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Aims: The aim of this study is to evaluate the change in incidence rate of shoulder arthroplasty, indications, and surgeon volume trends associated with these procedures between January 2003 and April 2021 in the province of Nova Scotia, Canada. Methods: A total of 1,545 patients between 2005 and 2021 were analyzed. Patients operated on between 2003 and 2004 were excluded due to a lack of electronic records. Overall, 84.1% of the surgeries (n = 1,299) were performed by two fellowship-trained upper limb surgeons, with the remainder performed by one of the 14 orthopaedic surgeons working in the province. Results: Total shoulder arthroplasty (TSA) was the most frequent procedure (32.17%; n = 497), followed by stemmed hemiarthroplasty (SHA) (27.7%; n = 428). The most frequent indication for primary shoulder arthroplasty was degenerative osteoarthritis (58.1%; n = 882), followed by acute proximal humerus fracture in 15.11% (n = 245), and rotator cuff arthropathy in 14.18% (n = 220). The overall rate of revision was 7.7% (2.8% to 11.2%). The number of TSAs and reverse shoulder arthroplasties (RSAs) has been increasing since 2016. The amount of revision cases is proportional to the number of operations performed in the same year throughout the study period. Conclusion: The incidence of shoulder arthroplasty in the Maritime Provinces has increased over the last 16 years. Revision rates are similar the those found in other large database registries. Reverse shoulder arthroplasty prevalence has increased since 2016. Cite this article: Bone Jt Open 2023;4(8):567–572.

Background: Reverse shoulder arthroplasty is gaining popularity owing to its proven longevity and good outcome scores. Scapular notching remains a concern. This study aimed to assess the safety of larger polyethylene glenospheres with increased eccentricity in comparison with the more conventional metal bearings. The secondary effects on scapular notching, clinical outcomes, range of movement, and complications were also analyzed. Methods: We conducted a 10-year retrospective review of 145 SMR reverse shoulder arthroplasties (LimaCorporate, Udine, Italy) in 132 patients with radiographs at a minimum of 2 years postoperatively. The primary outcome measure was the survivorship of the larger polyethylene glenospheres. Secondary outcomes were the presence and size of notching, subjective satisfaction score, American Shoulder and Elbow Surgeons score, Oxford Shoulder Score, range of motion, and shoulder-related complications. Results: No failures of the polyethylene glenospheres were noted in the 10-year period. At a minimum of 2 years’ follow-up, notching was noted in 16 (25%) of the metal glenospheres vs. 9 (11.1%) of the polyethylene glenospheres (P = .028). The mean Oxford Shoulder Score was lower for the metal glenospheres (P = .005). Range of motion, complications, and overall satisfaction were similar in both groups. Conclusion: The inverted bearing configuration demonstrated no failures at a minimum of 2 years’ follow-up. A larger study is required to determine whether the decreased incidence and size of early notching are related to the bearing size or material.

Optimal postoperative distalization (DSA) and lateralization (LSA) shoulder angles have been described as radiological measurements correlated with function after reverse shoulder arthroplasty (RSA). The proposed optimal values are DSA between 40° and 65° and LSA between 75° and 95°; however, whether these values can be reached with different implant designs is unclear. To determine which RSA implant could achieve higher rates of optimal DSA and LSA, to determine any association between each implant and optimal DSA and LSA, and to assess the correlation of the preoperative critical shoulder angle (CSA) and acromial index (AI) with the DSA and LSA. This was a retrospective comparative study of all patients who underwent primary RSA for rotator cuff arthropathy. Three RSA implant designs were included, based on which patients were divided into three groups: group 1 (FH Arrow™; 16 patients) comprised onlay implants with a 135° neck-shaft angle (NSA); group 2 (Biomet Comprehensive™; 20 patients) comprised onlay implants with a 147° NSA; group 3 (Mathys Affinis™; 15 patients) comprised inlay implants with a 155° NSA. The AI and CSA were measured on preoperative radiographs. The DSA and LSA were measured on true AP postoperative radiographs. The mean DSAs were 44°, 46°, and 46° (P = 0.671) and the mean LSAs were 92°, 91°, and 82° for groups 1, 2, and 3, respectively (P = 0.003). Group 3 had lower LSA than groups 1 (−10°; P = 0.005) and 2 (–9°; P = 0.002). Optimal DSA and LSA were achieved in 71% and 73% of all arthroplasties, respectively. No association between implant designs and achieving an optimal DSA or LSA was observed. None of the implant designs had DSA >65°. The most common cause of failure to reach an optimal LSA in onlay implants was a combination of LSA >95° and DSA <40°. The most common cause of failure in group 3 was DSA <40°. The DSA was negatively correlated with the AI (−0.384; P = 0.006) and CSA (−0.305; P = 0.033). No correlation was observed between the LSA and AI (P = 0.312) or CSA (P = 0.137). The LSA is lower with the Mathys Affinis™ implant than with the Biomet Comprehensive™ and FH Arrow™ implants; however, most LSAs are in the optimal ranges, and no association is observed between different implant designs and optimal DSA and LSA. Implant design, CSA, and AI should be considered during preoperative planning to achieve optimal DSA and LSA. [ABSTRACT FROM AUTHOR]

