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Background Arthritic glenoids are susceptible to vault perforation during total shoulder arthroplasty. We investigated the effects of glenoid perforation and subsequent cement extrusion on the suprascapular nerve and on the glenoid cement infiltration. Methods Total shoulder arthroplasty using three-pegged glenoid components were performed on 10 cadaveric shoulders assigned to two groups (perforation vs. control). In perforation group, the glenoids were reamed eccentrically and intentionally perforated medially through the central peg hole, whereas control group received perpendicular reaming with no perforation. Bone cement was applied to each peg. Spatial relationship between the extruded cement and the suprascapular nerve, and the amount of cement infiltration into the cancellous bone were evaluated. Results In perforation group, five specimens were perforated anteriorly, and two posteriorly. In the two posteriorly perforated specimens, the suprascapular nerve was in direct contact with extruded cement at the spinoglenoid notch. Perforation group showed significantly less cement infiltration into the cancellous bone than control group ( p = 0.008). Conclusions Glenoid perforation decreases the volume of cement infiltration into the cancellous bone potentially compromising glenoid component fixation. Glenoid perforation tends to occur anteriorly rather than posteriorly in arthritic glenoids; however, if perforation occurs posteriorly, the suprascapular nerve is at immediate risk from the extruded cement. Level of evidence: Basic science study.

BackgroundWe report functional outcomes at six years in patients with varying degrees of fatty infiltration and atrophy of the rotator cuff muscles who have undergone anatomic total shoulder replacement.MethodsA retrospective analysis of case notes and magnetic resonance imaging scans of patients undergoing total shoulder replacement for primary glenohumeral arthritis was performed. Patients were grouped based upon their pre-operative magnetic resonance imaging findings for fatty infiltration, muscle area and tendinopathy. Post-operative functional outcomes were assessed using the Oxford Shoulder Score and Quick Disabilities of the Arm, Shoulder and Hand score. Post-operative measurements were made for active shoulder movements.ResultsThirty-two patients were reviewed at a mean of 67 months following surgery. All patients demonstrated fatty infiltration on their pre-operative magnetic resonance imaging scan. Muscle atrophy was shown in 22 patients and 12 had tendinopathy. Multiple regression analysis showed no correlation between the Oxford Shoulder Score (p = 0.443), the Quick Disabilities of the Arm, Shoulder and Hand score (p = 0.419), forward flexion (p = 0.170), external rotation (p = 0.755) and any of the pre-operative independent variables.DiscussionThe degree of fatty infiltration, muscle atrophy and tendinopathy of the rotator cuff muscle on pre-operative magnetic resonance imaging scanning is not associated with functional outcome score or functional movement at medium-term follow-up following total shoulder replacement.Level of evidenceIV

Background The Walch B3 glenoid is theorized to be a progression of the B2 biconcave pattern. The present study aimed to compare glenoid indices between B2 and B3 patterns. We hypothesized that the B3 pattern would have significantly worse retroversion, inclination and medialization. Methods Computed tomography scans of 50 patients with B2 erosions [mean (SD) age 68 (9) years; 25 male] and 50 patients with B3 erosions [mean (SD) age 72 (8) years; 22 males] were converted into three-dimensional reconstructions. Retroversion, inclination, medialization and humeral head subluxation were compared. Results The data demonstrated no statistically significant differences [mean (SD)] between groups when assessing retroversion: B2 = 21 (8)°, B3 = 24 (7)° ( p = 0.602); glenoid inclination: B2 = 9 (6)°, B3 = 8 (6)° ( p = 0.967); or medialization: B2 = 12 (4) mm, B3 = 14 (4) mm ( p = 0.384). In the B2 group, the mean (SD) humeral head subluxation was 80% (10%) according to the scapular plane and 55% (9%) according to the glenoid plane, which was not statistically different from the B3 group with a mean (SD) humeral head subluxation of 81% (7%) according to the scapular plane ( p = 0.680) and 54% (7%) according to the glenoid plane ( p = 0.292). Conclusions These results demonstrated no significant differences between the B2 and B3 erosion patterns, with respect to the glenoid indicies measured. The aetiology of the B3 glenoid cannot be completely explained by progression of wear in a B2 glenoid.

BackgroundCementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears.Methods41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs ( n = 21) and cuff-deficient shoulders ( n = 20). Patients were assessed using Oxford and Constant questionnaires, patient satisfaction, range of motion measurements and by radiography.ResultsMean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60° to 126° and 44° to 77° in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly.ConclusionsCSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarthritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation.

Background Shoulder osteoarthritis is characterized by progressive wear of the joint. To grade the degree of joint deformity, the Walch classification of glenohumeral arthritis has been proposed. This classification is based on five categories (A1, A2, B1, B2, C), although its validity has been questioned. Methods The present study proposed a new classification in three categories and compared it in terms of inter- and intra-observer reliability with the complete Walch classification and regroup classification (A, B, C). Results One hundred and sixteen computed tomography scans of patients with shoulder arthritis were revised by three independent evaluators and were classified according to the three classifications. The kappa statistics were identical between the new classification and the complete Walch classification (0.87 and 0.874). The regroup Walch classification (A, B, C) demonstrated higher reliability (kappa = 0.92). Most of the disagreement between observers was observed between glenoid B1 and B2. Discussion We report the first study on the Walch classification to use a large number of patients and challenge its reliability. According to the results obtained, there is no advantage in changing the classification. Therefore, surgeons must be aware of higher risk of mistake for glenoid type B. The superiority of a classification in terms of the prediction of surgical decisions and outcome has to be determined.

The development of degenerative joint disease in the young active patient is an increasing and difficult problem. In this review, evidence for the role of nonoperative and operative treatment strategies is assessed with the objective of establishing guidelines for management, and identifying areas for future research. Glucosamine and chondroitin supplements, as well as steroid and hyaluronan injections are probably useful early in the disease. Arthroscopic debridement, capsular release, and microfracture are temporizing measures that can provide pain relief and defer more invasive surgery. Attempts to restore the cartilage surface with osteochondral autologous transplants or autologous chondrocyte implantation may be suitable as second-line therapy for focal defects, although resurfacing of more extensive lesions with biological membranes has proven more difficult. Because prosthetic arthroplasty is relatively contraindicated in young patients, particularly contact athletes, the search for an ideal solution remains elusive, and more clinical and basic science research is needed.