Pub Date : 2024-05-12DOI: 10.1053/j.sart.2024.03.016
Background
In total shoulder arthroplasty, the subscapularis tendon is routinely mobilized, by tenotomy, peel, or lesser tuberosity osteotomy, to visualize the joint and allow proper implant positioning. Careful mobilization of the subscapularis is undertaken to achieve an anatomic tension-free repair. This cadaveric study tests the biomechanical differences of 2 repair techniques of the subscapularis peel (SP) compared to the classically described technique. We hypothesize that adaptation of this SP technique using a custom-designed polyether-ether-ketone (PEEK) barrel in the bicipital groove may further stabilize suture repair of the subscapularis.
Methods
Twenty paired cadaveric shoulder specimens underwent SP and repair via transosseous suture fixation. The PEEK barrel used was a laboratory prototype designed for the study (Catalyst OrthoScience, Naples, FL, USA). Five specimens were repaired using a traditional Mason-Allen suture; their paired shoulders were repaired using the PEEK barrel and a Mason-Allen suture. Five specimens were repaired using the Krackow suture; their paired shoulders were repaired using the PEEK barrel and a Krackow suture. Mechanical testing was performed using a uni-axial materials testing system with primary outcome of gap displacement and secondary outcomes of maximum load to failure and method of failure.
Results
The Krackow repair method with and without PEEK augmentation was significantly stiffer than the Mason-Allen repair method with and without PEEK augmentation (P < .001 across all groups). Adding augmentation changed the strength of the Mason-Allen repair without achieving statistical significance (P = .0925). Intergroup differences in cyclic displacement were not statistically significant. The Krackow repair methods had higher mean maximal load at failure than the Mason-Allen repairs of 534 ± 108 N and 266 ± 98 N, respectively (P < .001). Maximum load at 5 mm displacement was significantly different across groups (P = .004). Methods of failure in the Mason-Allen technique groups included knot and tendon failure, and in the Krackow technique groups included suture failure and lesser tuberosity fracture.
Conclusion
Repairing the subscapularis with a Krackow suture is significantly stronger than a Mason-Allen repair in stiffness as well as load to failure. The results reported here compare a Krackow suture with a more common Mason-Allen suture configuration, and demonstrate the application of PEEK augmentation to subscapularis repair techniques. This study can guide surgeon selection of an ideal subscapularis repair technique for stemmed or stemless total shoulder arthroplasty.
{"title":"Use of a Krackow suture technique with PEEK barrel augmentation for subscapularis repair is stronger than use of a Mason-Allen suture technique","authors":"","doi":"10.1053/j.sart.2024.03.016","DOIUrl":"10.1053/j.sart.2024.03.016","url":null,"abstract":"<div><h3>Background</h3><p><span>In total shoulder arthroplasty<span>, the subscapularis tendon is routinely mobilized, by tenotomy, peel, or lesser tuberosity </span></span>osteotomy, to visualize the joint and allow proper implant positioning. Careful mobilization of the subscapularis is undertaken to achieve an anatomic tension-free repair. This cadaveric study tests the biomechanical differences of 2 repair techniques of the subscapularis peel (SP) compared to the classically described technique. We hypothesize that adaptation of this SP technique using a custom-designed polyether-ether-ketone (PEEK) barrel in the bicipital groove may further stabilize suture repair of the subscapularis.</p></div><div><h3>Methods</h3><p>Twenty paired cadaveric shoulder specimens underwent SP and repair via transosseous suture fixation. The PEEK barrel used was a laboratory prototype designed for the study (Catalyst OrthoScience, Naples, FL, USA). Five specimens were repaired using a traditional Mason-Allen suture; their paired shoulders were repaired using the PEEK barrel and a Mason-Allen suture. Five specimens were repaired using the Krackow suture; their paired shoulders were repaired using the PEEK barrel and a Krackow suture. Mechanical testing was performed using a uni-axial materials testing system with primary outcome of gap displacement and secondary outcomes of maximum load to failure and method of failure.</p></div><div><h3>Results</h3><p>The Krackow repair method with and without PEEK augmentation was significantly stiffer than the Mason-Allen repair method with and without PEEK augmentation (<em>P</em> < .001 across all groups). Adding augmentation changed the strength of the Mason-Allen repair without achieving statistical significance (<em>P</em> = .0925). Intergroup differences in cyclic displacement were not statistically significant. The Krackow repair methods had higher mean maximal load at failure than the Mason-Allen repairs of 534 ± 108 N and 266 ± 98 N, respectively (<em>P</em> < .001). Maximum load at 5 mm displacement was significantly different across groups (<em>P</em> = .004). Methods of failure in the Mason-Allen technique groups included knot and tendon failure, and in the Krackow technique groups included suture failure and lesser tuberosity fracture.</p></div><div><h3>Conclusion</h3><p>Repairing the subscapularis with a Krackow suture is significantly stronger than a Mason-Allen repair in stiffness as well as load to failure. The results reported here compare a Krackow suture with a more common Mason-Allen suture configuration, and demonstrate the application of PEEK augmentation to subscapularis repair techniques. This study can guide surgeon selection of an ideal subscapularis repair technique for stemmed or stemless total shoulder arthroplasty.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 685-692"},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030495","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}
Pub Date : 2024-05-11DOI: 10.1053/j.sart.2024.04.001
Background
Restoration of an anatomic joint line after anatomic total shoulder arthroplasty and of the optimal lateral offset after reverse total shoulder arthroplasty may be relatively straightforward when the glenoid does not present with severe erosion. However, in cases of severe glenoid bone loss, the surgeon is left with no preoperative landmark to restore these parameters. The objective of this study was to use statistical shape modeling, to predict the premorbid morphology of the glenoid. We hypothesized that this would allow us to accurately determine premorbid glenoid version and inclination, in addition to accurately quantifying bone loss and medialization.
