JSES International最新文献

{"title":"Trends in surgical procedures for shoulder instability among patients with Ehlers-Danlos syndrome or joint hypermobility syndrome","authors":"Arman Kishan MBBS ,&nbsp;Kiyanna Thomas BS ,&nbsp;Sanjay Kubsad BS ,&nbsp;Stanley Zhu BS ,&nbsp;Mohini Gharpure BS ,&nbsp;Henry Maxwell Fox MD ,&nbsp;Sarah Y. Nelson MD ,&nbsp;Umasuthan Srikumaran MD","doi":"10.1016/j.jseint.2024.08.178","DOIUrl":"10.1016/j.jseint.2024.08.178","url":null,"abstract":"<div><h3>Background</h3><div>Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are connective tissue disorders characterized by increased joint laxity, affecting musculoskeletal health and quality of life. In this study, we explored recent trends in surgical treatment of shoulder instability among patients with these disorders.</div></div><div><h3>Methods</h3><div>We searched the PearlDiver Mariner database, which includes deidentified US all-payer claims data from 2010 to 2020. We used procedure and diagnostic codes for EDS and JHS to select patients. The primary outcome was the yearly trend in relative utilization of the following 4 shoulder instability procedures: arthroscopic stabilization, Latarjet coracoid transfer, open capsulolabral repair, and open capsulolabral shift.</div></div><div><h3>Results</h3><div>Among 109,274 patients with EDS and 453,885 with JHS, 3.4% and 0.8% underwent shoulder instability procedures, respectively. Arthroscopic stabilization was the predominant treatment, with a mean utilization rate of 78% for EDS and 83% for JHS. Notably, the age at surgery increased for EDS patients but decreased for JHS patients. Female patients represented large proportions of those undergoing procedures in both the EDS group (83%) and the JHS group (77%).</div></div><div><h3>Conclusions</h3><div>Our findings indicate a consistent preference for arthroscopic stabilization in treating shoulder instability in patients with EDS and JHS. The trends in age suggest shifts in treatment strategies, possibly influenced by advancements in nonoperative interventions or varying symptom severity. The higher proportion of female patients aligns with the known prevalence of connective tissue disorders in women. Future research should explore outcomes, complications, and specific EDS subtypes to guide optimal treatment strategies for these challenging connective tissue disorders.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation, cross-cultural adaptation, validity, and reliability of the Indonesian version of the Oxford Shoulder Score for patients with shoulder pain","authors":"Romy Deviandri MD, PhD ,&nbsp;Afrianto Daud PhD ,&nbsp;Iman W. Aminata MD ,&nbsp;Putri Octarina BMed ,&nbsp;Nasywa D. Mecca ,&nbsp;Hugo C. van der Veen MD, PhD ,&nbsp;Inge van den Akker-Scheek MD, PhD","doi":"10.1016/j.jseint.2024.08.175","DOIUrl":"10.1016/j.jseint.2024.08.175","url":null,"abstract":"<div><h3>Background</h3><div>No questionnaire is currently available for use in patients with shoulder pain in an Indonesian-speaking population. This study aimed to translate the Oxford Shoulder Score (OSS) into Indonesian and assess its validity and reliability for use in Indonesian-speaking patients with shoulder pain.</div></div><div><h3>Methods</h3><div>After a forward and backward translation procedure, the validity and reliability of the questionnaire were investigated. All patients who were treated in a hospital in Indonesia for shoulder pain during the inclusion period were asked to complete 3 questionnaires: the Indonesia-OSS (I-OSS), the Medical Outcomes Study 12-Item Short-Form Health Survey, and the American Shoulder and Elbow Surgeons questionnaire. Participants were asked to complete the I-OSS a second time after a 1-week interval. Following Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement error were determined. The Bland-Altman method was used to explore systematic bias.