Reverse Total Shoulder Arthroplasty without Bone-Grafting for Severe Glenoid Bone Loss in Patients with Osteoarthritis and Intact Rotator Cuff
| Autor: | Uma Srikumaran, Edward G. McFarland, Gazi Huri, Steve A. Petersen, Yoon Suk Hyun |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
Reoperation musculoskeletal diseases medicine.medical_specialty Joint Prosthesis medicine.medical_treatment Population Osteoarthritis Bone grafting Prosthesis Rotator Cuff 03 medical and health sciences 0302 clinical medicine Notching medicine Humans Orthopedics and Sports Medicine Rotator cuff Range of Motion Articular education Aged Retrospective Studies Aged 80 and over 030222 orthopedics education.field_of_study Shoulder Joint business.industry 030229 sport sciences General Medicine Middle Aged medicine.disease Arthroplasty Surgery Radiography Scapula Treatment Outcome medicine.anatomical_structure Arthroplasty Replacement Shoulder Female Range of motion business |
| Zdroj: | Journal of Bone and Joint Surgery. 98:1801-1807 |
| ISSN: | 1535-1386 0021-9355 |
| DOI: | 10.2106/jbjs.15.01181 |
| Popis: | Background: Treating shoulders with osteoarthritis, an intact rotator cuff, and substantial glenoid bone loss is challenging. One option is reaming the glenoid flat and inserting a reverse prosthesis. This study reports the subjective, objective, and radiographic results of reverse total shoulder arthroplasty (RTSA) in this population. Methods: We retrospectively reviewed 42 consecutive patients (23 women; mean age, 71 years [range, 53 to 89 years]) with primary glenohumeral osteoarthritis, intact rotator cuffs, and Walch type-A2 (n = 19), B2 (n = 5), or C glenoids (n = 18) who had undergone a total of 42 RTSAs with glenoid reaming without bone-grafting between 2008 and 2013 (mean follow-up, 36 months [range, 24 to 66 months]). All patients were evaluated before and after surgery subjectively (using a visual analog scale for pain and 5 shoulder-specific outcome instruments), objectively (with goniometric examination of shoulder range of motion), and radiographically (to assess baseplate loosening and degree of scapular notching). Results: One baseplate (2%) failed, requiring revision surgery. There were no other signs of baseplate loosening in any patient at the last follow-up. Preoperatively to postoperatively, pain improved significantly (p < 0.001), as did all patient-reported outcome measures and the following range-of-motion parameters (p ≤ 0.001): active abduction, active flexion, and active external rotation with the arm elevated 90°. Eight (19%) of the patients had notching. Conclusions: RTSA without bone-grafting and with medialization of the baseplate in patients with osteoarthritis and severe glenoid bone loss resulted in significant improvement in pain and function with reliable short-term implant survivorship and may be a good alternative to anatomical TSA. Longer follow-up is needed to determine the relative advantages and disadvantages. This was an “off-label” indication for this device. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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