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Russell F. Warren - One of the best experts on this subject based on the ideXlab platform.
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anterior deltoid deficiency in reverse total Shoulder Replacement a biomechanical study with cadavers
Journal of Bone and Joint Surgery-british Volume, 2012Co-Authors: Lawrence V. Gulotta, Edward V. Craig, Daniel Choi, Timothy M Wright, P Marinello, Frank A Cordasco, Russell F. WarrenAbstract:Reverse total Shoulder Replacement (RTSR) depends on adequate deltoid function for a successful outcome. However, the anterior deltoid and/or axillary nerve may be damaged due to prior procedures or injury. The purpose of this study was to determine the compensatory muscle forces required for scapular plane elevation following RTSR when the anterior deltoid is deficient. The soft tissues were removed from six cadaver Shoulders, except for tendon attachments. After implantation of the RTSR, the Shoulders were mounted on a custom-made Shoulder simulator to determine the mean force in each muscle required to achieve 30° and 60° of scapular plane elevation. Two conditions were tested: 1) Control with an absent supraspinatus and infraspinatus; and 2) Control with anterior deltoid deficiency. Anterior deltoid deficiency resulted in a mean increase of 195% in subscapularis force at 30° when compared with the control (p = 0.02). At 60°, the subscapularis force increased a mean of 82% (p < 0.001) and the middle deltoid force increased a mean of 26% (p = 0.04). Scapular plane elevation may still be possible following an RTSR in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid. Attempts to preserve the subscapularis, if present, might maximise post-operative function.
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Sports Participation After Shoulder Replacement Surgery
The American journal of sports medicine, 2008Co-Authors: Eric C. Mccarty, Robert G. Marx, Deb Maerz, David W. Altchek, Russell F. WarrenAbstract:BackgroundReturn to sports after total hip or knee Replacement surgery has been extensively described. However, the return to general sporting activities after Shoulder Replacement surgery has not been well documented. With improved implant survivorship, patient expectation of function is high.PurposeThe purpose of this study was to assess the outcome and ability of patients returning to sports after Shoulder Replacement surgery.Study DesignCase series; Level of evidence, 4.MethodsSeventy-five patients (86 Shoulder Replacements) who participated in sports or recreational activities before surgery were followed for a minimum of 2 years. Their preoperative and postoperative sports participation and level of competition were assessed. The frequency of their activity, modifications in activity, and length of time it took to resume sports participation after the operation were all reviewed.ResultsThe mean age at follow-up was 65.5 years (range, 24-88). The average follow-up was 3.7 years (range, 2-9.4). Sixty-...
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Outcomes analysis of revision total Shoulder Replacement.
The Journal of bone and joint surgery. American volume, 2006Co-Authors: Joshua S. Dines, Edward V. Craig, Russell F. Warren, Stephen Fealy, Eric J. Strauss, Answorth A. Allen, David M. DinesAbstract:Background: The number of total Shoulder arthroplasties has increased exponentially over the last ten years, creating a more prominent role for revision Shoulder arthroplasty in the future. The main reasons for failure of Shoulder arthroplasty can be classified as soft-tissue deficiencies, osseous deficiencies, component wear, or infection. We hypothesized that, despite appropriate surgical techniques, the outcome of revision total Shoulder Replacement can be predicted on the basis of the indication for the revision procedure. Methods: We conducted a retrospective review of seventy-eight Shoulders that had undergone revision Shoulder arthroplasty. The Shoulders were divided into two categories: (1) those with osseous or component-related problems and (2) those with soft-tissue deficiency. Category 1 consisted of four cohorts of Shoulders: twenty-two treated with revision of the glenoid component, sixteen treated with conversion of a hemiarthroplasty to a total Shoulder arthroplasty because of glenoid arthrosis, eight treated with revision of the humeral stem, and four treated for a periprosthetic fracture. Category 2 consisted of five cohorts of Shoulders: ten treated with rotator cuff repair following total Shoulder Replacement, four with a failed tuberosity