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Background The purpose of this study was to evaluate the mid-term results of an Oxford phase-3 unicompartmental knee arthroplasty ( UKA) for medial arthritis in Chinese patients. Methods The study included 64 patients who underwent a minimally invasive Oxford phase-3 UKA for medial knee arthritis. The patients were clinically evaluated preoperatively and at the final follow-up according to the clinical and functional components of the Knee Society Score ( KSS), the Hospital for Special Surgery knee score and range of motion. A Kaplan-Meier survivorship analysis was performed with revision surgery as the end point. Results The mean preoperative clinical KSSs increased from 63.2 to 91.4 post-operatively, and the mean functional KSSs increased from 54.9 to 86.5 post-operatively. In addition, the mean Hospital for Special Surgery scores increased from 59.5 to 86.4. The mean active knee flexion increased from 109.1° preoperatively to 123.6° post-operatively. A total of six patients (six knees) required revision surgery at the time of the maximum 10-year follow-up. Four conversions to total knee arthroplasty were performed because of arthritis progression in the lateral compartment. One revision to total knee arthroplasty was performed for aseptic loosening, and one liner exchange was performed for wear. The cumulative survival rates at the 6- and 8-year follow-ups were 97% and 93%, respectively. Conclusion Oxford phase-3 UKA was largely applicable for medial arthritis in Chinese patients. However, the Oxford phase-3 medial UKA selection criteria for young Chinese males need further exploration to obtain the best treatment effect. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the best surgical management of infected shoulder arthroplasty.Methods: A literature review from 1996 to 2016 identified 15 level IV studies that met inclusion criteria. Persistent infection (PI) was considered as treatment failure. Success was regarded as the absence of symptomatic PI without necessity for further treatment. Surgical outcomes were reported according to the mean weighted Constant and Murley score (CMS) for each treatment group.Results: Overall, 287 patients (146 males/141 females) were identified at a mean follow-up of 50.4 (range 32-99.6) months. The PI in the whole population was 11.5%. The pooled mean CMS, available for 218 patients, was 39 ± 13. Twenty-seven patients (9.4%) were treated with debridement (PI 29.6%, CMS 41 ± 12), 52 patients (18.1%) with resection arthroplasty (PI 11.5%, CMS 29 ± 16), 33 patients (11.5%) with permanent spacers (PI 6.1%, CMS 31 ± 14), 98 patients (34.2%) with two-stage revisions (PI 14.3%, CMS 42 ± 12) and 77 patients (26.8%) with one-stage revisions (PI 3.9%, CMS 49 ± 11). Debridement showed the highest PI rate (29.6%) and one-stage revisions reported the lowest PI rate (3.9%). Resection arthroplasty and spacers showed the poorest CMS when compared to the other procedures (p ≤ 0.0001). The debridement PI rate was significantly higher than almost any other procedure. CMS was significantly higher in patients undergoing revision compared to non-revision procedures (45 ± 12 vs. 35 ± 14) (p < 0.0001). One-stage revisions achieved significantly better results in terms of the PI rate compared to two-stage revisions (p = 0.0223), but not in terms of CMS.Conclusion: Debridement showed the highest PI rate (29.6%) and should not be recommended for the management of infected shoulder arthroplasty. Revisions reported better functional outcomes compared to non-revision procedures. The presence of a significantly lower PI rate with comparablely high mean CMS values suggests that one-stage (where technically applicable) could be superior to two-stage revisions. Unfortunately, well-designed randomized controlled trials using validated patient-based outcomes are lacking in this field.Level Of Evidence: Systematic Review of level IV studies, Level IV. [ABSTRACT FROM AUTHOR]

Copyright of Obere Extremitat is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: We hypothesize that a dual mobility cup can be safely used via the direct anterior approach, without increasing the risk of complications or incorrect positioning.Materials and Methods: This retrospective study compared 201 primary total hip arthroplasties using a dual mobility cup performed via direct anterior approach without a traction table, to 101 arthroplasties performed via posterolateral approach. Implant positioning, function scores, and early complications were recorded.Results: Implant positioning was appropriate in both groups, with a higher cup anteversion in direct anterior approach. The complications rates were similar in both groups, with no dislocation or infection.Conclusion: The direct anterior approach without traction table associated with a dual mobility cup does not increase the risk of complications or non-optimal positioning of implants. This strategy is interesting for patients with high risk of post-operative dislocation. [ABSTRACT FROM AUTHOR]

Background: Proximal humeral fractures are common in older patients. The majority are minimally displaced and are associated with good outcomes after nonoperative treatment. Poorer outcomes are associated with displaced, multipart fractures. There is no clear benefit from surgical fracture fixation compared to nonoperative treatment. Replacement of the fractured humeral head with a hemiarthroplasty is another treatment option, but has not been shown to be clearly superior to nonoperative treatment or internal fixation. Recently, reverse total shoulder arthroplasty has been used to treat these fractures, particularly in the older population with several case series demonstrating good outcomes. No comparative trial has been performed to test the effectiveness of reverse total shoulder arthroplasty against nonoperative treatment.Methods/design: ReShAPE (Reverse Shoulder Arthroplasty for the treatment of Proximal humeral fractures in the Elderly) is a multicenter combined randomized and observational study. The primary objective is to compare pain and function 12 months post fracture using the American Shoulder and Elbow Society (ASES) score in patients aged 70 years or older with three- and four-part proximal humeral fractures treated by either reverse shoulder arthroplasty or nonoperative treatment. Secondary outcome measures will include the DASH (Disability of the Arm, Shoulder and Hand) score, the EQ-5D (EuroQol Health Survey), the EQ-VAS, pain, radiological parameters and complications.Discussion: The study will assess the effectiveness of reverse shoulder arthroplasty for complex proximal humeral fractures and thereby guide treatment of a common injury in the older population.Trial Registration: World Health Organization Universal Trial Number (WHO UTN): U1111-1180-5452 . Registered on 10 March 2016. Australian and New Zealand Clinical Trials Registry (ANZCTR): 12616000345482 . Registered on 16 March 2016. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to measure the relationship of potential clinical and radiographic predictors and medium-term clinical outcomes after total shoulder arthroplasty in primary osteoarthritis.Materials and Methods: In a prospective follow-up study, preoperatively collected clinical and radiographic variables were recorded in 103 patients with an average age of 66 years (range 37-83 years) to measure their influence on the clinical outcome by use of the Constant score. The average length of follow-up was 6 years (range 3-12 years). Radiographs and a computed tomography (CT) of the shoulders were obtained preoperatively for evaluating the acromiohumeral distance, the lateral glenohumeral offset and the morphology of the glenoid, which was classified according to the method by Walch (type-A1 to type-C glenoids).Results: The mean Constant score improved from its preoperative value of 25 points (range 6-54 points) to 65 points (range 10-86 points) postoperatively (p < 0.001). The mean age- and sex-normalized Constant score was similarly improved from 34 points (range 8-78 points) preoperatively to 90 points (range 14-130 points) at the time of follow-up (p < 0.001). The Walch classification of glenoid wear had a significant negative effect (r = -0.32, p < 0.001). The other predictors showed no significant influence on the Constant score (p > 0.05).Conclusion: A higher Walch classification is a negative predictor for the postoperative clinical function. The proven significant negative effect  on outcomes in total shoulder arthroplasty emphasizes the importance of the preoperative evaluation of humeral head subluxation and glenoid erosion, which are associated with less favorable postoperative results. The measured internal patient variables gave no negative predictions on the medium-term clinical outcomes in the study population. [ABSTRACT FROM AUTHOR]

