Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Perioperative Pain Management in Patients Being Treated for Opioid Use Disorder: The Orthopaedic Surgeon's Role and Strategies for Comprehensive Care.","authors":"Emily Benson, Tipu Khan, Hillary Rolfs, Niaz Ahankoob","doi":"10.5435/JAAOS-D-24-00786","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00786","url":null,"abstract":"<p><p>Approximately 280,000 deaths in this country were attributed to opioid overdose between 1999 and 2021, increasing fivefold within this period. Orthopaedic surgeons have had a large contribution to this epidemic; they have been found to be the third highest prescribers of opioid medications. Multiple pharmacologic and nonpharmacologic treatment options for opioid use disorder (OUD) have been developed. The three most commonly used medications are methadone, buprenorphine, and naltrexone. In part owing to the use of these medications, states such as Oregon have seen a 20% decrease in opioid abuse and a 30% decrease in fatal overdoses. Historically, orthopaedic surgeons receive minimal formal training on managing postoperative pain in patients with OUD. Patients with OUD may experience neuroplastic changes from long-term exposure to opioids, which, in turn, diminish the analgesic effect of opioid medications in the acute postoperative period. Patients become more sensitive to painful stimuli, ultimately leading to loss of opioid efficacy. Undertreating pain may contribute to unnecessary patient suffering and can lead to mistrust within the patient-physician relationship. Overtreating pain may have catastrophic consequences such as disruption of sobriety, respiratory compromise, and death. It is recommended to include a pain management specialist or service during the perioperative period, if possible. This article clarifies the orthopaedic surgeon's role in the perioperative care of this patient population by providing an overview of medications used to treat OUD, pain control strategies, psychosocial concerns, and legal considerations, with the goal of streamlining care to improve patient safety and outcomes.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702065","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":"GPT-4 as a Source of Patient Information for Carpal Tunnel Surgery: A Comparative Analysis Against Google Web Search.","authors":"Paul G Mastrokostas, Aaron B Lavi, Bruce B Zhang, Leonidas E Mastrokostas, Scott Liu, Katherine M Connors, Jennifer Hashem","doi":"10.5435/JAAOS-D-24-00249","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00249","url":null,"abstract":"<p><strong>Introduction: </strong>Carpal tunnel surgery (CTS) accounts for approximately 577,000 surgeries in the United States annually. This high frequency raises concerns over the dissemination of medical information through artificial intelligence chatbots, Google, and healthcare professionals. The objectives of this study are to determine whether GPT-4 and Google differ in (1) the type of questions asked, (2) the readability of responses, and (3) the accuracy of numerical responses for the top 10 most frequently asked questions (FAQs) about CTS.</p><p><strong>Methods: </strong>A Google search was conducted to identify the top 10 FAQs related to CTS, which were then queried in GPT-4. Responses were categorized using the Rothwell classification system and evaluated for readability using Flesch Reading Ease and Flesch-Kincaid grade level scores. Statistical analyses included Cohen kappa coefficients for interobserver reliability and Student t-tests for comparing response characteristics. Statistical significance was set at the 0.05 level.</p><p><strong>Results: </strong>This study found that 70% of Google's FAQs were fact based, predominantly focusing on technical details (40%) and specific activities (40%). GPT-4's FAQs were mainly factual (50%), with technical details (40%) being the most queried topic. Complete agreement in interobserver reliability was observed. Google's answers were more readable than GPT-4's, with a Flesch Reading Ease score of 56.40 vs. 34.19 (P = 0.001) and a Flesch-Kincaid grade level of 9.93 vs. 12.85 (P = 0.007). Google responses were shorter, with an average word count of 91.50 compared with GPT-4's 162.90 (P = 0.013). For numerical responses to FAQs, GPT-4 and Google differed in nine out of 10 questions, with GPT-4 often providing broader time frames.</p><p><strong>Conclusion: </strong>GPT-4 offers a more detailed and technically oriented approach to addressing patient queries about CTS when compared with Google. This suggests that GPT-4 can offer detailed insights where patients seek more in-depth information, enhancing the quality of healthcare education.</p><p><strong>Level of evidence: </strong>NA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732968","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":"Application and Analysis of the Enhanced Recovery After Surgery Opioid Prescription Protocol in Arthroscopy and Arthroplasty Patients.","authors":"Wali U Pirzada, Simran Shamith, Thalia Le, Terence L Thomas, Sina Ramtin, Asif M Ilyas","doi":"10.5435/JAAOS-D-24-01232","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01232","url":null,"abstract":"<p><strong>Introduction: </strong>Surgery and postoperative opioid prescriptions are critical periods for potential drug dependence and diversion. Enhanced recovery after surgery (ERAS) pathways aim to improve patient outcomes by leveraging preoperative education, emphasizing nonopioid pain management, and using less invasive surgical techniques. The study hypothesis was that the use of ERAS pathways would decrease postoperative opioid prescribing after arthroscopy and arthroplasty surgeries.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients treated by 11 orthopaedic surgeons at 9 Iowa hospitals from November 2022 to March 2024. Patients were divided into arthroplasty (n = 67) and arthroscopy (n = 33) cohorts. Opioids prescribed before and after ERAS implementation were measured and converted to morphine milligram equivalents (MMEs). Statistical analyses included the Wilcoxon signed rank test, Mann-Whitney U test, and chi-squared test.</p><p><strong>Results: </strong>The mean pre-ERAS prescription size was 389 MMEs (range: 140 to 900 MMEs) for the overall cohort postoperatively, with arthroplasty at 451 MMEs (range: 200 to 900 MMEs) and arthroscopy at 264 MMEs (range: 140 to 450 MMEs). After ERAS, the overall mean size dropped to 194 MMEs (range: 38 to 600 MMEs), with arthroplasty at 210 MMEs (range: 38 to 600 MMEs) and arthroscopy at 161 MMEs (range: 45 to 315 MMEs). Both cohorts saw significant reductions, with a mean 47% reduction in arthroplasty and a mean 33% reduction in arthroscopy (both P < 0.001). Statistical analysis found percent reduction of prescription size to be greater in the arthroplasty cohort than in the arthroscopy cohort (P < 0.001). Arthroscopy patients had a higher mean percentage of MMEs prescribed leftover (60%) compared with arthroplasty patients (27%; P< 0.001).</p><p><strong>Conclusion: </strong>The study hypothesis was upheld as ERAS pathways resulted in a notable reduction in prescribing of opioids postoperatively after both arthroplasty and arthroscopic surgeries. ERAS pathways should continue to be tailored and studied to improve postoperative recovery while decreasing the reliance on opioids postoperatively for pain management.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702060","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":"Tenosynovial Giant Cell Tumor and Pigmented Villonodular Synovitis.","authors":"Alysia K Kemp, Brian Brigman, Geoffrey Siegel, Charles A Popkin, Wakenda K Tyler","doi":"10.5435/JAAOS-D-24-01255","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01255","url":null,"abstract":"<p><p>Tenosynovial giant cell tumors (TGCTs) are a spectrum of benign growths that can occur in both intra-articular and extra-articular locations. The pattern of involvement also varies from nodular, typically small-volume disease to extensive and diffuse synovial infiltration. Surgical resection remains the treatment of choice for most patients and resection techniques include arthroscopic, open, or a combined approach. However, TGCT can be locally aggressive and exhibit high recurrence rates even after adequate surgical removal. Improved understanding of the complex genetic and environmental factors that lead to these proliferative disorders have modernized treatment options. Discovery of the unique role that tumor cell expression of the colony-stimulating-factor1 and propagation of the inflammatory cascade has led to the use of adjuvant medications to improve outcomes. In-depth knowledge of the etiology, clinical presentation, diagnosis, workup, historical treatments, and new treatment options for patients with TGCT are crucial for orthopaedic surgeons to understand and work effectively with a multidisciplinary treatment team.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702067","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":"Geographic Location Markedly Affects Academic Productivity of Pediatric Orthopaedic Surgeons.","authors":"Michael K Viggiano, McKenzie A Mayer, Patrick M Pema, Kevin M Posner, Alexander Rompala, Suleiman Y Sudah, Avrum L Joffe","doi":"10.5435/JAAOS-D-24-01061","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01061","url":null,"abstract":"<p><strong>Introduction: </strong>Existing literature lacks clarity on how research output during orthopaedic training correlates with the later productivity of pediatric orthopaedic surgeons. This study aims to examine the academic productivity of pediatric orthopaedic surgeons at different career stages and its relation to geographic training location.</p><p><strong>Methods: </strong>The 2023 to 2024 Pediatric Orthopaedic Society of North America directory was used to identify pediatric orthopaedic fellowship faculty. Training history, current institution, and publication data before residency, during residency, fellowship, and after fellowship were collected. Attending publication rates and H-indices were calculated. Multivariate linear regression assessed relationships between publication numbers at various stages and attending publication rate and H-index. A P value of <0.05 was considered significant. Geographical regions were compared for attending publications, rates, and H-indices.</p><p><strong>Results: </strong>A total of 398 pediatric orthopaedic surgeons from 45 fellowship programs were identified. The average number of publications per faculty member was 58.0 ± 72.0, with an H-index of 14.5 ± 13.2. The average attending publication rate was 2.99 ± 3.30. Residency (P < 0.001) and fellowship (P < 0.001) publication numbers were markedly associated with higher attending publication rates. Residency in the northeast was markedly associated with higher total attending publications (P = 0.043), rates (P = 0.021), and H-indices (P = 0.001) compared with other regions.</p><p><strong>Discussion/conclusion: </strong>This study shows a strong correlation between higher research output during residency and fellowship, especially in the Northeast, and increased academic productivity as an attending. These findings may affect academic hiring and emphasize the importance of selecting residency and fellowship programs for future research success.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702062","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":"Management of Ankle Arthritis: Joint-Preserving and Joint-Sacrificing Strategies.","authors":"James R Lachman, Steven L Haddad","doi":"10.5435/JAAOS-D-24-00955","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00955","url":null,"abstract":"<p><p>The disability caused by ankle arthritis is notable. The challenges in management of ankle joint degeneration are attributed to greater load transmission during activity and unique joint kinematics when compared with the hip and knee. Furthermore, characteristics of ankle cartilage pose unique challenges when compared with other weight-bearing joints. Joint-sacrificing procedures dominated historic management of ankle joint arthritis. In this review, both joint-preserving and joint-sacrificing techniques will be discussed.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702064","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":"FastFrame Knee Spanning External Fixation Associated With Lower Cost Than Modular Frame Configurations: A Comparative Cohort Study.","authors":"Luke A Myhre, Elleanor H Sato, Lillia Steffenson, Zachary Olsen, David L Rothberg, Lucas S Marchand, Justin Haller","doi":"10.5435/JAAOS-D-24-00372","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00372","url":null,"abstract":"<p><strong>Introduction: </strong>External fixation costs have been identified as a primary driver of initial cost in the care of tibial plateau fractures. Because hospital systems and institutions pursue value-based care, external fixation choices become a uniquely surgeon-dependent driver of cost. Our objective was to determine differences in cost in a prepackaged, single-use, external fixation system compared with standard, modular, knee spanning frames. Secondary objectives were to determine differences in surgical time and loss of distraction between the two types of fixation.</p><p><strong>Methods: </strong>This was a retrospective cohort study at an academic level 1 trauma center. Fifty-nine patients were treated with knee spanning external fixation over a 7-year period (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association 41-B/C). Patients received either the Zimmer FastFrame external fixator or a conventional-style, modular, external fixator. The primary outcome was implant and supply cost. The secondary outcomes were operating room facility cost, surgical time, and percent of distraction lost.</p><p><strong>Results: </strong>The FastFrame cohort demonstrated a 24.9% decrease in surgical times (29.2 vs. 38.9 minutes, P = 0.002), with a 37% decrease in supply and implant cost of conventional cohort (0.63x vs. 1x, P < 0.001). Operating room facility cost was less than the conventional cohort (0.72x vs. 1x, P = 0.41), and total cost was 21.8% less (0.78x vs. 1x, P = 0.07), although these did not reach statistical significance. The Fastframe cohort lost less distraction (72.6% vs. 62.8%, P = 0.02).</p><p><strong>Conclusion: </strong>The FastFrame demonstrates a lower supply and implant cost, faster surgical times, and demonstrated clinical equivalence in regard to loss of distraction when compared with conventional, modular, external fixator.</p><p><strong>Level of evidence: </strong>Diagnostic-Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702061","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":"\"FATAL Graft\": A Diagnostic Algorithm for the Workup of Anterior Cruciate Ligament Reconstruction Graft Failure.","authors":"Andrew S Bi, Mark A Pianka, Laith M Jazrawi, Michael J Alaia","doi":"10.5435/JAAOS-D-24-00974","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00974","url":null,"abstract":"<p><p>There are multiple etiologies for revision anterior cruciate ligament reconstruction (ACLR), including but not limited to infection, arthrofibrosis, and graft failure, which should be distinguished before revision ACLR. Graft failure occurs when the reconstructed ligament does not restore knee stability, and it includes both graft rupture and functional failure in the setting of an intact graft. The causes of graft failure following ACLR can be divided into surgeon-controllable factors (ie, tunnel position, graft choice, alignment) and patient-centric factors (ie, patient age, tissue quality from systemic disease or smoking, compliance/traumatic reruptures). The purpose of this review is to propose an organized, easy-to-remember algorithm for the workup of surgeon-controlled ACLR graft failure etiologies, represented by the acronym \"FATAL Graft.\"</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732918","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":"Risk Factors of Diaphyseal Femoral Nonunions: A Systematic Review and Meta-analysis.","authors":"Tyler K Williamson, Jonathan G Eastman, Timothy Achor, Stephen J Warner","doi":"10.5435/JAAOS-D-24-01064","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01064","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary nailing of diaphyseal femur fractures often results in reliable union, with union rates ranging from 96% to 100%. However, femoral nonunions (FNUs) can be a debilitating clinical condition for patients. The purpose of this review was to identify and characterize the predictors of nonunion after femoral midshaft fractures.</p><p><strong>Methods: </strong>A systematic search was conducted using key terms \"femoral shaft non-union,\" \"femoral diaphyseal non-union,\" \"femoral shaft fracture,\" \"femoral diaphysis fracture,\" and \"femoral midshaft fracture\" published before June 2024. Human studies describing risk factors associated with development of FNUs were included. Articles were excluded if not able to assess risk factors of FNUs. Data synthesis summarized outcome measures and study designs appropriately in the results. SPSS meta-analysis function was used to calculate the mean effect size estimate (MESE) and 95% confidence intervals for each outcome.</p><p><strong>Results: </strong>This search yielded a total of 7,879 studies, and after exclusion criteria were assessed, 26 articles comprising 14,170 patients with diaphyseal femoral fractures were included. These studies included 973 fractures developing nonunions after surgical intervention. A total of 25 factors were assessed. Age (MESE = 1.33 [0.92 to 1.74]; P < 0.001) and type 2 diabetes (MESE = 1.77 [1.03 to 2.52]; P < 0.001) were significant patient-specific risk factors. Arbeitsgemeinschaft Osteosynthesefragen/Orthopaedic Trauma Association 32B (MESE = 0.94 [0.35 to 1.53]; P < 0.001) and Winquist-Hansen type 3 (MESE = 1.45 [0.63 to 2.26]; P < 0.001) were significant injury-specific factors, along with butterfly fragment size and displacement and open fractures. Open reduction (MESE = 0.80 [0.30 to 1.30]; P < 0.001) and postoperative nonsteroidal anti-inflammatory drug use (MESE = 1.17 [0.08 to 2.27]; P = 0.04) were significant surgical-specific and management-specific risk factors, along with external fixation and iatrogenic comminution.</p><p><strong>Discussion: </strong>Age, diabetes, fracture classification grading, and postoperative nonsteroidal anti-inflammatory drug use were among the factors placing patients at the highest risk of femoral diaphyseal nonunions, including other patient-specific, injury-specific, surgical, and management factors. Future studies are warranted to use a prospective study design, identify diaphyseal nonunion-specific risk factors, and implement evidence-based prevention strategies.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702066","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":"Local Subcutaneous Fat Depth Is Associated With Increased Complications After Total Shoulder Arthroplasty.","authors":"Lucas R Haase, Molly M Piper, Margaret A Sinkler, John T Strony, Kira L Smith, Robert J Gillespie, Raymond E Chen","doi":"10.5435/JAAOS-D-24-01288","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01288","url":null,"abstract":"<p><strong>Background: </strong>Increased body mass index (BMI) is a well-documented risk factor for complications after lower extremity arthroplasty. The literature in total shoulder arthroplasty (TSA) displays notable variation. The utility of BMI in predicting complications in TSA may be limited because of differences in weight distribution. Prior studies in spine surgery have demonstrated increased complications based on subcutaneous fat depth at the incision site. The purpose of this study was to determine whether tissue depth may be associated with an increased risk of complication after primary TSA.</p><p><strong>Methods: </strong>A retrospective study was done on all patients undergoing primary TSA between January 2018 and December of 2021. Postoperative complications of superficial surgical site infection, prosthetic joint infection stress fracture, and implant instability were recorded. Preoperative advanced imaging was used to measure total tissue depth and subcutaneous fat depth at the level of the coracoid and bicipital groove. A combination of univariate and multivariate statistics was used to determine association between tissue depth and postoperative complication.</p><p><strong>Results: </strong>A total of 219 patients were included in the study. Twenty-nine patients experienced a total of 31 complications. The complication group had a higher percentage of reverse TSA to anatomic. The complication group had a markedly higher depth of subcutaneous fat tissue at the coracoid and bicipital groove (18.82 and 17.53 mm, respectively) compared with the control group (15.05 mm and 11.77; P = 0.046 and P = 0.005). On multivariate analysis, these differences remained statistically significant.</p><p><strong>Conclusion: </strong>Local subcutaneous fat depth at the coracoid process and bicipital groove was associated with increased rates of complications. In addition, BMI did not demonstrate an association with complications. It is possible that different weight distributions within the upper extremity limit the utility of BMI in risk stratification.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702063","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}