Seminars in Arthroplasty最新文献

{"title":"Uncemented reverse shoulder arthroplasty in proximal humeral fractures: comparative study of two different press fit stems","authors":"Marta Navarro Bosch MD ,&nbsp;Jose Enrique Aroca Navarro MD ,&nbsp;Juan Aguilar Gonzalez MD","doi":"10.1053/j.sart.2024.03.003","DOIUrl":"10.1053/j.sart.2024.03.003","url":null,"abstract":"<div><h3>Background</h3><p><span>Reverse shoulder arthroplasty (RSA) has extended its indications in recent years to include complex </span>proximal humerus fractures (PHFs) in elderly patients. The traditional approach in cases of PHF has been to cement the stem but, as in orthopedic surgery, the current trend in PHF is to avoid cementing the humeral stem as well.</p></div><div><h3>Methods</h3><p>We evaluated 63 patients (representing 63 shoulders) who underwent RSA with uncemented stem after acute fracture of the proximal humerus. We analyzed the clinical and radiological outcomes, as well as medium-term complications, using two different prosthesis models.</p></div><div><h3>Results</h3><p><span><span>The mean postoperative follow-up period was 21-23 months, and the mean age of the patients was 74.5 years. The average Constant Score was 56.94 points; there were no statistical significant differences in Constant Score depending on the prosthesis model used. No cases of aseptic loosening were observed. However, there was evidence of stress-shielding in prostheses with diaphyseal fixation, although this phenomenon did not appear to have functional or clinical consequences for the patients. </span>Intraoperative complications occurred in 6.35% of cases, and </span>postoperative complications were noted in 4.92%.</p></div><div><h3>Conclusion</h3><p>Based on the results of this study, we can affirm that the use of RSA with cementless stems in PHF can be a safe alternative, providing satisfactory clinical, functional, and radiographic results in the short term without the need to use cement in their fixation. The choice of prosthesis model may influence the occurrence of radiographic phenomena but does not seem to affect clinical outcome.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 593-601"},"PeriodicalIF":0.0,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048847","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 evaluation of patients over the age of 75 receiving either anatomic or reverse total shoulder arthroplasty: a single-institution retrospective analysis","authors":"","doi":"10.1053/j.sart.2024.03.002","DOIUrl":"10.1053/j.sart.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are proven surgical treatment options for both traumatic and degenerative conditions of the shoulder. Our objective is to report both clinical and patient-reported outcomes (PROs) of patients over the age of 75 at the time of arthroplasty. We hypothesize no functional difference in outcomes between patient groups.</p></div><div><h3>Methods</h3><p>Patients over the age of 75 at the time of surgery who received primary aTSA or rTSA between 2009 and 2020 with a minimum of two-year follow-up were selected. A retrospective chart review was performed. Patients 60-75 were included as a control group. 2:1 propensity matching using sex, Charlson Comorbidity Index, preoperative forward elevation (FE), and external rotation (ER) was used in selecting a comparison cohort of patients 60-75. Statistical analysis included the <em>t</em>-test, Wilcoxon signed-rank test, and chi-squared test.</p></div><div><h3>Results</h3><p>For aTSA, 25 patients older than 75 years fit the inclusion criteria. The mean follow-up time was 4.2 (2.0-12.0) years. aTSA patients over the age of 75 had significant improvements in FE 111 to 141 degrees (<em>P</em> = .007), ER 28 to 44 degrees (<em>P</em> &lt; .001), and internal rotation (IR) sacrum to L4 (<em>P</em> = .003). There were also improvements in FE strength (FES) 4+/5 to 5/5 (<em>P</em> = .0303) and IR strength (IRS) but not ER strength (ERS) from 4+/5 to 5/5 (<em>P</em> = .098). There was no significant difference in range of motion (ROM), strength, or PROs between age groups (&gt;75 years vs. 60-74 years). For rTSA, 47 patients older than 75 years fit the inclusion criteria. Average clinical follow-up was 3.5 (2.0-10.6) years. Patients demonstrated ROM improvements in ER (31 to 40 degrees, <em>P</em> = .0413), FE (96 to 138 degrees, <em>P</em> &lt;.001) but not IR (L5 to L4, <em>P</em> = .3509). There were significant improvements in postoperative strength in FES (4-/5 to 4+/5, <em>P</em> &lt;.001), ERS (4-/5 to 4+/5, <em>P</em> &lt;.001), and IRS (4/5 to 5/5, <em>P</em> &lt;.001). The only significant difference between propensity-matched age groups was postoperative IR (L4 to L5, <em>P</em> = .013). There were no significant differences in PROs between different age groups.