Seminars in Arthroplasty最新文献

{"title":"Complications after primary and revision shoulder arthroplasty: a matched cohort study","authors":"Joshua I. Mathew BS ,&nbsp;Peter J. Chabot BA ,&nbsp;Michelle E. Kew MD ,&nbsp;Michael C. Fu MD ,&nbsp;Samuel A. Taylor MD ,&nbsp;Joshua S. Dines MD ,&nbsp;David M. Dines MD ,&nbsp;Lawrence V. Gulotta MD","doi":"10.1053/j.sart.2024.09.003","DOIUrl":"10.1053/j.sart.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total shoulder arthroplasty typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>Retrospective chart review was conducted for patients who underwent revision anatomic or reverse shoulder arthroplasty between January 2015 and May 2021 (N = 152). A cohort of patients who underwent primary shoulder arthroplasty in the same period was generated by matching 1:1 for implant type (anatomic/reverse), age, and surgery date. Demographic data, patient-reported outcomes, surgical details, surgical complications, and reoperations were collected for both cohorts (N = 304). Chi-square, t-test, Fisher’s exact test, and Mann-Whitney test were used as appropriate.</div></div><div><h3>Results</h3><div>The revision cohort had a significantly higher rate of surgical complications than the primary cohort (N = 58, 38.2% vs. N = 22, 14.5%; <em>P</em> &lt; .0001). The distribution of complication types differed significantly between the primary and revision cohorts (<em>P</em> = .018). Revision patients reported less improvement in Single-Assessment Numeric Evaluation score from baseline to 2-year follow-up compared to primary patients (postoperative and preoperative scores 33.9 ± 35.9 vs. 52.3 ± 32.5; <em>P</em> = .036). Patients in the primary cohort who underwent a previous shoulder surgery before their shoulder arthroplasty were more likely to experience complications than those who did not (<em>P</em> &lt; .001). The most common surgical complications in the revision cohort were persistent pain (N = 20) and periprosthetic joint infection (N = 10), while the most common complications in the primary cohort were persistent pain (N = 6) and instability (N = 4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision patients (120 ± 68 min) than primary patients (94 ± 31 min; <em>P</em> &lt; .0001). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (<em>P</em> = .043).</div></div><div><h3>Conclusion</h3><div>Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent surgical complications and worse clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 71-76"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284735","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":"Accessing information provided via artificial intelligence regarding reverse and anatomic total shoulder arthroplasty","authors":"Suhasini Gupta BS ,&nbsp;Brett D. Haislup MD ,&nbsp;Alayna K. Vaughan MD ,&nbsp;Ryan A. Hoffman MD ,&nbsp;Anand M. Murthi MD","doi":"10.1053/j.sart.2024.09.001","DOIUrl":"10.1053/j.sart.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to analyze the quality, accuracy, and readability of information provided by an artificial intelligence (AI) interface ChatGPT (OpenAI, San Francisco). We searched ChatGPT for commonly asked questions by patients regarding anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>ChatGPT was used to answer 30 commonly asked questions by patients regarding aTSA and rTSA, inputted as “total shoulder replacement” and “reverse shoulder replacement”. These questions were categorized based on the Rothwell criteria into <em>Fact</em>, <em>Policy</em>, and <em>Value</em>. The answers generated were analyzed for quality, accuracy, and readability using the DISCERN scale, JAMA benchmark criteria, Flesch-Kincaid Reading Ease Score (FRES) and Grade Level (FKGL).</div></div><div><h3>Results</h3><div>For both rTSA and aTSA the DISCERN score for <em>Fact</em> questions was 57, <em>Policy</em> questions was 61, and for <em>Value</em> questions was 58 (all were all considered “good”). The JAMA benchmark criteria was 0, representing the lowest score for <em>Fact</em>, <em>Policy</em>, <em>and Value</em> questions for both rTSA and aTSA questions. The FRES score for the aTSA answers for <em>Fact</em> was 15.15, for <em>Policy</em> was 11.14, and for <em>Value</em> questions was 10.95. The FRES score for rTSA questions for <em>Fact</em> is 48.02, <em>Policy</em> is 12.51, and <em>Value</em> is 17.22. The FKGL for aTSA answer for <em>Fact</em> was 17.48, <em>Policy</em> was 17.72 and <em>Value</em> was 17.96. The FKGL for rTSA questions for <em>Fact</em> are 8.10, <em>Policy</em> is 17.27, and <em>Value</em> is 16.56.