Seminars in Arthroplasty最新文献

{"title":"Os acromiale: functional consequences in reverse total shoulder arthroplasty","authors":"Jean Gaillard MD ,&nbsp;Julien Berhouet MD, PhD ,&nbsp;Romain Lancigu MD ,&nbsp;Laurent Baverel MD ,&nbsp;Florent Lespagnol MD ,&nbsp;Florent Jamard MD ,&nbsp;Vincent Crenn MD, PhD","doi":"10.1053/j.sart.2025.09.014","DOIUrl":"10.1053/j.sart.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Deltoid tension and stress applied to the acromion are exacerbated after reverse total shoulder arthroplasty (rTSA): an os acromiale could alter postoperative functional outcome. The primary objective was to investigate whether os acromiale influenced the functional outcome of rTSA at 12 and 24 months postoperatively. The secondary objective was to investigate whether the type of os acromiale (preacromion, mesoacromion, and meta-acromion) had an influence on the functional outcome of rTSA at 2 years postoperatively, on the occurrence of tilt of the acromion after rTSA and the consequences of this tilt on functional outcome.</div></div><div><h3>Methods</h3><div>This observational, retrospective, and multicenter study enrolled 378 patients, including 46 patients with an os acromiale, matched for statistical analysis into 2 groups (ratio 1:3). Functional outcome was assessed at 12 and 24 months postoperatively using the Constant–Murley Score (CMS). The tilt of the acromion was checked on control radiographs at 12 and 24 months postoperatively.</div></div><div><h3>Results</h3><div>The presence of an os acromiale was associated with an inferior functional outcome compared with patients with a “healthy acromion” at 12 months (CMS: 62.9 ± 12.1 vs. 67.5 ± 9.8; <em>P</em> = .025) and at 24 months postoperatively (CMS: 68.2 ± 11.8 vs. 73.5 ± 10.0; <em>P</em> = .011), with a decrease in abduction strength. The “mesoacromion” group (n = 18) had lower mean CMS at 12 months (59.9 ± 13.5 vs. 67.5 ± 9.8; <em>P</em> = .032) and 24 months (65.0 ± 13.6 vs. 73.5 ± 10.0; <em>P</em> = .020) postoperatively compared with the “healthy acromion” group. Tilt of the acromion, visualized in 50% (n = 23) of patients with an os acromiale, was more frequently found in the “mesoacromion” group (<em>P</em> = .002), with no consequence on CMS at 12 months (65.2 ± 11.8 vs. 62.6 ± 12.6; <em>P</em> = .986) and 24 months (67.5 ± 11.8 vs. 68.3 ± 12.2; <em>P</em> = .836).</div></div><div><h3>Conclusion</h3><div>The presence of an os acromiale could decrease the functional outcome of patients undergoing rTSA, particularly abduction strength at 12 and 24 months. The mesoacromion, compared with the preacromion, could reduce functional outcome and increase the risk of acromion tilt at 24 months. Nevertheless, in clinical practice, the decrease in functional outcome appears to be slight and requires further examination through additional studies. The value of intraoperative prophylactic stabilization of a mesoacromion and adapted postoperative rehabilitation should also be evaluated to optimize recovery of the shoulder abductor apparatus.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151514"},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798470","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":"Computed tomography density of the acromion prior to reverse total shoulder arthroplasty","authors":"Shu Su MBBS/BMedSci, MMed, FRANZCR ,&nbsp;Sarah Warby PhD, BPhysio(Hon) ,&nbsp;Xiao Chen MBBS, MMed, FRANZCR ,&nbsp;Julie Tate BSc(Hons), PgCert(CT) ,&nbsp;Gregory Hoy FRACS, FAOrthA, FACSEP, FASMF ,&nbsp;Warwick Wright MBBS, FRACS(Orth), DipAnat, DipComSci ,&nbsp;Shane Barwood MBBS, FRACS(Orth) ,&nbsp;Brendan Soo MBBS, FRACS(Orth) ,&nbsp;Richard Dallalana MBBS, FRACS, FAOrthA ,&nbsp;Andrew H. Rotstein MBBS, FRANZCR","doi":"10.1053/j.sart.2025.09.011","DOIUrl":"10.1053/j.sart.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Acromial stress fracture (ASF) is an acknowledged complication of reverse total shoulder arthroplasty (rTSA). Many potential causes for ASF have been theorized, the most well-established being osteoporosis, however few studies directly measure acromion density in patients planned for rTSA. This study aims to compare the acromial density between patients planned for rTSA, age and gender-matched controls and young gender-matched controls on computed tomography (CT) imaging.