Seminars in Arthroplasty最新文献

{"title":"Acute bony Bankart and proximal humeral dislocation in an elderly patient treated with distal tibial allograft glenoid augmentation and reverse shoulder arthroplasty: a case report","authors":"Edwin A. Valencia-Ramon MD, Rocio Pasache-Lozano MD, J. Andrew I. Trenholm MD, MSc, FRCS, Ivan Wong MD, FRCSC, MAcM, Dip Sports Med, FAANA","doi":"10.1053/j.sart.2024.01.005","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.005","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 425-429"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000166/pdfft?md5=6e053cec454a7946bcdd7215c4a4dafd&pid=1-s2.0-S1045452724000166-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072693","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":"Does prior ipsilateral steroid injection affect outcomes after shoulder arthroplasty?","authors":"Sarah J. Girshfeld BA ,&nbsp;Gabriel Lama BS ,&nbsp;Brandon Macknofsky BS ,&nbsp;Clyde Fomunung BS, MBA ,&nbsp;Devin John MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Howard Routman MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2024.01.008","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA).</p></div><div><h3>Methods</h3><p>A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (&lt;3 months, 3-12 months, and &gt;12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score.</p></div><div><h3>Results</h3><p>421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; <em>P</em> &lt; .001) and older age (75 vs. 70; <em>P</em> &lt; .001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; <em>P</em> = .025) and abduction (70° vs. 60°; <em>P</em> = .004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (<em>P</em> = .009 and <em>P</em> = .007, respectively), and MCID for American Shoulder and Elbow Surgeons (<em>P</em> = .046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (<em>P</em> = .024). Complication and reoperation rates were comparable between groups.</p></div><div><h3>Conclusion</h3><p>Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 398-405"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072694","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":"Outcomes of anatomic total shoulder arthroplasty revised to reverse shoulder arthroplasty in patients with contained central glenoid bone defects","authors":"Guillermo Marquez MD ,&nbsp;Seth L. Carder MD ,&nbsp;Brennen L. Lucas MD ,&nbsp;Harry A. Morris MD ,&nbsp;Bernard F. Hearon MD","doi":"10.1053/j.sart.2024.01.010","DOIUrl":"10.1053/j.sart.2024.01.010","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study is to present the outcomes of patients with failed total shoulder arthroplasty (TSA) who were treated by conversion to reverse shoulder arthroplasty (RSA).</p></div><div><h3>Methods</h3><p>This retrospective cohort study investigates patients who underwent single-stage revision from TSA to RSA by one of three fellowship-trained orthopedic surgeons between 2012 and 2020. Patients with central bone defects in the glenoid were included, whereas those with uncontained peripheral or combined glenoid defects or with infections requiring a 2-stage revision were excluded. The glenoid baseplate size and use of bone graft augmentation were recorded. A minimum 2-year postsurgical follow-up was required to participate in the outcome evaluations. Primary outcome measures were shoulder pain on the visual analog scale and active shoulder forward flexion and abduction, while secondary outcome measures included patient satisfaction, procedure complications, and reoperations. The Wilcoxon signed rank exact test was used to compare preoperative and postoperative clinical data.</p></div><div><h3>Results</h3><p>Data from 18 shoulders in 16 patients, average age 74 years, were analyzed. The standard 28-mm-sized baseplate with longer and wider central peg was implanted in 12 of 18 reconstructions. Bone graft augmentation of the glenoid was required in 4 of 6 cases when the 25-mm mini baseplate was used. Clinical evaluation of 13 patients (15 shoulders) with an average of 5 (range, 2-10) years after surgery showed statistically significant improvements in median visual analog scale shoulder pain score decreasing from 7 to 0 (<em>P</em> &lt; .001), median active shoulder forward flexion increasing from 90° to 140° (<em>P</em> &lt; .001), and median active shoulder abduction increasing from 60° to 125° (<em>P</em> &lt; .001). In 14 of 15 cases, the patient was satisfied with the outcome. There were minor complications in 2 cases (13%), but there were no major complications or reoperations.