</p></div><div><h3>Conclusion</h3><p>aTSA and rTSA provide significant improvements in ER, FE, ROM, ERS, FES, and IRS in patients over the age of 75 with no significant difference in outcomes compared to a younger cohort.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 577-584"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000403/pdfft?md5=e597892d3cd0c21dbf00aa2f9c77d35c&pid=1-s2.0-S1045452724000403-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792802","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":"Comparison of genomic DNA sequencing to anerobic cultures to detect efficacy of hydrogen peroxide at reducing cutibacterium acnes bacterial burden during primary shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.02.006","DOIUrl":"10.1053/j.sart.2024.02.006","url":null,"abstract":"<div><h3>Background</h3><p><span><span>The purpose of this investigation is to compare Cutibacterium acnes diagnosis using culturing vs. </span>genomic DNA sequencing (NextGen) at various timepoints and locations during primary </span>total shoulder arthroplasty<span>. Additionally, we intend to compare the effects of hydrogen peroxide on standard culture technique results with genomic DNA sequencing.</span></p></div><div><h3>Methods</h3><p>A prospective diagnostic study of 40 patients undergoing primary total shoulder arthroplasty was performed. Intraoperatively, 4 tissue samples were collected per patient: subdermal skin edge following initial skin incision<span><span><span>, subdermal skin edge following hydrogen peroxide soak for 5 minutes, glenohumeral joint capsule, and subdermal skin edge prior to </span>wound closure. Each tissue specimen was collected twice (one for culture analysis and the other for genomic (NextGen) DNA sequencing analysis) for a total of 8 specimens per patient and 320 tissue specimens in total. All anaerobic cultures were held for 14 days. Each culture plate was divided into quadrants and the amount of growth was quantified. Tissue samples were collected for </span>genomic sequencing<span> DNA analysis. Genomic sequencing results provided relative percentage of bacteria for each specimen detected.</span></span></p></div><div><h3>Results</h3><p><span>There were 18/40 males (45%) and no postoperative complications<span><span>. Average age was 72.2 ± 11.8. Overall, 18% (29/160) of standard anaerobic cultures were positive for C. Acnes and 26% (942/160) were positive with genomic (Nextgen) DNA sequencing. When comparing the NextGen results with anaerobic standard cultures, there was a calculated negative predictive value of 85.6% and positive predictive value of 28.6%. Sensitivity of the NextGen was 41.4% and specificity was 77.1%. </span>Bacterial culture rates did not significantly change from the beginning to the end of surgery as demonstrated on standard culturing and the NextGen analysis (</span></span><em>P</em> &gt; .05). After treatment with hydrogen peroxide, the standard culturing technique showed no significant difference between the samples; however, there was a significant increase in bacterial burden (12.4%) noted with NextGen analysis (<em>P</em> = .0147).</p></div><div><h3>Conclusion</h3><p>NextGen culturing is a novel technique to help identify shoulder prosthetic joint infections. These results show that, NextGen is better at identifying the absence<span> of infection, but has a high false positive rate indicative of its ability to identify contaminants as compared to standard anaerobic culturing methods. The increase in bacterial burden after peroxide treatment noted with NextGen could also be secondary to the test’s increased ability to identify both living and dead bacterial pathogens.