Seminars in Arthroplasty最新文献

{"title":"Acromial bony adaptations in rotator cuff tear arthropathy facilitates acromial stress fracture following reverse total shoulder arthroplasty","authors":"Ryan E. Harold MD,&nbsp;Patrick T. Sweeney MD,&nbsp;Michael T. Torchia MD,&nbsp;Jack Kramer BA","doi":"10.1053/j.sart.2023.12.011","DOIUrl":"10.1053/j.sart.2023.12.011","url":null,"abstract":"<div><h3>Background</h3><p>Acromial stress fractures (ASFs) after reverse total shoulder arthroplasty (RSA) can have a potentially devastating impact on shoulder function. They are often difficult to effectively treat. Multiple studies have shown a higher incidence of ASF after RSA in patients with cuff tear arthropathy (CTA). This study introduces and explores a new hypothesis. Our hypothesis is that 1) patients with CTA experience a preoperative pathologic superiorly directed force on their acromion, and 2) this leads to acromial bending moments on the acromion that are very different from patients with glenohumeral osteoarthritis (GHOA) and after RSA, and finally 3) these pathologic loads may result in abnormal bony remodeling and adaptations in CTA, which may then predispose patients to ASF after RSA.</p></div><div><h3>Methods</h3><p>A finite element analysis model was developed to compare three loading conditions on the acromion: preoperative CTA, preoperative GHOA, and postoperative-RSA. Regions of the highest tensile and compressive stresses were identified and compared between groups.</p></div><div><h3>Results</h3><p>The finite element analysis model presented shows that patients with a preoperative diagnosis of CTA experience a stress distribution reversal after RSA, whereas GHOA patients do not. The results support that in CTA, the humerus produces pathologic strains and torques on the acromion. Over time, the acromion may slowly remodel in response, resulting in bony adaptations. Abrupt reversal of stresses and strains in CTA after RSA may lead to ASFs, as the acromion has adapted to a different stress pattern.</p></div><div><h3>Conclusion</h3><p>This study introduces one potential contributing factor for the higher rates of ASF after RSA in patients with a preoperative diagnosis of CTA; understanding this phenomenon is the first step to preventing it. Once the forces seen in CTA are abruptly reversed after RSA, the biological race is on between the formation of an acromial stress fracture and the body’s ability to again remodel the acromion to accommodate its new loading state. Additional clinical studies are needed to further investigate this new theory.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 383-391"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140518646","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 significance of intraoperative glenohumeral joint load evaluation using a novel humeral sensor in navigated reverse total shoulder arthroplasty","authors":"Allan W. Wang FRACS, MD, PhD ,&nbsp;Ashton May MD ,&nbsp;William Blakeney FRACS, MD, MS ,&nbsp;Stefan Bauer MD ,&nbsp;Jay Ebert PhD","doi":"10.1053/j.sart.2023.12.009","DOIUrl":"10.1053/j.sart.2023.12.009","url":null,"abstract":"<div><h3>Background</h3><p>Advances in preoperative planning and technology have assisted the surgeon in appropriate placement of implants during reverse total shoulder arthroplasty (RTSA). However, assessment of soft tissue tension, balance, and stability remains subjective and dependent on surgeon experience. The aims of this study are to measure intraoperative joint loads with a novel trial humeral load sensor during RTSA, to evaluate the utility of this device in the operative setting, and to determine the association between recorded joint loads and postoperative patient-reported outcomes.</p></div><div><h3>Methods</h3><p>A pilot study of 15 patients with the diagnosis of osteoarthritis, rotator cuff arthropathy, or massive cuff tear were scheduled for computer-navigated RTSA and intraoperative joint load measurements. Following appropriate soft tissue releases, load recordings were made in standardized arm positions: neutral, across the chest, behind the back, and overhead. Participants were clinically and radiographically reviewed at 3 and 12 months post-surgery for evidence of joint instability, bony stress reaction or fracture, and American Shoulder and Elbow Surgeons (ASES) score.