Bone resorption from stress shielding around the humeral stem is a recognized complication after shoulder arthroplasty, contributing to revision failure and periprosthetic fractures. Shorter humeral stem designs have been developed to minimize stress shielding and facilitate revision surgery. However, few studies have compared bone resorption between standard and short stems using unified classification systems and both clinical and biomechanical analyses. This study aimed to compare humeral bone resorption and stress distribution between standard and short stems of the same implant design.
Methods
This study assessed humeral bone resorption in 40 shoulders treated with hemiarthroplasty for cuff tear arthropathy, using the same uncemented stem design from the Comprehensive Total Shoulder System (Biomet, Warsaw, IN, USA). Participants were grouped into standard (n = 20) and short stem (n = 20) categories. Bone resorption was evaluated radiographically across 7 zones using a morphology-based classification system. Finite element analysis based on patient-specific computed tomography data simulated stress distribution under loading.
Results
Radiographs showed significantly less severe resorption (grade ≥3) in the lateral diaphysis (zone 2) for the short stem group compared the standard group (P = .015). Finite element analysis indicated higher stress in the short stem group at zone 2 (P = .009) and medial diaphysis (zone 6) (P = .028). No significant radiographic difference was observed in zone 6, possibly due to preserved loading from muscle attachments.
Conclusion
Short humeral stems were associated with reduced lateral diaphyseal bone resorption, likely reflecting more favorable stress distribution. These findings suggest that short stems may limit stress shielding and support bone preservation following shoulder arthroplasty.
{"title":"Bone resorption and stress distribution in standard vs. short stems of the Comprehensive Total Shoulder System for shoulder arthroplasty","authors":"Kazuya Inoue MD, PhD , Naoki Suenaga MD, PhD , Naomi Oizumi MD, PhD , Hiroshi Yamaguchi MD, PhD , Naoki Miyoshi MD , Shuzo Morita MD , Shimpei Kurata MD, PhD , Akira Imanaka MD , Keisuke Tsujimura MD , Kenji Kawamura MD, PhD","doi":"10.1016/j.sart.2026.151541","DOIUrl":"10.1016/j.sart.2026.151541","url":null,"abstract":"<div><h3>Background</h3><div>Bone resorption from stress shielding around the humeral stem is a recognized complication after shoulder arthroplasty, contributing to revision failure and periprosthetic fractures. Shorter humeral stem designs have been developed to minimize stress shielding and facilitate revision surgery. However, few studies have compared bone resorption between standard and short stems using unified classification systems and both clinical and biomechanical analyses. This study aimed to compare humeral bone resorption and stress distribution between standard and short stems of the same implant design.</div></div><div><h3>Methods</h3><div>This study assessed humeral bone resorption in 40 shoulders treated with hemiarthroplasty for cuff tear arthropathy, using the same uncemented stem design from the Comprehensive Total Shoulder System (Biomet, Warsaw, IN, USA). Participants were grouped into standard (n = 20) and short stem (n = 20) categories. Bone resorption was evaluated radiographically across 7 zones using a morphology-based classification system. Finite element analysis based on patient-specific computed tomography data simulated stress distribution under loading.</div></div><div><h3>Results</h3><div>Radiographs showed significantly less severe resorption (grade ≥3) in the lateral diaphysis (zone 2) for the short stem group compared the standard group (<em>P</em> = .015). Finite element analysis indicated higher stress in the short stem group at zone 2 (<em>P</em> = .009) and medial diaphysis (zone 6) (<em>P</em> = .028). No significant radiographic difference was observed in zone 6, possibly due to preserved loading from muscle attachments.</div></div><div><h3>Conclusion</h3><div>Short humeral stems were associated with reduced lateral diaphyseal bone resorption, likely reflecting more favorable stress distribution. These findings suggest that short stems may limit stress shielding and support bone preservation following shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 2","pages":"Article 151541"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116529","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}
Pub Date : 2026-01-13DOI: 10.1016/j.sart.2026.151550
Maxwell C. Alley MD , W. Doug Werry BA , Alan Shi MD , Alexander Ment BA , Paul M. Smiley MD , Brian T. Samuelsen MD, MBA , John Garfi MS , Mark J. Lemos MD
Background
Reverse total shoulder arthroplasty (rTSA) is a reliable and frequently utilized treatment for large rotator cuff tears with associated arthritis. Acromion and scapular spine stress injuries and fractures have been shown to be a common complication after rTSA, with an incidence as high as 11% in some reports. This complication can result in pain and loss of functionality. While many risk factors have been reported, this study investigates physician learning curve, a rarely examined feature, to identify whether the incidence of acromial stress fracture (ASF) decreases with the experience of the surgeon.
Methods
A retrospective review was performed for all patients undergoing rTSA at a single institution by one of two surgeons using the same rTSA system from 2005 to 2020. Cases were divided into an “early group” (2005-2015) and a “late group” (2015-2020). Patients were followed through their treatment course, with chart review ending in 2020 to ensure a minimum 2-year follow-up. Statistical analysis was determined via Fisher exact test with an alpha level of 0.05.
Results
One hundred eighty-five patients (56 males, 129 females) were reviewed. The early group consisted of 102 patients, 7 of which were diagnosed with ASFs. The late group consisted of 83 patients, none of which experienced ASF. This yielded a statistical significance via Fisher exact test. No significant differences were found between rates of dislocation, nerve palsy, deep, and superficial infections between groups.
Conclusion
Results suggest that there is a learning curve to rTSA, specifically regarding the incidence of ASF. A potential cause of this discrepancy is tension placed on the deltoid, which is key to achieving a stable rTSA. Less-experienced surgeons may over-tension this element of the procedure, leading to a stress fracture. Future studies may seek to improve intraoperative assessment of deltoid tension to optimally balance the risk of dislocation and ASF.