The management of glenoid bone loss is a major challenge in both complex primary and revision arthroplasty surgery. To deal with this problem, a number of techniques have been advocated, although there has been no previous systematic review of the literature. In the present review, we have attempted to identify a coherent strategy for addressing this problem, taking into account the degree of bone loss, the advantages and limits of standard implants, bone reconstruction techniques and the use of customized prostheses. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical and radiological outcomes of acetabular reconstruction using a reinforcement device (RD) in combination with bone grafting in Paprosky type 2 and 3 acetabular bone defects.Methods: Morselised bone grafts were used to fill cavitary defects and a structural graft placed in the superior part of the acetabulum in cases of cranial bone defects, with a proximally fixed RD (Protetim, Hódmezővásárhely, Hungary) implanted in all cases. Construct stability, device positioning, hip centre of rotation and medial acetabular wall thickness were evaluated radiologically. Survival rates were estimated with aseptic loosening and revision for any reason as endpoints.Results: The 28 patients (29 hips) were followed for 4.8 ± 2.7 years (range, 2-10.4 years). Hip centre of rotation was lowered in all cases, with no significant differences between the mean values obtained post-operatively and at the last follow-up. Medial acetabular wall thickness and RD abduction angle were maintained up to the last evaluation. Bone grafts integrated by two years post-operatively in the majority of cases. Kaplan-Meier survival rates were 85.2 % and 82.1 % for the two endpoints at ten years.Conclusions: Acetabular reconstruction using a proximally fixed RD in combination with bone grafting offered good mid-term results in the treatment of acetabular bone defects. In cases of severe bone loss, the structural allograft allowed placement of the RD with ischial contact, rendering survival rates similar to RDs with both iliac and ilioischial fixation. The technique was successful in restoring and maintaining medial acetabular bone stock and construct stability for up to ten years. [ABSTRACT FROM AUTHOR]

Introduction: The use of total shoulder arthroplasty (TSA) to treat primary glenohumeral osteoarthritis (GHOA) is increasing. Factors influencing patient satisfaction after surgery have not been well documented. The aim of this study was to determine demographic, radiologic, and surgical, factors predictive for satisfaction after TSA for GHOA. Materials and Methods: Between 2005 and 2012, 95 shoulders undergoing TSA for GHOA by a single surgeon were eligible for inclusion in the study. Age, gender, previous surgeries, American Society of Anesthesiologists (ASA) score, and Walch glenoid morphology were analyzed as satisfaction predictors. Patients with Walch glenoid type C were excluded. Results: Data on 80/92(87 %) shoulders were available at a mean of 3 years (range 2-9). Three complications (3 %) and 2 failures (2 %) occurred. The outcome scores collected significantly improved from preoperative values (p < 0.05). Median patient satisfaction was 10/10. Gender, age, previous surgery, ASA score, and Walch morphology were not associated with patient satisfaction. Conclusions: TSA provided excellent results for patients with idiopathic GHOA with low complication and failure rates. Outcomes after TSA for type B glenoid morphology with posterior subluxation were similar to outcomes after TSA for centered type A morphology. Overall patient satisfaction was high and was not influenced by the demographic, anatomic, and surgical variables investigated. Level Of Evidence: III, Therapeutic study, Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

The deltoid muscle plays a critical role in the biomechanics of shoulders undergoing reverse shoulder arthroplasty (RSA). However, both pre- and postoperative assessment of the deltoid muscle quality still remains challenging. The purposes of this study were to establish a novel methodology of shear wave elastography (SWE) to quantify the mechanical properties of the deltoid muscle, and to investigate the reliability of this technique using cadaveric shoulders for the purpose of RSA. Eight fresh-frozen cadaveric shoulders were obtained. The deltoid muscles were divided into 5 segments (A1, A2, M, P1 and P2) according to the muscle fiber orientation and SWE values were measured for each segment. Intra- and inter-observer reliability was evaluated using intraclass correlation coefficient (ICC). To measure the response of muscle tension during RSA, the humeral shaft was osteotomized and subsequently elongated by an external fixator (intact to 15 mm elongation). SWE of the deltoid muscle was measured under each stretch condition. Intra- and inter-observer reliability of SWE measurements for all regions showed 0.761–0.963 and 0.718–0.947 for ICC(2,1). Especially, SWE measurements for segments A2 and M presented satisfactory repeatability. Elongated deltoid muscles by the external fixator showed a progressive increase in passive stiffness for all muscular segments. Especially, SWE outcomes of segments A2 and M reliably showed an exponential growth upon stretching (R2 = 0.558 and 0.593). Segmental measurements using SWE could be reliably and feasibly used to quantitatively assess the mechanical properties of the deltoid muscle, especially in the anterior and middle portions. This novel technique based on the anatomical features may provide helpful information of the deltoid muscle properties during treatment of RSA. [ABSTRACT FROM AUTHOR]

Introduction: The field of shoulder endoprothetics has undergone a rapid development in the last years. The purpose of the study was to provide an overview of the development of shoulder arthroplasties in Germany from 2005 until 2012. This study hypothesized that the surgical procedures of the shoulder joint is still increasing and have not reached a plateau until 2012. Methods: Data of the German federal statistical office from 2005 until 2012 were analyzed to quantify hemiarthroplasty, anatomic total shoulder and reversed total shoulder arthroplasty rates depending on age, gender and main coded indications. Procedure codes and diagnosis were analyzed for each year. Comparative analyses were used to visualize the difference between the types of shoulder endoprostheses. Results: A total number of 139.272 shoulder arthroplasties were performed between 2005 and 2012. Total should arthroplasties have increased continuously until 2009. In 2009 more total shoulder arthroplasties have been performed than hemiprothesis implantations, which have culminated in 2008. All in all, women have been treated 3-fold higher than men regarding hemiarthroplasty, total shoulder arthroplasties or reversed total shoulder arthroplasties. Under the age of 60 years the majority of treated patients were male. Conclusion: Since 2005 shoulder arthroplasties are still increasing in Germany, whereas a slight reduction could be detected for shoulder hemiarthroplasty from 2009 up until 2012. Meanwhile total shoulder arthroplasties and reversed total shoulder arthroplasties are still increasing. Women have experienced a 3-fold higher hemiarthroplasty, total shoulder and reversed shoulder arthroplasties than men except for individual younger than 60 years. [ABSTRACT FROM AUTHOR]

