Effects of Chronic Kidney Disease on Perioperative and 180 Day Complication Rates Following Total Shoulder Arthroplasty

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

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Reverse total shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b.bjj-2020-2101 ◽

2021 ◽

pp. 1-9

Author(s):

Eleanor G. Burden ◽

Timothy J. Batten ◽

Christopher D. Smith ◽

Jonathan P. Evans

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Implant Design ◽

Complication Rates ◽

Scapular Notching ◽

Cuff Tear ◽

Patient Reported ◽

Reverse Total Shoulder

Aims This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. Conclusion This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design.

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Total Shoulder Arthroplasty versus Reverse Total Shoulder Arthroplasty: Outcome Comparison in Osteoarthritis patients with or without Concurrent Rotator Cuff Deficiency

10.21203/rs.3.rs-146668/v1 ◽

2021 ◽

Author(s):

Zeling Long ◽

Tony Chieh-Ting Huang ◽

Hanzhong Yu ◽

Wanchun Wang ◽

Yicun Wang

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Structural Damage ◽

Clinical Decision Making ◽

Total Shoulder Arthroplasty ◽

Economic Cost ◽

Reverse Total Shoulder Arthroplasty ◽

Complication Rates ◽

Rotator Cuff Deficiency ◽

Reverse Total Shoulder

Abstract BackgroundOsteoarthritis (OA) is a common shoulder disorder that impacts shoulder functions. Shoulder arthroplasty is often required to restore function and quality of life. Reverse total shoulder arthroplasty (RSA), which was originally designed mainly for irreparable rotator cuff damage, has gained popularity in recent years for the treatment of advanced shoulder OA instead of the clinically standard total shoulder arthroplasty (TSA). However, this RSA has some nonnegligible flaws such as higher complications rate and economic cost, not mention the following problems caused by irreversible physical structural damage. Therefore, the employment of RSA needs to be carefully considered.PurposeThis study aimed to compare TSA and RSA in OA patients with or without rotator cuff damage to better guide clinical decision making. We believe the radical use of RSA in patients without rotator cuff deficiency may cause more harm than good.Study designCross-sectional studyMethodsWe queried the Nationwide Inpatient Sample (NIS) database from 2011 to 2014 to collect information on OA patients who received TSA and RSA. Patients were divided into 2 groups of comparison according to the presence of rotator cuff deficiency and matched with propensity score analysis.Results A total of 57,156 shoulder arthroplasties were identified. RSA patients in the rotator cuff deficiency group had significant higher transfusion rates and longer hospital stays. RSA patients without rotator cuff deficiency had a statistically significantly higher number of implant-related mechanical complications, acute upper respiratory infections and postoperative pain. Overall, RSA incurred higher costs in both groups.ConclusionFor OA patients with rotator cuff deficiencies, RSA has its benefits as complication rates were comparable to TSA. For those patients without rotator cuff deficiencies, the use of RSA should be reconsidered as there were more complications with higher severity.

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The effect of subscapularis management technique on outcomes and complication rates following reverse total shoulder arthroplasty

Seminars in Arthroplasty ◽

10.1053/j.sart.2020.04.005 ◽

2020 ◽

Vol 30 (1) ◽

pp. 42-49

Author(s):

Jacob T. Hartline ◽

Tyler J. Brolin ◽

Jim Y. Wan ◽

Daniel T. Dibaba ◽

Frederick M. Azar ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Management Technique ◽

Complication Rates ◽

Reverse Total Shoulder

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Cemented humeral stem versus press-fit humeral stem in total shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b9.bjj-2018-1369.r1 ◽

2019 ◽

Vol 101-B (9) ◽

pp. 1107-1114 ◽

Cited By ~ 3

Author(s):

M. Uy ◽

J. Wang ◽

N. S. Horner ◽

A. Bedi ◽

T. Leroux ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Operative Time ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

A Priori ◽

Optimal Choice ◽

Complication Rates ◽

Press Fit ◽

Fixation Type

Aims The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). Materials and Methods A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis. Results There was a total of 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems. Exploratory meta-regression found that longer follow-up was a moderating variable for revision (p = 0.003). Conclusion Cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock. Cite this article: Bone Joint J 2019;101-B:1107–1114.

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Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates

Joints ◽

10.11138/jts/2015.3.2.072 ◽

2015 ◽

Vol 03 (02) ◽

pp. 72-77 ◽

Cited By ~ 9

Author(s):

Lorenzo Mattei ◽

Stefano Mortera ◽

Chiara Arrigoni ◽

Filippo Castoldi

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Scientific Community ◽

Total Shoulder Arthroplasty ◽

Persistent Pain ◽

Reverse Total Shoulder Arthroplasty ◽

Complication Rates ◽

Shoulder Replacement ◽

Reverse Total Shoulder ◽

Loss Of Strength

A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity.

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