Objective The purposes of this study were to compare functional outcomes, radiographic stem chang... more Objective The purposes of this study were to compare functional outcomes, radiographic stem changes and complication rate in patients with proximal humeral fractures operated with cemented or uncemented RSA. Methods Retrospective review of 68 primary RSAs in PHF, 45 cemented/23 uncemented. Functional outcomes were evaluated according to constant, ASES scales and the range of motion (ROM). Radiographic assessment was performed at a minimum of two years post-operatively. Results The mean follow-up cemented/uncemented was 37.8/26.5 months ( p = .04) and the mean age 78/80 years old ( p = .09). The functional outcome and range of movement were equivalent in the two groups except for the forward flexion that was significantly higher in the cemented group ( p = .03). Stress shielding was seen in 30.4% of uncemented group and none in the cemented. Anatomic tuberosity healing was significantly higher with uncemented components compared with cemented components (64% vs 91%, p = .02). Cemented stems had radiolucent lines with a width of 2 mm or more in three or more Gruen zones in 9% vs 0% in the uncemented group and an evident change in the stem position was present in 4% vs 0% in the non-cemented group. Conclusion At mid-term follow-up, no differences in functional outcomes were detected depending on the stem fixation technique. Cemented stems, however, have a complication rate (including stem loosening) significantly higher than press-fit stems.
BackgroundAccurate placement of glenoid component in reverse shoulder arthroplasty remains a chal... more BackgroundAccurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of flu...
European Journal of Orthopaedic Surgery & Traumatology, 2021
Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced th... more Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced the initially high complication and revision rates associated with this implant. However, instability continues to be a leading cause of reoperation after RTSA, being related in previous studies with medialized designs. The aim of this study was to determine the dislocation rate with the employment of two medialized modular systems of RTSA in our institution. A retrospective review of two different modular systems of RTSA (SMR Modular Shoulder System and Delta XTEND Reverse Shoulder) was performed between 2009 and 2017 with a minimum 3-year follow-up. Baseline demographic, clinical (Constant, ASES and ROM), and radiographic data were collected. Characteristics of postoperative instability cases were also evaluated. 237 primary RTSA (41% SMR/59% Delta) and 34 revision RTSA (44% SMR/56% Delta) with a mean follow-up of 75.6 ± 5.2 months (79.2 SMR/86.3 Delta, p = .586) were included in the present study. Indications for primary RTSA were osteoarthritis, rotator cuff tear arthropathy and massive irreparable rotator cuff tear (64%), acute fracture (32%), and fracture sequelae (4%). Subscapularis tendon was always repaired in degenerative pathology and tuberosities reattached in traumatic cases. The mean age of the global series was 76.5 ± 5.3 years (75.8 SMR/78.6 Delta, p = .104) with a mean Constant/ASES score at final follow-up of 68.5 ± 4.3/72.9 ± 20.3 (71/68 SMR and 69/74 Delta, p = .653 and .642). Only 2 patients (one acute fracture and one fracture sequelae) suffered an early postoperative anterior dislocation (before 3 months) which represents a rate of .84% in primary cases and .73% including revision surgery. Closed reduction manoeuvres were not successful, and both patients required revision surgery. At the end follow-up, both were stable and had no further dislocations. The dislocation rate after RTSA with the employment of two contemporary modular systems with a medialized centre of rotation is extremely low, especially when compared with the previously published series with the original Grammont design. Acute fracture and fracture sequelae were the main diagnoses associated with this instability. The reasons for the low dislocation rate are multifactorial, but the improvement in the baseplate position according to the more recent standards of “ideal position” and technical aspects such as subscapularis repair or tuberosity reattachment in fractures probably play an important role in this aspect.
