Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Apr 2017
Comparative StudyComparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair.
Repair of the subscapularis with reverse total shoulder arthroplasty (rTSA) is controversial. The purpose of this study is to quantify rTSA outcomes in patients with and without subscapularis repair to determine if there is any impact on clinical outcomes. ⋯ Significant clinical improvements were observed for both the subscapularis-repaired and non-repaired cohorts, with some statistical differences observed using a variety of outcome measures. Repair of the subscapularis did not lead to inferior clinical outcomes as predicted by biomechanical models. No difference was noted in the complication or scapular notching rates between cohorts. These clinical results show that rTSA using a lateralized humeral prosthesis delivers reliable clinical improvements with a low risk of instability, regardless of subscapularis repair.
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J Shoulder Elbow Surg · Apr 2017
Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty.
Alternative techniques have been developed to address pain after shoulder arthroplasty and are well documented. We evaluated the effect of adding intraoperative liposomal bupivacaine and intravenous dexamethasone during shoulder arthroplasty. ⋯ These changes to the perioperative shoulder arthroplasty protocol decreased hospitalization length of stay, narcotic requirement, and pain.
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J Shoulder Elbow Surg · Apr 2017
Comparative StudyContinuous versus single shot brachial plexus block and their relationship to discharge barriers and length of stay.
Brachial plexus block has been associated with improved pain control and decreased length of stay in patients undergoing upper extremity arthroplasty. Continuous delivery is associated with a shorter length of stay; however, comparisons to single-shot delivery in this setting are scarce. As the paradigm shifts to outpatient arthroplasty in the era of bundled payments, there exists a strong impetus to identify the most effective mode of analgesia associated with the least risk to patients. ⋯ There was no demonstrated disparity in the rate of complications associated with single-shot vs. continuous brachial plexus block. However, the continuous indwelling catheter was associated with an increased incidence of potential barriers to discharge and an increased length of stay compared with patients receiving single-shot regional anesthesia.
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J Shoulder Elbow Surg · Apr 2017
Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.
This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. ⋯ In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes.
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J Shoulder Elbow Surg · Mar 2017
Comparative StudyPrimary reverse total shoulder arthroplasty outcomes in patients with subscapularis repair versus tenotomy.
Reverse total shoulder arthroplasty (RTSA) is now performed at nearly the same rate as anatomic total shoulder arthroplasty in the United States. Repair of the subscapularis is of vital importance in total shoulder arthroplasty; however, its utilization in RTSA has recently been questioned. ⋯ Primary RTSAs with or without subscapularis repair have similar clinical outcome scores, range of motion, strength, and rates of complications including dislocations at 3 years of follow-up.