Methods
Fifty-six bilateral computed tomography scans of the shoulders of patients scheduled for shoulder arthroplasty and determined to have unilateral osteoarthritis (primary osteoarthritis or cuff tear arthropathy with a healthy contralateral side) were obtained. A statistical shape model was automatically applied on the pathologic arthritic side to predict its premorbid anatomy. Glenoid version, inclination, height, width, and glenoid and scapula lateral offset were measured automatically. These measurements were obtained on the pathological arthritic cases, on the contralateral control healthy cases, and on the premorbid predictions of the pathological arthritic cases and were compared pair by pair.
Results
The mean difference between the pathological arthritic side and the contralateral healthy side was 9.1° ± 7.3° for version, 4.8° ± 4.8° for inclination, 4.9 ± 4.5 mm for height, 4.7 ± 5.3 mm for width, 2.4 ± 1.9 mm for scapula lateral offset, and the glenoid lateral offset was 1.5 ± 1.5 mm. The mean difference between the premorbid prediction of the pathological side and the contralateral healthy side was reduced to 3.3° ± 2.4° for version, 3.4° ± 2.6° for inclination, 3.0 ± 1.9 mm for height, 2.3 ± 1.4 mm for width, 2.2 ± 1.7 mm for scapula lateral offset, and the glenoid lateral offset was 0.9 ± 0.8 mm.
Conclusion
This study shows that statistical shape modeling can allow accurate prediction of the premorbid morphology of the glenoid. This could help optimize implant selection and positioning after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty to restore optimal soft-tissue tension.
{"title":"Prediction of premorbid three-dimensional anatomy of the glenoid based on statistical shape modeling","authors":"","doi":"10.1053/j.sart.2024.04.001","DOIUrl":"10.1053/j.sart.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Restoration of an anatomic joint line after anatomic total shoulder arthroplasty<span> and of the optimal lateral offset after reverse total shoulder arthroplasty<span> may be relatively straightforward when the glenoid does not present with severe erosion. However, in cases of severe glenoid bone loss, the surgeon is left with no preoperative landmark to restore these parameters. The objective of this study was to use statistical shape modeling, to predict the premorbid morphology of the glenoid. We hypothesized that this would allow us to accurately determine premorbid glenoid version and inclination, in addition to accurately quantifying bone loss and medialization.</span></span></p></div><div><h3>Methods</h3><p>Fifty-six bilateral computed tomography scans<span><span> of the shoulders of patients scheduled for shoulder arthroplasty and determined to have unilateral osteoarthritis (primary osteoarthritis or </span>cuff tear arthropathy<span> with a healthy contralateral<span><span> side) were obtained. A statistical shape model was automatically applied on the pathologic arthritic side to predict its premorbid anatomy. Glenoid version, inclination, height, width, and glenoid and </span>scapula lateral offset were measured automatically. These measurements were obtained on the pathological arthritic cases, on the contralateral control healthy cases, and on the premorbid predictions of the pathological arthritic cases and were compared pair by pair.</span></span></span></p></div><div><h3>Results</h3><p>The mean difference between the pathological arthritic side and the contralateral healthy side was 9.1° ± 7.3° for version, 4.8° ± 4.8° for inclination, 4.9 ± 4.5 mm for height, 4.7 ± 5.3 mm for width, 2.4 ± 1.9 mm for scapula lateral offset, and the glenoid lateral offset was 1.5 ± 1.5 mm. The mean difference between the premorbid prediction of the pathological side and the contralateral healthy side was reduced to 3.3° ± 2.4° for version, 3.4° ± 2.6° for inclination, 3.0 ± 1.9 mm for height, 2.3 ± 1.4 mm for width, 2.2 ± 1.7 mm for scapula lateral offset, and the glenoid lateral offset was 0.9 ± 0.8 mm.</p></div><div><h3>Conclusion</h3><p>This study shows that statistical shape modeling can allow accurate prediction of the premorbid morphology of the glenoid. This could help optimize implant selection and positioning after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty to restore optimal soft-tissue tension.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 698-707"},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054435","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}
Pub Date : 2024-05-11DOI: 10.1053/j.sart.2024.04.002
Background
Parkinson’s disease (PD) is a neurodegenerative disorder that causes resting tremor and rigidity. Total shoulder arthroplasty (TSA) in patients with PD has proven to be a challenging clinical scenario and is associated with a high risk of complications. The purpose of this study is to explore the relationship between patients diagnosed with PD and outcomes following shoulder arthroplasty (SA).
Methods
Institutional records were queried for patients with PD who underwent SA from 2009 to 2020. Patient medical documentation was retrospectively reviewed to assess demographic information, comorbidity status, preoperative and postoperative range of motion measurements, and complications. Mean ± standard deviation was reported for continuous variables.
Results
A total of 17 patients were identified that met the inclusion criteria. The mean age of the cohort was 57.6 ± 10.6 years at the time of PD diagnosis and 68.1 ± 6.9 years at the time of surgery. The mean follow-up was 1.6 ± 1.2 years. The most common indications for surgery were degenerative joint disease, osteoarthritis, rotator cuff arthropathy, proximal humerus fracture, and rotator cuff tear (1). Mean forward elevation improved from 126.6 ± 24.8° to 131.2 ± 27.8°; mean external rotation improved from 29.4 ± 17.3° to 38.8 ± 10.5°.
