PURPOSE OF THE STUDY In the last number of years, the anatomic hemiarthoplasty has gradually been pushed out of clinical practice by modern reverse shoulder arthroplasty (RSA) designs. This is due to the clear excellent functional results of RSAs in a wide spectrum of indication criteria. Nevertheless, RSAs have several possible complications that cannot occur in an anatomic hemiarthroplasty. In anatomic hemiarthoplasty, the importance of correct indication criteria and observing correct operative technique including soft tissue reconstruction is much more important than in RSA. Furthermore, there is a clear recent trend of increased use of humeral components fixed only in the proximal metaphyseal cancellous bone. Our aim was to summarise our six-year experience with the SMR® Stemless (LimaCorporate, Italy) system which is one of the most modern ones. MATERIAL AND METHODS Twenty cases of SMR® Stemless anatomic shoulder hemiarthroplasty performed between 2016 and 2021 were included in the study. All patients were followed up prospectively. The function was evaluated preoperatively and at the last follow-up. We evaluated the range of active elevation, classic Constant Score (CS) and pain level according to the visual analogue scale (VAS). Statistical evaluation was performed by using basic statistical methods and the statistical significance of the results was assessed with a paired t-test. Level of statistical significance was set at p= 0.01. RESULTS The mean follow-up in our cohort was 3.01 years (range 0.32-5.69, Median 2.82, SD 1.56) All cases were indicated for surgery due to primary osteoarthritis with a limitation of movement and pain. The mean postoperative CS was 85.7 (range 70-96, Median 86, SD 6.83). The mean active elevation postoperatively was 143° (range 100-170°, Median 150°, SD 20.76). Mean postoperative pain according to VAS was 1.05 (range 0-4, Median 1, SD 1.02). The mean preoperative elevation was 60.5° (range 30-100°, Median 65°, SD 18.83). After surgery the mean elevation increased to 143° (range 100-170°, Median 150°, SD 20.76). Statistical evaluation showed a statistically significant increase in the CS (41.7 preoperatively to 85.7 postoperatively), range of active elevation (60.5° preoperatively to 143° postoperatively) and a statistically significant decrease in pain (VAS 6.95 preoperatively to 1.05 postoperatively). We observed no cases of failure or loosening of the implant. A statistically significant increase in post-operative range of motion was demonstrated. DISCUSSION Most modern shoulder arthroplasty designs now include implants allowing for proximal humerus metaphyseal fixation in hemiarthroplasty and even RSA designs. The advantage of metaphyseal fixation without the use of a longer stem is clear. Notably, treatment of periprosthetic humeral fractures is simpler, extraction of the implant for any reason is easier and the preoperative anatomic position of the humeral head can be respected. As with any anatomic shoulder arthroplasty, the functional result is dependent on correct indication criteria, precise surgical technique, correct humeral head position and soft tissue reconstruction - primarily the rotator cuff. CONCLUSIONS Between 2016 and 2021, we performed 20 SMR® stemless shoulder hemiarthroplasties for primary osteoarthritis. The mean follow up was 3 years. The shoulder function improved significantly post-operatively in all patients. There were no cases of implant loosening or failure. Radiographic evaluation showed no implant loosening or change in implant position in the humeral metaphysis. Key words: shoulder joint replacement, reverse shoulder arthroplasty, SMR, stemless, total shoulder arthroplasty, shoulder hemiarthroplasty, EPOCA, wear.