Background: The best surgical modality for treating chronic periprosthetic shoulder infections has not been established, with a lack of randomised comparative studies. This systematic review compares the infection eradication rate and functional outcomes after single- or two-stage shoulder exchange arthroplasty, to permanent spacer implant or resection arthroplasty.Methods: Full-text papers and those with an abstract in English published from January 2000 to June 2014, identified through international databases, such as EMBASE and PubMed, were reviewed. Those reporting the success rate of infection eradication after a single-stage exchange, two-stage exchange, resection arthroplasty or permanent spacer implant, with a minimum follow-up of 6 months and sample size of 5 patients were included.Results: Eight original articles reporting the results after resection arthroplasty (n = 83), 6 on single-stage exchange (n = 75), 13 on two-stage exchange (n = 142) and 8 papers on permanent spacer (n = 68) were included. The average infection eradication rate was 86.7 % at a mean follow-up of 39.8 months (SD 20.8) after resection arthroplasty, 94.7 % at 46.8 months (SD 17.6) after a single-stage exchange, 90.8 % at 37.9 months (SD 12.8) after two-stage exchange, and 95.6 % at 31.0 months (SD 9.8) following a permanent spacer implant. The difference was not statistically significant (p = 0.650). Regarding functional outcome, patients treated with single-stage exchange had statistically significant better postoperative Constant scores (mean 51, SD 13) than patients undergoing a two-stage exchange (mean 44, SD 9), resection arthroplasty (mean 32, SD 7) or a permanent spacer implant (mean 31, SD 9) (p = 0.029). However, when considering studies comparing pre- and post-operative Constant scores, the difference was not statistically significant.Conclusion: This systematic review failed to demonstrate a clear difference in infection eradication and functional improvement between all four treatment modalities for established periprosthetic shoulder infection. The relatively low number of patients and the methodological limitations of the studies available point out the need for well designed multi-center trials to further assess the best treatment option of peri-prosthetic shoulder infection. [ABSTRACT FROM AUTHOR]

Purpose: The correct amount of arm lengthening in reverse shoulder arthroplasty is crucial to provide joint stability and good results. Determination has been proposed according to radiographs. However, radiographic measurements are error prone in regards to positioning of the arm with regard to the radiographic beam. The purpose of this study was to evaluate the precision of radiographic measurements compared to CT scans of the upper limb following reverse shoulder arthroplasty.Methods: Thirty patients undergoing onlay reverse shoulder arthroplasty with comparative radiographs and CT scans of both humeri were included in this study. Arm length, humeral length as well as the arm and humeral lengthening were evaluated on pre- and postoperative radiographs compared to postoperative CT scans following a previously validated protocol.Results: We found an excellent correlation for arm length and humeral length for radiographic and CT measurements (r > 0.90). The postoperative humeral and arm lengthening compared to the contralateral side was 0.1 (-1.2 to 1.2) cm and 2.8 (0.2 to 5.2) cm for the CT scans, and -0.6 (-4.1 to 2.0) cm and 1.9 (-2.3 to 5.0) cm for the radiographs. For arm lengthening, correlation coefficient was good (r = 0.7) even though radiographs indicated arm shortening in five cases whereas arm lengthening was observed on CT scans.Conclusions: Measurements on radiographs and CT scans are comparable in most of the cases. However, we observed some important variations that question the reliability of radiographic measurements in up to 20 % of cases. Therefore, a CT scan appears to be necessary in the event of postoperative complications (e.g., instability, neurological problems). [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review is to summarise tear pattern classification and management options for massive rotator cuff tears (MRCT), as well as to propose a treatment paradigm for patients with a MRCT.Method: Data from 70 significant papers were reviewed in order to define the character of reparability and the possibility of alternative techniques in the management of MRCT.Results: Massive rotator cuff tears (MRCT) include a wide panoply of lesions in terms of tear pattern, functional impairment, and reparability. Pre-operative evaluation is critical to successful treatment. With the advancement of medical technology, arthroscopy has become a frequently used method of treatment, even in cases of pseudoparalytic shoulders. Tendon transfer is limited to young patients with an irreparable MRCT and loss of active rotation. Arthroplasty can be considered for the treatment of a MRCT with associated arthritis.Conclusion: There is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology, and includes personal experience and data from case series. [ABSTRACT FROM AUTHOR]

Purpose: Unicompartmental knee arthroplasty (UKA) presents low morbidity and complication risk and provides excellent outcomes and fast recovery. Despite these facts, knee-replacement registries have shown high failure rates for UKA, especially when compared with traditional TKA. The purpose of this study was therefore to report outcomes, complications, and ten year survivorship rate of medial ZUK unicompartmental knee prosthesis.Methods: We retrospectively analysed 136 medial UKAs in 124 patients, with a maximum follow-up of ten years. Patients were assessed through the International Knee Society (IKS) scores and range of motion (ROM). A complete X-ray study was performed in all patients. Limb alignment was assessed by measuring the femorotibial mechanical alignment. At surgery, bone resections were performed according to proximal tibial epiphyseal axis.Results: Mean IKS knee score improved from 45.7 (range 35-63) points preoperatively to 87.2 (range 71-100) points at the latest follow-up. Mean IKS function score improved from 50.9 (range 40-70) points to 89.1 (range 75-100) points (p < 0.05). Mean ROM increased from 106.1° (range 98-123°) to 128.6° (range 116-139°) (p < 0.01). Four cases (2.9 %) were revised due to failure for any cause, so that survivorship was 97.1 % at the latest follow-up.Conclusions: This study demonstrates excellent outcomes and survivorship for the ZUK unicompartmental knee prosthesis. Based on our findings, we believe that the ZUK prosthesis offers an effective and durable solution for treating medial degeneration of the knee. Level of Evidence IV - Retrospective case series study. [ABSTRACT FROM AUTHOR]

Background: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. Methods: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of gleno- sphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. Results: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. Conclusions: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck. [ABSTRACT FROM AUTHOR]

Purpose: Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have theoretical advantages over their FB counterparts, it is not clear whether they are associated with better outcomes. A systematic review was conducted to examine survivorship differences and differences in failure modes of between FB and MB designs.Methods: PubMed, Scirus and Cochrane library databases were searched for medial UKA outcome studies. A total of 44 papers, involving 9,463 knees, were eligible. Outcomes examined included knee function, survivorship and the reasons for, and incidence of, revision for FB and MB prostheses. Random effects meta-analysis was employed to obtain pooled revision rate estimates. Where available, cause-specific time to revision was extracted.Results: Mean follow-up was 8.7 years for FB and 5.9 years for MB prostheses. There were no other relevant baseline differences. The overall crude revision rate for FB and for MB prostheses was 0.90 (95 % confidence interval (CI) 0.65-1.21) and 1.51 (95 % CI 1.11-1.93) per 100 component years, respectively. After stratification on follow-up time and age, the revision rates were not substantially different, aside for younger patients in short term from studies with short-term follow-up.Conclusion: No essential differences between the two designs were observed. MB and FB UKA designs have comparable revision rates. As our study is based on predominantly observational data, with large variations in reporting standards, inferences should be drawn with caution.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Glenoid component survival is critical to good long-term outcomes in total shoulder arthroplasty. Optimizing the fixation environment is paramount. The purpose of this study was to compare two glenoid cementing techniques for fixation in total shoulder arthroplasty. Methods: Sixteen cadaveric specimens were randomized to receive peg-only cementation (CPEG) or full back-side cementation (CBACK). Physiological cyclic loading was performed and implant displacement was recorded using an optical tracking system. The cement mantle was examined with micro-computed tomography before and after cyclic loading. Results: Significantly greater implant displacement away from the inferior portion of the glenoid was observed in the peg cementation group when compared to the fully cemented group during the physiological loading. The displacement was greatest at the beginning of the loading protocol and persisted at a diminished rate during the remainder of the loading protocol. Micro-CT scanning demonstrated that the cement mantle remained intact in both groups and that three specimens in the CBACK group demonstrated microfracturing in one area only. Discussion: Displacement of the CPEG implants away from the inferior subchondral bone may represent a suboptimal condition for long-term implant survival. Cement around the back of the implant is suggested to improve initial stability of all polyethylene glenoid implants. Clinical relevance: Full cementation provides greater implant stability when compared to limited cementation techniques for insertion of glenoid implants. Loading characteristics are more favorable when cement is placed along the entire back of the implant contacting the subchondral bone. [ABSTRACT FROM AUTHOR]

Background: Complex proximal humeral fractures are very difficult to treat particularly in patients older than 65 years with an osteoporotic bone and tuberosities compromised. The goal of this paper is to evaluate radiological outcomes at mid-term follow-up of proximal humerus fractures treated with reverse shoulder arthroplasty using a dedicated fracture stem. Materials and methods: The study population included 98 patients who underwent reverse shoulder with a dedicated fracture stem for an acute proximal humerus fracture; 87/98 patients were available for analysis. There were 62 female and 25 male patients, and the mean age was 76.2 years at the time of surgery (range 61-90 years). Clinical and radiological outcomes were evaluated at a mean follow-up of 27 months after surgery. Results: Average active elevation was 137.7°, external rotation 29.1°, and internal rotation 40.7°. Overall, the tuberosity healing rate was 75 %. There was a significant increase in active anterior elevation, external rotation, and internal rotation among patients who demonstrated radiographic evidence of tuberosity healing. All tuberosity nonunions (21 cases) occurred preferentially in females, but this number did not reach statistical significance. Conclusion: RSP using a dedicated stem is a very viable solution to treat complex humerus proximal fracture. Reliable restoration of elevation can be expected. However, in patients in whom tuberosity healing occurs, a better active elevation other than restoration of active rotational movement can be observed. [ABSTRACT FROM AUTHOR]

The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62 %. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the clinical and radiological outcome of the Total Evolutive Shoulder System (TESS) in patients with cuff tear arthropathy and patients in need of a revision arthroplasty. Methods: In this sequential study, 67 patients (56 non-stemmed, 11 stemmed) were evaluated after a mean follow-up of 17.5 months. The relative Constant and DASH scores, radiological joint geometry changes, complications and postoperative problems, which are not likely to affect the outcome, were evaluated. Results: A significant increase was noticed for the relative Constant (11.3 vs. 78.8 %) and DASH scores (73.7 vs. 31.8) without significant differences between both etiology groups. Complication rates were similar to previous studies. An aseptic loosening of the non-stemmed humeral component was not noticed in the cuff tear arthropathy group, whereas one case with a loosening was noticed in the revision arthroplasty group. With nine cases (13.4 %), scapular notching rates were very low. On average, the acromiohumeral distance increased by 17 mm and the humeral offset by 13.9 mm; the height of the center of rotation decreased by 4.6 mm and the lateral glenohumeral offset by 6.1 mm, p < 0.05, respectively. Conclusion: Regarding the joint geometry, surgery with the TESS system provided adequate distalization and medialization of the humerus and the center of rotation. This corresponds to a good clinical outcome. The use of the surgical opportunity to implant the prosthesis with a relatively low neck-shaft angle might explain the low rates of scapular notching in our series. Regarding the case with a loosening of the humeral component, the surgeon should carefully indicate a stemless version for metaphyseal press-fit fixation in patients with revision arthroplasty. [ABSTRACT FROM AUTHOR]

Copyright of Obere Extremitat is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and purpose - There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA). Patients and methods - We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient-reported outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis with adjustment for age, sex, and previous surgery. Results - During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were treated with reverse shoulder arthroplasty (rTSA). 130 patients returned a completed questionnaire, and the total mean WOOS score was 63. The cumulative 5-year revision rate was 7%. Most revisions occurred after RHA, with a revision rate of 14%. Mean WOOS score was similar for RHA and for SHA. Interpretation - This study shows that shoulder arthroplasty, regardless of design, is a good option in terms of reducing pain and improving function in RA patients. The high revision rate in the RHA group suggests that other designs may offer better implant survival. However, this should be confirmed in larger studies. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty has recently received attention for treatment of rotator cuff tear arthropathy. However, many complications of reverse total shoulder arthroplasty have also been reported, and infection is a major complication. We are reporting on a case of an approximately 77-year-old female patient who underwent reverse total shoulder arthroplasty with surgical site infection caused by Mycobacterium tuberculosis. The patient had undergone irrigation and debridement two times due to infectious signs at 8 months after a reverse total shoulder arthroplasty. At the last debridement operation, we performed AFB staining, culture for Mycobacterium tuberculosis and biopsy. Mycobacterium tuberculosis was cultured and we did not hesitate to administer 4 regimen therapy for tuberculosis. The outpatient follow-up result was satisfactory without recurrence. At the time of the latest follow-up, the degree of pain and function were good. [ABSTRACT FROM AUTHOR]

Introduction: This study documents 2-year clinical and radiographic results following reversed total shoulder arthroplasty using a novel prosthesis with inverted bearing materials (polyethylene glenoid; metal humeral component). This design was intended to avoid massive PE abrasion on the humeral side. Therefore, we predicted a lack of subsequent osteolysis-induced exacerbation of scapular notching, and because of other design features and modified operating technique a reduced notching rate. Materials and methods: An ongoing, prospective, international, multicenter study of patients implanted with a novel prosthesis at six European centers. The current analysis presents 2-year follow-up data (patients operated between December 2007 and July 2009). Clinical evaluation tools comprised the Constant-Murley score (CS), the American Shoulder and Elbow Surgeon score, range of motion, and a visual analog scale to assess pain and satisfaction. Radiographs were evaluated for notching and radiolucent lines. Any complications were recorded. Results: In total, 113 prostheses (113 patients) with a mean follow-up of 27.6 (±3.6) months were analyzed. CS increased from 22.5 (±13.7) to 65.3 (±14.9) points ( p = 0.06). Inferior scapular notching (only grade 1 and 2) was identified in 20.5 % of patients, with no signs of PE-induced osteolysis. 4.4 % of patients experienced an implant-related complication. Conclusions: Inversion of the materials led to another type of notching with no signs of PE-induced osteolysis and no increase in the risk of short-term complications. Clinical results were comparable with other prostheses. Mid- to long-term results are required before any firm conclusions on clinical outcome and survival can be drawn. [ABSTRACT FROM AUTHOR]

