Seminars in Arthroplasty最新文献

{"title":"Choice of glenoid inclination correction method affects reverse shoulder arthroplasty baseplate loading","authors":"Emiko R. Hourston BEng ,&nbsp;Kaitlyn Kuchinka BEng ,&nbsp;Jaylan Hamad BEng ,&nbsp;George S. Athwal MD ,&nbsp;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> &lt; .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}

{"title":"Pneumonia before shoulder arthroplasty increases the risk of medical and surgical complications in a time-dependent manner","authors":"Tyler T. Brady BS ,&nbsp;Romir P. Parmar BS ,&nbsp;Alejandro M. Holle BS ,&nbsp;Michael H. Amini MD ,&nbsp;Evan Lederman MD ,&nbsp;Midhat Patel MD","doi":"10.1016/j.sart.2025.151539","DOIUrl":"10.1016/j.sart.2025.151539","url":null,"abstract":"<div><h3>Background</h3><div>While prior pneumonia (PNA) is a known risk factor for complications in surgery, its influence on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study aimed to evaluate how the timing and history of PNA affect postoperative outcomes after TSA.</div></div><div><h3>Methods</h3><div>A large insurance claims database was queried to identify patients undergoing primary TSA, anatomic and reverse, with a minimum of 2 years of follow-up. Patients with a diagnosis of PNA within 2 years before TSA were propensity-score matched 1:1 to controls without prior PNA based on demographics and Elixhauser comorbidity index and its individual components. Outcomes of interest included medical and surgical complications. Subgroup analyses were performed based on PNA timing (&lt;3, 3-6, 6-12, 12-18, and 18-24 months), PNA type (bacterial vs. viral), and further stratified by causative organism.</div></div><div><h3>Results</h3><div>A total of 8,619 patients with prior PNA within 2 years of surgery were matched to 8,619 controls. Patients with prior PNA had increased odds of postoperative PNA (odds ratio (OR) 3.06, 95% confidence interval (CI) 2.40-3.91), acute myocardial infarction (MI) (OR 1.50, 95% CI 1.05-2.15), deep venous thrombosis (OR 1.60, 95% CI 1.15-2.22), and urinary tract infection (OR 1.18, 95% CI 1.03-1.34). PNA occurring within 3 months prior to TSA was associated with the highest odds for postoperative PNA (OR 5.21, 95% CI 3.66-7.42) and MI (2.28, 95% CI 1.23-4.21). Additionally, patients with prior PNA had increased odds of aseptic loosening (OR 1.25, 95% CI 1.04-1.51) and periprosthetic fracture (OR 1.88, 95% CI 1.21-2.91), but no significant associations were seen in time-dependent analyses. Viral PNA was associated with increased rates of postoperative MI (OR 3.40, 95% CI 1.45-8.00), compared to controls. Streptococcal PNA was notably associated with postoperative PNA (OR 7.26, 95% CI 3.90-13.55), while <em>Mycoplasma</em> <em>pneumoniae</em> was associated with wound dehiscence (OR 10.10, 95% CI 1.33-76.76) compared to controls.</div></div><div><h3>Conclusion</h3><div>A history of PNA is associated with higher risk of complications after TSA, especially when within 3 months or 6 months before surgery. Both timing and organism influence outcomes, highlighting the importance of pulmonary optimization prior to surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151539"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037718","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":"Perceived influence of preoperative information in reverse total shoulder arthroplasty patients","authors":"Stephanie M. Barbone DHSc, OTR/L, CHT ,&nbsp;Zachary R. Zimmer MD, FAAOS ,&nbsp;David Lutton MD, FAAOS ,&nbsp;Norman W. Gill PT, DSc","doi":"10.1016/j.sart.2025.151537","DOIUrl":"10.1016/j.sart.2025.151537","url":null,"abstract":"<div><h3>Background</h3><div>While prehabilitation has shown benefits in other joint arthroplasties, specific preoperative guidance for reverse total shoulder arthroplasty (rTSA) remains underdeveloped. Patients often enter surgery with varying levels of preparedness and understanding, which can be shaped by inconsistent communication and limited resources. This study examines how patients perceive the preoperative education they received and how it influenced their recovery experiences.</div></div><div><h3>Methods</h3><div>A qualitative instrumental case study was conducted. Sixteen adult patients who underwent elective rTSA in the previous eight months were recruited from orthopedic clinics and a university hospital rehabilitation center in Washington, D.C. Semistructured interviews explored patients' expectations, pain management, functional challenges, and support systems. Transcripts were coded using thematic analysis guided by interpretive description to identify recurring patterns and insights.