Seminars in Arthroplasty最新文献

{"title":"Comparison of humeral head resurfacing versus stemless humeral components in anatomic total shoulder arthroplasty: a multicenter investigation with minimum 2-year follow-up","authors":"Joseph S. Tramer MD ,&nbsp;Tewfik Benkalfate MD ,&nbsp;Gabriel B. Burdick MD ,&nbsp;Robert M. Titelman MD ,&nbsp;Felix H. Savoie MD ,&nbsp;Curtis R. Noel MD ,&nbsp;Christopher P. Roche MSE, MBA ,&nbsp;Thomas W. Wright MD ,&nbsp;Chris Roberts MD ,&nbsp;Ryan W. Simovitch MD ,&nbsp;Joseph D. Zuckerman MD ,&nbsp;Pierre-Henri Flurin MD ,&nbsp;Stephanie J. Muh MD","doi":"10.1053/j.sart.2023.06.016","DOIUrl":"10.1053/j.sart.2023.06.016","url":null,"abstract":"<div><h3>Background</h3><p><span>The purpose of this investigation was to compare minimum two-year outcomes of anatomic total shoulder arthroplasty (aTSA) performed with </span>humeral head resurfacing (HHR) vs. stemless implants.</p></div><div><h3>Methods</h3><p>A retrospective review of a large multicenter database was conducted. All patients who underwent aTSA with either HHR or stemless implants with minimum two-year follow-up were evaluated. Range of motion (ROM) and patient-reported outcomes (PROs) including Constant Score, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons score<span><span>, University of California Los Angeles Shoulder Score, Shoulder Pain and Disability Index, and </span>Shoulder Arthroplasty Smart score were collected for all patients presurgery and postsurgery. Radiographic data was collected to determine the presence of radiolucent lines as well as evaluate implant sizing and anatomic shoulder restoration.</span></p></div><div><h3>Results</h3><p>Overall, 127 patients were included with 49 patients receiving HHR and 78 stemless aTSA. Preoperatively, patients in the HHR group had worse ROM and PRO scores (<em>P</em> &lt; .05). Although the stemless group had significantly greater active abduction (148 ± 28 vs. 116 ± 22, <em>P</em> &lt; .001), forward flexion (154 ± 21 vs. 141 ± 15, <em>P</em> &lt; .001) and external rotation (50 ± 16 vs. 34 ± 17, <em>P</em> &lt; .001) and exhibited better scores on the SST (10.4 ± 2.0 vs. 9.5 ± 1.9, <em>P</em> = .014) at final postoperative evaluation, the HHR group had a greater improvement from preoperative to final postoperative evaluation in active forward flexion (50 ± 22 vs. 32 ± 20, <em>P</em> &lt; .001) and internal rotation (3 ± 2 vs. 1 ± 2, <em>P</em> = .004) as well as all PROs measured (<em>P</em> &lt; .01). Both groups demonstrated significant improvements in all PROs and ROM from presurgery to postsurgery (<em>P</em> &lt; .05). Rates of overstuffing (8.7% in HHR vs. 20.8% stemless, <em>P</em> = .098), oversizing (39.1% in HHR vs. 31.3% in stemless, <em>P</em> = .436), and radiolucent lines around the glenoid components (13.0% in HHR vs. 18.8% in stemless, <em>P</em> = .450) were not significantly different between the groups. One patient in the stemless group required a revision surgery for aseptic glenoid loosening, otherwise no other major complications were reported.</p></div><div><h3>Conclusion</h3><p>aTSA performed both with stemless implants and HHR resulted in significant improvements in ROM and multiple PROs at minimum two-year follow-up with a low complication rate. The HHR group had worse preoperative shoulder function, which contributed to a greater magnitude of improvement in ROM and across all PROs from presurgery to postsurgery, despite the stemless group having better ROM and SST scores at final follow-up.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 666-674"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134539147","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":"An in vitro analysis of various antibiotic cement combinations against Cutibacterium acnes","authors":"Amrit Vinod MD ,&nbsp;Thomas Listopadzki MD ,&nbsp;Kevin Kohut MD ,&nbsp;Sonja Pavlesen MD ,&nbsp;John Crane MD, PhD ,&nbsp;Lin Feng MA ,&nbsp;Thomas Duquin MD ,&nbsp;Matthew DiPaola MD","doi":"10.1053/j.sart.2023.06.025","DOIUrl":"10.1053/j.sart.2023.06.025","url":null,"abstract":"<div><h3>Background</h3><p><em>Cutibacterium acnes</em> is the most