Patient reported outcome measures of bilateral reverse total shoulder arthroplasty compared to bilateral anatomic total shoulder arthroplasty.
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SUBMITTER: Welborn BT
PROVIDER: S-EPMC6919371 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundReverse shoulder arthroplasty normally has adequate functional outcomes in patients with cuff tear arthropathy. The present study aimed to investigate the midterm clinical outcomes of reverse shoulder arthroplasty in Japanese patients with rheumatoid arthritis.MethodsBetween July 2014 and May 2016, reverse shoulder arthroplasty was performed in 14 rheumatic shoulders with joint destruction and rotator cuff tears. The range of motion, Constant score, and Shoulder36, which is a patient-reported outcome measure, were compared preoperatively and postoperatively. The prevalence of subscapular notching, subscapular osteophytes, postoperative fractures, and stress shielding of the humeral stem were evaluated by X-ray.ResultsRange of motion significantly improved from 77 to 122 degrees in flexion and from 67 to 111 degrees in abduction at four years. The Constant score significantly improved from 27 to 62, and each domain of Shoulder36 also significantly increased at four years. There was no dislocation, infection, or loosening of the prosthesis. Three shoulders presented scapular notching, and three cemented humeral stems showed stress shielding in the proximal humeral cortical bone.ConclusionReverse shoulder arthroplasty performed in Japanese patients with rheumatoid arthritis not only decreased the pain and improved the function of the shoulder joint but also significantly improved patients' health and activity of daily living in midterm results.
| S-EPMC7846690 | biostudies-literature
Project description:PURPOSE OF REVIEW:Reverse total shoulder arthroplasty (RTSA) is a procedure that has been increasingly utilized since its inception over 20 years ago. The purpose of this review is to present the most up to date practice and advances to the RTSA literature from the last 5 years. RECENT FINDINGS:Recent literature on RTSA has focused on identifying complications, maximizing outcomes, and determining its cost-effectiveness. RTSA has become a valuable tool in the treatment of various shoulder pathologies from fractures to massive-irreparable rotator cuff tears. Maximizing outcomes, proper patient counseling, and limiting complications are vital to a successful procedure. RTSA can be a difficult procedure; however, when utilized appropriately, it can be an invaluable tool in the orthopedic surgeon's armament. Recent evidence suggests, more and more, that RTSA not only provides value to the patient, but it is also cost-effective.
| S-EPMC7083978 | biostudies-literature
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.
| S-EPMC7528875 | biostudies-literature
Project description:BackgroundThe purpose of this study was to determine the optimal window for collection of patient-reported outcome measures (PROMs) after total joint arthroplasty (TJA).MethodsOur prospectively collected institutional joint registry was queried for patients who underwent primary, unilateral TJAs. The primary outcomes were the net changes in WOMAC, SF-12 MCS, SF-12 PCS, OHS, KSCRS, and UCLA activity rating system at 6, 12, and 24 months postoperatively. Secondary outcomes were data acquisition costs and follow-up attrition rates.ResultsEight hundred sixty-six procedures (450 total hip arthroplasties, 416 TKAs) were analyzed. A consistent plateau in all PROMs was noted by 6 months postoperatively-except for SF-12 MCS which showed no significant changes at any time interval. For TKA, the percentage of overall improvement achieved by 6 months was 88.7%, 84.5%, 100%, and 90.5% for the WOMAC, SF-12 PCS, UCLA, and KSCRS, respectively. For total hip arthroplasty, these values were 92.7%, 83.5%, 88.0%, and 89.8% for WOMAC, SF-12 PCS, UCLA, and OHS, respectively. There were marginal improvements from 6 to 12 months and no improvement from 12 to 24 months. Follow-up rates at 6, 12, and 24 months were 85%, 69%, and 40%, respectively. Our institutional costs for collecting a complete data set per patient were $128, $158, and $272 for 6, 12, and 24 months, respectively.ConclusionsMost of the improvement in PROMs after primary TJA occurs within the first 6 months. In addition, limiting PROMs collection to 6 months appears to be cost-efficient owing to increased attrition rates beyond this time interval.
| S-EPMC7083724 | biostudies-literature
Project description:The effects of tranexamic acid (TXA) in the setting of shoulder arthroplasty are unclear. The objective of this study was to examine the effects of TXA in reducing the need for blood transfusions and blood loss in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA).We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective cohort studies (RCS) that compared outcomes of patients who did and did not receive TXA during TSA or RTSA. We searched Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE for relevant studies. We assessed the risk of bias of the included studies and calculated pooled risk estimates. The primary outcome was transfusion rate, and secondary outcomes were changes in hemoglobin, estimated total blood loss (ETBL), blood loss via drainage, operative time, hospital stay, overall complications, and thromboembolic events.We identified 3 RCTs and 3 RCS including 677 patients with 680 shoulders (343 TXA and 337 non-TXA). The random-effects model meta-analysis showed that TXA group had a lower transfusion rate (risk ratio (RR) 0.34, 95% CI 0.14 to 0.79), less change in hemoglobin (mean difference (MD) -0.64 g/dl, 95% CI -0.81 to -?0.46), and reduced ETBL (MD -249.24 ml, 95% CI -338.74 to -?159.74). In patients with RTSA, the TXA group had a lower transfusion rate (RR 0.28, 95% CI 0.14 to 0.79), less ETBL (MD -249.15 ml, 95% CI -426.60 to -?71.70), less change in hemoglobin (MD -?0.64 g/dl, 95% CI -0.86 to -?0.42), and less blood loss via drainage (MD -?84.56 ml, 95% CI -145.72.14 to -?23.39) than non-TXA group.The use of TXA in primary shoulder arthroplasty appears safe, and can reduce transfusion rate, changes in hemoglobin, and perioperative total blood loss, especially in patients with RTSA.Systematic Review and meta-analysis, III.
| S-EPMC5816518 | biostudies-literature
Project description:BackgroundReverse total shoulder arthroplasty (RTSA) provides reconstructive options in patients previously not candidates for total shoulder arthroplasty (TSA) or who have failed previous anatomic TSA. Revision from anatomic TSA to RTSA previously required removal of all components, a difficult and extensive procedure. Modular humeral components permit conversion from anatomic TSA to RTSA without removal of well-fixed humeral components.Questions/purposesOur purpose is to present a case series of patients treated for the unique and not previously reported complication of humeral tray-taper failure following modular RTSA. Challenges in diagnosis and treatment are described, including the use of dynamic fluoroscopy and manufacturer-specific instruments for component revision.MethodsFive patients with a total of six humeral tray-taper failures were identified from 300 patients with first-generation (titanium) humeral trays over a 7-year period. Dynamic fluoroscopic evaluation aided in diagnosis in a majority of the cases. All cases have been revised to second-generation (cobalt chrome) humeral trays.ResultsAverage follow-up was 22?±?23 months (range 3-60 months). One individual required a second revision for the same complication, but otherwise, no additional procedures were required. Symptom relief was obtained in all patients.ConclusionsThis case series illustrates a previously unpublished complication of humeral tray-taper junction failure following modular RTSA. Clinical and radiographic diagnosis is challenging; however, dynamic fluoroscopic evaluation permits identification of the component failure, and revision surgery results in good outcomes. We must, however, continue to evaluate what activities are recommend for patients following shoulder arthroplasty, specifically reverse total shoulder arthroplasty.
| S-EPMC4733694 | biostudies-literature
Project description:The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome.This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented.We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome.Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.
| S-EPMC3997773 | biostudies-literature
Project description:BackgroundThe implantation rates of reverse total shoulder arthroplasties (RTSAs) are increasing worldwide, resulting in higher absolute numbers of the associated complications and revision surgeries. This requires the discussion of salvage therapies for failed RTSAs without revision to a new RTSA. Revision to hemiarthroplasty may offer a valid fallback option in certain cases. This study aimed to analyze the incidence, indications, and clinical outcomes, especially the reduction in pain levels compared to a matched control group.MethodsOur prospectively enrolled patient cohort of RTSA implantations at a tertiary referral center between January 2005 and December 2018 was retrospectively queried for revision to a hemiarthroplasty. For clinical outcome evaluation, a minimum follow-up duration of 2 years after revision to hemiarthroplasty was required. Clinical outcome measures were compared to two matching groups, one with RTSA preserving revision and one without any reintervention. The outcome measures were the absolute and relative Constant-Murley score (aCS and rCS), Subjective Shoulder Value (SSV), range of motion, and pain.ResultsA total of 21 out of 1237 RTSAs (1.7%) underwent salvage revision to hemiarthroplasty at a mean time of 20 ± 21 months (range, 1-75 months). Of those, 12 were available for a minimum follow-up of 2 years after revision to a hemiarthroplasty. The main indications were glenoid loosening (8/12), scapular spine fracture (2/12), and instability (2/21). Clinical outcome was analyzed at a mean follow-up period of 46 ± 26 months (24 months to 123 months) after revision to a hemiarthroplasty. The revision significantly reduced CS pain from 6 ± 4 points to 12 ± 3 points (scale 0 to 15 with 15 as optimum, P < .01). The aCS, rCS, SSV, and range of motion did not improve. Comparison with the RTSA preserving revision group and the RTSA group without reintervention showed significantly worse outcome scores for aCS (33 ± 10 vs. 55 ± 19 vs. 69 ± 12 points), rCS (41 ± 14% vs. 67 ± 20% vs. 84 ± 13%), SSV (35 ± 19% vs. 64 ± 20% vs. 81 ± 15%), flexion (53 ± 27° vs. 64 ± 20° vs. 128 ± 24°), and abduction (50 ± 23° vs. 109 ± 42° vs. 142 ± 24°). Pain was similar in all groups at the last follow-up visit.ConclusionIn a few cases, RTSA retention or revision to another RTSA is impossible. For those patients, conversion to hemiarthroplasty is a valid fallback option to reduce the patient's pain levels and provide low-level function.
