Total Shoulder Arthroplasty

Shoulder arthroplasty has been the subject of marked advances over the last few years. Modern implants provide a wide range of options, including resurfacing of the humeral head, anatomic hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty and trauma-specific implants for fractures and nonunions. Most humeral components achieve successful long-term fixation without bone cement. Cemented all-polyethylene glenoid components remain the standard for anatomic total shoulder arthroplasty. The results of shoulder arthroplasty vary depending on the underlying diagnosis, the condition of the soft-tissues, and the type of reconstruction. Total shoulder arthroplasty seems to provide the best outcome for patients with osteoarthritis and inflammatory arthropathy. The outcome of hemiarthroplasty for proximal humerus fractures is somewhat unpredictable, though it seems to have improved with the use of fracture-specific designs, more attention to tuberosity repair, and the selective use of reverse arthroplasty, as well as a shift in indications towards internal fixation. Reverse shoulder arthroplasty has become extremely popular for patients with cuff-tear arthropathy, and its indications have been expanded to the field of revision surgery. Overall, shoulder arthroplasty is a very successful procedure with predictable pain relief and substantial improvements in motion and function.

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Shoulder arthroplasty for juvenile idiopathic arthritis

Journal of Orthopaedic Surgery ◽

10.1177/2309499019890615 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949901989061

Author(s):

Suroosh Madanipour ◽

Aditya Prinja ◽

Marcus Lee ◽

Abbas Rashid

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Shoulder Arthroplasty ◽

Preoperative Evaluation ◽

Implant Design ◽

Significant Heterogeneity ◽

Post Operative Pain ◽

Inflammatory Arthropathy ◽

Long Term Follow Up ◽

And Function

There is limited literature to guide shoulder surgeons in the management of juvenile idiopathic arthritis (JIA). We aim to help clinicians to formulate an approach to the surgical management of the condition through a review of the available literature on arthroplasty in JIA, general considerations when operating on patients with inflammatory arthropathy and recommendations based on the authors’ experience. Four articles report formal data on arthroplasty in JIA with favourable improvements in post-operative pain and function scores after the long-term follow-up. Significant heterogeneity in treatment and a lack of standardisation in quantitative outcomes highlights the need for further larger scale and higher quality research. The aim of this study is to review the evidence and provide information on preoperative evaluation of surgical candidates, operative techniques, choice of implant design and to evaluate functional outcomes in patients who undergo shoulder arthroplasty.

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Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/1758573220917653 ◽

2020 ◽

pp. 175857322091765

Author(s):

Betty Zhang ◽

Gavinn Niroopan ◽

Chetan Gohal ◽

Bashar Alolabi ◽

Timothy Leroux ◽

...

Keyword(s):

Bone Loss ◽

Shoulder Arthroplasty ◽

Bone Grafting ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Level Of Evidence ◽

Total Shoulder Arthroplasties ◽

Component Loosening ◽

Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499018768570 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901876857 ◽

Cited By ~ 4

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.

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TOTAL SHOULDER ARTHROPLASTY, AN OVERVIEW, INDICATINS AND PROSTHETIC OPTIONS

Wiadomości Lekarskie ◽

10.36740/wlek202009112 ◽

2020 ◽

Vol 73 (9) ◽

pp. 1870-1873

Author(s):

Mateusz Wicha ◽

Agnieszka Tomczyk-Warunek ◽

Jaromir Jarecki ◽

Anna Dubiel

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Shoulder Function ◽

Long Term Result ◽

Glenohumeral Osteoarthritis ◽

Hip Arthroplasties ◽

Reverse Total Shoulder

Shoulder arthroplasty (SA) has improved significantly over the last twenty years. It offers the effective treatment for patients with severe shoulder dysfunctions. The indications for this procedure have recently expanded tremendously. However, the most common are glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus and osteonecrosis of a humeral head. There is range of the procedures, such as resurfacing of humeral head, anatomic total shoulder arthroplasty, hemiarthroplasty and reverse shoulder arthroplasty. All of them could significantly improve patients quality of life. The outcomes of the shoulder arthroplasty are very satisfying in terms of pain relief and considerable improvements in shoulder function as well as in motion. However, this procedure is not so popular as knee or hip arthroplasties. The reasons for this phenomenon are not clear. The complication rate is considerably low. The most common are periprosthetic fractures, infections, implant loosening and instability. The reasonable solution is a conversion to reverse total shoulder arthroplasty. The survivorship of the prosthesis is up to 12 years, which is acceptable by patients. Long term result are still not clear. Surgeons performing SA opt for deltopectoral approach which provides good exposure of the joint also for revisions. The aim: To summarize knowledge about SA based on current literature.

