Seminars in Arthroplasty最新文献

{"title":"The role of patient mental health and other psychological factors in the outcomes of shoulder arthroplasty: a systematic review and meta-analysis","authors":"Alexander J. MacFarlane MD ,&nbsp;Tamari Bekauri BSc ,&nbsp;Sonja Pavelseen MD, MS ,&nbsp;M. Nadir Haider MD, PhD ,&nbsp;Thomas R. Duquin MD","doi":"10.1053/j.sart.2025.01.007","DOIUrl":"10.1053/j.sart.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Depression and anxiety have been associated with poor patient outcomes and higher adverse events in lower extremity reconstruction as well as total shoulder arthroplasty. However, these results can be conflicting. Additionally, depression and anxiety may be considered an incomplete understanding of a patient's mental health and mental readiness for surgery. We have proposed evaluating several other psychological factors in addition to depression and anxiety, which include somatization, pain catastrophizing, resilience, self-efficacy, and kinesiophobia.</div></div><div><h3>Methods</h3><div>We searched PubMed, EMBASE, and Cochrane systematically from inception until June of 2024. Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. The meta-analysis was conducted by comparing the effects of emotional disorders (ED's) on preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) score.</div></div><div><h3>Results</h3><div>A total of 24 articles were included in the final analysis. The mean Newcastle-Ottawa Quality Assessment Scale score was 6.63 of a possible 9 points. Four articles were included in the meta-analysis. We found no difference in the preoperative ASES score (d = −0.363 [−0.733, 0.007], <em>P</em> = .055) irrespective of diagnosis or type of ED (0.210) or procedure (0.506). However, postoperative ASES scores were statistically significantly lower (d = −0.511 [−0.722, −0.300], <em>P</em> &lt; .001) for those with ED, independent of the type of ED (<em>P</em> = .671) or procedure (<em>P</em> = .589). Of the 7 articles included with range of motion (ROM) outcomes, we found 4 articles supporting worse ROM, 2 articles supporting improved ROM, and 1 article supporting no differences when associated with ED.</div></div><div><h3>Conclusions</h3><div>Depression and anxiety are linked to poorer patient-reported outcomes following total shoulder arthroplastybased on our meta-analysis. However, we found conflicting evidence regarding the effects of ED's on postoperative ROM.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 286-298"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891228","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":"Mid-term outcomes following reverse and anatomic shoulder arthroplasty: a systematic review and meta-analysis","authors":"Conor McNamee MB, BCh, BAO ,&nbsp;Andrew Kelly MB, BCh, BAO ,&nbsp;Thomas Deane MB, BCh, BAO ,&nbsp;James G. Kelly MB, BCh, BAO ,&nbsp;William Blakeney MBBS, MS, MSc, FRACS","doi":"10.1053/j.sart.2025.01.009","DOIUrl":"10.1053/j.sart.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA), is increasingly used worldwide to treat a growing number of pathologies. By the reversing the native joint configuration, rTSA has been shown to significantly alleviate pain and restore motion even for patients with end-stage pathology. Despite this, there is a lack of evidence substantiating the comparative effectiveness of rTSA vs. anatomic arthroplasty, particularly in the mid-to long-term.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysesguidelines. The PubMed, Embase, and Scopus databases were searched on February 12, 2024, without date restrictions. Studies in English comparing outcomes of rTSA and anatomic total shoulder arthroplasty (aTSA) with a mean follow-up of at least 4 years were included. Meta-analyses employed random effects models to assess differences in functional outcomes, complication rates, and revision rates between the surgeries.</div></div><div><h3>Results</h3><div>The search yielded 8 comparative studies involving 3453 patients, revealing significant functional improvements in aTSA over rTSA at midterm follow-ups, such as better forward flexion, abduction, and external rotation. However, rTSA resulted in a significantly lower rate of revision surgeries. No significant differences were found in total complication rates, instability, or infection rates between the groups. Both surgeries showed similar patient-reported outcome measures.