Hypothesis: The aim was to evaluate risk factors for complications, revision, and mid- to long-term outcomes after reverse shoulder arthroplasty (RSA) implanted for proximal humeral fracture sequelae (PHFS).
Methods: The radiographs of 98 patients (mean age, 68 years) who underwent RSA for the treatment of PHFS were reviewed at a minimum 5-year follow-up. PHFS were divided into 4 types according to the Boileau classification: type 1 (46 cases), type 2 (6 cases), type 3 (12 cases), and type 4 (34 cases). The tuberosities underwent osteotomy in 28 cases and excision in 12 (all type 3 or 4 PHFS). The mean follow-up period was 8.4 years (range, 5-14 years).
Results: The functional results and rate of RSA survival without revision (85% vs. 100% at 10 years, P = .007) were significantly lower for types 3 and 4 vs. types 1 and 2. Overall, our findings showed that RSA for PHFS is not the panacea that surgeons once believed: At a mean follow-up of 8.5 years (range, 5-14 years), 59% of the patients in our series had fair or poor results. Patients who underwent tuberosity osteotomy or excision had lower functional results (adjusted Constant score, 69% vs. 88%; P < .001), more postoperative complications (32% vs. 9%, P = .003), and a higher revision rate (15% vs. 2%, P = .017). Patients who underwent tuberosity osteotomy or excision at the time of RSA were at risk of postoperative prosthetic instability and humeral stem loosening. The absence of the greater tuberosity at last radiographic follow-up was predictive of higher rates of complications and revisions, as well as a poorer final outcome. Previous fracture fixation was associated with a higher rate of complete tuberosity resorption (56% vs. 33%, P = .026) and with higher rates of postoperative complications (27% vs. 13%, P = .099) and reinterventions (17% vs. 2%, P = .018).
Conclusion: The functional results and rates of complications and revision depend on the type of fracture sequelae and tuberosity management. Patients with more severe (type 3 and 4) fracture sequelae who undergo tuberosity osteotomy or excision are at risk of having a poorer functional result and higher rates of complications and revision with lower survival. Previous fracture fixation is also a prejudicial factor.
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http://dx.doi.org/10.1016/j.jse.2020.03.010 | DOI Listing |
Clin Orthop Relat Res
January 2025
Department of Radiology, Chongqing Health Center for Women and Children/Women and Children's Hospital of Chongqing Medical University, Chongqing, PR China.
Background: Nonweightbearing preoperative assessments avoid quadriceps contraction that tends to affect patellar motion and appear to be inaccurate in quantifying anatomic factors, which can lead to incorrect corrections and postoperative complications.
Questions/purposes: (1) Does the relationship of patellar axial malalignment and other anatomic factors change during weightbearing? (2) What anatomic factor was most strongly correlated with recurrent patellar dislocation during weightbearing?
Methods: This prospective, comparative, observational study recruited participants at our institution between January 2023 and September 2023. During this time, all patients with recurrent patellar dislocations received both weightbearing and nonweightbearing CT scans; control patients who received unilateral CT scans because of injuries or benign tumors received both weightbearing and nonweightbearing CT scans.
Orthop Traumatol Surg Res
January 2025
Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160 Antony, France.
Anterior tibial tuberosity osteotomy is a well-described therapeutic option for the treatment of patellar instability. External torsion of the anterior tibial tuberosity can be one of several factors that adversely affect the patellofemoral joint and its stability. The Anterior Tibial Tubercle Internal Torsion Osteotomy (ATTITO) allows the correction of excessive external torsion of the tibial tuberosity in a safe and reproducible manner.
View Article and Find Full Text PDFKnee Surg Sports Traumatol Arthrosc
January 2025
Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Purpose: To propose a new sign of patellar maltracking in recurrent patellar dislocation (RPD) and compare the differences in lower limb rotational and bony structural abnormalities among the different signs.
Patients And Methods: A retrospective study included 279 patients (mean age: 22 years; female: 81%) who underwent primary surgery for RPD over the past 4 years was performed. The patients were grouped based on the characteristics of patellar tracking: low-, moderate- and high-grade J-sign.
J Shoulder Elbow Surg
January 2025
Department of Orthopaedic Surgery and Traumatology, UZ Gent, C. Heymanslaan 10, 9000 Gent, Belgium.
Background: Mobilization of the subscapularis muscle (SSC) is crucial for optimal access to the glenohumeral joint during anatomical total shoulder arthroplasty (ATSA). However, the ideal mobilization technique remains controversial. This study aimed to assess the impact of the lesser tuberosity C-block osteotomy, a modified lesser tuberosity osteotomy, on the postoperative subscapularis (SSC) volume following anatomical shoulder arthroplasty and compare it to the volume of the infraspinatus/teres minor.
View Article and Find Full Text PDFPurpose: Tibial rotational deformity is a known risk factor for patellofemoral joint (PFJ) disorders. However, it is commonly associated with other abnormalities which affect the PFJ. The purpose of this study was to describe the prevalence of associated factors known to affect PFJ in patients undergoing rotational tibial osteotomy and their implication for the correction level.
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