Seminars in Arthroplasty最新文献

{"title":"Is anatomical radial head arthroplasty more effective for acute or for chronic traumatic lesions? A retrospective cohort study","authors":"Giuseppe Bardellini MD ,&nbsp;Biagio Abate MD ,&nbsp;Clelia Rota MD ,&nbsp;Andrea Pautasso MD ,&nbsp;Andrea Celli MD ,&nbsp;Luigi Celli MD","doi":"10.1053/j.sart.2025.05.004","DOIUrl":"10.1053/j.sart.2025.05.004","url":null,"abstract":"<div><h3>Background</h3><div>Radial head arthroplasty (RHA) can achieve favorable outcomes in patients with radial head (RH) and neck fractures. Notably, it has proved effective in treating both acute fractures and traumatic injuries, where delayed treatment can lead to secondary degenerative changes, soft tissue contractures, and altered biomechanics. Yet, the outcomes of RHA performed in these two groups have never been compared. Anatomical RHA is designed to replicate the native RH geometry, providing stable elbow kinematics and correct load distribution. This study compares the clinical and radiographic results of anatomical RHA in patients with acute lesions and chronic post-traumatic conditions.</div></div><div><h3>Methods</h3><div>We reviewed the data of 52 consecutive patients who were managed by anatomical RHA (Anatomical Radial Head; Acumed, Hillsboro, OR, USA) for acute RH fracture or chronic sequelae of traumatic injury at our institution. Assessments included range of motion and stability using the Mayo Elbow Performance Score, Quick Disabilities of the Arm, Shoulder, and Hand score, Visual Analog Scale score, and overall patient satisfaction. Radiographs were analyzed for signs of loosening, periarticular ossification, and degenerative changes of the ulnohumeral joint and capitellum.</div></div><div><h3>Results</h3><div>At a mean follow-up of 70 months, 23 (44%) patients had achieved excellent outcomes with a Mayo Elbow Performance Score greater than 90 points and a mean Quick Disabilities of the Arm, Shoulder, and Hand score of 7 (range, 0-18.2). The mean range of motion was 111° in flexion–extension (range, 70°-140°) and 144° in pronation–supination (range, 100°-160°). There were 13 (25%) complications requiring secondary surgery in the first 29 months. The implant revision rate was 7.7%. At the last follow-up, 42/52 patients (81%) were satisfied with their outcome. The clinical and radiological outcomes between the groups were not significantly different.</div></div><div><h3>Conclusion</h3><div>The anatomical RH system is a viable option for acute and chronic trauma patients. Despite these encouraging results, prospective studies with larger sample sizes are required to validate them.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 573-584"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685855","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":"Glucagon-like peptide-1 receptor agonist use is not associated with reduced postoperative complications in obese patients after total shoulder arthroplasty","authors":"Mark F. Megerian MD ,&nbsp;Rajiv P. Reddy MD ,&nbsp;Billy I. Kim MD ,&nbsp;Alexander E. White MD ,&nbsp;Miles Miller BS, MPH ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Michael C. Fu MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.05.006","DOIUrl":"10.1053/j.sart.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has increased substantially in the orthopedic patient population, necessitating investigation into their perioperative safety profile. Limited studies have investigated the use of GLP-1 RAs in the setting of total shoulder arthroplasty (TSA). Therefore, the purpose of this study was to evaluate the 90-day and 2-year postoperative outcomes in patients with body mass index &gt;30 kg/m² who received GLP-1 RA medication prior to primary TSA (reverse TSA or anatomic total shoulder arthroplasty [aTSA]) compared to matched controls.</div></div><div><h3>Methods</h3><div>A national administrative claims database was retrospectively reviewed from 2010 to 2022. Obese patients (body mass index &gt;30 kg/m²) with GLP-1 RA use within the 90 days preceding their TSA were identified and compared to a propensity score matched cohort without GLP-1 RA use (1:4 ratio). The database was queried using International Classification of Diseases, ninth and tenth revisions, and Current Procedural Terminology codes to identify the study cohort. Outcomes were compared via univariate analysis and included 90-day postoperative medical and surgical complications, 90-day readmissions, and 2-year surgical complications. <em>P</em> values were adjusted for multiple comparisons using the Bonferroni method.</div></div><div><h3>Results</h3><div>Ninety-day outcomes were obtained for 518 GLP-1 RA users and 2,070 matched nonusers and 2-year outcomes were available for 359 GLP-1 RA users and 1,436 matched nonusers. In the 90-day and 2-year postoperative period, there were no differences in the rates of medical complications, surgical complications, readmissions, or reoperations between GLP-1 RA users and nonusers. GLP-1 RA users experienced a higher rate of acute kidney injury in the 90-day postoperative period (14.1% vs. 3.7%) and a decreased rate of rotator cuff tear (8% vs. 13.6%) at 2 years as compared to nonusers, though these trends were not significant.</div></div><div><h3>Conclusion</h3><div>There was no difference in rate of medical or surgical complications after primary TSA (aTSA and reverse TSA) in obese patients taking GLP-1 RA medication as compared to matched controls. There were nonsignificant trends toward increased acute kidney injury rate at 90 days following TSA and decreased rotator cuff tear rate at 2 years following aTSA in GLP-1 RA users.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 591-598"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685857","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":"Single-stage revision of periprosthetic shoulder arthroplasty infection is more cost effective than two-stage revision: a break-even cost analysis","authors":"Mathangi J. Sridharan MD,&nbsp;Al-Hassan Dajani BS,&nbsp;Andrew R. Jensen MD, MBE","doi":"10.1053/j.sart.2025.04.012","DOIUrl":"10.1053/j.sart.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div><span>Periprosthetic joint infections (PJIs) of the shoulder carry significant financial and functional burdens. No consensus exists on whether a single-stage or two-stage revision surgery protocol is optimal for treatment of shoulder PJI. In this study, we performed a break-even </span>cost analysis to guide clinical decision making between performing single- vs. two-stage revision surgery in treating shoulder PJI.</div></div><div><h3>Methods</h3><div>Institutional cost data were collected for all primary and revision shoulder arthroplasties performed at a single institution from January 2018 to June 2023. A break-even cost analysis equation was used to solve for the reinfection rate at which the cost of a single-stage revision surgery protocol breaks even with the cost of a two-stage revision surgery protocol. Cost variables were derived from institutional data. Rates of complications, both infectious and aseptic, were derived from published studies.</div></div><div><h3>Results</h3><div>The modified equation demonstrated that a 58% reinfection rate of a single-stage revision protocol would be necessary to financially break-even with a two-stage revision surgery protocol. Rates of complications were varied across published ranges to account for clinical variability and demonstrate the breadth of the equation. These variations again yielded break-even rates between 54% and 62%.</div></div><div><h3>Conclusion</h3><div>The reinfection rate at which a single-stage revision surgery for shoulder PJI breaks even with a two-stage revision is approximately 58%, which far exceeds the reinfection rate seen in clinical practice with single-stage revisions. Thus, strictly from a cost perspective, single-stage revision arthroplasty for PJI after shoulder arthroplasty is more cost-effective than a two-stage revision.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 547-552"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685860","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":"Comparison of internal rotation strength after reverse total shoulder arthroplasty without subscapularis repair: lateralized vs. medialized prosthesis design","authors":"Chang Hee Baek MD,&nbsp;Chaemoon Lim MD,&nbsp;Jung Gon Kim MD,&nbsp;Bo Taek Kim MD,&nbsp;Seung Jin Kim MS","doi":"10.1053/j.sart.2025.06.006","DOIUrl":"10.1053/j.sart.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is an effective treatment option for rotator cuff tear arthropathy. It was reported that lateralized rTSA showed no significant difference whether subscapularis (SSC) was repaired or not. On the other hand, SSC repair has been associated with a lower rate of dislocation and improved internal rotation (IR) in medialized rTSA. To date, no study has directly compared lateralized and medialized rTSA without SSC repair, aiming to clarify the specific effect of lateralized rTSA in this context. The purpose of this retrospective clinical comparative study is to compare the clinical outcomes focused on IR strength between medialized and lateralized rTSA without SSC repair.</div></div><div><h3>Methods</h3><div>This study included patients who underwent rTSA between January 2014 and December 2016, in whom SSC repair was not performed. Among them, patients who received medialized rTSA prosthesis were classified into medialized rTSA group, while those who received lateralized rTSA prosthesis were classified into lateralized rTSA group. Clinical outcomes were assessed using pain scores, patient-reported outcome measures (PROMs), active range of motion, active range of motion strength, and toileting ability. Radiologic outcomes were evaluated as the presence of acromial stress fractures, scapular notching, and loosening of the implanted components on plain radiographs. For comparison of mid-term outcomes, clinical and radiologic outcomes between the two groups were compared at 5 years postoperatively.</div></div><div><h3>Results</h3><div>Fifty-six patients of medialized rTSA group and 58 patients of lateralized rTSA group were included for study population. The clinical results were significantly improved in both groups. There was no significant difference in visual analog scale score and patient-reported outcome measures. Although both groups showed significant improvements in rage of motion, the lateralized rTSA group had significantly better mean postoperative IR at the back (6.8 ± 1.8 vs. 5.7 ± 1.7, <em>P</em> = .001). Although there was no significant difference in the ability to perform toileting activities between the two groups, 69.6% of medialized rTSA group and 69.0% of lateralized rTSA group had a difficulty. Moreover, there was no significant improvement of external rotation strength and IR strength in both groups.</div></div><div><h3>Conclusion</h3><div>Both medialized and lateralized rTSA without SSC repair had no improvement of IR strength, and showed significant difficulty in IR related toileting activities. As a result, lateralized rTSA prosthesis had no advantage in IR strength and IR-related toileting activities in case of SSC nonrepair.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 645-653"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685813","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":"Rate of improvement following reverse shoulder arthroplasty: a comparison of primary and revision reverse shoulder arthroplasty","authors":"Ali A. Mohamed BS, MS ,&nbsp;Devin Q. John MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Aghdas Movassaghi BS ,&nbsp;Diego J.L. Lima MD ,&nbsp;Howard Routman DO ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2025.07.001","DOIUrl":"10.1053/j.sart.2025.07.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;As the incidence of reverse shoulder arthroplasty (rTSA) increases, so do the expected revision rates. Despite this, little is known about postoperative recovery rates following revision rTSA. This study aimed to determine the rate of improvement for patients who underwent revision rTSA compared to patients who underwent primary rTSA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective review of 476 patients who underwent rTSA by a single fellowship-trained shoulder surgeon was conducted. In this cohort, 386 patients underwent primary rTSA and 90 patients underwent revision rTSA. Demographics, range of motion, and outcome scores—including the Simple Shoulder Test, Constant–Murray Score, University of California at Los Angeles Shoulder Score, Shoulder Pain and Disability Index (SPADI), Shoulder Arthroplasty Smart score, and American Shoulder and Elbow Surgeons scores—were collected preoperatively and postoperatively for both cohorts. Outcome scores were collected at 6 weeks, 3 months, 6 months, 12 months, and 24 months. The rate of improvement in each outcome measure was quantified and compared between primary rTSA and revision rTSA, and final follow-up scores were compared between the two groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 476 patients (primary rTSA = 386 patients, revision rTSA = 90 patients) were included in the final analysis. Preoperatively, no baseline differences were observed in patient-reported outcome measures or functional scores between the revision and primary rTSA groups. Postoperatively, both groups demonstrated improvements in outcome scores from their preoperative assessments. When postoperative outcomes were evaluated over time, revision rTSA patients showed lower scores than the primary rTSA cohort as early as 3 months in SPADI (46.6 vs. 58.6; &lt;em&gt;P&lt;/em&gt; = .03) and 6 months for forward elevation (126.3 vs. 141; &lt;em&gt;P&lt;/em&gt; = .04). Between 12 and 24 months, analysis revealed no significant changes in improvement trends for both revision rTSA and primary rTSA groups (&lt;em&gt;P&lt;/em&gt; &gt; .05), indicating that recovery stabilizes after the first year. However, postoperative outcomes collected at final follow-up visit demonstrated that the revision rTSA cohort achieved less favorable results compared to the primary rTSA group. Specifically, the revision rTSA group did not achieve the same level of improvement in Simple Shoulder Test (6.8 vs. 9.2, d = 0.67, &lt;em&gt;P&lt;/em&gt; &lt; .01), University of California at Los Angeles (25.2 vs. 29.8, d = 0.60, &lt;em&gt;P&lt;/em&gt; &lt; .01), American Shoulder and Elbow Surgeons (62.6 vs. 77, d = 0.61, &lt;em&gt;P&lt;/em&gt; = .01), SPADI (50 vs. 30.8, d = 0.60, &lt;em&gt;P&lt;/em&gt; = .01), and Shoulder Arthroplasty Smart (63.2 vs. 71.8, d = 0.53, &lt;em&gt;P&lt;/em&gt; = .02) as observed in the primary rTSA cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Although revision rTSA shows an early recovery pace comparable to primary rTSA, it plateaus at lower absolute patient-reported outcome measure and ","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 662-668"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685807","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":"Does social deprivation status affect the complication profile among patients undergoing total shoulder arthroplasty? A matched cohort analysis","authors":"Akhil Katakam MD ,&nbsp;Tej Joshi MD ,&nbsp;Tuckerman Jones MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Amanda Azer MD ,&nbsp;Sefy A. Paulose MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1053/j.sart.2025.06.004","DOIUrl":"10.1053/j.sart.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Employment, living status, and income level are a few examples of social determinants of health (SDoH). Patients determined to be suffering in any of these SDoH have been previously identified as being socially deprived, which has been associated with numerous poor outcomes following total shoulder arthroplasty (TSA). This study aimed to further clarify the relationship between SDoH and medical and operative outcomes following TSA. We hypothesized that patients classified as being socially deprived would suffer higher medical and orthopedic complications compared to patients without a history of social deprivation.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Research Network database to identify patients with a history of social deprivation who underwent TSA. These patients were propensity score–matched to TSA patients without this exposure using several demographic and comorbidity-related variables. Outcomes assessed included multiple surgery-related, implant-related, and medical-related complications. Kaplan–Meier survival analysis and chi-square testing were used to evaluate outcomes, with results reported as hazard ratios (HRs), 95% confidence intervals, and <em>P</em> values, with significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 2,808 propensity-matched patients (1,404 in each cohort) were analyzed. Within 30 days of surgery, hospital readmissions (HR 1.74, <em>P</em> &lt; .001) and emergency department (ED) visits (HR 1.83, <em>P</em> &lt; .001) were higher in the social deprivation group. Rates of acute kidney injury (AKI) (HR 2.115, <em>P</em> = .004) and urinary tract infections (UTIs) (HR 2.70, <em>P</em> &lt; .001) were also higher within 30 days in the social deprivation group. Dislocation rate was also higher in socially deprived group at 30 days (HR 11.09, <em>P</em> = .004). Readmissions, ED visits, AKI, and UTI rates were also higher at 90 days in this cohort. There was no association with higher adverse postoperative outcomes at 1 year, 2 year, and any time in the socially deprived group.</div></div><div><h3>Conclusion</h3><div>Patients who were classified as socially deprived were associated with more readmissions, ED visits, a higher dislocation rate, and medical complications, including UTI and AKI especially in the short-term postoperative period compared to those who were not classified in this category. This study indicates a link between SDoH and patient postoperative outcomes in the setting of TSA, underscoring the need for surgeon awareness regarding these factors when treating patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 628-635"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative glucagon-like peptide-1 receptor agonist use is not associated with increased complications in obese patients undergoing total shoulder arthroplasty: a propensity-matched large database study","authors":"Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Rajiv P. Reddy MD ,&nbsp;Mark Megerian MD ,&nbsp;Alexander E. White MD ,&nbsp;Miles Miller BS, MPH ,&nbsp;John M. Apostolakos MD, MPH ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.06.001","DOIUrl":"10.1053/j.sart.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Obesity significantly impacts outcomes in shoulder arthroplasty, leading to higher complication rates. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for weight loss and glycemic control, but their perioperative safety in shoulder arthroplasty remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used the TriNetX Network to analyze obese patients (body mass index [BMI] &gt;30 kg/m²) undergoing anatomic or reverse shoulder arthroplasty across 67 health care organizations. Patients were categorized by preoperative GLP-1 RA use and matched 1:1 using propensity scores to balance the cohorts based on demographic variables and comorbid conditions such as age, race, ethnicity, BMI, diabetes, and hypertension. Outcomes assessed at 90 days and 1 year included revision surgery, emergency department visits, readmission, deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury, prosthetic joint stiffness, postoperative rotator cuff tear, mechanical complications, periprosthetic fracture, prosthetic joint infection, surgical site infection, airway aspiration, cardiac arrest, transfusion, and prosthetic joint dislocation.</div></div><div><h3>Results</h3><div>After matching, there were no statistically significant differences between GLP-1 RA users (n = 2,132) and controls at both time points of comparison. Rates of DVT, PE, revision surgery, prosthetic joint stiffness, readmission, emergency department utilization, airway aspiration, and other complications were comparable between groups.</div></div><div><h3>Conclusion</h3><div>Perioperative GLP-1 RA use prior to primary shoulder arthroplasty in obese patients (BMI &gt;30 kg/m²) was not associated with increased risk of DVT, PE, airway aspiration, or other postoperative complications at 90-day or 1-year follow-up. These findings support the perioperative safety of GLP-1 RAs in obese patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 604-611"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685931","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":"Effects of psychiatric comorbidity on perioperative outcomes in primary total elbow arthroplasty","authors":"Lawrence C. Vanderham MS, PA ,&nbsp;Alexander S. Guareschi MD ,&nbsp;John W. Moore BS ,&nbsp;Richard J. Friedman MD, FRCSC ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Josef K. Eichinger MD","doi":"10.1053/j.sart.2025.01.010","DOIUrl":"10.1053/j.sart.2025.01.010","url":null,"abstract":"<div><h3>Background</h3><div>Current literature consistently demonstrates the negative impact of mental health disorder (MHD) on orthopedic perioperative outcomes in arthroplasty of the hip, knee, and shoulder. To date, minimal literature exists investigating the effects of MHD on total elbow arthroplasty (TEA) outcomes. The purpose of this study is to evaluate the influence of MHD on perioperative complications, revision, and readmission rates, length of stay, and disposition in patients undergoing primary TEA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried and 5742 subjects undergoing primary TEA were identified, between 2015 and 2020. Two cohorts, with and without MHD were formed. Significant variables and outcomes were identified using bivariate analysis. Variables identified as significant were placed in multivariate analysis to identify independent predictors. Continuous variables between the two cohorts were analyzed with linear regression.</div></div><div><h3>Results</h3><div>Patients with a MHD were found to have higher rates of several medical and surgical complications including respiratory complications (0.6% vs. 0.1%; odds ratio [OR] 4.4 [95% confidence interval (CI) 1.6, 12], <em>P</em> = .002, wound dehiscence (0.8% vs. 0.1%; OR 11 [95% CI 3.0, 37], <em>P</em> &lt; .001), and prosthetic loosening (11% vs. 6.4%; OR 1.7 [95% CI 1.4, 2.1], <em>P</em> &lt; .001). A multivariate analysis identified MHD as an independent predictor of readmission (OR 1.3 [95% CI 1.2-1.5], <em>P</em> &lt; .001) and revision (OR 1.3 [95% CI 1.1-1.6], <em>P</em> &lt; .001) within 180 days of TEA.</div></div><div><h3>Conclusion</h3><div>Patients with a pre-existing MHD undergoing primary TEA are at increased risk for perioperative comorbidity. Careful consideration for surgery and potential risk mitigation should be considered in this at-risk population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 327-335"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of glenoid baseplate peripheral screw number on micromotion in reverse total shoulder arthroplasty","authors":"Elise J. Martin PhD ,&nbsp;Alexander J. MacFarlane MD ,&nbsp;Thomas R. Duquin MD ,&nbsp;Mark T. Ehrensberger PhD","doi":"10.1053/j.sart.2025.02.004","DOIUrl":"10.1053/j.sart.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid baseplate loosening continues to be a challenge when assessing failure of reverse total shoulder arthroplasty (RSA). The baseplate is commonly attached to the glenoid bone surface using a series of screws. This study looks to examine the impact of the number of peripheral screws (0-, 2-, or 4-screws) on the initial fixation of an RSA glenoid baseplate. The possibility of retaining fewer screws could allow for the preservation of the already limited bone stock available in the glenoid.</div></div><div><h3>Methods</h3><div>Three constructs, with 10 samples each, were prepared with differing numbers of locking peripheral screws: 4-screw (2 superior/inferior, 2 anterior/posterior), 2-screw (2 superior/inferior), or 0-screw. In addition, all samples were fixed with a central screw that is placed within the central boss of the implant. Then each baseplate was implanted within 15 pounds/cubic foot rigid polyurethane foam and embedded within polymethylmethacrylate. An initial and final displacement test were conducted by statically applying a shear load (350N) and compressive load (430N) and measuring baseplate displacements via linear variable differential transformers. In-between these two static measurements each sample was cycled through an arc of abduction (+30° to −15°) at ¼ Hz for 10,000 cycles while maintain a normal load of 750N. The displacement of the baseplate was also measured real-time during the cycling phase using three-dimensional digital image correlation.</div></div><div><h3>Results</h3><div>The results from the initial and final static testing indicated varying statistical significance between the different constructs, but the measurements taken during active cycling were able to indicate that the 0-screw construct was significantly less stable than the 2- or 4-screw constructs in terms of both shear (initial: 68.86 ± 23.77μm, 29.40 ± 8.34μm, 22.71 ± 11.23μm); (final:116.72 ± 73.20μm, 64.54 ± 8.36μm, 53.11 ± 33.86μm) and compressive displacements (initial: 65.81 ± 17.81μm, 12.57 ± 5.25μm, 30.60 ± 28.85); (final: 204.22 ± 126.22μm, 37.24 ± 14.58μm, 70.11 ± 59.39μm).</div></div><div><h3>Discussion</h3><div>Differences were found in baseplate stability when comparing a 4- and 2- screw construct to a 0-screw construct. In addition, the results indicate that taking measurements real-time during cyclic loading tends to allow for more accurate and consistent measurement of baseplate displacement in this type of biomechanical testing compared to a simple static initial and final displacement test. This result indicates a promising option for the preservation of glenoid bone stock following RSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 354-361"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766767","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":"Improved patient outcomes and range of motion following primary and revision reverse total shoulder arthroplasty utilizing a custom glenoid implant for glenoid deficiency","authors":"Spencer M. Comfort MD ,&nbsp;Lucas J. Ray MD ,&nbsp;Jonathan D. Harley BA ,&nbsp;Rebekah M. Kleinsmith MD ,&nbsp;Haley D. Puckett MD ,&nbsp;Jonathan P. Braman MD ,&nbsp;Alicia K. Harrison MD ,&nbsp;Allison J. Rao MD","doi":"10.1053/j.sart.2025.03.008","DOIUrl":"10.1053/j.sart.2025.03.008","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid bone loss in the primary and revision setting of reverse total shoulder arthroplasty (rTSA) creates the challenge of sufficient glenoid component positioning and fixation and is at risk of early mechanical failure and aseptic baseplate loosening. The purpose of this study was to evaluate clinical outcomes of primary and revision rTSA utilizing a custom glenoid implant for treatment of glenoid bone deficiency.</div></div><div><h3>Methods</h3><div>Patients who underwent rTSA with a Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) custom glenoid implant in the primary or revision setting performed by 2 orthopedic surgeons between April 2016 and October 2023 were included. Demographic, prior surgical history, preoperative assessment, radiographic parameters, intraoperative procedures, and complication data were collected. Preoperative and postoperative range of motion and Single Assessment Numeric Evaluation (SANE) scores were compared and minimal clinically important difference was calculated for shoulder forward flexion (aFF), shoulder external rotation (aER), and SANE scores.</div></div><div><h3>Results</h3><div>Fifty-two shoulders (50 patients) met the inclusion criteria with 49 shoulders (47 patients) (94%) completing follow-up at mean 15.3 ± 21.0 months (range: 3-91 months). Mean age was 67 ± 13 with 25 females (51%). There were 16 (33%) primary and 33 (67%) revision rTSAs. There was significant improvement from preoperative to postoperative aFF (n = 45, 79 ± 35 to 118 ± 36, <em>P</em> &lt; .001), aER (n = 42, 18 ± 24 to 29 ± 21, <em>P</em> = .02), and SANE score (n = 34, 32 ± 22 to 69 ± 23, <em>P</em> &lt; .001). Minimal clinically important difference was calculated to be 69% for aFF, 67% for aER, and 79% for SANE. Two shoulders (4%) required revision surgery.</div></div><div><h3>Conclusion</h3><div>At mean follow-up of 15.3 months, rTSA with VRS custom glenoid implants for the treatment of glenoid bone deficiency in the primary and revision setting demonstrated improved patient-reported-outcomes and range of motion with low complication rate.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 431-437"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766962","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}