</div></div><div><h3>Results</h3><div>Data of 100 patients could be used to determine validity, and data of 87 patients to determine test-retest reliability. Construct validity can be considered good, as more than 75% of the predefined hypotheses on correlations between the I-OSS and the other questionnaires could be confirmed. An intraclass correlation coefficient value of 0.99 was found, indicating good test-retest reliability. A Cronbach’s α of 0.95 implied good internal consistency, and no floor or ceiling effects were found. The standard error of measurement was 1.8, with minimal detectable change at the individual level was 5.1, and at the group level was 0.5. Bland-Altman analysis showed no systematic bias.</div></div><div><h3>Conclusion</h3><div>The I-OSS can be considered a valid and reliable questionnaire for Indonesian-speaking patients with shoulder pain.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Latarjet reduces residual apprehension, redislocation and possibility of dislocation arthropathy compared to arthroscopic Bankart repair despite greater bipolar bone loss in anterior glenohumeral instability","authors":"Ceyhun Çağlar MD ,&nbsp;Serhat Akçaalan MD ,&nbsp;Batuhan Akbulut MD ,&nbsp;Mehmet Can Kengil MD ,&nbsp;Mahmut Uğurlu MD ,&nbsp;Metin Doğan MD","doi":"10.1016/j.jseint.2024.08.181","DOIUrl":"10.1016/j.jseint.2024.08.181","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic Bankart repair (ABR) and the open Latarjet (OL) procedure are the most frequently preferred methods in the treatment of anterior glenohumeral instability. The aim of this study was to compare patients who underwent ABR or OL due to anterior glenohumeral instability in terms of functional capacity, glenohumeral bone loss, residual apprehension, redislocation, and dislocation arthropathy.</div></div><div><h3>Methods</h3><div>A total of 56 patients who underwent ABR or OL due to anterior glenohumeral instability between January 2018 and December 2021 were evaluated retrospectively. There were 32 patients in the ABR group and 24 patients in the OL group. Patients’ demographic characteristics, number of preoperative dislocations, and return-to-work, and follow-up periods were recorded. Glenoid bone loss, Hill–Sachs interval, and Hill–Sachs depth were measured from preoperative computed tomography sections. The American Shoulder and Elbow Surgeons score, the Western Ontario Shoulder Instability Index score, Rowe score, and joint range of motion were calculated. Patients were also asked about residual apprehension, postoperative redislocations, dislocation arthropathy, and surgery satisfaction.</div></div><div><h3>Results</h3><div>The mean age of the ABR group was 22.5 ± 3.9 years (28 men, 4 women), while that of the OL group was 25.0 ± 4.8 years (22 men, 2 women). The mean number of dislocations was 2.7 ± 1.3 in the ABR and 10.9 ± 5.5 in the OL (<em>P</em> = .001). Higher values of glenoid bone loss (%) (ABR: 6 ± 2; OL: 20 ± 4), Hill–Sachs interval (mm) (ABR: 8 ± 3; OL: 21 ± 3), and Hill–Sachs depth (mm) (ABR: 5 ± 2; OL: 8 ± 2) were measured in the OL (<em>P</em> = .001 for all), reflecting significantly more bone loss. Residual apprehension was detected in 10 patients in the ABR and 2 patients in the OL (<em>P</em> = .007). While 4 patients in the ABR had a history of redislocation, no redislocation occurred in the OL (<em>P</em> = .012). Dislocation arthropathy development was observed in 9 patients in the ABR and 4 patients in the OL (<em>P</em> = .038), according to the modified Samilson and Prieto classification. External rotation in adduction and external rotation in 90° abduction were approximately 5° higher in the OL (<em>P</em> = .011 and <em>P</em> = .016, respectively).</div></div><div><h3>Conclusion</h3><div>The ABR and OL methods both provide satisfactory outcomes in the treatment of anterior glenohumeral instability with appropriate indications. The OL procedure is preferred for patients with more dislocations and greater bipolar bone loss. Despite greater bipolar bone loss, the OL procedure provides lower rates of residual apprehension, redislocation, and dislocation arthropathy. Additionally, due to the stability it provides, there is less loss in external rotation.