{"title":"The incidence of acromial stress injury after reverse total shoulder arthroplasty: surgeon learning curve","authors":"Maxwell C. Alley MD , W. Doug Werry BA , Alan Shi MD , Alexander Ment BA , Paul M. Smiley MD , Brian T. Samuelsen MD, MBA , John Garfi MS , Mark J. Lemos MD","doi":"10.1016/j.sart.2026.151550","DOIUrl":"10.1016/j.sart.2026.151550","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is a reliable and frequently utilized treatment for large rotator cuff tears with associated arthritis. Acromion and scapular spine stress injuries and fractures have been shown to be a common complication after rTSA, with an incidence as high as 11% in some reports. This complication can result in pain and loss of functionality. While many risk factors have been reported, this study investigates physician learning curve, a rarely examined feature, to identify whether the incidence of acromial stress fracture (ASF) decreases with the experience of the surgeon.</div></div><div><h3>Methods</h3><div>A retrospective review was performed for all patients undergoing rTSA at a single institution by one of two surgeons using the same rTSA system from 2005 to 2020. Cases were divided into an “early group” (2005-2015) and a “late group” (2015-2020). Patients were followed through their treatment course, with chart review ending in 2020 to ensure a minimum 2-year follow-up. Statistical analysis was determined via Fisher exact test with an alpha level of 0.05.</div></div><div><h3>Results</h3><div>One hundred eighty-five patients (56 males, 129 females) were reviewed. The early group consisted of 102 patients, 7 of which were diagnosed with ASFs. The late group consisted of 83 patients, none of which experienced ASF. This yielded a statistical significance via Fisher exact test. No significant differences were found between rates of dislocation, nerve palsy, deep, and superficial infections between groups.</div></div><div><h3>Conclusion</h3><div>Results suggest that there is a learning curve to rTSA, specifically regarding the incidence of ASF. A potential cause of this discrepancy is tension placed on the deltoid, which is key to achieving a stable rTSA. Less-experienced surgeons may over-tension this element of the procedure, leading to a stress fracture. Future studies may seek to improve intraoperative assessment of deltoid tension to optimally balance the risk of dislocation and ASF.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 2","pages":"Article 151550"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116528","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}
Pub Date : 2026-01-13DOI: 10.1016/j.sart.2026.151545
Kola D. George MD , Taylor L. Cunningham BA , John W. Moore BS , Alexander S. Guareschi MD , Brandon L. Rogalski MD , Richard J. Friedman MD, FRCSC
Background
Frailty is a state of age-related decline that has been associated with negative outcomes and increased complications following orthopedic surgery. The Hospital Frailty Risk Score (HFRS) is a newer comorbidity index designed to measure frailty. The purpose of this study was to determine how frailty, as measured by the HFRS, affects complication rates following revision total shoulder arthroplasty (TSA).
Methods
The National Inpatient Sample was queried from 2016 to 2020 to identify revision TSA cases. HFRS was calculated, and patients with a score of ≥5 were said to be frail. Frail patients were matched 1:1 on age and sex to yield 4,465 frail cases and 4,470 control cases. Frail and nonfrail patients were compared across demographic information, preoperative comorbidities, postoperative complications, and healthcare utilization measures. Binary logistic regression was used to identify postoperative complications for which HFRS was independently predictive.
Results
Frail patients had higher HFRS than nonfrail patients (P < .001) and higher rates of smoking (P < .001) and lower rates of alcohol abuse (P < .001) and drug abuse (P < .001). Frail patients were more likely to have Medicare insurance (P < .001) and more likely to be white (P < .001). Following binary logistic regression, HFRS was an independent predictor of increased mortality (P < .001), Acute Respiratory Distress Syndrome (P < .001), acute renal failure (P < .001), bleeding (P < .001), cellulitis (P < .001), surgical site infection (P < .001), pneumonia (P < .001), sepsis (P < .001), shock (P < .001), transfusion (P < .001), urinary tract infection (P < .001), and periprosthetic fracture (P < .001). HFRS was independently predictive of decreased rates of periprosthetic loosening (P < .001) and osteolysis (P < .001). Frail patients had increased resource utilization compared to nonfrail patients, including higher cost (P < .001) and increased hospital length of stay (P < .001).
Discussion
Frailty, when measured using the HFRS, is associated with increased postoperative complications, healthcare costs, and reoperation in patient's undergoing revision TSA. Increased HFRS scores are associated with adverse outcomes following revision TSA. Our study emphasizes the importance of careful patient selection undergoing this procedure. The assessment of patient frailty utilizing HFRS serves to be a valuable resource to predict the risk of poor outcomes in revision TSA.
{"title":"The Hospital Frailty Risk Score predicts increased mortality, complication, and resource utilization following revision total shoulder arthroplasty","authors":"Kola D. George MD , Taylor L. Cunningham BA , John W. Moore BS , Alexander S. Guareschi MD , Brandon L. Rogalski MD , Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2026.151545","DOIUrl":"10.1016/j.sart.2026.151545","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a state of age-related decline that has been associated with negative outcomes and increased complications following orthopedic surgery. The Hospital Frailty Risk Score (HFRS) is a newer comorbidity index designed to measure frailty. The purpose of this study was to determine how frailty, as measured by the HFRS, affects complication rates following revision total shoulder arthroplasty (TSA).</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried from 2016 to 2020 to identify revision TSA cases. HFRS was calculated, and patients with a score of ≥5 were said to be frail. Frail patients were matched 1:1 on age and sex to yield 4,465 frail cases and 4,470 control cases. Frail and nonfrail patients were compared across demographic information, preoperative comorbidities, postoperative complications, and healthcare utilization measures. Binary logistic regression was used to identify postoperative complications for which HFRS was independently predictive.</div></div><div><h3>Results</h3><div>Frail patients had higher HFRS than nonfrail patients (<em>P</em> < .001) and higher rates of smoking (<em>P</em> < .001) and lower rates of alcohol abuse (<em>P</em> < .001) and drug abuse (<em>P</em> < .001). Frail patients were more likely to have Medicare insurance (<em>P</em> < .001) and more likely to be white (<em>P</em> < .001). Following binary logistic regression, HFRS was an independent predictor of increased mortality (<em>P</em> < .001), Acute Respiratory Distress Syndrome (<em>P</em> < .001), acute renal failure (<em>P</em> < .001), bleeding (<em>P</em> < .001), cellulitis (<em>P</em> < .001), surgical site infection (<em>P</em> < .001), pneumonia (<em>P</em> < .001), sepsis (<em>P</em> < .001), shock (<em>P</em> < .001), transfusion (<em>P</em> < .001), urinary tract infection (<em>P</em> < .001), and periprosthetic fracture (<em>P</em> < .001). HFRS was independently predictive of decreased rates of periprosthetic loosening (<em>P</em> < .001) and osteolysis (<em>P</em> < .001). Frail patients had increased resource utilization compared to nonfrail patients, including higher cost (<em>P</em> < .001) and increased hospital length of stay (<em>P</em> < .001).</div></div><div><h3>Discussion</h3><div>Frailty, when measured using the HFRS, is associated with increased postoperative complications, healthcare costs, and reoperation in patient's undergoing revision TSA. Increased HFRS scores are associated with adverse outcomes following revision TSA. Our study emphasizes the importance of careful patient selection undergoing this procedure. The assessment of patient frailty utilizing HFRS serves to be a valuable resource to predict the risk of poor outcomes in revision TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151545"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077508","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}
Pub Date : 2026-01-10DOI: 10.1016/j.sart.2026.151542
Abhay Mathur MD , Evan R. Simpson BS , Patrick Saunders MD , Bernadin Bernardino BS , Clayton Hui BS , Hafiz F. Kassam MD
Background
Reverse total shoulder arthroplasty (rTSA) has become the dominant form of shoulder arthroplasty with rapidly increasing utilization. As such, rTSA revision rates are also sharply rising. Patients with neuromuscular (NM) disorders may be particularly vulnerable, yet their risk of revision after rTSA remains poorly defined.
