The Experts below are selected from a list of 2601 Experts worldwide ranked by ideXlab platform
Frederick A Matsen - One of the best experts on this subject based on the ideXlab platform.
-
failure of the glenoid component in anatomic Total Shoulder Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Anastasios Papadonikolakis, Moni B Neradilek, Frederick A MatsenAbstract:Background: Although glenoid component failure is one of the most common complications of anatomic Total Shoulder Arthroplasty, substantial evidence from the recent published literature is lacking regarding the temporal trend in the rate of this complication and the risk factors for its occurrence. Methods: We conducted a systematic review and identified twenty-seven articles presenting data on glenoid component failure rates that met the inclusion criteria. These articles represented data from 3853 Total Shoulder arthroplasties performed from 1976 to 2007. Results: Asymptomatic radiolucent lines occurred at a rate of 7.3% per year after the primary Shoulder replacement. Symptomatic glenoid loosening occurred at 1.2% per year, and surgical revision occurred at 0.8% per year. There was no significant evidence that the rate of symptomatic loosening has diminished over time. Keeled components had greater rates of asymptomatic radiolucent lines compared with pegged components in side-by-side comparison studies. However, as a result of wide variability in outcomes reporting, only sex, Walch class, and diagnosis were significantly associated with the risk of glenoid component failure in the overall analysis. Conclusions: This is the first systematic review of the published evidence on glenoid component failure. Although the authors of individual articles proposed various risk factors for glenoid component failure, many of these relationships were not significant in the present study. A consistent methodological approach to future investigations is likely to improve the quality of the evidence on which patients, techniques, and prostheses are selected for Total Shoulder Arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
-
glenoid component failure in Total Shoulder Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: Frederick A Matsen, Jeremiah Clinton, Alexander Bertelsen, Joseph R. Lynch, Michael L. RichardsonAbstract:Glenoid component failure is the most common complication of Total Shoulder Arthroplasty. Glenoid components fail as a result of their inability to replicate essential properties of the normal glenoid articular surface to achieve durable fixation to the underlying bone, to withstand repeated eccentric loads and glenohumeral translation, and to resist wear and deformation. The possibility of glenoid component failure should be considered whenever a Total Shoulder Arthroplasty has an unsatisfactory result. High-quality radiographs made in the plane of the scapula and in the axillary projection are usually sufficient to evaluate the status of the glenoid component. Failures of prosthetic glenoid Arthroplasty can be understood in terms of failure of the component itself, failure of seating, failure of fixation, failure of the glenoid bone, and failure to effectively manage eccentric loading. An understanding of these modes of failure leads to strategies to minimize complications related to prosthetic glenoid Arthroplasty.
-
the reverse Total Shoulder Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Frederick A Matsen, Christian Gerber, Pascal Boileau, Gilles Walch, 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 …
-
metastatic carcinoma to the acromion in a patient after Total Shoulder Arthroplasty a case report and review of the literature
Journal of Shoulder and Elbow Surgery, 2002Co-Authors: Emma Woodhouse, Edward V Fehringer, Peter M Benda, Frederick A MatsenAbstract:Nonconstrained Total Shoulder Arthroplasty is a reliable treatment for symptomatic advanced glenohumeral arthritis in patients with intact rotator cuffs.4,7,10 Painful Total Shoulder Arthroplasty is often attributed to component wear, soft-tissue problems, or bony deficiency. In order of frequency, the most common causes of painful Shoulder Arthroplasty are component loosening, instability, rotator cuff tear, periprosthetic fracture, infection, implant failure (including dissociation of modular components), and deltoid denervation.11 Although pain after Total Shoulder Arthroplasty is often attributable to one of these problems, it can also stem from rarer conditions that are not related to the surgery itself. We report a case of pain after primary Total Shoulder Arthroplasty caused by occult metastatic lung carcinoma to the acromion. In hindsight, despite clinical and radiographic evidence of post-traumatic arthritis, some or all of the patient’s original Shoulder pain may have been related to occult metastases.
