Seminars in Arthroplasty最新文献

{"title":"Surgeon experience and procedure type are associated with intraoperative cost and efficiency in shoulder arthroplasty: a retrospective multicenter study","authors":"Andrew M. Schmidt ME ,&nbsp;Garrett K. Berger MD, PharmD ,&nbsp;Rebecca L. Hill DrPH ,&nbsp;Zimin Zhuang MS ,&nbsp;Rebecca Gambatese MPH ,&nbsp;Anna C. Davis PhD ,&nbsp;Heather A. Prentice PhD ,&nbsp;Anshuman Singh MD ,&nbsp;Ronald A. Navarro MD","doi":"10.1016/j.sart.2026.151554","DOIUrl":"10.1016/j.sart.2026.151554","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder arthroplasty is performed with increasing frequency, which has prompted greater attention to understand the drivers of procedural cost and surgical efficiency. While surgeon experience has been linked to improved outcomes in other orthopedic domains, its association with intraoperative cost and operative time in shoulder arthroplasty is unclear. In addition, differences in intraoperative resource utilization between anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are not well defined.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of 4,143 primary elective aTSA and rTSA procedures performed between 2018 and 2023 across 21 centers within an integrated health care system. Surgeon experience was evaluated using 3 metrics: annual case volume, total prior shoulder arthroplasties, and years in practice. Cost data were categorized as implant and supply costs, and operative time was used to assess surgical efficiency. Nine multivariable generalized linear mixed models (3 predictors × 3 outcomes) were used, adjusting for patient demographics, comorbidities, procedure type, and surgery year, with surgeon included as a random effect.</div></div><div><h3>Results</h3><div>Higher annual case volume (≥30 cases/y) was associated with 11% lower supply costs (<em>P</em> &lt; .001) and 5% shorter operative times (<em>P</em> = .023). More years in practice (≥nine years) was associated with 6% shorter operative times (<em>P</em> &lt; .001). Total prior arthroplasties were not associated with cost or operative time after adjustment. rTSA was associated with 36% higher implant costs, 8% lower supply costs, and 8% shorter operative times compared to aTSA (<em>P</em> &lt; .001 for each).</div></div><div><h3>Conclusion</h3><div>Annual case volume and years in practice were associated with greater intraoperative efficiency in shoulder arthroplasty. rTSA demonstrated distinct resource utilization patterns compared to aTSA, highlighting the importance of procedure-specific benchmarking in optimizing surgical cost efficiency.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 2","pages":"Article 151554"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174872","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":"Bone resorption and stress distribution in standard vs. short stems of the Comprehensive Total Shoulder System for shoulder arthroplasty","authors":"Kazuya Inoue MD, PhD ,&nbsp;Naoki Suenaga MD, PhD ,&nbsp;Naomi Oizumi MD, PhD ,&nbsp;Hiroshi Yamaguchi MD, PhD ,&nbsp;Naoki Miyoshi MD ,&nbsp;Shuzo Morita MD ,&nbsp;Shimpei Kurata MD, PhD ,&nbsp;Akira Imanaka MD ,&nbsp;Keisuke Tsujimura MD ,&nbsp;Kenji Kawamura MD, PhD","doi":"10.1016/j.sart.2026.151541","DOIUrl":"10.1016/j.sart.2026.151541","url":null,"abstract":"<div><h3>Background</h3><div>Bone resorption from stress shielding around the humeral stem is a recognized complication after shoulder arthroplasty, contributing to revision failure and periprosthetic fractures. Shorter humeral stem designs have been developed to minimize stress shielding and facilitate revision surgery. However, few studies have compared bone resorption between standard and short stems using unified classification systems and both clinical and biomechanical analyses. This study aimed to compare humeral bone resorption and stress distribution between standard and short stems of the same implant design.</div></div><div><h3>Methods</h3><div>This study assessed humeral bone resorption in 40 shoulders treated with hemiarthroplasty for cuff tear arthropathy, using the same uncemented stem design from the Comprehensive Total Shoulder System (Biomet, Warsaw, IN, USA). Participants were grouped into standard (n = 20) and short stem (n = 20) categories. Bone resorption was evaluated radiographically across 7 zones using a morphology-based classification system. Finite element analysis based on patient-specific computed tomography data simulated stress distribution under loading.