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Total shoulder replacement and osteoporosis
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Total shoulder replacement is an effective treatment for painful arthritis of the shoulder, most commonly osteoarthrosis and inflammatory arthrosis. The number of procedures being performed is increasing substantially—in 2012 the UK National Joint Registry documented around 2500 shoulder replacements, and by 2017 more than 6500 procedures were reported. It is estimated that in the United States around 53,000 shoulder replacements are performed each year. However, that compares with more than 91,000 hip replacements in the United Kingdom and a million in the United States during 2017.
Upper limb
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The glenohumeral joint is commonly involved in rheumatoid arthritis (Figure34.14). As is typical of this condition, there is osteoporosis, destruction of the articular cartilage and synovial proliferation with pannus formation. The rotator cuff is weakened and frequently tears. Arthroscopic synovectomy may slow the progress of the joint destruction and lead to a reduction in pain and improvement in range of movement, though it is needed much less frequently since the introduction of biological therapies for rheumatoid disease. Intra-articular steroid injections may also be helpful. Shoulder replacement is complicated by poor bone stock and damage to the stabilising structures around the shoulder, especially the rotator cuff. The patient should only expect a reduction in pain. Any increase in range of movement is a bonus.
Shoulder arthroplasty
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Werner Anderl, Brenda Laky, Philipp R. Heuberer
In a first series14 we investigated the 2-year outcome with the stemless shoulder prosthesis of small implants and were able to show that especially active patients mobilized their shoulder immediately after the procedure and presented with improved subjective outcome. A next series of patients with large defects underwent arthroscopic humeral head resurfacing with 30/35 mm implants. In total we had five revisions (9.6%) because of ongoing OA with increasing pain and decreasing range of motion leading to secondary total shoulder replacement. All of these patients showed severe glenoid arthritis during index surgery. Revision surgery with total shoulder replacement resulted in the same outcome as after primary total shoulder replacement. Summarizing, we could observe that when severe chondral damage (Outerbridge IV°) on the glenoid is present, the procedure is more likely to fail, in the sense of a progressive further development of OA. Thus, we now combine the arthroscopic partial humeral head resurfacing with an arthroscopic glenoid resurfacing.
Rotator cuff repair with biological graft augmentation causes adverse tissue outcomes
Published in Acta Orthopaedica, 2020
Mustafa S Rashid, Richard D J Smith, Navraj Nagra, Kim Wheway, Bridget Watkins, Sarah Snelling, Stephanie G Dakin, Andrew J Carr
In an infraspinatus repair canine model augmented with a human dermal graft, observed infiltration of the grafts occurred by 6 weeks on histology and chronic inflammation was noted. 2 of 10 failed repairs demonstrated increased inflammatory infiltrate that the authors concluded may represent rejection of the human dermal matrix graft (Adams et al. 2006). There is a paucity of clinical studies that have evaluated in vivo human tissue response to biological patches. Histological samples from an individual case report revealed extensive infiltration of noninflammatory host cells and blood vessels (Snyder et al. 2009). A case series of 4 patients undergoing bridging repair of large rotator cuff tears with Permacol showed very poor results (Soler et al. 2007). All 4 patients failed to improve. Fluid in the subdeltoid bursa was seen in all patients on MRI (1 aspirated to confirm sterile effusion). 2 of 4 patients went on to have a reverse total shoulder replacement. At the time of surgery, it was noted that histology demonstrated chronic inflammation with necrotic fibrous material (Soler et al. 2007).
In silico study of glenoid perforation during total shoulder arthroplasty: the effects on stress & micromotion
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Abdul Hadi Abdul Wahab, Amir Putra Md Saad, Ardiyansyah Syahrom, Mohammed Rafiq Abdul Kadir
The key to long-term success for total shoulder arthroplasty can be achieve by gaining a stable fixation of the glenoid component. Several aspects had been studied includes implant perforation (Hsu et al. 2014), cementing technique (Choi et al. 2013), type of implant fixation (Knowles et al. 2019) and material of implant fixation (Flatow and Olujimi 2017) with aimed to achieve stable fixation. Accurate implant positioning by avoiding glenoid vault perforation was belief to play a role in long-term success after total shoulder replacement by improving implant stability (Ting and Poon 2013; Press et al. 2014). Glenoid implant perforation occurred due to several factors such as implant malposition during surgery, bone erosion and size of implant. A number of previous short term follow-up studies reported that, glenoid implant perforation did not associated with glenoid component loosening (Hsu et al. 2014; Press et al. 2014).
What are the costs of glenohumeral osteoarthritis in the year prior to a total shoulder arthroplasty (TSA)?
Published in The Physician and Sportsmedicine, 2020
Azeem Tariq Malik, Julie Y Bishop, Andrew Neviaser, Nikhil Jain, Safdar N Khan
The current health-care system is undergoing a major reform in an attempt to address the increasing economic burden posed by fee-for-service models of payments. Contrary to fee-for-service models, value-based health-care models are based on the principle of enhancing the use of cost-effective health-care interventions, in an attempt to curtail un-necessary resource utilization and minimize the financial burden on health-care systems. The current study notes a high utilization of conservative modalities in the year prior to undergoing an ATSA, most of which do not have enough scientific evidence to support their use [7]. Based on the results of the current study, it appears that the utilization of these conservative options may be primarily based on physician opinion. Another vital argument to take into account is that patient expectations may be influencing the use of these conservative modalities [8], given that most patients naturally are wary of undergoing a major invasive procedure such as a shoulder replacement. A useful method of tackling the latter concern is through the promotion of increased dissemination of information of non-operative and/or conservative modalities and shared-decision making between providers and patients to ensure that the use of such modalities are only limited to those patients who would benefit most from it.