Seminars in Arthroplasty最新文献

{"title":"Total shoulder arthroplasty: prices unrelated to quality, compliance reporting remains low","authors":"Bradley A. Lezak MD, MPH,&nbsp;Melissa Song BS,&nbsp;Mark Pianka MD, MBA,&nbsp;Joseph Bosco III MD","doi":"10.1016/j.sart.2025.151528","DOIUrl":"10.1016/j.sart.2025.151528","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare price transparency regulations aim to reduce costs and empower patient decision-making, yet compliance and the relationship between pricing and quality for orthopedic procedures such as total shoulder arthroplasty (TSA) remain poorly characterized.</div></div><div><h3>Methods</h3><div>Hospitals across New York State were queried for TSA pricing data. Compliance with Centers for Medicare and Medicaid Services price transparency requirements was assessed, and hospitals providing both commercial and self-pay rates were included. Hospital quality metrics were obtained from publicly available Centers for Medicare and Medicaid Services databases. Multivariable linear regression was used to evaluate associations between TSA pricing, hospital demographics, and quality indicators.</div></div><div><h3>Results</h3><div>Of 219 hospitals queried, 84 (38.4%) were compliant with federally mandated price transparency reporting. TSA pricing demonstrated wide variability, with cash prices ranging from $1,571 to $139,203 (mean, $29,104) and commercial rates from $1,375 to $139,203 (mean, $21,573). Higher Area Deprivation Index, greater bed count, methicillin-resistant <em>Staphylococcus aureus</em> bacteremia rates, and readmission rates following hip or knee replacement were positively associated with increased cash prices. Surgical site infection rates after colon surgery were associated with higher commercial rates. No strong correlations were observed between TSA pricing and overall hospital quality metrics.</div></div><div><h3>Conclusion</h3><div>Compliance with federal price transparency regulations for TSA remains limited. TSA pricing varies substantially and is not reliably associated with hospital quality. Efforts to enhance transparency and better align cost with quality are necessary to advance value-based care in orthopedic surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151528"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037651","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":"Postoperative bleeding complications in total shoulder arthroplasty patients with atrial fibrillation or flutter: a matched cohort analysis","authors":"Akhil Katakam MD,&nbsp;Amanda Azer MD,&nbsp;Sai Vendidandi BS,&nbsp;Ajitha Bala BS,&nbsp;Ari J. Clements MD,&nbsp;Daniel Calem MD,&nbsp;Tej Joshi MD,&nbsp;Balazs Galdi MD","doi":"10.1053/j.sart.2025.08.006","DOIUrl":"10.1053/j.sart.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is becoming an increasingly common procedure done for a variety of indications, including proximal humerus fractures and glenohumeral osteoarthritis. The incidence of atrial fibrillation (AF) in the general population is also increasing, posing the question of anticoagulation use in patients undergoing TSA. This study aims to assess postoperative outcomes in patients with AF or atrial flutter undergoing TSA.</div></div><div><h3>Methods</h3><div>The TriNetX database was queried for all patients undergoing TSA who had a concurrent diagnosis of AF or atrial flutter on anticoagulants (rivaroxaban, apixaban, warfarin). Patients were grouped based on their exposure to each medication and were followed for 30 and 90 days postoperatively. Outcomes collected include prosthetic joint infection, wound complications, thrombotic events (deep vein thrombosis and pulmonary embolism), bleeding events (intracranial, respiratory, and gastrointestinal bleeding), ischemic events (myocardial infarction and stroke), and laboratory measures of hemoglobin and hematocrit.</div></div><div><h3>Results</h3><div>A total of 3,334 propensity-matched patients were included in the study. At 30 and 90 days, rivaroxaban compared to warfarin was associated with a significantly lower rate of intracranial bleeds (<em>P</em> &lt; .01) and higher mean hemoglobin (<em>P</em> &lt; .01) and hematocrit levels (<em>P</em> &lt; .01). In addition, patients on warfarin had a higher risk of ischemic stroke (<em>P</em> = .032). Rivaroxaban and apixaban showed similar bleeding, ischemic, and embolic events at 90 days. However, patients on rivaroxaban had a higher rate of death within 30 days when compared to patients on apixaban (<em>P</em> &lt; .01), but after 90 days, there was no significant difference. At the 30- and 90-day follow-up, apixaban was associated with fewer pulmonary embolisms, deep vein thrombosis (<em>P</em> &lt; .05), bleeding complications, including intracranial bleed (<em>P</em> &lt; .05) and gastrointestinal bleed (<em>P</em> &lt; .01) when compared to warfarin. There was no significant difference found between any group for prosthetic joint infection, wound breakdown, hematoma, respiratory bleed, myocardial infarction, revision, and death.