scholarly journals Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty

2021 ◽  
Vol 10 (24) ◽  
pp. 5773
Author(s):  
Maciej J. K. Simon ◽  
Helen Crofts ◽  
Treny Sasyniuk ◽  
Kayla Johnston ◽  
Derek Plausinis ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Total Shoulder Arthroplasty ◽  
Female Gender ◽  
Glenoid Component ◽  
Component Position ◽  
Short Term ◽  
Patient Reported ◽  
Patient Reported Measures

Background: Malpositioning of the glenoid component in total shoulder arthroplasty (TSA) remains the primary source of loosening. The purpose of this study is firstly, to quantify postoperative glenoid component position in patients having a TSA and secondly, to explore whether glenoid component radiolucency is associated with glenoid position, clinical outcomes and patient-reported measures in the short-term (two year) follow-up period. Methods: This study was a sub-study of a larger clinical trial that included patients who underwent a TSA and who were randomized into two different glenoid types with a minimum two-year follow-up period. Post-operative radiographic assessments (six weeks and two years) were used to measure glenoid component position (version, inclination, offset) and humeral head centering anterior–posterior (AP) and superior–inferior (SI), and to assess glenoid component radiolucent scoring (modified Lazarus). Pre-operative X-rays were used to measure glenoid version, inclination and Walch classification. Patient-reported measures (PROMs) included the EQ-5D health slider and the Western Ontario Osteoarthritis (WOOS) and American Shoulder and Elbow Surgeons (ASES) score and were captured at baseline and two years postoperative. Clinical outcomes including range of motion and complications were also documented. Statistical analysis included t-tests and regression modeling. Results: Ninety-one patients with an average age of 69.9 ± 6.2 years were included in this study. Glenoid component position improved significantly in version (−19.4 ± 8.6° to −17.7 ± 8.5°; p < 0.045) and inclination (11.5 ± 7.1° to 5.9 ± 6.3°; p < 0.00001) from preoperative to six weeks postoperative. Glenoid component offset in SI and humeral head centering in AP remained unchanged throughout the follow-up. Radiolucency (Lazarus classification) was recorded in 21 cases (17.3%) with a Lazarus score of 1 (15 cases) and 2 (6 cases). The EQ-5D health slider, WOOS and ASES, and ROM confirmed continuous improvements from the preoperative scores to the two-year follow-up (p < 0.05). Regression models showed no correlation between glenoid component radiolucency at two years and the postoperative week six glenoid component position; however, female gender was a significant variable. Conclusion: Glenoid component changes from its original native glenoid were observed following TSA. Glenoid inclination was improved more than version from baseline, and the humeral head remained well-centered in AP and SI at two years. Radiolucency of the glenoid at two years is not negatively associated with PROMs or component position; however, female gender was identified as a significant predictor and warrants further investigation. Complications are not associated with glenoid position or radiolucency, but longer-term follow-up is required.

scholarly journals Short-Term Outcomes of the Grammont Reverse Shoulder Arthroplasty: Comparison between First and Second Generation Delta Prosthesis

Joints ◽  
2021 ◽  
Author(s):  
Riccardo Luigi Alberio ◽  
Marco Landrino ◽  
Paolo Fornara ◽  
Federico Alberto Grassi
Keyword(s):  
Shoulder Arthroplasty ◽  
Second Generation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Radiographic Evaluation ◽  
Glenoid Component ◽  
Consecutive Series ◽  
Short Term ◽  
Component Loosening

Abstract Purpose This article compares short-term outcomes of two series of patients, who underwent reverse total shoulder arthroplasty (RTSA) with two different implants, both based on Grammont's principles: the Delta III (D-3) and the Delta Xtend (D-XT) prostheses. Methods The D-3 group included a consecutive series of 26 patients (mean age 75 years), that were treated between 2000 and 2006; the D-XT group included a consecutive series of 31 patients (mean age 72.5 years), for a total of 33 implants performed between 2011 and 2015. In both groups the most common diagnoses were cuff tear arthropathy (18 and 22 shoulders, respectively) and malunion of proximal humerus fractures (3 and 5). All procedures were performed by the same surgeon. Constant–Murley score (CMS) was used to assess clinical and functional outcomes. Radiographic evaluation included the true anteroposterior and axillary views. Results Twenty-three patients of the D-3 group and 22 patients (24 shoulders) of the D-XT group were evaluated at a mean follow-up of 42 months (range 26–84) and 44 months (range 26–66), respectively. Four complications occurred in the D-3 group (1 partial deltoid detachment, 1 dislocation, and 2 glenoid component loosening), while one early postoperative infection occurred in the D-XT group. Increases in elevation and CMS between preoperative and postoperative period were observed in both groups; only the D-XT group showed a slight improvement in rotations. The incidence of scapular notching was significantly different between the two groups: 100% for D-3 and 22.2% for D-XT in patients with a minimum follow-up of 5 years. Conclusion Prosthetic design evolution and greater acquaintance with this surgery have undoubtedly led to an improvement in short-term outcomes with second generation implants of RTSA. Future studies will have to ascertain whether newer implants, relying on biomechanical solutions alternative to Grammont's original concept, might provide additional advantages and minimize drawbacks.

