Reverse total shoulder arthroplasty (RTSA) has been reported to be associated with a complication rate that is four times that of conventional total shoulder arthroplasty. It is the purpose of this ...article to identify and understand the most common and most serious complications of RTSA and to review current methods of prevention and treatment. The current literature was reviewed to identify type and prevalence of reported complications and to identify risk factors, preventive measures as well as technical details for management strategies for complications of RTSA. The variable accuracy of reporting and the heterogeneity of methodology in the literature limited our study, however, a definitive ranking of most to least common complication emerged. The currently identified most common complication is scapular notching. The clinically most relevant complications are infection, instability and acromial fractures. Haematoma formation used to be very frequent but can be controlled, glenoid component loosening, however, is rare when compared with conventional total shoulder replacement. In conclusion, RTSA is associated with a high rate of complications. Their incidence and the results of their treatment are inconsistently reported. To document and then prevent complications, a standardised monitoring tool including clear definitions and assessment instructions appears necessary.
This study investigated the hypothesis that functional outcome remains significantly improved over the preoperative state beyond 15 years of reverse total shoulder arthroplasty (RTSA) for irreparable ...rotator cuff dysfunction.
Operations were performed on 22 shoulders at a mean age of 68 (range, 54-77) years. The patients could personally be reviewed clinically and radiographically in intervals of 2 to 5 years and with a final follow-up examination at no less than 15 years (mean, 16.1; range, 15-19 years). The RTSA was a primary procedure in 7 procedures, and 15 patients had undergone at least 1 previous nonarthroplasty procedure.
The mean absolute Constant score (CS) had improved from 23 ± 11 to 58 ± 19 points (P < .001) and the relative CS (rCS) from 30% ± 13% to 73% ± 23% (P < .001) at final follow-up. Significant improvements were seen in mean pain scores (4 to 12 points; P < .001), active anterior elevation (53° to 101°; P = .001), abduction (55° to 86°; P = .005), and Subjective Shoulder Value (27% to 78%; P = .001). The mean rCS and Subjective Shoulder Value did not significantly deteriorate over 15 years, but mean active abduction was significantly reduced over time (P = .018). One or more complications were recorded in 13 patients (59%), with 6 failed RTSAs (27%).The mean rCS of patients with complications (explantations excluded) was not significantly inferior compared with that of patients without complications (62% vs. 81%; P = .090).
This early series of RTSA shows a substantial complication and failure rate. If, however, complications can be treated without removal of the implants, outcome is not compromised. Overall shoulder function and subjective outcome remained significantly improved and highly satisfactory during the entire study period.
Background The role of reverse shoulder arthroplasty (RTSA) in the relatively young individual is currently unclear. Our study evaluates the midterm to long-term results of RTSA for patients aged ...younger than 65 years with pseudoparalysis secondary to massive irreparable rotator cuff tears, with or without arthritis. Methods Between 1997 and 2006, 46 RTSAs (41 patients) were performed. Mean age was 60 years (range, 46-64 years). At the latest follow-up, 5 patients had died and 1 was lost, leaving 35 patients (40 shoulders) with a mean follow-up of 93 months (range, 60-171 months). Results The mean relative Constant score increased from 34% to 74% ( P < .0001) and the subjective shoulder value improved from 23% to 66% ( P < .0001). Significant improvements were seen in active forward elevation (72° to 119°), pain scores, and strength ( P < .001). One or more complications occurred in 15 shoulders (37.5%), with 6 failures (15%) resulting in removal or conversion to hemiarthroplasty (3 with infection, 3 with glenoid loosening). Ten shoulders (25%) underwent partial or total component exchange, conversion to hemiarthroplasty, or removal. Of the 15 patients who developed complications, 9 did not require prosthesis removal or conversion and functional outcome and subjective shoulder value were similar to those with no complications ( P > .4). Conclusion RTSA in younger patients provides significant subjective improvement and substantial gain in overall function, which is maintained up to 10 years. Although the complication rate is high, most can be treated successfully without compromise to clinical outcome. However, it is imperative that the high complication rate is explained to patients, with the risks and benefits carefully considered.
A fast and memory-efficient calculation of theoretical isotope patterns is crucial for the routine interpretation of mass spectrometric data. For high-resolution experiments, calculations must ...procure the exact masses and probabilities of relevant isotopologues over a wide range of polyisotopic compounds, while pruning low-probable ones. Here, a novel albeit simple treelike structure is introduced to swiftly derive sets of relevant subisotopologues for each element in a molecule, which are then combined to the isotopologues of the full molecule. In contrast to existing approaches, transitions via single replacements of the most abundant isotope per element are used in separable tree branches to derive subisotopologues from each other. Moreover, the underlying transition trees prevent redundant replacements and permit the detection of the most probable isotopologue in a first phase. A relative threshold can then be exploited in a second parallelized phase for a precise prepruning of large fractions of the remaining subisotopologues. The gain in performance from such early pruning and the lower variation in the distortion of simulated data with use of relative rather than absolute thresholds were validated in a large-scale benchmark simulation, unprecedentedly comprising several thousand molecular formulas. Both the algorithm and a wealth of related features are freely available as R-package enviPat and as a user-friendly Web interface.
