ABSTRACT
BACKGROUND: The reverse total shoulder arthroplasty (RTSA) is a common therapy for the fracture sequelae (FS) of the proximal humerus. The aim of this study was to show the short and midterm clinical outcome of the RTSA for FS and to identify prognostic factors. METHODS: Data from 46 patients with chronic FS who underwent RTSA were analysed. The clinical follow-up included the Constant score and radiographic examination. Patients were divided into groups based on the Boileau classification of FS, and the degree of metaphyseal bone loss was measured (Boileau type I 9 patients; type II 3 patients; type III 8 patients and type IV 16 patients). Scapular notching was assessed according to the classification of Sirveaux. RESULTS: The mean postoperative Constant score was 57. Clinical outcomes were similar among the various FS groups, as defined according to the Boileau classification, but patients who had undergone revision arthroplasty had a significantly inferior mean Constant score than patients with type IV FS. There were no significant differences between patients who were initially managed with conservative therapy and those treated surgically. Patients with metaphyseal bone loss >3 cm showed inferior clinical scores. Inferior scapular notching was seen in 25 patients, and had a negative effect on the clinical outcome. Complications included five infections and one dislocation. CONCLUSION: Metaphyseal bone loss was unfavourable prognostic factors in patients with FS treated with RTSA. However, the Boileau classification did not serve as a prognostic criterion. Previous operative or conservative treatment had no influence on the outcome and scapular notching was associated with inferior clinical results.
Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Range of Motion, Articular/physiology , Shoulder Fractures/surgery , Surgical Wound Infection/diagnosis , Aged , Analysis of Variance , Arthroplasty, Replacement, Shoulder/rehabilitation , Cohort Studies , Exercise Therapy/methods , Female , Humans , Male , Middle Aged , Pain Measurement , Prognosis , Recovery of Function , Recurrence , Retrospective Studies , Risk Assessment , Shoulder Fractures/diagnostic imaging , Statistics, Nonparametric , Surgical Wound Infection/therapy , Treatment OutcomeABSTRACT
PURPOSE: The presence of inferior scapula notching is significantly affected by the anatomy the scapula and can be influenced by the glenosphere design and position and the onlay type. MATERIALS AND METHODS: A biomechanical study was undertaken with 13 human shoulder specimens in a robot-assisted shoulder simulator. Inferior scapula contact during adduction of the humerus was detected using a contact pressure film. Computed tomography scans with three-dimensional reconstructions of each specimen were performed. RESULTS: The greatest improvement of the scapula notching angle (SNA) was achieved by simultaneous implantation of a shallow humeral onlay and an eccentric glenosphere design: 16.3-19.0° (P < 0.005). The SNA was significantly decreased by 5.8° when shifting from a 38 mm centric glenosphere to a 42 mm centric glenosphere (P < 0.005) and by 8.9° comparing the 38 mm centric glenosphere with 38 mm eccentric glenosphere (P < 0.005). The solitary implantation of a shallow onlay significantly decreased the SNA depending on the glenosphere size between 7.4° and 8.0° (P = 0.001). A more inferior position of the metaglene as well as a long scapula neck (P = 0.029) and a large lateral scapula pillar angle (P = 0.033) were correlated with a lower SNA. CONCLUSION: This study demonstrates the importance of inferior glenosphere placement and the benefit of eccentric glenosphere and shallow humeral cup design to reduce the adduction deficit of the reverse shoulder. The presence of a short neck of the scapula can have a negative prognostic effect on inferior impingement during adduction of the arm. LEVEL OF EVIDENCE: Basic Science Study.
ABSTRACT
Clinical studies on primary osteoarthritis have shown better results of total shoulder arthroplasty (TSA) compared to hemiarthroplasty (HA) regarding the function, revision rate and postoperative pain relief. However, a clear recommendation for implantation of TSA or HA, depending on the glenoid type of erosion, does not exist. The aim of the study was to compare the results of TSA and HA with respect to the preoperative glenoid type. In this study, 41 patients were examined retrospectively; among them, 25 patients were treated with stemmed anatomic TSA and 16 with stemmed anatomic HA. The degree of osteoarthritis was determined according to Samilson and the glenoid erosion was classified according to Walch. The clinical outcome of the patients was determined by using the Constant Score (CS) and the Simple Shoulder Test at final follow-up. Patients after TSA demonstrated a significantly improved internal rotation compared to HA patients. Patients with preoperative B1 glenoid showed better pain relief after TSA compared to HA. For patients with preoperative type A2 glenoid a significantly higher CS was found after TSA compared to HA. We were able to show good short-term results after TSA and HA. Our findings suggest a better internal rotation for TSA compared to HA, superior clinical outcome for patients with preoperative A2 glenoid and lower pain level for patients with a preoperative B1 glenoid. However, these results need to be confirmed by further studies.
