Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.
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ABSTRACT:
SUBMITTER: Craig RS
PROVIDER: S-EPMC7173708 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Publications
Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.
Craig Richard S RS Goodier Henry H Singh Jasvinder A JA Hopewell Sally S Rees Jonathan L JL
The Cochrane database of systematic reviews 20200421
<h4>Background</h4>Shoulder replacement surgery is an established treatment for patients with end-stage glenohumeral osteoarthritis or rotator cuff tear arthropathy who have not improved with non-operative treatment. Different types of shoulder replacement are commonly used, but their relative benefits and risks compared versus one another and versus other treatments are uncertain. This expanded scope review is an update of a Cochrane Review first published in 2010.<h4>Objectives</h4>To determin ...[more]
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Project description:BackgroundMetallic humeral and glenoid lateralized implants have been developed to prevent common problems that can emerge using Grammont's concept (ie, medialization of center of rotation, decreased humeral offset, scapular notching) in reverse shoulder arthroplasty. The purpose of this study was to evaluate the clinical and radiological results of metallic humeral and glenoid lateralized implants for cuff tear arthropathy (CTA) and primary osteoarthritis (OA).MethodsIn this prospective study, patients with CTA or OA who underwent reverse shoulder arthroplasty using augmented base plates for glenoid lateralization and a "curved stem" design for the humeral side were included. The Constant-Murley score and Subjective Shoulder Value were documented at 1- and 2-year follow-ups. Radiographs were reviewed for scapular notching, instability, loosening, osteolysis, ossification, bone resorption, or fractures. Lateralization and distalization shoulder angles were evaluated at the final follow-up.ResultsThere were 23 patients with CTA and 19 patients with OA (27 women; mean age, 76 years; range, 59-85) available for examination at 2 years. Both groups increased significantly in all outcome measures compared with baseline (P < .01). Although patients with OA generally had lower baseline scores, the outcome scores were similar and did not show any statistically significant differences. The mean Constant-Murley score and Subjective Shoulder Value at the final follow-up were 78 points (standard deviation [SD] 10) and 84% (SD 11) for patients with CTA, respectively, and corresponding values were 80 points (SD 16) and 92% (SD 12) for the OA group. No scapular notching was observed. The mean value of the lateralization shoulder angle was 81.5° (SD 9.7) and for the distalization shoulder angle was 54.8° (SD 9.4). Neither scapular spine fractures nor instability was observed in this patient cohort.ConclusionMetallic humeral and glenoid lateralization achieves excellent clinical results in terms of shoulder function, pain relief, muscle strength, and patient-reported subjective assessment without instability or radiographic signs of scapular notching. Patients with primary OA showed an overall trend toward better clinical improvement than patients with CTA.
| S-EPMC8888182 | biostudies-literature
Project description:Myosteatosis is the pathological accumulation of lipid that occurs in conjunction with atrophy and fibrosis following skeletal muscle injury or disease. Little is known about the mechanisms by which lipid accumulates in myosteatosis, but many studies have demonstrated the degree of lipid infiltration negatively correlates with muscle function and regeneration. Our goal was to identify biochemical pathways that lead to muscle dysfunction and lipid accumulation in injured rotator cuff muscles, a model that demonstrates severe myosteatosis. Adult rats were subjected to a massive tear to the rotator cuff musculature. After a period of either 0 (healthy control), 10, 30, or 60 days, muscles were prepared for RNA sequencing, shotgun lipidomics, metabolomics, biochemical measures, electron microscopy, and muscle fiber contractility. Following rotator cuff injury, there was a decrease in muscle fiber specific force production that was lowest at 30d. There was a dramatic time dependent increase in triacylglyceride content. Interestingly, genes related to not only triacylglyceride synthesis, but also lipid oxidation were largely downregulated over time. Using bioinformatics techniques, we identified that biochemical pathways related to mitochondrial dysfunction and reactive oxygen species were considerably increased in muscles with myosteatosis. Long chain acyl-carnitines and L-carnitine, precursors to beta-oxidation, were depleted following rotator cuff tear. Electron micrographs showed injured muscles displayed large lipid droplets within mitochondria at early time points, and an accumulation of peripheral segment mitochondria at all time points. Several markers of oxidative stress were elevated following rotator cuff tear. The results from this study suggest that the accumulation of lipid in myosteatosis is not a result of canonical lipid synthesis, but occurs due to decreased lipid oxidation in mitochondria. A failure in lipid utilization by mitochondria would ultimately cause an accumulation of lipid even in the absence of increased synthesis. Further study will identify whether this process is required for the onset of myosteatosis.
