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 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!
[1] Pottinger P, Butler-Wu S, Neradilek MB,
Merritt A, Bertelsen A, Jette JL, Warme WJ, Matsen FA 3rd. Prognostic factors
for bacterial cultures positive for Propionibacterium acnes and other organisms
in a large series of revision shoulder arthroplasties performed for stiffness,
pain, or loosening.
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.
Substantial cultures of Propionibacterium can be found in
apparently aseptic shoulders revised three years or more after the index
arthroplasty. J Shoulder Elbow
Surg. 2014 Jul 8. pii: S1058-2746(14)00248-1.
[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, Réunion, 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
Consultation for those who live a distance away from Seattle.
To see the topics covered in this Blog, click here
===
Check out the new Shoulder Arthritis Book - click here.
Click here to see the new Rotator Cuff Book
Consultation for those who live a distance away from Seattle.
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 including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
