Seminars in Arthroplasty最新文献

{"title":"Incidence of anatomic total shoulder arthroplasty vs. reverse total shoulder arthroplasty in cuff intact osteoarthritis in males vs. females 70 years or older","authors":"Ronald A. Navarro MD ,&nbsp;Michael T. Kody MD ,&nbsp;Joaquin Sanchez-Sotelo MD ,&nbsp;Carolyn Hettrich MD, MPH ,&nbsp;Ayushmita De PhD ,&nbsp;Stephen C. Weber MD ,&nbsp;Oke A. Anakwenze MD ,&nbsp;Stephen F. Brockmeier MD ,&nbsp;Grant E. Garrigues MD ,&nbsp;John E. Kuhn MD ,&nbsp;Patrick St Pierre MD ,&nbsp;Samuel A. Taylor MD ,&nbsp;Gerald R. Williams MD","doi":"10.1053/j.sart.2024.01.016","DOIUrl":"10.1053/j.sart.2024.01.016","url":null,"abstract":"<div><h3>Background</h3><p>While there has been increased attention to the use of reverse total shoulder arthroplasty (RTSA) to treat rotator cuff intact glenohumeral osteoarthritis (RCIOA) for older age groups, there has not been as precise an assessment of the differences in utilization for female vs. male patients or in specific age groups. Our purpose was to determine if differences existed in the utilization of shoulder arthroplasty to treat RCIOA based on gender and age in North America.</p></div><div><h3>Methods</h3><p>Anatomic total shoulder arthroplasty (ATSA) and RTSA cases were queried from the American Academy of Orthopaedic Surgeons Shoulder and Elbow Registry between January 2015 and December 2021. Cases were included if they had a diagnosis of RCIOA, defined by the International Classification of Diseases-10 codes M19.011, M19.012, and M19.019. Cases were stratified by procedure, age, gender, and year of surgery. Chi-square and Fisher’s exact tests were calculated to assess the associations between procedure type and patient demographics.</p></div><div><h3>Results</h3><p>There were 2748 (48.06%) ATSA and 2970 (51.94%) RTSA procedures reported to the American Academy of Orthopaedic Surgeons Shoulder and Elbow Registry. There was a significant relationship between procedure type and age group (<em>P</em> &lt; .001) in that ATSA was utilized more frequently than RTSA for patients ages &lt;70 years old, and this relationship reversed for ages ≥ 70 years old. Female patients were more likely to receive RTSA (<em>P</em> &lt; .001). When looking at the relationship between procedure type and gender by age group, both genders were more likely to receive ATSA compared to RTSA for age groups 50-59 and 60-69 (<em>P</em> = .0097 and <em>P</em> = .0005, respectively) but not for other age groups. For patients ≥ 70 years old, both females and males were more likely to receive RTSA, but this relationship did not reach statistical significance (<em>P</em> = .1094). For both genders and ages ≥ 70 years old, there was a significant relationship between year and procedure type (<em>P</em> &lt; .0001) in that RTSA was more commonly utilized in 2017 and onward.</p></div><div><h3>Discussion and Conclusion</h3><p>When assessing patients with RCIOA, the use of ATSA and RTSA was similar, but for patients 50 to 69 years old, for both genders, the use of ATSA was greater. Although RTSA was more commonly used for both genders in the ≥ 70 years old population, this difference was not significant. Interestingly, for both genders, ages ≥ 70 years old, RTSA was significantly more utilized from 2017 onward. This analysis highlights the influence of age and gender in use of ATSA and RTSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 475-481"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268242","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":"Factors in total shoulder arthroplasty revision: insights from a national database analysis","authors":"Parker K. Chenault BA,&nbsp;Nicholas J. Peterman BS,&nbsp;Dylan C. Crawford BA,&nbsp;Mark W. Schmitt MD,&nbsp;John R. Tuttle MD","doi":"10.1053/j.sart.2024.02.001","DOIUrl":"10.1053/j.sart.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty (TSA) is increasingly recognized as a therapeutic solution for various shoulder disorders. However, the correlation between preoperative determinants of health and postoperative TSA revisions remains underexplored. These correlations are scientifically important as they may be used to design higher-level clinical studies to confirm if they are in-fact predictive of revision. As such, this investigation aims to identify possible health and demographic disparities between primary TSA and revision TSA cohorts.