-
the magnitude and durability of functional improvement after Total Shoulder Arthroplasty for degenerative joint disease
Journal of Shoulder and Elbow Surgery, 2001Co-Authors: Benjamin A Goldberg, Sarah E Jackins, Kevin G Smith, Barry Campbell, Frederick A MatsenAbstract:Abstract So that patients with degenerative glenohumeral joint disease who wish to consider Total Shoulder Arthroplasty will be better informed, we sought to document the magnitude and durability of the improvement in Shoulder function after this procedure. The function of 124 Shoulders with primary degenerative joint disease was documented by patient self-assessment with the Simple Shoulder Test before and sequentially after Total Shoulder Arthroplasty performed with a standardized technique. Patients reported that they could perform 3.8 ± 0.3 (SEM) of the 12 Simple Shoulder Test functions before surgery. The Total number of performable functions was consistent at different follow-up intervals: 8.0 ± 0.4 at 6 months, 9.5 ± 0.4 at 1 year, 10.0 ± 0.3 at 2 years, 9.2 ± 0.4 at 3 years, 9.6 ± 0.4 at 4 years, and 10.0 ± 0.4 at 5 years. We conclude that Total Shoulder Arthroplasty can provide substantial and durable improvement in Shoulder function. (J Shoulder Elbow Surg 2001;10:464-9.)
Scott P Steinmann - One of the best experts on this subject based on the ideXlab platform.
-
structural bone grafting for glenoid deficiency in primary Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Brian J Klika, John W Sperling, Scott P Steinmann, Cathy D Schleck, Clint Wooten, William S Harmsen, Robert H CofieldAbstract:Background Glenoid bone grafting can be useful to restore an asymmetrically eroded glenoid to better support the glenoid component and improve positioning. The purpose of this study was to evaluate the clinical and radiographic results of patients undergoing structural bone grafting for glenoid deficiency with placement of a cemented glenoid component during primary Total Shoulder Arthroplasty. Methods Between January 1, 1976, and December 31, 2008, 24 patients (25 Shoulders) of 2607 Shoulders undergoing primary Total Shoulder Arthroplasty (0.96%) had structural bone grafting with a humeral head autograft and screw fixation. The mean clinical follow-up was 8.7 years, and the mean radiographic follow-up was 7.6 years. Results Twenty-three Shoulders experienced pain relief, and patients expressed satisfaction with the operation in these Shoulders. Postoperative active elevation averaged 148°, and external rotation with the arm at the side averaged 60°. On radiographic evaluation, 10 Shoulders had glenoids at risk for component loosening. Two of these Shoulders were symptomatic and underwent revision surgery to address glenoid component loosening. The Neer result rating was excellent in 18 Shoulders, satisfactory in 5, and unsatisfactory in the 2 Shoulders undergoing revision. Conclusion Structural bone grafting in primary Total Shoulder Arthroplasty is uncommonly necessary. When it is performed, the clinical outcomes are favorable; however, radiographic analysis shows a moderate rate of failure of glenoid component fixation. It seems likely that alternative treatment methods may prove to be more effective in addressing glenoid wear.
-
biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Steven A Giuseffi, Prasit Wongtriratanachai, Hiromichi Omae, Akin Cil, Mark E Zobitz, John W Sperling, Scott P SteinmannAbstract:Background Total Shoulder Arthroplasty is traditionally performed through an anterior deltopectoral exposure with subscapularis tenotomy. Postoperative subscapularis dysfunction is common and adversely affects clinical outcomes. Consequently, surgeon interest in lesser tuberosity osteotomy has grown in an effort to improve subscapularis repair strength. This study investigated the biomechanical strength of subscapularis tenotomy vs lesser tuberosity osteotomy in the setting of Total Shoulder Arthroplasty. Materials and methods Uncemented humeral prostheses were placed in 20 paired upper extremities from 10 cadavers. For each respective cadaver, 1 limb underwent lesser tuberosity osteotomy and the contralateral limb underwent subscapularis tenotomy. The cadaveric specimens then underwent cyclic displacement and maximum load to failure testing. Results The subscapularis tenotomy specimens exhibited significantly less cyclic displacement (0.8 mm) than the osteotomy group (1.8 mm), with a 95% confidence interval (CI) for the difference of 0.5 to 1.5 mm (P = 0.002). The maximum load to failure was 439 ± 96 N for tenotomy and 447 ± 89 N for osteotomy (95% CI for the difference of −58 to 75), which was not significant (P = .78). Conclusion Lesser tuberosity osteotomy was not significantly stronger than subscapularis tenotomy in maximum load to failure testing, with minimal clinical significance set at 100 N. Subscapularis tenotomy repair showed statistically significant less cyclic displacement than lesser tuberosity osteotomy. Further research is needed to clarify how the biomechanical results immediately after subscapularis tenotomy and lesser tuberosity osteotomy correlate with clinical outcomes.
