Shoulder instability after total shoulder arthroplasty: a case of arthroscopic repair.
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ABSTRACT:
SUBMITTER: Gee AO
PROVIDER: S-EPMC3903956 | biostudies-literature | 2014 Feb
REPOSITORIES: biostudies-literature
Publications
Shoulder instability after total shoulder arthroplasty: a case of arthroscopic repair.
Gee Albert O AO Angeline Michael E ME Dines Joshua S JS Dines David M DM
HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20131212 1
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Project description:PurposeThis study evaluates outcomes of a consistent arthroscopic stabilization technique for recurrent posterior instability.Methods79 shoulders with symptomatic posterior instability treated with arthroscopic repair and evaluated at a follow-up of 36 months. The mean age was 25.4 years of which 66 males and 13 females, and in 75% the dominant shoulder was affected. A known traumatic injury had occurred in 80%, with 25% having a documented dislocation. Arthroscopic repair was performed through an anterosuperior 12 O'clock viewing portal. Suture anchor repairs were performed in 60 cases and plication to the intact labrum in 19. A shoulder immobilizer was used for 4 weeks, followed by progressive range of motion, weightlifting at 3 months and return to contact sports at 6 months. The 79 cases had complete pre-op and post-op shoulder outcome scores.ResultsSignificant improvement from preoperatively to final follow-up was seen for ASES scores, from 58 to 93. All patients returned to their previous level of athletic activity. Two patients reported postoperative instability; none required reoperation. There were no other postoperative complications.ConclusionsThis study represents a consecutive series of patients with recurrent posterior instability undergoing arthroscopic posterior stabilization. In this population arthroscopic posterior labral repair and capsular plication provided significant clinical improvement with low recurrence and revision rate.
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Project description:Stiffness is a well-known complication after reverse shoulder arthroplasty. Although multiple factors may be involved, the main cause for stiffness is rarely identified. Imaging studies frequently are inconclusive in ruling out mechanical or biological causes. Periprosthetic infection should be always suspected, but the absence of major clinical signs and accurate diagnostic tests is frequent. A lack of objective criteria establishing a diagnosis and when to proceed with revision surgery is often present in such cases. Moreover, additional surgical procedures should be carefully evaluated, as they can represent a point of no return. Shoulder arthroscopy plays an increasingly important role in these cases, either as a diagnostic or therapeutic tool. There are no reports about arthroscopy on stiffness after reverse shoulder arthroplasty. In this Technical Note, we describe an arthroscopic technique aimed to identify potential causes of reverse shoulder arthroplasty stiffness. Subsequent circumferential release is described and discussed.
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Project description:We present a technique for arthroscopic glenoid removal in a case of glenoid loosening after total shoulder arthroplasty (TSA). The presented technique is technically feasible and may be useful if 1-stage surgery with glenoid reimplantation is not indicated. To exclude low-grade infection, the presented technique allows for an intraoperative infection workup such as intraoperative cultures. However, glenoid loosening in TSA is a well-known problem and has been described before. The advantages of the presented technique include minimally invasive surgery, decreased pain, preservation of the subscapularis tendon, and assurance of exclusion of low-grade infection before reimplantation of a new glenoid implant. In this case a 73-year-old patient was treated with a TSA for severe osteoarthritis of the right shoulder in April 2014. Because of persistent anterior shoulder pain postoperatively, radiographic evaluation was performed and showed signs of glenoid loosening 6 months after surgery without any clinical signs of infection. To exclude low-grade infection, arthroscopy of the right shoulder was performed. Arthroscopy showed a totally loosened glenoid component leading to arthroscopic glenoid removal by use of a special forceps.
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Project description:Aseptic glenoid component loosening after anatomic total shoulder arthroplasty remains an important cause of late clinical failure and revision surgery. We present here the surgical technique of all-arthroscopic removal and glenoid bone grafting. Arthroscopic removal of a loose glenoid component and bone grafting of the glenoid defect without dermal allograft preserves glenoid bone stock and obviates the need for multiple suture anchors to hold the graft in place.
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Project description:Posterior shoulder instability, although relatively rare in the general population, is more commonly seen in athletes, especially those in contact sports. Although nonoperative treatment has been associated with satisfactory results in the setting of posterior shoulder instability, conservative management may ultimately fail and lead to recurrence particularly in young, male patients. Both arthroscopic and open repair techniques to address posterior instability have been described, with each showing positive patient-reported outcomes, low risk of recurrence, and considerably high return-to-sport rates. In particular, arthroscopic treatment includes the following: capsular plication and knotted and/or knotless suture anchor fixation. The purpose of this technique is to describe our preferred technique to treat recurrent posterior shoulder instability through arthroscopic labral repair using knotless suture anchor fixation.
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Project description:Initial treatment of shoulder multidirectional instability (MDI) consists of nonoperative modalities of physical therapy and rehabilitation; if this fails, surgical treatment can become necessary. MDI of the shoulder can be challenging to manage in individuals who fail conservative management. Historically, surgical treatment for MDI has been open capsular plication; however, arthroscopic capsular plication has now become the standard of care, with outcomes similar to the open procedure. The purpose of this article and Video 1 is to describe our arthroscopic technique for pancapsular shift with labral repair.
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Project description:A lesser tuberosity osteotomy (LTO) is commonly performed during total shoulder arthroplasty to access the glenohumeral joint. Healing of the LTO is critical to optimizing the outcome of the procedure and is enhanced by a repair that provides stability and compression across the osteotomy site. The purpose of this article is to describe a technique that uses a tensionable suture construct to repair the LTO during anatomic total shoulder arthroplasty using a stemless humeral component. The technique involves passing a row of high-tensile sutures through bone tunnels lateral to the osteotomy site (transosseous sutures) and another row of sutures through the humeral implant (implant sutures). One limb of each bone tunnel suture is then tied to its corresponding limb of implant suture and the remaining free strands of the tied sutures are manually tensioned and tied to each other. This technique is an efficient and reproducible method for creating compression and stability across the osteotomy site that facilitates bony healing.
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Project description:Anatomic total shoulder arthroplasty, when used for treatment of primary glenohumeral arthritis, is historically very successful. We propose a novel technique for subscapularis repair during closure of a deltopectoral approach to the shoulder with subscapularis peel. Our technique allows for early motion following surgery and also provides for improved subscapularis repair integrity and resilience during postoperative rehabilitation. Postoperatively, we allow passive and active assisted range of motion at week 1, limited active range of motion at week 2, and unrestricted external rotation range of motion beginning at week 6. The use of our technique has led to improved patient outcomes with regard to range of motion postoperatively following anatomic total shoulder arthroplasty and we recommend its adoption into practice.
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Project description:Humeral avulsion of the glenohumeral ligament (HAGL) is a rare cause of anterior shoulder instability. Recurrent instability and anterior shoulder pain could be caused by an unrepaired HAGL; therefore, making the diagnosis is crucial. Only a few articles describe arthroscopic HAGL repair. This uncommon technique uses lateral decubitus arthroscopy and standard Bankart instrumentation. Different methods used to facilitate visualization of the working space as well as anchor placements are described.
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Project description:Capsulolabral augmentation is one of the most used arthroscopic techniques to address multidirectional instability of the shoulder. Given the thin and weak capsule seen in the affected patients, reconstruction in this subset of patients can be particularly challenging. This arthroscopic technique aims to reduce the capsular volume and deepen the glenoid socket through the creation of a particularly voluminous "bumper" along the glenoid bone. Increasing the depth of the glenoid facilitates a concavity-compression stabilizing effect and, therefore, shoulder stability, especially midrange stability. This technique aims to augment the bump of the standard capsulolabral reconstruction by using a resorbable surgical mesh derived from porcine skin.
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