Background: The influence of diagnosis on outcomes after reverse shoulder arthroplasty (RSA) is not completely understood. The purpose of this study was to compare clinical outcomes of different pathologies. Methods: A total of 132 RSAs were performed for the following diagnoses: (1) rotator cuff tear arthropathy(RCA), (2) massive cuff tear(MCT) with osteoarthritis(OA), (3) MCT without OA, (4) arthritis, (5) acute proximal humeral fracture, (6) malunion, (7) nonunion, and (8) revision. All patients had minimum 2-year clinical follow-up (mean=47months; range=24-155months). Range of motion, Oxford Shoulder Score, visual analog scale scores for function, and health-related quality-of-life measures were obtained preoperatively and postoperatively. Results: Mean OSS was 30. The RCA, MCT-with-OA, MCT-without-OA, and arthritis groups all exhibited significant improvements in all outcome scores and in all planes of motion. The malunion, nonunion, and revision groups showed improvements in Oxford Shoulder scores, forward flexion, and abduction. The average changes for all other outcomes and planes of motions were also positive but did not reach statistical significance. After adjustment for age and compared with RCA, female patients with malunion had significantly poorer forward flexion (P < .05), those with OA had significantly better abduction (P < .05), and those with fractures had significantly worse patient satisfaction (P < .05). Among male patients, those with MCTs without OA had significantly worse satisfaction (P < .05). Conclusion: RSA reliably provides improvement regardless of preoperative diagnosis. Although subtle differences exist between male and female patients, improvements in clinical outcome scores were apparent after RSA.

Chronic (>3 weeks) locked anterior dislocations of the glenohumeral joint is a rare condition. These dislocations usually occur in debilitated and elderly patients. When severe bone loss and/or advanced arthritis occurs, shoulder arthroplasty can be necessary.
The aim was to evaluate the functional outcome of patients with chronic anterior locked glenohumeral dislocation treated with a reverse shoulder arthroplasty(RSA).
All patients treated for chronic anterior glenoumeral dislocations with RSA in our institution in 2018 were retrospectively evaluated. Function at latest follow-up was evaluated with Constant-Murley Score(CMS), range of motion(ROM) measured using a goniometer was recorded for elevation and external rotation, the most cephalad spinal level reached by the thumb was used for internal rotation. All patients had pre-operative shoulder trauma series X-rays and CT–scan, post-operatively they were evaluated with X-ray.
6 patients: 5 females and 1 male, with a mean age of 69,5 years(64-80) were evaluated. Mean time from dislocation to surgical treatment was 7 weeks(5-10). Mean follow-up time was 8 months(6-16). One of the patient had severe anterior glenoid bone loss that was treated with humeral head autograft. Mean CMS at latest follow-up was 65(35-80). Mean shoulder flexion was 105º (55º-170º), external rotation 18º (-0,5º–26º); internal rotation media was waist (L3) (buttock–T12 vertebra). Postoperative radiographs at latest follow-up showed no sign of scapular notching, humeral or glenoid loosening or heterotopic ossification.
Reverse shoulder arthroplasty can be a reliable method of treatment for chronic anterior locked shoulder dislocation and good and predictable functional results can be expected.

Background: Staged reverse shoulder arthroplasty (RSA) with temporary implantation of an antibiotic-loaded spacer is widely accepted but still discussed controversially. This study investigated infection control rate, functional outcome, and infection-free survival rate after staged RSA in the mid- to long-term follow-up on one of the largest patient cohorts available till date. It was hypothesized that staged RSA would show a high infection-free survival rate. Methods: A total of 39 patients treated with staged RSA for primary septic arthritis (n = 8), secondary infection (n = 8), or periprosthetic infection (n = 23) were retrospectively included. The infection control rate was calculated based on cultures taken intraoperatively at spacer removal and RSA implantation. Infection-free survival was defined as no revision due to infection. The minimum follow-up period for functional outcome assessment was 2 years (n = 14; mean, 76 months; range, 31-128 months). Results: The infection control rate was 90%. The cumulative infection-free survival rate was 91% after 128 months. Follow-up examinations showed a mean Constant score of 48 (range, 7-85), a mean QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score of 40.0 (range, 11.4-93.3), and a mean pain score of 1.6 (range, 0-7). Conclusion: Staged RSA implantation confirms as a successful treatment for infections of the shoulder. The infection control rate is very satisfactory. However, patients and surgeons must be aware of functional impairment even after successful treatment of infections.

