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[PMID]:28460192
[Au] Autor:Karampinos DC; Holwein C; Buchmann S; Baum T; Ruschke S; Gersing AS; Sutter R; Imhoff AB; Rummeny EJ; Jungmann PM
[Ad] Endereço:Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
[Ti] Título:Proton Density Fat-Fraction of Rotator Cuff Muscles Is Associated With Isometric Strength 10 Years After Rotator Cuff Repair: A Quantitative Magnetic Resonance Imaging Study of the Shoulder.
[So] Source:Am J Sports Med;45(9):1990-1999, 2017 Jul.
[Is] ISSN:1552-3365
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Quantitative muscle fat-fraction magnetic resonance (MR) imaging techniques correlate with semiquantitative Goutallier scores with failure after rotator cuff (RC) repair. PURPOSE: To investigate the relationship of proton density fat fraction (PDFF) of the RC muscles with semiquantitative MR scores, cartilage T2 relaxation times, and clinical isometric strength measurements in patients 10 years after unilateral RC repair. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Bilateral shoulder MR imaging was performed in 13 patients (11 male, 2 female; age, 72 ± 8 years) 10.9 ± 0.4 years after unilateral autologous periosteal flap augmented RC repair (total shoulders assessed, N = 26). Goutallier classification, muscle atrophy, RC tendon integrity, and cartilage defects were determined based on morphological MR sequences. A paracoronal 2D multi-slice multi-echo sequence was used for quantitative cartilage T2 mapping. A chemical shift-encoding-based water-fat separation technique (based on a 6-echo 3D spoiled gradient echo sequence) was used for quantification of the PDFF of RC muscles. Isometric shoulder abduction strength was measured clinically. Mean and SD, Pearson correlation, and partial Spearman correlation were calculated. RESULTS: There were 6 RC full-thickness retears in ipsilateral shoulders and 6 RC full-thickness tears in contralateral shoulders. Isometric shoulder abduction strength was not significantly different between ipsilateral and contralateral shoulders (50 ± 24 N vs 54 ± 24 N; P = .159). The mean PDFF of RC muscles was 11.7% ± 10.4% (ipsilateral, 14.2% ± 8.5%; contralateral, 9.2% ± 7.8%; P = .002). High supraspinatus PDFF correlated significantly with higher Goutallier scores ( R = 0.75, P < .001) and with lower isometric muscle strength ( R = -0.49, P = .011). This correlation remained significant after adjustment for muscle area measurements and tendon rupture ( R = -0.41, P = .048). More severe cartilage defects at the humerus were significantly associated with higher supraspinatus PDFF ( R = 0.44; P = .023). Cartilage T2 values did not correlate with muscle PDFF ( P > .05). CONCLUSION: MR imaging-derived RC muscle PDFF is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes. It therefore provides complementary, clinically relevant information in tracking RC muscle composition on a quantitative level.
[Mh] Termos MeSH primário: Cartilagem Articular/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
Manguito Rotador/diagnóstico por imagem
Articulação do Ombro/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Artroplastia
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Força Muscular
Atrofia Muscular/diagnóstico por imagem
Prótons
Manguito Rotador/cirurgia
Lesões do Manguito Rotador/cirurgia
Artropatia de Ruptura do Manguito Rotador/diagnóstico por imagem
Ombro/cirurgia
Articulação do Ombro/cirurgia
Traumatismos dos Tendões/cirurgia
Tendões/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Protons)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1177/0363546517703086


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[PMID]:28374051
[Au] Autor:Leung AS; Hippe DS; Ha AS
[Ad] Endereço:Department of Radiology, University of Washington, 1959 N.E. Pacific Street, Box 357115, Seattle, WA, 98195, USA.
[Ti] Título:Cuff tear arthropathy shoulder hemiarthroplasty: a radiographic outcome study.
[So] Source:Skeletal Radiol;46(7):909-918, 2017 Jul.
