Seminars in Arthroplasty最新文献

{"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}

{"title":"Morphometry of the proximal humerus and the relationship to global offset","authors":"John J. Heifner MD ,&nbsp;Gabriel Pertierra MD ,&nbsp;Austin T. Vegas DO ,&nbsp;Robert J. Rowland DO ,&nbsp;Deana M. Mercer MD ,&nbsp;Jorge L. Orbay MD","doi":"10.1053/j.sart.2024.07.005","DOIUrl":"10.1053/j.sart.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Previous research has consistently identified the medial and posterior offset of the native humeral head in relation to the intramedullary canal. These anatomic parameters and others such as humeral head and intramedullary diameter provide valuable insight for prosthesis development. However, it is critical to understand the relationship of morphometry to the native center of rotation. Our objective was to use 3-dimensional analysis to demonstrate the native morphometry of the proximal humerus and those relationships to global offset.</div></div><div><h3>Methods</h3><div>Fourteen cadaveric humeri were manually measured then digitally analyzed following 3-dimensional scanning. Pearson’s r was used to determine the relationship between variables.</div></div><div><h3>Results</h3><div>The mean digital humeral head diameter (Hd^d) was 46.5 (± 4.67) mm and the mean manual humeral head diameter was 46.8 (± 4.42) mm. The mean global offset (GO) was 6.36 (± 2.21) mm, and the mean best fit sphere diameter was 46.5 (± 4.63) mm. Pearson’s r = 0.58 (95% confidence interval 0.07-0.84, <em>P</em> = .021) for GO and Hd^d which indicates a moderate correlation. Pearson’s r = 0.96 (95% confidence interval 0.89-0.99, <em>P</em> &lt; .001) for Hd^d and manual humeral head diameter which indicates a strong correlation.</div></div><div><h3>Discussion</h3><div>Native GO demonstrated a moderately positive correlation to humeral head diameter. The manual measurement of head diameter was strongly correlated to the 3-dimensional software value which reinforces the importance of intraoperative measurement. These data contribute to further understanding of shoulder morphometry which is integral to prosthesis design which impacts postoperative function and complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 907-914"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747735","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":"Prediction of overnight stay following shoulder arthroplasty utilizing machine learning","authors":"Benjamin Miltenberg MD ,&nbsp;Teja Yeramosu MD ,&nbsp;William L. Johns MD ,&nbsp;Gabriel Onor MD ,&nbsp;Brandon Martinazzi MD ,&nbsp;Michael Chang MD ,&nbsp;Surena Namdari MD","doi":"10.1053/j.sart.2024.07.010","DOIUrl":"10.1053/j.sart.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) has evolved from requiring extended inpatient hospital stays to favoring same-day discharges, influenced by improved surgical techniques, patient optimization, and the risks associated with inpatient stays. The removal of TSA from Medicare's inpatient-only list in 2021 underscores this shift. However, the need for accurate prediction of post-TSA admission remains, as hospital admissions are costly and linked to increased morbidity and mortality. Machine learning algorithms offer potential advantages over traditional predictive models by identifying complex, nonlinear relationships. This study aimed to demonstrate and compare the performance of commonly used machine learning algorithms to predict overnight hospital stay (OHS) admission.</div></div><div><h3>Methods</h3><div>This study used data from the American College of Surgeons National Quality Improvement Program 2021 database to analyze patients who underwent primary, elective TSA. Patients were divided into short hospital stay of 0-1 days and OHS of &gt;1 day cohorts. Machine learning models, including Random Forest, Artificial Neural Network (ANN), Gradient Boosted Tree, Naïve Bayes, and Support Vector Machine, were trained and validated to predict OHS. The models' predictive capacities were compared using the area under the receiver operating characteristics curve, calibration, and decision curve analysis.</div></div><div><h3>Results</h3><div>Out of 5811 patients analyzed, 926 (15.9%) were discharged on the same day. The ANN model demonstrated the highest area under the receiver operating characteristics curve (0.811), indicating superior predictive ability. Important variables influencing OHS predictions included operative time, body mass index, functional status, and patient demographics, such as age, race, and home support. Machine learning models showed better predictive performance than multivariate logistic regression.