Seminars in Arthroplasty最新文献

{"title":"Medialization vs. lateralization of the glenoid baseplate in reverse shoulder arthroplasty: implications for clinical outcomes and functional performance: a systematic review and meta-analysis","authors":"James G. Kelly MB, BCh, BAO ,&nbsp;Thomas Deane MB, BCh, BAO ,&nbsp;Andrew Kelly MB, BCh, BAO ,&nbsp;Conor McNamee MB, BCh, BAO ,&nbsp;Stefan Bauer MD ,&nbsp;William Blakeney MBBS, MS, MSc, FRACS","doi":"10.1053/j.sart.2025.04.011","DOIUrl":"10.1053/j.sart.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Lateralization of the center of rotation (COR) in reverse shoulder arthroplasty (RSA) has been proposed to combat scapular notching and improve functional outcomes. Lateralizing the COR can be achieved by increasing the glenoid baseplate lateral offset. The aim of this review was to compare the effect of lateralization vs. medialization of the glenoid baseplate on outcomes, scapular notching, and complication rate in primary RSA.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of PubMed, EMBASE, and Cochrane Library using keywords was undertaken in December 2023. The search provided 908 studies. After review by two independent authors, 12 met the inclusion criteria and qualified for meta-analysis.</div></div><div><h3>Results</h3><div>Meta-analysis showed a significant decrease in scapular notching in the lateralized glenoid baseplate group. There was a trend towards improved external rotation in the lateralized group (mean difference = 4.86); however, this difference did not reach significance (<em>P</em> = .067). No other significant difference in functional outcomes, range of motion, or complications was observed between the two groups. A subgroup analysis of four studies that contained a medialized baseplate and lateralized stem as the medialized group vs. lateralized baseplate with lateralized stem as the lateralized group showed significantly inferior American Shoulder and Elbow Surgeons in the lateralized group (<em>P</em> = .018). The mean follow-up period was 31.1 months.</div></div><div><h3>Conclusion</h3><div>Lateralization of the glenoid component results in a significant decrease in scapular notching, with no significant difference in functional outcomes, range of motion, or complications compared to a medialized glenoid baseplate. The study showed significantly inferior American Shoulder and Elbow Surgeons scores amongst those lateralized at both baseplate and stem vs. those with a medialized baseplate and lateralized stem. Lateralization of the COR in RSA is still a relatively novel concept, and further studies are required, isolating the glenoid and the humeral variables, with longer follow-up periods, to assess long-term functional outcomes and complication rates.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 523-537"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766763","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":"Temporal trends in demographic, comorbidity, and episode-of-care in anatomic and reverse total shoulder arthroplasty from 2012 to 2020","authors":"Victoria E. Bindi BS ,&nbsp;Timothy R. Buchanan BS ,&nbsp;Robert J. Cueto MD ,&nbsp;Keegan M. Hones MD, MS ,&nbsp;Joseph J. King MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Kevin A. Hao MD","doi":"10.1053/j.sart.2025.04.008","DOIUrl":"10.1053/j.sart.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to characterize trends in the demographic characteristics, comorbidities, and episode-of-care outcomes for patients who underwent primary elective anatomic and reverse total shoulder arthroplasty between 2012 and 2020.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes for patients who underwent primary elective anatomic and reverse total shoulder arthroplasty between 2012 and 2020 (n = 32,112). Trends in continuous and categorical variables were evaluated using linear regression and the Cochran-Armitage trend test, respectively.</div></div><div><h3>Results</h3><div>Over the study period, the proportion of patients ages 60-80 years undergoing elective total shoulder arthroplasty (TSA) increased, while patients ≤60 and &gt;80 years decreased (<em>P</em> &lt; .001). There was a trend towards increasing obesity in patients undergoing elective TSA (<em>P</em> = .008). There was a reduction in the proportion of white patients undergoing elective TSA, with a concomitant increase in minority patients during the study period (<em>P</em> &lt; .001). There was an overall increase in the proportion of patients with an American Society of Anesthesiologists physical status score ≥3 (<em>P</em> &lt; .001) and a history of heart failure (<em>P</em> = .014). Conversely, there was a decrease in the proportion of patients with hypertension requiring medication and patients who received dialysis (<em>P</em> = .038 and <em>P</em> = .006, respectively). The rate of 30-day medical complications decreased from 8.5% to 4.5% during the study period (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Despite increasing medical complexity and increasing diversity of patients undergoing elective TSA during the study period (2012-2020), the rate of 30-day postoperative medical complication rates decreased. These findings demonstrate an improvement in the delivery of care in patients undergoing elective TSA. Reimbursement adjustments should reflect rising patient medical complexity, requiring a reevaluation of frameworks to align with evolving health care models and resource demands.