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John W Sperling - One of the best experts on this subject based on the ideXlab platform.
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MANAGING THE INFECTED Shoulder Arthroplasty
2019Co-Authors: John W SperlingAbstract:There remains to be substantial debate on the best treatment of the infected Shoulder Arthroplasty. Infection after Shoulder Arthroplasty is an uncommon but devastating complication with a reported...
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Shoulder Arthroplasty in patients with osteo-chondrodysplasias
International orthopaedics, 2017Co-Authors: Bradley S. Schoch, Robert H. Cofield, John W Sperling, Jean-david Werthel, Joaquin Sanchez-sotelo, Mark E. MorreyAbstract:Osteo-chondrodysplasias are a rare cause of limb malalignment, deformity and degenerative joint disease. Earlier in life, deformities may be managed with bony realignment and soft tissue releases; however, as degenerative changes progress, Arthroplasty may be considered. There are limited reports examining Shoulder Arthroplasty in this population. This study aims to assess pain relief, function, and re-operation rate of Shoulder Arthroplasty in patients with osteo-chondrodysplasias. Between January 1984 and December 2012, 13 Shoulders with end-stage arthritis secondary to osteo-chondrodysplasia underwent Shoulder Arthroplasty. Three were treated with hemiArthroplasty (HA), nine with anatomic total Shoulder Arthroplasty (TSA), and one with a reverse total Shoulder Arthroplasty (RSA). All Shoulders were followed for two years or until reoperation (mean 7.9 years, range 2–25). Shoulder Arthroplasty significantly improved pain, elevation, external rotation, and internal rotation. All but one patient considered their Shoulder to be better than pre-operatively; however, only two Shoulders received an excellent Neer rating. Seven Shoulders had satisfactory Neer ratings and four unsatisfactory. One TSA was converted to a RSA for aseptic glenoid loosening at 9.5 years (re-operation rate 8%). Pain relief and improved function can be expected in patients with osteo-chondrodysplasias despite challenging anatomy. Unlike the only previous case series reporting a 31% revision rate at mean follow-up of seven years, our series shows the incidence of failure to be much lower. With the advent of smaller humeral components, the need for custom implants may not be necessary, and surgeons may intervene earlier and more confidently in this population. Level of evidence: IV case series
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Is Shoulder Arthroplasty an option for charcot arthropathy
International orthopaedics, 2016Co-Authors: Bradley S. Schoch, Robert H. Cofield, John W Sperling, Jean-david Werthel, Joaquin Sanchez-soteloAbstract:Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder Arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control. The purpose of this study is to review the outcomes, complications, and survivorship of Shoulder Arthroplasty for Charcot arthropathy. Between January 2000 and December 2011, ten Shoulders with Charcot arthropathy were treated with Shoulder Arthroplasty at our Institution (six hemiArthroplasty, one total Shoulder Arthroplasty, three reverse Shoulder Arthroplasty). Shoulders were followed for a minimum of two years or until re-operation. Outcomes measures included pain, range of motion, complications, and reoperation. Shoulder Arthroplasty improved pain to a mean score of 2.6 at follow up. However, gains in range of motion were not as substantial, with mean elevation of only 105°. External rotation improved from 20 to 43°. Subjectively, six of the ten patients rated the result as much better or better. Two Shoulders underwent revision surgery at an average of five months after index Arthroplasty. Shoulder Arthroplasty for the treatment of the sequelae of a Charcot joint is a reasonable treatment option to provide substantial pain relief and improved motion. The relative indications of hemiArthroplasty, total Shoulder Arthroplasty, and reverse Shoulder Arthroplasty for this particular condition continue to evolve.