Introduction: Increase in the number of primary shoulder arthroplasty has led to an increase in the number of revisions which presents many complex challenges and often has inferior outcomes.Methods: Data was collected retrospectively, and patients were classified using Dines classification. Comprehensive case reviews were done to identify preoperative and intraoperative challenges. The primary outcome measure was Oxford shoulder score (OSS). The secondary measures were range of motion (ROM) and patient satisfaction (very satisfied, satisfied, not satisfied or worse). Results: 32 patients (one bilateral) were identified with a mean age of 67.64 years and the most common cause of revision was a combination of bone and soft tissue failure (39.3%). All patients (n=8) with hemiarthroplasty had rotator cuff deficiency while patients with resurfacing had both rotator cuff failure and bony erosion. 4 patients needed a proximal humeral osteotomy and six patients needed allograft reconstruction of the glenoid for bone loss. 21 shoulders were revised to reverse total shoulder arthroplasty (TSA), 2 to anatomical TSA, and 5 were left with cement spacer in situ. Mean duration of follow-up was 41.6 months. Mean OSS at the last follow-up was 26.88 with statistically significant improvement in ROM. There was no statistical difference in clinical outcomes (p>0.05) based on the type of primary prosthesis or cause of revision. 70% patients were pain-free. Patients with infection had inferior outcomes with a mean OSS of 17. Conclusion: Management of patients with failed shoulder arthroplasty is often challenging but has good clinical outcomes except in infections.

Introduction: Scapular Notching is one of the most common complications occurring after Reverse Shoulder Arthroplasty (RSA) with an incidence of upto 70%. Its functional implications are however uncertain. It can be attributed to many factors but it is not clearly known if the design of the prosthesis is one of them. Method: We retrospectively evaluated two different types of Grammot type RSA designs used in our institute - one with metal glenosphere (Group A) and the other with polyethylene glenosphere (Group B). Clinical and radiological evaluation was done to look for factors affecting scapular notching and its correlation with functional outcome. Results: A total of 94 patients (102 shoulders) underwent RSA between 2011 and 2017 with 60 patients in group A and 42 patients in group B. The mean follow-up was 38.7 months. The incidence of notching in group A was 55% (n=33) and in Group B was 62.9% (n=26). However, high-grade notching (grade 3 + grade 4) was more common in group A as compared to Group B which was statistically significant. Mean Oxford Shoulder Score (OSS) was 39.84 in patients with no notching, 38.62 in those with low-grade notching, and 34.29 in high-grade notching, the latter being statistically significant. A positive correlation was seen with r=0.308 between delta (difference between scapular neck angle (SNA) and prosthetic SNA) and grade of notching while it had a negative relationship with OSS. Conclusion: Scapular notching is affected by the type and position of glenosphere with an impact on functional outcome.

Introduction: Reverse Geometry Shoulder Arthroplasty (RGSA) is increasingly undertaken as a primary procedure for complex proximal humeral fractures (PHF) in acute traumatic settings to optimize patient outcomes. Methods: This was a retrospective case series of 51 patients who underwent a Trabecular Metal RGSA for non-reconstructable, acute three or four-part PHF performed by a single surgeon between 2013 and 2019 with a minimum follow-up of one year. This included 7 males & 44 female patients. Mean age was 76 years (range 61 to 91 years). Oxford shoulder score (OSS) along with relevant patient information relating to demographics and functional outcomes were collected at regular intervals in out-patient clinics and over the telephone. Complications (if any) were dealt appropriately during treatment course. Results: The mean follow-up was 3.08years. The mortality rate was 17.64% (n=9/51) and six patients were lost for follow-up. Patients had good range of motion and mean OSS of 38 post-operatively. The overall complication rate was 7.8%, and none of the patients had deep infections, scapular notching, or acromial fractures. Healing of repaired greater tuberosity was evident on radiographs in 62.7% of the patients. Conclusion: RGSA is certainly a rewarding surgery in a cohort of patients sustaining complex PHF and was associated with patient satisfaction along with restoration of function.

