Seminars in Arthroplasty最新文献

{"title":"Geographic travel distance does not influence preoperative patient expectations or postoperative clinical outcomes following total shoulder arthroplasty: a comparative analysis at an urban, tertiary care center","authors":"Harry Haran BA , Spencer M. Lee-Rey BA , Anthony Finocchiaro BS , Alyssa D. Althoff MD , Hassan Al-Naimi BS , Michael C. Fu MD, MHS , Samuel A. Taylor MD , Joshua S. Dines MD , Gabriella E. Ode MD , David M. Dines MD , Lawrence V. Gulotta MD , Christopher M. Brusalis MD","doi":"10.1016/j.sart.2025.151517","DOIUrl":"10.1016/j.sart.2025.151517","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed at high-volume tertiary care centers, with many patients either electing or required to travel long distances to receive specialized care. This study aimed to investigate the impact of geographic travel distance on preoperative patient expectations and postoperative clinical outcomes following TSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was performed evaluating patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA) from 2016 through 2021 at an urban, academic medical center. For each aTSA and rTSA, patients were stratified into 2 cohorts based on travel distance to the surgical center: local (<50 miles) or long-distance (>100 miles). Preoperative expectations, as defined by the Hospital for Special Surgery Expectations Surveys, functional outcomes (American Shoulder Elbow Surgeons, Single Assessment Numeric Evaluation, Shoulder Activity Scale), and patient satisfaction were assessed at baseline and minimum 2-year follow-up. Parametric test, nonparametric tests, and multivariable linear regression were used to compare patient groups for both aTSA and rTSA.</div></div><div><h3>Results</h3><div>Among 1,406 total patients, 885 aTSA patients (local = 737; long-distance = 148) and 521 rTSA patients (local = 413; long-distance = 108) were included in the study. Among patients undergoing aTSA, long-distance patients had significantly higher education levels (<em>P</em> = .01) and were more likely to identify as White (<em>P</em> = .01). Preoperative expectations scores (Hospital for Special Surgery Expectation Surveys) among aTSA patients did not differ significantly between cohorts (local: 74.87 ± 15.75, <em>n</em> = 737; long-distance: 77.64 ± 14.70, <em>n</em> = 148; <em>P</em> = .067). Functional outcomes and satisfaction improved regardless of travel distance (<em>P</em> > .05). In the rTSA cohort, multivariable regression analysis revealed that travel distance was not a significant predictor of higher preoperative patient expectations (<em>P</em> < .05). Clinical outcomes and satisfaction following both aTSA and rTSA demonstrated comparable and clinically meaningful improvements in both long-distance and local patient groups. In multivariable analysis for both aTSA and rTSA, travel distance did not influence patient-related outcomes (<em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>Patients traveling longer distances to undergo aTSA and rTSA at an urban, academic medical center had comparable preoperative expectations to patients residing locally. Long-distance patients achieved similar postoperative outcomes and satisfaction as local patients at an urban, tertiary care center. These findings suggest that intentional urban academic medical center selection, regardless of travel distance, does not negatively impact patient-related outcomes or satisfaction following TSA. However, they should be interp","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151517"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926464","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":"Choice of glenoid inclination correction method affects reverse shoulder arthroplasty baseplate loading","authors":"Emiko R. Hourston BEng ,&nbsp;Kaitlyn Kuchinka BEng ,&nbsp;Jaylan Hamad BEng ,&nbsp;George S. Athwal MD ,&nbsp;Joshua W. Giles PhD","doi":"10.1016/j.sart.2025.151535","DOIUrl":"10.1016/j.sart.2025.151535","url":null,"abstract":"<div><h3>Background</h3><div>When performing total shoulder arthroplasty, referencing the entire glenoid en face orientation to determine an inclination correction, termed here the “Total Shoulder Correction Angle” (TSCA), has proven helpful in positioning the anatomic glenoid implant. This method has also been used for reverse total shoulder arthroplasty (rTSA) baseplate positioning, leading to an unintended superior baseplate inclination. Thus, an rTSA-specific measurement using only the inferior glenoid, termed here the “Reverse Shoulder Correction Angle” (RSCA), was proposed to determine the required inclination. Still, it is unknown if using this correction angle has any appreciable impact on baseplate loading. Thus, the purpose of this basic science study was to compare shoulder biomechanics when baseplates are placed using the TSCA or RSCA method and to identify relationships between these biomechanical effects and variations in scapular anatomy.