Seminars in Arthroplasty最新文献

{"title":"Analysis of 516 cases of revision total elbow arthroplasty from the Dutch Arthroplasty Registry: centralization of care is the future","authors":"Ali Al-Hamdani MD ,&nbsp;Arno Macken MD ,&nbsp;Ante Prkic MD, PhD ,&nbsp;Bertram The MD, PhD ,&nbsp;Anneke Spekenbrink-Spooren MSc ,&nbsp;Denise Eygendaal MD, PhD","doi":"10.1053/j.sart.2024.01.006","DOIUrl":"10.1053/j.sart.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>The number of revision total elbow arthroplasty (TEA) remains relatively low. As a result, there are relatively few orthopedic surgeons and a limited number of centers with substantial expertise in revising TEA. This study provides a comprehensive description of the current practice concerning revision TEA in a northern European Country based on the data of the Dutch National Implant Registry.</p></div><div><h3>Methods</h3><p>Data of all revision TEA procedures performed between 2014 and 2022 were extracted from the national registry, including cases where the primary procedure was either not recorded in the registry or was not a TEA. Descriptive statistics were used to report the current practice of revision TEA in the Netherlands.</p></div><div><h3>Results</h3><p>Five hundred sixteen revision TEAs were performed in the Netherlands between 2014 and 2022. Eighty-four elbows required more than one revision during that period. The primary cause for revision was aseptic loosening 51%. The procedures were performed in 35 centers, and 21/35 centers performed 5 or less revision procedures per year. No center performed 20 or more revision procedures per year.</p></div><div><h3>Discussion</h3><p>All types of elbow arthroplasty are associated with a considerable rate of complications, and a direct volume-outcome relationship exists in these surgical procedures. Despite the considerable complication rate, the volume of revision TEA remains low, primarily due to the infrequent occurrence of primary procedures.</p></div><div><h3>Conclusion</h3><p>The study reported that aseptic loosening was the primary reason for revision TEA. We recommend centralizing infrequent surgical procedures such as revision TEA in selected highly specialized centers to increase surgeon and center volumes, aiming to yield more favorable outcomes.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 430-435"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000178/pdfft?md5=21180e25dc0f5fc388eaf08eaa17e3dd&pid=1-s2.0-S1045452724000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2023 Acknowledgment of Reviewers","authors":"","doi":"10.1053/j.sart.2024.01.001","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.001","url":null,"abstract":"","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 1","pages":"Pages 219-220"},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000026/pdfft?md5=15cb20cb1fa2aa487dbf93719614e7dd&pid=1-s2.0-S1045452724000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139743221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing ChatGPT responses to frequently asked questions regarding total shoulder arthroplasty","authors":"Jeremy M. Adelstein MD,&nbsp;Margaret A. Sinkler MD,&nbsp;Lambert T. Li MD,&nbsp;Raymond Chen MD,&nbsp;Robert J. Gillespie MD,&nbsp;Jacob Calcei MD","doi":"10.1053/j.sart.2024.01.003","DOIUrl":"10.1053/j.sart.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>“Dr. Google” has long been a resource for health information-seeking individuals. With the well-established presence of artificial intelligence in the healthcare world, it is reasonable to imagine that ChatGPT, an artificial intelligence-powered online chatbot, could become the next outlet for seeking medical advice online. Similar to Mika et al, this study aims to analyze the ChatGPT’s ability to answer frequently asked questions (FAQs) regarding total shoulder arthroplasty (TSA).</p></div><div><h3>Methods</h3><p>Ten FAQs regarding TSA were presented to ChatGPT and initial responses were recorded and analyzed against evidence-based literature. Responses were rated as “excellent response requiring no clarification,” “satisfactory response requiring minimal clarification,” “satisfactory response requiring moderate clarification,” or “unsatisfactory response requiring substantial clarification.”</p></div><div><h3>Results</h3><p>Only one response from ChatGPT was rated unsatisfactory and required substantial clarification. While no responses received an excellent rating, the average rating was considered to only require minimal or moderate clarification.