Background and purpose - Previously, implant survival of total shoulder prostheses was reported to be inferior to that of hemiprostheses. However, the use of total prostheses has increased in Norway due to reported good functional results. On this background, we wanted to study implant survival of 4 major shoulder prosthesis types in Norway between 1994 and 2012. Patients and methods - The study population comprised 4,173 patients with shoulder replacements reported to the Norwegian Arthroplasty Register, including 2,447 hemiprostheses (HPs), 444 anatomic total prostheses (ATPs), 454 resurfacing prostheses (RPs), and 828 reversed total prostheses (RTPs). Three time periods were compared: 1994-1999, 2000-2005, and 2006-2012. Kaplan-Meier failure curves were used to compare implant failure rates for subgroups of patients, and adjusted risks of revision were calculated using Cox regression analysis. Results - For prostheses inserted from 2006 through 2012, the 5-year survival rates were 95% for HPs (as opposed to 94% in 1994-1999), 95% for ATPs (75% in 1994-1999), 87% for RPs (96% in 1994-1999), and 93% for RTPs (91% in 1994-1999). During the study period, the implant survival improved significantly for ATPs (p < 0.001). A tendency of better results with acute fracture and worse results in sequelae after previous fractures was seen in all time periods. Interpretation - The 5-year implant survival rates were good with all prosthesis types, and markedly improved for anatomic total prostheses in the last 2 study periods. The better functional results with total shoulder prostheses than with hemiprostheses support the trend towards increased use of total shoulder prostheses. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to analyse the short- and medium-term clinical and radiographic results of cementless humeral head resurfacing in combination with a cemented glenoid component. Methods: Thirty-five patients with a mean age of 65 years (range 42-84) and a mean follow-up of three years (two to six) were followed up. The Constant score with its subgroups as well as shoulder motions and complications were recorded. Radiographs in two planes were analysed for loosening of the components. Results: Mean Constant score improved from 29 points (6-63) to 70 points (41-89; p < 0.001). Mean shoulder flexion increased from 89° (20-170) to 158° (100-180) and mean external rotation from 10° (−10-30) to 39° (10-80). Satisfaction rate was 94 % at final follow-up. None of the components was found to be loose. There were three neurological complications, probably related to increased forces on the humeral head retractor during glenoid preparation. Two of them resolved completely; in one patient hyposensitivity remained. Conclusion: Cementless humeral surface replacement arthroplasty in combination with a cemented glenoid component leads to an overall satisfactory clinical outcome. However, the high rate of neurological complications found in this study, probably related to difficult glenoid exposure, led us to discontinue this implant configuration. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the radiographic and functional outcomes of uncemented and cemented humeral fixation in reverse total shoulder arthroplasty (RTSA). Methods: A prospective research database was reviewed for RTSA patients from 2007 to 2010. Inclusion criteria were primary RTSA from one manufacturer (Exactech Equinoxe®) with a grit-blasted metaphyseal humeral stem and two year minimum follow-up. Exclusion criteria included shoulder arthroplasty for fractures, fracture sequelae or inflammatory arthropathy. Radiographic and functional outcomes were compared between the uncemented and cemented groups. Results: A total of 97 patients (58 women, 39 men) with 100 RTSAs met the inclusion criteria. Radiographic and clinical two year follow-up was available in 80 % (51 RTSAs) of the uncemented group and 89 % (32 RTSAs) of the cemented group (mean follow-up 3.5 years). Average age at surgery was 72 years. Both groups showed significant improvements in the 12-item Simple Shoulder Test (SST-12), 12-item Short Form (SF-12), Shoulder Pain and Disability Index 130 (SPADI-130), American Society of Shoulder and Elbow Surgeons (ASES) score and normalised Constant scores. One humeral loosening was seen in each group (2 % uncemented, 3 % cemented). Both groups' overall component revision rate was 6 % (one in each group relating to humeral component failure). There were no significant differences in complication rates, change in functional scores and range of motion improvement. Conclusions: Humeral component press-fitting in RTSA provides similar outcomes as cementation at a minimum two year follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Aseptic glenoid component loosening remains a common problem in total shoulder arthroplasty (TSA). This study presents long-term prospective follow-up after implantation of a glenoid component using the 'cancellous compaction technique' and its effect on clinical outcome and presence and progression of radiolucent lines (RLLs). Method: Thirty-nine TSAs were performed for primary osteoarthritis by one surgeon using the same technique. For the glenoid side, a keeled, polyethylene, convex-backed component was implanted using the 'cancellous compaction technique' consisting of minimal reaming, compaction bone grafting of the glenoid and minimal addition of cement. Postoperative clinical outcome was analysed using Constant scores and patient's subjective evaluation. Independent observers evaluated postoperative X-rays for radiolucent lines (RLL) around the base plate and keel. Results: At an average follow-up of 8.5 years (range 4.7-12.5), the Constant score improved from 33.5 to 73.0 points ( P < 0.0001). Active anterior elevation improved from an average 95 ° to 140° ( P < 0.0001), and active external rotation improved from 20° to 45° ( P < 0.0001). Pain score improved from 3.1 to 13.6 ( P < 0.0001). Radiologically, the RLL score increased from 1.09 (range, 0-3) postoperative to 5.7 (range, 0-18) ( P < 0.0001) at final follow-up. The occurrence of definite radiological glenoid loosening was 15.5 %. Constant scores deteriorated with the progression of RLLs ( P = 0.006). The rate of revision surgery for glenoid loosening was 2.5 %. Conclusions: This study showed highly satisfactory clinical outcomes and low rates of revision for glenoid loosening using a bone-saving compaction technique for implantation of an all-polyethylene glenoid component. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate functional outcomes of reverse shoulder arthroplasty (RSA) in patients with acute fracture and sequelae of the proximal humeral fractures. Methods: Thirty-seven patients were treated with RSA for acute fracture and sequelae of a proximal humeral fracture. The average age was 73 years (range 50-87 years). Twenty-one patients had had no previous surgery, seven patients had acute fractures and 14 patients had chronic fractures. Sixteen patients had had previous surgery. Active range of motion and Constant score were evaluated at a minimum follow-up of two years. Results: Active elevation was 102°, external rotation 24°, and internal rotation was up to L4 in all patients. In the group of patients without previous surgery treated with RSA, elevation was 116°, external rotation 24°, and internal rotation up to L3. In the group of patients with previous surgery treated with RSA, elevation was 84°, external rotation 19°, and internal rotation up to L4. In the group of patients with acute fracture treated with RSA, elevation was 124°, external rotation 28°, and internal rotation up to L4. In the group of patients with chronic or sequel of the fractures treated with RSA elevation was 114° , external rotation 28°, and internal rotation up to L3. Constant score in all patients was 54. Constant score in patients without previous surgery treated with RSA was 68 and with previous surgery it was 42. Conclusion: Patients without previous surgery treated with RSA for fractures had better functional results than patients who had undergone previous surgery. [ABSTRACT FROM AUTHOR]

