Anatomic total shoulder arthroplasty is one of the recommended surgical treatments for severe glenohumeral osteoarthritis, providing good pain relief and function. Aseptic loosening of the glenoid component, however, is a major cause for revision. Hybrid components have been introduced, combining traditional cemented fixation with porous titanium bone ingrowth to improve fixation. The purpose of this study was to report our midterm to longterm experience using such a component, including clinical outcomes and implant survival.
Methods
We reviewed all patients who were operated for primary osteoarthritis during the period 2011-19, leaving a minimum of 2-year follow-up. The severity of the osteoarthritis was graded using Samilson-Prieto score, while glenoid morphology was graded using the modified Walch classification. Clinical outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index, EQ-5D-5L, and Constant-Murley score. Postoperative radiographs were analyzed for radiolucent lines. Patient records were studied for complications including revisions. Supplementary data for revision and outcome were obtained from the Danish Shoulder Arthroplasty Registry. Kaplan-Meier estimates for implant survival were calculated.
Results
A total of 256 arthroplasties in 224 patients were included (mean age: 69 years ± 9 years, 149 females). 81% of cases were graded radiographically as severe osteoarthritis, according to Samilson-Prieto. Walch type B1 was most commonly followed by B2 (29% and 28% respectively). The mean follow-up time was 49 months (range 24-127). The response rate for patient reported outcomes was 91%. The median WOOS index was 94% (81%-99%), the median EQ-5D-5L was 0.87 (0.69-0.95), and the mean Constant-Murley score was 75 (SD 17.7). 13 cases (6%) had a WOOS index below 50%. 8.2% had complications related to surgery. A radiolucent line had developed around the central post in six cases and at the bone-cement interface in three cases at follow-up. Six cases had been revised (2.3%); three due to aseptic loosening of the glenoid. The 10-year survival estimate was 95.6 % (95% CI: 87.9%-98.5%).
Conclusion
Anatomic total shoulder arthroplasty with hybrid glenoid fixation provides excellent clinical outcome with a low complication rate in patients, with primary glenohumeral osteoarthritis. The 10-year survival rate is high and comparable to that reported for the best- performing all-polyethylene components. Longer observation is needed to see if hybrid fixation will outperform standard all-cemented components.
{"title":"Anatomic total shoulder arthroplasty using hybrid glenoid fixation with a porous-coated titanium post. Two- to ten-year follow-up of 256 cases with primary glenohumeral osteoarthritis","authors":"Adriano Axel Ceccotti MD , Mikkel Toettrup MD, PhD , Anica Morch MD , Hans-Christen Husum MD , Steen L. Jensen MD, PhD","doi":"10.1053/j.sart.2024.06.006","DOIUrl":"10.1053/j.sart.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty is one of the recommended surgical treatments for severe glenohumeral osteoarthritis, providing good pain relief and function. Aseptic loosening of the glenoid component, however, is a major cause for revision. Hybrid components have been introduced, combining traditional cemented fixation with porous titanium bone ingrowth to improve fixation. The purpose of this study was to report our midterm to longterm experience using such a component, including clinical outcomes and implant survival.</div></div><div><h3>Methods</h3><div>We reviewed all patients who were operated for primary osteoarthritis during the period 2011-19, leaving a minimum of 2-year follow-up. The severity of the osteoarthritis was graded using Samilson-Prieto score, while glenoid morphology was graded using the modified Walch classification. Clinical outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index, EQ-5D-5L, and Constant-Murley score. Postoperative radiographs were analyzed for radiolucent lines. Patient records were studied for complications including revisions. Supplementary data for revision and outcome were obtained from the Danish Shoulder Arthroplasty Registry. Kaplan-Meier estimates for implant survival were calculated.</div></div><div><h3>Results</h3><div>A total of 256 arthroplasties in 224 patients were included (mean age: 69 years ± 9 years, 149 females). 81% of cases were graded radiographically as severe osteoarthritis, according to Samilson-Prieto. Walch type B1 was most commonly followed by B2 (29% and 28% respectively). The mean follow-up time was 49 months (range 24-127). The response rate for patient reported outcomes was 91%. The median WOOS index was 94% (81%-99%), the median EQ-5D-5L was 0.87 (0.69-0.95), and the mean Constant-Murley score was 75 (SD 17.7). 13 cases (6%) had a WOOS index below 50%. 8.2% had complications related to surgery. A radiolucent line had developed around the central post in six cases and at the bone-cement interface in three cases at follow-up. Six cases had been revised (2.3%); three due to aseptic loosening of the glenoid. The 10-year survival estimate was 95.6 % (95% CI: 87.9%-98.5%).</div></div><div><h3>Conclusion</h3><div>Anatomic total shoulder arthroplasty with hybrid glenoid fixation provides excellent clinical outcome with a low complication rate in patients, with primary glenohumeral osteoarthritis. The 10-year survival rate is high and comparable to that reported for the best- performing all-polyethylene components. Longer observation is needed to see if hybrid fixation will outperform standard all-cemented components.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 867-876"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.sart.2024.07.003
Isadora D. Guarino MD, MEng , Peter J. Shaughnessy MD , Jacob S. Torrey MD , John-Erik Bell MD, MS , Douglas W. Van Citters PhD
Background
Glenoid component loosening is the most common cause of anatomic total shoulder arthroplasty failure, and osteolysis is a common intraoperative and radiographic finding associated with these failed arthroplasties. While preclinical testing can estimate failure mode and wear rates in the laboratory, there is limited in vivo data measuring polyethylene wear rate and location.
Methods
Using an institutional review board–approved total joint arthroplasty retrieval collection, 56 cemented all-polyethylene glenoid components from eleven different manufacturers were analyzed for in vivo dimensional change. We used the differential thickness measurement between the anteroposterior and superoinferior axes of each radially symmetrical implant to determine the dimensional change along that axis. A physiologic wear vector was determined for each retrieved device.