</div></div><div><h3>Methods</h3><div>Three groups were selected; (i) patients planned for rTSA (n = 25), (ii) age and gender-matched controls (n = 25), and (iii) young gender-matched controls less than 50 years old (n = 28). The density of the mid and posterior acromion was measured on CT using an established reliable method. One-way ANOVA was used to compare the mean differences in mid acromion and posterior acromion densities between all 3 groups. Post hoc comparisons between groups were performed using least significant difference. Significance was set at 0.05.</div></div><div><h3>Results</h3><div>There was a significant difference in bone density at the mid acromion between the 3 groups (<em>P</em> value &lt;.001). Post hoc analysis showed higher density in the planned rTSA group compared to age and gender-matched controls (<em>P</em> value = .002), and lower density in the planned rTSA compared to young gender-matched controls (<em>P</em> value &lt;.001). There was a significant difference in bone density at the posterior acromion between the 3 groups (<em>P</em> value &lt;.001). Post hoc analysis showed lower density in the planned rTSA compared to young gender-matched controls (<em>P</em> value &lt;.001).</div></div><div><h3>Conclusion</h3><div>The CT density of the mid and posterior acromion is highest in the young gender-matched control group, as well as higher in the mid acromion of patients planned for rTSA compared to age and gender-matched controls. Future studies of acromion density in patients with ASF post rTSA would assist in understanding the mechanisms responsible for the pathology.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151511"},"PeriodicalIF":0.0,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749324","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":"Use of patient-specific instrumentation for humeral osteotomy during anatomic shoulder arthroplasty leads to accurate recreation of the center of rotation","authors":"Lukas Dommer MD ,&nbsp;Kira Zumstein MD ,&nbsp;J Tomás Rojas MD ,&nbsp;Annabel Hayoz MSc ,&nbsp;Matthias A. Zumstein MD","doi":"10.1053/j.sart.2025.09.013","DOIUrl":"10.1053/j.sart.2025.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Correct restoration of proximal humeral anatomy (RPHA) after anatomic total shoulder arthroplasty (aTSA) has led to better clinical outcomes and survival rates. A recent study defined the achievement of RPHA as a deviation of the center of rotation from preoperative to postoperative of less than 3 mm and found that using 3-dimensional (3D) planning with standard cutting guides does not achieve this in 65% of the cases. The study aimed to radiographically measure the RPHA after implantation of aTSA using 3D planning and patient-specific instrumentation (PSI) for the humeral osteotomy. The second aim was to analyze the deviation between planned and postoperative parameters.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study 24 consecutive patients who underwent aTSA using 3D-planning including PSI for the humeral osteotomy were radiographically assessed using preoperative and postoperative standardized anteroposterior radiographs. The premorbid center of rotation (COR) was established using the circle method described by Youderian et al and a preoperative to postoperative deviation of ≤3 mm of the COR was considered a precise RPHA. Based on this, 2 groups were created (precise: ≤3 mm, nonprecise: &gt;3 mm). Additionally, the deviation between the planned- and postoperative values of neck–shaft angle (NSA), humeral head height and humeral cut height (HCH) was assessed. Outliers were defined as cases with one or more of the following deviations: &gt;10° NSA or 3 mm HCH. The comparison between groups was performed based on a normal distribution. We performed a comparison between the precise and nonprecise groups.