</p></div><div><h3>Conclusion</h3><p>ChatGPT was able to provide largely accurate responses to FAQs regarding TSA while appropriately reiterating the importance of always consulting a medical professional. ChatGPT could prove to be another avenue for supplementary medical information regarding TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 416-424"},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139829486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for rotator cuff tears and aseptic glenoid loosening after anatomic total shoulder arthroplasty","authors":"Stephen A. Parada MD ,&nbsp;Chris Peach FRCS (Tr & Orth), MD ,&nbsp;Wen Fan MS ,&nbsp;Josie Elwell PhD ,&nbsp;Pierre-Henri Flurin MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Joseph D. Zuckerman MD ,&nbsp;Christopher P. Roche MSE, MBA","doi":"10.1053/j.sart.2024.01.002","DOIUrl":"10.1053/j.sart.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study is to retrospectively analyze all primary anatomic total shoulder arthroplasty (aTSA) patients within a multicenter international database of a single prosthesis to identify risk factors for patients with rotator cuff tear (RCT) and aseptic glenoid loosening.</p></div><div><h3>Methods</h3><p>To investigate the risk factors for RCT and aseptic glenoid loosening, we retrospectively analyzed all aTSA patients with 2-year minimum follow-up from a multicenter international database of a single platform shoulder system, only excluding patients with a history of revision arthroplasty, infections, and humeral fractures. A univariate/multivariate analysis was conducted to compare primary aTSA patients who had report of: 1) a RCT and/or subscapularis failure and 2) aseptic glenoid loosening/cage glenoid dissociations, to identify the differences in (i) intrinsic patient demographics and comorbidities and (ii) implant and operative parameters. Finally, to adapt our statistical analysis for prospective identification of patients most at-risk for RCT and aseptic glenoid loosening, we stratified the dataset by multiple risk factor combinations and calculated the odds ratio (OR) to determine the impact of accumulating risk factors on the incidence rate of each complication.</p></div><div><h3>Results</h3><p>122 aTSA shoulders had a RCT for a rate of 3.2% and 123 aTSA shoulders had aseptic glenoid loosening for a rate of 3.3%. The multivariate analysis identified that aTSA patients with RCT were more likely to have previous shoulder surgery (<em>P</em> &lt; .001) and small size glenoids (<em>P</em> = .002). Additionally, the multivariate analysis identified that aTSA patients with aseptic glenoid loosening were more likely to be younger (≤62 years at the time of surgery, <em>P</em> = .001), have small size glenoids (<em>P</em> = .033) and have a nonhybrid glenoids (<em>P</em> &lt; .001). Stratifying patients with multiple risk factors identified multiple aTSA cohorts with ORs &gt;2 for RCT or aseptic glenoid loosening.</p></div><div><h3>Discussion</h3><p>This analysis of 2699 primary aTSA identified risk factors for the two most common postoperative complications: RCTs and aseptic glenoid loosening. Using these risk factors, we calculated ORs for patient cohorts with multiple risk factors to identify the patients with the greatest risk for each complication. This information is useful to guide the surgeon in their preoperative counseling and potentially mitigate the occurrence of these complications, by indicating patients with these risk-factors for alternative treatment strategies, like rTSA, instead of aTSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 406-415"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139825218","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":"Factors that influence blood loss requiring transfusion in total elbow arthroplasty: a retrospective study using ACS-NSQIP database","authors":"Parker K. Chenault BA ,&nbsp;Nicholas J. Peterman BS ,&nbsp;Christopher G. Hendrix MD ,&nbsp;Mark W. Schmitt MD ,&nbsp;Evan P. Sandefur BS ,&nbsp;Darren T. Hackley MS ,&nbsp;Maxwell O. Vest MD ,&nbsp;Cesar J. Bravo MD","doi":"10.1053/j.sart.2024.01.004","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Blood loss requiring transfusion is common in orthopedic surgeries. This study aims to identify modifiable factors associated with higher blood loss requiring transfusion in total elbow arthroplasty (TEA).</p></div><div><h3>Methods</h3><p>Data from the American College of Surgeons National Surgical Quality Improvement Program’s database was analyzed. Patients who underwent primary TEA from 2006 to 2021 were categorized based on blood loss requiring transfusion. Preoperative variables and comorbidities were compared using a multivariate regression to determine odds ratios (ORs).</p></div><div><h3>Results</h3><p>Out of 654 patients, 30 (4.6%) experienced blood loss requiring transfusion following TEA. On multivariate logistic regression, the following variables were significant: low preoperative hematocrit (&lt;36% in females, &lt;41% in males) (OR 18.2, <em>P</em> &lt; .01), inpatient location (OR 15.3, <em>P</em> &lt; .01), elevated preoperative creatinine (&gt;1.3 mg/dL) (OR 5.7, <em>P</em> &lt; .01), active smoking (OR 2.2, <em>P</em> = .01), chronic obstructive pulmonary disease (OR 2.1, <em>P</em> = .02), and low white blood cell count (&lt;4.5 × 10⁹/L) (OR 1.9, <em>P</em> = .03), and body mass index (OR 0.9, <em>P</em> &lt; .01).