Results
The implants had a median dimensional change of 0.13 mm/year (range 0.01-1.01mm/year) and the 25th and 75th percentiles were 0.060 and 0.22 mm/year, respectively. The average time to revision of devices with <0.1mm/year of wear was 140.9 months, while the averages for devices between 0.1-0.2mm/year and ≥0.2mm/year were 80.7 and 54.0 months, respectively. Devices with ≥0.2mm/year of wear had significantly shorter time to revision than those with <0.1mm/year (P = .0006). The devices had a similar material loss distribution in both superior-inferior and anterior-posterior directions, with 29 (52%) devices having a greater material loss in the superior-inferior distribution and the remaining 27 (48%) devices in the anterior-posterior axis. The physiologic wear vector had a mean of 47.3 degrees, with a relatively even distribution across all angles, suggesting that glenoid component loosening can occur along multiple axes.
Conclusion
We conclude that polyethylene wear is a contributing factor for early failure of cemented all-polyethylene glenoid implants and that anatomic total shoulder arthroplasty may benefit from advances in polyethylene processing. We also suggest that in vitro testing of new polymers and designs should incorporate motion vectors beyond the traditional IS rocking horse test.
{"title":"Rate of polyethylene wear correlates with earlier glenoid implant failure in anatomic total shoulder arthroplasty with cemented all-polyethylene glenoid components","authors":"Isadora D. Guarino MD, MEng , Peter J. Shaughnessy MD , Jacob S. Torrey MD , John-Erik Bell MD, MS , Douglas W. Van Citters PhD","doi":"10.1053/j.sart.2024.07.003","DOIUrl":"10.1053/j.sart.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid component loosening is the most common cause of anatomic total shoulder arthroplasty failure, and osteolysis is a common intraoperative and radiographic finding associated with these failed arthroplasties. While preclinical testing can estimate failure mode and wear rates in the laboratory, there is limited in vivo data measuring polyethylene wear rate and location.</div></div><div><h3>Methods</h3><div>Using an institutional review board–approved total joint arthroplasty retrieval collection, 56 cemented all-polyethylene glenoid components from eleven different manufacturers were analyzed for in vivo dimensional change. We used the differential thickness measurement between the anteroposterior and superoinferior axes of each radially symmetrical implant to determine the dimensional change along that axis. A physiologic wear vector was determined for each retrieved device.</div></div><div><h3>Results</h3><div>The implants had a median dimensional change of 0.13 mm/year (range 0.01-1.01mm/year) and the 25<sup>th</sup> and 75<sup>th</sup> percentiles were 0.060 and 0.22 mm/year, respectively. The average time to revision of devices with <0.1mm/year of wear was 140.9 months, while the averages for devices between 0.1-0.2mm/year and ≥0.2mm/year were 80.7 and 54.0 months, respectively. Devices with ≥0.2mm/year of wear had significantly shorter time to revision than those with <0.1mm/year (<em>P</em> = .0006). The devices had a similar material loss distribution in both superior-inferior and anterior-posterior directions, with 29 (52%) devices having a greater material loss in the superior-inferior distribution and the remaining 27 (48%) devices in the anterior-posterior axis. The physiologic wear vector had a mean of 47.3 degrees, with a relatively even distribution across all angles, suggesting that glenoid component loosening can occur along multiple axes.</div></div><div><h3>Conclusion</h3><div>We conclude that polyethylene wear is a contributing factor for early failure of cemented all-polyethylene glenoid implants and that anatomic total shoulder arthroplasty may benefit from advances in polyethylene processing. We also suggest that in vitro testing of new polymers and designs should incorporate motion vectors beyond the traditional IS rocking horse test.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 893-899"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840170","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 : 2024-11-29DOI: 10.1053/j.sart.2024.10.003
Oscar Covarrubias MD , Brandon Portnoff MD , Keiko Amano MD , Vadim Molla MD , Andrew Green MD
Background
Glenoid component loosening is a common cause of late failure after anatomic total shoulder arthroplasty (aTSA) and revision can be challenging due to glenoid bone loss. Revision to reverse shoulder arthroplasty requiring glenoid bone graft is associated with relatively high failure rates. Revision to humeral hemiarthroplasty (HHA) is an alternative. The purpose of this study was to evaluate the outcomes of revision of failed aTSA, with severe glenoid bone loss and intact rotator cuff to HHA.
Methods
This was a retrospective study of 18 patients (12 males) with failed aTSA, intact rotator cuff, and severe glenoid bone loss who were revised to HHA at a mean age of 68.9 ± 9.2 years and 9.0 ± 4.1 years after index aTSA. Mean follow-up was 7.6 ± 5.7 years. Glenoid defects were uncontained in 6 (33%). Glenoid bone grafting was performed in 11 (61%). A larger humeral head was used in 15 (83%) cases. Outcomes were assessed with the Simple Shoulder Test (SST), VAS pain, VAS quality of life (QoL), and shoulder range of motion. Plain radiographs were analyzed.
Results
There were significant improvements in SST (P = .005) and VAS pain (P < .001). Mean active forward elevation improved from 106 ± 36° to 120° ± 21° (P = .062). MCID for SST was met in 7 (39%) and VAS pain in 11 (61%). At final follow-up, 11 patients (61%) were satisfied with their current symptoms, 2 (11%) rated their satisfaction as neutral, and 5 (28%) were dissatisfied. There was progressive humeral medialization in 8 that was not significantly associated with the use of glenoid bone grafting (P = .912). Greater humeral medialization was strongly correlated with less improvement in SST (ρ = 0.68) and VAS QoL (ρ = −0.64). Seven patients had ≥ 2 positive intraoperative cultures, all Cutebacterium acnes. Three patients (17%) underwent subsequent revision to treat persistent pain and dysfunction; 1 to HHA, 2 to reverse shoulder arthroplasty.
Conclusion
Revision of failed aTSA with severe glenoid bone loss and functional rotator cuff to HHA can provide improved pain and patient reported outcome with low complication and re-revision rates and should be considered in selected cases.