</div></div><div><h3>Methods</h3><div>This study used a previously published modeling workflow that combined statistical shape model, musculoskeletal, and predictive modeling. Thirty scapular morphologies were generated using Latin Hypercube Sampling of the statistical shape model to yield a cohort that replicated normal variations in the population anatomy. A validated musculoskeletal model was modified using each generated morphology, and two virtual surgeries were performed on each model to place the rTSA baseplates: (1) using the TSCA and (2) using the RSCA. Each model underwent muscle-driven predictive simulation of a lateral-reaching task. Joint reaction force (JRF, in % bodyweight) and compression-to-shear force ratio time-series data were statistically tested using statistical parametric mapping paired <em>t</em>-tests.</div></div><div><h3>Results</h3><div>Significant differences (<em>P</em> ≤ .047) were identified in the JRF between the TSCA and RSCA methods. The TSCA method resulted in significantly higher JRFs (<em>P</em> &lt; .001) across the first 70% of motion because of large superior baseplate shear, with mean load differences in both forces of up to 25% bodyweight in the first 5% of motion. Using the RSCA method resulted in significantly higher JRFs in the last 20% of motion because of high shear and compressive forces, but its compression-to-shear force ratio remained significantly higher than the TSCA.</div></div><div><h3>Conclusion</h3><div>The results of this study demonstrate that using the RSCA, rather than the TSCA, to assist with rTSA baseplate positioning results in significantly less challenging loads for baseplate fixation across a motion, thus reducing the likelihood of early baseplate loosening.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151535"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037719","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":"Glenoid augments and revision risk following reverse and anatomic total shoulder arthroplasty","authors":"Anshuman Singh MD ,&nbsp;Kathryn E. Royse PhD, MPH, MSPH ,&nbsp;Danny Chan MD ,&nbsp;Jonathan Mina Ragheb BA ,&nbsp;Augustus Demanes MD ,&nbsp;David Y. Ding MD ,&nbsp;Elizabeth W. Paxton PhD ,&nbsp;Ronald A. Navarro MD","doi":"10.1053/j.sart.2025.07.005","DOIUrl":"10.1053/j.sart.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Augmented glenoid implant usage in shoulder arthroplasty bone loss cases has increased over the past decade. While safe in the short term, there are insufficient studies on longer term survivorship data on the newer generation of implants. We sought to determine whether there was a difference in survivorship for patients treated with glenoid augmentation vs. those with traditional total shoulder arthroplasty (TSA).</div></div><div><h3>Method</h3><div>A retrospective cohort study was conducted using data from a US integrated health-care system's shoulder arthroplasty registry. Patients ≥18 years who underwent primary shoulder arthroplasty for arthritis, inflammatory arthritis, and rotator cuff tear were included (2018-2024). Augmented and nonaugmented glenoids were compared separately for anatomic (aTSA) and reverse (rTSA) TSA. All-cause, aseptic, and revision risk due to infection were evaluated through cause-specific Cox proportional hazard regression with confounder and operating surgeon adjustment. Reason for revision was recorded. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented, a <em>P</em> &lt; .05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Augmented glenoid implants were identified in 11.9% (n = 500) of aTSA and 55.8% (n = 2,641) of rTSA procedures. All-cause 5-year cumulative revision probability was 2.3% for rTSA and 2.6% aTSA. Average follow-up time for aTSA was 3.4 years (standard deviation [STD] = 2.0 years) and 2.6 years for rTSA (STD = 2.0 years). Mean time to first revision in aTSA was 2.1 years (STD = 1.8 years). The most common reason for aTSA revision was rotator cuff tear. We observed a 27% decreased risk of aseptic revision in aTSA patients with augmented glenoids (HR = 0.73, 95% CI = 0.56-0.93, <em>P</em> = .012) and no difference in all-cause or revision for infection (HR = 0.64, 95% CI = 0.32-1.29, <em>P</em> = .209 and HR = 0.79, 95% CI = 0.53-1.18, <em>P</em> = .253, respectively). The mean time to first revision in rTSA was 1.8 years (STD = 2.0 years). The most common reason for rTSA revision is chronic dislocation (instability). In rTSA, we failed to detect a difference in all-cause, aseptic, or revision for infection in augmented compared to nonaugmented glenoids (HR = 1.01, 95% CI = 0.80-1.28, <em>P</em> = .919, HR = 0.99, 95% CI = 0.78-1.26, <em>P</em> = .929, and HR = 0.98, 95% CI = 0.74-1.30, <em>P</em> = .885, respectively).</div></div><div><h3>Conclusions</h3><div>We found a lower 5-year risk of aseptic revision in aTSA and no-difference by augment status for rTSA. Augmented glenoid implants have several advantages when addressing glenoid wear, and our data support the use of these implants in the toolkit to address glenoid pathology.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151488"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188017","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":"Decreasing body mass index and surgery on the nondominant shoulder, not implant factors, are the only independent predictors of internal rotation following reverse shoulder arthroplasty","authors":"Joseph T. Gibian MD ,&nbsp;Ethan Blum BS ,&nbsp;Jay D. Keener MD,&nbsp;Benjamin M. Zmistowski MD, MSCI","doi":"10.1053/j.sart.2025.08.001","DOIUrl":"10.1053/j.sart.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Internal rotation (IR) following reverse shoulder arthroplasty (rTSA) is a driver of patient satisfaction and the ability to perform activities of daily living (ADLs) but remains unpredictable. We aimed to identify independent predictors of achieving sufficient IR following rTSA by retrospectively reviewing a prospectively maintained, single-surgeon database.</div></div><div><h3>Methods</h3><div>A single-surgeon prospective database of all rTSAs performed over a 6-year period was maintained. Patient demographics, preoperative variables, and intraoperative variables were recorded. Two years postoperatively, patients self-reported their IR utilizing a previously validated tool, and those who could reach the mid-lumbar spine or higher were considered to have sufficient IR. Importantly, 2 implants were used: a relatively medialized, valgus neck-shaft angle implant, and a relatively lateralized, varus neck-shaft angle implant. Univariate and multivariate analyses were performed to identify factors associated with IR following rTSA. The ability to perform various ADLs was compared between patients who were able to attain sufficient IR and those who were not.</div></div><div><h3>Results</h3><div>Two hundred and twenty-six shoulders were included in the study. 34.7% demonstrated sufficient preoperative IR, which improved to 52.2% 2 years postoperatively. Body mass index (BMI), preoperative IR, subscapularis repair, and surgery on the nondominant upper extremity were all associated with achieving sufficient postoperative IR, but only decreasing BMI and surgery on the nondominant upper extremity were found to be independently associated with postoperative IR on multivariate analysis. Importantly, no implant factors were associated with improved postoperative IR. Achieving sufficient IR was associated with an improved ability to put on a coat, wash the back or clasp a bra, reach a high shelf, throw a ball overhand, do usual sporting activity, and improved ASES, ASES functional, and visual analog scale pain scores.</div></div><div><h3>Conclusion</h3><div>In this study of 226 rTSAs, patient BMI and surgery on the nondominant upper extremity were the only independent predictors of achieving sufficient 2-year postoperative IR, defined as reaching the mid-lumbar spine or higher. Achieving this level of IR was associated with improved ability to perform several ADLs, as well as improved outcome scores. Importantly, no implant factors were associated with improved postoperative IR, suggesting that patient selection remains the primary controllable variable for surgeons seeking to improve IR after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151495"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188020","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":"Impact of ankylosing spondylitis on shoulder arthroplasty","authors":"Jacob J. Triplet DO ,&nbsp;Ronda N. Esper BS ,&nbsp;Adnan Cheema MD ,&nbsp;Erick M. Marigi MD ,&nbsp;John W. Sperling MD, MBA ,&nbsp;Jonathan Barlow MD ,&nbsp;Mark E. Morrey MD, PhD ,&nbsp;Joaquin Sanchez-Sotelo MD, PhD","doi":"10.1053/j.sart.2025.07.007","DOIUrl":"10.1053/j.sart.