Seminars in Arthroplasty最新文献

{"title":"Biomechanical effect of instability at tendon transfer insertion in reverse shoulder arthroplasty with modified L'Episcopo procedure using fresh frozen cadaver","authors":"Yohei Shimada MD ,&nbsp;Nobuyasu Ochiai MD ,&nbsp;Eiko Hashimoto MD ,&nbsp;Hideki Kamijyo MD ,&nbsp;Kenta Inagaki MD ,&nbsp;Naoki Haraguchi MD","doi":"10.1053/j.sart.2025.09.009","DOIUrl":"10.1053/j.sart.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Reverse shoulder arthroplasty (rTSA) often has favorable postoperative outcomes but does not improve external rotation in patients with severe loss of shoulder external rotation. A modified L'Episcopo procedure was introduced to address this issue, but the optimal tendon transfer positions remain unclear. Instability is also a significant complication of rTSA. This study examines the biomechanical stability of rTSA with the modified L'Episcopo procedure using fresh-frozen cadavers.</div></div><div><h3>Methods</h3><div>Eight cadaveric upper limbs were used, with tendon transfer positions set at 225°, 270°, and 315° from the bicipital groove in the horizontal plane, and at the teres minor attachment and the middle level of the latissimus dorsi (LD) in the vertical plane. Six shoulder joint positions were evaluated.</div></div><div><h3>Results</h3><div>No significant stability differences across rotational or horizontal tendon transfer positions at 30° and 60° abduction. In the vertical plane, however, the teres minor level provided greater stability than the middle level of the LD (<em>P</em> &lt; .05). Stability improved at 60° abduction and with subscapularis repair, equalizing teres minor level and the middle level of the LD stability differences.</div></div><div><h3>Conclusion</h3><div>Tendon transfer to the teres minor level and subscapularis repair enhance anterior stability, suggesting these techniques may improve rTSA outcomes with the modified L'Episcopo procedure.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151509"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188207","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 perioperative diuretic use on complications after total shoulder arthroplasty: a propensity-matched cohort analysis","authors":"Zina Smadi MD ,&nbsp;Diane Ghanem MD ,&nbsp;Akin Adio BA ,&nbsp;Lisa Mahmoud MD ,&nbsp;Peter Boufadel MD ,&nbsp;Miguel Fiandeiro BA ,&nbsp;Amir Alsaidi BS ,&nbsp;Abdullah Ghali MD ,&nbsp;Joseph A. Abboud MD","doi":"10.1016/j.sart.2025.151538","DOIUrl":"10.1016/j.sart.2025.151538","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Diuretics are commonly prescribed medications with known effects on bone mineral density. However, their effect on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study examines the association between perioperative diuretic use and 90-day postoperative medical complications and 2-year implant-related outcomes in TSA patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective cohort study was conducted utilizing the TriNetX database (2003-2023) to identify patients undergoing TSA with documented perioperative use of diuretics (within 6 months before or after surgery). Patients were 1:1 propensity score-matched to controls based on demographics and comorbidities, yielding 14,595 matched pairs. Diuretic classes included loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitors (CAIs). Primary outcomes included 90-day postoperative medical complications and readmission. Secondary outcomes included 2-year revision surgery and implant-related complications. Relative risks (RRs), 95% confidence intervals, and &lt;em&gt;P&lt;/em&gt; values were calculated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Loop diuretics were significantly associated with higher risks of 90-day renal failure (RR: 3.1; &lt;em&gt;P&lt;/em&gt; &lt; .0001), pneumonia (RR: 3.0; &lt;em&gt;P&lt;/em&gt; &lt; .0001), sepsis (RR: 2.9; &lt;em&gt;P&lt;/em&gt; &lt; .0001), blood transfusion (RR: 3.8; &lt;em&gt;P&lt;/em&gt; &lt; .0001), and readmission (RR: 2.4; &lt;em&gt;P&lt;/em&gt; &lt; .0001), as well as increased 2-year rates of emergency department visits (RR: 1.3; &lt;em&gt;P&lt;/em&gt; &lt; .0001), hospital admissions (RR: 1.6; &lt;em&gt;P&lt;/em&gt; &lt; .0001), periprosthetic joint infection (RR: 1.4; &lt;em&gt;P&lt;/em&gt; = .015), revision surgery (RR: 1.3; &lt;em&gt;P&lt;/em&gt; = .046), and opioid use (RR: 1.4; &lt;em&gt;P&lt;/em&gt; &lt; .0001). Thiazide use showed a significant increase in renal failure at 90 days (RR: 1.6; &lt;em&gt;P&lt;/em&gt; = .002) and opioid use at 2 years (RR: 1.2; &lt;em&gt;P&lt;/em&gt; &lt; .0001). Potassium-sparing diuretics were linked to higher 90-day risks of blood transfusion (RR: 2.6; &lt;em&gt;P&lt;/em&gt; = .007) and readmission (RR: 1.6; &lt;em&gt;P&lt;/em&gt; = .003), but showed no significant impact on long-term outcomes. Osmotic diuretics were associated with 90-day anemia (RR: 2.1; &lt;em&gt;P&lt;/em&gt; = .043) and 2-year increases in admissions (RR: 1.9; &lt;em&gt;P&lt;/em&gt; = .030) and