Seminars in Arthroplasty最新文献

{"title":"Are orthopedic shoulder and elbow surgeons at risk for noise-induced hearing loss?","authors":"Matthew J. Schultz DO ,&nbsp;William T. DiCiurcio III DO ,&nbsp;Stephanie A. Kwan DO ,&nbsp;Jeffrey C. Lynch DO ,&nbsp;Dennis DeBernardis DO ,&nbsp;Luke Austin MD","doi":"10.1053/j.sart.2025.05.007","DOIUrl":"10.1053/j.sart.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to noise levels greater than 85 decibels [dB] is associated with increased incidence of hearing loss. However, the risk that occupational noise exposure poses to orthopedic shoulder and elbow (S&amp;E) surgeons is poorly understood. This study aims to (1) quantify the noise exposure of S&amp;E surgeons in the operating room to determine if they are exposed to harmful noise levels and (2) identify which procedures pose the greatest risk of noise-induced hearing loss.</div></div><div><h3>Methods</h3><div>Intraoperative audio recordings were collected during S&amp;E procedures via a wearable microphone worn under standard sterile surgical garb. S&amp;E procedures were characterized as open reduction and internal fixation, arthroscopic soft tissue procedures, open soft tissue procedures, and arthroplasty. The highest sound pressure level (maximum dB levels [MDLs]) and the average dB level projected over an 8-h period (time-weighted average) were reported. The percentage of allowable daily noise dose was reported as “dose,” and the measured dose projected for over 8-h was reported as “projected dose.”</div></div><div><h3>Results</h3><div>We collected 116 recordings consisting of 65 arthroplasties, 5 open reduction and internal fixation, 11 open soft tissue procedures (distal bicep tendon repairs), and 35 arthroscopic soft tissue procedures. The average MDL was greater than the average control MDL for all S&amp;E procedures and ranged from 88.7 to 112.6 dB. Shoulder arthroplasty had the highest average dose (1.4%), projected dose (8.4%), and time-weighted average (64.6 dB).</div></div><div><h3>Conclusion</h3><div>All recorded procedure types exposed surgeons to MDLs greater than 85 dB. Shoulder arthroplasty demonstrated the highest average exposure to harmful doses of noise and appears to pose the greatest risk for occupational noise exposure. Strategies should be considered to minimize the risk of noise-induced hearing loss amongst surgeons.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 599-603"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic total shoulder arthroplasty using a short humeral stem and a non-augmented, minimally cemented all-polyethylene glenoid: minimum 2-year outcome and predictors of clinical failure","authors":"Brian P. Kurcz MD ,&nbsp;Dennis A. DeBernardis DO ,&nbsp;Aaron Roberts DO ,&nbsp;Peter Regala MD ,&nbsp;Carl J. Replogle ,&nbsp;Cassie M. Fleckenstein MS ,&nbsp;Joseph Nolan PhD ,&nbsp;Samer S. Hasan MD, PhD","doi":"10.1053/j.sart.2025.04.007","DOIUrl":"10.1053/j.sart.2025.04.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Anatomic total shoulder arthroplasty (aTSA) using standard (non-augmented) glenoid implants has demonstrated excellent clinical results, but concerns have been raised regarding their use in patients with posterior glenoid wear. The primary purpose of this study is to investigate short-term patient-reported outcomes (PROs) and overall active range of motion in patients who underwent aTSA using short humeral stems and standard glenoid implants for glenohumeral arthritis with minimal or concentric wear and with posterior glenoid wear. The secondary purpose was to the determine predictors of an inferior outcome or reoperation following aTSA using this construct.