Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups

Am, Romano; Oliva, Francesco; Nastrucci, Guglielmo; Casillo, Pasquale; A, Di Giunta; Susanna, Massimiliano; Ascione, Francesco

doi:10.11138/mltj/2017.7.2.263

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…Reducing readmission rates may call for changes in healthcare practices and increased communication with patients on the importance of self-motivated preoperative health optimization. In fact, validated postoperative reverse TSA rehabilitation protocols are lacking, and Oliva et al showed that personalized postoperative treatment protocols specific to patients stratified by perioperative risks can decrease complication rates [18]. High-risk patients treated with frequent physician consultations with established goals of recovery and adjusted rehabilitation protocols are shown to have improved clinical results and decreased complications [18].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, validated postoperative reverse TSA rehabilitation protocols are lacking, and Oliva et al showed that personalized postoperative treatment protocols specific to patients stratified by perioperative risks can decrease complication rates [18]. High-risk patients treated with frequent physician consultations with established goals of recovery and adjusted rehabilitation protocols are shown to have improved clinical results and decreased complications [18]. As the landscape of healthcare economics shifts to value patient satisfaction outcomes, diabetes status is important to consider as part of a stratified rehabilitation protocol for a growing elderly population with inherent risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…As the landscape of healthcare economics shifts to value patient satisfaction outcomes, diabetes status is important to consider as part of a stratified rehabilitation protocol for a growing elderly population with inherent risk factors. Reverse TSA dislocation and complication rates are associated with poor healing of repaired soft tissues, and diabetes is important to take into account in the postoperative recovery phase as delayed growth factor production, endothelial progenitor cell dysfunction, and reduced granulation tissue formation are thought to impair wound and bone healing [18–20].…”

Section: Discussionmentioning

confidence: 99%

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Early postoperative complications and discharge time in diabetic patients undergoing total shoulder arthroplasty

et al. 2019

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PurposeWith the increasing elderly population and obesity epidemic, diabetes is an important factor in arthroplasty planning. Although research suggests diabetes is associated with increased postoperative morbidity after hip and knee replacement, the effect of diabetes and varying management with insulin versus non-insulin agents on total shoulder arthroplasty (TSA) is not established.MethodsAll TSAs from 2015 to 2016 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Age, gender, BMI, steroid, ASA, operative time, and smoking status were compared between all diabetics, diabetics on insulin, diabetics on non-insulin agents, and non-diabetics to account for confounding variables. Thirty-day postoperative complications, readmission rate, surgical site infection (SSI), and non-routine discharge to rehabilitation were compared using bivariate and multivariate binary logistic regression. Postoperative time to discharge between diabetic groups was analyzed using univariate ANOVA with Tukey’s test.ResultsThe analysis included 7246 patients (insulin in 5% (n = 380), non-insulin in 13% (n = 922), and non-diabetics in 82% (n = 5944)). Diabetics were more likely to have an ASA ≥ 3 compared to non-diabetics (89.5% vs 50.1%; p < 0.001). Bivariate logistic regression showed statistical significance in readmission and non-routine discharge between all diabetics and non-diabetics (OR 1.7, 1.4; p = 0.001, 0.001), but there was no significance between SSI rate (0.3% vs 0.4%; p = 0.924). Multivariate logistic regression between groups showed significance in readmission between non-insulin diabetics vs non-diabetics (OR 1.5; p = 0.027), readmission and non-routine discharge in insulin vs non-diabetics (OR 2.1, 1.7; p = 0.003, < 0.001), and no significance between insulin and non-insulin diabetics. Postoperative days to discharge were 2.4, 2.0, and 1.8 days in insulin, non-insulin, and non-diabetics respectively. Mean differences were significant between all groups.ConclusionsDiabetic patients are at a higher risk for readmission and non-routine discharge compared to non-diabetics. Despite no increased risk in SSI, longer postoperative discharge time in diabetics should be considered in TSA planning.Trial registrationNot applicableLevel of evidenceLevel III, case-control study