[Is] ISSN:1432-2161
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Cuff tear arthropathy (CTA) head prosthesis has recently become an alternative to standard shoulder hemiarthroplasty in patients with severe cuff disease by offering an increased surface area and decreased impingement. The purpose of this study is to evaluate the radiographic outcomes of CTA prosthesis and to correlate them with clinical outcomes. MATERIALS AND METHODS: In this retrospective study of CTA hemiarthroplasties over an 11-year period, two radiologists reviewed pre-/postoperative radiographs and clinical data. Radiographic complications were correlated with subsequent surgery using Cox regression models. Rates of surgical revision and radiographic complications over time were estimated using Kaplan-Meier curves. RESULTS: Ninety-seven CTA hemiarthroplasties were identified in 92 patients (5 bilateral) with a mean patient age of 68.7 years. Mean radiographic follow-up was 12 months with a mean of 3.3 radiographs per prosthesis. Twenty-six arthroplasties (26.8%) experienced at least one radiographic complication, including acromion remodeling (19.5%), anterior-posterior subluxation (5.2%), periprosthetic fracture (4.1%), glenoid remodeling (3.1%), hardware loosening (2.1%), superior subluxation (2.1%), and subsidence (1.0%). Eight cases underwent revision surgery (8.2%). The occurrence of a postoperative radiographic complication was associated with increased risk of surgical revision (hazard ratio 11.5, 95% CI: 2.4-55.7, p = 0.002); 73.5% of radiographic complications occurred by 3 months after the initial surgery (complication rate of 23.3%) based on Kaplan-Meier curve analysis. CONCLUSION: Radiographic complications after CTA head hemiarthroplasty are common with most occurring by 3 months after surgery and are highly associated with surgical revision.
[Mh] Termos MeSH primário: Hemiartroplastia
Artropatia de Ruptura do Manguito Rotador/diagnóstico por imagem
Artropatia de Ruptura do Manguito Rotador/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Substituição
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1007/s00256-017-2631-8


  3 / 13 MEDLINE  
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[PMID]:28355234
[Au] Autor:Yoon JP; Seo A; Kim JJ; Lee CH; Baek SH; Kim SY; Jeong ET; Oh KS; Chung SW
[Ad] Endereço:Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, Daegu, Korea.
[Ti] Título:Deltoid muscle volume affects clinical outcome of reverse total shoulder arthroplasty in patients with cuff tear arthropathy or irreparable cuff tears.
[So] Source:PLoS One;12(3):e0174361, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We aimed to estimate the interrelation between preoperative deltoid muscle status by measuring the 3-dimensional deltoid muscle volume and postoperative functional outcomes after reverse total shoulder arthroplasty(RTSA). Thirty-five patients who underwent RTSA participated in this study. All patients underwent preoperative magnetic resonance imaging(MRI) as well as pre- and postoperative radiography and various functional outcome evaluations at least 1 year. The primary outcome parameter was set as age- and sex-matched Constant scores. The 3-dimensional deltoid muscle model was generated using a medical image processing software and in-house code, and the deltoid muscle volume was calculated automatically. Various clinical and radiographic factors comprising the deltoid muscle volume adjusted for body mass index(BMI) were analyzed, and their interrelation with the outcome parameters was appraised using a multivariate analysis. As a result, all practical consequences considerably improved following surgery(all p<0.01). Overall, 20 and 15 indicated a higher and a lower practical consequence than the average, respectively, which was assessed by the matched Constant scores. The deltoid muscle volume adjusted for BMI(p = 0.009), absence of a subscapularis complete tear (p = 0.040), and greater change in acromion-deltoid tuberosity distance(p = 0.013) were associated with higher matched Constant scores. Multivariate analysis indicated that the deltoid muscle volume was the single independent prognostic factor for practical consequences(p = 0.011). In conclusion, the preoperative deltoid muscle volume significantly affected the functional outcome following RTSA in patients with cuff tear arthropathy or irreparable cuff tears. Therefore, more attention should be paid to patients with severe atrophied deltoid muscle who are at a high risk for poor practical consequences subsequent to RTSA.
[Mh] Termos MeSH primário: Artroplastia do Ombro
Músculo Deltoide/patologia
Artropatia de Ruptura do Manguito Rotador/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Músculo Deltoide/diagnóstico por imagem
Músculo Deltoide/fisiopatologia
Feminino
Seres Humanos
Masculino
Contração Muscular
Tamanho do Órgão
Amplitude de Movimento Articular
Recuperação de Função Fisiológica
Artropatia de Ruptura do Manguito Rotador/diagnóstico por imagem
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/fisiopatologia
Articulação do Ombro/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170330
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0174361


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[PMID]:28169600
[Au] Autor:Haeni D; Müller AM; Tamborrini G
[Ad] Endereço:1 FMH Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Basel.
[Ti] Título:Schulterschmerzen: Was tun bei einer symptomatischen, degenerativen Rotatorenmanschettenruptur?.
[So] Source:Praxis (Bern 1994);106(3):151-153, 2017 Feb.