</div></div><div><h3>Discussion</h3><div>The meta-analysis finds a lack of high-quality trials comparing aTSA and rTSA. Current evidence suggests that aTSA may offer better functional outcomes, while rTSA may provide a more durable construct with lower revision rates. These results are at a significant risk of bias, and robust trials are needed to validate these interpretations.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 305-317"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891237","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":"Early postoperative adverse cardiac events following total shoulder arthroplasty: a propensity-matched analysis of risk factors","authors":"Patrick J. Tansey MD ,&nbsp;Jad J. Lawand MS ,&nbsp;Elias Nasser BS ,&nbsp;Kaveh Momenzadeh MD ,&nbsp;Jeremy S. Somerson MD","doi":"10.1053/j.sart.2025.01.008","DOIUrl":"10.1053/j.sart.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac complications following total shoulder arthroplasty (TSA) are rare, potentially life-threatening events. Identifying risk factors (RF) for cardiac complications remains of interest to treating surgeons. This study aims to assess the impact of common comorbidities on perioperative cardiac complication risk following TSA.</div></div><div><h3>Methods</h3><div>Using the TriNetX national multicenter database, we identified patients who underwent TSA from January 2015 to January 2024. Patients were grouped into cohorts based on the presence or absence of cardiac RFs, such as diabetes mellitus (DM), renal insufficiency, previous myocardial infarction (MI), hypertension, and cerebrovascular disease (CVD) to create at-risk vs. control cohorts. These groups underwent 1:1 propensity score matching by age, sex, race, and ethnicity. A subanalysis for each specific RF was conducted. The incidence of postoperative adverse cardiac events was assessed at 1- and 3-month intervals using chi-squared tests, with a significance threshold set at <em>P</em> &lt; .002 following multiple comparison correction.</div></div><div><h3>Results</h3><div>After 1:1 propensity matching, 13,128 TSA patients were available for final analysis. At-risk patients with comorbidities had 1.4-3.8 times greater odds of postoperative heart failure at 30 days and 90 days (<em>P</em> &lt; .001) compared to controls. Patients with a history of CVD had 2.0 times greater odds of 30-day MI and heart failure compared to controls (<em>P</em> &lt; .001). Patients with a history of MI had the highest odds of troponin elevation (OR 3.8, <em>P</em> &lt; .001), MI (OR 21.0, <em>P</em> &lt; .001), and heart failure (OR 3.3, <em>P</em> &lt; .001) within the early postoperative period.</div></div><div><h3>Conclusion</h3><div>Patients with a history of MI, renal insufficiency, hypertension, CVD, or diabetes mellitus were associated with significantly greater odds of adverse cardiac events at 30 and 90 days following TSA. History of prior MI was the strongest independent RF, with an associated 21 times greater odds of postoperative MI at 30 and 90 days.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 299-304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891236","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 index and the Goutallier classification reliably predict rotator cuff integrity using computed tomography and magnetic resonance imaging as confirmed intraoperatively in shoulder arthroplasty patients","authors":"Alexander E. White MD ,&nbsp;Mihir S. Dekhne MD ,&nbsp;Michael Mazzucco BS ,&nbsp;Karthik Nathan MD ,&nbsp;Harry G. Greditzer 4th MD ,&nbsp;Michelle Kew MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.01.005","DOIUrl":"10.1053/j.sart.2025.01.005","url":null,"abstract":"<div><h3>Hypothesis</h3><div>We hypothesized that both computed tomography (CT) and magnetic resonance imaging (MRI) could be used reliably to measure the acromiohumeral index (AHI) and supraspinatus muscle atrophy through the use of Goutallier classification. Additionally, we hypothesized that these measurements could be used in combination to predict rotator cuff status, as verified by intraoperative assessment.</div></div><div><h3>Methods</h3><div>This was a retrospective case series of a prospectively maintained single institution’s shoulder arthroplasty registry. Patients who underwent anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty between March 2015 and July 2020 were eligible for inclusion if they had X-ray (XR), MRI, and CT scans performed within 6 months of surgery and rotator cuff integrity documented intraoperatively. AHI was measured for each patient using XR, MRI, and CT. Goutallier scores were assigned using both MRI and CT for supraspinatus muscle quality. Rotator cuff integrity was confirmed intraoperatively by the operating surgeon and reported to be (1) intact/attenuated or (2) torn. Intraclass correlation coefficients were calculated for each measurement and imaging modality and cut-point analysis was performed for predicting rotator cuff integrity.