scholarly journals Surgeon and Patient Upper Extremity Dominance Does Not Influence Clinical Outcomes After Total Shoulder Arthroplasty

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093210
Author(s):  
Daniel P. Berthold ◽  
Lukas N. Muench ◽  
Cameron Kia ◽  
Connor G. Ziegler ◽  
Samuel J. Laurencin ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Upper Extremity ◽  
Shoulder Arthroplasty ◽  
Clinical Relevance ◽  
Total Shoulder Arthroplasty ◽  
Patient Specific ◽  
Glenoid Version ◽  
Short Term ◽  
Pain Scores

Background: Surgeon- and patient-specific characteristics as they pertain to total shoulder arthroplasty (TSA) are limited in the literature. The influence of surgeon upper extremity dominance in TSA and whether outcomes vary among patients undergoing right or left TSA with respect to surgeon handedness have yet to be investigated. Purpose: To determine whether surgeon or patient upper extremity dominance has an effect on clinical outcomes after primary TSA at short-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data from an institutional shoulder registry. Patients who underwent primary TSA for glenohumeral osteoarthritis from June 2008 to August 2012 were included in the study. Preoperative and postoperative American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and visual analog scale (VAS) pain scores were evaluated. To determine the clinical relevance of ASES scores, the minimal clinically important difference (MCID), the substantial clinical benefit (SCB), and the patient acceptable symptom state (PASS) were used. Active forward elevation, abduction, and external rotation were recorded for each patient. Glenoid version was also evaluated preoperatively on standard radiographs. Results: Included in this study were 40 patients (n = 44 shoulders; mean age, 69.0 ± 7.3 years) with a mean follow-up of 36.5 ± 16.2 months. Final active range of motion between patients who underwent dominant versus nondominant and left versus right TSA by a right-handed surgeon was not significantly different. Clinical outcomes including the ASES, SST, and VAS pain scores were compared, and no statistical significance was identified between groups. With regard to the ASES score, 89% of patients achieved the MCID, 64% achieved the SCB, and 60% reached or exceeded the PASS. No significant difference in preoperative glenoid version between groups could be found. Conclusion: With the numbers available, neither patient nor surgeon upper extremity dominance had a significant influence on clinical outcomes after primary TSA at short-term follow-up. Clinical Relevance: The influence of surgeon and patient upper extremity dominance on TSA outcomes is an important consideration, given the preferential use of the dominant extremity exhibited by most patients during activities of daily living. To this, operating on a right shoulder might be technically more demanding for a right-handed surgeon and vice versa, as it is considered in other subspecialties.

scholarly journals Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

2021 ◽  
Vol 24 (3) ◽  
pp. 125-134
Author(s):  
Kirtan Tankshali ◽  
Dong-Whan Suh ◽  
Jong-Hun Ji ◽  
Chang-Yeon Kim
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Intraoperative Complications ◽  
Total Shoulder Arthroplasty ◽  
Asian Population ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

High Satisfaction and Return to Sports After Total Shoulder Arthroplasty in Patients Aged 55 Years and Younger

2017 ◽  
Vol 45 (7) ◽  
pp. 1664-1669 ◽  
Author(s):  
Grant H. Garcia ◽  
Joseph N. Liu ◽  
Alec Sinatro ◽  
Hao-Hua Wu ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Rate Of Return ◽  
Return To Sports ◽  
Rates Of Return ◽  
Satisfaction Rate ◽  
Vas Score ◽  
High Satisfaction

Background: Young, active candidates for total shoulder arthroplasty (TSA) are a unique group of patients. Not only do they demand longevity and improved function, but they also desire a return to physical activities. Purpose: To determine the rate of return to sports in patients aged ≤55 years undergoing TSA. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective review of consecutive patients who underwent anatomic TSA at a single institution. Exclusion criteria included age at the time of surgery >55 years and <2 years of follow-up. All patients had end-stage osteoarthritis with significant glenohumeral joint space narrowing. The final follow-up consisted of a patient-reported sports questionnaire, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) score. Results: From 70 eligible patients, 59 patients (61 shoulders) were included with an average follow-up of 61.0 months (range, 25-103 months) and average age at the time of surgery of 48.9 years (range, 25-55 years). The average VAS score improved from 5.6 to 0.9 ( P < .001), and the average ASES score improved from 39.3 to 88.4 ( P < .001). Forty-nine procedures (80.3%) were performed for a primary diagnosis of osteoarthritis. Four shoulders returned to the operating room; none were for glenoid loosening. There was a 93.2% satisfaction rate, and 67.7% of patients (n = 40) stated that they underwent their surgery to return to sports. Moreover, patients in 96.4% of shoulders (55/57) restarted at least 1 sport at an average of 6.7 months. Direct rates of return were as follows: fitness sports (97.2%), golf (93.3%), singles tennis (87.5%), swimming (77.7%), basketball (75.0%), and flag football (66.7%). Patients in 47 shoulders (82.4%) returned to a similar or higher level of sports; 90.3% returned to high-demand sports, and 83.8% returned to high upper extremity sports. There was no significant difference in rates of return to sports by body mass index, sex, age, preoperative diagnosis, revision status, and dominant extremity. Conclusion: In patients aged ≤55 years undergoing TSA, there was a 96.4% rate of return to ≥1 previous sports at an average of 6.7 months. Furthermore, at an average follow-up of 61.0 months, no patients needed revision of their glenoid component, despite an 83.8% rate of return to high upper extremity sports. While caution should still be advised in young, active patients undergoing TSA, these results demonstrate a high satisfaction rate and improved ability to return to most sports after surgery.

Radiographic and clinical outcomes of second generation Trabecular Metal™ glenoid components in total shoulder arthroplasty

2020 ◽  
pp. 175857322090998
Author(s):  
Raymond E Chen ◽  
Alexander M Brown ◽  
Alexander S Greenstein ◽  
Sandeep Mannava ◽  
Ilya Voloshin
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Second Generation ◽  
Total Shoulder Arthroplasty ◽  
Implant Survival ◽  
Trabecular Metal ◽  
Metal Debris ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

Background Total shoulder arthroplasty with second generation porous tantalum glenoid implants (Trabecular Metal™) has shown good short-term outcomes, but mid-term outcomes are unknown. This study describes the clinical, radiographic, and patient-rated mid-term outcomes of total shoulder arthroplasty utilizing cemented Trabecular Metal™ glenoid components. Methods Patients who underwent anatomic total shoulder arthroplasty with cemented Trabecular Metal™ glenoid components for primary osteoarthritis were identified for minimum five-year follow-up. The primary outcome measure was implant survival; secondary outcome measures included patient-rated outcome scores, shoulder range of motion findings, and radiographic analysis. Results Twenty-seven patients were enrolled in the study. Twenty-one patients had full radiographic follow-up. Mean follow-up was 6.6 years. There was 100% implant survival. Shoulder range of motion significantly improved and the mean American Shoulder and Elbow Society score was 89.8. There was presence of metal debris radiographically in 24% of patients. Twenty-nine percent of patients had evidence of radiolucency. Fourteen percent of patients had moderate superior subluxation. Conclusion Total shoulder arthroplasty with second generation cemented Trabecular Metal™ glenoid components yielded good outcomes at mean 6.6-year follow-up. Metal debris incidence and clinical outcomes were similar to short-term findings. The presence of metal debris did not significantly affect clinical outcomes. Continued observation of these patients will elucidate longer-term implant survival.

Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

2020 ◽  
pp. 175857322091682
Author(s):  
John-Rudolph H Smith ◽  
Darby A Houck ◽  
Jessica A Hart ◽  
Jonathan T Bravman ◽  
Rachel M Frank ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
English Language ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

scholarly journals Medium to long-term results of a recessed glenoid for glenoid resurfacing in total shoulder arthroplasty

2019 ◽  
Vol 12 (1_suppl) ◽  
pp. 31-39
Author(s):  
Mark Ross ◽  
Jean-Marc Glasson ◽  
Justin Alexander ◽  
Christopher G Conyard ◽  
Benjamin Hope ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Long Term Results ◽  
Shoulder Replacement ◽  
Shoulder Hemiarthroplasty ◽  
Total Shoulder Replacement ◽  
Implant Survivorship

