Journal of shoulder and elbow arthroplasty最新文献

{"title":"Inter and Intra-Rater Reliability of Using Computed Tomography to Assess Prosthesis Position Post Shoulder Arthroplasty","authors":"David A. Kelly, Sharon J Karamfiles, J. Coward, S. Goebel","doi":"10.1177/2471549220963790","DOIUrl":"https://doi.org/10.1177/2471549220963790","url":null,"abstract":"Background Computer models and cadaveric studies have demonstrated that humeral version has a significant impact on the impingement, stability, and range of motion of the prosthetic shoulder joint. Computed tomography (CT) has been used to measure native humeral version, however the reliability of using CT to measure humeral version post reverse total shoulder replacement has not yet been established. Aims To investigate the inter and intra-rater reliability of using CT to assess the post-operative humeral version following shoulder arthroplasty. Methodology Patients underwent a limited CT scan of the operative limb; positioned and protocoled by one consultant radiologist on one machine. The humeral version of the prostheses was calculated individually by two experienced, board certified consultant radiologists. They were blinded to each other’s measurements. The humeral version was calculated using the epicondylar axis. Data Overall, 20 shoulders are included; 12 females (60%), and 10 left-sided (50%). The median anteversion was 0° (range 33° retroversion–27° anteversion; IQ 6.75° retroversion–4.75° anteversion). The inter-rater reliability was 0.985 (95% CI: 0.964–0.994). The intra-rater reliability for radiologist A was 0.988 (95% CI: 0.969–0.995), and the intra-rater reliability for radiologist B was 0.976 (95% CI: 0.942–0.991). Conclusion The use of post operative CT has excellent inter and intra-rater reliability in measuring humeral version following shoulder arthroplasty. This study will facilitate future research regarding impact of the humeral version on patient outcomes.","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220963790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49088616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cue Ball Arthroplasty With Humeroradial Total Elbow Arthroplasty (TEA) Revision: An Approach to Managing Infection and Severe Ulnar Bone Loss in TEA.","authors":"Daniel E Gerow,&nbsp;Emily H Tan,&nbsp;H Brent Bamberger","doi":"10.1177/2471549220961592","DOIUrl":"https://doi.org/10.1177/2471549220961592","url":null,"abstract":"<p><p>Total elbow arthroplasties (TEA) have become more prevalent as indications expand. However, TEA complications remain a treatment conundrum. One such complication, periprosthetic joint infections (PJIs) have been reported to occur in up to 12% of all TEA procedures. Irrigation and debridement with retention of hardware and antibiotic suppression has a high failure rate. Two stage revisions of TEA, while more morbid, is an effective approach with previous studies showing a 79% eradication rate. These cases are often associated with periprosthetic bone loss, adding to the surgical complexity. In our case report, we present the case of a 59 year old diabetic male with a primary TEA secondary to a distal humerus fracture who developed a deep infection and was successfully treated with explantation, cue ball antibiotic cement arthroplasty, and humeroradial revision. This case report will discuss the cue ball antibiotic spacer technique and humeroradial revision as a salvage procedure in TEA revisions in the setting of extensive ulnar bone loss.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220961592","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis.","authors":"Patrick A Nelson, Changyow C Kwan, Vehniah K Tjong, Michael A Terry, Ujash Sheth","doi":"10.1177/2471549220949731","DOIUrl":"10.1177/2471549220949731","url":null,"abstract":"<p><strong>Background: </strong>There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure.</p><p><strong>Methods: </strong>A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan.</p><p><strong>Results: </strong>Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA.</p><p><strong>Conclusions: </strong>Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/31/d8/10.1177_2471549220949731.PMC8282171.