</p></div><div><h3>Methods</h3><p>Data for this research was sourced from the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2021. Patients were classified based on Current Procedural Terminology (CPT) codes into 2 groups: primary TSA (CPT: 23472) and revision TSA (CPT: 23473 or 23474). Nineteen demographic and preoperative variables were compared between the cohorts using multivariate logistic regression. Odds ratios (ORs) along with their 95% confidence intervals (CIs) were calculated and graphically displayed. To account for multiple exploratory comparisons, Bonferroni correction was utilized with an adjusted significance threshold of 0.0026.</p></div><div><h3>Results</h3><p>TSA revision patients were more likely to arrive from a nursing home (OR 1.87, 95% CI [1.50, 2.32], <em>P</em> &lt; .001), have diabetes (OR 1.09, 95% CI [1.05, 1.14], <em>P</em> &lt; .001), be diagnosed with Systemic inflammatory response syndrome prior to surgery (1.38, 95% CI [1.13, 1.69], <em>P</em> = .002) and less likely to have independent functional status prior to surgery (OR 0.69, 95% CI [0.63, 0.76], <em>P</em> &lt; .001). Moreover, those in the revision group were predominantly younger, male, receiving immunosuppressive therapy, exhibited baseline dyspnea, and had elevated American Society of Anesthesiologists class. Notably, factors such as smoking, racial background, and hypertension showed no significant differences (<em>P</em> &gt; .0026).</p></div><div><h3>Conclusions</h3><p>Contrary to contemporary literature, our findings suggest that, when demographic factors are controlled for, smoking is not correlated with revisions in TSA when compared to primary TSA. Furthermore, patients undergoing primary TSA are more likely to be functionally independent than patients undergoing revision TSA. While at the same time, a patient’s arrival at surgery from a nursing home gave the greatest likelihood of a revision.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 496-500"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term comparative outcomes of LIMA hybrid, metal-backed, and all cemented polyethylene glenoids","authors":"Andrew D. Lachance MD ,&nbsp;Shaya Shahsavarani MD ,&nbsp;Mohammad T. Azam MD ,&nbsp;Margaret E. Giro MS ,&nbsp;Joseph Y. Choi MD, PhD, MHA","doi":"10.1053/j.sart.2024.01.017","DOIUrl":"10.1053/j.sart.2024.01.017","url":null,"abstract":"<div><h3>Background</h3><p>This study aims to compare short-term functional outcomes and conversion rates to reverse shoulder arthroplasty between patients who underwent total shoulder arthroplasty (TSA) using a modular metal-backed glenoid component, a hybrid glenoid component, and an all-polyethylene component.</p></div><div><h3>Methods</h3><p>A retrospective review of individuals undergoing TSA between October 2014 and December 2020 was performed. Inclusion criteria included patients undergoing primary TSA for osteoarthritis during this time frame by 1 surgeon. Preoperative and postoperative variables included demographic information, American Shoulder and Elbow Surgeons score (ASES), and range of motion. Revision rates were also documented. Summary statistics were performed, using a 1-way analysis of variance with Tukey post hoc pairwise comparisons when the outcome reached significance.</p></div><div><h3>Results</h3><p>Fifty-two patients were included with age averaging 68 ± 8.1 years, with body mass index of 31 ± 5.8. 54% of patients were female with 12% having diabetes and only 2% were smokers. Follow-up averaged 42 months with patients undergoing metal-backed glenoid having longer follow-up at 56.5 months (<em>P</em> &lt; .001). ASES, forward elevation, and external rotation (ER) for every implant type improved significantly postoperatively (<em>P</em> &lt; .001) besides internal rotation and ER within the poly group (<em>P</em> = .072). No difference was found between the 3 groups for preoperative and postoperative ASES scores, forward elevation, internal rotation, and ER (<em>P</em> &gt; .05). Two patients within the poly group required revision due to rotator cuff tear (<em>P</em> = .225).</p></div><div><h3>Conclusion</h3><p>At 2 years, functional outcomes and patient-reported outcomes are similar in all 3 glenoid groups. There were slightly higher revision rates within the all-polyethylene group. If outcomes are similar among all groups, modular implant systems may be favorable to make conversion to revision TSA easier.