Total Shoulder Arthroplasty
Conditions
Keywords
Glenohumeral Osteoarthritis, Total Shoulder Arthroplasty, Subscapularis-Sparing, Prospective Study, Patient-Reported Outcomes
Brief summary
The investigators purpose of this study are to perform a prospective clinical study to determine the following after subscapularis-sparing anatomic total shoulder arthroplasty performed for glenohumeral osteoarthritis: 1. patient-reported outcomes 2. shoulder motion and strength 3. rotator cuff integrity 4. the accuracy of component placement and the completeness of osteophyte removal
Detailed description
Anatomic total shoulder arthroplasty (TSA) provides excellent pain relief and restoration of shoulder function in the setting of glenohumeral osteoarthritis. However, the surgical approach requires the subscapularis to be cut and repaired, via either a lesser tuberosity osteotomy, a subscapularis tenotomy, or a subscapularis peel.This repair must be protected post-operatively, even with a lesser tuberosity osteotomy, or it can displace or fail to heal, which complicates rehabilitation. Failure of the subscapularis repair occurs in 10-25% of patients. Failure of the subscapularis repair is often devastating for shoulder function and often requires revision to a reverse total shoulder arthroplasty. Even when muscle-tendon-bone healing does occur there is post-operative atrophy of the subscapularis that may compromise function and strength. Atrophy of the subscapularis may lead to imbalance of the rotator cuff musculature, leading to subluxation and glenoid loosening. While there have been attempts to develop approaches that do not involve cutting the subscapularis, they have been plagued by osteophyte retention, component malposition, damage to the deltoid, or damage to the supraspinatus. The principal investigator has spent four years developing a technique for anatomic total shoulder arthroplasty that does not involve cutting any muscles or tendons and has been through the learning curve with this technique by completing \>20 cases and at least as many cadaver surgeries during that time period. This technique has been designed to avoid the potential issues with prior attempts and utilizes purpose designed instrumentation and retractors.
Interventions
PROCEDURESubscapularis-Sparing Total Shoulder Arthroplasty
A surgical technique for anatomic total shoulder arthroplasty that does not involve cutting any muscles or tendons.
Sponsors
University of Utah
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing subscapularis-sparing anatomic total shoulder arthroplasty by the principal investigator at the University of Utah.
Exclusion criteria
* Patients unwilling to consent and comply with study procedures (i.e. follow up visits). * Patients under the age of 18. * Patients with contraindications to an anatomic total shoulder arthroplasty such as active infection, insufficient glenoid bone, damage to the rotator cuff, or a history of instability. * Patients with known prior shoulder arthroplasty. * Patients unable to undergo a magnetic resonance imaging study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient-reported outcome (American Shoulder and Elbow Surgeons (ASES) Score | Pre-operative | Shoulder specific scoring system out of 100. A patient-reported score with visual analog scale for pain and functional subscales ranging from 0 (worse pain and function loss) to 50 (no pain and excellent function). Both scores are summed for a maximum score of 100. |
| Patient-reported outcome (Simple Shoulder Test (SST)) | Pre-operative | There are 12 shoulder specific questions which the patient answers "yes" or "no". The questions ask about strength, function and range of motion. To score the test, divide the number of "yes" answers by the total number of questions answered and then multiply by 100. 0% is the worst score to 100% being the best score. |
| Patient-reported outcome (Visual Analogue Score (VAS)) | Pre-operative | VAS pain score (0 no pain - 10 severe pain) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORPeter Chalmers, M.D.
University of Utah Orthopaedics
Outcome results
None listed