• The Academic Congress of Korean Shoulder and Elbow Society
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• 2002.10a
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• pp.169-173
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• 2002

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.18-25
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• 2024

Background: The Discovery Elbow System (DES) utilizes a polyethylene bearing within the ulnar component. An exchange bearing requires preoperative freezing and implantation within 2 minutes of freezer removal to allow insertion. We report our outcomes and experience using this technique. Methods: This was an analysis of a two-surgeon consecutive series of DES bearing exchange. Inclusion criteria included patients in which exchange was attempted with a minimum 1-year follow-up. Clinical and radiographic review was performed 1, 2, 3, 5, 8 and 10 years postoperative. Outcome measures included range of movement, Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), complications and requirement for revision surgery. Results: Eleven DESs in 10 patients were included. Indications were bearing wear encountered during humeral component revision (n=5); bearing failure (n=4); and infection treated with debridement, antibiotics and implant retention (DAIR; n=2). Bearing exchange was conducted on the first attempt in 10 cases. One case required a second attempt. One patient developed infection postoperatively managed with two-stage revision. Mean follow-up of the bearing exchange DES was 3 years. No further surgery was required, with no infection recurrence in DAIR cases. Mean elbow flexion-extension and pronosupination arcs were 107°(±22°) and 140° (±26°). Mean OES was 36/48 (±12) and MEPS was 83/100 (±19). Conclusions: Our results support the use of DES bearing exchange in cases of bearing wear with well-fixed stems or acute infection. This series provides surgeons managing DES arthroplasty with management principles, successful and reproducible surgical techniques and expected clinical outcomes in performing DES polyethylene bearing exchange. Level of evidence: IV.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2004.11a
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• pp.129-135
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• 2004

만약 Glenoid side를 해부학적으로 정확하게 치환하고, 상완골측의 prosthesis를 삽입할 때 실제 골두의 크기와 같은 prosthetic head를 쓰고, humeral stem의 위치 및 높이를 정확하게 맞추어 삽입하여, humeral head component의 center와 glenoid component의 center가 일치되고 lateral glenohumeral offset이 정상에 가깝게 수술을 시행하면 인공 치환물로 대치된 glenohumeral joint가 정상에 가장 가까운 kinematics를 가질 수 있다 (당연한 얘기지만 이렇게 수술하려면 많은 경험이 필요). 따라서 Glenohumeral joint의 인공 관절 치환술은 항상 technique-dependant 수술이며, 아무리 좋은 치환물도 훌륭한 수술 기법보다 더 중요할 수는 없다.

• Clinics in Shoulder and Elbow
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• v.27 no.2
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• pp.196-202
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• 2024

Background: As the population is aging and indications are expanding, shoulder arthroplasty is becoming more frequent, especially bilateral staged replacement. However, surgeons are hesitant to use bilateral reverse prostheses due to potential limitations on activities of daily living. Methods: This meta-analysis was conducted to compare bilateral anatomic to bilateral reverse shoulder implants. PubMed, Cochrane, and Google Scholar (pages 1-20) were searched until April 2023. The clinical outcomes consisted of postoperative functional scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], Physical Component Score [PCS], Mental Component Score, and Simple Shoulder Test), pain, and range of motion (external rotation and forward elevation). Three studies were included in this meta-analysis. Results: Bilateral anatomic implants had better postoperative functional outcomes and range of motion, but no significant difference was seen in postoperative pain when compared to the reverse prosthesis. Better ASES score, SANE score, and PCS as well as better external rotation and forward elevation were seen in the bilateral anatomic shoulder replacement group, but no significant difference in pain levels was seen between the two groups Conclusions: The results may be explained by the lower baseline seen in the reverse prosthesis group, which may be due to an older population and different indications. Nevertheless, more randomized controlled studies are needed to confirm these findings. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.105-110
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• 2018

Since the introduction of shoulder arthroplasty by Neer in 1974, the design of not only the glenoid component but also the humeral component used in shoulder arthroplasty has continually evolved. Changes to the design of the humeral component include a gradually disappearing proximal fin; diversified surface finishes (such as smooth, grit-blasted, and porous coating); a more contoured stem from the originally straight and cylindrical shape; and the use of press-fit uncemented fixation as opposed to cemented fixation. Despite the evolution of the humeral component for shoulder arthroplasty, however, stem-related complications are not uncommon. Examples of stem-related complications include intraoperative humeral fractures, stem loosening, periprosthetic fractures, and stress shielding. These become much more common in revision arthroplasty, where patients are associated with further complications such as surgical difficulty in extracting the humeral component, proximal metaphyseal bone loss due to stress shielding, intraoperative humeral shaft fractures, and incomplete cement removal. Physicians have made many attempts to reduce these complications by shortening the stem of the humeral component. In this review, we will discuss some of the limitations of long-stem humeral components, the feasibility of replacing them with short-stem humeral components, and the clinical outcomes associated with short-stemmed humeral components in shoulder arthroplasty.

• Earthquakes and Structures
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• v.17 no.5
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• pp.489-499
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• 2019

Elastic-plastic behavior of nuclear power plant elbow piping under seismic loads has been conducted in this study. Finite element analyses are performed using classical Bilinear kinematic hardening model (BKIN) and Multilinear kinematic hardening model (MKIN) as well as a nonlinear kinematic hardening model (Chaboche model). The influence of internal pressure and seismic loading on ratcheting strain of elbow pipe is studied by means of the three models. The results found that the predicted results of Chaboche model is maximum, closely followed by the predicted results of MKIN model, and the minimum is the predicted results of BKIN model. Moreover, comparisons of analysis results for each plasticity model against predicted results for a equivalent cyclic loading elbow component and for a simplified piping system seismic test are presented in the paper.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.1-5
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• 1998

Rotator cuff disease is the most common cause of shoulder pain. Recent understanding of structure and mechanics enables scientific approach to the treatment of the cuff teat. It is an integral component in the normal movement and function of the shoulder. This article addresses current knowledge of the structure and biomechanics of the rotator cuff, and reviews various kind of operative treatment.

• Clinics in Shoulder and Elbow
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• v.23 no.4
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• pp.190-193
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• 2020

In general, reverse shoulder arthroplasty revision is performed using the same implant for both the humerus and glenoid components. However, the authors of the present case used different implants from what was used previously for treating instability with scapular notching and glenoid aseptic loosening and report the case.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.42-48
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• 2022

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2002.10a
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• pp.7-7
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• 2002

Historically, the decision to perform a hemiarthroplasty (HHR) versus a total shoulder arthroplasty (TSA) is based on the status of the glenoid and the status of the soft tissues (rotator cuff). In disease processes where the glenoid articular cartilage is relatively well preserved such as avascular necrosis and complex proximal humerus fractures, most orthopaedists recommend performing a HHR while preserving the native glenoid articular surface. At the other end of the spectrum, if the glenoid has excessive bone loss or is unreconstructible, a HHR is the preferred procedure. In patients who have deficient so(t-tissues (rotator cuff) such as rotator cuff tear arthropathy and, occasionally, rheumatoid arthritis, a HHR is the procedure of choice. The indications for HHR in osteoarthritis remain somewhat controversial. There is mounting evidence that performing a HHR for osteoarthritis is inferior to TSA. Recent developments, or 'third generation techniques and materials', in shoulder arthroplasty are expected to improve the longevity of TSA, particularly the glenoid component. In addition, newer designs of reverse-ball prostheses are entering the market with promising early results in patients with deficient rotator cuff mechanisms.