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Gilles Walch - One of the best experts on this subject based on the ideXlab platform.

  • lateralization in Reverse Shoulder Arthroplasty a descriptive analysis of different implants in current practice
    International Orthopaedics, 2019
    Co-Authors: Jeandavid Werthel, Gilles Walch, Pierric Deransart, Joaquin Sanchezsotelo, Emilie Vegehan, Philippe Valenti
    Abstract:

    Since its first description, the concept of Reverse Shoulder Arthroplasty (RSA) has evolved. The term lateralization remains unclear and is used to describe implants that lateralize on the glenoid side, the humeral side, or both. The objective of this study was to provide a clear definition of lateralization and to measure the lateralization achieved by the most commonly used implants. Twenty-eight different configurations with 22 different implants were analyzed. Glenoid, humeral, and global lateralization was measured on digitized templates. Implant lateralization was normalized to the lateral offset of the Delta III. Each implant was defined as a combination of one of two glenoid categories (medialized glenoid (MG), lateralized glenoid (LG), and one of four humeral categories (medialized humerus (MH), minimally lateralized humerus (LH), lateralized humerus (LH+). In addition, implants were separated in categories of 5-mm increments for global offset (medialized RSA (M-RSA), minimally lateralized RSA (ML-RSA), lateralized RSA (L-RSA), highly lateralized RSA (HL-RSA), and very highly lateralized RSA (VHL-RSA). The global lateral offset of the Delta III was 13.1 mm; global lateral offset of all designs in this study varied between 13.1 and 35.8 mm. Regarding their global lateral offset, five implants are M-RSA (lateral offset < 18.1 mm), five ML-RSA (18.1–23.1 mm), seven L-RSA (23.1–28.1 mm), six HL-RSA (28.1–33.1 mm), and one VHL-RSA (33.1–38.1 mm). There is high variability in the amount of lateralization provided by the majority of RSAs currently available. This descriptive analysis can help surgeons understand the features of implants in the market based on their lateralization in order to adapt the surgical technique depending on the expected lateral offset of the design being implanted.

  • glenosphere design affects range of movement and risk of friction type scapular impingement in Reverse Shoulder Arthroplasty
    Journal of Bone and Joint Surgery-british Volume, 2018
    Co-Authors: B S Werner, Jean Chaoui, Gilles Walch
    Abstract:

    Aims Scapular notching is a frequently observed radiographic phenomenon in Reverse Shoulder Arthroplasty (RSA), signifying impingement of components. The purposes of this study were to evaluate the...

  • Reverse Shoulder Arthroplasty for type 1 sequelae of a fracture of the proximal humerus
    Journal of Bone and Joint Surgery-british Volume, 2018
    Co-Authors: Patric Raiss, Thomas Bruckner, Pascal Boileau, G Alami, Petra Magosch, P Habermeyer, Gilles Walch
    Abstract:

    Aims The aim of this study was to analyze the results of Reverse Shoulder Arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff ...

  • Reverse Shoulder Arthroplasty for malunions of the proximal part of the humerus type 4 fracture sequelae
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Patric Raiss, Philippe Collin, Thomas Bruckner, Felix Zeifang, Pascal Boileau, Bradley T Edwards, Markus Loew, Gilles Walch
    Abstract:

    Background: The treatment of fracture sequelae of the proximal part of the humerus in combination with posttraumatic arthritis is challenging. The reported results of treatment with anatomic Shoulder Arthroplasty are disappointing. The aim of this multicenter study was to analyze the clinical and radiographic results of Reverse Shoulder Arthroplasty for treatment of posttraumatic sequelae of the proximal part of the humerus with malunion of the tuberosities. Methods: This was a retrospective, multicenter study of 42 patients (42 Shoulders) with the diagnosis of posttraumatic sequelae of the proximal part of the humerus with malunions of the tuberosities who were treated with Reverse Shoulder Arthroplasty between 2000 and 2010. The mean age at the time of Arthroplasty was 68 years (range, 27 to 83 years; median, 70 years). The dominant side was treated in 24 cases. The mean clinical and radiographic follow-up was 4 years (range, 2 to 13 years; median, 3.5 years). The Constant score including subgroups, Shoulder flexion, rotation motion, and radiographs of the affected Shoulders were analyzed before the surgical procedure and at the time of the latest follow-up. Patients categorized their postoperative results as very good, good, satisfactory, or unsatisfactory. Results: The mean Constant score increased from 19.7 points (range, 0 to 52 points) preoperatively to 54.9 points (range, 21 to 83 points) postoperatively (p < 0.0001). All of the subgroups of the Constant score also increased, as did active Shoulder flexion and external rotation (all p < 0.0001). In one case, loosening of the humeral and glenoid components occurred. Scapular notching was present in 22 Shoulders (52%) and was grade 1 in 12 cases, grade 2 in 4 cases, grade 3 in 2 cases, and grade 4 in 4 cases. Complications occurred in 4 patients (9.5%). Eighteen patients (43%) rated their result as very good, 19 (45%) rated their result as good, 4 (10%) rated their result as satisfactory, and one (2%) rated the result as unsatisfactory. Conclusions: Reverse Shoulder Arthroplasty is a viable treatment option for type-4 proximal humeral fracture sequelae that cannot otherwise be treated with anatomic Shoulder replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • Effect of humeral stem design on humeral position and range of motion in Reverse Shoulder Arthroplasty
    International orthopaedics, 2015
    Co-Authors: Alexandre Ladermann, Patrick J Denard, Pascal Boileau, Alain Farron, Pierric Deransart, Alexandre Terrier, Julien Ston, Gilles Walch
    Abstract:

    The impacts of humeral offset and stem design after Reverse Shoulder Arthroplasty (RSA) have not been well-studied, particularly with regard to newer stems which have a lower humeral inclination. The purpose of this study was to analyze the effect of different humeral stem designs on range of motion and humeral position following RSA. Using a three-dimensional computer model of RSA, a traditional inlay Grammont stem was compared to a short curved onlay stem with different inclinations (155°, 145°, 135°) and offset (lateralised vs medialised). Humeral offset, the acromiohumeral distance (AHD), and range of motion were evaluated for each configuration. Altering stem design led to a nearly 7-mm change in humeral offset and 4 mm in the AHD. Different inclinations of the onlay stems had little influence on humeral offset and larger influence on decreasing the AHD. There was a 10° decrease in abduction and a 5° increase in adduction between an inlay Grammont design and an onlay design with the same inclination. Compared to the 155° model, the 135° model improved adduction by 28°, extension by 24° and external rotation of the elbow at the side by 15°, but led to a decrease in abduction of 9°. When the tray was placed medially, on the 145° model, a 9° loss of abduction was observed. With varus inclination prostheses (135° and 145°), elevation remains unchanged, abduction slightly decreases, but a dramatic improvement in adduction, extension and external rotation with the elbow at the side are observed.

Mark A Frankle - One of the best experts on this subject based on the ideXlab platform.

  • acute surgical management of proximal humerus fractures orif vs hemiArthroplasty vs Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2020
    Co-Authors: Israel B Yahuaca, Mark A Mighell, Peter Simon, Kaitlyn N Christmas, Shaan Patel, Allen R Gorman, Mark A Frankle
    Abstract:

    Background Proximal humerus fracture treatment varies by surgeon preference and patient factors. This study compares patient and fracture characteristics, with outcomes between current surgical treatment options. Methods Between 1999 and 2018, 425 proximal humerus fractures underwent acute surgical management: open reduction internal fixation (ORIF, n = 211), hemiArthroplasty (HA, n = 108), or Reverse Shoulder Arthroplasty (RSA, n = 106). Patient and fracture characteristics included age, American Society of Anesthesiologists physical status classification (ASA), and fracture classification. Postoperative motion at 3, 6, and minimum 12 months (avg 20 ± 21 months), radiographic outcomes, and postoperative falls were analyzed. Results Average age for treatment groups was 65 ± 13 years (range: 18-93 years). Fractures were classified as 2- (11%), 3- (41%), or 4-part (48%). Age, ASA, and fracture classification were associated with selected surgical management (P Conclusion Older patients with high ASA were treated with Arthroplasty, and younger patients with lower ASA were treated with ORIF. All groups showed improvements in motion. At minimum 1 year of follow-up, there was no difference in motion between groups. ORIF and HA showed significantly more reoperations compared with RSA. Patients should be counseled about reoperation, fall risk, and prevention.