</div></div><div><h3>Results</h3><div>Of the patients, a total of 199 (132 anatomic total shoulder arthroplasty, 67 reverse total shoulder arthroplasty) met the inclusion criteria. Intraclass correlation coefficient values were as follows—Goutallier on CT: 0.76, Goutallier on MRI: 0.73, AHI on MRI: 0.81, AHI on XR: 0.76, and AHI on CT: 0.72. Median AHI measurements for patients with intact rotator cuffs were 7.50 mm on MRI, 7.80 mm on CT, and 8.65 mm on XR, whereas median AHI measurements for patients with torn rotator cuffs were 5.45 mm on MRI, 4.93 mm on CT, and 7.55 mm on XR. These intramodality differences were significantly different (<em>P</em> &lt; .001). Goutallier measurements on MRI and CT were significantly positively correlated (R = 0.93, <em>P</em> &lt; 2.2e-16). The optimal cut point for determining rotator cuff integrity using AHI was 6.40 mm on MRI, 5.75 mm on CT, and 7.90 mm on XR. The optimal cut point for predicting rotator cuff integrity when using Goutallier score was 1.50 on MRI and 1.00 on CT. In the diagnosis of a rotator cuff tear (partial or full-thickness), MRI sensitivity was 92.7% and specificity was 33.1%.</div></div><div><h3>Conclusion</h3><div>Both CT and MRI provide reliable assessments of supraspinatus muscle quality and AHI in shoulder arthroplasty candidates. Median AHI measurements are significantly lower when using CT and MRI and these differences are amplified in the case of rotator cuff insufficiency. Furthermore, both CT and MRI predict intraoperative rotator cuff status more reliably than XR when using cut points for Goutallier scores and AHI measurements.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 270-279"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891226","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":"Comparison study of patient demographics, causes, and risk factors associated with 90-day readmissions following primary reverse shoulder arthroplasty","authors":"Lucas R. Haase MD,&nbsp;Ajit M. Vakharia MD,&nbsp;Jason G. Ina MD,&nbsp;Anthony M. Imbrogno DO,&nbsp;Andrew Paliobeis MD,&nbsp;Raymond E. Chen MD,&nbsp;Robert J. Gillespie MD","doi":"10.1053/j.sart.2025.01.006","DOIUrl":"10.1053/j.sart.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>The use of reverse total shoulder arthroplasty (rTSA) has risen exponentially, likely due to the consistently favorable outcomes, an aging population, and expanding surgical indications. This increase in operative volume has led to a proportional increase inhospital readmissions. The purpose of this study was to (1) determine the 90-day readmission rates following rTSA, (2) identify the common surgical causes for readmission, and (3) evaluate patient-related risk factors associated with increased risk of readmission.</div></div><div><h3>Methods</h3><div>Patients undergoing rTSA were identified using a nationwide administrative database. The study group cohort included those patients who were readmitted within 90 days following the index procedure; whereas patients not readmitted served as controls. The query yielded 116,893 patients with 4705 readmitted and 112,118 not readmitted. Demographic information including sex, age, comorbidities, and Elixhauser Comorbidity index (ECI) were compared between groups. Chi-square analyses were used to compare patient demographics. Multivariate binomial logistics regression analyses were used to calculate odds ratios (ORs) on patient-related risk factors for 90-day readmissions. A <em>P</em> value less than .007 was considered statistically significant based on Bonferroni correction.</div></div><div><h3>Results</h3><div>The overall readmission rate was 4.03%, 40.5% of which were orthopedic-related. The most common causes of readmission were prosthetic dislocation (0.97%), deep and superficial surgical site infection (0.34%), and postoperative pain (0.19%). Readmitted patients had significantly higher rates of comorbid conditions. Comorbid conditions with the highest association with 90-day readmission were body mass index &gt; 40 (OR = 2.39), rheumatoid arthritis (OR = 1.90), iron deficiency anemia (OR = 1.79), and chronic kidney disease (OR = 1.62). ECI was significantly higher among the readmitted group (8.8 vs. 6.2; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Patients