Seminars in Arthroplasty最新文献_第5页

Impact of surgeon variability on outcomes after total shoulder arthroplasty: an analysis of 2188 surgeons 外科医生的差异对全肩关节置换术后疗效的影响：对 2188 名外科医生的分析

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-06-22 DOI: 10.1053/j.sart.2024.05.003

Favian Su MD, Cameron Nosrat BS, Ryan T. Halvorson MD, Drew A. Lansdown MD, Brian T. Feeley MD, C. Benjamin Ma MD, Alan L. Zhang MD

Background

There has been limited evaluation of surgeon-specific factors on outcomes after total shoulder arthroplasty (TSA). The goals of this study were (1) to determine the impact of surgeon procedural volume, career duration, practice type, and fellowship training on TSA outcomes at 2-year follow-up and (2) to evaluate the relative importance of surgeon variables in relation to patient variables in influencing outcomes.

Methods

The PearlDiver Mariner database was queried to identify all surgeons who performed a minimum of 11 TSA procedures from 2010 to 2018. An Internet search of publicly available data was performed to determine the career duration, practice type, and fellowship training of each surgeon. Multivariate logistic regression models were built to determine the relationship between surgeon-specific variables and 2-year surgical complications and revisions and 90-day readmissions. Variable importance of patient-specific and surgeon-specific factors was determined by the Akaike information criterion increase of these models.

Results

A total of 2188 surgeons who performed 93,122 TSA procedures were identified in this database. Higher reverse TSA surgical volume was associated with fewer surgical complications and revisions, although such a relationship was not observed for anatomic TSA. Revision after anatomic TSA was more common among surgeons who were in their first 5 years of practice. There was a higher risk of surgical complication and readmission among academic surgeons, but this did not equate with a higher risk of revision. The impact of these surgeon-specific factors on outcomes was small in relation to patient-level variables, such as age, sex, and number of medical comorbidities.

Conclusion

Surgeon procedural volume, career duration, and practice setting influence the surgical complication, revision, and readmission rates after TSA. The impact of surgeon factors was small relative to patient variables, highlighting the importance of patient selection in mitigating adverse outcomes.

背景对外科医生特异性因素对全肩关节置换术（TSA）术后疗效的影响评估有限。本研究的目标是：(1) 确定外科医生的手术量、职业生涯时间、执业类型和研究员培训对 2 年随访时 TSA 结果的影响；(2) 评估外科医生变量与患者变量在影响结果方面的相对重要性。对公开数据进行了互联网搜索，以确定每位外科医生的职业生涯时间、执业类型和奖学金培训情况。建立了多变量逻辑回归模型，以确定外科医生特异性变量与 2 年手术并发症、翻修和 90 天再入院之间的关系。患者特异性因素和外科医生特异性因素的变量重要性由这些模型的 Akaike 信息标准增加值决定。较高的反向 TSA 手术量与较少的手术并发症和翻修率有关，但在解剖 TSA 中未观察到这种关系。解剖型TSA术后翻修在开业5年以内的外科医生中更为常见。学术型外科医生的手术并发症和再入院风险较高，但这并不等同于翻修风险较高。与患者层面的变量（如年龄、性别和合并症数量）相比，这些外科医生特异性因素对结果的影响较小。相对于患者变量，外科医生因素的影响较小，这凸显了选择患者对减轻不良后果的重要性。

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引用次数: 0

Effect of glenosphere diameter and lateralization in primary reverse shoulder arthroplasty: a randomized clinical trial 初次反向肩关节置换术中关节盂直径和侧移的影响：随机临床试验

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-29 DOI: 10.1053/j.sart.2024.04.008

Erick M. Marigi MD , Ronda N. Esper BSc , Dirk R. Larson MS , Mark E. Morrey MD , Joaquin Sanchez-Sotelo MD, PhD

Background

Within reverse total shoulder arthroplasty (RSA), prior studies have suggested that smaller glenosphere diameters may result in higher rates of scapular notching and polyethylene wear, while lateralized glenospheres may allow for better range of motion (ROM); however, supportive data remains limited. Therefore, the purpose of this study was to report the outcomes of a prospective randomized clinical trial comparing 4 different glenosphere configurations based on diameter and lateral offset.

