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Background: Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively., Material: We performed a retrospective, single-center study including 62 TSA patients with a preoperative PHS of the glenohumeral joint (31 men, 31 women, 70 ± 9 years) between January 2000 and January 2014. Glenoids were classified as B2 (32 cases), B3 (13 cases), or C (17 cases). Glenoid retroversion was corrected by anterior asymmetric reaming. Patients were reviewed for clinical and CT scan assessment with a mean follow-up of 8.3 years (minimum 5 years). At final follow-up, the CT images were reconstructed in the scapular plane. A PHS index >65% defined persistence., Results: The revision-free rate was estimated at 93%. Correlation between PHS and retroversion was moderate preoperatively (ρ = 0.58) and strong at final follow-up (ρ = 0.73). Postoperative CT scans on average showed a surgical correction of PHS compared to preoperatively (79% vs. 65% respectively, P < .05) and retroversion (20° vs. 10° respectively, P < .05). At final follow-up, 25 of 62 patients had a persistence in the 2-dimensional (2D) model and 41 of 62 in the corrected 2D model. Persistence of PHS had no influence on clinical outcomes but did demonstrate a significantly higher glenoid loosening rate (20% vs. 59%, P < .05)., Conclusion: Correlation between PHS and retroversion was moderate preoperatively and strengthened at long-term follow-up. Anterior asymmetric reaming allowed for a surgical improvement of both PHS and retroversion, but it was not sufficient to maintain a correction over time. Glenoid loosening was more frequent in case of PHS persistence but seemingly without clinical relevance., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high., Methods: A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders., Results: There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction., Conclusions: One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Background: An assessment of the pathoanatomic parameters of the arthritic glenohumeral joint (GHJ) has the potential to identify discriminating metrics to differentiate glenoid types in shoulders with primary glenohumeral osteoarthritis (PGHOA). The aim was to identify the morphometric differences and threshold values between glenoid types including normal and arthritic glenoids with the various types in the Walch classification. We hypothesized that there would be clear morphometric discriminators between the various glenoid types and that specific numeric threshold values would allow identification of each glenoid type., Methods: The computed tomography scans of 707 shoulders were analyzed: 585 obtained from shoulders with PGHOA and 122 from shoulders without glenohumeral pathology. Glenoid morphology was classified according to the Walch classification. All computed tomography scans were imported in a dedicated automatic 3D-software program that referenced measurements to the scapular body plane. Glenoid and humeral modeling was performed using the best-fit sphere method, and the root-mean-square error was calculated. The direction and orientation of the glenoid and humerus described glenohumeral relationships., Results: Among shoulders with PGHOA, 90% of the glenoids and 85% of the humeral heads were directed posteriorly in reference to the scapular body plane. Several discriminatory pathoanatomic parameters were identified: GHJ narrowing < 3 mm was a discriminatory metric for type A glenoids. Posterior humeral subluxation > 70% discriminated type B1 from normal GHJs. The root-mean-square error was a discriminatory metric to distinguish type B2 from type A, type B3, and normal GHJs. Type B3 glenoids differed from type A2 by greater retroversion (>13°) and subluxation (>71%). The type C glenoid retroversion inferior limit was 21°, whereas normal glenoids never presented with retroversion > 16°., Conclusion: Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with PGHOA., (Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Recent studies have shown variations in glenoid bone density in asymmetric wear patterns but have yet to analyze non-arthritic or concentrically worn glenoids., Questions/purposes: The purpose of this study is to characterize and compare subchondral glenoid bone densities in both non-arthritic and A1, A2, B1, B2 and B3 osteoarthritic glenoids, as well as to assess uniformity in symmetric and asymmetric erosion wear patterns., Methods: In all, 150 computerized tomography (CT) scans containing equal numbers of non-arthritic (N), A1, A2, B1, B2 and B3 glenoids were segmented semi-automatically. Each reconstructed glenoid was divided first into anterior and posterior quadrants, and then further subdivided into four quadrants. Volumes of interest (VOI) were defined at depths of 0-2.5mm (Zone A), 2.5-5mm (Zone B) and 5-7.5mm (Zone C). Average bone densities were measured at each VOI depth and in each quadrant., Results: Osteoarthritic glenoids had higher mean bone densities than N glenoids. Mean bone densities were uniform amongst all quadrants for N glenoids, but not for osteoarthritic glenoids. In A1 glenoids, the antero-superior quadrant was less dense in Zone C. A2 glenoids had increased bone density measured posteriorly in Zones B and C. In B1 and B2 glenoids, Zones B and C demonstrated increased bone densities of posterior quadrants compared to anterior quadrants. B3 glenoids presented similar results as A1 and A2 glenoids. Cystic changes were more pronounced in anterior quadrants of A2, B1, B2 and B3 glenoids., Conclusion: This study demonstrates that osteoarthritic glenoids have greater bone density than non-arthritic glenoids, independent of depth of interest. It also confirms that N glenoids have uniform erosion wear patterns and that B1 and B2 glenoids have irregular wear patterns. It is the first study to reveal that A1, A2 and B3 glenoids, though geometrically symmetrical, have irregular bony densities similar to B2 glenoids. These findings have clinical implications for reaming the glenoid and implant fixation., Level of Evidence: Basic Science, Anatomy, Imaging., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: We evaluated survival and midterm results of pyrocarbon interposition shoulder arthroplasty (PISA) in arthritic patients younger than 65 years., Methods: Fifty-eight PISAs (InSpyre; Tornier-Wright, Bloomington, MN, USA), implanted in 56 patients between 2010 and 2015, were prospectively observed. The mean age at surgery was 52 ± 13 years. The cause was primary osteoarthritis (18), fracture sequelae (16), post-instability arthritis (15), aseptic necrosis (3), inflammatory disease (2), and failed hemiarthroplasty (4); 34 shoulders (61%) had previously undergone surgery. Glenoid erosion was assessed in 4 grades according to the Sperling classification. Humeral erosion was also assessed in 4 grades. Multivariate analysis was used to determine predisposing risk factors for both humeral and glenoid erosion., Results: At a mean follow-up of 47 ± 15 months, survival rate was 90%. Six patients (10%) required conversion to reverse total shoulder prosthesis for painful glenoid erosion (n = 2) and humeral erosion with greater tuberosity stress fractures (n = 4). The mean Constant score and subjective shoulder value significantly increased from 36 ± 14 points to 70 ± 15 points and 32% ± 14% to 75% ± 19%, respectively (P < .001). Humeral medialization was observed in 78% of the cases with increased pain score. Uncorrected anteroposterior implant subluxation (12 cases) was associated with lower Constant score (50 points vs. 72 points; P = .02) and lower subjective shoulder value (53% vs. 78%; P = .002). On multivariate analysis, no risk factors for glenoid or humeral erosion were found., Conclusion: At midterm follow-up, PISA does not protect from progressive glenoid erosion and can lead to greater tuberosity erosion and stress fractures. Longer follow-up is required to see whether PISA survival will be superior to that of hemiarthroplasty., (Copyright © 2019. Published by Elsevier Inc.)