</div></div><div><h3>Results</h3><div>Four primary themes emerged from the analysis: communication with the health care team, pain expectations and management, caregiver support in recovery, and postoperative functional limitations. Participants described how thorough communication fostered trust in their surgeons and influenced their preparedness. Pain experiences varied, with many expressing confusion about opioid protocols and nerve block management. Caregiver support was universally cited as essential, particularly for patients recovering alone or undergoing surgery on their dominant side. Patients reported significant challenges with basic activities, such as dressing and bathing, often underestimating these limitations preoperatively. Sleep disruption and sling use were also highlighted as preoperative education topics that hindered or supported recovery.</div></div><div><h3>Conclusion</h3><div>This study highlights the multifaceted nature of recovery following rTSA and emphasizes the need for tailored, practical preoperative education. While technical competence is essential, the provider's communication style and clarity are equally important in fostering patient trust and understanding. Patients benefit from education that sets realistic expectations about pain, sleep, daily functioning, and the critical role of caregiver support. By elevating the voices of patients, this study provides a deeper understanding of the patient experience after rTSA. It also suggests actionable opportunities for clinicians to enhance the content and delivery of preoperative counseling, ultimately supporting a more informed recovery journey for patients undergoing rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151537"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926414","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":"Discrepancies in relative value unit-based reimbursement for operative management of periprosthetic humerus fractures","authors":"Alyssa R. Henriquez BS,&nbsp;Samuel Lorentz MD,&nbsp;Bryan Crook MD,&nbsp;Lindsey V. Ruderman BA,&nbsp;Michael A. Moverman MD,&nbsp;Christopher S. Klifto MD,&nbsp;Oke Anakwenze MD, MBA","doi":"10.1016/j.sart.2025.151530","DOIUrl":"10.1016/j.sart.2025.151530","url":null,"abstract":"<div><h3>Background</h3><div>Relative value units (RVUs) are widely used to calculate physician reimbursement. In orthopedics, primary shoulder arthroplasty has been shown to afford higher reimbursement per unit time than revision surgery according to RVU-based models. This study seeks to compare the reimbursement of primary arthroplasty in comparison with surgery for periprosthetic fracture patients. Specifically, we evaluate the compensation of implant revision surgery and open reduction with internal fixation (ORIF) for periprosthetic fracture.</div></div><div><h3>Methods</h3><div>Primary arthroplasty patients and periprosthetic fracture patients were identified using current procedural terminology codes at a single institution from 2016 to 2024. Periprosthetic fracture patients who received either implant revision or ORIF were included and subdivided by procedure type. The Centers for Medicare &amp; Medicaid Services dollar/RVU conversion factors were used to calculate the reimbursement per minute. The assumption of an 8-h workday and 120 operative days per year was used to calculate daily, monthly, and annual reimbursement.</div></div><div><h3>Results</h3><div>Two hundred fifty primary arthroplasty patients and 49 periprosthetic fracture patients were identified for analysis. Twenty periprosthetic fracture patients received implant revision and 29 received ORIF. Patients who received ORIF had significantly higher body mass indices (BMIs) compared to primary arthroplasty patients (34.3 ± 9.5 vs. 30.4 ± 7.5; <em>P</em> = .011) and were predominantly female (90% vs. 63%, <em>P</em> = .004). ORIF provided significantly lower reimbursement-per-minute than primary arthroplasty ($2.63 ± 0.88 vs. $7.69 ± 2.36; <em>P</em> &lt; .001), with an average annual reimbursement difference of $298,484.4. Revision surgery provided comparable reimbursement-per-minute to primary arthroplasty ($7.21 ± 2.11 vs. $7.69 ± 2.36, <em>P</em> = .368), and comparable annual reimbursement ($461,358.48 ± 54,340.25 vs. $443,603.44 ± 21,298.01).</div></div><div><h3>Conclusion</h3><div>Implant revision for periprosthetic fracture provides comparable reimbursement to primary shoulder arthroplasty, while ORIF provides significantly lower reimbursement on a daily, monthly, and annual basis. Current RVU-based models do not adequately account for the increased operative time required to treat periprosthetic fracture cases with ORIF, which results in significant annual reimbursement differences.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151530"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926413","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":"Nonalcoholic fatty liver disease is associated with adverse medical, but not implant-related complications following total shoulder arthroplasty","authors":"Eric Mao BA ,&nbsp;Anh S. Le BS ,&nbsp;Alexander R. Zhu BA ,&nbsp;Emily O'Connell BS ,&nbsp;Umasuthan Srikumaran MD, MBA, MPH","doi":"10.1016/j.sart.2025.151529","DOIUrl":"10.1016/j.sart.2025.151529","url":null,"abstract":"<div><h3>Background</h3><div>Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition characterized by hepatic fat accumulation in the absence of alcohol consumption. Liver diseases such as cirrhosis are known to be associated with worse outcomes after total hip and total knee arthroplasty. However, these results may not generalize to NAFLD, which presents along a broader continuum of severity. This retrospective cohort study assessed the impact of NAFLD on outcomes following total shoulder arthroplasty (TSA).</div></div><div><h3>Methods</h3><div>Patients undergoing primary TSA were identified from a national database and stratified into two cohorts: those with NAFLD diagnosed prior to TSA and controls without NAFLD. Patients receiving a second TSA within two years were excluded to ensure laterality. Patients receiving TSA for indications of osteonecrosis or fracture were further excluded. To improve comparability between cohorts, 1:1 propensity score matching was performed based upon demographics and comorbidities identified to be significant at baseline. The incidence of implant-related and medical complications was assessed at 90 days and 2 years following TSA. Chi-square tests between cohorts were performed to calculate risk ratios, 95% confidence intervals, and their associated <em>P</em> values. Statistical significance was assessed at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>At 90 days after TSA, patients with NAFLD were more likely to experience pneumonia, bleeding requiring transfusions, and deep vein thrombosis (DVT) compared to controls. However, patients with NAFLD were less likely to require revision at this time point compared to controls. At two years after TSA, patients with NAFLD were still more likely to experience DVT and bleeding requiring transfusion. NAFLD patients were also still less likely to require revision when compared to controls. The incidence of mechanical loosening, prosthesis dislocation, periprosthetic fracture, and periprosthetic joint infection was not significantly different between cohorts at either timepoints.</div></div><div><h3>Discussion</h3><div>This study is the first to utilize a large-scale database to examine the association between NAFLD and complications following TSA. Our results indicate that patients with NAFLD are not at elevated risk of any implant-related complications following TSA. However, NAFLD patients may be at elevated risk of DVT, pneumonia, and bleeding requiring transfusion. These findings are unlike those reported for patients with other liver conditions undergoing TSA and suggest the existence of a unique risk profile for patients with NAFLD. Future work is necessary to elucidate the underlying mechanisms driving our observed associations and to determine whether preoperative optimization of NAFLD can mitigate the risk of medical complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151529"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926462","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":"Maximum of 10-year surgical outcomes following reverse total shoulder arthroplasty for rotator cuff arthropathy vs. proximal humerus fractures","authors":"Eric Cui BS ,&nbsp;Daniel Raftis BS ,&nbsp;Jackson W. Durbin BS ,&nbsp;Andrew Fealy BS ,&nbsp;Philip M. Parel BS ,&nbsp;Rachel Ranson DO ,&nbsp;Alana O'Mara MA ,&nbsp;Theodore Quan MD ,&nbsp;Jacob D. Mikula MD ,&nbsp;Ashish Vankara MD ,&nbsp;Zachary Zimmer MD ,&nbsp;Uma Srikumaran MD, MBA, MPH","doi":"10.1016/j.sart.2025.151527","DOIUrl":"10.1016/j.sart.2025.151527","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) in the setting of rotator cuff arthropathy (RCA) is an elective procedure in response to a chronic and degenerative process that occurs only after thorough preoperative risk stratification and adequate patient optimization. In contrast, rTSA secondary to proximal humerus fracture (PHF) is a response to an acute traumatic injury that frequently occurs in elderly patients with underlying comorbidities such as osteoporosis. These distinct patient populations may have unique risk profiles that could influence the long-term survivorship of implants and the specific indications for revision surgery. Despite the widespread use of rTSA for both RCA and PHF, the comparative long-term outcomes, revision rates, and indications for revision between these 2 patient populations are not well established.