Short and midterm results of reverse shoulder arthroplasty according to the preoperative etiology

Background

Reverse shoulder arthroplasty (RSA) has shown promising results for cuff tear arthropathy but the indication has been extended to fracture sequelae and revision shoulder arthroplasty with different preconditions. Further, the clinical relevance of inferior scapular notching for different etiologies is uncertain. Our hypothesis was that preoperative etiology as well as the occurrence of scapular notching would significantly influence the clinical outcome.

Methods

We reviewed 76 reverse shoulder arthroplasties for cuff tear arthropathy (45 patients), fracture sequelae (10 patients) and revision arthroplasty (21 patients) retrospectively. The follow-up consisted of 71 patients and the mean follow-up period was 23 months (±14 months). All patients were evaluated postoperatively using the Constant score adjusted for age and gender and the simple shoulder test. A radiological investigation was performed preoperatively and at the time of the final follow-up including the evaluation of scapular notching according to Sirveaux. For further evaluation of scapular notching, patients were separated into three groups according to the inferior glenosphere overlap: negative or no inferior overlap ?6–0 mm), mild overlap (1–4 mm) and pronounced overlap (5–9 mm).

Results

After a mean follow-up of 23 months the average age- and gender-adjusted Constant score (CS) was 77.8 % (±26 %). According to the etiology, patients with cuff tear arthropathy (CTA) showed a higher CS of 83 % compared with patients with fracture sequelae (CS 73 %) and compared with patients who had undergone RSA as a revision for failed shoulder arthroplasty (CS 69 %). The difference was significant comparing the cuff tear arthropathy patients with the revision surgery patients (p = 0.035). Within the group of fracture sequelae, patients with type three sequelae according to the Boileau classification (surgical neck nonunion) had a significantly worse outcome compared with the type four fracture sequelae patients (severe tuberosity dislocation) (CS 57 vs. 87 %, p = 0.01). The overall complication rate was 27 % with 8 % infections and 9 % dislocations. Revision surgery was necessary in 11.5 % with removal or replacement of the implants in 8 %. Inferior scapular notching was detected in 43 % of the patients. These patients had an inferior CS (70 ± 18 %) compared with patients without scapular notching (84 ± 25 %, p = 0.015). The incidence of scapular notching was significantly reduced with an increasing inferior overlap of the glenosphere.

Conclusions

In conclusion, we found the preoperative etiology to influence the clinical results after RSA with superior results given for cuff tear arthropathy and inferior results for revision arthroplasty and fracture sequelae type three. Further, we found a correlation between scapular notching and the clinical outcome. The inferior scapular notching was significantly reduced by an increased inferior glenosphere overlap.

Level of evidence

Level IV, case series, treatment study.     

Arm lengthening after reverse shoulder arthroplasty: a review

Purpose

The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications.

Methods

Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I–IV relevant to search terms.

Results

Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent.

Conclusions

Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.     

Short to mid-term results of stemless reverse shoulder arthroplasty in a selected patient population compared to a matched control group with stem

Purpose

Little scientific evidence on the clinical and radiological outcome after stemless reverse shoulder arthroplasty (RSA) exists. The hypothesis of this study was that stemless RSA has an inferior outcome compared to RSA with stem.

Methods

All cases of cuff-arthropathy fullfilling strict selection criteria (selection rate 18.4 %) were treated with stemless RSA between 2009 and 2013. Twenty nine of 37 cases (78.4 %) were clinically and radiologically examined by an independent observer. Twenty four of the 29 cases could be matched with 24 patients that underwent conventional stemmed RSA at a different institution based on the following criteria: indication (cuff-arthropathy), age (within 5 years), gender, and time of follow-up (within 2 years). Clincial and radiological outcomes of both groups were compared.

Results

After mean follow-up of 35 months (range 24–75) no significant difference regarding constant score, ASES, subjective shoulder value, pain score, patient satisfaction, strength, and range of motion was detected. One case of traumatic dislocation was observed in the stemless RSA group. Scapular notching grade 1 was detected in two cases of the stemless group while in the stemmed group five cases with grade 1 and four cases with grade 2 notching were observed. Average post-operative humeral component inclination (neck-shaft angle) in the stemless RSA group (134.4°) was significantly steeper than in the stemmed RSA group (155°) (p?<?0.001). No loosening of the humeral component was observed in both groups.