- MeSH
- Arthroplasty, Replacement, Shoulder * adverse effects methods MeSH
- Hemiarthroplasty * adverse effects MeSH
- Humeral Head MeSH
- Humans MeSH
- Osteoarthritis * surgery MeSH
- Pain, Postoperative etiology MeSH
- Shoulder Joint * surgery MeSH
- Shoulder MeSH
- Range of Motion, Articular MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The purpose of this study is to remind of the specific features of diagnosis and therapy of dorsal dislocations of the glenohumeral joint to prevent frequent neglect or misdiagnosis during primary treatment. Also, we strived to present our experience and outcomes of posterior dislocation treatment by McLaughlin procedure and its modified version. MATERIAL AND METHODS We retrospectively evaluated 7 patients who had been treated at our department in the period 2015-2019 by McLaughlin procedure or its modification. The group consisted of 5 men and 2 women aged 33-79 years. In five patients, the dislocation occurred during an epileptic seizure, in two patients during an accident. The patients were treated by McLaughlin procedure or the Neer modification of McLaughlin procedure. The deltoideopectoral surgical approach was always used. Based on the preoperative planning, we decided, or intraoperatively changed our decision, as to whether mere transposition of the subscapularis is satisfactory or whether transposition of the lesser tuberosity to the defect, a bone graft and arthroplasty are necessary. Postoperatively, the operated limb was fixed for 6 weeks in neutral position, which was followed by rehabilitation. RESULTS We evaluated subjective and objective outcomes of the surgery, the radiological finding and in 2 patients also a control CT scan. The function of the shoulder was assessed using the Constant shoulder score and the OSIS scoring system. The resulting score: the mean OSIS was 55.7 points (92.8%) and the mean Constant score was 86.2 points (86.2%), which we regard as a very good result. All patients consider the surgery successful and are satisfied with the outcome. No patient reported recurrent dislocation. DISCUSSION When treating the posterior dislocation of the shoulder, vital is the shoulder reducibility and also the presence or the size of reverse Hill-Sachs defect. The transfer of the subscapularis tendon can be performed as an open procedure or arthroscopically. Inveterate irreducible posterior dislocation of the shoulder is quite a rare diagnosis, which is why even at our department the McLauglin procedure is performed in the order of units per year only. CONCLUSIONS The surgical solution of inveterate posterior dislocation of the shoulder is hardly ever uncomplicated. The reduction alone is often insufficient and some other way of shoulder stabilisation is necessary, often times addressing the humeral head defect. In our to date experience, the McLaughlin procedure or the Neer s modification is an elegant and safe method to treat posterior dislocation with a humeral head defect. The functional outcomes are very good and enable the patients to reengage in everyday activities. Thanks to this procedure shoulder joint arthroplasty can be avoided in younger patients. Nonetheless, in defects that are greater than 50% of the head the replacement is necessary. Due to frequently associated rotator cuff injuries, the most often procedure indicated by us is the reverse total shoulder replacement. Key words: posterior dislocation of the shoulder, reverse Hill-Sachs defect, McLaughlin procedure, Neer s modification.
- MeSH
- Adult MeSH
- Humeral Head diagnostic imaging surgery MeSH
- Fractures, Compression * MeSH
- Middle Aged MeSH
- Humans MeSH
- Shoulder Dislocation * diagnosis surgery MeSH
- Shoulder Joint * surgery MeSH
- Shoulder MeSH
- Retrospective Studies MeSH
- Range of Motion, Articular MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The purpose of the study is to share the first experience of authors with the management of glenoid defects by a bone graft in reverse total shoulder arthroplasty. MATERIAL AND METHODS Evaluation of 7 patients was conducted, who underwent reverse total shoulder arthroplasty at the authors' department. Due to the presence of glenoid bone defect, augmentation was performed by bone graft, obtained either as an autograft harvested from the humeral head of the patient intraoperatively or as an allograft from the femoral head from the bone tissue bank. In all the implantations, a glenoid component with an extra-long "revision" peg was used. Postoperative fixation was secured only by a shoulder brace. Limited rehabilitation was commenced on the first postoperative day, full rehabilitation 5 weeks after the surgery. RESULTS The total ASES Shoulder Score increased from the mean 39.8 preoperatively to 75.2 postoperatively. Also, the overall range of motion improved, with the preoperative ventral flexion increasing from the mean 65.5° to 135.2°, abduction increasing from 63.9° preoperatively to 127.7° postoperatively, and external rotation increasing from 27.4° preoperatively to 45.1° postoperatively. In the evaluated group, 2 complications were observed, namely 1 case of bone graft breakage intraoperatively, necessitating the harvesting of a new bone graft, and 1 case of postoperative paresthesia of the fourth and the fifth finger, which completely disappeared within 4 months after the surgery. In the group of followed-up patients, no loosening of endoprosthetic components has so far been reported. DISCUSSION Glenoid defect constitutes one of the problems that need to be dealt with by the surgeon during the reverse total shoulder arthroplasty, most often it is accompanied by glenoid retroversion. The basic approach to defect management is to use the eccentric reaming technique which is, however, limited by the size of glenoid retroversion and can also worsen the already present glenoid medialization, with all the resulting consequences. Another option is to use solid bone grafts to correct glenoid version and simultaneously to lateralize the glenoid component. Yet another option is to use the prefabricated glenoid augments that are, however, not commonly available in the Czech market. CONCLUSIONS The short-term clinical outcomes of patients, in whom glenoid defect was during the reverse total shoulder arthroplasty managed by bone grafts, are very good. Radiological signs of bone-to-graph incorporation were present in all the patients of the followed-up group. Nonetheless, for the sake of evaluation of this method, more patients shall be included in the group and a longer follow-up is needed for their evaluation. Key words: reverse total shoulder arthroplasty, glenoid bone loss, glenoid retroversion, augmented implant.