[Is] ISSN:1661-8157
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Artropatia de Ruptura do Manguito Rotador/diagnóstico
Artropatia de Ruptura do Manguito Rotador/terapia
Dor de Ombro/etiologia
Dor de Ombro/terapia
[Mh] Termos MeSH secundário: Artroscopia
Seres Humanos
Imagem por Ressonância Magnética
Procedimentos Ortopédicos
Manejo da Dor
Modalidades de Fisioterapia
Fatores de Risco
Artropatia de Ruptura do Manguito Rotador/etiologia
Ruptura Espontânea
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170629
[Lr] Data última revisão:
170629
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE
[do] DOI:10.1024/1661-8157/a002597


  5 / 13 MEDLINE  
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[PMID]:27738892
[Au] Autor:Parsons M
[Ad] Endereço:Seacoast Orthopedics and Sports Medicine, 237 Route 108, Suite 205, Somersworth, NH, 03878, USA. impiv@comcast.net.
[Ti] Título:CORR Insights : What Factors are Associated With Clinically Important Improvement After Shoulder Hemiarthroplasty for Cuff Tear Arthropathy?
[So] Source:Clin Orthop Relat Res;474(12):2689-2691, 2016 12.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hemiartroplastia
Artropatia de Ruptura do Manguito Rotador
[Mh] Termos MeSH secundário: Artroplastia de Substituição
Seres Humanos
Manguito Rotador/cirurgia
Ombro/cirurgia
Articulação do Ombro/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161015
[St] Status:MEDLINE


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[PMID]:27530396
[Au] Autor:Somerson JS; Sander P; Bohsali K; Tibbetts R; Rockwood CA; Wirth MA
[Ad] Endereço:Department of Orthopaedics and Sports Medicine, University of Washington, 1959 N.E. Pacific St., Box 356500, Seattle, WA, 98195-6500, USA. jeremysomerson@gmail.com.
[Ti] Título:What Factors are Associated With Clinically Important Improvement After Shoulder Hemiarthroplasty for Cuff Tear Arthropathy?
[So] Source:Clin Orthop Relat Res;474(12):2682-2688, 2016 Dec.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In selected patients with a desire to maintain activity levels greater than those recommended after reverse total shoulder arthroplasty, hemiarthroplasty remains an option for treatment of cuff tear arthropathy (CTA). However, given the relatively small case series that have been reported to date, little is known regarding which patients will show functional improvement after this surgery. QUESTIONS/PURPOSES: We asked: What factors are associated with achieving the minimum clinically important difference in the simple shoulder test (SST) after hemiarthroplasty for cuff tear arthropathy? PATIENTS AND METHODS: Between 1991 and 2007, two surgeons at one academic center performed 48 shoulder hemiarthroplasties for CTA. No patients were known to have died before data collection, and of those not known to have died, 42 (88%) were available for followup at a mean of 48 months (range, 24-132 months). During that time, the general indications for this approach were glenohumeral arthritis with superior decentering of the humeral head. The majority of the patients with CTA were treated nonoperatively with patient-directed physical therapy and other modalities. A total of 42 patients (42 shoulders; 24 males and 18 females) with CTA were treated with hemiarthroplasty and followed for a mean of 48 months (range, 24-132 months). This is a retrospective study that made use of a longitudinally maintained database, which included physical examination of ROM, the SST, VAS, and standardized radiographs. At latest followup, 33 of 42 patients achieved a clinically important percentage of maximum possible improvement (%MPI) in SST score, defined as an improvement of 30% of the total possible improvement on the 12-point scale (with higher scores representing better results). RESULTS: Intraoperative findings of a rotator cuff tear limited to the supraspinatus and infraspinatus (odds ratio [OR], ∞; 95% CI, 2.01 to ∞; p = 0.020) and limited preoperative external rotation (15° [range, -40° to 45°] vs 35° [range, 20°-45°], OR, 0.71; 95% CI, 0.38-0.90; p < 0.001) were associated with achieving the defined minimum functional improvement (30% of MPI) on multivariate analysis. Preoperative active elevation (p = 0.679) and use of a CTA-specific implant (p = 0.707) were not significantly associated with achievement of 30% of MPI. CONCLUSION: Patients with intact teres minor and subscapularis tendons and patients with lower preoperative external rotation had a better prognosis for achieving a clinically important percentage of MPI at short-term followup. Although some patients were followed for more than 10 years, the majority were followed for fewer than 5 years; future studies will need to determine whether these early functional results are maintained for longer periods. LEVEL OF EVIDENCE: Level III, therapeutic study.
