Seminars in Arthroplasty最新文献

{"title":"Concomitant joint infection in shoulder periprosthetic fracture patients: a case series","authors":"Alyssa R. Henriquez BS, Bryan Crook MD, Lindsey V. Ruderman BA, Samuel Lorentz MD, Christopher S. Klifto MD, Oke Anakwenze MD, MBA","doi":"10.1053/j.sart.2025.04.001","DOIUrl":"10.1053/j.sart.2025.04.001","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 448-453"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766964","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":"Early clinical and radiological outcomes of a scapular spine load-bearing strut in custom glenoid implants for reverse total shoulder arthroplasty","authors":"Alastair J. Konarski FRCS, MBChB, BSc (Hons) ,&nbsp;Leanne Dupley FRCS, MBChB ,&nbsp;Nallamilli Rajyalakshmi Reddy MBBS, MS (Orth), MCh (Orth) ,&nbsp;Ian A. Trail FRCS, MBChB ,&nbsp;Michael J. Walton BMedSci, BMBS, MSc (SEM), FRCS (Tr&Orth) ,&nbsp;Stephen Bale FRCS (Orth), MBChB, BSc ,&nbsp;Puneet Monga FRCS (Orth), MBBS, DipSEM, MD","doi":"10.1053/j.sart.2025.03.009","DOIUrl":"10.1053/j.sart.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>Severe glenoid bone deficiency is a challenge in complex primary and revision shoulder arthroplasty, but lately, custom glenoid baseplates have demonstrated good outcomes. Lima Promade 3D-printed implants have recently utilized a strut to load share through the scapular spine to increase stability in patients with the most severe glenoid bone loss. We have assessed early clinical and radiological outcomes and reviewed complications.</div></div><div><h3>Methods</h3><div>This was a retrospective multisurgeon, single-center study, reviewing 19 patients with a minimum 2-year follow-up. Preoperative imaging was assessed for bone loss. Routinely performed postoperative computed tomography (CT) scans, radiographs, and Oxford Shoulder Scores were reviewed. CT scans were reported by independent musculoskeletal radiologists. Patient records were reviewed for any complications.</div></div><div><h3>Results</h3><div>19 patients with a mean age of 66 (42-89) and a mean follow-up of 3.6 years (2-8) were identified. 11 were revision procedures. 14/19 had severe bone loss (Seebauer-Gupta E4/C4) and 5 had severe dysplasia with &gt;30° retroversion (Seebauer-Gupta E3/E4). 16/19 had a postoperative CT scan, with 14 showing good osseointegration; 1 reported partial osseointegration, and 1 suspected loosening but was asymptomatic. One patient had a magnetic resonance imaging scan with no suspicion of loosening. Pre and postoperative Oxford Shoulder Scores were available in 13 patients and improved from a mean of 14/48 preoperatively to 32/48 postoperatively. Complications were reported in 5 patients (26%), with 1 humeral component revision, 2 with limited external rotation, 1 acromial stress fracture, and 1 keloid scarring. No glenoid baseplates required revision.</div></div><div><h3>Discussion</h3><div>This is the first case series to report on the use of a scapular spine strut as part of a custom glenoid baseplate construct. Early outcomes report good osseointegration and good improvements in patient-reported outcome measures. The complication rate in our series was within the range described in the literature for complex shoulder replacement, and we report 100% implant survival at a minimum of 2 years. Early outcomes would suggest this is a safe technique to balance shear forces and improve stability in patients with severe glenoid bone loss and does not appear to increase the risk of acromial stress fractures beyond that reported in the literature. Further study is on-going to assess the medium- and long-term outcomes in these patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 438-447"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766963","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":"COVID-19 infection within 6 months prior to total shoulder arthroplasty is an independent predictor of postoperative complications","authors":"Jason Silvestre MD ,&nbsp;Grace Bennfors MD ,&nbsp;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.2025.03.006","DOIUrl":"10.1053/j.sart.2025.03.006","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic significantly disrupted elective orthopedic surgeries such as total shoulder arthroplasty (TSA). Recent studies have shown an increased risk of complications following elective orthopedic surgeries in patients with a recent COVID-19 diagnosis. However, similar research specifically addressing TSA is lacking. The purpose of this study is to determine whether preoperative COVID-19 infection within the 6 months before primary elective TSA is associated with increased postoperative complications and increased length of stay.