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Evaluation of the results from non-arthroplastic treatment (arthroscopy) for shoulder arthrosis.

Miyazaki AN, Fregoneze M, da Silva LA, do Val Sella G, Garotti JE, Checchia SL - Rev Bras Ortop (2015)

Bottom Line: There were statistically significant mean differences in the values for elevation, lateral rotation and medial rotation from before to after the operation (p < 0.001) and there was a tendency (p = 0.057) toward poor results with greater length of time with complaints before the surgery.The total gain in UCLA score did not have any statistically significant relationship with any of the other variables analyzed.Greater length of time with complaints was a factor strongly suggestive of worse results.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objectives: To evaluate the functional results from patients with arthrosis who underwent an arthroscopic procedure, in an attempt to correlate these results with the patients' epidemiological profile, surgical technique used, possible complications and postoperative protocol.

Methods: Between 1998 and 2011, 31 patients (32 shoulders) with shoulder arthrosis underwent arthroscopic treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology of Santa Casa de São Paulo. Primary or secondary cases of shoulder arthrosis under the age of 70 years, in which the rotator cuff was intact, were included. Furthermore, cases in which, despite an indication for an arthroplastic procedure, an attempt to perform an alternative procedure had been chosen, were also included. The following were evaluated: sex, age, dominance, comorbidities, length of time with complaint, associated lesions, etiology, previous treatment, operation performed, postoperative protocol and pre and postoperative active ranges of motion. The functional evaluation was conducted using the UCLA criteria, before and after the operation. The joint cartilage alterations were classified in accordance with Outerbridge and the arthrosis by means of Walch.

Results: There were statistically significant mean differences in the values for elevation, lateral rotation and medial rotation from before to after the operation (p < 0.001) and there was a tendency (p = 0.057) toward poor results with greater length of time with complaints before the surgery. The total gain in UCLA score did not have any statistically significant relationship with any of the other variables analyzed.

Conclusion: Arthroscopic treatment of glenohumeral arthrosis provided functional improvement of the glenohumeral joint, with significant gains in elevation and lateral and medial rotation, and improvements in function and pain. Greater length of time with complaints was a factor strongly suggestive of worse results.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view of left shoulder, with camera positioned in the lateral portal of the left shoulder, showing: (A) arthrosis with loss of all of the cartilage from the humeral head; (B) anterior capsulotomy in progress using basket tweezers; (C) view of inferior capsulotomy; (D) view of posteroinferior capsulotomy.
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fig0010: Intraoperative view of left shoulder, with camera positioned in the lateral portal of the left shoulder, showing: (A) arthrosis with loss of all of the cartilage from the humeral head; (B) anterior capsulotomy in progress using basket tweezers; (C) view of inferior capsulotomy; (D) view of posteroinferior capsulotomy.

Mentions: The patients underwent arthroscopic surgery in lateral decubitus in order to enable adequate access to the posterior and posteroinferior portions of the capsule. The following stages were performed in a sequential manner: debridement, removal of free bodies, opening of the rotator interval, release of the coracohumeral ligament, anterior capsulotomy, change of portal, posterior capsulotomy, inferior capsulotomy and, finally, anteroinferior capsulotomy with the aid of surgical basket tweezers, in order to avoid injuring the axillary nerve. Some of these steps can be seen in Fig. 2A–D. In three patients, these procedures were considered sufficient. In the other patients, other procedures were added, on a case-by-case basis, and these are described and quantified in Table 2.


Evaluation of the results from non-arthroplastic treatment (arthroscopy) for shoulder arthrosis.

Miyazaki AN, Fregoneze M, da Silva LA, do Val Sella G, Garotti JE, Checchia SL - Rev Bras Ortop (2015)

Intraoperative view of left shoulder, with camera positioned in the lateral portal of the left shoulder, showing: (A) arthrosis with loss of all of the cartilage from the humeral head; (B) anterior capsulotomy in progress using basket tweezers; (C) view of inferior capsulotomy; (D) view of posteroinferior capsulotomy.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563078&req=5

fig0010: Intraoperative view of left shoulder, with camera positioned in the lateral portal of the left shoulder, showing: (A) arthrosis with loss of all of the cartilage from the humeral head; (B) anterior capsulotomy in progress using basket tweezers; (C) view of inferior capsulotomy; (D) view of posteroinferior capsulotomy.
Mentions: The patients underwent arthroscopic surgery in lateral decubitus in order to enable adequate access to the posterior and posteroinferior portions of the capsule. The following stages were performed in a sequential manner: debridement, removal of free bodies, opening of the rotator interval, release of the coracohumeral ligament, anterior capsulotomy, change of portal, posterior capsulotomy, inferior capsulotomy and, finally, anteroinferior capsulotomy with the aid of surgical basket tweezers, in order to avoid injuring the axillary nerve. Some of these steps can be seen in Fig. 2A–D. In three patients, these procedures were considered sufficient. In the other patients, other procedures were added, on a case-by-case basis, and these are described and quantified in Table 2.

Bottom Line: There were statistically significant mean differences in the values for elevation, lateral rotation and medial rotation from before to after the operation (p < 0.001) and there was a tendency (p = 0.057) toward poor results with greater length of time with complaints before the surgery.The total gain in UCLA score did not have any statistically significant relationship with any of the other variables analyzed.Greater length of time with complaints was a factor strongly suggestive of worse results.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objectives: To evaluate the functional results from patients with arthrosis who underwent an arthroscopic procedure, in an attempt to correlate these results with the patients' epidemiological profile, surgical technique used, possible complications and postoperative protocol.

Methods: Between 1998 and 2011, 31 patients (32 shoulders) with shoulder arthrosis underwent arthroscopic treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology of Santa Casa de São Paulo. Primary or secondary cases of shoulder arthrosis under the age of 70 years, in which the rotator cuff was intact, were included. Furthermore, cases in which, despite an indication for an arthroplastic procedure, an attempt to perform an alternative procedure had been chosen, were also included. The following were evaluated: sex, age, dominance, comorbidities, length of time with complaint, associated lesions, etiology, previous treatment, operation performed, postoperative protocol and pre and postoperative active ranges of motion. The functional evaluation was conducted using the UCLA criteria, before and after the operation. The joint cartilage alterations were classified in accordance with Outerbridge and the arthrosis by means of Walch.

Results: There were statistically significant mean differences in the values for elevation, lateral rotation and medial rotation from before to after the operation (p < 0.001) and there was a tendency (p = 0.057) toward poor results with greater length of time with complaints before the surgery. The total gain in UCLA score did not have any statistically significant relationship with any of the other variables analyzed.

Conclusion: Arthroscopic treatment of glenohumeral arthrosis provided functional improvement of the glenohumeral joint, with significant gains in elevation and lateral and medial rotation, and improvements in function and pain. Greater length of time with complaints was a factor strongly suggestive of worse results.

No MeSH data available.


Related in: MedlinePlus