Seminars in Arthroplasty最新文献

{"title":"Clinical outcomes based on planned glenoid baseplate retroversion in reverse total shoulder arthroplasty","authors":"Lauren E. Schell BS ,&nbsp;Stephanie J. Muh MD ,&nbsp;Josie A. Elwell PhD ,&nbsp;Skye Jacobson BS ,&nbsp;William R. Barfield PhD ,&nbsp;Christopher P. Roche MSE, MBA ,&nbsp;Josef K. Eichinger MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.01.014","DOIUrl":"10.1053/j.sart.2024.01.014","url":null,"abstract":"<div><h3>Background</h3><p>While surgeons attempt to correct the baseplate version of a reverse total shoulder arthroplasty (rTSA), clinical outcomes based on the planned final version remain unknown. The purpose of this study is to determine the clinical and radiographic outcomes of rTSA based on the planned final version of the baseplate. Our hypothesis is that increasing component retroversion will not affect outcomes.</p></div><div><h3>Methods</h3><p>All primary rTSA patients in a multicentered international registry with a 2-year minimum follow-up implanted with computer navigation were included, except fracture and revision indications. A single medialized glenoid/lateralized humerus rTSA implant system was used with a standard or augmented baseplate. Patients were stratified by baseplate type and final planned baseplate version into 2 cohorts: 0°-5° (Group 1) or 6°-15° (Group 2) of retroversion. Demographics, radiographic outcomes, range of motion, and patient-reported outcome scores were compared between groups using Welch’s t-test and Fisher’s Exact test.</p></div><div><h3>Results</h3><p>Five hundred and thirty-five patients (307 females/226 males/2 unknown) were identified, with a mean follow-up of 30 months. Demographics were similar between the cohorts. The mean native and final retroversion was 9.0° and 1.5° in Group 1 and 16.3° and 8.6° in Group 2, respectively. Preoperatively, 72% of patients were 6°-15° retroverted. Postoperatively, 73% of patients were 0°-5° retroverted and 27% were 6°-15°, with 97% of patients having less than or equal to 10° of planned baseplate retroversion. Without stratifying for baseplate types, there were no clinically significant differences between the cohorts with regards to postoperative pain, range of motion, or patient-reported outcome scores, except for abduction and internal rotation greater in the 6°-15° and 0°-5° cohorts, respectively. Scapular notching was low (7% vs. 8%) and less than reported without computer navigation. Complication and revision rates were similar between the 2 groups. Patient satisfaction was high (much better/better, 94% vs 95%) and not significantly different between the 2 groups.</p></div><div><h3>Discussion</h3><p>There were no significant clinical differences between cohorts. This study demonstrates that favorable outcomes are achieved with a planned final baseplate version of less than 15° retroversion, with few differences between 0°-5° and 6°-15°. rTSA is forgiving enough such that one may plan to correct preoperative retroversion to less than 15° postoperatively in lieu of targeting postoperative version between 0°-5° for patients with higher native retroversion, potentially requiring less eccentric reaming especially when combined with other corrective measures.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 469-474"},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271234","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":"Patients with chronic kidney disease can expect significant improvement in pain and function after shoulder arthroplasty","authors":"Katherine A. Burns MD ,&nbsp;Lynn M. Robbins PA-C ,&nbsp;Angela R. LeMarr BSN, RN, ONC ,&nbsp;Varun Gopinatth BS ,&nbsp;Diane J. Morton MS, MWC ,&nbsp;Melissa L. Wilson PhD, MPH","doi":"10.1053/j.sart.2024.01.011","DOIUrl":"10.1053/j.sart.2024.01.011","url":null,"abstract":"<div><h3>Background</h3><p>Chronic kidney disease (CKD) is associated with negative outcomes after hip and knee arthroplasty due to higher rates of infection, aseptic loosening, and transfusion. The purpose of this study was to compare clinical outcome scores and complication rate after shoulder arthroplasty (SA) for patients with and without CKD.