Seminars in Arthroplasty最新文献

{"title":"Can surgeons predict how much compensation is needed to correct glenoid inclination in reverse shoulder arthroplasty?","authors":"Mark Mouchantaf MD ,&nbsp;Gregorio Secci MD ,&nbsp;Manon Biegun MD ,&nbsp;Mikael Chelli MD ,&nbsp;Philipp Schippers MD ,&nbsp;Pascal Boileau MD, PhD","doi":"10.1053/j.sart.2025.06.005","DOIUrl":"10.1053/j.sart.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Correction of superior glenoid inclination, with a neutral reverse shoulder arthroplasty RSA angle, is crucial for achieving optimal outcomes and avoiding complications in RSA. This study aimed to assess the compensation distance (CD) required to correct the RSA angle without medialization. We hypothesized that measuring the RSA angle could provide a viable and simple method to estimate the extent of superior glenoid bone erosion and predict the CD needed to achieve neutral inclination of the baseplate during RSA.</div></div><div><h3>Methods</h3><div>We analyzed 101 preoperative computed tomography (CT) scans from 101 consecutive patients (mean age 76 ± 9 years) undergoing RSA for cuff tear arthropathy (84) or massive rotator cuff tear (MRCT = 17). Using validated 3-dimensional (3D) planning software, the baseplate was positioned inferiorly, tangent to the inferior glenoid rim (6 o'clock position), and adjusted to achieve neutral inclination (RSA angle = 0°). The CDs (the distance between the backside of the baseplate and the native glenoid) were measured at 2 levels: the superior edge of the baseplate (superior compensation distance [SCD]) and the center of the baseplate (CCD = central compensation distance). Univariate regression models were used to analyze the relationships between the RSA angle, glenoid inclination, and CDs. Predicted CDs for specific RSA angles were also calculated.</div></div><div><h3>Results</h3><div>The mean global glenoid inclination was 9° ± 6° (range: 0–27°), and the mean RSA angle was 15° ± 5.6° (range: 4–28°). There was a strong linear correlation between the RSA angle and the CDs: the higher the RSA angle, the greater the CDs. CCD had a correlation coefficient (ρ) of 0.83 (R² = 0.688; <em>P</em> &lt; .001), while SCD showed a stronger correlation with ρ = 0.93 (R² = 0.874; <em>P</em> &lt; .001). Subgroup analysis revealed no statistically significant differences between baseplate diameters (25 mm vs 29 mm) in their relationship with the RSA angle (interaction terms: <em>P</em> = .291 for CCD and <em>P</em> = .500 for SCD). Regression models demonstrated that SCD is approximately half the RSA angle: 5 mm for 10°, 7.5 mm for 15°, 10 mm for 20°, and 12.5 mm for 25°.</div></div><div><h3>Conclusion</h3><div>By measuring the RSA angle, surgeons can estimate the SCD (ie, the thickness of bone graft or metal augment) required to achieve neutral inclination of the baseplate. The value of SCD is approximately half the RSA angle value and is independent of the baseplate diameter (25 mm vs 29 mm).</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 636-644"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685811","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":"Study on stability of resurfacing total elbow arthroplasty: a cadaver study","authors":"Hiromasa Wakita MD ,&nbsp;Yusuke Matsuura MD, PhD ,&nbsp;Yohei Shimada MD, PhD ,&nbsp;Shinji Taniguchi MD, PhD ,&nbsp;Takane Suzuki MD, PhD ,&nbsp;Mitsuyasu Iwasawa MD, PhD ,&nbsp;Yoshihiko Tabira MD, PhD ,&nbsp;Yuichi Nagase MD, PhD ,&nbsp;Koji Fujita MD, PhD ,&nbsp;Jun Hirose MD, PhD ,&nbsp;Yasuhiro Ozasa MD, PhD ,&nbsp;Seiji Ohtori MD, PhD (Professor)","doi":"10.1053/j.sart.2025.06.002","DOIUrl":"10.1053/j.sart.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Although excellent clinical results have been reported for resurfacing total elbow arthroplasty, also known as K-elbow, there are still reports of complications due to postoperative instability of the elbow joint. Appropriate implant selection, proper implant placement, and establishment of soft tissue repair methods are necessary to prevent complications, but these requirements have not fully undergone scientific verification. Surgical techniques such as the extent of bone resection of the distal humerus and soft tissue repair methods require technical skill, but the extent to which these techniques contribute to joint stability is unclear. This study aimed to investigate the factors contributing to elbow joint stability after elbow arthroplasty using K-elbow and fresh-frozen cadavers.</div></div><div><h3>Methods</h3><div>Six upper limbs of fresh-frozen cadavers were used in this study. The resurfaced unlinked-type elbow prosthesis (K-elbow) was placed using a posterior approach. The distal humerus was resected at 0 mm, 2 mm, and 4 mm on the articular surface, and the artificial elbow joint was installed. Anchors were inserted into the olecranon, the biceps tuberosity, and the coronoid process to simulate the triceps, biceps, and brachialis muscles, and traction forces of 20 N, 10 N, and 10 N, respectively, were applied. In addition, a digital angle meter was attached to the forearm, and varus and valgus stress tests were performed at all elbow joint ranges of motion using forearm weight to evaluate the spacer effect. Furthermore, a stress test was performed for each soft tissue repair process at the 2-mm bone resection site to evaluate the stability of the procedure.</div></div><div><h3>Results</h3><div>As the extent of bone resection of the distal humerus increased, the extension angle tended to improve. Furthermore, as the extent of bone resection increased, elbow joint instability due to varus and valgus stress increased. Soft tissue repair did not affect elbow instability due to varus stress, but it tended to reduce elbow instability due to valgus stress. In addition, the triceps fascia suture reduced the external rotation angle of the elbow joint in response to valgus stress.</div></div><div><h3>Conclusion</h3><div>This cadaver study demonstrated that bone resection of the distal humerus significantly affects both the range of motion and stability of the elbow joint after K-elbow arthroplasty. The triceps fascia suture was identified as the most critical soft tissue repair procedure for ensuring elbow joint stability, particularly against valgus stress.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 612-619"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685853","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":"Is anatomical radial head arthroplasty more effective for acute or for chronic traumatic lesions? A retrospective cohort study","authors":"Giuseppe Bardellini MD ,&nbsp;Biagio Abate MD ,&nbsp;Clelia Rota MD ,&nbsp;Andrea Pautasso MD ,&nbsp;Andrea Celli MD ,&nbsp;Luigi Celli MD","doi":"10.1053/j.sart.2025.05.004","DOIUrl":"10.1053/j.sart.2025.05.004","url":null,"abstract":"<div><h3>Background</h3><div>Radial head arthroplasty (RHA) can achieve favorable outcomes in patients with radial head (RH) and neck fractures. Notably, it has proved effective in treating both acute fractures and traumatic injuries, where delayed treatment can lead to secondary degenerative changes, soft tissue contractures, and altered biomechanics. Yet, the outcomes of RHA performed in these two groups have never been compared. Anatomical RHA is designed to replicate the native RH geometry, providing stable elbow kinematics and correct load distribution. This study compares the clinical and radiographic results of anatomical RHA in patients with acute lesions and chronic post-traumatic conditions.</div></div><div><h3>Methods</h3><div>We reviewed the data of 52 consecutive patients who were managed by anatomical RHA (Anatomical Radial Head; Acumed, Hillsboro, OR, USA) for acute RH fracture or chronic sequelae of traumatic injury at our institution. Assessments included range of motion and stability using the Mayo Elbow Performance Score, Quick Disabilities of the Arm, Shoulder, and Hand score, Visual Analog Scale score, and overall patient satisfaction. Radiographs were analyzed for signs of loosening, periarticular ossification, and degenerative changes of the ulnohumeral joint and capitellum.</div></div><div><h3>Results</h3><div>At a mean follow-up of 70 months, 23 (44%) patients had achieved excellent outcomes with a Mayo Elbow Performance Score greater than 90 points and a mean Quick Disabilities of the Arm, Shoulder, and Hand score of 7 (range, 0-18.2). The mean range of motion was 111° in flexion–extension (range, 70°-140°) and 144° in pronation–supination (range, 100°-160°). There were 13 (25%) complications requiring secondary surgery in the first 29 months. The implant revision rate was 7.7%. At the last follow-up, 42/52 patients (81%) were satisfied with their outcome. The clinical and radiological outcomes between the groups were not significantly different.</div></div><div><h3>Conclusion</h3><div>The anatomical RH system is a viable option for acute and chronic trauma patients. Despite these encouraging results, prospective studies with larger sample sizes are required to validate them.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 573-584"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685855","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":"Glucagon-like peptide-1 receptor agonist use is not associated with reduced postoperative complications in obese patients after total shoulder arthroplasty","authors":"Mark F. Megerian MD ,&nbsp;Rajiv P. Reddy MD ,&nbsp;Billy I. Kim MD ,&nbsp;Alexander E. White MD ,&nbsp;Miles Miller BS, MPH ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Michael C. Fu MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.05.006","DOIUrl":"10.1053/j.sart.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has increased substantially in the orthopedic patient population, necessitating investigation into their perioperative safety profile. Limited studies have investigated the use of GLP-1 RAs in the setting of total shoulder arthroplasty (TSA). Therefore, the purpose of this study was to evaluate the 90-day and 2-year postoperative outcomes in patients with body mass index &gt;30 kg/m² who received GLP-1 RA medication prior to primary TSA (reverse TSA or anatomic total shoulder arthroplasty [aTSA]) compared to matched controls.</div></div><div><h3>Methods</h3><div>A national administrative claims database was retrospectively reviewed from 2010 to 2022. Obese patients (body mass index &gt;30 kg/m²) with GLP-1 RA use within the 90 days preceding their TSA were identified and compared to a propensity score matched cohort without GLP-1 RA use (1:4 ratio). The database was queried using International Classification of Diseases, ninth and tenth revisions, and Current Procedural Terminology codes to identify the study cohort. Outcomes were compared via univariate analysis and included 90-day postoperative medical and surgical complications, 90-day readmissions, and 2-year surgical complications. <em>P</em> values were adjusted for multiple comparisons using the Bonferroni method.</div></div><div><h3>Results</h3><div>Ninety-day outcomes were obtained for 518 GLP-1 RA users and 2,070 matched nonusers and 2-year outcomes were available for 359 GLP-1 RA users and 1,436 matched nonusers. In the 90-day and 2-year postoperative period, there were no differences in the rates of medical complications, surgical complications, readmissions, or reoperations between GLP-1 RA users and nonusers. GLP-1 RA users experienced a higher rate of acute kidney injury in the 90-day postoperative period (14.1% vs. 3.7%) and a decreased rate of rotator cuff tear (8% vs. 13.6%) at 2 years as compared to nonusers, though these trends were not significant.</div></div><div><h3>Conclusion</h3><div>There was no difference in rate of medical or surgical complications after primary TSA (aTSA and reverse TSA) in obese patients taking GLP-1 RA medication as compared to matched controls. There were nonsignificant trends toward increased acute kidney injury rate at 90 days following TSA and decreased rotator cuff tear rate at 2 years following aTSA in GLP-1 RA users.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 591-598"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of baseplate augmentation on humeral offset and clinical outcomes in reverse shoulder arthroplasty","authors":"Matthew Como BS,&nbsp;Rajiv P. Reddy MD, MS,&nbsp;Fritz Steuer MD,&nbsp;Ehab M. Nazzal MD,&nbsp;Romano Sebastiani MD,&nbsp;Confidence Njoku-Austin MD,&nbsp;Anya Singh-Varma MD,&nbsp;Warren P. Austin BS,&nbsp;Albert Lin MD","doi":"10.1053/j.sart.2025.06.003","DOIUrl":"10.1053/j.sart.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Metallic augmented baseplates have increasingly been used to correct glenoid deformity during reverse shoulder arthroplasty (RSA). However, few studies have examined their clinical outcomes and effect on humeral offset. The purpose of this study was to evaluate clinical outcomes and change in humeral offset from preoperative anatomic baseline of RSA performed with an augmented baseplate (aRSA) to RSA without baseplate augmentation. We hypothesized that aRSA would yield similar outcomes and complication rates to non-aRSA but result in a greater increase in global lateralization from preoperative to postoperative measurements.</div></div><div><h3>Methods</h3><div>This was a retrospective review of consecutive patients who underwent RSA between 2015 and 2021 at a single institution with a minimum 12-month follow-up. RSA performed with an augmented baseplate (aRSA) was compared to RSA performed without augmentation (control). Baseline demographics, and pre/postoperative humeral offset and glenoid version and inclination were obtained. Pre/postoperative range of motion (ROM) and patient reported outcomes including visual analog scale (VAS), subjective shoulder value (SSV), and American Shoulder and Elbow Surgeons scores, and complications were recorded. Independent sample <em>t</em>-tests and Chi-squared and Fisher's exact test were utilized for continuous and binary variables, respectively. Statistical significance was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>There were 58 patients in the aRSA cohort and 86 patients in the control cohort with similar mean follow-up times (22.16 vs. 19.65 months; <em>P</em> = .373). On average, the aRSA cohort had a greater absolute difference between preoperative and postoperative humeral offset than the control cohort (7.4 ± 4.2 vs. 5.9 ± 3.9 mm; <em>P</em> = .041). In both cohorts, all patient-reported outcomes and ROM parameters were significantly improved from preoperative baselines. At final follow-up, the aRSA cohort had slightly greater pain scores (1.2 ± 2.3 vs. 0.5 ± 1.0; <em>P</em> = .038) than the control cohort but SSV and American Shoulder and Elbow Surgeons were similar. Similar ROM was achieved between the cohorts. The control cohort had significantly greater improvements in VAS (7.0 ± 2.3 vs. 5.8 ± 3.1; <em>P</em> = .050) and SSV (59.3 ± 25.5 vs. 44.5 ± 22.4; <em>P</em> &lt; .001) compared to the aRSA cohort. There were no differences in complications.</div></div><div><h3>Conclusion</h3><div>RSA with metallic augmented baseplates achieves comparable overall clinical outcomes to non-aRSA at 12-month follow-up, with low revision and complication rates. However, the control cohort demonstrated greater gains in SSV and VAS, whereas the augmented group exhibited greater changes in humeral offset.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 620-627"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685812","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":"Single-stage revision of periprosthetic shoulder arthroplasty infection is more cost effective than two-stage revision: a break-even cost analysis","authors":"Mathangi J. Sridharan MD,&nbsp;Al-Hassan Dajani BS,&nbsp;Andrew R. Jensen MD, MBE","doi":"10.1053/j.sart.2025.04.012","DOIUrl":"10.1053/j.sart.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div><span>Periprosthetic joint infections (PJIs) of the shoulder carry significant financial and functional burdens. No consensus exists on whether a single-stage or two-stage revision surgery protocol is optimal for treatment of shoulder PJI. In this study, we performed a break-even </span>cost analysis to guide clinical decision making between performing single- vs. two-stage revision surgery in treating shoulder PJI.</div></div><div><h3>Methods</h3><div>Institutional cost data were collected for all primary and revision shoulder arthroplasties performed at a single institution from January 2018 to June 2023. A break-even cost analysis equation was used to solve for the reinfection rate at which the cost of a single-stage revision surgery protocol breaks even with the cost of a two-stage revision surgery protocol. Cost variables were derived from institutional data. Rates of complications, both infectious and aseptic, were derived from published studies.</div></div><div><h3>Results</h3><div>The modified equation demonstrated that a 58% reinfection rate of a single-stage revision protocol would be necessary to financially break-even with a two-stage revision surgery protocol. Rates of complications were varied across published ranges to account for clinical variability and demonstrate the breadth of the equation. These variations again yielded break-even rates between 54% and 62%.</div></div><div><h3>Conclusion</h3><div>The reinfection rate at which a single-stage revision surgery for shoulder PJI breaks even with a two-stage revision is approximately 58%, which far exceeds the reinfection rate seen in clinical practice with single-stage revisions. Thus, strictly from a cost perspective, single-stage revision arthroplasty for PJI after shoulder arthroplasty is more cost-effective than a two-stage revision.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 547-552"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685860","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":"Comparison of internal rotation strength after reverse total shoulder arthroplasty without subscapularis repair: lateralized vs. medialized prosthesis design","authors":"Chang Hee Baek MD,&nbsp;Chaemoon Lim MD,&nbsp;Jung Gon Kim MD,&nbsp;Bo Taek Kim MD,&nbsp;Seung Jin Kim MS","doi":"10.1053/j.sart.2025.06.006","DOIUrl":"10.1053/j.sart.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) is an effective treatment option for rotator cuff tear arthropathy. It was reported that lateralized rTSA showed no significant difference whether subscapularis (SSC) was repaired or not. On the other hand, SSC repair has been associated with a lower rate of dislocation and improved internal rotation (IR) in medialized rTSA. To date, no study has directly compared lateralized and medialized rTSA without SSC repair, aiming to clarify the specific effect of lateralized rTSA in this context. The purpose of this retrospective clinical comparative study is to compare the clinical outcomes focused on IR strength between medialized and lateralized rTSA without SSC repair.</div></div><div><h3>Methods</h3><div>This study included patients who underwent rTSA between January 2014 and December 2016, in whom SSC repair was not performed. Among them, patients who received medialized rTSA prosthesis were classified into medialized rTSA group, while those who received lateralized rTSA prosthesis were classified into lateralized rTSA group. Clinical outcomes were assessed using pain scores, patient-reported outcome measures (PROMs), active range of motion, active range of motion strength, and toileting ability. Radiologic outcomes were evaluated as the presence of acromial stress fractures, scapular notching, and loosening of the implanted components on plain radiographs. For comparison of mid-term outcomes, clinical and radiologic outcomes between the two groups were compared at 5 years postoperatively.</div></div><div><h3>Results</h3><div>Fifty-six patients of medialized rTSA group and 58 patients of lateralized rTSA group were included for study population. The clinical results were significantly improved in both groups. There was no significant difference in visual analog scale score and patient-reported outcome measures. Although both groups showed significant improvements in rage of motion, the lateralized rTSA group had significantly better mean postoperative IR at the back (6.8 ± 1.8 vs. 5.7 ± 1.7, <em>P</em> = .001). Although there was no significant difference in the ability to perform toileting activities between the two groups, 69.6% of medialized rTSA group and 69.0% of lateralized rTSA group had a difficulty. Moreover, there was no significant improvement of external rotation strength and IR strength in both groups.</div></div><div><h3>Conclusion</h3><div>Both medialized and lateralized rTSA without SSC repair had no improvement of IR strength, and showed significant difficulty in IR related toileting activities. As a result, lateralized rTSA prosthesis had no advantage in IR strength and IR-related toileting activities in case of SSC nonrepair.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 645-653"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685813","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":"Rate of improvement following reverse shoulder arthroplasty: a comparison of primary and revision reverse shoulder arthroplasty","authors":"Ali A. Mohamed BS, MS ,&nbsp;Devin Q. John MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Aghdas Movassaghi BS ,&nbsp;Diego J.L. Lima MD ,&nbsp;Howard Routman DO ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2025.07.001","DOIUrl":"10.1053/j.sart.2025.07.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;As the incidence of reverse shoulder arthroplasty (rTSA) increases, so do the expected revision rates. Despite this, little is known about postoperative recovery rates following revision rTSA. This study aimed to determine the rate of improvement for patients who underwent revision rTSA compared to patients who underwent primary rTSA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective review of 476 patients who underwent rTSA by a single fellowship-trained shoulder surgeon was conducted. In this cohort, 386 patients underwent primary rTSA and 90 patients underwent revision rTSA. Demographics, range of motion, and outcome scores—including the Simple Shoulder Test, Constant–Murray Score, University of California at Los Angeles Shoulder Score, Shoulder Pain and Disability Index (SPADI), Shoulder Arthroplasty Smart score, and American Shoulder and Elbow Surgeons scores—were collected preoperatively and postoperatively for both cohorts. Outcome scores were collected at 6 weeks, 3 months, 6 months, 12 months, and 24 months. The rate of improvement in each outcome measure was quantified and compared between primary rTSA and revision rTSA, and final follow-up scores were compared between the two groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 476 patients (primary rTSA = 386 patients, revision rTSA = 90 patients) were included in the final analysis. Preoperatively, no baseline differences were observed in patient-reported outcome measures or functional scores between the revision and primary rTSA groups. Postoperatively, both groups demonstrated improvements in outcome scores from their preoperative assessments. When postoperative outcomes were evaluated over time, revision rTSA patients showed lower scores than the primary rTSA cohort as early as 3 months in SPADI (46.6 vs. 58.6; &lt;em&gt;P&lt;/em&gt; = .03) and 6 months for forward elevation (126.3 vs. 141; &lt;em&gt;P&lt;/em&gt; = .04). Between 12 and 24 months, analysis revealed no significant changes in improvement trends for both revision rTSA and primary rTSA groups (&lt;em&gt;P&lt;/em&gt; &gt; .05), indicating that recovery stabilizes after the first year. However, postoperative outcomes collected at final follow-up visit demonstrated that the revision rTSA cohort achieved less favorable results compared to the primary rTSA group. Specifically, the revision rTSA group did not achieve the same level of improvement in Simple Shoulder Test (6.8 vs. 9.2, d = 0.67, &lt;em&gt;P&lt;/em&gt; &lt; .01), University of California at Los Angeles (25.2 vs. 29.8, d = 0.60, &lt;em&gt;P&lt;/em&gt; &lt; .01), American Shoulder and Elbow Surgeons (62.6 vs. 77, d = 0.61, &lt;em&gt;P&lt;/em&gt; = .01), SPADI (50 vs. 30.8, d = 0.60, &lt;em&gt;P&lt;/em&gt; = .01), and Shoulder Arthroplasty Smart (63.2 vs. 71.8, d = 0.53, &lt;em&gt;P&lt;/em&gt; = .02) as observed in the primary rTSA cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Although revision rTSA shows an early recovery pace comparable to primary rTSA, it plateaus at lower absolute patient-reported outcome measure and ","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 662-668"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685807","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 social deprivation status affect the complication profile among patients undergoing total shoulder arthroplasty? A matched cohort analysis","authors":"Akhil Katakam MD ,&nbsp;Tej Joshi MD ,&nbsp;Tuckerman Jones MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Amanda Azer MD ,&nbsp;Sefy A. Paulose MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1053/j.sart.2025.06.004","DOIUrl":"10.1053/j.sart.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Employment, living status, and income level are a few examples of social determinants of health (SDoH). Patients determined to be suffering in any of these SDoH have been previously identified as being socially deprived, which has been associated with numerous poor outcomes following total shoulder arthroplasty (TSA). This study aimed to further clarify the relationship between SDoH and medical and operative outcomes following TSA. We hypothesized that patients classified as being socially deprived would suffer higher medical and orthopedic complications compared to patients without a history of social deprivation.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Research Network database to identify patients with a history of social deprivation who underwent TSA. These patients were propensity score–matched to TSA patients without this exposure using several demographic and comorbidity-related variables. Outcomes assessed included multiple surgery-related, implant-related, and medical-related complications. Kaplan–Meier survival analysis and chi-square testing were used to evaluate outcomes, with results reported as hazard ratios (HRs), 95% confidence intervals, and <em>P</em> values, with significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 2,808 propensity-matched patients (1,404 in each cohort) were analyzed. Within 30 days of surgery, hospital readmissions (HR 1.74, <em>P</em> &lt; .001) and emergency department (ED) visits (HR 1.83, <em>P</em> &lt; .001) were higher in the social deprivation group. Rates of acute kidney injury (AKI) (HR 2.115, <em>P</em> = .004) and urinary tract infections (UTIs) (HR 2.70, <em>P</em> &lt; .001) were also higher within 30 days in the social deprivation group. Dislocation rate was also higher in socially deprived group at 30 days (HR 11.09, <em>P</em> = .004). Readmissions, ED visits, AKI, and UTI rates were also higher at 90 days in this cohort. There was no association with higher adverse postoperative outcomes at 1 year, 2 year, and any time in the socially deprived group.</div></div><div><h3>Conclusion</h3><div>Patients who were classified as socially deprived were associated with more readmissions, ED visits, a higher dislocation rate, and medical complications, including UTI and AKI especially in the short-term postoperative period compared to those who were not classified in this category. This study indicates a link between SDoH and patient postoperative outcomes in the setting of TSA, underscoring the need for surgeon awareness regarding these factors when treating patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 628-635"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685815","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":"Perioperative glucagon-like peptide-1 receptor agonist use is not associated with increased complications in obese patients undergoing total shoulder arthroplasty: a propensity-matched large database study","authors":"Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Rajiv P. Reddy MD ,&nbsp;Mark Megerian MD ,&nbsp;Alexander E. White MD ,&nbsp;Miles Miller BS, MPH ,&nbsp;John M. Apostolakos MD, MPH ,&nbsp;Samuel A. Taylor MD","doi":"10.1053/j.sart.2025.06.001","DOIUrl":"10.1053/j.sart.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Obesity significantly impacts outcomes in shoulder arthroplasty, leading to higher complication rates. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for weight loss and glycemic control, but their perioperative safety in shoulder arthroplasty remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used the TriNetX Network to analyze obese patients (body mass index [BMI] &gt;30 kg/m²) undergoing anatomic or reverse shoulder arthroplasty across 67 health care organizations. Patients were categorized by preoperative GLP-1 RA use and matched 1:1 using propensity scores to balance the cohorts based on demographic variables and comorbid conditions such as age, race, ethnicity, BMI, diabetes, and hypertension. Outcomes assessed at 90 days and 1 year included revision surgery, emergency department visits, readmission, deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury, prosthetic joint stiffness, postoperative rotator cuff tear, mechanical complications, periprosthetic fracture, prosthetic joint infection, surgical site infection, airway aspiration, cardiac arrest, transfusion, and prosthetic joint dislocation.</div></div><div><h3>Results</h3><div>After matching, there were no statistically significant differences between GLP-1 RA users (n = 2,132) and controls at both time points of comparison. Rates of DVT, PE, revision surgery, prosthetic joint stiffness, readmission, emergency department utilization, airway aspiration, and other complications were comparable between groups.</div></div><div><h3>Conclusion</h3><div>Perioperative GLP-1 RA use prior to primary shoulder arthroplasty in obese patients (BMI &gt;30 kg/m²) was not associated with increased risk of DVT, PE, airway aspiration, or other postoperative complications at 90-day or 1-year follow-up. These findings support the perioperative safety of GLP-1 RAs in obese patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 4","pages":"Pages 604-611"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685931","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}