</span></p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 552-557"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406213","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":"Anatomic shoulder arthroplasty in patients 40 years or younger","authors":"Evan M. Banks BS ,&nbsp;Jonathan P. Braman MD ,&nbsp;Alicia K. Harrison MD ,&nbsp;Allison J. Rao MD","doi":"10.1053/j.sart.2024.02.009","DOIUrl":"10.1053/j.sart.2024.02.009","url":null,"abstract":"<div><h3>Background</h3><p>Glenohumeral arthritis in adults less than 40 years old represents a challenging clinical scenario to manage. While patients older than 55 have had reproducible success with current shoulder arthroplasty techniques, young patients have historically had less successful outcomes, possibly due to higher physical demands and more complex pathologies. Despite these concerns, anatomic total shoulder arthroplasty (TSA) remains the treatment of choice for young, active patients with severe glenohumeral arthritis and intact rotator cuff. We hypothesize that TSA provides significant relief in pain and functional outcomes in patients less than 40 years old.</p></div><div><h3>Methods</h3><p>We performed a single-institution retrospective analysis of consecutive patients aged 40 years and younger who underwent TSA between 2007 and 2022. Demographic data included age, sex, body mass index, Charlson comorbidity index, and preoperative diagnosis. Outcome measures included the Single-Assessment Numerical Evaluation (SANE) score, final range of motion, complications, and revision rate. Statistically significant differences between variables were evaluated using a 2-sample t-test at an α level of <em>P</em> &lt; .05.</p></div><div><h3>Results</h3><p>Twenty-six TSAs were performed in 23 patients with an average final follow-up of 2 years after the procedure. The average age was 33.4 ± 5.3 years with a range of 19-39 years. The most common preoperative diagnosis was osteoarthritis (46%), followed by rheumatoid arthritis (27%) and osteonecrosis/avascular necrosis (19%). The most common glenoid morphology was type B (15) of which 14 were B2 glenoid, followed by type A (11). The SANE score, mean active forward elevation, abduction, external rotation, and internal rotation all improved significantly (<em>P</em> &lt; .05) by the final follow-up. On average, patients in all groups were able to achieve minimal clinically important difference in SANE score after 1 year. There was 1 complication reported of an early postoperative infection treated with irrigation and débridement, and no revision surgeries were performed during the follow-up period.</p></div><div><h3>Discussion/Conclusion</h3><p>TSA significantly improved functional outcome measures in patients less than 40 years old with a low rate of complications and revisions in short-term outcomes. As the frequency of TSA continues to increase in adults less than 40 years old, additional studies recording long-term functional outcomes and implant survivorship in this population can be explored.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 524-531"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404900","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 role of antibiotic and drug allergies on adverse outcomes after shoulder arthroplasty: a nationwide database analysis of 153,384 patients","authors":"","doi":"10.1053/j.sart.2024.02.003","DOIUrl":"10.1053/j.sart.2024.02.003","url":null,"abstract":"<div><h3>Background</h3><p>The goal of this study is to examine the impact of antibiotic and other drug allergies on the incidence of complications and revisions following shoulder arthroplasty (SA). Our hypothesis posits that patients with antibiotics or other drug allergies will have a higher rate of complications and revision surgeries following SA.</p></div><div><h3>Methods</h3><p>All data collection involved utilizing the PearlDiver national database and Current Procedural Terminology code 23472 to identify individuals who had undergone primary anatomic or reverse SA within the period of 1/1/2010-10/31/2021. The initial population was categorized into three groups: patients with antibiotic allergies, patients with other drug allergies, and patients with no reported drug allergies. The two allergy groups were examined against the nonallergy group to draw comparisons concerning surgical complications, medical complications, and revision surgeries. The evaluation of complications took place at the 30 day and 90 day postoperative time points, while revisions were assessed at the 30 day, 1 year, 3 year, 5 year, and 10 year postoperative time points.