Establishing thresholds for achievement of clinically significant satisfaction at two years following shoulder arthroplasty: the patient acceptable symptomatic state

2020 ◽  
Author(s):  
Evan M. Polce ◽  
Theodore S. Wolfson ◽  
William K. Skallerud ◽  
Bhargavi Maheshwer ◽  
Michael C. Fu ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Clinically Significant

Anatomic total shoulder arthroplasty in rheumatoid arthritis: A systematic review

2020 ◽  
pp. 175857322095415
Author(s):  
Ahmed Haleem ◽  
Ajaykumar Shanmugaraj ◽  
Nolan S. Horner ◽  
Timothy Leroux ◽  
Moin Khan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Significant Heterogeneity ◽  
Tissue Quality ◽  
Patient Reported ◽  
Clinically Significant ◽  
Reverse Total Shoulder

Purpose Given the poor soft-tissue quality in rheumatoid arthritis patients, many believe that rheumatoid arthritis should be treated with reverse total shoulder arthroplasty (rTSA). The purpose of this paper is to systematically assess outcomes of anatomic total shoulder arthroplasty (aTSA) in rheumatoid arthritis to determine if aTSA remains a viable option. Methods A comprehensive literature search was conducted identifying articles relevant to aTSA in the setting of rheumatoid arthritis with intact rotator cuff. Outcomes include clinical outcomes and rates of complication and revision. Results Ten studies were included with a total of 279 shoulders with mean follow-up of 116 ± 69 months. The mean age was 68 ± 10 years. Survivorship was 97%, 97% and 89% at 5, 10 and 20 years, respectively. The overall complication rate was 9%. Radiolucency was present in 69% of patients, of which 34% were at risk of loosening at 79 months. The overall rate of revision was 8.4%. Studies generally reported clinically significant improvements in range of motion, Constant score and ASES score. Conclusion aTSA in the rheumatoid patient results in improvements in range of motion and patient-reported outcomes. Rates of complications and survivorship are generally good in this population. However, it should be noted that there is significant heterogeneity in outcome reporting amongst the literature on this topic and that many studies fail to adequately report complication and revision rates. When compared to rTSA in patients with rheumatoid arthritis, evidence suggests that aTSA is still a viable treatment option despite the shift in utilization to rTSA.

Clinically significant subscapularis failure after anatomic shoulder arthroplasty: is it worth repairing?

2020 ◽  
Vol 29 (9) ◽  
pp. 1831-1835
Author(s):  
Vahid Entezari ◽  
Tyler Henry ◽  
Benjamin Zmistowski ◽  
Mihir Sheth ◽  
Thema Nicholson ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Clinically Significant

Single Assessment Numeric Evaluation (SANE) is a reliable metric to measure clinically significant improvements following shoulder arthroplasty

2019 ◽  
Vol 28 (11) ◽  
pp. 2238-2246 ◽  
Author(s):  
Anirudh K. Gowd ◽  
Michael D. Charles ◽  
Joseph N. Liu ◽  
Simon P. Lalehzarian ◽  
Brandon C. Cabarcas ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Clinically Significant

scholarly journals Accuracy of Humeral Implant Positioning Using a Canal-Sparing Total Shoulder Arthroplasty System

2019 ◽  
Vol 3 ◽  
pp. 247154921984483
Author(s):  
Eric S Baranek ◽  
David P Trofa ◽  
William N Levine ◽  
Steven S Goldberg
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Humeral Head Prosthesis ◽  
The Difference ◽  
Clinically Significant ◽  
Shoulder Arthroplasties ◽  
Improved Accuracy

Background Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as ΔCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canal-sparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with ΔCOR ≥3.0 mm were deemed clinically significant outliers. Results The average ΔCOR in the MPO group was 1.7 ± 1.2 mm versus 2.8 ± 1.5 mm in the stemmed group ( P = .00005). The incidence of outliers was lower (14.5% vs 40.0%, P = .005), and there were more cases with a ΔCOR ≤1.0 mm (32.7% vs 3.6%, P = .0001) in the MPO group compared to the stemmed group. Conclusion The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.

scholarly journals Glenoid vault perforation in total shoulder arthroplasty: Do we need computer guidance?

2019 ◽  
pp. 175857321988506
Author(s):  
Jennifer N Flynn ◽  
Malin Wijeratna ◽  
Matthew Evans ◽  
Steven Lee ◽  
David McD Taylor ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Bone Ingrowth ◽  
Total Shoulder Arthroplasty ◽  
Increased Risk ◽  
Potential Failure ◽  
Clinically Significant ◽  
Component Loosening ◽  
Bony Morphology ◽  
Computer Planning

The proliferation of computer 3D simulation and computer-generated guides is aimed at minimizing perforation of the glenoid vault by glenoid pegs in shoulder arthroplasty, based on assumptions that perforation leads to worse outcomes by component loosening and potential failure. We evaluated outcomes of glenoid peg perforation testing the assumption that perforation produces worse results. Eighty-three shoulders underwent shoulder arthroplasty with pegged hybrid fixation (bone-ingrowth flanged central glenoid peg and peripheral cemented pegs) without precision signal injector guides or use of 3D planning software. Outcomes were determined by American Shoulder and Elbow Score and Oxford Shoulder Score. Fine slice CT determined the presence of vault perforation and the extent of lucent lines at the prosthesis–bone interface and bony morphology of the vault perforation. Follow-up was 46.7 months (24–99). Seven shoulders (8%) demonstrated perforation of glenoid vault. Bony ingrowth and cortical overgrowth occurred despite perforation, with no clinically significant differences in clinical or radiological outcomes in shoulders with and without glenoid vault perforation. None of these patients underwent revision surgery. Despite not utilizing computer planning and/or guides, 92% of implants did not perforate the glenoid vault. However, glenoid vault perforation in our series produced excellent outcomes with no increased risk of revision as a result of glenoid vault perforation.

EM of human atherosclerosis: Aortic fatty streaks with transitional lesion features

1992 ◽  
Vol 50 (1) ◽  
pp. 622-623
Author(s):  
K. Florian Klemp ◽  
J.R. Guyton
Keyword(s):  
Foam Cell ◽  
Cell Formation ◽  
Processing Technique ◽  
Foam Cell Formation ◽  
Tissue Preparation ◽  
Electron Microscopic ◽  
Extracellular Lipid ◽  
Electron Microscopic Cytochemistry ◽  
Human Atherosclerosis ◽  
Clinically Significant

The earliest distinctive lesions in human atherosclerosis are fatty streaks (FS), characterized initially by lipid-laden foam cell formation. Fibrous plaques (FP), the clinically significant lesions, differ from FS in several respects. In addition to foam cells, the FP also exhibit fibromuscular proliferation and a necrotic core region rich in extracellular lipid. The possible transition of FS into mature FP has long been debated, however. A subset of FS described by Katz etal., was intermediate in lipid composition between ordinary FS and FP. We investigated this hypothesis by electron microscopic cytochemistry by employing a tissue processing technique previously described by our laboratory. Osmium-tannic acid-paraphenylenediamine (OTAP) tissue preparation enabled ultrastructural analysis of lipid deposits to discern features characteristic of mature fibrous plaques.

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