Seminars in Arthroplasty最新文献

{"title":"The effect of socioeconomic status on clinical outcomes and implant survivorship after revision shoulder arthroplasty","authors":"Anton Khlopas MD ,&nbsp;Akshay R. Reddy BS ,&nbsp;Kevin A. Hao BS ,&nbsp;Logan Wright BA ,&nbsp;Wojciech K. Dzieza MD ,&nbsp;Joseph J. King MD ,&nbsp;Jonathan O. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Kevin Farmer MD ,&nbsp;Thomas W. Wright MD","doi":"10.1053/j.sart.2024.12.001","DOIUrl":"10.1053/j.sart.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Low socioeconomic status (SES) has been shown to correlate with poorer preoperative and postoperative pain and functional scores in patients undergoing joint arthroplasty. The aim of this study was to investigate the effect of SES on baseline and postoperative outcome scores and implant survivorship after revision shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively collected single-institution database was performed to identify patients who underwent revision shoulder arthroplasty. Patient zip codes were used to identify their corresponding national area deprivation index (ADI) rank. A correlation analysis between national ADI rank and preoperative, postoperative, and preoperative to postoperative improvement in range of motion, shoulder strength, and clinical outcome scores in patients with minimum 2-year follow-up was performed. In addition, patients were grouped according to their national ADI rank (0-50, 51-75, and 76-100) to compare achievement of the minimum clinically important difference (MCID), substantial clinical benefit, patient acceptable symptom state, and revision-free implant survivorship.</div></div><div><h3>Results</h3><div>A total of 141 revision shoulder arthroplasties with a mean follow-up of 5.0 ± 2.8 years were included. No correlation between national ADI rank and any preoperative or postoperative outcome measure was identified. In addition, there was no difference in the achievement of the MCID, substantial clinical benefit, and patient acceptable symptom state for all outcome measures except a greater proportion of patients with an ADI rank between 51 and 75 achieving the MCID for the Constant score (<strong><em>P</em> = .031</strong>). There was no difference in implant survivorship between ADI groups (<em>P</em> = .912).</div></div><div><h3>Conclusion</h3><div>Lower SES was not associated with poorer preoperative or postoperative pain and functional outcomes, neither there is a greater risk of implant failure necessitating rerevision. These findings contrast the previously recognized role of SES on primary joint replacement outcomes, suggesting that other factors such as the failure mode of primary TSA (ie, the indication for revision TSA) may have a greater role in determining the preoperative presentation and prognosis of revision TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 166-173"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891221","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":"Re-evaluating the metal-backed glenoid in anatomic total shoulder arthroplasty","authors":"Nathan Sarli BS ,&nbsp;Kassem Ghayyad MD ,&nbsp;Samuel Harmsen MD ,&nbsp;G. Russell Huffman MD, MPH","doi":"10.1053/j.sart.2024.12.002","DOIUrl":"10.1053/j.sart.2024.12.002","url":null,"abstract":"<div><div>The idea of metal-backed glenoid (MBG) components offers a promising alternative to traditional all-polyethylene (PE), cemented glenoid implants in total shoulder arthroplasty (TSA). Despite the historically high success rate of TSA, challenges such as backside wear, PE debris disease, and significant glenoid bone loss during revision surgeries necessitate the development of improved glenoid component designs. Unlike original designs, the modern MBG components are modular and convertible, exemplified by advancements from companies like Lima, Arthrex, and Zimmer. The ability to exchange PE liners and ultimately to convert to a reverse TSA in the current generation of implants has addressed some early concerns and offers insight into previously elusive solutions for anatomic total shoulder replacements. These more modern MBG components simplify the conversion from anatomic TSA to reverse shoulder arthroplasty, thus shortening the surgery, minimizing blood loss and reducing the complication rates associated with revision surgeries. They also enable correction of glenoid deformities both with respect to glenoid version and glenoid inclination that proven elusive with all PE implants. This paper highlights the design improvements, clinical indications, and future prospects of these components, underscoring their role in enhancing patient outcomes in TSA and hinting that further design developments are needed.