Seminars in Arthroplasty最新文献

{"title":"Does bisphosphonate use in osteoporotic patients undergoing total shoulder arthroplasty have a protective effect? A propensity-matched analysis","authors":"Akhil Katakam MD ,&nbsp;Tej Joshi MD ,&nbsp;Tuckerman Jones MD ,&nbsp;Amanda Azer MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Sefy A. Paulose MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1053/j.sart.2025.05.003","DOIUrl":"10.1053/j.sart.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis and its associated complications, such as fractures, place a significant burden on health care systems. Bisphosphonates are a standard treatment for osteoporosis, shown to maintain bone mineral density and reduce fracture risk. However, their role in patients undergoing reverse total shoulder arthroplasty (rTSA) remains unclear, particularly regarding complications like acromial stress fractures and other prosthesis-related outcomes. This study investigates the impact of bisphosphonate usage on postoperative outcomes in osteoporotic patients undergoing rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Research Network database to identify patients with osteoporosis who underwent rTSA. Patients were stratified into two cohorts based on preoperative bisphosphonate usage. Propensity score matching (1:1) was utilized to balance demographic characteristics, comorbidities, prior surgery, and medication use. Outcomes assessed included acromial stress fractures, revision rates, aseptic loosening, and periprosthetic fractures at 1 year postoperatively.</div></div><div><h3>Results</h3><div>A total of 1,208 propensity-matched patients (604 in each cohort) were analyzed. In the bisphosphonate group, 25 (4.1%) of patients were diagnosed with an acromial stress fracture compared to 23 (3.6%) in the control group (odds ratio 1.142, 95% confidence interval 0.637-2.049, <em>P</em> = .655). No significant differences were observed in revision rates (<em>P</em> = .712), aseptic loosening (<em>P</em> = 1.000), or periprosthetic fractures (<em>P</em> = 1.000) between cohorts.</div></div><div><h3>Conclusion</h3><div>Bisphosphonate usage does not decrease the incidence of acromial stress fractures in osteoporotic patients undergoing rTSA. Future studies should focus on the potential additional interventions to mitigate the risk of acromial stress fracture in osteoporotic patients undergoing rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 568-572"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685854","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 deltoid muscle volume correlates with early postoperative range of motion in flexion after reverse shoulder arthroplasty","authors":"Jun Kawamata MD ,&nbsp;Shoji Fukuta MD, PhD ,&nbsp;Daisuke Nakai MD, PhD ,&nbsp;Kohei Yoshikawa MD ,&nbsp;Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.07.003","DOIUrl":"10.1053/j.sart.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>After reverse shoulder arthroplasty (RSA), the deltoid muscle is the main source of kinematic force, and muscle strength is essential for movement of the shoulder joint. The purpose of this study was to assess the correlation of preoperative deltoid muscle volume with clinical outcomes after RSA. Our hypothesis was that preoperative deltoid muscle volume would be associated with range of motion (ROM), especially in forward flexion.</div></div><div><h3>Methods</h3><div>The study included 49 patients who underwent RSA for cuff tear arthropathy. The mean follow-up duration was 3.3 years. Preoperative deltoid muscle volume was measured in 3 dimensions on computed tomography scans. Postoperative clinical outcomes were evaluated by active ROM and the University of California, Los Angeles shoulder rating scale score. Correlations of deltoid muscle volume with clinical outcomes were investigated. Cases were classified according to whether flexion was 135° or more (the ≥135 group) or less than 135° (the &lt;135 group) at the final observation. Logistic regression analysis was used to identify predictors of more than 135° of flexion. The cutoff value for deltoid muscle volume was determined by receiver operating characteristic curve analysis.