Early Experience of Reverse Total Shoulder Arthroplasty in a Public Hospital in Malaysia (original) (raw)
Related papers
2020
Background Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty. Methods Included were patients with unilateral cuff arthropathy (Hamada grades >=2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE’s for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shou...
International Journal of Orthopaedics Sciences, 2019
Reverse Shoulder Arthroplasty is done for Cuff Tear Arthropathy (CTA) and other indications. We hypothesize that CTA patients and patients with other indications will have differing functional outcome following RSA. We retrospectively studied 23 patients treated in our center between 2014 and 2017. The patients who were aged 60 and above with normal Deltoid function, normal cognition and a minimum follow-up of 12 months were included. Of the 23 patients, 16 had CTA and 7 had either a complex fracture dislocation, arthritis with malunion, excision arthroplasty or a chronic dislocation. We compared the functional outcome using Constant Shoulder Score at a mean follow up of 24.6 months. The post-operative scores were significantly higher in the CTA group, but the magnitude of functional improvement from preoperative status following RSA was either comparable (absolute change) or even better (percentage change) in non-CTA patients compared to CTA patients. There were no significant differences in the complication rates between the two groups. We conclude that one should not be discouraged by the lower values of functional scores in RSA done for non-CTA indications and be aware that the functional improvement following RSA in such complex cases is encouragingly better than that following RSA in CTA.
Early Follow-up of Reverse Total Shoulder Arthroplasty in Patients Sixty Years of Age or Younger
The Journal of Bone & Joint Surgery, 2013
Background: Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of shoulder arthritis and rotator cuff deficiency. Concerns over the longevity of the prosthesis have resulted in this procedure being reserved for the elderly. There are limited data in the literature with regard to outcomes in younger patients. We report on the early outcomes of RSA in a group of patients who were sixty years or younger and who were followed for a minimum of two years. Methods: A retrospective multicenter review of sixty-six patients (sixty-seven RSAs) with a mean age of 52.2 years was performed. The indications included rotator cuff insufficiency (twenty-nine), massive rotator cuff disorder with osteoarthritis (eleven), failed primary shoulder arthroplasty (nine), rheumatoid arthritis (six), posttraumatic arthritis (four), and other diagnoses (eight). Forty-five shoulders (67%) had at least one prior surgical intervention, and thirty-one shoulders (46%) had multiple prior surgical procedures. Results: At a mean follow-up time of 36.5 months, mean active forward elevation of the arm as measured at the shoulder improved from 54.6°to 134.0°and average active external rotation improved from 10.0°to 19.6°. A total of 81% of patients were either very satisfied or satisfied. The mean American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) score for pain improved from 40.0 to 72.4 and 7.5 to 3.0, respectively. The ability to achieve postoperative forward arm elevation of at least 100°was the only significant predictor of overall patient satisfaction (p < 0.05) that was identified in this group. There was a 15% complication rate postoperatively, and twenty-nine shoulders (43%) had evidence of scapular notching at the time of the latest follow-up. Conclusions: RSA as a reconstructive procedure improved function at the time of short-term follow-up in our young patients with glenohumeral arthritis and rotator cuff deficiency. Objective outcomes in our patient cohort were similar to those in previously reported studies. However, overall satisfaction was much lower in this patient population (81%) compared with that in the older patient population as reported in the literature (90% to 96%).
Journal of Shoulder and Elbow Surgery, 2015
Background: Anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are increasingly common procedures employed to treat arthritic conditions. Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff, concerns about RTSA persist because of variable complication rates and outcomes. Methods: This is a prospective, case-control study comparing outcomes and complications after TSA and RTSA. The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy. Average clinical follow-up was more than 2 years in both groups. Major complications included infection, periprosthetic fracture, instability, glenoid loosening, and need for revision surgery. Patient outcome measures included the American Shoulder and Elbow Surgeons score, pain visual analog scale score, and goniometer-measured range of motion. Plain radiographs were reviewed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA. Results: At 2 years, there were no differences in rate of major complications (TSA, 15%; RTSA, 13%; P ¼ .808) or revision surgeries (TSA, 11%; RTSA, 9%). Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups. TSA patients had greater external rotation than RTSA patients did (53 vs 38 ; P ¼ .001). Otherwise, forward flexion, abduction, and internal rotation were comparable in range of motion. Conclusions: TSA and RTSA have similar complication rates, need for revision, patient-reported outcomes, and range of motion at 2 years of follow-up. The use of side-by-side cohorts in this study allows standardized comparison between these 2 shoulder arthroplasty procedures.
Reverse shoulder arthroplasty. Part 1: Systematic review of clinical and functional outcomes
International Journal of Shoulder Surgery, 2015
Many factors influence the outcomes of reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and functional outcomes of RSA depending on the surgical approach, type of prosthesis, and indication for surgery through a comprehensive, systematic review. A literature search was conducted (1985 to June 2012) using PubMed, CINAHL, EBSCO-SPORTDiscus, and Cochrane Central Register of Controlled Trials. Levels I-IV evidence, in-vivo human studies (written in English with minimum of 2 years of follow-up and sample size of 10 patients) reporting clinical and/or functional outcomes after RSA were included. The outcomes were analyzed depending on the surgical approach, type of prosthesis (with medialized or lateralized center of rotation), or indication for surgery. A total of 35 studies were included involving 2049 patients (mean [SD] percentage of females, age, and follow-up of 71.6% [13.4], 71.5 years [3.7], and 43.1 months [18.8], respectively). Studies using deltopectoral approach with lateralized prostheses demonstrated greater improvement in external rotation compared with medialized prostheses with the same approach (mean 22.9° and 5°, respectively). In general, RSA for cuff tear arthropathy demonstrated higher improvements in Constant and American Shoulder and Elbow Society scores, and range of motion compared with revision of anatomic prosthesis, failed rotator cuff repair, and fracture sequelae. Lateralized prostheses provided more improvement in external rotation compared to medialized prostheses. Indications of RSA for cuff tear arthropathy demonstrated higher improvements in the outcomes compared with other indications. RSA demonstrated high patient's satisfaction regardless of the type of prosthesis or indication for surgery. Level of Evidence: Level IV.
