The Stiff Shoulder

Dilisio, Matthew F.; Elhassan, Bassem T.; Higgins, Laurence D.; Warner, Jon J.P.

doi:10.1016/b978-0-323-29731-8.00019-2

Cited by 5 publications

(3 citation statements)

References 311 publications

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“…These patients had preoperative aspirations performed because they presented with obvious signs of infection that were likely caused by organisms other than C. acnes or coagulase-negative Staphylococcus species. Dilisio et al 71 studied 41 shoulder periprosthetic joint infections and found that arthroscopic tissue biopsy was substantially more reliable than aspiration; the sensitivity, specificity, positive predictive value, and negative predictive value were all 100% for the arthroscopic tissue biopsy and the sensitivity was 16.7%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 58.3% for aspiration.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

et al. 2019

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The indolent microorganisms responsible for shoulder periprosthetic joint infection make diagnosis difficult because they do not have clear clinical signs or reliable serum laboratory markers.» Administering benzoyl peroxide to the skin of the surgical site and intra-articular injections of antibiotics during a surgical procedure have shown potential for preventing periprosthetic joint infection in patients undergoing shoulder arthroplasty.

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Section: Laboratory Evaluationmentioning

confidence: 99%

Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

et al. 2019

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“…PJI typically leads to 1 or 2-stage revision surgery 1,2 . Traditionally, a 2stage revision with an antibiotic spacer has been preferred to ensure infection clearance prior to revision implant placement; however, the additional surgical procedure introduces patient morbidity and a potential for postoperative complications 10 . To circumvent the need for additional operations, a 1stage revision has been proposed 9 , with some studies finding no difference in infection clearance or functional outcomes between the 2 treatment approaches 1,2 .…”

mentioning

confidence: 99%

One Versus 2-Stage Revision for Shoulder Arthroplasty Infections

et al. 2021

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Background: There is controversy regarding the optimal treatment for infection following shoulder arthroplasty. The purpose of this systematic review is to analyze the bias in treatment selection, infection clearance rates, and functional outcomes after 1 versus 2-stage revision surgery for periprosthetic shoulder infections.Methods: A systematic search strategy following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in 4 phases. Articles were identified using MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases with Boolean search terms related to infection after shoulder arthroplasty. Included articles were analyzed for quality, and data were extracted for use. Preoperative treatment selection bias was analyzed and postoperative infection clearance rates and functional outcome scores were compared between 1 and 2-stage revision surgery for periprosthetic shoulder infection.Results: Overall, 163 1-stage shoulder procedures and 289 2-stage shoulder procedures were included in the analysis. Cutibacterium acnes was the organism most frequently grown on culture (37%) followed by coagulase-negative Staphylococcus (19%). The overall infection clearance rate was 95.6% for 1-stage and 85.2% for 2-stage procedures. In a comparison of the change in outcome scores from preoperatively to postoperatively between 1-stage and 2-stage revision, the Constant-Murley Score (CMS) improved 21.0 points (1-stage) versus 22.8 points (2stage), the American Shoulder and Elbow Surgeons (ASES) score improved 26.2 points versus 33.6 points, and the Simple Shoulder Test (SST) score improved 3.5 points versus 6.4 points, respectively. Overall, 23 of 26 studies cited a reason for selection of a 1 versus 2-stage procedure, which was due to standard treatment protocol in 10 studies, based on the timing of the infection (acute versus subacute versus chronic) in 5, due to a combination of factors (age, comorbidities, intraoperative appearance, adequacy of debridement, bone loss) in 6, and due to preoperative identification of a specific organism in 2.Conclusions: One-stage revisions resulted in higher infection clearance rates; however, 2-stage revisions resulted in greater functional improvement as measured with ASES and SST scores from the preoperative assessment to the final postoperative follow-up. The decision between 1 and 2-stage revisions is due to a combination of factors including pathogen type, timing of infection, findings on the preoperative clinical examination, the patient's own decision, the surgeon's preference, and the intraoperative soft-tissue/osseous appearance, which may have Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A740).

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“…A coronal-based tenotomy was performed according to the technique described by Dilisio et al [ 9 ]. They state that every 1 cm of lengthening produces 20° of external rotation, we aimed for a 2 cm tenotomy to achieve 40° of external rotation intraoperatively.…”

Section: Case Reportmentioning

confidence: 99%

Subscapularis Lengthening with Synthetic Augmentation for Reversal of Putti-Platt Procedure: A Case Report

Fu¹,

Aboelmagd²,

Malhas³

2023

JOCR

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Introduction: The Putti-Platt procedure is a historical technique for anterior shoulder stabilization, largely abandoned because it severely restricts movement, and causes arthritis and chronic pain. Patients continue to present with these sequelae, which can be difficult to manage. Here, we present the first published subscapularis re-lengthening for the reversal of Putti-Platt. Case Report: Patient: A 47-year-old Caucasian manual worker presented 25 years post-Putti-Platt, with chronic pain and movement restriction. External rotation was 0°, abduction was 60°, and forward flexion was 80°. He was unable to swim and struggled to work. Multiple arthroscopic capsular releases had provided no benefit. Technique: The shoulder was opened through the deltopectoral approach, and a coronal Z-incision lengthening tenotomy was made in subscapularis. The tendon was lengthened by 2 cm and the repair was reinforced using a synthetic cuff augment. Results: External rotation improved to 40°, and abduction and forward flexion to 170°. Pain resolved almost completely; Oxford Shoulder Score at 2-year follow-up was 43 (22 pre-operative). The patient returned to normal activity and reported complete satisfaction. Conclusion: This is the first application of subscapularis lengthening to Putti-Platt reversal. Two-year outcomes were excellent, demonstrating potential for significant benefit. Although presentations like this one are rare, our results support the potential of subscapularis lengthening (with synthetic augmentation) in the management of stiffness resistant to conventional treatment after Putti-Platt procedure. Keywords: Subscapularis lengthening, Putti-Platt, chronic shoulder pain, reversal.

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The Stiff Shoulder

Cited by 5 publications

References 311 publications

Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

One Versus 2-Stage Revision for Shoulder Arthroplasty Infections

Subscapularis Lengthening with Synthetic Augmentation for Reversal of Putti-Platt Procedure: A Case Report

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