Mid-term outcomes of a stemless ceramic head anatomic total shoulder replacement

Background In an anatomic shoulder replacement (aTSR) good results have been reported with the use of a stemless humeral prosthesis. In vitro a ceramic articulation with polyethylene has been shown to produce less polyethylene wear particles than with metal. This study aims to evaluate clinical and radiographic results of a stemless aTSR with a ceramic head articulating with a polyethylene glenoid component, with mid-term follow-up. Methods All patients (n = 92) in this prospective study had an aTSR utilizing a stemless humeral component with a ceramic head and a cemented double pegged cemented polyethylene glenoid component for glenohumeral osteoarthritis. Pre- and postoperative clinical evaluations at 2 years were performed using the ASES score, Constant score, SPADI score, DASH score, VAS pain score, patient satisfaction and range of motion. There was a 5-year evaluation of SPADI, ASES, pain, and satisfaction, plus radiographic assessment of glenoid component radiolucent lines and humeral osteolysis. Results Seventy-four cases (68.1 ± 7.1 years) had a five-year follow-up and demonstrated active elevation improvement from 91.3° preoperatively to 151.1° (p < 0.001). Further improvement was identified with the ASES from 41.6 to 94.3, the SPADI from 62.9 to 4.3, VAS pain from 5.6 to 0.4 (0–10), and satisfaction levels were at 96%. Sixty-two cases had no glenoid radiolucent lines with a maximum Lazarus score of 2 in one patient. Constant scores, available up to 2 years, improved significantly from 30.3 to 77.9 (p < 0.001). There was one case that required revision for glenoid loosening. Conclusions Overall, the 5-year results of this ceramic head prosthesis demonstrated good radiographic and clinical outcomes. Trial registration ACTRN12613001183774. Registered: 29 October 2013 - Retrospectively registered. Australian New Zealand Clinical Trials Registry (ANZCTR).

Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom

Background: This review aims to compare the outcomes for day case shoulder replacement with in-patient shoulder replacement surgery in a district general hospital. Methods: Seventy-three patients had 82 shoulder arthroplasty procedures. Forty-six procedures were undertaken in a dedicated stand-alone day-case unit and 36 were undertaken as in-patient cases. Patient were followed up at 6 weeks, 6 months and annually. Results: There was no significant difference between the outcomes of shoulder arthroplasty procedures performed in the day case or in-patient settings making this a safe option for surgical care in a unit with an appropriate care pathway. Six complications in total were observed, three in each group. Operation time was statistically shorter for day cases by 25.1 min (95% CI - 36.5 to −13.7; d = −0.95, 95% CI −1.42 to 0.48). Estimated marginal means (EMM) revealed lower post-surgery oxford pain scores in day cases (EMM = 3.25, 95% CI 2.35, 4.16) compared with inpatients (EMM = 4.65, 95% CI 3.64 to 5.67). Constant shoulder scores were higher in day cases versus inpatients. Conclusion: Day case shoulder replacement is safe with comparable outcomes to routine inpatient care for patients up to ASA 3 classification with high satisfaction and excellent functional outcomes.

Shoulder joint arthroplasty in young patients: Analysis of 8742 patients from the Australian Orthopaedic Association National Joint Replacement Registry

Background Shoulder replacement is a reliable treatment for the relief of pain and improvement of function in patients with glenohumeral arthritis, rotator cuff arthropathy, osteonecrosis and fracture. Limited data is available comparing revision rates for the different types of shoulder replacement when used in younger patients. This study aims to compare the survivorship of hemi resurfacing, stemmed hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty in younger patients using data from a large national arthroplasty registry. Methods Data from the Australian Orthopaedic Association National Joint Replacement Registry was obtained for the period 16 April 2004–31 December 2018. The study population included all shoulder arthroplasty patients aged <65 years. These were stratified into two groups: <55 years and 55–64 years. A total of 8742 primary shoulder arthroplasty procedures were analysed (1936 procedures in the <55 years and 6806 in the 55–64 years age group). Results In the <55 years age group, there was no difference in revision rate for total shoulder arthroplasty versus reverse total shoulder arthroplasty at any time point. Reverse total shoulder arthroplasty had a lower revision rate after six months when compared to hemi resurfacing (HRA) (p = 0.031). Also, reverse total shoulder arthroplasty had a higher early rate of revision in the first 12 months compared to hemiarthroplasty (p = 0.018). However, from 2 years reverse total shoulder arthroplasty had a lower revision rate overall (p = 0.029). In the 55–64 years patient age group, reverse total shoulder arthroplasty had a lower earlier revision rate. This was statistically significant compared to hemi resurfacing (HRA) (p = 0.028), hemiarthroplasty (p = 0.049) and total shoulder arthroplasty (p < 0.001). Conclusion This study demonstrated that for patients aged <55 years there was no significant difference in the rate of revision when total shoulder arthroplasty and reverse total shoulder arthroplasty were compared. reverse total shoulder arthroplasty had a lower rate of revision when compared to hemi resurfacing and hemiarthroplasty after 2 years. reverse total shoulder arthroplasty had the lowest comparative revision rate in patients aged 55–64 years overall.