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried to identify patients undergoing elective primary TSA in 2021. A total of 1032 patients were identified with a prior history of COVID-19 infection within the 6 months before TSA. Prior COVID-19 patients were propensity score matched 1:1 on age, sex, Charlson-Deyo Comorbidity Index, and discharge weight to patients without a prior diagnosis of COVID-19 who underwent elective primary TSA in 2021. Demographic information, preoperative comorbidities, postoperative complications, and health-care resource utilization was compared between prior COVID-19 patients and controls. Binary logistic regression was used to identify independent predictors of complications.</div></div><div><h3>Results</h3><div>Prior COVID-19 patients had higher rates of in-hospital postoperative complications than control patients (<em>P</em> &lt; .001). Prior COVID-19 patients had higher rates of specific complications than control patients, including débridement (<em>P</em> = .031), periprosthetic joint infection (PJI) (<em>P</em> &lt; .001), acute respiratory distress syndrome (<em>P</em> &lt; .001), acute renal failure (ARF) (<em>P</em> &lt; .001), pulmonary embolism (<em>P</em> &lt; .001), sepsis (<em>P</em> = .002), and urinary tract infection (<em>P</em> = .039). Following logistic regression analysis, history of a COVID-19 diagnosis was shown to be independently predictive of any in-hospital complication (<em>P</em> &lt; .001), PJI (<em>P</em> = .006), and ARF (<em>P</em> &lt; .001). Prior COVID-19 patients were found to have a longer hospital length of stay than controls (2.6 vs. 2.0; <em>P</em> &lt; .001) but had similar total health-care costs ($77,426 vs. $74,912, <em>P</em> = .385).</div></div><div><h3>Discussion</h3><div>There is an increased risk of medical (acute respiratory distress syndrome, ARF, pulmonary embolism, sepsis, urinary tract infection) and surgical (PJI) complications following elective TSA in patients with COVID-19 infection less than 6 months before the TSA. These findings highlight the importance of preoperative risk assessment and counseling for this patient population. Potential risk mitigation strategies may include venous thromboembolic prophylaxis, postoperative antibiotics, and early medical comanagement.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 406-412"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766960","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":"Improved patient outcomes and range of motion following primary and revision reverse total shoulder arthroplasty utilizing a custom glenoid implant for glenoid deficiency","authors":"Spencer M. Comfort MD ,&nbsp;Lucas J. Ray MD ,&nbsp;Jonathan D. Harley BA ,&nbsp;Rebekah M. Kleinsmith MD ,&nbsp;Haley D. Puckett MD ,&nbsp;Jonathan P. Braman MD ,&nbsp;Alicia K. Harrison MD ,&nbsp;Allison J. Rao MD","doi":"10.1053/j.sart.2025.03.008","DOIUrl":"10.1053/j.sart.2025.03.008","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid bone loss in the primary and revision setting of reverse total shoulder arthroplasty (rTSA) creates the challenge of sufficient glenoid component positioning and fixation and is at risk of early mechanical failure and aseptic baseplate loosening. The purpose of this study was to evaluate clinical outcomes of primary and revision rTSA utilizing a custom glenoid implant for treatment of glenoid bone deficiency.</div></div><div><h3>Methods</h3><div>Patients who underwent rTSA with a Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) custom glenoid implant in the primary or revision setting performed by 2 orthopedic surgeons between April 2016 and October 2023 were included. Demographic, prior surgical history, preoperative assessment, radiographic parameters, intraoperative procedures, and complication data were collected. Preoperative and postoperative range of motion and Single Assessment Numeric Evaluation (SANE) scores were compared and minimal clinically important difference was calculated for shoulder forward flexion (aFF), shoulder external rotation (aER), and SANE scores.</div></div><div><h3>Results</h3><div>Fifty-two shoulders (50 patients) met the inclusion criteria with 49 shoulders (47 patients) (94%) completing follow-up at mean 15.3 ± 21.0 months (range: 3-91 months). Mean age was 67 ± 13 with 25 females (51%). There were 16 (33%) primary and 33 (67%) revision rTSAs. There was significant improvement from preoperative to postoperative aFF (n = 45, 79 ± 35 to 118 ± 36, <em>P</em> &lt; .001), aER (n = 42, 18 ± 24 to 29 ± 21, <em>P</em> = .02), and SANE score (n = 34, 32 ± 22 to 69 ± 23, <em>P</em> &lt; .001). Minimal clinically important difference was calculated to be 69% for aFF, 67% for aER, and 79% for SANE. Two shoulders (4%) required revision surgery.</div></div><div><h3>Conclusion</h3><div>At mean follow-up of 15.3 months, rTSA with VRS custom glenoid implants for the treatment of glenoid bone deficiency in the primary and revision setting demonstrated improved patient-reported-outcomes and range of motion with low complication rate.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 431-437"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766962","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":"Reported outcome measures in total elbow arthroplasty: a systematic review","authors":"Timothy R. Buchanan BS ,&nbsp;Chris B. Lamprecht BS ,&nbsp;Victoria E. Bindi BS ,&nbsp;Oluwaferanmi T. Dada BS ,&nbsp;Michael Guyot BS ,&nbsp;Andrew H.A. Kaiser BS ,&nbsp;Robert J. Cueto BS ,&nbsp;Keegan M. Hones MD, MS ,&nbsp;Jonathan O. Wright MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Joseph J. King MD ,&nbsp;Kevin A. Hao MD","doi":"10.1053/j.sart.2025.03.007","DOIUrl":"10.1053/j.sart.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Total elbow arthroplasty (TEA) outcomes are historically modest with high rates of complications. While many studies have explored means of improving TEA outcomes, lack of standardization of outcome measures has made cross-study comparison difficult. This systematic review aims to characterize patient-reported outcome measures (PROMs), elbow range of motion (ROM), strength, and complications across the TEA literature.</div></div><div><h3>Methods</h3><div>We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify clinical studies on TEA from 1969 to 2023. Studies were excluded if they lacked clinical outcomes or included allograft prosthetic composites, hemiarthroplasties, or oncologic indications for TEA.</div></div><div><h3>Results</h3><div>We included 271 articles reporting on 23,005 elbows (21,665 patients) that underwent TEA (median age 62 years, 41% female, and median follow-up of 58 months). PROMs were reported by 60% (n = 161) of studies. The most common of the 15 identified PROMs was the Mayo Elbow Performance Score (89%, n = 144) followed by the visual analog scale for pain (15%, n = 24); Disabilities of Arm, Shoulder, and Hand score (12%, n = 20); Quick Disabilities of Arm, Shoulder, and Hand score (8%, n = 13); and Oxford Elbow score (7%, n = 11). The number of PROMs reported per study increased over time (<em>P</em> &lt; .001) and decreased with increasing cohort size (<em>P</em> = .004). Elbow ROM was reported by 82% (n = 223) of studies; arm strength was reported by 4% (n = 11) of studies, and complications were reported in 92% (n = 250) of studies.</div></div><div><h3>Conclusion</h3><div>Significant heterogeneity exists in the reporting of outcome measures in the TEA literature. To facilitate future cross-study comparison, we recommend reporting of at least the Mayo Elbow Performance Score, visual analog scale for pain, elbow ROM (flexion, extension, pronation, and supination), and elbow strength via objective elbow extension measurements.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 413-430"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766961","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":"Outcomes of reverse shoulder arthroplasty in patients with os acromiale: a systematic review","authors":"Gregorio Secci MD ,&nbsp;Mark Mouchantaf MD ,&nbsp;Philipp Schippers MD ,&nbsp;Manon Biegun MD ,&nbsp;Luigi Zanna MD ,&nbsp;Matteo Innocenti MD ,&nbsp;Raffaele Tucci MD ,&nbsp;Pascal Boileau MD, PhD","doi":"10.1053/j.sart.2025.03.004","DOIUrl":"10.1053/j.sart.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>When the acromion does not fully fuse during development, the resulting condition is known as os acromiale. Since the deltoid muscle, a key player in reverse shoulder arthroplasty (RSA), attaches to the acromion, surgeons may be hesitant to implant an RSA in these patients. Hence, the aim of this study is to report the clinical and radiological outcomes, as well as safety and effectiveness of RSA in patients with os acromiale.