Discussion
SA is an effective method of improving pain and function in PD patients. Patients undergoing anatomic TSA exhibited the most robust functional improvement in this cohort; however, anatomic TSA was associated with postoperative complications and similar functional measurements were achieved at final follow-up in patients who underwent reverse TSA. Thus, significant care must be taken to ensure the correct implant is chosen on an individual basis to maximize the potential for functional improvement.
{"title":"Shoulder arthroplasty outcomes in a series of patients diagnosed with Parkinson’s disease: a retrospective analysis","authors":"","doi":"10.1053/j.sart.2024.04.002","DOIUrl":"10.1053/j.sart.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Parkinson’s disease (PD) is a neurodegenerative disorder that causes resting tremor and rigidity. Total shoulder arthroplasty (TSA) in patients with PD has proven to be a challenging clinical scenario and is associated with a high risk of complications. The purpose of this study is to explore the relationship between patients diagnosed with PD and outcomes following shoulder arthroplasty (SA).</p></div><div><h3>Methods</h3><p>Institutional records were queried for patients with PD who underwent SA from 2009 to 2020. Patient medical documentation was retrospectively reviewed to assess demographic information, comorbidity status, preoperative and postoperative range of motion measurements, and complications. Mean ± standard deviation was reported for continuous variables.</p></div><div><h3>Results</h3><p>A total of 17 patients were identified that met the inclusion criteria. The mean age of the cohort was 57.6 ± 10.6 years at the time of PD diagnosis and 68.1 ± 6.9 years at the time of surgery. The mean follow-up was 1.6 ± 1.2 years. The most common indications for surgery were degenerative joint disease, osteoarthritis, rotator cuff arthropathy, proximal humerus fracture, and rotator cuff tear (1). Mean forward elevation improved from 126.6 ± 24.8° to 131.2 ± 27.8°; mean external rotation improved from 29.4 ± 17.3° to 38.8 ± 10.5°.</p></div><div><h3>Discussion</h3><p>SA is an effective method of improving pain and function in PD patients. Patients undergoing anatomic TSA exhibited the most robust functional improvement in this cohort; however, anatomic TSA was associated with postoperative complications and similar functional measurements were achieved at final follow-up in patients who underwent reverse TSA. Thus, significant care must be taken to ensure the correct implant is chosen on an individual basis to maximize the potential for functional improvement.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 693-697"},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000592/pdfft?md5=1108f239c89717f443dd1ee78a8de999&pid=1-s2.0-S1045452724000592-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141045148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1053/j.sart.2024.03.011
Background
The Nexel total elbow arthroplasty (TEA) is an evolution of the Coonrad-Morrey linked TEA. Theoretically, the new design has shown better mechanical properties, but the first clinical studies showed concerning rates of implant loosening, leading the authors to advocate for the discontinued use of the implant. The purpose of this study was to evaluate the short to mid-term results with the Nexel TEA in a single center cohort.
Methods
Between 2016 and 2020, 41 consecutive patients received 45 Nexel primary TEA at one institution. The cohort consisted of 5 men and 36 women with a mean age at surgery was 70 years (range, 42-93 years). The indications for primary TEA included 18 cases of rheumatoid arthritis, 24 acute fractures, and 3 cases of primary osteoarthritis. Follow-up assessment included the Mayo Elbow Performance Score, Oxford Elbow Score, range of motion, radiographic evaluation of implant loosening, complications, reasons for revision.
Results
The mean follow-up was 35 months (range 12-75 months). The median Mayo Elbow Performance Score was 82.5 points (range, 65- 100 points) and the Oxford Elbow Score was median 41.5 points (range, 17- 48 points). Mean range of motion at follow-up was; flexion 134° (range, 90°-140°), extension deficit 16° (range, 0°-90°), supination 71° (range, 30°-90°) and pronation 71° (range, 30°-90°). Radiolucent lines were observed in five cases around the humeral component and in one case around the ulnar component. There were four minor complications including prominent medial epicondyle, superficial infection, and transient ulnar nerve dysesthesia. Five elbows underwent revision surgery, three due to aseptic loosening of the humeral component, one due to periprosthetic fracture of the humerus, and one due to deep infection. The implant survival rate was 93.8% at 3 years.
Conclusion
The short- to mid-term clinical and functional results with the Nexel TEA in this series are promising. The study could not demonstrate a similar high revision rate as reported by other authors. However, longer follow-up time and larger series are warranted.