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Shoulder Arthroplasty for chondrolysis
Journal of shoulder and elbow surgery, 2016Co-Authors: Bradley S. Schoch, Robert H. Cofield, Jean-david Werthel, Joaquin Sanchez-sotelo, John W SperlingAbstract:Background Chondrolysis is a rare complication after Shoulder arthroscopy leading to early joint destruction. Shoulder Arthroplasty may be considered for end-stage chondrolysis, but concerns exist about implant survivorship, given the younger age of this population. This study aimed to assess pain relief, function, and survivorship of Shoulder Arthroplasty for chondrolysis and to assess risk factors for failure. Methods Between January 2000 and January 2013, 26 consecutive Shoulders with chondrolysis were treated at our institution with Shoulder Arthroplasty. All Shoulders had a prior arthroscopic procedure that predated a phase of rapid joint destruction. Twenty-three Shoulders were followed up for a minimum of 2 years or until reoperation (mean, 4.0 years; range, 0.7-8.6 years). The mean age of the patients was 40 years (range, 21-58 years). Outcome measures included pain, range of motion, postoperative modified Neer ratings, American Shoulder and Elbow Surgeons scores, complications, and reoperations. Results At most recent follow-up, only 14 of 23 Shoulders had no or mild pain. Overall pain scores improved from 4.7 to 2.6 points. Abduction and external rotation improved significantly. Five Shoulders required reoperation, 2 for glenoid loosening and 1 each for infection, instability, and stiffness. Subjectively, 8 patients rated their Shoulder as much better, 7 as better, 4 the same, and 4 worse. Most recent American Shoulder and Elbow Surgeons scores averaged 64 points (range, 20-95 points). Conclusions Shoulder Arthroplasty for the treatment of chondrolysis improves pain and range of motion. However, patient satisfaction is variable. Early follow-up shows a higher than expected rate of reoperation (25%). Patients undergoing Shoulder Arthroplasty for chondrolysis should be counseled appropriately about expectations after surgery.
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Shoulder Arthroplasty for sequelae of poliomyelitis.
Journal of shoulder and elbow surgery, 2015Co-Authors: Jean-david Werthel, Robert H. Cofield, John W Sperling, Bradley S. Schoch, Bassem T. ElhassanAbstract:Background Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of Arthroplasty in Shoulders with sequelae of poliomyelitis. Methods Seven patients (average age, 70 years) were treated between 1976 and 2013 with Shoulder Arthroplasty for the sequelae of polio. One patient underwent reverse Shoulder Arthroplasty, 2 had a hemiArthroplasty, and 4 had total Shoulder Arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Results Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after Shoulder Arthroplasty. Six Shoulders had no or mild pain at latest follow-up, and 6 Shoulders rated the result as much better or better. Mean Shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 Shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No Shoulder required revision or reoperation. Conclusions Shoulder Arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made.
Ronald A Navarro - One of the best experts on this subject based on the ideXlab platform.
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yearly trends in elective Shoulder Arthroplasty 2005 2013
Arthritis Care and Research, 2017Co-Authors: Mark T Dillon, Priscilla H Chan, Maria C S Inacio, Anshuman Singh, Edward H Yian, Ronald A NavarroAbstract:Objective: The purposes of this study were to evaluate the (1) change in incidence rate of Shoulder Arthroplasty, the (2) utilization of Shoulder Arthroplasty for specific indications, and the (3) surgeon volume trends associated with these procedures between 2005 and 2013. Methods: A population based cohort study was conducted using the over 7 million members of an integrated healthcare system in California. Shoulder Arthroplasty cases performed between 2005 and 2013 were identified using a Shoulder Arthroplasty Registry. Annual Shoulder Arthroplasty incidence rates per 100,000 patients were determined, and adjusted yearly changes in rates were estimated using incidence rate ratios (IRRs). Changes in surgeon volumes by year and number of surgeons performing different procedures were also compared. Results: The incidence of Shoulder Arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013. In patients with osteoarthritis, there was increasing utilization of total Shoulder Arthroplasty (IRR=1.12, 95% CI 1.11-1.14) and decreasing utilization of hemiArthroplasty (IRR=0.91, 95% CI 0.89-0.94). For patients with rotator cuff tear arthropathy, there was an increase in utilization of reverse total Shoulder Arthroplasty (IRR=1.33, 95% CI 1.29-1.37) but no change in hemiArthroplasty (IRR=0.99, 95% CI 0.92-1.05). The average surgeon yearly volume increased for total Shoulder Arthroplasty (p-value<0.001) and reverse total Shoulder Arthroplasty (p-value=0.020). Conclusion: Shoulder Arthroplasty is being used with greater frequency in this community based population. Surgeons are performing a higher yearly volume of Shoulder Arthroplasty, specifically total Shoulder Arthroplasty and reverse total Shoulder Arthroplasty. This article is protected by copyright. All rights reserved.
