JSES International最新文献

{"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}

{"title":"Optimal nerve release range and transposition distance in anterior ulnar nerve transposition for cubital tunnel syndrome: an anatomical study","authors":"Kohei Hirukawa MD ,&nbsp;Koji Sukegawa MD, PhD ,&nbsp;Yukie Metoki MD ,&nbsp;Takuya Tada MD ,&nbsp;Tomomi Mizuhashi ,&nbsp;Kentaro Uchida PhD ,&nbsp;Kenji Onuma MD, PhD ,&nbsp;Yuya Otake MD ,&nbsp;Motoyuki Ogawa MD, PhD ,&nbsp;Gen Inoue MD, PhD ,&nbsp;Masashi Takaso MD, PhD","doi":"10.1016/j.jseint.2025.07.003","DOIUrl":"10.1016/j.jseint.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Cubital tunnel syndrome, the second most common entrapment neuropathy, results from ulnar nerve compression at the medial epicondyle (ME). Conservative treatment often fails, requiring surgery. Transposition is an effective but invasive procedure, necessitating precise anatomical guidelines. We aimed to investigate the optimal anatomical measurements for ulnar nerve transposition to facilitate standardization of the technique.</div></div><div><h3>Methods</h3><div>We examined 12 upper limbs from 6 fresh-frozen cadavers with elbows flexed at 60° and forearms supinated. The optimal transposition distance was defined as the distance from the ME to where the ulnar and median nerves run parallel. We measured this distance; pivot points A and B (where the ulnar nerve's course changes after transposition); crossing points over the medial intermuscular septum and flexors (A′, B′); and ulnar nerve branch positions from the inferior border of the ME.</div></div><div><h3>Results</h3><div>After excluding 3 outliers using the interquartile range method, 10 limbs were analyzed. The transposition distance was 16.6 ± 3.3 mm. Pivot points A and B were 53.8 ± 6.5 mm and 50.2 ± 9.1 mm from the ME. Crossing points A′ and B′ were 39.6 ± 7.9 mm and 40.2 ± 6.7 mm. Nerve branches were 21.1 ± 6.0 mm, 32.4 ± 14.8 mm, and 50.9 ± 24.6 mm from the inferior border of the ME.</div></div><div><h3>Conclusion</h3><div>Anterior transposition shifts the ulnar nerve 17 mm anterior to the ME. To prevent kinking, dissection should extend 54 mm proximally and 50 mm distally, totaling approximately 105 mm. These measurements can guide intraoperative planning and emphasize the need for direct visualization to ensure safe and effective anterior transposition.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 6","pages":"Pages 2170-2175"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468978","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":"Is the circle perfect? Radiographic validation of the best fit circle in nonarthritic shoulders","authors":"Ryan A. Hoffman MD ,&nbsp;Ty Agaisse BS ,&nbsp;Brandon Portnoff MD ,&nbsp;Oscar Covarrubias MD ,&nbsp;Andrew Green MD","doi":"10.1016/j.jseint.2025.10.005","DOIUrl":"10.1016/j.jseint.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic reconstruction of the humeral articular segment is a recognized goal of implant designs for anatomic shoulder arthroplasty. The “best fit circle” (BFC) is used to determine the quality of proximal humeral reconstruction after anatomic shoulder arthroplasty. The purpose of this study was to validate the BFC using plain radiographs in a nonarthritic cohort.</div></div><div><h3>Methods</h3><div>Two hundred consecutive patients evaluated for nonarthritic shoulder conditions with true anterior-posterior radiographs were identified. 110 (55 percent) were male. The mean age was 56 ± 14 years. A native circle (NC) was determined from the humeral bone articular contour. The BFC was determined according to Youderian et al. Radius of curvature (ROC), center offset (CO), and articular segment thickness (AST) were measured. BFC and NC measurements were compared using 2 tailed paired Wilcoxon rank-sum tests. Pearson's correlation coefficients were used to evaluate associations between the BFC and NC measurements.</div></div><div><h3>Results</h3><div>The NC ROC was 0.21 ± 0.81 mm greater than the BFC ROC (<em>P</em> &lt; .001) and was greater than the BFC ROC in 124 cases (62 percent). The difference was greater than 2 mm in 6 cases (3 percent). The NC CO was 0.09 ± 1.21 mm medial to the BFC CO (<em>P</em> = .30) and was medial to the BFC CO in 110 cases (55 percent). The CO difference was greater than 2 mm in 19 cases (9.5 percent). The mean NC AST was 0.81 ± 1.27 mm greater than BFC AST (<em>P</em> &lt; .001) and greater than the BFC AST in 150 cases (75 percent). The difference in AST was greater than 2 mm in 46 cases (23 percent). The NC AST:ROC ratio was significantly greater than the BFC AST:ROC (0.79 vs. 0.75; <em>P</em> &lt; .001), and greater in 140 cases (70 percent). The NC AST:ROC was greater than 0.80 in 72 cases (36 percent) compared to 39 cases (19.5 percent) for the BFC. There was a significant difference in the position of the CO between males and females.</div></div><div><h3>Conclusion</h3><div>This study validates the BFC as a surrogate of the normal proximal humeral bony articular anatomy in most shoulders. On average, the NC is significantly larger than the BFC. In most cases the differences are small and likely clinically irrelevant. Nevertheless, there were outliers and using the BFC to determine the size of a prosthetic humeral head implant could risk error in these cases.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101403"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789927","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 an inlay, metaphyseal-based short humeral stem component in reverse shoulder arthroplasty","authors":"Cameron R. Guy MD,&nbsp;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.2025.10.006","DOIUrl":"10.1016/j.jseint.