Seminars in Arthroplasty最新文献

{"title":"Diagnosis of shoulder periprosthetic joint infection with atypical wounds: a case series of 12 patients","authors":"Charles J. Cogan MD, Midhat Patel MD, Joseph P. Iannotti MD, PhD, Jason C. Ho MD, Eric T. Ricchetti MD, Vahid Entezari MD, MMSc","doi":"10.1053/j.sart.2024.05.006","DOIUrl":"10.1053/j.sart.2024.05.006","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 807-812"},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000737/pdfft?md5=33a68c2138f28f5191e0a66c84d7ceb6&pid=1-s2.0-S1045452724000737-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048523","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":"Artificial intelligence to automatically measure glenoid inclination, humeral alignment, and the lateralization and distalization shoulder angles on postoperative radiographs after reverse shoulder arthroplasty","authors":"Linjun Yang PhD ,&nbsp;Rodrigo de Marinis MD ,&nbsp;Kristin Yu MD ,&nbsp;Erick Marigi MD ,&nbsp;Jacob F. Oeding MS ,&nbsp;John W. Sperling Jr ,&nbsp;Joaquin Sanchez-Sotelo MD, PhD","doi":"10.1053/j.sart.2024.05.002","DOIUrl":"10.1053/j.sart.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><p>Radiographic evaluation of the implant configuration after reverse shoulder arthroplasty<span> (RSA) is time-consuming and subject to interobserver disagreement. The final configuration is a combination of implant features and surgical execution. Artificial intelligence (AI) algorithms have been shown to perform accurate and efficient analysis of images. The purpose of this study was to develop an AI algorithm to automatically measure glenosphere inclination, humeral component inclination, and the lateralization and distalization shoulder angles (DSAs) on postoperative anteroposterior radiographs after RSA.</span></p></div><div><h3>Methods</h3><p><span>The Digital Imaging and Communications in Medicine files corresponding to postoperative anteroposterior radiographs obtained after implantation of 143 RSAs were retrieved and used in this study. Four angles were analyzed: (1) glenoid inclination angle (GIA, between the central fixation feature of the glenoid and the floor of the supraspinatus fossa), (2) humeral alignment angle (HAA, between the long axis of the </span>humeral shaft and a perpendicular to the metallic bearing of the prosthesis), (3) DSA, and (4) lateralization shoulder angle (LSA). A UNet segmentation model was trained to segment bony and implant elements using manually segmented training (n = 89) and validation (n = 22) images. Then, an image-processing–based pipeline was developed to measure all 4 angles using AI-segmented images. Measures performed by 3 physician observers and the AI algorithm were then completed in 32 additional images. The agreements among human observers and between observers and the AI algorithm were evaluated using intraclass correlation coefficients (ICCs) and absolute differences in degree.</p></div><div><h3>Results</h3><p>The ICCs (95% confidence interval) for manual measurements of LSA, DSA, GIA, and HAA were 0.79 (0.55, 0.90), 0.90 (0.80, 0.95), 0.96 (0.93, 0.98), and 0.99 (0.97, 0.99), respectively. The AI algorithm measured the 32 images in the test set in less than 2 minutes. The agreement between observers and the AI algorithm was lowest when measuring the LSA for observer 2, with an ICC of 0.77 (0.52, 0.89), and an absolute difference in degrees (median [interquartile range]) of 5 (4). Better agreements were found between the AI measurements and the average manual measurements: absolute differences in degree for LSA, DSA, GIA, and HAA were 3 (5), 2 (3), 2 (2), and 2 (1), respectively; ICCs for LSA, DSA, GIA, and HAA were 0.89 (0.79, 0.95), 0.96 (0.93, 0.98), 0.85 (0.68, 0.93), and 0.98 (0.95, 0.99), respectively.</p></div><div><h3>Conclusion</h3><p>The AI algorithm developed in this study can automatically measure the GIA, HAA, LSA, and DSA on postoperative anteroposterior radiographs obtained after implantation on RSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 779-788"},"PeriodicalIF":0.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049867","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 hybrid humerus reverse shoulder arthroplasty: a prospective study of bone grafting and metaphyseal fixation with undersized stem in the assessment of proximal humeral stress shielding and associated clinical outcome","authors":"Roberto Pareyon MD ,&nbsp;Helen Ingoe MBBS, FRCS Eng ,&nbsp;Mohammad N. Jomaa MD ,&nbsp;Kristine Italia FPOA ,&nbsp;Jashint Maharaj FRSPH ,&nbsp;Sarah L. Whitehouse PhD ,&nbsp;Kenneth Cutbush MBBS, FRACS, FAOrthoA ,&nbsp;Ashish Gupta MBBS, MSc, FRACS, FAOrthoA","doi":"10.1053/j.sart.2024.05.004","DOIUrl":"10.1053/j.sart.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>A significant proportion of revisions after reverse shoulder arthroplasty (RSA) is attributed to the humeral component. The purpose of this study is to evaluate the radiographic and clinical outcomes of the hybrid humerus technique for RSA using a Grammont-style humeral prosthesis in an onlay fashion with metaphyseal bone impaction grafting technique and undersized stem to avoid humeral stress shielding, notching, and loosening.</p></div><div><h3>Methods</h3><p>This is a prospective case series of patients who underwent RSA using the hybrid humerus technique with a minimum 2-year follow-up. Key steps of this technique include the use of undersized Grammont-style stem, impaction bone grafting of the proximal 5 cm of the humerus, and adjusting the height and offset of the stem depending on the patient stature, desired lateralization and distalization, and joint and soft tissue tension. Radiographic assessments were performed immediately after surgery, and at 1 and 2 years after surgery. These included assessment of metaphyseal and diaphyseal filling ratio, cortical narrowing, radiolucent lines, cortical lucencies, spot welding, scapular notching, and stem alignment. Preoperative and 2-year postoperative clinical assessments included American Shoulder and Elbow Surgeons score, Constant-Murley Score, University of California Los Angeles score, visual analog scale for pain, and active range of motion. Correlation between the filling ratios and clinical outcomes were also evaluated.</p></div><div><h3>Results</h3><p>Sixty-one patients were included in the study. The average metaphyseal and diaphyseal filling ratio on the postoperative X-ray was 0.66 and 0.54, and 0.67 and 0.54 at 2 years, respectively. Stress shielding was graded as none in 24 (40.7%), mild in 33 (55.9%), and moderate in 2 (3.4%). No stem had a change in position of more than 5°. At 2 years of follow-up, no humeral implant loosening was noted, with only 2 (3.4%) of the stems at risk of loosening. Thirty-nine (66.1%) had no notching, 14 (23.7%) were graded as mild, and 6 (10.2%) had moderate signs of notching. All clinical assessments significantly improved at 2 years (<em>P</em> &lt; .001), with a weak negative correlation between visual analog scale and metaphyseal filling ratio (r = −0.268, <em>P</em> = .036) but none between diaphyseal filling ratio and clinical outcomes.</p></div><div><h3>Conclusion</h3><p>The hybrid humerus technique of metaphyseal bone grafting with a low filling ratio stem presents a promising solution for reducing humeral complications in RSA. This technique demonstrates a low incidence of stress shielding and loosening, with excellent clinical outcomes at 2 years.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 797-806"},"PeriodicalIF":0.0,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000713/pdfft?md5=ce0f7ece85c74763621fecd2b7f9dc06&pid=1-s2.0-S1045452724000713-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048522","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":"Comparison of range of motion between 2-year clinical outcomes and predictions of a static scapula preoperative planning software for reverse shoulder arthroplasty","authors":"Marco Branni PhD ,&nbsp;Helen Ingoe MBBS, FRCS Eng, MD, MSc, PGCert ,&nbsp;Asma Salhi PhD ,&nbsp;Kristine Italia MD, FPOA ,&nbsp;Luke Gilliland MEng ,&nbsp;Marine Launay MEng ,&nbsp;Roberto Pareyon MD ,&nbsp;Jashint Maharaj MBBS ,&nbsp;Angus Lane BEng ,&nbsp;Peter Pivonka PhD ,&nbsp;Kenneth Cutbush MBBS, FRACS, FAOrthoA ,&nbsp;Ashish Gupta MBBS, MSc, FRACS, FAOrthoA","doi":"10.1053/j.sart.2024.05.001","DOIUrl":"10.1053/j.sart.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Preoperative planning has gained popularity in the management of reverse shoulder arthroplasty (RSA). Commercially available software provides 3-dimensional segmentation of scapula and humerus, as well as providing arc of motion for the implanted articulation and identifying potential areas of bony impingement. However, these software algorithms use a fixed scapula model, disregarding the preoperative clinical range of motion (C-ROM) of the patient, be it glenohumeral or scapulothoracic, as well as any soft tissue parameters. This study aims to compare the ROM based on preoperative planning software by using the implant position from postoperative computed tomography (CT) images (predicted ROM using preoperative planning software [P-ROM]), with the C-ROM assessed at minimum of 2 years of follow-up.</p></div><div><h3>Methods</h3><p>Preoperative and postoperative CT scans of 46 patients who underwent primary RSA between 2017 and 2021 were analyzed. At the postoperative 2-year review, each patient was assessed for active ROM. Implant size and position based on operative notes and postoperative CT scans were used to replicate the performed surgery in the planning software. Abduction, flexion, and external rotation motion were simulated and recorded. The relationship between C-ROM and P-ROM was investigated using linear regression analysis, Pearson correlation coefficient, and paired <em>t</em>-test.</p></div><div><h3>Results</h3><p>P-ROM was significantly lower than C-ROM at 2 years postoperatively (<em>P</em> &lt; .001), with an average discrepancy of 78° in abduction, 47° in flexion, and 37° in external rotation (C-ROM: abduction 155° ± 21° [80°-180°]; flexion 160° ± 17° [90°-180°]; external rotation 52° ± 14° [10°-80°] vs. P-ROM: abduction 77° ± 13° [53°-107°]; flexion 112° ± 25° [67°-180°]; external rotation 15° ± 21° [0°-79°]). The linear regression analysis indicated weak agreement between C-ROM and P-ROM (abduction R² = 0.03; flexion R² = 0.01; external rotation R² = 0.04). Pearson’s correlation coefficients revealed weak correlations of −0.18, 0.03, and 0.21 for abduction, flexion, and external rotation, respectively.</p></div><div><h3>Conclusion</h3><p>P-ROM based on preoperative software in its current form does not allow the prediction of the C-ROM at 2 years of follow-up for patients undergoing RSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 770-778"},"PeriodicalIF":0.0,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000683/pdfft?md5=9e26b694e21028969650eeda98c5e191&pid=1-s2.0-S1045452724000683-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049866","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":"Impact of surgeon variability on outcomes after total shoulder arthroplasty: an analysis of 2188 surgeons","authors":"Favian Su MD,&nbsp;Cameron Nosrat BS,&nbsp;Ryan T. Halvorson MD,&nbsp;Drew A. Lansdown MD,&nbsp;Brian T. Feeley MD,&nbsp;C. Benjamin Ma MD,&nbsp;Alan L. Zhang MD","doi":"10.1053/j.sart.2024.05.003","DOIUrl":"10.1053/j.sart.2024.05.003","url":null,"abstract":"<div><h3>Background</h3><p>There has been limited evaluation of surgeon-specific factors on outcomes after total shoulder arthroplasty (TSA). The goals of this study were (1) to determine the impact of surgeon procedural volume, career duration, practice type, and fellowship training on TSA outcomes at 2-year follow-up and (2) to evaluate the relative importance of surgeon variables in relation to patient variables in influencing outcomes.</p></div><div><h3>Methods</h3><p><span>The PearlDiver Mariner database was queried to identify all surgeons who performed a minimum of 11 TSA procedures from 2010 to 2018. An Internet search of publicly available data was performed to determine the career duration, practice type, and fellowship training of each surgeon. Multivariate logistic regression<span> models were built to determine the relationship between surgeon-specific variables and 2-year surgical complications and revisions and 90-day readmissions. Variable importance of patient-specific and surgeon-specific factors was determined by the </span></span>Akaike information criterion increase of these models.</p></div><div><h3>Results</h3><p>A total of 2188 surgeons who performed 93,122 TSA procedures were identified in this database. Higher reverse TSA surgical volume was associated with fewer surgical complications and revisions, although such a relationship was not observed for anatomic TSA. Revision after anatomic TSA was more common among surgeons who were in their first 5 years of practice. There was a higher risk of surgical complication and readmission among academic surgeons, but this did not equate with a higher risk of revision. The impact of these surgeon-specific factors on outcomes was small in relation to patient-level variables, such as age, sex, and number of medical comorbidities.</p></div><div><h3>Conclusion</h3><p>Surgeon procedural volume, career duration, and practice setting influence the surgical complication, revision, and readmission rates after TSA. The impact of surgeon factors was small relative to patient variables, highlighting the importance of patient selection in mitigating adverse outcomes.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 789-796"},"PeriodicalIF":0.0,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048521","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":"Effect of glenosphere diameter and lateralization in primary reverse shoulder arthroplasty: a randomized clinical trial","authors":"Erick M. Marigi MD ,&nbsp;Ronda N. Esper BSc ,&nbsp;Dirk R. Larson MS ,&nbsp;Mark E. Morrey MD ,&nbsp;Joaquin Sanchez-Sotelo MD, PhD","doi":"10.1053/j.sart.2024.04.008","DOIUrl":"10.1053/j.sart.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><p><span>Within reverse total shoulder arthroplasty (RSA), prior studies have suggested that smaller glenosphere diameters may result in higher rates of scapular notching and polyethylene wear, while lateralized glenospheres may allow for better range of motion (ROM); however, supportive data remains limited. Therefore, the purpose of this study was to report the outcomes of a prospective </span>randomized clinical trial comparing 4 different glenosphere configurations based on diameter and lateral offset.</p></div><div><h3>Methods</h3><p><span><span>Between 2016 and 2020, 113 primary RSAs with a diagnosis of either rotator cuff tear arthropathy<span> (n = 48, 42%), irreparable rotator cuff tears (n = 22, 19%), or primary glenohumeral </span></span>osteoarthritis<span> with subluxation<span> or glenoid bone loss (n = 43, 38%) were enrolled into a blinded prospective randomized clinical trial. The mean age of the patients included in the study was 73 ± 7 (range, 50-89) years, and 58 (51.3%) were males. All procedures were performed by two surgeons utilizing the ReUnion RSA system (Stryker, Mahwah, NJ, USA). Patients were randomized into four possible groups based on the diameter and lateral offset of the glenosphere implanted: 36 mm diameter with 2 mm (n = 34, 30.1%) or 6 mm (n = 28, 24.8%) of lateralization and 40 mm diameter with 2 mm (n = 29, 25.7%) or 6 mm (n = 22, 19.5%) of lateralization. Outcomes collected included pain, active ROM, strength, satisfaction, patient-reported outcome measures (PROMs), complications, </span></span></span>reoperations<span>, and revisions. PROMs included the Oxford Shoulder Score, the American Shoulder and Elbow Surgeons, and the quick Disabilities of the Arm, Shoulder and Hand questionnaire. All patients were followed for a minimum of 2 years.</span></p></div><div><h3>Results</h3><p>With the numbers available, glenosphere diameter and lateralization resulted in no differences in pain, ROM, strength, satisfaction, and PROMs at 1 year, 2 years, or final follow-up (All <em>P</em> &gt; .05). However, all 3 complications (10.7% vs. 0% vs. 0% vs. 0%; <em>P</em> = .025) and 2 revision surgeries (7.1% vs. 0% vs. 0% vs. 0%; <em>P</em> = .103) occurred in males, with the 36 + 6 cohort.</p></div><div><h3>Conclusions</h3><p>Using this particular RSA design, implantation of glenospheres with 36 mm or 40 mm of diameter and 2 mm or 6 mm of sphere lateralization did not translate into significant differences when primary RSA was performed in shoulders with rotator cuff tear arthropathy, irreparable cuff tears, or primary glenohumeral osteoarthritis. However, all observed complications occurred in males with the smallest diameter and lateralized glenosphere.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 746-754"},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049849","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":"Stemless RSA shows good short-term radiological stability and clinical outcomes in elderly patients","authors":"Maxime Antoni MD ,&nbsp;Pierre Alban Bouche MD, PhD ,&nbsp;Laurent Obert MD, PhD ,&nbsp;Alexandre Quemener MD ,&nbsp;Geoffroy Nourissat MD, PhD","doi":"10.1053/j.sart.2024.04.010","DOIUrl":"10.1053/j.sart.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><p>The main goal of this study was to investigate the influence of patient age on humeral implant fixation in stemless reverse shoulder arthroplasty (RSA). The secondary goals were to investigate the influence on the occurrence of complications and on clinical outcomes.</p></div><div><h3>Methods</h3><p><span>We performed a retrospective multicenter study, including a series of patients operated on for stemless RSA. All patients were reviewed at a minimum of 2 years, with clinical and radiographic evaluation. The primary endpoint was the occurrence of migration of the humeral implant at the final follow-up. Secondary endpoints were clinical scores, occurrence of postoperative complications, need for revision surgery, and radiographic changes. Each patient ≥70 year old was matched on gender and </span>body mass index,with a patient &lt; 70 year old on a 1:1 basis.