</p></div><div><h3>Results</h3><p>Intraoperative joint load measurements vary between participants, but there were no significant associations with age or body mass index (<em>P</em> &gt; .05). Mean joint load in the neutral position was recorded as 6.1 lbf (standard deviation [SD] 7.4 range 0-25). In each of the three testing positions, mean joint load was recorded in the range of 30-40 lbf. Maximum joint loads above 70 lbf were observed in individual participants. There were no postoperative complications including joint instability or bony stress reactions. At 3 months, no statistically significant correlations were observed between clinical scores and load measures. At 12 months, the mean ASES score was 83.1 (SD 11.6, range 63.3-98.3), and demonstrated a large and significant association with load magnitude in the behind back position (r = 0.66, <em>P</em> = .008). The mean ASES pain subscale score was 45.3 (SD 6.4, range 30.0-50.0) and demonstrated a significant association with load magnitude in the behind back position (r = 0.69, <em>P</em> = .004) and with load magnitude in the across chest position (r = 0.55, <em>P</em> = .034). No other significant associations were observed.</p></div><div><h3>Discussion</h3><p>This pilot study indicates a novel humeral trial load sensor can be used safely and effectively during RTSA. This trial reports a range of intraoperative joint load measurements in neutral and commonly performed arm positions, which at 12 months post-surgery are associated with satisfactory shoulder function. Further clinical studies are required to define an upper limit for intraoperative joint load, which may potentially compromise clinical outcome.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 364-370"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000075/pdfft?md5=85544e9fccff20b461f5736554ec74ca&pid=1-s2.0-S1045452724000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640283","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":"Fracture vs. standard stem for proximal humerus fractures using reverse total shoulder arthroplasty","authors":"Ronit Kulkarni BS,&nbsp;Josie Elwell PhD,&nbsp;Chris P. Roche MSE,&nbsp;Josef K. Eichinger MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2023.12.008","DOIUrl":"10.1053/j.sart.2023.12.008","url":null,"abstract":"<div><h3>Background</h3><p>Reverse total shoulder arthroplasty (rTSA) and hemiarthroplasty are recognized treatment options for significantly displaced proximal humerus fractures. Repair of the tuberosities and preservation of rotator cuff function is a principle of treatment to enhance function and prevent instability. Humeral fracture stems were developed to improve tuberosity union with hemiarthroplasty, and similarly fracture stems are used with rTSA with promising results. However, there are conflicting studies on the use of fracture stems in improving outcomes in rTSA for proximal humerus fracture. The purpose of this study is to determine the clinical and radiographic outcomes, complication and revision rates, and patient satisfaction for fracture vs. standard stems for acute proximal humerus fracture treated with rTSA.</p></div><div><h3>Methods</h3><p>A prospective multi-institutional institutional review board approved registry with a minimum two-year follow-up was queried and identified 231 patients that underwent rTSA for acute proximal humerus fracture, 187 of which received a fracture stem and 44 that received a standard stem. Patients were excluded if there was a previous fracture repair, malunion, or nonunion. Patient demographics, clinical and radiographic outcomes, complications, revision surgery, and patient reported outcome measures were collected preoperatively and at latest follow-up postoperatively.</p></div><div><h3>Results</h3><p>The mean follow-up was 48 <span><math><mrow><mo>±</mo></mrow></math></span> 24 and 54 <span><math><mrow><mo>±</mo></mrow></math></span> 34 months, mean age was 74 <span><math><mrow><mo>±</mo></mrow></math></span> 7.9 and 72 <span><math><mrow><mo>±</mo></mrow></math></span> 8.6 years, and mean body mass index was 28 <span><math><mrow><mo>±</mo></mrow></math></span> 6.1 and 30 <span><math><mrow><mo>±</mo></mrow></math></span> 5.3 kg/m² for fracture and standard stems, respectively. Both fracture and standard stem groups showed significant improvements in patient reported clinical outcomes preoperative to postoperatively. Postoperatively, patients with fracture and standard stems had comparable abduction, forward elevation, internal rotation, external rotation, Visual Analog Scale pain, Global Shoulder Function scale, Simple Shoulder Test scale, American Shoulder and Elbow Surgeons scale, University of California Los Angeles Shoulder score, and Shoulder Arthroplasty Smart score. Patient satisfaction was high and did not differ between the two groups. Similar rates of humeral radiolucent lines, scapular notching, complications, and revision rates occurred between the fracture vs. standard stem groups.