Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jul 2021
Early to midterm outcomes of anatomic shoulder arthroplasty performed on dysplastic glenoids.
Treatment of primary osteoarthritis with glenoid dysplasia or Walch type C glenoids remains controversial. There is scant literature available on patient outcomes after anatomic shoulder arthroplasty in patients with Walch type C glenoids. The purpose of this study was to evaluate the outcomes of total shoulder arthroplasty (TSA) for Walch type C dysplastic glenoids with standard (nonaugmented) glenoid components compared with TSA for glenoids with concentric wear and minimal erosion (Walch type A1). We hypothesized that TSA performed for Walch type C dysplastic glenoids with standard glenoid components can reliably produce successful results at short- to midterm follow-up. ⋯ Anatomic TSA reliably produced clinically significant improvements in pain and function and similar short- to midterm outcomes in patients with Walch type C dysplastic glenoids compared with patients with type A1 glenoids. Anatomic TSA with standard (nonaugmented) glenoid components should remain an option in patients with Walch type C dysplastic glenoids despite emerging treatment options including augmented glenoid components and reverse TSA.
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J Shoulder Elbow Surg · Jul 2021
Survival of Stemless Humeral Head Replacement in Anatomic Shoulder Arthroplasty. A prospective Study.
The long-term results of shoulder arthroplasty using stemless humeral head components with a mean follow-up period > 10 years were not available until now. The aim of this study was to evaluate the long-term results of shoulder arthroplasty using a stemless humeral head component. ⋯ Stemless humeral head replacement showed no loosening and a significant improvement in shoulder function after a mean period of 11 years. The long-term clinical and radiologic results as well as the survivorship of anatomic shoulder arthroplasty using a stemless humeral head implant are comparable to the long-term results of standard stemmed anatomic shoulder arthroplasty.
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J Shoulder Elbow Surg · Jul 2021
Randomized Controlled TrialOpioid Requirement After Rotator Cuff Repair is Low With a Multimodal Approach to Pain.
Current practices may aim to blunt rather than understand postoperative pain. Perhaps the most common serious complication of arthroscopic rotator cuff repair (ARCR) is persistence of opiate medication intake. Patients still receive upwards of 80 oxycodone 5 mg pills, or 600 morphine milligram equivalents (MMEs), leading more than 20% of opioid-naïve subjects to continue to fill opioid prescriptions beyond 180 days after surgery. Developing evidence-based guidelines for narcotic prescription after ARCR presents an opportunity for orthopedic surgeons to address the opioid epidemic. ⋯ With a multimodal approach, the majority of patients undergoing ARCR can manage postoperative pain with 15 or fewer oxycodone 5 mg tablets (112.5 MMEs) and maintain a high degree of satisfaction. The addition of an LB ISNB may further reduce the consumption of postoperative narcotics compared with a standard ISNB. This study provides evidence that may be used for surgeon guidelines in the effort to reduce opioid prescriptions after ARCR.
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J Shoulder Elbow Surg · Jul 2021
Low-Profile Double Plating of Unstable Osteoporotic Olecranon Fractures: A Biomechanical Comparative Study.
In the treatment of unstable olecranon fractures, anatomically preshaped locking plates exhibit superior biomechanical results compared with tension band wiring. However, posterior plating (PP) still is accompanied by high rates of plate removal because of soft-tissue irritation and discomfort. Meanwhile, low-profile plates precontoured for collateral double plating (DP) are available and enable muscular soft-tissue coverage combined with angular-stable fixation. The goal of this study was to biomechanically compare PP with collateral DP for osteosynthesis of unstable osteoporotic fractures. ⋯ Angular-stable DP showed comparable biomechanical stability to PP in unstable osteoporotic olecranon fractures under high-cycle loading conditions. Failure due to bony triceps avulsion following DP requires further clinical and biomechanical investigation, for example, on suture augmentation or different screw configurations.
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J Shoulder Elbow Surg · Jul 2021
A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation.
Superior capsular reconstruction (SCR) treatment of massive, symptomatic, irreparable rotator cuff tears (RCTs) has become a more recently used procedure. However, there is a lack of consensus surrounding optimal graft choice for the SCR technique, and current dermal grafts have increased cost and are technically challenging because of a need for multiple implants. The purpose of this study was to biomechanically investigate a biological lower-cost alternative as a support for the superior capsule reconstruction concept: an isolated semitendinosus tendon (STT) allograft and a combination graft with the long head of the biceps tendon (LHBT) in an established massive posterosuperior RCT cadaver model. ⋯ In a dynamic shoulder simulator model, both the STT and the STT-LHBT repair techniques improved glenohumeral joint kinematics in an amount similar to previously reported "traditional" SCR techniques for treatment of an irreparable posterosuperior RCT.