opioid use (RR: 2.9; &lt;em&gt;P&lt;/em&gt; &lt; .0001). CAIs exhibited elevated 90-day risks for outcomes like myocardial infarction, pulmonary embolism, stroke, and surgical site infection (where controls had zero incidence), though no statistically significant 2-year outcomes were observed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Loop diuretics were consistently associated with markedly higher risks of perioperative complications, including renal failure, infection, transfusion, sepsis, and readmission, as well as increased long-term health care utilization, revision surgery, and opioid dependence. Thiazides, potassium-sparing, osmotic diuretics, and CAIs were each linked to distinct but","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151538"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926411","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":"Digital technology in shoulder arthroplasty: what do surgeons want? What will industry offer?","authors":"Jon J.P. Warner MD,&nbsp;Sarah Koljaka BA,&nbsp;James Satalich MD,&nbsp;Kevin Wall MD, MPH,&nbsp;Nicholas Wiley BA, MS","doi":"10.1016/j.sart.2025.151536","DOIUrl":"10.1016/j.sart.2025.151536","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The emergence of technology in orthopedics has accelerated rapidly with promises of improving outcomes, precision of surgery, and learning curves for surgeons. Shoulder arthroplasty surgery has lagged spine, hip, and knee in the application of new technology such as robotics and artificial intelligence (AI). Recent advances, driven by surgeon—industry collaboration, have expanded applications of immersive virtual, augmented, and mixed reality, AI, and robotics. The purpose of this study was to identify surgeon preferences regarding digital technology and compare them to the current industry strategy to identify alignment and opportunities for future collaboration and scaling of technology.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Anonymous surveys were administered to shoulder arthroplasty surgeons from 3 international organizations specific to shoulder care (American Shoulder and Elbow Surgeons, European Society for Surgery of the Shoulder and the Elbow – SECEC, and the Codman Shoulder Society). Nine leading companies using and developing digital technology for shoulder replacements received separate surveys. Physician surveys gathered data on arthroplasty volume, preoperative planning, and desired technological innovations. Industry leaders ranked priorities for developing digital tools for orthopedic surgeons and outlined revenue models to maximize value.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 192 surgeons responded (American Shoulder and Elbow Surgeons = 88, SECEC = 57, Codman Shoulder Society = 47), along with 6 of 9 industry organizations. Ninety-six percent of responding surgeons perform preoperative planning, of which 82% use digital tools. Thirty-four percent use virtual reality (VR) for preoperative planning, while intraoperatively 24% use navigation, 23% mixed reality, and 12% patient-specific guides. Both surgeons and industry ranked AI/machine learning (AI/ML) as their top priority. Industry reported error reduction, data generation for best practices, and improved efficiency as main value drivers of AI. Intraoperative navigation, mixed/augmented reality, immersive VR, and robotics ranked lower in priority for industry and surgeons. Surgeons emphasized reliability and patient outcome tracking, which industry did not consider a key focus. No consistent business model for AI/ML emerged.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Both surgeons and industry identified AI/ML as the top priority for digital technology development, though industry provided no clear business model for its future sustainability. Other technologies were considered valuable, but surgeons were unclear on the value proposition of virtual planning. Immersive VR surgery as an educational tool seems to be a lower priority for both surgeons and industry, though most surgeons have had no experience with this technology thus far. Overall, digital innovation is a shared priority, with AI/ML offering the clearest value, although the busines","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151536"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926412","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":"Cementless shoulder arthroplasty Aramis: does humeral stress shielding depend on stem size?","authors":"Laurent Nové-Josserand MD ,&nbsp;Lyliane Ly MD ,&nbsp;Jérome Vogel MD ,&nbsp;Thais Dutra Vieira MD ,&nbsp;Philippe Collotte MD ,&nbsp;Arnaud Walch MD ,&nbsp;Stanislas Gunst MD","doi":"10.1053/j.sart.2025.09.007","DOIUrl":"10.1053/j.sart.