Recently, the 3-dimensional (3D) morphology of the coracoacromial complex in nonpathologic shoulders has been described. The aim of this study was to evaluate and compare the coracoacromial complex in pathologic shoulders (glenohumeral osteoarthritis [GHOA] and cuff tear arthropathy [CTA]) and nonpathologic shoulders. A 3D computed tomography reconstruction of 205 scapulae was performed (49 with GHOA, 48 with CTA, and 108 in normal shoulders [NL]). Subsequently, the center of the glenoid circle and several points at the coracoid, acromion, and glenoid were determined. The distances between these points and the rotation of the coracoacromial complex were calculated, and the acromion-glenoid angle was measured. The acromial overhang was significantly different between the NL (37 mm) and CTA (35 mm) groups (P =.045), as well as between the CTA and GHOA groups (33 mm) (P =.010). The acromion-glenoid angle showed a significant difference between the NL (mean, 50°) and GHOA (mean, 42°) groups (P <.001) and between the CTA (mean, 50°) and GHOA groups (P <.001). Furthermore, a significant difference was found in the acromial height, which was larger in the GHOA group (36 mm) than in the CTA group (30 mm) (P <.001) or NL group (30 mm) (P <.001). This 3D morphologic study showed that the acromial part of the complex was turned more posteriorly in both pathologic groups. Furthermore, we found the coracoacromial complex to be more cranial to the glenoid center in the GHOA group. Finally, a significant difference in the lateral overhang of the coracoacromial complex was observed between the 3 groups. The NL group had a larger overhang than the CTA group, and the CTA group in turn had a larger overhang than the GHOA group. [ABSTRACT FROM AUTHOR]

Abstract Superior capsular reconstruction is a recently described procedure for the treatment of irreparable supraspinatus tendon tears. Graft options that have been previously described include autogenous fascia lata and decellularized dermal graft. No studies were published with the use of fascia lata allograft. The purpose of this technical note is to describe the surgical technique of superior capsular reconstruction using fascia lata allograft. The procedure is performed by arthroscopic visualization, with the patient positioned in the lateral decubitus position. The authors describe a technique based on the use of a double-pulley knot in the glenoid and greater tuberosity, facilitating the procedure and allowing the graft to be brought into the subacromial space in the definitive position, with the appropriate tension. The allografts are available from this institution's tissue bank, cryopreserved and submitted to microbiological and histopathological evaluation. Superior capsular reconstruction is a promising surgery. The technique described in the present technical note shows a viable arthroscopic alternative, with a smaller number of anchors when compared with other techniques.

Although reverse shoulder arthroplasty is used in massive rotator cuff tears, it is also used in proximal humerus fractures and shoulder arthroplasty revision. In this study, we aimed to examine the early radiological and clinical results of patients undergoing reverse shoulder arthroplasty with different diagnoses. Between 2010 and 2013, reverse shoulder arthroplasty was applied to 10 patients (4 men, 6 women) with the diagnosis of arthropathy due to rotator cuff tear (n: 7), multi-fragmentary proximal humerus fracture (n: 2) and hemiarthroplasty revision (n: 1). The median age of the patients was 74 (64-85) years and the median follow-up was 15.5 (3-35) months. Patients were assessed in terms of joint range of motion, Constant score and Visual Pain Scale (VAS) and radiological examinations before and after surgery. Preoperative active shoulder flexion, abduction, internal and external rotation degrees of the patients were 65, 30, 40 and 50 degrees, and 105, 95, 30, 57.5 degrees respectively in their final controls. Constant score was 20.5 (14-63) preoperatively, and 54.5 (38-64) in the final controls (p‹0.05). While the preoperative VAS was 7 (3-9), it was found to be 1.5 (1-3) in the final controls (p‹0.05). As a complication, scapular notching was observed in one patient. Internal external rotation values were better in the rotator cuff arthropathy group than the fracture group. Reverse shoulder arthroplasty, especially in the treatment of patients with rotator cuff arthropathy, has good early results and a low complication rate. We recommend paying attention to the glenoid component location to avoid scapular notching. [ABSTRACT FROM AUTHOR]