</p></div><div><h3>Results</h3><p>This database study identified 153,384 patients (10,106 with antibiotic allergies, 16,982 with other drug allergies, and 126,296 with no allergies) who had received SA. Compared to patients without allergies, patients in both allergy cohorts were more likely to require revision surgery across all analyzed time points (<em>P</em> &lt; .001). Patients with antibiotic allergies experienced higher rates of surgical site infections (SSI) (30 days: 1.0% vs. 0.8%, odds ratio 1.25 [95% confidence interval 1.02-1.53], <em>P</em> = .04; 90 days: 1.3% vs. 1.1%, 1.26 [1.06-1.51], <em>P</em> = .011) and prosthetic joint infections (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.27], <em>P</em> &lt; .001; 90 days: 0.9% vs. 0.3%, 2.60 [2.06-3.27], <em>P</em> &lt; .001) at both time points. Patients with allergies to other drugs were more likely to develop prosthetic joint infection (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.21], <em>P</em> &lt; .001; 90 days: 0.8% vs. 0.3%, 2.51 [2.08-3.04], <em>P</em> &lt; .001), but there was no statistical difference in SSI rates compared to patients without allergies (30 days: 0.9% vs. 0.8%, 1.10 [0.93-1.31], <em>P</em> = .279; 90 days: 1.2% vs. 1.1%, 1.16 [1.00-1.34], <em>P</em> = .055).</p></div><div><h3>Discussion</h3><p>Patients with antibiotic and other drug allergies demonstrated a higher likelihood of requiring revision surgery after undergoing SA. Patients with antibiotic allergies displayed an increased susceptibility to all complications analyzed apart from bleeding, while patients with other drug allergies displayed an increased susceptibility to all complications except for SSIs.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 545-551"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000312/pdfft?md5=e50e8b9b7ec5bb3d434c3aa4a89163bf&pid=1-s2.0-S1045452724000312-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403572","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":"Anatomic and reverse total shoulder arthroplasty: variables affecting 90-day overall reimbursement","authors":"","doi":"10.1053/j.sart.2024.02.007","DOIUrl":"10.1053/j.sart.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty<span> (TSA) is a common orthopedic procedure that can be performed as an anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty<span> (rTSA). These are effective procedures that are being performed with increasing frequency. Understanding the overall 90-day reimbursement variability and their drivers may help the health care systems better understand related considerations to reduce health-care expenditure. The current study predicts there will be large variability in reimbursement highlighting the need for further understanding.</span></span></p></div><div><h3>Methods</h3><p>Using the 2015-2021 Q1 M151 PearlDiver dataset, patients who underwent aTSA or rTSA were isolated. Patients were excluded if they were aged less than 18 years, had an indication of traumatic, infectious, or oncologic diagnoses within 90-days of surgery, or were not in the dataset for at least 90 days before and after surgery. Patient demographics, comorbidities, 90-day postoperative events, insurance type, and geographic region were abstracted. The overall 90-day reimbursements were then assessed and correlated with these variables having multivariable linear regression.</p></div><div><h3>Results</h3><p><span>A total of 112,188 TSA patients (aTSA: 36,164 [32.2%]; rTSA: 76,024 [67.8%]) were identified. The average ± standard deviation 90-day overall postoperative reimbursement for aTSA was $6714.26 ± 9587.46 and rTSA was $6246.45 ± 9506.59. The total reimbursement for aTSA was $242,814,515 and for rTSA was $474,836,301. Variables independently associated with greater 90-day overall reimbursement were mostly related to 90-day postoperative events, including hospital readmission [+$6694.51], emergency department visit [+$2129.89], and adverse events [+$2055.84]), geographic region of the country where the procedure was performed (relative to West, South [+$4302.88], Midwest [+$3428.84], and Northeast [+$530.92]), and insurance plan (relative to commercial, Medicare [-$1268.01], and Medicaid [-$901.79]) (</span><em>P</em> &lt; .0001 for each). Lesser factors included male sex (relative to female +$207.30), Elixhauser-Comorbidity Index (+$51.93 per point increase), age (-$77.16 per year increase), and rTSA surgery type (relative to aTSA -$556.17).