Search

Systemic disorders including diabetes mellitus, obesity, and depression affect the outcomes of reverse shoulder arthroplasty (RSA). Sarcopenia (a general skeletal muscle disorder) is common in elderly people, but its effect on patients after RSA is not clear. We hypothesized that the preoperative sarcopenia indices of grip strength and general skeletal muscle mass would correlate with the clinical outcomes of RSA. Grip strength and general skeletal muscle mass were measured in patients scheduled (between 2016 and 2021) for primary RSA to treat cuff tear arthropathy, an unrepairable cuff tear, or osteoarthritis with a large cuff tear. Before surgery, grip strength was measured using a hydraulic dynamometer and general skeletal muscle mass was calculated from the appendicular relative skeletal muscle mass index (aRSMI) using dual-energy X-ray absorptiometry. In all, 58 patients were included; the minimal follow-up duration was 12 months. The postoperative clinical results (pain, active range of motion, shoulder strength, and functional scores) were evaluated during scheduled outpatient visits. We calculated correlations between the preoperative sarcopenia indices, and the clinical results at the final follow-up. The mean preoperative grip strength and aRSMI were 21.6 ± 4.0 kg and 5.98 ± 0.84 kg/m2 in females and 30.6 ± 7.5 kg and 7.21 ± 0.94 kg/m2 in males, respectively; the grip strength and aRSMI were not associated with each other (P =.083). Ten females (25%) and 10 males (56%) met the criteria for sarcopenia. The postoperative abduction shoulder strength and Constant-Murley shoulder score increased significantly with higher preoperative grip strength (R = 0.420 and P =.001; and R = 0.497 and P <.001, respectively) and the American Shoulder and Elbow Surgeons score was related to the preoperative aRSMI (R = 0.320, P =.039). The shoulder strength and functional score after RSA correlated positively with the preoperative grip strength. Measuring grip strength before RSA allows the surgeon to predict shoulder strength after RSA. [ABSTRACT FROM AUTHOR]

The reverse shoulder arthroplasty (RSA) was originally designed for cuff tear arthropathy (CTA). Over time, the indications have expanded to rheumatoid arthritis (RA). This study aimed to compare the outcomes of RSA in patients with RA and CTA to determine if there is any impact on clinical and radiographic outcomes. In this retrospective comparative study (performed from August 2010 to March 2017), 61 shoulders from 59 consecutive patients (RA group: 24 patients [26 shoulders], CTA group: 35 patients [35 shoulders]) who underwent primary RSA, were included. The average follow-up period was 31 months (range, 24-64 months). Patients were assessed with the use of the visual analog scale pain score, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, the Single Assessment Numeric Evaluation score, range of motion (ROM), and imaging studies included the β angle, glenoid component superior tilt, and scapular notching. The clinical results improved significantly in both groups, but there was no statistically significant difference between the RA group and the CTA group. Significant intergroup differences were observed regarding the β angle (73° ± 11° for the RA group vs. 85° ± 8° for the CTA group; P <.001) and glenoid component superior tilt (12 cases for the RA group vs. 4 cases for the CTA group; P <.001) at the final follow-up. The Scapular notching was observed in 19 (73%) and 24 (69%) shoulders in the RA and CTA groups, respectively (P =.662). There were 7 (27%) complications in the RA group and 3 (9%) in the CTA group. Fractures involving greater tuberosity, lesser tuberosity, acromion, glenoid, and peri-implant were observed either intraoperatively or postoperatively in 6 shoulders in the RA group and in 3 shoulders in the CTA group. One case of transient musculocutaneous nerve palsy in the RA group was noted. None of the patients required revision surgery for any reason. Compared with CTA patients, RA patients achieved similar clinical outcomes following RSA. However, surgeons should pay attention to the positioning of the glenoid component during the surgery and the risk of intraoperative fractures in RA patients. [ABSTRACT FROM AUTHOR]

Background Context: It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.Purpose: The purpose of this study was to investigate the risk factors for newly developed OVCFs after treatment by vertebroplasty (VP), kyphoplasty (KP), or conservative treatment.Study Design/setting: A retrospective comparative study.Patient Sample: One hundred thirty-two patients who had radiographic follow-up data for one year or longer among 356 patients who were diagnosed with OVCF and underwent VP, KP or conservative treatment between March 2007 and February 2016.Outcome Measures: All records were examined for age, sex, body mass index (BMI), rheumatoid arthritis and other medical comorbidities, osteoporosis medication, bone mineral density (BMD), history of vertebral and nonvertebral fractures, treatment methods used, level of fractures, and presence of multiple fracture sites.Methods: Patients were divided into those who manifested new OVCF (Group A) and those who did not (Group B). For the risk factor analysis, student's t-tests and chi-square tests were used in univariate analysis. Multivariate logistic regression analysis was carried out on variables with a p<.1 in the univariate analysis.Results: Newly developed OVCFs occurred in 46 of the 132 patients (34.8%). Newly developed OVCF increased significantly with factors such as average age (p=.047), low BMD T-score of the lumbar spine (p=.04) and of the femoral neck (p=.046), advanced age (>70 years) (p=.011), treatment by cement augmentation (p=.047) and low compliance with osteoporosis medication (p=.029). In multivariate regression analysis, BMD T-score of the lumbar spine (p=.009) and treatment by cement augmentation (p=.044) showed significant correlations with the occurrence of new OVCFs with a predictability of 71.4%.Conclusion: Osteoporotic vertebral compression fracture patients with low BMD T-score of the lumbar spine and those who have been treated by cement augmentation have an increased risk of new OVCFs after treatment and, therefore, require especially careful observation and attention. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture.Patients and Methods: One hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4±4.1days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors.Results: Simultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p=0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01-0.57).Conclusions: The prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture. [ABSTRACT FROM AUTHOR]

