Seminars in Arthroplasty最新文献

{"title":"The effect of social deprivation on hospital utilization following shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.04.005","DOIUrl":"10.1053/j.sart.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><p><span>Disparities in social determinants of health have been linked to worse patient-reported outcomes and higher rates of hospital readmission following </span>shoulder arthroplasty<span>. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized in the context of shoulder arthroplasty.</span></p></div><div><h3>Methods</h3><p>A retrospective review was performed from of a single institution’s experience with primary shoulder arthroplasty between 2012 and 2020. Demographic variables (age, race, and legal sex) and healthcare utilization (hospital readmission, emergency department<span> (ED) visits, follow-up visits, and telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on Area Deprivation Index tercile and compared.</span></p></div><div><h3>Results</h3><p>A total of 780 patients were included. The least, intermediate, and most deprived groups consisted of 195, 371, and 214 patients, respectively. The level of social deprivation was not a predictor of increased healthcare utilization through readmission, the ED, or the outpatient clinic. Identifying as Black or African American was an independent predictor of readmission and ED visitation. Female sex was an independent predictor of increased postoperative telephone calls.</p></div><div><h3>Conclusion</h3><p>Patients undergoing shoulder arthroplasty have similar use of hospital resources regardless of their level of social deprivation. We hope these results can be used to guide clinical decision-making, increase transparency, and manage patient outcomes following shoulder arthroplasty surgery.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 724-729"},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140568","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":"Finite element analysis of acromial fracture after reverse total shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.04.004","DOIUrl":"10.1053/j.sart.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of acromial fracture after reverse total shoulder arthroplasty (RSA) is reportedly 2.6%-8.4%, and clinical outcomes differ among fracture sites. However, few studies have investigated the factors affecting fracture sites. This study aimed to reproduce acromial fractures after RSA by replicating the postoperative displacement of the humerus using finite element models (FEMs), and to investigate the effect of humeral displacement on the fracture site.</p></div><div><h3>Methods</h3><p>Six patients (mean age, 76.3 ± 7.9 years; 5 women and 1 man) with acromial fractures after RSA treated at our institution were included. Among them, 3 had Levy Type 1 fractures, whereas the other 3 had Levy Type 2 fractures. Preoperative computed tomography data were used to create a 3-dimensional FEM. All elements within the proximal 2 cm of the clavicle and the scapular body were completely constrained. The entire humerus was forcibly displaced following its displacement after RSA, as measured by preoperative and postoperative computed tomography. The fracture sites, total displacement, external constraint of the humerus at the initial fracture, and bone density from the acromion to the scapular spine were investigated. Values of <em>P</em> &lt; .05 were considered statistically significant in tests of statistical inference but were interpreted as reference values due to the small number of cases.</p></div><div><h3>Results</h3><p>There were no major differences in humeral displacement between Type 1 and Type 2 fractures. Although the fracture sites in the FEM were slightly more medial than the actual fracture sites, they were similar. The total displacement and external constraint of the humerus at the initial fracture were similar in Type 1 and Type 2 fractures. The distribution of bone density from the acromion to the scapular spine differed between fracture types.</p></div><div><h3>Conclusion</h3><p>We were able to reproduce acromial fractures after RSA by replicating humeral displacement using FEM. The extent and direction of humeral displacement may not significantly affect the acromial fracture site, whereas the bone density distribution from the acromion to the scapular spine may affect it.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 716-723"},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000610/pdfft?md5=07cc68718199a6637ff08597ebc308b6&pid=1-s2.0-S1045452724000610-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of smoking status on survivorship and clinical outcomes following total shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.04.006","DOIUrl":"10.1053/j.sart.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><p>Smoking has been strongly associated with poor healing and worse outcomes following various joint arthroplasties, including worse functional measurements and increased complication rates. While smoking is associated with adverse events and complications in shoulder arthroplasty, the role of smoking in functional measurements and patient-reported outcomes (PROs) remains to be fully characterized.