Seminars in Arthroplasty最新文献

{"title":"Trabecular metal backed glenoids in anatomic total shoulder arthroplasty: outcomes after a decade on average","authors":"","doi":"10.1053/j.sart.2024.03.013","DOIUrl":"10.1053/j.sart.2024.03.013","url":null,"abstract":"<div><h3>Background</h3><p>First-generation trabecular metal (TM) backed glenoids reported poor implant survival and were recalled from the market. Second generation TM glenoids have demonstrated promising findings at short- and mid-term follow-up. In our study, we report on clinical and radiographic outcomes of TM glenoids with an average of 10 years of clinical and radiographic follow-up.</p></div><div><h3>Methods</h3><p>The charts of 14 TM glenoid patients with minimum 5 years follow-up were retrospectively analyzed. The primary end points included implant survival, range of motion, and patient-reported outcomes. Additionally, radiographic data (metal debris, lateral humeral offset (LHO), acromiohumeral interval (AHI)) were studied.</p></div><div><h3>Results</h3><p><span>The mean age at surgery was 52 ± 11 years and the mean follow-up time was 10 ± 3 years. Implant survivorship was 100%. Range of motion improved significantly following surgery. Forward elevation changed from 120 ± 22º preoperatively to 155 ± 13º postoperatively (</span><em>P</em> &lt; .01). The mean external rotation showed a statistically significant increase from 19 ± 30º preoperatively to 54 ± 13º postoperatively (<em>P</em> &lt; .01). Internal rotation improved six vertebral levels on average (<em>P</em> &lt; .01). Pain levels decreased significantly from 7 ± 1 to 2 ± 2 (<em>P</em> &lt; .01) while American Shoulder and Elbow Surgeons Shoulder scores increased from 35 ± 10 to 83 ± 21 (<em>P</em> &lt; .01). Simple Shoulder Test scores demonstrated an improvement from 5 ± 3 to 10 ± 3 (<em>P</em> &lt; .01). No patients had glenoid loosening, metal debris, or radioluency on radiographic imaging. The immediate LHO was 18 (standard deviation [SD] ± 9) and final LHO of 16 (SD ± 8) (<em>P</em> value = .01). The immediate AHI was 12 (SD ± 3) and final AHI was 11 (SD ± 3) (<em>P</em> value = .01).</p></div><div><h3>Conclusion</h3><p>TM backed glenoids should remain in the modern orthopedic surgeon’s armamentarium of procedures. This particular glenoid design showed 100% implant survival at a decade following surgery, and provided sustained improvements in range of motion and shoulder function in osteoarthritic patients.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 657-662"},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037946","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":"Operative time and relative value units for total shoulder arthroplasty based on pathology in the United States","authors":"","doi":"10.1053/j.sart.2024.03.012","DOIUrl":"10.1053/j.sart.2024.03.012","url":null,"abstract":"<div><h3>Background</h3><p>Despite total shoulder arthroplasty<span> (TSA) and reverse TSA<span><span> (rTSA) being fundamentally different procedures, and indicated in different pathologies (rTSA for rotator cuff<span> deficiency [RCD] and proximal humeral fractures [PHFx] and anatomic TSA [aTSA] for glenohumeral </span></span>osteoarthritis<span> [GHOA]), they have the same Current Procedural Terminology (CPT) code (23472). This paper’s aim is to investigate differences in operative time and work-related value units (wRVUs) per hour among these pathologies, and ultimately determine if there is a need to assign separate CPTs for aTSA and rTSA.</span></span></span></p></div><div><h3>Methods</h3><p>A retrospective cohort of data from the American College of Surgeons–National Surgical Quality Improvement Program was collected, all patients who underwent aTSA or rTSA (CPT: 23472) between the years of 2006 and 2019 for diagnoses of GHOA, RCD, and PHFx were included. Data collected included patient age, body mass index, operative time, and wRVUs per hour.</p></div><div><h3>Results</h3><p>Compared to GHOA (reference group), the average operative time for the RCD cohort was 12.242 minutes shorter (<em>P</em> &lt; .001), while the wRVUs were higher by 1.627 (<em>P</em> &lt; .001). The average operative time for rTSAs in the PHFx cohort were 17.615 minutes longer (<em>P</em> &lt; .001), while the wRVUs were lower by 2.205 (<em>P</em> &lt; .001).</p></div><div><h3>Conclusion</h3><p>The average operative time for rTSAs for both RCDs and PHFx were longer than that for aTSAs for GHOA. Additionally, wRVUs were lower for rTSAs for RCD and PHFx compared to aTSAs for GHOA. This elucidates inconsistency in reimbursement structure for the procedures, which should be revisited.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 663-671"},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029991","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":"Staged bilateral total shoulder arthroplasty: a single institutional experience with mid-term follow-up","authors":"","doi":"10.1053/j.sart.2024.03.014","DOIUrl":"10.1053/j.sart.2024.03.014","url":null,"abstract":"<div><h3>Background</h3><p>The preferred surgical approach for surgical treatment of advanced glenohumeral arthritis is shoulder arthroplasty (SA). Considering the growing volume and success of SA, patients with bilateral shoulder disease are likely to undergo surgery on both shoulders. There are numerous studies evaluating the outcomes of bilateral hip and knee arthroplasty, but a paucity of information examining bilateral SA. This study intends to evaluate the clinical outcomes of patients undergoing staged bilateral anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA).</p></div><div><h3>Methods</h3><p>Institutional records were queried for patients who underwent staged bilateral aTSA or rTSA from 2009 to 2020. Patient records were retrospectively reviewed to assess preoperative and postoperative range of motion (ROM) and strength measurements, demographic information, and complications. Mean ± standard deviation was reported for all continuous variables. Mean functional measurements were compared using a 2-Sample <em>t</em>-Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via Chi-squared test. Patients were included in the outcome analysis if they had a bilateral TSA with the same procedure (i.e. aTSA on both sides, or rTSA on both sides).</p></div><div><h3>Results</h3><p>43 patients (15 male, 28 female) were included. There was an average time of 1.8 years between surgeries. Of the 43 patients, 26 patients had staged bilateral aTSAs and 14 had staged bilateral rTSAs with three patients who had different surgeries on each shoulder. The three patients with different surgeries on each shoulder were excluded from outcome analysis. Patients who had staged aTSA operations demonstrated significant improvement in external rotation (<em>P</em> = .0191, <em>P</em> &lt; .001), forward elevation (FE) (<em>P</em> = .0004, <em>P</em> &lt; .001), and internal rotation (IR) (<em>P</em> = .0183, <em>P</em> = .0166) after the first and second surgeries. Staged rTSA patients showed significant improvement in FE after the first (<em>P</em> = .0043) and second surgeries (<em>P</em> = .016). Patients demonstrated significant increase in strength of external rotation (<em>P</em> = .0136), FE (<em>P</em> = .0088), and IR (<em>P</em> = .0206) after the first rTSA. There was no corresponding increase in strength testing after the second bilateral rTSA surgery. The average Single Assessment Numeric Evaluation, Contralateral Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores for all surgeries were 84 ± 10, 83 ± 13, 75 ± 20, and 9 ± 2, respectively for the first surgery and 82 ± 13, 83 ± 13, 71 ± 21, and 8 ± 3 for the second surgery.</p></div><div><h3>Conclusion</h3><p>Individuals that undergo staged aTSA procedures gain a better ROM and IR strength after both operations. However, individuals that undergo staged rTSA procedures have an improved R","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 672-678"},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400052X/pdfft?md5=4e2e391a2bf796b4926fdf1d3577ceb3&pid=1-s2.0-S104545272400052X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043376","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":"Limited preoperative forward flexion does not impact outcomes between anatomic or reverse shoulder arthroplasty for primary glenohumeral arthritis","authors":"","doi":"10.1053/j.sart.2024.03.007","DOIUrl":"10.1053/j.sart.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><p>Anatomic total shoulder arthroplasty<span><span> (TSA) remains the treatment of choice for primary glenohumeral osteoarthritis<span> with an intact rotator cuff (PGHOA). However, </span></span>reverse total shoulder arthroplasty (RSA) has gained popularity as a primary procedure in selected patients who may be at risk for postoperative rotator cuff dysfunction or glenoid loosening. The purpose of this study was to compare short-term outcomes between TSA and RSA in patients with PGHOA and limited preoperative forward flexion (FF).