scholarly journals Does Having a Rotator Cuff Repair Before Total Shoulder Arthroplasty Influence Outcomes?

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094277
Author(s):  
Brandon J. Erickson ◽  
Daphne Ling ◽  
Alexandra Wong ◽  
Joshua S. Dines ◽  
David M. Dines ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Matched Control ◽  
Total Shoulder Arthroplasty ◽  
Control Group ◽  
Level Of Evidence ◽  
Significant Difference ◽  
History Of ◽  
Glenohumeral Osteoarthritis

Background: The number of rotator cuff repairs (RCRs) is increasing each year. Total shoulder arthroplasty (TSA) is a successful treatment option for patients with glenohumeral osteoarthritis with a functioning rotator cuff. Purpose/Hypothesis: The purposes of this study were to report the outcomes of TSA in patients with ipsilateral RCR and determine whether patients with a history of ipsilateral RCR who subsequently underwent TSA had differences in outcomes compared with matched controls who underwent TSA with no history of RCR. We hypothesized that patients with prior RCR will have significant improvements in clinical outcome scores, with no difference in outcomes after TSA compared with those with no prior RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients eligible for inclusion were those with a history of prior RCR who underwent TSA at a single institution with a minimum 2-year follow-up between 2000 and 2015. Outcomes for this group, including American Shoulder and Elbow Surgeons (ASES) scores, were reported and then compared with a matched control group of patients who underwent TSA with no history of prior RCR. Controls were matched based on age, sex, and preoperative ASES score. Results: Overall, 14 patients (64% males; mean ± SD age, 65.1 ± 11.1 years) underwent prior ipsilateral RCR before TSA. ASES scores significantly improved from 42.9 to 78.5 at 2 years and to 86.6 at 5 years. When compared with 42 matched control patients (matched 1:3) who underwent TSA with no history of RCR, there was no significant difference in ASES scores at 2 years (78.5 vs 85.3; P = .19) and 5 years (86.6 vs 90.9; P = .72) between the prior RCR and no RCR groups. Conclusion: TSA in patients with a history of prior ipsilateral RCR led to significant improvements in clinical outcomes. No difference in clinical outcomes at 2 or 5 years after TSA was found between patients with and without a history of prior ipsilateral RCR.

Does having a rotator cuff repair prior to reverse total shoulder arthroplasty influence the outcome?

2019 ◽  
Vol 101-B (1) ◽  
pp. 63-67 ◽  
Author(s):  
B. J. Erickson ◽  
D. Ling ◽  
A. Wong ◽  
J. J. Eno ◽  
J. S. Dines ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Rotator Cuff Repair ◽  
Matched Control ◽  
Reverse Shoulder Arthroplasty ◽  
Control Group ◽  
Study Group ◽  
Matched Control Group ◽  
Significant Difference ◽  
Cuff Repair

Aims The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair. Patients and Methods All patients with a history of rotator cuff repair who underwent RSA between 2000 and 2015 with a minimum follow-up of two years were eligible for inclusion as the study group. Outcomes, including the American Shoulder and Elbow Surgeons (ASES) scores, were compared with a matched control group of patients who underwent RSA without having previously undergone rotator cuff repair. Results The study group included 45 patients. Their mean age was 69 years (sd 8.6) and 27 patients (60%) were women. The mean ASES score improved from 43.1 to 76.6 two years postoperatively, and to 66.9 five years postoperatively. There was no significant difference between the outcomes at two years in the two groups (all p ≥ 0.05), although there was significantly more improvement in ASES scores in the control group (44.5 vs 33.4; p = 0.01). However, there was no significant difference between ASES scores at two and five years when baseline ASES scores were matched in the two groups (p = 0.42 at two years; p = 0.35 at five years). Conclusion Significant improvements in ASES scores were seen following RSA in patients who had previously undergone rotator cuff repair. They had higher baseline ASES scores than those who had not previously undergone this surgery. However, there was no significant difference in outcomes between the two groups, two years postoperatively. Previous rotator cuff repair does not appear to affect the early outcome after RSA adversely.

No significant difference in risk of prolonged opioid use following outpatient versus inpatient total shoulder arthroplasty: A propensity matched analysis

2021 ◽  
pp. 175857322110607
Author(s):  
Michelle Xiao ◽  
Daniel M Curtis ◽  
Emilie V Cheung ◽  
Michael T Freehill ◽  
Geoffrey D Abrams
Keyword(s):  
Shoulder Arthroplasty ◽  
Nearest Neighbor ◽  
Total Shoulder Arthroplasty ◽  
Opioid Use ◽  
Therapeutic Level ◽  
Level Of Evidence ◽  
Opioid Prescription ◽  
Significant Difference ◽  
Outpatient Settings ◽  
Baseline Demographic

Background The purpose of this investigation was to compare rates of filled opioid prescriptions and prolonged opioid use in opioid naïve patients undergoing total shoulder arthroplasty (TSA) in inpatient versus outpatient settings. Methods A retrospective cohort study was conducted using a national insurance claims database. Inpatient and outpatient cohorts were created by identifying continuously enrolled, opioid naïve TSA patients. A greedy nearest-neighbor algorithm was used to match baseline demographic characteristics between cohorts with a 1:1 inpatient to outpatient ratio to compare the primary outcomes of filled opioid prescriptions and prolonged opioid use following surgery between cohorts. Results A total of 11,703 opioid naïve patients (mean age 72.5 ± 8.5 years, 54.5% female, 87.6% inpatient) were included for analysis. After propensity score matching (n = 1447 inpatients; n = 1447 outpatients), outpatient TSA patients were significantly more likely to fill an opioid prescription in the perioperative window compared to inpatients (82.9% versus 71.5%, p < 0.001). No significant differences in prolonged opioid use were detected (5.74% inpatient versus 6.77% outpatient; p = 0.25). Conclusions Outpatient TSA patients were more likely to fill opioid prescriptions compared to inpatient TSA patients. The quantity of opioids prescribed and rates of prolonged opioid use were similar between the cohorts. Level of evidence Therapeutic Level III.

SLAC WRIST IN THE ABSENCE OF RECOGNISED TRAUMA AND CPPD

Hand Surgery ◽  
2010 ◽  
Vol 15 (03) ◽  
pp. 193-201 ◽  
Author(s):  
J. Pollock ◽  
A. A. Giachino ◽  
K. Rakhra ◽  
G. DiPrimio ◽  
H. Hrushowy ◽  
...  
Keyword(s):  
Matched Control ◽  
Carpal Bone ◽  
Control Group ◽  
Level Of Evidence ◽  
Matched Control Group ◽  
Extremity Trauma ◽  
History Of ◽  
Comparative Cohort Study ◽  
Upper Extremity Trauma ◽  
Slac Wrist

Purpose: This comparative cohort study was designed to determine whether non-traumatic SLAC wrist exists, and is associated with abnormal carpal bone kinematics (specifically, decreased lunate flexion). Methods: SLAC patients with no recognised history of upper extremity trauma were prospectively compared with an age-matched control group. Results: Thirty-five subjects (69 wrists), included 33 non-traumatic SLAC wrists and 36 control wrists. The non-traumatic SLAC group had significantly different radiographic kinematic analysis compared to the control group. Flexion of the asymptomatic non-degenerative wrist of the non-traumatic SLAC group was distributed 70% through the lunocapitate (LC) joint and only 30% through the RL joint (p < 0.05). Conversely, flexion was more evenly distributed in the control group (48% LC and 52% RL). The non-traumatic SLAC group had abnormal wrist kinematics even in the non-involved side. Conclusions: This study suggests that non-traumatic SLAC does exist. We believe that non-traumatic SLAC begins with abnormal wrist kinematics and that the dorsal radiolunate ligament restricts lunate flexion but not scaphoid flexion, leading to increased SL angles and, with years, eventual attrition of the SL ligament. Type of Study/Level of Evidence: Prognostic, Level IV.

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 Early migration of stemless and stemmed humeral components after total shoulder arthroplasty for osteoarthritis—study protocol for a randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marc Randall Kristensen Nyring ◽  
Bo S. Olsen ◽  
Müjgan Yilmaz ◽  
Michael M. Petersen ◽  
Gunnar Flivik ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Controlled Trial ◽  
Total Shoulder Arthroplasty ◽  
Additional Patient ◽  
Randomized Controlled ◽  
Humeral Component ◽  
Patient Reported ◽  
Glenohumeral Osteoarthritis

Abstract Background Glenohumeral osteoarthritis can, in the most severe cases, require surgery with insertion of a shoulder arthroplasty. A design with a stem in the humeral bone canal is currently regarded as the standard treatment option in patients who have an intact rotator cuff function, but complications related to the stem including humeral fractures can have devastating consequences. By using a stemless humeral component, stem-related complications can be reduced. The aim of this study is to compare the Comprehensive Nano stemless total shoulder arthroplasty (intervention group) with the Comprehensive stemmed total shoulder arthroplasty (control group). Materials and methods This is a randomized controlled trial comparing the stemless and the stemmed total shoulder arthroplasty. All Danish citizens with glenohumeral osteoarthritis indicating a total shoulder arthroplasty referred to the orthopedic department at Copenhagen University Hospital in Herlev/Gentofte will be offered participation. The following exclude from participation: below 18 years of age, cognitive or linguistic impairment, insufficient function of the rotator cuff, poor bone quality, and ASA groups 4–5. A total of 122 patients will be included of which 56 will be part of a radiostereometric analysis (RSA) study of humeral component migration. The primary outcomes are magnitude of migration of the humeral component assessed by RSA and patient-reported outcome by Western Ontario Osteoarthritis of the Shoulder index (WOOS). The secondary outcomes are additional patient-reported outcomes, functional outcome, readmission, complications, revisions, and changes in bone mineral density (BMD) of the proximal humerus assessed by duel energy x-ray absorptiometry (DXA) and economy (cost-utility analysis). The patients are examined before the operation and 3, 6, 12, and 24 months postoperative. Discussion To our knowledge, RSA has never been used to access migration of a stemmed or a stemless humeral component nor has the stemmed and the stemless humeral component been compared with regard to pain relief and shoulder function in a randomized clinical trial. Today, the two designs are considered equal in the treatment of osteoarthritis. The study will provide surgeons and patients with information about shoulder arthroplasty for osteoarthritis and assist them in decision-making. Trial registration ClinicalTrials.gov NCT04105478. Registered on 25 September 2019

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