undergoing rTSA with increased body mass index, rheumatoid artthritis, chronic kidney disease and iron deficiency anemia were at increased risk for readmission. Patients with increased ECI also had increased odds of readmission. Well-powered prospective studies are necessary to better understand the impact of comorbid conditions on the risk for readmission. However, the current study can be used by orthopedic surgeons and other health-care professionals to educate patients with significant comorbid conditions to better predict the chance of readmission after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 280-285"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891227","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 influence of sex: a deep dive into reverse total shoulder arthroplasty outcomes","authors":"Asimina Lazaridou PhD ,&nbsp;Pamela M. Rist ScD ,&nbsp;Daniela Brune BSc ,&nbsp;Tim Schneller MSc ,&nbsp;Philipp Moroder MD ,&nbsp;Markus Scheibel MD","doi":"10.1053/j.sart.2025.01.003","DOIUrl":"10.1053/j.sart.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>The increasing prevalence of reverse total shoulder arthroplasty (RTSA) highlights the need for detailed analyses of sex-based outcomes. This study aims to elucidate the differences in functional, pain, and radiological outcomes between sexes following RTSA, addressing a crucial gap in understanding how sex influences recovery and overall results.</div></div><div><h3>Methods</h3><div>We analyzed data from RTSA procedures recorded between 2006 and 2022 in a local registry, with an average age of 72 years. Linear mixed models and logistic regression models were utilized to explore associations between clinical outcomes (range of motion, function, and pain), radiological outcomes (scapular notching, bone resorption, and implant loosening), and sex up to 24 months. A mediation analysis was conducted to assess the mediating effects of negative affect between sex and pain.</div></div><div><h3>Results</h3><div>Out of 2747 RTSA cases, 1804 (65%) were performed on female patients. Differences were noted over the 24 month follow-up with males demonstrating better overall function compared to females (<em>P</em> &lt; .001). Females demonstrated increased preoperative pain levels compared to males without significant differences postsurgery. Linear mixed models revealed significant effects of sex on pain, function, flexion, and internal rotation over time. No differences were noted in any of the radiological outcomes over time. Mediation analysis showed a significant indirect effect (b = −0.107 (95% confidence interval [−0.145, −0.07], <em>P</em> &lt; .001)) between sex and postsurgical pain.</div></div><div><h3>Conclusion</h3><div>Although radiological outcomes were comparable, a detailed analysis reveals sex differences in clinically important outcomes. These differences should be considered during preoperative counseling and in risk stratification for patients undergoing RTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 263-269"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891225","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":"Thank you to our reviewers for 2024","authors":"","doi":"10.1053/j.sart.2025.01.001","DOIUrl":"10.1053/j.sart.2025.01.001","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 116-117"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284736","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":"A national shift to outpatient total shoulder arthroplasty in the United States after regulatory changes: a 10-year analysis of current trends in procedure volume, complications, and health-care utilization","authors":"Emma T. Smolev BA,&nbsp;Kenny Ling MD,&nbsp;Elizabeth Wang MD,&nbsp;Joseph Kim BS,&nbsp;Edward D. Wang MD","doi":"10.1053/j.sart.2024.12.011","DOIUrl":"10.1053/j.sart.2024.12.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;On January 1, 2021, total shoulder arthroplasty (TSA) was removed from the Medicare “Inpatient Only List”, allowing for reimbursement of outpatient TSA and broadening patient access to outpatient TSA for patients on these insurances. The purpose of this study is to analyze the trends in inpatient vs. outpatient TSA due to the regulatory change in reimbursement. In addition, we analyze differences in 30-day postoperative complications following inpatient vs. outpatient TSA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All patients who underwent TSA between 2011 and 2022 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Postoperative complications were reported within 30 days of procedure. Goodness-of-fit Chi-square test with summary statistics was employed to identify differences in 30-day complications, readmissions, and reoperations between cohorts. Statistical significance was assessed at &lt;em&gt;P&lt;/em&gt; = .05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 45,986 patients underwent TSA between 2011 and 2022. 