scholarly journals Shoulder arthroplasty in patients with upper extremity lymphedema may result in transient or permanent lymphedema worsening

2019 ◽  
Vol 12 (1_suppl) ◽  
pp. 53-60
Author(s):  
Julia Lee ◽  
Ngoc Tram V Nguyen ◽  
Dave Shukla ◽  
John W Sperling ◽  
Robert H Cofield ◽  
...  
Keyword(s):  
Lymph Node ◽  
Breast Carcinoma ◽  
Upper Extremity ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Deep Infection ◽  
Node Dissection ◽  
Superficial Infection ◽  
Glenoid Loosening

Introduction Upper extremity lymphedema can complicate mastectomy, lymph node dissection, and radiation. The purpose of this study is to present the outcomes of shoulder arthroplasty in patients with lymphedema. Methods The 19 shoulders with a shoulder arthroplasty and lymphedema on the surgical side (6 anatomic, 12 reverse, 1 hemiarthroplasty) were followed for four years (1–10 years). There were 2 males and 17 females; average age was 67.8 (48–86) years. Breast carcinoma was the most common reason for lymphedema (75%). A dedicated lymphedema questionnaire could be completed for 14 shoulders. Results Pain improved from moderate or severe preoperatively to no or mild in 18 shoulders. Motion improved in elevation (55° preoperatively, 107° at last follow-up), external rotation (14°, 43°), and internal rotation (sacrum, L5). Complications included an acromion stress fracture with a deep infection (1), deep infection (1), superficial infection (1), and glenoid loosening (1). Lymphedema worsened in nine cases, but worsening was permanent in only four. Currently, lymphedema treatment is being performed by 93% of survey respondents. No patients reported lymphangitis or lymphangiosarcoma. Conclusion Shoulder arthroplasty for an upper extremity with lymphedema provides substantial improvements in pain and motion; however, infection is a concerning complication. Fifty percent of the patients will experience worsening of their lymphedema and in 20% worsening may be permanent.

scholarly journals Glenoid loosening and migration in reverse shoulder arthroplasty

2019 ◽  
Vol 101-B (4) ◽  
pp. 461-469 ◽  
Author(s):  
A. Lädermann ◽  
A. J. Schwitzguebel ◽  
T. B. Edwards ◽  
A. Godeneche ◽  
L. Favard ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Multivariable Analysis ◽  
Range Of Movement ◽  
Original Cohort ◽  
Glenoid Loosening

Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.

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

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.

Minimum five-year outcomes of reverse total shoulder arthroplasty using a trabecular metal glenoid base plate

2021 ◽  
Vol 103-B (8) ◽  
pp. 1333-1338
Author(s):  
Pradeep Kankanalu ◽  
Zakk M. Borton ◽  
Marie L. Morgan ◽  
Tim Cresswell ◽  
Marius P. Espag ◽  
...  
Keyword(s):  
At Risk ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Base Plate ◽  
Reverse Total Shoulder Arthroplasty ◽  
Trabecular Metal ◽  
Reverse Total Shoulder ◽  
Glenoid Loosening

Aims Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes. Methods All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up. Results The implant was revised in ten shoulders (5.2%) with a median time to revision of 21.2 months (interquartile range (IQR) 9.9 to 41.8). The Kaplan-Meier survivorship estimate at seven years was 95.9% (95% confidence interval (CI) 91.7 to 98; 35 RTSAs at risk) for aseptic mechanical failure of the glenoid and 94.8% (95% CI 77.5 to 96.3; 35 RTSAs at risk) for all-cause revision. Minimum five-year clinical and radiological outcomes were available for 103 and 98 RTSAs respectively with a median follow-up time of six years (IQR 5.2 to 7.0). Median postoperative Oxford Shoulder Score was 38 (IQR 31 to 45); median Constant and Murley score was 60 (IQR 47.5 to 70); median forward flexion 115° (IQR 100° to 125°); median abduction 95° (IQR 80° to 120°); and external rotation 25° (IQR 15° to 40°) Scapular notching was seen in 62 RTSAs (63.2%). Conclusion We present the largest and longest-term series of TM-backed glenoid implants demonstrating 94.8% all-cause survivorship at seven years. Specifically pertaining to glenoid loosening, survival of the implant increased to 95.9%. In addition, we report satisfactory minimum five-year clinical and radiological outcomes. Cite this article: Bone Joint J 2021;103-B(8):1333–1338.

