Microbiology was negative for infection and the patient underwent revision arthrodesis. Only two of these united while the remaining two patients (29%) had failed to achieve union at final follow-up [5]. p"UC) (2018) Satisfied patients after shoulder arthrodesis for brachial plexus lesions even after 20 years of follow-up. demonstrated reasonable pain relief and improved shoulder stability in their cohort [7]. A comprehensive search of the SMHS electronic theatre databases was performed, spanning years 2001-2019. J Pediatr Orthop 31: 679-682. J Hand Surg Eur 36: 541-547. 0000062725 00000 n Indications for surgery were; post-traumatic osteonecrosis of the humeral head with and without brachial plexus injury, osteoarthritis with obstetric brachial plexus injury, post-traumatic osteoarthritis with and without axillary nerve palsy, post-traumatic osteoarthritis with instability, and recurrent instability due to refractory seizures. Chammas M, Goubier JN, Coulet B, Reckendorf GMZ, Picot MC, et al. 0000005068 00000 n Clinical records and imaging were then reviewed to determine patient outcomes. It was retrospective in nature. 0000038771 00000 n 4ZsX%p=+@}{gK1pR&|"+G] Clinical records and imaging were then reviewed to determine patient demographics and outcomes. Shoulder arthrodesis was extremely uncommon in SMHS, with only seven recorded cases over a 19 year period. Both patients treated for instability symptoms reported frustration at their reduced range of motion postoperatively. 0000003402 00000 n Wagner, et al. Shoulder arthrodesis is an uncommon surgical procedure performed for a range of shoulder pathology including brachial plexus injury, instability or as a salvage procedure for failed arthroplasty and tumour cases. The use of plate fixation and sufficient autograft is well supported in the literature [5,8,9,11-13]. Orthopedics 14: 849-855. (2018) Long-term outcomes of glenohumeral arthrodesis. 771 0 obj <> endobj Thangarajah T, Higgs D, Bayley JL, Lambert SM (2017) Glenohumeral arthrodesis for recurrent types II and III shoulder instability. followed 27 patients for a mean of six years. Miller JD, Pinero JR, Goldstein R, Yen YM, Eves W, et al. 0000041893 00000 n 0000006745 00000 n 0000007520 00000 n Shoulder arthrodesis is an uncommon surgical procedure. endstream endobj 783 0 obj <> endobj 784 0 obj <>stream In Chammas cohort, 26 of 27 had improved satisfaction and all had gone on to union [15]. 0000064295 00000 n 0000015803 00000 n 482 0 obj <>/Filter/FlateDecode/ID[]/Index[476 25]/Info 475 0 R/Length 53/Prev 1098836/Root 477 0 R/Size 501/Type/XRef/W[1 2 1]>>stream Patients being treated for instability were frustrated by reduced range of motion post-operatively. Shoulder arthrodesis is a viable surgical treatment for a wide range of shoulder pathology. We believe high rates of drug addiction (71%), smoking (57%) and unemployment (71%) in our cohort contributed to high rates of chronic pain and complications. The majority of our cohort lived outside the metropolitan region, meaning poorer access to health services and thus more likely to present late. Plate and screw fixation with sufficient bone graft is the favoured surgical technique. <]/Prev 1568652/XRefStm 2385>> Instability scores and subjective shoulder value improved. Three (11%) sustained humerus fractures [15]. Most cohorts report good outcomes for patients at long term follow-up despite a high incidence of complications and re-operation rates. 0000009736 00000 n P>t@dBOco)mWv9~qjj>"`;AK^bugiv@Z}ShE_?p{zy;($^@ All employed patients returned to work including one as a manual labourer. Patients having shoulder arthrodesis for recurrent instability tend to have worse outcomes than those having arthrodesis for other indications [7]. J Hand Surg Eur 44: 248-255. %%EOF looked at a cohort of six young epileptic patients who had recurrent instability attributed to seizures [2]. found malposition of the humerus leads to poorer outcomes [3]. Atlan, et al. Bone Joint J 96: 1525-1529. 0000018205 00000 n hbbrf`b``3 1x4>Fc k 43% had ongoing pain, all of which were chronic pain sufferers with pre-existing opioid addiction. 