  • massive rotator cuff tear when to consider Reverse Shoulder Arthroplasty
    Current Reviews in Musculoskeletal Medicine, 2018
    Co-Authors: Thomas R. Sellers, Adham Abdelfattah, Mark A Frankle
    Abstract:

    The purpose of this review is to discuss the indications for Reverse Shoulder Arthroplasty (RSA) in the treatment of massive rotator cuff tear (MCT), review the reported outcomes in the literature, and outline our approach and surgical technique for treating these patients. While RSA remains a successful and well-accepted treatment for cuff tear arthropathy (CTA), management of MCT in the absence of arthritis is controversial. In this particular setting, patients best suited for RSA are elderly, lower-demand individuals with chronic, irreparable MCT, and pseudoparalysis. Age  90% at 10 years. Treatment of MCT must be individualized for each patient. When patient selection is optimized, RSA is a reliable means of relieving pain and improving function with excellent success. Further investigation is necessary to better define its indications and assess the role of alternative, joint-salvaging procedures.

  • Reverse Shoulder Arthroplasty for massive rotator cuff tear risk factors for poor functional improvement
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Robert U Hartzler, Brandon M Steen, Michael M Hussey, Michael C Cusick, Benjamin J Cottrell, Rachel Clark, Mark A Frankle
    Abstract:

    Background Some patients unexpectedly have poor functional improvement after Reverse Shoulder Arthroplasty (RSA) for massive rotator cuff tear without glenohumeral arthritis. Our aim was to identify risk factors for this outcome. We also assessed the value of RSA for cases with poor functional improvement vs. controls. Methods The study was a retrospective case-control analysis for primary RSA performed for massive rotator cuff tear without glenohumeral arthritis with minimum 2-year follow-up. Cases were defined as Simple Shoulder Test (SST) score improvement of ≤1, whereas controls improved SST score ≥2. Risk factors were chosen on the basis of previous association with poor outcomes after Shoulder Arthroplasty. Latissimus dorsi tendon transfer results were analyzed as a subgroup. Value was defined as improvement in American Shoulder and Elbow Surgeons (ASES) score per $10,000 hospital cost. Results In a multivariate binomial logistic regression analysis, neurologic dysfunction ( P  = .006), age P  = .02), and high preoperative SST score ( P  = .03) were independently associated with poor functional improvement. Latissimus dorsi tendon transfer patients significantly improved in active external rotation (−0.3° to 38.7°; P P Conclusions Young age, high preoperative function, and neurologic dysfunction were associated with poor functional improvement. Surgeons should consider these associations in counseling and selection of patients. Concurrent latissimus dorsi transfer was successful in restoring active external rotation in a subgroup of patients. The critical economic importance of improved patient selection is emphasized by the very low value of the procedure in the case group.

  • results of closed management of acute dislocation after Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Matthew J Teusink, Benjamin J Cottrell, Ioannis P Pappou, Daniel G Schwartz, Mark A Frankle
    Abstract:

    Background Postoperative instability continues to be one of the most common complications limiting outcomes of Reverse Shoulder Arthroplasty (RSA). The optimal management of this complication remains unknown. The purpose of this study was to evaluate the outcomes of patients with postoperative dislocation after RSA managed with closed reduction. Methods All patients who were treated with a closed reduction for dislocation after RSA in the period between May 2002 and September 2011 were identified and retrospectively reviewed. Final outcomes including recurrent instability, need for revision surgery, American Shoulder and Elbow Surgeons outcome score, and range of motion were evaluated. Results A total of 21 patients were identified. Nearly 50% of cases (10 of 21) had previous surgery, with 80% (8 of 10) of these being previous Arthroplasty. The average time to first dislocation was 200 days, with 62% (13 of 21) occurring in the first 90 days. At average follow-up of 28 months, 62% of these Shoulders remained stable (13 of 21), 29% required revision surgery (6 of 21), and 9% remained unstable (2 of 21). The average American Shoulder and Elbow Surgeons score was 68.0 for patients treated with closed reduction for instability and 62.7 for those treated with revision surgery ( P  = .64). Discussion This study shows that an initial dislocation episode after RSA with use of this implant can be successfully managed with closed reduction and temporary immobilization in more than half of cases. Given that outcomes after revision surgery are not different from those after closed treatment, we would continue to recommend an initial attempt at closed reduction in the office setting in all cases of postoperative RSA dislocation.

