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Reverse rotator cuff surgery

John M Tokish, Thomas C Alexander, Michael J Kissenberth, Richard J Hawkins
BACKGROUND: Pseudoparalysis remains one of the most challenging conditions in shoulder surgery. Long thought of as an unsolvable problem, recent advances in surgical techniques offer potential return of overhead motion in the setting of massive irreparable rotator cuff tears. This article summarizes the available literature including existing definitions and the results of different treatment approaches regarding range of motion, outcome scores, and reversal. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the MEDLINE database, Cochrane database, Physiotherapy Evidence Database, and Google Scholar database was performed for studies that defined a preoperative shoulder group as having pseudoparalysis...
June 2017: Journal of Shoulder and Elbow Surgery
S Petrillo, U G Longo, R Papalia, V Denaro
PURPOSE: To report the outcomes and complications of reverse shoulder arthroplasty (RSA) in massive irreparable rotator cuff tears (MIRCT) and cuff tear arthropathy (CTA). METHODS: A systematic review of the literature contained in Medline, Cochrane, EMBASE, Google Scholar and Ovid databases was conducted on May 1, 2016, according to PRISMA guidelines. The key words "reverse total shoulder arthroplasty" or "reverse total shoulder prostheses" with "rotator cuff tears"; "failed rotator cuff surgery"; "massive rotator cuff tears"; "irreparable rotator cuff tears"; "cuff tear arthropathy"; "outcomes"; "complications" were matched...
April 25, 2017: Musculoskeletal Surgery
Jean Kany, Jijo Jose, Denis Katz, Jean David Werthel, Padmanaban Sekaran, Rajkumar S Amaravathi, Philippe Valenti
BACKGROUND: Instability is one of the major causes of failures in unconstrained anatomic total shoulder arthroplasty (TSA). This study reviewed the instabilities that may occur in an anatomic shoulder platform system to identify its potential predictors. We hypothesized that soft tissue deficiency was the main cause of instability and that the best treatment option would be conversion to a reverse shoulder arthroplasty (RSA). MATERIALS AND METHODS: Between 2003 and 2013, we reviewed 27 patients who experienced postoperative instability, and the overall incidence was 5...
February 27, 2017: Journal of Shoulder and Elbow Surgery
M Holschen, B Franetzki, K-A Witt, D Liem, J Steinbeck
Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. BACKGROUND: Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants...
February 15, 2017: Musculoskeletal Surgery
M Vosloo, N Keough, M A De Beer
The rotator cuff (RC) insertions according to most anatomical texts are described as being separate from one another. However, clear fusion of the RC tendon fibres exists with prior studies showing this interdigitation forming a common, continuous insertion onto and around the lesser and greater tubercles (LT and GT) of the humerus. Current surgical repair methods (especially arthroscopic techniques) rarely mention or consider these connections during repair and suture anchor implantation. The general principles of RC surgery remain a controversial subject, due to various available techniques, surgeon experience and preference, and the contradicting success rates...
February 16, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
K Soudy, C Szymanski, C Lalanne, C Bourgault, A Thiounn, A Cotten, C Maynou
BACKGROUND: The objective of this study was to assess clinical and computed-tomography (CT) outcomes at least 2 years after humeral head resurfacing to treat concentric gleno-humeral osteoarthritis. HYPOTHESIS: Humeral head resurfacing provides similar outcomes to those achieved with stemmed humeral head implants. MATERIALS AND METHODS: This single-centre retrospective study included 40 Copeland™ and 65 Aequalis™ humeral resurfacing heads implanted between 2004 and 2012...
May 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
Philipp Moroder, Eva Schulz, Marian Mitterer, Fabian Plachel, Herbert Resch, Stefan Lederer
BACKGROUND: Promising short-term outcomes after pectoralis major tendon transfer for the treatment of an irreparable anterosuperior rotator cuff tear have been reported. The purpose of this study was to evaluate the long-term outcome. METHODS: Twenty-seven consecutive patients with irreparable anterosuperior rotator cuff tears without advanced cuff arthropathy or advanced humeral head migration were treated with a partial subcoracoid pectoralis major tendon transfer between 2004 and 2005...
February 1, 2017: Journal of Bone and Joint Surgery. American Volume
J Kircher
Implantation of reverse shoulder endoprostheses is becoming more popular for elderly patients besides the well-established standard anatomic endoprostheses. The reasons for this are the increased life expectancy, age-dependent degeneration of the rotator cuff leading to cuff tear arthropathy, posttraumatic disability after failed osteosynthesis and primary reverse fracture arthroplasty. Stemless implants are more frequently used for primary osteoarthritis with the bone quality being the limiting factor. Modern implant systems allow the stepwise extension from bone preserving primary implants to modular and convertible revision implants that allow a partial exchange of components...