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Early postoperative complications and discharge time in diabetic patients undergoing total shoulder arthroplasty

et al. 2019

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“…However, it is related with an enhancive number of complications and postoperative discomforts [15,20,22,56–60]. In particular, the occurrence of SS fractures has a prevalence ranging from 0.8% to 10.2% [6,13,14,16,20,22,56,58,60–68]. As far as we know, few studies have put forward the variable anatomy of SS [51–54].…”

Section: Discussionmentioning

confidence: 99%

The Anatomical Variation of the Scapular Spine in A Chinese Population

et al. 2019

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BackgroundThe occurrence of fractures and risks following reverse total shoulder arthroplasty (rTSA) is common due to the variation of scapular spine (SS). Therefore, the consideration of the variable osteological features of SS prior to surgery may prove to be significant for the implementation of rTSA. This study aimed to propose a classification of SS through particular and quantitative parameters.Material/MethodsIn total, 354 intact dry scapulae were geometrical measured and classified on account of anatomical characteristics and the shapes of SS.ResultsType I SS was found, and this was the most frequency was type (27.97%). The least common type was type II. The type of SS had a direct association with bone stock and bone mineral density. Type II represented an association with a much thinner spine and restricted cortical and cancellous bone; types II and V were also associated with a crooked SS, which had a more complex morphology.ConclusionsThis study offered a comprehensive classification of SS in the Chinese population. On the whole, this study indicates that knowledge of the morphological variations of SS can prompt the diagnosis of scapular fractures and can promote more successful rTSA procedures, and the relative clinical trial is necessary to support it.

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“…Bioactive glass was added both between the stem and cones, and as a proximal humerus augmentation ( Figure 5 and Figure 6 ) in order to improve defect filling and attempt to avoid a new infection, thus increasing implant stability and integration. The surgical technique has already been described in detail [ 48 ]. The high porosity of these cones results in satisfactory primary fixation on recipient bone and cement fixation on the intramedullary side, sealing the component.…”

Section: Bone Loss Management—tantalum Conesmentioning

confidence: 99%

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

Romano

Ascione

Casillo³

et al. 2020

JCM

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Periprosthetic joint infections of the shoulder (PJIS) are the major cause for revision within the first two post-operative years, and are challenging both to diagnose and treat. Success depends on early identification of microorganisms, appropriate surgical procedures and efficient antibiotic administration. The peculiar microbiology of the shoulder may render the criteria for hip/knee PJI management inappropriate. In addition, later cases with clinically subtle signs often present diagnostic challenges. In recent years, specific issues of PJIS have been managed through the use of new instruments, such as MicroDTTect in pathogen detection and Bioactive Glass and tantalum cones in humeral bone loss. In the literature to date, no reports have been found that discuss the application in shoulder revisions and infections. The early identification of the microorganisms that cause infection may help improve both treatment strategies and the efficacy of therapy. MicroDTTect proved to be more efficient than swab collection for bacterial identification in orthopedic surgery, thus reducing analysis costs. The increasing number of shoulder arthroplasties is associated with an increase in the number of revisions. In cases of massive metaphyseal humeral bone loss, several techniques have been described; no reports have been reported regarding tantalum in humeral bone loss management. In some cases the tantalum cones required adaptation for femoral diaphysis in the augmentation of the humerus metaphysis and bone loss management improvement. Obtaining stable osseointegration of prosthetic implants is one of the greatest issues in orthopedic surgery, and even more crucial in revisions. Bioactive glasses demonstrated good regenerative and osseointegration properties, and an excellent candidate as a bone graft, scaffold and antibiotics deliverer. The Bioactive glasses were used to increase prosthesis-bone interface stability and fill bone defects in PJIS revision surgeries, contributing to the prevention of re-infection. Longer-term follow-up will be necessary to determine if construction durability is improved in the long term.

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Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups

Abstract: SummaryBackground: Rehabilitation after Reverse Shoulder Arthroplasty (RSA) is still object of discussion with no based evidence guidelines.

Cited by 14 publications

References 25 publications

Early postoperative complications and discharge time in diabetic patients undergoing total shoulder arthroplasty

Early postoperative complications and discharge time in diabetic patients undergoing total shoulder arthroplasty

The Anatomical Variation of the Scapular Spine in A Chinese Population

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

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