</div></div><div><h3>Results</h3><div>Preoperative deltoid volume was correlated with flexion (6 weeks, r = 0.45, <em>P</em> = .003; 3 months, r = 0.33, <em>P</em> = .023; 6 months, r = 0.31, <em>P</em> = .027; 1 year, r = 0.31, <em>P</em> = .033; final observation, r = 0.33, <em>P</em> = .022) and internal rotation at 1 year (r = −0.29 <em>P</em> = .042). Univariable analysis identified statistically significant between-group differences in preoperative external rotation (&lt;135 group, 10.3 ± 20.1°; ≥135 group, 28.0 ± 27.6°; <em>P</em> = .03), preoperative pain score (2.9 ± 1.7 points and 4.3 ± 2.6 points, respectively; <em>P</em> = .45), and preoperative deltoid volume (169.0 ± 62.5 ml and 223.2 ± 59.1 ml; <em>P</em> = .008). Logistic regression analysis identified preoperative factors associated with ≥135° of flexion to be deltoid volume (odds ratio 1.02, 95% confidence interval 1.00-1.03, <em>P</em> = .017) and preoperative external rotation (odds ratio 1.03, 95% confidence interval 1.00-1.05, <em>P</em> = .04). Receiver operating characteristic curve analysis identified a deltoid volume of 204.6 ml (area under the curve 0.737, sensitivity 0.64, specificity 0.81) as the cutoff value for a final ROM in flexion of ≥135°.</div></div><div><h3>Conclusion</h3><div>A correlation was observed between preoperative deltoid muscle volume and ROM in flexion after RSA, especially in the early postoperative stage.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 678-684"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685750","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 extended oral antibiotic prophylaxis after primary total shoulder arthroplasty, 2010-2021","authors":"Arman Kishan MBBS ,&nbsp;Sanjay Kubsad BS ,&nbsp;Jeffrey Y. Wang BS ,&nbsp;Duc Nguyen MD ,&nbsp;Santiago A. Lozano-Calderón MD, PhD ,&nbsp;Umasuthan Srikumaran MD, MBA, MPH ,&nbsp;Matthew J. Best MD","doi":"10.1053/j.sart.2025.06.007","DOIUrl":"10.1053/j.sart.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>The absence of national guidelines on the use of extended oral antibiotic (EOA) prophylaxis has led to inconsistent use of EOA to prevent prosthetic joint infection after total shoulder arthroplasty (TSA). Our investigation aimed to determine temporal trends and prescription patterns in the use of EOA prophylaxis after TSA from 2010 to 2021, particularly for patients considered at high risk for infection.</div></div><div><h3>Methods</h3><div>Using the PearlDiver database, we identified 289,908 patients who underwent primary TSA from 2010 to 2021. EOA was defined as antibiotic use initiated before, during, or immediately after surgery and continued for 2 days or more postoperatively. Compounded annual growth rate and linear regression were used for trend analysis. Stratification measures were demographic variables, geographic location, insurance type, and risk factors for infection.</div></div><div><h3>Results</h3><div>Among primary TSA patients, 3.8% received EOA after TSA. Antibiotic use after TSA increased by a compounded annual growth rate of 6.2% from 2010 to 2021. Associations were observed between EOA prescription patterns and factors such as age, sex, Charlson Comorbidity Index value, geographic region, and insurance type. Cephalexin was the most frequently prescribed antibiotic, but prescriptions of cephalexin declined during the study period, while doxycycline prescriptions increased. Most patients received EOA for 2-7 days. Patients at high risk for infection, including those with diabetes, a history of tobacco use, chronic kidney disease, and autoimmune disorders, were more likely to receive EOAs compared to those without these factors.</div></div><div><h3>Conclusion</h3><div>This study provides insights into the dynamic landscape of EOA prophylaxis after TSA. The observed changes during the study period—namely, the increase in EOA prescriptions, demographic variation in prescription patterns, and shifting antibiotic preferences—highlight the evolving nature of clinical practice in the absence of standardized national guidelines. Continued research is needed to improve prophylactic strategies for patients with risk factors for infection. Surgeons can use this information to establish their own guidelines tailored to their patients, considering factors such as age, comorbid conditions, and regional practices, while closely monitoring for adverse effects and antibiotic resistance patterns.