They may also be under-reported due to the fact that spontaneous recovery happens in many cases.57 The most common nerve dysfunction after RSA involves the axillary nerve, although post-operative radial, ulnar, and musculocutaneous nerve palsies have been reported as well.58 Partial recovery of the axillary nerve may affect the clinical outcome, as it can affect deltoid strength.46 The suprascapular nerve and artery may be at risk at the spinoglenoid notch when drilling the posterior screw. Walch et al studied the influence of an injury to the acromion in 457 consecutive RSA.62 Pre-operative acromial injuries did not affect the clinical outcome, but post-operative spine fractures were detrimental in regard to function.
Advanced imaging techniques are helpful in the diagnosis of acromial and scapular spine fractures (middle column). The location of the acromial fracture may impact the outcome. Due to the forces occurring at the glenoid, most early reports were wary of the outcome of these implants. Ek et al reported the results of patients undergoing RSA for massive irreparable cuff tears with a mean age of 60 years, at a mean follow-up of 93 months.3 Three of 46 implants (6.5%) required removal due to glenoid loosening, with an impact on outcome scores.
Коляното На Облекчаване На Болката
In this study, eight of 34 uncemented humeral stems failed for aseptic loosening at eight years of follow-up. None of the patients had humeral loosening or radiological signs of loosening at two years’ follow-up. Distalisation of the glenoid component with an eccentric component, along with the use of a humeral component with a more vertical joint line with or without humeral lateralisation may be advantageous in these situations. The long-term implant survival at ten years was 91%, with 16% radiologic signs of glenoid loosening at ten years for older patients with rotator cuff arthropathy.37 It remains to be seen whether the long-term results of medialised RSA are replicated with more lateralised designs. Excessive arm lengthening greater than 2 cm has been shown as a potential risk.31 Anatomical studies show that lateralisation is less harmful for the nerve than distalisation.59 Alentorn-Geli et al showed in their meta-analysis a 2.9% rate of neurological injury in medialised RSA versus 0.5% in lateralised COR.
Guide des tailles
Repeated Impact-Based Control
Une variété de couleurs
Неизвестен Производител и Произход
Ускоряване на регенерацията на хрущялната тъкан
State of the Art
увеличава подвижността на ставите
Изчезването на болка, подуване и зачервяване
Fig. 4 AP radiograph of a right shoulder in a patient with a RSA for rotator cuff arthropathy two years after implantation showing grade III scapular notching. Melis et al reported on the radiological findings of a multicentre study evaluating 122 RSA with eight years’ minimum follow-up.38 Cemented stems showed signs of radiolucency without implant migration in 20% of cases. Uncemented stems showed proximal bone resorption and signs of stress shielding in 8% of cases, with stem diameter being related to the degree of bone resorption. The mean Constant Score and forward active elevation of this group was 35 and 81º, compared with 57 and 124º in the control group, with three being dissatisfied with the result. Complications after reverse shoulder arthroplasty (see Table 1) continue to be higher in primary and revision shoulder surgery when compared to total shoulder arthroplasty. 13. Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G. бабини илачи за болки в кръста
. Reverse total shoulder arthroplasty: a review of results according to etiology.
Болка В Крака
Factors that may explain the higher infection rate include increased implant surface, a larger dead space, patient factors and the complexity of some of the indications.16 The reported incidence in the literature varies from 1% to 15%. In a meta-analysis, Zumstein et al reported a mean infection rate of 3.8% in a systematic review including primary and revision RSA, with a higher rate in revision surgery.14 For non-reverse arthroplasty, lower rates of infection have been reported. Fig. 3 This figure shows an anteroposterior radiograph of a patient that had suffered a revision arthroplasty for failure of a hemiarthroplasty for fracture. Different systems may have different modes of disassembly, and it remains to be seen whether this complication can be completely eliminated. Eccentric glenospheres with an inferior offset and glenoid components with increased lateral offset (bony or metal) can reduce the rate of notching. Mizuno et al analysed the influence of an eccentric glenosphere in 47 consecutive cases compared with an historical group operated by the same surgeon.52 The rate of notching was not different, but the severity was reduced by the use of an eccentric glenosphere.
Облекчаване На Болката В Реално Време
The rate of notching using an RSA with a medialised centre of rotation has been 47.3% in RSA with a medialised centre of rotation, with some studies reporting rates of up to 97%.2,23,44,46 The reported rate of notching of 4.6% with the use of lateralised RSA is significantly lower compared to medialised designs.27 Another radiological finding sometimes seen in the same location as notching is traction spurs in the inferior glenoid, which some authors have attributed to triceps traction enthesopathy due to insufficient release when using an antero-superior approach and heterotopic ossification, which is usually found in association with notching. After normalisation of PCR and ESR counts and a successful clinical course, the patient was revised to another cemented reverse shoulder arthroplasty. Glenosphere dissociation after reverse shoulder arthroplasty.