</div></div><div><h3>Methods</h3><div>Patients who underwent primary rTSA were identified using Current Procedural Terminology and International Classification of Diseases codes from a national claims database and stratified into PHF and RCA cohorts. Patients were included if they had at least two years of postoperative data. These cohorts were propensity score matched by age, gender, and Charlson Comorbidity Index to control for potential confounders. The 10-year and 5-year cumulative incidence rate and risk of all-cause revision, periprosthetic fracture (PPF), periprosthetic joint infection (PJI), dislocation, and mechanical loosening were determined using Kaplan-Meier and Cox proportional hazard analyses.</div></div><div><h3>Results</h3><div>In total, 23,684 patients were included in this study, with 7,982 patients (33.70%) and 15,702 patients (66.30%) included in the PHF and RCA cohort, respectively. The 10-year cumulative risk for all-cause revision (hazard ratio [HR]: 1.5; <em>P</em> &lt; .001), PPF (HR: 1.7; <em>P</em> &lt; .001), dislocation (HR: 1.7; <em>P</em> &lt; .001), and PJI (HR: 1.31; <em>P</em> = .001) were all significantly higher in the PHF cohort compared to the RCA cohort. Similarly, at the 5-year mark, the risk of all-cause revision (HR: 1.6; <em>P</em> &lt; .001), PPF (HR: 1.6; <em>P</em> &lt; .001), dislocation (HR: 1.7; <em>P</em> &lt; .001), and PJI (HR: 1.3; <em>P</em> = .002) was also significantly higher in the PHF cohort. In contrast, mechanical loosening did not differ significantly between groups at both the 5-year and 10-year marks.</div></div><div><h3>Conclusion</h3><div>Over a 10-year period, patients undergoing rTSA for PHF demonstrated a higher risk of all-cause revision, PPF, dislocation, and PJI. These findings highlight the importance of counseling patients about the likely long-term outcomes following an rTSA for PHF compared to elective RCA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151527"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of glenosphere size on outcomes and complications associated with reverse shoulder arthroplasty: a systematic review and meta-analysis","authors":"Thomas A. Deane MD, MB, BCh, BAO ,&nbsp;Andrew J. Kelly MD, MB, BCh, BAO ,&nbsp;Conor McNamee MD, MB, BCh, BAO ,&nbsp;James G. Kelly MD, MB, BCh, BAO ,&nbsp;Stefan Bauer MD, MB, BCh, BAO ,&nbsp;William G. Blakeney MBBS, MS, MSc, FRACS","doi":"10.1016/j.sart.2025.151525","DOIUrl":"10.1016/j.sart.2025.151525","url":null,"abstract":"<div><h3>Background</h3><div>Glenosphere diameter is a variable component in different reverse shoulder arthroplasty designs. The size of the glenosphere influences the amount of glenosphere overhang. Computer and cadaveric models have postulated that increased glenosphere overhang may restore better range of motion and decrease complications including scapular notching. Alternatively, it has been postulated that increasing glenosphere size may increase tension on the posterior capsule and reduce internal rotation. There is conflicting evidence in the literature regarding the clinical outcomes of increased glenosphere size.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using search engines in PubMed, EMBASE, and Cochrane to retrieve all relevant studies. The Cochrane Risk of Bias Assessment Tool 2 (RoB-2) and risk of Bias in Non-Randomized trials were used to assess for bias. We present log risk ratios for dichotomous variables and raw mean differences (MDs) for continuous variables. The large glenosphere group was defined as ≥40 mm while the small glenosphere group was defined as ≤39 mm.</div></div><div><h3>Results</h3><div>Five studies were included in the quantitative meta-analysis conducted in this paper, comparing 1,217 shoulders. Results of the primary outcomes when comparing large to small glenosphere were as follows: abduction (MD: 0.52; 95% confidence interval [CI]: −5.90, 4.86), forward flexion (MD: 2.38; 95% CI: −1.37, 6.13), external rotation (MD: 2.9; 95% CI: −1.96, 7.76), Constant-Murley Score (MD: 0.49, 95% CI: −2.79, 3.78), American Shoulder and Elbow Surgeons (MD: 3.23; 95% CI: 0.92, 5.54), and scapular notching (odds ratio: −0.07; 95% CI: −0.2, 0.06).</div></div><div><h3>Conclusion</h3><div>The use of larger glenosphere sizes may not have any effect on range of motion or scapular notching. There is a statistically significant improvement in ASES scores, which is below the Minimal Clinically Important Difference.