</p></div><div><h3>Discussion and conclusion</h3><p>The current study leveraged a large, administrative database to evaluate over 100,000 TSA patients and found large variations in 90-day overall reimbursements. The variables mostly associated with increased reimbursement were related to 90-day postoperative events (as might be expected and underscoring the need to minimize such events) and geographic regions and insurance plan (highlighting differences that might be able to be addressed). Interestingly, while patient demographics, comorbidities, and anatomic vs. reverse total shoulder were associated with reimbursements, these were to lesser extents. Unde","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 564-570"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405694","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":"Total shoulder arthroplasty in patients with a history of cerebrovascular accident: a matched case–control study","authors":"","doi":"10.1053/j.sart.2024.02.008","DOIUrl":"10.1053/j.sart.2024.02.008","url":null,"abstract":"<div><h3>Background</h3><p><span>With increasing survivorship following cerebrovascular accidents (CVAs), more patients with a history of CVA are undergoing </span>total shoulder arthroplasty (TSA). The purpose of this study is to determine the impact of prior CVA on the perioperative outcomes following TSA.</p></div><div><h3>Methods</h3><p>The Nationwide Readmissions Database was queried from 2010 to 2019 to identify all patients with a history of CVA undergoing TSA. Eight hundred seventeen cases were identified and case matched on a 1:2 ratio for age, sex, obesity status, and year of procedure. Patient demographic characteristics were collected and analyzed for differences between the 2 groups. Data on length of stay, 180-day complications, 180-day readmissions, and 180-day mortality were collected and analyzed for differences between the 2 groups.</p></div><div><h3>Results</h3><p>Eight hundred seventeen cases of patients with a history of CVA were matched with 1634 patients without a history of CVA undergoing TSA. The average age was 71. Fifty six percent of patients were female, and 23% of patients were obese. Patients with CVA had higher incidence of tobacco use (<em>P</em><span> &lt; .001), deficiency anemia (</span><em>P</em><span> &lt; .001), electrolyte disorders (</span><em>P</em> &lt; .001), paralysis (<em>P</em><span> &lt; .001), coagulopathy (</span><em>P</em><span> &lt; .001), heart valve disorders (</span><em>P</em> &lt; .001), history of myocardial infarction (<em>P</em> &lt; .001), and higher rates of chronic diseases, such as hypertension (<em>P</em> &lt; .001), diabetes (<em>P</em> &lt; .001), liver disease (<em>P</em><span> &lt; .001), congestive heart failure (</span><em>P</em> &lt; .001), renal failure (<em>P</em><span> &lt; .001), and peripheral vascular disease (</span><em>P</em> &lt; .001). Patients with a history of CVA had higher rates of complications, readmissions, and revisions within 180 days (<em>P</em> &lt; .001). One hundred eighty–day mortality was similar between the 2 groups. The average length of stay was 3.2 days in patients with a history of CVA compared to 1.4 days in those without a history of CVA (<em>P</em> &lt; .001).</p></div><div><h3>Conclusion</h3><p>Patients with a history of CVA have a higher rate of medical comorbidities than those without. These patients have higher rates of complications within 180 days of procedure, 180-day readmissions, and 180-day revisions. One hundred eighty–day mortality was similar between the 2 groups. Surgeons should take care to ensure thorough preoperative optimization and risk discussions to try and minimize postoperative adverse outcomes.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 558-563"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403858","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 to short-term radiographic follow-up of metal-augmented baseplates in reverse shoulder arthroplasty for treatment of glenoid deformity in glenohumeral arthritis and rotator cuff arthropathy","authors":"Cory D. Smith MD,&nbsp;Bailey Johnson MD,&nbsp;Chelsea Smith BS,&nbsp;David Shukla MD,&nbsp;Russell Petrie MD,&nbsp;Hafiz Kassam MD,&nbsp;Daniel Debottis MD","doi":"10.1053/j.sart.2024.02.004","DOIUrl":"10.1053/j.sart.2024.02.004","url":null,"abstract":"<div><h3>Hypothesis and background</h3><p>As reverse total shoulder arthroplasty (rTSA) has evolved, the use of augmented glenoid baseplates has increased. While there are benefits of metal augmentation, literature concerning the mid- to long-term follow-up of these implants is emerging. The purpose of this study is to report early to short-term radiographic follow-up of patients with glenoid deformity treated with a metal-augmented glenoid baseplate. Our hypothesis is that we will see a low incidence of osteolysis, loosening, complications, and revision of these implants regardless of diagnosis, augment type, or patient demographics.