</p></div><div><h3>Conclusion</h3><p>There were no significant differences in postoperative clinical outcomes, radiographic outcomes, complication rate, revision rate, and patient satisfaction between the fracture and standard stem groups for the treatment of acute proximal humerus fracture usi","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 371-376"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632230","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":"Increased risk of 90-day deep surgical site infection and periprosthetic joint infection following total shoulder arthroplasty in psoriasis patients","authors":"Philip M. Parel BS ,&nbsp;Amil R. Agarwal BA ,&nbsp;Abhisri Ramesh BS, MBA ,&nbsp;Andrew B. Harris MD ,&nbsp;Kevin Mathew MD ,&nbsp;Matthew J. Best MD ,&nbsp;Uma Srikumaran MD, MBA, MPH","doi":"10.1053/j.sart.2023.12.006","DOIUrl":"10.1053/j.sart.2023.12.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Psoriasis, a chronic, immune-mediated disease, is a known risk factor for infectious complications following certain surgical procedures such as lower extremity arthroplasty. However, there is a paucity in the literature that observes the association of psoriasis and infectious complications following total shoulder arthroplasty (TSA). The primary research question was whether a diagnosis of psoriasis is associated with increased odds of short-term infectious complications and long-term surgical complications.</p></div><div><h3>Materials and methods</h3><p>A retrospective cohort analysis was performed using the PearlDiver all-payers’ claims database. Patients who underwent primary TSA were identified using Current Procedural Terminology and International Classification of Diseases procedure codes. Patients were then stratified into two groups: (1) patients with psoriasis who underwent TSA, and (2) patients without psoriasis who underwent TSA. Primary outcomes included the incidence of 90-day infectious complications including periprosthetic joint infection, deep surgical site infection, and sepsis. Secondary outcomes included the incidence of 5-year surgical complications including all-cause revision, aseptic revision, and septic revision. Univariate and multivariable regression analyses were conducted to compare complications between the cohorts.</p></div><div><h3>Results</h3><p>In total, 89,321 patients were included in this study, with 3311 (3.71%) having psoriasis. Patients with psoriasis had significantly higher odds of 90-day infectious complications following TSA including periprosthetic joint infection (1.63; <em>P</em> = .014) and deep surgical site infection (1.79; <em>P</em> = .003), when compared to those without psoriasis. There were no significant differences in odds of 5-year all-cause revisions, septic revisions, and aseptic revisions between the two cohorts.</p></div><div><h3>Discussion</h3><p>Psoriasis is associated with significantly higher 90-day infectious complications but not long-term implant complications. Orthopedic surgeons should be aware of the increased acute infectious complications in this population, promote preoperative counseling and extensive infectious precautions, and consider the use of alternative prophylaxis against infection. These findings also have implications for risk adjustments in increasingly common bundled payments or shared risk payment models.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 348-353"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632859","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":"Anatomic total shoulder arthroplasty with stemless humeral component, nonspherical head, and inlay glenoid: clinical outcomes at mean 4.4-year follow-up","authors":"Brett M. Cascio MD ,&nbsp;William S. Pietrzak PhD ,&nbsp;Kayla DeJean BS","doi":"10.1053/j.sart.2023.12.007","DOIUrl":"10.1053/j.sart.2023.12.007","url":null,"abstract":"<div><h3>Background</h3><p>Limitations of traditional stemmed anatomic total shoulder arthroplasty (aTSA) with a spherical head and onlay glenoid include 1) inaccurate replication of native nonspherical humeral head kinematics, 2) substantial bone resection, and 3) susceptibility to glenoid loosening. Our purpose was to examine the outcomes of stemless aTSA with a nonspherical head and inlay glenoid.