</p></div><div><h3>Conclusion</h3><p>The overall rate of blood loss requiring transfusion in TEA was 4.6%. Identifying preoperative risk factors is crucial to minimize transfusion risk. Optimizing patient lab values may help reduce transfusion rates. Blood-saving techniques and antifibrinolytic agents like tranexamic acid should be considered for patients at increased risk of transfusion.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 392-397"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072711","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":"Acromion and scapular spine fractures after reverse shoulder arthroplasty: rate of detection by computed tomography","authors":"Daniel F. Schodlbauer MD ,&nbsp;Austin Vegas DO ,&nbsp;Julie Glener MD ,&nbsp;Casey Beleckas MD ,&nbsp;Jonathan C. Levy MD","doi":"10.1053/j.sart.2023.12.010","DOIUrl":"10.1053/j.sart.2023.12.010","url":null,"abstract":"<div><h3>Background</h3><p>Acromion and scapular spine fractures (ASFs) after reverse total shoulder arthroplasty have been reported at a rate of 3.9 percent. Radiographs have been shown to be unreliable at identifying these fractures, with an estimated 20% false negative rate. A computed tomography (CT) scan is typically performed when initial radiographs are inconclusive and clinical suspicion for ASF remains high. However, the accuracy of identifying ASF fractures after reverse shoulder arthroplasty (RSA) with CT has not been studied. The purpose of this paper is to evaluate the ability of CT scans to detect clinically suspected ASF fractures after RSA when initial radiographs are inconclusive.</p></div><div><h3>Methods</h3><p>A retrospective review of our institution’s shoulder and elbow repository identified 111 patients treated with RSA from 2006 to 2022 that subsequently sustained an ASF. Upon clinical suspicion of an ASF, a 4-view radiographic series was obtained. If no fracture was clearly identified, a thin-cut CT was obtained. Additional four-view radiographic series were taken at each subsequent follow-up. Rate of detection by CT scan was defined using the number of cases with positive scans out of the number in which both a CT scan was performed, and a fracture was identified on either CT scan or other additional follow-up imaging.</p></div><div><h3>Results</h3><p>After inconclusive radiographs, a CT was ordered for 61 patients (55%) at a median of 1.3 weeks after the onset of signs/symptoms suspicious for ASF. Fractures were identified in 52 cases (85.2%) at a median of 1.6 weeks after the onset of sign/symptoms. The fracture was not seen on CT in 9 cases at a median of 0.9 week after the onset of sign/symptoms, representing a false negative rate of 14.8%. These fractures were later identified on radiographs at a median of 5.9 weeks following the CT scan. No statistical differences were observed in sensitivity of CT scan between fracture types. Fractures initially missed on CT scan eventually displaced and became nonunions.</p></div><div><h3>Conclusion</h3><p>CT scans can be helpful in identifying and characterizing ASF following RSA, with an overall rate of detection (sensitivity) of 85%. Consideration of alternative advanced imaging may be needed for patients with negative CT scans and a high index of clinical suspicion for ASF.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 377-382"},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140522434","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":"Acromial bony adaptations in rotator cuff tear arthropathy facilitates acromial stress fracture following reverse total shoulder arthroplasty","authors":"Ryan E. Harold MD,&nbsp;Patrick T. Sweeney MD,&nbsp;Michael T. Torchia MD,&nbsp;Jack Kramer BA","doi":"10.1053/j.sart.2023.12.011","DOIUrl":"10.1053/j.sart.2023.12.011","url":null,"abstract":"<div><h3>Background</h3><p>Acromial stress fractures (ASFs) after reverse total shoulder arthroplasty (RSA) can have a potentially devastating impact on shoulder function. They are often difficult to effectively treat. Multiple studies have shown a higher incidence of ASF after RSA in patients with cuff tear arthropathy (CTA). This study introduces and explores a new hypothesis. Our hypothesis is that 1) patients with CTA experience a preoperative pathologic superiorly directed force on their acromion, and 2) this leads to acromial bending moments on the acromion that are very different from patients with glenohumeral osteoarthritis (GHOA) and after RSA, and finally 3) these pathologic loads may result in abnormal bony remodeling and adaptations in CTA, which may then predispose patients to ASF after RSA.</p></div><div><h3>Methods</h3><p>A finite element analysis model was developed to compare three loading conditions on the acromion: preoperative CTA, preoperative GHOA, and postoperative-RSA. Regions of the highest tensile and compressive stresses were identified and compared between groups.</p></div><div><h3>Results</h3><p>The finite element analysis model presented shows that patients with a preoperative diagnosis of CTA experience a stress distribution reversal after RSA, whereas GHOA patients do not. The results support that in CTA, the humerus produces pathologic strains and torques on the acromion. Over time, the acromion may slowly remodel in response, resulting in bony adaptations. Abrupt reversal of stresses and strains in CTA after RSA may lead to ASFs, as the acromion has adapted to a different stress pattern.</p></div><div><h3>Conclusion</h3><p>This study introduces one potential contributing factor for the higher rates of ASF after RSA in patients with a preoperative diagnosis of CTA; understanding this phenomenon is the first step to preventing it. Once the forces seen in CTA are abruptly reversed after RSA, the biological race is on between the formation of an acromial stress fracture and the body’s ability to again remodel the acromion to accommodate its new loading state. Additional clinical studies are needed to further investigate this new theory.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 383-391"},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140518646","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 significance of intraoperative glenohumeral joint load evaluation using a novel humeral sensor in navigated reverse total shoulder arthroplasty","authors":"Allan W. Wang FRACS, MD, PhD ,&nbsp;Ashton May MD ,&nbsp;William Blakeney FRACS, MD, MS ,&nbsp;Stefan Bauer MD ,&nbsp;Jay Ebert PhD","doi":"10.1053/j.sart.2023.12.009","DOIUrl":"10.1053/j.sart.2023.12.009","url":null,"abstract":"<div><h3>Background</h3><p>Advances in preoperative planning and technology have assisted the surgeon in appropriate placement of implants during reverse total shoulder arthroplasty (RTSA). However, assessment of soft tissue tension, balance, and stability remains subjective and dependent on surgeon experience. The aims of this study are to measure intraoperative joint loads with a novel trial humeral load sensor during RTSA, to evaluate the utility of this device in the operative setting, and to determine the association between recorded joint loads and postoperative patient-reported outcomes.</p></div><div><h3>Methods</h3><p>A pilot study of 15 patients with the diagnosis of osteoarthritis, rotator cuff arthropathy, or massive cuff tear were scheduled for computer-navigated RTSA and intraoperative joint load measurements. Following appropriate soft tissue releases, load recordings were made in standardized arm positions: neutral, across the chest, behind the back, and overhead. Participants were clinically and radiographically reviewed at 3 and 12 months post-surgery for evidence of joint instability, bony stress reaction or fracture, and American Shoulder and Elbow Surgeons (ASES) score.</p></div><div><h3>Results</h3><p>Intraoperative joint load measurements vary between participants, but there were no significant associations with age or body mass index (<em>P</em> &gt; .05). Mean joint load in the neutral position was recorded as 6.1 lbf (standard deviation [SD] 7.4 range 0-25). In each of the three testing positions, mean joint load was recorded in the range of 30-40 lbf. Maximum joint loads above 70 lbf were observed in individual participants. There were no postoperative complications including joint instability or bony stress reactions. At 3 months, no statistically significant correlations were observed between clinical scores and load measures. At 12 months, the mean ASES score was 83.1 (SD 11.6, range 63.3-98.3), and demonstrated a large and significant association with load magnitude in the behind back position (r = 0.66, <em>P</em> = .008). The mean ASES pain subscale score was 45.3 (SD 6.4, range 30.0-50.0) and demonstrated a significant association with load magnitude in the behind back position (r = 0.69, <em>P</em> = .004) and with load magnitude in the across chest position (r = 0.55, <em>P</em> = .034). No other significant associations were observed.</p></div><div><h3>Discussion</h3><p>This pilot study indicates a novel humeral trial load sensor can be used safely and effectively during RTSA. This trial reports a range of intraoperative joint load measurements in neutral and commonly performed arm positions, which at 12 months post-surgery are associated with satisfactory shoulder function. Further clinical studies are required to define an upper limit for intraoperative joint load, which may potentially compromise clinical outcome.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 364-370"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000075/pdfft?md5=85544e9fccff20b461f5736554ec74ca&pid=1-s2.0-S1045452724000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}