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Cementless total shoulder arthroplasty (TSA) preserves humeral bone stock and thus facilitates revision surgery. Less experienced surgeons intuitively tend to use large filling ratios to ensure good fixation and alignment of the humeral implant. The aim of this study was to radiographically quantify stress shielding at two years' follow-up in 2 groups of patients with the same cementless stem implanted 5 years apart. The main hypothesis was that lower filling ratios would not be associated with greater stem misalignment. The secondary hypothesis was that lower filling ratios would be associated with reduced humeral stress shielding.</div></div><div><h3>Methods</h3><div>This single-center retrospective study involved 2 groups of patients who underwent anatomic or reverse total shoulder arthroplasty (rTSA) for primary or secondary osteoarthritis or massive rotator cuff tear, with the same Aramis humeral implants, either in 2013-14 (group 1, N = 59) or in 2019 (group 2, N = 47). Coronal stem alignment and filling ratios were measured on immediate postoperative and last follow-up radiographs, at a mean follow-up of two years. Stress shielding was evaluated in terms of medial cortical narrowing, medial metaphysis thinning, and lateral metaphysis thinning.</div></div><div><h3>Results</h3><div>The proportion of patients with the 2 narrowest stem sizes (8.5 or 10) was 51% (30/59) in group 1 and 96% (45/47) in group 2. Filling ratios in group 2 were significantly lower than in group 1 (<em>P</em> &lt; .001), but stem alignment angles were clinically equivalent and actually lower in group 2 than in group 1 (mean angle, 2.2° vs. 2.7°, <em>P</em> = .03). Anatomic TSA patients had mild medial cortical narrowing and metaphysis thinning and none or minimal lateral metaphysis thinning, with no difference between the 2 groups. rTSA patients had mild medial cortical narrowing and metaphysis thinning, with no significant difference between the 2 groups, but lateral metaphysis thinning was less frequent and less severe among group 2 patients (0.69 ± 0.32 vs. 0.87 ± 0.17; <em>P</em> = .01).</div></div><div><h3>Conclusion</h3><div>In these 2 groups of cementless TSA patients, treated by the same surgeon and with the same implant 5 years apart, more recently treated patients had significantly narrower but similarly well-aligned stems, supporting the study hypothesis. These reduced filling ratios were associated with less frequent and less severe lateral stress shielding in patients with rTSA. The prevalence of medial stress shielding for both TSA and of lateral stress shielding for rTSA suggests different mechanisms are involved.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151507"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698127","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":"Socioeconomic and demographic factors affecting outcomes in total shoulder arthroplasty","authors":"Alexander C. Dippre BS,&nbsp;Jakob M. Miller BS,&nbsp;Sophia A. Sitsis BS,&nbsp;Robert Henke BS,&nbsp;Maxwell A. Northrop BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2026.151546","DOIUrl":"10.1016/j.sart.2026.151546","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic and demographic factors play a major role in patient well-being. However, how these factors can affect outcomes following total shoulder arthroplasty (TSA) has not been well-documented. The purpose of this study is to determine how socioeconomic and demographic factors affect outcomes following primary TSA. We hypothesize that certain socioeconomic and demographic factors—including primary contact, race, age, sex, and travel distance—are associated with differences in postoperative outcomes following primary TSA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 556 patients who underwent primary anatomic or reverse TSA at a single tertiary center between 2013 and 2023, with a minimum of two years of follow-up. Patients were grouped by primary contact (spouse vs. others), age (≥70 years vs. &lt;70 years), sex, Area Deprivation Index (ADI), and race (white vs. black). Independent <em>t</em>-test, chi-square test, and multivariate linear regression were used to compare postoperative abduction, American Shoulder and Elbow Surgeons score, pain via the visual analog scale, length of stay, and internal rotation (IR) score.</div></div><div><h3>Results</h3><div>Patients aged 70 and older had lower postoperative abduction (mean difference [MD] = 14° [95% confidence interval (CI), 4.44-23.6]; <em>P</em> = .005). Patients in the top ADI quartile had improved postoperative IR score (MD = 0.72 [95% CI, 0.18-1.26]; <em>P</em> = .01). Patients with a spousal primary contact had a shorter length of stay than patients without a spousal primary contact (MD = 0.75 [95% CI, 0.02-1.48]; <em>P</em> = .047). White patients had higher postoperative American Shoulder and Elbow Surgeons scores (MD = 15 [95% CI, 9.2-21.2]; <em>P</em> &lt; .001) and lower pain scores (MD = 1.75 [95% CI, 1.08-2.43]; <em>P</em> &lt; .001). Female patients had a higher postoperative IR score than male patients (MD = 0.57 [95% CI, 0.21-0.93]; <em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>This study demonstrated significant differences in postoperative outcomes across multiple socioeconomic and demographic factors, including primary contact, age, race, ADI, and sex. These results support our hypothesis that socioeconomic and demographic factors play a significant role in determining outcomes following primary TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151546"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077648","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":"Sickle cell disease independently predicts increased 180-day complication rates and transfusions following primary total shoulder arthroplasty","authors":"Hailey Ninness BS,&nbsp;Jarrod Woodland BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.07.006","DOIUrl":"10.1053/j.sart.