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 482-489"},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283106","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":"What specific activities are patients performing 2 years after primary anatomic total shoulder arthroplasty?","authors":"Alexander E. White MD ,&nbsp;Joshua T. Bram MD ,&nbsp;Anthony Finocchiaro BS ,&nbsp;Christopher M. Brusalis MD ,&nbsp;David M. Dines MD ,&nbsp;Joshua S. Dines MD ,&nbsp;Andreas Kontaxis PhD ,&nbsp;Samuel A. Taylor MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Michael C. Fu MD, MHS","doi":"10.1053/j.sart.2024.01.015","DOIUrl":"10.1053/j.sart.2024.01.015","url":null,"abstract":"<div><h3>Background</h3><p>Returning patients to their desired activities following anatomic total shoulder arthroplasty (aTSA) is an important criterion to achieve high patient satisfaction. While patients who undergo aTSA return to sports at relatively high rates, individuals’ specific desired and achieved activities following aTSA remain poorly defined.</p></div><div><h3>Methods</h3><p>A shoulder arthroplasty registry at a tertiary-care orthopedic hospital was reviewed retrospectively between February 1, 2016, and January 1, 2021, to identify specific patient activity and functional capabilities following aTSA at a minimum of 2 years postoperatively. Individual items and responses of the American Shoulder and Elbow Surgeons and Shoulder Activity Scale relating to activity levels, as well as free text responses pertaining to usual work and sport, were tabulated.</p></div><div><h3>Results</h3><p>Among 597 patients who underwent 632 primary anatomic TSAs (mean age 65.9 ± 8.3 years, 41.5% female), the median American Shoulder and Elbow Surgeons score per affected limb improved from 40.0 (interquartile range (IQR) 27.4-54.7) preoperatively to 94.9 (IQR 83.8-98.3) at 2 years (<em>P</em> &lt; .001), while median Shoulder Activity Scale improved from 8.0 (IQR 5.0-12.0) preoperatively to 10.0 (6.0-14.0) at 2 years (<em>P</em> &lt; .001). Two years after surgery, 78.5%, 88.6%, and 83.5% of patients were able to comb their hair, manage toileting, and put on a coat without any difficulty, respectively. A relatively small proportion of patients were able to reach a high shelf (64.7%) and lift 10 pounds above the shoulder (57.4%) without difficulty. Of the 524 (82.9%) patients who returned to recreational activities 2 years after surgery, golf (25.6%), walking (22.7%), weight training (16.8%), and swimming (15.8%) were the most commonly reported activities. Cooking and cleaning (29.9%, n = 189), desk-related work (27.2%, n = 172), yard-work or gardening (14.2%, n = 90), heavy lifting activities (6.5%, n = 41), and grocery shopping (2.5%, n = 16) were the most common forms of usual work.</p></div><div><h3>Conclusion</h3><p>Patients undergoing aTSA report a wide spectrum of desired recreational activities. A range of functional capabilities exists within this patient population with regards to usual sporting activity, work activity, and activities of daily living. Preoperative patient counseling may attempt to identify patients’ desired postoperative activities for more individualized education regarding their prognosis for returning to desired activities.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 490-495"},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279407","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 outcomes based on planned glenoid baseplate retroversion in reverse total shoulder arthroplasty","authors":"Lauren E. Schell BS ,&nbsp;Stephanie J. Muh MD ,&nbsp;Josie A. Elwell PhD ,&nbsp;Skye Jacobson BS ,&nbsp;William R. Barfield PhD ,&nbsp;Christopher P. Roche MSE, MBA ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.01.014","DOIUrl":"10.1053/j.sart.2024.01.014","url":null,"abstract":"<div><h3>Background</h3><p>While surgeons attempt to correct the baseplate version of a reverse total shoulder arthroplasty (rTSA), clinical outcomes based on the planned final version remain unknown. The purpose of this study is to determine the clinical and radiographic outcomes of rTSA based on the planned final version of the baseplate. Our hypothesis is that increasing component retroversion will not affect outcomes.