</div></div><div><h3>Conclusion</h3><div>Rivaroxaban and apixaban demonstrated fewer postoperative bleeding and embolic events when compared to warfarin. This may indicate their superiority in the treatment of AF and atrial flutter in the perioperative period for patients undergoing shoulder arthroplasty. However, further research is indicated to understand the causes of these differences and whether preoperative anticoagulation medication changes should be considered among patients undergoing shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151500"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188014","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":"Reconstruction of large glenoid bone defects with graft and extended caged base plate yields positive mid-term results","authors":"Khemerin Eng MRCS ,&nbsp;Eshan Oderuth MBBS, BSc, FRCS(Tr & Orth) ,&nbsp;Ali Shah MBBS MRCS FRCR ,&nbsp;Aveek Mitra FRCS(Tr & Orth) ,&nbsp;Ben Gooding FRCS(Tr & Orth) ,&nbsp;John Geoghegan FRCSEd (Tr & Orth) ,&nbsp;Malin Wijeratna BSc (Hons), MBBS, FRCS (Tr & Orth)","doi":"10.1053/j.sart.2025.08.002","DOIUrl":"10.1053/j.sart.2025.08.002","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective study assessed postoperative functional outcomes and radiographic graft integration following reverse total shoulder arthroplasty (rTSA) and glenoid reconstruction using computed navigation.</div></div><div><h3>Methods</h3><div>A case series of 14 patients underwent rTSA with an augmented glenoid baseplate using autograft or allograft. All patients had preoperative computed tomography scanning to assess glenoid defects and repeat scans at a minimum of 12 months to assess graft integration. Outcome measures were collected, consisting of the Oxford Shoulder Score (OSS), visual analogue pain scale (VAS), and range of motion figures at a minimum 12-month follow-up.</div></div><div><h3>Results</h3><div>This study included 14 patients (13 females, 1 male) with a median age of 74 (range: 58-86) years, a median body mass index of 29 (range: 18-35), and a median American Society of Anesthesiologists physical status classification system of 2 (range: 1-3). Ten were primary replacements, and 4 were revisions. Humeral head autograft was used for 6 patients, and femoral head allograft in 8 patients. All patients demonstrated graft integration on computed tomography at a median of 15 months (range: 11-42 months). The outcome measures (OSS, VAS, and range of motion) revealed overall improvement in functional outcomes. Median OSS improved from 21 (range: 7-34) preoperatively to 45 (range: 12-49), median VAS improved from 8 (range: 5-10) to 0 (range: 0-8), median lateral abduction improved from 60 to 90°, and median forward flexion 80 to 140°. These improvements were significant. Glenoid version correction, although not significant, improved from a median of 24° retroversion to 9° retroversion. Navigation was performed in all patients except 2, one by choice in a primary rTSA and the other due to intraoperative coracoid fracture during a revision case.</div></div><div><h3>Conclusion</h3><div>This study demonstrated an effective solution for managing complex glenoid defects in rTSA with excellent radiographic and functional outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151496"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188018","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":"Hand dominance does not influence patient-reported outcomes following anatomic or reverse total shoulder arthroplasty: a retrospective cohort study","authors":"Spencer M. Lee-Rey BA ,&nbsp;Harry Haran BA ,&nbsp;Alyssa D. Althoff MD ,&nbsp;Christopher Wilhelm MD ,&nbsp;Anthony Finocchiaro BS ,&nbsp;Samuel A. Taylor MD ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Joshua S. Dines MD ,&nbsp;David M. Dines MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Michael C. Fu MD, MHS","doi":"10.1053/j.sart.2025.09.002","DOIUrl":"10.1053/j.sart.