Assenmacher, Andrew T.

Aims Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. Patients and Methods Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. Results One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. Conclusion Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520–1525

Purpose: Reverse shoulder arthroplasty (RSA) improves pain and function with very good satisfaction. Concerns exist about some activities of daily living (ADLs) involving internal rotation. The purpose of this study was to report how patients with bilateral RSA perform various ADLs. Methods: Thirty-one primary bilateral RSA patients (average age 76 years; 21 women and 10 men) completed a survey to assess various outcomes. The average time between the second arthroplasty and the survey was 2.7 years (range 1.0–7.8 years). Results: All clinical parameters were favorable. All patients reported being able to easily manage toileting and 87% reaching their back pocket. However, 29% found difficulty and 39% were unable to wash their back or put on bra. In comparison with various unilateral arthroplasty types, there was no statistical difference in overall activities ( p < 0.05). Conclusion: Bilateral RSA can provide good functional outcome and high satisfaction. Patients manage most ADLs easily with some limitations in activities requiring extreme internal rotation.

Background: Revision of failed anatomic total shoulder arthroplasty or hemiarthroplasty is a challenging procedure. Restoring adequate soft tissue balance in the revision setting can be particularly problematic. When persistent posterior instability is encountered in the revision setting, options include changing component position or size, posterior capsular plication (PCP), or conversion to a reverse arthroplasty. The purpose of this study was to report the clinical and radiographic outcomes, complications, and reoperations of PCP performed in the setting of revision anatomic shoulder arthroplasty. Patients and Methods: Between 1975 and 2013, 15 patients (16 shoulders) had PCP during revision anatomic shoulder arthroplasty. Indications for revision arthroplasty included posterior instability in 15, glenoid loosening in 3, polyethylene wear in 2, and glenoid erosion in 1 shoulder. The mean (standard deviation (SD)) age was 60.1 (12.6) years, and the median (range) follow-up was 68 (2–228) months. A retrospective chart review was conducted to obtain all data. Results: At the last follow-up, nine shoulders (56%) had absence of posterior radiographic subluxation. Five (31%) cases underwent reoperation due to persistent posterior instability. Complications were observed in seven (44%) cases. Complete pain relief was achieved in four (25%) shoulders. The mean (SD) postoperative forward flexion, external rotation, and the American Shoulder and Elbow Surgeons score were 110° (41°), 40° (29°), and 62.1 (21.9), respectively. Results were excellent in two (13%), satisfactory in seven (44%), and unsatisfactory in seven (44%) shoulders. Conclusions: PCP to correct posterior instability during revision anatomic shoulder arthroplasty had an unacceptably high failure rate. In these circumstances, consideration should instead be given to conversion to a reverse shoulder arthroplasty.

Purpose: To compare the outcomes of total shoulder arthroplasty (TSA) with posterior capsule plication (PCP) and reverse shoulder arthroplasty (RSA) in patients with primary osteoarthritis, posterior subluxation, and bone loss (Walch B2). Patients and methods: All shoulders undergoing anatomic TSA with PCP were retrospectively identified (group 1, G1) and compared to shoulders undergoing RSA (group 2, G2) for Walch B2 osteoarthritis. There were 15 patients in G1 (mean (SD) age and follow-up of 70.5 (7.5) years and 42.8 (18.4) months, respectively) and 16 patients in G2 (mean (SD) age and follow-up of 72.6 (5.4) years and 35.1 (14.2) months, respectively). Results: Both groups had substantial improvements in pain and function. In G1, results were excellent in 80% and satisfactory in 20%, compared to 81% and 6% in G2, respectively ( p = 0.2). The mean (SD) American Shoulder and Elbow Surgeons score was 91.2 (6.7) and 80.3 (14.3) in G1 and G2, respectively ( p = 0.08). The mean Simple Shoulder Test score was 10.6 in G1 and 8.5 in G2 ( p = 0.01). There were no reoperations in either group, but G1 had seven postoperative complications. Conclusions: The outcomes of TSA with PCP are comparable to RSA in patients with osteoarthritis and biconcave glenoids. However, TSA leads to more complications while RSA leads to lower functional outcomes.

Abstract Distal biceps tendon (DBT) conditions comprise a spectrum of disorders including bicipitoradial bursitis, partial tears, acute and chronic complete tears. In low-demand patients with complete DBT tears, non-operative treatment may be entertained provided the patient understands the potential for residual weakness, particularly in forearm supination. Most acute tears are best treated by primary repair using either single-incision or double-incision techniques with good clinical outcomes. Single-incision techniques may carry a higher risk of nerve-related complications, whereas double-incision techniques have historically been considered to carry a higher risk of heterotopic ossification, particularly if the ulna is exposed. Various fixation techniques, including bone tunnels, cortical buttons, suture anchors, interference screws or a combination seem to provide different fixation strength but similar clinical outcomes. Some chronic tears may be repaired primarily, provided tendon tissue can be identified; alternatively, autograft or allograft reconstruction can be considered, and good outcomes have been reported with both techniques. Cite this article: Alentorn-Geli E, Assenmacher AT, Sanchez-Sotelo J. Distal biceps tendon injuries: a clinically relevant current concepts review. EFORT Open Rev 2016;1:316-324. DOI: 10.1302/2058-5241.1.000053.

Abstract Tendon transfer options to reconstruct a massive irreparable posterior‐superior rotator cuff tear include latissimus dorsi, teres major, or lower trapezius transfer. We previously described the lower trapezius transfer using a 2‐incision approach, which includes a medial incision to harvest the lower trapezius and lateral transacromial incision to expose the rotator cuff and then perform the transfer through a deep tunnel connecting these 2 sites. In this report, we describe an arthroscopic‐assisted technique of lower trapezius transfer augmented with an Achilles tendon allograft to reconstruct an irreparable posterior‐superior rotator cuff tear. Technique Video video See video under supplementary data.

Purpose To (1) evaluate long‐term outcomes of osteochondral allograft (OCA) with regard to clinical outcome scores, reoperation and failure rates, and (2) examine if certain factors predispose patients to worse outcomes. Methods A comprehensive review was performed with specific inclusion criteria for studies with long‐term outcomes after OCA. Studies reported on patient clinical scores such as Hospital for Special Surgery score, Knee Society Score (knee and function score), and Lysholm score. Reoperation and failure rates were recorded for each study. Modified Coleman Methodology Scores assessed study methodological quality. Results Five studies with a total of 291 patients (55% male, 45% female) and average age of 34.8 years (range, 15 to 69 years) were included. Of all lesions, 67% were on the femoral condyles, 29% on the tibial plateau, and 4% were patellofemoral. All scores (Knee Society Function Score, Knee Society Knee Score, and Lysholm score) have significant mean improvement from preoperative to final follow‐up. The mean postoperative Hospital for Special Surgery score was 84.1. The mean failure rate was 25% at 12.3 years with a reoperation rate of 36%. A total of 72% of the failures were conversion to total (68%) or unicompartmental (4%) knee arthroplasty and 28% involved graft removal, graft fixation, and graft revision. Patellofemoral lesions (83%) had a significantly higher reoperation rate than lesions involving the tibial plateau or the femoral condyles (34%, P = .01). Conclusions Overall, OCA demonstrated significant improvements in clinical outcome scores and good durability with successful outcomes in 75% of the patients at 12.3 years after surgery. Patellofemoral lesions are associated with decreased clinical improvement and more frequent reoperations. The orthopaedic literature is limited by heterogeneity in surgical technique, lesion and patient characteristics, and reporting of nonstandardized outcome measures. Level of Evidence Level IV, systematic review of Level II and IV studies.