reconstruction, four with cuff tear arthropathy, five with instability, and five with infection. Patients were evaluated with the UCLA subjective outcome instrument, the L'Insalata Shoulder questionnaire, and a subjective satisfaction scale (maximum score of 5 points). Results: The average UCLA score was 21.4 points and the average L'Insalata score was 68.73 points for the seventy-eight Shoulders that were analyzed. The average score on the subjective satisfaction questionnaire was 2.91 points. According to the UCLA scores, twenty-four revisions were considered to have had an excellent result; fifteen, a good result; twenty-four, a fair result; and fifteen, a poor result. The average scores for the category-1 Shoulders were significantly better than those for the category-2 Shoulders (p < 0.05). Of the different types of operations, revision or implantation of a glenoid component and open reduction and internal fixation of a periprosthetic fracture provided the best outcomes. Tuberosity reconstruction, hemiarthroplasty for treatment of cuff tear arthropathy, and revision due to infection had uniformly poor outcomes. Conclusions: In general, these results indicate that the outcome of revision Shoulder arthroplasty can be predicted on the basis of the indication for the procedure. Component revisions, excluding humeral head revision for salvage, provide the best results, whereas soft-tissue reconstructions can be expected to yield poorer results overall. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
Jonathan L Rees - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Shoulder Replacement surgery for osteoarthritis and rotator cuff tear arthropathy
The Cochrane database of systematic reviews, 2020Co-Authors: R Craig, Henry Goodier, Jasvinder A Singh, Sally Hopewell, Jonathan L ReesAbstract:BACKGROUND Shoulder Replacement surgery is an established treatment for patients with end-stage glenohumeral osteoarthritis or rotator cuff tear arthropathy who have not improved with non-operative treatment. Different types of Shoulder Replacement are commonly used, but their relative benefits and risks compared versus one another and versus other treatments are uncertain. This expanded scope review is an update of a Cochrane Review first published in 2010. OBJECTIVES To determine the benefits and harms of Shoulder Replacement surgery in adults with osteoarthritis (OA) of the Shoulder, including rotator cuff tear arthropathy (RCTA). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, SportDiscus, and Web of Science up to January 2019. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. SELECTION CRITERIA We included randomised studies comparing any type of Shoulder Replacement surgery versus any other surgical or non-surgical treatment, no treatment, or placebo. We also included randomised studies comparing any type of Shoulder Replacement or technique versus another. Study participants were adults with osteoarthritis of the glenohumeral joint or rotator cuff tear arthropathy. We assessed the following major outcomes: pain, function, participant-rated global assessment of treatment success, quality of life, adverse events, serious adverse events, and risk of revision or re-operation or treatment failure. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We collected trial data on benefits and harms. MAIN RESULTS We included 20 studies involving 1083 participants (1105 Shoulders). We found five studies comparing one type of Shoulder Replacement surgery to another type of Shoulder Replacement surgery, including three studies comparing conventional stemmed total Shoulder Replacement (TSR) surgery to stemmed humeral hemiarthroplasty. The remaining 15 studies compared one type of Shoulder Replacement to the same type of Replacement performed with a technical modification or a different prosthetic component. We found no studies comparing Shoulder Replacement surgery to any other type of surgical treatment or to any type of non-surgical treatment. We found no studies comparing reverse total Shoulder Replacement surgery to any other type of treatment or to any type of Replacement. Trial size varied from 16 to 161 participants. Participant mean age ranged from 63 to 81 years. 