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 174-179"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891222","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 dual-cup reverse shoulder replacement improves impingement-free motion","authors":"Rayan Alabsi BS, MS ,&nbsp;Tejasvi Subramanya BS, MS ,&nbsp;Michael G. Livesey MD ,&nbsp;Logan C. Kolakowski MD ,&nbsp;Subham Badhyal PhD ,&nbsp;Kevin Aroom MS, PE ,&nbsp;Li-Qun Zhang PhD ,&nbsp;Martha O. Wang PhD ,&nbsp;Mohit N. Gilotra MD, MS","doi":"10.1053/j.sart.2024.12.004","DOIUrl":"10.1053/j.sart.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Advances in reverse shoulder arthroplasty (RSA) design have improved functional outcomes, which approach those of the anatomic total shoulder arthroplasty in certain patients. However, restoration of motion, especially functional internal rotation (IR), remains a concern following RSA. A novel dual-cup RSA design was developed to improve impingement-free range of motion. The passive motion of the dual-cup RSA is compared to that of a commercially available RSA design in a cadaveric model.</div></div><div><h3>Methods</h3><div>Five fresh-frozen cadaveric upper-extremity specimens were included in the study. The scapula was rigidly fixed, allowing for isolation of glenohumeral joint motion. The novel dual-cup RSA design was tested with and without a flanged component. The dual-cup has an outer diameter of 36 mm, articulates with a 32 + 4 mm glenosphere, and provides 6 mm of glenoid lateralization. A 32 + 4 mm lateralized glenosphere and a 36 + 6 mm lateralized glenosphere served as controls. Measurements of motion were performed using an electromagnetic tracking device and modes of impingement were recorded. An analysis of variance test was performed with a post-hoc Tukey test to compare the relative changes in range of motion among groups.</div></div><div><h3>Results</h3><div>The dual-cup <em>(without flange)</em> design improved external rotation at 0° abduction by 20.9° and improved IR by 11.5° compared to the 32 + 4 mm control (<em>P</em> &lt; .01). In 90° abduction, the dual-cup improved external rotation by 11.9° compared to the 32 + 4 mm control, a significant improvement relative to the 36 + 6 mm control (<em>P</em> &lt; .05). The dual-cup improved functional IR by 12.4° relative to the 32 + 4 mm control, a significant improvement relative to the 36 + 6 mm control (<em>P</em> &lt; .05). The dual-cup did not significantly improve IR at 45° or 90° abduction compared to control models. Humeral component impingement on the glenoid was not observed at any end-range of motion in the implant with the flanged design.</div></div><div><h3>Discussion</h3><div>The dual-cup design improves all rotational motions relative to control models except IR with an abduction angle reaching or exceeding 45°. The dual-cup design improves impingement free motion, including functional IR, without additional lateralization in this study. The dual-dup with flange design eliminates impingement of the humeral cup on the glenoid neck without significantly affecting most motions relative to control models.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 188-194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890588","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":"Reverse and total shoulder arthroplasty among Medicare patients in the ambulatory surgery center: a matched cohort study and retrospective review of 90-day complications","authors":"Claire E. Hays MD ,&nbsp;Abu Mohd Naser PhD ,&nbsp;Thomas W. Throckmorton MD ,&nbsp;Tyler J. Brolin MD","doi":"10.1053/j.sart.2024.12.003","DOIUrl":"10.1053/j.sart.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Studies have shown the safety of outpatient total shoulder arthroplasty (TSA) in ambulatory surgery centers (ASCs), but none have specifically examined Medicare patients. Until recently, all TSAs among Medicare patients were required to be completed in a hospital as no ASC code (Current Procedural Terminology 23472) existed. The purpose of this study was to compare the intraoperative and 90-day episode of care complications among Medicare patients undergoing reverse total shoulder arthroplasty (rTSA) or anatomic total shoulder arthroplasty (aTSA) at a freestanding ambulatory surgery center to those of Medicare patients undergoing TSA as hospital inpatients (INPTs) or at a freestanding surgery center with commercial insurance. Our hypothesis was no difference between cohorts would be seen.</div></div><div><h3>Methods</h3><div>Our institution’s records were queried for all patients undergoing rTSA or aTSA from 2018 through 2022 who completed 90-day follow-up. Three cohorts were identified: all Medicare patients undergoing TSA in an ASC, an age and American Society of Anesthesiologists score best match 1:1 cohort of Medicare patients undergoing shoulder arthroplasty in the hospital, and all privately insured patients undergoing TSA in an ASC. A total of 395 patients met inclusion for analysis. Surgical complications, postoperative complications, hospital (re)admissions, and revisions were identified.