Mid- to long-term follow-up of shoulder arthroplasty for primary glenohumeral osteoarthritis in patients aged 60 or under

Neyton, Lionel; Kirsch, Jacob M.; Collotte, Philippe; Collin, Philippe; Gossing, Louis; Chelli, Mikaël; Walch, Gilles

doi:10.1016/j.jse.2019.03.006

Cited by 62 publications

(34 citation statements)

References 44 publications

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“…Also, the lower activity levels associated with older age may be protective of secondary rotator cuff tears after TSA, as some studies have demonstrated that younger, more active patients are actually at higher risk of requiring revision arthroplasty. 3,6,12,17,19,22,24,30 We did find that there was a progression of anterior and superior humeral head subluxation rates between first postoperative radiographs and final radiographs. These radiographic findings may be indicative of anterosuperior rotator cuff thinning or dysfunction over time.…”

Section: Discussionmentioning

confidence: 68%

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Jensen

Tangtiphaiboontana

Marigi

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The relative indications of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) continue to evolve. Some surgeons favor RSA over TSA for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff due to fear of a postoperative (secondary) rotator cuff tear in this age group. However, RSA is associated with unique complications and a worse functional arc of motion compared with TSA. Therefore, it is important to understand the clinical outcomes and rates of revision surgery and secondary rotator cuff tears in elderly patients undergoing TSA. Methods: Between January 1, 2010, and December 31, 2017, 377 consecutive TSAs were performed for primary GHOA in 340 patients 70 years of age or older. The mean age at surgery was 76.2 years (standard deviation [SD], 4.9). Clinical evaluation included pain, motion, and American Shoulder and Elbow Surgeons score. Radiographs were reviewed for preoperative morphology and postoperative complications. All complications and reoperations were recorded. The average clinical follow-up time was 3.3 years (SD, 2.0). Statistical analyses were performed, and Kaplan-Meier implant survival estimates were calculated. For all analyses, a P value <.05 was considered statistically significant. Results: The mean pain visual analog scale and American Shoulder and Elbow Surgeons score at the final follow-up were 1.6 (SD, 2.2) and 78.0 (SD, 17.8), respectively. Forward elevation and external rotation increased from 96 (SD, 30 ) and 26 (SD, 20 ) preoperatively to 160 (SD, 32 ) and 64 (SD, 26 ) postoperatively (P < .001 for each). The percentage of patients who had internal rotation to L5 or greater increased from 24.8% preoperatively to 71.8% postoperatively (P < .001). Revision surgery was performed in 3 shoulders (0.8%), and the 5-year implant survival estimate was 98.9% (95% confidence interval: 97.3%-100%). There were 3 medical (0.8%), 10 minor surgical (2.7%), and 5 major surgical (1.3%) complications. No shoulder had radiographic evidence of humeral component loosening, whereas 7 (2%) had evidence of some degree of glenoid component loosening. In total, there were 5 secondary rotator cuff tears (1.3%), of which 2 (0.5%) required revision surgery. Conclusion: Elderly patients with primary GHOA and an intact rotator cuff have excellent clinical and radiographic outcomes after This study was reviewed and approved by our institutional review board (#12-007498).

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Section: Discussionmentioning

confidence: 68%

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Jensen

Tangtiphaiboontana

Marigi

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…Herkömmliche Strategien, wie exzentrisches Fräsen, Verzicht auf ein glenoidales Implantat mit lediglich Durchführung einer Hemiarthroplastik und konfektionierte augmentierte Implantate stoßen mit zunehmender Komplexität des Glenoiddefekts dabei an ihre Grenzen bzw. sind mit schlechteren Ergebnissen vergesellschaftet [16,22,24,25,27,33,37]. Der Aufbau komplexer Glenoiddefekte durch Knochentransplantate birgt das Risiko von Graftresorption und Implantatversagen, so dass unter Umständen ein zweizeitiges Vorgehen bei mangelnder gleichzeitiger Verankerungsmöglichkeit der Endoprothese notwendig wird [7,13,15,19,20,21,34,36].…”

Section: Zusatzmaterials Onlineunclassified

Patientenindividuelle glenoidale Implantate in der Schulterendoprothetik

Petermann

Agneskirchner

2021

Arthroskopie

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ZusammenfassungDie Behandlung ausgeprägter glenoidaler Knochendefekte ist herausfordernd. Patientenindividuelle glenoidale Implantate stellen diesbezüglich ein neues Verfahren dar, welches mit enormen potenziellen Vorteilen behaftet ist. Die eigenen Erfahrungen zeigen, dass mit dieser Technologie einerseits der glenoidale Knochendefekt reproduzierbar wiederherzustellen ist und andererseits eine stabile Verankerung und eine hochpräzise Implantatpositionierung entsprechend der präoperativen Planung erzielt werden kann. Dies stellt sich besonders im Vergleich zu Alternativverfahren, wie der knöchernen Glenoidaugmentation, als substanzieller Vorteil der Technik für diese häufig hochdefizitären und anspruchsvollen Situationen dar. Nach Durchführung einer Computertomographie (CT) der Schulter wird präoperativ das individuelle Implantatdesign dreidimensional detailliert computergestützt geplant. Von zentraler Bedeutung für die korrekte und planungsgetreue Positionierung des definitiven Implantats während der Operation ist eine präzise Einbringung eines Kirschner-Drahts mittels PSI(„patient specific instrumentation“)-Guide.. Nach Fixation der glenoidalen Komponente kann diese mit Standardimplantaten des jeweiligen Systems kombiniert werden. Die aktuell vorhandene Literatur ist ermutigend und zeigt, dass kurzfristig signifikante klinische Erfolge mit dem Verfahren erzielbar sind. Weitere Forschung im Sinne von biomechanischen Untersuchungen und längeren Nachuntersuchungszeiträumen ist wünschenswert, um die Wertigkeit des Verfahrens weiter zu präzisieren.

