Evaluation of the effectiveness of the use of low-traumatic surgical access in the reverse shoulder arthroplasty

Abstract

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance.

AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty.

MATERIALS AND METHODS: In the period 2017–2020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months.

RESULTS: In the main group, excellent results (<25 points on DASH) were observed in 73 patients, good results (26–50 points) — in 10 patients. In 1 patient, the results were assessed as satisfactory (51–75 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result).

CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.

Keywords

reverse arthroplasty / shoulder arthroplasty / surgical aggression / a minimally invasive method

References

[1] Frankle M, Marberry S, Pupello D. Reverse shoulder arthroplasty. Cham; 2016. 486 p.

[2] Frankle M., Marberry S., Pupello D. Reverse shoulder arthroplasty. Cham, 2016. 486 p.

[3] Karapetyan GS. Metody korrektsii operativnoi agressii v kompleksnom lechenii ortopedicheskoi patologii [dissertation abstract]. Moscow; 2009. 90 p. (In Russ).

[4] Карапетян Г.С. Методы коррекции оперативной агрессии в комплексном лечении ортопедической патологии : автореф. дис. … канд. мед. наук. Москва, 2009. 90 с.

[5] Magosch P, Burkhart K, Mauch F, et al. Schulterprothesenregister Jahresbericht 2020 (2006-2019). Bern; 2020. 61 p. (In German).

[6] Magosch P., Burkhart K., Mauch F., et al. Schulterprothesenregister Jahresbericht 2020 (2006–2019). Bern, 2020. 61 p. (In German).

[7] Reed M, Howard P, Brittain R, et al. National Joint Registry 17th Annual Report. Hemel Hempstead; 2020. 312 p.

[8] Reed M., Howard P., Brittain R., et al. National Joint Registry 17th Annual Report. Hemel Hempstead, 2020. 312 p.

[9] Kesyan GA, Urazgil’deev RZ, Karapetyan GS, et al. Reverse shoulder arthroplasty in difficult clinical cases. Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2019;(4):111–120. (In Russ).

[10] Кесян Г.А., Уразгильдеев Р.З., Карапетян Г.С., и др. Реверсивное эндопротезирование плечевого сустава в сложных клинических случаях // Вестник Смоленской государственной медицинской академии. 2019. № 4. С. 111–120.

[11] Bauer R, Kershbaumer F, Poisel S. Operativnye dostupy v travmatologii i ortopedii. [Operative Zuganswege in Orthopadie und Traumatologie]. Translated from German. Yakimov LA, editor. Moscow: Izdatel’stvo Panfilova; 2015. 408 p. (In Russ).

[12] Бауэр Р., Кершбаумер Ф., Пойзель З. Оперативные доступы в травматологии и ортопедии. Перевод с нем., под ред. Л.А. Якимова. Москва : Издательство Панфилова, 2015. 408 с.

[13] Solod EI, Lazarev AF, Gudushauri YaG, et al. New possibilities of surgical treatment of fractures of the proximal humerus. Vestnik travmatologii i ortopedii im. N. N. Priorova. 2011;(1):21–27. (In Russ).

[14] Солод Э.И., Лазарев А.Ф., Гудушаури Я.Г., и др. Новые возможности оперативного лечения переломов проксимального отдела плечевой кости // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2011. № 1. С. 21–27.

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