</p></div><div><h3>Methods</h3><p>All primary rTSA patients in a multicentered international registry with a 2-year minimum follow-up implanted with computer navigation were included, except fracture and revision indications. A single medialized glenoid/lateralized humerus rTSA implant system was used with a standard or augmented baseplate. Patients were stratified by baseplate type and final planned baseplate version into 2 cohorts: 0°-5° (Group 1) or 6°-15° (Group 2) of retroversion. Demographics, radiographic outcomes, range of motion, and patient-reported outcome scores were compared between groups using Welch’s t-test and Fisher’s Exact test.</p></div><div><h3>Results</h3><p>Five hundred and thirty-five patients (307 females/226 males/2 unknown) were identified, with a mean follow-up of 30 months. Demographics were similar between the cohorts. The mean native and final retroversion was 9.0° and 1.5° in Group 1 and 16.3° and 8.6° in Group 2, respectively. Preoperatively, 72% of patients were 6°-15° retroverted. Postoperatively, 73% of patients were 0°-5° retroverted and 27% were 6°-15°, with 97% of patients having less than or equal to 10° of planned baseplate retroversion. Without stratifying for baseplate types, there were no clinically significant differences between the cohorts with regards to postoperative pain, range of motion, or patient-reported outcome scores, except for abduction and internal rotation greater in the 6°-15° and 0°-5° cohorts, respectively. Scapular notching was low (7% vs. 8%) and less than reported without computer navigation. Complication and revision rates were similar between the 2 groups. Patient satisfaction was high (much better/better, 94% vs 95%) and not significantly different between the 2 groups.</p></div><div><h3>Discussion</h3><p>There were no significant clinical differences between cohorts. This study demonstrates that favorable outcomes are achieved with a planned final baseplate version of less than 15° retroversion, with few differences between 0°-5° and 6°-15°. rTSA is forgiving enough such that one may plan to correct preoperative retroversion to less than 15° postoperatively in lieu of targeting postoperative version between 0°-5° for patients with higher native retroversion, potentially requiring less eccentric reaming especially when combined with other corrective measures.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 469-474"},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271234","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":"Patients with chronic kidney disease can expect significant improvement in pain and function after shoulder arthroplasty","authors":"Katherine A. Burns MD ,&nbsp;Lynn M. Robbins PA-C ,&nbsp;Angela R. LeMarr BSN, RN, ONC ,&nbsp;Varun Gopinatth BS ,&nbsp;Diane J. Morton MS, MWC ,&nbsp;Melissa L. Wilson PhD, MPH","doi":"10.1053/j.sart.2024.01.011","DOIUrl":"10.1053/j.sart.2024.01.011","url":null,"abstract":"<div><h3>Background</h3><p>Chronic kidney disease (CKD) is associated with negative outcomes after hip and knee arthroplasty due to higher rates of infection, aseptic loosening, and transfusion. The purpose of this study was to compare clinical outcome scores and complication rate after shoulder arthroplasty (SA) for patients with and without CKD.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study of prospectively collected data and reviewed all patients who underwent primary SA from January 2015 to December 2019 by one surgeon at one institution. Revision arthroplasty patients were excluded. We evaluated results from patients with CKD (glomerular filtration rate [GFR] <span><math><mrow><mo>≤</mo></mrow></math></span> 59) and without CKD (GFR <span><math><mrow><mo>≥</mo></mrow></math></span> 60). Outcome measures including visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores were compared between cohorts. Minimum clinically important difference (MCID) and substantial clinical benefit also were determined for this cohort. Univariate and multivariable regression was performed to assess the influence of CKD on outcome measures and risk of complications.</p></div><div><h3>Results</h3><p>518 patients met inclusion criteria; 4 patients did not have recorded GFR, leaving 514 patients for analysis. 