{"title":"Conversion of failed anatomic total shoulder replacement with severe glenoid bone defect to humeral hemiarthroplasty","authors":"Oscar Covarrubias MD , Brandon Portnoff MD , Keiko Amano MD , Vadim Molla MD , Andrew Green MD","doi":"10.1053/j.sart.2024.10.003","DOIUrl":"10.1053/j.sart.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid component loosening is a common cause of late failure after anatomic total shoulder arthroplasty (aTSA) and revision can be challenging due to glenoid bone loss. Revision to reverse shoulder arthroplasty requiring glenoid bone graft is associated with relatively high failure rates. Revision to humeral hemiarthroplasty (HHA) is an alternative. The purpose of this study was to evaluate the outcomes of revision of failed aTSA, with severe glenoid bone loss and intact rotator cuff to HHA.</div></div><div><h3>Methods</h3><div>This was a retrospective study of 18 patients (12 males) with failed aTSA, intact rotator cuff, and severe glenoid bone loss who were revised to HHA at a mean age of 68.9 ± 9.2 years and 9.0 ± 4.1 years after index aTSA. Mean follow-up was 7.6 ± 5.7 years. Glenoid defects were uncontained in 6 (33%). Glenoid bone grafting was performed in 11 (61%). A larger humeral head was used in 15 (83%) cases. Outcomes were assessed with the Simple Shoulder Test (SST), VAS pain, VAS quality of life (QoL), and shoulder range of motion. Plain radiographs were analyzed.</div></div><div><h3>Results</h3><div>There were significant improvements in SST (<em>P</em> = .005) and VAS pain (<em>P</em> < .001). Mean active forward elevation improved from 106 ± 36° to 120° ± 21° (<em>P</em> = .062). MCID for SST was met in 7 (39%) and VAS pain in 11 (61%). At final follow-up, 11 patients (61%) were satisfied with their current symptoms, 2 (11%) rated their satisfaction as neutral, and 5 (28%) were dissatisfied. There was progressive humeral medialization in 8 that was not significantly associated with the use of glenoid bone grafting (<em>P</em> = .912). Greater humeral medialization was strongly correlated with less improvement in SST (ρ = 0.68) and VAS QoL (ρ = −0.64). Seven patients had ≥ 2 positive intraoperative cultures, all <em>Cutebacterium acnes</em>. Three patients (17%) underwent subsequent revision to treat persistent pain and dysfunction; 1 to HHA, 2 to reverse shoulder arthroplasty.</div></div><div><h3>Conclusion</h3><div>Revision of failed aTSA with severe glenoid bone loss and functional rotator cuff to HHA can provide improved pain and patient reported outcome with low complication and re-revision rates and should be considered in selected cases.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 106-115"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284738","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 : 2024-11-14DOI: 10.1053/j.sart.2024.10.001
Ankit Choudhury BA, Matthew Van Boxtel MD, Jessica Hanley MD
Background
Total Shoulder Arthroplasty (TSA) is a commonly performed orthopedic procedure for shoulder arthritis. Type II Diabetes Mellitus (T2DM) has been associated with negative postoperative outcomes following TSA. Glucagon-like peptide-1 receptor (GLP-1) agonists are increasingly popular drugs that have proven to be effective in the management of T2DM. To date, there is no study evaluating the complication profile following TSA of patients taking GLP-1 agonists.
Methods
A retrospective cohort analysis was conducted on patients from the TriNetX Database who underwent TSA between January 2018 and December 2023. All patients had a diagnosis of T2DM at the time of index procedure. Patients were stratified into two groups according to their GLP-1 agonist prescription status. Medical complications that occurred within 90 days and surgical complications that occurred within 2 years of index procedure were collected. A univariate logistic regression analysis was conducted to examine the initial connection between the active use of GLP-1 agonists and postoperative outcomes. Subsequently, an inverse propensity score-weighted binary logistic regression was used to adjust for potential biases.
Results
A total of 8254 patients met our inclusion criteria. The “non-GLP-1” and “GLP-1” groups included 7749 and 505 patients, respectively. The use of GLP-1 agonists did not incur increased risk of any medical or surgical complications following TSA. Our unadjusted analysis demonstrated that the use of GLP-1 agonists was significantly associated with lower odds of mortality within 90 days of surgery (OR 0.17, 95% CI 0.0043-0.99, P = .0435). GLP-1 agonist use was associated with decreased risk of mortality within 90 days when subjected to inverse propensity score-weighted analysis (OR 0.077, 95% CI 0.011-0.554, P = .011). The use of GLP-1 agonists was not a predictor for any other medical or surgical complications in inverse-propensity score weighted-analysis, although decreased risk of wound dehiscence approached significance (OR 0.256, 95% CI 0.061-1.074, P = .063).
Conclusion
Preoperative GLP-1 agonist use is associated with reduced 90-day mortality in T2DM patients undergoing TSA, without increasing other postoperative complications. These findings support the continued use of GLP-1 agonists in perioperative management to optimize surgical outcomes in this patient population.