[Mh] Termos MeSH primário: Hemiartroplastia
Artropatia de Ruptura do Manguito Rotador/cirurgia
Articulação do Ombro/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Fenômenos Biomecânicos
Bases de Dados Factuais
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Medição da Dor
Amplitude de Movimento Articular
Recuperação de Função Fisiológica
Estudos Retrospectivos
Fatores de Risco
Artropatia de Ruptura do Manguito Rotador/diagnóstico
Artropatia de Ruptura do Manguito Rotador/fisiopatologia
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/fisiopatologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160818
[St] Status:MEDLINE


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[PMID]:27490156
[Au] Autor:Thorpe A; Hurworth M; O'Sullivan P; Mitchell T; Smith A
[Ad] Endereço:School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. a.thorpe@curtin.edu.au.
[Ti] Título:Rising trends in surgery for rotator cuff disease in Western Australia.
[So] Source:ANZ J Surg;86(10):801-804, 2016 Oct.
[Is] ISSN:1445-2197
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Increasing rates of surgery for rotator cuff disease have been reported in the past decade in a number of countries worldwide. Rising surgery rates do not correspond with equivalent increases in shoulder pain prevalence. The aims of the study were: to investigate trends in population-adjusted surgical rates for rotator cuff disease in Western Australia (WA) from 2001 to 2013; to compare population-adjusted arthroscopic surgical trends between (i) private versus public hospital setting; (ii) sex and (iii) different age groups; and to evaluate rising health care costs associated with arthroscopic surgical rates for rotator cuff disease. METHODS: Numbers and costs for surgical procedures for rotator cuff disease performed in WA were extracted from the WA Department of Health database for the 13-year period, 2001-2013. RESULTS: Rising surgical trends were demonstrated with arthroscopic subacromial decompression (ASAD) and arthroscopic reconstruction showing large proportional increases of 108.7 and 68.4%, respectively. Increasing trends were mostly linear across private and public hospital settings, gender groups and different age groups. The rise in consumer price index-adjusted costs for ASAD in private and public hospitals was 273.7 and 320.8%, respectively, and for arthroscopic reconstruction 220.2 and 472.5%, respectively. CONCLUSION: The substantial increase in arthroscopic surgery rates for rotator cuff disease and associated costs in WA over the period 2001-2013 is in spite of evidence that surgical outcomes are no different to exercise interventions. Conservative treatments should be recommended as an initial treatment choice, to arrest escalating health care costs.
[Mh] Termos MeSH primário: Artroscopia/tendências
Padrões de Prática Médica/tendências
Lesões do Manguito Rotador/cirurgia
Artropatia de Ruptura do Manguito Rotador/cirurgia
Síndrome de Colisão do Ombro/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Distribuição por Idade
Idoso
Idoso de 80 Anos ou mais
Artroscopia/economia
Artroscopia/estatística & dados numéricos
Bases de Dados Factuais
Feminino
Custos de Cuidados de Saúde/estatística & dados numéricos
Custos de Cuidados de Saúde/tendências
Hospitais Privados/economia
Hospitais Privados/estatística & dados numéricos
Hospitais Privados/tendências
Hospitais Públicos/economia
Hospitais Públicos/estatística & dados numéricos
Hospitais Públicos/tendências
Seres Humanos
Masculino
Meia-Idade
Padrões de Prática Médica/economia
Padrões de Prática Médica/estatística & dados numéricos
Lesões do Manguito Rotador/economia
Artropatia de Ruptura do Manguito Rotador/economia
Distribuição por Sexo
Síndrome de Colisão do Ombro/economia
Austrália Ocidental
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160805
[St] Status:MEDLINE
[do] DOI:10.1111/ans.13691


  8 / 13 MEDLINE  
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[PMID]:27403865
[Au] Autor:Campbell M
[Ad] Endereço:Via Christi Sports Medicine, 707 N Emporia Ave, Wichita, KS 67214.
[Ti] Título:Problems With Large Joints: Shoulder Conditions.
[So] Source:FP Essent;446:25-30, 2016 07.
