Seminars in Arthroplasty最新文献

{"title":"Outpatient trends in total shoulder arthroplasty outcomes","authors":"Brandon Penland MD, PharmD ,&nbsp;Robert T. Henke BS ,&nbsp;John W. Moore BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.09.003","DOIUrl":"10.1053/j.sart.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is the most common orthopedic procedure for treating end-stage osteoarthritis of the glenohumeral joint and proximal humeral fractures. Surgical advancements have allowed an increasing number of TSA to be performed in the outpatient setting. Previous studies have shown a positive correlation between patient satisfaction and the number of outpatient TSA preformed. This purpose of this study is to analyze trends in postoperative complications following outpatient TSA from 2010-2020.</div></div><div><h3>Methods</h3><div>The National Surgical Quality Improvement Database was queried from 2010 to 2020 to identify patients who underwent primary TSA. The patients were then separated into inpatient (n = 30,316) and outpatient groups (n = 3,433) and complication rates were compared. These groups were separated by year and analyzed for preoperative demographic data, preoperative comorbidities, and postoperative complications. TSA patients were subdivided into early (2014-2016) and late (2018-2020) groups. Postoperative complications between early and late groups for both outpatient and inpatient cohorts were compared.</div></div><div><h3>Results</h3><div>The number of TSA performed both inpatient and outpatient increased yearly. The percentage of TSA performed outpatient increased from 5.0% in 2010 to 19% in 2020. Patients receiving outpatient TSA were more likely to be male (50% vs. 43%; <em>P</em> &lt; .001), younger in age (68 vs. 69; <em>P</em> &lt; .001), have a lower body mass index (30 vs. 31; <em>P</em> &lt; .001) and overall fewer preoperative comorbidities compared to inpatient. The late groups of both outpatient and inpatient cohorts had lower rates of bleeding, reported as 0.5% and 1.7%, respectively, despite a significant increase in the average number of American Society of Anesthesiologists Class 3 or higher patients (59% and 60%, respectively) compared to the early groups.</div></div><div><h3>Conclusion</h3><div>Despite an increasing proportion of patients undergoing outpatient TSA over time, complication rates for outpatient TSA remain comparable to or below those of inpatient TSA. Both outpatient and inpatient TSA experienced lower rates of complications in the late cohort compared to the early cohort, despite patients from the later cohort having higher American Society of Anesthesiologists classifications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151503"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188069","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":"Platelet-rich plasma injections prior to total shoulder arthroplasty may be associated with increased infection risk in a time-dependent manner","authors":"Romir P. Parmar BS ,&nbsp;Devin Morrow MD ,&nbsp;Alejandro M. Holle BS ,&nbsp;Michael H. Amini MD ,&nbsp;Elizabeth Batterton MD ,&nbsp;Evan Lederman MD ,&nbsp;Midhat Patel MD","doi":"10.1053/j.sart.2025.09.012","DOIUrl":"10.1053/j.sart.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>While platelet-rich plasma (PRP) is widely used for managing shoulder pathology, its implications when administered shortly before total shoulder arthroplasty (TSA) are unclear. This study investigates postoperative outcomes associated with PRP use within one year of TSA, with a focus on infection and revision rates.</div></div><div><h3>Methods</h3><div>Using the PearlDiver Mariner database (2010-2022), we identified 83 patients who received PRP injections within one year before undergoing TSA. These patients were propensity score matched 1:4 to 332 controls based on the following: age, Charlson-Deyo Comorbidity Index, gender, tobacco use, obesity, and diabetes. Postoperative outcomes, including 3-month and 3-year infection rates and revision TSA, were compared. A subgroup analysis was performed based on the timing of PRP injection: 0-6 months vs. 6-12 months before surgery. Statistical analysis included unpaired <em>t</em>-tests and chi-square tests to compare baseline demographics. Postoperative outcomes were analyzed using odds ratios (ORs) with 95% confidence intervals and chi-square tests. Statistical significance was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>Baseline characteristics were well-matched between groups (<em>P</em> &gt; .9 for all variables). While not statistically significant, patients who received PRP within one year prior to TSA experienced numerically higher rates of 3-month infection (2.4% vs. 0.3%; OR, 8.17; <em>P</em> = .384), 3-year infection (3.6% vs. 1.5%; OR, 2.45; <em>P</em> = .517), and revision TSA (4.8% vs. 1.2%; OR, 4.15; <em>P</em> = .270). Subgroup analysis revealed a significantly increased risk of 3-month infection in patients who received PRP within 0-6 months before TSA (6.1% vs. 0.3%; OR, 21.4; 95% CI, 1.88-242.21; <em>P</em> = .001). No infections occurred in the 6-12 month PRP subgroup.