JSES International最新文献

{"title":"ChatGPT can provide satisfactory answers to patient questions regarding biceps tenodesis","authors":"Darcy I. Ottomanelli MS ,&nbsp;Paxton G. Sweeney BA ,&nbsp;Stephen G. Silver MD ,&nbsp;Rocco Bassora MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Oscar Vazquez MD","doi":"10.1016/j.jseint.2025.04.013","DOIUrl":"10.1016/j.jseint.2025.04.013","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder pain often arises from pathology affecting the long head of the biceps brachii tendon, with biceps tenodesis recognized as a widely-accepted treatment. Research indicates a significant correlation between preoperative expectations and postoperative satisfaction, emphasizing the pivotal role of patient education. Although advancements in artificial intelligence (AI) technology, such as ChatGPT, hold promise for providing comprehensive health-related information, the accuracy can vary. This study aims to assess the quality and accuracy of ChatGPT's responses to patient inquiries about biceps tenodesis, offering insight on AI’s contribution to enhancing patients' understanding and expectation management.</div></div><div><h3>Methods</h3><div>A list of the 10 most frequently asked patient questions regarding biceps tenodesis were identified from the websites of various orthopedic institutions. Each question was individually entered into the most current version of ChatGPT at the time of data collection (v3.5), and the responses were recorded. The responses were then reviewed by four board-certified orthopedic surgeons and graded based on two evidence-based rating systems: the ChatGPT response rating system and the AI response metric. Additionally, the reading level required to fully comprehend the responses was calculated using the Flesch-Kincaid Grade Level assessment.</div></div><div><h3>Results</h3><div>Of the 10 responses evaluated, 1 was deemed excellent, requiring no clarification, and 7 were satisfactory, needing minimal clarification according to the ChatGPT response rating system. Two out of 10 responses were rated by surgeons as excellent, clear, comprehensive, and aligned with current literature. Seven responses were deemed good, being mostly clear and complete and in line with current literature. On average, a Flesch-Kincaid score indicated that 18.5 years of education were required to fully comprehend the responses, corresponding to the level of a college graduate.</div></div><div><h3>Discussion/Conclusion</h3><div>Most of the ChatGPT responses can provide satisfactory but limited information to answer patients' questions about biceps tenodesis. The reading level required to comprehend the response was too advanced for the average patient, leading to potential misunderstanding and misinterpretation of the response. Recognizing the limitations of ChatGPT to accurately and comprehensively answer patient questions can help guide surgeons when approaching discussions with patients regarding biceps tenodesis.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1378-1384"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyethylene wear: an under-reported cause of failed shoulder arthroplasty","authors":"Brandon Fisher MD ,&nbsp;Matthew Astolfi MD ,&nbsp;Justin DesLaurier MD ,&nbsp;Karen Childers MS ,&nbsp;James Y.J. Lee MD ,&nbsp;Marisa Samani BA ,&nbsp;Madeleine DeClercq BS ,&nbsp;J. Michael Wiater MD","doi":"10.1016/j.jseint.2025.04.002","DOIUrl":"10.1016/j.jseint.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Polyethylene (PE) wear after shoulder arthroplasty is a rarely reported cause of failure. The goal of this study was to present the clinical, radiographic, and intraoperative findings in a consecutive series of patients who presented with PE wear after shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>Data of patients who presented with features of PE wear between 2018 and 2024 were reviewed. Patient demographics and historical data regarding index surgery, implant characteristics, and manufacturer information were collected. Upon presentation after index arthroplasty, chief complaints, radiographic features, and clinical examinations were analyzed. Intraoperative findings and surgical management were reviewed in patients who underwent revision.</div></div><div><h3>Results</h3><div>43 patients were included in this study. The average time after index surgery to initial presentation was 12.1 ± 4.8 years after anatomic total shoulder arthroplasty (aTSA) and 8.3 ± 3.4 years after reverse total shoulder arthroplasty (rTSA). The most common chief complaint was new onset pain for 77% of patients with prior aTSA and new onset instability in 57% of patients with prior rTSA. Most (&gt;80%) aTSA glenoid components and rTSA humeral liners were comprised of conventional, noncrosslinked PE. All patients had radiographic evidence of proximal humeral bone loss. 65% of patients underwent revision with aggressive soft tissue débridement and synovectomy. Implant management was based on bone loss, presence of implant loosening, and soft tissue findings.