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Yearly Trends in Elective Shoulder Arthroplasty, 2005–2013
Arthritis care & research, 2017Co-Authors: Mark T Dillon, Priscilla H Chan, Maria C S Inacio, Anshuman Singh, Edward H Yian, Ronald A NavarroAbstract:Objective: The purposes of this study were to evaluate the (1) change in incidence rate of Shoulder Arthroplasty, the (2) utilization of Shoulder Arthroplasty for specific indications, and the (3) surgeon volume trends associated with these procedures between 2005 and 2013. Methods: A population based cohort study was conducted using the over 7 million members of an integrated healthcare system in California. Shoulder Arthroplasty cases performed between 2005 and 2013 were identified using a Shoulder Arthroplasty Registry. Annual Shoulder Arthroplasty incidence rates per 100,000 patients were determined, and adjusted yearly changes in rates were estimated using incidence rate ratios (IRRs). Changes in surgeon volumes by year and number of surgeons performing different procedures were also compared. Results: The incidence of Shoulder Arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013. In patients with osteoarthritis, there was increasing utilization of total Shoulder Arthroplasty (IRR=1.12, 95% CI 1.11-1.14) and decreasing utilization of hemiArthroplasty (IRR=0.91, 95% CI 0.89-0.94). For patients with rotator cuff tear arthropathy, there was an increase in utilization of reverse total Shoulder Arthroplasty (IRR=1.33, 95% CI 1.29-1.37) but no change in hemiArthroplasty (IRR=0.99, 95% CI 0.92-1.05). The average surgeon yearly volume increased for total Shoulder Arthroplasty (p-value
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Mortality After Shoulder Arthroplasty
The Journal of arthroplasty, 2014Co-Authors: Maria C S Inacio, Mark T Dillon, Ronald A Navarro, Alexander Miric, Faith Anthony, Elizabeth W. PaxtonAbstract:Abstract One year post-operative mortality among patients with primary elective total Shoulder Arthroplasty (ETSA) and traumatic Shoulder Arthroplasty (TSA) were compared to the general population of a large healthcare system. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. 614 ETSA patients, 1.0% one year mortality, and 168 TSA patients, 5.4% mortality rate, were evaluated. Patients with ETSA (SMR = 0.4, 95% CI 0.1–0.7) had lower odds of mortality than expected, while patients with TSA (SMR = 1.8, 95% CI 0.6–3.0) did not have higher than expected odds of mortality compared to the reference population. Understanding excess mortality following Shoulder Arthroplasty surgery allows providers to evaluate current practices and identify ways to optimize patients prior to surgery.
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The effect of surgeon and hospital volume on Shoulder Arthroplasty perioperative quality metrics
Journal of shoulder and elbow surgery, 2014Co-Authors: Anshu Singh, Mark T Dillon, Edward H Yian, Miwa Takayanagi, Mary F. Burke, Ronald A NavarroAbstract:Background There has been a significant increase in both the incidence of Shoulder Arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern Shoulder Arthroplasty is limited. This study examines the effect of surgeon or hospital Shoulder Arthroplasty volume on perioperative metrics related to Shoulder hemiArthroplasty, total Shoulder Arthroplasty, and reverse Shoulder Arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. Methods Prospective data were analyzed from a multicenter Shoulder Arthroplasty registry; 1176 primary Shoulder Arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index. Results Surgeon volume is inversely correlated with length of stay for hemiArthroplasty and total Shoulder Arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiArthroplasty, with blood loss for total and reverse Shoulder Arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed Shoulder Arthroplasty 30 to 50 minutes faster than low-volume surgeons did. Conclusions Higher surgeon and hospital case volumes led to improved perioperative metrics with all Shoulder Arthroplasty procedures, including reverse total Shoulder Arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex Shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers.
Mark T Dillon - One of the best experts on this subject based on the ideXlab platform.
