Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Aug 2017
Survival of the pegged glenoid component in shoulder arthroplasty: part II.
Loosening of the glenoid component is a primary reason for failure of an anatomic shoulder arthroplasty. Pegged glenoids were designed in an effort to outperform keeled components. This study evaluated the midterm clinical and radiographic survival of a single implant design with implantation of an in-line pegged glenoid component and identified risk factors for radiographic loosening and clinical failure. ⋯ Despite the predominant thinking that pegged glenoid components may be superior to keeled designs, midterm radiographic and clinical failure rates were high with this pegged component design, particularly after 5 years. Advanced presurgical glenoid erosion and younger patient age are risk factors for radiographic loosening. Revision rates underestimate radiographic glenoid loosening.
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J Shoulder Elbow Surg · Aug 2017
Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty.
Shoulder arthroplasty is an effective procedure for managing patients with shoulder pain secondary to end-stage arthritis. Insurance status has been shown to be a predictor of patient morbidity and mortality. The current study evaluated the effect of patient insurance status on perioperative outcomes after shoulder replacement surgery. ⋯ Private insurance payer status is associated with a lower risk of perioperative medical and surgical complications compared with an age- and sex-matched Medicare and Medicaid/uninsured payer status. Mortality was not statistically associated with payer status. Primary insurance payer status should be considered as an independent risk factor during preoperative risk stratification for shoulder arthroplasty procedures.
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J Shoulder Elbow Surg · Jul 2017
Randomized Controlled TrialLiposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: a prospective randomized controlled trial.
Pain management strategies following shoulder arthroplasty vary significantly. Liposomal bupivacaine (LB) is an extended-release delivery of a phospholipid bilayer encapsulating bupivacaine that can result in drug delivery up to 72 hours. Prior studies in lower extremity surgery demonstrated efficacy of LB in comparison to a single-shot peripheral nerve block; however, no study has investigated LB in a total shoulder arthroplasty population. Therefore, this study compared LB vs. an indwelling interscalene nerve block (IINB). ⋯ Use of an IINB provides superior pain management in the immediate postoperative setting as demonstrated by decreased narcotic medication consumption and lower subjective pain scores.
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J Shoulder Elbow Surg · Jul 2017
Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes?
The purpose of this study was to investigate whether healed tuberosities yield better rotational range of motion (ROM) and functional outcomes compared with unhealed tuberosities after reverse shoulder arthroplasty in elderly patients with comminuted proximal humerus fractures. ⋯ After reverse shoulder arthroplasty for 4-part proximal humerus fracture, tuberosities were healed in an anatomic position in 37% of patients. However, there were no significant differences in functional outcomes and ROM between the 2 groups, with the exception of external rotation, which was better in the healed tuberosity group. Therefore, tuberosity healing is not a prerequisite for satisfactory outcomes after reverse shoulder arthroplasty for 4-part proximal humerus fractures in elderly patients.
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J Shoulder Elbow Surg · Jun 2017
Functional results of bilateral reverse total shoulder arthroplasty.
The purpose of this study was to analyze a population of patients with bilateral reverse total shoulder arthroplasty (RTSA) to evaluate their ability to perform activities of daily living and personal hygiene tasks. ⋯ Bilateral RTSA provides predictable pain relief and improved function. Hygiene practices are unaltered for most patients, and the other patients rapidly develop simple compensatory strategies and retain independence in activities of daily living.