Search

Introduction Reverse total shoulder arthroplasty (RTSA) is a widely recognized treatment to reduce pain and improve shoulder function for patients in various disease stages of cuff tear arthropathy (CTA). However, it remains unclear whether outcomes after RTSA depend on the preoperative stage of CTA. Therefore, this study evaluated whether the Hamada classification influences midterm clinical outcomes after RTSA. Materials and methods In this multicenter observational study, patients underwent inverted bearing RTSA for massive rotator cuff tears or CTA. Shoulders were grouped into those with (Hamada grades 4a, 4b, and 5) and those without (Hamada grades 1, 2, and 3) glenohumeral arthritis. Clinical outcomes, including range of motion, Constant score, American Shoulder and Elbow Surgeons score, and visual analog scale for pain and satisfaction, were determined preoperatively and at 24 and > 30 months. All complications were recorded, and survival free from any implant component revision was calculated. Results Overall, 202 patients (211 shoulders) were treated with RTSA at a mean age of 75.8 ± 6.6 years (range 41.9–91.6 years). Of these, 144 patients (151 shoulders) were available for a mean follow-up of 79.9 ± 24.7 months (range 30.2–132.3 months). No significant between-group differences were found for clinical outcomes at 24 and > 30 months (P > 0.05). Furthermore, the Hamada classification did not correlate with clinical outcomes at 24 (P = 0.98) and > 30 months (P = 0.29). Revision-free implant component survival was similar between groups (P = 0.17). Postoperative complications were found in 11 shoulders, of which 10 required revision. Conclusions Inverted bearing RTSA was found to be an effective treatment with similarly good midterm clinical outcomes, similar revision rates, and high implant survival rates in every stage of massive rotator cuff tears. Overall, the preoperative Hamada classification did not influence clinical outcomes or complications after RTSA.

Introduction This study documents 2-year clinical and radiographic results following reversed total shoulder arthroplasty using a novel prosthesis with inverted bearing materials (polyethylene glenoid; metal humeral component). This design was intended to avoid massive PE abrasion on the humeral side. Therefore, we predicted a lack of subsequent osteolysis-induced exacerbation of scapular notching, and because of other design features and modified operating technique a reduced notching rate. Materials and methods An ongoing, prospective, international, multicenter study of patients implanted with a novel prosthesis at six European centers. The current analysis presents 2-year follow-up data (patients operated between December 2007 and July 2009). Clinical evaluation tools comprised the Constant–Murley score (CS), the American Shoulder and Elbow Surgeon score, range of motion, and a visual analog scale to assess pain and satisfaction. Radiographs were evaluated for notching and radiolucent lines. Any complications were recorded. Results In total, 113 prostheses (113 patients) with a mean follow-up of 27.6 (±3.6) months were analyzed. CS increased from 22.5 (±13.7) to 65.3 (±14.9) points (p = 0.06). Inferior scapular notching (only grade 1 and 2) was identified in 20.5 % of patients, with no signs of PE-induced osteolysis. 4.4 % of patients experienced an implant-related complication. Conclusions Inversion of the materials led to another type of notching with no signs of PE-induced osteolysis and no increase in the risk of short-term complications. Clinical results were comparable with other prostheses. Mid- to long-term results are required before any firm conclusions on clinical outcome and survival can be drawn.

Les recidives de syndrome du canal carpien sont rares (0,3–19 %). Le traitement de choix est la neurolyse a ciel ouvert associe a un traitement etiologique et a un lambeau de protection du nerf. La neurolyse endoscopique selon la technique d’âgee a fait ses preuves dans le traitement du syndrome du canal carpien. Le but de cette etude est d’evaluer la faisabilite et les resultats du traitement des recidives du canal carpien grâce a cette technique. Nous avons traite vingt et un patients presentant une recidive de compression du nerf median au poignet par simple section du LAAC sous endoscopie. Tous les patients presentaient une recidive apres une periode de guerison complete de 3 mois minimum. Un EMG confirmait l’augmentation des latences et une diminution des vitesses de conduction du nerf median. Un examen clinique complet, une echographie ou une IRM etaient systematiquement realises. Tous les patients ont ete revus cliniquement avec un recul moyen de 16,71 mois. L’âge moyen est de 64,2 ans (31–86), 86 % etaient atteints du cote dominant, et 61 % avaient une activite manuelle. L’intervention initiale etait sous endoscopie dans 10 cas, a ciel ouvert dans 9 cas et sous Knife-light dans 2 cas. Le delai entre les deux chirurgies etait de 105 mois (9–248). A la revision, le score QuickDash moyen etait de 16,74/100, le Carpal Tunnel Syndrome Symptom Severity Score de 16,19 et le Carpal Tunnel Syndrome Functional Status Score de 12,8. Dix-huit patients etaient satisfaits. Deux patients ressentaient toujours des paresthesies diffuses. Il persistait une hypoesthesie pulpaire dans 3 cas. Vingt-trois pour cent decrivait une perte de force importante. On denombre 3 echecs + une algoneurodystrophie, une patiente presentant un syndrome persistant n’ayant pas ete amelioree. Un patient, partiellement ameliore, presentait aussi une souffrance radiculaire. La technique d’âgee peut aussi etre utilisee dans les recidives du canal carpien. Dans ces cas elle reste une technique efficace et fiable, beaucoup moins delabrante et permettant une recuperation rapide. Elle necessite une selection rigoureuse des patients. Il doit s’agir de recidives vraies, sans etiologie evidente et sans troubles trophiques. Un bilan preoperatoire comprenant un examen clinique, un EMG et un bilan iconographique est necessaire. Enfin, une information rigoureuse et documentee du patient sur les risques de conversion peroperatoire et d’echec est indispensable.