</p></div><div><h3>Methods</h3><p>Institutional electronic medical records were used to study patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) between 2009 and 2020 with at least 2 years of follow-up. Patients were called to obtain PROs. Patients were stratified into 3 cohorts, by tobacco smoking status: current, former, and never smokers.</p></div><div><h3>Results</h3><p>Among 498 patients who underwent TSA, 280 were aTSAs and 218 were rTSAs. Within aTSAs, 28 patients were classified as current, 99 as former, and 153 as never smokers. In rTSAs, 20 were current, 68 were former, and 130 were never smokers. Current smokers were younger at the time of surgery than former and never smokers in both aTSA (current: 58.8 ± 8.5; former: 63.9 ± 9.2; never: 62.8 ± 9.0 years; <em>P</em> = .031) and rTSA (current: 59.0 ± 6.8; former: 68.5 ± 7.2; never: 69.0 ± 9.0 years; <em>P</em> &lt; .001). Furthermore, current smokers experienced lower 5-year implant survival in aTSA (current: 84.3%; former: 98.8%; never: 95.0%; <em>P</em> = .015) and rTSA (current: 82.4%; former: 94.5%; never: 94.1%; <em>P</em> = .004). No differences were found among the 3 cohorts for preoperative range of motion (ROM) and strength, or postoperative ROM and strength in the aTSA cohort. rTSA preoperative measurements demonstrated no differences in ROM and strength, and only postoperative forward elevation strength and external rotation strength were found to be different. PROs were found to be of similar magnitude for all patients in the aTSA and rTSA groups.</p></div><div><h3>Conclusion</h3><p>The findings of this study indicate that current smokers exhibited a higher likelihood of necessitating TSA at a younger age and had higher implant failure rates. However, functional measurements were only marginally affected by smoking status.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 730-737"},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000634/pdfft?md5=21fe6fd34d2d4a3762697225064df951&pid=1-s2.0-S1045452724000634-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distalization and lateralization shoulder angles: do they have a role in predicting postoperative clinical outcomes?","authors":"","doi":"10.1053/j.sart.2024.04.003","DOIUrl":"10.1053/j.sart.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Lateralization Shoulder Angle (LSA) and Distalization Shoulder Angle (DSA) have been proposed to estimate the appropriateness of reverse shoulder arthroplasty (RSA) positioning. The purpose of this study was to evaluate the predictive value of DSA and LSA over clinical outcomes in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up.</p></div><div><h3>Methods</h3><p><span><span>A retrospective analysis of a consecutive series of RSAs performed between 2017 and 2021 was carried out. Inclusion criteria were primary RSA as a treatment for Cuff Tear Arthropathy<span>, Massive Irreparable rotator cuff tear, </span></span>Osteoarthritis or </span>Rheumatoid arthritis<span>, a true anteroposterior radiograph of the affected shoulder in neutral rotation at final follow-up, a minimum follow-up of 12 months, radiograph used to measure the angles, and clinical evaluation<span> with the same follow-up. Outcome measures were shoulder range of motion (ROM), visual analog scale (VAS) for pain and Constant-Murley score (CS).</span></span></p></div><div><h3>Results</h3><p>A total of 83 patients were included in the study. Patients achieved on average, 130 ± 14.14° of flexion, 97.5 ± 17.67° of abduction, 62.5 ± 3.53° and 72.5 ± 10.60° of external rotation, respectively, at 0° and 90° of abduction, and 5.13° of internal rotation. The mean VAS and CS were, respectively, 2.5 ± 3.5 mm and 69 ± 2.82 points at last follow-up. The mean DSA and LSA were 45 ± 2.72 and 92.99 ± 9.17, respectively. Neither the linear nor the quadratic regression fit for DSA or LSA revealed relevant associations with any of individual ROM measures, except for the quadratic fit correlating LSA and forward flexion (beta = 0.029, <em>P</em> = .027). Linear fit showed a low reverse, but significant, association between DSA and VAS (beta = −0.56, <em>P</em> = .036) and an association of LSA with both CS (beta = −0.344, <em>P</em> = .009) and VAS (beta = 0.091, <em>P</em> = .01). Quadratic models showed higher R squared for all associations, but correlation was significant only between VAS and LSA (beta = 0.006, <em>P</em> = .011)</p></div><div><h3>Conclusion</h3><p>We present the first evaluation of the predictive value of both DSA and LSA in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up. DSA and LSA play only a marginal to no role in the prediction of RSA postoperative ROM and might have a role in predicting VAS and CS.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 708-715"},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141139720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a Krackow suture technique with PEEK barrel augmentation for subscapularis repair is stronger than use of a Mason-Allen suture technique","authors":"","doi":"10.1053/j.sart.2024.03.016","DOIUrl":"10.1053/j.sart.2024.03.016","url":null,"abstract":"<div><h3>Background</h3><p><span>In total shoulder arthroplasty<span>, the subscapularis tendon is routinely mobilized, by tenotomy, peel, or lesser tuberosity </span></span>osteotomy, to visualize the joint and allow proper implant positioning. Careful mobilization of the subscapularis is undertaken to achieve an anatomic tension-free repair. This cadaveric study tests the biomechanical differences of 2 repair techniques of the subscapularis peel (SP) compared to the classically described technique. We hypothesize that adaptation of this SP technique using a custom-designed polyether-ether-ketone (PEEK) barrel in the bicipital groove may further stabilize suture repair of the subscapularis.</p></div><div><h3>Methods</h3><p>Twenty paired cadaveric shoulder specimens underwent SP and repair via transosseous suture fixation. The PEEK barrel used was a laboratory prototype designed for the study (Catalyst OrthoScience, Naples, FL, USA). Five specimens were repaired using a traditional Mason-Allen suture; their paired shoulders were repaired using the PEEK barrel and a Mason-Allen suture. Five specimens were repaired using the Krackow suture; their paired shoulders were repaired using the PEEK barrel and a Krackow suture. Mechanical testing was performed using a uni-axial materials testing system with primary outcome of gap displacement and secondary outcomes of maximum load to failure and method of failure.</p></div><div><h3>Results</h3><p>The Krackow repair method with and without PEEK augmentation was significantly stiffer than the Mason-Allen repair method with and without PEEK augmentation (<em>P</em> &lt; .001 across all groups). Adding augmentation changed the strength of the Mason-Allen repair without achieving statistical significance (<em>P</em> = .0925). Intergroup differences in cyclic displacement were not statistically significant. The Krackow repair methods had higher mean maximal load at failure than the Mason-Allen repairs of 534 ± 108 N and 266 ± 98 N, respectively (<em>P</em> &lt; .001). Maximum load at 5 mm displacement was significantly different across groups (<em>P</em> = .004). Methods of failure in the Mason-Allen technique groups included knot and tendon failure, and in the Krackow technique groups included suture failure and lesser tuberosity fracture.</p></div><div><h3>Conclusion</h3><p>Repairing the subscapularis with a Krackow suture is significantly stronger than a Mason-Allen repair in stiffness as well as load to failure. The results reported here compare a Krackow suture with a more common Mason-Allen suture configuration, and demonstrate the application of PEEK augmentation to subscapularis repair techniques. This study can guide surgeon selection of an ideal subscapularis repair technique for stemmed or stemless total shoulder arthroplasty.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 685-692"},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030495","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":"Prediction of premorbid three-dimensional anatomy of the glenoid based on statistical shape modeling","authors":"","doi":"10.1053/j.sart.2024.04.001","DOIUrl":"10.1053/j.sart.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Restoration of an anatomic joint line after anatomic total shoulder arthroplasty<span> and of the optimal lateral offset after reverse total shoulder arthroplasty<span> may be relatively straightforward when the glenoid does not present with severe erosion. However, in cases of severe glenoid bone loss, the surgeon is left with no preoperative landmark to restore these parameters. The objective of this study was to use statistical shape modeling, to predict the premorbid morphology of the glenoid. We hypothesized that this would allow us to accurately determine premorbid glenoid version and inclination, in addition to accurately quantifying bone loss and medialization.</span></span></p></div><div><h3>Methods</h3><p>Fifty-six bilateral computed tomography scans<span><span> of the shoulders of patients scheduled for shoulder arthroplasty and determined to have unilateral osteoarthritis (primary osteoarthritis or </span>cuff tear arthropathy<span> with a healthy contralateral<span><span> side) were obtained. A statistical shape model was automatically applied on the pathologic arthritic side to predict its premorbid anatomy. Glenoid version, inclination, height, width, and glenoid and </span>scapula lateral offset were measured automatically. These measurements were obtained on the pathological arthritic cases, on the contralateral control healthy cases, and on the premorbid predictions of the pathological arthritic cases and were compared pair by pair.</span></span></span></p></div><div><h3>Results</h3><p>The mean difference between the pathological arthritic side and the contralateral healthy side was 9.1° ± 7.3° for version, 4.8° ± 4.8° for inclination, 4.9 ± 4.5 mm for height, 4.7 ± 5.3 mm for width, 2.4 ± 1.9 mm for scapula lateral offset, and the glenoid lateral offset was 1.5 ± 1.5 mm. The mean difference between the premorbid prediction of the pathological side and the contralateral healthy side was reduced to 3.3° ± 2.4° for version, 3.4° ± 2.6° for inclination, 3.0 ± 1.9 mm for height, 2.3 ± 1.4 mm for width, 2.2 ± 1.7 mm for scapula lateral offset, and the glenoid lateral offset was 0.9 ± 0.8 mm.