</div></div><div><h3>Results</h3><div>The mean age was 60.8 (standard deviation (SD) ± 8.3) years, 12 (50%) male, 14 (58%) right shoulders and a mean operating time of 124.6 (SD ± 17.2) min. All humeral components were cementless. The mean deviation of COR was 2.3 (SD ± 1.1) mm, with 5 (21%) cases deviating &gt;3 mm and thus being nonprecise. The deviation between planned and postoperative values of NSA and HCH was 5.0° (SD ± 4.1) and 3.2 mm (SD ± 2.0). There were 13 (54%) outliers (13 due to HCH and 3 due to NSA, while 3 fulfilled both criteria and were thus not counted twice). A comparative group analysis between precise and nonprecise groups showed no significant difference in NSA, humeral head height, or HCH.</div></div><div><h3>Conclusions</h3><div>The use of PSI for the humeral osteotomy in aTSA leads to a precise RPHA in 79% of cases. Prospective randomized control trials with long-term follow-up are needed to prove these findings and assess their clinical implication.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151513"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188205","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":"Platelet-rich plasma injections prior to total shoulder arthroplasty may be associated with increased infection risk in a time-dependent manner","authors":"Romir P. Parmar BS ,&nbsp;Devin Morrow MD ,&nbsp;Alejandro M. Holle BS ,&nbsp;Michael H. Amini MD ,&nbsp;Elizabeth Batterton MD ,&nbsp;Evan Lederman MD ,&nbsp;Midhat Patel MD","doi":"10.1053/j.sart.2025.09.012","DOIUrl":"10.1053/j.sart.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>While platelet-rich plasma (PRP) is widely used for managing shoulder pathology, its implications when administered shortly before total shoulder arthroplasty (TSA) are unclear. This study investigates postoperative outcomes associated with PRP use within one year of TSA, with a focus on infection and revision rates.</div></div><div><h3>Methods</h3><div>Using the PearlDiver Mariner database (2010-2022), we identified 83 patients who received PRP injections within one year before undergoing TSA. These patients were propensity score matched 1:4 to 332 controls based on the following: age, Charlson-Deyo Comorbidity Index, gender, tobacco use, obesity, and diabetes. Postoperative outcomes, including 3-month and 3-year infection rates and revision TSA, were compared. A subgroup analysis was performed based on the timing of PRP injection: 0-6 months vs. 6-12 months before surgery. Statistical analysis included unpaired <em>t</em>-tests and chi-square tests to compare baseline demographics. Postoperative outcomes were analyzed using odds ratios (ORs) with 95% confidence intervals and chi-square tests. Statistical significance was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>Baseline characteristics were well-matched between groups (<em>P</em> &gt; .9 for all variables). While not statistically significant, patients who received PRP within one year prior to TSA experienced numerically higher rates of 3-month infection (2.4% vs. 0.3%; OR, 8.17; <em>P</em> = .384), 3-year infection (3.6% vs. 1.5%; OR, 2.45; <em>P</em> = .517), and revision TSA (4.8% vs. 1.2%; OR, 4.15; <em>P</em> = .270). Subgroup analysis revealed a significantly increased risk of 3-month infection in patients who received PRP within 0-6 months before TSA (6.1% vs. 0.3%; OR, 21.4; 95% CI, 1.88-242.21; <em>P</em> = .001). No infections occurred in the 6-12 month PRP subgroup.</div></div><div><h3>Conclusion</h3><div>PRP administration within six months of TSA may be associated with a significantly increased risk of early postoperative infection. These findings suggest that the timing of PRP injections prior to TSA may have clinical implications, but further prospective studies are necessary to determine whether PRP plays a role in postoperative infection risk.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151512"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841505","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":"Biomechanical effect of instability at tendon transfer insertion in reverse shoulder arthroplasty with modified L'Episcopo procedure using fresh frozen cadaver","authors":"Yohei Shimada MD ,&nbsp;Nobuyasu Ochiai MD ,&nbsp;Eiko Hashimoto MD ,&nbsp;Hideki Kamijyo MD ,&nbsp;Kenta Inagaki MD ,&nbsp;Naoki Haraguchi MD","doi":"10.1053/j.sart.2025.09.009","DOIUrl":"10.1053/j.sart.