INTRODUCTION Rotator cuff disorders present a high retear rate despite advances in surgical treat... more INTRODUCTION Rotator cuff disorders present a high retear rate despite advances in surgical treatment. Tissue engineering could therefore be interesting in order to try to enhance a more biological repair. RhBMP-2 is one of the most osteogenic growth factors and it also induces the formation of collagen type I. However, it has a short half-life and in order to get a more stable release over time it could be integrated in a more slowly degradable carrier, such as an alginate-chitin scaffold. The aim of this study was to investigate the role of the alginate-chitin scaffold alone and in combination with different concentrations of rhBMP-2 when applied on chronic rotator cuff lesions in a rat model. MATERIALS AND METHODS We performed an experimental study with 80 Sprague-Dawley rats, 8 months old, with a chronic rupture of the supraspinatus tendon that was repaired with a modified Mason Allen suture. A scaffold was applied over the suture and 4 groups were obtained; suture (S) only suture, double control (DC) alginate and chitin scaffold, single sample (SS) scaffold of alginate with rhBMP-2 (20 µg rhBMP-2) and chitin, double sample (DS) a scaffold containing alginate with rhBMP-2 and chitin with rhBMP-2 (40 µg rhBMP-2). Macroscopic, histological and biomechanical studies were performed at 4 months after reparation. RESULTS The modified Åström and Rausing's histological scale (the higher the score the worse outcome, 0 points=native tendon) was applied: S got 52 points compared to DC 30 (p = 0,034), SS 22 (p = 0,009) and DS 16 (p = 0,010). Biomechanically the maximum load was highest in DC (63,05 N), followed by DS (61,60 N), SS (52,35 N) and S (51,08), p = 0,025 DS vs S. As to the elastic constant a higher value was obtained in DC (16,65), DS (12,55) and SS (12,20) compared to S (9,33), p = 0,009 DC vs S and 0,034 DS vs S. CONCLUSIONS The alginate-chitin scaffold seems to promote a more biological response after the reparation of a chronic rotator cuff lesion. Its effect is further enhanced by the addition of rhBMP-2 since the osteotendinous junction is more native-like and has better biomechanical properties.
Revista Española de Cirugía Ortopédica y Traumatología, 2019
Resumen La descompresion subacromial artroscopica aislada (DSA) es un procedimiento quirurgico am... more Resumen La descompresion subacromial artroscopica aislada (DSA) es un procedimiento quirurgico ampliamente utilizado que presenta un elevado porcentaje de exito. Sin embargo, hasta un 25% de los pacientes puede presentar dolor residual tras la intervencion. No esta claro si el procesamiento aberrante del dolor, como ocurre en la fibromialgia (FM), podria ejercer un efecto deletereo en los resultados obtenidos. Para testar esta hipotesis hemos realizado un estudio casos-controles retrospectivo de los pacientes en los que se ha realizado una descompresion subacromial artroscopica como procedimiento quirurgico unico. Material y metodos Se seleccionaron 26 pacientes con diagnostico preoperatorio de fibromialgia de una serie de 293 pacientes intervenidos mediante DSA entre 2008-2015. Seis pacientes se perdieron durante el seguimiento. Cada paciente con diagnostico de fibromialgia fue emparejado con un control (n = 20). Los resultados fueron evaluados mediante la escala DASH, Constant, Constant relativo a la edad y sexo (rCS) y la escala visual analogica (EVA). La satisfaccion del paciente fue evaluada con una pregunta dicotomica. Se considero fracaso del procedimiento la presencia de una puntuacion superior a 3 en la EVA en el ultimo seguimiento. Resultados La media de edad de los grupos FM/control fue de 51/48 anos, con un seguimiento medio de 36/42 meses respectivamente. Ambos grupos experimentaron una mejoria postoperatoria significativa en las escalas de EVA, DASH y rCS (p Conclusiones La fibromialgia puede ser considerada como factor pronostico que condiciona un peor resultado postoperatorio tras DSA. Sin embargo, debido a la mejoria clinica que experimentan estos pacientes frente a su estado preoperatorio, recomendamos realizar este tratamiento quirurgico cuando exista indicacion.
