Research into the fixation stability of the glenoid baseplate in reverse shoulder arthroplasty / 中华创伤骨科杂志

Reverse shoulder arthroplasty (RSA) was proposed to deal with rotator cuff tear arthropathy in the 1970s and improved from 1985 to 1995 by Dr. Grammont who designed the contemporary type of reverse shoulder prosthesis successfully. The number of RSAs has grown rapidly over the past decade. Currently, the indications for RSA include, in addition to rotator cuff tear arthropathy, massive rotator cuff tears which can not be repaired, proximal humerus fractures or their sequelae, inflammatory shoulder disease, osteoarthritis with abnormal glenoid morphology, anatomic revision after failed total shoulder arthroplasty or hemiarthroplasty, and shoulder tumors. Absolute contraindications to RSA include infection, complete axillary nerve palsy, neuropathic shoulder arthropathy, and glenoid bone loss. At present, the stability of the glenoid baseplate, an important factor affecting the incidence of postoperative complications, is mainly achieved by implantation of the screws for the glenoid baseplate base. Therefore, correct implantation of the screws is of great significance to reduce the complications in RSA.

Two cases of bilateral reverse shoulder arthroplasty performed in patients with rheumatoid arthritis / Journal of Rural Medicine

Bilateral shoulder joint disorders caused by rheumatoid arthritis significantly impair daily functioning owing to a lack of contralateral compensation. In Japan, reverse shoulder joint prostheses were approved in 2014. This was expected to improve the surgical outcomes of rheumatoid shoulder arthroplasty. We report two patients with rheumatoid arthritis who underwent bilateral reverse shoulder arthroplasty. This study aims to evaluate their postoperative clinical outcomes and activities of daily living. The patients were women in their 70s with stage III class 2 rheumatoid arthritis. Their treatment and postoperative activities of daily living were retrospectively reviewed. The first patient underwent the inlay type and experienced a residual limitation of external rotation postoperatively; therefore, she was restricted to dress with front-open clothes. However, she was able to undress after the lining of the garment was changed to a slippery material. The second patient underwent the onlay type and showed almost no limitations in postoperative activities of daily living. She was able to undress with an external rotation of 40–50°. Bilateral reverse shoulder arthroplasty improved range of motion, the Japanese Orthopaedic Association shoulder score, and functional outcomes. Only a few difficulties were encountered in the activities of daily living.

Resultados a mediano plazo de la prótesis invertida en la artropatía de manguito / Results in the medium long term of the reverse shoulder prosthesis in the cuff arthropathy

Resumen: Introducción: El estadio final de la artropatía de manguito (AM) genera dolor e invalidez, el tratamiento mediante artroplastía invertida (AI) muestra buenos índices de reducción de dolor y mejoras en movilidad. El objetivo de nuestro trabajo fue evaluar de manera retrospectiva los resultados a mediano plazo de la artroplastía invertida de hombro en nuestro centro. Material y método: Retrospectivamente analizamos 21 pacientes (23 prótesis) sometidos a AI con el diagnóstico de AM. La edad media fue de 75.21 años. El seguimiento mínimo fue de 60 meses. Analizamos las escalas ASES, DASH y CONSTANT preoperatorias y en la última visita de seguimiento. Se analizó la escala VAS preoperatoria y postoperatoria y rango de movilidad preoperatoria y postoperatoria. Resultados: Mejoraron todas las escalas funcionales y dolor (p < 0.001). ASES en 38.91 puntos (IC 95% 30.97-46.84); CONSTANT en 40.89 puntos (IC 95% 34.57-47.21); DASH en 52.65 puntos (IC 95% 46.31-59.0) p < 0.001; y 5.41 puntos (IC 95% 4.31-6.50) en VAS. Mejoraron con significación estadística la flexión (66.52o a 113.91o); y la abducción (63.69o a 105.85o). No obtuvimos significación estadística en rotación externa ni en rotación interna. Aparecieron complicaciones en 14 pacientes; 11 notching glenoideo, una infección crónica, una infección tardía y una fractura intraoperatoria de glenoides. Conclusiones: La AI de hombro representa una alternativa eficaz para el tratamiento de la AM. Puede esperarse alivio del dolor y una mejoría en la flexión y abducción del hombro; la ganancia en rotaciones es poco predecible.

Abstract: Introduction: The final stage of rotator cuff tear arthropathy generates pain and disability, treatment with reverse shoulder arthroplasty shows in different published studies good rates of pain reduction and improvements in mobility. the objective of our study was to retrospectively evaluate the medium-term results of inverted shoulder replacement at our center. Material and methods: Retrospectively, we analyzed 21 patients (23 prosthetics) undergoing reverse shoulder arthroplasty with the diagnosis of rotator cuff tear arthropathy. The average age of patients was 75.21 years The minimum follow-up was 60 months. We analyzed in all preoperative ASES, DASH and CONSTANT patients, and a new functional assessment was made using these same scales at the last follow-up visit. We analyzed pre and postoperative VAS as well as pre and postoperative mobility range. Results: We achieved a statistically significant improvement in all functional scale and pain values (p < 0.001). The ASES scale showed an improvement of 38.91 points (95% CI 30.97-46.84); the 40.89-point CONSTANT scale (95% 34.57-47.21) and the 52.65-point DASH scale (95% 46.31-59.0) p < 0.001. We found an improvement of 5.41 points (95% CI 4.31-6.50) on the VAS scale. We also achieved a statistically significant improvement in flexion values 66.52o to 113.91o degrees; abduction 63.69o to 105.85o degrees at the end of the follow-up. We did not get statistical significance in terms of external rotation but with a tendency to improve in the obtained values; instead in internal rotation we obtained results that showed a tendency to worsen. Complications occurred during follow-up in 14 patients; 11 in relation to notching glenoid, one patient with a chronic infection, one patient with a late infection and one intraoperative fracture of glenoid. Conclusions: Reverse shoulder arthroplasty is an effective treatment of rotator cuff arthropathy. Pain relief and improvement in shoulder flexion and abduction can be expected especially; the gain in rotations is unpredictable.

Análisis comparativo de tres modelos de prótesis reversa de hombro basados en los nuevos ángulos de distalización y lateralización / Comparative analysis of three models of reverse shoulder prosthesis based on the new angles of distalization and lateralization

Resumen: Objetivo: Comparar resultados funcionales e imagenológicos de tres modelos protésicos según el índice de lateralización y distalización. En un grupo heterogéneo de diagnósticos (fractura, artropatía de manguito, secuela de fractura y artrosis glenohumeral). Material y métodos: Cohorte prospectiva de 33 pacientes sometidos a prótesis reversa de hombro entre Diciembre 2014 y Julio 2017 con un seguimiento mínimo de un año. Se definieron tres grupos, G: 10 pacientes con Grammont clásico (155o, Glena medializada); B: nueve pacientes con Bio-RSA (155o, glena lateralizada ósea); y A: 14 con Arrow (135o, glena lateralizada metálica). Las variables fueron: datos demográficos, clínicos, funcionales y radiológicos (ángulo de lateralización y distalización). Para el análisis estadístico se utilizaron pruebas de ANOVA, T-test y regresión lineal, con una significancia estadística de 5%. Resultados: El ángulo de lateralización del hombro (LSA) fue significativamente mayor en el grupo A (98o A, 79o G, 80o B) (p < 0.05). El ángulo de distalización del hombro (DSA) del grupo B fue significativamente superior al A (52o B, 39o A) (p < 0.05) y no significativamente superior al G (48o G) (p = 0.06). No se demostró una correlación entre el LSA y DSA con la rotación externa (p = 0.51) y elevación activa (p = 0.41), respectivamente. En índices clínicos (elevación anterior, rotación externa, rotación interna) y funcionales (índice Constant ajustado y evaluación subjetiva de hombro) no encontramos diferencias significativas entre los distintos modelos protésicos (p > 0.05). Conclusiones: El ángulo de lateralización fue mayor en el modelo Arrow y distalización en el modelo Bio-RSA. No encontramos correlación clínica-radiológica en esta serie heterogénea de pacientes.