</div></div><div><h3>Results</h3><div>Radiographs showed significantly less severe resorption (grade ≥3) in the lateral diaphysis (zone 2) for the short stem group compared the standard group (<em>P</em> = .015). Finite element analysis indicated higher stress in the short stem group at zone 2 (<em>P</em> = .009) and medial diaphysis (zone 6) (<em>P</em> = .028). No significant radiographic difference was observed in zone 6, possibly due to preserved loading from muscle attachments.</div></div><div><h3>Conclusion</h3><div>Short humeral stems were associated with reduced lateral diaphyseal bone resorption, likely reflecting more favorable stress distribution. These findings suggest that short stems may limit stress shielding and support bone preservation following shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 2","pages":"Article 151541"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116529","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 incidence of acromial stress injury after reverse total shoulder arthroplasty: surgeon learning curve","authors":"Maxwell C. Alley MD ,&nbsp;W. Doug Werry BA ,&nbsp;Alan Shi MD ,&nbsp;Alexander Ment BA ,&nbsp;Paul M. Smiley MD ,&nbsp;Brian T. Samuelsen MD, MBA ,&nbsp;John Garfi MS ,&nbsp;Mark J. Lemos MD","doi":"10.1016/j.sart.2026.151550","DOIUrl":"10.1016/j.sart.2026.151550","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is a reliable and frequently utilized treatment for large rotator cuff tears with associated arthritis. Acromion and scapular spine stress injuries and fractures have been shown to be a common complication after rTSA, with an incidence as high as 11% in some reports. This complication can result in pain and loss of functionality. While many risk factors have been reported, this study investigates physician learning curve, a rarely examined feature, to identify whether the incidence of acromial stress fracture (ASF) decreases with the experience of the surgeon.</div></div><div><h3>Methods</h3><div>A retrospective review was performed for all patients undergoing rTSA at a single institution by one of two surgeons using the same rTSA system from 2005 to 2020. Cases were divided into an “early group” (2005-2015) and a “late group” (2015-2020). Patients were followed through their treatment course, with chart review ending in 2020 to ensure a minimum 2-year follow-up. Statistical analysis was determined via Fisher exact test with an alpha level of 0.05.</div></div><div><h3>Results</h3><div>One hundred eighty-five patients (56 males, 129 females) were reviewed. The early group consisted of 102 patients, 7 of which were diagnosed with ASFs. The late group consisted of 83 patients, none of which experienced ASF. This yielded a statistical significance via Fisher exact test. No significant differences were found between rates of dislocation, nerve palsy, deep, and superficial infections between groups.</div></div><div><h3>Conclusion</h3><div>Results suggest that there is a learning curve to rTSA, specifically regarding the incidence of ASF. A potential cause of this discrepancy is tension placed on the deltoid, which is key to achieving a stable rTSA. Less-experienced surgeons may over-tension this element of the procedure, leading to a stress fracture. Future studies may seek to improve intraoperative assessment of deltoid tension to optimally balance the risk of dislocation and ASF.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 2","pages":"Article 151550"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116528","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 effect of glenosphere size on outcomes and complications associated with reverse shoulder arthroplasty: a systematic review and meta-analysis","authors":"Thomas A. Deane MD, MB, BCh, BAO ,&nbsp;Andrew J. Kelly MD, MB, BCh, BAO ,&nbsp;Conor McNamee MD, MB, BCh, BAO ,&nbsp;James G. Kelly MD, MB, BCh, BAO ,&nbsp;Stefan Bauer MD, MB, BCh, BAO ,&nbsp;William G. Blakeney MBBS, MS, MSc, FRACS","doi":"10.1016/j.sart.2025.151525","DOIUrl":"10.1016/j.sart.2025.151525","url":null,"abstract":"<div><h3>Background</h3><div>Glenosphere diameter is a variable component in different reverse shoulder arthroplasty designs. The size of the glenosphere influences the amount of glenosphere overhang. Computer and cadaveric models have postulated that increased glenosphere overhang may restore better range of motion and decrease complications including scapular notching. Alternatively, it has been postulated that increasing glenosphere size may increase tension on the posterior capsule and reduce internal rotation. There is conflicting evidence in the literature regarding the clinical outcomes of increased glenosphere size.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using search engines in PubMed, EMBASE, and Cochrane to retrieve all relevant studies. The Cochrane Risk of Bias Assessment Tool 2 (RoB-2) and risk of Bias in Non-Randomized trials were used to assess for bias. We present log risk ratios for dichotomous variables and raw mean differences (MDs) for continuous variables. The large glenosphere group was defined as ≥40 mm while the small glenosphere group was defined as ≤39 mm.