The role of shoulder fusion in the era of arthroplasty

González-Díaz, Rafael; Rodríguez-Merchán, E. Carlos; Gilbert, Marvin S.

doi:10.1007/s002640050151

Cited by 44 publications

(25 citation statements)

References 18 publications

(41 reference statements)

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“…Our observations support those of Walch et al Although the followup periods were relatively short in the present study, the data suggest that open cuff repair could reduce the risk of grade progression and improve the preoperative radiographic grade, which is consistent with the findings of Nich et al [19]. After glenohumeral arthritis (Grades 4 and 5) develops, arthrodesis [4,10], hemiarthroplasty [23,26], or total shoulder arthroplasty including reverse total shoulder arthroplasty [8] should be considered, because the situation is shifted to articular cartilage degeneration. Much work is still needed to fully elucidate the natural history of massive cuff tear arthritis as well as to refine the treatment indications at each stage of progression.…”

Section: Discussionsupporting

confidence: 92%

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Hamada

Yamanaka²,

Uchiyama

et al. 2011

Clinical Orthopaedics &Amp; Related Research

243

131

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Background In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4. Questions/purposes We therefore determined (1) whether patient characteristics and MRI findings differed between the grades at initial examination and final followup; (2) which factors affected progression to a higher grade; (3) whether the retear rate of repaired tendons differed among the grades; and (4) whether the radiographic grades at final followup differed from those at initial examination among patients treated operatively. Patients and Methods We retrospectively reviewed 75 patients with massive rotator cuff tears. Thirty-four patients were treated nonoperatively and 41 operatively.

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Section: Discussionsupporting

confidence: 92%

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Hamada

Yamanaka²,

Uchiyama

et al. 2011

Clinical Orthopaedics &Amp; Related Research

243

131

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“…Traction neuritis of the suprascapular nerve may also occur with excessive abduction (González-Diaz et al 1997). Correction of a malpositioned arthrodesis may result in substantial relief of pain and improved ability to perform activities of daily living (Groh et al 1997).…”

Section: Discussionmentioning

confidence: 99%

“…Current indications include failed arthroplasty, bone deficiency of the proximal humerus after tumor resection, chronic infection, severe instability, posttraumatic brachial plexus injury, and paralysis of the deltoid muscle and rotator cuff (Clare et al 2001). Other indications are inflammatory arthritis with severe rotator cuff involvement, irreparable rotator cuff tears, and painful osteoarthritis in patients in need of strength more than movement (González-Diaz et al 1997). Several techniques for fixation of the arthrodesis, both external and internal, have been described.…”

mentioning

confidence: 99%

Long-term outcome of shoulder arthrodesis performed with plate fixation: 18 patients examined after 3–15 years

Dimmen

Madsen

2007

Acta Orthopaedica

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Background and purpose There have been few reports on the long-term function after shoulder arthrodesis. We report the outcome after shoulder arthrodesis with plate fixation in 18 patients who were followed for 3-15 years.Methods 25 patients with a median age of 64 (19-75) years were operated with a shoulder arthrodesis between 1982 and 2003. Standard AO surgical technique with plating was used in all patients. 18 of the patients were examined retrospectively after a mean of 8 (3-15) years. 6 of the other patients had died and 1 refused examination.Results Radiologically, all but two arthrodeses fused completely. The remaining two were partially fused, within the glenohumeral joint or between humerus and acromion. The mean Oxford shoulder score was 32 and the mean ASES shoulder index was 59. Nine patients had intermittent or continuous pain; their mean pain score on a visual analog scale was 3. One patient had been re-operated after 4 months because of severe pain and 1 was operated due to a humeral shaft fracture after 8 months. 1 patient suffered from a complex regional pain syndrome. No infections occurred.Interpretation In this patient series there were few complications after shoulder arthrodesis, and the longterm functional results were acceptable.

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“…To our knowledge, there are few studies analysing the management of infected shoulder prostheses. Treatment options are one-or two-stage exchange, irrigation and débridement, resection arthroplasty, chronic suppression or even arthrodesis or amputation [4,6,[11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature

Weber

Utzschneider

Sadoghi

et al. 2010

International Orthopaedics (SICOT)

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Experience with infected shoulder arthroplasty is limited. Treatment options are either one-or two-stage reimplantation, débridement with retention of the prosthesis, resection arthroplasty or arthrodesis. We retrospectively analysed ten patients with an infected shoulder prosthesis and evaluated the diagnostic and therapeutic management as well as the clinical outcome, assessed by the Constant score, Neer's criteria and the mean abduction ability. We identified an infecting organism before surgery in nine patients. Four patients were treated by two-stage exchange reimplantation, five by resection arthroplasty and one underwent serial débridement combined with vacuum-irrigation therapy. Infection was eradicated in all patients of this series. The mean Constant score in resected patients was 32.7, in patients treated by stage exchange 40.1 (no difference) and we measured 90 points in the patient with retention of the implant. In patients treated by resection arthroplasty, merely the mean abduction yielded a better result (63 vs 31°) than in patients treated by two-stage exchange-with the pain level being identical in both groups. Treatment of infected shoulder implants in patients who often have to deal with concomitant diseases remains unsatisfactory. Two-stage exchange procedures yielded only slightly better functional results than resection arthroplasty, which should be considered in cases of elderly or chronically ill patients because it offers good pain relief. Serial débridement combined with irrigation therapy is a new method which offers good clinical results, however with an unknown risk of persisting infection. The authors recommend isolating the infecting organism prior to surgery to allow the administration of organism-specific antibiotics as early as possible during surgery in order to efficiently eradicate the infection.

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The role of shoulder fusion in the era of arthroplasty

Cited by 44 publications

References 18 publications

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Long-term outcome of shoulder arthrodesis performed with plate fixation: 18 patients examined after 3–15 years

Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature

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