scholarly journals Stemless Total Shoulder: A Review of Biomechanical Fixation and Recent Results

2021 ◽  
Vol 5 ◽  
pp. 247154922110084
Author(s):  
Jeremy Wodarek ◽  
Edward Shields
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Stress Shielding ◽  
The United States ◽  
Anatomic Reconstruction ◽  
Bone Stock ◽  
Normal Anatomy ◽  
The Third ◽  
Effective Technology ◽  
Loss Of Strength

Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.

Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty

2018 ◽  
Vol 27 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Patrick J. Denard ◽  
Matthew P. Noyes ◽  
J. Brock Walker ◽  
Yousef Shishani ◽  
Reuben Gobezie ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Short Stem

Comparison of Methods to Predict Scapular Notching From Radiographs After Reverse Total Shoulder Arthroplasty

2012 ◽  
Author(s):  
Heath B. Henninger ◽  
Michael D. Harris ◽  
Kristen R. Petersen ◽  
Robert T. Burks ◽  
Robert Z. Tashjian
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
A Priori ◽  
Stress Shielding ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Implant Placement ◽  
And Function ◽  
Reverse Total Shoulder

Scapular notching is a complication of reverse total shoulder arthroplasty (rTSA) that results in bone loss on the lateral border of the scapula. Notching has been reported in up to 86% of patients at 5 year follow-up [1], and is graded 1–4 as a function of progressive bone loss [2]. Notching may arise from impingement, erosion, periprosthetic osteolysis, stress shielding or a combination of these [1]. Glenosphere position can mitigate notching by limiting hardware impingement [3–5], but may increase the forces required to abduct the arm [6]. Clinicians might optimize patient range of motion and function via implant placement if susceptibility to notching was known a-priori.

Long-Term Radiographic Changes in Stemless Press-Fit Total Shoulder Arthroplasty

2020 ◽  
Author(s):  
Sascha Beck ◽  
Theodor Patsalis ◽  
André Busch ◽  
Florian Dittrich ◽  
Alexander Wegner ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Shoulder Prosthesis ◽  
Mild Stress ◽  
Press Fit ◽  
Radiographic Changes

Abstract Introduction Stemmed humeral implants have represented the gold standard in total shoulder arthroplasty (TSA) for decades. Like many other joints, the latest trends in TSA designs aim at bone preservation. Current studies have demonstrated that native proximal humeral bone stresses are most closely mimicked by stemless implants. Nevertheless, there are concerns about the long-term performance of stemless designs. The aim of the present study was to evaluate the long-term radiographic changes at the proximal humerus in anatomical stemless press-fit TSA. Materials and Methods Between 2008 and 2010, 48 shoulders in 43 patients were resurfaced using an anatomic stemless shoulder prosthesis (TESS, Biomet). Thirty shoulders in twenty-five patients who were aged 65.7 ± 9.9 (34 to 82) years were available for clinical and radiographic review at a mean follow-up of 94.0 ± 8.9 (78 to 110) months. Results Radiographic changes of the proximal humerus due to stress shielding were found in 38.4% of the stemless TESS implants. Mild stress shielding accounted for 80% of the observed radiographic changes. Radiographs exhibited stable fixation of the stemless humeral press-fit implant at early and late follow-up. In contrast, radiolucent lines at the glenoid implant were found in 96.1% of the cases. Irrespective of the degree of radiographic changes, clinical scores (VAS, Quick-DASH, Constant score) significantly improved at follow-up. Conclusions The anatomic stemless press-fit implant seems to be favorable in terms of implant-related stress shielding. Clinical outcome was not affected by radiographic changes, demonstrating an 8-year clinical performance that seems to be comparable to conventional stemmed TSA.

Total Shoulder Arthroplasty Using OVO®/OVO® Motion with Inlay Glenoid Shoulder Arthroplasty System

2021 ◽  
Author(s):  
Sercan Yalcin ◽  
Michael Scarcella ◽  
Anthony Miniaci
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
The United States ◽  
Complex Problem ◽  
Shoulder Replacement ◽  
High Demand ◽  
Patient Reported ◽  
Shoulder Arthritis ◽  
Glenohumeral Osteoarthritis

The incidence of patients undergoing total shoulder arthroplasty (TSA) for glenohumeral osteoarthritis has been steadily increasing in the United States. TSA with humeral head resurfacing with an inlay glenoid using OVO®/OVO® Motion (Arthrosurface, Inc., Franklin, Massachusetts) is an anatomic implant solution to shoulder arthritis. Anatomic resurfacing has demonstrated promising clinical- and patient-reported outcomes in the literature in both active and low-demand patients. Furthermore, patients are capable of returning to high-demand activities, such as weightlifting, which are restricted with conventional total shoulder replacement designs. Resurfacing designs offer a simple solution to a complex problem.

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.