</div></div><div><h3>Conclusion</h3><div>Overall, the quality of answers provided by AI open model, ChatGPT was considered “good.” The information provided had lower reliability, and lack of information regarding funding and disclosures. Most of the information generated by ChatGPT was also found to have the readability of “academic level text”, while <em>Fact</em> related information on reverse shoulder arthroplasty was found to have the readability of 9th grade level, which may be too complex for most patients. Overall, these results indicate that ChatGPT can provide correct answers to questions about aTSA and rTSA, although we would caution patients from utilizing this resource due to the lack of citations and complexity of the output that ChatGPT provides. Importantly, all answers provided by AI suggested reaching out to physicians to get more accurate and personalized advise, to factor into the shared decisions making model.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 56-61"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284920","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":"Clinical and radiological outcomes of a highly lateralized reverse shoulder arthroplasty in patients with a height of 160 cm or less versus a height of 170 cm or more","authors":"Mohamad K. Moussa MD, MSc,&nbsp;Maria Guillermina Bruchmann MD,&nbsp;Donald Tedah MD,&nbsp;Akil Prabhakar MD,&nbsp;Luis José Maria Suarez-Jimenez MD,&nbsp;Ahmad Nassar MD,&nbsp;Carlos Murillo-Nieto MD,&nbsp;Philippe Valenti MD","doi":"10.1053/j.sart.2024.09.002","DOIUrl":"10.1053/j.sart.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>To evaluates the impact of patient height (less than 160 cm and greater than 170 cm) on outcomes of lateralized reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Method</h3><div>This retrospective case–control study of 31 lateralized rTSA patients, with follow-ups ranging from 12 to 28 months, was divided into 2 groups: 14 short-stature (≤160 cm) and 17 taller (≥170 cm) patients. Preoperative planning utilized e-ORTHO templating software (FH Orthopaedics, Mulhouse, France), ensuring uniform lateralization shoulder angle and distalization shoulder angles across groups. Primary outcomes included range of motion (ROM), while secondary outcomes comprised Constant Score (absolute/ponderate), subjective shoulder value (SSV), and visual analog scale (VAS). Discrepancies in scores between groups were evaluated for clinical relevance against minimal clinically important difference benchmarks. Incidences of scapular notching were also recorded.</div></div><div><h3>Results</h3><div>All the clinical parameters analyzed were improved postoperatively in both groups (<em>P</em> &lt; .05). No significant difference was observed in postoperative ROM, ponderate Constant, and VAS between groups (<em>P</em> &gt; .05) except for forward elevation which was higher in the taller group (142.9 ± 27.6 compared to 163.5 ± 11.1 <em>P</em> = .018). For SSV, the taller group had higher postoperative SSV (<em>P</em> = .037). However, the difference was less than the minimal clinically important difference for SSV (−5.97 [95% confidence interval: −10.17 to 1.76], <em>P</em> = .01) and thus was considered not clinically significant. No scapular notching was detected in either group.</div></div><div><h3>Conclusion</h3><div>When planned positioning angles are respected (lateralization shoulder angle, distalization shoulder angle), the benefits of highly lateralized rTSA are consistent regardless of patient stature. Both groups had comparable results across ROM, ponderate Constant, and VAS except for forward elevation which was higher in the taller group.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 62-70"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early diagnosis and revision repair of lesser tuberosity osteotomy failure after anatomic total shoulder arthroplasty","authors":"Kevin K. Chen MD,&nbsp;Chuheng Xing BS,&nbsp;James M. Gregory MD","doi":"10.1053/j.sart.2024.08.004","DOIUrl":"10.1053/j.sart.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Lesser tuberosity osteotomy (LTO) in total shoulder arthroplasty (TSA) has a relatively high success rate owing to bone-to-bone healing and modern repair techniques. Failure of the LTO repair has been associated with poorer outcomes, decreased patient satisfaction, and the potential need for revision arthroplasty. Despite this, few studies closely examined outcomes for revision LTO repair in the setting of prior TSA.</div></div><div><h3>Methods</h3><div>A retrospective review of all TSAs performed by a single surgeon from 2016 until 2023 was performed to identify all cases with LTO failure who underwent acute revision LTO repair. Baseline characteristics, postoperative complications including infection, need for revision surgery, and time to revision surgery were collected and reported on all TSA patients. All patients were followed for a minimum of 1 year after their TSA and revision LTO fixation if required. Subgroup analysis was performed on the LTO revision cohort to evaluate for potential risk factors.