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Ankylosing spondylitis (AS) is an autoimmune spondyloarthropathy. Little has been published on the outcome of shoulder arthroplasty (SA) for the treatment of glenohumeral arthritis in AS. We report on the clinical and radiographic results, as well as the postoperative complications following SA in this patient cohort.</div></div><div><h3>Methods</h3><div>A retrospective review of our Institution's Total Joint Registry database identified 14 patients with a confirmed diagnosis of AS who were treated with primary SA and had been followed for a minimum of 2 years. Our cohort included 7 men and 7 women with a mean age of 63 years. There were 1 hemiarthroplasty, 4 anatomic total shoulder arthroplasties, and 9 reverse total shoulder arthroplasties. The average follow-up time was 5 years.</div></div><div><h3>Results</h3><div>In patients with AS, SA provided significant improvements in elevation (93° to 131°; <em>P</em> &lt; .001), external rotation (22°-38°; <em>P</em> &lt; .001), internal rotation (3.5-4.9; <em>P</em> &lt; .001), external rotation strength (3.6 to 4.6; <em>P</em> &lt; .001), and internal rotation strength (3.6 to 4.5; <em>P</em> &lt; .001). Postoperative complications included radiographic humeral head subluxation over time, heterotopic ossification, glenoid erosion, stress shielding, and polyethylene wear.</div></div><div><h3>Conclusions</h3><div>SA is an effective treatment modality for glenohumeral arthritis in patients with AS. Patients may expect improvements in pain, function, motion, and strength.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151490"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188206","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":"Does subscapularis tendon repair during primary reverse total shoulder replacement improve shoulder stability or functional outcomes: a systematic review and meta-analysis","authors":"Mohamed Elbeshbeshy MBChB,&nbsp;Rahel Rashid MBChB,&nbsp;Zaid Hashim MBBS,&nbsp;Abdaal Munir MBBS,&nbsp;Israa Kadhmawi MBChB,&nbsp;Conor Magee MBChB, MD,&nbsp;David Hawkes MBChB","doi":"10.1016/j.sart.2025.151520","DOIUrl":"10.1016/j.sart.2025.151520","url":null,"abstract":"<div><h3>Background</h3><div>The role of subscapularis tendon repair (STR) in reverse total shoulder arthroplasty (RTSA) continues to be debated. Proponents highlight the benefits as enhanced shoulder stability, greater internal rotation, and improved functional outcomes. Critics however argue it may limit external rotation and increase revision and complication rates. The aim of this review was to evaluate the impact of STR on shoulder stability and clinical outcomes in the context of primary RTSA.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases was performed to identify studies comparing outcomes between patients undergoing primary RTSA with STR and those with no STR (nSTR). The primary outcome was shoulder instability. Secondary outcomes included functional scores (American Shoulder and Elbow Surgeons score, Constant-Murley Score, and visual analog scale), range of motion, revision rate, and complications. Meta-analysis was performed using a random-effects model, and heterogeneity was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>A total of 19 studies met the inclusion criteria. One study had a critical risk of bias leading to its exclusion from the meta-analysis, resulting in the inclusion of the remaining 18 studies with 8,231 patients. STR was associated with a significantly lower risk of postoperative shoulder instability (RR 0.47, 95% confidence interval [CI] 0.28-0.81, I2 = 0%, <em>P</em> = .006), higher American Shoulder and Elbow Surgeons scores (mean difference = 3.47, 95% CI: 1.84-5.10, <em>P</em> &lt; .0001), Constant-Murley Score (mean difference = 2.43, 95% CI: 0.66-4.20, <em>P</em> = .006), and internal rotation scores (standardized mean difference = 0.46, 95% CI: 0.28-0.63, <em>P</em> = .0003). No significant differences were observed in visual analog scale scores, external rotation, revision rates, or overall complication rates between groups. Heterogeneity was accounted for by implementing random-effects models.