2018-08-29 | GSE103266 | GEO
Project description:Introduction: A massive rotator cuff tear (RCT) leads to glenohumeral joint destabilization and characteristic degenerative changes, termed cuff tear arthropathy (CTA). Understanding the response of articular cartilage to a massive RCT will elucidate opportunities to promote homeostasis following restoration of joint biomechanics with rotator cuff repair. Mechanically activated calcium-permeating channels, in part, modulate the response of distal femoral chondrocytes in the knee against injurious loading and inflammation. The objective of this study was to investigate PIEZO1-mediated mechanotransduction of glenohumeral articular chondrocytes in the altered biomechanical environment following RCT to ultimately identify potential therapeutic targets to attenuate cartilage degeneration after rotator cuff repair. Methods: First, we quantified mechanical susceptibility of chondrocytes in mouse humeral head cartilage ex vivo with treatments of specific chemical agonists targeting PIEZO1 and TRPV4 channels. Second, using a massive RCT mouse model, chondrocytes were assessed for mechano-vulnerability, PIEZO1 expression, and calcium signaling activity 14-week post-injury, an early stage of CTA. Results: In native humeral head chondrocytes, chemical activation of PIEZO1 (Yoda1) significantly increased chondrocyte mechanical susceptibility against impact loads, while TRPV4 activation (GSK101) significantly decreased impact-induced chondrocyte death. A massive RCT caused morphologic and histologic changes to the glenohumeral joint with decreased sphericity and characteristic bone bruising of the posterior superior quadrant of the humeral head. At early CTA, chondrocytes in RCT limbs exhibit a significantly decreased functional expression of PIEZO1 compared with uninjured or sham controls. Discussion: In contrast to the hypothesis, PIEZO1 expression and activity is not increased, but rather downregulated, after massive RCT at the early stage of cuff tear arthropathy. These results may be secondary to the decreased axial loading after glenohumeral joint decoupling in RCT limbs.
| S-EPMC10508846 | biostudies-literature
Project description:Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
| S-EPMC8245121 | biostudies-literature
Project description:ObjectiveTo establish an animal model of modified cuff tear arthropathy (mCTA) in order to better replicate the pathophysiology associated with rotator cuff tear-induced humeral head collapse.DesignmCTA was induced by transection of the rotator cuff, the long head of the biceps brachii (LHB), and superior half of the joint capsule in the right shoulder of 12-week-old rats; the left shoulder underwent sham surgery. The severity of CTA was quantitated using the Murine Shoulder Arthritis Score (MSAS). The trabecular bone of the humeral head and metaphysis was analyzed using bone histomorphometry. The expression of proinflammatory cytokines and catabolic enzymes was evaluated immunohistochemically.ResultsIn the mCTA model, the MSAS increased starting from 2 weeks after induction, and there was notable subchondral bone collapse with fibrous cells at 4 weeks. The mCTA cartilage exhibited positive staining for TNF-α, IL-1β/6, MMP-3/13, and ADAMTS5. The trabecular bone volume was reduced not only in the subchondral bone but also in the metaphysis of the humeri, and bone resorption was enhanced in these areas. In the collapsed subchondral bone, both bone formation and resorption were increased. The fibrous cells showed expression of TNF-α, IL-6, and MMP-13, along with specific markers of mesenchymal stem cells. Furthermore, the fibrous cells showed osteoblastic characteristics (RUNX2-positive) and expressed RANKL.ConclusionsThe LHB and the capsuloligamentous complex are critical stabilizers of the glenohumeral joint, serving to prevent the advancement of CTA following massive rotator cuff tears. Fibrous cells appear to play a role in the humeral head bone resorption.