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 654-661"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685758","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":"Determining the minimal clinically important difference and substantial clinical benefit following revision reverse shoulder arthroplasty","authors":"Ali A. Mohamed MS ,&nbsp;Anna Redden BS ,&nbsp;Jacob Calpey BS ,&nbsp;Aghdas Movassaghi BS ,&nbsp;Garrett R. Jackson MD ,&nbsp;Howard Routman DO ,&nbsp;Diego J.L. Lima MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2025.07.004","DOIUrl":"10.1053/j.sart.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) has become a more common procedure due to its expanded indications and successful outcomes. The concern with this growth is the increased number of complications that may lead to more revision surgery. Given revision surgery has increased complexity and difficulty in recovery for patients, understanding outcomes can help guide patients and surgeons in decision-making. This study aimed to establish the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for reverse TSA performed as a revision procedure for failed prior shoulder arthroplasty types.</div></div><div><h3>Methods</h3><div>A retrospective review of all patients who underwent revision reverse TSA (rTSA) performed as a revision procedure for failed prior shoulder arthroplasty from 2007 to 2020 by a single fellowship-trained orthopedic surgeon was performed. Patient demographics, range of motion, and patient-reported outcome measures including Simple Shoulder Test (SST), Constant-Murley, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA), Shoulder Pain and Disability Index (SPADI), and Shoulder Arthroplasty Smart (SAS), were collected preoperatively and postoperatively at the last follow-up visit. MCID and SCB were calculated using the anchor-based method. Analyses were performed using paired- and independent-sample t-tests and logistic regressions were used to identify potential predictors for meeting MCID and SCB.</div></div><div><h3>Results</h3><div>A total of 91 patients were included in this analysis. The cohort had a mean age of 67.8 years and a mean body mass index of 29.7 kg/m². A majority of the cohort was male (51.7%) and Caucasian (93.2%). The MCID was found to be 3.5 for SST, 30.6 for Constant-Murley Score, 25.3 for ASES, 11.2 for UCLA, −42.1 for SPADI, 17.4 for SAS, 56.4° for forward flexion, 47.6° for abduction and 11.7° for external rotation. The SCB was found to be 6.3 for SST, 34.3 for CMS, 45.6 for ASES, 17.6 for UCLA, −56.8 for SPADI, 30.1 for SAS, 78.4° for forward flexion, 66.8° for abduction and 7.9° for external rotation. MCID was achieved by 72.5% of patients and 43.9% (n = 40) met SCB at final follow-up. Age, sex, and body mass index were not found to be significantly associated with meeting MCID or SCB.</div></div><div><h3>Conclusions</h3><div>This study establishes MCID and SCB thresholds for rTSA performed as a revision procedure for failed prior shoulder arthroplasties, providing valuable benchmarks for assessing patient outcomes. Most patients achieved meaningful improvements (MCID), and a significant portion reached SCB. These findings help set recovery expectations and highlight that patient-specific factors have a limited impact on outcomes after rTSA performed as a revision surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 685-691"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685858","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 3-dimensional planning optimizes glenoid retroversion correction in shoulder arthroplasty using hemi-wedged augmented baseplates","authors":"Luis Navas MD ,&nbsp;Sebastian Schmidt MD ,&nbsp;Carolina Vogel MD ,&nbsp;Thorsten Guehring MD, PhD","doi":"10.1053/j.sart.2025.05.002","DOIUrl":"10.1053/j.sart.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid version and inclination can be corrected with an augmented baseplate during reverse shoulder arthroplasty (rTSA) procedures. To achieve an optimal correction of both glenoid version and inclination, this study investigated whether the preoperative use of a 3-dimensional planning system improved the correction of glenoid anatomy in terms of glenoid version (0°) and inclination (rTSA 0°).