</div></div><div><h3>Results</h3><div>A total of 166 patients underwent TSA with LTO. Of these, eight patients were diagnosed with an acute LTO failure at a mean of 5.7 weeks after surgery and underwent revision LTO fixation at a mean of 6.3 weeks after surgery. At a mean follow-up of 147.9 weeks (standard deviation: 90.3; range: 52.1-284.9), seven of eight patients (87.5%) demonstrated healing of their LTO and had no complaints, complications, or reoperations at the latest follow-up. One patient developed a periprosthetic infection requiring two-stage revision. No patients in the overall cohort underwent revision shoulder arthroplasty due to subscapularis failure.</div></div><div><h3>Conclusion</h3><div>Early identification of subscapularis failure is important to optimize outcomes of revision fixation. Use of LTO for subscapularis repair is beneficial by allowing early radiographic detection of subscapularis failure. Revision LTO repair can be successful when performed acutely and appears to minimize the need for revision shoulder arthroplasty due to subscapularis failure.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 48-55"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284926","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":"Trends in total shoulder arthroplasty utilization and implant pricing","authors":"Gabrielle Dykhouse BS ,&nbsp;Anthony Finocchiaro BS ,&nbsp;Carl M. Cirino MD ,&nbsp;Ashwin Mahesh BS ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Joshua S. Dines MD ,&nbsp;Michael C. Fu MD, MHS","doi":"10.1053/j.sart.2024.08.003","DOIUrl":"10.1053/j.sart.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is the third most common total joint replacement procedure in the United States, with high rates of success and cost-effectiveness. As indications continue to expand, anatomic TSA (aTSA), reverse shoulder arthroplasty (RSA), and hemiarthroplasty are available procedures for treating patients with varying end-stage shoulder pathologies. While previous studies have documented trends in overall costs and reimbursements in TSA, there is limited information regarding recent trends in implant utilization, pricing, and procedure type. Therefore, this study aimed to analyze trends in implant and technology utilization for TSA in the United States between 2013 and 2022 to inform decision-making and improve clinical best practices.</div></div><div><h3>Methods</h3><div>Utilization trends and average implant prices between 2013 and 2022 were extracted from Orthopedic Network News, the largest publicly available implant registry. All costs and prices were adjusted for inflation. Trends were analyzed using linear regressions.</div></div><div><h3>Results</h3><div>Averages and nationwide estimates for 2022 were based off 7339 shoulder cases from 117 US hospitals. RSA significantly increased from 40% in 2013 to 72% of all shoulder arthroplasties in 2022 (β = 4.18; <em>P</em> &lt; .001), whereas aTSA significantly decreased from 43% to 20% (β = −0.34; <em>P</em> &lt; .001), and hemiarthroplasty significantly decreased from 10% to 1% (β = −1.07; <em>P</em> &lt; .001). Other types of procedures, such as revisions and shoulder resurfacings, constituted 7%. Anatomic constructs showed a rise in stemless humeral component usage from 2% in 2017 to 10% in 2022 (β = 1.4; <em>P</em> &lt; .01). Financially, Medicare physician payment for shoulder surgeries witnessed significant decline from $1882 USD in 2017 to $1428 in 2023 (β = −73; <em>P</em> &lt; .001). The inflation-adjusted cost of aTSA also decreased from $8055 in 2013 to $6223 in 2022 (β = −173.56; <em>P</em> &lt; .01), and RSA from $12,207 to $8882 in 2022 (β = −318.31; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Trends in primary TSA procedures feature a growing prevalence of RSA as compared to aTSA, in addition to a rise in stemless humeral implants within aTSA. As both Medicare physician reimbursements and implant prices continue to decrease, it is important for surgeons to consider the tradeoffs of different implant materials and patient-specific technology when performing such procedures.