Seminars in Arthroplasty最新文献

{"title":"Tuberosity healing in reverse shoulder arthroplasty for proximal humerus fractures with a diaphyseal press-fit humeral stem","authors":"Benjamin W. Szerlip DO ,&nbsp;Matthew T. Glazier DO ,&nbsp;Walter R. Smith MD ,&nbsp;Mitzi S. Laughlin PhD ,&nbsp;T. Bradley Edwards MD","doi":"10.1053/j.sart.2024.06.004","DOIUrl":"10.1053/j.sart.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Reverse shoulder arthroplasty (RSA) is a viable option for proximal humerus fractures (PHFs) in the elderly, and cemented humeral fixation is the standard of care. This study evaluates the influence of a diaphyseal press-fit stem with a 142° humeral inclination on tuberosity healing (TH) and functional outcome in RSA for PHF.</div></div><div><h3>Methods</h3><div>Twenty-three patients received an RSA for PHF by a single surgeon at one center over a 2-year period. The humeral stem design was intended for diaphyseal press fit with a 142° humeral inclination. The tuberosities were repaired for each patient with bone graft and a standard suture technique. Patients’ clinical and radiographic outcomes were collected with a minimum 12-month follow-up.</div></div><div><h3>Results</h3><div>Nineteen of 23 patients (83%), with a mean age of 75 + years, were available for follow-up at an average of 14 months. Radiographic analysis showed 68% of patients had evidence of TH. Grade 1 scapular notching was found in 32% of patients. There was no implant loosening or subsidence noted. Average range of motion was 163° ± 15° degrees of forward flexion, 113° ± 24° of abduction, internal rotation to the waist, and an average external rotation of 7 ± 1.5 as measured by the Constant-Murley score. The average American Shoulder and Elbow Surgeons score was 81.8, and the average Constant-Murley score was 67.9. While not significant, those with TH trended toward better clinical outcomes. There was a 0% revision rate.</div></div><div><h3>Conclusion</h3><div>A press-fit stem designed for diaphyseal fixation provides consistent reliable results in RSA for PHF. A high percentage of TH was appreciated with a 142° humeral inclination, neutral glenosphere construct, and a standardized bone grafting, suture technique. TH is associated with improved patient outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 854-861"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704491","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":"Short-term clinical and radiographic outcomes with modular long stem for revision reverse total shoulder arthroplasty","authors":"Eddie Y. Lo MD ,&nbsp;Austin Witt MD ,&nbsp;Alvin Ouseph MS ,&nbsp;Monia Nazemi MS ,&nbsp;Nancy Weingast BSN ,&nbsp;Sumant G. Krishnan MD","doi":"10.1053/j.sart.2024.07.006","DOIUrl":"10.1053/j.sart.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>When performing reverse total shoulder arthroplasty with compromised proximal bone fixation, surgeons must consider using specialized stems with a distal press-fit design. In this study, the authors report on the clinical and radiographic outcomes of patients who underwent surgical management with modular diaphyseal press-fit stems.</div></div><div><h3>Methods</h3><div>In 2017-2021, patients who underwent revision reverse total shoulder arthroplasty reconstruction with diaphyseal press-fit stems (Aequalis Adjustable Stem [AS] or Aequalis Flex Revive Stem [RS]; Stryker, Kalamazoo, MI, USA) with minimum 1-year follow-up were identified. Patients with complex proximal humerus and scapula fractures, neurological injuries, and custom humeral replacements were excluded. Demographics and clinical follow-up data including range of motion, Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder Elbow Surgeons (ASES) Score, and Single Assessment Numeric Evaluation were retrospectively reviewed. Postoperative radiographs were reviewed for aseptic humeral loosening, periprosthetic instability, stress shielding, periprosthetic fractures, and humeral stem failure.</div></div><div><h3>Results</h3><div>Sixty-five patients (29 AS and 36 RS) had mean follow-up of 25 months (standard deviation ± 16). Mean anterior elevation improved from 57° ± 39 preoperative to 121° ± 31 postoperatively. Mean external rotation improved from 3° ± 17 to 34° ± 16. Mean internal rotation improved from 4° ± 13 to 35° ± 26. Mean VAS improved from 6.7 ± 2.2 to 2.9 ± 1.5. Mean SST improved from 13% ± 13% to 65% ± 22%. Mean ASES score improved from 19 ± 13 to 60 ± 18. Mean Single Assessment Numeric Evaluation improved from 25% ± 18% to 71% ± 17%. There were statistically significant differences in mean postoperative VAS (<em>P</em> = .0017), SST (<em>P</em> = .025), and ASES score (<em>P</em> = .0228) in favor of the RS group. There were no other notable differences between groups. The most common complications were aseptic humeral stem loosening (24% vs. 3%, <em>P</em> = .018) and periprosthetic instability (10% vs. 6%, <em>P</em> = .649) for the AS and RS cohorts, respectively. There was no statistically significant difference between surgical revision rates between the AS and RS cohorts (24% vs. 8%, respectively. <em>P</em> = .096).</div></div><div><h3>Discussion</h3><div>Diaphyseal press-fit modular humeral stem can provide a viable surgical alternative in compromised proximal humeral bone. At short-term follow-up, the clinical and radiographic outcomes are comparable to other stem designs. Further studies are necessary to identify risks and causes of failure associated with modular diaphyseal press-fit stems.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 915-923"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747736","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- to long-term outcomes of reverse total shoulder arthroplasty: a systematic review","authors":"Kira L. Smith BS ,&nbsp;Luc M. Fortier MD ,&nbsp;Margaret A. Sinkler MD ,&nbsp;Monish S. Lavu MHM ,&nbsp;Jacob G. Calcei MD ,&nbsp;Robert J. Gillespie MD ,&nbsp;Raymond E. Chen MD","doi":"10.1053/j.sart.2024.07.011","DOIUrl":"10.1053/j.sart.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><div>The reverse total shoulder arthroplasty (rTSA) is increasingly gaining popularity in treating various traumatic and degenerative glenohumeral diseases as well as rotator cuff-deficient shoulders. An investigation of midterm outcomes of rTSA is warranted as this is a relatively new procedure when compared to other forms of arthroplasty. This systematic literature review evaluates midterm outcomes of rTSA at a minimum of five-year follow-up.</div></div><div><h3>Methods</h3><div>A literature search was performed for studies reporting long-term outcomes of rTSA in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Papers were included if they described long-term outcomes of rTSA at a minimum of 5-year follow-up. Data were collected on patient demographics, including age, gender, and body mass index. Follow-up duration, indication for surgery, patient-reported outcome measures, and range of motion (ROM) were also recorded. Complication rates and device survivorship were also collected.</div></div><div><h3>Results</h3><div>There were a total of 4127 patients from 34 included studies. The overall study population was 74% female, and the average age was 72.6 years (23-95). The most common diagnosis was cuff tear arthropathy [35.2%], followed by proximal humerus fracture [19.5%], and rotator cuff tears [14.9%]. Patient-reported outcome measures improved significantly when comparing preoperative and postoperative values. ROM, including forward elevation, abduction, and external rotation, also improved significantly postoperatively. The overall complication rate was 14.7% (n = 981). The most common complications were implant loosening (3.3%, n = 219) and instability or dislocation (3.3%, n = 218). The overall revision rate was 5.5% (n = 310). The device survivorship rate at a minimum of 5 years was 94%.</div></div><div><h3>Conclusion</h3><div>This systematic review demonstrated that outcomes of rTSA performed for a variety of shoulder pathologies demonstrate significant improvement in nearly all patient-reported outcome scores as well as significant improvement in ROM at long-term follow-up. The overall complication rate of 14.7% is relatively low, and the device survivorship is good at 94% at a minimum of 5 years.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 953-963"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748287","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":"High in-hospital preoperative anxiety levels are not associated with an increased length of stay or readmission following primary shoulder arthroplasty","authors":"Rocio A.L. Crabb MD ,&nbsp;Viraj Deshpande BS ,&nbsp;Noemi Urquiza BS ,&nbsp;Kyle Schoell MD ,&nbsp;Sean Guerrero MHA ,&nbsp;Edward J. Quilligan BS ,&nbsp;Hafiz F. Kassam MD","doi":"10.1053/j.sart.2024.06.005","DOIUrl":"10.1053/j.sart.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Anxiety is prevalent in our society, affecting all facets of patients’ lives. There is, however, a paucity of literature exploring how anxiety extends into the orthopedic perioperative setting. We sought to analyze a subset of patients undergoing primary shoulder arthroplasty to determine whether correlations exist between anxiety, patient characteristics, time spent in the hospital, and likelihood of returning to the hospital after discharge.