Journal of Shoulder and Elbow Surgery最新文献

{"title":"Single Shot Interscalene Block with Liposomal Bupivacaine versus Non-Liposomal Bupivacaine in Shoulder Arthroplasty.","authors":"Samuel Lorentz, Jay M Levin, Eric Warren, Eoghan T Hurley, Frederic B Mills, Bryan S Crook, Emily Poehlein, Cynthia L Green, W Michael Bullock, Jeff C Gadsden, Christopher S Klifto, Oke Anakwenze","doi":"10.1016/j.jse.2024.05.046","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.046","url":null,"abstract":"<p><strong>Background: </strong>Regional anesthesia is a valuable component of multimodal pain control in total shoulder arthroplasty (TSA), and multiple interscalene block anesthetic options exist, including non-liposomal interscalene bupivacaine (NLIB) and liposomal interscalene bupivacaine (LIB). The purpose of the current of study was to compare pain control and opioid consumption within 48 hours postoperative in those undergoing TSA with either LIB or NLIB.</p><p><strong>Methods: </strong>This was a retrospective cohort study at a single academic medical center including consecutive patients undergoing inpatient (>23-hour hospitalization) primary anatomic or reverse TSA from 2016 to 2020 who received either LIB or a NLIB for perioperative pain control. Perioperative patient outcomes were collected including pain levels and opioid usage, as well as 30- and 90-day ED visits or readmissions. The primary outcome was postoperative pain and opioid use.</p><p><strong>Results: </strong>Overall, 489 patients were included in this study (316 LIB and 173 NLIB). Pain scores at 3, 6, 12, and 48 hours postoperatively were not statistically significantly different (p>0.05 for all). However, the LIB group had improved pain scores at 24- and 36-hours postoperative (p<0.05 all). There was no difference in the incidence of severe postoperative pain, defined as a 9 or 10 NRS-11 score, between the two anesthesia groups after adjusting for preoperative pain and baseline opioid use (OR: 1.25; 95% CI: 0.57-2.74; p=0.57). Overall, 99/316 (31.3%) of patients receiving LIB did not require any postoperative opioids compared with 38/173 (22.0%) receiving NLIB; however, this difference was not statistically significant after adjusting for prior opioid use and preoperative pain (p=0.33). No statistically significant differences in postoperative total morphine equivalents or mean daily morphine equivalents consumed between the groups were found during their hospital stays (p>0.05 for both). Finally, no significant differences in 30- and 90-day ED visits or readmission rates were found (all p>0.05).</p><p><strong>Conclusion: </strong>LIB and NLIB demonstrated differences in patient reported pain scores at 24- and 36-hours post operation, although these did not reach clinical significance. There were no statistically significant differences in opioid consumption during the hospital stay, including opioid use, total morphine equivalents and daily mean morphine equivalents consumed during the hospital stay. Additionally, no differences were observed in 30- and 90-day ED visits or readmission rates.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735471","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":"EFFECTIVENESS OVER TIME OF THE REVERSE SHOULDER PROSTHESIS FOR ACUTE PROXIMAL HUMERAL FRACTURE.","authors":"Emilio Sebastiá-Forcada, Julia González-Casanueva, Francisco Antonio Miralles-Muñoz, Laiz Lissette Bello Tejeda, Carlos de la Pinta-Zazo, M Flores Vizcaya-Moreno","doi":"10.1016/j.jse.2024.05.045","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.045","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (RSA) has proven to be an effective surgical procedure for irreparable rotator cuff tears, comminuted fractures of the proximal humerus and shoulder arthroplasty revision surgeries. We know from the literature that the functional results are good in the short term, but not whether these results remain stable in the long term or, on the contrary, show a deterioration in functionality.</p><p><strong>Objective: </strong>This study aims to analyze the functionality, degree of satisfaction, complications, and prosthesis survival at different cut-off points in patients with complex proximal humerus fractures treated with RSA, with a minimum postoperative follow-up of 7 years.