Lack of elevation and external rotation in the shoulder: Reverse total shoulder arthroplasty combined with latissimus dorsi transfer to the humerus versus the greater tuberosity

2019 ◽  
pp. 175857321988404
Author(s):  
Manuel Zafra ◽  
Pilar Uceda ◽  
Francisco Muñoz ◽  
Carmen Ruiz-Bonilla ◽  
Pilar Font
Keyword(s):  
Latissimus Dorsi ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Greater Tuberosity ◽  
Latissimus Dorsi Transfer ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Reverse Total Shoulder

Background The purpose of this study was to prospectively compare clinical outcomes of reverse total shoulder arthroplasty (RTSA) combined with latissimus dorsi transfer by modified L’Episcopo (Group I) versus the greater tuberosity (Group II) in patients with lack of elevation and external rotation in the shoulder. Materials and methods Eighteen patients participated in the study. They were placed randomly into two groups of nine patients in each group. The results were evaluated prior to surgery and at the end follow-up. Results The average follow-up was 33.2 months. The mean ASES scores improved from 13 points to 79 in Group I and from 15 to 73 in Group II. The mean Constant shoulder scores improved from 19 to 66 in Group I and from 18 to 67 in Group II. Mean active elevation increased from 59° to 147° in Group I and from 58° to 148° in Group II. The mean external rotation scores increased from −43° to 7° in Group I and from −41° to 23° in Group II. Conclusion Comparing clinical outcomes and active elevation, there were no significant differences. The latissimus dorsi transfer to the greater tuberosity provided greater external rotation than did the modified L’Episcopo transfer.

Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer

2021 ◽  
pp. 175857322199634
Author(s):  
Akshar V Patel ◽  
Douglas J Matijakovich ◽  
Robert L Brochin ◽  
Ryley K Zastrow ◽  
Bradford O Parsons ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
P Value ◽  
Latissimus Dorsi Transfer ◽  
Reverse Total Shoulder

Background Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. Methods We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t-test and proportions using the Chi-square test. Results Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2–87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0–14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (−7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. Conclusions In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low. Level of evidence: IV; Case series.

scholarly journals Clinical Predictors for Optimal Forward Elevation in Primary Reverse Total Shoulder Arthroplasty

2019 ◽  
Vol 3 ◽  
pp. 247154921983152
Author(s):  
David R Sollaccio ◽  
Joseph J King ◽  
Aimee Struk ◽  
Kevin W Farmer ◽  
Thomas W Wright
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Univariate Analysis ◽  
Reverse Total Shoulder Arthroplasty ◽  
Clinical Patient ◽  
Group I ◽  
Group Ii ◽  
Reverse Total Shoulder ◽  
Shoulder Elevation

Background Few studies in the literature analyze clinical factors associated with superoptimal and suboptimal forward elevation in primary reverse total shoulder arthroplasty (RTSA). We investigate the functional outcome stratified by shoulder elevation 12 months after primary RTSA and its correlation with selected clinical patient factors. Methods We analyzed prospectively collected data within a comprehensive surgical database on patients who had undergone primary RTSA between June 2004 and June 2013. Two hundred eighty-six shoulders were stratified into 2 groups: group I for shoulders that had achieved at least 145° of active forward elevation 12 months postoperatively (90th percentile of active forward elevation, 29 shoulders) and group II for shoulders that never achieved at least 90° of active forward elevation 12 months postoperatively (10th percentile of active forward elevation, 28 shoulders). Statistical analysis associated independent clinical variables with postoperative motion using univariate analysis followed by logistic regression. Results Active shoulder elevation of at least 90° was achieved 12 months postoperatively in 259 subjects (90%). Upon comparison with group II (<90° elevation), subjects in group I (≥145° elevation) were found to have improved postoperative active elevation and relatively younger age, lower American Society of Anesthesiologists score, increased preoperative active elevation, increased shoulder strength, increased passive elevation, decreased elevation lag, increased active and passive external rotation, and improved validated outcome scores. When assessing significant preoperative variables, the only independent predictor of improved postoperative forward elevation was preoperative active forward elevation. Conclusion These findings illuminate significant factors in the ability to achieve functional active shoulder elevation after primary RTSA. They may help surgeons appropriately counsel patients about anticipated functional prognosis following primary RTSA.

Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty

2018 ◽  
Vol 100-B (6) ◽  
pp. 761-766 ◽  
Author(s):  
M. Holschen ◽  
M-K. Siemes ◽  
K-A. Witt ◽  
J. Steinbeck
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humeral Fracture ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Operating Time ◽  
Humeral Fracture ◽  
Reverse Total Shoulder Arthroplasty ◽  
The Mean ◽  
Reverse Total Shoulder

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

Development of Adverse Sequelae in Children Born with Subclinical Congenital Toxoplasma Infection

PEDIATRICS ◽  
1980 ◽  
Vol 66 (5) ◽  
pp. 767-774 ◽  
Author(s):  
Christopher B. Wilson ◽  
Jack S. Remington ◽  
Sergio Stagno ◽  
David W. Reynolds
Keyword(s):  
Group Treatment ◽  
Toxoplasma Infection ◽  
Newborn Period ◽  
Group I ◽  
Neurologic Sequelae ◽  
The Mean ◽  
Iq Scores ◽  
Group Ii ◽  
Score Range

Most infants born with congenital Toxoplasma infection are asymptomatic in the newborn period, and therefore their infection is not recognized. We performed follow-up evaluations on 24 such children. The mean age of these children at last examination was 8.5 years. In group I (13 children), the diagnosis was made prospectively. In group II (11 children), no symptoms or signs were noted in the newborn period and the diagnosis was made only after the first sign developed. Eighty-five percent of the children in group I and all of the children in group II have developed chorioretinitis. In group I, three children (23%) have unilateral blindness; in group II, three children (27%) and five children (45%) have unilateral and bilateral blindness, respectively. One child (8%) in group I and two children (18%) in group II developed severe, permanent neurologic sequelae after they initially presented with eye disease. Two of the children in each group are now retarded (IQ score range, 36 to 62). Six of the children in group I who were tested sequentially have had lower IQ scores (mean change from 97 to 74) on repeat tests performed an average of 5.5 years later. Less severe neurologic, intellectual, and audiologic deficits were observed in other children in each group. Treatment of some children may have had a beneficial effect on their outcome.

scholarly journals Osseous changes following reverse total shoulder arthroplasty combined with latissimus dorsi transfer: a case series

2020 ◽  
Vol 4 (4) ◽  
pp. 964-968
Author(s):  
Jason S. Klein ◽  
Peter S. Johnston ◽  
Benjamin W. Sears ◽  
Manan S. Patel ◽  
Armodios M. Hatzidakis ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Latissimus Dorsi ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Reverse Total Shoulder Arthroplasty ◽  
Latissimus Dorsi Transfer ◽  
Osseous Changes ◽  
Reverse Total Shoulder
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