Severe glenoid retroversion is best treated with asymmetric reaming in total shoulder arthroplasty–Affirms

Osteoarthritis in the shoulder is frequently associated with and complicated by a substantial degree of posterior glenoid wear. It is present to some degree in the majority of patients. The optimal management of posterior erosion has been debated; however, the true anatomic version of the glenoid compared to the degree of posterior erosion is unknown, because of the mobile nature of the scapula and variations in spinal posture and thoracic shape. The fact remains that in order to suitably achieve a stable gleno-humeral implant arthroplasty, the majority of osteoarthritic shoulders can be managed with asymmetric reaming. In certain cases where subluxation is present or retroversion is still greater than 15°, new techniques of supplemental bone grafting can be employed, without resorting to offset, built-up, asymmetrical implants, which have a track record of failure.     

Severe glenoid retroversion is best treated with asymmetric reaming in total shoulder arthroplasty–Opposes

Degenerative arthritis of the shoulder is a common orthopaedic condition, and the number of total shoulder arthroplasty procedures is increasing with the aging population. During total shoulder arthroplasty, reconstruction of the glenoid side of the joint can be particularly difficult in the face of posterior wear or excessive retroversion. Treatment options for posterior wear or excessive retroversion of the glenoid include asymmetric reaming of the high anterior side, bone grafting, or posterior augmentation of the glenoid component. A posterior augmented glenoid component allows the surgeon to maintain bone stock while correcting the posterior deficiency of the glenoid and avoiding the potential for medialization of the humeral component with anterior high side reaming. Bone grafting can be beneficial but relies on graft healing to successfully obtain stability.     

Subscapularis integrity and patient-reported outcomes after total shoulder arthroplasty: does time to mobilization matter?

BackgroundMaintaining subscapularis integrity may be a significant variable in optimizing patient outcomes following total shoulder arthroplasty. Multiple factors have been reported in orthopedic literature as a contributor to subscapularis failure. Most surgeons follow a protocol that calls for some period of immobilization. However, time of mobilization and rehabilitation is still a point of discussion, as no consensus currently exists. Our study aimed to compare postoperative outcomes of patients who followed a traditional immobilization protocol to those who underwent rapid mobilization.MethodsA single-blinded, randomized controlled clinical trial was conducted between December 2015 and May 2018. Patients were prospectively enrolled and randomized using a 1:1 random allocation into 2 groups: prolonged immobilization for 4 weeks or rapid mobilization at 1 week. All cases were performed by a single, fellowship-trained shoulder and elbow surgeon with standard pre- and intra-operative protocols. Metallic markers were used to mark the musculotendinous junction of the subscapularis tendon. Postoperatively, patients were notified of their randomization assignment and provided detailed instructions on when to begin mobilization. Patient-reported outcome measures, physical examination, and radiologic assessments were evaluated preoperatively and at 6 weeks, 3 months, 6 months, 12 months, and 32 months postoperatively. Our primary outcome was clinical and radiographic subscapularis failure.ResultsForty-three patients consented with 40 procedures randomized to the 2 cohorts. Among these 40 procedures, there were up to 235 follow-up visits over 32 months. Of the 40 procedures, 2 (5.0%) were complicated with a postoperative tear, both associated with a weak belly test and radiographically confirmed with medialization of the surrogate markers on plain radiographs. No statistically significant difference was seen between the prolonged immobilization and rapid mobilization groups for American Shoulder and Elbow Surgeons shoulder score, Constant Shoulder Score, Visual Analog Scale Score, Simple Shoulder Test Score, and Short-Form Surveys at any follow-up point (all P > .05). On evaluating active forward flexion and external rotation, no statistically significant difference was also appreciated between the 2 groups at any time point (all P > .05).DiscussionOur randomized control trial compared currently accepted protocols to immobilize for 4 weeks following total shoulder arthroplasty using a peel to early mobilization at 1 week and found no statistical and clinical difference in outcomes. However, further study is necessary before a consensus recommendation can be made.     

