Seminars in Arthroplasty最新文献

{"title":"Modeling highly crosslinked polyethylene vs. non–highly crosslinked polyethylene glenoid revision rates for anatomic shoulder arthroplasty in osteoarthritis including differing polyethylene glenoid fixation designs","authors":"David R.J. Gill MB ChB, FRACS, FAOrthA ,&nbsp;Sophia Corfield PhD (Hons) ,&nbsp;Dylan Harries BSc (Hons), PhD ,&nbsp;Richard S. Page BMedSci, MBBS, FRACS, FAOrthA","doi":"10.1053/j.sart.2024.06.003","DOIUrl":"10.1053/j.sart.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>We compared anatomic total shoulder arthroplasty (aTSA) for osteoarthritis to both highly crosslinked polyethylene (XLPE) and non–highly crosslinked polyethylene (non-XLPE) to determine the rate of revision for multiple patient and implant characteristics, modeling the effect of variation in glenoid fixation design (glenoid component type).</div></div><div><h3>Methods</h3><div>Data from a large national arthroplasty registry were analyzed for the period April 16, 2004, to December 31, 2022. The study population included all primary aTSA (stemmed and stemless shoulder arthroplasty) procedures with a primary diagnosis of osteoarthritis and performed using prostheses in current use. These procedures were grouped into 2 cohorts: all polyethylene-bearing glenoid components with either XLPE or non-XLPE. The cumulative percent revision was determined using Kaplan–Meier estimates of survivorship and hazard ratios from Cox proportional hazard models adjusted for age, sex, humeral head size, humeral fixation, type of primary (total stemmed or stemless anatomic), glenoid component type (modular and nonmodular metal-backed glenoid, cemented polyethylene glenoid, and polyethylene glenoid with modified central peg), and surgeon volume (after 2008). Possible interactions were examined. A subanalysis from January 1, 2017, captured the additional patient demographics of American Society of Anesthesiologists score, body mass index, and glenoid morphology.</div></div><div><h3>Results</h3><div>Of 11,003 aTSA procedures, the cumulative percent revision at 14 years for all XLPE glenoids (n = 3865) was 5.8% (95% confidence interval [CI] 3.9, 8.7), and 18.7% (95% CI 16.6, 21.0) for non-XLPE (n = 7138). XLPE had a lower rate of revision from 2 years (non-XLPE vs. XLPE 2 years + hazard ratio = 1.66, (95% CI 1.09, 2.53), <em>P</em> = .018) adjusting for age, sex, humeral head size, type of primary, humeral stem fixation, and glenoid component type. Overall, glenoid component type and polyethylene type were strongly associated (<em>P</em> &lt; .001 and <em>P</em> = .021, respectively) with all-cause aTSA revision rates. The difference between non-XLPE and XLPE is observed across all polyethylene glenoid types. When considering procedures performed between 2017 and 2022, XLPE vs. non-XLPE rates of revision were not significantly different with extended adjustment at subanalysis, but loosening did not predominate for non-XLPE until year 6 of follow-up.</div></div><div><h3>Conclusion</h3><div>Both the glenoid design and the type of polyethylene predict the revision rate for aTSA. However, the relative rates of revision between glenoid designs did not differ with polyethylene type. While the polyethylene type was not associated with aTSA revision rates in a more contemporary analysis, the incidence of loosening in non-XLPE prostheses combinations was higher from 6 years may explain this.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 843-853"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700738","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 effect of primary language on access to specialized orthopedic care","authors":"Jessica V. Baran BS ,&nbsp;Jared Kushner BS ,&nbsp;Anna Redden BS ,&nbsp;Katelyn Kane BS ,&nbsp;Carlos Fernandez MD ,&nbsp;Shay V. Daji MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2024.06.001","DOIUrl":"10.1053/j.sart.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Language barriers can negatively impact the quality of care for non-English speaking patients. Lack of access to health-care providers who speak multiple languages or interpreters in medical offices can result in delayed appointment times, delayed treatment, and increased complications. Access to shoulder surgeons with subspecialty training is limited and this has been established which may further exacerbate the problem with access for these patients. The purpose of this study was to determine the effect of primary language spoken on access to specialty shoulder care in South Florida.</div></div><div><h3>Methods</h3><div>Three populous, diverse counties in South Florida were selected for data collection. Sixty-nine orthopedic offices were identified by Google search and selected via random number generator. Investigators used the Secret Shopper methodology to contact each office to schedule an appointment for a shoulder arthroplasty for a family member who spoke exclusively English or Spanish using a blocked phone number. The ability to schedule a new patient appointment with a fellowship-trained shoulder specialist, the waiting period for the scheduled appointment, and interpretation services for Spanish-speaking patients were collected.</div></div><div><h3>Results</h3><div>Of the 69 offices called, 35 met inclusion criteria. There were no significant differences in wait times for shoulder arthroplasty based on primary language spoken. There was no difference in wait time to see a shoulder specialist between Spanish (13.7 days) and English-speaking patients (12.9 days) (<em>P</em> = .835)). Wait times with a nonfellowship-trained orthopedic surgeon between Spanish and English-speaking patients was also not different (9.5 days and 11.96 days, respectively (<em>P</em> = .522). Similarly, no difference existed in phone call duration (<em>P</em> = .56), median income and wait times for a general orthopedic surgeon, with r = −0.26 (<em>P</em> = .105), or a shoulder specialist, with r = −0.19 (<em>P</em> = .22). Of the clinics accepting patients, 74.3% (n = 26/35) offered Spanish interpretation with 42.3% (n = 11/26) providing a multilingual physician, 26.9% (n = 7/26) a translating service, 23.1% (n = 6/26) had a staff member capable of translation, and 7.7% (n = 2/26) had an available professional interpreter.</div></div><div><h3>Conclusion</h3><div>While access to orthopedic specialty care may be similar for Spanish-speaking and English-speaking patients in South Florida, over 25% of clinics lack multilingual physicians or qualified interpreter access. This can negatively impact surgical decision-making, postoperative care and outcomes after shoulder surgery. It is essential the orthopedic community advocates for the proper resources to optimally assist surgeons and provide quality care for Spanish-speaking orthopedic patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 832-837"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716445","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":"Internal rotation-based activities of daily living show limitations following reverse shoulder arthroplasty versus anatomic shoulder arthroplasty","authors":"Galo C. Bustamante BS,&nbsp;Erryk S. Katayama BS,&nbsp;Mustaqueem Pallumeera BS,&nbsp;Louis S. Barry BS,&nbsp;John S. Barnett BS,&nbsp;Akshar V. Patel BS,&nbsp;Gregory L. Cvetanovich MD,&nbsp;Julie Y. Bishop MD,&nbsp;Ryan C. Rauck MD","doi":"10.1053/j.sart.2024.07.001","DOIUrl":"10.1053/j.sart.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><div>One of the more common limitations after reverse total shoulder arthroplasty (rTSA) is limited internal rotation (IR). Outcomes after rTSA are commonly reported as patient-reported outcome measures (PROMs) but are rarely assessed by specific activities of daily living (ADLs). Analyzing ADLs evaluates for specific motions from PROMs. The purpose of this study is to investigate the deficit in IR following rTSA through ADLs.</div></div><div><h3>Methods</h3><div>A retrospective case-control study was conducted using institutional medical records. Patients who underwent total shoulder arthroplasty between 2009 and 2020 were reviewed for demographic and clinical variables (type of arthroplasty, indication, range of motion and strength). PROMs were taken by phone at 2-year minimum follow-up. Statistics were calculated as two-tailed using Chi-square or simple t-tests as appropriate.</div></div><div><h3>Results</h3><div>Among 208 patients, 114 aTSA, and 94 rTSA were identified and included in this study. Both groups reported significant increases in range of motion and strength postoperatively. PROMs were mostly similar between aTSA and rTSA (Single Assessment Numeric Evaluation 83.4 ± 17.1 vs. 82.3 ± 18.4, <em>P</em> = .643; visual analog scale Pain 2.2 ± 2.8 vs. 1.8 ± 2.4, <em>P</em> = .247), while Simple Shoulder Test did show a difference (9.2 ± 2.8 vs. 7.8 ± 3.2, <em>P</em> = .001) with higher scores in the aTSA cohort. The ADLs which showed significant disparity between aTSA and rTSA were toileting (<em>P</em> = .001), donning a coat (<em>P</em> = .017), reaching one’s back (<em>P</em> = .017), as well as throwing overhand (0.013) with rTSA patients reporting more difficulty in all these ADLs.</div></div><div><h3>Conclusion</h3><div>Both aTSA and rTSA are safe and efficacious options for shoulder replacement, as evidenced by high Single Assessment Numeric Evaluation and low visual analog scale pain scores and should be used according to their established indications. Surgeons may counsel rTSA patients about potential increased deficits in ADLs reliant on IR such as managing toileting and dressing compared to aTSA recipients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 877-883"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840007","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":"Examination of the factors associated with humeral head size as calculated by 3-dimensional computed tomography in patients with rotator cuff tears","authors":"Kohei Uekama MD,&nbsp;Takasuke Miyazaki PT, PhD,&nbsp;Shingo Maesako MD,&nbsp;Shogo Tsutsumi PT, PhD,&nbsp;Noboru Taniguchi MD, PhD","doi":"10.1053/j.sart.2024.07.004","DOIUrl":"10.1053/j.sart.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Despite the effectiveness of 3-dimensional computed tomography (3D-CT) for identifying bone and joint conditions, there are few clinical data on humeral head enlargement in patients with rotator cuff tears (RCTs), including cuff tear arthropathy (CTA). This study aimed to investigate the factors correlated with humeral head size measured through 3D-CT in patients with RCTs.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 43 preoperative patients who were diagnosed via RCTs. The severity of RCTs was classified into 3 types: small-medium tears, large-massive tears, and CTA. The 3D-radius was calculated from the raw radius data using 3D-CT and adjusted by height as a corrected-radius. The reliability of the 3D-radius measurements was calculated as the intraclass correlation coefficient. Various statistical analyses, including correlation coefficients, group comparisons, and multiple regression analyses, were used to explore factors associated with humeral head size.</div></div><div><h3>Results</h3><div>The interobserver reliability of the 3D-radius was 0.903. The corrected-radius on the affected side exhibited correlations with age (r = 0.598, <em>P</em> &lt; .001) and the acromion-humeral interval (r = −0.609, <em>P</em> &lt; .001). Group comparison between tear sizes, the CTA group had larger corrected-radius than the other groups (<em>P</em> = .001), with no significant difference between the small-medium tear and large-massive tear groups (<em>P</em> = .932). Multiple regression analysis adjusted for covariates revealed that the corrected-radius was correlated with age and the acromion-humeral interval (<em>P</em> &lt; .05, R² = 0.474).</div></div><div><h3>Conclusion</h3><div>These findings provide valuable clinical insights into the factors associated with humeral head enlargement, particularly in patients with RCTs. The measurement method we used holds promise for informing the selection of artificial head sizes during the preoperative planning of total shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 900-906"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of mental health on major complications following total shoulder arthroplasty","authors":"Kenny Ling MD ,&nbsp;Emily N. Moya BA ,&nbsp;Jack Tesoriero MD ,&nbsp;Robert Martino BS ,&nbsp;David E. Komatsu PhD ,&nbsp;Edward D. Wang MD","doi":"10.1053/j.sart.2024.07.007","DOIUrl":"10.1053/j.sart.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>The volume of total shoulder arthroplasty (TSA) procedures has seen a remarkable surge over the past decade in the United States. Recent research has shown an association between depression and poorer postoperative outcomes following shoulder, hip, and knee arthroplasties. The purpose of this study was to examine the relationship between patients with a diagnosis of depression and/or anxiety and the risk of major postoperative complications after TSA.</div></div><div><h3>Methods</h3><div>The TriNetX Research Network database was queried on May 30, 2023. Patient cohorts and outcomes were defined using International Classification for Disease, 10^th Edition diagnosis codes and Current Procedural Terminology codes. After propensity score matching, the two cohorts were analyzed for differences in major outcomes within two years following the initial procedure.</div></div><div><h3>Results</h3><div>Of the 45,838 patients who underwent TSA identified in TriNetX, 15,074 patients were included in the depression/anxiety cohort and 30,764 were included in the no depression/anxiety cohort. Propensity score matching was performed to match 13,392 patients from each cohort. Compared to patients with no depression nor anxiety, patients with either depression and/or anxiety were identified to have a higher risk for dislocation (odds ratio [OR] 1.502, 95% confidence interval [CI] 1.285-1.756; <em>P</em> &lt; .001), periprosthetic joint infection (OR 1.309, 95% CI 1.123-1.525; <em>P</em> = .001), periprosthetic fracture (OR 1.661, 95% CI 1.341-2.056; <em>P</em> &lt; .001), and revision TSA (OR 1.316, 95% CI 1.150-1.506; <em>P</em> &lt; .001) within 2 years after the initial procedure.