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients in this study underwent aTSA with minimal glenoid reaming to achieve &gt;90% contact of a pegged, all-polyethylene standard glenoid implant, inserted with minimal cement. Plain radiographs, active range of motion, and PROs—comprising American Shoulder and Elbow Surgeons (ASES), simple shoulder test, and visual analog scale pain scores—were obtained preoperatively and at final follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;One hundred twenty-eight consecutive aTSAs in 122 patients (75 males) with mean age of 66 years (range 48-84) were reviewed. Thirteen patients were lost to follow-up, 6 patients were deceased or had cognitive impairment precluding evaluation, and 5 patients underwent early revision for subscapularis failure, leaving 104 aTSAs for evaluation at minimum 2-year follow-up (mean 3 years, range 2-5.6 years). Twenty-four shoulders had undergone previous surgery. Fifty-nine patients had posterior glenoid wear (Walch B2 or B3) and 47 had concentric or minimal glenoid wear (Walch A1, A2, or B1). Forward elevation improved from 101° ± 25° to 147° ± 17°, abduction from 87° ± 26° to 145° ± 23°, external rotation from 21° ± 15° to 45° ± 13°, and internal rotation from the sacrum to thoracolumbar junction (&lt;em&gt;P&lt;/em&gt; &lt; .001 for all). Overall, ASES improved from 41 ± 20 to 89 ± 13, simple shoulder test from 4.5 ± 2.9 to 10.2 ± 2.5, and visual analog scale pain from 5.5 ± 2.5 to 0.7 ± 1.3 (&lt;em&gt;P&lt;/em&gt; &lt; .001). Ten patients had a final ASES score &lt;70, which was associated with a history of previous surgery (&lt;em&gt;P&lt;/em&gt; = .03). The degree of posterior glenoid wear did not influence any outcome score. Eight patients underwent subsequent ipsilateral shoulder surgery including 5 (4%) undergoing revision to reverse shoulder arthroplasty for subscapularis insufficiency (2 following traumatic injury). No revisions for prosthetic joint infection or humeral or glenoid implant loosening were performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;aTSA using a minimally cemented standard glenoid implant following partial version correction for Walch B2 and B3 glenoids leads to marked improvements in ROM and PROs, regardless of glenoid wear pattern. No reoperations were performed for glenoid or humeral loosening or infection at","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 539-546"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does bisphosphonate use in osteoporotic patients undergoing total shoulder arthroplasty have a protective effect? A propensity-matched analysis","authors":"Akhil Katakam MD ,&nbsp;Tej Joshi MD ,&nbsp;Tuckerman Jones MD ,&nbsp;Amanda Azer MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Sefy A. Paulose MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1053/j.sart.2025.05.003","DOIUrl":"10.1053/j.sart.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis and its associated complications, such as fractures, place a significant burden on health care systems. Bisphosphonates are a standard treatment for osteoporosis, shown to maintain bone mineral density and reduce fracture risk. However, their role in patients undergoing reverse total shoulder arthroplasty (rTSA) remains unclear, particularly regarding complications like acromial stress fractures and other prosthesis-related outcomes. This study investigates the impact of bisphosphonate usage on postoperative outcomes in osteoporotic patients undergoing rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Research Network database to identify patients with osteoporosis who underwent rTSA. Patients were stratified into two cohorts based on preoperative bisphosphonate usage. Propensity score matching (1:1) was utilized to balance demographic characteristics, comorbidities, prior surgery, and medication use. Outcomes assessed included acromial stress fractures, revision rates, aseptic loosening, and periprosthetic fractures at 1 year postoperatively.</div></div><div><h3>Results</h3><div>A total of 1,208 propensity-matched patients (604 in each cohort) were analyzed. In the bisphosphonate group, 25 (4.1%) of patients were diagnosed with an acromial stress fracture compared to 23 (3.6%) in the control group (odds ratio 1.142, 95% confidence interval 0.637-2.049, <em>P</em> = .655). No significant differences were observed in revision rates (<em>P</em> = .712), aseptic loosening (<em>P</em> = 1.000), or periprosthetic fractures (<em>P</em> = 1.000) between cohorts.