Seminars in Arthroplasty最新文献

{"title":"Incidence of 30- and 90-day readmission rates after revision shoulder arthroplasty in the United States","authors":"Tej Joshi MD , Daniel Calem MD , Daniella Ogilvie MD , Suleiman Sudah MD , Dhruv Mendiratta BS , Isabella Blanchard BS , John Erickson MD","doi":"10.1053/j.sart.2024.12.009","DOIUrl":"10.1053/j.sart.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of shoulder arthroplasty is increasing at an exponential rate. This comes with an inherently associated increase in revision shoulder arthroplasty. Due to the increasing prevalence of revision surgery, combined with a decrease in reimbursement and high healthcare cost of revision surgery, minimizing additional healthcare expenditure is of interest. The purpose of this study is to provide an in-depth analysis of readmission rates after revision shoulder arthroplasty to potentially help reduce overall healthcare expenditure and improve systematic efficiency regarding patient care.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried for revision shoulder arthroplasty procedures performed in the United States between 2016 and 2018 utilizing the ICD-10 Procedure Coding System. The national incidence was calculated, including patient demographics, comorbidities, facility characteristics, and overall rates and causes of both 30- and 90-day readmissions after revision shoulder arthroplasty procedure. The revision groups were then further subdivided into single component revisions and explantations.</div></div><div><h3>Results</h3><div>There were 31,289 revision shoulder arthroplasty cases estimated using weighted values. The average age of patients undergoing a revision procedure was 66.9, and of which 50.2% were females. The average length of stay was 2.9 days with total hospital charges averaging $82,314.76 per admission. Patients were more commonly discharged home vs. to a rehab facility (86.5% vs. 12.9%) and Medicare was the most common payer (67.9%). The average all-cause 30-day readmission rate was 3.09%. The average all-cause 90-day readmission rate was 3.58% when all-cause 30-day readmissions were excluded. For single component procedures, the most common surgical diagnosis for 30-day and 90-day readmissions was dislocation (5.56% and 2.48%, respectively). For explantation procedures, the most common surgical diagnosis for 30-day readmission was dislocation, followed by infection (1.49% vs. 0.90%, respectively). At 90 days, infection was the most common (1.04%). Cumulatively, the most common surgical diagnosis for readmission was dislocation followed by infection at both 30-days (1.81% and 0.9-%, respectively) and 90-days (1.09% and 1.02%, respectively). Atrial fibrillation followed by acute kidney failure was the most common medical diagnosis at both 30- (0.27% and 0.16%, respectively) and 90-day readmissions (0.17% and 0.12%, respectively).</div></div><div><h3>Conclusions</h3><div>Revision shoulder arthroplasty poses a cumulative risk of readmission within 30- and 90-days of 3.09% and 3.58%, respectively, with most readmissions occurring within the first 30 days. The most common overall diagnoses associated with readmission following a revision shoulder arthroplasty procedure were dislocation and infection with acute kidney failure being the most common medical diagnos","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 226-234"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890642","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":"No age cutoff accurately prognosticates the likelihood of 30-day medical complications, unplanned readmissions, and death after elective primary total shoulder arthroplasty","authors":"Timothy R. Buchanan BS ,&nbsp;Victoria E. Bindi BS ,&nbsp;Keegan M. Hones MD, MS ,&nbsp;Joseph J. King MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Kevin A. Hao MD","doi":"10.1053/j.sart.2024.12.008","DOIUrl":"10.1053/j.sart.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Many surgeons and practices have adopted age cutoffs for performing total shoulder arthroplasty (TSA). The purpose of this study was to determine whether there exists an age cutoff of increased risk for 30-day medical complications, unplanned readmissions, and death after elective TSA.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients aged 40-89 who underwent elective primary TSA from 2012 to 2020. Receiver operator curve analysis was used to attempt to identify a threshold in age that discriminated likelihood of a 30-day postoperative medical complications, unplanned readmissions, or death. The area under the curve (AUC) and the Matthews Correlation Coefficient (MCC) were determined for each model to identify their predictive value (AUC of 0.5 and MCC of 0 reflect no better than chance). Analyses were performed on the overall cohort and subcohorts stratified by sex, body mass index, and 5-item modified frailty index (mFI-5).