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Reverse shoulder arthroplasty (rTSA) often has favorable postoperative outcomes but does not improve external rotation in patients with severe loss of shoulder external rotation. A modified L'Episcopo procedure was introduced to address this issue, but the optimal tendon transfer positions remain unclear. Instability is also a significant complication of rTSA. This study examines the biomechanical stability of rTSA with the modified L'Episcopo procedure using fresh-frozen cadavers.</div></div><div><h3>Methods</h3><div>Eight cadaveric upper limbs were used, with tendon transfer positions set at 225°, 270°, and 315° from the bicipital groove in the horizontal plane, and at the teres minor attachment and the middle level of the latissimus dorsi (LD) in the vertical plane. Six shoulder joint positions were evaluated.</div></div><div><h3>Results</h3><div>No significant stability differences across rotational or horizontal tendon transfer positions at 30° and 60° abduction. In the vertical plane, however, the teres minor level provided greater stability than the middle level of the LD (<em>P</em> &lt; .05). Stability improved at 60° abduction and with subscapularis repair, equalizing teres minor level and the middle level of the LD stability differences.</div></div><div><h3>Conclusion</h3><div>Tendon transfer to the teres minor level and subscapularis repair enhance anterior stability, suggesting these techniques may improve rTSA outcomes with the modified L'Episcopo procedure.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151509"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188207","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":"The association of post-traumatic stress disorder with postoperative complications in total shoulder arthroplasty: a propensity-matched cohort study","authors":"Ahmad R. Alhankawi BA ,&nbsp;Alejandro M. Holle BS ,&nbsp;Collin L. Braithwaite MD ,&nbsp;M. Lane Moore MD, MBA ,&nbsp;Javin J. Patel BS ,&nbsp;Jeffrey D. Hassebrock MD","doi":"10.1053/j.sart.2025.09.010","DOIUrl":"10.1053/j.sart.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative post-traumatic stress disorder (PTSD) has previously been associated with increased rates of complications following various orthopedic procedures. However, there is a paucity in the literature regarding the association of PTSD with complications in the context of total shoulder arthroplasty (TSA). Thus, the purpose of this study was to compare postoperative medical and surgical complications among patients with and without PTSD.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent TSA with a diagnosis code for PTSD within 6 months of TSA were matched 1:4 to controls without PTSD using propensity score matching. Matching was performed based on age, gender, Charlson Comorbidity Index, and other comorbidities. Multivariable logistic regressions accounting for age, gender, Charlson Comorbidity Index, alcohol abuse, and substance abuse, were employed to compare complications between groups. Postoperative complications were assessed at 90 days, 1 year, and 2 years. Complications assessed included myocardial infarction, deep vein thrombosis, wound dehiscence, acute kidney injury, sepsis, readmission, revision, periprosthetic joint infection, aseptic loosening, fracture, among others. Statistical comparisons were made using odds ratios (ORs) with 95% confidence intervals, and a <em>P</em> value of &lt;.05 was considered statistically significant. Bonferroni correction was applied that determined a <em>P</em> value = .0029 as the threshold for significance.</div></div><div><h3>Results</h3><div>The query resulted in a total of 4,137 patients (3,092 control and 1,045 PTSD) who underwent TSA. The PTSD cohort displayed elevated prevalence of emergency department visits (OR 1.68) and acute kidney injury (OR 2.13) within 90 days of surgery compared to controls. At 1- and 2-year following TSA, the PTSD cohort displayed similar rates of revision, periprosthetic joint infection (PJI), dislocation, aseptic loosening, periprosthetic fracture, and postoperative stiffness compared to controls.