Background: Results of anatomic shoulder arthroplasty for glenohumeral osteoarthritis with severe glenoid retroversion are unpredictable with a high rate of glenoid loosening. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, with good early results. We sought to confirm this at longer follow-up (minimum 5 years). The study hypothesis was that early results would endure over time., Methods: We retrospectively reviewed all RSAs performed in 7 centers from 1998 to 2010. The inclusion criteria were primary glenohumeral osteoarthritis with B1, B2, B3, or C glenoid. Forty-nine shoulders in 45 patients fulfilled the criteria. Bone grafting was performed in 16 cases. Clinical outcomes were evaluated with the Constant score (CS) and shoulder range of motion., Results: The mean total CS increased from 30 preoperatively to 68 points (P < .001) with significant improvements in all the subsections of the CS and range of motion. Scapular notching was observed in 20 shoulders (43%), grade 1 in 5 (11%), grade 2 in 7 (15%), grade 3 in 5 (11%), and grade 4 in 3 (6%). The glenoid bone graft healed in all the shoulders. Partial inferior lysis of the bone graft was present in 8 cases (50%). Scapular notching and glenoid bone graft resorption had no influence on the CS (P = .147 and P = .798)., Conclusion: RSA for the treatment of primary glenohumeral osteoarthritis in patients with posterior glenoid deficiency and humeral subluxation without rotator cuff insufficiency resulted in excellent clinical outcomes at a minimum of 5 years of follow-up., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: Osteoarthritis may be observed after surgery for instability and in the natural history of pathology. The primary objective was to analyze the late clinical and radiographic results of reverse shoulder arthroplasties (RSA) for patients who had instability arthropathy., Methods: This is a retrospective cohort of 25 patients with a mean follow-up of 6.6 years. Patients had a history of instability surgery (80%) or multiple closed reductions. All were clinically evaluated with the constant score (CS), and radiologically (true AP view and Y view)., Results: No significant differences in pre- and post-operative function, radiologic status, and complication rate between the patients treated with a prior bone block procedure for the anterior instability and those treated by a capsular plication or non-operatively. A 36-mm sphere was implanted in 67%. Bone grafting of the glenoid was needed in 71%. No intra-operative complication has been reported. Clinically, the active anterior elevation increased from 70° to 140° (p < 0.01) and external rotation from 9° to 21° (p = 0.02). The adjusted CS increased from 38 to 98 (p < 0.01). Two early post-operative complications were collected: one spine fracture and one superficial infection. No early or late dislocation or neurologic complication was observed. At the latest follow-up, there were 38.10% of glenoid spurs, and 55% of scapular notch., Conclusions: The overall complication rate in this specific group is relatively low. Patients' satisfaction rate is high and clearly higher than those reported with anatomic TSA for this indication. Clinical results are comparable to other studies describing results of RSA.