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted to evaluate the outcomes of RSA in patients with os acromiale, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four studies with a total of 100 patients (103 shoulders) were reviewed. Data on clinical outcomes, range of motion, pain relief, and complications were reported.</div></div><div><h3>Results</h3><div>Patients with os acromiale undergoing RSA showed significant improvements in clinical outcomes. The mean weighted postoperative Constant-Murley score was 69 points, with improved range of motion. In 38.8% of cases, a postoperative acromial tilt was reported; however, this did not significantly affect the outcome.</div></div><div><h3>Conclusions</h3><div>RSA can be considered a safe and reliable procedure for patients with os acromiale, offering improvements in both pain and function, similar to those observed in patients without os acromiale. More than one-third of patients (38.8%) experience os acromiale tilting, which did not show clinical relevance.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 387-396"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766956","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":"Risk factors for periprosthetic fractures following total shoulder arthroplasty in patients younger than 50 years of age","authors":"Eric Cui BS ,&nbsp;Andrew Fealy BS ,&nbsp;Jackson W. Durbin BS ,&nbsp;Philip M. Parel BS ,&nbsp;Seyedeh Zahra Mousavi BS ,&nbsp;Amil R. Agarwal MD ,&nbsp;Ami Kapadia MD ,&nbsp;Theodore Quan MD ,&nbsp;Sabrina Gill MD ,&nbsp;Rachel Ranson DO ,&nbsp;Zachary R. Zimmer MD ,&nbsp;Uma Srikumaran MD, MBA, MPH","doi":"10.1053/j.sart.2025.03.003","DOIUrl":"10.1053/j.sart.2025.03.003","url":null,"abstract":"<div><h3>Background</h3><div>The rise of total shoulder arthroplasties (TSAs) has led to a concomitant increase in the incidence of periprosthetic fractures (PPFs). The treatment of PPF remains a technical challenge for orthopedic surgeons, as surgical management can lengthen recovery time and cause secondary complications, including potential nonunion, implant failure, and neurovascular injury. Prior studies investigated risk factors associated with PPFs following TSA in patients over the age of 60. To date, no studies have exclusively examined the potential risk factors for PPF in patients under the age of 50. Therefore, the purpose of this study was to investigate these potential risk factors for PPF following TSA in patients under the age of 50.</div></div><div><h3>Methods</h3><div>Patients who underwent primary TSA with subsequent postoperative PPF within 2 years of surgery were identified using a national claims database. Patients were stratified into 5 age cohorts as follows: under 20, 20-30, 30-40, 40-50, and 50-60 years of age. Baseline demographics between the study cohorts were compared using Pearson’s chi-squared test and Student <em>t</em>-tests, where appropriate. Multivariate logistic regression analysis was utilized to observe significant differences in risk factors for 2-year PPFs using the age 50-60 cohort as a reference with the output recorded as the odds ratios (OR), 95% confidence intervals (95% confidence interval), and the <em>P</em> value. A <em>P</em> value less than .05 was used as the significance level for this study.</div></div><div><h3>Results</h3><div>Risk factors for increased 2-year PPFs included neurological disease (OR: 1.97), chronic kidney disease (OR: 1.51), drug abuse (OR: 2.38), and prior shoulder trauma (OR: 3.45) compared to the age 50-60 cohort (<em>P</em> &lt; .05 for all). Protective factors included shoulder osteoarthritis (OR: 0.72) and male sex (OR: 0.43) for the risk of PPF (<em>P</em> &lt; .05 for all).</div></div><div><h3>Conclusion</h3><div>This study identified several risk factors associated with increased incidence of PPFs within 2 years following TSA in patients under the age of 50, including neurological disease, chronic kidney disease, drug abuse, and prior shoulder trauma. Of note, shoulder osteoarthritis and male sex were protective factors against early PPF. The findings highlight the importance of evaluating younger TSA patients for these risk factors preoperatively. Modifiable risks such as drug abuse should be addressed, while nonmodifiable risks may warrant closer follow-up or surgical technique adjustments. Overall, this risk stratification can guide surgeons in counseling younger patients and optimizing outcomes following surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 380-386"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766955","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":"Acromion and scapular spine fractures following reverse total shoulder arthroplasty: operative versus nonoperative management","authors":"John W. Moore BS,&nbsp;Robert Reis BS,&nbsp;Megan E. Welsh BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC,&nbsp;Josef K. Eichinger MD","doi":"10.1053/j.sart.2025.03.001","DOIUrl":"10.1053/j.sart.2025.03.