</span></p></div><div><h3>Methods</h3><p><span>A retrospective review was performed on a multi-institutional registry of patients to identify patients aged less than 80 years undergoing TSA or RSA for PGHOA with preoperative FF ≤ 90°. Forty-five TSAs were identified and matched by age and sex to 45 patients undergoing RSA. A subset of 22 TSAs and 24 RSAs with severely limited preoperative FF of ≤ 70° was also analyzed. Range of motion including FF, external rotation and internal rotation, strength, and patient-reported outcomes including visual analog scale pain score, Western Ontario Osteoarthritis of the Shoulder index score, Veterans RAND 12 mental score, </span>American Shoulder and Elbow Surgeons score, and Constant-Murley score were evaluated at a minimum of 2 years postoperative.</p></div><div><h3>Results</h3><p>No significant differences were observed in postoperative FF, external rotation, or strength measurements between groups. The limited FF TSA group achieved significantly improved internal rotation compared to the RSA group (L2 vs. L4, <em>P</em> &lt; .002). No significant differences were observed between TSA and RSA in American Shoulder and Elbow Surgeons, visual analog scale, Constant, or Single Assessment Numeric Evaluation scores (<em>P</em> &gt; .05) for both the overall comparison and subset of patients with FF of ≤ 70°. However, patients in the RSA cohort showed a significantly higher return to normal sporting activities than the TSA group.</p></div><div><h3>Conclusion</h3><p>Patients aged less than 80 years with PGHOA and limited preoperative FF achieve similar postoperative range of motion and patient-reported outcomes whether treated with TSA or RSA. Therefore, limited preoperative FF does not appear to be a major determinant of outcomes for PGHOA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 626-631"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043512","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":"Is there a role for acromioplasty and tuberoplasty in reverse shoulder arthroplasty to improve impingement-free range of motion?","authors":"María Brotat-Rodríguez MD, PhD ,&nbsp;Juan David Lacouture MD ,&nbsp;Riccardo Ranieri MD ,&nbsp;Olivier Dhollander MD ,&nbsp;Pascal Boileau MD, PhD","doi":"10.1053/j.sart.2024.03.008","DOIUrl":"10.1053/j.sart.2024.03.008","url":null,"abstract":"<div><h3>Hypothesis and Background</h3><p>Lateralizing the center of rotation in reverse shoulder arthroplasty<span> (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture.</span></p></div><div><h3>Methods</h3><p>Eighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications.</p></div><div><h3>Results</h3><p>After virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (<em>P</em> &lt; .001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed.</p></div><div><h3>Conclusion</h3><p>In a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 617-625"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048849","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":"Three-dimensional scapular orientation: a comparison of glenohumeral osteoarthritis and cuff tear arthropathy to the unaffected shoulder","authors":"Teja Polisetty BS ,&nbsp;Ryan Lohre MD ,&nbsp;Evan A. Glass BS ,&nbsp;Daniel P. Swanson BS ,&nbsp;Adam R. Bowler BA ,&nbsp;Sanne Vancleef PhD ,&nbsp;Ward Bartels PhD ,&nbsp;Randa Elmallah MD ,&nbsp;Bassem Elhassan MD ,&nbsp;Jacob M. Kirsch MD ,&nbsp;Eric T. Ricchetti MD ,&nbsp;Andrew Jawa MD","doi":"10.1053/j.sart.2024.03.009","DOIUrl":"10.1053/j.sart.2024.03.009","url":null,"abstract":"<div><h3>Background</h3><p>Scapular orientation may play an important role in preoperative planning for shoulder arthroplasty; however, there is currently no defined method for producing standardized three-dimensional measurements. The purpose of this study is to develop a reproducible measurement system of scapular orientation and to evaluate differences between unaffected shoulders and those with diagnoses of primary glenohumeral osteoarthritis (GHOA) and rotator cuff tear arthropathy (CTA).</p></div><div><h3>Methods</h3><p>Patients receiving computed tomography scans for preoperative shoulder arthroplasty planning were enrolled prospectively. Thin sliced axial images that included bilateral shoulders and the thorax were reformatted. The pathology of the bilateral glenohumeral joints was defined as GHOA, CTA, or unaffected. Scapular orientation was defined relative to the thorax using three-dimensional models to define the protraction, rotation, and tilt angles in the supine position. Univariate analysis was performed to compare demographics and scapular measurements between patients with GHOA, CTA, and unaffected shoulder pathology. Multivariate linear regression analysis was performed to identify independent predictors of scapular orientation.