Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty? The Prevalence of Glenohumeral Osteoarthrosis in Unstable Shoulders * The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. Relevance of Arm Position and Muscle Activity on Three-Dimensional Glenohumeral Translation in Patients with Traumatic and Atraumatic Shoulder Instability * A randomized clinical trial comparing open and arthroscopic stabilization for recurrent traumatic anterior shoulder instability: two-year follow-up with disease-specific quality-of-life outcomes. The Incidence and Characteristics of Shoulder Instability at the United States Military Academy Arthroscopic Versus Conservative Treatment of First Anterior Dislocation of the Shoulder in Adolescents The treatment of primary anterior shoulder dislocations. An Evaluation of the Apprehension, Relocation, and Surprise Tests for Anterior Shoulder Instability Effect of taping on the shoulders of Australian football players The reversed gap technique produces anatomical alignment with less midflexion instability in total knee arthroplasty: a prospective randomized trial Postural control in rheumatoid arthritis patients scheduled for total knee arthroplasty. Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results. Nonoperative Management for In-Season Athletes with Anterior Shoulder Instability Return to Play and Recurrent Instability After In-Season Anterior Shoulder Instability Systematic Review of Arthroscopic Versus Open Repair for Recurrent Anterior Shoulder Dislocations External Rotation Immobilization for Primary Shoulder Dislocation: A Randomized Controlled Trial The effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception. A Prospective, Randomized Evaluation of Arthroscopic Stabilization versus Nonoperative Treatment in Patients with Acute, Traumatic, First-Time Shoulder Dislocations * Evaluation of immobilization in external rotation after primary traumatic anterior shoulder dislocation: 5-year results
BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures Background A concern regarding  reverse shoulder arthroplasty ( RSA )  is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty . Questions / purpose sWe determined ( 1 ) the rate of instability and infection ; ( 2 ) whether diagnosis influenced instability and infection rates ; and ( 3 ) whether these complications affect ASES , Constant , and WOOS scores after RSA . Methods A prospect i ve data base , clinical charts , and radiographs of 284 patients who had undergone primary ( n = 212 patients ) or revision ( n = 72 patients ) RSA  were review ed to identify patients whose postoperative course was complicated by instability or infection . Results The rate of instability was similar in patients with primary ( eleven of 212 [ 5 % ) ] and revision ( six of 72 [ 8 % ] ) reverse arthroplasty . The rate of infection was higher in the revision ( five of 72 [ 7 % ] ) than in the primary ( three of 212 [ 1 % ] ) group . Patients with an irreparable subscapularis tendon had a higher rate of instability ( 14 of 123 [ 12 % ] ) compared with patients with a repairable subscapularis tendon ( one of 161 [ less than 1 % ] ) . The fracture sequelae group had the highest rate of instability ( seven of 25 [ 28 % ] ) among diagnoses within the primary group . The rates of infection were similar between the diagnoses within the primary group . The improvements in the ASES score , the Constant score , and the WOOS score from preoperatively to postoperatively were better in the no instability/infection group as compared with the instability/infection group . Conclusions This information confirms the available literature allowing surgeons to give patients realistic expectations regarding the infection and instability rates after RSA.Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background Glenohumeral osteoarthritis has been a well-described complication of open procedures to correct shoulder instability . What remains unknown is whether chondral injuries sustained during instability episodes contribute to osteoarthritis or whether the cause is primarily the stabilization procedure itself . Purpose To determine the prevalence of osteoarthrosis in a large data base of patients with acute and chronic shoulder instability before primary stabilization surgery . Study Design Retrospective review of prospect ively collected data . Methods Surgical and demographic data were collected on 422 patients with a diagnosis of shoulder instability who underwent arthroscopic examination and shoulder stabilization .  Results There was a significant association between the grade of osteoarthrosis and the presence of osteoarthritis ( grade III or IV chondral damage ) with time from injury to surgery . Patients with osteoarthritis  were significantly older than those without ( 34.9 versus 29.6 years ) . Multivariate analysis identified older age and time from injury to surgery as independent predictors of osteoarthritis . We found no association between direction of instability and the presence of osteoarthritis . Conclusion The overall prevalence of glenohumeral osteoarthrosis was low . Predictors of osteoarthritis included time from injury to surgery and age Introduction Over the last decade , proprioceptive function gained increasing attention in joint disorders such as instability of the shoulder . Common tests for evaluation of proprioception are limited by their complexity and high technical dem and s. Thus , they are hardly applicable during daily routine . Our hypothesis was that the simplified “ laser-pointer assisted angle reproduction test ” ( LP-ART ) presented here allows for clinical ly feasible assessment of proprioceptive shoulder function . Methods Active angle reproduction capability as an aspect of sensorimotor function was evaluated with the new method in patients with shoulder instability ( n = 24 ) and healthy controls ( n = 24 ) . 