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The reported incidence of acromial and scapular spine fractures (ASFs) following reverse total shoulder arthroplasty (rTSA) is approximately 5%. There is no consensus on whether to treat ASFs operatively or nonoperatively. This study reviewed patients diagnosed with ASFs following rTSA to determine which patients are successfully managed nonoperatively versus those who undergo surgery. We hypothesized that nonoperative and operative treatment results in equivalent outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A database of prospectively enrolled patients was reviewed to identify patients who underwent rTSA and were diagnosed with a postoperative ASF from 2015 to 2022 with a minimum 2-year follow-up (n = 19). Nonoperative treatment was initially attempted on all patients. Patients were separated into operative (n = 7) and nonoperative (n = 12) groups based on treatment. Demographic information and clinical outcomes were compared between patients. ASF patients were then matched 1:1 to a group of nonfracture rTSA patients on age (±12 months), sex, body mass index (±2.0), follow-up duration (±6 months), and whether the dominant arm was affected, yielding an ASF group (n = 19) and a nonfracture control group (n = 19). Demographic information and clinical outcomes at last follow-up were compared between groups. Clinical outcomes included American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value, Visual Analog Scale (VAS) pain, and range of motion (ROM).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Patients with Levy type I fractures were more likely to be treated operatively (71.4% vs. 8.3%; &lt;em&gt;P&lt;/em&gt; = .013). Patients with Levy type I fractures had higher VAS pain scores than those with type II or III fractures (4.7 vs. 1.8 vs. 1.0; &lt;em&gt;P&lt;/em&gt; = .014). Patients with fractures lateral to the glenoid articular surface had lower ASES scores (57.7 vs. 71.8; &lt;em&gt;P&lt;/em&gt; = .05) and higher VAS pain scores (3.7 vs. 1.2; &lt;em&gt;P&lt;/em&gt; = .009) than patients with nonlateral ASFs. Regardless of operative or nonoperative treatment, ASF patients had lower ASES scores (64.3 vs. 88.2; &lt;em&gt;P&lt;/em&gt; &lt; .001), lower Subjective Shoulder Values (69.0 vs. 85.8; &lt;em&gt;P&lt;/em&gt; &lt; .001), and higher VAS pain scores (2.5 vs. 0.8; &lt;em&gt;P&lt;/em&gt; = .007) compared to nonfracture controls. ASF patients had inferior ROM, including less flexion/extension, (131 vs. 156; &lt;em&gt;P&lt;/em&gt; &lt; .001), less external rotation (46 vs. 58; &lt;em&gt;P&lt;/em&gt; = .024), and lower internal rotation scores (4.7 vs. 5.9; &lt;em&gt;P&lt;/em&gt; &lt; .001) than nonfracture controls.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The development of ASFs, regardless of treatment modality, was associated with inferior outcomes and ROM compared to nonfracture rTSA patients. Type I fractures were more likely to fail nonoperative treatment than medial fractures. Lateral fractures had inferior outcomes compared to medial fractures. Fall prevention and adequate lifting restrictions may significantly lower t","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 362-370"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral shoulder arthroplasty for rotator cuff intact glenohumeral osteoarthritis: anatomic versus reverse shoulder arthroplasty","authors":"Michael P. Kucharik MD ,&nbsp;Christian M. Schmidt II MD ,&nbsp;Raahil Patel MD ,&nbsp;Josué G. Layuno-Matos BS ,&nbsp;Kaitlyn N. Christmas BS, CCRC ,&nbsp;Logan Kolakowski MD ,&nbsp;Mark A. Frankle MD","doi":"10.1053/j.sart.2025.03.002","DOIUrl":"10.1053/j.sart.2025.03.002","url":null,"abstract":"<div><h3>Background</h3><div>The objectives of this study are (1) to analyze outcomes in patients with rotator cuff intact glenohumeral osteoarthritis (GHOA) who have undergone primary anatomic total shoulder arthroplasty (TSA) and contralateral primary reverse total shoulder arthroplasty (RSA), or vice versa; (2) to determine if patients with bilateral GHOA have similar patterns of pathology between shoulders; and (3) to determine how radiographic anatomic reconstructions for both TSA and RSA impact patient-reported outcome measures (PROMs) and rates of revision.