</div></div><div><h3>Results</h3><div>We included 31,741 patients (56% female) that underwent elective primary TSA. 21% of patients had an mFI-5 of ≥2. The rate of 30-day postoperative medical complications, unplanned readmissions, and death was 6.3%, with unplanned readmissions (2.8%), intraoperative or postoperative transfusions (2.1%), and urinary tract infections (0.7%) being the most common complications. The AUC and MCC for the 30-day medical complications in the overall cohort (age threshold: 74-years old) were 0.59 and 0.08, respectively, reflecting poor predictive value. After stratifying based on sex, body mass index, and mFI-5, the highest AUC and MCC values obtained were 0.62 and 0.14, reflecting poor predictive value.</div></div><div><h3>Conclusion</h3><div>Age cutoffs poorly predict the risk of 30-day medical complications, unplanned readmissions, or death after elective TSA. Rather than a strict age cutoff, surgeons should consider multivariable risk stratification tools and clinical acumen to identify patients at risk for early postoperative medical complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 218-225"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890641","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":"Inflammatory bowel disease is an independent predictor for complications following total shoulder arthroplasty","authors":"Jason Silvestre MD ,&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.2024.12.007","DOIUrl":"10.1053/j.sart.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>The demand for total shoulder arthroplasty (TSA) in patients with inflammatory bowel disease (IBD) is expected to increase. The purpose of this study is to determine the perioperative outcomes in patients with IBD (Crohn’s disease [CD] and ulcerative colitis [UC]) compared to those without IBD following primary TSA.</div></div><div><h3>Methods</h3><div>The National Readmission Database was queried to identify 683 patients with CD and 566 patients with UC undergoing primary TSA between 2010 and 2020. Case–control matching generated controls in a 1:3 proportion based on age, sex, and preoperative medical diagnoses. Primary outcomes included postoperative medical and surgical complications, clinical outcomes within 180 days, total hospital length of stay, discharge disposition, and total costs of care after TSA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multivariate analyses identified independent risk factors for postoperative complications after TSA.</div></div><div><h3>Results</h3><div>Compared to matched controls, patients with CD undergoing TSA had higher odds of complications including sepsis (OR 35, CI, 8.2-148), dislocation (OR 27, 3.4-211), prosthetic loosening (OR 21, 2.5-168), transfusion requirement (OR 8.9, CI, 2.9-28), and acute respiratory distress syndrome (OR 8.5, CI, 3.3-22). Compared to matched controls, patients with UC undergoing TSA had higher odds of sepsis (OR 15, CI, 1.7-129), acute respiratory distress syndrome (OR 7.9, CI, 2.8-22), and acute renal failure (OR 3.2, CI, 1.7-6.0). No differences in rates of readmission, revision TSA, or mortality were observed between the 2 groups relative to their controls. Total cost of care ($20,808 vs. $17,488) was higher in patients with UC. However, length of stay and discharge disposition was similar to matched controls for both CD and UC patients. On multivariate analysis, CD and UC were identified as independent risk factors for medical and implant-related complications, including dislocation and prosthetic loosening (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>IBD is an independent risk factor for higher rates of medical and surgical complications following primary TSA. This information can help orthopedic surgeons appropriately counsel patients with IBD on the risks following TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 210-217"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890640","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":"Using machine learning to predict postoperative complications of total shoulder arthroplasty","authors":"Carter M. Powell BA,&nbsp;William N. Newton MD,&nbsp;Robert J. Reis BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.12.006","DOIUrl":"10.1053/j.sart.2024.12.006","url":null,"abstract":"<div><h3>Background</h3><div>Previous efforts to use machine learning to predict complications following primary total shoulder arthroplasty (TSA) have shown promise, but the clinical significance of such predictive models has been limited by inadequate sample sizes and short (∼30 day) follow-up periods. The Nationwide Readmissions Database, with a large sample size and longer follow-up period, has the potential to reduce the noise of previous modeling efforts. The purpose of this study is to evaluate the accuracy and effectiveness of 4 different models for predicting 180-day complications, extended length of stay (LOS), and mechanical failures in patients undergoing primary TSA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried for patients who underwent TSA from 2016 to 2020. Primary outcomes were complications within 180 days, extended LOS (defined as &gt;2 days), and mechanical failure. For each outcome, 4 models were created using Python v3.9. Models included a weighted logistic regression, random forest classifier, gradient boosting classifier, and an artificial neural network. Model performance was assessed using accuracy, area under the receiver operating characteristic curve (area under the curve [AUC]), sensitivity, positive predictive value (PPV), and F1 score.