15 patients had traumatic , 9 non-traumatic anterior instability ( 6 bilateral ) , 17 were treated surgically , 13 non-operatively . Tests were performed in flexion and abduction in different angles ( 55 ° , 90 ° , 125 ° ) in r and omized order . Results Angle reproduction capability was worst below shoulder level ( 55 ° ) in all groups . Best results were achieved at shoulder level ( 90 ° ) . Healthy controls showed overall better results than patients with instability . Patients after surgical stabilization had better results in 55 ° and 90 ° abduction compared to instability patients before surgery . Conclusions The new LP-ART presented here is a technically simple , yet effective instrument for evaluation of the proprioceptive function of the shoulder . In contrast to former test setups it is feasible in daily routine . Compared to healthy controls , patients with unstable shoulder joints show significant proprioceptive disorders that can be quantified by the LP-ART BACKGROUND Anterior dislocation of the glenohumeral joint in younger patients is associated with a high risk of recurrence and persistent functional deficits . The aim of this study was to assess the efficacy of a primary arthroscopic Bankart repair , while controlling for the therapeutic effects produced by the arthroscopic intervention and joint lavage . METHODS In a single-center , double-blind clinical trial , eighty-eight adult patients under thirty-five years of age who had sustained a primary anterior glenohumeral dislocation were r and omized to receive either an arthroscopic examination and joint lavage alone or together with an anatomic repair of the Bankart lesion .  Assessment of the rate of recurrent instability , functional outcome ( with use of three scores ) , range of movement , patient satisfaction , direct health-service costs , and treatment complications was completed for eighty-four of these patients ( forty-two in each group ) during the subsequent two years . RESULTS In the two years after the primary dislocation , the risk of a further dislocation was reduced by 76 % and the risk of all recurrent instability was reduced by 82 % in the Bankart repair group compared with the group that had arthroscopy and lavage alone . The functional scores were also better ( p < 0.05 ) , the treatment costs were lower ( p = 0.012 ) , and patient satisfaction was higher ( p < 0.001 ) after arthroscopic repair . The improved functional outcome appeared to be mediated through the prevention of instability since the functional outcome in patients with stable shoulders was similar , irrespective of the initial treatment allocation . The patients who had a Bankart repair and played contact sports were also more likely to have returned to their sport at two years ( relative risk = 3.4 , p = 0.007 ) . CONCLUSIONS Following a first-time anterior dislocation of the shoulder , there is a marked treatment benefit from primary arthroscopic repair of a Bankart lesion , which is distinct from the so-called background therapeutic effect of the arthroscopic examination and lavage of the joint . However , primary repair does not appear to confer a functional benefit to patients with a stable shoulder at two years after the dislocation BACKGROUND The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients . We performed a prospect i ve cohort study to evaluate these outcomes . We also aim ed to produce guidelines for the design of future clinical trials , assessing the efficacy of interventions design ed to improve the outcome after a primary dislocation . METHODS We performed a prospect i ve cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization , followed by a physical therapy program . Patients received regular clinical follow-up to assess whether recurrent instability had developed . Functional assessment s were made and were compared for two subgroups : those who had not had instability develop and those who had received operative stabilization to treat recurrent instability . RESULTS On survival analysis , instability developed in 55.7 % of the shoulders within the first two years after the primary dislocation and increased to 66.8 % by the fifth year . The younger male patients were most at risk of instability , and 86.7 % of all of the patients known to have recurrent instability had this complication develop within the first two years . A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients . Sample -size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions design ed to reduce the prevalence of recurrent instability and improve the functional outcome . CONCLUSIONS Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation . There is substantial variation in the risk of instability , with younger males having the highest risk and females having a much lower risk . Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits , with use of an assessment tool specifically for shoulder instability , during the first two years after the initial dislocation Background No quantitative data on glenohumeral translation exist allowing one to distinguish insufficiency of the active or passive stabilizers in different forms of shoulder instability . Hypothesis To determine whether 1 ) in traumatic or atraumatic shoulder instability an increase of glenohumeral translation can be observed in specific relevant arm positions , 2 ) muscle activity leads to recentering of the humeral head , and 3 ) there exist differences between traumatic and atraumatic instability . Study Design Prospect i ve clinical trial . Methods In 12 patients with traumatic and 10 patients with atraumatic instability , both shoulders  were examined in different arm positions — with and without muscle activity — by using open magnetic resonance imaging and a three-dimensional postprocessing technique . Results At 90 ° of abduction and external rotation , translation ( anterior-inferior ) was significantly higher in patients with traumatic unstable shoulders compared with their contralateral side ( 3.6 ± 1.5 versus 0.7 ± 1.6 mm ) . In patients with atraumatic instability , significantly increased translation ( 4.7 ± 2.0 mm ) was observed , with the direction being nonuniform . Muscle activity led to significant recentering in traumatic but not in atraumatic instability . Conclusions In traumatic instability , increased translation was observed only in functionally important arm positions , whereas intact active stabilizers demonstrate sufficient recentering . In atraumatic instability , a de central ized head position was recorded also during muscle activity , suggesting alterations of the active stabilizers . Clinical Relevance Clinical Relevance : These data are relevant for optimizing diagnostics and therapeutic strategies BACKGROUND The literature comparing open and arthroscopic repair for glenohumeral instability is conflicting . We performed a prospect i ve , expertise-based , r and omized clinical trial to compare open shoulder stabilization with arthroscopic shoulder stabilization by measuring quality -of-life outcomes and recurrence rates at two years among patients treated for traumatic anterior shoulder instability . METHODS Computer-generated , variable-block-size , concealed r and omization allocated 196 patients to either the open-repair group ( n = 98 ) or the arthroscopic-repair group ( n = 98 ) . An expertise-based r and omization design was employed to avoid a differential bias in terms of physician experience . Outcomes were measured at baseline , at three and six months postoperatively , and at one and two years postoperatively with use of the Western Ontario Shoulder Instability Index ( WOSI ) and the American Shoulder and Elbow Surgeons ( ASES ) functional outcome scale . Recurrent instability was also analyzed . RESULTS There were no significant differences in outcome scores at baseline . At two years , seventy-nine patients in the open group and eighty-three patients in the arthroscopic group were available for follow-up . There was no significant difference in mean WOSI scores between the groups ; the mean WOSI score ( and st and ard deviation ) for the open group was 85.2 ± 20.4 ( 95 % confidence interval [ CI ] = 80.5 to 89.8 ) , and for the arthroscopic group , 81.9 ± 19.8 ( 95 % CI = 77.4 to 86.4 ) ; p = 0.31 . There was also no significant difference in mean ASES scores : 91.4 ± 12.7 ( 95 % CI = 88.5 to 94.4 ) for the open group and 88.2 ± 15.9 ( 95 % CI = 84.6 to 91.8 ) for the arthroscopic group ; p = 0.17 . Recurrence rates at two years were significantly different : 11 % in the open group and 23 % in the arthroscopic group ( p = 0.05 ) . Recurrent instability was more likely in patients with a preoperative Hill-Sachs lesion and in male patients who were twenty-five years old and younger . There was no significant difference in shoulder motion between the groups at two years . CONCLUSIONS There was no difference between open and arthroscopic repair in terms of patient quality of life . Open repair result ed in a significantly lower risk of recurrence . Secondary outcome data from this trial suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hill-Sachs lesion Background The literature provides little information detailing the incidence of traumatic shoulder instability in young , healthy athletes . Hypothesis Shoulder instability is common in young athletes . Study Design Descriptive epidemiologic study . Methods We prospect ively captured all traumatic shoulder instability events at the United States Military Academy between September 1 , 2004 , and May 31 , 2005 . Throughout this period , all new traumatic shoulder instability events were evaluated with physical examination , plain radiographs , and magnetic resonance imaging . Instability events were classified according to direction , chronicity , and type ( subluxation or dislocation ) . Subject demographics , mechanism of injury , and sport were evaluated . Results Among 4141 