</div></div><div><h3>Conclusion</h3><div>Overall, this study showed that patients who have depression and/or anxiety have a higher risk for dislocation, periprosthetic joint infection, revision TSA, and periprosthetic fracture within two years after TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 924-927"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747737","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":"Tuberosity healing in reverse shoulder arthroplasty for proximal humerus fractures with a diaphyseal press-fit humeral stem","authors":"Benjamin W. Szerlip DO ,&nbsp;Matthew T. Glazier DO ,&nbsp;Walter R. Smith MD ,&nbsp;Mitzi S. Laughlin PhD ,&nbsp;T. Bradley Edwards MD","doi":"10.1053/j.sart.2024.06.004","DOIUrl":"10.1053/j.sart.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Reverse shoulder arthroplasty (RSA) is a viable option for proximal humerus fractures (PHFs) in the elderly, and cemented humeral fixation is the standard of care. This study evaluates the influence of a diaphyseal press-fit stem with a 142° humeral inclination on tuberosity healing (TH) and functional outcome in RSA for PHF.</div></div><div><h3>Methods</h3><div>Twenty-three patients received an RSA for PHF by a single surgeon at one center over a 2-year period. The humeral stem design was intended for diaphyseal press fit with a 142° humeral inclination. The tuberosities were repaired for each patient with bone graft and a standard suture technique. Patients’ clinical and radiographic outcomes were collected with a minimum 12-month follow-up.</div></div><div><h3>Results</h3><div>Nineteen of 23 patients (83%), with a mean age of 75 + years, were available for follow-up at an average of 14 months. Radiographic analysis showed 68% of patients had evidence of TH. Grade 1 scapular notching was found in 32% of patients. There was no implant loosening or subsidence noted. Average range of motion was 163° ± 15° degrees of forward flexion, 113° ± 24° of abduction, internal rotation to the waist, and an average external rotation of 7 ± 1.5 as measured by the Constant-Murley score. The average American Shoulder and Elbow Surgeons score was 81.8, and the average Constant-Murley score was 67.9. While not significant, those with TH trended toward better clinical outcomes. There was a 0% revision rate.</div></div><div><h3>Conclusion</h3><div>A press-fit stem designed for diaphyseal fixation provides consistent reliable results in RSA for PHF. A high percentage of TH was appreciated with a 142° humeral inclination, neutral glenosphere construct, and a standardized bone grafting, suture technique. TH is associated with improved patient outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 854-861"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704491","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":"Short-term clinical and radiographic outcomes with modular long stem for revision reverse total shoulder arthroplasty","authors":"Eddie Y. Lo MD ,&nbsp;Austin Witt MD ,&nbsp;Alvin Ouseph MS ,&nbsp;Monia Nazemi MS ,&nbsp;Nancy Weingast BSN ,&nbsp;Sumant G. Krishnan MD","doi":"10.1053/j.sart.2024.07.006","DOIUrl":"10.1053/j.sart.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>When performing reverse total shoulder arthroplasty with compromised proximal bone fixation, surgeons must consider using specialized stems with a distal press-fit design. In this study, the authors report on the clinical and radiographic outcomes of patients who underwent surgical management with modular diaphyseal press-fit stems.</div></div><div><h3>Methods</h3><div>In 2017-2021, patients who underwent revision reverse total shoulder arthroplasty reconstruction with diaphyseal press-fit stems (Aequalis Adjustable Stem [AS] or Aequalis Flex Revive Stem [RS]; Stryker, Kalamazoo, MI, USA) with minimum 1-year follow-up were identified. Patients with complex proximal humerus and scapula fractures, neurological injuries, and custom humeral replacements were excluded. Demographics and clinical follow-up data including range of motion, Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder Elbow Surgeons (ASES) Score, and Single Assessment Numeric Evaluation were retrospectively reviewed. Postoperative radiographs were reviewed for aseptic humeral loosening, periprosthetic instability, stress shielding, periprosthetic fractures, and humeral stem failure.</div></div><div><h3>Results</h3><div>Sixty-five patients (29 AS and 36 RS) had mean follow-up of 25 months (standard deviation ± 16). Mean anterior elevation improved from 57° ± 39 preoperative to 121° ± 31 postoperatively. Mean external rotation improved from 3° ± 17 to 34° ± 16. Mean internal rotation improved from 4° ± 13 to 35° ± 26. Mean VAS improved from 6.7 ± 2.2 to 2.9 ± 1.5. Mean SST improved from 13% ± 13% to 65% ± 22%. Mean ASES score improved from 19 ± 13 to 60 ± 18. Mean Single Assessment Numeric Evaluation improved from 25% ± 18% to 71% ± 17%. There were statistically significant differences in mean postoperative VAS (<em>P</em> = .0017), SST (<em>P</em> = .025), and ASES score (<em>P</em> = .0228) in favor of the RS group. There were no other notable differences between groups. The most common complications were aseptic humeral stem loosening (24% vs. 3%, <em>P</em> = .018) and periprosthetic instability (10% vs. 6%, <em>P</em> = .649) for the AS and RS cohorts, respectively. There was no statistically significant difference between surgical revision rates between the AS and RS cohorts (24% vs. 8%, respectively. <em>P</em> = .096).