Abstract: Purpose: Compare functional and radiological outcomes of three different designs of reverse shoulder arthroplasty according to distalization and lateralization shoulder angle, in heterogenic diagnostics (fracture, cuff arthropathy, fracture sequela and osteoarthritis). Material and methods: Prospective cohort of 33 patients of reverse shoulder arthroplasty (RSA) between December 2014 and July 2017 with a minimum one year of follow-up. We defined three groups, G: 10 patients with Grammont (155o, Medialized Glena), B: 9 patients with Bio-RSA (155º, lateralized bone glena) and A: 14 patients with Arrow (135o, lateralized metallic glena). We analyze demographic, clinical, functional and radiological outcomes (lateralization shoulder angle (LSA) and distalization shoulder angle (DSA)). For the statistical analysis, ANOVA, T-tests and linear regression tests were used, with a statistical significance of 5%. Results: The LSA was significantly higher in group A (98o A, 79o G, 80o B) (p < 0.05). In DSA, group B was significantly higher than A (52o B, 39o A) (p < 0.05) and not significant to G (48o G) (p = 0.06). There was no correlation of LSA and DSA with external rotation (p = 0.51) and active elevation (p = 0.41), respectively. There was no significant clinical (anterior elevation, external rotation, internal rotation) and functional outcomes (adjusted Constant score and subjective shoulder evaluation) differences between the different RSA models (p > 0.05). Conclusions: The LSA was higher in the Arrow and the DSA was higher in Bio-RSA. We did not find Clinical - Radiological correlation in this heterogeneous series of patients.

Hemiarthroplasty versus reverse shoulder arthroplasty for complex proximal humeral fractures in the aged: a meta-analysis / 中华创伤骨科杂志

Objective:To compare the advantages and disadvantages of hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) in the treatment of complex proximal humeral fractures in the elderly patients.Methods:Pubmed, the Cochrane Library, EMBASE, and Chinese databases like CNKI, Wanfang Data and Weipu were searched for studies comparing HA and RSA in the treatment of complex proximal humeral fractures in the elderly (>60 years) from 2000 to 2020. After the studies were included and excluded by a set of inclusion and exclusion criteria and evaluated for their quality, their radiological and functional data were extracted and analyzed using software Stata 14.0.Results:Included in this meta-analysis were 11 studies with a total of 771 patients. RSA was superior to HA in outcomes like forward flexion ( SMD=-1.043, 95% CI: -1.551 to -0.534, P=0.000), abduction ( SMD=-0.811, 95% CI: -1.470 to -0.153, P=0.016), Constant score ( SMD=-0.699, 95% CI: -1.118 to -0.280, P=0.001), American Shoulder Elbow Surgeons’ Form (ASES) ( SMD=-0.931, 95% CI: -1.256 to -0.606, P<0.001), and Simple Shoulder Test (SST) ( SMD=-0.598, 95% CI: -1.181 to -0.016, P=0.044). HA led to a higher complication rate ( RR=2.14, 95% CI: 1.11 to 4.14, P=0.024), a higher joint stiffness rate ( RR=6.467,95% CI: 1.923 to 21.755, P=0.003) and a higher revision rate ( RR=5.796, 95% CI: 1.927 to 17.434, P=0.002). There were no statistically significant differences between RSA and HA in tuber healing rate ( RR=0.850, 95% CI: 0.669 to 1.080, P=0.182), internal rotation ( SMD=0.536, 95% CI: -0.394 to 1.466, P=0.259), external rotation ( SMD=-0.366, 95% CI: -0.916 to 0.184, P=0.192), implant infection ( RR=1.550, 95% CI: 0.330 to 7.286, P=0.579) or Disabilities of the Arm, Shoulder and Hand (DASH) score ( SMD=0.286, 95% CI: -0.278 to 0.850, P=0.032). Although there was no significant difference between RSA and HA in visual analogue scale (VAS) score ( SMD=0.440, 95% CI: -0.113 to 0.993, P=0.119), RSA scored better ( SMD=-1.101, 95% CI: -2.090 to -0.112, P=0.029). Conclusion:For elderly patients (>60 years) with complex proximal humeral fracture, RSA may be a more effective surgical intervention which can lead to better early and mid-term clinical outcomes than HA.

Tuberosity Healing after Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: Is there Clinical Improvement? / Consolidação dos tubérculos na artroplastia reversa do ombro após fratura proximal do úmero: Existe melhoria nos resultados funcionais?