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) is a genetically inherited defect in the hemoglobin protein that predisposes individuals to red blood cell sickling. SCD can lead to orthopedic complications such as avascular necrosis and can require joint replacement, including total shoulder arthroplasty (TSA) as a treatment. The incidence of TSA continues to rise and advancements in treatment have improved the lifespan of SCD patients, yet the impact of SCD on primary TSA outcomes remains underexplored. The purpose of this study is to examine the effect of SCD on primary TSA outcomes and hospital resource utilization. We hypothesize that SCD is independently predictive of increased complications and transfusion requirements following TSA and is associated with increased hospital resource utilization.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2015 to 2021 to identify patients with SCD undergoing elective primary TSA (n = 144). These patients were propensity score matched 1:3 based on age, sex, year, and Elixhauser comorbidity index score, yielding 432 control patients. Demographic and discharge information, preoperative comorbidities, and postoperative complications were compared between groups. Binary logistic regression was used to identify independent predictors of significant complications.</div></div><div><h3>Results</h3><div>Patients with SCD were more likely to be in lower quartiles of median household incomes than controls. They had longer length of stay on average (2.2 vs. 1.6 days; <em>P</em> &lt; .001) despite having no difference in cost or discharge disposition. SCD patients had higher rates of chronic lung disease (<em>P</em> &lt; .001), coagulopathies (<em>P</em> = .013), diabetes with complications (<em>P</em> &lt; .001), myocardial infarction (<em>P</em> = .048), renal failure (<em>P</em> &lt; .001), and lower rates of depression (<em>P</em> = .012), and hypothyroidism (<em>P</em> = .047) than controls. SCD patients had higher rates of any complication within 180 days (<em>P</em> &lt; .001), readmission within 180 days (<em>P</em> = .021) and transfusions (<em>P</em> &lt; .001) compared to controls. SCD was shown to be independently predictive of increased 180-day complication rates and transfusions.</div></div><div><h3>Conclusions</h3><div>SCD is an independent risk factor for increased 180-day complication rates and higher transfusion rates following a primary elective TSA. SCD was associated with longer length of stay without a difference in cost or discharge disposition. SCD patients had increased risk of several preoperative comorbidities. These results should be considered by orthopedic surgeons when assessing preoperative risk and to proactively address any modifiable comorbidities or risk factors in SCD patients undergoing TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151489"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188068","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":"Use of patient-specific instrumentation for humeral osteotomy during anatomic shoulder arthroplasty leads to accurate recreation of the center of rotation","authors":"Lukas Dommer MD ,&nbsp;Kira Zumstein MD ,&nbsp;J Tomás Rojas MD ,&nbsp;Annabel Hayoz MSc ,&nbsp;Matthias A. Zumstein MD","doi":"10.1053/j.sart.2025.09.013","DOIUrl":"10.1053/j.sart.2025.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Correct restoration of proximal humeral anatomy (RPHA) after anatomic total shoulder arthroplasty (aTSA) has led to better clinical outcomes and survival rates. A recent study defined the achievement of RPHA as a deviation of the center of rotation from preoperative to postoperative of less than 3 mm and found that using 3-dimensional (3D) planning with standard cutting guides does not achieve this in 65% of the cases. The study aimed to radiographically measure the RPHA after implantation of aTSA using 3D planning and patient-specific instrumentation (PSI) for the humeral osteotomy. The second aim was to analyze the deviation between planned and postoperative parameters.