Seminars in Arthroplasty最新文献

{"title":"The role of antibiotic and drug allergies on adverse outcomes after shoulder arthroplasty: a nationwide database analysis of 153,384 patients","authors":"","doi":"10.1053/j.sart.2024.02.003","DOIUrl":"10.1053/j.sart.2024.02.003","url":null,"abstract":"<div><h3>Background</h3><p>The goal of this study is to examine the impact of antibiotic and other drug allergies on the incidence of complications and revisions following shoulder arthroplasty (SA). Our hypothesis posits that patients with antibiotics or other drug allergies will have a higher rate of complications and revision surgeries following SA.</p></div><div><h3>Methods</h3><p>All data collection involved utilizing the PearlDiver national database and Current Procedural Terminology code 23472 to identify individuals who had undergone primary anatomic or reverse SA within the period of 1/1/2010-10/31/2021. The initial population was categorized into three groups: patients with antibiotic allergies, patients with other drug allergies, and patients with no reported drug allergies. The two allergy groups were examined against the nonallergy group to draw comparisons concerning surgical complications, medical complications, and revision surgeries. The evaluation of complications took place at the 30 day and 90 day postoperative time points, while revisions were assessed at the 30 day, 1 year, 3 year, 5 year, and 10 year postoperative time points.</p></div><div><h3>Results</h3><p>This database study identified 153,384 patients (10,106 with antibiotic allergies, 16,982 with other drug allergies, and 126,296 with no allergies) who had received SA. Compared to patients without allergies, patients in both allergy cohorts were more likely to require revision surgery across all analyzed time points (<em>P</em> &lt; .001). Patients with antibiotic allergies experienced higher rates of surgical site infections (SSI) (30 days: 1.0% vs. 0.8%, odds ratio 1.25 [95% confidence interval 1.02-1.53], <em>P</em> = .04; 90 days: 1.3% vs. 1.1%, 1.26 [1.06-1.51], <em>P</em> = .011) and prosthetic joint infections (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.27], <em>P</em> &lt; .001; 90 days: 0.9% vs. 0.3%, 2.60 [2.06-3.27], <em>P</em> &lt; .001) at both time points. Patients with allergies to other drugs were more likely to develop prosthetic joint infection (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.21], <em>P</em> &lt; .001; 90 days: 0.8% vs. 0.3%, 2.51 [2.08-3.04], <em>P</em> &lt; .001), but there was no statistical difference in SSI rates compared to patients without allergies (30 days: 0.9% vs. 0.8%, 1.10 [0.93-1.31], <em>P</em> = .279; 90 days: 1.2% vs. 1.1%, 1.16 [1.00-1.34], <em>P</em> = .055).</p></div><div><h3>Discussion</h3><p>Patients with antibiotic and other drug allergies demonstrated a higher likelihood of requiring revision surgery after undergoing SA. Patients with antibiotic allergies displayed an increased susceptibility to all complications analyzed apart from bleeding, while patients with other drug allergies displayed an increased susceptibility to all complications except for SSIs.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 545-551"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000312/pdfft?md5=e50e8b9b7ec5bb3d434c3aa4a89163bf&pid=1-s2.0-S1045452724000312-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic and reverse total shoulder arthroplasty: variables affecting 90-day overall reimbursement","authors":"","doi":"10.1053/j.sart.2024.02.007","DOIUrl":"10.1053/j.sart.2024.02.007","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty<span> (TSA) is a common orthopedic procedure that can be performed as an anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty<span> (rTSA). These are effective procedures that are being performed with increasing frequency. Understanding the overall 90-day reimbursement variability and their drivers may help the health care systems better understand related considerations to reduce health-care expenditure. The current study predicts there will be large variability in reimbursement highlighting the need for further understanding.</span></span></p></div><div><h3>Methods</h3><p>Using the 2015-2021 Q1 M151 PearlDiver dataset, patients who underwent aTSA or rTSA were isolated. Patients were excluded if they were aged less than 18 years, had an indication of traumatic, infectious, or oncologic diagnoses within 90-days of surgery, or were not in the dataset for at least 90 days before and after surgery. Patient demographics, comorbidities, 90-day postoperative events, insurance type, and geographic region were abstracted. The overall 90-day reimbursements were then assessed and correlated with these variables having multivariable linear regression.</p></div><div><h3>Results</h3><p><span>A total of 112,188 TSA patients (aTSA: 36,164 [32.2%]; rTSA: 76,024 [67.8%]) were identified. The average ± standard deviation 90-day overall postoperative reimbursement for aTSA was $6714.26 ± 9587.46 and rTSA was $6246.45 ± 9506.59. The total reimbursement for aTSA was $242,814,515 and for rTSA was $474,836,301. Variables independently associated with greater 90-day overall reimbursement were mostly related to 90-day postoperative events, including hospital readmission [+$6694.51], emergency department visit [+$2129.89], and adverse events [+$2055.84]), geographic region of the country where the procedure was performed (relative to West, South [+$4302.88], Midwest [+$3428.84], and Northeast [+$530.92]), and insurance plan (relative to commercial, Medicare [-$1268.01], and Medicaid [-$901.79]) (</span><em>P</em> &lt; .0001 for each). Lesser factors included male sex (relative to female +$207.30), Elixhauser-Comorbidity Index (+$51.93 per point increase), age (-$77.16 per year increase), and rTSA surgery type (relative to aTSA -$556.17).</p></div><div><h3>Discussion and conclusion</h3><p>The current study leveraged a large, administrative database to evaluate over 100,000 TSA patients and found large variations in 90-day overall reimbursements. The variables mostly associated with increased reimbursement were related to 90-day postoperative events (as might be expected and underscoring the need to minimize such events) and geographic regions and insurance plan (highlighting differences that might be able to be addressed). Interestingly, while patient demographics, comorbidities, and anatomic vs. reverse total shoulder were associated with reimbursements, these were to lesser extents. Unde","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 564-570"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total shoulder arthroplasty in patients with a history of cerebrovascular accident: a matched case–control study","authors":"","doi":"10.1053/j.sart.2024.02.008","DOIUrl":"10.1053/j.sart.2024.02.008","url":null,"abstract":"<div><h3>Background</h3><p><span>With increasing survivorship following cerebrovascular accidents (CVAs), more patients with a history of CVA are undergoing </span>total shoulder arthroplasty (TSA). The purpose of this study is to determine the impact of prior CVA on the perioperative outcomes following TSA.</p></div><div><h3>Methods</h3><p>The Nationwide Readmissions Database was queried from 2010 to 2019 to identify all patients with a history of CVA undergoing TSA. Eight hundred seventeen cases were identified and case matched on a 1:2 ratio for age, sex, obesity status, and year of procedure. Patient demographic characteristics were collected and analyzed for differences between the 2 groups. Data on length of stay, 180-day complications, 180-day readmissions, and 180-day mortality were collected and analyzed for differences between the 2 groups.</p></div><div><h3>Results</h3><p>Eight hundred seventeen cases of patients with a history of CVA were matched with 1634 patients without a history of CVA undergoing TSA. The average age was 71. Fifty six percent of patients were female, and 23% of patients were obese. Patients with CVA had higher incidence of tobacco use (<em>P</em><span> &lt; .001), deficiency anemia (</span><em>P</em><span> &lt; .001), electrolyte disorders (</span><em>P</em> &lt; .001), paralysis (<em>P</em><span> &lt; .001), coagulopathy (</span><em>P</em><span> &lt; .001), heart valve disorders (</span><em>P</em> &lt; .001), history of myocardial infarction (<em>P</em> &lt; .001), and higher rates of chronic diseases, such as hypertension (<em>P</em> &lt; .001), diabetes (<em>P</em> &lt; .001), liver disease (<em>P</em><span> &lt; .001), congestive heart failure (</span><em>P</em> &lt; .001), renal failure (<em>P</em><span> &lt; .001), and peripheral vascular disease (</span><em>P</em> &lt; .001). Patients with a history of CVA had higher rates of complications, readmissions, and revisions within 180 days (<em>P</em> &lt; .001). One hundred eighty–day mortality was similar between the 2 groups. The average length of stay was 3.2 days in patients with a history of CVA compared to 1.4 days in those without a history of CVA (<em>P</em> &lt; .001).</p></div><div><h3>Conclusion</h3><p>Patients with a history of CVA have a higher rate of medical comorbidities than those without. These patients have higher rates of complications within 180 days of procedure, 180-day readmissions, and 180-day revisions. One hundred eighty–day mortality was similar between the 2 groups. Surgeons should take care to ensure thorough preoperative optimization and risk discussions to try and minimize postoperative adverse outcomes.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 558-563"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early to short-term radiographic follow-up of metal-augmented baseplates in reverse shoulder arthroplasty for treatment of glenoid deformity in glenohumeral arthritis and rotator cuff arthropathy","authors":"Cory D. Smith MD,&nbsp;Bailey Johnson MD,&nbsp;Chelsea Smith BS,&nbsp;David Shukla MD,&nbsp;Russell Petrie MD,&nbsp;Hafiz Kassam MD,&nbsp;Daniel Debottis MD","doi":"10.1053/j.sart.2024.02.004","DOIUrl":"10.1053/j.sart.2024.02.004","url":null,"abstract":"<div><h3>Hypothesis and background</h3><p>As reverse total shoulder arthroplasty (rTSA) has evolved, the use of augmented glenoid baseplates has increased. While there are benefits of metal augmentation, literature concerning the mid- to long-term follow-up of these implants is emerging. The purpose of this study is to report early to short-term radiographic follow-up of patients with glenoid deformity treated with a metal-augmented glenoid baseplate. Our hypothesis is that we will see a low incidence of osteolysis, loosening, complications, and revision of these implants regardless of diagnosis, augment type, or patient demographics.</p></div><div><h3>Methods</h3><p>We performed a single-center retrospective review of all patients undergoing primary reverse shoulder arthroplasty with an augmented metallic baseplate for rotator cuff arthropathy and glenohumeral arthritis. Patients undergoing revision procedures or reverse arthroplasty for fractures were excluded. All patients had a minimum of 1-year radiographic follow-up. Preoperative imaging was reviewed to confirm the diagnosis and glenoid deformity classification. Postoperative radiographs were reviewed for evidence of complications, revisions, osteolysis, baseplate loosening, and failure. Clinical data were reviewed for complications.</p></div><div><h3>Results</h3><p>Primary rTSA with a metal-augmented baseplate (38 full wedge and 22 half wedge augments) was performed on 60 patients who met inclusion criteria (mean age 74 ± 7). The average radiographic follow-up of all patients was 17 months. In our cohort, there was one patient with aseptic loosening of a full wedge implant that was not revised. There were no other complications, revision surgeries, baseplate failures, or acromial stress fractures. Six patients developed scapular notching, and five patients were found to have asymptomatic glenoid osteolysis. Two patients with full wedge implants developed aseptic humeral loosening. Pearson chi-square post hoc analysis found no correlation between augment type, gender, or glenoid deformity classification and radiographic changes such as glenoid or humeral osteolysis, loosening, or scapular notching. We did find a statistically significant correlation (<em>P</em> = .018) between patients with body mass index &gt; 35 and glenoid osteolysis.</p></div><div><h3>Discussion and conclusion</h3><p>Primary rTSA for patients with rotator cuff arthropathy or glenohumeral arthritis with glenoid deformity corrected with metal-augmented glenoid baseplates results in a low complication rate and an acceptable outcome at a minimum 1-year follow-up. Compared to other similar cohorts, our patients did not experience any acromial stress fractures, and only one patient had loosening of the glenoid component that was not ultimately revised. Further studies with longer follow-up will be needed, but early outcomes are promising and support the increase in the use of these implants.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 509-513"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary shoulder arthroplasty in tobacco users: a systematic review of patient-reported outcomes and complications in 338,117 cases","authors":"Matthew R. Bryan BS ,&nbsp;Alex E. White MD ,&nbsp;Alexander H. King BS ,&nbsp;Ryan J. Healy BS ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2024.02.005","DOIUrl":"10.1053/j.sart.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this systematic review was to characterize the association between tobacco use and postoperative outcomes, complications, and revision rates following shoulder arthroplasty through a systematic review of the literature.</p></div><div><h3>Methods</h3><p>The PubMed/MEDLINE and Embase databases were queried for studies published between January 1, 1985, and April 18, 2023, comparing outcomes following both anatomic and reverse total shoulder arthroplasty (TSA) between tobacco users and nontobacco users. Studies with a level of evidence IV or greater were included, while case reports, systematic reviews, basic science studies, and studies including revision arthroplasty were excluded. American Shoulder and Elbow Surgeons scores, simple shoulder test scores, visual analog scale for pain, complications, readmissions, and reoperations were reported.</p></div><div><h3>Results</h3><p>A total of 20 unique studies including 338,117 shoulder arthroplasties (38,225 [11.3%] performed on tobacco users) were included in this review. Patient-reported outcome measures, including American Shoulder and Elbow Surgeons, simple shoulder test, and visual analog scale, were overall superior in nontobacco users compared to tobacco users. Similarly, tobacco users had lower patient acceptable symptomatic state achievement, worse Single Assessment Numeric Evaluation scores (odds ratio 0.647; 95% confidence interval, 0.324-1.293; <em>P</em> = .0221), and worse constant scores (odds ratio, 0.478; 95% confidence interval, 0.251-0.909; <em>P</em> = .027). Tobacco users demonstrated a higher rate of complications in four of the eight included studies. Two included studies found higher rates of readmission in tobacco users (15.3% vs. 13.6%, <em>P</em> = .007 and 7.8% vs. 7.1%, <em>P</em> = .001), though six included studies found no significant difference in readmissions. Nine of 11 studies that included reoperation as a variable found higher rates of reoperation in tobacco users, with three reaching statistical significance (<em>P</em> &lt; .05). Tobacco users experienced higher rates of gastrointestinal complications (0.07% vs. 0.01%, <em>P</em> = .021), acute renal failure (2.5% vs. 1.9%, <em>P</em> = .005), acute respiratory distress (1.3% vs. 0.9%, <em>P</em> = .002), need for ventilator assistance (1.2% vs. 0.7%, <em>P</em> &lt; .001), instability of the prosthesis (<em>P</em> &lt; .001), pneumonia (<em>P</em> &lt; .001), sepsis (<em>P</em> = .001), and myocardial infarction (<em>P</em> &lt; .001). Smokers also demonstrated increased postoperative opioid use (2643 mg oral morphine equivalents) compared to nonsmokers (2121 mg) and former smokers (2015 mg; <em>P</em> = .04).</p></div><div><h3>Conclusion</h3><p>Tobacco use is associated with inferior outcomes after TSA, including lower patient-reported outcome measures, increased complications, and higher reoperation rates. Further high-level, prospective studies with long-term follow-u","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 514-523"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics associated with rerevision of primary inlay and onlay reverse shoulder arthroplasty. Analysis from the Australian Orthopaedic Association National Joint Replacement Registry","authors":"David R.J. Gill MBChB, FRACS, FAOrthA ,&nbsp;Sophia Corfield PhD (Hons) ,&nbsp;Carl Holder MBiostat ,&nbsp;Richard S. Page BMedSci, MBBS, FRACS, FAOrthA","doi":"10.1053/j.sart.2024.02.002","DOIUrl":"10.1053/j.sart.2024.02.002","url":null,"abstract":"<div><h3>Background</h3><p>Two designs of primary reverse total shoulder arthroplasty (rTSA), inlay reverse total shoulder arthroplasty (in-rTSA) and onlay reverse total shoulder arthroplasty (on-rTSA) that had undergone an aseptic revision were compared to determine differences in the rate of rerevision.</p></div><div><h3>Methods</h3><p>In this comparative observational national registry study between January 1, 2012, and December 31, 2021, all rTSA utilizing either a modular inlay or onlay metaphyseal humeral component that had been revised for aseptic reasons formed 2 cohort groups. The cumulative percentage rerevision (2^nd CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for age and sex. A minor category revision involved exchange of parts not fixed to bone whilst major revisions did. The primary and revision diagnoses, surgeon primary volume experience, and revision category were compared. Shoulder Modular Replacement (SMR)/SMR L1 or L2 combination (Lima Corporate, San Daniele del Friuli, Italy) was excluded at subanalysis.</p></div><div><h3>Results</h3><p>The 2^nd CPR at 3 years was 20.4% (95% confidence interval 17.1, 24.1) for in-rTSA (n = 571) and 16.1%(11.6, 22.2) for on-rTSA (n = 249). The risk of rerevision was not different between the 2 cohort groups. Primary diagnosis fracture was associated with an increased risk of rerevision for on-rTSA (entire period on-rTSA HR = 3.16(1.50, 6.68), <em>P</em> = .002), and in-rTSA at subanalysis (entire period on-rTSA HR = 2.91(1.33, 6.33), <em>P</em> = .007). 59.9% of in-rTSA and 24.1% of on-rTSA aseptic revisions were minor. The revision diagnosis, the surgical experience of rTSA and if the revision was major or minor did not change the rate of rerevision. The most common reason for both in-rTSA (50%) and (43.2%) on-rTSA rerevision was instability/dislocation.</p></div><div><h3>Discussion</h3><p>Rerevision rates of in-rTSA and on-rTSA after aseptic revision are high. The primary rather the revision diagnosis changed rerevision rates in contemporary rTSA surgery. Minor revisions did not reduce rerevision rates for in-rTSA or on-rTSA compared to humeral/glenoid revision. Increased surgical experience of primary rTSA did not change the rate of rerevision of in-rTSA or on-rTSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 501-508"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140281023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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}