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 497-504"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767170","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":"Primary total shoulder arthroplasty in the setting of anterior glenoid wear","authors":"Casey M. Beleckas MD,&nbsp;Albert D. Mousad MD,&nbsp;Benjamin Lack BS,&nbsp;Todd W. Phillips MD,&nbsp;Jonathan C. Levy MD","doi":"10.1053/j.sart.2025.04.010","DOIUrl":"10.1053/j.sart.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Anterior glenoid wear is an uncommon pattern of glenohumeral arthritis. This study sought to report outcomes after primary anatomic total shoulder athroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) in this patient cohort.</div></div><div><h3>Methods</h3><div>Operative notes of patients treated with primary aTSA or rTSA over a 16-year period were reviewed for patients with anterior glenoid wear noted intraoperatively. Preoperative computed tomography scans were measured to determine version. Patient-reported outcome measures, range of motion, strength, and complications were measured at a minimum of 2 years postoperatively.</div></div><div><h3>Results</h3><div>1.9% (51/2,712) of patients treated with primary shoulder arthroplasty during the study period were noted to have anterior glenoid wear. Thirty-seven patients had a minimum of 2-year follow-up (12 aTSA; 25 rTSA). Patient-reported outcome measures improved in both cohorts from baseline, without difference noted between groups. Both groups reported improvements in range of motion at final follow-up with the exception of internal rotation, which demonstrated no improvement in either group. One patient treated with aTSA underwent revision to rTSA for a loose glenoid and subscapularis insufficiency. A second developed subscapularis insufficiency but was successfully treated nonoperatively. In the rTSA cohort, two patients sustained acromion fractures, both of which were successfully treated nonoperatively. A third patient sustained a traumatic periprosthetic humeral fracture requiring revision.</div></div><div><h3>Conclusion</h3><div>Patients treated with either aTSA or rTSA reported successful outcomes at a minimum of 2-year follow-up.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 517-522"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767172","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":"Physical therapy following shoulder arthroplasty: an assessment of telerehabilitation vs. in-person physical therapy","authors":"Olivia C. O'Reilly MD,&nbsp;Maria Bozoghlian MD,&nbsp;Natalie Glass PhD,&nbsp;Michael Shaffer PT, MSPT, OCS, ATC,&nbsp;Jeffrey Fleming DPT, OCS, ATC, CSCS,&nbsp;James V. Nepola MD,&nbsp;Brendan M. Patterson MD, MPH","doi":"10.1053/j.sart.2025.04.009","DOIUrl":"10.1053/j.sart.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>It is unclear whether supervised postoperative physical therapy (PT) is necessary after shoulder arthroplasty. The COVID-19 pandemic necessitated social distancing and limitation of nonessential exposure to health care, bringing remote health care, or “telehealth,” to the forefront. Telerehabilitation provides alternative PT that confers more flexible participation and limits extraneous travel and exposure. We hypothesize video-based, interactive telehealth PT after anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) demonstrates similar improvement in shoulder range of motion (ROM) and patient-reported outcome measures (PROMs) compared to conventional PT.</div></div><div><h3>Materials and methods</h3><div>This was a single-center, prospective, randomized controlled trial. All patients indicated for primary shoulder arthroplasty were screened for enrollment. Participants were randomized to in-person PT (control) or telerehabilitation postoperatively. Demographic information was collected. Outcome measures included American Shoulder and Elbow Surgeons, visual analog scale (VAS) pain, and Patient-Reported Outcomes Measurement Information System Pain Interference scores. Shoulder ROM, including forward elevation FE, abduction, internal rotation, and external rotation, was measured. Outcome measures were collected preoperatively and at postoperative visits at 2 and 6 weeks, 3 and 6 months, and 1 year.