Rheumatoid Arthritis: Goldhahn J

Simmen BR, Bogoch ER, Goldhahn J. · Upper Extremity Department, Schulthess Klinik in Zürich, Switzerland. · Nat Clin Pract Rheumatol. · Pubmed #18334981 No free full text.

Abstract: Longstanding rheumatoid arthritis (RA) leads to disability, caused mainly by joint destruction. The current goals of surgical intervention are to restore function and quality of life, prevent joint deterioration, relieve pain, and correct deformity. A number of different surgical treatment options are available to patients with RA, including synovectomy, arthrodesis, joint replacement, and soft tissue and special hand surgery; nonoperative management is also important. Decision-making and timing for orthopedic intervention are complex issues because of polyarticular involvement. Functional impairment, pain, and the subsequent loss of quality of life and inability to work have become the main considerations for surgical reconstruction. Early referral for orthopedic treatment can lead to improved functional benefit for patients with RA. The decision for orthopedic intervention should be established by an interdisciplinary team that includes rheumatologists and orthopedic surgeons experienced in the surgery of RA. Priority should be given to the joint that causes the greatest disability and pain. Disease progression and pharmaceutical treatment options should be taken into consideration when establishing an orthopedic intervention protocol.

Simmen BR, Schwyzer HK, Flury MP, Goldhahn J. · Abteilung Obere Extremität, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland. · Oper Orthop Traumatol. · Pubmed #19326066 No free full text.

Abstract: OBJECTIVE: Exact restoration of the glenohumeral joint, especially in the case of complex pathologies, due to high prosthesis modularity and in situ assembly; later conversion to inverse design with same shaft possible. INDICATIONS: Primary shoulder osteoarthritis, secondary joint destruction after previous fracture or its treatment, humeral head necrosis, or inflammatory processes, revisions of defect situations such as hemiprostheses. CONTRAINDICATIONS: General contraindications of total shoulder arthroplasty, additionally, functional loss of the rotator cuff, advanced osteoporosis, narrow medullary canal, e.g., in patients with juvenile rheumatoid arthritis. SURGICAL TECHNIQUE: After deltopectoral approach free resection of the humeral head along landmarks, stepwise rasping of the humeral medullary canal, insertion of the rectangled stem, realignment of humeral height with the body, realignment of inclination and possible retroversion with the inclination set. The asymmetric head ensures exact restoration of the joint center. Implantation of the cemented glenoid, test of range of motion and soft-tissue tension, and exchange of components in situ, if necessary. RESULTS: A prospective evaluation of the first 146 consecutive patients with 1-year follow-up revealed significant improvements of about 151% regarding pain and of about 98% in function without significant differences between different indications. Four shaft fissures were observed and treated with intraoperative cerclages during the learning period. No further fissures were noted after adaptation of the surgical procedure and subsequent guidelines. One traumatic and one atraumatic head rotation were observed but should be prevented with a new torque wrench. Similar functional results can be achieved even in complex shoulder pathologies due to the high modularity of the prosthesis.

Simmen BR, Bachmann LM, Drerup S, Schwyzer HK, Burkhart A, Flury MP, Goldhahn J. · Upper Extremity Department, Schulthess Clinic, Zurich, Switzerland. · J Shoulder Elbow Surg. · Pubmed #18818102 No free full text.

Abstract: The purpose of this report is to assess the association of concomitant biceps tenodesis in total shoulder arthroplasty with treatment success 1 year after total shoulder arthroplasty. Of 136 consecutive shoulders (124 patients) undergoing primary total shoulder arthroplasty between 2003 and 2006, 54 (39.7%) underwent biceps tenodesis. For each patient, we obtained potential preoperative confounding data, such as age; gender; presence of rheumatoid arthritis; Short Form 36; number of previous shoulder operations; Disabilities of the Arm, Shoulder and Hand score; Shoulder Pain and Disability Index score; and insurance status. At the 1-year follow-up, we calculated the Constant score of all patients (ranging from 0 [worst] to 100 [best]). We first determined the crude association of concomitant biceps tenodesis with 1-year treatment success (Constant score > or =80) and then fitted a multivariate model correcting for potential confounders to assess the adjusted association of the biceps tenodesis on treatment success. The total number of treatment successes was 46 of 136 shoulders (33.8% of all prosthesis implantations). The crude association (odds ratio) of a concomitant biceps tenodesis with treatment success was 2.38 (95% confidence interval [CI] 1.15 to 4.93; P = .02). When adjusting for potential confounders, we found that this association slightly increased to 2.97 (95% CI 1.00 to 8.85; P = .05). Concomitant biceps tenodesis appears to have a favorable effect on 1-year treatment success after total shoulder arthroplasty.