Methods
A retrospective cohort analysis of the PearlDiver database (2010-2022) was conducted. Patients with NM diagnoses undergoing primary rTSA were identified using International Classification of Diseases, Ninth Revision, 10th Revision, and Current Procedural Terminology codes. The primary outcome was revision rTSA. A 1:1 propensity score match was performed, controlling for age, sex, and Charlson Comorbidity Index. Chi-square and paired t-tests were used for analysis.
Results
A total of 13,771 primary rTSAs were performed between 2010 and 2022 in patients with 13 underlying NM disorders. Among 9 disorders with adequate data, revision rates were highest for cerebral palsy (9.0%), Charcot neuropathy (8.6%), and multiple sclerosis (8.2%). In matched analyses, Parkinson's disease (P < .001) and multiple sclerosis (P = .028) were associated with significantly higher risk of revision rTSA, while epilepsy/seizure and cerebrovascular disease/stroke were not.
Conclusions
Underlying NM disorders, particularly Parkinson's disease and multiple sclerosis, significantly increase the risk of revision after rTSA. These findings highlight the importance of preoperative counseling, risk stratification, and optimization in this high-risk population.
{"title":"Impact of neuromuscular diseases on revision risk after reverse total shoulder arthroplasty","authors":"Abhay Mathur MD , Evan R. Simpson BS , Patrick Saunders MD , Bernadin Bernardino BS , Clayton Hui BS , Hafiz F. Kassam MD","doi":"10.1016/j.sart.2026.151542","DOIUrl":"10.1016/j.sart.2026.151542","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) has become the dominant form of shoulder arthroplasty with rapidly increasing utilization. As such, rTSA revision rates are also sharply rising. Patients with neuromuscular (NM) disorders may be particularly vulnerable, yet their risk of revision after rTSA remains poorly defined.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis of the PearlDiver database (2010-2022) was conducted. Patients with NM diagnoses undergoing primary rTSA were identified using International Classification of Diseases, Ninth Revision, 10th Revision, and Current Procedural Terminology codes. The primary outcome was revision rTSA. A 1:1 propensity score match was performed, controlling for age, sex, and Charlson Comorbidity Index. Chi-square and paired <em>t</em>-tests were used for analysis.</div></div><div><h3>Results</h3><div>A total of 13,771 primary rTSAs were performed between 2010 and 2022 in patients with 13 underlying NM disorders. Among 9 disorders with adequate data, revision rates were highest for cerebral palsy (9.0%), Charcot neuropathy (8.6%), and multiple sclerosis (8.2%). In matched analyses, Parkinson's disease (<em>P</em> < .001) and multiple sclerosis (<em>P</em> = .028) were associated with significantly higher risk of revision rTSA, while epilepsy/seizure and cerebrovascular disease/stroke were not.</div></div><div><h3>Conclusions</h3><div>Underlying NM disorders, particularly Parkinson's disease and multiple sclerosis, significantly increase the risk of revision after rTSA. These findings highlight the importance of preoperative counseling, risk stratification, and optimization in this high-risk population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151542"},"PeriodicalIF":0.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037734","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}
Pub Date : 2026-01-10DOI: 10.1016/j.sart.2026.151546
Alexander C. Dippre BS, Jakob M. Miller BS, Sophia A. Sitsis BS, Robert Henke BS, Maxwell A. Northrop BS, John W. Moore BS, Brandon L. Rogalski MD, Richard J. Friedman MD, FRCSC
Background
Socioeconomic and demographic factors play a major role in patient well-being. However, how these factors can affect outcomes following total shoulder arthroplasty (TSA) has not been well-documented. The purpose of this study is to determine how socioeconomic and demographic factors affect outcomes following primary TSA. We hypothesize that certain socioeconomic and demographic factors—including primary contact, race, age, sex, and travel distance—are associated with differences in postoperative outcomes following primary TSA.
Methods
This retrospective cohort study included 556 patients who underwent primary anatomic or reverse TSA at a single tertiary center between 2013 and 2023, with a minimum of two years of follow-up. Patients were grouped by primary contact (spouse vs. others), age (≥70 years vs. <70 years), sex, Area Deprivation Index (ADI), and race (white vs. black). Independent t-test, chi-square test, and multivariate linear regression were used to compare postoperative abduction, American Shoulder and Elbow Surgeons score, pain via the visual analog scale, length of stay, and internal rotation (IR) score.
Results
Patients aged 70 and older had lower postoperative abduction (mean difference [MD] = 14° [95% confidence interval (CI), 4.44-23.6]; P = .005). Patients in the top ADI quartile had improved postoperative IR score (MD = 0.72 [95% CI, 0.18-1.26]; P = .01). Patients with a spousal primary contact had a shorter length of stay than patients without a spousal primary contact (MD = 0.75 [95% CI, 0.02-1.48]; P = .047). White patients had higher postoperative American Shoulder and Elbow Surgeons scores (MD = 15 [95% CI, 9.2-21.2]; P < .001) and lower pain scores (MD = 1.75 [95% CI, 1.08-2.43]; P < .001). Female patients had a higher postoperative IR score than male patients (MD = 0.57 [95% CI, 0.21-0.93]; P = .002).
Conclusion
This study demonstrated significant differences in postoperative outcomes across multiple socioeconomic and demographic factors, including primary contact, age, race, ADI, and sex. These results support our hypothesis that socioeconomic and demographic factors play a significant role in determining outcomes following primary TSA.