Methods

Between 2016 and 2020, 113 primary RSAs with a diagnosis of either rotator cuff tear arthropathy (n = 48, 42%), irreparable rotator cuff tears (n = 22, 19%), or primary glenohumeral osteoarthritis with subluxation or glenoid bone loss (n = 43, 38%) were enrolled into a blinded prospective randomized clinical trial. The mean age of the patients included in the study was 73 ± 7 (range, 50-89) years, and 58 (51.3%) were males. All procedures were performed by two surgeons utilizing the ReUnion RSA system (Stryker, Mahwah, NJ, USA). Patients were randomized into four possible groups based on the diameter and lateral offset of the glenosphere implanted: 36 mm diameter with 2 mm (n = 34, 30.1%) or 6 mm (n = 28, 24.8%) of lateralization and 40 mm diameter with 2 mm (n = 29, 25.7%) or 6 mm (n = 22, 19.5%) of lateralization. Outcomes collected included pain, active ROM, strength, satisfaction, patient-reported outcome measures (PROMs), complications, reoperations, and revisions. PROMs included the Oxford Shoulder Score, the American Shoulder and Elbow Surgeons, and the quick Disabilities of the Arm, Shoulder and Hand questionnaire. All patients were followed for a minimum of 2 years.

Results

With the numbers available, glenosphere diameter and lateralization resulted in no differences in pain, ROM, strength, satisfaction, and PROMs at 1 year, 2 years, or final follow-up (All P > .05). However, all 3 complications (10.7% vs. 0% vs. 0% vs. 0%; P = .025) and 2 revision surgeries (7.1% vs. 0% vs. 0% vs. 0%; P = .103) occurred in males, with the 36 + 6 cohort.

Conclusions

Using this particular RSA design, implantation of glenospheres with 36 mm or 40 mm of diameter and 2 mm or 6 mm of sphere lateralization did not translate into significant differences when primary RSA was performed in shoulders with rotator cuff tear arthropathy, irreparable cuff tears, or primary glenohumeral osteoarthritis. However, all observed complications occurred in males with the smallest diameter and lateralized glenosphere.

背景在反向全肩关节置换术（RSA）中，先前的研究表明，较小的关节囊直径可能会导致较高的肩胛骨切迹率和聚乙烯磨损率，而侧向化的关节囊可能会获得更好的运动范围（ROM）；然而，支持性数据仍然有限。因此，本研究旨在报告一项前瞻性随机临床试验的结果，该试验比较了基于直径和侧向偏移的 4 种不同的关节囊配置。方法在2016年至2020年间，113名诊断为肩袖撕裂关节病（48人，占42%）、肩袖撕裂不可修复（22人，占19%）或原发性盂肱骨关节炎伴脱位或盂骨缺损（43人，占38%）的原发性RSA患者被纳入一项盲法前瞻性随机临床试验。研究对象的平均年龄为 73 ± 7（50-89）岁，男性 58 人（51.3%）。所有手术均由两名外科医生使用 ReUnion RSA 系统（史赛克，美国新泽西州马华市）进行。根据植入的关节盂直径和外侧偏移量，患者被随机分为四组：直径 36 毫米，外侧偏移量为 2 毫米（34 人，30.1%）或 6 毫米（28 人，24.8%）；直径 40 毫米，外侧偏移量为 2 毫米（29 人，25.7%）或 6 毫米（22 人，19.5%）。收集的结果包括疼痛、活动度、力量、满意度、患者报告结果指标（PROMs）、并发症、再次手术和翻修。PROM包括牛津肩关节评分、美国肩肘外科医生评分以及快速手臂、肩部和手部残疾问卷。所有患者均接受了至少 2 年的随访。结果根据现有数据，在 1 年、2 年或最终随访中，关节盂直径和侧移在疼痛、关节活动度、力量、满意度和 PROMs 方面均无差异（所有 P 均为 0.05）。然而，在 36+6 队列中，所有 3 例并发症（10.7% vs. 0% vs. 0% vs. 0%；P = .025）和 2 例翻修手术（7.1% vs. 0% vs. 0%；P = .103）均发生在男性身上。结论采用这种特殊的RSA设计，在肩袖撕裂关节病、不可修复的肩袖撕裂或原发性盂肱骨关节炎的肩部进行初级RSA时，植入直径为36毫米或40毫米、球体侧向为2毫米或6毫米的盂球不会产生显著差异。然而，所有观察到的并发症都发生在具有最小直径和侧化盂球的男性身上。