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study 24 consecutive patients who underwent aTSA using 3D-planning including PSI for the humeral osteotomy were radiographically assessed using preoperative and postoperative standardized anteroposterior radiographs. The premorbid center of rotation (COR) was established using the circle method described by Youderian et al and a preoperative to postoperative deviation of ≤3 mm of the COR was considered a precise RPHA. Based on this, 2 groups were created (precise: ≤3 mm, nonprecise: &gt;3 mm). Additionally, the deviation between the planned- and postoperative values of neck–shaft angle (NSA), humeral head height and humeral cut height (HCH) was assessed. Outliers were defined as cases with one or more of the following deviations: &gt;10° NSA or 3 mm HCH. The comparison between groups was performed based on a normal distribution. We performed a comparison between the precise and nonprecise groups.</div></div><div><h3>Results</h3><div>The mean age was 60.8 (standard deviation (SD) ± 8.3) years, 12 (50%) male, 14 (58%) right shoulders and a mean operating time of 124.6 (SD ± 17.2) min. All humeral components were cementless. The mean deviation of COR was 2.3 (SD ± 1.1) mm, with 5 (21%) cases deviating &gt;3 mm and thus being nonprecise. The deviation between planned and postoperative values of NSA and HCH was 5.0° (SD ± 4.1) and 3.2 mm (SD ± 2.0). There were 13 (54%) outliers (13 due to HCH and 3 due to NSA, while 3 fulfilled both criteria and were thus not counted twice). A comparative group analysis between precise and nonprecise groups showed no significant difference in NSA, humeral head height, or HCH.</div></div><div><h3>Conclusions</h3><div>The use of PSI for the humeral osteotomy in aTSA leads to a precise RPHA in 79% of cases. Prospective randomized control trials with long-term follow-up are needed to prove these findings and assess their clinical implication.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151513"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188205","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":"Analysis of mechanical factors related to scapular notching and medial scapular bone spurs with reverse total shoulder arthroplasty and the reduction of their appearance with inferior glenosphere offset","authors":"Paul J. Pottanat MD,&nbsp;Robert Reis BS,&nbsp;Chase Walton MS,&nbsp;Nikhil Vallabhaneni BS,&nbsp;Megan E. Welsh BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC,&nbsp;Josef K. Eichinger MD","doi":"10.1016/j.sart.2025.151523","DOIUrl":"10.1016/j.sart.2025.151523","url":null,"abstract":"<div><h3>Background</h3><div>Scapular notching and bone spur formation on the inferior scapular neck is a common radiographic finding following reverse total shoulder arthroplasty (rTSA). The purpose of the current study is to (1) determine the time point these radiographic findings develop in the postoperative period and (2) determine the effect of inferior glenoid offset on the formation of notching and bone spurs following rTSA.</div></div><div><h3>Methods</h3><div>A shoulder arthroplasty registry with prospectively collected data was queried to identify patients who underwent rTSA using the Exatech Equinoxe implant at an academic medical center between June 2017 and June 2022. Postoperative radiographs were analyzed for the presence of scapular notching, scapular bone spurs, prosthetic loosening, periprosthetic fracture, and hardware failure. Bone spurs were defined as bone formation medial to the lateral border of the scapula and in continuity with the scapular neck which were not present on preoperative radiographs.</div></div><div><h3>Results</h3><div>In a cohort of 185 rTSA patients, radiographic analysis demonstrated that both scapular notching and medial scapular bone spurs predominantly developed early in the postoperative period, with most changes evident between 3 months and 6 months. Binary logistic regression demonstrated that increased inferior glenosphere offset significantly reduced the risk of scapular bone spurs (odds ratio = 0.79; 95% confidence interval: 0.70-0.88, <em>P</em> &lt; .001) and notching (odds ratio = 0.95, 95% confidence interval: 0.84-1.08 <em>P</em> &lt; .001), with offsets of ∼8.2 mm and ∼9.6 mm predicted less than 10% probability, respectively. Cross-lagged analysis showed a strong early correlation between bone spurs and notching (r = 0.876, R² = 0.767) and that early bone spur progression predicted subsequent increases in notch severity.</div></div><div><h3>Conclusion</h3><div>Early postoperative development of medial scapular bone spurs is predictive of subsequent scapular notching, which indicates a common pathomechanical process of engagement of the humeral component and medial scapula for both types of radiographic findings after rTSA. Increased inferior glenosphere positioning protects against both notching and bone spur formation.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151523"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977805","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":"Clinical outcomes of augmented baseplates in reverse total shoulder arthroplasty: a systematic review","authors":"Clevio Desouza MD ,&nbsp;Chiranjivi Jani MD","doi":"10.1053/j.sart.2025.07.008","DOIUrl":"10.1053/j.sart.