➢ Stemless anatomic and reverse shoulder arthroplasty designs have been shown to have equivalent short-term clinical outcomes compared with stemmed designs; however, to our knowledge, there have been no published long-term follow-up studies. ➢ Radiographic results in the short-term follow-up period show a low prevalence of component loosening, stress shielding, or osteolysis. ➢ Stemless arthroplasty requires an accurate humeral-head osteotomy to properly restore humeral anatomy because of the lack of a stem as a guide. ➢ There is only 1 design approved by the U.S. Food and Drug Administration (FDA) currently available, to our knowledge, but there are several ongoing Investigational Device Exemption (IDE) studies.
Management of failed rotator cuff repair may be difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair healing. Variable outcomes have been reported in patients who undergo revision rotator cuff repair; however, a systematic surgical approach may increase the likelihood of a successful outcome. Numerous cellular and mechanical biologic augments, including platelet-rich plasma, platelet-rich fibrin matrix, mesenchymal stem cells, and acellular dermal matrix grafts, have been used in rotator cuff repair; however, conflicting or inconclusive outcomes have been reported in patients who undergo revision rotator cuff repair with the use of these augments. A variety of tendon transfer options, including latissimus dorsi, teres major, lower trapezius, pectoralis minor, pectoralis major, combined pectoralis major and latissimus dorsi, and combined latissimus dorsi and teres major, are available for the management of massive irreparable rotator cuff tears. Ultimately, the optimization of surgical techniques and the use of appropriate biologic/tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair.
][3][4][5][6] TSA is most commonly performed for degenerative shoulder conditions such as glenohumeral osteoarthritis (OA).Reverse shoulder arthroplasty (RSA) has been used in Europe since the 1980s and was approved by the Food and Drug Administration in 2004. 7)RSA is a treatment option for patients with cuff tear arthropathy (CTA), which has yielded consistent results.The number of TSA and especially RSA procedures performed each year continues to increase. 8)The cause of the increase in RSAs performed is multifactorial, but
We sought to characterize humeral-sided radiographic changes at a minimum of 2 years after reverse shoulder arthroplasty (RSA) to determine their association with specific implantation techniques.The immediate and most recent postoperative anteroposterior radiographs of 120 shoulders with primary RSA and a minimum of 2-years of radiographic follow-up were analyzed (mean follow-up 35.2 months). Stress shielding was evaluated by measuring cortical thickness at 4 different locations. Three independent examiners evaluated radiographs for humeral osteolysis, radiolucent lines, stress shielding, stem loosening, and scapular notching.The cortical diameter, marker of external stress shielding, significantly decreased from initial to most recent measurement (P<0.001), but did not differ between cemented and uncemented groups. Cemented stems had significantly more osteolysis and radiolucent lines; uncemented stems had significantly more internal stress shielding (P<001). The presence of scapular notching was significantly correlated with the presence of humeral osteolysis (P<0.001). Three (2.5%) stems were deemed "at risk" for loosening and 2 (1.7%) were loose.Cemented humeral stems were associated with an increased rate of radiolucent lines and osteolysis, whereas uncemented stems were associated with more internal stress shielding. Humeral cortical thickness significantly decreased over time regardless of fixation. There was an association between scapular notching and increased humeral osteolysis.