</div></div><div><h3>Conclusion</h3><div>Bisphosphonate usage does not decrease the incidence of acromial stress fractures in osteoporotic patients undergoing rTSA. Future studies should focus on the potential additional interventions to mitigate the risk of acromial stress fracture in osteoporotic patients undergoing rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 568-572"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction of a new outcome measure for total shoulder arthroplasty: subjective patient outcome tracker (SPOT)","authors":"B. Gage Griswold MD,&nbsp;Brian P. Davis MD,&nbsp;Hayden B. Schuette DO,&nbsp;Benjamin W. Sears MD,&nbsp;Andrea Stapleford BS,&nbsp;Libby Mauter MSPT,&nbsp;Jacqueline Bader MS,&nbsp;Mallory Boyd MS,&nbsp;Armodios M. Hatzidakis MD","doi":"10.1053/j.sart.2025.05.001","DOIUrl":"10.1053/j.sart.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Patient-reported outcome measures (PROMs) provide a quantifiable rating of a patient's subjective symptoms prior to and following treatment of shoulder pathology. Shoulder Subjective Patient Outcome Tracker (SPOT) is a novel outcomes measure with 10 satisfaction domains to pinpoint shoulder-specific functions. The purpose of this study is to introduce and demonstrate the utility of SPOT for patients undergoing total shoulder arthroplasty<span>. The authors hypothesize SPOT will demonstrate high correlations to existing PROMs with a corresponding large effect size.</span></div></div><div><h3>Methods</h3><div><span>Over a 1-year evaluation period, SPOT, American Shoulder and Elbow Surgeons (ASES) assessment, and Single Assessment Numeric Evaluation (SANE) scores were administered preoperatively and at 2 years postoperatively for patients undergoing anatomic total shoulder arthroplasty<span> (aTSA) and reverse shoulder arthroplasty (rTSA). Additionally, nonsurgical patients with glenohumeral </span></span>osteoarthritis were administered SPOT at 2 separate time points. Interoutcome agreement, correlation, and sensitivity of SPOT to ASES and SANE were evaluated, and the floor/ceiling effect of SPOT was assessed. Test-retest reliability was conducted on the nonsurgical cohort.</div></div><div><h3>Results</h3><div>A total of 139 patients were included with 73 postoperative aTSA and 66 postoperative rTSA patients. Twelve patients managed nonoperatively were included in test-retest analysis. Preoperatively, there was low correlation between SPOT and ASES and moderate correlation between SPOT and SANE. At 2 years postoperatively, there was high correlation between SPOT and ASES and between SPOT and SANE. There was good agreement between SPOT and ASES in both aTSA and rTSA cohorts and between SPOT and SANE in the aTSA cohort. Additionally, the large effect size of SPOT was similar to the effect size of ASES and SANE. There was high correlation in the test-retest evaluation in a nonoperative cohort indicating reliability of SPOT at the 2 time points assessed.</div></div><div><h3>Conclusion</h3><div>SPOT is a shoulder-specific, effective PROM with a low administrative burden, tailored for patients undergoing aTSA or rTSA. It demonstrates high reliability, strong correlations, and a large effect size comparable to established shoulder-specific PROMs. SPOT is more discriminatory and specific than the SANE score, offering valuable, detailed insights into patients’ perceived deficits before and after shoulder arthroplasty.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 553-560"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative deltoid muscle volume correlates with early postoperative range of motion in flexion after reverse shoulder arthroplasty","authors":"Jun Kawamata MD ,&nbsp;Shoji Fukuta MD, PhD ,&nbsp;Daisuke Nakai MD, PhD ,&nbsp;Kohei Yoshikawa MD ,&nbsp;Koichi Sairyo MD, PhD","doi":"10.1053/j.sart.2025.07.003","DOIUrl":"10.1053/j.sart.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>After reverse shoulder arthroplasty (RSA), the deltoid muscle is the main source of kinematic force, and muscle strength is essential for movement of the shoulder joint. The purpose of this study was to assess the correlation of preoperative deltoid muscle volume with clinical outcomes after RSA. Our hypothesis was that preoperative deltoid muscle volume would be associated with range of motion (ROM), especially in forward flexion.