Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 469 | Issue 9 | Sep, 2011

Grammont’s Idea: The Story of Paul Grammont’s Functional Surgery Concept and the Development of the Reverse Principle

Emmanuel Baulot MD, François Sirveaux MD, Pascal Boileau MD

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.

A History of Reverse Total Shoulder Arthroplasty

Evan L. Flatow MD, Alicia K. Harrison MD

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.

How Reverse Shoulder Arthroplasty Works

Matthew Walker MD, Jordan Brooks BS, Matthew Willis MD, Mark Frankle MD

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.

A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

Kazutoshi Hamada MD, PhD, Kaoru Yamanaka MD, PhD, Yoshiyasu Uchiyama MD, PhD, Takahiko Mikasa MD, Motohiko Mikasa MD, PhD

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.

Surgical Technique: The Anterosuperior Approach for Reverse Shoulder Arthroplasty

Daniel Molé MD, Frank Wein MD, Charles Dézaly MD, Philippe Valenti MD, François Sirveaux MD

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?

Luc Favard MD, Christophe Levigne MD, Cécile Nerot MD, Christian Gerber MD, Lieven Wilde MD, Daniel Mole MD

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.

Reverse Total Shoulder Arthroplasty Improves Function in Cuff Tear Arthropathy

Betsy M. Nolan MD, Elizabeth Ankerson BS, J. Michael Wiater MD

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).

Can Reverse Shoulder Arthroplasty be Used with Few Complications in Rheumatoid Arthritis?

Anders Ekelund MD, PhD, Ragnhild Nyberg PT

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.

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

Lieven Wilde MD, PhD, Pascal Boileau MD, PhD, Hans Bracht MD

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.

A Complication-based Learning Curve From 200 Reverse Shoulder Arthroplasties

Laurence B. Kempton MD, Elizabeth Ankerson BS, J. Michael Wiater MD

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.

What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty?

George J. Trappey MD, Daniel P. O’Connor PhD, T. Bradley Edwards MD

A concern regarding reverse shoulder arthroplasty (RSA) is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty.

Scapular Notching in Reverse Shoulder Arthroplasty: Is It Important to Avoid It and How?

Christophe Lévigne MD, Jérome Garret MD, Pascal Boileau MD, Ghassan Alami MD, Luc Favard MD, Gilles Walch MD

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: Recognition and Strategies to Minimize Clinical Impact

Gregory P. Nicholson MD, Eric J. Strauss MD, Seth L. Sherman MD

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.

Is Reverse Shoulder Arthroplasty a Reasonable Alternative for Revision Arthroplasty?

Luke Austin MD, Benjamin Zmistowski BS, Edward S. Chang MD, Gerald R. Williams MD

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 Treating Prosthetic Shoulder Infections

Vani J. Sabesan MD, Jason C. Ho MS, David Kovacevic MD, Joseph P. Iannotti MD, PhD

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.

Scapula Fractures After Reverse Total Shoulder Arthroplasty: Classification and Treatment

Lynn A. Crosby MD, Adam Hamilton MD, Todd Twiss MD

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.

Do Less Medialized Reverse Shoulder Prostheses Increase Motion and Reduce Notching?

Philippe Valenti MD, Philippe Sauzières MD, Denis Katz MD, Ibrahim Kalouche MD, Alexandre Sahin Kilinc MD

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

Pascal Boileau MD, Grégory Moineau MD, Yannick Roussanne MD, Kieran O’Shea FRCSI

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.

Does Norepinephrine Influence Pain Behavior Mediated by Dorsal Root Ganglia?: A Pilot Study

Katsumasa Tanimoto MD, PhD, Tsuneo Takebayashi MD, PhD, Takeshi Kobayashi MD, PhD, Noritsugu Tohse MD, PhD, Toshihiko Yamashita MD, PhD

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

Is Metal-on-Metal Squeaking Related to Acetabular Angle of Inclination?

Thomas Bernasek MD, David Fisher MD, David Dalury MD, Melissa Levering BS, Kirk Dimitris MD

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.

Functional and Anatomic Orientation of the Femoral Head

David Wright BSc, Cari Whyne PhD, Michael Hardisty MSc, Hans J. Kreder MD, MPH, FRCS, Omri Lubovsky MD

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

Alister J. Hart FRCSG(Orth), John A. Skinner FRCS(Orth), Johann Henckel MRCS, Barry Sampson MRSC CChem, Fabiana Gordon PhD

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.

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

Florian D. Naal MD, Ronny Pilz MD, Urs Munzinger MD, Otmar Hersche MD, Michael Leunig MD

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.

Relationships of the Lateral Femoral Cutaneous Nerve to Bony Landmarks

Mehmet Üzel MD, PhD, Salih Murat Akkin MD, Ercan Tanyeli MD, Jürgen Koebke PhD

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

Kyung-Hag Lee MD, Yong-Chan Ha MD, Young-Kyun Lee MD, Hyun Kang MD, Kyung-Hoi Koo MD

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

Abdo Bachoura MD, Thierry G. Guitton MSc, R. Malcolm Smith MD, Mark S. Vrahas MD, David Zurakowski PhD, David Ring MD, PhD

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.

Nerve Monitoring During Proximal Humeral Fracture Fixation: What Have We Learned?

William J. Warrender BS, Stephen Oppenheimer MD, PhD, Joseph A. Abboud MD

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.

A Method to Localize The Radial Nerve Using the ‘Apex Of Triceps Aponeurosis’ as a Landmark

Sumit Arora MS Ortho, DNB Ortho, Navneet Goel MS Ortho, Gursimrat Singh Cheema MS Ortho, Sumit Batra MS Ortho, DNB Ortho, Lalit Maini MS Ortho

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

Patrick Vavken MD, MSc, FRSPH

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.

Reply to Letter to the Editor: Unexplained Fractures: Child Abuse or Bone Disease: A Systematic Review

Nirav K. Pandya MD, Keith Baldwin MD, MPH, MSPT, Atul F. Kamath MD, Dennis R. Wenger MD, Harish S. Hosalkar MD, MBMS (Ortho), FCPS (Ortho), DNB (Ortho)

Erratum to: The John Charnley Award: A Study of Implant Failure in Metal-on-Metal Surface Arthroplasties

Pat Campbell PhD, Paul E. Beaulé MD, Edward Ebramzadeh PhD, Michel J. Le Duff MA, Koen Smet MD, Zhen Lu PhD, Harlan C. Amstutz MD

Erratum to: Risk Factors Affecting Outcome of Metal-on-Metal Surface Arthroplasty of the Hip

Paul E. Beaulé MD, Fredrick J. Dorey PhD, Michel J. Le Duff MA, Thomas Gruen MS, Harlan C. Amstutz MD

Emerging Ideas: Treatment of Precollapse Osteonecrosis Using Stem Cells and Growth Factors

Quanjun Cui MD, MSc, Edward A. Botchwey PhD

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.

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