common cause of prosthetic shoulder infection. Treatment often requires the placement of an antibiotic-loaded cement spacer. The exact combination of antibiotic and cement that best targets this organism is not fully understood. In this study, we performed an <em>in vitro</em> investigation of various antibiotic combinations in Simplex and Palacos cement to determine their efficacy against three <em>C acnes</em> strains. We hypothesized that gentamicin alone would underperform other antibiotics including vancomycin and ertapenem against <em>C acnes</em> in an <em>in vitro</em> environment. Additionally, we hypothesized that Palacos cement would outperform Simplex cement.</p></div><div><h3>Methods</h3><p>Strains were cultured and antibiotic cement beads were plated in six combinations. Zones of inhibition (mm) were measured, and beads were transferred to a new culture plate at 7-day intervals. This procedure was carried out for 81 days. Mixed model for longitudinal repeated measures for continuous data was used to determine the antibiotic combination that produced the most robust zone of inhibition over time.</p></div><div><h3>Results</h3><p>For vancomycin, gentamicin, and vancomycin + gentamicin, these data demonstrated that for two strains, Palacos cement with vancomycin and gentamicin produced the most robust zone of inhibition over time (<em>P</em> &lt; .0001, <em>P</em> &lt; .0001, respectively). For one strain, Palacos cement combined with vancomycin alone produced the most robust response (<em>P</em> &lt; .0001). The second highest response for this strain was seen in Palacos cement combined with vancomycin and gentamicin. Ertapenem induced the largest response among all antibiotics that we tested against all 3 strains, but its effect was short-lived (one week or less) compared to vancomycin or vancomycin with gentamicin (35-81 days). Gentamicin response in both cement combinations against <em>C acnes</em> was weak and lasted at most 14 days.</p></div><div><h3>Discussion</h3><p>These data suggest that Palacos cement likely offers a better elution profile than Simplex in <em>in vitro C acnes</em>-related prosthetic shoulder infection strains. Vancomycin and gentamicin in combination demonstrated the most prolonged response for eradication of the 3 <em>C acnes</em> strains tested. Additionally, ertapenem may be a promising option as it showed a short-lived but robust clearing response. Gentamicin weakly inhibits <em>C acnes</em> growth calling into question its use in premade spacers.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 707-714"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452723001062/pdfft?md5=ebbfc6bc0d7e6f8a454a93fcabd543bc&pid=1-s2.0-S1045452723001062-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115863108","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":"Shoulder arthroplasty outcomes in patients with major depressive disorder or generalized anxiety disorder","authors":"Noah A. Kuhlmann MS, BS ,&nbsp;Sreten Franovic MS, BS ,&nbsp;Gabriel B. Burdick BS ,&nbsp;Danielle S. Hanson BS ,&nbsp;Miriam E. Dash BS ,&nbsp;Ayooluwa S. Ayoola MD ,&nbsp;Stephanie J. Muh MD","doi":"10.1053/j.sart.2023.07.005","DOIUrl":"10.1053/j.sart.2023.07.005","url":null,"abstract":"<div><h3>Background</h3><p>Anxiety and depression are among the most common mental health disorders<span> in the United States and have been linked to increased health-care utilization and poorer clinical outcomes. However, data on the relationship between anxiety and depression and outcomes after shoulder arthroplasty (SA) are both limited and conflicting.</span></p></div><div><h3>Methods</h3><p><span><span>This retrospective cohort study<span> examined the influence of a preoperative diagnosis of anxiety and/or major depressive disorder (MDD) on outcomes following shoulder arthroplasty, such as range of motion, pain, perioperative and </span></span>postoperative complications<span>, and readmission rates. A retrospective chart review of our health system’s electronic medical record was performed for dates of service January 2014–December 2019. Patients who underwent primary </span></span>total shoulder arthroplasty<span> or reverse total shoulder arthroplasty<span> were considered for inclusion. These patients were then divided into two groups based on the presence or absence of an anxiety disorder and/or MDD in their past medical history.