</div></div><div><h3>Conclusion</h3><div>Machine learning models, particularly the ANN model, outperform traditional regression methods in predicting post-TSA admission, highlighting their utility in optimizing patient selection for outpatient surgery. These models identify important variables associated with increased risk of OHS, aiding in preoperative planning and patient counseling. Integrating machine learning into clinical practice may enhance surgical outcomes and patient satisfaction while reducing health-care costs.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 943-952"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748286","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":"Bariatric surgery patients have 5-year risk of revision following total shoulder arthroplasty comparable to that of class III obesity patients","authors":"Sanjay Kubsad BS ,&nbsp;Arman Kishan MBBS ,&nbsp;Jordan Holland MPH ,&nbsp;Henry Maxwell Fox MD ,&nbsp;Jacob D. Mikula MD ,&nbsp;Sarah Y. Nelson MD, MS ,&nbsp;Umasuthan Srikumaran MD, MPH, MBA","doi":"10.1053/j.sart.2024.05.005","DOIUrl":"10.1053/j.sart.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Obesity has been correlated with heightened risk of complications after orthopedic surgeries. Bariatric surgery (BS) is an effective tool commonly utilized for the reduction of body mass index. However, the impact of BS on complications in total shoulder arthroplasty (TSA) remains inadequately investigated. This study examines the 5-year risk of revision following TSA in patients with a history of BS compared to matched cohorts without history of BS.</div></div><div><h3>Methods</h3><div>Utilizing the PearlDiver Mariner database, a retrospective cohort analysis was conducted on over 157 million U.S. patients from January 2010 to October 2021. Inclusion criteria identified patients undergoing primary TSA with a minimum 2-year follow-up. Propensity-score matching was employed to control for covariates, comparing BS patients with a matched control and a matched class III obesity control without history of BS. Demographics, comorbidities, and outcomes, including 5-year cumulative incidence of revision were analyzed.</div></div><div><h3>Results</h3><div>The 5-year cumulative incidence of all-cause revision within the BS group was found to be 4.6%. While this represented a higher risk than that of the general population (hazard ratio 1.70; 95% confidence interval 1.21-2.39), there was no significant difference when compared to controls with class III obesity. The BS cohort had higher risk of revision secondary to dislocation/subluxation and rotator cuff tear than in the general population. When compared to the class III obesity cohort, only the risk of revision due to rotator cuff tear was found to be higher.</div></div><div><h3>Conclusion</h3><div>Individuals with a history of BS showed a higher risk of revision than a cohort without history of BS and an equivalent risk of revision compared to a cohort of class III obesity controls after undergoing TSA. Though obesity is an important risk factor for complications after TSA, BS might not be an effective tool for preoperative risk optimization.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 827-831"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748292","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":"Anatomic total shoulder arthroplasty using hybrid glenoid fixation with a porous-coated titanium post. Two- to ten-year follow-up of 256 cases with primary glenohumeral osteoarthritis","authors":"Adriano Axel Ceccotti MD ,&nbsp;Mikkel Toettrup MD, PhD ,&nbsp;Anica Morch MD ,&nbsp;Hans-Christen Husum MD ,&nbsp;Steen L. Jensen MD, PhD","doi":"10.1053/j.sart.2024.06.006","DOIUrl":"10.1053/j.sart.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty is one of the recommended surgical treatments for severe glenohumeral osteoarthritis, providing good pain relief and function. Aseptic loosening of the glenoid component, however, is a major cause for revision. Hybrid components have been introduced, combining traditional cemented fixation with porous titanium bone ingrowth to improve fixation. The purpose of this study was to report our midterm to longterm experience using such a component, including clinical outcomes and implant survival.