</p></div><div><h3>Conclusion</h3><p>This study shows that statistical shape modeling can allow accurate prediction of the premorbid morphology of the glenoid. This could help optimize implant selection and positioning after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty to restore optimal soft-tissue tension.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 698-707"},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054435","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":"Shoulder arthroplasty outcomes in a series of patients diagnosed with Parkinson’s disease: a retrospective analysis","authors":"","doi":"10.1053/j.sart.2024.04.002","DOIUrl":"10.1053/j.sart.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Parkinson’s disease (PD) is a neurodegenerative disorder that causes resting tremor and rigidity. Total shoulder arthroplasty (TSA) in patients with PD has proven to be a challenging clinical scenario and is associated with a high risk of complications. The purpose of this study is to explore the relationship between patients diagnosed with PD and outcomes following shoulder arthroplasty (SA).</p></div><div><h3>Methods</h3><p>Institutional records were queried for patients with PD who underwent SA from 2009 to 2020. Patient medical documentation was retrospectively reviewed to assess demographic information, comorbidity status, preoperative and postoperative range of motion measurements, and complications. Mean ± standard deviation was reported for continuous variables.</p></div><div><h3>Results</h3><p>A total of 17 patients were identified that met the inclusion criteria. The mean age of the cohort was 57.6 ± 10.6 years at the time of PD diagnosis and 68.1 ± 6.9 years at the time of surgery. The mean follow-up was 1.6 ± 1.2 years. The most common indications for surgery were degenerative joint disease, osteoarthritis, rotator cuff arthropathy, proximal humerus fracture, and rotator cuff tear (1). Mean forward elevation improved from 126.6 ± 24.8° to 131.2 ± 27.8°; mean external rotation improved from 29.4 ± 17.3° to 38.8 ± 10.5°.</p></div><div><h3>Discussion</h3><p>SA is an effective method of improving pain and function in PD patients. Patients undergoing anatomic TSA exhibited the most robust functional improvement in this cohort; however, anatomic TSA was associated with postoperative complications and similar functional measurements were achieved at final follow-up in patients who underwent reverse TSA. Thus, significant care must be taken to ensure the correct implant is chosen on an individual basis to maximize the potential for functional improvement.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 693-697"},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000592/pdfft?md5=1108f239c89717f443dd1ee78a8de999&pid=1-s2.0-S1045452724000592-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141045148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and mid-term results after total elbow replacement with the Nexel total elbow arthroplasty: a consecutive case series of 45 elbows","authors":"","doi":"10.1053/j.sart.2024.03.011","DOIUrl":"10.1053/j.sart.2024.03.011","url":null,"abstract":"<div><h3>Background</h3><p>The Nexel total elbow arthroplasty (TEA) is an evolution of the Coonrad-Morrey linked TEA. Theoretically, the new design has shown better mechanical properties, but the first clinical studies showed concerning rates of implant loosening, leading the authors to advocate for the discontinued use of the implant. The purpose of this study was to evaluate the short to mid-term results with the Nexel TEA in a single center cohort.</p></div><div><h3>Methods</h3><p>Between 2016 and 2020, 41 consecutive patients received 45 Nexel primary TEA at one institution. The cohort consisted of 5 men and 36 women with a mean age at surgery was 70 years (range, 42-93 years). The indications for primary TEA included 18 cases of rheumatoid arthritis, 24 acute fractures, and 3 cases of primary osteoarthritis. Follow-up assessment included the Mayo Elbow Performance Score, Oxford Elbow Score, range of motion, radiographic evaluation of implant loosening, complications, reasons for revision.</p></div><div><h3>Results</h3><p>The mean follow-up was 35 months (range 12-75 months). The median Mayo Elbow Performance Score was 82.5 points (range, 65- 100 points) and the Oxford Elbow Score was median 41.5 points (range, 17- 48 points). Mean range of motion at follow-up was; flexion 134° (range, 90°-140°), extension deficit 16° (range, 0°-90°), supination 71° (range, 30°-90°) and pronation 71° (range, 30°-90°). Radiolucent lines were observed in five cases around the humeral component and in one case around the ulnar component. There were four minor complications including prominent medial epicondyle, superficial infection, and transient ulnar nerve dysesthesia. Five elbows underwent revision surgery, three due to aseptic loosening of the humeral component, one due to periprosthetic fracture of the humerus, and one due to deep infection. The implant survival rate was 93.8% at 3 years.