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 42-47"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284924","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":"Perioperative outcomes using computer navigation in primary total shoulder arthroplasty","authors":"Melanie T. Bertolino BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;John W. Moore BS ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.07.013","DOIUrl":"10.1053/j.sart.2024.07.013","url":null,"abstract":"<div><h3>Introduction</h3><div>The utilization of computer navigation to improve glenoid component placement in primary total shoulder arthroplasty (TSA) is becoming increasingly prevalent. However, there is a paucity of literature examining the perioperative outcomes and cost of this technology compared to standard instrumentation. The purpose of this study was to compare the perioperative complications and healthcare utilization between computer navigation and standard instrumentation in primary TSA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients who underwent TSA with computer navigation (n = 752) were propensity score matched in a 1:3 proportion to patients who underwent TSA with standard instrumentation (n = 2256) for age, sex, smoking status, alcohol abuse, hypertension, diabetes mellitus, congestive heart failure, obesity, peripheral vascular disease, chronic kidney disease, chronic liver disease, and chronic lung disease. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative complications, and hospital utilization metrics between the 2 groups. Chi-square and student <em>t</em>-tests identified differences in categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>Patients undergoing TSA with computer navigation exhibited lower rates of revision within 180 days (<em>P</em> &lt; .001) and lower rates of certain postoperative medical and surgical complications, including acute renal failure (<em>P</em> = .006), urinary tract infection (<em>P</em> = .015), acute respiratory distress syndrome (<em>P</em> = .045), surgical site infection (<em>P</em> = .022), dislocation (<em>P</em> = .012), and prosthetic loosening (<em>P</em> = .032). Computer navigation patients had a higher cost of initial admission (<em>P</em> &lt; .001) but were less likely to have extended hospital stays (<em>P</em> = .047), less likely to be discharged with home healthcare (<em>P</em> &lt; .001), and more likely to be discharged routinely (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>TSA with computer navigation was associated with lower revision rates and reduced postoperative complications. Although greater initial costs were observed, decreased extended hospital stays and more routine discharges show promise for long-term cost efficiency. These findings underscore the advantages of computer navigation in TSA and should be considered by orthopedic surgeons when evaluating choice of instrumentation.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 7-12"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284921","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 component cyclical failure decreases with increasing baseplate contact: a biomechanical study","authors":"Hafiz F. Kassam MD ,&nbsp;Josiah Valk DO ,&nbsp;Stephen Wiseman DO ,&nbsp;Lucein N. Blaine BS ,&nbsp;Ana Mata-Fink MD ,&nbsp;Steven Tommasini PhD ,&nbsp;Theodore A. Blaine MD","doi":"10.1053/j.sart.2024.08.002","DOIUrl":"10.1053/j.sart.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid baseplate loosening remains a common mode of failure in reverse shoulder arthroplasty. One of the key factors to baseplate stability is theorized to be maximization of baseplate backside contact. The purpose of this biomechanical study is to investigate the role of varying degrees of backside bony glenoid support in component stability for reverse total shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>Twenty synthetic scapular models were divided into 3 test groups of 5 scapulae with glenoid baseplate contacts of 40%, 60%, and 75%, and one control group with glenoid baseplate contact of 100%. Standardized application of a commercially available glenoid baseplate and glenosphere was performed. The scapulae were mounted on a linear bearing with a humeral component and polyethylene liner which were affixed to a biaxial servohydraulic fatigue testing system. Each specimen was loaded for 10,000 cycles or to failure, about a 55° arc along the glenosphere at a rate of 1 Hz as a 750 N compression load was applied. Failure was defined as fracture of the scapula with implant fixation compromise. Before and after loading, stability of the baseplate was assessed by quantifying the total motion between the model and the baseplate with digital calipers as a ramp load between 0 and 150 N was applied. Two-sample unpaired <em>t</em>-tests were performed with significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>Baseplate contacts of 40% (1623 ± 227, <em>P</em> = .0001), 60% (3299 ± 1170, <em>P</em> = .0001), and 75% (5615 ± 1587, <em>P</em> = .0077) demonstrated statistically significant decrease in the average number of cycles to failure in all cohorts compared to our control (8641 ± 1070). Cycles taken for initial cracks to progress to failure showed no significant differences; 40% contact (862 ± 452, <em>P</em> = .4751), 60% contact (1651 ± 996, <em>P</em> = .4318), 75% contact (2882 ± 1347, <em>P</em> = .0620), and 100% control (1166 ± 657). Baseplate contacts of 40% (6150.4 ± 444.0, <em>P</em> = .0006), 60% (4647.1 ± 552.3, <em>P</em> = .0072), and 75% (2927.8 ± 918.5, <em>P</em> = .2573) demonstrated increasing micromotion (pre-post cyclical loading) in all cohorts compared to our control (2074.7 ± 1164.6) with statistical significance at 40% and 60%.