</p></div><div><h3>Results</h3><p>Forty-five patients aged ≥70 years were included and matched, with 45 patients aged &lt;70 years, giving a total of 90 patients (54.4% men) with the mean age being 68.5 ± 7.9 years. There was no difference between the 2 groups in terms of surgical modalities. There was no correlation between age and clinical outcomes. Three migrations of the humeral implant occurred, none leading to a revision, without any influence of age (<em>P</em> = 1.0). We found no correlation between patient age and the occurrence of a postoperative complication (<em>P</em><span> = 1.0), reoperation (</span><em>P</em> = 1.0) or any of the other radiographic parameters assessed.</p></div><div><h3>Conclusion</h3><p>This study reported the stability of stemless RSA implants in elderly patients. Clinical outcomes, complication, and revision rates were not affected by age either.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 762-769"},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049851","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":"Bilateral aseptic loosening of glenoid and humeral components after anatomic shoulder arthroplasty: a case report","authors":"Nathan Sherman MD, MBA ,&nbsp;Robert V. Childers MS ,&nbsp;Bryn Nisbet MD ,&nbsp;Andrew Knox PA ,&nbsp;Andrew Mahoney MD","doi":"10.1053/j.sart.2024.04.009","DOIUrl":"10.1053/j.sart.2024.04.009","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 755-761"},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049850","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":"In vitro analysis of various antibiotic and cement combinations against S. epidermidis and S. lugdunensis for treatment of periprosthetic shoulder infection","authors":"","doi":"10.1053/j.sart.2024.04.007","DOIUrl":"10.1053/j.sart.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p><span><span><span>Periprosthetic joint infections (PJIs) are devastating potential complications after </span>arthroplasty<span> surgery with significant therapeutic challenges. Many authors advocate for two-stage revision arthroplasty<span> for PJI of the shoulder which includes explanation with antibiotic spacer placement. The optimal antibiotic/cement combination for PJI in the shoulder is not known. The purpose of this study is to analyze various cement and antibiotic concentrations against </span></span></span>Coagulase negative staphylococcus species, </span><span><span>S. epidermidis</span></span> and <em>S. lugdunensis</em>.</p></div><div><h3>Methods</h3><p><span>Five strains of coagulase negative </span><em>Staph</em><span> were taken from clinically documented orthopedic infections<span><span><span> Both Simplex and Palacos cement were used to create antibiotic laden beads and mixed with either </span>ertapenem, </span>vancomycin<span>, gentamicin<span>, or a combination of ertapenem<span> + vancomycin<span> or ertapenem + gentamicin. The bacteria were plated on lysogeny broth agar plates and 3 beads were added per plate. Samples were analyzed for zone of inhibition at 24 hours, 72 hours, and 1 week. After 1 week, beads were transferred to new plates with bacteria and the process was repeated for 6 weeks.</span></span></span></span></span></span></p></div><div><h3>Results</h3><p>Results showed that ertapenem beads with both Simplex and Palacos cement showed the largest zones of inhibition for all samples. Vancomycin in Palacos cement and vancomycin in combination with ertapenem in Simplex and Palacos cement showed consistent zones of inhibition for the duration of the experiments. Ertapenem in combination with either vancomycin or gentamicin may allow for a powerful initial burst of killing followed by consistent antibiotic elution as opposed to gentamicin alone.</p></div><div><h3>Conclusion</h3><p>While many premade spacers on the market are infused with gentamicin, our in vitro models demonstrate more efficacious bacterial eradication for antibiotics such as ertapenem and vancomycin specifically for certain low virulence organisms that are commonly found in PJI around the shoulder.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 738-745"},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141141749","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":"Update from the Editors-in-Chief","authors":"J. Michael Wiater MD,&nbsp;Theodore A. Blaine MD","doi":"10.1053/j.sart.2023.09.002","DOIUrl":"https://doi.org/10.1053/j.sart.2023.09.002","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Page 275"},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072709","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}