</div></div><div><h3>Conclusion</h3><div>PRP administration within six months of TSA may be associated with a significantly increased risk of early postoperative infection. These findings suggest that the timing of PRP injections prior to TSA may have clinical implications, but further prospective studies are necessary to determine whether PRP plays a role in postoperative infection risk.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151512"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841505","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":"Nonalcoholic fatty liver disease is associated with adverse medical, but not implant-related complications following total shoulder arthroplasty","authors":"Eric Mao BA ,&nbsp;Anh S. Le BS ,&nbsp;Alexander R. Zhu BA ,&nbsp;Emily O'Connell BS ,&nbsp;Umasuthan Srikumaran MD, MBA, MPH","doi":"10.1016/j.sart.2025.151529","DOIUrl":"10.1016/j.sart.2025.151529","url":null,"abstract":"<div><h3>Background</h3><div>Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition characterized by hepatic fat accumulation in the absence of alcohol consumption. Liver diseases such as cirrhosis are known to be associated with worse outcomes after total hip and total knee arthroplasty. However, these results may not generalize to NAFLD, which presents along a broader continuum of severity. This retrospective cohort study assessed the impact of NAFLD on outcomes following total shoulder arthroplasty (TSA).</div></div><div><h3>Methods</h3><div>Patients undergoing primary TSA were identified from a national database and stratified into two cohorts: those with NAFLD diagnosed prior to TSA and controls without NAFLD. Patients receiving a second TSA within two years were excluded to ensure laterality. Patients receiving TSA for indications of osteonecrosis or fracture were further excluded. To improve comparability between cohorts, 1:1 propensity score matching was performed based upon demographics and comorbidities identified to be significant at baseline. The incidence of implant-related and medical complications was assessed at 90 days and 2 years following TSA. Chi-square tests between cohorts were performed to calculate risk ratios, 95% confidence intervals, and their associated <em>P</em> values. Statistical significance was assessed at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>At 90 days after TSA, patients with NAFLD were more likely to experience pneumonia, bleeding requiring transfusions, and deep vein thrombosis (DVT) compared to controls. However, patients with NAFLD were less likely to require revision at this time point compared to controls. At two years after TSA, patients with NAFLD were still more likely to experience DVT and bleeding requiring transfusion. NAFLD patients were also still less likely to require revision when compared to controls. The incidence of mechanical loosening, prosthesis dislocation, periprosthetic fracture, and periprosthetic joint infection was not significantly different between cohorts at either timepoints.</div></div><div><h3>Discussion</h3><div>This study is the first to utilize a large-scale database to examine the association between NAFLD and complications following TSA. Our results indicate that patients with NAFLD are not at elevated risk of any implant-related complications following TSA. However, NAFLD patients may be at elevated risk of DVT, pneumonia, and bleeding requiring transfusion. These findings are unlike those reported for patients with other liver conditions undergoing TSA and suggest the existence of a unique risk profile for patients with NAFLD. Future work is necessary to elucidate the underlying mechanisms driving our observed associations and to determine whether preoperative optimization of NAFLD can mitigate the risk of medical complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151529"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926462","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":"Efficacy and safety of the new Mirror anatomic total shoulder system: a preliminary report of a prospective multicentric trial","authors":"Kutalmiş Albayrak MD ,&nbsp;Matthias Zumstein MD ,&nbsp;Christophe Monnin MD ,&nbsp;Vilijam Zdravkovic MD ,&nbsp;Bernhard Jost