0000016952 00000 n 0000021238 00000 n 0000019067 00000 n Ruhmann O, Schmolke S, Bohnsack M, Flamme C, Wirth CJ (2005) Shoulder arthrodesis: Indications, technique, results, and complications. 771 66 Both of the employed patients returned to their pre-operative occupation, including one manual labourer. 0000018289 00000 n 71% of patients suffered from drug addiction, and 57% were smokers. hbbd``b`i @ H j#c6H All Rights Reserved. Seven shoulder arthrodesis procedures were performed. 0000022535 00000 n 0000000016 00000 n All Rights Reserved. Despite high complication rates, cohorts generally have good outcomes. Plate and screw constructs were used in all seven patients. Patients undergoing shoulder arthrodesis were identified. _4}2LGlqqg=;]4mL?]W+r5!74iV5Mqd_5y wwrutspsqqC_3z evaluated a diverse cohort of 29 patients at a mean follow up of 12 years (range 2-22 years) [7]. J Bone Joint Surg Am 100: 598-604. 0000006832 00000 n Shoulder arthrodesis is an extremely uncommon procedure, with only seven recorded cases over 19 years. Patients undergoing shoulder arthrodesis were identified. ClinMed International Library. In another cohort of eight patients with obstetric brachial plexus injuries all were satisfied with the outcome of shoulder arthrodesis with improvements in their range of motion [4]. One patient developed a deep infection and periprosthetic fracture 6 weeks post-fusion. 0000003271 00000 n Follow-up was variable in duration with a 14% (one patient) loss to follow-up. Median American Society of Anaesthesiologists (ASA) score was 2 (range 1-3). 0000048961 00000 n Cohorts report generally good outcomes despite high rates of complications. PDF | HTML | XML | ePUB, International Archives of Orthopaedic Surgery, Dr. Sheldon M Moniz, Department of Orthopaedic Surgery, Fremantle Hospital, Alma St, Fremantle WA 6160, Australia. A sparse number of retrospective cohorts appear in the literature. Five patients (71%) had achieved union at last follow-up. The fracture was managed conservatively. Two (7%) had non-unions requiring re-operation and bone graft. We anticipate our cohort to have a high incidence of confounding social factors that increase the risk for high-energy trauma, late presentation and non-compliance. also found the inclusion of the acromion in the fusion was crucial to prevent non-union [7]. 0000041633 00000 n 2020 Bochat K, et al. 29% of patients' required further surgery for infection and non-union. A comprehensive search of the electronic theatre databases for the South Metropolitan Health Service of Western Australia was performed for 2001-2019. hb```b`` "@1v,& 'X^UZl~K?:@x$"B!3.z0p`cocVS}:6(dtmapp6!@ "3|Z.J:mzn`YXR:M~]Z9S^"[tqd,k#!/C|MDo>a* Rowe CR (1974) Re-evaluation of the position of the arm in arthrodesis of the shoulder in the adult. Rowe described the goals of shoulder arthrodesis in 1974 [6]. Int Arch Orthop Surg 3:019. doi.org/10.23937/2643-4016/1710019, Department of Orthopaedic Surgery, Fremantle Hospital, Australia. %%EOF Drug abuse, cigarette smoking and unemployment rates are high within our cohort. (2012) Functional outcome of glenohumeral fusion in brachial plexus palsy: A report of 54 cases. Mean time to fusion was 16 months (range 8-31 months). This patient underwent two further operations; open lavage then subsequent removal of metal. 0000012133 00000 n H\@)rbx?; ~Y One did not attend follow-up beyond five months and was pain-free at last visit. trailer endstream endobj startxref Wagner, et al. Bekhelyar Z, Djeffel AB, Cambon-Binder A (2019) Glenohumeral fusion in adults with sequelae of obstetrical brachial plexus injury: A report of eight cases. 0000006259 00000 n found that cortico-cancellous autograft in the subacromial space signicantly increased fusion (43% vs. 4% P < 0.001) in their cohort of 54 patients [11]. 0000001649 00000 n 0000055834 00000 n Three (43%) had ongoing pain beyond 12 months. Wagner, et al. The final patient had recently undergone revision shoulder arthrodesis. 