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151525"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term clinical and radiographic outcomes following shoulder hemiarthroplasty","authors":"William A. Ranson MD,&nbsp;Evan M. Michaelson MD,&nbsp;Akiro H. Duey MD,&nbsp;Akshar V. Patel MD,&nbsp;Evan L. Flatow MD,&nbsp;Dave R. Shukla MD,&nbsp;Paul J. Cagle MD","doi":"10.1016/j.sart.2025.151526","DOIUrl":"10.1016/j.sart.2025.151526","url":null,"abstract":"<div><h3>Background</h3><div>The utilization of shoulder hemiarthroplasty (HA) has decreased in recent decades, with glenoid erosion being a main concern. Existing long-term follow-up studies involve a limited diversity of early implants and lack a thorough assessment of the effects of glenoid erosion on patient outcomes. This study sought to report the long-term survivorship of HA in patients treated with a variety of implants, the vast majority being of design generations subsequent to the early monoblock prostheses. An additional aim of this study was to characterize the incidence and severity of glenoid erosion and to elucidate the effects on patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of prospectively collected data was performed on a consecutive series of HAs performed by a single surgeon between 1994 and 2012. Thirty-five shoulders met the inclusion criteria. In the primary analysis, shoulders were split into 2 cohorts based on whether or not they required revision surgery. A survivorship curve was plotted and the characteristics of the cohorts compared. In the secondary analysis, patients were split into 3 cohorts based on final glenoid erosion severity. Visual analog scale, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores, as well as range of motion, were then compared between the erosion cohorts.</div></div><div><h3>Results</h3><div>Seven of 35 shoulders (20.0%) underwent revision at an average of 9.3 years postoperatively, while 28 shoulders (80.0%) did not require revision at an average final follow-up of 15.3 years. The estimated 15-year survival rate was 83.0%. Glenoid erosion occurred in 26 (73.4%) shoulders and symptomatic glenoid erosion accounted for 4 of 7 (57.1%) revisions. Severity of glenoid erosion was not associated with differences in visual analog scale (<em>P</em> = .54), American Shoulder and Elbow Surgeons (<em>P</em> = .75), or Simple Shoulder Test (<em>P</em> = .77) scores. The development of severe glenoid wear was independently associated with decreased forward elevation (<em>P</em> = .03), external rotation (<em>P</em> &lt; .01), and internal rotation (IR) (<em>P</em> &lt; .01). The development of mild glenoid erosion trended toward an association with inferior IR (<em>P</em> = .06).</div></div><div><h3>Conclusion</h3><div>HA remains a viable option for the management of various shoulder pathologies with an estimated 15-year survival rate of 83.0%. Progressive glenoid erosion was present radiographically in 73.4% of patients at an average of 15.3 years postoperatively. Symptomatic glenoid wear accounted for over half of HA revisions. The development of severe glenoid wear was independently predictive of decreased range of motion in all planes. IR was particularly sensitive to erosive change, trending toward decreased motion with mild glenoid wear.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151526"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885142","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":"Efficacy and safety of the new Mirror anatomic total shoulder system: a preliminary report of a prospective multicentric trial","authors":"Kutalmiş Albayrak MD ,&nbsp;Matthias Zumstein MD ,&nbsp;Christophe Monnin MD ,&nbsp;Vilijam Zdravkovic MD ,&nbsp;Bernhard Jost MD","doi":"10.1016/j.sart.2025.151524","DOIUrl":"10.1016/j.sart.2025.151524","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (aTSA) is a highly effective therapy for patients with glenohumeral arthritis and an intact rotator cuff. However, implant failure due to progressive cuff pathology or loosening of the glenoid component is a well-established long-term complication. Therefore, a new prosthesis design has been developed to address these problems by “mirroring” the pairing materials improving longevity of the glenoid component and facilitating the potential conversion to reverse configuration by further design novelties. This proof-of-concept study reports on the safety and clinical efficacy of this novel Mirror anatomic total shoulder arthroplasty (Mirror aTSA) with preliminary, 1-year follow-up data.