</p></div><div><h3>Conclusion</h3><p>In patients with symptomatic TSA from component failure, shoulder instability, or rotator cuff insufficiency, single-stage revision to RSA for those with contained glenoid bone defects is a reliable salvage option to reduce shoulder pain and improve shoulder motion. At a mean 5-year follow-up, we observed 100% implant survival in 15 cases.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 442-450"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400021X/pdfft?md5=78357ed03a441a0b8edb7ceb88d70d05&pid=1-s2.0-S104545272400021X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966397","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":"YouTube content on shoulder arthroplasty is highly viewed but is of poor educational quality","authors":"Javier Ardebol MD, MBA ,&nbsp;Ali Īhsan Kiliç MD ,&nbsp;Simon Hwang MS ,&nbsp;Theresa Pak DO ,&nbsp;Mariano E. Menendez MD ,&nbsp;Patrick J. Denard MD","doi":"10.1053/j.sart.2024.01.009","DOIUrl":"10.1053/j.sart.2024.01.009","url":null,"abstract":"<div><h3>Background</h3><p>YouTube videos on shoulder arthroplasty cover a broad range of topics, from patient testimonials to surgical techniques. Inherent to this platform, there are no quality control measures to monitor this content. The purpose of this study is to evaluate the quality and popularity of videos on shoulder arthroplasty on YouTube, using both previously described scores and a proposed novel shoulder arthroplasty–specific score assessing educational content.</p></div><div><h3>Methods</h3><p>A search was performed using the keywords “shoulder arthroplasty” and “shoulder replacement” on YouTube. Videos were sorted by relevance and the first 50 videos for each keyword were included in a playlist. The videos in the playlist were then sorted by popularity and the first 50 were included for analysis. Videos in a non-English language, duplicate videos, or those lacking audio were excluded. Video source, content, time since upload, duration, like and dislike count, were inputted for analysis. The view ratio and video power index were used to assess for popularity. Quality, reliability and educational content were evaluated with the Global Quality Score (GQS), <em>Journal of the American Medical Association</em> (JAMA), and the novel Shoulder Arthroplasty Video Content (SAVC) score, respectively.</p></div><div><h3>Results</h3><p>The 50 videos had an average of 285,375 views and a mean duration of 10.8 minutes. Video content was comprised of primarily surgical technique (46%) and patient experience (44%), with most of the videos uploaded from university-affiliated physicians (30%), non-affiliated physicians (28%), and medical (i.e., animations from health websites) (26%) sources. Mean GQS (i.e., quality) and JAMA (i.e., reliability) scores for all videos were 3.2 ± 1.2 out of 5 and 2.4 ± 1.4 out of 4, respectively. Median GQS was comparable across sources, content, and procedure type. Although median JAMA scores were similar among procedure and content type, academic and medical sources showed significantly higher scores among video source categories (<em>P</em> = .04). The mean SAVC score was 19.5 ± 10.7 out of 45 possible points. While there was no significant difference in SAVC scores when categorized by procedure type, a significant difference was observed when assessed by source (<em>P</em> = .02) and content (<em>P</em> = .01). Specifically, medical sources had the highest median score for video source and patient experience for content.</p></div><div><h3>Conclusion</h3><p>Shoulder arthroplasty videos on YouTube reach a considerable audience, but the educational content and reliability are low. Understanding this can help caution patients on the limitations of educational content on YouTube.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 436-441"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139967154","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":"Analysis of 516 cases of revision total elbow arthroplasty from the Dutch Arthroplasty Registry: centralization of care is the future","authors":"Ali Al-Hamdani MD ,&nbsp;Arno Macken MD ,&nbsp;Ante Prkic MD, PhD ,&nbsp;Bertram The MD, PhD ,&nbsp;Anneke Spekenbrink-Spooren MSc ,&nbsp;Denise Eygendaal MD, PhD","doi":"10.1053/j.sart.2024.01.006","DOIUrl":"10.1053/j.sart.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>The number of revision total elbow arthroplasty (TEA) remains relatively low. As a result, there are relatively few orthopedic surgeons and a limited number of centers with substantial expertise in revising TEA. This study provides a comprehensive description of the current practice concerning revision TEA in a northern European Country based on the data of the Dutch National Implant Registry.</p></div><div><h3>Methods</h3><p>Data of all revision TEA procedures performed between 2014 and 2022 were extracted from the national registry, including cases where the primary procedure was either not recorded in the registry or was not a TEA. Descriptive statistics were used to report the current practice of revision TEA in the Netherlands.</p></div><div><h3>Results</h3><p>Five hundred sixteen revision TEAs were performed in the Netherlands between 2014 and 2022. Eighty-four elbows required more than one revision during that period. The primary cause for revision was aseptic loosening 51%. The procedures were performed in 35 centers, and 21/35 centers performed 5 or less revision procedures per year. No center performed 20 or more revision procedures per year.</p></div><div><h3>Discussion</h3><p>All types of elbow arthroplasty are associated with a considerable rate of complications, and a direct volume-outcome relationship exists in these surgical procedures. Despite the considerable complication rate, the volume of revision TEA remains low, primarily due to the infrequent occurrence of primary procedures.</p></div><div><h3>Conclusion</h3><p>The study reported that aseptic loosening was the primary reason for revision TEA. We recommend centralizing infrequent surgical procedures such as revision TEA in selected highly specialized centers to increase surgeon and center volumes, aiming to yield more favorable outcomes.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 430-435"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000178/pdfft?md5=21180e25dc0f5fc388eaf08eaa17e3dd&pid=1-s2.0-S1045452724000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966626","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":"2023 Acknowledgment of Reviewers","authors":"","doi":"10.1053/j.sart.2024.01.001","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.001","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 1","pages":"Pages 219-220"},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000026/pdfft?md5=15cb20cb1fa2aa487dbf93719614e7dd&pid=1-s2.0-S1045452724000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139743221","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":"Assessing ChatGPT responses to frequently asked questions regarding total shoulder arthroplasty","authors":"Jeremy M. Adelstein MD,&nbsp;Margaret A. Sinkler MD,&nbsp;Lambert T. Li MD,&nbsp;Raymond Chen MD,&nbsp;Robert J. Gillespie MD,&nbsp;Jacob Calcei MD","doi":"10.1053/j.sart.2024.01.003","DOIUrl":"10.1053/j.sart.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>“Dr. Google” has long been a resource for health information-seeking individuals. With the well-established presence of artificial intelligence in the healthcare world, it is reasonable to imagine that ChatGPT, an artificial intelligence-powered online chatbot, could become the next outlet for seeking medical advice online. Similar to Mika et al, this study aims to analyze the ChatGPT’s ability to answer frequently asked questions (FAQs) regarding total shoulder arthroplasty (TSA).</p></div><div><h3>Methods</h3><p>Ten FAQs regarding TSA were presented to ChatGPT and initial responses were recorded and analyzed against evidence-based literature. Responses were rated as “excellent response requiring no clarification,” “satisfactory response requiring minimal clarification,” “satisfactory response requiring moderate clarification,” or “unsatisfactory response requiring substantial clarification.”</p></div><div><h3>Results</h3><p>Only one response from ChatGPT was rated unsatisfactory and required substantial clarification. While no responses received an excellent rating, the average rating was considered to only require minimal or moderate clarification.</p></div><div><h3>Conclusion</h3><p>ChatGPT was able to provide largely accurate responses to FAQs regarding TSA while appropriately reiterating the importance of always consulting a medical professional. ChatGPT could prove to be another avenue for supplementary medical information regarding TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 416-424"},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139829486","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":"Risk factors for rotator cuff tears and aseptic glenoid loosening after anatomic total shoulder arthroplasty","authors":"Stephen A. Parada MD ,&nbsp;Chris Peach FRCS (Tr & Orth), MD ,&nbsp;Wen Fan MS ,&nbsp;Josie Elwell PhD ,&nbsp;Pierre-Henri Flurin MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Joseph D. Zuckerman MD ,&nbsp;Christopher P. Roche MSE, MBA","doi":"10.1053/j.sart.2024.01.002","DOIUrl":"10.1053/j.sart.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study is to retrospectively analyze all primary anatomic total shoulder arthroplasty (aTSA) patients within a multicenter international database of a single prosthesis to identify risk factors for patients with rotator cuff tear (RCT) and aseptic glenoid loosening.</p></div><div><h3>Methods</h3><p>To investigate the risk factors for RCT and aseptic glenoid loosening, we retrospectively analyzed all aTSA patients with 2-year minimum follow-up from a multicenter international database of a single platform shoulder system, only excluding patients with a history of revision arthroplasty, infections, and humeral fractures. A univariate/multivariate analysis was conducted to compare primary aTSA patients who had report of: 1) a RCT and/or subscapularis failure and 2) aseptic glenoid loosening/cage glenoid dissociations, to identify the differences in (i) intrinsic patient demographics and comorbidities and (ii) implant and operative parameters. Finally, to adapt our statistical analysis for prospective identification of patients most at-risk for RCT and aseptic glenoid loosening, we stratified the dataset by multiple risk factor combinations and calculated the odds ratio (OR) to determine the impact of accumulating risk factors on the incidence rate of each complication.</p></div><div><h3>Results</h3><p>122 aTSA shoulders had a RCT for a rate of 3.2% and 123 aTSA shoulders had aseptic glenoid loosening for a rate of 3.3%. The multivariate analysis identified that aTSA patients with RCT were more likely to have previous shoulder surgery (<em>P</em> &lt; .001) and small size glenoids (<em>P</em> = .002). Additionally, the multivariate analysis identified that aTSA patients with aseptic glenoid loosening were more likely to be younger (≤62 years at the time of surgery, <em>P</em> = .001), have small size glenoids (<em>P</em> = .033) and have a nonhybrid glenoids (<em>P</em> &lt; .001). Stratifying patients with multiple risk factors identified multiple aTSA cohorts with ORs &gt;2 for RCT or aseptic glenoid loosening.</p></div><div><h3>Discussion</h3><p>This analysis of 2699 primary aTSA identified risk factors for the two most common postoperative complications: RCTs and aseptic glenoid loosening. Using these risk factors, we calculated ORs for patient cohorts with multiple risk factors to identify the patients with the greatest risk for each complication. This information is useful to guide the surgeon in their preoperative counseling and potentially mitigate the occurrence of these complications, by indicating patients with these risk-factors for alternative treatment strategies, like rTSA, instead of aTSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 406-415"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139825218","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 that influence blood loss requiring transfusion in total elbow arthroplasty: a retrospective study using ACS-NSQIP database","authors":"Parker K. Chenault BA ,&nbsp;Nicholas J. Peterman BS ,&nbsp;Christopher G. Hendrix MD ,&nbsp;Mark W. Schmitt MD ,&nbsp;Evan P. Sandefur BS ,&nbsp;Darren T. Hackley MS ,&nbsp;Maxwell O. Vest MD ,&nbsp;Cesar J. Bravo MD","doi":"10.1053/j.sart.2024.01.004","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Blood loss requiring transfusion is common in orthopedic surgeries. This study aims to identify modifiable factors associated with higher blood loss requiring transfusion in total elbow arthroplasty (TEA).</p></div><div><h3>Methods</h3><p>Data from the American College of Surgeons National Surgical Quality Improvement Program’s database was analyzed. Patients who underwent primary TEA from 2006 to 2021 were categorized based on blood loss requiring transfusion. Preoperative variables and comorbidities were compared using a multivariate regression to determine odds ratios (ORs).</p></div><div><h3>Results</h3><p>Out of 654 patients, 30 (4.6%) experienced blood loss requiring transfusion following TEA. On multivariate logistic regression, the following variables were significant: low preoperative hematocrit (&lt;36% in females, &lt;41% in males) (OR 18.2, <em>P</em> &lt; .01), inpatient location (OR 15.3, <em>P</em> &lt; .01), elevated preoperative creatinine (&gt;1.3 mg/dL) (OR 5.7, <em>P</em> &lt; .01), active smoking (OR 2.2, <em>P</em> = .01), chronic obstructive pulmonary disease (OR 2.1, <em>P</em> = .02), and low white blood cell count (&lt;4.5 × 10⁹/L) (OR 1.9, <em>P</em> = .03), and body mass index (OR 0.9, <em>P</em> &lt; .01).</p></div><div><h3>Conclusion</h3><p>The overall rate of blood loss requiring transfusion in TEA was 4.6%. Identifying preoperative risk factors is crucial to minimize transfusion risk. Optimizing patient lab values may help reduce transfusion rates. Blood-saving techniques and antifibrinolytic agents like tranexamic acid should be considered for patients at increased risk of transfusion.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 392-397"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072711","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":"Acromion and scapular spine fractures after reverse shoulder arthroplasty: rate of detection by computed tomography","authors":"Daniel F. Schodlbauer MD ,&nbsp;Austin Vegas DO ,&nbsp;Julie Glener MD ,&nbsp;Casey Beleckas MD ,&nbsp;Jonathan C. Levy MD","doi":"10.1053/j.sart.2023.12.010","DOIUrl":"10.1053/j.sart.2023.12.010","url":null,"abstract":"<div><h3>Background</h3><p>Acromion and scapular spine fractures (ASFs) after reverse total shoulder arthroplasty have been reported at a rate of 3.9 percent. Radiographs have been shown to be unreliable at identifying these fractures, with an estimated 20% false negative rate. A computed tomography (CT) scan is typically performed when initial radiographs are inconclusive and clinical suspicion for ASF remains high. However, the accuracy of identifying ASF fractures after reverse shoulder arthroplasty (RSA) with CT has not been studied. The purpose of this paper is to evaluate the ability of CT scans to detect clinically suspected ASF fractures after RSA when initial radiographs are inconclusive.</p></div><div><h3>Methods</h3><p>A retrospective review of our institution’s shoulder and elbow repository identified 111 patients treated with RSA from 2006 to 2022 that subsequently sustained an ASF. Upon clinical suspicion of an ASF, a 4-view radiographic series was obtained. If no fracture was clearly identified, a thin-cut CT was obtained. Additional four-view radiographic series were taken at each subsequent follow-up. Rate of detection by CT scan was defined using the number of cases with positive scans out of the number in which both a CT scan was performed, and a fracture was identified on either CT scan or other additional follow-up imaging.</p></div><div><h3>Results</h3><p>After inconclusive radiographs, a CT was ordered for 61 patients (55%) at a median of 1.3 weeks after the onset of signs/symptoms suspicious for ASF. Fractures were identified in 52 cases (85.2%) at a median of 1.6 weeks after the onset of sign/symptoms. The fracture was not seen on CT in 9 cases at a median of 0.9 week after the onset of sign/symptoms, representing a false negative rate of 14.8%. These fractures were later identified on radiographs at a median of 5.9 weeks following the CT scan. No statistical differences were observed in sensitivity of CT scan between fracture types. Fractures initially missed on CT scan eventually displaced and became nonunions.</p></div><div><h3>Conclusion</h3><p>CT scans can be helpful in identifying and characterizing ASF following RSA, with an overall rate of detection (sensitivity) of 85%. Consideration of alternative advanced imaging may be needed for patients with negative CT scans and a high index of clinical suspicion for ASF.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 377-382"},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140522434","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}