Objective: The reverse shoulder arthroplasty (RSA) has revolutionized the modern reconstructive shoulder surgery. Initially recommended for rotator cuff arthropathy, its indications have been expanded to massive cuff tears, rheumatoid arthritis and fracture care.The aim of this study was, to evaluate the clinical and radiological results after a reverse shoulder arthroplasty and to assess the impact on quality of life.

Methods : Retrospective case series evaluating 37 patients undergoing reverse shoulder arthroplasty with at least two years of clinical follow up assessment. The clinical assessment was performed before and after the operation using the Oxford shoulder score, the Visual Analogue Pain score and the Constant-Murley score. Types of complications such as infection and dislocation as well as radiographic appearance of notching were also recorded.

Results: The patients who underwent a reverse shoulder arthroplasty, improved from 15.43±1.864 to 36.08±1.963, p<0.001 according to the Oxford shoulder score in their 2year post-operative appointment. According to the Constant Murley score, patients also improved significantly from 24.97±2.303 to 46.65±1.874, p<0.001.The pain was reduced from 8.43±0.26 to 1.99±2.55, p<0.001.

Conclusion: Patients who underwent a reverse shoulder arthroplasty had a significant improvement in their quality of life, indicating that reverse shoulder arthroplasty improves the range of movement and reduces the amount of pain in the affected shoulder. From our case series, the expanded indications for its use are totally justified, making reverse shoulder arthroplasty a valuable tool in modern orthopaedic practice.

COVID-19 has changed healthcare forever. Our elective patients are suffering, with the number waiting for arthroplasty in a health state ‘worse than death’ doubling during the pandemic. We need to think of novel ways to help treat the incoming tsunami of patients requiring arthroplasty. Day case arthroplasty could be the answer – this abstract provides a protocol for this. The protocol can be split up into 4 stages: pre-operative; intra-operative; post-operative; follow-up. Pre-operative: this stage involves identifying appropriate patients. Our criteria are: age < 75 years, medical criteria (no hx of IHD, CHF, uncontrolled HTN, COPD, OSA and VTE), BMI < 35, ASA < 3, no opioid dependence, social criteria (independent, lives within an hour of the hospital, good social support). Intra-operative: anaesthesia involves a general anaesthetic and a block. We get intra-operative X-rays to confirm prosthesis placement. Post-operative: discharge is with an analgesic pack. Bloods are not routinely indicated and the patient gets a physio assessment and plan prior to discharge. Follow-up: outpatient review in 2/52 for a wound check and physio, 6/52 for an X-ray and physio, 1 year for an X-ray.

Introduction: Functional outcomes following reverse geometry shoulder arthroplasty can vary. This study assessed the effects of glenosphere size, humeral stem version, posterior rotator cuff status and subscapularis repair on patient reported outcome and range of motion. Methods: A consecutive series of 132 patients from two orthopaedic centres that use the same onlay system for reverse shoulder arthroplasty were reviewed over a 6-year period. Outcome measures consisted of the Oxford shoulder score (OSS) and range of motion (ROM) at one year following surgery. These were assessed against glenosphere sizes (small (36-38 mm) and large (40-42 mm)), humeral stem retroversion (less or more than 20 degrees), rotator cuff status (posterior rotator cuff present or absent) and subscapularis tendon (repaired or not) at the end of procedure. Results: Larger glenospheres and less humeral stem retroversion yielded better ROM and OSS but this was not statistically significant. Subscapularis repair had no effect on outcomes. Preservation of posterior rotator cuff tendons improved functional outcomes. The number of tendons present at the end of procedure had a positive effect on outcome (best with two tendons and better with one compared to a completely bold humeral head) Conclusion: Preservation of posterior rotator cuff tendons during reverse shoulder arthroplasty improves clinical outcomes while subscapularis repair is found to be unnecessary. Implant size and version in reverse geometry arthroplasty have no significant effects on clinical outcome.