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study of prospectively collected data and reviewed all patients who underwent primary SA from January 2015 to December 2019 by one surgeon at one institution. Revision arthroplasty patients were excluded. We evaluated results from patients with CKD (glomerular filtration rate [GFR] <span><math><mrow><mo>≤</mo></mrow></math></span> 59) and without CKD (GFR <span><math><mrow><mo>≥</mo></mrow></math></span> 60). Outcome measures including visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores were compared between cohorts. Minimum clinically important difference (MCID) and substantial clinical benefit also were determined for this cohort. Univariate and multivariable regression was performed to assess the influence of CKD on outcome measures and risk of complications.</p></div><div><h3>Results</h3><p>518 patients met inclusion criteria; 4 patients did not have recorded GFR, leaving 514 patients for analysis. 389 patients had normal GFR; 125 had CKD. Patients with CKD had lower overall preoperative and postoperative ASES, SST, and SANE scores but demonstrated similar levels of clinical improvement from preoperative to postoperative time points (Δ ASES 41.4 ± 21.8 vs. 42.9 ± 21.4, <em>P</em> = .55), (Δ SST 4.8 ± 3.4 vs. 4.9 ± 3.3, <em>P</em> = .08), (Δ SANE 40.7 ± 29.1 vs. 42.4 ± 26.5, <em>P</em> = .77). Both cohorts achieved MCID for ASES, SST, and SANE scores. Univariately, patients with CKD were at high risk to require transfusion (OR 16.2 (1.9, 139.7), <em>P</em> = .01) despite similar intraoperative estimated blood loss (156.9 ± 132.5mL vs. 153.8 ± 89.7mL, <em>P</em> = .77). CKD patients also were at higher risk for intraoperative fracture (OR 5.4 (1.3, 23.0), <em>P</em> = .02). CKD patients were not at higher risk for prosthetic joint infection (OR 3.2 (0.2, 50.8), <em>P</em> = .42), medical complications (OR 0.9 (0.2, 4.4), <em>P</em> = .89), or revision (OR 1.9 (0.7, 4.9), <em>P</em> = .19) in this cohort. Multivariable analysis of any complication after SA demonstrated that renal disease was not an independent risk factor for overall complication risk in this cohort (OR 1.1 (0.7, 1.8) <em>P</em> = .650).</p></div><div><h3>Conclusion</h3><p>Surgeons can be assured that patients who have CKD achieve similar gains in clinical outcomes as other patients. Despite experiencing a higher risk for transfusion and intraoperative fracture, renal disease was not an independent risk factor for complications after SA in this small coh","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 457-463"},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269017","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 postoperative stiffness following primary anatomic and reverse total shoulder arthroplasty","authors":"Lawrence C. Vanderham MS, PA,&nbsp;Nikhil Vallabhaneni BA,&nbsp;Skye Jacobson BS,&nbsp;Jacqueline G. Tobin MS,&nbsp;Alexander S. Guareschi BS,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.01.012","DOIUrl":"10.1053/j.sart.2024.01.012","url":null,"abstract":"<div><h3>Background</h3><p>Shoulder stiffness following both primary anatomic and reverse total shoulder arthroplasty (TSA) is a potential complication that is likely underreported. The deleterious effects of postoperative stiffness following TSA and the burden placed on both the patient and the healthcare system have not been well studied. The purpose of this study is to determine the incidence of postoperative stiffness following primary TSA and analyze the effect it has on short-term outcomes up to 180 days following primary TSA.</p></div><div><h3>Methods</h3><p>This was a retrospective, comparative cohort study. The Nationwide Readmissions Database was queried from 2010 to 2020 for patients who had undergone primary TSA using International Classification of Diseases Clinical Modification and Procedure Coding System codes. Patients were then separated into stiff and non-stiff cohorts. A one-to-one match was performed based on age, sex, and the Charlson comorbidity index. Statistical analyses included chi-square, sample <em>t</em>-tests, logistic, and linear regression.</p></div><div><h3>Results</h3><p>A total of 7792 subjects were included in the study. The overall incidence of postoperative stiffness was 1.8%. Patients with stiffness following primary TSA were 57% more likely to be readmitted within 180 days (odds ratio [OR] = 1.57) and had increased hospital costs by over $5000 (<em>P</em> &lt; .001), but mortality rates were not increased. However, the odds of experiencing any medical complication or revision decreased by 52% and 76%, respectively, in the stiff group (OR = 0.48, and OR = 0.24, respectively). Postoperative stiffness was inversely predictive of prosthetic dislocation (OR = 0.03), loosening (OR = 0.03), and periprosthetic fracture (OR = 0.04).