Seminars in Arthroplasty最新文献_第4页

Trends in total shoulder arthroplasty utilization and implant pricing

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-09-23 DOI: 10.1053/j.sart.2024.08.003

Gabrielle Dykhouse BS , Anthony Finocchiaro BS , Carl M. Cirino MD , Ashwin Mahesh BS , Lawrence V. Gulotta MD , Joshua S. Dines MD , Michael C. Fu MD, MHS

Background

Total shoulder arthroplasty (TSA) is the third most common total joint replacement procedure in the United States, with high rates of success and cost-effectiveness. As indications continue to expand, anatomic TSA (aTSA), reverse shoulder arthroplasty (RSA), and hemiarthroplasty are available procedures for treating patients with varying end-stage shoulder pathologies. While previous studies have documented trends in overall costs and reimbursements in TSA, there is limited information regarding recent trends in implant utilization, pricing, and procedure type. Therefore, this study aimed to analyze trends in implant and technology utilization for TSA in the United States between 2013 and 2022 to inform decision-making and improve clinical best practices.

Methods

Utilization trends and average implant prices between 2013 and 2022 were extracted from Orthopedic Network News, the largest publicly available implant registry. All costs and prices were adjusted for inflation. Trends were analyzed using linear regressions.

Results

Averages and nationwide estimates for 2022 were based off 7339 shoulder cases from 117 US hospitals. RSA significantly increased from 40% in 2013 to 72% of all shoulder arthroplasties in 2022 (β = 4.18; P < .001), whereas aTSA significantly decreased from 43% to 20% (β = −0.34; P < .001), and hemiarthroplasty significantly decreased from 10% to 1% (β = −1.07; P < .001). Other types of procedures, such as revisions and shoulder resurfacings, constituted 7%. Anatomic constructs showed a rise in stemless humeral component usage from 2% in 2017 to 10% in 2022 (β = 1.4; P < .01). Financially, Medicare physician payment for shoulder surgeries witnessed significant decline from $1882 USD in 2017 to $1428 in 2023 (β = −73; P < .001). The inflation-adjusted cost of aTSA also decreased from $8055 in 2013 to $6223 in 2022 (β = −173.56; P < .01), and RSA from $12,207 to $8882 in 2022 (β = −318.31; P < .001).

Conclusion

Trends in primary TSA procedures feature a growing prevalence of RSA as compared to aTSA, in addition to a rise in stemless humeral implants within aTSA. As both Medicare physician reimbursements and implant prices continue to decrease, it is important for surgeons to consider the tradeoffs of different implant materials and patient-specific technology when performing such procedures.

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引用次数: 0

Perioperative outcomes using computer navigation in primary total shoulder arthroplasty

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-09-12 DOI: 10.1053/j.sart.2024.07.013

Melanie T. Bertolino BS , Alexander S. Guareschi MD , John W. Moore BS , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC

Introduction

The utilization of computer navigation to improve glenoid component placement in primary total shoulder arthroplasty (TSA) is becoming increasingly prevalent. However, there is a paucity of literature examining the perioperative outcomes and cost of this technology compared to standard instrumentation. The purpose of this study was to compare the perioperative complications and healthcare utilization between computer navigation and standard instrumentation in primary TSA.

Methods

The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients who underwent TSA with computer navigation (n = 752) were propensity score matched in a 1:3 proportion to patients who underwent TSA with standard instrumentation (n = 2256) for age, sex, smoking status, alcohol abuse, hypertension, diabetes mellitus, congestive heart failure, obesity, peripheral vascular disease, chronic kidney disease, chronic liver disease, and chronic lung disease. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative complications, and hospital utilization metrics between the 2 groups. Chi-square and student t-tests identified differences in categorical and continuous variables, respectively.

Results

Patients undergoing TSA with computer navigation exhibited lower rates of revision within 180 days (P < .001) and lower rates of certain postoperative medical and surgical complications, including acute renal failure (P = .006), urinary tract infection (P = .015), acute respiratory distress syndrome (P = .045), surgical site infection (P = .022), dislocation (P = .012), and prosthetic loosening (P = .032). Computer navigation patients had a higher cost of initial admission (P < .001) but were less likely to have extended hospital stays (P = .047), less likely to be discharged with home healthcare (P < .001), and more likely to be discharged routinely (P < .001).

Conclusion

TSA with computer navigation was associated with lower revision rates and reduced postoperative complications. Although greater initial costs were observed, decreased extended hospital stays and more routine discharges show promise for long-term cost efficiency. These findings underscore the advantages of computer navigation in TSA and should be considered by orthopedic surgeons when evaluating choice of instrumentation.

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引用次数: 0

Glenoid component cyclical failure decreases with increasing baseplate contact: a biomechanical study

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-09-10 DOI: 10.1053/j.sart.2024.08.002

Hafiz F. Kassam MD , Josiah Valk DO , Stephen Wiseman DO , Lucein N. Blaine BS , Ana Mata-Fink MD , Steven Tommasini PhD , Theodore A. Blaine MD

Background

Glenoid baseplate loosening remains a common mode of failure in reverse shoulder arthroplasty. One of the key factors to baseplate stability is theorized to be maximization of baseplate backside contact. The purpose of this biomechanical study is to investigate the role of varying degrees of backside bony glenoid support in component stability for reverse total shoulder arthroplasty.