- MeSH
- Arthroplasty, Replacement, Shoulder methods MeSH
- Transplantation, Autologous MeSH
- Femur Head transplantation MeSH
- Humeral Head transplantation MeSH
- Transplantation, Homologous MeSH
- Humans MeSH
- Scapula surgery MeSH
- Shoulder Joint surgery MeSH
- Retrospective Studies MeSH
- Range of Motion, Articular MeSH
- Bone Transplantation methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- MeSH
- External Fixators utilization MeSH
- Fracture Fixation classification methods MeSH
- Humeral Fractures diagnostic imaging surgery MeSH
- Ankle Fractures diagnostic imaging surgery MeSH
- Humeral Head diagnostic imaging surgery injuries MeSH
- Humans MeSH
- Shoulder Dislocation * diagnostic imaging surgery MeSH
- Metacarpal Bones diagnostic imaging surgery injuries MeSH
- Finger Injuries surgery MeSH
- Hand Injuries diagnostic imaging surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Overall MeSH
A rare case of a fracture of the anatomical neck of the humerus associated with a posterior dislocation of the shoulder in a 43-year-old man is presented. It was managed by immediate surgery using locking plate osteosynthesis. The shoulder was immobilised for 5 weeks in a Gilchrist brace. The outcome was very good with a full range of motion and a stable shoulder at 1 year after injury, with no signs of avascular necrosis of the humeral head. The aetiology of this injury and possibilities of its treatment are discussed. Key words: shoulder dislocation, humeral fractures.
- MeSH
- Adult MeSH
- Humeral Fractures pathology physiopathology surgery MeSH
- Humeral Head pathology physiopathology surgery MeSH
- Bone Plates MeSH
- Humans MeSH
- Shoulder Dislocation physiopathology surgery MeSH
- Range of Motion, Articular MeSH
- Fracture Fixation, Internal instrumentation MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Kazuistika 36letého rekreačního potápěče, u kterého se rozvinula avaskulární nekróza hlavice humeru, s největší pravděpodobností po rychlé dekompresi. Tento případ kesonové nemoci s následným rozvojem osteonekrózy v oblasti hlavice proximálního humeru byl na našem pracovišti léčen artroskopicky s dobrým funkčním výsledkem.
Case report of 36 year old recreational scubadiver who developed avascular necrosis of humeral head following fast decompresion. In this case report we present well documentated case of avascular necrosis of humeral head in caisson disease. Patient was treated arthroscopicaly with satisfactory clinical result.
- MeSH
- Arthroscopy MeSH
- Decompression Sickness * etiology pathology MeSH
- Adult MeSH
- Humeral Head surgery pathology MeSH
- Humans MeSH
- Osteonecrosis * diagnosis etiology surgery radiography MeSH
- Diving adverse effects MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Úspěch kloubních náhrad závisí na více faktorech, mezi něž patří výběr pacienta, design endoprotézy, způsob fixace ke kostnímu lůžku, kvalita kosti a měkkých tkání, pečlivá operační technika, pooperační péče. Reverzní náhrada ramena se jeví jako vhodné operační řešení akutních i chronických postižení ramenního kloubu ve správně indikovaných případech. Její implantace je považována většinou chirurgů za obtížnější výkon než náhrady jiných kloubů. V práci autoři shrnují vlastní operační techniku ve dvou hlavních indikačních skupinách. Přehledně jsou popsány rozdíly v operační technice, včetně výhod a nevýhod v jednotlivých skupinách, a zdůrazněny důležité momenty operace. V každé skupině je popsáno polohování pacienta na operačním stole, vlastní technika, ale i pooperační péče. Závěrem jsou shrnuty v bodech zásady správné implantace reverzní náhrady ramena, zásadní kroky operace a čeho se vyvarovat, specifika implantace z traumatologické indikace.
The success of joint replacements depends on several factors, including patient selection, design of the prosthesis and the method of fixation to bone bed, quality of bone and soft tissue, meticulous surgical technique and postoperative care. Reverse shoulder replacement seems to be reliable surgical management of acute and chronic disability of the shoulder joint in appropriately selected cases. Its implantation is considered by most surgeons to be more difficult performance than those other joints. The authors summarize the surgical technique in two main indication groups. Clearly explains the differences in surgical technique, including advantages and disadvantages in each group and highlights important moments of surgery. In each group described positioning of the patient on the operating table, operative technique itself, but also post-operative care. In the conclusion summarizes the principles of implantation reverse shoulder replacement, essential steps in surgery and what to avoid, specificity implantation in trauma indication.