MD","doi":"10.1016/j.sart.2025.151524","DOIUrl":"10.1016/j.sart.2025.151524","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (aTSA) is a highly effective therapy for patients with glenohumeral arthritis and an intact rotator cuff. However, implant failure due to progressive cuff pathology or loosening of the glenoid component is a well-established long-term complication. Therefore, a new prosthesis design has been developed to address these problems by “mirroring” the pairing materials improving longevity of the glenoid component and facilitating the potential conversion to reverse configuration by further design novelties. This proof-of-concept study reports on the safety and clinical efficacy of this novel Mirror anatomic total shoulder arthroplasty (Mirror aTSA) with preliminary, 1-year follow-up data.</div></div><div><h3>Methods</h3><div>This prospective study included patients who underwent Mirror aTSA for osteoarthritis at 2 centers between January 2022 and November 2023. All patients had a follow-up of at least 12 months.</div></div><div><h3>Results</h3><div>The study included 20 consecutive patients (median age: 69, range 29-89 years, 9 male and 11 female patients) with established shoulder osteoarthritis and a clinically/US/magnetic resonance imaging confirmed competent rotator cuff, who were operated on by 2 senior surgeons. The median follow-up was 14.2 months (range 12.1 to 26.4 months). The Constant score showed a significant improvement from a median of 49.1 points (range 24-69.7) preoperatively to a median of 81.8 points (range 69-96) at 12 months follow-up. Similarly, the Oxford Shoulder Score) and Subjective Shoulder Value also improved from 27 points (range 8–37) and 40% (range 10–75%) preoperatively to a median of 48 points (range 38–48) and 95% (range 40%–100%) postoperatively, respectively. No complications related to the procedure or prosthesis were observed.</div></div><div><h3>Conclusion</h3><div>This study confirms that the novel Mirror aTSA provides highly satisfactory clinical and radiological results at the 12-month follow-up. While long-term results are still pending, our preliminary clinical and radiological results are encouraging.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151524"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926463","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":"Predictors of 90-day emergency department utilization after shoulder arthroplasty: a retrospective cohort study","authors":"Carter D. Bernal MS ,&nbsp;Frank Sierra BS ,&nbsp;Andres Ramos BS ,&nbsp;Shannon Tse BMBS ,&nbsp;David Dallas-Orr MD, MBA, MTM ,&nbsp;Daniel C. Santana MD, MS ,&nbsp;Derek Bond MD ,&nbsp;James Van Den Bogaerde MD ,&nbsp;Robert M. Szabo MD, MPH ,&nbsp;Ryan D. Freshman MD ,&nbsp;Mariano E. Menendez MD ,&nbsp;Christopher O. Bayne MD","doi":"10.1016/j.sart.2025.151516","DOIUrl":"10.1016/j.sart.2025.151516","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) visits after shoulder arthroplasty increase healthcare costs and strain hospital resource allocation. This study evaluates complications and ED utilization within 90 days after shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted for adult patients who underwent primary anatomic shoulder arthroplasty, reverse shoulder arthroplasty, or hemiarthroplasty at a single academic center hospital between 2016 and 2024. Demographics, surgical indications, procedure type, and 90-day surgical complications, including deep infection, dislocation, periprosthetic fracture, and reoperation, were recorded. 90-day ED visits were classified as “avoidable” (suitable for outpatient management), “unavoidable” (appropriate), or “comorbidity-related.” Logistic regression was used to identify predictors of postoperative ED visits.</div></div><div><h3>Results</h3><div>A total of 303 patients (50.3% female, mean age = 69.6) with 342 shoulder arthroplasties were analyzed. Among these patients, 54 (15.8%) presented to the ED within 90 days postoperatively, most commonly for postoperative pain, surgical site erythema and edema, dislocation, and infection. Patients who presented to the ED were generally sicker (Charlson Comorbidity Index of 3.87 vs. 3.68 [<em>P</em> &lt; .001]) and had a greater degree of pain preoperatively (visual analog scale pain score of 5.64 vs. 4 [<em>P</em> &lt; .001]). Multivariable logistic regression showed that ED utilization in the year prior to surgery was associated with ED presentation in the 90 days following shoulder arthroplasty (odds ratio: 2.17 [95% confidence interval: 1.06, 4.46]). Subgroup analysis of patients with ED visits revealed 12 (22.2%) had avoidable shoulder-related ED visits, 11 (20.4%) had unavoidable shoulder-related ED visits, and 31 (57.4%) had ED visits related to other medical comorbidities.