ABSTRACT
BACKGROUND: The aim of this multicentre retrospective study was to compare reverse total shoulder arthroplasty clinical outcomes with glenospheres of different diameters, designs and materials. METHODS: Between 2003 and 2008, 133 patients were divided into three groups: 60 (45%) with 36-mm standard CoCrMo (group A), 21 (16%) with 36-mm eccentric cobalt-chromium-molybdenum (CoCrMo) (group B) and 52 (39%) with 44-mm cross-linked ultra-high molecular weight polyethylene (X-UHMWPE) (group C) glenospheres. Mean (SD) follow-up was 38.7 (17.4) months. Clinical evaluation included Constant score and range of motion. Radiographic analysis included radiolucent lines, instability, loosening and assessment of scapular notching. RESULTS: Mean Constant score significantly increased for all groups (Wilcoxon test, p < 0.001). Group C allowed a higher and stable increase in range of motion. After 12 months and 24 months, groups C and B showed less pain than group A (Mann-Whitney U-test, p < 0.05). Group C had significantly lower scapular notching than group B (Mann-Whitney U-test, p = 0.001) and A (Mann-Whitney U-test, p = 0.009) at 12 months, 24 months and 36 months. Groups A and C presented 5 (8.3%) and 4 (7.6%) early complications, respectively. CONCLUSIONS: The present study reported good results for all groups, although groups C and A presented better clinical outcomes, significantly lower notching and instability. A 44-mm X-UHMWPE glenosphere allowed a faster and more stable functional recovery, despite poorest pre-operative conditions. Additional long-term studies are needed to evaluate survivorship.
ABSTRACT
This study was designed to assess donor site morbidity after using the serratus anterior muscle as a free vascularized flap. The 3 distal slips of the serratus anterior were harvested from 3 dominant and 4 nondominant shoulders of 7 consecutive patients (age range, 36-61 years) to treat chronic osteitis or infected nonunions of the lower limb. Both donor and recipient sites healed primarily in all patients. Six of the 7 patients were enrolled in a postoperative shoulder-strengthening program. Preoperative and 3-month follow-up Constant scores and peak torque values of the operated shoulders were compared using the Wilcoxon matched pairs signed rank test. The pre- and postoperative Constant score were 95% and 93% respectively. Peak shoulder torque for abduction, adduction, flexion, and extension was assessed at both 60 degrees /second and 120 degrees /second. No statistical differences were found between the pre- and postoperative values. At the final follow-up (mean, 17 months), clinical examination revealed no scapular winging in all patients. Six patients answered a self-administered questionnaire to assess function of the shoulder. The average score in the pain domain was 36.3 points (with 40 points meaning free of pain). The average score in the activities of daily living domain was 18.5 of 20 points. The overall satisfaction rate with the donor site was very good in 2 patients and good in 4 patients. In conclusion, removal of the 3 distal slips of the serratus anterior for use as a free vascularized transfer did not impair shoulder function in this group of patients.