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“…TSA is considered the gold standard in patients with severe glenohumeral osteoarthritis who have failed nonoperative treatment, as it results in good reproducible outcomes. 1,3,6,15,20,22 However, shoulder joint replacement may not be the optimal management strategy for younger patients with higher demands and longer life expectancy, and younger patient age has been reported as a risk factor for revision surgery after TSA. 2,3,20 Brewley et al 2 demonstrated that patients younger than 65 years had a 3.4-fold increased risk for revision surgery after TSA.…”

Section: Discussionmentioning

confidence: 99%

“…Glenohumeral osteoarthritis in the young and active patient is a challenging abnormality to treat. Total shoulder arthroplasty (TSA) is often referred to as the gold standard, 3,15 as it has been shown to result in reproducible and satisfactory outcomes. 1,6,20,22 However, younger patients often have higher activity levels, greater function, and higher expectations, which may raise concerns regarding implant longevity.…”

mentioning

confidence: 99%

Total Shoulder Arthroplasty After Previous Arthroscopic Surgery for Glenohumeral Osteoarthritis: A Case-Control Matched Cohort Study

et al. 2021

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Background: When comprehensive arthroscopic management (CAM) for glenohumeral osteoarthritis fails, total shoulder arthroplasty (TSA) may be needed, and it remains unknown whether previous CAM adversely affects outcomes after subsequent TSA. Purpose: To compare the outcomes of patients with glenohumeral osteoarthritis who underwent TSA as a primary procedure with those who underwent TSA after CAM (CAM-TSA). Study Design: Cohort study; Level of evidence, 3. Methods: Patients younger than 70 years who underwent primary TSA or CAM-TSA and were at least 2 years postoperative were included. A total of 21 patients who underwent CAM-TSA were matched to 42 patients who underwent primary TSA by age, sex, and grade of osteoarthritis. Intraoperative blood loss and surgical time were assessed. Patient-reported outcome (PRO) scores were collected preoperatively and at final follow-up including the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), visual analog scale, and patient satisfaction. Revision arthroplasty was defined as failure. Results: Of 63 patients, 56 of them (19 CAM-TSA and 37 primary TSA; 88.9%) were available for follow-up. There were 16 female (28.6%) and 40 male (71.4%) patients with a mean age of 57.8 years (range, 38.8-66.7 years). There were no significant differences in intraoperative blood loss ( P > .999) or surgical time ( P = .127) between the groups. There were 4 patients (7.1%) who had failure, and failure rates did not differ significantly between the CAM-TSA (5.3%; n = 1) and primary TSA (8.1%; n = 3) groups ( P > .999). Additionally, 2 patients underwent revision arthroplasty because of trauma. A total of 50 patients who did not experience failure (17 CAM-TSA and 33 primary TSA) completed PRO measures at a mean follow-up of 4.8 years (range, 2.0-11.5 years), with no significant difference between the CAM-TSA (4.4 years [range, 2.1-10.5 years]) and primary TSA (5.0 years [range, 2.0-11.5 years]) groups ( P = .164). Both groups improved significantly from preoperatively to postoperatively in all PRO scores ( P < .05). No significant differences in any median PRO scores between the CAM-TSA and primary TSA groups, respectively, were seen at final follow-up: ASES: 89.9 (interquartile range [IQR], 74.9-96.6) versus 94.1 (IQR, 74.9-98.3) ( P = .545); SANE: 84.0 (IQR, 74.0-94.0) versus 91.5 (IQR, 75.3-99.0) ( P = .246); QuickDASH: 9.0 (IQR, 3.4-27.3) versus 9.0 (IQR, 5.1-18.1) ( P = .921); SF-12 PCS: 53.8 (IQR, 50.1-57.1) versus 49.3 (IQR, 41.2-56.5) ( P = .065); and patient satisfaction: 9.5 (IQR, 7.3-10.0) versus 9.0 (IQR, 5.3-10.0) ( P = .308). Conclusion: Patients with severe glenohumeral osteoarthritis who failed previous CAM benefited similarly from TSA compared with patients who opted directly for TSA.

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Mid- to long-term follow-up of shoulder arthroplasty for primary glenohumeral osteoarthritis in patients aged 60 or under

Cited by 62 publications

References 44 publications

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Patientenindividuelle glenoidale Implantate in der Schulterendoprothetik

Total Shoulder Arthroplasty After Previous Arthroscopic Surgery for Glenohumeral Osteoarthritis: A Case-Control Matched Cohort Study

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