-
integrity and function of the subscapularis after Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2010Co-Authors: Jeffrey D Jackson, Akin Cil, Jay Smith, Scott P SteinmannAbstract:Background Reported healing rates of a subscapularis tenotomy have been extremely variable in the literature. The purpose of this study was to document the subscapularis healing rate after subscapularis tenotomy using ultrasound, and to correlate healing with physical examination findings and Shoulder internal rotation strength. Methods Fifteen patients who underwent Total Shoulder Arthroplasty due to unilateral osteoarthritis were evaluated after a minimum of 6 months follow-up with ultrasound, physical examination, and internal rotation strength testing. At surgery, a subscapularis tenotomy utilized to approach the Shoulder. Postoperatively, no formal physical therapy program was utilized. Results Seven of the 15 Shoulders had a complete tear of the repaired subscapularis tendon based on ultrasound examination. The lift-off and abdominal compression tests correlated poorly with the ultrasonographic condition of the subscapularis. The bear hug test using dynamometry did correlate with tendon integrity. Patients with a subscapularis tear after Arthroplasty experienced significant weakness in isometric ( P = .01) and isokinetic ( P P = .04). No patient demonstrated anterior subluxation on examination or by radiograph. Conclusion Subscapularis tear after Total Shoulder Arthroplasty is a common finding, which cannot be diagnosed reliably by physical examination or radiographs. In this population, subscapularis integrity did not correlate with pain or subjective patient outcome. Failure to heal the subscapularis tenotomy is probably more common than has been previously reported based on only physical examination testing.
Robert H Cofield - One of the best experts on this subject based on the ideXlab platform.
-
structural bone grafting for glenoid deficiency in primary Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Brian J Klika, John W Sperling, Scott P Steinmann, Cathy D Schleck, Clint Wooten, William S Harmsen, Robert H CofieldAbstract:Background Glenoid bone grafting can be useful to restore an asymmetrically eroded glenoid to better support the glenoid component and improve positioning. The purpose of this study was to evaluate the clinical and radiographic results of patients undergoing structural bone grafting for glenoid deficiency with placement of a cemented glenoid component during primary Total Shoulder Arthroplasty. Methods Between January 1, 1976, and December 31, 2008, 24 patients (25 Shoulders) of 2607 Shoulders undergoing primary Total Shoulder Arthroplasty (0.96%) had structural bone grafting with a humeral head autograft and screw fixation. The mean clinical follow-up was 8.7 years, and the mean radiographic follow-up was 7.6 years. Results Twenty-three Shoulders experienced pain relief, and patients expressed satisfaction with the operation in these Shoulders. Postoperative active elevation averaged 148°, and external rotation with the arm at the side averaged 60°. On radiographic evaluation, 10 Shoulders had glenoids at risk for component loosening. Two of these Shoulders were symptomatic and underwent revision surgery to address glenoid component loosening. The Neer result rating was excellent in 18 Shoulders, satisfactory in 5, and unsatisfactory in the 2 Shoulders undergoing revision. Conclusion Structural bone grafting in primary Total Shoulder Arthroplasty is uncommonly necessary. When it is performed, the clinical outcomes are favorable; however, radiographic analysis shows a moderate rate of failure of glenoid component fixation. It seems likely that alternative treatment methods may prove to be more effective in addressing glenoid wear.