0000012899 00000 n These included six periprosthetic fractures, seven non-unions, and three infections. reviewed outcomes of 11 children suffering polio who underwent shoulder arthrodesis for flail shoulder [14]. Richards RR, Beaton D, Hudson AR (1993) Shoulder arthrodesis with plate xation: Functional outcome analysis. Pre-operative counselling is of particular importance in patients undergoing shoulder arthrodesis for instability symptoms. 0000002582 00000 n 0000016354 00000 n Three (6%) had not united at last follow-up. Although complication rates are high, patients generally have good outcomes. 476 0 obj <> endobj {(:~w;~w;N?dUUM7a^)({=~{=~B"2ftn~y]|-c2oe~n7p$ +- endstream endobj 772 0 obj <>/Metadata 77 0 R/PageLabels 74 0 R/Pages 76 0 R/StructTreeRoot 79 0 R/Type/Catalog/ViewerPreferences<>>> endobj 773 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/StructParents 3/TrimBox[0.0 0.0 585.0 783.0]/Type/Page>> endobj 774 0 obj <> endobj 775 0 obj <> endobj 776 0 obj <> endobj 777 0 obj <> endobj 778 0 obj <> endobj 779 0 obj <> endobj 780 0 obj <> endobj 781 0 obj <> endobj 782 0 obj <>stream Rate of shoulder fusion was 71% at a mean of 17 months. It is performed for a wide range of clinical presentations including brachial plexus injury (traumatic or iatrogenic), recurrent shoulder instability, failed shoulder arthroplasty, and tumour cases. One patient was lost to follow-up. endstream endobj 785 0 obj [821 0 R] endobj 786 0 obj <>stream +vq8-y0.n6E 0000014822 00000 n 0000002385 00000 n We aim to add to the body of evidence, specifically patient demographics and social factors. 0000011664 00000 n %PDF-1.4 % reported that excessive abduction and external rotation lead to winging of scapula at rest, which results in pain [10]. 0000022686 00000 n Pre-operative counselling is important in patients with recurrent instability who need to accept a loss of range of motion to gain stability. First, the hand should reach the face, head and body midline both anteriorly and posteriorly. Shoulder arthrodesis, Glenohumeral joint arthrodesis, Social factors, Patient outcomes, Surgical outcomes. hb```f``Ra`b``bd@ A37c#H(` VtGqU/``22}Ba_B iVhLF$?"kK{F 0000008458 00000 n 0000029489 00000 n The majority of patients were male (five). 0000007493 00000 n H\@FyZv/{Z\ctcb\ P8&U=~?8uE4x$Awq$>^In^n^VesI+cWg{}x5%4l-ohiWmXN1LElfe~wg3;[NCsh56Nc,2BrH!. There is a gap in the literature about the social demographic of patients undergoing shoulder arthrodesis. This was attributable to a loss of range of motion [2]. One patient had 11 previous surgeries on the affected shoulder, another three procedures, while three patients had not had any previous surgery. In the neurologically compromised patient, shoulder arthrodesis allows the scapulothoracic joint to transfer meaningful movement to the elbow, wrist and hand. Five (71%) were unemployed. 0000063082 00000 n nv?]`pB?/g ? 0000005658 00000 n 0000063987 00000 n Procedures were performed by five different Consultant Orthopaedic surgeons, all with a special interest in shoulder surgery. ocSm^UwX&CAG9i[ t&H, Get The Best Streaming Servers For Media Streaming & Unlimited Bandwidth Upto 1GBPS, Buy The Best VPS Plan Which Suits Your Needs, Select The Best AMD Ryzen Servers - Perfect For Gaming & Media Streaming - Less Than 24 Hours Delivery, Chose the Best Dedicated Server & Customize the Servers - DMCA Free Dedicated Servers, Get The Dedicated Servers For Gaming,Business & Capable Bandwidth Upto 1GBPS Network Port, Get The Dedicated Servers For Media Streaming & Unlimited Bandwidth Upto 40 GBPS Network Port, Buy The Storage Dedicated Servers For VOD's & Movies, Secure your domain name by registering it today, Transfer now to extend your domain by 1 year. The optimal position of the fused arm remains unclear. Numerous other cohorts in the literature report similarly high rates of complications [5,7,11,14,15]. Shoulder arthrodesis is a viable option in employed patients including manual labourers, as all employed patients returned to work, including one as a manual labourer. ' Dp:vHa [6Pka7|aU2p8aRf{n3SWftMU&yL5c|H J?gsYNw{9(@H2laO{h%@@;5'XjSf[t;m; CC74v40t4(u4kDGEGa@@)& 0Ht4 q078`4,P 0000020993 00000 n Shoulder arthrodesis is an uncommon procedure with reliable outcomes despite high rates of complications. 