{"title":"Short- and mid-term results after total elbow replacement with the Nexel total elbow arthroplasty: a consecutive case series of 45 elbows","authors":"","doi":"10.1053/j.sart.2024.03.011","DOIUrl":"10.1053/j.sart.2024.03.011","url":null,"abstract":"<div><h3>Background</h3><p>The Nexel total elbow arthroplasty (TEA) is an evolution of the Coonrad-Morrey linked TEA. Theoretically, the new design has shown better mechanical properties, but the first clinical studies showed concerning rates of implant loosening, leading the authors to advocate for the discontinued use of the implant. The purpose of this study was to evaluate the short to mid-term results with the Nexel TEA in a single center cohort.</p></div><div><h3>Methods</h3><p>Between 2016 and 2020, 41 consecutive patients received 45 Nexel primary TEA at one institution. The cohort consisted of 5 men and 36 women with a mean age at surgery was 70 years (range, 42-93 years). The indications for primary TEA included 18 cases of rheumatoid arthritis, 24 acute fractures, and 3 cases of primary osteoarthritis. Follow-up assessment included the Mayo Elbow Performance Score, Oxford Elbow Score, range of motion, radiographic evaluation of implant loosening, complications, reasons for revision.</p></div><div><h3>Results</h3><p>The mean follow-up was 35 months (range 12-75 months). The median Mayo Elbow Performance Score was 82.5 points (range, 65- 100 points) and the Oxford Elbow Score was median 41.5 points (range, 17- 48 points). Mean range of motion at follow-up was; flexion 134° (range, 90°-140°), extension deficit 16° (range, 0°-90°), supination 71° (range, 30°-90°) and pronation 71° (range, 30°-90°). Radiolucent lines were observed in five cases around the humeral component and in one case around the ulnar component. There were four minor complications including prominent medial epicondyle, superficial infection, and transient ulnar nerve dysesthesia. Five elbows underwent revision surgery, three due to aseptic loosening of the humeral component, one due to periprosthetic fracture of the humerus, and one due to deep infection. The implant survival rate was 93.8% at 3 years.</p></div><div><h3>Conclusion</h3><p>The short- to mid-term clinical and functional results with the Nexel TEA in this series are promising. The study could not demonstrate a similar high revision rate as reported by other authors. However, longer follow-up time and larger series are warranted.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 632-638"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400049X/pdfft?md5=6b925fb9ec17f44154fd417004848ed8&pid=1-s2.0-S104545272400049X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-08DOI: 10.1053/j.sart.2024.03.005
Background
The Humeral retroversion angle (HRA) has been described in the literature as the orientation of the humeral head compared with the epicondylar axis of the distal humerus. HRA is a crucial measurement for designing shoulder prostheses and surgical technique, and is often noted to range from 25° to 35° in healthy adults. However, a wide range of individual variability has been reported in literature, with reported values ranging from −6° to 74°. Various imaging modalities including X-rays, computed tomography scans, and magnetic resonance imaging have historically been used to measure this angle, but conventional 2-dimensional technologies may result in inaccuracy and variability in angular measurements. Therefore, recent studies have focused on using 3-dimensional (3D) modalities to measure HRA. These studies have shown promising results regarding accuracy and clinical significance, although most have only included a small number of subjects and have not procured conclusive findings. This study aims to measure the HRA in a large sample of subjects using 3D imaging to establish measurements for the general population.
Methods
We examined the right and left cadaveric humerus from 559 individuals (146 females and 413 males). All of the humeri underwent computed tomography scan and surface models generated. 3D landmarks were automatically calculated on each 3D bone using custom-written software in C++. Those landmarks were used to calculate (1) HRA as the angle between the epicondylar axis and the humeral neck axis and (2) humeral proximal neck angle (HPNA) as the angle between the humeral neck axis and the anatomical axis. Descriptive statistics of both HRA and HPNA was analyzed using JMP Pro statistical software version 15.2.0.
Results
The HPNA was found to be 137.7° ± 1.04° for males and 136.34° ± 1.4° for females with a 95% confidence interval. HRA was found to be 39.89° ± 12.77° for males and 38.89° ± 3.15° for females with a 95% confidence interval. Results of analysis of variance revealed that males had a statistically significant larger HRA than females (P < .001).
Conclusion
Our study suggests using a standardized measurement for the HRA, which we believe may improve operative outcomes. However, future prospective trials are required to validate our results in a clinical setting.
背景文献中将肱骨后倾角（HRA）描述为肱骨头与肱骨远端髁轴相比的方向。HRA 是设计肩关节假体和手术技术的关键测量指标，健康成年人的 HRA 通常在 25° 到 35° 之间。然而，文献报道的个体差异很大，报告值从-6°到74°不等。包括 X 光、计算机断层扫描和磁共振成像在内的各种成像模式历来被用于测量这一角度，但传统的二维技术可能会导致角度测量的不准确性和可变性。因此，最近的研究侧重于使用三维（3D）模式来测量 HRA。这些研究在准确性和临床意义方面都取得了可喜的成果，但大多数研究只涉及少量受试者，并未得出结论性结论。本研究旨在使用三维成像技术测量大样本受试者的 HRA，以确定普通人群的测量值。方法我们检查了 559 名受试者（146 名女性和 413 名男性）的左右肱骨尸体。所有肱骨均接受了计算机断层扫描并生成了表面模型。我们使用定制的 C++ 软件自动计算每块三维骨骼上的三维地标。这些地标用于计算：（1）肱骨外上髁轴线与肱骨颈轴线之间的夹角 HRA；（2）肱骨近端颈角（HPNA），即肱骨颈轴线与解剖轴线之间的夹角。结果发现男性的 HPNA 为 137.7° ± 1.04°，女性为 136.34° ± 1.4°，置信区间为 95%。在 95% 的置信区间内，男性的 HRA 为 39.89° ± 12.77°，女性为 38.89° ± 3.15°。方差分析结果显示，男性的 HRA 在统计学上显著大于女性（P < .001）。然而，未来还需要进行前瞻性试验，以便在临床环境中验证我们的结果。
{"title":"Three-dimensional measurement of humeral retroversion on a large academic cadaveric database","authors":"","doi":"10.1053/j.sart.2024.03.005","DOIUrl":"10.1053/j.sart.2024.03.005","url":null,"abstract":"<div><h3>Background</h3><p><span>The Humeral retroversion angle (HRA) has been described in the literature as the orientation of the humeral head compared with the epicondylar axis of the </span>distal humerus<span>. HRA is a crucial measurement for designing shoulder prostheses and surgical technique, and is often noted to range from 25° to 35° in healthy adults. However, a wide range of individual variability has been reported in literature, with reported values ranging from −6° to 74°. Various imaging modalities including X-rays, computed tomography scans<span>, and magnetic resonance imaging have historically been used to measure this angle, but conventional 2-dimensional technologies may result in inaccuracy and variability in angular measurements. Therefore, recent studies have focused on using 3-dimensional (3D) modalities to measure HRA. These studies have shown promising results regarding accuracy and clinical significance, although most have only included a small number of subjects and have not procured conclusive findings. This study aims to measure the HRA in a large sample of subjects using 3D imaging to establish measurements for the general population.