Purpose: To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear. Methods: Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self–passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self–passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery. Results: Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106). Conclusions: Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. Level of Evidence: Level II, randomized controlled trial. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the clinical and radiologic results of arthroscopic tuberoplasty for symptomatic irreparable massive rotator cuff tears. Methods: This study enrolled 32 patients (32 shoulders) who underwent arthroscopic tuberoplasty for irreparable massive rotator cuff tears and were followed up for at least 24 months. The mean patient age at the time of surgery was 62.4 years (range, 43 to 76 years), and the mean duration of follow-up was 40 months (range, 24 to 63 months). The Constant score and the University of California, Los Angeles score were used for clinical evaluation. The acromiohumeral interval and inferior scapulohumeral line continuity were used for radiologic evaluation. Results: Twenty-six shoulders underwent arthroscopic tuberoplasty with concomitant acromioplasty, and 6 shoulders had only arthroscopic tuberoplasty. The Constant score increased from a preoperative mean of 47.6 points to 70.4 points at the last follow-up (P < .001). The University of California, Los Angeles score also improved from a preoperative mean of 15.4 points to 27.1 points at the last follow-up (P < .001), with 3 shoulders (9%) rated as excellent, 23 (72%) as good, and 6 (19%) as poor. The active range of forward flexion improved from 115.9° to 142.7° (P = .024). The final outcomes were not statistically affected by sex, age, preoperative mobility, and existence of a lesion of the long head of the biceps tendon. However, preoperative acromiohumeral interval and inferior scapulohumeral line continuity were statistically correlated with the final results (P < .001 and P = .047, respectively). Conclusions: Arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated, would be an option for diminishing pain and improving active forward elevation for irreparable massive rotator cuff tears. In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Hypothesis: Although conservative treatment is the first option for the treatment of calcific tendinitis, only a few reports have described its results, without documenting the radiologic changes over time of calcific deposits. We hypothesized that conservative treatment for calcific tendinitis of the shoulder would produce good clinical results in most patients and that the initial radiologic appearance of calcific deposits would not affect the final results. Materials and methods: The study enrolled 87 consecutive patients (92 shoulders) who were diagnosed with calcific tendinitis and underwent conservative treatment. The mean age at the time of first visit was 53.2 years. The mean follow-up period was 16.1 months. Results: At the final follow-up, the Constant score increased to 83.64 points from a mean of 76.17 points at initial visit (P < .001). The score on the University of California, Los Angeles (UCLA) Shoulder Rating Scale improved from 23.42 to 29.69 points (P < .001), and there were 7 excellent (8%), 59 good (64%), and 26 poor (28%) results. Eleven shoulders (12%) revealed complete resolution of calcific deposits; 46 (50%) decreased in size; 18 (20%) had no change in size; and 17 (18%) increased in size. Discussion: Most patients in calcific tendinitis require treatment due to very severe shoulder pain, and conservative treatment may take precedence over operative treatment. Radiologic changes of calcific deposits report varying results depending on treatment methods. This study suggested that good radiologic results may be expected without performing special therapies. Conclusion: Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits. By radiologic type, 46% of the calcific deposits had a tendency to become more cloudy and inhomogeneous than initial findings, and 62% presented complete resolution or decrease in the size. [Copyright &y& Elsevier]

Purpose This study evaluated the biomechanical properties of a new volar locking plate made by 3-dimensional printing using titanium alloy powder and 2 conventional volar locking plates under static and dynamic loading conditions that were designed to replicate those seen during fracture healing and early postoperative rehabilitation. Methods For all plate designs, 12 fourth-generation synthetic composite radii were fitted with volar locking plates according to the manufacturers’ technique after segmental osteotomy. Each specimen was first preloaded 10 N and then was loaded to 100 N, 200 N, and 300 N in phases at a rate of 2 N/s. Each construct was then dynamically loaded for 2,000 cycles of fatigue loading in each phase for a total 10,000 cycles. Finally, the constructs were loaded to a failure at a rate of 5 mm/min. Results All 3 plates showed increasing stiffness at higher loads. The 3-dimensional printed volar locking plate showed significantly higher stiffness at all dynamic loading tests compared with the 2 conventional volar locking plates. The 3-dimensional printed volar locking plate had the highest yield strength, which was significantly higher than those of 2 conventional volar locking plates. Conclusions A 3-dimensional printed volar locking plate has similar stiffness to conventional plates in an experimental model of a severely comminuted distal radius fracture in which the anterior and posterior metaphyseal cortex are involved. Clinical relevance These results support the potential clinical utility of 3-dimensional printed volar locking plates in which design can be modified according the fracture configuration and the anatomy of the radius. [ABSTRACT FROM AUTHOR]