</p></div><div><h3>Methods</h3><p>Sixty patients (63 shoulders) with end-stage glenohumeral osteoarthritis were treated by a single surgeon. The study population was limited to 22 patients/25 shoulders (13 male, 12 female; mean age 65.6 years) with 2-year minimum follow-up (mean 51.8 months) subdivided into 2 groups by age. The young group included 5 patients/5 shoulders (3 male, 2 female; mean age 52.2 years; mean follow-up 62.4 months), while the elderly group included 17 patients/20 shoulders (10 male, 10 female; mean age 68.9 years; mean follow-up 49.2 months). At the final follow-up, patient satisfaction and complications were evaluated and the Constant-Murley, American Shoulder and Elbow Surgeons, and SF-36 scores were compared to preoperative values. First postoperative radiographs were compared to the final follow-up for signs of gross loosening, implant tilt, subsidence, and periprosthetic radiolucency.</p></div><div><h3>Results</h3><p>No humeral shaft fractures, infections, glenoid/humeral component loosening, radiolucencies, shoulder dislocations, or neurovascular complications were encountered. No reoperations or revisions were performed. The entire study population (25 shoulders) showed significant increases in the Constant score (47.4-82.8, <em>P</em> &lt; .001), American Shoulder and Elbow Surgeons score (36.9-88.1, <em>P</em> &lt; .001), and all components of the SF-36 score (<em>P</em> &lt; .014) except general health perceptions (<em>P</em> = .490), role imitations (emotional) (<em>P</em> = .232), and mental health (<em>P</em> = .746), with a 95% patient satisfaction rate. There were no significant differences between the young and elderly groups in any outcomes (<em>P</em> &gt; .107).</p></div><div><h3>Conclusion</h3><p>Our results suggest that stemless aTSA performed with a nonspherical humeral head and inlay glenoid is a safe and effective treatment for glenohumeral osteoarthritis in both young and elderly patients. However, longer term studies with larger patient populations will be required for corroboration.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 354-363"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637449","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":"Predicting pain and function with the neutrophil-to-lymphocyte ratio in patients following primary reverse total shoulder arthroplasty","authors":"Andrew J. Nasr DPT ,&nbsp;Alexander Kowalske BSA ,&nbsp;Jijia Wang PhD ,&nbsp;Nitin B. Jain MD ,&nbsp;Michael Khazzam MD","doi":"10.1053/j.sart.2023.12.005","DOIUrl":"10.1053/j.sart.2023.12.005","url":null,"abstract":"<div><h3>Background</h3><p>Glenohumeral joint osteoarthritis is prevalent in the middle-aged and elderly population, affecting approximately 16%-20% of individuals. Total shoulder arthroplasty has become a common treatment for osteoarthritis, with a notable rise in the use of reverse total shoulder arthroplasty (rTSA) over the past decade. Despite improvements in surgical technique and prostheses, 22% of patients continue to experience chronic pain following shoulder arthroplasty. Currently, medical practitioners lack a reliable method for identifying which patients will suffer from persistent pain and functional limitations after surgery. In this context, the neutrophil-to-lymphocyte ratio (NLR), known for measuring immune-inflammatory reactions and neuroendocrine stress, has gained significant attention. Therefore, the purpose of this study was to explore the predictive potential of the NLR in identifying patients who will experience elevated pain and functional limitations after primary rTSA.</p></div><div><h3>Methods</h3><p>This study was a retrospective cohort design. Patient data were collected retrospectively between 2019 and 2021 and grouped based on preoperative NLR (≥2.5 and &lt;2.5). Primary outcome measures assessed were the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), Pittsburgh Sleep Quality Index, and Single Assessment Numeric Evaluation score. Secondary outcomes included active shoulder elevation and external rotation range of motion. Outcome measures were captured before surgery and at 6 and 12 months after surgery.