Pub Date : 2025-12-05DOI: 10.1016/j.sart.2025.151517
Harry Haran BA , Spencer M. Lee-Rey BA , Anthony Finocchiaro BS , Alyssa D. Althoff MD , Hassan Al-Naimi BS , Michael C. Fu MD, MHS , Samuel A. Taylor MD , Joshua S. Dines MD , Gabriella E. Ode MD , David M. Dines MD , Lawrence V. Gulotta MD , Christopher M. Brusalis MD
<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed at high-volume tertiary care centers, with many patients either electing or required to travel long distances to receive specialized care. This study aimed to investigate the impact of geographic travel distance on preoperative patient expectations and postoperative clinical outcomes following TSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was performed evaluating patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA) from 2016 through 2021 at an urban, academic medical center. For each aTSA and rTSA, patients were stratified into 2 cohorts based on travel distance to the surgical center: local (<50 miles) or long-distance (>100 miles). Preoperative expectations, as defined by the Hospital for Special Surgery Expectations Surveys, functional outcomes (American Shoulder Elbow Surgeons, Single Assessment Numeric Evaluation, Shoulder Activity Scale), and patient satisfaction were assessed at baseline and minimum 2-year follow-up. Parametric test, nonparametric tests, and multivariable linear regression were used to compare patient groups for both aTSA and rTSA.</div></div><div><h3>Results</h3><div>Among 1,406 total patients, 885 aTSA patients (local = 737; long-distance = 148) and 521 rTSA patients (local = 413; long-distance = 108) were included in the study. Among patients undergoing aTSA, long-distance patients had significantly higher education levels (<em>P</em> = .01) and were more likely to identify as White (<em>P</em> = .01). Preoperative expectations scores (Hospital for Special Surgery Expectation Surveys) among aTSA patients did not differ significantly between cohorts (local: 74.87 ± 15.75, <em>n</em> = 737; long-distance: 77.64 ± 14.70, <em>n</em> = 148; <em>P</em> = .067). Functional outcomes and satisfaction improved regardless of travel distance (<em>P</em> > .05). In the rTSA cohort, multivariable regression analysis revealed that travel distance was not a significant predictor of higher preoperative patient expectations (<em>P</em> < .05). Clinical outcomes and satisfaction following both aTSA and rTSA demonstrated comparable and clinically meaningful improvements in both long-distance and local patient groups. In multivariable analysis for both aTSA and rTSA, travel distance did not influence patient-related outcomes (<em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>Patients traveling longer distances to undergo aTSA and rTSA at an urban, academic medical center had comparable preoperative expectations to patients residing locally. Long-distance patients achieved similar postoperative outcomes and satisfaction as local patients at an urban, tertiary care center. These findings suggest that intentional urban academic medical center selection, regardless of travel distance, does not negatively impact patient-related outcomes or satisfaction following TSA. However, they should be interp
{"title":"Geographic travel distance does not influence preoperative patient expectations or postoperative clinical outcomes following total shoulder arthroplasty: a comparative analysis at an urban, tertiary care center","authors":"Harry Haran BA , Spencer M. Lee-Rey BA , Anthony Finocchiaro BS , Alyssa D. Althoff MD , Hassan Al-Naimi BS , Michael C. Fu MD, MHS , Samuel A. Taylor MD , Joshua S. Dines MD , Gabriella E. Ode MD , David M. Dines MD , Lawrence V. Gulotta MD , Christopher M. Brusalis MD","doi":"10.1016/j.sart.2025.151517","DOIUrl":"10.1016/j.sart.2025.151517","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed at high-volume tertiary care centers, with many patients either electing or required to travel long distances to receive specialized care. This study aimed to investigate the impact of geographic travel distance on preoperative patient expectations and postoperative clinical outcomes following TSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was performed evaluating patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA) from 2016 through 2021 at an urban, academic medical center. For each aTSA and rTSA, patients were stratified into 2 cohorts based on travel distance to the surgical center: local (<50 miles) or long-distance (>100 miles). Preoperative expectations, as defined by the Hospital for Special Surgery Expectations Surveys, functional outcomes (American Shoulder Elbow Surgeons, Single Assessment Numeric Evaluation, Shoulder Activity Scale), and patient satisfaction were assessed at baseline and minimum 2-year follow-up. Parametric test, nonparametric tests, and multivariable linear regression were used to compare patient groups for both aTSA and rTSA.</div></div><div><h3>Results</h3><div>Among 1,406 total patients, 885 aTSA patients (local = 737; long-distance = 148) and 521 rTSA patients (local = 413; long-distance = 108) were included in the study. Among patients undergoing aTSA, long-distance patients had significantly higher education levels (<em>P</em> = .01) and were more likely to identify as White (<em>P</em> = .01). Preoperative expectations scores (Hospital for Special Surgery Expectation Surveys) among aTSA patients did not differ significantly between cohorts (local: 74.87 ± 15.75, <em>n</em> = 737; long-distance: 77.64 ± 14.70, <em>n</em> = 148; <em>P</em> = .067). Functional outcomes and satisfaction improved regardless of travel distance (<em>P</em> > .05). In the rTSA cohort, multivariable regression analysis revealed that travel distance was not a significant predictor of higher preoperative patient expectations (<em>P</em> < .05). Clinical outcomes and satisfaction following both aTSA and rTSA demonstrated comparable and clinically meaningful improvements in both long-distance and local patient groups. In multivariable analysis for both aTSA and rTSA, travel distance did not influence patient-related outcomes (<em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>Patients traveling longer distances to undergo aTSA and rTSA at an urban, academic medical center had comparable preoperative expectations to patients residing locally. Long-distance patients achieved similar postoperative outcomes and satisfaction as local patients at an urban, tertiary care center. These findings suggest that intentional urban academic medical center selection, regardless of travel distance, does not negatively impact patient-related outcomes or satisfaction following TSA. However, they should be interp","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151517"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926464","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 : 2025-12-05DOI: 10.1016/j.sart.2025.151515
Sailesh V. Tummala MD , Alejandro M. Holle BS , Cara Lai MD , Brian Miller MD , John M. Tokish MD
Background
Reverse total shoulder arthroplasty (rTSA) has become an increasingly popular surgical option for treating complex proximal humerus fractures with expanding indications in younger patients. The purpose was to compare the complication and reoperation rates between rTSA) and open reduction and internal fixation (ORIF) for 3- or 4-part proximal humerus fractures, and to analyze the impact of patient age on these outcomes. The secondary aim was to evaluate complications of patients undergoing rTSA following ORIF compared to primary rTSA for proximal humerus fracture.
Methods
A retrospective cohort study using a large administrative claims database was conducted to evaluate patients with 3- or 4-part proximal humerus fractures. Patients were grouped by surgical management and indication (rTSA vs. ORIF for 3- or 4-part fractures, 3-part fractures only, or 4-part fractures only), and complication and reoperation rates within 2 years of the index surgery were compared. To explore the effect of age, cohorts were further subdivided into 5-year increments from 50 to 85 years old, and multivariable logistic regressions were employed to analyze outcomes.