Background: Superior humeral migration has been established as a component of rotator cuff disease, as it disrupts normal glenohumeral kinematics. Decreased acromiohumeral interval (AHI) as measured on radiographs has been used to indicate rotator cuff tendinopathy. Currently, the data are mixed regarding the specific rotator cuff pathology that contributes the most to humeral head migration. Purpose: To determine the relationship between severity of rotator cuff tears (RCTs) and AHI via a large sample of magnetic resonance imaging (MRI) shoulder examinations. Study Design: Cohort study; Level of evidence, 3. Methods: A search was performed for 3-T shoulder MRI performed in adults for any indication between January 2010 and June 2019 at a single institution. Three orthopaedic surgeons and 1 musculoskeletal radiologist measured AHI on 2 separate occasions for patients who met the inclusion criteria. Rotator cuff pathologies were recorded from imaging reports made by fellowship-trained musculoskeletal radiologists. Results: A total of 257 patients (mean age, 52 years) met the inclusion criteria. Of these, 199 (77%) had at least 1 RCT, involving the supraspinatus in 174 (67.7%), infraspinatus in 119 (46.3%), subscapularis in 80 (31.1%), and teres minor in 3 (0.1%). Full-thickness tears of the supraspinatus, infraspinatus, or subscapularis tendon were associated with significantly decreased AHI (7.1, 5.3, and 6.8 mm, respectively) compared with other tear severities (P <.001). Having a larger number of RCTs was also associated with decreased AHI (ρ = –0.157; P =.012). Isolated infraspinatus tears had the lowest AHI (7.7 mm), which was significantly lower than isolated supraspinatus tears (8.9 mm; P =.047). Conclusion: Although various types of RCTs have been associated with superior humeral head migration, this study demonstrated a significant correlation between a complete RCT and superior humeral migration. Tears of the infraspinatus tendon seemed to have the greatest effect on maintaining the native position of the humeral head. Further studies are needed to determine whether early repair of these tears can slow the progression of rotator cuff disease. [ABSTRACT FROM AUTHOR]

The influence of diagnosis on outcomes after reverse shoulder arthroplasty (RSA) is not completely understood. The purpose of this study was to compare clinical outcomes of different pathologies. A total of 699 RSAs were performed for the following diagnoses: (1) rotator cuff tear arthropathy (RCA), (2) massive cuff tear (MCT) with osteoarthritis (OA), (3) MCT without OA, (4) OA, (5) acute proximal humeral fracture, (6) malunion, (7) nonunion, and (8) inflammatory arthropathy. All patients had minimum 2-year clinical follow-up (mean, 47 months; range, 24-155 months). Range of motion, Simple Shoulder Test scores, American Shoulder and Elbow Surgeons scores, visual analog scale scores for function, and health-related quality-of-life measures were obtained preoperatively and postoperatively. The RCA, MCT-with-OA, MCT-without-OA, and OA groups all exhibited significant improvements in all outcome scores and in all planes of motion from preoperatively until a minimum of 2 years postoperatively. The malunion, nonunion, and inflammatory arthropathy groups showed improvements in American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores, forward flexion, and abduction. The average changes for all other outcomes and planes of motions were also positive but did not reach statistical significance. After adjustment for age and compared with RCA, female patients with malunion had significantly poorer forward flexion (P <.05), those with OA had significantly better abduction (P <.05), and those with fractures had significantly worse patient satisfaction (P <.05). Among male patients, those with MCTs without OA had significantly worse satisfaction (P <.05). RSA reliably provides improvement regardless of preoperative diagnosis. Although subtle differences exist between male and female patients, improvements in clinical outcome scores were apparent after RSA. [ABSTRACT FROM AUTHOR]

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Background Reverse total shoulder arthroplasty (RSA) is a recent concept that enables good functional outcomes in cases of massive rotator cuff tear and cuff tear arthropathy. Design parameters influence the functional results and complications. The purpose of this study is to present the results of a novel RSA, the Total Evolutive Shoulder System (TESS; Biomet, Warsaw, IN, USA), based on a reverse corolla without a stem. Methods We enrolled 101 patients with 105 RSAs in a prospective study, with a minimum follow-up period of 24 months. The analysis concerned 91 RSAs in 87 patients (61 men and 26 women), with a mean age of 73 years, at a mean follow-up of 41 months (range, 24-69 months). Results Ninety-six percent of patients rated their satisfaction as good or excellent. Mean flexion was 143° (range, 90°-170°), and mean external rotation was 39° (range, 20°-70°). The Constant score improved from 40 points preoperatively to 68 points at last follow-up ( P < .001). The mean American Shoulder and Elbow Surgeons score was 24 points. The mean neck-shaft angle was 154° (range, 142°-165°). Inferior scapular notching occurred in 17 cases (19%). The notching rate was higher when the glenometaphyseal angle increased ( P < .001), when the inferior tilt decreased ( P = .003), and when the neck-shaft angle increased. There was no evidence of component loosening. Conclusion TESS RSA provided encouraging midterm results with favorable outcomes and a low rate of complications. The stemless TESS with a reverse corolla is a reliable, less invasive system. [ABSTRACT FROM AUTHOR]

Summary: Rotator cuff arthropathy is a specific and uncommon disease entity. It affects mainly elderly, but often active people. The exact causes are not known, but there is evidence of genetic predisposition, crystal disease and mechanical factors. There are numerous treatment options for both the pain and dysfunction. Generally, non-operative measures are successful, if used appropriately and timely. Arthroscopic debridement and washout alone has only short-term benefit, but arthroscopic biceps tenotomy or tenodesis is effective in eliminating pain caused by long head of biceps tendon pathology. Anatomical hemi-arthroplasty, whether stemmed or surface replacement, primarily improves pain. However, modern designs specifically for cuff tear arthropathy have shown improved functional results. Surface replacement implants also confer the benefits of being less invasive and of preserving bone. Reverse total shoulder arthroplasty is a powerful tool for the elderly patient with unresponsive painful pseudoparalysis. However, it has a high complication rate and should be used with care. [Copyright &y& Elsevier]