Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up

Autor: Eldho Paul, Nathan Kirzner, Ash Moaveni
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
musculoskeletal diseases
medicine.medical_specialty
Shoulder
lcsh:Diseases of the musculoskeletal system
medicine.medical_treatment
Scapular fracture
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Notching
lcsh:Orthopedic surgery
medicine
Humans
Orthopedics and Sports Medicine
Prospective Studies
Aged
Retrospective Studies
Aged
80 and over
030222 orthopedics
Stress fractures
business.industry
Scapular notching
Retrospective cohort study
030229 sport sciences
Middle Aged
medicine.disease
Arthroplasty
Functional outcomes
Surgery
lcsh:RD701-811
Treatment Outcome
Reverse shoulder arthroplasty
Arthroplasty
Replacement
Shoulder
Orthopedic surgery
Cohort
Female
lcsh:RC925-935
business
BIO-RSA
Cohort study
Follow-Up Studies
Research Article
Scapular insufficiency fractures
Zdroj: Journal of Orthopaedic Surgery and Research, Vol 13, Iss 1, Pp 1-7 (2018)
Journal of Orthopaedic Surgery and Research
DOI: 10.1186/s13018-018-0955-2
Popis: Background Bony increased-offset reverse shoulder arthroplasty (BIO-RSA) may address issues such as inferior scapular notching, prosthetic instability and limited postoperative shoulder rotation; all of which have been reported with the standard RSA and attributed to the medialized design. We hypothesised that this lateralization may increase the rate of scapular stress fractures. Methods A retrospective review of prospectively collected data was performed on patients who had undergone a RSA between January 2013 and October 2016. A comparative cohort study was designed to compare patients with a standard Grammont-style RSA to those with a BIO-RSA using the same implant. Functional outcome was measured by the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the Subjective Shoulder Value (SSV), the Western Ontario Osteoarthritis of the Shoulder (WOOS) index and pain scores. Radiographs were obtained for all patients and examined for the presence of scapular fracture as well as scapular notching and graft incorporation. Results A total of forty patients (22 patients in the standard RSA cohort and 18 with BIO-RSA) were included in the study. Patient characteristics (including age, gender, length of follow-up, dominant side and osteoporosis) were similar in both groups (p > 0.05). The average postoperative follow-up was 20 months (range 12–48 months). There was bone graft incorporation in all BIO-RSA patients at the final radiological follow-up, with no evidence of graft resorption. The overall scapular stress fracture rate was 12.5% (9.1% in the standard RSA and 16.7% in the BIO-RSA). The rates were similar in both cohorts (p = 0.64). All fractures were managed conservatively. To determine whether the presence of a scapular stress fracture had an influence on outcomes, the cohort was divided into cases with and without fracture. Patients with a stress fracture had worse ASES (p = 0.028) and WOOS (p = 0.048) scores. Additionally, osteoporosis was present more commonly in the fracture group (80% vs 17%; p = 0.01). A statistically significant difference was identified when comparing the rates of scapular notching between standard RSA and BIO-RSA cohorts (68% vs 33%; p = 0.028). Furthermore, when notching was present, significantly worse outcome scores were present in all outcome measures (p
Databáze: OpenAIRE
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