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic and reverse total shoulder arthroplasties (aTSA and rTSA) are increasingly common procedures with generally high satisfaction rates. While hand dominance influences the performance of activities of daily living, its role in patient-reported outcomes and satisfaction following aTSA or rTSA remains unclear. This study aims to evaluate the influence of hand dominance on ipsilateral aTSA and rTSA patient-reported outcome measures.</div></div><div><h3>Methods</h3><div>A single-institution retrospective cohort study was performed by assessing -clinical outcomes following aTSA or rTSA procedures performed from 2016 to 2022. Patients were stratified based on dominant vs. nondominant limb shoulder arthroplasty procedures. Independent t-tests and linear regression models adjusting for patient-reported confounding variables were used to evaluate the association between hand dominance and postoperative clinical outcomes following aTSA and rTSA.</div></div><div><h3>Results</h3><div>A total of 488 patients undergoing a primary shoulder arthroplasty procedure (362 aTSA [200 dominant hand; 162 nondominant hand]; 126 rTSA [71 dominant hand; 55 nondominant hand]) met inclusion criteria. After stratifying by procedure type, no significant differences in postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI), Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), or Shoulder Arthroplasty Smart scores were observed between dominant and nondominant limb arthroplasty cohorts (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Patient-reported outcomes following total shoulder arthroplasty were not associated with hand dominance. These findings may be used as an adjunct to counsel patients regarding postoperative outcomes following shoulder arthroplasty regardless of hand dominance.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151502"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188067","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":"Thank you to our reviewers for 2025","authors":"","doi":"10.1016/j.sart.2025.151540","DOIUrl":"10.1016/j.sart.2025.151540","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151540"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of race and socioeconomic status on the attainment of substantial clinical benefit following total shoulder arthroplasty","authors":"Jakob M. Miller BS,&nbsp;Sophia A. Sitsis BS,&nbsp;Robert T. Henke BS,&nbsp;Maxwell A. Northrop BS,&nbsp;Alexander C. Dippre BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2025.151522","DOIUrl":"10.1016/j.sart.2025.151522","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is a procedure designed to improve mobility and alleviate pain due to degenerative conditions, and rates are expected to grow significantly in the coming years as the population ages. Previous studies provide ample evidence that factors such as race, income status, and gender influence utilization and outcomes following TSA. However, these studies fail to assess objective achievement of substantial clinical benefit (SCB) using verified outcome measures or whether patients report achievement of SCB. The purpose of this study is to identify whether race and socioeconomic status (SES) impact the attainment of SCB in patients undergoing primary TSA at a minimum follow-up of two years.</div></div><div><h3>Methods</h3><div>A total of 625 patients who underwent primary TSA with a minimum 2-year follow-up (mean, 4 years) at our institution from 2013 to 2023 were selected for analysis. Variables of interest obtained for each patient include age, sex, laterality, body mass index, race, area deprivation index decile, American Shoulder and Elbow Surgeons (ASES) scores, and self-reported patient satisfaction following TSA. Analysis of categorical variables was achieved using chi-squared tests, while continuous variables were examined using t-tests and one-way analysis of variance. Post hoc Tukey honest significant difference tests were used in the event of a significant result. Using the achievement of SCB as an outcome variable, multivariate logistic association models were created to adjust for confounding variables.