Journal of Shoulder and Elbow Surgery最新文献

{"title":"The influence of age on cellular senescence in injured versus healthy muscle and its implications on rotator cuff injuries.","authors":"Kevin C Wang, Justin Lau, Steven M Garcia, Aboubacar Wague, Sankalp Sharma, Xuhui Liu, Brian T Feeley","doi":"10.1016/j.jse.2025.02.008","DOIUrl":"10.1016/j.jse.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>Advanced age increases the prevalence of rotator cuff tears and affects the success of repair surgeries. Cellular senescence is proposed as a key mechanism behind these age-related differences, likely due to contribution of the senescence-associated secretory phenotype. This state is linked to various age-related diseases, including rotator cuff injuries.</p><p><strong>Materials and methods: </strong>Rotator cuff muscle samples were obtained from young and aged patients who underwent surgery. Samples were processed for single-cell RNA sequencing to analyze cellular differences. Cells were isolated and sequenced to identify different cell populations and their gene expression profiles.</p><p><strong>Results: </strong>Six major cell populations were identified in rotator cuff muscle tissue, including fibroadipogenic progenitor cells (FAPs), satellite cells, endothelial cells, pericytes, macrophages, and T cells. Aged FAPs showed higher expression of senescence markers and genes associated with fibrosis and inflammation. Younger FAPs had higher levels of extracellular matrix remodeling genes. Specifically, ATF3-a senescence marker-was found to be elevated in aged FAPs. In silico analysis highlighted a potential role of ATF3 in regulating FAP differentiation.</p><p><strong>Conclusions: </strong>Markers of cellular senescence are significantly elevated in older human rotator cuff tissue samples compared with young rotator cuff. Of specific interest is ATF3, a gene that has been previously implicated in regulating adipogenesis, which demonstrates a trend to function in a protective capacity against the formation of fibrosis in computational analysis of our data.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587838","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 patient-reported outcomes and radiographic findings do not significantly change between 1 and 2 years postoperatively after primary anatomic shoulder arthroplasty.","authors":"Midhat Patel, Charles J Cogan, Sambit Sahoo, Dylan Cannon, Gagan Grewal, Tammy M Owings, Jinjin Ma, Catherine Shemo, Andrew Baker, Bong Jae Jun, Joseph P Iannotti, Jason C Ho, Eric T Ricchetti, Kathleen A Derwin, Jonathan C Levy, Vahid Entezari","doi":"10.1016/j.jse.2025.02.012","DOIUrl":"10.1016/j.jse.2025.02.012","url":null,"abstract":"<p><strong>Background: </strong>It is unclear if there are significant changes in clinical and radiographic outcomes between 1 and 2 years postoperatively after total shoulder arthroplasty (TSA). The current multicenter study sought to compare patient-reported outcome measures (PROMs), range of motion, and radiographic analysis of glenoid and humeral loosening between 1 and 2-years postoperatively in a cohort of patients after primary anatomic TSA (aTSA).</p><p><strong>Methods: </strong>A retrospective cohort of patients who underwent primary aTSA between 2017 and 2018 at 2 high-volume shoulder arthroplasty centers and had baseline, 1 and 2-year PROMs were included in the study. The American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numerical Evaluation scores were collected. Radiographs were evaluated at 1- and 2- years for humeral calcar resorption and glenoid component radiolucent lines and osteolysis.</p><p><strong>Results: </strong>Two hundred eleven patients were included. Median preoperative version was -5° [IQR -8; -2] and inclination was 6° [IQR 4; 9]. There was no statistically significant difference between 1 and 2-years total ASES score (92.6 [IQR 86.7; 97.9] vs. 95 [IQR 85; 98.3], P = .71), ASES pain sub-score (50 [IQR 45; 50] vs. 50 [IQR 45; 50], P = .05), Single Assessment Numerical Evaluation score (90 [IQR 83.5; 98] vs. 93 [IQR 85; 98.3], P = .60) and external rotation (55° [IQR 50; 60] vs. 60° [IQR 50; 60], P = .66). There was a statistically significant difference in the ASES function sub-score (43.3 [IQR 38.9; 48.2] vs. 46.3 [IQR 41.2; 48.3], P = .03, respectively), and forward elevation (150° [IQR 135; 160] vs. 155° [IQR 143.8; 165], P = .002). One hundred forty-five of 211 (69%) patients had complete radiographic data. There was no statistically significant difference in the incidence of glenoid component osteolysis (3.4% vs. 5.4%, P = .25), radiolucent lines (36.1% vs. 29.9%, P = .15), or humeral calcar resorption (58.5% vs. 49.7%, P = .06) between 1 and 2 years. There were 2 (0.9%) complications in the cohort, both of which occurred within the first 12 months postoperatively.</p><p><strong>Conclusion: </strong>The present study demonstrates no changes in most PROMs and all measured radiographic findings between 1 and 2-years postoperatively after primary aTSA. This data can help drive clinical decision-making with regard to the need for visits at both 1 and 2 years postoperatively for the collection of PROMs, which add cost for the health care system and patients. Additionally, this may support lowering the minimum threshold required for reporting of \"short term\" follow-up in clinical research for aTSA.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587879","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":"Predictors of failing same-day discharge after shoulder arthroplasty: developing a model to improve outcomes and reduce health care cost.","authors":"Ehab M Nazzal, Fritz Steuer, Matthew Como, Ryan Gilbert, Samuel Adida, Shaquille J C Charles, Zachary J Herman, Ariana Lott, Jonathan D Hughes, Albert Lin","doi":"10.1016/j.jse.2025.02.007","DOIUrl":"10.1016/j.jse.2025.02.007","url":null,"abstract":"<p><strong>Background: </strong>With increasing efforts to transition shoulder arthroplasty to the ambulatory surgery setting, there is increased interest in predictive factors of failure of same-day discharge (SDD). The purpose of this study was to identify predictors of failing SDD, defined as requiring at least an overnight hospital stay after shoulder arthroplasty, and to develop a predictive model to identify which patients may require postoperative hospital admission.</p><p><strong>Methods: </strong>A retrospective review of a consecutive series of patients with rotator cuff arthropathy or osteoarthritis treated with primary anatomic or reverse total shoulder arthroplasty between January 2019 and June 2023 was conducted. Inclusion criteria included patients intended for SDD, whereas patients who underwent arthroplasty for fractures, patients younger than 45 years, and patients with incomplete data were excluded. Data on demographics, Charlson Comorbidity Index, preoperative opioid use, and preoperative steroid injections were collected. In addition, intraoperative metrics including American Society of Anesthesiologists score, surgical/anesthesia time, surgical start time, and blood loss were recorded. Multivariate logistic regression was used to identify predictors of failure of SDD. Results were displayed as odds ratios (OR) and 95% confidence intervals. The α threshold was set to P < .05.</p><p><strong>Results: </strong>A total of 333 patients (69 anatomic total shoulder arthroplasty and 264 reverse total shoulder arthroplasty) were included with 92 failures of SDD (27.6%). According to multivariate results, we found older age (OR: 1.44, P = .004), anesthesia start time per hour later in the day (OR: 6.03, P = .017), preoperative opioid use within the past year (OR: 1.82, P = .046), and female sex (OR: 2.76, P = .001) as statistically significant risk factors for not achieving SDD. In addition, each half-hour increase in length of time under anesthesia was statistically significant, increasing odds of failing SSD by 4.28 per half hour (P < .001). A diagnosis of rotator cuff arthropathy had 3.40 greater odds of failing to achieve SDD as compared with a diagnosis of osteoarthritis (P < .001). Overall, the model had a high level of predictability, yielding a receiver operating characteristic curve area under the curve of 83%.</p><p><strong>Conclusions: </strong>Older age, rotator cuff arthropathy, female sex, preoperative opioid use, and prolonged anesthesia exposure were significant predictors of failure of SDD after shoulder arthroplasty. These results support the utility in risk stratification strategies of patients to accurately triage them into SDD pathways. In addition, our results suggested that collaboration between surgeons and anesthesia teams may allow for more accurate risk stratification and optimization of resource utilization when deciding which patients are appropriate candidates for SDD.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587882","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":"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}