Simmen BR, Bachmann LM, Drerup S, Schwyzer HK, Burkhart A, Goldhahn J. · Orthopedics Department, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland. · Osteoarthritis Cartilage. · Pubmed #18061485 No free full text.

Abstract: OBJECTIVE: To Estimate the probability of treatment success 1 year after a total shoulder arthroplasty by developing a model based on preoperative clinical factors. METHOD: Between June 2003 and December 2006, 140 patients undergoing shoulder operations were assessed for age, gender, current rheumatoid arthritis, Short Form (SF) 36 physical and mental sum scores, previous shoulder operations, the Disabilities of Arm, Shoulder and Hand (DASH) symptom and function scores, the Shoulder Pain and Disability Index (SPADI), and insurance status. One year after the operation a Constant score of 80 or more out of 100 indicated successful treatment. Patient variables were analyzed with a logistic regression model augmented in a stepwise manner and bootstrapped 100 times. Variables selected at least 33 times were incorporated into a final model and the Area under the Receiver Operating Characteristics Curve (aROC) was calculated. RESULTS: There were 47/140 (33.6%) successful treatments. The probability of success was reduced in patients with previous shoulder operations (Odds Ratio [O.R.] 0.17, 95% Confidence Interval (95%CI) 0.04-0.85; P=0.03) and older than 75 years (O.R. 0.21, 95%CI 0.05-0.77; P=0.02). The probability of success increased in patients with a higher SF 36 mental sum score (O.R. 1.03, 95%CI 0.96-1.09, P=0.42) and a higher DASH function score (O.R. 1.05, 95%CI 1.02-1.07, P=0.001). The aROC was 0.79 (0.70-0.88) indicating that the model has a high predictive capacity. CONCLUSION: Once validated this model based on four preoperative clinical factors offers a prediction of whether a patient will respond to treatment 1 year after total shoulder arthroplasty.

Goldhahn J, Kolling C, Gay S, Simmen BR. · Upper Extremity Department, Schulthess Clinic, Zürich, Switzerland. · Nat Clin Pract Rheumatol. · Pubmed #17299449 No free full text.

Abstract: BACKGROUND: A 46-year-old, nonsmoking, nulliparous woman with a 23-year history of rheumatoid arthritis presented with severely destructed right shoulder, right elbow, and right wrist joints, which resulted in a complete loss of working ability. INVESTIGATIONS: Physical examination, X-ray, MRI, ultrasound, functional staging using the Shoulder Pain and Disability Index, the Patient Rated Elbow Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the health-related quality-of-life Short Form 36 questionnaire, determination of the c-reactive protein level, erythrocyte sedimentation rate, Disease Activity Score 28 and the metalloproteinase profile, and histology of removed synovial tissue. DIAGNOSIS: Severe destruction of the right shoulder and elbow (Larsen grade IV) resulting from late-stage seropositive rheumatoid arthritis. MANAGEMENT: Reconstruction of the elbow and ipsilateral shoulder in a two-step procedure: replacement of the elbow joint with a semiconstrained Gschwend-Scheier-Bahler III (GSB III) elbow prosthesis (Zimmer, Inc., Warsaw, IN) followed by replacement of the shoulder with the Promos Modular Shoulder System (Plus Orthopedics AG, Rotkreuz, Switzerland) 1 month later. The patient received 4 weeks of inpatient rehabilitation.

Angst F, Goldhahn J, John M, Herren DB, Simmen BR. · Obere Extremitäten- und Handchirurgie, Schulthess-Klinik, Zürich, Schweiz. · Orthopade. · Pubmed #15856166 No free full text.

Abstract: BACKGROUND: Patients with elbow destruction due to rheumatoid arthritis (RA) or trauma (PT) were compared to population-based normative data and to each other after total elbow arthroplasty. PATIENTS AND METHODS: Pain, function, and biopsychosocial health were multidimensionally assessed by the generic Short Form 36 (SF-36), the condition-specific Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the Patient Related Elbow Evaluation form (PREE) instrument and analyzed by uni- and multivariate methods. RESULTS: Compared to normative values, the examined 59 RA patients were significantly affected in the function scales of the SF-36 and in all DASH scales. The 20 PT patients were worse than the norm only in the DASH function. Function was lower in RA than in PT in the SF-36 scales and in the DASH (RA: 44.4, PT: 70.3, p<0.001). This difference was less distinct in the PREE. CONCLUSION: Total elbow arthroplasty led to a pain-free outcome and normal quality of life, but failed to restore complete function. Functional deficits were larger in the RA patients and could also be measured by the SF-36, possibly due to polyarticular affection.

Kolling C, Herren DB, Simmen BR, Goldhahn J. · No affiliation provided · Ann Rheum Dis. · Pubmed #19605747 No free full text.

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