Abstract Objective To compare the functional results of patients with complex proximal humerus fracture submitted to total shoulder reverse arthroplasty with and without tuberosity healing. The secondary goal was to know the tuberosity healing rate after reverse shoulder arthroplasty with our surgical technique. Methods A retrospective, cohort type study, with a prospective database collection. In total, 28 patients fulfilled the inclusion criteria: age ≥ 65 years, reverse shoulder arthroplasty for complex proximal humerus fracture (type-3 or -4, according to Neer), and a minimum of 24 months of follow-up. At six months of follow-up, all of the patients were evaluated radiographically for tuberosity, and then they were divided into 2 groups: those with healed tuberosities and those with non-healed tuberosities. A clinical evaluation using the Constant score, active range of motion and the Visual Analog Scale (VAS) at the last follow-up was also performed. Results Tuberosity healing occurred in 21 patients (76.3%). There were statistically significant differences in the Constant scoring system (p < 0.001), forward elevation (p = 0.020), internal rotation (p = 0.001) and external rotation (p = 0.003) when comparing the group of healed tuberosities with the group of non-healed tuberosities. No differences were found regarding the VAS score. Conclusion Tuberosity healing results in an improvement of the functional outcomes of patients submitted to reverse shoulder arthroplasty as a treatment for complex proximal humeral fractures in the elderly.

Resumo Objetivo Comparar os resultados funcionais entre pacientes com fratura complexa do úmero proximal submetidos a artroplastia reversa com tubérculos consolidados e tubérculos não consolidados. O objetivo secundário foi determinar a taxa de consolidação dos tubérculos com este tipo de prótese. Métodos Estudo de tipo coorte, retrospectivo, com coleta prospectiva de dados. No total, 28 pacientes cumpriram os critérios de inclusão: idade superior a 65 anos, prótese reversa do ombro por fratura complexa do úmero proximal (3 ou 4 partes, segundo Neer), e tempo de seguimento mínimo de 24 meses. Aos seis meses, todos os pacientes foram avaliados radiograficamente quanto à consolidação dos tubérculos e divididos em dois grupos: grupo com tubérculos consolidados e grupo com tubérculos não consolidados. A avaliação funcional realizou-se segundo o sistema de pontuação de Constant, da amplitude de movimento ativo, e da Escala Visual Analógica (EVA) à data da última consulta. Registaram-se todas as complicações. Resultados A consolidação dos tubérculos ocorreu em 21 pacientes (76,3%). Verificou-se diferenças estatisticamente significativas no sistema de pontuação de Constant (p < 0.001), elevação anterior (p = 0.020), rotação interna (p = 0.001) e externa (p = 0.003), quando se comparou o grupo dos tubérculos consolidados com o grupo dos tubérculos não consolidados. Não houve diferenças significativas na EVA entre os 2 grupos. Conclusão A consolidação dos tubérculos traduz uma melhoria dos resultados funcionais em pacientes submetidos a artroplastia reversa do ombro como tratamento de fraturas complexas do úmero proximal em idosos.

Prognostic Radiological Factors Affecting Clinical Outcomes of Reverse Shoulder Arthroplasty in the Korean Population

BACKGROUND: Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population. METHODS: We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014. RESULTS: In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, p = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; p = 0.001), greater prosthesis scapular neck angle (average, 104° ± 10.3°; p = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; p = 0.012), lower inferior baseplate tilt angle (average, 105.5° ± 9.2°; p = 0.009), and varus humeral neck-shaft angle (p = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores. CONCLUSIONS: Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

Is Acromial Fracture after Reverse Total Shoulder Arthroplasty a Negligible Complication?: A Systematic Review

BACKGROUND: The purpose of this study was to investigate the incidence of acromial fracture after reverse total shoulder arthroplasty (RTSA) and clinical and radiological outcomes of treatment of the fracture. METHODS: A systematic review was performed to identify studies that reported the results of treatment of acromial fractures after RTSA. A literature search was conducted by two investigators using four databases (PubMed, Embase, Cochrane, and Ovid Medline). RESULTS: Fifteen studies (2,857 shoulders) satisfied our inclusion criteria. The incidence of acromial fracture after RTSA was 4.0% (114 / 2,857). The mean age of the patients at the time of fracture was 72.9 years (range, 51 to 91 years). The mean time from RTSA to diagnosis of acromial fracture was 9.4 months (range, 1 to 94 months). One hundred shoulders (87.7%) were treated conservatively and 14 shoulders (12.3%) were treated surgically. The mean follow-up period after acromial fracture was 33.8 months. The overall union rate was 50.0% (43.8% for conservative treatment and 87.5% for operative treatment). The fracture incidence was significantly different among the medial glenoid and medial humerus prosthesis design (8.4%), the lateral glenoid and medial humerus design (4.0%), and the medial glenoid and lateral humerus design (2.8%). The mean values at final follow-up were as follows: visual analog scale score, 2.2; American Shoulder and Elbow Surgeons score, 59.1; Constant score, 59.7; and Simple Shoulder Test, 5.8. The mean forward flexion, abduction, and external rotation were 102.3°, 92.3°, and 25.8°, respectively. CONCLUSIONS: Acromial fractures after RTSA are a complication neither uncommon nor negligible. In the absence of studies with high-level evidence, there is a controversy on the outcomes after treatment. Further well-designed prospective randomized controlled studies with a long-term follow-up should be performed to ascertain the diagnosis, treatment, and prognosis of acromial fractures after RTSA.