Analysis of complications of reverse total shoulder arthroplasty
Joints
the aim of this study was to analyze complications of reverse total shoulder arthroplasty (RTSA) used to treat different shoulder diseases. from March 2000 to March 2013, 195 RTSA were implanted by the senior Author. The indications for reverse prosthesis surgery were secondary osteoarthritis (OA) in 49 cases, irreparable rotator cuff tear (RCT) in 48 cases, and complex humeral fractures in 75 cases, while 19 were patients requiring surgical revision for first prosthesis implant. We used different prostheses with different designs. the clinical and radiological results of all the patients were analyzed retrospectively at an average follow-up of 7 years. The cases were divided into four groups on the basis of the diagnosis and complications were classified as perioperative, postoperative, or late. The mean total Constant score improved from 28 to 69 points in the OA group; from 21 to 70.8 points in the irreparable RCT group, to 76.4 in the fracture group, and from 16.6 to 59.8 points...
What is a Successful Outcome Following Reverse Total Shoulder Arthroplasty?
The Open Orthopaedics Journal, 2010
Background:With variations in joint destruction, patient expectations and health status, it can be difficult to interpret outcomes following arthroplasty. The purpose of this study was to determine the relationships between different outcome indicators in 44 patients followed for two years after a reverse shoulder arthroplasty. Methods:Prospectively collected outcomes included the Constant-Murley score, Simple Shoulder Test (SST), range of motion (ROM), strength, patient satisfaction with their care and independent clinician case-review to determine global clinical outcome. Continuous outcomes were divided in two subgroups according to definitions of functional outcomes. Cohen’s kappa was used to evaluate agreement between outcomes. Pearson correlations were used to quantify interrelationships. Results:Although 93% of patients were substantially satisfied, fewer had good results on the other outcomes: 68% on global clinical outcome, 46% on SST and 73% on Constant-Murley score. The S...
Reverse versus anatomical shoulder arthroplasty in patients with intact rotator cuff
International Orthopaedics, 2020
Purpose The study objective was to compare the clinical results of reverse total shoulder arthroplasty (rTSA) and anatomical total shoulder arthroplasty (aTSA) in patients with osteoarthritis and intact rotator cuff. We hypothesised that the clinical results using rTSA would be comparable with those obtained with aTSA in this group of patients. Methods The study included 51 patients with shoulder osteoarthritis and intact rotator cuff who underwent rTSA or aTSA. The range of motion, Constant-Murley score and strength in external rotation were recorded pre-operatively and at the two year follow-up. Subjective post-operative results were measured using the subjective shoulder value (SSV) score and a satisfaction questionnaire. Results The post-operative improvement was significant in both groups, subjectively and concerning all parameters of the Constant-Murley score. Post-operatively, no significant difference was noted between the two groups for active anterior elevation (AAE), active external rotation (ER), internal rotation (IR) or Constant-Murley score (67 ± 12 in the rTSA group vs 71 ± 11 in the aTSA group). An exception was the Constant-Murley range of motion sub-score, which was better in the aTSA group (p = 0.028). No significant complications necessitating revision surgery were encountered. Discussion Our findings are consistent with previous studies showing good results of rTSA with shoulder osteoarthritis and intact rotator cuff with a good restoration of the IR, similar to that obtained with aTSA. Conclusion The rTSA is a valid option for shoulder osteoarthritis and intact rotator cuff in older adult patients.
Impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty
Journal of Shoulder and Elbow Surgery, 2011
Background: Our purpose was to evaluate the outcome of the Delta reverse shoulder prosthesis (DePuy France, Saint Priest, France) in a consecutive series of 68 shoulders and perform a comparison of patients with and without previous shoulder arthroscopy for cuff tear reconstruction. Patients and methods: We assessed 68 shoulders in 66 patients (36 women and 30 men) with a mean age of 66 years (range, 53-84 years), first preoperatively and then at a minimum of 2 years' follow-up, using the Constant score for pain; Constant Shoulder Score; Oxford Shoulder Score; University of California, Los Angeles shoulder rating scale; and Disabilities of the Arm, Shoulder and Hand score. Any complications were assessed according to Goslings and Gouma. Results: We report statistically significant improvements of all obtained scores at a mean follow-up of 42 months (range, 24-96 months) in both groups. Significant outcome differences between 29 patients with previous shoulder arthroscopy for cuff tear reconstruction and 39 patients without previous shoulder arthroscopy were not observed. In total, 8 complications occurred: 1 nerve lesion, 3 cases of loosening of the humeral stem, and 4 cases of luxation of the glenoid component. Conclusion: We conclude that reverse total shoulder arthroplasty with the Delta prosthesis is significantly beneficial in terms of less shoulder pain, greater stability, and gain in range of motion without this beneficial effect being significantly weakened by previous insufficient shoulder arthroscopy for cuff tear reconstruction. We believe that previous arthroscopic cuff tear reconstruction should therefore be included in the treatment algorithm. Level of evidence: Level III, Case-Control Study, Treatment Study.