Seminars in Arthroplasty最新文献

{"title":"The influence of sex: a deep dive into reverse total shoulder arthroplasty outcomes","authors":"Asimina Lazaridou PhD ,&nbsp;Pamela M. Rist ScD ,&nbsp;Daniela Brune BSc ,&nbsp;Tim Schneller MSc ,&nbsp;Philipp Moroder MD ,&nbsp;Markus Scheibel MD","doi":"10.1053/j.sart.2025.01.003","DOIUrl":"10.1053/j.sart.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>The increasing prevalence of reverse total shoulder arthroplasty (RTSA) highlights the need for detailed analyses of sex-based outcomes. This study aims to elucidate the differences in functional, pain, and radiological outcomes between sexes following RTSA, addressing a crucial gap in understanding how sex influences recovery and overall results.</div></div><div><h3>Methods</h3><div>We analyzed data from RTSA procedures recorded between 2006 and 2022 in a local registry, with an average age of 72 years. Linear mixed models and logistic regression models were utilized to explore associations between clinical outcomes (range of motion, function, and pain), radiological outcomes (scapular notching, bone resorption, and implant loosening), and sex up to 24 months. A mediation analysis was conducted to assess the mediating effects of negative affect between sex and pain.</div></div><div><h3>Results</h3><div>Out of 2747 RTSA cases, 1804 (65%) were performed on female patients. Differences were noted over the 24 month follow-up with males demonstrating better overall function compared to females (<em>P</em> &lt; .001). Females demonstrated increased preoperative pain levels compared to males without significant differences postsurgery. Linear mixed models revealed significant effects of sex on pain, function, flexion, and internal rotation over time. No differences were noted in any of the radiological outcomes over time. Mediation analysis showed a significant indirect effect (b = −0.107 (95% confidence interval [−0.145, −0.07], <em>P</em> &lt; .001)) between sex and postsurgical pain.</div></div><div><h3>Conclusion</h3><div>Although radiological outcomes were comparable, a detailed analysis reveals sex differences in clinically important outcomes. These differences should be considered during preoperative counseling and in risk stratification for patients undergoing RTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 263-269"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891225","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":"Thank you to our reviewers for 2024","authors":"","doi":"10.1053/j.sart.2025.01.001","DOIUrl":"10.1053/j.sart.2025.01.001","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 116-117"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284736","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":"A national shift to outpatient total shoulder arthroplasty in the United States after regulatory changes: a 10-year analysis of current trends in procedure volume, complications, and health-care utilization","authors":"Emma T. Smolev BA,&nbsp;Kenny Ling MD,&nbsp;Elizabeth Wang MD,&nbsp;Joseph Kim BS,&nbsp;Edward D. Wang MD","doi":"10.1053/j.sart.2024.12.011","DOIUrl":"10.1053/j.sart.2024.12.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;On January 1, 2021, total shoulder arthroplasty (TSA) was removed from the Medicare “Inpatient Only List”, allowing for reimbursement of outpatient TSA and broadening patient access to outpatient TSA for patients on these insurances. The purpose of this study is to analyze the trends in inpatient vs. outpatient TSA due to the regulatory change in reimbursement. In addition, we analyze differences in 30-day postoperative complications following inpatient vs. outpatient TSA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All patients who underwent TSA between 2011 and 2022 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Postoperative complications were reported within 30 days of procedure. Goodness-of-fit Chi-square test with summary statistics was employed to identify differences in 30-day complications, readmissions, and reoperations between cohorts. Statistical significance was assessed at &lt;em&gt;P&lt;/em&gt; = .05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 45,986 patients underwent TSA between 2011 and 2022. 