Abstract
Introduction
Locked anterior shoulder dislocation (LASD) is an uncommon condition associated with bone, articular cartilage, and soft tissue damage. In selected cases, shoulder arthroplasty (SA) may be the best treatment. The purpose of this study was to assess outcomes of SA for LASD.
Materials and methods
Between 1976 and 2013, 19 SAs [three hemiarthroplasties (HA), seven total shoulder arthroplasties (TSA), and nine reverse shoulder arthroplasties (RSA), mean age 62 years] were performed for LASD. Shoulders were followed for at least two years (range, 2-30 years, mean 7.1). Clinical and radiographic outcomes were studied.
Results/discussion
Three SAs required re-operation, two TSAs for early redislocation and one HA for late, painful glenoid arthrosis. Four additional shoulders (two TSA, two HA) were unstable at most recent follow-up. Pain improved from 4.7 to 2.2 (p < 0.0001) out of 5, elevation from 51 to 94 degrees (p = 0.004), and external rotation from 1 to 34 degrees (p = 0.01). There were two excellent, seven satisfactory, and ten unsatisfactory modified Neer ratings. Compared to TSA/HA, RSA experienced fewer re-operations (0 vs. 3, hazard ratio, 2.03*10^-9, p = 0.0844) and instability (0 vs. 6, p = 0.0108). Similar post-operative pain (p = 0.2192), range of motion (p = 0.2432-0.5299), strength (p = 0.2099), satisfaction (p = 0.6563), outcomes scores (p = 0.0683-0.0933), and complication rate (p = 0.3698) were seen with RSA vs. TSA/HA.
Conclusions
RSA for the treatment of chronic LASD provides greater pain relief, and improvement in range of motion (ROM) compared to TSA/HA. Anatomic SA is associated with a high rate of instability not seen with RSA. Therefore, anatomic SA (TSA/HA) is likely not indicated in these difficult circumstances.
Level of Evidence: IV
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References
Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, Romeo AA (2012) The Hill-Sachs lesion: diagnosis, classification, and management. JAAOS 20:242–252. doi:10.5435/jaaos-20-04-242
Sahajpal DT, Zuckerman JD (2008) Chronic glenohumeral dislocation. J Am Acad Orthop Surg 16:385–398
Cheng SL, Mackay MB, Richards RR (1997) Treatment of locked posterior fracture-dislocations of the shoulder by total shoulder arthroplasty. J Shoulder Elbow Surg 6:11–17
Flatow EL, Miller SR, Neer CS (1993) Chronic anterior dislocation of the shoulder. J Shoulder Elbow Surg 2:2–10. doi:10.1016/s1058-2746(09)80131-6
Goga IE (2003) Chronic shoulder dislocations. J Shoulder Elbow Surg 12:446–450. doi:10.1016/s1058274603000880
Pritchett JW, Clark JM (1987) Prosthetic replacement for chronic unreduced dislocations of the shoulder. Clin Orthop Relat Res 216:89–93
Rowe CR, Zarins B (1982) Chronic unreduced dislocations of the shoulder. J Bone Joint Am Am 64:494–505
Schulz TJ, Jacobs B, Patterson RL (1969) Unrecognized dislocations of the shoulder. J Trauma 9:1009–1023
Sperling JW, Pring M, Antuna SA, Cofield RH (2004) Shoulder arthroplasty for locked posterior dislocation of the shoulder. J Shoulder Elbow Surg 13:522–527. doi:10.1016/s1058274604000886
Wooten C, Klika B, Schleck CD, Harmsen WS, Sperling JW, Cofield RH (2014) Anatomic shoulder arthroplasty as treatment for locked posterior dislocation of the shoulder. J Bone Joint Surg Am 96:e19–e19. doi:10.2106/jbjs.l.01588
Berry DJ, Kessler M, Morrey BF (1997) Maintaining a hip registry for 25 years. Mayo Clinic experience. Clin Orthop Relat Res 344:61–68
McGrory BJ, Morrey BF, Rand JA, Ilstrup DM (1996) Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty 11:47–57
Smith AM, Barnes SA, Sperling JW, Farrell CM, Cummings JD, Cofield RH (2006) Patient and physician-assessed shoulder function after arthroplasty. J Bone Joint Surg Am 88:508–513. doi:10.2106/JBJS.E.00132
Schulz TJ, Jacobs B, Patterson RL Jr (1969) Unrecognized dislocations of the shoulder. J Trauma 9(12):1009–1023. doi:10.1097/00005373-196912000-00005
McLaughlin HL (1952) Posterior dislocation of the shoulder. J Bone Joint Surg Am 24A(3):584–590