Journal of shoulder and elbow surgery, Jan 20, 2018
Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have ... more Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injurie...
Journal of shoulder and elbow surgery, Jan 10, 2017
Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose o... more Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose of this study was to determine the complications, rate of healing, and functional results of glenoid bone grafting in primary or revision surgery with reverse shoulder arthroplasty. We retrospectively reviewed 23 patients with glenoid bone loss who underwent primary or revision surgery using a glenoid bone graft with a minimum follow-up of 2 years. Range of motion and the Constant, American Shoulder and Elbow Surgeons, and visual analog scale scores were obtained from preoperative assessment and the latest follow-up visit. Radiographic evaluation included analysis of plain radiographs as well as preoperative and follow-up computed tomography. Three patients were excluded from the study. Allografts were used in 13 cases and autografts in 7 cases. The mean Constant score improved from 30.7 ± 9.4 to 51.3 ± 13.4 (P < .001). At a mean follow-up of 26 months, computed tomography imaging reve...
Revista espanola de cirugia ortopedica y traumatologia
Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of r... more Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of rhBMP-2 in a carrier could improve the biomechanical and histological properties of the repair. Controlled experimental study conducted on 40 rats with section and repair of the supraspinatus tendon and randomisation to one of five groups: Group 1 (control) only suture; Group 2 (double control), suture and alginate-chitin carrier; Group 3 (alginate-control), the rhBMP-2 was added to the alginate; Group 4 (chitin-control) application of the rhBMP-2 to the chitin, and Group 5 (double sample): The two components of the carrier (alginate and chitin) have rhBMP-2. A biomechanical and histological analysis was performed at 4 weeks. A gap was observed in all cases 4 weeks after supraspinatus detachment. The re-rupture rate was 7.5%, with 20% of them in the control-alginate Group. Histologically the best results were obtained in the double sample group: 4.5 (3.3-5.0). Double sample were also able...
Objective The purposes of this study were to compare functional outcomes, radiographic stem chang... more Objective The purposes of this study were to compare functional outcomes, radiographic stem changes and complication rate in patients with proximal humeral fractures operated with cemented or uncemented RSA. Methods Retrospective review of 68 primary RSAs in PHF, 45 cemented/23 uncemented. Functional outcomes were evaluated according to constant, ASES scales and the range of motion (ROM). Radiographic assessment was performed at a minimum of two years post-operatively. Results The mean follow-up cemented/uncemented was 37.8/26.5 months ( p = .04) and the mean age 78/80 years old ( p = .09). The functional outcome and range of movement were equivalent in the two groups except for the forward flexion that was significantly higher in the cemented group ( p = .03). Stress shielding was seen in 30.4% of uncemented group and none in the cemented. Anatomic tuberosity healing was significantly higher with uncemented components compared with cemented components (64% vs 91%, p = .02). Cemented stems had radiolucent lines with a width of 2 mm or more in three or more Gruen zones in 9% vs 0% in the uncemented group and an evident change in the stem position was present in 4% vs 0% in the non-cemented group. Conclusion At mid-term follow-up, no differences in functional outcomes were detected depending on the stem fixation technique. Cemented stems, however, have a complication rate (including stem loosening) significantly higher than press-fit stems.
BackgroundAccurate placement of glenoid component in reverse shoulder arthroplasty remains a chal... more BackgroundAccurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of flu...
