JSES International最新文献

{"title":"Clinical outcome of reverse total shoulder arthroplasty (comprehensive system) after failed rotator cuff repair with a medium-term follow-up: comparison with reverse total shoulder arthroplasty for massive rotator cuff tear without osteoarthritis","authors":"Ji Un Kim MD ,&nbsp;Ji Young Yoon MD ,&nbsp;Young Dae Jeon MD ,&nbsp;Hyung Ki Cho MD ,&nbsp;Hyeon Jang Jeong MD, PhD ,&nbsp;Joo Han Oh MD, PhD","doi":"10.1016/j.jseint.2025.06.012","DOIUrl":"10.1016/j.jseint.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>We compared the clinical outcomes of primary reverse total shoulder arthroplasty (rTSA) in patients with massive rotator cuff tears (mRCTs) without osteoarthritis (OA), secondary rTSA in patients with failed rotator cuff repair (RCR), and primary rTSA in patients with cuff tear arthropathy (CTA) as a control group.</div></div><div><h3>Methods</h3><div>Among 364 patients who underwent rTSA between March 2014 and August 2019, 153 were included. All patients underwent surgery with a single implant type and were followed for a minimum of 4 years. Patients were categorized into three groups: primary rTSA for mRCT without OA (mRCT group, n = 24), primary rTSA for CTA (CTA group, n = 104), and rTSA for failed rotator cuff repair group (fRCR; fRCR group, n = 25). The mean age was 71.5 ± 6.3 (range, 53-83) years, with a mean follow-up of 54.7 ± 12.9 (range, 48-98) months. Functional outcomes were assessed using the active range of motion, the visual analog scale for pain, the simple shoulder test, the American Shoulder and Elbow Surgeons score, the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and the Constant score at the final follow-up.</div></div><div><h3>Results</h3><div>All functional outcomes significantly improved postoperatively in each group (<em>P</em> &lt; .05). However, the fRCR group presented worse outcomes compared to the other groups, including visual analog scale for pain (2.1 ± 0.5), forward flexion (126° ± 4°), external rotation (42 ± 4°), American Shoulder and Elbow Surgeons score (76 ± 5), and Constant score (55 ± 3) (<em>P</em> &lt; .05). Postoperative complications and radiologic outcomes were not significantly different between the groups (<em>P</em> = .890).</div></div><div><h3>Conclusion</h3><div>Considering the worse clinical outcomes of secondary rTSA after failed RCR compared to primary rTSA for mRCT without OA and/or CTA, careful selection of appropriate candidates for RCR or primary rTSA as a treatment option for mRCT without OA is essential, according to their healing potential.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2081-2086"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468648","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":"Preoperative antibiotic prophylaxis in primary shoulder arthroplasty patients: a systematic review","authors":"Kevin C. Liu MD,&nbsp;Justin T. Jabara MD,&nbsp;Miguel A. Lizarraga BS,&nbsp;Andrew P. Gatto DO,&nbsp;Brian Feeley MD","doi":"10.1016/j.jseint.2025.06.010","DOIUrl":"10.1016/j.jseint.2025.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Cefazolin is the primary antibiotic used for prevention of shoulder arthroplasty (SA) infection. However, vancomycin, clindamycin, and doxycycline may be used, specifically for patients with penicillin allergies or known bacterial colonization. Due to limited existing data, the aim of this systematic review was to characterize contemporary antibiotic prophylaxis choices and report infection rates based on the prophylactic regimen in patients undergoing SA.</div></div><div><h3>Methods</h3><div>The online databases CINAHL Complete, EMBASE, MEDLINE, the Cochrane Central Registry of Controlled Trials, and Web of Science were searched from database inception to September 25, 2024. Clinical studies comparing preoperative antibiotic regimens and reporting postoperative complications were included. Nonrandomized and randomized studies were assessed using the Methodological Index for Non-Randomized Studies tool and the revised Cochrane Risk of Bias 2 tool, respectively.</div></div><div><h3>Results</h3><div>The search strategy identified 7 eligible studies, of which 2 were randomized controlled trials and 5 were retrospective series, including 33,159 procedures (hemiarthroplasty, anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and humeral head arthroplasty). The most commonly used antibiotic was cefazolin. All-cause infection rates ranged from 1.0%-1.1% for cefazolin, 1.1%-2.4% for vancomycin, and 3.2%-4.1% for clindamycin. One randomized controlled trial found no significant reduction in intraoperative culture positivity rates with the addition of doxycycline to cefazolin.</div></div><div><h3>Conclusion</h3><div>Cefazolin is the preferred antibiotic prophylaxis for SA, with vancomycin and clindamycin as viable alternatives. Future investigations could evaluate the benefit of dual antibiotic therapy and develop evidence-based treatment algorithms for high-risk patients who may require non–cefazolin prophylaxis.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2062-2068"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468759","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":"Concomitant biceps intervention does not affect the outcome in the treatment of partial-thickness rotator cuff tear","authors":"Keigo Honoki MD ,&nbsp;Jarret Woodmass MD ,&nbsp;Sarah Harris BSc Eng ,&nbsp;Afsana Hasan MD ,&nbsp;Rodrigo Brandariz MD ,&nbsp;Peter MacDonald MD","doi":"10.1016/j.jseint.2025.05.038","DOIUrl":"10.1016/j.jseint.2025.05.038","url":null,"abstract":"<div><h3>Background</h3><div>Although procedures for long head of biceps (LHB), including LHB tenotomy and tenodesis, are commonly performed for patients with rotator cuff tear (RCT), the data about concomitant biceps procedures in the treatment of partial-thickness (PT) RCT has been limited.</div></div><div><h3>Methods</h3><div>Retrospective data were provided by the institutional Pan Am Clinic Orthopedic Surgery registry. The single surgical center collects surgeon- and patient-reported data for all arthroscopic surgeries as standard of care. Patients who underwent shoulder surgery for PT-RCT between April 2019 and August 2022 were included in this study. All patients were eligible for 1-year follow-up. Demographic, operative, and patient-reported outcomes were compared for patients treated with and without concomitant LHB intervention. Subanalyses compared patients treated with biceps tenotomy and biceps tenodesis. Operative data included LHB and RCT condition at the time of surgery, and outcomes included revision status, complications and the patient-reported outcomes American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation score. Continuous variables were compared using a two-sided independent <em>t</em>-test, and categorical variables were compared using a chi-squared or Fisher's exact test.</div></div><div><h3>Results</h3><div>The rate of LHB pathology including inflammation, partial tear, or rupture associated with PT-RCT was 58% (n = 66/113). Fifty-six percent (n = 63/113) of the patients treated for partial supraspinatus tendon tear underwent concomitant LHB intervention (Group I), and 44% (n = 50/113) did not undergo LHB intervention (Group N). The mean age of study patients was 54 years (standard deviation = 12), and 37% were female (male n = 71; female n = 42). Within Group I, 48% (n = 30/63) underwent tenotomy and 52% (n = 33/63) underwent tenodesis. LHB condition at the time of surgery was different between Group N and Group I (Fisher's exact <em>P</em> &lt; .001) and between the tenotomy and tenodesis groups (Fisher's exact <em>P</em> &lt; .001). No other significant differences were found in operative variables or patient-reported variables preoperatively or at the 1-year follow-up.</div></div><div><h3>Conclusion</h3><div>Concomitant biceps intervention does not affect the clinical outcome in arthroscopic shoulder surgery for PT-RCT. There was no significant difference in clinical outcomes between LHB tenodesis and tenotomy in the treatment of arthroscopic PT-RCT when LHB intervention was performed.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1994-1998"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468787","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":"Risk factors for coracoclavicular reconstruction failure: a systematic review","authors":"Braeden R. Gooch BS ,&nbsp;Josh W. Thibeault BS ,&nbsp;Charles R. Reiter BS ,&nbsp;Matthew S. Smith MD ,&nbsp;Joshua C. Setliff MD ,&nbsp;John W. Cyrus MS ,&nbsp;James R. Satalich MD ,&nbsp;J. Brett Goodloe MD ,&nbsp;Jennifer L. Vanderbeck MD","doi":"10.1016/j.jseint.2025.07.007","DOIUrl":"10.1016/j.jseint.