Background Recessed mini-glenoid components provide an alternative to total shoulder replacement that may avoid some of the known shortcomings and complications associated with shoulder hemiarthroplasty or standard glenoid components in difficult cases. This study reports survivorship, radiological and clinical outcomes of a recessed mini-glenoid implant in a consecutive cohort. Methods Retrospective cohort study reporting outcomes of 28 consecutive shoulders (27 patients) following total shoulder replacement using a recessed, cemented mini-glenoid implant at two sites. Results The most frequent diagnosis was primary osteoarthritis (79%); glenoid morphology was Walch Type A (67%), B1 15%, B2 10% and C 10%. At final follow-up, pain was 16.3 (SD = 23.1), American Shoulder and Elbow Score was 64.5 (SD = 31.9) and (normalized) Constant score was 83.0 (SD = 20.7). Implant survivorship at average final follow-up of seven years (3–13) was 96.4%. Seven mini-glenoids showed small peripheral radiolucent lines at one-year X-ray follow-up but were non-progressive on subsequent imaging. Discussion Recessed polyethylene mini-glenoid is an attractive alternative for shoulder arthroplasty and provides an intermediate solution between standard glenoid components and hemiarthroplasty. Our medium to long-term results demonstrate reliable clinical outcomes, absence of glenoid erosion, low complication rate and satisfactory implant survivorship.

Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up

2016 ◽  
Vol 25 (7) ◽  
pp. 1163-1169 ◽  
Author(s):  
Danielle J. Casagrande ◽  
Di L. Parks ◽  
Travis Torngren ◽  
Mark A. Schrumpf ◽  
Samuel M. Harmsen ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Short Stem ◽  
Radiographic Evaluation ◽  
Short Term ◽  
Press Fit

scholarly journals Negligible Correlation between Radiographic Measurements and Clinical Outcomes in Patients Following Primary Reverse Total Shoulder Arthroplasty

2021 ◽  
Vol 10 (4) ◽  
pp. 809
Author(s):  
Daniel P. Berthold ◽  
Daichi Morikawa ◽  
Lukas N. Muench ◽  
Joshua B. Baldino ◽  
Mark P. Cote ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Prosthesis Design ◽  
Radiographic Measurements ◽  
Reverse Total Shoulder ◽  
Shoulder Angle

Previous attempts to measure lateralization, distalization or inclination after reverse total shoulder arthroplasty (rTSA) and to correlate them with clinical outcomes have been made in the past years. However, this is considered to be too demanding and challenging for daily clinical practice. Additionally, the reported findings were obtained from heterogeneous rTSA cohorts using 145° and 155° designs and are limited in external validity. The purpose of this study was to investigate the prognostic preoperative and postoperative radiographic factors affecting clinical outcomes in patients following rTSA using a 135° prosthesis design. In a multi-center design, patients undergoing primary rTSA using a 135° design were included. Radiographic analysis included center of rotation (COR), acromiohumeral distance (AHD), lateral humeral offset (LHO), distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), and glenoid and baseplate inclination. Radiographic measurements were correlated to clinical and functional outcomes, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (STT), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) score, active forward elevation (AFE), external rotation (AER), and abduction (AABD), at a minimum 2-year follow-up. There was a significant correlation between both DSA (r = 0.299; p = 0.020) and LSA (r = −0.276; p = 0.033) and the degree of AFE at final follow-up. However, no correlation between DSA (r = 0.133; p = 0.317) and LSA (r = −0.096; p = 0.471) and AER was observed. Postoperative AHD demonstrated a significant correlation with final AFE (r = 0.398; p = 0.002) and SST (r = 0.293; p = 0.025). Further, postoperative LHO showed a significant correlation with ASES (r = −0.281; p = 0.030) and LSA showed a significant correlation with ASES (r = −0.327; p = 0.011), SANE (r = −0.308, p = 0.012), SST (r = −0.410; p = 0.001), and VAS (r = 0.272; p = 0.034) at terminal follow-up. All other correlations were found to be non-significant (p > 0.05, respectively). Negligible correlations between pre- and postoperative radiographic measurements and clinical outcomes following primary rTSA using a 135° prosthesis design were demonstrated; however, these observations are of limited predictive value for outcomes following rTSA. Subsequently, there remains a debate regarding the ideal placement of the components during rTSA to most sufficiently restore active ROM while minimizing complications such as component loosening and scapular notching. Additionally, as the data from this study show, there is still a considerable lack of data in assessing radiographic prosthesis positioning in correlation to clinical outcomes. As such, the importance of radiographic measurements and their correlation with clinical and functional outcomes following rTSA may be limited.

