The Prevalence of Glenohumeral Osteoarthrosis in Unstable Shoulders * Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. Primary hemiarthroplasty in four-part fractures of the proximal humerus: randomized trial of two different implant systems. Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. A randomized clinical trial comparing open and arthroscopic stabilization for recurrent traumatic anterior shoulder instability: two-year follow-up with disease-specific quality-of-life outcomes. Management of unstable elbows following complex fracture-dislocations--the "terrible triad" injury. Anterior cruciate reconstruction combined with autologous osteochondral transplantation Systematic Review of Arthroscopic Versus Open Repair for Recurrent Anterior Shoulder Dislocations Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty? Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study. Relevance of Arm Position and Muscle Activity on Three-Dimensional Glenohumeral Translation in Patients with Traumatic and Atraumatic Shoulder Instability * Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. Total shoulder arthroplasty using a subscapularis-sparing approach: a radiographic analysis. Comparison of Arthroscopic and Open Anterior Shoulder Stabilization: A Two to Six-Year Follow-up Study*
Background Glenohumeral osteoarthritis has been a well-described complication of open procedures to correct shoulder instability . What remains unknown is whether chondral injuries sustained during instability episodes contribute to osteoarthritis or whether the cause is primarily the stabilization procedure itself . Purpose To determine the prevalence of osteoarthrosis in a large data base of patients with acute and chronic shoulder instability before primary stabilization surgery . Study Design Retrospective review of prospect ively collected data . Methods Surgical and demographic data were collected on 422 patients with a diagnosis of shoulder instability who underwent arthroscopic examination and shoulder stabilization .  Results There was a significant association between the grade of osteoarthrosis and the presence of osteoarthritis ( grade III or IV chondral damage ) with time from injury to surgery . Patients with osteoarthritis  were significantly older than those without ( 34.9 versus 29.6 years ) . Multivariate analysis identified older age and time from injury to surgery as independent predictors of osteoarthritis . We found no association between direction of instability and the presence of osteoarthritis . Conclusion The overall prevalence of glenohumeral osteoarthrosis was low . Predictors of osteoarthritis included time from injury to surgery and age BACKGROUND Anterior dislocation of the glenohumeral joint in younger patients is associated with a high risk of recurrence and persistent functional deficits . The aim of this study was to assess the efficacy of a primary arthroscopic Bankart repair , while controlling for the therapeutic effects produced by the arthroscopic intervention and joint lavage . METHODS In a single-center , double-blind clinical trial , eighty-eight adult patients under thirty-five years of age who had sustained a primary anterior glenohumeral dislocation were r and omized to receive either an arthroscopic examination and joint lavage alone or together with an anatomic repair of the Bankart lesion .  Assessment of the rate of recurrent instability , functional outcome ( with use of three scores ) , range of movement , patient satisfaction , direct health-service costs , and treatment complications was completed for eighty-four of these patients ( forty-two in each group ) during the subsequent two years . RESULTS In the two years after the primary dislocation , the risk of a further dislocation was reduced by 76 % and the risk of all recurrent instability was reduced by 82 % in the Bankart repair group compared with the group that had arthroscopy and lavage alone . The functional scores were also better ( p < 0.05 ) , the treatment costs were lower ( p = 0.012 ) , and patient satisfaction was higher ( p < 0.001 ) after arthroscopic repair . The improved functional outcome appeared to be mediated through the prevention of instability since the functional outcome in patients with stable shoulders was similar , irrespective of the initial treatment allocation . The patients who had a Bankart repair and played contact sports were also more likely to have returned to their sport at two years ( relative risk = 3.4 , p = 0.007 ) . CONCLUSIONS Following a first-time anterior dislocation of the shoulder , there is a marked treatment benefit from primary arthroscopic repair of a Bankart lesion , which is distinct from the so-called background therapeutic effect of the arthroscopic examination and lavage of the joint . However , primary repair does not appear to confer a functional benefit to patients with a stable shoulder at two years after the dislocation BACKGROUND The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients . We performed a prospect i ve cohort study to evaluate these outcomes . We also aim ed to produce guidelines for the design of future clinical trials , assessing the efficacy of interventions design ed to improve the outcome after a primary dislocation . METHODS We performed a prospect i ve cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization , followed by a physical therapy program . Patients received regular clinical follow-up to assess whether recurrent instability had developed . Functional assessment s were made and were compared for two subgroups : those who had not had instability develop and those who had received operative stabilization to treat recurrent instability . RESULTS On survival analysis , instability developed in 55.7 % of the shoulders within the first two years after the primary dislocation and increased to 66.8 % by the fifth year . The younger male patients were most at risk of instability , and 86.7 % of all of the patients known to have recurrent instability had this complication develop within the first two years . A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients . Sample -size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions design ed to reduce the prevalence of recurrent instability and improve the functional outcome . CONCLUSIONS Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation . There is substantial variation in the risk of instability , with younger males having the highest risk and females having a much lower risk . Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits , with use of an assessment tool specifically for shoulder instability , during the first two years after the initial dislocation The objective of this study was to determine the effect of different prosthetic systems on the functional and radiographic outcomes after shoulder arthroplasty for fractures . This study comprised 35 patients ( 28 women and 7 men ) with a mean age of 74 years ( range , 56 - 88 years ) who sustained 4-part fractures of the proximal humerus and were r and omly allocated to 2 different groups regarding the type of prosthesis . The 2 systems used differ mainly in the type of fixation of the tuberosities . In group 1 ( EPOCA ) , the fixation was achieved with wire cables through a medial and a lateral hole in the stem , whereas in group 2 ( HAS ) , the fixation was performed by use of transosseous braided sutures . After a follow-up of 1 year , the functional and radiographic outcomes were evaluated . The retrieved data demonstrate that rigid fixation and anatomic positioning of the tuberosities ( group 1 ) increase the rate of bony healing superior to all other factors . There was a statistically significant difference regarding the relative individual Constant score ( P = .001 ) and the mean active range of motion ( flexion , P < .001 ; abduction , P = .001 ; external rotation in adduction , P = .01 ; and external rotation in 90 degrees abduction , P = .001 ) when both groups were compared , showing a better outcome in the EPOCA group for all parameters . Radiologic findings , like heterotopic ossification , glenoid erosion , or subluxation , had no significant influence on the outcome in this study . Accurate placement of the tuberosities and healing at the bone-bone interface of the rotator cuff seem to be the most important factors influencing the outcome in prosthetic care of fractures PURPOSE The aim of this study was to evaluate , prospect ively , outcomes following arthroscopic Bankart repair performed with 2 types of suture anchor -- the G II ( DePuy Mitek , Raynham , MA ) nonabsorbable anchor and the Panalok ( DePuy Mitek ) absorbable anchor . METHODS Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder who were seen in a single unit between April of 2000 and June of 2003 were considered for inclusion in the study . Patients were assessed preoperatively and postoperatively by means of a subjective , patient-related outcome measurement tool ( Oxford Instability Score ) , a visual analogue scale for pain and instability ( VAS Pain and VAS Instability ) , and a quality -of-life question naire ( Short Form-12 [ SF-12 ] ) . Length of follow-up was 1.5 to 5 years ( mean , 2.6 y ) . The incidence of recurrent instability and the level of sporting ability were recorded . Patients were r and omized to undergo surgical repair with nonabsorbable or absorbable anchors . RESULTS A total of 130 patients were included in this study , of whom 6 were lost to follow-up ; therefore 124 patients ( 95 % ) completed the study . Both types of anchor were highly effective . No differences in rate of recurrence or in any of the scores were noted between the 2 groups . In all , 4 patients in the nonabsorbable group and 3 in the absorbable group experienced additional episodes of dislocation after a traumatic event . Rate of redislocation in the whole series was therefore 6 % . In addition , 4 patients , all of them from the absorbable group ( 4 % ) , described ongoing symptoms of instability but no true dislocations . In all , 85 % of the patient group have returned to their previous level of sporting activity . CONCLUSIONS No differences in outcomes of arthroscopic Bankart repair were seen whether absorbable or nonabsorbable anchors were used . Both are highly effective , with a redislocation rate of 6 % . LEVEL OF EVIDENCE Level I , therapeutic r and omized controlled trial BACKGROUND The literature comparing open and arthroscopic repair for glenohumeral instability is conflicting . We performed a prospect i ve , expertise-based , r and omized clinical trial to compare open shoulder stabilization with arthroscopic shoulder stabilization by measuring quality -of-life outcomes and recurrence rates at two years among patients treated for traumatic anterior shoulder instability . METHODS Computer-generated , variable-block-size , concealed r and omization allocated 196 patients to either the open-repair group ( n = 98 ) or the arthroscopic-repair group ( n = 98 ) . An expertise-based r and omization design was employed to avoid a differential bias in terms of physician experience . Outcomes were measured at baseline , at three and six months postoperatively , and at one and two years postoperatively with use of the Western Ontario Shoulder Instability Index ( WOSI ) and the American Shoulder and Elbow Surgeons ( ASES ) functional outcome scale . Recurrent instability was also analyzed . RESULTS There were no significant differences in outcome scores at baseline . At two years , seventy-nine patients in the open group and eighty-three patients in the arthroscopic group were available for follow-up . There was no significant difference in mean WOSI scores between the groups ; the mean WOSI score ( and st and ard deviation ) for the open group was 85.2 ± 20.4 ( 95 % confidence interval [ CI ] = 80.5 to 89.8 ) , and for the arthroscopic group , 81.9 ± 19.8 ( 95 % CI = 77.4 to 86.4 ) ; p = 0.31 . There was also no significant difference in mean ASES scores : 91.4 ± 12.7 ( 95 % CI = 88.5 to 94.4 ) for the open group and 88.2 ± 15.9 ( 95 % CI = 84.6 to 91.8 ) for the arthroscopic group ; p = 0.17 . Recurrence rates at two years were significantly different : 11 % in the open group and 23 % in the arthroscopic group ( p = 0.05 ) . Recurrent instability was more likely in patients with a preoperative Hill-Sachs lesion and in male patients who were twenty-five years old and younger . There was no significant difference in shoulder motion between the groups at two years . CONCLUSIONS There was no difference between open and arthroscopic repair in terms of patient quality of life . Open repair result ed in a significantly lower risk of recurrence . Secondary outcome data from this trial suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hill-Sachs lesion Complex fracture-dislocations of the elbow can often be either irreducible or unstable , with an inability to hold the reduction or with the delayed development of subluxation or dislocation . The aim of the present study was to evaluate the etiology of the instability , both osseous and ligamentous , and the results of stabilization with a combination of internal fixation , ligament repair , radial head arthroplasty and , when necessary , hinged external fixation . Figures 1 and 2 represent our formulated protocol and treatment algorithm for elbow fracture-dislocation in this series of thirty-two patients . Fig. 1 Constellation of the “ terrible triad ” injury and the anatomic structures encountered . LUCL = lateral ulnar collateral ligament , and MUCL = medial ulnar collateral ligament . The so-called terrible triad injury has a history of complicated outcomes as the surgeon attempts to maximize functional range-of-motion goals while maintaining stability1 - 3 . On the basis of previous evaluations of these specific injuries and the recent evolution of surgical protocol s , the restoration of congruency and stability coupled with progressive rehabilitation can reliably enhance the functional outcome 4 - 6 . Thirty-two consecutive patients with unstable elbow injuries who had been referred to three tertiary centers were prospect ively recruited for the present study between 2001 