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Primary Unconstrained Shoulder Arthroplasty in Patients with a Fixed Anterior Glenohumeral Dislocation
J. Matsoukis, MD1; W. Tabib, MD1; P. Guiffault, MD1; A. Mandelbaum, MD1; Gilles Walch, MD2; Chantal Némoz, PHD3; Zenia E. Cortés, MD4; T. Bradley Edwards, MD4
1 Department of Orthopaedic Surgery, Groupe Hospitalier du Havre, Hôpital Jacques Monod, BP 24, 76083 Le Havre CEDEX, France
2 Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, 85 Cours Albert Thomas, 69003 Lyon, France
3 Department of Biostatistics, Hôpitaux de Lyon, 162 Avenue Lacassagne, 69424 Lyon CEDEX 03, France
4 Fondren Orthopedic Group, LLP, 7401 South Main Street, Houston, TX 77030. E-mail address for T.B. Edwards: bemd@fondren.com
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In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Tornier Company. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Tornier Company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, Lyon, France

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(3):547-552. doi: 10.2106/JBJS.E.00368
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Background: Reports of shoulder arthroplasty for the treatment of fixed glenohumeral dislocation are rare. The purpose of this study was to analyze the results following shoulder arthroplasty in patients with a fixed anterior shoulder dislocation.

Methods: Eleven patients were evaluated at a minimum of twenty-four months after they underwent an arthroplasty for the treatment of a fixed anterior shoulder dislocation. Four patients underwent a total shoulder arthroplasty, and the remainder were treated with a hemiarthroplasty. Four shoulders had osseous reconstruction of the anterior aspect of the glenoid. The patients were evaluated with use of the Constant score, measurement of active anterior elevation and external rotation, the patient's subjective grading of the result, and a radiographic examination.

Results: The mean Constant score improved from 21.1 points preoperatively to 46.0 points following the arthroplasty, and the mean active anterior elevation improved from 48.6° to 90.0°. The pain component of the Constant score was the most reliably improved parameter, increasing from a mean of 4.8 points preoperatively to a mean of 11.0 points postoperatively. Eight patients reported that the result was excellent or good, and the remaining three considered it to be fair. We observed seven complications in five patients, including four cases of anterior instability of the shoulder. Two of the four patients treated with a total shoulder replacement were seen to have definite loosening of the glenoid component on follow-up radiographs.

Conclusions: Shoulder arthroplasty in patients with a fixed anterior shoulder dislocation is fraught with difficulties and complications. Although arthroplasty reliably relieved shoulder pain in this population, limited functional results should be expected.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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