</div></div><div><h3>Methods</h3><div>This prospective study included patients who underwent Mirror aTSA for osteoarthritis at 2 centers between January 2022 and November 2023. All patients had a follow-up of at least 12 months.</div></div><div><h3>Results</h3><div>The study included 20 consecutive patients (median age: 69, range 29-89 years, 9 male and 11 female patients) with established shoulder osteoarthritis and a clinically/US/magnetic resonance imaging confirmed competent rotator cuff, who were operated on by 2 senior surgeons. The median follow-up was 14.2 months (range 12.1 to 26.4 months). The Constant score showed a significant improvement from a median of 49.1 points (range 24-69.7) preoperatively to a median of 81.8 points (range 69-96) at 12 months follow-up. Similarly, the Oxford Shoulder Score) and Subjective Shoulder Value also improved from 27 points (range 8–37) and 40% (range 10–75%) preoperatively to a median of 48 points (range 38–48) and 95% (range 40%–100%) postoperatively, respectively. No complications related to the procedure or prosthesis were observed.</div></div><div><h3>Conclusion</h3><div>This study confirms that the novel Mirror aTSA provides highly satisfactory clinical and radiological results at the 12-month follow-up. While long-term results are still pending, our preliminary clinical and radiological results are encouraging.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151524"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926463","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":"Cannabis use as a negative predictor of complications following total shoulder arthroplasty","authors":"Kathryn E. Grabowski BA ,&nbsp;Kenny Ling MD ,&nbsp;Edward D. Wang MD","doi":"10.1016/j.sart.2025.151521","DOIUrl":"10.1016/j.sart.2025.151521","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed to improve shoulder function, driven by demographic shifts and advances in surgical techniques. Simultaneously, cannabis use amongst adults is rising due to increased legalization and expanding medical indications. Studies report varying effects of cannabis use on postoperative outcomes after total knee arthroplasty, hip arthroplasty, and spine surgery, but data on its impact following TSA remain limited. Given the increasing demand for TSA and rising prevalence of cannabis use in the U.S., it is important to understand how cannabis use impacts postoperative complications following TSA. The purpose of this study was to analyze the relationship between cannabis use and adverse postoperative outcomes following TSA.</div></div><div><h3>Methods</h3><div>The TriNetX national database was queried for records of patients who underwent TSA between January 1st, 2010, and December 31st, 2024. Patient cohorts and outcomes were defined using International Classification for Disease, 10th edition diagnosis codes and Current Procedural Terminology codes. After 1:1 propensity score matching, the cannabis user and noncannabis user cohorts were analyzed for differences in major outcomes 90 days and 2 years following the procedure.</div></div><div><h3>Results</h3><div>A total of 75,574 patients were identified in TriNetX who underwent TSA from 2010 to 2024. Of these, 2,043 had concomitant cannabis use and 73,531 had no prior record of cannabis use. After 1:1 propensity score matching based on demographics and comorbidities, 2,042 patients in each cohort were directly compared for postoperative outcomes. Compared to noncannabis users, patients who used cannabis had a higher risk for chronic obstructive pulmonary disease exacerbation (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.28-3.35; <em>P</em> = .003), acute kidney failure (OR 1.56, 95% CI 1.10-2.21; <em>P</em> = .012), and pneumonia (OR 1.85, 95% CI 1.17-2.92; <em>P</em> = .007) within 90 days of the procedure. Compared to patients who did not use cannabis, those who did had a higher risk for prosthesis loosening (OR 1.79, 95% CI 1.06-3.03; <em>P</em> = .028), opioid dependence or abuse (OR 2.01, 95% CI 1.15-3.53; <em>P</em> = .013), and infection and inflammatory reaction due to prosthesis (OR 1.55, 95% CI 1.01-2.19; <em>P</em> = .012) within 2 years.</div></div><div><h3>Conclusion</h3><div>Preoperative cannabis use was associated with several postoperative complications 90 days and 2 years following TSA. In the setting of increasing TSA utilization, preoperative patient counseling on cannabis cessation before TSA may be beneficial for postoperative outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151521"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037650","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}