European Journal of Orthopaedic Surgery & Traumatology, 2021
Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced th... more Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced the initially high complication and revision rates associated with this implant. However, instability continues to be a leading cause of reoperation after RTSA, being related in previous studies with medialized designs. The aim of this study was to determine the dislocation rate with the employment of two medialized modular systems of RTSA in our institution. A retrospective review of two different modular systems of RTSA (SMR Modular Shoulder System and Delta XTEND Reverse Shoulder) was performed between 2009 and 2017 with a minimum 3-year follow-up. Baseline demographic, clinical (Constant, ASES and ROM), and radiographic data were collected. Characteristics of postoperative instability cases were also evaluated. 237 primary RTSA (41% SMR/59% Delta) and 34 revision RTSA (44% SMR/56% Delta) with a mean follow-up of 75.6 ± 5.2 months (79.2 SMR/86.3 Delta, p = .586) were included in the present study. Indications for primary RTSA were osteoarthritis, rotator cuff tear arthropathy and massive irreparable rotator cuff tear (64%), acute fracture (32%), and fracture sequelae (4%). Subscapularis tendon was always repaired in degenerative pathology and tuberosities reattached in traumatic cases. The mean age of the global series was 76.5 ± 5.3 years (75.8 SMR/78.6 Delta, p = .104) with a mean Constant/ASES score at final follow-up of 68.5 ± 4.3/72.9 ± 20.3 (71/68 SMR and 69/74 Delta, p = .653 and .642). Only 2 patients (one acute fracture and one fracture sequelae) suffered an early postoperative anterior dislocation (before 3 months) which represents a rate of .84% in primary cases and .73% including revision surgery. Closed reduction manoeuvres were not successful, and both patients required revision surgery. At the end follow-up, both were stable and had no further dislocations. The dislocation rate after RTSA with the employment of two contemporary modular systems with a medialized centre of rotation is extremely low, especially when compared with the previously published series with the original Grammont design. Acute fracture and fracture sequelae were the main diagnoses associated with this instability. The reasons for the low dislocation rate are multifactorial, but the improvement in the baseplate position according to the more recent standards of “ideal position” and technical aspects such as subscapularis repair or tuberosity reattachment in fractures probably play an important role in this aspect.
INTRODUCTION Rotator cuff disorders present a high retear rate despite advances in surgical treat... more INTRODUCTION Rotator cuff disorders present a high retear rate despite advances in surgical treatment. Tissue engineering could therefore be interesting in order to try to enhance a more biological repair. RhBMP-2 is one of the most osteogenic growth factors and it also induces the formation of collagen type I. However, it has a short half-life and in order to get a more stable release over time it could be integrated in a more slowly degradable carrier, such as an alginate-chitin scaffold. The aim of this study was to investigate the role of the alginate-chitin scaffold alone and in combination with different concentrations of rhBMP-2 when applied on chronic rotator cuff lesions in a rat model. MATERIALS AND METHODS We performed an experimental study with 80 Sprague-Dawley rats, 8 months old, with a chronic rupture of the supraspinatus tendon that was repaired with a modified Mason Allen suture. A scaffold was applied over the suture and 4 groups were obtained; suture (S) only suture, double control (DC) alginate and chitin scaffold, single sample (SS) scaffold of alginate with rhBMP-2 (20 µg rhBMP-2) and chitin, double sample (DS) a scaffold containing alginate with rhBMP-2 and chitin with rhBMP-2 (40 µg rhBMP-2). Macroscopic, histological and biomechanical studies were performed at 4 months after reparation. RESULTS The modified Åström and Rausing's histological scale (the higher the score the worse outcome, 0 points=native tendon) was applied: S got 52 points compared to DC 30 (p = 0,034), SS 22 (p = 0,009) and DS 16 (p = 0,010). Biomechanically the maximum load was highest in DC (63,05 N), followed by DS (61,60 N), SS (52,35 N) and S (51,08), p = 0,025 DS vs S. As to the elastic constant a higher value was obtained in DC (16,65), DS (12,55) and SS (12,20) compared to S (9,33), p = 0,009 DC vs S and 0,034 DS vs S. CONCLUSIONS The alginate-chitin scaffold seems to promote a more biological response after the reparation of a chronic rotator cuff lesion. Its effect is further enhanced by the addition of rhBMP-2 since the osteotendinous junction is more native-like and has better biomechanical properties.
