Systematic Review and Meta-Analysis of Locked Posterior Dislocation of the Shoulder Treated with Shoulder Arthroplasty: Improved Outcomes for Total Shoulder Arthroplasty are Associated with Increased Age

Locked shoulder dislocations account for up to 5% of shoulder dislocations. These relatively rare injuries are characterized by dislocation of the humeral head from the scapular glenoid cavity with the humeral head incarcerated on the glenoid in a “locked” fashion. Diagnosis is often delayed because of the complexity of clinical presentation and subtle radiographic findings, resulting in locking of the humeral head out of the glenoid cavity with severe functional deficits. Most commonly, there are bony injuries to the glenoid and humeral head that engage and prevent closed reduction. Since few patients present with this injury, evidence-based treatment guidelines have not been established. The objective of this review is to assess postoperative outcomes following shoulder arthroplasty for locked posterior shoulder dislocations (LPSD) to guide best practices for treatment. This systematic review was conducted following PRISMA guidelines, searching the PubMed and Web of Science databases for original articles assessing outcomes following arthroplasty for locked posterior shoulder dislocations. Seven publications that evaluated 102 patients were included. Additionally, nine case studies were included, assessing 20 shoulder arthroplasties. Overall, the analysis demonstrated significant improvement in shoulder pain following total shoulder arthroplasty (TSA) (P = 0.0003). Older operative patient ages for TSA resulted in significantly improved modified Neer outcomes scores and patient satisfaction compared to younger patients (P = 0.047). A positive correlation was noted for the duration of dislocation and necessity for revision surgery following hemiarthroplasty (HSA) and TSA combined and TSA separately. The risk ratios assessing the incidence of postoperative complications (RR = 0.56, 95% CI = 0.28–1.11) and necessity for revision surgery (RR = 0.58, 95% CI = 0.24–1.39) were insignificant but noted outcomes favoring TSA. Data from the included studies show that both TSA and HSA are efficacious at treating locked posterior shoulder dislocation. Postoperative outcomes following TSA versus HSA are similar. TSA may be a more efficacious surgical treatment in elderly patients, with improved outcomes and patient satisfaction scores compared to younger patients. Early diagnosis and treatment of posterior locked dislocations may lead to reduced postoperative complications and revision surgery, signaling the importance of proper injury investigation and early treatment. The role of RSA in the management of locked posterior shoulder dislocation remains to be determined, as there is insufficient clinical outcome data currently in the literature.     

A “convertible” humeral stem: A step forward in revision of total shoulder arthroplasty

Revision total shoulder arthroplasty is performed for a variety of patient symptoms, including shoulder pain, instability, or stiffness. The technical reasons found for revision include component loosening or malposition. Removing the humeral stem during revision can increase morbidity and blood loss during a procedure. The ability to use a universal stem that can be utilized in both anatomic and reverse shoulder arthroplasty can be beneficial in three main areas. For revision surgeries, cost is much less, OR time is decreased, and complications are much less frequent.     

Shoulder arthroplasty in patients with ipsilateral hemiparesis: a safe and durable procedure? A case series

HypothesisShoulder arthroplasty is a safe and durable procedure that provides pain relief, improved range of motion (ROM), and minimal complications for shoulder pain and dysfunction in patients with ipsilateral hemiparesis.MethodsThis is a retrospective review of all adult patients who underwent primary reverse total shoulder arthroplasty (RSA) or total shoulder arthroplasty (TSA) in the hemiparetic upper extremity at a single quaternary care academic medical center from 1988 to 2019. Patients were excluded if their neurologic insult was secondary to a spinal-cord injury, cerebral palsy, or inflammatory arthritis, if they underwent a hemiarthroplasty, if they exhibited mild hemiparesis (Medical Research Council Scale of ≥4), or if they had less than 30 days of radiographic follow-up. The primary clinical outcome was revision surgery for any reason. The secondary clinical outcomes included pain using the visual analog scale, ROM via active-assisted manual muscle testing (AAROM), and postoperative complications. The primary radiographic outcome was implant lucency using a standard scale.ResultsA total of 5 shoulders in 5 patients were included, 4 RSAs and 1 TSA with a mean clinical follow-up of 6.2 years (range: 1.42-14.2 years) and mean radiographic follow-up of 3.7 years (range: 31 days-13.5 years). No patient underwent revision surgery. The mean visual analog scale score significantly improved from 7.6 to 1.4 at the last follow-up (P = .005). The mean forward elevation AAROM improved from 27° preoperatively to 88° at the last follow-up (P = .015). There was no significant difference in external rotation at the last follow-up (P = .105). One patient had asymptomatic grade 1 glenoid component lucency with superior subluxation of the humerus after undergoing TSA at a final follow-up of 4.5 years. No other complications were reported.ConclusionShoulder arthroplasty is a durable procedure that provides pain relief, improved AAROM, and minimal complications in patients with ipsilateral hemiparesis. The increase in active-assisted forward elevation ROM can improve caregiver ease with hygiene and dressing. Patients in this study who underwent RSA did not have subsequent glenohumeral dislocation. Larger numbers of patients would be required for adequate power analysis regarding instability in this cohort of patients who may be at risk; our small series did not identify any instability events.Level of evidenceLevel IV; Treatment Study