Clinical outcomes of reverse shoulder arthroplasty for the treatment of failed fixation of proximal humeral fracrtures in the elderly patients / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcomes of reverse total shoulder arthroplasty as a revision procedure for the failed fixation of proximal humeral fractures in the elderly patients.@*METHODS@#A retrospective analysis was performed on 8 patients with failed internal fixation of proximal humeral fractures from May 2014 to March 2020, including 3 males and 5 females, aged from 65 to 75 years old. All 8 patients underwent reverse total shoulder arthroplasty, and the mean time between initial fixation and reverse total shoulder arthroplasty ranged from 8 to 16 months. Range of motion(ROM), University of California at Los Angeles(UCLA) shoulder score, visual analogue scale (VAS), self-rating anxiety scale(SAS), and Constant-Murley score of shoulder function were assessed pre-operatively and at the last follow-up. Complications relating to the surgery were recorded.@*RESULTS@#All 8 patients successfully followed up. The mean follow-up after reverse total shoulder arhroplasty ranged from 16 to 28 months. The range of motion (forward flexion, external rotation, abduction and internal rotation) of the affected shoulder was significantly improved after surgery, and the post-operative VAS, SAS and UCLA scores were also significantly improved. For the Constant-Murley score of shoulder joint function, the total scores and the subscores of pain, daily activities, range of motion and strength test at the last follow-up were all significantly improved. Scapular glenoid notch was observed in patient, which was evaluated as grade 1 on imaging. All the other patients did not develop specific or non-specific complications.@*CONCLUSION@#Reverse total shoulder arhroplasty is an appropriate treatment as a revision surgery for failed fixation of proximal humeral fractures. It has shown satisfactory clinical outcomes, accelerating the rehabilitation of shoulder function and improving the quality of life.

Two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of proximal humeral fracture / 中国修复重建外科杂志

Objective: To summarize the effectiveness of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of the proximal humeral fracture. Methods: Between June 2014 and January 2018, 17 patients with deep infection and humeral head necrosis or bone nonunion after internal fixation of proximal humeral fractures were treated. There were 8 males and 9 females, aged from 52 to 78 years (mean, 63.8 years). The infection occurred at 19-66 months after the initial internal fixation (mean, 34.8 months). Microbial culture of joint fluid was positive in 14 cases and negative in 3 cases. The preoperative Constant score, American shoulder and elbow surgeons (ASES) score, and visual analogue scale (VAS) score were 36.41±8.65, 31.06±7.43, and 7.29±0.99, respectively. The preoperative ranges of forward flexion, abduction, external rotation were (45.88±12.46), (42.18±12.31), and (16.76±4.92)°, respectively. The preoperative range of internal rotation was buttock in 9 cases, lumbosacral joint in 3 cases, L 3 in 5 cases. At the first-stage surgery, the thorough debridement was done and the antibiotic-impregnated bone cement spacer was placed after the removal of internal fixation. After the infections disappeared, the two-stage reverse total shoulder arthroplasty was performed. The mean interval between the two procedures was 4.2 months (range, 3.0-6.5 months). Results: All the incisions healed primarily and no complications such as recurrent infection or vascular nerve injury occurred. All patients were followed up 15-32 months (mean, 22.0 months). At last follow-up, the ranges of forward flexion, abduction, and external rotation were (109.00±23.66), (98.53±16.92), (41.41±6.82)°, respectively; and the range of internal rotation was lumbosacral joint in 5 cases, L 3 in 8 cases, T 12 in 4 cases. The range of motion of shoulder joints at last follow-up was significant improved when compared with the preoperative range of motion ( P<0.05). The Constant score (64.88±8.70), ASES score (65.18±8.10), and VAS score (2.94±1.25) were significantly superior to the preoperative scores ( P<0.05). X-ray films showed that no prosthesis loosening occurred. Conclusion: Two-stage reverse total shoulder arthroplasty is an effective treatment for the postoperative deep infection after internal fixation of the proximal humeral fracture, which has advantages of low risk of infection recurrence, good shoulder function, and satisfactory short-term effectiveness.