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electromyography of the Shoulder Musculature during Passive Rehabilitation Exercises","authors":"Janelle A. Cross, J. deVries, Mason Mocarski, Nicholas C. Ketchum, Eileen Compty, Matthew C. Krimmer, Jessica M. Fritz, C. Vetter","doi":"10.1177/2471549220960044","DOIUrl":"https://doi.org/10.1177/2471549220960044","url":null,"abstract":"Background Medical professionals remain conflicted about the best rehabilitation protocol a patient should perform after rotator cuff repair surgery. Exercises deemed passive may be activating the shoulder muscles to a moderate level, thus putting the surgical repair construct at risk for re-injury. The purpose of this study was to measure the activation of the rotator cuff and surrounding musculature during exercises used in physical therapy following rotator cuff repair surgery using electromyography (EMG). Methods Muscle activation was recorded in fourteen participants performing sixteen exercises. Four fine wire electrodes (supraspinatus, infraspinatus, subscapularis, teres minor) and six surface electrodes (upper and middle division of the trapezius, anterior, medial and posterior head of the deltoid, biceps brachii) were utilized. EMG activity values for each muscle were normalized to the maximum voluntary isometric contraction and activation levels were assessed. Results Twelve of the sixteen exercises tested were moderately active in the subscapularis muscle. The results show the subscapularis muscle was activated in all three planes of motion. Discussion Most exercises were found to have low activation levels for the supraspinatus, infraspinatus and teres minor muscles. While the exercises examined in this study appear to be safe for the more commonly repaired supraspinatus, caution should be used when administering exercises to individuals with repairs involving the subscapularis.","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220960044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46320630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty.","authors":"Micah L MacAskill,&nbsp;Rachel J Thomas,&nbsp;Leslie A Barnes","doi":"10.1177/2471549220949147","DOIUrl":"https://doi.org/10.1177/2471549220949147","url":null,"abstract":"<p><p><b>Introduction:</b> Reverse shoulder arthroplasty is a useful procedure with broadening applications, but it has the best outcomes when used for rotator cuff tear arthropathy. However, this procedure is not without complications. While scapular notching and aseptic loosening are more common complications that have been extensively studied in the literature, dissociation of the glenoid component and incomplete glenosphere seating has not received much attention. Specifically, little research has explored appropriate management of incomplete seating of the glenosphere component, and no gold standard for treatment of this complication has emerged. <b>Methods:</b> In the case described here, an elderly patient with an incompletely seated glenosphere component post-operatively opted to pursue conservative management in order to avoid revision surgery if possible. <b>Results:</b> The partially engaged, superiorly directed components in this case exhibited spontaneous complete and symmetric seating of the glenosphere between six and twelve months post-operatively, indicating that conservative management of this complication in low-demand patients may be a viable option to avoid the risks associated with revision surgery. <b>Conclusion:</b> Further research should be pursued to explore what patient and prosthesis design factors may be suited to observation with serial radiographs when incomplete seating of the glenosphere component occurs.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220949147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Method for Measuring Glenoid Version on Standard Magnetic Resonance Imaging.","authors":"Nicholas J Maister,&nbsp;Andrew Hely,&nbsp;Liam G Twycross,&nbsp;Stephen D Gill,&nbsp;Richard S Page","doi":"10.1177/2471549220926826","DOIUrl":"https://doi.org/10.1177/2471549220926826","url":null,"abstract":"<p><strong>Background: </strong>The most effective method and modality for measuring glenoid version for different shoulder conditions is uncertain. Computed tomography (CT) imaging exposes the patient to radiation, and standard magnetic resonance imaging (MRI) does not consistently image the entire scapula. This study investigates the reliability of a new method for assessing glenoid version using routine shoulder MRI.</p><p><strong>Methods: </strong>MRI images of 20 patients undergoing arthroscopy for shoulder instability were independently assessed by 3 clinicians for osseous and chondrolabral glenoid version. To assess glenoid version, a line was drawn from medial corner of the glenoid body to midpoint of the glenoid face. A line perpendicular to this was the reference against which to measure glenoid version. Measurements were repeated after 3 months to assess intra- and interobserver reliability. Reliability was determined using intraclass correlation coefficients (ICCs).