74.7% (n = 34,341) underwent inpatient TSA. The annual volume of inpatient TSA from 2020 to 2022 had a 50% decrease (3552 to 1779). The annual volume of outpatient TSA increased by 449% (885 to 4861) during the same period. Compared to patients who underwent inpatient TSA from 2011 to 2020, the 2021-2022 inpatient TSA cohort were more likely to be age ≥75 years (&lt;em&gt;P&lt;/em&gt; &lt; .001), female gender (&lt;em&gt;P&lt;/em&gt; &lt; .001), body mass index ≥35 (&lt;em&gt;P&lt;/em&gt; &lt; .001), American Society of Anesthesiologists ≥3 (&lt;em&gt;P&lt;/em&gt; &lt; .001), dependent functional status (&lt;em&gt;P&lt;/em&gt; &lt; .001), and had significantly higher comorbidities including diabetes (&lt;em&gt;P&lt;/em&gt; = .005), chronic obstructive pulmonary disease (&lt;em&gt;P&lt;/em&gt; &lt; .001), hypertension (&lt;em&gt;P&lt;/em&gt; &lt; .001), steroid use (&lt;em&gt;P&lt;/em&gt; &lt; .001), and bleeding disorder (&lt;em&gt;P&lt;/em&gt; = .050). Amongst all outpatient TSA, patients from 2021 to 2022 were more likely to be age ≥65 years (&lt;em&gt;P&lt;/em&gt; &lt; .001), female gender (&lt;em&gt;P&lt;/em&gt; &lt; .001), body mass index ≥35 (&lt;em&gt;P&lt;/em&gt; = .001), American Society of Anesthesiologists ≥3 (&lt;em&gt;P&lt;/em&gt; &lt; .001), dependent functional status (&lt;em&gt;P&lt;/em&gt; &lt; .001), and had significantly higher comorbidities including diabetes (&lt;em&gt;P&lt;/em&gt; &lt; .001), chronic obstructive pulmonary disease (&lt;em&gt;P&lt;/em&gt; &lt; .001), congestive heart failure (&lt;em&gt;P&lt;/em&gt; = .014), and hypertension (&lt;em&gt;P&lt;/em&gt; = .039). The outpatient cohort had fewer 30-day complications and reoperations in both 2011-2020 and 2021-2022. Both inpatient and outpatient hospital length of stay decreased over time; however, the outpatient cohort had shorter hospital length of stay (&lt;em&gt;P&lt;/em&gt; &lt; .001). Mean operative time for inpatient TSA increased from 109.43 minutes (2011-2020) to 112.91 minutes (2021-2022), while the mean outpatient TSA operative time decreased from 113.86 to 102.94 minutes during the same time periods (&lt;em&gt;P&lt;/em&gt; &","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 246-253"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890587","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":"Learning curve for intraoperative computer navigation in reverse total shoulder arthroplasty by the cumulative sum method","authors":"Jun Kawamata MD ,&nbsp;Shoji Fukuta MD, PhD ,&nbsp;Yusuke Fukuta MD ,&nbsp;Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.01.002","DOIUrl":"10.1053/j.sart.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative navigation facilitates accurate glenoid component placement. However, introducing a new surgical technique inevitably entails a learning curve for surgeons. This study aimed to determine the learning curve for intraoperative navigation in reverse total shoulder arthroplasty (RSA).</div></div><div><h3>Methods</h3><div>Fifty-two consecutive patients were analyzed who underwent RSA using the ExactechGPS navigation system between January 2020 and June 2023. Total operation time and time for each surgical stage (bony landmark time, baseplate implantation time, and screw insertion time) were recorded in the navigation system. After surgery, glenoid inclination and version were measured using preoperative planning software, and the deviations in inclination (ΔInc) and version (Δver) from the preoperative plan were investigated. The correlation between the chronological case number and the study variables was evaluated. The cases were divided chronologically into groups I-V (I-IV, 10 cases; V, 12 cases) and compared for operation time, blood loss, and baseplate positioning.</div></div><div><h3>Results</h3><div>Total operation time trended downward (R² = 0.20, <em>P</em> &lt; .001) from 124.9 ± 10.2 minutes in group I to 126.8 ± 22.7 minutes in group II, 121.5 ± 16.0 minutes in group III, 108.6 ± 13.3 minutes in group IV, and 106.9 ± 10.6 minutes in group V, with a significant difference between groups I and V (<em>P</em> = .035). Screw insertion time also trended downward (R² = 0.16, <em>P</em> &lt; .001); the difference between group I and groups IV and V was significant (I vs. IV, <em>P</em> = .044; I vs. V, <em>P</em> = .017). No significant differences in trends were found in the other stages (bony landmark time, R² = 0.02, <em>P</em> = .37; baseplate implantation time, R² = 0.07, <em>P</em> = .08) or in blood loss. For baseplate positioning, the mean deviation of the achieved inclination from that planned was 2.5° (range, 0°-7.6°). The mean deviation of the achieved version from that planned was 2.7° (range, 0°-8.4°). There was no significant difference in Δinc or Δver among the groups. No learning curve was observed in terms of Δinc (R² = 0.05, <em>P</em> = .09) or Δver (R² = 0.006, <em>P</em> = .59).</div></div><div><h3>Conclusion</h3><div>Total operation and screw insertion times in RSA trended downward following the introduction of intraoperative navigation. In our experience, about 30 cases were required to shorten the operation time. The learning curve for intraoperative navigation resulted in high accuracy within 3° for both inclination and version immediately after its introduction.