Buechel Pappas Resurfacing Shoulder Replacement: Evolution and over 40 Years of Clinical Experience

Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the humeral head, depending upon the pathological process involved. Degenerative glenohumeral arthritis with mild to moderate involvement of subchondral bone allowed for a resurfacing option, while severe humeral head involvement required a partial or full humeral head replacement attached to an intramedullary stem for fixation. All components evolved from cemented to cementless application by 1982. The purpose of this paper is to describe the progression of Buechel-Pappas (B-P) shoulder replacement development from the early 1970’s in both cemented and cement less applications. Methods: Clinical evaluations of “Floating-Socket” TSR, followed by B-P stem-type, resurfacing types, bipolar-type and revision components, all of which comprise the B-P Shoulder Replacement System, were performed over a 49-year period. Results: “Floating-Socket” implants improved the results of simple, constrained ball-in-socket designs, but generally failed by glenoid component loosening in both chimpanzee and human applications. Unconstrained resurfacing-type components, both anatomical humeral head and full proximal humeral components, were quite successful, with minimal failures observed in long-term studies. Bipolar salvage implants, used for severe proximal deficiencies, revisions and massive rotator cuff arthropathy, were also very successful;providing overhead range of motion in many patients. Conclusions: Resurfacing hemiarthroplasty, in patients with intact or repairable rotator cuff mechanisms, gave the most satisfactory results and were the least technically complicated to perform, requiring minimal instrumentation. Resurfacing of full proximal humeral deficiencies, using femoral resurfacing components, gave similar clinical results to more complex semi-constrained devices, also with less technical difficulties and simple instrumentation.

Return to work following shoulder arthroplasty:A systematic review

BACKGROUND Many patients prioritize the ability to return to work(RTW)after shoulder replacement surgeries such as total shoulder arthroplasty(TSA),reverse TSA(rTSA),and shoulder hemiarthroplasty(HA).Due to satisfactory clinical and functional long-term outcomes,the number of shoulder replacements performed will continue to rise into this next decade.With younger individuals who compose a significant amount of the workforce receiving shoulder replacements,patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.AIM To summarize RTW outcomes following TSA,rTSA,and HA,and analyze the effects of workers’compensation status on RTW rates and ability.METHODS This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search regarding RTW following shoulder arthroplasty was performed using four databases(PubMed,Scopus,Embase,and Cochrane Library),and the Reference Citation Analysis(https://www.referencecitationanalysis.com/).All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included.Nonclinical studies,literature reviews,case reports,and those not reporting on RTW after shoulder arthroplasty were excluded.RESULTS The majority of patients undergoing TSA,rTSA,or HA were able to RTW betweenone to four months,depending on work demand stratification.While sedentary or light demand jobs generally have higher rates of RTW,moderate or heavy demand jobs tend to have poorer rates of return.The rates of RTW following TSA(71%-93%)were consistently higher than those reported for HA(69%-82%)and rTSA(56%-65%).Furthermore,workers’compensation status negatively influenced clinical outcomes following shoulder arthroplasty.Through a pooled means analysis,we proposed guidelines for the average time to RTW after TSA,rTSA,and HA.For TSA,rTSA,and HA,the average time to RTW regardless of work demand stratification was 1.93±3.74 mo,2.3±2.4 mo,and 2.29±3.66 mo,respectively.CONCLUSION The majority of patients are able to RTW following shoulder arthroplasty.Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.