scholarly journals Treatment Effects of Reverse Total Shoulder Arthroplasty – A Simple Method to Measure Outcomes at 6, 12, 24 and 60 Months for Each Patient

2020 ◽  
Author(s):  
Joerg Huber ◽  
Ulrich Irlenbusch ◽  
Max J Kääb ◽  
Falk Reuther ◽  
Georges Kohut ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Shoulder Arthroplasty ◽  
Treatment Effects ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
P Value ◽  
Simple Method ◽  
The Mean ◽  
Grade 3 ◽  
Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods Included were patients with unilateral cuff arthropathy (Hamada grades >=2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade).Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Two years postoperatively the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year TE's ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 at 1 year, 0.76 at 2 years and 0.73 at 5 years. Conclusions The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. The mean treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s. Trial registration: Comité intercantonal d'éthique (Jura, Fribourg, Neuchâtel), number 01/2008, 24.09.2008

scholarly journals Treatment Effects of Reverse Total Shoulder Arthroplasty – A Simple Method to Measure Outcomes at 6, 12, 24 and 60 Months for Each Patient

2020 ◽  
Author(s):  
Joerg Huber ◽  
Ulrich Irlenbusch ◽  
Max J Kääb ◽  
Falk Reuther ◽  
Georges Kohut ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Shoulder Arthroplasty ◽  
Treatment Effects ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
P Value ◽  
Simple Method ◽  
The Mean ◽  
Grade 3 ◽  
Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods Included were patients with unilateral cuff arthropathy (Hamada grades >=2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade). Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Two years postoperatively the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year TE's ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 at 1 year, 0.76 at 2 years and 0.73 at 5 years. Conclusions The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. The mean treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s. Trial registration: Comité intercantonal d'éthique (Jura, Fribourg, Neuchâtel), number 01/2008, 24.09.2008

scholarly journals Treatment Effects of Reverse Total Shoulder Arthroplasty – A Simple Method to Measure Outcomes at 6, 12, 24 and 60 Months for Each Patient

2020 ◽  
Author(s):  
Joerg Huber ◽  
Ulrich Irlenbusch ◽  
Max J Kääb ◽  
Falk Reuther ◽  
Georges Kohut ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Shoulder Arthroplasty ◽  
Treatment Effects ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
P Value ◽  
Simple Method ◽  
The Mean ◽  
Grade 3 ◽  
Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods Included were patients with unilateral cuff arthropathy (Hamada grades >=2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade).Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Two years postoperatively the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year TE's ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 at 1 year, 0.76 at 2 years and 0.73 at 5 years. Conclusions The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. The mean treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s. Trial registration: Comité intercantonal d'éthique (Jura, Fribourg, Neuchâtel), number 01/2008, 24.09.2008

scholarly journals Treatment Effects of Reverse Total Shoulder Arthroplasty for Unilateral Cuff Tear Arthropathy – Outcomes at 6, 12, 24 and 60 Months and Confounders

2020 ◽  
Author(s):  
Jorg Huber ◽  
Ulrich Irlenbusch ◽  
Max J Kääb ◽  
Falk Reuther ◽  
Georges Kohut ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Shoulder Arthroplasty ◽  
Treatment Effects ◽  
Total Shoulder Arthroplasty ◽  
P Value ◽  
Cuff Tear Arthropathy ◽  
Simple Method ◽  
Cuff Tear ◽  
The Mean ◽  
Dominant Side

Abstract Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement for each patient individually. The method was applied to measure outcome of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods The patients with reversed total shoulder arthroplasty (RSA) of five European clinics were included in this prospective study. The treatment effects (TE) were calculated for each patient as complaint reduction/baseline complaints. 1 is the maximal treatment effect and corresponds to a patient without complaints. A positive number means amelioration, 0 = unchanged, a negative number means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative grade of cuff tear arthropathy, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade). Results 203 patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Over the 24-months, the mean ASES score augmented significant from 20.5 to 78.7 (p<0.001). The 2 year treatment effects ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE’s (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE’s. The patients with higher ASA grade had lower TE’s (ASA grade 4+ vs. 1, p-value 0.013). The mean TE’s were 0.77 at 6-months, 0.81 12-months, 0.76 24-months and 0.73 at 60-months. Conclusions The treatment effects for reverse shoulder arthroplasty vary from 1 to 0.09. The treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE’s were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE’s.

scholarly journals Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901876857 ◽  
Author(s):  
Eduard Alentorn-Geli ◽  
Nathan R Wanderman ◽  
Andrew T Assenmacher ◽  
John W Sperling ◽  
Robert H Cofield ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Simple Shoulder Test ◽  
Posterior Subluxation ◽  
The Mean ◽  
Group 2 ◽  
And Function ◽  
Group 1

Purpose: To compare the outcomes of total shoulder arthroplasty (TSA) with posterior capsule plication (PCP) and reverse shoulder arthroplasty (RSA) in patients with primary osteoarthritis, posterior subluxation, and bone loss (Walch B2). Patients and methods: All shoulders undergoing anatomic TSA with PCP were retrospectively identified (group 1, G1) and compared to shoulders undergoing RSA (group 2, G2) for Walch B2 osteoarthritis. There were 15 patients in G1 (mean (SD) age and follow-up of 70.5 (7.5) years and 42.8 (18.4) months, respectively) and 16 patients in G2 (mean (SD) age and follow-up of 72.6 (5.4) years and 35.1 (14.2) months, respectively). Results: Both groups had substantial improvements in pain and function. In G1, results were excellent in 80% and satisfactory in 20%, compared to 81% and 6% in G2, respectively ( p = 0.2). The mean (SD) American Shoulder and Elbow Surgeons score was 91.2 (6.7) and 80.3 (14.3) in G1 and G2, respectively ( p = 0.08). The mean Simple Shoulder Test score was 10.6 in G1 and 8.5 in G2 ( p = 0.01). There were no reoperations in either group, but G1 had seven postoperative complications. Conclusions: The outcomes of TSA with PCP are comparable to RSA in patients with osteoarthritis and biconcave glenoids. However, TSA leads to more complications while RSA leads to lower functional outcomes.

Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review

2021 ◽  
pp. jisakos-2020-000581
Author(s):  
Edoardo Franceschetti ◽  
Edoardo Giovannetti de Sanctis ◽  
Pietro Gregori ◽  
Alessio Palumbo ◽  
Michele Paciotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Return To Sport ◽  
Rate Of Return ◽  
Return To Sports ◽  
The Mean ◽  
Reverse Total Shoulder ◽  
Subjective Level

ImportanceOne of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery.ObjectiveThe aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance.Evidence reviewThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), Embase and Cochrane Library databases. All the studies analysing the rates were pooled; data were extracted and statistically analysed. The eligibility criteria were studies with at least 20 adult patients recruited. All studies had to relate return to sports after RSA.FindingsA total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33–88 years) and 3.6 years (range 1–9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases.Conclusions and relevanceBased on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure.Level of evidenceIV.

scholarly journals Revision anatomic shoulder arthroplasty with posterior capsular plication for correction of posterior instability

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901878952
Author(s):  
Eduard Alentorn-Geli ◽  
Nathan R Wanderman ◽  
Andrew T Assenmacher ◽  
John W Sperling ◽  
Robert H Cofield ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Polyethylene Wear ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Revision Arthroplasty ◽  
Posterior Instability ◽  
Capsular Plication ◽  
The Mean

Background: Revision of failed anatomic total shoulder arthroplasty or hemiarthroplasty is a challenging procedure. Restoring adequate soft tissue balance in the revision setting can be particularly problematic. When persistent posterior instability is encountered in the revision setting, options include changing component position or size, posterior capsular plication (PCP), or conversion to a reverse arthroplasty. The purpose of this study was to report the clinical and radiographic outcomes, complications, and reoperations of PCP performed in the setting of revision anatomic shoulder arthroplasty. Patients and Methods: Between 1975 and 2013, 15 patients (16 shoulders) had PCP during revision anatomic shoulder arthroplasty. Indications for revision arthroplasty included posterior instability in 15, glenoid loosening in 3, polyethylene wear in 2, and glenoid erosion in 1 shoulder. The mean (standard deviation (SD)) age was 60.1 (12.6) years, and the median (range) follow-up was 68 (2–228) months. A retrospective chart review was conducted to obtain all data. Results: At the last follow-up, nine shoulders (56%) had absence of posterior radiographic subluxation. Five (31%) cases underwent reoperation due to persistent posterior instability. Complications were observed in seven (44%) cases. Complete pain relief was achieved in four (25%) shoulders. The mean (SD) postoperative forward flexion, external rotation, and the American Shoulder and Elbow Surgeons score were 110° (41°), 40° (29°), and 62.1 (21.9), respectively. Results were excellent in two (13%), satisfactory in seven (44%), and unsatisfactory in seven (44%) shoulders. Conclusions: PCP to correct posterior instability during revision anatomic shoulder arthroplasty had an unacceptably high failure rate. In these circumstances, consideration should instead be given to conversion to a reverse shoulder arthroplasty.

scholarly journals Reverse Total Shoulder Arthroplasty for Treatment of 3- and 4-Part Proximal Humeral Fractures: Clinical and Radiological Analysis With Minimum Follow-Up of 2 Years

2020 ◽  
Vol 11 ◽  
pp. 215145932091532
Author(s):  
Luis Barbosa ◽  
Luis Pires ◽  
Paulo Rego ◽  
Raul Alonso
Keyword(s):  
Elderly Patients ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Complication Rates ◽  
The Mean ◽  
Complex Proximal Humeral Fractures

Background: Hemiarthroplasty has been associated with inferior and unpredictable outcomes when used in the treatment of complex proximal humeral fractures in elderly patients. In this age-group, reverse shoulder arthroplasty is gaining popularity due to the promising results presented in recent evidence. Our aim is to analyze the cases of complex proximal humeral fractures treated by reverse shoulder arthroplasty, regarding functional results and complications. Materials and Methods: Thirty-five fractures from 33 patients with the mean age of 73.5 (65-81) years were treated with reverse shoulder arthroplasty for complex fractures of the proximal humerus. These patients were followed for a mean of 38.3 months (24-68) and analyzed regarding clinical outcomes and complications. Results: The average Quick-Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 6.8 points and 78.3%, respectively. The mean Constant score on the affected side was 64.4 points, 19.5% less than the nonoperated side. The mean active elevation was 123°, abduction 109°, external rotation 38°, and internal rotation 41°. The radiographic tuberosity healing rate was 85.7%. There were no significant differences in outcomes, between patient with healed and reabsorbed tuberosities. Inferior scapular notching was seen in 8 patients. The global complication rate was 12.8%. Conclusion: Reverse shoulder arthroplasty yields good and reproductive results with acceptable complication rates in selected elderly patients with complex proximal humeral fractures.

Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty

2018 ◽  
Vol 100-B (6) ◽  
pp. 761-766 ◽  
Author(s):  
M. Holschen ◽  
M-K. Siemes ◽  
K-A. Witt ◽  
J. Steinbeck
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humeral Fracture ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Operating Time ◽  
Humeral Fracture ◽  
Reverse Total Shoulder Arthroplasty ◽  
The Mean ◽  
Reverse Total Shoulder

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

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