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 254-262"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891224","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":"Changes from baseline in patient-reported outcomes and patient satisfaction do not vary significantly between 1 and 2 years postoperatively after shoulder arthroplasty: a multicenter analysis of 2580 patients","authors":"Midhat Patel MD ,&nbsp;Molly G. Sekar MD ,&nbsp;Lea McDaniel MD ,&nbsp;Haroon M. Kisana MD ,&nbsp;Joshua B. Sykes MD ,&nbsp;Michael H. Amini MD","doi":"10.1053/j.sart.2024.12.010","DOIUrl":"10.1053/j.sart.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>At the present time, most orthopedic journals require 2 years of follow-up data for clinical studies. However, it is unclear if there are significant changes in patient-reported outcomes (PROs) between 1 and 2 years postoperatively. The current study sought to evaluate changes in PROs between 1 and 2 years postoperatively after shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A prospective, multicenter registry was queried for all patients that underwent primary total shoulder arthroplasty, primary reverse shoulder arthroplasty (RSA), revision RSA, and RSA for fracture. Patients with preoperative, 6-month, 1-year, and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) scores were included. We evaluated mean ASES scores, Δ (improvement from preoperative) ASES, and Percent Maximum Possible Improvement. We also evaluated achievement of Clinically Significant Outcomes (CSOs) for the ASES score, including the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptom State. Patient satisfaction questionnaires were also evaluated.</div></div><div><h3>Results</h3><div>A total of 2580 patients were identified that underwent shoulder arthroplasty for all indications with full follow-up data. Overall, changes between 1 and 2 years postoperatively were minimal: ASES score 0.8, Δ ASES 0.8, and % Maximum Possible Improvement 1.6%. Similarly, the percentage of patients who achieved CSOs was minimally different at 1 and 2 years: Minimal Clinically Important Difference −0.4%, Substantial Clinical Benefit 1.1%, and Patient-Acceptable Symptom State 2.4%. Subgroup analyses of all primary arthroplasties, primary total shoulder arthroplasty, primary RSA, revision RSA, and RSA for proximal humerus fracture revealed similar, minimal changes from 1 to 2 years postoperatively. Overall, less than 5% of patients changed their responses to any of the satisfaction questions between 1 and 2 years: 4.1% of patients changed their answer with respect to pain, 2.8% with respect to function, 3.9% with respect to activities of daily living, and 2.5% with respect to ability to return to sports.</div></div><div><h3>Conclusion</h3><div>PROs, achievement of CSOs, and patient satisfaction are minimally different at 1 and 2 years after shoulder arthroplasty. This data suggests that accepting 1-year, rather than 2-year, outcomes for short-term reporting of shoulder arthroplasty may facilitate improvement in follow-up rates with less risk of bias due to loss to follow-up, more timely dissemination of information, and decreased administrative burden. This does not change the need for midterm and long-term studies.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 235-245"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890643","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":"Incidence of 30- and 90-day readmission rates after revision shoulder arthroplasty in the United States","authors":"Tej Joshi MD ,&nbsp;Daniel Calem MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Suleiman Sudah MD ,&nbsp;Dhruv Mendiratta BS ,&nbsp;Isabella Blanchard BS ,&nbsp;John Erickson MD","doi":"10.1053/j.sart.2024.12.009","DOIUrl":"10.1053/j.sart.2024.12.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The incidence of shoulder arthroplasty is increasing at an exponential rate. This comes with an inherently associated increase in revision shoulder arthroplasty. Due to the increasing prevalence of revision surgery, combined with a decrease in reimbursement and high healthcare cost of revision surgery, minimizing additional healthcare expenditure is of interest. The purpose of this study is to provide an in-depth analysis of readmission rates after revision shoulder arthroplasty to potentially help reduce overall healthcare expenditure and improve systematic efficiency regarding patient care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The Nationwide Readmissions Database was queried for revision shoulder arthroplasty procedures performed in the United States between 2016 and 2018 utilizing the ICD-10 