389 patients had normal GFR; 125 had CKD. Patients with CKD had lower overall preoperative and postoperative ASES, SST, and SANE scores but demonstrated similar levels of clinical improvement from preoperative to postoperative time points (Δ ASES 41.4 ± 21.8 vs. 42.9 ± 21.4, <em>P</em> = .55), (Δ SST 4.8 ± 3.4 vs. 4.9 ± 3.3, <em>P</em> = .08), (Δ SANE 40.7 ± 29.1 vs. 42.4 ± 26.5, <em>P</em> = .77). Both cohorts achieved MCID for ASES, SST, and SANE scores. Univariately, patients with CKD were at high risk to require transfusion (OR 16.2 (1.9, 139.7), <em>P</em> = .01) despite similar intraoperative estimated blood loss (156.9 ± 132.5mL vs. 153.8 ± 89.7mL, <em>P</em> = .77). CKD patients also were at higher risk for intraoperative fracture (OR 5.4 (1.3, 23.0), <em>P</em> = .02). CKD patients were not at higher risk for prosthetic joint infection (OR 3.2 (0.2, 50.8), <em>P</em> = .42), medical complications (OR 0.9 (0.2, 4.4), <em>P</em> = .89), or revision (OR 1.9 (0.7, 4.9), <em>P</em> = .19) in this cohort. Multivariable analysis of any complication after SA demonstrated that renal disease was not an independent risk factor for overall complication risk in this cohort (OR 1.1 (0.7, 1.8) <em>P</em> = .650).</p></div><div><h3>Conclusion</h3><p>Surgeons can be assured that patients who have CKD achieve similar gains in clinical outcomes as other patients. Despite experiencing a higher risk for transfusion and intraoperative fracture, renal disease was not an independent risk factor for complications after SA in this small coh","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 457-463"},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269017","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":"Complications associated with postoperative stiffness following primary anatomic and reverse total shoulder arthroplasty","authors":"Lawrence C. Vanderham MS, PA,&nbsp;Nikhil Vallabhaneni BA,&nbsp;Skye Jacobson BS,&nbsp;Jacqueline G. Tobin MS,&nbsp;Alexander S. Guareschi BS,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.01.012","DOIUrl":"10.1053/j.sart.2024.01.012","url":null,"abstract":"<div><h3>Background</h3><p>Shoulder stiffness following both primary anatomic and reverse total shoulder arthroplasty (TSA) is a potential complication that is likely underreported. The deleterious effects of postoperative stiffness following TSA and the burden placed on both the patient and the healthcare system have not been well studied. The purpose of this study is to determine the incidence of postoperative stiffness following primary TSA and analyze the effect it has on short-term outcomes up to 180 days following primary TSA.</p></div><div><h3>Methods</h3><p>This was a retrospective, comparative cohort study. The Nationwide Readmissions Database was queried from 2010 to 2020 for patients who had undergone primary TSA using International Classification of Diseases Clinical Modification and Procedure Coding System codes. Patients were then separated into stiff and non-stiff cohorts. A one-to-one match was performed based on age, sex, and the Charlson comorbidity index. Statistical analyses included chi-square, sample <em>t</em>-tests, logistic, and linear regression.</p></div><div><h3>Results</h3><p>A total of 7792 subjects were included in the study. The overall incidence of postoperative stiffness was 1.8%. Patients with stiffness following primary TSA were 57% more likely to be readmitted within 180 days (odds ratio [OR] = 1.57) and had increased hospital costs by over $5000 (<em>P</em> &lt; .001), but mortality rates were not increased. However, the odds of experiencing any medical complication or revision decreased by 52% and 76%, respectively, in the stiff group (OR = 0.48, and OR = 0.24, respectively). Postoperative stiffness was inversely predictive of prosthetic dislocation (OR = 0.03), loosening (OR = 0.03), and periprosthetic fracture (OR = 0.04).