Background: Preoperative computed tomography (CT) measurements of glenoid version and inclination are recommended for planning glenoid implantation in shoulder arthroplasty. However, current manual or semi-automated 2-dimensional (2D) and 3-dimensional (3D) methods are user-dependent and time-consuming. We assessed whether the use of a 3D automated method is accurate and reliable to measure glenoid version and inclination in osteoarthritic shoulders., Methods: CT scans of osteoarthritic shoulders of 60 patients scheduled for shoulder arthroplasty were obtained. Automated, surgeon-operated, image analysis software (Glenosys; Imascap) was developed to measure glenoid version and inclination. The anatomic scapular reference planes were defined as the mean of the peripheral points of the scapular body as well as the plane perpendicular to it, passing along the supraspinatus fossa line. Measurements were compared with those obtained using previously described manual or semi-automated methods, including the Friedman version angle on 2D CTs, Friedman method on 3D multiplanar reconstructions (corrected Friedman method), Ganapathi-Iannotti and Lewis-Armstrong methods on 3D volumetric reconstructions (for glenoid version), and Maurer method (for glenoid inclination).The mean differences (and standard deviation) and the concordance correlation coefficients (CCCs) were calculated. Two orthopaedic surgeons independently examined the images for the interobserver analysis, with one of them measuring them twice more for the intraobserver analysis; interobserver and intraobserver reliability was calculated using the intraclass correlation coefficients (ICCs)., Results: The mean difference in the Glenosys glenoid version measurement was 2.0° ± 4.5° (CCC = 0.93) compared with the Friedman method, 2.5° ± 3.2° (CCC = 0.95) compared with the corrected Friedman method, 1.5° ± 4.5° (CCC = 0.94) compared with the Ganapathi-Iannotti method, and 1.8° ± 3.8° (CCC = 0.95) compared with the Lewis-Armstrong method. There was a mean difference of 0.2° ± 4.7° (CCC = 0.78) between the inclination measurements made with the Glenosys and Maurer methods. The difference between the overall average 2D and 3D measurements was not significant (p = 0.45)., Conclusions: Use of fully automated software for 3D measurement of glenoid version and inclination in arthritic shoulders is reliable and accurate, showing excellent correlation with previously described manual or semi-automated methods., Clinical Relevance: The use of automated surgeon-operated image analysis software to evaluate 3D glenoid anatomy eliminates interobserver and intraobserver discrepancies, improves the accuracy of preoperative planning for shoulder replacement, and offers a potential gain of time for the surgeon.

Background: Posterior humeral subluxation is the main cause of failure of total shoulder arthroplasty. We aimed to compare humeral head subluxation in various reference planes and to search for a correlation with retroversion, inclination, and glenoid wear., Materials and Methods: We included 109 computed tomography scans of primary glenohumeral osteoarthritis and 97 of shoulder problems unrelated to shoulder osteoarthritis (controls); all computed tomography scans were reconstructed in the anatomic scapular plane and the glenoid hull plane that we defined. In both planes, we measured retroversion, inclination, glenohumeral offset (Walch index), and scapulohumeral offset., Results: Retroversion in the scapular plane (Friedman method) was lower than that in the glenoid hull plane for controls and for arthritic shoulders. The threshold of scapulohumeral subluxation was 60% and 65% in the scapular plane and glenoid hull plane, respectively. The mean upward inclination was lower in the scapular plane (Churchill method) than in the glenoid hull plane (Maurer method). In the glenoid hull plane, 35% of type A2 glenoids showed glenohumeral offset greater than 75%, with mean retroversion of 25.6° ± 6° as compared with 7.5° ± 7.2° for the "centered" type A2 glenoids (P < .0001) and an upward inclination of -1.4° ± 8° and 6.3° ± 7° (P = .03), respectively. The correlation between retroversion and scapulohumeral offset was r = 0.64 in the glenoid hull plane and r = 0.59 in the scapular plane (P < .05)., Conclusion: Measurement in the glenoid hull plane may be more accurate than in the scapular plane. Thus, the glenoid hull method allows for better understanding type B3 of the modified Walch classification., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: Traditionally and since Neer, the humeral side of shoulder arthroplasty consisted of a stemmed component but the real need for stem fixation in total shoulder arthroplasty (TSA) has barely been investigated. The current study evaluated the clinical and radiological outcomes with a stemless TSA., Methods: Forty-seven patients, 20 female and 27 male patients with an average age of 63, were selected in four orthopaedic centres during a four year period, and implanted with a humeral head prosthesis with a three-fin design and titanium coating. Aetiologies were: primary osteoarthritis (29), fracture sequelae (12) and avascular osteonecrosis (6). Minimum follow-up was two years (range 24-51 months). The patients were evaluated with the Constant score (CS) and radiological exams., Results: Two patients had revision of the implants, one for persistent pain and one for secondary massive rotator cuff tear. At the final follow-up, the mean CS was 69, with an average gain of 36. All parameters improved with a foremost in pain relief. Mean satisfaction rate was 87%. Average anterior active elevation was 131° with a gain of 48. Radiologic evaluations showed stable implants in all cases. However, 17 cases demonstrated radiolucent areas, particularly superior and lateral to the implant, which neither decreased nor increased with time. No revisions were related to humeral component loosening., Conclusions: Stemless TSA provides the same results as compared to TSA with a humeral stem. We are still unsure as to the nature of the lucent zones and we are continuing our investigation to better understand this radiological phenomenon.