</div></div><div><h3>Conclusion</h3><div>ED visits after shoulder arthroplasty are common, often related to postoperative pain, and potentially responsive to quality improvement initiatives. Previous ED visit in the year prior to shoulder arthroplasty is associated with 90-day postoperative ED visits.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151516"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926410","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":"Discrepancies in relative value unit-based reimbursement for operative management of periprosthetic humerus fractures","authors":"Alyssa R. Henriquez BS,&nbsp;Samuel Lorentz MD,&nbsp;Bryan Crook MD,&nbsp;Lindsey V. Ruderman BA,&nbsp;Michael A. Moverman MD,&nbsp;Christopher S. Klifto MD,&nbsp;Oke Anakwenze MD, MBA","doi":"10.1016/j.sart.2025.151530","DOIUrl":"10.1016/j.sart.2025.151530","url":null,"abstract":"<div><h3>Background</h3><div>Relative value units (RVUs) are widely used to calculate physician reimbursement. In orthopedics, primary shoulder arthroplasty has been shown to afford higher reimbursement per unit time than revision surgery according to RVU-based models. This study seeks to compare the reimbursement of primary arthroplasty in comparison with surgery for periprosthetic fracture patients. Specifically, we evaluate the compensation of implant revision surgery and open reduction with internal fixation (ORIF) for periprosthetic fracture.</div></div><div><h3>Methods</h3><div>Primary arthroplasty patients and periprosthetic fracture patients were identified using current procedural terminology codes at a single institution from 2016 to 2024. Periprosthetic fracture patients who received either implant revision or ORIF were included and subdivided by procedure type. The Centers for Medicare &amp; Medicaid Services dollar/RVU conversion factors were used to calculate the reimbursement per minute. The assumption of an 8-h workday and 120 operative days per year was used to calculate daily, monthly, and annual reimbursement.</div></div><div><h3>Results</h3><div>Two hundred fifty primary arthroplasty patients and 49 periprosthetic fracture patients were identified for analysis. Twenty periprosthetic fracture patients received implant revision and 29 received ORIF. Patients who received ORIF had significantly higher body mass indices (BMIs) compared to primary arthroplasty patients (34.3 ± 9.5 vs. 30.4 ± 7.5; <em>P</em> = .011) and were predominantly female (90% vs. 63%, <em>P</em> = .004). ORIF provided significantly lower reimbursement-per-minute than primary arthroplasty ($2.63 ± 0.88 vs. $7.69 ± 2.36; <em>P</em> &lt; .001), with an average annual reimbursement difference of $298,484.4. Revision surgery provided comparable reimbursement-per-minute to primary arthroplasty ($7.21 ± 2.11 vs. $7.69 ± 2.36, <em>P</em> = .368), and comparable annual reimbursement ($461,358.48 ± 54,340.25 vs. $443,603.44 ± 21,298.01).</div></div><div><h3>Conclusion</h3><div>Implant revision for periprosthetic fracture provides comparable reimbursement to primary shoulder arthroplasty, while ORIF provides significantly lower reimbursement on a daily, monthly, and annual basis. Current RVU-based models do not adequately account for the increased operative time required to treat periprosthetic fracture cases with ORIF, which results in significant annual reimbursement differences.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151530"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926413","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":"Patients 60 years old or younger have an increased risk of complications following reverse total shoulder arthroplasty: a propensity-score matched analysis","authors":"Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Alexander E. White MD ,&nbsp;Aakash K. Shah BA ,&nbsp;Samuel A. Taylor MD ,&nbsp;John M. Apostolakos MD, MPH","doi":"10.1016/j.sart.2025.151519","DOIUrl":"10.1016/j.sart.2025.151519","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) continues to be performed at increasing rates in younger patients. Further investigation is needed to further define the complication and risk profile for this younger patient population.</div></div><div><h3>Methods</h3><div>The TriNetX database was utilized to perform a retrospective analysis comparing younger (≤60 years) and older (&gt;60 years) patients undergoing rTSA. Patients were matched 1:1 using propensity scores to balance demographics and comorbidities. Outcomes assessed included 1-year, 2-year, and 5-year postoperative complications and revision rates. The Bonferroni adjusted significance threshold was set at <em>P</em> = .0166.