R Allen Gorman1, Kaitlyn N Christmas1, Peter Simon2, Mark A Mighell3, Mark A Frankle4. 1. Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA. 2. Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida College of Engineering and Morsani College of Medicine, Tampa, FL, USA. 3. Florida Orthopaedic Institute, Tampa, FL, USA. 4. Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
Abstract
INTRODUCTION: The purpose of this study was to evaluate the outcomes, revisions, and complications between a first-generation cemented modular humeral implant and a second-generation monolithic, primarily uncemented humeral implant in reverse total shoulder arthroplasty with 135° neck-shaft angle and varying degrees of metallic glenosphere offsets. METHODS: We retrospectively evaluated patients undergoing reverse total shoulder arthroplasty from 2004 to 2014 with a first-generation cemented modular humeral implant (400 patients) or second-generation monolithic humeral stem (231 patients), who had at minimum 2-year clinical and radiographic follow-up. RESULTS: Both groups of patients had similar improvement of clinical outcomes (American Shoulder and Elbow Surgeons +30 points vs. +34 points, respectively) with improvements in all planes of motion (forward flexion +70° vs. +75°, abduction +61° vs. +71°, external rotation +23° vs. +22°, and internal rotation +1.6 vs. +1.5 level improvement, respectively). The incidence of humeral loosening for the cemented group was 3.6%, whereas in the uncemented group it was 0.4% (P = .01). A total of 28 shoulders treated with the cementing technique (4.0%) and 6 patients treated with the press-fit technique (1.5%) were revised (P = .028). The rate of postoperative acromial fractures within the first year was 3.4% in the cemented group and 1.8% in the uncemented group (P = .177). CONCLUSIONS: Both the first-generation cemented modular humeral stem implant and the second-generation monolithic humeral stem implant had equivalent clinical outcomes. In addition, with the monolithic stem primarily using press-fit fixation, there was a significant reduction in the incidence of radiographic loosening and the need for revision compared with a cemented stem.
INTRODUCTION: The purpose of this study was to evaluate the outcomes, revisions, and complications between a first-generation cemented modular humeral implant and a second-generation monolithic, primarily uncemented humeral implant in reverse total shoulder arthroplasty with 135° neck-shaft angle and varying degrees of metallic glenosphere offsets. METHODS: We retrospectively evaluated patients undergoing reverse total shoulder arthroplasty from 2004 to 2014 with a first-generation cemented modular humeral implant (400 patients) or second-generation monolithic humeral stem (231 patients), who had at minimum 2-year clinical and radiographic follow-up. RESULTS: Both groups of patients had similar improvement of clinical outcomes (American Shoulder and Elbow Surgeons +30 points vs. +34 points, respectively) with improvements in all planes of motion (forward flexion +70° vs. +75°, abduction +61° vs. +71°, external rotation +23° vs. +22°, and internal rotation +1.6 vs. +1.5 level improvement, respectively). The incidence of humeral loosening for the cemented group was 3.6%, whereas in the uncemented group it was 0.4% (P = .01). A total of 28 shoulders treated with the cementing technique (4.0%) and 6 patients treated with the press-fit technique (1.5%) were revised (P = .028). The rate of postoperative acromial fractures within the first year was 3.4% in the cemented group and 1.8% in the uncemented group (P = .177). CONCLUSIONS: Both the first-generation cemented modular humeral stem implant and the second-generation monolithic humeral stem implant had equivalent clinical outcomes. In addition, with the monolithic stem primarily using press-fit fixation, there was a significant reduction in the incidence of radiographic loosening and the need for revision compared with a cemented stem.
Authors: Yaiza Lopiz; Carlos García-Fernandez; María Vallejo-Carrasco; Daniel Garriguez-Pérez; Loreto Achaerandio; Carmen Tesoro-Gonzalo; Fernando Marco Journal: Int Orthop Date: 2022-01-16 Impact factor: 3.075
Authors: Alexander Paszicsnyek; Olivia Jo; Harshi Sandeepa Rupasinghe; David C Ackland; Thomas Treseder; Christopher Pullen; Greg Hoy; Eugene T Ek; Lukas Ernstbrunner Journal: J Clin Med Date: 2022-01-12 Impact factor: 4.241