0000017723 00000 n J Bone Joint Surg Am 90: 70-77. Surgical outcomes were reasonable with the rate of shoulder fusion 71% at a mean of 17 months. We aim to investigate the outcomes of all patients undergoing shoulder arthrodesis within the South Metropolitan Health Service (SMHS) from 2001-2019. 0000006033 00000 n Chammas, et al. 0000043672 00000 n Eur J Orthop Surg Traumatol 28: 1089-1094. 0 hXQo8+z{H-$C6[vb n}R_k uHrmY{d$RG!LYFLZd! "3!5F#{B&mhP,{"*zbB`Xs8eaU?|f:/d"dg_[yQ&%J>/Y$|[Br)8 HbI:Zd-/"-`Ce6IhzqD-W\}#As^Wd6,f/%zM|Y6 aFI:O6ol]o$K6i@Pbrn$_EZ^$kL2`2Yg:e. The patient last attended follow-up five months after index procedure and at this time reported no pain. startxref 836 0 obj <>stream There was also a diverse range of indications for glenohumeral arthrodesis as opposed to a group of patients with a single pathology. $dBIU@Ql! xref 11 patients (38%) underwent further surgery for non-union (seven patients), debridement and lavage for deep infection (two), fracture fixation (two), and removal of metal due to irritation (one). J Bone Joint Surg Br 86: 692-695. 0000011269 00000 n Miller, et al. The optimal position of the humerus is still debated. Patients having shoulder arthrodesis for instability were frustrated by reduced range of motion post-operatively, consistent with previous findings in the literature [3]. Please enter a number between 8 and 64 for the password length. Souza, et al. 0000022605 00000 n Third, the shoulder should be comfortable when the arm is at rest against the trunk, without scapula winging [6]. Sousa R, Pereira A, Massada M, Trigueiros M, Lemos R, et al. The majority of literature supports 15 to 25 of forward exion and abduction and 40 to 45 of internal rotation [6-9]. Bochat K, Moniz SM, Mattin AC (2020) Clinical & Surgical Outcomes of Shoulder Arthrodesis: A Cohort of Seven Cases from the South Metropolitan Health Service of Western Australia. Richard Madayag, Clinical applications reporter, Theatre Management System, South Metropolitan Health Service of Western Australia. 0000029220 00000 n Four patients (57%) lived outside the Perth metropolitan region. 0000008117 00000 n and Chammas, et al. Four (57%) were active cigarette smokers. endstream endobj 835 0 obj <>/Filter/FlateDecode/Index[79 692]/Length 46/Size 771/Type/XRef/W[1 1 1]>>stream While their instability scores improved, two of the six patients had a decreased mean subjective shoulder score. These patients had previously had up to 11 failed procedures each (mean of four). J Bone Joint Surg Am 56: 913-922. Thangarajah T, Alexander S, Bayley I, Lambert SM (2014) Glenohumeral arthrodesis for the treatment of recurrent shoulder instability in epileptic patients. 0000012484 00000 n Patients have often had multiple previous surgeries, with arthrodesis employed as a salvage procedure [1,2]. 0000063631 00000 n Stark DM, Bennett JB, Tullos HS (1991) Rigid internal xation for shoulder arthrodesis. J Shoulder Elbow Surg 14: 38-50. H\0=Ob EEM D"o_hFj$9_q?>\u0pm$/L2[5$i|zp;v>)K4/?$>6aly;df6M}o-tvlvz9wz8'p:Uw IY'kL;_?xscxE6)fYW3[O1^2[dad,l6Ni7-6fA`A`A`A`A`Af{( Atlan, et al. Scalise and Iannotti's cohort had four of seven patients (57%) require revision surgery with bone graft. sd6.0~Asi+jY4Y&+86;t>IM^Ms)lllp +A 29% of patients required further surgery for infection and persistent pain. demonstrated improvements in pain, function and strength for brachial plexus injury patients post-shoulder arthrodesis [3]. 0000006147 00000 n 0000004294 00000 n %PDF-1.5 % Screw xation was associated with a lower rate of postoperative fractures and implant removal for irritation in a cohort of 43 patients, but the use of plates and bone-grafting improved the rates of union [12]. Surgical history of the remaining two patients was unknown (Table 1). Vander Lingen, et al. observed that abduction or exion of 25 led to better shoulder and extremity function [7]. At an average of 4 years follow-up (range 1.5-8 years) subjective shoulder function and pain were significantly improved (p = 0.008) [5]. All of these three patients had a pre-operative opioid addiction and were chronic pain patients. (2011) Shoulder arthrodesis in adult brachial plexus injury: What is the optimal position? 