社会经济和人口因素在患者幸福感中起着重要作用。然而，这些因素如何影响全肩关节置换术（TSA）后的预后还没有很好的文献记载。本研究的目的是确定社会经济和人口因素如何影响原发性TSA后的结果。我们假设某些社会经济和人口因素——包括主要接触者、种族、年龄、性别和旅行距离——与原发性TSA术后结果的差异有关。方法本回顾性队列研究纳入了556例2013 - 2023年间在单一三级中心接受初级解剖或反向TSA的患者，随访时间至少为2年。患者按主要接触者（配偶与他人）、年龄（≥70岁与≤70岁）、性别、区域剥夺指数（ADI）和种族（白人与黑人）分组。采用独立t检验、卡方检验和多元线性回归比较术后外展、美国肩关节外科医生评分、视觉模拟量表疼痛、住院时间和内旋（IR）评分。结果70岁及以上患者术后外展发生率较低(平均差值[MD] = 14°[95%可信区间（CI）， 4.44-23.6]；P = .005)。ADI四分位数最高的患者术后IR评分改善（MD = 0.72 [95% CI, 0.18-1.26]; P = 0.01）。有配偶主要接触者的患者比没有配偶主要接触者的患者住院时间短（MD = 0.75 [95% CI, 0.02-1.48]; P = 0.047）。白人患者术后美国肩肘外科医生评分较高（MD = 15 [95% CI, 9.2-21.2]; P < 0.001），疼痛评分较低（MD = 1.75 [95% CI, 1.08-2.43]; P < 0.001）。女性患者术后IR评分高于男性患者（MD = 0.57 [95% CI, 0.21-0.93]; P = 0.002）。结论：该研究表明，术后预后在多种社会经济和人口统计学因素中存在显著差异，包括主要接触者、年龄、种族、ADI和性别。这些结果支持了我们的假设，即社会经济和人口因素在决定初次TSA后的结果中起着重要作用。
{"title":"Socioeconomic and demographic factors affecting outcomes in total shoulder arthroplasty","authors":"Alexander C. Dippre BS, Jakob M. Miller BS, Sophia A. Sitsis BS, Robert Henke BS, Maxwell A. Northrop BS, John W. Moore BS, Brandon L. Rogalski MD, Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2026.151546","DOIUrl":"10.1016/j.sart.2026.151546","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic and demographic factors play a major role in patient well-being. However, how these factors can affect outcomes following total shoulder arthroplasty (TSA) has not been well-documented. The purpose of this study is to determine how socioeconomic and demographic factors affect outcomes following primary TSA. We hypothesize that certain socioeconomic and demographic factors—including primary contact, race, age, sex, and travel distance—are associated with differences in postoperative outcomes following primary TSA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 556 patients who underwent primary anatomic or reverse TSA at a single tertiary center between 2013 and 2023, with a minimum of two years of follow-up. Patients were grouped by primary contact (spouse vs. others), age (≥70 years vs. <70 years), sex, Area Deprivation Index (ADI), and race (white vs. black). Independent <em>t</em>-test, chi-square test, and multivariate linear regression were used to compare postoperative abduction, American Shoulder and Elbow Surgeons score, pain via the visual analog scale, length of stay, and internal rotation (IR) score.</div></div><div><h3>Results</h3><div>Patients aged 70 and older had lower postoperative abduction (mean difference [MD] = 14° [95% confidence interval (CI), 4.44-23.6]; <em>P</em> = .005). Patients in the top ADI quartile had improved postoperative IR score (MD = 0.72 [95% CI, 0.18-1.26]; <em>P</em> = .01). Patients with a spousal primary contact had a shorter length of stay than patients without a spousal primary contact (MD = 0.75 [95% CI, 0.02-1.48]; <em>P</em> = .047). White patients had higher postoperative American Shoulder and Elbow Surgeons scores (MD = 15 [95% CI, 9.2-21.2]; <em>P</em> < .001) and lower pain scores (MD = 1.75 [95% CI, 1.08-2.43]; <em>P</em> < .001). Female patients had a higher postoperative IR score than male patients (MD = 0.57 [95% CI, 0.21-0.93]; <em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>This study demonstrated significant differences in postoperative outcomes across multiple socioeconomic and demographic factors, including primary contact, age, race, ADI, and sex. These results support our hypothesis that socioeconomic and demographic factors play a significant role in determining outcomes following primary TSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151546"},"PeriodicalIF":0.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077648","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}
Pub Date : 2026-01-10DOI: 10.1016/j.sart.2026.151547
Sarah Jenkins MD , Robert J. Reis BS , Josie Elwell PhD , Christopher Roche ME, MBA , Alexander Hafey MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC
Background
Obesity is a well-established risk factor for complications after total shoulder arthroplasty (TSA), and morbidly obese patients may be denied surgery due to concerns about poor outcomes. In the current health care climate, patient-reported outcome measures (PROMs) are increasingly used to define success after elective orthopedic procedures. Most studies on TSA in obese patients focus on objective metrics such as complication rates, range of motion, and radiographic parameters, while data on the subjective patient experience remain limited. The purpose of this study is to examine the effects of increasing obesity and body mass index (BMI) on PROMs and satisfaction in obese patients undergoing primary TSA.
Methods
There were 2,525 patients with a BMI >30 kg/m2 who underwent primary anatomic or reverse TSA that were identified in a prospective international shoulder registry and stratified according to the World Health Organization classification for obesity. Patient demographics, preoperative and minimum 2-year postoperative PROM, patient satisfaction scores, and complications and revisions were compared between patients with Class I (BMI 30-34.99 kg/m2), Class II (BMI 35-39.99), and Class III (BMI >40 kg/m2) obesity.
Results
Class II and III patients were younger, more likely to be female, and more likely to have hypertension or diabetes than Class I patients. Preoperatively, Class III patients reported higher visual analog scale pain and lower Constant and American Shoulder and Elbow Surgeons scores than Class I or II patients, and lower Shoulder Arthroplasty Smart scores than Class I patients. TSA led to significant improvement in all PROM across all Classes. At a mean follow-up of 53 months, there were no significant between-group differences in patient satisfaction rates or PROM except for a lower Constant score in Class III patients compared to Class I patients; however, this difference did not exceed the minimum clinically important difference.
Conclusion
In obese patients undergoing primary TSA, the severity of obesity does not have a clinically significant impact on postoperative PROM or patient satisfaction, arguing against the use of BMI cutoffs in TSA. With appropriate medical optimization, morbidly obese patients can achieve functional improvement and satisfaction levels comparable to those of their less obese counterparts.