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引用次数: 0

Stemless RSA shows good short-term radiological stability and clinical outcomes in elderly patients 无茎 RSA 在老年患者中显示出良好的短期放射学稳定性和临床疗效

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-29 DOI: 10.1053/j.sart.2024.04.010

Maxime Antoni MD , Pierre Alban Bouche MD, PhD , Laurent Obert MD, PhD , Alexandre Quemener MD , Geoffroy Nourissat MD, PhD

Background

The main goal of this study was to investigate the influence of patient age on humeral implant fixation in stemless reverse shoulder arthroplasty (RSA). The secondary goals were to investigate the influence on the occurrence of complications and on clinical outcomes.

Methods

We performed a retrospective multicenter study, including a series of patients operated on for stemless RSA. All patients were reviewed at a minimum of 2 years, with clinical and radiographic evaluation. The primary endpoint was the occurrence of migration of the humeral implant at the final follow-up. Secondary endpoints were clinical scores, occurrence of postoperative complications, need for revision surgery, and radiographic changes. Each patient ≥70 year old was matched on gender and body mass index,with a patient < 70 year old on a 1:1 basis.

Results

Forty-five patients aged ≥70 years were included and matched, with 45 patients aged <70 years, giving a total of 90 patients (54.4% men) with the mean age being 68.5 ± 7.9 years. There was no difference between the 2 groups in terms of surgical modalities. There was no correlation between age and clinical outcomes. Three migrations of the humeral implant occurred, none leading to a revision, without any influence of age (P = 1.0). We found no correlation between patient age and the occurrence of a postoperative complication (P = 1.0), reoperation (P = 1.0) or any of the other radiographic parameters assessed.

Conclusion

This study reported the stability of stemless RSA implants in elderly patients. Clinical outcomes, complication, and revision rates were not affected by age either.

背景本研究的主要目的是调查患者年龄对无柄反向肩关节置换术（RSA）中肱骨假体固定的影响。我们进行了一项回顾性多中心研究，其中包括一系列接受无柄反向肩关节置换术的患者。我们对所有患者进行了至少两年的复查，并进行了临床和放射学评估。主要终点是最后随访时肱骨假体是否发生移位。次要终点是临床评分、术后并发症发生率、翻修手术需求和放射学变化。结果45名年龄≥70岁的患者与45名年龄为70岁的患者进行了配对，共有90名患者（54.4%为男性），平均年龄为（68.5 ± 7.9）岁。两组患者在手术方式上没有差异。年龄与临床结果之间没有相关性。肱骨假体发生了三次移位，均未导致翻修，与年龄无关（P = 1.0）。我们发现患者年龄与术后并发症（P = 1.0）、再次手术（P = 1.0）或任何其他放射学评估参数之间均无相关性。临床结果、并发症和翻修率也不受年龄影响。

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引用次数: 0

Bilateral aseptic loosening of glenoid and humeral components after anatomic shoulder arthroplasty: a case report 解剖肩关节置换术后盂和肱骨组件双侧无菌性松动：病例报告

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-29 DOI: 10.1053/j.sart.2024.04.009

Nathan Sherman MD, MBA , Robert V. Childers MS , Bryn Nisbet MD , Andrew Knox PA , Andrew Mahoney MD

引用次数: 0

In vitro analysis of various antibiotic and cement combinations against S. epidermidis and S. lugdunensis for treatment of periprosthetic shoulder infection 针对表皮葡萄球菌和卢格杜纳菌的各种抗生素和骨水泥组合用于治疗假体周围肩关节感染的体外分析

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-20 DOI: 10.1053/j.sart.2024.04.007

Background

Periprosthetic joint infections (PJIs) are devastating potential complications after arthroplasty surgery with significant therapeutic challenges. Many authors advocate for two-stage revision arthroplasty for PJI of the shoulder which includes explanation with antibiotic spacer placement. The optimal antibiotic/cement combination for PJI in the shoulder is not known. The purpose of this study is to analyze various cement and antibiotic concentrations against Coagulase negative staphylococcus species, S. epidermidis and S. lugdunensis.

