Journal of shoulder and elbow surgery
-
J Shoulder Elbow Surg · Jan 2015
Management of deep postoperative shoulder infections: is there a role for open biopsy during staged treatment?
Despite the gold standard treatment of 2-stage exchange arthroplasty, reinfection after periprosthetic shoulder infections and periarticular osteomyelitis can be as high as 37%. This study describes a protocol to detect persistent deep shoulder infection before revision arthroplasty. ⋯ Despite prior staged treatment for deep postoperative shoulder infections, specimens obtained from open biopsy before replantation detected a persistent infection rate of 22% in all patients and 38% in patients with P acnes infection, which may indicate a role for this procedure in the prevention of recurrent infections.
-
J Shoulder Elbow Surg · Jan 2015
National utilization of reverse total shoulder arthroplasty in the United States.
The substantial increase in the utilization of shoulder arthroplasty in the United States during the past decade is partly attributable to the growing acceptance of reverse shoulder arthroplasty (RSA). This study compared the national utilization of and indications for shoulder hemiarthroplasty, total shoulder arthroplasty (TSA), and RSA. ⋯ RSAs accounted for one third of all shoulder arthroplasty procedures in the United States in 2011. Whereas the majority of RSAs are performed for rotator cuff tear arthropathy, one quarter of proximal humerus fractures are treated with RSA, suggesting the strong uptake of this relatively new procedure in the United States.
-
J Shoulder Elbow Surg · Jan 2015
Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.
Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented. ⋯ Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.
-
J Shoulder Elbow Surg · Jan 2015
Preoperative opioid use and outcomes after reverse shoulder arthroplasty.
The potential adverse effect of preoperative opioid use on outcomes after reverse shoulder arthroplasty (RSA) has not been investigated. The purpose of this study was to evaluate outcomes after RSA in patients with a history of preoperative opioid use and compare them with a control group without a history of preoperative opioid use. ⋯ Improvements can be expected in patients with a history of preoperative opioid use; however, patients with preoperative opioid use have a lower preoperative baseline and should not expect to reach the same peak outcome scores after RSA as patients without a history of preoperative opioid use.
-
J Shoulder Elbow Surg · Jan 2015
The treatment of clavicular shaft fractures with an innovative locked intramedullary device.
Displaced and shortened clavicular shaft fractures can be treated by intramedullary fixation; however, hardware migration and soft tissue irritation at the insertion site have complicated its use. The aim of this study was to determine whether the new Sonoma CRx intramedullary device (Sonoma Orthopedic Products Inc, Santa Rosa, CA, USA) could be used successfully to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of shoulder without the development of secondary complications. ⋯ The Sonoma CRx is a good alternative device to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of the shoulder. Future research should focus on when nailing and plating should be used to treat clavicular shaft fractures most optimally.