</div></div><div><h3>Conclusion</h3><div>This study suggests that PTSD is associated with a higher incidence of emergency department visits and acute kidney injury within 90 days following TSA. No increase in the incidence of other major or minor complications was noted.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151510"},"PeriodicalIF":0.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188204","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":"The financial impact of high comorbidity burden in primary total shoulder arthroplasty","authors":"Maxwell A. Northrop BS,&nbsp;Alexander C. Dippre BS,&nbsp;Sophia A. Sitsis BS,&nbsp;Jakob M. Miller BS,&nbsp;Robert T. Henke BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.09.008","DOIUrl":"10.1053/j.sart.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Comorbidities are increasingly prevalent in patients undergoing total shoulder arthroplasty (TSA) and may significantly influence both postoperative outcomes and perioperative costs. The purpose of this study is to evaluate the impact of increasing comorbidities on the clinical outcomes and financial burden in patients undergoing primary TSA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2022 to identify patients undergoing primary anatomic or reverse TSA. Patients with a Charlson-Deyo Comorbidity Index ≥5 were grouped as high comorbidity burden (HCB) and those &lt;5 as non-HCB. Propensity score matching was performed to minimize baseline differences between the HCB and non-HCB groups, resulting in 12,476 matched patients (6,238 per group). Total charges, hospital costs, length of hospital stay (LOS), and 180-day postoperative outcomes were compared. Continuous variables were compared with Welch's t-test and categorical variables with chi-square or Fisher's exact test.</div></div><div><h3>Results</h3><div>HCB patients incurred significantly higher total charges ($76,876 vs. $70,262; +9.4%; <em>P</em> &lt; .001) and hospital costs ($20,943 vs. $19,135; +9.5%; <em>P</em> &lt; .001). HCB patients had a significantly longer average LOS (2.7 vs. 1.7 days; <em>P</em> &lt; .001), elevated risk of readmission (14.4% vs. 9.3%; odds ratio (OR) 1.6; <em>P</em> &lt; .001), death (1.0% vs. 0.3%; OR 3.8; <em>P</em> &lt; .001), and discharge to a rehabilitation facility (1.4% vs. 0.4%; OR 3.6; <em>P</em> &lt; .001). The overall 180-day risk of complications was greater in the HCB group (29.1% vs. 17.4%; OR 1.9; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>HCB is associated with an elevated risk of medical and surgical complications following TSA, contributing to longer LOS, increased risk of readmission within 180 days, and significantly higher perioperative costs. These findings underscore the need for reimbursement models to account for increasing comorbidity burdens and the value of optimized perioperative management of comorbid conditions.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151508"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841504","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":"Influence of radiographic viewing perspective on the reverse shoulder arthroplasty angle","authors":"Brittany Percin BS ,&nbsp;Thomas Suter MD ,&nbsp;Matthijs Jacxsens MD, PhD ,&nbsp;Christopher D. Joyce MD ,&nbsp;Robert Z. Tashjian MD ,&nbsp;Peter N. Chalmers MD ,&nbsp;Heath B. Henninger PhD","doi":"10.1053/j.sart.2025.09.006","DOIUrl":"10.1053/j.sart.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>The reverse shoulder arthroplasty (RSA) angle quantifies inclination of the inferior glenoid and, thus the correction required during reverse total shoulder arthroplasty. There are no data on the effect of two-dimensional (2D) radiographic projection on the RSA angle or on the relationships between 2D true anterior-posterior (AP) views and their three-dimensional (3D) counterparts.