Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus

Boileau, Pascal; Trojani, Christophe; Walch, Gilles; Krishnan, Sumant G.; Romeo, Anthony A.; Sinnerton, R.

doi:10.1067/mse.2001.115985

Cited by 311 publications

(220 citation statements)

References 23 publications

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“…The survival rate for TSA can exceed 90 % at ten years follow-up and 80 % at 15 years [5,[8][9][10][11]33]. A concern about hemiarthroplasty in the treatment of humeral head fracture is that the survival rate rises from 50 % to 80 % at medium follow-up [12][13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

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Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

Castagna

Delcogliano

et al. 2013

International Orthopaedics (SICOT)

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Purpose Revision of a shoulder arthroplasty to a reverse arthroplasty is a highly demanding procedure. The aim of this study is to report the clinical results of hemi and total shoulder prosthesis revisions to reverse implants without removal of the humeral stem, using a modular shoulder replacement system (SMR Lima LTD). We retrospectively reviewed 26 patients who underwent an operation from 2004 to 2009. Methods The patients were divided into two groups: in Group I, 18 patients underwent a revision of hemiarthroplasty implanted for fracture; in Group II, eight patients underwent a revision of anatomical total prosthesis. All patients were evaluated at a mean follow-up of 32.3 (±12.7) months using the Constant score rating scale and by range of motion evaluation, EQ-VAS, X-ray and CT scan. Results The Constant score of each patient was 47.88 (±5.88) after the revision. The EQ-VAS improved from 40 (±20) to 70 (±10). All patients improved in terms of range of motion.The radiographs and CT scans obtained after revision showed good integration and no signs of loosening of the implant. The mean time of surgery was recorded as 62′ (±8′), with a maximum blood loss of less than 300 ml in all cases. Conclusions Our study demonstrates that using a full modular system at the time of the first implant allows avoidance of the step to remove the humeral stem and metal back in cases of shoulder prosthesis revision to a reverse prosthesis, resulting in a short operative time, few intraoperative complications and a satisfactory clinical outcome at medium-term follow-up.

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Section: Discussionmentioning

confidence: 99%

“…However, the survival rate reported in recent studies rose from 50 % to 80 % at medium-term follow-up [12][13][14][15][16][17][18]. Implant failure is frequently due to tuberosity resorption, tuberosity non-union and cuff deficiency [13,[19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

Castagna

Delcogliano

et al. 2013

International Orthopaedics (SICOT)

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“…Boileau et al [4] demonstrated that migration and malunion of the greater tuberosity could lead to subacromial impingement, superior migration of the prosthesis, joint stiffness and consistent pain in the shoulder. A poor greater tuberosity position has also been shown to change the lever arm in the glenohumeral joint abduction, alter the local biomechanical characteristics, accelerate the process of prosthesis and glenoid wear and finally lead to prosthetic failure [23,24]. In 2007, we conducted a study that included 59 proximal humeral fracture patients treated with standard humeral head replacements with a mean follow-up time of 22.2 months [25].…”

Section: Discussionmentioning

confidence: 99%

Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Jiang

2013

International Orthopaedics (SICOT)

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Purpose Shoulder arthroplasty is one of the options for the treatment of complex proximal humeral fractures. The purpose of this study was to assess the clinical and radiographic results of the trabecular metal shoulder prosthesis in the treatment of complex proximal humeral fractures. Methods Fifty-one consecutive patients with complex proximal humeral fractures who underwent primary shoulder arthroplasties with the trabecular metal™ prosthesis were enrolled in this study. At the final follow-up appointment, 42 of the patients (82.4 % of the total patients enrolled) were available for both clinical and radiographic evaluation. There were 28 women and 14 men with a mean age of 65.4±10.7 years. The dominant arm was involved in 30 of the cases. According to Neer's classification, there were seven three-part fractures, 27 four-part fractures and eight head-splitting fractures. Additionally, there were 37 hemiarthroplasties and five total shoulder arthroplasties.Results After a mean follow-up of 37.0±8.4 months (range 24-52 months), the average ranges of motion were: 38.6±15.0°f or external rotation, L3 level for internal rotation and 132.3±36.0°for forward elevation. The mean American Shoulder and Elbow Surgeons, visual analogue scale and University of California, Los Angeles scores were 82.1±14.1, 0.4±1.1 and 28.8±5.1, respectively. The post-operative radiographs exhibited an anatomically attached greater tuberosity in 39 of the 42 shoulders. Of the three patients with greater tuberosity complications, as displayed by their radiographs, two were observed with malpositioned tuberosities, while the other greater tuberosity was resorbed. Proximal migration of the prosthesis was observed in all three shoulders with greater tuberosity complications and in two shoulders with an anatomically attached greater tuberosity. No neurovascular injury, infection or prosthetic loosening was identified during the final follow-up appointments.Conclusions Satisfactory results can be expected with the trabecular metal shoulder prosthesis for the treatment of complex proximal humeral fractures. The post-operative radiographs demonstrated an anatomically healed greater tuberosity in 93 % of the patients at a minimum follow-up time of two years.

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“…O grupo do trauma agudo foi dividido em subgrupos segundo a classificação de Neer para fraturas da extremidade proximal do úmero e de acordo com a presença e direção de luxação associada (6) ; as sequelas traumáticas foram divididas em subgrupos de acordo com a classificação de Boileau et al (7) (Figura 2). (7) foi a fratura-luxação inveterada ou luxação inveterada em 22 casos (41%), seguida pelas consolidações viciosas em 11 casos (20%), assim como as pseudartroses da extremidade proximal do úmero, também em 11 casos (20%) e, por fim, as necroses em 10 casos (19%) (Gráfico 2). O período médio entre a lesão e a cirurgia foi de 23 meses (2-180 meses).…”

Section: Métodosunclassified

“…Consideramos que esses dados corroborem a necessidade de tratamento primário adequado das lesões traumáticas da extremidade proximal do úmero, uma vez que essa lesão acomete pacientes jovens, prováveis candidatos, no futuro, à revisão cirúrgica. A artroplastia primária do ombro em pacientes com sequelas traumá-ticas é considerada um desafio técnico para a maioria dos cirurgiões experimentados; as revisões artroplásticas nesses pacientes serão um desafio ainda maior (7) .…”

Section: Gráfico 5 -Percentuais De Pacientes Submetidos a Artroplastiunclassified

Registro de artroplastias do ombro

Filho

Galvão²,

Monteiro³

et al. 2009

Rev. bras. ortop.

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Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus

Cited by 311 publications

References 23 publications

Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

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