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[PMID]:29201302
[Au] Autor:Padegimas EM; Narzikul A; Lawrence C; Hendy BA; Abboud JA; Ramsey ML; Williams GR; Namdari S
[Ad] Endereço:Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
[Ti] Título:Antibiotic Spacers in Shoulder Arthroplasty: Comparison of Stemmed and Stemless Implants.
[So] Source:Clin Orthop Surg;9(4):489-496, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Background: Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers. Methods: All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed. Results: There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m vs. stemmed group, 31.5 ± 8.3 kg/m ; = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109° ± 23°. Within the stemmed group, 12 of 15 (80.0%, = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94° ± 43° (range, 30° to 150°; = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation. Conclusions: Stemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers.
[Mh] Termos MeSH primário: Antibacterianos/administração & dosagem
Artroplastia do Ombro/efeitos adversos
Infecções Relacionadas à Prótese/tratamento farmacológico
Prótese de Ombro/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Hemiartroplastia/efeitos adversos
Seres Humanos
Masculino
Meia-Idade
Duração da Cirurgia
Infecções Relacionadas à Prótese/microbiologia
Infecções Relacionadas à Prótese/cirurgia
Amplitude de Movimento Articular
Reoperação
Estudos Retrospectivos
Articulação do Ombro/fisiopatologia
Tobramicina/administração & dosagem
Vancomicina/administração & dosagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 6Q205EH1VU (Vancomycin); VZ8RRZ51VK (Tobramycin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.4.489


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[PMID]:29257012
[Au] Autor:Sanchez-Sotelo J; Wagner ER; Sim FH; Houdek MT
[Ad] Endereço:Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
[Ti] Título:Allograft-Prosthetic Composite Reconstruction for Massive Proximal Humeral Bone Loss in Reverse Shoulder Arthroplasty.
[So] Source:J Bone Joint Surg Am;99(24):2069-2076, 2017 Dec 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Reverse total shoulder arthroplasty (RTSA) performed in the setting of massive proximal humeral bone loss often requires special reconstructive techniques. Restoration of the proximal part of the humerus with an allograft provides a number of theoretical benefits, including implant support, restoration of humeral length, deltoid tensioning, and an opportunity to repair the posterior aspect of the cuff to improve strength in external rotation and repair of the subscapularis to improve stability. However, reverse allograft-prosthesis composites (APCs) are costly, are technically demanding to use, and can be compromised by progressive allograft resorption. METHODS: Between 2005 and 2012, the lead author used an APC reconstruction in 8 primary and 18 revision RTSAs (26 patients; mean age, 62 years; mean body mass index, 27.9 kg/m). The indications for the primary RTSAs included severe proximal humeral bone loss after trauma (n = 5) and tumor resection (n = 3). The indications in the revision setting were failed hemiarthroplasty (n = 11), anatomic total shoulder arthroplasty (n = 4), and reverse arthroplasty (n = 3). The most common reason for revision was instability (n = 10). A compression plate was used for graft-to-host fixation in all shoulders. Shoulders were assessed for pain, motion, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, Neer score, revision or reoperation, radiographic evidence of graft union or resorption, and implant fixation. The mean duration of follow-up was 4 years (range, 2 to 10 years). RESULTS: RTSA using an APC construct resulted in substantial improvements in pain scores (p < 0.0001), elevation (p < 0.0001), and external rotation (p = 0.004). With the numbers available, there were no significant differences in clinical outcomes between primary and revision cases. No patients required revision surgery for nonunion at the host-allograft junction. The mean time to union was 7 months, with 1 patient requiring bone-grafting for delayed union. Other complications included dislocation, deep infection, graft fracture, and periprosthetic fracture distal to the previous APC construct in 1 patient each. The 2 and 5-year revision-free survival rate was 96%. CONCLUSIONS: Reconstruction of proximal humeral bone loss with an APC at the time of primary or revision RTSA is safe and effective, with acceptable functional outcomes and complication rates. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Artroplastia do Ombro/efeitos adversos
Reabsorção Óssea/diagnóstico por imagem
Transplante Ósseo/métodos
Instabilidade Articular/prevenção & controle
Articulação do Ombro/diagnóstico por imagem
Prótese de Ombro
[Mh] Termos MeSH secundário: Adulto
Idoso
Artroplastia do Ombro/métodos
Reabsorção Óssea/fisiopatologia
Reabsorção Óssea/cirurgia
Estudos de Coortes
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Desenho de Prótese
Recuperação de Função Fisiológica/fisiologia
Reoperação/métodos
Estudos Retrospectivos
Medição de Risco
Articulação do Ombro/fisiopatologia
Articulação do Ombro/cirurgia
Transplante Homólogo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01495


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[PMID]:28948516
[Au] Autor:Chen X; Reddy AS; Kontaxis A; Choi DS; Wright T; Dines DM; Warren RF; Berhouet J; Gulotta LV
[Ad] Endereço:Hospital for Special Surgery, 535 East 70 Street, New York, NY, 10021, USA. chenx@hss.edu.
