Biomechanics and Design of Shoulder Arthroplasty

1995 ◽  
Vol 209 (4) ◽  
pp. 207-213 ◽  
Author(s):  
P J J McCullagh
Keyword(s):  
Shoulder Arthroplasty ◽  
State Of The Art ◽  
Early Experience ◽  
Clinical Results ◽  
Design Activity ◽  
Shoulder Replacement ◽  
Humeral Component ◽  
Key Features

Since the introduction by Neer in 1973 of the metal-on-plastic unconstrained total shoulder replacement, unfortunately there have been no long-term clinical follow-up reports. Short- to mid-term information (less than ten years) indicates good to excellent clinical results in approximately 90 per cent of cases. While this early experience is encouraging, much attention has been focused on tucencies of the glenoid componenti which although they may not predispose to failure, have led to considerable design activity. The humeral component has also advanced in design, with modularity of the head in particular providing greater intra-operative flexibility. State-of-the-art instrumentation, borrowing key features found beneficial to hip and knee joint replacement, is an important advancement in contemporary systems. The aim of this paper is to position shoulder arthroplasty in relation to biomechanical considerations and recommendations from clinical experience.

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.

scholarly journals Early outcomes of augmented glenoid components in anatomic total shoulder arthroplasty: a systematic review

2021 ◽  
pp. 175857322110329
Author(s):  
Ujash Sheth ◽  
James YJ Lee ◽  
Diane Nam ◽  
Patrick Henry
Keyword(s):  
Los Angeles ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Clinical Results ◽  
Long Term Outcomes ◽  
Simple Shoulder Test ◽  
Radiographic Outcomes ◽  
Glenoid Retroversion

Background The objective was to evaluate the short-term clinical and radiological outcomes following augmented anatomic total shoulder arthroplasty in patients with posterior glenoid deficiency. Methods An electronic search of EMBASE, MEDLINE, and PubMed identified studies reporting clinical and radiographic outcomes following augmented anatomic total shoulder arthroplasty among patients with posterior glenoid deficiency. Results Nine studies including 312 shoulders underwent anatomic total shoulder arthroplasty using an augmented glenoid implant between 2015 and 2020. A statistically significant improvement in range of motion (ROM), visual analog scale (VAS), American Shoulder & Elbow Surgeons (ASES), Constant, University of California - Los Angeles and Simple Shoulder Test (SST) scores was demonstrated at mean follow-up of 37.1 months. Glenoid retroversion improved from 21.8° to 9.5°. At final follow-up, radiolucency was reported in 35.1% of shoulders. The 16° full-wedge augment led to higher and more severe radiographic lucency, while high peg perforation rates (44%) were observed among 5-mm augment stepped implants. The overall rate of complication was 2.6%. Rate of revision surgery was 1.9%. Conclusions Overall, early- to mid-term outcomes following augmented anatomic total shoulder arthroplasty for posterior glenoid deficiency demonstrate good to excellent overall clinical results. More radiographic and clinical failures were reported in larger full wedge (16°) augments and stepped augments (5 mm). Prospective studies examining mid- and long-term outcomes will help further elucidate safety and efficacy of these relatively new implants.

scholarly journals Reverse Shoulder Arthroplasty With Proximal Humeral Replacement for the Management of Massive Proximal Humeral Bone Loss

2018 ◽  
Vol 2 ◽  
pp. 247154921877984 ◽  
Author(s):  
Dave R Shukla ◽  
Julia Lee ◽  
Devin Mangold ◽  
Robert H Cofield ◽  
Joaquin Sanchez-Sotelo ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Clinical Results ◽  
Humeral Component ◽  
Attachment Sites ◽  
Lateral Offset ◽  
Component Loosening ◽  
Shoulder Arthroplasties

Background Substantial proximal humeral bone loss may compromise reverse shoulder arthroplasty secondary to limited implant support, insufficient soft tissue tension due to shortening, lack of attachment sites for the posterosuperior cuff when present, and lack of lateral offset of the deltoid. In these circumstances, use of a proximal humeral replacement may be considered. Patients/Methods Between 2012 and 2014, 34 consecutive reverse shoulder arthroplasties were performed using a proximal humeral replacement system. The indications were failed shoulder arthroplasty (15), oncology reconstruction (9), humeral malunion/nonunion (7), prior resection arthroplasty (2), and intraoperative fracture (1). All patients were included in the survival analysis. Twenty-two patients with minimum 2-year follow-up were included in analysis of clinical results. Results Among the cohort of 34 patients, there were 8 additional reoperations: humeral loosening (3), periprosthetic fracture (2), irrigation and debridement (2), and glenoid loosening (1). Humeral component loosening occurred exclusively in patients undergoing revision shoulder arthroplasty. The 4 patients had an average 3.75 prior procedures before the proximal humeral replacement. Two of the revisions were from cemented to uncemented stems. Among the 23 patients with minimum 2-year follow-up, there was significant improvement in pain scores (4.1 vs 0.6), forward elevation (31 vs 109) degrees, and 81% were satisfied. Conclusion Use of a proximal humeral replacement when performing a reverse shoulder arthroplasty in the complex setting of substantial proximal humerus bone loss provides good clinical results and a particularly low dislocation rate. However, the rate of loosening of the humeral component in the revision setting suggests that proximal humeral replacement components should be cemented when revising a previously cemented stem. IRB 16-006966.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

scholarly journals Journey of the glenoid in anatomic total shoulder replacement

2018 ◽  
Vol 11 (2) ◽  
pp. 140-148 ◽  
Author(s):  
Alessandro Castagna ◽  
Raffaele Garofalo
Keyword(s):  
Shoulder Arthroplasty ◽  
Current Practice ◽  
Total Shoulder Arthroplasty ◽  
Shoulder Function ◽  
Patient Specific ◽  
Glenoid Component ◽  
Shoulder Replacement ◽  
Final Destination ◽  
Component Loosening

