scholarly journals Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures

2021 ◽  
Vol 10 (21) ◽  
pp. 5123
Author(s):  
Alexander Klug ◽  
Eva Herrmann ◽  
Sebastian Fischer ◽  
Reinhard Hoffmann ◽  
Yves Gramlich
Keyword(s):  
Shoulder Arthroplasty ◽  
Negative Binomial ◽  
Reverse Shoulder Arthroplasty ◽  
Revision Arthroplasty ◽  
Fracture Prevention ◽  
Study Data ◽  
Annual Number ◽  
Future Research ◽  
Population Forecasts ◽  
Shoulder Arthroplasties

Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany (2010–2019) and population forecasts until 2040 were gathered. A Poisson and a negative binomial approach using monotone B-splines were modeled for all types of prostheses to project the annual number and incidence of primary and revision arthroplasty. Additionally, trends in main indicators were also gathered and expected changes were calculated. Overall, the number of primary shoulder replacements is set to increase significantly by 2040, reaching at least 37,000 (95% CI 32,000–44,000) procedures per year. This trend is mainly attributable to an about 10-fold increased use of fracture-related reverse shoulder arthroplasty in patients over 80 years of age, although the number of procedures in younger patients will also rise substantially. In contrast, hemiarthroplasties will significantly decrease. The number of revision procedures is projected to increase subsequently, although the revision burden is forecast to decline. Using these country-specific projection approaches, a massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. These growth rates are substantially higher than those from hip or knee arthroplasty. As these trends are similar in most Western countries, this draws attention to the international issue, of: if healthcare systems will be able to allocate human and financial resources adequately, and if future research and fracture-prevention programs may help to temper this rising burden in the upcoming decades.

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

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

Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

2020 ◽  
pp. 175857322092115
Author(s):  
Bradley S Schoch ◽  
Joseph J King ◽  
Joseph Zuckerman ◽  
Thomas W Wright ◽  
Chris Roche ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reoperation Rate ◽  
Patient Reported ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

scholarly journals Debridement, antibiotics, and implant retention in infected shoulder arthroplasty caused by Serratia marcescens: a case report

2022 ◽  
Author(s):  
Sungjoon Lim ◽  
Jun-Bum Lee ◽  
Myoung Yeol Shin ◽  
In-Ho Jeon
Keyword(s):  
Serratia Marcescens ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Sinus Tract ◽  
Complex Case ◽  
Infected Nonunion ◽  
Effective Option ◽  
Implant Retention

Periprosthetic joint infection (PJI) is one of the most devastating complications that can occur after shoulder arthroplasty. Although staged revision arthroplasty is the standard treatment in many cases, surgical intervention with debridement, antibiotics, and implant retention (DAIR) can be an effective option for acute PJI. We report a complex case of infected reverse shoulder arthroplasty (RSA) in a 73-year-old male. The patient had been previously treated for infected nonunion of a proximal humerus fracture caused by methicillin-resistant Staphylococcus epidermidis. He presented with a sinus tract 16 days after the implantation of RSA and was diagnosed with PJI caused by Serratia marcescens. The patient was successfully treated with DAIR and was free of infection at the last follow-up visit at four years postoperatively.

How common are acromial and scapular spine fractures after reverse shoulder arthroplasty?

2019 ◽  
Vol 101-B (6) ◽  
pp. 627-634 ◽  
Author(s):  
J. J. King ◽  
S. S. Dalton ◽  
L. V. Gulotta ◽  
T. W. Wright ◽  
B. S. Schoch
Keyword(s):  
Incidence Rate ◽  
Shoulder Arthroplasty ◽  
Inflammatory Arthritis ◽  
English Literature ◽  
Reverse Shoulder Arthroplasty ◽  
Revision Arthroplasty ◽  
Fracture Rate ◽  
Spine Fractures ◽  
Wide Range ◽  
Scapular Spine

Aims Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature. Materials and Methods A systematic review using the search terms “reverse shoulder”, “reverse total shoulder”, or “inverted shoulder” was performed using PubMed, Web of Science, and Cochrane databases between 1 January 2010 and 31 March 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were included if they reported on RSA outcomes and the incidence rate of acromial and/or scapular spine fractures. The rate of these fractures was evaluated for primary RSA, revision RSA, RSA indications, and RSA implant design. Results The review included 90 articles out of 686 identified after exclusions. The incidence rate of acromial and/or scapular spine fractures was 2.8% (253/9048 RSAs). The fracture rate was similar for primary and revision RSA (2.8% vs 2.1%; p = 0.4). Acromial fractures were most common after RSA for inflammatory arthritis (10.9%) and massive rotator cuff tears (3.8%). The incidence was lowest in RSA for post-traumatic arthritis (2.1%) and acute proximal humerus fractures (0%). Lateralized glenosphere design had a significantly higher rate of acromial fractures compared with medial glenosphere designs. Conclusion Based on current English literature, acromial and/or scapular spine fractures occur at a rate of 2.8% after RSA. The incidence is slightly more common after primary compared with revision arthroplasty. Also, higher rates of acromial fractures are reported in RSA performed for inflammatory arthritis and in the lateralized glenoid design. Cite this article: Bone Joint J 2019;101-B:627–634.

scholarly journals Risk factors for instability after reverse shoulder arthroplasty

2019 ◽  
pp. 175857321986426 ◽  
Author(s):  
Vincenzo Guarrella ◽  
Mikael Chelli ◽  
Peter Domos ◽  
Francesco Ascione ◽  
Pascal Boileau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Functional Results ◽  
Younger Patients ◽  
Long Term Follow Up ◽  
Shoulder Arthroplasties ◽  
Postoperative Instability

Background This study aims to identify risk factors related to postoperative instability after reverse shoulder arthroplasty and evaluate the modalities and results of treatments in a large series of patients, with medium to long-term follow-up. Methods Retrospective multicenter series of 1035 consecutive Grammont type reverse shoulder arthroplasties implanted between 1992 and 2010. 19.9% had a reverse shoulder arthroplasty with bony lateralization on the glenoid side. Patients were reviewed and radiographed with minimum five years’ follow-up. Results At a mean follow-up of eight years, the overall rate of postoperative instability was 3.0%. Instability was more frequent in case of reverse shoulder arthroplasty for revision surgery, in younger patients, in case of scapular notching, and tuberosity resorption. Lateralized reverse shoulder arthroplasties were associated with a lower instability rate. A reoperation to restore stability was needed in 70% of cases. The improvement in Constant Score was lower in patients with unstable reverse shoulder arthroplasties when compared to stable reverse shoulder arthroplasties. Conclusions Younger patients are at higher risk for instability after Grammont type reverse shoulder arthroplasty implantation. Conversely, lateralized reverse shoulder arthroplasties resulted protective. When conservative treatment had failed, shoulder stability can be obtained with reoperation or prosthetic revision (needed in 70% of the cases), but to the price of lower functional results.

Mid-term radiological results of a cementless short humeral component in anatomical and reverse shoulder arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 610-614 ◽  
Author(s):  
W. R. Aibinder ◽  
D. W. Bartels ◽  
J. W. Sperling ◽  
J. Sanchez-Sotelo
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Stress Shielding ◽  
Radiological Findings ◽  
Humeral Component ◽  
Bone Changes ◽  
The Mean ◽  
Shoulder Arthroplasties ◽  
Glenoid Loosening

Aims Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA). Patients and Methods A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4). Results Greater tuberosity stress shielding was noted in 14 shoulders (two TSA and 12 RSA) and was graded as mild in nine, moderate in two, and severe in three. Medial calcar resorption was noted in 23 shoulders (seven TSA and 16 RSA), and was graded as mild in 21 and moderate in two. No humeral components were revised for loosening or considered to be loose radiologically. Nine shoulders underwent reoperation for infection (n = 3), fracture of the humeral tray (n = 2), aseptic glenoid loosening (n = 1), and instability (n = 3). No periprosthetic fractures occurred. Conclusion Implantation of this particular short cementless humeral component at the time of TSA or RSA was associated with a low rate of adverse radiological findings on the humeral side at mid-term follow-up. Our data do not raise any concerns regarding the use of a short stem in TSA or RSA. Cite this article: Bone Joint J 2019;101-B:610–614.

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 Multimodality imaging in shoulder arthroplasties Part 1: Biomechanics, indications, preoperative imaging, and types of arthroplasties – A pictorial review

2021 ◽  
Vol 3 ◽  
pp. 24-29
Author(s):  
Matthew Sarvesvaran ◽  
Siddharth Thaker ◽  
Suresh Srinivasan ◽  
Rahatdeep Singh Brar ◽  
Raj Bhatt ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Multimodality Imaging ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Preoperative Imaging ◽  
Shoulder Biomechanics ◽  
Case Examples ◽  
Pictorial Review ◽  
Shoulder Arthroplasties

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.

scholarly journals Imaging of shoulder arthroplasties and their complications: a pictorial review

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Damien Combes ◽  
Romain Lancigu ◽  
Patrick Desbordes de Cepoy ◽  
Filippo Caporilli-Razza ◽  
Laurent Hubert ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Shoulder Arthroplasty ◽  
Shoulder Joint ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Glenoid Component ◽  
Humeral Component ◽  
Number Of Patients ◽  
Component Loosening ◽  
Shoulder Arthroplasties

Abstract Currently, an increasing number of patients benefit from shoulder prosthesis implantation. Radiologists are therefore more often confronted with imaging examinations involving shoulder arthroplasty, whether during a dedicated examination or incidentally. Standard radiography is the first-line imaging modality in the follow-up of these implants, before the possible use of cross-sectional imaging modalities (computed tomography and magnetic resonance imaging), ultrasound, or nuclear medicine examinations. Shoulder arthroplasties are divided into three categories: reverse shoulder arthroplasty, total shoulder arthroplasty, and partial shoulder joint replacement (including humeral hemiarthroplasty and humeral head resurfacing arthroplasty). Each of these prostheses can present complications, either shared by all types of arthroplasty or specific to each. Infection, periprosthetic fractures, humeral component loosening, heterotopic ossification, implant failure, and nerve injury can affect all types of prostheses. Instability, scapular notching, and acromial fractures can be identified after reverse shoulder arthroplasty implantation. Glenoid component loosening and rotator cuff tear are specific complications of total shoulder arthroplasty. Progressive wear of the native glenoid is the only specific complication observed in partial shoulder joint replacement. Knowledge of different types of shoulder prostheses and their complications’ radiological signs is crucial for the radiologist to initiate prompt and adequate management.

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