Clinical and radiological follow-up of the Aequalis third-generation cemented total shoulder replacement

Khan, Adam Z.; Bunker, Tim; Kitson, J.

doi:10.1302/0301-620x.91b12.22139

Cited by 111 publications

(83 citation statements)

References 36 publications

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“…This is consistent with the literature, in which the most common reasons for failure of hemiarthroplasties or total shoulder arthroplasties include superior migration or subluxation of the humeral head secondary to rotator cuff dysfunction occurring in 17% to 54% of patients [2,7,13,17,19,30,34] with the likelihood of a higher incidence with longer followup [5,34]. Our study showed that a modular stem designed for exchange has distinct advantages in the case of revision and that the quality of implantation (prosthetic height and torsion) at the index operation is important, because improper positioning can mandate stem exchange even in a system designed to allow stem preservation.…”

Section: Discussionsupporting

confidence: 92%

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Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Wieser

Borbas

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background If revision of a failed anatomic hemiarthroplasty or total shoulder arthroplasty is uncertain to preserve or restore satisfactory rotator cuff function, conversion to a reverse total shoulder arthroplasty has become the preferred treatment, at least for elderly patients. However, revision of a well-fixed humeral stem has the potential risk of loss of humeral bone stock, nerve injury, periprosthetic fracture, and malunion or nonunion of a humeral osteotomy with later humeral component loosening. Questions/purposes The purposes of this study were to determine whether preservation of a modular stem is associated with (1) less blood loss and operative time; (2) fewer perioperative and postoperative complications, including reoperations and revisions; and/or (3) improved Constant and Murley scores and subjective shoulder values for conversion to a reverse total shoulder arthroplasty compared with stem revision. Methods Between 2005 and 2011, 48 hemiarthroplasties and eight total shoulder arthroplasties (total = 56 shoulders; 54 patients) were converted to an Anatomical TM reverse total shoulder arthroplasty system without (n = 13) or with (n = 43) stem exchange. Complications and revisions for all patients were tallied through review of medical and surgical records. The outcomes scores included the Constant and Murley score and the subjective shoulder value. Complete clinical followup was available on 80% of shoulders (43 patients; 45 of 56 procedures, 32 with and 13 without stem exchange) at a minimum of 12 months (mean, 37 months; range, 12-83 months). Results Blood loss averaged 485 mL (range, 300-700 mL; SD, 151 mL) and surgical time averaged 118 minutes (range, 90-160 minutes; SD, 21 minutes) without stem exchange and 831 mL (range, 350-2000 mL; SD, 400 mL) and 176 minutes (range, 120-300 minutes; SD, 42 minutes) with stem exchange (p = 0.001). Intraoperative complications (8% versus 30%; odds ratio [OR], 5.2) and reinterventions (8% versus 14%; OR, 1.9) were substantially fewer in patients without stem exchange. The complication rate leading to dropout from the study was substantial in the stem revision group (six patients; 43 shoulders [14%]), but there were no complication-related dropouts in the stemretaining group. If, however, such complications could be avoided, with the numbers available we detected no difference in the functional outcome between the two groups. Conclusions Patients undergoing revision of stemmed hemiarthroplasty or total to reverse total shoulder arthroplasty without stem exchange had less intraoperative blood loss and operative time, fewer intraoperative complications, and fewer revisions than did patients whose index revision procedures included a full stem exchange.

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Section: Discussionsupporting

confidence: 92%

“…In the majority of patients, revision is performed to treat cuff failure with associated instability [2,19,30,34] or glenoid erosion [3]. With instability, secondary cuff failures, or glenoid erosion, the humeral component often is well fixed in the humeral shaft.…”

Section: Introductionmentioning

confidence: 99%

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Wieser

Borbas

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The majority of patients maintain their improvements over the long term; however, complications and failures do occur, and these have been associated with component malposition, glenoid failure, and glenohumeral malalignment [4]. Additionally, complications such as prosthetic loosening, periprosthetic fractures, rotator cuff tears, and instability have an adverse effect on pain and function [12,21].…”