</p></div><div><h3>Methods</h3><p>We performed a single-center retrospective review of all patients undergoing primary reverse shoulder arthroplasty with an augmented metallic baseplate for rotator cuff arthropathy and glenohumeral arthritis. Patients undergoing revision procedures or reverse arthroplasty for fractures were excluded. All patients had a minimum of 1-year radiographic follow-up. Preoperative imaging was reviewed to confirm the diagnosis and glenoid deformity classification. Postoperative radiographs were reviewed for evidence of complications, revisions, osteolysis, baseplate loosening, and failure. Clinical data were reviewed for complications.</p></div><div><h3>Results</h3><p>Primary rTSA with a metal-augmented baseplate (38 full wedge and 22 half wedge augments) was performed on 60 patients who met inclusion criteria (mean age 74 ± 7). The average radiographic follow-up of all patients was 17 months. In our cohort, there was one patient with aseptic loosening of a full wedge implant that was not revised. There were no other complications, revision surgeries, baseplate failures, or acromial stress fractures. Six patients developed scapular notching, and five patients were found to have asymptomatic glenoid osteolysis. Two patients with full wedge implants developed aseptic humeral loosening. Pearson chi-square post hoc analysis found no correlation between augment type, gender, or glenoid deformity classification and radiographic changes such as glenoid or humeral osteolysis, loosening, or scapular notching. We did find a statistically significant correlation (<em>P</em> = .018) between patients with body mass index &gt; 35 and glenoid osteolysis.</p></div><div><h3>Discussion and conclusion</h3><p>Primary rTSA for patients with rotator cuff arthropathy or glenohumeral arthritis with glenoid deformity corrected with metal-augmented glenoid baseplates results in a low complication rate and an acceptable outcome at a minimum 1-year follow-up. Compared to other similar cohorts, our patients did not experience any acromial stress fractures, and only one patient had loosening of the glenoid component that was not ultimately revised. Further studies with longer follow-up will be needed, but early outcomes are promising and support the increase in the use of these implants.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 509-513"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405303","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":"Primary shoulder arthroplasty in tobacco users: a systematic review of patient-reported outcomes and complications in 338,117 cases","authors":"Matthew R. Bryan BS ,&nbsp;Alex E. White MD ,&nbsp;Alexander H. King BS ,&nbsp;Ryan J. Healy BS ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2024.02.005","DOIUrl":"10.1053/j.sart.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this systematic review was to characterize the association between tobacco use and postoperative outcomes, complications, and revision rates following shoulder arthroplasty through a systematic review of the literature.</p></div><div><h3>Methods</h3><p>The PubMed/MEDLINE and Embase databases were queried for studies published between January 1, 1985, and April 18, 2023, comparing outcomes following both anatomic and reverse total shoulder arthroplasty (TSA) between tobacco users and nontobacco users. Studies with a level of evidence IV or greater were included, while case reports, systematic reviews, basic science studies, and studies including revision arthroplasty were excluded. American Shoulder and Elbow Surgeons scores, simple shoulder test scores, visual analog scale for pain, complications, readmissions, and reoperations were reported.