Seminars in Arthroplasty最新文献

{"title":"The effects of glenoid baseplate peripheral screw number on micromotion in reverse total shoulder arthroplasty","authors":"Elise J. Martin PhD ,&nbsp;Alexander J. MacFarlane MD ,&nbsp;Thomas R. Duquin MD ,&nbsp;Mark T. Ehrensberger PhD","doi":"10.1053/j.sart.2025.02.004","DOIUrl":"10.1053/j.sart.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid baseplate loosening continues to be a challenge when assessing failure of reverse total shoulder arthroplasty (RSA). The baseplate is commonly attached to the glenoid bone surface using a series of screws. This study looks to examine the impact of the number of peripheral screws (0-, 2-, or 4-screws) on the initial fixation of an RSA glenoid baseplate. The possibility of retaining fewer screws could allow for the preservation of the already limited bone stock available in the glenoid.</div></div><div><h3>Methods</h3><div>Three constructs, with 10 samples each, were prepared with differing numbers of locking peripheral screws: 4-screw (2 superior/inferior, 2 anterior/posterior), 2-screw (2 superior/inferior), or 0-screw. In addition, all samples were fixed with a central screw that is placed within the central boss of the implant. Then each baseplate was implanted within 15 pounds/cubic foot rigid polyurethane foam and embedded within polymethylmethacrylate. An initial and final displacement test were conducted by statically applying a shear load (350N) and compressive load (430N) and measuring baseplate displacements via linear variable differential transformers. In-between these two static measurements each sample was cycled through an arc of abduction (+30° to −15°) at ¼ Hz for 10,000 cycles while maintain a normal load of 750N. The displacement of the baseplate was also measured real-time during the cycling phase using three-dimensional digital image correlation.</div></div><div><h3>Results</h3><div>The results from the initial and final static testing indicated varying statistical significance between the different constructs, but the measurements taken during active cycling were able to indicate that the 0-screw construct was significantly less stable than the 2- or 4-screw constructs in terms of both shear (initial: 68.86 ± 23.77μm, 29.40 ± 8.34μm, 22.71 ± 11.23μm); (final:116.72 ± 73.20μm, 64.54 ± 8.36μm, 53.11 ± 33.86μm) and compressive displacements (initial: 65.81 ± 17.81μm, 12.57 ± 5.25μm, 30.60 ± 28.85); (final: 204.22 ± 126.22μm, 37.24 ± 14.58μm, 70.11 ± 59.39μm).</div></div><div><h3>Discussion</h3><div>Differences were found in baseplate stability when comparing a 4- and 2- screw construct to a 0-screw construct. In addition, the results indicate that taking measurements real-time during cyclic loading tends to allow for more accurate and consistent measurement of baseplate displacement in this type of biomechanical testing compared to a simple static initial and final displacement test. This result indicates a promising option for the preservation of glenoid bone stock following RSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 354-361"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766767","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 Artificial Intelligence Shoulder Arthroplasty Score: development and validation of a tool for large language model responses to common patient questions regarding total shoulder arthroplasty","authors":"Benjamin Fiedler MD ,&nbsp;Jeffrey Hauck BS ,&nbsp;T. Bradley Edwards MD ,&nbsp;Hussein A. Elkousy MD ,&nbsp;Paul J. Cagle MD ,&nbsp;Todd Phillips MD","doi":"10.1053/j.sart.2025.02.003","DOIUrl":"10.1053/j.sart.2025.02.003","url":null,"abstract":"<div><h3>Background and Hypothesis</h3><div>While research into artificial intelligence, specifically large language model (LLM), ability to respond to patient questions regarding specific orthopedic pathologies continues to grow, no tool presently exists to systematically and comprehensively evaluate the quality of LLM responses. The present study seeks to develop and validate the Artificial Intelligence Shoulder Arthroplasty Score (AISAS) to create a comprehensive, standardized, and reproducible system for evaluating artificial intelligence responses to patient questions regarding their orthopedic pathology.</div></div><div><h3>Methods</h3><div>The novel scoring tool, AISAS, was developed to include four equally weighted components related to accuracy, completeness, clarity, and readability. Fifteen common patient questions on glenohumeral arthritis were asked one by one to three of the most used LLMs: ChatGPT (version 3.5), Claude (version 3.5) Sonnet, and Gemini. Ten shoulder and elbow fellowship trained orthopedic surgeons used the proposed framework to evaluate each of the 45 responses. Inter-rater reliability was calculated via Cohen's kappa and rater-score correlation was calculated via Cronbach's alpha.