Shoulder and Elbow最新文献

{"title":"Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty.","authors":"John A Martino, Alexander S Guareschi, Brandon L Rogalski, Josef K Eichinger, Richard J Friedman","doi":"10.1177/17585732241306098","DOIUrl":"10.1177/17585732241306098","url":null,"abstract":"<p><strong>Introduction: </strong>Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.</p><p><strong>Methods: </strong>The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients with a diagnosis of cirrhosis (<i>n</i> = 627) were matched in a 1:1 proportion to patients who did not have cirrhosis. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative outcomes, and hospital utilization metrics between the two groups. Following Bonferroni correction, an alpha value of 0.003 defined significance.</p><p><strong>Results: </strong>Patients with cirrhosis exhibited higher rates of postoperative medical and implant-related complications following primary TSA, including acute renal failure (6.3% vs 1.1%: <i>p</i> < 0.001), urinary tract infection (3.5% vs 0.6%; <i>p</i> < 0.001), transfusions (3.0% vs 0.2%; <i>p</i> < 0.001), acute respiratory distress syndrome (2.9% vs 0.2%: <i>p</i> = 0.002), surgical site infection (2.0% vs 0.2%: <i>p</i> = 0.001), dislocation (2.1% vs 0.0%: <i>p</i> < 0.001), and prosthetic loosening (1.5% vs 0.0%; <i>p</i> = 0.002). These patients also exhibited higher rates of all-cause complications (32% vs 9.2%: <i>p</i> < 0.001) and mortality (1.5% vs 0.0%; <i>p</i> = 0.002) within 180 days of surgery and had an increased cost of admission ($24,633 vs $18,500; <i>p</i> < 0.001) and LOS (2.6 vs 1.5 days; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Patients with cirrhosis were found to have increased risk of medical and surgical complications, higher costs, and longer LOS following TSA. These findings can assist orthopedic surgeons in developing strategies in the preoperative period to mitigate complications in this at-risk patient group.</p><p><strong>Level of evidence: </strong>Level III - Retrospective cohort study.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241306098"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865732","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":"Revision radiocapitellar arthroplasty by mismatched implant components - A salvage option: A report of two cases with a minimum three-year follow-up.","authors":"Tiago Martinho, Pieter Caekebeke, Lotte Verstuyft, Roger van Riet","doi":"10.1177/17585732241297152","DOIUrl":"10.1177/17585732241297152","url":null,"abstract":"<p><p>Radiocapitellar arthroplasty has been shown to improve pain and function in patients with a degenerative joint. Due to problems with the loosening of the radial head component, one of the few available systems was removed from the global market. This offered specific challenges in terms of treatment strategies when one or both components of a system that is no longer available fail. Due to the very different geometry of the capitellar implant, revision of the capitellar component would require a complex procedure, likely requiring bone graft and a high chance of early failure, leaving resection or interposition arthroplasty as the only available option. Although implant mismatch is common practice in hip and knee arthroplasty with satisfactory results, it should remain a salvage option as the off-label use of components gives rise to several medicolegal implications. We report two cases of radiocapitellar arthroplasty partial revision, by replacing only the radial head component with an implant from another system while keeping the well-fixed original capitellar component in place. At a minimum of three-year follow-up, both cases improved from poor to good and excellent Mayo elbow performance scores. There were no signs of implant failure on standard radiographs.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241297152"},"PeriodicalIF":1.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814418","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":"Does long-term surveillance of primary linked total elbow arthroplasty identify failing implants requiring revision?","authors":"Daniel Leslie James Morris, Avneet Minhas, Katherine Walstow, Lisa Pitt, Marie Morgan, Tim Cresswell, Marius P Espag, David I Clark, Amol A Tambe","doi":"10.1177/17585732241301356","DOIUrl":"10.1177/17585732241301356","url":null,"abstract":"<p><strong>Background: </strong>Scoping review has identified a lack of evidence guiding long-term follow-up of elbow arthroplasty. We report the effectiveness of primary linked total elbow arthroplasty surveillance in identifying failing implants requiring revision.</p><p><strong>Methods: </strong>A prospective database recording consecutive primary linked total elbow arthroplasty and subsequent surveillance in an elbow unit was analysed. Arthroplasties performed between 01.10.2013 and 31.07.2022 were included, with a minimum 1-year follow-up. Surveillance involves specialist physiotherapist review 1, 2, 3, 5, 8 and 10 years postoperatively. Patient-initiated review could occur between time points. Outcome measures include a number of surveillance reviews offered and attended; and the proportion that identified a failing implant requiring revision.</p><p><strong>Results: </strong>Ninety-seven primary linked total elbow arthroplasties with minimum 1-year follow-up were performed (76 Discovery, 14 Nexel, 7 Coonrad/Morrey). Sixteen patients died prior to 31.07.2023, and three implants required revision <1 year postoperatively. 290 of 328 offered surveillance appointments were attended (88.4%). Five implants required revision ≥1 year post-operatively, with revision requirements identified by surveillance in all cases. Three failures occurred at 5 years postoperatively, and two failures occurred at 8 years postoperatively. Overall, 1.7% attended surveillance appointments identified a failing implant requiring revision.