Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis

dc.contributor.advisorRoche, Stephenen_ZA
dc.contributor.authorGrey, Barend Christiaanen_ZA
dc.date.accessioned2017-08-28T13:11:47Z
dc.date.available2017-08-28T13:11:47Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The majority of literature on RSA consists of case series with short follow-up periods. It remains unknown which factors contribute to aseptic stem loosening in RSA. Our analysis aimed to compare the incidence of aseptic stem loosening, humeral radiolucent lines (RLL) and revision for stem loosening between: 1) cemented and uncemented stems, and 2) different etiological subgroups Methods: In a systematic review 75 articles were included after assessment of study methodology and a meta-analysis of 1660 cemented and 805 uncemented stems was performed. We compared the incidence of aseptic stem loosening, humeral RLL, and revision for stem loosening between: 1) cemented and uncemented stems from cohorts with short (< 5 years) mean follow-up periods, long (≥ 5 years) mean follow-up periods, and all cohorts combined; and 2) different etiological subgroups. Results: The overall incidence of aseptic stem loosening was 1%. When comparing cemented to uncemented stems, there was no significant difference in the incidence of aseptic stem loosening or of revision for stem loosening in both the short and long term follow-up groups. Humeral RLL were more common with cemented stems (15.9% versus 9.5%, p = 0.002). The highest incidence of aseptic stem loosening occurred in the tumor subgroup (10.81%), followed by RSA as revision for failed arthroplasty (3.66%). No stem loosening was seen in the acute fracture or fracture sequelae groups. Conclusion: Aseptic stem loosening occurred more commonly in cohorts with long follow-up times (2% vs 0.8%, p = 0.01). There was no difference in the incidence of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Humeral RLL occurred more frequently when cemented stems were used. Patients treated with RSA following excision of proximal humerus tumors and RSA as revision for failed arthroplasty were at greater risk of aseptic stem loosening.en_ZA
dc.identifier.apacitationGrey, B. C. (2017). <i>Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences. Retrieved from http://hdl.handle.net/11427/24990en_ZA
dc.identifier.chicagocitationGrey, Barend Christiaan. <i>"Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences, 2017. http://hdl.handle.net/11427/24990en_ZA
dc.identifier.citationGrey, B. 2017. Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Grey, Barend Christiaan AB - Background: Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The majority of literature on RSA consists of case series with short follow-up periods. It remains unknown which factors contribute to aseptic stem loosening in RSA. Our analysis aimed to compare the incidence of aseptic stem loosening, humeral radiolucent lines (RLL) and revision for stem loosening between: 1) cemented and uncemented stems, and 2) different etiological subgroups Methods: In a systematic review 75 articles were included after assessment of study methodology and a meta-analysis of 1660 cemented and 805 uncemented stems was performed. We compared the incidence of aseptic stem loosening, humeral RLL, and revision for stem loosening between: 1) cemented and uncemented stems from cohorts with short (< 5 years) mean follow-up periods, long (≥ 5 years) mean follow-up periods, and all cohorts combined; and 2) different etiological subgroups. Results: The overall incidence of aseptic stem loosening was 1%. When comparing cemented to uncemented stems, there was no significant difference in the incidence of aseptic stem loosening or of revision for stem loosening in both the short and long term follow-up groups. Humeral RLL were more common with cemented stems (15.9% versus 9.5%, p = 0.002). The highest incidence of aseptic stem loosening occurred in the tumor subgroup (10.81%), followed by RSA as revision for failed arthroplasty (3.66%). No stem loosening was seen in the acute fracture or fracture sequelae groups. Conclusion: Aseptic stem loosening occurred more commonly in cohorts with long follow-up times (2% vs 0.8%, p = 0.01). There was no difference in the incidence of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Humeral RLL occurred more frequently when cemented stems were used. Patients treated with RSA following excision of proximal humerus tumors and RSA as revision for failed arthroplasty were at greater risk of aseptic stem loosening. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis TI - Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis UR - http://hdl.handle.net/11427/24990 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/24990
dc.identifier.vancouvercitationGrey BC. Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/24990en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Health and Rehabilitation Sciencesen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherOrthopaedic Surgeryen_ZA
dc.titleHumeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysisen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMSc (Med)en_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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