</div></div><div><h3>Results</h3><div>A total of 178,003 patients underwent primary TSA from 2016 to 2020. For predicting 180-day complications, gradient-boosted classification had the highest discriminative ability and sensitivity (accuracy: 0.69, AUC: 0.71, sensitivity: 0.59, PPV: 0.21, and F1: 0.31). For predicting extended LOS, an artificial neural network proved most effective (accuracy: 0.79, AUC: 0.82, sensitivity: 0.67, PPV: 0.43, and F1: 0.52; Table II). For mechanical complications, all models were equally poor at predicting complications.</div></div><div><h3>Conclusion</h3><div>Machine learning has the potential to accurately predict rare outcomes from heterogenous data; however, the quality of predictive models is dependent on the quality of the input data. Although machine-learning models are superior to simpler methods at predicting certain outcomes, such as extended LOS, they currently lack the sensitivity and PPV to be clinically significant.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 203-209"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890639","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":"Functional deficiencies following reverse and anatomic total shoulder arthroplasty: detecting true differences","authors":"Jeffrey R. Hill MD ,&nbsp;Arakua N. Welbeck MD ,&nbsp;Jeffrey J. Olson MD ,&nbsp;Alexander W. Aleem MD ,&nbsp;Jay D. Keener MD ,&nbsp;Benjamin M. Zmistowski MD","doi":"10.1053/j.sart.2024.12.005","DOIUrl":"10.1053/j.sart.2024.12.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Reverse total shoulder arthroplasty (rTSA) has gained traction as a reliable treatment option for glenohumeral osteoarthritis (GHOA). Much of this pivot from anatomic total shoulder arthroplasty (aTSA) to rTSA has centered on the described lower revision rates in the latter, as well as the reported equivalence in composite patient-reported outcomes between the two modes of TSA. Yet, this fails to highlight the nuanced effects each can have on everyday activities. This retrospective study aims to identify specific tasks that remain difficult for patients after TSA for GHOA and assess the difference in ability to perform specific daily tasks between aTSA and rTSA for GHOA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients with minimum 2-year follow-up after undergoing TSA for GHOA were identified from a single-institution registry. Patient-reported outcome data from the American Shoulder and Elbow Surgeons (ASES), Western Ontario Osteoarthritis of the Shoulder (WOOS) index, and Single Assessment Numeric Evaluation surveys were collected at 2-year follow-up. Composite scores as well as each individual component score were compared between the two arthroplasty types by univariate analysis. When a difference in a component was found, further analysis was performed using multivariate linear regression (WOOS) or a multivariate logistic regression (ASES), while controlling for potential confounding variables. All analyses were performed in SPSS (version 28.0; IBM; Armonk, NY, USA).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;317 TSAs were identified with two-year follow-up (mean age 67.2 years, 53.9% males), with 219 being anatomic TSA (69.1%). Postoperatively, there was gross improvement in visual analog scale pain (&lt;em&gt;P&lt;/em&gt; &lt; .001) and ASES scores (&lt;em&gt;P&lt;/em&gt; &lt; .001), with improvements noted in each ASES functional component (&lt;em&gt;P&lt;/em&gt; &lt; .001). No differences were noted in all composite survey scores between aTSA and rTSA (&lt;em&gt;P&lt;/em&gt; &gt; .15). Across the entire cohort, there was continued difficulty with behind-the-back and overhead activities. While rTSA patients reported better postoperative stiffness (&lt;em&gt;P&lt;/em&gt; = .02), they also noted more difficulty in tasks including washing their backs/doing up a bra (ASES, &lt;em&gt;P&lt;/em&gt; = .001), tucking in a shirt (WOOS, &lt;em&gt;P&lt;/em&gt; = .01), styling hair (WOOS, &lt;em&gt;P&lt;/em&gt; = .02) and lifting 4.54 kg (10 lbs) above shoulder level (ASES, &lt;em&gt;P&lt;/em&gt; = .001). Even when adjusting for confounding variables, rTSA was an independent predictor for decreased ability to tuck in shirt (WOOS, &lt;em&gt;P&lt;/em&gt; &lt; .001) and put on a coat (ASES; &lt;em&gt;P&lt;/em&gt; = .03)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study illustrates the subtle differences in postoperative function in patients treated with aTSA versus rTSA for GHOA, most notably in overhead and behind-the-back activities. This knowledge provides surgeons and patients with greater understanding of the true differences in anticipated outcomes between","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 195-202"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890589","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 socioeconomic status on clinical outcomes and implant survivorship after revision shoulder arthroplasty","authors":"Anton Khlopas MD ,&nbsp;Akshay R. Reddy BS ,&nbsp;Kevin A. Hao BS ,&nbsp;Logan Wright BA ,&nbsp;Wojciech K. Dzieza MD ,&nbsp;Joseph J. King MD ,&nbsp;Jonathan O. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Kevin Farmer MD ,&nbsp;Thomas W. Wright MD","doi":"10.1053/j.sart.2024.12.001","DOIUrl":"10.1053/j.sart.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Low socioeconomic status (SES) has been shown to correlate with poorer preoperative and postoperative pain and functional scores in patients undergoing joint arthroplasty. The aim of this study was to investigate the effect of SES on baseline and postoperative outcome scores and implant survivorship after revision shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively collected single-institution database was performed to identify patients who underwent revision shoulder arthroplasty. Patient zip codes were used to identify their corresponding national area deprivation index (ADI) rank. A correlation analysis between national ADI rank and preoperative, postoperative, and preoperative to postoperative improvement in range of motion, shoulder strength, and clinical outcome scores in patients with minimum 2-year follow-up was performed. In addition, patients were grouped according to their national ADI rank (0-50, 51-75, and 76-100) to compare achievement of the minimum clinically important difference (MCID), substantial clinical benefit, patient acceptable symptom state, and revision-free implant survivorship.</div></div><div><h3>Results</h3><div>A total of 141 revision shoulder arthroplasties with a mean follow-up of 5.0 ± 2.8 years were included. No correlation between national ADI rank and any preoperative or postoperative outcome measure was identified. In addition, there was no difference in the achievement of the MCID, substantial clinical benefit, and patient acceptable symptom state for all outcome measures except a greater proportion of patients with an ADI rank between 51 and 75 achieving the MCID for the Constant score (<strong><em>P</em> = .031</strong>). There was no difference in implant survivorship between ADI groups (<em>P</em> = .912).</div></div><div><h3>Conclusion</h3><div>Lower SES was not associated with poorer preoperative or postoperative pain and functional outcomes, neither there is a greater risk of implant failure necessitating rerevision. These findings contrast the previously recognized role of SES on primary joint replacement outcomes, suggesting that other factors such as the failure mode of primary TSA (ie, the indication for revision TSA) may have a greater role in determining the preoperative presentation and prognosis of revision TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 166-173"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891221","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":"Re-evaluating the metal-backed glenoid in anatomic total shoulder arthroplasty","authors":"Nathan Sarli BS ,&nbsp;Kassem Ghayyad MD ,&nbsp;Samuel Harmsen MD ,&nbsp;G. Russell Huffman MD, MPH","doi":"10.1053/j.sart.2024.12.002","DOIUrl":"10.1053/j.sart.2024.12.002","url":null,"abstract":"<div><div>The idea of metal-backed glenoid (MBG) components offers a promising alternative to traditional all-polyethylene (PE), cemented glenoid implants in total shoulder arthroplasty (TSA). Despite the historically high success rate of TSA, challenges such as backside wear, PE debris disease, and significant glenoid bone loss during revision surgeries necessitate the development of improved glenoid component designs. Unlike original designs, the modern MBG components are modular and convertible, exemplified by advancements from companies like Lima, Arthrex, and Zimmer. The ability to exchange PE liners and ultimately to convert to a reverse TSA in the current generation of implants has addressed some early concerns and offers insight into previously elusive solutions for anatomic total shoulder replacements. These more modern MBG components simplify the conversion from anatomic TSA to reverse shoulder arthroplasty, thus shortening the surgery, minimizing blood loss and reducing the complication rates associated with revision surgeries. They also enable correction of glenoid deformities both with respect to glenoid version and glenoid inclination that proven elusive with all PE implants. This paper highlights the design improvements, clinical indications, and future prospects of these components, underscoring their role in enhancing patient outcomes in TSA and hinting that further design developments are needed.