Rapid growth of myxoid leiomyosarcoma of the vulva during pregnancy: a case report

2004 ◽  
Vol 14 (1) ◽  
pp. 172-175 ◽  
Author(s):  
A. R. Di Gilio ◽  
G. Cormio ◽  
L. Resta ◽  
C. Carriero ◽  
V. Loizzi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Smooth Muscle ◽  
Case Report ◽  
Lymph Node ◽  
Cesarean Section ◽  
Recurrent Disease ◽  
Node Dissection ◽  
Smooth Muscle Tumors ◽  
Vulvar Mass

Smooth muscle tumors arising in the vulva are rare. Leiomyosarcoma is the most common variant of vulvar sarcoma, and very few cases have been reported during pregnancy. A 36-year-old woman presented with a progressively enlarging vulvar mass during pregnancy, diagnosed as a Bartholin's gland cyst. The lesion was resected at 38 weeks of gestation during cesarean section and diagnosis of myxoid leiomyosarcoma of the vulva was made. Six weeks later the patients were referred to our center and submitted to wide vulvar excision with groin lymph node dissection that revealed the presence of a small residual focus of leiomyosarcoma. At 30 months of follow-up the patient was well without any sign of recurrent disease. Leiomyosarcoma should be included in the differential diagnosis of vulvar masses; progressively enlarging vulvar lesion should be biopsied even during pregnancy. Leiomyosarcoma should be considered in the differential diagnosis of vulvar mass.

scholarly journals Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Paolo Ceccarini ◽  
Rosario Petruccelli ◽  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Auro Caraffa
Keyword(s):  
Wound Dehiscence ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Bone Union ◽  
Wound Complications ◽  
Fisher Exact Test ◽  
Superficial Infection ◽  
Operative Care ◽  
Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

Isolated same-basin lymph node recurrence after precision lymph node excision for clinically evident melanoma metastasis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9576-9576
Author(s):  
Kevin Lynch ◽  
Yinin Hu ◽  
Norma Farrow ◽  
Yun Song ◽  
Max Meneveau ◽  
...  
Keyword(s):  
Lymph Node ◽  
Disease Control ◽  
Lymph Node Dissection ◽  
Patient Preference ◽  
Distant Metastases ◽  
Node Dissection ◽  
Melanoma Patients ◽  
Regional Disease ◽  
In Transit

9576 Background: While management of the nodal basin for melanoma has largely moved to observation for microscopic sentinel lymph node (SLN) metastasis, complete lymph node dissection (CLND) remains the current standard of care for melanoma patients with macroscopic, clinically detectable lymph node metastases (cLN). As CLND is associated with high surgical morbidity, we sought to study whether cLN may be safely managed by excision of only clinically abnormal nodes (precision lymph node dissection, PLND). Currently, a small subset of patients with cLN do not undergo CLND because of frailty or patient preference. We hypothesized that in these selected patients, PLND would provide acceptable regional control rates. Methods: Retrospective chart review was conducted at four academic tertiary care hospitals to identify melanoma patients who underwent PLND for cLN. cLN were defined as palpable or radiographically abnormal nodes. Recurrences were categorized as local/in-transit, same-basin lymph node, or distal lymph node/visceral. The primary outcome was isolated same-basin recurrence after PLND. Results: Twenty-one patients underwent PLND for cLN without synchronous distant metastases (characteristics of primary lesions summarized in Table). Reasons for forgoing CLND included patient preference (n=8), imaging indeterminate for distant metastases (n=2), comorbidities (n=4), loss to follow up (n=1), partial response to checkpoint blockade (n=1), or not reported (n=5). The inguinal node basin was the most common site (n=10), followed by the axillary (n=8) and cervical basins (n=3). A median of 2 nodes were resected at PLND, and 68% of resected nodes were positive for melanoma (median: 1, range: 1-3 nodes). Median follow-up was 23 months from PLND, and recurrence was observed in 28.6% of patients overall. Only 1 patient (4.8%) developed an isolated same-basin recurrence. The 3-year cumulative incidence of isolated same-basin recurrence was 5.3%, while risk of isolated local/in-transit recurrence or distant basin/visceral metastasis were 19.8% and 33.3%, respectively. Complications from PLND were reported in 1 patient (4.8%) and were limited to post-operative seroma and lymphedema. Conclusions: These pilot data suggest that PLND may offer acceptable regional disease control for cLN. Post-operative morbidity from PLND was also low, raising the possibility that PLND may provide adequate regional disease control without the morbidity associated with CLND. These data justify additional, prospective evaluation of PLND in selected patients.[Table: see text]