{"title":"Effect of obesity severity on patient-reported outcome measures and patient satisfaction following total shoulder arthroplasty","authors":"Sarah Jenkins MD , Robert J. Reis BS , Josie Elwell PhD , Christopher Roche ME, MBA , Alexander Hafey MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2026.151547","DOIUrl":"10.1016/j.sart.2026.151547","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a well-established risk factor for complications after total shoulder arthroplasty (TSA), and morbidly obese patients may be denied surgery due to concerns about poor outcomes. In the current health care climate, patient-reported outcome measures (PROMs) are increasingly used to define success after elective orthopedic procedures. Most studies on TSA in obese patients focus on objective metrics such as complication rates, range of motion, and radiographic parameters, while data on the subjective patient experience remain limited. The purpose of this study is to examine the effects of increasing obesity and body mass index (BMI) on PROMs and satisfaction in obese patients undergoing primary TSA.</div></div><div><h3>Methods</h3><div>There were 2,525 patients with a BMI >30 kg/m<sup>2</sup> who underwent primary anatomic or reverse TSA that were identified in a prospective international shoulder registry and stratified according to the World Health Organization classification for obesity. Patient demographics, preoperative and minimum 2-year postoperative PROM, patient satisfaction scores, and complications and revisions were compared between patients with Class I (BMI 30-34.99 kg/m<sup>2</sup>), Class II (BMI 35-39.99), and Class III (BMI >40 kg/m<sup>2</sup>) obesity.</div></div><div><h3>Results</h3><div>Class II and III patients were younger, more likely to be female, and more likely to have hypertension or diabetes than Class I patients. Preoperatively, Class III patients reported higher visual analog scale pain and lower Constant and American Shoulder and Elbow Surgeons scores than Class I or II patients, and lower Shoulder Arthroplasty Smart scores than Class I patients. TSA led to significant improvement in all PROM across all Classes. At a mean follow-up of 53 months, there were no significant between-group differences in patient satisfaction rates or PROM except for a lower Constant score in Class III patients compared to Class I patients; however, this difference did not exceed the minimum clinically important difference.</div></div><div><h3>Conclusion</h3><div>In obese patients undergoing primary TSA, the severity of obesity does not have a clinically significant impact on postoperative PROM or patient satisfaction, arguing against the use of BMI cutoffs in TSA. With appropriate medical optimization, morbidly obese patients can achieve functional improvement and satisfaction levels comparable to those of their less obese counterparts.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151547"},"PeriodicalIF":0.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077507","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}
Pub Date : 2025-12-17DOI: 10.1016/j.sart.2025.151528
Bradley A. Lezak MD, MPH, Melissa Song BS, Mark Pianka MD, MBA, Joseph Bosco III MD
Background
Healthcare price transparency regulations aim to reduce costs and empower patient decision-making, yet compliance and the relationship between pricing and quality for orthopedic procedures such as total shoulder arthroplasty (TSA) remain poorly characterized.
Methods
Hospitals across New York State were queried for TSA pricing data. Compliance with Centers for Medicare and Medicaid Services price transparency requirements was assessed, and hospitals providing both commercial and self-pay rates were included. Hospital quality metrics were obtained from publicly available Centers for Medicare and Medicaid Services databases. Multivariable linear regression was used to evaluate associations between TSA pricing, hospital demographics, and quality indicators.
Results
Of 219 hospitals queried, 84 (38.4%) were compliant with federally mandated price transparency reporting. TSA pricing demonstrated wide variability, with cash prices ranging from $1,571 to $139,203 (mean, $29,104) and commercial rates from $1,375 to $139,203 (mean, $21,573). Higher Area Deprivation Index, greater bed count, methicillin-resistant Staphylococcus aureus bacteremia rates, and readmission rates following hip or knee replacement were positively associated with increased cash prices. Surgical site infection rates after colon surgery were associated with higher commercial rates. No strong correlations were observed between TSA pricing and overall hospital quality metrics.
Conclusion
Compliance with federal price transparency regulations for TSA remains limited. TSA pricing varies substantially and is not reliably associated with hospital quality. Efforts to enhance transparency and better align cost with quality are necessary to advance value-based care in orthopedic surgery.
{"title":"Total shoulder arthroplasty: prices unrelated to quality, compliance reporting remains low","authors":"Bradley A. Lezak MD, MPH, Melissa Song BS, Mark Pianka MD, MBA, Joseph Bosco III MD","doi":"10.1016/j.sart.2025.151528","DOIUrl":"10.1016/j.sart.2025.151528","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare price transparency regulations aim to reduce costs and empower patient decision-making, yet compliance and the relationship between pricing and quality for orthopedic procedures such as total shoulder arthroplasty (TSA) remain poorly characterized.</div></div><div><h3>Methods</h3><div>Hospitals across New York State were queried for TSA pricing data. Compliance with Centers for Medicare and Medicaid Services price transparency requirements was assessed, and hospitals providing both commercial and self-pay rates were included. Hospital quality metrics were obtained from publicly available Centers for Medicare and Medicaid Services databases. Multivariable linear regression was used to evaluate associations between TSA pricing, hospital demographics, and quality indicators.</div></div><div><h3>Results</h3><div>Of 219 hospitals queried, 84 (38.4%) were compliant with federally mandated price transparency reporting. TSA pricing demonstrated wide variability, with cash prices ranging from $1,571 to $139,203 (mean, $29,104) and commercial rates from $1,375 to $139,203 (mean, $21,573). Higher Area Deprivation Index, greater bed count, methicillin-resistant <em>Staphylococcus aureus</em> bacteremia rates, and readmission rates following hip or knee replacement were positively associated with increased cash prices. Surgical site infection rates after colon surgery were associated with higher commercial rates. No strong correlations were observed between TSA pricing and overall hospital quality metrics.</div></div><div><h3>Conclusion</h3><div>Compliance with federal price transparency regulations for TSA remains limited. TSA pricing varies substantially and is not reliably associated with hospital quality. Efforts to enhance transparency and better align cost with quality are necessary to advance value-based care in orthopedic surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151528"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037651","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}