</div></div><div><h3>Methods</h3><div>We measured preoperative and postoperative glenoid version and inclination by rTSA angle by x-ray and computed tomography scans in 50 prospective cases of rTSA with wedged baseplates. All patients underwent an rTSA due to osteoarthritis and rotator cuff insufficiency. All 50 patients underwent rTSA with the use of a hemi-wedge to correct the glenoid morphology. Twenty five patients additionally underwent a preoperative planning with the Signature ONE Planner to determine the exact rotational position of the hemi-wedge. rTSA angle was determined in preoperative and postoperative x-rays, and glenoid version was determined in preoperative and postoperative computed tomography scans at 3 different glenoid levels. The Signature ONE Planner system determined the rotation, position, and size of the hemi-wedge (10°, 20°, or 30°). A control group of 25 patients underwent hemi-wedge rTSA without preoperative planning. The position of the sphere and the sphere bone overhang distance (mm) was determined in both groups.</div></div><div><h3>Results</h3><div>In all 50 patients, the inclination was almost corrected anatomically from a preoperative rTSA angle of 16.2° ± 6.4° to 2.4° ± 3.5° postoperatively, irrespective of the use of Signature ONE Planner. In comparison, the average correction of retroversion was worse and achieved to a lower degree but the use of Signature ONE Planner significantly improved the correction of retroversion in all 3 parts of the glenoid to an almost anatomical level (<em>P</em> &lt; .0001). In both groups, the sphere bone overhang distance was between 4 and 5 mm without scapular notching.</div></div><div><h3>Discussion and Conclusion</h3><div>The anatomical correction of a retroverted glenoid with a hemi-wedge baseplate can be considerably improved by the preoperative use of the Signature ONE planning system. Preoperative planning can thus help surgeons to achieve an optimal baseplate position and may thus improve the correction of the glenoid retroversion after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 561-567"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685808","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":"Can surgeons predict how much compensation is needed to correct glenoid inclination in reverse shoulder arthroplasty?","authors":"Mark Mouchantaf MD ,&nbsp;Gregorio Secci MD ,&nbsp;Manon Biegun MD ,&nbsp;Mikael Chelli MD ,&nbsp;Philipp Schippers MD ,&nbsp;Pascal Boileau MD, PhD","doi":"10.1053/j.sart.2025.06.005","DOIUrl":"10.1053/j.sart.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Correction of superior glenoid inclination, with a neutral reverse shoulder arthroplasty RSA angle, is crucial for achieving optimal outcomes and avoiding complications in RSA. This study aimed to assess the compensation distance (CD) required to correct the RSA angle without medialization. We hypothesized that measuring the RSA angle could provide a viable and simple method to estimate the extent of superior glenoid bone erosion and predict the CD needed to achieve neutral inclination of the baseplate during RSA.</div></div><div><h3>Methods</h3><div>We analyzed 101 preoperative computed tomography (CT) scans from 101 consecutive patients (mean age 76 ± 9 years) undergoing RSA for cuff tear arthropathy (84) or massive rotator cuff tear (MRCT = 17). Using validated 3-dimensional (3D) planning software, the baseplate was positioned inferiorly, tangent to the inferior glenoid rim (6 o'clock position), and adjusted to achieve neutral inclination (RSA angle = 0°). The CDs (the distance between the backside of the baseplate and the native glenoid) were measured at 2 levels: the superior edge of the baseplate (superior compensation distance [SCD]) and the center of the baseplate (CCD = central compensation distance). Univariate regression models were used to analyze the relationships between the RSA angle, glenoid inclination, and CDs. Predicted CDs for specific RSA angles were also calculated.</div></div><div><h3>Results</h3><div>The mean global glenoid inclination was 9° ± 6° (range: 0–27°), and the mean RSA angle was 15° ± 5.6° (range: 4–28°). There was a strong linear correlation between the RSA angle and the CDs: the higher the RSA angle, the greater the CDs. CCD had a correlation coefficient (ρ) of 0.83 (R² = 0.688; <em>P</em> &lt; .001), while SCD showed a stronger correlation with ρ = 0.93 (R² = 0.874; <em>P</em> &lt; .001). Subgroup analysis revealed no statistically significant differences between baseplate diameters (25 mm vs 29 mm) in their relationship with the RSA angle (interaction terms: <em>P</em> = .291 for CCD and <em>P</em> = .500 for SCD). Regression models demonstrated that SCD is approximately half the RSA angle: 5 mm for 10°, 7.5 mm for 15°, 10 mm for 20°, and 12.5 mm for 25°.