</div></div><div><h3>Conclusion</h3><div>STR should be attempted during RTSA if feasible, as it potentially improves shoulder stability. However, the impact of STR on clinically-significant functional outcomes, range of motion, pain level, revision rates, and complications remains inconclusive. Further high-quality randomized controlled trials are needed to validate these findings. Acknowledging that the feasibility of STR likely reflects favorable intrinsic patient and pathology characteristics, further high-quality randomized controlled trials are needed to validate these findings.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151520"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885143","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":"Computed tomography density of the acromion prior to reverse total shoulder arthroplasty","authors":"Shu Su MBBS/BMedSci, MMed, FRANZCR ,&nbsp;Sarah Warby PhD, BPhysio(Hon) ,&nbsp;Xiao Chen MBBS, MMed, FRANZCR ,&nbsp;Julie Tate BSc(Hons), PgCert(CT) ,&nbsp;Gregory Hoy FRACS, FAOrthA, FACSEP, FASMF ,&nbsp;Warwick Wright MBBS, FRACS(Orth), DipAnat, DipComSci ,&nbsp;Shane Barwood MBBS, FRACS(Orth) ,&nbsp;Brendan Soo MBBS, FRACS(Orth) ,&nbsp;Richard Dallalana MBBS, FRACS, FAOrthA ,&nbsp;Andrew H. Rotstein MBBS, FRANZCR","doi":"10.1053/j.sart.2025.09.011","DOIUrl":"10.1053/j.sart.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Acromial stress fracture (ASF) is an acknowledged complication of reverse total shoulder arthroplasty (rTSA). Many potential causes for ASF have been theorized, the most well-established being osteoporosis, however few studies directly measure acromion density in patients planned for rTSA. This study aims to compare the acromial density between patients planned for rTSA, age and gender-matched controls and young gender-matched controls on computed tomography (CT) imaging.</div></div><div><h3>Methods</h3><div>Three groups were selected; (i) patients planned for rTSA (n = 25), (ii) age and gender-matched controls (n = 25), and (iii) young gender-matched controls less than 50 years old (n = 28). The density of the mid and posterior acromion was measured on CT using an established reliable method. One-way ANOVA was used to compare the mean differences in mid acromion and posterior acromion densities between all 3 groups. Post hoc comparisons between groups were performed using least significant difference. Significance was set at 0.05.</div></div><div><h3>Results</h3><div>There was a significant difference in bone density at the mid acromion between the 3 groups (<em>P</em> value &lt;.001). Post hoc analysis showed higher density in the planned rTSA group compared to age and gender-matched controls (<em>P</em> value = .002), and lower density in the planned rTSA compared to young gender-matched controls (<em>P</em> value &lt;.001). There was a significant difference in bone density at the posterior acromion between the 3 groups (<em>P</em> value &lt;.001). Post hoc analysis showed lower density in the planned rTSA compared to young gender-matched controls (<em>P</em> value &lt;.001).</div></div><div><h3>Conclusion</h3><div>The CT density of the mid and posterior acromion is highest in the young gender-matched control group, as well as higher in the mid acromion of patients planned for rTSA compared to age and gender-matched controls. Future studies of acromion density in patients with ASF post rTSA would assist in understanding the mechanisms responsible for the pathology.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151511"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749324","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":"Maximum of 10-year surgical outcomes following reverse total shoulder arthroplasty for rotator cuff arthropathy vs. proximal humerus fractures","authors":"Eric Cui BS ,&nbsp;Daniel Raftis BS ,&nbsp;Jackson W. Durbin BS ,&nbsp;Andrew Fealy BS ,&nbsp;Philip M. Parel BS ,&nbsp;Rachel Ranson DO ,&nbsp;Alana O'Mara MA ,&nbsp;Theodore Quan MD ,&nbsp;Jacob D. Mikula MD ,&nbsp;Ashish Vankara MD ,&nbsp;Zachary Zimmer MD ,&nbsp;Uma Srikumaran MD, MBA, MPH","doi":"10.1016/j.sart.2025.151527","DOIUrl":"10.1016/j.sart.2025.151527","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) in the setting of rotator cuff arthropathy (RCA) is an elective procedure in response to a chronic and degenerative process that occurs only after thorough preoperative risk stratification and adequate patient optimization. In contrast, rTSA secondary to proximal humerus fracture (PHF) is a response to an acute traumatic injury that frequently occurs in elderly patients with underlying comorbidities such as osteoporosis. These distinct patient populations may have unique risk profiles that could influence the long-term survivorship of implants and the specific indications for revision surgery. Despite the widespread use of rTSA for both RCA and PHF, the comparative long-term outcomes, revision rates, and indications for revision between these 2 patient populations are not well established.