Reverse shoulder arthroplasty without subscapularis repair for the treatment of proximal humeral fractures in the elderly

Grassi, Federico Alberto; Zorzolo, I.

doi:10.1007/s12306-014-0321-4

Cited by 43 publications

(15 citation statements)

References 20 publications

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“…Reverse Total Shoulder Arthroplasty (RTSA) is primarily indicated for the treatment of rotator cuff tear arthropathy or massive rotator cuff tears that are deemed irrepairable 9,15,17,20 . Despite these indications, it is often possible to repair portions of the subscapularis and infraspinatus/teres minor; however, there is disagreement regarding whether these tissues should be repaired as their effects on RTSA biomechanics and outcomes remain unclear 6,7,10,16 . Additionally, the indications for RTSA have expanded to include surgical conditions with an intact rotator cuff, such as the management of A2, B2, or C glenoid erosions 8,22 .…”

Section: Introductionmentioning

confidence: 99%

The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty

Giles

Langohr

Johnson

et al. 2016

Journal of Shoulder and Elbow Surgery

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Introduction: There is disagreement regarding whether, when possible, the rotator cuff should be repaired in conjunction with reverse total shoulder arthroplasty (RTSA). Therefore, we investigated the effects of rotator cuff repair in RTSA models with varying magnitudes of humeral and glenosphere lateralization (HLat & GLat). Methods: Six fresh-frozen cadaveric shoulders were tested on a validated in-vitro muscle driven motion simulator. Each specimen was implanted with a custom adjustable, load-sensing RTSA after creation of a simulated rotator cuff tear. The effects of 4 RTSA configurations (0&10mm x HLat & GLat) on deltoid force and joint load during abduction with/without rotator cuff repair were assessed. Results: Increasing HLat and GLat significantly affected deltoid force (-2.5±1.7%BodyWeight (%BW), p=0.016 & +7.7±5.6%BW, p=0.016). Rotator cuff repair interacted with HLat & GLat (p=0.005) such that with no HLat, GLat increased deltoid force without cuff repair (8.1±5.1%BW, p=0.012) and this effect was increased with cuff repair (12.8±7.8%BW, p=0.010), but addition of HLat mitigated this effect. Rotator cuff repair increased joint load (+11.9±5.1%BW, p=0.002), as did GLat (+13.3±3.7%BW, p<0.001), and these interacted such that increasing GLat markedly increases cuff repair's negative effects (9.4±3.2%BW, p=0.001 vs 14.4±7.4%BW, p=0.005). Conclusion: Rotator cuff repair, especially in conjunction with GLat, produces an antagonistic effect that increases deltoid and joint loading. The long-term effects of this remain unknown; however, combining these factors may prove undesirable. HLat improves joint compression through deltoid wrapping and increases the deltoid's mechanical advantage. Therefore, it could be used in place of rotator cuff repair, thus avoiding its complications.

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Section: Introductionmentioning

confidence: 99%

The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty

Giles

Langohr

Johnson

et al. 2016

Journal of Shoulder and Elbow Surgery

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“…Another key point, in order to avoid a secondary instability, is to reattach the lesser tuberosity, especially in cases of OA and RCT (13), although in the Literature some studies reported a good results without subscapularis reattachment (14). We had 3 cases of perioperative humeral shaft fracture treated successfully with cerclages.…”

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confidence: 99%

Analysis of complications of reverse total shoulder arthroplasty

Russo

Rotonda²,

Ciccarelli

et al. 2015

Joints

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“…Some humeral prosthesis have proximal ingrowth potential to control fragments; others are coated with hydroxyapatite or have windows in the proximal stem for better bone grafting from humeral head to enhance tuberosity integration [10]. Few studies have investigated the role of lesser tuberosity-subscapularis repair with controversial results [40-42]. A deficient subscapularis predisposes the prosthesis to anterior instability, placing additional demands and requiring attention.…”

Section: Available Treatments Of Proximal Humeral Fracturesmentioning

confidence: 99%

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

Gigis¹,

Nenopoulos²,

Giannekas³

et al. 2017

TOORTHJ

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Background:Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.Methods:We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.Results:Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.Conclusion:Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

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Reverse shoulder arthroplasty without subscapularis repair for the treatment of proximal humeral fractures in the elderly

Cited by 43 publications

References 20 publications

The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty

The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty

Analysis of complications of reverse total shoulder arthroplasty

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

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