</div></div><div><h3>Results</h3><div>AISAS use for Claude and ChatGPT produced moderate agreement (<em>k</em> = 0.55 and 0.43) while Gemini produced substantial reliability among raters ((<em>k</em> = 0.66). Cronbach's alpha scores demonstrated excellent correlation of Gemini ratings (⍺ = 0.91) and acceptable correlation of the Claude and ChatGPT ratings (⍺ = 0.79 and 0.75).</div></div><div><h3>Discussion and Conclusion</h3><div>AISAS use enables systematic assessment of the overall quality of an LLM response, as well as the individual components of a response that may vary in quality to enable easy comparisons for LLM responses. Furthermore, it offers a tool to trend the progress of LLMs in ability to respond to patient questions. Establishing such a framework to guide areas of improvement for LLMs will serve to optimize LLMs as a patient tool, identify areas for improvement, and allow physicians to better direct patients on how to utilize these tools for optimal use.</div></div><div><h3>Conclusion</h3><div>The AISAS is a comprehensive and reproducible tool for evaluating LLM responses, with high levels of inter-rater reliability. AISAS use can help to evaluate responses to patient questions to guide growth and improvement of LLMs for use in the orthopedic setting.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 348-353"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766764","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 anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty assessed with the patient-reported outcomes measurement information system","authors":"Seung-Ho Ben Bae BS ,&nbsp;Michael Doran MD ,&nbsp;Carol A. Janney PhD ,&nbsp;James E. Carpenter MD ,&nbsp;Asheesh Bedi MD ,&nbsp;Bruce S. Miller MD, MS","doi":"10.1053/j.sart.2025.02.001","DOIUrl":"10.1053/j.sart.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>There has been little comparison of patient-reported outcomes in the setting of anatomic and reverse total shoulder arthroplasty (rTSA). Furthermore, the expected recovery timeline following the two procedures has not been well defined. This study examines the use of the National Institutes of Health-developed Patient-Reported Outcomes Measurement Information System (PROMIS) to compare the postsurgical physical function (PF) and pain interference (PI) of patients undergoing anatomic total shoulder arthroplasty (aTSA) and rTSA.</div></div><div><h3>Methods</h3><div>PROMIS PI and PROMIS PF scores were prospectively collected on patients undergoing shoulder arthroplasty in our practice between 2019 and 2023. Analysis for the PROMIS domains of PI (n = 91) and PF (n = 69) were restricted to patients who had baseline scores and at least 1 postsurgical assessment within a year of surgery.</div></div><div><h3>Results</h3><div>Patients undergoing aTSA exhibited greater PF scores at presurgery (<em>P</em> = .07) and postsurgery (<em>P</em> = .02) compared to patients undergoing rTSA. Overall, PF scores significantly improved from presurgery to postsurgery regardless of type of surgery, and the absolute change in PF scores (aTSA: 5.1 + 9.0; rTSA: 3.7 + 7.3) did not statistically differ by type of surgery (<em>P</em> = .47). Significant improvements in PF scores primarily occurred in the first 90 days after surgery. PI scores significantly decreased after both rTSA (−6.3 + 10.4; 95% confidence interval: −9.0, −3.6) and aTSA (−8.5 + 11.0; 95% confidence interval: −12.4, −4.5). PI scores at presurgery and postsurgery, in addition to the absolute change in PI scores from presurgery to postsurgery, did not differ statistically between the two procedures (<em>P</em> &gt; .35).</div></div><div><h3>Discussion</h3><div>Patients experienced statistically significant and statistically equivalent improvements in PROMIS PF and PI scores after both aTSA and rTSA. The results suggest that patients experience a rapid improvement in PF within 90 days of surgery, which is maintained for at least up to 1 year after surgery. Both surgeries also result in rapid improvements in pain within 90 days, with a plateau effect after the 90-day mark. Overall, the results of this study yield useful information regarding the timeline and nature of postsurgical recovery related to physical functional and pain after aTSA and rTSA when measured with PROMIS scores.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 336-342"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766765","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":"Stem height in reverse total shoulder arthroplasty for fracture: deltoid and pectoralis major tendon distances from an inlay tray","authors":"Theodore L. Schoenfeldt MD ,&nbsp;Austin Darden BS ,&nbsp;Nicholas Crosby MD ,&nbsp;Gregory Merrell MD","doi":"10.1053/j.sart.2025.02.002","DOIUrl":"10.1053/j.sart.