</p></div><div><h3>Results</h3><p>At 6 months following surgery, patients with an NLR ≥2.5 scored significantly worse on the VAS (<em>P</em> = .0171), ASES (<em>P</em> = .0015), and Single Assessment Numeric Evaluation (<em>P</em> = .0226). Differences in Pittsburgh Sleep Quality Index scores were not significant (<em>P</em> = .2705). Forward elevation and external rotation range of motion were similar between groups at 6 months (<em>P</em> = .7777 and <em>P</em> = .2630, respectively). There was no statistically significant difference between groups at 12 months across all variables. Multivariate analysis showed that an NLR &lt;2.5 had a significant positive effect on the ASES score (<em>P</em> = .0011) at 6 months after adjusting for age, gender, body mass index, depression, low back pain, and diabetes.</p></div><div><h3>Conclusions</h3><p>Management of patients with chronic pain continues to be challenging with limited high-value interventions. Early identification of patients likely to have a protracted recovery following rTSA would allow for a multidisciplinary approach earlier in the recovery phase. Based on our results, patients who had a preoperative NLR value greater than 2.5 reported higher levels of pain, more functional limitations, and perceived poorer function at 6 months following rTSA. However, these effects were relatively small and not observed at the 12-month mark.</p","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 332-339"},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139538909","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 effect of humeral diaphyseal stem filling ratio on clinical and radiological outcome","authors":"Stijn G.C.J. de Joode MD,&nbsp;Philipp Kriechling MD,&nbsp;Alexandra S. Volp MD,&nbsp;Stefan Klotz MD,&nbsp;Mazda Farshad,&nbsp;Karl Wieser,&nbsp;Florian Grubhofer MD","doi":"10.1053/j.sart.2023.12.004","DOIUrl":"10.1053/j.sart.2023.12.004","url":null,"abstract":"<div><h3>Background</h3><p>The stem of the reverse shoulder arthroplasty (RSA) used in this study population relies on diaphyseal anchorage. The surgical strategy was to insert the largest possible stem size to achieve an adequate press-fit fixation resulting in a high diaphyseal filling ratio (FR). However, for different reasons, a high FR was sometimes not achievable. The aim of this study was to analyze the effect of different FR (high/medium/low) on clinical and radiographic outcome (ie, subsidence and humeral peri-implant bone resorption), complications, and revision surgeries after RSA.</p></div><div><h3>Methods</h3><p>One hundred ninety nine patients were included and analyzed for clinical and radiologic outcome at a mean follow-up of 31.8 months after RSA. Diaphyseal humeral stem FR were measured directly postoperative and patients were divided into a low (N = 67), medium (N = 66), or high (N = 66) FR group. Humeral component complications and revision surgeries were measured as primary end points. Constant-Murley Score, range of motion, and the Subjective Shoulder Value were analyzed for clinical outcome. Periprosthetic bone resorption, radiolucent lines, shaft subsidence, and change in shaft alignment were measured for radiologic outcome.</p></div><div><h3>Results</h3><p>Two intraoperative fractures were seen in the high FR group (3%) and none in the other groups. There was no clinical humeral component loosening and no correlation could be found between FR and revision surgery. No differences were found between the low, medium, or high FR groups regarding range of motion, Subjective Shoulder Value, and absolute and relative Constant-Murley Scores (<em>P</em> &gt; .05). Bone resorption was significantly more present in the high FR group, compared to the low FR ratio group, 4.5 (standard deviation ± 2.2) vs. 6.4 (standard deviation ± 1.8), respectively (<em>P</em> &lt; .001). However, no difference could be observed regarding radiolucent lines, shaft subsidence, or shaft alignment changes between the 3 groups.</p></div><div><h3>Conclusion</h3><p>High humeral diaphyseal stem FR in RSA is associated with more humeral bone resorption and might increase the risk for intraoperative stem fractures, compared to medium and low humeral diaphyseal stem FR. However, the FR does not have an effect on functional outcome or radiographic loosening signs after a mid-term follow-up of 31.8 months.