Conclusion

At short to mid-term follow-up, stemless RSA does not feature inferior clinical or radiological outcomes in a strictly selected patient population.

     

Reverse sural rotational flap in the coverage of the lower leg after musculoskeletal oncologic resection

Background

The coverage of soft tissue defects in the lower extremity has proven to be challenging. The reverse sural flap provides reliable coverage with minimal complications.

Methods

Six patients with sarcomas at the distal leg, ankle, and foot were treated with the reverse sural artery flap. Data was gathered for demographics, comorbidities, type of tumor, size of defect, flap viability, healing time, donor-site morbidity, recurrence, functional outcome, and range of motion.

Results

All patients possessed a primary sarcoma that traditionally would have required a free flap for coverage. The average size of defect was 94 cm² (range 50–143) and was covered by flaps that ranged between 10?×?13 cm and 10?×?5 cm. Flap viability was 100 %, with healing occurring by 18 weeks (range 4–32 weeks). Donor-site morbidity was 0 %. Average revised MSTS score was 80 % or 24/40 (range 15–29). Average ROM for dorsi flexion was 0 ° and plantar flexion was 17.5 ° (range 10–25). Average time of follow-up was 8.75 months (range 4–14).

Conclusions

In most patients without associated risk factors such as diabetes, the reverse sural flap can be performed safely. However, in patients with identifiable risk factors for partial flap failure, consideration should be given to alternative options such as free flap reconstruction in order not to delay or interrupt adjuvant radiotherapy. Level of Evidence: Level IV, therapeutic study.     

Treatment strategies for infection after reverse shoulder arthroplasty

Introduction

Infection after reverse shoulder arthroplasty (RSA) is a disastrous complication. No clear guidelines describing specific management strategies for infection after RSA are available.

Methods

We retrospectively analyzed 20 patients treated for deep infection after RSA. Initial irrigation and debridement and exchange of the polyethylene inlay were performed in seven patients, and initial two-stage revision was performed in 12 and initial resection arthroplasty in one patient. Patient charts were reviewed for risk factors, clinical symptoms and investigations of those symptoms, pre- and postoperative X-rays, interval until revision surgery, causative bacteria, complications, final clinical outcome and patient satisfaction.

Results

The mean overall postoperative Constant–Murley Score (CMS) was 42.6 points, the mean UCLA score was 20.8, the mean simple shoulder test (SST) was 5.5, and the mean VAS was 1.5. When comparing the CMS, UCLA score and the SST between the revision RSA group and the resection group, significant differences between the groups were found (p < 0.05). Irrigation, debridement and exchange of the polyethylene inlay were successful only in two of the four patients with acute infection. The three patients with subacute infections were treated with initial irrigation and debridement and exchange of the polyethylene inlay, which were not successful.

Conclusion

The relatively high patient satisfaction can be explained by the low pain level once the patient is free from infection. However, functional results are poor in most cases, and this possible outcome must be discussed with the patient in the preoperative setting.     

Akromionrekonstruktion nach arthroskopischer subakromialer Dekompression und iatrogener Akromiondestruktion

Objective

Reconstruction of the acromion, to achieve pain relief and better function of the deltoid muscle.

Indications

After partial or complete removal of the acromion.

Contraindications

General surgical contraindications. Paresis of the axillary nerve.

Surgical technique

Strategy of the operation with X-ray and CT scan. Patient in beach chair position. Disinfection of the shoulder and lateral pelvic region. Exploration of the defect area and searching for the lateral clavicula and spinascapulae end. Removal of a pelvic bone block. Fixation of the pelvic bone block to the spina scapulae with K-wires and finally osteosynthesis by a Reco plate (Synthes, Umkirch, Germany), wound closure.

Postoperative management

For the first 6 weeks, a cast with the arm in 90° abduction. Passive motion without the cast should be performed once a day. Starting in week 7, weekly reduction of abduction (90°/60°/30°/0°). Active mobilization starting in week 10. Start to practice with weight bearing in week 13.

Results

Pain relief improved from VAS 7–9 to VAS 2–3. Improved ROM can be seen postoperatively and after 6 months for abduction/adduction 50–0–50°, anteversion/retroversion 80–0–10°, rotation out/in 40–0–10°.     