</p></div><div><h3>Conclusion</h3><p>The incidence of postoperative stiffness following primary TSA was low at 1.8 %. These patients were found to be at increased risk for readmission within 180 days and incurred significantly higher hospital costs compared to the non-stiff cohort. However, postoperative stiffness did not increase the odds of experiencing increased medical complications, mechanical complications, mortality, or revision at 180 days. This information can help guide surgeons in discussion with and management of patients who develop stiffness following primary TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 464-468"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408094","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":"Regional compared to general anesthesia for total shoulder arthroplasty","authors":"Nikhil Vallabhaneni BA,&nbsp;Lawrence C. Vanderham MS, PA-C,&nbsp;Skye Jacobson BS,&nbsp;Jacqueline G. Tobin MS,&nbsp;Alexander S. Guareschi BS,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.01.013","DOIUrl":"10.1053/j.sart.2024.01.013","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty (TSA) is a common procedure for numerous shoulder pathologies, including glenohumeral arthritis, rotator cuff tears, and proximal humerus fractures. Prior literature has shown that patients undergoing total hip and knee arthroplasty under regional anesthesia (RA) are at significantly lower risk of postoperative complications and reoperation compared to general anesthesia (GA). The purpose of this study is to compare GA vs. RA in patients undergoing primary elective TSA.</p></div><div><h3>Methods</h3><p>The National Surgical Quality Improvement Program database was queried from 2010 to 2019 to identify all patients who underwent primary elective TSA with the use of GA (n = 24,563) or RA (n = 475). After matching based on age, sex, and the American Society of Anesthesiologists classification score, 475 matched pairs of patients undergoing TSA using GA or RA were compared. Relevant demographic characteristics and postoperative complication, readmission, and reoperation rates within 30 days of surgery were compared between groups. Operative time and total hospital length of stay (LOS) were also compared. Chi-squared tests were used to compare categorical variables. Continuous variables were compared using independent sample <em>t</em>-test and one-way ANOVA for binomial and multinomial groups, respectively.</p></div><div><h3>Results</h3><p>RA patients exhibited significantly higher rates of readmission (<em>P</em> &lt; .001) and reoperation (<em>P</em> = .034) compared to GA patients. GA patients showed higher operative times than RA patients when comparing the two cohorts and stratifying patients by body mass index. GA patients also exhibited significantly increased LOS (<em>P</em>=&lt;.001) compared to RA patients. Except for increased readmission and reoperation rates, there was no significant difference in the remaining medical complication rates between the groups.</p></div><div><h3>Conclusion</h3><p>RA patients were found to have higher rates of readmission and reoperation within 30 days of surgery compared to GA patients. GA was associated with longer operative times compared to RA across various body mass index groups. GA was associated with longer LOS compared to RA. However, for all perioperative and short-term postoperative medical complications, patients undergoing TSA under RA had similar rates to GA patients. These findings can be used to guide clinical decision-making when selecting the appropriate anesthetic strategy for patients requiring elective primary TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 451-456"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140089406","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":"Glenoid fixation strategies: cemented, metal-backed, and hybrid","authors":"Nikhil Adapa MD,&nbsp;Andrew J. Rosso BS,&nbsp;Salvatore M. Cavallaro MD,&nbsp;Kevin J. Setter MD","doi":"10.1053/j.sart.2023.07.001","DOIUrl":"10.1053/j.sart.2023.07.001","url":null,"abstract":"<div><h3>Background</h3><p>Glenoid loosening and wear remain one of the most common complications after total shoulder arthroplasty. In this article, we will review all polyethylene glenoids, metalbacked glenoids, inlay glenoids, and hybrid constructs.