[Is] ISSN:2159-3000
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The shoulder is the most mobile joint in the body. It requires an extensive support system to create mobility while providing stability. Although there are many etiologies of shoulder pain, weakness, and instability, most injuries in the shoulder are due to overuse. Rotator cuff tears, labral tears, calcific tendinopathy, and impingement often result from chronic overuse injuries. Acute injuries include dislocations that can cause labral tears or other complications. Frozen shoulder refers to a typically benign condition of restricted range of motion that may spontaneously resolve but can cause prolonged pain and discomfort. The history combined with specific shoulder examination techniques can help family physicians successfully diagnose shoulder conditions. X-ray imaging typically is sufficient to rule out more serious etiologies when evaluating patients with shoulder conditions. However, imaging with magnetic resonance imaging (MRI) study or ultrasonography for rotator cuff tears, and MRI study with intra-articular contrast for labral tears, is needed to confirm these diagnoses. Corticosteroid injections and physical therapy are first-line treatments for most shoulder conditions. Surgical options typically are reserved for patients for whom conservative treatments are ineffective, and typically are performed arthroscopically.
[Mh] Termos MeSH primário: Transtornos Traumáticos Cumulativos/diagnóstico por imagem
Lesões do Ombro/diagnóstico por imagem
Articulação do Ombro/diagnóstico por imagem
[Mh] Termos MeSH secundário: Corticosteroides/uso terapêutico
Bursite/diagnóstico por imagem
Bursite/terapia
Calcinose/diagnóstico por imagem
Calcinose/terapia
Transtornos Traumáticos Cumulativos/terapia
Seres Humanos
Injeções Intra-Articulares
Instabilidade Articular/diagnóstico por imagem
Instabilidade Articular/terapia
Imagem por Ressonância Magnética
Modalidades de Fisioterapia
Radiografia
Lesões do Manguito Rotador/diagnóstico por imagem
Lesões do Manguito Rotador/terapia
Artropatia de Ruptura do Manguito Rotador/diagnóstico por imagem
Artropatia de Ruptura do Manguito Rotador/terapia
Luxação do Ombro/diagnóstico por imagem
Luxação do Ombro/terapia
Síndrome de Colisão do Ombro/diagnóstico por imagem
Síndrome de Colisão do Ombro/terapia
Lesões do Ombro/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170216
[Lr] Data última revisão:
170216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160713
[St] Status:MEDLINE


  9 / 13 MEDLINE  
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[PMID]:27392769
[Au] Autor:Werner BC; Chang B; Nguyen JT; Dines DM; Gulotta LV
[Ad] Endereço:Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA, 22903, USA. bcw4x@virginia.edu.
[Ti] Título:What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?
[So] Source:Clin Orthop Relat Res;474(12):2672-2681, 2016 Dec.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) questionnaire was developed to provide a standardized method for evaluating shoulder function. Previous studies have determined the clinical responsiveness of this outcome measure for heterogenous populations or patients with nonoperatively treated rotator cuff disease. Currently, to our knowledge, no studies exist that establish the clinically relevant change in the ASES score after shoulder arthroplasty. QUESTIONS/PURPOSES: We asked: (1) What are the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the ASES score after primary and reverse shoulder arthroplasties? (2) Are the MCID and SCB for the ASES score different between primary and reverse shoulder arthroplasties? (3) What patient-related factors are associated with achieving the MCID and SCB after total shoulder arthroplasty and reverse shoulder arthroplasty? METHODS: A longitudinally maintained institutional shoulder arthroplasty registry was retrospectively queried for patients who underwent primary shoulder arthroplasty, including anatomic or reverse total shoulder arthroplasty from 2007 to 2013, with a minimum 2-year followup. Seven hundred ninety-four patients were identified and eligible; 304 of these patients did not have 2 years of followup or complete datasets, resulting in a study cohort of 490 patients (62% of the 794 potentially eligible). The MCID and SCB of the ASES score for these patients was calculated using an anchor-based method, using four different anchors measuring satisfaction with work, activities, overall, and activity from the SF-36. The MCID (anchored to somewhat satisfied) and SCB (very satisfied) of the ASES score were calculated for the entire cohort and stratified by arthroplasty type. Multivariate logistic regression of patient-related factors that influence the MCID and SCB achievement was performed. RESULTS: The MCID for all patients combined ranged from 6.3 to 13.5; for the overall satisfaction anchor, the MCID was 13.5 ± 4.5 (95% CI, 4.8-22.3). The SCB for the overall cohort ranged from 12.0 to 36.6; for the overall satisfaction anchor, the SCB was 36.6 ± 3.8 (95% CI, 29.1-44.1). There were no differences in the MCID of the ASES score between anatomic and reverse shoulder arthroplasty for any of the anchors (p = 0.159-0.992) or the SCB for any of the anchors (p = 0.467-0.977). Combining anatomic and reverse shoulder arthroplasty in one group, higher preoperative ASES score (odds ratio [OR], 0.96; 95% CI, 0.94-0.98; p < 0.001), having a reverse shoulder arthroplasty (OR, 0.36; 95% CI, 0.16-0.85; p = 0.016), and having rheumatoid arthritis were independent predictors of not achieving an MCID for the ASES 2 years after surgery. Higher preoperative ASES score (OR, 0.91; 95% CI, 0.89-0.92; p < 0.001), a diagnosis of rotator cuff tear arthropathy (OR, 0.14; 95% CI, 0.07-0.30; p < 0.001), a diagnosis of back pain (OR, 0.42; 95% CI, 0.24-0.71); p = 0.002), and living alone (OR, 0.36; 95% CI, 0.19-0.69; p = 0.002) were all independent predictors of not achieving SCB after shoulder arthroplasty. CONCLUSIONS: Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their ASES score experience a clinically important change, whereas those who have at least a 23-point improvement in their ASES score experience a substantial clinical benefit. High preoperative function was associated with a decreased likelihood of achieving clinically important change after total shoulder arthroplasty. LEVEL OF EVIDENCE: Level III, therapeutic study.
