PMID- 36049701
OWN - NLM
STAT- MEDLINE
DCOM- 20230117
LR  - 20230117
IS  - 1532-6500 (Electronic)
IS  - 1058-2746 (Linking)
VI  - 32
IP  - 2
DP  - 2023 Feb
TI  - Stemless total shoulder arthroplasty using a novel multiplanar osteotomy and 
      elliptical humeral head results in both improved early range of motion and 
      radiographic center of rotation compared with standard total shoulder 
      arthroplasty.
PG  - 318-325
LID - S1058-2746(22)00661-9 [pii]
LID - 10.1016/j.jse.2022.07.016 [doi]
AB  - BACKGROUND: Restoration of the native glenohumeral anatomy is an important 
      consideration in obtaining optimal range of motion (ROM) after anatomic total 
      shoulder arthroplasty (TSA). Recently, a new stemless TSA system has been 
      developed that uses both a multiplanar osteotomy (MPO), to improve the surgeon's 
      ability to restore humeral center of rotation (COR), and an elliptical humeral 
      head to improve ROM. The purpose of our study was to compare the difference in 
      early postoperative ROM and restoration of radiographic COR, between this 
      stemless TSA and standard stemmed TSAs. METHODS: This was a retrospective review 
      of 50 consecutive primary TSAs performed by a single surgeon for glenohumeral 
      osteoarthritis. The initial cohort underwent TSA with a standard stemmed humeral 
      component with a circular humeral head (n = 25), whereas the subsequent cohort 
      underwent stemless TSA using an MPO and an elliptical humeral head (n = 25). 
      Postoperative data collection included active shoulder ROM as measured by 
      goniometer, complications or revision surgery, and measurements of radiographic 
      COR. Patients were assessed at 6 weeks, 12 weeks, 6 months, and 12 months after 
      surgery. Change in COR was determined on postoperative radiographs by 2 
      fellowship-trained surgeons on 2 separate occasions. Intra- and interrater 
      reliability were computed using intraclass correlation coefficients. RESULTS: For 
      both mean forward flexion (FF) and external rotation (ER), there was greater ROM 
      in the MPO-elliptical group at all time points, which was statistically 
      significant. Mean change in FF favored the MPO group at 6 and 12 weeks and was 
      statistically significant and above the minimal clinically important difference 
      (MCID): 6 weeks, standard -15.8 degrees  vs. MPO 8.4 degrees  (P = .004); 12 weeks, standard 6.4 degrees  
      vs. MPO 29.2 degrees  (P = .001). Mean change in ER favored the MPO group at 6 weeks and 
      was statistically significant: standard 5.4 degrees  vs. MPO 14.0 degrees  (P = .02). There were 
      no revision surgeries in either group. Average change in COR was 2.7 mm in the 
      standard group and 1.8 mm in the MPO-elliptical group, which was statistically 
      significant (P < .001). Number of patients with >3 mm of difference in COR was 10 
      (40%) in the standard group and 1 (5%) in the MPO-elliptical group, which was 
      statistically significant (P = .002). Average intraclass correlation coefficient 
      was 0.75, indicating good reliability within and between surgeon measurements. 
      CONCLUSION: The use of a multiplanar osteotomy and elliptical humeral head was 
      associated with improved early range of motion and better reproduction of the 
      radiographic COR compared with standard stemmed TSA.
CI  - Copyright (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. 
      Published by Elsevier Inc. All rights reserved.
FAU - Budge, Matthew D
AU  - Budge MD
AD  - Kaiser Permanente Northwest, Salem, OR, USA. Electronic address: 
      mdbudge@hotmail.com.
FAU - Orvets, Nathan
AU  - Orvets N
AD  - Kaiser Permanente Northwest, Salem, OR, USA.
LA  - eng
PT  - Journal Article
DEP - 20220829
PL  - United States
TA  - J Shoulder Elbow Surg
JT  - Journal of shoulder and elbow surgery
JID - 9206499
SB  - IM
MH  - Humans
MH  - *Arthroplasty, Replacement, Shoulder/methods
MH  - *Shoulder Joint/diagnostic imaging/surgery
MH  - Humeral Head/diagnostic imaging/surgery
MH  - Reproducibility of Results
MH  - Range of Motion, Articular
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Total shoulder arthroplasty
OT  - center of rotation
OT  - elliptical humeral head
OT  - follow-up
OT  - outcome
OT  - radiographs
OT  - range of motion
OT  - stemless
EDAT- 2022/09/02 06:00
MHDA- 2023/01/18 06:00
CRDT- 2022/09/01 19:27
PHST- 2022/03/17 00:00 [received]
PHST- 2022/07/08 00:00 [revised]
PHST- 2022/07/10 00:00 [accepted]
PHST- 2022/09/02 06:00 [pubmed]
PHST- 2023/01/18 06:00 [medline]
PHST- 2022/09/01 19:27 [entrez]
AID - S1058-2746(22)00661-9 [pii]
AID - 10.1016/j.jse.2022.07.016 [doi]
PST - ppublish
SO  - J Shoulder Elbow Surg. 2023 Feb;32(2):318-325. doi: 10.1016/j.jse.2022.07.016. 
      Epub 2022 Aug 29.