</p><p><strong>Discussion: </strong>This is the first series reporting the effectiveness of primary linked total elbow arthroplasty surveillance in identifying implants requiring revision.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241301356"},"PeriodicalIF":1.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814413","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":"Racial and ethnic disparities in short-stay primary total shoulder arthroplasty.","authors":"Vivek N Pandey, Sarah K Thomas, John W Moore, Alexander S Guareschi, Brandon L Rogalski, Josef K Eichinger, Richard J Friedman","doi":"10.1177/17585732241303097","DOIUrl":"10.1177/17585732241303097","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of literature evaluating the utilization of short-stay total shoulder arthroplasty (TSA) in different racial groups. The purpose of this study is to compare short-stay TSA utilization and postoperative outcomes across racial groups.</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 to 2018 to identify patients who underwent primary short-stay TSA, defined as a length of stay of less than 2 midnights. Annual proportions of short-stay TSA, demographic variables, preoperative comorbidities, and postoperative complications were compared across groups.</p><p><strong>Results: </strong>All racial groups showed increases in the proportion of short-stay TSA cases over time, but this increase was most evident in Whites. Hispanics had increased rates of pneumonia (0.8% vs. 0.2%; <i>p</i> = 0.002) and transfusion (2.0% vs 1.0%; <i>p</i> = 0.015) compared to Whites, but no other differences in outcomes were observed between groups.</p><p><strong>Discussion: </strong>Postoperative outcomes were similar across groups despite differing comorbidity profiles, suggesting that short-stay TSA is being implemented appropriately based on perceived preoperative risk. However, differences in utilization across groups suggest that underlying disparities may exist. Given the continued increase in short-stay TSA procedures, opportunities to resolve racial disparities are essential in mitigating the effects of social determinants of health in minority patient groups.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241303097"},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796187","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":"Editorial - Michael Thomas.","authors":"Michael Thomas","doi":"10.1177/17585732241302893","DOIUrl":"https://doi.org/10.1177/17585732241302893","url":null,"abstract":"","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241302893"},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796183","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":"Evaluation of the accuracy and interobserver agreement of the reverse shoulder angle in the preoperative planning of reverse total shoulder arthroplasties.","authors":"Geraldo Motta, Marcus Vinícius Amaral, Márcio Cohen, Marcio Schiefer, Raphael Soares da Fonseca, Ana Carolina Leal Carolina Oliveira","doi":"10.1177/17585732241300686","DOIUrl":"10.1177/17585732241300686","url":null,"abstract":"<p><strong>Background: </strong>Differences in implant positioning between anatomical and reverse shoulder arthroplasties have raised concerns about the adequacy of assessing the global glenoid inclination (GGI) using the method described by Maurer to define the position of the metallic base in reverse shoulder arthroplasty. The reverse shoulder angle (RSA) has been proposed to measure the inclination of the lower half of the glenoid. This study aims to evaluate the interobserver agreement of manual measurements of the RSA using two-dimensional (2D) computed tomography (CT) images and its relationship with the automated measurement of the GGI.</p><p><strong>Methods: </strong>This cross-sectional study evaluated 2D CT images of 38 CT scans of patients with degenerative shoulder diseases. Manual measurements of the RSA were conducted by five independent shoulder surgeons. GGI measured by automated software was determined.</p><p><strong>Results: </strong>The interclass correlation coefficient was 0.72 for RSA. Mean RSA was 25.7° ± 7.1°, significantly higher than automated GGI measurements (11.2 ± 9.0; <i>p</i> < .0001). On average, RSA was 14.6 ± 6.3 greater than GGI, irrespective, diagnosis, Favard's glenoid subtype, and version angle.</p><p><strong>Conclusion: </strong>Our study demonstrated that the RSA angle can be reproducibly used to assess glenoid inclination on 2D CT images presenting high interobserver agreement. RSA differs significantly from the GGI, indicating that measuring glenoid inclination for reverse or anatomical arthroplasty requires distinct methodologies that account for the inherent differences in these angles.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241300686"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751906","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":"Racial disparities in early postoperative proximal humerus fracture outcomes: Do minorities face longer operative times, extended hospital stays, and higher risks?","authors":"Arman Kishan, Alexander R Zhu, Stanley Zhu, Gyeongtae S Moon, Ansh Kishan, Sukrit J Suresh, Matthew J Best, Umasuthan Srikumaran","doi":"10.1177/17585732241299052","DOIUrl":"10.1177/17585732241299052","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities in orthopedic surgery outcomes have been extensively documented, highlighting systemic biases in care. Proximal humerus fractures (PHFs), about 6% of all fractures, are rising, especially among the elderly. Despite the prevalence of PHFs, a research gap exists regarding racial disparities in postoperative complications and outcomes.