Deep infection after rotator cuff repair Athwal, George S., MD, FRCSC; Sperling, John W., MD, MBA; Rispoli, Damian M., MD ...
Journal of shoulder and elbow surgery,
05/2007, Letnik:
16, Številka:
3
Journal Article
Recenzirano
Currently, there is little information available concerning the outcome of patients with infection after rotator cuff repair. The purpose of this study was to review retrospectively the incidence, ...clinical presentation, bacteriology, treatment, and outcomes of patients with rotator cuff repair complicated by deep infection. Between 1975 and 2003, 39 cases of deep infection after rotator cuff repair were identified in 38 patients. At a final follow-up of 8.2 years (range, 30 months to 19.8 years), 7 patients had died and 2 had been lost to follow-up, leaving 29 for outcome evaluation. Propionibacterium acnes was the most common organism isolated, infecting 20 of 39 cases (51%). At final follow-up, mean active elevation was 120° and mean external rotation was 45°. The American Shoulder and Elbow Surgeons score averaged 67 points (range, 5-100 points), and the Simple Shoulder Test score averaged 7.3 points (range, 1-12 points). The results were excellent in 7 shoulders, satisfactory in 9, and unsatisfactory in 11. The data from this study suggest that the eradication of deep infection after rotator cuff repair is possible; however, substantial functional limitations are not unusual. In addition, the treating surgeon should be aware of the high incidence of Propionibacterium and the importance of allowing a minimum of 7 days of culture to identify this organism.
Background Restoration of soft tissue balance for intraoperative posterior instability during anatomic total shoulder arthroplasty (TSA) is particularly difficult. The effectiveness of posterior ...capsular plication (PCP) in restoring soft tissue balance is largely unknown. The purpose of this study was to report the outcomes, complications, and reoperations of primary TSA in which a PCP was performed to correct excessive intraoperative posterior subluxation. Methods Thirty-eight shoulders (37 patients) underwent PCP for intraoperative posterior instability during anatomic TSA. The mean (standard deviation) age was 68 (10) years, and the median (range) clinical and radiographic follow-up periods were 60 (10-154) and 48 (1.5-154) months, respectively. A retrospective chart review was conducted to obtain clinical and radiographic data. Results TSA resulted in significant improvements in pain and range of motion. The mean (standard deviation) Simple Shoulder Test and American Shoulder and Elbow Surgeons scores were 9.4 (2.7) and 81.1 (19.8), respectively. PCP resulted in restoration of soft tissue balance in 27 shoulders (71%). The remaining 11 shoulders had evidence of posterior subluxation, including posterior dislocation in 2 shoulders. Revision surgery was performed in only 3 shoulders (7.9%), all for instability. However, there was a high rate of radiographic glenoid component loosening (12 shoulders, 32%). Overall results were excellent in 24 (63.2%), satisfactory in 10 (26.3%), and unsatisfactory in 4 (10.5%) shoulders. Recurrence of posterior subluxation was associated with worse motion and strength as well as with a higher rate of glenoid loosening. Conclusions PCP seems to correct excessive intraoperative posterior subluxation in approximately two-thirds of the shoulders undergoing anatomic TSA. However, posterior subluxation does recur in the remaining third, and the overall rate of radiographic glenoid loosening is of concern.
Reverse total shoulder arthroplasty (RSA) has become the most utilized form of arthroplasty of the shoulder. Acromial stress fractures and scapular spine stress fractures are rare, yet ...well-recognized complications of RSA with ongoing studies identifying whether patient factors or prosthetic designs serve as risk factors. Specifically, it remains unclear if or how the position of the humeral tray (inlay or onlay) in RSA affects rates of periscapular fractures. The purpose of this article is to describe our technique for RSA using an onlay prosthesis, a variable-offset humeral tray, and an augmented glenoid baseplate, as well as to review the published results of acromial and scapular spine fractures after RSA based on humeral implant design.
Background This is an update on a previously documented cohort of patients who underwent shoulder arthroplasty for rheumatoid arthritis, with a minimum 5-year clinical follow-up. Methods The ...survivorship of 303 consecutive shoulder arthroplasties (108 hemiarthroplasties, 195 total shoulder arthroplasties) for rheumatoid arthritis at one institution was assessed. There were 255 arthroplasties in the clinical analysis and 188 in the radiographic analysis. Results Kaplan-Meier survivorship free of revision at 5 years and 10 years was 96.1% and 92.9% for total shoulder arthroplasty (TSA) and 89.2% and 87.9% for hemiarthroplasty (HA). The most common indications were glenoid loosening (5%) and infection (2%) for TSA revision and glenoid arthrosis (7%) for HA revision. Pain relief was greater with TSA than with HA. In patients with an intact rotator cuff, in comparing TSA with HA, those with a TSA had greater improvements in pain scores (−2.7 vs −1.8 on a 5-point scale) and degrees of elevation (45 versus 24) ( P = .08). Approximately 30% of humeral components and 73% of glenoid components had periprosthetic lucencies. There was a shift in position of the glenoid in 33% of TSAs, and 36% were “at risk.” Eighty-one percent of HAs had moderate or severe glenoid erosion. Discussion/Conclusion Both HA and TSA provide pain relief and improved motion in patients with rheumatoid arthritis. In patients with an intact rotator cuff, pain relief and range of motion are more improved with TSA compared with HA. There is a high rate of component lucency, but component revision is uncommon.
Shoulder arthroplasty for chondrolysis Schoch, Bradley, MD; Werthel, Jean-David, MD; Cofield, Robert, MD ...