Background Locking plates for open reduction–internal fixation (ORIF) of proximal humeral fractures are widely used. We observed an unusually high number of patients with complications referred to ...our institution. It was the purpose of this study to report these complications, as well as their treatment and outcome. Materials and methods From 2003 to 2010, all patients treated for complications after ORIF with locking plates for proximal humeral fractures were prospectively collected and retrospectively analyzed. Patients were followed up clinically and radiographically. Results In total, 121 patients (67 women and 54 men; mean age, 59 years) were referred after primary locking plate ORIF; 80% had a 3- or 4-part fracture. A mean of 3 complications occurred per patient, including malreduction, primary screw cutout, malunion, nonunion, avascular necrosis, and infection. Secondary screw cutout was found in 57% of patients, causing glenoid destruction in 33% of patients. A mean of 1.5 revision surgeries were needed. Hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty improved the mean Constant score (24 to 55 points, P < .05; 29 to 54 points, P = .3; and 25 to 48 points, P < .05, respectively) after a mean of 24 months. In 6 patients, glenoid implantation was no longer possible because of the destruction by perforated head screws. Conclusion In this negatively selected series, complications resulted in secondary arthroplasties in over 50% of the patients. Shoulder function, though improved, remained substantially restricted even after revision surgery. Glenoid destruction by locking screws was the most devastating and previously almost unseen complication, which limited the options of treatment.
Background The etiology of rotator cuff disease is age related, as documented by prevalence data. Despite conflicting results, growing evidence suggests that distinct scapular morphologies may ...accelerate the underlying degenerative process. The purpose of the present study was to evaluate the predictive power of 5 commonly used radiologic parameters of scapular morphology to discriminate between patients with intact rotator cuff tendons and those with torn rotator cuff tendons. Methods A pre hoc power analysis was performed to determine the sample size. Two independent readers measured the acromion index, lateral acromion angle, and critical shoulder angle on standardized anteroposterior radiographs. In addition, the acromial morphology according to Bigliani and the acromial slope were determined on true outlet views. Measurements were performed in 51 consecutive patients with documented degenerative rotator cuff tears and in an age- and sex-matched control group of 51 patients with intact rotator cuff tendons. Receiver operating characteristic analyses were performed to determine cutoff values and to assess the sensitivity and specificity of each parameter. Results Patients with degenerative rotator cuff tears demonstrated significantly higher acromion indices, smaller lateral acromion angles, and larger critical shoulder angles than patients with intact rotator cuffs. However, no difference was found between the acromial morphology according to Bigliani and the acromial slope. With an area under the receiver operating characteristic curve of 0.855 and an odds ratio of 10.8, the critical shoulder angle represented the strongest predictor for the presence of a rotator cuff tear. Conclusion The acromion index, lateral acromion angle, and critical shoulder angle accurately predict the presence of degenerative rotator cuff tears.
The aim of this systematic review was to evaluate the longitudinal evolution of midterm to long-term results of reverse total shoulder arthroplasty (RTSA) for patients with massive irreparable ...rotator cuff tears (miRCT).
Databases were scanned for studies of RTSA for miRCT. Studies with a minimum Level IV of evidence were considered eligible. Studies were included if they reported a minimum of 5 years of follow-up and excluded if they reported RTSA combined with tendon transfers or as revision arthroplasty. Data were grouped based on results after 5 to 7 years, 7 to 10 years, and 10 to 20 years of follow-up.
Eight studies with a total of 365 shoulders were included. After a mean follow-up of 9.5 years (range, 5-20 years), the preoperative absolute and relative Constant scores were significantly improved from 24 to 59 points (P = .004) and from 33% to 74% (P = .009). The preoperative Subjective Shoulder Value improved from 23% to 72% (P = .049). Active anterior elevation and abduction also improved significantly (P = .004 and P = .014, respectively), but active external rotation remained unchanged (P = .855). None of the clinical scores or active ranges of motion significantly deteriorated up to 20 years after the operation (P > .05). After 10 years, 42% of the RTSAs showed grade III or IV inferior scapular notching.
