Introduction: We report the functional and radiographic outcomes of use of the modular Anatomical shoulder system (Zimmer) at our institution.Methods: A series of 33 shoulders (30 patients) where followed up for a mean of 37.4 months . Two patients died and three were lost to follow up. Pre-op diagnosis in the remainder was osteoarthritis (20), post-traumatic (6), and avascular necrosis (1). The mean age was 74 years.Results: Visual Analogue Pain (VAP) scores improved significantly (p<.05) from an average pre-op score of 8.8 to an average post-op score of 2.5. The mean post-op Disability of Arm, Shoulder and Hand (DASH) score was 38. The Modified Neer Rating for all was 11 excellent, 12 satisfactory, four unsatisfactory. Four cases showed signs of glenohumeral radiolucency but no evidence of progression. One periprosthetic fracture was managed successfully non-operatively. and one dislocation managed with closed reduction.Conclusion: The Anatomical total shoulder replacement provides satisfactory functional and radiographic outcomes and is readily achievable in this group of patients in the short to medium term follow up. Introduction Neer described the total shoulder replacement (TSR) in the 1970’s with the addition of a glenoid component for shoulder arthoplasty(11). Since then, there has been a progressive improvement, culminating in the concept of anatomical reconstruction of the proximal humerus and the concept of achieving anatomical replication continues to drive all enthusiasts in joint arthroplasty. The variations in shoulder design are no exception. These range from, cemented and un-cemented, modularity of offset and height, to resurface the glenoid or not, cemented and uncemented glenoid, glenoid components with pegs, keel, or screws to altered centre of rotation as in the reverse arthroplasty for rotator cuff arthropathy(236141516). Other surgeons have used surface replacement implants with good results(59). Shoulder arthroplasty is performed for a number of reasons these include osteoarthosis, avascular necrosis, inflammatory arthritis and trauma. Neer (11) believed that implants with a design which mimicked the normal anatomy would provide the best function and durability. However second generation modular implants did not achieve reliable results(4), and it has been the third-generation systems that have recreated structure and geometry which matches the normal anatomy to a greater extent than those of the second-generation (13) The Anatomical total shoulder replacement has been in use for a period of seven years. It aims to provide adjustability in the prosthetic head offset, neck angle and retrotorsion. The aim of this series is to provide early to medium term results of the Anatomical total shoulder replacement (Zimmer). Methods Between February 2001 and November 2007, 33 consecutive Anatomical total shoulder replacements where performed. At the time of review two patients had died of unrelated causes (one of the dead patients had bilateral replacements) and three where lost to follow-up. The remaining 27 shoulders where all reviewed at a research clinic. We retrospectively assessed 25 patients (two bilateral) who had the above procedure performed. The primary clinical indication for surgery was pain with a secondary clinical indication of functional loss, and diagnostic indications for surgery were primary osteoarthritis, avascular necrosis (AVN) and trauma. Exclusion criteria included rotator cuff arthropathy, any signs of sepsis and neurological deficiency. Patients where reviewed in a research clinic for assessment using the validated DASH score as a primary outcome measure. Secondary outcome measures were pre and post-op visual analogue pain scores, radiological analysis based on three plain x-ray views (anteroposterior, axillary and scapular lateral) figures Ia, b, c, range of movement (forward elevation, lateral abduction, internal and external rotation), the modified Neer rating grade and complication
展开▼