Methods

Five strains of coagulase negative Staph were taken from clinically documented orthopedic infections Both Simplex and Palacos cement were used to create antibiotic laden beads and mixed with either ertapenem, vancomycin, gentamicin, or a combination of ertapenem + vancomycin or ertapenem + gentamicin. The bacteria were plated on lysogeny broth agar plates and 3 beads were added per plate. Samples were analyzed for zone of inhibition at 24 hours, 72 hours, and 1 week. After 1 week, beads were transferred to new plates with bacteria and the process was repeated for 6 weeks.

Results

Results showed that ertapenem beads with both Simplex and Palacos cement showed the largest zones of inhibition for all samples. Vancomycin in Palacos cement and vancomycin in combination with ertapenem in Simplex and Palacos cement showed consistent zones of inhibition for the duration of the experiments. Ertapenem in combination with either vancomycin or gentamicin may allow for a powerful initial burst of killing followed by consistent antibiotic elution as opposed to gentamicin alone.

Conclusion

While many premade spacers on the market are infused with gentamicin, our in vitro models demonstrate more efficacious bacterial eradication for antibiotics such as ertapenem and vancomycin specifically for certain low virulence organisms that are commonly found in PJI around the shoulder.

背景假体关节感染（PJI）是关节置换手术后具有破坏性的潜在并发症，治疗难度很大。许多学者主张对肩关节 PJI 进行两阶段翻修关节置换术，其中包括对抗生素垫片置入进行解释。目前尚不清楚治疗肩关节 PJI 的最佳抗生素/水泥组合。本研究的目的是分析各种骨水泥和抗生素浓度对凝固酶阴性葡萄球菌、表皮葡萄球菌和卢格杜南葡萄球菌的作用。方法从临床记录的骨科感染病例中提取五株凝固酶阴性葡萄球菌，用 Simplex 和 Palacos 水泥制成含抗生素的微珠，并与厄他培南、万古霉素、庆大霉素或厄他培南+万古霉素或厄他培南+庆大霉素的组合混合。将细菌培养在溶菌肉汤琼脂平板上，每个平板加入 3 个微珠。分别在 24 小时、72 小时和 1 周后分析样品的抑菌区。结果结果表明，在所有样品中，使用 Simplex 和 Palacos 水泥的厄他培南珠显示出最大的抑菌区。Palacos 水泥中的万古霉素以及 Simplex 和 Palacos 水泥中万古霉素与厄他培南的组合在实验期间显示出一致的抑菌区。与单独使用庆大霉素相比，厄他培南与万古霉素或庆大霉素联合使用可能会产生强大的初始杀伤力，随后抗生素会被持续洗脱。结论虽然市场上许多预制垫片都注入了庆大霉素，但我们的体外模型显示，厄他培南和万古霉素等抗生素对肩周炎中常见的某些低毒性微生物的杀灭效果更好。