Reverse shoulder prosthesis in patients with rheumatoid arthritis: a systematic review

Purpose

To obtain detailed information on the outcomes of patients with rheumatoid arthritis (RA) undergoing reverse shoulder arthroplasty (RSA)

Methods

A literature search was conducted for studies reporting on the use of RSA in RA patients from 1990 to 2014. The inclusion criteria were a report of sufficient information on pre-operative status and surgical outcome allowing evaluation of the therapeutic potential of RSA in RA. The literature search resulted in 586 hits, but only five studies that met the inclusion criteria were assessed.

Results

There were 100 shoulders that had been operated on, of which 87 were followed for a mean of 55.4 months, the longest follow-up being 11.9 years Most patients had glenohumeral erosive lesions of Larsen Grade III or IV. The Delta III prosthesis was implanted in most cases and in three studies bone graft was used for severe glenoid lesions. The main outcome measures employed were the Constant score (Cs) and ASES questionnaire. The mean increase in Cs and ASES score after surgery was 42.4 and 54 points, respectively. The mean post-operative forward elevation was 120.6°, the average increment being 51° and the mean increase of abduction was 58.5°. The mean prevalence of scapular notching was 35.4 %. The rate of adverse events was 31 %, but the vast majority were of minor severity. Eight prostheses underwent revision, due to infection in four.

Conclusions

RSA implanted in RA patients would appear to give similar results to those obtained in massive cuff tears with or without arthropathy.

     

How does reverse shoulder replacement change the range of motion in activities of daily living in patients with cuff tear arthropathy? A prospective optical 3D motion analysis study

Background

Reverse total shoulder arthroplasty (RSA) can improve function in cuff tear arthropathy (CTA) shoulders, but limited exact data are available about the maximum values in 3D motion analysis, and as to how improvements translate into the normal range of motion (ROM) in activities of daily living (ADLs).

Methods

This study included nine consecutive patients (n = 9) who received RSA for CTA without muscle transfers. We measured shoulder movement by a novel 3D motion analysis using the Heidelberg upper extremity model (HUX) which can eliminate compensatory movements of the scapula, and the trunk. The measurement included active maximum values, and four ADLs.

Results

Comparing the pre- to the 1-year postoperative status, RSA was associated with a significant increase in the mean maximum values for active flexion of about 43° (SD ± 31) from 66° to 109° (p = 0.001), for active abduction of about 37° (SD ± 26) from 57° to 94° (p = 0.001), and for the active adduction of about 28° (SD ± 10) from 5° to 33° (p = 0.002). Comparing the preoperative to the postoperative ROM in the ADLs in flexion/extension, ROM improved significantly in all ADLs, in abduction/adduction in three of four ADLs. No significant changes were observed in internal/external rotation in any ADLs.

Conclusion

RSA improves the active maximum ROM for flexion, abduction, and adduction. The patients are able to take advantage of this ROM increase in ADLs in flexion and in most ADL in abduction, but only in trend in internal and external rotation.

Level of evidence

Level IV, Case Series with no comparison group.     

A Clinical Pathway for Total Shoulder Arthroplasty—A Pilot Study

Background

Appropriate pain management after total shoulder arthroplasty (TSA) facilitates rehabilitation and may improve clinical outcomes.

Questions/purposes

This prospective, observational study evaluated a multimodal analgesia clinical pathway for TSA.

Methods

Ten TSA patients received an interscalene nerve block (25 cm³ 0.375% ropivacaine) with intraoperative general anesthesia. Postoperative analgesia included regularly scheduled non-opioid analgesics (meloxicam, acetaminophen, and pregabalin) and opioids on demand (oral oxycodone and intravenous patient-controlled hydromorphone). Patients were evaluated twice daily to assess pain, anterior deltoid strength, handgrip strength, and sensory function.

Results

The nerve block lasted an average of 18 h. Patients had minimal pain after surgery; 0 (median score on a 0–10 scale) in the Post-Anesthesia Care Unit (PACU) but increased on postoperative day (POD) 1 to 2.3 (0.0, 3.8; median (25%, 75%)) at rest and 3.8 (2.1, 6.1) with movement. Half of the patients activated the patient-controlled analgesia four or fewer times in the first 24 h after surgery. Operative anterior deltoid strength was 0 in the PACU but returned to 68% by POD 1. Operative hand strength was 0 (median) in the PACU, but the third quartile (75%) had normalized strength 49% of preoperative value.

