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Biomedical subjects

Robert H Cofield

Publications and source records attributed to Robert H Cofield.

41 records · Page 3Linked to original sources
PubMedDate not supplied

Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger.

Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. All 114 shoulders were included in the survival analysis. There was significant long-term pain relief (P < .01) and improvement in active abduction (P < .01) and external rotation (P < .01) with both procedures. There was not a significant difference between total shoulder arthroplasty and hemiarthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 total shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after total shoulder arthroplasty (60%) compared with hemiarthroplasty (34%) (P = .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 total shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among total shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiarthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for total shoulder arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.

Adult↗
PubMedDate not supplied

Shoulder arthroplasty for proximal humeral malunions: long-term results.

Between 1976 and 1997, 50 shoulders with proximal humeral malunions in 50 patients were treated with hemiarthroplasty or total shoulder arthroplasty and followed up for a mean of 9 years (range, 2-21 years) or until the time of revision surgery. Of these, 13 had a 4-part malunion, 24 had a 3-part greater tuberosity malunion, 6 had a 2-part greater tuberosity malunion, and 7 had a 2-part head segment malunion. Articular incongruity resulted from an articular surface step-off in 5 shoulders, from osteonecrosis in 19, and from secondary degenerative arthritis in 26. Shoulder arthroplasty resulted in significant pain relief (P <.005). At most recent follow-up, shoulder pain was more intense in patients who had initial operative treatment of their fracture, in those with osteonecrosis, and in those who had arthroplasty less than 2 years after their fracture. Active elevation improved from 65 degrees to 102 degrees on average, and external rotation improved from 12 degrees to 35 degrees on average. There was significantly less postoperative motion in those who had initial operative treatment of their fracture or who underwent tuberosity osteotomy. Of the 24 shoulders undergoing tuberosity osteotomy, 14 healed in good position, 4 had a nonunion develop, 3 had some degree of malunion develop, and in 3 the tuberosity resorbed. On the basis of the Neer result rating, 12 shoulders had an excellent result, 13a satisfactory result, and 25 an unsatisfactory result. Unsatisfactory results occurred in 8 who underwent reoperation with component revision or removal and because of lack of postoperative motion in 14, moderate pain in 2, and patient dissatisfaction in 1. All shoulders with tuberosity nonunion or resorption had an unsatisfactory result.

Arthroplasty↗
PubMedDate not supplied

Shoulder arthroplasty for proximal humeral nonunions.

Between 1980 and 1997, 27 patients underwent shoulder arthroplasty because of pain or functional impairment due to a proximal humeral nonunion. Twenty-five of the 27 shoulders with a mean 6-year follow-up period (range, 2-15 years) were included in the study. There were 19 women and 6 men, with a mean age of 65 years. The most frequent original fracture types were 2-part surgical neck (64%) and 3-part greater tuberosity fractures (28%). Twenty-one shoulders underwent hemiarthroplasty, and 4 underwent total shoulder arthroplasty. Shoulder arthroplasty resulted in significant pain relief, with mean pain scores decreasing from 4.6 to 1.8 points (P <.05). Mean active elevation improved from 41 degrees preoperatively to 88 degrees postoperatively (P <.05), and mean external rotation from 22 degrees to 38 degrees (P =.045). In 11 shoulders the greater tuberosity resorbed or was nonunited. Two of the 25 shoulders required another operation after the arthroplasty: one for periprosthetic humeral fracture and one for instability. Twenty shoulders were much better or better, and 5 were the same or worse. On the basis of a modified Neer result rating system, there was 1 excellent result, 11 satisfactory results, and 13 unsatisfactory results. Patients who have significant functional impairment from a nonunion of the humeral surgical neck with failed internal fixation, severe osteoporosis, cavitation of the humeral head, or secondary osteoarthritis may benefit from shoulder arthroplasty. Although function is not completely restored, pain relief and high levels of subjective satisfaction can be achieved.

Aged↗
PubMedDate not supplied

Pediatric shoulder instability: presentation, findings, treatment, and outcomes.

There is no one large study on pediatric shoulder instability. The purposes of this study were to characterize patients with shoulder subluxation or dislocation, the treatments provided, outcomes, and the predictors of good outcomes. Seventy shoulders in 66 patients were retrospectively reviewed, all with follow-up >2 years. The authors defined characteristics, treatment, outcomes, and associations between patient and treatment variables and outcome measures. Instability was associated with boys, adolescents, and trauma. Forty-two shoulders received physical therapy, and 28 required surgery. At follow-up, 54 of 70 described their shoulders as "better" or "much better," and 90% were performing at the same or higher levels of sports and work. Surgically treated patients were less likely to have recurrent instability or to report limitations. The current study is a large study of pediatric shoulder instability. Surgery improved stability, but overall, stability improved over time, with few patients having limitations at moderate- to long-term follow-up.

Adolescent↗