Pub Date : 2025-12-17DOI: 10.1016/j.sart.2025.151538
Zina Smadi MD , Diane Ghanem MD , Akin Adio BA , Lisa Mahmoud MD , Peter Boufadel MD , Miguel Fiandeiro BA , Amir Alsaidi BS , Abdullah Ghali MD , Joseph A. Abboud MD
<div><h3>Background</h3><div>Diuretics are commonly prescribed medications with known effects on bone mineral density. However, their effect on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study examines the association between perioperative diuretic use and 90-day postoperative medical complications and 2-year implant-related outcomes in TSA patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted utilizing the TriNetX database (2003-2023) to identify patients undergoing TSA with documented perioperative use of diuretics (within 6 months before or after surgery). Patients were 1:1 propensity score-matched to controls based on demographics and comorbidities, yielding 14,595 matched pairs. Diuretic classes included loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitors (CAIs). Primary outcomes included 90-day postoperative medical complications and readmission. Secondary outcomes included 2-year revision surgery and implant-related complications. Relative risks (RRs), 95% confidence intervals, and <em>P</em> values were calculated.</div></div><div><h3>Results</h3><div>Loop diuretics were significantly associated with higher risks of 90-day renal failure (RR: 3.1; <em>P</em> < .0001), pneumonia (RR: 3.0; <em>P</em> < .0001), sepsis (RR: 2.9; <em>P</em> < .0001), blood transfusion (RR: 3.8; <em>P</em> < .0001), and readmission (RR: 2.4; <em>P</em> < .0001), as well as increased 2-year rates of emergency department visits (RR: 1.3; <em>P</em> < .0001), hospital admissions (RR: 1.6; <em>P</em> < .0001), periprosthetic joint infection (RR: 1.4; <em>P</em> = .015), revision surgery (RR: 1.3; <em>P</em> = .046), and opioid use (RR: 1.4; <em>P</em> < .0001). Thiazide use showed a significant increase in renal failure at 90 days (RR: 1.6; <em>P</em> = .002) and opioid use at 2 years (RR: 1.2; <em>P</em> < .0001). Potassium-sparing diuretics were linked to higher 90-day risks of blood transfusion (RR: 2.6; <em>P</em> = .007) and readmission (RR: 1.6; <em>P</em> = .003), but showed no significant impact on long-term outcomes. Osmotic diuretics were associated with 90-day anemia (RR: 2.1; <em>P</em> = .043) and 2-year increases in admissions (RR: 1.9; <em>P</em> = .030) and opioid use (RR: 2.9; <em>P</em> < .0001). CAIs exhibited elevated 90-day risks for outcomes like myocardial infarction, pulmonary embolism, stroke, and surgical site infection (where controls had zero incidence), though no statistically significant 2-year outcomes were observed.</div></div><div><h3>Conclusion</h3><div>Loop diuretics were consistently associated with markedly higher risks of perioperative complications, including renal failure, infection, transfusion, sepsis, and readmission, as well as increased long-term health care utilization, revision surgery, and opioid dependence. Thiazides, potassium-sparing, osmotic diuretics, and CAIs were each linked to distinct but
利尿剂是常用的处方药，已知对骨密度有影响。然而，它们对全肩关节置换术（TSA）后预后的影响尚不清楚。本研究探讨了TSA患者围手术期使用利尿剂与术后90天医疗并发症和2年种植体相关结果之间的关系。方法利用TriNetX数据库（2003-2023）进行回顾性队列研究，以确定经TSA手术围手术期（术前或术后6个月内）使用利尿剂的患者。根据人口统计学和合并症，患者与对照组进行1:1的倾向评分匹配，产生14,595对匹配。利尿剂包括环类、噻嗪类、保钾类、渗透性和碳酸酐酶抑制剂（CAIs）。主要结局包括术后90天的医疗并发症和再入院。次要结果包括2年翻修手术和种植体相关并发症。计算相对危险度（RRs）、95%置信区间和P值。结果环状利尿剂与90天肾衰竭（RR: 3.1; P < 0.0001）、肺炎（RR: 3.0; P < 0.0001）、脓毒症（RR: 2.9; P < 0.0001）、输血（RR: 3.8; P < 0.0001）、再入院（RR: 2.4; P < 0.0001）的高风险显著相关，2年内急诊科就诊率（RR: 1.3; P < 0.0001）、住院率（RR: 1.6; P < 0.0001）、假体周围关节感染（RR: 1.4; P = 0.015）、翻修手术(RR: 1.3；P = 0.046)和阿片类药物使用（RR: 1.4; P < 0.0001）。噻嗪类药物的使用在第90天（RR: 1.6; P = 0.002）和阿片类药物的使用在第2年（RR: 1.2; P < 0.0001）时显示了肾功能衰竭的显著增加。保钾利尿剂与较高的90天输血风险（RR: 2.6; P = 0.003）和再入院风险（RR: 1.6; P = 0.003）相关，但对长期预后无显著影响。渗透性利尿剂与90天贫血（RR: 2.1; P = 0.043）、2年入院率增加（RR: 1.9; P = 0.030）和阿片类药物使用（RR: 2.9; P < 0.0001）相关。CAIs在90天内出现心肌梗死、肺栓塞、中风和手术部位感染（对照组发生率为零）等结果的风险升高，但没有观察到2年的显著结果。结论：环形利尿剂与围手术期并发症（包括肾功能衰竭、感染、输血、败血症和再入院）的风险显著升高相关，同时增加了长期医疗保健利用、翻修手术和阿片类药物依赖。噻嗪类药物、保钾剂、渗透性利尿剂和cai均与不同但更有限的不良后果相关。这些发现强调了在接受慢性利尿剂治疗的手术患者中需要提高警惕和量身定制的围手术期管理。
{"title":"The effect of perioperative diuretic use on complications after total shoulder arthroplasty: a propensity-matched cohort analysis","authors":"Zina Smadi MD , Diane Ghanem MD , Akin Adio BA , Lisa Mahmoud MD , Peter Boufadel MD , Miguel Fiandeiro BA , Amir Alsaidi BS , Abdullah Ghali MD , Joseph A. Abboud MD","doi":"10.1016/j.sart.2025.151538","DOIUrl":"10.1016/j.sart.2025.151538","url":null,"abstract":"<div><h3>Background</h3><div>Diuretics are commonly prescribed medications with known effects on bone mineral density. However, their effect on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study examines the association between perioperative diuretic use and 90-day postoperative medical complications and 2-year implant-related outcomes in TSA patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted utilizing the TriNetX database (2003-2023) to identify patients undergoing TSA with documented perioperative use of diuretics (within 6 months before or after surgery). Patients were 1:1 propensity score-matched to controls based on demographics and comorbidities, yielding 14,595 matched pairs. Diuretic classes included loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitors (CAIs). Primary outcomes included 90-day postoperative medical complications and readmission. Secondary outcomes included 2-year revision surgery and implant-related complications. Relative risks (RRs), 95% confidence intervals, and <em>P</em> values were calculated.</div></div><div><h3>Results</h3><div>Loop diuretics were significantly associated with higher risks of 90-day renal failure (RR: 3.1; <em>P</em> < .0001), pneumonia (RR: 3.0; <em>P</em> < .0001), sepsis (RR: 2.9; <em>P</em> < .0001), blood transfusion (RR: 3.8; <em>P</em> < .0001), and readmission (RR: 2.4; <em>P</em> < .0001), as well as increased 2-year rates of emergency department visits (RR: 1.3; <em>P</em> < .0001), hospital admissions (RR: 1.6; <em>P</em> < .0001), periprosthetic joint infection (RR: 1.4; <em>P</em> = .015), revision surgery (RR: 1.3; <em>P</em> = .046), and opioid use (RR: 1.4; <em>P</em> < .0001). Thiazide use showed a significant increase in renal failure at 90 days (RR: 1.6; <em>P</em> = .002) and opioid use at 2 years (RR: 1.2; <em>P</em> < .0001). Potassium-sparing diuretics were linked to higher 90-day risks of blood transfusion (RR: 2.6; <em>P</em> = .007) and readmission (RR: 1.6; <em>P</em> = .003), but showed no significant impact on long-term outcomes. Osmotic diuretics were associated with 90-day anemia (RR: 2.1; <em>P</em> = .043) and 2-year increases in admissions (RR: 1.9; <em>P</em> = .030) and opioid use (RR: 2.9; <em>P</em> < .0001). CAIs exhibited elevated 90-day risks for outcomes like myocardial infarction, pulmonary embolism, stroke, and surgical site infection (where controls had zero incidence), though no statistically significant 2-year outcomes were observed.