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yearly trends in elective Shoulder Arthroplasty 2005 2013
Arthritis Care and Research, 2017Co-Authors: Mark T Dillon, Priscilla H Chan, Maria C S Inacio, Anshuman Singh, Edward H Yian, Ronald A NavarroAbstract:Objective: The purposes of this study were to evaluate the (1) change in incidence rate of Shoulder Arthroplasty, the (2) utilization of Shoulder Arthroplasty for specific indications, and the (3) surgeon volume trends associated with these procedures between 2005 and 2013. Methods: A population based cohort study was conducted using the over 7 million members of an integrated healthcare system in California. Shoulder Arthroplasty cases performed between 2005 and 2013 were identified using a Shoulder Arthroplasty Registry. Annual Shoulder Arthroplasty incidence rates per 100,000 patients were determined, and adjusted yearly changes in rates were estimated using incidence rate ratios (IRRs). Changes in surgeon volumes by year and number of surgeons performing different procedures were also compared. Results: The incidence of Shoulder Arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013. In patients with osteoarthritis, there was increasing utilization of total Shoulder Arthroplasty (IRR=1.12, 95% CI 1.11-1.14) and decreasing utilization of hemiArthroplasty (IRR=0.91, 95% CI 0.89-0.94). For patients with rotator cuff tear arthropathy, there was an increase in utilization of reverse total Shoulder Arthroplasty (IRR=1.33, 95% CI 1.29-1.37) but no change in hemiArthroplasty (IRR=0.99, 95% CI 0.92-1.05). The average surgeon yearly volume increased for total Shoulder Arthroplasty (p-value<0.001) and reverse total Shoulder Arthroplasty (p-value=0.020). Conclusion: Shoulder Arthroplasty is being used with greater frequency in this community based population. Surgeons are performing a higher yearly volume of Shoulder Arthroplasty, specifically total Shoulder Arthroplasty and reverse total Shoulder Arthroplasty. This article is protected by copyright. All rights reserved.
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Yearly Trends in Elective Shoulder Arthroplasty, 2005–2013
Arthritis care & research, 2017Co-Authors: Mark T Dillon, Priscilla H Chan, Maria C S Inacio, Anshuman Singh, Edward H Yian, Ronald A NavarroAbstract:Objective: The purposes of this study were to evaluate the (1) change in incidence rate of Shoulder Arthroplasty, the (2) utilization of Shoulder Arthroplasty for specific indications, and the (3) surgeon volume trends associated with these procedures between 2005 and 2013. Methods: A population based cohort study was conducted using the over 7 million members of an integrated healthcare system in California. Shoulder Arthroplasty cases performed between 2005 and 2013 were identified using a Shoulder Arthroplasty Registry. Annual Shoulder Arthroplasty incidence rates per 100,000 patients were determined, and adjusted yearly changes in rates were estimated using incidence rate ratios (IRRs). Changes in surgeon volumes by year and number of surgeons performing different procedures were also compared. Results: The incidence of Shoulder Arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013. In patients with osteoarthritis, there was increasing utilization of total Shoulder Arthroplasty (IRR=1.12, 95% CI 1.11-1.14) and decreasing utilization of hemiArthroplasty (IRR=0.91, 95% CI 0.89-0.94). For patients with rotator cuff tear arthropathy, there was an increase in utilization of reverse total Shoulder Arthroplasty (IRR=1.33, 95% CI 1.29-1.37) but no change in hemiArthroplasty (IRR=0.99, 95% CI 0.92-1.05). The average surgeon yearly volume increased for total Shoulder Arthroplasty (p-value
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Mortality After Shoulder Arthroplasty
The Journal of arthroplasty, 2014Co-Authors: Maria C S Inacio, Mark T Dillon, Ronald A Navarro, Alexander Miric, Faith Anthony, Elizabeth W. PaxtonAbstract:Abstract One year post-operative mortality among patients with primary elective total Shoulder Arthroplasty (ETSA) and traumatic Shoulder Arthroplasty (TSA) were compared to the general population of a large healthcare system. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. 614 ETSA patients, 1.0% one year mortality, and 168 TSA patients, 5.4% mortality rate, were evaluated. Patients with ETSA (SMR = 0.4, 95% CI 0.1–0.7) had lower odds of mortality than expected, while patients with TSA (SMR = 1.8, 95% CI 0.6–3.0) did not have higher than expected odds of mortality compared to the reference population. Understanding excess mortality following Shoulder Arthroplasty surgery allows providers to evaluate current practices and identify ways to optimize patients prior to surgery.