</span></span></p></div><div><h3>Results</h3><p>595 patients with a minimum follow-up of one year were considered for analysis. Of these, 205 patients (34.5%) had diagnoses of an anxiety and/or MDD and were assigned to the psychiatric comorbidity group, while 390 (65.5%) were assigned to the control group. The psychiatric comorbidity group was significantly younger (68.3 ± 9.3 vs. 70.5 ± 10.0, <em>P</em> = .008) and more heavily female (68.7% vs. 48.7%, <em>P</em> &lt; .001). The length of stay was significantly longer in the psychiatric comorbidity group than in the control group (1.9 ± 2.4 vs. 1.5 ± 0.9 days, <em>P</em><span> = .023). Postoperative range of motion, visual analog scale pain scores (1.8 ± 2.7 vs. 1.3 ± 2.3, </span><em>P</em> = .059), complication rates (7.8% vs. 6.9%, <em>P</em> = .681), and revision rates (4.9% vs. 3.6%, <em>P</em><span> = .448) were not significantly different between the psychiatric comorbidity and control groups, respectively. All-cause emergency department visitation and hospital readmission rates were also similar between the two groups at 30, 60, and 90 days postoperatively.</span></p></div><div><h3>Conclusion</h3><p>Our results suggest that a preoperative diagnosis of MDD or anxiety does not affect pain, postoperative outcomes, complications, or readmission rates following shoulder arthroplasty.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 722-726"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117298521","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":"Computer-assisted planning for revision shoulder arthroplasty","authors":"Joaquin Sanchez-Sotelo MD, PhD","doi":"10.1053/j.sart.2023.03.005","DOIUrl":"10.1053/j.sart.2023.03.005","url":null,"abstract":"<div><p>Preoperative planning software has emerged as one of the most useful applications of computer-assisted surgery to the field of shoulder arthroplasty<span>. As the burden of revision shoulder arthroplasty has continued to increase, and the value of preoperative planning software has been widely recognized for primary arthroplasty, preoperative planning in revision cases is desired by any surgeons. The development of revision planning software faces certain challenges, including segmentation of implants, artefact reduction, regulatory constraints, and other. Currently, certain planning software packages are available only when custom-made implants are being ordered, whereas a couple of products allow planning essentially every case. Finally, certain healthcare institutions have developed programs for point-of-care planning and 3D-printing. This article reviews the state of the art of preoperative planning software in revision shoulder arthroplasty and provides directions for additional future developments.</span></p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 817-823"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132837886","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 supplemental testosterone use on shoulder arthroplasty infection rates","authors":"Favian Su MD,&nbsp;Charles J. Cogan MD,&nbsp;Juan Serna BS,&nbsp;Brian T. Feeley MD,&nbsp;C. Benjamin Ma MD,&nbsp;Drew A. Lansdown MD","doi":"10.1053/j.sart.2023.06.020","DOIUrl":"10.1053/j.sart.2023.06.020","url":null,"abstract":"<div><h3>Background</h3><p><span>Supplemental testosterone use among patients undergoing shoulder arthroplasty can increase the </span><span><span>Cutibacterium acnes</span></span> load on the skin. Although higher <em>C acnes</em> loads on the skin are associated with higher amounts of bacteria in deep tissues, it is unknown whether preoperative testosterone use increases the risk of shoulder prosthetic joint infection. Therefore, the purpose of this study was to determine if there is a temporal relationship between testosterone use and the risk of prosthetic joint infection after shoulder arthroplasty.