Methods

Twenty synthetic scapular models were divided into 3 test groups of 5 scapulae with glenoid baseplate contacts of 40%, 60%, and 75%, and one control group with glenoid baseplate contact of 100%. Standardized application of a commercially available glenoid baseplate and glenosphere was performed. The scapulae were mounted on a linear bearing with a humeral component and polyethylene liner which were affixed to a biaxial servohydraulic fatigue testing system. Each specimen was loaded for 10,000 cycles or to failure, about a 55° arc along the glenosphere at a rate of 1 Hz as a 750 N compression load was applied. Failure was defined as fracture of the scapula with implant fixation compromise. Before and after loading, stability of the baseplate was assessed by quantifying the total motion between the model and the baseplate with digital calipers as a ramp load between 0 and 150 N was applied. Two-sample unpaired t-tests were performed with significance set at P < .05.

Results

Baseplate contacts of 40% (1623 ± 227, P = .0001), 60% (3299 ± 1170, P = .0001), and 75% (5615 ± 1587, P = .0077) demonstrated statistically significant decrease in the average number of cycles to failure in all cohorts compared to our control (8641 ± 1070). Cycles taken for initial cracks to progress to failure showed no significant differences; 40% contact (862 ± 452, P = .4751), 60% contact (1651 ± 996, P = .4318), 75% contact (2882 ± 1347, P = .0620), and 100% control (1166 ± 657). Baseplate contacts of 40% (6150.4 ± 444.0, P = .0006), 60% (4647.1 ± 552.3, P = .0072), and 75% (2927.8 ± 918.5, P = .2573) demonstrated increasing micromotion (pre-post cyclical loading) in all cohorts compared to our control (2074.7 ± 1164.6) with statistical significance at 40% and 60%.

Conclusion

These biomechanical tests demonstrate that decreasing glenoid baseplate backside contact leads to increased micromotion and fewer cycles to failure. This supports the surgical goal of achieving maximal glenoid baseplate backside contact, suggesting that decreased glenoid baseplate support could contribute to significant loosening.

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引用次数: 0

Nonspherical humeral arthroplasty increases internal rotation: a biomechanical comparison of the native humeral head to nonspherical and spherical humeral implants

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-09-10 DOI: 10.1053/j.sart.2024.07.014

Kyle Schoell MD , Victor Hung BS , Genevieve Fraipont BA , Michelle H. McGarry MS , G. Russell Huffman MD, MPH , Hafiz Kassam MD , Thay Q. Lee PhD

Background

Nonspherical humeral head implants more closely resemble native humeral anatomy than spherical components and may better replicate native shoulder range of motion (ROM) and kinematics. The purpose of this study was to compare shoulder ROM and kinematics of a commercially available nonspherical humeral head implant with the native humeral head and a height matched, custom manufactured spherical implant.

Methods

Six fresh frozen cadaveric shoulder specimens were used with a custom shoulder testing system. The native shoulder was tested in multiple positions under anatomic muscle loading. Each specimen was tested for ROM and glenohumeral joint kinematics by measuring the humeral head apex and humeral head center (HHC) translation per degree of rotation using a MicroScribe digitizer. Measurements were then repeated after implantation of a spherical and, subsequently, a nonspherical humeral head prothesis.

Results

The nonspherical implant had significantly more internal rotation (IR) compared to the spherical implant at 0° abduction (10.6 ± 6.2° more IR, P = .004, 95% confidence interval [CI]: −13.3, 34.5), 30° abduction (5.7 ± 2.8°, P = .009, 95% CI: −12.6, 24.0) and 60° abduction (6.8 ± 2.7°, P = .002, 95% CI: −8.3, 22.1) in the scapular plane, and 60° abduction (6.9 ± 2.0°, P = .031, 95% CI: −12, 25.6) in the coronal plane. The nonspherical implant had more IR than the native head at 60° of abduction in the scapular plane (7.0 ± 2.2° P = .002, 95% CI: −10.3, 24.3). The spherical head had less IR than the native head at 0° abduction (7.2 ± 4.8°, P = .031, 95% CI: 32.5, 18.1). There were no differences in humeral head apex translation per degree of rotation noted between the spherical implant or nonspherical implant and the native shoulder. The nonspherical head had less HHC translation than the native shoulder at 30° abduction in the forward flexion plane (P = .007); otherwise, there were no statistically significant differences in HHC translation between the native shoulder, the spherical head, and the nonspherical head. There was no significant difference observed between the average difference in anterior-posterior and superior-inferior radius of curvature of the nonspherical implants (2.0 ± 0.7 mm) and the native humeral heads (1.9 ± 1.3 mm) [P = .926].