</div></div><div><h3>Conclusion</h3><div>By measuring the RSA angle, surgeons can estimate the SCD (ie, the thickness of bone graft or metal augment) required to achieve neutral inclination of the baseplate. The value of SCD is approximately half the RSA angle value and is independent of the baseplate diameter (25 mm vs 29 mm).</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 636-644"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685811","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":"Safety of rapid discharge after total shoulder arthroplasty in septuagenarian and octogenarian patients","authors":"Keneth R. Granados BS ,&nbsp;Marco E. Guareschi BS ,&nbsp;John W. Moore BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.05.005","DOIUrl":"10.1053/j.sart.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>There is limited literature assessing whether patients older than age 70 can be safely discharged within a day (ie, rapid discharge [RD]), following primary total shoulder arthroplasty (TSA). The purpose of this study is to assess postoperative outcomes following TSA with RD (RD-TSA) in septuagenarian and octogenarian patients compared to those with lengthier hospital stays (LD-TSA).</div></div><div><h3>Methods</h3><div>The National Surgical Quality Improvement Program database was queried from 2006 to 2019 to identify patients who underwent elective primary TSA. Septuagenarian and octogenarian patients who underwent RD-TSA were compared to septuagenarian and octogenarian patients who underwent TSA with lengthier hospital stays (LD-TSA). Demographics, preoperative comorbidities, and rates of complications, readmission, reoperation, and mortality within 30 days of surgery were compared between RD-TSA and LD-TSA patients.</div></div><div><h3>Results</h3><div>Septuagenarian and octogenarian patients who underwent RD-TSA were less likely to be female (<em>P</em> &lt; .001) and had a lower mean age (<em>P</em> &lt; .001) and body mass index (<em>P</em> &lt; .001). RD-TSA patients were more likely to be functionally independent (<em>P</em> &lt; .001) with lower American Society of Anesthesiologists classifications (<em>P</em> &lt; .001) when compared to LD-TSA patients. Patients aged 70 years and older who underwent RD-TSA exhibited lower rates of any adverse events (<em>P</em> = .001) and bleeding requiring transfusion (<em>P</em> &lt; .001) compared to LD-TSA patients. Septuagenarian and octogenarian patients who underwent RD-TSA were less likely to have hypertension (<em>P</em> &lt; .001) and diabetes mellitus (<em>P</em> &lt; .001) compared to LD-TSA patients. The average total operating time (<em>P</em> &lt; .001) was significantly lower for RD-TSA compared to LD-TSA, without a notable difference in readmission rates between the groups.</div></div><div><h3>Conclusion</h3><div>Septuagenarian and octogenarian patients who underwent RD-TSA exhibited significantly fewer postoperative complications compared to septuagenarian and octogenarian patients who underwent LD-TSA. Patients aged 70 years and older who received RD-TSA were less likely to have diabetes, hypertension requiring medication, and bleeding requiring transfusion compared to LD-TSA. These findings indicate that RD-TSA is safe and efficacious when utilized in appropriately selected septuagenarian and octogenarian patient populations.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 585-590"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685856","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":"Examining the structure of the American Academy of Orthopaedic Surgeons appropriateness criteria for persons with shoulder osteoarthritis, an intact rotator cuff, and glenoid retroversion","authors":"Daniel L. Riddle PT, PhD, FAPTA ,&nbsp;Levent Dumenci PhD","doi":"10.1053/j.sart.2025.07.002","DOIUrl":"10.1053/j.sart.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>The American Academy of Orthopaedic Surgeons has led an effort to develop RAND/University of California Los Angeles appropriateness criteria for a variety of musculoskeletal surgical treatments. A recently developed appropriateness system is the shoulder osteoarthritis (OA) appropriateness system. The purpose of our study was to examine the structure of this appropriateness system and determine contributions of each predictive criterion to final decisions of appropriate, may be appropriate, or rarely appropriate for 5 surgical treatments for shoulder OA.