Purpose: In modern modular reverse total shoulder arthroplasty designs, glenosphere disengagement has recently been described in systems that use a locking screw and Morse taper for fixation between the glenosphere and baseplate. This complication is unreported in modern systems that do not use a Morse taper design. The purpose of this paper is to report cases of glenosphere disengagement and its incidence in a previously unreported design. Methods: This study is a retrospective review of 40 patients who underwent reverse total shoulder arthroplasty for rotator cuff arthropathy using the Equinoxe® reverse total shoulder system, which uses a non-Morse taper design. Two patients were diagnosed with glenosphere disengagement postoperatively. Results: In this series two of 40 patients were retrospectively diagnosed with glenosphere disengagement. One patient had complete and one partial disengagement. Both patients were revised and subsequently did well. This represents an overall incidence of glenosphere disengagement of 5 % in this design. Conclusions: This series demonstrates an overall incidence of glenosphere disengagement of 5 % in reverse total shoulder arthroplasty with a non-Morse taper design. The incidence of overall and complete disengagement is higher in this series than previously published in modern designs with Morse tapers. Features unique to this design, include the non-Morse taper interface, offset screw placement and unique bone graft cage, may explain its higher incidence of disengagement. Surgeons who use this system should be aware of this potential complication. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to review and synthesize the current best evidence for the use of intraoperative navigation in the implantation of glenoid components in total shoulder prostheses. Methods: We conducted a systematic, online search using PubMed, EMBASE, CCTR, and CINAHL using 'Arthroplasty, Replacement'(Mesh) AND (shoulder) AND (navi* OR computer). Data on study design and quality as well as accuracy of positioning and complications were extracted independently and in duplicate. After assessment of study heterogeneity, DerSimonian-Laird random effect models were used to pool data from the individual studies. Results: The systematic search revealed 359 manuscripts in total. After exclusion of duplicates and irrelevant publications, 6 groups of 247 shoulders from 5 studies were included. The pooled weighted mean difference for deviation from neutral version was −6.4° (95 %CI −7.9 to −5.3) in favor of navigation, which is consistent with a statistically significant difference ( p < 0.01). In the navigation group, 2 superior glenoid screws were reported as perforating compared to 5 screws (1 inferior, 4 superior) in the control group. There was no difference in tilt at a WMD of 2.7 (95 %CI −1.4 to 6.8, p = 0.192). Conclusions: Navigation allows for significantly more accurate glenoid version, but the clinical meaningfulness of the absolute improvement over standard techniques is questionable. However, navigation is a valuable teaching tool that might prove very beneficial not for the patient at hand, but for those treated by the operating surgeon in the future. Level of evidence: Level II-meta-analysis of non-homogenous controlled trials. [ABSTRACT FROM AUTHOR]

Background: Use of a baseplate with a smaller diameter in reverse shoulder arthroplasty is increasing, especially in patients with a small glenoid or glenoid wear. However, the effect of a smaller baseplate on stability of the glenoid component has not been evaluated. Thus, the purpose of this study was to determine whether a smaller baseplate (25 mm) is beneficial to the initial stability of the glenoid component compared to that with a baseplate of a commonly used size (29 mm). Methods: Micromotion of glenoid components attached to 14 scapulae of fresh-frozen cadavers was measured and compared between 25- and 29-mm baseplates in biomechanical testing. Impingement-free range of motion in abduction, adduction, internal rotation, and external rotation was evaluated by using a simulated computer model constructed based on the same fresh-frozen cadavers used in biomechanical testing. Results: Micromotion at the inferior third of the glenoid-glenosphere interface was higher in the 29- mm baseplate group than in the 25-mm baseplate group during both 0.7- and 1-body weight cyclic loading in biomechanical testing. Adduction deficit was smaller, and total impingement-free range of motion from abduction to adduction and rotation were greater in the 25-mm baseplate group than in the 29-mm baseplate group in the simulated computer model. Conclusions: Use of a baseplate with a smaller diameter (25 mm) in reverse shoulder arthroplasty is suitable for improving the primary stability of the glenoid component. With a smaller baseplate, impingement-free range of motion is optimized in a smaller glenoid. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article reports on studies about shoulder replacement in patients with glenohumeral osteoarthritis. Topics discussed include patient outcomes and risks of revision after shoulder replacement, a comparison between resurfacing shoulder arthroplasty and stemmed hemiarthroplasty and the characteristics of glenohumeral osteoarthritis. Also discussed is the history of shoulder replacement surgery and the history of the development of the Danish Shoulder Arthroplasty Registry (DSR).

The number of shoulder arthroplasties performed in the United States has more than doubled in the last decade. Additionally, there has been a trend toward use of reverse total shoulder arthroplasty and minimally invasive surgical techniques, such as resurfacing humeral head arthroplasty. Thus radiologists will more frequently encounter imaging of shoulder arthroplasty and these new designs. Successful postoperative radiologic evaluation of shoulder reconstructions requires an understanding of their fundamental hardware design, physiologic objective, preoperative imaging assessment, normal postoperative radiologic appearance, and findings and types of complication. This article discusses the designs of prostheses used around the shoulder joint, delineates indications and alternatives for each of the different types of hardware, reviews radiographic and cross-sectional preoperative imaging of shoulder arthroplasty, illustrates normal postoperative imaging findings and measurements, and provides examples of hardware complications. [ABSTRACT FROM AUTHOR]

Clinical and subclinical neurological injury after reverse shoulder arthroplasty (RSA) may jeopardize functional outcomes due to the risk of irreversible damage to the axillary nerve. We proposed a simple anatomical study in order to assess the macroscopic effects on the axillary nerve when lowering the humerus as performed during RSA implantation. We also measured the effect on the axillary nerve of a lateralization of the humerus. Between 2011 and 2012, cadaveric dissections of 16 shoulder specimens from nine fresh human cadavers were performed in order to assess the effects on the axillary nerve after the lowering and lateralization of the humerus. We assessed the extent of stretching of the axillary nerve in four positions in the sagittal plane [lowering of the humerus: great tuberosity in contact with the acromion (position 1), in contact with the upper (position 2), middle (position 3) and lower rim of the glenoid (position 4)] and three positions in the frontal plane [lateralization of the humerus: humerus in contact with the glenoid (position 1), humerus lateralized 1 cm (position 2) and 2 cm (position 3)]. When the humerus was lowered, clear macroscopical changes appeared below the middle of the glenoid (the highest level of tension). As regards the lateralization of the humerus, macroscopic study and measurements confirm the absence of stretching of the nerve in those positions. Lowering of the humerus below the equator of the glenoid changes the course and tension of the axillary nerve and may lead to stretching and irreversible damage, compromising the function of the deltoid. Improvements in the design of the implants and modification of the positioning of the glenosphere to avoid notching and to increase mobility must take into account the anatomical changes induced by the prosthesis and its impact on the brachial plexus. Level of Evidence and study type Level IV. [ABSTRACT FROM AUTHOR]

The article discuses a multicentre retrospective study conducted to compare reverse total shoulder arthroplasty (RTSA) clinical outcomes. It is noted that the study compared the incidence of scapular notching, range of motion (ROM), pain and implant stability after RTSA with glenospheres of different design and materials and found that crosslinked ultra-high molecular weight polyethyleneg glenosphere help in faster and more stable functional recovery.