and 2005 . Six of these patients had been unsuccessfully managed at outside facilities and had been transferred to our care . The unsuccessful treatments had included attempted closed reduction ( four patients ) , radial head excision ( one patient ) , and open reduction and internal fixation of the proximal part of the ulna ( one patient ) . Fig. 2 Treatment algorithm proposed for the achievement of anatomic fixation and mechanical stability in patients with complex fracture-dislocations of the elbow . EUA = examination under anesthesia , MUCL = medial ulnar collateral ligament , LUCL = lateral ulnar collateral ligament , P/L = posterolateral stability , and ORIF = open reduction and internal fixation . All The purpose of this prospect i ve study was to evaluate the results of simultaneous anterior cruciate ligament ( ACL ) reconstruction and osteochondral autograft transplantation performed in patients suffering an anterior instability associated with symptomatic full-thickness cartilage defects . Our clinical report includes the first 21 patients ( six women , 15 men ) who have been followed up for 32 months or longer . The average patient age was 29 years ( range 22–44 years ) , and mean time from injury to the combined reconstructive surgery was 10 months ( range 4–27 months ) . The cartilage defects had a mean area of 3.5 cm2 ( range 2.0–5.0 cm2 ) . All patients were evaluated according to the IKDC , Lysholm and Tegner scoring scales by an independent observer . A visual analogue scale ( VAS ) reflecting patient pain was evaluated . Assessment using the IKDC knee scoring scale revealed 81 % of the patients with a normal or nearly normal knee joint . There was a significant improvement in subjective discomfort , and the KT-1000 arthrometric evaluation showed a reduction of the ventral tibial translation ( 5.9 to 1.9 mm ) . All but two patients had returned to full activities without restriction and were asymptomatic . The results of this study suggest that symptomatic full-thickness articular cartilage defects associated with ACL instability can be effectively treated by performing ACL reconstruction and osteochondral autologous grafts in one procedure . However , only the years which follow will show the long-term outcome of the patients Context : It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair . Objective : The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability . Study Design : Systematic review of level I and II studies . Data Sources : PubMed , EMBASE , the Cochrane Data base of Systematic Review s , and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria . Study Selection : Inclusion criteria were English- language level I or level II trials involving the treatment of recurrent anterior shoulder instability . Exclusion criteria included non-English- language studies ; level III , IV , or V studies ; and trials examining treatment of first-time shoulder dislocation , posterior shoulder dislocation , or diagnoses other than recurrent anterior shoulder dislocations . Data Extraction : Included studies underwent quality appraisal independently by each author identifying strengths , weaknesses , and biases . Results : Four r and omized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations .  These studies show no statistically significant difference between the 2 operative approaches . No long-term follow-up data describing the effects of either surgical approach are available at this time . Each investigation had weaknesses in study design that decreased the validity of its findings . Conclusions : While limited , the available evidence from r and omized controlled trials does not show a statistically significant difference in redislocation rates , return to activity , and functional outcomes between the arthroscopic and open repair groups . Range of motion is marginally better following arthroscopic treatment when compared with open repair . Recommendations on the optimal surgical intervention can not be provided BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures BACKGROUND There is no consensus on what type of arthroplasty is best for the treatment of complex proximal humeral fractures in elderly patients . The purpose of this prospect i ve study was to compare the outcomes of reverse shoulder arthroplasty ( RSA ) and hemiarthroplasty ( HA ) . METHODS Sixty-two patients older than 70 years were r and omized to RSA  ( 31 patients ) and HA  ( 31 patients ) . One HA patient died at 1 year , and she was excluded . The mean follow-up was 28.5 months ( range , 24 - 49 months ) . RESULTS Compared with HA patients , RSA patients had significantly higher ( P = .001 ) mean University of California-Los Angeles ( 29.1 vs 21.1 ) and Constant ( 56.1 vs 40.0 ) scores , forward elevation ( 120.3 ° vs 79.8 ° ) , and abduction ( 112.9 ° vs 78.7 ° ) but no difference in internal rotation ( 2.7 ° vs 2.6 ° ; P = .91 ) . The Disabilities of the Arm , Shoulder , and H and score was higher in the HA patients ( 17 vs 29 ; P = .001 ) . In the HA group , 56.6 % of tuberosities healed and 30 % resorbed . Patients with failure of tuberosities had significantly worse functional outcomes . There were 2 complications ( intraoperative humeral fracture and superficial infection ) . One patient was manipulated under general anesthesia because of postoperative stiffness . Six patients with HA  had proximal migration that required revision to RSA . In the RSA group , 64.5 % of tuberosities healed and 13.2 % resorbed . Functional outcome was irrespective of healing of the tuberosities . Notching was observed in only 1 RSA patient . One patient developed a hematoma and another a deep infection requiring a 2-stage revision to another RSA . CONCLUSION RSA result ed in better pain and function and lower revision rate . Revision from HA to RSA does not appear to improve outcomes Background A concern regarding  reverse shoulder arthroplasty ( RSA )  is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty . Questions / purpose sWe determined ( 1 ) the rate of instability and infection ; ( 2 ) whether diagnosis influenced instability and infection rates ; and ( 3 ) whether these complications affect ASES , Constant , and WOOS scores after RSA . Methods A prospect i ve data base , clinical charts , and radiographs of 284 patients who had undergone primary ( n = 212 patients ) or revision ( n = 72 patients ) RSA  were review ed to identify patients whose postoperative course was complicated by instability or infection . Results The rate of instability was similar in patients with primary ( eleven of 212 [ 5 % ) ] and revision ( six of 72 [ 8 % ] ) reverse arthroplasty . The rate of infection was higher in the revision ( five of 72 [ 7 % ] ) than in the primary ( three of 212 [ 1 % ] ) group . Patients with an irreparable subscapularis tendon had a higher rate of instability ( 14 of 123 [ 12 % ] ) compared with patients with a repairable subscapularis tendon ( one of 161 [ less than 1 % ] ) . The fracture sequelae group had the highest rate of instability ( seven of 25 [ 28 % ] ) among diagnoses within the primary group . The rates of infection were similar between the diagnoses within the primary group . The improvements in the ASES score , the Constant score , and the WOOS score from preoperatively to postoperatively were better in the no instability/infection group as compared with the instability/infection group . Conclusions This information confirms the available literature allowing surgeons to give patients realistic expectations regarding the infection and instability rates after RSA.Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND This prospect i ve longitudinal study compared clinical and radiologic outcomes of  total shoulder arthroplasty ( TSA )  using 3 different prosthetic design s , the Neer II system , the Bigliani-Flatow ( BF ) , and a stemless prosthesis , the Total Evolutive Shoulder System ( TESS ) . MATERIAL S AND METHODS Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA  were followed up for 2 years . Four patient-oriented disability outcomes were used . The clinical data collected before surgery and at follow-up assessment s during a 2-year period included active range of motion ( ROM ) in 6 directions and strength . Radiographic signs of glenoid and humeral component loosening were recorded . The incidence of humeral head subluxation was documented . RESULTS Seventy-four patients completed the study . There was a significant improvement in the 4 disability measures , ROM , and strength at 2 years in all 3 groups ( P < .0001 ) . Active external rotation at 90 ° abduction was statistically significantly lower in the Neer II group ( P = .001 ) . The incidence of lucent lines around the glenoid component was higher in the Neer II group ( P = .0002 ) . No statistically significant relationship was seen between type of prosthesis and patient satisfaction ( P > 0.05 ) . CONCLUSIONS The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction . The Neer II was associated with less active external rotation and more lucent lines Background No quantitative data on glenohumeral translation exist allowing one to distinguish insufficiency of the active or passive stabilizers in different forms of shoulder instability . Hypothesis To determine whether 1 ) in traumatic or atraumatic shoulder instability an increase of glenohumeral translation can be observed in specific relevant arm positions , 2 ) muscle activity leads