</p></div><div><h3>Methods</h3><p>The PearlDiver database was queried to identify a cohort of patients who underwent shoulder arthroplasty (hemiarthroplasty, anatomic or reverse total shoulder arthroplasty) with a minimum 2-year follow-up. Current Procedural Terminology<span> and International Classification of Diseases codes were used to compare the demographics and comorbidities of patients with (n = 2285) and without testosterone use (n = 41,712). Patients with testosterone use were further stratified by the duration between last testosterone use and surgery. Prosthetic joint infection rates were compared between those with and without testosterone use.</span></p></div><div><h3>Results</h3><p>The overall prevalence of testosterone use was 3.4%. Patients who used testosterone within 6 months prior to shoulder arthroplasty had a significantly higher rate of prosthetic joint infection at 3.4% compared to those without use at 2.4% [odds ratio (OR) = 1.44 (95% confidence interval (CI): 1.03-2.01), <em>P</em><span> = .042]. However, patients who used testosterone between 6 and 12 months before surgery did not have a significantly higher rate of infection. On multivariate analysis, only younger age [OR = 0.98 (95% CI: 0.97-0.99), </span><em>P</em> &lt; .001] and diabetes [OR = 1.26 (95% CI: 1.10-1.44), <em>P</em> &lt; .001] were independent risk factors for the development of an infection.</p></div><div><h3>Conclusion</h3><p>Testosterone use within 6 months of shoulder arthroplasty<span> may be associated with higher rates of prosthesis joint infection. However, patients who were taking testosterone but stopped before surgery did not have a higher rate of infection compared to those who never used the medication. Surgeons should actively screen patients for testosterone use. A referral to the patient’s endocrinologist to discuss the risks and benefits of testosterone cessation prior to shoulder arthroplasty may also be warranted.</span></p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 675-681"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116517878","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":"Patient survivorship after anatomic total shoulder arthroplasty: are patients failing before their prosthetics? a 10-year minimum follow-up analysis","authors":"Adam Z. Khan MD ,&nbsp;Mohamad Y. Fares MD ,&nbsp;Alayna Vaughan MD ,&nbsp;Akash Singh MD ,&nbsp;Joseph A. Abboud MD","doi":"10.1053/j.sart.2023.07.009","DOIUrl":"10.1053/j.sart.2023.07.009","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Since the development of shoulder replacement, focus has been placed on the timeline in which surgical complications occur, like glenoid loosening or </span>rotator cuff<span> insufficiency. What has been less researched is longer term patient survival following shoulder arthroplasty. This study aimed to evaluate patient and implant </span></span>survivorship<span> after anatomic total shoulder arthroplasty at a minimum 10-year follow-up and identify risk factors for mortality and revision surgery.</span></p></div><div><h3>Methods</h3><p><span><span>This was a single-institution, retrospective, cohort study of all patients who underwent primary anatomic total shoulder arthroplasty for glenohumeral osteoarthritis<span> from 2005 to 2011. Patient characteristics including age, sex, </span></span>body mass index<span>, race, and Charleston comorbidity index (CCI) were recorded. A patient medical record query and a national obituary database query were performed to assess for revision surgery or patient mortality. Reason for revision surgery was recorded. Statistical analyses were performed to compare groups and assess for associated risk factors (</span></span><em>P</em> &lt; .05 was significant).