</div></div><div><h3>Methods</h3><div>We reviewed all patients who were operated for primary osteoarthritis during the period 2011-19, leaving a minimum of 2-year follow-up. The severity of the osteoarthritis was graded using Samilson-Prieto score, while glenoid morphology was graded using the modified Walch classification. Clinical outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index, EQ-5D-5L, and Constant-Murley score. Postoperative radiographs were analyzed for radiolucent lines. Patient records were studied for complications including revisions. Supplementary data for revision and outcome were obtained from the Danish Shoulder Arthroplasty Registry. Kaplan-Meier estimates for implant survival were calculated.</div></div><div><h3>Results</h3><div>A total of 256 arthroplasties in 224 patients were included (mean age: 69 years ± 9 years, 149 females). 81% of cases were graded radiographically as severe osteoarthritis, according to Samilson-Prieto. Walch type B1 was most commonly followed by B2 (29% and 28% respectively). The mean follow-up time was 49 months (range 24-127). The response rate for patient reported outcomes was 91%. The median WOOS index was 94% (81%-99%), the median EQ-5D-5L was 0.87 (0.69-0.95), and the mean Constant-Murley score was 75 (SD 17.7). 13 cases (6%) had a WOOS index below 50%. 8.2% had complications related to surgery. A radiolucent line had developed around the central post in six cases and at the bone-cement interface in three cases at follow-up. Six cases had been revised (2.3%); three due to aseptic loosening of the glenoid. The 10-year survival estimate was 95.6 % (95% CI: 87.9%-98.5%).</div></div><div><h3>Conclusion</h3><div>Anatomic total shoulder arthroplasty with hybrid glenoid fixation provides excellent clinical outcome with a low complication rate in patients, with primary glenohumeral osteoarthritis. The 10-year survival rate is high and comparable to that reported for the best- performing all-polyethylene components. Longer observation is needed to see if hybrid fixation will outperform standard all-cemented components.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 867-876"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699314","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":"Rate of polyethylene wear correlates with earlier glenoid implant failure in anatomic total shoulder arthroplasty with cemented all-polyethylene glenoid components","authors":"Isadora D. Guarino MD, MEng ,&nbsp;Peter J. Shaughnessy MD ,&nbsp;Jacob S. Torrey MD ,&nbsp;John-Erik Bell MD, MS ,&nbsp;Douglas W. Van Citters PhD","doi":"10.1053/j.sart.2024.07.003","DOIUrl":"10.1053/j.sart.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid component loosening is the most common cause of anatomic total shoulder arthroplasty failure, and osteolysis is a common intraoperative and radiographic finding associated with these failed arthroplasties. While preclinical testing can estimate failure mode and wear rates in the laboratory, there is limited in vivo data measuring polyethylene wear rate and location.</div></div><div><h3>Methods</h3><div>Using an institutional review board–approved total joint arthroplasty retrieval collection, 56 cemented all-polyethylene glenoid components from eleven different manufacturers were analyzed for in vivo dimensional change. We used the differential thickness measurement between the anteroposterior and superoinferior axes of each radially symmetrical implant to determine the dimensional change along that axis. A physiologic wear vector was determined for each retrieved device.</div></div><div><h3>Results</h3><div>The implants had a median dimensional change of 0.13 mm/year (range 0.01-1.01mm/year) and the 25^th and 75^th percentiles were 0.060 and 0.22 mm/year, respectively. The average time to revision of devices with &lt;0.1mm/year of wear was 140.9 months, while the averages for devices between 0.1-0.2mm/year and ≥0.2mm/year were 80.7 and 54.0 months, respectively. Devices with ≥0.2mm/year of wear had significantly shorter time to revision than those with &lt;0.1mm/year (<em>P</em> = .0006). The devices had a similar material loss distribution in both superior-inferior and anterior-posterior directions, with 29 (52%) devices having a greater material loss in the superior-inferior distribution and the remaining 27 (48%) devices in the anterior-posterior axis. The physiologic wear vector had a mean of 47.3 degrees, with a relatively even distribution across all angles, suggesting that glenoid component loosening can occur along multiple axes.