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Biomedical subjects

John W Sperling

Publications and source records attributed to John W Sperling.

At least 19 recordsLinked to original sources
PubMed2007

Outcomes of shoulder arthroplasty in Olmsted County, Minnesota: a population-based study.

Most studies on shoulder arthroplasty include a diverse group of patients presenting to a tertiary care center. Little information is available regarding outcomes in a community setting. We reviewed 98 residents (110 shoulders) of Olmsted County, Minnesota who had shoulder arthroplasties from 1976 to 2000. There were 65 total shoulder arthroplasties and 45 humeral head replacements. The most common indications were osteoarthritis for total shoulder arthroplasties (48/65) and acute fracture for hemiarthroplasties (27/45). The Neer ratings were excellent or satisfactory in 92% of total shoulder arthroplasties and 56% of hemiarthroplasties. The 10-year survival rate was 96%. The mean postoperative active forward elevation was greater in patients who had a total shoulder arthroplasty (132 degrees) compared with a hemiarthroplasty (113 degrees), as was external rotation (total shoulder arthroplasties = 58 degrees, humeral head replacements = 38 degrees). The outcomes for total shoulder arthroplasty and hemiarthroplasty compared favorably with outcomes reported in the literature. There was a high rate of satisfactory or excellent results after total shoulder arthroplasty for osteoarthritis. Hemiarthroplasty offered less satisfactory results, most likely related to the use of this procedure for trauma. This information will assist the community surgeon in counseling patients and weighing the risks and benefits of a shoulder arthroplasty.

Adult↗
PubMed2006

The effect of glenoid component size on the stability of total shoulder arthroplasty.

Frequently, during the course of total shoulder arthroplasty, the measurement of the patient's native glenoid is between the available prosthetic glenoid sizes. Technically, it may be easier for the surgeon to implant a smaller glenoid component. Currently, there is no information regarding the difference in joint stability by use of glenoid components of different sizes. Stability ratio measurements were performed by use of a multiaxis testing machine with 3 different glenoid sizes (small, medium, and large) and compared by use of analysis of variance and the Tukey HSD test. Changes in the size of the glenoid component were found to have a significant effect on the stability ratio. At a load of 50 N, the stability ratio increased by 18% from the small to the medium glenoid component and by 15% from the medium to the large glenoid in the superoinferior axis. In the anteroposterior axis, the stability ratio increased by 17% from small to medium and by 10% from medium to large. The results from this study indicate a modest increase in stability when one chooses the larger of the 2 glenoid components.

Arthroplasty, Replacement↗
PubMed2006

Early complications of operatively treated proximal humeral fractures.

Minimal information exists regarding early complications after operatively treated proximal humeral fractures. Of the 82 shoulders that had osteosynthesis, 42 had a (nonmedical) complication, with 21 requiring further surgery. Of 42 shoulders with complications, 12 were related to incomplete reduction, 16 had loss of anatomic fracture fixation, 9 had delayed healing, 3 had an infection, 1 had rotator cuff failure, and 1 had loose bodies. Fixed-angle plates had lower rates of initial malpositioning and resultant malunion. Of the 22 shoulders requiring hemiarthroplasty, 14 had an early complication. Of these, 7 had complications relating to implant insertion or tuberosity malreduction at the index operation and 7 had problems with tuberosity healing. The rate of complications after operative treatment of proximal humeral fractures is high. All efforts at fracture fragment fixation with osteosynthesis and hemiarthroplasty should be directed at obtaining anatomic fracture fixation that resists displacement.

Adult↗
PubMed2006

Arthroscopic rotator cuff debridement in patients with rheumatoid arthritis.

There is little information available concerning the results of rotator cuff debridement in patients with rheumatoid arthritis (RA). We performed a review of 16 shoulders with underlying RA that underwent arthroscopic rotator cuff tear debridement; there were 10 full-thickness tears and 6 partial-thickness tears. Of the 10 patients with full-thickness rotator cuff tears, 8 had unsatisfactory results, whereas none of the patients with partial-thickness tears had unsatisfactory results. Pain was improved in 5 of 6 shoulders with partial-thickness cuff tears, whereas only 5 of 10 with full-thickness tears had an improvement with regard to pain. Motion did not improve in either group. Patients with RA who require operative intervention for pain relief because of rotator cuff tearing can be treated successfully with debridement alone. However, pain relief was less predictable with large or massive tears when compared with partial-thickness tears, and functional gains were not achieved in either group.