</p></div><div><h3>Results</h3><p>Three hundred and sixty two patients met inclusion criteria. Mean patient age was 65.4 ± 10.02 years and 242 (66.9%) patients were male. Mean body mass index was 29.73 ± 5.62 and the mean CCI was 3.28 ± 1.29. A total of 56 patients (15.5%) passed away within the study period prior to undergoing revision surgery, while 20 (5.5%) underwent revision surgery within the study period. Reason for revision included rotator cuff insufficiency (8), glenoid loosening (4), posterior instability (4), infection (3), and culture negative continued shoulder pain (1). On Analysis of Variance analysis, older age and higher CCI were associated with an increased risk of mortality (<em>P</em> &lt; .001). Patients in the revision cohort were significantly younger than patients who did not undergo revision surgery (60.3 years vs. 64.3 years, <em>P</em> = .01).</p></div><div><h3>Conclusion</h3><p>Older patients (mean age 72.2 years) and patients with more medical comorbidities are more likely to retain their index procedure implants throughout their lifetime than to undergo revision surgery. This study provides data and an insight into preoperative patient guidance, shoulder implant selection, and shared medical decision-making.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 756-760"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121963888","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 total shoulder arthroplasty for rheumatoid arthritis","authors":"Akshar V. Patel BS,&nbsp;Christopher A. White MA,&nbsp;Troy Li BS,&nbsp;Carl Cirino MD,&nbsp;Benjamin D. Gross BS,&nbsp;Dave R. Shukla MD,&nbsp;Bradford O. Parsons MD,&nbsp;Evan L. Flatow MD,&nbsp;Paul J. Cagle MD","doi":"10.1053/j.sart.2023.06.022","DOIUrl":"10.1053/j.sart.2023.06.022","url":null,"abstract":"<div><h3>Background</h3><p><span>Rheumatoid arthritis (RA) can lead to debilitating pain, decreased bone stock, and poor </span>rotator cuff<span><span> quality in afflicted patients. Patients with chronic pain from RA may necessitate surgical intervention, including shoulder arthroplasty, at a younger age than their osteoarthritic counterparts. For several decades, anatomic </span>total shoulder arthroplasty<span> (TSA) or hemiarthroplasty remained the dominant treatments for RA patients. The objective of this abstract is to report on mid-term to long-term outcomes following TSA for RA.</span></span></p></div><div><h3>Materials and Methods</h3><p>This study retrospectively analyzed patients who necessitated TSA for RA. Range of motion scores (forward elevation, external rotation, and internal rotation) and patient-reported outcomes (American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Visual Analog Scale scores) were compared preoperatively and postoperatively. Preoperative and postoperative radiographic measures (lateral humeral offset, acromiohumeral interval, and subluxation) were reviewed by 2 fellowship-trained orthopedic surgeons and the averages were used for analysis.</p></div><div><h3>Results</h3><p>Included in the analysis were 13 patients (17 shoulders) with an average follow-up time of 8.1 ± 3.6 years. The mean age was 65.3 ± 10.5 years. Forward flexion (Preop: 112^o ± 43^o, Postop: 145^o ± 35^o; <em>P</em> = .03), external rotation (Preop: 31^o ± 20^o, Postop: 46^o ± 15^o; <em>P</em> = .04), and internal rotation (Preop: L2, Postop: T11; <em>P</em> = .02) all improved significantly when preoperative and postoperative values were compared. Furthermore, American Shoulder and Elbow Surgeons (Preop: 33 ± 20, Postop: 74 ± 19; <em>P</em> = .0002), Simple Shoulder Test (Preop: 4 ± 2, Postop: 8 ± 4; <em>P</em> = .003), and Visual Analog Scale pain (Preop: 7 ± 3, Postop: 2 ± 2; <em>P</em> = .002) scores all significantly improved. Analysis of preoperative and postoperative radiographs showed a significant difference in lateral humeral offset (Preop: 14 ± 3, Final: 8 ± 9; <em>P</em> = .02) and acromiohumeral interval (Preop: 11 ± 3, Postop: 7 ± 3; <em>P</em> = .01) measurements; glenoid radiolucency was seen in 10/17 patients at follow-up.</p></div><div><h3>Conclusion</h3><p>This study contributes to the available literature on TSA for RA at mid-term to long-term follow-up. We show that improvements are obtainable at mid-term evaluation, showing significant pain reduction and increased shoulder function and range of motion. Ultimately, this study demonstrates that TSA is an option for RA patients who require shoulder replacement.