</div></div><div><h3>Methods</h3><div>The study included 49 patients who underwent RSA for cuff tear arthropathy. The mean follow-up duration was 3.3 years. Preoperative deltoid muscle volume was measured in 3 dimensions on computed tomography scans. Postoperative clinical outcomes were evaluated by active ROM and the University of California, Los Angeles shoulder rating scale score. Correlations of deltoid muscle volume with clinical outcomes were investigated. Cases were classified according to whether flexion was 135° or more (the ≥135 group) or less than 135° (the &lt;135 group) at the final observation. Logistic regression analysis was used to identify predictors of more than 135° of flexion. The cutoff value for deltoid muscle volume was determined by receiver operating characteristic curve analysis.</div></div><div><h3>Results</h3><div>Preoperative deltoid volume was correlated with flexion (6 weeks, r = 0.45, <em>P</em> = .003; 3 months, r = 0.33, <em>P</em> = .023; 6 months, r = 0.31, <em>P</em> = .027; 1 year, r = 0.31, <em>P</em> = .033; final observation, r = 0.33, <em>P</em> = .022) and internal rotation at 1 year (r = −0.29 <em>P</em> = .042). Univariable analysis identified statistically significant between-group differences in preoperative external rotation (&lt;135 group, 10.3 ± 20.1°; ≥135 group, 28.0 ± 27.6°; <em>P</em> = .03), preoperative pain score (2.9 ± 1.7 points and 4.3 ± 2.6 points, respectively; <em>P</em> = .45), and preoperative deltoid volume (169.0 ± 62.5 ml and 223.2 ± 59.1 ml; <em>P</em> = .008). Logistic regression analysis identified preoperative factors associated with ≥135° of flexion to be deltoid volume (odds ratio 1.02, 95% confidence interval 1.00-1.03, <em>P</em> = .017) and preoperative external rotation (odds ratio 1.03, 95% confidence interval 1.00-1.05, <em>P</em> = .04). Receiver operating characteristic curve analysis identified a deltoid volume of 204.6 ml (area under the curve 0.737, sensitivity 0.64, specificity 0.81) as the cutoff value for a final ROM in flexion of ≥135°.</div></div><div><h3>Conclusion</h3><div>A correlation was observed between preoperative deltoid muscle volume and ROM in flexion after RSA, especially in the early postoperative stage.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 678-684"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in extended oral antibiotic prophylaxis after primary total shoulder arthroplasty, 2010-2021","authors":"Arman Kishan MBBS ,&nbsp;Sanjay Kubsad BS ,&nbsp;Jeffrey Y. Wang BS ,&nbsp;Duc Nguyen MD ,&nbsp;Santiago A. Lozano-Calderón MD, PhD ,&nbsp;Umasuthan Srikumaran MD, MBA, MPH ,&nbsp;Matthew J. Best MD","doi":"10.1053/j.sart.2025.06.007","DOIUrl":"10.1053/j.sart.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>The absence of national guidelines on the use of extended oral antibiotic (EOA) prophylaxis has led to inconsistent use of EOA to prevent prosthetic joint infection after total shoulder arthroplasty (TSA). Our investigation aimed to determine temporal trends and prescription patterns in the use of EOA prophylaxis after TSA from 2010 to 2021, particularly for patients considered at high risk for infection.</div></div><div><h3>Methods</h3><div>Using the PearlDiver database, we identified 289,908 patients who underwent primary TSA from 2010 to 2021. EOA was defined as antibiotic use initiated before, during, or immediately after surgery and continued for 2 days or more postoperatively. Compounded annual growth rate and linear regression were used for trend analysis. Stratification measures were demographic variables, geographic location, insurance type, and risk factors for infection.</div></div><div><h3>Results</h3><div>Among primary TSA patients, 3.8% received EOA after TSA. Antibiotic use after TSA increased by a compounded annual growth rate of 6.2% from 2010 to 2021. Associations were observed between EOA prescription patterns and factors such as age, sex, Charlson Comorbidity Index value, geographic region, and insurance type. Cephalexin was the most frequently prescribed antibiotic, but prescriptions of cephalexin declined during the study period, while doxycycline prescriptions increased. Most patients received EOA for 2-7 days. Patients at high risk for infection, including those with diabetes, a history of tobacco use, chronic kidney disease, and autoimmune disorders, were more likely to receive EOAs compared to those without these factors.