Adult↗
PubMed2006

Surgical anatomy of the triceps brachii tendon: anatomical study and clinical correlation.

BACKGROUND: The triceps tendon has been described as a single unit with contribution from each of the 3 heads of the muscle. An observation at the time of surgical repair of a triceps tendon injury led to an anatomical study to further define the anatomy of this tendon as it inserts on the olecranon. HYPOTHESIS: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads. STUDY DESIGN: Descriptive laboratory study and case report. METHODS: Eight cadaveric elbows were dissected to examine the triceps tendon. None of the specimens had any evidence of prior injury or surgery to the elbow. All specimens were fresh-frozen and stored at -4 degrees C until they were thawed for use. Skin and subcutaneous tissue were removed, and the tendon of each head of the triceps was explored from the muscle to its bony insertion. RESULTS: In all 8 specimens, on gross inspection, the medial head had a separate insertion deep to the common insertion of the lateral and long heads. The muscle of the medial head extended further distally than did the long and lateral heads. The medial head was muscular to its deep insertion, with a small amount of tendon blended with the muscle distally. Histologic analysis demonstrated that the tendon of the medial head and that of the other 2 heads are confluent distally at their olecranon insertion. CONCLUSION: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads on gross inspection. Histologic studies show the insertion of these 2 tendons is confluent. CLINICAL RELEVANCE: This anatomy has important implications for surgical repair of these tendon injuries. Rupture of the deep triceps insertion alone can occur and lead to weakness of elbow extension with the elbow flexed beyond 90 degrees . Triceps strength should be tested with the elbow fully flexed when injury to the tendinous insertion is suspected.

Adult↗
PubMed2006

Double suture technique to delineate PASTA lesions.

A common method of treating PASTA (partial articular surface tendon avulsion) lesions involves completing the tear followed by arthroscopic repair. Frequently, the boundaries of the tear are difficult to determine from the bursal side with the use of a single marking stitch. Therefore, we describe a simple technique that allows the surgeon to reproducibly define the boundaries of the partial tear. Following a standard arthroscopic examination of the articular portion of the shoulder joint, the PASTA lesion is identified. A spinal needle is introduced and the most anterior and posterior aspects of the tear are marked by passing 2 sutures. Following a bursectomy, the 2 sutures that clearly define the boundaries of the tear are identified. The tear is then completed by "connecting the dots" outlined by the sutures and an arthroscopic repair is performed in the standard manner.

Arthroscopy↗
PubMed2006

Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis.

PURPOSE: Currently, there is little information available concerning the results of shoulder synovectomy in patients with rheumatoid arthritis. Furthermore, it remains difficult to assess the success of shoulder synovectomy because of a high association of rotator cuff tears in rheumatoid patients. We hypothesized that synovectomy in patients with a functionally intact rotator cuff would provide durable pain relief. TYPE OF STUDY: Case series. METHODS: Sixteen shoulders in 13 patients with rheumatoid arthritis were treated with arthroscopic shoulder synovectomy from 1988 to 2002 with a mean follow-up of 5.5 years. Patients with full-thickness rotator cuff tears or partial tears that required repair were excluded. Two of the 13 patients had been diagnosed with juvenile rheumatoid arthritis and 11 had adult-onset disease. The medical records of the patients were reviewed and patients were assessed clinically and by questionnaire to assess pain, satisfaction, range of motion, radiographic outcomes, and occurrence of complications. RESULTS: There was an improvement in pain at long-term follow-up in 13 of 16 patients (P < .001). Active shoulder elevation improved from a median of 145 degrees to 160 degrees but was not significant (P = .14). External rotation improved significantly (P = .01) from a median of 45 degrees (range, 0 degrees to 90 degrees) to 60 degrees (range, 0 degrees to 100 degrees). According to the Neer rating system, there were 5 excellent, 8 satisfactory, and 3 unsatisfactory results. Seven of 8 shoulders followed-up radiographically for more than 1 year showed radiographic progression of disease. All 3 patients reporting pain that was no better or worse than before surgery had radiographic arthrosis at last follow-up with advancing periarticular erosions and reduction of glenoid articular space. CONCLUSIONS: Arthroscopic synovectomy of the shoulder in patients with rheumatoid arthritis with an intact rotator cuff offers a reliable decrease in pain with less predictable improvements in range of motion. Limitations in predicting final results based on preoperative radiographs should be discussed with patients; those with more advanced radiographic changes may not benefit from the procedure. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series, no control group.