</div></div><div><h3>Results</h3><div>The mean age was significantly older in the Medicare ASC cohort (mean 72.79 years) and Medicare INPT cohort (73.01y) compared with the privately insured ASC cohort (59.45 y). Overall, 33 (8.4%) complications, three revisions and four (re)admissions occurred within 90 days. There was one urgent hospital transfer in the privately insured ASC cohort. The overall complication rates for each group were not significantly different: 10.0% for Medicare ASC, 11.1% for Medicare INPTs, and 6.5% for privately insured ASC (<em>P</em> value = .339). The risk ratio (RR) for incidence of within 90-day postoperative complications was not significantly different amongst the cohorts. The RR for Medicare ASC patients was 0.9 compared with Medicare INPTs, and 1.53 compared with privately insured ASC patients. The RR for ASC patients (Medicare and privately insured) was 0.68 compared with Medicare INPTs. There was no significant increase in risk of complications among the Medicare ASC patients compared with either cohort regardless of surgical age, sex, body mass index, or American Society of Anesthesiologists score.</div></div><div><h3>Conclusion</h3><div>Medicare ASC patients undergoing rTSA or aTSA had a similar postoperative complication RR compared with Medicare INPTs and commercially insured ASC patients. Our findings suggest that TSA can be performed safely in freestanding ASCs on appropriately selected Medicare patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 180-187"},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891223","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":"Patient and surgical risk factors for dislocation after reverse shoulder arthroplasty: a study by the American Shoulder and Elbow Surgeons multicenter complications of reverse shoulder arthroplasty research group","authors":"ASES Complications of RSA Research Group,&nbsp;Evan A. Glass BS ,&nbsp;Adam R. Bowler BA ,&nbsp;Michael J. Maxwell MD ,&nbsp;Declan R. Diestel BA ,&nbsp;Miranda McDonald-Stahl BS ,&nbsp;Calista S. Stevens BA ,&nbsp;Christopher Canizares BS ,&nbsp;Pamela A. Chan MS ,&nbsp;Daniel P. Swanson BS ,&nbsp;Ryan Lohre MD ,&nbsp;Michael A. Moverman MD ,&nbsp;Richard Puzzitiello MD ,&nbsp;Himmat Sahi MS ,&nbsp;Kuhan A. Mahendraraj BA, MS ,&nbsp;Kiet Le PA-C ,&nbsp;Warren R. Dunn MD ,&nbsp;Dylan J. Cannon BS ,&nbsp;Lisa GM. Friedman MD ,&nbsp;Jaina A. Gaudette BSE ,&nbsp;Andrew Jawa MD","doi":"10.1053/j.sart.2024.11.004","DOIUrl":"10.1053/j.sart.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to identify patient and surgical factors associated with dislocation after reverse shoulder arthroplasty (RSA) in a large multicenter cohort.</div></div><div><h3>Methods</h3><div>A retrospective study using data from 15 institutions and 24 American Shoulder and Elbow Surgeons members across the United States was performed. Patients who underwent RSA between January 2013 and June 2019 with 3-month minimum follow-up were included. All components of methodology were determined by the Delphi method, an iterative survey process, requiring 75% consensus among all surgeons. Dislocations were defined as complete loss of articulation between the humeral component and the glenosphere with associated radiographic confirmation. Binary logistic regression was performed to determine predictors of dislocation following RSA.</div></div><div><h3>Results</h3><div>Overall, 6621 patients with a mean follow-up of 19.2 ± 15.6 months were included. The incidence of dislocation was 2.1% (n = 138), 1.6% (n = 99) in primary RSA, and 6.5% (n = 39) among revision RSAs (<em>P</em> &lt; .001). Dislocations occurred at a median of 7.0 weeks (interquartile range 3.0-36.0) after surgery with 22.5% (n = 31) following a trauma. Factors independently predictive of dislocation, in order of decreasing effect, were a preoperative diagnosis of nonunion fracture sequelae (odds ratio [OR] 8.31; <em>P</em> &lt; .001), revision arthroplasty (OR 4.82; <em>P</em> &lt; .001), the presence of a humeral spacer (OR 3.24; <em>P</em> &lt; .001), a preoperative diagnosis of rotator cuff arthropathy or massive rotator cuff tear (OR 2.91; <em>P</em> &lt; .001), the presence of a constrained polyethylene liner (OR 2.18; <em>P</em> = .001), male sex (OR 1.95; <em>P</em> = .001), and the lack of subscapularis repair (OR 1.61; <em>P</em> = .032) indicating a modest improvement in model fit compared to the null model.</div></div><div><h3>Conclusion</h3><div>Patient factors such as being male, having large rotator cuff tears, undergoing revision RSA, or undergoing RSA for the sequelae of fracture nonunion appear to significantly increase the risk of postoperative dislocation after RSA. Surgical factors predictive of dislocation included the presence of a humeral spacer, constrained polyethylene liner, and lack of subscapularis repair, indicating a surgeon intraoperative awareness of potential instability.