Procedure Coding System. The national incidence was calculated, including patient demographics, comorbidities, facility characteristics, and overall rates and causes of both 30- and 90-day readmissions after revision shoulder arthroplasty procedure. The revision groups were then further subdivided into single component revisions and explantations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 31,289 revision shoulder arthroplasty cases estimated using weighted values. The average age of patients undergoing a revision procedure was 66.9, and of which 50.2% were females. The average length of stay was 2.9 days with total hospital charges averaging $82,314.76 per admission. Patients were more commonly discharged home vs. to a rehab facility (86.5% vs. 12.9%) and Medicare was the most common payer (67.9%). The average all-cause 30-day readmission rate was 3.09%. The average all-cause 90-day readmission rate was 3.58% when all-cause 30-day readmissions were excluded. For single component procedures, the most common surgical diagnosis for 30-day and 90-day readmissions was dislocation (5.56% and 2.48%, respectively). For explantation procedures, the most common surgical diagnosis for 30-day readmission was dislocation, followed by infection (1.49% vs. 0.90%, respectively). At 90 days, infection was the most common (1.04%). Cumulatively, the most common surgical diagnosis for readmission was dislocation followed by infection at both 30-days (1.81% and 0.9-%, respectively) and 90-days (1.09% and 1.02%, respectively). Atrial fibrillation followed by acute kidney failure was the most common medical diagnosis at both 30- (0.27% and 0.16%, respectively) and 90-day readmissions (0.17% and 0.12%, respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Revision shoulder arthroplasty poses a cumulative risk of readmission within 30- and 90-days of 3.09% and 3.58%, respectively, with most readmissions occurring within the first 30 days. The most common overall diagnoses associated with readmission following a revision shoulder arthroplasty procedure were dislocation and infection with acute kidney failure being the most common medical diagnos","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 226-234"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890642","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":"No age cutoff accurately prognosticates the likelihood of 30-day medical complications, unplanned readmissions, and death after elective primary total shoulder arthroplasty","authors":"Timothy R. Buchanan BS ,&nbsp;Victoria E. Bindi BS ,&nbsp;Keegan M. Hones MD, MS ,&nbsp;Joseph J. King MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Kevin A. Hao MD","doi":"10.1053/j.sart.2024.12.008","DOIUrl":"10.1053/j.sart.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Many surgeons and practices have adopted age cutoffs for performing total shoulder arthroplasty (TSA). The purpose of this study was to determine whether there exists an age cutoff of increased risk for 30-day medical complications, unplanned readmissions, and death after elective TSA.</div></div><div><h3>Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients aged 40-89 who underwent elective primary TSA from 2012 to 2020. Receiver operator curve analysis was used to attempt to identify a threshold in age that discriminated likelihood of a 30-day postoperative medical complications, unplanned readmissions, or death. The area under the curve (AUC) and the Matthews Correlation Coefficient (MCC) were determined for each model to identify their predictive value (AUC of 0.5 and MCC of 0 reflect no better than chance). Analyses were performed on the overall cohort and subcohorts stratified by sex, body mass index, and 5-item modified frailty index (mFI-5).</div></div><div><h3>Results</h3><div>We included 31,741 patients (56% female) that underwent elective primary TSA. 21% of patients had an mFI-5 of ≥2. The rate of 30-day postoperative medical complications, unplanned readmissions, and death was 6.3%, with unplanned readmissions (2.8%), intraoperative or postoperative transfusions (2.1%), and urinary tract infections (0.7%) being the most common complications. The AUC and MCC for the 30-day medical complications in the overall cohort (age threshold: 74-years old) were 0.59 and 0.08, respectively, reflecting poor predictive value. After stratifying based on sex, body mass index, and mFI-5, the highest AUC and MCC values obtained were 0.62 and 0.14, reflecting poor predictive value.