</p></div><div><h3>Results</h3><p>One hundred fifty-eight shoulders, comprising 79 patients were included. Twenty-seven percent (n = 21/79) of patients had an unaffected contralateral shoulder. Shoulders with GHOA had significantly greater downward scapular rotation (-14 ± 7 degrees) than both unaffected shoulders (-8 ± 7 degrees; <em>P</em> &lt; .001) and those with CTA (-7 ± 8 degrees; <em>P</em> &lt; .001). Increased downward scapular rotation was predicted by a shoulder pathology of GHOA in multivariate analysis (beta -7.09; <em>P</em> &lt; .001). The magnitude of side-to-side difference was greatest in scapular rotation for patients with GHOA compared to CTA, with no significant differences in tilt or protraction.</p></div><div><h3>Conclusion</h3><p>Scapular rotation in the supine position varies by shoulder pathology, with greater downward rotation seen in patients with primary GHOA. These findings underscore the need for awareness of scapular orientation in addition to glenoid morphology when evaluating and planning shoulder arthroplasty cases.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 639-647"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000476/pdfft?md5=faa7884f850257b607c13730e6f3901c&pid=1-s2.0-S1045452724000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049865","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":"Prognostic value of the Favard classification for patients before and after reverse shoulder arthroplasty performed for rotator cuff tear arthropathy","authors":"Kevin A. Hao BS ,&nbsp;Josie Elwell PhD ,&nbsp;Pierre-Henri Flurin MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Christopher P. Roche MSE, MBA ,&nbsp;Christopher A. Colasanti MD ,&nbsp;Joseph D. Zuckerman MD ,&nbsp;Ryan W. Simovitch MD","doi":"10.1053/j.sart.2024.03.010","DOIUrl":"10.1053/j.sart.2024.03.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Although the Favard classification is commonly utilized by surgeons to describe the supero-inferior morphology of the glenoid when treating rotator cuff&lt;span&gt; arthropathy&lt;span&gt; (RCA), its utility in prognosticating patients’ clinical state before and after reverse shoulder arthroplasty (RSA) remains unproven. We assessed the prognostic value of the Favard glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in RSA.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A prospectively collected, multicenter database for a single-platform shoulder arthroplasty system was queried for patients with RCA who underwent RSA with a minimum 2-year clinical follow-up. Differences in patient reported outcome scores (PROMs) (Simple Shoulder Test, American Shoulder and Elbow Surgeons, Shoulder Pain and Disability Index&lt;span&gt;&lt;span&gt;, visual analog scale pain, Shoulder Function score), combined patient-reported and clinical-input scores (Constant, University of California Los Angeles, Shoulder Arthroplasty Smart), active range of motion values (forward elevation, abduction, external rotation [ER], internal rotation [IR]), radiographic outcomes (humeral radiolucency line rates, scapular notching rate), and the incidence of &lt;/span&gt;postoperative complications and revision surgery were compared by glenoid deformity type per the Favard classification. Comparisons were performed to assess the ability of the Favard classification to prognosticate the preoperative, postoperative, and improved state after RSA.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;400 RSAs performed for RCA were included. Comparison of outcomes between Favard glenoid types resulted in 6 pairwise comparisons of 12 clinical outcome metrics, yielding 72 total Favard glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 216 possible pairwise Favard glenoid type/metric comparisons, statistical significance was only reached for 3% of the combinations (7/216). Among E0, E1, and E2 glenoids, the only statistically significant pairwise comparison identified among all three clinical states was a more favorable preoperative American Shoulder and Elbow Surgeons score for E0 vs. E2 glenoids. Preoperatively, E3 glenoids had poorer ER, IR, and Shoulder Arthroplasty Smart scores compared to E0 glenoids and poorer ER compared to E2 glenoids. Postoperatively, E3 glenoids had a poorer IR score compared to E0 glenoids and poorer ER compared to E1 glenoids. No pairwise differences in preoperative to postoperative improvement were found. There were no statistically significant pairwise differences in humeral lucency rate, scapular notching rate, complication rates, or revision rates between Favard glenoid types.