</div></div><div><h3>Results</h3><div>At 1 year, younger patients experienced a significantly higher rate of recurrent dislocation (5.8% vs. 3.1%, risk ratio [RR] = 1.9, 95% confidence interval [CI] 1.3–2.7, <em>P</em> = .001), with no significant differences in periprosthetic joint infection (PJI; <em>P</em> = .040) or revision surgery (<em>P</em> = .033). At 2 years, recurrent dislocation remained higher in the younger cohort (6.4% vs. 3.8%, RR = 1.7, 95% CI 1.2–2.4, <em>P</em> = .003), while PJI (<em>P</em> = .107) and revision surgery (<em>P</em> = .025) rates showed no significant differences. At 5 years, both recurrent dislocation (8.9% vs. 5.8%, RR = 1.5, 95% CI 1.2–2.0, <em>P</em> = .003) and revision surgery (7.2% vs. 4.7%, RR = 1.5, 95% CI 1.1–2.1, <em>P</em> = .008) remained significantly higher in younger patients, whereas PJI rates were not significantly different (<em>P</em> = .075).</div></div><div><h3>Conclusion</h3><div>Patients aged 60 years and undergoing rTSA demonstrated significantly higher rates of recurrent dislocation and revision surgery compared to older patients. These findings suggest that younger patients maybe at greater risk of postoperative complications after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151519"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926408","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 obesity severity on patient-reported outcome measures and patient satisfaction following total shoulder arthroplasty","authors":"Sarah Jenkins MD ,&nbsp;Robert J. Reis BS ,&nbsp;Josie Elwell PhD ,&nbsp;Christopher Roche ME, MBA ,&nbsp;Alexander Hafey MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2026.151547","DOIUrl":"10.1016/j.sart.2026.151547","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a well-established risk factor for complications after total shoulder arthroplasty (TSA), and morbidly obese patients may be denied surgery due to concerns about poor outcomes. In the current health care climate, patient-reported outcome measures (PROMs) are increasingly used to define success after elective orthopedic procedures. Most studies on TSA in obese patients focus on objective metrics such as complication rates, range of motion, and radiographic parameters, while data on the subjective patient experience remain limited. The purpose of this study is to examine the effects of increasing obesity and body mass index (BMI) on PROMs and satisfaction in obese patients undergoing primary TSA.</div></div><div><h3>Methods</h3><div>There were 2,525 patients with a BMI &gt;30 kg/m² who underwent primary anatomic or reverse TSA that were identified in a prospective international shoulder registry and stratified according to the World Health Organization classification for obesity. Patient demographics, preoperative and minimum 2-year postoperative PROM, patient satisfaction scores, and complications and revisions were compared between patients with Class I (BMI 30-34.99 kg/m²), Class II (BMI 35-39.99), and Class III (BMI &gt;40 kg/m²) obesity.</div></div><div><h3>Results</h3><div>Class II and III patients were younger, more likely to be female, and more likely to have hypertension or diabetes than Class I patients. Preoperatively, Class III patients reported higher visual analog scale pain and lower Constant and American Shoulder and Elbow Surgeons scores than Class I or II patients, and lower Shoulder Arthroplasty Smart scores than Class I patients. TSA led to significant improvement in all PROM across all Classes. At a mean follow-up of 53 months, there were no significant between-group differences in patient satisfaction rates or PROM except for a lower Constant score in Class III patients compared to Class I patients; however, this difference did not exceed the minimum clinically important difference.</div></div><div><h3>Conclusion</h3><div>In obese patients undergoing primary TSA, the severity of obesity does not have a clinically significant impact on postoperative PROM or patient satisfaction, arguing against the use of BMI cutoffs in TSA. With appropriate medical optimization, morbidly obese patients can achieve functional improvement and satisfaction levels comparable to those of their less obese counterparts.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151547"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077507","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 financial impact of high comorbidity burden in primary total shoulder arthroplasty","authors":"Maxwell A. Northrop BS,&nbsp;Alexander C. Dippre BS,&nbsp;Sophia A. Sitsis BS,&nbsp;Jakob M. Miller BS,&nbsp;Robert T. Henke BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.09.008","DOIUrl":"10.1053/j.sart.