Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease

Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty (TSA). Patients and Methods In this prospective study, we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively. There were 31 women and 32 men; their mean age was 71 years (53 to 89). The pain threshold, which was measured using a Pain Matcher (PM) unit, the degree of pain (visual analogue scale at rest and on exertion, and function using the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded preoperatively, as well as three and 12 months postoperatively. Results We found an inverse relationship between both the preoperative PM threshold and pain (VAS) at rest and the 12-month postoperative QuickDASH score (Pearson correlation coefficient (r) ≥ 0.4, p < 0.05). A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain (VAS) at rest were the only factors associated with the QuickDASH score at 12 months. Conclusion These findings indicate the importance of central sensitization in the restoration of function after TSA. Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients. Cite this article: Bone Joint J 2018;100-B:480–4.

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Comparison of Methods to Predict Scapular Notching From Radiographs After Reverse Total Shoulder Arthroplasty

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80194 ◽

2012 ◽

Author(s):

Heath B. Henninger ◽

Michael D. Harris ◽

Kristen R. Petersen ◽

Robert T. Burks ◽

Robert Z. Tashjian

Keyword(s):

Bone Loss ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

A Priori ◽

Stress Shielding ◽

Reverse Total Shoulder Arthroplasty ◽

Scapular Notching ◽

Implant Placement ◽

And Function ◽

Reverse Total Shoulder

Scapular notching is a complication of reverse total shoulder arthroplasty (rTSA) that results in bone loss on the lateral border of the scapula. Notching has been reported in up to 86% of patients at 5 year follow-up [1], and is graded 1–4 as a function of progressive bone loss [2]. Notching may arise from impingement, erosion, periprosthetic osteolysis, stress shielding or a combination of these [1]. Glenosphere position can mitigate notching by limiting hardware impingement [3–5], but may increase the forces required to abduct the arm [6]. Clinicians might optimize patient range of motion and function via implant placement if susceptibility to notching was known a-priori.

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Influence of Humeral Version and Deltoid Tension on Glenohumeral Kinematics After Reverse Total Shoulder Arthroplasty

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53323 ◽

2011 ◽

Author(s):

Heath B. Henninger ◽

Alexej Barg ◽

Robert Z. Tashjian ◽

Robert T. Burks ◽

Kent N. Bachus ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Outcome Measures ◽

Shoulder Arthroplasty ◽

Surgical Intervention ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

And Function ◽

Reverse Total Shoulder

Reverse total shoulder arthroplasty (rTSA) is used to improve pain and function in arthritic, rotator cuff deficient shoulders. Surgical intervention is considered successful if range of motion and stability of the joint is maximized and force to abduct the arm is minimized. Implant hardware positioning may affect these outcome measures.

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Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

Journal of Orthopaedic Surgery ◽

10.1177/2309499018768570 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901876857 ◽

Cited By ~ 4

Author(s):

Eduard Alentorn-Geli ◽

Nathan R Wanderman ◽

Andrew T Assenmacher ◽

John W Sperling ◽

Robert H Cofield ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Simple Shoulder Test ◽

Posterior Subluxation ◽

The Mean ◽

Group 2 ◽

And Function ◽

Group 1

Purpose: To compare the outcomes of total shoulder arthroplasty (TSA) with posterior capsule plication (PCP) and reverse shoulder arthroplasty (RSA) in patients with primary osteoarthritis, posterior subluxation, and bone loss (Walch B2). Patients and methods: All shoulders undergoing anatomic TSA with PCP were retrospectively identified (group 1, G1) and compared to shoulders undergoing RSA (group 2, G2) for Walch B2 osteoarthritis. There were 15 patients in G1 (mean (SD) age and follow-up of 70.5 (7.5) years and 42.8 (18.4) months, respectively) and 16 patients in G2 (mean (SD) age and follow-up of 72.6 (5.4) years and 35.1 (14.2) months, respectively). Results: Both groups had substantial improvements in pain and function. In G1, results were excellent in 80% and satisfactory in 20%, compared to 81% and 6% in G2, respectively ( p = 0.2). The mean (SD) American Shoulder and Elbow Surgeons score was 91.2 (6.7) and 80.3 (14.3) in G1 and G2, respectively ( p = 0.08). The mean Simple Shoulder Test score was 10.6 in G1 and 8.5 in G2 ( p = 0.01). There were no reoperations in either group, but G1 had seven postoperative complications. Conclusions: The outcomes of TSA with PCP are comparable to RSA in patients with osteoarthritis and biconcave glenoids. However, TSA leads to more complications while RSA leads to lower functional outcomes.