</p><p><strong>Results: </strong>Interclass correlation coefficients showed at least good reliability for most estimates of intraobserver reliability (ICC ≥ .66) and excellent reliability for most estimates of interobserver reliability (ICC ≥ .84), with the exception of some inferior glenoid measurements where ICC was poor (ICC ≤.41).</p><p><strong>Discussion: </strong>We propose that this new method of measuring glenoid on standard axial MRI can be used as a simple, practical, and reliable method in shoulder instability patients, which will reduce the requirement for CT in this group.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220926826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse Shoulder Arthroplasty for Failed Proximal Humerus Osteosynthesis With Intramedullary Allograft: A Case Series","authors":"Teja S. Polisetty, P. DeVito, Hyrum Judd, Andy R. Malarkey, Jonathan C. Levy","doi":"10.1177/2471549220925464","DOIUrl":"https://doi.org/10.1177/2471549220925464","url":null,"abstract":"Introduction The presence of retained intramedullary fibular allograft presents many challenges during reverse shoulder arthroplasty (RSA), which have been discussed in limited fashion. This case series presents a single-surgeon experience with 6 patients treated with RSA following failed osteosynthesis of proximal humerus fractures using intramedullary allografts. Methods A retrospective review was conducted of RSA patients with a minimum of 2-year follow-up (exception of 1 deceased patient) for failed plate fixation of proximal humerus fractures. Two cohorts were created based on the presence of an intramedullary allograft during the procedure. Patient-reported outcome measures, active range of motion, time to revision, surgical time, complications, and case descriptions were obtained from chart review and radiographic analysis. Results When treating patients with a retained allograft, the surgeon used a guide pin from a cannulated screw set to advance through the graft, and a cannulated drill was used to ream and bypass the allograft, contributing to a 22% increase in surgical time (151 vs 124 min). Intraoperative complications were observed only in the allograft cohort (50%; 3 of 6), including cortical perforation with cement extrusion, humeral loosening, and proximal humerus bone loss. Patients treated with a retained allograft experienced pain relief (P  =  .001) but did not gain significant functional improvements. Conclusion RSA for failed proximal humerus fixation with healed intramedullary allograft is associated with increased operative time and intraoperative complications, and patients can mostly expect pain relief. Techniques for humeral canal preparation and stem placement to bypass the allograft are helpful in managing these revisions.","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220925464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44102685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Preoperative and Postoperative Glenoid Retroversion Influence Outcomes After Reverse Total Shoulder Arthroplasty?","authors":"Drew Lansdown,&nbsp;Edward C Cheung,&nbsp;Weiyuan Xiao,&nbsp;Austin Lee,&nbsp;Alan L Zhang,&nbsp;Brian T Feeley,&nbsp;C Benjamin Ma","doi":"10.1177/2471549220912552","DOIUrl":"https://doi.org/10.1177/2471549220912552","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on the effect of glenoid retroversion in clinical outcomes following reverse total shoulder arthroplasty (RTSA). The purpose of this study was to evaluate if surgical correction of retroversion affects outcomes following RTSA.</p><p><strong>Methods: </strong>An institutional database was utilized to identify 177 patients (mean age: 68.2 ± 10.1 years) with minimum 2-year follow-up after primary RTSA. Glenoid version was measured on preoperative and postoperative radiographs. American Shoulder and Elbow Surgeons (ASES) scores and range of motion were collected before and after RTSA. Change in retroversion was determined by comparing preoperative and postoperative glenoid retroversion on radiographs using paired Wilcoxon signed-rank test. Spearman's rank correlation was used to investigate relationships between ASES scores and glenoid retroversion.</p><p><strong>Results: </strong>The mean postoperative ASES composite score (75.5 ± 22.7) was significantly higher than preoperative (36.8 ± 19.2; <i>P</i> < .0001). The mean preoperative glenoid retroversion was 9.1 ± 6.7° compared to 6.5 ± 5.1° postoperatively (<i>P</i> < .0001). There was no correlation between postoperative ASES scores and preoperative retroversion (<i>r</i> = .014, <i>P</i> = .85) or postoperative retroversion (<i>r</i> = -.043, <i>P</i> = .57). There was no statistical relationship between postoperative retroversion and range of motion, though there is a risk of inadequate power given the sample size.