-
periprosthetic fractures associated with primary Total Shoulder Arthroplasty and primary humeral head replacement a thirty three year study
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Jasvinder A Singh, John W Sperling, Cathy D Schleck, William S Harmsen, Robert H CofieldAbstract:Background: The objective of this study was to assess the frequency of, and risk factors for, periprosthetic fractures during and after Shoulder Arthroplasty. Methods: All adults treated with a primary Total Shoulder Arthroplasty or humeral head replacement at the Mayo Clinic Medical Center from 1976 to 2008 were identified. Periprosthetic fractures were validated by medical record review. Univariate and multivariable-adjusted logistic regression analyses were used to assess the association of demographic factors (age, sex, and body mass index [BMI]), underlying diagnosis, implant fixation (cemented or uncemented), American Society of Anesthesiologists (ASA) class, and comorbidity as assessed with the Deyo-Charlson index. Results: The cohort consisted of 2207 patients treated with a Total of 2588 primary Total Shoulder arthroplasties and 1349 patients treated with 1431 humeral head replacements. Seventy-two medical-record-confirmed periprosthetic fractures occurred in association with the Total Shoulder arthroplasties. These consisted of forty-seven intraoperative fractures (forty humeral fractures, five glenoid fractures, and two fractures for which the site was unclear) and twenty-five postoperative fractures (twenty humeral fractures, three glenoid fractures, and two fractures for which the site was unclear). There were thirty-three fractures associated with the humeral head replacements. Fifteen were intraoperative (eight humeral fractures and seven glenoid fractures), and eighteen were postoperative (sixteen humeral fractures and two glenoid fractures). In the multivariable regression analysis of the Total Shoulder arthroplasties, female sex (odds ratio [OR], 4.19; 95% confidence interval [CI], 1.82 to 9.62; p < 0.001; a 2.4% rate for women versus 0.6% for men) and the underlying diagnosis (p = 0.04; posttraumatic arthritis: OR, 2.55; 95% CI, 0.92 to 7.12) were associated with a significantly higher risk of intraoperative humeral fracture in general, and female sex was associated with the risk of intraoperative humeral shaft fracture (OR, infinity; p < 0.001). In combined analyses of all patients (treated with either Total Shoulder Arthroplasty or humeral head replacement), a higher Deyo-Charlson index was significantly associated with an increased risk of postoperative periprosthetic humeral shaft fracture (OR, 1.27; 95% CI, 1.11 to 1.45); p < 0.001), after adjusting for the type of surgery (Total Shoulder Arthroplasty or humeral head replacement). Conclusions: The overall risk of periprosthetic fractures after Total Shoulder Arthroplasty or humeral head replacement was low. Women had a significantly higher risk of intraoperative humeral shaft fracture. The underlying diagnosis (especially posttraumatic arthritis) was significantly associated with the risk of intraoperative humeral fracture, and comorbidity was significantly associated with the risk of postoperative humeral shaft fracture. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
-
minimum fifteen year follow up of neer hemiArthroplasty and Total Shoulder Arthroplasty in patients aged fifty years or younger
Journal of Shoulder and Elbow Surgery, 2004Co-Authors: John W Sperling, Robert H Cofield, Charles M RowlandAbstract:Seventy-eight Neer hemiarthroplasties and thirty-six Neer Total Shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine Total Shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. All 114 Shoulders were included in the survival analysis. There was significant long-term pain relief (P < .01) and improvement in active abduction (P < .01) and external rotation (P < .01) with both procedures. There was not a significant difference between Total Shoulder Arthroplasty and hemiArthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 Total Shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after Total Shoulder Arthroplasty (60%) compared with hemiArthroplasty (34%) (P = .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 Total Shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among Total Shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiArthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for Total Shoulder Arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with Shoulder Arthroplasty. However, there is a moderate rate of hemiArthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiArthroplasty or Total Shoulder Arthroplasty is offered to patients aged 50 years or younger.
-
Total Shoulder Arthroplasty in patients with parkinson s disease
Journal of Shoulder and Elbow Surgery, 1996Co-Authors: Thomas J Kryzak, John W Sperling, Cathy D Schleck, Robert H CofieldAbstract:Currently, there is little information available on the results of Total Shoulder Arthroplasty (TSA) in patients with Parkinson's disease. The purpose of the current study was to determine the results, risk factors for an unsatisfactory outcome, and rates of failure of TSA in patients with Parkinson's disease. Between 1978 and 2005, 49 Total Shoulder arthroplasties were performed in patients with Parkinson's disease for osteoarthritis of the Shoulder. Forty-three Shoulders (36 patients) were followed for a minimum of 2 years (mean, 8 years) or until the time of revision surgery. Total Shoulder Arthroplasty in patients with Parkinson's disease was associated with significant improvement in pain from 4.6 to 1.8 (P .05). Eight Shoulders underwent revision Arthroplasty. Three of the 8 revisions were performed less than 1 year from the time of surgery due to instability. Total Shoulder Arthroplasty is associated with significant long-term improvement in pain, external rotation, and abduction in patients with Parkinson's disease. However, early postoperative instability appears to be higher in this patient population. The results of TSA in our patients with Parkinson's disease were marginal, with 20 (47%) achieving unsatisfactory results.
John W Sperling - One of the best experts on this subject based on the ideXlab platform.