scholarly journals Overlap Anastomosis for Digestive Reconstruction during Laparoscopic Distal Gastrectomy with Intensive Regional Lymph Node Dissection: Physiological Impact of Preserving the Mesenteric Autonomic Nerves in the Lifted Jejunal Limb

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Taku Kitano ◽  
Daiki Yasukawa ◽  
Yuki Aisu ◽  
Tomohide Hori
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Distal Gastrectomy ◽  
Surgical Techniques ◽  
Laparoscopic Distal Gastrectomy ◽  
Autonomic Nerve ◽  
Autonomic Nerves ◽  
Node Dissection ◽  
Regional Lymph Node Dissection

Laparoscopic gastrectomy is a treatment for gastric cancer, and isoperistaltic side-to-side reconstruction is called “overlap anastomosis.” The physiological advantages of preserving the autonomic nerves in the jejunal limb for digestive reconstruction are well known. Here, we focused on overlap anastomosis with autonomic nerve-preserved mesojejunum of the lifted jejunal limb for laparoscopic distal gastrectomy with intentional lymph node dissection. Our surgical techniques and technical pitfalls were described in detail. The jejunum was partially sacrificed to preserve the autonomic nerves in the lifted jejunal limb. The length of the staple line was 35 – 40 mm. The endostapler entry was carefully closed to avoid even subtle stenosis. Twelve patients were retrospectively evaluated with a follow-up of 5.0 ± 0.6 years. Histological findings according to the Japanese classification were stage IA or IB. Dietary intake and postoperative ambulation occurred at 3.3 ± 1.0 and 1.3 ± 0.5 days after surgery, respectively. Postoperative complications according to Clavien–Dindo classification were one each of grade I and grade II. Postoperative hospital stay was 6.7 ± 1.6 days. Five patients were medication-free at final follow-up, with no recurrence in any patient. Overlap anastomosis with autonomic nerve-preserved jejunal limb was safe and feasible for laparoscopic distal gastrectomy with lymph node dissection.

scholarly journals Stewart–Treves syndrome: a case report

2013 ◽  
Vol 95 (5) ◽  
pp. e6-e8 ◽  
Author(s):  
DG McKeown ◽  
PJ Boland
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Early Treatment ◽  
Radical Mastectomy ◽  
Node Dissection ◽  
Modified Radical Mastectomy ◽  
Patient Death ◽  
Cutaneous Lesions ◽  
Chemotherapeutic Treatment

We present a case of chronic lymphoedema that progressed to Stewart–Treves syndrome in a 63-year-old woman with a previous modified radical mastectomy, associated lymph node dissection, chemotherapy and radiotherapy. While producing stabilisation of most cutaneous lesions initially, chemotherapeutic treatment of the angiosarcoma did not prevent subsequent metastasis and patient death. We urge vigilance and regular follow-up appointments for patients following a mastectomy with chronic lymphoedema to facilitate prevention or early treatment of this devastating syndrome.

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