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      Technical difficulty in component sizing and positioning in humeral resurfacing: Relationship to clinical outcomes

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          Abstract

          INTRODUCTION: Resurfacing of the glenohumeral joint has gained popularity since its first introduction. Among other advantages, it is reported to allow closer replication of individual anatomy - failure of which may produce inferior clinical results. We review a cohort of patients who had undergone proximal humeral resurfacing, to evaluate certain radiological parameters of component sizing and positioning, and to correlate these with the clinical outcomes. MATERIALS AND METHODS: From January 2000 to March 2011, 51 humeral resurfacing procedures were performed in 49 patients. Patients were contacted for review, and assessed using patient-reported outcome measures. An Oxford Shoulder Score (OSS) as well as a subjective satisfaction and outcome questionnaire were completed, as well as details regarding further surgery or revision. Radiographs were evaluated for component size, offset, inclination and height. Two patients had demised, ten patients were not contactable, and in four the medical files had been lost. In the remaining 35 shoulders, the average follow-up was 5.43 years. The mean age at time of surgery was 64.8 years (range 36 to 84). RESULTS: Complications included eight revisions (average 2.4 years post-surgery), while a further one patient awaits revision. The mean OSS in the unrevised shoulders was 36.1 (range 10 to 48). There was no difference between the revised and unrevised group for peri-operative variables (pre-op diagnosis, smoking status, age, gender, surgeon involved), or any of the radiographic variables (inclination, offset, prosthesis height, increase in head size). In the unrevised group, there was no correlation between the OSS and radiographic measurements of offset, inclination or head height. Prostheses that subjectively appeared mal-sized or mal-positioned obtained better OSSs and subjective satisfaction scores. Revised cases were all subjectively satisfied post revision to stemmed total shoulder replacement. CONCLUSION: We have demonstrated difficulties in correct sizing and component placement as evident by the post-operative radiographic analysis, but are unable to correlate these with clinical scores. We have encountered a wide range of patient-reported shoulder scores and levels of satisfaction which, however unexplainably, have shown better scores for subjectively mal-sized and mal-positioned prostheses.

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          Increasing incidence of shoulder arthroplasty in the United States.

          The number of total shoulder arthroplasties performed in the United States increased slightly between 1990 and 2000. However, the incidence of shoulder arthroplasty in recent years has not been well described. The purpose of the present study was to examine recent trends in shoulder hemiarthroplasty and total shoulder arthroplasty along with the common reasons for these surgical procedures in the United States. We modeled the incidence of shoulder arthroplasty from 1993 to 2008 with use of the Nationwide Inpatient Sample. On the basis of hemiarthroplasty and total shoulder arthroplasty cases that were identified with use of surgical procedure codes, we conducted a design-based analysis to calculate national estimates. While the annual number of hemiarthroplasties grew steadily, the number of total shoulder arthroplasties showed a discontinuous jump (p < 0.01) in 2004 and increased with a steeper linear slope (p < 0.01) since then. As a result, more total shoulder arthroplasties than hemiarthroplasties have been performed annually since 2006. Approximately 27,000 total shoulder arthroplasties and 20,000 hemiarthroplasties were performed in 2008. More than two-thirds of total shoulder arthroplasties were performed in adults with an age of sixty-five years or more. Osteoarthritis was the primary diagnosis for 43% of hemiarthroplasties and 77% of total shoulder arthroplasties in 2008, with fracture of the humerus as the next most common primary diagnosis leading to hemiarthroplasty. The number of shoulder arthroplasties, particularly total shoulder arthroplasties, is growing faster than ever. The use of reverse total arthroplasty, which was approved by the United States Food and Drug Administration in November 2003, may be part of the reason for the greater increase in the number of total shoulder arthroplasties. A long-term follow-up study is warranted to evaluate total shoulder arthroplasty in terms of patient outcomes, safety, and implant longevity.
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            Questionnaire on the perceptions of patients about shoulder surgery.

            We developed a 12-item questionnaire for completion by patients having shoulder operations other than stabilisation. A prospective study of 111 patients was undertaken before operation and at follow-up six months later. Each patient completed the new questionnaire and the SF36 form. Some filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon assessed the Constant shoulder score. The single score derived from the questionnaire had a high internal consistency. Reproducibility, examined by test-retest reliability, was found to be satisfactory. The validity of the questionnaire was established by obtaining significant correlations in the expected direction with the Constant score and the relevant scales of the SF36 and the HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. Changes in scores were compared with the patients' responses to postoperative questions about their condition. The standardised effect size for the new questionnaire compared favourably with that for the SF36 and the HAQ. The new questionnaire was the most efficient in distinguishing patients who said that their shoulder was much better from all other patients. The shoulder questionnaire provides a measure of outcome for shoulder operations which is short, practical, reliable, valid and sensitive to clinically important changes.
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              The development of a disease-specific quality of life measurement tool for osteoarthritis of the shoulder: The Western Ontario Osteoarthritis of the Shoulder (WOOS) index.

              The purpose of this study was to develop and validate a disease-specific quality of life measurement tool for osteoarthritis (OA) of the shoulder. An instrument which could be used as the primary outcome measure in clinical trials involving patients with OA of the shoulder was developed using a specific methodological protocol: (1) identification of a specific patient population; (2) item generation; (3) item reduction; (4) pre-testing of the prototype questionnaire and (5) determining the validity, reliability and responsiveness of the final questionnaire. The final instrument contains 19 items, each with a visual analog response option for the four domains (six questions for pain and physical symptoms, five questions for sport, recreation and work, five questions for lifestyle function and three questions for emotional function). Ten of the 19 questions had not been identified previously on other shoulder measurement tools. The instrument proved to be valid by demonstrating predicted correlations with previously published shoulder measures, global health status measure and range of motion. The new instrument was also more responsive than other shoulder measurement tools, a global health status measure and range of motion. Since the patient's own perception of changes in health status is the most important indicator of the success of treatment we suggest that this measurement tool be used as the primary outcome in clinical evaluation of various treatments for OA of the shoulder and monitoring patients over time. Copyright 2001 OsteoArthritis Research Society International.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                saoj
                SA Orthopaedic Journal
                SA orthop. j.
                Champagne Media (Pty) Ltd (Pretoria )
                2309-8309
                September 2015
                : 14
                : 3
                : 32-42
                Affiliations
                [1 ] University of KwaZulu-Natal
                [2 ] University of Cape Town
                [3 ] University of Cape Town
                Article
                S1681-150X2015000300004
                10.17159/2309-8309/2015/V14N3A3
                2bfd2698-aeb5-4bf6-b1cd-a9d08d5758cc

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO South Africa

                Self URI (journal page): http://www.scielo.org.za/scielo.php?script=sci_serial&pid=1681-150X&lng=en
                Categories
                Health Care Sciences & Services
                Orthopedics

                Orthopedics,Health & Social care
                shoulder replacement,shoulder arthroplasty,humeral resurfacing

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