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 340-347"},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000014/pdfft?md5=c7d944c74a4d66428fc25e46455d0f2c&pid=1-s2.0-S1045452724000014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635200","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":"Teres minor deficiency does not predict clinically inferior external rotation after reverse total shoulder arthroplasty: a 2-year matched cohort study","authors":"Anthony J. Marois MD,&nbsp;Tyler J. Brolin MD,&nbsp;David L. Bernholt MD,&nbsp;Frederick M. Azar MD,&nbsp;Thomas W. Throckmorton MD","doi":"10.1053/j.sart.2023.11.003","DOIUrl":"10.1053/j.sart.2023.11.003","url":null,"abstract":"<div><h3>Background</h3><p><span>Current teaching maintains that reverse total shoulder arthroplasty (RTSA) is unlikely to restore external rotation (ER) without a functional posterior </span>rotator cuff, specifically the teres minor (TM). This study compared restoration of ER in TM-deficient (TMD) with TM-intact (TMI) shoulders after RTSA.</p></div><div><h3>Methods</h3><p><span>All patients who underwent lateralized RTSA using an onlay prosthesis with no adjunct tendon transfers between January 2014 and July 2020 and with 2-year follow-up were identified. Preoperative imaging review identified patients with TMD, and </span>propensity score matching was used to create a control group of equal size. TMD was divided into three subgroups: 1) atrophy; 2) fracture/malunion/nonunion (proximal humerus); and 3) endoprosthesis. Primary outcome measures were active ER range of motion (ROM) measured at the side, ΔER ROM from baseline, ER strength, and American Shoulder and Elbow Surgeons subscore question, “can you reach back of head.”</p></div><div><h3>Results</h3><p>Thirty-nine patients with TMD shoulders (atrophy: n = 15; fracture n = 14; endoprosthesis: n = 10) were matched with 39 patients with TMI shoulders. Although TMD was associated with reduced baseline ER ROM (13.6 vs. 28.8; <em>P</em> = .004), the TMD group achieved greater ΔER ROM 2 years after RTSA (24.6 vs. 10.3; <em>P</em> = .014) and demonstrated comparable 2-year ER ROM (38.6 vs. 40.7; <em>P</em> = .484). The TMD group had a higher rate of ER weakness (12% vs. 0%; <em>P</em> = .044) but no difference in ability to reach back of head (unable: 24% vs. 20%; <em>P</em> = .686) or patient-reported functional scores (2-year American Shoulder and Elbow Surgeons: 76.2 vs. 74.8; <em>P</em> = .793).</p></div><div><h3>Conclusion</h3><p>This study suggests that patients with an insufficient or absent teres minor can achieve satisfactory ER ROM and function after lateralized RTSA similar to their TMI peers. Future study will seek to identify muscle activation patterns of the shoulder girdle that allow TMD patients to overcome this insufficiency to perform activities requiring ER.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 297-303"},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392236","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":"Press-fit humeral implants in revision shoulder arthroplasty are as effective as cemented arthroplasty: a retrospective cohort study","authors":"Joseph W. Kocan MD ,&nbsp;Amrit V. Vinod MD ,&nbsp;Sonja Pavlesen MD, MS ,&nbsp;Mathew J. DiPaola MD ,&nbsp;Thomas R. Duquin MD","doi":"10.1053/j.sart.2023.11.002","DOIUrl":"10.1053/j.sart.2023.11.002","url":null,"abstract":"<div><h3>Background</h3><p>Revision shoulder arthroplasty (RSA) is an increasingly common procedure that can involve cemented or uncemented humeral implants. Although cement fixation is often advocated, it is not clear if the outcome is comparable to that of press-fit fixation. This study evaluated the survivorship and outcomes of cemented and press-fit humeral components in patients undergoing RSA at our institution.</p></div><div><h3>Methods</h3><p>Medical records from adult patients who underwent RSA were reviewed retrospectively. Demographics and surgical data as well as subjective and objective outcome measures were collected. Patients were stratified into 3 groups according to their humeral revision type: cemented, uncemented, and retained stems.</p></div><div><h3>Results</h3><p>A total of 70 RSA patients with an average follow-up of 51.8 ± 43.9 months were included in the analysis: stems were cemented in 18.6% of the patients, uncemented in 61.4%, and retained in 20.0%. There were no significant group differences in patient characteristics. Follow-up data were available for 54 (77.1%) patients 2 or more years after RSA. There were no differences in patient-reported outcome measures among the groups. Active abduction at 1 year was greater for uncemented revisions than for cemented and retained stem components (128.9° ± 49.7° vs. 98.1° ± 55.7° and 100.8° ± 49.9°, respectively; <em>P</em> &lt; .05). Patients in the uncemented and retained stem cohorts had greater strength in forward flexion, abduction, and external rotation than those in the cemented cohort, whereas patients in the cemented stem group had lower internal rotation strength at 1 and 2+ years of follow-up (<em>P</em> &lt; .05). Postoperative radiographs indicated that none of the stems were at risk for failure. However, humeral bone loss was more common among those with uncemented stems (<em>P</em> = .02); in most of the cases, the loss was attributable to stress shielding. Survivorship of the implants did not differ among the groups, ranging from 91.1% to 92.3%.