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to assess the 2-year functional and radiographic outcomes of an inlay metaphyseal-based short humeral stem component in reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>All patients between January 2021 and May 2022 that underwent primary rTSA utilizing an inlay metaphyseal-based short humeral stem by a single surgeon were included. Initial stem position (varus/valgus) was measured on a Grashey anteroposterior radiograph of the shoulder postoperatively and compared to the stem position at &gt; 2 years to assess subsidence and shift in position. Bone adaptations to the greater tuberosity (GT) were assessed at final follow-up.</div></div><div><h3>Results</h3><div>Overall, 29 patients met inclusion criteria, with 23 patients (79% follow-up) following up at an average of 29 months (range, 24 to 38 months). Initial stem position was 2.4 ± 3.3° of valgus (range, 9° valgus to 2.6° varus). The final &gt; 2-year stem position was 1.7 ± 2.8° of valgus (range, 7.4° valgus to 3.9° varus). No patients (0%) displayed evidence of stem subsidence at final follow-up. Overall, 9 patients (39.1%) were found to have bony changes of the GT. The American Shoulder and Elbow Surgeons and visual analog scale pain scores improved by an average of 38 ± 20 (<em>P</em> &lt; .001) and 4.5 ± 2.3 (<em>P</em> &lt; .001) points, respectively. Average final postoperative range of motion measurements were 148.3 ± 8.7° for forward flexion and 35.0 ± 8.5° for external rotation. Internal rotation was recorded as lumbosacral junction or greater in 92% of patients.</div></div><div><h3>Conclusion</h3><div>Patients undergoing rTSA with an inlay metaphyseal-based short humeral stem demonstrate reliable coronal plane alignment on initial placement, minimal shift in position, no stem subsidence, low rates of scapular notching, and stress shielding postoperatively. Approximately one-third of patients display radiographic changes of the GT. The use of intramedullary cutting guide and a 145 neck-shaft angle construct results in accurate stem placement and low risk of complications.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101404"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789928","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 uncemented humeral components perform better than cemented humeral components in reverse total shoulder arthroplasty for acute proximal humerus fracture? A New Zealand Joint Registry study","authors":"Alex B. Boyle MBChB, MPH ,&nbsp;Scott M. Bolam MBChB, PhD ,&nbsp;Chris M.A. Frampton PhD ,&nbsp;Peter Poon MBChB, FRACS ,&nbsp;Adam Dalgleish MBChB, FRACS ,&nbsp;Ryan Gao MBChB, PhD, FRACS","doi":"10.1016/j.jseint.2025.10.009","DOIUrl":"10.1016/j.jseint.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is increasingly used in unreconstructible and comminuted proximal humerus fractures. There is ambiguity as to whether uncemented or cemented humeral components (stems) have better survival and patient-reported outcome measures in this context. The aim of this study was to compare implant survival, risk of revision, reason for revision, and functional outcomes between cemented and uncemented stems for rTSA performed for acute proximal humerus fractures.</div></div><div><h3>Methods</h3><div>Prospectively collected data from the New Zealand Joint Registry, a national database with capture &gt;95%, were used to compare the survival rates and Oxford Shoulder Scores of rTSA performed for trauma (trauma rTSA) using cemented or uncemented stems between January 2002 and December 2024. Reason for revision and patient demographics were recorded. Revision rates (rates per 100 observed component years) and functional outcomes (Oxford Shoulder Score at 6-month and 5-year follow-up) were compared using a multivariate Cox proportional hazards regression model and adjusted by age, sex, American Society of Anesthesiologists class, and surgeon volume of rTSA per year.</div></div><div><h3>Results</h3><div>Over the 22-year study period, 843 rTSA procedures were performed for acute proximal humeral fracture representing 4,668 component years. Of these trauma rTSA procedures, 326 utilized a cemented stem (cemented trauma rTSA) and 517 utilized an uncemented stem (uncemented trauma rTSA). The number of revisions per 100 component-years for cemented trauma rTSA was 0.64, compared to 0.36 for uncemented trauma rTSA. This difference was not statistically significant (<em>P</em> = .122). Mean Oxford Scores 6 months postoperatively were 30.4 for cemented trauma rTSA and 31.3 for uncemented trauma rTSA (<em>P</em> = .365). Mean Oxford Scores 5 years postoperatively were 36.2 for cemented trauma rTSA and 39.5 and for uncemented trauma rTSA (<em>P</em> = .049), although this is less than the minimally clinically important difference.</div></div><div><h3>Conclusion</h3><div>In the context of increasing use of rTSA for acute proximal humerus fractures, revision rates and patient-reported outcomes are similar between cemented and uncemented humeral stems. Uncemented humeral components are therefore an acceptable first-line treatment for proximal humerus fractures in appropriate patients.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 1","pages":"Article 101407"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839783","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}