{"title":"The impact of GLP-1 receptor agonists on postoperative outcomes following total shoulder arthroplasty","authors":"Ankit Choudhury BA, Matthew Van Boxtel MD, Jessica Hanley MD","doi":"10.1053/j.sart.2024.10.001","DOIUrl":"10.1053/j.sart.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Total Shoulder Arthroplasty (TSA) is a commonly performed orthopedic procedure for shoulder arthritis. Type II Diabetes Mellitus (T2DM) has been associated with negative postoperative outcomes following TSA. Glucagon-like peptide-1 receptor (GLP-1) agonists are increasingly popular drugs that have proven to be effective in the management of T2DM. To date, there is no study evaluating the complication profile following TSA of patients taking GLP-1 agonists.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted on patients from the TriNetX Database who underwent TSA between January 2018 and December 2023. All patients had a diagnosis of T2DM at the time of index procedure. Patients were stratified into two groups according to their GLP-1 agonist prescription status. Medical complications that occurred within 90 days and surgical complications that occurred within 2 years of index procedure were collected. A univariate logistic regression analysis was conducted to examine the initial connection between the active use of GLP-1 agonists and postoperative outcomes. Subsequently, an inverse propensity score-weighted binary logistic regression was used to adjust for potential biases.</div></div><div><h3>Results</h3><div>A total of 8254 patients met our inclusion criteria. The “non-GLP-1” and “GLP-1” groups included 7749 and 505 patients, respectively. The use of GLP-1 agonists did not incur increased risk of any medical or surgical complications following TSA. Our unadjusted analysis demonstrated that the use of GLP-1 agonists was significantly associated with lower odds of mortality within 90 days of surgery (OR 0.17, 95% CI 0.0043-0.99, <em>P</em> = .0435). GLP-1 agonist use was associated with decreased risk of mortality within 90 days when subjected to inverse propensity score-weighted analysis (OR 0.077, 95% CI 0.011-0.554, <em>P</em> = .011). The use of GLP-1 agonists was not a predictor for any other medical or surgical complications in inverse-propensity score weighted-analysis, although decreased risk of wound dehiscence approached significance (OR 0.256, 95% CI 0.061-1.074, <em>P</em> = .063).</div></div><div><h3>Conclusion</h3><div>Preoperative GLP-1 agonist use is associated with reduced 90-day mortality in T2DM patients undergoing TSA, without increasing other postoperative complications. These findings support the continued use of GLP-1 agonists in perioperative management to optimize surgical outcomes in this patient population.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 94-99"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284974","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 : 2024-11-13DOI: 10.1053/j.sart.2024.09.004
Robert A. Cecere BS, Michelle E. Kew MD, Joshua Mathew BS, Amy Lu BS, Gabrielle L. Dykhouse BS, Anna B. Williams BA, Michael Fu MD, Samuel Taylor MD, Joshua Dines MD, David Dines MD, Lawrence V. Gulotta MD
<div><h3>Background</h3><div>1-2% of patients who undergo anatomic and reverse total shoulder arthroplasty are diagnosed with a prosthetic joint infection (PJI), which requires revision surgery, prolonged recovery and rehabilitation, and antibiotic treatment. During the COVID-19 pandemic, anecdotal evidence suggested an increased rate of PJI among all patient populations. However, there have been no studies characterizing PJI incidence following shoulder arthroplasty during the COVID-19 pandemic. In the present study, we sought to evaluate the incidence of shoulder PJI during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Patients undergoing revision shoulder arthroplasty for PJI at an academic medical center between 2017 and 2021 were identified: patients before COVID-19 (2017-2019) and patients during COVID-19 (2020-2021). Patient demographics, laboratory data, history of COVID-19 infection and vaccination, antibiotic treatment, and final surgical treatment were collected. Patient-reported outcome measures (American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeric Evaluation, surgical Apgar score, Patient-Reported Outcome Measurement Information System (physical function, pain intensity, upper extremity, global 10), and Veterans RAND 12-item Health Survey or Medical Outcomes Study short-form health survey version 2) were collected. PJI incidence was calculated from a retrospective chart review, which identified patients with PJI as defined by the International Consensus Meeting on musculoskeletal infection in 2018 and who underwent revision surgery and antibiotic treatment. Incidence rate analysis and independent t-tests were conducted to compare the mean baseline patient-reported outcome measures. Descriptive analysis of the collected data included means and standard deviations for continuous variables and frequencies and percentages for discrete variables. Statistical significance was set at a <em>P</em> value < .05.</div></div><div><h3>Results</h3><div>46 patients were identified with 20 patients undergoing a revision surgery for a PJI during the pre-COVID-19 time interval and 26 during the COVID-19 time interval. 20% underwent single-stage revision (4 pre-COVID-19 and 5 during COVID-19), 50% underwent two-stage revision (10 pre-COVID-19 and 13 during COVID-19), and 30% underwent a debridement, antibiotics, and implant retention procedure (6 pre-COVID-19 and 8 during COVID-19). There was a significant increase in shoulder PJI infections between the pre-COVID-19 time interval and during COVID-19, with PJI incidence rates of 1.1% and 2.1%, respectively (<em>P</em> = .028). There was no significant difference in any outcome scores, microbes on aspiration, inflammatory markers, or duration of treatment between the two time intervals.</div></div><div><h3>Conclusion</h3><div>While this study does not show clear evidence to an underlying mechanism explaining the increased PJI incidence observed during the COVID-
{"title":"Incidence of shoulder prosthetic joint infection throughout the COVID-19 pandemic","authors":"Robert A. Cecere BS, Michelle E. Kew MD, Joshua Mathew BS, Amy Lu BS, Gabrielle L. Dykhouse BS, Anna B. Williams BA, Michael Fu MD, Samuel Taylor MD, Joshua Dines MD, David Dines MD, Lawrence V. Gulotta MD","doi":"10.1053/j.sart.2024.09.004","DOIUrl":"10.1053/j.sart.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>1-2% of patients who undergo anatomic and reverse total shoulder arthroplasty are diagnosed with a prosthetic joint infection (PJI), which requires revision surgery, prolonged recovery and rehabilitation, and antibiotic treatment. During the COVID-19 pandemic, anecdotal evidence suggested an increased rate of PJI among all patient populations. However, there have been no studies characterizing PJI incidence following shoulder arthroplasty during the COVID-19 pandemic. In the present study, we sought to evaluate the incidence of shoulder PJI during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Patients undergoing revision shoulder arthroplasty for PJI at an academic medical center between 2017 and 2021 were identified: patients before COVID-19 (2017-2019) and patients during COVID-19 (2020-2021). Patient demographics, laboratory data, history of COVID-19 infection and vaccination, antibiotic treatment, and final surgical treatment were collected. Patient-reported outcome measures (American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeric Evaluation, surgical Apgar score, Patient-Reported Outcome Measurement Information System (physical function, pain intensity, upper extremity, global 10), and Veterans RAND 12-item Health Survey or Medical Outcomes Study short-form health survey version 2) were collected. PJI incidence was calculated from a retrospective chart review, which identified patients with PJI as defined by the International Consensus Meeting on musculoskeletal infection in 2018 and who underwent revision surgery and antibiotic treatment. Incidence rate analysis and independent t-tests were conducted to compare the mean baseline patient-reported outcome measures. Descriptive analysis of the collected data included means and standard deviations for continuous variables and frequencies and percentages for discrete variables. Statistical significance was set at a <em>P</em> value < .05.</div></div><div><h3>Results</h3><div>46 patients were identified with 20 patients undergoing a revision surgery for a PJI during the pre-COVID-19 time interval and 26 during the COVID-19 time interval. 20% underwent single-stage revision (4 pre-COVID-19 and 5 during COVID-19), 50% underwent two-stage revision (10 pre-COVID-19 and 13 during COVID-19), and 30% underwent a debridement, antibiotics, and implant retention procedure (6 pre-COVID-19 and 8 during COVID-19). There was a significant increase in shoulder PJI infections between the pre-COVID-19 time interval and during COVID-19, with PJI incidence rates of 1.1% and 2.1%, respectively (<em>P</em> = .028). There was no significant difference in any outcome scores, microbes on aspiration, inflammatory markers, or duration of treatment between the two time intervals.</div></div><div><h3>Conclusion</h3><div>While this study does not show clear evidence to an underlying mechanism explaining the increased PJI incidence observed during the COVID-","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 77-82"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284964","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 : 2024-11-13DOI: 10.1053/j.sart.2024.09.005
Alejandro M. Holle BS , Sailesh V. Tummala MD , Jelena Pejic BA , Eugenia Lin MD , Steven J. Hattrup MD , John M. Tokish MD
Background
No prior study has separated the effects of smokeless tobacco from traditional cigarettes in patients undergoing anatomic total shoulder (aTSA) and reverse total shoulder arthroplasty (rTSA). Therefore, the purpose of this study was to evaluate the effects of smokeless tobacco on postoperative outcomes after aTSA and rTSA.