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (RTSA) has emerged as a favorable treatment for comminuted proximal humerus fractures, however, can be challenging due to the need to restore humeral height. Minimal research has been done investigating distances from anatomic landmarks to inlay tray designs in RTSA. This study evaluated anatomic references for use in RTSA and investigated how inlay stem designs impact distances from anatomic landmarks.</div></div><div><h3>Methods</h3><div>Twelve fresh frozen cadaver shoulders were dissected via a standard deltopectoral approach. Zimmer Trabecular Metal and DonJoy Orthopedics Altivate inlay stems were utilized in each cadaver, placed with the prosthesis tray flush with the cut. Measurements were taken from the top of the deltoid insertion to the most medial and lateral edges of the prosthesis tray (distance between deltoid tendon insertion and medial tray and distance between deltoid tendon insertion and lateral tray, respectively). Measurements were also taken from the transverse fibers at the top pectoralis major tendon (PMT) insertion to the most medial and lateral prosthesis tray (distance between PMT and medial tray and distance between pecotralis major tendon and lateral tray, respectively).</div></div><div><h3>Results</h3><div>Using the Zimmer system, the average distance from the deltoid insertion to the medial tray edge was 64.8 ± 13.1 mm, and the average distance from the deltoid insertion to the lateral tray edge was 84.9 ± 10.7 mm. The average distance from the pectoralis insertion to the medial tray edge was 30 ± 4.3 mm, and the average distance from the pectoralis insertion to the lateral tray edge was 49.4 ± 4.3 mm. Using the DonJoy Orthopedics system, the average distance from the deltoid insertion to the medial tray edge was 64.6 ± 11.9 mm, and the average distance from the deltoid insertion to the lateral tray edge was 86.4 ± 10.7 mm. The average distance from the pectoralis insertion to the medial tray edge was 29.8 ± 4.2 mm, and the average distance from the pectoralis insertion to the lateral tray edge was 51.2 ± 3.1 mm. The overall mean distance between PMT and medial tray and distance between pecotralis major tendon and lateral tray was 29.9 ± 4.2 mm and 50.3 ± 3.7 mm, respectively, and the overall mean distance between deltoid tendon insertion and medial tray and distance between deltoid tendon insertion and lateral tray was 64.7 ± 12.2 mm and 85.7 ± 10.5 mm, respectively.</div></div><div><h3>Conclusion</h3><div>More precise and accurate ratios were found using the PMT insertion compared to the deltoid tendon insertion. Measurements using two different inlay tray system manufacturers were comparable. These findings aid surgeons intraoperatively in the attempt of proper prosthesis placement during RTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 343-347"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766766","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 role of patient mental health and other psychological factors in the outcomes of shoulder arthroplasty: a systematic review and meta-analysis","authors":"Alexander J. MacFarlane MD ,&nbsp;Tamari Bekauri BSc ,&nbsp;Sonja Pavelseen MD, MS ,&nbsp;M. Nadir Haider MD, PhD ,&nbsp;Thomas R. Duquin MD","doi":"10.1053/j.sart.2025.01.007","DOIUrl":"10.1053/j.sart.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Depression and anxiety have been associated with poor patient outcomes and higher adverse events in lower extremity reconstruction as well as total shoulder arthroplasty. However, these results can be conflicting. Additionally, depression and anxiety may be considered an incomplete understanding of a patient's mental health and mental readiness for surgery. We have proposed evaluating several other psychological factors in addition to depression and anxiety, which include somatization, pain catastrophizing, resilience, self-efficacy, and kinesiophobia.</div></div><div><h3>Methods</h3><div>We searched PubMed, EMBASE, and Cochrane systematically from inception until June of 2024. Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. The meta-analysis was conducted by comparing the effects of emotional disorders (ED's) on preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) score.</div></div><div><h3>Results</h3><div>A total of 24 articles were included in the final analysis. The mean Newcastle-Ottawa Quality Assessment Scale score was 6.63 of a possible 9 points. Four articles were included in the meta-analysis. We found no difference in the preoperative ASES score (d = −0.363 [−0.733, 0.007], <em>P</em> = .055) irrespective of diagnosis or type of ED (0.210) or procedure (0.506). However, postoperative ASES scores were statistically significantly lower (d = −0.511 [−0.722, −0.300], <em>P</em> &lt; .001) for those with ED, independent of the type of ED (<em>P</em> = .671) or procedure (<em>P</em> = .589). Of the 7 articles included with range of motion (ROM) outcomes, we found 4 articles supporting worse ROM, 2 articles supporting improved ROM, and 1 article supporting no differences when associated with ED.