| S-EPMC8568842 | biostudies-literature
Project description:BackgroundThe number of hip, knee and shoulder arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched an initiative (called PaRIS Initiative) for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the launch of the Initiative in Italy given that IOR hosts the Registry of Orthopedic Prosthetic Implants (RIPO), a region-wide registry which collects joint implant data from all the hospitals in the Emilia-Romagna Region. In this specific geographic area information related to PROMs after joint replacement is unknown. This paper describes the protocol of a study (PaRIS-IOR) that aims to implement the collection of a set of PROMs within an existing implant registry in Italy. The study will also investigate the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention.MethodsThe PaRIS-IOR study is a prospective, single site, cohort study that consists of the administration of PROMs questionnaires to patients on the list for elective arthroplasty. The questionnaires will be administered to the study population within 30 days before surgery, and then at 6 and 12 months following surgery. The study population will consist of consecutive adult patients undergoing either hip, knee or shoulder arthroplasty. The collected data will be linked with those routinely collected by the RIPO in order to assess the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention.DiscussionThe PaRIS-IOR study could have important implications in targeting the factors influencing functional outcomes and quality of life reported by patients after hip, knee and shoulder arthroplasty, and will also represent the first systematic collection of PROMs related to arthroplasty in Italy.Trial registrationProtocol version (1.0) and trial registration data are available on the platform www.clinicaltrial.gov with the identifier NCT03790267 , first posted on December 31, 2018.
| S-EPMC6694507 | biostudies-literature
Project description:BackgroundThe advent of modular shoulder arthroplasty systems has allowed the conversion of hemiarthroplasty or total shoulder arthroplasty to reverse total shoulder arthroplasty (RTSA) without removing a well-fixed stem.Questions/purposesTo determine the feasibility, functional outcome, and complication profile of RTSA modular conversion.MethodsA prospective shoulder arthroplasty registry was queried for consecutive patients scheduled for a modular conversion from January 1, 2007, to April 1, 2015. Eligible patients had medical charts and operative records reviewed for preoperative diagnosis, age, medical comorbidities, preoperative American Shoulder and Elbow Society (ASES) score, preoperative Visual Analogue Scale (VAS) pain and instability scores, and intraoperative findings. Each patient was then contacted by telephone or mail to complete up-to-date ASES and VAS questionnaires.ResultsSeventeen patients underwent a modular conversion. Nine patients were scheduled for modular conversion but underwent humeral revision due to excessive soft tissue tension (65.3% modular conversion rate). Average follow-up was 37.4 months (range 10.0-67.6 months). Pain scores improved from 5.3 (range 0.4 to 8.0) to 2.4 (range 0 to 9.3) (p?<?0.01), instability VAS from 5.2 (range 0 to 10) to 1.1 (range 0 to 6.8) (p?<?0.01), and ASES scores improved from 35.2 (range 20.7 to 61.3) to 65.6 (range 11.8 to 92) (p?<?0.01).ConclusionsModular conversion of an anatomic to a RTSA is feasible in a majority of patients. Despite the complexity of the procedure, modular conversion of hemiarthroplasty or TSA to RTSA can significantly improve functional outcomes with a low rate of complications.
| S-EPMC5481267 | biostudies-literature