Robert H. Cofield

Total shoulder arthroplasty with a tissue-ingrowth glenoid component*

A newly designed, uncemented, tissue-ingrowth glenoid component with a porous surface was used in association with the Neer humeral head prosthesis for 32 total shoulder arthroplasties in 29 patients. The diagnoses for the shoulders were osteoarthritis in 17, rheumatoid arthritis in eight, and traumatic arthritis in seven. Follow-up evaluations averaged 51 months (range, 29 to 80 months). Five complications occurred, necessitating four reoperations: two for glenoid component dissociation, one for humeral loosening, and one for infection. Little or no pain was experienced after the operation in 27 (96%) of the 28 shoulders that required no additional surgery. Average active abduction was 145°, average external rotation was 59°, and median internal rotation was to 112. Three glenoid components had probable loosening on radiographic examination. Eight shoulders had some degree of instability; a complication related to the glenoid component (polyethylene dissociation) or probable loosening not yet requiring reoperation developed in four of these (p < 0.02). These data support the continuing use of an uncemented, tissue-ingrowth glenoid component in arthritic shoulders with adequate bone support. Joint instability must be avoided to lessen complications and the need for revision surgery.

Shoulder arthrography for determination of size of rotator cuff tear.

One hundred eight shoulder arthrograms were performed in 105 patients who subsequently underwent surgical repair of a rotator cuff tear. Eighty-seven were single-contrast arthrograms and 21 were double-contrast studies; three or more views were used for all shoulders. Four readers independently evaluated the arthrograms (two orthopaedic surgeons and two radiologists). The size of the rotator cuff tear could be categorized into one of four groups with accuracy in only 56% of the cases; however, the fear size was identified with accuracy or within one size category in 96% of the shoulders studied.

Outcomes of Primary Reverse Shoulder Arthroplasty for Dislocation Arthropathy

Background Proper soft tissue balance is paramount to maintaining stability and a functional arc of motion in shoulder arthroplasty but is impaired in patients with prior glenohumeral (GH) dislocations. The purpose of this study was to determine the clinical outcomes, revisions, and complications of reverse shoulder arthroplasty (RSA) in patients with a history of glenohumeral dislocation. Methods Twenty-four patients with a history of GH dislocations that developed arthropathy underwent primary RSA from 2007 to 2013 were retrospectively reviewed. Mean follow-up was 3.3 years (2–7 years). Mean age was 70 years. Eight patients (33%) and 7 patients (29%) had complete or partial subscapularis deficiency, respectively. Results Twenty-two patients (92%) had little to no pain at final follow-up. Mean shoulder elevation improved from 48° to 120° (Pu2009<u2009.001) and mean external rotation increased from 13.2° to 48° (Pu2009<u2009.001). There were trends toward less complete pain relief and poorer motion in those with complete subscapularis deficiency. None of the patients experienced a postoperative dislocation or evidence of glenoid loosening at final radiographic follow-up, but 1 patient (4.2%) underwent early revision to a hemiarthroplasty for glenoid loosening. Conclusion RSA provides patients with prior glenohumeral dislocations a stable, pain-free arc of motion. Postoperative instability was not identified as a major failure mode at short-term follow-up. Complete subscapularis deficiency is a risk factor for poorer clinical outcome.

Treatment and Outcomes of Reverse Shoulder Arthroplasty Dislocations

Background Dislocation is a challenging complication after reverse shoulder arthroplasty (RSA). We sought to evaluate the outcome of nonoperative and operative management of the dislocation after primary and revision RSA. Methods Between 2006 and 2013, dislocation occurred in 12/1081 primary RSAs (1.1%) and 15/342 revision RSAs (4.4%). Seventeen (69%) shoulders dislocated within 3 months of surgery. Ten (68%) patients underwent revision RSA for prosthetic instability. Mean age was 69 years, and mean follow-up after index RSA was 4 years. Results Closed reduction and bracing achieved a stable shoulder in 60% (3/5 patients) after primary and 20% (1/5 patients) after revision RSA dislocation. Operative management achieved a stable shoulder in 88% (7/8 patients) of primary and 64% (7/11 patients) of revision RSAs (Pu2009=u2009.40). Overall, 9 shoulders (33%) had persistent instability at the final follow-up: 2/12 (17%) primaries versus 7/15 (47%) revisions (Pu2009=u2009.08). Preoperative prosthetic instability was the main risk factor for chronic instability in the revision cohort (Pu2009=u2009.02). Worse functional outcomes were associated with the dislocation of a revision RSA (Pu2009=u2009.02). Conclusion After primary RSA dislocations, closed reduction is successful in half, while revision surgery is successful in 85% of cases. Conversely, closed reduction of a dislocated revision RSA is rarely successful, while revision surgery is successful 65% of the time. Every attempt should be made to achieve stability at the time of primary and revision RSA, since reduction or revision surgery does not guarantee the restoring stability.