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>The coracoclavicular (CC) ligament reconstruction for acromioclavicular injuries is performed through a variety of surgical techniques and fixation methods. The purpose of this study is to determine the risk factors associated with failure of CC reconstruction, regardless of the fixation method used.</div></div><div><h3>Methods</h3><div>A systematic review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, and Cochrane were searched through November 2024 for studies analyzing the failures of CC reconstructive surgery. Studies that quantified risk factors for CC reconstruction failure were included.</div></div><div><h3>Results</h3><div>Seven studies comprising 781 CC reconstructions were analyzed with an overall failure rate of 19.1%. Clavicle tunnel malposition in anatomic reconstructions was the most cited risk factor for failure. Position was defined as either the distance from the lateral aspect of the clavicle to the tunnels or as a ratio between this distance and the length of the clavicle. Three studies cited increased failure risk with medial malposition of the conoid or trapezoid tunnels. Specific parameters included conoid tunnel ratio &gt;0.25, (odds ratio (OR) = 5.67), trapezoid ratio &gt;0.15 (OR = 4.2), conoid tunnel &gt;47 mm (OR = 4.67), and trapezoid tunnel &gt;24 mm (OR = 4.2). Lateral conoid tunnel malposition with a conoid tunnel ratio &lt;0.20 (OR = 40) was also noted to increase failure risk. Another study identified increased risk of failure when surgeons use tunnel ratios instead of tunnel distance in mm intraoperatively (OR = 4.609). Placement of a lateral coracoid button, as opposed to a central button, was cited in 2 studies as significant risk factors (OR = 9.614, 13.87). Other risk factors included osteoporosis (OR = 8.652), weight-bearing before 6 weeks from surgery (OR = 6.4), surgery &gt;6 weeks from initial injury (OR = 2.65), osteolysis (OR = 4.386), patient age &gt;40 (OR = 3.14), and open reconstruction (OR = 4.25).</div></div><div><h3>Conclusions</h3><div>Conoid and trapezoid tunnel malposition, both medially and laterally, were significantly associated with an increased risk of failure. Additionally, patient age, osteoporosis, osteolysis, time to weight bearing after surgery, delayed presentation of more than 6 weeks from initial injury, should be considered when considering surgical intervention.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 1965-1971"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468888","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":"Smaller glenosphere size and increased baseplate retroversion improve postoperative internal rotation after reverse total shoulder arthroplasty performed with a 135° humeral implant and lateralized glenoid","authors":"Joseph Adams ,&nbsp;Samer Al-Humadi MD ,&nbsp;Brian C. Werner MD ,&nbsp;Philipp Moroder MD ,&nbsp;Patric Raiss MD ,&nbsp;Asheesh Bedi MD ,&nbsp;Evan Lederman MD ,&nbsp;Justin Griffin MD","doi":"10.1016/j.jseint.2025.06.004","DOIUrl":"10.1016/j.jseint.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Optimal placement of the glenosphere in reverse shoulder arthroplasty (rTSA) is a key component affecting postoperative range of motion (ROM) but remains a subject of ongoing research. The purpose of this study was to evaluate the relationship between three-dimensional (3D) glenosphere position and orientation relative to anatomic scapular landmarks and postoperative patient-reported outcomes and ROM following rTSA.</div></div><div><h3>Methods</h3><div>A retrospective multicenter cohort study was conducted on primary rTSAs performed with a 135° humeral inlay component and a lateralized glenoid component between November 2016 and March 2022. Surgeries performed with a 3D plan and patient-specific transfer instrumentation with minimum 2-year clinical follow-up were included. Implant position was extracted from preoperative planning software, focusing on pin position (center of the glenosphere) and glenosphere diameter, version, and overhang relative to scapular anatomic landmarks. ROM and American Shoulder and Elbow Surgeons (ASES) scores were assessed at 2-year follow-up, with linear regression models utilized to analyze the relationships between preoperative and intraoperative variables and postoperative outcomes while adjusting for confounding variables.</div></div><div><h3>Results</h3><div>A total of 75 rTSAs met the study criteria. For every 1 millimeter increase in glenosphere diameter, there was a 0.5 spinal level decrease in internal rotation (IR) spine (<em>P</em> ≤ .005) and a 2.5° decrease in forward flexion (<em>P</em> ≤ .005). For every 4° increase in baseplate retroversion, there was a 1 spinal level improvement in IR spine (<em>P</em> = .009). Superior tilt of the baseplate was associated with a decrease in internal rotation at 90° of abduction (3° decrease per 1° of increased superior tilt, <em>P</em> ≤ .001). ASES scores were also significantly affected, with a 3.5 point decrease per millimeter increase in glenosphere diameter (<em>P</em> ≤ .001), but improved by a 1 point per millimeter increase in pin-to-coracoid distance (<em>P</em> = .015).</div></div><div><h3>Conclusion</h3><div>In patients with 3D planning and patient-specific instrumentation, smaller glenosphere diameter, increased baseplate retroversion, and avoidance of superior tilt improve IR after rTSA performed with a 135° humeral component and lateralized glenoid. A smaller glenosphere diameter and increased distance from the coracoid also improved ASES scores. This data suggests that with the use of a lateralized glenoid in rTSA, efforts should be made to increase the glenosphere distance from the coracoid, avoid a superior tilted positioning of the baseplate, and consider a smaller glenosphere when in between sizes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2037-2043"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468893","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 Montecranon classification—a comprehensive treatment strategy for complex proximal ulna fracture dislocations","authors":"Christian Spross MD ,&nbsp;Michael Strässle MD ,&nbsp;Jesse Jupiter MD ,&nbsp;Roger van Riet MD ,&nbsp;Alberto G. Schneeberger MD ,&nbsp;Andrew Choo MD ,&nbsp;Denise Eygendaal MD, PhD ,&nbsp;Kutalmis Albayrak MD ,&nbsp;Jonas Grossmann PhD ,&nbsp;Vilijam Zdravkovic MD ,&nbsp;Bernhard Jost MD","doi":"10.1016/j.jseint.2025.07.008","DOIUrl":"10.1016/j.jseint.2025.07.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Complex proximal ulna fracture dislocations include Monteggia-like fractures and transolecranon fracture dislocations. Since 2011, we introduced a structured classification and treatment algorithm for these fractures in a Swiss teaching hospital, considering ligamentous structures, the coronoid process, and the radial head. This classification, named the Montecranon classification (MC), was validated by users with varying experience levels through a retrospective clinical analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All consecutive patients treated for a complex proximal ulnar fracture dislocation between 2011 and 2022 were retrospectively analyzed. Fractures were classified according to the Bado, Jupiter, Mayo, and the new MC.&lt;/div&gt;&lt;div&gt;For the clinical study, patients treated according to the MC were retrospectively analyzed including final range of motion, EuroQol 5-Dimensions-5-Levels Score, Quick DASH, Mayo Elbow Performance Score, analysis of complications/revisions, and radiographic assessment for posttraumatic arthritis. Patients included had at least one year of clinical and radiographic follow-up.&lt;/div&gt;&lt;div&gt;For validation, 22 randomly selected cases were sent to 4 elbow experts, 3 young consultants, and 3 novice doctors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 43 patients (mean 55 years, range: 19-87) who suffered a complex proximal ulnar fracture dislocation, 30 patients met the inclusion criteria. Four patients (13%) had a transolecranon fracture dislocation, and 26 patients (87%) had a Monteggia-like fracture. The mean follow-up was 4.2 years (range: 1-10). At the final follow-up, the mean flexion-extension arc was 126° (range: 40-155), the mean Mayo Elbow Performance Score was 93 points (range: 70-100), and the mean qDASH was 19 points (range: 0-82). A total of 21 patients (70%) needed a secondary surgery after a mean of 364 days (range: 7-883). Whereof, hardware removal was performed in 12 (57%) patients. A significant correlation was found between decreased final range of motion and higher grade of MC fracture type.