جستجوی مقالات مرتبط با کلیدواژه « total shoulder arthroplasty » در نشریات گروه « پزشکی »

This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA). A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected. A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications were equivalent. While younger patients and heavy laborers had improved ER following HHR, their pain relief was greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic factors. Level of evidence: III

The purpose of this analysis is to present a two-year follow-up of patient-reported outcomes, revision rate, and notable radiographic features of a convertible, diaphyseal-fit anatomic total shoulder arthroplasty system (ATSA). From June 2012 to June 2015, 100 shoulders were treated with ATSA using a convertible, diaphyseal-fit stem. Functional outcomes and radiographic findings were assessed preoperatively and at 6 months, 1 year, and 2 years postoperatively. Complications and reoperations were also determined. Ninety-three shoulders were analyzed in this study. Patients were 47.3% male and had an average age of 67.3±8.1-years-old (range 44.7-89.1). Two-year clinical outcomes show a revision rate of 4.3%. Average preoperative ASES was 37.1±18.9 (6.7-86.7), SST (77.4%) was 3.1±2.4 yes responses (0-9), and SANE (88.2) was 25.4±21.5% (0-85.0%). At two years post-operative average (75% follow-up) ASES was 89.3±15.1 (37.0-100), SST was 10.0±2.5 yes responses (0-12), and SANE was 85.6%±17.0% (33.0-100%). Radiographic analysis at two years identified 2 shoulders (4%) with glenoid radiolucency (both Lazarus grade 1), 5 shoulders with at least one humeral radiolucent line (10%), and 9 shoulders (18%) with stress-shielding. There were 12 shoulders (24%) with distal pedestal formation. This finding was associated with the presence of radiolucent lines (P=0.002). This two-year analysis identified improvement in ASES, SST, and SANE scores and a low revision rate. presence presence of a distal pedestal was associated with increased rates of radiolucent lines. Further analysis with longer-term and more robust follow-up will improve our understanding of the risks and benefits of this shoulder system.Level of evidence: II

Total shoulder arthroplasty surgeries have continued to increase in popularity with a concomitant expansion of the indications for these procedures. The purpose of our study is to evaluate the global perioperative treatment of these patients, from preoperative optimization and patient selection through postoperative therapy regimens. We electronically sent a survey to the members of the American Society of Shoulder and Elbow surgeons that queried surgeons on several important elements in the global care of shoulder arthroplasty patients. Questions were designed to evaluate common preoperative, intraoperative, and postoperative treatment decisions. Only 3 out of 24 questions (12.5%) reached the 75% large majority mark, with five questions (20.8%) failing to reach a majority response. An additional 3 questions failed to show any significant answer distribution. This variability among shoulder practices likely represents a fairly surgeon-specific treatment algorithm currently. This may correspond to a lack of robust, evidence-based guidelines. Level of evidence: Level IVKeywords: Total shoulder arthroplasty; preoperative optimization; postoperative rehabilitation

Historically, the shoulder arthroplasty humeral component has been designed for the management of infections, tumours and fractures. In all these cases the stem was needed as a scaffold. Original humeral components were not developed for use in shoulder arthritis, so these designs and derivates had a long stem. The newest humeral implants innovations consist in shortening of the implant, or even removing the whole stem, to rely on stemless fixation at the level of the metaphysis. This implies the advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, easier implant removal at revision, and humeral component placement independent from the humeral diaphyseal axis. Nowadays, surgeons try to balance the need for a stable fixation of the humeral component with the potential need for revision surgery. Complications of revision shoulder arthroplasty are related to the need for removing a well-fixed humeral stem, the length of the procedure, and the need to treat severe bone loss. 

The primary goals of total shoulder arthroplasty (TSA) are to relieve pain, improve range of motion,and restore function. Physical therapy is commonly used to help achieve these goals. Recent evidence has pointedto the success and safety of a purely physician-guided, home-based or internet-based, program versus the traditionaltherapist guided program.The purpose of this study was to evaluate outcomes of TSA in patients using a web-based, home therapy program.

A retrospective review was performed of TSA patients who were given the option of using a web-based,home therapy program. Functional outcomes were collected preoperatively, 6-month, and 12-month post-operativeexaminations. Physical examination parameters were recorded at preoperative, 3-month, 6-month, and 12-month timepoints.

Forty-seven patients used the web-based, home therapy program and had complete follow-up data at alltime intervals. All mean range of motion parameters and functional scores improved significantly from preoperatively topostoperatively. There was one reported complication in a patient who sustained a subscapularis rupture and underwentsubsequent open repair at 10 months postoperatively.

This study demonstrates successful improvements in range of motion and functional outcomes in asubset of patients who utilized an online therapy program after TSA. Future study will be necessary to directly compareresults in patients enrolled in formal, outpatient therapy programs and to determine barriers to utilization of web-basedtherapy programs.Level of evidence: IV

The projected increase in revision shoulder arthroplasty has increased interest in the outcomes of theseprocedures. Glenoid component removal and conversion to a hemiarthroplasty (HA) is an option for aseptic glenoidloosening after anatomic total shoulder arthroplasty (aTSA). We identified patients who had undergone revision shoulder arthroplasty over a 15-year period. 17 patientsmet inclusion and exclusion criteria, and a retrospective chart review was conducted for pre-surgical and operativedata. We contacted patients at a mean follow-up of 70 months from revision surgery for implant survival, reoperationsand functional outcomes scores. Implant survival was estimated to be 88% at 2 years and 67% at 5 years. Mean ASES score for survivingimplants was 58 ± 22. Mean SANE score was 54 ± 24, and mean VAS pain score was 3.5 ± 2.8. Mean SF-12 Mentaland Physical scores were 46 ± 15 and 38 ± 10, respectively. Five patients (50% of those with surviving implants)reported being either very satisfied or satisfied with the status of their shoulder. There were complications in 6 patients(35%) and 5 patients (29%) required reoperation. HA following failed aTSA due to glenoid loosening produced modest clinical results and satisfaction rates.Reverse arthroplasty may be a more reliable treatment strategy in this patient population.Level of evidence: IV

Laminar flow ventilation systems were developed to reduce surgical contamination in joint arthroplastyto avoid periprosthetic joint infection (PJI). The goals of this study are to evaluate the cost-effectiveness and economicviability of installing and maintaining a laminar flow system in an operating room. A Monte Carlo simulation was used to evaluate the cost effectiveness of laminar flow. The variables includedwere cost to treat PJI, incidence of PJI, cost of laminar flow, years of operating room use, and arthroplasty volume asthe dependent variable. Laminar flow would be financially-justified when 1,217 (SD: 319) TSA cases are performed annually withassumed 10% reduction in PJI from laminar flow and 487 (SD: 127) with assumed 25% reduction. In a high volume OR,laminar flow costs $25.24 per case (assuming 10% reduction) and $8.24 per case (assuming 25% reduction). Laminarflow would need to reduce the incidence of PJI by 35.1% (SD: 9.1) to be a cost-effective strategy. This analysis demonstrates the substantial arthroplasty volume and large reduction in PJI rates required tojustify the installation and maintenance costs of this technology. This high cost of implementation should be consideredprior to installing laminar flow systems.Level of evidence: II

This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization basedon patient race. The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplastyutilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoingshoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-blacksubpopulations. The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Femalesaccounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, P<0.0001)and were younger (62.6 vs. 67.2 years, P<0.0001), compared to the non-black patients. Regarding insurance type,1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of fivemajor insurance categories, including private, Medicare, Medicaid, workers’ compensation, and personal injury,indicated no difference in insurance patterns (χ2=3.658, P=0.454). The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national andinstitutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Blackpatients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-blackpatients. The obtained results highlighted the need for the expansion of black patients’ access to care services relatedto major joint reconstruction.Level of evidence: III

It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals ofthis study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmakingof shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system forprimary osteoarthritis of the shoulder. Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a differentcombination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose atreatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations andchi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performedon surgical cases. An intra-class correlation (ICC) was used to assess observer agreement. The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the subanalysisof operative cases, the significant correlations were: KL grade [0.64], age [0.39], and activity level [-0.10].The chi square analysis was significant (P<0.01) for all factors, but the practical significance of activity level wasminimal. The ICCs were [inter](intra): KL [0.79] (0.84), patient management [0.54]. When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors moststrongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operationwere the patient’s KL grade and age. Additionally, the KL classification demonstrated excellent observer reliability.However, there was only moderate agreement among shoulder specialists regarding treatment, indicating that thisremains a controversial topic.Level of evidence: III

The purpose of this study was to determine a correlation between surgical case order and the length of operative time, total length of time in the operating room, time until discharge from the hospital, and the incidence of intraoperative complications for primary total shoulder arthroplasty cases. A retrospective review was conducted of records for all individual primary total shoulder arthroplasty and reverse total shoulder arthroplasty at a single hospital. In order to compare true parameters and minimize variables, only the cases performed by one senior author were analyzed. Operative and hospital records were reviewed. There were 162 primary TSA and with the following order: 55 first order cases, 46 second order cases, 34 third order cases, 21 fourth order cases, and six fifth order cases. There were 71 primary rTSA patients included (27:27:10:6:1). Length of stay was statistically increased for both female gender (8.3%; 95% confidence interval (CI)= 0.5- 16.7%; P=0.0386) and fourth case order compared to first case (13.3%; 95% CI = 0.6%; 27.6%) P=0.041). For reverse TSA, there was no analyzed predictor that was significant. Even between anatomic TSA and reverse TSA patients, there was variability in what factors played a part in case inpatient length of stay. As such, we believe that this study highlights that case order can have an effect on operating room parameters for shoulder arthroplasty patients. The need for larger studies remains to better define that effect.

The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients.
Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties (between 2007-2013) performed at a single institution were identified. All patients underwent routine preoperative and postoperative day one (POD1) chemistry panels. Each clinically significant component of the Chem-7 panel was independently evaluated using a multivariate analysis to identify risk factors for abnormal results. Associated clinical intervention rates were also calculated.
Data from 1,012 patients (248 RTSA; 764 aTSA) was analyzed. 5.4% of patients had at least one preoperative abnormal chemistry result. On multivariate analysis, patients with abnormal preoperative Chem-7 labs and a history of renal disease had significantly increased risk for abnormal POD1 labs (p Renal disease and a preoperative abnormal chemistry result are important risk factors for abnormal postoperative Chem-7. Optimizing renal status and correcting abnormal blood chemistry results preoperatively may reduce the incidence of abnormal postoperative chemistry results.