74.7% (n = 34,341) underwent inpatient TSA. The annual volume of inpatient TSA from 2020 to 2022 had a 50% decrease (3552 to 1779). The annual volume of outpatient TSA increased by 449% (885 to 4861) during the same period. Compared to patients who underwent inpatient TSA from 2011 to 2020, the 2021-2022 inpatient TSA cohort were more likely to be age ≥75 years (&lt;em&gt;P&lt;/em&gt; &lt; .001), female gender (&lt;em&gt;P&lt;/em&gt; &lt; .001), body mass index ≥35 (&lt;em&gt;P&lt;/em&gt; &lt; .001), American Society of Anesthesiologists ≥3 (&lt;em&gt;P&lt;/em&gt; &lt; .001), dependent functional status (&lt;em&gt;P&lt;/em&gt; &lt; .001), and had significantly higher comorbidities including diabetes (&lt;em&gt;P&lt;/em&gt; = .005), chronic obstructive pulmonary disease (&lt;em&gt;P&lt;/em&gt; &lt; .001), hypertension (&lt;em&gt;P&lt;/em&gt; &lt; .001), steroid use (&lt;em&gt;P&lt;/em&gt; &lt; .001), and bleeding disorder (&lt;em&gt;P&lt;/em&gt; = .050). Amongst all outpatient TSA, patients from 2021 to 2022 were more likely to be age ≥65 years (&lt;em&gt;P&lt;/em&gt; &lt; .001), female gender (&lt;em&gt;P&lt;/em&gt; &lt; .001), body mass index ≥35 (&lt;em&gt;P&lt;/em&gt; = .001), American Society of Anesthesiologists ≥3 (&lt;em&gt;P&lt;/em&gt; &lt; .001), dependent functional status (&lt;em&gt;P&lt;/em&gt; &lt; .001), and had significantly higher comorbidities including diabetes (&lt;em&gt;P&lt;/em&gt; &lt; .001), chronic obstructive pulmonary disease (&lt;em&gt;P&lt;/em&gt; &lt; .001), congestive heart failure (&lt;em&gt;P&lt;/em&gt; = .014), and hypertension (&lt;em&gt;P&lt;/em&gt; = .039). The outpatient cohort had fewer 30-day complications and reoperations in both 2011-2020 and 2021-2022. Both inpatient and outpatient hospital length of stay decreased over time; however, the outpatient cohort had shorter hospital length of stay (&lt;em&gt;P&lt;/em&gt; &lt; .001). Mean operative time for inpatient TSA increased from 109.43 minutes (2011-2020) to 112.91 minutes (2021-2022), while the mean outpatient TSA operative time decreased from 113.86 to 102.94 minutes during the same time periods (&lt;em&gt;P&lt;/em&gt; &","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 246-253"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890587","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":"Learning curve for intraoperative computer navigation in reverse total shoulder arthroplasty by the cumulative sum method","authors":"Jun Kawamata MD ,&nbsp;Shoji Fukuta MD, PhD ,&nbsp;Yusuke Fukuta MD ,&nbsp;Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.01.002","DOIUrl":"10.1053/j.sart.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative navigation facilitates accurate glenoid component placement. However, introducing a new surgical technique inevitably entails a learning curve for surgeons. This study aimed to determine the learning curve for intraoperative navigation in reverse total shoulder arthroplasty (RSA).</div></div><div><h3>Methods</h3><div>Fifty-two consecutive patients were analyzed who underwent RSA using the ExactechGPS navigation system between January 2020 and June 2023. Total operation time and time for each surgical stage (bony landmark time, baseplate implantation time, and screw insertion time) were recorded in the navigation system. After surgery, glenoid inclination and version were measured using preoperative planning software, and the deviations in inclination (ΔInc) and version (Δver) from the preoperative plan were investigated. The correlation between the chronological case number and the study variables was evaluated. The cases were divided chronologically into groups I-V (I-IV, 10 cases; V, 12 cases) and compared for operation time, blood loss, and baseplate positioning.