47% of participants were male. Sixteen trials reported participants with a diagnosis of osteoarthritis and intact rotator cuff tendons. Four trials reported patients with osteoarthritis and a rotator cuff tear or rotator cuff tear arthropathy. All studies were at unclear or high risk of bias for at least two domains, and only one study was free from high risk of bias (included in the main comparison). The most common sources of bias were lack of blinding of participants and assessors, attrition, and major baseline imbalance. Three studies allowed a comparison of conventional stemmed TSR surgery versus stemmed humeral hemiarthroplasty in people with osteoarthritis. At two years, low-quality evidence from two trials (downgraded for bias and imprecision) suggested there may be a small but clinically uncertain improvement in pain and function. On a scale of 0 to 10 (0 is no pain), mean pain was 2.78 points after stemmed humeral hemiarthroplasty and 1.49 points lower (0.1 lower to 2.88 lower) after conventional stemmed TSR. On a scale of 0 to 100 (100 = normal function), the mean function score was 72.8 points after stemmed humeral hemiarthroplasty and 10.57 points higher (2.11 higher to 19.02 higher) after conventional stemmed TSR. There may be no difference in quality of life based on low-quality evidence, downgraded for risk of bias and imprecision. On a scale of 0 to 100 (100 = normal), mean mental quality of life was rated as 57.4 points after stemmed humeral hemiarthroplasty and 1.0 point higher (5.1 lower to 7.1 higher) after conventional stemmed TSR. We are uncertain whether there is any difference in the rate of adverse events or the rate of revision, re-operation, or treatment failure based on very low-quality evidence (downgraded three levels for risk of bias and serious imprecision). The rate of any adverse event following stemmed humeral hemiarthroplasty was 286 per 1000, and following conventional stemmed TSR 143 per 1000, for an absolute difference of 14% fewer events (25% fewer to 21% more). Adverse events included fractures, dislocations, infections, and rotator cuff failure. The rate of revision, re-operation, or treatment failure was 103 per 1000, and following conventional stemmed TSR 77 per 1000, for an absolute difference of 2.6% fewer events (8% fewer to 15% more). Participant-rated global assessment of treatment success was not reported. AUTHORS' CONCLUSIONS Although it is an established procedure, no high-quality randomised trials have been conducted to determine whether Shoulder Replacement might be more effective than other treatments for osteoarthritis or rotator cuff tear arthropathy of the Shoulder. We remain uncertain about which type or technique of Shoulder Replacement surgery is most effective in different situations. When humeral hemiarthroplasty was compared to TSR surgery for osteoarthritis, low-quality evidence led to uncertainty about whether there is a clinically important benefit for patient-reported pain or function and suggested there may be little or no difference in quality of life. Evidence is insufficient to show whether TSR is associated with greater or less risk of harm than humeral hemiarthroplasty. Available randomised studies did not provide sufficient data to reliably inform conclusions about adverse events and harm. Although reverse TSR is now the most commonly performed type of Shoulder Replacement, we found no studies comparing reverse TSR to any other type of treatment.
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How long does a Shoulder Replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 10 years of follow-up
The Lancet Rheumatology, 2020Co-Authors: Jonathan P Evans, R Craig, Jonathan Evans, Hasan Raza Mohammad, Adrian Sayers, Ashley W Blom, Michael R Whitehouse, Jonathan L ReesAbstract:Summary Background Shoulder Replacement is an increasingly common treatment for end-stage degenerative Shoulder conditions. Some Shoulder Replacements are unsuccessful and additional operations might be required. It is important for patients and clinicians to know how long Shoulder Replacements last and how effectively they reduce pain and improve function. This study aims to determine the longevity and long-term efficacy of Shoulder Replacements. Methods In this systematic review and meta-analysis, we searched MEDLINE and Embase from their inception to Sept 24, 2019, for case series and registry data reporting 10-year or longer survival of total Shoulder Replacements, humeral hemiarthroplasties, and reverse total Shoulder Replacements of a specific brand of implant. Survival, implant, and patient-reported outcome measures data were extracted. The primary outcome was implant survival. We reviewed and analysed national joint Replacement registries separately. We weighted each series by SE and calculated a pooled survival estimate at years 10, 15, and 20. For patient-reported outcome measures we pooled the standardised mean difference at 10 years. This study is registered with PROSPERO, CRD42019140221. Findings 