</div></div><div><h3>Conclusion</h3><div>Age cutoffs poorly predict the risk of 30-day medical complications, unplanned readmissions, or death after elective TSA. Rather than a strict age cutoff, surgeons should consider multivariable risk stratification tools and clinical acumen to identify patients at risk for early postoperative medical complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 218-225"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890641","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":"Inflammatory bowel disease is an independent predictor for complications following total shoulder arthroplasty","authors":"Jason Silvestre MD ,&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.2024.12.007","DOIUrl":"10.1053/j.sart.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>The demand for total shoulder arthroplasty (TSA) in patients with inflammatory bowel disease (IBD) is expected to increase. The purpose of this study is to determine the perioperative outcomes in patients with IBD (Crohn’s disease [CD] and ulcerative colitis [UC]) compared to those without IBD following primary TSA.</div></div><div><h3>Methods</h3><div>The National Readmission Database was queried to identify 683 patients with CD and 566 patients with UC undergoing primary TSA between 2010 and 2020. Case–control matching generated controls in a 1:3 proportion based on age, sex, and preoperative medical diagnoses. Primary outcomes included postoperative medical and surgical complications, clinical outcomes within 180 days, total hospital length of stay, discharge disposition, and total costs of care after TSA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multivariate analyses identified independent risk factors for postoperative complications after TSA.</div></div><div><h3>Results</h3><div>Compared to matched controls, patients with CD undergoing TSA had higher odds of complications including sepsis (OR 35, CI, 8.2-148), dislocation (OR 27, 3.4-211), prosthetic loosening (OR 21, 2.5-168), transfusion requirement (OR 8.9, CI, 2.9-28), and acute respiratory distress syndrome (OR 8.5, CI, 3.3-22). Compared to matched controls, patients with UC undergoing TSA had higher odds of sepsis (OR 15, CI, 1.7-129), acute respiratory distress syndrome (OR 7.9, CI, 2.8-22), and acute renal failure (OR 3.2, CI, 1.7-6.0). No differences in rates of readmission, revision TSA, or mortality were observed between the 2 groups relative to their controls. Total cost of care ($20,808 vs. $17,488) was higher in patients with UC. However, length of stay and discharge disposition was similar to matched controls for both CD and UC patients. On multivariate analysis, CD and UC were identified as independent risk factors for medical and implant-related complications, including dislocation and prosthetic loosening (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>IBD is an independent risk factor for higher rates of medical and surgical complications following primary TSA. This information can help orthopedic surgeons appropriately counsel patients with IBD on the risks following TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 210-217"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890640","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":"Using machine learning to predict postoperative complications of total shoulder arthroplasty","authors":"Carter M. Powell BA,&nbsp;William N. Newton MD,&nbsp;Robert J. Reis BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.12.006","DOIUrl":"10.1053/j.sart.2024.12.006","url":null,"abstract":"<div><h3>Background</h3><div>Previous efforts to use machine learning to predict complications following primary total shoulder arthroplasty (TSA) have shown promise, but the clinical significance of such predictive models has been limited by inadequate sample sizes and short (∼30 day) follow-up periods. The Nationwide Readmissions Database, with a large sample size and longer follow-up period, has the potential to reduce the noise of previous modeling efforts. The purpose of this study is to evaluate the accuracy and effectiveness of 4 different models for predicting 180-day complications, extended length of stay (LOS), and mechanical failures in patients undergoing primary TSA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried for patients who underwent TSA from 2016 to 2020. Primary outcomes were complications within 180 days, extended LOS (defined as &gt;2 days), and mechanical failure. For each outcome, 4 models were created using Python v3.9. Models included a weighted logistic regression, random forest classifier, gradient boosting classifier, and an artificial neural network. Model performance was assessed using accuracy, area under the receiver operating characteristic curve (area under the curve [AUC]), sensitivity, positive predictive value (PPV), and F1 score.