</div></div><div><h3>Methods</h3><div>All 48 clinical vignettes were used. All predictors (age classified as young or older/elderly; physiologic demand as low or high; degree of glenoid retroversion as &gt;20°-30°, &gt;30°; glenoid classification as type B2, type B3, type C; and preoperative shoulder active elevation as &gt; 90° or less than 90°) were used in the vignettes. Multivariable logistic regression and a chi-square automatic interaction detection decision tree approach were used to determine the system structure and contribution of each predictor variable used to rate appropriateness.</div></div><div><h3>Results</h3><div>For each of 5 treatments (2 types of anatomic shoulder arthroplasty, reverse shoulder arthroplasty, hemiarthroplasty, and arthroscopic débridement), multivariable logistic regression and chi-square automatic interaction detection are reported. For example, for reverse shoulder arthroplasty, the predictors with the largest odds ratios (ORs) for vignettes rated as “may be appropriate” as compared to “appropriate” were high physiological demand (OR = 2.63 × 10¹⁵) and glenoid type C (OR = 81.50 × 10⁴). For anatomic shoulder arthroplasty, predictors with the largest ORs for vignettes rated as “may be appropriate” as compared to “appropriate” were glenoid type C (OR = 24.74), greater than 30° retroversion, and &lt;90° active shoulder elevation (both OR = 24.74).</div></div><div><h3>Conclusion</h3><div>The American Academy of Orthopaedic Surgeons shoulder OA system has substantial limitations. It uses a limited number of vignettes, with a consequent lack of symptom spectrum representation, an absence of “appropriate” or “rarely appropriate” ratings for all treatments and an absence of critically important patient-centered measures of pain and functional loss. Alternative published appropriateness criteria appear to have greater potential for clinical use and should be considered for future study.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 669-677"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685859","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":"Effect of baseplate augmentation on humeral offset and clinical outcomes in reverse shoulder arthroplasty","authors":"Matthew Como BS,&nbsp;Rajiv P. Reddy MD, MS,&nbsp;Fritz Steuer MD,&nbsp;Ehab M. Nazzal MD,&nbsp;Romano Sebastiani MD,&nbsp;Confidence Njoku-Austin MD,&nbsp;Anya Singh-Varma MD,&nbsp;Warren P. Austin BS,&nbsp;Albert Lin MD","doi":"10.1053/j.sart.2025.06.003","DOIUrl":"10.1053/j.sart.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Metallic augmented baseplates have increasingly been used to correct glenoid deformity during reverse shoulder arthroplasty (RSA). However, few studies have examined their clinical outcomes and effect on humeral offset. The purpose of this study was to evaluate clinical outcomes and change in humeral offset from preoperative anatomic baseline of RSA performed with an augmented baseplate (aRSA) to RSA without baseplate augmentation. We hypothesized that aRSA would yield similar outcomes and complication rates to non-aRSA but result in a greater increase in global lateralization from preoperative to postoperative measurements.</div></div><div><h3>Methods</h3><div>This was a retrospective review of consecutive patients who underwent RSA between 2015 and 2021 at a single institution with a minimum 12-month follow-up. RSA performed with an augmented baseplate (aRSA) was compared to RSA performed without augmentation (control). Baseline demographics, and pre/postoperative humeral offset and glenoid version and inclination were obtained. Pre/postoperative range of motion (ROM) and patient reported outcomes including visual analog scale (VAS), subjective shoulder value (SSV), and American Shoulder and Elbow Surgeons scores, and complications were recorded. Independent sample <em>t</em>-tests and Chi-squared and Fisher's exact test were utilized for continuous and binary variables, respectively. Statistical significance was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>There were 58 patients in the aRSA cohort and 86 patients in the control cohort with similar mean follow-up times (22.16 vs. 19.65 months; <em>P</em> = .373). On average, the aRSA cohort had a greater absolute difference between preoperative and postoperative humeral offset than the control cohort (7.4 ± 4.2 vs. 5.9 ± 3.9 mm; <em>P</em> = .041). In both cohorts, all patient-reported outcomes and ROM parameters were significantly improved from preoperative baselines. At final follow-up, the aRSA cohort had slightly greater pain scores (1.2 ± 2.3 vs. 0.5 ± 1.0; <em>P</em> = .038) than the control cohort but SSV and American Shoulder and Elbow Surgeons were similar. Similar ROM was achieved between the cohorts. The control cohort had significantly greater improvements in VAS (7.0 ± 2.3 vs. 5.8 ± 3.1; <em>P</em> = .050) and SSV (59.3 ± 25.5 vs. 44.5 ± 22.4; <em>P</em> &lt; .001) compared to the aRSA cohort. There were no differences in complications.