Conclusion

The results of this biomechanical study suggest that the commercially available nonspherical humeral head has improved IR when compared to a custom, height controlled spherical implant and offers ROM and kinematics similar to the native humeral head in a cadaveric model.

{"title":"Nonspherical humeral arthroplasty increases internal rotation: a biomechanical comparison of the native humeral head to nonspherical and spherical humeral implants","authors":"Kyle Schoell MD , Victor Hung BS , Genevieve Fraipont BA , Michelle H. McGarry MS , G. Russell Huffman MD, MPH , Hafiz Kassam MD , Thay Q. Lee PhD","doi":"10.1053/j.sart.2024.07.014","DOIUrl":"10.1053/j.sart.2024.07.014","url":null,"abstract":"<div><h3>Background</h3><div>Nonspherical humeral head implants more closely resemble native humeral anatomy than spherical components and may better replicate native shoulder range of motion (ROM) and kinematics. The purpose of this study was to compare shoulder ROM and kinematics of a commercially available nonspherical humeral head implant with the native humeral head and a height matched, custom manufactured spherical implant.</div></div><div><h3>Methods</h3><div>Six fresh frozen cadaveric shoulder specimens were used with a custom shoulder testing system. The native shoulder was tested in multiple positions under anatomic muscle loading. Each specimen was tested for ROM and glenohumeral joint kinematics by measuring the humeral head apex and humeral head center (HHC) translation per degree of rotation using a MicroScribe digitizer. Measurements were then repeated after implantation of a spherical and, subsequently, a nonspherical humeral head prothesis.</div></div><div><h3>Results</h3><div>The nonspherical implant had significantly more internal rotation (IR) compared to the spherical implant at 0° abduction (10.6 ± 6.2° more IR, <em>P</em> = .004, 95% confidence interval [CI]: −13.3, 34.5), 30° abduction (5.7 ± 2.8°, <em>P</em> = .009, 95% CI: −12.6, 24.0) and 60° abduction (6.8 ± 2.7°, <em>P</em> = .002, 95% CI: −8.3, 22.1) in the scapular plane, and 60° abduction (6.9 ± 2.0°, <em>P</em> = .031, 95% CI: −12, 25.6) in the coronal plane. The nonspherical implant had more IR than the native head at 60° of abduction in the scapular plane (7.0 ± 2.2° <em>P</em> = .002, 95% CI: −10.3, 24.3). The spherical head had less IR than the native head at 0° abduction (7.2 ± 4.8°, <em>P</em> = .031, 95% CI: 32.5, 18.1). There were no differences in humeral head apex translation per degree of rotation noted between the spherical implant or nonspherical implant and the native shoulder. The nonspherical head had less HHC translation than the native shoulder at 30° abduction in the forward flexion plane (<em>P</em> = .007); otherwise, there were no statistically significant differences in HHC translation between the native shoulder, the spherical head, and the nonspherical head. There was no significant difference observed between the average difference in anterior-posterior and superior-inferior radius of curvature of the nonspherical implants (2.0 ± 0.7 mm) and the native humeral heads (1.9 ± 1.3 mm) [<em>P</em> = .926].</div></div><div><h3>Conclusion</h3><div>The results of this biomechanical study suggest that the commercially available nonspherical humeral head has improved IR when compared to a custom, height controlled spherical implant and offers ROM and kinematics similar to the native humeral head in a cadaveric model.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 31-41"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284923","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}

引用次数: 0

Nonoperative management of glenoid baseplate failure in reverse shoulder arthroplasty

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-09-10 DOI: 10.1053/j.sart.2024.07.012

Raymond E. Chen MD , Alayna K. Vaughan BS , Mark D. Lazarus MD , Gerald R. Williams MD , Surena Namdari MD, MSc

Background

Glenoid baseplate failure in reverse total shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA.

Methods

Utilizing a single-institution database, a retrospective review was performed to identify patients from 2010 to 2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. The exclusion criteria included revision surgery and presence of active infection. Included patients had a minimum 2-year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications, and techniques. Radiographs were reviewed to determine the etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true anteroposterior radiographs immediately postoperatively and after baseplate failure.

Results

Eighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. The mean age was 77 years, body mass index was 28, and 8 out of 12 were female. The mean Charlson Comorbidity Index score was 4.1. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 43.0, and visual analog scale (VAS) pain was 6.3. At a mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, single assessment numeric evaluation of 49%, and 50% of patients were satisfied with their outcome. The preoperative and final follow-up ASES and VAS scores were similar. The average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, the mean glenosphere inclination angle after failure (131°) was significantly greater than the initial inclination angle (100°), P = .03. The other 2 failures resulted in increased baseplate anteversion. 8 out of 18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction.

Conclusion

Nonoperative management of glenoid baseplate failure yields modest patient-reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.