-
structural bone grafting for glenoid deficiency in primary Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Brian J Klika, John W Sperling, Scott P Steinmann, Cathy D Schleck, Clint Wooten, William S Harmsen, Robert H CofieldAbstract:Background Glenoid bone grafting can be useful to restore an asymmetrically eroded glenoid to better support the glenoid component and improve positioning. The purpose of this study was to evaluate the clinical and radiographic results of patients undergoing structural bone grafting for glenoid deficiency with placement of a cemented glenoid component during primary Total Shoulder Arthroplasty. Methods Between January 1, 1976, and December 31, 2008, 24 patients (25 Shoulders) of 2607 Shoulders undergoing primary Total Shoulder Arthroplasty (0.96%) had structural bone grafting with a humeral head autograft and screw fixation. The mean clinical follow-up was 8.7 years, and the mean radiographic follow-up was 7.6 years. Results Twenty-three Shoulders experienced pain relief, and patients expressed satisfaction with the operation in these Shoulders. Postoperative active elevation averaged 148°, and external rotation with the arm at the side averaged 60°. On radiographic evaluation, 10 Shoulders had glenoids at risk for component loosening. Two of these Shoulders were symptomatic and underwent revision surgery to address glenoid component loosening. The Neer result rating was excellent in 18 Shoulders, satisfactory in 5, and unsatisfactory in the 2 Shoulders undergoing revision. Conclusion Structural bone grafting in primary Total Shoulder Arthroplasty is uncommonly necessary. When it is performed, the clinical outcomes are favorable; however, radiographic analysis shows a moderate rate of failure of glenoid component fixation. It seems likely that alternative treatment methods may prove to be more effective in addressing glenoid wear.
-
periprosthetic fractures associated with primary Total Shoulder Arthroplasty and primary humeral head replacement a thirty three year study
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Jasvinder A Singh, John W Sperling, Cathy D Schleck, William S Harmsen, Robert H CofieldAbstract:Background: The objective of this study was to assess the frequency of, and risk factors for, periprosthetic fractures during and after Shoulder Arthroplasty. Methods: All adults treated with a primary Total Shoulder Arthroplasty or humeral head replacement at the Mayo Clinic Medical Center from 1976 to 2008 were identified. Periprosthetic fractures were validated by medical record review. Univariate and multivariable-adjusted logistic regression analyses were used to assess the association of demographic factors (age, sex, and body mass index [BMI]), underlying diagnosis, implant fixation (cemented or uncemented), American Society of Anesthesiologists (ASA) class, and comorbidity as assessed with the Deyo-Charlson index. Results: The cohort consisted of 2207 patients treated with a Total of 2588 primary Total Shoulder arthroplasties and 1349 patients treated with 1431 humeral head replacements. Seventy-two medical-record-confirmed periprosthetic fractures occurred in association with the Total Shoulder arthroplasties. These consisted of forty-seven intraoperative fractures (forty humeral fractures, five glenoid fractures, and two fractures for which the site was unclear) and twenty-five postoperative fractures (twenty humeral fractures, three glenoid fractures, and two fractures for which the site was unclear). There were thirty-three fractures associated with the humeral head replacements. Fifteen were intraoperative (eight humeral fractures and seven glenoid fractures), and eighteen were postoperative (sixteen humeral fractures and two glenoid fractures). In the multivariable regression analysis of the Total Shoulder arthroplasties, female sex (odds ratio [OR], 4.19; 95% confidence interval [CI], 1.82 to 9.62; p < 0.001; a 2.4% rate for women versus 0.6% for men) and the underlying diagnosis (p = 0.04; posttraumatic arthritis: OR, 2.55; 95% CI, 0.92 to 7.12) were associated with a significantly higher risk of intraoperative humeral fracture in general, and female sex was associated with the risk of intraoperative humeral shaft fracture (OR, infinity; p < 0.001). In combined analyses of all patients (treated with either Total Shoulder Arthroplasty or humeral head replacement), a higher Deyo-Charlson index was significantly associated with an increased risk of postoperative periprosthetic humeral shaft fracture (OR, 1.27; 95% CI, 1.11 to 1.45); p < 0.001), after adjusting for the type of surgery (Total Shoulder Arthroplasty or humeral head replacement). Conclusions: The overall risk of periprosthetic fractures after Total Shoulder Arthroplasty or humeral head replacement was low. Women had a significantly higher risk of intraoperative humeral shaft fracture. The underlying diagnosis (especially posttraumatic arthritis) was significantly associated with the risk of intraoperative humeral fracture, and comorbidity was significantly associated with the risk of postoperative humeral shaft fracture. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