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper limb functional testing: does age, gender, and sport influence performance?","authors":"Camille Tooth PT, PhD ,&nbsp;Cédric Schwartz PhD ,&nbsp;Jean-Louis Croisier PT, PhD ,&nbsp;Amandine Gofflot PT ,&nbsp;Stephen Bornheim PT, PhD ,&nbsp;Bénédicte Forthomme PT, PhD","doi":"10.1016/j.jseint.2024.08.177","DOIUrl":"10.1016/j.jseint.2024.08.177","url":null,"abstract":"<div><h3>Background</h3><div>Musculoskeletal adaptations are common in overhead athletes. As they also are involved in injury prevention, there has been an increase in their evaluation through shoulder screening over the last years. However, for some evaluations, and especially for functional testing, there is a lack of normative values, which limits the interpretation of the values measured. Moreover, the influence of age, gender, and sport on upper limb functional tests remains underexplored.</div></div><div><h3>Methods</h3><div>Five hundred eighty seven athletes (handball players, rugby players, swimmers, tennis players, and volleyball players) performed a battery of upper limb functional tests between 2018 and 2023, including the Modified-Athletic Shoulder Test, the Single Arm Medicine Ball Throw, the Seated Single Arm Shot Put Test, the Upper Limb Rotation Test, the Upper Quarter Y Balance Test, the Modified Closed Kinetic Chain Upper Extremity Stability Test, and the Posterior Shoulder Endurance Test. In total, normative values as well as the influence of age, gender, and sport on upper limb functional performance were obtained for 496 of them.</div></div><div><h3>Results</h3><div>The Modified-Athletic Shoulder Test revealed sport-specific adaptations, with dominant arms significantly outperforming nondominant arms, notably in handball, rugby, and tennis. The Single Arm Medicine Ball Throw and Seated Single Arm Shot Put Test highlighted the influence of age and gender on upper limb power, with males consistently outperforming females. The Upper Limb Rotation Test demonstrated similar rotation in both arms across sports, while gender disparities were still observed. The Upper Quarter Y Balance Test exhibited surprising consistency in upper-quarter balance across sports and age groups (<em>P</em> &gt; .05). The Modified Closed Kinetic Chain Upper Extremity Stability Test showed age-related improvements in stability, while the Posterior Shoulder Endurance Test demonstrated age-related differences in posterior shoulder endurance in swimmers.</div></div><div><h3>Conclusion</h3><div>This study contributes to advances in sports medicine by better understanding functional shoulder performances in upper limb athletes. The differences observed according to the sport, gender, or age underscore the importance of sport-specific assessments and interventions. Moreover, the normative values provided will be essential for primary prevention as well as for determining return-to-play capacity after an injury or surgery.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual assessment of internal rotation in reverse shoulder arthroplasty based on statistical shape models of scapular size","authors":"Lisa A. Galasso MD ,&nbsp;Alexandre Lädermann MD ,&nbsp;Brian C. Werner MD ,&nbsp;Stefan Greiner MD ,&nbsp;Nick Metcalfe BS ,&nbsp;Patrick J. Denard MD","doi":"10.1016/j.jseint.2024.07.014","DOIUrl":"10.1016/j.jseint.2024.07.014","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to assess impingement-free internal rotation (IR) in a virtual reverse shoulder arthroplasty simulation using a Statistical Shape Model based on scapula size.