</div></div><div><h3>Conclusion</h3><div>We conclude that polyethylene wear is a contributing factor for early failure of cemented all-polyethylene glenoid implants and that anatomic total shoulder arthroplasty may benefit from advances in polyethylene processing. We also suggest that in vitro testing of new polymers and designs should incorporate motion vectors beyond the traditional IS rocking horse test.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 893-899"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840170","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":"Conversion of failed anatomic total shoulder replacement with severe glenoid bone defect to humeral hemiarthroplasty","authors":"Oscar Covarrubias MD ,&nbsp;Brandon Portnoff MD ,&nbsp;Keiko Amano MD ,&nbsp;Vadim Molla MD ,&nbsp;Andrew Green MD","doi":"10.1053/j.sart.2024.10.003","DOIUrl":"10.1053/j.sart.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid component loosening is a common cause of late failure after anatomic total shoulder arthroplasty (aTSA) and revision can be challenging due to glenoid bone loss. Revision to reverse shoulder arthroplasty requiring glenoid bone graft is associated with relatively high failure rates. Revision to humeral hemiarthroplasty (HHA) is an alternative. The purpose of this study was to evaluate the outcomes of revision of failed aTSA, with severe glenoid bone loss and intact rotator cuff to HHA.</div></div><div><h3>Methods</h3><div>This was a retrospective study of 18 patients (12 males) with failed aTSA, intact rotator cuff, and severe glenoid bone loss who were revised to HHA at a mean age of 68.9 ± 9.2 years and 9.0 ± 4.1 years after index aTSA. Mean follow-up was 7.6 ± 5.7 years. Glenoid defects were uncontained in 6 (33%). Glenoid bone grafting was performed in 11 (61%). A larger humeral head was used in 15 (83%) cases. Outcomes were assessed with the Simple Shoulder Test (SST), VAS pain, VAS quality of life (QoL), and shoulder range of motion. Plain radiographs were analyzed.</div></div><div><h3>Results</h3><div>There were significant improvements in SST (<em>P</em> = .005) and VAS pain (<em>P</em> &lt; .001). Mean active forward elevation improved from 106 ± 36° to 120° ± 21° (<em>P</em> = .062). MCID for SST was met in 7 (39%) and VAS pain in 11 (61%). At final follow-up, 11 patients (61%) were satisfied with their current symptoms, 2 (11%) rated their satisfaction as neutral, and 5 (28%) were dissatisfied. There was progressive humeral medialization in 8 that was not significantly associated with the use of glenoid bone grafting (<em>P</em> = .912). Greater humeral medialization was strongly correlated with less improvement in SST (ρ = 0.68) and VAS QoL (ρ = −0.64). Seven patients had ≥ 2 positive intraoperative cultures, all <em>Cutebacterium acnes</em>. Three patients (17%) underwent subsequent revision to treat persistent pain and dysfunction; 1 to HHA, 2 to reverse shoulder arthroplasty.</div></div><div><h3>Conclusion</h3><div>Revision of failed aTSA with severe glenoid bone loss and functional rotator cuff to HHA can provide improved pain and patient reported outcome with low complication and re-revision rates and should be considered in selected cases.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 106-115"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284738","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":"Reconstruction after shoulder resection for tumors: comparison between allograft prosthetic composite and reverse shoulder arthroplasty with cement sleeve","authors":"Lisa Peduzzi MD ,&nbsp;Clement Ferri MD ,&nbsp;Coraline Houpin MD ,&nbsp;Andrea Fernandez MD ,&nbsp;Francois Sirveaux MD, PhD","doi":"10.1053/j.sart.2024.10.004","DOIUrl":"10.1053/j.sart.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus is a common site for primary bone tumors and metastatic disease. Reconstruction with reverse shoulder arthroplasty (RSA) after resection is a surgical challenge and presented a high risk of complication.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study to identify outcomes of 2 types of reconstruction: allograft prosthetic composite (APC) and RSA with cement sleeve. We analyzed demographic characteristics, clinical outcomes at &gt;2 years, complications, further surgery, and death.