Alterations in Shoulder Motion Following Copeland® Shoulder Resurfacing Arthroplasty

Introduction: Copeland® shoulder resurfacing arthroplasty (CSRA) proponents suggest that it replicates the normal joint anatomy by providing restoration of the humeral head structure in terms of offset, version, angulation and shape. Most studies note the clinical improvement after CSRA. The aim of this study was to investigate the changes in motion analysis in patients following CSRA for range of motion tasks namely; flexion, abduction, external and internal rotation. In addition, all patients undertook three activities of daily living tasks namely; reaching behind the head, reaching for the contralateral shoulder and reaching behind the back.<br/><br/>Method: Twenty-three shoulders (19 patients) with glenohumeral osteoarthritis agreed to participate in the study. Pre-operatively, patients underwent a clinical assessment, pain scoring (VAS 0-10) and shoulder scoring with Constant-Murley (CS) and Oxford Shoulder Score (OSS) by an independent nurse practitioner. Subsequently, patients underwent motion analysis, which involved placement of reflective markers on their upper torso that accurately recorded specific tasks of their shoulders’ movements using eight high-tech three-dimensional (3D) Vicon cameras. The markers were placed according to the International Society of Biomechanics (ISB) guidelines. The same set of assessments was postoperatively recorded at four and 12 months respectively for both range of motion tasks and activities of daily living tasks.<br/><br/>Result: Nineteen shoulders (15 patients) completed the study. No patients had any problems while undertaking the study. Two patients were unwell to return for analysis and one patient moved away. The mean age of the patients was 72 years (range 52-84) and there were 15 females and four males. The pain score improved significantly postoperatively (p&lt;0.001). Both CS and OSS improved significantly following surgery at both follow-up periods (p&lt;0.001).<br/><br/>Clinically both flexion and abduction improved significantly post-operatively (p&lt;0.001). However, the motion analysis data showed that only abduction improved post-operatively significantly (p&lt;0.001). The flexion improved significantly (p&lt;0.007) by 4 months post-operatively but thereafter a loss of flexion was noted at 12 month mark. Both external and internal rotation significantly improved post-operatively (p&lt;0.05) when comparing the pre-operative value to the two post-operative assessments both clinically and kinematically.<br/><br/>When analysing the three activities of daily living tasks kinematically significant improvements in movement (both flexion-extension and abduction-adduction planes) were noted post-operatively (p&lt;0.05) compared to the pre-operative value for behind the head and behind the back tasks. The contralateral shoulder tasks did not show a significant improvement when comparing pre-operative measurements to either of the two post-operative assessments (four and 12 months) in any plane.<br/><br/>Conclusion: This present study is the first research to utilise objective biomechanical tools in addition to clinical measurements and outcome scores to assess the CSRA outcomes. In addition, the present study also investigated the effect the CRSA procedure had on a set of tasks of daily living. It confirmed substantial improvements in shoulder motion by state of the art kinematic analysis methods, which compliments the enhanced clinical scores in patients undergoing CSRA. We have shown in the present prospective study that CSRA provided significant improvement in pain, range of motion, functional tasks and outcomes scores making it a viable alternative to conventional stemmed shoulder arthroplasty in a select group of patients. In addition, we reveal that the results from our study match those reported in other studies in the literature. We rejected our null hypothesis that the range of motion does not significantly improve after CSRA.<br/><br/>This finding that the scores and function following CSRA continue to improve with time up to one year is important to know as this will help clinicians and therapists to plan the future management of post-operative patients and also investigate those who do not follow the trend.<br/><br/>This study fully supports the use of 3D motion analysis as a useful tool for assessing and monitoring treatments and surgical procedures providing independent, objective, standardised and sensitive analysis of outcomes. The ability to pick up loss of flexion with time exclusively by the kinematic method as noted in the present study is an important finding. It highlights the ability of the kinematic methods to pick up small but significant changes in shoulder motion which may have important clinical implications. Its strength to analyse complex motion of joints especially in upper limb will encourage its use as a vital tool in the orthopaedic assessment practice in future.

Name dc:type.qualificationname

Doctor of Medicine

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

University of Dundee

Year dc:date.issued

2014

Author dc:creator

• Jariwala, Arpit

Advisors dc:contributor.advisor

• Wigderowitz, Carlos
• Abboud, Rami

Language dc:language

eng

Identifier

oai:discovery.dundee.ac.uk:studenttheses/604e20ab-9580-408b-bfb0-5414c0890977

OAI identifier oai:identifier

oai:discovery.dundee.ac.uk:studenttheses/604e20ab-9580-408b-bfb0-5414c0890977