Anatomic total shoulder arthroplasty (TSR) has been shown to generate good to excellent results for patients with osteoarthritis and a functioning rotator cuff. Many studies have reported that the glenoid component loosening and failure remain the most common long-term complication of total shoulder arthroplasty. The approach to glenoid component is critical because a surgeon should consider patient-specific anatomy, preserving bone stock and joint line restoration, for a good and durable shoulder function. Over the years, different glenoid design and materials have been tried in various configurations. These include cemented polyethylene, uncemented metal-backed and hybrid implants. Although advances in biomechanics, design and tribology have improved our understanding of the glenoid, the journey of the glenoid component in anatomic total shoulder arthroplasty has not yet reached its final destination. This article attempts to describe the evolution of the glenoid component in anatomic TSR and current practice.

scholarly journals Long-term follow-up to ensure quality care of individuals diagnosed with newborn screening conditions: Early experience in New England

2010 ◽  
Vol 12 ◽  
pp. S220-S227 ◽  
Author(s):  
Inderneel Sahai ◽  
Roger B. Eaton ◽  
Jaime E. Hale ◽  
Eleanor A. Mulcahy ◽  
Anne Marie Comeau
Keyword(s):  
Newborn Screening ◽  
New England ◽  
Quality Care ◽  
Early Experience ◽  
Long Term Follow Up

scholarly journals RETROSPECTIVE EVALUATION OF SUCCESS OF IMPLANT SUPPORTED PROSTHESIS: EARLY RESULTS

2020 ◽  
Vol 7 (12) ◽  
pp. 189-198
Author(s):  
Zeynep Başağaoğlu Demirekin ◽  
Yavuz Findik ◽  
S. Süha Turkaslan ◽  
Timuçin Baykul ◽  
Merve Erken
Keyword(s):  
Treatment Options ◽  
Clinical Results ◽  
Long Term Results ◽  
Retrospective Evaluation ◽  
Early Results ◽  
Single Crown ◽  
Long Term Follow Up ◽  
Implant Therapy

Introduction: The interpretation of clinical results of dental implant supported prosthesis treatment is very crucial to be able to make a comparison between different implant systems and treatment options and furthermore to benefit the experiences of the other clinicians. However, the clinical outcomes of these studies should be reported in an objective way and be independent from the system used and also be prepared in accordance with certain criteria and standards that have been accepted scientifically world-wide for being reliable and describing long-term results. Aim: Three-hundred and eighty-two consecutive NTA implants were performed on ninety-nine patients. The implants used in 2016 and the constructed restorations were retrospectively analyzed. In addition, the effect of the experience of clinician was evaluated related with the success of the implant therapy. Materials and Method: This retrospective study was conducted in the Department of Prosthodontics Süleyman Demirel University. Three-hundred and eighty-two consecutive NTA implants were performed on ninety-nine patients. The implants used in 2016 and the constructed restorations were retrospectively analyzed. Results: The implants were followed for at least 2 years. In total, 239 implants were inserted. It was found in 143 mandibles. Prosthetic restorations were determined to be partial prosthetics (219), single crown (81) and overdenture prosthetics (64). During the evaluation period, 6 implants failed before prosthetic treatment, ten decementations, six retentive screw loosening and five porcelain chipping were detected. Discussion and Conclusions: The early results of our study are consistent with the results of other studies. However, long-term follow-up is required for more accurate assessments.

Long-Term Clinical Results following Correction of Incompetent Superficial and Perforating Veins in Patients with Deep Venous Incompetence and Ulcers

1993 ◽  
Vol 8 (3) ◽  
pp. 128-131 ◽  
Author(s):  
H. Åkesson
Keyword(s):  
Venous Pressure ◽  
Clinical Results ◽  
Venous Ulceration ◽  
Perforating Veins ◽  
Venous Ulcers ◽  
Increased Risk ◽  
A Prospective Study ◽  
Volumetric Measures

Objectives: To assess the presence of venous ulcers following stripping of the saphenous vein and ligation of perforating veins in patients with deep venous incompetence. Design: Retrospective follow-up after a median of 41 months following surgery. Patients: Thirty operated limbs in 25 patients with venous ulcers, originally entering a prospective study of physiological changes following surgery for venous insufficiency. Interventions: An interview regarding absence of ulcers, expressed as a percentage of the follow-up time after surgery – the ‘ulcer-free period’. Correlation with ambulatory venous pressure (AVP) and foot volumetric measures following surgery. Main outcome measures: The presence or absence of venous ulcers. Results: The ulcer-free period for the whole group was 76%. There was a significant (p<0.05) difference in the ulcer-free period in limbs with an AVP below 60 mmHg (89%) compared with limbs with a higher AVP (70%). Conclusion: Failure to normalize AVP with surgery results in persistent high venous pressure and an increased risk of venous ulceration recurrences.

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