</p><p><strong>Material and methods: </strong>Analytical, longitudinal and prospective observational study of a cohort of patients treated for a fracture of the proximal humerus with PIH. Functional outcome was assessed using the Constant scale and the Constant adjusted for age and gender of the patients. Quality of life was measured using the University of California at Los Angeles Shoulder Assessment scale (UCLA) and the Disability of the Arm, Shoulder and Hand score scale (QuickDASH). In addition, range of motion, pain and radiological variables of loosening, scapular notching and tuberosity consolidation were assessed.</p><p><strong>Results: </strong>Thirty-three patients were included with a mean postoperative follow-up of 8.3 years (range 7-12 years). There was a progressive and significant decrease in Constant score at 5and7years follow-up compared to the baseline assessment 2 years after surgery, although the effect size was not significant. The age- and sex-adjusted Constant as well as the UCLA scale did not show statistically significant variations at follow-up. Both shoulder abduction and anterior shoulder flexion correlated well with the final QuickDASH score. Radiological variables did not influence any of the study outcome variables.</p><p><strong>Conclusion: </strong>The functionality and quality of life of patients with complex proximal humerus fractures treated with RSA decreased significantly compared to the 2-year evaluation, although this change was not clinically relevant. Survival of RSA was satisfactory in the medium to long term with a low complication rate.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735468","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":"Improved restoration of biomechanical factors using a narrow-box shape reconstruction compared to a wide one in superior capsular reconstruction for irreparable supraspinatus tendon tears. A biomechanical study using a static shoulder simulator.","authors":"Sebastian Wegmann, Stephanie Kahmann, Christoph Marchal, Tim Leschinger, Kilian Wegmann, Lars-Peter Mueller, Michael Hackl","doi":"10.1016/j.jse.2024.05.040","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.040","url":null,"abstract":"<p><strong>Purpose: </strong>To biomechanically compare superior glenohumeral translation, subacromial contact pressures and area in a box-shape reconstruction using the long head of biceps tendon (LHBT) in an irreparable supraspinatus tendon tear model.</p><p><strong>Methods: </strong>Seven cadaveric shoulders (mean age 61 years; range 32-84 years; SD 22.3) were tested with a custom testing rig used to evaluate superior translation, subacromial contact pressures and areas at 0°, 30° and 60° of glenohumeral abduction. Conditions tested included the native state, a complete tear of the supraspinatus tendon, a wide box-shaped, double-bundle LHBT superior capsular reconstruction (wide BS-SCR), and a narrow box-shaped, double-bundle LHBT superior capsular reconstruction (narrow BS-SCR).</p><p><strong>Results: </strong>Compared to the wide box-shape SCR, the narrow box-shape SCR had statistically significant lower median contact pressure at 30° and 60°. The subacromial contact area showed a statistically significant difference at 0° (p=0.001) and 30° (p=0.004) for the narrow compared to wide box-shape SCR. At an abduction angle of 0°, the narrow SCR could restore superior translation statistically significant better compared to the wide construct. For all angles, the wide and narrow box-shaped SCR increased the median subacromial distance statistically significantly. The contact areas in 30° and 60° of abduction were higher for all scenarios, both peaking in the intact state in 30° with approximately 600 mm².</p><p><strong>Conclusions: </strong>In comparison to a wide box-shape, a narrow box-shape SCR using the LHBT has biomechanical advantages in regard of subacromial contact pressures, the subacromial contact areas as well as the acromiohumeral distance. The width of the reconstruction therefore has direct influence in the success of the technique.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735469","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":"Overexpression of PRDM16 Improves Muscle Function after Rotator Cuff Tears.","authors":"He Zhang, Aboubacar Wague, Agustin Diaz, Mengyao Liu, Luke Sang, Alex Youn, Sankalp Sharma, Nesa Milan, Hubert Kim, Brian Feeley, Xuhui Liu","doi":"10.1016/j.jse.2024.05.037","DOIUrl":"10.1016/j.jse.2024.05.037","url":null,"abstract":"<p><strong>Introduction: </strong>Muscle atrophy, fibrosis and fatty infiltration (FI) are commonly seen in rotator cuff tears (RCT), which are critical factors that directly determine the clinical outcomes for patients with this injury. Therefore, improving muscle quality after RCT is crucial in improving the clinical outcome of tendon repair. In recent years, it has been discovered that adults have functional beige/brown adipose tissue (BAT) which can secrete batokines to promote muscle growth. PRDM16, a PR-domain containing protein, was discovered with the ability to determine the brown fat cell fate and stimulate its development. Thus, the goal of this study is to discover the role of PRDM16 in improving muscle function after massive tendon tears using a transgenic mouse model with an elevated level of PRDM16 expression.</p><p><strong>Methods: </strong>Transgenic aP2 driven PRDM16 overexpression mice and C57BL/6J mice underwent unilateral supraspinatus (SS) tendon transection and suprascapular nerve transection (TTDN) as described previously (N=8 in each group). DigiGait was performed to evaluate forelimb function at 6 weeks post the TTDN injury. Bilateral SS muscles, interscapular brown fat, epididymal white fat, and inguinal beige fat were harvested for analysis. The expression of PRDM16 in adipose tissue was detected by Western Blot. Masson's trichome staining was conducted to evaluate the muscle fibrosis and Oil Red O staining was used to determine the fat infiltration. Muscle fiber type was determined by MHC expression via immunostaining. All data was presented in the form of mean±SD. T-test and two-way ANOVA analysis was performed to determine a statistically significant difference between groups. Significance was considered when P<0.05.</p><p><strong>Results: </strong>Western blot data showed an increased expression of PRDM16 protein in both white and brown fat in PRDM16-overexpression mice compared to wild-type (WT) mice. Even though PRDM16 overexpression had no effect on increasing muscle weight, it significantly improved the forelimbs function with longer brake, stance and stride time, larger stride length and paw area in mice after RCT. Additionally, PRDM16 overexpression mice showed no difference in amount of fibrosis when compared to WT mice, however, they had significantly reduced area of fatty infiltration. These mice also exhibited abundant MHC-IIx fiber percentage in supraspinatus muscle after TTDN.</p><p><strong>Conclusion: </strong>Overexpression of PRDM16 significantly improved muscle function and reduced fatty infiltration after rotator cuff tears. Promoting BAT activity is beneficial in improving rotator cuff muscle quality and shoulder function after RCT.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735470","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":"Augmented Reality Assisted Intraoperative Navigation Increases Precision of Glenoid Inclination in Reverse Shoulder Arthroplasty.","authors":"Rony-Orijit Dey Hazra, Alp Paksoy, Jan-Philipp Imiolczyk, Henry Gebauer, Agahan Hayta, Doruk Akgün","doi":"10.1016/j.jse.2024.05.039","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.039","url":null,"abstract":"<p><strong>Background: </strong>Reverse Total Shoulder Arthroplasty (RTSA) is the standard of care for patients with glenohumeral osteoarthritis and rotator cuff deficiency. Preoperative RTSA planning based on medical images and patient-specific instruments has been established over the last decade. This study aims to determine the effects of using augmented reality assisted intraoperative navigation (ARIN) for baseplate positioning in RTSA compared to preoperative planning. It is hypothesized that ARIN will decrease deviation between preoperative planning and postoperative baseplate positioning. Moreover, ARIN will decrease deviation between the (senior) more (> 50 RTSA/year) and less experienced (junior) surgeon (5-10 RTSA/year).</p><p><strong>Methods: </strong>Preoperative CT scans of sixteen fresh-frozen cadaveric shoulders were obtained. Baseplate placements were planned using a validated software. The data was then converted and uploaded to the augmented reality system (NextAR; Medacta International, Castel San Pietro, Switzerland). Each of the eight RTSAs were implanted by a senior and a junior surgeon, with four RTSAs utilizing ARIN and four without. A postoperative CT scan was performed in all cases. The scanned scapulae were segmented, and the preoperative scan was laid over the postoperative scapula by nearest iterative point cloud analysis. The deviation from the planned entry point and trajectory was calculated regarding the inclination, retroversion, medialization (reaming depth)/lateralization, antero-posterior position and superior/inferior position of the baseplate. Data are reported as mean ± standard deviation (SD) or mean and 95% confidence interval (CI). P values <0.05 were considered statistically significant.</p><p><strong>Results: </strong>The use of ARIN yielded a reduction in the absolute difference between planned and obtained inclination from 9° (SD: 4°) to 3° (SD°:2) (p=0.011). Mean difference in planned-obtained inclination between surgeons was 3° in free-hand surgeries (95%CI: -4,10, p=0.578), while this difference reduced to 1° (95%CI: -6, 7, p=0.996) using ARIN. Retroversion, medialization (reaming depth)/lateralization, antero-posterior position and superior/inferior position of the baseplate were not affected by using ARIN. Surgical duration was increased using ARIN for both the senior (10 mins) and junior (18 mins) surgeon.</p><p><strong>Conclusions: </strong>The implementation of augmented reality assisted intraoperative navigation (ARIN) leads to greater accuracy of glenoid component placement, specifically with respect to inclination. Further studies have to verify if this increased accuracy is clinical important. Furthermore, ARIN allows less experienced surgeons to achieve a similar level of accuracy in component placement comparable to more experienced surgeons. However, the potential advantages of ARIN in RTSA are counterbalanced by an increase in operative time.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735537","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":"Solid organ transplant patients do well after shoulder arthroplasty: a propensity matched analysis.","authors":"Akshar V Patel, George R Durisek, Erryk S Katayama, Amogh I Iyer, Jordan Haber, Gregory L Cvetanovich, Julie Y Bishop, Ryan C Rauck","doi":"10.1016/j.jse.2024.05.041","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.041","url":null,"abstract":"<p><strong>Background: </strong>SOT recipients are commonly prescribed immunosuppressive therapies which may predispose patients to higher infection and complication rates following total shoulder arthroplasty. This article aims to analyze the effects SOT and subsequent immunosuppressive regimens have on the functional and patient reported outcomes of total shoulder arthroplasties.</p><p><strong>Methods: </strong>A single institution, multi-surgeon retrospective case-control study investigating the functional and patient reported outcomes of shoulder arthroplasty after SOT was conducted between the years of 2010-2020. To be included in the study, patients must have undergone SOT prior to primary total shoulder arthroplasty. A 4:1 match-paired control group lacking SOT prior to arthroplasty was then constructed. Thirty-four SOT patients (18 males and 16 females) and 136 control patients (77 male and 59 female) were included in the study. Patients were analyzed who underwent SOT prior to shoulder arthroplasty, with outcomes compared to controls who only underwent arthroplasty. The primary outcomes include range of motion (ROM) and strength in forward elevation, external rotation, and internal rotation, and patient reported outcomes.</p><p><strong>Results: </strong>There was no significant difference in improvement for range of motion and strength between the two cohorts, but within each cohort, improvement was statistically significant. In the SOT patients, forward elevation improved by 56^o ± 52^o, external rotation increased 13^o ± 20^o, and internal rotation increased by two vertebral levels. In the non-SOT patients, forward elevation improved 45^o ± 51^o, external rotation increased 16^o ± 25^o, and internal rotation increased by three vertebral levels. SOT patients had equivocal VAS pain and Simple Shoulder Test scores but lower ASES (59 ± 13 vs 79 ± 2; p=0.002) and SANE (61 ± 30 vs 84 ± 17; p<.001) scores than non-SOT patients. Complication rates were significantly higher in the SOT group (15% vs 6%; p=0.05), but incidence of surgical revisions was not significantly different (SOT = 3%; non-SOT = 5%; p=0.59).</p><p><strong>Conclusion: </strong>Shoulder arthroplasty is a safe, effective surgical intervention for improving shoulder function in patients with a history of SOT. Despite being on chronic immunosuppressive regimens, our solid organ transplants had comparable clinical outcomes and revision rates, but higher complication rates.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735472","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":"Outcomes and Performance Following Posteromedial Elbow Debridement in Major League Baseball Players.","authors":"Colby C Wollenman, Phillip J Davis, Gabriel C Lane, Jacob A Fox, Eric N Bowman, Lance E LeClere","doi":"10.1016/j.jse.2024.05.035","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.035","url":null,"abstract":"<p><strong>Background: </strong>Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic débridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure, and none have specifically addressed professional level athletes.</p><p><strong>Hypothesis/purpose: </strong>We hypothesized that following posteromedial elbow débridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance.</p><p><strong>Methods: </strong>Using publicly accessible websites, MLB athletes undergoing posteromedial elbow débridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included Earned Runs Average (ERA), Walks Plus Hits Per Innings Pitched (WHIP), innings pitched, and fastball velocity.</p><p><strong>Results: </strong>A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n=32) of players returned to play at the MLB level at a mean time of 176.1 ± 69 days. Pitchers exhibited a return to play (RTP) rate of 76.9% (n=20) at 175.8 ± 16 days. A total of 38.5% (n=10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n=5). No statistically significant differences between single season pre/postoperative pitching metrics were identified. A small but significant (p<0.05) decrease in fastball velocity (94.4 vs 92.84; p=0.02) was observed over a three-season comparison.</p><p><strong>Conclusion: </strong>Contrary to our hypothesis, this study demonstrates that posteromedial elbow débridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season pre- and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724867","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":"High Delta Angle after Reverse Total Shoulder Arthroplasty increases stresses of the acromion: Biomechanical study of different implant positions.","authors":"Pascal Schenk, Nikita Sutter, Erasmo Molina, Karl Wieser, Christian Gerber, Elias Bachmann","doi":"10.1016/j.jse.2024.05.034","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.034","url":null,"abstract":"<p><strong>Background: </strong>Acromial fractures after Reverse Total Shoulder Arthroplasty (RTSA) are a common complication. Nevertheless, only a few studies have identified risk factors for acromial fractures after RTSA. High delta angle (combination of inferiorization and medialization of the center of rotation) after RTSA was identified as a risk factor in recent studies. The aim of this study was the biomechanical exploration of different delta angles and implant configurations with regard to the acromial stress.</p><p><strong>Methods: </strong>In a rigid body model of the upper extremity muscle, forces of the deltoid muscle were calculated before and after implanting RTSA in different arm and implant positions. The deltoid muscle was divided into an anterior, middle, and posterior part. Implant positions of the glenoid components were changed in the medialization, lateralization and inferiorization of the center of rotation (COR) as well as lateralization of the humeral component. Further, in a finite element model of the upper extremity, the stresses of the acromion in the same implant design configurations were measured.</p><p><strong>Results: </strong>Differences in acromial stress between different delta angle model configurations were observed. Lateralization (5 mm, 10 mm) of the glenosphere reduced maximal acromial stress by 21% (1.5 MPa) and 31% (1.3 MPa), respectively. Inferiorization (5 mm, 10 mm) of the glenosphere increased maximal acromial stress by 5% (2.0 MPa) and 15% (2.2MPa), respectively. Changes in positioning the humeral component was found to have the highest impact in this model configuration. A 10 mm lateralized humeral component reduced acromial stress by 37% (1.2 MPa) while in the 6 mm medialized configuration, an increase in acromial stress by 83% (3.48 MPa) was observed. There was a high correlation between delta angle and acromial stress (R-squared = 0.967).