Seminars in Arthroplasty最新文献

{"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}

{"title":"Analysis of mechanical factors related to scapular notching and medial scapular bone spurs with reverse total shoulder arthroplasty and the reduction of their appearance with inferior glenosphere offset","authors":"Paul J. Pottanat MD,&nbsp;Robert Reis BS,&nbsp;Chase Walton MS,&nbsp;Nikhil Vallabhaneni BS,&nbsp;Megan E. Welsh BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC,&nbsp;Josef K. Eichinger MD","doi":"10.1016/j.sart.2025.151523","DOIUrl":"10.1016/j.sart.2025.151523","url":null,"abstract":"<div><h3>Background</h3><div>Scapular notching and bone spur formation on the inferior scapular neck is a common radiographic finding following reverse total shoulder arthroplasty (rTSA). The purpose of the current study is to (1) determine the time point these radiographic findings develop in the postoperative period and (2) determine the effect of inferior glenoid offset on the formation of notching and bone spurs following rTSA.</div></div><div><h3>Methods</h3><div>A shoulder arthroplasty registry with prospectively collected data was queried to identify patients who underwent rTSA using the Exatech Equinoxe implant at an academic medical center between June 2017 and June 2022. Postoperative radiographs were analyzed for the presence of scapular notching, scapular bone spurs, prosthetic loosening, periprosthetic fracture, and hardware failure. Bone spurs were defined as bone formation medial to the lateral border of the scapula and in continuity with the scapular neck which were not present on preoperative radiographs.</div></div><div><h3>Results</h3><div>In a cohort of 185 rTSA patients, radiographic analysis demonstrated that both scapular notching and medial scapular bone spurs predominantly developed early in the postoperative period, with most changes evident between 3 months and 6 months. Binary logistic regression demonstrated that increased inferior glenosphere offset significantly reduced the risk of scapular bone spurs (odds ratio = 0.79; 95% confidence interval: 0.70-0.88, <em>P</em> &lt; .001) and notching (odds ratio = 0.95, 95% confidence interval: 0.84-1.08 <em>P</em> &lt; .001), with offsets of ∼8.2 mm and ∼9.6 mm predicted less than 10% probability, respectively. Cross-lagged analysis showed a strong early correlation between bone spurs and notching (r = 0.876, R² = 0.767) and that early bone spur progression predicted subsequent increases in notch severity.</div></div><div><h3>Conclusion</h3><div>Early postoperative development of medial scapular bone spurs is predictive of subsequent scapular notching, which indicates a common pathomechanical process of engagement of the humeral component and medial scapula for both types of radiographic findings after rTSA. Increased inferior glenosphere positioning protects against both notching and bone spur formation.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151523"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977805","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":"Effect of race and socioeconomic status on the attainment of substantial clinical benefit following total shoulder arthroplasty","authors":"Jakob M. Miller BS,&nbsp;Sophia A. Sitsis BS,&nbsp;Robert T. Henke BS,&nbsp;Maxwell A. Northrop BS,&nbsp;Alexander C. Dippre BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2025.151522","DOIUrl":"10.1016/j.sart.2025.151522","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is a procedure designed to improve mobility and alleviate pain due to degenerative conditions, and rates are expected to grow significantly in the coming years as the population ages. Previous studies provide ample evidence that factors such as race, income status, and gender influence utilization and outcomes following TSA. However, these studies fail to assess objective achievement of substantial clinical benefit (SCB) using verified outcome measures or whether patients report achievement of SCB. The purpose of this study is to identify whether race and socioeconomic status (SES) impact the attainment of SCB in patients undergoing primary TSA at a minimum follow-up of two years.