</p></div><div><h3>Conclusion</h3><p>The incidence of postoperative stiffness following primary TSA was low at 1.8 %. These patients were found to be at increased risk for readmission within 180 days and incurred significantly higher hospital costs compared to the non-stiff cohort. However, postoperative stiffness did not increase the odds of experiencing increased medical complications, mechanical complications, mortality, or revision at 180 days. This information can help guide surgeons in discussion with and management of patients who develop stiffness following primary TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 464-468"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408094","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":"Regional compared to general anesthesia for total shoulder arthroplasty","authors":"Nikhil Vallabhaneni BA,&nbsp;Lawrence C. Vanderham MS, PA-C,&nbsp;Skye Jacobson BS,&nbsp;Jacqueline G. Tobin MS,&nbsp;Alexander S. Guareschi BS,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.01.013","DOIUrl":"10.1053/j.sart.2024.01.013","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty (TSA) is a common procedure for numerous shoulder pathologies, including glenohumeral arthritis, rotator cuff tears, and proximal humerus fractures. Prior literature has shown that patients undergoing total hip and knee arthroplasty under regional anesthesia (RA) are at significantly lower risk of postoperative complications and reoperation compared to general anesthesia (GA). The purpose of this study is to compare GA vs. RA in patients undergoing primary elective TSA.</p></div><div><h3>Methods</h3><p>The National Surgical Quality Improvement Program database was queried from 2010 to 2019 to identify all patients who underwent primary elective TSA with the use of GA (n = 24,563) or RA (n = 475). After matching based on age, sex, and the American Society of Anesthesiologists classification score, 475 matched pairs of patients undergoing TSA using GA or RA were compared. Relevant demographic characteristics and postoperative complication, readmission, and reoperation rates within 30 days of surgery were compared between groups. Operative time and total hospital length of stay (LOS) were also compared. Chi-squared tests were used to compare categorical variables. Continuous variables were compared using independent sample <em>t</em>-test and one-way ANOVA for binomial and multinomial groups, respectively.</p></div><div><h3>Results</h3><p>RA patients exhibited significantly higher rates of readmission (<em>P</em> &lt; .001) and reoperation (<em>P</em> = .034) compared to GA patients. GA patients showed higher operative times than RA patients when comparing the two cohorts and stratifying patients by body mass index. GA patients also exhibited significantly increased LOS (<em>P</em>=&lt;.001) compared to RA patients. Except for increased readmission and reoperation rates, there was no significant difference in the remaining medical complication rates between the groups.</p></div><div><h3>Conclusion</h3><p>RA patients were found to have higher rates of readmission and reoperation within 30 days of surgery compared to GA patients. GA was associated with longer operative times compared to RA across various body mass index groups. GA was associated with longer LOS compared to RA. However, for all perioperative and short-term postoperative medical complications, patients undergoing TSA under RA had similar rates to GA patients. These findings can be used to guide clinical decision-making when selecting the appropriate anesthetic strategy for patients requiring elective primary TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 451-456"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140089406","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 fixation strategies: cemented, metal-backed, and hybrid","authors":"Nikhil Adapa MD,&nbsp;Andrew J. Rosso BS,&nbsp;Salvatore M. Cavallaro MD,&nbsp;Kevin J. Setter MD","doi":"10.1053/j.sart.2023.07.001","DOIUrl":"10.1053/j.sart.2023.07.001","url":null,"abstract":"<div><h3>Background</h3><p>Glenoid loosening and wear remain one of the most common complications after total shoulder arthroplasty. In this article, we will review all polyethylene glenoids, metalbacked glenoids, inlay glenoids, and hybrid constructs.</p></div><div><h3>Methods</h3><p>We hope to synthesize existing literature to understand strategies that can contribute to a more durable and longer lasting implant.</p></div><div><h3>Results</h3><p>Although all polyethylene glenoids remain the gold standard, recent literature hints at the potential benefits of metal-backed, inset and hybrid glenoids.