{"title":"In vitro analysis of various antibiotic and cement combinations against S. epidermidis and S. lugdunensis for treatment of periprosthetic shoulder infection","authors":"","doi":"10.1053/j.sart.2024.04.007","DOIUrl":"10.1053/j.sart.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p><span><span><span>Periprosthetic joint infections (PJIs) are devastating potential complications after </span>arthroplasty<span> surgery with significant therapeutic challenges. Many authors advocate for two-stage revision arthroplasty<span> for PJI of the shoulder which includes explanation with antibiotic spacer placement. The optimal antibiotic/cement combination for PJI in the shoulder is not known. The purpose of this study is to analyze various cement and antibiotic concentrations against </span></span></span>Coagulase negative staphylococcus species, </span><span><span>S. epidermidis</span></span> and <em>S. lugdunensis</em>.</p></div><div><h3>Methods</h3><p><span>Five strains of coagulase negative </span><em>Staph</em><span> were taken from clinically documented orthopedic infections<span><span><span> Both Simplex and Palacos cement were used to create antibiotic laden beads and mixed with either </span>ertapenem, </span>vancomycin<span>, gentamicin<span>, or a combination of ertapenem<span> + vancomycin<span> or ertapenem + gentamicin. The bacteria were plated on lysogeny broth agar plates and 3 beads were added per plate. Samples were analyzed for zone of inhibition at 24 hours, 72 hours, and 1 week. After 1 week, beads were transferred to new plates with bacteria and the process was repeated for 6 weeks.</span></span></span></span></span></span></p></div><div><h3>Results</h3><p>Results showed that ertapenem beads with both Simplex and Palacos cement showed the largest zones of inhibition for all samples. Vancomycin in Palacos cement and vancomycin in combination with ertapenem in Simplex and Palacos cement showed consistent zones of inhibition for the duration of the experiments. Ertapenem in combination with either vancomycin or gentamicin may allow for a powerful initial burst of killing followed by consistent antibiotic elution as opposed to gentamicin alone.</p></div><div><h3>Conclusion</h3><p>While many premade spacers on the market are infused with gentamicin, our in vitro models demonstrate more efficacious bacterial eradication for antibiotics such as ertapenem and vancomycin specifically for certain low virulence organisms that are commonly found in PJI around the shoulder.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 738-745"},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141141749","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

Update from the Editors-in-Chief 主编的最新消息

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-20 DOI: 10.1053/j.sart.2023.09.002

J. Michael Wiater MD, Theodore A. Blaine MD

引用次数: 0

The effect of social deprivation on hospital utilization following shoulder arthroplasty 社会贫困对肩关节置换术后住院率的影响

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-18 DOI: 10.1053/j.sart.2024.04.005

Background

Disparities in social determinants of health have been linked to worse patient-reported outcomes and higher rates of hospital readmission following shoulder arthroplasty. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized in the context of shoulder arthroplasty.

Methods

A retrospective review was performed from of a single institution’s experience with primary shoulder arthroplasty between 2012 and 2020. Demographic variables (age, race, and legal sex) and healthcare utilization (hospital readmission, emergency department (ED) visits, follow-up visits, and telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on Area Deprivation Index tercile and compared.

Results

A total of 780 patients were included. The least, intermediate, and most deprived groups consisted of 195, 371, and 214 patients, respectively. The level of social deprivation was not a predictor of increased healthcare utilization through readmission, the ED, or the outpatient clinic. Identifying as Black or African American was an independent predictor of readmission and ED visitation. Female sex was an independent predictor of increased postoperative telephone calls.

Conclusion

Patients undergoing shoulder arthroplasty have similar use of hospital resources regardless of their level of social deprivation. We hope these results can be used to guide clinical decision-making, increase transparency, and manage patient outcomes following shoulder arthroplasty surgery.

背景健康的社会决定因素方面的差异与肩关节置换术后患者报告的较差结果和较高的再入院率有关。对于外科医生来说，识别围手术期医疗利用率增加的预测因素对改善治疗效果和降低医疗总成本尤为重要。在肩关节置换术中，社会贫困对医疗利用率的影响尚未完全定性。方法：我们对一家医疗机构在 2012 年至 2020 年间的主要肩关节置换术经验进行了回顾性研究。记录了手术后 90 天内的人口统计学变量（年龄、种族和法定性别）和医疗保健使用情况（再入院、急诊科就诊、复诊和电话呼叫）。记录地区贫困指数，并根据患者的相对社会贫困程度将其分为三等分。然后根据地区贫困指数的三等分进行分层，并对结果进行比较。最贫困组、中等贫困组和最贫困组分别有 195 名、371 名和 214 名患者。社会贫困程度并不能预测再次入院、急诊室或门诊的医疗使用率。黑人或非裔美国人身份是再入院和急诊室就诊的独立预测因素。结论接受肩关节置换术的患者无论其社会贫困程度如何，对医院资源的使用情况都相似。我们希望这些结果能用于指导临床决策、增加透明度和管理肩关节置换术后的患者预后。

