Shoulder Arthrodesis Long Term follow-up

Current Research

Shoulder Arthrodesis Long Term follow-up

Background    

An uncommon and technically complex procedure, long term results of shoulder fusion remain scarce.

Colloquially known as “shoulder fusion,” gleno-humeral arthrodesis is a procedure in which the proximal end of the humerus is fused to the glenoid surface of the scapula in order to eliminate all motion of this joint. Despite resultant restriction, patients with good motor control can still achieve around one third of normal shoulder range of motion because the scapula-thoracic motion is left intact.

Reverse shoulder arthroplasty has successfully replaced many situations where fusion was historically indicated including resection arthroplasty, failed conventional arthroplasty, rotator cuff arthropathy and recurrent intractable instability. Despite such progress, fusion remains the only valid option for other indications. Following brachial plexus injuries for example, fusion helps patients regain the ability to position their hand in space and prevents dislocation due to decreased muscular tone. It is also useful in conditions where the use of prosthetic implants is precluded, such as native or chronic prosthetic joint infection, and young high-demand patients with advanced destruction of the gleno-humeral joint[1–3].

Because shoulder fusion is an uncommon and technically complex procedure, literature remains scarce and consists mostly of technical notes[4,5], short patient series[1,6,7], or reports of short to mid-term follow-up[2]. Only two studies describe long-term results, with varying operative techniques[3] or a limited study group[8]. As patients tend to be relatively young at the time of operation, long-term results are critical to further establish both the benefits of this procedure and occurrence of overuse complications which are often underreported.

This study aims to analyse long-term outcomes and complications in patients who underwent shoulder fusion by a single surgeon in a single centre, in order to improve patient information on their expected long-term function. Moreover, it aims to provide guidance to surgeons regarding the optimal position for this procedure, something which remains debated[9].

Objectives

The primary objective of this study is to evaluate the long term results of shoulder arthrodesis. The hypothesis is that long term outcome of shoulder arthrodesis is still satisfactory despite overuse degeneration of adjacent joints, notably the acromioclavicular and sternoclavicular joints.

The primary outcome is to evaluate long term function of patients who underwent glenohumeral arthrodesis by assessing self-reported range of motion and well established subjective outcome scores including pain VAS, SSV, and Oxford score, as well as a questionnaire locating any pain related to overuse of adjacent joints, such as the acromioclavicular and sternoclavicular joints.

The secondary outcome measure will be a clinical and radiological exam for patients available for a consultation. This will allow in-depth assessment of their clinical function and additional radiographic information concerning quality of bone fusion, hardware migration, definitive hummer-scapular angle and degeneration of the aforementioned adjacent joints.

Design

This is an observational non-comparative retrospective study of approximately 40 patients.

Study Procedure

Shoulder function of patients will be assessed via self-evaluation questionnaires and well-established subjective shoulder scores. If willing to participate and travel, patients will also be called back for a 45 minute clinical and radiological follow up at the Orthopaedic Clinic at Royal North Shore Hospital.

Inclusion Criteria

  • Patients who underwent a gleno-humeral fusion procedure by a single surgeon (Prof Sonnabend) with a minimum follow-up of 1 year will be considered as potentially eligible for this study.

Exclusion Criteria

  • Patients incapable of giving informed consent to participate in this study

Statistical Procedure

As this will be an observational non-comparative study, only limited statistical considerations will be necessary. Therefore, the planned sample size of 40 patients (representing the number of patients who underwent shoulder arthrodesis by Prof Sonnabend) will be sufficient for relevant observations. For baseline characteristics, variables will be reported as mean± standard deviation and median (range) for continuous variables, and proportions for categorical variables. P values < 0.05 will be considered statistically significant. All data will be entered into a spreadsheet. 

Ethics and Governance

Approved by the Northern Sydney Local Health District Human Research Ethics Committee to be undertaken at the Mater Hospital Sydney. HREC reference LNR/16/HAWKE/108.

Status

Patient follow up has begun. Results should be available in 2017.

References

  • Thangarajah, T., Alexander, S., Bayley, I. & Lambert, S. M. Glenohumeral arthrodesis for the treatment of recurrent shoulder instability in epileptic patients. Bone Jt. J. 96, 1525–1529 (2014).
  • Atlan, F. et al. Functional Outcome of Glenohumeral Fusion in Brachial Plexus Palsy: A Report of 54 Cases. J. Hand Surg. 37, 683–688 (2012).
  • Cofield, R. H. & Briggs, B. T. Glenohumeral arthrodesis. Operative and long-term functional results. J Bone Jt. Surg Am 61, 668–677 (1979).
  • Lädermann, A. & Denard, P. J. Arthroscopic Glenohumeral Arthrodesis With O-Arm Navigation. Arthrosc. Tech. 3, e205–e209 (2014).
  • Padiolleau, G., Marchand, J. B., Odri, G. A., Hamel, A. & Gouin, F. Scapulo-humeral arthrodesis using a pedicled scapular pillar graft following resection of the proximal humerus. Orthop. Traumatol. Surg. Res. 100, 181–185 (2014).
  • Alta, T. D. W. & Willems, W. J. Once an arthrodesis, always an arthrodesis? J. Shoulder Elbow Surg. 25, 232–237 (2016).
  • Porcellini, G., Savoie, F. H., Campi, F., Merolla, G. & Paladini, P. Arthroscopically Assisted Shoulder Arthrodesis: Is It an Effective Technique? Arthrosc. J. Arthrosc. Relat. Surg. 30, 1550–1556 (2014).
  • Dimmen, S. & Madsen, J. E. Long-term outcome of shoulder arthrodesis performed with plate fixation: 18 patients examined after 3–15 years. Acta Orthop. 78, 827–833 (2007).
  • Sousa, R. et al. Shoulder arthrodesis in adult brachial plexus injury: what is the optimal position? J. Hand Surg. Eur. Vol. 36, 541–547 (2011).
  • Cunningham, G., Lädermann, A., Denard, P. J., Kherad, O. & Burkhart, S. S. Correlation Between American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation Score After Rotator Cuff or SLAP Repair. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 31, 1688–1692 (2015).
  • Carter, C. W., Levine, W. N., Kleweno, C. P., Bigliani, L. U. & Ahmad, C. S. Assessment of shoulder range of motion: introduction of a novel patient self-assessment tool. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 24, 712–717 (2008).
  • National Statement on Ethical Conduct in Human Research (2007) – Updated December 2013 (the National Statement), Commonwealth of Australia, Canberra.

Lead Investigator:

Prof David Sonnabend

Commenced:

May 2016

Category:

Current Research

{Updated November 2016}

The VAULT Study (Reliability of Glenoid Version Measurement on 3D-corrected axial CT scan)
In Research - Current

Humeral Head to Greater Tuberosity Angle Study

The VAULT Study - Glenoid Version Measurement
In Research - Current

The VAULT Study – Glenoid Version Measurement

The FUSE Study (Fitness band Used in Shoulder Evaluation)
In Research - Current

The FUSE Study – Fitness band Used in Shoulder Evaluation

TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty
In Research - Current

The TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty)

In Research - Current

Shoulder Arthrodesis Long Term follow-up

In Research - Current

The TXA 2 Study (Systemic Tranexamic Acid in Shoulder Arthroscopy and Rotator Cuff Repair)