  • accuracy of patient specific guided glenoid baseplate positioning for Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2014
    Co-Authors: Jonathan C Levy, Mark A Frankle, Nathan G Everding, Louis Keppler
    Abstract:

    Background The accuracy of reproducing a surgical plan during Shoulder Arthroplasty is improved by computer assistance. Intraoperative navigation, however, is challenged by increased surgical time and additional technically difficult steps. Patient-matched instrumentation has the potential to reproduce a similar degree of accuracy without the need for additional surgical steps. The purpose of this study was to examine the accuracy of patient-specific planning and a patient-specific drill guide for glenoid baseplate placement in Reverse Shoulder Arthroplasty. Methods A patient-specific glenoid baseplate drill guide for Reverse Shoulder Arthroplasty was produced for 14 cadaveric Shoulders based on a plan developed by a virtual preoperative 3-dimensional planning system using thin-cut computed tomography images. Using this patient-specific guide, high-volume Shoulder surgeons exposed the glenoid through a deltopectoral approach and drilled the bicortical pathway defined by the guide. The trajectory of the drill path was compared with the virtual preoperative planned position using similar thin-cut computed tomography images to define accuracy. Results The drill pathway defined by the patient-matched guide was found to be highly accurate when compared with the preoperative surgical plan. The translational accuracy was 1.2 ± 0.7 mm. The accuracy of inferior tilt was 1.2° ± 1.2°. The accuracy of glenoid version was 2.6° ± 1.7°. Conclusion The use of patient-specific glenoid baseplate guides is highly accurate in reproducing a virtual 3-dimensional preoperative plan. This technique delivers the accuracy observed using computerized navigation without any additional surgical steps or technical challenges.

Pascal Boileau - One of the best experts on this subject based on the ideXlab platform.

  • Reverse Shoulder Arthroplasty for type 1 sequelae of a fracture of the proximal humerus
    Journal of Bone and Joint Surgery-british Volume, 2018
    Co-Authors: Patric Raiss, Thomas Bruckner, Pascal Boileau, G Alami, Petra Magosch, P Habermeyer, Gilles Walch
    Abstract:

    Aims The aim of this study was to analyze the results of Reverse Shoulder Arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff ...

  • Reverse Shoulder Arthroplasty for malunions of the proximal part of the humerus type 4 fracture sequelae
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Patric Raiss, Philippe Collin, Thomas Bruckner, Felix Zeifang, Pascal Boileau, Bradley T Edwards, Markus Loew, Gilles Walch
    Abstract:

    Background: The treatment of fracture sequelae of the proximal part of the humerus in combination with posttraumatic arthritis is challenging. The reported results of treatment with anatomic Shoulder Arthroplasty are disappointing. The aim of this multicenter study was to analyze the clinical and radiographic results of Reverse Shoulder Arthroplasty for treatment of posttraumatic sequelae of the proximal part of the humerus with malunion of the tuberosities. Methods: This was a retrospective, multicenter study of 42 patients (42 Shoulders) with the diagnosis of posttraumatic sequelae of the proximal part of the humerus with malunions of the tuberosities who were treated with Reverse Shoulder Arthroplasty between 2000 and 2010. The mean age at the time of Arthroplasty was 68 years (range, 27 to 83 years; median, 70 years). The dominant side was treated in 24 cases. The mean clinical and radiographic follow-up was 4 years (range, 2 to 13 years; median, 3.5 years). The Constant score including subgroups, Shoulder flexion, rotation motion, and radiographs of the affected Shoulders were analyzed before the surgical procedure and at the time of the latest follow-up. Patients categorized their postoperative results as very good, good, satisfactory, or unsatisfactory. Results: The mean Constant score increased from 19.7 points (range, 0 to 52 points) preoperatively to 54.9 points (range, 21 to 83 points) postoperatively (p < 0.0001). All of the subgroups of the Constant score also increased, as did active Shoulder flexion and external rotation (all p < 0.0001). In one case, loosening of the humeral and glenoid components occurred. Scapular notching was present in 22 Shoulders (52%) and was grade 1 in 12 cases, grade 2 in 4 cases, grade 3 in 2 cases, and grade 4 in 4 cases. Complications occurred in 4 patients (9.5%). Eighteen patients (43%) rated their result as very good, 19 (45%) rated their result as good, 4 (10%) rated their result as satisfactory, and one (2%) rated the result as unsatisfactory. Conclusions: Reverse Shoulder Arthroplasty is a viable treatment option for type-4 proximal humeral fracture sequelae that cannot otherwise be treated with anatomic Shoulder replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • Effect of humeral stem design on humeral position and range of motion in Reverse Shoulder Arthroplasty
    International orthopaedics, 2015
    Co-Authors: Alexandre Ladermann, Patrick J Denard, Pascal Boileau, Alain Farron, Pierric Deransart, Alexandre Terrier, Julien Ston, Gilles Walch
    Abstract:

    The impacts of humeral offset and stem design after Reverse Shoulder Arthroplasty (RSA) have not been well-studied, particularly with regard to newer stems which have a lower humeral inclination. The purpose of this study was to analyze the effect of different humeral stem designs on range of motion and humeral position following RSA. Using a three-dimensional computer model of RSA, a traditional inlay Grammont stem was compared to a short curved onlay stem with different inclinations (155°, 145°, 135°) and offset (lateralised vs medialised). Humeral offset, the acromiohumeral distance (AHD), and range of motion were evaluated for each configuration. Altering stem design led to a nearly 7-mm change in humeral offset and 4 mm in the AHD. Different inclinations of the onlay stems had little influence on humeral offset and larger influence on decreasing the AHD. There was a 10° decrease in abduction and a 5° increase in adduction between an inlay Grammont design and an onlay design with the same inclination. Compared to the 155° model, the 135° model improved adduction by 28°, extension by 24° and external rotation of the elbow at the side by 15°, but led to a decrease in abduction of 9°. When the tray was placed medially, on the 145° model, a 9° loss of abduction was observed. With varus inclination prostheses (135° and 145°), elevation remains unchanged, abduction slightly decreases, but a dramatic improvement in adduction, extension and external rotation with the elbow at the side are observed.

  • revision surgery of Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2013
    Co-Authors: Pascal Boileau, Barbara Melis, David Duperron, Gregory Moineau, Adam Rumian, Yung Han
    Abstract:

    Background There is limited knowledge regarding revision of Reverse Shoulder Arthroplasty (RSA). This study assesses reasons for failure in RSA and evaluates the outcomes of revision RSA. Materials and methods Between 1997 and 2009, 37 patients with RSA had revision surgery. Clinical and radiologic examinations performed preoperatively and at 3 months, at 6 months, and then annually postoperatively were analyzed retrospectively. Patients were reviewed with a minimum 2-year follow-up. Results The most common causes for RSA revision were prosthetic instability (48%); humeral loosening, derotation, or fracture (21%); and infection (19%). Only 2 patients (3%) had to be reoperated on for glenoid loosening. More than 1 re-intervention was performed in 11 patients (30%) because of recurrence of the same complication or appearance of a new complication. Underestimation of humeral shortening and excessive medialization were common causes of recurrent prosthetic instability. Proximal humeral bone loss was found to be a cause for humeral loosening or derotation. Previous surgery was found as a potential cause of low-grade infection. At a mean follow-up of 34 months, 32 patients (86%) had retained the RSA whereas 2 patients (6%) had undergone conversion to humeral hemiArthroplasty and 3 (8%) to a resection Arthroplasty. The mean Constant score in patients who retained the RSA increased from 19 points before revision to 47 points at last follow-up ( P Conclusions Even if revision may lead to several procedures in the same patient, preservation or replacement of the RSA is largely possible, allowing for a functional Shoulder. Full-length scaled radiographs of both humeri are recommended to properly assess humeral shortening and excessive medialization before revision.

  • Reverse Shoulder Arthroplasty in patients with pre operative impairment of the deltoid muscle
    Journal of Bone and Joint Surgery-british Volume, 2013
    Co-Authors: Alexandre Ladermann, Patrick J Denard, Philippe Collin, Gilles Walch, Luc Favard, Thomas Bradley Edwards, F Sirveaux, Omar Kherad, Pascal Boileau
    Abstract:

    The indications for Reverse Shoulder Arthroplasty (RSA) continue to be expanded. Associated impairment of the deltoid muscle has been considered a contraindication to its use, as function of the RSA depends on the deltoid and impairment of the deltoid may increase the risk of dislocation. The aim of this retrospective study was to determine the functional outcome and risk of dislocation following the use of an RSA in patients with impaired deltoid function. Between 1999 and 2010, 49 patients (49 Shoulders) with impairment of the deltoid underwent RSA and were reviewed at a mean of 38 months (12 to 142) post-operatively. There were nine post-operative complications (18%), including two dislocations. The mean forward elevation improved from 50° (sd 38; 0° to 150°) pre-operatively to 121° (sd 40; 0° to 170°) at final follow-up (p < 0.001). The mean Constant score improved from 24 (sd 12; 2 to 51) to 58 (sd 17; 16 to 83) (p < 0.001). The mean Single Assessment Numeric Evaluation score was 71 (sd 17; 10 to 95) and the rate of patient satisfaction was 98% (48 of 49) at final follow-up. These results suggest that pre-operative deltoid impairment, in certain circumstances, is not an absolute contraindication to RSA. This form of treatment can yield reliable improvement in function without excessive risk of post-operative dislocation. Cite this article: Bone Joint J 2013;95-B:1106–13.

Bradley T Edwards - One of the best experts on this subject based on the ideXlab platform.

  • Reverse Shoulder Arthroplasty for malunions of the proximal part of the humerus type 4 fracture sequelae
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Patric Raiss, Philippe Collin, Thomas Bruckner, Felix Zeifang, Pascal Boileau, Bradley T Edwards, Markus Loew, Gilles Walch
    Abstract:

    Background: The treatment of fracture sequelae of the proximal part of the humerus in combination with posttraumatic arthritis is challenging. The reported results of treatment with anatomic Shoulder Arthroplasty are disappointing. The aim of this multicenter study was to analyze the clinical and radiographic results of Reverse Shoulder Arthroplasty for treatment of posttraumatic sequelae of the proximal part of the humerus with malunion of the tuberosities. Methods: This was a retrospective, multicenter study of 42 patients (42 Shoulders) with the diagnosis of posttraumatic sequelae of the proximal part of the humerus with malunions of the tuberosities who were treated with Reverse Shoulder Arthroplasty between 2000 and 2010. The mean age at the time of Arthroplasty was 68 years (range, 27 to 83 years; median, 70 years). The dominant side was treated in 24 cases. The mean clinical and radiographic follow-up was 4 years (range, 2 to 13 years; median, 3.5 years). The Constant score including subgroups, Shoulder flexion, rotation motion, and radiographs of the affected Shoulders were analyzed before the surgical procedure and at the time of the latest follow-up. Patients categorized their postoperative results as very good, good, satisfactory, or unsatisfactory. Results: The mean Constant score increased from 19.7 points (range, 0 to 52 points) preoperatively to 54.9 points (range, 21 to 83 points) postoperatively (p < 0.0001). All of the subgroups of the Constant score also increased, as did active Shoulder flexion and external rotation (all p < 0.0001). In one case, loosening of the humeral and glenoid components occurred. Scapular notching was present in 22 Shoulders (52%) and was grade 1 in 12 cases, grade 2 in 4 cases, grade 3 in 2 cases, and grade 4 in 4 cases. Complications occurred in 4 patients (9.5%). Eighteen patients (43%) rated their result as very good, 19 (45%) rated their result as good, 4 (10%) rated their result as satisfactory, and one (2%) rated the result as unsatisfactory. Conclusions: Reverse Shoulder Arthroplasty is a viable treatment option for type-4 proximal humeral fracture sequelae that cannot otherwise be treated with anatomic Shoulder replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • risk factors for periprosthetic infection after Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Brent J Morris, Daniel T Oconnor, Daniel Torres, Hussein A Elkousy, Gary M Gartsman, Bradley T Edwards
    Abstract:

    Background Management of periprosthetic infection after Reverse Shoulder Arthroplasty (RSA) remains a challenge. Whereas the infection rate after RSA has improved, more information would be helpful to identify patient risk factors for infection after RSA. The purpose of this study was to evaluate risk factors for infection after RSA. Methods We identified 301 primary RSAs with a minimum of 1-year follow-up in a prospectively collected Shoulder Arthroplasty registry. We performed bivariate and multivariable logistic regression analyses to assess the association between patient demographic and clinical characteristics (age, sex, smoking, diabetes, rheumatoid arthritis, body mass index, and history of prior failed hemiArthroplasty or total Shoulder Arthroplasty) and periprosthetic infection after RSA. Results There were 15 periprosthetic infections after RSA (5.0%). Patients with a history of RSA for failed Arthroplasty (odds ratio, 5.75; 95% confidence interval, 2.01-16.43; P  = .001) and patients younger than 65 years had an increased risk for development of an infection (odds ratio, 4.0; 95% confidence interval, 1.21-15.35; P  = .021). History of smoking, diabetes, rheumatoid arthritis, or obesity did not contribute to an increased risk of infection after RSA. Conclusions This is the first study evaluating risk factors for infection after RSA while controlling for confounding variables with multivariable analysis. The greatest risk factors for infection after RSA were history of a prior failed Arthroplasty and age younger than 65 years. Patients with these clinical characteristics should be counseled preoperatively about the increased risk for development of infection after RSA.

  • preoperative opioid use and outcomes after Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Brent J Morris, Hussein A Elkousy, Gary M Gartsman, Mitzi S Laughlin, Bradley T Edwards
    Abstract:

    Background The potential adverse effect of preoperative opioid use on outcomes after Reverse Shoulder Arthroplasty (RSA) has not been investigated. The purpose of this study was to evaluate outcomes after RSA in patients with a history of preoperative opioid use and compare them with a control group without a history of preoperative opioid use. Methods Sixty-eight RSAs performed for rotator cuff tear arthropathy (CTA) with a minimum of 2 years of follow-up were identified in a prospective Shoulder Arthroplasty registry. Thirty-two patients with a history of preoperative opioid use for Shoulder pain were compared with a control group of 36 patients who did not use opioids preoperatively. Shoulder function scores and range of motion measurements were assessed preoperatively and at the final follow-up. Results No differences were noted between the 2 groups in age, gender, duration of follow-up, depression, smoking, chronic back pain, diabetes, heart disease, or body mass index. Preoperative opioid use was associated with significantly lower preoperative Shoulder function scores. Both groups significantly improved on all Shoulder function scores and for range of motion measurements from the preoperative to the final follow-up assessment; however, the nonopioid group had significantly better outcomes. The magnitude of change between the groups from preoperatively to the final follow-up was nearly identical. Conclusions Improvements can be expected in patients with a history of preoperative opioid use; however, patients with preoperative opioid use have a lower preoperative baseline and should not expect to reach the same peak outcome scores after RSA as patients without a history of preoperative opioid use.

  • Reverse Shoulder Arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus type 3 fracture sequelae
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Patric Raiss, Thomas Bruckner, Bradley T Edwards, Markus Loew, Manuel Ribeiro Da Silva, Gilles Walch
    Abstract:

    Background: Fracture sequelae of the proximal part of the humerus are challenging conditions, and various treatment options have been described. The purpose of this multicenter study was to analyze the clinical and radiographic outcomes as well as the complications following semiconstrained Reverse total Shoulder Arthroplasty for the treatment of nonunion of a surgical neck fracture of the proximal part of the humerus. Methods: Thirty-two patients with a mean age of sixty-eight years (range, forty-eight to eighty-three years) managed with a Reverse Shoulder Arthroplasty for the treatment of nonunion of a proximal humeral fracture were analyzed clinically and radiographically. The mean duration of follow-up was four years (range, two to twelve years). The Constant score, active Shoulder mobility, all complications, and revision procedures were recorded. Results: The mean Constant score increased from 14.2 points (range, 2 to 35 points) to 46.6 points (range, 6 to 75 points) (p < 0.001). The mean Shoulder flexion increased from 42.9° (range, 0° to 160°) to 109.7° (range, 0° to 170°) (p < 0.001), and the mean external rotation increased from 0.5° (range, −40° to 60°) to 13.1° (range, −30° to 60°) (p < 0.005). No component loosening occurred, but 50% (sixteen) of the patients had radiographic evidence of scapular notching. There were thirteen complications (41%) leading to nine revision surgical procedures (28%). The most common complication was a dislocation following Reverse Shoulder Arthroplasty, which occurred in 34% (eleven) of the patients. An intraoperative resection of the humeral head fragment and the tuberosities was associated with increased risk of dislocation (p < 0.007). Conclusions: Nonunions of the proximal part of the humerus can be treated with Reverse Shoulder Arthroplasty. Although clinical outcomes improved significantly, we found an unacceptably high rate of dislocations associated with intraoperative resection of the tuberosities. The tuberosities and the attached rotator cuff should be preserved if possible to reduce the risk of dislocation after Reverse total Shoulder Arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • influence of arm lengthening in Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2012
    Co-Authors: Alexandre Ladermann, Philippe Collin, Gilles Walch, Bradley T Edwards, Guillaume Bacle, Barbara Melis, Anne Lubbeke, Gregory N Drake, Francois Sirveaux
    Abstract:

    Adequate deltoid tension obtained through restoration of humeral and arm length is one of the keys for postoperative function and prevention of instability following Reverse Shoulder Arthroplasty (RSA). With a classic Grammont prosthesis, postoperative humeral lengthening is approximately 2 mm and arm lengthening is approximately 24 mm. Humeral and arm lengthening have been correlated with stability and improvement in active anterior elevation, whereas shortening of these variables leads to an increased risk of dislocation and poor active anterior elevation, respectively. Subclinical neurologic lesions are a frequent consequence of lengthening with a drastically increasing prevalence above 40 mm of arm lengthening. Therefore, arm lengthening should be controlled with 0–2 cm being a reasonable goal to avoid postoperative neurological impairment. Preoperative planning is mandatory in revision cases. However, current conventional radiographic preoperative planning techniques are limited.

Ryan T Bicknell - One of the best experts on this subject based on the ideXlab platform.

  • comparing conventional and computer assisted surgery baseplate and screw placement in Reverse Shoulder Arthroplasty
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Gabriel Venne, Brian J Rasquinha, David R Pichora, Randy E Ellis, Ryan T Bicknell
    Abstract:

    Background Preoperative planning and intraoperative navigation technologies have each been shown separately to be beneficial for optimizing screw and baseplate positioning in Reverse Shoulder Arthroplasty (RSA) but to date have not been combined. This study describes development of a system for performing computer-assisted RSA glenoid baseplate and screw placement, including preoperative planning, intraoperative navigation, and postoperative evaluation, and compares this system with a conventional approach. Materials and methods We used a custom-designed system allowing computed tomography (CT)–based preoperative planning, intraoperative navigation, and postoperative evaluation. Five orthopedic surgeons defined common preoperative plans on 3-dimensional CT reconstructed cadaveric Shoulders. Each surgeon performed 3 computer-assisted and 3 conventional simulated procedures. The 3-dimensional CT reconstructed postoperative units were digitally matched to the preoperative model for evaluation of entry points, end points, and angulations of screws and baseplate. Values were used to find accuracy and precision of the 2 groups with respect to the defined placement. Statistical analysis was performed by t tests (α = .05). Results Comparison of the groups revealed no difference in accuracy or precision of screws or baseplate entry points ( P  > .05). Accuracy and precision were improved with use of navigation for end points and angulations of 3 screws ( P P  > .05). Navigated baseplate end point precision was improved ( P P  > .05). Conclusion We conclude that CT-based preoperative planning and intraoperative navigation allow improved accuracy and precision for screw placement and precision for baseplate positioning with respect to a predefined placement compared with conventional techniques in RSA.

  • Reverse Shoulder Arthroplasty combined with a modified latissimus dorsi and teres major tendon transfer for Shoulder pseudoparalysis associated with dropping arm
    Clinical Orthopaedics and Related Research, 2008
    Co-Authors: Pascal Boileau, Ryan T Bicknell, Christopher Chuinard, Yannick Roussanne, Nathalie Rochet, Christophe Trojani
    Abstract:

    Although a Reverse Shoulder Arthroplasty (RSA) can restore active elevation in the cuff deficient Shoulder, it cannot restore active external rotation when both the infraspinatus and teres minor muscles are absent or atrophied. We hypothesized that a latissimus dorsi and teres major (LD/TM) transfer with a concomitant RSA would restore Shoulder function and activities of daily living (ADLs). We prospectively followed 11 consecutive patients (mean age, 70 years) with a combined loss of active elevation and external rotation (Shoulder pseudoparalysis and dropping arm) who underwent this procedure. All had severe cuff tear arthropathy (Hamada Stage 3, 4, or 5) and severe atrophy or fatty infiltration of infraspinatus and teres minor on preoperative MRI or CT-scan. The combined procedure was performed through a single deltopectoral approach in the same session. Postoperatively, mean active elevation increased from 70° to 148° (+78°) and external rotation from −18° to 18° (+36°). The Constant score, subjective assessment and ADLs improved. The combination of a RSA and LD/TM transfer restored both active elevation and external rotation in this selected subgroup of patients with a cuff deficient Shoulder and absent or atrophied infraspinatus and teres minor.