scholarly journals Short-Term Outcomes of the Grammont Reverse Shoulder Arthroplasty: Comparison between First and Second Generation Delta Prosthesis

Joints ◽  
2021 ◽  
Author(s):  
Riccardo Luigi Alberio ◽  
Marco Landrino ◽  
Paolo Fornara ◽  
Federico Alberto Grassi
Keyword(s):  
Shoulder Arthroplasty ◽  
Second Generation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Radiographic Evaluation ◽  
Glenoid Component ◽  
Consecutive Series ◽  
Short Term ◽  
Component Loosening

Abstract Purpose This article compares short-term outcomes of two series of patients, who underwent reverse total shoulder arthroplasty (RTSA) with two different implants, both based on Grammont's principles: the Delta III (D-3) and the Delta Xtend (D-XT) prostheses. Methods The D-3 group included a consecutive series of 26 patients (mean age 75 years), that were treated between 2000 and 2006; the D-XT group included a consecutive series of 31 patients (mean age 72.5 years), for a total of 33 implants performed between 2011 and 2015. In both groups the most common diagnoses were cuff tear arthropathy (18 and 22 shoulders, respectively) and malunion of proximal humerus fractures (3 and 5). All procedures were performed by the same surgeon. Constant–Murley score (CMS) was used to assess clinical and functional outcomes. Radiographic evaluation included the true anteroposterior and axillary views. Results Twenty-three patients of the D-3 group and 22 patients (24 shoulders) of the D-XT group were evaluated at a mean follow-up of 42 months (range 26–84) and 44 months (range 26–66), respectively. Four complications occurred in the D-3 group (1 partial deltoid detachment, 1 dislocation, and 2 glenoid component loosening), while one early postoperative infection occurred in the D-XT group. Increases in elevation and CMS between preoperative and postoperative period were observed in both groups; only the D-XT group showed a slight improvement in rotations. The incidence of scapular notching was significantly different between the two groups: 100% for D-3 and 22.2% for D-XT in patients with a minimum follow-up of 5 years. Conclusion Prosthetic design evolution and greater acquaintance with this surgery have undoubtedly led to an improvement in short-term outcomes with second generation implants of RTSA. Future studies will have to ascertain whether newer implants, relying on biomechanical solutions alternative to Grammont's original concept, might provide additional advantages and minimize drawbacks.

scholarly journals Short-term Results of a New Anatomic Stemless Shoulder Arthroplasty- A Prospective Multicentre Study

2021 ◽  
Author(s):  
Tomas Smith ◽  
Alexander Ellwein ◽  
Roman Karkosch ◽  
Spiros Tsamassiotis ◽  
Hauke Horstmann ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Short Term ◽  
Oxford Shoulder Score ◽  
Prospective Multicentre Study ◽  
Early Results ◽  
Shoulder Score

Abstract Background: Anatomic total shoulder arthroplasty (TSA) has been continuously developed and current designs include stemless or canal-sparing humeral components. In the literature stemless and canal sparing TSA showed good clinical and radiographic results, which were comparable to stemmed TSA. The aim of this study was to determine the short-term clinical and radiological outcomes of a new stemless TSA design. Methods: A prospective multicentre study including 154 total shoulder arthroplasty patients with a follow up of 12 months was performed. At the time of follow up 129 patients were available for review. The adjusted Constant Murley score [33], Oxford shoulder score, EQ-5D-5L score and radiographs were examined preoperatively, 3 and 12 months after the implantation of the new stemless TSA implant GLOBAL ICON™ (DePuy Synthes, Warsaw, IN, USA). Complications were documented.Results: Implant Kaplan-Meier survivorship was 98.7% at 12 months. From baseline to 12 months follow-up, all scores showed a progressive significant mean improvement. The mean adjusted Constant score increased from 42.3 to 96.1 points (p<0.001). The Oxford shoulder score showed an increase of 21.6 points (p<0.001). The postoperative radiographs showed no continuous radiolucent lines, subsidence, aseptic loosening or progressive radiolucency, but one osteolytic lesion was observed. Only 2 prostheses were revised. Conclusion: The new GLOBAL ICON stemless TSA showed good clinical and radiographic results at short-term follow up which were comparable to early results of other stemless TSA. Further studies with longer follow up are needed in the future.

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