Conclusions

Patients did well with this multimodal analgesic protocol. Pain scores were low, half of the patients used little or no intravenous opiate, and some patients had good handgrip strength. Future research can focus on increasing duration of analgesia from the nerve block, minimizing motor block, lowering pain scores, and avoiding intravenous opioids.     

Die Auswirkung definierter Varusdeformitäten am proximalen Humerus auf die Elevationskräfte des Armes

Objectives

This study investigated the hypothesis that different varus deformities of the humeral head decrease the efficiency of the M. supraspinatus (SSP) and increase the deltoid elevation forces.

Methods

A varus deformity model of the proximal humerus was developed with an intact rotator cuff and deltoid muscle in human specimens. Three groups were differentiated per random distribution: group I (n=8): 45° varus deformity, group II (n=8): 20° varus deformity, and a control group (n=8). The effect of different varus malunions (20° and 45° varus) on the SSP efficiency and on the arm elevation forces was analyzed with a robot-assisted shoulder simulator and a force-controlled hydraulic system in three defined phases of elevation: 0–30°, 30–60°, and 60–90°.

Results

The SSP efficiency (i.e., the degree of elevation per unit muscle force) was 0.12±0.03°/N in group I, 0.18±0.05°/N in group II, and 0.24±0.10°/N in the control group and was significantly lesser in group I than in group II (p=0.036) and in the control group (p=0.039). Under physiological loading of the rotator cuff, the deltoid elevation force per elevation angle was significantly greater in groups l and ll compared to the control group in the elevation phases between 0–30° and 60–90°. In case of an unloaded SSP (i.e., simulation of a SSP tear), the elevation forces were significantly greater in group l than in group ll (p=0.040), and in the control group (p=0.004) in the elevation phase between 60° and 90°.

Conclusion

Varus deformities of the humeral head significantly decreased the SSP efficiency (45° varus), and significantly increased the arm elevation forces (≥20° varus in the elevation phases 0–30° and 60–90°). The hypothesis of our study could be confirmed.     

Displaced mid-shaft clavicular fractures: surgical treatment with intramedullary screw fixation

Introduction

Clavicle fractures account for around 4 % of all fractures and up to 44 % of fractures of the shoulder girdle. Fractures of the middle third account for approximately 80 % of all clavicle fractures. Management of mid-shaft clavicular fractures is often challenging and the outcome can be unsatisfactory.

Materials and methods

We prospectively evaluated 20 patients (16 males and 4 females) with an average age of 31 years (range 18–50 years) presented with fresh mid-shaft clavicular fractures who underwent open intramedullary fixation using a 6.5 partially threaded cancellous screw. The screw was inserted from the lateral fragment after retrograde drilling of that fragment. Average follow-up period was 16 months (range 10–24).

Results

All cases united within 7–9 weeks (mean 8.2). Superficial infection was observed in one patient, three experienced decreased sensation over the site of incision, and four had symptoms of frozen shoulder.

Discussion and conclusion

The technique is safe, simple, reliable method for fixation of displaced mid-shaft clavicle fractures with minimal complications and excellent functional outcomes. No complaints or indications for hardware removal after fractures healing.     

Revision to Reverse Total Shoulder Arthroplasty Restores Stability for Patients With Unstable Shoulder Prostheses

Background

Instability after shoulder arthroplasty remains a complication with limited salvage options. Reoperation for instability with anatomic designs has led to high rates of persistent instability, therefore we aimed to evaluate the use of RSA for treatment of prosthetic instability.

Questions/purposes

(1) After revision shoulder arthroplasty to a reverse prosthesis (RSA), what is the survivorship free from dislocations at 2 and 5 years? (2) What factors are associated with dislocations? (3) What is the survivorship free from revision after revision to RSA? (4) From preoperation to postrevision to RSA, what are the clinical outcomes—the proportion of patients with moderate to severe pain, shoulder elevation and external rotation ROM, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores?