927 non-duplicate articles were identified by our search, nine articles (reporting ten series) were eligible for analysis of survival and six articles were eligible for analysis of patient reported outcomes. The ten series reported all-cause survival of 529 total Shoulder Replacements and 364 humeral hemiarthroplasties; no series for reverse total Shoulder Replacement met the inclusion criteria. The estimated 10-year survival for total Shoulder Replacement was 94·6% (95% CI 93·6–97·6) and humeral hemiarthroplasties was 90·4% (87·0–94·0). A single registry contributed 7651 total Shoulder Replacements, 1395 humeral hemiarthroplasties, and 7953 reverse total Shoulder Replacements. The pooled registry 10-year survival was 92·0% (95% CI 91·0–93·0) for total Shoulder Replacement, 85·5% (83·3–87·7) for humeral hemiarthroplasties, and 94·4% (93·4–95·7) for patients with osteoarthritis who had reverse total Shoulder Replacement and 93·6% (91·1–95·8) for patients with rotator cuff arthropathy who had reverse total Shoulder Replacement. Pooled 10-year patient-reported outcome measures showed a substantial improvement from baseline scores, with a standardised mean difference of 2·13 (95% CI 1·93–2·34). Interpretation Our data show that approximately 90% of Shoulder Replacements last for longer than 10 years and patient-reported benefits are sustained. Our findings will be of use to surgeons and patients in the informed consent process and to health-care providers for resource planning. Funding The National Institute for Health Research, the National Joint Registry for England, Wales, Northern Ireland, and Isle of Man, and the Royal College of Surgeons of England.
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serious adverse events and lifetime risk of reoperation after elective Shoulder Replacement population based cohort study using hospital episode statistics for england
BMJ, 2019Co-Authors: R Craig, Jennifer C E Lane, Andrew Carr, Dominic Furniss, Gary S Collins, Jonathan L ReesAbstract:Abstract Objectives To provide accurate risk estimates of serious adverse events after elective Shoulder Replacement surgery for arthritis, including age and sex specific estimates of the lifetime risk of revision surgery. Design Population based cohort study. Setting Hospital episode statistics for NHS England, including civil registration mortality data. Participants 58 054 elective Shoulder Replacements in 51 895 adults (aged ≥50 years) between April 1998 and April 2017. Main outcome measures The lifetime risk of revision surgery, calculated using an actuarial life table approach and the cumulative probability method. Rates of serious adverse events at 30 and 90 days post-surgery: pulmonary embolism, myocardial infarction, lower respiratory tract infection, acute kidney injury, urinary tract infection, cerebrovascular events, and all cause death. Secondary outcome measures were the number of surgeries performed each year and Kaplan-Meier estimates of revision risk at 3, 5, 10, and 15 years. Results The number of Shoulder Replacements performed each year increased 5.6-fold between 1998 and 2017. Lifetime risks of revision surgery ranged from 1 in 37 (2.7%, 95% confidence interval 2.6% to 2.8%) in women aged 85 years and older to 1 in 4 (23.6%, 23.2% to 24.0%) in men aged 55-59 years. The risks of revision were highest during the first five years after surgery. The risk of any serious adverse event at 30 days post-surgery was 1 in 28 (3.5%, 3.4% to 3.7%), and at 90 days post-surgery was 1 in 22 (4.6%, 4.4% to 4.8%). At 30 days, the relative risk of pulmonary embolism compared with baseline population risk was 61 (95% confidence interval 50 to 73) for women aged 50-64. Serious adverse events were associated with increasing age, comorbidity, and male sex. 1 in 5 (21.2%, 17.9% to 25.1%) men aged 85 years and older experienced at least one serious adverse event within 90 days. Conclusions Younger patients, particularly men, need to be aware of a higher likelihood of early failure of Shoulder Replacement and the need for further and more complex revision Replacement surgery. All patients should be counselled about the risks of serious adverse events. These risks are higher than previously considered, and for some could outweigh any potential benefits. Our findings caution against unchecked expansion of Shoulder Replacement surgery in both younger and older patients. The more accurate age and sex specific estimates of risk from this study are long overdue and should improve shared decision making between patients and clinicians. Study registration ClinicalTrials.gov NCT03573765.