[Ti] Título:Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study.
[So] Source:Clin Orthop Relat Res;475(12):3090-3099, 2017 Dec.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Version correction via eccentric reaming reduces clinically important retroversion in Walch type B2 glenoids (those with substantial glenoid retroversion and a second, sclerotic neoglenoid cavity) before total shoulder arthroplasty (TSA). Clinically, an increased risk of glenoid component loosening in B2 glenoids was hypothesized to be the result of compromised glenoid bone quality attributable to eccentric reaming. However, no established guidelines exist regarding how much version correction can be applied without compromising the quality of glenoid bone. QUESTIONS/PURPOSES: (1) How does version correction correlate to the reaming depth and the volume of resected bone during eccentric reaming of B2 glenoids? (2) How does version correction affect the density of the remaining glenoid bone? (3) How does version correction affect the spatial distribution of high-quality bone in the remaining glenoid? METHODS: CT scans of 25 patients identified with Walch type B2 glenoids (age, 68 ± 9 years; 14 males, 11 females) were selected from a cohort of 111 patients (age, 69 ± 10 years; 50 males, 61 females) with primary shoulder osteoarthritis who underwent TSA. Virtual TSA with version corrections of 0°, 5°, 10°, and 15° was performed on 25 CT-reconstructed three-dimensional models of B2 scapulae. After simulated eccentric reaming at each version correction angle, bone density (Hounsfield units [HUs]) was analyzed in five adjacent 1-mm layers under the reamed glenoid surface. Remaining high-quality bone (> 650 HUs) distribution in each 1-mm layer at different version corrections was observed on spatial distribution maps. RESULTS: Larger version corrections required more bone resection, especially from the anterior glenoid. Mean bone densities in the first 1-mm bone bed under the reamed surface were lower with 10° (523.3 ± 79.9 HUs) and 15° (479.5 ± 81.0 HUs) version corrections relative to 0° (0°, 609.0 ± 103.9 HUs; mean difference between 0° and 15°, 129.5 HUs [95% CI, 46.3-212.8 HUs], p < 0.001; mean difference between 0° and 10°, 85.7 HUs [95% CI, 8.6-162.9 HUs], p = 0.021) version correction. Similar results were observed for the second 1-mm bone bed. Spatial distribution maps qualitatively showed a decreased frequency of high-quality bone in the anterior glenoid as version correction increased. CONCLUSIONS: A version correction as low as 10° was shown to reduce the density of the glenoid bone bed for TSA glenoid fixation in our computational study that simulated reaming on CT-reconstructed B2 glenoid models. Increased version correction resulted in gradual depletion of high-quality bone from the anterior region of B2 glenoids. CLINICAL RELEVANCE: This computational study of eccentric reaming of the glenoid before TSA quantitatively showed glenoid bone quality is sensitive to version correction via simulated eccentric reaming. The bone density results of our study may benefit surgeons to better plan TSA on B2 glenoids needing durable bone support, and help to clarify goals for development of precision surgical tools.
