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Background Mobile health (mHealth)— the use of medical applications in healthcare settings —include tools that can support self-management after surgery and thereby contribute to early postoperative recovery. Providing patients with timely and interactive information through mHealth is hypothesized to positively influence recovery after reverse shoulder arthroplasty (RSA). The aim of this study is to determine the effectiveness of both interactive and personalized information and a rehabilitation protocol with a mobile application compared to generic non-personalized digital information on postoperative recovery in patients undergoing primary RSA. Methods A multicentre randomised controlled trial will be conducted in two Dutch hospitals. In total 170 patients undergoing elective, primary RSA will be included. Participants will be randomly allocated to one of the two groups on a 1:1 ratio. The intervention group will receive interactive postoperative information on a daily basis. The control group will receive generic, non-personalized digital information. The primary outcome is defined as functional recovery measured using the Oxford Shoulder Score (OSS) at 6 weeks. Secondary outcomes are: pain, physical functioning, quality of life, length of stay, complications, treatment satisfaction and app usage. The between group difference will be analysed using linear mixed-effects regression. Discussion This randomised controlled trial will compare the postoperative recovery rate in patients undergoing RSA between patients receiving an interactive mHealth application with generic digital information. The results from this study can contribute to improving postoperative care for patients undergoing RSA. Trial registration This trial is registered in ClinicalTrials.gov (NCT06520085) on the 22nd of July 2024.

Background Proximal humerus fractures (PHF) are common and painful injuries, with the majority resulting from falls from a standing height. As with other fragility fractures, its age-specific incidence is increasing. Surgical treatment with hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) have been increasingly used for displaced 3- and 4-part fractures despite a lack of good quality evidence as to whether one type of arthroplasty is superior to the other, and whether surgery is better than non-surgical management. The PROFHER-2 trial has been designed as a pragmatic, multicentre randomised trial to compare the clinical and cost-effectiveness of RSA vs HA vs Non-Surgical (NS) treatment in patients with 3- and 4-part PHF. Methods Adults over 65 years of age presenting with acute radiographically confirmed 3- or 4-part fractures, with or without associated glenohumeral joint dislocation, who consent for trial participation will be recruited from around 40 National Health Service (NHS) Hospitals in the UK. Patients with polytrauma, open fractures, presence of axillary nerve palsy, pathological (other than osteoporotic) fractures, and those who are unable to adhere to trial procedures will be excluded. We will aim to recruit 380 participants (152 RSA, 152 HA, 76 NS) using 2:2:1 (HA:RSA:NS) randomisation for 3- or 4-part fractures without joint dislocation, and 1:1 (HA:RSA) randomisation for 3- or 4-part fracture dislocations. The primary outcome is the Oxford Shoulder Score at 24 months. Secondary outcomes include quality of life (EQ-5D-5L), pain, range of shoulder motion, fracture healing and implant position on X-rays, further procedures, and complications. Independent Trial Steering Committee and Data Monitoring Committee will oversee the trial conduct, including the reporting of adverse events and harms. Discussion The PROFHER-2 trial is designed to provide a robust answer to guide the treatment of patients aged 65 years or over who sustain 3- and 4-part proximal humeral fractures. The pragmatic design and recruitment from around 40 UK NHS hospitals will ensure immediate applicability and generalisability of the trial findings. The full trial results will be made available in a relevant open-access peer-reviewed journal. Trial registration ISRCTN76296703. Prospectively registered on 5th April 2018

Background The purpose of this study was to assess the long-term results of the stemless onlay Comprehensive Nano reverse total shoulder arthroplasty (rTSA) system. Methods We evaluated 35 shoulders at an average follow-up of 106 ± 14.6 months (range, 80–135) (follow-up rate 66%). Patients were evaluated via the Constant–Murley scale, the DASH score (Disabilities of the Arm, Shoulder and Hand) and the subjective shoulder value (SSV). Furthermore, a visual analog scale (VAS) for pain intensity was used. The passive glenohumeral range of motion and active total range of motion were recorded. Radiographic assessment was performed on true antero-posterior and axillary views. Results The mean age at surgery was 72.8 ± 6.7 years (range, 47–82). Four patients were revised to a stemmed implant during the follow-up period and were excluded from further assessment. In the remaining group, the Constant score was 82.9 ± 13.1 (range, 40–97), the DASH score was 10.6 ± 17.3 (range, 0–77.5), the SSV was 85.0 ± 18.1 (range, 10–100), and the VAS score for pain was 0.9 ± 1.7/10 (range, 0–7). The mean active flexion and abduction values were 159.8 ± 13.8 and 155.9 ± 20.1, whereas the active external and internal rotation values averaged 34.8 ± 15.3 and 88.9 ± 7.9, respectively. Grade I radiolucency lines (RLLs) were found in 4 patients (14.3%). RLLs > 1 mm were not observed. Two patients experienced early varus displacement of the humeral tray with full reintegration without revision. Revisions to a stemmed implant were performed for atraumatic peg breakage of the humeral tray in 2 patients, early septic loosening in one patient and periprosthetic fracture in one patient. Grade 1 notching was found in 17.9%, and acromion stress fracture was found in 3.6%. Three patients experienced postoperative neurological deficits, with complete recovery in 2 patients. Conclusions Compared with published data on stemmed and stemless rTSA, the comprehensive Nano rTSA system in the present study has comparable or even superior clinical outcomes at long-term follow-up. The rates of implant-associated complications and revision, however, are high compared with those reported in the literature. Trial registration Retrospectively registered on 6th August 2025 German Clinical Trial Register, clinical trial number DRKS00037624, https//www.drks.de/DRKS00037624.

IntroductionShoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS).Methods and analysisRAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants.Ethics and disseminationEthics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets.Trial registration numberISRCTN12216466.

Background Reverse total shoulder arthroplasty (RTSA) is a widely used treatment for both traumatic and degenerative glenohumeral joint diseases. Despite its popularity, data on outcomes sorted according to indications have revealed inconsistent results. Furthermore, the clinical outcome is rarely analysed in a differentiated manner using several scores. This retrospective, single-center study aimed to investigate the impact of indications on the clinical outcomes of RTSA. Methods The Constant Score, EQ-5D-5L, DASH Score were sent by post to 263 patients who received a RTSA between February 2011 and March 2022. The follow-up period was 12-139 months. Patients were categorized into primary-fracture, secondary-intervention, and degenerative-disease groups based on the indications for RTSA. We have calculated the corresponding average scores for each group. Results Of the 263 patients included in the study, 136 completed the questionnaire. The mean follow-up duration was 48 months. All outcome measures were approximately normally distributed. The mean values were as follows. Constant Score: degenerative disease 58 ± 19, primary fracture 52 ± 18, secondary intervention 49 ± 18. DASH Score: degenerative disease 35 ± 20, primary fracture 40 ± 17, secondary intervention 42 ± 20. EQ-5D-5L Index: degenerative disease 0.72 ± 0.24, primary fracture 0.75 ± 0.20, secondary intervention 0.68 ± 0.39. Conclusions In this study, clinical outcomes after RTSA varied according to the underlying indication, with the best results observed in patients with degenerative diseases and the lowest in patients undergoing secondary interventions. Further studies with larger, multi-centre cohorts are needed to confirm these findings and to strengthen the evidence base before clinical recommendations can be made. Trial registration 593/21ek.

IntroductionPrevious trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled unblinded trial tested the hypothesis that a continuous infusion of local anesthetic for an interscalene brachial plexus block still provides superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac.MethodsSixty patients undergoing shoulder arthroplasty or arthroscopic rotator cuff repair were randomized to receive a bolus of ropivacaine 0.5%, 20 mL, with or without a continuous infusion of ropivacaine 0.2% 4–8 mL/hour, for an interscalene brachial plexus block. Patients were provided with intravenous morphine patient-controlled analgesia. The primary outcome was cumulative intravenous morphine consumption at 24 hours postoperatively. Secondary outcomes included pain scores at rest and on movement, and functional outcomes, measured over 48 hours after surgery.ResultsMedian (IQR) cumulative intravenous morphine consumption at 24 hours postoperatively was 10 mg (4–24) in the continuous infusion group and 14 mg (8–26) in the single injection group (p=0.74). No significant between-group differences were found for any of the secondary outcomes.ConclusionsA continuous infusion of local anesthetic for an interscalene brachial plexus block does not provide superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. The findings of this study are limited by performance and detection biases.Trial registration number NCT04394130.

Introduction Postoperative instability following reverse total shoulder arthroplasty (RTSA) is one of the most common complications and remains a significant clinical challenge. Although implant positioning, design, and surgical technique are known to influence stability, there is no universally accepted management strategy when dislocation recurs. This study reports two rare cases of early, atraumatic recurrent dislocation after RTSA, highlighting the complexity of this complication. Methods and results Between 2014 and 2023, 182 reverse total shoulder arthroplasties (RTSAs) were performed at our institution by a single surgeon using a consistent technique. We retrospectively identified two patients who developed recurrent dislocation. One patient underwent RTSA for an acute proximal humerus fracture, and the other for fracture malunion. Dislocation occurred at 2 and 3 weeks postoperatively, respectively, without any traumatic event. Both cases required operative reduction, as closed reduction in the emergency setting was unsuccessful. Despite upsizing to a thicker polyethylene liner, instability persisted. Ultimately, open reduction followed by immobilization in an abduction brace for six weeks was performed. During follow-up, no further dislocations occurred, and both patients retained their prosthesis with acceptable functional outcomes. Conclusion Early recurrent dislocation can occur despite correct implant orientation and satisfactory intraoperative stability testing. In such cases, open reduction followed by prolonged immobilization may offer a viable option to avoid revision or resection arthroplasty.

IntroductionIndications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not.Methods50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant–Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients.ResultsPatients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°–60°) vs. 32° (20°–45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13–90) vs. 69.5 (40–79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA.ConclusionSSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery.

Background Massive degenerative rotator cuff tears (MRCTs) represent a persistent challenge in shoulder surgery. While arthroscopic rotator cuff repair (ARCR) remains a widely accepted treatment with good functional outcomes, it is associated with a risk of retear and progression to cuff tear arthropathy. Reverse shoulder arthroplasty (RSA) has emerged as a viable alternative, particularly in cases where the reparability of the cuff is uncertain, offering pain relief and functional improvement. However, the optimal treatment approach for repairable MRCT in patients aged 60 to 80 years remains debated. This trial aims to assess whether RSA provides non-inferior outcomes to ARCR in patients with degenerative MRCTs, with a particular focus on function, pain, and quality of life. Methods This is a prospective, randomized, controlled, non-inferiority trial. A total of 145 patients with symptomatic, repairable MRCT will be enrolled and randomized in a 1:1 ratio to undergo either ARCR or RSA. The primary outcome is the American Shoulder and Elbow Surgeons (ASES) score at 24 months postoperatively. Secondary outcomes include ASES at 6 weeks and 6 months; Visual Analog Scale (VAS) for pain; Single Assessment Numeric Evaluation (SANE); Constant score; range of motion (ROM) in flexion, extension, and internal/external rotation; repair integrity (ultrasound for ARCR, radiographs for RSA); and complication rates. PROMs will be assessed at baseline, 1.5, 6, and 24 months. All adverse events and complications will be systematically recorded. Discussion This trial will provide robust comparative data to assess whether RSA is non-inferior to ARCR at two years postoperatively in terms of shoulder function and patient-reported outcomes in patients with repairable MRCT. The results aim to support evidence-based decision-making in clinical practice. Trial registration The protocol was approved by the Ethics Committee Board (CCER 2023–00111) in March 2023 and by ClinicalTrial.gov (NCT05807854).

Aims In reverse shoulder arthroplasty (RSA), different implant designs range from medializing implants to strongly lateralizing onlay designs with different neck-shaft-angles (NSA). Thus different degrees of lateralization are currently used. Aim of this study was to compare clinical and radiological outcomes of three different implant designs in a homogeneous patient cohort with primary osteoarthritis (OA). Methods Patients with OA who underwent RSA between 03/2014 and 01/2020 were included and categorized into three groups based on RSA design: group MD (medialized-distalized design: eccentric glenosphere, 155° NSA), group L (lateralized design: + 4 mm centric glenosphere, 135° NSA), group LD (lateralized-distalized design: eccentric glenospheres, + 3 mm baseplate, curved onlay stem 145° NSA). Inclusion criteria were complete clinical and radiological 24 months follow-up (FU) including range of motion (ROM), Constant-Murley score (CS), Subjective Shoulder Value (SSV). In addition, scapular notching and adverse events were recorded. Results Group MD including 26 patients (81% female; mean age: 77.9 years) reached 71 (range: 60–85) points in CS and 90% (range: 40–100) in SSV. In group L, 46 patients (98% female; mean age: 75.2 years) achieved a CS of 75 (59–85) points and SSV was 95% (60–100). In group LD, 25 patients (68% female; mean age: 76.3 years) presented a CS of 79 (30–100) points and SSV of 93% (50–100). Group L and group LD achieved significantly better abduction, internal and external rotation ( p  < 0.001), forward flexion ( p  = 0.023) and SSV ( p  = 0.046). Scapular notching was present in 22% of MD patients (13% grade 1; 4% grade 2; 4% grade 4), 16% in group L (all grade 1) and 9% in group LD (all grade 2). No prosthesis related complication occurred in any group. Conclusion In patients with primary OA, the lateralized and lateralized-distalized designs result in superior subjective satisfaction in SSV and improved ROM in all planes compared to the traditional distalized-medialized implant designs. In all three groups, no implant related complications were noted.