</div></div><div><h3>Methods</h3><div>The inclusion criteria were patients with bilateral rotator cuff intact GHOA who underwent primary TSA and subsequently contralateral primary RSA, or vice versa, between January 2004 and January 2023 with completed PROMs and at least 1 year of clinical follow-up from their most recent arthroplasty procedure.</div></div><div><h3>Results</h3><div>(1) There were no differences for American Shoulder and Elbow Surgeons score between TSA and RSA shoulders at any timepoint between preoperative and 24-month follow-up. Six (12.0%) TSA shoulders underwent revision during the follow-up period compared to 1 (2.0%) RSA shoulder (<em>P</em> = .050). (2) Both TSA and RSA shoulders demonstrated similar glenoid retroversion (<em>P</em> = .323), glenoid inclination (<em>P</em> = .718), and posterior humeral head subluxation (<em>P</em> = .262). (3) TSA shoulders with changes in the center of rotation (ΔCOR) ≤3 mm experienced a greater increase in changes in American Shoulder and Elbow Surgeons score than those with ΔCOR &gt;3 mm at the 3-6–month follow-up (<em>P</em> = .023) and at final follow-up (<em>P</em> &lt; .001). TSA reconstructions with ΔCOR ≤3 mm experienced a lower rate of revision (4.5% vs. 17.8%) (<em>P</em> = .300). There was no difference in any PROM at any timepoint among RSA reconstructions with ΔCOR ≤10 mm, 10-20 mm, or ≥20 mm.</div></div><div><h3>Conclusion</h3><div>When performed for the treatment of GHOA in patients with bilateral pathology, TSA and RSA yielded similar clinical outcomes. Patients with bilateral GHOA had similar patterns of pathology between shoulders in terms of retroversion, inclination, and posterior humeral head subluxation. The findings highlight the importance of achieving an anatomic reconstruction for TSA and suggest that while an anatomic reconstruction for RSA may be ideal, deviations from the anatomic center of rotation may be better tolerated for RSA than for TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 371-379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766954","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":"Effects of psychiatric comorbidity on perioperative outcomes in primary total elbow arthroplasty","authors":"Lawrence C. Vanderham MS, PA ,&nbsp;Alexander S. Guareschi MD ,&nbsp;John W. Moore BS ,&nbsp;Richard J. Friedman MD, FRCSC ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD","doi":"10.1053/j.sart.2025.01.010","DOIUrl":"10.1053/j.sart.2025.01.010","url":null,"abstract":"<div><h3>Background</h3><div>Current literature consistently demonstrates the negative impact of mental health disorder (MHD) on orthopedic perioperative outcomes in arthroplasty of the hip, knee, and shoulder. To date, minimal literature exists investigating the effects of MHD on total elbow arthroplasty (TEA) outcomes. The purpose of this study is to evaluate the influence of MHD on perioperative complications, revision, and readmission rates, length of stay, and disposition in patients undergoing primary TEA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried and 5742 subjects undergoing primary TEA were identified, between 2015 and 2020. Two cohorts, with and without MHD were formed. Significant variables and outcomes were identified using bivariate analysis. Variables identified as significant were placed in multivariate analysis to identify independent predictors. Continuous variables between the two cohorts were analyzed with linear regression.</div></div><div><h3>Results</h3><div>Patients with a MHD were found to have higher rates of several medical and surgical complications including respiratory complications (0.6% vs. 0.1%; odds ratio [OR] 4.4 [95% confidence interval (CI) 1.6, 12], <em>P</em> = .002, wound dehiscence (0.8% vs. 0.1%; OR 11 [95% CI 3.0, 37], <em>P</em> &lt; .001), and prosthetic loosening (11% vs. 6.4%; OR 1.7 [95% CI 1.4, 2.1], <em>P</em> &lt; .001). A multivariate analysis identified MHD as an independent predictor of readmission (OR 1.3 [95% CI 1.2-1.5], <em>P</em> &lt; .001) and revision (OR 1.3 [95% CI 1.1-1.6], <em>P</em> &lt; .001) within 180 days of TEA.</div></div><div><h3>Conclusion</h3><div>Patients with a pre-existing MHD undergoing primary TEA are at increased risk for perioperative comorbidity. Careful consideration for surgery and potential risk mitigation should be considered in this at-risk population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 327-335"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766754","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}