[Mh] Termos MeSH primário: Artrite/cirurgia
Artroplastia do Ombro
Indicadores Básicos de Saúde
Artropatia de Ruptura do Manguito Rotador/cirurgia
Articulação do Ombro/cirurgia
Inquéritos e Questionários
[Mh] Termos MeSH secundário: Atividades Cotidianas
Idoso
Artrite/diagnóstico
Artrite/fisiopatologia
Artroplastia do Ombro/efeitos adversos
Fenômenos Biomecânicos
Emprego
Feminino
Nível de Saúde
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Satisfação do Paciente
Valor Preditivo dos Testes
Recuperação de Função Fisiológica
Sistema de Registros
Estudos Retrospectivos
Artropatia de Ruptura do Manguito Rotador/diagnóstico
Artropatia de Ruptura do Manguito Rotador/fisiopatologia
Articulação do Ombro/fisiopatologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160710
[St] Status:MEDLINE


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[PMID]:27365476
[Au] Autor:Theivendran K; Varghese M; Large R; Bateman M; Morgan M; Tambe A; Espag M; Cresswell T; Clark DI
[Ad] Endereço:Royal Derby Hospital, Derby, Derbyshire, DE22 3NE, UK.
[Ti] Título:Reverse total shoulder arthroplasty using a trabecular metal glenoid base plate: functional and radiological outcomes at two to five years.
[So] Source:Bone Joint J;98-B(7):969-75, 2016 Jul.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate. PATIENTS AND METHODS: We reviewed 125 consecutive primary reverse total shoulder arthroplasties (RTSA) implanted in 124 patients for rotator cuff arthropathy. There were 100 women and 24 men in the study group with a mean age of 76 years (58 to 89). The mean follow-up was 32 months (24 to 60). No patient was lost to follow-up. RESULTS: There were statistically significant improvements in the mean range of movement and Oxford Shoulder Score (p < 0.001). Kaplan-Meier survivorship at five years was 96.7% (95% confidence interval 91.5 to 98.7) with aseptic glenoid failure as the end point. Radiologically, 63 shoulders (50.4%) showed no evidence of notching, 51 (40.8%) had grade 1 notching, ten (8.0%) had grade 2 notching and one (0.8%) had grade 4 notching. Radiolucency around the glenoid base plate was found in one patient (0.8%) and around the humeral stem in five (4.0%). In all, three RTSA (2.4%) underwent revision surgery for aseptic mechanical failure of the glenoid within 11 months of surgery due to malseating of the glenosphere. CONCLUSION: The clinical results of this large independent single unit series are comparable to those from previous series of RTSA reported in the literature. A trabecular metal base plate is safe and effective in the medium-term. Cite this article: Bone Joint J 2016;98-B:969-75.
[Mh] Termos MeSH primário: Artroplastia do Ombro/instrumentação
Artroplastia do Ombro/métodos
Desenho de Prótese
Articulação do Ombro/diagnóstico por imagem
Prótese de Ombro
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias
Amplitude de Movimento Articular
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
Artropatia de Ruptura do Manguito Rotador/cirurgia
Articulação do Ombro/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170131
[Lr] Data última revisão:
170131
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160702
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.98B7.37688



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