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引用次数: 0

Finite element analysis of acromial fracture after reverse total shoulder arthroplasty 反向全肩关节置换术后肩峰骨折的有限元分析

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-18 DOI: 10.1053/j.sart.2024.04.004

Background

The prevalence of acromial fracture after reverse total shoulder arthroplasty (RSA) is reportedly 2.6%-8.4%, and clinical outcomes differ among fracture sites. However, few studies have investigated the factors affecting fracture sites. This study aimed to reproduce acromial fractures after RSA by replicating the postoperative displacement of the humerus using finite element models (FEMs), and to investigate the effect of humeral displacement on the fracture site.

Methods

Six patients (mean age, 76.3 ± 7.9 years; 5 women and 1 man) with acromial fractures after RSA treated at our institution were included. Among them, 3 had Levy Type 1 fractures, whereas the other 3 had Levy Type 2 fractures. Preoperative computed tomography data were used to create a 3-dimensional FEM. All elements within the proximal 2 cm of the clavicle and the scapular body were completely constrained. The entire humerus was forcibly displaced following its displacement after RSA, as measured by preoperative and postoperative computed tomography. The fracture sites, total displacement, external constraint of the humerus at the initial fracture, and bone density from the acromion to the scapular spine were investigated. Values of P < .05 were considered statistically significant in tests of statistical inference but were interpreted as reference values due to the small number of cases.

Results

There were no major differences in humeral displacement between Type 1 and Type 2 fractures. Although the fracture sites in the FEM were slightly more medial than the actual fracture sites, they were similar. The total displacement and external constraint of the humerus at the initial fracture were similar in Type 1 and Type 2 fractures. The distribution of bone density from the acromion to the scapular spine differed between fracture types.

Conclusion

We were able to reproduce acromial fractures after RSA by replicating humeral displacement using FEM. The extent and direction of humeral displacement may not significantly affect the acromial fracture site, whereas the bone density distribution from the acromion to the scapular spine may affect it.

背景据报道，反向全肩关节置换术（RSA）后肩峰骨折的发生率为 2.6%-8.4%，不同骨折部位的临床结果也不尽相同。然而，很少有研究对影响骨折部位的因素进行调查。本研究旨在通过使用有限元模型（FEM）复制术后肱骨的移位，重现RSA术后肱骨肩峰骨折的情况，并研究肱骨移位对骨折部位的影响。方法纳入在我院接受治疗的6例RSA术后肱骨肩峰骨折患者（平均年龄76.3±7.9岁；5名女性和1名男性）。其中3例为Levy 1型骨折，另外3例为Levy 2型骨折。术前计算机断层扫描数据用于创建三维有限元模型。锁骨近端2厘米范围内的所有元素和肩胛体都被完全限制。根据术前和术后计算机断层扫描的测量结果，整个肱骨在RSA术后移位后被强制移位。对骨折部位、总移位量、骨折初期肱骨的外部约束以及肩峰至肩胛骨棘的骨密度进行了研究。结果1型和2型骨折的肱骨移位没有明显差异。虽然有限元模型中的骨折部位比实际骨折部位稍偏内侧，但两者相似。1型和2型骨折的肱骨总移位和初始骨折时的外部约束相似。从肩峰到肩胛骨脊柱的骨密度分布在不同骨折类型之间存在差异。肱骨移位的程度和方向可能不会对肩峰骨折部位产生明显影响，而肩峰至肩胛骨棘的骨密度分布可能会对其产生影响。

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引用次数: 0

The role of smoking status on survivorship and clinical outcomes following total shoulder arthroplasty 吸烟状况对全肩关节置换术后存活率和临床效果的影响

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-18 DOI: 10.1053/j.sart.2024.04.006

Background

Smoking has been strongly associated with poor healing and worse outcomes following various joint arthroplasties, including worse functional measurements and increased complication rates. While smoking is associated with adverse events and complications in shoulder arthroplasty, the role of smoking in functional measurements and patient-reported outcomes (PROs) remains to be fully characterized.