</div></div><div><h3>Methods</h3><div>A database of over 10,000 scapulae utilized for preoperative planning for shoulder arthroplasty was analyzed with a Statistical Shape Model to obtain 5 scapula sizes including the mean and 2 standard deviations. For each scapula model, one glenosphere size (33-42 mm) was selected as the best fit based on consensus among 3 shoulder surgeons. Virtual implantation variables included 1) lateral offset (0-12 mm in 2-mm increments), 2) inferior eccentricity (0, 2.5, 5, and 7.5 mm), and 3) posterior eccentricity (0, 2.5, and 5 mm). The neck shaft angle was fixed at 135° with an inlay design humeral prosthesis. IR at the side (IR0) and in abduction (IRABD) were then simulated.</div></div><div><h3>Results</h3><div>Maximum impingement-free IR0 was reached with increasing inferior offset in combination with increasing lateralization. Lateralization was the most important variable in increasing impingement-free IRABD. Maximum IRABD was reached at 4-6 mm of lateralization with smaller scapula (−2 to 0 standard deviation). Increasing lateralization up to 12 mm continues to increase IRABD for larger-sized scapula (+1 to +2 standard deviation). Optimal inferior offset and lateralization to maximize IR did have a small loss of external rotation in neutral abduction. There was no loss of external rotation in 60° of abduction.</div></div><div><h3>Conclusion</h3><div>In a virtual model, the glenosphere position required to maximize IR varied by scapula size. For smaller scapulae, maximum IR0 was reached with a combination of 2.5-mm inferior offset and 0- 4 mm of lateralization. For larger scapulae, maximum IR0 was reached with a combination of 2.5 mm of inferior offset and 4 mm of lateralization. The amount of lateralization required to maximize IRABD also varies by scapula size. Maximum IRABD was reached in smaller scapula with 4-6 mm of lateralization and at least 12 mm of lateralization in larger scapula. These findings may be applied in the clinical decision-making process knowing that impingement-free IR and IRABD can be maximized with combinations of inferior offset and lateralization based on scapula size with minimal effect on external rotation and external rotation in 60° of abduction.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glenoid wear and migration pattern of a humeral head resurfacing implant: a prospective study using radio stereometric analysis","authors":"Michael Axenhus MD, PhD,&nbsp;Magnus Ödquist MD, PhD,&nbsp;Hassan Abbaszadegan MD, PhD,&nbsp;Olof Sköldenberg MD, PhD,&nbsp;Björn Salomonsson MD, PhD","doi":"10.1016/j.jseint.2024.07.012","DOIUrl":"10.1016/j.jseint.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>The humeral head resurfacing arthroplasty (HHR) is normally used as a hemi shoulder arthroplasty and has been in use for the treatment of Gleno-Humeral osteoarthritis (OA) of the shoulder for more than 30 years. Some studies, however, shows that anatomical total shoulder arthroplasty provides better improvement in function than a HHR for patients with OA. Reasons for this may be a progressive glenoid wear (GW) or loosening of the HHR. We, therefore, wanted to investigate the migration pattern of the HHR and also GW by using radio stereometric analysis (RSA).</div></div><div><h3>Methods</h3><div>21 patients (21 shoulders) with OA and a mean age of 64 years were enrolled in the study. They all received the Copeland humeral resurfacing head and were followed for 2 years with RSA. We evaluated the clinical outcome at 2 years with Western Ontario Osteoarthritis of the Shoulder (WOOS), EuroQol 5 dimension 3L and Constant Shoulder Score. In addition, we assessed data on WOOS and revisions until 5 years follow-up by using the local clinic data within the Swedish Shoulder Arthroplasty Register.</div></div><div><h3>Results</h3><div>After an initial migration at two months the implants were stable in relation to the humerus with no statistically significant difference between the 2 months and the 2 years value (<em>P</em> = .23). The GW continued to increase during the study period with an initial migration of mean 2.3 mm and at 2 years 3.5 mm with a statistically difference between the 6 months and 2 years value (<em>P</em> = .046). The WOOS, EuroQol 5 dimension 3L and Constant Shoulder Score were all improved at 2 years compared to the preoperative values. We found a weak correlation between GW at 2 years and the WOOS score at 2 and 5 years, but these did not reach statistical significance. There were 4 revisions within 5 years after the primary operation, all due to pain.