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 688-694"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115991760","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 glenoid bone density is associated with systemic osteoporosis in primary shoulder arthroplasty","authors":"Troy Q. Tabarestani BA ,&nbsp;Jay M. Levin MD, MBA ,&nbsp;Eric Warren BS ,&nbsp;Prince Boadi BS ,&nbsp;Jack Twomey-Kozak BS ,&nbsp;Colleen Wixted MBA ,&nbsp;Daniel E. Goltz MD, MBA ,&nbsp;John Wickman MD, MBA ,&nbsp;Eoghan T. Hurley MB, MCh, PhD ,&nbsp;Oke Anakwenze MD, MBA ,&nbsp;Christopher S. Klifto MD","doi":"10.1053/j.sart.2023.07.006","DOIUrl":"10.1053/j.sart.2023.07.006","url":null,"abstract":"<div><h3>Background</h3><p><span>In shoulder arthroplasty, poor bone mineral density can impact humeral and glenoid fixation, as well as increase the risk of </span>periprosthetic fracture<span>. The purposes of this study were to (1) determine the association between preoperative glenoid and humeral Hounsfield units (HUs) with systemic bone density in primary shoulder arthroplasty, (2) determine a threshold for HU on preoperative shoulder computed tomography (CT) to classify patients as osteoporotic, and (3) identify which anatomic T-score locations were significantly associated with glenoid and/or humeral HU measurements.</span></p></div><div><h3>Methods</h3><p><span><span>Consecutive patients who had both a preoperative shoulder CT and a dual-energy x-ray absorptiometry (DEXA) scan were included. HU measurements of the glenoid vault and </span>proximal humerus<span> were recorded. DEXA T-scores from the spine, hip, and femoral neck<span> were recorded, and osteoporosis was defined as a T-score of −2.5 or lower in any of the anatomic sites. Patients were grouped into osteoporosis and nonosteoporosis cohorts and these cohorts were compared using standard statistical tests. To assess the association between HUs and DEXA T-score, </span></span></span>linear regression analysis was performed. Additional receiver operating characteristic analysis was performed to evaluate the ability of HUs to classify patients as osteoporotic.</p></div><div><h3>Results</h3><p><span>A total of 162 patients undergoing primary shoulder arthroplasty with both preoperative CT and DEXA scores were included. The osteoporosis cohort had significantly lower body mass index (</span><em>P</em> = .001), although no other significant differences in demographics were found between the 2 cohorts. The osteoporosis cohort was associated with significantly lower glenoid vault bone density in HUs (183 ± 104 vs. 303 ± 157, <em>P</em> = .004) and trended toward significantly lower proximal humeral bone density in HUs (34.3 ± 54.8 vs. 64.5 ± 58.2, <em>P</em> = .058). Glenoid HU threshold of 175 had an area under the curve of 0.75, with sensitivity of 80.8% and specificity of 62.5% for classifying systemic osteoporosis. HUs of both the glenoid (<em>P</em> = .031) and proximal humerus (<em>P</em> = .003) were significantly associated with femoral neck T-scores on linear regression analysis. Similarly, HUs of both the glenoid (<em>P</em> &lt; .001) and proximal humerus (<em>P</em> = .009) were significantly associated with spine T-scores on linear regression analysis.</p></div><div><h3>Discussion</h3><p>This study found that glenoid vault HU is significantly associated with systemic osteoporosis and can be used as a screening tool for detecting osteoporosis preoperatively. In addition to implications for component fixation and periprosthetic fracture, local bone density evaluation on shoulder CT prior to shoulder arthroplasty represents an opportunity for osteoporosis screening.