Shoulder Replacement Arthroplasty after Failed Proximal Humerus Fracture / 대한정형외과학회잡지

Proximal humerus fracture can be defined as a fracture that occurs in the surgical neck or proximal part of the humerus. Despite the appropriate treatment, however, various complications and sequelae can occur, and the treatment is quite difficult often requiring surgical treatment, such as a shoulder replacement. The classification of sequelae after a proximal humerus fracture is most commonly used by Boileau and can be divided into two categories and four types. Category I is an intracapsular impacted fracture that is not accompanied by important distortions between the tuberosities and humeral head. An anatomic prosthesis can be used without greater tuberosity osteotomy. In category I, there are type 1 with cephalic collapse or necrosis with minimal tuberosity malunion and type 2 related to locked dislocation or fracture-dislocation. Category II is an extracapsular dis-impacted fracture with gross distortion between the tuberosities and the humeral head. To perform an anatomic prosthesis, a tuberosity osteotomy should be performed. In category II, there are type 3 with nonunion of the surgical neck and type 4 with severe tuberosity malunion. In type 1, non-constrained arthroplasty (NCA) without a tuberosity osteotomy should be considered as a treatment. On the other hand, reverse shoulder arthroplasty (RSA) should be considered if types 1C or 1D accompanied by valgus or varus deformity or severe fatty degeneration of the rotator cuff. In general, the results are satisfactory when NCA is performed in type 2 sequelae. On the other hand, RSA can be considered as an option when there is no bony defect of the glenoid and a defect of the rotator cuff is accompanied. In type 3, it would be effective to perform internal fixation with a bone wedge graft rather than shoulder replacement arthroplasty. Recent reports on the results of RSA are also increasing. On the other hand, recent reports suggest that good results are obtained with RSA in type 3. In type 4, RSA should be considered as a first option.

The clinical effects of reverse shoulder arthroplasty for the patients with the cuff tear arthritis / 中华外科杂志

Objective@#To analyze the clinical effects of reverse shoulder arthroplasty (RSA) for the patients with the cuff tear arthritis(CTA).@*Methods@#A retrospective analysis of 12 patients who had underwent primary RSA for treatment of CTA from January 2012 to June 2017 in Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University. There were 8 males and 4 females, aged 69.4 years (range: 64-73 years). The operation was performed in a conventional manner, the subscapularis and biceps tendon were repaired separately.The preoperative and postoperative American shoulder elbow surgeons score and university of California at LosAngeles score of patients were recorded. The complications and the images of radiological examinations were collected. Data were analyzed by paired-samples t-test.@*Results@#At mean follow-up of (34.7±18.1) months (range:3-66 months), the preoperative ASEA score improved from 58.2±8.2 to 92.9±2.9 (t=14.32, P=0.00) and UCLA score improved from 13.2±1.5 to 30.8±1.7(t=23.14, P=0.00). No complications like loosening of prosthesis, superficial wound infection and shoulder dislocation were noted.@*Conclusion@#Reverse shoulder arthroplasty have satisfactory effect for the patients with the cuff tear arthritis.

Radiologic Comparison of Humeral Position according to the Implant Designs Following Reverse Shoulder Arthroplasty: Analysis between Medial Glenoid/Medial Humerus, Lateral Glenoid/Medial Humerus, and Medial Glenoid/Lateral Humerus Designs

BACKGROUND: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. METHODS: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation (LHO(COR)), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. RESULTS: The increment in postoperative AED was 19.92 ± 3.93 mm in group A, 24.52 ± 5.25 mm in group B, and 25.97 ± 5.29 mm in group C, respectively (p=0.001). The increment in postoperative LHO was 0.13 ± 6.30 mm, 8.00 ± 12.14 mm, and 7.42 ± 6.88 mm, respectively (p=0.005). The increment in postoperative LHOCOR was 20.76 ± 6.06 mm, 22.04 ± 5.15 mm, and 28.11 ± 4.14 mm, respectively (p=0.002). CONCLUSIONS: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and LHO(COR) between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.

Reverse Shoulder Arthroplasty in Patients with Rheumatoid Arthritis: A Systematic Review

BACKGROUND: There are limited data available regarding the results of reverse shoulder arthroplasty (RSA) in patients with rheumatoid arthritis (RA). We performed a systematic review of the literature to investigate the radiological and clinical outcomes after RSA in patients with RA. METHODS: A literature search for publications between 1987 and 2014 was conducted by 2 independent reviewers using PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials. Articles were retrieved by an electronic search using keywords and their combinations. Studies that met inclusion criteria were assessed for pertinent data. RESULTS: Seven studies including 123 shoulders met the inclusion criteria. The mean age of the patients was 67.9 years and the mean follow-up period was 46.6 months. The mean Constant score and American Shoulder and Elbow Surgeons (ASES) score increased from 18.6 and 27.5 preoperatively to 58.6 and 73.7, respectively, at the final follow-up evaluation. The mean active forward flexion, abduction, and external rotation increased from 57.2°, 50.4°, and 11.4° to 127.1°, 116.7°, and 26.4°, respectively. The incidence of scapular notching was 33.7%. Twenty-seven (22.0%) of 123 shoulders had one or more complications, 12 of which (44.4%) had intraoperative or postoperative fractures. Nine shoulders (7.3%) had one or more revision surgeries. CONCLUSIONS: RSA in RA showed similar short- to mid-term results without higher complication rates as compared to RSA in cuff tear arthropathy. Although RSA can be considered a reliable treatment option in patients with RA, further large-scale studies are required to determine the long-term survival of the implant.

Reverse Total Shoulder Arthroplasty: Salvage Procedure for Failed Prior Arthroplasty

BACKGROUND: To evaluate the clinical outcome of revision of primary shoulder replacement by using reverse total shoulder arthroplasty (RTSA). METHODS: Seven patients underwent revision RTSA with a mean follow-up of 22.1 months (range, 12 to 54 months). Their mean age at the time of operation was 75.5 years (range, 70 to 80 years). Assessments were performed on the preoperative and postoperative visual analogue scale (VAS) score, muscle strength, range of motion, University of California at Los Angeles (UCLA) score, Constant score, subjective satisfaction and the anteroposterior and axillary views of the glenohumeral joint. The primary operation was hemiarthroplasty in 5 patients, total shoulder replacement in 1 patient, and reverse shoulder arthroplasty in 1 patient. The cause of revision surgery was infection in 2 patients, humeral stem loosening in 2 patients, glenoid arthropathy in 2 patients, and glenoid loosening in 1 patient. The mean duration from primary operation to revision surgery was 52 months (range, 27 to 120 months). RESULTS: The VAS score for pain during motion was improved from 7.3 preoperatively to 2.1 postoperatively (p = 0.03). There were increases in the mean active forward flexion (from 62.1° to 92.8°), abduction (from 70° to 87.1°), external rotation (from 44.2° to 47.4°), and internal rotation (from L5 to L4; p > 0.05) postoperatively. Performance in activities of daily living improved (p > 0.05), except for lifting 10 lb above the shoulder (from 1.2 to 1.1; p = 0.434). Overall, 5 of 7 patients were satisfied with the results of revision surgery. The mean Constant score improved from 44.8 preoperatively to 57.1 postoperatively (p = 0.018). The mean UCLA score improved from 12.8 preoperatively to 22.8 postoperatively (p = 0.027). In the postoperative radiological evaluation, no radiolucency was observed around the base plate or humeral stem. CONCLUSIONS: Pain could be reduced after revision RTSA, but improvements in range of motion and function were difficult to achieve. We think that the patients' satisfaction was relatively high despite the low function score due to the preoperative severe pain and marked limitation of range of motion.