Encouraging outcomes of stemless ceramic head anatomic shoulder arthroplasty in severe primary osteoarthritis (Walch type B glenoids)

Background: We report the radiological and functional outcomes at five years in patients with severe osteoarthritis of the glenohumeral joint and a Walch type B glenoid who have undergone stemless anatomic total shoulder replacement. Methods: A retrospective analysis of case notes, computed tomography scans and plain radiographs of patients undergoing anatomic total shoulder replacement for primary glenohumeral osteoarthritis were performed. Patients were grouped by the severity of their osteoarthritis using the modified Walch classification, glenoid retroversion and posterior humeral head subluxation. An evaluation was made using modern planning software. Functional outcomes were assessed using the American shoulder and elbow surgeons score, shoulder pain and disability index and visual analogue scale. Annual Lazarus scores were reviewed as regard to glenoid loosening. Results: Thirty patients were reviewed at 5 years. Analysis of all patient-reported outcome measures demonstrated significant improvement at 5-year review, American shoulder and elbow surgeons ( p = <0.0001), shoulder pain and disability index ( p = 0.0001), visual analogue scale ( p = 0.0001). Radiological associations between Walch scores and Lazarus scores were not statistically significant ( p = 0.1251) at 5 years. There were no associations between features of glenohumeral osteoarthritis and patient-reported outcome measures. Discussion: The severity of osteoarthritis did not show any association with glenoid component survivorship or with patient-reported outcome measures at 5 years review. Level of evidence: IV.

Dissociation of the Glenosphere: A rare Post-operative Complication of Reverse shoulder Replacement

Introduction: Reverse shoulder replacement (RSR) has been accepted as the treatment of choice for glenohumeral arthritis with irreparable rotator cuff tear. Dislocation has been a potential complication of RSR but glenosphere disengagement is a rare complication itself. There have been only few published reports of this complication in the literature. Case Report: In this case report, we have presented a case of repeated disengagement of glenoid sphere post-RSR in a 72-year-old male retired army personnel operated with Zimmer Biomet comprehensive RSR design. Conclusion: In our case scenario, we postulate that soft-tissue interposition was the reason for disengagement during first episode and was successfully relocated after removal. However, the subsequent disengagement was due to improper seating of sphere due to large central screw. Revision to a smaller central screw size appears to be the definitive solution in such case. Keywords: Reverse shoulder replacement, glenosphere disengagement, glenohumeral arthritis, irreparable rotator cuff tear.

Preoperative Preparation of Patients with Anemia before Shoulder Replacement

The preoperative anemia in patients increases the risk of perioperative blood transfusion, myocardial infarction, ischemic stroke, acute kidney injury, and higher nosocomial and 30-day mortality, lengthens the duration of treatment, and increases the risk of re-hospitalization.The objective: to improve treatment results of patients after revision shoulder replacement through management of preoperative anemia.Subjects and methods. 170 medical files of patients who underwent revision shoulder replacement from 2014 to 2021 were retrospectively analyzed. On the day when they were examined by the physician, all patients had blood hemoglobin level below 130 g/l. The patients were divided into two groups that were comparable in their characteristics. Patients of the Main Group (n = 90) received preoperative preparation with iron carboxymaltate in combination with recombinant human erythropoietin 4 weeks before the expected date of surgery. Patients of the Control Group (n = 80) did not have any specific preparation.Results. The data obtained showed that the volume of intraoperative and postoperative drainage blood loss did not differ statistically between the groups; hemoglobin blood level in patients from the Main Group was statistically significantly higher both before the surgery and on the first day after it, and no hemotransfusion was indicated. In the Control Group, a statistically significantly greater decrease in hemoglobin level was observed in the postoperative period; 3 (3.8%) patients in the Control Group required RBC-transfusion. Complications in the early postoperative period (myocardial infarction, pulmonary embolism, and cardiac arrhythmia) were significantly less frequent in the Main Group versus the Control one (4.5% of cases vs. 8.8%; p < 0.05).Conclusion. The use of iron carboxymaltate at the dose of 1,000 mg once and, if necessary, repeatedly in 14 days in combination with recombinant human erythropoietin at the dose of 150 IU/kg allows preparing patients for revision shoulder replacement within the period from two weeks to one month. Preoperative management of anemia until the hemoglobin concentration reaches 130 g/l using the proposed regimen can significantly reduce the need for blood transfusion and frequency of somatic complications in the early postoperative period.