Background: The aims of this study were to determine the survival of anatomic total shoulder arthroplasty with uncemented metal-backed (MB) glenoid components with a polyethylene (PE) insert in primary osteoarthritis, to assess the reasons for revision surgery, and to identify patients and diagnostic factors that influence failure rates., Methods: Between 1994 and 1999, 165 patients (mean age, 68 years) with primary osteoarthritis were treated with anatomic total shoulder arthroplasty using an uncemented MB/PE glenoid component. Outcomes were assessed both clinically and radiologically with a minimum of 2 years of follow-up. A prosthetic survival curve was constructed with the end point defined as either partial or complete revision, using 100% confidence intervals., Results: Survival rate free of revision was 46% (100% confidence interval, 32%-54%) at 12 years. At a mean follow-up of 8.5 years (range, 2-16 years), revision was required in 61 patients (37%); 80% of shoulders undergoing revision (49 of 61) had evidence of PE wear. Glenoid loosening (because of osteolysis secondary to wear debris), soft tissue deficiency, and prosthetic instability were the most common modes of failure. Younger patients and biconcave glenoids (with posterior humeral subluxation) have a negative effect on implant survival. Proximal humerus osteolysis was significantly more frequent in shoulders with PE wear. Exchange of the PE insert (with conservation of the MB tray) was possible in only 3% of the revised shoulders., Conclusion: Uncemented MB glenoid resurfacing is not a viable long-term therapeutic option because of accelerated PE wear leading to early revision surgery. Conservation of the MB tray with reinsertion of a new PE insert is rarely possible because of glenoid bone loss, implant loosening, soft tissue deficiency, and prosthetic instability. Younger patients and biconcave glenoids have a negative effect on implant survival., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Anatomic total shoulder arthroplasty (TSA) gives good outcome in the treatment of primary osteoarthritis, but it is not known whether this also applies to patients over 80 years old., Patients and Methods: We retrospectively assessed outcome in patients over the age of 80 after anatomic TSA, performed for primary osteoarthritis with a preoperative intact rotator cuff (group O, n = 32). We compared it with outcome in a group of patients under the age of 70 (group Y, n = 32). Subjective outcome, Constant score, and radiological findings were analyzed., Results: At a mean follow-up time of 7 years, there were no statistically significant differences between the groups. In group O, 24 patients were very satisfied and in group Y, 23 patients were very satisfied; the subjective shoulder value was 81% in both groups. Mean Constant score was 65 in group O and 67 in group Y. Moderate or severe radiological upper migration of the humeral head was detected in 1 patient in group O and in 3 patients in group Y. One patient in group Y was revised for glenoid loosening., Interpretation: Good to excellent results can be expected after anatomic TSA in patients over the age of 80. Our findings suggest that they have similar results to those in patients around 70 years of age.

Background: Our purposes were to analyze radiographic changes around humeral components and to determine the influence of these changes on the clinical outcome of shoulder arthroplasty., Methods: Three hundred and ninety-five shoulders with primary osteoarthritis were treated with a shoulder replacement and were analyzed clinically and radiographically with a standardized protocol. Radiographs were evaluated for osteolysis and stress-shielding of the proximal part of the humerus and loosening of the humeral and glenoid components. The arthroplasty configurations included (1) hemiarthroplasty with cement (thirty shoulders), (2) hemiarthroplasty without cement (thirty-six), (3) total shoulder replacement with a cemented stem and a cemented flat-backed glenoid component (eighty-nine), (4) total shoulder replacement with a cemented stem and a cemented convex-backed glenoid component (ninety-four), (5) total shoulder replacement with a cemented stem and an uncemented metal-backed glenoid component (seventy-nine), and (6) total shoulder replacement with an uncemented stem and a cemented convex-backed glenoid component (sixty-seven). The mean duration of follow-up was 8.2 years (range, four to eighteen years)., Results: The Constant score and shoulder motion were significantly greater at the latest follow-up examination than preoperatively (p < 0.001). One cemented stem loosened after a periprosthetic fracture, and another was judged to be at risk for loosening. Stress-shielding was noted only around uncemented stems in 63% of the shoulders with such stems. Osteolysis of the proximal part of the humerus occurred only with total shoulder arthroplasty in 43% of the shoulders. Patients with osteolysis had a poorer clinical outcome (p < 0.001). Shoulders with osteolysis around the proximal part of the humerus had more glenoid loosening and polyethylene wear (p < 0.001)., Conclusions: Glenoid issues have a substantial effect on humeral bone in shoulder arthroplasty. Polyethylene wear appears to be associated with the development of osteolysis of the proximal part of the humerus after total shoulder arthroplasty. With our implants, stress-shielding was only observed with uncemented humeral stems. The uncemented and cemented stem designs analyzed in this study appeared comparable and can be recommended for clinical use.