Patient-specific Guides Using 3-dimensional Reconstruction Provide Accuracy and Reproducibility in Reverse Total Shoulder Arthroplasty

BACKGROUND: We aimed to evaluate whether the use of our novel patient-specific guide (PSG) with 3-dimensional reconstruction in reverse total shoulder arthroplasty (RTSA) would allow accurate and reliable implantation of the glenoid and humeral components. METHODS: 20 fresh-frozen cadaveric shoulders were used. The PSG group (n=10) and conventional group (n=10) was evaluated the accuracy and reproducibility of implant positioning between before and after surgery on the computed tomography image. RESULTS: The superoinferior and anteroposterior offset in the glenoid component were 0.42 ± 0.07, 0.50 ± 0.08 in the conventional group and 0.45 ± 0.03, 0.46 ± 0.02 in the PSG group. The inclination and version angles were −1.93° ± 4.31°, 2.27° ± 5.91° and 0.46° ± 0.02°, 3.38° ± 2.79°. The standard deviation showed a smaller difference in the PSG group. The anteroposterior and lateromedial humeral canal center offset in the humeral component were 0.45 ± 0.12, 0.48 ± 0.15 in the conventional group and 0.46 ± 0.59 (p=0.794), 0.46 ± 0.06 (p=0.702) in the PSG group. The PSG showed significantly better humeral stem alignment. CONCLUSIONS: The use of PSGs with 3-dimensional reconstruction reduces variabilities in glenoid and humerus component positions and prevents extreme positioning errors in RTSA.

Conversion of Failed Reverse Total Shoulder Arthroplasty to Hemiarthroplasty: Three Cases of Instability and Three Cases of Glenoid Loosening

BACKGROUND: Glenoid loosening and postoperative instability are common causes of failed reverse total shoulder arthroplasty (RTSA). When soft-tissue problems or large glenoid bone defect interferes with reimplantation in revision RTSA, conversion to hemiarthroplasty can be considered. We present a case series of patients who underwent conversion to hemiarthroplasty due to glenoid loosening and early instability after RTSAs, along with clinical results. METHODS: A total of 72 primary RTSAs using the Aequalis prosthesis were performed at our institution from May 2009 to December 2016. Of these, five patients, including one with humeral neck fracture and absent rotator cuff and four with cuff tear arthropathy, underwent conversion to hemiarthroplasty. Another patient who had RTSA at a local clinic underwent hemiarthroplasty at our institution for unresolved postoperative anterior dislocation. The mean age of the six patients was 71.7 years (range, 62 to 76 years), and the mean follow-up period was 24.4 months (range, 18 to 30 months). Clinical assessments were conducted by using the visual analog scale (VAS), American Shoulder and Elbow Surgery (ASES) score, and University of California at Los Angeles (UCLA) shoulder score at the last follow-up. RESULTS: The conversion to hemiarthroplasty in the six patients dramatically improved the mean VAS score (preoperative, 8.1; postoperative, 2.5), ASES score (preoperative, 22.1; postoperative, 56.5), and UCLA score (preoperative, 12; postoperative, 18.1). However, the range of motion was almost unchanged after surgery. CONCLUSIONS: Conversion to hemiarthroplasty can be a good alternative to revision RTSA in patients with serious complications (such as unresolved instability and glenoid loosening) difficult to treat with revision RTSA.

