This work presents a polymer-based tactile capacitive sensor capable of measuring joint reaction forces of reverse total shoulder arthroplasty (RTSA). The capacitive sensor contains a polydimethylsiloxane (PDMS) dielectric layer with an array of electrodes. The sensor was designed in such a way that four components of glenohumeral contact forces can be quantified to help ensure proper soft tissue tensioning during the procedure. Fabricated using soft lithography, the sensor has a loading time of approximately 400 ms when a 14.13 kPa load is applied and has a sensitivity of 1.24 × 10−3 pF/kPa at a load of 1649 kPa. A replica RTSA prothesis was 3D printed, and the sensor was mounted inside the humeral cap. Four static right shoulder positions were tested, and the results provided an intuitive graphical description of the pressure distribution across four quadrants of the glenohumeral joint contact surface. It may help clinicians choose a right implant size and offset that best fit a patient’s anatomy and reduce postoperative biomechanical complications such as dislocation and stress fracture of the scapula.
Specific emphasis has been placed on higher-quality research (Level-I and II studies) and particularly relevant Level-III studies. Rotator Cuff RepairThe decision to indicate operative repair for degenerative rotator cuff tears is controversial. Kukkonen et al. 1 provided a mean 6.2-year follow-up in 150 patients who were >55 years of age; had small, full-thickness supraspinatus tears; and were randomized to physiotherapy only, acromioplasty and physiotherapy, or repair, acromioplasty, and physiotherapy. The mean change in Constant score (the primary outcome) was similar in the 3 groups, as were changes in the visual analog scale (VAS) pain and satisfaction scores. There was a significant progression of arthritis from baseline to follow-up for the entire cohort without a difference between groups. The authors suggested that operative repair is no better than conservative treatment and does not protect against degeneration of the glenohumeral joint.Long-term follow-up comparing single-row and doublerow repair techniques is uncommon. Lapner et al. 2 reported a 10-year follow-up to a previous 2-year report of a randomized controlled trial (RCT) of 90 patients comparing single-row and double-row repair. At 10 years, the Western Ontario Rotator Cuff Index (WORC) scores were higher in the double-row group. Between 2 and 10 years, significant decreases in the WORC and American Shoulder and Elbow Surgeons (ASES) scores were seen in the single-row repair group but not in the double-row repair group. Only 30 patients had 10-year ultrasound data, which demonstrated similar retear rates between groups: 23% for the single-row repair group compared with 42% for the double-row repair group (p = 0.418). The authors concluded that double-row fixation preserved joint function Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H167).
» Radial head arthroplasty is a viable surgical option when a radial head fracture cannot be reconstructed. Radial head arthroplasty provides a load-bearing articular structure against the capitellum in unstable fractured elbows.» Studies have emphasized the importance of choosing the correct implant size to replicate the native radial head anatomy, citing various consequences of improperly sized radial head prostheses. Overstuffing of the radiocapitellar joint, or lengthening of the radius, has been extensively studied because of its detrimental effects on elbow biomechanics, but other types of improper sizing also have negative consequences.» In the setting of severe fracture-dislocation or revision surgery, anatomic landmarks that are useful for prosthesis sizing often are missing. Various methods have been described to provide guidance for the accurate sizing of a prosthetic radial head; a retrieved radial head, the proximal edge of the lesser sigmoid notch, the radiocapitellar synovial fold, and the ulnohumeral joint space all represent useful references.» Intraoperative radiographic examination is an important step while assessing implant size, including the height of the prosthetic radial head.» Since no single method is perfect on its own, the surgeon should combine as many reference measures as possible, both before and during the procedure, for accurate prosthesis sizing in order to achieve successful outcomes.
Traditional evaluation of non-traumatic shoulder pain (NTSP) involves four radiographic views of the joint: AP, Grashey (G), axillary (AX), and lateral scapular (LS). The LS view has historically been useful in diagnosing various glenohumeral injuries. However, some studies have questioned the clinical utility of the LS view. PURPOSE: To determine if including the LS view makes meaningful contribution to accurate diagnosis and treatment plan for NTSP. METHODS: Two sets of fifty clinical vignettes were developed based on patients who presented with NTSP. Each set included identical patient history and physical exam findings, but different radiographs. The first set included AP, G, and AX views. The second set included AP, G, AX, and LS views. Four independent raters initially evaluated the first set of vignettes and provided diagnoses, need for further imaging, and treatment recommendations. Each rater repeated the evaluation one month later with the second set of vignettes. Cohen's kappa was used to assess intra-observer reliability across both sets of vignettes. A survey was also created and distributed to members of American Shoulder and Elbow Surgeons (ASES) to evaluate how often surgeons utilize the LS view, and for what reason. RESULTS: Cohen's kappa demonstrated substantial intra-rater reliability between the two sets of vignettes for diagnosis (0.702), x-ray findings (0.645) and further studies (0.620). Percent agreement was calculated and showed that raters maintained the same diagnosis in 77.5% of cases across both sets of vignettes. Furthermore, none of the raters recommended further x-rays when evaluating the first set of vignettes, suggesting they did not feel a need for the LS view prior to developing a diagnosis and treatment plan. Of surgeons who responded to the ASES survey, 82.6% routinely order a LS radiograph to evaluate patients with NTSP. Indications included: better characterization of acromion morphology (75.4%), better appreciation of humeral head relative to glenoid (38.2%), and better evaluation of scapular morphology (28.1%). CONCLUSION: Most surgeons who responded to the ASES survey report routinely ordering a LS radiograph in the initial evaluation of NTSP. However, responses to clinical vignettes suggest that a LS view may not provide a meaningful contribution to diagnosis.
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