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 147-157"},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891219","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 ChatGPT vs. Google web search in anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty: from a patient’s perspective","authors":"Alexander K. Hahn MD ,&nbsp;Gregory M. Connors BS ,&nbsp;Martinus Megalla MD ,&nbsp;Zachary T. Grace MD ,&nbsp;Brett J. Croen MD ,&nbsp;Michael R. Mancini MD ,&nbsp;Matthew R. LeVasseur MD ,&nbsp;Corey R. Dwyer MD ,&nbsp;Katherine J. Coyner MD, MBA","doi":"10.1053/j.sart.2024.11.005","DOIUrl":"10.1053/j.sart.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence, which encompasses machine learning and natural language processing has made strides in recent years. Among these models, ChatGPT has gained attention for its abilities to allow for interactive responses. Given the rising popularity of ChatGPT, and its ability to understand medical complexity, this study aimed to evaluate ChatGPT’s utility in answering medical questions vs. the most widely used search engine in the United States, Google. The goal of this study is to replicate a patient’s web search to assess the utility of ChatGPT vs. Google regarding the most popular questions asked by patients undergoing a total shoulder replacement and reverse total shoulder replacement.</div></div><div><h3>Methods</h3><div>A Google web search was performed with the following search terms: “total shoulder replacement” and “reverse total shoulder replacement” and the top 10 frequently asked questions (FAQs) for each term were recorded along with the source. ChatGPT was then asked for the top 10 FAQs searched for total shoulder replacement and reverse total shoulder replacement and responses recorded. A Google web search was then completed using the same search terms and the top 10 FAQs, which included a numerical response were recorded. These questions were then placed into ChatGPT. Both the Google web search and ChatGPT responses to the questions were recorded, along with the source that provided the answer.</div></div><div><h3>Results</h3><div>Eight of the 20 questions were similar when performing a Google Web search and ChatGPT for the search terms “total shoulder replacement.” Ten of the 20 questions were similar when using the search term “reverse shoulder replacement”. The most common subcategory was “evaluation of surgery” for Google (6 of 20) and “technical” for ChatGPT (5 of 20). The most common sources for answers to the top 10 FAQs for Google for both total shoulder arthroplasty and reverse total shoulder arthroplasty were academic sources (9 of 20).</div></div><div><h3>Conclusion</h3><div>Google and ChatGPT users ask similar types of questions and reveal similar answers. ChatGPT typically offers more detailed answers but is less transparent at providing its source and generates improper sources up to 47% of the time. However, for properly cited references, ChatGPT typically uses credible government or academic sources compared to Google. Since Google is currently more familiar for its users than ChatGPT, it may be easier to use for patients wanting fast, simple answers to their questions, while ChatGPT may be superior for patients who may have multiple questions that want longer answers.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 158-165"},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891220","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":"Comparison of glenoid screw length between 3D planned length and standard surgical measurement in reverse shoulder arthroplasty","authors":"Mathieu Dejonghe MD ,&nbsp;Christophe De Decker MD ,&nbsp;Dirk Petré MD","doi":"10.1053/j.sart.2024.11.002","DOIUrl":"10.1053/j.sart.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid positioning and fixation have important implications for the outcome and survival of reverse shoulder arthroplasty. Therefore, we aim to assess new methods of assuring correct placement and fixation of the glenoid component. 3-dimensional (3D) planning can help correctly position the glenoid, however, reproducibility of the plan perioperatively is sometimes difficult. Adjustable, reusable, patient-adapted guides may be as useful and a lot more cost-reducing compared to printed models in patient-specific instrumentation.</div></div><div><h3>Methods</h3><div>This prospective study compared preoperatively planned screw lengths for glenoid screws and perioperatively measured screw lengths in reverse shoulder arthroplasty in 44 patients. Therefore, 3D planning to determine optimal screw length and trajectory were carried out preoperatively, while during surgery screw trajectories were measured. Statistical analysis involved analyzing the correlation between the measured screw length and the planned screw length. Our primary endpoint was to see whether preoperative 3D planning without patient-specific guides can accurately predict glenoid screw length and aid in the correct positioning and fixation of glenoid baseplates.