Outcomes of Bilateral Shoulder Arthroplasties: A Comparison of Bilateral Total Shoulder Arthroplasties and Bilateral Reverse Shoulder Arthroplasties

BACKGROUND: The purpose of this study was to compare outcomes of patients who underwent bilateral total shoulder arthroplasties (TSAs) for osteoarthritis (OA) versus bilateral reverse shoulder arthroplasties (RSAs) for cuff tear arthropathy (CTA). METHODS: Inclusion criteria were patients who underwent bilateral TSAs for OA or bilateral RSAs for CTA with at least 2 years of follow-up. Twenty-six TSA patients (52 shoulders) were matched 2 to 1 with 13 RSA patients (26 shoulders) by sex, age at first surgery, and time between surgeries. Outcomes measured were shoulder range of motion (ROM), complications, and patient-reported scores. RESULTS: Preoperatively, TSA patients had significantly better forward elevation (FE) of both shoulders than RSA patients (dominant side [Dom]: 103° ± 32° vs. 81° ± 31°, p = 0.047; nondominant side [non-Dom]: 111° ± 28° vs. 70° ± 42°, p = 0.005) without significant differences in external (ER) or internal rotation (IR). Postoperatively, TSA patients had significantly better FE (Dom and non-Dom: 156° ± 12°, 156° ± 14° vs. 134° ± 24°, 137° ± 23°; p = 0.006, p = 0.019) and ER (42° ± 11°, 43° ± 10° vs. 24° ± 12°, 25° ± 10°; p < 0.001, p < 0.001) bilaterally and IR of their dominant arm (L1 vs. L4, p = 0.045). TSA patients had significantly better activities of daily living external and internal rotations (ADLEIR) scores (Dom and non-Dom: 35.3 ± 1.0, 35.5 ± 0.9 vs. 32.1 ± 2.4, 32.5 ± 2.2; p = 0.001, p = 0.001), American Shoulder and Elbow Surgeons scores (94.2 ± 8.4, 94.2 ± 8.2 vs. 84.7 ± 10.0, 84.5 ± 8.0; p = 0.015, p = 0.004), and Single Assessment Numerical Evaluation (SANE) scores (93.5 ± 7.6, 93.8 ± 11.8 vs. 80.5 ± 14.2, 82.3 ± 13.1; p = 0.014, p = 0.025), with no significant difference in visual analog scale pain scores (0.4 ± 1.0, 0.3 ± 1.0 vs. 0.7 ± 1.3, 0.8 ± 1.2) bilaterally. CONCLUSIONS: Overall, patients with bilateral TSAs and RSAs exhibited improved ROM and patient-reported outcomes. Those with bilateral TSAs had better functional outcomes than those with bilateral RSAs.

Relationship of Intraoperative Anatomical Landmarks, the Scapular Plane and the Perpendicular Plane with Glenoid for Central Guide Insertion during Shoulder Arthroplasty

BACKGROUND: This study was undertaken to evaluate the positional relationship between planes of the glenoid component (the scapular plane and the perpendicular plane to the glenoid) and its surrounding structures. METHODS: Computed tomography (CT) images of both shoulders of 100 patients were evaluated using the 3-dimensional CT reconstruction program (Aquarius®; TeraRecon). We determined the most lateral scapular bony structure of the scapular plane and measured the shortest distance between the anterolateral corner of the acromion and the scapular plane. The distance between the scapular plane and the midpoint of the line connecting the posterolateral corner of acromion and the anterior tip of the coracoid process (fulcrum axis) was also evaluated. The perpendicular plane was then adjusted to the glenoid and the same values were re-assessed. RESULTS: The acromion was the most lateral scapular structure of scapular plane and perpendicular plane to the glenoid. The average distance from the anterolateral corner of the acromion to the scapular plane was 10.44 ± 5.11 mm, and to the plane perpendicular to the glenoid was 9.55 ± 5.13 mm. The midpoint of fulcrum axis was positioned towards the acromion and was measured at 3.90 ± 3.21 mm from the scapular plane and at 3.84 ± 3.17 mm from the perpendicular plane to the glenoid. CONCLUSIONS: Our data indicates that the relationship between the perpendicular plane to the glenoid plane and its surrounding structures is reliable and can be used as guidelines during glenoid component insertion (level of evidence: Level IV, case series, treatment study).