- Keywords
- plánovaná operace, traumatologická indikace, reverzní náhrada, zásady implantace,
- MeSH
- Arthroplasty, Replacement * methods instrumentation MeSH
- Shoulder Fractures surgery MeSH
- Humeral Head surgery MeSH
- Humerus surgery MeSH
- Humans MeSH
- Scapula anatomy & histology surgery MeSH
- Perioperative Care MeSH
- Shoulder Injuries MeSH
- Posture MeSH
- Joint Prosthesis * MeSH
- Shoulder Joint * surgery physiopathology MeSH
- Rotator Cuff surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Arthroplasty, Replacement * history methods instrumentation trends utilization MeSH
- Humeral Head surgery injuries MeSH
- Humans MeSH
- Shoulder Injuries MeSH
- Prostheses and Implants trends MeSH
- Shoulder Joint * anatomy & histology pathology growth & development MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Historical Article MeSH
Cíl studie: Naše retrospektivní multicentrická studie (3 centra daná pracovišti autorů) hodnotí 2leté výsledky léčby za použití PHILOS dlahy u pacientů s dislokovanými tří- nebo čtyřúlomkovými zlomeninami proximálního humeru. Materiál a metody: Do výsledků studie bylo zařazeno 120 pacientů (78 žen a 42 mužů ve věku 20 až 86 let). Pacienti s mnohočetnými poraněními a pacienti s patologickými zlomeninami byli ze studie vyřazeni. Celkem 81 pacientů bylo starších a celkem 39 bylo mladších 65 let. Operováno bylo z deltoidopektorálního přístupu v plážové poloze pacienta. Všichni pacienti byli kontrolováni ve 2 a 6 týdnech od operace a následně ve 3, 6, 9, 12 a 24 měsících. Funkční výsledek byl hodnocen za použití Constant skóre. Standardními rtg snímky na každé kontrole byla hodnocena pozice dlahy a postup hojení kosti. Funkční výsledek u pacientů starších 65 let byl porovnáván s výsledkem pacientů mladších 65 let. Výsledky: Průměrná doba sledování byla 24 měsíců (8 až 49). Celkem 117 pacientů bylo ke konci sledování primárně zhojeno klinicky a radiologicky. Průměrný čas do zhojení zlomeniny byl 11,5 týdne (7 až 20) od operace. Průměrné Constant skóre při poslední kontrole bylo 73,7. Průměrné Constant skóre u pacientů starších 65 let bylo 71,3 (36 až 80) u mladších 65 let 74,5 (42 až 96). Neprokázali jsme rozdíl ve funkčních výsledcích mezi mladšími (<65 let) a staršími (>65 let) pacienty. Použití PHILOS dlahy bylo v našem souboru spojeno s malým počtem komplikací (7,5 %) a minimální nutností následné reoperace. Diskuze: Na základě provedené retrospektivní studie se domníváme, že PHILOS dlaha přináší dobré výsledky v léčbě pacientů s dislokovanými tří- a čtyřúlomkovými zlomeninami proximálního humeru, zajišťuje adekvátní stabilitu úlomků s možností časné mobilizace bez ohrožení kostního hojení a garantuje dobrý funkční a klinický výsledek, při relativně nízkém riziku komplikací.
Purpose of the study: Our retrospective multicentric study evaluated 2-year results of using a PHILOS plate in treatment of displaced 3- and 4-part fractures of proximal humerus. Material and methods: 120 patients were included in the study (78 women, 42 men, aged 20 to 86). Patients with multiple injuries and patients with pathological fractures were excluded from the study. 81 patients were older than 65 years and 39 were younger. Deltoidpectoral approach was used in beach-chair position of the patient. All patients were examined 2 and 6 weeks following the surgery and then at 3, 6 ,9, 12 and 24 months. Functional outcome was evaluated using Constant score. Standard X-ray imaging was used to evaluate the position of the plate and progress of bone healing. Functional outcome of patients older than 65 years was compared to younger patients. Results: Average period of follow-up was 24 months (8 to 49). Total of 117 patients were primarily healed both clinically and radiologically speaking. Average healing time was 11,5 weeks (7 to 20) from the surgery. Average Constant score at final examination was 73,7. Average Constant score in patients older than 65 years was 71,3 (36 to 80), in younger patients it was 74,5 (42 to 96). We did not prove a statistically significant difference of functional outcome between younger (<65 years) and older patients (>65 years). Using a PHILOS plate was not associated with higher number of complications (7,5%). Discussion: Depending on our retrospective study we consider that using a PHILOS plate brings good results in treatment of patients with displaced 3-and 4-part fractures of proximal humerus, secures adequate stability with the possibility of early mobilisation without threatening the bone healing and guarantees a good functional and clinical outcome, with a relatively low risk of complications.
- MeSH
- Adult MeSH
- Humeral Fractures * diagnosis etiology surgery classification therapy MeSH
- Shoulder Fractures surgery therapy MeSH
- Humeral Head surgery MeSH
- Fracture Healing MeSH
- Internal Fixators * MeSH
- Bone Plates * MeSH
- Bone Screws MeSH
- Middle Aged MeSH
- Humans MeSH
- Osteoporosis surgery MeSH
- Postoperative Complications radiography MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Fracture Fixation, Internal * methods statistics & numerical data adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Evaluation Study MeSH
- Multicenter Study MeSH