Arthritis, Rheumatoid↗
PubMed2006

Case reports: Shoulder arthroplasty in transplant recipients: a report of five cases.

The fate of shoulder arthroplasties in transplant recipients is unknown but potential concerns include the immunocompromised state and inferior bone quality of these patients. We retrospectively reviewed five shoulder arthroplasties performed from January 1, 1985 to December 31, 2001 in four patients who previously had transplant surgery. All patients were followed up for a minimum of 2 years (mean, 5.4 years). The results were graded according to a modified Neer result rating system. There were four excellent results and one satisfactory result. There were no intraoperative complications, infections, or revisions. In this limited group of patients the results of shoulder arthroplasty after transplantation were satisfactory.

Adult↗
PubMed2006

Patient and physician-assessed shoulder function after arthroplasty.

BACKGROUND: We found no information in the literature regarding the relationship between patient and physician-derived outcome assessments with a shoulder questionnaire. In this study, we examined a group of patients who were assessed with patient and physician-administered questionnaires following shoulder arthroplasty. METHODS: From August 2003 to February 2004, sixty-seven consecutive patients who had been followed for a minimum of six months after shoulder arthroplasty were evaluated with a self-administered and an identical physician-directed shoulder questionnaire that assessed clinical and functional outcomes at the time of routine follow-up. An assessment of the agreement between physicians and patients as well as the factors that affected agreement was performed. RESULTS: The intraclass correlation indicated almost perfect physician-patient agreement (>0.80) on items related to overall pain, pain at night, pain with activity, stability, and active elevation and substantial agreement (intraclass correlation, 0.66 and 0.69) between the physician and patient assessments of pain without activity and strength. While the differences were small, on the average physician ratings for pain were lower (indicating less pain) than patient ratings for pain, physicians rated stability and strength as being closer to normal, and they reported less active elevation. There was substantial agreement between the physician and patient assessments of outcome with the modified Neer system (intraclass correlation = 0.75), with 87% agreement if excellent and satisfactory outcomes were combined. CONCLUSIONS: A patient-derived questionnaire can provide a high level of agreement with surgeon assessments of outcome following shoulder surgery. Patient-administered methods should continue to be evaluated as a means of assessment of these patients.

Adult↗
PubMed2006

Humeral head replacement for the treatment of osteoarthritis.

BACKGROUND: Humeral head replacement has been used successfully for the treatment of osteoarthritis of the shoulder for decades. The purpose of this study was to define the results of this form of treatment, the risk factors for an unsatisfactory outcome, and the rates of failure over time. METHODS: Between 1978 and 1997, sixty humeral head replacements were performed at our institution for the treatment of osteoarthritis. Five patients (seven shoulders) died less than five years postoperatively, and one patient (two shoulders) was lost to follow-up. Fifty-one humeral head replacements in forty-nine patients with a complete postoperative evaluation and operative records who had been followed for a minimum of five years (mean, 11.3 years) or until revision were included in the study. All sixty shoulders were included in the survival analysis. RESULTS: Overall, there was significant long-term pain relief (p<0.0001) as well as improvement in active abduction (p<0.0001), internal rotation (p<0.024), and external rotation (p<0.0001) following the humeral head replacement. However, moderate pain was reported in nine shoulders and severe pain, in seven. Ten of the fifty-one shoulders underwent revision surgery, which was done to treat painful glenoid arthrosis in nine of the ten. Radiographs were available for thirty-nine shoulders, and they demonstrated an increase in glenoid erosion at a mean of 10.7 years postoperatively (p<0.0001). Five shoulders had humeral periprosthetic lucent lines of 1.5 mm in thickness, and three of them had a complete line; one humeral component had shifted in position. According to a modification of the Neer result rating system, there were ten excellent results, twenty satisfactory results, and twenty-one unsatisfactory results. CONCLUSIONS: Substantial clinical improvement can occur after humeral head replacement for osteoarthritis of the shoulder, but there is a high rate of unsatisfactory results and revision surgery. The decision as to whether this is the optimal surgical procedure for the treatment of osteoarthritis of the shoulder requires careful consideration.

Adult↗
PubMed2006

Shoulder arthritis in the young adult: arthroscopy to arthroplasty.

Young adult patients with shoulder arthritis present challenging treatment decisions for the orthopaedic surgeon. Patients treated with shoulder arthroplasty have the youngest average age of all patients who undergo joint arthroplasty. However, in the young, active patient or in those without advanced disease, joint arthroplasty may not be appropriate. Arthroscopic treatment or interposition arthroplasty may provide symptomatic relief without radically compromising future procedures.

Arthritis↗
PubMed2005

Arthroscopic technique for treatment of synovial chondromatosis of the glenohumeral joint.

Synovial chondromatosis of the shoulder has been treated in the past with an open arthrotomy, removal of loose bodies, and synovectomy. Several authors have described arthroscopy as a means of treating this rare disorder because of the excellent visualization of the glenohumeral joint, decreased morbidity, and early rehabilitation potential. This article offers a technique in which a large-bore cannula and high pressure and flow are used to facilitate the removal of loose bodies from the joint.

Arthroscopy↗
PubMed2005

Outcomes are poor after treatment of sepsis in the rheumatoid shoulder.

Currently, there is little information regarding treatment of shoulder sepsis in patients with rheumatoid arthritis. This study examines the prognosis and outcome after operative treatment of native shoulder infection in patients with rheumatoid arthritis. Seventeen patients were retrospectively reviewed (20 shoulders) after surgical intervention for shoulder sepsis between 1982 and 2002. Nine patients (12 shoulders) were associated with multiple joint infections. The most common isolated organism from cultures was Staphylococcus aureus in 15 shoulders. Three patients died during initial admission to the hospital (at 7 days, 5 months, and 6 months) because of multisystem organ failure and multiple joint infections. Fourteen patients (15 shoulders) survived for followup, with two excellent, six satisfactory, and seven unsatisfactory results. Mean active elevation was 100 degrees. Further surgery was required in three patients: one synovectomy and two shoulder arthrodeses. In this study, patients with shoulder sepsis with rheumatoid arthritis were found to have a high rate of multiple joint sepsis and unsatisfactory shoulder function.

Aged↗
PubMed2005

Infection after clavicle fractures.

Currently there are no reported series on the treatment of patients cared for after infection of their clavicular fractures. Therefore, our purpose in doing this study was to review patients who were treated for infection after clavicle fractures at our institutions between 1995 and 2001 to determine the organisms responsible for infection, the union rates, and the functional results. During this period, six patients were treated for infection after a clavicular fracture. Five patients had a postoperative infection after attempts at open reduction and internal fixation. One patient had an infection after her nonunion eroded through the skin. Four patients presented 3 months or fewer from the time of injury/surgery. Three patients had a polymicrobial infection and three patients had single-organism infections. Infection may be acute or significantly delayed from the time of the initial surgical procedure. Among those patients with continued nonunions despite surgical intervention, late infection should be suspected. In this series only two patients with infected clavicles went on to bony union. The surgeon should be aware of the extreme difficulty in treating this complication and its poor prognosis.

Adolescent↗
PubMed2005

Rotator cuff repair in patients with rheumatoid arthritis.