</div></div><div><h3>Conclusion</h3><div>The marker-free RSA can be used in clinical studies for assessing migration in HHR implants and was also for the first time used to measure GW. The Copeland HHR seems to obtain a secure fixation in the humerus but shows continuous GW up to two years.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic anterior stabilization of the shoulder using buttons","authors":"José Carlos Garcia Jr MD, PhD,&nbsp;Cindy Yukie Nakano Schincariol MD,&nbsp;Ricardo Berriel Mendes MD,&nbsp;Paulo Cavalcante Muzy MD","doi":"10.1016/j.jseint.2024.06.016","DOIUrl":"10.1016/j.jseint.2024.06.016","url":null,"abstract":"<div><h3>Background</h3><div>Surgical procedures to treat anterior shoulder instability are essentially divided into those for significant bone loss and those without relevant bone loss. However, there is a gray area between these procedures that would not require bone grafting but would benefit from improved stabilization mechanisms. This study evaluates a technique based on the triple soft tissue block, the dynamic anterior stabilization of the shoulder, using an adjustable button.</div></div><div><h3>Methods</h3><div>Twenty patients that underwent surgical procedure from September 2017 to March 2022 were prospectively evaluated. All were assessed with University of California-Los Angeles, American Shoulder and Elbow Surgeons scores, and measurement of external rotation of the shoulder before and 24 or more months after surgery, and the Rowe score at least 24 months postsurgery. The Rowe score was compared to the standard of 90, bone loss was also measured.</div></div><div><h3>Results</h3><div>The mean University of California-Los Angeles score changed from 25.60 ± 2.83 before surgery to 34.60 ± 0.82 postsurgery <em>P</em> &lt; .01; American Shoulder and Elbow Surgeons from 84.99 ± 8.94 before surgery to 97.34 ± 4.39 postsurgery <em>P</em> &lt; .01; Rowe with an average of 98.00 ± 2.99 compared to the standard 90 of excellent results <em>P</em> &lt; .01. The average loss of lateral rotation was 2.25° ± 2.55 (0°-5°), and the average bone loss in patients was 8% ± 2.48% (0%-20%).</div></div><div><h3>Conclusion</h3><div>The proposed procedure demonstrated safety and effectiveness in treating recurrent anterior glenohumeral instability.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved patient reported outcomes with knotless double-row rotator cuff repair with and without lateral row biceps tenodesis at 2- and 5-years","authors":"Giovanna Medina MD, PhD ,&nbsp;Mathew Quattrocelli DO ,&nbsp;Natalie Lowenstein BS, MPH ,&nbsp;Jamie Collins PhD ,&nbsp;Elizabeth Matzkin MD","doi":"10.1016/j.jseint.2024.06.013","DOIUrl":"10.1016/j.jseint.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to report outcomes of an arthroscopic knotless double-row (DR) rotator cuff repair (RCR) technique at 2- and 5- years postoperatively, and to compare clinical outcomes in patients undergoing knotless DR RCR with incorporated lateral row biceps tenodesis (LRT) vs. those without LRT.</div></div><div><h3>Methods</h3><div>All primary RCR surgeries were performed by a single surgeon at a single institution using a knotless transosseous equivalent (TOE) technique. The postoperative rehabilitation protocol was standardized for all patients. The primary outcomes collected included American Shoulder and Elbow Surgeons (ASES) Function, ASES Index, Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), Veterans RAND 12-Item Health Survey (VR-12) physical and mental, and Visual Analogue Scale (VAS) scores.