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Although useful for describing degenerative changes to the glenohumeral joint, the Favard classification offers little prognostic information regarding patien","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 648-656"},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049864","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":"Race, gender, and income negatively impact patient-reported outcomes following total shoulder arthroplasty","authors":"Joshua P. Castle MD,&nbsp;Michael A. Gaudiani MD,&nbsp;Johnny K. Kasto MD,&nbsp;Noah Elagamy BS,&nbsp;Matthew A. Gasparro BS,&nbsp;Matthew Corsi BS,&nbsp;Eric X. Jiang MD,&nbsp;Eric C. Makhni MD,&nbsp;Jared M. Mahylis MD,&nbsp;Stephanie J. Muh MD","doi":"10.1053/j.sart.2024.03.006","DOIUrl":"10.1053/j.sart.2024.03.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Social determinants of health&lt;span&gt; (SDOH) refer to social and economic factors that influence a patient’s health status. The purpose of this study was to investigate the impact of SDOH on preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and postoperative resource utilization following primary shoulder arthroplasty (SA).&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;This retrospective chart review evaluated data from all patients who underwent primary SA (including anatomic, reverse, and hemiarthroplasty) at a single health system between May 2020 and May 2022. Patients without at least 6-month postoperative PROMIS questionnaires and those undergoing revision surgeries were excluded. The &lt;/span&gt;electronic medical record was used to identify SDOH for each patient, and PROMIS scores for Upper Extremity (PROMIS-UE), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed electronically at respective preoperative and postoperative visits. &lt;/span&gt;Univariate analysis using independent 2-group &lt;/span&gt;&lt;em&gt;t&lt;/em&gt;&lt;span&gt;-tests and Chi-squared tests were used to analyze the mean difference between patient groups based on SDOH. Multivariate linear regressions&lt;span&gt; were performed with all predictors used in the univariate model using the least squares method.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The study included 248 patients who underwent SA, with a mean age of 67.9 years. Caucasian patients were over-represented in the highest quartile of median household income (MHI) compared to Black patients (35.1% vs. 17.2%) who were over-represented in the lowest MHI quartile (37.9% vs. 8.3%). At 6-month postoperative, black patients had significantly lower UE (33.8 ± 6.2 vs. 38.1 ± 9.0; &lt;em&gt;P&lt;/em&gt; = .03) and greater PI scores (59.1 ± 6.1 vs. 55.6 ± 8.6; &lt;em&gt;P&lt;/em&gt; = .145) compared to Caucasian patients. Similarly, at 6-month follow-up, the lowest MHI quartile had lower UE (33.8 ± 7.7 vs. 39.6 ± 8.8; &lt;em&gt;P&lt;/em&gt; = .01) and higher PI scores (58.7 ± 6.5 vs. 54.3 ± 8.2; &lt;em&gt;P&lt;/em&gt; &lt; .01) compared to the highest MHI quartile, and females demonstrated lower UE (36.3 ± 7.9 vs. 38.6 ± 9.8; &lt;em&gt;P&lt;/em&gt; = .04) and higher D scores (46.2 ± 9.1 vs. 42.0 ± 8.6; &lt;em&gt;P&lt;/em&gt; = .046) compared to males. Government/public insurance demonstrated lower UE (36.8 ± 8.0 vs. 39.8 ± 10.4; &lt;em&gt;P&lt;/em&gt; = .03) and higher D scores (45.9 ± 9.2 vs. 40.6 ± 7.6; &lt;em&gt;P&lt;/em&gt; = .03) compared to private insurance. At 12-month follow-up, females demonstrated lower UE scores compared to males (36.0 ± 10.2 vs. 40.1 ± 11.3; &lt;em&gt;P&lt;/em&gt; = .03). Black patients harbored lower UE, PI, and D scores compared to Caucasian patients, although not statistically significant.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Several socioeconomic factors such as race, gender, and insurance status are associated with differential outcomes after SA. Patients who are Black, female, current smokers, and from the lowest in","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 608-616"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048848","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":"Sleep apnea in patients undergoing reverse shoulder arthroplasty is associated with greater complications and healthcare utilization","authors":"","doi":"10.1053/j.sart.2024.02.010","DOIUrl":"10.1053/j.sart.2024.02.010","url":null,"abstract":"<div><h3>Background</h3><p><span>Sleep apnea<span> (SA) has been shown to negatively affect cognition, immunity, and bone mineralization. There is conflicting evidence for the contribution of SA to outcomes following </span></span>total shoulder arthroplasty<span>. However, the impact of SA on reverse shoulder arthroplasty (RSA) has not been elucidated. A substantial increase in utilization of RSA is projected through the 2030s. Our objective was to assess postoperative medical and implant-related complications and healthcare utilization in patients with SA undergoing RSA.