</div></div><div><h3>Results</h3><div>Forty-four patients were included. Twenty five of the 44 superior screws (56.8%) were adequately predicted (r = 0.69 [<em>P</em> &lt; .001]). Thirty six of 44 screws (81.8%) differed by a maximum of 1 size. Twenty two of the 44 inferior screws (50%) were adequately planned (r = 0.37 [<em>P</em> = .013]). Also, 36 of 44 screws (81.8%) differed by a maximum of 1 size. In 13 cases, an anterior screw was placed of which only 3 were adequately planned (23.1%) (r = 0.62 [<em>P</em> = .025]). A posterior screw was also used in 13 cases of which 4 were the same as planned (30.7%) (r = 0.35 [<em>P</em> = .245]). Of all screws per patient, 13 received the same length of screws as preoperatively planned (29%). All implants in 26 of 44 patients (59%) were adequately predicted within a maximum difference of 1 size.</div></div><div><h3>Conclusion</h3><div>3D planning and reusable guides can aid in the correct placement of glenoid components; however, accuracy could be improved by adding rotational control to the implantation of the glenoid and taking into account the depth of ream. A large discrepancy between planned and measured screw length offers an extra control that could trigger the surgeon’s attention in case of misplacement.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 134-140"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891217","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":"Early postoperative opioid consumption following liposomal bupivacaine compared to standard bupivacaine in interscalene brachial plexus block for shoulder arthroplasty","authors":"Jonathan D. Harley BA,&nbsp;Confidence Njoku Austin MD,&nbsp;Jerome C. Murray MD,&nbsp;Alicia K. Harrison MD,&nbsp;Allison J. Rao MD","doi":"10.1053/j.sart.2024.11.003","DOIUrl":"10.1053/j.sart.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>To retrospectively compare early postoperative opioid consumption in patients undergoing shoulder arthroplasty who receive an interscalene brachial plexus nerve block with either standard or liposomal bupivacaine.</div></div><div><h3>Methods</h3><div>A retrospective review was performed at a large multicenter health-care system. Patients included those who underwent primary total shoulder arthroplasty or reverse shoulder arthroplasty between January 2021 and January 2024, were aged 18-99 at the time of hospital admission, had a primary diagnosis of osteoarthritis, and received an interscalene brachial plexus nerve block using either standard bupivacaine or liposomal bupivacaine before surgery. The primary outcome was opioid usage, measured in morphine milligram equivalents (MMEs). Secondary outcomes were length of stay and readmission rate.</div></div><div><h3>Results</h3><div>A total of 870 patients were included in the study. Liposomal bupivacaine was associated with a statistically significant reduction in opioid consumption at postoperative day 0 (median: 0.0 vs. 7.5 MME, <em>P</em> &lt; .001), day 1 (0.0 vs. 15.0 MME, <em>P</em> &lt; .001), and cumulatively during admission (4.0 vs. 25.2 MME, <em>P</em> &lt; .001). Reductions in opioid consumption on postoperative day 1 and during the entire admission were judged to be clinically significant. Patients receiving liposomal bupivacaine were much more likely to receive 0 MME during their admission (relative risk: 2.84, 95% confidence interval: 2.23-3.63, <em>P</em> &lt; .001). Patients who received liposomal bupivacaine had shorter admissions compared to control (1.19 ± 0.70 days vs. 1.38 ± 1.24 days, <em>P</em> = .01). There were no differences in readmission rate (<em>P</em> = .83) or time to readmission (<em>P</em> = .73) between groups.</div></div><div><h3>Conclusion</h3><div>Liposomal bupivacaine delivered via interscalene brachial plexus block was shown to significantly reduce immediate postoperative opioid consumption and length of stay compared to standard bupivacaine before shoulder arthroplasty. Furthermore, patients receiving liposomal bupivacaine were more likely to be opioid-free during their surgical admission.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 141-146"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891218","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":"Outcomes of reverse total shoulder arthroplasty in patients aged under 60 vs. over 60 years","authors":"Louis W. Barry BS,&nbsp;Erryk S. Katayama BA,&nbsp;Nicholas Pappa MD,&nbsp;John S. Barnett BS,&nbsp;Akshar V. Patel BS,&nbsp;Ryan C. Rauck MD,&nbsp;Julie Y. Bishop MD,&nbsp;Gregory L. Cvetanovich MD","doi":"10.1053/j.sart.2024.11.001","DOIUrl":"10.1053/j.sart.