Seminars in Arthroplasty最新文献

{"title":"High in-hospital preoperative anxiety levels are not associated with an increased length of stay or readmission following primary shoulder arthroplasty","authors":"Rocio A.L. Crabb MD ,&nbsp;Viraj Deshpande BS ,&nbsp;Noemi Urquiza BS ,&nbsp;Kyle Schoell MD ,&nbsp;Sean Guerrero MHA ,&nbsp;Edward J. Quilligan BS ,&nbsp;Hafiz F. Kassam MD","doi":"10.1053/j.sart.2024.06.005","DOIUrl":"10.1053/j.sart.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Anxiety is prevalent in our society, affecting all facets of patients’ lives. There is, however, a paucity of literature exploring how anxiety extends into the orthopedic perioperative setting. We sought to analyze a subset of patients undergoing primary shoulder arthroplasty to determine whether correlations exist between anxiety, patient characteristics, time spent in the hospital, and likelihood of returning to the hospital after discharge.</div></div><div><h3>Methods</h3><div>After obtaining institutional review board approval, our hospital prospectively identified and approached all patients undergoing total shoulder arthroplasty between February and June of 2023. Patients completed the Visual Analog Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS), two validated tools used to assess preoperative anxiety levels and need for information, in the preoperative holding area before surgery. Patient demographics, hospital length of stay (LOS), and 30-day readmission rate were collected and analyzed.</div></div><div><h3>Results</h3><div>A total of 79 patients were enrolled. Nineteen percent of patients were found to be anxious using the APAIS tool, while 37.7% of patients were found to be anxious using the VAS-A tool. No significant correlation was found between APAIS or VAS-A anxiety scoring and hospital LOS. No significant correlation was found between APAIS or VAS-A anxiety scoring and 30-day readmission rate. A significant correlation was found between APAIS anxiety scoring and body mass index (BMI), as well as VAS-A scoring and BMI. However, no significant correlation was found between BMI and hospital LOS or between BMI and 30-day readmission rate.</div></div><div><h3>Conclusion</h3><div>Our study did not find a statistically significant correlation between immediate preoperative anxiety levels in patients undergoing shoulder arthroplasty and their length of stay or 30-day readmission rate. We did discover a linear relationship between patient BMI and their preoperative anxiety scores; however, no significant direct correlation was found between a patient’s BMI and their length of stay or their 30-day readmission rate. Our findings suggest that higher levels of preoperative anxiety should not preclude a patient from the benefits of consideration of early discharge planning such as same-day total shoulder replacement.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 862-866"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845068","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":"Male patients experience similar improvement in clinical and functional outcomes despite higher revision rates following reverse shoulder arthroplasty compared to female patients: a systematic review and meta-analysis","authors":"Colton Mowers BS ,&nbsp;Divesh Sachdev BS ,&nbsp;Derrick M. Knapik MD ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Benjamin T. Lack BS ,&nbsp;Justin T. Childers BS, MS ,&nbsp;Devin Q. John MD ,&nbsp;Vani J. Sabesan MD ,&nbsp;Garrett R. Jackson MD","doi":"10.1053/j.sart.2024.07.008","DOIUrl":"10.1053/j.sart.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>To compare patient-reported outcomes, range of motion, and rates of revision surgery following primary reverse shoulder arthroplasty (RSA) between male and female patients.</div></div><div><h3>Methods</h3><div>A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A literature search was performed on January 20, 2024, using the PubMed, Embase, and Scopus library databases for human clinical studies reporting postoperative outcomes and revision rates following RSA between male and female patients. Studies were excluded if patients underwent RSA for proximal humerus fractures. Preoperative and postoperative outcome scores and revision rates were stratified by patient sex and quantitatively compared. The quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria.</div></div><div><h3>Results</h3><div>Five studies consisting of 3227 male (mean age, 72.2 years; mean follow-up, 29.4 months) and 5649 female (mean age, 72.7 years; mean follow-up, 29.2 months) patients were included. At final follow-up, male and female patients reported similar improvements in postoperative Constant scores (mean difference, −1.63; <em>P</em> = .17), American Shoulder and Elbow Surgeons scores (mean difference, −1.66; <em>P</em> = .26), external rotation (mean difference, −1.82°; <em>P</em> = .17), forward flexion (mean difference, 0.47°; <em>P</em> = .91), and abduction (mean difference, 0.85°; <em>P</em> = .82) when compared to female patients. Revision rates were significantly higher in males when compared to those in females (5.1% vs. 1.9%, respectively; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Males undergoing RSA report similar improvement in postoperative patient-reported outcomes and range of motion values at a mean final follow-up of 29.4 months when compared to females with a mean final follow-up of 29.2 months. However, revision rates were significantly higher in males.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 928-935"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747738","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":"Readability of English and Spanish online patient education materials for shoulder arthroplasty","authors":"Jacob S. Ghahremani BA ,&nbsp;Jenna E. Ogi BS ,&nbsp;Michael T. Kody MD ,&nbsp;Ronald A. Navarro MD","doi":"10.1053/j.sart.2024.07.002","DOIUrl":"10.1053/j.sart.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Online patient educational materials (OPEMs) are a vital source of information for those undergoing shoulder arthroplasty, though their utility is limited by patient health literacy as the average American reads at an eighth-grade level. To promote optimal reading comprehension, the American Medical Association and National Institutes of Health recommend that OPEMs be written at or below a sixth-grade level. The purpose of this study is to analyze the readability of English and Spanish shoulder arthroplasty OPEMs.</div></div><div><h3>Methods</h3><div>Google Search was used to identify the first 25 eligible Shoulder Arthroplasty OPEMs in both English and Spanish using the search terms “shoulder replacement” and “reemplazo de hombro.” Readability of the English OPEMs was calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Index (FRE), Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index. The readability of Spanish OPEMs was calculated using the Fernandez-Huerta Index (FHI; the Spanish version of FRE), Fernandez-Huerta Index Grade Level, Gutiérrez de Polini's Fórmula de compresibilidad, and Índice Flesch-Szigriszt.</div></div><div><h3>Results</h3><div>The mean FHI of Spanish OPEMs was significantly higher than the mean FRE of English OPEMs (60.09 vs. 51.48). As such, Spanish OPEMs were written at a significantly lower grade level than English OPEMs (9.70 vs. 11.53). There was not an English or Spanish OPEM that was written at or below a sixth-grade reading level. 4% of Spanish OPEMs and 4% of English OPEMs were written below an eighth-grade reading level. 52% of Spanish OPEMs and 8% of English OPEMs were written between an eighth- and ninth-grade reading level. The designation of OPEMs as being Very Easy/Easy, Standard/Normal, Fairly/Somewhat Difficult, or Difficult/Very Difficult was significantly dependent on whether the OPEM was written in English or Spanish.</div></div><div><h3>Discussion and conclusion</h3><div>English shoulder arthroplasty OPEMs were written at a higher reading difficulty than Spanish OPEMs. However, neither English nor Spanish OPEMs were written at a reading level at or below the recommended sixth-grade reading level. As older adults and those in the United States with limited English proficiency are susceptible to low health literacy, OPEMs must be written at an accessible reading level for all. Addressing these disparities in OPEM readability will improve patient care and understanding of shoulder arthroplasty and other orthopedic procedures.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 884-892"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850929","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":"Fibromyalgia syndrome is an independent predictor of increased complications, revision, and cost of admission within 180 days of total shoulder arthroplasty","authors":"John W. Moore BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.07.009","DOIUrl":"10.1053/j.sart.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Fibromyalgia syndrome (FMS) frequently afflicts patients undergoing total shoulder arthroplasty (TSA), yet research investigating the effects of FMS on postoperative outcomes following TSA is lacking. The purpose of this study is to determine if patients with FMS are at increased risk for complications, readmission, revision, and mortality following primary elective TSA compared to a matched cohort of patients without FMS.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients were stratified into two groups based on the presence of preoperative FMS. Patients with FMS were matched 1:1 based on age, sex, and Charlson-Deyo Comorbidity Index using an optimized matching algorithm to patients without FMS to generate an equal sized control group for statistical comparison. 5506 matched pairs of patients with and without FMS were identified and used for statistical analysis. Preoperative demographic and comorbidity data, postoperative outcomes, and economic and hospital metrics were compared between the two groups. Multivariate analysis was conducted to control for the influence of independent risk factors other than FMS on postoperative outcomes.</div></div><div><h3>Results</h3><div>Patients with FMS were more likely to be active smokers (<em>P</em> &lt; .001) and have chronic kidney disease (<em>P</em> &lt; .001) prior to surgery. Patients with FMS exhibited increased rates of complications, including requiring a transfusion (<em>P</em> = .002), acute respiratory distress syndrome (<em>P</em> &lt; .001), surgical site infection (<em>P</em> &lt; .001), dislocation (<em>P</em> &lt; .001), prosthetic loosening (<em>P</em> &lt; .001), and fracture (<em>P</em> &lt; .001) compared to patients without FMS. Patients with FMS also exhibited higher rates of all-cause complications (<em>P</em> &lt; .001) and revision TSA (<em>P</em> &lt; .001) and decreased rates of readmission (<em>P</em> = .002) within 180 days of surgery. Mean cost of admission was found to be $1639 higher in patients with FMS (<em>P</em> &lt; .001), despite no difference in total hospital length of stay or discharge disposition.</div></div><div><h3>Conclusion</h3><div>Patients with FMS are more likely to develop medical and surgical complications following primary TSA. Though associated with multiple comorbidities, FMS is an independent predictor of several adverse events. Orthopedic surgeons should be aware of the increased risk of FMS on TSA when determining treatment plans.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 936-942"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748285","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 impact of nutritional status on revision total shoulder arthroplasty: perioperative outcomes and complications","authors":"Skye Jacobson BS,&nbsp;Jacqueline G. Tobin MS,&nbsp;Lawrence C. Vanderham MS, PA,&nbsp;Nikhil Vallabhaneni BS,&nbsp;Alexander S. Guareschi BS,&nbsp;William R. Barfield PhD,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.06.002","DOIUrl":"10.1053/j.sart.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div>As the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin &lt; 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample <em>t</em> tests, and multivariate analysis on SPSS.</div></div><div><h3>Results</h3><div>Patients within the low albumin cohort were more likely to be female (<em>P</em> = .008), increased mean age (<em>P</em> = .018), on dialysis (<em>P</em> = .002), had undergone an emergency procedure (<em>P</em> &lt; .001), classified with a dependent functional status (<em>P</em> &lt; .001), and had a higher American Society of Anesthesiologists classification (<em>P</em> &lt; .001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, <em>P</em> &lt; .001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (<em>P</em> = .025), increased bleeding/transfusion complications (8.4% vs. 3.3%, <em>P</em> = .021), and increased reoperation rate (8.4% vs. 0.71%, <em>P</em> = .034). No significant difference in readmission was found (<em>P</em> = .226).</div></div><div><h3>Conclusion</h3><div>Eleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 838-842"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700148","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":"Reaching MCID, SCB, and PASS for ASES, SANE, SST, and VAS following shoulder arthroplasty does not correlate with patient satisfaction","authors":"Adam Z. Khan MD ,&nbsp;Alayna Vaughan MD ,&nbsp;Zachary S. Aman BS ,&nbsp;Mark D. Lazarus MD ,&nbsp;Gerald R. Williams MD ,&nbsp;Surena Namdari MD","doi":"10.1053/j.sart.2024.03.017","DOIUrl":"10.1053/j.sart.2024.03.017","url":null,"abstract":"<div><h3>Background</h3><div>Minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have been established in the literature to gauge shoulder arthroplasty treatment effectiveness. These metrics are established based on anchoring questions that do not account for a patient’s satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), and visual analog scale (VAS) at 2 years following shoulder arthroplasty correlates with overall patient satisfaction.</div></div><div><h3>Methods</h3><div>This was a single-institution, retrospective, cohort study of all patients who underwent shoulder replacement from 2015 to 2019. Preoperative and 2-year postoperative ASES, SANE, SST, and VAS scores were recorded. Previously established MCID, SCB, and PASS values were used. Patients were contacted and underwent a survey to assess: (1) on a scale of 1 to 10, what is your overall satisfaction with your surgical outcome? (2) if you could go back in time, would you undergo this operation again? (yes/no); and (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess the relationship between reaching MCID, SCB, or PASS and the 3 outcome metrics above.</div></div><div><h3>Results</h3><div>Three hundred fifty two patients were included. Mean preoperative ASES was 42.2 ± 16.4, SANE was 35.5 ± 18.9, SST was 4.5 ± 2.6, and VAS was 5.3 ± 2.4. Mean 2-year ASES was 87.8 ± 16.0, SANE was 87.1 ± 15.7, SST was 9.8 ± 2.4, and VAS was 0.9 ± 1.8. Mean patient satisfaction was 9.0 ± 2.0, 331 (94.0%) patients would undergo surgery again, and 330 (93.8%) patients would recommend surgery. Spearman correlation coefficients were weak or very weak for reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS and all 3 study outcome metrics.</div></div><div><h3>Discussion</h3><div>Patient overall satisfaction is one of many considerations when indicating a patient for shoulder replacement and evaluating their ultimate long-term outcome. Reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS following shoulder arthroplasty did not correlate with a patient’s overall satisfaction, willingness to undergo surgery again, or willingness to recommend surgery to a friend or family member. Further investigation into the reliability and clinical value of currently defined MCID, SCB, and PASS metrics is needed.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 819-826"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141042881","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":"Comparing comorbidity burden between patients undergoing ambulatory rotator cuff repair vs. inpatient anatomic total shoulder arthroplasty","authors":"Zoe W. Hinton MD,&nbsp;Colleen W. Wixted MBA,&nbsp;Kevin A. Wu BS,&nbsp;John Atwater BS,&nbsp;Daniel E. Goltz MD, MBA,&nbsp;John R. Wickman MD, MBA,&nbsp;Jay M. Levin MD, MBA,&nbsp;Joshua K. Helmkamp MD,&nbsp;Tally E. Lassiter MD, MHA,&nbsp;Christopher S. Klifto MD,&nbsp;Oke A. Anakwenze MD, MBA","doi":"10.1053/j.sart.2024.03.004","DOIUrl":"10.1053/j.sart.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff repair (RCR) patients routinely undergo same-day discharge in an ambulatory setting, while anatomic total shoulder arthroplasty (TSA) cases have historically been performed in an inpatient hospital setting. For healthier patients, however, TSA has increasingly transitioned to same-day discharge. Understanding whether a true difference in comorbidity burden exists between these patient groups would inform the appropriateness of outpatient TSA in an ambulatory setting.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of patients undergoing primary TSA and same-day, ambulatory RCR performed between September 2017 and May 2021 at a single institution by 3 fellowship-trained orthopedic surgeons. Selected sociodemographic factors and the Elixhauser Comorbidity Index (30 variables) were used to summarize and compare comorbidity burden. Only patients &gt;50 year old were included. Chi-square and Kruskal-Wallis testing was used to compare the prevalence or severity for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>1433 cases met inclusion criteria, including 146 (34%) primary inpatient TSAs and 287 (66%) ambulatory RCRs. There were few differences in comorbidity burden between TSA and RCR, with TSA having a significantly higher prevalence for only 4 Elixhauser comorbidities and RCR having a higher prevalence of 1 comorbidity, although none survive a Bonferroni correction. TSA patients had a significantly higher prevalence of uncomplicated (<em>P</em> = .04192) and complicated hypertension (<em>P</em> = .0336), chronic pulmonary disease (<em>P</em> = .0045), and cardiac arrhythmia (<em>P</em> = .0031). The prevalence of diabetes (<em>P</em> = .029758) was significantly higher among RCR patients. Additionally, age (<em>P</em> = .011) was significantly higher among TSA patients. Of the TSA cohort, there were 10 incidences (1%) of 90-day readmission whereas there were 14 incidences (5%) of 90-day readmissions after RCR.