</div></div><div><h3>Conclusion</h3><div>These biomechanical tests demonstrate that decreasing glenoid baseplate backside contact leads to increased micromotion and fewer cycles to failure. This supports the surgical goal of achieving maximal glenoid baseplate backside contact, suggesting that decreased glenoid baseplate support could contribute to significant loosening.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 22-30"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284922","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":"Nonspherical humeral arthroplasty increases internal rotation: a biomechanical comparison of the native humeral head to nonspherical and spherical humeral implants","authors":"Kyle Schoell MD ,&nbsp;Victor Hung BS ,&nbsp;Genevieve Fraipont BA ,&nbsp;Michelle H. McGarry MS ,&nbsp;G. Russell Huffman MD, MPH ,&nbsp;Hafiz Kassam MD ,&nbsp;Thay Q. Lee PhD","doi":"10.1053/j.sart.2024.07.014","DOIUrl":"10.1053/j.sart.2024.07.014","url":null,"abstract":"<div><h3>Background</h3><div>Nonspherical humeral head implants more closely resemble native humeral anatomy than spherical components and may better replicate native shoulder range of motion (ROM) and kinematics. The purpose of this study was to compare shoulder ROM and kinematics of a commercially available nonspherical humeral head implant with the native humeral head and a height matched, custom manufactured spherical implant.</div></div><div><h3>Methods</h3><div>Six fresh frozen cadaveric shoulder specimens were used with a custom shoulder testing system. The native shoulder was tested in multiple positions under anatomic muscle loading. Each specimen was tested for ROM and glenohumeral joint kinematics by measuring the humeral head apex and humeral head center (HHC) translation per degree of rotation using a MicroScribe digitizer. Measurements were then repeated after implantation of a spherical and, subsequently, a nonspherical humeral head prothesis.</div></div><div><h3>Results</h3><div>The nonspherical implant had significantly more internal rotation (IR) compared to the spherical implant at 0° abduction (10.6 ± 6.2° more IR, <em>P</em> = .004, 95% confidence interval [CI]: −13.3, 34.5), 30° abduction (5.7 ± 2.8°, <em>P</em> = .009, 95% CI: −12.6, 24.0) and 60° abduction (6.8 ± 2.7°, <em>P</em> = .002, 95% CI: −8.3, 22.1) in the scapular plane, and 60° abduction (6.9 ± 2.0°, <em>P</em> = .031, 95% CI: −12, 25.6) in the coronal plane. The nonspherical implant had more IR than the native head at 60° of abduction in the scapular plane (7.0 ± 2.2° <em>P</em> = .002, 95% CI: −10.3, 24.3). The spherical head had less IR than the native head at 0° abduction (7.2 ± 4.8°, <em>P</em> = .031, 95% CI: 32.5, 18.1). There were no differences in humeral head apex translation per degree of rotation noted between the spherical implant or nonspherical implant and the native shoulder. The nonspherical head had less HHC translation than the native shoulder at 30° abduction in the forward flexion plane (<em>P</em> = .007); otherwise, there were no statistically significant differences in HHC translation between the native shoulder, the spherical head, and the nonspherical head. There was no significant difference observed between the average difference in anterior-posterior and superior-inferior radius of curvature of the nonspherical implants (2.0 ± 0.7 mm) and the native humeral heads (1.9 ± 1.3 mm) [<em>P</em> = .926].</div></div><div><h3>Conclusion</h3><div>The results of this biomechanical study suggest that the commercially available nonspherical humeral head has improved IR when compared to a custom, height controlled spherical implant and offers ROM and kinematics similar to the native humeral head in a cadaveric model.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 31-41"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284923","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":"Nonoperative management of glenoid baseplate failure in reverse shoulder arthroplasty","authors":"Raymond E. Chen MD ,&nbsp;Alayna K. Vaughan BS ,&nbsp;Mark D. Lazarus MD ,&nbsp;Gerald R. Williams MD ,&nbsp;Surena Namdari MD, MSc","doi":"10.1053/j.sart.2024.07.012","DOIUrl":"10.1053/j.sart.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid baseplate failure in reverse total shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA.</div></div><div><h3>Methods</h3><div>Utilizing a single-institution database, a retrospective review was performed to identify patients from 2010 to 2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. The exclusion criteria included revision surgery and presence of active infection. Included patients had a minimum 2-year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications, and techniques. Radiographs were reviewed to determine the etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true anteroposterior radiographs immediately postoperatively and after baseplate failure.</div></div><div><h3>Results</h3><div>Eighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. The mean age was 77 years, body mass index was 28, and 8 out of 12 were female. The mean Charlson Comorbidity Index score was 4.1. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 43.0, and visual analog scale (VAS) pain was 6.3. At a mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, single assessment numeric evaluation of 49%, and 50% of patients were satisfied with their outcome. The preoperative and final follow-up ASES and VAS scores were similar. The average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, the mean glenosphere inclination angle after failure (131°) was significantly greater than the initial inclination angle (100°), <em>P</em> = .03. The other 2 failures resulted in increased baseplate anteversion. 8 out of 18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction.</div></div><div><h3>Conclusion</h3><div>Nonoperative management of glenoid baseplate failure yields modest patient-reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284891","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":"Preoperative rotator cuff fatty infiltration and muscle atrophy do not negatively influence outcomes following anatomic total shoulder arthroplasty","authors":"Jalen Thomas MS ,&nbsp;Evan A. Glass BS ,&nbsp;Adam R. Bowler BA ,&nbsp;Himmat Sahi MS ,&nbsp;Daniel P. Swanson BS ,&nbsp;Munis Ashraf MBBS, DNB ,&nbsp;Girinivasan Chellamuthu MBBS, MS ,&nbsp;Vanessa Charubhumi MD ,&nbsp;Miranda McDonald-Stahl BS ,&nbsp;Kiet Le PA-C ,&nbsp;Jacob M. Kirsch MD ,&nbsp;Andrew Jawa MD","doi":"10.1053/j.sart.2024.08.001","DOIUrl":"10.1053/j.sart.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (TSA) is an effective surgical option for the treatment of primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. While an intact rotator cuff is essential to the success of TSA, little is known about how preoperative rotator cuff muscle quality may impact clinical outcomes. In this study, we sought to determine the effects of rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on clinical outcomes following TSA.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively maintained, single-surgeon registry was used to identify patients undergoing TSA for GHOA between April 2015 and March 2020. Patients were included if they had preoperative magnetic resonance imaging available, an intact rotator cuff, and complete preoperative and minimum 2-year postoperative patient-reported outcome measures (PROMs) and active range of motion (ROM) measurements. Preoperative MA and FI of the rotator cuff were assessed on magnetic resonance imaging by measuring muscle cross-sectional area and using the Goutallier classification system, respectively. Pearson’s correlation was used to determine any relationship between MA and clinical outcomes. Univariate analysis was used to compare clinical outcomes of patients with moderate-to-severe FI to those with minimal-to-mild FI.</div></div><div><h3>Results</h3><div>There were 163 shoulders from 154 patients with a mean age of 62.5 (standard deviation = 7.4) and a mean follow-up of 2.9 years (standard deviation 1.2) that met inclusion criteria. Rotator cuff muscle area was not correlated with any preoperative or postoperative ROM or PROMs (<em>P</em> &gt; .05). However, the ratio of infraspinatus and teres minor (posterior cuff) to subscapularis muscle area was minimally negatively correlated with change in Single Assessment Numerical Evaluation (<em>r =</em> −0.171, <em>P</em> = .029) and change in internal rotation (<em>r =</em> −0.207, <em>P</em> = .008), although the clinical relevance is unclear. No significant differences in preoperative ROM or PROMs were found between patients with minimal-to-mild and moderate-to-severe FI (<em>P</em> &gt; .05).</div></div><div><h3>Conclusion</h3><div>Preoperative rotator cuff muscle volume and FI do not impact clinical outcomes following TSA in patients with GHOA and intact rotator cuffs. TSA remains a viable surgical treatment for individuals with GHOA and an intact rotator cuff, provided the MA and FI are not so severe that a patient may be indicated for another type of treatment.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 13-21"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143352166","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}