</div></div><div><h3>Results</h3><div>We included 32 patients, at a mean age of 46 years. Fourteen (44%) were metastatic at the time of diagnosis. Eighteen underwent RSA with cement sleeve reconstruction, and 14 underwent APC. Death, complication, reintervention, and revision were analyzed in the 32 patients. The mean humeral resection length was 11 cm. Twelve patients (37.5%) died, at mean 1.8 years after surgery. Neither having an invaded margin (<em>P</em> = .21), having a pathological fracture at the time of the surgical intervention (<em>P</em> = .88), nor being metastatic at the time of diagnosis (<em>P</em> = .07) was associated with an increased risk of death. The complication rate was 50%, the reintervention rate was 16%, and the revision rate was 16%. There was no difference in complication, reintervention, and revision rate between the APC and the cement sleeve group. Twenty-one patients were available for clinical analysis at &gt; 2-year follow-up (mean 46 months). There was no statistical difference in the total Constant score between the cement sleeve group (mean 54 points) and the APC group (mean 59 points), <em>P</em> = .75. There was no difference for AAE at last follow-up between the 2 groups (99.3 points for the cement sleeve group versus 117 points for the APC group, <em>P</em> = .45).</div></div><div><h3>Conclusion</h3><div>RSA is a suitable option for reconstruction after resection of the proximal humerus. The cement sleeve seems to provide acceptable outcomes without increased risk of complication or further surgery. This option could be considered in metastatic or frail patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 119-126"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890494","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 GLP-1 receptor agonists on postoperative outcomes following total shoulder arthroplasty","authors":"Ankit Choudhury BA,&nbsp;Matthew Van Boxtel MD,&nbsp;Jessica Hanley MD","doi":"10.1053/j.sart.2024.10.001","DOIUrl":"10.1053/j.sart.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Total Shoulder Arthroplasty (TSA) is a commonly performed orthopedic procedure for shoulder arthritis. Type II Diabetes Mellitus (T2DM) has been associated with negative postoperative outcomes following TSA. Glucagon-like peptide-1 receptor (GLP-1) agonists are increasingly popular drugs that have proven to be effective in the management of T2DM. To date, there is no study evaluating the complication profile following TSA of patients taking GLP-1 agonists.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted on patients from the TriNetX Database who underwent TSA between January 2018 and December 2023. All patients had a diagnosis of T2DM at the time of index procedure. Patients were stratified into two groups according to their GLP-1 agonist prescription status. Medical complications that occurred within 90 days and surgical complications that occurred within 2 years of index procedure were collected. A univariate logistic regression analysis was conducted to examine the initial connection between the active use of GLP-1 agonists and postoperative outcomes. Subsequently, an inverse propensity score-weighted binary logistic regression was used to adjust for potential biases.</div></div><div><h3>Results</h3><div>A total of 8254 patients met our inclusion criteria. The “non-GLP-1” and “GLP-1” groups included 7749 and 505 patients, respectively. The use of GLP-1 agonists did not incur increased risk of any medical or surgical complications following TSA. Our unadjusted analysis demonstrated that the use of GLP-1 agonists was significantly associated with lower odds of mortality within 90 days of surgery (OR 0.17, 95% CI 0.0043-0.99, <em>P</em> = .0435). GLP-1 agonist use was associated with decreased risk of mortality within 90 days when subjected to inverse propensity score-weighted analysis (OR 0.077, 95% CI 0.011-0.554, <em>P</em> = .011). The use of GLP-1 agonists was not a predictor for any other medical or surgical complications in inverse-propensity score weighted-analysis, although decreased risk of wound dehiscence approached significance (OR 0.256, 95% CI 0.061-1.074, <em>P</em> = .063).</div></div><div><h3>Conclusion</h3><div>Preoperative GLP-1 agonist use is associated with reduced 90-day mortality in T2DM patients undergoing TSA, without increasing other postoperative complications. These findings support the continued use of GLP-1 agonists in perioperative management to optimize surgical outcomes in this patient population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 94-99"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284974","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}