</p></div><div><h3>Results</h3><p>A total of 20 unique studies including 338,117 shoulder arthroplasties (38,225 [11.3%] performed on tobacco users) were included in this review. Patient-reported outcome measures, including American Shoulder and Elbow Surgeons, simple shoulder test, and visual analog scale, were overall superior in nontobacco users compared to tobacco users. Similarly, tobacco users had lower patient acceptable symptomatic state achievement, worse Single Assessment Numeric Evaluation scores (odds ratio 0.647; 95% confidence interval, 0.324-1.293; <em>P</em> = .0221), and worse constant scores (odds ratio, 0.478; 95% confidence interval, 0.251-0.909; <em>P</em> = .027). Tobacco users demonstrated a higher rate of complications in four of the eight included studies. Two included studies found higher rates of readmission in tobacco users (15.3% vs. 13.6%, <em>P</em> = .007 and 7.8% vs. 7.1%, <em>P</em> = .001), though six included studies found no significant difference in readmissions. Nine of 11 studies that included reoperation as a variable found higher rates of reoperation in tobacco users, with three reaching statistical significance (<em>P</em> &lt; .05). Tobacco users experienced higher rates of gastrointestinal complications (0.07% vs. 0.01%, <em>P</em> = .021), acute renal failure (2.5% vs. 1.9%, <em>P</em> = .005), acute respiratory distress (1.3% vs. 0.9%, <em>P</em> = .002), need for ventilator assistance (1.2% vs. 0.7%, <em>P</em> &lt; .001), instability of the prosthesis (<em>P</em> &lt; .001), pneumonia (<em>P</em> &lt; .001), sepsis (<em>P</em> = .001), and myocardial infarction (<em>P</em> &lt; .001). Smokers also demonstrated increased postoperative opioid use (2643 mg oral morphine equivalents) compared to nonsmokers (2121 mg) and former smokers (2015 mg; <em>P</em> = .04).</p></div><div><h3>Conclusion</h3><p>Tobacco use is associated with inferior outcomes after TSA, including lower patient-reported outcome measures, increased complications, and higher reoperation rates. Further high-level, prospective studies with long-term follow-u","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 514-523"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400329","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":"Characteristics associated with rerevision of primary inlay and onlay reverse shoulder arthroplasty. Analysis from the Australian Orthopaedic Association National Joint Replacement Registry","authors":"David R.J. Gill MBChB, FRACS, FAOrthA ,&nbsp;Sophia Corfield PhD (Hons) ,&nbsp;Carl Holder MBiostat ,&nbsp;Richard S. Page BMedSci, MBBS, FRACS, FAOrthA","doi":"10.1053/j.sart.2024.02.002","DOIUrl":"10.1053/j.sart.2024.02.002","url":null,"abstract":"<div><h3>Background</h3><p>Two designs of primary reverse total shoulder arthroplasty (rTSA), inlay reverse total shoulder arthroplasty (in-rTSA) and onlay reverse total shoulder arthroplasty (on-rTSA) that had undergone an aseptic revision were compared to determine differences in the rate of rerevision.</p></div><div><h3>Methods</h3><p>In this comparative observational national registry study between January 1, 2012, and December 31, 2021, all rTSA utilizing either a modular inlay or onlay metaphyseal humeral component that had been revised for aseptic reasons formed 2 cohort groups. The cumulative percentage rerevision (2^nd CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age and sex. A minor category revision involved exchange of parts not fixed to bone whilst major revisions did. The primary and revision diagnoses, surgeon primary volume experience, and revision category were compared. Shoulder Modular Replacement (SMR)/SMR L1 or L2 combination (Lima Corporate, San Daniele del Friuli, Italy) was excluded at subanalysis.</p></div><div><h3>Results</h3><p>The 2^nd CPR at 3 years was 20.4% (95% confidence interval 17.1, 24.1) for in-rTSA (n = 571) and 16.1%(11.6, 22.2) for on-rTSA (n = 249). The risk of rerevision was not different between the 2 cohort groups. Primary diagnosis fracture was associated with an increased risk of rerevision for on-rTSA (entire period on-rTSA HR = 3.16(1.50, 6.68), <em>P</em> = .002), and in-rTSA at subanalysis (entire period on-rTSA HR = 2.91(1.33, 6.33), <em>P</em> = .007). 59.9% of in-rTSA and 24.1% of on-rTSA aseptic revisions were minor. The revision diagnosis, the surgical experience of rTSA and if the revision was major or minor did not change the rate of rerevision. The most common reason for both in-rTSA (50%) and (43.2%) on-rTSA rerevision was instability/dislocation.</p></div><div><h3>Discussion</h3><p>Rerevision rates of in-rTSA and on-rTSA after aseptic revision are high. The primary rather the revision diagnosis changed rerevision rates in contemporary rTSA surgery. Minor revisions did not reduce rerevision rates for in-rTSA or on-rTSA compared to humeral/glenoid revision. Increased surgical experience of primary rTSA did not change the rate of rerevision of in-rTSA or on-rTSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 501-508"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140281023","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}