[Mh] Termos MeSH primário: Artroplastia de Substituição/métodos
Cavidade Glenoide/cirurgia
Osteoartrite/cirurgia
Osteotomia/métodos
Modelagem Computacional Específica para o Paciente
Articulação do Ombro/cirurgia
Cirurgia Assistida por Computador
[Mh] Termos MeSH secundário: Idoso
Artroplastia de Substituição/efeitos adversos
Artroplastia de Substituição/instrumentação
Densidade Óssea
Feminino
Cavidade Glenoide/diagnóstico por imagem
Cavidade Glenoide/fisiopatologia
Seres Humanos
Imagem Tridimensional
Masculino
Meia-Idade
Osteoartrite/diagnóstico por imagem
Osteoartrite/fisiopatologia
Osteotomia/efeitos adversos
Desenho de Prótese
Interpretação de Imagem Radiográfica Assistida por Computador
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/fisiopatologia
Prótese de Ombro
Cirurgia Assistida por Computador/efeitos adversos
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171117
[Lr] Data última revisão:
171117
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170927
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-017-5510-7


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[PMID]:28796543
[Au] Autor:Shim E; Kang Y; Ahn JM; Lee E; Lee JW; Oh JH; Kang HS
[Ad] Endereço:1 Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundanggu, Seongnam-si, Gyeonggi-do, Korea.
[Ti] Título:Metal Artifact Reduction for Orthopedic Implants (O-MAR): Usefulness in CT Evaluation of Reverse Total Shoulder Arthroplasty.
[So] Source:AJR Am J Roentgenol;209(4):860-866, 2017 Oct.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objective of this study is to evaluate the effect of the metal artifact reduction algorithm for orthopedic implants (O-MAR) on CT image quality for patients with reverse total shoulder arthroplasty (RTSA), with emphasis placed on the evaluation of bone in the vicinity of prostheses. MATERIALS AND METHODS: Sixty-five patients who underwent CT scanning after RTSA were enrolled in the study. Two radiologists analyzed the images reconstructed with filtered back projection (FBP) with or without O-MAR processing. Images were evaluated to determine the degree of streaking artifacts, the confidence in depicting various structures around the prosthesis, and the presence of pseudolesions. The mean CT number and SD of the selected ROIs placed in the greater tuberosity, glenoid bone, and deltoid muscle were recorded. For measurements from the greater tuberosity and glenoid bone, the frequency with which the measurement met the typical CT number of bone was calculated. RESULTS: O-MAR images showed less metal streak artifact and noise and provided better visualization of the axillary neurovascular bundle compared with FBP images, with a statistically significant difference (p < 0.001 for all). FBP images were found to be statistically significantly better than O-MAR images, offering better visualization of bone cortex, bone trabeculae, and the bone-prosthesis interface (p < 0.001 for all). Scapular pseudonotching was observed on 4.6% of FBP images and 36.9% of O-MAR images. The pseudocemented appearance was noted on 47.7% of O-MAR images but was not seen on FBP images. CONCLUSION: The use of O-MAR improved CT image quality for patients with RTSA in the aspect of metal artifact reduction and soft-tissue profile. However, O-MAR tends to degrade depiction of the bone trabeculae and bone cortex and generate new artifacts, including a pseudocemented appearance and scapular pseudonotching.