Revista Española de Cirugía Ortopédica y Traumatología, 2019
Resumen La descompresion subacromial artroscopica aislada (DSA) es un procedimiento quirurgico am... more Resumen La descompresion subacromial artroscopica aislada (DSA) es un procedimiento quirurgico ampliamente utilizado que presenta un elevado porcentaje de exito. Sin embargo, hasta un 25% de los pacientes puede presentar dolor residual tras la intervencion. No esta claro si el procesamiento aberrante del dolor, como ocurre en la fibromialgia (FM), podria ejercer un efecto deletereo en los resultados obtenidos. Para testar esta hipotesis hemos realizado un estudio casos-controles retrospectivo de los pacientes en los que se ha realizado una descompresion subacromial artroscopica como procedimiento quirurgico unico. Material y metodos Se seleccionaron 26 pacientes con diagnostico preoperatorio de fibromialgia de una serie de 293 pacientes intervenidos mediante DSA entre 2008-2015. Seis pacientes se perdieron durante el seguimiento. Cada paciente con diagnostico de fibromialgia fue emparejado con un control (n = 20). Los resultados fueron evaluados mediante la escala DASH, Constant, Constant relativo a la edad y sexo (rCS) y la escala visual analogica (EVA). La satisfaccion del paciente fue evaluada con una pregunta dicotomica. Se considero fracaso del procedimiento la presencia de una puntuacion superior a 3 en la EVA en el ultimo seguimiento. Resultados La media de edad de los grupos FM/control fue de 51/48 anos, con un seguimiento medio de 36/42 meses respectivamente. Ambos grupos experimentaron una mejoria postoperatoria significativa en las escalas de EVA, DASH y rCS (p Conclusiones La fibromialgia puede ser considerada como factor pronostico que condiciona un peor resultado postoperatorio tras DSA. Sin embargo, debido a la mejoria clinica que experimentan estos pacientes frente a su estado preoperatorio, recomendamos realizar este tratamiento quirurgico cuando exista indicacion.
Journal of shoulder and elbow surgery, Jan 20, 2018
Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have ... more Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injurie...
Journal of shoulder and elbow surgery, Jan 10, 2017
Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose o... more Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose of this study was to determine the complications, rate of healing, and functional results of glenoid bone grafting in primary or revision surgery with reverse shoulder arthroplasty. We retrospectively reviewed 23 patients with glenoid bone loss who underwent primary or revision surgery using a glenoid bone graft with a minimum follow-up of 2 years. Range of motion and the Constant, American Shoulder and Elbow Surgeons, and visual analog scale scores were obtained from preoperative assessment and the latest follow-up visit. Radiographic evaluation included analysis of plain radiographs as well as preoperative and follow-up computed tomography. Three patients were excluded from the study. Allografts were used in 13 cases and autografts in 7 cases. The mean Constant score improved from 30.7 ± 9.4 to 51.3 ± 13.4 (P < .001). At a mean follow-up of 26 months, computed tomography imaging reve...
Revista espanola de cirugia ortopedica y traumatologia
Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of r... more Rotator cuff repairs have shown a high level of re-ruptures. It is hypothesised that the use of rhBMP-2 in a carrier could improve the biomechanical and histological properties of the repair. Controlled experimental study conducted on 40 rats with section and repair of the supraspinatus tendon and randomisation to one of five groups: Group 1 (control) only suture; Group 2 (double control), suture and alginate-chitin carrier; Group 3 (alginate-control), the rhBMP-2 was added to the alginate; Group 4 (chitin-control) application of the rhBMP-2 to the chitin, and Group 5 (double sample): The two components of the carrier (alginate and chitin) have rhBMP-2. A biomechanical and histological analysis was performed at 4 weeks. A gap was observed in all cases 4 weeks after supraspinatus detachment. The re-rupture rate was 7.5%, with 20% of them in the control-alginate Group. Histologically the best results were obtained in the double sample group: 4.5 (3.3-5.0). Double sample were also able...
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