</span></span></p></div><div><h3>Methods</h3><p><span>We examined the right and left cadaveric humerus from 559 individuals (146 females and 413 males). All of the humeri underwent computed tomography scan and surface models generated. 3D landmarks were automatically calculated on each 3D bone using custom-written software in C++. Those landmarks were used to calculate (1) HRA as the angle between the epicondylar axis and the </span>humeral neck axis and (2) humeral proximal neck angle (HPNA) as the angle between the humeral neck axis and the anatomical axis. Descriptive statistics of both HRA and HPNA was analyzed using JMP Pro statistical software version 15.2.0.</p></div><div><h3>Results</h3><p>The HPNA was found to be 137.7° ± 1.04° for males and 136.34° ± 1.4° for females with a 95% confidence interval. HRA was found to be 39.89° ± 12.77° for males and 38.89° ± 3.15° for females with a 95% confidence interval. Results of analysis of variance revealed that males had a statistically significant larger HRA than females (<em>P</em> < .001).</p></div><div><h3>Conclusion</h3><p>Our study suggests using a standardized measurement for the HRA, which we believe may improve operative outcomes. However, future prospective trials are required to validate our results in a clinical setting.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 602-607"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052777","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}
Pub Date : 2024-05-08DOI: 10.1053/j.sart.2024.03.015
Background
Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. It is unclear if seasonal timing of surgery affects outcomes.
Methods
Patients who underwent TSA between 2015 and 2021 and were enrolled in a multicenter registry were eligible for inclusion. Date of surgery was recorded and was divided up into winter, spring, summer, and fall. Demographic data and Walch classification were recorded. Baseline strength, range of motion (ROM), and patient-reported outcomes were recorded. Patient-reported outcomes and ROM at 2 years of follow-up were assessed and compared between TSA groups for each season.
Results
Overall, 506 patients were included in the analysis. Breakdown by season was winter (N = 124), spring (N = 118), summer (N = 120), and fall (N = 144). There were no differences in baseline demographics between patients based on season of surgery or Walch classification. No difference existed in baseline ROM, clinical outcomes, or strength between seasonal groups. There were no differences in 2-year clinical outcomes, ROM, or strength between groups.
Conclusion
There is no difference in clinical outcomes based on seasonal timing for patients who undergo TSA. Patients should feel confident that their outcomes will not vary based on the season in which they undergo TSA.
{"title":"Seasonal timing of surgery does not affect clinical outcomes in total shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.03.015","DOIUrl":"10.1053/j.sart.2024.03.015","url":null,"abstract":"<div><h3>Background</h3><p>Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. It is unclear if seasonal timing of surgery affects outcomes.</p></div><div><h3>Methods</h3><p>Patients who underwent TSA between 2015 and 2021 and were enrolled in a multicenter registry were eligible for inclusion. Date of surgery was recorded and was divided up into winter, spring, summer, and fall. Demographic data and Walch classification were recorded. Baseline strength, range of motion (ROM), and patient-reported outcomes were recorded. Patient-reported outcomes and ROM at 2 years of follow-up were assessed and compared between TSA groups for each season.</p></div><div><h3>Results</h3><p>Overall, 506 patients were included in the analysis. Breakdown by season was winter (N = 124), spring (N = 118), summer (N = 120), and fall (N = 144). There were no differences in baseline demographics between patients based on season of surgery or Walch classification. No difference existed in baseline ROM, clinical outcomes, or strength between seasonal groups. There were no differences in 2-year clinical outcomes, ROM, or strength between groups.</p></div><div><h3>Conclusion</h3><p>There is no difference in clinical outcomes based on seasonal timing for patients who undergo TSA. Patients should feel confident that their outcomes will not vary based on the season in which they undergo TSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 679-684"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029744","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}
Pub Date : 2024-05-07DOI: 10.1053/j.sart.2024.03.013
Background
First-generation trabecular metal (TM) backed glenoids reported poor implant survival and were recalled from the market. Second generation TM glenoids have demonstrated promising findings at short- and mid-term follow-up. In our study, we report on clinical and radiographic outcomes of TM glenoids with an average of 10 years of clinical and radiographic follow-up.
Methods
The charts of 14 TM glenoid patients with minimum 5 years follow-up were retrospectively analyzed. The primary end points included implant survival, range of motion, and patient-reported outcomes. Additionally, radiographic data (metal debris, lateral humeral offset (LHO), acromiohumeral interval (AHI)) were studied.
Results
The mean age at surgery was 52 ± 11 years and the mean follow-up time was 10 ± 3 years. Implant survivorship was 100%. Range of motion improved significantly following surgery. Forward elevation changed from 120 ± 22º preoperatively to 155 ± 13º postoperatively (P < .01). The mean external rotation showed a statistically significant increase from 19 ± 30º preoperatively to 54 ± 13º postoperatively (P < .01). Internal rotation improved six vertebral levels on average (P < .01). Pain levels decreased significantly from 7 ± 1 to 2 ± 2 (P < .01) while American Shoulder and Elbow Surgeons Shoulder scores increased from 35 ± 10 to 83 ± 21 (P < .01). Simple Shoulder Test scores demonstrated an improvement from 5 ± 3 to 10 ± 3 (P < .01). No patients had glenoid loosening, metal debris, or radioluency on radiographic imaging. The immediate LHO was 18 (standard deviation [SD] ± 9) and final LHO of 16 (SD ± 8) (P value = .01). The immediate AHI was 12 (SD ± 3) and final AHI was 11 (SD ± 3) (P value = .01).