[Mh] Termos MeSH primário: Algoritmos
Artefatos
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/cirurgia
Prótese de Ombro
Tomografia Computadorizada por Raios X
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia do Ombro
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.16.17684


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[PMID]:28730988
[Au] Autor:Gascoyne TC; McRae SMB; Parashin SL; Leiter JRS; Petrak MJ; Bohm ER; MacDonald PB
[Ad] Endereço:From the Orthopaedic Innovation Centre, Concordia Hip and Knee Institute, Winnipeg, Man. (Gascoyne, Parashin, Petrak); the Concordia Joint Replacement Group, Concordia Hip & Knee Institute, Winnipeg, Man. (Gascoyne, Parashin, Petrak, Bohm); the Pan Am Clinic, Winnipeg, Man. (McRae, Leiter, MacDo
[Ti] Título:Radiostereometric analysis of keeled versus pegged glenoid components in total shoulder arthroplasty: a randomized feasibility study.
[So] Source:Can J Surg;60(4):273-279, 2017 Aug.
[Is] ISSN:1488-2310
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study aimed to assess differences in the fixation and functional outcomes between pegged and keeled all-polyethylene glenoid components for standard total shoulder arthroplasty. METHODS: Patients were randomized to receive a keeled or pegged all-polyethylene glenoid component. We used model-based radiostereometric analysis (RSA) to assess glenoid fixation and subjective outcome measures to assess patient function. Follow-up examinations were completed at 6 weeks and 6, 12 and 24 months after surgery. Modifications to the RSA surgical, imaging and analytical techniques were required throughout the study to improve the viability of the data. RESULTS: Stymied enrolment resulted in only 16 patients being included in our analyses. The RSA data indicated statistically greater coronal plane migration in the keeled glenoid group than in the pegged group at 12 and 24 months. Functional outcome scores did not differ significantly between the groups at any follow-up. One patient with a keeled glenoid showed high component migration after 24 months and subsequently required revision surgery 7 years postoperatively. CONCLUSION: Despite a small sample size, we found significant differences in migration between glenoid device designs. Although clinically these findings are not robust, we have shown the feasibility of RSA in total shoulder arthroplasty as well as the value of a high-precision metric to achieve objective results in a small group of patients.
[Mh] Termos MeSH primário: Artroplastia do Ombro/métodos
Cavidade Glenoide
Avaliação de Processos e Resultados (Cuidados de Saúde)
Polietileno
Desenho de Prótese/normas
Falha de Prótese
Análise Radioestereométrica/métodos
Reoperação
Prótese de Ombro/normas
[Mh] Termos MeSH secundário: Artroplastia do Ombro/efeitos adversos
Estudos de Viabilidade
Seguimentos
Seres Humanos
Desenho de Prótese/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
9002-88-4 (Polyethylene)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE


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[PMID]:28349211
[Au] Autor:Valenti P; Aliani D; Maroun C; Werthel JD; Elkolti K
[Ad] Endereço:Paris Shoulder Unit, Clinique Bizet, Paris, France. Philippe.valenti@wanadoo.fr.
[Ti] Título:Shoulder hemiarthroplasty for proximal humeral fractures: analysis of clinical and radiographic outcomes at midterm follow-up: a series of 51 patients.
[So] Source:Eur J Orthop Surg Traumatol;27(3):309-315, 2017 Apr.
[Is] ISSN:1633-8065
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:Shoulder hemiarthroplasty has historically been the gold standard treatment for proximal humeral fractures not suitable to open reduction and internal fixation. In the last decades, reverse shoulder arthroplasty has gained more and more importance. Aim of this study is to retrospectively analyze subjective and objective outcomes of a group of consecutive patients. Fifty-one patients were evaluated with a mean follow-up of 18 months (range 12-60). For all the cases, the same surgical technique was performed in all cases. Range of motion, Constant-Murley score, ponderate Constant-Murley score, visual analog score and a patients' self-assessment scale were calculated. Anatomic tuberosities healing, stem positioning or mobilization were evaluated on postoperative X-rays and follow-up CT-scans. Statistical analysis was performed to calculate a correlation between subjective and objective results. Thirty-five patients (75%) declared to be satisfied of the operated shoulder. The mean CMS was 50 (17-91), the mean pCMS 72 (16-111). The mean forward flexion measured was 98° (40°-170°), the mean external rotation with adducted arm 22° (0°-60°), the mean internal rotation at sacrum (gluteus-T12). Four implants needed revision. Forty-seven stems were correctly positioned; 84.3% of tuberosities was anatomic or low positioned and consolidated in 74.5% of cases. Statistical analysis revealed significant correlation between CMS, pCMS, VAS and subjective satisfaction and between anatomic tuberosities healing and 3-part fractures. HA implant is a valid and reliable technique for the treatment of proximal humeral fracture. From our data, patients' satisfaction depends upon pain relief more than upon restore of function.