Methods

Institutional electronic medical records were used to study patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) between 2009 and 2020 with at least 2 years of follow-up. Patients were called to obtain PROs. Patients were stratified into 3 cohorts, by tobacco smoking status: current, former, and never smokers.

Results

Among 498 patients who underwent TSA, 280 were aTSAs and 218 were rTSAs. Within aTSAs, 28 patients were classified as current, 99 as former, and 153 as never smokers. In rTSAs, 20 were current, 68 were former, and 130 were never smokers. Current smokers were younger at the time of surgery than former and never smokers in both aTSA (current: 58.8 ± 8.5; former: 63.9 ± 9.2; never: 62.8 ± 9.0 years; P = .031) and rTSA (current: 59.0 ± 6.8; former: 68.5 ± 7.2; never: 69.0 ± 9.0 years; P < .001). Furthermore, current smokers experienced lower 5-year implant survival in aTSA (current: 84.3%; former: 98.8%; never: 95.0%; P = .015) and rTSA (current: 82.4%; former: 94.5%; never: 94.1%; P = .004). No differences were found among the 3 cohorts for preoperative range of motion (ROM) and strength, or postoperative ROM and strength in the aTSA cohort. rTSA preoperative measurements demonstrated no differences in ROM and strength, and only postoperative forward elevation strength and external rotation strength were found to be different. PROs were found to be of similar magnitude for all patients in the aTSA and rTSA groups.

Conclusion

The findings of this study indicate that current smokers exhibited a higher likelihood of necessitating TSA at a younger age and had higher implant failure rates. However, functional measurements were only marginally affected by smoking status.

背景吸烟与各种关节置换术后的愈合不良和更差的预后密切相关，包括更差的功能测量和更高的并发症发生率。虽然吸烟与肩关节置换术中的不良事件和并发症有关，但吸烟在功能测量和患者报告结果（PROs）中的作用仍有待全面研究。方法使用机构电子病历对 2009 年至 2020 年间接受过初级解剖全肩关节置换术（aTSA）和反向 TSA（rTSA）且随访至少 2 年的患者进行研究。研究人员致电患者以获得其 PROs。患者按吸烟状况分为3个组群：目前吸烟者、曾经吸烟者和从不吸烟者。结果在498名接受TSA的患者中，280名是aTSA，218名是rTSA。在 aTSA 中，28 名患者被归类为当前吸烟者，99 名患者被归类为曾经吸烟者，153 名患者被归类为从不吸烟者。在 rTSA 中，有 20 名患者目前吸烟，68 名患者曾经吸烟，130 名患者从未吸烟。在 aTSA（目前吸烟者：58.8 ± 8.5 岁；曾经吸烟者：63.9 ± 9.2 岁；从不吸烟者：62.8 ± 9.0 岁；P = .031）和 rTSA（目前吸烟者：59.0 ± 6.8 岁；曾经吸烟者：68.5 ± 7.2 岁；从不吸烟者：69.0 ± 9.0 岁；P <.001）中，目前吸烟者在手术时的年龄比曾经吸烟者和从不吸烟者年轻。此外，在 aTSA（目前：84.3%；曾经：98.8%；从未：95.0%；P = .015）和 rTSA（目前：82.4%；曾经：94.5%；从未：94.1%；P = .004）中，目前吸烟者的 5 年植入存活率较低。在 aTSA 组群中，术前活动范围 (ROM) 和力量以及术后 ROM 和力量在 3 个组群中没有发现差异；在 rTSA 组群中，术前测量结果显示 ROM 和力量没有差异，只有术后前抬力量和外旋力量有差异。结论本研究结果表明，目前吸烟的患者在较年轻时需要进行TSA的可能性较高，植入失败率也较高。然而，功能测量结果受吸烟状况的影响很小。

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引用次数: 0

Distalization and lateralization shoulder angles: do they have a role in predicting postoperative clinical outcomes? 肩关节远端化和外侧化角度：它们在预测术后临床结果方面有作用吗？

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-05-18 DOI: 10.1053/j.sart.2024.04.003

Background

Lateralization Shoulder Angle (LSA) and Distalization Shoulder Angle (DSA) have been proposed to estimate the appropriateness of reverse shoulder arthroplasty (RSA) positioning. The purpose of this study was to evaluate the predictive value of DSA and LSA over clinical outcomes in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up.

Methods

A retrospective analysis of a consecutive series of RSAs performed between 2017 and 2021 was carried out. Inclusion criteria were primary RSA as a treatment for Cuff Tear Arthropathy, Massive Irreparable rotator cuff tear, Osteoarthritis or Rheumatoid arthritis, a true anteroposterior radiograph of the affected shoulder in neutral rotation at final follow-up, a minimum follow-up of 12 months, radiograph used to measure the angles, and clinical evaluation with the same follow-up. Outcome measures were shoulder range of motion (ROM), visual analog scale (VAS) for pain and Constant-Murley score (CS).

Results

A total of 83 patients were included in the study. Patients achieved on average, 130 ± 14.14° of flexion, 97.5 ± 17.67° of abduction, 62.5 ± 3.53° and 72.5 ± 10.60° of external rotation, respectively, at 0° and 90° of abduction, and 5.13° of internal rotation. The mean VAS and CS were, respectively, 2.5 ± 3.5 mm and 69 ± 2.82 points at last follow-up. The mean DSA and LSA were 45 ± 2.72 and 92.99 ± 9.17, respectively. Neither the linear nor the quadratic regression fit for DSA or LSA revealed relevant associations with any of individual ROM measures, except for the quadratic fit correlating LSA and forward flexion (beta = 0.029, P = .027). Linear fit showed a low reverse, but significant, association between DSA and VAS (beta = −0.56, P = .036) and an association of LSA with both CS (beta = −0.344, P = .009) and VAS (beta = 0.091, P = .01). Quadratic models showed higher R squared for all associations, but correlation was significant only between VAS and LSA (beta = 0.006, P = .011)

Conclusion

We present the first evaluation of the predictive value of both DSA and LSA in a group of patients treated by the same surgeon with the same clinical and radiographic follow-up. DSA and LSA play only a marginal to no role in the prediction of RSA postoperative ROM and might have a role in predicting VAS and CS.

背景肩关节外侧化角度（LSA）和肩关节远端化角度（DSA）已被提出用于评估反向肩关节置换术（RSA）定位的适当性。本研究旨在评估DSA和LSA对同一外科医生治疗的一组患者临床结果的预测价值，并进行相同的临床和放射学随访。纳入标准包括：作为肩袖撕裂性关节病、肩袖大面积撕裂、骨关节炎或类风湿性关节炎的主要治疗方法的RSA，最终随访时患肩中立位旋转的真实前后位X光片，至少12个月的随访，用于测量角度的X光片，以及相同随访的临床评估。衡量结果的指标包括肩关节活动范围（ROM）、疼痛视觉模拟量表（VAS）和康斯坦茨-默里评分（CS）。在外展 0° 和 90° 时，患者平均分别实现了 130 ± 14.14° 的屈曲、97.5 ± 17.67° 的外展、62.5 ± 3.53° 和 72.5 ± 10.60° 的外旋以及 5.13° 的内旋。最后一次随访时，平均 VAS 和 CS 分别为 2.5 ± 3.5 mm 和 69 ± 2.82 分。DSA和LSA的平均值分别为（45 ± 2.72）和（92.99 ± 9.17）。DSA或LSA的线性回归拟合和二次回归拟合均未显示与任何单项ROM测量相关，只有LSA和前屈的二次拟合相关（β=0.029，P=0.027）。线性拟合结果显示，DSA 与 VAS 之间的反向关联度较低，但具有显著性（β = -0.56，P = 0.036），LSA 与 CS（β = -0.344，P = 0.009）和 VAS（β = 0.091，P = 0.01）均有关联。四元模型显示所有相关性的 R 平方都较高，但只有 VAS 和 LSA 之间的相关性显著（beta = 0.006，P = .011）。DSA和LSA在预测RSA术后ROM方面作用微弱甚至没有作用，但在预测VAS和CS方面可能有作用。

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