Purpose: Reverse shoulder prostheses have been gaining popularity in recent years. A short metaphyseal stem design will allow bone stock preservation and minimize stem related complications. We examined the clinical and radiographic short-term outcome of a short metaphyseal stem reverse shoulder arthroplasty. Methods: Thirty-one patients, with a mean follow-up of 36 months (24-52), were evaluated clinically with the Constant-Murley score, patient satisfaction and pain relief scores. The fixation of the glenoid and humeral components, subsidence and notching were evaluated on radiographs. The indications were cuff tear arthropathy (22), fracture sequelae (five) and rheumatoid arthritis (four). Results: The average Constant score improved from 12.7 (range two to 31) pre-operatively to 56.2 (range 17-86) postoperatively. It rose from 13.5 to 58.3 in patients with Cuff arthropathy, from 15.8 to 62.0 in revision arthroplasty, from 10.2 to 47.4 in those with fracture sequelae, and from 11.5 to 55.3 in patients with rheumatoid arthritis. The overall mean patient satisfaction score improved from 2.4/10 to 8.5/10 and mean pain score improved from 0.8/15 to 12.5/15. We found an overall improvement in active forward flexion from 46.8 to 128.5° and from 41.6 to 116.5° in abduction. No humeral loosening or subsidence was observed. Two cases of grade 1-2 glenoid notching were reported. Overall there were three intra-operative fractures that did not affect the operation and healed without affecting the good results. There were five late traumatic periprosthetic fractures, only one of them required a revision surgery to a stemmed implant and the rest healed without surgery. There were two early dislocations that had to be revised. Conclusions: The clinical and radiographic evaluation of a bone preserving metaphyseal humeral component in reverse shoulder arthroplasty is promising, with good clinical results, no signs of loosening or subsidence. [ABSTRACT FROM AUTHOR]

Background Radial mismatch, glenohumeral conformity ratios and differences between cartilaginous and osseous radii highly depend on the measured plane. The comparison of cartilaginous radii between the humeral head and glenoid in different planes provides new information to understand the degree of conformity during abduction of the upper limb. Methods To investigate the radii, computed tomography (CT) images in the soft tissue kernel of nine specimens were analysed using an image visualization software. Statistical analysis of the obtained data was performed using the t test. Results Measurements of the radii in the glenoid revealed a significantly larger radius for bone than cartilage, whereas for the humeral head the opposite was the case. The highest ratios for cartilage in the transverse plane were found in the inferior and central areas of the joint surface, whereas the smallest ratios were found in the superior area. The radial mismatch varied between 0.1 and 13.6 mm, depending on the measured plane. Conclusions The results suggest that in abduction, the cartilaginous guidance of the humeral head decreases. This might permit the humeral head an anterior-posterior shifting as well as superior-inferior translation. Surgical reconstruction of the normal glenohumeral relationships necessitates precise information about the glenohumeral morphology to ensure proper sizing and correct placement of prosthetic components and osteochondral allografts. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and purpose - Glenoid reconstruction and inverted glenoid re-implantation is strongly advocated in revisions of failed reverse shoulder arthroplasty (RSA). Nevertheless, severe glenoid deficiency may preclude glenoid reconstruction and may dictate less favorable solutions, such as conversion to hemiarthropasty or resection arthropasty. The CAD/CAM shoulder (Stanmore Implants, Elstree, UK), a hip arthroplasty-inspired implant, may facilitate glenoid component fixation in these challenging revisions where glenoid reconstruction is not feasible. We questioned (1) whether revision arthroplasty with the CAD/CAM shoulder would alleviate pain and improve shoulder function in patients with failed RSA, not amenable to glenoid reconstruction, (2) whether the CAD/CAM hip-inspired glenoid shell would enable secure and durable glenoid component fixation in these challenging revisions. Patients and methods - 11 patients with failed RSAs and unreconstructable glenoids underwent revision with the CAD/CAM shoulder and were followed-up for mean 35 (28-42) months. Clinical outcomes included the Oxford shoulder score, subjective shoulder value, pain rating, physical examination, and shoulder radiographs. Results - The average Oxford shoulder score and subjective shoulder value improved statistically significantly after the revision from 50 to 33 points and from 17% to 48% respectively. Pain rating at rest and during activity improved significantly from 5.3 to 2.3 and from 8.1 to 3.8 respectively. Active forward flexion increased from 25 to 54 degrees and external rotation increased from 9 to 21 degrees. 4 patients required reoperation for postoperative complications. No cases of glenoid loosening occurred. Interpretation - The CAD/CAM shoulder offers an alternative solution for the treatment of failed RSA that is not amenable to glenoid reconstruction. [ABSTRACT FROM AUTHOR]

Hypothesis: Reverse shoulder arthroplasty (RSA) yields unsatisfactory results after deltoid flap reconstruction due to defect of the deltoid muscle. Methods: We retrospectively reviewed the outcome of 19 patients after failed deltoid flap reconstruction treated with RSA. Follow-up was after a mean of 4.5 years. Results: Seven patients (37 %) had nine postoperative complications requiring totally 16 revision surgeries. Nonetheless, at latest follow-up, 17 patients had no or mild, two had moderate, and none had severe pain. Before RSA; 13 patients had a pseudoparesis. At latest follow-up, none of the patients had a pseudoparesis. Mean flexion was 121° (90°-160°). Abduction strength averaged 2.3 kg (range 0-5.4 kg). The mean constant score was 70 % (range 28-98 %). Of the 19 patients, 15 were very satisfied with the outcome, four were satisfied, and none was dissatisfied. The mean overall subjective shoulder value was 73 % (30-95 %) of the value of a normal shoulder. Conclusions: Despite of a localized defect of the deltoid muscle after deltoid flap repair, RSA can reliably be associated with a satisfactory outcome. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study is to evaluate the minimum three-year follow-up results of reverse total shoulder arthroplasty (RTSA) for glenohumeral (GH) arthritic and pseudoparalytic patients with severe rotator cuff deficiency. Materials and Methods: We evaluated 13 patients (three males and 10 females) who underwent RTSA from July 2007 to July 2010. The average follow-up duration was 54.2 months (range, 37~74 months). Clinical results were evaluated using the Visual Analog Scale (VAS) for pain, active Range of Motion (ROM): active forward flexion (aFF); active external rotation at the side (aERs); active internal rotation to the back (aIRb), American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and intraoperative and postoperative complications. Results: VAS score improved from 7.5(6~10) points to 1.5(0~4), and ROM of active forward elevation improved from 42.7(10~100)°to 129.1(110~180)°. In addition, ASES score improved from preoperative 32.9 (11.7~46.7) points to 80.2(58.3~95.0) postoperatively, and KSS score improved from 36.8(24~47) points to 78.4 (61~92). Twelve out of 13 cases showed various degrees of scapular notching at the last follow-up. There was one case of intraoperative anterior glenoid fracture and two cases of temporary nerve injury. Revision surgery was performed in two cases for treatment of delayed postoperative deep infection. Conclusion: According to minimum three-year follow-up results, RTSA may be an effective treatment option for glenohumeral (GH) arthritic and pseudoparalytic patients. However, considering the possibility of complications related to delayed deep infection or surgeon's technique, RTSA should be judiciously and carefully indicated by expert surgeons. [ABSTRACT FROM AUTHOR]