students , 117 experienced new traumatic shoulder instability events during the study period ; 11 experienced multiple events . The mean age of these 117 subjects was 20.0 years ; 101 students were men ( 86.3 % ) , and 16 were women ( 13.7 % ) . The 1-year incidence proportion was 2.8 % . The male incidence proportion was 2.9 % and the female incidence proportion was 2.5 % . Eighteen events were dislocations ( 15.4 % ) , and 99 were subluxations ( 84.6 % ) . Of the 99 subluxations , 45 ( 45.5 % ) were primary events , while 54 ( 54.5 % ) were recurrent . Of the 18 dislocations , 12 ( 66.7 % ) were primary events , while 6 ( 33.3 % ) were recurrent . The majority of the 117 events were anterior in nature ( 80.3 % ) , while 12 ( 10.3 % ) were posterior , and 11 ( 9.4 % ) were multidirectional . Forty-four percent ( 43.6 % ) of the instability events experienced were as a result of contact injuries , while 41.0 % were a result of noncontact injuries , including 9 subluxations caused by missed punches during boxing ; information was unavailable for the remaining 15 % . Conclusion Glenohumeral instability is a common injury in this population , with subluxations comprising 85 % of instability events Background : Conservative treatment of posttraumatic antero-inferior shoulder instability leads to a high failure rate in a young and active population . However , treatment in an adolescent age group is not well documented . Methods : We conducted a prospect i ve study with adolescent patients ( age 15 to 18 y ) who suffered a first traumatic anterior dislocation of the shoulder . Two groups of patients were formed . The first group was treated with early arthroscopic stabilization and the second was treated conservatively . There were 43 shoulders in the operative group and 29 shoulders in the conservative group . The rehabilitation protocol was the same for both groups . All patients were followed up prospect ively after 12 , 24 , and 36 months using Rowe Score . Results : A total of 38 shoulders in the surgical group and 27 shoulders in the conservative group could be completely evaluated . From the conservative group , 19 patients ( 70.3 % ) suffered a recurrence of the instability . From the arthroscopic group , 5 patients ( 13.1 % ) suffered a recurrence of the instability . Conclusions : In an adolescent population ( 15 to 18 y ) , conservative treatment after first traumatic shoulder dislocation including immobilization in internal rotation leads to a significantly higher and unacceptable high failure rate compared with early arthroscopic stabilization . Level of Evidence : Level II— prospect i ve comparative study The treatment of primary anterior shoulder dislocations is complex and challenging . The goal of treatment is to achieve a stable , pain-free shoulder with a full range of motion . The currently available evidence on the outcomes of nonsurgical treatment and immediate surgical stabilization conflicts ; decision making must also take into account patient-specific variables , including age , occupation , functional dem and s , sports participation , physical characteristics , and compliance . Although recurrence rates after anterior shoulder dislocation are difficult to pinpoint , abundant data indicate that the shoulder is more vulnerable to instability after a first traumatic dislocation . Relatively young patient age at the time of injury is the most consistent and significant prognostic factor for recurrent instability . Male gender is independently predictive of recurrent instability . Most recent studies have not identified sports participation or a type of sports activity as correlated with the risk of recurrent instability . Nonsurgical treatment typically involves closed reduction , a period of immobilization , and physical therapy for strengthening the rotator cuff and scapular stabilizers . The evidence for this treatment strategy is largely anecdotal , and the literature on its efficacy is inconclusive . Several recent studies suggested that immobilization of the shoulder in external rotation after a primary traumatic anterior shoulder dislocation may decrease the risk of recurrent instability more than conventional sling immobilization . The limited evidence available from r and omized , controlled trials supports early surgical stabilization of a first traumatic anterior dislocation in high-risk young adults who engage in dem and ing physical activities . Although different outcome tools were used , the reported recurrence rates and functional outcomes consistently and significantly favored surgical treatment over nonsurgical treatment in this population of young , active patients . Early or prophylactic stabilization is not advisable unless the patient has a high risk of recurrence Background Although there are many studies describing tests for shoulder instability , there are few assessing the validity of these tests in diagnosing anterior shoulder instability . Purpose To assess the validity of the apprehension , relocation , and surprise tests as predictors of anterior shoulder instability . Study Design Retrospective review of prospect ively collected data . Methods Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent , blinded examiners : traumatic anterior instability ( 18 ) , rotator cuff tendinosis ( 17 ) , posterior instability ( 2 ) , glenohumeral osteoarthritis ( 4 ) , or multidirectional instability ( 5 ) .  