Arthroplasty of the shoulder joint

2016

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The Journal of Bone and Joint Surgery. British volume, 2006

Scandinavian Journal of Rheumatology, 2006

Objective: To provide estimates of patient outcomes following shoulder arthroplasty using Neer-II type humeral prosthesis and to examine variation in outcomes due to patient and prosthesis characteristics. Methods: North American and Western European published articles were identified through a computerized literature search and bibliography review. Studies were included if they enrolled 15 or more patients, discriminated between hemi-arthroplasty (HEMI) and total shoulder arthroplasty (TSA) and measured pain relief, gain in range of motion (ROM), radiographic follow-up (w2 years), short-and long-term complications, and revision surgery. Results: A total of 40 studies satisfied the inclusion criteria. The total number of patients enrolled was 3584. The mean follow-up was 59 months. The mean patient age was 62 years, 65% of patients were women and 73% underwent TSA. All reports showed relevant pain relief, increase in ROM, and high satisfaction rates for HEMI and TSA in both osteoarthritis (OA) and rheumatoid arthritis (RA). The overall rate of revision was 8%. Significant differences between HEMI and TSA for both diagnoses were found for all outcome parameters. Conclusion: Shoulder arthroplasty is a safe and effective procedure for OA and RA patients. The diagnosis, shoulder pathology, and prosthesis specifics were significant predictors of outcomes. We therefore emphasize that conclusions on the outcome of shoulder arthroplasty can only be made if differentiated between these patient and prosthesis specifics. Limitations in the reporting style of these articles severely constrain the ability to explore variation in outcomes due to study, patient, or prosthesis characteristics and restrict their generalisability.

2018

Shoulder arthroplasty is a complex procedure that is becoming increasingly more utilized throughout the world. Due to the numerous static and dynamic stabilizers of the glenohumeral joint, along with the relative proximity to vital neurovascular structures, great care must be taken to access the joint in a safe and effective manner. To date, there are two well-described approaches utilized in shoulder arthroplasty: the deltopectoral approach and the anterosuperior approach. Both of these approaches are effective in accessing the glenohumeral joint; however, due to their anatomic location, they both have distinct advantages and disadvantages. The aim of this book chapter is to describe the methodology for approaching the glenohumeral joint through each of these approaches, as well as to discuss the advantages and disadvantages of utilizing each. In addition, we aim to discuss the various methodologies for closing these wounds and, briefly, to discuss the other approaches described in...

Advances in Shoulder Surgery

Shoulder arthroplasty is a complex procedure that is becoming increasingly more utilized throughout the world. Due to the numerous static and dynamic stabilizers of the glenohumeral joint, along with the relative proximity to vital neurovascular structures, great care must be taken to access the joint in a safe and effective manner. To date, there are two well-described approaches utilized in shoulder arthroplasty: the deltopectoral approach and the anterosuperior approach. Both of these approaches are effective in accessing the glenohumeral joint; however, due to their anatomic location, they both have distinct advantages and disadvantages. The aim of this book chapter is to describe the methodology for approaching the glenohumeral joint through each of these approaches, as well as to discuss the advantages and disadvantages of utilizing each. In addition, we aim to discuss the various methodologies for closing these wounds and, briefly, to discuss the other approaches described in the orthopedic literature.

Joint Bone Spine, 2010

The development of modern shoulder replacement surgery started over half a century ago with the pioneering work done by CS Neer. Several designs for shoulder prostheses are now available, allowing surgeons to select the best design for each situation. When the rotator cuff is intact, unconstrained prostheses produce reliable and reproducible results, with prosthesis survival rates of 97% after 10 years and 84% after 20 years. In patients with three-or four-part fractures of the proximal humerus, the outcome of shoulder arthroplasty depends largely on healing of the greater tuberosity, which is therefore a major treatment objective. Factors crucial to greater tuberosity union include selection of the optimal prosthesis design, flawless fixation of the tuberosities, and appropriate postoperative immobilization. The reverse shoulder prosthesis developed by Grammont has been recognized since 1991 as a valid option for patients with glenohumeral osteoarthritis. Ten-year prosthesis survival rates are 91% overall (including trauma and revisions) and 94% for glenohumeral osteoarthritis with head migration. These good results are generating interest in the reverse shoulder prosthesis as a treatment option in situations where unconstrained prostheses are unsatisfactory (primary glenohumeral osteoarthritis with marked glenoid cavity erosion; comminuted fractures in patients older than 75 years; post-traumatic osteoarthritis with severe tuberosity malunion or nonunion; massive irreparable rotator cuff tears with pseudoparalysis; failed rotator cuff repair; and proximal humerus tumor requiring resection of the rotator cuff insertions).