</div></div><div><h3>Methods</h3><div>Patients who underwent primary rTSA were identified using Current Procedural Terminology and International Classification of Diseases codes from a national claims database and stratified into PHF and RCA cohorts. Patients were included if they had at least two years of postoperative data. These cohorts were propensity score matched by age, gender, and Charlson Comorbidity Index to control for potential confounders. The 10-year and 5-year cumulative incidence rate and risk of all-cause revision, periprosthetic fracture (PPF), periprosthetic joint infection (PJI), dislocation, and mechanical loosening were determined using Kaplan-Meier and Cox proportional hazard analyses.</div></div><div><h3>Results</h3><div>In total, 23,684 patients were included in this study, with 7,982 patients (33.70%) and 15,702 patients (66.30%) included in the PHF and RCA cohort, respectively. The 10-year cumulative risk for all-cause revision (hazard ratio [HR]: 1.5; <em>P</em> &lt; .001), PPF (HR: 1.7; <em>P</em> &lt; .001), dislocation (HR: 1.7; <em>P</em> &lt; .001), and PJI (HR: 1.31; <em>P</em> = .001) were all significantly higher in the PHF cohort compared to the RCA cohort. Similarly, at the 5-year mark, the risk of all-cause revision (HR: 1.6; <em>P</em> &lt; .001), PPF (HR: 1.6; <em>P</em> &lt; .001), dislocation (HR: 1.7; <em>P</em> &lt; .001), and PJI (HR: 1.3; <em>P</em> = .002) was also significantly higher in the PHF cohort. In contrast, mechanical loosening did not differ significantly between groups at both the 5-year and 10-year marks.</div></div><div><h3>Conclusion</h3><div>Over a 10-year period, patients undergoing rTSA for PHF demonstrated a higher risk of all-cause revision, PPF, dislocation, and PJI. These findings highlight the importance of counseling patients about the likely long-term outcomes following an rTSA for PHF compared to elective RCA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151527"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077509","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":"Pneumonia before shoulder arthroplasty increases the risk of medical and surgical complications in a time-dependent manner","authors":"Tyler T. Brady BS ,&nbsp;Romir P. Parmar BS ,&nbsp;Alejandro M. Holle BS ,&nbsp;Michael H. Amini MD ,&nbsp;Evan Lederman MD ,&nbsp;Midhat Patel MD","doi":"10.1016/j.sart.2025.151539","DOIUrl":"10.1016/j.sart.2025.151539","url":null,"abstract":"<div><h3>Background</h3><div>While prior pneumonia (PNA) is a known risk factor for complications in surgery, its influence on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study aimed to evaluate how the timing and history of PNA affect postoperative outcomes after TSA.</div></div><div><h3>Methods</h3><div>A large insurance claims database was queried to identify patients undergoing primary TSA, anatomic and reverse, with a minimum of 2 years of follow-up. Patients with a diagnosis of PNA within 2 years before TSA were propensity-score matched 1:1 to controls without prior PNA based on demographics and Elixhauser comorbidity index and its individual components. Outcomes of interest included medical and surgical complications. Subgroup analyses were performed based on PNA timing (&lt;3, 3-6, 6-12, 12-18, and 18-24 months), PNA type (bacterial vs. viral), and further stratified by causative organism.