Interobserver reliability was also determined . Results In subjects who had a feeling of apprehension on all three tests , the mean positive and negative predictive values were 93.6 % and 71.9 % , respectively . The surprise test was the single most accurate test ( sensitivity = 63.89 % ; specificity = 98.91 % ) . An improvement in the feeling of apprehension or painwith the relocation test added little to the value of the tests . Interobserver reliability was determined to be 0.83 . Conclusions and Clinical Relevance The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability Background : Taping of the shoulder is common in many sports , particularly Australian football , a contact sport that often involves marking ( catching ) the ball overhead and has a high incidence of shoulder instability . Hypothesis : Taping of the shoulder reduces glenohumeral joint laxity and improves proprioception without impairing function . Study design : Crossover study design . Methods : 33 male players aged 18–31 years were recruited from a local Australian football club . The dominant shoulder of each player was tested with and without taping in a r and omised fashion by an examiner blinded to the presence or absence of taping . The tests were ( 1 ) inferior glenohumeral joint laxity ( the Orthopaedic Research Institute laxometer ) , ( 2 ) shoulder joint position sense accuracy using an optical tracking system  , and ( 3 ) h and balling accuracy . Results : The methods for testing laxity and joint position sense had good intraobserver reliability and sensitivity . All subjects tolerated the taping and testing . Glenohumeral joint laxity ( p = 0.75 ) , joint position sense ( p = 0.56 ) and h and balling accuracy ( p = 0.6 ) were not changed by taping . Conclusions : Taping of the shoulder joint in uninjured and non-symptomatic Australian football players in a pattern that attempted not to restrict their range of overhead movement did not significantly affect the accuracy of joint position sense , inferior laxity or h and ball accuracy . Clinical relevance : These data suggest that taping of the shoulder is unlikely to decrease the incidence of injury — specifically dislocation — of the shoulder in Australian football players Purpose No surgical technique is capable of controlling the stability of the joint in midflexion . The purpose of the present study was to present and evaluate a surgical technique that aims to reduce the need for soft-tissue release and optimize stability in midflexion . Methods Sixty knee joints were included in this prospect i ve r and omized study . Surgery was performed either according to a classical gap ( GT ) technique or using the reversed gap ( RG ) technique . In the RG , the femoral component was positioned parallel to the surgical transepicondylar axis using a preoperative MRI and a navigation system . The frontal alignment of the tibia was then selected to produce a symmetric flexion gap . Then , the frontal alignment of the femoral component was adjusted to produce a symmetric extension gap . Soft-tissue release was defined to be extensive if more than two steps or stabilizing structures were involved . Joint stability was measured at different flexion angles ( −5 ° to 120 ° ) using a gap tensioning device and the trial femoral implant . Results In the GT group , 16 knee joints ( 53 % ) showed an instability of more than 2 mm at 5 ° , 30 ° or 60 ° , compared with 8 knee joints ( 27 % ) in the RG group ( p = 0.035 ) . The RG did not lead to a reduction in the number of soft-tissue releases , but they were less extensive . Conclusion RG reduced midflexion instability and the number of extensive soft-tissue releases . It may simplify the operation by reducing the extent of soft-tissue releases and avoid instability-related problems of knee arthroplasty . Nevertheless , it should only be performed under controlled conditions until long-term clinical data are available . Level of evidence OBJECTIVE To investigate the use of compensatory visual and attentional control strategies for st and ing balance in patients with rheumatoid arthritis ( RA ) with severe knee joint impairment . DESIGN Experimental 2-group design . SETTING Specialized clinic for orthopedics , rheumatology , and rehabilitation in The Netherl and s. PARTICIPANTS Eighteen patients without comorbidity ( age range , 65 + /- 7.7 yr ; 16 women , 2 men ) from a consecutive sample of patients with RA scheduled for total knee arthroplasty ; 23 controls of the same age group also were tested ( 13 women , 10 men ) . MAIN OUTCOME MEASURES By means of a dual-plate force platform , the velocity of center of pressure ( COP ) fluctuations were analyzed in the anteroposterior and lateral sway directions during quiet st and ing with eyes open , eyes closed , and while performing a secondary attention-dem and ing arithmetic task . RESULTS Patients showed an average 80 % greater COP velocity in both directions of sway compared with controls . In addition , stability deteriorated substantially more in patients than controls when deprived of visual information , which was associated with the degree of knee destruction . The effect of the arithmetic task was small and similar in patients and controls . CONCLUSION RA patients with severe knee joint impairment can have a substantial basic postural instability ; their relatively high reliance on visual information suggests impaired sensory feedback from the lower limbs . Current research is aim ed at determining whether these postural deficits can be improved by total knee replacement BACKGROUND Several stemless shoulder implants are available on the market , but only a few studies have presented results with sufficient mid- to long-term follow-up . The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement . METHODS This is a prospect i ve cohort study evaluating the  stemless shoulder prosthesis since 2005 .  Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders ; 17 underwent total shoulder replacement , and 32 underwent hemiarthroplasty . Forty-three patients were clinical ly and radiologically monitored after a mean of 9 years ( range , 90 - 127 months ; follow-up rate , 88 % ) . The indications for shoulder replacement were primary osteoarthritis in 7 shoulders , post-traumatic in 24 , instability in 7 , cuff tear arthropathy in 2 , postinfectious arthritis in 1 , and revision arthroplasty in 2 . RESULTS The Constant-Murley Score improved significantly from 52 % to 79 % ( P < .0001 ) . The active range of motion also increased significantly for flexion from 101 ° to 118 ° ( P = .022 ) , for abduction from 79 ° to 105 ° ( P = .02 ) , and for external rotation from 21 ° to 43 ° ( P < .0001 ) . Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention . No revision caused by loosening or countersinking of the humeral implant was observed . CONCLUSIONS The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation st and ard shoulder arthroplasty Background Acute or recurrent anterior shoulder instability is a frequent injury for in-season athletes . Treatment options for this injury include shoulder immobilization , rehabilitation , and shoulder stabilization surgery . Purpose To determine if in-season athletes can be returned to their sports quickly and effectively after nonoperative treatment for an anterior instability episode . Methods Over a 2-year period , 30 athletes matched the inclusion criteria for this study . Nineteen athletes had experienced anterior dislocations , and 11 had experienced subluxations . All were treated with physical therapy and fitted , if appropriate , with a brace . These athletes were followed for the number of recurrent instability episodes , additional injuries , subjective ability to compete , and ability to complete their season or seasons of choice . Results Twenty-six of 30 athletes were able to return to their sports for the complete season at an average time missed of 10.2 days ( range , 0 - 30 years ) . Ten athletes suffered sport-related recurrent instability episodes ( range , 0 - 8 years ) . An average of 1.4 recurrent instability episodes per season per athlete occurred . There were no further injuries attributable to the shoulder instability . Sixteen athletes underwent surgical stabilization for their shoulders during the subsequent off-season . Conclusions Most of the athletes were able to return to their sport and complete their seasons after an episode of anterior shoulder instability , although 37 % experienced at least 1 additional episode of instability during the season Background : There is no consensus on the optimal treatment of in-season athletes with anterior shoulder instability , and limited data are available to guide return to play . Purpose : To examine the likelihood of return to sport and the recurrence of instability after an in-season anterior shoulder instability event based on the type of instability ( subluxation vs dislocation ) . Additionally , injury factors and patient-reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season . Study Design : Cohort study ( prognosis ) ; Level of evidence , 2 . Methods : Over 2 academic years , 45 contact intercollegiate athletes were prospect ively enrolled in a multicenter observational study to assess return to play after in-season anterior glenohumeral instability . Baseline data collection included shoulder injury characteristics and shoulder-specific patient-reported outcome scores at the time of injury . All athletes underwent an accelerated rehabilitation program without shoulder immobilization and were followed during their competitive season to assess the success of return to play and recurrent instability . Results : Thirty-three of 45 ( 73 % ) athletes returned to sport for either all or part of the season after a median 5 days lost from competition ( interquartile range , 13 ) . Twelve athletes ( 27 % ) successfully completed the season without recurrence . Twenty-one athletes ( 64 % ) returned to in-season play and had subsequent recurrent instability including 11 recurrent dislocations and 10 recurrent subluxations . Of the 33 athletes returning to in-season sport after an instability event , 67 % ( 22/33 ) completed the season . Athletes with a subluxation were 5.3 times more likely ( odds ratio [ OR ] , 5.32 ; 95 % CI , 1.00 - 28.07 ; P = .049 ) to return to sport during the same season when compared with those with dislocations . Logistic regression analysis suggests that the Western Ontario Shoulder Instability Index ( OR , 1.05 ; 95 % CI , 1.00 - 1.09 ; P = .037 ) and Simple Shoulder Test ( OR , 1.03 ; 95 % CI , 1.00 - 1.05 ; P = .044 ) administered after the initial instability event are predictive of the ability to return to play . Time loss from sport after a shoulder instability event was most strongly and inversely correlated with the Simple Shoulder Test ( P = .007 ) at the time of initial injury . Conclusion : In the largest prospect i ve study evaluating shoulder instability in in-season contact athletes , 27 % of athletes returned to play and completed the season without subsequent instability . While the majority of athletes who return to sport complete the season , recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation Context : It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair . Objective : The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability . Study Design : Systematic review of level I and II studies . Data Sources : PubMed , EMBASE , the Cochrane Data base of Systematic Review s , and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria . Study Selection : Inclusion criteria were English- language level I or level II trials involving the treatment of recurrent anterior shoulder instability . Exclusion criteria included non-English- language studies ; level III , IV , or V studies ; and trials examining treatment of first-time shoulder dislocation , posterior shoulder dislocation , or diagnoses other than recurrent anterior shoulder dislocations . Data Extraction : Included studies underwent quality appraisal independently by each author identifying strengths , weaknesses , and biases . Results : Four r and omized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations .  These studies show no statistically significant difference between the 2 operative approaches . No long-term follow-up data describing the effects of either surgical approach are available at this time . Each investigation had weaknesses in study design that decreased the validity of its findings . Conclusions : While limited , the available evidence from r and omized controlled trials does not show a statistically significant difference in redislocation rates , return to activity , and functional outcomes between the arthroscopic and open repair groups . Range of motion is marginally better following arthroscopic treatment when compared with open repair . Recommendations on the optimal surgical intervention can not be provided Background The traditional treatment for primary anterior shoulder dislocations has been immobilization in a sling with the arm in a position of adduction and internal rotation . However , recent basic science and clinical data have suggested recurrent instability may be reduced with immobilization in external rotation after primary shoulder dislocation . Questions / purpose sWe performed a r and omized controlled trial to compare the ( 1 ) frequency of recurrent instability and ( 2 ) disease-specific quality -of-life scores after treatment of first-time shoulder dislocation using either immobilization in external rotation or immobilization in internal rotation in a group of young patients . Methods Sixty patients younger than 35 years of age with primary , traumatic , anterior shoulder dislocations were r and omized ( concealed , computer-generated ) to immobilization with either an internal rotation sling ( n = 29 ) or an external rotation brace ( n = 31 ) at a mean of 4 days after closed reduction ( range , 1–7 days ) . Patients with large bony lesions or polytrauma were excluded . The two groups were similar at baseline . Both groups were immobilized for 4 weeks with identical therapy protocol s thereafter . Blinded assessment s were completed by independent observers for a minimum of 12 months ( mean , 25 months ; range , 12–43 months ) . Recurrent instability was defined as a second documented anterior dislocation or multiple episodes of shoulder subluxation severe enough for the patient to request surgical stabilization . Vali date d disease-specific quality -of-life data ( Western Ontario Shoulder Instability index [ WOSI ] , American Shoulder and Elbow Surgeons evaluation [ ASES ] ) were also collected . Ten patients ( 17 % , five from each group ) were lost to followup . Reported compliance with immobilization in both groups was excellent ( 80 % ) . Results With the numbers available , there was no difference in the rate of recurrent instability between groups : 10 of 27 patients ( 37 % ) with the external rotation brace versus 10 of 25 patients ( 40 % ) with the sling redislocated or developed symptomatic recurrent instability ( p = 0.41 ) . WOSI scores were not different between groups ( p = 0.74 ) and , although the difference in ASES scores approached statistical significance ( p = 0.05 ) , the magnitude of this difference was small and of uncertain clinical importance . Conclusions Despite previous published findings , our results show immobilization in external rotation did not confer a significant benefit versus sling immobilization in the prevention of recurrent instability after primary anterior shoulder dislocation . Further studies with larger numbers may eluci date whether functional outcomes , compliance , or comfort with immobilization can be improved with this device . Level of Evidence Level I , therapeutic study . See Instructions for Authors for a complete description of levels of evidence The effect of glenohumeral arthritis and subsequent  total shoulder arthroplasty ( TSA ) on shoulder proprioception has not been evaluated previously . A prospect i ve analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken .  Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA . The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested ( flexion , abduction , and external rotation ) . There were significant differences ( P < .05 ) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems . Six months after TSA , position sense was significantly improved ( P < .05 ) and was not significantly different from that in the contralateral shoulder or the comparison group . Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side ( P < .05 ) . Six months after TSA , the sensitivity to detection of motion improved ( P < .01 ) and was not significantly different than that in the uninvolved contralateral shoulder . In addition , the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group . This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis . After TSA , there was a marked improvement in proprioception Background Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations . Hypothesis Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment . Study Design Prospect i ve , r and omized clinical trial . Methods Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute , traumatic shoulder dislocations in young athletes . Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program . Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients . The average follow-up was 36 months . Results Three patients were lost to follow-up . Twelve nonoperatively treated patients remained for follow-up . Nine of these ( 75 % ) developed recurrent instability . Six of the nine have required subsequent open Bankart repair for recurrent instability . Of the nine operatively treated patients available for follow-up , only one ( 11.1 % ) developed recurrent instability . Conclusions Arthroscopic stabilization of traumatic , first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional , nonoperative treatment Background It is still not clear which method is the most efficient for treating primary traumatic anterior shoulder dislocation .  Immobilization in external rotation has become increasingly discussed within the last 10 years . The aim of this study was to evaluate the rate of recurrence and clinical outcome of the immobilization in external rotation after primary traumatic anterior dislocation within a midterm period of 5 years . Additionally , a summary of literature is given according to the present knowledge of this issue . Methods From May 2004 to May 2006 , 28 patients with primary traumatic anterior shoulder dislocations were included in a prospect i ve MRI-controlled study . After a follow-up of 5 years , the recurrence rate and clinical outcomes of the patients were evaluated using clinical scores ( Constant and Murley score , Western Ontario Shoulder Instability Index , Rowe score ) . Results After 5 years , 26 patients ( 93 % ; males , n = 25 ; female , n = 1 ; mean age , 29.3 years ) were interviewed concerning re-dislocations . In the meantime , four patients ( 15 % ) experienced a re-dislocation ( ø 12.2 months ) after the end of the immobilization . Overall , 21 patients ( 75 % ) were included in a clinical follow-up ( CM score : ø 92.8 points ; Western Ontario Shoulder Instability Index : ø 87 % ; Rowe score ( in 17 patients ): ø 94.2 points ) . Upon clinical examination , unidirectional anterior instability was found in one patient , which corresponds to an overall instability rate of 19 % within the examined patient population including the re-dislocations . Conclusions Immobilization in external rotation shows satisfactory results after 5 years in regard to recurrence and instability rates and clinical outcomes . The data show that with immobilization in external rotation , re-dislocations occur within the first 2 years
Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis ; however , the difference is not statistically significant .
When reverse shoulder arthroplasties ( RSA ) were considered as a subgroup and compared to anatomic shoulder replacements ( total shoulders and hemiarthroplasties ) , they showed a lower revision rate
Chronic anterior glenohumeral joint instability is a common situation and can lead to progressive cartilage deterioration and ultimately instability arthopathy .
Progressive cartilage deterioration can occur despite conservative or surgical treatment and the sequelae of these conditions are often addressed with total shoulder arthroplasty .
Aims of the present study were to analyze the available literature to describe the technical aspects of this particular operation and to report outcomes and complication rates .
The hypothesis was that shoulder arthropalsty in the sequelae of instability had lower outcomes and higher complication rates than arthroplasties for primary arthritis .
Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology .