JSES International最新文献

{"title":"A prospective randomized controlled trial on the effect of music therapy intervention on pain and anxiety in adult patients undergoing total shoulder arthroplasty","authors":"Raymond Y. Kim MD ,&nbsp;Hannah H. Nam MD ,&nbsp;Janice W. Stouffer MT-BC ,&nbsp;Christina A. Myers MT-BC ,&nbsp;Susan E. Hassenbein CCRP ,&nbsp;Gary F. Updegrove MD ,&nbsp;Vernon M. Chinchilli PhD ,&nbsp;Yue Zhang MPH ,&nbsp;Sanjib Adhikary MD ,&nbsp;April D. Armstrong MD","doi":"10.1016/j.jseint.2025.101438","DOIUrl":"10.1016/j.jseint.2025.101438","url":null,"abstract":"<div><h3>Background</h3><div>Leading studies have demonstrated that patients treated with music therapy (MT) show decreased pain intensity, anxiety, length of hospitalization, and increased pain relief. This study investigated whether MT would reduce pre- and postoperative pain and anxiety in patients undergoing shoulder arthroplasties.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized, nonblinded clinical trial. Patients were randomized into 3 groups: live MT, recorded MT, and control. The primary objective was to determine the change in pain and anxiety scores from pre-MT to post-MT. Linear mixed-effects models were developed to account for repeated measurements within each patient, analyzing pain scores and anxiety T-scores.</div></div><div><h3>Results</h3><div>Total of 108 patients were included in the study. Patients receiving live MT reported significantly greater reduction in pain score (<em>P</em> = .0013) and anxiety score (<em>P</em> = .0002) compared to patients in the control. Patients receiving recorded MT also reported significantly greater reduction in pain score (<em>P</em> = .0142) and anxiety score (<em>P</em> = .0186) compared to patients in the control group. There were no significant differences in pain score (<em>P</em> = .4663) or anxiety score (<em>P</em> = .1791) between the live and recorded MT groups.</div></div><div><h3>Conclusions</h3><div>Patients receiving MT intervention had a significantly greater reduction in pain and anxiety scores compared to the control. Findings were not dependent on live vs. recorded presentation. This study demonstrates the potential benefits of incorporating MT to minimize anxiety and postoperative pain in patients undergoing shoulder arthroplasties.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101438"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humeral head in rotator cuff tear arthropathy shows reduced cartilage damage and uniform subchondral bone osteoporosis: a histomorphometric analysis","authors":"Shingo Maesako MD ,&nbsp;Takashi Tasaki MD, PhD ,&nbsp;Kohei Uekama MD ,&nbsp;Seiya Yokoyama PhD ,&nbsp;Shingo Maeda MD, PhD ,&nbsp;Ikumi Kitazono MD, PhD ,&nbsp;Noboru Taniguchi MD, PhD ,&nbsp;Akihide Tanimoto MD, PhD","doi":"10.1016/j.jseint.2025.101435","DOIUrl":"10.1016/j.jseint.2025.101435","url":null,"abstract":"<div><h3>Background</h3><div>This study histologically assessed alterations in the articular cartilage, subchondral bone, and trabecular bone in patients with rotator cuff tear arthropathy (CTA) versus those with osteoarthritis (OA) of the humeral head.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated 59 humeral heads (37 CTA and 22 OA cases) resected during shoulder arthroplasty and 7 shoulder specimens from cadaveric controls. Bone density was evaluated by computed tomography. Histological evaluations were analyzed semiquantitatively for Osteoarthritis Research Society International scores, articular cartilage thickness, subchondral bone plate thickness, and trabecular bone mass and distribution, using standard staining techniques.</div></div><div><h3>Results</h3><div>CTA cases showed significantly lower Hounsfield units in the trabecular and metaphyseal bones on the affected side than on the healthy side. In contrast, no significant difference in Hounsfield units was observed in OA cases. A histological analysis showed lower Osteoarthritis Research Society International scores in CTA than in OA, which indicated moderate cartilage degeneration. Subchondral trabecular bone in CTA cases was uniformly thinned, whereas OA cases showed variable trabecular morphology, with areas of both thickening and thinning. Consequently, the humeral head bone volume was smaller in CTA than in OA.</div></div><div><h3>Conclusion</h3><div>CTA is characterized by moderate cartilage degeneration and uniform subchondral trabecular bone loss, which may underlie complications associated with reverse shoulder arthroplasty. These findings may serve as a foundation for further studies of appropriate surgical strategies and preoperative interventions for osteoporosis.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101435"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of sarcopenia with surgical outcomes and complications following reverse total shoulder arthroplasty: a matched cohort study with comparative analysis against anatomic total shoulder arthroplasty","authors":"Majd Mzeihem MD ,&nbsp;Ali Rteil MD, Msc ,&nbsp;Roma Fe Mabanag MD ,&nbsp;Jason Koh MD ,&nbsp;Farid Amirouche PhD","doi":"10.1016/j.jseint.2025.101431","DOIUrl":"10.1016/j.jseint.2025.101431","url":null,"abstract":"<div><h3>Background</h3><div>Sarcopenia, defined as age-related loss of skeletal muscle mass and function, has been linked to poor outcomes postoperatively. While anatomic total shoulder arthroplasty (aTSA) relies on rotator cuff integrity, reverse total shoulder arthroplasty (rTSA) depends primarily on deltoid function. This retrospective cohort study aims to evaluate the association of sarcopenia with postoperative outcomes following total shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>This study utilized TriNetX to analyze data from a cohort of 24,566 patients who underwent total shoulder arthroplasty. One-to-one exact matching was done to control variables across the control rTSA, sarcopenia rTSA, and sarcopenia aTSA cohorts. Postoperative outcomes were assessed at 3 and 6 months and at 1, 2, and 3 years. Independent <em>t-</em>tests and chi-square analyses were done for continuous and categorical variables.</div></div><div><h3>Results</h3><div>Postoperatively the sarcopenic rTSA group demonstrated significantly higher odds of surgical complications (odds ratio [OR]: 2.22, <em>P</em> = .03 at 3 months; OR: 1.87, <em>P</em> = .06 at 6 months) and pain (OR: 2.22, <em>P</em> &lt; .001 at 3 months; OR: 2.34, <em>P</em> &lt; .001 at 6 months), as well as prosthetic joint infection (<em>P</em> = .002 at 3 months), postoperative blood transfusion (OR: 2.10, <em>P</em> = .03 at 3 months), and readmission (OR: 1.68, <em>P</em> &lt; .001 at 3 months). By 1 year, the sarcopenic group also showed significantly higher odds of revision (OR: 1.25, <em>P</em> = .04) and postoperative opioid abuse/dependence (OR: 2.46, <em>P</em> = .004 at 1 year). Notably, sarcopenic rTSA patients had increased rates of prosthetic complications at 3 years (OR: 1.54, <em>P</em> = .002). Overall, no significant differences in complication rates were observed between sarcopenic patients undergoing rTSA and aTSA, with both procedures demonstrating comparable outcomes through two years.</div></div><div><h3>Conclusion</h3><div>Sarcopenia has been identified as a significant factor affecting patient outcomes following shoulder arthroplasty. Sarcopenic patients demonstrated higher rates of surgical complications, pain, prosthetic joint infection, postoperative blood transfusion, and readmission, as well as long-term complications and higher odds of revision, postoperative opioid abuse, and prosthetic complications. The slightly higher early complication rates in the rTSA sarcopenic cohort compared to the aTSA sarcopenic cohort may be attributable to patients selected for rTSA being generally more comorbid rather than to the procedure itself. Given that sarcopenia has been associated with adverse postoperative outcomes, early identification and further investigation into targeted postoperative interventions may help clarify its potential role in recovery.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101431"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humeral and glenoid lateralization based on glenoid-humeral axis interval results in functional improvements following reverse shoulder arthroplasty","authors":"Shinji Imai MD, PhD","doi":"10.1016/j.jseint.2025.101436","DOIUrl":"10.1016/j.jseint.2025.101436","url":null,"abstract":"<div><h3>Background</h3><div>The optimal glenoid or humeral lateralization in reverse total shoulder arthroplasty (rTSA) remains unknown. The author hypothesized that stepwise humeral lateralization and stepwise glenoid lateralization based on the intraoperatively measured glenoid-humeral axis interval (GHI) could improve clinical outcomes compared to consistent lateralization that was assigned irrespective of the GHI. In this study, GHI was measured using the superior approach, but it can also be measured using the deltopectoral approach.</div></div><div><h3>Methods</h3><div>Fifty-four patients were treated with nonlateralized inlay-type implants (group A). Forty patients received the same type of inlay rTSA with an 8.0 mm-thick bony-increased offset (group B). Moreover, 50 patients underwent inlay rTSA with glenoid lateralization (Group C), whereas 45 underwent onlay rTSA with humeral lateralization (Group D). Groups C and D were stratified into 3 subgroups based on their GHI—C1 and D1 (GHI &lt;20.0 mm), C2 and D2 (20.0≤ GHI &lt;25.0), and C3 and D3 (GHI ≥26.0). Subgroups C1, C2, and C3 were lateralized to the glenoid side, whereas D1, D2, and D3 were lateralized to the humeral side. Baseline and 2-year postoperative measurements—active anterior elevation; external rotation at 0° arm abduction; external rotation at 90° arm abduction; pain visual analog scale score; Constant score; and University of California, Los Angeles score—were compared between groups.</div></div><div><h3>Results</h3><div>The consistent lateralization that was assigned irrespective of GHI (group B) did not improve clinical parameters as compared to the nonlateralization (group A), excluding external rotation at 90° arm abduction (65.9 ± 9.6, <em>P</em> &lt; .001). The both GHI-based lateralization (groups C and D) significantly improved the clinical parameters. The GHI-based glenoid lateralization (Group C) had the highest anterior elevation (146.1° ± 11.2, <em>P</em> = .010), external rotation at 0° arm abduction (44.1° ± 10.6, &gt;0.001), and University of California, Los Angeles score (27.5 ± 2.1, <em>P</em> = .002). The GHI-based humeral lateralization (group D) showed the highest Constant score (67.8 ± 8.2, <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>The stepwise glenoid and humeral lateralization based on the GHI improved outcomes compared with the nonlateralization or the consistent lateralization that was assigned irrespective of the GHI.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101436"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labral morphology does not compensate for reduced bony glenoid concavity in stable shoulders","authors":"Alexander J. Vervaecke MD ,&nbsp;Charles Thery MD ,&nbsp;Victor Housset MD ,&nbsp;Philipp Moroder MD, PhD ,&nbsp;Jean-David Werthel MD, PhD","doi":"10.1016/j.jseint.2025.101422","DOIUrl":"10.1016/j.jseint.2025.101422","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid concavity plays a critical role in shoulder stability via the concavity-compression mechanism. While the bony glenoid concavity, quantified by the bony shoulder stability ratio (BSSR), is a known determinant of stability, the labrum also contributes to the overall glenoid concavity. It remains unclear whether the labrum compensates for reduced bony concavity in stable shoulders. This study aimed to investigate the relationship between labral and bony glenoid concavity implementing the labral shoulder stability ratio (LSSR) and BSSR, respectively. We hypothesized that shoulders with reduced bony concavity (lower BSSR) would demonstrate increased labral concavity (higher LSSR), suggesting a compensatory mechanism.</div></div><div><h3>Methods</h3><div>In this retrospective imaging study, 36 patients (mean age: 26.7 years) undergoing shoulder computed tomography arthrography between January 2020 and December 2024 for noninstability indications were included. BSSR and LSSR were calculated from standardized axial computed tomography images using three-dimensional multiplanar reconstructions. Concavity depth and radius were measured on the bony and chondrolabral contours, and the respective stability ratios were calculated. Inter-rater reliability was assessed using Bland-Altman plots and Pearson correlation. Pearson correlation analysis and subgroup comparisons were conducted to assess the relationship between BSSR and LSSR.</div></div><div><h3>Results</h3><div>The mean BSSR was 28.3% ± 11.1% (range: 10.2%-52.5%), and the mean LSSR was 77.9% ± 10.8% (range: 49.1%-100%). There was no significant correlation between BSSR and LSSR (r = 0.01, <em>P</em> = 1.000). A low positive correlation was observed between glenoid bone depth and labral depth (r = 0.33, <em>P</em> = .049), and no significant relationship was found between the radius of the bony and labral best-fit circles (r = −0.11, <em>P</em> = .515). Subgroup analysis comparing patients with low BSSR (≤25th percentile) vs. high BSSR (≥75th percentile) showed no significant difference in LSSR values (78.8% vs. 75.9%, <em>P</em> = .554). Inter-rater agreement was good for both BSSR and LSSR measurements.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that labral morphology does not compensate for reduced bony glenoid concavity in clinically stable shoulders. Contrary to our hypothesis, lower BSSR was not associated with increased labral concavity, and no inverse relationship was observed between bone and labral curvature.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101422"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A standardized construct of blocked threaded wires for treating complex three-part proximal humerus fractures. A long-term follow-up of a previously published series","authors":"Yuri Piccolo MD,&nbsp;Vittorio Candela MD,&nbsp;Daniele De Meo MD,&nbsp;Carmine Zoccali MD, PhD,&nbsp;Stefano Gumina MD, PhD","doi":"10.1016/j.jseint.2025.101437","DOIUrl":"10.1016/j.jseint.2025.101437","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous pinning is classically considered an option for treating proximal humerus fractures (PHFs) in elderly low-demanding patients; recently, promising clinical and radiographic medium-term outcomes have been documented after the treatment of displaced PHF using different configurations of blocked threaded wires. However, long-term follow-up (FU) is still lacking. The aim of the present study was to evaluate the clinical and radiographic outcomes of a previously published midterm FU cohort after a minimum of 8 years.</div></div><div><h3>Methods</h3><div>In this observational study, all 52 patients from the midterm outcome paper were asked to visit our institution for consultation and X-rays. Patients who could not return for an on-site consultation because of poor health completed a self-administered questionnaire with the assistance of his/her general practitioner, and the responses were finalized via a telephone interview. The individual relative Constant-Murley score and the visual analog scale (VAS) were recorded. In radiographic evaluation, both arthritis progression and signs of avascular necrosis were recorded. Complications and reoperation were registered and classified as early (&lt;2 years) and delayed (&gt;2 years).</div></div><div><h3>Results</h3><div>Of the initial 52 patients, 2 died before the long-term evaluation and 3 were lost to FU. Clinical data were thus obtained for 47 patients (90%), and radiographic data were obtained in 40 patients (77%). The minimum follow-up was 8 years [range: 96-118 months; mean (standard deviation): 102 (4.5) months]. The mean patient age was 68.7 years (standard deviation: 6.3). The mean individual relative Constant-Murley score at the final FU was 83.5%. Regarding the VAS, 36 patients referred their pain as 0 (76.5%), 8 as 1 (17%) and 3 as 2 (6.5%). According to the radiographic assessment, avascular necrosis was present in 2 patients (5%) while 2 patients developed signs of arthritis (Samilson Prieto 2). VAS score was 1/10 in patients with avascular necrosis, whereas a VAS of 2/10 was registered in patients with arthritis. No additional major complications occurred beyond the one previously reported in the midterm analysis: a fracture nonunion who refused any further treatment due to comorbidities. Two superficial infections treated with 5 days of oral antibiotics occurred during the midterm FU. One patient referred an arthroscopic rotator cuff repair 5 years postsurgery with symptoms starting 5 months before the procedure.</div></div><div><h3>Conclusion</h3><div>Treatment of complex PHF with a construct of blocked threaded wires after an anatomical open/mini-open reduction led to excellent clinical and radiological outcomes with a low rate of complications compared with published results of the other surgical options.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101437"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to fishing and hunting recreation after shoulder arthroscopy and arthroplasty, a PacWest Shoulder Study Group survey","authors":"Jay Thompson DO ,&nbsp;Jake X. Checketts DO ,&nbsp;Mallory A. Podosin BS ,&nbsp;Javier Ardebol MD, MBA ,&nbsp;Patrick J. Denard MD ,&nbsp;Dan Guttmann MD ,&nbsp;PacWest Shoulder Study Group","doi":"10.1016/j.jseint.2025.101432","DOIUrl":"10.1016/j.jseint.2025.101432","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines on return to wildlife sports including fishing, shooting, and archery after arthroscopic rotator cuff repairs (ARCRs) and shoulder arthroplasty are lacking. This study seeks to characterize surgeons' postoperative return to sport protocols for ARCR and shoulder arthroplasty with common wildlife sports such as fishing, shooting, and archery.</div></div><div><h3>Methods</h3><div>One hundred and eighty-two fellowship-trained shoulder surgeons who are members of the PacWest Shoulder Study group were sent a Google Forms survey containing 7 global questions (with 5 sub questions each) specific to the return to wildlife sports after shoulder surgery. Responses to categorical variables were displayed as percentages and fractions.</div></div><div><h3>Results</h3><div>Eighty-one (44.5%) of the 182 surgeons responded. Overall, no surgeons would apply a lifelong restriction on fishing, but 20 (24.7%) surgeons would limit casting techniques with massive rotator cuff tears. All 81 (100%) surgeons would allow their patients to return to shooting handguns, but 2 (2.5%)-5 (6.2%) surgeons respectively would prohibit returning to shooting shotguns and rifles after arthroplasty. Twenty-seven (33.3%) surgeons would delay return to archery until after 6 months for massive rotator cuff tears. In both the massive tear and reverse total shoulder arthroplasty groups, surgeons would limit bow weight restrictions to less than 18 kg (40 lbs) (22; 27.2%). The massive rotator cuff tear group was more often restricted to return within 6 months or later in all sports (fishing (75; 92.6%), handgun (70; 86.4%), shotgun (77; 95.1%), rifle (77; 95.1%), and archery (70; 86.4%)).</div></div><div><h3>Conclusion</h3><div>Patients can have a high expectation of return to wildlife sports following shoulder surgery. Surgeons are most restrictive in return to wildlife sports following ARCR of massive tears.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101432"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of reverse shoulder arthroplasty and glenohumeral arthrodesis for end-stage shoulder instability","authors":"Ayham Jaber MD ,&nbsp;Tyler J. Uppstrom MD ,&nbsp;Marilee P. Horan MPH ,&nbsp;Christopher J. Hawryluk MBS ,&nbsp;Yazan Jaber MD ,&nbsp;Matthew T. Provencher MD, MBA ,&nbsp;Peter J. Millett MD, MSc","doi":"10.1016/j.jseint.2025.101429","DOIUrl":"10.1016/j.jseint.2025.101429","url":null,"abstract":"<div><h3>Hypothesis</h3><div>End-stage multidirectional recurrent shoulder instability (RSI) that is unresponsive to nonoperative treatment is a puzzling pathology, with no consensus on standard of care. The purpose is to report and compare outcomes of glenohumeral arthrodesis (GHA) and reverse total shoulder arthroplasty (rTSA). We hypothesized that both treatment options would be acceptable, but rTSA patients would have better function and higher patient satisfaction.</div></div><div><h3>Methods</h3><div>Patients who underwent primary GHA or rTSA for isolated RSI by a single surgeon were included. Failure was defined as a conversion surgery or major component exchange. Patient-reported outcome measures (American Shoulder and Elbow Surgeons, Single Assessment Numerical Evaluation, Quick Disabilities of the Arm, Shoulder and Hand, 12-item Short Form) were assessed preoperatively and postoperatively. Persistent instability and patient satisfaction were reported.</div></div><div><h3>Results</h3><div>Thirteen shoulders in 11 patients with end-stage RSI underwent either GHA (n = 8) or rTSA (n = 5) with a mean age was 29.7 ± 11.8 years. Ehlers-Danlos syndrome was present in 5 patients. Follow-up rate was 93% (12/13). One GHA patient required conversion to rTSA. One GHA patient underwent hardware removal and a varus-producing osteotomy for scapular pain. No persistent instability was reported. No significant differences were found in demographics or preoperative patient-reported outcomes. American Shoulder and Elbow Surgeons (GHA: 64.4 ± 15.4; rTSA: 89.6 ± 12.6, <em>P</em> = .016) and Single Assessment Numerical Evaluation (GHA: 60 ± 24; rTSA: 85.2 ± 20.9, <em>P</em> = .040) scores were higher at follow-up in the rTSA group. Quick Disabilities of the Arm, Shoulder and Hand scores were significantly lower (<em>P</em> = .026) in the rTSA group, indicating less disability. Both groups reported high median satisfaction on a 1–10 scale [GHA: 8 (range: 3–10), rTSA: 10 (range: 5–10), <em>P</em> = .156].</div></div><div><h3>Conclusion</h3><div>rTSA and GHA are viable options in treating end-stage RSI. rTSA resulted in better function and lower revision surgery rates, suggesting rTSA provides better shoulder mobility while maintaining stability.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101429"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do patients trust the tech? Exploring perception, confidence, and knowledge of innovations in shoulder arthroplasty","authors":"Aghdas Movassaghi BS ,&nbsp;Elizabeth W. Chan BS ,&nbsp;Justin T. Childers MS ,&nbsp;Benjamin T. Lack BS ,&nbsp;Garrett R. Jackson MD ,&nbsp;Clyde Fomunung MD ,&nbsp;Roya Osswald ,&nbsp;Vani J. Sabesan MD","doi":"10.1016/j.jseint.2025.101415","DOIUrl":"10.1016/j.jseint.2025.101415","url":null,"abstract":"<div><h3>Background</h3><div>As surgical technologies, such as three-dimensional preoperative planning, computer navigation, and augmented reality, become increasingly utilized in shoulder arthroplasty, questions remain about their value from the patient's perspective. While education and patient interest have driven demand and technology adoption in hip and knee arthroplasty, their role in shoulder procedures remains unclear. This study aimed to evaluate patient perceptions of innovative technologies in shoulder arthroplasty and assess whether preoperative education influences confidence, satisfaction, and expectations.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 87 patients scheduled to undergo shoulder arthroplasty at a single institution completed a preoperative survey assessing demographics, baseline familiarity with surgical technologies, and perceptions of surgeon use of innovative tools prior to seeing their provider. Following this, patients then viewed a standardized educational video on the role of technology in shoulder arthroplasty. Postvideo responses measured changes in confidence, satisfaction, and outcome expectations. Statistical analysis included paired t-tests and analysis of variance to evaluate prepost changes and demographic associations.</div></div><div><h3>Results</h3><div>Over half of patients (56.3%) were unfamiliar with innovative technologies at baseline, yet 60.9% reported increased confidence in surgeons using it. Most patients (66.7%) preferred the use of advanced planning technologies, though only 41.5% would choose a low-volume surgeon using these tools over a high-volume surgeon using conventional techniques. Improvements in confidence were significantly correlated with higher education and income levels (r = 0.31, <em>P</em> = .003). After viewing an educational video, patient confidence in their surgeon increased (<em>P</em> = .03), and expectations for improved outcomes (<em>P</em> &lt; .001), fewer complications (<em>P</em> &lt; .001), less pain (<em>P</em> &lt; .001), and faster recovery (<em>P</em> &lt; .001) significantly rose. Despite favorable perceptions, 62.1% of patients were unwilling to pay more, travel further, or wait longer to receive care involving innovative technologies.</div></div><div><h3>Conclusion</h3><div>Targeted preoperative education on surgical technology may improve patient confidence, strengthen perceptions of surgeon competency, and elevate expectations of care. While enthusiasm for advanced tools was observed following education, broader adoption may still be influenced by cost and accessibility. These findings support the role of brief, technology-focused education in enhancing the overall patient experience in shoulder arthroplasty.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101415"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bot vs. doc—who is better at reading proximal humerus fracture x-rays?","authors":"Kyle K. Obana MD,&nbsp;Mark Ren MD,&nbsp;Andrew J. Luzzi MD,&nbsp;Matthew R. LeVasseur MD,&nbsp;Hasani W. Swindell MD,&nbsp;William N. Levine MD","doi":"10.1016/j.jseint.2025.101426","DOIUrl":"10.1016/j.jseint.2025.101426","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence is becoming increasingly utilized as a source of convenient, efficient, and cost-effective information. Considering the potential utility of ChatGPT as an adjuvant in clinical decision making, the current study evaluates (1) the accuracy of ChatGPT-5 at evaluating shoulder x-rays containing either normal or proximal humerus fracture (PHFx) diagnoses and (2) interrater reliability between ChatGPT and orthopedic surgeons at different levels of training.</div></div><div><h3>Methods</h3><div>The Stanford University Musculoskeletal Radiographs publicly accessible dataset was utilized, and 70 x-rays (35 PHFx, 35 normal) were analyzed after inclusion and exclusion criteria were applied. X-rays were reviewed independently by an orthopedic surgery junior resident, senior resident, shoulder/elbow fellow, and shoulder/elbow fellowship-trained attending. X-rays for each patient were uploaded to ChatGPT-5 and questions were asked using a response-based algorithm.</div></div><div><h3>Results</h3><div>ChatGPT-5 demonstrated a sensitivity of 61.8%, specificity of 74.3%, and an overall accuracy of 67.1% for PHFx x-rays. ChatGPT incorrectly diagnosed 25.7% of normal x-rays with a fracture or dislocation. ChatGPT incorrectly diagnosed 23.5% of isolated PHFx x-rays as normal, 8.8% with an isolated glenohumeral dislocation without fracture, and 5.7% with a PHFx dislocation. Inter-rater reliability for ChatGPT was slight for displaced parts and poor for fractured part, Neer parts, and located glenohumeral joint. Junior and senior residents had moderate to substantial agreement with the attending reads (fractured part, displaced parts, Neer parts), while the fellow had substantial to almost perfect agreement.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that ChatGPT-5 is highly inaccurate at identifying PHFx on shoulder x-rays, characterizing the fracture patterns, and providing accurate interpretations of shoulder x-rays. Over-reliance on generative artificial intelligence to guide clinical decisions risks harm to the patients and should be approached with limited credence.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 2","pages":"Article 101426"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}