{"title":"Nonoperative management of glenoid baseplate failure in reverse shoulder arthroplasty","authors":"Raymond E. Chen MD , Alayna K. Vaughan BS , Mark D. Lazarus MD , Gerald R. Williams MD , Surena Namdari MD, MSc","doi":"10.1053/j.sart.2024.07.012","DOIUrl":"10.1053/j.sart.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid baseplate failure in reverse total shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA.</div></div><div><h3>Methods</h3><div>Utilizing a single-institution database, a retrospective review was performed to identify patients from 2010 to 2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. The exclusion criteria included revision surgery and presence of active infection. Included patients had a minimum 2-year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications, and techniques. Radiographs were reviewed to determine the etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true anteroposterior radiographs immediately postoperatively and after baseplate failure.</div></div><div><h3>Results</h3><div>Eighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. The mean age was 77 years, body mass index was 28, and 8 out of 12 were female. The mean Charlson Comorbidity Index score was 4.1. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 43.0, and visual analog scale (VAS) pain was 6.3. At a mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, single assessment numeric evaluation of 49%, and 50% of patients were satisfied with their outcome. The preoperative and final follow-up ASES and VAS scores were similar. The average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, the mean glenosphere inclination angle after failure (131°) was significantly greater than the initial inclination angle (100°), <em>P</em> = .03. The other 2 failures resulted in increased baseplate anteversion. 8 out of 18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction.</div></div><div><h3>Conclusion</h3><div>Nonoperative management of glenoid baseplate failure yields modest patient-reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 1","pages":"Pages 1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143284891","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}

引用次数: 0

Preoperative rotator cuff fatty infiltration and muscle atrophy do not negatively influence outcomes following anatomic total shoulder arthroplasty

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-09-10 DOI: 10.1053/j.sart.2024.08.001

Jalen Thomas MS , Evan A. Glass BS , Adam R. Bowler BA , Himmat Sahi MS , Daniel P. Swanson BS , Munis Ashraf MBBS, DNB , Girinivasan Chellamuthu MBBS, MS , Vanessa Charubhumi MD , Miranda McDonald-Stahl BS , Kiet Le PA-C , Jacob M. Kirsch MD , Andrew Jawa MD

Background

Anatomic total shoulder arthroplasty (TSA) is an effective surgical option for the treatment of primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. While an intact rotator cuff is essential to the success of TSA, little is known about how preoperative rotator cuff muscle quality may impact clinical outcomes. In this study, we sought to determine the effects of rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on clinical outcomes following TSA.

Methods

A retrospective review of a prospectively maintained, single-surgeon registry was used to identify patients undergoing TSA for GHOA between April 2015 and March 2020. Patients were included if they had preoperative magnetic resonance imaging available, an intact rotator cuff, and complete preoperative and minimum 2-year postoperative patient-reported outcome measures (PROMs) and active range of motion (ROM) measurements. Preoperative MA and FI of the rotator cuff were assessed on magnetic resonance imaging by measuring muscle cross-sectional area and using the Goutallier classification system, respectively. Pearson’s correlation was used to determine any relationship between MA and clinical outcomes. Univariate analysis was used to compare clinical outcomes of patients with moderate-to-severe FI to those with minimal-to-mild FI.

Results

There were 163 shoulders from 154 patients with a mean age of 62.5 (standard deviation = 7.4) and a mean follow-up of 2.9 years (standard deviation 1.2) that met inclusion criteria. Rotator cuff muscle area was not correlated with any preoperative or postoperative ROM or PROMs (P > .05). However, the ratio of infraspinatus and teres minor (posterior cuff) to subscapularis muscle area was minimally negatively correlated with change in Single Assessment Numerical Evaluation (r = −0.171, P = .029) and change in internal rotation (r = −0.207, P = .008), although the clinical relevance is unclear. No significant differences in preoperative ROM or PROMs were found between patients with minimal-to-mild and moderate-to-severe FI (P > .05).

Conclusion

Preoperative rotator cuff muscle volume and FI do not impact clinical outcomes following TSA in patients with GHOA and intact rotator cuffs. TSA remains a viable surgical treatment for individuals with GHOA and an intact rotator cuff, provided the MA and FI are not so severe that a patient may be indicated for another type of treatment.

背景解剖性全肩关节置换术（TSA）是治疗肩袖完整的原发性盂肱骨关节炎（GHOA）的有效手术方案。虽然完整的肩袖对 TSA 的成功至关重要，但人们对术前肩袖肌肉质量如何影响临床结果却知之甚少。在这项研究中，我们试图确定肩袖脂肪浸润（FI）和肌肉萎缩（MA）对 TSA 术后临床结果的影响。方法我们对一个前瞻性维护的单个外科医生登记处进行了回顾性审查，以确定 2015 年 4 月至 2020 年 3 月间因 GHOA 而接受 TSA 的患者。如果患者有术前磁共振成像、完整的肩袖、完整的术前和至少两年的术后患者报告结果测量（PROMs）和主动活动范围测量（ROM），则纳入该患者。术前肩袖的MA和FI分别通过测量肌肉横截面积和使用Goutallier分类系统进行磁共振成像评估。采用皮尔逊相关性来确定 MA 与临床结果之间的关系。结果154名患者的163个肩部符合纳入标准，他们的平均年龄为62.5岁（标准差=7.4），平均随访时间为2.9年（标准差1.2）。肩袖肌肉面积与术前、术后 ROM 或 PROM 均无相关性（P > .05）。然而，冈下肌和小圆肌（后肩袖）与肩胛下肌的肌肉面积比值与单次评估数值评价的变化（r = -0.171，P = .029）和内旋的变化（r = -0.207，P = .008）呈最小负相关，但临床相关性尚不清楚。结论术前肩袖肌肉体积和 FI 不会影响 GHOA 和完好肩袖患者 TSA 术后的临床效果。对于患有 GHOA 且肩袖完好的患者来说，TSA 仍是一种可行的手术治疗方法，前提是 MA 和 FI 不严重到患者需要接受其他类型治疗的程度。