Section: Introductionmentioning

confidence: 99%

Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Lapner

Jiang

Zhang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Shoulder arthroplasty provides reliable pain relief and restoration of function. However, the effects of fatty infiltration and atrophy in the supraspinatus and infraspinatus muscles on functional outcomes are not well understood. Questions/purposes The purposes of this study were to (1) compare preoperative with postoperative fatty infiltration and atrophy of the supraspinatus and infraspinatus muscles after primary shoulder arthroplasty; and (2) identify any associations between these variables and outcome measures.Methods A retrospective analysis was undertaken of 62 patients with a mean age of 67 years (range, 34-90 years) who underwent shoulder arthroplasty. CT scans were conducted preoperatively and at 12 months postoperatively. Outcome variables included the degree of supraspinatus and infraspinatus fatty infiltration (percent fatty infiltration and Goutallier grade), muscle area (percent muscle area and Warner atrophy grade), shoulder strength, and the Western Ontario Osteoarthritis Score (WOOS), American Shoulder and Elbow Surgeons score, and Constant outcome score. Results Preoperatively, the mean percent fatty infiltration (FI) within the supraspinatus and infraspinatus was identical at 14%. One year after shoulder arthroplasty, both muscles had less fatty infiltration (6% and 7%, respectively; p \ 0.001). Similarly, the Goutallier grade significantly improved postoperatively for the supraspinatus (p = 0.0037) and infraspinatus (p = 0.0007). Conversely, measures of muscle atrophy remained unchanged postoperatively (p [ 0.251). Preoperatively, greater supraspinatus percent FI was negatively associated with preoperative shoulder strength (r = 0.37, p = 0.001) and Constant score (r = 0.38, p = 0.001). Postoperative infraspinatus percent FI was negatively associated with postoperative strength (r = 0.3, p = 0.021) and Constant score (r = 0.3, p = 0.04). Multivariable regression One of the authors (GSA) received research funding support from

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“…McCoy et al found good pain relief in up to 93% after surgery [4]. However, despite high patient satisfaction and good pain relief, function is unpredictable and often poor, with patients in some series averaging elevation below the horizontal [5][6][7]. Barrett et al reported active forward flexion averaged 34 degrees in 140 anatomical shoulder replacements where 50% of patients had significant cuff pathology [8].…”

Section: Introductionmentioning

confidence: 99%

“…Cuff tears in rheumatoid patients are extremely common (20%-100%) [6,9,10] and when present, lead to inferior results of joint replacement due to poor pain relief, superior humeral migration, increased shear forces, eccentric wear, instability, early failure and glenoid loosening rates as high as 50% [6,7,[11][12][13][14]. It is therefore clear that the rotator cuff is an important prognosticator of outcome.…”

Section: Introductionmentioning

confidence: 99%

Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review

Gee¹,

Hanson²,

Saithna³

et al. 2015

Open Orthopaedics J

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Abstract:Background: Anatomical shoulder replacement for rheumatoid arthritis (RA) is complicated by a high incidence of rotator cuff tears and glenoid erosion. This can lead to poor function and early failure. Reverse shoulder arthroplasty (RSA) has gained popularity as an alternative. This systematic review attempts to further define the role of RSA in RA.Methods: A systematic review identified seven studies reporting outcomes of RSA in RA patients. Studies were critically appraised, and data on outcomes, complications and technical considerations were extracted and analysed.Results: One hundred and twenty one shoulders were included (mean follow up 46.9 months). Consistent improvements in the main outcome measures were noted between studies. Ninety five percent of patients described excellent to satisfactory outcomes. The minimum mean forward elevation reported in each study was 115 degrees. Symptomatic glenoid loosening (1.7%), deep infection (3.3%) and revision surgery (5%) rates were no higher than for a population of mixed aetiologies.Discussion: Previous concerns regarding high pre-and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review. Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies. Conclusion:The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients.

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Clinical and radiological follow-up of the Aequalis third-generation cemented total shoulder replacement

Cited by 111 publications

References 36 publications

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review

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