</span></p></div><div><h3>Methods</h3><p>A retrospective review of a private insurance claims database was conducted from 2010 to 2021. All cases of RSA and those with a prior diagnosis of SA were identified using their corresponding diagnosis and procedural codes. Patients undergoing RSA with a diagnosis of SA were matched to control patients 1:2 based on demographic and comorbidity profiles.</p></div><div><h3>Results</h3><p>A total of 18,229 SA patients were matched to 35,988 control patients. The SA cohort had significantly greater odds of all medical complications assessed compared to the control cohort. The SA cohort had greater odds of all implant-related complications including dislocation and mechanical loosening when compared to the control cohort. Mean length of stay was significantly greater in the SA group.</p></div><div><h3>Conclusion</h3><p>The current data demonstrate that SA patients may have an increased risk of complications and healthcare burden following RSA compared to RSA patients without SA. These findings indicate potential value in preoperative screening for SA prior to RSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 571-576"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777042","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":"Intraoperative changes to the components planned preoperatively do not affect short-term, postoperative clinical outcomes after reverse total shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.03.001","DOIUrl":"10.1053/j.sart.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Three-dimensional, computed tomography<span> preoperative planning has been increasingly adopted among shoulder arthroplasty<span> surgeons. Prior studies have not examined outcomes in patients undergoing reverse total shoulder arthroplasty in which the surgeon implanted prostheses that deviated from the preoperative plan compared to patients in which the surgeon followed the preoperative plan. The hypothesis of this study was that clinical outcomes would not be different between patients in which the surgeon utilized components that deviated from those predicted in the preoperative plan and patients in which the surgeon followed the preoperative plan.</span></span></p></div><div><h3>Methods</h3><p>A retrospective review of patients that had preoperative planning for reverse total shoulder arthroplasty<span> from April 2017 through February 2022 was performed. Patients were stratified into two groups: patients in which the surgeon utilized components that deviated from those anticipated by the preoperative plan (changed group), and patients in which the surgeon utilized all of the components anticipated by the preoperative plan (as planned group). Patient-reported outcomes including the Western Ontario Osteoarthritis<span> Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Shoulder Activity Level were recorded preoperatively, at one year, and at two years. Preoperative and one-year postoperative range of motion was recorded.</span></span></p></div><div><h3>Results</h3><p>One hundred and eighty-nine patients were included in this study. One hundred forty-seven patients had intraoperative changes to their preoperative plan and 42 patients underwent reverse total arthroplasty without changes to their preoperative plan. There was no difference determined between any patient-reported outcome score at the one- and two-year postoperative time points between the as planned group and the changed group. No differences were found in range of motion between groups. Patients initially planned to undergo anatomic total shoulder arthroplasty that were intraoperatively converted to a reverse total shoulder arthroplasty had equivalent outcomes compared to those that had 1) other intraoperative deviations or 2) had no changes to their original preoperative plan.</p></div><div><h3>Conclusion</h3><p>Patients undergoing reverse total shoulder arthroplasty that had an intraoperative deviation to the components utilized in the preoperative plan had equivalent 1) patient-reported outcomes at one and two years after surgery and 2) range of motion one year after surgery compared to those that did not change from the preoperative plan. This study suggests it is safe to make intraoperative changes to the components utilized in the preoperative plan without concern for inferior postoperative outcomes when performing reverse total shoulder arthroplasty.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 585-592"},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766278","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}