</p><p><strong>Methods: </strong>Data from the American College of Surgeons NSQIP database from 2006 to 2021 were analyzed, including 41,285 patients with PHFs. CPT and ICD codes guided inclusion and exclusion criteria. Propensity-score matching balanced a cohort of 17,052 patients. Demographic variables, comorbidities, and outcomes were analyzed using univariate statistics, chi-square tests, and Fisher's exact tests.</p><p><strong>Results: </strong>Post propensity-score matching, significant demographic disparities emerged between white and minority patients. Minority patients had longer operative times (<i>p</i> < .001) and hospital stays (<i>p</i> = .001) than white patients. Minority patients also exhibited higher rates of mortality (<i>p</i> = .04) and unplanned re-intubation (<i>p</i> = .04).</p><p><strong>Conclusion: </strong>This study revealed significant racial disparities in early postoperative outcomes for PHFs. Despite surgical advancements, minorities have prolonged operative times, extended hospital stays, and heightened risks of adverse events. Action is needed to ensure healthcare equity and justice and to address disparities in PHF surgical management across diverse demographics.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241299052"},"PeriodicalIF":1.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711022","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":"Abstracts for the 36th Annual Scientific Meeting BESS 2024.","authors":"","doi":"10.1177/17585732241291698","DOIUrl":"https://doi.org/10.1177/17585732241291698","url":null,"abstract":"","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241291698"},"PeriodicalIF":1.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710797","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":"Minimum two-year follow-up of a reverse total shoulder arthroplasty using a wedged baseplate.","authors":"Simon J M Parker, Simon N Bell, Féoline Wiemer, Jennifer A Coghlan, Harry D Clitherow, Helen M Rayment","doi":"10.1177/17585732241293396","DOIUrl":"10.1177/17585732241293396","url":null,"abstract":"<p><strong>Background: </strong>Avoiding inclination of the glenoid baseplate in reverse shoulder arthroplasty often requires considerable glenoid reaming. It is proposed that the use of a metal wedged baseplate in all patients can achieve neutral inclination with reduced glenoid reaming.</p><p><strong>Materials and methods: </strong>A prospective clinical single-centre study with minimum two-year follow-up was carried out. Glenoid deformity was classified on CT and surgery planned using BluePrint^TM. The Tornier Perform^® Reversed Wedged Augmented Glenoid was used in all cases. Clinical outcome scores and radiographs were assessed.</p><p><strong>Results: </strong>Seventy-three patients, mean age 76.6 years. Twenty-eight demonstrated no glenoid deformity and 19 demonstrated marked retroversion. Seventy completed two-year follow-up. Mean pain scores fell from 6 to 0.7. All Patient Reported Outcome Meaures (PROMS) were significantly improved. Active elevation increased by 62° and external rotation by 28.7° (<i>p</i> < 0.001). In patients with no glenoid wear (E0/A1), correction of inferior inclination was achievable with a 15° full-wedge baseplate in all cases, reducing the reaming depth by 4.4 mm (<i>p</i> < 0.001). In patients with severe glenoid wear, a 35° half wedge baseplate was often necessary to correct the deformity. The most common complications were stress reactions/fractures.</p><p><strong>Conclusion: </strong>A metal wedged baseplate can achieve neutral inclination in all patients, minimising bone reaming and preserving lateralisation with good two-year outcomes.</p><p><strong>Level of evidence: </strong>IV (case series with no comparison group).</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241293396"},"PeriodicalIF":1.5,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711015","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":"Arthroscopic evaluation for posterolateral rotatory instability of the elbow.","authors":"Riikka Koso, Anthony Logli, Asher Mirvish, Mark Baratz","doi":"10.1177/17585732241293326","DOIUrl":"10.1177/17585732241293326","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the sensitivity of three arthroscopic techniques for intraoperative assessment of posterolateral rotatory instability (PLRI).</p><p><strong>Methods: </strong>The study was performed using six fresh frozen cadaveric upper extremities. The three arthroscopic tests were the modified ulnohumeral drive through test, the annular drive through test, and proximal radioulnar joint instrumentation. Sequential soft tissue sectioning was performed to create four stages of instability: baseline, transection of the anterior half of the lateral collateral ligament complex (i.e., the radial collateral ligament), transection of the posterior half of the LCL complex (i.e., the lateral ulnar collateral ligament), and finally the release of the common extensor origin. Each test was repeated with the elbow at 90-degrees flexion in neutral rotation and at 45-degrees extension in full supination.</p><p><strong>Results: </strong>Each test appropriately identified loss of the lateral ulnar collateral ligament. The modified ulnohumeral drive through test and the annular drive through test were most sensitive for loss of the radial collateral ligament. Elbow position did not affect test sensitivity.</p><p><strong>Conclusions: </strong>Each of the tests identified PLRI with high sensitivity, regardless of elbow position. The ulnohumeral and annular ligament drive through tests were more sensitive for radial collateral ligament disruption.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241293326"},"PeriodicalIF":1.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648950","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}