Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Nov 2004
Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger.
Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. ⋯ However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.
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J Shoulder Elbow Surg · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialContinuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results.
Shoulder surgery is often associated with severe postoperative pain. Previous results in which single or continuous subacromial infiltration of local anesthetics was used as a method of postoperative pain relief have been contradictory. This study was initiated to evaluate the postoperative analgesic effect of a subacromial continuous 0.25% bupivacaine infusion at a rate of 6 mL/h after elective open shoulder surgery. ⋯ No major technical or pharmacologic side effects were noticed, and the indwelling pain catheter was well tolerated by all patients. There was no statistically significant difference (P < .05) either in total cumulative morphine consumption microg/48 h (73.2 +/- 43.1 vs 60.9 +/- 35.9) or in subjective pain perception 10-point visual analog scale (3.2 +/- 1.4 vs 3.1 +/- 1.5) between the two study groups. The continuous subacromial infiltration of 0.25% bupivacaine at a rate of 6 mL/h is concluded to be ineffective in providing pain relief supplementary to patient-controlled analgesia after open rotator cuff repair and acromioplasty surgery.
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J Shoulder Elbow Surg · Nov 2004
Conversion of painful hemiarthroplasty to total shoulder arthroplasty: long-term results.
The purpose of this study was to evaluate the outcome after conversion of painful hemiarthroplasty to total shoulder arthroplasty (TSA). Sixteen consecutive patients who underwent revision TSA for failed humeral head replacement (HHR) at our institution from 1988 to 2000 were evaluated. The mean interval from the time of HHR to revision TSA was 3.5 years (range, 11 months to 10.5 years). ⋯ The mean visual analog pain score was 2.4 (range, 0-6) out of 10. Evidence of posterior glenoid erosion was found in 64% (7/11) of these patients. On the basis of the complexity of the surgery and the 47% unsatisfactory rate, we conclude that revision of a failed HHR to a TSA is a salvage procedure whose results are inferior to those of primary TSA.
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J Shoulder Elbow Surg · Nov 2004
Comparative StudyPositron emission tomography imaging of musculoskeletal tumors in the shoulder girdle.
The shoulder girdle presents unique features for the preoperative planning of musculoskeletal tumors. This is the first trial to evaluate positron emission tomography (PET) analysis for preoperative planning in shoulder girdle tumors. Fifty-two patients were examined with fluorine 18 fluoro-2-deoxy-D-glucose (FDG)-PET and/or alpha-methyltyrosine (FMT)-PET. ⋯ The mean SUVs for malignant tumors were significantly higher than those for benign lesions. However, a useful cutoff SUV was not found in either FDG- or FMT-PET for differentiating malignant from benign tumors from receiver operating characteristic curve analysis. SUVs on FDG- and FMT-PET may merely be limited to differentiating malignant from benign tumors in the shoulder girdle.