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Shoulder Replacement surgery for osteoarthritis and rotator cuff tear arthropathy
Cochrane Database of Systematic Reviews, 2017Co-Authors: R Craig, Henry Goodier, Jasvinder A Singh, Sally Hopewell, Jonathan L ReesAbstract:BACKGROUND Shoulder Replacement surgery is an established treatment for patients with end-stage glenohumeral osteoarthritis or rotator cuff tear arthropathy who have not improved with non-operative treatment. Different types of Shoulder Replacement are commonly used, but their relative benefits and risks compared versus one another and versus other treatments are uncertain. This expanded scope review is an update of a Cochrane Review first published in 2010. OBJECTIVES To determine the benefits and harms of Shoulder Replacement surgery in adults with osteoarthritis (OA) of the Shoulder, including rotator cuff tear arthropathy (RCTA). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, SportDiscus, and Web of Science up to January 2019. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. SELECTION CRITERIA We included randomised studies comparing any type of Shoulder Replacement surgery versus any other surgical or non-surgical treatment, no treatment, or placebo. We also included randomised studies comparing any type of Shoulder Replacement or technique versus another. Study participants were adults with osteoarthritis of the glenohumeral joint or rotator cuff tear arthropathy. We assessed the following major outcomes: pain, function, participant-rated global assessment of treatment success, quality of life, adverse events, serious adverse events, and risk of revision or re-operation or treatment failure. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We collected trial data on benefits and harms. MAIN RESULTS We included 20 studies involving 1083 participants (1105 Shoulders). We found five studies comparing one type of Shoulder Replacement surgery to another type of Shoulder Replacement surgery, including three studies comparing conventional stemmed total Shoulder Replacement (TSR) surgery to stemmed humeral hemiarthroplasty. The remaining 15 studies compared one type of Shoulder Replacement to the same type of Replacement performed with a technical modification or a different prosthetic component. We found no studies comparing Shoulder Replacement surgery to any other type of surgical treatment or to any type of non-surgical treatment. We found no studies comparing reverse total Shoulder Replacement surgery to any other type of treatment or to any type of Replacement. Trial size varied from 16 to 161 participants. Participant mean age ranged from 63 to 81 years. 47% of participants were male. Sixteen trials reported participants with a diagnosis of osteoarthritis and intact rotator cuff tendons. Four trials reported patients with osteoarthritis and a rotator cuff tear or rotator cuff tear arthropathy. All studies were at unclear or high risk of bias for at least two domains, and only one study was free from high risk of bias (included in the main comparison). The most common sources of bias were lack of blinding of participants and assessors, attrition, and major baseline imbalance. Three studies allowed a comparison of conventional stemmed TSR surgery versus stemmed humeral hemiarthroplasty in people with osteoarthritis. At two years, low-quality evidence from two trials (downgraded for bias and imprecision) suggested there may be a small but clinically uncertain improvement in pain and function. On a scale of 0 to 10 (0 is no pain), mean pain was 2.78 points after stemmed humeral hemiarthroplasty and 1.49 points lower (0.1 lower to 2.88 lower) after conventional stemmed TSR. On a scale of 0 to 100 (100 = normal function), the mean function score was 72.8 points after stemmed humeral hemiarthroplasty and 10.57 points higher (2.11 higher to 19.02 higher) after conventional stemmed TSR. There may be no difference in quality of life based on low-quality evidence, downgraded for risk of bias and imprecision. On a scale of 0 to 100 (100 = normal), mean mental quality of life was rated as 57.4 points after stemmed humeral hemiarthroplasty and 1.0 point higher (5.1 lower to 7.1 higher) after conventional stemmed TSR. We are uncertain whether there is any difference in the rate of adverse events or the rate of revision, re-operation, or treatment failure based on very low-quality evidence (downgraded three levels for risk of bias and serious imprecision). The rate of any adverse event following stemmed humeral hemiarthroplasty was 286 per 1000, and following conventional stemmed TSR 143 