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Comparative Outcomes of Various Combinations of Bilateral Shoulder Arthroplasty

Hand ◽

10.1177/1558944718820953 ◽

2019 ◽

Vol 15 (5) ◽

pp. 707-712 ◽

Cited By ~ 1

Author(s):

Jennifer Kurowicki ◽

Jacob J. Triplet ◽

Samuel Rosas ◽

Derek D. Berglund ◽

Brandon Horn ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Simple Shoulder Test ◽

Patient Reported ◽

And Function

Background: In the setting of bilateral shoulder arthroplasty (BSA), differences in functional outcomes and motion between anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are unknown. The purpose of this study was to compare the effectiveness of treatment for various combinations of TSA procedures. Methods: A review of prospectively collected data from an institutional shoulder surgery repository was performed for patients who underwent any combination of bilateral TSA or RSA surgery. Based on the combination of shoulder arthroplasty, patients were divided into the following subgroups: bilateral TSA (TSA/TSA), bilateral RSA (RSA/RSA), or unilateral TSA with contralateral RSA (TSA/RSA). A total of 73 patients (146 shoulders), with a minimum of 2-year follow-up, who underwent any combination of bilateral TSA or RSA from 2007 to 2014 were included. Pre- and postoperative patient-reported outcome measures and measured motion were evaluated between the 3 groups. Results: There were 47 TSA/TSA, 17 RSA/RSA, and 9 TSA/RSA patients with a mean age of 72 years and mean follow-up of 51 months. Preoperatively, TSA/TSA had significantly higher Simple Shoulder Test scores, Visual Analog Scale (VAS) function, active elevation, and active external rotation compared with RSA/RSA. Postoperative scores were significantly superior in TSA/TSA compared with other combinations of shoulder arthroplasty except VAS pain and function. Change in pre- to postoperative (effectiveness of treatment) internal rotation was superior in the TSA/TSA group compared with RSA/RSA and TSA/RSA; however, no other differences were observed. Conclusions: Bilateral TSA patients have higher preoperative function and motion. Although some postoperative outcomes differ among combinations of BSA, the overall effectiveness of treatment for patients undergoing BSA is similar between various combinations of arthroplasty.

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Primary reverse shoulder arthroplasty for acute proximal humerus fractures: A 5-year long term retrospective study of elderly patients

Injury ◽

10.1016/j.injury.2019.09.019 ◽

2019 ◽

Vol 50 (11) ◽

pp. 1974-1977 ◽

Cited By ~ 6

Author(s):

Pierfrancesco Luciani ◽

L. Farinelli ◽

R. Procaccini ◽

C. Verducci ◽

A. Gigante

Keyword(s):

Retrospective Study ◽

Elderly Patients ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Reverse Shoulder Arthroplasty ◽

Proximal Humerus Fractures ◽

Humerus Fractures

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Humeral Head Shape in Native and Prosthetic Joint Replacement

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219848150 ◽

2019 ◽

Vol 3 ◽

pp. 247154921984815

Author(s):

Joseph P Iannotti ◽

Bong Jae Jun ◽

Jason Teplensky ◽

Eric Ricchetti

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty ◽

Biomechanical Properties ◽

Head Shape ◽

Prosthetic Joint ◽

The Subject ◽

Kinematic Properties

Background Nonspherical prosthetic humeral head designs have become increasingly popular as they better approximate the native shoulder anatomy and biomechanical properties and is supported by the existing literature. It remains to be seen how this will impact postoperative outcomes for total shoulder arthroplasty providing a justification for this review. Methods A review and synthesis of the literature on the subject of joint replacement in the native and prosthetic humeral head was performed. Results Our review encompasses the anatomical, biomechanical, and finite element data present in the literature for native and prosthetic joint replacement. They describe the native humeral head as more elliptical (nonspherical) than circular (spherical) and that nonspherical prosthetics more closely approximate glenohumeral kinematic properties. Conclusion A nonspherical prosthetic may influence long-term clinical outcomes in hemiarthroplasty and anatomic total shoulder arthroplasty though further research in this area is necessary.

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Early complications of reverse total shoulder arthroplasty

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027210-14 ◽

2020 ◽

Vol 27 (2) ◽

pp. 10-14

Author(s):

Aleksey V. Lychagin ◽

Guren A. Kesian ◽

Eugeny B. Kalinskу ◽

Nikilay A. Sukharev

Keyword(s):

Shoulder Arthroplasty ◽

Periprosthetic Fracture ◽

Soft Tissues ◽

Preventive Measures ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Clinical Information ◽

Early Complications ◽

Foreign Countries ◽

Reverse Total Shoulder

Background. The frequency of early complications after reverse shoulder arthroplasty remains high enough, and the overall complication rate is reported from 4.7% to 38%. Methods. We did 23 primary reverse shoulder arthroplasty and used clinical information after these operations in our study. As a comparative material, we used date from registers of foreign countries, as well as information from special literature. Results. Early complications were found in five cases (21.7%) in our study: two cases (8.7%) of a periprosthetic fracture; three patients (13.2%) had dislocation components. We studied these complications and formulated rules preventive measures. Conclusions. (1) The most common early complications after revers total shoulder arthroplasty were instability components, periprosthetic fracture. (2) These types of complications arise due to unbalanced soft tissues, inadequate selection of the size of the glenosphere, interposition of soft tissues, and inadequate term of loads on the operated limb. (3) The number of these complications can be reduced by observing preventive measures at all stages of treatment.

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