[Mh] Termos MeSH primário: Hemiartroplastia/métodos
Fraturas do Ombro/cirurgia
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Autoavaliação Diagnóstica
Feminino
Seguimentos
Hemiartroplastia/instrumentação
Seres Humanos
Masculino
Meia-Idade
Satisfação do Paciente
Amplitude de Movimento Articular
Reoperação
Estudos Retrospectivos
Rotação
Fraturas do Ombro/complicações
Fraturas do Ombro/fisiopatologia
Articulação do Ombro/cirurgia
Dor de Ombro/etiologia
Dor de Ombro/cirurgia
Prótese de Ombro
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1007/s00590-017-1927-7


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[PMID]:28261432
[Au] Autor:Choi CH; Kim SG; Lee JJ; Kwack BH
[Ad] Endereço:Shoulder and Elbow Joint Service, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea.
[Ti] Título:Comparison of Clinical and Radiological Results according to Glenosphere Position in Reverse Total Shoulder Arthroplasty: A Short-term Follow-up Study.
[So] Source:Clin Orthop Surg;9(1):83-90, 2017 Mar.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In a previous biomechanical study, eccentric glenospheres with more inferior position of the center of rotation were shown to improve range of motion and reduce the incidence of scapular notching after reverse total shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and radiological results of RSA using an eccentric glenosphere to those using a concentric glenosphere and to determine the usefulness of the eccentric glenosphere. METHODS: From 2009 to 2015, we performed a retrospective review of 20 consecutive patients who underwent RSA using a deltopectoral approach. Nine patients underwent RSA using a concentric glenosphere (group A) while 11 had an eccentric glenosphere (group B). The average follow-up period was 13.9 months (range, 12 to 18 months). All glenoid components were placed with 15° of inferior tilt. Clinical results were assessed using the visual analog pain scale score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, the Korean shoulder scoring system (KSS), and the Constant score. On radiological evaluation, prosthesisscapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenoshere rim distance (inferior glenoshpere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance, and severity of notching according to the Nerot-Sirveaux classification were assessed. RESULTS: The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. A significant intergroup difference was observed with regard to PGRD (24.8 ± 1.6 mm for group A vs. 22.2 ± 1.9 mm for group B; = 0.002) and inferior glenosphere overhang (2.0 ± 1.7 mm for group A vs. 5.8 ± 1.6 mm for group B; = 0.000). Seven of 9 patients in group A developed notching compared with 2 of 11 patients in group B ( = 0.022). The other radiological parameters such as inferior tilt and AT and GT distances were not significantly different between two groups. Complications such as loosening and scapular fractures did not occur. CONCLUSIONS: The eccentric glenosphere in RSA was more effective in reducing the rate of notching than the concentric glenosphere although clinical outcomes were not significantly different in the short-term follow-up.
