Custom, 3-Dimensional Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty: Part 3—Prosthesis Placement, Subscapularis Repair, and Postoperative Rehabilitation
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PROVIDER: S-EPMC10714274 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Project description:During anatomic total shoulder arthroplasty, careful dissection and meticulous soft tissue management ensure adequate visualization of the articular and bony surfaces, allowing the proper use of surgical instrumentation and ensuring accurate placement of prosthetic components. Exposure must be balanced with protection of the surrounding soft tissues, as well as neurovascular structures, which can have long-term postoperative implications. In Part 2 of this technique series for the management of glenohumeral osteoarthritis, we describe our technical approach for dissection, exposure, and management of soft tissues in anatomic total shoulder arthroplasty, including pearls and pitfalls, as well as a discussion of the benefits and risks of the most common approaches.
| S-EPMC10714241 | biostudies-literature
Project description:Successful total shoulder arthroplasty relies on a multitude of factors specific to patients, implant selection, and surgical technique. Among technical factors, correct intraoperative placement of prosthetic components is paramount. Three-dimensional computed tomography has emerged as a vital tool, allowing surgeons to measure glenoid inclination, glenoid version, and humeral head subluxation more accurately and reproducibly. Several commercial preoperative planning software resources are available to determine the optimal size and positioning of prosthetic components yet do so at significant cost and with meaningful time constraints. At our institution, we have applied the principles of these technologies to develop a custom, 3-dimensionally printed glenoid guide for accurate placement of the central pin. In this technical note, we describe our evaluation of patients with glenohumeral arthritis, as well as our step-by-step procedure for designing and printing a custom patient-specific instrumentation glenoid guide for anatomic total shoulder arthroplasty.
| S-EPMC10714211 | biostudies-literature
Project description:Traditionally, total shoulder arthroplasty is performed using a deltopectoral approach through which the glenohumeral joint is accessed by mobilization of the subscapularis. Despite several variations on the subscapularis management techniques, postoperative complications, including subscapularis deficiency and lower functional outcomes, remain an area for improvement. The purpose of this Technical Note is to describe in detail our technique for management of the subscapularis in the setting of a stemless humeral implant through which the repair is planned and almost entirely performed at the beginning of the case, prior to the subscapularis peel. This technique aims to improve outcomes after total shoulder arthroplasty by 1) avoiding the anatomic implant with anchor drilling, 2) improving procedure efficiency, and 3) anatomically "repairing" the subscapularis prior to takedown by placing anchors exactly at the repair-tension site.
| S-EPMC8897647 | biostudies-literature
Project description:Subscapularis management and repair are crucial during total shoulder arthroplasty to maximize outcomes. Bioinductive implants have been used to aid in repair of tendons in a variety of surgical techniques. In this surgical technique, we demonstrate our technique of subscapularis repair augmentation with a bioinductive implant during anatomic total shoulder arthroplasty.
| S-EPMC10773233 | biostudies-literature
Project description:Subscapularis repair failure following anatomic total shoulder arthroplasty (TSA) can compromise postoperative range of motion and joint stability, often leading to persistent pain and worse outcomes. Augmenting the subscapularis repair, particularly in at-risk patients, may provide a more robust construct and prevent subscapularis failure. The long head of the biceps tendon (LHBT) is an accessible autograft with applications previously described in several shoulder procedures. In this technical note and accompanying video, we describe LHBT augmentation of subscapularis repair following TSA. The LHBT is released from the supraglenoid tubercle and is passed through the subscapularis tendon vertically in a pulvertaft weave fashion. Transosseous sutures are used to complete the peel repair, with the LHBT acting as a rip-stop to help protect the repair from suture pullout. In addition, the incorporated LHBT remains in continuity with the remainder of the biceps distally and may act as a dynamic stabilizer. This technique, termed the "Biceps-Subscap Sling" technique, provides additional structural integrity to subscapularis repair and is a cost-effective, biologically active option.