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引用次数: 0

Diagnosis of shoulder periprosthetic joint infection with atypical wounds: a case series of 12 patients 诊断肩关节假体周围感染的非典型伤口：12 例患者的病例系列研究

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-06-28 DOI: 10.1053/j.sart.2024.05.006

Charles J. Cogan MD, Midhat Patel MD, Joseph P. Iannotti MD, PhD, Jason C. Ho MD, Eric T. Ricchetti MD, Vahid Entezari MD, MMSc

引用次数: 0

Artificial intelligence to automatically measure glenoid inclination, humeral alignment, and the lateralization and distalization shoulder angles on postoperative radiographs after reverse shoulder arthroplasty 人工智能自动测量反向肩关节置换术后X光片上的盂倾角、肱骨对齐情况以及肩关节外侧角和远侧角

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-06-24 DOI: 10.1053/j.sart.2024.05.002

Linjun Yang PhD , Rodrigo de Marinis MD , Kristin Yu MD , Erick Marigi MD , Jacob F. Oeding MS , John W. Sperling Jr , Joaquin Sanchez-Sotelo MD, PhD

Background

Radiographic evaluation of the implant configuration after reverse shoulder arthroplasty (RSA) is time-consuming and subject to interobserver disagreement. The final configuration is a combination of implant features and surgical execution. Artificial intelligence (AI) algorithms have been shown to perform accurate and efficient analysis of images. The purpose of this study was to develop an AI algorithm to automatically measure glenosphere inclination, humeral component inclination, and the lateralization and distalization shoulder angles (DSAs) on postoperative anteroposterior radiographs after RSA.

Methods

The Digital Imaging and Communications in Medicine files corresponding to postoperative anteroposterior radiographs obtained after implantation of 143 RSAs were retrieved and used in this study. Four angles were analyzed: (1) glenoid inclination angle (GIA, between the central fixation feature of the glenoid and the floor of the supraspinatus fossa), (2) humeral alignment angle (HAA, between the long axis of the humeral shaft and a perpendicular to the metallic bearing of the prosthesis), (3) DSA, and (4) lateralization shoulder angle (LSA). A UNet segmentation model was trained to segment bony and implant elements using manually segmented training (n = 89) and validation (n = 22) images. Then, an image-processing–based pipeline was developed to measure all 4 angles using AI-segmented images. Measures performed by 3 physician observers and the AI algorithm were then completed in 32 additional images. The agreements among human observers and between observers and the AI algorithm were evaluated using intraclass correlation coefficients (ICCs) and absolute differences in degree.

Results

The ICCs (95% confidence interval) for manual measurements of LSA, DSA, GIA, and HAA were 0.79 (0.55, 0.90), 0.90 (0.80, 0.95), 0.96 (0.93, 0.98), and 0.99 (0.97, 0.99), respectively. The AI algorithm measured the 32 images in the test set in less than 2 minutes. The agreement between observers and the AI algorithm was lowest when measuring the LSA for observer 2, with an ICC of 0.77 (0.52, 0.89), and an absolute difference in degrees (median [interquartile range]) of 5 (4). Better agreements were found between the AI measurements and the average manual measurements: absolute differences in degree for LSA, DSA, GIA, and HAA were 3 (5), 2 (3), 2 (2), and 2 (1), respectively; ICCs for LSA, DSA, GIA, and HAA were 0.89 (0.79, 0.95), 0.96 (0.93, 0.98), 0.85 (0.68, 0.93), and 0.98 (0.95, 0.99), respectively.

Conclusion

The AI algorithm developed in this study can automatically measure the GIA, HAA, LSA, and DSA on postoperative anteroposterior radiographs obtained after implantation on RSA.