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The effect of surgeon and hospital volume on Shoulder Arthroplasty perioperative quality metrics
Journal of shoulder and elbow surgery, 2014Co-Authors: Anshu Singh, Mark T Dillon, Edward H Yian, Miwa Takayanagi, Mary F. Burke, Ronald A NavarroAbstract:Background There has been a significant increase in both the incidence of Shoulder Arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern Shoulder Arthroplasty is limited. This study examines the effect of surgeon or hospital Shoulder Arthroplasty volume on perioperative metrics related to Shoulder hemiArthroplasty, total Shoulder Arthroplasty, and reverse Shoulder Arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. Methods Prospective data were analyzed from a multicenter Shoulder Arthroplasty registry; 1176 primary Shoulder Arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index. Results Surgeon volume is inversely correlated with length of stay for hemiArthroplasty and total Shoulder Arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiArthroplasty, with blood loss for total and reverse Shoulder Arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed Shoulder Arthroplasty 30 to 50 minutes faster than low-volume surgeons did. Conclusions Higher surgeon and hospital case volumes led to improved perioperative metrics with all Shoulder Arthroplasty procedures, including reverse total Shoulder Arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex Shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers.
Gilles Walch - One of the best experts on this subject based on the ideXlab platform.
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Complications in total Shoulder Arthroplasty.
Instructional course lectures, 2013Co-Authors: John W Sperling, Gilles Walch, Richard J Hawkins, Andrew P Mahoney, Joseph D. ZuckermanAbstract:A wider spectrum of complications associated with Shoulder Arthroplasty is expected because of the substantial increase in the prevalence of this procedure over the past decade. It is helpful to review the management and methods needed to prevent the most common complications associated with Shoulder Arthroplasty.
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Reverse Shoulder Arthroplasty
Current Reviews in Musculoskeletal Medicine, 2011Co-Authors: Christopher J. Smithers, Allan A. Young, Gilles WalchAbstract:The reverse Shoulder Arthroplasty emerged as a potential solution for those patients who could not be managed effectively with a conventional total Shoulder Arthroplasty. Grammont revolutionized the design by medializing and distalizing the center of rotation and utilizing a large convex glenoid surface and concave humeral component with a neck-shaft angle of 155°. This design has been highly successful in cuff deficient Shoulders, and indications continue to broaden. Many mid-term studies have improved upon the early encouraging results. Long-term studies are starting to emerge, demonstrating good survivorship, but progressive functional and radiographic deterioration continue to be concerning. Careful patient selection and attention to appropriate technique are required to reduce the current high rate of complications. New prosthesis designs are continuing to develop to address some of these limitations.
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Prevalence of neurologic lesions after total Shoulder Arthroplasty.
The Journal of bone and joint surgery. American volume, 2011Co-Authors: Alexandre Lädermann, Anne Lübbeke, Barbara Melis, Richard Stern, Panayiotis Christofilopoulos, Guillaume Bacle, Gilles WalchAbstract:Background: Clinically evident neurologic injury of the involved limb after total Shoulder Arthroplasty is not uncommon, but the subclinical prevalence is unknown. The purposes of this prospective study were to determine the subclinical prevalence of neurologic lesions after reverse Shoulder Arthroplasty and anatomic Shoulder Arthroplasty, and to evaluate the correlation of neurologic injury to postoperative lengthening of the arm. Methods: All patients undergoing either a reverse or an anatomic Shoulder Arthroplasty were included during the period studied. This study focused on the clinical, radiographic, and preoperative and postoperative electromyographic evaluation, with measurement of arm lengthening in patients who had reverse Shoulder Arthroplasty according to a previously validated protocol. Results: Between November 2007 and February 2009, forty-one patients (forty-two Shoulders) underwent reverse Shoulder Arthroplasty (nineteen Shoulders) or anatomic primary Shoulder Arthroplasty (twenty-three Shoulders). The two groups were similar with respect to sex distribution, preoperative neurologic lesions, and Constant score. Electromyography performed at a mean of 3.6 weeks postoperatively in the reverse Shoulder Arthroplasty group showed subclinical electromyographic changes in nine Shoulders, involving mainly the axillary nerve; eight resolved in less than six months. In the anatomic Shoulder Arthroplasty group, a brachial plexus lesion was evident in one Shoulder. The prevalence of acute postoperative nerve injury was significantly more frequent in the reverse Shoulder Arthroplasty group (p = 0.002), with a 10.9 times higher risk (95% confidence interval, 1.5 to 78.5). Mean lengthening (and standard deviation) of the arm after reverse Shoulder Arthroplasty was 2.7 ± 1.8 cm (range, 0 to 5.9 cm) compared with the normal, contralateral side. Conclusions: The occurrence of peripheral neurologic lesions following reverse Shoulder Arthroplasty is relatively common, but usually transient. Arm lengthening with a reverse Shoulder Arthroplasty may be responsible for these nerve injuries.