</div></div><div><h3>Results</h3><div>A total of 8,619 patients with prior PNA within 2 years of surgery were matched to 8,619 controls. Patients with prior PNA had increased odds of postoperative PNA (odds ratio (OR) 3.06, 95% confidence interval (CI) 2.40-3.91), acute myocardial infarction (MI) (OR 1.50, 95% CI 1.05-2.15), deep venous thrombosis (OR 1.60, 95% CI 1.15-2.22), and urinary tract infection (OR 1.18, 95% CI 1.03-1.34). PNA occurring within 3 months prior to TSA was associated with the highest odds for postoperative PNA (OR 5.21, 95% CI 3.66-7.42) and MI (2.28, 95% CI 1.23-4.21). Additionally, patients with prior PNA had increased odds of aseptic loosening (OR 1.25, 95% CI 1.04-1.51) and periprosthetic fracture (OR 1.88, 95% CI 1.21-2.91), but no significant associations were seen in time-dependent analyses. Viral PNA was associated with increased rates of postoperative MI (OR 3.40, 95% CI 1.45-8.00), compared to controls. Streptococcal PNA was notably associated with postoperative PNA (OR 7.26, 95% CI 3.90-13.55), while <em>Mycoplasma</em> <em>pneumoniae</em> was associated with wound dehiscence (OR 10.10, 95% CI 1.33-76.76) compared to controls.</div></div><div><h3>Conclusion</h3><div>A history of PNA is associated with higher risk of complications after TSA, especially when within 3 months or 6 months before surgery. Both timing and organism influence outcomes, highlighting the importance of pulmonary optimization prior to surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151539"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037718","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 Hospital Frailty Risk Score predicts increased mortality, complication, and resource utilization following revision total shoulder arthroplasty","authors":"Kola D. George MD ,&nbsp;Taylor L. Cunningham BA ,&nbsp;John W. Moore BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2026.151545","DOIUrl":"10.1016/j.sart.2026.151545","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a state of age-related decline that has been associated with negative outcomes and increased complications following orthopedic surgery. The Hospital Frailty Risk Score (HFRS) is a newer comorbidity index designed to measure frailty. The purpose of this study was to determine how frailty, as measured by the HFRS, affects complication rates following revision total shoulder arthroplasty (TSA).</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried from 2016 to 2020 to identify revision TSA cases. HFRS was calculated, and patients with a score of ≥5 were said to be frail. Frail patients were matched 1:1 on age and sex to yield 4,465 frail cases and 4,470 control cases. Frail and nonfrail patients were compared across demographic information, preoperative comorbidities, postoperative complications, and healthcare utilization measures. Binary logistic regression was used to identify postoperative complications for which HFRS was independently predictive.</div></div><div><h3>Results</h3><div>Frail patients had higher HFRS than nonfrail patients (<em>P</em> &lt; .001) and higher rates of smoking (<em>P</em> &lt; .001) and lower rates of alcohol abuse (<em>P</em> &lt; .001) and drug abuse (<em>P</em> &lt; .001). Frail patients were more likely to have Medicare insurance (<em>P</em> &lt; .001) and more likely to be white (<em>P</em> &lt; .001). Following binary logistic regression, HFRS was an independent predictor of increased mortality (<em>P</em> &lt; .001), Acute Respiratory Distress Syndrome (<em>P</em> &lt; .001), acute renal failure (<em>P</em> &lt; .001), bleeding (<em>P</em> &lt; .001), cellulitis (<em>P</em> &lt; .001), surgical site infection (<em>P</em> &lt; .001), pneumonia (<em>P</em> &lt; .001), sepsis (<em>P</em> &lt; .001), shock (<em>P</em> &lt; .001), transfusion (<em>P</em> &lt; .001), urinary tract infection (<em>P</em> &lt; .001), and periprosthetic fracture (<em>P</em> &lt; .001). HFRS was independently predictive of decreased rates of periprosthetic loosening (<em>P</em> &lt; .001) and osteolysis (<em>P</em> &lt; .001). Frail patients had increased resource utilization compared to nonfrail patients, including higher cost (<em>P</em> &lt; .001) and increased hospital length of stay (<em>P</em> &lt; .001).</div></div><div><h3>Discussion</h3><div>Frailty, when measured using the HFRS, is associated with increased postoperative complications, healthcare costs, and reoperation in patient's undergoing revision TSA. Increased HFRS scores are associated with adverse outcomes following revision TSA. Our study emphasizes the importance of careful patient selection undergoing this procedure. The assessment of patient frailty utilizing HFRS serves to be a valuable resource to predict the risk of poor outcomes in revision TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151545"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077508","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}