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 174-179"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A dual-cup reverse shoulder replacement improves impingement-free motion","authors":"Rayan Alabsi BS, MS ,&nbsp;Tejasvi Subramanya BS, MS ,&nbsp;Michael G. Livesey MD ,&nbsp;Logan C. Kolakowski MD ,&nbsp;Subham Badhyal PhD ,&nbsp;Kevin Aroom MS, PE ,&nbsp;Li-Qun Zhang PhD ,&nbsp;Martha O. Wang PhD ,&nbsp;Mohit N. Gilotra MD, MS","doi":"10.1053/j.sart.2024.12.004","DOIUrl":"10.1053/j.sart.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Advances in reverse shoulder arthroplasty (RSA) design have improved functional outcomes, which approach those of the anatomic total shoulder arthroplasty in certain patients. However, restoration of motion, especially functional internal rotation (IR), remains a concern following RSA. A novel dual-cup RSA design was developed to improve impingement-free range of motion. The passive motion of the dual-cup RSA is compared to that of a commercially available RSA design in a cadaveric model.</div></div><div><h3>Methods</h3><div>Five fresh-frozen cadaveric upper-extremity specimens were included in the study. The scapula was rigidly fixed, allowing for isolation of glenohumeral joint motion. The novel dual-cup RSA design was tested with and without a flanged component. The dual-cup has an outer diameter of 36 mm, articulates with a 32 + 4 mm glenosphere, and provides 6 mm of glenoid lateralization. A 32 + 4 mm lateralized glenosphere and a 36 + 6 mm lateralized glenosphere served as controls. Measurements of motion were performed using an electromagnetic tracking device and modes of impingement were recorded. An analysis of variance test was performed with a post-hoc Tukey test to compare the relative changes in range of motion among groups.</div></div><div><h3>Results</h3><div>The dual-cup <em>(without flange)</em> design improved external rotation at 0° abduction by 20.9° and improved IR by 11.5° compared to the 32 + 4 mm control (<em>P</em> &lt; .01). In 90° abduction, the dual-cup improved external rotation by 11.9° compared to the 32 + 4 mm control, a significant improvement relative to the 36 + 6 mm control (<em>P</em> &lt; .05). The dual-cup improved functional IR by 12.4° relative to the 32 + 4 mm control, a significant improvement relative to the 36 + 6 mm control (<em>P</em> &lt; .05). The dual-cup did not significantly improve IR at 45° or 90° abduction compared to control models. Humeral component impingement on the glenoid was not observed at any end-range of motion in the implant with the flanged design.</div></div><div><h3>Discussion</h3><div>The dual-cup design improves all rotational motions relative to control models except IR with an abduction angle reaching or exceeding 45°. The dual-cup design improves impingement free motion, including functional IR, without additional lateralization in this study. The dual-dup with flange design eliminates impingement of the humeral cup on the glenoid neck without significantly affecting most motions relative to control models.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 188-194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890588","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":"Reverse and total shoulder arthroplasty among Medicare patients in the ambulatory surgery center: a matched cohort study and retrospective review of 90-day complications","authors":"Claire E. Hays MD ,&nbsp;Abu Mohd Naser PhD ,&nbsp;Thomas W. Throckmorton MD ,&nbsp;Tyler J. Brolin MD","doi":"10.1053/j.sart.2024.12.003","DOIUrl":"10.1053/j.sart.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Studies have shown the safety of outpatient total shoulder arthroplasty (TSA) in ambulatory surgery centers (ASCs), but none have specifically examined Medicare patients. Until recently, all TSAs among Medicare patients were required to be completed in a hospital as no ASC code (Current Procedural Terminology 23472) existed. The purpose of this study was to compare the intraoperative and 90-day episode of care complications among Medicare patients undergoing reverse total shoulder arthroplasty (rTSA) or anatomic total shoulder arthroplasty (aTSA) at a freestanding ambulatory surgery center to those of Medicare patients undergoing TSA as hospital inpatients (INPTs) or at a freestanding surgery center with commercial insurance. Our hypothesis was no difference between cohorts would be seen.</div></div><div><h3>Methods</h3><div>Our institution’s records were queried for all patients undergoing rTSA or aTSA from 2018 through 2022 who completed 90-day follow-up. Three cohorts were identified: all Medicare patients undergoing TSA in an ASC, an age and American Society of Anesthesiologists score best match 1:1 cohort of Medicare patients undergoing shoulder arthroplasty in the hospital, and all privately insured patients undergoing TSA in an ASC. A total of 395 patients met inclusion for analysis. Surgical complications, postoperative complications, hospital (re)admissions, and revisions were identified.