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 727-734"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126675507","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":"Innovation, value, and cost containment in shoulder arthroplasty","authors":"Jon J.P. Warner MD ,&nbsp;Uma Srikumaran MD, MPH, MBA ,&nbsp;Florian Grubhofer MD ,&nbsp;Abdulaziz F. Ahmed MD ,&nbsp;Michael Navarro Jr BS ,&nbsp;Argen Omurzakov BA ,&nbsp;The Codman Shoulder Society","doi":"10.1053/j.sart.2023.04.002","DOIUrl":"10.1053/j.sart.2023.04.002","url":null,"abstract":"<div><h3>Background</h3><p><span>The words “innovation” and “value” are generally not used in the same sentence when considering orthopedics. When used independently, however, it is evident that there has been no shortage of innovation within the field of orthopedics, especially in </span>shoulder arthroplasty. Despite the abundance of innovations in shoulder arthroplasty prostheses and implants, it remains a challenge to identify whether there is apparent value associated with a given product. More often than not, new innovations are introduced with the promise of added value but prove to solely increase cost with no nominal outcome improvement.</p></div><div><h3>Objective</h3><p>This article considers shoulder arthroplasty within the contexts of innovation, value, and cost. In order to define innovation, value, and cost, we look to the work of numerous experts and scholars in the fields of business, economics, and medicine. Our goal is to identify the shortcomings of current innovations in shoulder arthroplasty. Our purpose is to hold these innovations accountable for the holistic consideration of the value equation—namely, improved outcomes and reduced costs. The ideal innovation in shoulder arthroplasty shoulder offer tangible value to all stakeholders involved in the episode of care inclusive of patients, surgeons, insurers, and vendors/industry.</p></div><div><h3>Results</h3><p>Under the premise that modern shoulder innovations are increasing in cost but have failed to demonstrate substantial improvements in patient<span> treatment outcomes, we identify a number of key issues within shoulder surgery that remain: (1) better anatomical glenoid longevity, (2) better restoration of range of motion with reverse replacement, (3) reduced cost of implants, and (4) more transparency in outcomes.</span></p></div><div><h3>Conclusion</h3><p>In order to qualify an innovation in shoulder arthroplasty which creates value, it must be backed by robust evidence-based studies that demonstrate the desired improved outcomes and reduced cost without any interfering biases.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 830-838"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117269048","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":"Technological innovations in shoulder arthroplasty: how does planning software work?","authors":"Jessica L. Churchill MD,&nbsp;Vahid Entezari MD, MMSc,&nbsp;Jason C. Ho MD,&nbsp;Joseph P. Iannotti MD, PhD,&nbsp;Eric T. Ricchetti MD","doi":"10.1053/j.sart.2023.05.002","DOIUrl":"10.1053/j.sart.2023.05.002","url":null,"abstract":"<div><p><span>Both anatomic total shoulder arthroplasty<span> and reverse shoulder arthroplasty<span> have seen increasing utilization over the last 20 years. Malpositioned components present a significant risk for loosening and failure in both total shoulder arthroplasty and reverse shoulder arthroplasty . Preoperative planning with three-dimensional computed tomography<span><span> imaging and virtual implant templating can help surgeons determine optimal implant position and has been shown to provide superior accuracy over standard 2D computed tomography imaging without virtual templating. Surgeons can use preoperative planning software to evaluate complex cases of glenoid bone loss or deformity requiring </span>bone grafts or augmented implants to determine what surgical correction and techniques are necessary to achieve the goals of </span></span></span></span>implant placement. While the development of preoperative planning software represents a technological advancement, it is important for surgeons to understand that variations can exist between different commercially available software programs in their methods of bony segmentation and landmark placement, which can lead to some differences in the measurement of pathology. This article will review how this technology is utilized to better understand preoperative bony deformity and optimize implant positioning.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"33 4","pages":"Pages 846-856"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125669194","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}