</div></div><div><h3>Conclusion</h3><div>This study provides insights into the dynamic landscape of EOA prophylaxis after TSA. The observed changes during the study period—namely, the increase in EOA prescriptions, demographic variation in prescription patterns, and shifting antibiotic preferences—highlight the evolving nature of clinical practice in the absence of standardized national guidelines. Continued research is needed to improve prophylactic strategies for patients with risk factors for infection. Surgeons can use this information to establish their own guidelines tailored to their patients, considering factors such as age, comorbid conditions, and regional practices, while closely monitoring for adverse effects and antibiotic resistance patterns.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 654-661"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the minimal clinically important difference and substantial clinical benefit following revision reverse shoulder arthroplasty","authors":"Ali A. Mohamed MS ,&nbsp;Anna Redden BS ,&nbsp;Jacob Calpey BS ,&nbsp;Aghdas Movassaghi BS ,&nbsp;Garrett R. Jackson MD ,&nbsp;Howard Routman DO ,&nbsp;Diego J.L. Lima MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2025.07.004","DOIUrl":"10.1053/j.sart.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) has become a more common procedure due to its expanded indications and successful outcomes. The concern with this growth is the increased number of complications that may lead to more revision surgery. Given revision surgery has increased complexity and difficulty in recovery for patients, understanding outcomes can help guide patients and surgeons in decision-making. This study aimed to establish the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for reverse TSA performed as a revision procedure for failed prior shoulder arthroplasty types.</div></div><div><h3>Methods</h3><div>A retrospective review of all patients who underwent revision reverse TSA (rTSA) performed as a revision procedure for failed prior shoulder arthroplasty from 2007 to 2020 by a single fellowship-trained orthopedic surgeon was performed. Patient demographics, range of motion, and patient-reported outcome measures including Simple Shoulder Test (SST), Constant-Murley, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA), Shoulder Pain and Disability Index (SPADI), and Shoulder Arthroplasty Smart (SAS), were collected preoperatively and postoperatively at the last follow-up visit. MCID and SCB were calculated using the anchor-based method. Analyses were performed using paired- and independent-sample t-tests and logistic regressions were used to identify potential predictors for meeting MCID and SCB.</div></div><div><h3>Results</h3><div>A total of 91 patients were included in this analysis. The cohort had a mean age of 67.8 years and a mean body mass index of 29.7 kg/m². A majority of the cohort was male (51.7%) and Caucasian (93.2%). The MCID was found to be 3.5 for SST, 30.6 for Constant-Murley Score, 25.3 for ASES, 11.2 for UCLA, −42.1 for SPADI, 17.4 for SAS, 56.4° for forward flexion, 47.6° for abduction and 11.7° for external rotation. The SCB was found to be 6.3 for SST, 34.3 for CMS, 45.6 for ASES, 17.6 for UCLA, −56.8 for SPADI, 30.1 for SAS, 78.4° for forward flexion, 66.8° for abduction and 7.9° for external rotation. MCID was achieved by 72.5% of patients and 43.9% (n = 40) met SCB at final follow-up. Age, sex, and body mass index were not found to be significantly associated with meeting MCID or SCB.</div></div><div><h3>Conclusions</h3><div>This study establishes MCID and SCB thresholds for rTSA performed as a revision procedure for failed prior shoulder arthroplasties, providing valuable benchmarks for assessing patient outcomes. Most patients achieved meaningful improvements (MCID), and a significant portion reached SCB. These findings help set recovery expectations and highlight that patient-specific factors have a limited impact on outcomes after rTSA performed as a revision surgery.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 685-691"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative 3-dimensional planning optimizes glenoid retroversion correction in shoulder arthroplasty using hemi-wedged augmented baseplates","authors":"Luis Navas MD ,&nbsp;Sebastian Schmidt MD ,&nbsp;Carolina Vogel MD ,&nbsp;Thorsten Guehring MD, PhD","doi":"10.1053/j.sart.2025.05.002","DOIUrl":"10.1053/j.sart.