</div></div><div><h3>Results</h3><div>Total operation time trended downward (R² = 0.20, <em>P</em> &lt; .001) from 124.9 ± 10.2 minutes in group I to 126.8 ± 22.7 minutes in group II, 121.5 ± 16.0 minutes in group III, 108.6 ± 13.3 minutes in group IV, and 106.9 ± 10.6 minutes in group V, with a significant difference between groups I and V (<em>P</em> = .035). Screw insertion time also trended downward (R² = 0.16, <em>P</em> &lt; .001); the difference between group I and groups IV and V was significant (I vs. IV, <em>P</em> = .044; I vs. V, <em>P</em> = .017). No significant differences in trends were found in the other stages (bony landmark time, R² = 0.02, <em>P</em> = .37; baseplate implantation time, R² = 0.07, <em>P</em> = .08) or in blood loss. For baseplate positioning, the mean deviation of the achieved inclination from that planned was 2.5° (range, 0°-7.6°). The mean deviation of the achieved version from that planned was 2.7° (range, 0°-8.4°). There was no significant difference in Δinc or Δver among the groups. No learning curve was observed in terms of Δinc (R² = 0.05, <em>P</em> = .09) or Δver (R² = 0.006, <em>P</em> = .59).</div></div><div><h3>Conclusion</h3><div>Total operation and screw insertion times in RSA trended downward following the introduction of intraoperative navigation. In our experience, about 30 cases were required to shorten the operation time. The learning curve for intraoperative navigation resulted in high accuracy within 3° for both inclination and version immediately after its introduction.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 254-262"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891224","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":"Changes from baseline in patient-reported outcomes and patient satisfaction do not vary significantly between 1 and 2 years postoperatively after shoulder arthroplasty: a multicenter analysis of 2580 patients","authors":"Midhat Patel MD ,&nbsp;Molly G. Sekar MD ,&nbsp;Lea McDaniel MD ,&nbsp;Haroon M. Kisana MD ,&nbsp;Joshua B. Sykes MD ,&nbsp;Michael H. Amini MD","doi":"10.1053/j.sart.2024.12.010","DOIUrl":"10.1053/j.sart.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>At the present time, most orthopedic journals require 2 years of follow-up data for clinical studies. However, it is unclear if there are significant changes in patient-reported outcomes (PROs) between 1 and 2 years postoperatively. The current study sought to evaluate changes in PROs between 1 and 2 years postoperatively after shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A prospective, multicenter registry was queried for all patients that underwent primary total shoulder arthroplasty, primary reverse shoulder arthroplasty (RSA), revision RSA, and RSA for fracture. Patients with preoperative, 6-month, 1-year, and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) scores were included. We evaluated mean ASES scores, Δ (improvement from preoperative) ASES, and Percent Maximum Possible Improvement. We also evaluated achievement of Clinically Significant Outcomes (CSOs) for the ASES score, including the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptom State. Patient satisfaction questionnaires were also evaluated.</div></div><div><h3>Results</h3><div>A total of 2580 patients were identified that underwent shoulder arthroplasty for all indications with full follow-up data. Overall, changes between 1 and 2 years postoperatively were minimal: ASES score 0.8, Δ ASES 0.8, and % Maximum Possible Improvement 1.6%. Similarly, the percentage of patients who achieved CSOs was minimally different at 1 and 2 years: Minimal Clinically Important Difference −0.4%, Substantial Clinical Benefit 1.1%, and Patient-Acceptable Symptom State 2.4%. Subgroup analyses of all primary arthroplasties, primary total shoulder arthroplasty, primary RSA, revision RSA, and RSA for proximal humerus fracture revealed similar, minimal changes from 1 to 2 years postoperatively. Overall, less than 5% of patients changed their responses to any of the satisfaction questions between 1 and 2 years: 4.1% of patients changed their answer with respect to pain, 2.8% with respect to function, 3.9% with respect to activities of daily living, and 2.5% with respect to ability to return to sports.</div></div><div><h3>Conclusion</h3><div>PROs, achievement of CSOs, and patient satisfaction are minimally different at 1 and 2 years after shoulder arthroplasty. This data suggests that accepting 1-year, rather than 2-year, outcomes for short-term reporting of shoulder arthroplasty may facilitate improvement in follow-up rates with less risk of bias due to loss to follow-up, more timely dissemination of information, and decreased administrative burden. This does not change the need for midterm and long-term studies.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 235-245"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890643","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}