</div></div><div><h3>Results</h3><div>Five studies were included in the quantitative meta-analysis conducted in this paper, comparing 1,217 shoulders. Results of the primary outcomes when comparing large to small glenosphere were as follows: abduction (MD: 0.52; 95% confidence interval [CI]: −5.90, 4.86), forward flexion (MD: 2.38; 95% CI: −1.37, 6.13), external rotation (MD: 2.9; 95% CI: −1.96, 7.76), Constant-Murley Score (MD: 0.49, 95% CI: −2.79, 3.78), American Shoulder and Elbow Surgeons (MD: 3.23; 95% CI: 0.92, 5.54), and scapular notching (odds ratio: −0.07; 95% CI: −0.2, 0.06).</div></div><div><h3>Conclusion</h3><div>The use of larger glenosphere sizes may not have any effect on range of motion or scapular notching. There is a statistically significant improvement in ASES scores, which is below the Minimal Clinically Important Difference.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151525"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926415","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":"Shoulder arthroplasty in patients with prior hip, knee, or shoulder periprosthetic joint infection: a safe option?","authors":"Daniel E. Goltz MD, MBA,&nbsp;Miguel Fiandeiro BA,&nbsp;Ryan M. Cox MD,&nbsp;Ryan Lopez MD,&nbsp;Nabil Mehta MD,&nbsp;Jie J. Yao MD,&nbsp;Thema Nicholson MS,&nbsp;Mark D. Lazarus MD,&nbsp;Surena Namdari MD, MSc","doi":"10.1016/j.sart.2025.151518","DOIUrl":"10.1016/j.sart.2025.151518","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) following anatomic or reverse total shoulder arthroplasty (aTSA, rTSA) is a fortunately rare but devastating complication. Controversy exists regarding both prevention and treatment. Given its severity to the patient and cost to the system, minimizing its risk remains a priority. Some patients may be seen for consideration of shoulder arthroplasty who have previously been treated for PJI of the other shoulder or lower extremity (ie, hip or knee). However, the effect this clinical history has on the likelihood of subsequent PJI in the primary setting remains unknown. The purpose of this study is to understand whether this history poses increased risk of PJI following aTSA or rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed involving all patients who underwent aTSA or rTSA between May 2011 and September 2023 at a single institution, as well as any patients who experienced a PJI of a total hip or knee arthroplasty between April 1999 and December 2019. Patients with a shoulder, hip, or knee PJI history who subsequently underwent a primary shoulder arthroplasty comprised the study cohort. The clinical course of these patients was then studied for any subsequent PJI.</div></div><div><h3>Results</h3><div>Institutional databases of over 1,000 lower extremity PJI cases and over 100 definite or probable shoulder arthroplasty PJI cases were cross-referenced with over 14,000 available shoulder arthroplasty cases extracted from the electronic medical record. Of these, 16 primary and 2 revision cases in 13 patients were identified that involved an aTSA (N = 4) or rTSA (N = 14) following a prior upper (N = 2) or lower (N = 16) extremity PJI. Median follow-up of all patients was 4.5 years, with 13 patients having a minimum follow-up of 2 years. These cases were performed a median of 3.9 years following treatment of their prior PJI, which most often involved <em>Staphylococcus</em> species (66.6%). No patients experienced a PJI of their shoulder arthroplasty at final follow-up, with mean (standard deviation) American Shoulder Elbow Surgeons scores of 83.0 (9.9). One patient sustained a periprosthetic fracture postoperative day 1 requiring revision, and one patient was revised at 3 weeks for instability.</div></div><div><h3>Discussion</h3><div>A history of prior total hip, knee, or shoulder arthroplasty PJI did not result in the infection of any subsequent primary aTSA or rTSA cases at a single high-volume institution, providing some reassurance as part of the preoperative risk stratification process.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151518"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841502","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":"Os acromiale: functional consequences in reverse total shoulder arthroplasty","authors":"Jean Gaillard MD ,&nbsp;Julien Berhouet MD, PhD ,&nbsp;Romain Lancigu MD ,&nbsp;Laurent Baverel MD ,&nbsp;Florent Lespagnol MD ,&nbsp;Florent Jamard MD ,&nbsp;Vincent Crenn MD, PhD","doi":"10.1053/j.sart.2025.09.014","DOIUrl":"10.1053/j.sart.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Deltoid tension and stress applied to the acromion are exacerbated after reverse total shoulder arthroplasty (rTSA): an os acromiale could alter postoperative functional outcome. The primary objective was to investigate whether os acromiale influenced the functional outcome of rTSA at 12 and 24 months postoperatively. The secondary objective was to investigate whether the type of os acromiale (preacromion, mesoacromion, and meta-acromion) had an influence on the functional outcome of rTSA at 2 years postoperatively, on the occurrence of tilt of the acromion after rTSA and the consequences of this tilt on functional outcome.</div></div><div><h3>Methods</h3><div>This observational, retrospective, and multicenter study enrolled 378 patients, including 46 patients with an os acromiale, matched for statistical analysis into 2 groups (ratio 1:3). Functional outcome was assessed at 12 and 24 months postoperatively using the Constant–Murley Score (CMS). The tilt of the acromion was checked on control radiographs at 12 and 24 months postoperatively.</div></div><div><h3>Results</h3><div>The presence of an os acromiale was associated with an inferior functional outcome compared with patients with a “healthy acromion” at 12 months (CMS: 62.9 ± 12.1 vs. 67.5 ± 9.8; <em>P</em> = .025) and at 24 months postoperatively (CMS: 68.2 ± 11.8 vs. 73.5 ± 10.0; <em>P</em> = .011), with a decrease in abduction strength. The “mesoacromion” group (n = 18) had lower mean CMS at 12 months (59.9 ± 13.5 vs. 67.5 ± 9.8; <em>P</em> = .032) and 24 months (65.0 ± 13.6 vs. 73.5 ± 10.0; <em>P</em> = .020) postoperatively compared with the “healthy acromion” group. Tilt of the acromion, visualized in 50% (n = 23) of patients with an os acromiale, was more frequently found in the “mesoacromion” group (<em>P</em> = .002), with no consequence on CMS at 12 months (65.2 ± 11.8 vs. 62.6 ± 12.6; <em>P</em> = .986) and 24 months (67.5 ± 11.8 vs. 68.3 ± 12.2; <em>P</em> = .836).</div></div><div><h3>Conclusion</h3><div>The presence of an os acromiale could decrease the functional outcome of patients undergoing rTSA, particularly abduction strength at 12 and 24 months. The mesoacromion, compared with the preacromion, could reduce functional outcome and increase the risk of acromion tilt at 24 months. Nevertheless, in clinical practice, the decrease in functional outcome appears to be slight and requires further examination through additional studies. The value of intraoperative prophylactic stabilization of a mesoacromion and adapted postoperative rehabilitation should also be evaluated to optimize recovery of the shoulder abductor apparatus.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151514"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798470","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":"Better outcomes? Rotator cuff repair vs. reverse shoulder arthroplasty for massive rotator cuff tears in an elderly population","authors":"Laila Khoury BS ,&nbsp;Anna Redden BS ,&nbsp;William Pallissery BS ,&nbsp;Garrett R. Jackson MD ,&nbsp;Connor Donley MD ,&nbsp;Aghdas Movassaghi BS ,&nbsp;Jocelyn Lubert MD ,&nbsp;Gregory Gilot MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2025.09.001","DOIUrl":"10.1053/j.sart.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in surgical technology with rotator cuff repairs (RCRs), it has been reported as high as a 90% retear rate for large and massive rotator cuff tears (mRCTs). A reverse shoulder arthroplasty (rTSA) has been proposed as an alternative and more recent treatment option for elderly patients with MRCTs. This study aimed to provide evidence to better understand the role of rTSA in large rotator cuff tears without rotator cuff arthropathy by comparing patient-reported outcomes, opioid usage, and pain scores for patients treated with RCR vs. rTSA for MRCT without evidence of arthropathy.</div></div><div><h3>Methods</h3><div>All patients who underwent primary rTSA or primary rotator cuff repair for MRCT from 2017 to 2019 by 2 fellowship-trained shoulder surgeons at a single institution were retrospectively identified through a prospectively collected database. Range of motion, opioid usage, and outcomes scores, including the American Shoulder and Elbow Surgeons (ASES) score, Penn (PSS) score, Constant score (CS), and Subjective Shoulder Value were compared between RCR and rTSA patients at baseline, 6 weeks, 3 months, and 12 months postoperatively.</div></div><div><h3>Results</h3><div>A total of 46 patients were analyzed. Twenty-two patients were treated with RCR (mean age, 61.9 years) and 24 underwent rTSA (mean age, 67.1 years). No significant differences between scores such as preoperative ASES, PSS, CS, or Subjective Shoulder Value scores were appreciated between groups. At 6 weeks postoperatively, mean PSS (<em>P</em> &lt; .001), ASES function (<em>P</em> = .003), and CS (<em>P</em> = .005) were significantly higher in the rTSA group compared to the RCR group. No significant difference in patient-reported outcomes at 3 months or the final follow-up was appreciated between groups. At the final follow-up, internal rotation was significantly higher in the RCR group (<em>P</em> = .049).</div></div><div><h3>Conclusion</h3><div>Our results demonstrated that both RCR and rTSA showed significant improvements in all pain and functional scores for patients with MRCTs. Those patients treated with rTSA showed better initial recovery with significant difference at 6 weeks postoperatively while the RCR group showed slightly better final range of motion. rTSA is comparable to RCR, suggesting that both options are good solutions for the right patient with MRCTs. However, surgeons should be aware of the tradeoffs associated with each option and further studies are needed to examine long-term functional outcomes, and retear rates in these patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151501"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188071","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":"Reoperation roulette: unveiling diagnosis-specific complication rates in anatomic and reverse total shoulder arthroplasty","authors":"Jackson P. Tate MD,&nbsp;Nolan M. Reinhart MD,&nbsp;Taylor M. Troutman MD,&nbsp;William F. Sherman MD, MBA,&nbsp;Michael J. O'Brien MD","doi":"10.1053/j.sart.2025.07.010","DOIUrl":"10.1053/j.sart.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA), including anatomic TSA (aTSA) and reverse TSA (rTSA), is an effective surgical treatment for various degenerative shoulder pathologies. While initially developed for osteoarthritis (OA) and rotator cuff tear arthropathy (RCA), respectively, aTSA and rTSA now address conditions such as avascular necrosis (AVN), rheumatoid arthritis (RA), and post-traumatic osteoarthritis (PTOA). This study analyzed reoperation and complication rates associated with aTSA and rTSA across different pathologies, hypothesizing that outcomes vary significantly based on the underlying condition.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the PearlDiver Mariner database, containing deidentified patient data from 2010 to Q3 2022. Patients undergoing anatomic and reverse TSA for each indication of interest were identified using Current Procedural Terminology and International Classification of Diseases-10 codes. Multivariable logistic regression was used to compare rates of reoperation, infection, instability, mechanical complications, and periprosthetic fracture across indications, with the OA cohort serving as the control.</div></div><div><h3>Results</h3><div>This study included 20,460 aTSA and 31,236 rTSA cases. Within 2 years, RA patients had significantly higher infection rates after aTSA (4.7 vs. 1.0%; odds ratio [OR]: 3.56; 95% confidence interval [CI]: 1.47-7.35) and instability after rTSA (2.9 vs. 1.2%; OR: 2.27; 95% CI: 1.00-4.41). Patients who had PTOA had significantly higher instability (2.1 vs. 1.2%; OR: 1.88; 95% CI: 1.22-2.78) and overall complication rates after rTSA. Patients with AVN had significantly higher periprosthetic fractures after aTSA (2.0 vs. 0.3%; OR: 4.88; 95% CI: 1.79-11.16). Patients with RCA had significantly higher reoperations following aTSA (3.7 vs. 0.3%; OR: 15.25; 95% CI: 9.98-23.10) and rTSA (0.6 vs. 0.4%; OR: 1.59; 95% CI: 1.10-2.26), as well as higher overall complications following both aTSA (9.9 vs. 2.4%; OR: 4.09; 95% CI: 3.17-5.23) and rTSA (4.3 vs. 3.8%; OR: 1.19; 95% CI: 1.04-1.35).</div></div><div><h3>Conclusion</h3><div>This study reveals the variability in reoperation and complication rates among patients undergoing TSA for RA, PTOA, AVN, and RCA. These data can be used to counsel patients prior to surgery. Complication rates were higher for rTSA compared to aTSA for all diagnoses except AVN. Reoperation rates were highest among those with RCA. In this challenging patient population, aTSA had a higher complication profile. These data suggest that rTSA may be a more favorable option than aTSA for RCA, despite the higher overall complication rate.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151493"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188209","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 association of post-traumatic stress disorder with postoperative complications in total shoulder arthroplasty: a propensity-matched cohort study","authors":"Ahmad R. Alhankawi BA ,&nbsp;Alejandro M. Holle BS ,&nbsp;Collin L. Braithwaite MD ,&nbsp;M. Lane Moore MD, MBA ,&nbsp;Javin J. Patel BS ,&nbsp;Jeffrey D. Hassebrock MD","doi":"10.1053/j.sart.2025.09.010","DOIUrl":"10.1053/j.sart.