Okke Heerspink

The shoulder is one of the most complex joints in the body. Besides a wide range of motion it also has to be stable. The rotator cuff is a major stabiliser of the glenohumoral joint. With increasing age rotator cuff tears are common. Successful treatment is described following surgical (rotator cuff repair) and conservative treatment. The aim of this thesis is to optimise management of degenerative rotator cuff tears. A randomised controlled trial was performed to compare both treatment modalities. At the one yearly follow up in all included patients standardized functional outcome scores were taken. In our population of patients we found at one year no significant differences in functional outcome scores. The best scores were found in the group of patients with an intact rotator cuff following repair. However, in 73% of patients treated surgically a retear was found. MRI assesment of the rotator cuff tear was commenced at inclusion and one year following treatment. We found during ...

Abstract Hypothesis The reversed shoulder arthroplasty, as introduced by Grammont, has had many modifications over time. One of these modifications was reducing the neck-shaft angle (NSA) from 155 degrees to 135 degrees. Biomechanical studies indicated that lowering the NSA increases external rotation, and reduces abduction and the incidence of scapular notching. The purpose of this study was to compare range of motion, functional outcome measures and complications in patients undergoing reversed shoulder arthroplasty, depending on the NSA, through a systematic review and meta-analysis. Methods A literature search was conducted (articles published from January 1985 till January 2020) in the PubMed/Medline, Embase, CINAHL databases and the Cochrane library. All studies reporting outcomes after primary reversed shoulder arthroplasty for osteoarthritis and rotator cuff-related disease were included. Patients were divided into two groups: a medialized design (MD) with a NSA of 150-155 degrees and a lateralized design (LD) with a NSA of less than 150 degrees. Pooled effects were calculated in the form of mean differences and 95% confidence intervals (CI). Risk of bias was assessed using the ROBINS-1 tool for non-RCTs and the RoB tool for RCTs. Results A total of 21 studies and 3134 arthroplasties were included: 1366 with a MD and 1678 with a LD. The mean age was 73.0 years (MD 74.0 and LD 72.5). A direct comparative meta-analysis was not feasible, and therefore all data were compared using the minimal clinical important difference. The MD group demonstrated a larger improvement in abduction (56.76°, 95% CI 37.03 – 76.49) compared to the LD group (48.52°, 95% CI 28.27 – 68.78), however the LD group demonstrated a larger improvement in external rotation with the arm at the side (MD: 7.69°, 95% CI 0.01 – 15.37; LD: 16.14° 95% CI 7.18 – 25.09). When looking at the postoperative range of motion, the MD group had more abduction than the LD group (MD: 136.28°, 95% CI 127.36 – 145.20; LD: 127.77° 95% CI 117.02 – 138.52). Both designs had a comparable improvement in the Constant Murley Score (MD 42.04 points, LD 41.14 points). Lowering the NSA was accompanied by a decrease in dislocation rate (MD: 4.6%; LD: 1.4%; P-value 0.037) and notching rate (MD: 40.3%; LD: 17.3%; P-value Conclusion In our analysis lowering the NSA decreases the amount of abduction, but increases the amount of external rotation. This change in ROM is accompanied by less scapular notching and dislocations. There is no clear impact on functional outcome measures.

Background Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient’s self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it. Objective This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, qual...

Patient satisfaction after a surgical procedure is dependent on meeting preoperative expectations. There is currently no patient expectations survey available for patients undergoing shoulder surgery that is validated, reliable, and easy to use in daily practice. The aim of this study was to develop a Patient Expectations of Shoulder Surgery (PESS) survey. In 315 patients, answers to an open-ended question about patient expectations were collected before shoulder surgery to develop the PESS survey. Patients' expectations of the PESS survey were associated with clinical outcome (change of Disabilities of the Arm, Shoulder, and Hand score). Content validity was assessed by a panel of 10 patients scheduled for shoulder surgery, and test-retest reliability was evaluated. Six items were included in the PESS survey: pain relief, improved range of motion, improved ability to perform daily activities, improved ability to perform work, improved ability to participate in recreational acti...