scholarly journals Hybrid Glenoid Designs in Anatomic Total Shoulder Arthroplasty: A Systematic Review

2021 ◽  
pp. 155633162110408
Author(s):  
Ahmed Haleem ◽  
Phelopater Sedrak ◽  
Chetan Gohal ◽  
George S. Athwal ◽  
Moin Khan ◽  
...  
Keyword(s):  
Los Angeles ◽  
Shoulder Arthroplasty ◽  
Bone Ingrowth ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Glenoid Component ◽  
Patient Reported

Background: Hybrid glenoid components in total shoulder arthroplasty (TSA) utilize both polyethylene and metal components to provide short-term stability and long-term biologic fixation through bone ingrowth. Questions/Purpose: We sought to systematically review the literature for studies that assessed outcomes of TSA performed using hybrid glenoid components. Methods: PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched systematically for articles measuring clinical and patient-reported outcomes and rates of complication and revision following TSA using a hybrid glenoid component. Results: Seven studies with 593 shoulders were included in this review. The mean age of patients was 65 ± 1 years, and 46% of the population was male. Mean follow-up was 50 months (4.2 years). The overall complication rate was 7% and rate of revision was 2.5%; glenoid radiolucency was present in 33% of shoulders at mean follow-up of 50 months. Mean improvements in forward elevation, external rotation, internal rotation score, and abduction were 49°, 28°, 2 points, and 42°, respectively. Mean improvements in Constant, American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores were 36 points, 52 points, and 17 points, respectively. Conclusion: Our review found that TSA using hybrid glenoid components results in low rates of complication and revision at early follow-up. Long-term studies are warranted to understand more fully the role of hybrid glenoid components in TSA.

Use of a custom alignment guide to improve glenoid component position in total shoulder arthroplasty

2012 ◽  
Vol 21 (12) ◽  
pp. 2860-2866 ◽  
Author(s):  
Eduardo M. Suero ◽  
Musa Citak ◽  
Darrick Lo ◽  
Aaron J. Krych ◽  
Edward V. Craig ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Glenoid Component ◽  
Component Position ◽  
Alignment Guide

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.

Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

2020 ◽  
pp. 175857322091682
Author(s):  
John-Rudolph H Smith ◽  
Darby A Houck ◽  
Jessica A Hart ◽  
Jonathan T Bravman ◽  
Rachel M Frank ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
English Language ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

scholarly journals Anatomic Total Shoulder Arthroplasty Using a Self-Pressurizing Pegged Bone-Preserving Cemented Glenoid Component: A 2- to 5-Year Follow-up Study

2018 ◽  
Vol 2 ◽  
pp. 247154921775047
Author(s):  
Joaquin Sanchez-Sotelo ◽  
Ngoc Tram V Nguyen ◽  
Mark Morrey
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Loose Body ◽  
Deep Infection ◽  
Glenoid Component ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties ◽  
And Function

Background: High rates of radiographic loosening have been reported with various glenoid designs. Many available designs sacrifice most of the bone at the central portion of the glenoid vault, creating large areas of deficiency when revision becomes necessary. The purpose of this study was to report the 2- to 5-year outcome of shoulder arthroplasty using a bone-preserving all-polyethylene glenoid components with self-pressurizing pegs. Methods: Between August 2011 and December 2014, 202 consecutive anatomic total shoulder arthroplasties (TSAs) were performed by a single surgeon with implantation of a self-pressurizing cemented pegged glenoid component in 190 patients (12 patients had both shoulders replaced). Patients were followed up prospectively and evaluated for pain, motion, strength, American Shoulder and Elbow Surgeons (ASES) scores, and radiographic changes. The mean follow-up time was 2.7 (2–5) years. Results: TSA improved pain and function reliably. At the most recent follow-up, 94% of the shoulders had no or mild pain. Motion included 154 ± 25° of elevation, 68 ± 18° of external rotation, and median internal rotation to T10 (range, iliac crest to T4). The most recent average ASES score was 82 ± 15 points. Early postoperative radiographs showed no radiolucent lines. No humeral or glenoid component was considered radiographically loose at the most recent follow-up. Complications requiring reoperation included subscapularis insufficiency (4), posterior instability (2), deep infection (1), stiffness (1), and a painful loose body (1). No components were revised for loosening. Conclusions: Anatomic TSA using a cemented bone-preserving all-polyethylene pegged self-pressurizing glenoid component provided satisfactory clinical outcomes and survival at 2 to 5 years.

