. The methodological quality was assessed using a Methodological Index for Nonrandomized Studies (MINORS) score. Statistical analysis was performed with Review Manager (Version 5.4, The Cochrane Collaboration). Results: A total of four comparative studies involving 978 patients were included. In the pooled analysis, the reinsertion of the subscapularis yielded better functional outcomes in terms of the constant (P < 0.00001) and ASES (P = 0.002) scores. The forward elevation, external rotation at 0°, internal rotation, and dislocation rates were comparable between the two groups (P = n.s.), while statistically increased abduction was observed in those patients who did not have their subscapularis repaired (P < 0.00001). Conclusion: The results of the present findings suggest that it seems reasonable to reinsert the subscapularis whenever it is present, in good tissue conditions, and with no evidence of fatty degeneration of its muscle belly. Level of evidence: Level III meta-analysis

scholarly journals Clinical Outcomes of Revision Arthroscopic Capsulolabral Repair for Recurrent Anterior Shoulder Instability With Moderate Glenoid Bone Defects: A Comparison With Primary Surgery

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110598
Author(s):  
Young Dae Jeon ◽  
Hyong Suk Kim ◽  
Sung-Min Rhee ◽  
Myeong Gon Jeong ◽  
Joo Han Oh
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Shoulder Instability ◽  
External Rotation ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Primary Surgery ◽  
Significant Difference ◽  
Primary Groups

Background: The optimal revision surgery for failed primary arthroscopic capsulolabral repair (ACR) has yet to be determined. Revision ACR has shown promising results. Purpose: To compare the functional, strength, and radiological outcomes of revision ACR and primary ACR for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2007 and April 2017, a total of 85 patients underwent ACR (revision: n = 23; primary: n = 62). Functional outcome scores and positive apprehension signs were evaluated preoperatively, at 1 year, and then annually. Isokinetic internal and external rotation strengths were evaluated preoperatively and at 1 year after surgery. Results: The mean follow-up was 36.5 ± 10.2 months (range, 24-105 months). There was no significant difference between the revision and primary groups in the glenoid bone defect size at the time of surgery (17.3% ± 4.8% vs 15.4% ± 5.1%, respectively; P = .197). At the final follow-up, no significant differences were found in the American Shoulder and Elbow Surgeons score (97.6 ± 3.1 vs 98.0 ± 6.2, respectively; P = .573), Western Ontario Shoulder Instability Index score (636.7 ± 278.1 vs 551.1 ± 305.4, respectively; P = .584), or patients with a positive apprehension sign (17.4% [4/23] vs 11.3% [7/62], respectively; P = .479) between the revision and primary groups. There was no significant difference between the revision and primary groups for returning to sports at the same preoperative level (65.2% vs 80.6%, respectively; P = .136) and anatomic healing failure at 1 year after surgery (13.0% vs 3.2%, respectively; P = .120). Both groups recovered external rotation strength at 1 year after surgery (vs before surgery), although the strength was weaker than in the uninvolved shoulder. In the revision group, a larger glenoid bone defect was significantly related to a positive apprehension sign (22.0% ± 3.8%) vs a negative apprehension sign (16.0% ± 3.2%; cutoff = 20.5%; P = .003). Conclusion: In patients with moderate glenoid bone defect sizes (10%-25%), clinical outcomes after revision ACR were comparable to those after primary ACR. However, significant glenoid bone loss was related to a positive remaining apprehension sign in the revision group. Surgeons should consider these findings when selecting their revision strategy for patients with failed anterior shoulder stabilization.

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