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

Rheumatoid arthritis (RA) is a systemic disease with medication as the treatment of choice. However, surgical treatment is recommended when no improvement is noted despite aggressive conservative treatment. Synovectomy provides desirable outcomes for RA patients in the early stage with a glenohumeral joint of Larsen grade II or less; conversely, arthroplasty is recommended for patients with a glenohumeral joint of grade III or higher. RA patients often have attenuation and dysfunction of the rotator cuff, and reverse shoulder arthroplasty has been proven to provide favorable outcomes in some patients. RA is often complicated with osteoporosis and bony deformity; therefore, close attention is necessary to prevent fractures during shoulder arthroplasty.

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

Rheumatoid arthritis (RA) is a systemic disease with medication as the treatment of choice. However, surgical treatment is recommended when no improvement is noted despite aggressive conservative treatment. Synovectomy provides desirable outcomes for RA patients in the early stage with a glenohumeral joint of Larsen grade II or less; conversely, arthroplasty is recommended for patients with a glenohumeral joint of grade III or higher. RA patients often have attenuation and dysfunction of the rotator cuff, and reverse shoulder arthroplasty has been proven to provide favorable outcomes in some patients. RA is often complicated with osteoporosis and bony deformity; therefore, close attention is necessary to prevent fractures during shoulder arthroplasty.

Reverse Shoulder Arthroplasty with Tendon Transfer Using Single Incision for Massive Rotator Cuff Tear with Loss of External Rotation / 대한정형외과학회잡지

In patients with massive rotator cuff tears, operative treatment is considered if there is no improvement after conservative treatment. Reverse shoulder arthroplasty is an option among several treatments. However, in cases of massive rotator cuff tears that extend to the teres minor with combined loss of active elevation and external rotation, reverse shoulder arthroplasty alone might not restore the active external rotation. As a consequence, patients continue to feel inconvenienced in performing activities of daily living. Reverse shoulder arthroplasty, with latissimus dorsi and teres major transfer, can restore functional range of motion in forward flexion and in external rotation. Herein, we report a case of massive rotator cuff tear with literature review.

Reverse Total Shoulder Arthroplasty for Massive Cuff Tear and Cuff Tear Arthropathy in Elderly Patients / 대한정형외과학회잡지

PURPOSE: We wanted to assess the short term clinical outcomes and the effectiveness of reverse total shoulder replacement for massive rotator cuff tears with cuff tear arthropathy in elderly patients. MATERIALS AND METHODS: Between September 2007 and January 2009, 17 reverse total shoulder arthroplasties were performed on patients with an average age of 69.3 (58-80) years. The follow up period was an average of 17.9 (12-32) months. The outcomes were evaluated using the visual analogue scale, the range of motion, the muscle strength, the Constant score, the UCLA score and the Korea shoulder score. We performed radiological measurements of medialization of the center of rotation, distalization of the humerus, and tilting of the inferior glenoid on the preoperative and postoperative radiographs. RESULTS: The VAS improved from 7.2+/-3.6 preoperatively to 1.6+/-1.0 postoperatively. The average preoperative active forward fl exion was 51.5+/-28.4 degrees, which improved to 131.5+/-20.7 degrees at the final follow-up. The internal rotation was deteriorated from L2 to L5 (p<0.001, 0.001, 0.011). The average Constant score improved from 23.9+/-5.1 points before surgery to 62.2+/-9.1 points at the time of follow-up and the UCLA score and KSS score also rose from 7.6+/-2.4 and 27.0+/-7.5 points to 26.3+/-3.6 and 69.2+/-10.4 points respectively, which were statistically significant. For the radiological measurements, the medialization of rotation of the center was a mean of 20.6 mm+/-4.3 and the distalization of the humerus was a mean 22.8 mm+/-5.56. The glenoid inferior tilting increased a mean of 12.1+/-4.3 degrees. Inferior scapular notching was observed in two cases. CONCLUSION: The reverse total shoulder arthroplasty produced good results when used for the treatment of massive rotator cuff tear and cuff tear arthropathy. Forward fl exion was significantly improved, but on the contrary internal rotation was deteriorated. Considering the technical difficulties and the possibility of complications, the reverse total shoulder arthroplasty should be judiciously used by expert surgeons.