</div></div><div><h3>Discussion</h3><div>Diaphyseal press-fit modular humeral stem can provide a viable surgical alternative in compromised proximal humeral bone. At short-term follow-up, the clinical and radiographic outcomes are comparable to other stem designs. Further studies are necessary to identify risks and causes of failure associated with modular diaphyseal press-fit stems.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 915-923"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747736","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":"Mid- to long-term outcomes of reverse total shoulder arthroplasty: a systematic review","authors":"Kira L. Smith BS ,&nbsp;Luc M. Fortier MD ,&nbsp;Margaret A. Sinkler MD ,&nbsp;Monish S. Lavu MHM ,&nbsp;Jacob G. Calcei MD ,&nbsp;Robert J. Gillespie MD ,&nbsp;Raymond E. Chen MD","doi":"10.1053/j.sart.2024.07.011","DOIUrl":"10.1053/j.sart.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><div>The reverse total shoulder arthroplasty (rTSA) is increasingly gaining popularity in treating various traumatic and degenerative glenohumeral diseases as well as rotator cuff-deficient shoulders. An investigation of midterm outcomes of rTSA is warranted as this is a relatively new procedure when compared to other forms of arthroplasty. This systematic literature review evaluates midterm outcomes of rTSA at a minimum of five-year follow-up.</div></div><div><h3>Methods</h3><div>A literature search was performed for studies reporting long-term outcomes of rTSA in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Papers were included if they described long-term outcomes of rTSA at a minimum of 5-year follow-up. Data were collected on patient demographics, including age, gender, and body mass index. Follow-up duration, indication for surgery, patient-reported outcome measures, and range of motion (ROM) were also recorded. Complication rates and device survivorship were also collected.</div></div><div><h3>Results</h3><div>There were a total of 4127 patients from 34 included studies. The overall study population was 74% female, and the average age was 72.6 years (23-95). The most common diagnosis was cuff tear arthropathy [35.2%], followed by proximal humerus fracture [19.5%], and rotator cuff tears [14.9%]. Patient-reported outcome measures improved significantly when comparing preoperative and postoperative values. ROM, including forward elevation, abduction, and external rotation, also improved significantly postoperatively. The overall complication rate was 14.7% (n = 981). The most common complications were implant loosening (3.3%, n = 219) and instability or dislocation (3.3%, n = 218). The overall revision rate was 5.5% (n = 310). The device survivorship rate at a minimum of 5 years was 94%.</div></div><div><h3>Conclusion</h3><div>This systematic review demonstrated that outcomes of rTSA performed for a variety of shoulder pathologies demonstrate significant improvement in nearly all patient-reported outcome scores as well as significant improvement in ROM at long-term follow-up. The overall complication rate of 14.7% is relatively low, and the device survivorship is good at 94% at a minimum of 5 years.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 953-963"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748287","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":"High in-hospital preoperative anxiety levels are not associated with an increased length of stay or readmission following primary shoulder arthroplasty","authors":"Rocio A.L. Crabb MD ,&nbsp;Viraj Deshpande BS ,&nbsp;Noemi Urquiza BS ,&nbsp;Kyle Schoell MD ,&nbsp;Sean Guerrero MHA ,&nbsp;Edward J. Quilligan BS ,&nbsp;Hafiz F. Kassam MD","doi":"10.1053/j.sart.2024.06.005","DOIUrl":"10.1053/j.sart.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Anxiety is prevalent in our society, affecting all facets of patients’ lives. There is, however, a paucity of literature exploring how anxiety extends into the orthopedic perioperative setting. We sought to analyze a subset of patients undergoing primary shoulder arthroplasty to determine whether correlations exist between anxiety, patient characteristics, time spent in the hospital, and likelihood of returning to the hospital after discharge.