January 2017: Der Orthopäde
Edward G McFarland, Gazi Huri, Yoon Suk Hyun, Steve A Petersen, Uma Srikumaran
BACKGROUND: Treating shoulders with osteoarthritis, an intact rotator cuff, and substantial glenoid bone loss is challenging. One option is reaming the glenoid flat and inserting a reverse prosthesis. This study reports the subjective, objective, and radiographic results of reverse total shoulder arthroplasty (RTSA) in this population. METHODS: We retrospectively reviewed 42 consecutive patients (23 women; mean age, 71 years [range, 53 to 89 years]) with primary glenohumeral osteoarthritis, intact rotator cuffs, and Walch type-A2 (n = 19), B2 (n = 5), or C glenoids (n = 18) who had undergone a total of 42 RTSAs with glenoid reaming without bone-grafting between 2008 and 2013 (mean follow-up, 36 months [range, 24 to 66 months])...
November 2, 2016: Journal of Bone and Joint Surgery. American Volume
Seok Won Chung, Bo Mi Choi, Ja Yeon Kim, Yong-Soo Lee, Jong Pil Yoon, Kyung-Soo Oh, Kyung Sik Park
PURPOSE: To analyze and compare the gene and protein expression characteristics in torn rotator cuff tendon tissues between diabetic and nondiabetic patients. METHODS: This was a pilot study. Twelve samples of rotator cuff tendon tissue from diabetic patients (mean age, 62.3 ± 9.9 years) and 12 age- and sex-matched nondiabetic tendon tissues (62.3 ± 9.9 years) were acquired from the torn tendon end of medium rotator cuff tears during arthroscopic surgery, after applying the same inclusion and exclusion criteria...
March 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
M Petri, J A Greenspoon, S G Moulton, P J Millett
BACKGROUND: Massive rotator cuff tears in active patients with minimal glenohumeral arthritis remain a particular challenge for the treating surgeon. METHODS: A selective literature search was performed and personal surgical experiences are reported. RESULTS: For patients with irreparable rotator cuff tears, a reverse shoulder arthroplasty or a tendon transfer are often performed. However, both procedures have rather high complication rates and debatable long-term results, particularly in younger patients...
2016: Open Orthopaedics Journal
U Butt, M S Rashid, D Temperley, S Crank, A Birch, A J Freemont, I A Trail
AIMS: The aim of this study was to analyse human muscle tissue before and after rotator cuff repair to look for evidence of regeneration, and to characterise the changes seen in the type of muscle fibre. PATIENTS AND METHODS: Patients were assessed pre-operatively and one year post-operatively using the Oxford Shoulder Score (OSS) and MRI. The cross-sectional area and distribution of the type of muscle fibre were assessed on biopsies, which were taken at surgery and one year post-operatively...
October 2016: Bone & Joint Journal
Raffaele Garofalo, Brody Flanagin, Alessandro Castagna, Vittorio Calvisi, Sumant G Krishnan
BACKGROUND AND PURPOSE: Rupture of the anterior and middle deltoid muscle associated with rotator cuff tear arthropathy (RCA) could result in a definitive loss of shoulder function. The purpose of this study was to evaluate clinical outcomes after a concomitant reverse shoulder arthroplasty (RSA) and deltoid repair under these circumstances. MATERIALS AND METHODS: Between 2006 and 2012, 18 consecutive patients with a mean age of 69.7 years, affected by massive irreparable rotator cuff tear and associated dehiscence or rupture of anterior and middle deltoid muscle underwent this operation through a modified anterosuperior approach...
November 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Jeremy S Somerson, Patrick Sander, Kamal Bohsali, Ryan Tibbetts, Charles A Rockwood, Michael A Wirth
BACKGROUND: In selected patients with a desire to maintain activity levels greater than those recommended after reverse total shoulder arthroplasty, hemiarthroplasty remains an option for treatment of cuff tear arthropathy (CTA). However, given the relatively small case series that have been reported to date, little is known regarding which patients will show functional improvement after this surgery. QUESTIONS/PURPOSES: We asked: What factors are associated with achieving the minimum clinically important difference in the simple shoulder test (SST) after hemiarthroplasty for cuff tear arthropathy? PATIENTS AND METHODS: Between 1991 and 2007, two surgeons at one academic center performed 48 shoulder hemiarthroplasties for CTA...
