Papers by Philippe Debeer
Postoperative scapular fractures are infrequent complications of reverse total shoulder arthropla... more Postoperative scapular fractures are infrequent complications of reverse total shoulder arthroplasty (RTSA). The aim of this study is to discuss the functional outcome, clinical outcome and pain scores of these fractures and to analyze these outcome results based on fracture location. A systematic review in accordance with the PRISMA guidelines was conducted. Pubmed, EMBASE, Web of Science, Cochrane library and Ovid have been screened. A total of 78 RTSA in 12 articles were retained for qualitative analysis. The average minimum follow- up was 33.3 ± 14.4 months (range 12-60 months) and the mean age was 74.4 ± 5.6 years (range 63-85 years) with a mean female percentage of 90.9%. Overall, the mean DASH score was 39.8 ± 9.4 points (range 29.5- 48.0 points), ASES score 53.4 ± 23.3 points (range 13.3-95.0 points), SST 3.2 ± 2.2 points (range 0.0- 5.1 points), the only OSS 28.0 points and Constant- Murley shoulder score 50.5 ± 20.0 points (range 31.5- 69.0). The mean anterior elevation wa...
OBJECTIVE To examine the effectiveness of a single Botulinum Toxin A (BTX-A) infiltration in the ... more OBJECTIVE To examine the effectiveness of a single Botulinum Toxin A (BTX-A) infiltration in the pectoralis major muscle, in addition to a standard physical therapy (PT) programme on upper limb impairments and dysfunctions after breast cancer treatment. METHODS Fifty breast cancer patients with persistent pain 3 months after finishing treatment participated in a double-blinded randomised controlled trial. The intervention group received a single BTX-A infiltration. The control group received a placebo (saline) infiltration. Within one week after the infiltration, all patients attended an individual PT programme (12 sessions) during the first 3 months. Outcome parameters were active shoulder range of motion, upper limb strength, scapular statics and shoulder function. Measures were taken before the intervention, at 1, 3 (i.e. after the intervention) and 6 months follow-up. RESULTS No differences between groups were found for all outcome parameters over the course of 6 months. However...
Isolated avulsions of the lesser humeral tuberosity are rare injuries and only account for approx... more Isolated avulsions of the lesser humeral tuberosity are rare injuries and only account for approximately 2% of all fractures of the proximal humerus. In skeletally immature patients, these fractures tend to be even more unusual. The fact that lesser tuberosity fractures in children are uncommon injuries is reflected in the paucity of literature on the management and outcome of these injuries. The first avulsion of the lesser tuberosity was described in 1895 in a 17-year-old boy with an ipsilateral humeral fracture. In 1985, White and Riley were the first to publish a formal report an isolated subscapularis avulsion in a child. So far, 33 cases of isolated avulsions of the lesser tuberosity in adolescent patients (patients aged < younger than 21 years) have been reported (Table I). One of the main reasons is that the diagnosis of this injury is not easy and often leads to a delayed diagnosis. We report 2 patients with neglected lesser tuberosity fractures during childhood and thei...
Journal of Experimental Orthopaedics
Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen sh... more Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen shoulder patients on objective indices of shoulder functionality and subjective outcomes of pain, mobility, kinesiophobia, depression, and anxiety, and (2) progress knowledge about the reciprocal temporal relationship between psychological parameters at baseline and objective and subjective outcomes at 3-month follow-up. Methods We evaluated the clinical and psychological status of 72 patients with a frozen shoulder before and after hydrodilatation, using the Constant Murley score, the Visual Analogue score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, and the Shoulder Pain And Disability Index. Results We noted a significant improvement in functionality, pain and disability (p
Journal of Shoulder and Elbow Surgery
BACKGROUND Periprosthetic shoulder infection (PSI) remains a devastating complication after rever... more BACKGROUND Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI is limited, and the optimal strategy and related clinical outcome remains unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed. METHODS An RSA database was retrospectively reviewed to identify infections after primary and revised RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome and recurrence. RESULTS Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into: débridement and implant retention (DAIR) (n=6; 17%); 1-stage revision (n=1; 3%); 2-stage revision (n=16; 44%); multiple stage revisions (> 2 stages) (n=7; 19%); definitive spacer (n=2; 6%) and resection arthroplasty (n=4; 11%). The most common causative pathogens were Staphylococcus epidermidis (n=11; 31%) and Cutibacterium acnes (n=9; 25%). Four patients (11%) were diagnosed with recurrence, all of them were initially treated with a DAIR approach. The median follow-up was 36 months (range 24-132 months). CONCLUSION PSI is typically caused by low-virulent pathogens, which often are diagnosed with a delay resulting in chronic infection at time of surgery. Our results indicate that treating patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (i.e. 1- and 2-stage) does not compromise the functional result as compared to implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (i.e. 1 versus 2-stage exchange) has a better outcome overall.