</div></div><div><h3>Conclusion</h3><div>Loop diuretics were consistently associated with markedly higher risks of perioperative complications, including renal failure, infection, transfusion, sepsis, and readmission, as well as increased long-term health care utilization, revision surgery, and opioid dependence. Thiazides, potassium-sparing, osmotic diuretics, and CAIs were each linked to distinct but","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151538"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926411","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}
Pub Date : 2025-12-17DOI: 10.1016/j.sart.2025.151536
Jon J.P. Warner MD, Sarah Koljaka BA, James Satalich MD, Kevin Wall MD, MPH, Nicholas Wiley BA, MS
<div><h3>Background</h3><div>The emergence of technology in orthopedics has accelerated rapidly with promises of improving outcomes, precision of surgery, and learning curves for surgeons. Shoulder arthroplasty surgery has lagged spine, hip, and knee in the application of new technology such as robotics and artificial intelligence (AI). Recent advances, driven by surgeon—industry collaboration, have expanded applications of immersive virtual, augmented, and mixed reality, AI, and robotics. The purpose of this study was to identify surgeon preferences regarding digital technology and compare them to the current industry strategy to identify alignment and opportunities for future collaboration and scaling of technology.</div></div><div><h3>Methods</h3><div>Anonymous surveys were administered to shoulder arthroplasty surgeons from 3 international organizations specific to shoulder care (American Shoulder and Elbow Surgeons, European Society for Surgery of the Shoulder and the Elbow – SECEC, and the Codman Shoulder Society). Nine leading companies using and developing digital technology for shoulder replacements received separate surveys. Physician surveys gathered data on arthroplasty volume, preoperative planning, and desired technological innovations. Industry leaders ranked priorities for developing digital tools for orthopedic surgeons and outlined revenue models to maximize value.</div></div><div><h3>Results</h3><div>A total of 192 surgeons responded (American Shoulder and Elbow Surgeons = 88, SECEC = 57, Codman Shoulder Society = 47), along with 6 of 9 industry organizations. Ninety-six percent of responding surgeons perform preoperative planning, of which 82% use digital tools. Thirty-four percent use virtual reality (VR) for preoperative planning, while intraoperatively 24% use navigation, 23% mixed reality, and 12% patient-specific guides. Both surgeons and industry ranked AI/machine learning (AI/ML) as their top priority. Industry reported error reduction, data generation for best practices, and improved efficiency as main value drivers of AI. Intraoperative navigation, mixed/augmented reality, immersive VR, and robotics ranked lower in priority for industry and surgeons. Surgeons emphasized reliability and patient outcome tracking, which industry did not consider a key focus. No consistent business model for AI/ML emerged.</div></div><div><h3>Conclusion</h3><div>Both surgeons and industry identified AI/ML as the top priority for digital technology development, though industry provided no clear business model for its future sustainability. Other technologies were considered valuable, but surgeons were unclear on the value proposition of virtual planning. Immersive VR surgery as an educational tool seems to be a lower priority for both surgeons and industry, though most surgeons have had no experience with this technology thus far. Overall, digital innovation is a shared priority, with AI/ML offering the clearest value, although the busines
{"title":"Digital technology in shoulder arthroplasty: what do surgeons want? What will industry offer?","authors":"Jon J.P. Warner MD, Sarah Koljaka BA, James Satalich MD, Kevin Wall MD, MPH, Nicholas Wiley BA, MS","doi":"10.1016/j.sart.2025.151536","DOIUrl":"10.1016/j.sart.2025.151536","url":null,"abstract":"<div><h3>Background</h3><div>The emergence of technology in orthopedics has accelerated rapidly with promises of improving outcomes, precision of surgery, and learning curves for surgeons. Shoulder arthroplasty surgery has lagged spine, hip, and knee in the application of new technology such as robotics and artificial intelligence (AI). Recent advances, driven by surgeon—industry collaboration, have expanded applications of immersive virtual, augmented, and mixed reality, AI, and robotics. The purpose of this study was to identify surgeon preferences regarding digital technology and compare them to the current industry strategy to identify alignment and opportunities for future collaboration and scaling of technology.</div></div><div><h3>Methods</h3><div>Anonymous surveys were administered to shoulder arthroplasty surgeons from 3 international organizations specific to shoulder care (American Shoulder and Elbow Surgeons, European Society for Surgery of the Shoulder and the Elbow – SECEC, and the Codman Shoulder Society). Nine leading companies using and developing digital technology for shoulder replacements received separate surveys. Physician surveys gathered data on arthroplasty volume, preoperative planning, and desired technological innovations. Industry leaders ranked priorities for developing digital tools for orthopedic surgeons and outlined revenue models to maximize value.</div></div><div><h3>Results</h3><div>A total of 192 surgeons responded (American Shoulder and Elbow Surgeons = 88, SECEC = 57, Codman Shoulder Society = 47), along with 6 of 9 industry organizations. Ninety-six percent of responding surgeons perform preoperative planning, of which 82% use digital tools. Thirty-four percent use virtual reality (VR) for preoperative planning, while intraoperatively 24% use navigation, 23% mixed reality, and 12% patient-specific guides. Both surgeons and industry ranked AI/machine learning (AI/ML) as their top priority. Industry reported error reduction, data generation for best practices, and improved efficiency as main value drivers of AI. Intraoperative navigation, mixed/augmented reality, immersive VR, and robotics ranked lower in priority for industry and surgeons. Surgeons emphasized reliability and patient outcome tracking, which industry did not consider a key focus. No consistent business model for AI/ML emerged.</div></div><div><h3>Conclusion</h3><div>Both surgeons and industry identified AI/ML as the top priority for digital technology development, though industry provided no clear business model for its future sustainability. Other technologies were considered valuable, but surgeons were unclear on the value proposition of virtual planning. Immersive VR surgery as an educational tool seems to be a lower priority for both surgeons and industry, though most surgeons have had no experience with this technology thus far. Overall, digital innovation is a shared priority, with AI/ML offering the clearest value, although the busines","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151536"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926412","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}
