Tuesday, June 7, 2011

Shoulder arthritis articles from June JSES - fixation of humeral component, shoulder arthroplasty complications

There are a number of articles of interest in the June issue of the Journal of Shoulder and Elbow Surgery, but without a doubt is the note on the passing of the Father of Modern Shoulder Surgery, Dr. Neer, a friend, a teacher, a scientist, a surgeon, and an advocate for the best in care for patients with shoulder problems. We will all miss his leadership.
Another article, Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial comes to the conclusion that 'cemented fixation of the humeral component provides better quality of life, strength, and range of motion than uncemented fixation'.  However, the component used in this study, the Bigliani/Flatow Total Shoulder Solution/Zimmer,  (shown below)
has a cylindrical stem that does not have an opportunity for a good press fit in the humeral canal in contrast to the prosthesis shown in our April 6 post. Furthermore, the authors did not use impaction grafting when inserting the prosthesis without cement. Thus the article's title might have been better phrased as "Cemented Fixation vs Simple Press Fitting of a Humeral Component with a Cylindrical Stem For Osteoarthritis of the Shoulder." Given that caveat, the data do indicate that the Bigliani/Flatow Total Shoulder Solution/Zimmer yields better results when cemented. The results of our preferred method are well documented.

A third article, Factors Predicting Complication Rates After Primary Shoulder Arthroplasty,  documents that when shoulder arthroplasty is done for fracture, there are more complications than when the procedure is performed for arthritis. This article also shows that older patients and patients with rheumatoid arthritis had a lower risk of revision surgery, presumably because of lower activity levels. Implant survival rates were not found to be different between total shoulder and hemiarthroplasty procedures.

A fourth article, Ream and Run for Shoulder Arthritis - patients under 55 years, is the topic of the other post from today.


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