Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis.

Introduction: This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear. Materials and Methods: We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO. Results: From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001]. Conclusion: Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.

Remote Follow-up of Shoulder Arthroplasty Patients During COVID-19 Pandemic - Is This the way Forward?

BACKGROUND: The COVID-19 Pandemic has affected the way health care systems function across the globe. Apart from eliminating the risk of being in a vulnerable environment during the pandemic such as a hospital setting, virtual arthroplasty follow-up reduces the demand on funding and resources on the National Health Services (NHS). METHODS: We retrospectively reviewed our shoulder arthroplasty patients (55) operated between October 2018 to November 2020 at both our hospital sites. For remote follow-up, patients were contacted on a scheduled appointment date via telephone by an orthopaedic surgeon to enquire about their wound, pain and function. Patients were questioned as per questionnaire from the Oxford Shoulder Score (OSS) and American Shoulder and Elbow Surgeons (ASES) Standardised Assessment form. RESULTS: 50 patients were included in the final data set after excluding those who had died (5 patients). All patients had had final x-rays with full Covid-19 precautions at the time of final follow-up. No patient had wound problems except one who had concerns of wound appearance. There were no cases of notching, impingement, deep infection, dislocation or nerve injury. Of the 50 patients, 40 (80%) patients were satisfied to have a remote follow-up. 36 (72%) patients said they wouldn't mind a remote follow-up appointment. CONCLUSION: Remote follow-up via audio consultation may be an effective alternative to in person visits after shoulder arthroplasty. Patients in this series demonstrated a high level of satisfaction with virtual visits and post-operative complications were effectively identified.

The accuracy of plain radiographs in diagnosing degenerate rotator cuff disease.

BACKGROUND: A number of radiographic signs have been previously demonstrated to be associated with degenerative rotator cuff tears. An ability to predict the presence of a tear by radiography would permit the early commencement of appropriate treatment and the avoidance of unnecessary invasive investigations. The aim of the present study was to determine the accuracy of using radiographic signs to predict the presence of a cuff tear on arthroscopy. METHODS: Fifty consecutive patients who had undergone shoulder arthroscopy and had pre-operative plain radiographs were included. Pre-operative radiographs were reviewed by a consultant shoulder surgeon, a consultant radiologist and a senior clinical fellow for the following signs: acromial spur; subjective reduction of subacromial space; sourcil sign; acromial acetabularization; os acromiale; greater tuberosity cortical irregularity; greater tuberosity sclerosis; humeral head rounding; cyst; and reduction in acromiohumeral head distance. RESULTS: The presence of tuberosity sclerosis (p < 0.0001), tuberosity irregularities (p < 0.0001), tuberosity cyst (p = 0.004) and sourcil sign (p = 0.019) was associated with the presence of a rotator cuff tear. The combined sensitivity of prediction of tear by the observers following radiographic review was 91.7%, with a combined negative predictive value of 80%. CONCLUSIONS: The assessment of radiographs by senior clinicians is a useful tool for confirming the absence of a rotator cuff tear.

Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears.

BACKGROUND: The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). METHODS: This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. RESULTS: All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; p = 0.016), and abduction by 25° (p = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. CONCLUSIONS: In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon. LEVEL OF EVIDENCE: Level IV: Therapeutic study (case series).

Arthroscopic treatment of posterior shoulder instability: a systematic review.

PURPOSE: We performed a systematic review of the literature to determine the early and midterm outcomes of arthroscopic stabilization for posterior shoulder instability. METHODS: We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for related articles published in the English language. The 2 authors selected studies for inclusion or exclusion. The inclusion criteria included a minimum of 1 year of follow-up, with at least 20 patients in the study population. RESULTS: We included 6 studies, with a total of 387 patients (396 shoulders). All studies were retrospective, Level IV studies, except for 1 prospective study (Level II). In 81.06% of cases, patients reported a significant traumatic episode. The mean follow-up period was 44.4 months, and the mean recurrence rate was 5.37%. Most of the patients were able to return to sport (mean, 92.5%). CONCLUSIONS: The early and midterm results of arthroscopic stabilization of the shoulder for posterior instability are promising. Most of the patients were satisfied with the results of surgery and were able to return to sport. Larger studies and more prospective randomized trials are needed to confirm these findings. LEVEL OF EVIDENCE: Level IV, systematic review of 1 Level II study and 5 Level IV studies.

Is early operative fixation of unstable ankle fractures cost effective? Comparison of the cost of early versus late surgery.

INTRODUCTION: A retrospective study of all patients who sustained an ankle fracture requiring operative treatment was performed. 98 patients were admitted over a 14-month time period. All fractures treated conservatively were excluded. MATERIALS AND METHODS: The inpatient length of stay and the cost of operating less than and more than 24 and 48 h from admission was determined. RESULTS: There was a significant difference (p value <0.001) in cost and length of stay in patients operated less than and more than 24 h, and less than and more than 48 h from admission. There was no difference in cost and length of stay between the 2 groups of less than 24 and 48 h. However, length of stay and cost rose significantly if the operation was delayed more than 48 h. CONCLUSION: The results show that the length of stay and cost is significantly reduced by operating on ankle fractures early. There is no significant difference in the length of stay or cost if the operation is performed earlier than 24 or 48 h from admission.