</div></div><div><h3>Methods</h3><div>Digitally reconstructed radiographs of the 2D true AP view of N = 68 scapulae, a subset in controlled ante-/retroversion and extension/flexion views, and their corresponding 3D anatomic models were analyzed. The RSA angle was measured on true AP images with the glenoid in profile at the intersection of lines defined by the supraspinatus fossa and inferior glenoid rim. On altered viewing perspectives, the glenoid face was visible, and thus the anterior and posterior rims. Since it was often unclear which was anterior and posterior, for consistency the RSA angle was measured at the most medial and lateral rims, and glenoid midpoint to determine the influence of measurement location. The 3D RSA angle was measured on 3D models using semi-automated techniques. Data were analyzed to determine the effects of viewing perspective and measurement location on the RSA angle and to compare 2D true AP to 3D measures.</div></div><div><h3>Results</h3><div>The 2D RSA angle was 18.1 ± 7.1° (range: 1.1° to 35.3°), while the 3D RSA angle was 10.1 ± 7.3° (−8.1° to 25.7°) (<em>P</em> &lt; .001). Ante-/retroversion views had large effects on the RSA angle. The lateral rim was the most susceptible to error (up to 25.8 ± 6.6°) and the glenoid midpoint was least susceptible (less than 5.6 ± 6.5°). Extension/flexion was also influential, but the magnitudes were generally much less than ante/retroversion. Trends due to viewing perspective differed between the medial rim, lateral rim, and glenoid midpoint. The glenoid midpoint maintained the flattest distribution with the smallest errors across the views. Inter- and intra-rater reliability in measuring RSA angles was good to excellent (≥ 0.754).</div></div><div><h3>Conclusion</h3><div>The 2D RSA angle experiences viewing perspective errors when not measured on a true AP radiograph. The glenoid midpoint provided the most consistent and smallest maximum error, with good to excellent reliability. The 3D underestimated the 2D RSA angle on true AP images by an average of −8.0°, with similar variability. When using 2D imaging, a true AP image is desirable; otherwise, use the glenoid midpoint to minimize viewing perspective errors. Comparisons between radiographic measures and 3D preoperative planning should consider the bias between the two techniques, and 3D measures should be evaluated for their measurement techniques within the respective preoperative planning softwares to ensure consistency and reliability among manufacturers.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151506"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188050","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":"Comparing outcomes of inpatient vs. outpatient total shoulder arthroplasty","authors":"J. Ambrose Martino BS,&nbsp;Maxwell A. Northrop BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2025.09.005","DOIUrl":"10.1053/j.sart.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed as an outpatient procedure. The purpose of this study is to compare the clinical outcomes and complications of outpatient vs. inpatient TSA.</div></div><div><h3>Methods</h3><div>The TriNetX database from 2005 to 2025 was used to identify 2 cohorts of patients who underwent TSA. Cohort 1 were operated on in an inpatient setting, while cohort 2 were operated on in an outpatient setting. Propensity score matching was performed using a 1:1, matching based on preoperative demographic characteristics and comorbidities, including age, gender, and body mass index. After matching, each cohort was composed of 25,557 cases. Both medical and surgical complications were collected within the 5-year follow-up window. Independent <em>t</em>-tests and relative risk ratios (RRs) were completed within the TriNetX database.</div></div><div><h3>Results</h3><div>Significantly increased risks were observed for several medical complications in the inpatient cohort, including an increased risk of analgesic prescription (RR:1.109), readmission rate (RR:1.392), occupational utilization (RR: 1.314), mortality (RR: 1.387), thrombosis (RR: 1.355), sepsis (RR: 1.282), acute respiratory distress syndrome (RR: 1.295), pneumonia (RR:1.214), pulmonary embolism (RR: 1.215), cellulitis (RR: 1.2), transfusion rates (RR: 1.448), bleeding (RR: 1.369), urinary tract infection (RR: 1.27), gastrointestinal (RR: 1.288), stroke (RR: 1.306), cardiovascular complications (RR: 1.22), acute renal failure (1.311), and respiratory complications (RR: 1.311). Several surgical complications were also found to have increased risk in the inpatient cohort, including revisions (RR: 1.165), prosthetic complications (RR: 1.28), broken hardware (RR: 1.258), periprosthetic infection (RR: 1.408), removal of hardware (RR: 1.303), mechanical loosening (RR: 1.398), dislocation (RR: 1.236), infection following procedure (RR: 1.346), wound dehiscence (RR: 1.258), and débridement (RR: 1.305).</div></div><div><h3>Conclusion</h3><div>Outpatient TSA is associated with reduced risk of periprosthetic complications, infection, cardiovascular events, thrombosis, bleeding, and transfusion up to 5 years postoperatively. Outpatients utilized less health care postoperatively, as seen by lower risk of readmission, revision, mortality, emergency department, and occupational therapy utilization compared to inpatient TSA patients. These findings support that outpatient TSA is safe and may be advantageous for appropriately selected patients.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151505"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188051","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":"Cementless shoulder arthroplasty Aramis: does humeral stress shielding depend on stem size?","authors":"Laurent Nové-Josserand MD ,&nbsp;Lyliane Ly MD ,&nbsp;Jérome Vogel MD ,&nbsp;Thais Dutra Vieira MD ,&nbsp;Philippe Collotte MD ,&nbsp;Arnaud Walch MD ,&nbsp;Stanislas Gunst MD","doi":"10.1053/j.sart.2025.09.007","DOIUrl":"10.1053/j.sart.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Cementless total shoulder arthroplasty (TSA) preserves humeral bone stock and thus facilitates revision surgery. Less experienced surgeons intuitively tend to use large filling ratios to ensure good fixation and alignment of the humeral implant. The aim of this study was to radiographically quantify stress shielding at two years' follow-up in 2 groups of patients with the same cementless stem implanted 5 years apart. The main hypothesis was that lower filling ratios would not be associated with greater stem misalignment. The secondary hypothesis was that lower filling ratios would be associated with reduced humeral stress shielding.</div></div><div><h3>Methods</h3><div>This single-center retrospective study involved 2 groups of patients who underwent anatomic or reverse total shoulder arthroplasty (rTSA) for primary or secondary osteoarthritis or massive rotator cuff tear, with the same Aramis humeral implants, either in 2013-14 (group 1, N = 59) or in 2019 (group 2, N = 47). Coronal stem alignment and filling ratios were measured on immediate postoperative and last follow-up radiographs, at a mean follow-up of two years. Stress shielding was evaluated in terms of medial cortical narrowing, medial metaphysis thinning, and lateral metaphysis thinning.</div></div><div><h3>Results</h3><div>The proportion of patients with the 2 narrowest stem sizes (8.5 or 10) was 51% (30/59) in group 1 and 96% (45/47) in group 2. Filling ratios in group 2 were significantly lower than in group 1 (<em>P</em> &lt; .001), but stem alignment angles were clinically equivalent and actually lower in group 2 than in group 1 (mean angle, 2.2° vs. 2.7°, <em>P</em> = .03). Anatomic TSA patients had mild medial cortical narrowing and metaphysis thinning and none or minimal lateral metaphysis thinning, with no difference between the 2 groups. rTSA patients had mild medial cortical narrowing and metaphysis thinning, with no significant difference between the 2 groups, but lateral metaphysis thinning was less frequent and less severe among group 2 patients (0.69 ± 0.32 vs. 0.87 ± 0.17; <em>P</em> = .01).</div></div><div><h3>Conclusion</h3><div>In these 2 groups of cementless TSA patients, treated by the same surgeon and with the same implant 5 years apart, more recently treated patients had significantly narrower but similarly well-aligned stems, supporting the study hypothesis. These reduced filling ratios were associated with less frequent and less severe lateral stress shielding in patients with rTSA. The prevalence of medial stress shielding for both TSA and of lateral stress shielding for rTSA suggests different mechanisms are involved.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151507"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698127","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}