Dataset Information

Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature.

ABSTRACT:

Background

Humeral stem length in anatomic total shoulder arthroplasty (TSA) continues to decrease in an attempt to preserve bone. Outcomes following short-stem TSA are not well documented. The purpose was to systematically review and report the outcomes and revisions following short-stem humeral implants for TSA.

Methods

A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting TSA outcomes of short-stem implants with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and described.

Results

Thirteen studies were included (average follow-up: 33 months, range 24-84 months; 8 studies [62%] were multicenter and 6 [46%] were from Europe). All studies were published in the last 8 years, and almost all (12/13, 92%) reported results of uncemented components. Most of the studies (9/13, 70%) reported results from the Aequalis Ascend or Ascend Flex Stem (Tornier). Improvements were seen in all measured range of motion planes and patient-reported outcome scores. Complications were infrequent, with a 2% humeral loosening rate, a 3% overall revision rate, and a 1% rate of revision for aseptic humeral loosening. Radiographic results showed a 13% rate of radiolucent lines, a 16% rate of condensation lines, and a 22% rate of calcar osteolysis.

Conclusion

Short-stem TSA humeral implants provide excellent results, with low revision rates in the short term. Long-term follow-up will be necessary to understand the clinical impact of radiographic calcar osteolysis.

SUBMITTER: Erickson BJ

PROVIDER: S-EPMC7075780 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature.

Erickson Brandon J BJ Chalmers Peter N PN Denard Patrick J PJ Gobezie Reuben R Romeo Anthony A AA Lederman Evan S ES

JSES international 20200128 1

<h4>Background</h4>Humeral stem length in anatomic total shoulder arthroplasty (TSA) continues to decrease in an attempt to preserve bone. Outcomes following short-stem TSA are not well documented. The purpose was to systematically review and report the outcomes and revisions following short-stem humeral implants for TSA.<h4>Methods</h4>A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Therapeutic clinical outcome inv ...[more]

PMID: 32195473

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Project description:IntroductionAnatomical total shoulder arthroplasty (TSA) is an effective treatment adopted for patients with glenohumeral osteoarthritis (OA). The glenoid component failure is the main risk that occurs in this therapeutic choice; however, doubts remain regarding the selection of the best implant for avoiding complication. This systematic review aims to evaluate the glenoid component in TSA by comparing the complications of different types of implants.Methods and analysisA systematic review of randomised clinical trials or quasi-randomised trials will be performed by applying the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols and comparing polyethylene (keeled and pegged) versus metal-backed implants in adult patients with glenohumeral OA. Our search strategy will be performed using MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, EMBASE and Web of Science. Data management and extraction will be performed using a data withdrawal form and by analysing study method characteristics, participant characteristics, intervention characteristics, results and methodological domains. The database search will be performed by February 2021. The Grading of Recommendations Assessment, Development and Evaluation will be used for assessing the quality of evidence of each study selected; however, some critical and important outcomes were determined such as the shoulder function through functional scores (Constant-Murley and American Shoulder and Elbow Surgeons), complications represented by pain (Visual Analogue Scale), surgical revision, radiograph radiolucency and loosening. The confidence in estimated effects for these outcomes will be applied as the overall confidence. The outcomes will be defined as early or late, according to the postoperative follow-up of less than or greater than 1 year, respectively, for complications and radiographs. For the shoulder function, follow-ups will be divided into 6, 12 and 24 months. Heterogeneity is expected in systematic reviews; therefore, the selection of outcomes, as well as the sample size, and specific statistical analysis can lead to meta-analysis; however, if it fails, narrative evidence synthesis will be conducted. Other analyses such as descriptive, subgroup and sensitivity analyses will be performed whenever possible. This systematic review will, therefore, provide evidence concerning the best clinical practice for avoiding complications.Ethics and disseminationThis study has been approved by the Institutional Review Board of Universidade Federal de São Paulo (protocols 0725/2017, 2.157.415 and 70473017.5.0000.5505), and the findings will be disseminated through peer-reviewed publication and conference presentations.Prospero registration numberCRD42018079537.