0000013650 00000 n J Shoulder Elbow Surg 26: 687-691. Five patients (71%) suffered from drug addiction (four opioid, one methamphetamine). Van der Lingen, et al. 0000003892 00000 n By continuing to use this website, you agree to our Terms of Use | Privacy Policy. The second patient had loosening at the 13-month mark and underwent removal of metal and biopsy. Subjective shoulder function and pain were significantly improved in Scalise and Iannotti cohort at an average of 4 years follow-up [5]. Two patients (29%) required further surgery. [Z$>)A`w.0 1830}G )_ |Fe =[ 43% of patients had ongoing pain post arthrodesis, all of which were chronic pain sufferers with pre-existing opioid addiction. J Shoulder Elbow Surg 2: 225-239. Acta Orthop Traumatol Turc 45: 412-420. Copyright 2022 JRY Hosting Services. Atlan reports a 94% fusion rate [11]. had 10 of 54 patients (18%) require re-operation for delayed union at a mean follow-up of 37 months [11]. 12 patients (41%) had postoperative complications. Wagner, et al. Surgeons assessed the patient's passive ability to get the hand to mouth and face intra-operatively. Van der Lingen MAJ, de Joode SGCJ, Schtanus MGM, Grimm B, van Nie FA, et al. Pre-operative counselling is important in patients with recurrent instability who need to accept a loss of range of motion to gain stability. 0000014358 00000 n At a mean follow-up of 41 months, one patient had required revision surgery for non-union, two required corrective osteotomies, and six patients had metalwork removed due to discomfort. We expect a high incidence of confounding factors including multiple previous surgeries, unemployment, cigarette smoking and drug abuse to impact patient outcomes. The major limitation of our study was the small sample size. 0000015353 00000 n 0000041216 00000 n Mean patient age was 34 (range 22-45). All patients in Miller's cohort were satisfied at the final follow-up with minimal pain [14]. (2004) Glenohumeral arthrodesis in upper and total brachial plexus palsy. 0000055749 00000 n 0000013241 00000 n 0000010474 00000 n ,EV!B B B3 X@*hi^)ygVP_Bq 0 endstream endobj 477 0 obj <> endobj 478 0 obj <> endobj 479 0 obj <>stream Most cohorts report a high incidence of complications and return to theatre. 0000002747 00000 n Wagner ER, McLaughlin R, Sarfani S, Cofield RH, Sperling JW, et al. 0000020023 00000 n 0000017363 00000 n 500 0 obj <>stream Second, the arm should be in a position of maximum strength to lift, push and pull. Thangarajah, et al. Scalise JJ, Iannotti JP (2008) Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty. It has utility for employed patients including manual labourers. JRY Hosting Services, 100 Mason Road, Texas, USA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. _Kr-y,Y\s)Rz*4` Special Edition - Streaming Servers - US/UK, AMD Ryzen - 1 GBPS - Super Dedicated Servers, DMCA - UKR - Dedicated Servers - 1GBPS To 10GBPS Port Speed, Metered Servers - Limited Speed - Upto 1GBPS, Unmetered Media Servers - Upto 10 GBPS | 40 GBPS. Atlan F, Durand S, Fox M, Levy P, Belkheyar Z, et al. Esenyel CZ, Ozturk K, Imren Y, Ayanoglu S (2011) Shoulder arthrodesis with plate xation. Rates of previous surgery were lower than expected (29-57%). 0000031329 00000 n (2011) Shoulder arthrodesis for treatment of ail shoulder in children with polio. 0000021676 00000 n dYAV,p:E Thangarajah, et al. J Hand Surg Am 37: 683-688. Four patients (57%) were pain-free at last follow-up. 0000052681 00000 n 0000063252 00000 n 0000008889 00000 n evaluated a cohort of eight patients who underwent shoulder arthrodesis for pain and dysfunction secondary to recurrent instability [1]. Scalise and Iannotti analyzed seven patients who had failed shoulder arthroplasty and went on to arthrodesis.