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The reverse total Shoulder Arthroplasty.
Instructional course lectures, 2008Co-Authors: Frederick A Matsen Iii, Pascal Boileau, Gilles Walch, Christian Gerber, Ryan T BicknellAbstract:A reverse total Shoulder Arthroplasty is a prosthesis that should be used in patients who have specific contraindications to the more conventional total Shoulder prosthetic replacements. The patient and surgeon should understand that this reconstruction is technically more difficult and is associated with more complications than conventional Shoulder reconstructions. The reverse total Shoulder Arthroplasty has been used in Europe more than in North America, and the experience in Europe is guiding its use in North America. An understanding of the mechanics of the reverse total Shoulder Arthroplasty and the technical details of its implantation will help in understanding its role in Shoulder reconstruction.
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the reverse total Shoulder Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Frederick A Matsen, Pascal Boileau, Gilles Walch, Christian Gerber, Ryan T BicknellAbstract:A reverse total Shoulder Arthroplasty is a procedure considered for patients whose Shoulder problem cannot be effectively managed with a conventional total Shoulder replacement. The reverse total Shoulder prosthesis is based on a concept introduced by Professor Paul Grammont, in which a convex articular surface is fixed to the glenoid and a concave articular surface is fixed to the proximal part of the humerus1 (Fig. 1). This prosthesis addresses some of the limitations of conventional Arthroplasty. To understand the role of the reverse total Shoulder Arthroplasty, one must first understand the limitations of conventional Arthroplasty. A conventional or anatomic Shoulder Arthroplasty is the replacement of damaged joint surfaces with prosthetic components that approximate the normal joint surfaces and are stabilized by mechanisms similar to those stabilizing a native glenohumeral joint. In performing a conventional Arthroplasty, the surgeon is faced with the following limitations. ### Limited Ability to Manage Glenohumeral Translation The normal glenohumeral joint consists of a small, shallow concave glenoid with a compliant rim for articulation with a spherical humeral head. The small articular surface and minimal constraint of the glenoid allow a large range of rotational motion before the humeral neck abuts on the glenoid rim. They also allow small physiologic translations of the humeral head on the glenoid in response to loads that are applied tangential to the glenoid joint surface. Translation also occurs at the extremes of glenohumeral motion, permitting a greater range of motion than would be possible if the humeral head did not translate. While the compliant rim of the normal glenoid enables full surface contact during small humeral translations, this attribute is not replicated by the much less compliant polyethylene joint surface of a conventional Shoulder Arthroplasty. If the prosthetic glenoid surface conforms exactly to the humeral head (i.e., if each has the same radius of curvature), no translation …
Pascal Boileau - One of the best experts on this subject based on the ideXlab platform.
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Revision Reverse Shoulder Arthroplasty.
The Journal of the American Academy of Orthopaedic Surgeons, 2019Co-Authors: Peter N. Chalmers, Anthony A. Romeo, Pascal Boileau, Robert Z. TashjianAbstract:As Shoulder Arthroplasty becomes increasingly common, the burden of revision Shoulder Arthroplasty is also increasing. Revision reverse Shoulder Arthroplasty requires an understanding of the causes of failure and the evaluation of these causes and their sequelae, including infection, instability, component loosening, humeral bone loss, and glenoid bone loss. Revision reverse Shoulder Arthroplasty is technically complex. On the humeral side, corticotomy may be required for component removal, and bone grafting may be necessary to achieve rotational stability and to restore humeral length and avoid undertensioning and instability. On the glenoid side, bone loss is common, structural bone grafting is not infrequently required, and proper component positioning is required to avoid impingement and component loosening. Although the outcomes are generally inferior to primary reverse total Shoulder Arthroplasty and complications and revision surgeries are common, revision procedures still lead to notable improvements in pain, motion, and function.