</div></div><div><h3>Methods</h3><div>A total of 625 patients who underwent primary TSA with a minimum 2-year follow-up (mean, 4 years) at our institution from 2013 to 2023 were selected for analysis. Variables of interest obtained for each patient include age, sex, laterality, body mass index, race, area deprivation index decile, American Shoulder and Elbow Surgeons (ASES) scores, and self-reported patient satisfaction following TSA. Analysis of categorical variables was achieved using chi-squared tests, while continuous variables were examined using t-tests and one-way analysis of variance. Post hoc Tukey honest significant difference tests were used in the event of a significant result. Using the achievement of SCB as an outcome variable, multivariate logistic association models were created to adjust for confounding variables.</div></div><div><h3>Results</h3><div>Black race was found to be negatively associated with the achievement of SCB (odds ratio = 0.444, <em>P</em> = .018). Income category was not found to be associated with SCB attainment (<em>P</em> = .173). Preoperative ASES scores were found to be significantly lower for Black patients compared to White patients (36.40 vs. 24.48, <em>P</em> &lt; .001). Preoperative ASES scores were found to be significantly lower for the lowest income quartile compared to the 2 highest income quartiles (25.78 vs. 36.79 and 40.50, <em>P</em> &lt; .001). ASES score improvement was found to be significantly higher in the lowest quartile compared to the top quartile of earners (57.48 vs. 45.76, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Black race was significantly associated with decreased attainment of SCB, while income status did not significantly affect SCB attainment. Despite lower preoperative ASES scores, Black and low SES patients showed similar ASES score improvements on average compared to White and high SES patients. These results highlight persistent disparities in health care access but suggest that low preoperative shoulder function does not preclude patients from improving, although they achieve SCB to a lesser degree.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151522"},"PeriodicalIF":0.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926409","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":"Patients 60 years old or younger have an increased risk of complications following reverse total shoulder arthroplasty: a propensity-score matched analysis","authors":"Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Alexander E. White MD ,&nbsp;Aakash K. Shah BA ,&nbsp;Samuel A. Taylor MD ,&nbsp;John M. Apostolakos MD, MPH","doi":"10.1016/j.sart.2025.151519","DOIUrl":"10.1016/j.sart.2025.151519","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) continues to be performed at increasing rates in younger patients. Further investigation is needed to further define the complication and risk profile for this younger patient population.</div></div><div><h3>Methods</h3><div>The TriNetX database was utilized to perform a retrospective analysis comparing younger (≤60 years) and older (&gt;60 years) patients undergoing rTSA. Patients were matched 1:1 using propensity scores to balance demographics and comorbidities. Outcomes assessed included 1-year, 2-year, and 5-year postoperative complications and revision rates. The Bonferroni adjusted significance threshold was set at <em>P</em> = .0166.</div></div><div><h3>Results</h3><div>At 1 year, younger patients experienced a significantly higher rate of recurrent dislocation (5.8% vs. 3.1%, risk ratio [RR] = 1.9, 95% confidence interval [CI] 1.3–2.7, <em>P</em> = .001), with no significant differences in periprosthetic joint infection (PJI; <em>P</em> = .040) or revision surgery (<em>P</em> = .033). At 2 years, recurrent dislocation remained higher in the younger cohort (6.4% vs. 3.8%, RR = 1.7, 95% CI 1.2–2.4, <em>P</em> = .003), while PJI (<em>P</em> = .107) and revision surgery (<em>P</em> = .025) rates showed no significant differences. At 5 years, both recurrent dislocation (8.9% vs. 5.8%, RR = 1.5, 95% CI 1.2–2.0, <em>P</em> = .003) and revision surgery (7.2% vs. 4.7%, RR = 1.5, 95% CI 1.1–2.1, <em>P</em> = .008) remained significantly higher in younger patients, whereas PJI rates were not significantly different (<em>P</em> = .075).</div></div><div><h3>Conclusion</h3><div>Patients aged 60 years and undergoing rTSA demonstrated significantly higher rates of recurrent dislocation and revision surgery compared to older patients. These findings suggest that younger patients maybe at greater risk of postoperative complications after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151519"},"PeriodicalIF":0.