背景反向肩关节置换术（RSA）后对植入物结构的放射影像学评估非常耗时，而且观察者之间的意见也不一致。最终配置是植入物特征和手术执行的综合结果。人工智能（AI）算法已被证明能对图像进行准确有效的分析。本研究的目的是开发一种人工智能算法，用于自动测量RSA术后前后位X光片上的盂唇倾角、肱骨组件倾角以及肩关节外侧化角和远端化角（DSAs）。方法本研究检索并使用了与植入143枚RSA后获得的术后前后位X光片相对应的医学数字成像和通信文件。研究分析了四个角度：(1)盂倾角（GIA，盂中央固定特征与冈上窝底面之间的角度），(2)肱骨对准角（HAA，肱骨轴长轴与假体金属轴承垂直线之间的角度），(3)DSA，(4)肩外侧角（LSA）。使用人工分割的训练图像（n = 89）和验证图像（n = 22）训练 UNet 分割模型来分割骨骼和假体元素。然后，开发了一个基于图像处理的管道，使用人工智能分割的图像测量所有 4 个角度。然后，由 3 名医生观察员和人工智能算法对另外 32 幅图像进行测量。结果人工测量 LSA、DSA、GIA 和 HAA 的 ICCs（95% 置信区间）分别为 0.79（0.55，0.90）、0.90（0.80，0.95）、0.96（0.93，0.98）和 0.99（0.97，0.99）。人工智能算法在不到 2 分钟的时间内测量了测试集中的 32 幅图像。在测量观察者 2 的 LSA 时，观察者与人工智能算法之间的一致性最低，ICC 为 0.77（0.52，0.89），度数的绝对差异（中位数[四分位间范围]）为 5（4）。人工智能测量结果与平均人工测量结果之间的一致性更好：LSA、DSA、GIA 和 HAA 的绝对度数差异分别为 3 (5)、2 (3)、2 (2) 和 2 (1)；LSA、DSA、GIA 和 HAA 的 ICC 分别为 0.89 (0.79, 0.95)、0.96（0.93，0.98）、0.85（0.68，0.93）和 0.98（0.95，0.99）。结论本研究开发的人工智能算法可以自动测量 RSA 植入术后正位片上的 GIA、HAA、LSA 和 DSA。

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引用次数: 0

The hybrid humerus reverse shoulder arthroplasty: a prospective study of bone grafting and metaphyseal fixation with undersized stem in the assessment of proximal humeral stress shielding and associated clinical outcome 混合型肱骨反向肩关节置换术：在评估肱骨近端应力屏蔽和相关临床结果时采用骨移植和骨骺固定术的前瞻性研究

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-06-22 DOI: 10.1053/j.sart.2024.05.004

Roberto Pareyon MD , Helen Ingoe MBBS, FRCS Eng , Mohammad N. Jomaa MD , Kristine Italia FPOA , Jashint Maharaj FRSPH , Sarah L. Whitehouse PhD , Kenneth Cutbush MBBS, FRACS, FAOrthoA , Ashish Gupta MBBS, MSc, FRACS, FAOrthoA

Background

A significant proportion of revisions after reverse shoulder arthroplasty (RSA) is attributed to the humeral component. The purpose of this study is to evaluate the radiographic and clinical outcomes of the hybrid humerus technique for RSA using a Grammont-style humeral prosthesis in an onlay fashion with metaphyseal bone impaction grafting technique and undersized stem to avoid humeral stress shielding, notching, and loosening.

Methods

This is a prospective case series of patients who underwent RSA using the hybrid humerus technique with a minimum 2-year follow-up. Key steps of this technique include the use of undersized Grammont-style stem, impaction bone grafting of the proximal 5 cm of the humerus, and adjusting the height and offset of the stem depending on the patient stature, desired lateralization and distalization, and joint and soft tissue tension. Radiographic assessments were performed immediately after surgery, and at 1 and 2 years after surgery. These included assessment of metaphyseal and diaphyseal filling ratio, cortical narrowing, radiolucent lines, cortical lucencies, spot welding, scapular notching, and stem alignment. Preoperative and 2-year postoperative clinical assessments included American Shoulder and Elbow Surgeons score, Constant-Murley Score, University of California Los Angeles score, visual analog scale for pain, and active range of motion. Correlation between the filling ratios and clinical outcomes were also evaluated.

Results

Sixty-one patients were included in the study. The average metaphyseal and diaphyseal filling ratio on the postoperative X-ray was 0.66 and 0.54, and 0.67 and 0.54 at 2 years, respectively. Stress shielding was graded as none in 24 (40.7%), mild in 33 (55.9%), and moderate in 2 (3.4%). No stem had a change in position of more than 5°. At 2 years of follow-up, no humeral implant loosening was noted, with only 2 (3.4%) of the stems at risk of loosening. Thirty-nine (66.1%) had no notching, 14 (23.7%) were graded as mild, and 6 (10.2%) had moderate signs of notching. All clinical assessments significantly improved at 2 years (P < .001), with a weak negative correlation between visual analog scale and metaphyseal filling ratio (r = −0.268, P = .036) but none between diaphyseal filling ratio and clinical outcomes.

Conclusion

The hybrid humerus technique of metaphyseal bone grafting with a low filling ratio stem presents a promising solution for reducing humeral complications in RSA. This technique demonstrates a low incidence of stress shielding and loosening, with excellent clinical outcomes at 2 years.