Methods
A retrospective cohort study utilizing a large insurance database was conducted. Patients undergoing primary TSA with a minimum two-year follow-up were included. Smokeless tobacco only users, cigarette only users, and nontobacco users were propensity score matched based on demographic variables and comorbidities. Postoperative medical complications and surgery-specific complications were compared among groups. Patient groups were further stratified by surgical technique: aTSA or rTSA. Multivariable logistic regressions were employed to account for confounding variables.
Results
Smokeless tobacco use was not associated with increased risk of complications after TSA compared to nonusers. Cigarette use was associated with an increased risk of pneumonia (OR: 1.20), wound dehiscence (OR: 1.39), emergency department (ED) visits (OR: 1.40), and readmissions (OR: 1.12) within 90 days as well as infection (OR: 1.21), aseptic loosening (OR: 1.28), dislocation (OR: 1.27), fracture (OR: 1.30), and revision surgery (OR: 1.19) within 2 years compared to nonusers. After separating by surgical technique, smokeless tobacco use, after aTSA was associated with fewer 90-day ED visits (OR: 0.52), while cigarette only use was associated with increased risk of rotator cuff tear (OR: 1.17) and fracture (OR: 1.88) within two years compared to nonusers. Compared to cigarette smokers, smokeless tobacco users had significantly decreased risk of ED visits (OR: 0.40) within 90 days and implant removal (OR: 0.13) within two years of surgery. For rTSA, smokeless tobacco use was not associated with increased risk of complications compared to nonuser controls; however, cigarette use was associated with an increased risk of ED utilization (OR: 1.33) within 90 days as well as aseptic loosening (OR: 1.32) and irrigation and debridement (OR: 1.37) within two years. Smokeless tobacco use, when compared to cigarette users, was associated with significantly fewer shoulder dislocations (OR: 0.27) within two years.
Conclusion
Smokeless tobacco use was associated with a lower risk of complications compared to cigarette users and no difference compared to nonusers after aTSA and rTSA. These findings suggest that while all tobacco use, including smokeless tobacco and cigarettes, is best avoided prior to surgery, the risks associated with smokeless tobacco use may be less severe than those linked to cigarette smoking after aTSA and rTSA.
{"title":"Smokeless tobacco use is associated with a lower risk of perioperative complications and revision surgery after anatomic and reverse total shoulder arthroplasty compared to cigarette smokers","authors":"Alejandro M. Holle BS , Sailesh V. Tummala MD , Jelena Pejic BA , Eugenia Lin MD , Steven J. Hattrup MD , John M. Tokish MD","doi":"10.1053/j.sart.2024.09.005","DOIUrl":"10.1053/j.sart.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>No prior study has separated the effects of smokeless tobacco from traditional cigarettes in patients undergoing anatomic total shoulder (aTSA) and reverse total shoulder arthroplasty (rTSA). Therefore, the purpose of this study was to evaluate the effects of smokeless tobacco on postoperative outcomes after aTSA and rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study utilizing a large insurance database was conducted. Patients undergoing primary TSA with a minimum two-year follow-up were included. Smokeless tobacco only users, cigarette only users, and nontobacco users were propensity score matched based on demographic variables and comorbidities. Postoperative medical complications and surgery-specific complications were compared among groups. Patient groups were further stratified by surgical technique: aTSA or rTSA. Multivariable logistic regressions were employed to account for confounding variables.</div></div><div><h3>Results</h3><div>Smokeless tobacco use was not associated with increased risk of complications after TSA compared to nonusers. Cigarette use was associated with an increased risk of pneumonia (OR: 1.20), wound dehiscence (OR: 1.39), emergency department (ED) visits (OR: 1.40), and readmissions (OR: 1.12) within 90 days as well as infection (OR: 1.21), aseptic loosening (OR: 1.28), dislocation (OR: 1.27), fracture (OR: 1.30), and revision surgery (OR: 1.19) within 2 years compared to nonusers. After separating by surgical technique, smokeless tobacco use, after aTSA was associated with fewer 90-day ED visits (OR: 0.52), while cigarette only use was associated with increased risk of rotator cuff tear (OR: 1.17) and fracture (OR: 1.88) within two years compared to nonusers. Compared to cigarette smokers, smokeless tobacco users had significantly decreased risk of ED visits (OR: 0.40) within 90 days and implant removal (OR: 0.13) within two years of surgery. For rTSA, smokeless tobacco use was not associated with increased risk of complications compared to nonuser controls; however, cigarette use was associated with an increased risk of ED utilization (OR: 1.33) within 90 days as well as aseptic loosening (OR: 1.32) and irrigation and debridement (OR: 1.37) within two years. Smokeless tobacco use, when compared to cigarette users, was associated with significantly fewer shoulder dislocations (OR: 0.27) within two years.</div></div><div><h3>Conclusion</h3><div>Smokeless tobacco use was associated with a lower risk of complications compared to cigarette users and no difference compared to nonusers after aTSA and rTSA. These findings suggest that while all tobacco use, including smokeless tobacco and cigarettes, is best avoided prior to surgery, the risks associated with smokeless tobacco use may be less severe than those linked to cigarette smoking after aTSA and rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 83-93"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284973","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 : 2024-09-27DOI: 10.1053/j.sart.2024.09.003
Joshua I. Mathew BS , Peter J. Chabot BA , Michelle E. Kew MD , Michael C. Fu MD , Samuel A. Taylor MD , Joshua S. Dines MD , David M. Dines MD , Lawrence V. Gulotta MD
Background
Patients who undergo total shoulder arthroplasty typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty.