Pub Date : 2025-12-17DOI: 10.1016/j.sart.2025.151535
Emiko R. Hourston BEng , Kaitlyn Kuchinka BEng , Jaylan Hamad BEng , George S. Athwal MD , Joshua W. Giles PhD
Background
When performing total shoulder arthroplasty, referencing the entire glenoid en face orientation to determine an inclination correction, termed here the “Total Shoulder Correction Angle” (TSCA), has proven helpful in positioning the anatomic glenoid implant. This method has also been used for reverse total shoulder arthroplasty (rTSA) baseplate positioning, leading to an unintended superior baseplate inclination. Thus, an rTSA-specific measurement using only the inferior glenoid, termed here the “Reverse Shoulder Correction Angle” (RSCA), was proposed to determine the required inclination. Still, it is unknown if using this correction angle has any appreciable impact on baseplate loading. Thus, the purpose of this basic science study was to compare shoulder biomechanics when baseplates are placed using the TSCA or RSCA method and to identify relationships between these biomechanical effects and variations in scapular anatomy.
Methods
This study used a previously published modeling workflow that combined statistical shape model, musculoskeletal, and predictive modeling. Thirty scapular morphologies were generated using Latin Hypercube Sampling of the statistical shape model to yield a cohort that replicated normal variations in the population anatomy. A validated musculoskeletal model was modified using each generated morphology, and two virtual surgeries were performed on each model to place the rTSA baseplates: (1) using the TSCA and (2) using the RSCA. Each model underwent muscle-driven predictive simulation of a lateral-reaching task. Joint reaction force (JRF, in % bodyweight) and compression-to-shear force ratio time-series data were statistically tested using statistical parametric mapping paired t-tests.
Results
Significant differences (P ≤ .047) were identified in the JRF between the TSCA and RSCA methods. The TSCA method resulted in significantly higher JRFs (P < .001) across the first 70% of motion because of large superior baseplate shear, with mean load differences in both forces of up to 25% bodyweight in the first 5% of motion. Using the RSCA method resulted in significantly higher JRFs in the last 20% of motion because of high shear and compressive forces, but its compression-to-shear force ratio remained significantly higher than the TSCA.
Conclusion
The results of this study demonstrate that using the RSCA, rather than the TSCA, to assist with rTSA baseplate positioning results in significantly less challenging loads for baseplate fixation across a motion, thus reducing the likelihood of early baseplate loosening.
{"title":"Choice of glenoid inclination correction method affects reverse shoulder arthroplasty baseplate loading","authors":"Emiko R. Hourston BEng , Kaitlyn Kuchinka BEng , Jaylan Hamad BEng , George S. Athwal MD , Joshua W. Giles PhD","doi":"10.1016/j.sart.2025.151535","DOIUrl":"10.1016/j.sart.2025.151535","url":null,"abstract":"<div><h3>Background</h3><div>When performing total shoulder arthroplasty, referencing the entire glenoid en face orientation to determine an inclination correction, termed here the “Total Shoulder Correction Angle” (TSCA), has proven helpful in positioning the anatomic glenoid implant. This method has also been used for reverse total shoulder arthroplasty (rTSA) baseplate positioning, leading to an unintended superior baseplate inclination. Thus, an rTSA-specific measurement using only the inferior glenoid, termed here the “Reverse Shoulder Correction Angle” (RSCA), was proposed to determine the required inclination. Still, it is unknown if using this correction angle has any appreciable impact on baseplate loading. Thus, the purpose of this basic science study was to compare shoulder biomechanics when baseplates are placed using the TSCA or RSCA method and to identify relationships between these biomechanical effects and variations in scapular anatomy.</div></div><div><h3>Methods</h3><div>This study used a previously published modeling workflow that combined statistical shape model, musculoskeletal, and predictive modeling. Thirty scapular morphologies were generated using Latin Hypercube Sampling of the statistical shape model to yield a cohort that replicated normal variations in the population anatomy. A validated musculoskeletal model was modified using each generated morphology, and two virtual surgeries were performed on each model to place the rTSA baseplates: (1) using the TSCA and (2) using the RSCA. Each model underwent muscle-driven predictive simulation of a lateral-reaching task. Joint reaction force (JRF, in % bodyweight) and compression-to-shear force ratio time-series data were statistically tested using statistical parametric mapping paired <em>t</em>-tests.</div></div><div><h3>Results</h3><div>Significant differences (<em>P</em> ≤ .047) were identified in the JRF between the TSCA and RSCA methods. The TSCA method resulted in significantly higher JRFs (<em>P</em> < .001) across the first 70% of motion because of large superior baseplate shear, with mean load differences in both forces of up to 25% bodyweight in the first 5% of motion. Using the RSCA method resulted in significantly higher JRFs in the last 20% of motion because of high shear and compressive forces, but its compression-to-shear force ratio remained significantly higher than the TSCA.</div></div><div><h3>Conclusion</h3><div>The results of this study demonstrate that using the RSCA, rather than the TSCA, to assist with rTSA baseplate positioning results in significantly less challenging loads for baseplate fixation across a motion, thus reducing the likelihood of early baseplate loosening.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151535"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037719","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}
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