</div></div><div><h3>Results</h3><div>Black race was found to be negatively associated with the achievement of SCB (odds ratio = 0.444, <em>P</em> = .018). Income category was not found to be associated with SCB attainment (<em>P</em> = .173). Preoperative ASES scores were found to be significantly lower for Black patients compared to White patients (36.40 vs. 24.48, <em>P</em> &lt; .001). Preoperative ASES scores were found to be significantly lower for the lowest income quartile compared to the 2 highest income quartiles (25.78 vs. 36.79 and 40.50, <em>P</em> &lt; .001). ASES score improvement was found to be significantly higher in the lowest quartile compared to the top quartile of earners (57.48 vs. 45.76, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Black race was significantly associated with decreased attainment of SCB, while income status did not significantly affect SCB attainment. Despite lower preoperative ASES scores, Black and low SES patients showed similar ASES score improvements on average compared to White and high SES patients. These results highlight persistent disparities in health care access but suggest that low preoperative shoulder function does not preclude patients from improving, although they achieve SCB to a lesser degree.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151522"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926409","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":"Long-term clinical and radiographic outcomes following shoulder hemiarthroplasty","authors":"William A. Ranson MD,&nbsp;Evan M. Michaelson MD,&nbsp;Akiro H. Duey MD,&nbsp;Akshar V. Patel MD,&nbsp;Evan L. Flatow MD,&nbsp;Dave R. Shukla MD,&nbsp;Paul J. Cagle MD","doi":"10.1016/j.sart.2025.151526","DOIUrl":"10.1016/j.sart.2025.151526","url":null,"abstract":"<div><h3>Background</h3><div>The utilization of shoulder hemiarthroplasty (HA) has decreased in recent decades, with glenoid erosion being a main concern. Existing long-term follow-up studies involve a limited diversity of early implants and lack a thorough assessment of the effects of glenoid erosion on patient outcomes. This study sought to report the long-term survivorship of HA in patients treated with a variety of implants, the vast majority being of design generations subsequent to the early monoblock prostheses. An additional aim of this study was to characterize the incidence and severity of glenoid erosion and to elucidate the effects on patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of prospectively collected data was performed on a consecutive series of HAs performed by a single surgeon between 1994 and 2012. Thirty-five shoulders met the inclusion criteria. In the primary analysis, shoulders were split into 2 cohorts based on whether or not they required revision surgery. A survivorship curve was plotted and the characteristics of the cohorts compared. In the secondary analysis, patients were split into 3 cohorts based on final glenoid erosion severity. Visual analog scale, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores, as well as range of motion, were then compared between the erosion cohorts.</div></div><div><h3>Results</h3><div>Seven of 35 shoulders (20.0%) underwent revision at an average of 9.3 years postoperatively, while 28 shoulders (80.0%) did not require revision at an average final follow-up of 15.3 years. The estimated 15-year survival rate was 83.0%. Glenoid erosion occurred in 26 (73.4%) shoulders and symptomatic glenoid erosion accounted for 4 of 7 (57.1%) revisions. Severity of glenoid erosion was not associated with differences in visual analog scale (<em>P</em> = .54), American Shoulder and Elbow Surgeons (<em>P</em> = .75), or Simple Shoulder Test (<em>P</em> = .77) scores. The development of severe glenoid wear was independently associated with decreased forward elevation (<em>P</em> = .03), external rotation (<em>P</em> &lt; .01), and internal rotation (IR) (<em>P</em> &lt; .01). The development of mild glenoid erosion trended toward an association with inferior IR (<em>P</em> = .06).</div></div><div><h3>Conclusion</h3><div>HA remains a viable option for the management of various shoulder pathologies with an estimated 15-year survival rate of 83.0%. Progressive glenoid erosion was present radiographically in 73.4% of patients at an average of 15.3 years postoperatively. Symptomatic glenoid wear accounted for over half of HA revisions. The development of severe glenoid wear was independently predictive of decreased range of motion in all planes. IR was particularly sensitive to erosive change, trending toward decreased motion with mild glenoid wear.