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is a widely accepted treatment for rotator cuff arthropathy and complex glenohumeral arthritis. However, managing severe glenoid wear, particularly with retroversion, superior inclination, or bone loss, remains a challenge. Augmented baseplates offer a promising solution by improving fixation strength and maintaining bone stock without excessive bone removal or grafting. This systematic review evaluates the clinical, radiographic, and functional outcomes of augmented baseplates in rTSA compared to conventional techniques, including standard baseplates and, where available, bone grafting.</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ovid MEDLINE, EMBASE, and PubMed databases were searched from inception to October 2024 for studies evaluating augmented baseplates in rTSA. Inclusion criteria included clinical studies with ≥10 patients, a minimum 12-month follow-up, and documented functional, radiographic, and complication outcomes. Data extraction included demographics, implant type, functional scores, range of motion, and complication rates.</div></div><div><h3>Results</h3><div>Eight studies with 837 patients were included. The mean follow-up was 38.5 months. Augmented baseplates demonstrated significant improvements in forward elevation (+53°), abduction (+47°), and external rotation (+19°). Functional scores improved significantly, with pooled increases in American Shoulder and Elbow Surgeons Shoulder Score (+45.9), Constant (+33.7), and University of California Los Angeles (+16.9) scores. The overall complication rate was 5.9%, including baseplate loosening (1.2%), instability (0.8%), and acromial stress fractures (1.0%). Pooled outcomes demonstrated moderate heterogeneity (I² values ranging from 31% to 52%).</div></div><div><h3>Conclusion</h3><div>Augmented baseplates in rTSA provide effective correction of glenoid deformities while minimizing bone loss and surgical complexity. They may offer improved functional outcomes, reduced complication rates, and reliable fixation compared to conventional techniques, making them an increasingly considered option.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151491"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188019","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":"Trends in intra-articular injection utilization for the treatment of adhesive capsulitis","authors":"Anthony Bishara BA,&nbsp;Seyedeh Zahra Mousavi BS,&nbsp;Jean Fleuriscar MD,&nbsp;Ethan Harris BS,&nbsp;Uma Srikumaran MD, MBA, MPH","doi":"10.1053/j.sart.2025.09.004","DOIUrl":"10.1053/j.sart.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Adhesive capsulitis (AC) is a common shoulder condition characterized by pain, limited range of motion, and diminished quality of life. Management of AC often includes intra-articular injections, such as corticosteroids (CSs), ketorolac, hyaluronic acid (HA), and platelet-rich plasma to provide symptom relief. This study examines utilization trends of injection types across various demographic groups of patients with AC over a 10-year period.</div></div><div><h3>Methods</h3><div>This retrospective analysis used the TriNetX Research Network to identify patients who received intra-articular injections for AC between January 1, 2013, and December 31, 2023. The primary outcome was yearly utilization trends, which were stratified by sex, age group, and race. Compound annual growth rate (CAGR) measured annual changes, while linear regression analyses with an interaction term assessed differences in utilization between demographic groups.</div></div><div><h3>Results</h3><div>Among 340,142 patients with AC, 29,494 received intra-articular injections, with 62.72% being female and 33.30% being male. Injections were most common in those aged 46-60 (n = 10,921), followed by those aged 61-75 (n = 12,484), and &gt;76 years (n = 4,148). HA exhibited the highest CAGR at 18.56%, followed by CS at 16.76%. Despite HA leading in overall growth, CS usage increased at the fastest rate over the study period (<em>P</em> &lt; .001). Patients aged 31-45 and 46-60 had the most substantial increase in CS injection use, with a CAGR of 25.65% and 20.70%, respectively. Racial trends revealed that white patients had greater increases in HA use compared to Asian patients (<em>P</em> &lt; .001) and higher platelet-rich plasma use compared to Black patients (<em>P</em> = .026). There were few differences in utilization based on sex.</div></div><div><h3>Conclusion</h3><div>Utilization of intra-articular injections for AC has increased considerably over the past decade, with notable demographic differences. The rapid growth of HA and CS usage, particularly among younger and White patients, may reflect treatment preferences and potential demographic disparities that necessitate further studies.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151504"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188070","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}