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Each year, the incidence of reverse total shoulder arthroplasty (RSA) rises. Although RSA yields positive outcomes in older patients, such as improved range of motion (ROM) and reduced pain with rare occurrences of revision surgery, its application in patients under 60 years of age introduces distinct challenges. As RSA becomes increasingly common in younger patients, it is essential to compare outcomes to an older cohort to balance the advantages of early intervention against potential complications and the long-term durability of implants.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on a total of 220 patients who underwent primary RSA with a minimum of 2 years of clinical follow-up. The procedures were performed by 7 surgeons at a single institution. These patients were divided into 2 groups: under and over 60 years of age. Demographic and baseline variables were extracted from electronic medical records. Preoperative and postoperative outcomes of ROM and strength were recorded. Patient-reported outcomes were obtained via phone call.</div></div><div><h3>Results</h3><div>The under-60 group included 50 patients (mean age 56.9 ± 4.6 years) with a mean follow-up of 4.9 ± 2.7 years. The over-60 group included 170 patients (mean age 71.2 ± 6.0 years) with a mean follow-up of 4.5 ± 2.1 years. When compared, the under-60 group had significantly higher postoperative external rotation ROM (&lt;60: 44° ± 25° vs. &gt;60: 39^° ± 12^°, <em>P</em> = .048) and internal rotation ROM (&lt;60: sacrum vs. &gt;60: L5, <em>P</em> = .035). Of the 50 patients in the under-60 cohort, 6 had complications (12.0%), all resulting in revision at an average of 1.7 years after primary RSA. In the over-60 group, 11 patients had 11 complications (6.5%), with 6 undergoing revision surgery. The under-60 cohort had a significantly lower implant survival rate, with a rate of 94.0% at 2 years, 85.9% at 5 years, and 85.8% at 10 years compared with 97.6% at 2 years, 96.7% at 5 years, and 94.9% at 10 years in the over-60 cohort (<em>P</em> = .021).</div></div><div><h3>Conclusion</h3><div>RSA is safe and effective for patients who are 60 years and younger compared with older patients, although the complication rate is nearly 2 times higher in the younger cohort. An early intervention yields important considerations: younger individuals often have heightened postoperative expectations due to increased demand for arm usage. As the trend toward increasing use of RSA continues, we emphasize the importance of careful patient selection to ensure optimal outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 127-133"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891216","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":"Interest in reverse total shoulder arthroplasty is increasing! An analysis of publication frequency and Google Trends","authors":"Catherine M. Call BA ,&nbsp;Joseph B. Kahan MD","doi":"10.1053/j.sart.2024.10.002","DOIUrl":"10.1053/j.sart.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) procedure volume is increasing, as is reverse total shoulder arthroplasty (RTSA) procedure volume, which continues to make up a larger proportion of all TSA procedures performed. Whether growing procedure volume is associated with growing patient interest has not yet been assessed with the field of shoulder arthroplasty. The present study aimed to evaluate trends in public and scientific interest in RTSA compared to TSA by assessing Google Trends and publication frequency data, respectively.</div></div><div><h3>Methods</h3><div>Google Trends data and publication frequency data on PubMed were collected for RTSA and TSA between January 2010 and December 2023. Trend analyses were performed.</div></div><div><h3>Results</h3><div>Over the 13-year period between January 1, 2010 and December 31, 2023, Google Trends search data demonstrated that RTSA searches are growing as a share of TSA searches, indicating an upward trajectory for RTSA over the entirety of the study period. PubMed literature revealed RTSA represents a rising proportion of all TSA publications, increasing significantly from 31% to 58% of the total publications (<em>P</em> &lt; .001). Publications for both RTSA and TSA have increased 668% and 233%, respectively, over the study period.</div></div><div><h3>Conclusion</h3><div>RTSA encompasses an increasing portion of patient interest in TSA and, similarly, a growing share of publications on TSA. The significant upward trajectory of these trend lines over the entirety of the study period suggests both public and research interest in RTSA will continue to grow. Trends demonstrating rising public awareness and interest can inform surgeons planning for a future of increased demand for RTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 100-105"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284737","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}