Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty? The Prevalence of Glenohumeral Osteoarthrosis in Unstable Shoulders * The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability
BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures Background A concern regarding  reverse shoulder arthroplasty ( RSA )  is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty . Questions / purpose sWe determined ( 1 ) the rate of instability and infection ; ( 2 ) whether diagnosis influenced instability and infection rates ; and ( 3 ) whether these complications affect ASES , Constant , and WOOS scores after RSA . Methods A prospect i ve data base , clinical charts , and radiographs of 284 patients who had undergone primary ( n = 212 patients ) or revision ( n = 72 patients ) RSA  were review ed to identify patients whose postoperative course was complicated by instability or infection . Results The rate of instability was similar in patients with primary ( eleven of 212 [ 5 % ) ] and revision ( six of 72 [ 8 % ] ) reverse arthroplasty . The rate of infection was higher in the revision ( five of 72 [ 7 % ] ) than in the primary ( three of 212 [ 1 % ] ) group . Patients with an irreparable subscapularis tendon had a higher rate of instability ( 14 of 123 [ 12 % ] ) compared with patients with a repairable subscapularis tendon ( one of 161 [ less than 1 % ] ) . The fracture sequelae group had the highest rate of instability ( seven of 25 [ 28 % ] ) among diagnoses within the primary group . The rates of infection were similar between the diagnoses within the primary group . The improvements in the ASES score , the Constant score , and the WOOS score from preoperatively to postoperatively were better in the no instability/infection group as compared with the instability/infection group . Conclusions This information confirms the available literature allowing surgeons to give patients realistic expectations regarding the infection and instability rates after RSA.Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background Glenohumeral osteoarthritis has been a well-described complication of open procedures to correct shoulder instability . What remains unknown is whether chondral injuries sustained during instability episodes contribute to osteoarthritis or whether the cause is primarily the stabilization procedure itself . Purpose To determine the prevalence of osteoarthrosis in a large data base of patients with acute and chronic shoulder instability before primary stabilization surgery . Study Design Retrospective review of prospect ively collected data . Methods Surgical and demographic data were collected on 422 patients with a diagnosis of shoulder instability who underwent arthroscopic examination and shoulder stabilization .  Results There was a significant association between the grade of osteoarthrosis and the presence of osteoarthritis ( grade III or IV chondral damage ) with time from injury to surgery . Patients with osteoarthritis  were significantly older than those without ( 34.9 versus 29.6 years ) . Multivariate analysis identified older age and time from injury to surgery as independent predictors of osteoarthritis . We found no association between direction of instability and the presence of osteoarthritis . Conclusion The overall prevalence of glenohumeral osteoarthrosis was low . Predictors of osteoarthritis included time from injury to surgery and age Introduction Over the last decade , proprioceptive function gained increasing attention in joint disorders such as instability of the shoulder . Common tests for evaluation of proprioception are limited by their complexity and high technical dem and s. Thus , they are hardly applicable during daily routine . Our hypothesis was that the simplified “ laser-pointer assisted angle reproduction test ” ( LP-ART ) presented here allows for clinical ly feasible assessment of proprioceptive shoulder function . Methods Active angle reproduction capability as an aspect of sensorimotor function was evaluated with the new method in patients with shoulder instability ( n = 24 ) and healthy controls ( n = 24 ) . 15 patients had traumatic , 9 non-traumatic anterior instability ( 6 bilateral ) , 17 were treated surgically , 13 non-operatively . Tests were performed in flexion and abduction in different angles ( 55 ° , 90 ° , 125 ° ) in r and omized order . Results Angle reproduction capability was worst below shoulder level ( 55 ° ) in all groups . Best results were achieved at shoulder level ( 90 ° ) . Healthy controls showed overall better results than patients with instability . Patients after surgical stabilization had better results in 55 ° and 90 ° abduction compared to instability patients before surgery . Conclusions The new LP-ART presented here is a technically simple , yet effective instrument for evaluation of the proprioceptive function of the shoulder . In contrast to former test setups it is feasible in daily routine . Compared to healthy controls , patients with unstable shoulder joints show significant proprioceptive disorders that can be quantified by the LP-ART
Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis ; however , the difference is not statistically significant .
When reverse shoulder arthroplasties ( RSA ) were considered as a subgroup and compared to anatomic shoulder replacements ( total shoulders and hemiarthroplasties ) , they showed a lower revision rate
Chronic anterior glenohumeral joint instability is a common situation and can lead to progressive cartilage deterioration and ultimately instability arthopathy .
Progressive cartilage deterioration can occur despite conservative or surgical treatment and the sequelae of these conditions are often addressed with total shoulder arthroplasty .
Aims of the present study were to analyze the available literature to describe the technical aspects of this particular operation and to report outcomes and complication rates .
The hypothesis was that shoulder arthropalsty in the sequelae of instability had lower outcomes and higher complication rates than arthroplasties for primary arthritis .
Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology .