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Study Shows iTSA Surgery Improves Function, Reduces Pain Among Patients with Advanced Glenohumeral Arthritis

Baptist Health Miami Orthopedics & Sports Medicine Institute found anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid replacement results in improved function and less pain for patients with advanced glenohumeral arthritis.

Published in JSES International, the treatment study followed 36 patients who had inlay total shoulder arthroplasty (iTSA). The new treatment option is intended for patients with advanced glenohumeral arthritis who need primary shoulder reconstruction. Compared to stemless, stemmed, or reverse TSA, bone stock in the proximal humerus is preserved, the nonspherical shape is maintained, and the glenoid joint line is not lateralized. The implant combination aims for anatomic reapproximation on both sides of the joint.

While results from partial humeral inlay arthroplasty have been reported, clinical evidence on the combination of nonspherical humeral head (HH) and inlay glenoid replacement was limited. The Baptist Health Miami Orthopedic & Sports Medicine Institute study sought to quantify patient outcomes, including pain, range of motion, and satisfaction at various intervals after iTSA surgery.

“The goal was to determine absolute and relative improvements on patient reported outcomes and range of motion and assess postoperative changes using various sensitivity analyses,” Dr. John Uribe and authors wrote.

Dr. John Uribe

Dr. John Uribe

Of the 36 patients who participated, three had bilateral iTSA for a total of 39 shoulders included in the study. Surgical technique, implant manufacturer, hospital length of stay (< 23 hours) and rehabilitation protocols were the same for each patient. Patient reported outcomes (PROs) were collected preoperatively, at four to six weeks, and at three, six,12, and 24 months postoperatively, and annually thereafter.

Each patient level of glenohumeral arthritis was staged preoperatively using the Samilson-Prieto Classification. Most were grade 3 (37) while two were grade 2. Glenoids were assessed on axillary radiographs according to the original Walch classification.

Following surgery, PROs were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder assessment form (ASES) and a Visual Analog Scale for Pain (VAS-Pain). An independent observer measured active forward elevation (FE) and external rotation (ER).

  • The lower bound of the confidence interval for mean ASES scores was above the Minimal Clinically Important Difference (MCID) threshold starting three months postoperatively, and above or at Substantial Clinical Benefits (SCB) threshold levels from 6 to 41 months.
  • Patients reported substantial pain relief at one month after the procedure and continued to report improvement during the first six months after surgery. At the last follow-up, pain scores were comparable to results reported by stemmed TSA.
  • Range of motion improvement varied, depending on patients’ preoperative status. The group with the lowest ROM preoperatively saw the largest mean improvement of 42.5 degrees in external rotation and 68.3 degrees in forward elevation.
  • Patients had an average blood loss of 102 ml compared to 593 ml in a group of patients who had stemmed TSA.

No implants were revised during the 41-month study period, nor was there evidence of periprosthetic radiolucency and component failure defined as loss of humeral taper connection, implant dislocation, glenoid fracture, and glenoid component dislocation on postoperative radiographs. One patient did develop arthrofibrosis two years after surgery, which was treated with arthroscopic lysis of adhesions, and one patient developed a small nonunion glenoid rim fracture that was managed conservatively.

“Initial results provide further support for this new option in primary shoulder replacement,” Dr. Uribe and team wrote in the paper. “Treatment with inlay total shoulder arthroplasty demonstrated significant functional improvement, excellent pain relief, and patient satisfaction in patients with advanced shoulder arthritis and various glenoid morphology types.”

Baptist Health Miami Orthopedics & Sports Medicine Institute is committed to providing innovative treatments and pioneering research. Comprised of highly specialized, board-certified and fellowship-trained orthopedic physicians, the Institute leverages the power of Baptist Health’s expert clinicians, compassionate caregivers and leading-edge technology.

About Baptist Health Miami Orthopedics & Sports Medicine Institute

Miami Orthopedics & Sports Medicine Institute offers comprehensive services for athletes and non-athletes – from physical and cognitive evaluation to rehabilitation and surgical reconstruction. The Institute is the sports medicine provider for the Miami Dolphins, Miami HEAT, Florida Panthers, Florida International University athletics, Orange Bowl, Miami Open Tennis, Miami Marathon and Half Marathon and Miami-Dade County Public Schools.

Miami Orthopedics & Sports Medicine Institute is part of Baptist Health South Florida, the largest healthcare organization in the region, with 11 hospitals, more than 23,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. In addition, it includes Baptist Health Medical Group; Baptist Health Quality Network; and Baptist Health Care On Demand, a virtual health platform. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World’s Most Ethical Companies.

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