Seminars in Arthroplasty最新文献

{"title":"Conversion of failed anatomic total shoulder replacement with severe glenoid bone defect to humeral hemiarthroplasty","authors":"Oscar Covarrubias MD ,&nbsp;Brandon Portnoff MD ,&nbsp;Keiko Amano MD ,&nbsp;Vadim Molla MD ,&nbsp;Andrew Green MD","doi":"10.1053/j.sart.2024.10.003","DOIUrl":"10.1053/j.sart.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid component loosening is a common cause of late failure after anatomic total shoulder arthroplasty (aTSA) and revision can be challenging due to glenoid bone loss. Revision to reverse shoulder arthroplasty requiring glenoid bone graft is associated with relatively high failure rates. Revision to humeral hemiarthroplasty (HHA) is an alternative. The purpose of this study was to evaluate the outcomes of revision of failed aTSA, with severe glenoid bone loss and intact rotator cuff to HHA.</div></div><div><h3>Methods</h3><div>This was a retrospective study of 18 patients (12 males) with failed aTSA, intact rotator cuff, and severe glenoid bone loss who were revised to HHA at a mean age of 68.9 ± 9.2 years and 9.0 ± 4.1 years after index aTSA. Mean follow-up was 7.6 ± 5.7 years. Glenoid defects were uncontained in 6 (33%). Glenoid bone grafting was performed in 11 (61%). A larger humeral head was used in 15 (83%) cases. Outcomes were assessed with the Simple Shoulder Test (SST), VAS pain, VAS quality of life (QoL), and shoulder range of motion. Plain radiographs were analyzed.</div></div><div><h3>Results</h3><div>There were significant improvements in SST (<em>P</em> = .005) and VAS pain (<em>P</em> &lt; .001). Mean active forward elevation improved from 106 ± 36° to 120° ± 21° (<em>P</em> = .062). MCID for SST was met in 7 (39%) and VAS pain in 11 (61%). At final follow-up, 11 patients (61%) were satisfied with their current symptoms, 2 (11%) rated their satisfaction as neutral, and 5 (28%) were dissatisfied. There was progressive humeral medialization in 8 that was not significantly associated with the use of glenoid bone grafting (<em>P</em> = .912). Greater humeral medialization was strongly correlated with less improvement in SST (ρ = 0.68) and VAS QoL (ρ = −0.64). Seven patients had ≥ 2 positive intraoperative cultures, all <em>Cutebacterium acnes</em>. Three patients (17%) underwent subsequent revision to treat persistent pain and dysfunction; 1 to HHA, 2 to reverse shoulder arthroplasty.</div></div><div><h3>Conclusion</h3><div>Revision of failed aTSA with severe glenoid bone loss and functional rotator cuff to HHA can provide improved pain and patient reported outcome with low complication and re-revision rates and should be considered in selected cases.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 106-115"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284738","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":"Reconstruction after shoulder resection for tumors: comparison between allograft prosthetic composite and reverse shoulder arthroplasty with cement sleeve","authors":"Lisa Peduzzi MD ,&nbsp;Clement Ferri MD ,&nbsp;Coraline Houpin MD ,&nbsp;Andrea Fernandez MD ,&nbsp;Francois Sirveaux MD, PhD","doi":"10.1053/j.sart.2024.10.004","DOIUrl":"10.1053/j.sart.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus is a common site for primary bone tumors and metastatic disease. Reconstruction with reverse shoulder arthroplasty (RSA) after resection is a surgical challenge and presented a high risk of complication.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study to identify outcomes of 2 types of reconstruction: allograft prosthetic composite (APC) and RSA with cement sleeve. We analyzed demographic characteristics, clinical outcomes at &gt;2 years, complications, further surgery, and death.</div></div><div><h3>Results</h3><div>We included 32 patients, at a mean age of 46 years. Fourteen (44%) were metastatic at the time of diagnosis. Eighteen underwent RSA with cement sleeve reconstruction, and 14 underwent APC. Death, complication, reintervention, and revision were analyzed in the 32 patients. The mean humeral resection length was 11 cm. Twelve patients (37.5%) died, at mean 1.8 years after surgery. Neither having an invaded margin (<em>P</em> = .21), having a pathological fracture at the time of the surgical intervention (<em>P</em> = .88), nor being metastatic at the time of diagnosis (<em>P</em> = .07) was associated with an increased risk of death. The complication rate was 50%, the reintervention rate was 16%, and the revision rate was 16%. There was no difference in complication, reintervention, and revision rate between the APC and the cement sleeve group. Twenty-one patients were available for clinical analysis at &gt; 2-year follow-up (mean 46 months). There was no statistical difference in the total Constant score between the cement sleeve group (mean 54 points) and the APC group (mean 59 points), <em>P</em> = .75. There was no difference for AAE at last follow-up between the 2 groups (99.3 points for the cement sleeve group versus 117 points for the APC group, <em>P</em> = .45).</div></div><div><h3>Conclusion</h3><div>RSA is a suitable option for reconstruction after resection of the proximal humerus. The cement sleeve seems to provide acceptable outcomes without increased risk of complication or further surgery. This option could be considered in metastatic or frail patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 2","pages":"Pages 119-126"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890494","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 impact of GLP-1 receptor agonists on postoperative outcomes following total shoulder arthroplasty","authors":"Ankit Choudhury BA,&nbsp;Matthew Van Boxtel MD,&nbsp;Jessica Hanley MD","doi":"10.1053/j.sart.2024.10.001","DOIUrl":"10.1053/j.sart.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Total Shoulder Arthroplasty (TSA) is a commonly performed orthopedic procedure for shoulder arthritis. Type II Diabetes Mellitus (T2DM) has been associated with negative postoperative outcomes following TSA. Glucagon-like peptide-1 receptor (GLP-1) agonists are increasingly popular drugs that have proven to be effective in the management of T2DM. To date, there is no study evaluating the complication profile following TSA of patients taking GLP-1 agonists.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted on patients from the TriNetX Database who underwent TSA between January 2018 and December 2023. All patients had a diagnosis of T2DM at the time of index procedure. Patients were stratified into two groups according to their GLP-1 agonist prescription status. Medical complications that occurred within 90 days and surgical complications that occurred within 2 years of index procedure were collected. A univariate logistic regression analysis was conducted to examine the initial connection between the active use of GLP-1 agonists and postoperative outcomes. Subsequently, an inverse propensity score-weighted binary logistic regression was used to adjust for potential biases.</div></div><div><h3>Results</h3><div>A total of 8254 patients met our inclusion criteria. The “non-GLP-1” and “GLP-1” groups included 7749 and 505 patients, respectively. The use of GLP-1 agonists did not incur increased risk of any medical or surgical complications following TSA. Our unadjusted analysis demonstrated that the use of GLP-1 agonists was significantly associated with lower odds of mortality within 90 days of surgery (OR 0.17, 95% CI 0.0043-0.99, <em>P</em> = .0435). GLP-1 agonist use was associated with decreased risk of mortality within 90 days when subjected to inverse propensity score-weighted analysis (OR 0.077, 95% CI 0.011-0.554, <em>P</em> = .011). The use of GLP-1 agonists was not a predictor for any other medical or surgical complications in inverse-propensity score weighted-analysis, although decreased risk of wound dehiscence approached significance (OR 0.256, 95% CI 0.061-1.074, <em>P</em> = .063).</div></div><div><h3>Conclusion</h3><div>Preoperative GLP-1 agonist use is associated with reduced 90-day mortality in T2DM patients undergoing TSA, without increasing other postoperative complications. These findings support the continued use of GLP-1 agonists in perioperative management to optimize surgical outcomes in this patient population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 94-99"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284974","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 shoulder prosthetic joint infection throughout the COVID-19 pandemic","authors":"Robert A. Cecere BS,&nbsp;Michelle E. Kew MD,&nbsp;Joshua Mathew BS,&nbsp;Amy Lu BS,&nbsp;Gabrielle L. Dykhouse BS,&nbsp;Anna B. Williams BA,&nbsp;Michael Fu MD,&nbsp;Samuel Taylor MD,&nbsp;Joshua Dines MD,&nbsp;David Dines MD,&nbsp;Lawrence V. Gulotta MD","doi":"10.1053/j.sart.2024.09.004","DOIUrl":"10.1053/j.sart.2024.09.004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;1-2% of patients who undergo anatomic and reverse total shoulder arthroplasty are diagnosed with a prosthetic joint infection (PJI), which requires revision surgery, prolonged recovery and rehabilitation, and antibiotic treatment. During the COVID-19 pandemic, anecdotal evidence suggested an increased rate of PJI among all patient populations. However, there have been no studies characterizing PJI incidence following shoulder arthroplasty during the COVID-19 pandemic. In the present study, we sought to evaluate the incidence of shoulder PJI during the COVID-19 pandemic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients undergoing revision shoulder arthroplasty for PJI at an academic medical center between 2017 and 2021 were identified: patients before COVID-19 (2017-2019) and patients during COVID-19 (2020-2021). Patient demographics, laboratory data, history of COVID-19 infection and vaccination, antibiotic treatment, and final surgical treatment were collected. Patient-reported outcome measures (American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeric Evaluation, surgical Apgar score, Patient-Reported Outcome Measurement Information System (physical function, pain intensity, upper extremity, global 10), and Veterans RAND 12-item Health Survey or Medical Outcomes Study short-form health survey version 2) were collected. PJI incidence was calculated from a retrospective chart review, which identified patients with PJI as defined by the International Consensus Meeting on musculoskeletal infection in 2018 and who underwent revision surgery and antibiotic treatment. Incidence rate analysis and independent t-tests were conducted to compare the mean baseline patient-reported outcome measures. Descriptive analysis of the collected data included means and standard deviations for continuous variables and frequencies and percentages for discrete variables. Statistical significance was set at a &lt;em&gt;P&lt;/em&gt; value &lt; .05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;46 patients were identified with 20 patients undergoing a revision surgery for a PJI during the pre-COVID-19 time interval and 26 during the COVID-19 time interval. 20% underwent single-stage revision (4 pre-COVID-19 and 5 during COVID-19), 50% underwent two-stage revision (10 pre-COVID-19 and 13 during COVID-19), and 30% underwent a debridement, antibiotics, and implant retention procedure (6 pre-COVID-19 and 8 during COVID-19). There was a significant increase in shoulder PJI infections between the pre-COVID-19 time interval and during COVID-19, with PJI incidence rates of 1.1% and 2.1%, respectively (&lt;em&gt;P&lt;/em&gt; = .028). There was no significant difference in any outcome scores, microbes on aspiration, inflammatory markers, or duration of treatment between the two time intervals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;While this study does not show clear evidence to an underlying mechanism explaining the increased PJI incidence observed during the COVID-","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 77-82"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284964","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":"Smokeless tobacco use is associated with a lower risk of perioperative complications and revision surgery after anatomic and reverse total shoulder arthroplasty compared to cigarette smokers","authors":"Alejandro M. Holle BS ,&nbsp;Sailesh V. Tummala MD ,&nbsp;Jelena Pejic BA ,&nbsp;Eugenia Lin MD ,&nbsp;Steven J. Hattrup MD ,&nbsp;John M. Tokish MD","doi":"10.1053/j.sart.2024.09.005","DOIUrl":"10.1053/j.sart.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>No prior study has separated the effects of smokeless tobacco from traditional cigarettes in patients undergoing anatomic total shoulder (aTSA) and reverse total shoulder arthroplasty (rTSA). Therefore, the purpose of this study was to evaluate the effects of smokeless tobacco on postoperative outcomes after aTSA and rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study utilizing a large insurance database was conducted. Patients undergoing primary TSA with a minimum two-year follow-up were included. Smokeless tobacco only users, cigarette only users, and nontobacco users were propensity score matched based on demographic variables and comorbidities. Postoperative medical complications and surgery-specific complications were compared among groups. Patient groups were further stratified by surgical technique: aTSA or rTSA. Multivariable logistic regressions were employed to account for confounding variables.</div></div><div><h3>Results</h3><div>Smokeless tobacco use was not associated with increased risk of complications after TSA compared to nonusers. Cigarette use was associated with an increased risk of pneumonia (OR: 1.20), wound dehiscence (OR: 1.39), emergency department (ED) visits (OR: 1.40), and readmissions (OR: 1.12) within 90 days as well as infection (OR: 1.21), aseptic loosening (OR: 1.28), dislocation (OR: 1.27), fracture (OR: 1.30), and revision surgery (OR: 1.19) within 2 years compared to nonusers. After separating by surgical technique, smokeless tobacco use, after aTSA was associated with fewer 90-day ED visits (OR: 0.52), while cigarette only use was associated with increased risk of rotator cuff tear (OR: 1.17) and fracture (OR: 1.88) within two years compared to nonusers. Compared to cigarette smokers, smokeless tobacco users had significantly decreased risk of ED visits (OR: 0.40) within 90 days and implant removal (OR: 0.13) within two years of surgery. For rTSA, smokeless tobacco use was not associated with increased risk of complications compared to nonuser controls; however, cigarette use was associated with an increased risk of ED utilization (OR: 1.33) within 90 days as well as aseptic loosening (OR: 1.32) and irrigation and debridement (OR: 1.37) within two years. Smokeless tobacco use, when compared to cigarette users, was associated with significantly fewer shoulder dislocations (OR: 0.27) within two years.</div></div><div><h3>Conclusion</h3><div>Smokeless tobacco use was associated with a lower risk of complications compared to cigarette users and no difference compared to nonusers after aTSA and rTSA. These findings suggest that while all tobacco use, including smokeless tobacco and cigarettes, is best avoided prior to surgery, the risks associated with smokeless tobacco use may be less severe than those linked to cigarette smoking after aTSA and rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 83-93"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications after primary and revision shoulder arthroplasty: a matched cohort study","authors":"Joshua I. Mathew BS ,&nbsp;Peter J. Chabot BA ,&nbsp;Michelle E. Kew MD ,&nbsp;Michael C. Fu MD ,&nbsp;Samuel A. Taylor MD ,&nbsp;Joshua S. Dines MD ,&nbsp;David M. Dines MD ,&nbsp;Lawrence V. Gulotta MD","doi":"10.1053/j.sart.2024.09.003","DOIUrl":"10.1053/j.sart.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total shoulder arthroplasty typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>Retrospective chart review was conducted for patients who underwent revision anatomic or reverse shoulder arthroplasty between January 2015 and May 2021 (N = 152). A cohort of patients who underwent primary shoulder arthroplasty in the same period was generated by matching 1:1 for implant type (anatomic/reverse), age, and surgery date. Demographic data, patient-reported outcomes, surgical details, surgical complications, and reoperations were collected for both cohorts (N = 304). Chi-square, t-test, Fisher’s exact test, and Mann-Whitney test were used as appropriate.</div></div><div><h3>Results</h3><div>The revision cohort had a significantly higher rate of surgical complications than the primary cohort (N = 58, 38.2% vs. N = 22, 14.5%; <em>P</em> &lt; .0001). The distribution of complication types differed significantly between the primary and revision cohorts (<em>P</em> = .018). Revision patients reported less improvement in Single-Assessment Numeric Evaluation score from baseline to 2-year follow-up compared to primary patients (postoperative and preoperative scores 33.9 ± 35.9 vs. 52.3 ± 32.5; <em>P</em> = .036). Patients in the primary cohort who underwent a previous shoulder surgery before their shoulder arthroplasty were more likely to experience complications than those who did not (<em>P</em> &lt; .001). The most common surgical complications in the revision cohort were persistent pain (N = 20) and periprosthetic joint infection (N = 10), while the most common complications in the primary cohort were persistent pain (N = 6) and instability (N = 4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision patients (120 ± 68 min) than primary patients (94 ± 31 min; <em>P</em> &lt; .0001). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (<em>P</em> = .043).</div></div><div><h3>Conclusion</h3><div>Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent surgical complications and worse clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 71-76"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284735","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":"Accessing information provided via artificial intelligence regarding reverse and anatomic total shoulder arthroplasty","authors":"Suhasini Gupta BS ,&nbsp;Brett D. Haislup MD ,&nbsp;Alayna K. Vaughan MD ,&nbsp;Ryan A. Hoffman MD ,&nbsp;Anand M. Murthi MD","doi":"10.1053/j.sart.2024.09.001","DOIUrl":"10.1053/j.sart.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to analyze the quality, accuracy, and readability of information provided by an artificial intelligence (AI) interface ChatGPT (OpenAI, San Francisco). We searched ChatGPT for commonly asked questions by patients regarding anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>ChatGPT was used to answer 30 commonly asked questions by patients regarding aTSA and rTSA, inputted as “total shoulder replacement” and “reverse shoulder replacement”. These questions were categorized based on the Rothwell criteria into <em>Fact</em>, <em>Policy</em>, and <em>Value</em>. The answers generated were analyzed for quality, accuracy, and readability using the DISCERN scale, JAMA benchmark criteria, Flesch-Kincaid Reading Ease Score (FRES) and Grade Level (FKGL).</div></div><div><h3>Results</h3><div>For both rTSA and aTSA the DISCERN score for <em>Fact</em> questions was 57, <em>Policy</em> questions was 61, and for <em>Value</em> questions was 58 (all were all considered “good”). The JAMA benchmark criteria was 0, representing the lowest score for <em>Fact</em>, <em>Policy</em>, <em>and Value</em> questions for both rTSA and aTSA questions. The FRES score for the aTSA answers for <em>Fact</em> was 15.15, for <em>Policy</em> was 11.14, and for <em>Value</em> questions was 10.95. The FRES score for rTSA questions for <em>Fact</em> is 48.02, <em>Policy</em> is 12.51, and <em>Value</em> is 17.22. The FKGL for aTSA answer for <em>Fact</em> was 17.48, <em>Policy</em> was 17.72 and <em>Value</em> was 17.96. The FKGL for rTSA questions for <em>Fact</em> are 8.10, <em>Policy</em> is 17.27, and <em>Value</em> is 16.56.</div></div><div><h3>Conclusion</h3><div>Overall, the quality of answers provided by AI open model, ChatGPT was considered “good.” The information provided had lower reliability, and lack of information regarding funding and disclosures. Most of the information generated by ChatGPT was also found to have the readability of “academic level text”, while <em>Fact</em> related information on reverse shoulder arthroplasty was found to have the readability of 9th grade level, which may be too complex for most patients. Overall, these results indicate that ChatGPT can provide correct answers to questions about aTSA and rTSA, although we would caution patients from utilizing this resource due to the lack of citations and complexity of the output that ChatGPT provides. Importantly, all answers provided by AI suggested reaching out to physicians to get more accurate and personalized advise, to factor into the shared decisions making model.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 56-61"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological outcomes of a highly lateralized reverse shoulder arthroplasty in patients with a height of 160 cm or less versus a height of 170 cm or more","authors":"Mohamad K. Moussa MD, MSc,&nbsp;Maria Guillermina Bruchmann MD,&nbsp;Donald Tedah MD,&nbsp;Akil Prabhakar MD,&nbsp;Luis José Maria Suarez-Jimenez MD,&nbsp;Ahmad Nassar MD,&nbsp;Carlos Murillo-Nieto MD,&nbsp;Philippe Valenti MD","doi":"10.1053/j.sart.2024.09.002","DOIUrl":"10.1053/j.sart.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>To evaluates the impact of patient height (less than 160 cm and greater than 170 cm) on outcomes of lateralized reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Method</h3><div>This retrospective case–control study of 31 lateralized rTSA patients, with follow-ups ranging from 12 to 28 months, was divided into 2 groups: 14 short-stature (≤160 cm) and 17 taller (≥170 cm) patients. Preoperative planning utilized e-ORTHO templating software (FH Orthopaedics, Mulhouse, France), ensuring uniform lateralization shoulder angle and distalization shoulder angles across groups. Primary outcomes included range of motion (ROM), while secondary outcomes comprised Constant Score (absolute/ponderate), subjective shoulder value (SSV), and visual analog scale (VAS). Discrepancies in scores between groups were evaluated for clinical relevance against minimal clinically important difference benchmarks. Incidences of scapular notching were also recorded.</div></div><div><h3>Results</h3><div>All the clinical parameters analyzed were improved postoperatively in both groups (<em>P</em> &lt; .05). No significant difference was observed in postoperative ROM, ponderate Constant, and VAS between groups (<em>P</em> &gt; .05) except for forward elevation which was higher in the taller group (142.9 ± 27.6 compared to 163.5 ± 11.1 <em>P</em> = .018). For SSV, the taller group had higher postoperative SSV (<em>P</em> = .037). However, the difference was less than the minimal clinically important difference for SSV (−5.97 [95% confidence interval: −10.17 to 1.76], <em>P</em> = .01) and thus was considered not clinically significant. No scapular notching was detected in either group.</div></div><div><h3>Conclusion</h3><div>When planned positioning angles are respected (lateralization shoulder angle, distalization shoulder angle), the benefits of highly lateralized rTSA are consistent regardless of patient stature. Both groups had comparable results across ROM, ponderate Constant, and VAS except for forward elevation which was higher in the taller group.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 62-70"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284734","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 diagnosis and revision repair of lesser tuberosity osteotomy failure after anatomic total shoulder arthroplasty","authors":"Kevin K. Chen MD,&nbsp;Chuheng Xing BS,&nbsp;James M. Gregory MD","doi":"10.1053/j.sart.2024.08.004","DOIUrl":"10.1053/j.sart.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Lesser tuberosity osteotomy (LTO) in total shoulder arthroplasty (TSA) has a relatively high success rate owing to bone-to-bone healing and modern repair techniques. Failure of the LTO repair has been associated with poorer outcomes, decreased patient satisfaction, and the potential need for revision arthroplasty. Despite this, few studies closely examined outcomes for revision LTO repair in the setting of prior TSA.</div></div><div><h3>Methods</h3><div>A retrospective review of all TSAs performed by a single surgeon from 2016 until 2023 was performed to identify all cases with LTO failure who underwent acute revision LTO repair. Baseline characteristics, postoperative complications including infection, need for revision surgery, and time to revision surgery were collected and reported on all TSA patients. All patients were followed for a minimum of 1 year after their TSA and revision LTO fixation if required. Subgroup analysis was performed on the LTO revision cohort to evaluate for potential risk factors.</div></div><div><h3>Results</h3><div>A total of 166 patients underwent TSA with LTO. Of these, eight patients were diagnosed with an acute LTO failure at a mean of 5.7 weeks after surgery and underwent revision LTO fixation at a mean of 6.3 weeks after surgery. At a mean follow-up of 147.9 weeks (standard deviation: 90.3; range: 52.1-284.9), seven of eight patients (87.5%) demonstrated healing of their LTO and had no complaints, complications, or reoperations at the latest follow-up. One patient developed a periprosthetic infection requiring two-stage revision. No patients in the overall cohort underwent revision shoulder arthroplasty due to subscapularis failure.</div></div><div><h3>Conclusion</h3><div>Early identification of subscapularis failure is important to optimize outcomes of revision fixation. Use of LTO for subscapularis repair is beneficial by allowing early radiographic detection of subscapularis failure. Revision LTO repair can be successful when performed acutely and appears to minimize the need for revision shoulder arthroplasty due to subscapularis failure.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 48-55"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in total shoulder arthroplasty utilization and implant pricing","authors":"Gabrielle Dykhouse BS ,&nbsp;Anthony Finocchiaro BS ,&nbsp;Carl M. Cirino MD ,&nbsp;Ashwin Mahesh BS ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Joshua S. Dines MD ,&nbsp;Michael C. Fu MD, MHS","doi":"10.1053/j.sart.2024.08.003","DOIUrl":"10.1053/j.sart.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is the third most common total joint replacement procedure in the United States, with high rates of success and cost-effectiveness. As indications continue to expand, anatomic TSA (aTSA), reverse shoulder arthroplasty (RSA), and hemiarthroplasty are available procedures for treating patients with varying end-stage shoulder pathologies. While previous studies have documented trends in overall costs and reimbursements in TSA, there is limited information regarding recent trends in implant utilization, pricing, and procedure type. Therefore, this study aimed to analyze trends in implant and technology utilization for TSA in the United States between 2013 and 2022 to inform decision-making and improve clinical best practices.</div></div><div><h3>Methods</h3><div>Utilization trends and average implant prices between 2013 and 2022 were extracted from Orthopedic Network News, the largest publicly available implant registry. All costs and prices were adjusted for inflation. Trends were analyzed using linear regressions.</div></div><div><h3>Results</h3><div>Averages and nationwide estimates for 2022 were based off 7339 shoulder cases from 117 US hospitals. RSA significantly increased from 40% in 2013 to 72% of all shoulder arthroplasties in 2022 (β = 4.18; <em>P</em> &lt; .001), whereas aTSA significantly decreased from 43% to 20% (β = −0.34; <em>P</em> &lt; .001), and hemiarthroplasty significantly decreased from 10% to 1% (β = −1.07; <em>P</em> &lt; .001). Other types of procedures, such as revisions and shoulder resurfacings, constituted 7%. Anatomic constructs showed a rise in stemless humeral component usage from 2% in 2017 to 10% in 2022 (β = 1.4; <em>P</em> &lt; .01). Financially, Medicare physician payment for shoulder surgeries witnessed significant decline from $1882 USD in 2017 to $1428 in 2023 (β = −73; <em>P</em> &lt; .001). The inflation-adjusted cost of aTSA also decreased from $8055 in 2013 to $6223 in 2022 (β = −173.56; <em>P</em> &lt; .01), and RSA from $12,207 to $8882 in 2022 (β = −318.31; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Trends in primary TSA procedures feature a growing prevalence of RSA as compared to aTSA, in addition to a rise in stemless humeral implants within aTSA. As both Medicare physician reimbursements and implant prices continue to decrease, it is important for surgeons to consider the tradeoffs of different implant materials and patient-specific technology when performing such procedures.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 42-47"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284924","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}