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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.

Purpose: Glenoid loosening after total shoulder arthroplasty (TSA) is influenced by the position of the glenoid component. 3D planning software and patient-specific guides seem to improve positioning accuracy, but their respective individual application and role are yet to be defined. The aim of this study was to evaluate the accuracy of freehand implantation after 3D pre-operative planning and to compare its accuracy to that of a targeting guide., Method: Seventeen patients scheduled for TSA for primary glenohumeral arthritis were enrolled in this prospective study. Every patient had pre-operative planning, based on a CT scan. Glenoid component implantation was performed freehand, guided by 3D views displayed in the operating room. The position of the glenoid component was determined by manual segmentation of post-operative CT scans and compared to the planned position. The results were compared to those obtained in a previous work with the use of a patient-specific guide., Results: The mean error for the central point was 2.89 mm (SD ± 1.36) with the freehand method versus 2.1 mm (SD ± 0.86) with use of a targeting guide (p = 0.05). The observed difference was more significant (p = 0.03) for more severely retroverted glenoids (> 10°). The mean errors for version and inclination were respectively 4.82° (SD ± 3.12) and 4.2° (SD ± 2.14) with freehand method, compared to 4.87° (SD ± 3.61) and 4.39° (SD ± 3.36) with a targeting guide (p = 0.97 and 0.85, respectively)., Conclusion: 3D pre-operative planning allowed accurate glenoid component positioning with a freehand method. Compared to the freehand method, patient-specific guides slightly improved the position of the central point, especially for severely retroverted glenoids, but not the orientation of the component.

Background: The use of reverse shoulder arthroplasty has considerably increased since first introduced in 1985. Despite demonstrating early improvement of function and pain, there is limited information regarding the durability and longer-term outcomes of this prosthesis., Questions/purposes: We determined complication rates, functional scores over time, survivorship, and whether radiographs would develop signs of loosening., Patients and Methods: We retrospectively reviewed 527 reverse shoulder arthroplasties performed in 506 patients between 1985 and 2003. Clinical and radiographic assessment was performed in 464 patients with a minimum followup of 2 years and 148 patients with a minimum followup of 5 years (mean, 7.5 years; range, 5-17 years). Cumulative survival curves were established with end points being prosthesis revision and Constant-Murley score of less than 30 points., Results: Eighty-nine of 489 had at least one complication for a total of 107 complications. Survivorship free of revision was 89% at 10 years with a marked break occurring at 2 and 9 years. Survivorship to a Constant-Murley score of less than 30 was 72% at 10 years with a marked break observed at 8 years. We observed progressive radiographic changes after 5 years and an increasing frequency of large notches with long-term followup., Conclusions: Although the need for revision of reverse shoulder arthroplasty was relatively low at 10 years, Constant-Murley score and radiographic changes deteriorated with time. These findings are concerning regarding the longevity of the reverse shoulder arthroplasty, and therefore caution must be exercised when recommending reverse shoulder arthroplasty, especially in younger patients., Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The shoulder capsular sitffness must be managed first by a physiotherapist and the arthroscopic release is indicated after failure. The clinical assessment is essential and reveals the loss of passive motion in specified direction. The x-rays and imaging are necessary for excluding the other etiologies of shoulder stiffness. The arthroscopic treatment is part of he treatment strategy which has to be explained to the patient. The arthroscopic treatment starts by measuring under anesthesia the loss of passive motion. The next step consists of the release of the rotator interval followed by resection of the anterior capsule. Finally, the posterior capsule is cut according to the location of the capsular retraction. The interest of the subacromial debridement is still of debate. The postoperative pain control and the rehabilitation are part of the treatment. The literature analysis demonstrates the efficiency of the arthroscopic treatment, even if the post-op care are often long. A delay of 6 months is currently necessary to obtain the final results. The main advantages of the arthroscopic treatment is to address specifically the retracted capsule and to perform a selective release which allow to start rehabilitation program early.