Difference in the Surgical Approach in Reverse Total Shoulder Arthroplasty for Cuff Tear Arthroplasty: Comparison of the Radiological and Clinical Result according to the Deltopectoral and Anterosuperior Approach / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological results of reverse total shoulder arthroplasty (RSA) using an anterosuperior approach with those using a deltopectoral approach to determine the difference in cuff tear arthroplasty between both approaches. MATERIALS AND METHODS: A retrospective review of 24 consecutive patients who underwent RSA due to cuff tear arthroplasty from February 2014 to November 2015 was performed. The anterosuperior and deltopectoral approaches were 12 cases each. The mean age was 72 years and the mean follow-up period was 13.2 months. The clinical results were assessed using the visual analogue pain scale, American Shoulder and Elbow Surgeon score, Korean shoulder scoring system, and the Constant score. The prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenosphere rim distance (inferior glenosphere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance were assessed, and severity of notching according to the Nerot-Sirveaux classification, were measured from the radiology evaluation. RESULTS: Compared to the anterosuperior approach, the PSNA (9.6°, p=0.018) and inferior glenosphere overhang (2.0 mm, p=0.024) were significantly greater in the deltopectoral approach and the PGRD (2.2 mm, p=0.043) was shorter. The AT and GT distance was similar in the two groups. Two and three cases of implant notching occurred on deltopectoral approach and anterosuperior approach, respectively. No metal loosening, acromion fracture, or nerve injury was noted. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. CONCLUSION: The anterosuperior approach could cause the superior position of the glenoid baseplate and a decrease in the inferior tilt compared to the deltopectoral approach, but the clinical results had improved in both groups and there was no difference between the two groups.

Infections after shoulder arthroplasty are correlated with higher anesthetic risk score: a case-control study in Brazil

ABSTRACT Purposes: Shoulder arthroplasty (SA) has been performed by many years for the treatment of several conditions, including osteoarthritis and proximal humeral fractures following trauma. Surgical site infection (SSI) following Shoulder arthroplasty remains a challenge, contributing to increased morbidity and costs. Identification of risk factors may help implementing adequate strategies to prevent infection. We aimed to identify pre- and intra-operative risk factors associated with deep infections after Shoulder arthroplasty. Methods: An unmatched case-control study was conducted to describe the prevalence, clinical and microbiological findings, and to evaluate patient and surgical risk factors for prosthetic shoulder infection (PSI), among 158 patients who underwent SA due to any reason, at a tertiary public university institution. Risk factors for PSI was assessed by uni- and multivariate analyses using multiple logistic regression. Results: 168 SA from 158 patients were analyzed, with an overall infection rate of 9.5% (16/168 cases). Subjects undergoing SA with American Society of Anesthesiologists (ASA) grade III or higher (odds ratio [OR] = 5.30, 95% confidence interval [CI] = 1.58-17.79, p < 0.013) and presenting local hematoma after surgery (odds ratio [OR] = 7.10, 95% confidence interval [CI] = 1.09-46.09, p = 0.04) had higher risk for PSI on univariate analysis. However, only ASA score grade III or higher remained significant on multivariate analysis (OR = 4.74, 95% CI = 1.33-16.92, p = 0.016). Gram-positive cocci and Gram-negative bacilli were equally isolated in 50% of cases; however, the most commonly detected bacterium was Pseudomonas aeruginosa (18.7%). Conclusion: This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified.

Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México / Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico

Resumen: Introducción: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. Caso clínico: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). Discusión: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Abstract: Introduction: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. Clinical case: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. Discussion: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

Recent Updates Regarding Outcomes and Complications of Reverse Total Shoulder Arthroplasty

Indications of reverse total shoulder arthroplasty (RTSA) have been consistently extended by technical advancements in reverse arthroplasty prosthesis, continuous development of the implants, accumulated experiences and its successful treatment outcomes; accordingly, its use has rapidly increased. RTSA has been performed for a variety of indications, with variable outcomes depending on the initial diagnosis. However, controversial opinions still exist regarding the design of reverse arthroplasty prosthesis (medialized or lateralized design and the neck-shaft angle of the humeral prosthesis), suture of the subscapularis tendon, use of cement during placement of the humeral prosthesis, and surgical procedures; therefore, these should be investigated so that they can be better understood.

Recent Updates Regarding Outcomes and Complications of Reverse Total Shoulder Arthroplasty

Indications of reverse total shoulder arthroplasty (RTSA) have been consistently extended by technical advancements in reverse arthroplasty prosthesis, continuous development of the implants, accumulated experiences and its successful treatment outcomes; accordingly, its use has rapidly increased. RTSA has been performed for a variety of indications, with variable outcomes depending on the initial diagnosis. However, controversial opinions still exist regarding the design of reverse arthroplasty prosthesis (medialized or lateralized design and the neck-shaft angle of the humeral prosthesis), suture of the subscapularis tendon, use of cement during placement of the humeral prosthesis, and surgical procedures; therefore, these should be investigated so that they can be better understood.

Patients' Satisfaction after Reverse Total Shoulder Arthroplasty Is Affected by Preoperative Functional Status

BACKGROUND: The purpose of this study is to evaluate the functional outcomes of reverse total shoulder arthroplasty (RTSA) and to assess factors affecting the patients' subjective satisfaction after RTSA. METHODS: Forty-three patients (mean age, 75.0 ± 5.2 years) who underwent RTSA for cuff tear arthropathy or irreparable cuff tears with preoperative magnetic resonance imaging and pre- and postoperative radiographs at 1 year, and whose various functional outcomes including pain visual analogue scale (VAS), simple shoulder test, Constant score, American Shoulder and Elbow Surgeons score, and active range of motion were evaluated preoperatively and at the last follow-up (>12 months) were enrolled. The outcome parameter was set as a satisfaction scale. Various clinical and radiographic factors were analyzed, and their correlations with postoperative satisfaction were evaluated. RESULTS: All functional scores, VAS pain score, and active forward flexion showed significant improvement after surgery (all p<0.001). Twenty-nine patients were satisfied with the results and 14 were dissatisfied. The presence of pseudoparalysis (p=0.028) and worse preoperative function (all p<0.05) were related with higher satisfaction. Any radiologic parameters did not affect patients' postoperative satisfaction. CONCLUSIONS: All patients showed a good functional outcome after RTSA, however the patients' subjective postoperative satisfaction was affected by preoperative functional status (higher satisfaction in poor preoperative function), not by radiological findings.

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature.

Patients' Satisfaction after Reverse Total Shoulder Arthroplasty Is Affected by Preoperative Functional Status

BACKGROUND: The purpose of this study is to evaluate the functional outcomes of reverse total shoulder arthroplasty (RTSA) and to assess factors affecting the patients' subjective satisfaction after RTSA. METHODS: Forty-three patients (mean age, 75.0 ± 5.2 years) who underwent RTSA for cuff tear arthropathy or irreparable cuff tears with preoperative magnetic resonance imaging and pre- and postoperative radiographs at 1 year, and whose various functional outcomes including pain visual analogue scale (VAS), simple shoulder test, Constant score, American Shoulder and Elbow Surgeons score, and active range of motion were evaluated preoperatively and at the last follow-up (>12 months) were enrolled. The outcome parameter was set as a satisfaction scale. Various clinical and radiographic factors were analyzed, and their correlations with postoperative satisfaction were evaluated. RESULTS: All functional scores, VAS pain score, and active forward flexion showed significant improvement after surgery (all p<0.001). Twenty-nine patients were satisfied with the results and 14 were dissatisfied. The presence of pseudoparalysis (p=0.028) and worse preoperative function (all p<0.05) were related with higher satisfaction. Any radiologic parameters did not affect patients' postoperative satisfaction. CONCLUSIONS: All patients showed a good functional outcome after RTSA, however the patients' subjective postoperative satisfaction was affected by preoperative functional status (higher satisfaction in poor preoperative function), not by radiological findings.

Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report

Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

BACKGROUND: There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. METHODS: Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. RESULTS: There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). CONCLUSIONS: The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature.

Clinical and Radiological Results of Reverse Total Shoulder Arthroplasty Using a 25-mm Glenoid Baseplate

BACKGROUND: The size of the baseplate used in reverse total shoulder arthroplasty (RTSA) tends to be larger than the average size of the glenoid in the Korean population. The mismatch between the sizes of the baseplate and the patient's glenoid may result in improper fixation of the glenoid baseplate. This in turn may lead to the premature loosening of the glenoid component. Thus, we evaluated the short-term results of using a 25-mm baseplate in RTSA. METHODS: Seventeen patients with cuff tear arthropathy underwent RTSA with a 25-mm baseplate. The mean age of the patients was 70.1 years, and the mean follow-up period was 14.0 months. We evaluated clinical outcomes preoperatively and postoperatively: the range of shoulder motion, the American Shoulder and Elbow Surgeons (ASES) score, and the Korean Shoulder Society (KSS) score. RESULTS: We found that the mean ASES score and KSS improved from 35.0 to 74.4 (p<0.001) and from 46.9 to 71.8 (p<0.001) with RTSA. The mean forward elevation and abduction, external rotation also improved from 78.6degrees to 134.3degrees (p<0.05) and from 66.6degrees to 125.0degrees (p<0.05), from 20.2degrees to 28.4degrees (p=0.43). Postoperative complications were seen in 12% of patients, but neither the loosening of the glenoid baseplate nor inferior scapular notching were observed. CONCLUSION: In sum, the results of using a 25-mm baseplate in RTSA were similar to those of previous reports. Even though the outcomes are those of a short-term follow-up, neither the loosening of the glenoid baseplate nor the scapular notching were observed.

Evaluating Scapular Notching after Reverse Total Shoulder Arthroplasty

BACKGROUND: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. METHODS: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. RESULTS: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. CONCLUSIONS: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.

Effect of Preoperative Fatty Degeneration of the Deltoid and the Teres Minor Muscles on the Clinical Outcome after Reverse Total Shoulder Arthroplasty

BACKGROUND: To evaluate the effect of preoperative fatty degeneration of deltoid and teres minor muscles on the clinical outcome in patient with reverse total shoulder arthroplasty (RTSA). METHODS: Nineteen patients with RTSA were enrolled. The mean follow-up period was 16.1 months. The fatty degeneration of three distinct parts in each deltoid and the teres minor muscle was measured using a preoperative magnetic resonance imaging. Postoperatively, the muscle strengths for forward elevation (FE), abduction (Abd), and external rotation (ER) were measured using a myometer at the last follow-up. The parameters for clinical outcome were Constant Score (CS) and Korean Shoulder Score (KSS). RESULTS: The number of cases was 10 in group 1 and 9 in group 2. The strength of FE and Abd were significantly higher in group 1 (p<0.001 and p<0.001, respectively), and the strength of ER was not different significantly between two groups (p=0.065). For the clinical outcome, both CS and KSS were higher in group 1 (p=0.002 and p=0.002, respectively). The number of patients in group A was 11, and group B was 8. Although there was not a significant difference in terms of FE and Abd between group A and B (p=0.091, p=0.238), ER was significantly higher in group A (p=0.012). We did not find a significant difference in the clinical scores (CS, p=0.177 and KSS, p=0.238). CONCLUSIONS: These findings suggest the importance of a preoperative evaluation of the fatty degeneration of deltoid and teres minor muscles for predicting postoperative strength and clinical outcome.