Primary Unconstrained Shoulder Arthroplasty in Patients with a Fixed Anterior Glenohumeral Dislocation

Matsoukis, Jean; Tabib, W; Guiffault, P.; Mandelbaum, A.; Walch, Gilles; Némoz, C.; Cortés, Zenia E.; Edwards, T. Bradley

doi:10.2106/jbjs.e.00368

Cited by 35 publications

(23 citation statements)

References 11 publications

(5 reference statements)

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“…Defects greater than 40% of the humeral head can lead to recurrent or permanent dislocation so one must consider prosthetic replacement as an alternative for reconstruction of the proximal humerus. There have only been a few case reports of resurfacing of the humeral head and either hemiarthroplasty or total shoulder arthroplasty in the setting of HSLs or glenoid defects in association with dislocation [ 55 - 58 ]. Hemiarthroplasty or TSA is best suited to older patients with preexisting glenohumeral osteoarthritis and osteopenic bone, who will not benefit from reconstruction and instead may achieve greater postoperative motion and pain control with a replacement procedure.…”

Section: Arthroplastymentioning

confidence: 99%

Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation

Yates

Choudhry

Waseem

2017

TOORTHJ

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Background:Defects to the articular surface of the humeral head have been known to be associated with shoulder dislocation since the 19th century. It wasn't until 1934 that the first description of the ubiquitous compression fracture of the posterolateral humeral head that occurs with traumatic anterior instability appeared. From 1940, this defect became referred to as a Hill-Sachs lesion after the investigators who reported the condition. The significance of, and therefore treatment of, these and other such bony defects around the shoulder joint has been hotly debated.Methods:We reviewed the available current literature to determine and report on the most up to date concepts and treatment techniques being used to manage bony defects of the shoulder.Results:Numerous surgical options have been proposed to manage bony defects of the shoulder, including a variety of defect-filling procedures, with good outcomes. However, the small numbers and diversity of case mix makes for difficult comparisons.Conclusion:We are currently developing a greater appreciation of how both the humeral and glenoid defects interact and therefore should be assessed and addressed simultaneously in order to improve patient outcomes. More research and collaboration is needed to determine the optimal method of assessing and managing these patients.

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Section: Arthroplastymentioning

confidence: 99%

Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation

Yates

Choudhry

Waseem

2017

TOORTHJ

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“…Nevertheless, glenohumeral arthrosis after instability does not seem to be predictive of instability after arthroplasty. 31,[64][65][66][67]102 The only logical and effective surgical treatment for anterior instability is usually revision to a reverse TSA.…”

Section: Anterior Instabilitymentioning

confidence: 99%

Complications of unconstrained shoulder prostheses

Gonzalez

Alami

Baqué

et al. 2011

Journal of Shoulder and Elbow Surgery

188

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“…The authors report an age and gender adjusted Constant score of 60% 48 months after operation with a mean active shoulder abduction of 90° and a mean active external rotation of 26°. Raiss et al [4] used a humeral head resurfacing to treat 10 patients with fixed anterior glenohumeral dislocations. In one case a re-rupture of the subscapularis tendon occurred after redislocation two weeks after arthroplasty and in another case an erosion of the glenoid cartilage was associated with severe pain leading to revision with total shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…So the main concern was about possible instability with prothesis dislocation and an expected poor functional result. The literature alerts for that, but the analysis are made with the use of hemi or total shoulder arthroplasty, that are unconstraint implants that theoretical favor instability if the soft tissues are not of quality or ruptured, for example the subscapularis [2,4,13]. The reversed shoulder arthroplasty does not rely in the cuff, because the new center of rotation obtained, tensions the deltoid muscle and increases its lever arm, remaining the working horse of reversed shoulder arthroplasty mobility.…”

Section: Discussionmentioning

confidence: 99%

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Untitled

2016

MOJOR

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An anterior glenohumeral dislocation is a serious condition which can lead to soft tissue damage and substantial defects of the humeral head and glenoid. Little is known about the results of shoulder arthroplasty for the treatment of fixed glenohumeral dislocation. We present a case of an fixed anterior glenohumeral dislocation that developed with no associated trauma in a humeral head with an ongoing avascular necrosis in 75 years old patient with Parkinson disease. The patient had severe pain and a pseudo paralysis of the right arm. Radiology revealed a bone loss of the posterior head. The patient was submitted to a reversed shoulder arthroplasty and at 1 year follow up is happy with no pain; the subjective outcome scores substantially increased and had fair gains in arm mobility with no evidence of instabilities or other complications. We believe, based on the literature, and on recent advances in the implants and surgical technique, that shoulder reverse arthroplasty will probably achieve better results than unconstrained shoulder implants in treating fixed anterior dislocations in geriatric patients.

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Primary Unconstrained Shoulder Arthroplasty in Patients with a Fixed Anterior Glenohumeral Dislocation

Abstract: Shoulder arthroplasty in patients with a fixed anterior shoulder dislocation is fraught with difficulties and complications. Although arthroplasty reliably relieved shoulder pain in this population, limited functional results should be expected.

Cited by 35 publications

References 11 publications

Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation

Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation

Complications of unconstrained shoulder prostheses

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