to recentering of the humeral head , and 3 ) there exist differences between traumatic and atraumatic instability . Study Design Prospect i ve clinical trial . Methods In 12 patients with traumatic and 10 patients with atraumatic instability , both shoulders  were examined in different arm positions — with and without muscle activity — by using open magnetic resonance imaging and a three-dimensional postprocessing technique . Results At 90 ° of abduction and external rotation , translation ( anterior-inferior ) was significantly higher in patients with traumatic unstable shoulders compared with their contralateral side ( 3.6 ± 1.5 versus 0.7 ± 1.6 mm ) . In patients with atraumatic instability , significantly increased translation ( 4.7 ± 2.0 mm ) was observed , with the direction being nonuniform . Muscle activity led to significant recentering in traumatic but not in atraumatic instability . Conclusions In traumatic instability , increased translation was observed only in functionally important arm positions , whereas intact active stabilizers demonstrate sufficient recentering . In atraumatic instability , a de central ized head position was recorded also during muscle activity , suggesting alterations of the active stabilizers . Clinical Relevance Clinical Relevance : These data are relevant for optimizing diagnostics and therapeutic strategies BACKGROUND Treatment of complex three and four-part proximal humeral fractures with  hemiarthroplasty in elderly patients has yielded mixed clinical results . Reverse shoulder arthroplasty has emerged as a treatment option for comminuted proximal humeral fractures for these patients . The purpose of the study was to perform a prospect i ve evaluation of patient outcomes comparing hemiarthroplasty and reverse shoulder arthroplasty for the treatment of comminuted proximal humeral fractures in elderly patients . METHODS Fifty-three consecutive elderly patients ( average age , 74.4 years ) underwent an arthroplasty for a complex proximal humeral fracture . Indications for arthroplasty were four-part fractures , three-part fractures with severe comminution of the greater tuberosity , and fractures that involved an articular split of the humeral head . Twenty-six patients underwent hemiarthroplasty ( the HA group ) , followed by twenty-seven patients who underwent reverse shoulder arthroplasty ( the RSA group ) . A total of forty-seven patients ( twenty-three in the HA group and twenty-four in the RSA group ) were available for follow-up at a minimum of two years . RESULTS Final average outcome scores were lower in the HA group than in the RSA group ( American Shoulder and Elbow Surgeons [ ASES ] score of 62 versus 77 [ p = 0.0001 ] and Simple Shoulder Test [ SST ] of 5.8 versus 7.4 [ p = 0.0062 ] ) , and patient-reported satisfaction was lower in the HA group than in the RSA group ( 61 % versus 91 % ; p = 0.038 ) . Radiographic healing of the tuberosities occurred in 61 % of the patients in the HA group compared with 83 % of the patients in the RSA group ( p = 0.17 ) . Forward elevation of the arm was higher in the RSA group ( 139 ° ) than in the HA group ( 100 ° ) ( p = 0.0002 ) , but no significant differences were observed for shoulder external rotation or internal rotation . Complication rates in both groups were similar . Three patients ( 13 % ) in the HA group elected revision to reverse shoulder arthroplasty because of failed tuberosity healing and result ant shoulder pseudoparesis . CONCLUSIONS In this series , reverse shoulder arthroplasty result ed in better clinical outcomes and a similar complication rate compared with hemiarthroplasty for the treatment of comminuted proximal humeral fractures in the elderly BACKGROUND Traditional total shoulder arthroplasty ( TSA ) involves releasing the subscapularis tendon for exposure . This can potentially lead to subscapularis insufficiency , compromised function , and dissatisfaction . A novel TSA technique preserves the subscapularis tendon by performing the procedure entirely through the rotator interval , allowing accelerated rehabilitation . However , early reports on this approach have noted malpositioning of the humeral component and residual osteophytes . In a r and omized trial , we examined the incidence of humeral head malpositioning , incorrect sizing , and residual osteophytes on postoperative radiographs after subscapularis-sparing TSA  compared with the traditional approach . METHODS Patients were prospect ively r and omized to undergo TSA performed through the traditional or subscapularis-sparing approach .  