</div></div><div><h3>Results</h3><div>Three hundred forty-two patients met inclusion criteria, of which 262 patients underwent isolated RCR and 61 underwent RCR with a concomitant LRT, 15 underwent RCR with concomitant tenotomy and 4 had RCR with débridement of the biceps. Significant improvements in VAS, ASES, SANE, SST, and VR-12 scores were observed at all-time points in all patient groups. No statistically significant differences in outcomes were noted in patients undergoing RCR with a lateral row tenodesis vs. those undergoing RCR alone. Similarly, no differences were seen when stratified by age, sex, body mass index, Worker’s Compensation status, smoking, and diabetes mellitus. Based on ASES, 81% of patients met minimum clinically important difference, and 64% met maximal outcome improvement at 1-year postoperatively.</div></div><div><h3>Conclusion</h3><div>Knotless DR TOE arthroscopic RCR significantly improves patient-reported clinical outcomes at 1-, 2- and 5-year follow-ups. These results are reflected in clinical practice because 80% achieve minimum clinically important difference postoperatively. Patient-related factors, including body mass index, age, sex, Worker’s Compensation, and diabetes mellitus do not significantly affect patient-reported outcomes in the first 5 years after surgery. Smokers have worse baseline scores which persist at 2-year follow-up. Lastly, adding an arthroscopic LRT in knotless DR TOE arthroscopic RCR provides similar clinical outcomes to knotless DR TOE arthroscopic RCR without biceps tenodesis.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior nonarthroplasty shoulder surgery and modifiable risk factors negatively affect patient outcomes after shoulder arthroplasty","authors":"Katherine A. Burns MD ,&nbsp;Lynn M. Robbins PA-C ,&nbsp;Angela R. LeMarr BSN, RN, ONC ,&nbsp;Diane J. Morton MS, MWC ,&nbsp;Varun Gopinatth BS ,&nbsp;Melissa L. Wilson PhD, MPH","doi":"10.1016/j.jseint.2024.07.011","DOIUrl":"10.1016/j.jseint.2024.07.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Total shoulder arthroplasty frequently is performed in patients with a history of shoulder surgery. The purpose of this study was to evaluate clinical outcomes after primary shoulder arthroplasty in patients with a history of nonarthroplasty shoulder surgery, and whether certain modifiable risk factors (MRFs) were negatively associated with final outcome measures. The secondary purpose was to determine if costs or complications were higher in patients with prior shoulder surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective cohort study of all patients who underwent primary shoulder arthroplasty from January 2015 to December 2019 by one surgeon at one institution. Patients who received hemiarthroplasty were excluded. Univariate analysis was performed to assess the influence of prior shoulder surgery on costs, complications, and patient-reported outcome measures. Multivariable analysis was performed to determine if MRF negatively affected results, defined as anemia, malnutrition, obesity, uncontrolled diabetes, tobacco use, and opioid use.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;512 patients met inclusion criteria; 139 patients had at least one prior shoulder surgery. Patients with history of prior shoulder surgery were younger (65.2 ± 9.3 years vs. 70.7 ± 9.1 years, &lt;em&gt;P&lt;/em&gt; &lt; .001), more likely to be male (52.2% vs. 47.8%, &lt;em&gt;P&lt;/em&gt; = .016), more likely to have smoking history (20.1% vs. 10.5%, &lt;em&gt;P&lt;/em&gt; = .002), and borderline more likely to use preoperative opioids (47.5% vs. 38.9%, &lt;em&gt;P&lt;/em&gt; = .078) while reporting significantly higher pain scores at final follow-up (visual analog scale for pain 1.7 ± 2.4 vs. 1.1 ± 1.9, &lt;em&gt;P&lt;/em&gt; = .001) and lower patient-reported outcome measure (&lt;em&gt;P&lt;/em&gt; ≤ .017 for all). The final American Shoulder and Elbow Surgeons score (ASES) score was independently negatively impacted by a history of prior surgery (&lt;em&gt;β&lt;/em&gt; = −4.25 (−7.92, −0.56), &lt;em&gt;P&lt;/em&gt; = .024) and other nonmodifiable factors including