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Comorbidities are increasingly prevalent in patients undergoing total shoulder arthroplasty (TSA) and may significantly influence both postoperative outcomes and perioperative costs. The purpose of this study is to evaluate the impact of increasing comorbidities on the clinical outcomes and financial burden in patients undergoing primary TSA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2022 to identify patients undergoing primary anatomic or reverse TSA. Patients with a Charlson-Deyo Comorbidity Index ≥5 were grouped as high comorbidity burden (HCB) and those &lt;5 as non-HCB. Propensity score matching was performed to minimize baseline differences between the HCB and non-HCB groups, resulting in 12,476 matched patients (6,238 per group). Total charges, hospital costs, length of hospital stay (LOS), and 180-day postoperative outcomes were compared. Continuous variables were compared with Welch's t-test and categorical variables with chi-square or Fisher's exact test.</div></div><div><h3>Results</h3><div>HCB patients incurred significantly higher total charges ($76,876 vs. $70,262; +9.4%; <em>P</em> &lt; .001) and hospital costs ($20,943 vs. $19,135; +9.5%; <em>P</em> &lt; .001). HCB patients had a significantly longer average LOS (2.7 vs. 1.7 days; <em>P</em> &lt; .001), elevated risk of readmission (14.4% vs. 9.3%; odds ratio (OR) 1.6; <em>P</em> &lt; .001), death (1.0% vs. 0.3%; OR 3.8; <em>P</em> &lt; .001), and discharge to a rehabilitation facility (1.4% vs. 0.4%; OR 3.6; <em>P</em> &lt; .001). The overall 180-day risk of complications was greater in the HCB group (29.1% vs. 17.4%; OR 1.9; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>HCB is associated with an elevated risk of medical and surgical complications following TSA, contributing to longer LOS, increased risk of readmission within 180 days, and significantly higher perioperative costs. These findings underscore the need for reimbursement models to account for increasing comorbidity burdens and the value of optimized perioperative management of comorbid conditions.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151508"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841504","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":"Extended proximal humeral cement technique in reverse shoulder arthroplasty","authors":"Gary Beemer MD, MS,&nbsp;Steven Graefe MD,&nbsp;Padmavathi Ponnuru PhD,&nbsp;Gary Updegrove MD,&nbsp;Nathan Lanham MD,&nbsp;April Armstrong MD, MSc, FRCSC","doi":"10.1053/j.sart.2025.08.005","DOIUrl":"10.1053/j.sart.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this retrospective study was to report outcomes, humeral loosening, and complication rates of reverse shoulder arthroplasty utilizing an extended proximal humeral cement technique.</div></div><div><h3>Methods</h3><div>A total of 60 shoulders in 57 patients underwent reverse shoulder arthroplasty with an extended proximal humeral cement technique. Indications for surgery included rotator cuff tear arthropathy and patients with healed proximal humerus fractures with associated arthritis. The mean follow-up was 4.3 years (range 2.1-8.0) years. Survivorship, complications, radiographic findings, and patient characteristics were collected and analyzed.</div></div><div><h3>Results</h3><div>Stress shielding, as represented by cortical bone resorption, was observed in 59 of 60 (98.3%) shoulders. Radiolucent lines were most commonly observed in the proximal portion of the stem. Scapular notching was observed in 29 of 60 (48.3%) shoulders with 28 of 60 (46.7%) exhibiting grade 1 notching and 1 (1.7%) presenting with grade 2 notching. There were no patients with grade 3 or 4 scapular notching. Partial or complete resorption of the greater tuberosity was observed in 56 of 60 (93.3%) shoulders. No stems were deemed “at risk” for loosening and no subsidence was observed in any patient. There was no correlation between radiolucent lines and scapula notching (<em>P</em> = .0906) or cortical bone resorption and stem size (<em>P</em> = .3907). In addition, there was no correlation between length of follow-up and radiolucent lines or stress shielding (<em>P</em> 0.8762). One revision was performed for infection postoperatively (survivorship of 98.3%).</div></div><div><h3>Conclusion</h3><div>The extended proximal humeral cement technique demonstrated good mid-term survival rates with low complications and no loosening or subsidence. This technique can be considered in scenarios where there is concern for humeral component implant stability.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151499"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188013","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}