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      Shoulder Osteoarthritis

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      Author(s): 1 , * , 2
      Publication date (Electronic):
      Journal: Arthritis
      Publisher: Hindawi Publishing Corporation

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          Abstract

          Osteoarthritis (OA) is the most frequent cause of disability in the USA, affecting up to 32.8% of patients over the age of sixty. Treatment of shoulder OA is often controversial and includes both nonoperative and surgical modalities. Nonoperative modalities should be utilized before operative treatment is considered, particularly for patients with mild-to-moderate OA or when pain and functional limitations are modest despite more advanced radiographic changes. If conservative options fail, surgical treatment should be considered. Although different surgical procedures are available, as in other joints affected by severe OA, the most effective treatment is joint arthroplasty. The aim of this work is to give an overview of the currently available treatments of shoulder OA.

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          Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.

          Pascal Boileau, Duncan Watkinson, Armodios M Hatzidakis … (2015)
          This clinical study was performed to analyze the midterm results and potential complications of the reverse prosthesis in different diagnosis. Forty-five consecutive patients with Grammont prosthesis were evaluated clinically and radiographically with a mean follow-up of 40 months (range, 24-72 months). The indication was a massive and irreparable cuff tear associated with arthrosis (CTA) in 21 cases, fracture sequelae (FS) with arthritis in 5 cases, and failure of a revision arthroplasty (revision) in 19 cases. Fourteen complications occurred in 11 patients. 3 dislocations, 3 deep infections (all 3 in the revision group), 1 case of aseptic humeral loosening, 2 periprosthetic humeral fractures, 1 intraoperative glenoid fracture, 1 wound hematoma, 2 late acromial fractures, and 1 axillary nerve palsy. Of the patients, 10 (22%) required further surgery: 4 reoperations, 4 prosthesis revisions, and 2 prosthesis removals. Complications were higher in revision than in CTA (47% vs. 5%). All 3 groups showed a significant increase in active elevation (from 55 degrees preoperatively to 121 degrees postoperatively) and Constant score (from 17 to 58 points) but no significant change in active external rotation (from 7 degrees to 11 degrees ) or internal rotation (S1 preoperatively and postoperatively). Of the patients, 78% were satisfied or very satisfied with the result and 67% had no or slight pain. However, the postoperative Constant score, adjusted Constant score, and American Shoulder and Elbow Surgeons shoulder score were all significantly higher in the CTA group with as compared with the revision group (P = .01, .004, and .002, respectively). Scapular notching was seen in 24 cases (68%). No glenoid loosening was observed at current follow-up, even when the notch extended beyond the inferior screw (28% of cases). Atrophy of severe fatty infiltration of the teres minor was associated with lower external rotation (15 degrees vs 0 degrees , P = .02) and lower functional results (Constant score of 46 points vs 66 points, P < .007). The Grammont reverse prosthesis can improve function and restore active elevation in patients with incongruent cuff-deficient shoulders; active rotation is usually unchanged. Results are less predictable and complication and revision rates are higher in patients undergoing revision surgery as compared with those in patients with CTA. Results of the reverse prosthesis depend on the diagnosis and on the remaining cuff muscles, specifically the teres minor. Surgeons should be vigilant with regard to low-grade infection in revision surgery.
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            Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.

            Jacques Guery, Luc Favard, François Sirveaux … (2006)
            Reverse total shoulder arthroplasty is currently being used to treat selected patients with disabling shoulder arthropathy. The purposes of this study were to investigate the medium-term results of reverse total shoulder arthroplasty and to analyze the influence of etiology on the result. We carried out a multicenter study with a minimum follow-up of five years and determined the survival rate of the prosthesis according to the initial etiology of the shoulder arthropathy. Eighty prostheses were implanted in seventy-seven patients between 1992 and 1998. Sixty-six shoulders had an arthropathy with a massive rotator cuff tear, and fourteen shoulders had a disorder with another etiology (rheumatoid arthritis, trauma, or revision arthropathy). At the time of review, eighteen patients had died and two were lost to follow-up. The remaining fifty-seven patients (sixty shoulders) were examined or interviewed by telephone at a mean follow-up of 69.6 months. Cumulative survival curves were generated with replacement of the prosthesis, glenoid loosening, and a functional Constant score of <30 as the end points. The survival rate with replacement of the prosthesis and glenoid loosening as the end points were 91% and 84%, respectively, at 120 months, with shoulders that had arthropathy with a massive rotator cuff tear demonstrating a significantly better result than those that had a disorder with another etiology (p < 0.05). On the other hand, the survival rate with an absolute Constant score of <30 as an end point was 58% at 120 months, with no significant difference with respect to etiology. Two breaks were observed in the survival curves. The first concerned survival until replacement of the prosthesis and occurred at around three years, reflecting early loosening of the prosthesis. The curve then became stable. A second break started at around six years and reflected progressive deterioration of the functional result. Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands.
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              A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis.