The operating surgeon was blinded to the r and omization until the day of surgery . Anatomic reconstruction measurements included humeral head height , humeral head centering , humeral head medial offset , humeral head diameter ( HHD ) , and head-neck angle . Two independent review ers analyzed the postoperative radiographs to determine anatomic restoration of the humeral head and the presence of residual osteophytes . RESULTS We r and omized 96 patients to undergo either the st and ard approach ( n = 50 ) or the subscapularis-sparing approach ( n = 46 ) . There were no significant differences in humeral head height , humeral head centering , humeral head medial offset , HHD , head-neck angle , and anatomic reconstruction index between the 2 groups . However , significantly more postoperative osteophytes ( P = .0001 ) were noted in the subscapularis-sparing TSA group . Although the overall mean was not statistically different , further analysis of HHD showed that more patients in the subscapularis-sparing TSA group were outliers ( mismatch > 4 mm ) than in the traditional TSA group . CONCLUSIONS Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing TSA , retained osteophytes and significant mismatch of the HHD raise concerns regarding long-term outcomes Background : Sixty-three consecutive patients with recurrent traumatic anterior shoulder instability underwent  operative repair . The decision to select either arthroscopic Bankart repair or open capsular shift was based on the findings of an examination under anesthesia and the findings at the time of arthroscopy . Thirty-nine patients with only anterior translation on examination under anesthesia and a discrete Bankart lesion underwent arthroscopic Bankart repair with use of absorbable transfixing implants .  Twenty-four patients with inferior translation in addition to anterior translation on examination under anesthesia and capsular laxity or injury on arthroscopy underwent an open capsular shift . Methods : Treatment outcomes for each group were determined according to the scoring systems of Rowe et al. , the American Shoulder and Elbow Surgeons , and the Short Form-36 . Failure was defined as recurrence of dislocation or subluxation or the finding of apprehension .  Fifty-nine ( 94 percent ) of the sixty-three patients were examined and filled out a question naire at a mean of fifty-four months ( range , twenty-seven to seventy-two months ) following surgery . Results : There were no significant differences between the two groups with regard to the prevalence of failure or any of the other measured parameters of outcome . An unsatisfactory outcome occurred after nine ( 24 percent ) of thirty-seven arthroscopic repairs and after four ( 18 percent ) of twenty-two open reconstructions . All cases of recurrent instability result ed from a reinjury in a contact sport or a fall less than two years postoperatively . The treatment groups did not differ with regard to patient age , h and dominance , mechanism of initial injury , duration of follow-up , or delay until surgery . Measured losses of motion were minimal and , with the exception of forward elevation , slightly more of which was lost after the open capsular shifts ( p = 0.05 ) , did not differ between the two forms of treatment . Approximately 75 percent of the patients in each group returned to their favorite recreational sports with no or mild limitations . As rated by the patients , the result was good or excellent after thirty-one ( 84 percent ) of the arthroscopic procedures and after twenty ( 91 percent ) of the open procedures . Conclusions : Arthroscopic and open repair techniques for the treatment of recurrent traumatic shoulder instability yield comparable results if the procedure is selected on the basis of the pathological findings at the time of surgery
Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis ; however , the difference is not statistically significant .
When reverse shoulder arthroplasties ( RSA ) were considered as a subgroup and compared to anatomic shoulder replacements ( total shoulders and hemiarthroplasties ) , they showed a lower revision rate
Chronic anterior glenohumeral joint instability is a common situation and can lead to progressive cartilage deterioration and ultimately instability arthopathy .
Progressive cartilage deterioration can occur despite conservative or surgical treatment and the sequelae of these conditions are often addressed with total shoulder arthroplasty .
Aims of the present study were to analyze the available literature to describe the technical aspects of this particular operation and to report outcomes and complication rates .
The hypothesis was that shoulder arthropalsty in the sequelae of instability had lower outcomes and higher complication rates than arthroplasties for primary arthritis .
Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology .