Journal of Shoulder and Elbow Surgery最新文献

{"title":"Re-evaluating Surgical Treatment Protocol for Unstable Proximal Humerus Fractures: Emphasizing Soft Tissue Preservation via Minimally Invasive Approach over Structural Allograft Augmentation in Deltopectoral Approach: a Single-center Retrospective Study.","authors":"Kuan-Ting Chen, Chien-Chieh Wang, Po-Kuan Wu, Wen-Shuo Chang, Chung-Han Ho, Chi-Sheng Chien, Tsung-Mu Wu","doi":"10.1016/j.jse.2025.01.048","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.048","url":null,"abstract":"<p><strong>Background: </strong>Managing unstable proximal humerus fractures (PHFs), particularly in elderly patients, is challenging due to the need to balance stability with minimizing surgical trauma. The conventional deltopectoral approach with structural allograft for medial support is widely used but can involve significant soft tissue disruption. This study compares clinical and radiographic outcomes between a minimally invasive deltoid-split (MIS-DS) approach without allograft and the traditional deltopectoral approach with allograft.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective case-control study of 171 patients with unstable Neer's 3- and 4-part PHFs treated from January 2016 to July 2021. Patients were divided into two groups: the MIS-DS approach without allograft (n=90) and the deltopectoral approach with structural allograft (n=81). Outcome measures included range of motion (ROM), Constant-Murley (C-M), ASES, QuickDASH scores, and radiographic evaluations for fracture union, varus collapse, and screw perforation over a mean follow-up of 29.0 ± 2.4 months.</p><p><strong>Results: </strong>Clinical outcomes, including C-M and ASES scores, ROM, and QuickDASH, were comparable between the two groups. Radiographic assessments showed an avascular necrosis rate of 6.4%, varus collapse of 11.1%, and screw perforation of 8.8% across both cohorts. The allograft group demonstrated a shorter mean surgical time, though reoperation rates did not significantly differ.</p><p><strong>Conclusion: </strong>The MIS-DS approach, which emphasizes soft tissue preservation, achieves clinical and radiographic outcomes comparable to those of the deltopectoral approach with structural allograft augmentation in treating unstable PHFs. Given the similar outcomes between these techniques, surgeons may choose the approach they are most comfortable with, based on their expertise and the specific needs of the patient. Further prospective studies are recommended to validate these findings across larger populations.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¹⁸F-FDG PET/CT for the diagnosis of septic shoulder arthritis: metabolic uptake pattern and diagnostic performance.","authors":"Stefanie Heidemanns, Hannah Korzeniowski, Leopold Henssler, Lisa Klute, Jirka Grosse, Volker Alt, Dirk Hellwig, Maximilian Kerschbaum","doi":"10.1016/j.jse.2025.01.047","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.047","url":null,"abstract":"<p><strong>Background: </strong>Septic arthritis, although rare, is a critical joint-threatening emergency. The shoulder, being the third most common site after knee and hip joints, is predominantly affected by hematogenous spread of infection. F-18-FDG PET/CT has shown promise in identifying infectious foci and modifying treatment plans. This study aims to differentiate the metabolic patterns of septic shoulder arthritis from various stages of shoulder osteoarthritis using F-18-FDG PET/CT and assess its diagnostic performance.</p><p><strong>Methods: </strong>We retrospectively included subsequent patients diagnosed with septic shoulder arthritis between November 2017 and October 2023, who had undergone whole-body F-18-FDG PET/CT scans within two weeks before and after diagnosis. The control group included non-infected contralateral shoulder joints and patients who underwent F-18-FDG PET/CT for malignant melanoma staging without evidence of acute infections. Visual and quantitative analyses of F-18-FDG uptake, measured as SUVmax, were conducted. Osteoarthritis severity was categorized using the Kellgren and Lawrence system. To establish a cut-off for septic shoulder arthritis, a joint-liver-ratio was calculated using the SUVmax of the shoulder joint and liver. Intra- and interobserver reliability were assessed through repeated measurements.</p><p><strong>Results: </strong>Of 150 shoulders 149 were included in the study: 13 into the experimental group with confirmed septic arthritis and 136 into the control group. One shoulder was excluded from the control group due to metastasis. Thirteen shoulders had confirmed septic arthritis. In the control group F-18-FDG uptake measured by SUVmax increased significantly with osteoarthritis severity (p=0.001). Septic shoulder arthritis exhibited markedly higher F-18-FDG uptake compared to controls (p<0.001). Visual intensity assessments corroborated these findings (p<0.001). For a cut-off value of 1 for the joint-liver-ratio, sensitivity, specificity, positive predictive value and negative predictive value for distinguishing between septic shoulder arthritis and osteoarthritis were 92.3%, 80.9%, 31.6% and 99.1%, respectively. Inter- and intraobserver reliability were moderate to high. The intraclass correlation coefficients (ICC) for SUV measurements in the total shoulder were 0.994 and 0.996, respectively, while Cohen's kappa coefficients for visual analysis were 0.570 and 0.891.</p><p><strong>Conclusion: </strong>F-18-FDG PET/CT effectively differentiates septic shoulder arthritis from varying stages of osteoarthritis. The SUVmax in liver can be used as a cut-off value with high sensitivity and specificity. A negative F-18-FDG PET/CT excludes septic shoulder arthritis.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glenoid Version and Inclination Can be Accurately Predicted for Shoulder Arthroplasty from Preoperative Computed Tomography Scans Utilizing Virtual Implant Positioning^TM Despite Missing Angulus Inferior Data Using Statistical Shape Modeling.","authors":"Brian C Werner, Siddhant Thakur, Nick Metcalfe, Sergii Poltaretskyi","doi":"10.1016/j.jse.2025.01.041","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.041","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT)-based preoperative planning has become increasingly popular for shoulder arthroplasty. Scans which omit the angulus inferior of the scapula are common and can result in a rejection, but the effect of small amounts of missing scapula on the calculation of native version and inclination are unclear. The goals of this study were: (1) to determine the effect of increasing amounts of missing angulus inferior data on computed version and inclination and (2) to compare two methods of registering the scapula and calculating native version and inclination with increasing amounts of missing angulus inferior data.</p><p><strong>Methods: </strong>100 shoulder CT scans uploaded for clinical use were selected from a large database to encompass a broad spread of glenoid pathologies for the study. The mean retroversion was -9.7 degrees (range -37.8 to 5.5 degrees) and mean inclination 9.0 degrees (range -5.7 to 30.0 degrees). Each CT scan was first processed as it would be clinically within the Virtual Implant Positioning preoperative planning software. Each scapula then successively had 10mm, 20mm and 30mm of angulus inferior removed from the CT scan. The new version and inclination were then assessed using two methods: (1) the best fit scapular plane with an assumed point for the angulus inferior and (2) using a statistical shape model (SSM). Mean differences in calculated version and inclination were then compared to the true native version and inclination, and between the best fit plane method and SSM method for each level of inferior scapula cropping.</p><p><strong>Results: </strong>For the best fit plane method, no statistically significant mean differences were noted between 0 and 10 or 20mm of angulus inferior cropping, however 30mm of cropping resulted in statistically significant different mean differences in version (p < 0.001) and inclination (p = 0.040). For the SSM, there were no significant differences in the mean differences in version or inclination for any of the cropping levels. For all comparisons, the SSM statistically out-performed the best fit plane method.</p><p><strong>Conclusions: </strong>Less than 20 mm of missing angulus inferior data does not have a statistically significant effect on calculations of native version and inclination for preoperative CT-based planning utilizing Virtual Implant Positioning for shoulder arthroplasty. For patients with missing angulus inferior data, use of an SSM for scapula registration results in statistically significantly less mean and maximum differences from the true version and inclination compared to a 3D least squares best fit plane method.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pectoralis major tendon tears - a biomechanical study to analyze the influence of intra-tendinous suture distance on repair stability.","authors":"Christopher Wahlers, Kai Hoffeld, Jan Hockmann, Lars Peter Müller, Tim Leschinger, Michael Hackl","doi":"10.1016/j.jse.2025.01.045","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.045","url":null,"abstract":"<p><strong>Background: </strong>Tendon tears of the pectoralis major (PM) are uncommon and can be challenging to manage. The lack of consensus on optimal repair methods for PM tendon tears prompts further investigation.</p><p><strong>Methods: </strong>24 fresh-frozen shoulder specimens were used for this biomechanical in-vitro investigation. After simulating complete tears of the PM at its insertion, repair was performed with three suture anchors using a locking whipstitch technique of the PM tendon over a length of 2 (Group 2), 4 (Group 4) or 6 cm (Group 6), 8 specimens per group. Incremental cyclic loading of the specimens was performed from 10-200 N and the number of cycles and the force until failure (5 mm gap formation at the tendon-bone interface) occurred were analyzed.</p><p><strong>Results: </strong>The mean number of cycles until failure was 89 for group 2, 81 for group 4 and 175 for group 6. Group 6 withstood significantly more loading cycles than groups 2 and 4 (p = .019). The mean force until failure was 63.8 N for group 2, 67.5 N for group 4 and 110.0 N for group 6. Group 6 reached significantly higher failure loads when compared to groups 2 and 4 (p ≤ .014).</p><p><strong>Conclusions: </strong>This study contributes valuable insights into the optimal suture technique for repair of PM tendon tears, highlighting the biomechanical stability associated with varying lengths of locking whipstitches. The results of this investigation show that a locking whipstitch of the PM tendon over a length of 6 cm provides superior biomechanical properties at time zero. Clinical data is necessary to evaluate its relevance on the functional patient outcome.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Periprosthetic Joint Infection in Revision Shoulder Arthroplasty.","authors":"Bryan S Crook, Tom R Doyle, Mikhail Bethell, Samuel G Lorentz, Mark M Cullen, Eoghan T Hurley, Jessica L Seidelman, Thorsten M Seyler, Oke A Anakwenze, Christopher S Klifto","doi":"10.1016/j.jse.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.040","url":null,"abstract":"<p><strong>Introduction: </strong>In those undergoing revision shoulder arthroplasty, the diagnosis of periprosthetic joint infection (PJI) remains challenging with many clinical and diagnostic variables being considered. The purpose of the study was to evaluate the predictive value of pertinent preoperative and intraoperative factors associated with eventual PJI as determined by the 2018 International Consensus Meeting (ICM) criteria.</p><p><strong>Materials & methods: </strong>All revision shoulder arthroplasties performed at a single tertiary referral medical center from July 2013 and January 2024 were retrospectively analyzed. Patients were evaluated as definite, probable, possible or unlikely infection according to the 2018 ICM criteria.</p><p><strong>Results: </strong>Overall, 386 patients underwent revision shoulder arthroplasty, with a mean age of 70 ± 10 years and51.3% were female. According to the ICM criteria, 38 patients (9.8%) had definite PJI, 22 had probable PJI (5.7%), 23 had possible PJI (6.0%) and 302 were unlikely to have PJI (78.2%). The majority of patients (n, 71.8%) diagnosed with definitive PJI had one major criteria for diagnosis, with all 3 criteria only occurring in 5.1% of these patients. Patients with definite PJI met a mean of 4.6 ± 3.3 minor criteria, and those with probable PJI met a mean of 4.6 ± 2.9 minor criteria. Elevated ESR had the highest PPV (75.0%) of preoperative lab values collected, while elevated synovial white count and PMN% each had a PPV of 80%.</p><p><strong>Discussion: </strong>The majority of revisions shoulder arthroplasties are performed for patients who are unlikely to have a PJI, with less than 10% meeting ICM criteria for definite PJI. Most patients meeting criteria for definite PJI met only 1 major criteria, underscoring the importance of minor criteria in diagnosis. Serum ESR and CRP had moderate sensitivity and specificity for PJI, and aspiration may still have value in the standard diagnostic workup of shoulder PJI.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Metal Ion Levels in Patients with Failed Total Shoulder Arthroplasty.","authors":"Rishi Chatterji, Brandon T Fisher, Avianna Arapovic, Yuying Xing, J Michael Wiater","doi":"10.1016/j.jse.2025.01.046","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.046","url":null,"abstract":"<p><strong>Background: </strong>Shoulder arthroplasty systems are transitioning towards modular prosthesis options with the goal of reducing complication profiles and increasing range of motion. Modularity may increase the potential for fretting, corrosion, and subsequent release of metal ions. The purpose of this study was to identify associations between implant designs, metallurgy, patient characteristics, and serum metal ion levels in patients undergoing revision shoulder arthroplasty.</p><p><strong>Methods: </strong>51 patients that underwent revision shoulder arthroplasty were retrospectively reviewed based on prospectively collected data. All patients had serum metal ion levels (titanium, cobalt, chromium) measured in parts per billion (ppb) prior to their revision arthroplasty. Trends and correlations to serum ion levels were examined based on implant materials, number of modular components, and patient characteristics.</p><p><strong>Results: </strong>21 patients had prior anatomic total shoulder arthroplasty (ATSA) and 30 had prior reverse total shoulder arthroplasty (RTSA). The average age at primary arthroplasty was 64.7 years (49.0-84.0). The average term of implant was 4.83 years (0.18-21.0). 46 patients (90%) had titanium based humeral stems. 21 (100 %) ATSA humeral heads were comprised of cobalt chrome. 5 patients with prior ATSA had hybrid titanium and polyethylene glenoid components. In those with RTSA, 30 (100 %) had glenoid components composed of titanium baseplates and cobalt chrome glenospheres. Titanium ion levels were significantly higher in patients with greater than 7 total modular components (12.6 vs. 6.09 ppb, p=0.008). Titanium ion levels were significantly higher in patients with greater than 4 modular components when excluding screws (12.1 vs. 5.06, p = 0.038). The number of modular components did not have a statistically significant effect on cobalt or chromium serum ion levels. Patients with intraoperative metallosis during revision surgery had titanium ion levels 10.51 units higher on average (p = 0.009) than those without metallosis. There was no difference in titanium (p=0.63), cobalt (p=0.29), or chromium (p=0.58) levels in those patients with a proven infection compared to those without.</p><p><strong>Conclusions: </strong>Increasing modularity in primary TSA should be weighed with the potential for increased serum metal ion levels, particularly titanium. While the systemic effects of elevated serum titanium remain largely unknown, it may be a predictor for occult corrosion or need for revision. Metallosis poses challenges in the revision setting; however, the implications of increased serum metal ion levels on clinical outcomes after revision shoulder arthroplasty requires further studies.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Treatment of Proximal Humerus Fractures with an Early Active Motion Protocol - A Prospective Randomized Controlled Trail.","authors":"Ulrich Crepaz-Eger, Lukas Dankl, Dominik Knierzinger, Clemens Hengg","doi":"10.1016/j.jse.2025.01.042","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.042","url":null,"abstract":"<p><strong>Background: </strong>Proximal humerus fractures are common injuries in elderly patients. While a majority of fractures can be treated conservatively, open reduction and internal fixation (ORIF) with locking plates is still the most commonly used operative treatment modality. Regarding postoperative treatment, there is currently no consensus in the literature. A restrictive rehabilitation regime, which can lead to a prolonged and effortful rehabilitation process, may not make full use of the possibilities, that modern angular stable implants in combination with adequate patient selection and improved operative techniques have to offer. Therefore, the aim of our study is to investigate the functional results of a novel early active motion rehabilitation protocol for postoperative treatment of proximal humerus fractures treated with a locking plate.</p><p><strong>Methods: </strong>From 03.01.2016 to 02.29.2023 patients were prospectively screened for inclusion. In the conventional group (CG), patients underwent a strict postoperative protocol with immobilization in a shoulder-arm-sling for four weeks, which should be worn day and night. In the early functional group (EFG), no restrictions regarding movement and force were given. In both groups, no heavy lifting, no exhausting physical activity, and no blunt force on the arm was performed for three months postoperatively. Within a follow-up of 24 months, primary and secondary outcome parameters were collected.</p><p><strong>Results: </strong>We could not find a significant difference in DASH-Score, Constant Score and relative CS for the injured shoulder at any point of observation. After 24 Months, Constant score showed a mean of 81.3 (SD 11.6) points in the CG and 77.6 (SD 14) points in the EFG. Relative Constant Score was 89.8% of the uninjured side in both groups, respectively. DASH score showed a mean of 15.9 (SD 15.8) in the CG and 13.8 (SD 14.8) in the EFG. There was also no significant difference in VAS-score, Patient satisfaction and EQ-5-D-score in between the groups.</p><p><strong>Conclusion: </strong>We could demonstrate, that early active motion rehabilitation for postoperative treatment after locking plate fixation of proximal humerus fractures was not inferior to a restrictive treatment protocol after a follow-up period of 24 months, even in a slightly older and more comorbid patient population. Further studies investigating postoperative rehabilitation after ORIF of proximal humerus fractures should be conducted.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Microbial Landscape and Variations Based on Biological Sex, Age and Biopsy Location in the Shoulder Skin Microbiome.","authors":"Eleanor Burden, Yohannes Seyoum, Jonathan Peter Evans, William Thomas, Jeffrey Kitson, Timothy Batten, Rachel Patel, Mark van der Giezen, Christopher Smith","doi":"10.1016/j.jse.2025.01.044","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.044","url":null,"abstract":"<p><strong>Background: </strong>The organisms responsible for periprosthetic joint infections (PJI) of the shoulder are often skin pathogens originating from the patient's own skin flora at the time of surgery. Understanding the normal skin flora around the shoulder is an important step to identify the range of organisms that could be responsible for PJI, and ensure optimization of culture mediums to identify them. This study aimed to provide the first description of the shoulder skin microbiome using high-throughput next-generation sequencing methodology, and explore variations by age, biological sex and biopsy location.</p><p><strong>Methods: </strong>Patients undergoing arthroscopic surgery were approached for informed consent to have punch biopsies taken from anterior, lateral and posterior arthroscopy portal sites. DNA extraction was undertaken followed by Illumina sequencing, focusing on the V3-V4 regions of the 16S rRNA gene. Amplicon sequence variants (ASV) were generated using Deblur workflow and used for taxonomic assignment. Variation in the microbiota community based on age, biological sex and biopsy location was assessed through alpha and beta diversity metric calculations using phyloseq R package.</p><p><strong>Result: </strong>Sixty-two patients (24 female, 38 male) aged 18 to 80 were recruited, resulting in 186 punch biopsy samples for analysis. Following removal of low-prevalence taxa, 606 ASVs were aggregated at genus level resulting in 214 genera across 13 phyla. The top 20 most abundant genera accounted for 73.5% of the overall sequence count. Cutibacterium was the most abundant genus within the study population, followed by Ralstonia, Staphylococcus, Bacteroides and Streptococcus. Significant differences were observed in beta diversity metrics when comparing by biological sex, which accounted for 3.9%-5.3% of variation in the microbial community, but not age or biopsy location. Males displayed a greater proportion of Gram-positive and aerobic bacteria while females exhibited a greater proportion of Gram-negative and stress tolerant bacteria.</p><p><strong>Conclusion: </strong>This is the first study to look specifically at the microbiome of the cutaneous shoulder and describe the most abundant genera and compositional differences based on age, biological sex and biopsy location. Biological sex was the only host co-variant studied which reached significance in explaining microbiota variation. The top 20 most abundant genera, accounting for 74% of the overall sequence count, would be isolated with standard microbiological culture. As such this study does not highlight a need to change current culture investigation practice for shoulder PJI, but serves as an important catalogue of skin commensals around the operative site in shoulder surgery.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence of aseptic loosening and the potential impact of strut allografts in revision total elbow arthroplasty.","authors":"Jae Woo Shim, Dong Suk Kim, Min Jong Park","doi":"10.1016/j.jse.2025.01.043","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.043","url":null,"abstract":"<p><strong>Hypothesis and background: </strong>Revision total elbow arthroplasty (TEA) is challenging because of poor bone stock. We hypothesized that strut allografts providing structural reinforcement would reduce occurrence of aseptic loosening after revision TEA.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent revision TEA at our hospital between 2005 and 2022. Patients were excluded from the study if the bone loss was too severe and required allograft-prosthetic composite reconstruction, if the implant stem was not replaced, or if the follow-up period was < 2 years. Cortical thinning was defined as follows: 1) the overall cortical thickness was < 50% compared to the contralateral side, or 2) the cortex was locally thinner than the surrounding area by < 50% on the radiograph. Implant stability and aseptic loosening were analyzed on the final radiograph. The patients were divided into a Strut allograft group (n=9) and a Non-graft group (n=9) for comparison.</p><p><strong>Results: </strong>Eighteen patients were analyzed during the study period. There were 8 males and 10 females with an average age of 66 years (range, 39-82 years). The average follow-up period was 61 months (range, 24-183). Cortical thinning was observed in 11 patients (61%) at the time of revision TEA. There were no differences in pain visual analog scale, Quick-Disabilities of the Arm, Shoulder and Hand Score, and range of motion between the two groups. Aseptic loosening occurred in 1 patient (11%) in the Strut allografts group and in 3 patients (33%) in the Non-graft group, however this difference was not statistically significant. In Non-graft group, three patients developed aseptic loosening and subsequently underwent re-revision arthroplasty. In Strut allografts group, one patient had aseptic loosening, however the patient remained asymptomatic and observed without revision.</p><p><strong>Conclusion: </strong>Cortical thinning occurred in 61% of the patients undergoing revision TEA. Aseptic loosening is the most common complication of revision TEA, observed in 22% of the cases. The use of strut allografts did not show a significant association with a lower incidence of aseptic loosening. However, it may still have clinical value.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The changing effect of surgeon volume on revision rates in shoulder arthroplasty with time in Australia.","authors":"David R J Gill, Sophia Corfield, Peiyao Du, Michael J McAuliffe","doi":"10.1016/j.jse.2025.01.037","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.037","url":null,"abstract":"<p><strong>Background: </strong>The concept that surgical volume effects rates of total primary shoulder arthroplasty (TSA) revision is widely accepted. The aim of this study was to determine if surgical volume is confounded by patient, implant, institutional factors and time from TSA.</p><p><strong>Methods: </strong>Using data from a large national arthroplasty registry for the period 1 January 2008 to 31 December 2022, all interactions with orthopedic surgeon volume (SV) undertaking primary TSA procedures for all diagnoses were examined. A sub-analysis from 1 January 2017 provided a contemporary analysis with additional patient demographics. The primary outcome measure was the cumulative percentage revision (CPR) which was defined using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazard models with a multivariable adjustment.</p><p><strong>Results: </strong>The incidence of orthopedic surgeons completing TSA nationally increased from 0.9 per 100,000 population in 2008 to 1.8 in 2022. Of 55,605 TSA procedures, the CPR at 11 years varied from 8.8% (95% confidence interval (CI) 8.0, 9.6) and 5.6% (95%CI 4.0, 7.7) for implants by SV < 10 per annum surgeons and SV >35 prostheses, respectively. Instability/dislocation was the most common reason for revision. SV had a significant effect on the revision rate for all diagnoses (p= 0.001), instability/dislocation (p=0.018) and revision within 5 years of primary arthroplasty (p=0.011). In contrast, at sub analysis (last 5 years) there was no interaction both with main effects (SV effect adjusted by age and gender) and with an extended adjustment for both instability/dislocation and all cause revision.</p><p><strong>Conclusions: </strong>Nationally there is an increasing incidence of primary TSA procedures and surgeons performing them. The association between SV and revision rate is complex. While there is an association with main effects, there was no association in the last five years. Reduction in instability/dislocation revision rates contributed to this change. Patient, implant or institutional factors did not confound analysis of surgeon volume on primary TSA revision rates, but recency did.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}