| S-EPMC10714269 | biostudies-literature
Project description:Anatomic total shoulder arthroplasty, when used for treatment of primary glenohumeral arthritis, is historically very successful. We propose a novel technique for subscapularis repair during closure of a deltopectoral approach to the shoulder with subscapularis peel. Our technique allows for early motion following surgery and also provides for improved subscapularis repair integrity and resilience during postoperative rehabilitation. Postoperatively, we allow passive and active assisted range of motion at week 1, limited active range of motion at week 2, and unrestricted external rotation range of motion beginning at week 6. The use of our technique has led to improved patient outcomes with regard to range of motion postoperatively following anatomic total shoulder arthroplasty and we recommend its adoption into practice.
| S-EPMC10426494 | biostudies-literature
Project description:Anatomic total shoulder arthroplasty (TSA) has become more common as surgical indications have expanded. However, the burden of revision shoulder arthroplasty has inevitably increased as well. Multiple studies have examined the use of reverse total shoulder arthroplasty (rTSA) as a revision option for failed anatomic TSA with a massive irreparable rotator cuff tear. Successful reconstruction of failed TSA with rTSA requires sufficient glenoid bone to place the glenoid segment, enough proximal humeral bone to allow for implantation of the humeral component, and sufficient tension in the soft-tissue envelope to ensure implant stability. In this article, we describe our preferred rTSA revision technique for the treatment of a failed TSA.
| S-EPMC9939549 | biostudies-literature
Project description:The purpose of this study was to compare patient reported functional outcomes following bilateral aTSA vs rTSA. A retrospective review was conducted on twenty-six pateints who underwent staged bilateral aTSA or rTSA, with a minimum of 2 years follow up. Thirteen patients were included in each group, and patient assessed functional outcomes were measured using the PENN Score, ASES, SST, and SF-12. No statistically significant differences were found between the two groups for all functional outcome scores, patient satisfaction, or SF-12. These findings suggest that patients undergoing bilateral rTSA can expect functional outcomes similar to those obtained after bilateral aTSA. None of the authors involved in the work nor any of the author's institutions at any time received payment or services from a third party for any aspect of the submitted work and have no conflicts of interest to disclose.
| S-EPMC6919371 | biostudies-literature
Project description:PurposeGiven the poor soft-tissue quality in rheumatoid arthritis patients, many believe that rheumatoid arthritis should be treated with reverse total shoulder arthroplasty (rTSA). The purpose of this paper is to systematically assess outcomes of anatomic total shoulder arthroplasty (aTSA) in rheumatoid arthritis to determine if aTSA remains a viable option.MethodsA comprehensive literature search was conducted identifying articles relevant to aTSA in the setting of rheumatoid arthritis with intact rotator cuff. Outcomes include clinical outcomes and rates of complication and revision.ResultsTen studies were included with a total of 279 shoulders with mean follow-up of 116 ± 69 months. The mean age was 68 ± 10 years. Survivorship was 97%, 97% and 89% at 5, 10 and 20 years, respectively. The overall complication rate was 9%. Radiolucency was present in 69% of patients, of which 34% were at risk of loosening at 79 months. The overall rate of revision was 8.4%. Studies generally reported clinically significant improvements in range of motion, Constant score and ASES score.ConclusionaTSA in the rheumatoid patient results in improvements in range of motion and patient-reported outcomes. Rates of complications and survivorship are generally good in this population. However, it should be noted that there is significant heterogeneity in outcome reporting amongst the literature on this topic and that many studies fail to adequately report complication and revision rates. When compared to rTSA in patients with rheumatoid arthritis, evidence suggests that aTSA is still a viable treatment option despite the shift in utilization to rTSA.
| S-EPMC8899319 | biostudies-literature
Project description:A lesser tuberosity osteotomy (LTO) is commonly performed during total shoulder arthroplasty to access the glenohumeral joint. Healing of the LTO is critical to optimizing the outcome of the procedure and is enhanced by a repair that provides stability and compression across the osteotomy site. The purpose of this article is to describe a technique that uses a tensionable suture construct to repair the LTO during anatomic total shoulder arthroplasty using a stemless humeral component. The technique involves passing a row of high-tensile sutures through bone tunnels lateral to the osteotomy site (transosseous sutures) and another row of sutures through the humeral implant (implant sutures). One limb of each bone tunnel suture is then tied to its corresponding limb of implant suture and the remaining free strands of the tied sutures are manually tensioned and tied to each other. This technique is an efficient and reproducible method for creating compression and stability across the osteotomy site that facilitates bony healing.
| S-EPMC11329035 | biostudies-literature