</div></div><div><h3>Conclusion</h3><div>Surgeons should be aware of the possible sequelae of PE wear in patients after shoulder arthroplasty, especially those with conventional, noncrosslinked PE. New onset pain and weakness after a symptom-free holiday (years) are common after aTSA. New onset instability and pain after a symptom-free holiday (years) are common after rTSA. Radiographic findings can include humeral and glenoid bone loss, a narrowed glenoid clear space, and eccentricity of the articulation. The diagnosis is provisionally made and confirmed intraoperatively. Revision poses unique challenges and should include aggressive synovectomy, débridement, and individualized bone loss management. Further studies are crucial for understanding this emerging phenomenon after shoulder arthroplasty.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1293-1302"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined arthroscopic rotator cuff repair with mesenchymal stem cell augmentation shows similar functional outcomes but a higher structural integrity rate compared with isolated repair: a meta-analysis of comparative studies","authors":"Erminia Cofano MD, PhD ,&nbsp;Roberto Minici MD ,&nbsp;Giovanna Spina MD ,&nbsp;Domenico Laganà MD ,&nbsp;Olimpio Galasso MD ,&nbsp;Giorgio Gasparini MD ,&nbsp;Italian Orthopaedic Research Society,&nbsp;Michele Mercurio MD","doi":"10.1016/j.jseint.2025.03.017","DOIUrl":"10.1016/j.jseint.2025.03.017","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic rotator cuff repair (RCR) has guaranteed satisfactory outcomes but remains associated with a significant rate of tendon-bone healing failure. Mesenchymal stem cells (MSCs) have been tested as a promising cell-based therapy for rotator cuff tear (RCT). MSC augmentation has been proposed as a therapy associated with surgical repair, potentially enhancing the overall surgical outcomes for patients with RCTs. The aim of this meta-analysis was to compare functional and structural outcomes between arthroscopic RCR combined with MSC augmentation vs. isolated RCR for RCT.</div></div><div><h3>Methods</h3><div>The PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search keywords, and 5 studies were included. The first author, journal name, year of publication, study design, patient demographics, type of surgery, and follow-up period were recorded. The data extracted for quantitative analysis included the visual analog scale, University of California at Los Angeles score, flexion, external rotation, and retear. Random and fixed effect models were used for the meta-analysis of pooled mean differences and odds ratios.</div></div><div><h3>Results</h3><div>A total of 415 patients were identified, 203 of whom underwent combined RCR and MSC augmentation, and 212 underwent isolated RCR. The mean ages were 62.2 ± 6.2 and 61.6 ± 5.7 years in the combined RCR and MSC injection and isolated RCR groups, respectively. The mean follow-up was 17.5 ± 8.7 and 17.6 ± 8 months. Comparable postoperative visual analog scale score (<em>P</em> = .59), flexion (<em>P</em> = .68), external rotation (<em>P</em> = .42), and University of California at Los Angeles score (<em>P</em> = .92) were found between the groups. Significantly higher rotator cuff retear rate was found in the isolated RCR group (17.7% and 35% for the RCR and MSC injection and isolated RCR groups, respectively; odds ratio = −0.19, 95% confidence interval [−0.34, −0.04], <em>P</em> = .01).</div></div><div><h3>Conclusion</h3><div>Arthroscopic surgical repair combined with MSC augmentation reported better structural outcomes compared to isolated surgical repair for RCT. Pain and functional outcomes were similar between the two groups.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1191-1198"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of modified Hoffer transfer and subscapularis release on glenohumeral joint remodeling in brachial plexus birth palsy children with moderate-severe glenohumeral deformities: a case series study","authors":"Ahmad S. Aly PhD ,&nbsp;Shady Mahmoud PhD, FRCS Ortho","doi":"10.1016/j.jseint.2025.01.009","DOIUrl":"10.1016/j.jseint.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of brachial plexus birth injury sequelae is historically based on glenohumeral joint deformity as described by Waters. Patients with advanced deformities usually treated with bony procedures based on the unknown remodeling potentials following soft tissue rebalance. We aim to assess the clinical and radiological outcomes following soft tissue rebalance of this group.</div></div><div><h3>Methods</h3><div>Eight patients (age: 3-6.3 years) with advanced stages (Waters type 3-5) residual Erb’s palsy were retrospectively included. They were treated by modified Hoffer transfer and subscapularis release procedure and followed up for 13-49 months. Assessment tools were clinical and radiological.</div></div><div><h3>Results</h3><div>There were statistically significant improvements of all assessed parameters. The mean aggregated modified Mallet score improved from 19.38 preoperatively to 27.88 at the end of follow-up. Radiologically, the mean glenoid retroversion improved from −17.87° preoperatively to −6.12° at the end. Similarly, the percent humeral head anterior to glenoid fossa improved from mean 22.18% to 38.12%. All these changes are reflected on glenohumeral deformity stage (Waters classification) with improvements of all patients by 2 grades apart from 2 who improved by 1.</div></div><div><h3>Conclusion</h3><div>Moderate-severe shoulder deformity secondary to brachial plexus birth injury sequelae can be effectively treated by soft tissue rebalance and it could alter the natural history of the disease.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1083-1089"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution and trends in the management of acromioclavicular joint dislocations: an epidemiological analysis from Germany between 2013 and 2023","authors":"Philipp Herrmann MD,&nbsp;Martin Luedemann MD,&nbsp;Thilo Lehmeyer MD,&nbsp;Sebastian Frischholz MD,&nbsp;Maximilian Rudert MD,&nbsp;Kilian List MD,&nbsp;Ioannis Stratos MD,&nbsp;Felix Hochberger MD","doi":"10.1016/j.jseint.2025.03.005","DOIUrl":"10.1016/j.jseint.2025.03.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to analyze nationwide trends in the management of hospitalized patients with acromioclavicular joint dislocations (ACJDs) in Germany over the past decade, focusing on surgical procedures and demographic patient data. The investigation examines the shift from conventional open stabilization techniques to mini-open and arthroscopically assisted approaches.</div></div><div><h3>Materials and methods</h3><div>Hospital billing data from the Federal Statistical Office of Germany (2013-2023) were analyzed, including patients diagnosed with ACJD (International Classification of Diseases-10: primary diagnosis International Classification of Diseases S43.1) who underwent surgical reconstruction of the ACJD (German Operation and Procedure Classification System codes: 5-814b, 5-807.4, 5-807.5, 5-807.6, 5-930.0, 5-852.f, and 5-852.f8). Data included year of diagnosis, patient sex, surgical codes, and age (grouped in 5-year intervals). Data processing used R software for transformation and Tableau Desktop for subgroup analyses, stratified by type of procedure type, sex, and age. Statistical analyses, including linear regression and chi-squared tests, were conducted using GraphPad Prism (GraphPad Software, Inc., San Diego, CA, USA). Statistical significance was set at <em>P</em> ≤ .05.</div></div><div><h3>Results</h3><div>From 2013 to 2023, 82,254 patients were hospitalized and surgically treated for ACJD in Germany, indicating a decline in inpatient surgical management (<em>P</em> &lt; .05). This reduction primarily reflects a decrease in the number of inpatient procedures rather than changes in hospitalization duration or a shift toward outpatient surgery. Arthroscopically assisted stabilization increased from 19.6% in 2013 to 37.5% in 2023, becoming the most common surgical technique, while open techniques, such as plate stabilization and screw or Kirschner wire fixation, significantly decreased (<em>P</em> &lt; .05). Tendon augmentation procedures showed a notable rise despite their rarity (<em>P</em> &lt; .005). Arthroscopic techniques were predominantly used in younger patients (mean age: 39.6 years), while open reduction with plates was the most commonly used method in the age group over 60 years (<em>P</em> &lt; .05). ACJD incidence was 8.2 times higher in men than women, with significant male dominance across all surgical techniques (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Over the past decade, the management of ACJD s in Germany has shifted toward arthroscopically assisted stabilization, particularly in younger patients, while traditional open techniques have declined. Numbers of hospitalized treated cases have decreased, with a strong male predominance and age-related preferences influencing surgical approaches.