Background: The aim of this study was to radiographically analyze the long-term glenoid migration patterns following total shoulder arthroplasty to better understand the factors responsible for loosening., Methods: Complete radiographic follow-up of more than five years was available for 518 total shoulder arthroplasties performed for primary glenohumeral osteoarthritis with use of an anatomically designed prosthesis with a cemented, all-polyethylene, keeled glenoid component. Radiographs were assessed for humeral head subluxation, periprosthetic radiolucent lines, and shifting of the position of the glenoid component. The type of migration of the glenoid was defined according to the direction of tilt, or as subsidence in the case of medial migration., Results: Definite radiographic evidence of glenoid loosening was observed in 166 shoulders (32%) and was characterized by radiolucency of ≥2 mm over the entire bone-cement interface in thirty shoulders and by a migration of the glenoid component (shift or subsidence) in 136 shoulders. Three predominant patterns of migration of the glenoid component were observed: superior tilting in fifty-two shoulders (10%), subsidence in forty-one shoulders (7.9%), and posterior tilting in thirty-three shoulders (6.4%). Superior tilting of the glenoid was associated with three risk factors: low positioning of the glenoid component, superior tilt of the glenoid component on the immediate postoperative coronal plane radiographs, and superior subluxation of the humeral head (p < 0.05 for all). Subsidence of the glenoid component was associated with the use of reaming to optimize the seating and positioning of the glenoid component (p < 0.001). Posterior tilting of the glenoid component was associated with preoperative posterior subluxation (i.e., a Walch type-B glenoid) and with excessive reaming (p < 0.01 for both)., Conclusions: The three patterns of migration observed in this study underscore the potential importance of the supporting bone beneath the glenoid component. In some shoulders, use of a keel or pegs to provide fixation of a polyethylene component in the absence of good support from subchondral bone may not be sufficient to resist compressive and eccentric forces, resulting in loosening. Preserving subchondral bone may be important for long-term longevity of the glenoid component.

Purpose: We assessed the clinical and radiologic results of a cemented all-polyethylene convex-back keeled glenoid component used with a third-generation prosthesis., Methods: Between 1996 and 2003, in 4 European centers, 333 shoulder arthroplasties were performed for primary osteoarthritis by use of a cemented all-polyethylene convex-back keeled glenoid component. Kaplan-Meier survivorship analysis was performed, and clinical outcome was assessed with the Constant score, range of motion, and subjective evaluation., Results: At a mean of 89.5 months' follow-up, the Constant score improved from 31.4 to 67.6 points (P < .0001). Active forward elevation improved from 94.9° to 146.6° (P < .0001) and external rotation from 9.0° to 35.3° (P < .0001). Of the patients, 93.5% were either satisfied or very satisfied. The rate of revision for glenoid loosening was 0.6%; however, the rate of radiologic glenoid loosening was 18.9%. Glenoid survival was 99.7% at 5 years and 98.3% at 10 years with endpoint defined as revision surgery for glenoid loosening and 99.7% at 5 years and 51.5% at 10 years with endpoint defined as radiologic loosening., Conclusions: We showed highly satisfactory clinical outcomes and extremely low rates of revision for glenoid loosening using a cemented convex-back keeled glenoid. There was a concerning rate of radiologic loosening, which only became apparent after 5 years, and this was associated with excessive glenoid reaming. Because radiologic changes are progressive and precede the need for revision, innovations in this field need to report radiologic and clinical results with follow-up of at least 5 to 10 years to prove any superiority., (Copyright © 2011. Published by Mosby, Inc.)

The purpose of this study was to compare the radiographic results of 2 different glenoid component designs. This series consisted of 66 shoulder arthroplasties with primary osteoarthritis divided into 2 groups based on glenoid component type. One group comprised shoulders receiving cemented flat-back polyethylene glenoid implants. The other group comprised shoulders receiving cemented convex-back polyethylene glenoid implants. Immediate postoperative and 2-year postoperative radiographs were evaluated for the presence and progression of periglenoid radiolucencies, and the 2 groups were compared. Radiolucent line scores were calculated and compared for each group. The keeled, convex-back glenoid component was radiographically better than the keeled, flat-back glenoid component.