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926408","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":"Does subscapularis tendon repair during primary reverse total shoulder replacement improve shoulder stability or functional outcomes: a systematic review and meta-analysis","authors":"Mohamed Elbeshbeshy MBChB,&nbsp;Rahel Rashid MBChB,&nbsp;Zaid Hashim MBBS,&nbsp;Abdaal Munir MBBS,&nbsp;Israa Kadhmawi MBChB,&nbsp;Conor Magee MBChB, MD,&nbsp;David Hawkes MBChB","doi":"10.1016/j.sart.2025.151520","DOIUrl":"10.1016/j.sart.2025.151520","url":null,"abstract":"<div><h3>Background</h3><div>The role of subscapularis tendon repair (STR) in reverse total shoulder arthroplasty (RTSA) continues to be debated. Proponents highlight the benefits as enhanced shoulder stability, greater internal rotation, and improved functional outcomes. Critics however argue it may limit external rotation and increase revision and complication rates. The aim of this review was to evaluate the impact of STR on shoulder stability and clinical outcomes in the context of primary RTSA.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases was performed to identify studies comparing outcomes between patients undergoing primary RTSA with STR and those with no STR (nSTR). The primary outcome was shoulder instability. Secondary outcomes included functional scores (American Shoulder and Elbow Surgeons score, Constant-Murley Score, and visual analog scale), range of motion, revision rate, and complications. Meta-analysis was performed using a random-effects model, and heterogeneity was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>A total of 19 studies met the inclusion criteria. One study had a critical risk of bias leading to its exclusion from the meta-analysis, resulting in the inclusion of the remaining 18 studies with 8,231 patients. STR was associated with a significantly lower risk of postoperative shoulder instability (RR 0.47, 95% confidence interval [CI] 0.28-0.81, I2 = 0%, <em>P</em> = .006), higher American Shoulder and Elbow Surgeons scores (mean difference = 3.47, 95% CI: 1.84-5.10, <em>P</em> &lt; .0001), Constant-Murley Score (mean difference = 2.43, 95% CI: 0.66-4.20, <em>P</em> = .006), and internal rotation scores (standardized mean difference = 0.46, 95% CI: 0.28-0.63, <em>P</em> = .0003). No significant differences were observed in visual analog scale scores, external rotation, revision rates, or overall complication rates between groups. Heterogeneity was accounted for by implementing random-effects models.</div></div><div><h3>Conclusion</h3><div>STR should be attempted during RTSA if feasible, as it potentially improves shoulder stability. However, the impact of STR on clinically-significant functional outcomes, range of motion, pain level, revision rates, and complications remains inconclusive. Further high-quality randomized controlled trials are needed to validate these findings. Acknowledging that the feasibility of STR likely reflects favorable intrinsic patient and pathology characteristics, further high-quality randomized controlled trials are needed to validate these findings.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151520"},"PeriodicalIF":0.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885143","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":"Shoulder arthroplasty in patients with prior hip, knee, or shoulder periprosthetic joint infection: a safe option?","authors":"Daniel E. Goltz MD, MBA,&nbsp;Miguel Fiandeiro BA,&nbsp;Ryan M. Cox MD,&nbsp;Ryan Lopez MD,&nbsp;Nabil Mehta MD,&nbsp;Jie J. Yao MD,&nbsp;Thema Nicholson MS,&nbsp;Mark D. Lazarus MD,&nbsp;Surena Namdari MD, MSc","doi":"10.1016/j.sart.2025.151518","DOIUrl":"10.1016/j.sart.2025.151518","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) following anatomic or reverse total shoulder arthroplasty (aTSA, rTSA) is a fortunately rare but devastating complication. Controversy exists regarding both prevention and treatment. Given its severity to the patient and cost to the system, minimizing its risk remains a priority. Some patients may be seen for consideration of shoulder arthroplasty who have previously been treated for PJI of the other shoulder or lower extremity (ie, hip or knee). However, the effect this clinical history has on the likelihood of subsequent PJI in the primary setting remains unknown. The purpose of this study is to understand whether this history poses increased risk of PJI following aTSA or rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed involving all patients who underwent aTSA or rTSA between May 2011 and September 2023 at a single institution, as well as any patients who experienced a PJI of a total hip or knee arthroplasty between April 1999 and December 2019. Patients with a shoulder, hip, or knee PJI history who subsequently underwent a primary shoulder arthroplasty comprised the study cohort. The clinical course of these patients was then studied for any subsequent PJI.