</div></div><div><h3>Methods</h3><div>After obtaining institutional review board approval, our hospital prospectively identified and approached all patients undergoing total shoulder arthroplasty between February and June of 2023. Patients completed the Visual Analog Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS), two validated tools used to assess preoperative anxiety levels and need for information, in the preoperative holding area before surgery. Patient demographics, hospital length of stay (LOS), and 30-day readmission rate were collected and analyzed.</div></div><div><h3>Results</h3><div>A total of 79 patients were enrolled. Nineteen percent of patients were found to be anxious using the APAIS tool, while 37.7% of patients were found to be anxious using the VAS-A tool. No significant correlation was found between APAIS or VAS-A anxiety scoring and hospital LOS. No significant correlation was found between APAIS or VAS-A anxiety scoring and 30-day readmission rate. A significant correlation was found between APAIS anxiety scoring and body mass index (BMI), as well as VAS-A scoring and BMI. However, no significant correlation was found between BMI and hospital LOS or between BMI and 30-day readmission rate.</div></div><div><h3>Conclusion</h3><div>Our study did not find a statistically significant correlation between immediate preoperative anxiety levels in patients undergoing shoulder arthroplasty and their length of stay or 30-day readmission rate. We did discover a linear relationship between patient BMI and their preoperative anxiety scores; however, no significant direct correlation was found between a patient’s BMI and their length of stay or their 30-day readmission rate. Our findings suggest that higher levels of preoperative anxiety should not preclude a patient from the benefits of consideration of early discharge planning such as same-day total shoulder replacement.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 862-866"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845068","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":"Readability of English and Spanish online patient education materials for shoulder arthroplasty","authors":"Jacob S. Ghahremani BA ,&nbsp;Jenna E. Ogi BS ,&nbsp;Michael T. Kody MD ,&nbsp;Ronald A. Navarro MD","doi":"10.1053/j.sart.2024.07.002","DOIUrl":"10.1053/j.sart.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Online patient educational materials (OPEMs) are a vital source of information for those undergoing shoulder arthroplasty, though their utility is limited by patient health literacy as the average American reads at an eighth-grade level. To promote optimal reading comprehension, the American Medical Association and National Institutes of Health recommend that OPEMs be written at or below a sixth-grade level. The purpose of this study is to analyze the readability of English and Spanish shoulder arthroplasty OPEMs.</div></div><div><h3>Methods</h3><div>Google Search was used to identify the first 25 eligible Shoulder Arthroplasty OPEMs in both English and Spanish using the search terms “shoulder replacement” and “reemplazo de hombro.” Readability of the English OPEMs was calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Index (FRE), Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index. The readability of Spanish OPEMs was calculated using the Fernandez-Huerta Index (FHI; the Spanish version of FRE), Fernandez-Huerta Index Grade Level, Gutiérrez de Polini's Fórmula de compresibilidad, and Índice Flesch-Szigriszt.</div></div><div><h3>Results</h3><div>The mean FHI of Spanish OPEMs was significantly higher than the mean FRE of English OPEMs (60.09 vs. 51.48). As such, Spanish OPEMs were written at a significantly lower grade level than English OPEMs (9.70 vs. 11.53). There was not an English or Spanish OPEM that was written at or below a sixth-grade reading level. 4% of Spanish OPEMs and 4% of English OPEMs were written below an eighth-grade reading level. 52% of Spanish OPEMs and 8% of English OPEMs were written between an eighth- and ninth-grade reading level. The designation of OPEMs as being Very Easy/Easy, Standard/Normal, Fairly/Somewhat Difficult, or Difficult/Very Difficult was significantly dependent on whether the OPEM was written in English or Spanish.</div></div><div><h3>Discussion and conclusion</h3><div>English shoulder arthroplasty OPEMs were written at a higher reading difficulty than Spanish OPEMs. However, neither English nor Spanish OPEMs were written at a reading level at or below the recommended sixth-grade reading level. As older adults and those in the United States with limited English proficiency are susceptible to low health literacy, OPEMs must be written at an accessible reading level for all. Addressing these disparities in OPEM readability will improve patient care and understanding of shoulder arthroplasty and other orthopedic procedures.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 884-892"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850929","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":"Male patients experience similar improvement in clinical and functional outcomes despite higher revision rates following reverse shoulder arthroplasty compared to female patients: a systematic review and meta-analysis","authors":"Colton Mowers BS ,&nbsp;Divesh Sachdev BS ,&nbsp;Derrick M. Knapik MD ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Benjamin T. Lack BS ,&nbsp;Justin T. Childers BS, MS ,&nbsp;Devin Q. John MD ,&nbsp;Vani J. Sabesan MD ,&nbsp;Garrett R. Jackson MD","doi":"10.1053/j.sart.2024.07.008","DOIUrl":"10.1053/j.sart.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>To compare patient-reported outcomes, range of motion, and rates of revision surgery following primary reverse shoulder arthroplasty (RSA) between male and female patients.</div></div><div><h3>Methods</h3><div>A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A literature search was performed on January 20, 2024, using the PubMed, Embase, and Scopus library databases for human clinical studies reporting postoperative outcomes and revision rates following RSA between male and female patients. Studies were excluded if patients underwent RSA for proximal humerus fractures. Preoperative and postoperative outcome scores and revision rates were stratified by patient sex and quantitatively compared. The quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria.</div></div><div><h3>Results</h3><div>Five studies consisting of 3227 male (mean age, 72.2 years; mean follow-up, 29.4 months) and 5649 female (mean age, 72.7 years; mean follow-up, 29.2 months) patients were included. At final follow-up, male and female patients reported similar improvements in postoperative Constant scores (mean difference, −1.63; <em>P</em> = .17), American Shoulder and Elbow Surgeons scores (mean difference, −1.66; <em>P</em> = .26), external rotation (mean difference, −1.82°; <em>P</em> = .17), forward flexion (mean difference, 0.47°; <em>P</em> = .91), and abduction (mean difference, 0.85°; <em>P</em> = .82) when compared to female patients. Revision rates were significantly higher in males when compared to those in females (5.1% vs. 1.9%, respectively; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Males undergoing RSA report similar improvement in postoperative patient-reported outcomes and range of motion values at a mean final follow-up of 29.4 months when compared to females with a mean final follow-up of 29.2 months. However, revision rates were significantly higher in males.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 928-935"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747738","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":"Fibromyalgia syndrome is an independent predictor of increased complications, revision, and cost of admission within 180 days of total shoulder arthroplasty","authors":"John W. Moore BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.07.009","DOIUrl":"10.1053/j.sart.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Fibromyalgia syndrome (FMS) frequently afflicts patients undergoing total shoulder arthroplasty (TSA), yet research investigating the effects of FMS on postoperative outcomes following TSA is lacking. The purpose of this study is to determine if patients with FMS are at increased risk for complications, readmission, revision, and mortality following primary elective TSA compared to a matched cohort of patients without FMS.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients were stratified into two groups based on the presence of preoperative FMS. Patients with FMS were matched 1:1 based on age, sex, and Charlson-Deyo Comorbidity Index using an optimized matching algorithm to patients without FMS to generate an equal sized control group for statistical comparison. 5506 matched pairs of patients with and without FMS were identified and used for statistical analysis. Preoperative demographic and comorbidity data, postoperative outcomes, and economic and hospital metrics were compared between the two groups. Multivariate analysis was conducted to control for the influence of independent risk factors other than FMS on postoperative outcomes.</div></div><div><h3>Results</h3><div>Patients with FMS were more likely to be active smokers (<em>P</em> &lt; .001) and have chronic kidney disease (<em>P</em> &lt; .001) prior to surgery. Patients with FMS exhibited increased rates of complications, including requiring a transfusion (<em>P</em> = .002), acute respiratory distress syndrome (<em>P</em> &lt; .001), surgical site infection (<em>P</em> &lt; .001), dislocation (<em>P</em> &lt; .001), prosthetic loosening (<em>P</em> &lt; .001), and fracture (<em>P</em> &lt; .001) compared to patients without FMS. Patients with FMS also exhibited higher rates of all-cause complications (<em>P</em> &lt; .001) and revision TSA (<em>P</em> &lt; .001) and decreased rates of readmission (<em>P</em> = .002) within 180 days of surgery. Mean cost of admission was found to be $1639 higher in patients with FMS (<em>P</em> &lt; .001), despite no difference in total hospital length of stay or discharge disposition.</div></div><div><h3>Conclusion</h3><div>Patients with FMS are more likely to develop medical and surgical complications following primary TSA. Though associated with multiple comorbidities, FMS is an independent predictor of several adverse events. Orthopedic surgeons should be aware of the increased risk of FMS on TSA when determining treatment plans.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 936-942"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748285","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 impact of nutritional status on revision total shoulder arthroplasty: perioperative outcomes and complications","authors":"Skye Jacobson BS,&nbsp;Jacqueline G. Tobin MS,&nbsp;Lawrence C. Vanderham MS, PA,&nbsp;Nikhil Vallabhaneni BS,&nbsp;Alexander S. Guareschi BS,&nbsp;William R. Barfield PhD,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.06.002","DOIUrl":"10.1053/j.sart.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div>As the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin &lt; 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample <em>t</em> tests, and multivariate analysis on SPSS.</div></div><div><h3>Results</h3><div>Patients within the low albumin cohort were more likely to be female (<em>P</em> = .008), increased mean age (<em>P</em> = .018), on dialysis (<em>P</em> = .002), had undergone an emergency procedure (<em>P</em> &lt; .001), classified with a dependent functional status (<em>P</em> &lt; .001), and had a higher American Society of Anesthesiologists classification (<em>P</em> &lt; .001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, <em>P</em> &lt; .001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (<em>P</em> = .025), increased bleeding/transfusion complications (8.4% vs. 3.3%, <em>P</em> = .021), and increased reoperation rate (8.4% vs. 0.71%, <em>P</em> = .034). No significant difference in readmission was found (<em>P</em> = .226).</div></div><div><h3>Conclusion</h3><div>Eleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 838-842"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700148","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":"Reaching MCID, SCB, and PASS for ASES, SANE, SST, and VAS following shoulder arthroplasty does not correlate with patient satisfaction","authors":"Adam Z. Khan MD ,&nbsp;Alayna Vaughan MD ,&nbsp;Zachary S. Aman BS ,&nbsp;Mark D. Lazarus MD ,&nbsp;Gerald R. Williams MD ,&nbsp;Surena Namdari MD","doi":"10.1053/j.sart.2024.03.017","DOIUrl":"10.1053/j.sart.2024.03.017","url":null,"abstract":"<div><h3>Background</h3><div>Minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have been established in the literature to gauge shoulder arthroplasty treatment effectiveness. These metrics are established based on anchoring questions that do not account for a patient’s satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), and visual analog scale (VAS) at 2 years following shoulder arthroplasty correlates with overall patient satisfaction.</div></div><div><h3>Methods</h3><div>This was a single-institution, retrospective, cohort study of all patients who underwent shoulder replacement from 2015 to 2019. Preoperative and 2-year postoperative ASES, SANE, SST, and VAS scores were recorded. Previously established MCID, SCB, and PASS values were used. Patients were contacted and underwent a survey to assess: (1) on a scale of 1 to 10, what is your overall satisfaction with your surgical outcome? (2) if you could go back in time, would you undergo this operation again? (yes/no); and (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess the relationship between reaching MCID, SCB, or PASS and the 3 outcome metrics above.</div></div><div><h3>Results</h3><div>Three hundred fifty two patients were included. Mean preoperative ASES was 42.2 ± 16.4, SANE was 35.5 ± 18.9, SST was 4.5 ± 2.6, and VAS was 5.3 ± 2.4. Mean 2-year ASES was 87.8 ± 16.0, SANE was 87.1 ± 15.7, SST was 9.8 ± 2.4, and VAS was 0.9 ± 1.8. Mean patient satisfaction was 9.0 ± 2.0, 331 (94.0%) patients would undergo surgery again, and 330 (93.8%) patients would recommend surgery. Spearman correlation coefficients were weak or very weak for reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS and all 3 study outcome metrics.</div></div><div><h3>Discussion</h3><div>Patient overall satisfaction is one of many considerations when indicating a patient for shoulder replacement and evaluating their ultimate long-term outcome. Reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS following shoulder arthroplasty did not correlate with a patient’s overall satisfaction, willingness to undergo surgery again, or willingness to recommend surgery to a friend or family member. Further investigation into the reliability and clinical value of currently defined MCID, SCB, and PASS metrics is needed.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 819-826"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141042881","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":"Comparing comorbidity burden between patients undergoing ambulatory rotator cuff repair vs. inpatient anatomic total shoulder arthroplasty","authors":"Zoe W. Hinton MD,&nbsp;Colleen W. Wixted MBA,&nbsp;Kevin A. Wu BS,&nbsp;John Atwater BS,&nbsp;Daniel E. Goltz MD, MBA,&nbsp;John R. Wickman MD, MBA,&nbsp;Jay M. Levin MD, MBA,&nbsp;Joshua K. Helmkamp MD,&nbsp;Tally E. Lassiter MD, MHA,&nbsp;Christopher S. Klifto MD,&nbsp;Oke A. Anakwenze MD, MBA","doi":"10.1053/j.sart.2024.03.004","DOIUrl":"10.1053/j.sart.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff repair (RCR) patients routinely undergo same-day discharge in an ambulatory setting, while anatomic total shoulder arthroplasty (TSA) cases have historically been performed in an inpatient hospital setting. For healthier patients, however, TSA has increasingly transitioned to same-day discharge. Understanding whether a true difference in comorbidity burden exists between these patient groups would inform the appropriateness of outpatient TSA in an ambulatory setting.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of patients undergoing primary TSA and same-day, ambulatory RCR performed between September 2017 and May 2021 at a single institution by 3 fellowship-trained orthopedic surgeons. Selected sociodemographic factors and the Elixhauser Comorbidity Index (30 variables) were used to summarize and compare comorbidity burden. Only patients &gt;50 year old were included. Chi-square and Kruskal-Wallis testing was used to compare the prevalence or severity for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>1433 cases met inclusion criteria, including 146 (34%) primary inpatient TSAs and 287 (66%) ambulatory RCRs. There were few differences in comorbidity burden between TSA and RCR, with TSA having a significantly higher prevalence for only 4 Elixhauser comorbidities and RCR having a higher prevalence of 1 comorbidity, although none survive a Bonferroni correction. TSA patients had a significantly higher prevalence of uncomplicated (<em>P</em> = .04192) and complicated hypertension (<em>P</em> = .0336), chronic pulmonary disease (<em>P</em> = .0045), and cardiac arrhythmia (<em>P</em> = .0031). The prevalence of diabetes (<em>P</em> = .029758) was significantly higher among RCR patients. Additionally, age (<em>P</em> = .011) was significantly higher among TSA patients. Of the TSA cohort, there were 10 incidences (1%) of 90-day readmission whereas there were 14 incidences (5%) of 90-day readmissions after RCR.</div></div><div><h3>Conclusion</h3><div>Overall, few differences in the prevalence of individual comorbidities (and sociodemographic parameters) existed between patients undergoing outpatient RCR and inpatient primary anatomic TSA. Comorbidities with larger differences can be either optimized preoperatively or managed chronically, and given these similarities, TSA may be similarly appropriate for ambulatory settings, particularly as efficiencies in operative time and improvements in regional anesthesia continue to evolve.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 813-818"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786950","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}