Journal of shoulder and elbow surgery,
09/2016, Letnik:
25, Številka:
9
Journal Article
Recenzirano
Background Chondrolysis is a rare complication after shoulder arthroscopy leading to early joint destruction. Shoulder arthroplasty may be considered for end-stage chondrolysis, but concerns exist ...about implant survivorship, given the younger age of this population. This study aimed to assess pain relief, function, and survivorship of shoulder arthroplasty for chondrolysis and to assess risk factors for failure. Methods Between January 2000 and January 2013, 26 consecutive shoulders with chondrolysis were treated at our institution with shoulder arthroplasty. All shoulders had a prior arthroscopic procedure that predated a phase of rapid joint destruction. Twenty-three shoulders were followed up for a minimum of 2 years or until reoperation (mean, 4.0 years; range, 0.7-8.6 years). The mean age of the patients was 40 years (range, 21-58 years). Outcome measures included pain, range of motion, postoperative modified Neer ratings, American Shoulder and Elbow Surgeons scores, complications, and reoperations. Results At most recent follow-up, only 14 of 23 shoulders had no or mild pain. Overall pain scores improved from 4.7 to 2.6 points. Abduction and external rotation improved significantly. Five shoulders required reoperation, 2 for glenoid loosening and 1 each for infection, instability, and stiffness. Subjectively, 8 patients rated their shoulder as much better, 7 as better, 4 the same, and 4 worse. Most recent American Shoulder and Elbow Surgeons scores averaged 64 points (range, 20-95 points). Conclusions Shoulder arthroplasty for the treatment of chondrolysis improves pain and range of motion. However, patient satisfaction is variable. Early follow-up shows a higher than expected rate of reoperation (25%). Patients undergoing shoulder arthroplasty for chondrolysis should be counseled appropriately about expectations after surgery.
Purpose Patients with inflammatory arthritis frequently develop destructive shoulder arthritis and rotator cuff tearing. Reconstruction with anatomical shoulder replacement produces lesser results ...than for other etiologies such as osteoarthritis. We postulated that reconstruction with reverse shoulder prostheses would lead to early satisfactory results for these patients. Methods We carried out a retrospective review of 19 shoulders treated with reverse shoulder prostheses at a mean follow-up of 37 months. We rated patients' pain using a visual analog pain scale (VAPS) and noted active range of motion in forward elevation, abduction, and external rotation. American Shoulder and Elbow Society and Simple Shoulder Test SST scores were available for 12 patients preoperatively and 16 postoperatively. We graded final results using the modified Neer scale. Results Preoperatively, the mean VAPS was 6.5, with average flexion of 68, abduction 66, and external rotation 23°. The American Shoulder and Elbow Society score averaged 27 and the SST 1. Postoperatively, the VAPS was 1 and flexion was 138°, abduction 134°, and external rotation 52°. The mean ASES score increased to 76 and the SST to 8. There were 12 excellent, 5 satisfactory, and 2 unsatisfactory results. Complications included 2 scapular spine fractures, 1 acromial fracture, 1 dislocation, and 1 ulnar neuropathy. We found scapular notching in 42% of the shoulders. Six shoulders had grade 1 notching, and 2 shoulders grade 2 notching. There was no evidence of glenoid loosening, but we saw complete bone–cement radiolucency around 2 cemented stems. Conclusions At early follow-up, reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients. Type of study/level of evidence Therapeutic IV.
Hypothesis The purposes of this study were to determine the incidence of blood transfusion after revision shoulder arthroplasty and to assess risk factors associated with an increased risk of ...transfusion. Materials and methods Between 1994 and 2008, 566 consecutive revision shoulder procedures were performed at our institution, which formed the basis of this study. The patient's age, sex, body mass index, comorbidities, preoperative and postoperative hemoglobin level, details of the surgery, operative time, and transfusion details were documented retrospectively from medical records. Results Overall, 11.3% of patients (64 of 566) required a transfusion. An increased transfusion rate was associated with age (odds ratio OR per 10 years, 1.5 95% confidence interval (CI), 1.2 to 2.0; P = .002), operative time (≤5 hours vs >5 hours) (OR, 3.3 95% CI, 1.9 to 5.8; P < .001), diabetes (OR, 2.3 95% CI, 1.2 to 4.4; P = .01), and cardiac disease (OR, 2.7 95% CI, 1.5 to 5.0; P < .001). There were significant associations between preoperative hemoglobin level (OR, 0.4 per 1 point 95% CI, 0.3 to 0.5; P < .001) and a decreased odds of transfusion. The type of surgery (surgery on humeral component) also had an impact on the need for transfusion ( P < .001). Conclusions Older age, low preoperative hemoglobin level, increased operative time, diabetes, presence of cardiac disease, and type of revision surgery are associated with higher postoperative transfusion rates. These factors should be taken into consideration to more accurately predict the need for transfusion and modify preoperative blood-ordering protocols.
Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated ...with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision. Moreover, loading of the metaphyseal region rather than the diaphysial region with traditional stemmed implants can decrease stress shielding. When compared to stemmed-implants, stemless aTSA has demonstrated similar outcomes and complication rates. The purpose of this article is to analyze published outcomes and complications following the utilization of stemless aTSA. Additionally, key aspects of the surgical technique that may promote optimal results in stemless aTSA implantation are presented.
Salami Publishing Mallon, William J., MD; Kuhn, John E., MD, MS; Sperling, John W., MD, MBA ...
Journal of shoulder and elbow surgery,
10/2016, Letnik:
25, Številka:
10
Journal Article
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