</div></div><div><h3>Results</h3><div>Institutional databases of over 1,000 lower extremity PJI cases and over 100 definite or probable shoulder arthroplasty PJI cases were cross-referenced with over 14,000 available shoulder arthroplasty cases extracted from the electronic medical record. Of these, 16 primary and 2 revision cases in 13 patients were identified that involved an aTSA (N = 4) or rTSA (N = 14) following a prior upper (N = 2) or lower (N = 16) extremity PJI. Median follow-up of all patients was 4.5 years, with 13 patients having a minimum follow-up of 2 years. These cases were performed a median of 3.9 years following treatment of their prior PJI, which most often involved <em>Staphylococcus</em> species (66.6%). No patients experienced a PJI of their shoulder arthroplasty at final follow-up, with mean (standard deviation) American Shoulder Elbow Surgeons scores of 83.0 (9.9). One patient sustained a periprosthetic fracture postoperative day 1 requiring revision, and one patient was revised at 3 weeks for instability.</div></div><div><h3>Discussion</h3><div>A history of prior total hip, knee, or shoulder arthroplasty PJI did not result in the infection of any subsequent primary aTSA or rTSA cases at a single high-volume institution, providing some reassurance as part of the preoperative risk stratification process.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151518"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841502","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":"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 ,&nbsp;Spencer M. Lee-Rey BA ,&nbsp;Anthony Finocchiaro BS ,&nbsp;Alyssa D. Althoff MD ,&nbsp;Hassan Al-Naimi BS ,&nbsp;Michael C. Fu MD, MHS ,&nbsp;Samuel A. Taylor MD ,&nbsp;Joshua S. Dines MD ,&nbsp;Gabriella E. Ode MD ,&nbsp;David M. Dines MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Christopher M. Brusalis MD","doi":"10.1016/j.sart.2025.151517","DOIUrl":"10.1016/j.sart.2025.151517","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 (&lt;50 miles) or long-distance (&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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 (&lt;em&gt;P&lt;/em&gt; = .01) and were more likely to identify as White (&lt;em&gt;P&lt;/em&gt; = .01). Preoperative expectations scores (Hospital for Special Surgery Expectation Surveys) among aTSA patients did not differ significantly between cohorts (local: 74.87 ± 15.75, &lt;em&gt;n&lt;/em&gt; = 737; long-distance: 77.64 ± 14.70, &lt;em&gt;n&lt;/em&gt; = 148; &lt;em&gt;P&lt;/em&gt; = .067). Functional outcomes and satisfaction improved regardless of travel distance (&lt;em&gt;P&lt;/em&gt; &gt; .05). In the rTSA cohort, multivariable regression analysis revealed that travel distance was not a significant predictor of higher preoperative patient expectations (&lt;em&gt;P&lt;/em&gt; &lt; .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 (&lt;em&gt;P&lt;/em&gt; &gt; .05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;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}

{"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 ,&nbsp;Alejandro M. Holle BS ,&nbsp;Cara Lai MD ,&nbsp;Brian Miller MD ,&nbsp;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> &lt; .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> &lt; .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}

{"title":"Predictors of 90-day emergency department utilization after shoulder arthroplasty: a retrospective cohort study","authors":"Carter D. Bernal MS ,&nbsp;Frank Sierra BS ,&nbsp;Andres Ramos BS ,&nbsp;Shannon Tse BMBS ,&nbsp;David Dallas-Orr MD, MBA, MTM ,&nbsp;Daniel C. Santana MD, MS ,&nbsp;Derek Bond MD ,&nbsp;James Van Den Bogaerde MD ,&nbsp;Robert M. Szabo MD, MPH ,&nbsp;Ryan D. Freshman MD ,&nbsp;Mariano E. Menendez MD ,&nbsp;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> &lt; .001]) and had a greater degree of pain preoperatively (visual analog scale pain score of 5.64 vs. 4 [<em>P</em> &lt; .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}