</p></div><div><h3>Methods</h3><p>We hope to synthesize existing literature to understand strategies that can contribute to a more durable and longer lasting implant.</p></div><div><h3>Results</h3><p>Although all polyethylene glenoids remain the gold standard, recent literature hints at the potential benefits of metal-backed, inset and hybrid glenoids.</p></div><div><h3>Conclusion</h3><p>As the number of total shoulder arthroplasties that are being done annually continues to rise, renewed interest into glenoid fixation strategies is paramount to help improve patient satisfaction, implant durability, and combat rising healthcare expenditure.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 1","pages":"Pages 266-274"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452723001104/pdfft?md5=01d5b8b67d195a1e09a2e6963aba5d05&pid=1-s2.0-S1045452723001104-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113977431","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":"Early radiographic and clinical outcomes of primary short stem anatomic total shoulder arthroplasty with a peripherally enhanced fixation glenoid: a multicenter study","authors":"Vahid Entezari MD, MMSc ,&nbsp;Jason C. Ho MD ,&nbsp;Sambit Sahoo MD, PhD ,&nbsp;Michael Del Core MD ,&nbsp;Dylan Cannon BS ,&nbsp;Gagan Grewal BS ,&nbsp;Tammy M. Owings DEng ,&nbsp;Jinjin Ma PhD ,&nbsp;Catherine Shemo BS ,&nbsp;Andrew Baker MS ,&nbsp;Bong Jae Jun PhD ,&nbsp;Yuxuan Jin MS ,&nbsp;Peter B. Imrey PhD ,&nbsp;Joseph P. Iannotti MD, PhD ,&nbsp;Eric T. Ricchetti MD ,&nbsp;Kathleen Derwin PhD ,&nbsp;Jonathan Levy MD","doi":"10.1053/j.sart.2024.01.007","DOIUrl":"10.1053/j.sart.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>Glenoid component loosening remains the most common reason for revision of anatomic total shoulder arthroplasty (aTSA). We assessed early clinical and radiographic outcomes following aTSA using a press-fit short stem and a peripherally enhanced fixation glenoid.</p></div><div><h3>Methods</h3><p>275 consecutive patients with end-stage glenohumeral arthritis and Walch A- or B-type glenoid morphology who underwent primary aTSA in 2017-2018 at two high-volume shoulder arthroplasty institutions were evaluated, and patient-reported outcomes (PROMs) and radiographic findings were studied in those with completed baseline and minimum 2-year follow-up, respectively. Patient demographics, glenoid morphology, body mass index (BMI), Charlson Comorbidity Index (CCI), range of motion, American Shoulder and Elbow Surgeons (ASES) score, and Simple Assessment Numeric Evaluation score were collected. Radiographic analysis of glenoid and humeral components was performed. Multivariable logistic, equal adjacent odds ordinal, and beta regression were respectively used to identify predictors of glenoid radiolucent lines, humeral calcar resorption, and total ASES score.</p></div><div><h3>Results</h3><p>Patients were 43% female, with a mean age of 66, a median BMI of 30, and median follow-up of 28.4 months. ASES and Simple Assessment Numeric Evaluation scores improved by respective medians of 54.4 and 55.0 points, forward elevation by median 35°, and external rotation by median 30° (all <em>P</em> &lt; .001 for preoperative to postoperative change). Postoperative radiographs of 177 cases showed 10 (5.7%) glenoid osteolysis, 51 (28.8%) glenoid radiolucent lines, and 81 (45.8%) calcar resorptions. The follow-up duration (median 40.1 vs. 27.2 months; <em>P</em> &lt; .001), BMI (median 27.5 vs. 30.7; <em>P</em> &lt; .001), and Charlson Comorbidity Index (Q3 0 vs. 1; <em>P</em> = .02) were associated with glenoid osteolysis in bivariate analyses. In multiple logistic regression, surgeon (C vs. A/B) was the only statistically significant predictor of glenoid radiolucent lines [OR 0.27, 95% CI (0.1, 0.8)]. By descending importance, Surgeon C [OR 6.5 (2.0, 20.5)], humeral canal filling ratio [upper vs. lower quartile OR 2.3 (1.3, 4.0)], mediolateral humeral head deviation [upper vs. lower quartile OR 1.9 (1.0, 3.5)], and glenoid osteolysis [OR 13.5 (2.6, 71.6)] significantly predicted greater calcar resorption. Longer follow-up duration marginally statistically significantly predicted lower ASES score [upper vs. lower quartile OR 0.8 (0.6, 1.0)].