We compared the prevalence of periglenoid radiolucencies between two glenoid component preparation techniques used in total shoulder arthroplasties. Seventy-two consecutive patients with primary osteoarthritis had total shoulder arthroplasties using one prosthetic system with flat-back keeled polyethylene glenoid components. Thirty-seven shoulders had glenoid implants that were cemented after standard curettage preparation of the keel slot. Thirty-five shoulders had glenoid implants that were cemented after using bone compaction to prepare the keel slot. The immediate postoperative and 2-year postoperative radiographs were examined to evaluate the presence and progression of periglenoid radiolucencies. The curettage group had a higher rate (38%) of keel radiolucencies than the compaction group (11%) seen on the immediate postoperative radiographs. Both groups had progression of periglenoid radiolucencies with time. Progression of the radiolucent lines was worse in the curettage group 2 years after arthroplasty. Preparation of the glenoid component keel slot with the bone compaction technique seems to achieve better fixation of flat-back keeled polyethylene glenoid components in total shoulder arthroplasties.

This study evaluated the effects of concomitant biceps tenodesis in patients undergoing shoulder arthroplasty for primary osteoarthritis. Six hundred eighty-eight shoulders that had undergone replacement for primary glenohumeral arthritis were reviewed at a mean 43 months postoperatively. One hundred twenty-one patients had undergone a biceps tenodesis at arthroplasty, while the remaining patients did not. Tenodesis was significantly better than no tenodesis in most outcome parameters. No difference was found between the groups in complication rate. Biceps tenodesis is a useful adjunct to shoulder arthroplasty in the treatment of primary osteoarthritis.

Fifteen shoulders with primary osteoarthritis and dysplastic glenoid morphology underwent shoulder arthroplasty (eleven total shoulder arthroplasties and four hemiarthroplasties). Patients were evaluated at a mean of 37 months after replacement with clinical examination, Constant score, subjective patient opinion, and radiographic examination. One glenoid component was loose, necessitating removal; the remainder of the prostheses were in place at latest follow-up. Significant improvement was observed in Constant score (32 points preoperatively vs 71 points postoperatively) and active mobility (anterior elevation, 89 degrees preoperatively vs 146 degrees postoperatively; external rotation, 7 degrees preoperatively vs 45 degrees postoperatively) after arthroplasty. This study demonstrates that the rare scenario of osteoarthritis coupled with a dysplastic glenoid can be treated successfully with shoulder arthroplasty.

Six hundred one total shoulder arthroplasties and eighty-nine hemiarthroplasties were performed for primary osteoarthritis of the shoulder. Patients were evaluated with a physical examination, Constant score, and radiographic evaluation. The minimum follow-up was 2 years. At follow-up, the Constant score averaged 64 points, the adjusted Constant score averaged 86%, active anterior elevation averaged 130 degrees, and active external rotation averaged 36 degrees for the hemiarthroplasties. The Constant score averaged 70 points, the adjusted Constant score averaged 96%, active anterior elevation averaged 145 degrees, and active external rotation averaged 42 degrees for the total shoulder arthroplasties. Eighty-six percent of hemiarthroplasties and ninety-four percent of total shoulder arthroplasties had good or excellent results. Differences were statistically significant for all parameters. Total shoulder arthroplasty provided better scores for pain, mobility, and activity than hemiarthroplasty. Fifty-six percent of total shoulder arthroplasties had a radiolucent line around the glenoid component. Total shoulder arthroplasty provides results superior to those of hemiarthroplasty in primary osteoarthritis.

Background: Rotator cuff disease is uncommon in primary glenohumeral osteoarthritis. Consequently, the prognostic implications of rotator cuff disease in patients undergoing prosthetic replacement for the treatment of primary glenohumeral osteoarthritis are uncertain. The purpose of this study was to report the effects of the condition of the supraspinatus tendon and the rotator cuff musculature on the results of shoulder arthroplasty in the treatment of primary osteoarthritis., Methods: Five hundred and fifty-five shoulders in 514 patients who had an arthroplasty for the treatment of primary glenohumeral osteoarthritis as part of a multicenter study were evaluated. Forty-one shoulders had a partial-thickness tear of the supraspinatus, and forty-two had a full-thickness tear. Ninety shoulders had moderate (stage-2) fatty degeneration of the infraspinatus, and nineteen had severe (stage-3 or 4) degeneration. Eighty-four shoulders had moderate fatty degeneration of the subscapularis, and fifteen had severe degeneration. The influence of the condition of the supraspinatus tendon and the infraspinatus and subscapularis musculature on the postoperative outcome was evaluated with respect to the scores according to the system of Constant and Murley, active mobility, subjective satisfaction, radiographic result, and rate of complications., Results: The shoulders were evaluated at a mean of 43.1 months postoperatively. With the numbers available, supraspinatus tears were not found to influence the postoperative outcome with respect to the total Constant score, active mobility, subjective satisfaction, radiographic result, or rate of complications. Additionally, the treatment of these tears did not markedly influence the outcome parameters. Conversely, both shoulders with moderate fatty degeneration and those with severe degeneration of the infraspinatus were associated with poorer results than those with no degeneration with respect to the total Constant score (p < 0.0005), active external rotation (p < 0.0005), active forward flexion (p = 0.001), and subjective satisfaction (p = 0.031). Similar although less dramatic results were seen with fatty degeneration of the subscapularis., Conclusions: This study demonstrates that minimally retracted or nonretracted rotator cuff tears that are limited to the supraspinatus tendon do not appreciably affect most shoulder-specific outcome parameters in shoulder arthroplasty performed for the treatment of primary osteoarthritis. Conversely, fatty degeneration of the infraspinatus and, less importantly, subscapularis musculature adversely affects many of these parameters.