[Mh] Termos MeSH primário: Artroplastia do Ombro/métodos
Lesões do Manguito Rotador/cirurgia
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Artroplastia do Ombro/efeitos adversos
Artroplastia do Ombro/instrumentação
Fenômenos Biomecânicos
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Medição da Dor
Dor Pós-Operatória/etiologia
Radiografia
Amplitude de Movimento Articular
Estudos Retrospectivos
Lesões do Manguito Rotador/complicações
Articulação do Ombro/cirurgia
Dor de Ombro/etiologia
Prótese de Ombro
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.1.83


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[PMID]:28238043
[Au] Autor:Boyer E; Menu G; Loisel F; Saadnia R; Uhring J; Adam A; Rochet S; Clappaz P; Baudouin E; Lascar T; Cermeno R; Obert L
[Ad] Endereço:Orthopedic, Traumatology, and Hand Surgery Unit, CHRU Besancon - University of Bourgogne - Franche Comte, Bd Fleming, 25030, Besançon, France. etienneboyerlurton@hotmail.fr.
[Ti] Título:Cementless and locked prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: prospective clinical evaluation of hemi- and reverse arthroplasty.
[So] Source:Eur J Orthop Surg Traumatol;27(3):301-308, 2017 Apr.
[Is] ISSN:1633-8065
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Cemented stem remains the gold standard for prosthesis in trauma. The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem (hemi and reverse) for 3- and 4-part proximal humeral fractures. MATERIALS AND METHODS: One hundred and thirty-four 3- and 4-part fractures have been treated by locked stem, 69 with hemiarthroplasty [mean age 68 years (50-90)] and 65 with reversed [mean age 78 years (66-91)]. The length of the stem was 15 cm with a proximal coating of HA automatic locking system (two screws) and four different diameters. Preliminary cadaver study allowed us to validate the system (22 shoulders, no injuries of nerves, locking system efficient). RESULTS: In the group of hemi, Constant score with ponderation reached 72 (11-120) and QDash 31.2 (4.5-77.27) with a mean FU of 25 months (6-96). In the group of reversed, Constant score with ponderation reached 77.6 (28.8-119) and QDash 36.2 (2-84) with a mean FU of 15 months (6-41). Specific complications due to locking system reached 3% but without reoperation. Other complications were capsulitis and infection. DISCUSSION: In this population of elderly patient, new fall with periprosthetic fracture or infection led the surgeon to remove the stem. At shoulder level, the removal of a cemented stem remains a highly demanding procedure with sometimes bad functional results and elevated level of complications. This series is the first one of locked stem without significant complications. Locked stem remains a new but logical tool in trauma.
[Mh] Termos MeSH primário: Artroplastia do Ombro/instrumentação
Hemiartroplastia/instrumentação
Fraturas do Ombro/cirurgia
Articulação do Ombro/fisiopatologia
Prótese de Ombro
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia do Ombro/métodos
Cadáver
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Amplitude de Movimento Articular
Fraturas do Ombro/fisiopatologia
Articulação do Ombro/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170227
[St] Status:MEDLINE
[do] DOI:10.1007/s00590-017-1926-8


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[PMID]:28093375
[Au] Autor:Fleischer J; Schleyer A; Nassutt R; Grittner U; Ojodu I; Hopp SJ
[Ad] Endereço:Department of trauma and orthopedics, Marien hospital, Am Hirschberg, 66606 St. Wendel, Germany. Electronic address: joerg.fleischer1@freenet.de.
[Ti] Título:Biomechanical strength and failure mechanism of different tubercula refixation methods within the framework of an arthroplasty for shoulder fracture.
[So] Source:Orthop Traumatol Surg Res;103(2):165-169, 2017 Apr.