</div></div><div><h3>Results</h3><div>Eighty-one patients were randomized, and 70 had postoperative outcome data available. Between intervention groups, there were no significant differences in baseline characteristics, preoperative PROMs, or ROM (<em>P</em> &gt; .05). Overall, more participants underwent RSA (62.7%). TSA and RSA patients tended to improve in a parallel fashion to each other over time, with a relative plateau after 6 months. Both telerehabilitation and in-person PT cohorts followed a similar pattern of improvement in PROMs and ROM outcomes up to 1 year postoperatively, with no statistically-significant differences between groups. In patients who underwent TSA or RSA, there were no statistically significant differences in postoperative PROMs or ROM, regardless of therapy modality.</div></div><div><h3>Conclusion</h3><div>Postoperative results suggest nearly parallel increases in PROMs and shoulder ROM, both during and after PT. There were no statistically significant differences in PROMs and ROM outcomes between telerehabilitation and in-person therapy 1 year postoperatively, irrespective of surgical intervention. Telerehabilitation after shoulder arthroplasty may offer similar outcomes with the benefit of instruction and oversight from a therapist within the patient's home. Policy change to allow insurance coverage of telerehabilitation should be considered given its viability as a rehabilitation strategy.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 505-516"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767171","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":"Preoperative acromiohumeral interval may predict early achievement of clinically meaningful outcomes in reverse shoulder arthroplasty patients: a retrospective review of preoperative imaging studies","authors":"Alex E. White MD ,&nbsp;Michael Mazzucco BS ,&nbsp;Karthik Nathan MD ,&nbsp;Mihir S. Dekhne MD ,&nbsp;Matthew R. Bryan BS ,&nbsp;Harry G. Greditzer 4th MD ,&nbsp;Michelle Kew MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.04.006","DOIUrl":"10.1053/j.sart.2025.04.006","url":null,"abstract":"<div><h3>Hypothesis</h3><div>The aim of this study was to examine the predictive value of preoperative acromiohumeral interval (AHI) and Goutallier grade across multiple imaging modalities on patient-reported outcomes following both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). We hypothesized that a higher AHI and lower Goutallier grades preoperatively would predict better patient reported outcome measures following both aTSA and rTSA.</div></div><div><h3>Methods</h3><div>Patients who underwent aTSA and rTSA were identified from our institution's shoulder arthroplasty registry and included if they had computed tomography (CT), magnetic resonance imaging (MRI), and x-ray (XR) within 6 months of surgery and complete American Shoulder and Elbow Surgeons scores at 2 years. Two raters independently measured AHI on all three imaging modalities and assigned a Goutallier grade for supraspinatus muscle quality using MRI and CT. Logistic regression and cut-point analysis using the Youden index was performed for each radiographic measurement to determine their ability to predict achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for American Shoulder and Elbow Surgeons.</div></div><div><h3>Results</h3><div>A total of 199 patients (132 aTSA, 67 rTSA) were included. Interclass correlation coefficient values demonstrated moderate to strong agreement across modalities. Rates of MCID and SCB achievement did not differ significantly between the aTSA and rTSA groups. Patients who underwent rTSA with AHI &gt;6 mm on CT (<em>P</em> = .018) and &gt;7 mm on XR (<em>P</em> = .044) were significantly more likely to achieve the MCID at 1 year. Patients who underwent rTSA with an AHI &gt;6 mm on MRI were significantly more likely to achieve SCB at 1 year (<em>P</em> = .031). These significant associations did not persist at 2 years. No threshold for AHI or Goutallier was significantly associated with MCID or SCB in aTSA at any timepoint. In cut-point analysis, all area under the curve measurements were less than 0.700, indicating poor predictive ability.</div></div><div><h3>Conclusion</h3><div>The present study demonstrates that an AHI threshold of 6 mm on MRI and CT and 7 mm on XR may predict the achievement of significant clinical outcomes at 1-year for rTSA. These findings suggest that the rotator cuff may play a role in expediting the recovery process for patients undergoing rTSA. Despite this, however, there are no reliable optimal cut-points for predicting the achievement of meaningful clinical outcomes following aTSA and rTSA using AHI measurements and Goutallier grades. Factors beyond standard radiologic measurements should be considered when prognosticating long-term clinical outcomes following shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 