Reverse shoulder prosthesis has been developed to treat the clinical and pathological condition noted as cuff tear arthropathy (CTA). The current models of reverse shoulder arthroplasty (RSA) expose the procedure to the risk of scapular notching, possibly leading to loosening of the glenoid. The purpose of this study was to report updated results at a minimum follow-up of four years of 25 patients underwent reverse shoulder arthroplasty between 2006 and 2010 with an eccentric 36-mm glenoid component (SMR Lima).Introduction
Aim
Reverse shoulder arthroplasty (RSA) is a reasonable treatment modality in patients with Cuff Tear Arthropaty and massive irreparable cuff tears. RSA has been shown to increase patient function and decrease pain. The aim of this study is to evaluate the clinical and radiographic results of a 44 polyethylene glenosphere. Since 2008 we treated 88 patients with cuff tear arthropaty and irreparable massive cuff tear, using an RSA. We selected 80 patients with minimum FU of 24 months in which we used an implant with polyethylene glenosphere and metal humeral insert. Size of the glenosphere used was 44. All patients were assessed with the Constant score and with VAS. The shoulder ROM was measured preoperatively and postoperatively.Introduction:
Methods:
Different surgical approaches have been proposed for the treatment of chondral lesions. However surgical management of osteochondral defects of the knee joint involving subchondral bone are still under debate. The aim of this prospective non-randomized uncontrolled clinical investigation is to confirm the effectiveness of a commercially available biomimetic osteochondral scaffold in regenerating cartilage and subchondral bone of severe osteochondral lesions of the knee joint with one step surgery.Background:
Purpose:
The aim of this retrospective study is to evaluate clinically and radiographically the effectiveness of implanting an eccentric glenosphere and if a correct glenosphere positioning would avoid the occurrence of notching. since 2006 40 patients with shoulder eccentric osteoarthritis were treated with reverse shoulder arthroplasty with a 36 mm eccentric glenosphere. We have selected 25 patients, with a minimum follow up of 24 months. The patients were clinically evaluated with the Constant score and SST and with X-ray, MRI and/or CT before and after surgery. At the follow up we evaluated the presence or absence of notch, and we measured the PSNA (prosthesis-scapular neck angle), the DBSNG (distance between the scapular neck angle and glenosphere), the PGRD distance (peg glenoid distance). Stastistical analysis was performed with a paired t test.INTRODUCTION
METHODS
Reverse shoulder prosthesis may lead to scapular notching, caused by attrition of the upper humeral component with scapular neck. We compared the clinical and radiographic results obtained with a SMR prosthesis, which allows a concentric or an eccentric glenosphere to be applied. 67 patients, mean age 73 years, were treated with reverse prosthesis using concentric and eccentric glenosphere. In patients with concentric glenosphere, the glenosphere extended about 4 mm below the glenoid. The eccentric glenosphere protected the upper glenoid neck by its inferior prolongment. Patients were followed for a mean of 33 months. At final F-U the Constant Score (C.S.) and the score with the Simple Shoulder test (S.S.T.) were calculated. Radiographs were obtained to evaluate the presence of scapular notching, psna (prosthesis-scapular neck angle), pgrd (peg- glenoid rim distance) and DBSNG (distance between scapular neck and glenosfere). Included in this study were patients, as much homogeneous as possible by age and pathology, 25 with concentric (Group I) and 30 with eccentric (Group II) glenosphere, who had a minimum F-U of 24 months. Statistical analysis was performed with a paired test.Purpose
Patients and methods
the aim of the study is to evaluate the clinical results of the shoulder prosthesis revision procedure to reverse implant without removing the humeral stem using a modular system (Lima LTD) and determine if this procedure is beneficial for the patients. e selected only the patients where a revision to reverse (RSA) of hemiarthroplasty (Hemi) originally implanted for fracture (Group I) and revision to reverse (RSA) of anatomical total prosthesis (TSA) were performed. From 2004 to 2009 26 cases responding to these parameters were identified: 18 cases in Group I (failed hemiarthroplasty for tuberosities resorptions or rotator cuff failure) and 8 in Group II (failed TSA for rotator cuff omplication). The mean follow-up was 32 months (min 18–max 76) and the mean age was 72 (min 65–max 80) Clinical assessment was performed with preoperative and postoperative Constant score rating scale (CS) and range of motion evaluation (ROM) Radiological assessment was performer by AP and Axial X-ray views. Operative time was calculated.Introduction
Methods
Traumatic anterior shoulder dislocation and sub-luxation are common injuries. But few studies have compared arthroscopic and open stabilization of the shoulder at long-term follow up. The purpose of our study is to show whether an arthroscopic approach to repair Bankart lesion can obtain the same results at long follow up as an open procedure. We analyzed 110 non-randomized consecutive shoulders in 110 patients who underwent a surgical repair of recurrent anterior shoulder instability between 1990 and 1999. Eighty-two patients were available at long term follow up (74,5% retrieval rate). In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid suture (modified Caspari) between 1990 and 1995 (mean 15,7 year FU), whereas, 33 patients (40.2%) (group B) were treated with open repair between 1995 and 1999 (mean 12,7 year FU). We evaluated the patients in terms of failure rates, Rowe and UCLA scores. The failure cases in the forty-nine patients treated with arthroscopic suture were 13, six dislocations and seven subluxations. The group A had also a Rowe score: function 24.2+8.2, stability 42.4+13.9, range of movement 18.6+3.8, total score 85.0+22.46. The UCLA score was: pain 8.8+1.7, function 8.6+2.1, muscle power 9.2+1.6, total score 26.4+4.8. Of the thirty-three patients treated with open repair, three had at least one post-op dislocations and four felt sometimes subluxations. The Rowe score in group B was: function 23.6+9.7, stability 41.2+14.9, range of movement 18.3+3.9, total score 83.2+24.4. Moreover the UCLA score was: pain 8.8+1.9, function 8.8+1.9, muscle power 9.2+1.2, total score 26.9+4.2. We showed that both techniques were fairly good in treatment of shoulder instability. In our series no significant difference was observed in redislocation rate and in Rowe and UCLA scores between the two groups. The recurrence rate (subluxations and dislocations) was high in both groups: the arthroscopic group had 26.5% and the open one had 21.2%. Our recurrence rate following open repair was higher than in many studies, while the rate after arthroscopic transglenoid procedure was almost equivalent. We hypothesize that one of the reasons for these higher recurrence rates may be the long term follow up. Another cause could be our decision to include subluxation as a failure value, even if there is no agreement about. In fact we believe it to be an important disability factor in sport as in life activities. After surgery, most of the patients returned to their preinjuried activities. But at long term follow up almost all patients have stopped high level sport activity. Moreover, at this long term follow up, some patients told us a feeling of muscle weakness in the last years. In conclusion patients had good impressions about their shoulders thanks to surgery, but also because of lower functional demand.
The animals were sacrificed after 4 months. The implants and joint surfaces were evaluated on a macroscopic (Implant Gross Assessment Score; Gross Assessment of Joints Score) and histological level.