Project description:Background:With an increasing volume of primary total shoulder arthroplasties (TSA), the number of revision TSA cases is expected to increase as well. However, the postoperative medical morbidity of revision TSA has not been clearly described. Questions/Purposes:The purpose of this study was to determine the rate of postoperative complications following revision TSA, relative to primary TSA. In addition, we sought to identify independent predictors of complications, as well as to compare operative time and postoperative length of stay between primary and revision TSA. Methods:Patients who underwent primary/revision TSA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Differences in complications, readmission rates, operative time, length of stay, and predictors of complications were evaluated using bivariate and multivariate analyses. Results:A total of 10,371 primary TSA (95.4%) and 496 revision TSA cases (4.6%) were identified. The overall complication rate was 6.5% in primary and 10.7% in revision TSA patients (p < 0.001). Multivariate analysis identified an increased risk of any complication (odds ratio 1.73, p < 0.001), major complication (2.08, p = 0.001), and wound infection (3.45, p = 0.001) in revision TSA patients, relative to primary cases. Operative time was increased in revision cases (mean ± standard deviation, 125 ± 62.5), relative to primary (115 ± 47.7, p < 0.001). Age > 75, female sex, history of diabetes or chronic obstructive pulmonary disease, and American Society of Anesthesiologists classification ? 3 were associated with increased risk of any complication. Smoking history was the only significant predictor of wound infection. Conclusion:Revision TSA, in comparison to primary, poses an increased risk of postoperative complications, particularly wound infections. A history of smoking was an independent predictor of wound infections.

Project description:Malpositioning of the glenoid component in total shoulder arthroplasty (TSA) remains the primary source of loosening. The purpose of this study is firstly, to quantify postoperative glenoid component position in patients having a TSA and secondly, to explore whether glenoid component radiolucency is associated with glenoid position, clinical outcomes and patient-reported measures in the short-term (two year) follow-up period. This study was a sub-study of a larger clinical trial that included patients who underwent a TSA and who were randomized into two different glenoid types with a minimum two-year follow-up period. Post-operative radiographic assessments (six weeks and two years) were used to measure glenoid component position (version, inclination, offset) and humeral head centering anterior-posterior (AP) and superior-inferior (SI), and to assess glenoid component radiolucent scoring (modified Lazarus). Pre-operative X-rays were used to measure glenoid version, inclination and Walch classification. Patient-reported measures (PROMs) included the EQ-5D health slider and the Western Ontario Osteoarthritis (WOOS) and American Shoulder and Elbow Surgeons (ASES) score and were captured at baseline and two years postoperative. Clinical outcomes including range of motion and complications were also documented. Statistical analysis included t-tests and regression modeling. Ninety-one patients with an average age of 69.9 ± 6.2 years were included in this study. Glenoid component position improved significantly in version (-19.4 ± 8.6° to -17.7 ± 8.5°; p < 0.045) and inclination (11.5 ± 7.1° to 5.9 ± 6.3°; p < 0.00001) from preoperative to six weeks postoperative. Glenoid component offset in SI and humeral head centering in AP remained unchanged throughout the follow-up. Radiolucency (Lazarus classification) was recorded in 21 cases (17.3%) with a Lazarus score of 1 (15 cases) and 2 (6 cases). The EQ-5D health slider, WOOS and ASES, and ROM confirmed continuous improvements from the preoperative scores to the two-year follow-up (p < 0.05). Regression models showed no correlation between glenoid component radiolucency at two years and the postoperative week six glenoid component position; however, female gender was a significant variable. Glenoid component changes from its original native glenoid were observed following TSA. Glenoid inclination was improved more than version from baseline, and the humeral head remained well-centered in AP and SI at two years. Radiolucency of the glenoid at two years is not negatively associated with PROMs or component position; however, female gender was identified as a significant predictor and warrants further investigation. Complications are not associated with glenoid position or radiolucency, but longer-term follow-up is required.

Dataset Information

Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature.

Background

Methods

Results

Conclusion

Publications

Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature.

Similar Datasets

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