</div></div><div><h3>Conclusion</h3><div>Overall, few differences in the prevalence of individual comorbidities (and sociodemographic parameters) existed between patients undergoing outpatient RCR and inpatient primary anatomic TSA. Comorbidities with larger differences can be either optimized preoperatively or managed chronically, and given these similarities, TSA may be similarly appropriate for ambulatory settings, particularly as efficiencies in operative time and improvements in regional anesthesia continue to evolve.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 813-818"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786950","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":"Morphometry of the proximal humerus and the relationship to global offset","authors":"John J. Heifner MD ,&nbsp;Gabriel Pertierra MD ,&nbsp;Austin T. Vegas DO ,&nbsp;Robert J. Rowland DO ,&nbsp;Deana M. Mercer MD ,&nbsp;Jorge L. Orbay MD","doi":"10.1053/j.sart.2024.07.005","DOIUrl":"10.1053/j.sart.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Previous research has consistently identified the medial and posterior offset of the native humeral head in relation to the intramedullary canal. These anatomic parameters and others such as humeral head and intramedullary diameter provide valuable insight for prosthesis development. However, it is critical to understand the relationship of morphometry to the native center of rotation. Our objective was to use 3-dimensional analysis to demonstrate the native morphometry of the proximal humerus and those relationships to global offset.</div></div><div><h3>Methods</h3><div>Fourteen cadaveric humeri were manually measured then digitally analyzed following 3-dimensional scanning. Pearson’s r was used to determine the relationship between variables.</div></div><div><h3>Results</h3><div>The mean digital humeral head diameter (Hd^d) was 46.5 (± 4.67) mm and the mean manual humeral head diameter was 46.8 (± 4.42) mm. The mean global offset (GO) was 6.36 (± 2.21) mm, and the mean best fit sphere diameter was 46.5 (± 4.63) mm. Pearson’s r = 0.58 (95% confidence interval 0.07-0.84, <em>P</em> = .021) for GO and Hd^d which indicates a moderate correlation. Pearson’s r = 0.96 (95% confidence interval 0.89-0.99, <em>P</em> &lt; .001) for Hd^d and manual humeral head diameter which indicates a strong correlation.</div></div><div><h3>Discussion</h3><div>Native GO demonstrated a moderately positive correlation to humeral head diameter. The manual measurement of head diameter was strongly correlated to the 3-dimensional software value which reinforces the importance of intraoperative measurement. These data contribute to further understanding of shoulder morphometry which is integral to prosthesis design which impacts postoperative function and complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 907-914"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747735","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":"Prediction of overnight stay following shoulder arthroplasty utilizing machine learning","authors":"Benjamin Miltenberg MD ,&nbsp;Teja Yeramosu MD ,&nbsp;William L. Johns MD ,&nbsp;Gabriel Onor MD ,&nbsp;Brandon Martinazzi MD ,&nbsp;Michael Chang MD ,&nbsp;Surena Namdari MD","doi":"10.1053/j.sart.2024.07.010","DOIUrl":"10.1053/j.sart.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) has evolved from requiring extended inpatient hospital stays to favoring same-day discharges, influenced by improved surgical techniques, patient optimization, and the risks associated with inpatient stays. The removal of TSA from Medicare's inpatient-only list in 2021 underscores this shift. However, the need for accurate prediction of post-TSA admission remains, as hospital admissions are costly and linked to increased morbidity and mortality. Machine learning algorithms offer potential advantages over traditional predictive models by identifying complex, nonlinear relationships. This study aimed to demonstrate and compare the performance of commonly used machine learning algorithms to predict overnight hospital stay (OHS) admission.