</div></div><div><h3>Methods</h3><div>After obtaining institutional review board approval, our hospital prospectively identified and approached all patients undergoing total shoulder arthroplasty between February and June of 2023. Patients completed the Visual Analog Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS), two validated tools used to assess preoperative anxiety levels and need for information, in the preoperative holding area before surgery. Patient demographics, hospital length of stay (LOS), and 30-day readmission rate were collected and analyzed.</div></div><div><h3>Results</h3><div>A total of 79 patients were enrolled. Nineteen percent of patients were found to be anxious using the APAIS tool, while 37.7% of patients were found to be anxious using the VAS-A tool. No significant correlation was found between APAIS or VAS-A anxiety scoring and hospital LOS. No significant correlation was found between APAIS or VAS-A anxiety scoring and 30-day readmission rate. A significant correlation was found between APAIS anxiety scoring and body mass index (BMI), as well as VAS-A scoring and BMI. However, no significant correlation was found between BMI and hospital LOS or between BMI and 30-day readmission rate.</div></div><div><h3>Conclusion</h3><div>Our study did not find a statistically significant correlation between immediate preoperative anxiety levels in patients undergoing shoulder arthroplasty and their length of stay or 30-day readmission rate. We did discover a linear relationship between patient BMI and their preoperative anxiety scores; however, no significant direct correlation was found between a patient’s BMI and their length of stay or their 30-day readmission rate. Our findings suggest that higher levels of preoperative anxiety should not preclude a patient from the benefits of consideration of early discharge planning such as same-day total shoulder replacement.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 862-866"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845068","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":"Readability of English and Spanish online patient education materials for shoulder arthroplasty","authors":"Jacob S. Ghahremani BA ,&nbsp;Jenna E. Ogi BS ,&nbsp;Michael T. Kody MD ,&nbsp;Ronald A. Navarro MD","doi":"10.1053/j.sart.2024.07.002","DOIUrl":"10.1053/j.sart.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Online patient educational materials (OPEMs) are a vital source of information for those undergoing shoulder arthroplasty, though their utility is limited by patient health literacy as the average American reads at an eighth-grade level. To promote optimal reading comprehension, the American Medical Association and National Institutes of Health recommend that OPEMs be written at or below a sixth-grade level. The purpose of this study is to analyze the readability of English and Spanish shoulder arthroplasty OPEMs.</div></div><div><h3>Methods</h3><div>Google Search was used to identify the first 25 eligible Shoulder Arthroplasty OPEMs in both English and Spanish using the search terms “shoulder replacement” and “reemplazo de hombro.” Readability of the English OPEMs was calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Index (FRE), Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index. The readability of Spanish OPEMs was calculated using the Fernandez-Huerta Index (FHI; the Spanish version of FRE), Fernandez-Huerta Index Grade Level, Gutiérrez de Polini's Fórmula de compresibilidad, and Índice Flesch-Szigriszt.</div></div><div><h3>Results</h3><div>The mean FHI of Spanish OPEMs was significantly higher than the mean FRE of English OPEMs (60.09 vs. 51.48). As such, Spanish OPEMs were written at a significantly lower grade level than English OPEMs (9.70 vs. 11.53). There was not an English or Spanish OPEM that was written at or below a sixth-grade reading level. 4% of Spanish OPEMs and 4% of English OPEMs were written below an eighth-grade reading level. 52% of Spanish OPEMs and 8% of English OPEMs were written between an eighth- and ninth-grade reading level. The designation of OPEMs as being Very Easy/Easy, Standard/Normal, Fairly/Somewhat Difficult, or Difficult/Very Difficult was significantly dependent on whether the OPEM was written in English or Spanish.</div></div><div><h3>Discussion and conclusion</h3><div>English shoulder arthroplasty OPEMs were written at a higher reading difficulty than Spanish OPEMs. However, neither English nor Spanish OPEMs were written at a reading level at or below the recommended sixth-grade reading level. As older adults and those in the United States with limited English proficiency are susceptible to low health literacy, OPEMs must be written at an accessible reading level for all. Addressing these disparities in OPEM readability will improve patient care and understanding of shoulder arthroplasty and other orthopedic procedures.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 884-892"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850929","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}