Conclusion
TM backed glenoids should remain in the modern orthopedic surgeon’s armamentarium of procedures. This particular glenoid design showed 100% implant survival at a decade following surgery, and provided sustained improvements in range of motion and shoulder function in osteoarthritic patients.
{"title":"Trabecular metal backed glenoids in anatomic total shoulder arthroplasty: outcomes after a decade on average","authors":"","doi":"10.1053/j.sart.2024.03.013","DOIUrl":"10.1053/j.sart.2024.03.013","url":null,"abstract":"<div><h3>Background</h3><p>First-generation trabecular metal (TM) backed glenoids reported poor implant survival and were recalled from the market. Second generation TM glenoids have demonstrated promising findings at short- and mid-term follow-up. In our study, we report on clinical and radiographic outcomes of TM glenoids with an average of 10 years of clinical and radiographic follow-up.</p></div><div><h3>Methods</h3><p>The charts of 14 TM glenoid patients with minimum 5 years follow-up were retrospectively analyzed. The primary end points included implant survival, range of motion, and patient-reported outcomes. Additionally, radiographic data (metal debris, lateral humeral offset (LHO), acromiohumeral interval (AHI)) were studied.</p></div><div><h3>Results</h3><p><span>The mean age at surgery was 52 ± 11 years and the mean follow-up time was 10 ± 3 years. Implant survivorship was 100%. Range of motion improved significantly following surgery. Forward elevation changed from 120 ± 22º preoperatively to 155 ± 13º postoperatively (</span><em>P</em> < .01). The mean external rotation showed a statistically significant increase from 19 ± 30º preoperatively to 54 ± 13º postoperatively (<em>P</em> < .01). Internal rotation improved six vertebral levels on average (<em>P</em> < .01). Pain levels decreased significantly from 7 ± 1 to 2 ± 2 (<em>P</em> < .01) while American Shoulder and Elbow Surgeons Shoulder scores increased from 35 ± 10 to 83 ± 21 (<em>P</em> < .01). Simple Shoulder Test scores demonstrated an improvement from 5 ± 3 to 10 ± 3 (<em>P</em> < .01). No patients had glenoid loosening, metal debris, or radioluency on radiographic imaging. The immediate LHO was 18 (standard deviation [SD] ± 9) and final LHO of 16 (SD ± 8) (<em>P</em> value = .01). The immediate AHI was 12 (SD ± 3) and final AHI was 11 (SD ± 3) (<em>P</em> value = .01).</p></div><div><h3>Conclusion</h3><p>TM backed glenoids should remain in the modern orthopedic surgeon’s armamentarium of procedures. This particular glenoid design showed 100% implant survival at a decade following surgery, and provided sustained improvements in range of motion and shoulder function in osteoarthritic patients.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 657-662"},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037946","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}
Pub Date : 2024-05-06DOI: 10.1053/j.sart.2024.03.012
Background
Despite total shoulder arthroplasty (TSA) and reverse TSA (rTSA) being fundamentally different procedures, and indicated in different pathologies (rTSA for rotator cuff deficiency [RCD] and proximal humeral fractures [PHFx] and anatomic TSA [aTSA] for glenohumeral osteoarthritis [GHOA]), they have the same Current Procedural Terminology (CPT) code (23472). This paper’s aim is to investigate differences in operative time and work-related value units (wRVUs) per hour among these pathologies, and ultimately determine if there is a need to assign separate CPTs for aTSA and rTSA.
Methods
A retrospective cohort of data from the American College of Surgeons–National Surgical Quality Improvement Program was collected, all patients who underwent aTSA or rTSA (CPT: 23472) between the years of 2006 and 2019 for diagnoses of GHOA, RCD, and PHFx were included. Data collected included patient age, body mass index, operative time, and wRVUs per hour.
Results
Compared to GHOA (reference group), the average operative time for the RCD cohort was 12.242 minutes shorter (P < .001), while the wRVUs were higher by 1.627 (P < .001). The average operative time for rTSAs in the PHFx cohort were 17.615 minutes longer (P < .001), while the wRVUs were lower by 2.205 (P < .001).
Conclusion
The average operative time for rTSAs for both RCDs and PHFx were longer than that for aTSAs for GHOA. Additionally, wRVUs were lower for rTSAs for RCD and PHFx compared to aTSAs for GHOA. This elucidates inconsistency in reimbursement structure for the procedures, which should be revisited.