December 2016: Clinical Orthopaedics and related Research
Brian T Samuelsen, Eric R Wagner, Matthew T Houdek, Bassem T Elhassan, Joaquín Sánchez-Sotelo, Robert Cofield, John W Sperling
BACKGROUND: Reverse total shoulder arthroplasty (RTSA) has classically been reserved for patients older than 65 years with rotator cuff arthropathy, pseudoparalysis, and severe pain. This investigation assessed outcomes in a consecutive series of patients aged 65 and younger undergoing primary RTSA. METHODS: There were 63 patients (67 shoulders; 40 women, 27 men) with a mean age of 60 years (range, 50-65 years). Indications were cuff tear arthropathy (CTA) in 51, severe glenohumeral arthritis in 15, and osteonecrosis in 1...
January 2017: Journal of Shoulder and Elbow Surgery
Patric Raiss, T Bradley Edwards, Thomas Bruckner, Markus Loew, Felix Zeifang, Gilles Walch
BACKGROUND: The aim of this multicenter study was to analyze the clinical and radiographic outcome and to report on the types of complications in patients with chronic locked shoulder dislocation treated with reverse shoulder arthroplasty. METHODS: Twenty-two patients with a mean age of 71 years were included. The mean duration of follow-up was 3.5 years. Preoperatively, computed tomography or magnetic resonance imaging scans were performed and analyzed for bone defects and the status of the rotator cuff...
February 2017: Journal of Shoulder and Elbow Surgery
Brian C Werner, Brenda Chang, Joseph T Nguyen, David M Dines, Lawrence V Gulotta
BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) questionnaire was developed to provide a standardized method for evaluating shoulder function. Previous studies have determined the clinical responsiveness of this outcome measure for heterogenous populations or patients with nonoperatively treated rotator cuff disease. Currently, to our knowledge, no studies exist that establish the clinically relevant change in the ASES score after shoulder arthroplasty. QUESTIONS/PURPOSES: We asked: (1) What are the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the ASES score after primary and reverse shoulder arthroplasties? (2) Are the MCID and SCB for the ASES score different between primary and reverse shoulder arthroplasties? (3) What patient-related factors are associated with achieving the MCID and SCB after total shoulder arthroplasty and reverse shoulder arthroplasty? METHODS: A longitudinally maintained institutional shoulder arthroplasty registry was retrospectively queried for patients who underwent primary shoulder arthroplasty, including anatomic or reverse total shoulder arthroplasty from 2007 to 2013, with a minimum 2-year followup...
December 2016: Clinical Orthopaedics and related Research
K Theivendran, M Varghese, R Large, M Bateman, M Morgan, A Tambe, M Espag, T Cresswell, D I Clark
AIM: We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate. PATIENTS AND METHODS: We reviewed 125 consecutive primary reverse total shoulder arthroplasties (RTSA) implanted in 124 patients for rotator cuff arthropathy. There were 100 women and 24 men in the study group with a mean age of 76 years (58 to 89). The mean follow-up was 32 months (24 to 60). No patient was lost to follow-up. RESULTS: There were statistically significant improvements in the mean range of movement and Oxford Shoulder Score (p < 0...
July 2016: Bone & Joint Journal
Clay Riley, John Idoine, Yousef Shishani, Reuben Gobezie, Bradley Edwards
Reverse total shoulder arthroplasty (TSA) is a useful intervention for older patients with glenohumeral arthritis and a deficient rotator cuff. However, as a semiconstrained prosthesis, conventional reverse TSA implanted in a young patient could fail over time secondary to polyethylene wear and subsequent osteolysis. A metal-on-metal prosthesis may avoid this type of failure. The purpose of this study is to assess the outcomes in an initial cohort of young patients who underwent reverse TSA using a metal-on-metal prosthesis...
September 1, 2016: Orthopedics
Brent J Morris, Richard E Haigler, John M Cochran, Mitzi S Laughlin, Hussein A Elkousy, Gary M Gartsman, T Bradley Edwards
The potential adverse effect of body mass index (BMI) on shoulder function scores after reverse shoulder arthroplasty (RSA) has not been investigated. We conducted a study to examine outcomes of RSA performed for rotator cuff tear arthropathy (RCTA) across BMI categories (normal weight, overweight, obese). We hypothesized that, compared with normal-weight patients, obese patients would have worse shoulder function scores, worse mobility, and more complications. Using a prospective shoulder arthroplasty registry, we identified 77 primary RSAs performed for RCTA with minimum 2-year follow-up...
May 2016: American Journal of Orthopedics
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