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151526"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885142","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":"Cannabis use as a negative predictor of complications following total shoulder arthroplasty","authors":"Kathryn E. Grabowski BA ,&nbsp;Kenny Ling MD ,&nbsp;Edward D. Wang MD","doi":"10.1016/j.sart.2025.151521","DOIUrl":"10.1016/j.sart.2025.151521","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed to improve shoulder function, driven by demographic shifts and advances in surgical techniques. Simultaneously, cannabis use amongst adults is rising due to increased legalization and expanding medical indications. Studies report varying effects of cannabis use on postoperative outcomes after total knee arthroplasty, hip arthroplasty, and spine surgery, but data on its impact following TSA remain limited. Given the increasing demand for TSA and rising prevalence of cannabis use in the U.S., it is important to understand how cannabis use impacts postoperative complications following TSA. The purpose of this study was to analyze the relationship between cannabis use and adverse postoperative outcomes following TSA.</div></div><div><h3>Methods</h3><div>The TriNetX national database was queried for records of patients who underwent TSA between January 1st, 2010, and December 31st, 2024. Patient cohorts and outcomes were defined using International Classification for Disease, 10th edition diagnosis codes and Current Procedural Terminology codes. After 1:1 propensity score matching, the cannabis user and noncannabis user cohorts were analyzed for differences in major outcomes 90 days and 2 years following the procedure.</div></div><div><h3>Results</h3><div>A total of 75,574 patients were identified in TriNetX who underwent TSA from 2010 to 2024. Of these, 2,043 had concomitant cannabis use and 73,531 had no prior record of cannabis use. After 1:1 propensity score matching based on demographics and comorbidities, 2,042 patients in each cohort were directly compared for postoperative outcomes. Compared to noncannabis users, patients who used cannabis had a higher risk for chronic obstructive pulmonary disease exacerbation (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.28-3.35; <em>P</em> = .003), acute kidney failure (OR 1.56, 95% CI 1.10-2.21; <em>P</em> = .012), and pneumonia (OR 1.85, 95% CI 1.17-2.92; <em>P</em> = .007) within 90 days of the procedure. Compared to patients who did not use cannabis, those who did had a higher risk for prosthesis loosening (OR 1.79, 95% CI 1.06-3.03; <em>P</em> = .028), opioid dependence or abuse (OR 2.01, 95% CI 1.15-3.53; <em>P</em> = .013), and infection and inflammatory reaction due to prosthesis (OR 1.55, 95% CI 1.01-2.19; <em>P</em> = .012) within 2 years.</div></div><div><h3>Conclusion</h3><div>Preoperative cannabis use was associated with several postoperative complications 90 days and 2 years following TSA. In the setting of increasing TSA utilization, preoperative patient counseling on cannabis cessation before TSA may be beneficial for postoperative outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151521"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of comorbidities with primary total shoulder arthroplasty and health-care utilization","authors":"Robert T. Henke BS,&nbsp;Maxwell A. Northrop BS,&nbsp;Alexander C. Dippre BS,&nbsp;Jakob M. Miller BS,&nbsp;Sophia A. Sitsis BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.08.004","DOIUrl":"10.1053/j.sart.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is the most common procedure to treat end-stage osteoarthritis and other pathologies seen in the elderly. Increased age is associated with increases in the incidence of comorbidities. Over the last 25 years, common comorbidities such as diabetes and hypertension have increased to include 9.4% to 14% of the adult population in the United States. The purpose of this study is to analyze the effects of various comorbidities on hospital charge (HC), hospital cost (HCo), and length of stay (LOS) and therefore to maximize the efficient use of resources.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried to identify patients who underwent primary TSA between 2016 and 2022. Matching was done for age, sex, and each of the comorbidities except the one of interest. This ensured the isolation of the comorbidity of interest by pairing patients that were similar in all aspects except the presence of the comorbidity of interest. The matched patient group then underwent multivariant regression adjusted for age, sex, race, year, hospital region, and the comorbidity of interest. This was done for each outcome measure of interest to determine the effect on HC, HCo, and LOS.