| S-EPMC10407568 | biostudies-literature
Project description:ObjectivesThis cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) of patients with rotator cuff tears towards arthroscopic shoulder surgery (ASS), based on the hypothesis that the knowledge of the procedure among patients would be sufficient, which in turn might influence their practice and attitude.DesignCross-sectional study.SettingPatients were recruited from Tong Ren Hospital between September and October 2022.ParticipantsA total of 588 patients were included in the study.InterventionsNo interventions were administered.Primary and secondary outcome measuresKnowledge, attitude and practice scores were measured using a self-administered questionnaire.ResultsOut of 588 patients included, 50.51% had undergone ASS. Lower education level and monthly income, shorter weekly exercise time and shorter disease duration were identified as independent risk factors for the KAP total score. Structural equation modelling revealed a direct positive effect of knowledge on attitude, but neither knowledge nor attitude influenced practice scores.ConclusionsPatients with rotator cuff tears demonstrated relatively poor knowledge, a neutral attitude and moderate practice towards ASS, highlighting the need for patient education and counselling to enhance understanding and decision-making regarding ASS.
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Project description:This study examines the association between strength measurements and supraspinatus tear in patients with shoulder pain. This study characterized determinants of abduction strength among patients with tears.A total of 208 patients with shoulder pain were recruited. Strength was tested using a handheld dynamometer. Supraspinatus tears were diagnosed by combination of clinical assessment and blinded magnetic resonance imaging review. Associations of supraspinatus tear with patient characteristics and strength measurements (abduction, internal rotation and external rotation) were assessed using multivariable logistic regression models.Patients with supraspinatus tear had decreased abduction strength (P = 0.02) and decreased external rotation strength (P < 0.01). When adjusted for age, sex, tear laterality, and body mass index, decreased abduction strength (odds ratio, 1.18/kg; 95% confidence interval, 1.06-1.32) and decreased external rotation strength (odds ratio, 1.29/kg; 95% confidence interval, 1.14-1.48) were associated with supraspinatus tear. In patients with tear, age 60 yrs or older, female sex, and visual analog scale pain score were significantly associated with decreased abduction strength but tear size, fatty infiltration, and atrophy were not.Decreased abduction and external rotation strength were associated with supraspinatus tear in patients with shoulder pain. In this cohort, the abduction strength of patients with tears was influenced by demographic factors but not tear characteristics.
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Project description:We harvested the blood samples from rotator cuff tear patients with and without shoulder stiffness.Then, circulating exosomes were harvested, and the miRNAs content was analyzed with an aim to idenfity differentially expressed miRNAs.
2021-08-31 | GSE182896 | GEO
Project description:Massive tears of the rotator cuff can result in severe functional deficits due to loss of the axial force couple and effective fulcrum that the intact cuff normally provides. For massive, irreparable rotator cuff tears, especially in the setting of early to moderate degenerative changes, reverse total shoulder arthroplasty functions to modify the center of joint rotation, allowing the deltoid and intact components of the cuff to carry out shoulder function more effectively. Our preferred technique uses a standard open deltopectoral shoulder approach with a 3-dimensional glenoid baseplate model and a 135° prosthesis in an onlay configuration to reduce the risk of scapular notching and increase lateralization of the humerus.
| S-EPMC9244853 | biostudies-literature
Project description:BackgroundChronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.MethodsThis retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000-2013) between these two cohorts.ResultsThis study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36-1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04-2.06).ConclusionThe present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.
| S-EPMC6876882 | biostudies-literature