Ken Faber

Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. A prospective, randomized trial.

BACKGROUNDnBoth total shoulder arthroplasty and hemiarthroplasty have been used commonly to treat severe osteoarthritis of the shoulder; however, their effect on disease-specific quality-of-life outcome is unknown. The purpose of this study was to compare the quality-of-life outcome following hemiarthroplasty with that following total shoulder arthroplasty in patients with osteoarthritis of the shoulder.nnnMETHODSnForty-two patients with a diagnosis of osteoarthritis of the shoulder were randomized to receive a hemiarthroplasty or a total shoulder arthroplasty. One patient died, and all others were evaluated preoperatively and at six weeks and three, six, twelve, eighteen, and twenty-four months postoperatively with use of a standardized format including a disease-specific quality-of-life measurement tool (Western Ontario Osteoarthritis of the Shoulder [WOOS] index), general shoulder rating scales (University of California at Los Angeles [UCLA] shoulder scale, Constant score, and American Shoulder and Elbow Surgeons [ASES] evaluation form), general pain scales (McGill pain score and visual analogue scale), and a global health measure (Short Form-36 [SF-36]). When a patient required revision of a hemiarthroplasty to a total shoulder arthroplasty, the last score before he or she crossed over was used for the analysis.nnnRESULTSnSignificant improvements in disease-specific quality of life were seen two years after both the total shoulder arthroplasties and the hemiarthroplasties. There were no significant differences in quality of life (WOOS score) between the group treated with total shoulder arthroplasty and that treated with hemiarthroplasty (90.6 +/- 13.2 and 81.5 +/- 24.1 points, respectively; p = 0.18). The other outcome measures demonstrated similar findings. Two patients in the hemiarthroplasty group crossed over to the other group by undergoing a revision to a total shoulder arthroplasty because of glenoid arthrosis.nnnCONCLUSIONSnBoth total shoulder arthroplasty and hemiarthroplasty improve disease-specific and general quality-of-life measurements. With the small number of patients in our study, we found no significant differences in these measurements between the two treatment groups.nnnLEVEL OF EVIDENCEnTherapeutic Level I.

Advanced cement technique improves fixation in elbow arthroplasty.

An in vitro study was conducted to assess the efficacy of advanced cementing techniques in the fixation of the humeral stem in elbow arthroplasty. Sixteen fresh frozen cadaveric distal humeri were prepared to accept an acrylic sham humeral stem. Conventional cementing technique using doughy cement manually inserted and packed was performed in 8 specimens. The advanced cementing technique, consisting of canal irrigation, brushing and drying with gauze, canal plugging, and low viscosity cement pressurization with a delivery system was performed in the other specimens. All humeri subsequently were sectioned into 10 mm thick sections, photographed, and digitized to quantify the perimeter and area of the stem, cement mantle, corticocancellous junction, and cement voids. The degree of cement filling, determined from the area fraction of cement to the total available area within the corticocancellous junction, was significantly greater in the advanced group compared with the conventional group. Mechanical assessment of the specimens consisted of a push out load to failure test of the cement mantle from bone. For all locations in the distal humerus, the failure load and failure stress in the advanced group was significantly greater than the conventional group. It is concluded that development of an effective cement restrictor and application of advanced cement techniques in vivo should improve the initial fixation of the humeral component and may decrease the incidence of aseptic loosening associated with elbow arthroplasty.

Outcomes and complications of ulnar shortening osteotomy: an institutional review

BackgroundUlnar impaction syndrome (UIS) is a common cause of ulnar wrist pain. Patients may be candidates for surgical intervention if nonoperative options are ineffective. At our institution, ulnar shortening osteotomy is the preferred procedure to manage this disorder. The purpose of this study was to present patient reported outcomes and complication rates of ulnar shortening osteotomy (USO) at mid-term follow-up.MethodsA retrospective chart review of 72 patients (75 wrists) obtained from our institutional database was performed. At a mean 32xa0months postoperatively, telephone interviews (nu2009=u200953) were performed for all patients who were available for follow-up. The patient-rated wrist evaluation (PRWE), a validated outcome tool, was completed and complications were reviewed.ResultsPatient-rated outcomes were favorable; however, complications were frequent and included: delayed union (10/75, 13.3xa0%), nonunion (6/75, 8xa0%), and complex regional pain syndrome (5/75, 6.7xa0%). Ten patients (13.3xa0%) required revision surgery. Thirty-four patients (45.3xa0%) required hardware removal with 4/30 (11.4xa0%) of these patients experiencing refracture. Smokers (mean PRWE 67.1) and patients with workers’ compensation claims (mean PRWE 64.9) reported higher residual pain and disability than their counterparts (mean PRWE 28.0; 25.2).ConclusionsGeneral outcome measures were favorable. Smokers and patients with workers’ compensation claims experienced significantly poorer outcomes. However, the incidence of nonunion and delayed union was higher than most reports in the literature. Furthermore, we demonstrated a high refracture rate (11.4xa0%) following removal of hardware.

Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management

Study Design: Clinical Commentary. Introduction: Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. Purpose of the Study: The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. Methods/Results/Discussion: N/A for clinical commentary. Conclusions: The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. Level of Evidence: 5.

Feasibility of an at Home, Online, Yoga-Based and Standard Exercise Intervention for Rotator Cuff Injuries

Exercise has been shown to benefit RC patients in terms of reducing pain, improving strength, ROM and function.3 However, clinical studies have primarily examined the role of traditional exercise for RC rehabilitation. The effects of yoga as exercise through an online home based setting have been scarcely investigated. This chapter will discuss the feasibility of a 6-week long exercise intervention. The purposes of this feasibility study were to: