Thursday, November 21, 2019

Total shoulder arthroplasty - selecting the glenoid component

Clinical and radiographic comparison of a hybrid cage glenoid to a cemented polyethylene glenoid in anatomic total shoulder arthroplasty

These authors report the clinical and radiographic outcomes of 316 Exactech hybrid cage glenoids below left) to an age-matched, sex-matched, and follow-up–matched cohort of 316 Exactech cemented all polyethylene glenoid (below right) in patients undergoing anatomic total shoulder arthroplasty with 2 years’ minimum follow-up.


The Exactech cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P . .0088) than the Exactech all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred as shown below.


In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P . .0088).

Comment: These authors point out the importance of exact alignment of the drilled holes and the direction of impaction required by the metal-coated  pegs.

The required direction and accuracy may be difficult to achieve because of challenges with exposure, especially in retroverted glenoids.

Failure to achieve the desired alignment of the holes with the reamed bony surface can result in failure of the component as shown below.

In contrast to the all-polyethylene component with smooth pegs used in this study, we prefer a component with a fluted central peg.

This component has several advantages, including (1) the flexibility of the pegs that can better accommodate minor degrees of malalignment in comparison to the more rigid hybrid pegs and (2) the fluted central peg that allows bone ingrowth which cannot occur with the smooth pegs used in this study.


To see a YouTube of our technique for total shoulder arthroplasty, click on this link.

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Shoulder arthritis in a body builder managed with a ream and run

An active bodybuilder in his mid 50s presented with bilateral shoulder pain and these radiographs





He elected to have bilateral ream and run procedures so that he could continue his weight training.
At two years after surgery, he returned to the office with comfortable and functional shoulders and these x-rays.




At three years after surgery he sent these videos and kindly allowed us to share them here.




The surgical technique for this procedure can be seen on YouTube by clicking on this link and this link.

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Cuff tear arthropathy in an active 70 year old

An active man in is life 70s presents with a chronically painful shoulder and this x-ray

 

In spite of the severity of his cuff tear arthropathy, he had active elevation to 140 degrees.

Because of his desire to continue a high level of physical activity, he elected to have a cuff tear arthropathy arthroplasty. At the time of surgery, the supraspinatus and infraspinatus tendons were absent and the subscapularis was detached. His coracoacromial arch was intact.

At three months after surgery he returned to the office where the x-ray below was obtained.


His shoulder was comfortable and he was back at his physical activities. He kindly gave us permission to present this video of his motion.


While many surgeons may have recommended a reverse total shoulder for this patient, we are impressed with the comfort and function that can be achieved for active individuals using the robust CTA arthroplasty. A video of the technique for this procedure can be found at this link.

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Monday, November 18, 2019

YouTube surgical videos

We have recently posted videos of our approach to common shoulder procedures for shoulder conditions, such as arthritis and rotator cuff tears.

These YouTubes can be viewed by clicking  here.











Wednesday, October 30, 2019

Periprosthetic shoulder infections - who is at greatest risk?

Factors predictive of Cutibacterium periprosthetic shoulder infections: a retrospective study of 342 prosthetic revisions

Cutibacterium are the most common cause of periprosthetic shoulder infections, as defined by 2 deep cultures. Established Cutibacterium periprosthetic infections cannot be resolved without prosthesis removal. However, the decision for implant removal must be made from an assessment of infection risk before the results of intraoperative cultures are finalized. These authors hypothesized that the risk for a Cutibacterium infection is associated with characteristics that are available at the time of revision arthroplasty.

In a retrospective review of 342 patients having prosthetic revisions between 2006 and 2018 for whom definitive deep culture results were available, they used univariate and multivariate analyses to compare the preoperative and intraoperative characteristics of 101 revisions with Cutibacterium periprosthetic infections to the characteristics of 241 concurrent revisions not meeting the definition of infection.

Patients with definite Cutibacterium periprosthetic infections were younger (59  ± 10 vs. 64 ± 12, P <.001), were more likely to be male (91% vs. 44%, P <.001), were more likely to have had their index procedure performed for primary osteoarthritis (54% vs. 39%, P . .007), were more likely to be taking testosterone supplements (8% vs. 2%, P ..02), had lower American Society of Anesthesiologists scores (1.9 ± 0.7 vs. 2.3 ± 0.7, P < .001), and had lower body mass indices (29 ± 5 vs. 31 ± 7, P ..005). Patients with definite Cutibacterium periprosthetic infections also had significantly higher preoperative loads of Cutibacterium on their unprepared skin surface (1.7 0.9 vs. 0.4 0.8, P < .001) and were more likely to have the surgical finding of synovitis (41% vs. 16%, P < .001).



This study indicates that the risk of a revised shoulder arthroplasty having a definite Cutibacterium periprosthetic infection was associated with certain readily available preoperative and intraoperative observations, such as patient age and sex, ASA, BMI, the use of testosterone supplements, the results of preoperative skin surface cultures, and the intraoperative finding of synovitis. Because these observations are available to the surgeon at the time of revision arthroplasty, they may be considered in the intraoperative decisions regarding the advisability of prosthesis exchange.

Comment:  This study suggests that, contrary to the experience with hip and knee periprosthetic infections, patients with shoulder periprosthetic infections are more likely to be young, healthy males. There is evidence to suggest that the levels of the male sex hormone, testosterone, may increase the production of sebum in the sebaceous glands of the dermis overlying the shoulder as well as the number of cutbaterium in these glands. Thus young male, healthy patients having shoulder arthroplasty appear more likely to have Cutibacterium introduced into their wounds at the time of shoulder arthroplasty.

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Thursday, October 24, 2019

Ream and Run and Total Shoulder - comparing and contrasting

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Wednesday, October 23, 2019

B2 glenoid in a 45 year old active man - how could it be treated?





Total shoulder with posterior augmented glenoid?
Total shoulder with posterior bone graft?
Total shoulder with corrective reaming?
Reverse total shoulder?

After a discussion of these options, the patient elected a ream and run procedure. An anteriorly eccentric humeral head and a rotator interval plication were required to achieve posterior stability. 



Two years after surgery he returned for a similar procedure. At that time he had these x-rays



His function, the result of a vigorous persistent rehabilitation effort on his part, is shown in the video below (taken just before a procedure on his left shoulder).




=====
To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'