Results
A total of 3,081 patients underwent rTSA and 4,160 patients underwent ORIF for 3- or 4-part fracture. ORIF patients were 1.58 times more likely to experience a complication within 2 years (95% confidence interval: 1.39-1.79, P < .001) and 2.32 times more likely to have a reoperation within 2 years compared to rTSA patients (95% confidence interval: 1.79-3.04, P < .001). ORIF for 3-part fractures in patients aged 65-79 were more likely to have a complication and reoperation within 2 years, while those younger than 65 and aged 80-84 showed no difference compared to rTSA. For 4-part fractures, all age groups except those over 80 showed a higher complication rate, and patients older than 55 showed a higher reoperation rate within 2 years of ORIF as compared to rTSA.
Conclusion
ORIF of three- and four-part proximal humerus fractures was noted to have a significantly higher rate of 2-year complications and reoperations for patients older than 55 years of age as compared to rTSA. In patients with three-part fractures, rTSA was noted to have significantly lower complication and reoperation rates in those older than 65. In patients with four-part fractures, rTSA was noted to have a lower complication and reoperation rates in those older than 55. When comparing primary rTSA to rTSA after ORIF for 3- and 4- part proximal humerus fractures, there was no significant difference in complication rate; however, there was a significantly increased likelihood of reoperation within 2 years with revision cases.
{"title":"Reverse total shoulder arthroplasty is associated with decreased complication and reoperation rates compared to open reduction and internal fixation for three- and four-part proximal humerus fractures in adult patients","authors":"Sailesh V. Tummala MD , Alejandro M. Holle BS , Cara Lai MD , Brian Miller MD , John M. Tokish MD","doi":"10.1016/j.sart.2025.151515","DOIUrl":"10.1016/j.sart.2025.151515","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) has become an increasingly popular surgical option for treating complex proximal humerus fractures with expanding indications in younger patients. The purpose was to compare the complication and reoperation rates between rTSA) and open reduction and internal fixation (ORIF) for 3- or 4-part proximal humerus fractures, and to analyze the impact of patient age on these outcomes. The secondary aim was to evaluate complications of patients undergoing rTSA following ORIF compared to primary rTSA for proximal humerus fracture.</div></div><div><h3>Methods</h3><div>A retrospective cohort study using a large administrative claims database was conducted to evaluate patients with 3- or 4-part proximal humerus fractures. Patients were grouped by surgical management and indication (rTSA vs. ORIF for 3- or 4-part fractures, 3-part fractures only, or 4-part fractures only), and complication and reoperation rates within 2 years of the index surgery were compared. To explore the effect of age, cohorts were further subdivided into 5-year increments from 50 to 85 years old, and multivariable logistic regressions were employed to analyze outcomes.</div></div><div><h3>Results</h3><div>A total of 3,081 patients underwent rTSA and 4,160 patients underwent ORIF for 3- or 4-part fracture. ORIF patients were 1.58 times more likely to experience a complication within 2 years (95% confidence interval: 1.39-1.79, <em>P</em> < .001) and 2.32 times more likely to have a reoperation within 2 years compared to rTSA patients (95% confidence interval: 1.79-3.04, <em>P</em> < .001). ORIF for 3-part fractures in patients aged 65-79 were more likely to have a complication and reoperation within 2 years, while those younger than 65 and aged 80-84 showed no difference compared to rTSA. For 4-part fractures, all age groups except those over 80 showed a higher complication rate, and patients older than 55 showed a higher reoperation rate within 2 years of ORIF as compared to rTSA.</div></div><div><h3>Conclusion</h3><div>ORIF of three- and four-part proximal humerus fractures was noted to have a significantly higher rate of 2-year complications and reoperations for patients older than 55 years of age as compared to rTSA. In patients with three-part fractures, rTSA was noted to have significantly lower complication and reoperation rates in those older than 65. In patients with four-part fractures, rTSA was noted to have a lower complication and reoperation rates in those older than 55. When comparing primary rTSA to rTSA after ORIF for 3- and 4- part proximal humerus fractures, there was no significant difference in complication rate; however, there was a significantly increased likelihood of reoperation within 2 years with revision cases.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151515"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841503","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 : 2025-12-04DOI: 10.1016/j.sart.2025.151516
Carter D. Bernal MS , Frank Sierra BS , Andres Ramos BS , Shannon Tse BMBS , David Dallas-Orr MD, MBA, MTM , Daniel C. Santana MD, MS , Derek Bond MD , James Van Den Bogaerde MD , Robert M. Szabo MD, MPH , Ryan D. Freshman MD , Mariano E. Menendez MD , Christopher O. Bayne MD
Background
Emergency department (ED) visits after shoulder arthroplasty increase healthcare costs and strain hospital resource allocation. This study evaluates complications and ED utilization within 90 days after shoulder arthroplasty.
Methods
A retrospective review was conducted for adult patients who underwent primary anatomic shoulder arthroplasty, reverse shoulder arthroplasty, or hemiarthroplasty at a single academic center hospital between 2016 and 2024. Demographics, surgical indications, procedure type, and 90-day surgical complications, including deep infection, dislocation, periprosthetic fracture, and reoperation, were recorded. 90-day ED visits were classified as “avoidable” (suitable for outpatient management), “unavoidable” (appropriate), or “comorbidity-related.” Logistic regression was used to identify predictors of postoperative ED visits.
Results
A total of 303 patients (50.3% female, mean age = 69.6) with 342 shoulder arthroplasties were analyzed. Among these patients, 54 (15.8%) presented to the ED within 90 days postoperatively, most commonly for postoperative pain, surgical site erythema and edema, dislocation, and infection. Patients who presented to the ED were generally sicker (Charlson Comorbidity Index of 3.87 vs. 3.68 [P < .001]) and had a greater degree of pain preoperatively (visual analog scale pain score of 5.64 vs. 4 [P < .001]). Multivariable logistic regression showed that ED utilization in the year prior to surgery was associated with ED presentation in the 90 days following shoulder arthroplasty (odds ratio: 2.17 [95% confidence interval: 1.06, 4.46]). Subgroup analysis of patients with ED visits revealed 12 (22.2%) had avoidable shoulder-related ED visits, 11 (20.4%) had unavoidable shoulder-related ED visits, and 31 (57.4%) had ED visits related to other medical comorbidities.
Conclusion
ED visits after shoulder arthroplasty are common, often related to postoperative pain, and potentially responsive to quality improvement initiatives. Previous ED visit in the year prior to shoulder arthroplasty is associated with 90-day postoperative ED visits.
