Seminars in Arthroplasty最新文献

{"title":"Acromion and scapular spine fractures following reverse total shoulder arthroplasty: operative versus nonoperative management","authors":"John W. Moore BS, Robert Reis BS, Megan E. Welsh BS, Brandon L. Rogalski MD, Richard J. Friedman MD, FRCSC, Josef K. Eichinger MD","doi":"10.1053/j.sart.2025.03.001","DOIUrl":"10.1053/j.sart.2025.03.001","url":null,"abstract":"<div><h3>Background</h3><div>The reported incidence of acromial and scapular spine fractures (ASFs) following reverse total shoulder arthroplasty (rTSA) is approximately 5%. There is no consensus on whether to treat ASFs operatively or nonoperatively. This study reviewed patients diagnosed with ASFs following rTSA to determine which patients are successfully managed nonoperatively versus those who undergo surgery. We hypothesized that nonoperative and operative treatment results in equivalent outcomes.</div></div><div><h3>Methods</h3><div>A database of prospectively enrolled patients was reviewed to identify patients who underwent rTSA and were diagnosed with a postoperative ASF from 2015 to 2022 with a minimum 2-year follow-up (n = 19). Nonoperative treatment was initially attempted on all patients. Patients were separated into operative (n = 7) and nonoperative (n = 12) groups based on treatment. Demographic information and clinical outcomes were compared between patients. ASF patients were then matched 1:1 to a group of nonfracture rTSA patients on age (±12 months), sex, body mass index (±2.0), follow-up duration (±6 months), and whether the dominant arm was affected, yielding an ASF group (n = 19) and a nonfracture control group (n = 19). Demographic information and clinical outcomes at last follow-up were compared between groups. Clinical outcomes included American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value, Visual Analog Scale (VAS) pain, and range of motion (ROM).</div></div><div><h3>Results</h3><div>Patients with Levy type I fractures were more likely to be treated operatively (71.4% vs. 8.3%; <em>P</em> = .013). Patients with Levy type I fractures had higher VAS pain scores than those with type II or III fractures (4.7 vs. 1.8 vs. 1.0; <em>P</em> = .014). Patients with fractures lateral to the glenoid articular surface had lower ASES scores (57.7 vs. 71.8; <em>P</em> = .05) and higher VAS pain scores (3.7 vs. 1.2; <em>P</em> = .009) than patients with nonlateral ASFs. Regardless of operative or nonoperative treatment, ASF patients had lower ASES scores (64.3 vs. 88.2; <em>P</em> < .001), lower Subjective Shoulder Values (69.0 vs. 85.8; <em>P</em> < .001), and higher VAS pain scores (2.5 vs. 0.8; <em>P</em> = .007) compared to nonfracture controls. ASF patients had inferior ROM, including less flexion/extension, (131 vs. 156; <em>P</em> < .001), less external rotation (46 vs. 58; <em>P</em> = .024), and lower internal rotation scores (4.7 vs. 5.9; <em>P</em> < .001) than nonfracture controls.</div></div><div><h3>Conclusion</h3><div>The development of ASFs, regardless of treatment modality, was associated with inferior outcomes and ROM compared to nonfracture rTSA patients. Type I fractures were more likely to fail nonoperative treatment than medial fractures. Lateral fractures had inferior outcomes compared to medial fractures. Fall prevention and adequate lifting restrictions may significantly lower t","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 362-370"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767080","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 clinical and radiological outcomes of a scapular spine load-bearing strut in custom glenoid implants for reverse total shoulder arthroplasty","authors":"Alastair J. Konarski FRCS, MBChB, BSc (Hons) ,&nbsp;Leanne Dupley FRCS, MBChB ,&nbsp;Nallamilli Rajyalakshmi Reddy MBBS, MS (Orth), MCh (Orth) ,&nbsp;Ian A. Trail FRCS, MBChB ,&nbsp;Michael J. Walton BMedSci, BMBS, MSc (SEM), FRCS (Tr&Orth) ,&nbsp;Stephen Bale FRCS (Orth), MBChB, BSc ,&nbsp;Puneet Monga FRCS (Orth), MBBS, DipSEM, MD","doi":"10.1053/j.sart.2025.03.009","DOIUrl":"10.1053/j.sart.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>Severe glenoid bone deficiency is a challenge in complex primary and revision shoulder arthroplasty, but lately, custom glenoid baseplates have demonstrated good outcomes. Lima Promade 3D-printed implants have recently utilized a strut to load share through the scapular spine to increase stability in patients with the most severe glenoid bone loss. We have assessed early clinical and radiological outcomes and reviewed complications.</div></div><div><h3>Methods</h3><div>This was a retrospective multisurgeon, single-center study, reviewing 19 patients with a minimum 2-year follow-up. Preoperative imaging was assessed for bone loss. Routinely performed postoperative computed tomography (CT) scans, radiographs, and Oxford Shoulder Scores were reviewed. CT scans were reported by independent musculoskeletal radiologists. Patient records were reviewed for any complications.</div></div><div><h3>Results</h3><div>19 patients with a mean age of 66 (42-89) and a mean follow-up of 3.6 years (2-8) were identified. 11 were revision procedures. 14/19 had severe bone loss (Seebauer-Gupta E4/C4) and 5 had severe dysplasia with &gt;30° retroversion (Seebauer-Gupta E3/E4). 16/19 had a postoperative CT scan, with 14 showing good osseointegration; 1 reported partial osseointegration, and 1 suspected loosening but was asymptomatic. One patient had a magnetic resonance imaging scan with no suspicion of loosening. Pre and postoperative Oxford Shoulder Scores were available in 13 patients and improved from a mean of 14/48 preoperatively to 32/48 postoperatively. Complications were reported in 5 patients (26%), with 1 humeral component revision, 2 with limited external rotation, 1 acromial stress fracture, and 1 keloid scarring. No glenoid baseplates required revision.</div></div><div><h3>Discussion</h3><div>This is the first case series to report on the use of a scapular spine strut as part of a custom glenoid baseplate construct. Early outcomes report good osseointegration and good improvements in patient-reported outcome measures. The complication rate in our series was within the range described in the literature for complex shoulder replacement, and we report 100% implant survival at a minimum of 2 years. Early outcomes would suggest this is a safe technique to balance shear forces and improve stability in patients with severe glenoid bone loss and does not appear to increase the risk of acromial stress fractures beyond that reported in the literature. Further study is on-going to assess the medium- and long-term outcomes in these patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 438-447"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766963","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 Artificial Intelligence Shoulder Arthroplasty Score: development and validation of a tool for large language model responses to common patient questions regarding total shoulder arthroplasty","authors":"Benjamin Fiedler MD ,&nbsp;Jeffrey Hauck BS ,&nbsp;T. Bradley Edwards MD ,&nbsp;Hussein A. Elkousy MD ,&nbsp;Paul J. Cagle MD ,&nbsp;Todd Phillips MD","doi":"10.1053/j.sart.2025.02.003","DOIUrl":"10.1053/j.sart.2025.02.003","url":null,"abstract":"<div><h3>Background and Hypothesis</h3><div>While research into artificial intelligence, specifically large language model (LLM), ability to respond to patient questions regarding specific orthopedic pathologies continues to grow, no tool presently exists to systematically and comprehensively evaluate the quality of LLM responses. The present study seeks to develop and validate the Artificial Intelligence Shoulder Arthroplasty Score (AISAS) to create a comprehensive, standardized, and reproducible system for evaluating artificial intelligence responses to patient questions regarding their orthopedic pathology.</div></div><div><h3>Methods</h3><div>The novel scoring tool, AISAS, was developed to include four equally weighted components related to accuracy, completeness, clarity, and readability. Fifteen common patient questions on glenohumeral arthritis were asked one by one to three of the most used LLMs: ChatGPT (version 3.5), Claude (version 3.5) Sonnet, and Gemini. Ten shoulder and elbow fellowship trained orthopedic surgeons used the proposed framework to evaluate each of the 45 responses. Inter-rater reliability was calculated via Cohen's kappa and rater-score correlation was calculated via Cronbach's alpha.</div></div><div><h3>Results</h3><div>AISAS use for Claude and ChatGPT produced moderate agreement (<em>k</em> = 0.55 and 0.43) while Gemini produced substantial reliability among raters ((<em>k</em> = 0.66). Cronbach's alpha scores demonstrated excellent correlation of Gemini ratings (⍺ = 0.91) and acceptable correlation of the Claude and ChatGPT ratings (⍺ = 0.79 and 0.75).</div></div><div><h3>Discussion and Conclusion</h3><div>AISAS use enables systematic assessment of the overall quality of an LLM response, as well as the individual components of a response that may vary in quality to enable easy comparisons for LLM responses. Furthermore, it offers a tool to trend the progress of LLMs in ability to respond to patient questions. Establishing such a framework to guide areas of improvement for LLMs will serve to optimize LLMs as a patient tool, identify areas for improvement, and allow physicians to better direct patients on how to utilize these tools for optimal use.</div></div><div><h3>Conclusion</h3><div>The AISAS is a comprehensive and reproducible tool for evaluating LLM responses, with high levels of inter-rater reliability. AISAS use can help to evaluate responses to patient questions to guide growth and improvement of LLMs for use in the orthopedic setting.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 348-353"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766764","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 associations of comorbidities with healthcare utilization among patients undergoing total shoulder arthroplasty","authors":"William ElNemer BS ,&nbsp;John P. Avendano BS ,&nbsp;Zaid Elsabbagh BS ,&nbsp;Myung-Jin Cha BS ,&nbsp;Andrew B. Harris MD ,&nbsp;Edward G. McFarland MD ,&nbsp;Matthew J. Best MD ,&nbsp;Savyasachi C. Thakkar MD ,&nbsp;Umasuthan Srikumaran MD, MBA","doi":"10.1053/j.sart.2025.03.005","DOIUrl":"10.1053/j.sart.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total shoulder arthroplasty (TSA) often have chronic comorbidities such as obesity, hypertension, and diabetes. Management of these comorbidities and their associated complications can lead to increased utilization of hospital resources, increasing the cost of care and the length of patients' hospital stay. Because the rate of TSAs is increasing, it is important for physicians and policymakers to understand which patient factors may contribute to healthcare utilization and to develop protocols that may address those factors or inform reimbursements. Using length of stay (LOS), hospital charges (HC), and hospital costs (HCo) as a proxy for healthcare utilization, our study asked whether, for patients undergoing TSA, there is an association between these measures and patient comorbidities.</div></div><div><h3>Methods</h3><div>A national database was queried for patients who underwent primary TSA from 2012 to 2020. A total of 31 comorbidities were classified using the Elixhauser Comorbidity Index. People with the comorbidity metastatic cancer were excluded. For each comorbidity of interest, patients were matched to another patient in the database by age, sex, and all other comorbidities except the comorbidity of interest. Matched cohorts were analyzed via multivariable regression analyses controlled for age, sex, year of procedure, hospital location, and comorbidities to predict differences in LOS, HC, and HCo.</div></div><div><h3>Results</h3><div>A total of 157,034 TSAs were included. Mean HC, HCo, and LOS were $74,974, $19,733, and 1.7 days, respectively. When comparing patients with analyzed comorbidities to those without, all comorbidities except smoking, tumor, renal or liver disease, and HIV/AIDS were associated with longer LOS; paralysis, pulmonary hypertension, weight loss, and fluid and electrolyte disorders were associated with 34%, 28%, 24%, and 23% greater odds of having an LOS ≥3 days (all <em>P</em> &lt; .001); and weight loss, blood loss anemia, and coagulopathy were associated with 11%, 10%, and 5% greater HC, respectively (<em>P</em> = .039, .002, .024). Weight loss, pulmonary hypertension, and lymphoma were associated with 11%, 8%, and 6% greater HCo, respectively (<em>P</em> = .014, .021, .046), than in patients without those comorbidities.</div></div><div><h3>Conclusion</h3><div>This study offers targets for reduction of HC, HCo, and LOS for patients with these modifiable and nonmodifiable ailments through protocol change. Optimization programs targeting malnourished patients and patients with pulmonary hypertension and other comorbidities are encouraged. These results provide clinicians a quantifiable way to communicate financial burden and recovery time after TSA. Future research could investigate the synergistic effects of these comorbidities.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 397-405"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766959","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":"Preoperative acromiohumeral interval may predict early achievement of clinically meaningful outcomes in reverse shoulder arthroplasty patients: a retrospective review of preoperative imaging studies","authors":"Alex E. White MD ,&nbsp;Michael Mazzucco BS ,&nbsp;Karthik Nathan MD ,&nbsp;Mihir S. Dekhne MD ,&nbsp;Matthew R. Bryan BS ,&nbsp;Harry G. Greditzer 4th MD ,&nbsp;Michelle Kew MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.04.006","DOIUrl":"10.1053/j.sart.2025.04.006","url":null,"abstract":"<div><h3>Hypothesis</h3><div>The aim of this study was to examine the predictive value of preoperative acromiohumeral interval (AHI) and Goutallier grade across multiple imaging modalities on patient-reported outcomes following both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). We hypothesized that a higher AHI and lower Goutallier grades preoperatively would predict better patient reported outcome measures following both aTSA and rTSA.</div></div><div><h3>Methods</h3><div>Patients who underwent aTSA and rTSA were identified from our institution's shoulder arthroplasty registry and included if they had computed tomography (CT), magnetic resonance imaging (MRI), and x-ray (XR) within 6 months of surgery and complete American Shoulder and Elbow Surgeons scores at 2 years. Two raters independently measured AHI on all three imaging modalities and assigned a Goutallier grade for supraspinatus muscle quality using MRI and CT. Logistic regression and cut-point analysis using the Youden index was performed for each radiographic measurement to determine their ability to predict achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for American Shoulder and Elbow Surgeons.</div></div><div><h3>Results</h3><div>A total of 199 patients (132 aTSA, 67 rTSA) were included. Interclass correlation coefficient values demonstrated moderate to strong agreement across modalities. Rates of MCID and SCB achievement did not differ significantly between the aTSA and rTSA groups. Patients who underwent rTSA with AHI &gt;6 mm on CT (<em>P</em> = .018) and &gt;7 mm on XR (<em>P</em> = .044) were significantly more likely to achieve the MCID at 1 year. Patients who underwent rTSA with an AHI &gt;6 mm on MRI were significantly more likely to achieve SCB at 1 year (<em>P</em> = .031). These significant associations did not persist at 2 years. No threshold for AHI or Goutallier was significantly associated with MCID or SCB in aTSA at any timepoint. In cut-point analysis, all area under the curve measurements were less than 0.700, indicating poor predictive ability.</div></div><div><h3>Conclusion</h3><div>The present study demonstrates that an AHI threshold of 6 mm on MRI and CT and 7 mm on XR may predict the achievement of significant clinical outcomes at 1-year for rTSA. These findings suggest that the rotator cuff may play a role in expediting the recovery process for patients undergoing rTSA. Despite this, however, there are no reliable optimal cut-points for predicting the achievement of meaningful clinical outcomes following aTSA and rTSA using AHI measurements and Goutallier grades. Factors beyond standard radiologic measurements should be considered when prognosticating long-term clinical outcomes following shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 488-496"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767169","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":"Pullout strength of screws used for baseplate fixation in reverse shoulder arthroplasty: a cadaveric study","authors":"Masashi Kano MD ,&nbsp;Shoji Fukuta MD, PhD ,&nbsp;Jun Kawamata MD ,&nbsp;Katsutoshi Miyatake MD, PhD ,&nbsp;Kosaku Higashino MD, PhD ,&nbsp;Keizo Wada MD, PhD ,&nbsp;Koichi Tomita MD, PhD ,&nbsp;Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.04.003","DOIUrl":"10.1053/j.sart.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown that bicortical screw fixation is biomechanically superior to unicortical screw fixation. However, no data are available on the pullout strength of screws used for glenoid fixation in reverse shoulder arthroplasty (RSA). The purpose of this study was to determine the differences in biomechanical strength between unicortical and bicortical fixation of the baseplate screws in RSA.</div></div><div><h3>Methods</h3><div>Both scapulae from 14 fresh frozen cadavers (7 men, 7 women) were used to compare the pullout strength of the superior and inferior screws used with the Trabecular Metal Reverse Shoulder System (Zimmer Biomet, Warsaw, IN, USA). Screws were inserted unicortically in one scapula of each specimen and bicortically in the other scapula. The pullout strength of each screw was evaluated using a universal testing machine.</div></div><div><h3>Results</h3><div>Mean pullout strength of the superior screws was 716.5 ± 300.4 N for unicortical fixation and 1241.3 ± 475.9 N for bicortical fixation, and that of the inferior screws was 272.3 ± 125.8 N and 666.2 ± 481.7 N, respectively. Pullout strength of the superior and inferior screws was significantly higher for bicortical fixation than for unicortical fixation. Pullout strength of the superior screws was 854.2 ± 314.0 N in unicortical fixation and 1374.7 ± 466.8 N in bicortical fixation in men, and 578.7 ± 209.6 N and 1107.8 ± 446.5 N, respectively, in women; the pullout strength of the inferior screws was 285.5 ± 139.0 N and 922.3 ± 549.5 N, respectively, in men, and 259.2 ± 109.5 N and 410.2 ± 176.4 N in women. Although the pullout strength was higher in men, the difference was not statistically significant, except for inferior bicortical screws. The ratio of the pullout strength for an inferior screw to that of a superior screw was 0.48. The ratio of the pullout strength for unicortical fixation to that of bicortical fixation was 0.58 for superior screws and 0.41 for inferior screws. The pullout strength of screws in women was 0.69 of that in men.</div></div><div><h3>Conclusion</h3><div>Bicortical screw fixation is stronger than unicortical screw fixation for the glenoid component in RSA, as in other regions. Pullout strength of the superior screws was significantly higher than that of the inferior screws in both unicortical and bicortical fixation. Fixation of inferior bicortical screws was impaired more significantly in women than in men. Therefore, bicortical fixation of the inferior screw is recommended for women and for patients with poor bone quality.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 464-470"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767166","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":"Reverse or anatomic shoulder arthroplasty for glenohumeral osteoarthritis in patients over 70: readmission rates and utilization trends","authors":"Tej Joshi MD ,&nbsp;Akhil Katakam MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Tuckerman Jones MD ,&nbsp;Francis J. Sirch MD ,&nbsp;Daniel Calem MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1053/j.sart.2025.04.002","DOIUrl":"10.1053/j.sart.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is increasingly used to treat elderly patients with primary glenohumeral osteoarthritis regardless of rotator cuff integrity to avoid potential future revision surgery. We aimed to determine whether there was a difference in readmission rates and profile of patients aged ≥70 who underwent rTSA vs. anatomic total shoulder arthroplasty (aTSA) for GHOA and analyze a trend in the utilization of each arthroplasty type.</div></div><div><h3>Methods</h3><div>Nationwide Readmissions Database was queried to identify all patients aged ≥70 undergoing either rTSA or aTSA for GHOA from 2016 to 2021. The patients were then tracked to identify subsequent readmissions within 30 and 90 days. Patient demographics, readmission rates, and causes of readmission were analyzed.</div></div><div><h3>Results</h3><div>84,463 (33.6%) aTSA and 166,585 (66.4%) rTSA patients were identified utilizing weighted data. Of all patients undergoing aTSA, 2.3% and 2.1% were readmitted at 30 and 90 days, respectively. Of rTSA patients, 3.5% and 3.0% were readmitted at 30 and 90 days, respectively. At 30 and 90 days, patients undergoing rTSA were 1.314 (95% CI: 1.245-1.387; <em>P</em> &lt; .001) and 1.223 (95% CI: 1.156-1.294; <em>P</em> &lt; .001) times more likely to be readmitted than patients who underwent aTSA. From 2016 to 2021, there was a significant increase in utilization of rTSA for GHOA, with a 3.8% increase in utilization per year.</div></div><div><h3>Conclusion</h3><div>Patients ≥70 undergoing rTSA for GHOA have a higher risk of readmission at both 30 and 90 days. There continues to be a significant increase in the utilization of rTSA for GHOA at a rate of 3.8% per year.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 454-463"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767165","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":"Reported outcome measures in total elbow arthroplasty: a systematic review","authors":"Timothy R. Buchanan BS ,&nbsp;Chris B. Lamprecht BS ,&nbsp;Victoria E. Bindi BS ,&nbsp;Oluwaferanmi T. Dada BS ,&nbsp;Michael Guyot BS ,&nbsp;Andrew H.A. Kaiser BS ,&nbsp;Robert J. Cueto BS ,&nbsp;Keegan M. Hones MD, MS ,&nbsp;Jonathan O. Wright MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Joseph J. King MD ,&nbsp;Kevin A. Hao MD","doi":"10.1053/j.sart.2025.03.007","DOIUrl":"10.1053/j.sart.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Total elbow arthroplasty (TEA) outcomes are historically modest with high rates of complications. While many studies have explored means of improving TEA outcomes, lack of standardization of outcome measures has made cross-study comparison difficult. This systematic review aims to characterize patient-reported outcome measures (PROMs), elbow range of motion (ROM), strength, and complications across the TEA literature.</div></div><div><h3>Methods</h3><div>We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify clinical studies on TEA from 1969 to 2023. Studies were excluded if they lacked clinical outcomes or included allograft prosthetic composites, hemiarthroplasties, or oncologic indications for TEA.</div></div><div><h3>Results</h3><div>We included 271 articles reporting on 23,005 elbows (21,665 patients) that underwent TEA (median age 62 years, 41% female, and median follow-up of 58 months). PROMs were reported by 60% (n = 161) of studies. The most common of the 15 identified PROMs was the Mayo Elbow Performance Score (89%, n = 144) followed by the visual analog scale for pain (15%, n = 24); Disabilities of Arm, Shoulder, and Hand score (12%, n = 20); Quick Disabilities of Arm, Shoulder, and Hand score (8%, n = 13); and Oxford Elbow score (7%, n = 11). The number of PROMs reported per study increased over time (<em>P</em> &lt; .001) and decreased with increasing cohort size (<em>P</em> = .004). Elbow ROM was reported by 82% (n = 223) of studies; arm strength was reported by 4% (n = 11) of studies, and complications were reported in 92% (n = 250) of studies.</div></div><div><h3>Conclusion</h3><div>Significant heterogeneity exists in the reporting of outcome measures in the TEA literature. To facilitate future cross-study comparison, we recommend reporting of at least the Mayo Elbow Performance Score, visual analog scale for pain, elbow ROM (flexion, extension, pronation, and supination), and elbow strength via objective elbow extension measurements.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 413-430"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications associated with preoperative anemia and risk factors for blood transfusion after shoulder arthroplasty: a systematic review","authors":"Eddie K. Afetse BS, BA ,&nbsp;Olivia M. Jochl AB ,&nbsp;Ajay C. Kanakamedala MD ,&nbsp;Joseph Ruzbarsky MD ,&nbsp;Matthew T. Provencher MD, MBA, MC USNR (Ret.)","doi":"10.1053/j.sart.2025.01.004","DOIUrl":"10.1053/j.sart.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Patients with preoperative anemia (PA) demonstrated higher complications rates following several orthopedic procedures. This systematic review aims to assess outcomes in patients with PA undergoing shoulder arthroplasty (SA) and to identify risk factors contributing to increased post-transfusion rates following SA.</div></div><div><h3>Methods</h3><div>This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on complications after SA in patients with PA. Study demographics and information on outcomes including outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the methodological index for nonrandomized studies scoring system.</div></div><div><h3>Results</h3><div>Between 2006 and 2023, 17 articles meeting inclusion criteria were published and analyzed in this systematic review, encompassing a total of 201,442 patients. Four studies with a total of 145,787 patients (63.7% female) with mean age of 72.6 years investigated PA, and 26,130 patients had PA. Thirteen studies investigated blood transfusion risk in 55,655 patients (56.9% female) with a mean age of 64.1 years. Patients with PA demonstrated a 24.4% complication rate, compared to 8.8% in those without such a diagnosis. Stratification by PA severity revealed a 34.9% complication rate in patients with moderate to severe PA. Notably, lower preoperative hemoglobin (Hb &lt; 13.5 g/L) and revision SA were correlated with a higher risk of postoperative transfusion.</div></div><div><h3>Conclusion</h3><div>Patients with PA had elevated rates of complications, readmissions, and reoperations after SA. Furthermore, lower preoperative Hb levels and revision SA were associated with an increased risk of postoperative transfusion. This systematic review indicated that PA may have adverse effects on outcomes after SA and suggested that preoperative optimization of patients with PA may reduce complication rates after SA. Moreover, this data suggests that preoperative optimization of patients with PA may improve outcomes after SA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 319-326"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766753","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":"Area deprivation index is associated with readmission and length of stay following primary shoulder arthroplasty","authors":"Patrick E. Saunders MD ,&nbsp;Abhay Mathur MD ,&nbsp;Clayton Hui BS ,&nbsp;Sean Guerrero MHA ,&nbsp;Viraj Deshpande BS ,&nbsp;Evan Simpson BS ,&nbsp;Edward J. Quilligan BS ,&nbsp;Hafiz F. Kassam MD","doi":"10.1053/j.sart.2025.04.005","DOIUrl":"10.1053/j.sart.2025.04.005","url":null,"abstract":"<div><h3>Background</h3><div>There is increased focus in the US health-care system on the role that social determinants of health have on disparities in health-care outcomes. Socioeconomic status has been identified as a crucial element affecting postoperative outcomes of elective orthopedic procedures. The Area Deprivation Index (ADI) is a metric used to quantify socioeconomic disadvantage between different neighborhoods or Census Block Groups. The ADI score for a given zip code is normalized to the entire country as a percentile or to a specific state as a decile to measure a neighborhood's relative socioeconomic disadvantage. Higher ADI scores indicate greater levels of social disadvantage. The purpose of this study was to assess the effect of ADI on postoperative length of stay (LOS), readmission, and emergency department (ED) visits following primary shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively collected single-institution surgical database was conducted. Patients undergoing primary elective anatomic and reverse total shoulder arthroplasty were identified. Zip codes corresponding to patients' primary residence at the time of surgery were gathered and converted to ADI scores normalized to the state of California. A propensity score match was used to create demographically equivalent populations of low (&lt;5) and high (≥5) ADI. We assessed the association between ADI and postoperative LOS, 30- and 90-day readmission, and 3-, 7-, and 90-day ED visits.</div></div><div><h3>Results</h3><div>A total of 1,012 patients were included in the study. An ADI of greater than or equal to 5 was significantly associated with lower readmission rate at 30 and 90 days (0.5% vs. 5.3%, <em>P</em> = .01). There was a positive correlation between high ADI and longer LOS, which did not reach statistical significance (30.42 hours vs. 27.55 hours, <em>P</em> = .089). There was no significant difference in ED visits at any time point between the low and high ADI groups.</div></div><div><h3>Conclusion</h3><div>An ADI of greater than or equal to 5, or higher socioeconomic disadvantage, was significantly associated with lower 30- and 90-day readmission rates after primary total shoulder arthroplasty. Our results also demonstrated a positive trend between high ADI and longer LOS postoperatively. Orthopedic providers should be mindful of their patients' level of social deprivation so that they may provide additional support and resources as necessary to improve their operative outcomes and mitigate their risk for complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 482-487"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767168","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}