</p></div><div><h3>Conclusion</h3><p>The short- to mid-term clinical and functional results with the Nexel TEA in this series are promising. The study could not demonstrate a similar high revision rate as reported by other authors. However, longer follow-up time and larger series are warranted.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 632-638"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400049X/pdfft?md5=6b925fb9ec17f44154fd417004848ed8&pid=1-s2.0-S104545272400049X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional measurement of humeral retroversion on a large academic cadaveric database","authors":"","doi":"10.1053/j.sart.2024.03.005","DOIUrl":"10.1053/j.sart.2024.03.005","url":null,"abstract":"<div><h3>Background</h3><p><span>The Humeral retroversion angle (HRA) has been described in the literature as the orientation of the humeral head compared with the epicondylar axis of the </span>distal humerus<span>. HRA is a crucial measurement for designing shoulder prostheses and surgical technique, and is often noted to range from 25° to 35° in healthy adults. However, a wide range of individual variability has been reported in literature, with reported values ranging from −6° to 74°. Various imaging modalities including X-rays, computed tomography scans<span>, and magnetic resonance imaging have historically been used to measure this angle, but conventional 2-dimensional technologies may result in inaccuracy and variability in angular measurements. Therefore, recent studies have focused on using 3-dimensional (3D) modalities to measure HRA. These studies have shown promising results regarding accuracy and clinical significance, although most have only included a small number of subjects and have not procured conclusive findings. This study aims to measure the HRA in a large sample of subjects using 3D imaging to establish measurements for the general population.</span></span></p></div><div><h3>Methods</h3><p><span>We examined the right and left cadaveric humerus from 559 individuals (146 females and 413 males). All of the humeri underwent computed tomography scan and surface models generated. 3D landmarks were automatically calculated on each 3D bone using custom-written software in C++. Those landmarks were used to calculate (1) HRA as the angle between the epicondylar axis and the </span>humeral neck axis and (2) humeral proximal neck angle (HPNA) as the angle between the humeral neck axis and the anatomical axis. Descriptive statistics of both HRA and HPNA was analyzed using JMP Pro statistical software version 15.2.0.</p></div><div><h3>Results</h3><p>The HPNA was found to be 137.7° ± 1.04° for males and 136.34° ± 1.4° for females with a 95% confidence interval. HRA was found to be 39.89° ± 12.77° for males and 38.89° ± 3.15° for females with a 95% confidence interval. Results of analysis of variance revealed that males had a statistically significant larger HRA than females (<em>P</em> &lt; .001).</p></div><div><h3>Conclusion</h3><p>Our study suggests using a standardized measurement for the HRA, which we believe may improve operative outcomes. However, future prospective trials are required to validate our results in a clinical setting.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 602-607"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052777","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":"Seasonal timing of surgery does not affect clinical outcomes in total shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.03.015","DOIUrl":"10.1053/j.sart.2024.03.015","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. It is unclear if seasonal timing of surgery affects outcomes.</p></div><div><h3>Methods</h3><p>Patients who underwent TSA between 2015 and 2021 and were enrolled in a multicenter registry were eligible for inclusion. Date of surgery was recorded and was divided up into winter, spring, summer, and fall. Demographic data and Walch classification were recorded. Baseline strength, range of motion (ROM), and patient-reported outcomes were recorded. Patient-reported outcomes and ROM at 2 years of follow-up were assessed and compared between TSA groups for each season.</p></div><div><h3>Results</h3><p>Overall, 506 patients were included in the analysis. Breakdown by season was winter (N = 124), spring (N = 118), summer (N = 120), and fall (N = 144). There were no differences in baseline demographics between patients based on season of surgery or Walch classification. No difference existed in baseline ROM, clinical outcomes, or strength between seasonal groups. There were no differences in 2-year clinical outcomes, ROM, or strength between groups.</p></div><div><h3>Conclusion</h3><p>There is no difference in clinical outcomes based on seasonal timing for patients who undergo TSA. Patients should feel confident that their outcomes will not vary based on the season in which they undergo TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 679-684"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029744","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}