Evaluation of clinical outcomes of cementless total hip arthroplasty in patients under 30 years of age

Background

Historically, performing a successful hip joint replacement in patients aged fewer than 30 years has been an orthopedic challenge. The newer generation of prostheses and surgical techniques has the potential to increase the longevity of implants. The purpose of this study was to evaluate the outcomes of cementless hip arthroplasty in patients aged fewer than 30 years.

Materials and methods

In this cross-sectional study, 41 patients (46 hips) were studied with a mean age of 24, 4 (from 17 to 30 years) of whom underwent cementless metal–polyethylene hip arthroplasty from 2004 to 2007. The Harris hip score (HHS) was used to assess the functional consequences. Patients were followed up in terms of early complications (thrombophlebitis of the lower limbs, dislocation, hematoma and infection) and late complications (aseptic loosening, dislocation and reoperation) at weeks 3 and 6, at 3 and 6 months, 1 year after surgery and annually thereafter.

Results

Patients were followed for an average of 5 years and 2 months (from 51 to 82 months). One early complication (symptomatic thrombophlebitis) and one late dislocation (2.2 %) were observed. There were no cases of aseptic loosening or osteolysis at the end of follow-up. The preoperative HHS was 59.6 (from 41 to 76), which rose to 82 and 83.5 after the 1-year and final follow-up, respectively, which was a significant increase.

Conclusions

Hip arthroplasty using a new generation of cementless proximal porous prosthesis with resistant polyethylene to cover the joint surfaces in patients aged fewer than 30 years is satisfactory and is accompanied by low complications.     

Does diabetes affect functional outcomes after shoulder arthroplasty?

ObjectivesThe purpose of this study was to assess whether diabetes affects functional and physical outcomes following shoulder arthroplastyMethodsA cohort of 140 patients were tested preoperatively, at an early follow-up visit (between 3-6 months) and at late follow-up visit (between 1-3 years) following shoulder arthroplasty. The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form measured shoulder pain and function and the Short-Form-12 (SF-12) measured physical health status. Shoulder goniometry and dynamometry were used to assess motion and strength. Diabetic status was self-reported.ResultsThere were significant improvements in function and physical health status for both diabetic and nondiabetic patients at the late follow-up visit. For patients with diabetes, shoulder function (ASES: 0-30) improved from 5 (5) to 18 (6) scores (p < 0.001) and physical health status improved from 27 (6) to 38 (8) scores (p < 0.001). For patients without diabetes, shoulder function improved from 8 (5) to 19 (8) scores (p < 0.001) and physical health status improved from 31 (8) to 40 (12) scores (p < 0.001). No significant differences between diabetic and nondiabetic patients was detected at the late follow-up.ConclusionPatients with diabetes achieve large clinical benefits from shoulder arthroplasty, with follow-up outcomes equally positive to those without diabetes. Future prospective studies with a larger sample size of patients with diabetes are needed to confirm the results of this study.Level of evidenceII     

Food and Drug Administration–reported complications of anatomic stemless total shoulder arthroplasty vary with implant model

BackgroundStemless shoulder arthroplasty not only allows for shorter operative time and less blood loss but also for placement of the humeral head independent of the diaphysis, thereby preserving bone that may be needed for further revisions. The purpose of this study was to evaluate the current adverse event profile for anatomic stemless shoulder arthroplasty using the Manufacturer and User Facility Device database.MethodsThe adverse event reports mandated by the US Food and Drug Administration for all hospitals housed in the Manufacturer and User Facility Device database were screened for mention of anatomic stemless total shoulder arthroplasty (TSA). Each applicable report was then characterized by implant design and failure mode.ResultsThe most commonly reported stemless implants were the Zimmer Biomet Sidus, Zimmer Biomet Nano, and Arthrex Eclipse. The most common complications were pain/stiffness (16.8%), glenoid component loosening (12%), glenoid component failure (11%), and problems with attachment onto the humeral insert (9.9%).ConclusionsBecause of the benefits of increased bone preservation with less operative time and decreased blood loss compared with anatomic stemmed TSA, stemless implants are becoming increasingly popular in clinical practice. There were no findings that discourage the use of stemless TSA in the right candidate.Level of evidenceLevel III; Database Case Series Treatment Study