Prosthetic Arthroplasty of the Shoulder

Twenty-six patients, 18 with rheumatoid arthritis, underwent arthroplasty of the shoulder between 1973 and 1980, with an average follow-up of 3 years. The Stan-more and Kessel arthroplasties and the Neer hemiarthroplasty were used. Twenty-one patients undergoing 22 elective arthroplasties considered that the operation was worthwhile. Pain was completely relieved in 12 shoulders. Movement was improved in 18 shoulders. The priority of restoring movements which improved independence and self-respect is emphasised; the results were far superior to those obtained by an arthrodesis.     

Symptomatic Glenoid Loosening Complicating Total Shoulder Arthroplasty

Glenoid component loosening is one of the most common causes of failed total shoulder arthroplasty. Previous reports indicate that it is desirable to reimplant the glenoid component during revision shoulder arthroplasty. The purpose of our study was to retrospectively evaluate the satisfaction of patients undergoing glenoid revision (reimplantation or resection) following total shoulder replacement specifically for symptomatic glenoid loosening. Twenty-eight shoulders that developed symptomatic glenoid loosening following primary total shoulder arthroplasty were included in the study. Patients were retrospectively evaluated at a minimum of 2 years postoperatively. Patients either underwent resection followed by reimplantation of the glenoid component (13) or resection of the component with or without bone grafting (15). Each patient was evaluated with the UCLA Shoulder Scale and the Constant–Murley Shoulder Assessment. There were seven excellent, 13 good, five fair and three poor results on the UCLA score. Functional outcome scores trended higher in the reimplantation group but were not statistically significant. Both groups reported equal pain relief and satisfaction. Five out of 15 patients underwent arthroscopic resection of the glenoid, and these patients scored as well on the UCLA and Constant scores as the reimplantation group. When symptomatic glenoid loosening is the indication for revision total shoulder replacement, patients tend to achieve good to excellent results. Though functional scores were slightly higher in the reimplantation group, satisfaction was equally high in both groups. Resection, when indicated, should be performed arthroscopically as this improved functional outcome in our series.     

What would you do? Challenges in shoulder surgery

The treatment of glenohumeral joint disorders presents a challenge to the orthopedic provider. The adept shoulder surgeon must be facile with the management of both primary and complex shoulder pathologies. The cases presented are represented for their complexity and to present management principles that are fundamental to appropriate treatment of both simple and complex glenohumeral diseases. Furthermore, these cases are presented in the light of complex decision making regarding arthroplasty and the older active patient.     

Total Shoulder Arthroplasty Utilizing Mini-Stem Humeral Components: Technique and Short-Term Results

Introduction  

Throughout the field of orthopedic surgery, there has been a trend toward using smaller incisions and implants that preserve as much normal anatomy as possible. The use of bone sparing technology, such as partial and full surface replacements of the humeral head, while attractive in younger patients, does not allow the best exposure for proper glenoid replacement. Additionally, there are other situations when the use of surface replacements is contraindicated. There are also patients with an existing total elbow replacement or a humeral malunion or deformity in which a traditional long-stem component would not fit. For these reasons, a mini-stem humeral component for total shoulder arthroplasty was developed.     

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

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.     

Deformation and Loosening of the Tibial Component in Knee Arthroplasty with Unicompartmental Endoprostheses

Roentgenological signs of deformation and loosening of the tibial component in knee arthroplasties with unicompartmental endoprostheses occurred in one-third of 87 rheumatoid (RA) knees within 2 years and in one-fifth of 107 osteoarthritic (OA) knees within 3 years after the operation. Compared with thicker components significantly more 6 mm components in RA, and 6 and 9 mm components in OA became deformed and loose. There was no difference in the clinical assessment of the knees with and without deformed tibial components. Reoperations were recorded during an extended follow-up. In the group with initially asymptomatic loosening twelve RA knees within four and a half years and three OA knees within four years developed pain on weight-bearing and had to be reoperated. One patient (OA) had loose components without any roentgenological signs; the loosening was first discovered when the unoperated compartment was revised because of secondary osteoarthrosis. Knees fitted with 6 mm components more often required reoperation because of loosening than did those with thicker components.     

Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review

Rotator cuff tears have been reported to be uncommon following total shoulder arthroplasty (TSA). Postoperative rotator cuff tears can lead to pain, proximal humeral migration, and glenoid component loosening. The purpose of this paper was to evaluate the incidence of post-TSA rotator cuff tears or dysfunction in osteoarthritic patients. A systematic review of multiple databases was performed using preferred reporting items for systematic reviews and meta-analyses guidelines. Levels I-IV evidence clinical studies of patients with primary osteoarthritis with a minimum 2-year follow-up were included. Fifteen studies with 1259 patients (1338 shoulders) were selected. Student''s t-tests were used with a significant alpha value of 0.05. All patients demonstrated significant improvements in motion and validated clinical outcome scores (P < 0.001). Radiographic humeral head migration was the most commonly reported data point for extrapolation of rotator cuff integrity. After 6.6 ± 3.1 years, 29.9 ± 20.7% of shoulders demonstrated superior humeral head migration and 17.9 ± 14.3% migrated a distance more than 25% of the head. This was associated with an 11.3 ± 7.9% incidence of postoperative superior cuff tears. The incidence of radiographic anterior humeral head migration was 11.9 ± 15.9%, corresponding to a 3.0 ± 13.6% rate of subscapularis tears. We found an overall 1.2 ± 4.5% rate of reoperation for cuff injury. Nearly all studies reported indirect markers of rotator cuff dysfunction, such as radiographic humeral head migration and clinical exam findings. This systematic review suggests that rotator cuff dysfunction following TSA may be more common than previously reported. IV, systematic review of Levels I-IV studies.     

Midterm results of Oxford shoulder hemiarthroplasty

Background:

Hemiarthroplasty of the shoulder is known to provide satisfactory long term results provided concentric reduction can be obtained in a high percentage of patients. Careful soft tissue balancing with appropriate adaptation of version of the component appears to allow good results permitting centering of the arthroplasty without replacement of a glenoid component.

Materials and Methods:

29 consecutive patients (30 shoulders) who underwent Oxford cementless shoulder hemiarthroplasty between 2004 and 2006 were analyzed. Mean age was 71 years (range 34-91 years, 95% of the confidence interval [CI] of standard deviation [SD] was 10.32-17.58). Mean duration of preoperative symptoms was 42.8 months (range 9-84 months, 95% CI of SD was 17.83-30.11). Patients’ self reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome.

Results:

The mean initial OSS was 17.9 (range 7-43, 95% CI of the SD was 7.19-12.13). The score improved by an average of 16.9 points at a mean followup of 5.9 years (range 4.3-7.6 years) to reach mean final OSS of 34.8 (range 13-48, 95% CI of the SD was 9.31-15.73). The improvement of OSS was highly significant with a two tailed P < 0.0001 and 95% CI of this difference was 11.47-22.20.

Conclusion:

This study demonstrates shoulder hemiarthroplasty as reliable procedure for improvement of shoulder function as shown by the patients’ self reported outcome score (OSS) in end stage glenohumeral arthritis with intact or reparable rotator cuff at midterm followup. Our results suggest successful outcome of the Oxford shoulder hemiarthroplasty (Corin, UK) away from its originating center and in hospitals where fewer shoulder replacements are performed.     

人工肱骨头置换治疗肱骨近端三、四部分骨折

目的探讨人工肱骨头置换治疗肱骨近端骨折,术中应注意的关键问题. 方法采用Thompson入路行人工肱骨头置换术23例. 术后随访6～36个月,平均随访21.1个月.用ASES评分对患肩进行术后功能评估.结果医师客观评定:全部患者肩关节活动明显改善,肌力恢复良好,肩关节稳定,5例轻压痛,1例发生撞击.患者主观评定:疼痛平均102分,肩关节稳定平均106分,完成10个日常生活动作22例,完成7个日常生活动作1例.复查X线片显示人工肱骨头位置良好,无假体松动,肱骨大、小结节骨折愈合. 结论术中肩周软组织保护及修复,人工肱骨头假体安装和肱骨大、小结节解剖重建是提高人工肱骨头置换术疗效的关键技术.     

人工肱骨头置换治疗高龄患者肱骨头颈部骨折疗效观察

目的探讨人工肱骨头置换治疗高龄患者肱骨头颈部粉碎性骨折的可行性及疗效。方法回顾性分析2011年1月～2012年4月收治的17例高龄肱骨头颈部粉碎性骨折患者的临床资料,平均年龄70.4(65～78)岁,其中65～70岁10例,70～75岁5例,75岁以上2例。右侧13例,左侧4例,均行人工肱骨头置换。结果所有患者术后2周伤口拆线,Ⅰ期甲级愈合,无感染病例。术后17例均获得随访,时间6～12个月。17例患者术后6个月恢复生活自理,无假体松动、脱位、伤口感染及慢性疼痛等并发症发生。结论人工肱骨头置换治疗高龄肱骨头颈部粉碎性骨折能较快地恢复患肩功能,提高患者生活质量。