Grammont’s Idea: The Story of Paul Grammont’s Functional Surgery Concept and the Development of the Reverse Principle
The increased use of the reverse prosthesis over the last 10 years is due to a large series of publications using the reverse prosthesis developed by Paul Grammont. However, there is no article reporting the story of the concepts developed by Grammont.
Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs.
The reverse total shoulder arthroplasty was introduced to treat the rotator cuff-deficient shoulder. Since its introduction, an improved understanding of the biomechanics of rotator cuff deficiency and reverse shoulder arthroplasty has facilitated the development of modern reverse arthroplasty designs.
In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4.
The anterosuperior approach used for reverse shoulder arthroplasty is an intermediate between the transacromial approach originally proposed by Paul Grammont and the anterosuperior approach described by D. B. Mackenzie for shoulder arthroplasty. As an alternative to the deltopectoral approach, the anterosuperior approach has the advantages of simplicity and postoperative stability.
Reverse Prostheses in Arthropathies With Cuff Tear: Are Survivorship and Function Maintained Over Time?
The use of reverse shoulder arthroplasty has considerably increased since first introduced in 1985. Despite demonstrating early improvement of function and pain, there is limited information regarding the durability and longer-term outcomes of this prosthesis.
Early failure due to glenoid loosening with anatomic total shoulder arthroplasty in patients with severe rotator cuff deficiency led to the development of the reverse ball-and-socket shoulder prosthesis. The literature reports improved short-term pain and function scores following modern reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy (CTA).
Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been reported. These studies do not, however, typically include many patients with rheumatoid arthritis (RA) and it is unclear whether the failure rates are similar.
Normal function of the upper limb is seldom restored after limb-sparing surgery for tumors of the proximal humerus. The literature suggests superior shoulder function is achieved in the short term with reverse total shoulder arthroplasty compared to other techniques when performed for conditions with rotator cuff deficiency. It is unclear whether this superiority is maintained when reverse total shoulder arthroplasty is performed for tumors.
Reported early complication rates in reverse total shoulder arthroplasty have widely varied from 0% to 75% in part due to a lack of standard inclusion criteria. In addition, it is unclear whether revision arthroplasty is associated with a higher rate of complications than primary arthroplasty.
A concern regarding reverse shoulder arthroplasty (RSA) is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty.
Scapular notching, erosion of the scapular neck related to impingement by the medial rim of the humeral cup during adduction, is a radiographic sign specific to reverse shoulder arthroplasty (RSA). Its clinical and radiological consequences remain unclear.
Scapular notching is a unique complication of Grammont-style reverse total shoulder arthroplasty. While reverse total shoulder arthroplasty has revolutionized the treatment of pseudoparalysis secondary to cuff tear arthropathy, the implications of scapular notching with regard to patient function and implant stability remain unclear.
Reverse shoulder arthroplasty (RSA) improves function in selected patients with complex shoulder problems. However, we presume patient function would vary if performed primarily or for revision and would vary with other patient-specific factors.
Two-stage reimplantation for prosthetic joint infection reportedly has the lowest risk for recurrent infection. Most studies to date have evaluated revision surgery for infection using an anatomic prosthetic. As compared with anatomic prostheses, reverse total shoulder arthroplasty is reported to have a higher rate of infection.
Reverse total shoulder arthroplasty (RTSA) implants have been developed to treat patients with deficient rotator cuffs. The nature of this procedure’s complications and how these complications should be managed continues to evolve. Fractures of the scapula after RTSA have been described, but the incidence and best methods of treatment are unclear.
Cuff tear arthropathy is the primary indication for total reverse shoulder arthroplasty. In patients with pseudoparalytic shoulders secondary to irreparable rotator cuff tear, reverse shoulder arthroplasty allows restoration of active anterior elevation and painless shoulder. High rates of glenoid notching have also been reported. We designed a new reverse shoulder arthroplasty with a center of rotation more lateral than the Delta prosthesis to address this problem.
Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation
Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure.
Postganglionic neurons in the sympathetic nervous system reportedly are involved in lumbar radicular pain and release norepinephrine (NE), a neurotransmitter. Increased numbers of sympathetic nerve fibers have been found in dorsal root ganglion (DRG) neurons in a root constriction model. Whether this is a reasonable model for pain, however, is unclear
Postoperative audible squeaking has been well documented in ceramic-on-ceramic hip prostheses, and several metal-on-metal (MOM) THA designs, specifically those used for large-head resurfacing and MOM polyethylene sandwich designs, and are attributed to different implant- and patient-specific factors. Current literature does not identify the incidence of squeaking in modular MOM THA or possible etiologic factors.
Femoral neck geometry directly affects load transmission through the hip. Orientations may be described anatomically or using functional definitions that consider load transmission.
Insufficient Acetabular Version Increases Blood Metal Ion Levels after Metal-on-metal Hip Resurfacing
Many factors affect the blood metal ion levels after metal-on-metal (MOM) hip arthroplasty. The main surgically adjustable variable is the amount of coverage of the head provided by the cup which is a function of the inclination and version angles. However, most studies have used plain radiographs which have questionable precision and accuracy, particularly for version and large diameter metal heads; further, these studies do not simultaneously assess version and inclination. Thus the relationship between version and blood metal ions levels has not been resolved.
There is growing evidence that different resurfacing implants are associated with variable survival and revision rates. A registry analysis indicated the Durom resurfacing implant had high revision rates at 5 years, whereas three original studies reported low revision rates at short-term followups. Thus, the revision rates appear controversial.
The lateral femoral cutaneous nerve (LFCN) can be at risk during, for example, the insertion of pins in the anterior superior iliac spine (ASIS) during external fixation of the pelvis, total hip arthroplasty through a direct anterior approach, open surgery for impingement in the hip through an anterior approach, and periacetabular osteotomy. During surgery, the surgeon usually assumes the location of the LFCN by using the ASIS as a landmark.
Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery
Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks.
Infirmity and Injury Complexity are Risk Factors for Surgical-site Infection after Operative Fracture Care
Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear.
The incidence of neurologic injury after proximal humerus fractures is variable, ranging from 6.2% to as much as 67%. However, it is unclear what factors might contribute to these injuries or whether they can be prevented by intraoperative nerve monitoring.
The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm.
Rationale for and Methods of Superiority, Noninferiority, or Equivalence Designs in Orthopaedic, Controlled Trials
To provide value-based healthcare in orthopaedics, controlled trials are needed to assess the comparative effectiveness of treatments. Typically comparative trials are based on superiority testing using statistical tests that produce a p value. However, as orthopaedic treatments continue to improve, superiority becomes more difficult to show and, perhaps, less important as margins of improvement shrink to clinically irrelevant levels. Alternative methods to compare groups in controlled trials are noninferiority and equivalence. It is important to equip the reader of the orthopaedic literature with the knowledge to understand and critically evaluate the methods and findings of trials attempting to establish superiority, noninferiority, and equivalence.
Osteonecrosis (ON) of the femoral head is a devastating disease affecting young patients at their most productive age, causing major socioeconomic burdens. ON is associated with various etiologic factors, and the pathogenesis of the disease is unknown. Most investigators believe the disease is the result of secondary microvascular compromise with subsequent bone and marrow cell death and defective bone repair.