</p></div><div><h3>Conclusions</h3><p>Following aTSA with a peripherally enhanced fixation glenoid, pain, range of motion, and patient-reported outcomes significantly improved at a minimum of 2 years with only 5.7% glenoid osteolysis despite heterogeneous preoperative glenoid pathologies.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 533-544"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400018X/pdfft?md5=5798049c015a5e8d3b97ebfeb7b800b4&pid=1-s2.0-S104545272400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049863","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":"Acute bony Bankart and proximal humeral dislocation in an elderly patient treated with distal tibial allograft glenoid augmentation and reverse shoulder arthroplasty: a case report","authors":"Edwin A. Valencia-Ramon MD,&nbsp;Rocio Pasache-Lozano MD,&nbsp;J. Andrew I. Trenholm MD, MSc, FRCS,&nbsp;Ivan Wong MD, FRCSC, MAcM, Dip Sports Med, FAANA","doi":"10.1053/j.sart.2024.01.005","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.005","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 425-429"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000166/pdfft?md5=6e053cec454a7946bcdd7215c4a4dafd&pid=1-s2.0-S1045452724000166-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does prior ipsilateral steroid injection affect outcomes after shoulder arthroplasty?","authors":"Sarah J. Girshfeld BA ,&nbsp;Gabriel Lama BS ,&nbsp;Brandon Macknofsky BS ,&nbsp;Clyde Fomunung BS, MBA ,&nbsp;Devin John MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Howard Routman MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2024.01.008","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA).</p></div><div><h3>Methods</h3><p>A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (&lt;3 months, 3-12 months, and &gt;12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score.</p></div><div><h3>Results</h3><p>421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; <em>P</em> &lt; .001) and older age (75 vs. 70; <em>P</em> &lt; .001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; <em>P</em> = .025) and abduction (70° vs. 60°; <em>P</em> = .004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (<em>P</em> = .009 and <em>P</em> = .007, respectively), and MCID for American Shoulder and Elbow Surgeons (<em>P</em> = .046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (<em>P</em> = .024). Complication and reoperation rates were comparable between groups.</p></div><div><h3>Conclusion</h3><p>Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 398-405"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of anatomic total shoulder arthroplasty revised to reverse shoulder arthroplasty in patients with contained central glenoid bone defects","authors":"Guillermo Marquez MD ,&nbsp;Seth L. Carder MD ,&nbsp;Brennen L. Lucas MD ,&nbsp;Harry A. Morris MD ,&nbsp;Bernard F. Hearon MD","doi":"10.1053/j.sart.2024.01.010","DOIUrl":"10.1053/j.sart.2024.01.010","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study is to present the outcomes of patients with failed total shoulder arthroplasty (TSA) who were treated by conversion to reverse shoulder arthroplasty (RSA).</p></div><div><h3>Methods</h3><p>This retrospective cohort study investigates patients who underwent single-stage revision from TSA to RSA by one of three fellowship-trained orthopedic surgeons between 2012 and 2020. Patients with central bone defects in the glenoid were included, whereas those with uncontained peripheral or combined glenoid defects or with infections requiring a 2-stage revision were excluded. The glenoid baseplate size and use of bone graft augmentation were recorded. A minimum 2-year postsurgical follow-up was required to participate in the outcome evaluations. Primary outcome measures were shoulder pain on the visual analog scale and active shoulder forward flexion and abduction, while secondary outcome measures included patient satisfaction, procedure complications, and reoperations. The Wilcoxon signed rank exact test was used to compare preoperative and postoperative clinical data.