-
biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Steven A Giuseffi, Prasit Wongtriratanachai, Hiromichi Omae, Akin Cil, Mark E Zobitz, John W Sperling, Scott P SteinmannAbstract:Background Total Shoulder Arthroplasty is traditionally performed through an anterior deltopectoral exposure with subscapularis tenotomy. Postoperative subscapularis dysfunction is common and adversely affects clinical outcomes. Consequently, surgeon interest in lesser tuberosity osteotomy has grown in an effort to improve subscapularis repair strength. This study investigated the biomechanical strength of subscapularis tenotomy vs lesser tuberosity osteotomy in the setting of Total Shoulder Arthroplasty. Materials and methods Uncemented humeral prostheses were placed in 20 paired upper extremities from 10 cadavers. For each respective cadaver, 1 limb underwent lesser tuberosity osteotomy and the contralateral limb underwent subscapularis tenotomy. The cadaveric specimens then underwent cyclic displacement and maximum load to failure testing. Results The subscapularis tenotomy specimens exhibited significantly less cyclic displacement (0.8 mm) than the osteotomy group (1.8 mm), with a 95% confidence interval (CI) for the difference of 0.5 to 1.5 mm (P = 0.002). The maximum load to failure was 439 ± 96 N for tenotomy and 447 ± 89 N for osteotomy (95% CI for the difference of −58 to 75), which was not significant (P = .78). Conclusion Lesser tuberosity osteotomy was not significantly stronger than subscapularis tenotomy in maximum load to failure testing, with minimal clinical significance set at 100 N. Subscapularis tenotomy repair showed statistically significant less cyclic displacement than lesser tuberosity osteotomy. Further research is needed to clarify how the biomechanical results immediately after subscapularis tenotomy and lesser tuberosity osteotomy correlate with clinical outcomes.
-
minimum fifteen year follow up of neer hemiArthroplasty and Total Shoulder Arthroplasty in patients aged fifty years or younger
Journal of Shoulder and Elbow Surgery, 2004Co-Authors: John W Sperling, Robert H Cofield, Charles M RowlandAbstract:Seventy-eight Neer hemiarthroplasties and thirty-six Neer Total Shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine Total Shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. All 114 Shoulders were included in the survival analysis. There was significant long-term pain relief (P < .01) and improvement in active abduction (P < .01) and external rotation (P < .01) with both procedures. There was not a significant difference between Total Shoulder Arthroplasty and hemiArthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 Total Shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after Total Shoulder Arthroplasty (60%) compared with hemiArthroplasty (34%) (P = .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 Total Shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among Total Shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiArthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for Total Shoulder Arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with Shoulder Arthroplasty. However, there is a moderate rate of hemiArthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiArthroplasty or Total Shoulder Arthroplasty is offered to patients aged 50 years or younger.
-
Total Shoulder Arthroplasty in patients with parkinson s disease
Journal of Shoulder and Elbow Surgery, 1996Co-Authors: Thomas J Kryzak, John W Sperling, Cathy D Schleck, Robert H CofieldAbstract:Currently, there is little information available on the results of Total Shoulder Arthroplasty (TSA) in patients with Parkinson's disease. The purpose of the current study was to determine the results, risk factors for an unsatisfactory outcome, and rates of failure of TSA in patients with Parkinson's disease. Between 1978 and 2005, 49 Total Shoulder arthroplasties were performed in patients with Parkinson's disease for osteoarthritis of the Shoulder. Forty-three Shoulders (36 patients) were followed for a minimum of 2 years (mean, 8 years) or until the time of revision surgery. Total Shoulder Arthroplasty in patients with Parkinson's disease was associated with significant improvement in pain from 4.6 to 1.8 (P .05). Eight Shoulders underwent revision Arthroplasty. Three of the 8 revisions were performed less than 1 year from the time of surgery due to instability. Total Shoulder Arthroplasty is associated with significant long-term improvement in pain, external rotation, and abduction in patients with Parkinson's disease. However, early postoperative instability appears to be higher in this patient population. The results of TSA in our patients with Parkinson's disease were marginal, with 20 (47%) achieving unsatisfactory results.
Surena Namdari - One of the best experts on this subject based on the ideXlab platform.