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Anatomic Total Shoulder Arthroplasty Using a Self-Pressurizing Pegged Bone-Preserving Cemented Glenoid Component: A 2- to 5-Year Follow-up Study

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549217750478 ◽

2018 ◽

Vol 2 ◽

pp. 247154921775047

Author(s):

Joaquin Sanchez-Sotelo ◽

Ngoc Tram V Nguyen ◽

Mark Morrey

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Total Shoulder Arthroplasty ◽

Loose Body ◽

Deep Infection ◽

Glenoid Component ◽

Total Shoulder Arthroplasties ◽

Shoulder Arthroplasties ◽

And Function

Background: High rates of radiographic loosening have been reported with various glenoid designs. Many available designs sacrifice most of the bone at the central portion of the glenoid vault, creating large areas of deficiency when revision becomes necessary. The purpose of this study was to report the 2- to 5-year outcome of shoulder arthroplasty using a bone-preserving all-polyethylene glenoid components with self-pressurizing pegs. Methods: Between August 2011 and December 2014, 202 consecutive anatomic total shoulder arthroplasties (TSAs) were performed by a single surgeon with implantation of a self-pressurizing cemented pegged glenoid component in 190 patients (12 patients had both shoulders replaced). Patients were followed up prospectively and evaluated for pain, motion, strength, American Shoulder and Elbow Surgeons (ASES) scores, and radiographic changes. The mean follow-up time was 2.7 (2–5) years. Results: TSA improved pain and function reliably. At the most recent follow-up, 94% of the shoulders had no or mild pain. Motion included 154 ± 25° of elevation, 68 ± 18° of external rotation, and median internal rotation to T10 (range, iliac crest to T4). The most recent average ASES score was 82 ± 15 points. Early postoperative radiographs showed no radiolucent lines. No humeral or glenoid component was considered radiographically loose at the most recent follow-up. Complications requiring reoperation included subscapularis insufficiency (4), posterior instability (2), deep infection (1), stiffness (1), and a painful loose body (1). No components were revised for loosening. Conclusions: Anatomic TSA using a cemented bone-preserving all-polyethylene pegged self-pressurizing glenoid component provided satisfactory clinical outcomes and survival at 2 to 5 years.

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Total Shoulder Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001105010106 ◽

2011 ◽

Vol 5 (1) ◽

pp. 106-114 ◽

Cited By ~ 28

Author(s):

Joaquin Sanchez-Sotelo

Keyword(s):

Shoulder Arthroplasty ◽

Soft Tissues ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Inflammatory Arthropathy ◽

Wide Range ◽

The Subject ◽

Humerus Fractures ◽

And Function

Shoulder arthroplasty has been the subject of marked advances over the last few years. Modern implants provide a wide range of options, including resurfacing of the humeral head, anatomic hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty and trauma-specific implants for fractures and nonunions. Most humeral components achieve successful long-term fixation without bone cement. Cemented all-polyethylene glenoid components remain the standard for anatomic total shoulder arthroplasty. The results of shoulder arthroplasty vary depending on the underlying diagnosis, the condition of the soft-tissues, and the type of reconstruction. Total shoulder arthroplasty seems to provide the best outcome for patients with osteoarthritis and inflammatory arthropathy. The outcome of hemiarthroplasty for proximal humerus fractures is somewhat unpredictable, though it seems to have improved with the use of fracture-specific designs, more attention to tuberosity repair, and the selective use of reverse arthroplasty, as well as a shift in indications towards internal fixation. Reverse shoulder arthroplasty has become extremely popular for patients with cuff-tear arthropathy, and its indications have been expanded to the field of revision surgery. Overall, shoulder arthroplasty is a very successful procedure with predictable pain relief and substantial improvements in motion and function.

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Subscapularis Management in Total Shoulder Arthroplasty: Current Evidence Comparing Peel, Osteotomy, and Tenotomy

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549218807772 ◽

2018 ◽

Vol 2 ◽

pp. 247154921880777 ◽

Cited By ~ 1

Author(s):

Troy D Bornes ◽

Meaghan D Rollins ◽

Peter LC Lapner ◽

Martin J Bouliane

Keyword(s):

Shoulder Arthroplasty ◽

Controlled Trial ◽

Total Shoulder Arthroplasty ◽

Current Evidence ◽

Management Options ◽

Level Of Evidence ◽

Lesser Tuberosity ◽

Optimal Approach ◽

Improved Function ◽

And Function

The optimal approach to management of the subscapularis in total shoulder arthroplasty (TSA) is controversial. Options include the subscapularis tenotomy, lesser tuberosity osteotomy (LTO), and peel. This review provides a summary of subscapularis anatomy and function, outcomes associated with subscapularis management options in TSA, and postoperative subscapularis deficiency. Based on the available literature, LTO appears to result in improved function and subscapularis integrity relative to tenotomy, while peel and LTO have generally led to equivalent outcomes. The highest level of evidence to date is derived from a randomized controlled trial that demonstrated that outcomes following peel and LTO were not significantly different. There is currently a paucity of high-quality evidence as most studies have consisted of small retrospective series with varying outcome measures. Furthermore, the optimal approach to establishing the diagnosis of subscapularis deficiency following TSA is unclear.

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