</p><p><strong>Conclusion: </strong>Implant design configuration has an impact on the acromial stress. High delta angles correlate with an increase in acromial stress. Both lateralization of the COR and the humerus decreased the acromial stress in our study. The lateralization of the humerus has the highest impact in influencing acromial stress. Due to contrary results in the current literature, further studies with focus on the acromial stress influenced by different anatomical variants of the shoulder and the acromion are needed before a clinical recommendation can be made.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724866","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":"Comparison Of Early And Late Aseptic Baseplate Failure In Primary Reverse Shoulder Arthroplasty With And Without Structural Glenoid Autograft.","authors":"Eddie Y Lo, Austin Witt, Alvin Ouseph, Paolo Montemaggi, Raffaele Garofalo, Alexander Sanders, Temilola Majekodunmi, Jeffrey Sodl, Sumant G Krishnan","doi":"10.1016/j.jse.2024.05.038","DOIUrl":"https://doi.org/10.1016/j.jse.2024.05.038","url":null,"abstract":"<p><strong>Introduction: </strong>Early reverse total shoulder arthroplasty (RTSA) designs demonstrated high glenoid baseplate complication and revision rates. While contemporary designs have reduced the incidence of glenoid baseplate failures, there are reports of elevated failure risks in RTSA with glenoid bone grafting within the first 2 years. This study aims to evaluate the incidence and etiology of aseptic glenoid baseplate failure with a contemporary central screw baseplate. The null hypothesis is that majority of the baseplate failure occurs within the first 2 years and use of glenoid bone grafting does not lead to higher risk of baseplate failure.</p><p><strong>Methods: </strong>In 2014 - 2019, 753 consecutive patients who underwent primary RSA using the same inlay press-fit humeral stem and monoblock central screw baseplate were retrospectively reviewed. Fracture and septic arthropathy cases were excluded. All patients underwent preoperative radiographic and computed tomography evaluation. If there was significant glenoid erosion (Walch A2, B2, B3, C1, C2, E2, E3, and/or E4 variants), patient-specific structural glenoid bone grafting was performed. All patients underwent standardized radiographic follow-up and failure was strictly defined as any hardware breakage and/or shift in glenoid baseplate position. Failures were defined as \"early\" if occurring within 2 years and \"late\" if occurring greater than 2 years after surgery. Comparative analysis was performed to evaluate demographics, glenoid graft use, and graft union rates between the cohorts.</p><p><strong>Results: </strong>There were 23 patients with baseplate failures (23/753, 3.0%) at mean of 23 months. Twenty-two failures (96%) occurred in patients who received structural glenoid bone grafting. Only 1 failure (0.2%) occurred when bone grafting was not indicated (p<0.001). The most common failure pattern was associated with B2 glenoid (16/23, 70%). There were 5 (22%) early failures and 18 (78%) late failures. There were no differences in any patient demographic characteristics between cohorts. All 5 early failures had graft nonunion and 4/5 occurred without trauma. In the 18 late failures , 9/18 (50%) occurred without trauma (p=0.135). Seventeen of these patients had glenoid grafting, of which 9/17 (53%) had graft nonunion.</p><p><strong>Conclusions: </strong>Contemporary RTSA glenoid baseplate designs have an acceptably low incidence of failure. However, the addition of structural bone graft to correct glenoid wear leads to higher aseptic baseplate failure rate. The majority of these patients suffer failure after the 2-year postoperative mark, highlighting the necessity of longer follow-up. Further analysis is necessary to quantify glenoid characteristics (severity of glenoid erosion, critical size of graft) associated with failure.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724865","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":"Letter to the Editor: A type II error likely exists due to the low sample size.","authors":"Dipit Sahu","doi":"10.1016/j.jse.2024.05.033","DOIUrl":"10.1016/j.jse.2024.05.033","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724863","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}