scholarly journals Anatomical total shoulder arthroplasty in young patients with osteoarthritis

2018 ◽  
Vol 100-B (4) ◽  
pp. 485-492 ◽  
Author(s):  
M. O. Gauci ◽  
N. Bonnevialle ◽  
G. Moineau ◽  
M. Baba ◽  
G. Walch ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Polyethylene Wear ◽  
Total Shoulder Arthroplasty ◽  
Young Patients ◽  
Glenoid Component ◽  
Implant Survival ◽  
Survivorship Analysis ◽  
Kaplan Meier ◽  
Glenoid Loosening

Aims Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components. Materials and Methods A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan–Meier survivorship analysis was performed with revision as the endpoint. Results A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years’ follow-up, the rate of implant survival was 74% (sd 0.09) for polyethylene components and 24% (sd 0.10) for metal-backed components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted glenoid (Walch B2) had an adverse effect on the survival of a metal-backed component. Conclusion The survival of a cemented polyethylene glenoid component is three times higher than that of a cementless metal-backed glenoid component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) glenoid have the highest risk of failure. Cite this article: Bone Joint J 2018;100-B:485–92.

Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up

2016 ◽  
Vol 25 (7) ◽  
pp. 1163-1169 ◽  
Author(s):  
Danielle J. Casagrande ◽  
Di L. Parks ◽  
Travis Torngren ◽  
Mark A. Schrumpf ◽  
Samuel M. Harmsen ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Short Stem ◽  
Radiographic Evaluation ◽  
Short Term ◽  
Press Fit

scholarly journals Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty With a Nonspherical Humeral Head and Inlay Glenoid in Elite Weight Lifters: A Prospective Case Series

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110210
Author(s):  
Sercan Yalcin ◽  
Michael Scarcella ◽  
Joshua Everhart ◽  
Linsen Samuel ◽  
Anthony Miniaci
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Weight Lifting ◽  
Rate Of Return ◽  
Radiographic Outcomes ◽  
Weight Lifters ◽  
Shoulder Score

Background: Weight lifting after total shoulder arthroplasty (TSA) can place significant stresses on implants that could lead to instability, loosening, and increased wear. A TSA system with nonspherical humeral head resurfacing and inlay glenoid—which improves the biomechanics and thus reduces instability, wear, and potential loosening—may be able to tolerate repetitive loads from weight lifting. Purpose: To determine clinical and radiographic outcomes after TSA in weight lifters. Study Design: Case series; Level of evidence, 4. Methods: We prospectively enrolled 16 weight lifters (mean ± SD age, 57.2 ± 7.8 years; 15 male) undergoing primary anatomic TSA (n = 17 shoulders, 1 staged bilateral) with nonspherical humeral head resurfacing and inlay glenoid replacement for glenohumeral osteoarthritis between February 2015 and February 2019. Exclusion criteria were rotator cuff deficiency, revision TSA, post-traumatic arthritis, and inflammatory arthritis. Outcome measures included the rate of return to weight lifting, results of patient-reported outcome measures (Penn Shoulder Score, Kerlan-Jobe Orthopaedic Clinic, and 12-Item Veterans RAND Health Survey), radiographic outcomes, and complication rate. Results: Follow-up was obtained on all patients at a mean of 38 months (range, 14-63 months). All patients returned to competitive weight lifting at 15.6 ± 6.9 weeks. Compared to the preoperative weight lifting level, at last follow-up patients reported performance at the following level: lighter weight, 1 (6%); same weight, 8 (50%); heavier weight, 7 (44%). Preoperative eccentric posterior glenoid wear was common (71% Walch B2 classification; 12/17), but posterior humeral subluxation improved at follow-up according to the Walch index (mean, 55.5% preoperative vs 48.5% postoperative; P < .001) and contact point ratio (mean, 63.9% preoperative vs 50.1% postoperative; P < .001). Pre- to postoperative improvements were seen in Penn Shoulder Score (44.3 vs 82.6; P < .001), Kerlan-Jobe Orthopaedic Clinic (50.6 vs 91.1; P < .001), and 12-Item Veterans RAND Health Survey physical component score but not mental component score. No signs of radiographic loosening were detected in follow-up images, nor were there any postoperative instability episodes or revision surgeries. Conclusion: There were substantial improvements in shoulder function and a high rate of return to weight lifting after TSA with a nonspherical humeral head resurfacing and inlay glenoid component. Radiographically, the humeral head centralized on the glenoid after surgery, and there was no evidence of component loosening at a mean 38-month follow-up.

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