</div></div><div><h3>Methods</h3><div>This study used data from the American College of Surgeons National Quality Improvement Program 2021 database to analyze patients who underwent primary, elective TSA. Patients were divided into short hospital stay of 0-1 days and OHS of &gt;1 day cohorts. Machine learning models, including Random Forest, Artificial Neural Network (ANN), Gradient Boosted Tree, Naïve Bayes, and Support Vector Machine, were trained and validated to predict OHS. The models' predictive capacities were compared using the area under the receiver operating characteristics curve, calibration, and decision curve analysis.</div></div><div><h3>Results</h3><div>Out of 5811 patients analyzed, 926 (15.9%) were discharged on the same day. The ANN model demonstrated the highest area under the receiver operating characteristics curve (0.811), indicating superior predictive ability. Important variables influencing OHS predictions included operative time, body mass index, functional status, and patient demographics, such as age, race, and home support. Machine learning models showed better predictive performance than multivariate logistic regression.</div></div><div><h3>Conclusion</h3><div>Machine learning models, particularly the ANN model, outperform traditional regression methods in predicting post-TSA admission, highlighting their utility in optimizing patient selection for outpatient surgery. These models identify important variables associated with increased risk of OHS, aiding in preoperative planning and patient counseling. Integrating machine learning into clinical practice may enhance surgical outcomes and patient satisfaction while reducing health-care costs.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 943-952"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748286","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":"Bariatric surgery patients have 5-year risk of revision following total shoulder arthroplasty comparable to that of class III obesity patients","authors":"Sanjay Kubsad BS ,&nbsp;Arman Kishan MBBS ,&nbsp;Jordan Holland MPH ,&nbsp;Henry Maxwell Fox MD ,&nbsp;Jacob D. Mikula MD ,&nbsp;Sarah Y. Nelson MD, MS ,&nbsp;Umasuthan Srikumaran MD, MPH, MBA","doi":"10.1053/j.sart.2024.05.005","DOIUrl":"10.1053/j.sart.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Obesity has been correlated with heightened risk of complications after orthopedic surgeries. Bariatric surgery (BS) is an effective tool commonly utilized for the reduction of body mass index. However, the impact of BS on complications in total shoulder arthroplasty (TSA) remains inadequately investigated. This study examines the 5-year risk of revision following TSA in patients with a history of BS compared to matched cohorts without history of BS.</div></div><div><h3>Methods</h3><div>Utilizing the PearlDiver Mariner database, a retrospective cohort analysis was conducted on over 157 million U.S. patients from January 2010 to October 2021. Inclusion criteria identified patients undergoing primary TSA with a minimum 2-year follow-up. Propensity-score matching was employed to control for covariates, comparing BS patients with a matched control and a matched class III obesity control without history of BS. Demographics, comorbidities, and outcomes, including 5-year cumulative incidence of revision were analyzed.</div></div><div><h3>Results</h3><div>The 5-year cumulative incidence of all-cause revision within the BS group was found to be 4.6%. While this represented a higher risk than that of the general population (hazard ratio 1.70; 95% confidence interval 1.21-2.39), there was no significant difference when compared to controls with class III obesity. The BS cohort had higher risk of revision secondary to dislocation/subluxation and rotator cuff tear than in the general population. When compared to the class III obesity cohort, only the risk of revision due to rotator cuff tear was found to be higher.</div></div><div><h3>Conclusion</h3><div>Individuals with a history of BS showed a higher risk of revision than a cohort without history of BS and an equivalent risk of revision compared to a cohort of class III obesity controls after undergoing TSA. Though obesity is an important risk factor for complications after TSA, BS might not be an effective tool for preoperative risk optimization.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 827-831"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748292","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}