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1040-1047"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biceps tendon augmentation in arthroscopic partial repair of irreparable massive rotator cuff tears: a systematic review and meta-analysis","authors":"Evan M. Polce MD ,&nbsp;Kyle N. Kunze MD ,&nbsp;Jake Koehler ,&nbsp;Michael C. Fu MD, MHS ,&nbsp;Samuel A. Taylor MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;David M. Dines MD ,&nbsp;Joshua S. Dines MD","doi":"10.1016/j.jseint.2025.02.015","DOIUrl":"10.1016/j.jseint.2025.02.015","url":null,"abstract":"<div><h3>Background</h3><div>There remains debate as to whether augmentation of large and massive irreparable rotator cuff tears (MIRCTs) with long head of the biceps tendon (LHBT) in the setting of arthroscopic partial repair (PR) confers a clinical benefit. The purpose of the current study was to synthesize population-level data from the current literature to determine whether LHBT augmentation for PR of MIRCTs reduces the incidence of re-tears and improves clinical outcomes compared with PR alone.</div></div><div><h3>Methods</h3><div>The PubMed/MEDLINE, Embase, OVID, and Cochrane Libraries were queried in April 2024 for trials directly comparing PR with PR with LHBT augmentation for MIRCTs. Information pertaining to diagnostic imaging indices (Goutallier grades), patient-reported outcome measures, range of motion, and adverse events (re-tear rate, reoperations, complications, conversion to arthroplasty) were recorded when reported. DerSimonian-Laird random-effects models were constructed to quantify effect estimates for categorical and continuous outcomes, represented as pooled incidence and standardized mean differences with associated confidence estimates, respectively.</div></div><div><h3>Results</h3><div>Six studies encompassing the outcomes of 367 patients (PR: n = 188, 51.2%; PR + LHBT: n = 179, 48.8%) were included. The mean age and follow-up among included studies ranged from 59.5-69.3 years and 20.5-39.9 months, respectively. The pooled incidence of re-tears was lower in the PR with LHBT augmentation group compared with PR alone, but not statistically significant (38% vs. 52%, <em>P</em> = .26). There were no significant differences in any range of motion parameters between the groups at the final follow-up (all <em>P</em> &gt; .05). Of 4 patient-reported outcome measures amenable for meta-analysis, the University of California-Los Angeles score was the only metric in which a significant difference was observed, favoring the PR with LHBT augmentation cohort (30.2 vs. 32.6, <em>P</em> &lt; .01); no statistically significant between-group differences were demonstrated for American Shoulder and Elbow Surgeons, VAS pain, or Constant-Murley scores (all <em>P</em> &gt; .05). There were no significant differences in mean postoperative acromiohumeral interval between groups (<em>P</em> = .11).</div></div><div><h3>Conclusion</h3><div>Among patients undergoing arthroscopic PR of MIRCTs, LHBT augmentation did not result in superior clinical outcomes compared with PR alone. Although the 14% reduction in the incidence of re-tears observed with LHBT augmentation was not statistically significant, it may represent a clinically important difference.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1124-1135"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High healthcare utilization and associated costs in the year prior to both primary reverse and anatomic shoulder arthroplasty: a study of 2393 patients from a private insurance database","authors":"Jason Corban MD ,&nbsp;Krishna Mandalia BS ,&nbsp;Darren Nin PhD ,&nbsp;Ya-Wen Chen MD, MPH ,&nbsp;Yutung Lan MD, MPH ,&nbsp;Ruijia Niu MPH ,&nbsp;David Chang PhD, MPH, MBA ,&nbsp;Eric Smith MD ,&nbsp;Kaley Beall MPH ,&nbsp;Sarav Shah MD","doi":"10.1016/j.jseint.2025.03.006","DOIUrl":"10.1016/j.jseint.2025.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Reverse shoulder arthroplasty (rTSA) has recently become more prevalent than anatomic shoulder arthroplasty (aTSA) in primary settings. With a shift toward value-based healthcare models, it is essential to quantify the costs of nonoperative management to optimize resource utilization. The purpose of this investigation was to quantify the cost of non-operative interventions in the year prior to both aTSA and rTSA.