EFORT Open Reviews

The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the delt...

European Journal of Radiology, 2008

Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40 degrees in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and "bone stock", prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40 degrees of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening.

2009

A aprovação pelo Congresso norte-americano, enviada à Casa Branca de Obama, sobre a declaração do "genocídio" dos Arménios pelos Turquia na segunda , 2010

As the Ottoman Empire of old was dying, the deportation of Armenians and resettlement of Muslims in their lands was part of a broader project intended to permanently restructure the demographics of Anatolia. It began harshly. Many Armenian homes, businesses, and land were preferentially allocated to Muslims from outside the empire, nomads, and the estimated 800,000 (largely Kurdish) Ottoman subjects displaced because of the ongoing war with Russia. The "cleansing" could hardly by clearer. This was followed by a a series of geographical calculations: Muslims were spread out (and typically limited to 10 percent in any area) among larger Turkish populations so that they would lose their distinctive characteristics, such as the use of non-Turkish languages or nomadism. These migrants were exposed to harsh conditions and, in some cases, violence or restriction from leaving their new villages..The ethnic cleansing of Anatolia—the Armenian genocide, Assyrian genocide, and expulsion of Greeks after World War I—paved the way for the formation of an ethno-national Turkish state. In September 1918, Talaad Pasha emphasized that regardless of losing the war of 1914-1918, he had succeeded at "transforming Turkey to a nation-state in Anatolia". Indeed, the Pasha declared that "We have been blamed for not making a distinction between guilty and innocent Armenians. [To do so] was impossible. Because of the nature of things, one who was still innocent today could be guilty tomorrow. The concern for the safety of Turkey simply had to silence all other concerns. Our actions were determined by national and historical necessity". So, the government decreed that "any Muslim who harboured an Armenian against the will of the authorities would be executed". The genocide is extensively documented in the archives of Germany, Austria, the United States, Russia, France, and the United Kingdom, as well as the Ottoman archives, despite systematic purges of incriminating documents by Turkey. The estimate varies, but consensual that 800,000 to 1,1 million Armenians were killed. Many managed to run out of the moribund Empire, creating an enormous diaspora of Armenians. The numbers are astounding: Intentional, state-sponsored killing of Armenians mostly ceased by the end of January 1917, although sporadic massacres and forced starvation continued. Both contemporaries and later historians have estimated that around 1 million Armenians died during the genocide, with figures ranging from 600,000 to 1.5 million deaths. It has been consensual that between 800,000 and 1.2 million Armenians were deported, and contemporaries estimated that by late 1916 only 200,000 were still alive. As the victorious British Army slowly and then quickly advanced in 1917 and 1918 northwards through the Levant, they liberated around 100,000 to 150,000 Armenians working for the Ottoman military under abysmal conditions, not including those held by Arab tribes. This was by no means all. As a result of the Bolshevik Revolution and a subsequent separate peace with the Central Powers, the Russian army withdrew and Ottoman forces advanced into eastern Anatolia. The First Republic of Armenia was proclaimed in May 1918, at which time 50 percent of its population were refugees and 60 percent of its territory was under Ottoman occupation. Turkey, under Erdogan, continues to deny it ever happened. Albeit the US Congress pressed him, President Barack Obama never accepted to recognize that there was a "genocide". The question I framed in this interview was an attempt to try and map out and perhaps explain “why” Obama should then, as I expected said “no”. He did so in 2010, in 2012, and again in 2015. It was Joe Biden who, in 2021, asserted that yes, the massacres fit the bill of a “genocide”.