scholarly journals Subscapularis Peel in Anatomic Total Shoulder Arthroplasty

2018 ◽  
Vol 2 ◽  
pp. 247154921881340
Author(s):  
Corey T Clyde ◽  
Thomas W Throckmorton ◽  
Thomas R Duquin
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Clinical Studies ◽  
Total Shoulder Arthroplasty ◽  
Subscapularis Tendon ◽  
Lesser Tuberosity ◽  
Repair Method ◽  
Advantages And Disadvantages ◽  
Repair Technique ◽  
Viable Treatment

Background Anatomic total shoulder arthroplasty is a viable treatment option for patients with glenohumeral arthritis and an intact rotator cuff with successful outcomes. However, one complication is rupture of the subscapularis tendon postoperatively. Controversy exists regarding the optimal technique of subscapularis tendon management. The purpose of the present article is to review subscapularis peel repair method. Methods The current literature on anatomic total shoulder arthroplasty and subscapularis peel was reviewed to determine the viability of the repair technique. Results Both biomechanical and clinical studies have demonstrated advantages and disadvantages of the subscapularis peel technique, most often by way of direct comparison with lesser tuberosity osteotomy, without consensus as to a superior repair method. Discussion The subscapularis peel repair in anatomic total shoulder arthroplasty when performed correctly may yield successful biomechanical and clinical outcomes for patients.

BIOMECHANICAL AND CLINICAL EVALUATION OF A NOVEL LESSER TUBEROSITY REPAIR TECHNIQUE IN TOTAL SHOULDER ARTHROPLASTY

2005 ◽  
Vol 87 ◽  
pp. 1-8
Author(s):  
BRENT A. PONCE ◽  
RAJ S. AHLUWALIA ◽  
AUGUSTUS D. MAZZOCCA ◽  
REUBEN G. GOBEZIE ◽  
JON J.P. WARNER ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Lesser Tuberosity ◽  
Repair Technique

scholarly journals Comparison of Subscapularis Management and Repair Techniques

2019 ◽  
Vol 3 ◽  
pp. 247154921984815 ◽  
Author(s):  
Robin Dunn ◽  
Christopher D Joyce ◽  
Jonathan T Bravman
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Subscapularis Tendon ◽  
Lesser Tuberosity ◽  
Crucial Step ◽  
Optimal Strength ◽  
Subscapularis Tenotomy ◽  
Repair Techniques

Management of the subscapularis tendon is a crucial step during the approach for total shoulder arthroplasty. The method of mobilizing the tendon and the technique used to repair it determine the initial integrity of the subscapularis and impact its capacity to heal. Currently, there exist 3 well-described and well-studied approaches to managing and repairing the subscapularis: subscapularis tenotomy, subscapularis peel, and lesser tuberosity osteotomy. More recently, a subscapularis-sparing approach has been proposed as an option. There is debate in the literature regarding which technique provides optimal strength and stability for subscapularis repair following shoulder arthroplasty. In this symposium, we provide an overview of each of the techniques and review the biomechanical studies comparing them.

scholarly journals Treatment Outcomes of Lesser Tuberosity Osteotomy Nonunion After Total Shoulder Arthroplasty

2018 ◽  
Vol 2 ◽  
pp. 247154921880777
Author(s):  
Zachary J Bloom ◽  
Cesar D Lopez, BA ◽  
Stephen P Maier ◽  
Brian B Shiu ◽  
Djuro Petkovic ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Shoulder Arthroplasty ◽  
Surgical Repair ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Radiographic Evaluation ◽  
Lesser Tuberosity ◽  
Conservative Care ◽  
Conservative Group

Introduction Lesser tuberosity osteotomy (LTO) during anatomic total shoulder arthroplasty has a 13% nonunion rate. Treatment for LTO nonunion is controversial and poorly described in the literature. The purpose of this study was to compare the surgical and nonsurgical treatment outcomes of LTO nonunion. Methods A retrospective case series of 9 consecutive patients with LTO nonunion after primary anatomic shoulder arthroplasty at 1 institution from 2010 to 2016 were studied. Outcomes measured were radiographic evaluation of LTO on axillary X-ray, clinical range of motion (ROM), subscapularis strength, and pain at the time of LTO nonunion diagnosis and after either conservative care or surgical repair of the LTO nonunion. Results LTO nonunion was treated surgically in 4 and conservatively in 5 patients with average follow-up of 30 and 22 months, respectively. There were no significant differences in age, sex, or smoking status between groups. Treatment decision was a shared model of surgeon and patient. Displaced LTO nonunion was treated surgically in 2 and conservatively in 3 patients. There were no differences in LTO union rate of 50% in the surgical versus 60% in the conservative group. Abdominal compression test was abnormal in 50% of surgical versus 40% of conservative groups. At follow-up, ROM was lower in the surgical group with 128° forward elevation (FE) and 33° external rotation (ER) compared to 148° FE and 62° ER. Only 1 patient with LTO nonunion required conversion to reverse replacement. Conclusion LTO nonunion after shoulder arthroplasty is rare. Surgical repair of LTO nonunion does not significantly improve clinical or radiographic outcomes compared to conservative care.

Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542199712
Author(s):  
Jordan D. Walters ◽  
Stephen F. Brockmeier
Keyword(s):  
Bone Quality ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Lesser Tuberosity ◽  
Critical Elements ◽  
Implant Placement ◽  
Humeral Component ◽  
Component Loosening ◽  
Deltopectoral Approach

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

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