Methods

All shoulder arthroplasties revised for prosthetic instability using RSA components between January 2004 and July 2014 were retrospectively studied. During the period in question, we performed 82 revisions for instability of an anatomic total shoulder arthroplasty (TSA) (n = 62), hemiarthroplasty (n = 13), or reverse TSA (n = 7). We typically used a reverse TSA to treat this problem, but we identified 12 treated in other ways, including revision of a TSA to hemiarthroplasty (n = 3), revision of a reverse TSA to hemiarthroplasty (n = 2), revision of hemiarthroplasty to a hemiarthroplasty (n = 1), and revision of an anatomic TSA to another anatomic TSA (n = 6). This left 70 patients for evaluation; of those, 65 (93%) were available for analysis at a mean of 3 years (range, 2–10 years). A total of seven patients died. Eight of the 65 shoulders were not evaluated during the last 5 years, including three in patients who died earlier. The mean age of the patients at the time of revision RSA was 65 years (range, 40–89 years). Data were obtained from a longitudinally maintained institutional joint registry. Instability was defined as severe subluxation confirmed on clinical and radiographic examinations. We evaluated pain and ROM, and Kaplan-Meier curves were used to estimate survivorship.

Results

The survivorship free from dislocation at 2 and 5 years was 87% (95% CI, 80%–94%) and 79% (95% CI, 67%–91%) respectively, with 10 of 65 (15%) patients having an episode of dislocation after revision surgery. Persistent instability was more common in those with a BMI greater than 35 kg/m² (hazard ratio [HR], 5; 95% CI, 2–16; p = 0.008) and prior hemiarthroplasty (HR, 5; 95% CI, 2–16; p = 0.005), whereas patients who had undergone a previous TSA were less likely to have persistent instability (HR, 0.08; 95% CI, 0.0–0.30; p < 0.001) The survival free from rerevision for any indication at 2 and 5 years was 85% (95% CI, 76%–94%) and 78% (95% CI, 66%–90%) respectively; with the numbers available, we were not able to find associated factors. Fewer patients had moderate or severe pain after revision to RSA (preoperative: 48 of 65 [74%]; postoperative: nine of 65 [14%]; p < 0.001). After surgery, patients showed improvement in shoulder elevation (preoperative: 42° [± 30°], postoperative: 112° [42°]; mean difference, 70° [95% CI, ? 83^o to 57°]; p < 0.001) and external rotation (preoperative: 20° [± 22°], postoperative: 42° [± 23°]; mean difference, 22° [95% CI, ? 30° to ? 14°]; p < 0.001). American Shoulder and Elbow Surgeons scores improved (preoperative: 21 [± 10], postoperative: 68 [± 14], mean difference, 46 [95% CI, ? 58 to ? 35]; p < 0.001); where a higher score is better. Simple Shoulder Test scores also improved (preoperative: 2/12 [± 2], postoperative: 7/12 [± 3]; mean difference, 5 [95% CI, ? 7 to ? 2.17]; p < 0.001); where a higher score is better.

Conclusions

Revision RSA for prosthetic instability after shoulder arthroplasty is associated with reasonable implant survival and few complications. Approximately one in seven patients will have a recurrent dislocation. In patients with persistent instability or with risk factors for instability, consideration should be given for use of larger glenospheres and increasing the lateral offset at the time of RSA.

Level of Evidence

Level IV, therapeutic study.

     

Good brace compliance reduced curve progression and surgical rates in patients with idiopathic scoliosis

Purpose

To examine the association between brace compliance and outcome.

Patients and methods

495 (457 females) patients with late onset juvenile and adolescent idiopathic scoliosis were examined prospectively before bracing and at least 2 years after brace weaning. One spine surgeon examined all patients. 381 (353 females) answered a standardised questionnaire and 355 had radiological examination after median 24 years. Compliance was defined as brace wear >20 h daily until weaning. Main outcomes were curve progression and surgery.

Results

At weaning, 76/389 compliers and 59/106 non-compliers had curve progression ≥6° (OR 5.2, 95 % CI 3.3–8.2). At long-term the numbers were 68/284 and 46/71 (OR 5.8, 95 % CI 3.3–10.2), 10/284 versus 17/71 had been operated (OR 8.6, 95 % CI 3.7–19.9).

Conclusion

We conclude that the risk for curve progression and surgery are reduced in patients with good brace compliance.     