</div></div><div><h3>Results</h3><div>The mean age was significantly older in the Medicare ASC cohort (mean 72.79 years) and Medicare INPT cohort (73.01y) compared with the privately insured ASC cohort (59.45 y). Overall, 33 (8.4%) complications, three revisions and four (re)admissions occurred within 90 days. There was one urgent hospital transfer in the privately insured ASC cohort. The overall complication rates for each group were not significantly different: 10.0% for Medicare ASC, 11.1% for Medicare INPTs, and 6.5% for privately insured ASC (<em>P</em> value = .339). The risk ratio (RR) for incidence of within 90-day postoperative complications was not significantly different amongst the cohorts. The RR for Medicare ASC patients was 0.9 compared with Medicare INPTs, and 1.53 compared with privately insured ASC patients. The RR for ASC patients (Medicare and privately insured) was 0.68 compared with Medicare INPTs. There was no significant increase in risk of complications among the Medicare ASC patients compared with either cohort regardless of surgical age, sex, body mass index, or American Society of Anesthesiologists score.</div></div><div><h3>Conclusion</h3><div>Medicare ASC patients undergoing rTSA or aTSA had a similar postoperative complication RR compared with Medicare INPTs and commercially insured ASC patients. Our findings suggest that TSA can be performed safely in freestanding ASCs on appropriately selected Medicare patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 180-187"},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891223","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 and surgical risk factors for dislocation after reverse shoulder arthroplasty: a study by the American Shoulder and Elbow Surgeons multicenter complications of reverse shoulder arthroplasty research group","authors":"ASES Complications of RSA Research Group,&nbsp;Evan A. Glass BS ,&nbsp;Adam R. Bowler BA ,&nbsp;Michael J. Maxwell MD ,&nbsp;Declan R. Diestel BA ,&nbsp;Miranda McDonald-Stahl BS ,&nbsp;Calista S. Stevens BA ,&nbsp;Christopher Canizares BS ,&nbsp;Pamela A. Chan MS ,&nbsp;Daniel P. Swanson BS ,&nbsp;Ryan Lohre MD ,&nbsp;Michael A. Moverman MD ,&nbsp;Richard Puzzitiello MD ,&nbsp;Himmat Sahi MS ,&nbsp;Kuhan A. Mahendraraj BA, MS ,&nbsp;Kiet Le PA-C ,&nbsp;Warren R. Dunn MD ,&nbsp;Dylan J. Cannon BS ,&nbsp;Lisa GM. Friedman MD ,&nbsp;Jaina A. Gaudette BSE ,&nbsp;Andrew Jawa MD","doi":"10.1053/j.sart.2024.11.004","DOIUrl":"10.1053/j.sart.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to identify patient and surgical factors associated with dislocation after reverse shoulder arthroplasty (RSA) in a large multicenter cohort.</div></div><div><h3>Methods</h3><div>A retrospective study using data from 15 institutions and 24 American Shoulder and Elbow Surgeons members across the United States was performed. Patients who underwent RSA between January 2013 and June 2019 with 3-month minimum follow-up were included. All components of methodology were determined by the Delphi method, an iterative survey process, requiring 75% consensus among all surgeons. Dislocations were defined as complete loss of articulation between the humeral component and the glenosphere with associated radiographic confirmation. Binary logistic regression was performed to determine predictors of dislocation following RSA.</div></div><div><h3>Results</h3><div>Overall, 6621 patients with a mean follow-up of 19.2 ± 15.6 months were included. The incidence of dislocation was 2.1% (n = 138), 1.6% (n = 99) in primary RSA, and 6.5% (n = 39) among revision RSAs (<em>P</em> &lt; .001). Dislocations occurred at a median of 7.0 weeks (interquartile range 3.0-36.0) after surgery with 22.5% (n = 31) following a trauma. Factors independently predictive of dislocation, in order of decreasing effect, were a preoperative diagnosis of nonunion fracture sequelae (odds ratio [OR] 8.31; <em>P</em> &lt; .001), revision arthroplasty (OR 4.82; <em>P</em> &lt; .001), the presence of a humeral spacer (OR 3.24; <em>P</em> &lt; .001), a preoperative diagnosis of rotator cuff arthropathy or massive rotator cuff tear (OR 2.91; <em>P</em> &lt; .001), the presence of a constrained polyethylene liner (OR 2.18; <em>P</em> = .001), male sex (OR 1.95; <em>P</em> = .001), and the lack of subscapularis repair (OR 1.61; <em>P</em> = .032) indicating a modest improvement in model fit compared to the null model.</div></div><div><h3>Conclusion</h3><div>Patient factors such as being male, having large rotator cuff tears, undergoing revision RSA, or undergoing RSA for the sequelae of fracture nonunion appear to significantly increase the risk of postoperative dislocation after RSA. Surgical factors predictive of dislocation included the presence of a humeral spacer, constrained polyethylene liner, and lack of subscapularis repair, indicating a surgeon intraoperative awareness of potential instability.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 147-157"},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891219","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}