</p><p><strong>Conclusions: </strong>Patient-reported outcomes and range of motion measurements following RTSA at short-term follow-up appear to be independent of either preoperative or postoperative glenoid retroversion.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220912552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Revision Reverse Shoulder Arthroplasty","authors":"B. Goldman, A. Halpern, M. J. Deal, Bradley P. Richey, Eric M. Mason, H. Gupta, Jonathan J. Callegari, César Bravo","doi":"10.1177/2471549220902296","DOIUrl":"https://doi.org/10.1177/2471549220902296","url":null,"abstract":"Background The number of reverse total shoulder arthroplasty procedures performed has increased in recent years due to expanding surgical indications. There has been a proportional increase in complications, with reported complication rates for a revision reverse total shoulder arthroplasty as high as 68%. Revising a reverse total shoulder is a complex procedure requiring significant preoperative planning. Methods A literature review of revision shoulder arthroplasty techniques was performed. No IRB approval was needed for this study. Results Instability is the most common reason for revision reverse total shoulder arthroplasty followed by infection. Revision arthroplasty is also needed in the setting of bone loss, aseptic loosening, and periprosthetic fracture. Each case requires a comprehensive preoperative plan to address each deformity for a successful result. Conclusions For this procedure to be successful, it is imperative that the physician understands the risk factors, identifies the cause, and is familiar with current surgical techniques. This study reviews both preoperative and perioperative management of reverse total shoulder arthroplasty in the revision setting.","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220902296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46055421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of Glenohumeral Osteoarthritis Does Not Correlate With Patient-Reported Outcomes.","authors":"Eitan M Kohan,&nbsp;Jeffrey Ryan Hill,&nbsp;Joseph D Lamplot,&nbsp;Alexander W Aleem,&nbsp;Jay D Keener,&nbsp;Aaron M Chamberlain","doi":"10.1177/2471549220901873","DOIUrl":"https://doi.org/10.1177/2471549220901873","url":null,"abstract":"<p><strong>Background: </strong>Patient pain and clinical function are important factors in decision-making for patients with glenohumeral osteoarthritis (GHOA). The correlation between radiographic severity of arthritis and demographic factors with modern patient-reported outcome measures has not yet been well defined.</p><p><strong>Methods: </strong>This cross-sectional study included 256 shoulders in 246 patients presenting with isolated GHOA. All patients obtained standard radiographs and completed the American Shoulder and Elbow Surgeons score, Simple Shoulder Test (SST), Shoulder Activity Scale, Visual Analog Scale, and Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive tests at the time of presentation. Radiographs were graded according to the Samilson-Prieto classification. Mean pain and functional scores were compared between the radiographic grades of osteoarthritis (OA) and demographic factors.</p><p><strong>Results: </strong>There were 6 shoulders rated as grade 1 OA, 41 shoulders as grade 2, 149 shoulders as grade 3a, and 65 shoulders as grade 3b. There was excellent interobserver reliability in grade of OA (κ = 0.77). There were no significant differences in patient-reported pain or any validated measure of clinical function between radiographic grades of OA (<i>P </i>><i> </i>.05). Males reported higher function and lower pain scores than females (<i>P </i>=<i> </i>.001-.066), although only the values for the SST and PROMIS physical function test were clinically relevant.</p><p><strong>Discussion: </strong>While gender correlated with pain and function, the clinical relevance is limited. Radiographic severity of GHOA does not correlate with patient-reported pain and function, and symptoms should remain the primary determinants of surgical decision-making. Further investigation is necessary to examine whether radiographic severity of OA influences improvement following operative intervention in this population.</p>","PeriodicalId":73942,"journal":{"name":"Journal of shoulder and elbow arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2471549220901873","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}