Optimal Screw Placement for Reverse Total Shoulder Arthroplasty

2010 ◽  
Author(s):  
Thuc-Quyen D. Nguyen ◽  
James Guido DiStefano ◽  
Andrew Y. Park ◽  
Gerd Diederichs ◽  
Jenni M. Buckley ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Glenoid Component ◽  
Catastrophic Failure ◽  
Bone Stock ◽  
Common Causes ◽  
Reverse Total Shoulder ◽  
Arthroplasty Surgery ◽  
Causes Of Failure

The reverse design of the total shoulder arthroplasty has been utilized for elderly patients with severely degenerated glenohumoral joints that are rotator cuff deficient. One of the most common causes of failure in shoulder arthroplasty involves loosening or catastrophic failure of the glenoid component. Such problems can be related to suboptimal fixation due to bone loss from fractures, severe degenerative changes and from previous failed arthroplasty surgery [1]. This emphasizes the need to secure the glenoid component with sound screw purchase beyond the glenoid vault. However, such fixation can often be tenuous as scapula bone quality is heterogeneous with a wide variation across short distances [2, 3]. Moreover, it can be difficult to identify regions with the best bone stock intraoperatively. This often requires multiple passes with the drill, which leads to further bone loss and potential decreased screw purchase. Thus, it is important for the surgeon to have a firm understanding of scapular anatomy with potential screw trajectories in mind.

Predictors of length of stay after elective total shoulder arthroplasty in the United States

2015 ◽  
Vol 24 (5) ◽  
pp. 754-759 ◽  
Author(s):  
John C. Dunn ◽  
Joseph Lanzi ◽  
Nicholas Kusnezov ◽  
Julia Bader ◽  
Brian R. Waterman ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The United States

scholarly journals Stress shielding following stemless anatomic total shoulder arthroplasty

2021 ◽  
pp. 175857322110588
Author(s):  
William R Aibinder ◽  
Fares Uddin ◽  
Ryan T Bicknell ◽  
Ryan Krupp ◽  
Markus Scheibel ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Stress Shielding ◽  
Implant Design ◽  
Level Of Evidence ◽  
Lesser Tuberosity ◽  
Significant Difference

Background Finite element analysis has suggested that stemless implants may theoretically decrease stress shielding. The purpose of this study was to assess the radiographic proximal humeral bone adaptations seen following stemless anatomic total shoulder arthroplasty. Methods A retrospective review of 152 prospectively followed stemless total shoulder arthroplasty utilizing a single implant design was performed. Anteroposterior and lateral radiographs were reviewed at standard time points. Stress shielding was graded as mild, moderate, and severe. The effect of stress shielding on clinical and functional outcomes was assessed. Also, the influence of subscapularis management on the occurrence of stress shielding was determined. Results At 2 years postoperatively, stress shielding was noted in 61 (41%) shoulders. A total of 11 (7%) shoulders demonstrated severe stress shielding with 6 occurring along the medial calcar. There was one instance of greater tuberosity resorption. At the final follow-up, no humeral implants were radiographically loose or migrated. There was no statistically significant difference in clinical and functional outcomes between shoulders with and without stress shielding. Patients undergoing a lesser tuberosity osteotomy had lower rates of stress shielding, which was statistically significant ( p = 0.021) Discussion Stress shielding does occur at higher rates than anticipated following stemless total shoulder arthroplasty, but was not associated with implant migration or failure at 2 years follow-up. Level of evidence IV, Case series.

scholarly journals Immediate Accelerated Shoulder Rehabilitation (IASR) vs. Standard Protocol following Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.

2020 ◽  
Author(s):  
Paul DeVito ◽  
Ryan Hatch ◽  
Avias Raja ◽  
Lauren Smudge ◽  
Travis Cambronne ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The United States ◽  
Rehabilitation Program ◽  
Reverse Total Shoulder Arthroplasty ◽  
Postoperative Rehabilitation ◽  
Randomized Controlled ◽  
Post Surgery ◽  
Accelerated Rehabilitation ◽  
Reverse Total Shoulder

Abstract Background: Recently, the reverse total shoulder arthroplasty (rTSA) became the most frequently performed form of shoulder replacement in the United States and abroad. While physical therapy is universally accepted and routinely practiced, published postoperative rehabilitation guidelines and modifications are based on protocols developed in 1975. Since then, the principle components and temporal concepts of timing and intensity of postoperative rehabilitation and protected immobilization have been controversially applied and expertly discussed without a prevailing consensus. Comparative literature that prospectively addresses treatment differences, influences on outcomes, and superiority or inferiority versus control does not exist. Thus, the objective of this pilot study is to compare an accelerated and immediate active shoulder rehabilitation (IASR) rehabilitation program with standard care in patients following rTSA.Methods: A prospective, randomized, controlled, parallel-designed, two-armed, non-blinded, superiority pilot trial. The comparator arms are an accelerated rehabilitation (IASR) strategy versus standardized care following rTSA (CPT: 23472). The primary outcome measures will be the change from pre-surgical baseline to 52 weeks post-surgery in the American Shoulder and Elbow (ASES) score, Simple Shoulder Test (SST), and global health assessment (PROMIS-10. Secondary and tertiary outcomes will assess subscapularis integrity, implant status, and overall rehabilitation costs compared to formal control. Patients will be recruited from a single site (TRIA Orthopaedic Center, Bloomington, MN) neighboring the fourteenth largest US metropolitan area.Discussion: This trial will be the first study to compare the efficacy and safety of two different postoperative rehabilitation strategies for patients following rTSA. Further, this will be the first study to investigate an accelerated rehabilitation program without a period of protected immobilization following rTSA. Finally, the results will assist in the shared clinical and surgical treatment decision-making process.

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