Pooled long-term results of RTSA for miRCT show significant improvement of overhead function and of objective and subjective outcome scores up to 20 years after surgery. Shoulder function and outcome scores also showed no significant deterioration between 5 and 20 years of follow-up. Longer follow-up will be needed to determine ultimate longevity.
The purpose of this study was to evaluate the subjective shoulder value (SSV) and to compare it with the Constant score (CS). The SSV is defined as a patient’s subjective shoulder assessment ...expressed as a percentage of an entirely normal shoulder, which would score 100%. Patients who underwent operative treatment for rotator cuff repair (n = 247), arthroplasty (n = 83), or stabilization for recurrent anterior instability (n = 111) were included in this study. Correlation between the SSV and CS was highest postoperatively and was higher in the rotator cuff group (0.80) than in the osteoarthritis (0.69) and instability (0.61) groups. The relative CS could reliably predict the variance in the SSV in patients with rotator cuff tears (54%) and osteoarthritis (41%) and, to a lesser extent, in instability patients (23%). The SSV is an easily administered, responsive, and valid measure of shoulder function. The SSV may offer an improvement over the CS in assessing shoulder instability patients, as the CS may overestimate the results of these patients.
Background Accurate assessment of glenoid inclination is of interest for a variety of conditions and procedures. The purpose of this study was to develop an accurate and reproducible measurement for ...glenoid inclination on standardized anterior-posterior (AP) radiographs and on computed tomography (CT) images. Materials and methods Three consistently identifiable angles were defined: Angle α by line AB connecting the superior and inferior glenoid tubercle (glenoid fossa) and the line identifying the scapular spine; angle β by line AB and the floor of the supraspinatus fossa; angle γ by line AB and the lateral margin of the scapula. Experimental study: these 3 angles were measured in function of the scapular position to test their resistance to rotation. Conventional AP radiographs and CT scans were acquired in extension/flexion and internal/external rotation in a range up to ±40°. Clinical study: the inter-rater reliability of all angles was assessed on AP radiographs and CT scans of 60 patients (30 with proximal humeral fractures, 30 with osteoarthritis) by 2 independent observers. Results The experimental study showed that angle α and β have a resistance to rotation of up to ±20°. The deviation from neutral position was not more than ±10°. The results for the inter-rater reliability analyzed by Bland-Altman plots for the angle β fracture group were (mean ± standard deviation) −0.1 ± 4.2 for radiographs and −0.3 ± 3.3 for CT scans; and for the osteoarthritis group were −1.2 ± 3.8 for radiographs and −3.0 ± 3.6 for CT scans. Conclusion Angle β is the most reproducible measurement for glenoid inclination on conventional AP radiographs, providing a resistance to positional variability of the scapula and a good inter-rater reliability.
BackgroundAt a mean follow-up of 3.1 years, twenty-seven consecutive repairs of massive rotator cuff tears yielded good and excellent clinical results despite a retear rate of 37%. Patients with a ...retear had improvement over the preoperative state, but those with a structurally intact repair had a substantially better result. The purpose of this study was to reassess the same patients to determine the long-term functional and structural results.MethodsAt a mean follow-up interval of 9.9 years, twenty-three of the twenty-seven patients returned for a review and were examined clinically, radiographically, and with magnetic resonance imaging with use of a methodology identical to that used at 3.1 years.ResultsTwenty-two of the twenty-three patients remained very satisfied or satisfied with the result. The mean subjective shoulder value was 82% (compared with 80% at 3.1 years). The mean relative Constant score was 85% (compared with 83% at 3.1 years). The retear rate was 57% at 9.9 years (compared with 37% at 3.1 years; p = 0.168). Patients with an intact repair had a better result than those with a failed reconstruction with respect to the mean absolute Constant score (81 compared with 64 points, respectively; p = 0.015), mean relative Constant score (95% and 77%; p = 0.002), and mean strength of abduction (5.5 and 2.6 kg; p = 0.007). The mean retear size had increased from 882 to 1164 mm (p = 0.016). Supraspinatus and infraspinatus muscle fatty infiltration had increased (p = 0.004 and 0.008, respectively). Muscles with torn tendons preoperatively showed more fatty infiltration than muscles with intact tendons preoperatively, regardless of repair integrity. Shoulders with a retear had a significantly higher mean acromion index than those without retear (0.75 and 0.65, respectively; p = 0.004).ConclusionsOpen repair of massive rotator cuff tears yielded clinically durable, excellent results with high patient satisfaction at a mean of almost ten years postoperatively. Conversely, fatty muscle infiltration of the supraspinatus and infraspinatus progressed, and the retear size increased over time. The preoperative integrity of the tendon appeared to be protective against muscle deterioration. A wide lateral extension of the acromion was identified as a previously unknown risk factor for retearing.Level of EvidenceTherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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