Methods
Retrospective chart review was conducted for patients who underwent revision anatomic or reverse shoulder arthroplasty between January 2015 and May 2021 (N = 152). A cohort of patients who underwent primary shoulder arthroplasty in the same period was generated by matching 1:1 for implant type (anatomic/reverse), age, and surgery date. Demographic data, patient-reported outcomes, surgical details, surgical complications, and reoperations were collected for both cohorts (N = 304). Chi-square, t-test, Fisher’s exact test, and Mann-Whitney test were used as appropriate.
Results
The revision cohort had a significantly higher rate of surgical complications than the primary cohort (N = 58, 38.2% vs. N = 22, 14.5%; P < .0001). The distribution of complication types differed significantly between the primary and revision cohorts (P = .018). Revision patients reported less improvement in Single-Assessment Numeric Evaluation score from baseline to 2-year follow-up compared to primary patients (postoperative and preoperative scores 33.9 ± 35.9 vs. 52.3 ± 32.5; P = .036). Patients in the primary cohort who underwent a previous shoulder surgery before their shoulder arthroplasty were more likely to experience complications than those who did not (P < .001). The most common surgical complications in the revision cohort were persistent pain (N = 20) and periprosthetic joint infection (N = 10), while the most common complications in the primary cohort were persistent pain (N = 6) and instability (N = 4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision patients (120 ± 68 min) than primary patients (94 ± 31 min; P < .0001). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (P = .043).
Conclusion
Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent surgical complications and worse clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks.
{"title":"Complications after primary and revision shoulder arthroplasty: a matched cohort study","authors":"Joshua I. Mathew BS , Peter J. Chabot BA , Michelle E. Kew MD , Michael C. Fu MD , Samuel A. Taylor MD , Joshua S. Dines MD , David M. Dines MD , Lawrence V. Gulotta MD","doi":"10.1053/j.sart.2024.09.003","DOIUrl":"10.1053/j.sart.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo total shoulder arthroplasty typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>Retrospective chart review was conducted for patients who underwent revision anatomic or reverse shoulder arthroplasty between January 2015 and May 2021 (N = 152). A cohort of patients who underwent primary shoulder arthroplasty in the same period was generated by matching 1:1 for implant type (anatomic/reverse), age, and surgery date. Demographic data, patient-reported outcomes, surgical details, surgical complications, and reoperations were collected for both cohorts (N = 304). Chi-square, t-test, Fisher’s exact test, and Mann-Whitney test were used as appropriate.</div></div><div><h3>Results</h3><div>The revision cohort had a significantly higher rate of surgical complications than the primary cohort (N = 58, 38.2% vs. N = 22, 14.5%; <em>P</em> < .0001). The distribution of complication types differed significantly between the primary and revision cohorts (<em>P</em> = .018). Revision patients reported less improvement in Single-Assessment Numeric Evaluation score from baseline to 2-year follow-up compared to primary patients (postoperative and preoperative scores 33.9 ± 35.9 vs. 52.3 ± 32.5; <em>P</em> = .036). Patients in the primary cohort who underwent a previous shoulder surgery before their shoulder arthroplasty were more likely to experience complications than those who did not (<em>P</em> < .001). The most common surgical complications in the revision cohort were persistent pain (N = 20) and periprosthetic joint infection (N = 10), while the most common complications in the primary cohort were persistent pain (N = 6) and instability (N = 4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision patients (120 ± 68 min) than primary patients (94 ± 31 min; <em>P</em> < .0001). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (<em>P</em> = .043).</div></div><div><h3>Conclusion</h3><div>Patients undergoing revision shoulder arthroplasty are at an increased risk for subsequent surgical complications and worse clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 71-76"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284735","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 : 2024-09-27DOI: 10.1053/j.sart.2024.09.001
Suhasini Gupta BS , Brett D. Haislup MD , Alayna K. Vaughan MD , Ryan A. Hoffman MD , Anand M. Murthi MD
Background
The purpose of this study is to analyze the quality, accuracy, and readability of information provided by an artificial intelligence (AI) interface ChatGPT (OpenAI, San Francisco). We searched ChatGPT for commonly asked questions by patients regarding anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).
Methods
ChatGPT was used to answer 30 commonly asked questions by patients regarding aTSA and rTSA, inputted as “total shoulder replacement” and “reverse shoulder replacement”. These questions were categorized based on the Rothwell criteria into Fact, Policy, and Value. The answers generated were analyzed for quality, accuracy, and readability using the DISCERN scale, JAMA benchmark criteria, Flesch-Kincaid Reading Ease Score (FRES) and Grade Level (FKGL).
Results
For both rTSA and aTSA the DISCERN score for Fact questions was 57, Policy questions was 61, and for Value questions was 58 (all were all considered “good”). The JAMA benchmark criteria was 0, representing the lowest score for Fact, Policy, and Value questions for both rTSA and aTSA questions. The FRES score for the aTSA answers for Fact was 15.15, for Policy was 11.14, and for Value questions was 10.95. The FRES score for rTSA questions for Fact is 48.02, Policy is 12.51, and Value is 17.22. The FKGL for aTSA answer for Fact was 17.48, Policy was 17.72 and Value was 17.96. The FKGL for rTSA questions for Fact are 8.10, Policy is 17.27, and Value is 16.56.
Conclusion
Overall, the quality of answers provided by AI open model, ChatGPT was considered “good.” The information provided had lower reliability, and lack of information regarding funding and disclosures. Most of the information generated by ChatGPT was also found to have the readability of “academic level text”, while Fact related information on reverse shoulder arthroplasty was found to have the readability of 9th grade level, which may be too complex for most patients. Overall, these results indicate that ChatGPT can provide correct answers to questions about aTSA and rTSA, although we would caution patients from utilizing this resource due to the lack of citations and complexity of the output that ChatGPT provides. Importantly, all answers provided by AI suggested reaching out to physicians to get more accurate and personalized advise, to factor into the shared decisions making model.
{"title":"Accessing information provided via artificial intelligence regarding reverse and anatomic total shoulder arthroplasty","authors":"Suhasini Gupta BS , Brett D. Haislup MD , Alayna K. Vaughan MD , Ryan A. Hoffman MD , Anand M. Murthi MD","doi":"10.1053/j.sart.2024.09.001","DOIUrl":"10.1053/j.sart.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to analyze the quality, accuracy, and readability of information provided by an artificial intelligence (AI) interface ChatGPT (OpenAI, San Francisco). We searched ChatGPT for commonly asked questions by patients regarding anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>ChatGPT was used to answer 30 commonly asked questions by patients regarding aTSA and rTSA, inputted as “total shoulder replacement” and “reverse shoulder replacement”. These questions were categorized based on the Rothwell criteria into <em>Fact</em>, <em>Policy</em>, and <em>Value</em>. The answers generated were analyzed for quality, accuracy, and readability using the DISCERN scale, JAMA benchmark criteria, Flesch-Kincaid Reading Ease Score (FRES) and Grade Level (FKGL).</div></div><div><h3>Results</h3><div>For both rTSA and aTSA the DISCERN score for <em>Fact</em> questions was 57, <em>Policy</em> questions was 61, and for <em>Value</em> questions was 58 (all were all considered “good”). The JAMA benchmark criteria was 0, representing the lowest score for <em>Fact</em>, <em>Policy</em>, <em>and Value</em> questions for both rTSA and aTSA questions. The FRES score for the aTSA answers for <em>Fact</em> was 15.15, for <em>Policy</em> was 11.14, and for <em>Value</em> questions was 10.95. The FRES score for rTSA questions for <em>Fact</em> is 48.02, <em>Policy</em> is 12.51, and <em>Value</em> is 17.22. The FKGL for aTSA answer for <em>Fact</em> was 17.48, <em>Policy</em> was 17.72 and <em>Value</em> was 17.96. The FKGL for rTSA questions for <em>Fact</em> are 8.10, <em>Policy</em> is 17.27, and <em>Value</em> is 16.56.</div></div><div><h3>Conclusion</h3><div>Overall, the quality of answers provided by AI open model, ChatGPT was considered “good.” The information provided had lower reliability, and lack of information regarding funding and disclosures. Most of the information generated by ChatGPT was also found to have the readability of “academic level text”, while <em>Fact</em> related information on reverse shoulder arthroplasty was found to have the readability of 9th grade level, which may be too complex for most patients. Overall, these results indicate that ChatGPT can provide correct answers to questions about aTSA and rTSA, although we would caution patients from utilizing this resource due to the lack of citations and complexity of the output that ChatGPT provides. Importantly, all answers provided by AI suggested reaching out to physicians to get more accurate and personalized advise, to factor into the shared decisions making model.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 56-61"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284920","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 : 2024-09-26DOI: 10.1053/j.sart.2024.09.002
Mohamad K. Moussa MD, MSc, Maria Guillermina Bruchmann MD, Donald Tedah MD, Akil Prabhakar MD, Luis José Maria Suarez-Jimenez MD, Ahmad Nassar MD, Carlos Murillo-Nieto MD, Philippe Valenti MD
Background
To evaluates the impact of patient height (less than 160 cm and greater than 170 cm) on outcomes of lateralized reverse total shoulder arthroplasty (rTSA).
Method
This retrospective case–control study of 31 lateralized rTSA patients, with follow-ups ranging from 12 to 28 months, was divided into 2 groups: 14 short-stature (≤160 cm) and 17 taller (≥170 cm) patients. Preoperative planning utilized e-ORTHO templating software (FH Orthopaedics, Mulhouse, France), ensuring uniform lateralization shoulder angle and distalization shoulder angles across groups. Primary outcomes included range of motion (ROM), while secondary outcomes comprised Constant Score (absolute/ponderate), subjective shoulder value (SSV), and visual analog scale (VAS). Discrepancies in scores between groups were evaluated for clinical relevance against minimal clinically important difference benchmarks. Incidences of scapular notching were also recorded.
Results
All the clinical parameters analyzed were improved postoperatively in both groups (P < .05). No significant difference was observed in postoperative ROM, ponderate Constant, and VAS between groups (P > .05) except for forward elevation which was higher in the taller group (142.9 ± 27.6 compared to 163.5 ± 11.1 P = .018). For SSV, the taller group had higher postoperative SSV (P = .037). However, the difference was less than the minimal clinically important difference for SSV (−5.97 [95% confidence interval: −10.17 to 1.76], P = .01) and thus was considered not clinically significant. No scapular notching was detected in either group.
Conclusion
When planned positioning angles are respected (lateralization shoulder angle, distalization shoulder angle), the benefits of highly lateralized rTSA are consistent regardless of patient stature. Both groups had comparable results across ROM, ponderate Constant, and VAS except for forward elevation which was higher in the taller group.