</div></div><div><h3>Results</h3><div>A total of 178,003 patients underwent primary TSA from 2016 to 2020. For predicting 180-day complications, gradient-boosted classification had the highest discriminative ability and sensitivity (accuracy: 0.69, AUC: 0.71, sensitivity: 0.59, PPV: 0.21, and F1: 0.31). For predicting extended LOS, an artificial neural network proved most effective (accuracy: 0.79, AUC: 0.82, sensitivity: 0.67, PPV: 0.43, and F1: 0.52; Table II). For mechanical complications, all models were equally poor at predicting complications.</div></div><div><h3>Conclusion</h3><div>Machine learning has the potential to accurately predict rare outcomes from heterogenous data; however, the quality of predictive models is dependent on the quality of the input data. Although machine-learning models are superior to simpler methods at predicting certain outcomes, such as extended LOS, they currently lack the sensitivity and PPV to be clinically significant.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 203-209"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890639","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":"Functional deficiencies following reverse and anatomic total shoulder arthroplasty: detecting true differences","authors":"Jeffrey R. Hill MD ,&nbsp;Arakua N. Welbeck MD ,&nbsp;Jeffrey J. Olson MD ,&nbsp;Alexander W. Aleem MD ,&nbsp;Jay D. Keener MD ,&nbsp;Benjamin M. Zmistowski MD","doi":"10.1053/j.sart.2024.12.005","DOIUrl":"10.1053/j.sart.2024.12.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Reverse total shoulder arthroplasty (rTSA) has gained traction as a reliable treatment option for glenohumeral osteoarthritis (GHOA). Much of this pivot from anatomic total shoulder arthroplasty (aTSA) to rTSA has centered on the described lower revision rates in the latter, as well as the reported equivalence in composite patient-reported outcomes between the two modes of TSA. Yet, this fails to highlight the nuanced effects each can have on everyday activities. This retrospective study aims to identify specific tasks that remain difficult for patients after TSA for GHOA and assess the difference in ability to perform specific daily tasks between aTSA and rTSA for GHOA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients with minimum 2-year follow-up after undergoing TSA for GHOA were identified from a single-institution registry. Patient-reported outcome data from the American Shoulder and Elbow Surgeons (ASES), Western Ontario Osteoarthritis of the Shoulder (WOOS) index, and Single Assessment Numeric Evaluation surveys were collected at 2-year follow-up. Composite scores as well as each individual component score were compared between the two arthroplasty types by univariate analysis. When a difference in a component was found, further analysis was performed using multivariate linear regression (WOOS) or a multivariate logistic regression (ASES), while controlling for potential confounding variables. All analyses were performed in SPSS (version 28.0; IBM; Armonk, NY, USA).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;317 TSAs were identified with two-year follow-up (mean age 67.2 years, 53.9% males), with 219 being anatomic TSA (69.1%). Postoperatively, there was gross improvement in visual analog scale pain (&lt;em&gt;P&lt;/em&gt; &lt; .001) and ASES scores (&lt;em&gt;P&lt;/em&gt; &lt; .001), with improvements noted in each ASES functional component (&lt;em&gt;P&lt;/em&gt; &lt; .001). No differences were noted in all composite survey scores between aTSA and rTSA (&lt;em&gt;P&lt;/em&gt; &gt; .15). Across the entire cohort, there was continued difficulty with behind-the-back and overhead activities. While rTSA patients reported better postoperative stiffness (&lt;em&gt;P&lt;/em&gt; = .02), they also noted more difficulty in tasks including washing their backs/doing up a bra (ASES, &lt;em&gt;P&lt;/em&gt; = .001), tucking in a shirt (WOOS, &lt;em&gt;P&lt;/em&gt; = .01), styling hair (WOOS, &lt;em&gt;P&lt;/em&gt; = .02) and lifting 4.54 kg (10 lbs) above shoulder level (ASES, &lt;em&gt;P&lt;/em&gt; = .001). Even when adjusting for confounding variables, rTSA was an independent predictor for decreased ability to tuck in shirt (WOOS, &lt;em&gt;P&lt;/em&gt; &lt; .001) and put on a coat (ASES; &lt;em&gt;P&lt;/em&gt; = .03)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study illustrates the subtle differences in postoperative function in patients treated with aTSA versus rTSA for GHOA, most notably in overhead and behind-the-back activities. This knowledge provides surgeons and patients with greater understanding of the true differences in anticipated outcomes between","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 195-202"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890589","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}