背景反向肩关节置换术（RSA）术后翻修的很大一部分原因是肱骨组件。本研究的目的是评估混合肱骨技术在RSA中的放射学和临床效果，该技术采用Grammont式肱骨假体，以嵌体方式植入，并采用骨骺骨植入技术和过小的骨干，以避免肱骨应力屏蔽、切口和松动。该技术的关键步骤包括：使用尺寸过小的格拉蒙式骨干，在肱骨近端5厘米处进行植入式植骨，并根据患者的身材、所需的外侧化和远端化以及关节和软组织张力调整骨干的高度和偏移量。术后立即进行放射学评估，术后1年和2年进行放射学评估。这些评估包括骺端和骺端充填比、皮质变窄、放射线、皮质透亮、点焊、肩胛骨切迹和骨干对齐情况。术前和术后两年的临床评估包括美国肩肘外科医生评分、Constant-Murley评分、加州大学洛杉矶分校评分、疼痛视觉模拟量表和活动范围。研究还评估了填充率与临床结果之间的相关性。术后 X 光片上骺端和骺端平均填充率分别为 0.66 和 0.54，2 年后分别为 0.67 和 0.54。应力屏蔽分为无应力屏蔽 24 例（40.7%）、轻度屏蔽 33 例（55.9%）和中度屏蔽 2 例（3.4%）。没有一个骨干的位置变化超过5°。在2年的随访中，没有发现肱骨假体松动，只有2个（3.4%）假体柄有松动的风险。39例（66.1%）患者未出现切迹，14例（23.7%）患者出现轻度切迹，6例（10.2%）患者出现中度切迹。所有临床评估结果在2年后均有明显改善（P <.001），视觉模拟量表与骺端填充率之间呈弱负相关（r = -0.268，P = .036），但骺端填充率与临床结果之间无相关性。该技术应力屏蔽和松动的发生率较低，2年后的临床效果极佳。

{"title":"The hybrid humerus reverse shoulder arthroplasty: a prospective study of bone grafting and metaphyseal fixation with undersized stem in the assessment of proximal humeral stress shielding and associated clinical outcome","authors":"Roberto Pareyon MD , Helen Ingoe MBBS, FRCS Eng , Mohammad N. Jomaa MD , Kristine Italia FPOA , Jashint Maharaj FRSPH , Sarah L. Whitehouse PhD , Kenneth Cutbush MBBS, FRACS, FAOrthoA , Ashish Gupta MBBS, MSc, FRACS, FAOrthoA","doi":"10.1053/j.sart.2024.05.004","DOIUrl":"10.1053/j.sart.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>A significant proportion of revisions after reverse shoulder arthroplasty (RSA) is attributed to the humeral component. The purpose of this study is to evaluate the radiographic and clinical outcomes of the hybrid humerus technique for RSA using a Grammont-style humeral prosthesis in an onlay fashion with metaphyseal bone impaction grafting technique and undersized stem to avoid humeral stress shielding, notching, and loosening.</p></div><div><h3>Methods</h3><p>This is a prospective case series of patients who underwent RSA using the hybrid humerus technique with a minimum 2-year follow-up. Key steps of this technique include the use of undersized Grammont-style stem, impaction bone grafting of the proximal 5 cm of the humerus, and adjusting the height and offset of the stem depending on the patient stature, desired lateralization and distalization, and joint and soft tissue tension. Radiographic assessments were performed immediately after surgery, and at 1 and 2 years after surgery. These included assessment of metaphyseal and diaphyseal filling ratio, cortical narrowing, radiolucent lines, cortical lucencies, spot welding, scapular notching, and stem alignment. Preoperative and 2-year postoperative clinical assessments included American Shoulder and Elbow Surgeons score, Constant-Murley Score, University of California Los Angeles score, visual analog scale for pain, and active range of motion. Correlation between the filling ratios and clinical outcomes were also evaluated.</p></div><div><h3>Results</h3><p>Sixty-one patients were included in the study. The average metaphyseal and diaphyseal filling ratio on the postoperative X-ray was 0.66 and 0.54, and 0.67 and 0.54 at 2 years, respectively. Stress shielding was graded as none in 24 (40.7%), mild in 33 (55.9%), and moderate in 2 (3.4%). No stem had a change in position of more than 5°. At 2 years of follow-up, no humeral implant loosening was noted, with only 2 (3.4%) of the stems at risk of loosening. Thirty-nine (66.1%) had no notching, 14 (23.7%) were graded as mild, and 6 (10.2%) had moderate signs of notching. All clinical assessments significantly improved at 2 years (<em>P</em> < .001), with a weak negative correlation between visual analog scale and metaphyseal filling ratio (r = −0.268, <em>P</em> = .036) but none between diaphyseal filling ratio and clinical outcomes.</p></div><div><h3>Conclusion</h3><p>The hybrid humerus technique of metaphyseal bone grafting with a low filling ratio stem presents a promising solution for reducing humeral complications in RSA. This technique demonstrates a low incidence of stress shielding and loosening, with excellent clinical outcomes at 2 years.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 797-806"},"PeriodicalIF":0.0,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000713/pdfft?md5=ce0f7ece85c74763621fecd2b7f9dc06&pid=1-s2.0-S1045452724000713-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048522","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}