per 1000, for an absolute difference of 14% fewer events (25% fewer to 21% more). Adverse events included fractures, dislocations, infections, and rotator cuff failure. The rate of revision, re-operation, or treatment failure was 103 per 1000, and following conventional stemmed TSR 77 per 1000, for an absolute difference of 2.6% fewer events (8% fewer to 15% more). Participant-rated global assessment of treatment success was not reported. AUTHORS' CONCLUSIONS Although it is an established procedure, no high-quality randomised trials have been conducted to determine whether Shoulder Replacement might be more effective than other treatments for osteoarthritis or rotator cuff tear arthropathy of the Shoulder. We remain uncertain about which type or technique of Shoulder Replacement surgery is most effective in different situations. When humeral hemiarthroplasty was compared to TSR surgery for osteoarthritis, low-quality evidence led to uncertainty about whether there is a clinically important benefit for patient-reported pain or function and suggested there may be little or no difference in quality of life. Evidence is insufficient to show whether TSR is associated with greater or less risk of harm than humeral hemiarthroplasty. Available randomised studies did not provide sufficient data to reliably inform conclusions about adverse events and harm. Although reverse TSR is now the most commonly performed type of Shoulder Replacement, we found no studies comparing reverse TSR to any other type of treatment.
T. D. Bunker - One of the best experts on this subject based on the ideXlab platform.
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Indications for reverse Shoulder Replacement: A systematic review
The Journal of bone and joint surgery. British volume, 2012Co-Authors: Christopher D. Smith, P.m. Guyver, T. D. BunkerAbstract:The outcome of an anatomical Shoulder Replacement depends on an intact rotator cuff. In 1981 Grammont designed a novel large-head reverse Shoulder Replacement for patients with cuff deficiency. Such has been the success of this Replacement that it has led to a rapid expansion of the indications. We performed a systematic review of the literature to evaluate the functional outcome of each indication for the reverse Shoulder Replacement. Secondary outcome measures of range of movement, pain scores and complication rates are also presented.
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Stemless Shoulder Replacement, the Best of Both Worlds: A Personal View:
Shoulder & Elbow, 2011Co-Authors: T. D. BunkerAbstract:Two decades of rapid advances in basic knowledge, industrial technology and surgical skill have made Shoulder Replacement a predictable, safe and successful operation. This article looks to pass on some of these advances in our understanding of anatomy, pathology, surgical approaches and releases. It looks at contentious issues such as the hemi versus total Shoulder debate, the stemmed, surface and stemless debate, the issues of DVT prophylaxis and prophylaxis against infection. Finally the article makes the plea that Shoulders are different from hips and knees and that long term results depend more upon cuff function than prosthetic failure.
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Clinical and radiological follow-up of the Aequalis third-generation cemented total Shoulder Replacement A MINIMUM TEN-YEAR STUDY
The Journal of bone and joint surgery. British volume, 2009Co-Authors: A. Khan, T. D. Bunker, Jeff KitsonAbstract:There are no long-term published results on the survival of a third-generation cemented total Shoulder Replacement. We describe a clinical and radiological study of the Aequalis total Shoulder Replacement for a minimum of ten years. Between September 1996 and May 1998, 39 consecutive patients underwent a primary cemented total Shoulder Replacement using this prosthesis. Data were collected prospectively on all patients each year, for a minimum of ten years, or until death or failure of the prosthesis. At a follow-up of at least ten years, 12 patients had died with the prosthesis intact and two had emigrated, leaving 25 available for clinical review. Of these, 13 had rheumatoid arthritis and 12 osteoarthritis. One refused radiological review leaving 24 with fresh radiographs.Survivorship at ten years was 100% for the humeral component and 92% for the glenoid component. The incidence of lucent lines was low. No humeral component was thought to be at risk and only two glenoid components. The osteoarthritic g...
Edward V. Craig - One of the best experts on this subject based on the ideXlab platform.