Two hundred sixty-eight anatomically designed shoulder arthroplasties for primary osteoarthritis were reviewed at a mean follow-up of 30 months. The Constant score adjusted for age and sex was 38% preoperatively and 97% at follow-up. Good or excellent results were observed in 77% of patients, and 94% were satisfied or very satisfied. Mean active forward elevation was 145 degree postoperatively, and all clinical parameters improved. Glenoid radiolucent lines were present in 58% of cases and were associated with a less satisfactory objective result. Postoperative active forward elevation, strength, and Constant score were inversely related to a tear of the supraspinatus or fatty degeneration of the infraspinatus. Patients who underwent biceps tenodesis had better pain relief. Complications occurred in 8.6% of cases, and 4.9% of shoulders required reoperation. Good early results can be obtained with nonconstrained shoulder arthroplasty in primary osteoarthritis.

Background The concept of free interposition arthroplasty proved successful for small joints of the hand, wrist, and foot, particularly after the use of implants coated with pyrocarbon, which enhanced their tribologic and elastic properties. The present study reports preliminary outcomes of a pyrocarbon-coated interposition shoulder arthroplasty (PISA) implant. Methods This was a prospective study of 67 consecutive patients who underwent shoulder PISA at 9 centers. The mean age at surgery was 51 years, with only 12 patients older than 60 years. The indications for surgery were primary glenohumeral arthritis in 42, avascular necrosis in 13, and secondary arthritis in 12 patients. Results Revision surgery was performed in 7 patients (10.4%), 2 (3.0%) were lost to follow-up, and the outcome assessments were incomplete in 3 (4.4%). This left 55 patients, aged 49.3 ± 12.0 years, with complete outcomes assessments at a mean follow-up of 26.8 ± 3.4 months. The Constant score improved from 34.1 ± 15.1 preoperatively to 66.1 ± 19.7 postoperatively. The radiographic findings revealed erosion in 6 glenoids and thinning of 3 humeral tuberosities. Conclusion In a cohort of young arthritic patients, PISA renders clinical scores and implant survival comparable to those of hemishoulder arthroplasty but remain inferior to those results reported for total shoulder arthroplasty. The study enabled identification of contraindications and potential causes of failure that wererelated to the concept of free interposition and smaller radius of curvature of the sphere. Until long-term results are available, this type of innovative implant should remain to be tested in a few specialized shoulder centers. [ABSTRACT FROM AUTHOR]

Background: Neer modified the Bankart procedure by combining a superoinferior capsular shift with the labral reattachment. The theoretical advantages of the modification were that such a procedure would restore the patient's anatomy and also treat the repeated capsular stretching encountered in anteroinferior instability without limiting external rotation and, thereby reducing the risk of arthritis. Questions/purposes: We therefore determined: (1) the rate of recurrent instability after this modification, (2) patient function, and (3) the incidence and stage of glenohumeral osteoarthritis at greater than 2 years followup in patients with traumatic anteroinferior instability. Methods: We retrospectively reviewed all 64 patients (average age, 27 years) who had the modified Bankart procedure for recurrent dislocations (n = 39) or subluxation (n = 25) from 1991 to 1997. The labrum was reattached with suture anchors and a superoinferior capsular shift was added. We determined the rate of recurrent instability, Rowe and Walch-Duplay scores and shoulder ROM, and the presence of glenohumeral osteoarthritis (modified Samilson and Prieto classification). The minimum followup was 24 months (median, 40 months; range, 24-120 months). Results: Recurrent instability occurred in seven of the 64 patients (11%) at an average of 25 months postoperatively (range, 7 days to 6 years); in six patients the recurrence was associated with trauma; five of the six patients underwent reoperation with a Latarjet procedure. Eight additional patients (13%) presented with persistent shoulder apprehension or discomfort. The average Rowe score was 83% (range, 20-100%) and average Walch-Duplay score 83% (range, 15-100%). However, only 36 of 64 (56%) patients could return to the same sport at the same level. The loss of external rotation was 13° compared with the contralateral side. Glenohumeral osteoarthritis incidence increased from 4% preoperatively to 17% postoperatively. Conclusions: The open Bankart procedure modified by Neer provided high function scores but a relatively low rate of return to sport and high rate of recurrent instability. Our rate of recurrent instability, similar to that obtained with arthroscopic Bankart procedures, has prompted us to abandon the open procedure. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Abstract: The development of modern shoulder replacement surgery started over half a century ago with the pioneering work done by CS Neer. Several designs for shoulder prostheses are now available, allowing surgeons to select the best design for each situation. When the rotator cuff is intact, unconstrained prostheses produce reliable and reproducible results, with prosthesis survival rates of 97% after 10 years and 84% after 20 years. In patients with three- or four-part fractures of the proximal humerus, the outcome of shoulder arthroplasty depends largely on healing of the greater tuberosity, which is therefore a major treatment objective. Factors crucial to greater tuberosity union include selection of the optimal prosthesis design, flawless fixation of the tuberosities, and appropriate postoperative immobilization. The reverse shoulder prosthesis developed by Grammont has been recognized since 1991 as a valid option for patients with glenohumeral osteoarthritis. Ten-year prosthesis survival rates are 91% overall (including trauma and revisions) and 94% for glenohumeral osteoarthritis with head migration. These good results are generating interest in the reverse shoulder prosthesis as a treatment option in situations where unconstrained prostheses are unsatisfactory (primary glenohumeral osteoarthritis with marked glenoid cavity erosion; comminuted fractures in patients older than 75 years; post-traumatic osteoarthritis with severe tuberosity malunion or nonunion; massive irreparable rotator cuff tears with pseudoparalysis; failed rotator cuff repair; and proximal humerus tumor requiring resection of the rotator cuff insertions). [ABSTRACT FROM AUTHOR]