488-496"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767169","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":"Area deprivation index is associated with readmission and length of stay following primary shoulder arthroplasty","authors":"Patrick E. Saunders MD ,&nbsp;Abhay Mathur MD ,&nbsp;Clayton Hui BS ,&nbsp;Sean Guerrero MHA ,&nbsp;Viraj Deshpande BS ,&nbsp;Evan Simpson BS ,&nbsp;Edward J. Quilligan BS ,&nbsp;Hafiz F. Kassam MD","doi":"10.1053/j.sart.2025.04.005","DOIUrl":"10.1053/j.sart.2025.04.005","url":null,"abstract":"<div><h3>Background</h3><div>There is increased focus in the US health-care system on the role that social determinants of health have on disparities in health-care outcomes. Socioeconomic status has been identified as a crucial element affecting postoperative outcomes of elective orthopedic procedures. The Area Deprivation Index (ADI) is a metric used to quantify socioeconomic disadvantage between different neighborhoods or Census Block Groups. The ADI score for a given zip code is normalized to the entire country as a percentile or to a specific state as a decile to measure a neighborhood's relative socioeconomic disadvantage. Higher ADI scores indicate greater levels of social disadvantage. The purpose of this study was to assess the effect of ADI on postoperative length of stay (LOS), readmission, and emergency department (ED) visits following primary shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively collected single-institution surgical database was conducted. Patients undergoing primary elective anatomic and reverse total shoulder arthroplasty were identified. Zip codes corresponding to patients' primary residence at the time of surgery were gathered and converted to ADI scores normalized to the state of California. A propensity score match was used to create demographically equivalent populations of low (&lt;5) and high (≥5) ADI. We assessed the association between ADI and postoperative LOS, 30- and 90-day readmission, and 3-, 7-, and 90-day ED visits.</div></div><div><h3>Results</h3><div>A total of 1,012 patients were included in the study. An ADI of greater than or equal to 5 was significantly associated with lower readmission rate at 30 and 90 days (0.5% vs. 5.3%, <em>P</em> = .01). There was a positive correlation between high ADI and longer LOS, which did not reach statistical significance (30.42 hours vs. 27.55 hours, <em>P</em> = .089). There was no significant difference in ED visits at any time point between the low and high ADI groups.</div></div><div><h3>Conclusion</h3><div>An ADI of greater than or equal to 5, or higher socioeconomic disadvantage, was significantly associated with lower 30- and 90-day readmission rates after primary total shoulder arthroplasty. Our results also demonstrated a positive trend between high ADI and longer LOS postoperatively. Orthopedic providers should be mindful of their patients' level of social deprivation so that they may provide additional support and resources as necessary to improve their operative outcomes and mitigate their risk for complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 482-487"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767168","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":"The associations of comorbidities with healthcare utilization among patients undergoing total shoulder arthroplasty","authors":"William ElNemer BS ,&nbsp;John P. Avendano BS ,&nbsp;Zaid Elsabbagh BS ,&nbsp;Myung-Jin Cha BS ,&nbsp;Andrew B. Harris MD ,&nbsp;Edward G. McFarland MD ,&nbsp;Matthew J. Best MD ,&nbsp;Savyasachi C. Thakkar MD ,&nbsp;Umasuthan Srikumaran MD, MBA","doi":"10.1053/j.sart.2025.03.005","DOIUrl":"10.1053/j.sart.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total shoulder arthroplasty (TSA) often have chronic comorbidities such as obesity, hypertension, and diabetes. Management of these comorbidities and their associated complications can lead to increased utilization of hospital resources, increasing the cost of care and the length of patients' hospital stay. Because the rate of TSAs is increasing, it is important for physicians and policymakers to understand which patient factors may contribute to healthcare utilization and to develop protocols that may address those factors or inform reimbursements. Using length of stay (LOS), hospital charges (HC), and hospital costs (HCo) as a proxy for healthcare utilization, our study asked whether, for patients undergoing TSA, there is an association between these measures and patient comorbidities.</div></div><div><h3>Methods</h3><div>A national database was queried for patients who underwent primary TSA from 2012 to 2020. A total of 31 comorbidities were classified using the Elixhauser Comorbidity Index. People with the comorbidity metastatic cancer were excluded. For each comorbidity of interest, patients were matched to another patient in the database by age, sex, and all other comorbidities except the comorbidity of interest. Matched cohorts were analyzed via multivariable regression analyses controlled for age, sex, year of procedure, hospital location, and comorbidities to predict differences in LOS, HC, and HCo.