{"title":"Predictors of 90-day emergency department utilization after shoulder arthroplasty: a retrospective cohort study","authors":"Carter D. Bernal MS , Frank Sierra BS , Andres Ramos BS , Shannon Tse BMBS , David Dallas-Orr MD, MBA, MTM , Daniel C. Santana MD, MS , Derek Bond MD , James Van Den Bogaerde MD , Robert M. Szabo MD, MPH , Ryan D. Freshman MD , Mariano E. Menendez MD , Christopher O. Bayne MD","doi":"10.1016/j.sart.2025.151516","DOIUrl":"10.1016/j.sart.2025.151516","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) visits after shoulder arthroplasty increase healthcare costs and strain hospital resource allocation. This study evaluates complications and ED utilization within 90 days after shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted for adult patients who underwent primary anatomic shoulder arthroplasty, reverse shoulder arthroplasty, or hemiarthroplasty at a single academic center hospital between 2016 and 2024. Demographics, surgical indications, procedure type, and 90-day surgical complications, including deep infection, dislocation, periprosthetic fracture, and reoperation, were recorded. 90-day ED visits were classified as “avoidable” (suitable for outpatient management), “unavoidable” (appropriate), or “comorbidity-related.” Logistic regression was used to identify predictors of postoperative ED visits.</div></div><div><h3>Results</h3><div>A total of 303 patients (50.3% female, mean age = 69.6) with 342 shoulder arthroplasties were analyzed. Among these patients, 54 (15.8%) presented to the ED within 90 days postoperatively, most commonly for postoperative pain, surgical site erythema and edema, dislocation, and infection. Patients who presented to the ED were generally sicker (Charlson Comorbidity Index of 3.87 vs. 3.68 [<em>P</em> < .001]) and had a greater degree of pain preoperatively (visual analog scale pain score of 5.64 vs. 4 [<em>P</em> < .001]). Multivariable logistic regression showed that ED utilization in the year prior to surgery was associated with ED presentation in the 90 days following shoulder arthroplasty (odds ratio: 2.17 [95% confidence interval: 1.06, 4.46]). Subgroup analysis of patients with ED visits revealed 12 (22.2%) had avoidable shoulder-related ED visits, 11 (20.4%) had unavoidable shoulder-related ED visits, and 31 (57.4%) had ED visits related to other medical comorbidities.</div></div><div><h3>Conclusion</h3><div>ED visits after shoulder arthroplasty are common, often related to postoperative pain, and potentially responsive to quality improvement initiatives. Previous ED visit in the year prior to shoulder arthroplasty is associated with 90-day postoperative ED visits.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151516"},"PeriodicalIF":0.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926410","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 : 2025-12-01DOI: 10.1053/j.sart.2025.05.007
Matthew J. Schultz DO , William T. DiCiurcio III DO , Stephanie A. Kwan DO , Jeffrey C. Lynch DO , Dennis DeBernardis DO , Luke Austin MD
Background
Exposure to noise levels greater than 85 decibels [dB] is associated with increased incidence of hearing loss. However, the risk that occupational noise exposure poses to orthopedic shoulder and elbow (S&E) surgeons is poorly understood. This study aims to (1) quantify the noise exposure of S&E surgeons in the operating room to determine if they are exposed to harmful noise levels and (2) identify which procedures pose the greatest risk of noise-induced hearing loss.
Methods
Intraoperative audio recordings were collected during S&E procedures via a wearable microphone worn under standard sterile surgical garb. S&E procedures were characterized as open reduction and internal fixation, arthroscopic soft tissue procedures, open soft tissue procedures, and arthroplasty. The highest sound pressure level (maximum dB levels [MDLs]) and the average dB level projected over an 8-h period (time-weighted average) were reported. The percentage of allowable daily noise dose was reported as “dose,” and the measured dose projected for over 8-h was reported as “projected dose.”
Results
We collected 116 recordings consisting of 65 arthroplasties, 5 open reduction and internal fixation, 11 open soft tissue procedures (distal bicep tendon repairs), and 35 arthroscopic soft tissue procedures. The average MDL was greater than the average control MDL for all S&E procedures and ranged from 88.7 to 112.6 dB. Shoulder arthroplasty had the highest average dose (1.4%), projected dose (8.4%), and time-weighted average (64.6 dB).
Conclusion
All recorded procedure types exposed surgeons to MDLs greater than 85 dB. Shoulder arthroplasty demonstrated the highest average exposure to harmful doses of noise and appears to pose the greatest risk for occupational noise exposure. Strategies should be considered to minimize the risk of noise-induced hearing loss amongst surgeons.
暴露在大于85分贝（dB）的噪音水平中与听力损失的发生率增加有关。然而，职业性噪声暴露对肩关节和肘关节整形外科医生的风险了解甚少。本研究旨在(1)量化S&；E外科医生在手术室中的噪音暴露，以确定他们是否暴露于有害的噪音水平；(2)确定哪些手术对噪音性听力损失的风险最大。方法在标准无菌手术服下佩戴可穿戴式麦克风，收集手术中录音。S&；E手术的特点是切开复位和内固定、关节镜下软组织手术、切开软组织手术和关节成形术。报告了最高声压级（maximum dB levels [MDLs]）和8 h内预测的平均dB级（时间加权平均值）。每日允许噪声剂量的百分比报告为“剂量”，预计超过8小时的测量剂量报告为“预计剂量”。结果我们收集了116例记录，包括65例关节置换术，5例切开复位内固定，11例切开软组织手术（肱二头肌远端肌腱修复）和35例关节镜下软组织手术。所有S&；E程序的平均MDL大于平均对照MDL，范围从88.7到112.6 dB。肩关节置换术的平均剂量最高（1.4%），预计剂量最高（8.4%），时间加权平均值最高（64.6 dB）。结论所有记录的手术类型对外科医生的mdl均大于85 dB。肩关节置换术显示出最高的有害噪声平均暴露剂量，似乎对职业性噪声暴露构成最大的风险。外科医生应考虑将噪声性听力损失风险降至最低的策略。
{"title":"Are orthopedic shoulder and elbow surgeons at risk for noise-induced hearing loss?","authors":"Matthew J. Schultz DO , William T. DiCiurcio III DO , Stephanie A. Kwan DO , Jeffrey C. Lynch DO , Dennis DeBernardis DO , Luke Austin MD","doi":"10.1053/j.sart.2025.05.007","DOIUrl":"10.1053/j.sart.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to noise levels greater than 85 decibels [dB] is associated with increased incidence of hearing loss. However, the risk that occupational noise exposure poses to orthopedic shoulder and elbow (S&E) surgeons is poorly understood. This study aims to (1) quantify the noise exposure of S&E surgeons in the operating room to determine if they are exposed to harmful noise levels and (2) identify which procedures pose the greatest risk of noise-induced hearing loss.</div></div><div><h3>Methods</h3><div>Intraoperative audio recordings were collected during S&E procedures via a wearable microphone worn under standard sterile surgical garb. S&E procedures were characterized as open reduction and internal fixation, arthroscopic soft tissue procedures, open soft tissue procedures, and arthroplasty. The highest sound pressure level (maximum dB levels [MDLs]) and the average dB level projected over an 8-h period (time-weighted average) were reported. The percentage of allowable daily noise dose was reported as “dose,” and the measured dose projected for over 8-h was reported as “projected dose.”</div></div><div><h3>Results</h3><div>We collected 116 recordings consisting of 65 arthroplasties, 5 open reduction and internal fixation, 11 open soft tissue procedures (distal bicep tendon repairs), and 35 arthroscopic soft tissue procedures. The average MDL was greater than the average control MDL for all S&E procedures and ranged from 88.7 to 112.6 dB. Shoulder arthroplasty had the highest average dose (1.4%), projected dose (8.4%), and time-weighted average (64.6 dB).</div></div><div><h3>Conclusion</h3><div>All recorded procedure types exposed surgeons to MDLs greater than 85 dB. Shoulder arthroplasty demonstrated the highest average exposure to harmful doses of noise and appears to pose the greatest risk for occupational noise exposure. Strategies should be considered to minimize the risk of noise-induced hearing loss amongst surgeons.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 599-603"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685930","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 : 2025-12-01DOI: 10.1053/j.sart.2025.04.007
Brian P. Kurcz MD , Dennis A. DeBernardis DO , Aaron Roberts DO , Peter Regala MD , Carl J. Replogle , Cassie M. Fleckenstein MS , Joseph Nolan PhD , Samer S. Hasan MD, PhD
<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (aTSA) using standard (non-augmented) glenoid implants has demonstrated excellent clinical results, but concerns have been raised regarding their use in patients with posterior glenoid wear. The primary purpose of this study is to investigate short-term patient-reported outcomes (PROs) and overall active range of motion in patients who underwent aTSA using short humeral stems and standard glenoid implants for glenohumeral arthritis with minimal or concentric wear and with posterior glenoid wear. The secondary purpose was to the determine predictors of an inferior outcome or reoperation following aTSA using this construct.</div></div><div><h3>Methods</h3><div>Patients in this study underwent aTSA with minimal glenoid reaming to achieve >90% contact of a pegged, all-polyethylene standard glenoid implant, inserted with minimal cement. Plain radiographs, active range of motion, and PROs—comprising American Shoulder and Elbow Surgeons (ASES), simple shoulder test, and visual analog scale pain scores—were obtained preoperatively and at final follow-up.</div></div><div><h3>Results</h3><div>One hundred twenty-eight consecutive aTSAs in 122 patients (75 males) with mean age of 66 years (range 48-84) were reviewed. Thirteen patients were lost to follow-up, 6 patients were deceased or had cognitive impairment precluding evaluation, and 5 patients underwent early revision for subscapularis failure, leaving 104 aTSAs for evaluation at minimum 2-year follow-up (mean 3 years, range 2-5.6 years). Twenty-four shoulders had undergone previous surgery. Fifty-nine patients had posterior glenoid wear (Walch B2 or B3) and 47 had concentric or minimal glenoid wear (Walch A1, A2, or B1). Forward elevation improved from 101° ± 25° to 147° ± 17°, abduction from 87° ± 26° to 145° ± 23°, external rotation from 21° ± 15° to 45° ± 13°, and internal rotation from the sacrum to thoracolumbar junction (<em>P</em> < .001 for all). Overall, ASES improved from 41 ± 20 to 89 ± 13, simple shoulder test from 4.5 ± 2.9 to 10.2 ± 2.5, and visual analog scale pain from 5.5 ± 2.5 to 0.7 ± 1.3 (<em>P</em> < .001). Ten patients had a final ASES score <70, which was associated with a history of previous surgery (<em>P</em> = .03). The degree of posterior glenoid wear did not influence any outcome score. Eight patients underwent subsequent ipsilateral shoulder surgery including 5 (4%) undergoing revision to reverse shoulder arthroplasty for subscapularis insufficiency (2 following traumatic injury). No revisions for prosthetic joint infection or humeral or glenoid implant loosening were performed.</div></div><div><h3>Conclusion</h3><div>aTSA using a minimally cemented standard glenoid implant following partial version correction for Walch B2 and B3 glenoids leads to marked improvements in ROM and PROs, regardless of glenoid wear pattern. No reoperations were performed for glenoid or humeral loosening or infection at
{"title":"Anatomic total shoulder arthroplasty using a short humeral stem and a non-augmented, minimally cemented all-polyethylene glenoid: minimum 2-year outcome and predictors of clinical failure","authors":"Brian P. Kurcz MD , Dennis A. DeBernardis DO , Aaron Roberts DO , Peter Regala MD , Carl J. Replogle , Cassie M. Fleckenstein MS , Joseph Nolan PhD , Samer S. Hasan MD, PhD","doi":"10.1053/j.sart.2025.04.007","DOIUrl":"10.1053/j.sart.2025.04.007","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (aTSA) using standard (non-augmented) glenoid implants has demonstrated excellent clinical results, but concerns have been raised regarding their use in patients with posterior glenoid wear. The primary purpose of this study is to investigate short-term patient-reported outcomes (PROs) and overall active range of motion in patients who underwent aTSA using short humeral stems and standard glenoid implants for glenohumeral arthritis with minimal or concentric wear and with posterior glenoid wear. The secondary purpose was to the determine predictors of an inferior outcome or reoperation following aTSA using this construct.</div></div><div><h3>Methods</h3><div>Patients in this study underwent aTSA with minimal glenoid reaming to achieve >90% contact of a pegged, all-polyethylene standard glenoid implant, inserted with minimal cement. Plain radiographs, active range of motion, and PROs—comprising American Shoulder and Elbow Surgeons (ASES), simple shoulder test, and visual analog scale pain scores—were obtained preoperatively and at final follow-up.</div></div><div><h3>Results</h3><div>One hundred twenty-eight consecutive aTSAs in 122 patients (75 males) with mean age of 66 years (range 48-84) were reviewed. Thirteen patients were lost to follow-up, 6 patients were deceased or had cognitive impairment precluding evaluation, and 5 patients underwent early revision for subscapularis failure, leaving 104 aTSAs for evaluation at minimum 2-year follow-up (mean 3 years, range 2-5.6 years). Twenty-four shoulders had undergone previous surgery. Fifty-nine patients had posterior glenoid wear (Walch B2 or B3) and 47 had concentric or minimal glenoid wear (Walch A1, A2, or B1). Forward elevation improved from 101° ± 25° to 147° ± 17°, abduction from 87° ± 26° to 145° ± 23°, external rotation from 21° ± 15° to 45° ± 13°, and internal rotation from the sacrum to thoracolumbar junction (<em>P</em> < .001 for all). Overall, ASES improved from 41 ± 20 to 89 ± 13, simple shoulder test from 4.5 ± 2.9 to 10.2 ± 2.5, and visual analog scale pain from 5.5 ± 2.5 to 0.7 ± 1.3 (<em>P</em> < .001). Ten patients had a final ASES score <70, which was associated with a history of previous surgery (<em>P</em> = .03). The degree of posterior glenoid wear did not influence any outcome score. Eight patients underwent subsequent ipsilateral shoulder surgery including 5 (4%) undergoing revision to reverse shoulder arthroplasty for subscapularis insufficiency (2 following traumatic injury). No revisions for prosthetic joint infection or humeral or glenoid implant loosening were performed.</div></div><div><h3>Conclusion</h3><div>aTSA using a minimally cemented standard glenoid implant following partial version correction for Walch B2 and B3 glenoids leads to marked improvements in ROM and PROs, regardless of glenoid wear pattern. No reoperations were performed for glenoid or humeral loosening or infection at","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 539-546"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685759","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 : 2025-12-01DOI: 10.1053/j.sart.2025.05.003
Akhil Katakam MD , Tej Joshi MD , Tuckerman Jones MD , Amanda Azer MD , Daniella Ogilvie MD , Sefy A. Paulose MD , Eitan M. Kohan MD , Francis G. Alberta MD
Background
Osteoporosis and its associated complications, such as fractures, place a significant burden on health care systems. Bisphosphonates are a standard treatment for osteoporosis, shown to maintain bone mineral density and reduce fracture risk. However, their role in patients undergoing reverse total shoulder arthroplasty (rTSA) remains unclear, particularly regarding complications like acromial stress fractures and other prosthesis-related outcomes. This study investigates the impact of bisphosphonate usage on postoperative outcomes in osteoporotic patients undergoing rTSA.
Methods
A retrospective cohort study was conducted using the TriNetX Research Network database to identify patients with osteoporosis who underwent rTSA. Patients were stratified into two cohorts based on preoperative bisphosphonate usage. Propensity score matching (1:1) was utilized to balance demographic characteristics, comorbidities, prior surgery, and medication use. Outcomes assessed included acromial stress fractures, revision rates, aseptic loosening, and periprosthetic fractures at 1 year postoperatively.
Results
A total of 1,208 propensity-matched patients (604 in each cohort) were analyzed. In the bisphosphonate group, 25 (4.1%) of patients were diagnosed with an acromial stress fracture compared to 23 (3.6%) in the control group (odds ratio 1.142, 95% confidence interval 0.637-2.049, P = .655). No significant differences were observed in revision rates (P = .712), aseptic loosening (P = 1.000), or periprosthetic fractures (P = 1.000) between cohorts.
Conclusion
Bisphosphonate usage does not decrease the incidence of acromial stress fractures in osteoporotic patients undergoing rTSA. Future studies should focus on the potential additional interventions to mitigate the risk of acromial stress fracture in osteoporotic patients undergoing rTSA.
{"title":"Does bisphosphonate use in osteoporotic patients undergoing total shoulder arthroplasty have a protective effect? A propensity-matched analysis","authors":"Akhil Katakam MD , Tej Joshi MD , Tuckerman Jones MD , Amanda Azer MD , Daniella Ogilvie MD , Sefy A. Paulose MD , Eitan M. Kohan MD , Francis G. Alberta MD","doi":"10.1053/j.sart.2025.05.003","DOIUrl":"10.1053/j.sart.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis and its associated complications, such as fractures, place a significant burden on health care systems. Bisphosphonates are a standard treatment for osteoporosis, shown to maintain bone mineral density and reduce fracture risk. However, their role in patients undergoing reverse total shoulder arthroplasty (rTSA) remains unclear, particularly regarding complications like acromial stress fractures and other prosthesis-related outcomes. This study investigates the impact of bisphosphonate usage on postoperative outcomes in osteoporotic patients undergoing rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Research Network database to identify patients with osteoporosis who underwent rTSA. Patients were stratified into two cohorts based on preoperative bisphosphonate usage. Propensity score matching (1:1) was utilized to balance demographic characteristics, comorbidities, prior surgery, and medication use. Outcomes assessed included acromial stress fractures, revision rates, aseptic loosening, and periprosthetic fractures at 1 year postoperatively.</div></div><div><h3>Results</h3><div>A total of 1,208 propensity-matched patients (604 in each cohort) were analyzed. In the bisphosphonate group, 25 (4.1%) of patients were diagnosed with an acromial stress fracture compared to 23 (3.6%) in the control group (odds ratio 1.142, 95% confidence interval 0.637-2.049, <em>P</em> = .655). No significant differences were observed in revision rates (<em>P</em> = .712), aseptic loosening (<em>P</em> = 1.000), or periprosthetic fractures (<em>P</em> = 1.000) between cohorts.</div></div><div><h3>Conclusion</h3><div>Bisphosphonate usage does not decrease the incidence of acromial stress fractures in osteoporotic patients undergoing rTSA. Future studies should focus on the potential additional interventions to mitigate the risk of acromial stress fracture in osteoporotic patients undergoing rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 568-572"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685854","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 : 2025-12-01DOI: 10.1053/j.sart.2025.05.001
B. Gage Griswold MD, Brian P. Davis MD, Hayden B. Schuette DO, Benjamin W. Sears MD, Andrea Stapleford BS, Libby Mauter MSPT, Jacqueline Bader MS, Mallory Boyd MS, Armodios M. Hatzidakis MD
Background
Patient-reported outcome measures (PROMs) provide a quantifiable rating of a patient's subjective symptoms prior to and following treatment of shoulder pathology. Shoulder Subjective Patient Outcome Tracker (SPOT) is a novel outcomes measure with 10 satisfaction domains to pinpoint shoulder-specific functions. The purpose of this study is to introduce and demonstrate the utility of SPOT for patients undergoing total shoulder arthroplasty. The authors hypothesize SPOT will demonstrate high correlations to existing PROMs with a corresponding large effect size.
Methods
Over a 1-year evaluation period, SPOT, American Shoulder and Elbow Surgeons (ASES) assessment, and Single Assessment Numeric Evaluation (SANE) scores were administered preoperatively and at 2 years postoperatively for patients undergoing anatomic total shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (rTSA). Additionally, nonsurgical patients with glenohumeral osteoarthritis were administered SPOT at 2 separate time points. Interoutcome agreement, correlation, and sensitivity of SPOT to ASES and SANE were evaluated, and the floor/ceiling effect of SPOT was assessed. Test-retest reliability was conducted on the nonsurgical cohort.
Results
A total of 139 patients were included with 73 postoperative aTSA and 66 postoperative rTSA patients. Twelve patients managed nonoperatively were included in test-retest analysis. Preoperatively, there was low correlation between SPOT and ASES and moderate correlation between SPOT and SANE. At 2 years postoperatively, there was high correlation between SPOT and ASES and between SPOT and SANE. There was good agreement between SPOT and ASES in both aTSA and rTSA cohorts and between SPOT and SANE in the aTSA cohort. Additionally, the large effect size of SPOT was similar to the effect size of ASES and SANE. There was high correlation in the test-retest evaluation in a nonoperative cohort indicating reliability of SPOT at the 2 time points assessed.
Conclusion
SPOT is a shoulder-specific, effective PROM with a low administrative burden, tailored for patients undergoing aTSA or rTSA. It demonstrates high reliability, strong correlations, and a large effect size comparable to established shoulder-specific PROMs. SPOT is more discriminatory and specific than the SANE score, offering valuable, detailed insights into patients’ perceived deficits before and after shoulder arthroplasty.
{"title":"Introduction of a new outcome measure for total shoulder arthroplasty: subjective patient outcome tracker (SPOT)","authors":"B. Gage Griswold MD, Brian P. Davis MD, Hayden B. Schuette DO, Benjamin W. Sears MD, Andrea Stapleford BS, Libby Mauter MSPT, Jacqueline Bader MS, Mallory Boyd MS, Armodios M. Hatzidakis MD","doi":"10.1053/j.sart.2025.05.001","DOIUrl":"10.1053/j.sart.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Patient-reported outcome measures (PROMs) provide a quantifiable rating of a patient's subjective symptoms prior to and following treatment of shoulder pathology. Shoulder Subjective Patient Outcome Tracker (SPOT) is a novel outcomes measure with 10 satisfaction domains to pinpoint shoulder-specific functions. The purpose of this study is to introduce and demonstrate the utility of SPOT for patients undergoing total shoulder arthroplasty<span>. The authors hypothesize SPOT will demonstrate high correlations to existing PROMs with a corresponding large effect size.</span></div></div><div><h3>Methods</h3><div><span>Over a 1-year evaluation period, SPOT, American Shoulder and Elbow Surgeons (ASES) assessment, and Single Assessment Numeric Evaluation (SANE) scores were administered preoperatively and at 2 years postoperatively for patients undergoing anatomic total shoulder arthroplasty<span> (aTSA) and reverse shoulder arthroplasty (rTSA). Additionally, nonsurgical patients with glenohumeral </span></span>osteoarthritis were administered SPOT at 2 separate time points. Interoutcome agreement, correlation, and sensitivity of SPOT to ASES and SANE were evaluated, and the floor/ceiling effect of SPOT was assessed. Test-retest reliability was conducted on the nonsurgical cohort.</div></div><div><h3>Results</h3><div>A total of 139 patients were included with 73 postoperative aTSA and 66 postoperative rTSA patients. Twelve patients managed nonoperatively were included in test-retest analysis. Preoperatively, there was low correlation between SPOT and ASES and moderate correlation between SPOT and SANE. At 2 years postoperatively, there was high correlation between SPOT and ASES and between SPOT and SANE. There was good agreement between SPOT and ASES in both aTSA and rTSA cohorts and between SPOT and SANE in the aTSA cohort. Additionally, the large effect size of SPOT was similar to the effect size of ASES and SANE. There was high correlation in the test-retest evaluation in a nonoperative cohort indicating reliability of SPOT at the 2 time points assessed.</div></div><div><h3>Conclusion</h3><div>SPOT is a shoulder-specific, effective PROM with a low administrative burden, tailored for patients undergoing aTSA or rTSA. It demonstrates high reliability, strong correlations, and a large effect size comparable to established shoulder-specific PROMs. SPOT is more discriminatory and specific than the SANE score, offering valuable, detailed insights into patients’ perceived deficits before and after shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 553-560"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685809","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}
After reverse shoulder arthroplasty (RSA), the deltoid muscle is the main source of kinematic force, and muscle strength is essential for movement of the shoulder joint. The purpose of this study was to assess the correlation of preoperative deltoid muscle volume with clinical outcomes after RSA. Our hypothesis was that preoperative deltoid muscle volume would be associated with range of motion (ROM), especially in forward flexion.
Methods
The study included 49 patients who underwent RSA for cuff tear arthropathy. The mean follow-up duration was 3.3 years. Preoperative deltoid muscle volume was measured in 3 dimensions on computed tomography scans. Postoperative clinical outcomes were evaluated by active ROM and the University of California, Los Angeles shoulder rating scale score. Correlations of deltoid muscle volume with clinical outcomes were investigated. Cases were classified according to whether flexion was 135° or more (the ≥135 group) or less than 135° (the <135 group) at the final observation. Logistic regression analysis was used to identify predictors of more than 135° of flexion. The cutoff value for deltoid muscle volume was determined by receiver operating characteristic curve analysis.
Results
Preoperative deltoid volume was correlated with flexion (6 weeks, r = 0.45, P = .003; 3 months, r = 0.33, P = .023; 6 months, r = 0.31, P = .027; 1 year, r = 0.31, P = .033; final observation, r = 0.33, P = .022) and internal rotation at 1 year (r = −0.29 P = .042). Univariable analysis identified statistically significant between-group differences in preoperative external rotation (<135 group, 10.3 ± 20.1°; ≥135 group, 28.0 ± 27.6°; P = .03), preoperative pain score (2.9 ± 1.7 points and 4.3 ± 2.6 points, respectively; P = .45), and preoperative deltoid volume (169.0 ± 62.5 ml and 223.2 ± 59.1 ml; P = .008). Logistic regression analysis identified preoperative factors associated with ≥135° of flexion to be deltoid volume (odds ratio 1.02, 95% confidence interval 1.00-1.03, P = .017) and preoperative external rotation (odds ratio 1.03, 95% confidence interval 1.00-1.05, P = .04). Receiver operating characteristic curve analysis identified a deltoid volume of 204.6 ml (area under the curve 0.737, sensitivity 0.64, specificity 0.81) as the cutoff value for a final ROM in flexion of ≥135°.
Conclusion
A correlation was observed between preoperative deltoid muscle volume and ROM in flexion after RSA, especially in the early postoperative stage.
背景：在反向肩关节置换术（RSA）后，三角肌是运动力的主要来源，肌肉力量对于肩关节的运动是必不可少的。本研究的目的是评估术前三角肌体积与RSA术后临床结果的相关性。我们的假设是术前三角肌体积与活动范围（ROM）有关，尤其是前屈。方法本研究纳入49例采用RSA治疗袖带撕裂性关节病的患者。平均随访时间为3.3年。术前通过计算机断层扫描三维测量三角肌体积。术后临床结果通过活动度ROM和加州大学洛杉矶分校肩部评定量表评分进行评估。研究三角肌体积与临床预后的相关性。根据最后观察时屈曲度≥135°（≥135组）或小于135°（<；135组）进行分类。使用逻辑回归分析来确定超过135°屈曲的预测因子。通过受试者工作特征曲线分析确定三角肌体积的临界值。结果术前三角肌体积与屈曲（6周，r = 0.45, P = 0.003； 3个月，r = 0.33, P = 0.023； 6个月，r = 0.31, P = 0.027； 1年，r = 0.31, P = 0.033；最后观察，r = 0.33, P = 0.022）和1年内旋（r = - 0.29, P = 0.042）相关。单变量分析发现，两组患者术前外旋度（≥135组，10.3±20.1°；≥135组，28.0±27.6°，P = 0.03）、术前疼痛评分（分别为2.9±1.7分和4.3±2.6分，P = 0.45）、术前三角肌容积（169.0±62.5 ml和223.2±59.1 ml, P = 0.008）差异均有统计学意义。Logistic回归分析发现术前因素与三角肌体积屈曲≥135°相关（优势比1.02,95%可信区间1.00-1.03,P = 0.017）和术前外旋相关（优势比1.03,95%可信区间1.00-1.05,P = 0.04）。受试者工作特征曲线分析确定三角肌体积为204.6 ml（曲线下面积0.737，灵敏度0.64，特异性0.81）作为屈曲≥135°时最终ROM的临界值。结论术前三角肌体积与RSA术后屈曲的ROM相关，尤其是术后早期。
{"title":"Preoperative deltoid muscle volume correlates with early postoperative range of motion in flexion after reverse shoulder arthroplasty","authors":"Jun Kawamata MD , Shoji Fukuta MD, PhD , Daisuke Nakai MD, PhD , Kohei Yoshikawa MD , Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.07.003","DOIUrl":"10.1053/j.sart.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>After reverse shoulder arthroplasty (RSA), the deltoid muscle is the main source of kinematic force, and muscle strength is essential for movement of the shoulder joint. The purpose of this study was to assess the correlation of preoperative deltoid muscle volume with clinical outcomes after RSA. Our hypothesis was that preoperative deltoid muscle volume would be associated with range of motion (ROM), especially in forward flexion.</div></div><div><h3>Methods</h3><div>The study included 49 patients who underwent RSA for cuff tear arthropathy. The mean follow-up duration was 3.3 years. Preoperative deltoid muscle volume was measured in 3 dimensions on computed tomography scans. Postoperative clinical outcomes were evaluated by active ROM and the University of California, Los Angeles shoulder rating scale score. Correlations of deltoid muscle volume with clinical outcomes were investigated. Cases were classified according to whether flexion was 135° or more (the ≥135 group) or less than 135° (the <135 group) at the final observation. Logistic regression analysis was used to identify predictors of more than 135° of flexion. The cutoff value for deltoid muscle volume was determined by receiver operating characteristic curve analysis.</div></div><div><h3>Results</h3><div>Preoperative deltoid volume was correlated with flexion (6 weeks, r = 0.45, <em>P</em> = .003; 3 months, r = 0.33, <em>P</em> = .023; 6 months, r = 0.31, <em>P</em> = .027; 1 year, r = 0.31, <em>P</em> = .033; final observation, r = 0.33, <em>P</em> = .022) and internal rotation at 1 year (r = −0.29 <em>P</em> = .042). Univariable analysis identified statistically significant between-group differences in preoperative external rotation (<135 group, 10.3 ± 20.1°; ≥135 group, 28.0 ± 27.6°; <em>P</em> = .03), preoperative pain score (2.9 ± 1.7 points and 4.3 ± 2.6 points, respectively; <em>P</em> = .45), and preoperative deltoid volume (169.0 ± 62.5 ml and 223.2 ± 59.1 ml; <em>P</em> = .008). Logistic regression analysis identified preoperative factors associated with ≥135° of flexion to be deltoid volume (odds ratio 1.02, 95% confidence interval 1.00-1.03, <em>P</em> = .017) and preoperative external rotation (odds ratio 1.03, 95% confidence interval 1.00-1.05, <em>P</em> = .04). Receiver operating characteristic curve analysis identified a deltoid volume of 204.6 ml (area under the curve 0.737, sensitivity 0.64, specificity 0.81) as the cutoff value for a final ROM in flexion of ≥135°.</div></div><div><h3>Conclusion</h3><div>A correlation was observed between preoperative deltoid muscle volume and ROM in flexion after RSA, especially in the early postoperative stage.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 678-684"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685750","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 : 2025-12-01DOI: 10.1053/j.sart.2025.06.007
Arman Kishan MBBS , Sanjay Kubsad BS , Jeffrey Y. Wang BS , Duc Nguyen MD , Santiago A. Lozano-Calderón MD, PhD , Umasuthan Srikumaran MD, MBA, MPH , Matthew J. Best MD
Background
The absence of national guidelines on the use of extended oral antibiotic (EOA) prophylaxis has led to inconsistent use of EOA to prevent prosthetic joint infection after total shoulder arthroplasty (TSA). Our investigation aimed to determine temporal trends and prescription patterns in the use of EOA prophylaxis after TSA from 2010 to 2021, particularly for patients considered at high risk for infection.
Methods
Using the PearlDiver database, we identified 289,908 patients who underwent primary TSA from 2010 to 2021. EOA was defined as antibiotic use initiated before, during, or immediately after surgery and continued for 2 days or more postoperatively. Compounded annual growth rate and linear regression were used for trend analysis. Stratification measures were demographic variables, geographic location, insurance type, and risk factors for infection.
Results
Among primary TSA patients, 3.8% received EOA after TSA. Antibiotic use after TSA increased by a compounded annual growth rate of 6.2% from 2010 to 2021. Associations were observed between EOA prescription patterns and factors such as age, sex, Charlson Comorbidity Index value, geographic region, and insurance type. Cephalexin was the most frequently prescribed antibiotic, but prescriptions of cephalexin declined during the study period, while doxycycline prescriptions increased. Most patients received EOA for 2-7 days. Patients at high risk for infection, including those with diabetes, a history of tobacco use, chronic kidney disease, and autoimmune disorders, were more likely to receive EOAs compared to those without these factors.
Conclusion
This study provides insights into the dynamic landscape of EOA prophylaxis after TSA. The observed changes during the study period—namely, the increase in EOA prescriptions, demographic variation in prescription patterns, and shifting antibiotic preferences—highlight the evolving nature of clinical practice in the absence of standardized national guidelines. Continued research is needed to improve prophylactic strategies for patients with risk factors for infection. Surgeons can use this information to establish their own guidelines tailored to their patients, considering factors such as age, comorbid conditions, and regional practices, while closely monitoring for adverse effects and antibiotic resistance patterns.
{"title":"Trends in extended oral antibiotic prophylaxis after primary total shoulder arthroplasty, 2010-2021","authors":"Arman Kishan MBBS , Sanjay Kubsad BS , Jeffrey Y. Wang BS , Duc Nguyen MD , Santiago A. Lozano-Calderón MD, PhD , Umasuthan Srikumaran MD, MBA, MPH , Matthew J. Best MD","doi":"10.1053/j.sart.2025.06.007","DOIUrl":"10.1053/j.sart.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>The absence of national guidelines on the use of extended oral antibiotic (EOA) prophylaxis has led to inconsistent use of EOA to prevent prosthetic joint infection after total shoulder arthroplasty (TSA). Our investigation aimed to determine temporal trends and prescription patterns in the use of EOA prophylaxis after TSA from 2010 to 2021, particularly for patients considered at high risk for infection.</div></div><div><h3>Methods</h3><div>Using the PearlDiver database, we identified 289,908 patients who underwent primary TSA from 2010 to 2021. EOA was defined as antibiotic use initiated before, during, or immediately after surgery and continued for 2 days or more postoperatively. Compounded annual growth rate and linear regression were used for trend analysis. Stratification measures were demographic variables, geographic location, insurance type, and risk factors for infection.</div></div><div><h3>Results</h3><div>Among primary TSA patients, 3.8% received EOA after TSA. Antibiotic use after TSA increased by a compounded annual growth rate of 6.2% from 2010 to 2021. Associations were observed between EOA prescription patterns and factors such as age, sex, Charlson Comorbidity Index value, geographic region, and insurance type. Cephalexin was the most frequently prescribed antibiotic, but prescriptions of cephalexin declined during the study period, while doxycycline prescriptions increased. Most patients received EOA for 2-7 days. Patients at high risk for infection, including those with diabetes, a history of tobacco use, chronic kidney disease, and autoimmune disorders, were more likely to receive EOAs compared to those without these factors.</div></div><div><h3>Conclusion</h3><div>This study provides insights into the dynamic landscape of EOA prophylaxis after TSA. The observed changes during the study period—namely, the increase in EOA prescriptions, demographic variation in prescription patterns, and shifting antibiotic preferences—highlight the evolving nature of clinical practice in the absence of standardized national guidelines. Continued research is needed to improve prophylactic strategies for patients with risk factors for infection. Surgeons can use this information to establish their own guidelines tailored to their patients, considering factors such as age, comorbid conditions, and regional practices, while closely monitoring for adverse effects and antibiotic resistance patterns.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 654-661"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685758","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 : 2025-12-01DOI: 10.1053/j.sart.2025.07.004
Ali A. Mohamed MS , Anna Redden BS , Jacob Calpey BS , Aghdas Movassaghi BS , Garrett R. Jackson MD , Howard Routman DO , Diego J.L. Lima MD , Vani J. Sabesan MD
Background
Total shoulder arthroplasty (TSA) has become a more common procedure due to its expanded indications and successful outcomes. The concern with this growth is the increased number of complications that may lead to more revision surgery. Given revision surgery has increased complexity and difficulty in recovery for patients, understanding outcomes can help guide patients and surgeons in decision-making. This study aimed to establish the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for reverse TSA performed as a revision procedure for failed prior shoulder arthroplasty types.
Methods
A retrospective review of all patients who underwent revision reverse TSA (rTSA) performed as a revision procedure for failed prior shoulder arthroplasty from 2007 to 2020 by a single fellowship-trained orthopedic surgeon was performed. Patient demographics, range of motion, and patient-reported outcome measures including Simple Shoulder Test (SST), Constant-Murley, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA), Shoulder Pain and Disability Index (SPADI), and Shoulder Arthroplasty Smart (SAS), were collected preoperatively and postoperatively at the last follow-up visit. MCID and SCB were calculated using the anchor-based method. Analyses were performed using paired- and independent-sample t-tests and logistic regressions were used to identify potential predictors for meeting MCID and SCB.
Results
A total of 91 patients were included in this analysis. The cohort had a mean age of 67.8 years and a mean body mass index of 29.7 kg/m2. A majority of the cohort was male (51.7%) and Caucasian (93.2%). The MCID was found to be 3.5 for SST, 30.6 for Constant-Murley Score, 25.3 for ASES, 11.2 for UCLA, −42.1 for SPADI, 17.4 for SAS, 56.4° for forward flexion, 47.6° for abduction and 11.7° for external rotation. The SCB was found to be 6.3 for SST, 34.3 for CMS, 45.6 for ASES, 17.6 for UCLA, −56.8 for SPADI, 30.1 for SAS, 78.4° for forward flexion, 66.8° for abduction and 7.9° for external rotation. MCID was achieved by 72.5% of patients and 43.9% (n = 40) met SCB at final follow-up. Age, sex, and body mass index were not found to be significantly associated with meeting MCID or SCB.
Conclusions
This study establishes MCID and SCB thresholds for rTSA performed as a revision procedure for failed prior shoulder arthroplasties, providing valuable benchmarks for assessing patient outcomes. Most patients achieved meaningful improvements (MCID), and a significant portion reached SCB. These findings help set recovery expectations and highlight that patient-specific factors have a limited impact on outcomes after rTSA performed as a revision surgery.
{"title":"Determining the minimal clinically important difference and substantial clinical benefit following revision reverse shoulder arthroplasty","authors":"Ali A. Mohamed MS , Anna Redden BS , Jacob Calpey BS , Aghdas Movassaghi BS , Garrett R. Jackson MD , Howard Routman DO , Diego J.L. Lima MD , Vani J. Sabesan MD","doi":"10.1053/j.sart.2025.07.004","DOIUrl":"10.1053/j.sart.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) has become a more common procedure due to its expanded indications and successful outcomes. The concern with this growth is the increased number of complications that may lead to more revision surgery. Given revision surgery has increased complexity and difficulty in recovery for patients, understanding outcomes can help guide patients and surgeons in decision-making. This study aimed to establish the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for reverse TSA performed as a revision procedure for failed prior shoulder arthroplasty types.</div></div><div><h3>Methods</h3><div>A retrospective review of all patients who underwent revision reverse TSA (rTSA) performed as a revision procedure for failed prior shoulder arthroplasty from 2007 to 2020 by a single fellowship-trained orthopedic surgeon was performed. Patient demographics, range of motion, and patient-reported outcome measures including Simple Shoulder Test (SST), Constant-Murley, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA), Shoulder Pain and Disability Index (SPADI), and Shoulder Arthroplasty Smart (SAS), were collected preoperatively and postoperatively at the last follow-up visit. MCID and SCB were calculated using the anchor-based method. Analyses were performed using paired- and independent-sample t-tests and logistic regressions were used to identify potential predictors for meeting MCID and SCB.</div></div><div><h3>Results</h3><div>A total of 91 patients were included in this analysis. The cohort had a mean age of 67.8 years and a mean body mass index of 29.7 kg/m<sup>2</sup>. A majority of the cohort was male (51.7%) and Caucasian (93.2%). The MCID was found to be 3.5 for SST, 30.6 for Constant-Murley Score, 25.3 for ASES, 11.2 for UCLA, −42.1 for SPADI, 17.4 for SAS, 56.4° for forward flexion, 47.6° for abduction and 11.7° for external rotation. The SCB was found to be 6.3 for SST, 34.3 for CMS, 45.6 for ASES, 17.6 for UCLA, −56.8 for SPADI, 30.1 for SAS, 78.4° for forward flexion, 66.8° for abduction and 7.9° for external rotation. MCID was achieved by 72.5% of patients and 43.9% (n = 40) met SCB at final follow-up. Age, sex, and body mass index were not found to be significantly associated with meeting MCID or SCB.</div></div><div><h3>Conclusions</h3><div>This study establishes MCID and SCB thresholds for rTSA performed as a revision procedure for failed prior shoulder arthroplasties, providing valuable benchmarks for assessing patient outcomes. Most patients achieved meaningful improvements (MCID), and a significant portion reached SCB. These findings help set recovery expectations and highlight that patient-specific factors have a limited impact on outcomes after rTSA performed as a revision surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 685-691"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685858","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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