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Capsular release following total shoulder arthroplasty: an analysis of early outcomes

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study is to analyze the outcomes of open and arthroscopic capsular release following total shoulder arthroplasty.

Methods

Over 15 years, 19 patients experienced persistent shoulder stiffness after anatomic total shoulder arthroplasty refractory to nonoperative treatment, requiring either open (n = 5) or arthroscopic (n = 14) capsular release. There were seven (39%) patients who had a prior diagnosis of stiffness before the primary arthroplasty.

Results

At a follow-up of 2.3 years (1–5.5), there were changes in range of motion, including forward flexion (77°–117°), abduction (49°–98°), external rotation (9°–19°), internal rotation at 0° (Sacrum to L1), and pain (4.1–2.3) scores (p < 0.01). There were seven (37%) patients that required a reoperation following the initial capsular release. The survival-free of reoperation at 2 and 5 years was 76% and 53%, respectively, while the survival-free of revision surgery at 2 and 5 years was 83%. Furthermore, three (16%) patients required a repeat capsular release. Overall, there were 11 (58%) complications, including stiffness (n = 9), infection (n = 1), subscapularis rupture (n = 2), glenoid loosening (n = 3), and pain with weakness requiring reoperation (n = 1).

Conclusions

Shoulder stiffness after total shoulder arthroplasty is a very difficult pathology to treat, with high rates of complications and reoperations after capsular release. Overall, in patients that do not develop glenoid loosening, capsular release does improve the patient’s pain and shoulder motion. Furthermore, when patients develop stiffness, it is critical to rule out other etiologies, such as glenoid loosening, prior to proceeding with capsular release.

Level of evidence IV

Retrospective case series.

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Funding

There were no grants or other sources of funding utilized for completion of this manuscript.

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Authors and Affiliations

  1. Shoulder Service, Massachusetts General Hospital, Department of Orthopedic Surgery, Boston Shoulder Institute, 55 Fruit Street, Suite 3200, Boston, MA, 02114, USA

    Eric R. Wagner, Michelle J. Chang, Muriel J. Solberg, Kathryn M. Welp, Tyler J. Hunt, Jarret M. Woodmass, Laurence D. Higgins & Jon J. P. Warner

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  1. Eric R. Wagner
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  2. Michelle J. Chang
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  3. Muriel J. Solberg
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  4. Kathryn M. Welp
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  5. Tyler J. Hunt
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  6. Jarret M. Woodmass
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  7. Laurence D. Higgins
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  8. Jon J. P. Warner
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Corresponding authors

Correspondence to Laurence D. Higgins or Jon J. P. Warner.

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Ethical standards

Each author certifies that his or her institution and the Partners Human Research Committee (2017P001865) approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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The authors have nothing to disclose that is relevant to this publication.

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Wagner, E.R., Chang, M.J., Solberg, M.J. et al. Capsular release following total shoulder arthroplasty: an analysis of early outcomes. Eur J Orthop Surg Traumatol 31, 167–173 (2021). https://doi.org/10.1007/s00590-020-02754-8

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  • DOI: https://doi.org/10.1007/s00590-020-02754-8

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