&lt;/div&gt;&lt;div&gt;The interobserver correlation for MC was moderate for novice doctors and young consultants (kappa = 0.63 and 0.55) and poor for elbow experts (0.47). The intraobserver correlation was moderate to good in all groups (kappa = 0.76, 0.53, and 0.76). All participants found the MC helpful (22%) to very helpful (78%) for understanding the fracture and planning ORIF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The MC with special attention to involvement of ligamentous structures, the coronoid process, and the radial head, as well as an associated structured reduction technique, is helpful for the management of complex proximal ulna fracture dislocations. Despite the high rate of secondary surgeries, the final clinical outcome may lead to good to excellent results in 90% of the cases. However, young surgeons with less experience seemed to profit more from this classification than experts.&lt;","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2176-2185"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468976","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":"Two-year functional and radiographic outcomes of a convertible metaphyseal-based short humeral stem in anatomic shoulder arthroplasty: a comparison to stemless humeral components","authors":"Michael A. Moverman MD,&nbsp;Adrik Da Silva BS,&nbsp;Christopher D. Joyce MD,&nbsp;Peter N. Chalmers MD,&nbsp;Robert Z. Tashjian MD","doi":"10.1016/j.jseint.2025.06.016","DOIUrl":"10.1016/j.jseint.2025.06.016","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to compare the restoration of humeral head anatomy, as well as 2-year radiographic and functional outcomes of anatomic total shoulder arthroplasty (aTSA) using a convertible metaphyseal-based short inlay humeral stem and a stemless humeral component.</div></div><div><h3>Methods</h3><div>All patients between May 2021 and May 2022 that underwent aTSA using a convertible metaphyseal-based short inlay humeral stem by a single surgeon were included and compared to a cohort of patients that underwent stemless aTSA by the same surgeon between February 2019 and October 2020. An intramedullary cutting guide, a large lesser tuberosity osteotomy (LTO) repaired with cerclage wires, and preoperative 3-dimensional planning were utilized in all cases. The restoration of humeral head anatomy was assessed on an AP radiograph of the proximal humerus 2 weeks postoperatively. Functional outcome scores, range of motion, and LTO healing were collected 2-years postoperatively. Calcar stress shielding was assessed on 2-year postoperative radiographs using the Levy classification.</div></div><div><h3>Results</h3><div>Overall, there were 26 patients (81.3% follow-up) in the stem group and 43 patients (84.3% follow-up) in the stemless group with 2-year follow-up data. All patients (32 stem/51 stemless) were included in the radiographic analysis assessing humeral head restoration. There were no differences in the humeral head height change (<em>P</em> = .733), percent of patients with &lt;5 mm of humeral head height change (<em>P</em> = .52), percent of patients with an acceptable neck shaft angle (&gt;130°) (<em>P</em> = 1), and mean shift in center of rotation (<em>P</em> = .546) between patients that underwent stemmed and stemless aTSA. There were no differences in American Shoulder and Elbow Surgeons scores (stem 93.8 ± 9.1; stemless 92.4 ± 10.8; <em>P</em> = .566), visual analog scale pain scores (stem 0.4 ± 1.1; stemless 0.4 ± 0.9; <em>P</em> = .941), or LTO bony union (stem 88.5%; stemless 92.6%; <em>P</em> = .083) between groups 2 years postoperatively. The stem group was found to have greater forward flexion at 2 years (<em>P</em> = .017), but similar external rotation at the side (<em>P</em> = .445) and internal rotation (<em>P</em> = .268). There were no differences in the degree of stress shielding between groups (<em>P</em> = .185).</div></div><div><h3>Conclusions</h3><div>Anatomic shoulder arthroplasty with a convertible metaphyseal-based short inlay humeral stem demonstrates excellent patient-reported functional and radiographic outcomes 2 years postoperatively. No differences in restoration of humeral head anatomy, degree of stress shielding, patient-reported functional outcomes, and osteotomy healing rates were identified between patients undergoing metaphyseal short-stemmed and stemless aTSA.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2098-2103"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468646","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":"Clinical accuracy of humeral and glenoid component placement in total shoulder arthroplasty using ASTRA patient-specific guides","authors":"Estelle Wigmore BEng (Hons) ,&nbsp;Joshua G. Twiggs PhD ,&nbsp;Mark Taylor PhD ,&nbsp;Rami M.A. Al-Dirini PhD ,&nbsp;Harry D.S. Clitherow MBChB, FRACS (Orth) ,&nbsp;Brendan C.L. Soo MBBS, FRACS (Orth) ,&nbsp;Warwick J.L. Wright MBBS, FRACS (Orth) ,&nbsp;Benjamin Kenny MBBS, FRACS (Orth)","doi":"10.1016/j.jseint.2025.08.007","DOIUrl":"10.1016/j.jseint.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Malalignment of the humeral and glenoid components in total shoulder arthroplasty is associated with complications such as instability, implant loosening, and restricted motion. While the accuracy of patient-specific instrumentation (PSI) for glenoid component orientation is well documented, the precision of PSI for humeral osteotomy has not yet been published for a noncadaveric environment. This study aims to calculate the deviation between the planned and achieved orientations of humeral and glenoid components using PSI in a clinical, in vivo setting.</div></div><div><h3>Methods</h3><div>Forty-six patients were enrolled. One patient was excluded due to an intraoperative change to humeral component selection. The gender, etiology for arthroplasty (osteoarthritis or cuff tear arthropathy), severity of glenoid wear based on the Walch classification, and procedure (anatomic or reverse) were recorded. Computed tomography (CT) scans were obtained preoperatively for 3-dimensional reconstruction, from which the target humeral and glenoid component orientations for each patient were selected by the surgeon in the ASTRA surgical planning platform (Enovis, Austin, TX, USA). Humeral and glenoid PSIs were designed and 3-dimensionally printed to execute the planned alignments. A postoperative CT scan was acquired and used to calculate the deviation between the planned and achieved humeral version, humeral neck-shaft angle, humeral osteotomy height, glenoid version, and glenoid inclination. Humeral version was able to be calculated for 22 patients (48.9%) with a CT scan which extended distally beyond the humeral epicondyles.</div></div><div><h3>Results</h3><div>A total of 8 outliers (17.8%) were identified across all orientation parameters: 5 outliers (11.1%) for humeral orientation and 3 (6.7%) for glenoid orientation. The average deviation was 2.9°, 2.2°, 1.3 mm, 1.7° and 1.4° for humeral version, humeral neck-shaft angle, humeral osteotomy height, glenoid version, and glenoid inclination, respectively. The mean deviation in glenoid version was greater in males than females (<em>P</em> = .007). However, no other statistically significant difference was found between the mean or variance in deviation when comparing cohorts stratified by etiology of arthroplasty, severity of glenoid wear, or surgical procedure.</div></div><div><h3>Conclusion</h3><div>PSI generated from CT-based planning can achieve precise execution of preoperative plans in 89% of humeral and 93% of glenoid components in both anatomic and reverse procedures across a variety of patient morphologies. The humeral guide, when used in a more challenging in vivo environment, demonstrates accuracy comparable to those observed in existing ex vivo studies.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2127-2140"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468692","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":"Long-term follow-up of stemless anatomic shoulder arthroplasty with a ceramic humeral head prosthesis: a multicenter study","authors":"Cormac Kelly FRCS Ed (Orth) ,&nbsp;Géza Pap MD (Prof) ,&nbsp;Richard W. Nyffeler MD ,&nbsp;Falk Reuther MD ,&nbsp;Ulrich Irlenbusch MD, PhD","doi":"10.1016/j.jseint.2025.06.007","DOIUrl":"10.1016/j.jseint.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Stemless anatomic total shoulder arthroplasty (aTSA) with ceramic implants have shown promising midterm clinical outcomes. However, long-term clinical data on ceramic humeral head prostheses are not available. We therefore evaluated the long-term clinical and radiographic outcomes, including implant survival and complication rates, of a stemless ceramic humeral head prosthesis in different shoulder pathologies.</div></div><div><h3>Methods</h3><div>In this prospective, multicenter, observational study, patients underwent stemless aTSA using a ceramic humeral head prosthesis. We recorded Constant–Murley Scores (CSs), radiolucent lines (RLLs), complications, and long-term prosthesis survival.</div></div><div><h3>Results</h3><div>We treated 238 patients (238 shoulders) with a stemless ceramic humeral head prosthesis. Clinical and radiographic outcomes were recorded from 120 shoulders at a median follow-up of 125.4 months, and complications from 229 shoulders. At final follow-up, CSs improved significantly from preoperative values (<em>P</em> &lt; .0001). Although RLLs appeared both at the glenoid and humerus, osteolysis, wear, and aseptic loosening were rare (0.9%) and confined to the glenoid side; no aseptic loosening of the humeral component was noted. Prosthesis survival at 13 years reached 89.9% for all revisions and 90.8% for humeral component revision.</div></div><div><h3>Conclusion</h3><div>Stemless aTSA with a ceramic humeral head prosthesis resulted in good CSs, a low number of clinically relevant RLLs, low incidences of glenoid osteolysis and aseptic loosening, no aseptic loosening of the humeral component, and high prosthesis survival rates in the long term. Moreover, nine out of ten prostheses remained in situ and were functional after 10 years, confirming the long-term success of this ceramic prosthesis.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2044-2052"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468889","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":"How to target the coronoid from the dorsal cortex","authors":"Simone Cassin MD ,&nbsp;Valeria Vismara MD ,&nbsp;Aurelien Traverso MD ,&nbsp;Christos Koukos MD ,&nbsp;Pietro Simone Randelli MD ,&nbsp;Paolo Arrigoni MD","doi":"10.1016/j.jseint.2025.08.008","DOIUrl":"10.1016/j.jseint.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>The coronoid process of the ulna is crucial for both anteroposterior and axial elbow stability. Currently, there is no safe and X-ray–free method for targeting the coronoid from the posterior cortex of the ulna, for temporary or permanent fixation. This study aims to define a range, easy to use in surgical practice, to safely target the coronoid process from the dorsal cortex of the ulna and to normalize the range based on the inter-epicondylar distance (IED).</div></div><div><h3>Methods</h3><div>For the study, 3 different parameters were assessed: the APEX (olecranon to coronoid apex distance), BASE (olecranon to coronoid base distance), and the IED from 109 computed tomographies.</div></div><div><h3>Results</h3><div>The mean APEX was 20.6 mm (19.3 mm in females and 21.3 mm in males), and the mean BASE was 33.9 mm (31.9 mm in females and 35.1 mm in males). The mean IED was 59 mm (53.3 mm in females and 62.3 mm in males), the mean ratio between APEX and IED was 0.3 (0.4 in females and 0.3 in males), the mean ratio between BASE and IED was 0.6 (0.6 in males and females). These data were significantly different in males and females (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>This study contributes to establishing a practical range for the safe targeting of the coronoid process from the dorsal cortex of the ulna in surgical practice. A safe approach to the coronoid can be achieved by maintaining a perpendicular trajectory to the dorsal cortex of the olecranon within a safe range of 2 to 3.5 cm from its most prominent point.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2186-2191"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468971","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}