</div></div><div><h3>Results</h3><div>The average LOS was 1.54 days, the mean HC was $76,651, and the mean HCo was $19,626. Pulmonary circulation disorders, weight loss, fluid/electrolyte disorders, paralysis, and chronic blood loss anemia had 31%, 29%, 19%, 12%, and 12% increases in HCo, respectively (<em>P</em> &lt; .01). Weight loss, fluid/electrolyte disorders, pulmonary circulation disorders, AIDs/HIV, and coagulopathies had 30%, 18%, 16%, 14%, and 14% increases in HC, respectively (<em>P</em> &lt; .05). Pulmonary circulation disorders, paralysis, fluid/electrolyte disorders, weight loss, and hypertension had 520%, 284%, 236%, 214%, and 126% increases in the odds that LOS would be greater than 3 days (<em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>This study found specific comorbidities that are directly associated with increases in health-care utilization, either with increased HC, HCo or LOS, suggesting the need for the development of strategies to target these comorbidities and maximize efficient use of resources. Additionally, this study highlights the significant impact of the COVID-19 pandemic and its effects on inpatient TSA patient outcomes This information can help match expectations between patients and surgeons regarding the possible financial burden specific to that patient's list of comorbidities.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151498"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188016","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":"Influence of radiographic viewing perspective on the reverse shoulder arthroplasty angle","authors":"Brittany Percin BS ,&nbsp;Thomas Suter MD ,&nbsp;Matthijs Jacxsens MD, PhD ,&nbsp;Christopher D. Joyce MD ,&nbsp;Robert Z. Tashjian MD ,&nbsp;Peter N. Chalmers MD ,&nbsp;Heath B. Henninger PhD","doi":"10.1053/j.sart.2025.09.006","DOIUrl":"10.1053/j.sart.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>The reverse shoulder arthroplasty (RSA) angle quantifies inclination of the inferior glenoid and, thus the correction required during reverse total shoulder arthroplasty. There are no data on the effect of two-dimensional (2D) radiographic projection on the RSA angle or on the relationships between 2D true anterior-posterior (AP) views and their three-dimensional (3D) counterparts.</div></div><div><h3>Methods</h3><div>Digitally reconstructed radiographs of the 2D true AP view of N = 68 scapulae, a subset in controlled ante-/retroversion and extension/flexion views, and their corresponding 3D anatomic models were analyzed. The RSA angle was measured on true AP images with the glenoid in profile at the intersection of lines defined by the supraspinatus fossa and inferior glenoid rim. On altered viewing perspectives, the glenoid face was visible, and thus the anterior and posterior rims. Since it was often unclear which was anterior and posterior, for consistency the RSA angle was measured at the most medial and lateral rims, and glenoid midpoint to determine the influence of measurement location. The 3D RSA angle was measured on 3D models using semi-automated techniques. Data were analyzed to determine the effects of viewing perspective and measurement location on the RSA angle and to compare 2D true AP to 3D measures.</div></div><div><h3>Results</h3><div>The 2D RSA angle was 18.1 ± 7.1° (range: 1.1° to 35.3°), while the 3D RSA angle was 10.1 ± 7.3° (−8.1° to 25.7°) (<em>P</em> &lt; .001). Ante-/retroversion views had large effects on the RSA angle. The lateral rim was the most susceptible to error (up to 25.8 ± 6.6°) and the glenoid midpoint was least susceptible (less than 5.6 ± 6.5°). Extension/flexion was also influential, but the magnitudes were generally much less than ante/retroversion. Trends due to viewing perspective differed between the medial rim, lateral rim, and glenoid midpoint. The glenoid midpoint maintained the flattest distribution with the smallest errors across the views. Inter- and intra-rater reliability in measuring RSA angles was good to excellent (≥ 0.754).</div></div><div><h3>Conclusion</h3><div>The 2D RSA angle experiences viewing perspective errors when not measured on a true AP radiograph. The glenoid midpoint provided the most consistent and smallest maximum error, with good to excellent reliability. The 3D underestimated the 2D RSA angle on true AP images by an average of −8.0°, with similar variability. When using 2D imaging, a true AP image is desirable; otherwise, use the glenoid midpoint to minimize viewing perspective errors. Comparisons between radiographic measures and 3D preoperative planning should consider the bias between the two techniques, and 3D measures should be evaluated for their measurement techniques within the respective preoperative planning softwares to ensure consistency and reliability among manufacturers.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151506"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188050","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}