</div></div><div><h3>Conclusion</h3><div>RSA with metallic augmented baseplates achieves comparable overall clinical outcomes to non-aRSA at 12-month follow-up, with low revision and complication rates. However, the control cohort demonstrated greater gains in SSV and VAS, whereas the augmented group exhibited greater changes in humeral offset.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 620-627"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685812","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":"Study on stability of resurfacing total elbow arthroplasty: a cadaver study","authors":"Hiromasa Wakita MD ,&nbsp;Yusuke Matsuura MD, PhD ,&nbsp;Yohei Shimada MD, PhD ,&nbsp;Shinji Taniguchi MD, PhD ,&nbsp;Takane Suzuki MD, PhD ,&nbsp;Mitsuyasu Iwasawa MD, PhD ,&nbsp;Yoshihiko Tabira MD, PhD ,&nbsp;Yuichi Nagase MD, PhD ,&nbsp;Koji Fujita MD, PhD ,&nbsp;Jun Hirose MD, PhD ,&nbsp;Yasuhiro Ozasa MD, PhD ,&nbsp;Seiji Ohtori MD, PhD (Professor)","doi":"10.1053/j.sart.2025.06.002","DOIUrl":"10.1053/j.sart.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Although excellent clinical results have been reported for resurfacing total elbow arthroplasty, also known as K-elbow, there are still reports of complications due to postoperative instability of the elbow joint. Appropriate implant selection, proper implant placement, and establishment of soft tissue repair methods are necessary to prevent complications, but these requirements have not fully undergone scientific verification. Surgical techniques such as the extent of bone resection of the distal humerus and soft tissue repair methods require technical skill, but the extent to which these techniques contribute to joint stability is unclear. This study aimed to investigate the factors contributing to elbow joint stability after elbow arthroplasty using K-elbow and fresh-frozen cadavers.</div></div><div><h3>Methods</h3><div>Six upper limbs of fresh-frozen cadavers were used in this study. The resurfaced unlinked-type elbow prosthesis (K-elbow) was placed using a posterior approach. The distal humerus was resected at 0 mm, 2 mm, and 4 mm on the articular surface, and the artificial elbow joint was installed. Anchors were inserted into the olecranon, the biceps tuberosity, and the coronoid process to simulate the triceps, biceps, and brachialis muscles, and traction forces of 20 N, 10 N, and 10 N, respectively, were applied. In addition, a digital angle meter was attached to the forearm, and varus and valgus stress tests were performed at all elbow joint ranges of motion using forearm weight to evaluate the spacer effect. Furthermore, a stress test was performed for each soft tissue repair process at the 2-mm bone resection site to evaluate the stability of the procedure.</div></div><div><h3>Results</h3><div>As the extent of bone resection of the distal humerus increased, the extension angle tended to improve. Furthermore, as the extent of bone resection increased, elbow joint instability due to varus and valgus stress increased. Soft tissue repair did not affect elbow instability due to varus stress, but it tended to reduce elbow instability due to valgus stress. In addition, the triceps fascia suture reduced the external rotation angle of the elbow joint in response to valgus stress.</div></div><div><h3>Conclusion</h3><div>This cadaver study demonstrated that bone resection of the distal humerus significantly affects both the range of motion and stability of the elbow joint after K-elbow arthroplasty. The triceps fascia suture was identified as the most critical soft tissue repair procedure for ensuring elbow joint stability, particularly against valgus stress.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 612-619"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685853","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}