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Revision Shoulder Arthroplasty
Textbook of Shoulder Surgery, 2019Co-Authors: Adam J. Seidl, Derek Axibal, Mikaël Chelli, Pascal BoileauAbstract:Described in 1983, Dr. Jules-Emile Pean performed the first glenohumeral joint Arthroplasty to replace a Shoulder damaged by tuberculosis [1, 2]. Since then, the indications for Shoulder Arthroplasty have expanded, including primary osteoarthritis, rotator cuff arthropathy, acute trauma, post-traumatic arthritis, inflammatory disease, osteonecrosis and tumors. In their epidemiological study of Shoulder Arthroplasty in the United States (US), Jain et al. found that primary Shoulder arthroplasties increased from ~52,000 in 2009 to ~67,000 in 2011. In 2011, anatomic Shoulder arthroplasties accounted for ~29,000 (44%), reverse Shoulder arthroplasties comprised ~22,000 (32%), and hemiarthroplasties comprised ~16,000 (23%) [3]. Westermann et al. found similar numbers in the US in 2011 [4]. As the number of Shoulder replacements continues to grow, so do the complications and need for subsequent revision surgeries. Unfortunately, complications after Shoulder Arthroplasty are not uncommon and oftentimes require revision surgery. Bohsali et al. found 404 complications in their analysis of 2540 Shoulder arthroplasties (15.9%) [2]. Others have reported similar complication rates [5, 6]. Jain found that the number of revision cases increased from 5070 in 2009 to 6028 in 2011 in the US, accounting for ~8% of all cases. Labek found revision rates of 8% in Norway and 6% in New Zealand [7]. Slightly higher numbers were seen in Farvard’s study in France, with a 11.2% revision rate in anatomic arthroplasties and 13.4% in reverse implants [8]. With an increase in the numbers of Shoulder arthroplasties performed each year, it is important that Shoulder surgeons recognize the common modes of failure and have strategies to address this failure with revision Shoulder Arthroplasty. This chapter outlines the different modes of failure for Shoulder Arthroplasty, including patient presentation and necessary investigations. Furthermore, this chapter discusses strategies and surgical techniques for revision Shoulder Arthroplasty and associated results.
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The reverse total Shoulder Arthroplasty.
Instructional course lectures, 2008Co-Authors: Frederick A Matsen Iii, Pascal Boileau, Gilles Walch, Christian Gerber, Ryan T BicknellAbstract:A reverse total Shoulder Arthroplasty is a prosthesis that should be used in patients who have specific contraindications to the more conventional total Shoulder prosthetic replacements. The patient and surgeon should understand that this reconstruction is technically more difficult and is associated with more complications than conventional Shoulder reconstructions. The reverse total Shoulder Arthroplasty has been used in Europe more than in North America, and the experience in Europe is guiding its use in North America. An understanding of the mechanics of the reverse total Shoulder Arthroplasty and the technical details of its implantation will help in understanding its role in Shoulder reconstruction.
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the reverse total Shoulder Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Frederick A Matsen, Pascal Boileau, Gilles Walch, Christian Gerber, Ryan T BicknellAbstract:A reverse total Shoulder Arthroplasty is a procedure considered for patients whose Shoulder problem cannot be effectively managed with a conventional total Shoulder replacement. The reverse total Shoulder prosthesis is based on a concept introduced by Professor Paul Grammont, in which a convex articular surface is fixed to the glenoid and a concave articular surface is fixed to the proximal part of the humerus1 (Fig. 1). This prosthesis addresses some of the limitations of conventional Arthroplasty. To understand the role of the reverse total Shoulder Arthroplasty, one must first understand the limitations of conventional Arthroplasty. A conventional or anatomic Shoulder Arthroplasty is the replacement of damaged joint surfaces with prosthetic components that approximate the normal joint surfaces and are stabilized by mechanisms similar to those stabilizing a native glenohumeral joint. In performing a conventional Arthroplasty, the surgeon is faced with the following limitations. ### Limited Ability to Manage Glenohumeral Translation The normal glenohumeral joint consists of a small, shallow concave glenoid with a compliant rim for articulation with a spherical humeral head. The small articular surface and minimal constraint of the glenoid allow a large range of rotational motion before the humeral neck abuts on the glenoid rim. They also allow small physiologic translations of the humeral head on the glenoid in response to loads that are applied tangential to the glenoid joint surface. Translation also occurs at the extremes of glenohumeral motion, permitting a greater range of motion than would be possible if the humeral head did not translate. While the compliant rim of the normal glenoid enables full surface contact during small humeral translations, this attribute is not replicated by the much less compliant polyethylene joint surface of a conventional Shoulder Arthroplasty. If the prosthetic glenoid surface conforms exactly to the humeral head (i.e., if each has the same radius of curvature), no translation …