-
revision of failed hemiArthroplasty and anatomic Total Shoulder Arthroplasty to reverse Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2019Co-Authors: Mihir M Sheth, Charles L Getz, Gerald R. Williams, Daniel Sholder, Surena NamdariAbstract:Background The impending burden of revision Shoulder Arthroplasty has increased interest in outcomes of revision procedures. Revision of failed anatomic Arthroplasty to reverse Total Shoulder Arthroplasty has shown promise alongside concerning complication rates. Methods Patients who underwent revision Shoulder Arthroplasty during a 7-year period at a tertiary care health system were identified. Presurgical and operative data were analyzed for 110 patients who met inclusion and exclusion criteria. Patients were contacted at a mean follow-up of 57 ± 26 months (range, 23-113 months) from revision surgery for functional outcomes scores, reoperations, and implant survival. Results Implant survival was 92% at 2 years and 74% at 5 years. Mean American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, and visual analog scale pain scores were 63 ± 24 (range, 5-97), 60 ± 25 (range, 0-100), and 2.9 ± 2.9 (range, 0-10), respectively. Seventy percent of patients were “very satisfied” or “satisfied with their outcome. Complications occurred in 18 patients (20%), and 10 patients (11%) underwent reoperation. Conclusions Modest patient results and satisfaction can be achieved with revision of a failed anatomic Arthroplasty to a reverse Total Shoulder Arthroplasty. As is typical of revision surgery, complications are common and can compromise results. Further study is needed to identify factors that may contribute to successful outcomes.
-
revision of failed hemiArthroplasty for painful glenoid arthrosis to anatomic Total Shoulder Arthroplasty
Journal of Shoulder and Elbow Surgery, 2018Co-Authors: Mihir M Sheth, Matthew L Ramsey, Mark D Lazarus, Joseph A Abboud, Gerald R. Williams, Daniel Sholder, Surena NamdariAbstract:Background The impending burden of revision Shoulder Arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiArthroplasty is a common cause of reoperation, and conversion to anatomic Total Shoulder Arthroplasty is one option. Methods We identified patients who underwent revision of painful hemiArthroplasty to Total Shoulder Arthroplasty over a 15-year period in a single tertiary-care health system. Presurgical and operative data were analyzed for 28 patients who met the inclusion and exclusion criteria. Patients were contacted at a minimum of 2 years' follow-up after revision surgery for functional outcome scores, reoperations, and implant survival. Results The 2- and 5-year implant survival rates were 93% and 86%, respectively. Functional outcomes were obtained from 21 patients with surviving implants. The mean American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Single Assessment Numerical Evaluation score were 78 ± 20, 2.3 ± 2.6, and 71 ± 24, respectively. The mean Short Form 12 mental and physical scores were 49 ± 10 and 43 ± 9, respectively. Of the patients, 17 (81%) were either satisfied or very satisfied with their outcome. Complications were seen in 10 patients (36%), and 6 patients (21%) required reoperation. Conclusions Anatomic Total Shoulder Arthroplasty following hemiArthroplasty can achieve successful outcomes and implant survival rates. Given our poor understanding of reverse Shoulder Arthroplasty longevity, this procedure should remain an option for patients with glenoid arthrosis and an intact rotator cuff.
-
economic decision model suggests Total Shoulder Arthroplasty is superior to hemiArthroplasty in young patients with end stage Shoulder arthritis
Clinical Orthopaedics and Related Research, 2016Co-Authors: Suneel B Bhat, Mark D Lazarus, Charles L Getz, Gerald R. Williams, Surena NamdariAbstract:Background Young patients with severe glenohumeral arthritis pose a challenging management problem for Shoulder surgeons. Two controversial treatment options are Total Shoulder Arthroplasty (TSA) and hemiArthroplasty. This study aims to characterize costs, as expressed by reimbursements for episodes of acute care, and outcomes associated with each treatment.
-
arthroscopically assisted conversion of Total Shoulder Arthroplasty to hemiArthroplasty with glenoid bone grafting
Orthopedics, 2011Co-Authors: Surena Namdari, David L GlaserAbstract:Aseptic loosening of the glenoid component after Total Shoulder Arthroplasty presents a considerable treatment challenge in the setting of substantial glenoid bone loss. Glenoid component explantation and bone grafting of defects have become common methods of recreating bone stock in hopes of preventing later fractures, maintaining joint kinematics, and allowing for later glenoid reimplantation if necessary. Although this has been traditionally accomplished via open techniques, this article describes an arthroscopic-assisted method of glenoid explantation and bone grafting for cases of aseptic glenoid loosening with contained bone defects.