</p></div><div><h3>Conclusion</h3><p>Press-fit humeral components may be a viable option for RSA in patients with adequate humeral bone stock.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 304-312"},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452723001736/pdfft?md5=dfd28cca3ba1586bbd05dc2234c22e42&pid=1-s2.0-S1045452723001736-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139393236","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":"Reverse total shoulder arthroplasty for proximal humerus fracture: a complex episode of care associated with increased surgical and medical complications","authors":"Cory K. Mayfield MD,&nbsp;Kevin C. Liu BS,&nbsp;N. Mina Hwang MPH,&nbsp;Ioanna K. Bolia MD, PhD,&nbsp;Seth C. Gamradt MD,&nbsp;Alexander E. Weber MD,&nbsp;Joseph N. Liu MD,&nbsp;Frank A. Petrigliano MD","doi":"10.1053/j.sart.2023.12.002","DOIUrl":"10.1053/j.sart.2023.12.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Reverse total shoulder arthroplasty (rTSA) remains a viable treatment option in elderly patients with proximal humerus fractures (PHF). However, the risk profile of this procedure in this patient population has not been well established by prior studies. The aim of this study is to examine whether there are differences in sociodemographic variables, underlying medical comorbidities, and 90-day outcomes between patients undergoing rTSA for osteoarthritis (OA) vs. PHF. We hypothesized that patients with PHF would be older and have higher comorbidity burden compared to glenohumeral OA controls. Furthermore, we hypothesized that rTSA would yield inferior outcomes and higher costs of care in patients with PHF compared to glenohumeral OA.</p></div><div><h3>Methods</h3><p>Patients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. PHF patients were identified using the International Classification of Diseases, Tenth Revision diagnosis codes and compared to OA controls. All patients &lt; 18 years old and those who underwent rTSA for other indications were excluded. Patients were matched in a 2:1 fashion based on age (± 3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, comorbidities and 90-day surgical (wound complications, dislocation, periprosthetic fracture, periprosthetic joint infection, stiffness, loosening, mechanical complications, and revision) and medical (deep vein thrombosis/pulmonary embolism, pneumonia, respiratory failure, renal failure, stroke, myocardial infarction, and sepsis) complications and readmission were compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at <em>P</em> &lt; .05. Odds ratio (OR) and 95% confidence interval were calculated.</p></div><div><h3>Results</h3><p>Before matching 51,150 OA controls and 11,394 PHF cases were identified. After matching, 8661 PHF cases were matched to 17,332 controls. Regarding surgical complications, PHF patients were at significantly increased risk of periprosthetic fracture (OR 2.35), dislocation (OR 2.87), superficial wound infection (OR 5.51), periprosthetic joint infection (OR 1.91) and 90-day revision (OR 4.76). PHF patients were at increased risk of all medical complications examined including hemorrhage (OR 2.20), anemia (OR 2.78) deep vein thrombosis (OR 3.10), pulmonary embolism (OR 2.83), pneumonia (OR 2.93), respiratory failure (OR 3.37), pneumonia (OR 2.93), stroke (OR 2.61), myocardial infarction (OR 2.79), acute renal failure (OR 4.06), urinary tract infection (OR 5.50) and sepsis (OR 3.71) as well as 90-day readmission (OR 2.13).</p></div><div><h3>Discussion/Conclusion</h3><p>Patients undergoing rTSA for PHF are at significantly increased risk of complications compared to OA controls. Furthermore, these patients are at increased risk of 90-day readmission. These findings should prompt dil","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 313-320"},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392635","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}