scholarly journals Inter and Intra-Rater Reliability of Using Computed Tomography to Assess Prosthesis Position Post Shoulder Arthroplasty

2020 ◽  
Vol 4 ◽  
pp. 247154922096379
Author(s):  
David A Kelly ◽  
Sharon J Karamfiles ◽  
Jonathan C Coward ◽  
Sven P Goebel
Keyword(s):  
Computed Tomography ◽  
Patient Outcomes ◽  
Shoulder Arthroplasty ◽  
Future Research ◽  
Shoulder Replacement ◽  
Rater Reliability ◽  
Operative Limb ◽  
Reverse Total Shoulder Replacement ◽  
Reverse Total Shoulder ◽  
One Machine

Background Computer models and cadaveric studies have demonstrated that humeral version has a significant impact on the impingement, stability, and range of motion of the prosthetic shoulder joint. Computed tomography (CT) has been used to measure native humeral version, however the reliability of using CT to measure humeral version post reverse total shoulder replacement has not yet been established. Aims To investigate the inter and intra-rater reliability of using CT to assess the post-operative humeral version following shoulder arthroplasty. Methodology Patients underwent a limited CT scan of the operative limb; positioned and protocoled by one consultant radiologist on one machine. The humeral version of the prostheses was calculated individually by two experienced, board certified consultant radiologists. They were blinded to each other’s measurements. The humeral version was calculated using the epicondylar axis. Data Overall, 20 shoulders are included; 12 females (60%), and 10 left-sided (50%). The median anteversion was 0° (range 33° retroversion–27° anteversion; IQ 6.75° retroversion–4.75° anteversion). The inter-rater reliability was 0.985 (95% CI: 0.964–0.994). The intra-rater reliability for radiologist A was 0.988 (95% CI: 0.969–0.995), and the intra-rater reliability for radiologist B was 0.976 (95% CI: 0.942–0.991). Conclusion The use of post operative CT has excellent inter and intra-rater reliability in measuring humeral version following shoulder arthroplasty. This study will facilitate future research regarding impact of the humeral version on patient outcomes.

scholarly journals Effectiveness of formal physical therapy following total shoulder arthroplasty: A systematic review

2018 ◽  
Vol 12 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Peter K Edwards ◽  
Jay R Ebert ◽  
Chris Littlewood ◽  
Tim Ackland ◽  
Allan Wang
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Future Research ◽  
Routine Practice ◽  
Post Surgery ◽  
Reverse Total Shoulder

Background Physical therapy is considered routine practice following total shoulder arthroplasty. To date, current regimens are based on clinical opinion, with evidence-based recommendations. The aim of this systematic review was to evaluate the effectiveness of total shoulder arthroplasty physical therapy programmes with a view to inform current clinical practice, as well as to develop a platform upon which future research might be conducted. Methods An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane Library to March 2018 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken. Results A total of 506 papers were identified in the electronic database search, with only one study showing moderate evidence of early physical therapy promoting a more rapid return of short-term improvement in function and pain. No studies evaluated the effectiveness of physical therapy programmes in reverse total shoulder arthroplasty procedures. Discussion Restoring range of motion and strength following total shoulder arthroplasty is considered important for patients to obtain a good outcome post-surgery and, when applied early, may offer more rapid recovery. Given the rising incidence of total shoulder arthroplasties, especially reverse total shoulder arthroplasty, there is an urgent need for high-quality, adequately powered randomised controlled trials to determine the effectiveness of rehabilitation programmes following these surgeries.

scholarly journals Treatment of Prosthetic Joint Infection and Reconstruction of a Massive Shoulder Defect after Reverse Total Shoulder Replacement

2020 ◽  
Vol 16 (2) ◽  
pp. 102-105
Author(s):  
Ji-An Choi ◽  
Jung-Ha Kwak ◽  
Kwang-Ryeol Lim ◽  
Chung-Min Yoon
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Necrotic Tissue ◽  
Shoulder Replacement ◽  
Total Shoulder Replacement ◽  
Prosthetic Joint ◽  
Radical Debridement ◽  
Reverse Total Shoulder Replacement ◽  
Reverse Total Shoulder ◽  
Shoulder Reconstruction

Prosthetic joint infection is a rare but serious complication of total shoulder replacement. After infection control, shoulder reconstruction is also required to repair the shoulder defect. The shoulder is a complex structure consisting of mechanical soft tissue and the joint, making reconstruction challenging. A 78-year-old female patient was diagnosed of wound necrosis and exposed prosthesis due to prosthetic joint infection after reverse total shoulder replacement. The infection was controlled with appropriate antibiotic treatment, and the necrotic tissue was removed by radical debridement. To reduce the size of the massive shoulder defect and minimize exposure of the prosthesis, negativepressure wound therapy (NPWT) was administered for 8 weeks and shoulder reconstruction was performed using a pedicled latissimus dorsi (LD) flap and split-thickness skin graft. The patient recovered without any complications, and no reinfection of the surgical site or other complications were observed during follow-up visits. This report demonstrates that antibiotic treatment, radical debridement of necrotic tissue, NPWT, and shoulder reconstruction using a pedicled LD flap can be an effective method of treatment for prosthetic joint infection with exposed prosthesis, tissue necrosis, and massive shoulder defect.

scholarly journals Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates

Joints ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 72-77 ◽  
Author(s):  
Lorenzo Mattei ◽  
Stefano Mortera ◽  
Chiara Arrigoni ◽  
Filippo Castoldi
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Scientific Community ◽  
Total Shoulder Arthroplasty ◽  
Persistent Pain ◽  
Reverse Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Shoulder Replacement ◽  
Reverse Total Shoulder ◽  
Loss Of Strength

A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity.

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