              Dianne Bryant, Robert Litchfield, Michael Sandow … (2005)
              A systematic review of the literature was performed to estimate the impact of hemiarthroplasty compared with total shoulder arthroplasty on function and range of motion in patients suffering from osteoarthritis of the shoulder. We conducted an electronic search for relevant studies published in any language from 1966 to 2004, a manual search of the proceedings from five major orthopaedic meetings from 1995 to 2003, and a review of the reference lists from potentially relevant studies. Four randomized clinical trials, with similar eligibility criteria and surgical techniques, that compared hemiarthroplasty and total shoulder arthroplasty for the treatment of primary osteoarthritis of the shoulder were found to be eligible. Authors from three of the four studies provided original patient data. Analysis of covariance focused on the two-year outcome and included a comparison of the aggregate University of California at Los Angeles shoulder score, four University of California at Los Angeles domain scores, and range of motion. A total of 112 patients (fifty managed with hemiarthroplasty and sixty-two managed with total shoulder arthroplasty), who had a mean age of sixty-eight years, were included in this analysis. A significant moderate effect was detected in the function domain of the University of California at Los Angeles shoulder score (p < 0.001) in favor of total shoulder arthroplasty (mean [and standard deviation], 8.1 +/- 0.3) compared with hemiarthroplasty (mean, 6.6 +/- 0.3). A significant difference in the pain score was found in favor of the total shoulder arthroplasty group (p < 0.0001). However, the large degree of heterogeneity (p = 0.006, I(2) = 80.2%) among the studies decreased our confidence that total shoulder arthroplasty provides a true, consistent benefit with regard to pain. There was a significant difference in the overall change in forward elevation of 13 degrees (95% confidence interval, 0.5 degrees to 26 degrees ) in favor of the total shoulder arthroplasty group (p = 0.008). At a minimum of two years of follow-up, total shoulder arthroplasty provided better functional outcome than hemiarthroplasty for patients with osteoarthritis of the shoulder. Since continuous degeneration of the glenoid after hemiarthroplasty or glenoid loosening after total shoulder arthroplasty may affect the eventual outcome, longer-term (five to ten-year) results are necessary to determine whether these findings remain consistent over time.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arthritis
                Journal ID (iso-abbrev): Arthritis
                Journal ID (publisher-id): ARTH
                Title: Arthritis
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-1984
                ISSN (Electronic): 2090-1992
                Publication date (Print): 2013
                Publication date (Electronic): 10 January 2013
                Volume: 2013
                Electronic Location Identifier: 370231
                Affiliations
                1Department of Orthopaedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), via Faggiana 1668, 04100 Latina, Italy
                2Department of Orthopaedics and Traumatology, Sapienza University of Rome, ICOT, via Faggiana 1668, 04100 Latina, Italy
                Author notes
                *Claudio Chillemi: c_chillemi@ 123456libero.it

                Academic Editor: Burkhard Leeb

                Author information
                https://orcid.org/0000-0001-6660-7751
                https://orcid.org/0000-0003-4717-7594
                Article
                DOI: 10.1155/2013/370231
                PMC ID: 3556427
                PubMed ID: 23365745
                SO-VID: 68a4bb8d-1afb-4d6f-995e-485bd00aa075
                Copyright © Copyright © 2013 C. Chillemi and V. Franceschini.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 August 2012
                Date accepted : 19 December 2012
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Rheumatology
                Data availability:
                ScienceOpen disciplines: Rheumatology

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