Tuesday, July 29, 2014

What has been accomplished by our shoulder research team over the past year

Each year we're asked to provide a summary of our activities conducted with the support of the Harryman/DePuy endowed Chair for Shoulder Research.

We thought the summary might be of interest to our readers and have posted it here.

Thanks to the support of individual contributors, the Harryman/DePuy Chair continues to yield high quality, clinically important contributions to the foundation of knowledge on which modern shoulder surgery is based. Simply stated, without your support, this research would not have taken place.  This past year our work has focused in several critical areas and I’ve tried to summarize them here.

(1) Propionibacterium infections after shoulder joint replacement
We have noted that infections with Propionibacterium – a normal inhabitant of our skin – can cause problems of joint pain and stiffness after shoulder joint replacement without obvious evidence of infection, such as fever, chills, tenderness or redness. [1] These organisms live in rather than on the skin so that skin surface preparation is not effective in eliminating the bacteria from the surgical field[2]. In fact, we did a study that showed that we could recover Propionibacterium from punch biopsies of the skin in spite of standard surgical skin preparation[3] The subtle evidence of infection can appear long after the surgery[4] so that a high index of suspicion is necessary to pursue the appropriate cultures at the time of all revision surgery and a comprehensive plan of surgical and antibiotic management is necessary to resolve the infection.

(2) The Axillary View
Contrary to the opinion of many, it is not necessary to get an expensive CT scan to identify the pathoanatomy of the shoulder before and the results after a ream and run procedure. Instead of a computerized tomographic scan, which costs more money and which subjects the patient to additional radiation, we use a plain axillary view to make the necessary determination of the anatomy of the arthritic shoulder and the effectiveness of the ream and run procedure in restoring the desired shoulder anatomy.[5]

(3) Failure of the glenoid component in total shoulder
The weak link in total shoulder replacement is the glenoid component[6]. While many surgeons are working to develop metal backed glenoid components, our research suggests that these metal backed glenoids have a much higher failure rate than all polyethylene components.[7] We continue to use an all-polyethylene component and are meticulously careful to craft the bone to fit this prosthesis so that the risk of loosening is minimized.

(4) Factors associated with failure of rotator cuff repair.
In a comprehensive review of the published literature, we discovered that – while the number of articles published about rotator cuff repair has increased dramatically over the last three decades – the clinical and anatomic results have not improved with time. In other words the ‘technological advances’ have not yielded better results for the patients. The weighted mean retear rate was 26.6% at a mean of 23.7 months after surgery. Retears were associated with more fatty infiltration, larger tear size, and advanced age. Interestingly, patient-reported outcomes were generally improved whether or not the repair restored the integrity of the rotator cuff. [8]

(5) Learning about improving patient safety by studying malpractice claims.
We reviewed 108 closed upper extremity liability claims from a large United States-wide insurer for events that occurred between 1996 and 2009. We found that liability claims were primarily for the care of common problems, such as fractures or degenerative conditions, rather than complex challenging conditions or disorders, such as deficiencies treated with replantation or tissue transfers. The most common adverse outcomes in these claims were nonunion or malunion of fractures, nerve injury, and infection. Most claims involved a permanent injury. The surgeon's operative skills were more commonly an issue in paid claims than in claims without payment. Claims for mismanagement of fractures were more likely to result in payment than nonfracture claims. We concluded that that the incidence of upper extremity claims made and claims paid may be reduced if surgeons acquire and maintain the knowledge and skills necessary for the care of the common conditions they encounter, including fractures.[9]

(6) The Blog.
Our blog on shoulder arthritis and rotator cuff tears has become immensely popular not only in the US but also in over 100 countries around the world.[10] [11] It now has almost 1000 posts reviewing concepts, recent articles and our cases of interest. There have been almost 500,000 page views as well as a major interest from Twitter and Facebook. The most popular posts include “the shoulder: arthritic or frozen”, “shoulder exercises”, “x-rays for shoulder arthritis”, “shoulder arthritis – what you should know about it” and “rotator cuff and rotator cuff tears – what you should know about them”.

As you can see, in addition to our active practice in helping individuals needing surgical reconstruction of their shoulders, things are busy in the research and teaching domains. All of our activities are supported by your contributions to the Harryman/DePuy Endowed Chair. For your interest and your support, we are most grateful.
If know of others who might like to support our program, please invite them to take a look at this PDF.
If you have any questions about our work or how you might continue to support it, please feel free to drop me an email anytime at matsen@uw.edu. Lot’s more coming up – stay tuned!

J Bone Joint Surg Am. 2012 Nov 21;94(22):2075-83.
[2] Matsen FA 3rd, Butler-Wu S, Carofino BC, Jette JL, Bertelsen A, Bumgarner R. Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing Propionibacterium from surgical sites. J Bone Joint Surg Am. 2013 Dec 4;95(23):e1811-7.
[3] Lee MJ, Matsen FA 3rd, Pottinger P, Bumgarner R, Butler-Wu S, Russ S. Propionibacterium Persists In The Skin In Spite Of Standard Surgical Preparation. The Journal of Bone and Joint Surgery. Accepted for Publication.
[4] McGoldrick E, McElvany MD, Butler-Wu S, Pottinger PS, Matsen FA 3rd.
[5] Matsen FA 3rd, Gupta A. Axillary View: Arthritic Glenohumeral Anatomy and Changes After Ream and Run. Clin Orthop Relat Res. 2014 Mar;472(3):894-902.
[6] Papadonikolakis A, Neradilek MB, Matsen FA 3rd. Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am. 2013 Dec 18;95(24):2205-12.
[7] Matsen FA 3rd, Papdonikolakis A. Metal-Backed Glenoid Components Have A Higher Rate Of Failure And Fail By Different of Bone and Joint Surgery. 2014 Jun 18;96(12):1041-1047.
[8] McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA 3rd. Rotator Cuff Repair: Published Evidence on Factors Associated With Repair Integrity and Clinical Outcome. Am J Sports Med. 2014 Apr 21.
[9] Matsen FA 3rd, Stephens L, Jette JL, Warme WJ, Huang JI, Posner KL.
J Hand Surg Am. 2014 Jan;39(1):91-9
[10] http://shoulderarthritis.blogspot.com/
[11] Albania, Algeria, Argentina, Armenia, Australia, Austria, Bahrain, Bangladesh, Barbados, Belarus, Belgium, Belize, Bosnia, Brazil, Bulgaria, Canada, Chile, China, Columbia, Costa Rica, Croatia, Cyprus, Czech Republic, Denmark, Dominican Republic, El Salvador, Egypt, Eritrea, Estonia, Finland, France, Georgia, Germany, Greece, Herzegovina, Hong Kong, Hungary, India, Indonesia, Iraq, Ireland, Isle of Man, Israel, Italy, Japan, Jordan, Kenya, Kuwait, Laos, Latvia, Lebanon, Libya, Lithuania, Malaysia, Malta, Mauritius, Mexico, Moldova, Mongolia, Morocco, Nambia, Nepal, Netherlands, New Zealand, Norway, Oman, Pakistan, Panama, Peru, Philippines, Poland, Portugal, Puerto Rico, RĂ©union, Romania, Russia, Saudi Arabia, Serbia, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sri Lanka, Sweden, Switzerland, Syria, Taiwan, Thailand, Trinidad and Tobago, Turkey, Ukraine, United Arab Emirates, United Kingdom, United States of America, Venezuela, Vietnam, and Yemen.


Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

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