Treatment of fracture sequelae of the proximal humerus: comparison of hemiarthroplasty and reverse total shoulder arthroplasty

Introduction

Fracture sequelae (FS) of the proximal humerus is a challenging scenario in shoulder surgery. Despite they have been traditionally treated with hemiarthroplasty (HA), the use of reverse shoulder arthroplasty (RSA) has been recently introduced. However, there are no studies comparing the results of HA and RSA in FS. The purpose of this study was to compare the functional and quality of life-related outcomes, and complications in the treatment of proximal humeral FS between HA and RSA.

Materials and methods

A therapeutic prospective non-randomized comparative study was conducted. All consecutive patients with diagnosis of FS after non-operative treatment of proximal humeral fractures and no previous shoulder surgery were considered for this study. A total of 32 patients (24 females, 8 males) with a mean (SD) age at the time of surgery of 80.1 (4.9) years were finally included: 12 in the HA group, and 20 in the RSA group. FS were treated with shoulder arthroplasty by the implantation of either HA or RSA. Constant score (total and specific items), quality of life (assessed through SF-36), and complications requiring revision surgery were compared between groups.

Results

All parameters of the Constant score significantly improved in the postoperative compared to preoperative period when considering the entire sample. The RSA group demonstrated a higher improvement in total Constant score (p = 0.06) and Constant activity level (p = 0.02) compared to the HA group. The HA demonstrated a higher number of complications compared to the RSA (p = 0.05). There were no differences in SF-36 scores between both groups.

Conclusions

The shoulder arthroplasty is an effective treatment for FS with significant improvement in pain and function. The RSA may be a better option than HA for FS given the trend towards better total Constant score and a significantly lower number of complications requiring revision surgery.

Level of evidence

Therapeutic level II evidence.     

Chest wall reconstruction after recurrent breast cancer using the scapular flap

Background

Breast cancer is a common female malignancy with numerous reconstructive options following mastectomy. However, in recurrent disease, few donor sites exist. The scapular flap may reconstruct ablative defects after recurrence. This paper describes its 5-year application.

Methods

All patients with recurrent breast cancer necessitating chest wall reconstruction with a scapular flap were included in this 5-year study. Patients were prospectively followed up for clinical, surgical and patient-reported outcome measures.

Results

Eight patients underwent scapular flap chest wall reconstruction for recurrent breast cancer. The majority of tumours were invasive ductal carcinomas (n?=?5; 62.5 %). Mean duration from primary breast cancer to scapular flap reconstruction was 12 years (range 2–32 years). All flaps survived, including patients who smoked and received adjuvant radiotherapy. Donor site morbidity was minimal with full ipsilateral limb functioning.

Conclusions

Scapular flap reconstruction of the chest is a safe, reliable and consistent technique in recurrent breast cancer. Level of Evidence: Level IV, therapeutic study.     

Die 3D-Bewegungsanalyse der oberen Extremität und ihre Anwendung in der Schulterendoprothetik

Background

The aim of this study was to analyze the range of motion of the shoulder and elbow during activities of daily living (ADL). Moreover, proprioception after shoulder arthroplasty was assessed.

Materials and methods

A new, marker-based 3D model for the upper extremities was used. Ranges of motion of the shoulder and elbow in 10 ADL were measured in a standardized fashion in seven subjects. Proprioception was measured in 26 patients with degenerative pathologies of the shoulder joint. A total of 13 patients received total shoulder replacement, 8 hemiarthroplasty, and 5 reverse prosthesis.

Results

A mean shoulder anteversion/retroversion of 100°, an abduction/adduction of 89°, and an external/ internal rotation of 205° were necessary to perform the ADL. The mean elbow extension/flexion was 110° and mean pro-/supination 127°. For the whole cohort, the proprioception value decreased 6 months after implantation of a shoulder prosthesis from 7.0° preoperatively to 8.1° postoperatively (p<0.05). There was a postoperative decrease of proprioception for all movements and for overall proprioception, but this was not significant. With regard to the different implants, a decrease of proprioception was also found, without reaching significance.

Conclusion

Complex, dynamic movements and joint angles of the upper extremity can be recorded using 3D motion analysis at any time. In contrast to other studies, decreased proprioception was found in the short term after shoulder prosthesis implantation.