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anterior deltoid deficiency in reverse total Shoulder Replacement a biomechanical study with cadavers
Journal of Bone and Joint Surgery-british Volume, 2012Co-Authors: Lawrence V. Gulotta, Edward V. Craig, Daniel Choi, Timothy M Wright, P Marinello, Frank A Cordasco, Russell F. WarrenAbstract:Reverse total Shoulder Replacement (RTSR) depends on adequate deltoid function for a successful outcome. However, the anterior deltoid and/or axillary nerve may be damaged due to prior procedures or injury. The purpose of this study was to determine the compensatory muscle forces required for scapular plane elevation following RTSR when the anterior deltoid is deficient. The soft tissues were removed from six cadaver Shoulders, except for tendon attachments. After implantation of the RTSR, the Shoulders were mounted on a custom-made Shoulder simulator to determine the mean force in each muscle required to achieve 30° and 60° of scapular plane elevation. Two conditions were tested: 1) Control with an absent supraspinatus and infraspinatus; and 2) Control with anterior deltoid deficiency. Anterior deltoid deficiency resulted in a mean increase of 195% in subscapularis force at 30° when compared with the control (p = 0.02). At 60°, the subscapularis force increased a mean of 82% (p < 0.001) and the middle deltoid force increased a mean of 26% (p = 0.04). Scapular plane elevation may still be possible following an RTSR in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid. Attempts to preserve the subscapularis, if present, might maximise post-operative function.
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Outcomes analysis of revision total Shoulder Replacement.
The Journal of bone and joint surgery. American volume, 2006Co-Authors: Joshua S. Dines, Edward V. Craig, Russell F. Warren, Stephen Fealy, Eric J. Strauss, Answorth A. Allen, David M. DinesAbstract:Background: The number of total Shoulder arthroplasties has increased exponentially over the last ten years, creating a more prominent role for revision Shoulder arthroplasty in the future. The main reasons for failure of Shoulder arthroplasty can be classified as soft-tissue deficiencies, osseous deficiencies, component wear, or infection. We hypothesized that, despite appropriate surgical techniques, the outcome of revision total Shoulder Replacement can be predicted on the basis of the indication for the revision procedure. Methods: We conducted a retrospective review of seventy-eight Shoulders that had undergone revision Shoulder arthroplasty. The Shoulders were divided into two categories: (1) those with osseous or component-related problems and (2) those with soft-tissue deficiency. Category 1 consisted of four cohorts of Shoulders: twenty-two treated with revision of the glenoid component, sixteen treated with conversion of a hemiarthroplasty to a total Shoulder arthroplasty because of glenoid arthrosis, eight treated with revision of the humeral stem, and four treated for a periprosthetic fracture. Category 2 consisted of five cohorts of Shoulders: ten treated with rotator cuff repair following total Shoulder Replacement, four with a failed tuberosity reconstruction, four with cuff tear arthropathy, five with instability, and five with infection. Patients were evaluated with the UCLA subjective outcome instrument, the L'Insalata Shoulder questionnaire, and a subjective satisfaction scale (maximum score of 5 points). Results: The average UCLA score was 21.4 points and the average L'Insalata score was 68.73 points for the seventy-eight Shoulders that were analyzed. The average score on the subjective satisfaction questionnaire was 2.91 points. According to the UCLA scores, twenty-four revisions were considered to have had an excellent result; fifteen, a good result; twenty-four, a fair result; and fifteen, a poor result. The average scores for the category-1 Shoulders were significantly better than those for the category-2 Shoulders (p < 0.05). Of the different types of operations, revision or implantation of a glenoid component and open reduction and internal fixation of a periprosthetic fracture provided the best outcomes. Tuberosity reconstruction, hemiarthroplasty for treatment of cuff tear arthropathy, and revision due to infection had uniformly poor outcomes. Conclusions: In general, these results indicate that the outcome of revision Shoulder arthroplasty can be predicted on the basis of the indication for the procedure. Component revisions, excluding humeral head revision for salvage, provide the best results, whereas soft-tissue reconstructions can be expected to yield poorer results overall. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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The radiology of total Shoulder Replacement
Radiologic clinics of North America, 1995Co-Authors: S. H. Slawson, Lenore I. Everson, Edward V. CraigAbstract:The indications for total Shoulder Replacement and the radiologic evaluation prior to the operation are discussed in depth in this article. Different approaches to clinical problems are also discussed and illustrated, as are normal findings. This is followed by a discussion of the complications of Shoulder reconstruction, including infection, fractures, and heterotopic bone formation. A review of the results is also given followed by a brief mention of a number of other orthopedic Shoulder devices and plates.