{"title":"Operative time and relative value units for total shoulder arthroplasty based on pathology in the United States","authors":"","doi":"10.1053/j.sart.2024.03.012","DOIUrl":"10.1053/j.sart.2024.03.012","url":null,"abstract":"<div><h3>Background</h3><p>Despite total shoulder arthroplasty<span> (TSA) and reverse TSA<span><span> (rTSA) being fundamentally different procedures, and indicated in different pathologies (rTSA for rotator cuff<span> deficiency [RCD] and proximal humeral fractures [PHFx] and anatomic TSA [aTSA] for glenohumeral </span></span>osteoarthritis<span> [GHOA]), they have the same Current Procedural Terminology (CPT) code (23472). This paper’s aim is to investigate differences in operative time and work-related value units (wRVUs) per hour among these pathologies, and ultimately determine if there is a need to assign separate CPTs for aTSA and rTSA.</span></span></span></p></div><div><h3>Methods</h3><p>A retrospective cohort of data from the American College of Surgeons–National Surgical Quality Improvement Program was collected, all patients who underwent aTSA or rTSA (CPT: 23472) between the years of 2006 and 2019 for diagnoses of GHOA, RCD, and PHFx were included. Data collected included patient age, body mass index, operative time, and wRVUs per hour.</p></div><div><h3>Results</h3><p>Compared to GHOA (reference group), the average operative time for the RCD cohort was 12.242 minutes shorter (<em>P</em> < .001), while the wRVUs were higher by 1.627 (<em>P</em> < .001). The average operative time for rTSAs in the PHFx cohort were 17.615 minutes longer (<em>P</em> < .001), while the wRVUs were lower by 2.205 (<em>P</em> < .001).</p></div><div><h3>Conclusion</h3><p>The average operative time for rTSAs for both RCDs and PHFx were longer than that for aTSAs for GHOA. Additionally, wRVUs were lower for rTSAs for RCD and PHFx compared to aTSAs for GHOA. This elucidates inconsistency in reimbursement structure for the procedures, which should be revisited.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 663-671"},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029991","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}
Pub Date : 2024-05-04DOI: 10.1053/j.sart.2024.03.014
Background
The preferred surgical approach for surgical treatment of advanced glenohumeral arthritis is shoulder arthroplasty (SA). Considering the growing volume and success of SA, patients with bilateral shoulder disease are likely to undergo surgery on both shoulders. There are numerous studies evaluating the outcomes of bilateral hip and knee arthroplasty, but a paucity of information examining bilateral SA. This study intends to evaluate the clinical outcomes of patients undergoing staged bilateral anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA).
Methods
Institutional records were queried for patients who underwent staged bilateral aTSA or rTSA from 2009 to 2020. Patient records were retrospectively reviewed to assess preoperative and postoperative range of motion (ROM) and strength measurements, demographic information, and complications. Mean ± standard deviation was reported for all continuous variables. Mean functional measurements were compared using a 2-Sample t-Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via Chi-squared test. Patients were included in the outcome analysis if they had a bilateral TSA with the same procedure (i.e. aTSA on both sides, or rTSA on both sides).
Results
43 patients (15 male, 28 female) were included. There was an average time of 1.8 years between surgeries. Of the 43 patients, 26 patients had staged bilateral aTSAs and 14 had staged bilateral rTSAs with three patients who had different surgeries on each shoulder. The three patients with different surgeries on each shoulder were excluded from outcome analysis. Patients who had staged aTSA operations demonstrated significant improvement in external rotation (P = .0191, P < .001), forward elevation (FE) (P = .0004, P < .001), and internal rotation (IR) (P = .0183, P = .0166) after the first and second surgeries. Staged rTSA patients showed significant improvement in FE after the first (P = .0043) and second surgeries (P = .016). Patients demonstrated significant increase in strength of external rotation (P = .0136), FE (P = .0088), and IR (P = .0206) after the first rTSA. There was no corresponding increase in strength testing after the second bilateral rTSA surgery. The average Single Assessment Numeric Evaluation, Contralateral Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores for all surgeries were 84 ± 10, 83 ± 13, 75 ± 20, and 9 ± 2, respectively for the first surgery and 82 ± 13, 83 ± 13, 71 ± 21, and 8 ± 3 for the second surgery.
Conclusion
Individuals that undergo staged aTSA procedures gain a better ROM and IR strength after both operations. However, individuals that undergo staged rTSA procedures have an improved R
{"title":"Staged bilateral total shoulder arthroplasty: a single institutional experience with mid-term follow-up","authors":"","doi":"10.1053/j.sart.2024.03.014","DOIUrl":"10.1053/j.sart.2024.03.014","url":null,"abstract":"<div><h3>Background</h3><p>The preferred surgical approach for surgical treatment of advanced glenohumeral arthritis is shoulder arthroplasty (SA). Considering the growing volume and success of SA, patients with bilateral shoulder disease are likely to undergo surgery on both shoulders. There are numerous studies evaluating the outcomes of bilateral hip and knee arthroplasty, but a paucity of information examining bilateral SA. This study intends to evaluate the clinical outcomes of patients undergoing staged bilateral anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA).</p></div><div><h3>Methods</h3><p>Institutional records were queried for patients who underwent staged bilateral aTSA or rTSA from 2009 to 2020. Patient records were retrospectively reviewed to assess preoperative and postoperative range of motion (ROM) and strength measurements, demographic information, and complications. Mean ± standard deviation was reported for all continuous variables. Mean functional measurements were compared using a 2-Sample <em>t</em>-Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via Chi-squared test. Patients were included in the outcome analysis if they had a bilateral TSA with the same procedure (i.e. aTSA on both sides, or rTSA on both sides).</p></div><div><h3>Results</h3><p>43 patients (15 male, 28 female) were included. There was an average time of 1.8 years between surgeries. Of the 43 patients, 26 patients had staged bilateral aTSAs and 14 had staged bilateral rTSAs with three patients who had different surgeries on each shoulder. The three patients with different surgeries on each shoulder were excluded from outcome analysis. Patients who had staged aTSA operations demonstrated significant improvement in external rotation (<em>P</em> = .0191, <em>P</em> < .001), forward elevation (FE) (<em>P</em> = .0004, <em>P</em> < .001), and internal rotation (IR) (<em>P</em> = .0183, <em>P</em> = .0166) after the first and second surgeries. Staged rTSA patients showed significant improvement in FE after the first (<em>P</em> = .0043) and second surgeries (<em>P</em> = .016). Patients demonstrated significant increase in strength of external rotation (<em>P</em> = .0136), FE (<em>P</em> = .0088), and IR (<em>P</em> = .0206) after the first rTSA. There was no corresponding increase in strength testing after the second bilateral rTSA surgery. The average Single Assessment Numeric Evaluation, Contralateral Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores for all surgeries were 84 ± 10, 83 ± 13, 75 ± 20, and 9 ± 2, respectively for the first surgery and 82 ± 13, 83 ± 13, 71 ± 21, and 8 ± 3 for the second surgery.</p></div><div><h3>Conclusion</h3><p>Individuals that undergo staged aTSA procedures gain a better ROM and IR strength after both operations. However, individuals that undergo staged rTSA procedures have an improved R","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 672-678"},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104545272400052X/pdfft?md5=4e2e391a2bf796b4926fdf1d3577ceb3&pid=1-s2.0-S104545272400052X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03DOI: 10.1053/j.sart.2024.03.007
Background
Anatomic total shoulder arthroplasty (TSA) remains the treatment of choice for primary glenohumeral osteoarthritis with an intact rotator cuff (PGHOA). However, reverse total shoulder arthroplasty (RSA) has gained popularity as a primary procedure in selected patients who may be at risk for postoperative rotator cuff dysfunction or glenoid loosening. The purpose of this study was to compare short-term outcomes between TSA and RSA in patients with PGHOA and limited preoperative forward flexion (FF).