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative post-traumatic stress disorder (PTSD) has previously been associated with increased rates of complications following various orthopedic procedures. However, there is a paucity in the literature regarding the association of PTSD with complications in the context of total shoulder arthroplasty (TSA). Thus, the purpose of this study was to compare postoperative medical and surgical complications among patients with and without PTSD.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent TSA with a diagnosis code for PTSD within 6 months of TSA were matched 1:4 to controls without PTSD using propensity score matching. Matching was performed based on age, gender, Charlson Comorbidity Index, and other comorbidities. Multivariable logistic regressions accounting for age, gender, Charlson Comorbidity Index, alcohol abuse, and substance abuse, were employed to compare complications between groups. Postoperative complications were assessed at 90 days, 1 year, and 2 years. Complications assessed included myocardial infarction, deep vein thrombosis, wound dehiscence, acute kidney injury, sepsis, readmission, revision, periprosthetic joint infection, aseptic loosening, fracture, among others. Statistical comparisons were made using odds ratios (ORs) with 95% confidence intervals, and a <em>P</em> value of &lt;.05 was considered statistically significant. Bonferroni correction was applied that determined a <em>P</em> value = .0029 as the threshold for significance.</div></div><div><h3>Results</h3><div>The query resulted in a total of 4,137 patients (3,092 control and 1,045 PTSD) who underwent TSA. The PTSD cohort displayed elevated prevalence of emergency department visits (OR 1.68) and acute kidney injury (OR 2.13) within 90 days of surgery compared to controls. At 1- and 2-year following TSA, the PTSD cohort displayed similar rates of revision, periprosthetic joint infection (PJI), dislocation, aseptic loosening, periprosthetic fracture, and postoperative stiffness compared to controls.</div></div><div><h3>Conclusion</h3><div>This study suggests that PTSD is associated with a higher incidence of emergency department visits and acute kidney injury within 90 days following TSA. No increase in the incidence of other major or minor complications was noted.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151510"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188204","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":"Impact of neuromuscular diseases on revision risk after reverse total shoulder arthroplasty","authors":"Abhay Mathur MD ,&nbsp;Evan R. Simpson BS ,&nbsp;Patrick Saunders MD ,&nbsp;Bernadin Bernardino BS ,&nbsp;Clayton Hui BS ,&nbsp;Hafiz F. Kassam MD","doi":"10.1016/j.sart.2026.151542","DOIUrl":"10.1016/j.sart.2026.151542","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) has become the dominant form of shoulder arthroplasty with rapidly increasing utilization. As such, rTSA revision rates are also sharply rising. Patients with neuromuscular (NM) disorders may be particularly vulnerable, yet their risk of revision after rTSA remains poorly defined.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis of the PearlDiver database (2010-2022) was conducted. Patients with NM diagnoses undergoing primary rTSA were identified using International Classification of Diseases, Ninth Revision, 10th Revision, and Current Procedural Terminology codes. The primary outcome was revision rTSA. A 1:1 propensity score match was performed, controlling for age, sex, and Charlson Comorbidity Index. Chi-square and paired <em>t</em>-tests were used for analysis.</div></div><div><h3>Results</h3><div>A total of 13,771 primary rTSAs were performed between 2010 and 2022 in patients with 13 underlying NM disorders. Among 9 disorders with adequate data, revision rates were highest for cerebral palsy (9.0%), Charcot neuropathy (8.6%), and multiple sclerosis (8.2%). In matched analyses, Parkinson's disease (<em>P</em> &lt; .001) and multiple sclerosis (<em>P</em> = .028) were associated with significantly higher risk of revision rTSA, while epilepsy/seizure and cerebrovascular disease/stroke were not.</div></div><div><h3>Conclusions</h3><div>Underlying NM disorders, particularly Parkinson's disease and multiple sclerosis, significantly increase the risk of revision after rTSA. These findings highlight the importance of preoperative counseling, risk stratification, and optimization in this high-risk population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151542"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037734","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}