</div></div><div><h3>Results</h3><div>A total of 157,034 TSAs were included. Mean HC, HCo, and LOS were $74,974, $19,733, and 1.7 days, respectively. When comparing patients with analyzed comorbidities to those without, all comorbidities except smoking, tumor, renal or liver disease, and HIV/AIDS were associated with longer LOS; paralysis, pulmonary hypertension, weight loss, and fluid and electrolyte disorders were associated with 34%, 28%, 24%, and 23% greater odds of having an LOS ≥3 days (all <em>P</em> &lt; .001); and weight loss, blood loss anemia, and coagulopathy were associated with 11%, 10%, and 5% greater HC, respectively (<em>P</em> = .039, .002, .024). Weight loss, pulmonary hypertension, and lymphoma were associated with 11%, 8%, and 6% greater HCo, respectively (<em>P</em> = .014, .021, .046), than in patients without those comorbidities.</div></div><div><h3>Conclusion</h3><div>This study offers targets for reduction of HC, HCo, and LOS for patients with these modifiable and nonmodifiable ailments through protocol change. Optimization programs targeting malnourished patients and patients with pulmonary hypertension and other comorbidities are encouraged. These results provide clinicians a quantifiable way to communicate financial burden and recovery time after TSA. Future research could investigate the synergistic effects of these comorbidities.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 397-405"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766959","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":"Reverse or anatomic shoulder arthroplasty for glenohumeral osteoarthritis in patients over 70: readmission rates and utilization trends","authors":"Tej Joshi MD ,&nbsp;Akhil Katakam MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Tuckerman Jones MD ,&nbsp;Francis J. Sirch MD ,&nbsp;Daniel Calem MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1053/j.sart.2025.04.002","DOIUrl":"10.1053/j.sart.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is increasingly used to treat elderly patients with primary glenohumeral osteoarthritis regardless of rotator cuff integrity to avoid potential future revision surgery. We aimed to determine whether there was a difference in readmission rates and profile of patients aged ≥70 who underwent rTSA vs. anatomic total shoulder arthroplasty (aTSA) for GHOA and analyze a trend in the utilization of each arthroplasty type.</div></div><div><h3>Methods</h3><div>Nationwide Readmissions Database was queried to identify all patients aged ≥70 undergoing either rTSA or aTSA for GHOA from 2016 to 2021. The patients were then tracked to identify subsequent readmissions within 30 and 90 days. Patient demographics, readmission rates, and causes of readmission were analyzed.</div></div><div><h3>Results</h3><div>84,463 (33.6%) aTSA and 166,585 (66.4%) rTSA patients were identified utilizing weighted data. Of all patients undergoing aTSA, 2.3% and 2.1% were readmitted at 30 and 90 days, respectively. Of rTSA patients, 3.5% and 3.0% were readmitted at 30 and 90 days, respectively. At 30 and 90 days, patients undergoing rTSA were 1.314 (95% CI: 1.245-1.387; <em>P</em> &lt; .001) and 1.223 (95% CI: 1.156-1.294; <em>P</em> &lt; .001) times more likely to be readmitted than patients who underwent aTSA. From 2016 to 2021, there was a significant increase in utilization of rTSA for GHOA, with a 3.8% increase in utilization per year.</div></div><div><h3>Conclusion</h3><div>Patients ≥70 undergoing rTSA for GHOA have a higher risk of readmission at both 30 and 90 days. There continues to be a significant increase in the utilization of rTSA for GHOA at a rate of 3.8% per year.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 454-463"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767165","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":"The hospital frailty risk score outperforms other risk stratification indices at predicting complications following total shoulder arthroplasty","authors":"John W. Moore BS ,&nbsp;Sophia Sitsis BS ,&nbsp;Vivek Pandey BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Jason Silvestre MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.04.004","DOIUrl":"10.1053/j.sart.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Frailty and comorbidity indices are commonly used to stratify risk in orthopedic patients. The purpose of this study was to examine the hospital frailty risk score (HFRS), Elixhauser Comorbidity Index (ECI), Charlson-Deyo Comorbidity Index (CCI), and Modified 5-Item Frailty Index (mFI-5) to determine which index more accurately predicted complications following primary total shoulder arthroplasty (TSA).