Methods
A retrospective review was performed on a multi-institutional registry of patients to identify patients aged less than 80 years undergoing TSA or RSA for PGHOA with preoperative FF ≤ 90°. Forty-five TSAs were identified and matched by age and sex to 45 patients undergoing RSA. A subset of 22 TSAs and 24 RSAs with severely limited preoperative FF of ≤ 70° was also analyzed. Range of motion including FF, external rotation and internal rotation, strength, and patient-reported outcomes including visual analog scale pain score, Western Ontario Osteoarthritis of the Shoulder index score, Veterans RAND 12 mental score, American Shoulder and Elbow Surgeons score, and Constant-Murley score were evaluated at a minimum of 2 years postoperative.
Results
No significant differences were observed in postoperative FF, external rotation, or strength measurements between groups. The limited FF TSA group achieved significantly improved internal rotation compared to the RSA group (L2 vs. L4, P < .002). No significant differences were observed between TSA and RSA in American Shoulder and Elbow Surgeons, visual analog scale, Constant, or Single Assessment Numeric Evaluation scores (P > .05) for both the overall comparison and subset of patients with FF of ≤ 70°. However, patients in the RSA cohort showed a significantly higher return to normal sporting activities than the TSA group.
Conclusion
Patients aged less than 80 years with PGHOA and limited preoperative FF achieve similar postoperative range of motion and patient-reported outcomes whether treated with TSA or RSA. Therefore, limited preoperative FF does not appear to be a major determinant of outcomes for PGHOA.
{"title":"Limited preoperative forward flexion does not impact outcomes between anatomic or reverse shoulder arthroplasty for primary glenohumeral arthritis","authors":"","doi":"10.1053/j.sart.2024.03.007","DOIUrl":"10.1053/j.sart.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><p>Anatomic total shoulder arthroplasty<span><span> (TSA) remains the treatment of choice for primary glenohumeral osteoarthritis<span> with an intact rotator cuff (PGHOA). However, </span></span>reverse total shoulder arthroplasty (RSA) has gained popularity as a primary procedure in selected patients who may be at risk for postoperative rotator cuff dysfunction or glenoid loosening. The purpose of this study was to compare short-term outcomes between TSA and RSA in patients with PGHOA and limited preoperative forward flexion (FF).</span></p></div><div><h3>Methods</h3><p><span>A retrospective review was performed on a multi-institutional registry of patients to identify patients aged less than 80 years undergoing TSA or RSA for PGHOA with preoperative FF ≤ 90°. Forty-five TSAs were identified and matched by age and sex to 45 patients undergoing RSA. A subset of 22 TSAs and 24 RSAs with severely limited preoperative FF of ≤ 70° was also analyzed. Range of motion including FF, external rotation and internal rotation, strength, and patient-reported outcomes including visual analog scale pain score, Western Ontario Osteoarthritis of the Shoulder index score, Veterans RAND 12 mental score, </span>American Shoulder and Elbow Surgeons score, and Constant-Murley score were evaluated at a minimum of 2 years postoperative.</p></div><div><h3>Results</h3><p>No significant differences were observed in postoperative FF, external rotation, or strength measurements between groups. The limited FF TSA group achieved significantly improved internal rotation compared to the RSA group (L2 vs. L4, <em>P</em> < .002). No significant differences were observed between TSA and RSA in American Shoulder and Elbow Surgeons, visual analog scale, Constant, or Single Assessment Numeric Evaluation scores (<em>P</em> > .05) for both the overall comparison and subset of patients with FF of ≤ 70°. However, patients in the RSA cohort showed a significantly higher return to normal sporting activities than the TSA group.</p></div><div><h3>Conclusion</h3><p>Patients aged less than 80 years with PGHOA and limited preoperative FF achieve similar postoperative range of motion and patient-reported outcomes whether treated with TSA or RSA. Therefore, limited preoperative FF does not appear to be a major determinant of outcomes for PGHOA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 626-631"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043512","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}
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