</div></div><div><h3>Methods</h3><div>An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with shoulder arthritis who underwent unilateral, isolated primary aTSA or rTSA from January 1, 2018, to December 31, 2019, were included. The main outcome was the total costs of nonoperative procedures in the year before surgery. The nonoperative procedures examined were (1) physical therapy (PT); (2) bracing; (3) intra-articular injections: professional fee, hyaluronic acid, and corticosteroids; (4) medication: nonsteroidal anti-inflammatory drugs, opioids, and acetaminophen; and (5) shoulder-specific imaging.</div></div><div><h3>Results</h3><div>The study comprised 2393 patients undergoing aTSA and rTSA. The average cost of nonoperative management in the year preceding shoulder arthroplasty was $1416 ± 2271 for a total of nearly $2.6 million (USD). The total cost of nonoperative procedures was significantly higher for women compared to men ($1552 ± 2268 vs. $1323 ± 2270, <em>P</em> &lt; .001). Patients undergoing rTSA incurred higher costs than those receiving aTSA ($1624 ± 2492 vs. $1092 ± 1827; <em>P</em> &lt; .001), primarily due to increased spending on PT ($547 ± 1584 vs. $198 ± 1292; <em>P</em> &lt; .001) and magnetic resonance imaging ($454 ± 790 vs. $242 ± 503; <em>P</em> &lt; .001). For those awaiting surgery for 10 months or longer, significantly more was spent on nonoperative management ($2130.36 ± 45.6 vs. $1229.55 ± 409.18, <em>P</em> = .03), with PT contributing to this even in the later months.</div></div><div><h3>Conclusion</h3><div>There is high health care utilization and associated cost of nonoperative procedures in the year prior to rTSA and aTSA. rTSA patients had significantly higher preoperative utilization and costs, mainly due to PT and magnetic resonance imaging. Most notably, for those waiting more than 10 months for rTSA, nearly 30% of the spending occurred in the last 3 months preceding surgery. As shoulder arthroplasty volumes rise, especially with increasing rTSA, it is important to delineate the current usage. This will allow payors and surgeons to critically appraise nonoperative modalities and direct their use to optimize efficacy while providing value-based care.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1257-1265"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distance of the radial nerve from distal interlocking screws in long-stem reverse shoulder arthroplasty: a cadaveric analysis","authors":"Ethan R. Harris BS,&nbsp;Steve S. Li BA,&nbsp;Seyedeh Zahra Mousavi BS,&nbsp;Prasenjit Saha BA,&nbsp;Mark A. Haft DO,&nbsp;Miriam D. Weisberg-Tannenbaum MD,&nbsp;Umasuthan Srikumaran MD, MBA, MPH","doi":"10.1016/j.jseint.2025.03.013","DOIUrl":"10.1016/j.jseint.2025.03.013","url":null,"abstract":"<div><div>Long-stem reverse total shoulder arthroplasty (rTSA) with interlocking screws is indicated for trauma and revision shoulder arthroplasty and enables fixation of the prosthesis without cement or a plate while maintaining rotational stability. We investigated the distance of the radial nerve from the distal interlocking screws of the long-stem rTSA to recommend a safe approach in placement of this prosthesis. The 3 distal 4.5-mm cortical interlocking screws of a 200-mm long-stem rTSA (FX Shoulder) were inserted with the humeral prosthesis at 0° and 20° of retroversion in 8 cadaveric specimens. A curvilinear incision from the anterolateral cubital fossa extending superolaterally along the humerus was made to expose the radial nerve between the brachialis and brachioradialis. The shortest distance from each screw to the radial nerve at 90° of elbow flexion was measured, and mean and standard deviations were calculated. At 0° of retroversion of the humeral prosthesis, the most distal 3 screws were a mean 9.5, 4.2, and 0.93 mm away from the radial nerve, respectively, whereas 20° of retroversion yielded mean screw-to-radial-nerve distances of 20, 15, and 8.7 mm, respectively. The mean distance to the radial nerve increased with increasing retroversion of the stem. We recommend using at least 20° of retroversion and making an incision anteriorly with careful retraction of soft tissues posteriorly on the humeral shaft to enable direct visualization during placement of the most distal interlocking screws to protect neurovascular structures.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1282-1285"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty","authors":"Cristina Bassi MD, FRCSC ,&nbsp;Diane Nam MSc, MD, FRCSC ,&nbsp;Elham Sabri MSc ,&nbsp;Darren Drosdowech MD, FRCSC ,&nbsp;J.W. Pollock MSc, MD, FRCSC ,&nbsp;Dominique Rouleau MD, FRCSC ,&nbsp;Taryn Hodgdon MD, FRCPC ,&nbsp;Katie McIlquham HBScHK ,&nbsp;Jonathan Doyon MD, FRCSC ,&nbsp;Peter Lapner MD, FRCSC","doi":"10.1016/j.jseint.2025.02.005","DOIUrl":"10.1016/j.jseint.