prosthesis type of reverse arthroplasty (&lt;em&gt;β&lt;/em&gt; = −6.31, confidence interval [CI] −10.02, −2.60, &lt;em&gt;P&lt;/em&gt; = .001), cardiac disease (&lt;em&gt;β&lt;/em&gt; = −3.59, CI −7.12, −.0.07, &lt;em&gt;P&lt;/em&gt; = .046), and any complication (&lt;em&gt;β&lt;/em&gt; = 0.28, CI 0.19, 0.36, &lt;em&gt;P&lt;/em&gt; &lt; .001). The final ASES score was negatively impacted by MRF including opioid use (&lt;em&gt;β&lt;/em&gt; = −4.08, CI: −7.32, −0.84, &lt;em&gt;P&lt;/em&gt; &lt; .001) and smoking status (&lt;em&gt;β&lt;/em&gt; = −7.59, CI: −12.69, −2.49, &lt;em&gt;P&lt;/em&gt; &lt; .001). Males had slightly higher final ASES scores (&lt;em&gt;β&lt;/em&gt; = 3.79, CI 0.46, 7.11, &lt;em&gt;P&lt;/em&gt; = .026). Patients with prior surgery were more likely to have an intraoperative stress fracture [odds ratio [OR] 4.6 (1.1, 19.5), &lt;em&gt;P&lt;/em&gt; = .038] and borderline more likely to have neurologic complication [OR 1.7 (1.0, 3.0), &lt;em&gt;P&lt;/em&gt; = .062] or any complication [OR 1.5 (1.0, 2.3), &lt;em&gt;P&lt;/em&gt; = .075].&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Patients with prior shoulder surgery were y","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of an open biopsy in the diagnosis of periprosthetic joint infection","authors":"Adrik Z. Da Silva BS ,&nbsp;Michael A. Moverman MD ,&nbsp;Silvia M. Soule BS ,&nbsp;Christopher D. Joyce MD ,&nbsp;Robert Z. Tashjian MD ,&nbsp;Peter N. Chalmers MD","doi":"10.1016/j.jseint.2024.07.010","DOIUrl":"10.1016/j.jseint.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Determining the presence of bacteria in the shoulder prior to shoulder arthroplasty can be challenging especially in the case of revision arthroplasty. An open biopsy provides an opportunity to obtain tissue samples with minimal patient morbidity. The purpose of this study was to characterize the diagnostic utility of an open shoulder biopsy.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed at an academic medical center. All patients that underwent an open shoulder biopsy using a small proximal deltopectoral incision between 2008 and 2021 were included. Demographics, surgical history, culture results, and development of subsequent infection were recorded. Subsequent infection was defined as the development of a sinus tract, purulent drainage, or revision surgery with greater than or equal to two tissues specimens with growth of the same bacterial species. Sensitivity and negative predictive value (NPV) of an open biopsy were calculated based on the development of subsequent infection. As culture positive patients were treated for their infection, positive predictive value and specificity could not be determined.</div></div><div><h3>Results</h3><div>We identified 55 patients that underwent 75 open biopsies. Most patients had a shoulder arthroplasty in place at the time of biopsy (69.1%), while 23.6% had an antibiotic spacer, and 7.3% had a native shoulder. Patients with a history of infection were more likely to have a spacer in place at the time of biopsy (65% vs. 0%; <em>P</em> &lt; .001). The sensitivity of an open biopsy was 60% and the NPV was 83% among patients with a shoulder arthroplasty with no history of infection to predict infection after revision arthroplasty. The sensitivity was 63% and NPV was 75% among patients with any history of shoulder infection. The sensitivity was 67% and the NPV was 83% among patients with an arthroplasty in place at the time of biopsy independent of prior infection. The sensitivity was 62% and the NPV was 75% among patients with an antibiotic spacer at the time of biopsy. Mean operative time was 32.2 ± 10.5 minutes.</div></div><div><h3>Discussion</h3><div>This diagnostic utility of an open shoulder biopsy is not influenced by whether there is a history of infection or whether there is currently a spacer or an arthroplasty in place, with a sensitivity between 60% and 67% and a NPV between 75% and 83%.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}