Purpose: Radiolucent lines (RLL) are frequent findings around cemented all-polyethylene glenoid implants. The present study evaluates the frequency, extend and the clinical impact of RLL around a cemented two-pegged glenoid implant with special focus on the influence of preoperative glenoid morphology. Our hypothesis was that glenoid morphology does not affect clinical outcome and RLL in the investigated setting. Methods: Between 2003 and 2008, a total of 113 cases of total shoulder arthroplasties (Affinis, Mathys Ltd Bettlach, Switzerland) were performed in three surgical centres using a pegged cemented polyethylene glenoid component. A total of 90 cases could be evaluated clinically and radiographically. Clinical outcome was analysed using the constant score (CS) and range of motion assessment. Radiographic evaluation was performed in true anterior-posterior and axial views with special focus on loosening and RLL. Further, preoperative glenoid morphology was documented and its correlation to radiolucent lines and clinical outcomes was evaluated. Results: At a mean of 58.8 (range 31.2-92.5)-month follow-up the CS improved from 21.5 points preoperatively to 62.3 points postoperatively. Radiolucent lines were found in 76.6 % of cases. If present, RLL were located at the backside of the implant (74.4 %) in the majority of the cases not around the pegs (10 %). There was no significant correlation between RLL and clinical outcome or follow-up time. The amount and extend of RLL were correlated to glenoid morphology with significantly higher values for glenoid types B2 and C according to Walch in comparison to glenoid types A1, A2 and B1. Conclusions: RLL did not affect clinical outcome and did not correlate with the follow-up time. Patients with glenoid morphology types B2 and C showed significantly worse radiographic results. Level of evidence: Level IV case series study. [ABSTRACT FROM AUTHOR]

Background Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. Methods In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudoparalysis (in 13 women), revision to reverse shoulder arthroplasty was performed between October 2006 and 2010, with retention of the humeral component using modular systems. Mean age at the time of operation was 70 (56-80) years. Pre- and postoperative evaluation followed a standardized protocol including Constant score, range of motion, and radiographic analysis. Mean follow-up time was 2.5 (2-5.5) years. Results Mean Constant score improved from 9 (2-16) to 41 (17-74) points. Mean lengthening of the arm was 2.6 (0.9-4.7) cm without any neurological complications. One patient required revision due to infection. Interpretation Modular systems allow retainment of a well-fixed humeral stem with good outcome. There is a risk of excessive humeral lengthening. [ABSTRACT FROM AUTHOR]

Purpose: The current models of reverse shoulder arthroplasty (RSA) expose the procedure to the risk of scapular notching, possibly leading to loosening of the glenoid. We compared the clinical and radiographic results obtained with a concentric or eccentric glenosphere to assess whether the eccentric design might give better clinical results and avoid or decrease the risk of scapular notching Methods: Of our patients, 31 underwent RSA using a concentric glenosphere (group A), while 29 had an eccentric glenosphere (group B). Postoperatively, patients were followed-up at one to 12 months and annually thereafter, with the mean being 33 months in group A and 27.5 in group B. In both groups the minimum follow up (F-U) was 24 months. Preoperatively and at each F-U starting from six months, patients were assessed using the Constant score. On radiographs, prosthesis scapular neck angle (PSNA), distance between scapular neck and glenosphere (DBSNG) and peg-glenoid rim distance (PGRD) were calculated. The severity of notching was classified in four grades. Results: In group A the mean Constant score increased by 30 points compared to the preoperative score and the active ROM increased considerably. At latest F-U, the mean PSNA, DBSNG and PGRD were, respectively, 87°, 3.4 mm and 19.8 mm. Glenoid notching was present in 42 % of cases. In group A, the mean Constant score increased by 34 points and the mean ROM was better than in group A. The average PSNA, PGRD and DBSNG were, respectively, 92°, 21.2 mm and 4.3 mm. Radiographs showed no inferior scapular notching. Conclusions: The eccentric glenosphere yielded better clinical results than the concentric glenosphere and was associated with no scapular notching. [ABSTRACT FROM AUTHOR]

Background: There is a growing tendency for complex proximal humerus fractures (PHF) in osteoporotic patients to be treated with reverse shoulder arthroplasty (RSA). It has been proposed that RSA has more benefits than other treatment options. The aim of our study was to investigate preoperative characteristics as well as clinical and radiological outcomes in patients with complex 3- or 4-part PHF who had undergone primary RSA. Methods: Patients with a minimum follow-up of 6 months who had undergone a primary RSA after 3- or 4-part PHF in the period between 2008 and 2011 were eligible for the study. Clinical records, X-rays and CT-scans were investigated and a clinical examination was performed. Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant-Murley score (CMS) were calculated. Sixteen patients were examined as part of the study. The mean follow-up was 20 months (range 6-42 months). According to Codman-Hertel classification we encountered 15 Hertel "12" and 1 Hertel "8" type fractures. Results: Thirty-two patients (27 female - 84.4%) with a mean age of 72 years underwent operations to treat complex 3- and 4-part fractures of the proximal humerus. Sixteen patients were reexamined. In 14 cases the dominant upper extremity was on the right, in 2 cases it was on the left, in 6 cases the right side was affected and in 10 cases the left side was affected. The mean CMS was 54.8 (range 18-95) and the mean DASH was 37.5 (range 2.9-81). A trend was established between the CMS and dominance of the affected shoulder. The CMS was better if the affected shoulder was on the non-dominant side (p-value 0.051). No statistical difference was noted between age and clinical outcome. Conclusions: Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA. RSA can provide immediate relief and good shoulder function in elderly patients. Nevertheless, the question of longevity of these implants remains to be observed. [ABSTRACT FROM AUTHOR]

Introduction: Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. However, the outcomes and postoperative complications are poorly described. Patients and methods: Between March 2005 and May 2010 114 S.T.A.R. prostheses were implanted by one surgeon at our institution. We retrospectively analysed the demographics, clinical outcomes and radiographic characteristics of 100 ankle prostheses (97 patients). Results: The average follow up was 36 months. The average preoperative AOFAS score of 36.87 (22-58) significantly increased to 75.99 postoperative. A total of 87 % of the patients reported a better life quality. Twenty-seven ankles incurred complications after primary surgery, and 21 prostheses required revision surgery, including four patients who required arthrodesis. Conclusion: Our study shows a high satisfaction rate after total ankle replacement and clear pain relief. Patients with a body mass Index higher than 30 showed a higher rate of complications. Compared with ankle fusion, the rates of complications are comparable. [ABSTRACT FROM AUTHOR]