Background: Reverse total shoulder arthroplasty is currently being used to treat selected patients with disabling shoulder arthropathy. The purposes of this study were to investigate the medium-term results of reverse total shoulder arthroplasty and to analyze the influence of etiology on the result., Methods: We carried out a multicenter study with a minimum follow-up of five years and determined the survival rate of the prosthesis according to the initial etiology of the shoulder arthropathy. Eighty prostheses were implanted in seventy-seven patients between 1992 and 1998. Sixty-six shoulders had an arthropathy with a massive rotator cuff tear, and fourteen shoulders had a disorder with another etiology (rheumatoid arthritis, trauma, or revision arthropathy). At the time of review, eighteen patients had died and two were lost to follow-up. The remaining fifty-seven patients (sixty shoulders) were examined or interviewed by telephone at a mean follow-up of 69.6 months. Cumulative survival curves were generated with replacement of the prosthesis, glenoid loosening, and a functional Constant score of <30 as the end points., Results: The survival rate with replacement of the prosthesis and glenoid loosening as the end points were 91% and 84%, respectively, at 120 months, with shoulders that had arthropathy with a massive rotator cuff tear demonstrating a significantly better result than those that had a disorder with another etiology (p < 0.05). On the other hand, the survival rate with an absolute Constant score of <30 as an end point was 58% at 120 months, with no significant difference with respect to etiology. Two breaks were observed in the survival curves. The first concerned survival until replacement of the prosthesis and occurred at around three years, reflecting early loosening of the prosthesis. The curve then became stable. A second break started at around six years and reflected progressive deterioration of the functional result., Conclusions: Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands.

Background: In shoulder arthroplasty, mismatch is defined as the difference in the radius or diameter of curvature between the humeral head and glenoid components. Recommendations for mismatch have not been substantiated scientifically. The purpose of this study was to evaluate the effect of mismatch on glenoid radiolucent lines., Methods: The results of 319 total shoulder arthroplasties performed for the treatment of primary osteoarthritis were evaluated. All of the arthroplasties were performed with a single type of prosthesis (Aequalis; Tornier, Montbonnot, France) that included a cemented, all-polyethylene glenoid component. Three sizes of glenoid components and seven humeral head diameters were utilized. Radial mismatch was categorized as < or = 4 mm, 4.5 to 5.5 mm, 6 to 7 mm, or >7 to 10 mm. Radiographs were evaluated at a mean of 53.5 months (range, twenty-four to 110 months) postoperatively. Glenoid radiolucent lines were scored with a scale ranging from 0 points for no radiolucency to 18 points for radiolucent lines exceeding 2 mm in six zones. Variance, linear contrasts polynomial, quadratic polynomial contrast statistical, and linear regression analyses were performed to evaluate the relationship between radial mismatch and glenoid radiolucent lines., Results: A significant linear relationship was found between mismatch and the glenoid radiolucency score (p < 0.0001), with significantly lower (better) radiolucency scores associated with radial mismatches of >5.5 mm., Conclusions: In this study of glenohumeral prosthetic mismatch ranging from 0 to 10 mm, the mismatch had a significant influence on the scores for the glenoid radiolucent lines, which were best when the radial mismatch was between 6 and 10 mm. The theoretical risk of prosthetic instability with larger mismatch values was not demonstrated within the range of mismatch values evaluated in this series.

Direct coronal oblique views of the shoulder were obtained with arthrographic computed tomography (CT) in 35 shoulders with surgical correlation. There were 18 complete cuff tears, four partial ones, two type 3 superior labral, anterior, and posterior (SLAP) lesions, and one type 4 SLAP lesion. The coronal sections were obtained after double-contrast shoulder arthrography and axial CT sections had already been obtained. The patient was seated directly on the slope of the gantry, and the shoulder to be studied was positioned in the center of the gantry. The maximal time needed for this procedure was 5 minutes. Rotator cuff tears were detected with a sensitivity of 95% and a specificity of 100%. The size of the tears as determined on the coronal sections was strongly correlated with surgical measurement (r = .939). All SLAP lesions were detected. The authors' experience shows that obtaining coronal oblique sections is an effective way to improve arthrographic CT.