</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2021 to identify primary TSAs. HFRS, ECI, CCI, and mFI-5 scores were calculated. Generalized additive models were used to evaluate each index. Accuracy was assessed using the area under the curve of the receiver operative curve (AUC of ROC).</div></div><div><h3>Results</h3><div>HFRS was superior at predicting any complication, any medical complication, any surgical complication, revision, periprosthetic fracture, prosthetic loosening, complications requiring débridement, transfusion, Acute Respiratory Disease Syndrome (ARDS), acute renal failure, pneumonia, sepsis, and urinary tract infection. ECI was superior at predicting readmission, postoperative bleeding, and pulmonary embolism. CCI and mFI-5 were not superior to the other indices.</div></div><div><h3>Discussion</h3><div>The HFRS outperformed all other risk stratification indices at predicting rates of any complication, any surgical complication, any medical complication, revision, infection requiring débridement, periprosthetic fracture, prosthetic loosening, ARDS, acute renal failure, pneumonia, sepsis, transfusion, and urinary tract infection. ECI was the second-best index and outperformed all other indices at predicting rates of readmission and pulmonary embolism. No index was acceptable (AUC of ROC &gt;0.7) at predicting surgical complications, readmissions, or revisions. These results indicate the HFRS may be the best risk stratification index for predicting complications following primary TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 471-481"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767167","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":"Pullout strength of screws used for baseplate fixation in reverse shoulder arthroplasty: a cadaveric study","authors":"Masashi Kano MD ,&nbsp;Shoji Fukuta MD, PhD ,&nbsp;Jun Kawamata MD ,&nbsp;Katsutoshi Miyatake MD, PhD ,&nbsp;Kosaku Higashino MD, PhD ,&nbsp;Keizo Wada MD, PhD ,&nbsp;Koichi Tomita MD, PhD ,&nbsp;Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.04.003","DOIUrl":"10.1053/j.sart.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown that bicortical screw fixation is biomechanically superior to unicortical screw fixation. However, no data are available on the pullout strength of screws used for glenoid fixation in reverse shoulder arthroplasty (RSA). The purpose of this study was to determine the differences in biomechanical strength between unicortical and bicortical fixation of the baseplate screws in RSA.</div></div><div><h3>Methods</h3><div>Both scapulae from 14 fresh frozen cadavers (7 men, 7 women) were used to compare the pullout strength of the superior and inferior screws used with the Trabecular Metal Reverse Shoulder System (Zimmer Biomet, Warsaw, IN, USA). Screws were inserted unicortically in one scapula of each specimen and bicortically in the other scapula. The pullout strength of each screw was evaluated using a universal testing machine.</div></div><div><h3>Results</h3><div>Mean pullout strength of the superior screws was 716.5 ± 300.4 N for unicortical fixation and 1241.3 ± 475.9 N for bicortical fixation, and that of the inferior screws was 272.3 ± 125.8 N and 666.2 ± 481.7 N, respectively. Pullout strength of the superior and inferior screws was significantly higher for bicortical fixation than for unicortical fixation. Pullout strength of the superior screws was 854.2 ± 314.0 N in unicortical fixation and 1374.7 ± 466.8 N in bicortical fixation in men, and 578.7 ± 209.6 N and 1107.8 ± 446.5 N, respectively, in women; the pullout strength of the inferior screws was 285.5 ± 139.0 N and 922.3 ± 549.5 N, respectively, in men, and 259.2 ± 109.5 N and 410.2 ± 176.4 N in women. Although the pullout strength was higher in men, the difference was not statistically significant, except for inferior bicortical screws. The ratio of the pullout strength for an inferior screw to that of a superior screw was 0.48. The ratio of the pullout strength for unicortical fixation to that of bicortical fixation was 0.58 for superior screws and 0.41 for inferior screws. The pullout strength of screws in women was 0.69 of that in men.</div></div><div><h3>Conclusion</h3><div>Bicortical screw fixation is stronger than unicortical screw fixation for the glenoid component in RSA, as in other regions. Pullout strength of the superior screws was significantly higher than that of the inferior screws in both unicortical and bicortical fixation. Fixation of inferior bicortical screws was impaired more significantly in women than in men. Therefore, bicortical fixation of the inferior screw is recommended for women and for patients with poor bone quality.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 464-470"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767166","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}