Résumé: L’ère moderne de la chirurgie prothétique de l’épaule s’est ouverte, il y a plus de 50 ans, avec Neer. Des prothèses au concept différent sont disponibles et peuvent être utilisées en fonction des indications. Dans les cas de coiffe saine, les résultats des prothèses « anatomiques » sont maintenant parfaitement reproductibles et fiables. Les dernières courbes de survie rapportées font état dans ces étiologies d’un taux de survie des prothèses de 97 % à dix ans et 84 % à 20 ans. Dans le traitement des fractures céphalotubérositaires en trois ou quatre parties, le résultat des prothèses est lié à la consolidation du trochiter et tous les efforts doivent être tournés vers son obtention : dessin adapté de la prothèse, ostéosynthèse parfaite des tubérosités, immobilisation postopératoire. La prothèse inversée de Grammont a été validée depuis 1991 dans les omarthroses. Les courbes de survie montrent 91 % de survie à dix ans, toutes étiologies confondues (post-traumatiques et reprises incluses) et 94 % à dix ans pour les seules omarthroses excentrées. Du fait de ces résultats, les indications sont en train de s’étendre aux arthroses centrées avec usure importante de glène, aux fractures des gens âgés (>75 ans) où il est difficile d’obtenir la consolidation des tubérosités, aux arthroses post-traumatiques avec cals vicieux sévères, pseudarthroses ou lyses des tubérosités, aux ruptures massives de la coiffe des rotateurs non réparables et pseudoparalytiques, aux échecs de réparation de la coiffe des rotateurs et aux tumeurs dont l’exérèse nécessite le sacrifice des insertions de la coiffe des rotateurs. [Copyright &y& Elsevier]

Résumé: Objectif: Déterminer la valeur diagnostique des tests cliniques de l’épaule utilisés au cours des tendinopathies dégénératives de la coiffe des rotateurs à travers une revue systématique de la littérature. Méthodes: Les bases de données Medline, Embase et Pascal Biomed ont été interrogées jusqu’au premier semestre 2006 à la recherche de publications ayant évalué au minimum sensibilité et spécificité, et puis si possible, valeurs prédictives et exactitude de ces tests. Les résultats ont été ensuite discutés et validés. Résultats: Neuf études ont été retenues, trois traitant des manœuvres de conflit sous-acromial et sept des tests de détection des tendinopathies de la coiffe des rotateurs. Les manœuvres de Neer et de Hawkins apparaissent comme sensibles mais peu spécifiques d’un conflit sous-acromial. Les ruptures du supra- et de l’infra-épineux sont détectées avec un profil de performance proche par les manœuvres de Jobe et le full can test d’une part, par la manœuvre de Patte et la rotation externe contrariée en position 1 d’autre part. Les tendinopathies, avec ou sans rupture, sont détectées de façon plus spécifique que sensible par la rotation externe active non contrariée pour l’infra-épineux et par le lift off test pour le subscapulaire. La mise en évidence d’un déficit de rotation interne active non contrariée est quant à elle sensible et spécifique de tendinopathie du subscapulaire quelle qu’elle soit dans une étude. Le palm up test apparaît peu performant pour l’étude du tendon du long biceps. Conclusions: Les données concernant la valeur diagnostique des tests cliniques au cours des tendinopathies de la coiffe des rotateurs restent parcellaires. Elles soulignent objectivement toutefois l’intérêt de certains d’entre eux. La poursuite de l’évaluation des tests cliniques au cours des tendinopathies de la coiffe des rotateurs apparaît nécessaire. [Copyright &y& Elsevier]