Journal of Shoulder and Elbow Surgery
Background: Shoulder arthroplasty (SA) complications require standardization of definitions and a... more Background: Shoulder arthroplasty (SA) complications require standardization of definitions and are not limited to events leading to revision operations. We aimed to define an international consensus core set of clinically relevant unfavorable events of SA to be documented in clinical routine practice and studies. Methods: A Delphi exercise was implemented with an international panel of experienced shoulder surgeons selected by nomination through professional societies. On the basis of a systematic review of terms and definitions and previous experience in establishing an arthroscopic rotator cuff repair core set, an organized list of SA events was developed and reviewed by panel members. After each survey, all comments and suggestions were considered to revise the proposed core set including local event groups, along with definitions, specifications, and timing of occurrence. Consensus was reached with at least twothirds agreement. Results: Two online surveys were required to reach consensus within a panel involving 96 surgeons. Between 88% and 100% agreement was achieved separately for local event groups including 3 intraoperative (device, osteochondral, and soft tissue) and 9 postoperative event groups. Experts agreed on a documentation period that ranged from 3 to 24 months after SA for 4 event groups (peripheral neurologic, vascular, surgical-site infection, and superficial soft tissue) and that was lifelong until implant revision for other groups (device, osteochondral, shoulder instability, pain, late hematogenous infection, and deep soft tissue). Conclusion: A structured core set of local unfavorable events of SA was developed by international consensus to support the standardization of SA safety reporting. Clinical application and scientific evaluation are needed.
Journal of shoulder and elbow surgery, 2018
Description of the native shape of a glenoid helps surgeons to preoperatively plan the position o... more Description of the native shape of a glenoid helps surgeons to preoperatively plan the position of a shoulder implant. A statistical shape model (SSM) can be used to virtually reconstruct a glenoid bone defect and to predict the inclination, version, and center position of the native glenoid. An SSM-based reconstruction method has already been developed for acetabular bone reconstruction. The goal of this study was to evaluate the SSM-based method for the reconstruction of glenoid bone defects and the prediction of native anatomic parameters. First, an SSM was created on the basis of 66 healthy scapulae. Then, artificial bone defects were created in all scapulae and reconstructed using the SSM-based reconstruction method. For each bone defect, the reconstructed surface was compared with the original surface. Furthermore, the inclination, version, and glenoid center point of the reconstructed surface were compared with the original parameters of each scapula. For small glenoid bone d...
Tijdschrift voor Geneeskunde
Abstract: Erfelijke of congenitale afwijkingen zijn onder te verdelen in diverse categorieën. Bij... more Abstract: Erfelijke of congenitale afwijkingen zijn onder te verdelen in diverse categorieën. Bij ongeveer 0, 6% van de nieuwgeborenen kunnen chromosomale afwijkingen worden vastgesteld. Deze afwijkingen kunnen wisselen van chromosoomduplicaties, volledige ...
Acta Orthopaedica Belgica, Dec 1, 2013
There is no consensus regarding treatment of periprosthetic shoulder infections. We retrospective... more There is no consensus regarding treatment of periprosthetic shoulder infections. We retrospectively reviewed 17 patients diagnosed with a periprosthetic shoulder infection. Patient demographics, preoperative diagnostics, therapeutic management and functional outcome were evaluated. The Constant-Murley score (CMS), Simple Shoulder Test (SST), Visual Analogue Score (VAS) and Disabilities of the Arm, Shoulder and Hand score (DASH) were used to assess clinical outcome. Pre-and intraoperative culture results and laboratory data, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were analyzed. Three patients were treated by two-stage revision arthroplasty, 5 by resection arthroplasty with implantation of a cement spacer, 8 by resection arthroplasty without spacer and one patient underwent polyethylene exchange and serial debridement. The mean follow-up was 4.7 years (range : 1-9.3). The CMS was 27.8 for the resection arthroplasty group, 22.7 for the two-stage revision group and 20.6 for the resection arthroplasty with spacer group. No patients received chronic antibiotic suppression. Mean CRP value was 3.7mg/L (range : 0.2-11.1). Infection was monobacterial in 8 patients and polymicrobial in 9. The most common organisms were Coagulase negative staphylococcus (CNS) (13/17) and Propionibacterium spp. (7/17). Complications included two humeral fractures. At a mean follow-up of 4.7 years, all but one patient were considered free of infection. Worst functional results were seen with the implantation of a definitive cement spacer. Two-stage revision arthroplasty remains the gold standard in chronic infections, but is associated with a high complication rate. One-stage revision to a reverse shoulder arthroplasty (RSA) is an attractive alternative in selected cases. A surgical treatment algorithm for infected shoulder arthroplasty is proposed.
Journal of Bone Joint Surgery British Volume, Sep 1, 2012
Journal of Shoulder and Elbow Surgery, 2016
Glenoid dissociation is a rare postoperative complication in reverse shoulder arthroplasty that h... more Glenoid dissociation is a rare postoperative complication in reverse shoulder arthroplasty that has severe consequences for the patient and requires revision in most cases. A mechanically compromised Morse taper is hypothesized to be the main cause of this complication, with bony impingements and soft tissue interpositioning being cited as the most important problems. Intraoperative assessment of the taper assembly is challenging. Current methods require applying considerable torque to the glenosphere or relying on radiographs. This in vitro study demonstrates how the assembly quality can be accurately determined in a nondestructive way by exploiting the implant-specific relation between screw and Morse taper characteristics by measuring the angular rotation-torque curve. The feasibility of the method is demonstrated on 2 reverse implant models. Several data features that can statistically discriminate between optimal and suboptimal assemblies are proposed. Suboptimal assemblies can be detected using the method presented, which could easily be integrated in the current surgical workflow. Clinical recommendations based on the method&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rationale are also presented, allowing detection of the most severe defect cases with surgical instruments currently in use.
The Journal of Hand Surgery British European Volume, Feb 1, 2007
A cohort of 119 patients with carpal tunnel syndrome completed the questionnaire of the Dutch ver... more A cohort of 119 patients with carpal tunnel syndrome completed the questionnaire of the Dutch version of the DASH score pre-operatively and one year postoperatively. The mean DASH score decreased from 38.2 to 22.0. There was a significant correlation with the Boston carpal tunnel outcome score (r ¼ 0:78). With an effect size of 0.87 and a standardized mean response of 0.69, the Dutch version of the DASH is highly responsive for the evaluation of the outcome of surgery for carpal tunnel syndrome.
Journal of Shoulder and Elbow Surgery, 2015
Glenoid component and screw malpositioning in cases of severe glenoid defects might result in com... more Glenoid component and screw malpositioning in cases of severe glenoid defects might result in complications. We examined the efficacy of a surgical method to treat severe glenoid defects, including a custom-made glenoid component and accurate screw positioning, using a patient-specific positioning guide. Glenoid defects were created in 10 cadaveric shoulders. Computed tomography images were used to plan reversed shoulder arthroplasty and design patient-specific glenoid components. A patient-specific positioning guide was designed for 5 specimens. The remaining 5 specimens were implanted without the guide. Computed tomography images were used to determine the postoperative glenoid component and screw positions. Differences from the preoperatively planned implant and screw positions were calculated. The patient-specific positioning guide significantly reduced the angular deviations from the planned glenoid implant positioning (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) and also significantly improved the positioning of the screws (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). In the group without the guide, the average total intraosseous screw length was 52% of the ideal preoperatively planned length compared with 89% for the group with the guide. A strong correlation (r = -0.85) was found between the orientation of the implant and the postoperative total intraosseous screw length. A patient-specific positioning guide significantly improves the position and fixation of a custom-made glenoid component in cases of severe glenoid defects.
Clin Orthop Related Res, 2007
We describe a 15-year-old girl who had winging of the right scapula develop after incorrect use o... more We describe a 15-year-old girl who had winging of the right scapula develop after incorrect use of a thoracolumbar orthosis. The girl was treated for idiopathic scoliosis, but after 2 years of bracing, progressive scapular winging and diminished range of motion in the right shoulder was observed. The girl reported that the superior part of the brace frequently hooked under the tip of the right scapula. This resulted in complete neuropathy of the dorsal scapular nerve. When using a thoracolumbar orthosis in the treatment of children with scoliosis, physicians must consider potential compressive injuries to the dorsal scapular nerve.
Acta orthopaedica Belgica
We report three cases of neuropathic arthropathy secondary to syringomyelia. In two cases both th... more We report three cases of neuropathic arthropathy secondary to syringomyelia. In two cases both the shoulder and elbow were involved. In the third case only involvement of the elbow was observed.
Acta orthopaedica Belgica
Pollicisation of the index finger for absence or severe hypoplasia of the thumb has been reported... more Pollicisation of the index finger for absence or severe hypoplasia of the thumb has been reported as a good procedure to recreate a new "thumb" with good cosmesis and acceptable function. The purpose of this study is to evaluate the outcome of our series. Seventeen patients with 24 involved hands agreed to come back for evaluation. The mean age at operation was 12 months. In 8 hands there was also a radial club hand. Buck Gramcko's technique was used with slight modifications. The mean follow-up time was 53 months (range, 6-142 months). The outcome was determined in a variety of ways : objective assessment of function and cosmesis (measurement of thumb length, girth and nail size), and subjective evaluation of function and aspect done with a patient/parent questionnaire and a visual analogue score. The mean functional score was excellent for one hand, good for eleven, fair for five and poor for five. The mean length was 96%, the width was 93%, the nail width was 85% as compared with the contralateral thumb. There was no significantly different outcome in the syndrome-related thumbs versus the isolated cases, nor in unilateral versus bilateral cases. A significantly worse outcome was seen for function and subjective evaluation in the radial clubhand associated thumbs and for the functional score for the more severe Blauth group.
Acta orthopaedica Belgica
The aim of this retrospective study was to assess the mid- and long-term functional and radiologi... more The aim of this retrospective study was to assess the mid- and long-term functional and radiological results following latissimus dorsi transfer for symptomatic irreparable tears of the supra- and infraspinatus tendons (postero-superior cuff tears). Twenty-six shoulders with an irreparable posterosuperior rotator cuff tear were assessed preoperatively and after latissimus dorsi transfer, using the Constant score and standard radiographs to determine the degree of osteoarthritis and to measure the acromio-humeral distance. After a minimal follow-up of one year (range: 13 to 124 months) we observed a significant increase in Constant score from 39 to 60 points at the time of the last follow-up (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00001). Eighty-five percent of the patients were satisfied or very satisfied with the result and would undergo the same surgery again. An increase in the grade of gleno-humeral osteoarthritis was noted in 38.5% of the operated shoulders, and this was associated with a lower Constant score. We noted a decrease in acromio-humeral distance, indicating further proximalisation of the humeral head, but this was not significant (p = 0.049).
Journal of Shoulder and Elbow Surgery, 2015
Acta orthopaedica Belgica, 2011
The incidence of arthroscopic subacromial decompression has been increasing over the last few yea... more The incidence of arthroscopic subacromial decompression has been increasing over the last few years. Little is known about the duration of sick leave after such a procedure. The aim of this study was to determine the time till return to full duty and to explore the various influencing factors. We retrospectively evaluated a group of 166 patients who consecutively underwent arthroscopic subacromial decompression for subacromial impingement syndrome. One hundred patients were professionally active at the time of surgery; the mean duration till return to full duty was 11.1 weeks. Self-employed workers had the shortest sick leave period (median time of 1 week). No statistically significant difference was seen between the group with a financial compensation from the national health insurance system (median time of 12 weeks) and the group with income replacement by a private insurance company (median time of 8 weeks). Patients performing manual labour typically had a longer period of sick...
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Papers by Philippe Debeer