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Prosthetic shoulder infection is the most common reason for revision arthroplasty within 2 years of the index procedure. Due to the preponderance of indolent and slow-growing infection in shoulder arthroplasty, establishing a diagnosis of infection prior to revision shoulder arthroplasty can be extremely difficult. The aim of this study was to determine the association between specific clinical symptoms and signs as well as nuclear imaging results with culture positive status in revision shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>This study is a secondary analysis of a multicenter prospective cohort study involving 4 sites and 69 patients who underwent revision shoulder arthroplasty. The cohort was 60% female with a mean age of 64 years (range 36-83 years). Outcomes of interest included preoperative specific clinical symptoms (pain at rest, fevers, chills, and sweats); and white blood cell (WBC) nuclear scan results. At least 5 synovial tissue biopsies from separate regions in the shoulder were obtained intra-operatively during revision surgery.</div></div><div><h3>Results</h3><div>Twenty-three percent of patients (n = 16) had confirmed culture positive infections based on the open biopsies. Sixty-four percent of patients presented with pain at rest. Pain at rest (<em>P</em> = .37), chills (<em>P</em> = .42), and sweats (<em>P</em> = .11) were not associated with infection status. Fever was not reported by any patients in the cohort. There was no association between infection status and erythrocyte sedimentation rate (<em>P</em> = .52), C-reactive protein (0.11), or WBC (<em>P</em> = .34). No patients in the cohort had a positive WBC nuclear scan.</div></div><div><h3>Conclusion</h3><div>This study suggests that specific clinical symptoms including pain at rest, systemic symptoms including fevers, chills, or sweats, and WBC bone scan are poorly associated with the presence of infection in revision shoulder arthroplasty. These findings point to the need for novel testing methods to establish the presence of infection in this patient population.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1228-1231"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the accuracy of a machine learning prediction for 2 different shoulder prostheses: an external validation study","authors":"Gianluca Caprili MD ,&nbsp;Andrea G. Calamita MD ,&nbsp;Michele Novi MD ,&nbsp;Domenico A. Campanacci MD, PhD ,&nbsp;Simone Nicoletti MD","doi":"10.1016/j.jseint.2025.04.024","DOIUrl":"10.1016/j.jseint.2025.04.024","url":null,"abstract":"<div><h3>Background</h3><div>The integration of machine learning in orthopedic surgery, including shoulder procedures, has garnered increasing interest. This retrospective analysis aims to externally validate a predictive analytics platform within a patient cohort undergoing reverse total shoulder arthroplasty for eccentric or concentric glenohumeral osteoarthritis.</div></div><div><h3>Methods</h3><div>Ninety patients who underwent reverse total shoulder arthroplasty at our institution in 2022 were selected for this study. Patients were divided into 2 groups based on the type of implant (50 Exactech Equinoxe and 40 Zimmer Biomet Comprehensive). Preoperative evaluations included 19 variables per the tool requirements (demographics, diagnosis, comorbidities, patient-reported pain and function, and range of motion). The study compared the tool's outcome predictions with postoperative outcomes at 3-6 months, 1 year, and 2 years postsurgery for visual analog scale and active range of movement. We also quantified the mean absolute error (MAE) separately in the 2 groups and compared it to the MAE from the internal validation of the same tool.</div></div><div><h3>Results</h3><div>Significant improvements in visual analog scale, active forward elevation, active abduction, and active external rotation met the minimal clinically important difference at 3-6 months, 1 year, and 2 years in both implant groups. Additionally, a modest improvement in active internal rotation was observed in both cohorts. In terms of MAE, we found a higher error than the internal validation only for forward elevation at 3-6 months in group 2 and a lower error in all the other outcome measures at all time points for both groups.</div></div><div><h3>Conclusion</h3><div>The predictive analytics platform demonstrated a lower or similar MAE than the internal validation for both groups. Notably, we found that the tool's predictions are generalizable to another shoulder prosthesis, even though it was not trained on that particular product. This tool holds promise for aiding clinicians in managing patient expectations.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 4","pages":"Pages 1352-1356"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}