BACKGROUND: Currently, there is very little information available regarding the results of rotator cuff repair in patients with rheumatoid arthritis. Therefore, we reviewed our experience to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure of this procedure. METHODS: We retrospectively reviewed the records of all patients with rheumatoid arthritis who had undergone repair of a rotator cuff tear at our institution from 1988 to 2002. Twenty-three shoulders in twenty-one patients were identified. The median duration of follow-up for the twenty shoulders that did not require revision surgery was 9.7 years. Nine shoulders had a partial-thickness tear, and fourteen had a full-thickness tear. The shoulders were assessed with regard to pain, functional outcome, and overall patient satisfaction. RESULTS: Patients with both partial and full-thickness rotator cuff tears had significant improvements in terms of overall pain (p < 0.05) and satisfaction (p < 0.05). Patients who had undergone repair of a partial-thickness tear had improved active elevation (from 155 degrees to 180 degrees; p = 0.03), whereas patients who had undergone repair of a full-thickness tear did not have improved elevation. Six of the fourteen shoulders with a full-thickness tear had an unsatisfactory result, whereas only two of the nine shoulders with a partial-thickness tear had an unsatisfactory result. CONCLUSIONS: Rotator cuff repair in patients with rheumatoid arthritis can be challenging. However, durable pain relief and patient satisfaction can be achieved. Functional gains should not be expected in patients with full-thickness rotator cuff tears. Repair of the rotator cuff in patients with rheumatoid arthritis can be undertaken when nonoperative measures for pain relief have failed.

Arthritis, Rheumatoid↗
PubMed2005

Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis.

Persistent shoulder pain is a very common condition that often has a multifactorial underlying pathology and is associated with high societal cost and patient burden. In 2000, the direct costs for the treatment of shoulder dysfunction in the United States totaled $7 billion. Persistent shoulder pain can result from bursitis, tendinitis, rotator cuff tear, adhesive capsulitis, impingement syndrome, avascular necrosis, glenohumeral osteoarthritis (OA), and other causes of degenerative joint disease or from traumatic injury, either in combination or as a separate entity. Rotator cuff disorders, adhesive capsulitis, and glenohumeral OA are all common causes of persistent shoulder pain, accounting for about 10%, 6%, and 2% to 5%, respectively, of all shoulder pain. All 3 conditions have complex etiologies, but they can be diagnosed in the majority of patients on the basis of medical history, focused physical examination, and plain film radiographs. This brief review and the following articles in this supplement focus on persistent shoulder pain associated with rotator cuff disorders, adhesive capsulitis, and glenohumeral OA.

Chronic Disease↗
PubMed2004

Periprosthetic humeral fractures after shoulder arthroplasty.

BACKGROUND: Currently, there is little information concerning periprosthetic humeral fractures after shoulder arthroplasty. Therefore, we reviewed our experience with these fractures to determine the results of treatment, the risk factors for periprosthetic fracture, and the rates of reoperation. METHODS: Between 1976 and 2001, nineteen postoperative periprosthetic humeral fractures occurred among 3091 patients who had undergone shoulder arthroplasty at our institution. Sixteen patients had a complete series of radiographs and were included in this study. The average time from the arthroplasty to the fracture was forty-nine months. Seven patients had severe osteopenia. Twelve fractures occurred at the tip of the prosthesis; of these, six extended proximally (type-A fractures) and six did not (type-B fractures). Three fractures occurred distal to the implant and extended into the distal humeral metaphysis (type-C fractures). One fracture occurred in the proximal metadiaphyseal region because of osteolysis. RESULTS: Six fractures healed after an average of 180 days of nonoperative treatment. Five fractures were treated operatively after an average of 123 days of unsuccessful nonoperative treatment. The remaining five fractures had immediate operative treatment. All sixteen fractures healed. One patient required multiple operations over a period of three years before union was achieved. With the exclusion of this patient and one other patient who received a custom prosthesis, the average time between the first operative procedure and union was 278 days. CONCLUSIONS: Our data do not clearly indicate the need for operative treatment of type-A fractures unless the humeral component is loose. A trial of nonoperative treatment may be considered for well-aligned type-B fractures that are associated with a well-fixed humeral component; however, operative intervention should be considered for type-B fractures that have not progressed toward union by three months. If the component is well fixed, open reduction and internal fixation may be performed. If the component is loose, revision with a long-stem component is recommended. For type-C fractures, a trial of nonoperative treatment is recommended.

Adult↗