</p></div><div><h3>Results</h3><p>Data from 18 shoulders in 16 patients, average age 74 years, were analyzed. The standard 28-mm-sized baseplate with longer and wider central peg was implanted in 12 of 18 reconstructions. Bone graft augmentation of the glenoid was required in 4 of 6 cases when the 25-mm mini baseplate was used. Clinical evaluation of 13 patients (15 shoulders) with an average of 5 (range, 2-10) years after surgery showed statistically significant improvements in median visual analog scale shoulder pain score decreasing from 7 to 0 (<em>P</em> &lt; .001), median active shoulder forward flexion increasing from 90° to 140° (<em>P</em> &lt; .001), and median active shoulder abduction increasing from 60° to 125° (<em>P</em> &lt; .001). In 14 of 15 cases, the patient was satisfied with the outcome. There were minor complications in 2 cases (13%), but there were no major complications or reoperations.</p></div><div><h3>Conclusion</h3><p>In patients with symptomatic TSA from component failure, shoulder instability, or rotator cuff insufficiency, single-stage revision to RSA for those with contained glenoid bone defects is a reliable salvage option to reduce shoulder pain and improve shoulder motion. At a mean 5-year follow-up, we observed 100% implant survival in 15 cases.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 442-450"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400021X/pdfft?md5=78357ed03a441a0b8edb7ceb88d70d05&pid=1-s2.0-S104545272400021X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YouTube content on shoulder arthroplasty is highly viewed but is of poor educational quality","authors":"Javier Ardebol MD, MBA ,&nbsp;Ali Īhsan Kiliç MD ,&nbsp;Simon Hwang MS ,&nbsp;Theresa Pak DO ,&nbsp;Mariano E. Menendez MD ,&nbsp;Patrick J. Denard MD","doi":"10.1053/j.sart.2024.01.009","DOIUrl":"10.1053/j.sart.2024.01.009","url":null,"abstract":"<div><h3>Background</h3><p>YouTube videos on shoulder arthroplasty cover a broad range of topics, from patient testimonials to surgical techniques. Inherent to this platform, there are no quality control measures to monitor this content. The purpose of this study is to evaluate the quality and popularity of videos on shoulder arthroplasty on YouTube, using both previously described scores and a proposed novel shoulder arthroplasty–specific score assessing educational content.</p></div><div><h3>Methods</h3><p>A search was performed using the keywords “shoulder arthroplasty” and “shoulder replacement” on YouTube. Videos were sorted by relevance and the first 50 videos for each keyword were included in a playlist. The videos in the playlist were then sorted by popularity and the first 50 were included for analysis. Videos in a non-English language, duplicate videos, or those lacking audio were excluded. Video source, content, time since upload, duration, like and dislike count, were inputted for analysis. The view ratio and video power index were used to assess for popularity. Quality, reliability and educational content were evaluated with the Global Quality Score (GQS), <em>Journal of the American Medical Association</em> (JAMA), and the novel Shoulder Arthroplasty Video Content (SAVC) score, respectively.</p></div><div><h3>Results</h3><p>The 50 videos had an average of 285,375 views and a mean duration of 10.8 minutes. Video content was comprised of primarily surgical technique (46%) and patient experience (44%), with most of the videos uploaded from university-affiliated physicians (30%), non-affiliated physicians (28%), and medical (i.e., animations from health websites) (26%) sources. Mean GQS (i.e., quality) and JAMA (i.e., reliability) scores for all videos were 3.2 ± 1.2 out of 5 and 2.4 ± 1.4 out of 4, respectively. Median GQS was comparable across sources, content, and procedure type. Although median JAMA scores were similar among procedure and content type, academic and medical sources showed significantly higher scores among video source categories (<em>P</em> = .04). The mean SAVC score was 19.5 ± 10.7 out of 45 possible points. While there was no significant difference in SAVC scores when categorized by procedure type, a significant difference was observed when assessed by source (<em>P</em> = .02) and content (<em>P</em> = .01). Specifically, medical sources had the highest median score for video source and patient experience for content.</p></div><div><h3>Conclusion</h3><p>Shoulder arthroplasty videos on YouTube reach a considerable audience, but the educational content and reliability are low. Understanding this can help caution patients on the limitations of educational content on YouTube.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 436-441"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139967154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}