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid version and inclination can be corrected with an augmented baseplate during reverse shoulder arthroplasty (rTSA) procedures. To achieve an optimal correction of both glenoid version and inclination, this study investigated whether the preoperative use of a 3-dimensional planning system improved the correction of glenoid anatomy in terms of glenoid version (0°) and inclination (rTSA 0°).</div></div><div><h3>Methods</h3><div>We measured preoperative and postoperative glenoid version and inclination by rTSA angle by x-ray and computed tomography scans in 50 prospective cases of rTSA with wedged baseplates. All patients underwent an rTSA due to osteoarthritis and rotator cuff insufficiency. All 50 patients underwent rTSA with the use of a hemi-wedge to correct the glenoid morphology. Twenty five patients additionally underwent a preoperative planning with the Signature ONE Planner to determine the exact rotational position of the hemi-wedge. rTSA angle was determined in preoperative and postoperative x-rays, and glenoid version was determined in preoperative and postoperative computed tomography scans at 3 different glenoid levels. The Signature ONE Planner system determined the rotation, position, and size of the hemi-wedge (10°, 20°, or 30°). A control group of 25 patients underwent hemi-wedge rTSA without preoperative planning. The position of the sphere and the sphere bone overhang distance (mm) was determined in both groups.</div></div><div><h3>Results</h3><div>In all 50 patients, the inclination was almost corrected anatomically from a preoperative rTSA angle of 16.2° ± 6.4° to 2.4° ± 3.5° postoperatively, irrespective of the use of Signature ONE Planner. In comparison, the average correction of retroversion was worse and achieved to a lower degree but the use of Signature ONE Planner significantly improved the correction of retroversion in all 3 parts of the glenoid to an almost anatomical level (<em>P</em> &lt; .0001). In both groups, the sphere bone overhang distance was between 4 and 5 mm without scapular notching.</div></div><div><h3>Discussion and Conclusion</h3><div>The anatomical correction of a retroverted glenoid with a hemi-wedge baseplate can be considerably improved by the preoperative use of the Signature ONE planning system. Preoperative planning can thus help surgeons to achieve an optimal baseplate position and may thus improve the correction of the glenoid retroversion after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 561-567"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of rapid discharge after total shoulder arthroplasty in septuagenarian and octogenarian patients","authors":"Keneth R. Granados BS ,&nbsp;Marco E. Guareschi BS ,&nbsp;John W. Moore BS ,&nbsp;Alexander S. Guareschi MD ,&nbsp;Brandon L. Rogalski MD ,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.05.005","DOIUrl":"10.1053/j.sart.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>There is limited literature assessing whether patients older than age 70 can be safely discharged within a day (ie, rapid discharge [RD]), following primary total shoulder arthroplasty (TSA). The purpose of this study is to assess postoperative outcomes following TSA with RD (RD-TSA) in septuagenarian and octogenarian patients compared to those with lengthier hospital stays (LD-TSA).</div></div><div><h3>Methods</h3><div>The National Surgical Quality Improvement Program database was queried from 2006 to 2019 to identify patients who underwent elective primary TSA. Septuagenarian and octogenarian patients who underwent RD-TSA were compared to septuagenarian and octogenarian patients who underwent TSA with lengthier hospital stays (LD-TSA). Demographics, preoperative comorbidities, and rates of complications, readmission, reoperation, and mortality within 30 days of surgery were compared between RD-TSA and LD-TSA patients.</div></div><div><h3>Results</h3><div>Septuagenarian and octogenarian patients who underwent RD-TSA were less likely to be female (<em>P</em> &lt; .001) and had a lower mean age (<em>P</em> &lt; .001) and body mass index (<em>P</em> &lt; .001). RD-TSA patients were more likely to be functionally independent (<em>P</em> &lt; .001) with lower American Society of Anesthesiologists classifications (<em>P</em> &lt; .001) when compared to LD-TSA patients. Patients aged 70 years and older who underwent RD-TSA exhibited lower rates of any adverse events (<em>P</em> = .001) and bleeding requiring transfusion (<em>P</em> &lt; .001) compared to LD-TSA patients. Septuagenarian and octogenarian patients who underwent RD-TSA were less likely to have hypertension (<em>P</em> &lt; .001) and diabetes mellitus (<em>P</em> &lt; .001) compared to LD-TSA patients. The average total operating time (<em>P</em> &lt; .001) was significantly lower for RD-TSA compared to LD-TSA, without a notable difference in readmission rates between the groups.</div></div><div><h3>Conclusion</h3><div>Septuagenarian and octogenarian patients who underwent RD-TSA exhibited significantly fewer postoperative complications compared to septuagenarian and octogenarian patients who underwent LD-TSA. Patients aged 70 years and older who received RD-TSA were less likely to have diabetes, hypertension requiring medication, and bleeding requiring transfusion compared to LD-TSA. These findings indicate that RD-TSA is safe and efficacious when utilized in appropriately selected septuagenarian and octogenarian patient populations.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 585-590"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the structure of the American Academy of Orthopaedic Surgeons appropriateness criteria for persons with shoulder osteoarthritis, an intact rotator cuff, and glenoid retroversion","authors":"Daniel L. Riddle PT, PhD, FAPTA ,&nbsp;Levent Dumenci PhD","doi":"10.1053/j.sart.2025.07.002","DOIUrl":"10.1053/j.sart.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>The American Academy of Orthopaedic Surgeons has led an effort to develop RAND/University of California Los Angeles appropriateness criteria for a variety of musculoskeletal surgical treatments. A recently developed appropriateness system is the shoulder osteoarthritis (OA) appropriateness system. The purpose of our study was to examine the structure of this appropriateness system and determine contributions of each predictive criterion to final decisions of appropriate, may be appropriate, or rarely appropriate for 5 surgical treatments for shoulder OA.</div></div><div><h3>Methods</h3><div>All 48 clinical vignettes were used. All predictors (age classified as young or older/elderly; physiologic demand as low or high; degree of glenoid retroversion as &gt;20°-30°, &gt;30°; glenoid classification as type B2, type B3, type C; and preoperative shoulder active elevation as &gt; 90° or less than 90°) were used in the vignettes. Multivariable logistic regression and a chi-square automatic interaction detection decision tree approach were used to determine the system structure and contribution of each predictor variable used to rate appropriateness.</div></div><div><h3>Results</h3><div>For each of 5 treatments (2 types of anatomic shoulder arthroplasty, reverse shoulder arthroplasty, hemiarthroplasty, and arthroscopic débridement), multivariable logistic regression and chi-square automatic interaction detection are reported. For example, for reverse shoulder arthroplasty, the predictors with the largest odds ratios (ORs) for vignettes rated as “may be appropriate” as compared to “appropriate” were high physiological demand (OR = 2.63 × 10¹⁵) and glenoid type C (OR = 81.50 × 10⁴). For anatomic shoulder arthroplasty, predictors with the largest ORs for vignettes rated as “may be appropriate” as compared to “appropriate” were glenoid type C (OR = 24.74), greater than 30° retroversion, and &lt;90° active shoulder elevation (both OR = 24.74).</div></div><div><h3>Conclusion</h3><div>The American Academy of Orthopaedic Surgeons shoulder OA system has substantial limitations. It uses a limited number of vignettes, with a consequent lack of symptom spectrum representation, an absence of “appropriate” or “rarely appropriate” ratings for all treatments and an absence of critically important patient-centered measures of pain and functional loss. Alternative published appropriateness criteria appear to have greater potential for clinical use and should be considered for future study.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 669-677"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685859","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}