引用次数: 0

Comparison of range of motion between 2-year clinical outcomes and predictions of a static scapula preoperative planning software for reverse shoulder arthroplasty 反向肩关节置换术 2 年临床结果与静态肩胛骨术前规划软件预测的活动范围比较

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-06-22 DOI: 10.1053/j.sart.2024.05.001

Marco Branni PhD , Helen Ingoe MBBS, FRCS Eng, MD, MSc, PGCert , Asma Salhi PhD , Kristine Italia MD, FPOA , Luke Gilliland MEng , Marine Launay MEng , Roberto Pareyon MD , Jashint Maharaj MBBS , Angus Lane BEng , Peter Pivonka PhD , Kenneth Cutbush MBBS, FRACS, FAOrthoA , Ashish Gupta MBBS, MSc, FRACS, FAOrthoA

Background

Preoperative planning has gained popularity in the management of reverse shoulder arthroplasty (RSA). Commercially available software provides 3-dimensional segmentation of scapula and humerus, as well as providing arc of motion for the implanted articulation and identifying potential areas of bony impingement. However, these software algorithms use a fixed scapula model, disregarding the preoperative clinical range of motion (C-ROM) of the patient, be it glenohumeral or scapulothoracic, as well as any soft tissue parameters. This study aims to compare the ROM based on preoperative planning software by using the implant position from postoperative computed tomography (CT) images (predicted ROM using preoperative planning software [P-ROM]), with the C-ROM assessed at minimum of 2 years of follow-up.

Methods

Preoperative and postoperative CT scans of 46 patients who underwent primary RSA between 2017 and 2021 were analyzed. At the postoperative 2-year review, each patient was assessed for active ROM. Implant size and position based on operative notes and postoperative CT scans were used to replicate the performed surgery in the planning software. Abduction, flexion, and external rotation motion were simulated and recorded. The relationship between C-ROM and P-ROM was investigated using linear regression analysis, Pearson correlation coefficient, and paired t-test.

Results

P-ROM was significantly lower than C-ROM at 2 years postoperatively (P < .001), with an average discrepancy of 78° in abduction, 47° in flexion, and 37° in external rotation (C-ROM: abduction 155° ± 21° [80°-180°]; flexion 160° ± 17° [90°-180°]; external rotation 52° ± 14° [10°-80°] vs. P-ROM: abduction 77° ± 13° [53°-107°]; flexion 112° ± 25° [67°-180°]; external rotation 15° ± 21° [0°-79°]). The linear regression analysis indicated weak agreement between C-ROM and P-ROM (abduction R² = 0.03; flexion R² = 0.01; external rotation R² = 0.04). Pearson’s correlation coefficients revealed weak correlations of −0.18, 0.03, and 0.21 for abduction, flexion, and external rotation, respectively.

Conclusion

P-ROM based on preoperative software in its current form does not allow the prediction of the C-ROM at 2 years of follow-up for patients undergoing RSA.

背景术前规划在反向肩关节置换术（RSA）的管理中越来越受欢迎。市售软件可对肩胛骨和肱骨进行三维分割，提供植入关节的运动弧度，并识别潜在的骨性撞击区域。然而，这些软件算法使用固定的肩胛骨模型，忽略了患者术前的临床活动范围（C-ROM），无论是盂肱关节还是肩胛胸关节，以及任何软组织参数。本研究旨在通过使用术后计算机断层扫描（CT）图像中的植入位置，将基于术前规划软件的ROM（使用术前规划软件预测的ROM [P-ROM]）与至少2年随访时评估的C-ROM进行比较。方法分析了2017年至2021年间接受初次RSA的46例患者的术前和术后CT扫描。术后 2 年复查时，对每位患者的活动 ROM 进行评估。根据手术记录和术后 CT 扫描结果确定的植入物大小和位置被用于在规划软件中复制已实施的手术。模拟并记录外展、屈曲和外旋运动。使用线性回归分析、皮尔逊相关系数和配对 t 检验研究了 C-ROM 和 P-ROM 之间的关系。001），平均差异为外展 78°、屈曲 47°、外旋 37°（C-ROM：外展 155°±21°[80°-180°]；屈曲 160°±17°[90°-180°]；外旋 52°±14°[10°-80°] vs. P-ROM：外展 77°±13°[53°-107°]；屈曲 112°±25°[67°-180°]；外旋 15°±21°[0°-79°]）。线性回归分析表明，C-ROM 和 P-ROM 之间的一致性较弱（外展 R2 = 0.03；屈曲 R2 = 0.01；外旋 R2 = 0.04）。皮尔逊相关系数显示，外展、屈曲和外旋的弱相关系数分别为-0.18、0.03和0.21。

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引用次数: 0