</p></div><div><h3>Conclusion</h3><p>As the number of total shoulder arthroplasties that are being done annually continues to rise, renewed interest into glenoid fixation strategies is paramount to help improve patient satisfaction, implant durability, and combat rising healthcare expenditure.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 1","pages":"Pages 266-274"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452723001104/pdfft?md5=01d5b8b67d195a1e09a2e6963aba5d05&pid=1-s2.0-S1045452723001104-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113977431","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":"Early radiographic and clinical outcomes of primary short stem anatomic total shoulder arthroplasty with a peripherally enhanced fixation glenoid: a multicenter study","authors":"Vahid Entezari MD, MMSc ,&nbsp;Jason C. Ho MD ,&nbsp;Sambit Sahoo MD, PhD ,&nbsp;Michael Del Core MD ,&nbsp;Dylan Cannon BS ,&nbsp;Gagan Grewal BS ,&nbsp;Tammy M. Owings DEng ,&nbsp;Jinjin Ma PhD ,&nbsp;Catherine Shemo BS ,&nbsp;Andrew Baker MS ,&nbsp;Bong Jae Jun PhD ,&nbsp;Yuxuan Jin MS ,&nbsp;Peter B. Imrey PhD ,&nbsp;Joseph P. Iannotti MD, PhD ,&nbsp;Eric T. Ricchetti MD ,&nbsp;Kathleen Derwin PhD ,&nbsp;Jonathan Levy MD","doi":"10.1053/j.sart.2024.01.007","DOIUrl":"10.1053/j.sart.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>Glenoid component loosening remains the most common reason for revision of anatomic total shoulder arthroplasty (aTSA). We assessed early clinical and radiographic outcomes following aTSA using a press-fit short stem and a peripherally enhanced fixation glenoid.</p></div><div><h3>Methods</h3><p>275 consecutive patients with end-stage glenohumeral arthritis and Walch A- or B-type glenoid morphology who underwent primary aTSA in 2017-2018 at two high-volume shoulder arthroplasty institutions were evaluated, and patient-reported outcomes (PROMs) and radiographic findings were studied in those with completed baseline and minimum 2-year follow-up, respectively. Patient demographics, glenoid morphology, body mass index (BMI), Charlson Comorbidity Index (CCI), range of motion, American Shoulder and Elbow Surgeons (ASES) score, and Simple Assessment Numeric Evaluation score were collected. Radiographic analysis of glenoid and humeral components was performed. Multivariable logistic, equal adjacent odds ordinal, and beta regression were respectively used to identify predictors of glenoid radiolucent lines, humeral calcar resorption, and total ASES score.</p></div><div><h3>Results</h3><p>Patients were 43% female, with a mean age of 66, a median BMI of 30, and median follow-up of 28.4 months. ASES and Simple Assessment Numeric Evaluation scores improved by respective medians of 54.4 and 55.0 points, forward elevation by median 35°, and external rotation by median 30° (all <em>P</em> &lt; .001 for preoperative to postoperative change). Postoperative radiographs of 177 cases showed 10 (5.7%) glenoid osteolysis, 51 (28.8%) glenoid radiolucent lines, and 81 (45.8%) calcar resorptions. The follow-up duration (median 40.1 vs. 27.2 months; <em>P</em> &lt; .001), BMI (median 27.5 vs. 30.7; <em>P</em> &lt; .001), and Charlson Comorbidity Index (Q3 0 vs. 1; <em>P</em> = .02) were associated with glenoid osteolysis in bivariate analyses. In multiple logistic regression, surgeon (C vs. A/B) was the only statistically significant predictor of glenoid radiolucent lines [OR 0.27, 95% CI (0.1, 0.8)]. By descending importance, Surgeon C [OR 6.5 (2.0, 20.5)], humeral canal filling ratio [upper vs. lower quartile OR 2.3 (1.3, 4.0)], mediolateral humeral head deviation [upper vs. lower quartile OR 1.9 (1.0, 3.5)], and glenoid osteolysis [OR 13.5 (2.6, 71.6)] significantly predicted greater calcar resorption. Longer follow-up duration marginally statistically significantly predicted lower ASES score [upper vs. lower quartile OR 0.8 (0.6, 1.0)].</p></div><div><h3>Conclusions</h3><p>Following aTSA with a peripherally enhanced fixation glenoid, pain, range of motion, and patient-reported outcomes significantly improved at a minimum of 2 years with only 5.7% glenoid osteolysis despite heterogeneous preoperative glenoid pathologies.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 533-544"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400018X/pdfft?md5=5798049c015a5e8d3b97ebfeb7b800b4&pid=1-s2.0-S104545272400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049863","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}