Background : Correct measurement of the native humeral head is critical for a successful anatomic shoulder replacement. We hypothesized that the circle made by specific area of humeral head correlate on different projections of plain X-rays.
Methods : Bilateral shoulder conventional radiograph of 109 patients without arthropathy or other abnormal findings of the humeral head were evaluated. Best-fit circle of the humeral head articular portion on shoulder anterior-posterior(AP), glenoid AP(Grashey view), outlet, axillary and 30° caudal tilt radiograph was drawn on PACS(Marosis m-view, Marotech). The radius of the circle in each projection of radiographs was measured and compared with.
Results : The best fit circle was made based on three points, drawn on medial and lateral end point of the anatomic neck and the lateral cortex below the greater tuberosity on AP and oblique radiograph. There was no significant difference in radius between right and left shoulder (P<0.001). Intraclass Correlation Coefficient for radius of the circle on both sides was, shoulder AP 0.990(95% CI 0.986-0.993), glenoid AP 0.992(95% CI 0.989-0.995), outlet 0.996(95% CI 0.994-0.997), axillary 0.994(95% CI 0.991-0.996) and 30° caudal tilt 0.993(95% CI 0.990-0.995).
Conclusions : Best-fit circle on humeral head could be made on different projections of plain X-rays. This simple method to determine the ideal size of humeral head can be useful in pre-operative planning in anatomical restoration of the shoulder to avoid problems of over-stuffing.

Introduction: Total elbow arthroplasty is an uncommon surgical procedure performed in selected cases of disabling elbow diseases. Osteolysis is the main cause of long-term revision surgery. Case presentation: 63-year-old male patient, with total right elbow arthroplasty 14 years ago, observed after fall with trauma to the right upper limb. He presented pain, deformity and functional limitation. The X-ray and CT scan showed a periprosthetic fracture above the humeral stem (type III of Mayo classification) with signs of osteolysis and loosening of the implants. He underwent total replacement by a semiconstrained prosthesis (Coonrad-Morrey design) with humeral and ulnar long stems. He performed physiotherapy and the X-ray at 3 months showed a healed fracture. After 6 months he presented 60º of range of motion, but moderate limitation for daily activities (DASH Score 62.5). Discussion: Total elbow arthroplasty is still associated with several complications including infections, periprosthetic fractures or aseptic loosening. In this case, the replacement by long stems and bypass of the local fracture allowed for greater stability, preserving the elbow motion and ensuring an effective consolidation. Despite some functional limitation, it didn´t affect the patient's perception of general health and quality of life. The lack of studies makes it difficult to compare with the current literature. Conclusion: The revision of total elbow arthroplasty is a demanding surgery, due to difficult exposure and failure of bone stock after cement and implants removal. It is a rescue procedure for selected patients as a result of the high rate of complications associated.

Background: Multi-fragmentary distal humeral fractures can be challenging to treat in older patients. Good results have been reported following open reduction internal fixation (ORIF) and hemiarthroplasty (EHA). To date there are no comparative studies comparing the outcomes of the two techniques. Objectives: Compare long term outcomes in patients treated with ORIF versus EHA for distal humeral fractures in patients over 60, minimum 12 months follow-up. Methods: 36 patients (mean age 73 years) treated surgically for a multi-fragmentary intra-articular distal humeral fracture were followed up for a mean duration of 34 months. Retrospective patient records and clinic letters were used to collect data. Outcomes of interest were: Oxford Elbow Score (OES), Visual Analogue pain Score (VAS), range of motion (ROM), complications, re-operations and radiographic complications. Results: Patients in the HA group had higher mean OES (42.5 vs 39.6) and lower VAS (0.5 vs 1.7), however neither of these were significantly different. There was no statistical difference in ROM between the two groups: mean flexion-extension arc (123.1° vs 111.9°). There were 14 complications in the ORIF group and 1 in the EHA group. This was statistically significant (6% vs 39%, p=0.04). There were more re-operations (6% vs 33%) and radiographic complications (22% vs 33%) in the ORIF group, but this was not statistically significant. Two patients had failed ORIF, requiring conversion to TEA. There were no failed EHA. Conclusion: This study demonstrated superior early outcomes following EHA for distal humeral fractures. Surveillance is required to assess the longevity of these results.