Cofield RH (1984) Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am 66:899–906
Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP (2010) Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am 92:296–303. doi:10.2106/jbjs.h.01296
Michener LA, McClure PW, Sennett BJ (2002) American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg 11:587-594. doi:10.1067/mse.2002.127096
Kirshblum SC, Waring W, Biering-Sorensen F, Burns SP, Johansen M, Schmidt-Read M, Donovan W, Graves D, Jha A, Jones L, Mulcahey MJ, Krassioukov A (2011) Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med 34:547–554. doi:10.1179/107902611x13186000420242
Neer CS 2nd, Watson KC, Stanton FJ (1982) Recent experience in total shoulder replacement. J Bone Joint Surg Am 64:319–337
Sperling JW, Cofield RH, Rowland CM (1998) Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results. J Bone Joint Surg Am 80:464–473
Sperling JW, Cofield RH (1998) Revision total shoulder arthroplasty for the treatment of glenoid arthrosis. J Bone Joint Surg Am 80:860–867
Walch G, Badet R, Boulahia A, Khoury A (1999) Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty 14:756–760
Adams JE, Sperling JW, Schleck CD, Harmsen WS, Cofield RH (2007) Outcomes of shoulder arthroplasty in Olmsted County, Minnesota: a population-based study. Clin Orthop Relat Res 455:176–182. doi:10.1097/01.blo.0000238870.99980.64
Barrett WP, Franklin JL, Jackins SE, Wyss CR, Matsen FA 3rd (1987) Total shoulder arthroplasty. J Bone Joint Surg Am 69:865–872
Boileau P, Sinnerton RJ, Chuinard C, Walch G (2006) Arthroplasty of the shoulder. J Bone Joint Surg (Br) 88:562–575. doi:10.1302/0301-620X.88B5.16466
Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15:527–540. doi:10.1016/j.jse.2006.01.003
Deshmukh AV, Koris M, Zurakowski D, Thornhill TS (2005) Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life. J Shoulder Elbow Surg 14:471–479. doi:10.1016/j.jse.2005.02.009
Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G (2006) Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 88:1742–1747. doi:10.2106/JBJS.E.00851
Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 85:1215–1223
Wirth MA, Tapscott RS, Southworth C, Rockwood CA Jr (2006) Treatment of glenohumeral arthritis with a hemiarthroplasty: a minimum five-year follow-up outcome study. J Bone Joint Surg Am 88:964–973. doi:10.2106/JBJS.D.03030
Matsoukis J, Tabib W, Guiffault P, Mandelbaum A, Walch G, Nemoz C, Cortes ZE, Edwards TB (2006) Primary unconstrained shoulder arthroplasty in patients with a fixed anterior glenohumeral dislocation. J Bone Joint Surg Am 88:547–552. doi:10.2106/JBJS.E.00368
Raiss P, Aldinger PR, Kasten P, Rickert M, Loew M (2009) Humeral head resurfacing for fixed anterior glenohumeral dislocation. Int Orthop 33:451–456. doi:10.1007/s00264-007-0487-6
Werner BS, Bohm D, Abdelkawi A, Gohlke F (2014) Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation. J Shoulder Elbow Surg 23:1655–1661. doi:10.1016/j.jse.2014.02.017
Kurowicki J, Triplet JJ, Momoh E, Moor MA, Levy JC (2016) Reverse shoulder in the treatment of locked anterior shoulders: a comparison with classic reverse shoulder indications. J Shoulder Elbow Surg 25(12):1954–1960. doi:10.1016/j.jse.2016.04.019
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No external sources of funding were utilized for this study.
Conflict of interest
Dr. Sanchez-Sotelo reports other from Stryker (Shoulder implant design), outside the submitted work; Dr. Cofield reports other from Royalties, outside the submitted work; In addition, Dr. Cofield has a patent Smith/Nephew issued. Dr. Sperling reports other from Zimmer-Biomet, outside the submitted work; No other author has any disclosures.
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Statz, J.M., Schoch, B.S., Sanchez-Sotelo, J. et al. Shoulder arthroplasty for locked anterior shoulder dislocation: a role for the reversed design. International Orthopaedics (SICOT) 41, 1227–1234 (2017). https://doi.org/10.1007/s00264-017-3450-1
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DOI: https://doi.org/10.1007/s00264-017-3450-1