{"title":"Clinical and radiological outcomes of a highly lateralized reverse shoulder arthroplasty in patients with a height of 160 cm or less versus a height of 170 cm or more","authors":"Mohamad K. Moussa MD, MSc, Maria Guillermina Bruchmann MD, Donald Tedah MD, Akil Prabhakar MD, Luis José Maria Suarez-Jimenez MD, Ahmad Nassar MD, Carlos Murillo-Nieto MD, Philippe Valenti MD","doi":"10.1053/j.sart.2024.09.002","DOIUrl":"10.1053/j.sart.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>To evaluates the impact of patient height (less than 160 cm and greater than 170 cm) on outcomes of lateralized reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Method</h3><div>This retrospective case–control study of 31 lateralized rTSA patients, with follow-ups ranging from 12 to 28 months, was divided into 2 groups: 14 short-stature (≤160 cm) and 17 taller (≥170 cm) patients. Preoperative planning utilized e-ORTHO templating software (FH Orthopaedics, Mulhouse, France), ensuring uniform lateralization shoulder angle and distalization shoulder angles across groups. Primary outcomes included range of motion (ROM), while secondary outcomes comprised Constant Score (absolute/ponderate), subjective shoulder value (SSV), and visual analog scale (VAS). Discrepancies in scores between groups were evaluated for clinical relevance against minimal clinically important difference benchmarks. Incidences of scapular notching were also recorded.</div></div><div><h3>Results</h3><div>All the clinical parameters analyzed were improved postoperatively in both groups (<em>P</em> < .05). No significant difference was observed in postoperative ROM, ponderate Constant, and VAS between groups (<em>P</em> > .05) except for forward elevation which was higher in the taller group (142.9 ± 27.6 compared to 163.5 ± 11.1 <em>P</em> = .018). For SSV, the taller group had higher postoperative SSV (<em>P</em> = .037). However, the difference was less than the minimal clinically important difference for SSV (−5.97 [95% confidence interval: −10.17 to 1.76], <em>P</em> = .01) and thus was considered not clinically significant. No scapular notching was detected in either group.</div></div><div><h3>Conclusion</h3><div>When planned positioning angles are respected (lateralization shoulder angle, distalization shoulder angle), the benefits of highly lateralized rTSA are consistent regardless of patient stature. Both groups had comparable results across ROM, ponderate Constant, and VAS except for forward elevation which was higher in the taller group.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 62-70"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284734","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 : 2024-09-23DOI: 10.1053/j.sart.2024.08.004
Kevin K. Chen MD, Chuheng Xing BS, James M. Gregory MD
Background
Lesser tuberosity osteotomy (LTO) in total shoulder arthroplasty (TSA) has a relatively high success rate owing to bone-to-bone healing and modern repair techniques. Failure of the LTO repair has been associated with poorer outcomes, decreased patient satisfaction, and the potential need for revision arthroplasty. Despite this, few studies closely examined outcomes for revision LTO repair in the setting of prior TSA.
Methods
A retrospective review of all TSAs performed by a single surgeon from 2016 until 2023 was performed to identify all cases with LTO failure who underwent acute revision LTO repair. Baseline characteristics, postoperative complications including infection, need for revision surgery, and time to revision surgery were collected and reported on all TSA patients. All patients were followed for a minimum of 1 year after their TSA and revision LTO fixation if required. Subgroup analysis was performed on the LTO revision cohort to evaluate for potential risk factors.
Results
A total of 166 patients underwent TSA with LTO. Of these, eight patients were diagnosed with an acute LTO failure at a mean of 5.7 weeks after surgery and underwent revision LTO fixation at a mean of 6.3 weeks after surgery. At a mean follow-up of 147.9 weeks (standard deviation: 90.3; range: 52.1-284.9), seven of eight patients (87.5%) demonstrated healing of their LTO and had no complaints, complications, or reoperations at the latest follow-up. One patient developed a periprosthetic infection requiring two-stage revision. No patients in the overall cohort underwent revision shoulder arthroplasty due to subscapularis failure.
Conclusion
Early identification of subscapularis failure is important to optimize outcomes of revision fixation. Use of LTO for subscapularis repair is beneficial by allowing early radiographic detection of subscapularis failure. Revision LTO repair can be successful when performed acutely and appears to minimize the need for revision shoulder arthroplasty due to subscapularis failure.
{"title":"Early diagnosis and revision repair of lesser tuberosity osteotomy failure after anatomic total shoulder arthroplasty","authors":"Kevin K. Chen MD, Chuheng Xing BS, James M. Gregory MD","doi":"10.1053/j.sart.2024.08.004","DOIUrl":"10.1053/j.sart.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Lesser tuberosity osteotomy (LTO) in total shoulder arthroplasty (TSA) has a relatively high success rate owing to bone-to-bone healing and modern repair techniques. Failure of the LTO repair has been associated with poorer outcomes, decreased patient satisfaction, and the potential need for revision arthroplasty. Despite this, few studies closely examined outcomes for revision LTO repair in the setting of prior TSA.</div></div><div><h3>Methods</h3><div>A retrospective review of all TSAs performed by a single surgeon from 2016 until 2023 was performed to identify all cases with LTO failure who underwent acute revision LTO repair. Baseline characteristics, postoperative complications including infection, need for revision surgery, and time to revision surgery were collected and reported on all TSA patients. All patients were followed for a minimum of 1 year after their TSA and revision LTO fixation if required. Subgroup analysis was performed on the LTO revision cohort to evaluate for potential risk factors.</div></div><div><h3>Results</h3><div>A total of 166 patients underwent TSA with LTO. Of these, eight patients were diagnosed with an acute LTO failure at a mean of 5.7 weeks after surgery and underwent revision LTO fixation at a mean of 6.3 weeks after surgery. At a mean follow-up of 147.9 weeks (standard deviation: 90.3; range: 52.1-284.9), seven of eight patients (87.5%) demonstrated healing of their LTO and had no complaints, complications, or reoperations at the latest follow-up. One patient developed a periprosthetic infection requiring two-stage revision. No patients in the overall cohort underwent revision shoulder arthroplasty due to subscapularis failure.</div></div><div><h3>Conclusion</h3><div>Early identification of subscapularis failure is important to optimize outcomes of revision fixation. Use of LTO for subscapularis repair is beneficial by allowing early radiographic detection of subscapularis failure. Revision LTO repair can be successful when performed acutely and appears to minimize the need for revision shoulder arthroplasty due to subscapularis failure.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 48-55"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284926","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号