Christopher S. Ahmad - One of the best experts on this subject based on the ideXlab platform.
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total Shoulder Replacement compared with humeral head Replacement for the treatment of primary glenohumeral osteoarthritis a systematic review
Journal of Shoulder and Elbow Surgery, 2007Co-Authors: Craig S. Radnay, Kevin J. Setter, Locky Chambers, William N. Levine, Louis U. Bigliani, Christopher S. AhmadAbstract:The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total Shoulder Replacement (TSR) and humeral head Replacement (HHR). The objective of this review was to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction, and revision surgery in patients with primary glenohumeral osteoarthritis. We searched computerized databases for clinical studies published between 1966 and 2004 that reported on Shoulder Replacement for primary glenohumeral osteoarthritis. Pain data were converted to a 100-point score. Outcome assessment data were pooled when possible, and analyses via normal test statistics were performed. We identified 23 studies, with a total of 1952 patients and mean follow-up of 43.4 months (range, 30-116.4 months). The mean level of evidence was 3.73. Among the 23 studies, 7 different outcome instruments were used. Of the 23 studies, 14 (n = 1185) reported pain relief, 15 (n = 1080) reported range of motion, 12 (n = 969) reported patient satisfaction, and 14 (n = 1474) reported revision surgery. Compared with HHR, TSR provided significantly greater pain relief (P < .0001), forward elevation (P < .0001), gain in forward elevation (P < .0001), gain in external rotation (P = .0002), and patient satisfaction (P < .0001). Furthermore, only 6.5% of all TSRs required revision surgery, which was significantly lower than the percentage for all patients undergoing HHR (10.2%) (P < .025). Only 1.7% of all-polyethylene glenoid components required revision. On the basis of this review and analysis, in comparison with HHR, TSR for the treatment of primary glenohumeral osteoarthritis significantly improves pain relief, range of motion, and satisfaction and has a significantly lower rate of revision surgery. Inconsistent outcome reporting and poor study design may warrant standardization of outcome instruments and improved study design in the future.
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Total Shoulder Replacement compared with humeral head Replacement for the treatment of primary glenohumeral osteoarthritis: A systematic review
Journal of shoulder and elbow surgery, 2007Co-Authors: Craig S. Radnay, Kevin J. Setter, Locky Chambers, William N. Levine, Louis U. Bigliani, Christopher S. AhmadAbstract:The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total Shoulder Replacement (TSR) and humeral head Replacement (HHR). The objective of this review was to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction, and revision surgery in patients with primary glenohumeral osteoarthritis. We searched computerized databases for clinical studies published between 1966 and 2004 that reported on Shoulder Replacement for primary glenohumeral osteoarthritis. Pain data were converted to a 100-point score. Outcome assessment data were pooled when possible, and analyses via normal test statistics were performed. We identified 23 studies, with a total of 1952 patients and mean follow-up of 43.4 months (range, 30-116.4 months). The mean level of evidence was 3.73. Among the 23 studies, 7 different outcome instruments were used. Of the 23 studies, 14 (n = 1185) reported pain relief, 15 (n = 1080) reported range of motion, 12 (n = 969) reported patient satisfaction, and 14 (n = 1474) reported revision surgery. Compared with HHR, TSR provided significantly greater pain relief ( P P P P = .0002), and patient satisfaction ( P P