</div></div><div><h3>Conclusions</h3><div>Depression and anxiety are linked to poorer patient-reported outcomes following total shoulder arthroplastybased on our meta-analysis. However, we found conflicting evidence regarding the effects of ED's on postoperative ROM.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 286-298"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891228","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":"Mid-term outcomes following reverse and anatomic shoulder arthroplasty: a systematic review and meta-analysis","authors":"Conor McNamee MB, BCh, BAO ,&nbsp;Andrew Kelly MB, BCh, BAO ,&nbsp;Thomas Deane MB, BCh, BAO ,&nbsp;James G. Kelly MB, BCh, BAO ,&nbsp;William Blakeney MBBS, MS, MSc, FRACS","doi":"10.1053/j.sart.2025.01.009","DOIUrl":"10.1053/j.sart.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA), is increasingly used worldwide to treat a growing number of pathologies. By the reversing the native joint configuration, rTSA has been shown to significantly alleviate pain and restore motion even for patients with end-stage pathology. Despite this, there is a lack of evidence substantiating the comparative effectiveness of rTSA vs. anatomic arthroplasty, particularly in the mid-to long-term.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysesguidelines. The PubMed, Embase, and Scopus databases were searched on February 12, 2024, without date restrictions. Studies in English comparing outcomes of rTSA and anatomic total shoulder arthroplasty (aTSA) with a mean follow-up of at least 4 years were included. Meta-analyses employed random effects models to assess differences in functional outcomes, complication rates, and revision rates between the surgeries.</div></div><div><h3>Results</h3><div>The search yielded 8 comparative studies involving 3453 patients, revealing significant functional improvements in aTSA over rTSA at midterm follow-ups, such as better forward flexion, abduction, and external rotation. However, rTSA resulted in a significantly lower rate of revision surgeries. No significant differences were found in total complication rates, instability, or infection rates between the groups. Both surgeries showed similar patient-reported outcome measures.</div></div><div><h3>Discussion</h3><div>The meta-analysis finds a lack of high-quality trials comparing aTSA and rTSA. Current evidence suggests that aTSA may offer better functional outcomes, while rTSA may provide a more durable construct with lower revision rates. These results are at a significant risk of bias, and robust trials are needed to validate these interpretations.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 305-317"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891237","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 postoperative adverse cardiac events following total shoulder arthroplasty: a propensity-matched analysis of risk factors","authors":"Patrick J. Tansey MD ,&nbsp;Jad J. Lawand MS ,&nbsp;Elias Nasser BS ,&nbsp;Kaveh Momenzadeh MD ,&nbsp;Jeremy S. Somerson MD","doi":"10.1053/j.sart.2025.01.008","DOIUrl":"10.1053/j.sart.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac complications following total shoulder arthroplasty (TSA) are rare, potentially life-threatening events. Identifying risk factors (RF) for cardiac complications remains of interest to treating surgeons. This study aims to assess the impact of common comorbidities on perioperative cardiac complication risk following TSA.</div></div><div><h3>Methods</h3><div>Using the TriNetX national multicenter database, we identified patients who underwent TSA from January 2015 to January 2024. Patients were grouped into cohorts based on the presence or absence of cardiac RFs, such as diabetes mellitus (DM), renal insufficiency, previous myocardial infarction (MI), hypertension, and cerebrovascular disease (CVD) to create at-risk vs. control cohorts. These groups underwent 1:1 propensity score matching by age, sex, race, and ethnicity. A subanalysis for each specific RF was conducted. The incidence of postoperative adverse cardiac events was assessed at 1- and 3-month intervals using chi-squared tests, with a significance threshold set at <em>P</em> &lt; .002 following multiple comparison correction.</div></div><div><h3>Results</h3><div>After 1:1 propensity matching, 13,128 TSA patients were available for final analysis. At-risk patients with comorbidities had 1.4-3.8 times greater odds of postoperative heart failure at 30 days and 90 days (<em>P</em> &lt; .001) compared to controls. Patients with a history of CVD had 2.0 times greater odds of 30-day MI and heart failure compared to controls (<em>P</em> &lt; .001). Patients with a history of MI had the highest odds of troponin elevation (OR 3.8, <em>P</em> &lt; .001), MI (OR 21.0, <em>P</em> &lt; .001), and heart failure (OR 3.3, <em>P</em> &lt; .001) within the early postoperative period.</div></div><div><h3>Conclusion</h3><div>Patients with a history of MI, renal insufficiency, hypertension, CVD, or diabetes mellitus were associated with significantly greater odds of adverse cardiac events at 30 and 90 days following TSA. History of prior MI was the strongest independent RF, with an associated 21 times greater odds of postoperative MI at 30 and 90 days.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 299-304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891236","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":"Preoperative acromiohumeral index and the Goutallier classification reliably predict rotator cuff integrity using computed tomography and magnetic resonance imaging as confirmed intraoperatively in shoulder arthroplasty patients","authors":"Alexander E. White MD ,&nbsp;Mihir S. Dekhne MD ,&nbsp;Michael Mazzucco BS ,&nbsp;Karthik Nathan MD ,&nbsp;Harry G. Greditzer 4th MD ,&nbsp;Michelle Kew MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.01.005","DOIUrl":"10.1053/j.sart.2025.01.005","url":null,"abstract":"<div><h3>Hypothesis</h3><div>We hypothesized that both computed tomography (CT) and magnetic resonance imaging (MRI) could be used reliably to measure the acromiohumeral index (AHI) and supraspinatus muscle atrophy through the use of Goutallier classification. Additionally, we hypothesized that these measurements could be used in combination to predict rotator cuff status, as verified by intraoperative assessment.</div></div><div><h3>Methods</h3><div>This was a retrospective case series of a prospectively maintained single institution’s shoulder arthroplasty registry. Patients who underwent anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty between March 2015 and July 2020 were eligible for inclusion if they had X-ray (XR), MRI, and CT scans performed within 6 months of surgery and rotator cuff integrity documented intraoperatively. AHI was measured for each patient using XR, MRI, and CT. Goutallier scores were assigned using both MRI and CT for supraspinatus muscle quality. Rotator cuff integrity was confirmed intraoperatively by the operating surgeon and reported to be (1) intact/attenuated or (2) torn. Intraclass correlation coefficients were calculated for each measurement and imaging modality and cut-point analysis was performed for predicting rotator cuff integrity.</div></div><div><h3>Results</h3><div>Of the patients, a total of 199 (132 anatomic total shoulder arthroplasty, 67 reverse total shoulder arthroplasty) met the inclusion criteria. Intraclass correlation coefficient values were as follows—Goutallier on CT: 0.76, Goutallier on MRI: 0.73, AHI on MRI: 0.81, AHI on XR: 0.76, and AHI on CT: 0.72. Median AHI measurements for patients with intact rotator cuffs were 7.50 mm on MRI, 7.80 mm on CT, and 8.65 mm on XR, whereas median AHI measurements for patients with torn rotator cuffs were 5.45 mm on MRI, 4.93 mm on CT, and 7.55 mm on XR. These intramodality differences were significantly different (<em>P</em> &lt; .001). Goutallier measurements on MRI and CT were significantly positively correlated (R = 0.93, <em>P</em> &lt; 2.2e-16). The optimal cut point for determining rotator cuff integrity using AHI was 6.40 mm on MRI, 5.75 mm on CT, and 7.90 mm on XR. The optimal cut point for predicting rotator cuff integrity when using Goutallier score was 1.50 on MRI and 1.00 on CT. In the diagnosis of a rotator cuff tear (partial or full-thickness), MRI sensitivity was 92.7% and specificity was 33.1%.</div></div><div><h3>Conclusion</h3><div>Both CT and MRI provide reliable assessments of supraspinatus muscle quality and AHI in shoulder arthroplasty candidates. Median AHI measurements are significantly lower when using CT and MRI and these differences are amplified in the case of rotator cuff insufficiency. Furthermore, both CT and MRI predict intraoperative rotator cuff status more reliably than XR when using cut points for Goutallier scores and AHI measurements.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 270-279"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891226","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":"Comparison study of patient demographics, causes, and risk factors associated with 90-day readmissions following primary reverse shoulder arthroplasty","authors":"Lucas R. Haase MD,&nbsp;Ajit M. Vakharia MD,&nbsp;Jason G. Ina MD,&nbsp;Anthony M. Imbrogno DO,&nbsp;Andrew Paliobeis MD,&nbsp;Raymond E. Chen MD,&nbsp;Robert J. Gillespie MD","doi":"10.1053/j.sart.2025.01.006","DOIUrl":"10.1053/j.sart.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>The use of reverse total shoulder arthroplasty (rTSA) has risen exponentially, likely due to the consistently favorable outcomes, an aging population, and expanding surgical indications. This increase in operative volume has led to a proportional increase inhospital readmissions. The purpose of this study was to (1) determine the 90-day readmission rates following rTSA, (2) identify the common surgical causes for readmission, and (3) evaluate patient-related risk factors associated with increased risk of readmission.</div></div><div><h3>Methods</h3><div>Patients undergoing rTSA were identified using a nationwide administrative database. The study group cohort included those patients who were readmitted within 90 days following the index procedure; whereas patients not readmitted served as controls. The query yielded 116,893 patients with 4705 readmitted and 112,118 not readmitted. Demographic information including sex, age, comorbidities, and Elixhauser Comorbidity index (ECI) were compared between groups. Chi-square analyses were used to compare patient demographics. Multivariate binomial logistics regression analyses were used to calculate odds ratios (ORs) on patient-related risk factors for 90-day readmissions. A <em>P</em> value less than .007 was considered statistically significant based on Bonferroni correction.</div></div><div><h3>Results</h3><div>The overall readmission rate was 4.03%, 40.5% of which were orthopedic-related. The most common causes of readmission were prosthetic dislocation (0.97%), deep and superficial surgical site infection (0.34%), and postoperative pain (0.19%). Readmitted patients had significantly higher rates of comorbid conditions. Comorbid conditions with the highest association with 90-day readmission were body mass index &gt; 40 (OR = 2.39), rheumatoid arthritis (OR = 1.90), iron deficiency anemia (OR = 1.79), and chronic kidney disease (OR = 1.62). ECI was significantly higher among the readmitted group (8.8 vs. 6.2; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Patients undergoing rTSA with increased body mass index, rheumatoid artthritis, chronic kidney disease and iron deficiency anemia were at increased risk for readmission. Patients with increased ECI also had increased odds of readmission. Well-powered prospective studies are necessary to better understand the impact of comorbid conditions on the risk for readmission. However, the current study can be used by orthopedic surgeons and other health-care professionals to educate patients with significant comorbid conditions to better predict the chance of readmission after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 280-285"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891227","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":"Complications associated with preoperative anemia and risk factors for blood transfusion after shoulder arthroplasty: a systematic review","authors":"Eddie K. Afetse BS, BA ,&nbsp;Olivia M. Jochl AB ,&nbsp;Ajay C. Kanakamedala MD ,&nbsp;Joseph Ruzbarsky MD ,&nbsp;Matthew T. Provencher MD, MBA, MC USNR (Ret.)","doi":"10.1053/j.sart.2025.01.004","DOIUrl":"10.1053/j.sart.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Patients with preoperative anemia (PA) demonstrated higher complications rates following several orthopedic procedures. This systematic review aims to assess outcomes in patients with PA undergoing shoulder arthroplasty (SA) and to identify risk factors contributing to increased post-transfusion rates following SA.</div></div><div><h3>Methods</h3><div>This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on complications after SA in patients with PA. Study demographics and information on outcomes including outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the methodological index for nonrandomized studies scoring system.</div></div><div><h3>Results</h3><div>Between 2006 and 2023, 17 articles meeting inclusion criteria were published and analyzed in this systematic review, encompassing a total of 201,442 patients. Four studies with a total of 145,787 patients (63.7% female) with mean age of 72.6 years investigated PA, and 26,130 patients had PA. Thirteen studies investigated blood transfusion risk in 55,655 patients (56.9% female) with a mean age of 64.1 years. Patients with PA demonstrated a 24.4% complication rate, compared to 8.8% in those without such a diagnosis. Stratification by PA severity revealed a 34.9% complication rate in patients with moderate to severe PA. Notably, lower preoperative hemoglobin (Hb &lt; 13.5 g/L) and revision SA were correlated with a higher risk of postoperative transfusion.</div></div><div><h3>Conclusion</h3><div>Patients with PA had elevated rates of complications, readmissions, and reoperations after SA. Furthermore, lower preoperative Hb levels and revision SA were associated with an increased risk of postoperative transfusion. This systematic review indicated that PA may have adverse effects on outcomes after SA and suggested that preoperative optimization of patients with PA may reduce complication rates after SA. Moreover, this data suggests that preoperative optimization of patients with PA may improve outcomes after SA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 319-326"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766753","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}