[Is] ISSN:1877-0568
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and suggested suture patterns. We aimed to evaluate, which forces currently used suture and cerclage materials withstand and to assess whether they are useful with regard to stability of reconstruction of tuberosities and which failure modes they display. MATERIAL AND METHODS: Using sheep infraspinatus tendons with attached tuberosities three different suture materials (suture 1: Ethibond size 2; suture 2: Orthocord size 2; suture 3: Fiberwire size 5) and a 0.8mm titanium cerclage wire were investigated. For each suture material as well as the cerclage wire 6 tests were carried out. A material testing machine was used to perform cyclic loading tests (20mm/min, F =50N, F =100N, respectively after 50 cycles: F +50N until failure). Outcome measures and thus comparison criteria were the maximum holding force, number of cycles reached, total elongation of the system (tendon and suture) and qualitative appraisal and documentation of the mechanism of failure. RESULTS: Overall average maximum forces between the fixation materials differed significantly (P=0.003), especially suture 3 (braided polyethylene coating, non-resorbable polyfile UHMW core) displayed superior results in comparison to the cerclage wire (P=0.016). Although, primary elongation of the cerclage technique was significantly lower compared to the suture materials (P=0.002). All tests showed a high initial lengthening and caused incision-like defects in the bone or tendon and led to failure and huge displacement of the tuberosities. DISCUSSION: Currently used suture and cerclage materials have a limited usefulness for refixation of tuberosities due to an increased risk of obstruction for bony consolidation. LEVEL OF EVIDENCE: Basic science, Biomechanics.
[Mh] Termos MeSH primário: Artroplastia/métodos
Fios Ortopédicos
Úmero/lesões
Úmero/cirurgia
Fraturas do Ombro/cirurgia
Suturas
[Mh] Termos MeSH secundário: Animais
Fenômenos Biomecânicos
Falha de Equipamento
Análise de Falha de Equipamento
Seres Humanos
Teste de Materiais
Polietileno
Polietilenotereftalatos
Ovinos
Prótese de Ombro
Técnicas de Sutura
Tendões
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Ethibond); 0 (Polyethylene Terephthalates); 9002-88-4 (Polyethylene)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170118
[St] Status:MEDLINE


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[PMID]:28050640
[Au] Autor:Collin P; Matsukawa T; Boileau P; Brunner U; Walch G
[Ad] Endereço:Institut Locomoteur de l'Ouest CHP Saint Grégoire (vivalto Santé), 6 Boulevard de la Boutière, 35740, Saint Grégoire, France. collin.ph@wanadoo.fr.
[Ti] Título:Is the humeral stem useful in anatomic total shoulder arthroplasty?
[So] Source:Int Orthop;41(5):1035-1039, 2017 05.
[Is] ISSN:1432-5195
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Traditionally and since Neer, the humeral side of shoulder arthroplasty consisted of a stemmed component but the real need for stem fixation in total shoulder arthroplasty (TSA) has barely been investigated. The current study evaluated the clinical and radiological outcomes with a stemless TSA. METHODS: Forty-seven patients, 20 female and 27 male patients with an average age of 63, were selected in four orthopaedic centres during a four year period, and implanted with a humeral head prosthesis with a three-fin design and titanium coating. Aetiologies were: primary osteoarthritis (29), fracture sequelae (12) and avascular osteonecrosis (6). Minimum follow-up was two years (range 24-51 months). The patients were evaluated with the Constant score (CS) and radiological exams. RESULTS: Two patients had revision of the implants, one for persistent pain and one for secondary massive rotator cuff tear. At the final follow-up, the mean CS was 69, with an average gain of 36. All parameters improved with a foremost in pain relief. Mean satisfaction rate was 87%. Average anterior active elevation was 131° with a gain of 48. Radiologic evaluations showed stable implants in all cases. However, 17 cases demonstrated radiolucent areas, particularly superior and lateral to the implant, which neither decreased nor increased with time. No revisions were related to humeral component loosening. CONCLUSIONS: Stemless TSA provides the same results as compared to TSA with a humeral stem. We are still unsure as to the nature of the lucent zones and we are continuing our investigation to better understand this radiological phenomenon.
[Mh] Termos MeSH primário: Artroplastia do Ombro/métodos
Úmero/cirurgia
Osteoartrite/cirurgia
Osteonecrose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Amplitude de Movimento Articular
Articulação do Ombro/cirurgia
Prótese de Ombro
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170105
[St] Status:MEDLINE
[do] DOI:10.1007/s00264-016-3371-4



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