Complications of unconstrained shoulder prostheses

Gonzalez, Jean-François; Alami, Ghassan B.; Baqué, F.; Walch, Gilles; Boileau, Pascal

doi:10.1016/j.jse.2010.11.017

Cited by 188 publications

(77 citation statements)

References 115 publications

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“…In anatomic total shoulder arthroplasty, the glenoid component accounts for 24 % of all complications [31]. In addition, a recent systematic review demonstrated that asymptomatic radiolucent lines appeared at a rate of 7.3 % per year after primary TSA [32].…”

Section: Common Failure Mechanisms Of and Difficulties In Shoulder Armentioning

confidence: 99%

“…Metal-backed glenoid components have higher complications compared to all polyethylene components, consequently cemented all-polyethelene components have become the implant of choice for most surgeons [31,32]. Revision shoulder arthroplasty universally leads to poorer outcomes when compared to the outcomes after a primary anatomic total shoulder arthroplasty, emphasizing the importance of getting the glenoid component correct at the primary surgical procedure [31,33].…”

Section: Common Failure Mechanisms Of and Difficulties In Shoulder Armentioning

confidence: 99%

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Planning software and patient-specific instruments in shoulder arthroplasty

Wylie

Tashjian

2016

Curr Rev Musculoskelet Med

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Computer planning software and patient-specific instrumentation have been investigated in multiple subspecialties of orthopedics with mixed results. Shoulder arthroplasty has evolved over the last decade with improvements in implant design and surgical instrumentation. Despite these advances, glenoid positioning in shoulder arthroplasty continues to be a difficult problem. Recent advances in threedimensional imaging techniques and the use of computer planning software may potentially address some of the common difficulties encountered by surgeons. The addition of patient-specific instrumentation and guides provide an option for patients with significant glenoid deformity that may allow improved accuracy of glenoid component implantation compared to using standard instrumentation. Studies have reported improved positioning of the glenoid component in both anatomic and reverse total shoulder arthroplasty with patientspecific instrumentation and guides. More research is needed to determine whether these improvements lead to better patient-reported outcomes or implant survival. In addition, further studies will be needed to address whether this technology is cost effective for large-scale implementation in the orthopedic community.

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Section: Common Failure Mechanisms Of and Difficulties In Shoulder Armentioning

confidence: 99%

Section: Common Failure Mechanisms Of and Difficulties In Shoulder Armentioning

confidence: 99%

Planning software and patient-specific instruments in shoulder arthroplasty

Wylie

Tashjian

2016

Curr Rev Musculoskelet Med

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“…The incidence of infection in RSR in these studies was between 0% and 4%, 20,21 compared with 1.1% reported for an anatomical replacement. 29 This is likely to be related to the two large dead spaces in RSR, the bursa that has been distended with fluid for many years, and the space underneath the glenosphere. These voids should be limited as much as possible.…”

Section: Complicationsmentioning

confidence: 99%

Indications for reverse shoulder replacement

Smith

Guyver

Bunker

2012

The Journal of Bone and Joint Surgery. British volume

124

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The outcome of an anatomical shoulder replacement depends on an intact rotator cuff. In 1981 Grammont designed a novel large-head reverse shoulder replacement for patients with cuff deficiency. Such has been the success of this replacement that it has led to a rapid expansion of the indications. We performed a systematic review of the literature to evaluate the functional outcome of each indication for the reverse shoulder replacement. Secondary outcome measures of range of movement, pain scores and complication rates are also presented.The modern reverse shoulder replacement (RSR) can offer a surgical option for the management of arthritis of the shoulder that would be precluded by a conventional design. 1,2The success of the prosthesis has led to expansion of the indications from cuff tear arthropathy to any disease about the shoulder where cuff function is deficient. 3-5The prosthesis has also been a financial success, leading many companies to introduce their own version with small changes to the original design, such as the Aequalis Reversed Shoulder (Tornier, SaintIsmier, France) and the SMR Shoulder (Lima, Udine, Italy). As a result of the expansion of the indications for RSR, the procedure now accounts for over a large proportion of all shoulder replacements performed in mainland Europe.This article will look at the benefits and risks of RSR for each indication. The original indication for RSR was cuff tear arthropathy. The results obtained for new indications were compared with those for cuff tear arthropathy, with a primary outcome measure as a functional score. Secondary outcome measures were range of movement, rate of complications and pain scores. In order to allow for comparison between groups, the outcome scores, complication rates and pain scores have been converted to percentages.A systematic review of the English-language literature was undertaken; the keywords used were shoulder and reverse; arthroplasty; inverse or delta. Medline, were all searched. Inclusion criteria included studies presenting new data from more than one case and where functional outcome scores were reported. Exclusion criteria included studies that had a mixture of surgical techniques presented as a single group. Further exclusion criteria for the cuff tear arthropathy group were studies published more than five years ago; studies with less than 50 patients and those from more than one centre.We identified 22 papers, which were reviewed in full. The complications of RSR for any indication were discussed and specific issues for each pathology highlighted.All the abstracts were reviewed independently by two of the authors (CDS, PG) to identify studies for full review and the bibliographies of these articles were also reviewed for additional studies. Any disagreements with regards to inclusion and exclusion were resolved by discussion with the senior author (TDB). Cuff tear arthropathyThe modern concept of cuff tear arthropathy is the combination of arthritis and a massive cuff tear where the shoulder joint may remain concent...

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“…Since their introduction [1], four generations of stemmed TSA designs were developed, and demonstrated satisfactory clinical outcomes for reduction of pain and improvement of mobility. The most frequently reported complication, however, is loosening of the glenoid component [2][3][4]. The most common humeral complications are: intra-operative fracture, loosening, stress-shilding and periprosthetic fracture [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Is the humeral stem useful in anatomic total shoulder arthroplasty?

Matsukawa

Boileau

Brunner

et al. 2017

International Orthopaedics (SICOT)

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Purpose Traditionally and since Neer, the humeral side of shoulder arthroplasty consisted of a stemmed component but the real need for stem fixation in total shoulder arthroplasty (TSA) has barely been investigated. The current study evaluated the clinical and radiological outcomes with a stemless TSA. Methods Forty-seven patients, 20 female and 27 male patients with an average age of 63, were selected in four orthopaedic centres during a four year period, and implanted with a humeral head prosthesis with a three-fin design and titanium coating. Aetiologies were: primary osteoarthritis (29), fracture sequelae (12) and avascular osteonecrosis (6). Minimum follow-up was two years (range 24-51 months). The patients were evaluated with the Constant score (CS) and radiological exams. Results Two patients had revision of the implants, one for persistent pain and one for secondary massive rotator cuff tear. At the final follow-up, the mean CS was 69, with an average gain of 36. All parameters improved with a foremost in pain relief. Mean satisfaction rate was 87%. Average anterior active elevation was 131°with a gain of 48. Radiologic evaluations showed stable implants in all cases. However, 17 cases demonstrated radiolucent areas, particularly superior and lateral to the implant, which neither decreased nor increased with time. No revisions were related to humeral component loosening. Conclusions Stemless TSA provides the same results as compared to TSA with a humeral stem. We are still unsure as to the nature of the lucent zones and we are continuing our investigation to better understand this radiological phenomenon.

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Complications of unconstrained shoulder prostheses

Cited by 188 publications

References 115 publications

Planning software and patient-specific instruments in shoulder arthroplasty

Planning software and patient-specific instruments in shoulder arthroplasty

Indications for reverse shoulder replacement

Is the humeral stem useful in anatomic total shoulder arthroplasty?

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